Quantifying the Size and Duration of a Microburst-Producing Chorus Region on 5 December 2017

Microbursts are impulsive (<1 s) injections of electrons into the atmosphere, thought to be caused by nonlinear scattering by chorus waves. Although attempts have been made to quantify their contribution to outer belt electron loss, the uncertainty in the overall size and duration of the microburst region is typically large, so that their contribution to outer belt loss is uncertain. We combine datasets that measure chorus waves (Van Allen Probes [RBSP], Arase, ground-based VLF stations) and microburst (>30 keV) precipitation (FIREBIRD II and AC6 CubeSats, POES) to determine the size of the microburst-producing chorus source region beginning on 5 December 2017. We estimate that the long-lasting (∼30 hr) microburst-producing chorus region extends from 4 to 8Δ MLT and 2-5Δ L. We conclude that microbursts likely represent a major loss source of outer radiation belt electrons for this event.

Statistical Properties of Electron Curtain Precipitation Estimated With AeroCube-6

Curtain precipitation is a recently discovered stationary, persistent, and latitudinally narrow electron precipitation phenomenon in low Earth orbit. Curtains are observed over consecutive passes of the dual AeroCube-6 CubeSats while their in-track lag varied from a fraction of a second to 65 s, with dosimeters that are sensitive to >35-keV electrons. This study uses the AeroCube-6 mission to quantify the statistical properties of 1,634 curtains observed over 3 years. We found that many curtains are narrower than 10 km in the latitudinal direction with 90% narrower than 20 km. We examined the geographic, magnetic local time, and geomagnetic dependence of curtains. We found that curtains are observed in the late-morning and premidnight magnetic local times, with a higher occurrence rate at premidnight, and curtains are observed more often during times of enhanced Auroral Electrojet. We found a few curtains in the bounce loss cone region above the North Atlantic, whose electrons were continuously scattered for at least 6 s. Such observations suggest that continuous curtain precipitation may be a significant loss of >35-keV electrons from the magnetosphere into the atmosphere. We hypothesize that the curtains observed in the bounce loss cone were accelerated by parallel electric fields, and we show that this mechanism is consistent with the observations.

The FIREBIRD-II CubeSat mission: Focused investigations of relativistic electron burst intensity, range, and dynamics

FIREBIRD-II is a National Science Foundation funded CubeSat mission designed to study the scale size and energy spectrum of relativistic electron microbursts. The mission consists of two identical 1.5 U CubeSats in a low earth polar orbit, each with two solid state detectors that differ only in the size of their geometric factors and fields of view. Having two spacecraft in close orbit allows the scale size of microbursts to be investigated through the intra-spacecraft separation when microbursts are observed simultaneously on each unit. Each detector returns high cadence (10 s of ms) measurements of the electron population from 200 keV to >1 MeV across six energy channels. The energy channels were selected to fill a gap in the observations of the Heavy Ion Large Telescope instrument on the Solar, Anomalous, and Magnetospheric Particle Explorer. FIREBIRD-II has been in orbit for 5 years and continues to return high quality data. After the first month in orbit, the spacecraft had separated beyond the expected scale size of microbursts, so the focus has shifted toward conjunctions with other magnetospheric missions. FIREBIRD-II has addressed all of its primary science objectives, and its long lifetime and focus on conjunctions has enabled additional science beyond the scope of the original mission. This paper presents a brief history of the FIREBIRD mission's science goals, followed by a description of the instrument and spacecraft. The data products are then discussed along with some caveats necessary for proper use of the data.

Electron Microburst Size Distribution Derived With AeroCube-6

Microbursts are an impulsive increase of electrons from the radiation belts into the atmosphere and have been directly observed in low Earth orbit and the upper atmosphere. Prior work has estimated that microbursts are capable of rapidly depleting the radiation belt electrons on the order of a day; hence, their role to radiation belt electron losses must be considered. Losses due to microbursts are not well constrained, and more work is necessary to accurately quantify their contribution as a loss process. To address this question, we present a statistical study of > 35 keV microburst sizes using the pair of AeroCube-6 CubeSats. The microburst size distribution in low Earth orbit and the magnetic equator was derived using both spacecraft. In low Earth orbit, the majority of microbursts were observed, while the AeroCube-6 separation was less than a few tens of kilometers, mostly in latitude. To account for the statistical effects of random microburst locations and sizes, Monte Carlo and analytic models were developed to test hypothesized microburst size distributions. A family of microburst size distributions were tested, and a Markov chain Monte Carlo sampler was used to estimate the optimal distribution of model parameters. Finally, a majority of observed microbursts map to sizes less than 200 km at the magnetic equator. Since microbursts are widely believed to be generated by scattering of radiation belt electrons by whistler mode waves, the observed microburst size distribution was compared to whistler mode chorus size distributions derived in prior literature.

Cabozantinib use in renal cell carcinoma

In the last several years, many new drugs have been approved to treat metastatic renal cell carcinoma (RCC). Cabozantinib is a novel multikinase inhibitor with activity against vascular endothelial growth factor receptor (VEGFR), proto-oncogene tyrosine-protein kinase receptor Ret and other kinases that recently joined this impressive list of approved agents. Cabozantinib is an active agent in the preclinical and clinical setting, having recently demonstrated superiority over everolimus in a blinded, randomized phase III study of patients with progressive RCC after at least one prior line of antiangiogenic therapy. This agent's toxicity profile is similar to those of other multikinase inhibitors approved to treat RCC. This review will explore cabozantinib's pharmacologic and safety profile and its preclinical and clinical activity in RCC.

Abstract OT3-07-03: Positive behavior change and weight loss in breast cancer survivors on hormonal adjuvant therapy: An energy balance research in cancer (EnBaR) prospective study

BACKGROUND: Observational studies have repeatedly linked obesity to increased cancer incidence, recurrence, and mortality, leading to cancer treatment guidelines that call for maintenance of a healthy body weight, regular physical activity (PA) regardless of body mass index (BMI), and modest weight loss for overweight and obese cancer survivors (CS). Despite these recommendations, newly published reports suggest that more than 70% of CS are overweight or obese, and only 1/3 engage in the recommended levels of PA. Although trials have demonstrated that energy balance (EB) interventions are feasible in CS, it has been concluded that ongoing behavioral support is needed to implement and sustain changes in weight and PA. Through the subsequent Energy Balance Research (EnBaR) the incorporation of a weight management and PA program focused on ongoing behavioral support for breast cancer survivors (BCS) as an effective method for implementation of lifestyle modifications will be investigated.

TRIAL DESIGN: This is a single-arm prospective observational study investigating if implementation of an EB Program for BCS is an effective intervention for producing lifestyle behaviors. Eligible subjects must be female BCS ≥18 years with BMI ≥25 who are initiating hormonotherapy (HT) as their only oncology treatment modality. Subjects will consult with a Registered Dietitian (RD) to establish goals based on specified interventions for reducing overall BMI at the time of initiating their prescribed HT. Subjects will subsequently receive telephone calls from the RD at bi-monthly intervals to discuss the established points of intervention, answering questions proposed by the RD from a set intervention measurement scale. Patients will also report for body composition analysis performed by the RD via InBody at Baseline, Day 90, and Day 180. InBody is a validated tool that utilizes direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA) to provide a highly accurate report of an individual's body composition.

AIMS: Determine change in Percent Body Fat (PBF) and BMI during adjuvant hormone treatment for breast cancer patients.

