Determinants of experience & satisfaction in telehealth psychiatry during the COVID-19 pandemic for patients & providers

Introduction

The objective of this study was to characterize the experiences and overall satisfaction of patients and providers with the March 2020 transition to telehealth in a psychiatric setting (telepsychiatry). The study also investigated how socio-demographic and clinical characteristics impact an individual's experiences and satisfaction with telepsychiatry.

Methods

Responses were collected from 604 patients and 154 providers engaged in clinical care at one of three participating Johns Hopkins Medicine outpatient psychiatric clinics between January 2020-March 2021. Survey data were collected by self-report via Qualtrics or telephone follow-up.

Results

Respondents were predominately female and White. Over 70% of patients and providers were generally satisfied with telepsychiatry. However, providers were more likely to favor in-person care over telepsychiatry for post-pandemic care 48% to 17% respectively, while 35% rated both modalities equivalently. Patients were more evenly divided with 45% preferring telepsychiatry compared to 42% for in-person care, and only 13% rating them equivalently. Among providers, technical difficulties were significantly associated with both less satisfaction and lower preference for telepsychiatry [odds ratio for satisfaction (ORS) = 0.12; odds ratio for preference (ORP) = 0.13]. For patients, factors significantly associated with both lower satisfaction and lower preference for telepsychiatry included technical difficulties (ORS = 0.20; ORP = 0.41), unstable access to the internet (ORS = 0.46; ORP = 0.50), worsening depression (ORS = 0.38; ORP = 0.36), and worsening anxiety (ORS = 0.41; ORP = 0.40). Factors associated with greater satisfaction and higher preference for telepsychiatry among patients included higher education (ORS = 2.13; ORP = 1.96) and a decrease in technical difficulties over time (ORS = 2.86; ORP = 2.35).

Discussion

Patients and providers were satisfied with telepsychiatry. However, there were greater differences between them in preferences for continuing to use telepsychiatry post-pandemic. These findings highlight factors that influence patient and provider preferences and should be addressed to optimize the use of telepsychiatry in the future.

Postpartum heavy episodic drinking: A survey to inform development of a text messaging intervention

INTRODUCTION

Text messaging interventions (TMI) are promising for addressing heavy episodic drinking (HED) in non-treatment-seeking postpartum women. Their anonymous delivery can overcome fear of consequences that often prevents postpartum women from seeking treatment for HED. We assessed feasibility and acceptability of text messaging to inform the development of a tailored TMI for postpartum HED.

METHODS

We surveyed 165 postpartum women recruited via a national Qualtrics panel on their drinking behaviours, mobile technology use and TMI preferences.

RESULTS

Twenty-five percent of the sample (N = 41) were classified as heavy episodic drinkers, with significant drinking reported before, during and after pregnancy, supporting the need for intervention. Feasibility of text messaging was supported by nearly universal mobile phone ownership and text messaging. Attitudes and intervention preferences varied, with 30% of HEDs likely to participate in an intervention asking them to receive automated messages, and 46% likely to participate in an intervention that included live texting with a counsellor. Respondents were more likely to participate in a study that asked them to respond to messages about mood and stress (63%) than daily drinking behaviours (35%), and were most interested in a TMI that included live texting with a counsellor. Nearly half the sample endorsed fear of child removal as a significant barrier to participation.

DISCUSSION AND CONCLUSIONS

Findings support the feasibility of text messaging as an intervention approach for postpartum HEDs. Postpartum women may have unique concerns and preferences that differ from other groups of HEDs, making a user-centred design approach critical.

Long term follow-up of EGFR mutated NSCLC cases

PURPOSE

A substantial fraction of all non-small cell lung cancers(NSCLC) carry a mutation in the EGFR gene for which an effective treatment with anti-tyrosine kinases(TKIs) is available. We studied the long term survival of these patients following the introduction of TKIs.

EXPERIMENTAL DESIGN

All consecutive cases of NSCLC newly diagnosed with advanced disease were referred for free tumor EGFR mutation testing at Clalit's national personalized medicine laboratory. Mutations and deletions in target codons 18-21 of EGFR were sought using RT-PCR and fragment analysis. Comprehensive EMRs were used to collect full data on treatments and clinical status.

RESULTS

A cohort of 3,062 advanced NSCLC cases, included 481(15.7%) somatic EGFR mutation carriers (17.5% of all adenocarcinomas, 26.7% of females with adenocarcinomas). TKIs treatment to EGFR mutation carriers was provided to 85% of all eligible. After a median follow up period of 15.9 months for EGFR mutated cases the hazard ratio for overall survival of EGFR-mutated NSCLC treated with TKIs was 0.55(0.49-0.63, p<0.0001) when compared with EGFR wild-type(WT) tumors under usual care. After adjusting for age, sex, ethnicity, smoking history and tumor histology, all of which had an independently significant effect on survival, the HR for TKI-treated, EGFR-mutated tumors, was 0.63 (0.55-0.71, p<0.0001). Treating EGFR-WT cases with TKIs yielded a high HR=1.32 (1.19-1.48).

CONCLUSIONS

TKIs given to EGFR mutated advanced NSCLC demonstrated a substantial survival benefit for at least five years. Squamous histology, smoking, male sex and Arab ethnicity were associated with higher NSCLC mortality hazard. Treating non-EGFR-mutated NSCLC with TKIs seems detrimental. Statement of Significance: • TKIs given to EGFR mutated advanced NSCLC demonstrated a substantial survival benefit for at least five years but not much longer. • Treating non-EGFR-mutated NSCLC with TKIs seems detrimental and should probably be avoided. • Squamous histology of non-small cell lung cancer, smoking history, male sex and Arab ethnicity were associated with altogether higher NSCLC mortality hazard.

