Respiratory Syncytial Virus-Associated Hospitalizations Among Children <5 Years Old: 2016 to 2020

BACKGROUND

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention.

METHODS

We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates.

RESULTS

Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]).

CONCLUSIONS

Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants.

Abstract P628: The Right Dose for the Right Patient - High Intensity Rosuvastatin Dosing in Patients With Chronic Kidney Disease

Introduction: The utilization of high intensity statins for lipid lowering therapy has revolutionized our approach to decreasing the incidence of myocardial infarction. In February 2003, rosuvastatin was approved by the FDA for use at dosages ranging from 5mg to 40mg daily, with lower doses recommended for patients with reduced glomerular filtration rates (GFRs). Prescribing patterns of rosuvastatin for patients with chronic kidney disease (CKD), notably those with a GFR < 30 mL/min/1.73m 2 , is largely unstudied.

Methods: A single center retrospective study of all admitted patients with a chart diagnosis of chronic kidney disease (CKD) over the course of one year was performed. Data on inpatient rosuvastatin orders and overall statin selection was collected and analyzed.

Results: Between 10/1/2021-10/1/2022, a total of 5359 patients were admitted with the diagnosis of CKD. In this cohort, 62% (n = 3325) had a prescription for a statin placed for continuation of outpatient care or new initiation of lipid lowering therapy. Most patients were on atorvastatin (69.4%, n = 2310) or rosuvastatin (20.9%, n = 695). Among inpatients with CKD, a total of 1465 inpatient rosuvastatin orders were placed. Almost 32% (n = 468) of these patients had an eGFR <30 mL/min/1.73m 2 . Of this cohort, 48% (n = 223) were prescribed doses of 20mg or 40mg rosuvastatin daily, which is above the FDA recommended dose for this population ( Figure 1 ).

Conclusions: A large percentage of patients on lipid lowering therapies have CKD, and data regarding renal outcomes associated with high doses of statins in this population are limited. In this large single center study, we found that nearly half of patients with eGFR <30 mL/min/1.73m 2 were on inappropriately high doses of rosuvastatin when considering their kidney function. Further research into long term outcomes and rosuvastatin dosing in this patient population is needed.

Effects of the COVID-19 Pandemic on Patients with Concussion Presenting to a Specialty Clinic

The purpose of this study is to examine the effects of the COVID-19 pandemic on patients presenting with concussion at a specialty clinic. This study used a retrospective cohort design to compare participants (n = 3021) with a suspected concussion, including a Pandemic cohort (n = 1139; March 2020-February 2021) and a Pre-Pandemic cohort (n = 1882; March 2019-February 2020). Concussions and patient characteristics including age, sex, days since injury, and injury mechanism were extracted from an electronic health record. There were 39.5% (n = 743) fewer concussions in Pandemic. Pandemic presented to the clinic 25.8 days later (p < 0.001) and were 1.9 years older (p < 0.001) than Pre-Pandemic. Sport-related concussions decreased 59.6% overall for Pandemic. Pandemic was associated with proportional increases of concussions involving recreational activities (odds ratio [OR] = 6.11; p < 0.001), motor vehicle collisions (OR = 1.39; p < 0.001), and falls/assaults (OR = 1.33; p < 0.001). A total of 9.4% (107/1139) of all Pandemic concussion initial clinical visits were performed using telehealth (0% in Pre-Pandemic). Concussion visit volume to a sub-specialty clinic decreased by approximately 40% during the COVID-19 pandemic and patients presented to the clinic nearly 1 month later. The increase in telehealth highlights the potential to expand clinical care outreach during the current and future pandemics or similar restrictive time periods.

178. Vaccine Effectiveness Against Influenza-associated Hospitalizations and Emergency Department (ED) Visits Among Children in the United States in the 2019–2020 Season

Background

The 2019–20 influenza season was predominated by early onset B/Victoria viruses followed by A(H1N1)pdm09 virus circulation. Over 95% of circulating B/Victoria viruses were subclade V1A.3, different from the Northern Hemisphere vaccine strain. Annual estimates of influenza vaccine effectiveness (VE) are important because of frequent changes in circulating and vaccine viruses.

Methods

We assessed VE among children 6 months–17 years old with acute respiratory illness and <10 days of symptoms enrolled during the 2019–20 influenza season at 7 pediatric hospitals (ED patients < 5 years at 3 sites) in the New Vaccine Surveillance Network. Combined mid-turbinate/throat swabs were tested for influenza virus using molecular assays. We estimated age-stratified VE from a test-negative design using logistic regression to compare odds of vaccination among children testing positive versus negative for influenza, adjusting for age in years, enrollment month, and site. For these preliminary analyses, vaccination status was by parental report.

Results

Among 2022 inpatients, 324 (16%) were influenza positive: 38% with influenza B/Victoria alone and 44% with influenza A(H1N1)pdm09 alone (Table). Among 2066 ED children, 653 (32%) were influenza positive: 45% with influenza B/Victoria alone and 43% with influenza A(H1N1)pdm09 alone. VE was 62% (95% confidence interval [CI], 51%–70%) against any influenza-related hospitalizations, 68% (95% CI, 55%–78%) for A(H1N1)pdm09 and 55% (95% CI, 35%–69%) for B/Victoria. VE by age group for any influenza-related hospitalizations was 57% (95% CI, 40%–69%) among children 6 months to < 5 years and 66% (95% CI, 49%–77%) among children 5–17 years. VE was 53% (95% CI, 42%–62%) against any influenza-related ED visits, 46% (95% CI, 28%–60%) for A(H1N1)pdm09 and 54% (95% CI, 39%–66%) for B/Victoria. VE by age group was 52% (95% CI, 37%–63%) among children 6 months to < 5 years and 42% (95% CI, 16%–60%) among children 5–17 years.

Conclusion

Influenza vaccination in the 2019–20 season provided substantial protection against laboratory-confirmed influenza-associated hospitalizations and ED visits associated with the two predominantly circulating influenza viruses among children, including against the emerging B/Victoria virus V1A.3 subclade.

