The empty pelvis syndrome: a core data set from the PelvEx collaborative

BACKGROUND

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

METHOD

Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

RESULTS

One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

CONCLUSIONS

EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

[Feline and canine giardiosis: An Update]

Giardia duodenalis is a facultative pathogenic intestinal parasite. Giardiosis in dogs and cats may appear with or without clinical signs. Typical signs include diarrhea with or without vomiting. The prevalence in young animals is high and may amount to up to 50%. There are 8 different genotypes (A - H), which are called assemblages. Assemblages C and D are most common in dogs and assemblage F most frequent in cats. However, animals may also be infected with the zoonotically effective assemblages A and B or exhibit mixed infections. The immunofluorescence test (IFA), the enzyme-linked immunosorbent assay (ELISA) and fecal centrifugation using zinc sulphate solution are currently recommended as diagnostic methods. Polymerase chain reaction (PCR) may be used to determine the corresponding assemblage. Approved treatments for giardiosis include fenbendazole and metronidazole. In addition, undertaking specific hygiene measures is warranted. Only animals showing clinical signs or those living in the same household with high-risk patients (e. g. immunosuppressed humans) are recommended to receive medication. The aim of treatment is clinical improvement of the diseased dogs and cats. Frequently, complete elimination of Giardia is not attained.

[Urinalysis in dogs and cats, part 2: Urine sediment analysis]

Examination of the urine sediment is part of a routine urinalysis and is undertaken in order to identify insoluble particles in the urine. This procedure is mainly used in the context of diagnostic evaluation of urinary tract diseases, but may also be useful for the diagnosis of systemic diseases and intoxications. Analysis of fresh urine is recommended as changes in cell morphology, cell lysis and in vitro crystal formation may occur in the course of its storage. Manual urine sediment analysis is still performed in many veterinary practices. Native wet-mount preparations are suitable for the identification and quantification of urine sediment particles. The examination of stained wet-mount preparations or air-dried smears may be necessary to further differentiate cells and to identify bacteria. For several years, automatic urine sediment analyzers have been available in veterinary medicine. These save considerable time and staff resources, however verification of the automatically generated results by an experienced observer remains necessary. Urine sediment particles that are frequently identified and clinically relevant include red blood cells, white blood cells, different types of epithelial cells, crystals, and casts as well as bacteria. Furthermore, parasite eggs, fungal hyphae, lipid droplets, spermatozoa, fibres, hair, mucus, plant parts or environmental contaminations may be found in the urine sediment and result in a complication of the result interpretation.

Modeling Respiratory Syncytial Virus Adult Vaccination in the United States With a Dynamic Transmission Model

BACKGROUND

Respiratory syncytial virus (RSV) is shown to cause substantial morbidity, hospitalization, and mortality in infants and older adults. Population-level modeling of RSV allows to estimate the full burden of disease and the potential epidemiological impact of novel prophylactics.

METHODS

We modeled the RSV epidemiology in the United States across all ages using a deterministic compartmental transmission model. Population-level symptomatic RSV acute respiratory tract infection (ARI) cases were projected across different natural history scenarios with and without vaccination of adults aged ≥60 years. The impact of vaccine efficacy against ARIs, infectiousness and vaccine coverage on ARI incidence were assessed. The impact on medical attendance, hospitalization, complications, death, and other outcomes was also derived.

RESULTS

Without a vaccine, we project 17.5-22.6 million symptomatic RSV ARI cases annually in adults aged ≥18 years in the US, with 3.6-4.8 million/year occurring in adults aged ≥60 years. Modeling indicates that up to 2.0 million symptomatic RSV-ARI cases could be prevented annually in ≥60-year-olds with a hypothetical vaccine (70% vaccine efficacy against symptomatic ARI and 60% vaccine coverage) and that up to 0.69 million/year could be prevented in the nonvaccinated population, assuming 50% vaccine impact on infectiousness.

CONCLUSIONS

The model provides estimated burden of RSV in the US across all age groups, with substantial burden projected specifically in older adults. Vaccination of adults aged ≥60 years could significantly reduce the burden of disease in this population, with additional indirect effect in adults aged <60 years due to reduced transmissibility.

[Urinalysis in dogs and cats, part 1: physical and chemical urinalysis]

The urinalysis of dogs and cats is an important part of the diagnostic evaluation of urinary tract diseases as well as for the identification of systemic diseases. A routine urinalysis consists of a physical and chemical examination of the urine as well as an examination of the urine sediment. Various urine collection methods (free-catch, catheterization, cystocentesis) are available. Each method has multiple advantages and disadvantages. The appropriate method must be chosen individually for each patient depending on the emphasis of the examination. The urine should ideally be examined within 30 minutes of collection as it is prone to change due to time and storage. Physical examination of the urine consists of the determination of urine color, clarity, and specific gravity which provides information regarding the concentration of the urine. The latter is determined by refractometry and needs to be interpreted in the context of the hydration status of the patient. Chemical examination of the urine consists of the determination of the pH value and the presence of blood/hemoglobin/myoglobin, protein, glucose, bilirubin, urobilinogen, nitrite, and ketones. The use of commercially available urine dipsticks is common. These must be stored and used according to the manufacturer's instructions and when interpreting the results, veterinary aspects need to be taken into consideration. The physical and chemical examinations of the urine represent rapid and readily performable methods that provide important information for the diagnosis or the exclusion of numerous diseases.

Diffusion and partitioning of different PFAS compounds through thermoplastic polyurethane and three different PVC-EIA liners

Perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorobutane sulfonic acid (PFBS), 6:2 fluorotelomer sulfonic acid (6:2 FTS), and GenX are tested for diffusion and sorption through thermoplastic polyurethane (TPU) and three ethylene interpolymer alloy (PVC-EIA) liners (EIA1, EIA2, and EIA3) with decreasing ketone ethylene ester (KEE) contents. The tests were conducted at room temperature (23 °C), 35 °C, and 50 °C. The tests show significant diffusion through the TPU as manifested by a decrease in the source concentration and an increase in the receptor concentrations of PFOA and PFOS over time, especially at higher temperatures. On the other hand, the PVC-EIA liners show excellent diffusive resistance to the PFAS compounds especially at 23 °C. At higher temperatures, the diffusion resistance of the PVC-EIA liner with the lowest KEE content, EIA3, was best at 50 °C followed by EIA1 (highest KEE content) and finally EIA2. Sorption tests showed no measurable partitioning of any of the compounds to the liners examined. Based on 535 days of diffusion testing, permeation coefficients are provided for all the compounds considered for the four liners at three temperatures. In addition, the P_g values for PFOA and PFOS are provided for a linear low density polyethylene (LLDPE) and a coextruded LLDPE - ethylene vinyl alcohol (EVOH) geomembrane based on 1246 to 1331 days of testing and are compared to those estimated for EIA1, EIA2, and EIA3.

Arginine-stimulated copeptin in children and adolescents

OBJECTIVE

Copeptin is secreted in isomolar amounts along with arginine vasopressin peptide (AVP) from the neurohypophysis. Its stability makes it a perfect candidate for the endocrine approach in the diagnosis of AVP deficiency (AVPD; cranial diabetes insipidus; CDI). However, pediatric reference values are lacking.

