Effect of functional excipients on the dissolution and membrane permeation of furosemide formulated into multiple-unit pellet system (MUPS) tablets

The effect of functional excipients (i.e. chitosan, sodium lauryl sulphate, NaHCO₃, and CaCO₃) formulated in multiple-unit pellet system (MUPS) tablets has been investigated on the dissolution and permeability of furosemide, a BCS class IV compound. Spherical beads were produced and compressed into MUPS tablets. MUPS tablet formulations were evaluated for hardness, disintegration, mass variation, friability, and dissolution (pH 1.2, pH 4.6, and pH 7.4). Ex vivo permeability studies were conducted across excised pig tissues (pyloric antrum and duodenal region) on selected experimental MUPS tablet formulations. Histological analysis was conducted on the tissues after exposure to selected experimental MUPS tablet formulations. Dissolution results in the 0.1 M HCl (pH 1.2) showed the highest effect of the excipients on furosemide release. Dissolution parameters showed increased dissolution of furosemide for the MUPS tablet formulations containing functional excipients: a 4.5-10-fold increase in the AUC values, the %_max showed a 60-70% increase and up to a 19-fold increase in DRi was seen. Permeability results revealed a 2.5-fold higher cumulative percentage transport for selected formulations. The results proved that functional excipients incorporated into beads, compressed into MUPS tablet formulations increased furosemide release as well as permeation across excised intestinal tissues.

Impact of Magnetic Field Configuration on Heat Transport in Stellarators and Heliotrons

We assess the magnetic field configuration in modern fusion devices by comparing experiments with the same heating power, between a stellarator and a heliotron. The key role of turbulence is evident in the optimized stellarator, while neoclassical processes largely determine the transport in the heliotron device. Gyrokinetic simulations elucidate the underlying mechanisms promoting stronger ion scale turbulence in the stellarator. Similar plasma performances in these experiments suggests that neoclassical and turbulent transport should both be optimized in next step reactor designs.

Estimating the diagnostic accuracy of the ankle-brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta-analysis

AIM

To systematically evaluate research investigating the accuracy of the ankle-brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort.

METHODS

A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta-analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed.

RESULTS

Thirty-three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72.

CONCLUSIONS

These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort.

1003 Sleep Spindle Abnormalities In Youth With Ptsd

Introduction

Sleep disturbance is central to the phenomenology of PTSD across the lifespan with up to 90% of youth with PTSD reporting sleep disturbance. Subjective sleep dysfunction has also been linked to the development, maintenance and severity of the disorder. However, to date there have been no objective EEG assessments of sleep in youth with PTSD, and little is known about how the disease impacts specific sleep features.

Methods

Ten youth with PTSD (aged 14.5±3.2; CAPS-CA score 60.5±25.3) and ten age-and sex-matched typically developing youth (TD) (aged 14.7±3.2) completed two non-consecutive overnight high-density EEG (256-channel) polysomnography sleep studies. Prior to sleep on one night, participants performed an emotion processing task. Group differences in sleep macrostructure variables were assessed with two-way ANOVA, and group differences in all-night spectral density were assessed using unpaired t-tests. An automatic algorithm was used to detect spindle amplitude, duration, and density topographically. Statistical non-parametric mapping (SnPM) cluster testing was used to determine significantly different topographic differences between groups.

Results

No significant group differences were observed in sleep macrostructure variables. All-night spectral density analysis revealed increased power in PTSD youth relative to TD youth in the sigma band on both task and baseline nights. PTSD youth showed higher spindle duration, higher integrated spindle activity, and higher spindle amplitude globally both nights relative to TD youth. The increase in spindle duration achieved significance in a robust frontal cluster on both nights (43-channel cluster (p = .044) on baseline night, 66-channel cluster (p = .019) on task night).

Conclusion

Structural and functional abnormalities of the prefrontal cortex are a prominent feature of pediatric PTSD. The observed increase in spindle duration may represent another marker of impaired cortical function in youth with PTSD reflecting a failure of cortical inhibition of the thalamically-generated spindle rhythm.

Support

K08 MH100267 to RH, Wisconsin Institute for Sleep and Consciousness Pilot Award to SJ

A pilot study evaluating chemotherapy tolerability for breast cancer patients who have received prior treatment and chest radiation for Hodgkin Lymphoma

MICROABSTRACT

Women treated with chest radiation for Hodgkin lymphoma (HL) have significantly higher risk of developing breast cancer, and little is known about how these patients tolerate chemotherapy for breast cancer. This small retrospective study identified 15 patients, noting that these patients tolerate proposed chemotherapy regimens for breast cancer in rates similar to those without prior HL and therapeutic radiation.

