Does serous tubal intraepithelial carcinoma (STIC) metastasize? The clonal relationship between STIC and subsequent high-grade serous carcinoma in BRCA1/2 mutation carriers several years after risk-reducing salpingo-oophorectomy

OBJECTIVE

The majority of high-grade serous carcinomas (HGSC) of the ovary, fallopian tube, and peritoneum arise from the precursor lesion called serous tubal intraepithelial carcinoma (STIC). It has been postulated that cells from STICs exfoliate into the peritoneal cavity and give rise to peritoneal HGSC several years later. While co-existent STICs and HGSCs have been reported to share similarities in their mutational profiles, clonal relationship between temporally distant STICs and HGSCs have been infrequently studied and the natural history of STICs remains poorly understood.

METHODS

We performed focused searches in two national databases from the Netherlands and identified a series of BRCA1/2 germline pathogenic variant (GPV) carriers (n = 7) who had STIC, and no detectable invasive carcinoma, at the time of their risk-reducing salpingo-oophorectomy (RRSO), and later developed peritoneal HGSC. The clonal relationship between these STICs and HGSCs was investigated by comparing their genetic mutational profile by performing next-generation targeted sequencing.

RESULTS

Identical pathogenic mutations and loss of heterozygosity of TP53 were identified in the STICs and HGSCs of five of the seven patients (71%), confirming the clonal relationship of the lesions. Median interval for developing HGSC after RRSO was 59 months (range: 24-118 months).

CONCLUSION

Our results indicate that cells from STIC can shed into the peritoneal cavity and give rise to HGSC after long lag periods in BRCA1/2 GPV carriers, and argues in favor of the hypothesis that STIC lesions may metastasize.

Equation of State and Thermometry of the 2D SU(N) Fermi-Hubbard Model

We characterize the equation of state (EoS) of the SU(N>2) Fermi-Hubbard Model (FHM) in a two-dimensional single-layer square optical lattice. We probe the density and the site occupation probabilities as functions of interaction strength and temperature for N=3, 4, and 6. Our measurements are used as a benchmark for state-of-the-art numerical methods including determinantal quantum Monte Carlo and numerical linked cluster expansion. By probing the density fluctuations, we compare temperatures determined in a model-independent way by fitting measurements to numerically calculated EoS results, making this a particularly interesting new step in the exploration and characterization of the SU(N) FHM.

Project Inclusive Genetics: Protecting reproductive autonomy from bias via prenatal patient-centered counseling

Clinician bias negatively impacts the healthcare received by marginalized communities. In this study, we explored factors that influence clinician and trainee bias against individuals with intellectual disabilities and its impact on clinical judgment in prenatal genetic testing settings. Specifically, we examined bias toward a fetus with a higher chance of developing a disability. We compared genetics specialists with their non-expert counterparts. This web-based study included clinical vignettes, implicit association tests (IATs), and an educational module. 595 participants were recruited via their institution or professional society. We conducted statistical analyses, including regression models controlling for key demographic characteristics, to analyze recommendation patterns and degree of change after the module. Genetics expertise strongly correlated with appropriate testing recommendation when the patient would not consider pregnancy termination (r = 1.784 pre-module, r = 1.502 post-module, p < 0.01). Factors that influenced pre-module recommendation to test include increased age (r = -0.029, p < 0.05), high religiosity (r = 0.525, p < 0.05), and participant personal preference against testing (r = 1.112, p < 0.01). Responses among participants without genetics expertise improved after the educational module (Z = -4.435, p < 0.01). 42% of non-experts who answered inappropriately changed their answer to match guidelines after the module. Individual bias, along with structural and institutional bias, permeates family planning encounters and significantly decreases quality of care. We demonstrate here that anti-bias training is effective, particularly for non-expert providers, and it can improve the care provided to individuals with intellectual disability. Evidence-based training such as this one can help providers make appropriate genetic counseling recommendations.

True coincidence summing correction for a BEGe detector in close geometry measurements

The true coincidence summing correction factor for a Broad Energy Germanium detector has been calculated at far and close geometry set-up using radioactive γ-ray sources. The correction factors were calculated using both experimental and analytical methods. Geant4 simulation was done to calculate the full-energy peak and total efficiencies of the detector. Standard, as well as fabricated mono-energetic γ-ray sources, were used for the γ-ray efficiency measurements. The simulated efficiencies of mono-energetic γ-ray sources were matched to the experimental γ-ray efficiencies by optimizing the detector parameters. The same parameters were used to obtain the full-energy peak and total efficiencies for γ-rays of current interest. Analytical and experimental correction factors were found to agree well with each other. The coincidence summing effect is found to be significant for source-to-detector distances less than 5 cm.

Genetics of Alzheimer's Disease in the African American Population

Black/African American (AA) individuals have a higher risk of Alzheimer's disease (AD) than White non-Hispanic persons of European ancestry (EUR) for reasons that may include economic disparities, cardiovascular health, quality of education, and biases in the methods used to diagnose AD. AD is also heritable, and some of the differences in risk may be due to genetics. Many AD-associated variants have been identified by candidate gene studies, genome-wide association studies (GWAS), and genome-sequencing studies. However, most of these studies have been performed using EUR cohorts. In this paper, we review the genetics of AD and AD-related traits in AA individuals. Importantly, studies of genetic risk factors in AA cohorts can elucidate the molecular mechanisms underlying AD risk in AA and other populations. In fact, such studies are essential to enable reliable precision medicine approaches in persons with considerable African ancestry. Furthermore, genetic studies of AA cohorts allow exploration of the ways the impact of genes can vary by ancestry, culture, and economic and environmental disparities. They have yielded important gains in our knowledge of AD genetics, and increasing AA individual representation within genetic studies should remain a priority for inclusive genetic study design.

Complete Heparin Reversal by Protamine during Off-Pump Coronary Artery Bypass Surgery (OPCAB): A Necessity or Myth?

