Repression of TRIM13 by chromatin assembly factor CHAF1B is critical for AML development

Acute myeloid leukemia (AML) is an aggressive blood cancer that stems from the rapid expansion of immature leukemic blasts in the bone marrow. Mutations in epigenetic factors represent the largest category of genetic drivers of AML. The chromatin assembly factor CHAF1B is a master epigenetic regulator of transcription associated with self-renewal and the undifferentiated state of AML blasts. Upregulation of CHAF1B, as observed in almost all AML samples, promotes leukemic progression by repressing the transcription of differentiation factors and tumor suppressors. However, the specific factors regulated by CHAF1B and their contributions to leukemogenesis are unstudied. We analyzed RNA sequencing data from mouse MLL-AF9 leukemic cells and bone marrow aspirates, representing a diverse collection of pediatric AML samples and identified the E3 ubiquitin ligase TRIM13 as a target of CHAF1B-mediated transcriptional repression associated with leukemogenesis. We found that CHAF1B binds the promoter of TRIM13, resulting in its transcriptional repression. In turn, TRIM13 suppresses self-renewal of leukemic cells by promoting pernicious entry into the cell cycle through its nuclear localization and catalytic ubiquitination of cell cycle-promoting protein, CCNA1. Overexpression of TRIM13 initially prompted a proliferative burst in AML cells, which was followed by exhaustion, whereas loss of total TRIM13 or deletion of its catalytic domain enhanced leukemogenesis in AML cell lines and patient-derived xenografts. These data suggest that CHAF1B promotes leukemic development, in part, by repressing TRIM13 expression and that this relationship is necessary for leukemic progression.

Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis

BACKGROUND

Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis.

METHODS

This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK.

RESULTS

Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing.

CONCLUSIONS

PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.

Magseed localisation of non-palpable breast lesions: experience from a single centre

AIM

To prospectively analyse patients undergoing magnetic seed (Magseed) localisation (MSL) to evaluate the outcome, and to retrospectively compare re-excision rates for MSL with previous wire-guided localisation (WGL) to assess the hypothesis that the introduction of MSL may lead to a lower re-excision rate.

MATERIALS AND METHODS

MSL commenced at University Hospital Crosshouse in December 2017. No other changes were made to radiological or surgical practice during this time. Data were collected prospectively on all patients undergoing MSL between December 2017 and December 2019, in a single breast unit. Data were gathered retrospectively on patients who had undergone localised breast procedures between January 2016 and December 2019 for comparison of re-excision rates.

RESULTS

Two hundred and fifty-five patients underwent MSL surgery between December 2017 and December 2019. Of those, 98% (n=250) patients underwent successful MSL at the first attempt. The Magseed was identified intraoperatively in 100% patients and surgical excision was performed. The re-excision rate reduced from 18.9% in 2016/2017, to 11.6% in 2018/2019 (p=0.098).

CONCLUSION

In conclusion, Magseed localisation has proved to be a safe and effective way of localising breast lesions, with the advantage of high accuracy. The reduction in re-excision rates at University Hospital Crosshouse with the introduction of Magseed® localisation is a potential benefit, which requires further study.

Improved Constraints on Primordial Gravitational Waves using Planck, WMAP, and BICEP/Keck Observations through the 2018 Observing Season

We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220  GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8  μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.

Norwich COVID-19 testing initiative pilot: evaluating the feasibility of asymptomatic testing on a university campus

Background

There is a high prevalence of COVID-19 in university-age students, who are returning to campuses. There is little evidence regarding the feasibility of universal, asymptomatic testing to help control outbreaks in this population. This study aimed to pilot mass COVID-19 testing on a university research park, to assess the feasibility and acceptability of scaling up testing to all staff and students.

Methods

This was a cross-sectional feasibility study on a university research park in the East of England. All staff and students (5625) were eligible to participate. All participants were offered four PCR swabs, which they self-administered over two weeks. Outcome measures included uptake, drop-out rate, positivity rates, participant acceptability measures, laboratory processing measures, data collection and management measures.