PURPOSE

Women treated for Hodgkin lymphoma (HL) with chest radiation have significantly higher risk of developing breast cancer, and little is known about how these patients tolerate chemotherapy for breast cancer.

METHODS

Women with breast cancer diagnosed from 1986-2015 after radiation for HL were identified from hospitals and clinics in St. Paul and Minneapolis, Minnesota. Patient, tumor and treatment characteristics, and clinical outcomes were abstracted from medical records and summarized using descriptive statistics. Chemotherapy was defined as tolerated if all scheduled doses and cycles were completed without deviation from the initial plan, with lack of grade 3 or higher toxicity attributable to chemotherapy in categories including blood, cardiac, gastrointestinal, fatigue and pain.

RESULTS

Forty-two patients with breast cancer and prior radiation for HL were identified, 15 of which received chemotherapy for breast cancer. We noted 75% tolerability of taxane-based and 100% tolerability of anthracycline-based chemotherapy, suggesting that most patients with prior radiation for HL tolerate chemotherapy for breast cancer. A subset of patients (N = 7) in this study were also treated with chemotherapy for HL prior to breast cancer diagnosis, and 86% (6 of 7) also tolerated chemotherapy for breast cancer.

CONCLUSIONS

Treatment of breast cancer is strongly influenced by prior treatment of HL. Although this study was small and did not meet statistical significance, the data suggest that these patients tolerate proposed chemotherapy regimens for breast cancer in rates similar to those without prior HL and therapeutic radiation. Larger studies comparing specific chemotherapy dosing schedules are needed to address this complicated population.

Initiating patient discussions about oocyte cryopreservation: Attitudes of obstetrics and gynaecology resident physicians

This study examined the attitudes of obstetrics and gynaecology (OB/GYN) resident physicians to initiating patient discussions regarding medical and elective oocyte cryopreservation (OC). The study used a cross-sectional online survey of OB/GYN medical residents in the USA, sampled from residency programmes approved by the American Council for Graduate Medical Education. In total, 208 medical residents, distributed evenly between postgraduate years 1-4, participated in the study. Residents' fertility knowledge and attitudes to initiating discussions about OC were gathered. Forty percent (n = 83) believed that OB/GYN residents should initiate discussions about OC with patients (initiators), while 60% (n = 125) did not (non-initiators). Initiators were less likely to overestimate the age at which a woman's fertility begins to decline, and were more likely to believe that discussions about OC and age-related fertility decline should take place during a well-woman annual examination. Initiators and non-initiators did not differ in their attitudes towards discussing OC with patients undergoing cancer treatments; however, initiators were significantly more likely to discuss elective OC with patients who were currently unpartnered or who wished to delay childbearing to pursue a career. Given the increasing age of childbearing among women, and the fact that women prefer to receive reproductive information from their healthcare providers, it is critical that such topics are discussed in consultations to assist patients in making more informed reproductive decisions. Further research is needed to assess the existing barriers to these discussions from both physician and patient perspectives.

Early patient-reported outcomes versus objective function after total hip and knee arthroplasty: a prospective cohort study

AIMS

The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy).

PATIENTS AND METHODS

A total of 80 patients aged 55 to 80 years undergoing THA or TKA for osteoarthritis were included in this prospective cohort study. The main outcome measure was change in patient reported hip or knee injury and osteoarthritis outcome score (HOOS/KOOS) from pre-operatively until post-operative day 13 (THA) or 20 (TKA). Secondary measures were correlations to objectively assessed change in physical performance (paced-walk, chair-stand, stair-climb tests) at day 14 (THA) or 21 (TKA) and actual physical activity (actigraphy) measured at day 12 and 13 (THA) or 19 and 20 (TKA).

RESULTS

Patients reported improved physical function (HOOS or KOOS) pre-operatively until day 13 (THA) or 20 (TKA) with a mean difference of 7 (95% confidence interval (CI) 1 to 13, p = 0.033) and 6 (95% CI 1 to 12, p = 0.033) percentage points, respectively. By contrast, objectively assessed physical function and activity declined, with no correlations between subjective and objective assessments for either THA or TKA patients (r² ≤ 0.16, p ≥ 0.314).

