Harmonizing Image Forgery Detection & Localization: Fusion of Complementary Approaches

Image manipulation is easier than ever, often facilitated using accessible AI-based tools. This poses significant risks when used to disseminate disinformation, false evidence, or fraud, which highlights the need for image forgery detection and localization methods to combat this issue. While some recent detection methods demonstrate good performance, there is still a significant gap to be closed to consistently and accurately detect image manipulations in the wild. This paper aims to enhance forgery detection and localization by combining existing detection methods that complement each other. First, we analyze these methods' complementarity, with an objective measurement of complementariness, and calculation of a target performance value using a theoretical oracle fusion. Then, we propose a novel fusion method that combines the existing methods' outputs. The proposed fusion method is trained using a Generative Adversarial Network architecture. Our experiments demonstrate improved detection and localization performance on a variety of datasets. Although our fusion method is hindered by a lack of generalization, this is a common problem in supervised learning, and hence a motivation for future work. In conclusion, this work deepens our understanding of forgery detection methods' complementariness and how to harmonize them. As such, we contribute to better protection against image manipulations and the battle against disinformation.

Hypofractionated Radiotherapy for Hematological Malignancies during COVID-19 Pandemic and Beyond

PURPOSE/OBJECTIVE(S)

Conventionally fractionated radiotherapy (RT) has shown to have excellent local control in hematological malignancies (HM). Up to date there is none or scant literature about the use of hypofractionated radiotherapy (HFRT) for the treatment of HM, this single institution study analyzed the efficacy of HFRT in HM. We hypothesized that HFRT in HM will result in a similar local tumor control that has been reported with standard fractionated RT.

MATERIALS/METHODS

In this retrospective study, we analyzed the data from patients within the provincial cancer registry diagnosed with HM treated with a curative intent using HFRT regimens suggested by International Lymphoma Radiation Oncology Group between 2020-2022 during the COVID-19 pandemic. Primary outcome of the study was overall response rate (ORR), measured as complete response (CR), partial response (PR) or stable disease (SD) within the irradiated field determined radiologically or clinically post completion of RT. Secondary end point was freedom from local progression (FFLP), calculated from the date of initiation of RT to the first date among in-field progression, death, and last follow-up. Summary statistics were used to describe cohort and treatment characteristics. FFLP was calculated by 1 minus cumulative incidence accounting for competing risk (i.e., death).

RESULTS

Of the 36 patients included for analysis, 18 were aggressive non-Hodgkin lymphoma (NHL), 9 were indolent NHL, 6 were Hodgkin lymphoma (HL) and 3 were other HM. Among them 25 had consolidation RT and 11 had definitive RT. HFRT daily dose per fraction ranged from 2.67 Gy to 5 Gy and total dose regimens ranged from 18 Gy to 42.5 Gy in 6 - 17 fractions and median equivalent dose in 2 Gy fractions (EQD2) for alpha/beta = 10Gy was 36 Gy (±7.5). ORR for the entire cohort was 94.4%. With a median follow up of 13.2 months, FFLP at one year for the entire cohort was 91.5% and death without infield progression was 8.7%. Among the 4 patients who had in radiation field recurrence, 2 had aggressive NHL and 2 had HL. No grade 3 or 4 acute toxicities were reported.

CONCLUSION

This retrospective study using HFRT showed an ORR and FFLP comparable to historical studies using standard fractionation. Further long-term follow-up is warranted to confirm these findings.

Overall survival in patients with advanced non-small cell lung cancer with KRAS G12C mutation with or without STK11 and/or KEAP1 mutations in a real-world setting

BACKGROUND

KRAS mutations occur frequently in advanced non-small cell lung cancer (aNSCLC); the G12C mutation is the most prevalent. Alterations in STK11 or KEAP1 commonly co-occur with KRAS mutations in aNSCLC. Using real-world data, we assessed the effect of KRAS G12C mutation with or without STK11 and/or KEAP1 mutations on overall survival (OS) in patients with aNSCLC receiving cancer immunotherapy (CIT), chemotherapy, or both in first line (1L) and second line (2L).

METHODS

Patients diagnosed with aNSCLC between January 2011 and March 2020 in a clinico-genomic database were included. Cox proportional hazards models adjusted for left truncation, baseline demographics and clinical characteristics were used to analyze the effect of STK11 and/or KEAP1 co-mutational status on OS in patients with KRAS wild-type (WT) or G12C mutation.

RESULTS

Of 2715 patients with aNSCLC without other actionable driver mutations, 1344 (49.5%) had KRAS WT cancer, and 454 (16.7%) had KRAS G12C-positive cancer. At 1L treatment start, significantly more patients with KRAS G12C-positive cancer were female, smokers, and had non-squamous histology, a higher prevalence of metastasis and programmed death-ligand 1 positivity than those with KRAS WT cancer. Median OS was comparable between patients with KRAS G12C-positive and KRAS WT cancer when receiving chemotherapy or combination CIT and chemotherapy in the 1L or 2L. Median OS was numerically longer in patients with KRAS G12C vs KRAS WT cancer treated with 1L CIT (30.2 vs 10.6 months, respectively) or 2L CIT (11.3 vs 7.6 months, respectively). Co-mutation of STK11 and KEAP1 was associated with significantly shorter OS in patients receiving any type of 1L therapy, regardless of KRAS G12C mutational status.