Distinct tribological endotypes of pathological human synovial fluid reveal characteristic biomarkers and variation in efficacy of viscosupplementation at reducing local strains in articular cartilage

OBJECTIVE

Viscosupplementation has been used for decades to treat mild to moderate osteoarthritis, yet it is unknown if the lubricating function of different pathological synovial fluids (SF) vary, or if they respond differentially to viscosupplementation. The objectives of this study were to (i) evaluate the friction coefficients and induced shear strains in articular cartilage when lubricated with pathological SF, (ii) identify the effect of hyaluronic acid (HA) supplementation on friction coefficients and shear strains, and (iii) identify SF biomarkers that correlate with lubricating function.

METHOD

Human pathological SF was grouped by white blood cell count (inflammatory: >2000 cells/mm³, n = 6; non-inflammatory: <2000 cells/mm³, n = 6). Compositional analyses for lubricin and cytokines were performed. Friction coefficients and local tissue shear strain measurements were coupled using new, microscale rheological analyses by lubricating neonatal bovine cartilage explants with SF alone and in a 1:1 ratio with HA (Hymovis®).

RESULTS

Friction coefficients were not significantly different between the inflammatory and non-inflammatory pathologies (p = 0.09), and were poorly correlated with peak tissue strains at the cartilage articular surface (R² = 0.34). A subset of inflammatory SF samples induced higher tissue strains, and HA supplementation was most effective at lowering friction and tissue strains in this inflammatory subset. Across all pathologies there were clear relationships between polymorphonuclear neutrophil (PMN), IL-8, and lubricin concentrations with cartilage tissue strains.

CONCLUSION

These results suggest that pathological SF is characterized by distinct tribological endotypes where SF lubricating behaviors are differentially modified by viscosupplementation and are identifiable by biomarkers.

Free abdominal gas on computed tomography in the emergency department: aetiologies and association between amount of free gas and mortality

INTRODUCTION

Free abdominal gas is an important finding with major clinical implications. However, data on the aetiologies and prognosis of patients with free gas are scarce. Our primary aim was to describe the sources of free abdominal gas on emergency department (ED) computed tomography (CT). The secondary aim was to evaluate the association between the amount of free gas and all-cause mortality.

METHODS

All patients who underwent CT in the ED between February 2012 and February 2019 with free abdominal gas were included in the study. A scoring system was used to assess the amount of free gas: small - gas bubbles; medium - any gas pocket ≤2cm in diameter; large - any gas pocket >2cm. Data were collected from laboratory and clinical assessment regarding the source of free gas and all-cause mortality.

RESULTS

A total of 372 patients had free abdominal gas. Colonic diverticulitis was the most common aetiology among those with a small or medium amount of free gas (81/250 [32.4%] and 12/71 [16.9%] respectively). For patients with a large amount of gas, peptic disease was the most common aetiology (11/51 [21.6%]). Three-quarters of the patients (280/372, 75.2%) had the source of free gas identified during ED admission. Ninety-day mortality rates were 7.2%, 9.9% and 21.6% for patients with small, medium and large amounts of gas respectively (p=0.007).

CONCLUSIONS

Colonic diverticulitis was the most common source of free abdominal gas and peptic disease was the most common cause of a large amount of free gas. Mortality rates correlated with the amount of gas and were significantly higher in patients with a large amount.

Electron-scale dynamics of the diffusion region during symmetric magnetic reconnection in space

Magnetic reconnection is an energy conversion process that occurs in many astrophysical contexts including Earth's magnetosphere, where the process can be investigated in situ by spacecraft. On 11 July 2017, the four Magnetospheric Multiscale spacecraft encountered a reconnection site in Earth's magnetotail, where reconnection involves symmetric inflow conditions. The electron-scale plasma measurements revealed (i) super-Alfvénic electron jets reaching 15,000 kilometers per second; (ii) electron meandering motion and acceleration by the electric field, producing multiple crescent-shaped structures in the velocity distributions; and (iii) the spatial dimensions of the electron diffusion region with an aspect ratio of 0.1 to 0.2, consistent with fast reconnection. The well-structured multiple layers of electron populations indicate that the dominant electron dynamics are mostly laminar, despite the presence of turbulence near the reconnection site.

Action of Newcastle Disease Virus on Human Blood Platelets

Newcastle Disease Virus induces a viscous metamorphosis like process in washed platelets.

This virus liberates from platelets lactic dehydrogenase and pyruvate kinase, depletes their ATP content and impairs their ability to concentrate 5-hydroxy-tryptamine.

Since Newcastle Disease Virus has adenosine triphosphatase activity, a possible role of this viral enzyme in the production of viscous metamorphosis and in inhibition of clot retraction is discussed.

Treatment of platelets by Newcastle Disease Virus or by particulate fraction from normal allantoic fluid causes liberation of a platelet factor 3-like substance.

Precision Measurement of the β Asymmetry in Spin-Polarized ^{37}K Decay

Using Triumf's neutral atom trap, Trinat, for nuclear β decay, we have measured the β asymmetry with respect to the initial nuclear spin in ^{37}K to be A_{β}=-0.5707(13)_{syst}(13)_{stat}(5)_{pol}, a 0.3% measurement. This is the best relative accuracy of any β-asymmetry measurement in a nucleus or the neutron, and is in agreement with the standard model prediction -0.5706(7). We compare constraints on physics beyond the standard model with other β-decay measurements, and improve the value of V_{ud} measured in this mirror nucleus by a factor of 4.