CONCLUSIONS

Early improvement in patient-reported physical function after THA/TKA does not correlate with objectively assessed function, and patient reported outcomes should not be used as the only measure of recovery. Cite this article: Bone Joint J 2017;99-B:1167-75.

An Overview of Mechanisms of Cry Toxin Resistance in Lepidopteran Insects

Arthropods have the capacity to evolve resistance to insecticides and insecticidal traits in genetically modified crops. Resistance development among Lepidoptera is a common phenomenon, and a repertoire of resistance mechanisms to various Cry toxins have been identified from laboratory, greenhouse, and field studies in this insect order. Elucidation of such resistance mechanisms is crucial for developing IRM (insect resistance management) strategies to ensure sustainable use of genetically modified crops. This mini review provides a comprehensive overview of mechanisms of resistance that have been reported for lepidopteran pests. This study demonstrated that resistance mechanisms are highly complex, and the most common mechanism of resistance is altered binding sites. It is yet to be established whether all these altered binding sites are regulated by an MAPK signaling pathway, which might suggest a universal mechanism of resistance in lepidopterans.

Abstract P5-08-12: HER2 status remains the primary predictor of improved survival in patients with BCBM over the past 2 decades (1996-2015)

BACKGROUND: Brain metastasis is a complication in advanced breast cancer (ABC) and is associated with poor prognosis. Incidence of breast cancer brain metastasis (BCBM) is increasing with advances in therapy, allowing patients to survive long enough to develop CNS metastasis. Improved outcomes have been documented in ABC over the past decades, largely related to the use of trastuzumab in HER2+ ABC. However, it remains unclear whether survival has improved in HER2- ABC in patients with BCBM. This study asks: has the improvement in systemic and radiotherapies for HER2- breast cancer impacted survival in patients with breast cancer brain metastasis.

OBJECTIVES: 1) To estimate whether date of BCBM diagnosis is associated with overall survival (OS) in patients diagnosed between 1996-2015. 2) To estimate whether OS of this patient population depends upon other demographic and clinical factors.

METHODS: This is a retrospective chart review of patients with diagnosis of BCBM between 1996-2015. Data collection includes: age at BCBM diagnosis, ethnicity, ER/PR/HER2 status, date of BCBM diagnosis, date of primary breast cancer diagnosis, date of death/last clinical follow-up, and treatment. Kaplan-Meier analysis and the log-rank test compared OS (time from diagnosis of BCBM until death or last clinical FU) between groups diagnosed in 5-year cohorts (1996-2000, 2001-2005, 2006-2010, 2011-2015). A univariate proportional hazards model was used to regress OS on date of diagnosis. A multivariate proportional hazards model was used which included the subset of patients diagnosed with BCBM in 2001 and later. This model adjusted for additional factors: race, time to development of BCBM diagnosis, age at the time of BCBM diagnosis, year of diagnosis as a continuous factor, ER, PR, while testing the significance of HER2 status. A p-value &lt; 0.05 was significant.

RESULTS: A total of 165 patients with BCBM were included in this analysis, with a median age of 53.8 (SD 13.0) at time of BCBM diagnosis. Most patients were Caucasian (66%; 109/165) or African-American (29%; 48/165). Although statistical significance was not attained, greater median overall survival was seen for patients diagnosed with BCBM in more recent 5-year cohorts (2011-2016, 9.5 months; 2006-2010, 8 months) than patients in older cohorts (2001-2006, 3.6 months; 1996-2000, 5.3 months), p=0.3. Date of diagnosis of BCBM as a continuous variable is predictive of overall survival (HR 0.83 [95% CI: 0.71-0.97] comparing 5-year intervals, p=0.016). After adjusting for the covariates listed above, HER2 positive status is predictive of overall survival (HR 0.34 [95% CI: 0.34-0.56]; p&lt;0.0001).

CONCLUSIONS: While survival has improved by 5.9 months over the past two decades, it remains highly dependent on HER2 status. Novel therapies for BCBM are greatly needed for ER+ and triple negative subtypes. Final results will include an expanded analysis to incorporate additional cases and three other categorical covariates measured during follow-up: whether the patient received radiotherapy, surgery, and/or medical therapy after diagnosis of brain metastases.

GRANT FUNDING: TL-1 CTSA Pre-Doctoral Training Grant (5TL1TR001116-03).

Citation Format: Narloch JL, Harnden K, Broadwater G, Peterson B, Hyslop T, Kirkpatrick J, Fecci P, Kim G, Blackwell KL. HER2 status remains the primary predictor of improved survival in patients with BCBM over the past 2 decades (1996-2015) [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 P5-08-12.