DESIGN AND PATIENTS

This is a monocentric retrospective analysis of donated residual serum samples from 72 children and adolescents who underwent arginine or growth hormone-releasing hormone-arginine stimulation to test GH secretory capacity from 2018 to 2022.

MEASUREMENTS

Copeptin was measured in baseline, 30-, and 60-min samples by BRAHMS Copeptin proAVP Kryptor immunofluorescence assay.

RESULTS

Of the 72 patients, 4 suffered from complete AVPD (CDI). The baseline level of copeptin in the 68 non-AVPD (non-CDI) patients was highly variable (range: 1.3-44.4 pmol/L). The increase after arginine was moderate (30 min range: 1.6-40.4 pmol/L). The median baseline and peak copeptin levels were 5.6 and 8.0 pmol/L, respectively. The 2.5th percentile of the baseline and peak values of copeptin were 2.1 and 3.3 pmol/L, respectively. The increase and peak value of copeptin were inversely related to age (R = -.405; p = .011, and R = -.335; p = .0072, respectively) but not to gender, body mass index (standard deviation score) or GH secretion. In the four patients with AVPD (CDI), baseline or stimulated copeptin was below the 2.5th percentile of non-AVPD (non-CDI) patients.

CONCLUSIONS

Stimulated copeptin is a promising parameter for the differential diagnosis of polyuria-polydipsia syndrome. However, the low copeptin increase after arginine and the high limit of quantification of the assay are problematic for use in paediatrics.

Comparison of the respiratory bacterial microbiome in cats with feline asthma and chronic bronchitis

Objectives

While feline chronic bronchitis (CB) is known as neutrophilic bronchial inflammation (NI), feline asthma (FA) is defined as an eosinophilic airway inflammation (EI). Feline chronic bronchial disease refers to both syndromes, with similar clinical presentations and applied treatment strategies. Recent studies described alterations of the microbiota composition in cats with FA, but little is known about the comparison of the lung microbiota between different types of feline bronchial disease. The study aimed to describe the bacterial microbiota of the lower respiratory tracts of cats with FA and CB and to identify potential differences.

Methods

Twenty-two client-owned cats with FA (n = 15) or CB (n = 7) confirmed via bronchoalveolar-lavage (BALF)-cytology were included. Next-generation sequencing analysis of 16S rRNA genes was performed on bacterial DNA derived from BALF samples. QIIME was used to compare microbial composition and diversity between groups.

Results

Evenness and alpha-diversity-indices did not significantly differ between cats with FA and CB (Shannon p = 0.084, Chao 1 p = 0.698, observed ASVs p = 0.944). Based on a PERMANOVA analysis, no significant differences were observed in microbial composition between animals of both groups (Bray-Curtis metric, R-value 0.086, p = 0.785; unweighted UniFrac metric, R-value −0.089, p = 0.799; weighted Unifrac metric, R-value −0.072, p = 0.823). Regarding taxonomic composition, significant differences were detected for Actinobacteria on the phylum level (p = 0.026), Mycoplasma spp. (p = 0.048), and Acinetobacteria (p = 0.049) on the genus level between cats with FA and CB, with generally strong interindividual differences seen. There was a significant difference in the duration of clinical signs before diagnosis in animals dominated by Bacteriodetes (median 12 months, range 2–58 months) compared to animals dominated by Proteobacteria (median 1 month, range 1 day to 18 months; p = 0.003).

Conclusions and relevance

Lung microbiota composition is very similar in cat populations with spontaneous FA and CB besides small differences in some bacterial groups. However, with disease progression, the lung microbiome of cats with both diseases appears to shift away from dominantly Proteobacteria to a pattern more dominated by Bacteriodetes. A substantial proportion of cats tested positive for Mycoplasma spp. via sequencing, while none of them tested positive using classical PCR.

Patient-reported outcome measures compared to professional dental assessments of monolithic ZrO2 implant fixed dental prostheses in complete digital workflows: A double-blind crossover randomized controlled trial

PURPOSE

This double-blind randomized controlled trial analyzed patient-reported outcome measures in terms of subjective patient satisfaction compared to objective dental evaluation of prosthetic treatment with 3-unit monolithic zirconium dioxide implant fixed dental prostheses (iFDPs) in 3 digital workflows.

MATERIAL AND METHODS

Twenty patients were restored with 3 iFDPs each on Straumann TL-implants with 2 completely digital workflows using different intraoral optical scanning systems with model-free fabrication of the restoration (Trios 3/3Shape [Test-1]; Virtuo Vivo/Straumann [Test-2]), and mixed analog-digital workflow with conventional impressions and digitized gypsum casts (Impregum/3M Espe [Control]). The order of impression-taking and the prosthetic try-in were randomly allocated. Sixty iFDPs were compared for patient satisfaction and dental evaluation using ANOVA.

RESULTS

For iFDP evaluation, patients generally provided more favorable ratings than dental experts, regardless of the workflow. ANOVA revealed no significant difference for overall satisfaction when comparing Test-1, Test-2, or Control, either for patients (f-ratio: 0.13; p = 0.876) or dentist (f-ratio: 1.55: p = 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f-ratio: 14.57; p < 0.001). Overall, the 3Shape workflow (Test-1) received the highest scores for all analyses.

CONCLUSIONS

The different digital workflows demonstrated minor influence on the subjective and objective evaluation of the monolithic zirconium dioxide iFDPs in nonesthetic regions; however, the dentist may significantly increase patient satisfaction by choosing intraoral scanning instead of conventional impressions. The dentist has to consider individual patients' needs to fulfill their expectations for a personalized solution.

Burden of respiratory syncytial virus infection in older and high-risk adults: a systematic review and meta-analysis of the evidence from developed countries

Background

Respiratory syncytial virus (RSV) significantly impacts the health of older and high-risk adults (those with comorbidities). We aimed to synthesise the evidence on RSV disease burden and RSV-related healthcare utilisation in both populations.

Methods

We searched Embase and MEDLINE for papers published between 2000 and 2019 reporting the burden and clinical presentation of symptomatic RSV infection and the associated healthcare utilisation in developed countries in adults aged ≥60 years or at high risk. We calculated pooled estimates using random-effects inverse variance-weighted meta-analysis.

Results

103 out of 3429 articles met the inclusion criteria. Among older adults, RSV caused 4.66% (95% CI 3.34–6.48%) of symptomatic respiratory infections in annual studies and 7.80% (95% CI 5.77–10.45%) in seasonal studies; RSV-related case fatality proportion (CFP) was 8.18% (95% CI 5.54–11.94%). Among high-risk adults, RSV caused 7.03% (95% CI 5.18–9.48%) of symptomatic respiratory infections in annual studies, and 7.69% (95% CI 6.23–9.46%) in seasonal studies; CFP was 9.88% (95% CI 6.66–14.43%). Data paucity impaired the calculation of estimates on population incidence, clinical presentation, severe outcomes and healthcare-related utilisation.

Conclusions

Older and high-risk adults frequently experience symptomatic RSV infection, with appreciable mortality; however, detailed data are lacking. Increased surveillance and research are needed to quantify population-based disease burden and facilitate RSV treatments and vaccine development.

Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

Comparison of the Anvajo Vet Fluidlab 1 urine sediment analyzer to manual microscopy and Idexx SediVue analysis for analysis of urine samples from cats and dogs

The Vet Fluidlab 1 (Anvajo), a new urine sediment analyzer for use in veterinary medicine, uses holographic microscopy to detect urine sediment particles in uncentrifuged urine. We compared the performance of the Fluidlab to manual microscopy and Idexx SediVue analysis for the detection of RBC, WBC, epithelial cells (EC), struvite crystals (STR), all crystals (CRY), and casts (CST) in urine samples from cats and dogs. The performance of the Fluidlab for the detection of bacteria was compared to bacterial culture. We included 624 urine samples from feline (238; 38%) and canine (386; 62%) patients; 227 samples had been submitted for bacterial culturing. The sensitivity of the Fluidlab compared to manual microscopy was 92.1% for RBC, 90.1% for WBC, 87.5% for EC, 67.6% for STR, 53.9% for CRY, and 12.5% for CST. Specificity was >97% for STR and CST, 90.0% for CRY, 78.4% for WBC, 59.4% for EC, and 55.1% for RBC. Sensitivities and specificities of the Fluidlab for analytes compared to manual microscopy were found to be similar to those obtained by the Fluidlab compared to SediVue analysis. Miscellaneous materials (e.g., lipid droplets, sperm, cell detritus) seemed to be the main reason for the high false-positive rate in RBC and EC classification by the Fluidlab. Detection of bacteria by the Fluidlab compared to bacterial culture had a sensitivity of 89.8% and a specificity of 72.3%. The performance of the Fluidlab is acceptable for the detection of WBC and bacteria; sensitivity for the detection of CRY and CST, and specificity for the detection of RBC and EC, require improvement.

Clinical Burden of Respiratory Syncytial Virus in Hospitalized Children Aged ≤5 years (INSPIRE Study)

Background

Respiratory syncytial virus (RSV) is a leading cause of hospitalizations in children (≤5 years of age); limited data compare burden by age.

Methods

This single-center retrospective study included children (≤5 years of age) hospitalized for >24 hours with reverse-transcription polymerase chain reaction (RT-PCR)–confirmed RSV infection (2015–2018). Hospital length of stay (LOS), intensive care unit (ICU) admissions, ICU LOS, supplemental oxygen, and medication use were assessed. Multivariate logistic regression analyses identified predictors of hospital LOS >5 days.

Results

Three hundred twelve patients had RSV infection (ages 0 to <6 months [35%], 6 to <12 months [15%], 1 to <2 years [25%], and 2–5 years [25%]); 16.3% had predefined comorbidities (excludes preterm infants). Median hospital LOS was 5.0 days and similar across age; 5.1% (16/312) were admitted to ICU (ICU LOS, 5.0 days), with those aged 0 to <6 months admitted most frequently (10/108 [9.3%]). Supplemental oxygen was administered in 57.7% of patients, with similar need across ages. Antibiotics were administered frequently during hospitalization (43.6%). Predictors of prolonged LOS included pneumonia (odds ratio [OR], 2.33), supplemental oxygen need (OR, 5.09), and preterm births (OR, 3.37). High viral load (RT-PCR RSV cycle threshold value <25) was associated with greater need for supplemental oxygen.

Conclusions

RSV causes substantial burden in hospitalized children (≤5 years), particularly preterm infants and those aged <6 months.

Adult height after treatment of neurosecretory dysfunction and comparison to idiopathic GHD

OBJECTIVE

Neurosecretory dysfunction (NSD) causes growth hormone deficiency (GHD). Data on adult height after recombinant human growth hormone (rhGH) treatment are lacking.

DESIGN AND PATIENTS

We collected treatment data of all patients with NSD seen between 1990 and 2017 at our outpatient department (tertiary centre) and measured adult height. For comparison, patients with idiopathic GHD were used. Diagnoses were based on short stature (<-2 standard deviation score [SDS]), continuously low height velocity (<25th percentile), delayed bone age (by >1 SD) and low serum IGF-1 concentration (<-2 SDS). NSD was defined by normal GH challenge results, but subnormal spontaneous GH secretion. Exclusion criteria were no information on adult height, underweight and other short stature disorders.

RESULTS

Out of 67 patients diagnosed with NSD, six were still growing, 31 had test results exceeding validated GH cut-offs and three had other disorders causing short stature. Out of the 25 eligible patients with NSD, 21 could be recruited. These patients reached an adult height of -0.85 SDS (mean); 0.34 SDS below midparental height. Height gain during treatment was 2.01 SDS. This outcome was not different to 32 patients with idiopathic GHD.

CONCLUSIONS

Long-term results suggest the viability of the diagnosis of NSD and the efficacy of rhGH treatment.

Corrigendum: GH responsiveness is not correlated to IGF1 P2 promoter methylation in children with Turner syndrome, GHD and SGA short stature

[This corrects the article DOI: 10.3389/fendo.2022.897897.].

GH Responsiveness Is not Correlated to IGF1 P2 Promoter Methylation in Children With Turner Syndrome, GHD and SGA Short Stature

BACKGROUND

The methylation of IGF1 promoter P2 was reported to negatively correlate with serum IGF-1 concentration and rhGH treatment response in children with idiopathic short stature. These findings have not yet been confirmed.

OBJECTIVE

This study aimed to determine IGF1 promoter P2 methylation in short children treated with rhGH and correlate clinical parameters with the methylation status. In addition, long-term stability of methylation during rhGH treatment was studied.

DESIGN

This was a single tertiary center study analyzing clinical GH response and IGF-1 serum concentration changes in patients with GHD (n=40), SGA short stature (n=36), and Turner syndrome (n=16) treated with rhGH. Data were correlated to the methylation of two cytosine residues (-137, +97) of the P2 promoter of IGF1 in blood cells measured by pyrosequencing in 443 patient samples.

RESULTS

Basal and stimulated IGF-1 concentrations, first year increment in height velocity and studentized residuals of a prediction model did not correlate to the methylation of -137 und +97 in IGF1 P2 promoter. The methylation of these two sites was relatively stable during treatment.

CONCLUSIONS

This study did not confirm IGF1 P2 promotor being a major epigenetic locus for GH responsiveness in patients treated with a normal dose of rhGH. Additional studies are warranted.

Comparison of Eight Commercially Available Faecal Point-of-Care Tests for Detection of Canine Parvovirus Antigen

A real-time polymerase chain reaction (qPCR) is considered the gold standard for the laboratory diagnosis of canine parvovirus (CPV) infection but can only be performed in specialized laboratories. Several point-of-care tests (POCT), detecting CPV antigens in faeces within minutes, are commercially available. The aim of this study was to evaluate eight POCT in comparison with qPCR. Faecal samples of 150 dogs from three groups (H: 50 client-owned, healthy dogs, not vaccinated within the last four weeks; S: 50 shelter dogs, healthy, not vaccinated within the last four weeks; p = 50 dogs with clinical signs of CPV infection) were tested with eight POCT and qPCR. Practicability, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), as well as overall accuracy were determined. To assess the differences between and agreement among POCT, McNemar’s test and Cohen’s Kappa statistic were performed. Specificity and PPV were 100.0% in all POCT. Sensitivity varied from 22.9–34.3% overall and from 32.7–49.0% in group P. VetexpertRapidTestCPVAg^® had the highest sensitivity (34.3% overall, 49.0% group P) and differed significantly from the 3 POCT with the lowest sensitivities (Fassisi^®Parvo (27.7% overall, 36.7% group P), Primagnost^®ParvoH+K (24.3% overall, 34.7% group P), FASTest^®PARVOCard (22.9% overall, 32.7% group P)). The agreement among all POCT was at least substantial (kappa >0.80). A positive POCT result confirmed the infection with CPV in unvaccinated dogs, whereas a negative POCT result did not definitely exclude CPV infection due to the low sensitivity of all POCT.