Trapped-Ion Quantum Logic with Global Radiation Fields

Trapped ions are a promising tool for building a large-scale quantum computer. However, the number of required radiation fields for the realization of quantum gates in any proposed ion-based architecture scales with the number of ions within the quantum computer, posing a major obstacle when imagining a device with millions of ions. Here, we present a fundamentally different approach for trapped-ion quantum computing where this detrimental scaling vanishes. The method is based on individually controlled voltages applied to each logic gate location to facilitate the actual gate operation analogous to a traditional transistor architecture within a classical computer processor. To demonstrate the key principle of this approach we implement a versatile quantum gate method based on long-wavelength radiation and use this method to generate a maximally entangled state of two quantum engineered clock qubits with fidelity 0.985(12). This quantum gate also constitutes a simple-to-implement tool for quantum metrology, sensing, and simulation.

The "Puck" energetic charged particle detector: Design, heritage, and advancements

Energetic charged particle detectors characterize a portion of the plasma distribution function that plays critical roles in some physical processes, from carrying the currents in planetary ring currents to weathering the surfaces of planetary objects. For several low-resource missions in the past, the need was recognized for a low-resource but highly capable, mass-species-discriminating energetic particle sensor that could also obtain angular distributions without motors or mechanical articulation. This need led to the development of a compact Energetic Particle Detector (EPD), known as the "Puck" EPD (short for hockey puck), that is capable of determining the flux, angular distribution, and composition of incident ions between an energy range of ~10 keV to several MeV. This sensor makes simultaneous angular measurements of electron fluxes from the tens of keV to about 1 MeV. The same measurements can be extended down to approximately 1 keV/nucleon, with some composition ambiguity. These sensors have a proven flight heritage record that includes missions such as MErcury Surface, Space ENvironment, GEochemistry, and Ranging and New Horizons, with multiple sensors on each of Juno, Van Allen Probes, and Magnetospheric Multiscale. In this review paper we discuss the Puck EPD design, its heritage, unexpected results from these past missions and future advancements. We also discuss high-voltage anomalies that are thought to be associated with the use of curved foils, which is a new foil manufacturing processes utilized on recent Puck EPD designs. Finally, we discuss the important role Puck EPDs can potentially play in upcoming missions.

Targeting of viral capsids to nuclear pores in a cell-free reconstitution system

Many viruses deliver their genomes into the nucleoplasm for viral transcription and replication. Here, we describe a novel cell-free system to elucidate specific interactions between viruses and nuclear pore complexes (NPCs). Nuclei reconstituted in vitro from egg extracts of Xenopus laevis, an established biochemical system to decipher nuclear functions, were incubated with GFP-tagged capsids of herpes simplex virus, an alphaherpesvirus replicating in the nucleus. Capsid binding to NPCs was analyzed using fluorescence and field emission scanning electron microscopy. Tegument-free capsids or viral capsids exposing inner tegument proteins on their surface bound to nuclei, while capsids inactivated by a high-salt treatment or covered by inner and outer tegument showed less binding. There was little binding of the four different capsid types to nuclei lacking functional NPCs. This novel approach provides a powerful system to elucidate the molecular mechanisms that enable viral structures to engage with NPCs. Furthermore, this assay could be expanded to identify molecular cues triggering viral genome uncoating and nuclear import of viral genomes.

Proposal for verification of the haldane phase using trapped ions

A proposal to use trapped ions to implement spin-one XXZ antiferromagnetic chains as an experimental tool to explore the Haldane phase is presented. We explain how to reach the Haldane phase adiabatically, demonstrate the robustness of the ground states to noise in the magnetic field and Rabi frequencies, and propose a way to detect them using their characteristics: an excitation gap and exponentially decaying correlations, a nonvanishing nonlocal string order, and a double degenerate entanglement spectrum. Scaling up to higher dimensions and more frustrated lattices, we obtain richer phase diagrams, and we can reach spin liquid phase, which can be detected by its entanglement entropy which obeys the boundary law.

Ranking of Prokaryotic Genomes Based on Maximization of Sortedness of Gene Lengths

How variations of gene lengths (some genes become longer than their predecessors, while other genes become shorter and the sizes of these factions are randomly different from organism to organism) depend on organismal evolution and adaptation is still an open question. We propose to rank the genomes according to lengths of their genes, and then find association between the genome rank and variousproperties, such as growth temperature, nucleotide composition, and pathogenicity. This approach reveals evolutionary driving factors. The main purpose of this study is to test effectiveness and robustness of several ranking methods. The selected method of evaluation is measuring of overall sortedness of the data. We have demonstrated that all considered methods give consistent results and Bubble Sort and Simulated Annealing achieve the highest sortedness. Also, Bubble Sort is considerably faster than the Simulated Annealing method.

