Full-body skin examination in screening for cutaneous malignancy: a focus on concealed sites and the practices of Australian dermatologists

BACKGROUND

Full-body skin examination (FSE) is a vital practice in the diagnosis of cutaneous malignancy. Precisely how FSE should be conducted with respect to concealed site inclusion remains poorly elucidated.

OBJECTIVE

To establish the approach of Australian dermatologists to concealed site examination (CSE).

METHODS

A cross-sectional study was performed consisting of an online self-administered 11-question survey delivered to fellows of the Australasian College of Dermatologists.

RESULTS

There were 237 respondents. Anogenitalia was the least often examined concealed site (4.6%), and 59.9, 32.9, and 14.3% reported always examining the scalp, breasts, and oral mucosa, respectively. Patient concern was the most frequently cited factor prompting examination, while many cited low incidence of pathology and limited chaperone availability as the main barriers to routine examination of these sites.

CONCLUSION

Most Australian dermatologists do not routinely examine breasts, oral mucosal, or anogenital sites as part of an FSE. Emphasis should be made on identifying individual patient risk factors and education regarding self-examination of sensitive sites. A consensus approach to the conduct of the FSE, including concealed sites, is needed to better delineate clinician responsibilities and address medicolegal implications.

Maternal aggressive behavior in interactions with adolescent offspring: Proximal social-cognitive predictors in depressed and nondepressed mothers

Maternal depressive symptoms are associated with elevations in harsh parenting behavior, including criticism, negative affect, and hostile or coercive behavior, and these behaviors contribute to associations between maternal depressive symptomatology and child functioning. We used multilevel survival analysis to examine social-cognitive processes as proximal predictors of the onset and offset of maternal aggressive behavior during interactions with their adolescent children. Low-income women (N = 180) were selected for either: (a) elevated depressive symptoms and a history of treatment for depression (depressed group) or (b) not more than mild levels of current depressive symptomatology, no history of depression treatment, and no current mental health treatment (nondepressed group). These women and their adolescent children (ages 11-14, M = 12.93; 96 male sex, as assigned at birth) participated in a dyadic problem-solving interaction and mothers completed a video-mediated recall procedure, in which they watched a segment of the interaction, labeled their adolescents' affect, and made attributions for their behavior. Mothers in the depressed group were more likely to initiate aggressive behavior and, once initiated, were less likely to transition out of it. Mothers in both groups were less likely to transition out of aggressive behavior when they made negative attributions for their adolescents' behavior. Findings point to promising cognitive and behavioral targets for intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ultra-low current electrospray ionization of chloroform solution for the analysis of perfluorinated sulfonic acids

RATIONALE

Femtoamp and picoamp electrospray ionization (ESI) characteristics of a nonpolar solvent were explored. The direct ESI mass spectrometry analysis of chloroform extract solution enabled rapid analysis of perfluorinated sulfonic acid analytes in drinking water.

METHODS

Neat chloroform solvent and extracts were directly used in a typical wire-in ESI setup using micrometer emitter tips. Ionization currents were measured with femtoamp sensitivity while ramping the spray voltage from 0 to -5000 V. Methanol was used as a comparison to illustrate the characteristics of electrospraying chloroform. The effects of spray voltage and inlet temperature were studied. A liquid-liquid extraction workflow was developed to analyze perfluorooctanoate sulfonate (PFOS) in drinking water using an ion-trap mass spectrometer.

RESULTS

The ionization onset of chloroform solution was 41 ± 17 fA at 300 V. The ionization current gradually increased with voltage while remaining below 100 pA when using voltages up to -5000 V. The ion signal of PFOS was significantly enhanced to improve the limit of detection (LoD) to 25 ppt in chloroform. Coupled with a liquid-liquid extraction workflow, LoD of 0.38-5.1 ppt and a quantitation range of 5-400 ppt were achieved for perfluorinated sulfonic compounds in 1-ml water samples.

CONCLUSIONS

Femtoamp and picoamp modes expand the solvent compatibility range of ESI and can enable quantitative analysis in parts per trillion (ppt) concentrations.

Gigaohm and Teraohm Resistors in Femtoamp and Picoamp Electrospray Ionization

The femtoamp electrospray ionization (femtoESI) mode has been shown to exhibit unique characteristics that may facilitate ionization efficiency studies and experiments requiring low ion beam flux. Investigation of femtoESI was hindered by a tiny, applied voltage window of 10-100 V, beyond which ionization currents quickly jumped to nanoamps. This window was difficult to locate because the exact onset voltage fluctuates due to variations in ion source alignments. Large resistors (0.1-100 TΩ) in series effectively expanded the femtoESI applied voltage range, up to 1400 V. By swapping resistors, rapid alternation allows for the comparison of both ESI modes under the same alignment. In peptide mixtures, analytes with lower surface activity are suppressed in the nanoESI mode whereas the femtoESI mode shows signal enhancement of less surface-active species. For protein solutions, there is little change in the charge states generated but the femtoESI mode does show a decrease in the average charge state of protein peaks. Peptides and proteins analyzed in the femtoESI mode also tend to generate higher intensity sodiated peaks over protonated peaks at specific charge states compared with nanoESI mode operation.

O108 Central adiposity influences serum calcium concentrations and increases risk of kidney stone disease

Introduction

Serum calcium (SCa) and adiposity are associated with kidney stone disease (KSD). We used conventional and genetic epidemiological approaches to further understanding of these relationships.

