Effects of adaptive duration to salinity in drinking water on behavior, weight gain and blood biochemical parameters in growing goats

This experiment aimed to determine the effect of adaptive duration to saline water on behaviors, weight gain and blood biochemical parameters in growing goats. The experiment was arranged in a completely randomized design, which included four treatments with five animals per group. The goats were administered either fresh water (control) or seawater with a salinity of 1.5%, with varying durations of adaptation to seawater. The adaptive durations included an abrupt change (A0) from fresh water to seawater with a salinity of 1.5% or stepwise adaptation either 4 (A4) or 7 (A7) days of increasing saline concentrations. The results showed that dry matter intake in the non-adapted goats (A0 group) was lower than that of the control group or the adapted goats throughout the experiment (p<0.05). In contrast, water intake from drinking saline water was greater than that in the control group (p<0.05). Body weigh did not differ among the treatments; however, non-adapted goats exhibited a lower weight gain than the adapted goats (p<0.05). The goats in the A0 and A4 groups exhibited increased plasma levels of urea, AST, and ALT compared with the control and A7 groups. However, blood electrolyte levels remained unchanged and were within the normal range for goats. Therefore, it is concluded that the stepwise adaptation to seawater with a salinity of 1.5% for 21 days has no influence on productivity and health status of goats.

Outcomes and Costs of the Transition From a Paper-Based Immunization System to a Digital Immunization System in Vietnam: Mixed Methods Study

BACKGROUND

The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits.

OBJECTIVE

This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system.

METHODS

This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective.

RESULTS

NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8% (202/580) in Hanoi and 29.4% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS.

CONCLUSIONS

The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs.

Prevalence and patterns of comorbidities in older people with type 2 diabetes in Australian primary care settings

OBJECTIVE

The aim of this study was to identify the prevalence and patterns of comorbidity in community-dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia.

METHODS

This study involved a cross-sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub-study data. In a series of sub-studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper-based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns.

RESULTS

Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6-70.0), followed by arthritis 52% (95% CI: 48.8-54.8), hyperlipidaemia 45% (95% CI: 41.8-47.9), ischemic heart disease, 23% (95% CI: 20.7-24.9), depression 16% (95% CI: 48.8-54.8), atrial fibrillation 10% (95% CI: 8.9-11.6), congestive heart failure 7% (95% CI: 6.0-8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4-8.2) and peripheral vascular disease 5% (95% CI: 4.4-6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure.

CONCLUSIONS

The prevalence of cardiovascular and non-cardiovascular comorbidities in community-dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long-term care for this population.

Current and Future States of Natural Killer Cell-Based Immunotherapy in Hepatocellular Carcinoma

Natural killer (NK) cells are innate lymphoid cells that exhibit high levels of cytotoxicity against NK-specific targets. NK cells also produce various cytokines, and interact with T cells, B cells, and dendritic cells to effectively serve as frontliners of the innate immune system. Produce various cytokines, and interact with T cells, B cells, and dendritic cells to effectively serve as frontliners of the innate immune system. Moreover, NK cells constitute the second most common immune cell in the liver. These properties have drawn significant attention towards leveraging NK cells in treating liver cancer, especially hepatocellular carcinoma (HCC), which accounts for 75% of all primary liver cancer and is the fourth leading cause of cancer-related death worldwide. Notable anti-cancer functions of NK cells against HCC include activating antibody-dependent cell cytotoxicity (ADCC), facilitating Gasdermin E-mediated pyroptosis of HCC cells, and initiating an antitumor response via the cGAS-STING signaling pathway. In this review, we describe how these mechanisms work in the context of HCC. We will then discuss the existing preclinical and clinical studies that leverage NK cell activity to create single and combined immunotherapies.

Surveying Nutrient Assessment with Photographs of Meals (SNAPMe): A Benchmark Dataset of Food Photos for Dietary Assessment

Photo-based dietary assessment is becoming more feasible as artificial intelligence methods improve. However, advancement of these methods for dietary assessment in research settings has been hindered by the lack of an appropriate dataset against which to benchmark algorithm performance. We conducted the Surveying Nutrient Assessment with Photographs of Meals (SNAPMe) study (ClinicalTrials ID: NCT05008653) to pair meal photographs with traditional food records. Participants were recruited nationally, and 110 enrollment meetings were completed via web-based video conferencing. Participants uploaded and annotated their meal photos using a mobile phone app called Bitesnap and completed food records using the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24®) version 2020. Participants included photos before and after eating non-packaged and multi-serving packaged meals, as well as photos of the front and ingredient labels for single-serving packaged foods. The SNAPMe Database (DB) contains 3311 unique food photos linked with 275 ASA24 food records from 95 participants who photographed all foods consumed and recorded food records in parallel for up to 3 study days each. The use of the SNAPMe DB to evaluate ingredient prediction demonstrated that the publicly available algorithms FB Inverse Cooking and Im2Recipe performed poorly, especially for single-ingredient foods and beverages. Correlations between nutrient estimates common to the Bitesnap and ASA24 dietary assessment tools indicated a range in predictive capacity across nutrients (cholesterol, adjusted R2 = 0.85, p < 0.0001; food folate, adjusted R2 = 0.21, p < 0.05). SNAPMe DB is a publicly available benchmark for photo-based dietary assessment in nutrition research. Its demonstrated utility suggested areas of needed improvement, especially the prediction of single-ingredient foods and beverages.

Links Between Childhood Abuse, Insidious Trauma, and Methamphetamine Use Across the Lifespan Among Gay, Bisexual, and Other Men Who Have Sex with Men: A Qualitative Analysis

Developmental and lifespan examinations of methamphetamine use among gay, bisexual, and other men who have sex with men (GBM) remain limited. We used a feminist trauma framework to examine potential links between childhood trauma, trauma-related stressors, and methamphetamine use among GBM. From June 2018 to October 2018, semi-structured interviews (N = 33) were conducted with GBM across British Columbia. Interviews focused on sexual experiences, support services, and methamphetamine use. Using thematic analysis, two overarching trauma-related themes were identified: developmental and insidious trauma and coping with trauma-related stressors. GBM's methamphetamine use co-occurred with childhood experiences of family- and peer-perpetrated heterosexism, childhood sexual abuse, and intersecting forms of oppression/marginalization. These experiences manifested as internalized shame, interpersonal anxiety, and low self-esteem. In adulthood, participants reported difficulty managing emotions, low self-confidence, and loneliness. GBM reported using methamphetamine to manage negative emotions, life stressors, and overcome barriers to interpersonal connection. Findings indicate a need for trauma-informed interventions that address underlying issues and help GBM cultivate supportive relationships.

An ethics framework for social listening and infodemic management

Issue

Successful response to an infodemic requires social listening and integrated analysis to produce infodemic insights by identifying questions, concerns, information voids and circulating narratives including health misinformation. There is currently a wide variation in social listening and infodemic insights generation practices, and a lack of frameworks to be applied on ethical values and standards.

Description of the problem

In the context of infodemic management, infodemic insights are generated based on social listening, health system and data from online and offline sources. Where there is a difference between health guidance and behaviors during an emergency, rapid infodemic insights can help understand the underlying drivers of this divergence. Integrated analysis of this data informs infodemic management strategies generate insights that advise a wide range of public health interventions. Present ethical challenges influence data processing and use.

Results

The World Health Organization (WHO) convened a group of experts to develop an ethical framework for social listening and infodemic management. It will guide health authorities and practitioners in planning and setting up infodemic insights teams and implementing infodemic management activities. To support the deliberation of the WHO expert group, a systematic review has been conducted to understand present ethical concerns and challenges.

Lessons

Infodemic management strategies raise ethical concerns that relate to data control, commercialization, transparency, accountability and implications. Power and power imbalances, human rights, privacy and dignity, trust and respect for cultural practices may arise during data collection, analysis, interpretation, and intervention design. Without proper ethical oversight and guidance, the implementation of infodemic management strategies could harm individuals and communities, erode trust, and undermine the effectiveness of responses to a public health emergency.

Key messages

• Social listening and infodemic management by health authorities require consideration of ethical principles and guidance.

• WHO ethics guidance will help public health authorities establish infodemic management practices, policies and strategies.