Common MUTYH mutations and colorectal cancer risk in multiethnic populations

MUTYH is associated with colorectal cancer (CRC) risk. We studied the frequency of MUTYH and risk of CRC in Arabs, North African and European Jews. Participants were all 593 Sephardi Moroccan Jews (232 cases, 361 controls) and all 631 Arabs (327 cases, 304 controls) recruited into a population-based study of colorectal cancer in Israel, as well as a random sample of 189 Ashkenazi Jewish cases. Two MUTYH mutations, G396D and Y179C, were studied in 1,413 individuals, with MUTYH sequence analysis in 46 cases with CRC in a sibling or adenoma. No carriers of mutations in MUTYH were identified in Ashkenazi Jews and only one in Arabs. In Sephardi Jews, 28 carriers of G396D, 25 (4.2%) heterozygotes and 3 (0.5%) homozygotes were identified. Four (0.7%) were heterozygote carriers of the Y179C mutation. Two compound heterozygous carriers of Y179C and G396D were identified. Homozygote carriers of G396D had nonsignificantly elevated risk of CRC (OR = 11.0, 95% CI: 0.91-213.9, p = 0.06), and combined bi-allelic carriers of G396D and Y179C had increased risk, OR = 17.4, 95% CI = (1.9-316.7, p = 0.009). Four of five bi-allelic carriers reported a family history of CRC. Sequencing of 46 colorectal cancer cases with family history and additional adenomas, did not identify any other non-founder mutations. MUTYH carriers of the two common founder mutations are profoundly under-represented among both Ashkenazi Jews and Arabs. The prevalence of MUTYH carriers of the common mutations is much higher in Sephardi Jews. Bi-allelic carriers of mutations in MUTYH, are associated with highly risk of colorectal cancer.

Clinically meaningful efficacy of a non-estrogen agent: re-analysis of phase-2 data evaluating MF101

OBJECTIVE

To evaluate the level of reduction in hot flushes among a cohort of postmenopausal women randomized to a phase-2 clinical trial evaluating MF101, a selective estrogen receptor β modulator, for treatment of vasomotor symptoms to determine clinically meaningful efficacy.

METHODS

We performed a re-analysis of data from a double-blinded, placebo-controlled trial of 217 postmenopausal women randomized to treatment with MF101 or placebo for 12 weeks. At study termination, participants were asked if they were satisfied enough with medication to continue therapy.

RESULTS

Of the women treated, 73% with ≥50% reduction in hot flush frequency and 77% with ≥60% reduction in hot flush frequency were willing to continue treatment.

CONCLUSION

A 50-60% reduction in hot flushes is clinically meaningful among postmenopausal women who are being treated with a non-estrogen agent such as MF101.

A dominant-negative form of POM121 binds chromatin and disrupts the two separate modes of nuclear pore assembly

Nuclear pore complexes (NPCs) are formed during two separate stages of the metazoan cell cycle. They are assembled into the re-forming nuclear envelope (NE) at the exit from mitosis and into an intact, expanding NE during interphase. Here, we show that a soluble internal fragment of the membrane nucleoporin POM121 has a dominant-negative effect on both modes of assembly in a cell-free reconstitution system. The soluble POM121 fragment binds chromatin at sites that are distinct from ELYS-Nup107-160 'seeding' sites and prevents membrane enclosure and NPC formation. Importin-β negatively regulates chromatin binding by the POM121 fragment through a conserved NLS motif and is also shown to affect the recruitment of the endogenous membrane protein to chromatin in the full assembly system. When an intact NE is present before the addition of the dominant-negative fragment, NPCs are inserted into the NE but membrane expansion is inhibited. This results in densely packed NPCs with no intervening membrane patches, as visualized by scanning electron microscopy. We conclude that POM121 plays an important role in both modes of assembly and links nuclear membrane formation and expansion to nuclear pore biogenesis.

MutYH mutation carriers have increased breast cancer risk

BACKGROUND

Variants of the mutY homolog gene MutYH, a DNA repair gene, are associated with increased risk of colorectal cancer; however, it remains unclear whether these variants also are associated with the risk of other cancers. The authors studied the risk of breast cancer associated with MutYH variants in a unique ethnic group of Sephardi Jews in Israel with a high prevalence of MutYH mutations.

METHODS

The study participants were 930 Sephardi Jewish women of North African origin who were recruited into the population-based case-control Breast Cancer in Northern Israel Study (BCINIS) either as breast cancer cases or as healthy controls. All participants contributed a blood sample and completed an interview. Two MutYH variants, a glycine-to-aspartic acid substitution at codon 396 (G396D) and a tyrosine-to-cysteine substitution at codon 179 (Y179C), were studied.

RESULTS

In the Sephardi Jews, among the healthy controls, 20 women (3.7%) were homozygote or heterozygote carriers of the G396D variant, and 4 women (0.7%) were heterozygote carriers of the Y179C variant. Breast cancer cases had a 6.7% prevalence of G396D, yielding a significantly elevated risk estimate for breast cancer (odds ratio, 1.86; 95% confidence interval, 1.02-3.39; P = .039). The tumors detected in carriers with MutYH variants were similar in characteristics to those without MutYH variants, as was the age at diagnosis.

CONCLUSIONS

Carriers of variants in MutYH, although not very common, may have an increased risk of breast cancer in Jews of North African origin. Identification of such carriers and special surveillance protocols may be warranted.

MRI versus breast-specific gamma imaging (BSGI) in the detection of synchronous breast cancer: A prospective head-to-head trial

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Background: Literature suggests that MRI identifies additional mammographically and sonographically occult cancers in 8-10% of newly diagnosed breast cancer patients. We have reported comparable sensitivity of BSGI to MRI in the detection of the known index cancer. We sought to prospectively compare BSGI to MRI in the identification of additional occult malignancies in newly diagnosed breast cancer patients.

Methods: Patients with newly diagnosed breast cancer from June 1, 2009 through February 4, 2011 were consented for an IRB approved protocol in which they underwent both breast MRI and BSGI. Each imaging study was read by a dedicated breast radiologist, with one reading all MRI, and another reading all BSGI studies. All subsequent biopsies were performed percutaneously under image guidance and reviewed by dedicated pathologists. The identification of additional occult breast cancers by MRI and BSGI was compared.