CONCLUSIONS

This real-world study showed that patients with KRAS G12C-positive or KRAS WT cancer have similar OS in the 1L or 2L when treated with chemotherapy or combination CIT and chemotherapy. In contrast to aNSCLC patients with EGFR or ALK driver mutations, patients with KRAS G12C-positive cancer may benefit from CIT monotherapy. Co-mutation of STK11 and KEAP1 was associated with significantly shorter survival, independent of KRAS G12C mutational status, reflecting the poor prognosis and high unmet need in this patient population.

Allopregnanolone Effects on Inhibition in Hippocampal Parvalbumin Interneurons

Allopregnanolone (AlloP) is a neurosteroid that potentiates ionotropic GABAergic (GABA_A) inhibition and is approved for treating postpartum depression in women. Although the antidepressant mechanism of AlloP is largely unknown, it could involve selective action at GABA_A receptors containing the δ subunit. Despite previous evidence for selective effects of AlloP on α4/δ-containing receptors of hippocampal dentate granule cells (DGCs), other recent results failed to demonstrate selectivity at these receptors (Lu et al., 2020). In contrast to DGCs, hippocampal fast-spiking parvalbumin (PV) interneurons express an unusual variant partnership of δ subunits with α1 subunits. Here, we hypothesized that native α1/δ receptors in hippocampal fast-spiking interneurons may provide a preferred substrate for AlloP. Contrary to the hypothesis, electrophysiology from genetically tagged PV interneurons in hippocampal slices from male mice showed that 100 nm AlloP promoted phasic inhibition by increasing the sIPSC decay, but tonic inhibition was not detectably altered. Co-application of AlloP with 5 μm GABA did augment tonic current, which was not primarily through δ-containing receptors. Furthermore, AlloP decreased the membrane resistance and the number of action potentials of DGCs, but the impact on PV interneurons was weaker than on DGCs. Thus, our results indicate that hippocampal PV interneurons possess low sensitivity to AlloP and suggest they are unlikely contributors to mood-altering effects of neurosteroids through GABA effects.

ODP019 A Case Study of the Association of Autoimmune Polyglandular Syndrome and Pulmonary Artery Hypertension

We report a patient with combined pulmonary arterial hypertension (PAH) and autoimmune polyglandular syndrome (APS) type 2. A 41 y/o woman with hypothyroidism presented for right heart (RHC) in the work up of PAH. Pt had a medical history of PAH diagnosed by transthoracic echocardiogram (TTE) and hypothyroidism. She reported symptoms of fatigue, shortness of breath with increased pigmentation of her skin progressive for several years. Preadmission lab found hyponatremia of 126 and potassium of 6.6. She was admitted and treated with IV insulin with D50, kayexalate, IV fluids. A random 11 AM cortisol was 0.57 mcg/dl N: AM: 6. 0–30. 0 mcg/dl; PM: 3. 0–16. 0 mcg/dl. Acosyntropin test was ordered. Pt failed the stimulation test (baseline 0.39, 30 min 0.49, 60 min 0.50, with an ACTH at baseline of 1423 pg/ml N: 7.2-63.3). Pt was started on hydrocortisone 20 mg AM/10 mg PM with fludrocortisone 0.1mg. On follow up at 2 weeks, her energy, mood, appetite and breathing tolerance had improved. Follow up RHC in 4 weeks found normalization of right heart pressures. APS is a collection of autoimmune diseases. Type I APS, caused by a defect in the autoimmune regulator (AIRE) gene, is diagnosed with two of three conditions, chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenal cortical insufficiency. Type II APS (formally "Schmidt's Syndrome"), associated with HLA haplotypes DR3 (DQB*0201) and DR4 (DQB1*0302), is diagnosed with chronic autoimmune adrenal insufficiency with either Type 1 DM or chronic autoimmune thyroid disease (commonly Hashimotos but can be Graves). It typically presents later in life compared to APS I, age 30-40s. The association between PAH is rare but has been noted in several case studies. It has been associated with APS I in Korniszewski et al. and Bhansali et al. For APS II, the first association was reported by Barrou et al. of a patient with hypothyroidism, hypogonadism, and adrenal insufficiency who later developed PAH. Two cases reported by García-Hernández et al found PAH with positive adrenal antibodies without adrenal insufficiency. In 2009 Walid R. et al. reported a case of severe adrenal insufficiency (hypotension, hypokalemia) with PAH. She improved with steroids, but her PAH was present on TTE four years after treatment started. Pt in that case declined RHC. The patient in this case study proceeded with a RHC which did show normalization of right heart pressures, the first reported case to document normalization of PAH with replacement steroid treatment.

Presentation: No date and time listed

Abstract P3-13-04: Clinical features and genetic alterations in patients (pts) with HER2-positive breast cancer (BC) and central nervous system (CNS) metastases (mets) in the real world