STATS/TARGET ACCRUAL: To assess % change in BMI and PBF between baseline and 180 days, one-sample t-tests will be used. Assuming an average (avg) baseline BMI of 33.7 with a standard deviation of 8.5; a sample of 120 patients will yield 89.4% power using a two-sided t-test to detect a 13% reduction in BMI to an avg of 29.32 and 82.8% power to detect a 12% reduction to an avg BMI of 29.656. Similarly, a t-test will have 83.7% power to detect a 12% decrease in % change in PBF assuming an avg baseline PBF of 41.36 with a standard deviation 10.5. The power calculations were accomplished by generating simulations of size 10,000 replications conducted at the 0.025 significance level using the TTEST procedure of SAS 9.4 [SAS Institute Inc., Cary, NC, USA]. The calculations assume a linear correlation of 0.5 between the baseline and Day 180 measurements and are Bonferroni corrected to maintain a familywise error of 0.05 for the primary analysis. All statistical analyses will be conducted using SAS 9.4. Statistical significance will be defined as p &lt; 0.05.

Citation Format: Scheuer R, Bendinger GM, Ensor Jr. JE, Nixon D, Randolph K, McGuirec E, Rados K, McNight JE, Pabbathi H, Panicker R, Johnson AT, Langlois C, Lammersfeld C, Alvarez RH. Positive behavior change and weight loss in breast cancer survivors on hormonal adjuvant therapy: An energy balance research in cancer (EnBaR) prospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-07-03.

Abstract OT3-08-01: A randomized study of personalized music therapy for patients with early stage breast cancer receiving chemotherapy

BACKGROUND: A review of the literature identifies high levels of anxiety and depression as adverse effects of oncology diagnosis and treatment, even for patients with curable cancers such as early stage breast cancer (ESBC). Studies have reported that music therapy yields remarkable, multi-dimensional benefits on an individual's mood and state of mind. The purpose of this trial is to evaluate the impact of personalized music therapy (PMT) in reducing anxiety and other adverse mental health symptoms experienced by patients receiving chemotherapy treatment for ESBC.

ELIGIBILITY: Females ≥ 18 years diagnosed with ESBC (Stage I-III) initiating intravenous chemotherapy as their only oncology treatment modality who report anxiety ≥ 4 on a numerical rating scale of 0-10.

TRIAL DESIGN: This is a 4-week, two-arm, randomized (1:1) trial evaluating the anti-anxiety benefits of PMT for women with ESBC initiating intravenous (IV) chemotherapy. The patients randomized to the experimental group will participate in 30-minute PMT sessions conducted by a Licensed Musical Therapist (LMT). Initial PMT will occur within 1 hour of the patient's first chemotherapy infusion (C1D1), then once weekly for the remaining 3 weeks of the trial. Patients randomized to the control group will be referred to the medical oncologist for standard of care (SOC) anxiety treatment. Outcomes will be measured via the Generalized Anxiety Disorder Assessment (GAD-7), the Center for Epidemiologic Studies Depression Scale (CES-D), the Pittsburgh Sleep Quality Index (PSQI), and the Symptom Inventory Tool-M.D. Anderson Symptom Inventory (SIT-MDASI) to be completed by both cohorts at baseline and regular intervals for the duration of the study.

AIMS: The primary endpoint is to determine the impact of PMT during chemotherapy treatment on patient reported anxiety (GAD-7). Secondary endpoints will determine the impact of PMT during chemotherapy treatment on patient reported depression (CES-D), sleep disturbances (PSQI), and quality of life (SIT-MDASI).

STATISTICAL METHODS/TARGET ACCRUAL: Patients will be randomized to receive either PMT or SOC using the Pocock-Simon dynamic allocation method to balance tumor stage between the arms. With 30 patients in each arm and approximate target accrual of 60, the study achieves 80.0% power to detect a 0.65 standard deviation unit effect size of the change in scale measure between baseline and 4 weeks at the 0.05 significance level using a one-sided two-sample t-test. GAD-7 change will be compared between the two arms using a two-sample t-test (Pooled Standard error or Satterthwaite approximation as appropriate). The secondary outcomes include CES-D, PSQI, and SIT-MDASI for which a longitudinal analysis of subscale scores will be conducted using a generalized linear mixed-effects model with fixed effects for treatment group and time. All statistical analyses will be conducted using SAS 9.3 [SAS Institute Inc., Cary, NC, USA]. Statistical significance will be defined as p &lt; 0.05.

Citation Format: Toole Jr. M, Bendinger GM, Ensor Jr. JE, Alvarez Tapias C, Smith E, McGuire E, Rados K, McNight JE, Pabbathi H, Panicker R, Johnson AT, Lammersfeld C, Alvarez RH. A randomized study of personalized music therapy for patients with early stage breast cancer receiving chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-08-01.

Abstract OT3-07-04: A randomized study comparing MoistHer to topical lidocaine for female breast cancer survivors with dyspareunia

BACKGROUND: Problems related to sexual function are known to affect quality of life in female breast cancer survivors (BCS). A leading symptom of sexual dysfunction reported by BCS is dyspareunia, defined as moderate to severe penetrative pain with intercourse that results in reduced frequency of intercourse or abstinence. Dyspareunia in females is most commonly caused by vaginal dryness and primarily treated with estrogen therapy, a contraindication for many BCS. A recent trial found that estrogen-deficient BCS with dyspareunia who applied topical lidocaine to the vulvar vestibule (VV) prior to penetrative intercourse (PI) reported decreased pain during PI and improvement of sexual distress (Goetsch MF, JCO 2015). Identification of additional non-hormonal therapies to target the VV prior to PI may therefore provide treatment options for the improvement of sexual dysfunction in BCS with dyspareunia.

TRIAL DESIGN: This is a double-blind, randomized trial to evaluate the benefits of applying natural lubricant MoistHer (MH) to the VV prior to PI in female BCS with dyspareunia. Subjects must be female ≥18 years BCS without active treatment (except for hormonotherapy), in a stable heterosexual partnership for ≥5 years, and report ≥ 3 months of consistent pain with PI. Patients with a history of pelvic pain, pelvic floor myalgia, vulvar dermatoses, or vaginismus will be excluded. Subjects will be randomized 1:1 to blinded home therapies of either MH or Topical Lidocaine (TL) for application to VV. MH is a commercially available vaginal moisturizer made of emu oil, tocopherol, safflower oil, and aloe extract and will be supplied by manufacturer Dromeo Inc. TL will be a 4% aqueous lidocaine hydrochloride solution prepared by research pharmacist (RP). Both MH and TL will be dispensed by RP in identical unmarked bottles. Subjects will agree to apply study liquid to VV and attempt PI at least twice per week for 4 weeks while maintaining a study diary to record pain scores. Outcomes will be measured via Sexual Function Questionnaire (SFQ), Female Sexual Distress Score-Revised (FSDS-R), and a rating of pain during PI on a scale of zero (no pain) to 10 (worst pain) via Numerical Rating Scale (NRS), to be completed by subjects at baseline, 2 weeks, and 4 weeks.

AIMS: Primary endpoint is pain with PI, to be reported as a score on the NRS. Secondary endpoints are improved quality of sexual life and resumption of PI, to be measured by the SFQ and FSDS-R.

STATS/TARGET ACCRUAL: A total of 50 patients will be recruited and randomized to receive either MH or TL at a 1:1 ratio (25 per group) using the Pocock-Simon dynamic allocation method. This sample size will achieve 94% power to detect at least 1.5 points NRS mean difference between treatments. NRS change will be compared between the two arms using a two-sample t-test (Pooled Standard error or Satterthwaite approximation as appropriate). Secondary outcomes include the SFQ and FSDS-R for which a longitudinal analysis of subscale scores will be conducted using a generalized linear mixed-effects model with fixed effects for treatment group and time. All statistical analyses will be conducted using SAS 9.3 [SAS Institute Inc., Cary, NC, USA]. Statistical significance will be defined as p &lt; 0.05.

Citation Format: Bendinger GM, Baptist S, Alvarez Tapias C, McGuire E, Rados K, Nixon D, Randolph K, McNight JE, Pabbathi H, Panicker R, Johnson AT, Geisler JP, Manahan KJ, Lammersfeld C, Avarez RH. A randomized study comparing MoistHer to topical lidocaine for female breast cancer survivors with dyspareunia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-07-04.