Results: Eighty-five patients underwent both MRI and BSGI. Twenty-one patients elected to undergo mastectomy without further management of imaging findings and were excluded, leaving 64 eligible patients. No additional lesions were found in 22 patients. Twenty-one patients had benign pathology on biopsied imaging findings. Metastatic axillary lymph nodes, satellite lesions or larger extent of disease was identified in 11 patients. Eleven occult breast cancers were identified in 10 patients (15.6%), 6 on MRI alone (9.4%), 3 on BSGI alone (4.7%), and 2 by both modalities (3.1%). There was no significant difference in the identification of occult cancer between MRI and BSGI (chi-square 0.77, p>0.1; Table).

Conclusions: BSGI has previously been shown to be as sensitive as MRI for detecting known invasive and in situ breast carcinoma. This study shows that BSGI is equally sensitive to MRI in the detection of synchronous mammographically and sonographically occult cancers in newly diagnosed breast cancer patients. Further research is needed to identify the false positive rates of BSGI and the effect on surgical management in comparison to MRI.

[Table: see text]

Nuclear import of an intact preassembled proteasome particle

Nuclear targeting of intact proteasome particles was tested in the Xenopus egg extract system. Both the 26S proteasome holoenzyme and the 20S core particle were targeted to the nuclear envelope but could not enter the nucleus. A novel proteolytically active 20S+ particle was actively imported into the nucleoplasm in a Ran-independent fashion.

The 26S proteasome is a conserved 2.5 MDa protein degradation machine that localizes to different cellular compartments, including the nucleus. Little is known about the specific targeting mechanisms of proteasomes in eukaryotic cells. We used a cell-free nuclear reconstitution system to test for nuclear targeting and import of distinct proteasome species. Three types of stable, proteolytically active proteasomes particles were purified from Xenopus egg cytosol. Two of these, the 26S holoenzyme and the 20S core particle, were targeted to the nuclear periphery but did not reach the nucleoplasm. This targeting depends on the presence of mature nuclear pore complexes (NPCs) in the nuclear envelope. A third, novel form, designated here as 20S+, was actively imported through NPCs. The 20S+ proteasome particle resembles recently described structural intermediates from other systems. Nuclear import of this particle requires functional NPCs, but it is not directly regulated by the Ran GTPase cycle. The mere presence of the associated “+” factors is sufficient to reconstitute nuclear targeting and confer onto isolated 20S core particles the ability to be imported. Stable 20S+ particles found in unfertilized eggs may provide a means for quick mobilization of existing proteasome particles into newly formed nuclear compartments during early development.

Clinical implications of UGT1A1*28 genotype testing in colorectal cancer patients

BACKGROUND

Metastatic colorectal cancer is frequently treated with irinotecan, a topoisomerase-I inhibitor. The UGT1A1 gene encodes for an enzyme that metabolizes irinotecan, and its genetic variants were shown to be associated with increased drug toxicity. We evaluated clinical outcomes associated with the UGT1A1*28 variant.

METHODS

The study included 329 colorectal cancer patients from the Israeli population-based Molecular Epidemiology of Colorectal Cancer study who were treated with a chemotherapy regimen that included irinotecan. Patients with metastases or disease recurrence were followed up for a median period of 2 years after occurrence of the event. Study end points were appearance of grade 3-4 hematological and gastroenterological toxicity, hospitalization due to toxic events (mostly neutropenia, fever, diarrhea, or vomiting), length of hospitalization, and overall survival. UGT1A1*28 was genotyped from peripheral blood DNA by fragment analysis and reported as number of TATA sequence repeats in the promoter of the gene.

RESULTS

The 7/7 variant of UGT1A1*28 was detected in 11.9% of the 329 participants. Grade 3-4 hematological toxicity was significantly higher in 7/7 carriers compared with 6/7 and 6/6 carriers (48.0%,10.2%, and 7.7% respectively; P < .001), as was the risk of toxicity-related hospitalization (45.8%, 25.3%, and 14.4% respectively; P = .001). Both short-term death within 2 months of treatment start (12.8%, 5.2%, and 2.9%, respectively) and median overall survival (1.6, 2.0, and 2.4 years, respectively; P = .01) were significantly worse in the 7/7 carriers. The age/stage-adjusted hazard ratio for patients with the 7/7 genotype compared with 6/6 was 1.7 (95% confidence interval, 1.1-2.3).

CONCLUSIONS

The UGT1A1*28 7/7 genotype is strongly associated with severe hematological toxicity and higher hospitalization rate and predicts lower survival of colorectal cancer in users of irinotecan.

