A case of metastatic melanoma in the liver mimicking colorectal cancer with synchronous liver metastasis

INTRODUCTION AND IMPORTANCE

Colorectal cancer (CRC) presenting with synchronous liver metastasis is relatively common, occurring in approximately 20 % of patients1. Herein we report an atypical case of a patient who presented with a new, obstructing colon mass with synchronous liver metastasis, biopsy proven to be malignant melanoma.

CASE PRESENTATION

An 81-year-old male presented to the hospital emergency department with abdominal pain, diarrhea, and 30-pound unintentional weight loss over the past 4 months. Investigations revealed an obstructing cecal mass with multiple large, hypodense hepatic masses suspicious for metastatic disease. A multidisciplinary evaluation ensued, and the decision was made to treat with palliative intent. The patient was surgically treated with a diverting stoma and an intraoperative biopsy of the hepatic masses demonstrated metastatic melanoma. The patient did report a remote history of malignant melanoma and underwent curative-intent resection a decade earlier. There was no evidence of a new primary cutaneous melanoma. A tentative plan for checkpoint inhibitor therapy was discussed, but his medical issues worsened, and the patient died before any anti-cancer therapy could be started.

CLINICAL DISCUSSION

The clinical picture of obstructing colon mass with synchronous liver masses most commonly represents a colon primary with synchronous liver metastasis. The capacity for melanoma to mimic other pathologies is unusual but has been described, with case reports describing metastasis to the eye, biliary hilum, liver, pancreas, colon, small bowel, and brain. This case serves as a good reminder that melanoma may mimic a variety of oncologic presentations, even after a very long disease-free interval.

CONCLUSION

Our patient suspected to have metastatic colon cancer was found instead to have metastatic melanoma, with significantly different therapeutic options and prognosis.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis

INTRODUCTION

Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences.

MATERIAL AND METHODS

We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives.

DISCUSSION

This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice.

OP0090 CLASSIFICATION OF PATIENTS WITH RELAPSING POLYCHONDRITIS BASED ON SOMATIC MUTATIONS IN UBA1

Background:

Somatic mutations in ubiquitin activating enzyme 1 (UBA1) cause a newly defined syndrome known as VEXAS. [1] More than fifty percent of patients currently identified with VEXAS meet diagnostic criteria for relapsing polychondritis (RP).

Objectives:

To determine the prevalence VEXAS within a cohort of patients with RP, to compare their clinical, laboratory, and immunologic features and to develop a clinical algorithm to inform genetic screening for VEXAS among patients with RP.

Methods:

Exome and targeted sequencing of the UBA1 gene was performed in a prospective observational cohort of patients with RP. Clinical and immunological characteristics of patients with RP were compared based on presence or absence of UBA1 mutations. Random forest was used to derive a clinical algorithm to identify patients with UBA1 mutations. Immune populations were quantified by multipanel flow cytometry. Categorical and continuous variables were compared using the chi square or Kruskal-Wallis test. P<0.05 defined statistical significance.

Results:

Seven of 92 patients with RP (7.6%) were confirmed to have UBA1 mutations (VEXAS-RP). Six additional patients with VEXAS-RP from other cohorts were included for subsequent analyses. Patients with VEXAS-RP were all male, older at disease onset, and commonly had fever, ear chondritis, skin involvement, deep vein thrombosis, and pulmonary infiltrates. Patients with RP as compared with VEXAS-RP had a significantly higher prevalence of airway chondritis, costochondritis and tenosynovitis/arthralgias. (Table). Mortality was significantly greater in VEXAS-RP than RP (27% vs 2% p=0.01). Maximum ESR, CRP, and mean corpuscular volume (MCV) values were significantly greater in VEXAS-RP. Absolute monocyte, lymphocyte, and platelet counts were significantly lower in VEXAS-RP. A decision tree based on male sex, MCV>100 fl and Platelet count<200 K/ul classified between VEXAS-RP and RP with 100% sensitivity and 96% specificity.

Table 1.