Abstract P4-19-05: Efficacy of screening and treatment of breast cancer patients reporting high level of distress

Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. A recent meta-analysis has shown that anxiety is the most common mental health issue among cancer survivors [Mitchell AJ, 2013]. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014]. Consensus-based recommendations have been published to help cancer centers meet the American College of Surgeons Commission on Cancer's accreditation requirement to screen for distress [Pirl, 2014] At our comprehensive community cancer center we perform distress screening using the M.D. Anderson Symptom Inventory (MDASI), composed of 27 questions. Pts who report moderate and severe levels of distress (≥5) on the MDASI are identified and referred for therapeutic interventions offered by the facility's integrative oncology services.

Materials and Methods: The MDASI is an assessment tool that captures pts' perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The 27-question MDASI is comprised of the M.D. Anderson Symptom Inventory (MDASI), a validated 19-item assessment instrument, with a Symptom Inventory Tool (SIT) added by our center of 8 questions and a free-text box. Symptoms are rated “at the worst” on an 11-point numeric scale ranging from 0 (“none present”) to 10 (“as bad as you can imagine”), as experienced by the patient in the past 24 hours.

Results: Over a ten-month period (9/1/2014 to 6/30/2015), 247 breast cancer (BC) pts completed the MDASI at intake and again ≥ 21 days after. Analysis of their initial surveys identified 69 pts (27.9%) who rated their distress as ≥ 5 (1st MDASI mean = 6.83), scores which would have initiated a support system response with referrals to integrative medicine services for intervention. Second MDASI results from these 69 BC pts revealed an average 2.29 distress score reduction (2nd MDASI mean = 4.48), with 51 pts (73.9%) reporting a decrease in distress, 7 pts (10.1%) having no change, and 11 pts (15.9%) reporting increased distress. More specifically, the group with decreased distress levels documented a mean distress score of 3 on their 2nd MDASI, averaging a significant 4-point diminution of distress for three-fourths of the BC pts heavily burdened by this symptom. The integrative services most utilized by these pts were Nutrition Therapy (100%), Spiritual Care (96.1%), Mind-Body Counseling (82.4%), Rehabilitation Therapy (41.2%), Acupuncture (35.3%), and Massage Therapy (35.3%).

Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in BC pts using integrative oncology approaches reduced distress in 74% of cases.

Citation Format: Daneker SR, Bendinger GM, Thomas JW, Smith E, Kendrick D, Hartman S, Gordon C, Barber K, Langlois C, Pabbathi H, McKnight JE, Johnson AT, Lammersfeld C, Denny D, Markman M, Alvarez RH. Efficacy of screening and treatment of breast cancer patients reporting high level of distress [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-05.

Abstract OT3-02-04: A randomized controlled trial comparing acupuncture versus usual care for the treatment of aromatase inhibitor-induced arthralgia (AIIA) in women with early-stage breast cancer

BACKGROUND: The increase in breast cancer (BC) survival is largely due to the benefits of hormonal therapy, such as tamoxifen and aromatase inhibitors (AIs), for the treatment of hormone-sensitive breast cancer. Recent clinical trials have demonstrated that AIs are more effective than tamoxifen at reducing BC recurrences. However, BC patients receiving AIs have a higher incidence of osteoporosis, bone fractures, and musculoskeletal symptoms, particularly joint pain and stiffness. The incidence of AIIA in the ATAC trial was 27.8% in patients taking anastrozole versus (vs) 21% in patients taking tamoxifen (Baum M, Lancet 2002). The arthralgia associated with AIs can be so debilitating that it contributes to a significant percentage of non-compliance and discontinuation of systemic treatment. Patients with cancer often show interest in complementary and integrative modalities for symptom management (Vickers AJ, Lancet 2001), of which Acupuncture (Ac) is one of the most utilized therapies.

ELIGIBILITY: Subjects must be female ≥18 years, have undergone mastectomy or breast-sparing surgery, and must have recovered from all pain-related effects of the surgery and radiotherapy with a minimum washout period of 30 days prior to registration. Patients should have ER and PR positive BC and be actively taking a 3rd-generation AI (Anastrozole, Letrozole, or Exemestane) for at least the 30 days prior to registration and plan to continue for at least one year after registration. ECOG PS &lt;2 and platelets counts &gt; 50,000/uL. Patients must not have received topical analgesic with exception of oral NSAIDS drugs ≤14 days to registration.

TRIAL DESIGN: This is a 12-week, two arm randomized (1:1) trial evaluating the benefit of Ac in BC patients experiencing AIIA.

AIMS: The aim of this study is to investigate the effectiveness of an integrative approach using Ac vs usual care (UC) treatment consisting of NSAIDs for the management of the AIIA.Primary endpoint is to compare the difference of Brief Pain Inventory-Short Form (BPI-SF) score at baseline vs week 8 between Ac and UC groups. Secondary endpoints are a) to compare the difference of BPI-SF score at baseline vs week 12 between Ac and UC groups, b) to compare the difference in AI adherence between Ac and UC groups and c) to compare the difference in patient initiated AI discontinuation between Ac and UC groups.

STATS/TARGET ACCRUAL: This is a randomized controlled phase II study with the goal to compare reduction in BPI-SF score for patients treated with Ac vs UC alone. Patients are randomized 1:1 between the two arms. Prior work has indicated a 2-point BPI-SF score reduction as clinically meaningful. A sample size of 56 patients yields a study with 90% power and a one-sided significance level of 0.025 to determine a difference in pain reduction ≥2. These calculations are based on the assumptions of normal distribution of the improvement in BPI-SF score and a standard deviation that is conservatively calculated to be 2.3. An additional 6 patients will be accrued to account for attrition.

Citation Format: Frank HS, Bendinger GM, Ensor Jr. JE, Neufeld N, Nixon D, Randolph K, McGuire E, Rados K, McNight JE, Pabbathi H, Panicker R, Johnson AT, Lammersfeld C, Alvarez R. A randomized controlled trial comparing acupuncture versus usual care for the treatment of aromatase inhibitor-induced arthralgia (AIIA) in women with early-stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-02-04.

Abstract P6-07-06: Clinicopathologic characterization and comprehensive genomic profiling (CGP) of advanced breast cancer patients with fibroblast growth factor receptor (FGFR) alterations

BACKGROUND: FGFR family members are infrequently mutated but are frequently overexpressed in breast cancer and often accompanied by increased, or altered, expression of FGF ligands. In this retrospective study, we reviewed a large series of FGFR altered breast cancer cases that received comprehensive genomic profiling (CGP) in the course of clinical care.

MATERIAL AND METHODS: CGP was performed on hybridization-captures, adaptor ligation-based libraries using DNA extracted from 40 μm formalin-fixed paraffin-embedded (FFPE) section cut at 10 μm performed in a CLIA-certified lab (Foundation Medicine, Inc.). The pathologic diagnosis of each case was confirmed on routine hematoxylin and eosin-stained slides, and all samples forwarded for DNA extraction contained a minimum of 20% of DNA derived from tumor cells. The FoundationOne test sequences the full coding regions of up to 315 cancer-related genes, and up to 28 genes that are frequently altered in cancer to detect all classes of genomic alterations including base substitutions, indels, copy-number alterations (CNA), and fusions/rearrangements. The average depth of coverage is greater than 600X. The genomic profiles of 2,617 patients with diverse advanced malignancies who were evaluated at Cancer Treatment Centers of America between 12/24/12 and 03/11/15 were reviewed. 176 FGFR alterations (7.8%) were detected, of which 76 (43.5%) were found in breast cancer cases out of 434 (16.5%). The study was carried out in accordance with WIRB Institutional Review Board.