Interleukin-6 Drives Mitochondrial Dysregulation and Accelerates Physical Decline: Insights From an Inducible Humanized IL-6 Knock-In Mouse Model

Chronic activation of inflammatory pathways (CI) and mitochondrial dysfunction are independently linked to age-related functional decline and early mortality. Interleukin 6 (IL-6) is among the most consistently elevated chronic activation of inflammatory pathways markers, but whether IL-6 plays a causative role in this mitochondrial dysfunction and physical deterioration remains unclear. To characterize the role of IL-6 in age-related mitochondrial dysregulation and physical decline, we have developed an inducible human IL-6 (hIL-6) knock-in mouse (TetO-hIL-6mitoQC) that also contains a mitochondrial-quality control reporter. Six weeks of hIL-6 induction resulted in upregulation of proinflammatory markers, cell proliferation and metabolic pathways, and dysregulated energy utilization. Decreased grip strength, increased falls off the treadmill, and increased frailty index were also observed. Further characterization of skeletal muscles postinduction revealed an increase in mitophagy, downregulation of mitochondrial biogenesis genes, and an overall decrease in total mitochondrial numbers. This study highlights the contribution of IL-6 to mitochondrial dysregulation and supports a causal role of hIL-6 in physical decline and frailty.

Spatially Resolved Whole Transcriptome Analysis of Histologically-Characterized Tissue Microarray of Patient-Matched Primary and Recurrent Glioblastomas to Identify Underlying Mechanisms of Treatment Resistance

PURPOSE/OBJECTIVE(S)

Glioblastoma multiforme (GBM) is a lethal CNS malignancy. Radiation therapy increases overall survival, but tumors often recur in high-radiation dose regions. Additionally, recent investigations have underscored the importance of intra-tumoral heterogeneity as a driver of GBM biology. The purpose of this investigation is to characterize transcriptome differences in primary and recurrent GBM patient clinical samples using a digital spatial profiling approach to better appreciate treatment resistance mechanisms.

MATERIALS/METHODS

To address the lack of understanding of molecular mechanisms of resistance in GBM, patient-matched primary and recurrent GBM pathological specimens were identified within the brain tissue biorepository and tissue cores were selected for generation of a tissue microarray (TMA). Hematoxylin and eosin staining with histomorphological (cellular tumor, pseudopalisading necrosis, invasive edge, and perivascular inflammation) scoring were performed in a blinded fashion for every core. This array was then molecularly characterized using digital spatial profiling of the transcriptome. Quality assurance including filtering of lowly expressed genes followed by downstream analyses of the data were performed using the manufacturer's recommended methods within their Bioconductor library. Gene Set Enrichment Analysis (GSEA) was then performed on the ranked gene lists.

RESULTS

After recommended filtering, 6171 genes and 248 regions of interest remained for downstream analysis representing 22 unique patients across four different tumor histomorphological types. Significance testing revealed 679 genes that were differentially expressed between primary and recurrent tumor samples (at FDR<1%). On GSEA analysis, the chromosomal positional locus that contains genes most strongly up-regulated is 12q14, a locus that was previously identified as genomically amplified in multiple patient-derived xenograft lines after radiation selection. Additionally, recurrent tumors display a transcriptional profile more similar to the mesenchymal subtype, whereas primary tumors have a more classical transcriptional phenotype. The epithelial-to-mesenchymal transition pathway is particularly strongly up-regulated in recurrent tumors.

CONCLUSION

Recurrent selection at previously identified genomic loci and molecular pathways underscores a possible conserved set of pathways for treatment resistance. This analysis has yielded a set of gene and molecular pathways that will guide future work in our lab targeting treatment resistance using novel therapeutics and radiation techniques in GBM. Future directions include assessing the feasibility of mapping these clinical samples onto our previously generated panel of comprehensively characterized patient-derived xenograft lines.

The Impact of TP53 Mutations and Use of the TP53-Mutation-Reactivating Agent APR-246 on Metastatic Castrate-Sensitive Prostate Cancer

PURPOSE/OBJECTIVE(S)

TP53 mutations appear to be enriched over the spectrum of metastatic castration-sensitive prostate cancer (mCSPC) and are associated with worse survival outcomes. We chose to further explore the impact of dominant negative (DN) TP53 mutations on mCSPC progression and pro-metastatic behaviors in addition to studying the ability of APR-246, a small molecule targeting TP53 mutants, to blunt pro-metastatic behaviors.

MATERIALS/METHODS

We retrospectively analyzed 531 mCSPC patients who underwent next-generation sequencing. Patients were stratified by metastasis timing (synchronous if metastasis present at diagnosis or metachronous if arising after definitive treatment of localized disease) and the number of metastatic lesions (oligometastatic ≤5 or polymetastatic >5 lesions). Tumors were classified based on TP53 mutation status (missense, truncating, or wild-type [WT]) and dominant negativity, which was defined as the production of a mutant protein that reduces the residual WT protein's transcriptional activity according to the World Health Organization TP53 database. Clinical outcomes were radiographic progression-free survival (rPFS) and overall survival (OS), evaluated with Kaplan-Meier and multivariable Cox regression. To verify the impact of TP53 mutation on metastasis, we created isogenic 22Rv1 prostate cancer cell lines that carried either TP53 WT or TP53 R175H and tested this mutation for migration, invasion, and anchorage-independent growth. APR-246 (25-80 µM) was tested for anti-metastatic properties in vitro and anti-tumor growth in 22Rv1 xenografted nude mice.

RESULTS

In our cohort, 155 (29.2%) had a TP53 mutation, which mostly occurred in the DNA-binding domain (85.16%). DN TP53 mutations were associated with more aggressive disease states: DN TP53 mutations were enriched in patients with synchronous (vs. metachronous: 20.7% vs. 6.3%, p < 0.01) and polymetastatic disease (vs. oligometastatic: 14.4% vs. 7.9%, p < 0.01). On multivariable analysis, DN TP53 mutations were correlated with shorter rPFS (HR = 1.97, 95% CI: 1.31-2.98, p < 0.01) and OS (HR = 2.05, 95% CI: 1.14-3.68, p = 0.02) compared to those with TP53 WT. In vitro, 22Rv1 cells with DN TP53 R175H mutation had increased abilities to migrate, invade, and form colonies compared to TP53 WT. APR-246 treatment of TP53 R175H mutants blunted the pro-metastatic effects of the cell line in vitro (p < 0.01 for all assays by unpaired t-test). Interestingly, APR-246 also inhibited xenograft tumor growth of 22Rv1 TP53 R175H mutants (p < 0.0001 by two-way ANOVA).

CONCLUSION

DN TP53 mutations were associated with poorer survival outcomes for mCSPC patients. DN TP53 mutations also promoted prostate cancer pro-metastatic behaviors in vitro, which was effectively counteracted by APR-246, making it a promising treatment option that should be explored further in early-phase clinical studies.

All that Glitters is Not Gold: Examining Cost Effectiveness Analyses in Radiation Oncology

PURPOSE/OBJECTIVE(S)

Cost effectiveness analyses (CEA) provide data for health policy decisions in resource constrained environments. These are important in Radiation Oncology as infrastructure and delivery costs increase and indications expand. The purpose of this study was to systematically review methodologic quality and trends in CEAs involving radiotherapy (RT).

MATERIALS/METHODS

A systematic review was performed on cost effectiveness/utility studies involving RT, querying PubMed and Embase from inception to September 2020. Non-English, reviews, abstracts and cost-only studies were excluded. Independent reviewers screened and abstracted study demographics, economic parameters and methodological details.

