Defining Ultra-Massive Transfusion through a Systematic Review

Background

Despite the widespread use of ultra-massive transfusion (UMT) as an intervention for trauma patients in hemorrhagic shock, no standard definition exists. We performed a systematic review to determine a consensus definition for UMT.

Methods

A search was performed from 1979-2022. The authors screened studies defining UMT and associated outcomes as defined by our prespecified PICO questions. The PRISMA guidelines were used.

Results

1662 articles met criteria for eligibility assessment, 17 for full-text review and eight for data extraction. Only two studies demonstrated a consensus definition of UMT, which used ≥20 units of red blood cell product within 24hrs. Parameters associated with increased mortality included lower blood pressure, lower pulse and lower Glasgow Coma Score at the time of presentation and a higher injury severity score and undergoing a resuscitative thoracotomy.

Conclusions

The absence of a consensus definition for UMT raises challenges from clinical, research and ethical perspectives. Based on our findings, the authors advocate for the feasibility of standardizing the definition of UMT as ≥20 units of red blood cell product within 24hrs.

Pre-clinical evaluation of a third generation absorbable antibacterial envelope

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Medtronic

Background

An absorbable antibacterial envelope (TYRX), which stabilizes cardiac implantable electronic devices (CIEDs) was shown to significantly reduce infections in a large randomized controlled trial (WRAP-IT). A 3rd generation envelope (T3) is being developed to improve the implanter experience and enable smoother device insertion with a redesigned, multifilament mesh, an enhanced form factor, and identical polymer coating and antibiotic concentrations as the currently available 2nd generation envelope (T2).

Purpose

To compare drug elution profiles of T3 vs T2 and evaluate the efficacy of T3 against bacteria commonly known to be associated with CIED infections.

Methods

The T3 drug elution profile was assessed in vitro by evaluating the amount of each drug, minocycline and rifampin, released at a given timepoint using an accelerated dissolution method. For comparative analysis with T2, elution curve equivalency was based on similarity factor values (f2) of ≥50 per FDA guidance. An in vivo elution study was also conducted (per the Principles of Laboratory Animal Care [NIH Publication no. 85-23 revised 1985]) to ensure drug concentrations met the minimal inhibitory concentration (MIC) through 7 days. Substantial equivalence was defined as rifampin and minocycline concentrations above MIC at 2hr post-implant and sustained through 7 days. In a further animal model, 12 pockets were created in 6 rabbits, for CIED insertion with and without T3 envelopes, to evaluate efficacy against gram+ and gram- bacteria. At day 7, implant sites were evaluated for signs of infection via macroscopic observations and microbial recovery procedures. A Fisher’s Exact Test was used for comparisons.

Results

The T3 envelope showed a similar elution profile to T2 in vitro (Figure) with f2 >50 (range 76-84). In the in vivo assessment, the T3 envelope eluted both antibiotics above the MIC at 2hr post-implant with sustained elution through 7 days, consistent with historical T2 performance. Further bacterial challenge studies in vivo showed a statistically significant reduction (p<0.05) in infections with 0/6 infected pockets in the CIED + T3 group vs 6/6 infected pockets in the CIED only group consistent with T2 performance (Table).

Conclusion

The 3rd generation absorbable antibacterial envelope demonstrated equivalent pre-clinical performance compared to the 2nd generation envelope as antibiotic elution curves were equivalent, elution was sustained at concentrations above MIC for 7 days, and infection rates were significantly reduced compared to no envelope. These results suggest equivalent clinical performance could be expected with the newly designed envelope.

Feasibility, preliminary efficacy, and accessibility of a twitter-based social support group vs Fitbit only to decrease sedentary behavior in women

BACKGROUND

Health behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content.

AIMS

We tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for social support, combined with a Fitbit, vs. Fitbit alone.

METHODS

In a 2-group pilot, 45 sedentary women from a heart clinic were randomized to Twitter + Fitbit activity tracker (Tweet4Wellness, n = 23) or Fitbit-only (control, n = 22). All received a Fitbit and 13 weeks of tailored weekly step goals. Tweet4Wellness consisted of a private Twitter support group, with daily automated behavior change "tweets" informed by behavior change theory, and encouragement to communicate within the group. Feasibility outcomes included recruitment and enrollment numbers, implementation challenges, and number and type of help requests from participants throughout the study period. Preliminary efficacy outcomes provided by Fitbit data were sedentary minutes, number of hours with >250 steps, maximum sitting bout, weighted sedentary median bout length, total steps, intensity minutes (>3.0 METS), and ratio of time spent sitting-to-moving. Acceptability outcomes included level of Twitter participation within Tweet4Wellness, and Likert scale plus open-ended survey questions on enjoyment and perceived effectiveness of intervention components. Survey data on acceptability of the features of the intervention were collected at 13 weeks (end-of-treatment [EOT]) and 22 weeks (follow-up).

RESULTS

The study was feasible, with addressable implementation challenges. Tweet4Wellness participants changed significantly from baseline to EOT relative to control participants on number of active hours p = .018, total steps p = .028, and ratio of sitting-to-moving, p = .014. Only sitting-to-moving was significant at follow-up (p = .047). Among Tweet4Wellness participants, each tweet sent during treatment was associated with a 0.11 increase in active hours per day (p = .04) and a 292-step increase per day (p < .001). Tweet4Wellness participants averaged 54.8 (SD = 35.4) tweets, totaling 1304 tweets, and reported liking the accountability and peer support provided by the intervention.