RESULTS: A total of 76 female breast cancer patients, having a median age 50 (range, 28-69), with FGFR alterations were reviewed. All patients had metastatic/relapsed advanced breast cancer. 54 patients were Estrogen Receptor-positive (70%), and 15 were HER2+ (20%). 6 patients had gBRCA deleterious mutations. 84% of the samples (n=67) tissue block were analyzed, and the anatomic sites represented by the samples were 24 breast primary tumor (31%), 15 liver (19%), 10 lymph nodes (13%), and other sites (37%). The median number of chemotherapies cycles was 4 (range, 1-12), and the median time to metastasis was 31 months (range, 0-175). At the time of this report, 31 patients (40%) were deceased. 79 FGFR gene alterations were identified in 76 patients, including FGFR1 (65), FGFR2 (6), FGFR3 (2), and FGFR4 (4), with all but 7 of these being amplifications. The most co-existent altered gene was TP53 (66%), and other altered genes included PIK3CA (37%), MYC (28%), FGF3/4/19 (17%), CCND1 (17%), and CCNE1 (16%). The subset of co-amplified FGF3/4/19 and FGFR amplified patients were all (7) ER+ except for 1 patient.

CONCLUSIONS: FGFR genomic alterations in breast cancer patients are predominantly amplifications and are most commonly observed in ER+ patients. Further review of treatment history will be performed to evaluate the hypothesis that alterations of FGFR is a modifier of response to endocrine therapy, and co-amplified FGF3/4/19 and FGFR breast cancer cases may be a distinct clinic-pathologic entity. Any patients in this series initiated on anti-FGFR targeted therapy will also be reported.

Citation Format: Alvarez RH, Thomas JW, Kramer K, Niu J, Ahn E, McKnight JE, Dhillon N, Pabbathi H, Johnson AT, Wang K, Ross JS, Miller VA, Stephens PJ, Daneker GW, Ali S, Markman M. Clinicopathologic characterization and comprehensive genomic profiling (CGP) of advanced breast cancer patients with fibroblast growth factor receptor (FGFR) alterations. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-07-06.

Abstract P5-17-11: Trends in incidence, patient characteristics, and management of lobular carcinoma in situ

Introduction: Lobular carcinoma in situ (LCIS) is a rare lesion accounting for only 5% of total breast cancer diagnosis; however, the incidence has continued to increase, albeit at a slower rate than was seen in the 1980s and 1990s. Current National Comprehensive Cancer Network (NCCN) guidelines recommend surgical excision of the breast tissue containing LCIS due to risk of concomitant malignancy, but wide variations in treatment exist. Using the Surveillance, Epidemiology, and End Results (SEER) and National Cancer Database (NCDB) participant user files, an extensive survey of women with LCIS breast cancer was completed. Our aim was to identify patient and facility characteristics that are associated with aggressive treatment (mastectomy) or under-treatment (no surgical excision) following LCIS diagnosis.

Methods: Women with a diagnosis of LCIS from 1998 to 2011 within the SEER and NCDB databases were identified. Incidence data was gathered from SEER while all other characteristics (patient, facility, and treatment factors) were obtained from the NCDB. A logistic regression model was created to examine factors associated LCIS treatment modalities recorded in the NCDB.

Results: The incidence of LCIS increased from 3.85 to 4.46 / 100,000 women between 2000 and 2011. 62,923 female patients with LCIS were identified within the NCDB. The majority of women diagnosed with LCIS were between the ages of 40 and 59 years (66.8%, N=42,044), white (87.4%, N=55,022), and non-Hispanic (86.9%, N=54,679). Following a diagnosis of LCIS, most women underwent surgical excision (71.1%, N=44,731), with an additional 20.7% undergoing mastectomy (N=13,039) or opting for no surgery (8.0%, N=5,023). Logistic regression analysis demonstrated that age over 60 years was associated with no surgical intervention (OR 1.49, p&lt;0.001), while age 40 to 59 were associated with aggressive therapy (OR 1.19, p&lt;0.001). Economic factors associated with no surgical intervention following LCIS diagnosis include: no insurance (OR 1.24, p&lt;0.001), government sponsored insurance (OR 1.48, p&lt;0.001), live in areas with median income less than $63,000 per year (OR 0.744, p&lt;0.001), and live in an area with higher rates of the population lacking high school education (OR 1.19, p&lt;0.001). Patients undergoing aggressive treatment were more likely to be white (OR 1.57, p&lt;0.001) and carry private insurance (OR 1.87, p&lt;0.001). Patients receiving care at an academic center were more likely to receive aggressive treatment (OR 1.22, p&lt;0.001). Living farther from treatment center was associated with increased odds of aggressive therapy, but not under-treatment (p&lt;0.001 vs p=0.906, respectively).

Conclusion: Despite being a rare cancer, the incidence of LCIS continues to rise. LCIS is predominantly a cancer diagnosed in white, non-hispanic women. Advanced age, poverty, lack of insurance, low high school graduation rates were factors significantly associated with under-treatment of LCIS. Conversely, white women between 40-59 yo with private insurance and treated at a cancer center were more likely to undergo aggressive treatment.

Citation Format: Johnson AT, Guo X, Nygaard RM, Zera RT. Trends in incidence, patient characteristics, and management of lobular carcinoma in situ. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-17-11.

Variation of respiratory resistance suggests optimization of airway caliber

Physiologically optimized processes, such as respiration, walking, and cardiac function, usually show a range of variability about the optimized value. Airway resistance has, in the past, been noted as variable, and this variability has been connected to pulmonary disease (e.g., asthma). A hypothesis was presented many years ago that postulated airway resistance as an optimized parameter in healthy individuals, and we have noticed that respiratory measurements made with the airflow perturbation device (APD) tend to be variable in nature. It was posited that this variability indicates that respiratory resistance is optimized similarly to other physiological processes. Fifty subjects with a wide range of demographics volunteered to have 100 measurements made of their respiratory resistances. Resistances were separated into inhalation and exhalation phases. These were plotted and shown to have frequency distributions that were consistent with expectations for an optimized process. The frequency distributions were not quite symmetrical, being skewed slightly toward upper resistances. Comparison between subject data and data from a mechanical respiratory analog showed that subject resistance variation is overwhelmingly from the respiratory system and not from the APD.

GSTM1 null and NAT2 slow acetylation genotypes, smoking intensity and bladder cancer risk: results from the New England bladder cancer study and NAT2 meta-analysis

Associations between bladder cancer risk and NAT2 and GSTM1 polymorphisms have emerged as some of the most consistent findings in the genetic epidemiology of common metabolic polymorphisms and cancer, but their interaction with tobacco use, intensity and duration remain unclear. In a New England population-based case-control study of urothelial carcinoma, we collected mouthwash samples from 1088 of 1171 cases (92.9%) and 1282 of 1418 controls (91.2%) for genotype analysis of GSTM1, GSTT1 and NAT2 polymorphisms. Odds ratios and 95% confidence intervals of bladder cancer among New England Bladder Cancer Study subjects with one or two inactive GSTM1 alleles (i.e. the 'null' genotype) were 1.26 (0.85-1.88) and 1.54 (1.05-2.25), respectively (P-trend = 0.008), compared with those with two active copies. GSTT1 inactive alleles were not associated with risk. NAT2 slow acetylation status was not associated with risk among never (1.04; 0.71-1.51), former (0.95; 0.75-1.20) or current smokers (1.33; 0.91-1.95); however, a relationship emerged when smoking intensity was evaluated. Among slow acetylators who ever smoked at least 40 cigarettes/day, risk was elevated among ever (1.82; 1.14-2.91, P-interaction = 0.07) and current heavy smokers (3.16; 1.22-8.19, P-interaction = 0.03) compared with rapid acetylators in each category; but was not observed at lower intensities. In contrast, the effect of GSTM1-null genotype was not greater among smokers, regardless of intensity. Meta-analysis of the NAT2 associations with bladder cancer showed a highly significant relationship. Findings from this large USA population-based study provided evidence that the NAT2 slow acetylation genotype interacts with tobacco smoking as a function of exposure intensity.