Disclosures

Janet A. Englund, MD, AstraZeneca (Scientific Research Study Investigator)GSK group of companies (Scientific Research Study Investigator)Meissa vaccines (Consultant)Merck (Scientific Research Study Investigator)Sanofi Pasteur (Consultant) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member)IDConnect (Advisor or Review Panel member)Quidel (Advisor or Review Panel member) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support) Christopher J. Harrison, MD, GSK (Grant/Research Support, Infant menigiciccal B conjugate vaccine trial)Merck (Research Grant or Support, Infant pneumococcal conjugate vaccine trial)

1714. Influenza C Virus in U.S. Children with Acute Respiratory Infection 2016-2019

Background

Influenza C virus (ICV) is associated with acute respiratory infection (ARI); however, the burden of ICV is not well-described. We sought to determine the burden and characteristics of ICV in a prospective, population-based cohort.

Methods

The study was conducted within the New Vaccine Surveillance Network (NVSN), a CDC-led, seven-site network that performs population-based surveillance for ARI in children < 5 years. Nasal/throat swabs were collected from emergency department (ED) or inpatient children with ARI, or healthy controls in clinic, between 12/05/2016-10/31/2019 and tested by real-time RT-PCR for ICV and other respiratory viruses. Preliminary data were extracted and demographic/clinical features of ICV+ cases analyzed. We sequenced the hemagglutinin-esterase (HE) gene from ICV+ Pittsburgh samples.

Results

Among 19,321 children with ARI or healthy controls enrolled and tested for ICV from 2016-2019, 115/17,668 (0.7%) ARI cases and 8/1653 (0.5%) healthy controls tested positive for ICV. The median age of ICV+ ARI subjects was 19 months (IQR 10,46) and 81(70%) were ≤36 months. 42.6% (49) were white, 33.9% (39) black, and 16.5% (19) Hispanic, with the remainder Asian or unknown; 56.5% (62) attended daycare. Among ICV+ ARI cases, 67.8% (78) had fever, 94.8% (109) cough, and 60.8% (70) wheezing. 45.2% (52) ICV+ cases occurred in 2016-17, 6.5% (8) in 2017-2018, and 47.8% (55) in 2018-19 (Table). 40% (46) of ICV+ cases were seen in the ED, while the remainder were inpatients. Median length of stay was 2d (IQR,1-3) with 15 admitted to ICU. 67.8% (78/115) ARI cases had 1 or 2 co-detected pathogens, with rhinovirus (26), respiratory syncytial virus (26), and adenovirus (14) most frequently co-detected. ARI symptoms including fever, myalgias, chills, and wheezing did not differ significantly between coinfected subjects and those who were only ICV+. HE sequences were in the two currently circulating Kanagawa and Sao Paulo lineages.

ICV+ Cases by Site and Year

Conclusion

ICV was an uncommon cause of ARI symptoms leading to healthcare encounters in young children. The prevalence varied year-to-year and between different geographic regions. Most children infected with ICV were ≤3 years old and had co-detected pathogens. ICV was similarly rarely detected in healthy controls.

Disclosures

Christopher J. Harrison, MD, GSK (Grant/Research Support, Infant menigiciccal B conjugate vaccine trial)Merck (Research Grant or Support, Infant pneumococcal conjugate vaccine trial) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member)IDConnect (Advisor or Review Panel member)Quidel (Advisor or Review Panel member)

900. Effect of Influenza Vaccine Priming on Current Season Vaccine Effectiveness among Children and Adolescents, US Flu VE Network 2014–2015 Through 2017–2018

Background

Studies have demonstrated that optimal protection against childhood influenza requires two “priming” doses of influenza vaccine in the first season of vaccination. Two doses of influenza vaccine are recommended for US children aged 6 months-8 years who received ≤1 dose in prior seasons. We examined risk of influenza among children fully or partially vaccinated during study seasons and vaccine effectiveness (VE) by the number of priming doses.

Methods

Analyses included children aged 6 months-17 years enrolled during outpatient visits for acute illness for ≤7 days with cough in the US Influenza Vaccine Effectiveness Network during 2014–2015 through 2017–2018. Participants’ respiratory specimens were tested for influenza by rRT-PCR. Vaccination histories back to birth year were obtained from electronic immunization records. VE was calculated by comparing vaccination odds among influenza-positive cases to test-negative controls, as 100 × (1 − odds ratio) adjusted for season, site, age, high-risk status, and calendar time.

Results

Of 7,583 children, 6,362 (84%) had received ≥1 dose in their lifetime. Among vaccinated children, 90% were primed prior to the enrollment season, and 80% were primed prior to age 2 years. Most (55%) received two priming doses in their first season. Among children recommended to receive two priming doses in the enrollment season, receipt of two doses vs. one was associated with a lower risk of influenza illness (aOR: 0.60; 95% CL: 0.36, 1.00). VE of ≥1 dose in the enrollment season against any influenza among unprimed children was 53% (95% CL: 36, 66). VE of ≥1 dose in the enrollment season was similar among children primed with one dose in their first season (46%; 95% CL: 34, 55) and among those primed with two doses (46%; 95% CL: 35, 55). Overall results were similar when stratified by age and for A/H3N2 viruses, which predominated during study years.

Conclusion

Among the US children recommended to receive two priming doses of vaccine in the enrollment season, receipt of two doses provided optimal protection. VE in seasons after the priming did not differ by the number of priming doses. Results were driven by predominance of A/H3N2 viruses and may not be similar for A/H1N1pdm09 or B viruses. Current US influenza vaccine recommendations for children are effective and appropriate.

Disclosures

All Authors: No reported Disclosures.