Methods

Waist-hip ratio (WHR), a marker of central adiposity, SCa and KSD data were analysed by adjusted linear regression using UK Biobank participants. Univariable, multivariable and mediation Mendelian randomisation (MR) were undertaken using 316 and 246 genetic instruments for WHR and SCa, respectively.

Results

Observational analyses of 3,466 KSD cases and 489,944 controls showed that participants of normal BMI (20–25kg/m2) but in the fifth quintile for WHR have greater risk of incident KSD compared to the first quintile (HR=1.39 (95%CI=1.18–1.63)). After adjustment for sex, age, serum vitamin D, and phosphate, higher WHR was positively associated with SCa (ß=0.04, 95%=CI 0.04–0.05, P<0.001). Univariable MR demonstrated that relative risk of KSD increases with increasing WHR and SCa; 1 standard deviation (SD) increases relative risk by 46% (95%CI=1.27–1.67, P=5.9e-8) and 63% (95%CI=1.37–1.93, P=2.0E-8), respectively. A 1 SD increase in WHR increases SCa by 0.11mmol/L (95%CI=0.07–0.14, P=1.8e-8). Multivariable MR revealed that SCa and WHR independently increase KSD relative risk (OR=1.71, 95%CI=1.49–1.96, P<0.001 and OR=1.41, 95%CI=1.17–1.69, P<0.001 respectively). Mediation MR established that 14% of the effect of WHR on KSD risk is mediated via alterations in SCa.

Conclusion

Central adiposity is causally linked to KSD, partly by raising SCa. Mechanisms by which central adiposity increases KSD risk, independent of and via SCa, remain to be revealed and may identify novel therapeutic methods for KSD.

Take-home message

Central adiposity and serum calcium are independent, causal risk factors for kidney stone disease. One mechanism by which central obesity increases risk of kidney stone disease is by influencing serum calcium concentrations.

Conducting and characterizing femto flow electrospray ionization

Femto flow electrospray ionization (ESI) with flow rates ranging from 240 fL min^-1 to the low pico level (<10 pL min^-1) was conducted and measured using a submicron emitter tip and relay ESI configuration. Signature analyte ion current intensities and profiles were observed. The obtained flow rate and ionization current enabled size calculation for initial charged nanodroplets.

Mowat-Wilson syndrome presenting with Shone's complex cardiac anomaly

A female infant, who was diagnosed antenatally with complex heart disease, confirmed to be Shone's complex postnatally, underwent bilateral pulmonary artery banding, patent ductus arteriosus stent insertion and balloon aortic valvuloplasty soon after birth. She was found to have bilateral megaureters, left hydronephrosis and asplenia. She was on lifelong prophylactic antibiotics and extra vaccines. She had two episodes of pseudo-obstruction of the small bowel, but barium follow-through was normal. She also had a large bowel obstruction and work-up for Hirschsprung disease confirmed the diagnosis. It was noticed that she had developmental delay and hypotonia, together with subtle dysmorphism. She also had failure to thrive and difficulty feeding. Exome sequencing revealed a diagnosis of Mowat-Wilson syndrome (MWS). This case shows a previously undescribed association of Shone's complex, a complex left-sided obstructive heart defect, and MWS. It also highlights the usefulness of trio-exome sequencing in detecting such rare mutations.

Interventions to Increase Sunscreen Use in Adults: A Review of the Literature

Skin cancers are the most common malignancy in Australia. Regular sunscreen use can reduce the incidence of cutaneous squamous cell carcinomas and actinic keratoses and has been associated with reducing the incidence of basal cell carcinomas and melanomas. However, sunscreen effectiveness is limited by the failure of the population to use it routinely. Interventions that promote the daily application of sunscreen may reduce the morbidity, mortality, and economic burden associated with skin malignancies. We reviewed the literature that examines the effectiveness of interventions to increase routine sunscreen use and found that no one strategy has been shown to be clearly effective in adults and that relatively few studies have aimed to increase routine use in groups at extreme skin cancer risk. Future research should consider how interventions can be best designed and how sunscreen use is measured so that cost-effective, feasible strategies that result in improved sunscreen use in adults can be established.

323 Association of Increased Body Mass Index and Waist to Hip Ratio with Kidney Stone Disease: a Prospective Analysis of 493,410 UK Biobank participants

Aim

To investigate the relationship between measures of adiposity and risk of incident kidney stone disease.

Method

The UK Biobank is a prospective cohort study of ∼500,000 participants whose height, weight, BMI, waist circumference, hip circumference, waist:hip ratio (WHR), total fat mass, fat-free mass, body-fat percentage, and percentage truncal fat were measured at enrolment with linkage to medical records. ICD-10 and OPCS codes identified individuals with a new diagnosis of nephrolithiasis from 2006-2010. Individuals with a history of kidney stones or incomplete data were excluded. Multivariate Cox-proportional hazard models were used to assess associations between anthropometric measures and incident kidney stones.

Results

From the UK Biobank, 493,410 individuals were identified for inclusion; 3,466 developed a kidney stone during the study period. Increasing weight, BMI, waist, and hip circumferences, WHR, and body and truncal fat were all associated with increased risk of incident kidney stone disease. However, after adjustment for BMI, only waist circumference and WHR remained significantly associated with risk of nephrolithiasis. In overweight patients, high (men 94-102cm, women 80-88cm) waist circumference or WHR (men &gt;0.9, women &gt;0.85) conferred &gt;40% increased risk of stone formation.