Results

798 (76%) of 1053 who registered provided at least one swab; 687 (86%) provided all four; 792 (99%) of 798 who submitted at least one swab had all negative results and 6 participants had one inconclusive result. There were no positive results. 458 (57%) of 798 participants responded to a post-testing survey, demonstrating a mean acceptability score of 4.51/5, with five being the most positive.

Conclusions

Repeated self-testing for COVID-19 using PCR is feasible and acceptable to a university population.

First Direct Measurement of ^{22}Mg(α,p)^{25}Al and Implications for X-Ray Burst Model-Observation Comparisons

Type-I x-ray bursts can reveal the properties of an accreting neutron star system when compared with astrophysics model calculations. However, model results are sensitive to a handful of uncertain nuclear reaction rates, such as ^{22}Mg(α,p). We report the first direct measurement of ^{22}Mg(α,p), performed with the Active Target Time Projection Chamber. The corresponding astrophysical reaction rate is orders of magnitude larger than determined from a previous indirect measurement in a broad temperature range. Our new measurement suggests a less-compact neutron star in the source GS1826-24.

New Measurement of ^{12}C+^{12}C Fusion Reaction at Astrophysical Energies

Carbon and oxygen burning reactions, in particular, ^{12}C+^{12}C fusion, are important for the understanding and interpretation of the late phases of stellar evolution as well as the ignition and nucleosynthesis in cataclysmic binary systems such as type Ia supernovae and x-ray superbursts. A new measurement of this reaction has been performed at the University of Notre Dame using particle-γ coincidence techniques with SAND (a silicon detector array) at the high-intensity 5U Pelletron accelerator. New results for ^{12}C+^{12}C fusion at low energies relevant to nuclear astrophysics are reported. They show strong disagreement with a recent measurement using the indirect Trojan Horse method. The impact on the carbon burning process under astrophysical scenarios will be discussed.

Relationship of Head Circumference and Age in the Prediction of the Real-Ear-to-Coupler Difference (RECD)

BACKGROUND

Pediatric hearing instrument fitting is optimally performed with individually obtained real-ear-to-coupler difference (RECD) measurements. If these measurements cannot be obtained, predicted values based on age are used. Recent evidence obtained from children aged 3-11 years suggests that head circumference (HC) may be a viable alternative or addition to age for use in RECD prediction.

PURPOSE

The purpose of the present study was to determine if HC can be used to predict RECDs in infants, children, and adults.

RESEARCH DESIGN

A correlational design was used. HC and RECD values were measured in all participants.

STUDY SAMPLE

Participants were 278 North American infants and children (136 males and 142 females) aged 1.6 months to 11 years and 109 adults (42 males and 67 females) aged 18 years to 83 years.

DATA COLLECTION AND ANALYSIS

After otoscopic inspection and immittance measurements were performed to assess candidacy for inclusion in the study, HC was measured twice for all participants and a single RECD measure was obtained for each participant at twelve frequencies (250 through 12500 Hz). The reliability of HC measurements was assessed with an intraclass correlation analysis. Linear regression analyses were performed with age and HC as predictor variables and RECDs as the dependent variable.

RESULTS

Analysis indicated good reliability of the HC measurement. The relationships between RECD and HC were comparable with the relationships between RECD and age. Combining HC and age did not improve predictive accuracy.

CONCLUSIONS

HC can be used in children and adults as an alternative metric in the prediction of RECDs when individual RECDs cannot be obtained.