In our country majority of the coronary artery bypass surgery (CABG) are done off-pump and was reported having excellent clinical outcome along with cost efficiency by various investigators. Heparin is commonly used as most effective anticoagulant, and protamine sulfate is now generally used to reverse the anticoagulant action of heparin. While under dosing of protamine may result in incomplete heparin reversal and prolonged anticoagulation, protamine overdosing is associated with impaired clot formation exerted by the intrinsic anti-coagulation properties of protamine itself, moreover protamine administration is associated with mild to severe cardiovascular and pulmonary complications. Apart from traditional full neutralization of heparin now-a-days, half dose protamine was also introduced showing good outcome regarding lower activated clotting time (ACT), overall, less surgical bleeding with less transfusion. This comparative study was designed to detect differences between traditional and decreased protamine dosing in Off-Pump Coronary Artery Bypass (OPCAB) surgery. Four hundred (400) patients who underwent Off-Pump Coronary Artery Bypass Surgery (OPCAB) surgery at our institution over a period of 12 months were analyzed and were divided into two groups. Group A- received 0.5mg of protamine per 100 unit of heparin; Group B-received 1.0mg of protamine per 100 unit of heparin. ACT, blood loss, hemoglobin and platelet count units of blood and blood product transfusion requirements, clinical outcome and hospital stay were assessed in each patient. This study showed that 0.5mg of protamine per 100 unit of heparin was always able to reverse the anticoagulant effect of heparin with no significant difference in hemodynamic parameters, amount of blood loss and requirements of blood transfusion in between the groups. A standard protamine dosing formula (protamine-heparin at ratio of 1:1) adequate for on-pump cardiac surgical procedures significantly overestimates protamine requirements for OPCAB. Patients treated with decreased protamine do not appear to have adverse outcomes in terms of post-operative bleeding.

O-199 Couples presenting to Infertility clinics - Are they really infertile?

Study question

Are couples presenting to infertility clinics actually infertile, or is there an undiagnosed underlying sexual dysfunction whose treatment can lead to natural conception avoiding the need for assisted reproductive techniques?

Summary answer

All couples presenting with infertility should be asked about sexual function. If sexual dysfunction is diagnosed, a signicant proportion can achieve pregnancy without assisted reproduction

What is known already

Infertility is defined as the inability to conceive after one year of frequent and regular unprotected sexual intercourse (SI). Although sexual histories are a key part of primary care screening guidelines for infertility, they are often overlooked during the infertility work-up. It is postulated that a large proportion of couples presenting to infertility clinics have underlying sexual dysfunction. Treatment through specialist counselling for couples with sexual dysfunction can help achieve pregnancy, negating the need for complex assisted reproductive techniques such as intravaginal insemination (IVI) and intrauterine insemination (IUl).

Study design, size, duration

108 couples were recruited from a national fertility clinic. The duration of the study was 3.5 years, from January 2016 to August 2019. The study was based primarily on surveys, where diagnostic work-up for infertility included tools for measuring sexual dysfunction, such as the IIEF-15 questionnaire. Our objectives were to find the extent of improvement of SI before and after specialist referral, and the time to conceive (TTC) in those with and without sexual dysfunction.

Participants/materials, setting, methods

Couples who never had successful completion of SI (despite producing an ejaculate sample) prior to clinic attendance were included. Treatment via specialist referral was then offered to these patients.

Data were analysed to compare outcomes between those who subsequently had successful SI (“Group A”) and those who had not had successful SI (“Group B”). Both groups were counselled for fertility treatments, such as IVI and IUI. TTC between the groups was analysed using Kaplan-Meier analysis

Main results and the role of chance

Out of 2057 couples presenting to the Infertility Clinic, 128 (5.98%) had never had successful SI. From this, 108 couples were included in the study. Two-thirds of couples revealed sexual difficulties at the beginning of the initial consultation. In men, erectile dysfunction was the predominant cause (70.4%, n = 76). In women, dyspareunia was the leading problem (18.2%, N = 20). Fertility investigations, which included hormone profiles, revealed normal results in most cases.

Treatment via referral to specialist sexual counselling was offered to all couples. Only 33 couples reported successful SI during subsequent visits (Group A). 13 of these 33 couples went on to conceive (11 naturally, 1 by IUI and 1 by IVI). The rest (n = 75), who had no improvement (Group B), had a significantly longer duration of sexual dysfunction, which was also more severe. Out of these 75 couples, 8 conceived (0 naturally, 6 by IVI, and 2 by IUI).The IIEF-15 scores (index for sexual dysfunction) between groups A and B were 10.72 ± 4.28 vs. 8 ± 4.73, P-value 0.0142. Group A couples (less severe sexual dysfunction) conceived earlier than Group B (mean duration 27.2 weeks vs. 48.8 weeks log-rank P value &lt;0.001).

Limitations, reasons for caution

The main limitations of this study include a small sample size and a small minority of couples refusing to undergo specialist counselling despite having sexual difficulties as they were only interested in assisted reproductive interventions such as IUl and IVI. These limitations hinder the internal/external validity of the study.

Wider implications of the findings

All couples presenting with infertility should be asked about sexual function. If sexual dysfunction is diagnosed, a signicant proportion can be helped to achieve pregnancy without assisted reproduction. In the cases of couples with persistent sexual difficulty, assisted reproductive techniques like IUI and IVI give a reasonable pregnancy rate.

Trial registration number

Not applicable

P-118 Timed Intercourse exacerbates the risk of sexual dysfunction in men &amp; women without an improvement in time to pregnancy

Study question

Investigate the differences in sexual dysfunction and time to pregnancy between infertile couples pursuing timed intercourse and Regular Intercourse (RI at least twice a week).

Summary answer

TI significantly increased the risk of SD compared to RI for both males and females after adjusting all other contributing factors.

What is known already

Timed Intercourse (TI) involves aligning sexual intercourse to the time around ovulation to increase the chance of conception in couples trying to conceive. Whilst TI is often advocated to increase conception rates and potentially accelerate the time to pregnancy (TTP) for infertile couples, the stressful nature of this approach may be associated with adverse effects such as sexual dysfunction (SD) within the couple.