Conclusions

This study indicates that android fat distribution is independently associated with increased risk of developing nephrolithiasis. Kidney stone disease is known to be associated with hypertension, cardiovascular disease, and diabetes, all of which have been linked to android body shape. Our findings provide insight into anthropometric risk factors for stone disease, will facilitate identification of patients at greatest risk of stone recurrence, and will inform prevention strategies.

Human-Guided Modality Informativeness for Affective States

This paper studies the hypothesis that not all modalities are always needed to predict affective states. We explore this hypothesis in the context of recognizing three affective states that have shown a relation to a future onset of depression: positive, aggressive, and dysphoric. In particular, we investigate three important modalities for face-to-face conversations: vision, language, and acoustic modality. We first perform a human study to better understand which subset of modalities people find informative, when recognizing three affective states. As a second contribution, we explore how these human annotations can guide automatic affect recognition systems to be more interpretable while not degrading their predictive performance. Our studies show that humans can reliably annotate modality informativeness. Further, we observe that guided models significantly improve interpretability, i.e., they attend to modalities similarly to how humans rate the modality informativeness, while at the same time showing a slight increase in predictive performance.

533The psychosocial profiles of children aged 11-12 years who have self-harmed: A prospective cohort study

Background

Self-harm in very young people can be a clinically ominous event. While most studies to date have focused on self-harm during the teenage years, fewer studies have examined children aged 12 years or under. We aimed to estimate the incidence and correlates of recent self-harm in a population-based, non-treatment-seeking sample of primary school-aged children.

Methods

1059 children from 43 primary schools in Melbourne, Australia were interviewed at the age of 8 years (Wave 1), and followed up annually until the age of 11 years (Waves 2-4). Interviews covered a range of physical and mental health, social, educational and family domains, including (at Wave 4) self-harm during the previous 12 months.

Results

At Wave 4 (mean age: 11.9 years), a total of 28 children (3%; 18 girls [3%], 10 boys [2%]) reported self-harming during the previous 12 months. When compared with children who reported no self-harm, they were more likely to report depression, anxiety, poor emotional control, frequent bullying victimisation (including online bullying), truancy, recent alcohol consumption, and antisocial behaviour during Waves 1-3. They were also more likely to report having few friends.

Conclusions

Self-harm was reported by a proportion of community-dwelling children aged 11-12 years. As these children were more likely to report a range of other adverse behaviours, experiences and health conditions, clinicians should consider the possibility of prior self-harm when assessing children presenting with such behaviours and issues.

Key messages

The focus of intervention efforts aimed at preventing and reducing adolescent self-harm should extend to primary school-aged children, with a focus on mental health and peer relationships during the pubertal transition.

356 Reducing Long Term Opioid Prescribing Post Thoracic Surgery

Introduction

Patients are routinely started on strong opioid analgesia after surgery with most receiving a prescription for these to continue discharge. We examine the analgesia prescribed in our unit, comparing to ERAS principles from EACTS. We aimed to reduce the total equivalent dose of morphine prescribed on discharge by implementing ERAS principles.

Method

We undertook a retrospective analysis of the analgesia prescribing for patients post open and VATS procedure noting the total dose opioids (using the equivalent dose of morphine). We examined how many patients were still being prescribed opioids analgesia long term, defined as 6 weeks post procedure. We implemented ERAS principles, changing to morphine rather than oxycodone, using short-acting preparations and increasing use of opioid sparing analgesia including NSAIDs.

Results

20% of patients started on strong opioids post procedure were still being prescribed these 6 weeks later. We used ERAS principles to reduce the equivalent dose of morphine dispensed on discharge by a third.

Conclusions

We identified a significant issue with long term opioid prescribing and initiated measures which have resulted in positive change. Our next cycle will measure the outcome of our changes on long-term prescribing implement a multi-disciplinary approach to try reducing the burden of long-term opioid prescribing further.

30 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma

Introduction

Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation.

We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61-year-old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia.

Method

Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity.

Conclusions

This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control, and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time.

This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.

Effect of surface topography on in vitro osteoblast function and mechanical performance of 3D printed titanium

Critical-sized defects remain a significant challenge in orthopaedics. 3D printed scaffolds are a promising treatment but are still limited due to inconsistent osseous integration. The goal of the study is to understand how changing the surface roughness of 3D printed titanium either by surface treatment or artificially printing rough topography impacts the mechanical and biological properties of 3D printed titanium. Titanium tensile samples and discs were printed via laser powder bed fusion. Roughness was manipulated by post-processing printed samples or by directly printing rough features. Experimental groups in order of increasing surface roughness were Polished, Blasted, As Built, Sprouts, and Rough Sprouts. Tensile behavior of samples showed reduced strength with increasing surface roughness. MC3T3 pre-osteoblasts were seeded on discs and analyzed for cellular proliferation, differentiation, and matrix deposition at 0, 2, and 4 weeks. Printing roughness diminished mechanical properties such as tensile strength and ductility without clear benefit to cell growth. Roughness features were printed on mesoscale, unlike samples in literature in which roughness on microscale demonstrated an increase in cell activity. The data suggest that printing artificial roughness on titanium scaffold is not an effective strategy to promote osseous integration.

The most influential papers in mitral valve surgery; a bibliometric analysis

This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.