Keratinocyte Carcinoma as a Marker of a High Cancer-Risk Phenotype

Keratinocyte carcinoma (KC) (also referred to as nonmelanoma skin cancer) is by far the most common form of human cancer. A personal history of KC is well established to be associated with increased risk of recurrent KC and malignant melanoma, a less common yet more fatal form of skin cancer. More surprising is that a substantial body of epidemiologic evidence now indicates that a personal history of KC is significantly associated with an overall elevated risk of noncutaneous malignancies. This association is not limited to one or a few types of cancer but applies across many different types of malignancy. This association has been consistently observed in prospective studies across genders for both major histologic types of KC, basal cell carcinoma and squamous cell carcinoma. The risk of other cancers has been even stronger in those with younger compared with older age of onset of KC. A robust body of evidence lends support to the notion that KC may be a marker of a high cancer-risk phenotype. The underlying mechanisms for this association remain to be elucidated, but the cross-cutting nature of this association across numerous malignancies suggests that research to uncover these mechanisms is a promising line of inquiry that could potentially yield valuable insight into human carcinogenesis.

Knowledge, attitudes, and intentions toward fertility awareness and oocyte cryopreservation among obstetrics and gynecology resident physicians

STUDY QUESTION

What knowledge, attitudes and intentions do US obstetrics and gynecology (OB/GYN) residents have toward discussing age-related fertility decline and oocyte cryopreservation with their patients?

SUMMARY ANSWER

Most OB/GYN residents believe that age-related fertility decline, but not oocyte cryopreservation, should be discussed during well-woman annual exams; furthermore, nearly half of residents overestimated the age at which female fertility markedly declines.

WHAT IS KNOWN ALREADY

Oocyte cryopreservation can be utilized to preserve fertility potential. Currently, no studies of US OB/GYN residents exist that question their knowledge, attitudes, and intentions toward discussing age-related fertility decline and oocyte cryopreservation with patients.

STUDY DESIGN, SIZE, DURATION

A cross-sectional online survey was conducted during the fall of 2014 among residents in American Council for Graduate (ACOG) Medical Education-approved OB/GYN residency programs. Program directors were emailed via the ACOG Council on Resident Education in Obstetrics and Gynecology server listing and asked to solicit resident participation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants included 238 residents evenly distributed between post-graduate years 1-4 with varied post-residency plans; 90% of residents were women and 75% were 26-30 years old. The survey was divided into three sections: demographics, fertility awareness, and attitudes toward discussing fertility preservation options with patients. Descriptive and inferential statistics were conducted.

MAIN RESULTS AND THE ROLE OF CHANCE

A strong majority of residents (83%) believed an OB/GYN should initiate discussions about age-related fertility decline with patients (mean patient age 31.8), and 73% percent believed these discussions should be part of an annual exam. One third of residents overestimated the age at which there is a slight decline in female fertility, while nearly half of residents overestimated the age at which female fertility markedly declines. Over three-quarters of residents (78.4%) also overestimated the likelihood of success using assisted reproductive treatments (ARTs). Residents were likely to support oocyte cryopreservation in cancer patients irrespective of the woman's age, but much less likely to support elective oocyte cryopreservation. For elective oocyte cryopreservation, 40% believed OB/GYNs should initiate discussions with patients (mean age 31.1), while only 20% believed this topic should be part of an annual exam.

LIMITATIONS, REASONS FOR CAUTION

Because the study invitation was sent through US OB/GYN residency program directors rather than directly to residents, it is possible that some residents did not receive the invitation to participate. This limits the generalizability of the findings.

WIDER IMPLICATIONS OF THE FINDINGS

Within the USA, there appears to be a critical need for improved education on fertility decline in OB/GYN residency programs. To promote informed reproductive decision-making among patients, efforts should be made to help OB/GYNs provide comprehensive fertility education to all women, while also respecting patient choices.

STUDY FUNDING/COMPETING INTERESTS

None.