Mechanistic study of the superior anti-cancer properties of a first-in-class small molecule targeting PCNA

e14636

Background: Proliferating cell nuclear antigen (PCNA), through its interaction with various proteins involved in DNA synthesis, cell cycle regulation, and DNA repair, plays a central role in maintaining genome stability. We previously reported a novel cancer associated PCNA isoform (dubbed caPCNA), which was predominantly expressed in a broad range of cancer cells and tumor tissues, but not significantly in non-malignant cells. We found that the caPCNA-specific antigenic site lies between L126 and Y133, a region within the interdomain connector loop of PCNA that is known to be a major binding site for many of PCNA’s interacting proteins. A cell permeable peptide harboring the L126-Y133 sequence inhibited PCNA function in cancer cells and selectively kills cancer cells and xenograft tumors. Methods: Based on these observations, we sought small molecules targeting this peptide region of PCNA as potential broad-spectrum anti-cancer agents. Results: Our effort led to a drug candidate, AOH1996, which selectively kills a broad range of cancer cells at high nanomolar concentrations, but is not associated with significant toxicity to non-malignant cells. It also works synergistically with DNA damaging chemotherapeutic drugs, such as cisplatin and irinotecan, to selectively kill cancer cells. This compound is orally available to animals and suppresses tumor growth in a dosage form compatible to clinical applications. Importantly, it doesn’t cause significant toxicity at 2.5 times its effective dose. Mechanistically, AOH1996 competes with T3, a known PCNA ligand, for binding to PCNA. However, the mechanism by which AOH1996 exerts its effect on cancer cells may not be identical to what have been reported for the T3 analogs. In particular, we found that AOH1996 interferes with the association of PCNA and MCM7 to euchromatin, leading to DNA replication stress, blockade of homologous recombination-mediated DNA repair, and induction of apoptosis in cancer cells. Conclusions: These findings demonstrated the potential of this compound as a novel therapeutic agent warranting clinical investigation for cancer treatment. We have started planning a phase 1 clinical study for this compound.

Abstract 3262: Biomarkers of response to deslorelin in women at high risk of breast cancer

Women with BRCA1 or BRCA2 mutations have a high breast cancer (BC) risk. Breast density is an independent biomarker of BC risk. We demonstrated that deslorelin (D), a gonadotropin-releasing hormone agonist (GnRHA), reduced mammographic breast density among BRCA1 carriers (Weitzel, CCR 2007). We report here on correlative studies in a Phase II chemoprevention study of intranasal D plus low-dose add-back estradiol and testosterone for 10 months in 10 premenopausal high-risk women. Pre- and post-study measures included mammographic and MRI breast density; serum hormone levels; breast tissue gene expression by Affymetrix GeneChip Human Genome U133 Plus 2.0 Array; Q-PCR to validate the top genes; analysis of sera by 2D-PAGE and LC-MS/MS Mass Spectrometry, validated by a marker specific ELISA. Nine of 10 participants showed a mean reduction in MRI volumetric breast density of 17.3% (p=0.045), a mean reduction in MRI fibroglandular volume of 15.1% (p=0.041) and a mean reduction in mammographic density of 31.9% (p=0.0033). The top five differentially expressed genes in breast tissue were: FOS, EGR1, FABP3, COL3A1 and COL1A1. From seven protein spots up-regulated following treatment, 65 sera proteins were initially identified as response biomarkers, with two of these, adiponectin and Vitamin D-binding protein, predicted by Ingenuity Pathway Analyses (IPA) to have a direct role in reducing breast density by possibly altering stromal and epithelial tissue viability and fat metabolism. FOS was identified through IPA in the Vitamin D-binding protein network and both COL3A1 and COL1A1 were identified in the adiponectin network. Of the nine subjects two had an increase of ≥ 5% BMI and two had a decrease of ≥ 5% BMI. There was no significant correlation between adiponectin level changes and BMI changes.Tissue micro-array gene expression and proteomic analyses of sera identified changes in biomarkers that correlated with reduced breast density among young high-risk women receiving a GnRHA-based chemoprevention regimen.

Pre/Post Human Serum Adiponectin LevelsA_Pre: 0 MB_ Post: 10 MFold (Post/Pre)Log A (0M)Log B (10M)T-Test (p) pairedS10.4630.3860.835-0.335-0.4130.014S20.3760.4131.097-0.425-0.385S30.2620.3671.403-0.583-0.435S40.6640.8021.209-0.178-0.096S50.2450.6082.487-0.612-0.216S60.3150.7552.399-0.502-0.122S70.4130.7991.936-0.385-0.098S80.5750.6461.123-0.240-0.190S90.4360.7331.680-0.361-0.135Average1.574224

Citation Format: Jeffrey N. Weitzel, Michael F. Press, Sharon R. Sand, Lei Zhang, Catherine Klifa, Malcolm Pike, Giske Ursin, Darcy V. Spicer, AnnaMarie Daniels, Josef Herzog, Yunan Miao, Gerald Wuenschell, Chun Li, Robert Hickey. Biomarkers of response to deslorelin in women at high risk of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3262.

Determining the longitudinal validity and meaningful differences in HRQL of the PedsQL™ Sickle Cell Disease Module

Background

Detecting change in health status over time and ascertaining meaningful changes are critical elements when using health-related quality of life (HRQL) instruments to measure patient-centered outcomes. The PedsQL™ Sickle Cell Disease module, a disease specific HRQL instrument, has previously been shown to be valid and reliable. Our objectives were to determine the longitudinal validity of the PedsQL™ Sickle Cell Disease module and the change in HRQL that is meaningful to patients.

Methods

An ancillary study was conducted utilizing a multi-center prospective trial design. Children ages 4–21 years with sickle cell disease admitted to the hospital for an acute painful vaso-oclusive crisis were eligible. Children completed HRQL assessments at three time points (in the Emergency Department, one week post-discharge, and at return to baseline (One to three months post-discharge). The primary outcome was change in HRQL score. Both distribution (effect size, standard error of measurement (SEM)) and anchor (global change assessment) based methods were used to determine the longitudinal validity and meaningful change in HRQL. Changes in HRQL meaningful to patients were identified by anchoring the change scores to the patient’s perception of global improvement in pain.