Clinical Characteristics of patients with RP vs VEXAS-RP

All Patientsn=98RPn=85VEXAS-RPn=13p valueDemographic CharacteristicsRace, White n (%)90 (92)77 (91)13 (100)0.59Sex, Male n (%)26 (27)13 (15)13 (100)<0.0001Age, Symptom onset, years, Median (IQR)38 (30-47)37 (28-43)56 (54-64)<0.0001Clinical SymptomsFever n (%)33 (34)20 (24)13 (100)<0.0001Ear chondritis n (%)61 (62)48 (56)13 (100)0.0015Nose chondritis n (%)83 (85)71 (84)12 (92)0.68Airway chondritis n (%)37 (38)37 (44)0 (0)0.0015Tenosynovitis/arthalgias n (%)83 (85)77 (91)6 (46)0.0005Skin involvement n (%)33 (34)22 (2611 (85)<0.0001Laboratory ValuesESR, mm/hr, median (IQR)12 (6-22)11 (5-19)66.5 (42-110)<0.0001CRP, mg/L, median (IQR)2.9 (0.8-9.6)1.9 (0.6-6.3)17.7 (9.6-99.5)<0.0001Platelet count (k/uL)246(201-299)258 (227-312)145 (100-169)<0.0001MCV fL93.05 (90-98)92.2 (89-95)105 (102-115)<0.0001Absolute lymphocyte count1.6 (1.1-2.3)1.78(1.4-2.4)0.92 (0.5-1.2)<0.0001CT scan abnormalitiesPulmonary infiltrates n (%)16 (16.33)6 (7.06)10 (77)<0.0001ComplicationsDeath n (%)6 (6)3 (4)3 (23)0.029Unprovoked DVT12 (12)4 (5)8 (62)<0.0001

N number; IQR = interquartile range

Conclusion:

Mutations in UBA1 are causal for disease in a subset of patients with RP. These patients are defined by disease onset in the fifth decade of life or later, male sex, ear/nose chondritis and hematologic abnormalities. Early identification is important in VEXAS given the associated high mortality rate.

References:

[1]Beck DB, Ferrada MA, Sikora KA, Ombrello AK, Collins JC, Pei W, Balanda N, Ross DL, Ospina Cardona D, Wu Z et al: Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med 2020, 383(27):2628-2638.

Disclosure of Interests:

None declared

Development of a Group-Based Community Health Worker Intervention to Increase Colorectal Cancer Screening Among Latinos

INTRODUCTION

Latinos are at higher risk of colorectal cancer (CRC) mortality than non-Hispanic Whites due, in part, to disparities in cancer screening. There is a need to evaluate community-based CRC interventions as they may reach underinsured communities and those at highest risk for CRC. This article describes the development of a group-based CRC intervention (Juntos contra el Cancer).

METHOD

Purposive sampling was used to recruit Latino men and women aged 50 to 75 years not-up-to-date with CRC screening. The development of the intervention was guided by the socioecologic framework, a community needs assessment, literature reviews, five focus groups (n = 39) from the target community and feedback from a Community Advisory Board.

RESULTS

Findings from focus groups suggested that a group-based, promotor or community health worker (CHW) led, cancer prevention education with linkages to care would address barriers to CRC screening.

CONCLUSION

Development of community-based CRC screening interventions should be informed by early and sustained community engagement. Interventions led by CHWs with linkages to care are feasible and can reach populations not connected to health care settings.

The experience of living after ECT: a qualitative meta-synthesis

BACKGROUND

Electroconvulsive therapy (ECT) is a controversial treatment. Research has predominantly focused on clinician assessment of short-term efficacy and, occasionally, on participant experiences of the treatment itself. While service user accounts of the long-term impacts of ECT are reported, they are dispersed throughout the literature and typically tangential to studie's main foci.

AIM

The aim of this study was to synthesise service-user accounts, within peer-reviewed literature, of long-term impacts of ECT in their daily lives.

METHODS

A qualitative meta-synthesis was conducted. A systematic literature search identified qualitative articles meeting the inclusion criteria. Results sections of eligible papers were analysed thematically.

RESULTS

From 16 eligible papers, the review identified 11 long-term impacts, four social influences and five strategies that people employed to navigate these long-term impacts.