Improvements in first-line systemic mRCC therapy: Challenging insights from a cross trial comparison of overall survival and subsequent therapies in recent phase III trials

705

Background: Using sunitinib (SUN) as the comparator, two out of three recent phase III clinical trials have shown an overall survival (OS) benefit in the alternative treatment arm (Checkmate 214 (C), Keynote 426 (K)). The Javelin 101(J) trial has yet to show a significant improvement. Methods: A cross-study comparison of OS for the sunitinib arms of C, K and J was carried out. Special focus was given to risk group stratification and subsequent therapies. Data from the SUN pivotal trial (SP) was also taken into account. Results: Across the C, K and SP trials, OS was similar at approximately 78%. Despite a lower percentage of favourable risk patients compared to K and SP, an OS of 82% was observed in J. At 18 months, OS survival curves split ranging from 65% ©, 72.1% (K) to 76% (J). OS in the SUN arm in J at 18 months was comparable to OS of Nivolumab/Ipilimumab in C (78%). The rate of subsequent therapies ranged from 34.3% (K), 39.2% (J) to 54% (C) in the SUN arms. At the time of the SP trial almost no subsequent therapy options existed. In the experimental arms, the rate of subsequent therapies was 51.8% ©, 20.5% (K) and 20.8% (J). The existing data give no clear evidence of a correlation between subsequent therapies and OS. However, an analysis of the subsequent therapies/patients discontinuing therapy ratio (ST/DIS) and type of subsequent therapy (PD1/L1 directed or therapy with proven OS benefit (pOS) in randomized trials) in the SUN arms may be more conclusive (see table). The rate of subsequent therapies (ST/DIS) as well as PD(L)1 or pOS therapies were highest in J, followed by K and C. Conclusions: Despite the difficulties of a cross trial comparison, this data should raise awareness of the influence of a more intense subsequent therapy. It points to the necessity to standardize subsequent therapies in 1st line trials if OS is a primary study aim. Given this analysis, it may be pertinent to ask if an optimal or near optimal subsequent therapy following SUN might be equal to a 1st line IO/IO therapy with regards to OS.[Table: see text]

A Prospective Study of Circulating Tumor DNA to Guide Matched Targeted Therapy in Lung Cancers

BACKGROUND

Liquid biopsy for plasma circulating tumor DNA (ctDNA) next-generation sequencing (NGS) is commercially available and increasingly adopted in clinical practice despite a paucity of prospective data to support its use.

METHODS

Patients with advanced lung cancers who had no known oncogenic driver or developed resistance to current targeted therapy (n = 210) underwent plasma NGS, targeting 21 genes. A subset of patients had concurrent tissue NGS testing using a 468-gene panel (n = 106). Oncogenic driver detection, test turnaround time (TAT), concordance, and treatment response guided by plasma NGS were measured. All statistical tests were two-sided.

RESULTS

Somatic mutations were detected in 64.3% (135/210) of patients. ctDNA detection was lower in patients who were on systemic therapy at the time of plasma collection compared with those who were not (30/70, 42.9% vs 105/140, 75.0%; OR = 0.26, 95% CI = 0.1 to 0.5, P < .001). The median TAT of plasma NGS was shorter than tissue NGS (9 vs 20 days; P < .001). Overall concordance, defined as the proportion of patients for whom at least one identical genomic alteration was identified in both tissue and plasma, was 56.6% (60/106, 95% CI = 46.6% to 66.2%). Among patients who tested plasma NGS positive, 89.6% (60/67; 95% CI = 79.7% to 95.7%) were also concordant on tissue NGS and 60.6% (60/99; 95% CI = 50.3% to 70.3%) vice versa. Patients who tested plasma NGS positive for oncogenic drivers had tissue NGS concordance of 96.1% (49/51, 95% CI = 86.5% to 99.5%), and directly led to matched targeted therapy in 21.9% (46/210) with clinical response.

CONCLUSIONS

Plasma ctDNA NGS detected a variety of oncogenic drivers with a shorter TAT compared with tissue NGS and matched patients to targeted therapy with clinical response. Positive findings on plasma NGS were highly concordant with tissue NGS and can guide immediate therapy; however, a negative finding in plasma requires further testing. Our findings support the potential incorporation of plasma NGS into practice guidelines.