Abnormal scaffold attachment factor 1 expression and localization in spinocerebellar ataxias and Huntington's chorea

SAFB1 is a DNA and RNA binding protein that is highly expressed in the cerebellum and hippocampus and is involved in the processing of coding and non-coding RNAs, splicing and dendritic function. We analyzed SAFB1 expression in the post-mortem brain tissue of spinocerebellar ataxia (SCA), Huntington's disease (HD), Multiple sclerosis (MS), Parkinson's disease patients and controls. In SCA cases, the expression of SAFB1 in the nucleus was increased and there was abnormal and extensive expression in the cytoplasm where it co-localized with the markers of Purkinje cell injury. Significantly, no SAFB1 expression was found in the cerebellar neurons of the dentate nucleus in control or MS patients; however, in SCA patients, SAFB1 expression was increased significantly in both the nucleus and cytoplasm of dentate neurons. In HD, we found that SAFB1 expression was increased in the nucleus and cytoplasm of striatal neurons; however, there was no SAFB1 staining in the striatal neurons of controls. In PD substantia nigra, we did not see any changes in neuronal SAFB1 expression. iCLIP analysis found that SAFB1 crosslink sites within ATXN1 RNA were adjacent to the start and within the glutamine repeat sequence. Further investigation found increased binding of SAFB1 to pathogenic ATXN1-85Q mRNA. These novel data strongly suggest SAFB1 contributes to the etiology of SCA and Huntington's chorea and that it may be a pathological marker of polyglutamine repeat expansion diseases.

Clinical features may help to identify children and adolescents with greatest risk for thyroid nodules

BACKGROUND

Thyroid nodules (TN) are detected in a small number of asymptomatic children and adolescents but are more frequently malignant (22-26%) than in adults leading some clinicians to perform thyroid ultrasound (US) for all children with goiter or autoimmune thyroiditis (AIT). Our study was designed to determine if suspicious clinical features predict the presence of TN in children with goiter or AIT so that US could be performed on those at highest risk.

METHODS

This was a retrospective review of 223 children and adolescents with goiter or AIT evaluated at a single institution. US was not performed on all patients. It is our practice to define glands that are large, firm, or nodular to palpation as "suspicious". Suspicious glands were interrogated by US and if TN was confirmed, this was further evaluated by fine-needle aspiration followed by surgery if indicated.

RESULTS

The median age was 12.9 years with 74.4% female. TN were confirmed by US in 16.6% of all patients but only 4.8% of those with AIT. By univariate analysis, TN were more common in those with family history of TN or differentiated thyroid carcinoma (DTC), thyroid asymmetry, and lower thyrotropin (TSH) levels. Differentiated thyroid carcinoma (DTC) was identified in 10.8% of TN and 1.8% of all patients. Firmness was significantly more common in patients with DTC (p = 0.0013).

CONCLUSION

TN were less common in those with AIT than reported in previous studies, suggesting that clinical features might fail to identify the majority of TN in patients with AIT. However, patients with asymmetric thyroid and a family history of TN or DTC have greatest risk for TN.

81 Can Simulation-Based Training be Used to Teach Geriatric Medicine?

Introduction

Health Education England (HEE) and the Joint Royal Colleges of Physicians Training Boards recognise the importance of simulation-based training especially for Core Medical Trainees in improving patient outcomes and enhancing learning (Enhancing UK Core Medical Training through Simulation based training, Health Education England 2016). Research also suggests simulation training can be used to address a wide variety of medical curricula agenda from emergency presentations to breaking bad news (Beaubien 2004, Quality & Safety in healthcare). HEE suggests simulation training can be used to develop understanding but also communication skills and awareness of human factors and are focusing on developing a national strategy.

Geriatric Medicine is complex and trainees are expected to be competent in managing elderly patients in a variety of presentations. Our aim was to ascertain the confidence levels of CMT doctors managing elderly patients and whether simulation-based teaching is effective for geriatric teaching.

Methods

Three scenarios addressing common geriatric conditions were developed by a Geriatric Medicine Registrar and overseen by Geriatric Consultant. Scenarios including delirium secondary to sepsis, Opiate toxicity secondary to acute kidney injury (complicated by addressing dementia and risk of self-harm) and identifying and demonstrating appropriate palliative approaches to a catastrophic subdural haemorrhage. Trainees were given a brief summary of a case and asked to review and manage the ‘patient’.

A geriatric registrar alongside two CMT doctors designed a pre and post confidence questionnaire using Likert scales and free text boxes to explore respondents’ views.

Results

100% of trainees found the simulation training useful and would recommend the sessions. 100% of trainees stated preference for simulation-based teaching opposed to lecture and work based assessments. Confidence increased across all three scenarios post simulation. 70% of trainees stated they felt confident to manage delirium with sepsis pre-simulation, this increased to 91% post simulation. Trainees commented ‘feel confident to manage sepsis but not complicated by delirium or AKI’ and ‘prefer simulation to lectures’

Conclusions

CMT doctors enjoy and find simulation training in geriatric medicine useful and show preponderance to this. Simulation training can be used to expose trainees to real life complex geriatric medicine scenarios in a safe environment. This programme will be developed to encompass additional medical scenarios and also to be delivered to foundation year doctors.

Global research priorities for youth mental health

AIM

Over the past two decades, the youth mental health field has expanded and advanced considerably. Yet, mental disorders continue to disproportionately affect adolescents and young adults. Their prevalence and associated morbidity and mortality in young people have not substantially reduced, with high levels of unmet need and poor access to evidence-based treatments even in high-income countries. Despite the potential return on investment, youth mental disorders receive insufficient funding. Motivated by these continual disparities, we propose a strategic agenda for youth mental health research.