RESULTS

After screening 1652 abstracts, 214 met criteria. The first publication was in 1995, and more than half (n = 113, 53%) were published after 2014. Author institutions were from North America (n = 128, 60%), Europe (n = 49, 23%) and Asia (n = 30, 14%) with most reporting in US$ (n = 143, 67%). A majority utilized a decision model (n = 164, 77%), healthcare payer perspective (n = 171, 80%) and a finite time horizon (n = 108, 50%). Publications spanned 96 unique journals, most commonly International Journal of Radiation and Oncological Biology and Physics (n = 35, 16%). Treatment intent was curative in 171 studies. Disease sites included breast (n = 34, 16%), genitourinary (n = 31, 14%), and gastrointestinal (n = 31, 14%). RT was mostly used as primary treatment (n = 144, 67%), followed by adjuvant (n = 70, 33%) and neoadjuvant (n = 10, 5%). Emerging topics included stereotactic RT (n = 45, 21%), immunotherapy (n = 6, 3%), oligometastasis (n = 4, 2%), and heavy particles (n = 23, 11%). RT was compared to other RT (n = 136, 64%), surgery (n = 43, 20%), drugs (n = 14, 7%) and observation (n = 31, 17%). Incomplete reporting was common. Missing elements included analysis perspective (n = 13, 6%), time horizon (n = 38, 18%), discounting of utilities (n = 71, 33%) or costs (n = 54, 25%), and willingness-to-pay threshold (n = 59, 28%). Furthermore, 27 studies did not perform sensitivity analyses, 36 did not evaluate incremental cost-effectiveness ratio and only 60 explicitly utilized recognized reporting guidelines. Conflict of interest statements were found in 63%, with sponsor statements in 59%; 25% were industry sponsors. Outcome parameters were obtained from primary (author institution/trial data) sources in 33%, including randomized trials (RCTs) (n = 20, 9%), retrospective data (n = 20, 9%) and population data (n = 9, 4%). The remainder utilized secondary sources including RCTs (n = 71, 33%), retrospective data (n = 35, 16%) or meta-analyses (n = 11, 5%). Outcomes included quality adjusted life years (n = 158, 74%), life-years (n = 30, 14%) or toxicity (n = 26,12%). 31% utilized author generated utilities; of literature derived only 49% were matched to disease and clinical context.

CONCLUSION

While CEAs are increasingly common in RT, reporting and methodologic rigor must improve. Greater use of published guidelines will improve data quality for decision makers.

Continuing Professional Development for Radiation Oncologists: Where are the Gaps and Barriers?

PURPOSE/OBJECTIVE(S)

Continuing professional development (CPD) involves continuing medical education (CME), as well as educational activities to enhance research, teaching and leadership skills. Although CPD has been well explored in other specialties, the literature pertaining to radiation oncology is lacking. We sought to evaluate current CPD practices of radiation oncologists (RO) and identify unmet needs and barriers.

MATERIALS/METHODS

An online survey on CPD was developed in English and French, approved by ethics board, and emailed to all RO departments across Canada. Respondents' current practices, preferences, barriers, and needs were explored across the CPD domains of CME, research, teaching and administrative skills.

RESULTS

One-hundred twenty-four radiation oncologists completed the survey with representation across all listed disease sites and provinces. Respondents had an average 13.6 years of experience as staff (6 months to 38 years) and 96% were affiliated with a university. ROs indicated the most helpful resources for CME were reading journal articles (27%), attending tumor boards (25%), conferences (19%), informal discussion with colleagues (11%), free online websites (e.g., NCCN) (4%) and Twitter (3.5%). Lack of time was unanimously regarded as a barrier for CME. Other barriers included growing clinical workloads, expanding literature, and a lack of renumeration for CME. The mean score was 3.5/5, between "neutral" and "satisfied" for "satisfaction that CME needs are met" on a 5-point Likert scale. Seventy-six percent of respondents are currently engaged in research, with 46% involved as a research supervisor. However, only 35% had protected time for research (ranging from 10-80% FTE). Time (89%), funding (63%) and human resources (63%) were cited as barriers. Respondents wanted to improve skills in statistical analysis, clinical trial design and grant writing. Most researchers (78%) were comfortable with quantitative methodologies. Conversely, only 35% were comfortable with qualitative methods. Nearly all respondents (98%) were involved with clinical teaching. While the majority of respondents were satisfied with their teaching ability, many wanted to improve skills in coaching, providing feedback and delivering lectures. The preferred learning formats for improving these skills were either workshops at conferences or online. Half of the respondents are currently in an administrative/leadership role, and of those that are not, only 30% were interested in pursuing future leadership positions. The main barriers cited were time and the experience required.

CONCLUSION

Overall satisfaction scores for current CME practices were mediocre amongst Canadian radiation oncologists - a group that is mostly in university-affiliated/academic practices with 98% involved in clinical teaching. There are notable barriers and unmet needs in research, teaching and administration - highlighting potential areas for future CPD initiatives in radiation oncology.

Open Versus Laparoscopic Right Hepatectomy for Hepatocellular Carcinoma Following Sequential TACE-PVE: A Multicentric Comparative Study

BACKGROUND

Right hepatectomy (RH) for hepatocellular carcinoma (HCC) is ideally preceded by transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE). Laparoscopic approach improves short-term outcome and textbook outcome (TO), which reflects the "ideal" surgical outcome, after RH. However, laparoscopic RH on an underlying diseased liver and after TACE/PVE remains a challenging procedure. The aim of this study was to compare the outcomes in patients who underwent laparoscopic liver resection (LLR) or open liver resection (OLR) following TACE/PVE.

PATIENTS AND METHODS

All patients with HCC who underwent RH after TACE/PVE in five French centers were retrospectively included. Outcomes were compared between the LLR group and the OLR group using propensity score matching (PSM). Quality of surgical care was defined by TO.

RESULTS

Between 2005 and 2019, 117 patients were included (41 in LLR group, 76 in OLR group). Overall morbidity was comparable (51% versus 53%, p = 0.24). In LLR group, TO was completed in 66% versus 37% in OLR group (p = 0.02). LLR and absence of clamping were the only factors associated with TO completion [hazard ratio (HR) 4.27, [1.77-10.28], p = 0.001]. After PSM, 5-year overall survival (OS) and progression-free survival (PFS) were 55% in matched LLR versus 77% in matched OLR, p = 0.35, and 13% in matched LLR versus 17% in matched OLR, p = 0.97. TO completion was independently associated with a better 5-year OS (65.2% versus 42.5%, p = 0.007).

CONCLUSION

Major LLR after TACE/PVE should be considered as a valuable option in expert centers to increase the chance of TO, the latter being associated with a better 5-year OS.

Echo intensity and gray-level co-occurrence matrix analysis of soft tissue grafting biomaterials and dental implants: an in vitro ultrasonographic pilot study

OBJECTIVE

To characterize different allogeneic and xenogeneic soft tissue graft substitutes and to assess their echo intensity and grayscale texture-related outcomes by using high-frequency ultrasonography (HFUS).

METHODS

Ten samples from each of the following biomaterials were scanned using HFUS: bilayered collagen matrix (CM), cross-linked collagen matrix (CCM), multilayered cross-linked collagen matrix (MCCM), human-derived acellular dermal matrix (HADM), porcine-derived acellular dermal matrix (PADM), collagen tape dressing (C) and dental implants (IMPs). The obtained images were then imported in a commercially available software for grayscale analysis. First-order grayscale outcomes included mean echo intensity (EI), standard deviation, skewness, and kurtosis, while second-order grayscale outcomes comprised entropy, contrast, correlation, energy and homogeneity derive from the gray-level co-occurrence matrix analysis. Descriptive statistics were performed for visualization of results, and one-way analysis of variance with Bonferroni post-hoc tests were performed to relative assessments of the biomaterials.

RESULTS

The statistical analysis revealed a statistically significant difference among the groups for EI (p < .001), with the group C showing the lowest EI, and the IMP group presenting with the greatest EI values. All groups showed significantly higher EI when compared with C (p < .001). No significant differences were observed for energy, and correlation, while a statistically significant difference among the groups was found in terms of entropy (p < 0.01), contrast (p < .001) and homogeneity (p < .001). IMP exhibited the highest contrast, that was significantly higher than C, HADM, PADM, CCM and CM.

CONCLUSIONS

HFUS grayscale analysis can be applied to characterize the structure of different biomaterials and holds potential for translation to in-vivo assessment following soft tissue grafting-related procedures.

Utilizing Low-Cost Sensors to Monitor Indoor Air Quality in Mongolian Gers

Air quality has important climate and health effects. There is a need, therefore, to monitor air quality both indoors and outdoors. Methods of measuring air quality should be cost-effective if they are to be used widely, and one such method is low-cost sensors (LCS). This study reports on the use of LCSs in Ulaanbataar, Mongolia to measure PM2.5 concentrations inside yurts or "gers". Some of these gers were part of a non-government agency (NGO) initiative to improve insulating properties of these housing structures. The goal of the NGO was to decrease particulate emissions inside the gers; a secondary result was to lower the use of coal and other biomass material. LCSs were installed in gers heated primarily by coal, and interior air quality was measured. Gers that were modified by increasing their insulating capacities showed a 17.5% reduction in PM2.5 concentrations, but this is still higher than recommended by health organizations. Gers that were insulated and used a combination of both coal and electricity showed a 19.1% reduction in PM2.5 concentrations. Insulated gers that used electricity for both heating and cooking showed a 48% reduction in PM2.5 but still had higher concentrations of PM2.5 that were 6.4 times higher than recommended by the World Health Organization (WHO). Nighttime and daytime trends followed similar patterns and trends in PM2.5 concentrations with slight variations. It was found that at nighttime the outside PM2.5 concentrations were generally higher than the inside concentrations of the gers in this study, meaning that PM2.5 would flow into the ger whenever the doors were opened, causing spikes in PM2.5 concentrations.