Introduction: Pts with HER2-positive metastatic BC (mBC) often develop CNS mets, which is associated with poor prognosis and negative impact on quality of life. Resistance to anti-HER2 treatment can lead to disease progression; furthermore, many therapies do not cross the blood-brain barrier, leading to an unmet need for effective CNS mets treatment. In this real world study, we explored the molecular profile and clinical features of pts with CNS and non-CNS mets to better understand tumor biology in these populations. Methods: This retrospective, cross-sectional, observational study evaluated pts with CNS mets or non-CNS mets at the time of HER2-positive mBC diagnosis using the Flatiron Health-Foundation Medicine Clinico-Genomic Database (FH-FMI CGDB). The database comprised de-identified data from ~280 US cancer clinics (~800 sites of care), and included pts with FMI comprehensive genomic profiling assays covering >300 cancer-related genes. Descriptive analyses were conducted for baseline demographic, clinical, and biomarker characteristics, as well as genetic alterations including single nucleotide variants (SNVs), copy number alterations (CNAs), and rearrangements. T-tests were used to compare continuous variables, chi-squared tests for categorical variables, and non-parametric tests for non-normal distributions. Results: Of 8204 pts with BC in the CGDB, 6111 females 18+ yrs were diagnosed with mBC on or after 1-1-2011, of whom 919 had HER2-positive mBC, and 314 had an FMI assay up to 120 days after mBC diagnosis. This study population included 45 pts with CNS mets and 269 pts with non-CNS mets (Table). FMI data were derived from the primary tumor (29% from breast) or a metastatic lesion (19%, 12%, and 4% from liver, lymph nodes, and brain, respectively). Pts with CNS vs non-CNS mets were significantly younger at initial and at mBC diagnosis (p=0.04). At mBC diagnosis, a higher percentage of pts with CNS vs non-CNS mets had ≥3 sites of mets (p=0.01) and mets sites in adrenal glands (p=0.01), while there was a trend toward lower rates of lung and liver mets (not significant [NS]). Pts with CNS mets were more likely to be hormone receptor-negative vs pts with non-CNS mets (NS). Missing data for HER2 results by IHC or FISH, tumor grade, and histology limited the interpretation of any observed differences. Pts with CNS vs non-CNS mets were more likely to have SNVs in TP53 (82% vs 64%, p=0.03) and CNAs in ERBB2 (60% vs 43%, p<0.05). The most common mutations in pts with CNS mets were TP53 (82%) and PIK3CA (29%), followed by ERBB2, BRCA1, ESR1, CDH1, MLL2, and ATRX (<9% each). The most common CNAs in pts with CNS mets were ERBB2 (60%) and MYC (20%), followed by CCND1, FGF19, FGF3, FGF4, and CCNE1 (13% each). Rearrangements were rare and no clear differences were observed between pts with CNS and non-CNS mets. Conclusions: Despite its small sample size, our analysis is one of the largest real world genomic studies in HER2-positive pts with CNS mets to date. Pts with CNS mets at mBC diagnosis showed potential distinguishing clinical and genetic features, including younger age, a higher proportion with adrenal gland mets and ≥3 sites of mets, and a higher prevalence of SNVs in TP53 and CNAs in ERBB2. Cautious interpretation is needed due to the small sample, unique pt population, and heterogeneity in tissue location. Further analyses can help elucidate the biology of CNS mets in these pts with a high unmet need.

Table. Demographic, clinical, and genetic characteristics of the study populationVariableCNS mets (n=45)Non-CNS mets (n=269)Total (N=314)p-valueMedian age at mBC diagnosis, years (interquartile range [IQR])55 (47-62)60 (51-68)59 (49-68)0.04Median age at early BC diagnosis, years (IQR)51 (43-60)55 (48-64)55 (46-64)0.04<45 years14 (31)54 (20)68 (22)45-64 years24 (53)148 (55)172 (55)≥65 years7 (16)67 (25)74 (24)Race, n (%)White23 (51)174 (65)197 (63)0.09Black/Asian4 (9)31 (12)35 (11)Other10 (22)43 (16)53 (17)Missing8 (18)21 (8)29 (9)Group stage at initial diagnosis, n (%)aI<4 (<9)25 (9)26 (8)0.12II22 (49)88 (33)110 (35)III11 (24)76 (28)87 (28)IV6 (13)59 (22)65 (21)Missing5 (11)21 (8)26 (8)Number of metastatic sites, n (%)111 (24)110 (41)121 (39)0.01213 (29)90 (34)103 (33)≥321 (47)69 (26)90 (29)SNVs (selected a priori), n (%)bTP5337 (82)173 (64)210 (67)0.03PIK3CA13 (29)97 (36)110 (35)0.45ERBB2<4 (<9)21 (8)24 (8)1ESR1<4 (<9)7 (3)10 (3)1PTEN<4 (<9)12 (4)14 (4)1CNAs (most common in all pts), n (%)bERBB227 (60)115 (43)142 (45)0.047MYC9 (20)61 (23)70 (22)0.84FGF196 (13)45 (17)51 (16)0.72aGroup stage is documented at the time of initial diagnosis in the pt health record or determined based on T, N, and M stage based on AJCC version at the time of the patient’s diagnosis, and does not include staging collected after systemic/radiation therapy, progression, and/or neoadjuvant treatment, if any.bp-values were not adjusted for multiple comparisons. Data not shown: additional univariate analyses of 129 genes on SNVs, CNAs and rearrangements yielded the following genes with the highest prevalence in pts with CNS mets: TP53 (82%), PIK3CA (29%), ERBB2 (<9%), CDH1 (<9%), ESR1 (<9%), BRCA1 (<9%), MLL2 (<9%), ATRX (<9%), and GATA3 (<9%) for SNVs; ERBB2 (60%), MYC (20%), CCND1 (13%), FGF19 (13%), FGF3 (13%), FGF4 (13%), and CCNE1 (13%) for CNAs; and CDK12 (<9%) and NF1 (<9%) for rearrangements.

Citation Format: Preet K. Dhillon, Peter Lambert, Thibaut Sanglier, Adam Knott, Eleonora Restuccia, Sanne L. de Haas, Chiara Lambertini. Clinical features and genetic alterations in patients (pts) with HER2-positive breast cancer (BC) and central nervous system (CNS) metastases (mets) in the real world [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-13-04.

