This land is your land, this could be marsh land: Property parcel characteristics of marsh migration corridors in Rhode Island, USA

Salt marshes, critical habitats offering many ecosystem services, are threatened by development, accelerated sea level rise (SLR) and other anthropogenic stressors that are projected to worsen. As seas rise, some salt marshes can migrate inland if there is adjacent, permeable, undeveloped land available. Facilitating marsh migration is necessary for coastal resilience efforts, but extensive coastal development can make finding suitable migration corridors challenging. This work seeks to characterize changes in land use, ownership, and economic value at the property parcel level within current versus future marsh areas for the state of Rhode Island, USA. We find that most parcels currently containing salt marsh are publicly owned, whereas most adjacent parcels projected to contain new salt marsh in 2050 are privately owned. Additionally, parcels containing new marsh in 2050 have 47% higher per-hectare assessed values than parcels containing current marsh. We describe the locations and characteristics of parcels within migration corridors with the lowest per-hectare values that may be the most cost-effective for marsh conservation practitioners to protect. This study highlights the expanding land use types and landowner sets that will be involved in marsh conservation decisions, and the economic value of potential migration corridors where costly tradeoffs may be necessary to promote coastal resilience.

Systemic anti-inflammatory treatment of atopic dermatitis during conception, pregnancy and breastfeeding: Interdisciplinary expert consensus in Northern Europe

Treating atopic dermatitis (AD) in pregnant or breastfeeding women, and in women and men with AD aspiring to be parents is difficult and characterized by uncertainty, as evidence to inform decision-making on systemic anti-inflammatory treatment is limited. This project mapped consensus across dermatologists, obstetricians and patients in Northwestern Europe to build practical advice for managing AD with systemic anti-inflammatory treatment in men and women of reproductive age. Twenty-one individuals (sixteen dermatologists, two obstetricians and three patients) participated in a two-round Delphi process. Full consensus was reached on 32 statements, partial consensus on four statements and no consensus on four statements. Cyclosporine A was the first-choice long-term systemic AD treatment for women preconception, during pregnancy and when breastfeeding, with short-course prednisolone for flare management. No consensus was reached on second-choice systemics preconception or during pregnancy, although during breastfeeding dupilumab and azathioprine were deemed suitable. It may be appropriate to discuss continuing an existing systemic AD medication with a woman if it provides good disease control and its benefits in pregnancy outweigh its risks. Janus kinase (JAK) inhibitors, methotrexate and mycophenolate mofetil should be avoided by women during preconception, pregnancy and breastfeeding, with medication-specific washout periods advised. For men preconception: cyclosporine A, azathioprine, dupilumab and corticosteroids are appropriate; a 3-month washout prior to conception is desirable for methotrexate and mycophenolate mofetil; there was no consensus on JAK inhibitors. Patient and clinician education on appropriate (and inappropriate) AD treatments for use in pregnancy is vital. A shared-care framework for interdisciplinary management of AD patients is advocated and outlined. This consensus provides interdisciplinary clinical guidance to clinicians who care for patients with AD before, during and after pregnancy. While systemic AD medications are used uncommonly in this patient group, considerations in this article may help patients with severe refractory AD.

ATP1A3 related disease manifesting as rapid onset dystonia-parkinsonism with prominent myoclonus and exaggerated startle

We report ATP1A3-associated rapid-onset dystonia-parkinsonism with an atypical presentation including myoclonus and exaggerated startle in four patients. Their prominence over parkinsonism prompted consideration of a syndromic diagnosis of myoclonus dystonia. ATP1α3 dysfunction in GABAergic neurons could explain these examination findings. The spectrum of ATP1A3-associated movement disorders includes myoclonus-dystonia.

Ultra-Low-Cost Disposable Hand-Held Clinical-Scale Propane Gas Hyperpolarizer for Pulmonary Magnetic Resonance Imaging Sensing

Hyperpolarized magnetic resonance imaging (MRI) contrast agents are revolutionizing the field of biomedical imaging. Hyperpolarized Xe-129 was recently FDA approved as an inhalable MRI contrast agent for functional lung imaging sensing. Despite success in research settings, modern Xe-129 hyperpolarizers are expensive (up to $1M), large, and complex to site and operate. Moreover, Xe-129 sensing requires specialized MRI hardware that is not commonly available on clinical MRI scanners. Here, we demonstrate that proton-hyperpolarized propane gas can be produced on demand using a disposable, hand-held, clinical-scale hyperpolarizer via parahydrogen-induced polarization, which relies on parahydrogen as a source of hyperpolarization. The device consists of a heterogeneous catalytic reactor connected to a gas mixture storage can containing pressurized hyperpolarization precursors: propylene and parahydrogen (10 bar total pressure). Once the built-in flow valve of the storage can is actuated, the precursors are ejected from the can into a reactor, and a stream of hyperpolarized propane gas is ejected from the reactor. Robust operation of the device is demonstrated for producing proton sensing polarization of 1.2% in a wide range of operational pressures and gas flow rates. We demonstrate that the propylene/parahydrogen gas mixture can retain potency for days in the storage can with a monoexponential decay time constant of 6.0 ± 0.5 days, which is limited by the lifetime of the parahydrogen singlet spin state in the storage container. The utility of the produced sensing agent is demonstrated for phantom imaging on a 3 T clinical MRI scanner located 100 miles from the agent/device preparation site and also for ventilation imaging of excised pig lungs using a 0.35 T clinical MRI scanner. The cost of the device components is less than $35, which we envision can be reduced to less than $5 for mass-scale production. The hyperpolarizer device can be reused, recycled, or disposed.

Moving into the red - a near infra-red optical probe for analysis of human neutrophil elastase in activated neutrophils and neutrophil extracellular traps

Neutrophils are the first immune cells recruited for defence against invading pathogens; however, their dysregulated activation and subsequent release of the enzyme human neutrophil elastase is associated with several, inflammation-based, diseases. Herein, we describe a FRET-based, tri-branched (one quencher, three fluorophores) near infrared probe that provides an intense OFF/ON amplified fluorescence signal for specific detection of human neutrophil elastase. The probe allowed selective detection of activated neutrophils and labelling of neutrophil extracellular traps.