Study design, size, duration

This prospective cohort study recruited 371 infertile couples who had been trying to conceive for more than a year, presenting to three regional infertility clinics between January 2016 and December 2018. 283 couples pursued TI and 88 couples pursued RI for a year, with all couples having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse.

Participants/materials, setting, methods

The SD score of both partners was assessed at the first visit using the validated Arizona Sexual Experiences Scale (ASEX) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). TTP was determined using Kaplan Meier Analysis in couples for whom natural conception was possible and no reversible fertility pathology was identified.

Main results and the role of chance

Timed Intercourse (TI) involves aligning sexual intercourse to the time around ovulation to increase the chance of conception in couples trying to conceive. Whilst TI is often advocated to increase conception rates and potentially accelerate the time to pregnancy (TTP) for infertile couples, the stressful nature of this approach may be associated with adverse effects such as sexual dysfunction (SD) within the couple.

TI significantly increased the risk of SD compared to RI for both males (Odds ratio [OR] 15.24, 95% confidence interval [CI] 7.96-29.15) and females (OR 5.52, 95% CI 2.38- 12.78), after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI carried a higher risk of developing erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between TI and RI (p = 0.1365).

Limitations, reasons for caution

TI, a well-known strategy for increasing conception rates, did not improve time to natural conception compared to regular sexual intercourse. In contrast, the risk of sexual dysfunction in both men and women was significantly higher in TI, compared with RI.

Wider implications of the findings

This large study raises the question of effectiveness of the long-held belief that TI (intercourse limited around the ovulation-time, based on different methods of ovulation-prediction) improves pregnancy outcomes.

Trial registration number

N/A

Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design

In the context of current U.S. racial justice movements, analysis of racism in medicine within medical education is a critical task for all institutions. To educate the next generation of physicians about racism in medicine and out of concern that the curriculum required critical assessment and change, a group of students and faculty at Boston University School of Medicine (BUSM) initiated a longitudinal curricular analysis through a vertical integration group, commissioned by the Medical Education Committee, from May 2019 to June 2020. The curriculum analysis and the major outcomes and guiding principles that emerged from it are described as a path forward, toward a more inclusive curriculum. The major elements of this analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competencies. The curricular recommendations fall into the following domains: (1) challenging the persistence of biological/genetic notions of race, (2) embedding structural practices in medical education to dismantle racism in medicine, and (3) promoting institutional climate change. Initial steps to implement these recommendations are described. The authors believe that the historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience, and patient outcomes. The key findings of the BUSM analysis are transferable to other medical education institutions, and the described review process can support peer institutions as they engage in the imperative work of institutional reflection and addressing the salient ideas and practices that uphold racism in medicine.

Role of power distance phenomena in blended learning in higher education post-Covid-19

COVID has posed several challenges for higher education. There is a rise in blended teaching and learning models that can improve the quality of education, observed Raman. Classroom interaction vital in quality of education is affected by power distance between the teacher and students, states Kasuya. Much research has been done on blended learning but hardly any on the role of power distance in blended learning in higher education, specifically post COVID. Keeping in mind the growing significance of blended learning shortly, it becomes strategically important to understand the role of power distance in blended learning in higher education post-COVID-19. This research paper tries to address the research gap. The study is exploratory, exploring the role of power distancing in blended learning formats during post-COVID-19. The findings indicate that there is a relationship between power distance and the autonomy of an individual. The higher the power distance between a teacher and a student from the teacher’s perspective, it becomes teacher-centred learning. So blended learning with the best of low power distances in terms of the media and delivery mechanism of offline and online ensures the mitigation of power between the teacher and the taught. The research will help the universities create a perfect blended learning format that enhances the quality of higher education. Due to the paucity of time and resources and a ban on respondent interaction due to pandemics, this research is based on secondary data analysis.

Realizing topological edge states with Rydberg-atom synthetic dimensions

A discrete degree of freedom can be engineered to match the Hamiltonian of particles moving in a real-space lattice potential. Such synthetic dimensions are powerful tools for quantum simulation because of the control they offer and the ability to create configurations difficult to access in real space. Here, in an ultracold ⁸⁴Sr atom, we demonstrate a synthetic-dimension based on Rydberg levels coupled with millimeter waves. Tunneling amplitudes between synthetic lattice sites and on-site potentials are set by the millimeter-wave amplitudes and detunings respectively. Alternating weak and strong tunneling in a one-dimensional configuration realizes the single-particle Su-Schrieffer-Heeger (SSH) Hamiltonian, a paradigmatic model of topological matter. Band structure is probed through optical excitation from the ground state to Rydberg levels, revealing symmetry-protected topological edge states at zero energy. Edge-state energies are robust to perturbations of tunneling-rates that preserve chiral symmetry, but can be shifted by the introduction of on-site potentials.

Synthetic dimensions, states of a system engineered to act as if they were a reconfigurable extra spatial dimension, have been demonstrated with different systems previously. Here the authors create a synthetic dimension using Rydberg atoms and configure it to support topological edge states.

BOX engineering to mitigate negative differential resistance in MFIS negative capacitance FDSOI FET: an analog perspective

Till date, the existing understanding of negative differential resistance (NDR) is obtained from metal-ferro-metal-insulator-semiconductor (MFMIS) FET, and it has been utilized for both MFMIS and metal-ferro-insulator-semiconductor (MFIS) based NCFETs. However, in MFIS architecture, the ferroelectric capacitance (C_FE) is not a lumped capacitance. Therefore, for MFIS negative capacitance (NC) devices, the physical explanation which governs the NDR mechanism needs to be addressed. In this work, for the first time, we present the first principle explanation of the NDR effect in MFIS NC FDSOI. We found that the output current variation with the drain to source voltage (V_DS), (i.e.g_ds) primarily depends upon two parameters: (a)V_DSdependent inversion charge gradient (∂n/∂V_DS); (b)V_DSsensitive electron velocity (∂v/∂V_DS), and the combined effect of these two dependencies results in NDR. Further, to mitigate the NDR effect, we proposed the BOX engineered NC FDSOI FET, in which the buried oxide (BOX) layer is subdivided into the ferroelectric (FE) layer and the SiO₂layer. In doing so, the inversion charge in the channel is enhanced by the BOX engineered FE layer, which in turn mitigates the NDR and a nearly zerog_dswith a minimal positive slope has been obtained. Through well-calibrated TCAD simulations, by utilizing the obtained positiveg_ds, we also designed aV_DSindependent constant current mirror which is an essential part of analog circuits. Furthermore, we discussed the impact of the FE parameter (remanent polarization and coercive field) variation on the device performances. We have also compared the acquired results with existing literature on NC-based devices, which justifies that our proposed structure exhibits complete diminution of NDR, thus enabling its use in analog circuit design.