Study of 3He(n,p)3H reaction at cosmological energies with trojan horse method

In the network of reactions present in the Big Bang nucleosynthesis, the 3He(n, p)3H has an important role which impacts the final 7Li abundance. The Trojan Horse Method (THM) has been applied to the 3He(d, pt)H reaction in order to extract the astrophysical S(E)-factor of the 3He(n, p)3H in the Gamow energy range. The experiment will be described in the present work together with the first preliminary results.

Relationship of Head Circumference and Age in the Prediction of the Real-Ear-to-Coupler Difference (RECD)

Background: Pediatric hearing instrument fitting is optimally performed with individually obtained realear-to-coupler difference (RECD) measurements. If these measurements cannot be obtained, predictedvalues based on age are used. Recent evidence obtained from children aged 3–11 years suggests thathead circumference (HC) may be a viable alternative or addition to age for use in RECD prediction.Purpose: The purpose of the present study was to determine if HC can be used to predict RECDs ininfants, children, and adults.Research Design: A correlational design was used. HC and RECD values were measured in allparticipants.Study Sample: Participants were 278 North American infants and children (136 males and 142 females)aged 1.6 months to 11 years and 109 adults (42 males and 67 females) aged 18 years to 83 years.Data Collection and Analysis: After otoscopic inspection and immittance measurements were performedto assess candidacy for inclusion in the study, HC was measured twice for all participantsand a single RECD measure was obtained for each participant at twelve frequencies (250 through12500 Hz). The reliability of HC measurements was assessed with an intraclass correlation analysis.Linear regression analyses were performed with age and HC as predictor variables and RECDs asthe dependent variable.Results: Analysis indicated good reliability of the HC measurement. The relationships between RECDand HC were comparable with the relationships between RECD and age. Combining HC and age did notimprove predictive accuracy.Conclusions: HC can be used in children and adults as an alternative metric in the prediction of RECDswhen individual RECDs cannot be obtained.

Tumor volumetric correlation with plasma cell free DNA (cfDNA) mutation detection in metastatic lung cancers

e14610

Background: In patients with metastatic lung cancers, analysis of cfDNA is increasingly used to detect oncogenes, frequently allowing matched targeted therapy. Mutation detection in cfDNA may be influenced by several factors, such as disease burden. We hypothesized that volumetrics, as routinely analyzed during radiation simulation, correlates with mutation detection in cfDNA. Methods: Patients underwent cfDNA analysis between 10/2016 and 1/2018. Those with metastatic NSCLC, adequate imaging for volumetric analysis (PET/CT and MRI brain), and who were treatment naïve at plasma draw were included. Plasma underwent a 21-gene next generation sequencing assay (Resolution Bioscience). A single observer segmented tumor volumes. Volume of disease was correlated with mutation detection in cfDNA for all 21 genes including the 8 NCCN oncogenes (EGFR, ALK, ROS1, BRAF, KRAS, HER2, RET, MET) with univariate Mann-Whitney. Results: Of the 210 pts with plasma, 52 met inclusion criteria. There were 22 males (42%), median age 67yo (IQR 59-74), 24 former smokers (median pack-years: 25), 44 adenocarcinomas (85%), 21 matched to targeted therapy based on cfDNA results (40%), and median cfDNA extracted concentration was 1.56 ng/mL (IQR 1.1 – 2.6 ng/mL). Involved sites included lymph nodes (n = 43), bone (n = 25), brain (n = 15), liver (n = 13), and adrenals (n = 12). Median total tumor volume was 67.0 mL (IQR 36.6-184.6 mL). When evaluating all 21 genes, cfDNA was mutation positive in 40 pts and negative in 12 pts. Median tumor volume was 77.6 mL and 40.4 mL for positive and negative, respectively (p = 0.12). For the 8 NCCN oncogenes, cfDNA was positive in 18 pts and negative in 34 pts. Median tumor volume was 105.3 mL and 67.0 mL for positive and negative, respectively (p = 0.40). Conclusions: Volumetric analysis showed there was a non-significant trend toward larger tumor volume among pts with positive cfDNA mutation detection. As the use of cfDNA continues to expand into earlier disease stage settings, volumetrics at diagnosis may become an increasingly important tool to help predict cfDNA mutation detection to guide targeted therapy. Further studies of volumetrics and cfDNA analysis are warranted.