CONCLUSION

Limited research has examined long-term experiences of ECT from service-user perspectives. These lived experience perspectives are required to facilitate peer-to-peer learning and assist future service delivery to align with needs of people living with long-term ECT impacts.

136 Effects of the homology direct repair enhancer RS-1 on pig embryo culture

Advances in genome editing technologies, such as the CRISPR/Cas9 system, have facilitated gene manipulation and the generation of pigs resistant to disease, models for studying human diseases and for xenotransplantation. However, double-strand breaks generated by the CRISPR/Cas9 system are preferentially repaired by the non-homologous end joining (NHEJ) pathway compared with high-fidelity homology-directed repair (HDR). All reports of pigs created by zygote injection of the CRISPR/Cas9 system result from NHEJ rather than HDR. The molecule known as RS-1 was found to stimulate RAD51 and thus enhance HDR. Thus, our goals are to understand this pathway by evaluating the response, as well as dosage and temporal effects, of RS-1 on porcine embryo development, and to determine a safe concentration to achieve high HDR rates without affecting embryo development. As RS-1 was added to culture medium from a 7.5mM stock solution in DMSO, we also evaluated whether RS-1 in solution could have affinity and migrate to the mineral oil overlay placed in the media during embryo culture. After IVF, embryos were cultured without RS-1 (control groups) or in the presence of RS-1 at 7.5 and 15 µM. At 7.5 µM, RS-1 improved HDR in rabbits created by zygote injection of the CRISPR/Cas9. Based on that, we designed five experimental groups to evaluate short- (A, 20h) and long-term (B, 144 h) effects of RS-1: two groups in the presence of RS-1 at 7.5 µM (7.5 µM A and 7.5 µM B), two control groups (control A and control B), and a group in the presence of RS-1 at 15 µM A for short-term exposure only. First, embryos in the groups containing (7.5 µM A, 7.5 µM B, and 15 µM A) and without RS-1 (control A and control B) were cultured for 20h without the mineral oil overlay. Then, embryos from control A, 7.5 µM A, and 15 µM A groups were washed and cultured without RS-1 until Day 6 in the presence of the mineral oil overlay. To evaluate long-term effects of RS-1, embryos from control B and 7.5 µM B groups were washed and transferred to medium without or with RS-1 at 7.5 µM, respectively, and cultured until Day 6 with no mineral oil overlay. We report the mean values for each set of data±s.e.m., and the degree of statistical significance in all analyses was defined at P&lt;0.05. We observed that the presence of RS-1 at 15 µM decreased cleavage rates (control A 79.1±2.7%; 7.5 µM A 83.6±1.6%; 15 µM 70.9±4.4%; control B 80.8±1.4%; 7.5 µM B 80.0±2.8%), and long-term exposure to RS-1 decreased development to the blastocyst stage (control A 46.5±3.0%; 7.5 µM A 42.7±3.4%; 15 µM 41.8±4.7%; control B 44.9±3.3%; 7.5 µM B 28.8±4.9%). In addition, RS-1 exposure decreased the total cell number compared with the controls (control A 61.4±2.8; 7.5 µM A 49.2±3.0; 15 µM 48.5±2.3; control B 59.9±3.4; 7.5 µM B 41.5±2.5), however no differences in apoptosis rates were observed between the treatments. Our work will serve as a basis to understand the effects of RS-1 and RAD51 during embryonic development and to improve the applicability of customizable nucleases for the production of genetically modified pigs.

Evaluation of Lethal Fish Sampling and the Nonlethal Alternative Under the Canadian Metal and Diamond Mining Environmental Effects Monitoring Program