Triangle Singularity as the Origin of the a_{1}(1420)

The COMPASS Collaboration experiment recently discovered a new isovector resonancelike signal with axial-vector quantum numbers, the a_{1}(1420), decaying to f_{0}(980)π. With a mass too close to and a width smaller than the axial-vector ground state a_{1}(1260), it was immediately interpreted as a new light exotic meson, similar to the X, Y, Z states in the hidden-charm sector. We show that a resonancelike signal fully matching the experimental data is produced by the decay of the a_{1}(1260) resonance into K^{*}(→Kπ)K[over ¯] and subsequent rescattering through a triangle singularity into the coupled f_{0}(980)π channel. The amplitude for this process is calculated using a new approach based on dispersion relations. The triangle-singularity model is fitted to the partial-wave data of the COMPASS experiment. Despite having fewer parameters, this fit shows a slightly better quality than the one using a resonance hypothesis and thus eliminates the need for an additional resonance in order to describe the data. We thereby demonstrate for the first time in the light-meson sector that a resonancelike structure in the experimental data can be described by rescattering through a triangle singularity, providing evidence for a genuine three-body effect.

B-cell clusters at the invasive margin associate with longer survival in early-stage oral-tongue cancer patients

In oral-cancer, the number of tumor-infiltrating lymphocytes (TILs) associates with improved survival, yet the prognostic value of the cellular composition and localization of TILs is not defined. We quantified densities, localizations, and cellular networks of lymphocyte populations in 138 patients with T1-T2 primary oral-tongue squamous cell carcinoma treated with surgical resections without any perioperative (chemo)radiotherapy, and correlated outcomes to overall survival (OS). Multiplexed in-situ immunofluorescence was performed for DAPI, CD4, CD8, CD20, and pan-cytokeratin using formalin-fixed paraffin-embedded sections, and spatial distributions of lymphocyte populations were assessed in the tumor and stroma compartments at the invasive margin (IM) as well as the center of tumors. We observed a high density of CD4, CD8, and CD20 cells in the stroma compartment at the IM, but neither lymphocyte densities nor networks as single parameters associated with OS. In contrast, assessment of two contextual parameters within the stroma IM region of tumors, i.e., the number of CD20 cells within 20 µm radii of CD20 and CD4 cells, termed the CD20 Cluster Score, yielded a highly significant association with OS (HR 0.38; p = .003). Notably, the CD20 Cluster Score significantly correlated with better OS and disease-free survival in multivariate analysis (HR 0.34 and 0.47; p = .001 and 0.019) as well as with lower local recurrence rate (OR: 0.13; p = .028). Taken together, our study showed that the presence of stromal B-cell clusters at IM, in the co-presence of CD4 T-cells, associates with good prognosis in early oral-tongue cancer patients.

A Literature Systematic Review with Meta-Analysis of Symptoms Prevalence in Covid-19: the Relevance of Olfactory Symptoms in Infection Not Requiring Hospitalization

PURPOSE OF REVIEW

To investigate the association between the olfactory dysfunction and the more typical symptoms (fever, cough, dyspnoea) within the Sars-CoV-2 infection (COVID-19) in hospitalized and non-hospitalized patients.

RECENT FINDINGS

PubMed, Scopus and Web of Science databases were reviewed from May 5, 2020, to June 1, 2020. Inclusion criteria included English, French, German, Spanish or Italian language studies containing original data related to COVID19, anosmia, fever, cough, and dyspnoea, in both hospital and non-hospital settings. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. A third author arbitrated full-text disagreements. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 11 of 135 studies fulfilled eligibility. Anosmia was estimated less prevalent than fever and cough (respectively rate difference = - 0.316, 95% CI: - 0.574 to - 0.058, Z = - 2.404, p < 0.016, k = 11 and rate difference = - 0.249, 95% CI: - 0.402 to - 0.096, Z = - 3.185, p < 0.001, k = 11); the analysis between anosmia and dyspnoea was not significant (rate difference = - 0.008, 95% CI: - 0.166 to 0.150, Z = - 0.099, p < 0.921, k = 8). The typical symptoms were significantly more frequent than anosmia in hospitalized more critical patients than in non-hospitalized ones (respectively [Q(1) = 50.638 p < 0.000, Q(1) = 52.520 p < 0.000, Q(1) = 100.734 p < 0.000).

SUMMARY

Patient with new onset olfactory dysfunction should be investigated for COVID-19. Anosmia is more frequent in non-hospitalized COVID-19 patients than in hospitalized ones.

Unraveling the Origin of Differentiable 'Turn-On' Fluorescence Sensing of Zn2+ and Cd2+ Ions with Squaramides

A squaramide ring conjugated with Schiff-bases decorated with hydroxy and methoxy functional groups differentially senses zinc and cadmium ions, which turn on the fluorescence. The feebly emitting free ligands light up in the presence of zinc and cadmium acetates, with the acetate ion playing a pivotal role as a conjugate anion. The selective and differentiable emission responses for zinc and cadmium ions make these ligands efficient multi-analyte sensing agents. Furthermore, these ligands could be used to differentially sense zinc and cadmium ions even in aqueous environments. The NMR investigations reveal marginal differences in the binding of zinc and cadmium ions to the ligands, whereas density functional theory calculations suggest the different extent of ligand-to-metal charge transfer (LMCT) contributes to the differential behavior. Finally, comparison of the excited-state dynamics of free ligand and the metal complexes reveal the appearance of longer lifetime (about 500-700 ps) component with complexation, due to rigidified molecular skeleton, thereby impeding the non-radiative processes.