CONCLUSION

A Twitter-delivered intervention for promoting physical activity among inactive women from a heart clinic was feasible, acceptable, and demonstrated preliminary efficacy in increasing daily active hours, daily total steps, and the ratio of sitting-to-moving from pre to post for the intervention compared with the control. Lessons learned from this pilot suggest that the next study should expand the recruitment pool, refine the intervention to increase group engagement, and select active hours, total steps, and ratio of sitting-to-movement as primary sedentary behavior measures.

Analysis of the Motional Stark Effect (MSE) diagnostic to measure the rotational transform and current profile in the Large Helical Device

The analysis method of the Motional Stark Effect (MSE) diagnostic to measure the rotational transform and current profiles in the Large Helical Device has been improved. This was done by using the Variational Moments Equilibrium Code to calculate an equilibrium database for various pressure profiles and current profiles. This method looks for the radial profile of the rotational transform in the equilibrium database that gives the best fit to the polarization angle profiles measured with the MSE diagnostic. This analysis improves the measurements of rotational transform, especially near the magnetic axis, where the sensitivity of the polarization angle measurements becomes low and the uncertainty due to error in the estimation of the Pfirsch-Schlüter current becomes large. The radial profiles of the rotational transform and current profiles for Electron Cyclotron Current Drive and Neutral Beam Current Drive are obtained in the new analysis method with a sufficiently high accuracy to discuss the discrepancy of the current density profiles between the measurements and the calculations.

0180 Sleep, Sleepiness, and Sleep Hygiene Related to Nomophobia (No Mobile Phone Phobia)

Introduction

Previously, active phone use at bedtime has been implicated in disrupted sleep and related complaints. To improve sleep, a recommendation following such findings is limiting phone use before and during bedtime. However, for those with the characteristic of “nomophobia”, fear of being out of mobile phone contact, this recommendation could exacerbate anxiety at and around bedtime and disrupt, rather than improve, sleep. In 2012, an estimated 77% of 18-24-year-olds could be identified as nomophobic. Because of the prevalence of nomophobia and its possible interaction with sleep, we explored the existence of nomophobia in a college-age population and its relationship to sleep, sleepiness, and sleep hygiene behaviors.

Methods

327 university students (age: M=19.7 years, SD=3.78) recruited from introductory psychology courses and campus newsletters were given extra credit or a chance to win $25 gift cards for participation. Participants completed demographic information, the Nomophobia Questionnaire (NMP-Q), the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, questions regarding associated features of inadequate sleep hygiene, and the Sleep Hygiene Index. Additional sleep hygiene questions assessed frequency of active and passive technology use during sleep time.

Results

89.4% of the participants had moderate or severe nomophobia. Greater nomophobia was significantly related to greater daytime sleepiness (ESS) (r(293)=.150, p&lt;.05), associated features of poor sleep (daytime sleepiness: r(297)=.097, p&lt;.05, and avolition: r(297)=.100, p&lt;.05), more maladaptive sleep hygiene behaviors including active technology use during sleep time (r(298)=.249, p&lt;.05), long daytime naps, inconsistent wake and bed times, using bed for non-sleep purposes, uncomfortable bed, and bedtime cognitive rumination (r’s=0.097 to 0.182).

Conclusion

Most participants experienced moderate to severe nomophobia with greater nomophobia associated with greater sleepiness, avolition, and poorer sleep hygiene. Nomophobia is likely to be an important consideration when treating sleep disorders and/or making any sleep hygiene recommendations.

Support

Hendrix College Charles Brewer Fund for Psychology

0194 Bedtime Technology Use and New Questions for the Sleep Hygiene Index

Introduction

We examined the relationship between bedtime active and passive social technology use (self and bedpartner) and daytime sleepiness/sleep. We generated questions to differentiate participants with and without bedpartners and updated passive personal, active bedpartner, and passive bedpartner social technology questions of the Sleep Hygiene Index.

Methods

327 students (age: M=19.7 years, SD=3.78) recruited through psychology courses and campus newsletters received extra credit or chances to win $25 gift cards. Participants completed demographic information, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, questions regarding associated features of inadequate sleep hygiene, and the Sleep Hygiene Index. Five questions assessed active and passive social technology use, presence of a bedpartner, and awareness of bedpartner active and passive social technology use during sleep time.

Results

61.8% and 62.7% of students reported frequently or always using active and passive bedtime social technology, respectively; and 23.5% and 29.1% reported noticing a partner’s active or passive use. More frequent active technology use was significantly related to greater daytime sleepiness (ESS) (r(305)=.193, p&lt;.05), sleep disturbances (PSQI-global: r(302)=.120, p&lt;.05), and associated features of inadequate sleep hygiene (daytime sleepiness, worry about sleep, mood disturbance, avolition, and reduced cognition (r(306)=.212, p&lt;.05)). Neither passive use nor passive or active partner use was significantly related to any sleep/sleepiness variables.

Conclusion

We continue to find students are frequent users of bedtime social technology which is related to daytime sleepiness, disrupted sleep, and related complaints. Passive and partner active/passive bedtime technology use may not have a significant impact on daytime sleepiness. It is possible younger participants are not good judges of passive or partner technology use or this younger population is resilient to these disruptions.

Support

none

Association of tumor-infiltrating lymphocytes with distant disease-free survival in the ShortHER randomized adjuvant trial for patients with early HER2+ breast cancer

BACKGROUND

There is the need to identify new prognostic markers to refine risk stratification for HER2-positive early breast cancer patients. The aim of this study was to evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free survival (DDFS) in patients with HER2-positive early breast cancer enrolled in the ShortHER adjuvant trial which compared 9 weeks versus 1-year trastuzumab in addition to chemotherapy, and to test the interaction between TILs and treatment arm.