OUP accepted manuscript

Background

Methods

Results

Conclusion

Effects of metals and persistent organic pollutants on the fitness and health of juveniles of the endangered european sturgeon Acipenser sturio Exposed to W1ater and sediments of the garonne and dordogne rivers

The last remaining population of European sturgeon (Acipenser sturio) lives in the Gironde-Garonne-Dordogne (France) catchment (GGD). Captive young individuals are released into the GGD hydrosystem each year, as part of a restocking programme. This study aims to assess the health status of juveniles A. sturio to current conditions in the GGD hydrosystem, to evaluate their capacity to survive and grow in a moderately anthropized ecosystems. 3-month-old farmed sturgeons were exposed for one month in experimental conditions that mimic the environmental conditions in the Garonne and Dordogne rivers, followed by five months of depuration. After one month of exposure, fish exposed to Dordogne and Garonne waters bioaccumulated higher levels of metals and persistent organic pollutants, displayed a reduced hepato-somatic index, and had depleted levels of lipids and glycogen content in their liver, when compared with the Reference group. However, metabolic and swimming performance, as well as the costs of swimming were not impaired. After the 5 months depuration, a significant decrease of K was observed for all exposure conditions. HSI also decreased with time. The overall health status and adaptive capacity of juvenile A. sturio appeared to be maintained over the experimental 6 months' period. Juveniles of A. sturio seem to have the adaptive capacity to survive and grow in the GGD hydrosystem, after being released as part of a restocking programme.

A microrobotic platform actuated by thermocapillary flows for manipulation at the air-water interface

Future developments in micromanufacturing will require advances in micromanipulation tools. Several robotic micromanipulation methods have been developed to position micro-objects mostly in air and in liquids. The air-water interface is a third medium where objects can be manipulated, offering a good compromise between the two previously mentioned ones. Objects at the interface are not subjected to stick-slip due to dry friction in air and profit from a reduced drag compared with those in water. Here, we present the ThermoBot, a microrobotic platform dedicated to the manipulation of objects placed at the air-water interface. For actuation, ThermoBot uses a laser-induced thermocapillary flow, which arises from the surface stress caused by the temperature gradient at the fluid interface. The actuated objects can reach velocities up to 10 times their body length per second without any on-board actuator. Moreover, the localized nature of the thermocapillary flow enables the simultaneous and independent control of multiple objects, thus paving the way for microassembly operations at the air-water interface. We demonstrate that our setup can be used to direct capillary-based self-assemblies at this interface. We illustrate the ThermoBot's capabilities through three examples: simultaneous control of up to four spheres, control of complex objects in both position and orientation, and directed self-assembly of multiple pieces.

Oxytocin quality: evidence to support updated global recommendations on oxytocin for postpartum hemorrhage

BACKGROUND

The use of quality injectable oxytocin effectively prevents and treats postpartum hemorrhage, the leading cause of maternal death worldwide. In low- and middle-income countries (LMICs), characteristics of oxytocin-specifically its heat sensitivity-challenge efforts to ensure its quality throughout the health supply chain. In 2019, WHO, UNFPA and UNICEF released a joint-statement to clarify and recommend that oxytocin should be kept in the cold chain (between 2 and 8 °C) during transportation and storage; however, confusion among stakeholders in LMICs persists.

OBJECTIVES AND METHODS

To further support recommendations in the WHO/UNFPA/UNICEF joint-statement, this paper reviews results of oxytocin quality testing in LMICs, evaluates product stability considerations for its management and considers quality risks for oxytocin injection throughout the health supply chain. This paper concludes with a set of recommended actions to address the challenges in maintaining quality for a heat sensitive pharmaceutical product.

RESULTS

Due to the heat sensitivity of oxytocin, its quality may be degraded at numerous points along the health supply chain including: At the point of manufacture, due to poor quality active pharmaceutical ingredients; lack of sterile manufacturing environments; or low-quality manufacturing processesDuring storage and distribution, due to lack of temperature control in the supply chain, including cold chain at the end user health facilitySafeguarding the quality of oxytocin falls under the purview of national medicines regulatory authorities; however, regulators in LMICs may not adhere to good regulatory practices.

CONCLUSIONS

Storing oxytocin from 2 to 8 °C throughout the supply chain is important for maintaining its quality. While short temperature excursions may not harm product quality, the cumulative heat exposure is generally not tracked and leads to degradation. National and sub-national policies must prioritize procurement of quality oxytocin and require its appropriate storage and management.

Temperature stability of oxytocin ampoules labelled for storage at 2°C-8°C and below 25°C: an observational assessment under controlled accelerated and temperature cycling conditions

INTRODUCTION

Oxytocin, administered via injection, is recommended by WHO for the prevention and treatment of postpartum haemorrhage. However, the susceptibility of oxytocin injection to thermal degradation has led WHO and UNICEF to recommend cold-chain storage of all oxytocin products. Nevertheless, some oxytocin products supplied to the global market are labelled for storage at ≤25°C, often with a shorter shelf-life relative to products labelled for refrigeration. Differences in labelled storage requirements can lead to uncertainties among stakeholders around the relative stability of oxytocin products and specifically whether ≤25°C products are more resistant to degradation. Such confusion can potentially influence policies associated with procurement, distribution, storage and the use of oxytocin in resource-poor settings.

OBJECTIVES

To compare the stability of oxytocin injection ampoules formulated for storage at ≤25°C with those labelled for refrigerated storage.

DESIGN

Accelerated and temperature cycling stability studies were performed with oxytocin ampoules procured by the United Nations Population Fund (UNFPA) from four manufacturers.