Complexities of Clinical Genetics Consultation: An Interprofessional Clinical Skills Workshop

INTRODUCTION

Advances in genomic medicine contribute to increased demand for clinical genetics services and require physicians to understand the interprofessional practice of this field. Medical students receive a foundation in genetics during preclinical studies, but variability in clinical experience may limit knowledge of and recruitment into this clinical specialty. In this resource, we describe an approach for simulating exposure to the practice of clinical genetics during the core pediatrics clerkship.

METHODS

Prior to class, students researched and considered a mock genetics case. In class, each of four small groups discussed two cases demonstrating varied presentations, with facilitation by genetic counseling students. Each case highlighted the variability in presentation, testing, management strategies, and psychosocial issues of a genetics case. Groups reported out to the class, and individuals completed an anonymous evaluation survey.

RESULTS

Surveys were distributed to nine of 10 pilot sessions (210 of 235 students) with a response rate of 48%. Students frequently reported no previous exposure to seeing patients with genetics professionals, indicated a preference for learning in case discussion format over traditional lectures, and felt the format helped them apply clinical skills and reasoning. Medical students appreciated the opportunity to interact with genetic counseling students in an interdisciplinary setting and desired further educational opportunities regarding delivering complex information to patients and their families.

DISCUSSION

This session expanded exposure to clinical genetics content and professionals, serving as an important foundation for further development of genetic knowledge during clinical training.

Granular dot-like staining with MLH1 immunohistochemistry is a clone-dependent artefact

Immunohistochemistry (IHC) for DNA mismatch repair proteins MLH1, PMS2, MSH2, and MSH6 is used for microsatellite instability (MSI) screening in colorectal carcinoma (CRC) and endometrial carcinoma (EC). Loss of PMS2, with retained MLH1 staining occurs in germline mutations of PMS2 gene, and is an indication for genetic testing. We report a pitfall of immunohistochemical interpretation in an EC, initially regarded as MLH1-positive and PMS2-negative. Review of the MLH1-IHC (M1-clone) revealed a granular, dot-like, nuclear staining. On repeating the MLH1-IHC with a different clone (ES05-clone), complete negativity was noted, and on molecular testing, MLH1 promotor methylation was detected. The dot-like pattern was therefore adjudged a clone-dependent artefact. On reviewing the archived MLH1-IHC slides, we observed the same dot-like pattern in two CRCs; in both cases the M1-clone had been used. Awareness of this artefact may prevent reporting errors, and unnecessary referrals for germline mutation testing.

Genomic education for the next generation of health-care providers

Historically, medical geneticists and genetic counselors have provided the majority of genetic services. Advances in technology, reduction in testing costs, and increased public awareness have led to a growing demand for genetic services in both clinical and direct-to-consumer spaces. Recent and anticipated changes in the workforce of genetic counselors and medical geneticists require a reexamination of the way we educate health-care providers and the means by which we provide access to genetic services. The time is ripe for rapid growth of genetic and genomic services, but to capitalize on these opportunities, we need to consider a variety of educational mechanisms to reach providers both within and beyond the traditional genetic counseling and medical genetics sectors, including nurses, physician assistants, and nongenetics physicians. This article summarizes the educational efforts underway in each of these professions.

Large debris dumps in the northern South China Sea

Knowledge of the abundance, source, and fate of marine debris in the deep sea is largely constrained thus far. Here, we report the existence of large deep-sea debris dumps that have not been reported before on the seafloor worldwide. Marine debris remarkably accumulated at ~1700-1800 m in the tributary submarine canyons of the Xisha Trough, northern South China Sea (SCS). Although marine debris in Xisha Trough is patchy, the debris abundance was as high as 36,818 and 51,929 items/km² at locations SY78 and SY82, respectively, which is one order of magnitude higher than that in other submarine canyons. We propose that most of the debris came from fishery and navigation activities, as indicated by the categories of debris collected from the seafloor dumps. Seasonal surface ocean currents of the SCS and geomorphology of submarine canyons possibly influence the movement of the debris from coasts to the deep seafloor.

From helices to health: undergraduate medical education in genetics and genomics

Rapid advances in genomic technologies combined with drastic reductions in cost and a growing number of clinical genomic tests are transforming medical practice. While enthusiasm about applications of precision medicine is high, the existing clinical genetics workforce is insufficient to meet present demands and will fall increasingly short as the use of genetic and genomic testing becomes more routine. To address this shortage, physicians in all areas of medicine will require genomic literacy. Undergraduate medical students, therefore, need a solid foundation in genetics and genomics so they can apply genomic medicine across a range of specialties. Here, we review the current trends and challenges in undergraduate medical genetics education in North America, highlight innovations and offer recommendations.

Abstract P5-05-01: Metabolic enzyme PFKFB4 activates transcriptional coactivator SRC-3 to drive aggressive metastatic breast cancer

Background: Metabolic rewiring is one of the central hallmarks of cancer progression and survival to support anabolic and energetic demands. Tumor cells constantly alter their metabolic state in response to oncogenic stimuli, nutrient availability, and interaction with immune cells however the precise regulation that precedes the metabolic alteration is poorly understood. Here we report a direct interaction of glycolytic enzyme PFKFB4 with transcriptional coregulator SRC-3. PFKFB4 functions as a critical regulator of Warburg effect and our study reveals that upon glucose stimulation PFKFB4 activates SRC-3 driving an invasive-metastatic breast cancer.

Methods: Molecular experiments were performed to understand the transcriptional activation of SRC-3 by PFKFB4 enzyme. Chromatin immunoprecipitation and gene expression studies were performed to investigate the functions of PFKFB4/SRC-3 crosstalk on transcriptional regulation. Metabolomics and isotope tracing studies were performed to identify the metabolic adaptations regulated by PFKFB4/SRC-3 in breast tumors. PFKFB4-knockout was established using CRISPR-Cas9 system and functional studies were carried out to define its role in tumor cell proliferation, invasion-migration, and breast to lung metastasis. Human breast tumor samples were evaluated to identify the clinical importance of PFKFB4/SRC-3 crosstalk in patients.