Electron beam induced structural transformations of SWNTs and DWNTs grown on Si3N4/Si substrates

Electron beam induced structural transformations are investigated in single-wall carbon nanotubes (SWNTs), double-wall carbon nanotubes (DWNTs) and crossed nanotube junctions. The nanotubes studied here are synthesized by the chemical vapor deposition method. The response of the nanotubes to an electron beam is found to be influenced by the presence of coatings of amorphous carbon, graphene fragments and structural defects on the tube surface. The dependence of structural modifications on electron beam irradiation dose is measured. While nanotubes with amorphous carbon, graphene fragment coverage and/or defects undergo rapid transformation leading to structure disintegration, those without such coverage or defects are more resistant to beam damage. In addition, it is shown that the amorphous carbon coverage on the double-wall nanotubes can be transformed into graphene layers during electron beam irradiation of coated nanotubes. Finally, the relative stability of nanotube side-wall and end-walls are investigated through sub-threshold energy and above threshold energy irradiation of a model system, C60-filled nanotubes (Peapods). The data indicates that electron beams could be used to join nanotubes end-to-end without damaging the side-walls.

Controlled switching of optical emission energies in semiconducting single-walled carbon nanotubes

We present scanning photoluminescence (PL) microscopy of freely suspended single-walled carbon nanotubes grown by chemically assisted vapor deposition (CVD) across micron-sized open apertures. Scans of the PL emission versus excitation position show unusual "holes"having subwavelength spatial features associated with abrupt blue shifts of the emission energy. By varying the excitation polarization, energy, intensity, and position, we demonstrate that optical switching in some nanotubes is controllable in a highly nonlinear manner by adjusting the nonequilibrium carrier density in the nanotube. Technologically important attributes include large spectral contrast between on/off states at room temperature, a dramatic response to small changes in light intensity near threshold, and the possibility that electrical charge injection could also be used to control emission energies.

Role of single defects in electronic transport through carbon nanotube field-effect transistors

The influence of defects on electron transport in single-wall carbon nanotube field-effect transistors (CNFETs) is probed by combined scanning gate microscopy (SGM) and scanning impedance microscopy (SIM). SGM images are used to quantify the depletion surface potential, and from this the Fermi level, at individual defects along the CNFET length. SIM is used to measure the voltage distribution along the CNFET. When the CNFET is in the conducting state, SIM reveals a uniform potential drop along its length, consistent with diffusive transport. In contrast, when the CNFET is "off," potential steps develop at the position of depleted defects. High-resolution imaging of a second set of weak defects is achieved in a new "tip-gated" SIM mode.

Mapping the one-dimensional electronic States of nanotube peapod structures

Arrays of C60 molecules nested inside single-walled nanotubes represent a class of nanoscale materials having tunable properties. We report electronic measurements of this system made with a scanning tunneling microscope and demonstrate that the encapsulated C60 molecules modify the local electronic structure of the nanotube. Our measurements and calculations also show that a periodic array of C60 molecules gives rise to a hybrid electronic band, which derives its character from both the nanotube states and the C60 molecular orbitals.

Telephone communications with several commercial respirators

Previous work showed that telephone communications while wearing military respirators degraded both word comprehension and recognition speed. In addition, electronic amplification of the speech diaphragm signal had shown no advantage to the extra hardware. This experiment was performed to test effects of different configurations of commercially available respirators on telephone communications accuracy and speed. Twelve pairs of subjects were separated into different rooms and communicated by telephone. Modified rhyme-test words were presented by computer to the speaker, who transmitted the word by telephone to the listener. During the first replication, subjects were given no instruction about telephone communications procedure. During the second replication subjects followed a communications protocol that instructed them when to move the telephone handset from their ears to their mouths. Results showed that the protocol uniformly improved communications accuracy without incurring any extra time penalty. Word comprehension was still twice as fast without a respirator as with a respirator. Accuracy with the protocol nearly equaled the no respirator control value for most respirators tested.

Work performance when breathing through different respirator exhalation resistances

This study evaluated performance of individuals exercising at a fixed workload and wearing full-facepiece respirators modified to provide expiratory resistances of 0.27, 0.47, 1.81, 4.43, and 12.27 cmH20 x s x L(-1). On five separate occasions, 15 volunteers exercised to voluntary endpoint on a treadmill at fixed speeds and grades chosen to elicit 85% of maximal aerobic capacity for an unencumbered condition. Exercise performance time was recorded at the cessation of each test. Results showed that performance time decreased linearly (R2 = 0.79; p<0.001) with increased resistances, and no threshold value below which expiratory resistance has no impact on performance was found. Average oxygen consumption rates and minute ventilation also decreased linearly with increased expiratory resistances, indicating that increases in expiratory resistance result in a considerable level of hypoventilation. From the perspective of respirator design, the results of this study suggest that the only practical expiratory resistance level limitation is the reduction in performance that will be acceptable to the end users.

Intraoperative ultrasound and other techniques to achieve negative margins

Over the past few decades new procedures and technologies have been introduced into clinical practice for the evaluation and management of breast disease. Ultrasound is rapidly becoming a valued tool in the armamentarium of the breast surgeon. The use of ultrasound by radiologists and breast surgeons to evaluate nonpalpalable detected breast lesions has increased dramatically. With its easy portability and improvements in the technology, the use of ultrasound has now expanded into the operating room. In this work we review the value of intraoperative ultrasound and other techniques in obtaining and assessing margin status.

Quantized phonon spectrum of single-wall carbon nanotubes

The electronic spectra of carbon nanotubes and other nanoscale systems are quantized because of their small radii. Similar quantization in the phonon spectra has been difficult to observe because of the far smaller energy scale. We probed this regime by measuring the temperature-dependent specific heat of purified single-wall nanotubes. The data show direct evidence of one-dimensional quantized phonon subbands. Above 4 kelvin, they are in excellent agreement with model calculations of individual nanotubes and differ markedly from the specific heat of two-dimensional graphene or three-dimensional graphite. Detailed modeling yields an energy of 4.3 millielectron volts for the lowest quantized phonon subband and a tube-tube (or "lattice") Debye energy of 1.1 millielectron volts, implying a small intertube coupling in bundles.

Effect of external dead volume on performance while wearing a respirator

Respirator dead volume accumulates exhaled carbon dioxide and returns it to the respiratory system during subsequent inhalations. Because inhaled carbon dioxide is known to be a powerful respiratory stimulant and psychoactive gas, respirator dead volume would be expected to influence performance times while respirators are worn during work. This experiment was performed at intense levels of treadmill walking (80-85% VO2max) to demonstrate maximum sensitivity to respiratory stress. Six dead volume conditions (representing a range of 280 to 1,160 mL) were imposed on the subjects. Results show linear decreases in performance times and breathing apparatus comfort with increasing dead volumes. For each 350 mL of external dead volume, a 19% decrease of performance time and an 18% decrease in breathing apparatus comfort can be expected.

Age-dependent prevalence of mutations at the GLC1A locus in primary open-angle glaucoma

PURPOSE

To screen a population with primary open-angle glaucoma for mutations in the gene that encodes the trabecular meshwork inducible glucocorticoid response protein (TIGR), also known as myocilin (MYOC).

METHODS

Ophthalmologic information was collected for study subjects with primary open-angle glaucoma and their relatives. Mutation screening of 74 primary open-angle glaucoma probands was conducted by sequencing TIGR/MYOC coding sequence and splice sites.

RESULTS

In 23 families we detected 13 nonsynonymous sequence changes, nine of which appear to be mutations likely to cause or contribute to primary open-angle glaucoma. Two mutations, Arg272Gly and Ile499Ser, and one nonsynonymous sequence variant, Asn57Asp, are novel. We found mutations in nine of 25 juvenile glaucoma probands (36%) and two of 49 adult-onset glaucoma probands (4%). Age classification of families rather than individual probands revealed mutations in three of nine families with strictly juvenile primary open-angle glaucoma (33%), and no mutations in 39 families with strictly adult-onset primary open-angle glaucoma (0%). In families with mixed-onset primary open-angle glaucoma containing both juvenile primary open-angle glaucoma and adult-onset primary open-angle glaucoma cases, we found mutations in eight of 26 families (31%).