Immune response to temperature stress in three bivalve species: Pacific oyster Crassostrea gigas, Mediterranean mussel Mytilus galloprovincialis and mud cockle Katelysia rhytiphora

Summer mortality of some bivalve species is often associated with the change of environmental temperature. This study compares the response of immunological parameters to temperature change in three marine bivalves: Pacific oyster Crassostrea gigas, Mediterranean mussel Mytilus galloprovincialis and mud cockle Katelysia rhytiphora. Each species was exposed to three temperatures, 15 °C, 20 °C and 25 °C for 14 days. The total haemocyte count (THC), phagocytosis, reactive oxygen species (ROS) and the activity of antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) were used as indicators to measure the response of each species to different temperatures. The highest temperature (25 °C) significantly increased the THC and phagocysis of haemocytes in all species. The SOD and CAT activities in the haemocytes of M. galloprovincialis and K. rhytiphora rapidly increased with temperature elevation, concomitantly with the increase of ROS ions. In contrast, the increases of ROS and SOD in C. gigas only occurred from 20 °C to 25 °C, suggesting that this intertidal species is more adaptive to different temperature levels. This study indicates that the activities of antioxidant enzymes can reflect the immune response of marine bivalves to thermal stress. Intertidal species such as Pacific oysters have a greater tolerance to thermal stress than subtidal species (e.g. Mediterranean mussel) and demersal species buried in sand (e.g. cockle).

Description of complex viewing geometries of fusion tomography diagnostics by ray-tracing

Ray-tracing techniques are applied to bolometry, a diagnostic where the finite collection volume is particularly sensitive to the machine and detector configuration. A technique is presented that can handle arbitrarily complex aperture and collimator geometries, neglecting reflection effects. Sight lines from the ASDEX Upgrade bolometer foils were ray-traced with a path tracing algorithm, where the optical path is represented by a statistical bundle of ray paths connecting the foil surface with the slit geometry. By using the full 3D machine model for the detector box and first wall, effects such as occlusion and vignetting were included in the calculation of the bolometer's étendue. Inversion matrices calculated with the ray-tracing technique were compared with the more conventional single-ray approach and shown to be naturally more constrained, requiring less regularisation. The two models were tested on a sample radiation scenario, and the common single-ray approximation is shown to be insufficient. These results are particularly relevant for the divertor where strong emission gradients may be present. The technique developed generalises well to arbitrarily complex viewing geometries and collimators, opening up a new design space for bolometer configurations that might not normally have been considered.

Correlation of next generation sequencing (NGS) of urine with tumor and plasma in patients with non-muscle invasive bladder cancer (NMIBC)

e16002

Background: The current standard-of-care surveillance protocols for post-treatment NMIBC patients involve invasive procedures that result in poor patient compliance. Detection of recurrent NMIBC tumor DNA in plasma or urine would provide a less invasive alternative, and here we examine the feasibility of this approach by performing targeted NGS on tumor, plasma, and urine samples from NMIBC patients. Methods: 5 patients with untreated NMIBC (histology: Ta(n = 3), T1(n = 2)) have been analyzed to date. Urine and plasma samples were taken just prior to tumor resection. Samples were analyzed using a capture panel that includes common mutations found in > 80% of NMIBC patients. Coverage includes the promoter region of the TERT gene, the entire coding regions of KDM6A and FGFR3, and copy number variation in PD-L1 and JAK2. Results: Mutations were observed in all tumor samples, with the TERT -124C > T promoter mutation found in 4 patients (AF:16-84%) and the TERT -146C > T promoter mutation found in the other (AF:19%). Deleterious mutations were found in KDM6A for 4 patients, and FGFR3 activating mutations were found in 2 patients. Amplification of FGFR3 was seen in one sample. When the 4 matched pairs of urine and tumor samples were examined, all of the called mutations in tumor were also found in urine at similar allele frequencies. This includes the detection of gene copy alterations. No such mutations were observed in plasma samples despite extensive sequencing ( > 2000 unique read coverage). Conclusions: These data show that canonical NMIBC mutations are readily detectable in urine and correlate well with tumor, suggesting that NMIBC tumors shed prolifically into urine, and indicate that further investigation of NGS sequencing of urine as a means of detecting NMIBC recurrence is warranted.