Limacina helicina shell dissolution as an indicator of declining habitat suitability owing to ocean acidification in the California Current Ecosystem

Few studies to date have demonstrated widespread biological impacts of ocean acidification (OA) under conditions currently found in the natural environment. From a combined survey of physical and chemical water properties and biological sampling along the Washington-Oregon-California coast in August 2011, we show that large portions of the shelf waters are corrosive to pteropods in the natural environment. We show a strong positive correlation between the proportion of pteropod individuals with severe shell dissolution damage and the percentage of undersaturated water in the top 100 m with respect to aragonite. We found 53% of onshore individuals and 24% of offshore individuals on average to have severe dissolution damage. Relative to pre-industrial CO2 concentrations, the extent of undersaturated waters in the top 100 m of the water column has increased over sixfold along the California Current Ecosystem (CCE). We estimate that the incidence of severe pteropod shell dissolution owing to anthropogenic OA has doubled in near shore habitats since pre-industrial conditions across this region and is on track to triple by 2050. These results demonstrate that habitat suitability for pteropods in the coastal CCE is declining. The observed impacts represent a baseline for future observations towards understanding broader scale OA effects.

A soft x-ray transmission grating imaging-spectrometer for the National Ignition Facility

A soft x-ray transmission grating spectrometer has been designed for use on high energy-density physics experiments at the National Ignition Facility (NIF); coupled to one of the NIF gated x-ray detectors it records 16 time-gated spectra between 250 and 1000 eV with 100 ps temporal resolution. The trade-off between spectral and spatial resolution leads to an optimized design for measurement of emission around the peak of a 100-300 eV blackbody spectrum. Performance qualification results from the NIF, the Trident Laser Facility and vacuum ultraviolet beamline at the National Synchrotron Light Source, evidence a <100 μm spatial resolution in combination with a source-size limited spectral resolution that is <10 eV at photon energies of 300 eV.

Analysis of molecular markers for metamorphic competency and their response to starvation or feeding in the mosquito, Aedes aegypti (Diptera: Culicidae)

The nutritional condition of fourth instar larvae of the yellow fever mosquito, Aedes aegypti, governs female longevity and egg production, both are key determinants of pathogen transmission. As well, nutrition provisions larval growth and development and attains its greatest pace in the last larval instar in preparation for metamorphosis to an adult. These developmental processes are regulated by a complex endocrine interplay of juvenile hormone, neuropeptides, and ecdysteroids that is nutrition sensitive. We previously determined that feeding for only 24h post-ecdysis was sufficient for fourth instar Ae. aegypti larvae to reach critical weight and accumulate sufficient nutritional stores to commit to metamorphosis. To understand the genetic basis of metamorphic commitment in Ae. aegypti, we profiled the expression of 16 genes known to be involved in the endocrine and nutritional regulation of insect metamorphosis in two ways. The first set is a developmental profile from the beginning of the fourth instar to early pupae, and the second set is for fourth instars starved or fed for up to 36 h. By comparing the two sets, we found that seven of the genes (AaegCYP302, AaegJHE43357, AaegBrCZ4, AaegCPF1-2, AaegCPR-7, AaegPpl, and AaegSlif) were expressed during metamorphic commitment in fourth instars and in fed but not starved larvae. Based on these results, the seven genes alone or in combination may serve as molecular indicators of nutritional and metamorphic status of fourth instar Ae. aegypti larvae and possibly other mosquito species in field and laboratory studies to gauge sub-lethal effects of novel and traditional cultural or chemical controls.

Primary CNS plasmablastic lymphoma: report of a case with CSF cytology, flow cytometry, radiology, histological correlation, and review of the literature

Plasmablastic lymphoma (PBL) is a rare subtype of diffuse large B cell lymphoma and commonly presents as an oral mass in HIV patients. Extraoral PBL has been reported, including one case of primary central nervous system PBL (PCNSPBL). The cytological features of PBL have been described, including cerebrospinal fluid (CSF) cytology findings for secondary CNS involvement by PBL. The etiology of PCNSPBL is still unknown. We report here the CSF cytology of a PCNSPBL, which shows a hypercellular specimen composed of markedly atypical, singly dispersed plasmacytoid cells with frequent abnormal mitoses and binucleation. The neoplastic cells are positive for CD138. Flow cytometry of the CSF specimen demonstrates a monoclonal neoplastic cell population, which is CD138 positive, kappa light chain positive, lambda light chain negative, and CD19 negative. Molecular analysis and immunohistochemical stains on a tissue biopsy confirmed the diagnosis and reveal concurrent infections with Epstein-Barr virus and human polyomavirus JC virus. Clinical and radiological correlations are reported, and the literature is reviewed. To the best of our knowledge, this is the first case report for CSF cytology of a PCNSPBL, demonstrating the utility of the cytological examination in the triage and diagnosis of this disease. Because of its dismal prognosis, it is critical for cytopathologists to be aware of the entity and recognize the neoplastic cells in CSF specimen. This report also emphasizes the importance of clinical and radiological correlation in the diagnosis of this lethal disease.