Abstract PD05-07: Use of Natural ER Beta Modulators in Treating Hormonal Therapy Resistant Breast Tumors

Although systemic hormone therapies that either block local estrogen production by aromatase inhibitors (AI) such as letrozole or block actions of estrogen/ER actions by anti-estrogens (AEs) like tamoxifen are well tolerated, unfortunately, essentially all breast cancers in women with advanced breast cancer develop resistance to these two classes of agents, and the benefit of adjuvant therapy (where micrometastatic disease is present but cannot be directly observed) is also limited by the development of resistance. In addition, side effects associated with the systemic inhibition of aromatase with current compounds limits their long-term utility of them as chemopreventative agents. We have investigated whether treatment of letrozole resistant breast cancer cells with selective plant-derived ER beta agonists (Liquiritigenin; LIQ or Nyasol; NYA) alone or in combination with letrozole affects the growth of AI resistant breast cancer cells, thereby restores sensitivity to AI. To test whether combination therapy restores sensitivity to letrozole, we have treated letrozole resistant breast cancer cells [LTLTca, derived from MCF-7-aromatase tumors resistant to letrozole] with either letrozole alone or with a combination of letrozole and LIQ/NYA. In addition, effects of these compounds on cell growth was also tested using different breast cancer cells including MCF-7, MCF-7-aromatase, ZR-75-1, ZR-75-aromatase, MDA-MB-231 along with tamoxifen resistant MCF-7 or MCF-7- PELP/ZR-75-PELP1. Compared to single agents, combination treatment not only restored sensitivity to letrozole but also resulted in decreased cell proliferation and increased apoptosis as well as increased ERα and decreased ERα levels in resistant cells. Combination of LIQ or NYA not only diminished cell growth in MCF-7-HER2, MCF-7-PELP1, and SKBR-3 breast cancer cells (that express endogenous aromatase) but also affected the expression of aromatase. Detailed investigations indicated that LIQ/NYA affects the induction of aromatase by specifically inhibiting breast cancer specific aromatase promoter 1.3 as well as its activity through inflammatory cytokine-mediated actions. These studies suggest the therapeutic benefit of LIQ or NYA ERα agonist to resensitize breast cancer cells that are resistant to AEs or AI and their ability to selectively inhibit tumor induction of aromatase. Our study suggests a novel role of natural ER beta agonists as valuable therapeutic modulators to treat endocrine sensitive as well as resistant tumors. (Supported by V-Foundation & P30 CA 54174, RRT)

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD05-07.

Abstract P5-01-03: MRI vs Breast Specific Gamma Imaging (BSGI) in Newly Diagnosed Breast Cancer: A Prospective Head-to-Head Trial

Introduction: Functional breast imaging is emerging as an adjunct to mammography and ultrasound in newly diagnosed breast cancer patients. Magnetic resonance Imaging (MRI) is the modality most widely employed. However, it is expensive, uncomfortable for certain patients, and interpretation is variable, depending upon a radiologist's expertise. Breast Specific Gamma Imaging (BSGI) has emerged as an alternative functional imaging study. While MRI evaluates differential enhancement of benign versus malignant lesions, BSGI evaluates the metabolic activity of normal versus abnormal cells by tagging mitochondria with Technecium99. In retrospective analyses, BSGI has been found to have similar sensitivity to MRI, but to date there has not been a prospective trial comparing these modalities in newly diagnosed breast cancer patients. We sought to prospectively compare BSGI to MRI in newly diagnosed breast cancer patients, to determine if this newer functional imaging study is as sensitive to MRI in detecting index lesions.

Methods: Patients with newly diagnosed invasive breast cancer from June 1, 2009 through May 31, 2010 were consented for an IRB approved protocol in which they underwent both breast MRI and BSGI. Each imaging study was read by a dedicated breast radiologist, with one radiologist reading all MRI, and another reading all BSGI studies. All subsequent biopsies were performed percutaneously, using image guidance. Patients were excluded if excisional biopsy was performed for diagnosis, or their MRI was performed at an outside facility. Patients with DCIS were also excluded. The sensitivity for each modality was calculated. Results: There were 53 patients enrolled in the study that had both MRI and BSGI for newly diagnosed invasive breast cancer. The sensitivity for MRI was 96% and for BSGI was 91% (Table 1) (P&gt;0.5, ns). There was one index tumor not seen on either MRI or BSGI. It was a 2mm invasive ductal carcinoma diagnosed by calcifications on mammogram. The other index tumor not seen on MRI was visualized on BSGI. Two of the remaining four index tumors not visualized on BSGI were located in the posterior breast. Two studies were false negative. These four lesions were visualized on MRI.

Discussion: In this prospective study comparing BSGI to MRI for newly diagnosed invasive breast cancer, BSGI was found to be as sensitive as MRI at detecting index lesions. Of the four false negative BSGI, two tumors were located near the chest wall, a known limitation of this technology. Larger prospective studies need to be performed to determine the true sensitivity and specificity of BSGI.

The intervals between miniature end-plate potentials in the frog are unlikely to be independently or exponentially distributed

1. It has been suggested that spontaneous quantal release of transmitter at the neuromuscular junction is a Poisson process. One logical argument against accepting the Poisson hypothesis is that so far relatively few intervals between miniature end-plate potentials (min.e.p.p.s) have been studied in any single experiment. Release is known to occur from many sites on the nerve terminal, so many intervals must be studied before drawing any conclusions about the timing of release from the individual sites. Moreover, the statistical methods that have been used are relatively insensitive to deviations from Poisson predictions.2. The Poisson hypothesis is evaluated with respect to three major criteria:(a) The fit to the exponential distribution is analysed by five goodness of fit tests which were applied to eleven sets of data, showing that it is unlikely that the data sets were generated by an exponential distribution.(b) The independence of intervals is assessed in two ways. First, the autocorrelogram of intervals is constructed. This shows an excess of significant positive correlations beyond the 5% limits of the Poisson expectation. Secondly, the unsmoothed power spectrum is calculated, and compared to the Poisson prediction by means of the modified mean test. Again, most sets deviate significantly from the Poisson expectation. It is unlikely that the intervals are independent.(c) The possibility of simultaneous occurrences is evaluated by construction of the amplitude histogram of min.e.p.p.s. In all sets the Poisson prediction for the frequency of multiples of the unit height was exceeded by the empirical data sets. The over-all conclusion is that the process which generates spontaneous releases is unlikely to be Poisson.