The Environmental Effects Monitoring (EEM) program, federally mandated to metal and diamond mines and mills in Canada, aims to ensure that fish, fish use, and their environment are sufficiently protected by the Metal and Diamond Mining Effluent Regulations (MDMER). Concerns have been raised regarding lethal fish sampling conducted for the program and the potential risk to fish populations. This study endeavored to calculate the extent of fish sacrificed during lethal EEM fish surveys to provide a more informed characterization for stakeholders. By extrapolating data from 28 studies conducted at 8 metal mines in Saskatchewan between 2004 and 2017, it was conservatively estimated that 60 060 ± 19 978 fish have been sacrificed for the program nationwide since its promulgation in 2002. This is almost 2 times greater than guidance recommendations due to numerous factors. Challenges faced when implementing the nonlethal fish population survey alternative were also evaluated, and some of these included data interpretation inconsistencies due to the lack of critical effect sizes (CES) included in the regulations for nonlethal effect endpoints, and reliance on capturing young of the year fish to assess the prescribed effect endpoints. Finally, a case study conducted to evaluate the congruity of lethal and nonlethal fish population survey results identified that the effect endpoints often produced conflicting conclusions for the same response variable. Ultimately, this study highlights that in order to strengthen and promote the use of nonlethal fish sampling as an alternate to the current standard of conducting lethal fish population surveys under the EEM program, the effect endpoints, study designs, and adoption of CES need to be thoroughly evaluated and included in the MDMER. If nonlethal sampling designs adequately provide the required data and meet program objectives, then there would be no need to continue sacrificing fish for the Canadian metal and diamond mining EEM program. Integr Environ Assess Manag 2019;00:1-10. © 2019 SETAC.

Estimation of scattered radiation in digital breast tomosynthesis

Digital breast tomosynthesis (DBT) is a promising technique to overcome the tissue superposition limitations found in planar 2D x-ray mammography. However, as most DBT systems do not employ an anti-scatter grid, the levels of scattered radiation recorded within the image receptor are significantly higher than that observed in planar 2D x-ray mammography. Knowledge of this field is necessary as part of any correction scheme and for computer modelling and optimisation of this examination. Monte Carlo (MC) simulations are often used for this purpose, however they are computationally expensive and a more rapid method of calculation is desirable. This issue is addressed in this work by the development of a fast kernel-based methodology for scatter field estimation using a detailed realistic DBT geometry. Thickness-dependent scatter kernels, which were validated against the literature with a maximum discrepancy of 4% for an idealised geometry, have been calculated and a new physical parameter (air gap distance) was used to estimate more accurately the distribution of scattered radiation for a series of anthropomorphic breast phantom models. The proposed methodology considers, for the first time, the effects of scattered radiation from the compression paddle and breast support plate, which can represent more than 30% of the total scattered radiation recorded within the image receptor. The results show that the scatter field estimator can calculate scattered radiation images in an average of 80 min for projection angles up to 25° with equal to or less than a 10% error across most of the breast area when compared with direct MC simulations.

Performance of a novel wafer scale CMOS active pixel sensor for bio-medical imaging

Recently CMOS active pixels sensors (APSs) have become a valuable alternative to amorphous silicon and selenium flat panel imagers (FPIs) in bio-medical imaging applications. CMOS APSs can now be scaled up to the standard 20 cm diameter wafer size by means of a reticle stitching block process. However, despite wafer scale CMOS APS being monolithic, sources of non-uniformity of response and regional variations can persist representing a significant challenge for wafer scale sensor response. Non-uniformity of stitched sensors can arise from a number of factors related to the manufacturing process, including variation of amplification, variation between readout components, wafer defects and process variations across the wafer due to manufacturing processes. This paper reports on an investigation into the spatial non-uniformity and regional variations of a wafer scale stitched CMOS APS. For the first time a per-pixel analysis of the electro-optical performance of a wafer CMOS APS is presented, to address inhomogeneity issues arising from the stitching techniques used to manufacture wafer scale sensors. A complete model of the signal generation in the pixel array has been provided and proved capable of accounting for noise and gain variations across the pixel array. This novel analysis leads to readout noise and conversion gain being evaluated at pixel level, stitching block level and in regions of interest, resulting in a coefficient of variation ⩽1.9%. The uniformity of the image quality performance has been further investigated in a typical x-ray application, i.e. mammography, showing a uniformity in terms of CNR among the highest when compared with mammography detectors commonly used in clinical practice. Finally, in order to compare the detection capability of this novel APS with the technology currently used (i.e. FPIs), theoretical evaluation of the detection quantum efficiency (DQE) at zero-frequency has been performed, resulting in a higher DQE for this detector compared to FPIs. Optical characterization, x-ray contrast measurements and theoretical DQE evaluation suggest that a trade off can be found between the need of a large imaging area and the requirement of a uniform imaging performance, making the DynAMITe large area CMOS APS suitable for a range of bio-medical applications.