Results

Moderate effect sizes (0.20–0.80) were determined for all domains except the Communication I and Cognitive Fatigue domains. The value of 1 SEM varied from 3.8–14.6 across all domains. Over 50% of patients improved by at least 1 SEM in Total HRQL score. A HRQL change score of 7–10 in the pain domains represented minimal perceived improvement in HRQL and a HRQL change score of 18 or greater represented moderate to large improvement.

Conclusions

The PedsQL™ Sickle Cell Disease Module is responsive to changes in HRQL in patients experiencing acute painful vaso-occlusive crises. The study data establish longitudinal validity and meaningful change parameters for the PedsQL™ Sickle Cell Disease Module.

Trial Registration

ClinicalTrials.gov (study identifier: NCT01197417). Date of registration: 08/30/2010

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0700-2) contains supplementary material, which is available to authorized users.

History of Somatization Is Associated with Prolonged Recovery from Concussion

OBJECTIVE

To determine the association between a history of somatization and prolonged concussion symptoms, including sex differences in recovery.

STUDY DESIGN

A prospective cohort study of 10- to 18-year-olds with an acute concussion was conducted from July 2014 to April 2015 at a tertiary care pediatric emergency department. One hundred twenty subjects completed the validated Children's Somatization Inventory (CSI) for pre-injury somatization assessment and Postconcussion Symptoms Scale (PCSS) at diagnosis. PCSS was re-assessed by phone at 2 and 4 weeks. CSI was assessed in quartiles with a generalized estimating equation model to determine relationship of CSI to PCSS over time.

RESULTS

The median age of our study participants was 13.8 years (IQR 11.5, 15.8), 60% male, with separate analyses for each sex. Our model showed a positive interaction between total CSI score, PCSS and time from concussion for females P < .01, and a statistical trend for males, P = .058. Females in the highest quartile of somatization had higher PCSS than the other 3 CSI quartiles at each time point (B -26.7 to -41.1, P values <.015).

CONCLUSIONS

Patients with higher pre-injury somatization had higher concussion symptom scores over time. Females in the highest somatization quartile had prolonged concussion recovery with persistently high symptom scores at 4 weeks. Somatization may contribute to sex differences in recovery, and assessment at the time of concussion may help guide management and target therapy.

25 GENOME EDITING OF SOMATIC CELL NUCLEAR TRANSFER DERIVED ZYGOTES BY CLUSTERED REGULARLY INTERSPACED SHORT PALINDROMIC REPEATS (CRISPR)/Cas9 GUIDE RNA INJECTION

Recent applications of the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 system have greatly improved the efficiency of genome editing in pigs. However, in some cases, genetically modified pig models need an additional modification to improve their application. The objective of this experiment was to determine whether a combination of somatic cell NT (SCNT) by using a previously modified donor cell line and subsequent zygote injection with CRISPR/Cas9 guide RNA to target a second gene would result in embryos and offspring successfully containing both modifications. Fibroblast cell lines were collected from fumarylacetoacetate hydrolase deficient (FAH–/–) fetuses and used as the donor cell line. Somatic cell NT was performed by standard technique. A CRISPR guide RNA specific for recombination activating gene 2 (RAG2) was designed and in vitro transcribed from a synthesised gBlock (IDT) containing a T7 promoter sequence, the CRISPR Guide RNA (20 bp), and 85 bp of tracer RNA. The gBlock was PCR amplified with Q5 polymerase (NEB, Ipswich, MA, USA) and in vitro transcribed with the MEGAshortscript™ T7 Transcription Kit (Life Technologies, Grand Island, NY, USA). Guide RNA (20 ng μL–1) and polyadenylated Cas9 (20 ng μL–1, Sigma, St. Louis, MO, USA) were co-injected into the cytoplasm of SCNT zygotes at 14 to 16 h after fusion and activation. Injected SCNT were then cultured in vitro in PZM3 + 1.69 mM arginine medium (MU1) to Day 5. Three embryo transfers were performed surgically into recipient gilts on Day 4 or 5 of oestrus (50, 62, or 70 embryos per pig) to evaluate in vivo development. The remaining embryos were cultured in MU1 to Day 7 and analysed for the presence of modifications to the RAG2 gene. Embryos were classified as modified if they contained an INDEL as measured by both gel electrophoresis and DNA sequencing of PCR amplicons spanning the targeted exon. The RAG2 modification rate was 83.3% (n = 6), of which 50% (n = 3) of the embryos contained biallelic modifications. All control embryos contained a wild-type RAG2 gene (n = 5). Embryo transfer resulted in a 33.3% pregnancy rate (1/3). The combination of SCNT and CRISPR/Cas9 zygote injection can be a highly efficient tool to successfully create pig embryos with an additional modification. This additional technique further improves the usefulness of already created genetically modified pig models. This study was funded by the National Institutes of Health via U42 OD011140.

Federal public health strategies to minimize the importation of communicable diseases into Canada

BACKGROUND

The global spread of communicable diseases is a growing concern largely as a result of increased international travel. In Canada, although most public health management of communicable diseases occurs at the front line, the federal government also takes actions to prevent and mitigate their importation.

OBJECTIVE

To describe the role of the Public Health Agency of Canada (PHAC) in minimizing the importation of communicable diseases through preventive measures taken before travellers leave Canada and through early detection and prompt containment measures taken when travellers arrive in the country with a potential communicable disease.

INTERVENTIONS

PHAC works to minimize the importation of communicable diseases into Canada by developing evidence-based travel health advice and targeted outreach activities geared to the public and to health care professionals. On the basis of the Quarantine Act and the International Health Regulations (2005), PHAC also conducts inspections of conveyances such as aircraft and boats and works with partners to conduct border screening to assess ill travellers entering the country.

CONCLUSION

PHAC plays an important role in preventing and minimizing the importation of communicable diseases into Canada in conjunction with clinicians, public health authorities at all levels of government and other federal government departments.