The stochastic properties of spontaneous quantal release of transmitter at the frog neuromuscular junction

1. Earlier results showed that it is unlikely that spontaneous quantal release of transmitter at the frog neuromuscular junction is produced by a Poisson process.2. Data sets were tested, by using the u statistic, to see whether if they are assumed to be generated by a Poisson process, the mean interval is changing monotonically with time. By this critieria, some of the data sets are stationary, others are not.3. A variety of mathematical transforms are employed on empirical data sets to characterize the properties of the spontaneous quantal release.(a) The intensity function, which calculates the frequency distribution of all possible combinations of intervals, shows an excess of short intervals, without any sign of periodicity.(b) The variance-time curve, which estimates the accumulated variance of the series as a function of time into the series, lies significantly above the Poisson prediction.(c) The power spectrum, whether calculated on the intervals or on the number of intervals in time bins, deviates significantly from the Poisson prediction at the low frequencies.(d) The ln-survivor curve has two phases: a concave section for the short intervals, and a roughly linear section for the intervals of greater length.These transforms indicate that the min.e.p.p.s are clustered.4. A series of models for spontaneous quantal release were considered.(a) A Poisson model. Rejected because of consistent failure to fit the data.(b) A periodic model. Rejected because the intervals should be ordered rather than clustered.(c) A time-dependent model, in which quantal release is governed by a Poisson process with a mean interval that is oscillating in time. This model will generate clustering; by the transforms the model can be shown to closely fit the data. However, an autocorrelation of min.e.p.p. amplitudes shows that there is a relationship between the amplitudes and their position in the series. This is not predicted by the time-dependent oscillating model.(d) A branching Poisson model, in which a primary release, generated by a Poisson process, is likely to be followed by one or more subsidiary releases from the same site. The parameters of the branching model can be determined from ln-survivor curves. Theoretical curves, created with these parameters, give power spectra, variance-time curves, and ln-survivor curves that strongly resemble those calculated from the data. The model also predicts a significant autocorrelation of amplitudes.5. Min.e.p.p.s recorded with an extracellular electrode also fit well to a branching Poisson model.6. The effects of raised [Ca(2+)](o) on the intervals between min.e.p.p.s were studied. In our experiments the change in extracellular solution did not produce any notable change in release statistics.7. The effects of elevated [K(+)](o) on the intervals between spontaneous releases were studied. Depolarization of the nerve terminal increases the frequency of primary releases and decreases the chance of having subsidiary releases.8. Possible physical mechanisms by which quantal release of transmitter from a nerve terminal would fit a branching Poisson model are described.

Stochastic properties of spontaneous transmitter release at the crayfish neuromuscular junction

1. Miniature excitatory junctional potentials (min.e.j.p.s) were recorded with an intracellular electrode from the adductor muscle of the dactyl of the first or second walking leg of the crayfish, Orconectes virilis.2. The intervals between the min.e.j.p.s were compared to the exponential prediction by five goodness of fit tests. The results indicate that the intervals are not exponentially distributed.3. The autocorrelogram of intervals shows that the intervals are unlikely to be independent.4. A stochastic analysis that includes the power spectrum of intervals, the variance-time curve, and the ln-survivor curve suggest that there is a clustering of min.e.j.p.s. The results are similar to those on the frog neuromuscular junction.5. An autocorrelogram of the min.e.j.p. amplitudes suggests that sizes are not independently distributed.6. These results, which are similar to those previously reported from the frog neuromuscular junction, support the use of the branching Poisson process as a theoretical model for the stochastic properties of spontaneous quantal release of transmitter.

Molecular analysis of the selective pro-apoptotic effect of BN107 on estrogen receptor negative breast cancer cells

Abstract #3128

While advances in early detection and adjuvant therapy for breast cancer have had a favorable impact on survival, patients who develop metastatic breast cancer generally succumb to death. Hormonal, targeted or chemotherapeutic strategies largely depend on the expression of their cognate receptors and are often accompanied by toxicities and intolerable side effects. Effective and less toxic therapies against the more aggressive and hormonal therapy-resistant estrogen receptor negative (ER-) breast cancer are urgently needed.&#x2028; Botanical medicine is one of the most popular complementary and alternative medical approaches, and Chinese herbal therapies are frequently sought and used by breast cancer patients. However, the molecular mechanisms through which certain herbal extracts exert anti-breast cancer activities remain largely unknown. Bionovo Inc. has a pipeline of anti-breast cancer products (BN#) based on herbal medicine in development. Here, we present preclinical data on the potential mechanisms of the pro-apoptotic effect of BN107 on breast cancer cells.&#x2028; A panel of breast cancer cell lines was examined and the most significant cytotoxic effect was observed in the less-differentiated, more aggressive, ER- breast cancer lines. Apoptosis appeared to be the major cellular pathway mediating the cytotoxicity of BN107 as evident from Annexin V binding, dissipation of mitochondrial potential, activation of caspases, and DNA fragmentation. Transcriptomic analysis comparing sensitive (ER+) versus resistant (ER-) cell lines revealed distinct patterns of gene expression in response to BN107. ER- breast cancer cells responded to BN107 by upregulating genes involved in apoptotic responses and cholesterol synthesis pathways; while ER+ breast cancer cells did so by regulating genes involved in cell growth and IGF-1 receptor signaling pathways. Further molecular analysis showed that BN107 induced death preferentially in ER- cells via rapid inactivation of AKT/ mTOR pathways. In addition, the sensitivity to BN107 was greatly reduced when ER expression was introduced in MDA-MB-231, an ER- cell line highly sensitive to BN107.&#x2028; BN107, an extract rich in triterpenoids, caused rapid alterations in cholesterol metabolism, presumably by interfering with cell membrane permeability/integrity. Co-administration of BN107 and cholesterol abolished the pro-apoptotic effect of BN107. We found that ER- breast cancer cells rich in caveolae/lipid rafts were highly sensitive to BN107. We showed that BN107 treatment in these cells resulted in subcellular redistribution of proteins that are associated with these specialized membrane/cellular structures.&#x2028; In conclusion, BN107 exerts pro-apoptotic activity preferentially on the more aggressive, ER- breast cancer cells. The cytotoxic activity of BN107 may be attributed to its ability to modify membrane permeability/integrity. Activity-guided isolation and further mechanistic studies are underway to identify potential chemical constituents responsible for the selective cytotoxic activities against ER- breast cancer cells.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3128.