Hazardous and contaminated sites within salt marsh migration corridors in Rhode Island, USA

As salt marshes attempt to migrate upland due to sea level rise, they will encounter many kinds of land development and infrastructure in highly populated, urbanized coastal communities. Hazardous and contaminated sites (HCSs) -- facilities and infrastructure that store, use, or release harmful substances -- are particularly concerning obstacles to salt marsh migration because of their potential to release contaminants if their structural integrity is compromised. Inventorying HCSs within migration pathways can inform coastal resilience planning. To understand what kinds of HCSs migrating marsh may encounter in Rhode Island, USA, we inventoried sites from federal and state sources, assigned contaminant hazard rankings to most sites, and overlayed them with projected marsh migration corridors. We found that HCSs are extensive across marsh migration corridors in the state, especially in urban areas. Among the most common HCSs in and around Rhode Island salt marshes are stormwater outfalls, underground storage tanks, and facilities registered with EPA's Resource Conservation and Recovery Act (RCRA) or EPA's National Pollutant Discharge Elimination System (NPDES). These sites pose varying hazards to human and aquatic life if breached, with some sites representing little or no threat but most posing some degree of hazard to their surroundings. This coastal HCSs inventory can inform prioritization and management of coastal salt marshes subject to accelerated sea level rise. Management decisions such as allowing marsh migration, implementing adaptation actions to build salt marsh elevation, or erecting physical barriers at marsh sites will influence future salt marsh extent, marshes' ability to provide ecosystem services, and public health exposures to toxic releases. In addition, as Rhode Island and other coastal states work to promote coastal resiliency, this type of inventory can inform decisions about which HCSs to prioritize for remediation and other climate adaptation actions. Marsh migration is just one potential consequence of sea level rise, so many of the considerations outlined here are widely applicable to the broader goal of preparing coastal communities for rising seas.

Military experience in the management of pelvic fractures from OIF/OEF

INTRODUCTION

Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.

METHODS

We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.

RESULTS

Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.

CONCLUSIONS

Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

Evaluating the Functional Equivalency of Test Organism Performance in Negative and Solvent Controls During Chronic Sediment Ecotoxicity Studies Based on US Environmental Protection Agency Guidance

The US Environmental Protection Agency (USEPA) considers sediment toxicity tests as conditional registration requirements for pesticides with soil Kd ≥50 L/kg-solid, Koc ≥1000 L/kg-organic carbon, or log Kow ≥3. The hydrophobicity of these compounds often necessitates use of solvents to ensure accurate and homogeneous dosing of spiked-sediment studies. For sediment tests, a volatile solvent (e.g., acetone) is generally used as a transient carrier. Due to low water solubility, test material is dissolved in a volatile solvent to create stock solutions. A measured aliquot of stock solution is then mixed with sand substrate, after which the solvent is evaporated. This spiking process results in negligible solvent exposure to organisms. In 2016, USEPA released final ecotoxicity test guidelines for subchronic freshwater (850.1735) and marine (850.1740) sediment test. These methods provide an option for conducting experiments with only a solvent control and no negative control. To adopt this testing strategy, functional equivalency between the negative and solvent control must be demonstrated. These test guidelines describe specific factors that should be considered for evaluating functional equivalency, including (a) the concentration of solvent in the test sediment after evaporation, (b) the levels of solvent that are known to affect organism health, (c) the known impurities in the solvent and their potential impact on organism health, and (d) the historical organism performance of solvent versus negative controls. Our analysis considers these factors and overall supports the elimination of the negative control requirement because this change is unlikely to impact the robustness or interpretability of spiked-sediment toxicity tests. Environ Toxicol Chem 2023;00:1-7. © 2023 CropLife America. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Laying it on thick: Ecosystem effects of sediment placement on a microtidal Rhode Island salt marsh

Heightened recognition of impacts to coastal salt marshes from sea-level rise has led to expanding interest in using thin-layer sediment placement (TLP) as an adaptation tool to enhance future marsh resilience. Building on successes and lessons learned from the Gulf and southeast U.S. coasts, projects are now underway in other regions, including New England where the effects of TLP on marsh ecosystems and processes are less clear. In this study, we report on early responses of a drowning, microtidal Rhode Island marsh (Ninigret Marsh, Charlestown, RI) to the application of a thick (10-48 cm) application of sandy dredged material and complimentary extensive adaptive management to quickly build elevation capital and enhance declining high marsh plant species. Physical changes occurred quickly. Elevation capital, rates of marsh elevation gain, and soil drainage all increased, while surface inundation, die-off areas, and surface ponding were greatly reduced. Much of the marsh revegetated within a few years, exhibiting aspects of classic successional processes leading to new expansive areas of high marsh species, although low marsh Spartina alterniflora recovered more slowly. Faunal communities, including nekton and birds, were largely unaffected by sediment placement. Overall, sediment placement provided Ninigret Marsh with an estimated 67-320 years of ambient elevation gain, increasing its resilience and likely long-term persistence. Project stakeholders intentionally aimed for the upper end of high marsh plant elevation growth ranges to build elevation capital and minimize maintenance costs, which also resulted in new migration corridors, providing pathways for future marsh expansion.

The role of context in elucidating drivers of animal movement

Despite its consequences for ecological processes and population dynamics, intra-specific variability is frequently overlooked in animal movement studies. Consequently, the necessary resolution to reveal drivers of individual movement decisions is often lost as animal movement data are aggregated to infer average or population patterns. Thus, an empirical understanding of why a given movement pattern occurs remains patchy for many taxa, especially in marine systems. Nonetheless, movement is often rationalized as being driven by basic life history requirements, such as acquiring energy (feeding), reproduction, predator-avoidance, and remaining in suitable environmental conditions. However, these life history requirements are central to every individual within a species and thus do not sufficiently account for the high intra-specific variability in movement behavior and hence fail to fully explain the occurrence of multiple movement strategies within a species. Animal movement appears highly context dependent as, for example, within the same location, the behavior of both resident and migratory individuals is driven by life history requirements, such as feeding or reproduction, however different movement strategies are utilized to fulfill them. A systematic taxa-wide approach that, instead of averaging population patterns, incorporates and utilizes intra-specific variability to enable predictions as to which movement patterns can be expected under a certain context, is needed. Here, we use intra-specific variability in elasmobranchs as a case study to introduce a stepwise approach for studying animal movement drivers that is based on a context-dependence framework. We examine relevant literature to illustrate how this context-focused approach can aid in reliably identifying drivers of a specific movement pattern. Ultimately, incorporating behavioral variability in the study of movement drivers can assist in making predictions about behavioral responses to environmental change, overcoming tagging biases, and establishing more efficient conservation measures.