[Cardiogenic shock following yew needle poisoning : Digoxin immune fab, va-ECMO and albumin dialysis for the treatment of a suicidal yew leaf poisoning]

We present the case of a 46-year-old male who developed refractory bradycardia with cardiogenic shock after attempting suicide by ingestion of yew leaves. Due to delayed availability of the Digoxin immune fab, a va-ECMO was established to maintain sufficient circulation. Administration of the digoxin fab resulted in recovery of spontaneous circulation. Continuous venovenous hemodiafiltration with hemoadsorption and albumin dialysis were initiated with the intention to remove immune fab-toxin complexes and as organ support in acute kidney and liver failure. Within 5 days the patient was successfully weaned from ECMO, liver support and renal replacement and discharged without physical sequelae.

Using the Idexx SediVue Dx to predict the need for urine bacteriologic culture in cats

We analyzed urine samples from 191 cats for bacteriuria with an automated urine sediment analyzer (Idexx SediVue Dx), combined with image review by an observer, and compared to bacteriologic culture results. Sixty-nine samples were unambiguously assigned to be free of bacteria by the instrument and the observer, and no bacterial growth was detected. Twenty-seven samples were unambiguously assigned to have bacteriuria; 24 of these 27 samples were culture-positive. For these samples, bacteriuria was predicted with a sensitivity of 100% and a specificity of 96%. A clear assignment was not possible for 95 samples, 81 of which were culture-negative. Specificity dropped to 45% when all samples were considered. Using the automated leukocyte count to predict bacteriuria, sensitivity was 82% and specificity was 75%. Automated sediment analysis is faster and less observer-dependent than sediment analysis under a microscope, but accurate detection of bacteriuria remains difficult in a large proportion of samples. Bacteriuria was significantly associated with leukocyte count; the leukocyte count was >5/high power field in 82% of culture-positive samples.

Time-efficiency and cost-analysis comparing three digital workflows for treatment with monolithic zirconia implant fixed dental prostheses: A double-blinded RCT

OBJECTIVES

This double-blinded randomized controlled trial investigated economic performance indicators (EPI) in terms of time-efficiency and production costs of 3-unit monolithic zirconium-dioxide (ZrO2) implant fixed dental prostheses (iFDP) in three different workflows.

METHODS

Twenty patients with two Straumann Tissue-Level-Implants received three iFDPs; two were fabricated in proprietary complete digital workflows with intraoral optical scanning and model-free fabrication with company-related CAD/CAM lab-software while one iFDP was manufactured on digitized casts from conventional impressions. The sequence of impression-taking for the three workflows (TRIOS 3/3Shape [Test-1]; Virtuo Vivo/Dental Wings [Test-2]; Impregum/3M Espe [Control]) was randomly allocated. Sixty iFDPs bonded to ti-base abutments were analyzed. Clinical and technical worksteps for Test-1/Test-2/Control were recorded and evaluated for time-efficiency including cost-analysis (CHF=Swiss Francs) using ANOVA-Tests (significance level α=0.05).

RESULTS

Mean total work time, as the sum of clinical plus technical steps, was 97.5 min (SD ± 23.6) for Test-1, 193.1 min (SD ± 25.2) for Test-2, and 172.6 min (SD ± 27.4) for Control. Times were significantly different between Test-1/Test-2 (p < 0.00001), Test-1/Control (p < 0.00001), and Test-2/Control (p < 0.03610). Technical costs were 566 CHF (SD ± 49.3) for Test-1, 711 CHF (SD ± 78.8) for Test-2, 812 CHF (SD ± 89.6) for Control, and were also significantly different for all comparisons (p < 0.00001).

CONCLUSIONS

Test-1 demonstrated the best performance for time-efficiency, Test-2 revealed the worst result. This indicates that digital workflows are not the same and not necessarily superior to analog workflows of monolithic ZrO2 iFDPs. Complexity decreases by reducing the number of steps following complete digital workflows, resulting in lower production costs compared to the mixed analog-digital workflow with conventional impressions.

CLINICAL SIGNIFICANCE

Complete digital workflows comprising intraoral optical scanning without physical models for treatment with monolithic ZrO2 iFDPs is an efficient alternative to mixed analog-digital workflows with conventional impressions and labside digitization of dental casts.

Cutaneous microRNA expression in healthy Labrador and Golden retrievers and retrievers with allergic and inflammatory skin diseases

BACKGROUND

MicroRNAs (miRNA) are short, single-stranded RNA molecules that regulate gene expression in a post-transcriptional manner. Their expression is proposed to be tissue-specific and alterations in miRNA expression have been detected in many diseases.

OBJECTIVE

To compare miRNA expression in the skin of healthy Labrador and golden retrievers, and those with allergic and nonallergic dermatitis.

METHODS AND MATERIALS

Formalin-fixed and paraffin-embedded (FFPE) skin specimens from seven healthy Labrador and golden retrievers, and seven dogs with allergic skin disease were collected. A further mixed nonallergic inflammation group consisted of samples from five dogs with fungal infection, demodicosis and mast cell tumours. Total RNA was extracted and miRNA primer assays for 18 target miRNAs (miR-142, miR-363, miR-18b, miR-451, miR-146a, miR-124, miR-409, miR-193b, miR-223, miR-215, miR-155, miR-423a, miR-143, miR-1839, miR-21, miR-34b, miR-146b and miR-202) were performed, with RNU6-2 and SNORD95 as miRNAs for normalisation. The selection of miRNAs for investigation was based on reported data and a pilot study evaluating miRNA extraction from FFPE tissue specimens.

RESULTS

In the two dogs with mast cell tumours, miRNA expression was undetermined for most miRNAs, so both were excluded from analysis. Although there were differences in the miRNA expression between healthy and inflamed skin, allergic and nonallergic inflammation showed similar expression patterns.

CONCLUSION AND CLINICAL RELEVANCE

Although the number of included dogs was small, based on this study, none of the evaluated miRNAs allowed differentiation of allergic dermatitis from other inflammatory skin diseases in retriever dogs.

Stem cell donor registry activities during the COVID-19 pandemic: a field report by DKMS

The COVID-19 pandemic has serious implications also for patients with other diseases. Here, we describe the effects of the pandemic on unrelated hematopoietic stem cell donation and transplantation from the perspective of DKMS, a large international donor registry. Especially, we cover the development of PBSC and bone marrow collection figures, donor management including Health and Availability Check (HAC), transport and cryopreservation of stem cell products, donor recruitment and business continuity measures. The total number of stem cell products provided declined by around 15% during the crisis with a particularly strong decrease in bone marrow products. We modified donor management processes to ensure donor and product safety. HAC instead of confirmatory typing was helpful especially in countries with strict lockdowns. New transport modes were developed so that stem cell products could be safely delivered despite COVID-19-related travel restrictions. Cryopreservation of stem cell products became the new temporary standard during the pandemic to minimize risks related to transport logistics and donor availability. However, many products from unrelated donors will never be transfused. DKMS discontinued public offline donor recruitment, leading to a 40% decline in new donors during the crisis. Most DKMS employees worked from home to ensure business continuity during the crisis.