Molecular analysis of the selective pro-apoptotic effect of the herbal extract BN108 on breast cancer cells

Abstract #3018

We present preclinical data on the potential mechanisms of the cytotoxic effect of the herbal extract BN108 towards cancer cells. Botanical medicine is one of the most popular complementary medical approaches, and herbal therapies are frequently sought and used by breast cancer patients. However, the molecular mechanisms through which certain herbal extracts exert growth inhibitory activity on breast cancer cells remain largely unknown.&#x2028; Treatment of a panel of breast cancer cell lines and normal mammary cells with BN108 induced cell death selectively in breast cancer lines. Normal mammary epithelial cells and fibroblasts were resistant to the cytotoxic effects of BN108. Breast cancer cells sensitive to BN108 underwent apoptotic death confirmed by Annexin V staining, caspase activation, cleavage of PARP and DNA fragmentation. In particular, caspases 4 and 9, whose activation is observed during apoptosis induced by endoplasmic reticulum stress, were proteolytically activated. Inhibition of caspase 4 partially protected breast cancer cells from cell death induced by BN108.&#x2028; Expression array analysis of cells treated with BN108 showed induction of expression of several known pro-apoptotic and anti-proliferative genes such as REDD1, p21CIP, cyclin G2, stratifin and more. BN108 induced rapid inactivation of AKT and mTOR kinases in breast cancer but not in non-transformed cells. Moreover, the well-defined targets of mTORC1, S6kinase and 4eBP1 were inactivated in BN108 treated cells.&#x2028; The expression array analysis also showed the induction by BN108 of numerous genes whose products code for enzymes within the cholesterol synthesis pathway. Interestingly, a transient increase in cholesterol synthesis was seen in breast cancer cells but not in normal cells following BN108 treatment. In general, cholesterol levels are higher in breast cancer cells compared to normal cells. Steroidal saponins are major components of BN108 extract, and they are known to deplete cell membrane cholesterol. Similar to BN108 extract, treatment with purified timosaponin AIII (a component of BN108 extract) also induced apoptosis and changes in cholesterol production in breast cancer cells but not in normal cells. It is possible that steroidal saponins induce a very transient depletion of cholesterol, followed by inactivation of AKT and mTOR, and negative feedback inhibition of the cholesterol synthesis pathway that is, in the end, is futile. None of these events are observed in normal cells.&#x2028; In conclusion, BN108 extract contains cytotoxic activity selective for transformed versus normal cells. These selective cytotoxic properties of BN108 could be related to its differential effects on cholesterol synthesis in breast cancer cells versus normal cells, as well as inhibition of major oncogenic pathways. Future studies will be aimed at understanding the molecular relationship between the BN1008 effect on cholesterol synthesis and induction of apoptosis, which may give rise to a unique pathway for targeting tumor cells.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3018.

[Epileptiform activities generated in vitro by human temporal lobe tissue]

Drug-resistant partial epilepsies, including temporal lobe epilepsies with hippocampal sclerosis and cortical dysplasias, offer the opportunity to study human epileptic activity in vitro since the preferred therapy often consists of the surgical removal of the epileptogenic zone. Slices of this tissue retain functional neuronal networks and may generate epileptic activity. The properties of cells in this tissue do not seem to be significantly changed, but excitatory synaptic characteristics are enhanced and GABAergic inhibition is preserved. Typically, epileptic activity is not generated spontaneously by the neocortex, whether dysplastic or not, but can be induced by convulsants. The initiation of ictal discharges in neocortex depends on both GABAergic signaling and increased extracellular potassium. In contrast, a spontaneous interictal-like activity is generated by tissues from patients with temporal lobe epilepsies associated with hippocampal sclerosis. This activity is initiated not in the hippocampus but in the subiculum, an output region that projects to the entorhinal cortex. Interictal events seem to be triggered by GABAergic cells, which paradoxically excite approximately 20% of subicular pyramidal cells, while simultaneously inhibiting the majority. Interictal discharges are therefore sustained by both GABAergic and glutamatergic signaling. The atypical depolarizing effects of GABA depend on a pathological elevation in the basal levels of chloride in some subicular cells, similar to those of developmentally immature cells. This defect is caused by the perturbation of the expression of the cotransporters regulating the intracellular chloride concentration, the importer NKCC1, and the extruder KCC2. Blockade of excessive NKCC1 by the diuretic bumetanide restores intracellular chloride and thus hyperpolarizing GABAergic actions, suppressing interictal activity.