Environmental conditions constrain nursery habitat value in Australian sub-tropical estuaries

High quality nursery grounds are important for species success and the long-term sustainability of fish stocks. However, even for important fisheries species, what constitutes nursery habitats is only coarsely defined, and details of specific requirements are often lacking. In this study we investigated upstream estuarine areas in central Queensland, Australia, to identify the environmental factors that constrain nursery ground utilization for important fisheries species. We used unbaited underwater video cameras to assess fish presence, and used a range of water quality sensors to record fluctuations in environmental conditions, likely to influence juveniles, over several months (e.g. tidal connection patterns, temperature, salinity and dissolved oxygen). We found that juveniles of three fisheries target species (Lutjanus argentimaculatus, Lutjanus russellii and Acanthopagrus australis) were common in the upstream sections of the estuaries. For each species, only a subset of the factors assessed were influential in determining nursery ground utilization, and their importance varied among species, even among the closely related L. argentimaculatus and L. russellii. Overall, tidal connectivity and the availability of complex structure, were the most influential factors. The reasons for the importance of connectivity are complex; as well as allowing access, tidal connectivity influences water levels, water temperature and dissolved oxygen - all important physiological requirements for successful occupation. The impact of variation in juvenile access to food and refuge in nursery habitat was not directly assessed. While crucial, these factors are likely to be subordinate to the suite of environmental characteristics necessary for the presence and persistence of juveniles in these locations. These results suggest that detailed environmental and biological knowledge is necessary to define the nuanced constraints of nursery ground value among species, and this detailed knowledge is vital for informed management of early life-history stages.

Restoration of marine ecosystems: Understanding possible futures for optimal outcomes

Accelerating declines in the extent, quality and functioning of the world's marine ecosystems have generated an upsurge in focus on practical solutions, with ecosystem restoration becoming an increasingly attractive mitigation strategy for systems as diverse as coral reefs, mangroves and tidal flats. While restoration is popular because it promises positive outcomes and a return to something approaching unimpacted condition and functioning, it involves substantial public and private investment, both for the initial restoration activity and for on-going maintenance of the restored asset. This investment often affords one big chance to get things right before irretrievable damage is done. As a result, precise, well considered and accountable decision-making is needed to determine the specific focus for restoration, the scale of restoration, the location for deploying restoration activities, and indeed whether or not restoration is necessary or even possible. We explore the environmental/ecological considerations and constraints governing optimal decisions about the nature, location and prioritisation of restoration activities in marine ecosystems, and in particular the constraints on achieving understanding of possible futures and the likelihood of achieving them. We conclude that action must be informed by a context-specific understanding of the historical situation, the current situation, the constraints on change, the range of potential outcome scenarios, and the potential futures envisioned.

Filaggrin mutations in relation to skin barrier and atopic dermatitis in early infancy

BACKGROUND

Loss-of-function mutations in the skin barrier gene filaggrin (FLG) increase the risk of atopic dermatitis (AD), but their role in skin barrier function, dry skin and eczema in infancy is unclear.

OBJECTIVES

To determine the role of FLG mutations for impaired skin barrier function, dry skin, eczema and AD at three months of age and through infancy.

METHODS

FLG mutations were analyzed in 1836 infants in the Scandinavian population-based PreventADALL study. Transepidermal water loss (TEWL), dry skin, eczema and AD were assessed at three, six and 12 months of age.

RESULTS

Filaggrin mutations were observed in 166 (9%) infants. At three months, carrying FLG mutations was not associated with impaired skin barrier function (TEWL > 11.3 g/m² /h) or dry skin, but with eczema (OR(95%CI): 2.76 (1.81, 4.23), p < 0.001). At six months, mutation carriers had significantly higher TEWL than non-mutation carriers (mean (95%CI) 9.68 (8.69, 10.68) vs. 8.24 (7.97, 8.15), p < 0.01) and at three and six months an increased risk of dry skin on truncus (OR: 1.87 (1.25, 2.80), p = 0.002; 2.44 (1.51, 3.95), p < 0.001) or extensor limb surfaces (1.52 (1.04, 2.22), p = 0.028; 1.74 (1.17, 2.57), p = 0.005). FLG mutations were associated with eczema and AD in infancy.

CONCLUSION

Filaggrin mutations were not associated with impaired skin barrier function or dry skin in general at three months of age, but increased the risk for eczema, as well as for dry skin on truncus and extensors at three and six months.

Water height modifies forelimb kinematics of horses during water treadmill exercise

Although equine water treadmills (WTs) are increasingly being used for the rehabilitation of equine athletes, the immediate- and short-term effects of this type of exercise on limb movement in the WT and overground are unknown. Therefore, the objective of this study was to evaluate the effects of WT exercise on equine forelimb kinematics on land and under various WT conditions before and after a prolonged period of WT conditioning. External markers were used to collect 2D kinematic data (joint extension, flexion, range of motion (ROM), elevation; stride mechanics) at 120 frames/s. Thirteen mixed breed, English performance horses were filmed under three test conditions: (1) horses walked on sand; (2) horses walked on a WT (water heights: dry, carpus, stifle); (3) horses walked on sand immediately following a WT session. Walking speeds during testing varied between horses, ranging from 1.3-1.5 m/s, but were held constant for each individual horse for all tests on both days. Testing occurred on days 1 and 10, with horses being trained on the WT for days 2 through 8 (28 min/day). Comparisons were made using linear mixed effects models. Carpal ROM and elbow ROM were greater when horses were walked in water, compared to without water (dry treadmill) and overground (P<0.0001 for all). This increased ROM was achieved primarily via an increase in joint flexion. With the addition of water, stride length increased and stride frequency decreased, accompanied by an increased percentage duration of swing phase. No effects of conditioning on gait mechanics were observed overground. Therefore, WT exercise may be meaningful for physical rehabilitation through increased joint flexion and ROM observed.

Association between atopic dermatitis and autoimmune diseases: a population-based case-control study

Background

Atopic dermatitis (AD) is a common chronic skin disorder and is well known to be associated with other atopic conditions. There is increasing evidence for an association also with nonatopic conditions, including autoimmune diseases, but data are limited about several autoimmune diagnoses.

Objectives

To investigate the association between AD and autoimmune diseases.

Methods

This case–control study used Swedish national healthcare registers. The source population comprised the entire Swedish population aged ≥ 15 years from 1968 to 2016. Cases, including all those with an inpatient diagnosis of AD (from 1968) and/or a specialist outpatient diagnosis of AD (from 2001), were matched by sex and age to healthy controls (104 832 cases of AD, 1 022 435 controls).