Results:Molecular studies revealed that PFKFB4 enzyme phosphorylates SRC-3 at serine 857 (S857) enhancing its transcriptional activity, whereas either suppression of PFKFB4 or ectopic expression of a phosphorylation-deficient SRC-3 mutant S857A (SRC-3S857A) significantly abolished SRC-3-mediated transcriptional output (p&lt;0.000001). Functionally, PFKFB4-driven SRC-3 activation drives glucose flux towards the pentose phosphate pathway enabling purine synthesis by transcriptionally upregulating the expression of enzyme transketolase (TKT). Deletion of PFKFB4 by CRISPR-Cas9 system resulted in significantly reduced proliferation (p&lt;0.05) and migration-invasion (p&lt;0.001) compared to wildtype breast tumor cells. Ablation of SRC-3 or PFKFB4 suppressed in vivo breast tumor growth and prevents metastasis to the lung from an orthotopic setting (p&lt;0.0001). PFKFB4 and phosphorylated SRC-3 levels are significantly increased in breast tumors (p=0.02), whereas, in patients with the basal subtype, PFKFB4 and SRC-3 drive a common protein signature that correlates with the poor survival of TNBC patients (p=0.03).

Conclusion:Our data suggest that the Warburg pathway enzyme PFKFB4 acts as a molecular fulcrum that couples sugar metabolism to transcriptional activation by stimulating SRC-3 to promote aggressive metastatic tumors. It also provides first evidence how Warburg pathway drives aggressive breast tumorigenesis by directly activating powerful oncogene SRC-3. Our work suggests that targeting the PFKFB4–SRC-3 axis may be therapeutically valuable in breast tumors that are notably dependent on glucose metabolism.

(This work is funded by grants from Susan G. Komen and NCI to S.D.)

Citation Format: Dasgupta S, Anand V, John H, Sawant Dessai A, Katsuta E, Takabe K, O'Malley B. Metabolic enzyme PFKFB4 activates transcriptional coactivator SRC-3 to drive aggressive metastatic 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 P5-05-01.

Abstract P2-02-04: CD73 expression regulated by estrogen signaling associates with poor prognosis in estrogen receptor (ER)-positive breast cancer

Introduction: CD73, a cell surface enzyme, catalyzes the generation of adenosine from ATP and ADP in the tumor microenvironment along with CD39. Accumulated extracellular adenosine functions as immune-suppressor, and also binds to adenosine receptors which promotes angiogenesis and cell proliferation that results in accelerate cancer progression. However, the clinical significance and molecular function of CD73 expression in breast cancer remains unclear.

Methods: Utilizing publicly available breast cancer cohorts of The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), clinical significance as well as underlying mechanisms were investigated. Molecular experiments were carried out in MCF7 cells, ER-positive breast cancer cell line, to investigate the role of estrogen signaling on CD73/CD39 expression.

Results: In treatment naïve TCGA cohort, CD73 expression level was significantly lower in ER-positive breast cancers compared to ER-negative tumors. Higher CD73 expression was associated with worse overall survival in whole cohort (p=0.021) and ER-positive tumors (p=0.003), but not in ER-negative tumors. Gene Set Enrichment Analysis revealed that estrogen response gene sets (Early; NES=-1.57, p=0.043, Late; NES=-1.61, p=0.021) were significantly enriched in CD73 low expressing ER-positive tumors, suggesting estrogen signaling may repress CD73 expression. To test this hypothesis, we analyzed the expression of CD73 and CD39 in MCF7 cells treated with estrogen, tamoxifen or both. Our data revealed that estrogen treatment suppressed CD73 and CD39 expression, whereas tamoxifen treatment enhanced expression of the genes. These findings suggest that CD73 and CD39 gene expression is suppressed by estrogen signaling, whereas binding of ER antagonists such as tamoxifen can remove the repressive effect on gene expression. On the other hand, epithelial-mesenchymal transition (EMT) (Normalized Enrichment Score; NES=2.41, p&lt;0.001) and angiogenesis (NES=2.33, p&lt;0.001) gene sets were significantly enriched in CD73 high expressing ER-positive tumors. CIBERSORT, which is an algorithm to estimate infiltrating immune cells by gene expression, demonstrated that CD73 high expressing ER-positive tumors have less infiltrating CD8-positive T cells, memory B cells and plasma cells, implying that CD73 high expressing tumors have immune suppressive environment, which is in agreement with the notion that CD73 high tumors are immunosuppressive. Finally, we found that CD73 expression was significantly elevated post-chemotherapy compared to tumors prior to the treatment (p=0.007), and CD73 high expression patients showed worse relapse-free survival in neoadjuvant chemotherapy patients cohort (p=0.003).

Conclusion: Molecular studies revealed that CD73 expression is regulated by estrogen signaling. Increased expression of CD73 significantly correlates with worse outcomes in ER-positive breast cancer patients. This may be due to upregulated pro-metastatic gene signatures such as EMT and angiogenesis as well as less infiltration of anti-cancer immune cells by adenosine generated by CD73 in the tumor microenvironment. Our data reveals an intriguing mechanism which may be responsible for recurrence and metastasis of ER-positive breast cancer.

Citation Format: Katsuta E, Anand V, Yan L, Dasgupta S, Takabe K. CD73 expression regulated by estrogen signaling associates with poor prognosis in estrogen receptor (ER)-positive 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 P2-02-04.

Homogeneous reduced moment in a gapful scalar chiral kagome antiferromagnet

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

The Undergraduate Training in Genomics (UTRIG) Initiative: early & active training for physicians in the genomic medicine era

Genomic medicine is transforming patient care. However, the speed of development has left a knowledge gap between discovery and effective implementation into clinical practice. Since 2010, the Training Residents in Genomics (TRIG) Working Group has found success in building a rigorous genomics curriculum with implementation tools aimed at pathology residents in postgraduate training years 1-4. Based on the TRIG model, the interprofessional Undergraduate Training in Genomics (UTRIG) Working Group was formed. Under the aegis of the Undergraduate Medical Educators Section of the Association of Pathology Chairs and representation from nine additional professional societies, UTRIG's collaborative goal is building medical student genomic literacy through development of a ready-to-use genomics curriculum. Key elements to the UTRIG curriculum are expert consensus-driven objectives, active learning methods, rigorous assessment and integration.