Associations between canine hookworm infection and dog owners' awareness, perception, and behaviour: A cross-sectional study in Brisbane, Queensland, 2019-2020

Canine hookworms are found globally, and infections have been recorded in domestic dogs visiting dog parks in Queensland, Australia. Some canine hookworms also present a risk of zoonotic transmission to humans. Potential transmission of hookworms can occur in the household and at public places because of lack of owner awareness and poor coverage of canine deworming. Between April 2019 and March 2020, faecal samples from owned dogs were collected from 39 dog parks in metropolitan Brisbane, Queensland, and tested for the presence of hookworm eggs using faecal floatation technique. Dog owners who provided samples were requested to complete a survey on their awareness, perceptions and behaviour regarding the risks and consequences of canine parasitic infection. Associations between dog owner demographics and responses to the survey were measured using Goodman and Kruskal's gamma. Statistical associations between canine hookworm infection in dogs and their owner's responses were quantified using a two-sample Wilcoxon rank-sum test. A total of five canine faecal samples from 175 respondents were found positive for hookworm eggs, corresponding to a sample- and park-level prevalence of 2.86% and 12.82%, respectively. Female dog owners were found to be more aware of the importance of regular deworming of their dogs (|γ| = 0.405). Our results indicate that hookworm infection was associated with a lower awareness of the importance of deworming (p = 0.007), less diligence in administration of deworming (p = 0.004), lower awareness of the risk of acquiring parasites from raw meat (p = 0.010), less likelihood of cooking meat before feeding it to their dogs (p = 0.028), and less likelihood to properly dispose their dog's faeces (p = 0.027). This study not only indicates a need for improving owner education towards the importance of deworming but also a need for changing owner's behaviours to reduce potential environmental contamination with infective hookworms. The latter in particular indicates a broader public health risk of disease transmission in public places due to improper disposal of dog faeces, especially in areas with higher canine hookworm infections.

Hypertension therapy using fixed-dose polypills that contain at least three medications

Fixed-dose combination (FDC) therapy may provide a solution to treatment gaps by overcoming reasons for therapeutic inertia. To synthesise and report on available evidence on standard or low-dose combination medicines that combine at least three antihypertensive medicines. A literature search was conducted via Scopus, Embase, PubMed and the Cochrane clinical trials database. Studies were eligible for inclusion if they were randomised clinical trials that included adults (>18 years) and examined the impact of at least three antihypertensive medications on blood pressure (BP). A total of 18 trials (n=14 307) were identified that examined combinations of three or four antihypertensive medicines. Ten trials investigated the effect of a standard dose triple combination polypill, four the effect of a low-dose triple and four the effect of a low-dose quadruple combination polypill. The mean difference (MD) in systolic BP ranged from -10.6 to -41.4 for the standard dose triple combination polypill in comparison with 2.1 to -34.5 for dual combination; -9.8 to -20.6 for a low-dose combination polypill in comparison with a MD of -0.9 to -5.2 for placebo; -9.0 to -29.3 for a low-dose combination polypill compared with -2.0 to -20.6 for monotherapy or usual care. All trials reported similar rates of adverse events. Ten studies reported medication adherence, six reported >95% adherence. Triple and quadruple combination antihypertensive medications are effective. Studies of low-dose triple and quadruple combinations involving treatment naïve populations suggest initiating such combinations are safe and effective as first-line therapy for stage 2 hypertension (BP >140/90 mm Hg).

Comparing secondary prevention for patients with coronary heart disease and stroke attending Australian general practices: a cross-sectional study using nationwide electronic database

OBJECTIVES

To compare secondary prevention care for patients with coronary heart disease (CHD) and stroke, exploring particularly the influences due to frequency and regularity of primary care visits.

SETTING

Secondary prevention for patients (≥18 years) in the National Prescription Service administrative electronic health record database collated from 458 Australian general practice sites across all states and territories.

DESIGN

Retrospective cross-sectional and panel study. Patient and care-level characteristics were compared for differing CHD/stroke diagnoses. Associations between the type of cardiovascular diagnosis and medication prescription as well as risk factor assessment were examined using multivariable logistic regression.

PARTICIPANTS

Patients with three or more general practice encounters within 2 years of their latest visit during 2016-2020.

OUTCOME MEASURES

Proportions and odds ratios (ORs) for (1) prescription of antihypertensives, antilipidaemics and antiplatelets and (2) assessment of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) in patients with stroke only compared against those with CHD only and those with both conditions.

RESULTS

There were 111 892 patients with CHD only, 27 863 with stroke only and 9791 with both conditions. Relative to patients with CHD, patients with stroke were underprescribed antihypertensives (70.8% vs 82.8%), antilipidaemics (63.1% vs 78.7%) and antiplatelets (42.2% vs 45.7%). With sociodemographic factors, comorbidities and level of care considered as covariates, the odds of non-prescription of any recommended secondary prevention medications were higher in patients with stroke only (adjusted OR 1.37; 95% CI (1.31, 1.44)) compared with patients with CHD only. Patients with stroke only were also more likely to have neither BP nor LDL-C monitored (adjusted OR 1.26; 95% CI (1.18, 1.34)). Frequent and regular general practitioner encounters were independently associated with the prescription of secondary prevention medications (p<0.001).

CONCLUSIONS

Secondary prevention management is suboptimal in cardiovascular disease patients and worse post-stroke compared with post-CHD. More frequent and regular primary care encounters were associated with improved secondary prevention.

Associations between KIR/KIR-ligand genotypes and clinical outcome for patients with advanced solid tumors receiving BEMPEG plus nivolumab combination therapy in the PIVOT-02 trial

Bempegaldesleukin (BEMPEG), a CD122-preferential IL2 pathway agonist, has been shown to induce proliferation and activation of NK cells. NK activation is dependent on the balance of inhibitory and excitatory signals transmitted by NK receptors, including Fc-gamma receptors (FCγRs) and killer immunoglobulin-like receptors (KIRs) along with their KIR-ligands. The repertoire of KIRs/KIR-ligands an individual inherits and the single-nucleotide polymorphisms (SNPs) of FCγRs can influence NK function and affect responses to immunotherapies. In this retrospective analysis of the single-arm PIVOT-02 trial, 200 patients with advanced solid tumors were genotyped for KIR/KIR-ligand gene status and FCγR SNP status and evaluated for associations with clinical outcome. Patients with inhibitory KIR2DL2 and its ligand (HLA-C1) observed significantly greater tumor shrinkage (TS, median change -13.0 vs. 0%) and increased PFS (5.5 vs. 3.3 months) and a trend toward improved OR (31.2 vs. 19.5%) compared to patients with the complementary genotype. Furthermore, patients with KIR2DL2 and its ligand together with inhibitory KIR3DL1 and its ligand (HLA-Bw4) had improved OR (36.5 vs. 19.6%), greater TS (median change -16.1 vs. 0%), and a trend toward prolonged PFS (8.4 vs. 3.6 months) as compared to patients with the complementary genotype. FCγR polymorphisms did not influence OR/PFS/TS.These data show that clinical response to BEMPEG plus nivolumab treatment in the PIVOT-02 trial may be associated with the repertoire of KIR/KIR-ligands an individual inherits. Further investigation and validation of these results may enable KIR/KIR-ligand genotyping to be utilized prospectively for identifying patients likely to benefit from certain cancer immunotherapy regimens.