Liquid biopsy in the clinic: A prospective study of plasma circulating tumor DNA (ctDNA) next generation sequencing (NGS) in patients with advanced non-small cell lung cancers to match targeted therapy

11536

Background: Liquid biopsy for plasma ctDNA NGS is a rapidly evolving science. Plasma ctDNA assays are commercially available and are increasingly adopted in the community with a paucity of evidence-based guidance. We set out to study the optimal timing and utility of plasma ctDNA NGS in clinic. Methods: Pts with advanced NSCLC who were driver unknown, defined as not having prior tissue NGS or clinical concern for tumor heterogeneity that may affect treatment decisions, were eligible. Peripheral blood was collected in a Streck tube (10mL), DNA extracted, and subjected to a bias-corrected hybrid-capture 21 gene targeted NGS assay in a CLIA lab with unique reads at 3000x and sensitive detection at variant allele frequency above 0.1% (ResolutionBio Bellevue, WA). Pts also had concurrent tissue NGS via MSK IMPACT. Clinical endpoints included detection of oncogenic drivers in plasma, ability to match pts to targeted therapy, concordance and turnaround time of plasma and tissue NGS. Results: Forty-one pts were prospectively accrued. Plasma ctDNA detected an oncogenic driver in 39% (16/41) of pts, of whom 17% (7/41) were matched to targeted therapy; including pts matched to clinical trials for HER2 exon 20 insertionYVMA, BRAF L597Q and MET exon14. Mean turnaround time for plasma was 7 days (4-12) and 28 days (20-43) for tissue. Plasma ctDNA was detected in 56% (23/41) of pts; detection was 40% (8/20) if blood was drawn on active therapy and 71% (15/21) if drawn off therapy, either at diagnosis or progression (Odds ratio 0.28, 95% CI 0.06 - 1.16; p = 0.06). All pts had concurrent tissue NGS; of the 10 samples resulted, there was 100% driver concordance between tissue and plasma in pts drawn off therapy. Conclusions: In pts who were driver unknown or who had clinical concern for tumor heterogeneity, plasma ctDNA NGS identified a variety of oncogenic drivers with a short turnaround time and matched them to targeted therapy. Plasma ctDNA detection was more frequent at diagnosis of metastatic disease or at progression. A positive finding of an oncogenic driver in plasma is highly specific, but a negative finding may still require tissue biopsy.

Mapping and evaluation of physical activity interventions for school-aged children

OBJECTIVES

A high degree of de-regulation, organisational fragmentation and funding cuts throughout UK schools in recent years has obscured the definitive structure and effectiveness of physical activity (PA) provision offered to children. This pilot study aimed to map the current structure and context of PA provision offered to school children in Southampton, and its alignment with existing empirical evidence about the likely effectiveness of such interventions.

STUDY DESIGN

Utilising a qualitative approach, the study focused upon school-based PA provision, since this setting was conjectured to show greater diversity when compared to settings outside of school, lending itself to further interventions than non-school PA provision.

METHODS

Interventions offered across nine schools (three junior, two primary, four secondary) were investigated and mapped through semi-structured interviews. Findings were benchmarked against other cities similar to Southampton in indices of multiple deprivation status via interviews with city council workers.