PATIENTS AND METHODS

Stromal TILs were assessed for 866 cases on centralized hematoxylin and eosin-stained tumor slides. The association of TILs as 10% increments with DDFS was assessed with Cox models. Kaplan-Meier curves were estimated for patients with TILs ≥20% and TILs <20%. Median follow-up was 6.1 years.

RESULTS

Median TILs was 5% (Q1-Q3 1%-15%). Increased TILs were independently associated with better DDFS in multivariable model [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.89, P = 0.006, for each 10% TILs increment]. Five years DDFS rates were 91.1% for patients with TILs <20% and 95.7% for patients with TILs ≥20% (P = 0.025). The association between 10% TILs increments and DDFS was significant for patients randomized to 9 weeks of trastuzumab (HR 0.60, 95% CI 0.41-0.88) but not for patients treated with 1 year of trastuzumab (HR 0.89, 95% CI 0.71-1.12; test for interaction P = 0.088). For patients with TILs <20%, the HR for the comparison between the short versus the long arm was 1.75 (95% CI 1.09-2.80, P=0.021); whereas, for patients with TILs ≥20% the HR for the comparison of short versus long arm was 0.23 (95% CI 0.05-1.09, P = 0.064), resulting in a significant interaction (P = 0.015).

CONCLUSIONS

TILs are an independent prognostic factor for HER2-positive early breast cancer patients treated with adjuvant chemotherapy and trastuzumab and may refine the ability to identify patients at low risk of relapse eligible for de-escalated adjuvant therapy.

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min^-1 [95% CI - 0.23; 0.29], LoA - 2.78 to 2.84 L min^-1 and MPE 48.0%. For pediatrics, pooled bias was - 0.02 L min^-1 [95% CI - 0.09; 0.05], LoA - 1.22 to 1.18 L min^-1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I² = 93%, p < 0.0001) and pediatrics (I² = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.

[Practice of parenting and related factors on children aged 0-5 in the urban areas of China]

Objective: To characterize the relations between the practice of parenting and associated factors on children (0-5 years old) in urban areas of China, in order to provide evidence for promoting the early development of children and to provide positive guidance and service programs on parenting. Methods: A total of 4 515 parents from 15 cities (14 provinces) were surveyed with a self-administered questionnaire. Parenting and Family Adjustment Scales (PAFAS) was used, including parameters as: consistency and coercive parenting, positive encouragement, parent-child relationship and parental emotion adjustment, family relationship and parental teamwork aspects, etc. Both single factor analysis and multiple linear regression were used to examine the associations between parenting practice, individual, parental and family factors. Results: The mean score of PAFAS was 21.00 (15.00-28.00), associated with factors as children's age, only-child family, premature delivery, father's education level, confidence on parenting, problems regarding the parental mood, annual family income, family structure and behavior on seeking professional help, etc. Results showed that there were big differences on the practice of parenting in China and influenced by variety of factors. Conclusions: The general situation of parenting was well, in the urban areas of China. The practice of parenting was associated with a series of individual, parental and family factors. Programs on improving the parenting skills and promoting the early development of children, should be highlighted.

Homogeneous reduced moment in a gapful scalar chiral kagome antiferromagnet

We present a quantitative experimental investigation of the scalar chiral magnetic order with in Nd3Sb3Mg2O14. Static magnetization reveals a net ferromagnetic ground state, and inelastic neutron scattering from the hyperfine coupled nuclear spin reveals a local ordered moment of 1.76(6) μ B , just 61(2)% of the saturated moment size. The experiments exclude static disorder as the source of the reduced moment. A 38(1) μ eV gap in the magnetic excitation spectrum inferred from heat capacity rules out thermal fluctuations and suggests a multipolar explanation for the moment reduction. We compare Nd3Sb3Mg2O14 to Nd pyrochlores and show that Nd2Zr2O7 is in a spin fragmented state using nuclear Schottky heat capacity.

A forced-choice preferential looking task for the assessment of vision in dogs: pilot study

OBJECTIVES

To describe preliminary use of a forced-choice preferential looking task for the clinical assessment of vision in dogs.

MATERIALS AND METHODS

The vision of 18 pet dogs was investigated in two separate studies using a forced-choice preferential looking task: multiple observers watched eye, head and body movements on video recordings to identify cues suggesting when a dog had seen the feature of interest. Human observer reliability was determined using eight dogs and computer-generated stimuli. Visual acuity was assessed using computer-generated grating stimuli: in real-time, an observer watched each dog's eye movement patterns and behaviour to decide whether each grating was seen. Stimuli were presented in a step-wise manner and were controlled by the observer. Acuity was estimated as the highest spatial frequency the dog was determined to have seen.

RESULTS

Median estimated visual acuity was better at 1 m compared to that at 3 m. Average test time was longer at a 3-m distance than at 1 m. Inter- and intra-observer reliability was better from 1 m than from 3 m.

CLINICAL SIGNIFICANCE

Preliminary use of a forced-choice preferential looking task for measurement of visual acuity in dogs has potential use as a clinical tool for the assessment of vision in dogs.