Improved calibration technique of the infrared imaging bolometer using ultraviolet light-emitting diodes

The technique used until recently utilizing the Ne-He laser for imaging bolometer foils calibration [B. J. Peterson et al., J. Plasma Fusion Res. 2, S1018 (2007)] has showed several issues. The method was based on irradiation of 1 cm spaced set of points on a foil by the laser beam moved by set of mirrors. Issues were the nonuniformity of laser power due to the vacuum window transmission nonuniformity and high reflection coefficient for the laser. Also, due to the limited infrared (IR) window size, it was very time consuming. The new methodology uses a compact ultraviolet (uv) light-emitting diodes installed inside the vacuum chamber in a fixed position and the foil itself will be moved in the XY directions by two vacuum feedthroughs. These will help to avoid the above mentioned issues due to lack of a vacuum window, fixed emitters, higher uv power absorption, and a fixed IR camera position.

51 DELAYED NUCLEOLOGENESIS IN PORCINE PREIMPLANTATION EMBRYOS DEVELOPED IN VIVO AND PRODUCED BY SOMATIC CELL NUCLEAR TRANSFER

Nucleolus is known to be a well-suited morphological marker for embryo technologies. Failure in de novo nucleolar formation during embryonic genome activation (EGA) has been observed in many species. The aim of the present study was to investigate nuclear changes and nucleolar formation during EGA in the porcine preimplantation embryos developed in vivo and produced by somatic cell nuclear transfer (SCNT). Embryos were collected at early and late 1-cell stage, 2-, 4-, and 8-cell stage, early and late blastocyst stage, fixed in 3% glutaraldehyde for 1 h, and processed for transmission electron microscopy. In vivo embryos from 1- and 2-cell stages showed electron dense, spherical nucleolar precursor bodies (NPB) in centrally located nuclei with well-developed nuclear envelope and condensed chromatin. Two 1-cell-stage embryos, however, had represented metaphase chromosomes in the periphery. At the 4-cell stage, in vivo embryos displayed fibrillo-granular nucleoli containing all 3 functional nucleolar compartments: fibrillar centers (FC), dense fibrillar component (DFC), and granular component (GC). The nuclei were centrally located, round, and had complete nuclear envelopes. The same types of nuclei and nucleoli were observed for all following stages. On the other hand, embryos produced by SCNT at early 1-cell stage showed centrally located, irregular-shaped nuclei with incomplete nuclear envelopes and condensed chromatin with large intact NPB. Exceptionally, 1 out of the 5 embryos presented a peripheral nucleus with partially condensed chromatin lacking nuclear envelope and fibrillo-granular nucleolus probably persisting from donor fibroblast. Only 2 out of 5 late-1-cell SCNT embryos showed nuclear structures. The nuclei had irregular shapes, complete nuclear membranes, and contained large NPB. At the 2- and 4-cell stages, the embryos presented central nuclei with complete nuclear envelopes. Some of the embryos showed more than one nucleus of varying shapes and sizes. The fibrillo-granular nucleoli were first observed toward the 8-cell stage. The embryos from this stage contained irregularly shaped nuclei with well-developed nuclear envelopes. The nucleoli displayed fibrillar and granular compartments in SCNT 8-cell stage embryos, but lacked the typically structured functional nucleoli observed in in vivo embryos. The absence of formation of functional nucleoli at the 4-cell stage and altered nuclear ultrastructure during the EGA in SCNT embryos, thus, may be one of the main reasons for decreased developmental competence of SCNT embryos.

Quantitative measures of presence in virtual environments: the roles of attention and spatial comprehension

Given that the best measures of presence currently available are subjective self-assessments, it is desirable to attempt to develop reliable, repeatable, quantitative measures. We present the results of two experiments intended to separate presence into measurable subcomponents: attention and spatial comprehension. The first experiment was a conventional dual-task study where we measured attentional demands of competing.virtual and real world experiences. The results suggest that attention may be a reasonable quantitative measure of presence. The study also showed that the use of sound increased the level of engagement experienced by participants. The second study attempted to correlate spatial knowledge acquisition with presence. The only component of spatial knowledge acquisition that was positively affected was landmark knowledge that improved with the addition of semantic verbal information. The data does not generally support a relationship between spatial comprehension and presence, but, again, it was found that the use of sound increased participants' sense of engagement in the virtual world. There are certainly other candidate subcomponents of presence, but we began our investigation here. An expanded investigation toward the development of an aggregate quantitative measure of presence is suggested.