Comparative Analysis of Whole Transcriptome Profiles in Septic Cardiomyopathy: Insights from CLP- and LPS-Induced Mouse Models

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, with septic cardiomyopathy being a common and severe complication. Despite its significant clinical impact, the molecular mechanisms underlying sepsis-induced cardiomyopathy (SICM) remain incompletely understood. In this study, we performed a comparative analysis of whole transcriptome profiles using RNA sequencing in mouse hearts in two widely used mouse models of septic cardiomyopathy. CLP-induced sepsis was achieved by surgical cecal ligation and puncture, while LPS-induced sepsis was induced using a 5 mg/kg intraperitoneal (IP) injection of lipopolysaccharide (LPS). For consistency, we utilized sham-operated mice as the control for septic models. Our aim was to identify key genes and pathways involved in the development of septic cardiomyopathy and to evaluate the similarities and differences between the two models. Our findings demonstrated that both the CLP and lipopolysaccharide LPS methods could induce septic heart dysfunction within 24 h. We identified common transcriptional regulatory regions in the septic hearts of both models, such as Nfkb1, Sp1, and Jun. Moreover, differentially expressed genes (DEGs) in comparison to control were involved in shared pathways, including regulation of inflammatory response, regulation of reactive oxygen species metabolic process, and the JAK-STAT signaling pathway. However, each model presented distinctive whole transcriptome expression profiles and potentially diverse pathways contributing to sepsis-induced heart failure. This extensive comparison enhances our understanding of the molecular basis of septic cardiomyopathy, providing invaluable insights. Accordingly, our study also contributes to the pursuit of effective and personalized treatment strategies for SICM, highlighting the importance of considering the specific causative factors.

Experiences of decision making about psychotropic medication during pregnancy and breastfeeding in women living with severe mental illness: a qualitative study

PURPOSE

The aim of this study was to explore the experiences of women living with severe mental illnesses making decisions about psychotropic medication use in pregnancy and breastfeeding, and what helped or hindered the decision-making process.

METHODS

We report on a qualitative study from 12 women who attended the pregnancy service between May 2018 and June 2019. Interviews occurred at 4-6 weeks postpartum on women with severe mental illnesses, which was nested within a larger mixed-methods study.

RESULTS

Three main themes were elicited from the participants' transcriptions and included (i) the decision-making process with subthemes of shared decision-making, consistency and complete care, collaboration and clear communication, and challenges of managing medication; (ii) how information is given, with subthemes of information delivery and communication breakdown; and (iii) breastfeeding dilemmas with subthemes of lithium and breastfeeding choice and autonomy regarding breastfeeding on medication.

CONCLUSION

Findings offer understanding of patients' experiences in the decision-making and use of psychotropic medication during pregnancy and breastfeeding. Women living with severe mental illnesses, such as bipolar and psychosis, face difficult medication decisions due to uncertainty around use in pregnancy, potentially causing conflict with their dual role as both persons with a diagnosed mental illness but also new mothers. The clinician needs to provide comprehensible and concise information, giving space for a woman's voice to be heard to guide them from a position of hesitancy to one of assurance. Collaboration within a multidisciplinary team and external care providers combined with consistency of care assists this process.

A National Referral Service for Paediatric Brachytherapy: An Evolving Practice and Outcomes Over 13 Years

AIMS

Most children requiring radiotherapy receive external beam treatment and few have tumours suitable for brachytherapy. No paediatric radiotherapy centre will treat enough patients from its own normal catchment population for expertise in brachytherapy to be developed and sustained. Following discussion and agreement in the national paediatric radiotherapy group, a service for paediatric brachytherapy in the UK has been developed. We report the process that has evolved over more than 10 years, with survival and functional outcome results.

MATERIALS AND METHODS

Since 2009, potential patients have been referred to the central paediatric oncology multidisciplinary team meeting, where imaging, pathology and treatment options are discussed. Since 2013, the National Soft Tissue Sarcoma Advisory Panel has also reviewed most patients, with the principal aim of advising on the most suitable primary tumour management for complex patients. Clinical assessment and examination under anaesthetic with biopsies may be undertaken to confirm the appropriateness of brachytherapy, either alone or following conservative surgery. Fractionated high dose rate brachytherapy was delivered to a computed tomography planned volume after implantation of catheters under ultrasound imaging guidance. Since 2019, follow-up has been in a dedicated multidisciplinary clinic.

RESULTS

From 2009 to 2021 inclusive, 35 patients (16 female, 19 male, aged 8 months to 17 years 6 months) have been treated. Histology was soft-tissue sarcoma in 33 patients and carcinoma in two. The treated site was pelvic in 31 patients and head and neck in four. With a median follow-up of 5 years, the local control and overall survival rates are 100%. Complications have been few, and functional outcome is good.

CONCLUSION

Brachytherapy is effective for selected paediatric patients, resulting in excellent tumour control and good functional results. It is feasible to deliver paediatric brachytherapy at a single centre within a national referral service.

Knockout of AMD-associated gene POLDIP2 reduces mitochondrial superoxide in human retinal pigment epithelial cells

Genetic and epidemiologic studies have significantly advanced our understanding of the genetic factors contributing to age-related macular degeneration (AMD). In particular, recent expression quantitative trait loci (eQTL) studies have highlighted POLDIP2 as a significant gene that confers risk of developing AMD. However, the role of POLDIP2 in retinal cells such as retinal pigment epithelium (RPE) and how it contributes to AMD pathology are unknown. Here we report the generation of a stable human RPE cell line ARPE-19 with POLDIP2 knockout using CRISPR/Cas, providing an in vitro model to investigate the functions of POLDIP2. We conducted functional studies on the POLDIP2 knockout cell line and showed that it retained normal levels of cell proliferation, cell viability, phagocytosis and autophagy. Also, we performed RNA sequencing to profile the transcriptome of POLDIP2 knockout cells. Our results highlighted significant changes in genes involved in immune response, complement activation, oxidative damage and vascular development. We showed that loss of POLDIP2 caused a reduction in mitochondrial superoxide levels, which is consistent with the upregulation of the mitochondrial superoxide dismutase SOD2. In conclusion, this study demonstrates a novel link between POLDIP2 and SOD2 in ARPE-19, which supports a potential role of POLDIP2 in regulating oxidative stress in AMD pathology.

Evolution of Radiographic Changes of a Vascularized Pedicled Nasoseptal Flap after Endonasal Endoscopic Skull Base Surgery

BACKGROUND AND PURPOSE

There is active research involving the radiographic appearance of the skull base following reconstruction. The purpose of this study was to describe the radiographic appearance of the vascularized pedicle nasoseptal flap after endoscopic skull base surgery across time.

MATERIALS AND METHODS

We performed chart and imaging review of all patients with intraoperative nasoseptal flap placement during endoscopic skull base surgery at a tertiary academic skull base surgery program between July 2018 and March 2021. All patients underwent immediate and delayed (>3 months) postoperative MR imaging. Primary outcome variables included flap and pedicle enhancement, flap thickness, and flap adherence to the skull base.

RESULTS

Sixty-eight patients were included. Flap (P = .003) enhancement significantly increased with time. Mean nasoseptal flap thickness on immediate and delayed postoperative scans was 3.8 and 3.9 mm, respectively (P = .181). The nasoseptal flap adhered entirely to the skull base in 37 (54.4%) and 67 (98.5%) patients on immediate and delayed imaging, respectively (P < .001).

CONCLUSIONS

Our findings demonstrate heterogeneity of the nasoseptal flap appearance after skull base reconstruction. While it is important for surgeons and radiologists to evaluate variations in flap appearance, the absence of enhancement and lack of adherence to the skull base on immediate postoperative imaging do not appear to predict reconstructive success and healing, with many flaps "self-adjusting" with time.

Cardiovascular disease in older patients with end-stage renal disease and chronic dialysis in Vietnam

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with chronic kidney disease, especially end-stage renal disease, exhibit a very high cardiovascular risk. In Vietnam, chronic kidney disease and cardiovascular disease (CVD) are very common in older people. However, there is limited studies on the complexity of CVD and other geriatric syndromes in older patients with end-stage renal disease and chronic dialysis.

Purpose

In this study in older patients with end-stage renal disease and chronic dialysis, we aim to: (1) Examine the prevalence of CVD and its impact on hospitalization, and (2) Compare the burden of common geriatric syndromes in patients with and without CVD.