Comparison of anatomical tibial plateau angle versus observer measurement from lateral radiographs in dogs

This study was conducted to compare the anatomical tibial plateau angle (TPA) with that measured by observers from a lateral radiograph of the limb, the hypothesis being that there would not be any statistically significant differences between the observer measured TPA and the true anatomical TPA. Twelve pelvic limbs from skeletally mature greyhound cadavers, without any clinical or radiographic evidence of stifle pathology, were used in this study. The radiographs were taken of each limb in a lateral position with the primary beam centered over the tibial eminences and collimated to include the stifle and tarso-crural joints. For subsequent radiographs, Kirschner wires were inserted to enable identification of the tibial plateau. The TPA was then measured, by three observers, from the plain radiographs and by one observer from the marked radiographs. The mean observer TPA was 24.4° (range 17–30°) and the mean anatomical TPA was 23.8° (range 15–31°). The mean and median discrepancy between the anatomical TPA and the observer TPA was negative and very small (− 0.64° and 0°). The magnitude of the discrepancy between individual measurements made by the observers tended to overestimate small angles and underestimate the large ones, and this trend is statistically significant. These results suggest that the measurements made by observers accurately represent the anatomical slope of the tibial plateau. Therefore, observer TPA is suitable for the planning and assessment of TPLO procedures. However, as the anatomical TPA moves away from a median angle (23.25°) the magnitude of error in the measurement increases.

Abstract GS6-05: Gain-of-function kinase library screen identifies FGFR1 amplification as a mechanism of resistance to antiestrogens and CDK4/6 inhibitors in ER+ breast cancer

Background: CDK4/6 inhibitors have been approved in combination with endocrine therapy for treatment of ER+ metastatic breast cancer. The goal of this study was to discover mechanisms of resistance to ER antagonists alone and in combination with CDK4/6 inhibitors.

Results: To achieve this goal, we used lentiviral vectors to individually express 559 human kinase open reading frames (ORFs) in ER+ MCF7 human breast cancer cells treated with fulvestrant ± the CDK4/6 inhibitor ribociclib. In MCF7 cells treated with fulvestrant alone or with ribociclib, we identified 15 and 17 kinases associated with resistance, respectively. Ten of these kinases overlapped in both groups. In a secondary screen, MCF7 cells were stably transduced with V5-tagged lentiviruses expressing the positive 'hits' for treatment with fulvestrant/ribociclib. Five of 17 kinases (FGFR1, FRK, HCK, FGR, CRKL) were confirmed to induce resistance to fulvestrant/palbociclib and fulvestrant/ribociblib. Survey of TCGA for copy number alterations and/or expression of these 5 genes showed only FGFR1 to be amplified/overexpressed in ˜15% of ER+ breast cancers. Experiments in vitro showed that ER+/FGFR1-amplified (amp) MDA-134, CAMA-1 and HCC1500 human breast cancer cells and MCF7 cells stably transduced with FGFR1 were relatively resistant to estrogen deprivation, fulvestrant and fulvestrant/palbociclib compared to non-FGFR1 amp MCF7 cells. This resistance was abrogated by treatment with the FGFR tyrosine kinase inhibitor (TKI) lucitanib. Treatment with fulvestrant or palbociclib alone modestly delayed growth of ER+/FGFR1-amp breast cancer patient-derived xenografts (PDX) established in nude mice. However, addition of the FGFR TKI erdafitinib to fulvestrant/palbociclib resulted in marked PDX regression in all mice without associated toxicity and a complete cell cycle arrest measured by Ki67. Treatment of FGFR-amp cells with FGF-2 strongly induced CCND1 (cyclin D1) expression. Downregulation of CCND1 with CCND1 RNAi oligonucleotides restored sensitivity of FGFR1-amp cells to fulvestrant/palbociclib, thus phenocopying the effect of FGFR TKIs. Conversely, overexpression of CCND1 in MCF7 cells induced resistance to estrogen deprivation and to fulvestrant ± palbociclib. Finally, we examined next gen sequencing of cell free tumor DNA by Guardant360 in 34 patients before and after progression on CDK4/6 inhibitor. In 10/34 (29%) post-progression specimens, we detected alterations in the FGFR pathway: FGFR1 amplification (n=7), FGFR1 N546K (n=1), FGFR2 N549K (n=1), and FGFR2 V395D (n=1) activating mutations.

Conclusions: These data suggest aberrant FGFR signaling is a mechanism of resistance to anti-ER therapies ± CDK4/6 inhibitors. We posit overexpression of cyclin D1 induced by both FGFR signaling and ER transcription plays a role in drug resistance. Based on these findings we propose ER+/FGFR1 amplified breast cancers are endocrine resistant and should be candidates for treatment with combinations of ER and FGFR antagonists. Accordingly, we have initiated a phase Ib trial of fulvestrant, palbociclib and erdafitinib in patients with antiestrogen resistant ER+/HER2-negative breast cancer with FGFR1-4 amplification.

Citation Format: Formisano L, Lu Y, Jansen VM, Bauer JA, Hanker A, Gonzalez Ericsson P, Lee K-M, Nixon MJ, Guerrero-Zotano AL, Schwarz LJ, Sanders M, Sudhan D, Dugger TC, Cruz MR, Behdad A, Cristofanilli M, Bardia A, O'Shaughnessy J, Mayer IA, Arteaga CL. Gain-of-function kinase library screen identifies FGFR1 amplification as a mechanism of resistance to antiestrogens and CDK4/6 inhibitors in ER+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS6-05.