224 CONSTRUCTION OF GENE TARGETING VECTORS FOR RAG-1 AND RAG-2

Gene targeting in mammalian cells has become a routine technique and is currently used to study gene function, create biomedical models, and generate potential tissue sources for xenotransplantation. Severe combined immunodeficiency (SCID) is a condition characterised by the absence of T cells and a lack of B cell function. Severe combined immunodeficiency affects ~1 out of every 100 000 infants. Autosomal recessive SCID can occur due to a mutation within the recombination activating genes (RAG-1/RAG-2) that play a role in recombination of immunoglobulins and T-cell receptors. Gene targeting has been used to create mouse models to study the effects of a RAG-1 or RAG-2 deficiency on the immune system. In 1992, Mombaerts et al. generated a homozygous mouse model of RAG-1 deficiency, whereas Shinkai et al. generated a homozygous mouse model of RAG-2. Both models resulted in the absence of mature T or B lymphocytes; which was concluded to be due to the lack of the ability to initiate the V(D)J recombination process. Because of the anatomical and physiological similarities between humans and pigs, a swine model of both RAG-1 and RAG-2 deficiency would have utility. We hypothesise that disruption of RAG-1, RAG-2, or both in swine will result in a SCID phenotype. A first step in the creation of a swine SCID model is to assemble targeting vectors. The objective of this work was to construct targeting vectors. To accomplish this goal, genomic DNA from porcine fetal fibroblasts was used to amplify a 6840-bp PCR product including the porcine RAG-1 gene. This fragment was cloned into TOPO pCR-XL (Invitrogen, Carlsbad, CA, USA). So that a mammalian G418 resistance cassette could be used for selection of targeting events, this plasmid was modified to remove the endogenous AphII gene (provides G418 resistance). The pKW4 contains LoxP (locus of X-ing over) sites that flank a G418 resistance cassette (based on mammalian codon usage), which is driven by a phosphoglycerate kinase (PGK) promoter (Lorson et al. 2011). This cassette was inserted into the RAG-1 gene to create the targeting construct pAB6. For RAG2, a 9466-bp PCR product i ncluding the RAG-2 gene was amplified and cloned into TOPO pCR-Blunt II (Invitrogen). The LoxP flanked G418 resistance cassette from pKW4 was inserted into the second exon of the RAG-2 gene sequence, creating the targeting construct pAB13. Further, diagnostic screening strategies were developed and validated to discriminate gene-targeting events from random integration. We report here 2 targeting vectors and validated screening methods for gene targeting in porcine fetal fibroblasts that have been validated for cloning. These vectors will be applied toward an effort to create a porcine SCID model. The implications of such a model include evaluation of basic immune function, evaluation of the innate immune system in vaccine efficacy, and organ transplantation.

Abstract P1-09-15: Perception of breast cancer risk in an underinsured safety net population

Background: Patient perception of breast cancer risk can affect compliance with screening mammography. In an underinsured population, we have previously found that being insured and adequate health literacy were strong predictors of use of screening mammography. Previous studies in other populations have found that patients with heighted perceived risk also have increased use of screening. Previous studies have found an average perceived risk of 30%. “Risk” and risk assessment are difficult concepts for many people and this may be problematic in undereducated populations. The current study was performed to evaluate women's perception of their lifetime risk of breast cancer in a safety net population.

Methods: From May 2012 to May 2013, all patients seen at a safety net Breast Clinic were asked to estimate their lifetime risk of breast cancer. “If 0 = no chance and 100% = for sure, what are your chances of getting breast cancer in your life?” Sociodemographic, clinical, and treatment variables were collected. Univariate analysis was performed to identify variables which were associated with picture choice. All of the variables with a p-value &lt;0.10 were included in the multivariate analysis.