Role of SMC1 in overcoming drug resistance in triple negative breast cancer

Triple-negative breast cancer (TNBC) is one of the hardest subtypes of breast cancer to treat due to the heterogeneity of the disease and absence of well-defined molecular targets. Emerging evidence has shown the role of cohesin in the formation and progression of various cancers including colon and lung cancer but the role of cohesin in breast cancer remains elusive. Our data showed that structural maintenance of chromosome 1 (SMC1), a subunit of the cohesin protein complex, is differentially overexpressed both at RNA and protein level in a panel of TNBC cell lines as compared to normal epithelial or luminal breast cancer cells, suggesting that the amplified product of this normal gene may play role in tumorigenesis in TNBC. In addition, our results show that induced overexpression of SMC1 through transient transfection enhanced cell migration and anchorage independent growth while its suppression with targeted small interfering RNA (siRNA) reduced the migration ability of TNBC cells. Increased expression of SMC1 also lead to increase in the mesenchymal marker vimentin and decrease in the normal epithelial marker, E-cadherin. Immunocytochemical studies along with flow cytometry and cell fractionation showed the localization of SMC1 in the nucleus, cytoplasm and also in the plasma membrane. The knockdown of SMC1 by siRNA sensitized the TNBC cells towards a PARP inhibitor (ABT-888) and IC₅₀ was approximately three fold less than ABT-888 alone. The cytotoxic effect of combination of SMC1 suppression and ABT-888 was also confirmed by the colony propagation assay. Taken together, these studies report for the first time that SMC1 is overexpressed in TNBC cells where it plays a role in cell migration and drug sensitivity, and thus provides a potential therapeutic target for this highly invasive breast cancer subtype.

Abstract 2039: Potential therapeutic peptides for neuroblastoma

Neuroblastoma (NB) is a form of cancer that starts in certain types of very primitive developing nerve cells found in an embryo or fetus. This type of cancer occurs in infants and young children. It is rarely found in children older than 10 years. NB is by far the most common cancer in infants (less than 1 year old). It accounts for about 7% of all cancers in children. There are approximately 650 new cases of NB each year in the United States. The types of treatment used may include surgery, chemotherapy, retinoid therapy, and radiation therapy. In many cases, especially when the cancer has spread too far to be completely removed by surgery, chemotherapy is the main treatment. Most children with NB will need to have chemotherapy. In most cases, treatment involves a combination of anticancer drugs. These therapies by-in-large always have significant side-effects. The goal of all therapies aimed at eradicating cancer, including NB, is to selectively destroy cancer cells while sparing normal tissue. Most chemotherapeutic or radiotherapeutic agents function by damaging DNA or interfering with DNA replication. Rapid advances in recent years have contributed significantly to identifying and understanding the roles of key proteins in DNA damage response pathways. (As a result, the nuclear protein PCNA has been shown to be a component of all DNA replication/repair processes in the human cell). Logically then, it is reasonable to assume that by altering the cellular response to DNA damage, perhaps through manipulating genes or proteins related to DNA repair, cell cycle checkpoint control, damage tolerance or apoptosis, the effectiveness of conventional cancer therapy can potentially be enhanced or used as novel targets for drug discovery. Of course, also selectively sensitizing cancer cells relative to normal tissues should improve the therapeutic ratio for anti-cancer treatment. Our laboratory's recent data indicate that the use of PCNA derived synthetic peptides promote NB cytotoxicity. The hypothesis driving our work is that specific peptides derived from the PCNA protein sequence (caPeptides) have the potential ability to block the binding of several cellular proteins that participate in DNA replication, repair, cell cycle control, transcription, and chromosomal recombination in cancer cells to full length PCNA. By disrupting the naturally occurring interaction between PCNA and the proteins that bind to, or interact, with PCNA, cellular functions that recruit PCNA would be disrupted in the NB cell. These peptides, either alone or in combination with other cancer therapy agents are potentially useful cancer chemotherapeutics or augmentors of the pharmacodynamic effect of specific anti-cancer chemotherapeutics.

Citation Format: Linda H. Malkas, Long Gu, Mingway Li, Shanna Smith, Robert Lingeman, Gerald Wuenschell, Lei Zhang, Robert Hickey. Potential therapeutic peptides for neuroblastoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2039. doi:10.1158/1538-7445.AM2013-2039

End-users, Public Services, and Industrial Relations: The Restructuring of Social Services in Ontario

The global financial crisis beginning in 2008 resulted in a ballooning public debt and government efforts to constrain public expenditures. Responses to the financial crisis and its impact on human services in Ontario demonstrate the complex interactions across key actors – employers, government, unions, and family advocates. Building on previous scholarship which has explored the role of end-users as industrial relations actors (Bellemare, 2000; Kessler and Bach, 2011) this study deepens our understanding of the role and impact of end-users on the process and outcomes of industrial relations in the social services sector. The main contribution of the paper shows how end-users play unique and complex roles as industrial relations actors in Ontario’s developmental services sector. End-users have had a significant impact at three distinct levels of the industrial relations system (Bellemare, 2000). First, at the strategic level of public policy, in addition to the more traditional forms of grassroots lobbying, end-users have taken on formal roles in the governance network shaping public policy. The impacts of end-user advocacy have contributed to the significant transformation of the developmental services sector, including the closure of the remaining provincially-run institutions in 2009. Second, at the organizational level, end-users have displaced the traditional roles of employers. In some cases, this displacement has resulted in end-users operating as co-managers, with end-user management rights enshrined in collective agreements. In more significant ways, end-users have entirely replaced agency-based managers and become the employer of direct support staff. Third, end-users have driven changes at the level of the work process itself, going beyond the co-production of services, contributing to changes in the nature of direct support work. The work process has shifted from a focus on custodial care to more complex objectives of community development and social inclusion.

Abstract 3185: Use of whole slide digital imaging for determination of caPCNA and Ki-67 labeling index in normal breast reductions and DCIS: Comparison of the two biomarkers using the Aperio image-based positive pixel algorithm

While mitotic rates as well as proliferation indices have been reported as significantly different among normal breast and different grades of breast cancer, a reproducible cut-off value has not emerged. The goal of this study was to determine whether more reproducible algorithms using whole slide digital images (WSDI) can define better cut-off values for the normal breast vs. DCIS.