Transpectoral Anterior Approach to the Axilla for Lymph Node Dissection in Association with Mastectomy Preserving Both Pectoral Muscles and Their Neurovascular Bundles

In Patey's mastectomy, which is still the most common operation for breast cancer, axillary node dissection (AND) is performed through the base of the axilla after retracting the pectoralis major muscle and excising the pectoralis minor muscle (some surgeons preserve the latter). This has the disadvantage of inadequate exposure of the axilla and the risk of damage to the neurovascular bundles supplying the pectoral muscles, which in the long run may lead to atrophy of these muscles. A transpectoral anterior approach to the axilla for AND in association with mastectomy was attempted in 115 cases to obviate the above-mentioned disadvantages. The approach included: 1) splitting of the pectoralis major between the clavicular and sternal fibers; 2) mobilization and swinging of the pectoralis minor into different directions by means of a sling to facilitate AND at selected levels. The major advantages of this approach were: 1) total preservation of both pectoral muscles with their neurovascular bundles maintained the normal anatomy and function of the shoulder; 2) the axilla was directly approached through the anterior wall instead of through the base; in this way the axillary contents were exposed almost at surface level; 3) the dissection plane could be limited to anterior to and below the axillary vein and the risk of postoperative lymphedema could thus be minimized; 4) change of position of the ipsilateral arm was not necessary; 5) the duration of surgery was reduced. Monoblock ablation of significant and suspected tissues, maintaining the normal anatomy and function of the shoulder, could be easily accomplished with this approach.

The art and science of selecting graduate students in the biomedical sciences: Performance in doctoral study of the foundational sciences

The goal of this study was to investigate associations between admissions criteria and performance in Ph.D. programs at Boston University School of Medicine. The initial phase of this project examined student performance in the classroom component of a newly established curriculum named "Foundations in Biomedical Sciences (FiBS)". Quantitative measures including undergraduate grade point average (GPA), graduate record examination (GRE; a standardized, computer-based test) scores for the verbal (assessment of test takers' ability to analyze, evaluate, and synthesize information and concepts provided in writing) and quantitative (assessment of test takers' problem-solving ability) components of the examination, previous research experience, and competitiveness of previous research institution were used in the study. These criteria were compared with competencies in the program defined as students who pass the curriculum as well as students categorized as High Performers. These data indicated that there is a significant positive correlation between FiBS performance and undergraduate GPA, GRE scores, and competitiveness of undergraduate institution. No significant correlations were found between FiBS performance and research background. By taking a data-driven approach to examine admissions and performance, we hope to refine our admissions criteria to facilitate an unbiased approach to recruitment of students in the life sciences and to share our strategy to support similar goals at other institutions.

Status of COMPASS RICH-1 Upgrade with MPGD-based Photon Detectors

A Set of new MPGD-based Photon Detectors is being built for the upgrade of COMPASS RICH-1. The detectors cover a total active area of 1.4 m2 and are based on a hybrid architecture consisting of two THGEM layers and a Micromegas. A CsI film on one THGEM acts as a reflective photocathode. The characteristics of the detector, the production of the components and their validation tests are described in detail.

Nano- and microparticles at fluid and biological interfaces

Systems with interfaces are abundant in both technological applications and biology. While a fluid interface separates two fluids, membranes separate the inside of vesicles from the outside, the interior of biological cells from the environment, and compartmentalize cells into organelles. The physical properties of interfaces are characterized by interface tension, those of membranes are characterized by bending and stretching elasticity. Amphiphilic molecules like surfactants that are added to a system with two immiscible fluids decrease the interface tension and induce a bending rigidity. Lipid bilayer membranes of vesicles can be stretched or compressed by osmotic pressure; in biological cells, also the presence of a cytoskeleton can induce membrane tension. If the thickness of the interface or the membrane is small compared with its lateral extension, both can be described using two-dimensional mathematical surfaces embedded in three-dimensional space. We review recent work on the interaction of particles with interfaces and membranes. This can be micrometer-sized particles at interfaces that stabilise emulsions or form colloidosomes, as well as typically nanometer-sized particles at membranes, such as viruses, parasites, and engineered drug delivery systems. In both cases, we first discuss the interaction of single particles with interfaces and membranes, e.g. particles in external fields, non-spherical particles, and particles at curved interfaces, followed by interface-mediated interaction between two particles, many-particle interactions, interface and membrane curvature-induced phenomena, and applications.

First Measurement of Transverse-Spin-Dependent Azimuthal Asymmetries in the Drell-Yan Process

The first measurement of transverse-spin-dependent azimuthal asymmetries in the pion-induced Drell-Yan (DY) process is reported. We use the CERN SPS 190  GeV/c π^{-} beam and a transversely polarized ammonia target. Three azimuthal asymmetries giving access to different transverse-momentum-dependent (TMD) parton distribution functions (PDFs) are extracted using dimuon events with invariant mass between 4.3  GeV/c^{2} and 8.5  GeV/c^{2}. Within the experimental uncertainties, the observed sign of the Sivers asymmetry is found to be consistent with the fundamental prediction of quantum chromodynamics (QCD) that the Sivers TMD PDFs extracted from DY have a sign opposite to the one extracted from semi-inclusive deep-inelastic scattering (SIDIS) data. We present two other asymmetries originating from the pion Boer-Mulders TMD PDFs convoluted with either the nucleon transversity or pretzelosity TMD PDFs. A recent COMPASS SIDIS measurement was obtained at a hard scale comparable to that of these DY results. This opens the way for possible tests of fundamental QCD universality predictions.