Results

AD was significantly associated with one or more autoimmune diseases compared with controls – adjusted odds ratio (aOR) 1·97, 95% confidence interval (CI) 1·93–2·01 – and this association was significantly stronger in the presence of multiple autoimmune diseases compared with only one. The association was strongest for autoimmune disorders involving the skin (aOR 3·10, 95% CI 3·02–3·18), the gastrointestinal tract (aOR 1·75, 95% CI 1·69–1·82) or connective tissue (aOR 1·50, 95% CI 1·42–1·58). In the overall analysis, men with AD had a stronger association with rheumatoid arthritis and coeliac disease than did women with AD. In subanalyses, the findings remained stable in multivariable analyses after adjustment for smoking and parental autoimmune disease.

Conclusions

This large population‐based study indicates significant autoimmune comorbidity of adults with AD, especially between AD and autoimmune dermatological, gastrointestinal and rheumatological diseases. Having multiple autoimmune diseases resulted in a stronger association with AD than having only one autoimmune disease.

What is already known about this topic?

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases.

Some studies have shown that AD is associated with some autoimmune diseases, such as Crohn disease, ulcerative colitis, coeliac disease, alopecia areata and vitiligo, but data are limited for several major autoimmune diagnoses.

What does this study add?

In this study, AD was associated with several autoimmune diseases, especially those involving the skin, the gastrointestinal tract or connective tissue.

The association was stronger for individuals with multiple autoimmune comorbidities.

Linked Comment: J.I. Silverberg. Br J Dermatol 2021; 185:243–244.

Plain language summary available online

Context Dependence: A Conceptual Approach for Understanding the Habitat Relationships of Coastal Marine Fauna

Coastal habitats, such as seagrasses, mangroves, rocky and coral reefs, salt marshes, and kelp forests, sustain many key fish and invertebrate populations around the globe. Our understanding of how animals use these broadly defined habitat types is typically derived from a few well-studied regions and is often extrapolated to similar habitats elsewhere. As a result, a working understanding of their habitat importance is often based on information derived from other regions and environmental contexts. Contexts such as tidal range, rainfall, and local geomorphology may fundamentally alter animal–habitat relationships, and there is growing evidence that broadly defined habitat types such as “mangroves” or “salt marsh” may show predictable spatial and temporal variation in habitat function in relation to these environmental drivers. In the present article, we develop a framework for systematically examining contextual predictability to define the geographic transferability of animal–habitat relationships, to guide ongoing research, conservation, and management actions in these systems.

A realistic fish-habitat dataset to evaluate algorithms for underwater visual analysis

Visual analysis of complex fish habitats is an important step towards sustainable fisheries for human consumption and environmental protection. Deep Learning methods have shown great promise for scene analysis when trained on large-scale datasets. However, current datasets for fish analysis tend to focus on the classification task within constrained, plain environments which do not capture the complexity of underwater fish habitats. To address this limitation, we present DeepFish as a benchmark suite with a large-scale dataset to train and test methods for several computer vision tasks. The dataset consists of approximately 40 thousand images collected underwater from 20 habitats in the marine-environments of tropical Australia. The dataset originally contained only classification labels. Thus, we collected point-level and segmentation labels to have a more comprehensive fish analysis benchmark. These labels enable models to learn to automatically monitor fish count, identify their locations, and estimate their sizes. Our experiments provide an in-depth analysis of the dataset characteristics, and the performance evaluation of several state-of-the-art approaches based on our benchmark. Although models pre-trained on ImageNet have successfully performed on this benchmark, there is still room for improvement. Therefore, this benchmark serves as a testbed to motivate further development in this challenging domain of underwater computer vision.

A modelling framework to assess the likely effectiveness of facemasks in combination with 'lock-down' in managing the COVID-19 pandemic

COVID-19 is characterized by an infectious pre-symptomatic period, when newly infected individuals can unwittingly infect others. We are interested in what benefits facemasks could offer as a non-pharmaceutical intervention, especially in the settings where high-technology interventions, such as contact tracing using mobile apps or rapid case detection via molecular tests, are not sustainable. Here, we report the results of two mathematical models and show that facemask use by the public could make a major contribution to reducing the impact of the COVID-19 pandemic. Our intention is to provide a simple modelling framework to examine the dynamics of COVID-19 epidemics when facemasks are worn by the public, with or without imposed 'lock-down' periods. Our results are illustrated for a number of plausible values for parameter ranges describing epidemiological processes and mechanistic properties of facemasks, in the absence of current measurements for these values. We show that, when facemasks are used by the public all the time (not just from when symptoms first appear), the effective reproduction number, Re , can be decreased below 1, leading to the mitigation of epidemic spread. Under certain conditions, when lock-down periods are implemented in combination with 100% facemask use, there is vastly less disease spread, secondary and tertiary waves are flattened and the epidemic is brought under control. The effect occurs even when it is assumed that facemasks are only 50% effective at capturing exhaled virus inoculum with an equal or lower efficiency on inhalation. Facemask use by the public has been suggested to be ineffective because wearers may touch their faces more often, thus increasing the probability of contracting COVID-19. For completeness, our models show that facemask adoption provides population-level benefits, even in circumstances where wearers are placed at increased risk. At the time of writing, facemask use by the public has not been recommended in many countries, but a recommendation for wearing face-coverings has just been announced for Scotland. Even if facemask use began after the start of the first lock-down period, our results show that benefits could still accrue by reducing the risk of the occurrence of further COVID-19 waves. We examine the effects of different rates of facemask adoption without lock-down periods and show that, even at lower levels of adoption, benefits accrue to the facemask wearers. These analyses may explain why some countries, where adoption of facemask use by the public is around 100%, have experienced significantly lower rates of COVID-19 spread and associated deaths. We conclude that facemask use by the public, when used in combination with physical distancing or periods of lock-down, may provide an acceptable way of managing the COVID-19 pandemic and re-opening economic activity. These results are relevant to the developed as well as the developing world, where large numbers of people are resource poor, but fabrication of home-made, effective facemasks is possible. A key message from our analyses to aid the widespread adoption of facemasks would be: 'my mask protects you, your mask protects me'.