RESULTS

Interviews highlighted only three formal PA specific interventions currently operating, and a hand full of informal interventions. Limited PA provision was attributed to a lack of time, money, and priority devoted towards PA within schools. Considerable disparity exists between the high prevalence of sport-oriented provision compared with the low prevalence of PA specific provision. Interviews with Portsmouth and Bristol city councils suggest that such findings may not be unique to Southampton.

CONCLUSIONS

In contrast to the extensive literature base detailing numerous PA interventions in school-aged children, our data suggest that a very small amount of such knowledge appears to translate into PA provision offered in Southampton schools. Our data highlight a significant discrepancy between sport and PA provision across schools. It is possible that the inability to successfully differentiate between sport and PA may present a further obstacle to the successful uptake of PA in the future. An extension of the PA mapping carried out, both countywide and nationally, provides a possible avenue for future research to confirm or contrast these initial insights.

Component reductions in oxygen delivery generate variable haemodynamic and stress hormone responses

BACKGROUND

In clinical practice, global oxygen delivery (DO2) is often considered as a whole; however pathological and adaptive responses after a decrease in individual constituents of the DO2 equation (cardiac output, haemoglobin, oxyhaemoglobin saturation) are likely to be diverse. We hypothesized that an equivalent decrease in DO2 after reductions in each separate component of the equation would result in different haemodynamic, tissue oxygenation, and stress hormonal responses.

METHODS

Anaesthetized, fluid-resuscitated male Wistar rats were subjected to circulatory, anaemic, or hypoxic hypoxia (by haemorrhage, isovolaemic haemodilution, and breathing a hypoxic gas mix, respectively), produced either rapidly over 5 min or graded over 30 min, to a targeted 50% decrease in global oxygen delivery. Sham-operated animals acted as controls. Measurements were made of haemodynamics, skeletal muscle tissue oxygen tension, blood gas analysis, and circulating stress hormone levels.

RESULTS

Whereas haemorrhage generated the largest decrease in cardiac output, and the greatest stress hormone response, haemodilution had the most marked effect on arterial pressure. In contrast, rapid hypoxaemia produced a minor impact on global haemodynamics yet induced the greatest decrease in regional oxygenation. A greater degree of hyperlactataemia was observed with graded insults compared with those administered rapidly.

CONCLUSIONS

Decreasing global oxygen delivery, achieved by targeted reductions in its separate components, induces varying circulatory, tissue oxygen tension, and stress hormone responses. We conclude that not all oxygen delivery is the same; this disparity should be emphasized in classical teaching and re-evaluated in patient management.

Evidence-based guideline recommendations on the use of positron emission tomography imaging in head and neck cancer

AIMS

To provide evidence-based practice guideline recommendations on the use of fluoro-2-deoxy-D-glucose positron emission tomography (PET) for diagnosis, staging and assessing treatment response, restaging or recurrence of head and neck cancer.

MATERIALS AND METHODS

A systematic review by Facey et al. (Health Technology Assessment 2007;11(44):iii-iv, xi-267) was used as the evidence base for recommendation development. As the review was limited to August 2005, the evidence base was updated to July 2011 using the same search strategies for MEDLINE and EMBASE used in the original review. The authors of the current systematic review drafted recommendations, which were reviewed, adapted and accepted by consensus by the Ontario provincial Head and Neck Disease Site Group and a special meeting of clinical experts.

RESULTS

The results of the Facey et al. review for head and neck cancer included five other systematic reviews and 31 primary studies. The 2005 to 2011 update search included four additional systematic reviews and 53 primary studies. Recommendations were developed based on this evidence and accepted by consensus.

CONCLUSIONS

PET is recommended in the M and bilateral nodal staging of all patients with head and neck squamous cell carcinoma where conventional imaging is equivocal, or where treatment may be significantly modified. PET is recommended in all patients after conventional imaging and in addition to, or prior to, diagnostic panendoscopy where the primary site is unknown. PET is recommended for the staging and assessment of recurrence of patients with nasopharyngeal carcinoma if conventional imaging is equivocal. PET is recommended for restaging patients who are being considered for major salvage treatment, including neck dissection.