CONCLUSIONS

Our data suggest that Gly252Arg, Arg272Gly, Glu323Lys, Gln368STOP, Pro370Leu, Thr377Met, Val426Phe, Ile477Asn, and Ile499Ser are likely to play roles that cause or contribute to the etiology of autosomal dominant primary open-angle glaucoma. Our finding of more TIGR/MYOC mutations in families with mixed-onset primary open-angle glaucoma than in the families with strictly adult-onset primary open-angle glaucoma implies that the presence of relatives with juvenile primary open-angle glaucoma in a family could be used as a basis for identifying a subset of the population with adult-onset primary open-angle glaucoma with higher prevalence of TIGR/MYOC mutations. To address this issue, and to refine estimations of mutation prevalence in these age-defined subpopulations, prospective study of a larger population ascertained entirely through adult-onset primary open-angle glaucoma probands will be needed.

Communication using a telephone while wearing a respirator

Respirators have been found to degrade communication effectiveness when wearers speak face-to-face. However, little is known about communication effectiveness when using the telephone and wearing a respirator. Eleven pairs of subjects were asked to pronounce and identify words chosen from Modified Rhyme Test lists. Each word appeared on a computer screen in one room and the speaker said the word into the telephone. The listener in another room identified the word and typed it into a computer linked with the first. Subjects wore U.S. Army M40 full-facepiece air-purifying respirators with hoods. Three different speech diaphragm arrangements and two hood materials were tested. Results show that accuracy suffered by about 10% when respirators and hoods were worn compared with the control condition. Word identification speed was one-third to one-half of the control (no respirator or hood) condition depending on specific equipment worn.

Effect of respirator inspiratory resistance level on constant load treadmill work performance

Respirator inspiratory resistance can affect performance times, especially when the experiment is optimized to elicit respiratory stress. Twelve subjects performed on a treadmill at constant speeds and grades chosen to result in performance times of 5-15 min. Six levels of inspiratory resistance were used, ranging from 0.78 to 7.64 cm H2O.sec/L. The results showed that performance times decrease linearly with resistance level, and no threshold resistance value is apparent. Inspiratory resistance also induces hypoventilation, with lower minute volumes and lower oxygen consumption values at higher resistances. These trends are also linear. From these results, there is no value for inspiratory resistance that can be given as a design goal. Other parameters such as weight and space may dictate filter resistance values, and these, in turn, will lead to determined performance degradations.

Synthesis and biological activity of high-affinity retinoic acid receptor antagonists

This article reports the synthesis and biological activity of new high affinity retinioic acid receptor (RAR) antagonists. The effect of introducing heteroatoms in the bicyclic ring system of the potent dihydronaphthalene RAR antagonist 8, and the variation of the pendant aromatic group on the ability of these compounds to function as RAR antagonists is discussed. The use of binding, transcriptional, and in vivo assays revealed that the 2,2-dimethylthiochromene analogue 59, and the 2,2-dimethylchromene derivative 85, were the most effective in blocking retinoid agonist induced activity.

Identification of the AP1-antagonism domain of retinoic acid receptors

Retinoids are therapeutically effective in the treatment of psoriasis, photoaging, acne, and certain cancers. Some of the therapeutic actions of retinoids can be ascribed to retinoic acid receptor (RAR)-mediated antagonism of AP1-dependent gene expression. The increased activity of transcription factor AP1, a complex of oncoproteins Jun and Fos, is associated with cell growth and proliferation. Retinoids, on the other hand, inhibit cell proliferation and affect differentiation, activities that possibly stem from an antagonism of AP1-mediated gene expression by RARs. To gain insight into the molecular mechanism of RAR-AP1 interaction, we have identified the regions of the RAR required for AP1 antagonism. We demonstrate that the AP1 antagonism domain of RAR is a complex of the core of the DNA binding domain and the hydrophobic zipper region. Further, both monomeric RAR and RAR-RXR heterodimers inhibit the expression of an AP1 reporter. CREB binding protein (CBP) has been described as a cofactor for AP1, various nuclear hormone receptor proteins including RARs, and certain other transcription factors and is required for their transactivation properties. Therefore, CBP has been proposed as a common limiting cofactor that can account for inhibition of AP1-dependent gene expression by RARs. Interestingly, however, our results along with previously reported observations suggest that in addition to CBP, there may be other limiting cofactor(s) responsible for mutual transrepression of RAR and AP1.

High affinity retinoic acid receptor antagonists: analogs of AGN 193109

A series of high affinity retinoic acid receptor (RAR) antagonists were prepared based upon the known antagonist AGN 193109 (2). Introduction of various phenyl groups revealed a preference for substitution at the para-position relative to the meta-site. Antagonists with the highest affinities for the RARs possessed hydrophobic groups, however, the presence of polar functionality was also well tolerated.

Respiratory resistance measured by an airflow perturbation device

The airflow perturbation device (APD) is an instrument for the measurement of respiratory resistance. The APD is small, lightweight, fast and requires no special breathing manoeuvres. Airflow perturbation determines resistance by superimposing a periodic signal onto spontaneous breathing with a variable resistance device. Respiratory impedance is the ratio of magnitude of pressure perturbation to magnitude of flow perturbation, and respiratory resistance is the in-phase portion of respiratory impedance. The APD was tested to determine its responses to repeated resistance measurements and to changes in resistance. A mechanical model test showed that the APD could detect increased resistance levels, but overestimated resistance when resistance increased with flow. Tests with human subjects showed that the APD gave results consistent from day to day, was able to detect added resistances, and gave resistance values correlated with airway resistance values obtained by body plethysmography. Accelerometers placed on the chests of the subjects showed that perturbations extend to the chest surface. Thus, the APD must measure total respiratory resistance.

Type-specific contributions to chromosome size differences in Escherichia coli

The Escherichia coli genome varies in size from 4.5 to 5.5 Mb. It is unclear whether this variation may be distributed finely throughout the genome or is concentrated at just a few chromosomal loci or on plasmids. Further, the functional correlates of size variation in different genome copies are largely unexplored. We carried out comparative macrorestriction mapping using rare-restriction-site alleles (made with the Tn10dRCP2 family of elements, containing the NotI, BlnI, I-CeuI, and ultra-rare-cutting I-SceI sites) among the chromosomes of laboratory E. coli K-12, newborn-sepsis-associated E. coli RS218, and uropathogenic E. coli J96. These comparisons showed just a few large accessory chromosomal segments accounting for nearly all strain-to-strain size differences. Of 10 sepsis-associated and urovirulence genes, previously isolated from the two pathogens by scoring for function, all were colocalized exclusively with one or more of the accessory chromosomal segments. The accessory chromosomal segments detected in the pathogenic strains from physical, macrorestriction comparisons may be a source of new virulence genes, not yet isolated by function.

Generating the Snellen Chart by computer

The Snellen Chart is the eye chart that is commonly used to measure visual acuity. The chart has combinations of nine different letters in eleven different lines, each smaller than the one above. Repeated measures of visual acuity may result in chart memorization and false information. Thus, a computer program was written to produce randomized multiple versions of Snellen eye charts. The chart may be changed at some distance from the computer in order to hear subject letter identifications during exercise testing. Different sized letters can also be produced so that the distance from the subject to the chart can vary.

GLC1A mutations point to regions of potential functional importance on the TIGR/MYOC protein

PURPOSE

The aim of this study was to screen affected members of glaucoma families for mutations in the Trabecular Meshwork Inducible Glucocorticoid Response (TIGR) gene also known by the name myocilin (MYOC) or by combined names such as TIGR/MYOC. Our primary objectives were (1) to identify mutations responsible for glaucoma in members of three families for which we have shown linkage between chromosome 1 GLC1A-region markers and the primary open angle glaucoma (POAG) phenotype, and (2) to determine the relationship of these and other mutations to key points of predicted function and structure of the TIGR/MYOC protein.