Methods

This is a prospective, observational, multi-centre study conducted at two dialysis units of two major hospitals in Vietnam. Consecutive patients aged 60 years or older who were diagnosed with end-stage renal disease and on chronic dialysis were recruited from November 2020 to June 2021. CVD was defined as having one of these conditions: heart failure, ischemic heart disease, and stroke. Participants were assessed for these common geriatric conditions: frailty (defined as a Clinical Frailty Scale total score ≥5), malnutrition (defined as a total score ≤7 from the Mini Nutritional Assessment Short Form), impairment in activities of daily living (defined as ADL score &lt;6), impairment in instrumental activities of daily living (defined as IADL score &lt;8), high risk of falls (assessed by the STEADI questionnaire), and polypharmacy (defined as the concurrent use of ≥5 medications). Participants were followed for 6 months after discharge. Multivariable logistic regression analysis was applied to examine the impact of CVD on 6-month hospitalization, adjusting for age, sex, and the geriatric conditions. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

There were 175 participants (mean age 72.4 ± 8.5, 58.9% female). CVD was present in 80% of the participants (ischemic heart disease: 49.7%, heart failure: 60.0%, stroke 25.7%). Participants with CVD had significantly higher prevalence of geriatric syndromes compared to those without CVD (Table 1). During 6-month follow-up, 48.6% of the participants had at least one hospitalization. In multivariable logistic regression model, the presence of CVD increased the risk of hospitalization (adjusted OR 4.70, 95%CI 1.72 – 12.85), allowing for age, sex, frailty, ADL impairment, IADL impairment, fall risk, malnutrition, polypharmacy (Table 2).

Conclusion

In this study, there was a very high prevalence of CVD in older patients with end-stage renal disease and chronic dialysis. Participants with CVD had higher burden of geriatric syndromes and their risk of 6-month hospitalization increased by approximately 5 times.

Contrast induced nephropathy in older Vietnamese patients undergoing coronary angiography and intervention

Funding Acknowledgements

Type of funding sources: None.

Background

The prevalence of coronary heart disease increases with age and older people accounted for a large proportion of patients presenting with coronary heart disease. Advancement in percutaneous coronary intervention (PCI) has contributed to reduced mortality in patients with coronary artery disease. However, coronary angiography and percutaneous intervention have also increased the risk of developing contrast induced nephropathy (CIN), especially in older patients. More than ten risk assessment tools have been developed to predict CIN. Among these, the Mehran risk score has been the most commonly used in Vietnam. In recent years, new simple risk prediction models have been proposed, including the contrast volume-to-glomerular filtration rate ratio (CV/GFR ratio). The CV/GFR ratio is calculated as the ratio of contrast medium quantity to glomerular filtration rate.

Purpose

The aim of this study was to (1) examine the incidence of CIN in a cohort of older patients undergoing coronary angiography and/or PCI at a tertiary hospital in Vietnam, (2) compare the validity of the CV/GFR ratio and the Mehran score in predicting CIN, and (3) to identify optimal cut-off points of these scales by which can help identify older patients with high risk of developing CIN in this population.

Methods

A prospective observational study was conducted in patients aged ≥ 60 years at a tertiary hospital in Vietnam from September 2019 to May 2020. CIN was defined as 25% increase in serum creatinine from baseline or 0.5mg/dL absolute increase in serum creatinine occurring within 48 hours post IV contrast administration. The CV/GFR ratio and the Mehran score were applied for predicting risk of CIN. Previous studies suggest Mehran score &gt;5 or CV/GFR ratio &gt;3.7 as a predictor of an early abnormal increase in serum creatinine after PCI. Receiver Operator Characteristic (ROC) was applied to evaluate area under the curve (AUC) of the CV/GFR ratio and Mehran score in predicting CIN, and the sensitivity, specificity for common cut-off points that were suggested in previous studies.

Results

A total of 170 participants were included in this study. They had a mean age of 70 years, 33.1% were women. The incidence of CIN was 9.4%. Participants with CIN had higher prevalence of chronic kidney disease, heart failure and anaemia at admission. The AUC of the CV/GFR ratio against CIN was 0.79 (95%CI 0.65-0.92), and of the Mehran score against CIN was 0.65 (95%CI 0.51-0.82) (Figure 1). The sensitivity and specificity for common cut-off points of the CV/GFR ratio and Mehran score are presented in Figure 2.

Conclusions

Our study found that CIN was common in older patients after PCI. Both CV/GFR ratio and Mehran score had good diagnostic value for predicting CIN in the study participants.

Magnetic-field-synchronized wireless modulation of neural activity by magnetoelectric nanoparticles

The in vitro study demonstrates wirelessly controlled modulation of neural activity using magnetoelectric nanoparticles (MENPs), synchronized to magnetic field application with a sub-25-msec temporal response. Herein, MENPs are sub-30-nm CoFe₂O₄@BaTiO₃ core-shell nanostructures. MENPs were added to E18 rat hippocampal cell cultures (0.5 μg of MENPs per 100,000 neurons) tagged with fluorescent Ca²⁺ sensitive indicator cal520. MENPs were shown to wirelessly induce calcium transients which were synchronized with application of 1200-Oe bipolar 25-msec magnetic pulses at a rate of 20 pulses/sec. The observed calcium transients were similar, in shape and magnitude, to those generated through the control electric field stimulation with a 50-μA current, and they were inhibited by the sodium channel blocker tetrodotoxin. The observed MENP-based magnetic excitation of neural activity is in agreement with the non-linear M - H hysteresis loop of the MENPs, wherein the MENPs' coercivity value sets the threshold for the externally applied magnetic field.

Evaluating the Oncology Research Internship (ORIoN) during the COVID-19 Pandemic: A Comparison of Virtual and In-Person Iterations

Purpose/Objective(s)

The Oncology Research Internship (ORIoN), a novel resident-supervised initiative for medical students (MS), was first established in 2018 and found to be mutually beneficial to both residents and MS. The COVID-19 pandemic halted many scholarly programs, including ORIoN, which relied heavily on mentorship through in-person interactions. We report results of the first virtual program, adapted to the COVID-19 pandemic, and compare participant feedback to previous in-person iterations.

Materials/Methods

ORIoN application details were published online and emailed to first- and second-year MS. A panel of 3 physicians reviewed and scored applications independently. Successful MS applicants were paired with volunteer resident supervisors; each pair supervised by a staff oncologist. Compared to previous years, all meetings, correspondences and presentations between MS, residents, and supervising oncologists were conducted exclusively remotely. Only chart reviews were conducted on-site by MS. At the program's conclusion, each MS delivered a live virtual oral presentation of their completed case report, previously done in-person. Resident and MS participants completed questionnaires pre-/post program. Responses were collected on a 5-point Likert scale with open-ended free-text responses. Survey results from this virtual and the previous in-person programs were compared.

Results

Of 54 applications (previously 32 in 2018), 9 MS (three first-year, six second-year) were accepted and assigned to 9 volunteer residents (6 radiation oncology, 2 medical oncology, 1 pathology). To date, 9 manuscripts have been completed with 2 submitted for publication (1 published, 1 under review). Survey response rates were 100% (9/9) for residents and 89% (8/9) for MS. In the post-program surveys comparing the virtual and prior in-person programs, 87.5% (7/8) MS felt comfortable completing a clinical research project (22% strongly agree (SA), 62.5% agree (A), previously 25% and 75% respectively) and 100% (8/8) felt comfortable writing a case report (50% SA, 50% A, previously 75%, 25% respectively). All MS felt comfortable giving an oral research presentation (37.5% SA, 62.5% A) and teaching another MS to complete a case report (37.5% SA, 50% A). Similar to the in-person program, MS unanimously agreed that ORIoN was a beneficial experience (100%) and felt the program contributed to their career goals (100%, previously 88%). Post-program, all residents felt comfortable as a supervisor (67% SA, 22% A, previously 33%, 67% respectively), reviewing manuscripts (56% SA, 33% A, previously 33%, 50% respectively) and providing constructive feedback to trainees (67% SA, 33% A, previously 17%, 67% respectively).

Conclusion

Compared to the previous in-person program, the virtual ORIoN retained strongly favorable ratings from MS and residents alike. These findings support adapting similar scholarly and mentorship programs to a virtual setting when in-person interactions are not feasible.

Delivering actionable infodemic insights and recommendations for the COVID-19 pandemic response

Issue

The COVID-19 pandemic and current recovery efforts have been complicated by a parallel infodemic. The infodemic has manifested itself in the rapid spread of questions, concerns and misinformation that can affect population attitudes and behavior harmful to health -promoting stigma and discrediting science, non-recommended treatments and cures, politicizing health programs and eroding trust in health workers and health systems.

Description

WHO's COVID-19 Pillar 2 (risk communication, community engagement and infodemic management) developed an integrated public health infodemic insights methodology for weekly analysis of social media, traditional media and other data sources to identify, categorize, and understand the key concerns and narratives expressed, and inform risk communication and response activities.