PFOA and PFOS diffusion through LLDPE and LLDPE coextruded with EVOH at 22 °C, 35 °C, and 50 °C

Diffusion of perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) through 0.1 mm and 0.75 mm LLDPE and 0.1 mm and 0.75 mm LLDPE coextruded with ethyl vinyl alcohol (denoted as CoEx) at room temperature (23 °C), 35 °C, and 50 °C is examined. These tests had negligible source depletion throughout the monitoring period, indicating limited contaminant partitioning and diffusion through the LLDPE. At 483 days, 23 °C receptor PFOA and PFOS concentrations, c_r, were <8 μg/L (c_r/c_o < 3.2 × 10^-4) for all tests, and at 399 days elevated temperature receptor concentrations were < 0.4 μg/L (c_r/c_o < 1.6 × 10^-5) at 35 °C and <0.5 μg/L (c_r/c_o < 2.0 × 10^-5) at 50 °C for both PFOA and PFOS. LLDPE partitioning coefficient, S_gf was 0.9-1.4 (PFOA) and 2.8-5.3 (PFOS) based on sorption tests at 23 °C. Based on the best estimates of permeation coefficient, P_gCoEx, for CoEx was consistently lower than P_gLLDPE. For PFOA, CoEx had P_gCoEx < 0.26 × 10^-16 m²/s at 23 °C, <11 × 10^-16 m²/s (35 °C), and < 10 × 10^-16 m²/s (50 °C) while LLDPE had P_gLLDPE < 3.1 × 10^-16 m²/s (23 °C), <13 × 10^-16 m²/s (35 °C), and <19 × 10^-16 m²/s (50 °C). For PFOS, CoEx and LLDPE had P_gCoEx < 0.55 × 10^-16 m²/s and P_gLLDPE < 3.2 × 10^-16 m²/s (23 °C), P_gCoEx < 8.3 × 10^-16 m²/s and P_gLLDPE < 40 × 10^-16 m²/s (35 °C), and P_gCoEx < 8.2 × 10^-16 m²/s and P_gLLDPE < 52 × 10^-16 m²/s (50 °C). These values are preliminary and may change (e.g., decrease) as more data comes available over time. The P_g values deduced for PFOA and PFOS are remarkably lower than those reported for other contaminants of concern, excepting BPA, which exhibits similar behaviour.

Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

AIM

At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection.

METHOD

Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival.

RESULTS

Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006).

CONCLUSION

Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

Diagnosis of severe growth hormone deficiency in the newborn

OBJECTIVE

Severe neonatal growth hormone deficiency (GHD) can cause recurrent hypoglycaemia. Early diagnosis is warranted. The aim of the study was to analyse the GH content in screening cards of 25 affected and 281 healthy newborns.

PATIENTS AND MEASUREMENTS

A total of 110 screening cards from ill newborns were sent to us for measuring GH content by a highly sensitive GH ELISA. Clinical information was obtainable in 61 cases. Severe GHD was defined by the presence of recurrent hypoglycaemia with a significant pituitary malformation or two additional pituitary hormone deficiencies. Screening cards from 281 healthy newborns (34.0-37.9 weeks) were prospectively analysed.

RESULTS

In 25 newborns (5 preterm), the definition of severe GHD was fulfilled based on recurrent hypoglycaemia in combination with malformation of the pituitary or midline structures in 21 cases and combined TSH and ACTH deficiency in four cases. The median GH concentration of those affected with severe GHD was 3.9 µg/L (range: 1.1-11.8), significantly below the previously reported reference range (P < .001). A GH concentration of 7 µg/L was confirmed as the cut-off for term newborns with the best accuracy (90.0% sensitivity and 98.7% specificity). The 95% reference range for healthy preterm newborns (n = 151) was 7.6-47.1 µg/L (median: 20.3 µg/L).

CONCLUSIONS

A GH content <7.0 µg/L in the newborn screening card confirms severe GHD with high accuracy. In preterm newborns, the lower limit of the reference interval was 0.6 µg/L higher than in term newborns. The newborn screening card is a valuable source for the very early diagnosis of GH deficiency.

Low expression of ANT1 confers oncogenic properties to rhabdomyosarcoma tumor cells by modulating metabolism and death pathways

Rhabdomyosarcoma (RMS) is the most frequent form of pediatric soft-tissue sarcoma. It is divided into two main subtypes: ERMS (embryonal) and ARMS (alveolar). Current treatments are based on chemotherapy, surgery, and radiotherapy. The 5-year survival rate has plateaued at 70% since 2000, despite several clinical trials. RMS cells are thought to derive from the muscle lineage. During development, myogenesis includes the expansion of muscle precursors, the elimination of those in excess by cell death and the differentiation of the remaining ones into myofibers. The notion that these processes may be hijacked by tumor cells to sustain their oncogenic transformation has emerged, with RMS being considered as the dark side of myogenesis. Thus, dissecting myogenic developmental programs could improve our understanding of RMS molecular etiology. We focused herein on ANT1, which is involved in myogenesis and is responsible for genetic disorders associated with muscle degeneration. ANT1 is a mitochondrial protein, which has a dual functionality, as it is involved both in metabolism via the regulation of ATP/ADP release from mitochondria and in regulated cell death as part of the mitochondrial permeability transition pore. Bioinformatics analyses of transcriptomic datasets revealed that ANT1 is expressed at low levels in RMS. Using the CRISPR-Cas9 technology, we showed that reduced ANT1 expression confers selective advantages to RMS cells in terms of proliferation and resistance to stress-induced death. These effects arise notably from an abnormal metabolic switch induced by ANT1 downregulation. Restoration of ANT1 expression using a Tet-On system is sufficient to prime tumor cells to death and to increase their sensitivity to chemotherapy. Based on our results, modulation of ANT1 expression and/or activity appears as an appealing therapeutic approach in RMS management.

A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study

BACKGROUND

Combining immune-checkpoint inhibitors with chemotherapy yielded an increased response rates in patients with metastatic triple-negative breast cancer (TNBC). Therefore, we evaluated the addition of durvalumab to standard neoadjuvant chemotherapy (NACT) in primary TNBC.

PATIENTS AND METHODS

GeparNuevo is a randomised phase II double-blind placebo-controlled study randomising patients with TNBC to durvalumab or placebo given every 4 weeks in addition to nab-paclitaxel followed by standard EC. In the window-phase durvalumab/placebo alone was given 2 weeks before start of nab-paclitaxel. Randomisation was stratified by stromal tumour-infiltrating lymphocyte (sTILs). Patients with primary cT1b-cT4a-d disease, centrally confirmed TNBC and sTILs were included. Primary objective was pathological complete response (pCR) (ypT0 ypN0).