Abstract 4421: SY-5609, an orally available selective CDK7 inhibitor demonstrates broad anti-tumor activity in vivo

Previously, we reported on a series of highly potent, selective, and non-covalent CDK7 inhibitors that demonstrated antiproliferative activity against triple-negative breast cancer (TNBC) and ovarian cancer (OVA) cell lines and tumor growth inhibition in cell line-derived (CDX) and patient-derived (PDX) mouse xenograft models. Here, we report on the in vitro and in vivo profile of our development candidate, SY-5609. Methods: Kinase inhibition assays at both Km and 2 mM [ATP] were used to assess inhibition of CDK2, CDK7, CDK9, and CDK12. SPR was used to determine the Kd, kon, and koff binding characteristics of SY-5609 to immobilized CDK7/Cyclin H dimer. CDK7 compound occupancy was determined using a biotinylated small molecule probe to pull down free CDK7 following incubating of HL60 cells with SY-5609. Inhibition of tumor cell line growth was assessed following 72 hrs of incubation with SY-5609. Flow cytometry was used to assess apoptosis and cell cycle modulation after 48 hrs of treatment. Effects on DNA damage and repair were assessed by immunofluorescence staining for γH2AX and RAD51 proteins. To assess in vivo effects, mice were implanted subcutaneously and randomized for treatment when tumors reached 150-200 mm3 and dosed orally for 3 weeks by both QD and BID dosing regimens. Collected tumor tissue samples were analyzed for protein levels of MCL1, pCDK2, MYC, and RNA Pol II CTD pSer5 by western blot. Results: SY-5609 bound CDK7/Cyclin H with a Kd of 0.059 nM and occupied CDK7 in HL60 cells with an EC50 of 33 nM. Cell growth inhibition EC50 values were 6-17 nM in a panel of solid tumor cell lines. Selectivity of SY-5609 over CDK12, CDK9, and CDK2 was 2492-, 2508-, and 8068-fold, respectively. SY-5609 led to induction of apoptosis, cell cycle arrest, and inhibition of DNA damage repair in tumor cell lines. Dose-dependent tumor growth inhibition was observed in a panel of CDX and PDX solid tumor models with both QD and BID dosing of SY-5609 with resulting decreases in direct (pCDK2, RNA Pol II CTD pSer5) and indirect (MCL1, MYC) protein biomarkers. In summary, we describe SY-5609, an orally available, potent, and selective CDK7 inhibitor that drives strong responses in CDX and PDX tumor models. These data support the rationale for advancing SY-5609 into IND-enabling studies.

Citation Format: Shanhu Hu, Jason Marineau, Kristin Hamman, Michael Bradley, Anneli Savinainen, Sydney Alnemy, Nisha Rajagopal, David Orlando, Claudio Chuaqui, Eric Olson. SY-5609, an orally available selective CDK7 inhibitor demonstrates broad anti-tumor activity in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4421.

Improving End-User Trust in the Quality of Commercial Probiotic Products

In a rapidly growing global probiotic market, end-users have difficulty distinguishing between high quality and poor quality products. This ambiguity threatens the trust consumers and healthcare providers have in probiotic products. To address this problem, we recommend that companies undergo third-party evaluations to certify probiotic quality and label accuracy. In order to communicate about product quality to end-users, indication of certification on product labels is helpful, although not all manufacturers choose to use this approach. Herein we discuss: third-party certification, the process of setting standards for identity, purity, and quantification of probiotics; some emerging methodologies useful for quality assessment; and some technical challenges unique to managing quality of live microbial products. This review provides insights of an Expert Panel engaged in this process and aims to update the reader on relevant current scientific methodologies. Establishing validated methodologies for all aspects of quality assessment is an essential component of this process and can be facilitated by established organizations, such as United States Pharmacopeia. Emerging methodologies including whole genome sequencing and flow cytometry are poised to play important roles in these processes.

Comparison of a Radiant Patient Warming Device with Forced Air Warming during Laparoscopic Cholecystectomy

The importance of maintaining a patient's core body temperature during anaesthesia to reduce the incidence of postoperative complications has been well documented. The standard practice of this institution is the use of a forced air device for intraoperative warming. The purpose of this study was to compare this standard with an alternative warming device using a radiant heat source which only heated the face.

This prospective, randomized controlled trial compared the efficacy of two methods of intraoperative warming: the BairHugger™ (Augustine Medical, U.S.A.) forced air device and the SunTouch™ (Fisher & Paykel Healthcare, N.Z.) radiant warmer during laparoscopic cholecystectomy in 42 female patients. Oesophageal core temperatures were recorded automatically on to computer during operations using standardised anaesthesia, intravenous infusions and draping.

The study failed to show any statistical or clinical difference between the two patient groups in terms of mean core temperature both intraoperatively (P=0.42) and in the recovery period (P=0.54). Mean start to end core temperature differences were marginly lower in the radiant group (0.08°C) but not statistically or clinically significantly different.

Given some of the drawbacks with forced air systems, such as the expense of the single use blanket, this new radiant warming device offers an alternative method of active warming with advantages in terms of cost and possible application to a wide variety of surgical procedures.

Bacterial and Pneumocystis Infections in the Lungs of Gene-Knockout Rabbits with Severe Combined Immunodeficiency

Using the CRISPR/Cas9 gene-editing technology, we recently produced a number of rabbits with mutations in immune function genes, including FOXN1, PRKDC, RAG1, RAG2, and IL2RG. Seven founder knockout rabbits (F0) and three male IL2RG null (-/y) F1 animals demonstrated severe combined immunodeficiency (SCID), characterized by absence or pronounced hypoplasia of the thymus and splenic white pulp, and absence of immature and mature T and B-lymphocytes in peripheral blood. Complete blood count analysis showed severe leukopenia and lymphocytopenia accompanied by severe neutrophilia. Without prophylactic antibiotics, the SCID rabbits universally succumbed to lung infections following weaning. Pathology examination revealed severe heterophilic bronchopneumonia caused by Bordetella bronchiseptica in several animals, but a consistent feature of lung lesions in all animals was a severe interstitial pneumonia caused by Pneumocystis oryctolagi, as confirmed by histological examination and PCR analysis of Pneumocystis genes. The results of this study suggest that these SCID rabbits could serve as a useful model for human SCID to investigate the disease pathogenesis and the development of gene and drug therapies.

Ballistic and snake photon imaging for locating optical endomicroscopy fibres

We demonstrate determination of the location of the distal-end of a fibre-optic device deep in tissue through the imaging of ballistic and snake photons using a time resolved single-photon detector array. The fibre was imaged with centimetre resolution, within clinically relevant settings and models. This technique can overcome the limitations imposed by tissue scattering in optically determining the in vivo location of fibre-optic medical instruments.