Genetics in LGB Assisted Reproduction: Two Flipped Classroom, Progressive Disclosure Cases

INTRODUCTION

There have been several educational reforms calling for increasing lesbian, gay, bisexual, and transgender (LGBT) education materials, application of basic sciences to clinical medicine, and active engagement of students. While the amount of educational materials for LGBT clinical cases is increasing, this session for preclinical medical students uniquely combines basic science population genetics, cisgender lesbian, gay, and bisexual (LGB) cultural issues and reproductive endocrinology in a 1.5-hour flipped classroom session.

METHODS

Students were assigned a prediscussion video and reading. Facilitators attended a 1.5-hour training session prior to discussion. Each classroom of 30 students with small groups of six was led by a third- or fourth-year medical student facilitator who taught from a PowerPoint that included discussion questions. An audience response system was used to show aggregated, real-time anonymous responses to case questions, a pre- and postsurvey was used to analyze changes in student attitudes and knowledge of assisted reproduction services for same-sex couples, and course evaluations captured overarching student impressions.

RESULTS

All first-year students (N = 180) attended this mandatory session. Audience response questions showed a high level of knowledge of population genetics concepts. Voluntary surveys showed a higher number of assisted reproduction recommendations for LGB patients compared to heterosexual patients before discussion, with this difference disappearing after the discussion. This may indicate a shift in student attitudes and knowledge of LGB patient barriers and assisted reproduction. Course evaluations showed appreciation of LGB material integration within the course.

DISCUSSION

Educators will be able to successfully integrate the application of population genetics, assisted reproduction cases, and an examination of cultural barriers in health care for LGB patients with this session.

Medical Genetics Ethics Case Collection: Discussion Materials for Medical Students in the Genomic Era

INTRODUCTION

This collection of cases in medical genetics focuses on ethical dimensions of genetic testing. Given the recent and continuing revolution in genetic testing technologies, understanding the nuances of genetic tests and the implications of their outcomes for patients is a critical learning goal for medical students.

METHODS

This case collection was developed for first-year medical students. The cases fall into two types: discussion cases that lend themselves to both small-group and lecture settings and brief audience-response clicker cases to be used in larger lecture settings. The cases span topics such as direct-to-consumer genetic testing, patient privacy, economic and legal issues of genetic testing, and secondary findings in whole exome/genome sequencing. The clicker cases can be used to punctuate class sessions on the related science, while the discussion cases can be deployed as a single 2-hour session focusing on ethics. The associated materials include teaching notes on the scientific and ethical dimensions of the cases, a slide presentation of the cases, and implementation advice.

RESULTS

Students found that engaging with these cases was very stimulating and eye-opening. Student comments indicated that they appreciated the opportunity to grapple with the ethical dimensions of the genetic testing technologies and that the challenges brought to light highlighted the complexity of medical practice in the genomic era.

DISCUSSION

Although these cases were originally developed for use with medical students, they could easily be adapted for use in postgraduate and CME settings to explore complex ethical scenarios on which even the experts disagree.

Abstract P6-01-15: Novel regulation of breast cancer cell aggressiveness by cancer testis antigen

We recently demonstrated that a vesicular endocytosis associated protein SH3GL2, attenuates spontaneous metastases of breast cancer cells by inducing a mesenchymal to epithelial differentiation and the onset of the intrinsic apoptotic pathway. The present study aims to understand the molecular mechanism behind the SH3Gl2 mediated reduction of spontaneous metastasis of the breast cancer cells.

We employed a cDNA microarray analysis of the SH3GL2-overexpressing breast cancer cells exhibiting reduced pulmonary metastasis and identified a 12.1 fold downregulation of SPANXB1, a cancer-testis antigen that regulates sperm motility. A limited number of studies reported an association between increased SPANXB1 expression and progression of melanoma and hepatocellular carcinoma. Augmented SPANXB1 mRNA and protein expression was evident in primary breast tumors and its upregulation was associated with pulmonary metastasis of breast cancer cells. However, the expression pattern of SPANXB1 and its role in BCa development and progression is unknown. By immunohistochemical analysis, we detected high expression (p=0.002) of SPANXB1 in 78% (18/23) of the primary breast cancer tissues and corresponding lymph node metastases compared to the matched normal breast tissues. A couple of non-tumorigenic human breast epithelial cell lines were stably transformed with SPANXB1 to understand its effect on cellular growth and progression. The SPANXB1-transformed cells exhibited increased invasion (p=0.0001) and epithelial to mesenchymal transition accompanied by an augmented expression ratio of Vimentin/E-Cadherin, molecules regulating differentiation and metastasis. The SPANXB1-transformed cells also exhibited a markedly reduced expression of SH3GL2, implicating a SPANXB1:SH3GL2 crosstalk accompanied by an enhanced production of lactate (p=0.004). Our investigation identifies new breast cancer promoting role of a cancer testis antigen, which bears potential for biomarker and targeted therapeutic development.

Citation Format: Kannan A, Wells RM, Ikebe M, Dasgupta S. Novel regulation of breast cancer cell aggressiveness by cancer testis antigen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-01-15.

A Single-center Experience of Kidney Transplantation from Donation after Circulatory Death: Challenges and Scope in India

Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. The present report describes the initial experience of transplantation of organs from DCD donors in a tertiary care center in India. Between 2011 and 2015, five donors had kidneys retrieved after cardiac arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following cardiopulmonary resuscitation (CPR), which was restarted in three patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 9/10 kidneys were utilized. Mean donor age was 29.6 ± 16.3 years, M:F 4:1 and mean age of recipients was 38.7 ± 10.8 years, M:F 7:2. Seven patients required dialysis in postoperative period. Mean postoperative day 0 urine output was 1.9 ± 2.6 L. Baseline creatinine achieved was 1.38 ± 0.35 mg/dl after a mean duration of 26.12 ± 15.4 days. Kidneys from donors where CPR was continued after the declaration of death (n = 3) had better recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days, baseline creatinine 1.36 ± 0.25 vs. 1.52 ± 0.45 mg%). In donors without CPR, one kidney never functioned and others had patchy cortical necrosis on protocol biopsy, which was not seen in the kidneys from donors with CPR. Kidneys from DCD donors can serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death seems to help in improving outcomes.