METHODS

DNA sequence determination was used to identify sequence changes in sections of the TIGR/MYOC gene that were PCR-amplified from genomic DNA from the probands of three previously-reported GLC1A juvenile-onset POAG families, UM:JG1, UM:JG3, UM:GL57, and unmapped family UM:JG5. Allele-specific oligonucleotide hybridization was used to screen for the identified mutations in PCR-amplified DNA from individual members of each pedigree and from a panel of 11 additional juvenile glaucoma family probands, 42 adult POAG family probands, and 43 normal individuals. Computerized algorithms were used to identify functional motifs and predict structures of normal and mutant forms of the protein.

RESULTS

Sequence changes were found that alter amino acids in the olfactomedin-like domain near the carboxy terminal end of the TIGR protein in affected members of families UM:JG1 (Pro370Leu), UM:JG3 (Val426Phe), UM:GL57 (Glu323Lys) and UM:JG5 (Gly252Arg). Co-segregation of glaucoma and Pro370Leu, Val426Phe, and Gly252Arg in known GLC1A families suggests that these are mutations. Although the Gly252Arg substitution observed in UM:JG5 is non-conservative, it was not possible to distinguish whether it is a mutation or a polymorphism. None of the sequence changes described in these families were observed in other juvenile glaucoma cases in this study, nor in any of the POAG or phenotypically normal individuals tested here. Analysis of amino acid sequence changes resulting from mutations described in this and other works demonstrate localization of many mutations in the vicinity of predicted functional motifs in the olfactomedin-like domain. Identification of rat latrophilin (LPH1/CIRL) as a new member of the olfactomedin-like protein family to which TIGR/MYOC belongs suggests that the region of olfactomedin homology is a protein domain that can occur in different protein contexts.

CONCLUSIONS

Location of mutations described in this and previous work suggests that some specific predicted protein motifs in the olfactomedin-like domain may be important to TIGR/MYOC function. In some cases, the role of TIGR/MYOC in the etiology of glaucoma may result from alteration of the sequences recognized by modifying enzymes such as casein kinase II. In other cases altered protein folding may affect access of enzymes to their target sequences on TIGR/MYOC. Although modifications and structures discussed here are predicted rather than proven, they provide a useful theoretical framework for design of subsequent experiments. Alterations to protein folding and predicted modification motifs cannot explain the pathogenic mechanisms of all of the known TIGR/MYOC glaucoma mutations.

The use of a retinoid receptor antagonist in a new model to study vitamin A-dependent developmental events

Multiple fetal anomalies occur in vitamin A deficient animals as well as in retinoic acid receptor gene 'knockout' mice, indicating that retinoic acid (an active metabolite of vitamin A) performs some essential functions in normal development. Additional approaches are needed to probe directly the stages and sites in the embryo where a presence of endogenous retinoic acid is indispensable. We have employed a new strategy for this purpose which involved an intervention in retinoic acid receptor (RAR)-dependent functions at specific developmental stages by means of a highly effective RAR antagonist, AGN 193109. We report that in an in vitro cell differentiation bioassay, AGN 193109 completely reversed the inhibitory action of a potent RAR agonist, AGN 190121. In pregnant mice, a single oral 1 mg/kg dose of the antagonist given on 8 day post coitum (dpc) produced a severe craniofacial anomaly (median cleft face or frontonasal dysplasia) and eye malformations in virtually all exposed fetuses. On the other hand, treatment on 11 dpc, a time in development when RARs are strategically expressed in the limb bud primordium, no limb anomalies could be induced by the antagonist. Even after a high dose of 100 mg/kg, limb development progressed normally in spite of the fact that measurable concentrations of the antagonist were present. Because retinoids are long known to influence skin morphology, we next monitored the effects of the antagonist on skin development. When given late in gestation, on 14 dpc, we found that the antagonist delayed differentiation and maturation of the fetal skin and hair follicles. We conclude that this model provides a convenient and pertinent system which enables us to seek and clarify true functions of retinoic acid and its cognate receptors in embryogenesis and in adult animals.

Clinical features associated with mutations in the chromosome 1 open-angle glaucoma gene (GLC1A)

BACKGROUND

A substantial proportion of cases of glaucoma have a genetic basis. Mutations causing glaucoma have been identified in the chromosome 1 open-angle glaucoma gene (GLC1A), which encodes a 57-kd protein known as myocilin. The normal role of this protein and the mechanism by which mutations cause glaucoma are not known.

METHODS

We screened 716 patients with primary open-angle glaucoma and 596 control subjects for sequence changes in the GLC1A gene.

RESULTS

We identified 16 sequence variations that met the criteria for a probable disease-causing mutation because they altered the predicted amino acid sequence and they were found in one or more patients with glaucoma, in less than 1 percent of the control subjects. These 16 mutations were found in 33 patients (4.6 percent). Six of the mutations were found in more than 1 subject (total, 99). Clinical features associated with these six mutations included an age at diagnosis ranging from 8 to 77 years and maximal recorded intraocular pressures ranging from 12 to 77 mm Hg.

CONCLUSIONS

A variety of mutations in the GLC1A gene are associated with glaucoma. The spectrum of disease can range from juvenile glaucoma to typical late-onset primary open-angle glaucoma.

Respirator performance ratings for speech intelligibility

A respirator degrades speech intelligibility and thus interferes with the ability of the wearer to communicate. The magnitude of this degradation is not well-studied and can vary as a function of numerous parameters. This study investigated the performance degradation of speech intelligibility in low-level noise for different speaker-listener distances and message sets (single words or predictable sentences) that occurred while wearing a respirator compared with not wearing a respirator. Thirteen speaker-listener pairs with normal hearing and speech were used. Speaker-listener separation distances were 0.61, 1.22, 1.83, 2.44, 3.05, and 3.66 m (2, 4, 6, 8, 10, and 12 ft) for the respirator condition and 1.22, 2.44, 3.05, 6.1, 9.15, and 12.2 m (4, 8, 10, 20, 30, and 40 ft) for the no-respirator condition. The means of the scores were used to determine the speech performance rating for both the single-word and sentence comprehension tests. The performance rating expresses the percentage of performance that can be expected while wearing a respirator compared with not wearing a respirator. Scores were interpolated linearly at distances at which no data were obtained. As expected, the speech performance rating was higher for the sentence comprehension test than for the single-word comprehension test at each distance. At a distance of 12.2 m, the speech performance rating for the sentence comprehension was 70%. For the single-word comprehension test, the speech performance rating was zero for distances greater than 9.1 m.

Sweat rate inside a full-facepiece respirator

The accumulation of sweat inside a full-facepiece respirator mask and the rise in facial skin temperature can be important factors for acceptability of respirators worn in the heat. This study questioned how much sweat would have to be removed from a respirator (if a design to remove accumulated sweat were possible). Results from 20 subjects sitting in a warm, humid environment (35 degrees C and 90% relative humidity) for 90 minutes indicated that the average value was about 0.203 g sweat/min from the face, head, and neck, with most of that coming from the neck region. Men were found to have higher sweating rates than women. The results indicate that a large amount of sweat could accumulate inside the mask over a typical 8-hour day. Average facial skin temperature was found to rise about 2 degrees C over the 90-minutes test, and this rise could likely be the cause of the very uncomfortable rating given to the respirator.

Identification of highly potent retinoic acid receptor alpha-selective antagonists

The syntheses and full retinoid receptor characterization of a novel series of retinoic acid receptor alpha (RAR alpha) antagonists, 1-5, are described. These compounds bind with high affinity to RAR alpha but were completely inactive in gene transactivation. They were also potent and effective antagonists of retinoic acid (RA) induced gene transcription at RAR alpha. Compounds 1-5 exhibited varying degrees of selectivity for RAR alpha relative to RAR beta/gamma, with compound 5 being the most selective in both binding and functional antagonism assays. These compounds will be invaluable tools in delineating the physiological roles of RAR alpha in development and in the adult animal and may themselves be useful therapeutic agents in human diseases associated with RAR alpha.