Abstract 1143: Targeting the transcriptional kinases CDK12 and CDK13 in breast and ovarian cancer

CDK12 and CDK13 regulate expression of large transcripts requiring substantial processing to produce mature mRNA. This transcriptional regulation includes coordinated phosphorylation of specific repeats within the C-terminal domain of RNA polymerase II and association with RNA processing factors (Chila, 2016). RNAi knockdown of CDK12 in cell culture decreases expression of DNA damage response genes, including BRCA1 and ATR, while enhancing sensitivity to DNA damaging agents (Blazek, 2011; Liang, 2015). Recently THZ531, a selective covalent inhibitor of CDK12 and CDK13, was shown to decrease expression of DNA damage response genes in cell culture (Zhang, 2016). Here we present further studies with THZ531 to guide our discovery program toward molecules suitable for clinical development and to explore mechanistic rationales for combining a CDK12/13 inhibitor with PARP inhibitors or DNA damaging agents for difficult-to-treat cancers such as high-grade serous ovarian cancer and triple-negative breast cancer. Using THZ531 as a benchmark, we developed assays capable of discriminating sub-nM inhibitors, including quantifying time-dependent covalent inhibition and cell-based CDK occupancy. Since CDK7, like CDK12 and CDK13, contains a cysteine residue proximal to the kinase active site, these approaches are critical to understand covalent inhibitor selectivity. Furthermore, we performed kinome paneling studies to better understand selectivity of this scaffold in support of our ongoing efforts to optimize CDK12/13 potency and selectivity. To pharmacologically investigate the previously reported effects of CDK12 RNAi, growth inhibition of a panel of ovarian and breast cancer cell lines was assessed following treatment with THZ531 (OVA EC50 = 50-200 nM (n=6); BRCA EC50 &lt;50 nM (n=4)). Expression profiling revealed that THZ531 treatment resulted in different sets of genes being affected than was observed following treatment with inhibitors targeting CDK7, CDK9 or BET-bromodomain proteins. Additionally, CDK12/13, CDK7 and CDK9 inhibitors were profiled in a broad cell line panel (n&gt;400) to reveal relationships between inhibitor sensitivity, mutation status, gene expression, and potential oncology indications that may be addressed by these different mechanisms. Finally THZ531 was synergistic with both PARP inhibitors and DNA damaging agents in ovarian and breast cancer cell lines. These data highlight cancer indications and combinations that may be particularly amenable to treatment with CDK12/13 inhibitors. While the pharmacokinetic properties of THZ531 preclude adequate target engagement in tumor tissue at tolerated doses in mouse model systems, our ongoing medicinal chemistry program is progressing to identify and optimize CDK12/13 inhibitors suitable for clinical evaluation.

Citation Format: Michael Bradley, Jason Marineau, Yoon Choi, Kristin Hamman, Goran Malojcic, David Orlando, Yixuan Ren, Nan Ke, Shanhu Hu, Eric Olson, Christian Fritz, Christopher Roberts. Targeting the transcriptional kinases CDK12 and CDK13 in breast and ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1143. doi:10.1158/1538-7445.AM2017-1143

Time-resolved spectroscopy at 19,000 lines per second using a CMOS SPAD line array enables advanced biophotonics applications

A SPAD-based line sensor fabricated in 130 nm CMOS technology capable of acquiring time-resolved fluorescence spectra (TRFS) in 8.3 milliseconds is presented. To the best of our knowledge, this is the fastest time correlated single photon counting (TCSPC) TRFS acquisition reported to date. The line sensor is an upgrade to our prior work and incorporates: i) parallelized interface from sensor to surrounding circuitry enabling high line rate to the PC (19,000 lines/s) and ii) novel time-gating architecture where detected photons in the OFF region are rejected digitally after the output stage of the SPAD. The time-gating architecture was chosen to avoid electrical transients on the SPAD high voltage supplies when gating is achieved by excess bias modulation. The time-gate has an adjustable location and time window width allowing the user to focus on time-events of interest. On-chip integrated center-of-mass (CMM) calculations provide efficient acquisition of photon arrivals and direct lifetime estimation of fluorescence decays. Furthermore, any of the SPC, TCSPC and on-chip CMM modes can be used in conjunction with the time-gating. The higher readout rate and versatile architecture greatly empower the user and will allow widespread applications across many techniques and disciplines. Here we focused on 3 examples of TRFS and time-gated Raman spectroscopy: i) kinetics of chlorophyll A fluorescence from an intact leaf; ii) kinetics of a thrombin biosensor FRET probe from quenched to fluorescence states; iii) ex vivo mouse lung tissue autofluorescence TRFS; iv) time-gated Raman spectroscopy of toluene at 3056 cm^-1 peak. To the best of our knowledge, we detect spectrally for the first time the fast rise in fluorescence lifetime of chlorophyll A in a measurement over single fluorescent transient.

Endoscopic sensing of alveolar pH

Previously unobtainable measurements of alveolar pH were obtained using an endoscope-deployable optrode. The pH sensing was achieved using functionalized gold nanoshell sensors and surface enhanced Raman spectroscopy (SERS). The optrode consisted of an asymmetric dual-core optical fiber designed for spatially separating the optical pump delivery and signal collection, in order to circumvent the unwanted Raman signal generated within the fiber. Using this approach, we demonstrate a ~100-fold increase in SERS signal-to-fiber background ratio, and demonstrate multiple site pH sensing with a measurement accuracy of ± 0.07 pH units in the respiratory acini of an ex vivo ovine lung model. We also demonstrate that alveolar pH changes in response to ventilation.

The potential impact of climate change on infectious diseases of Arctic fauna

Climate change is already affecting Arctic species including infectious disease agents and greater changes are expected. Some infectious diseases are already increasing but future changes are difficult to predict because of the complexity of host-agent-environment relationships. However mechanisms related to climate change that will influence disease patterns are understood. Warmer temperatures will benefit free living bacteria and parasites whose survival and development is limited by temperature. Warmer temperatures could promote survivability, shorter development rates and transmission. Insects such as mosquitoes and ticks that transmit disease agents may also benefit from climate change as well as the diseases they spread. Climate change will have significant impacts on biodiversity. Disease agents of species that benefit from warming will likely become more prevalent. Host species stressed by changing environmental conditions may be more vulnerable to disease agents. Warming could lead to increased agriculture and other economic opportunities in the Arctic bringing people, domestic food animals, pets and invasive species and their disease agents into Northern regions. Climate warming may also favor the release of persistent environmental pollutants some of which can affect the immune system and may favor increased rates of some diseases.

Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45

BACKGROUND

The introduction of unclassified new psychoactive substances (NPS) on the recreational drugs market through open online sale ('legal highs' or 'Internet drugs') continues unabated and represents a growing health hazard. The use of NPS has resulted in numerous, severe, adverse events and fatalities, due to unintended overdose or unknown toxic side-effects.