Modulation of Aneuploidy in Leishmania donovani during Adaptation to Different In Vitro and In Vivo Environments and Its Impact on Gene Expression

Aneuploidy is usually deleterious in multicellular organisms but appears to be tolerated and potentially beneficial in unicellular organisms, including pathogens. Leishmania, a major protozoan parasite, is emerging as a new model for aneuploidy, since in vitro-cultivated strains are highly aneuploid, with interstrain diversity and intrastrain mosaicism. The alternation of two life stages in different environments (extracellular promastigotes and intracellular amastigotes) offers a unique opportunity to study the impact of environment on aneuploidy and gene expression. We sequenced the whole genomes and transcriptomes of Leishmania donovani strains throughout their adaptation to in vivo conditions mimicking natural vertebrate and invertebrate host environments. The nucleotide sequences were almost unchanged within a strain, in contrast to highly variable aneuploidy. Although high in promastigotes in vitro, aneuploidy dropped significantly in hamster amastigotes, in a progressive and strain-specific manner, accompanied by the emergence of new polysomies. After a passage through a sand fly, smaller yet consistent karyotype changes were detected. Changes in chromosome copy numbers were correlated with the corresponding transcript levels, but additional aneuploidy-independent regulation of gene expression was observed. This affected stage-specific gene expression, downregulation of the entire chromosome 31, and upregulation of gene arrays on chromosomes 5 and 8. Aneuploidy changes in Leishmania are probably adaptive and exploited to modulate the dosage and expression of specific genes; they are well tolerated, but additional mechanisms may exist to regulate the transcript levels of other genes located on aneuploid chromosomes. Our model should allow studies of the impact of aneuploidy on molecular adaptations and cellular fitness.IMPORTANCE Aneuploidy is usually detrimental in multicellular organisms, but in several microorganisms, it can be tolerated and even beneficial. Leishmania-a protozoan parasite that kills more than 30,000 people each year-is emerging as a new model for aneuploidy studies, as unexpectedly high levels of aneuploidy are found in clinical isolates. Leishmania lacks classical regulation of transcription at initiation through promoters, so aneuploidy could represent a major adaptive strategy of this parasite to modulate gene dosage in response to stressful environments. For the first time, we document the dynamics of aneuploidy throughout the life cycle of the parasite, in vitro and in vivo We show its adaptive impact on transcription and its interaction with regulation. Besides offering a new model for aneuploidy studies, we show that further genomic studies should be done directly in clinical samples without parasite isolation and that adequate methods should be developed for this.

In vitro selection of miltefosine resistance in promastigotes of Leishmania donovani from Nepal: genomic and metabolomic characterization

In this study, we followed the genomic, lipidomic and metabolomic changes associated with the selection of miltefosine (MIL) resistance in two clinically derived Leishmania donovani strains with different inherent resistance to antimonial drugs (antimony sensitive strain Sb‐S; and antimony resistant Sb‐R). MIL‐R was easily induced in both strains using the promastigote‐stage, but a significant increase in MIL‐R in the intracellular amastigote compared to the corresponding wild‐type did not occur until promastigotes had adapted to 12.2 μM MIL. A variety of common and strain‐specific genetic changes were discovered in MIL‐adapted parasites, including deletions at the LdMT transporter gene, single‐base mutations and changes in somy. The most obvious lipid changes in MIL‐R promastigotes occurred to phosphatidylcholines and lysophosphatidylcholines and results indicate that the Kennedy pathway is involved in MIL resistance. The inherent Sb resistance of the parasite had an impact on the changes that occurred in MIL‐R parasites, with more genetic changes occurring in Sb‐R compared with Sb‐S parasites. Initial interpretation of the changes identified in this study does not support synergies with Sb‐R in the mechanisms of MIL resistance, though this requires an enhanced understanding of the parasite's biochemical pathways and how they are genetically regulated to be verified fully.

The awareness about mycotoxin contamination of food and feed: a survey in the Flemish population

The objective of this quantitative survey (n=520) was to determine the awareness of the risks of mycotoxin contaminated food and feed throughout the Flemish population. The study highlighted gaps in food and feed safety knowledge regarding mould growth and consequently the presence of mycotoxins. Most people were aware of the negative effects of mould species in food or feed. Around 60% of the people picked out moulds as the producers of mycotoxins, but the majority did not have an idea about the toxicity of these toxins, especially towards plants. Respondents were also asked about possible food products where mould growth could occur and who is responsible for guarding the safety of food and feed with respect to moulds and mycotoxins. All answers and considerations are presented and discussed. Education on mycotoxins should be the focus of the whole population in the near future.

Community health coalitions in context: associations between geographic context, member type and length of membership with coalition functions

The coalition literature recognizes context (geography, demographics and history) as a variable of interest, yet few coalition evaluation studies have focused on it. This study explores the association between geographic context and structures (e.g. member type) with functional characteristics (e.g. decision making or levels of conflict) in a statewide system of community health councils (coalitions). The study was part of a multiyear, statewide evaluation of New Mexico's health councils' contributions to systems-level changes. We adapted the Coalition Self-Assessment Survey (CSAS) for all county health council members and paid council coordinators. Both multilevel univariate and multivariate procedures were used to compare index scores, summaries of CSAS questions used to characterize council functions, with selected demographic variables and region. Member type was associated with decision making and policy capacity; paid staff expressed higher levels of agreement than voting members for both items. Length of membership was associated with decision making, positive leadership and shared vision. Results indicated that geographic context was significantly associated with many functional characteristics. The study highlights the idea that geographic context may influence coalition functioning. Understanding how geographic context influences coalition planning and actions may help explain differences among coalitions that on the surface share common organizational characteristics and external goals.