A prospective multicenter phase II trial of systemic ADH-1 in combination with melphalan via isolated limb infusion (M-ILI) in patients with advanced extremity melanoma

9025^

Background: ILI with melphalan dosing corrected for ideal body weight (IBW) is a well tolerated treatment for patients with in-transit extremity melanoma with an approximate 30% CR and 44% overall response rate. ADH-1 is a cyclic pentapeptide that disrupts N-cadherin adhesion complexes. ADH-1 when given systemically in a preclinical model with regional melphalan demonstrated synergistic antitumor activity and had minimal toxicity in a Phase I trial with M-ILI. Methods:AJCC stage IIIB or IIIC extremity melanoma patients were treated with 4000mg of ADH-1 administered systemically on Day 1 and 8 in addition to standard dose M-ILI corrected for IBW on Day 1. Drug pK, and N-cadherin IHC staining were performed on pretreatment tumor from all patients. The primary endpoint was response at 12 weeks determined by modified RECIST. Results: 46 patients were enrolled over 15 months at 4 institutions. Thirty-four patients are presently evaluable for 12 week response. In field responses include 14 CRs (41.2%%), 9 PRs (26.5%), 5 SDs (14.7%), and 6 PDs (17.6%). The OR rate was 67.7% and at a median follow-up of 30 weeks, 8 patients have sustained CRs over 6 months. Of 34 patients, 9 have developed disease outside the region of infusion (median time to progression 12 weeks) at median follow-up 36 weeks. N-cadherin was detected in 20 of 25 (80%) pretreatment tumor samples. Grade IV toxicities included CPK elevation (4), neutropenia (1), acute respiratory distress syndrome (1), pneumonitis (1), and pulmonary infiltrate (1). There were no limb losses or compartment syndromes. Conclusions:This study is not only the first prospective multi-center ILI trial but also the first ILI study to incorporate a targeted agent in an attempt to augment anti-tumor responses. The treatment was well tolerated with CR and OR rates that appear to be significantly improved from standard M-ILI alone. Targeting N-cadherin may represent a novel strategy for improving melanoma sensitivity to chemotherapeutic agents and warrants further investigation in a large randomized multi-center trial.

[Table: see text]

ASCO Conflict of Interest Policy and Exceptions

In compliance with the guidelines established by the ASCO Conflict of Interest Policy (J Clin Oncol. 2006 Jan 20;24[3]:519–521) and the Accreditation Council for Continuing Medical Education (ACCME), ASCO strives to promote balance, independence, objectivity, and scientific rigor through disclosure of financial and other interests, and identification and management of potential conflicts. According to the ASCO Conflict of Interest Policy, the following financial and other relationships must be disclosed: employment or leadership position, consultant or advisory role, stock ownership, honoraria, research funding, expert testimony, and other remuneration (J Clin Oncol. 2006 Jan 20;24[3]:520). The ASCO Conflict of Interest Policy disclosure requirements apply to all authors who submit abstracts to the Annual Meeting.

For clinical trials that began accrual on or after April 29, 2004, ASCO's Policy places some restrictions on the financial relationships of principal investigators (J Clin Oncol. 2006 Jan 20;24[3]:521). If a principal investigator holds any restricted relationships, his or her abstract will be ineligible for placement in the 2009 Annual Meeting unless the ASCO Ethics Committee grants an exception. Among the circumstances that might justify an exception are that the principal investigator (1) is a widely acknowledged expert in a particular therapeutic area; (2) is the inventor of a unique technology or treatment being evaluated in the clinical trial; or (3) is involved in international clinical oncology research and has acted consistently with recognized international standards of ethics in the conduct of clinical research. NIH-sponsored trials are exempt from the Policy restrictions. Abstracts for which authors requested and have been granted an exception in accordance with ASCO's Policy are designated with a caret symbol (^) in the Annual Meeting Proceedings.

For more information about the ASCO Conflict of Interest Policy and the exceptions process, please visit www.asco.org/conflictofinterest .