METHOD

Youth mental health experts and funders convened to develop youth mental health research priorities, via thematic roundtable discussions, that address critical evidence-based gaps.

RESULTS

Twenty-one global youth mental health research priorities were developed, including population health, neuroscience, clinical staging, novel interventions, technology, socio-cultural factors, service delivery, translation and implementation.

CONCLUSIONS

These priorities will focus attention on, and provide a basis for, a systematic and collaborative strategy to globally improve youth mental health outcomes.

A dual druggable genome-wide siRNA and compound library screening approach identifies modulators of parkin recruitment to mitochondria

Genetic and biochemical evidence points to an association between mitochondrial dysfunction and Parkinson's disease (PD). PD-associated mutations in several genes have been identified and include those encoding PTEN-induced putative kinase 1 (PINK1) and parkin. To identify genes, pathways, and pharmacological targets that modulate the clearance of damaged or old mitochondria (mitophagy), here we developed a high-content imaging-based assay of parkin recruitment to mitochondria and screened both a druggable genome-wide siRNA library and a small neuroactive compound library. We used a multiparameter principal component analysis and an unbiased parameter-agnostic machine-learning approach to analyze the siRNA-based screening data. The hits identified in this analysis included specific genes of the ubiquitin proteasome system, and inhibition of ubiquitin-conjugating enzyme 2 N (UBE2N) with a specific antagonist, Bay 11-7082, indicated that UBE2N modulates parkin recruitment and downstream events in the mitophagy pathway. Screening of the compound library identified kenpaullone, an inhibitor of cyclin-dependent kinases and glycogen synthase kinase 3, as a modulator of parkin recruitment. Validation studies revealed that kenpaullone augments the mitochondrial network and protects against the complex I inhibitor MPP+. Finally, we used a microfluidics platform to assess the timing of parkin recruitment to depolarized mitochondria and its modulation by kenpaullone in real time and with single-cell resolution. We demonstrate that the high-content imaging-based assay presented here is suitable for both genetic and pharmacological screening approaches, and we also provide evidence that pharmacological compounds modulate PINK1-dependent parkin recruitment.

Abstract P5-18-08: Defining molecular signatures to personalise management of patients with early breast cancer

Background

A review of breast screening highlighted the need to reduce overdiagnosis. Ductal Carcinoma In-Situ (DCIS) contributes significantly to this overdiagnosis. Epithelial cells in DCIS are as genetically advanced as those in invasive disease, focusing attention on the tumour microenvironment (ME). A key components of the ME in DCIS is the myoepithelial cell(MEC). These cells lie at the interface of the epithelial and stromal compartments, regulating cell function. We previously have identified changes in the MEC that contribute to tumour progression. Here we investigate the functional and clinical significance of a novel change in MEC phenotype: loss of Galectin-7 (Gal-7) expression. Gal-7 is proposed to play a role in apoptosis. We hypothesise that changes in MEC phenotype in DCIS alter the ME towards a pro-invasive phenotype, and hypothesise that loss of Gal-7 modifies the ME, destabilizes the MEC interface and ultimately may lead to loss of the MEC population through apoptosis.

Methods

Gal-7 expression and function was investigated in clinical samples and in-vitro model systems, respectively.

Gal-7 expression was assessed in a series of pure DCIS samples (low risk model) and DCIS with co-existant invasion (high risk model). Tissue sections were stained for Gal-7 and MEC expression scored on a duct-by-duct basis as positive, heterogeneous or negative.

An in-vitro model of normal primary myoepithelial cells isolated from reduction mammoplasty was used to investigate the functional impact of loss of Gal-7. These cells have high endogenous levels of Gal-7. Gal-7 was knocked down using siRNA and apoptosis assessed using cleaved caspase-3. The effect of Gal-7 on MEC layer integrity was assessed using immunofluorescence and adhesion assays.

The global impact of loss of Gal-7 was investigated using RNA sequencing.

Results

In the tissue analysis 1926 DCIS ducts were scored for MEC expression of Gal-7. Significantly more ducts showed loss of Gal-7 in DCIS with co-existant invasion, with pure DCIS showing 388 ducts positive and DCIS with invasion 144 DCIS ducts positive (p=0.0014). Pure DCIS and DCIS with invasion had 99 and 646 negative DCIS ducts respectively (p=0.0002).

In model systems of primary MEC, knockdown of Gal-7 resulted in increased expression of cleaved caspase-3, suggesting lower levels of Gal-7 increases apoptosis. In functional assays silencing Gal-7 reduces adhesion to both fibronectin and laminin extracellular matrices (p-value 0.005 and 0.001 respectively)

RNA sequencing indicates silencing Gal-7 increases LOX expression - a key regulator of the collagen matrix of the microenvironment.

Conclusion

Normal MEC strongly express Gal-7. Expression is lost in DCIS, with significantly more frequent loss in DCIS with co-existant invasion, suggesting that loss is associated with a more advanced phenotype. Functional assays indicate that loss of MEC Gal-7 enhances MEC apoptosis, which may be one mechanism by which this interface is lost during progression. Gal-7 negative MEC also show impaired adhesion to matrix proteins and lead to up-regulation of LOX, an enzyme key in promoting tumourigenesis. The incorporation of Gal-7 expression into a risk stratification algorithm has functional evidence and is currently being investigated.