METHOD

Using oxytocin ampoules procured by UNFPA, accelerated stability (up to 120 days) and temperature cycling (up to 135 days between elevated and refrigerated temperatures) studies were performed at 30°C, 40°C and 50°C. Oxytocin content was quantified using a validated HPLC-UV method.

RESULTS

All ampoules evaluated exhibited similar stability profiles under accelerated degradation conditions with the exception of one product formulated for ≤25°C storage, where the rate of degradation increased at 50°C relative to other formulations. Similar degradation trends at elevated temperatures were observed during temperature cycling, while no significant degradation was observed during refrigerated periods of the study.

CONCLUSION

Oxytocin ampoules formulated for non-refrigerated storage demonstrated comparable stability to those labelled for refrigerated storage and should not be interpreted by stakeholders as offering a more stable alternative. Furthermore, these products should not be procured for use in territories with high ambient temperatures, where all oxytocin injection products should be supplied and stored under refrigerated conditions.

Adherence to the guidelines: A comparison of biomarker testing implementation in metastatic non-squamous, non-small cell lung cancer in university versus community institutions

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Background: Molecular biomarkers have become essential in determining optimal treatment for patients with advanced non-small-cell-lung cancer (NSCLC). Few studies have evaluated the implementation of biomarker assessment (e.g. EGFR, ALK and ROS1) in routine clinical practice. We endeavored to assess adherence to biomarker testing guidelines in different clinical settings, specifically in a university hospital versus a community hospital in the same region. Methods: A retrospective analysis was conducted in newly diagnosed metastatic non-squamous-NSCLC patients comparing the compliance of biomarker testing based on nationally established guidelines available at the time of diagnosis. De-identified electronic health record (EHR) data were collected from Mercy Catholic Medical Center (MCMC) and Hahnemann University Hospital (HUH) between 1/1/15- 1/30/19. Results were compared in each setting to determine utilization of biomarker testing. Results: 27 patients were identified at MCMC and 41 at HUH. 22 (81%) patients at MCMC and 36 (88%) patients at HUH underwent appropriate molecular testing based on guidelines available at the time of diagnosis. Conclusions: Our data suggests that both university and community institutions have appropriately adapted the evolving guidelines for molecular testing for patients with non-squamous NSCLC. In the rare instances that molecular testing was not performed, the most common reason was inadequate amounts of tissue available. Newer technologies, such as next-gen sequencing and serum based testing, will make compliance with guidelines easier in the future, particularly as increasing numbers of molecular markers will need to be assessed.

Contact line stick-slip motion and meniscus evolution on micrometer-size wavy fibres

HYPOTHESIS

The architecture of complex-shaped fibres affects the motion of the contact line and the evolution of its associated menisci when a fibre is immersed into a liquid. Understanding and predicting the motion of the contact line is critical in the design of complex-shaped fibres for many engineering applications as well as for surface science. While wetting on classic circular cylinders has been well studied, singularities during the wetting process of complex-shaped fibres are not yet well understood.

EXPERIMENTS

The dynamic wetting behaviour of axisymmetric sinus-shaped fibres immersed vertically in a liquid volume was investigated. Fibres were 3D-printed down to micrometre dimensions, and the Wilhelmy method was used in parallel with meniscus shape analysis. Moreover, a quasi-static theoretical model predicting the contact line movement and free energy of the system evolution on these fibres is also proposed.

FINDINGS

The observation of liquid advancing and receding fronts highlighted a stick-slip motion of the meniscus depending on both the fibre surface curvature and its intrinsic wettability. The model predicts that the behaviour of the seemingly pinned and then jumping contact line, with associated changes in apparent contact angles, can be explained by the interplay between a constant local contact angle and the movement of the bulk liquid, leading to the storage of energy which is suddenly released when the contact line passes a given point of fibre curvature. Besides, acceleration/deceleration events that take place before and after the jumps are experimentally observed in good agreement with the model.

An evaluation of the impact of missing deaths on overall survival analyses of advanced non-small cell lung cancer patients conducted in an electronic health records database

Purpose

The aim of this study was to assess the impact of missing death data on survival analyses conducted in an oncology EHR‐derived database.

Methods

The study was conducted using the Flatiron Health oncology database and the National Death Index (NDI) as a gold standard. Three analytic frameworks were evaluated in advanced non‐small cell lung cancer (aNSCLC) patients: median overall survival [mOS]), relative risk estimates conducted within the EHR‐derived database, and “external control arm” analyses comparing an experimental group augmented with mortality data from the gold standard to a control group from the EHR‐derived database only. The hazard ratios (HRs) obtained within the EHR‐derived database (91% sensitivity) and the external control arm analyses, were compared with results when both groups were augmented with mortality data from the gold standard. The above analyses were repeated using simulated lower mortality sensitivities to understand the impact of more extreme levels of missing deaths.

Results

Bias in mOS ranged from modest (0.6–0.9 mos.) in the EHR‐derived cohort with (91% sensitivity) to substantial when lower sensitivities were generated through simulation (3.3–9.7 mos.). Overall, small differences were observed in the HRs for the EHR‐derived cohort across comparative analyses when compared with HRs obtained using the gold standard data source. When only one treatment arm was subject to estimation bias, the bias was slightly more pronounced, but increased substantially when lower sensitivities were simulated.

Conclusions

The impact on survival analysis is minimal with high mortality sensitivity with only modest impact associated within external control arm applications.