Developing web-based Triple P 'Positive Parenting Programme' for families of children with asthma

BACKGROUND

We examined the feasibility of self-directed Triple P 'Positive Parenting Programme' for optimizing parents' management of childhood asthma and behaviour.

METHODS

Eligible families were invited to access asthma-specific web-based Triple P as part of a preliminary randomized controlled study.

RESULTS

Initial study information and introductory website pages received considerable interest but intervention uptake was poor with high rates of attrition.

CONCLUSIONS

Although parents of children with asthma show willingness to access web-based parenting support, further work is necessary to develop engaging websites and determine barriers to uptake, and adherence to online parenting interventions with this population.

Heterologous screening of hybridomas for the development of broad-specific monoclonal antibodies against deoxynivalenol and its analogues

Hapten heterology was introduced into the steps of hybridoma selection for the development of monoclonal antibodies (MAbs) against deoxynivalenol (DON). Firstly, a novel heterologous DON hapten was synthesised and covalently coupled to proteins (i.e. bovine serum albumin (BSA), ovalbumin and horseradish peroxidase) using the linkage of cyanuric chloride (CC). After immunisation, antisera from different DON immunogens were checked for the presence of useful antibodies. Next, both homologous and heterologous enzyme-linked immunosorbent assays were conducted to screen for hybridomas. It was found that heterologous screening could significantly reduce the proportion of false positives and appeared to be an efficient approach for selecting hybridomas of interest. This strategy resulted in two kinds of broad-selective MAbs against DON and its analogues. They were quite distinct from other reported DON-antibodies in their cross-reactivity profiles. A unique MAb 13H1 derived from DON-CC-BSA immunogen could recognise DON and its analogues in the order of HT-2 toxin ≯ 15-acetyl-DON ≯ DON ≯ nivalenol, with IC50 ranging from 1.14 to 7.69 μg/ml. Another preferable MAb 10H10 generated from DON-BSA immunogen manifested relatively similar affinity to DON, 3-acetyl-DON and 15-acetyl-DON, with IC50 values of 22, 15 and 34 ng/ml, respectively. This is the first broad-specific MAb against DON and its two acetylated forms and thus it can be used for simultaneous detection of the three mycotoxins.

Deoxynivalenol content in wheat dust versus wheat grain: a comparative study

The present study, set up in the growing season 2011-2012, was designed to obtain quantitative data on the occurrence of deoxynivalenol in wheat grain and the corresponding wheat dust. The field experiment consisted of a complete randomised block design with five wheat varieties sown on a field on which maize was grown in the previous season. The impact of the tillage method and the influence of the wheat variety resistance on the deoxynivalenol content of wheat and wheat dust were investigated. The accumulation of deoxynivalenol in wheat dust was confirmed and a sigmoidal relationship between the deoxynivalenol content in wheat dust versus wheat grain was determined. Deoxynivalenol reduction was obtained by ploughing and by sowing moderately resistant wheat varieties. As wheat dust provides equal results and solves the problem of heterogeneity during sampling of conventional wheat matrix, the sampling of wheat dust can be considered as a promising alternative.

Anti-androgens act jointly in suppressing spiggin concentrations in androgen-primed female three-spined sticklebacks - prediction of combined effects by concentration addition

Increasing attention is being directed at the role played by anti-androgenic chemicals in endocrine disruption of wildlife within the aquatic environment. The co-occurrence of multiple contaminants with anti-androgenic activity highlights a need for the predictive assessment of combined effects, but information about anti-androgen mixture effects on wildlife is lacking. This study evaluated the suitability of the androgenised female stickleback screen (AFSS), in which inhibition of androgen-induced spiggin production provides a quantitative assessment of anti-androgenic activity, for predicting the effect of a four component mixture of anti-androgens. The anti-androgenic activity of four known anti-androgens (vinclozolin, fenitrothion, flutamide, linuron) was evaluated from individual concentration-response data and used to design a mixture containing each chemical at equipotent concentrations. Across a 100-fold concentration range, a concentration addition approach was used to predict the response of fish to the mixture. Two studies were conducted independently at each of two laboratories. By using a novel method to adjust for differences between nominal and measured concentrations, good agreement was obtained between the actual outcome of the mixture exposure and the predicted outcome. This demonstrated for the first time that androgen receptor antagonists act in concert in an additive fashion in fish and that existing mixture methodology is effective in predicting the outcome, based on concentration-response data for individual chemicals. The sensitivity range of the AFSS assay lies within the range of anti-androgenicity reported in rivers across many locations internationally. The approach taken in our study lays the foundations for understanding how androgen receptor antagonists work together in fish and is essential in informing risk assessment methods for complex anti-androgenic mixtures in the aquatic environment.

Targeted trapping surveys shed new light on the distribution and habitat characteristics of the Carpentarian pseudantechinus (Pseudantechinus mimulus), a threatened dasyurid marsupial

Through a targeted trapping survey we provide important new records and habitat descriptions for the Carpentarian pseudantechinus (Pseudantechinus mimulus) on mainland Australia, including the first records from landscapes dominated by rocks other than sandstone. We hypothesise that continued invasion by an introduced pasture grass may constitute an emerging threatening process to this rare species.

Prediction of postharvest firmness of apple using biological switch model

In this paper we present a model that predicts the softening of apple during ripening in the postharvest phase. Apple ripening starts with an autocatalytic production of ethylene, which triggers a multitude of biochemical processes like the degradation of cell wall material. This triggering of the ripening process has been modelled as a biological switch-using the activator-depleted substrate model, which is proposed earlier by Meinhardt in the field of developmental biology. The model has been calibrated using storage experiments using various apple cultivars. Furthermore, the model is proven to be valid using independent experimental data of Elstar apple under dynamic storage conditions.