Design: Whole tissue sections from 10 normal breast reductions and 10 cases of DCIS were evaluated by immunohistochemistry for caPCNA and Ki67 (Mib-1). Having identified an isoform of PCNA that was uniquely expressed by cancer cells (caPCNA) and distinct from the isoform expressed by non-malignant and normal cells (nmPCNA), antibody selectively binding to caPCNA was developed and used for these studies. Stained slides were scanned using the Aperio (Vista, California) automated whole slide scanning system (Scanscope CS) and were viewed using ImageScopeTM. Single fields of view from each WSDI measuring ∼420,000 µ2 and representing the highest density of caPCNA and Ki-67 positive nuclei were selected for analysis. Different areas were analyzed in a subset of slides to determine the variability in each case, and the total nuclear labeling index was generated using the Aperio positive pixel algorithm.

Results: We analyzed the labeling indices in 10 normal breast reductions and 10 DCIS cases. Both caPCNA and Ki-67 were nuclear specific with minimal cytoplasmic staining. The mean labeling indices for the Aperio automated positive pixel counts were caPCNA (0.15) and Ki-67 (0.12) for normal breast and caPCNA (0.52) and Ki-67 (0.29) for DCIS. The correlation coefficients between automated counts were 0.653 for normal breast and 0.616 for DCIS, with an overall correlation coefficient of 0.708 for the entire series.

Conclusions: Our analysis of both biomarkers yielded a similarly increasing labeling index for DCIS cases when compared to their expression in normal breast expression. The positive pixel algorithm method has a sampling bias due to subjective selection of the area being counted. In summary, the present results show similar findings for caPCNA and Ki-67 in normal breast reductions with no evidence of breast disease and in DCIS clinical cases. Comparing caPCNA with Ki-67, and unlike traditional PCNA, caPCNA can potentially better differentiate between normal breast and DCIS, and may be a useful biomarker for early stage cancer diagnosis.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3185. doi:10.1158/1538-7445.AM2011-3185

Abstract 5429: Cytotoxicity of AOH compounds targeting the interaction of caPCNA and its binding partners in human cancer cells

Previously we reported the identification of an acidic isoform of proliferating cell nuclear antigen (caPCNA) in various cancer cells. Proliferating Cell Nuclear Antigen (PCNA) interacts with multiple binding partners to carry out vital cellular processes including DNA replication, DNA damage repair, and cell-cycle progression. We hypothesize that caPCNA performs similar functions specifically in cancer cells and, therefore, disrupting interactions of caPCNA with its binding partners will prevent necessary cellular functions, resulting in cytotoxicity to cancer cells. AOH compounds were generated based on a focused computer molecular “docking” search for small molecules that specifically targeted the interaction of caPCNA and its binding partner FEN1. MTT assays suggest that several AOH compounds have promising anti-proliferation effects in human breast and pancreatic cancer cells with EC50 values as low as or less than 10uM (lead compounds). To further evaluate the cytotoxicity of lead AOH compounds, clonogenic survival assays were performed in MCF-7 cells treated with the small molecules for 2 hours. Results showed that AOH compounds induced cytotoxicity in cancer cells in a dose-dependent manner. The IC50s of these compounds were between 10 to 20uM in MCF-7cells. To investigate the effects of the AOH compounds on DNA replication and the cell cycle, in vitro SV40 DNA replication assays and flow cytometric analysis were performed. The G2/M phase cell population was increased from 8% to 30-80% in MCF-7 cells treated with 25uM AOH compounds for 48 hours, indicating an induction of G2 arrest. AOH compound at 10uM inhibited in vitro DNA replication in malignant cell extracts by 70-80% relative to untreated correspondent cell extracts. Taken together, the potent cytotoxicity of AOH compounds in cancer cells is correlated with their inhibition of DNA replication and induction of cell cycle arrest. The compounds may be useful in the future for clinical cancer chemotherapy as a single anticancer agent and/or in combination with other anti-neoplastic agents.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5429. doi:10.1158/1538-7445.AM2011-5429

Summary of NIH Medical-Surgical Emergency Research Roundtable held on April 30 to May 1, 2009

STUDY OBJECTIVE

In 2003, the Institute of Medicine Committee on the Future of Emergency Care in the United States Health System convened and identified a crisis in emergency care in the United States, including a need to enhance the research base for emergency care. As a result, the National Institutes of Health (NIH) formed an NIH Task Force on Research in Emergency Medicine to enhance NIH support for emergency care research. Members of the NIH Task Force and academic leaders in emergency care participated in 3 roundtable discussions to prioritize current opportunities for enhancing and conducting emergency care research. The objectives of these discussions were to identify key research questions essential to advancing the scientific underpinnings of emergency care and to discuss the barriers and best means to advance research by exploring the role of research networks and collaboration between the NIH and the emergency care community.

METHODS

The Medical-Surgical Research Roundtable was convened on April 30 to May 1, 2009. Before the roundtable, the emergency care domains to be discussed were selected and experts in each of the fields were invited to participate in the roundtable. Domain experts were asked to identify research priorities and challenges and separate them into mechanistic, translational, and clinical categories. After the conference, the lists were circulated among the participants and revised to reach a consensus.

RESULTS

Emergency care research is characterized by focus on the timing, sequence, and time sensitivity of disease processes and treatment effects. Rapidly identifying the phenotype and genotype of patients manifesting a specific disease process and the mechanistic reasons for heterogeneity in outcome are important challenges in emergency care research. Other research priorities include the need to elucidate the timing, sequence, and duration of causal molecular and cellular events involved in time-critical illnesses and injuries, and the development of treatments capable of halting or reversing them; the need for novel animal models; and the need to understand why there are regional differences in outcome for the same disease processes. Important barriers to emergency care research include a limited number of trained investigators and experienced mentors, limited research infrastructure and support, and regulatory hurdles. The science of emergency care may be advanced by facilitating the following: (1) training emergency care investigators with research training programs; (2) developing emergency care clinical research networks; (3) integrating emergency care research into Clinical and Translational Science Awards; (4) developing emergency care-specific initiatives within the existing structure of NIH institutes and centers; (5) involving emergency specialists in grant review and research advisory processes; (6) supporting learn-phase or small, clinical trials; and (7) performing research to address ethical and regulatory issues.