Incidence of spinal disease and role of spinal radiotherapy in multiple myeloma

Background

Spinal disease (spd) in multiple myeloma (mm) can be a major source of morbidity in newly diagnosed patients and long-term survivors. We retrospectively assessed the incidence of spinal disease in patients newly diagnosed with myeloma, its effect on survival, and the possible effect of spinal radiation therapy (rt).

Methods

Patients diagnosed with mm between 2010 and 2014 were identified through the provincial cancer registry. Plain radiography, computed tomography, and magnetic resonance imaging were reviewed to detect and document the type of spd. Data related to rt and systemic therapy were collected. Kaplan-Meier and time-varying Cox regression models were used to describe overall survival.

Results

Of 306 identified patients with newly diagnosed mm, 51% had spd, including 17% with lytic disease, 68% with compression fractures, and 15% with spinal cord compression. Of the patients with spd, 61% received spinal rt. Of those patients, 84% received spinal rt within 3 months after their diagnosis. Median dose was 20 Gy. Most patients (89.2%) received chemotherapy, and 22.5% underwent autologous stem-cell transplantation. Only 6 of the patients treated with spinal rt received re-irradiation to the same site. Overall survival was similar for patients with and without spd. On multivariate analysis, spinal rt had no effect on survival.

Conclusions

In patients newly diagnosed with mm, spd is a common presentation. With current systemic therapy, the presence of spd had no adverse effect on overall survival. The effect of spinal rt on overall survival was nonsignificant.

Quality of oxytocin ampoules available in health care facilities in the Democratic Republic of Congo: an exploratory study in five provinces

Background

Oxytocin injection is the first line therapy for the prevention and treatment of postpartum haemorrhage (PPH), the leading cause of maternal mortality. Currently access to high quality oxytocin in low and middle-income countries (LMICs) is compromised by variable manufacturing quality and the requirement for cold chain supply and storage to prevent product deterioration. Previous studies of oxytocin ampoules sampled from Africa, the region with highest maternal mortality rates, indicate that over half do not contain the specified amount of oxytocin. International efforts continue to further understand the issues relating to oxytocin quality in LMICs and this study is the first to assess oxytocin quality in the Democratic Republic of Congo (DRC), a country that bears one of the highest global rates of maternal mortality (693 maternal deaths per 100 000 live births). Importantly, the study methodology includes the use of investigative analytical techniques to understand the cause of quality deficiencies and inform remedial measures.

Methods

The study involved sampling of oxytocin injection ampoules from public and private health care facilities (n = 15) in urban and rural areas within five provinces of the DRC. Where available, each sample comprised 20 ampoules of oxytocin injection (10 IU/mL) with smaller numbers collected where supplies were limited. Sample collection used overt sampling and mystery shopper approaches, as appropriate. Analysis of ampoules for oxytocin content and known degradation products utilised validated HPLC and LCMS methods, respectively. Sterility testing was conducted in accordance with the United States Pharmacopeia monograph.

Results

Eighty percent of ampoules collected contained less than 90% of the specified content. Known degradation products of oxytocin were identified, indicating likely exposure to elevated temperatures post-manufacture. All samples contained an unknown impurity at a level of approximately 12.3% (8.0-20.5%) of the oxytocin main band peak. No samples failed sterility testing.

Conclusions

There is evidence of a high prevalence of poor quality oxytocin ampoules in health facilities in the DRC likely resulting from both manufacturing quality issues and uncontrolled storage. A more comprehensive post-marketing surveillance study of oxytocin quality is warranted.

Baseline Edmonton Symptom Assessment System and survival in metastatic renal cell carcinoma

Background

Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (mrcc) and might add to the existing prognostic models.

Methods

In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for mrcc between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment esas summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan-Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival.

Results

We identified 68 patients receiving first-line therapy for mrcc. Most had intermediate- or poor-risk disease based on both the Memorial Sloan Kettering Cancer Center (mskcc) and the International Metastatic Renal Cell Carcinoma Database Consortium (imdc) models. The median baseline esas summation score was 16 (range: 6-57). In univariable analysis, the hazard ratio for overall survival was 1.270 (p = 0.0047) per 10-unit increase in summation esas. In multivariable analysis, the hazard ratio was 1.208 (p = 0.0362) when controlling for mskcc risk group and 1.240 (p = 0.019) when controlling for imdc risk group.

Conclusions

Baseline symptom burden as measured by esas score appears to provide prognostic information for survival in patients with mrcc. Those results should encourage the investigation of patient-reported symptom scales as potential prognostic indicators for patients with advanced cancer.

Is IL-1β Further Evidence for the Role of Propionibacterium acnes in Degenerative Disc Disease? Lessons From the Study of the Inflammatory Skin Condition Acne Vulgaris

The pathogenesis of degenerative disc disease is a complex and multifactorial process in which genetics, mechanical trauma, altered loading and nutrition present significant etiological factors. Infection of the intervertebral disc with the anaerobic bacterium Propionibacterium acnes is now also emerging as a potentially new etiological factor. This human commensal bacterium is well known for its long association with the inflammatory skin condition acne vulgaris. A key component of inflammatory responses to P. acnes in acne appears to be interleukin (IL)-1β. Similarly, in degenerative disc disease (DDD) there is compelling evidence for the fundamental roles of IL-1β in its pathology. We therefore propose that P. acnes involvement in DDD is biologically very plausible, and that IL-1β is the key inflammatory mechanism driving the host response to P. acnes infection. Since there is a solid theoretical basis for this phenomenon, we further propose that the relationship between P. acnes infection and DDD is causal.