SU-E-T-588: A Treatment Planning Comparison of Dual-Arc VMAT Vs. Helical Tomotherapy for Post-Mastectomy Radiotherapy

PURPOSE

To investigate the feasibility of volumetric modulated arc therapy (VMAT) for post-mastectomy radiotherapy (PMRT) and to compare dual- arc VMAT treatment plans to helical tomotherapy (HT) plans on the basis of dosimetric quality, radiobiological calculations and delivery efficiency.

METHODS

Dual-arc VMAT and HT treatment plans were created for fifteen patients previously treated at our clinic. Planning target volumes (PTV) included the chest wall (CW) and regional lymph nodes. The following metrics were used to compare treatment plans for each patient: dose homogeneity index (DHI) and conformity index (CI); coverage of the PTV; dose to organs at risk (OAR); tumor control probability (TCP), normal tissue complication probability (NTCP) and secondary cancer complication probability (SCCP); and treatment delivery time. Differences between treatment plans were tested for significance using the paired Student's t-test.

RESULTS

Both modalities produced clinically acceptable PMRT plans. VMAT plans showed better CI (p < 0.01), and better OAR sparing at low doses than HT plans. For example, VMAT plans showed a 26% (p < 0.01) and 9% (p < 0.01) decrease in V5Gy in the lungs and heart respectively. On the other hand, HT plans showed better DHI (p < 0.01) and PTV coverage (p < 0.01). HT plans also showed slightly better OAR sparing at higher doses, including 8% (p < 0.01) and 9% (p < 0.01) lower maximum doses to the lungs and heart, respectively. Both modalities achieved nearly 100% tumor control and approximately 1% NTCP in the lungs and heart, with VMAT showing lower SCCP (p < 0.01). VMAT plans also required 66.2% less time to deliver.

CONCLUSIONS

Both VMAT and HT are suitable treatment options for PMRT. Our study showed that VMAT"'in addition to being significantly faster'"achieved better CI and low dose OAR sparing while HT achieved better DHI. This work was supported in part by a research support from Elekta, Ltd. However, Elekta, Ltd., did not participate in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit.

P1-07-19: Analysis of HER2−Status in Breast Cancer by Mass Spectrometry in Archival, Formalin-Fixed Tissues

HER2 (ERBB2) is overexpressed in about 25% of breast cancers and predicts clinical benefit from trastuzumab, as well as response to anthracycline-based chemotherapy. Fluorescence in situ hybridization (FISH) to detect HER2 gene copy number and immunohistochemistry (IHC) to detect HER2 protein levels are approved by the FDA to identify HER2−positive (H2) tumors. However, the 2007 ASCO/CAP report concluded that approximately 20% of HER2 testing may be inaccurate. Further, the available data did not clearly demonstrate clear superiority of either IHC or FISH as a predictor of benefit from anti-HER2 therapy. Discordance between these methods is as high as 5%. Thus, novel complementary quantitative methods for interrogating HER2 expression in tumors are needed.

Targeted protein analysis by multiple reaction monitoring mass spectrometry (MRM-MS) offers a powerful approach to configure assays for specific proteins without using antibodies. Our studies using this platform have demonstrated applicability to formalin-fixed, paraffin-embedded (FFPE) specimens. In the current studies, we used this approach to measure signals from two tryptic peptides specific to HER2, one each from the extracellular and intracellular domains, selected from among 28 candidates based on their signal intensity and sharpness of their chromatographic profiles. Preliminary studies with a HER2−overexpressing BT474 xenograft in mice demonstrated quantitation and detected previously reported HER2 ectodomain shedding. Subsequent analysis of FFPE tissue from five H2 and five triple-negative (TN) tumors yielded measurement of at least 1 femptomole of receptor for H2 tumors and less than 0.2 femptomole of receptor for TN tumors per microgram of digest analyzed. If we assume 200 picograms of protein per cell, the results suggest 110,00 to 468,000 receptors per cell in the H2 tumors and only 2,000 to 14,000 receptors per cell in the TN tumors. Despite significant biological variability in receptor levels measured among the specimens of each type, a clear separation of the H2 and TN tumors was achieved based on the peptide quantitation. This preliminary study demonstrates the potential of MRM-MS in FFPE tissue to provide an alternate approach to IHC-based protein analysis. MRM-MS offers the potential for more, accurate and robust HER2 quantification in clinical breast cancer tissues. The next phase of this work will encompass a larger sample set, including tumors with equivocal and negative FISH and/or IHC test results. Correlation with response to anti-Her2 therapy will be performed in samples with available follow-up data.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-07-19.

Association between placental mineral deposition, villous architecture and fetal aneuploidy

We retrospectively evaluated the relationship between fetal aneuploidy and placental mineral deposits and villous architecture in 2nd trimester placentas of mid-trimester pregnancy terminations for fetal anomaly. Study cases were aneuploid and matched with euploid controls. Six slides per case were histologically evaluated. Our findings showed significantly increased subtrophoblastic mineral depositions in aneuploidy placentas; also, villous architecture changes between study and control cases were significant for multifocal/extensive villous scalloping and syncytial budding. Our conclusion was that placental histological findings of extensive subtrophoblastic mineral deposition, multifocal/extensive villous scalloping and syncytial budding may suggest aneuploidy.