A phase I study of systemic sorafenib in combination with isolated limb infusion with melphalan (ILI-M) in patients (pts) with locally advanced in-transit melanoma

9065

Background: Sorafenib is a multi-kinase inhibitor that may also enhance the cytotoxicity of concurrently administered chemotherapy. In a preclinical model of regionally advanced melanoma, the combination of systemic Sorafenib and regional melphalan led to augmented tumor responses. Methods: A Phase I multicenter study was performed to evaluate the safety and pharmacokinetics (PK) of systemic Sorafenib in combination with ILI-M in patients with measurable in-transit melanoma of the extremity. Sorafenib dose escalation cohorts consisted of 200mg, 300mg, and 400mg administered systemically twice daily for one week prior and one week after a standard dose ILI-M corrected for ideal body weight. Tumor biopsies pre-therapy and pre-ILI were obtained to assess molecular changes associated with Sorafenib pretreatment. Response was defined at 3 months using RECIST. Results: Nine pts with high disease burden, including 7 previous ILI-M alone failures, have been treated; 3 in the first cohort and 6 in the second cohort. There were no grade 5 toxicities. Four patients had CTCAE Grade 4 toxicities including neutropenia (2), CPK elevation (1), and skin ulceration (1). In the remaining 5 patients, there were no >grade 3 toxicities. The maximally tolerated dose (MTD) has not yet been defined. Initial in field response determination in 6 of the 9 patients out at least 3 months includes 2 partial responses and 4 disease progressions. Conclusions: Systemic Sorafenib administered pre and post ILI-M is a well tolerated, novel targeted therapy approach to regionally advanced melanoma. An additional 10 patients will be enrolled to define the MTD. Correlation of response with drug PK, Sorafenib downregulation of pErk and Mcl1, and a melphalan resistance signature is in progress.

No significant financial relationships to disclose.

Scaphotrapezial arthritis after a carpometacarpal fusion in a patient with Marfan's Syndrome: case report

We report a case of scaphotrapezial arthritis that developed in a patient with Marfan's syndrome many years after a carpometacarpal fusion, which placed the thumb metacarpal in adduction. This problem was effectively treated with an abduction/opposition osteotomy, which both increased the patient's first web space and improved her arthritic symptoms.

Array-based comparative genomic hybridization characterizes a deletion associated with a t(15;17) in acute promyelocytic leukemia

The majority of de novo leukemias are characterized by well-known recurring translocations or inversions. In approximately 2% to 20% of these cases, deletions accompany these rearrangements. Because such deletions are undetectable by G-banding, aberrant fluorescence in situ hybridization (FISH) signal patterns are often the only indication of their presence. Array-based comparative genomic hybridization (a-CGH) permits examination of the entire genome at a resolution unattainable by G-banding or FISH. We present a case of a deletion of the derivative chromosome 17 of a t(15;17) in acute promyelocytic leukemia, the size and gene content of which were characterized by a-CGH. We hypothesize that this patient's more aggressive disease course is due to loss of one or more of these genes. Such submicroscopic deletions involving the t(15;17) have only rarely been reported, and, to our knowledge, this is the first case in which a-CGH has been applied to its characterization.

How durable are behavioral changes? Results from FRESH START: A randomized controlled trial to improve diet and exercise behaviors in breast and prostate cancer survivors

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Background: A healthy diet and regular exercise may improve the health, well-being and ultimate survival of cancer survivors. Last year, results of the FRESH START trial (n=543) were presented at ASCO; significant improvements in diet and exercise behaviors of breast and prostate cancer survivors were observed with two 10-month mailed print interventions - one that was sequentially- tailored and another using non-tailored print materials in the public domain (attention control). While both arms achieved significant improvements, those receiving the tailored intervention reported significantly greater changes (all p-values <.05). The durability of these changes, however, is not known. Methods: At 2-year follow-up, and after a 12-month wash-out, telephone surveys that were conducted at baseline and post-intervention (Diet History Questionnaire and 7-Day Physical Activity Recall) were repeated. Results: Ordinary Least Square analysis suggest that changes from baseline largely remain significant at 2-year follow-up for both interventions (see table ). Moreover, significant differences between arms are observed for dietary fat restriction and the practice of more lifestyle behaviors at goal level [i.e., consumption of ≥ 5 servings/day of fruits & vegetables (F&V), < 30% kcal from fat, and >150 min/week of exercise], with the tailored intervention arm achieving levels superior to those achieved in the attention control arm. Conclusions: Tailored and untailored interventions delivered over a 10-month period to cancer survivors exert durable effects on several lifestyle behaviors. However, the effects of the tailored intervention were initially more powerful and largely sustained over time (especially, with regard dietary fat restriction).

No significant financial relationships to disclose.

[Table: see text]