River Continuity Restoration and Diadromous Fishes: Much More than an Ecological Issue

Ecosystem fragmentation is a serious threat to biodiversity and one of the main challenges in ecosystem restoration. River continuity restoration (RCR) has often targeted diadromous fishes, a group of species supporting strong cultural and economic values and especially sensitive to river fragmentation. Yet it has frequently produced mixed results and diadromous fishes remain at very low levels of abundance. Against this background, this paper presents the main challenges for defining, evaluating and achieving effective RCR. We first identify challenges specific to disciplines. In ecology, there is a need to develop quantitative and mechanistic models to support decision making, accounting for both direct and indirect impacts of river obstacles and working at the river catchment scale. In a context of dwindling abundances and reduced market value, cultural services provided by diadromous fishes are becoming increasingly prominent. Methods for carrying out economic quantification of non-market values of diadromous fishes become ever more urgent. Given current challenges for rivers to meet all needs sustainably, conflicts arise over the legitimate use of water resources for human purposes. Concepts and methods from political science and geography are needed to develop understandings on how the political work of public authorities and stakeholders can influence the legitimacy of restoration projects. Finally, the most exciting challenge is to combine disciplinary outcomes to achieve a multidisciplinary approach to RCR. Accordingly, the co-construction of intermediary objects and diagrams of flows of knowledge among disciplines can be first steps towards new frameworks supporting restoration design and planning.

AQUa: an adaptive framework for compression of sequencing quality scores with random access functionality

Motivation

The past decade has seen the introduction of new technologies that significantly lowered the cost of genome sequencing. As a result, the amount of genomic data that must be stored and transmitted is increasing exponentially. To mitigate storage and transmission issues, we introduce a framework for lossless compression of quality scores.

Results

This article proposes AQUa, an adaptive framework for lossless compression of quality scores. To compress these quality scores, AQUa makes use of a configurable set of coding tools, extended with a Context-Adaptive Binary Arithmetic Coding scheme. When benchmarking AQUa against generic single-pass compressors, file sizes are reduced by up to 38.49% when comparing with GNU Gzip and by up to 6.48% when comparing with 7-Zip at the Ultra Setting, while still providing support for random access. When comparing AQUa with the purpose-built, single-pass, and state-of-the-art compressor SCALCE, which does not support random access, file sizes are reduced by up to 21.14%. When comparing AQUa with the purpose-built, dual-pass, and state-of-the-art compressor QVZ, which does not support random access, file sizes are larger by 6.42-33.47%. However, for one test file, the file size is 0.38% smaller, illustrating the strength of our single-pass compression framework. This work has been spurred by the current activity on genomic information representation (MPEG-G) within the ISO/IEC SC29/WG11 technical committee.

Availability and implementation

The software is available on Github: https://github.com/tparidae/AQUa.

Contact

tom.paridaens@ugent.be.

A deletion mutation in nfxB of in vitro-induced moxifloxacin-resistant Pseudomonas aeruginosa confers multidrug resistance

The modulation of efflux pump functions under fluoroquinolone (FQ) exposure is of great concern as it could result in occurrence of multidrug-resistant (MDR) bacterial strains. In this study, MDR mechanism in Pseudomonas aeruginosa induced via moxifloxacin (MOX) pressure was investigated. After serial MOX [concentration of 0.5 × the minimum inhibitory concentration (MIC)] exposure, the fully susceptible P. aeruginosa ATCC 9027 strain has increased its MIC not only toward MOX (1→128 mg/L) but also to other antibiotics. Furthermore, this MOX-exposed strain did not revert to antibiotic-sensitive phenotype when being cultured in antibiotic-free medium for 12 days. No mutation was observed for FQ-target (gyrA and parC) or most investigated efflux regulatory genes (mexT, mexR, and nalC) except nfxB in which a 100-bp deletion was found. This associated with the elevated expression of multidrug efflux pump operon (mexCD-oprJ) which could directly result in MDR phenotype.

Safety, Tolerability and Pharmacokinetics of Single Doses of Oxytocin Administered via an Inhaled Route in Healthy Females: Randomized, Single-blind, Phase 1 Study

BACKGROUND

The utility of intramuscular (IM) oxytocin for the prevention of postpartum hemorrhage in resource-poor settings is limited by the requirement for temperature-controlled storage and skilled staff to administer the injection. We evaluated the safety, tolerability and pharmacokinetics (PK) of a heat-stable, inhaled (IH) oxytocin formulation.

METHODS

This phase 1, randomized, single-center, single-blind, dose-escalation, fixed-sequence study (NCT02542813) was conducted in healthy, premenopausal, non-pregnant, non-lactating women aged 18-45years. Subjects initially received IM oxytocin 10 international units (IU) on day 1, IH placebo on day 2, and IH oxytocin 50μg on day 3. Subjects were then randomized 4:1 using validated GSK internal software to IH placebo or ascending doses of IH oxytocin (200, 400, 600μg). PK was assessed by comparing systemic exposure (maximum observed plasma concentration, area under the concentration-time curve, and plasma concentrations at 10 and 30min post dose) for IH versus IM oxytocin. Adverse events (AEs), spirometry, laboratory tests, vital signs, electrocardiograms, physical examinations, and cardiac telemetry were assessed.

FINDINGS

Subjects were recruited between September 14, 2015 and October 12, 2015. Of the 16 subjects randomized following initial dosing, 15 (IH placebo n=3; IH oxytocin n=12) completed the study. IH (all doses) and IM oxytocin PK profiles were comparable in shape. However, systemic exposure with IH oxytocin 400μg most closely matched IM oxytocin 10IU. Systemic exposure was approximately dose proportional for IH oxytocin. No serious AEs were reported. No clinically significant findings were observed for any safety parameters.