Results: 1,089 consecutive patients were seen. After exclusion of men and patients known to have breast cancer, 838 patients were included. The mean age was 43 years. 93% of the patients were uninsured or insured with Medicaid. Average education 10 years and 17% were non-Hispanic White (NHW). Overall the average perceived lifetime risk for the population was 29.7%. For all patients age 35 years+, the average Gail model Risk Assessment scores were 1.1% (5 year) and 9% (LT). Only 17% of patients would be considered at increased risk according to Gail model 5 year risk (&gt; 1.6%).

In univariate analysis, continuous variables associated with higher perceived risk were higher BMI (p = 0.003), more years of education (p = 0.0009), and higher 5 year Gail model score (p = 0.0005). Categorical variables associated with higher perceived lifetime risk were being insured (34% vs 27%; p = 0.004) and NonHispanic patients (34% vs 27%; p = 0.003). Adequate health literacy (38% vs 27%; p = 0.0001) and family history of breast cancer in a first degree relative (FDR; 43% vs 27%; p = 0.0001) were the variables with the strongest association with perceived risk. In multivariate analysis after adjustment for the above factors, only family history in FDR remained significant (p = 0.003).

Over a similar time period, being insured (OR 1.52; 95% CI 1.18 – 1.95; p = 0.001) and adequate health literacy (OR 3.75; 95% CI 2.71 – 5.19; p &lt; 0.0001) were the only variables significantly associated with the use of screening mammography.

Conclusions: Underinsured, minority women overestimate their lifetime risk of breast cancer (30%) at a magnitude similar to other populations. Family history has a strong influence on an underinsured populations’ perception of breast cancer risk. Patients who were insured or had adequate health literacy perceived a higher lifetime risk of breast cancer and were significantly more likely to use screening mammography.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-15.

Lipid infusion in the management of poisoning: a report of 6 canine cases

Intravenous administration of lipid is a relatively new treatment in the management of toxicity from lipophilic compounds. It is used in human medicine in the treatment of toxicity from lipophilic local anaesthetics and cardiotoxic drugs and can result in dramatic improvement in clinical status. We present six cases of poisoning in dogs successfully treated with lipid infusion after ingestion of ivermectin (3), moxidectin (2) and baclofen (1). The dogs ranged in age from eight weeks to 14 years, and weighed 4-30 kg. Intravenous lipid therapy was started between six and eight hours and 22 hours after ingestion, and all the dogs responded well. In four dogs, there was clinical improvement within one hour; one had improved within two hours and the other within 4.5 hours of lipid administration. The only adverse effect of lipid infusion reported was mild swelling and pain after extravasation in one case which resolved with conservative management. All the dogs were discharged within 24-52 hours after exposure (7-46 hours after the start of lipid administration), and none developed any apparent sequelae.

Can natural variability trigger effects on fish and fish habitat as defined in environment Canada's metal mining environmental effects monitoring program?

The Metal Mining Effluent Regulations (MMER) took effect in 2002 and require most metal mining operations in Canada to complete environmental effects monitoring (EEM) programs. An "effect" under the MMER EEM program is considered any positive or negative statistically significant difference in fish population, fish usability, or benthic invertebrate community EEM-defined endpoints. Two consecutive studies with the same statistically significant differences trigger more intensive monitoring, including the characterization of extent and magnitude and investigation of cause. Standard EEM study designs do not require multiple reference areas or preexposure sampling, thus results and conclusions about mine effects are highly contingent on the selection of a near perfect reference area and are at risk of falsely labeling natural variation as mine related "effects." A case study was completed to characterize the natural variability in EEM-defined endpoints during preexposure or baseline conditions. This involved completing a typical EEM study in future reference and exposure lakes surrounding a proposed uranium (U) mine in northern Saskatchewan, Canada. Moon Lake was sampled as the future exposure area as it is currently proposed to receive effluent from the U mine. Two reference areas were used: Slush Lake for both the fish population and benthic invertebrate community surveys and Lake C as a second reference area for the benthic invertebrate community survey. Moon Lake, Slush Lake, and Lake C are located in the same drainage basin in close proximity to one another. All 3 lakes contained similar water quality, fish communities, aquatic habitat, and a sediment composition largely comprised of fine-textured particles. The fish population survey consisted of a nonlethal northern pike (Esox lucius) and a lethal yellow perch (Perca flavescens) survey. A comparison of the 5 benthic invertebrate community effect endpoints, 4 nonlethal northern pike population effect endpoints, and 10 lethal yellow perch effect endpoints resulted in the observation of several statistically significant differences at the future exposure area relative to the reference area and/or areas. When the data from 2 reference areas assessed for the benthic invertebrate community survey were pooled, no significant differences in effect endpoints were observed. These results demonstrate weaknesses in the definition of an "effect" used by the MMER EEM program and in the use of a single reference area. Determination of the ecological significance of statistical differences identified as part of EEM programs conducted during the operational period should consider preexisting (background) natural variability between reference and exposure areas.