CONCLUSION

Enhancing the research base supporting the care of medical and surgical emergencies will require progress in specific mechanistic, translational, and clinical domains; effective collaboration of academic investigators across traditional clinical and scientific boundaries; federal support of research in high-priority areas; and overcoming limitations in available infrastructure, research training, and access to patient populations.

Microbial dynamics in upflow anaerobic sludge blanket (UASB) bioreactor granules in response to short-term changes in substrate feed

The upflow anaerobic sludge blanket (UASB) reactor is a microcosm for the methanogenic degradation of organic matter in anaerobic environments, and depends on the auto-formation of dense 3D biofilms of 1–3 mm in diameter, referred to as granular sludge (biogranules). Past research has shown that UASB and other methanogenic reactors are extremely stable functionally, but the underlying basis of the functional stability is not well understood. In this study, microbial dynamics in the communities residing in UASB biogranules were analysed to determine responses to short-term perturbations (change in reactor feed). The reactor was fed with simulated brewery wastewater (SBWW) for 1.5 months (phase 1), acetate/sulfate for 2 months (phase 2), acetate alone for 3 months (phase 3) and then a return to SBWW for 2 months (phase 4). Analysis of 16S rRNA, methanogen-associated mcrA and sulfate reducer-associated dsrAB gene-based-clone libraries showed a relatively simple community composed mainly of the methanogenic archaea (Methanobacterium and Methanosaeta), members of the green non-sulfur (Chloroflexi) group of bacteria and Syntrophobacter, Spirochaeta, Acidobacteria and Cytophaga-related bacterial sequences. The mcrA clone libraries were dominated throughout by Methanobacterium- and Methanospirillum-related sequences. Although the reactor performance remained relatively stable throughout the experiment, community diversity levels generally decreased for all libraries in response to a change from SBWW to acetate alone feed. There was a large transitory increase noted in 16S diversity at the 2 month sampling on acetate alone, entirely related to an increase in bacterial diversity. Upon return to SBWW conditions in phase 4, all diversity measures returned to near phase 1 levels. Our results demonstrated that microbial communities, even highly structured ones such as in UASB biogranules, are very capable of responding to rapid and major changes in their environment.

Abstract 4629: Expression of cancer-associated proliferating cell nuclear antigen (caPCNA) in various stages and types of neoplasia (breast, cervix, colon, gastric, lung, ovary, thyroid, and uterus)

Novel immunohistochemistry biomarkers that target specific cellular proteins that are either uniquely or primarily expressed by cancer cells are being developed. One of these biomarkers, caPCNA, [the cancer associated isoform of PCNA] may be useful as an aide for distinguishing early stage neoplasia from hyperplasia in clinical cases that are often difficult to interpret. The caPCNA isoform appears to be expressed almost exclusively in a large variety of cancer cells and at all Stages [1 to 4] of the disease. It is not consistently observed in most normal adjacent tissues. This study analyzed the expression of caPCNA, by immunohistochemistry (IHC) using an automated Ventana immunostaining platform. In the present study, IHC was performed on neutral buffered formalin fixed paraffin embedded tissues obtained from various pathology labs. Evaluation of carcinomas (120 cases) from various organs and clinical stages as well as normal adjacent tissue was performed. Immunostaining was localized in tumor cells only to the cell nucleus. CaPCNA expression was seen in 10 of 10 cervical Ca, 20 of 20 colon Ca, 10 of 10 thyroid Ca, 10 of 10 gastric Ca, 10 of 10 ovarian Ca, 25 of 25 breast Ca, 10 of 10 lung Ca, 11 of 12 uterine Ca, and 15 of 15 DCIS Ca. On a normal tissue panel, caPCNA immunostaining was seen in macrophages, syncytial trophoblasts in the placenta, GI tract crypt epithelial cells, and scattered staining in the basilar layer of the skin. Immunostaining of normal macrophages and most of the other reactive cell types was abolished by removal of the heavy chain of the primary antibody during creation of an Fab2' fragment of the anti-caPCNA antibody. In summary, the present results illustrate the localization of caPCNA at all stages, in many different types of neoplasms. CaPCNA may therefore be a useful biomarker for early stage cancer diagnosis and potentially maybe a predictor of patient outcome.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4629.

Abstract 1597: Expression of caPCNA and antineoplastic action of caPeptides in pancreatic cancer cells

Our laboratory previously reported the identification of an acidic isoform of proliferating cell nuclear antigen (caPCNA) in various cancer cells, which appears to be associated, at least in part, with malignant transformation of cells. The current studies show the expression of caPCNA in BXPC-3, Paca-2 and Capan-1 pancreatic cancer cells. Since Proliferating Cell Nuclear Antigen (PCNA) is involved in DNA replication and repair in prokaryote and eukaryote cells, we hypothesize that caPCNA is likely to perform similar functions specifically in cancer cells. Antibodies developed against caPCNA showed growth inhibition activity in cancer cells suggesting caPCNA is related to the proliferation of malignant cells. In order to begin to understand the function of caPCNA in cellular malignant transformation, we have investigated the interaction of caPCNA with its binding partners including flap structure-specific endonuclease 1(Fen-1) and xeroderma pimentosum complementation group G (XPG). We have identified an amino acid domain sequence that confers the cancer cell specificity of caPCNA. In the course of our studies we synthesized small caPCNA related peptides (caPeptides) derived from this sequence that promote cancer cell cytotoxicity. caPeptides have the potential ability to compete with several cellular proteins that participate in DNA replication, repair, cell cycle control, transcription, and chromosomal recombination for their naturally occurring binding site on caPCNA and block binding of full length caPCNA to these proteins. The disruption of the interaction between caPCNA and its binding proteins prevents cancer cellular functions (vital cellular machinery) that recruit caPCNA and therefore may lead caPCNA-derived peptides to be cytotoxic by themselves or in combination with cancer chemotherapeutic drugs. These peptides, either alone or in combination with other anticancer agents are potentially useful cancer chemotherapeutics or augmentors of the pharmacodynamic effect of specific anti-cancer chemotherapeutics. Our results show that these peptides demonstrate promising growth inhibition and cytotoxicity in pancreatic cancer cells. Considering that pancreatic cancer is well known for its high mortality rate due to its chemotherapy ineffectiveness our studies render further investigations on the action of caPCNA and the anti-neoplastic mechanism of the peptides in pancreatic cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1597.