Results

The infodemic characterization, integrated analysis and insights generation consisted of a 3-step mixed-methods approach. First, data was collected from publicly available social and news media and categorized into categories of conversations by a COVID-19 public health taxonomy. Second, the dataset was analyzed and compared week-on-week to identify changes in narratives and conversation sentiment. Third, the digital infodemic intelligence was reviewed by a group of subject matter experts and triangulated with other data sources to derive infodemic insights and provide recommendations for action for the week. The methodology has been applied to inform COVID-19 response, COVID-19 vaccine demand promotion, and preparing for mass gatherings or mass immunization campaigns.

Lessons

The methodology for infodemic intelligence generation and integration has introduced evidence-based analytical practices for generation of infodemic insights and recommendations for action into the work of WHO. It must be further adapted for use by different health programmes and preparedness functions, and is described WHO Field Infodemiology Manual.

Key messages

• Health authorities can use infodemic insights to respond to people’s concerns, questions and information deficits in a timely and effective manner.

• An evidence-based methodology has been developed and validated to generate infodemic insights and recommendations for action during an acute health event or emergency.

The WHO initiative to measure the effectiveness and impact of PHSM – key activities in 2022

The presentation will focus on two main outcomes of the WHO initiative: a global research agenda to steer future evidence generation on PHSM, and a central monitoring system for PHSM research. In September 2021, a global technical consultation with over 60 global experts was organized to review the existing evidence on PHSM and identify the initiative's priorities. The consultation provided an opportunity to have an initial discussion on potential research priorities. This became the basis for an iterative online consultation process. The draft research agenda includes seven main research themes including effectiveness, unintended consequences, methodological challenges and implementation considerations affecting the uptake of and adherence to PHSM. Workshop participants will be invited to comment on the suggested themes and propose additional priority questions for the research agenda. The central research monitoring system will consist of a global repository of primary studies and reviews investigating the effectiveness and broader multisectoral impact of PHSM. Indexed studies will be mapped against the key themes of the research agenda, facilitating real-time monitoring and evaluation of its progress. An AI-based mechanism for automated updating of systematic reviews will complement the database. This one-stop shop will allow researchers and decision-makers worldwide to access the latest evidence on PHSM and keep track of the synthesized effectiveness and impact of different interventions and combinations. The platform will further provide a protected working interface. This monitoring system for PHSM research enables timely access to and utilization of evidence indecision-making processes during health emergencies and fosters international collaboration on the analysis and interpretation of data. Workshop participants will be invited to review the alpha version of the platform.

Infodemic management for public health practitioners: landscape analysis and practical tools

Issue

Infodemics (i.e., overflow of information in physical and digital spaces that makes it difficult for people to make good health decisions) can undermine emergency response, but capacity for infodemic management has been limited in countries thus far. Specifically, there is a need to build capacities in the field with practical and scalable tools.

Description of the problem

WHO has developed tools and trainings to quickly build and enhance infodemic management (IM) capacity at the country-level, such as tools for rapid generation of IM insights and a framework for conducting landscape analyses to establish sustainable IM capacities. These were developed in collaboration with multidisciplinary experts who provided feedback. We sought to create tools that can be a basis for introducing evidence-generation in health information systems to inform emergency preparedness and response, and mainstream methods into routine infodemic diagnostics activities.

Results

The tools and trainings provide a comprehensive framework for diagnosing and addressing infodemics, such as a public health taxonomy to guide digital intelligence analysis and integrated analysis methods for generation of actionable insights. Additionally, the landscape analysis framework outlines steps for assessing strategic needs and assets for routinizing IM functions as part of existing public health systems and programs.

Lessons

The tools and trainings will be deployed in the field to evaluate utility. Feedback from users in the global WHO infodemic manager community will be systematically captured.

Key messages

• Field responders need practical tools and trainings that guide quick infodemic response during health emergencies.

• These tools and trainings can be used to diagnose and intervene on infodemics, even in settings where infodemic insights units are not yet established.

Measuring the burden of infodemics on health outcomes through harmonized global metrics

Issue/problem

Infodemics happen when an excess of information makes it difficult for people to discern what they see and hear to make good health decisions. Several challenges limit the usefulness of applying infodemiology research to the practice of managing infodemics including inconsistency in how information exposure is measured and a lack of focus on assessing associations with health behaviors.

Description of the problem

In 2021, WHO partnered with the University of Sydney to develop a study toolkit. We sought to create novel tools for measuring information exposure that can be easily deployed, linked to surveys measuring health behaviors, and implements a standardized study protocol so that data can be directly synthesized into a global analysis of information risk factors associated with health behaviors.

Results

A web-based study platform was developed, comprising tools for capturing information exposures within studies that link to health behavior surveys. The first tool is a smartphone application that asks users to actively record relevant information they see or hear in diary. The second application is a web browser plugin that passively tracks webpages with relevant keywords. Because localized studies follow a standardized protocol and de-identified participant data are recorded in a common format, local study investigators can opt-in to contributing study data to support global surveillance efforts.

Lessons

Through standardization of measurement tools and relevant study protocols, the toolkit can be used to quickly collect and synthesize data for global or regional analysis of infodemics, including in Europe. Validation of the toolkit in the field is needed to inform its open-source release.

Key messages

• A toolkit for measuring information risk factors associated with behavioral outcomes was developed.

• Global collaboration using the toolkit can improve synthesisability of studies investigating infodemic burden of disease.

Great Safety and Efficacy of a New Drug-eluting-stent manufactured in a developing country at minimal cost: the VSTENT at 3 years follow-up

Background

In the care patients with coronary artery disease, a new drug-eluting stent, the VSTENT, covered with sirolimus was designed and manufactured in a developing country at minimal cost. Beside the clinical concern, from an engineering perspective, the questions were: Was this stent flexible? What was its radial strength? Did this stent brace itself against the wall with a strong strut network? What was the cell size and design?

Methods

From 6.2019 to 8.2020, 150 patients from 5 hospitals underwent PCI with a new VSTENT in 212 lesions. At the index PCI (D1), a subgroup of 61 patients (40%) was preselected to undergo additional imaging procedures including intravascular ultrasound (IVUS=41) or optical coherence tomography (OCT=20). All patients were followed-up clinically every month for one year. At 6 months (D180) they underwent digital subtraction angiography (DSA=143) or a second IVUS or OCT for the intravascular subgroup. The rate of invasive imaging follow-up was 95% for DSA, 92% for IVUS and 95% for OCT. The rate of major adverse cardiovascular events (MACE: mortality, in-stent restenosis (ISR), Target lesion revascularization (TLR) and data on radial strength, longitudinal flexibility, expansion and coverage were calculated.

Results

In all patients, the technical success was 100% (successful balloon inflation, complete stent expansion, uneventful balloon removal). The VSTENTs were deployed in arteries of all sizes: small with diameter (D) = 2.5mm in 11.3%, D= 2.75mm in 24.1%, and in large arteries D= or &gt;3mm in 66.6% of patients. The stent length varied from 15–38mm with 80% &gt;20mm. 92% had good apposition as evidenced by OCT or IVUS. There was no acute in-stent thrombus, no loss of side branch and no perforation. There was one cardiac arrest with successful resuscitation. The bench and angiographic data on radial strength, longitudinal flexibility, expansion and coverage were excellent

In Figure 1, The VSTENT design has open cells in the middle and closed cell at both distal segments. This design of mixed closed and open cell increases the radial strength at both ends while preventing the diametric difference (dog-boning effect)

In Figure 2, after deployment of a VSTENT, the size of the open cell design in the middle of the stent is approximately 3.40 mm2 while the size of the distal closed cells design is 1.7 mm2.

At 6 months, the rate of angiographic ISR inside the stent and within the 5 mm from the two ends was 3.5%. The rate of late lumen loss was 0.8mm in the in-stent segment and 0.07mm within 5mm of the two ends. The composite MACE was 4.7% with 1 mortality (0.7%) and 4 TLRs. At 36 months follow-up, only one TLR was reported.

Conclusions

At 3 years follow-up, the rate of angiographic ISR and TLR of the VSTENT was low. The data on radial strength, longitudinal flexibility, expansion and coverage were excellent. The VSTENT could be an affordable choice for interventional cardiology service in developing countries.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): United Healthcare

What are the ideal systolic and diastolic blood pressure which do not injure the intima of iliac and coronary arteries?