Effect of altered vision on constant load exercise performance while wearing a respirator

Previous testing has shown that visual acuity greatly influences task performance at light work rate levels. At moderate to heavy work rates, however, the Performance Rating Table (PRT) predicts almost no visual acuity effect. This experiment was performed to determine if the PRT value is realistic. Ten subjects walked on a treadmill at 75-80% of their maximum heart rates until their voluntary end points. Subjects wore various masks of the same kind, each with a different set of clouded lenses. Visual acuities, as measured on the Snellen eye chart, were measured before, during, and after exercise. It was found that visual acuity did not influence performance time, and that an average value for a performance rating of 91 must have been influenced by other mask factors besides visual acuity. These other factors are most likely respiratory stress, thermal stress, and other vision elements. The full-facepiece masks used in this study adversely affected visual acuity by about three-quarters of a Snellen line during exercise. Postexercise visual acuities were found to first decrease below pre-exercise values, then become better than pre-exercise values, then decline asymptotically to pre-exercise values.

Retinoid-induced epiphyseal plate closure in guinea pigs

Vitamin A and its derivatives (retinoids) have been known to cause premature epiphyseal closure in humans as an unwanted side effect of chronic treatment. The purpose of the present study was to determine if guinea pigs could serve as an animal model of retinoid-induced epiphyseal plate closure, and to utilize this model to study the mechanism. Weanling male Hartley guinea pigs were treated ip via osmotic pump for up to 14 days with vehicle or 0.50 to 5.5 mg/kg/day of the retinoic acid receptor (RAR)-selective agonist AGN 190121. Histopathological examination of the proximal tibia of AGN 190121-treated guinea pigs revealed a dose-dependent disruption of the epiphyseal plate. The natural retinoids all-trans-retinoic acid and 13-cis-retinoic acid also induced epiphyseal plate closure in guinea pigs when administered by ip injection for 10 days. Prominent histological features of retinoid-induced epiphyseal closure included the loss of basophilic staining in the extracellular matrix of epiphyseal plate chondrocytes and the invasion of the epiphyseal plate by osteoclasts. To determine if the epiphyseal closure detected histologically was reversible, guinea pigs were treated for 6 days with the RAR-selective agonist (E)-4[2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthyl)propen- 1-y1]benzoic acid (TTNPB) or vehicle, and groups of guinea pigs were euthanized on Day 7 or 57. TTNPB but not vehicle treatment caused histological evidence of epiphyseal closure at both time points, and significant bone elongation between Day 7 and Day 57 was detected only in vehicle-treated animals. Epiphyseal closure and other toxic effects of TTNPB were blocked by cotreatment of guinea pigs with a fivefold molar excess of AGN 193109, an RAR antagonist. Taken together, these data demonstrate the utility of the guinea pig as an animal model of retinoid-induced epiphyseal closure and suggest that RAR activation is necessary and sufficient for this activity.

Retinoid-induced hypertriglyceridemia in rats is mediated by retinoic acid receptors

Retinoids in clinical use today are known to induce hypertriglyceridemia as one of their major side effects. The purpose of the present study was to determine, in an appropriate animal model, if retinoid-induced hypertriglyceridemia is mediated by retinoic acid receptors (RARs) and/or by retinoid X receptors (RXRs). Oral gavage of male Fischer rats with 13-cis-retinoic acid for 6 days caused a rapid and sustained increase in serum triglycerides that was reversible within 4 days posttreatment. In subsequent experiments, rats were treated by gavage once daily for 3 days with various retinoids, and serum triglyceride levels were determined 24 hr after the last treatment without fasting. All-trans- and 13-cis-retinoic acid, which can be converted to both RAR and RXR agonists, and 9-cis-retinoic acid, an RAR/RXR pan-agonist, caused dose-dependent increases in serum triglycerides at doses that did not cause weight loss or mucocutaneous toxicity. Ro 13-6298 and AGN 190121, two RAR-specific agonists, caused dose-dependent increases in serum triglycerides, although Ro 13-6298 only induced hypertriglyceridemia at weight-suppressive doses. Two RXR-selective agonists, LG100268 and AGN 191701, failed to induce hypertriglyceridemia or weight loss up to the highest doses tested. A structural isomer of AGN 190121 that does not activate RARs or RXRs, AGN 190727, did not induce hypertriglyceridemia. Hypertriglyceridemia induced by AGN 190121 was significantly inhibited by cotreatment with an RAR-selective antagonist, AGN 193109. Taken together, these data provide strong evidence that retinoid-induced hypertriglyceridemia is mediated, at least in part, by RARs. These data also suggest that RXR-specific agonists may have reduced potential to induce hypertriglyceridemia relative to RAR-active retinoids.

Identification and functional separation of retinoic acid receptor neutral antagonists and inverse agonists

Inverse agonists are ligands that are capable of repressing basal receptor activity in the absence of an agonist. We have designed a series of C-1-substituted acetylenic retinoids that exhibit potent antagonism of retinoic acid receptor (RAR)-mediated transactivation. Comparison of these related retinoid antagonists for their ability to repress basal RAR transcriptional activity demonstrates that the identity of the C-1 substituent differentiates these ligands into two groups: RAR inverse agonists and neutral antagonists. We show that treatment of cultured human keratinocytes with a RAR inverse agonist, but not a RAR neutral antagonist, leads to the repression of the serum-induced differentiation marker MRP-8. While RAR-selective agonists also repress expression of MRP-8, cotreatment with a RAR inverse agonist and a RAR agonist results in a mutual repression of their individual inhibitory activities, indicating the distinct modes of action of these two disparate retinoids in modulating MRP-8 expression. Our data indicate that RARs, like beta2-adrenoreceptors, are sensitive to inverse agonists and that this new class of retinoids will provide insight into the molecular mechanisms of RAR function in skin and other responsive tissues.

Probable exclusion of GLC1A as a candidate glaucoma gene in a family with middle-age-onset primary open-angle glaucoma

PURPOSE

To determine whether an adult-onset variety of primary open-angle glaucoma in family UM:POAG1 is linked to the previously mapped GLC1A juvenile-onset primary open-angle glaucoma locus on chromosome 1q or whether linkage can be excluded.

METHODS

Microsatellite repeat markers from the 9 cM D1S196 to D1S218 interval containing the GLC1A gene were amplified by polymerase chain reaction from DNA samples collected from 11 members of one sibship in family UM:POAG1. Haplotype analysis was carried out, including calculation of the probability that the observed data would have been obtained if the underlying cause of primary open-angle glaucoma in this family were a defect in a gene located in the tested interval. Linkage analysis was carried out under an autosomal dominant model for GLC1A glaucoma.

RESULTS

In family UM:POAG1, primary open-angle glaucoma was diagnosed in six surviving and one deceased member of a sibship of 13 individuals during the fifth or sixth decade of life. Glaucoma in this family has a later average age at diagnosis and significantly less elevation in intraocular pressure than GLC1A glaucoma so far described. Haplotype analysis, using a population prevalence up to 0.9%, shows that it is unlikely that the reported data would have been observed if primary open-angle glaucoma in this pedigree were due to the GLC1A locus on chromosome 1q21-q31. Linkage analysis under the juvenile glaucoma autosomal dominant model allowed exclusion of linkage across the entire GLC1A genetic inclusion interval, with a maximum lod score in the interval of -3.28.

CONCLUSION

The most likely interpretation of these observations is that a defect in the GLC1A glaucoma gene is not responsible for adult-onset primary open-angle glaucoma in family UM:POAG1. This suggests the existence of at least two primary open-angle glaucoma genes, the previously reported GLC1A gene on chromosome 1q and another gene located elsewhere in the genome. Diagnosis of UM:POAG1 glaucoma between 42 and 57 years of age also raises questions regarding the relation of the glaucoma present in this family to the common later-age-onset form of the disease.