Recombinant human angiostatin (rhAngiostatin) in combination with paclitaxel and carboplatin in patients with advanced non-small-cell lung cancer: a phase II study from Indiana University

BACKGROUND

Recombinant human angiostatin (rhAngiostatin) functions as a potent inhibitor of angiogenesis. This study combined rhAngiostatin with a standard chemotherapy regimen in patients with advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Eligible patients had chemotherapy-naïve stage IIIB (with pleural effusion) or IV NSCLC, performance status (PS) 0 or 1, no history of bleeding, brain metastasis or requirements for anti-coagulation. Patients received carboplatin (AUC 5) intravenously and paclitaxel (175 mg/m2) intravenously day 1 + subcutaneous rhAngiostatin at either 15 mg or 60 mg twice daily. Cycles were repeated every 3 weeks, for up to six cycles. Patients without progression after completing at least four cycles were continued on maintenance rhAngiostatin until disease progression.

RESULTS

Patient characteristics (n = 24) were: 16 males, median age 66 years (range 45-78), 54% PS 1, 83.3% stage IV and 62.5% adenocarcinoma. Grade 3/4 toxicities included: fatigue 47.8%, neutropenia 39.1%, dyspnea 39.1%, vascular 26.1% and infection 17.4%. The overall response rate was 39.1%, 39.1% stable disease and 21.7% progressive disease. Median time to progression was 144 days, and 1-year survival was 45.8%.

CONCLUSIONS

rhAngiostatin in combination with paclitaxel and carboplatin is feasible and results in a high disease control rate in patients with advanced NSCLC.

Prevalence of anemia in children presenting with apparent life-threatening events

BACKGROUND

Anemia has been associated with apparent life-threatening events (ALTEs) in children. However, the nature of the association has not been well described.

OBJECTIVES

This study was conducted to determine how often anemia occurs in children presenting with ALTEs. Specifically, the authors sought to prospectively describe hemoglobin (Hb) levels and mean corpuscular volumes (MCVs) in children presenting with either a single ALTE or recurrent events, and to compare the values with those of an age-matched control population. Patients who had recurrent events were compared with those who had single events because it was hypothesized that patients who were anemic would be more likely to have recurrent events.

METHODS

This was a prospective cohort study set in an urban, tertiary care emergency department of a large children's hospital. Children presenting with ALTEs and an age-matched control population were included. The mean Hb level, mean MCV, mean value for the mean corpuscular hemoglobin (MCH), and proportion of patients found to be anemic were measured.

RESULTS

Of 128 patients evaluated during the two-year study period, 108 were eligible for study and were age-matched to 108 control patients. Overall, the ALTE and control patients were similar with regard to age, gender, and race. However, the ALTE patients with recurrent events (37/108, 34.3%) were older (3.0 months vs. 1.6 and 2.1 months, p = 0.018) and had a lower mean Hb level (11.6 g/dL vs. 13.1 and 12.9 g/dL, p = 0.013), a lower MCH (30.3 fL vs. 33.1 and 32.4 fL, p < 0.001), and a lower MCV (88.4 pg vs. 96.6 and 93 pg, p < 0.01) than did the patients with a single event and the control patients, respectively. The rate of anemia in the ALTE patients with recurrent events was 21.6%, as compared with 16.9% of the patients with a single event (p = 0.13) and 9.3% of the control patients (p = 0.049).

CONCLUSIONS

Anemia is common in pediatric patients with recurrent ALTEs. Patients with recurrent ALTEs are older and have lower Hb, MCH, and MCV values than patients with a single ALTE and age-matched control patients. Significantly lower MCH and MCV values in patients with recurrent ALTEs suggest that iron deficiency may be associated with the recurrence of events.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa)

Outcome after cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002, a task force of the International Liaison Committee on Resuscitation (ILCOR) met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (ie, essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, emergency medical services system, and community.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries

Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002 a task force of ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conference. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.

Effect of novel benzoylphenylurea derivatives on DNA polymerase alpha activity using the synthesome-based in vitro model system

Six benzoylphenylurea (BPU) derivatives have been synthesized in Japan and extensively evaluated by the U.S. National Cancer Institute. They demonstrated potent antitumor activity in vitro against several cancer cell lines as well as in vivo against several tumor models. One of these agents, NSC639829, has now entered clinical trials. Studies have shown that these compounds are effective inhibitors of in vitro tubulin polymerization. The parent compound, NSC624548 (HO-221), has been shown to inhibit calf thymus DNA polymerase alpha activity. In this study we examined the effects of four BPU derivatives (NSC624548, NSC639828, NSC639829, and NSC654259) on the activity of the synthesome-associated DNA polymerase alpha, Escherichia coli DNA polymerase I, and calf thymus DNA polymerase alpha. Among the compounds tested, only NSC624548 and NSC639828 inhibited the activities of E. coli DNA polymerase I and calf thymus DNA polymerase alpha. Excess DNA polymerase I or DNA polymerase alpha dramatically reduced the inhibition produced by these compounds. NSC624548 and NSC639828 also showed inhibitory effects of the synthesome-associated DNA polymerase alpha similar to that produced upon using the purified E. coli and calf thymus enzymes. All of the four compounds did not show inhibitory effect on DNA polymerase delta. The similar pattern of inhibition these compounds exert on both the purified calf thymus and the synthesome-associated DNA polymerase alpha offers further support for the validity of the DNA synthesome as a novel in vitro model system for studying anticancer drug action.