Citation Format: Allen N, Allen M, Ahmed K, Gomm J, Nelan R, Nagano A, Chelala C, Gadaleta E, Thorat M, Cuzick J, Jones LJ. Defining molecular signatures to personalise management of patients with early breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-18-08.

Bullying, mental health and friendship in Australian primary school children

BACKGROUND

Frequent bullying predicts adolescent mental health problems, particularly depression. This population-based study with young Australian primary school children aimed to determine the frequency and mental health correlates of bullying, and whether friendship could be protective.

METHOD

Participants were a population-based sample of 1221 children aged 8-9 years attending 43 primary schools in metropolitan Melbourne, Australia. Children were taking part in the Childhood to Adolescence Transition Study. Children completed online questionnaires at school to measure peer relations and emotional well-being. Parents reported on their child's mental health in questionnaires sent to the home.

RESULTS

One in three children (29.2%) reported experiencing frequent bullying, defined as at least once a week. This included physical bullying alone (13.8%), verbal bullying alone (22.7%) and the combination (7.4%). Children who reported being frequently bullied self-reported higher internalising symptoms compared with children who did not report frequent bullying (M (SD) 1.6 (0.9) vs. 1.1 (0.8), p < .001). This difference was confirmed by parents' reports of their child's internalising symptoms (M (SD) 2.4 (2.3) vs. 2.1 (2.0), p = .026, respectively). Amongst children who reported frequent bullying, those with a group of friends had better emotional well-being.

CONCLUSIONS

A substantial proportion of children report experiencing bullying on a weekly basis early in primary school. Given the prevalence of bullying in primary school and its relationship to children's mental health, we recommend effective school-wide antibullying programmes. Further research can explore whether intervention to foster a group of friends around bullied children can improve their emotional well-being.

A Model of Δ9-Tetrahydrocannabinol Self-administration and Reinstatement That Alters Synaptic Plasticity in Nucleus Accumbens

BACKGROUND

Cannabis is the most widely used illicit drug, but knowledge of the neurological consequences of cannabis use is deficient. Two primary components of cannabis are Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). We established a THC+CBD model of self-administration and reinstated drug seeking to determine if, similar to other addictive drugs, cannabis produces enduring synaptic changes in nucleus accumbens core (NAcore) thought to contribute vulnerability to drug reinstatement.

METHODS

Sprague Dawley rats were trained to self-administer THC+CBD (n = 165) or were used as vehicle self-administering control animals (n = 24). Reinstatement was initiated by context, cues, drug priming, and stress (yohimbine injection). Enduring neuroadaptations produced by THC+CBD self-administration were assayed using four measures: dendritic spine morphology, long-term depression, alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid/N-methyl-D-aspartate ratios, and behavioral pharmacology.

RESULTS

We described a novel rodent model of cannabis relapse involving intravenous THC+CBD self-administration and drug seeking induced by conditioned context, cues, and stress. Cued reinstatement of THC+CBD seeking depended on a sequence of events implicated in relapse to other addictive drugs, as reinstatement was prevented by daily treatment with N-acetylcysteine or acute intra-NAcore pretreatment with a neuronal nitric oxide synthase or matrix metalloprotease-9 inhibitor, all of which normalize impaired glutamate homeostasis. The capacity to induce N-methyl-D-aspartate long-term depression in NAcore medium spiny neurons was abolished and dendritic spine density was reduced, but alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid/N-methyl-D-aspartate ratio was unaltered in THC+CBD-trained animals, akin to opioids, but not to psychostimulants.

CONCLUSIONS

We report enduring consequences of THC+CBD use on critical relapse circuitry and synaptic physiology in NAcore following rat self-administration and provide the first report of cue- and stress-induced reinstatement with this model.

The high-k poloidal scattering system for NSTX-U

An 8-channel, high-k poloidal far-infrared (FIR) scattering system is under development for the National Spherical Torus eXperiment Upgrade (NSTX-U). The 693 GHz poloidal scattering system replaces a 5-channel, 280 GHz high-k toroidal scattering system to study high-k electron density fluctuations on NSTX-U. The FIR probe beam launched from Bay G is aimed toward Bay L, where large aperture optics collect radiation at 8 simultaneous scattering angles ranging from 2° to 15°. The reduced wavelength in the poloidal system results in less refraction, and coupled with a new poloidal scattering geometry, extends measurement of poloidal wavenumbers from the previous limit of 7 cm^-1 up to >40 cm^-1. Steerable launch optics coupled with receiver optics that can be remotely translated in 5 axes allow the scattering volume to be placed from r/a = 0.1 out to the pedestal region (r/a ∼ 0.99) and allow for both upward and downward scattering to cover different regions of the 2D fluctuation spectrum.

Integrated plasma facing component calorimetry for measurement of shot integrated deposited energy in the NSTX-U

The upgrade to the National Spherical Torus eXperiment (NSTX-U) [J. Menard et al., Nucl. Fusion 52, 083015 (2012)] increases the injected neutral beam power up to 12 MW and the plasma current up to I_p = 2 MA for plasma durations up to 5 s. The graphite plasma facing components have been re-designed to handle greater heat and energy fluxes than were seen in NSTX using a castellated design. We present the experimental testing and validation of a castellated graphite target, similar to the prototype tile design, instrumented with thermocouples at various depths in the castellation. During testing, incident heat flux is provided by a programmed electron beam system and surface temperatures are measured via infrared thermography directly viewing the target surface. It was found that the thermocouple response scaled linearly with the measured surface temperature rise regardless of thermocouple depth in the castellation. A sensitivity of 14.3 °C/kJ of deposited energy was found when treating individual castellations as a semi-infinite solid.