RESULTS

A total of 174 patients were randomised, 117 participated in the window-phase. Median age was 49.5 years (range 23-76); 47 patients (27%) were younger than 40 years; 113 (65%) had stage ≥IIA disease, 25 (14%) high sTILs, 138 of 158 (87%) were PD-L1-positive. pCR rate with durvalumab was 53.4% (95% CI 42.5% to 61.4%) versus placebo 44.2% (95% CI 33.5% to 55.3%; unadjusted continuity corrected χ2P = 0.287), corresponding to OR = 1.45 (95% CI 0.80-2.63, unadjusted Wald P = 0.224). Durvalumab effect was seen only in the window cohort (pCR 61.0% versus 41.4%, OR = 2.22, 95% CI 1.06-4.64, P = 0.035; interaction P = 0.048). In both arms, significantly increased pCR (P < 0.01) were observed with higher sTILs. There was a trend for increased pCR rates in PD-L1-positive tumours, which was significant for PD-L1-tumour cell in durvalumab (P = 0.045) and for PD-L1-immune cell in placebo arm (P = 0.040). The most common immune-related adverse events were thyroid dysfunction any grade in 47%.

CONCLUSIONS

Our results suggest that the addition of durvalumab to anthracycline-/taxane-based NACT increases pCR rate particularly in patients treated with durvalumab alone before start of chemotherapy.

TRIAL REGISTRATION

ClinicalTrials.gov number: NCT02685059.

OR10-02 Diagnosis of Severe GH Deficiency in Newborns: New Reference Range for the Preterm and Confirmation of the GH Cut-Off

Introduction

Inborn severe GHD is caused by rare disorders of pituitary morphogenesis or function and frequently associated with additional pituitary hormone deficiencies. Affected newborns commonly present with recurrent hypoglycemia; therefore early diagnosis and therapy is warranted. The GH content of the newborn screening card is a reliable indicator of severe neonatal GHD. Here, we studied the GH content in screening cards and the history of 25 newborns with severe GHD. In addition, we determined the reference range of the GH content in screening cards from 282 healthy preterm newborns.

Patients and Methods

Since 2010, a total of 110 screening cards from hospitalized ill newborns were sent to our laboratory for measuring GH content. Using a questionnaire we obtained relevant clinical information from senders in 61 cases. Severe GHD was defined by the presence of recurrent neonatal hypoglycemia with either a significant cerebral MRI morphology or two additional pituitary hormone deficiencies. In addition, the GH content of screening cards from 282 healthy newborns born preterm with a gestational age at birth from 34.0 to 37.9 weeks was prospectively analyzed. The GH concentration of the eluate from the screening card was measured by a highly sensitive ELISA (Mediagnost, Germany); the GH serum concentration was calculated.

Results

In 25 patients, the definition of severe GHD of the newborn was fulfilled; based on recurrent hypoglycemia in combination with ectopia of the neurohypophysis in 17, septum pellucidum agenesis plus opticus hypoplasia in two, severely hypoplastic pituitary gland in two, and combined TSH and ACTH deficiency with no cMRI findings in four newborns. Five newborns with severe GHD were preterm. The median GH concentration of the term newborns with severe GHD (n=20) was 3.9 µg/l (range; 1.1 to 11.8). This was significantly below the previously reported reference data from healthy term newborns (n=269) (median 16.4 µg/l; 95% reference range 7.0 to 39.4) (p&lt;0.001). Using ROC plot analysis a GH serum concentration of 7.0 µg/l was identified as cut-off with the highest accuracy (90.0% sensitivity and 98.7% specificity). The median GH concentration of the 5 preterm newborns with severe GHD was 7.7 µg/l (range; 2.1 to 9.9). The newly determined 95% reference range for healthy newborns born preterm with a gestational age from 34.0 to 37.9 weeks (n=282) spanned from 7.9 to 41.1 µg/l with a median of 20.3 µg/l.

Conclusions

A GH content below 7.0 ng/ml in the newborn screening card identified severe GHD with 90% sensitivity and 98.7% specificity. In preterm newborns, the lower limit of the 95% reference interval was by 0.9 µg/l higher than in term newborns. The newborn screening card is a valuable source for the diagnosis of GH deficiency in newborns and young infants.

Tumour-specific microRNA expression pattern in canine intestinal T-cell-lymphomas

Intestinal T-cell lymphomas are common in dogs, but histopathological diagnosis remains challenging because of accompanying enteritis with lymphocyte involvement. Invasively taken full-layer biopsies are still required for reliable differentiation. The detection of specific microRNA expression patterns in canine intestinal T-cell lymphoma could provide new possibilities to differ intestinal lymphoma from benign inflammation and could lead to further understanding of lymphomagenesis. The objective of this study was to characterize microRNA expression in distinct groups of formalin-fixed and paraffin-embedded samples from canine intestinal T-cell lymphomas, lymphoplasmacellular enteritis and healthy intestinal tissue. In a preliminary test with two samples per group, total RNA was extracted (RNEasy FFPE Kit, Qiagen), reverse transcribed (miScript II RT Kit, Qiagen) and pre-amplified (miScript PreAmp PCR Kit, Qiagen). We performed comparative quantitative PCR on microRNA PCR Array plates (Qiagen) with pre-fabricated reactions for 183 different mature canine microRNAs. Subsequently, 12 microRNAs with conspicuous expression changes in the lymphoma group were selected and microRNA expression of all samples (n = 8) per group was analysed with individual microRNA assays (miScript Primer Assays, Qiagen) on the reverse transcribed RNA without pre-amplification. Our results revealed lymphoma-specific expression patterns, with down-regulation of the tumour-suppressing microRNAs miR-194, miR-192, miR-141 and miR-203, and up-regulation of oncogenic microRNAs, including microRNAs from the miR-106a~363 cluster. In addition, we detected only slight expression alterations between healthy intestinal tissue and lymphoplasmacellular enteritis cases. We conclude that microRNA expression patterns can be used to separate T-cell lymphomas from healthy tissue and benign inflammatory disorders.

Influence of preanalytic and analytic variables in canine and feline urine specific gravity measurement by refractometer

Urine specific gravity (USG), which is usually measured by refractometry, is an important indicator of renal concentrating ability. Few studies have evaluated refractometers with separate scales for canine and feline urine. Variables such as protein content or storage time may influence the USG. We compared the effects of measuring USG with a refractometer with single or separate scales for canine and feline urine, investigated inter- and intra-observer variability, and measured agreement between whole urine and supernatant. We evaluated the correlation between USG and osmolality, the influence of urinary protein on USG and osmolality, and the impact of storage time up to 6 mo. We examined 252 canine and 126 feline samples. Bland-Altman analysis revealed higher USG values of the single-scale refractometer than the dual-scale refractometer, with a mean difference (bias) of < 0.001 for canine and 0.003 for feline specimens. Inter- and intra-observer variability were acceptable. Good agreement was shown between USG of whole urine and supernatant. Correlations between USG and osmolality were excellent (0.98-0.99, p < 0.001). Proteinuria up to 1 g/L had no major impact on USG or osmolality. Storage time had no significant effect on USG. The difference between the refractometers is clinically irrelevant, and the use of a refractometer with separate feline and canine scales is unnecessary. Whole urine and supernatant stored up to 6 mo can both be used for USG measurement. The influence of proteinuria <1 g/L on USG and osmolality is negligible.