INTERPRETATION

These data suggest that similar oxytocin systemic exposure can be achieved with IM and IH administration routes, and no safety concerns were identified with either route. The inhalation route may offer the opportunity to increase access to oxytocin for women giving birth in resource-poor settings.

On the cohesion of fluids and their adhesion to solids: Young's equation at the atomic scale

Using large-scale molecular dynamics simulations, we model a 9.2nm liquid bridge between two solid plates having a regular hexagonal lattice and analyse the forces acting at the various interfaces for a range of liquid-solid interactions. Our objective is to study the mechanical equilibrium of the system, especially that at the three-phase contact line. We confirm previous MD studies that have shown that the internal pressure inside the liquid is given precisely by the Laplace contribution and that the solid exerts a global force at the contact line in agreement with Young's equation, validating it down to the nanometre scale, which we quantify. In addition, we confirm that the force exerted by the liquid on the solid has the expected normal component equal to γ_lvsinθ⁰, where γ_lv is the surface tension of the liquid and θ⁰ is the equilibrium contact angle measured on the scale of the meniscus. Recent thermodynamic arguments predict that the tangential force exerted by the liquid on the solid should be equal to the work of adhesion expressed as Wa⁰=γ_lv(1+cosθ⁰). However, we find that this is true only when any layering of the liquid molecules close to liquid-solid interface is negligible. The force significantly exceeds this value when strong layering is present.

Characteristics of advanced non-small cell lung cancer (aNSCLC) patients (pts) receiving molecular diagnostic (MD) testing in U.S. routine clinical practice

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Background: Hybrid capture (HC)-based next generation sequencing (NGS) combined with extensive molecular interpretation, such as Foundation Medicine (FMI) testing, is increasingly important for a comprehensive molecular diagnosis in the routine clinical management of lung cancer (LC) pts. FMI and other NGS platforms (including HC alone) support optimal treatment (trt) decisions by assessing multiple genetic alterations that drive LC progression. Our aim was to characterize aNSCLC pts receiving FMI or other types of MD tests using a real world oncology electronic health record (EHR) database. Methods: Flatiron aggregates pt-level EHR from a large network of cancer clinics in the US. Inclusion criteria were aNSCLC diagnosis and ≥2 clinic visits within the Flatiron network on or after January 1, 2011. Presence of MD testing was based on 5 LC biomarkers ( EGFR, ALK, KRAS, ROS1, PD-L1). Demographic and tumor characteristics at the time of aNSCLC diagnosis and trts received were summarized across 3 mutually exclusive testing groups (grps): FMI, other NGS and non-NGS. Results: As of Sept 30, 2016, the aNSCLC cohort included 30,489 pts across 4 groups: FMI (1,019 pts); other NGS (1,327 pts); non-NGS (15,205); no tests (12,938). As expected, the number of pts with FMI or NGS testing has increased in recent years. Pts in the FMI grp tended to be younger (66 vs. 68-69 years), non-smokers (25% vs. 17-19%) and have squamous cell histology (13% vs. 8-10%) compared to other MD test grps. 30% of FMI pts received testing prior to initiating first trt, compared with 38% of other NGS and 53% of non-NGS pts. For 565 pts (of 1,019) with available data on first trt after FMI testing, 24% (136 pts) initiated a NCCN recommended targeted trt for LC. In the FMI grp, 528 pts (52%) received at least one other MD test: EGFR (89%), ALK (83%), ROS1 (39%), KRAS (31%), PD-L1 (18%) and test types were 67% FISH, 55% PCR, 17% other NGS and 15% IHC. Conclusions: Differences in age, smoking and histology exist between pts receiving FMI vs. other MD tests. This analysis of a large real world pt cohort tested with FMI further supports the value of broad genomic profiling to identify rare driver mutations and ensure optimal trt.

Ovarian cancer in Manitoba: trends in incidence and survival, 1992-2011

BACKGROUND

Because the International Cancer Benchmarking Partnership, in a study of diagnosis years between 1995 and 2007, showed lower-than-expected survival for Manitoba's ovarian cancer patients, we undertook an analysis to describe the features of ovarian cancer diagnosed in Manitoba during a 20-year period. We also determined the most recent trends in survival to see if the previous results were sustained.

METHODS

In this retrospective cohort study, ovarian cancer cases diagnosed during 1992-2011 were extracted from the Manitoba Cancer Registry. The incidence of ovarian cancer was calculated for the overall group and for age, morphology, residence, treatment, and stage. Trends over time, with a particular focus on changes that might correlate with poor survival, were analyzed. The 1- and 3-year relative survival rates were also calculated.

RESULTS

The incidence of ovarian cancer did not vary over time (p = 0.640), even when stratified by age or morphology groups. Use of adjuvant chemotherapy decreased (p = 0.005) and use of neoadjuvant chemotherapy increased over time (p = 0.002). Diagnoses of stage iv cancers declined over time (p < 0.020). Trends in incidence did not coincide with previously observed decreases in relative survival.

CONCLUSIONS

A decline in diagnoses of stage iv ovarian cancer could be responsible for a recent increase in relative survival. However, sample size might have limited power in some analyses, and the previously reported decrease in relative survival might have been due to a random fluctuation in the data. Future efforts will focus on continued monitoring of the patterns of ovarian cancer presentation and outcomes in Manitoba.