 

For patients with coronary artery disease, hypertension (HTN) is a major risk factor. How could uncontrolled HTN start atherosclerosis? In our prior research, laminar flow in coronary arteries prevented the formation of plaques while turbulent flow injured the intima and triggered atherosclerosis. In this present study our question was: Which blood pressure (BP) level is optimal in not producing turbulence and so not injuring the intima?

Methods

At first, a systolic BP&lt;120mmHg and diastolic BP&lt;75mmHg) were arbitrarily set as controlled (group A) while a BP of &gt;160/105mmHg as uncontrolled (group B). All patients underwent a dynamic coronary angiogram recorded at 15 images/second or 0.06 seconds per image. The first image was of the index artery completely filled with contrast. In subsequent images the blood in white color moved in over a background of black contrast (Figure 1A). In 1B, 0.06 seconds later, the blood arrived at the mid segment (white arrow). In 1C, the flood moved forward, however there was darker contrast hanging at the mid segment, marking the location of collision from the retrograde against the antegrade flow (white arrow). The reason was that in uncontrolled BP the contraction of the left ventricle was stronger so in systole, the coronary blood could reverse its course, run on a retrograde direction, collide against the antegrade flow and create turbulence (1C).

At the end, before deploying a vascular closure device, an iliac angiogram was performed. In Figure 2, on a black background of contrast, the blood in white color moved forward with a pointed tip of laminar flow. 0.06 seconds later, the laminar tip was stopped abruptly with all the layers recoiling on each other like a falling stack of dominoes. In the next image. a large swirl of disorganized mixing of blood and contrast suggested the presence of turbulence caused by the collision.

The data to be collected were (1) the duration of the antegrade and retrograde flow, (2) duration of the collision (turbulence at the collision site)

Results

In the group A (BP &lt;120/75 mmHg), 90% of 20 patients had no retrograde flow nor collision in the iliac and short collision in coronary arteries (&lt;0.12 secs). In 30 patients of group B (BP &gt;160/105 mmHg), the duration of retrograde flow and collision in the iliac artery were prolonged at &gt;0.24 msecs. In the coronary arteries, the duration was prolonged at 0.18 msecs (all p&lt;0.05 compared with group A). These locations of turbulence correlated with the location of plaques in our prior studies.

Conclusion

In patients with uncontrolled HTN, the retrograde flow was prolonged, and the turbulence was intense. In contrary, for patients with controlled BP, there was no retrograde flow and weaker collision in coronary arteries. The results suggest that a BP of &lt;120/75 mmHg may not trigger the atherosclerotic process. New clinical trials with larger number of patients should be performed in search for the lowest ideal blood pressure.

Funding Acknowledgement

Type of funding sources: None.

NAV3 is a genetic determinant of myocardial recovery in dilated cardiomyopathy and attenuates cardiac fibrosis

Background

A genome-wide association study (GWAS) assessing change in left ventricular ejection fraction (LVEF) in dilated cardiomyopathy (DCM), a surrogate marker of morbidity and mortality in heart failure (HF), had not been performed previously and could provide insight into novel biological pathways that could lead to the development of new drugs that might target myocardial recovery. The presence and extent of cardiac fibrosis in DCM is independently associated with myocardial recovery and cardiovascular mortality.

Purpose

To identify the biological relevance of genetic targets that are associated with change in LVEF in patients with DCM.

Methods

A GWAS was performed using DNA from 686 patients with recent onset DCM who were on standard HF therapy using change in LVEF at a median of 6 months after initial diagnosis. Cultured human cardiac fibroblasts (HCFs) were used as an in vitro model to study the functional and biological relevance of the gene target identified in the GWAS. Specifically, HCFs were transfected with siRNA by using the Lipofectamine™ RNAiMAX Transfection Reagent for gene knockdown (KD). RNA-seq was performed using the Illumina TruSeq protocol with expression analysis conducted with the EdgeR package. Ingenuity Pathway Analysis was used.

Results

A single-nucleotide polymorphism, rs11105445(G&gt;A), mapping to the neuron navigator 3 (NAV3) gene (rs11105445, p=2.37E-07; beta 2.74±0.53) was associated with improvement in LVEF. We performed a phenome-wide association study using data from the UK Biobank and demonstrated that genetic variation in NAV3 was significantly associated with HF mortality (p=3.2E-28), highlighting the potential importance of this gene in HF. Using GTEx data we demonstrated that in LV tissue the minor allele A was associated with ↓NAV3 expression (p=0.03) suggesting that ↓NAV3 expression might be associated with improvement in LVEF. We demonstrated that NAV3 KD significantly ↓TGF-β1 mediated HCF transdifferentiation into myofibroblasts, ↓α-smooth muscle actin (ACTA2) and ↓collagen I (COL1A1), therefore NAV3 KD was anti-fibrotic (see Figure 1), 1a. HCFs treated by vehicle/TGF-β1 after KD of NAV3/ctrl, and ACTA2 and COL1A1 were analyzed by qPCR; 1b. Representative immunofluorescence staining for α-SMA (in green), RNA-seq after NAV3 KD followed by pathway analysis suggested that NAV3 exerted its effect by regulating cell cycle related proteins (Figure 2), 2a. Volcano plot shows significant differentially expressed genes identified by RNA-seq analysis (down-regulated in blue, up-regulated in red); 2b. NAV3 KD significantly increased expression of cell cycle related proteins, which was validated by Western blot.

Conclusions

Decreased expression of NAV3 is associated with myocardial recovery in DCM, most likely due to its anti-fibrotic effect via direct regulation of cell cycle proteins. The role of NAV3 as a novel therapeutic target in DCM needs to be explored.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Mayo Clinic Center for Individualized MedicineMayo Clinic Department of Cardiovascular Medicine

Dissecting the clinicopathologic, genomic, and immunophenotypic correlates of KRASG12D-mutated non-small-cell lung cancer

BACKGROUND

Allele-specific KRAS inhibitors are an emerging class of cancer therapies. KRAS-mutant (KRASMUT) non-small-cell lung cancers (NSCLCs) exhibit heterogeneous outcomes, driven by differences in underlying biology shaped by co-mutations. In contrast to KRASG12C NSCLC, KRASG12D NSCLC is associated with low/never-smoking status and is largely uncharacterized.

PATIENTS AND METHODS

Clinicopathologic and genomic information were collected from patients with NSCLCs harboring a KRAS mutation at the Dana-Farber Cancer Institute (DFCI), Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, and Imperial College of London. Multiplexed immunofluorescence for CK7, programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), Foxp3, and CD8 was carried out on a subset of samples with available tissue at the DFCI. Clinical outcomes to PD-(L)1 inhibition ± chemotherapy were analyzed according to KRAS mutation subtype.

RESULTS

Of 2327 patients with KRAS-mutated (KRASMUT) NSCLC, 15% (n = 354) harbored KRASG12D. Compared to KRASnon-G12D NSCLC, KRASG12D NSCLC had a lower pack-year (py) smoking history (median 22.5 py versus 30.0 py, P < 0.0001) and was enriched in never smokers (22% versus 5%, P < 0.0001). KRASG12D had lower PD-L1 tumor proportion score (TPS) (median 1% versus 5%, P < 0.01) and lower tumor mutation burden (TMB) compared to KRASnon-G12D (median 8.4 versus 9.9 mt/Mb, P < 0.0001). Of the samples which underwent multiplexed immunofluorescence, KRASG12D had lower intratumoral and total CD8+PD1+ T cells (P < 0.05). Among 850 patients with advanced KRASMUT NSCLC who received PD-(L)1-based therapies, KRASG12D was associated with a worse objective response rate (ORR) (15.8% versus 28.4%, P = 0.03), progression-free survival (PFS) [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.45-2.00, P = 0.003], and overall survival (OS; HR 1.45, 1.05-1.99, P = 0.02) to PD-(L)1 inhibition alone but not to chemo-immunotherapy combinations [ORR 30.6% versus 35.7%, P = 0.51; PFS HR 1.28 (95%CI 0.92-1.77), P = 0.13; OS HR 1.36 (95%CI 0.95-1.96), P = 0.09] compared to KRASnon-G12D.

CONCLUSIONS

KRASG12D lung cancers harbor distinct clinical, genomic, and immunologic features compared to other KRAS-mutated lung cancers and worse outcomes to PD-(L)1 blockade. Drug development for KRASG12D lung cancers will have to take these differences into account.