Sample preparation for Raman microspectroscopy

Raman spectroscopy and its variants allow for the investigation of a wide range of biological and biomedical samples, i. e. tissue sections, single cells and small molecules. The obtained information is on a molecular level. By making use of databases and chemometrical approaches, the chemical composition of complex samples can also be defined. The measurement procedure is straight forward, however most often sample preparation protocols must be implemented. While pure samples, such as high purity powders or highly concentrated chemicals in aqueous solutions, can be directly measured without any prior sample purification step, samples of biological origin, such as tissue sections, pathogens in suspension or biofluids, food and beverages often require pre-processing steps prior to Raman measurements. In this book chapter, different strategies for handling and processing various sample matrices for a subsequent Raman microspectroscopic analysis were introduced illustrating the high potential of this promising technique for life science and medical applications. The presented methods range from standalone techniques, such as filtration, centrifugation or immunocapture to innovative platform approaches which will be exemplary addressed. Therefore, the reader will be introduced to methods that will simplify the complexity of the matrix in which the targeted molecular species are present allowing direct Raman measurements with bench top or portable setups.

Is there a correlation between canine adult-onset demodicosis and other diseases?

Demodicosis is frequently seen in small animal practice. In older dogs, it is often associated with immunosuppression and immunosuppressive diseases. The aim of this study was to evaluate a larger number of dogs with adult-onset demodicosis (AOD) at the veterinary teaching hospitals of the University of Sydney/Australia and the University of Munich/Germany. Breed predispositions were compared with the two control populations. Of more than 20 000 dogs and 15 000 in each respective hospital population, 54 dogs in Munich and 68 dogs in Sydney were diagnosed with AOD at a mean age of 8 years. Breed predispositions were seen for West Highland White Terriers in Munich (p<0.0001) and Maltese Terriers and Shih Tzus in Sydney (p<0.01). Concurrent diseases were confirmed in approximately 40% of the dogs both in Munich and Sydney. A significant association was only found between AOD and hyperglucocorticoidism, hypothyroidism and (in Munich) leishmaniosis. Neoplastic diseases were not significantly more common in dogs with demodicosis than in the total population at both locations (p>0.05). Consequently, dogs with AOD should be evaluated for concurrent hyperglucocorticoidism and hypothyroidism, and, in areas of the world where this is prevalent, also for leishmaniosis.

Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery

Objective: This longitudinal observational study investigated how neural stretch-resistance in wrist and finger flexors develops after stroke and relates to motor recovery, secondary complications, and lesion location.

Methods: Sixty-one patients were assessed at 3 weeks (T1), three (T2), and 6 months (T3) after stroke using the NeuroFlexor method and clinical tests. Magnetic Resonance Imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL) and to perform voxel-based lesion symptom mapping.

Results: NeuroFlexor assessment demonstrated spasticity (neural component [NC] >3.4N normative cut-off) in 33% of patients at T1 and in 51% at T3. Four subgroups were identified: early Severe spasticity (n = 10), early Moderate spasticity (n = 10), Late developing spasticity (n = 17) and No spasticity (n = 24). All except the Severe spasticity group improved significantly in Fugl-Meyer Assessment (FMA-HAND) to T3. The Severe and Late spasticity groups did not improve in Box and Blocks Test. The Severe spasticity group showed a 25° reduction in passive range of movement and more frequent arm pain at T3. wCST-LL correlated positively with NC at T1 and T3, even after controlling for FMA-HAND and lesion volume. Voxel-based lesion symptom mapping showed that lesioned white matter below cortical hand knob correlated positively with NC.

Conclusion: Severe hand spasticity early after stroke is negatively associated with hand motor recovery and positively associated with the development of secondary complications. Corticospinal tract damage predicts development of spasticity. Early quantitative hand spasticity measurement may have potential to predict motor recovery and could guide targeted rehabilitation interventions after stroke.

Abstract P3-10-01: Single-cell profiling identifies hypoxic carcinoma cells as source of an immunosuppressive VEGFA metagene

Background:

We have previously shown that expression of the IL8/VEGFA-metagene eliminates the good prognostic effect of TILs in TNBC (PMID 21978456, 28750120). We also showed that the VEGFA metagene predicted response to neoadjuvant bevacizumab in the GeparQuinto trial (Karn 2017 SABCS #851166). The main cellular sources of the transcripts that comprise the VEGFA metagene are unknown since mRNA profiling of bulk biopsies contains signals from different cell types.

Methods:

Individual genes that comprise the VEGFA metagene were measured in bulk tissue- and single cell-RNA-Seq from breast cancer subtypes and normal cells on different platforms (Affymetrix n=4915, Agilent n=597, Illumina n=2433, RNA-Seq n=1215, Exome Capture RNA-Seq n=226, HTG-Seq n=243, sc-RNA-Seq n=24710). For blinded, orthogonal validation we performed immunohistochemistry. Effect of neoadjuvant chemotherapy with or without bevacizumab was studied by RNA-Seq and IHC on samples from GeparQuinto trial. SWOG S0800 (GSE114403), PROMIX (GSE87455), and GeparSixto trials were used for validation. TCGA was mined for mutations and somatic CNA. RNA-Seq from GeparNuevo was used for correlation with checkpoint inhibitor treatment.

Results:

We identified a stable core of six genes (VEGFA, ANGPTL4, ADM, NDRG1, DDIT4, CSTB) in different cohorts. Strong expression of this signature was mainly restricted to TNBC subtype and associated with poor prognosis within this subgroup. Single cell RNA-Seq of breast epithelial cells from 4 reduction mammoplasties and 4 TNBC revealed that these genes are coexpressed in individual epithelial cells and not associated with endothelial cells. In line with their presumed functions in cellular stress and hypoxia, immunohistochemistry revealed strong para-necrotic expression in TNBC. Moreover, high gene expression in TNBC was associated with mutations in DNA damage control pathways, somatic copy number alterations, and lower TILs. While chemotherapy led to downregulation, bevacizumab increased expression. In multivariate analysis, high pretreatment values predict pCR to both bevacizumab and chemotherapy (OR 2.40, P=0.006), which may be explained by sensitivity of tumors which are already under cellular stress. On the other hand, expression of the VEGFA metagene seems to create an immunosuppressive environment that counteracts the positive prognostic effect of TILs. In pre-treatment biopsies from the GeparNuevo checkpoint inhibitor trial we found a negative correlation of VEGFA metagene expression with the amount of the recently identified tissue-resident memory T cell subset (CD8TRM, PMID 29942092; P=0.002), while the subsequent increase of CD8TRM during treatment was larger in tumors with high VEGFA (P=0.019).

Conclusions:

Perinecrotic carcinoma cells under stress from hypoxia and or chromosomal instability are the source of the VEGFA metagene signature. Its predictive value in TNBC suggests estimating and reporting the amount of necrosis in the pathology report may be helpful in predicting response to preoperative chemotherapy, and could be used as stratification factor in clinical trials. The signature indicates an immunosuppressive environment and should be further studied in the context of immune therapies in combinations with anti-angiogenic treatment.

Citation Format: Karn T, Denkert C, Sinn BV, Weber K, Nekljudova V, Rody A, Meissner T, Hatzis C, El-Balat A, Becker S, Solbach C, Untch M, Schneeweiss A, von Minckwitz G, Loibl S, Pusztai L, Holtrich U. Single-cell profiling identifies hypoxic carcinoma cells as source of an immunosuppressive VEGFA metagene [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-01.