STUDIES IN RODENT POLIOMYELITIS : I. FURTHER EXPERIMENTS WITH THE MURINE STRAIN OF SK POLIOMYELITIS VIRUS

1. SK murine virus maintained over more than 200 serial mouse passages increased in virulence for mice from an initial intracerebral titer of about 1:1 million to a maximum titer of not less than 1:1 billion dilution activity. 2. Following intracerebral injection with murine virus of remote mouse passages, 5 of 13 rhesus monkeys developed a characteristic encephalitic syndrome. Repeated intravenous injection of massive doses of virus caused localized flaccid paralysis in 2 of 14 monkeys. 3. Intracerebral injection of graded doses of murine virus into mice of different age groups caused fatal paralysis in young and old animals alike. Infection with small doses of virus by peripheral routes, while uniformly fatal to young mice, was followed by survival of almost half of the old mice. 4. The incubation period of the disease in young mice infected intracerebrally with a standard dose of murine virus, when studied throughout the period of 1 year, was found considerably lengthened during the summer months. 5. Cross neutralization tests furnished no evidence for any serological relationship between SK murine virus and lymphocytic choriomeningitis virus. Theiler's virus was found to be neutralizable by antimurine horse serum and, to a lesser extent, by concentrated antipoliomyelitis horse serum; however, such inactivation, in both cases, was distinctly inferior to that occurring with SK murine virus. On the other hand, no neutralization whatsoever was obtained between SK murine virus and normal adult mouse serum, whereas the same serum completely neutralized Theiler's virus. Mice surviving infection with Theiler's virus, though acquiring immunity to this virus, remained fully susceptible to reinfection with SK murine virus. 6. Neutralization tests with SK murine virus against poliomyelitis-convalescent monkey sera gave irregular results, but neutralization of murine virus occurred regularly with a hyperimmune antipoliomyelitis horse serum. Hyperimmune antimurine horse and rabbit sera, on the other hand, failed to inactivate three strains of monkey poliomyelitis virus (SK, RMV, Aycock) by intracerebral tests in monkeys. The same sera inactivated murine virus in mice by intraperitoneal, but not by intracerebral injection of virus-serum mixtures. 7. The identity of SK murine virus and its relation to other rodent strains of poliomyelitis virus is discussed on the basis of the available data.

STUDIES IN RODENT POLIOMYELITIS : II. CULTIVATION OF THE MURINE STRAIN OF SK POLIOMYELITIS VIRUS

1. The murine virus may be grown in embryonic mouse brain-serum ultrafiltrate cultures. The virus fails to grow in embryonic chick tissue cultures or in fertilized egg preparations. 2. Some relationship can be demonstrated between the amount of nervous tissue and the infectivity of the culture. 3. Optimum titers of virus potency (10^–6) can be obtained by adjusting the pH of the growing culture at 7.3 to 7.6. 4. A simple pH inactivation curve for virus alone and for virus when actively growing in tissue culture has been obtained. 5. The rate of virus propagation, as determined by potency tests in mice, has been established for cultures which were seeded with large or small amounts of virus. The murine virus "grows" relatively fast. The optimum titer for a large inoculum was reached in 19 hours, for a small inoculum in 72 hours. 6. With extended subcultivation in vitro the cultured virus shows a loss of infectivity for mice by peripheral injection. However, potency as determined by intracerebral injection remains constant. 7. Mice surviving inoculation of culture virus by routes other than intracerebral acquire a relative resistance to reinfection with mouse passage virus. 8. The murine culture virus passes without difficulty through collodion membranes with an A.P.D. of 30 mµ. Its particle size may therefore be estimated as lying between 10 to 15 mµ. 9. On a basis of in vitro activity and cross infection, the murine culture virus is distinct from the virus of lymphocytic choriomeningitis. 10. Murine culture virus may be used as an interfering agent to block infection with poliomyelitis virus in monkeys. The interaction between the two viruses seems to be quantitatively limited. Such interference, with the present potency of culture virus, operates effectively only against comparatively small doses of monkey virus.

STUDIES OF A MURINE STRAIN OF POLIOMYELITIS VIRUS IN COTTON RATS AND WHITE MICE

1. A neurotropic murine virus was isolated by passing poliomyelitis virus (SK strain) from the monkey to cotton rats and white mice. 2. The murine virus has been grown in tissue culture consisting of embryonic mouse brain in ox serum ultrafiltrate. 3. The symptoms and lesions produced by the murine infection compare in all respects with those of poliomyelitis in monkey and man. 4. The murine virus, while highly pathogenic for mice and cotton rats, is non-pathogenic for albino rats, guinea pigs, and rabbits. It possesses limited pathogenicity for rhesus monkeys. 5. Although producing no paralysis in the above mentioned refractory animals, the murine virus may be recovered in active form from neural and extraneural sites of infected albino rats, guinea pigs, and monkeys, but not from rabbits. 6. The identity of the murine and monkey virus is further suggested by cross-neutralization between the murine virus and homologous (SK) and related (Aycock) antipoliomyelitis sera, as well as between homologous and related monkey poliomyelitis virus and antimurine virus sera. 7. Immunization of monkeys with live murine virus, in the form of mouse brain or tissue culture, seems to confer some degree of resistance against subsequent infection with the homologous poliomyelitis monkey virus. 8. The presence of the murine virus in the central nervous system of infected monkeys appears to interfere with the propagation of SK and Aycock poliomyelitis monkey virus in the same animal.