Consensus guidelines for the conduct and reporting of clinical trials in systemic light-chain amyloidosis

This manuscript summarizes the recommendations that emerged from the first Roundtable on Clinical Research in Immunoglobulin Light-chain Amyloidosis (AL), a meeting sponsored by the Amyloidosis Foundation (Clarkston, MI, USA) to develop a consensus of experts on a modern framework for clinical trial design and drug development in AL. Recent diagnostic and technical advances in AL, and updated consensus guidelines for assessing hematologic and organ responses, enable us to define study populations, appropriate end points, and other criteria for all phases of clinical research. This manuscript provides a framework for the design and conduct of systematic collaborative clinical research in AL to encourage more rapid testing of therapies and to expedite new drug development and approval.

[Gryphopsylla segregata Beaucournu & Sountsov, 1999: new status for G. jacobsoni segregata, description of the female and proposition of a new key for the genus Gryphopsylla (Siphonaptera - Pygiopsyllidae - Stivaliinae)]

La collecte d’une femelle de Gryphopsylla jacobsoni segregata Beaucournu & Sountsov, 1999 du nord de Bornéo nous permet de modifier le statut de ce taxon en celui de bonne espèce, proche mais distincte de G. jacobsoni (Jordan & Rothschild, 1922). La femelle de G. segregata est décrite et une clé remise à jour de ce genre est donnée.

Host specificity and niche partitioning in flea-small mammal networks in Bornean rainforests

The diversity of ectoparasites in Southeast Asia and flea-host associations remain largely understudied. We explore specialization and interaction patterns of fleas infesting non-volant small mammals in Bornean rainforests, using material from a field survey carried out in two montane localities in northwestern Borneo (Sabah, Malaysia) and from a literature database of all available interactions in both lowland and montane forests. A total of 234 flea individuals collected during our field survey resulted in an interaction network of eight flea species on seven live-captured small mammal species. The interaction network from all compiled studies currently includes 15 flea species and 16 small mammal species. Host specificity and niche partitioning of fleas infesting diurnal treeshrews and squirrels were low, with little difference in specialization among taxa, but host specificity in lowland forests was found to be higher than in montane forests. By contrast, Sigmactenus alticola (Siphonaptera: Leptopsyllidae) exhibited low host specificity by infesting various montane and lowland nocturnal rats. However, this species exhibited low niche partitioning as it was the only commonly recorded flea from rats on Borneo. Overall complementary specialization was of intermediate intensity for both networks and differed significantly from random association; this has important implications for specific interactions that are also relevant to the potential spread of vector-borne diseases.

Effects of dietary aflatoxin on the hepatic expression of apoptosis genes in growing barrows