OBJECTIVES

To try to find a possible common underlying cause for the skin-hair-eye symptoms complex observed in three men.

METHODS

From late 2013 to mid-2014, three Swedish men aged 23-34 years with a history of recreational drug use independently presented with similar and very remarkable clinical signs, requiring extensive examination and prolonged treatment.

RESULTS

Common clinical signs included hair depigmentation, hair loss, widespread folliculitis and dermatitis, painful intertriginous dermatitis, dry eyes, and elevated liver enzymes. Two of them also showed transverse white Mees' lines (leukonychia striata) on the fingernails and toenails, suggesting a temporary, drug-induced, disorganized keratinization. The clinical signs gradually disappeared over time. However, later on, two developed severe bilateral secondary cataracts requiring surgery. Because drug tests within the Swedish STRIDA project had demonstrated intake of the NPS opioid MT-45 in all patients, this was suspected to be the common causative agent.

CONCLUSIONS

These cases highlight the importance for physicians and health professionals to consider the increasing number of novel, untested recreational drugs, as a potential cause of unusual and otherwise unrecognized clinical signs and symptoms.

Adjectives as Information Sources for Reading-Comprehension Test Items

To replicate Bradley's (1970) investigation of various parts-of-speech as information sources for responses to reading-comprehension test items, 180 Ss in Grades 3, 4, and 5 were assigned to treatment groups which corresponded to grammatical deletions made in the reading paragraphs. Nouns were confirmed as the primary information source and adjectives were not confirmed as an information source. It was concluded that some artifact of task, administration, or random error was responsible for the previous finding of adjectives as information sources for responses to reading-comprehension test items.

12th International Conference on Conservative Management of Spinal Deformities – SOSORT 2015 Annual Meeting

O1 The functional properties of paraspinal muscles in adolescents with idiopathic scoliosis (AIS): A systematic review of the literature

Eric Parent, Alan Richter

O2 The importance of the lateral profile in the treatment of idiopathic scoliosis

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Paolo Pizzetti, Andrea Poscia, Lorenzo Aulisa

O3 Radiological outcome in Adolescent idiopathic scoliosis patients 20 years after treatment

Ane Simony, Steen Bach Christensen, Mikkel O Andersen

O4 Junctional Kyphosis, how can we detect and monitor it during growth?

Alessandra Negrini, Sabrina Donzelli, Laura Maserati, Fabio Zaina, Jorge H Villafane, Stefano Negrini

O5 Usefulness of the clinical measure of trunk imbalance in adolescent idiopathic scoliosis

Carole Fortin, Erin Grunstein, Hubert Labelle, Stefan Parent, Debbie Ehrmann Feldman

O6 Can ultrasound imaging be used to determine curve flexibility when designing spinal orthoses?

Edmond Lou, Rui Zheng, Doug Hill, Andreas Donauer, Melissa Tilburn, Jim Raso

O7 Reliability of the Schroth curve type classification in adolescents with idiopathic scoliosis (AIS)

Sanja Schreiber, Eric Parent, Greg Kawchuk, Douglas Hedden

O8 Can Trunk Appearance Perception Scale (TAPS) be used as a descriptive tool of scoliosis severity?

Judith Sánchez-Raya, Antonia Matamalas Adrover, Elisabetta D’Agata, Joan Bagó Granell

O9 Magnitude of the Cobb angle on an X-ray in relation to the angle of trunk rotation in children who come to the “Troniny” Scoliosis Treatment Centre

Marek Kluszczynski, Anna Kluszczyńska, Jacek Wąsik, Marta Motow-Czyż, Adam Kluszczyński

O10 Cobb angel measurement without X-ray, a novel method

Ane Simony, Karen Hojmark Hansen; Hanne Thomsen; Mikkel Meyer Andersen; Morten Vuust

O11 The postural tone magnitude and distribution in patients diagnosed with an adolescent idiopathic scoliosis: a preliminary study

Irmina Blicharska, Jacek Durmała, Bartosz Wnuk, Małgorzata Matyja

O12 From studies on the function of the respiratory system in children with body posture defects

Andrzej Szopa, Małgorzata Domagalska-Szopa, Weronika Gallert-Kopyto, Tomasz Łosień, Ryszard Plintla

O13 Scoliosis as the “first” sign of various diseases

Franz Landauer, Karl Vanas

O14 The effectiveness of core stabilization exercises versus conventional exercises in addition to brace wearing in patients with adolescent idiopathic acoliosis

Gozde Gur, Necdet Sukru Altun, Yavuz Yakut

O15 The effect of physiotherapy techniques on the body balance in patients with scoliosis treated with corrective appliances

Piotr Gawda, Piotr Majcher

O16 New combine method treating AIS – preliminary results

Lior Neuhaus Sulam

O17 Does a 4-week intensive course of ScolioGold therapy reduce angle of trunk rotation in scoliotic patients: a retrospective case series.

Michael Bradley, David Glynn, Alex Hughes, Erika Maude, Christine Pilcher

O18 Schroth physiotherapy method without bracing is an effective treatment for scoliosis in improving curves and avoiding surgery and should be offered as a treatment option for scoliosis in Canada: case series

Andrea Lebel, Victoria Ashley Lebel, Judit Orbán

O19 Rotation of the trunk and pelvis and coupled movements in the sagittal plane in double support stance in adolescent girls with idiopathic scoliosis

Agnieszka Stępień, Krzysztof Graff

O20 Curve progression analysis in Risser 0 patients orthotically managed with compliance monitors

D. Speers

O21 Conservative treatment in Scheuermann’s kyphosis: comparison between lateral curve and variation of the vertebral geometry

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Giuseppe Mastantuoni, Andrea Poscia, Lorenzo Aulisa

O22 The plaster cast in the conservative treatment of idiopathic scoliosis can still play a positive role?

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Francesco Falciglia, Andrea Poscia, Lorenzo Aulisa

O23 Bracing for Adolescent Idiopathic Scoliosis (AIS) and Scheuermann Kyphosis : The issue of overtreatment in Greece

Nikos Karavidas

O24 Efficacy of Milwaukee brace for correction of scheurmann kyphosis

Mohammadreza Etemadifar

O25 The three dimensional analysis of the Sforzesco brace correction

Sabrina Donzelli, Fabio Zaina, Monia Lusini, Salvatore Minnella, Luca Balzarini, Stefano Respizzi, Stefano Negrini

O26 Quality of Life in adolescents with idiopathic scoliosis: A comparison measured by the Kidscreen 27 between scoliotic patients and healthy controls

Kathrin Güttinger

O27 The degree of illness acceptance in young women with idiopathic scoliosis treated with orthopedic braces: a preliminary study

Jacek Durmała, Irmina Blicharska, Agnieszka Drosdzol–Cop, Violetta Skrzypulec–Plinta

O28 Which are the personality traits of the patients with Adolescent Idiopathic Scoliosis?