Fresh Allograft Replacement for Osteochondral Lesions of the Talus

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Large osteochondral lesion of the talus (OLT) can be difficult to treat. Although many treatment options exist, fresh osteochondral allograft transplantation has demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement as well as a secondary treatment option after failure of other cartilage repair techniques. Fresh osteochondral allografts are size-matched from organ donors and, in theory, have healthy articular cartilage and bone. However, the quality of allograft cartilage and bone has never been examined with respect to the OLT cartilage and bone being replaced. The purpose of this study was to perform a matched comparison of the cartilage and bone from patients OLTs to the fresh osteochondral allograft replacement.

Methods:

Discarded intact osteochondral specimens were collected from 8 patients undergoing surgery for an OLT. The specimens included the excised OLT and a portion of the fresh allograft replacement that the same patient received at the time of surgery. Histologic analysis was performed. The safranin-o histology was then scored using the International Cartilage Repair Society (ICRS) histopathology grading and staging system. In this system the grade determines cartilage and bone destruction on a scale of 0 to 6.5, the stage determines the percentage of involvement in the specimen on a scale of 0 to 4, and the total score is the grade multiplied by the stage. The surface roughness was also compared between the OLT and allograft cartilage using ImageJ software (NIH). Paired t-tests were performed on the ICRS grade, stage, and total score, and surface roughness comparing the OLTs and allografts. Significance was set at p<0.05.

Results:

Gross histological inspection of the samples demonstrated cartilage erosion and subchondral bone destruction in the OLTs. In constrast, the osteochondral allografts demonstrated intact cartilage surface and normal subchondral bone in the allografts (Figure 1). The ICRS grade, stage, and total score were significantly higher in the implanted allografts compared to the resected OLTs (Figure 2); indicating better cartilage and bone morphology for the allografts compared to the OLTs. In fact, the mean grade and stage for the allograft samples were both less than a score of 1 which corresponds to healthy cartilage and bone with less than 10% surface fibrillations. Moreover, the surface roughness of the allograft cartilage was significantly smoother than the OLT cartilage.

Conclusion:

This is the first study to demonstrate that the use of fresh allograft transplantation for the treatment of OLTs replaces the damaged cartilage and bone with normal or near normal cartilage and bone. The replacement of damaged cartilage and subchondral bone with normal or near normal cartilage and bone may be the reason for improved pain relief and functional outcomes after fresh allograft transplantation for OLTs.

CCQM-K121 - Monoterpenes in Nitrogen at 2.5 nmol mol-1 Final Report

The growing awareness of climate change, and continuing concerns regarding tropospheric and stratospheric chemistry, will require future measurements and standards for compounds linked to these issues. To globally monitor and control the emissions of these species in the atmosphere, it is necessary to demonstrate measurement equivalence at the highest levels of accuracy for assigned values of standards. This report describes the results of a key comparison for several important monoterpene species, which are relevant to atmospheric chemistry and climate. The comparison samples include α-pinene, 3-carene, R-limonene and 1,8-cineole in a nitrogen matrix gas, at a 2.5 nmol mol^-1 amount-of-substance fraction. The objective of this key comparison is to evaluate the participants' capabilities to measure trace-level monoterpenes using their own calibration techniques.

Agreement between renal prescribing references and determination of prescribing appropriateness in hospitalized patients with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown.

AIM

We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP.

DESIGN

Single-centre observational study.

METHODS

A random sample of hospitalized patients with CKD were grouped according to baseline CKD stage (3, 4, or 5). Prescriptions requiring caution in CKD were referenced against the Renal Drug Handbook (RDH) and British National Formulary (BNF) to identify PIP (non-compliance with recommendations). Inter-reference agreement was measured using percentage agreement and Kappa coefficient. Potential for harm consequent to PIP was assessed by physicians and pharmacists using a validated scale. One-year mortality was compared between patients with or without PIP during admission.

RESULTS

Among 119 patients (median age 73 years, 50% male), 136 cases of PIP were identified in 78 (65.5%) patients. PIP prevalence, per patient, was 64.7% using the BNF and 28.6% using the RDH (fair agreement, Kappa 0.33, P <  0.001). The majority (63.2%) of PIP cases detected exclusively by the BNF carried minimal or no potential for harm. PIP was not significantly associated with one-year mortality (34.7% vs. 21.1%, P = 0.14).

CONCLUSIONS

PIP was common in hospitalized patients with CKD. Substantial discordance between renal prescribing references was apparent. The development of universally-adopted, evidence-based, prescribing guidelines for CKD might optimize medications safety in this vulnerable group.

Acute kidney injury electronic alerts in primary care - findings from a large population cohort

BACKGROUND

Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.

AIMS

We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.

DESIGN

A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.

METHOD

The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.

RESULTS

28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.

CONCLUSION

The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.

Australian adolescents' beliefs and help-seeking intentions towards peers experiencing symptoms of depression and alcohol misuse

BACKGROUND

Many young people are reluctant to seek professional help for mental health problems, preferring to rely on their friends for support. It is therefore important to ensure that adolescents can identify signs of psychological distress in their peers, talk to them about these, and help them access appropriate services when necessary. The current study examined adolescents' ability to recognise symptoms of depression and alcohol misuse, perceived barriers to help-seeking, and their intentions to encourage a peer to seek help from a range of informal and formal help sources.