Abstract P2-08-10: Similarities between low hormone receptor positive and hormone receptor negative breast cancer: An analysis of 4366 patients from multicenter clinical trials

Background:

Currently, patients with breast cancer (BC) with hormone receptor (HR) immunohistochemical expression between 1-9% are eligible to receive endocrine therapy. However, recent data suggest that these tumors express a basal-like molecular phenotype associated with triple negative BC (TNBC) rather than luminal phenotype associated with HR positive BC. Here, we aimed to determine the differences between strong HR positive, low HR positive and negative HR BC, in regard to responsiveness to neoadjuvant chemotherapy (NACT) and disease free survival (DFS) in large cohorts from GBG clinical trials.

Methods:

In this retrospective analysis of data from women with BC treated in the neoadjuvant GeparQuinto (n=2572), GeparSixto (n=588) and GeparSepto (n=1206) clinical trials, we compared patients with three HR phenotypes: low positive (ER and/or PR= 1-9%), strong positive (ER or PR= 10-100%), and negative (ER and PR= &lt;1%), regarding pathological complete response (pCR, ypT0 ypN0) and DFS. A logistic regression model for endpoint pCR was performed on pooled data from all trials. Cox regression was used to model DFS for patients participating in GeparQuinto and GeparSixto trial, including 71 with low HR positive phenotype. The models were adjusted by age, tumor and nodal status, grading, Her2 status, histological type, stromal and tumor infiltrating lymphocytes and clinical trial. The survival model was additionally adjusted by pCR after NACT.

Results:

Patients median age was 49 years, the majority had clinical tumor stage 2 (54.1%), negative nodal status (54.7%), and Her2 negative tumors (72.4%). 85.1% of women had BC classified as no special histological type. The pCR rate across the studies was 26.2%. 145 (3.4%) patients had low HR positive, 2417 (57.3%) strong HR positive and 1658 (39.3%) HR negative tumors. After NACT, 16.3% of patients with strong HR positive BC achieved a pCR, while among those with HR negative and low HR positive tumors, pCR rates were 40.2% and 37.9%, respectively (p&lt;0.001). In the adjusted logistic regression model, there was no statistically significant difference between low HR positive and HR negative tumors (OR: 1.34, 95%-CI: (0.84-2.13), p=0.222). But strong HR positive tumors had a significantly lower chance of achieving a pCR compared to low HR positives (OR 0.48, 95%-CI: 0.30-0.76, p=0.002). Patients with strong HR positive BC had a better DFS than patients with low HR positive tumors (hazard ratio 0.35, 95%-CI: 0.18-0.70, p=0.003). DFS was not significantly different between patients with HR negative and low HR positive tumors (hazard ratio 0.74, 95%-CI: 0.38-1.43, p=0.370).

Conclusions:

Similarly to patients with negative HR tumors, patients with low HR positive tumors have a better responsiveness to NACT and worse survival rates, compared to patients with strongly HR positive BC. We suggest that studies on treatment options for basal-like/TNBC, should also consider including patients with low HR positive tumors.

Citation Format: Villegas SL, Lederer B, Untch M, Holms F, Ulmer H-U, Diebold K, Fasching PA, Weber K, Schmitt WD, Tesch H, Rezai M, Marmé F, Sinn B, Hackmann J, Schneeweiss A, Tannapfel A, Nekljudova V, Denkert C, Loibl S. Similarities between low hormone receptor positive and hormone receptor negative breast cancer: An analysis of 4366 patients from multicenter clinical trials [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-10.

The Diagnostic Value of IGF-2 and the IGF/IGFBP-3 System in Silver-Russell Syndrome

BACKGROUND/AIMS

Recently, we have described a family of 4 members presenting with intrauterine and postnatal growth failure, low IGF-2 levels, and signs of Silver-Russell syndrome (SRS) who carried a genomic IGF2 mutation. Here, we assess the value of IGF-2 in relation to SRS.

METHODS

We collected data from 48 SRS children and 48 short children born small for gestational age (SGA) seen at our center. The SRS children were 4.6 ± 2.0 years of age, and the SGA children were 4.8 ± 1.8 years of age. All patients were prepubertal and growth hormone naive. An 11p15 ICR1 loss of methylation (11p15LOM) was present in 22, maternal uniparental disomy of chromosome 7 (upd(7)mat) in 7, and IGF2 genomic mutation (IGF2mut) in 3 patients. Growth factors were measured by in-house radioimmunoassays.

RESULTS

The median IGF-2 standard deviation scores (SDSs) were: IGF2mut -1.75, upd(7)mat -1.69, nonsyndromic SGA -1.52, 11p15LOM -0.61, and clinical (tested negative) -0.55. The median IGF-2:IGF-1 concentration ratio was 2.57 in IGF2mut compared to 5.44 in 11p15LOM (p = 0.036), 7.84 in clinical, and 7.98 in upd(7)mat. Upd(7)mat patients had significantly lower IGF-1 and IGFBP-3 SDSs than patients with 11p15LOM (p ≤ 0.002).

CONCLUSION

Serum IGF-2 in combination with IGF-1 and IGFBP-3 can add to the clinical signs of SRS patients and help to perform targeted genetic testing. Further studies are needed.

Recent progress in surface-enhanced Raman spectroscopy for biological and biomedical applications: from cells to clinics

The application of surface-enhanced Raman spectroscopy (SERS) in biological and biomedical detection schemes is feasible due to its excellent molecular specificity and high sensitivity as well as the capability of SERS to be performed in complex biological compositions. SERS-based investigation of cells, which are the basic structure and functional unit of organisms, represents the starting point of this review. It is demonstrated that SERS provides a deep understanding of living cells as well as their microenvironment which is needed to assess the development of diseases. The clinical relevance of SERS is proved by its application for the detection of cancer cells and tumour margins under in vivo conditions and examples for theranostic approaches are discussed. This review article provides a comprehensive overview of the recent progress within the last 3 years.

Detection of feline Coronavirus in effusions of cats with and without feline infectious peritonitis using loop-mediated isothermal amplification

•

Diagnosis of feline infectious peritonitis is critical in terms of time.

•

Rapid detection methods for coronavirus are needed in cats.

•

Isothermal amplification assays are suitable as point-of-care tests.

•

The sensitivity of isothermal amplification assays for coronavirus detection is low.

Feline infectious peritonitis (FIP) is a fatal disease in cats worldwide. The aim of this study was to test two commercially available reaction mixtures in a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay to detect feline Coronavirus (FCoV) in body cavity effusions of cats with and without FIP, in order to minimize the time from sampling to obtaining results.

RNA was extracted from body cavity effusion samples of 71 cats, including 34 samples from cats with a definitive diagnosis of FIP, and 37 samples of control cats with similar clinical signs but other confirmed diseases. Two reaction mixtures (Isothermal Mastermix, OptiGene Ltd.and PCRun™ Molecular Detection Mix, Biogal) were tested using the same primers, which were designed to bind to a conserved region of the FCoV membrane protein gene. Both assays were conducted under isothermal conditions (61 °C–62 °C). Using the Isothermal Mastermix of OptiGene Ltd., amplification times ranged from 4 and 39 min with a sensitivity of 35.3% and a specificity of 94.6% for the reported sample group. Using the PCRun™ Molecular Detection Mix of Biogal, amplification times ranged from 18 to 77 min with a sensitivity of 58.8% and a specificity of 97.3%.

Although the RT-LAMP assay is less sensitive than real time reverse transcription PCR (RT-PCR), it can be performed without the need of expensive equipment and with less hands-on time. Further modifications of primers might lead to a suitable in-house test and accelerate the diagnosis of FIP.