Elisabetta D’Agata, Judith Sánchez-Raya

O29 How many Scolioses do exist in the same person? A zoom vision on the perception of the patient

Judith Sánchez-Raya, Elisabetta D’Agata

P1 The algorithm for the automatic detection of the pelvic obliquity based on analysis of the PA viev of the x-ray image

Sławomir Paśko, Wojciech Glinkowski

P2 Monitoring of spine curvatures and posture during pregnancy using surface topography – case study and method assessment

Jakub Michoński, Katarzyna Walesiak, Anna Pakuła, Robert Sitnik, Wojciech Glinkowski

P3 Spinal rotation under static and dynamic conditions: a prospective study comparing normative data vs. scoliosis

Helmut Diers

P4 The principle of non-surgical treatment of idiopathic scoliosis right-sided breast depending on the volatility of the formation of the intervertebral discs and vertebral bodies

Piotr Majcher, Piotr Gawda

P5 Unexpected late progression of adolescent idiopathic scoliosis treated with short-term, aggressive, full-time bracing and Schroth physiotherapy with excellent preliminary result: case study

Andrea Lebel, Victoria Ashley Lebel

P6 Visible posture in relation to the neuroanatomical and neurodynamical features in spinal deformations

Piet van Loon, Ruud van Erve, Andre Grotenhuis

P7 Immediate effects of scoliosis-specific corrective exercises on the Cobb angle after 1 week and after 1 year of practice

Karina Zapata, Eric Parent, Dan Sucato

P8 Retrospective analysis of idiopathic scoliosis medical records coming from one out-patient clinic for compatibility with Scoliosis Research Society criteria of brace treatment studies

Krzysztof Korbel, Mateusz Kozinoga, Łukasz Stoliński, Tomasz Kotwicki

P9 Adult female with severe progressive scoliosis possibly secondary to benign tumor removal at age 3 treated with scoliosis specific Schroth physiotherapy after refusing surgery: case study

Andrea Lebel, Victoria Ashley Lebel

P10 New aspects of scoliosis therapy planning and monitoring

Helmut Diers

P11 Outcome of intensive outpatient rehabilitation in an adult patient with M. Scheuermann evaluated by radiologic imaging – a case report

Hagit Berdishevsky

P12 The effectiveness of a Scoliosis Specific Home Exercise Program and bracing to reduce an idiopathic scoliosis curve with more than 90 % success in less than a year of exercises. Case report.

Hagit Berdishevsky

Abstract 4820: Selective CDK7 inhibitors suppress super enhancer-genes, induce massive apoptosis in acute myeloid leukemia and demonstrate durable in vivo efficacy

CDK7 acts bi-functionally as a CDK-activating kinase (CAK) controlling proliferation and as a transcriptional kinase phosphorylating the CTD-RNA Pol II, driving efficient transcriptional processes. CDK7 has recently emerged as an attractive gene control target in cancers addicted to oncogenic transcription factors, regulated by super-enhancers (SEs), (Kwiatkowski et al., 2014; Chipumuro et al., 2014; Christensen 2014; Wang 2015). Acute Myeloid Leukemias (AML) harbor a heterogeneous set of mutations resulting in an altered cell state and aberrant epigenetic and transcriptional control, yet lack targeted therapeutic options. Employing our SE-platform technology we reveal mechanistic insights underlying the vulnerability of AML to gene control modulation via selective CDK7 inhibition.

We describe first-in-class CDK7 inhibitors that covalently target a cysteine outside the kinase domain, resulting in sustained, highly selective inhibition. Several lead compounds exhibit significant biochemical potency (Ki = 10-60 nM and kinact = 5-13/h) and exquisite selectivity when profiled against &gt;400 other kinases. In a cancer cell line panel, acute leukemias emerged among the most sensitive to CDK7 inhibition. Moreover, AML cell lines undergo rapid and robust apoptosis within 24 hours. This is preceded by CDK7 target engagement and concomitant loss of P-CTD-RNAPolII suggesting the primary consequence of CDK7 inhibition is the impaired transcriptional activity of CDK7. Further investigation of the transcriptional consequences of CDK7 inhibition point to a reliance on key disease relevant SE-genes (e.g. MYB, HOX10A and MYC) that are predominantly reduced.

Given the covalent mechanism of our CDK7 inhibitors and PK profile in vivo, we use short treatments in vitro with subsequent washout of free drug to model intermittent dosing regimens in vivo. We demonstrate that short drug exposures maintain a robust irreversible apoptotic response in leukemia cells. In contrast, treated non-transformed cells recover from a transient G2/M arrest followed by re-synthesis of free CDK7 and no apoptosis/cell death. We have extended these findings to in vivo experiments whereby intermittent dosing in AML patient derived xenograft models (PDX) maintains efficacy (reducing human CD45+ leukemia cells to &lt;1%) and significant survival advantage. We have established a PD assay by measuring target engagement of CDK7 both in mouse xenografts and human blood to support: 1) establishing a PK-PD-efficacy relationship 2) quantifying target engagement during dose escalation in a Ph1 clinical trial.

In summary, we describe first-in-class CDK7 inhibitors that are potent and selective and lead to durable, complete responses in PDX models of AML. These data support the rationale for advancing one or more members of this class of compounds toward clinical development.

Citation Format: Shanhu Hu, Nan Ke, Yixuan Ren, Jeremy Lopez, Sofija Miljovska, David Orlando, Darby Schmidt, Michael Bradley, Kevin Sprott, Eric Olson, Christian C. Fritz, Yoon Jong Choi. Selective CDK7 inhibitors suppress super enhancer-genes, induce massive apoptosis in acute myeloid leukemia and demonstrate durable in vivo efficacy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4820.

Majocchis Granuloma Caused by Trichophyton mentagrophytes in 2 Immunocompetent Patients

Majocchi granuloma is an uncommon deep follicular inflammation caused by dermatophytes and affects immunocompetent and immunocompromised patients. The clinical findings overlap with other skin conditions such bacterial infections and inflammatory skin diseases, thereby delaying correct diagnosis. We describe 2 cases in immunocompetent patients.