METHOD

The current study used baseline data from a randomised controlled trial of a school-based intervention that teaches adolescents how to overcome barriers to accessing professional help for mental health and substance use problems (MAKINGtheLINK). Participants (n = 2456) were presented with two vignettes portraying depression and alcohol misuse, respectively, and were asked to identify the problems described. Participants provided data on their past help-seeking behaviour, confidence to help a peer, perceived barriers to help-seeking, and intentions to encourage a peer to seek help.

RESULTS

Health professionals were the main source of help that participants had relied on for depressive symptoms, followed by friends and parents. In contrast, friends were the main source of help that participants had relied on for alcohol and other drug problems, followed by health professionals and parents. Just over half of the sample correctly identified the problems described in the two vignettes, although the majority of participants were confident that they could talk to a peer and help them seek professional help if needed. Most agreed that the vignettes described problems that warranted professional help, however approximately half the sample was unsure or considered it unlikely that they would seek help if they experienced similar problems. For both disorders, participants were most likely to encourage a peer to seek help from their family, followed by formal help sources and friends.

CONCLUSIONS

While the results point towards a greater willingness to approach formal help sources, particularly for depression, peers remain an important source of support for young people experiencing mental health and substance use problems.

Academic Performance in Primary School Children With Common Emotional and Behavioral Problems

BACKGROUND

Many emotional and behavioral problems first emerge in primary school and are the forerunners of mental health problems occurring in adolescence. However, the extent that these problems may be associated with academic failure has been explored less. We aimed to quantify the association between emotional and behavioral problems with academic performance.

METHODS

A stratified random sample of 8- to 9-year-olds (N = 1239) were recruited from schools in Australia. Data linkage was performed with a national assessment of academic performance to assess reading and numeracy. Parent report assessed emotional and behavioral problems with students dichotomized into "borderline/abnormal" and "normal" categories.

RESULTS

One in 5 grade 3 students fell in the "borderline/abnormal" category. Boys with total difficulties (β = -47.8, 95% CI: -62.8 to -32.8), conduct problems, and peer problems scored lower on reading. Numeracy scores were lower in boys with total difficulties (β = -37.7, 95% CI: -53.9 to -21.5) and emotional symptoms. Children with hyperactivity/inattention scored lower in numeracy. Girls with peer problems scored lower in numeracy.

CONCLUSIONS

Boys with emotional and behavioral problems in mid-primary school were 12 months behind their peers. Children with emotional and behavioral problems are at high risk for academic failure, and this risk is evident in mid-primary school.

Ion Exchange Thermodynamics at the Rutile-Water Interface: Flow Microcalorimetric Measurements and Surface Complexation Modeling of Na-K-Rb-Cl-NO3 Adsorption

Flow microcalorimetry was used to investigate the energetics associated with Rb⁺, K⁺, Na⁺, Cl^-, and NO₃^- exchange at the rutile-water interface. Heats of exchange reflected differences in bulk hydration/dehydration enthalpies (Na⁺ > K⁺ > Rb⁺, and Cl^- > NO₃^-) such that exchanging Na⁺ or Cl^- from the surface was exothermic, reflecting their greater bulk hydration enthalpies. Exchange heats were measured at pH 2, 3.25, 5.8, and 11 and exhibited considerable differences as well as pH dependence. These trends were rationalized with the aid of a molecularly constrained surface complexation model (SCM) that incorporated the inner-sphere binding observed for the cations on the rutile (110) surface. Explicitly accounting for the inner-sphere binding configuration differences between Rb⁺, K⁺, and Na⁺, as well as accompanying differences in negative surface charge development, resulted in much better agreement with measured exchange ratios than by considering bulk hydration enthalpies alone. The observation that calculated exchange ratios agreed with those measured experimentally lends additional credence to the SCM. Consequently, flow microcalorimetry and surface complexation modeling are a useful complement of techniques for probing the energetics associated with ion exchange and adsorption processes and should also serve to help validate molecular simulations of interfacial energetics.

Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND

Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10-24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors.

METHODS

The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories.

FINDINGS

The leading causes of death in 2013 for young people aged 10-14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15-19 years (14·2%) and 20-24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20-24 years (17·1%) and the fourth highest for girls aged 15-19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15-19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20-24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20-24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20-24 years. Alcohol and drug use in those aged 10-24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs.

INTERPRETATION

Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems.

FUNDING

Bill & Melinda Gates Foundation.

FAT1 mutations cause a glomerulotubular nephropathy

Steroid-resistant nephrotic syndrome (SRNS) causes 15% of chronic kidney disease (CKD). Here we show that recessive mutations in FAT1 cause a distinct renal disease entity in four families with a combination of SRNS, tubular ectasia, haematuria and facultative neurological involvement. Loss of FAT1 results in decreased cell adhesion and migration in fibroblasts and podocytes and the decreased migration is partially reversed by a RAC1/CDC42 activator. Podocyte-specific deletion of Fat1 in mice induces abnormal glomerular filtration barrier development, leading to podocyte foot process effacement. Knockdown of Fat1 in renal tubular cells reduces migration, decreases active RAC1 and CDC42, and induces defects in lumen formation. Knockdown of fat1 in zebrafish causes pronephric cysts, which is partially rescued by RAC1/CDC42 activators, confirming a role of the two small GTPases in the pathogenesis. These findings provide new insights into the pathogenesis of SRNS and tubulopathy, linking FAT1 and RAC1/CDC42 to podocyte and tubular cell function.