The most common and toxic form of aflatoxin, aflatoxin B(1) (AFB(1)), is produced by molds growing on crops. Use of moldy corn can result in high concentrations of AFB(1) in swine diets, which could potentially lead to an increased incidence of aflatoxicosis, a disease associated with decreased health and performance through reduced feed intake, reduced BW gain, and impaired liver function. The objective of this study was to determine the effects of AFB(1) on the hepatic gene expression of growing barrows. Ninety Duroc × Yorkshire crossbred barrows (age = 35 ± 5 d; initial BW = 14.2 ± 3.0 kg) were allocated to 9 pens with 10 pigs per pen, and randomly assigned in a 3 × 3 factorial arrangements of treatments to receive diets containing 0 µg/kg of AFB(1), 250 µg/kg of AFB(1), or 500 µg/kg of AFB(1) for 7, 28, or 70 d. Because performance was most affected in animals administered AFB(1) for an extended period, liver samples from d 70 animals were used for RNA-sequencing analysis. Of 82,744 sequences probed, 179 had transcripts that were highly correlated (r ≥ |0.8|; P < 0.0001) with treatment. Of the 179 significant transcripts, 46 sequences were negatively and 133 sequences positively related to treatment. Forty-three unique functional groups were identified. Genes within the apoptosis regulation functional group were selected for 1) confirmation of d 70 gene expression differences using real-time reverse-transcription (RT)-PCR (n = 4 genes), and 2) investigation of d 7 expression to identify early responses to AFB(1) (n = 15 genes) using real-time RT-PCR. Expression of the 4 apoptosis genes selected for confirmation, cyclin-dependent kinase inhibitor 1A, zinc finger matrin type 3, kininogen 1, and pim-1 oncogene, was confirmed with real-time RT-PCR. Of the 15 genes tested in d 7 liver samples, 4 were differentially expressed: cyclin-dependent kinase inhibitor 1A; zinc finger matrin type 3; tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein, zeta polypeptide; and apoptosis enhancing nuclease. Results from this study demonstrate that administration of an AFB(1)-contaminated diet to growing barrows alters hepatic gene expression, and in particular apoptosis genes.

326 CONSTRUCTION OF A SPLICING-DEPENDENT SELECTABLE MARKER FOR GENE TARGETTING

Gene targeting in mammalian cells plays a crucial role in biotechnology. These experiments are characterised by low rates of homologous recombination and high rates of random integration. Therefore, many fibroblast colonies must be screened to identify a targeting event. To dramatically reduce the survival of random integration events, we have developed a splicing-dependent selectable marker strategy by introducing a mutation in a codon-optimized G418 resistance gene (mNeo). This mutation could be corrected upon homologous recombination. Since the C-terminal region of aminoglycoside phosphotransferase (AphII, Neo/Kan resistance) participates in formation of the active site of this enzyme, we hypothesised that addition of even one amino acid at the C-terminus would render this protein non-functional. To test this hypothesis, a mutation was introduced in an E. coli AphII expression vector that converted the stop codon of AphII to tryptophan (X265W, TGA > TGGTAA). This mutation was confirmed to inactivate AphII by independently characterising the G418 and Kanamycin resistance (or lack thereof) provided by the X265W mutation. To evaluate this mutation in mammalian cells, two intronless mammalian expression vectors were constructed that differed by the presence or absence of the X265W mutation. G418 resistance was only provided by the wildtype sequence, thus confirming that X265W inactivates AphII in mammalian cells. An identical mutation was then introduced into a eukaryotic expression vector based on mNEO. Further, the sequence was extended to create a 5′ intron splice site (TGA > TGGTAAGAGTT). This region was designed to direct splicing between the first and second G residues thus removing the G in the third position of the W codon. The 3′ intron splice sites was then designed to provide an A residue as the first base of the next exon so that successful splicing would correct the mutation by recreating an appropriately positioned stop codon (TGA). To evaluate this strategy in mammalian cells, two plasmids were constructed that harbored the X265W mutation embedded at the 5′ splice site of a downstream intron. In one plasmid (pSC3-G) the first base of the downstream exon begins with a G residue resulting in inactivation of AphII. In the other plasmid (pSC2-A), the first base of the downstream exon begisn with an A residue forming a stop codon that allows for active, wildtype AphII. These plasmids were transfected into porcine fetal fibroblasts and subjected to selection with G418. A positive control plasmid and pSC2-A produced colonies that were too numerous to count. A negative control plasmid and pSC3-G produced no colonies. It can be concluded that the X265W mutation can be corrected by splicing to an exon that begins with an A residue. This splicing-dependent selectable marker may prove useful in gene targeting experiments when the site of modification is followed by an exon that begins with an A.