Investigating Object Affordance in People with Complex Regional Pain Syndrome: No Alterations in the Automatic Activation of Motor Plans

Complex Regional Pain Syndrome (CRPS) is a condition of chronic pain, predominantly affecting one limb. CRPS is characterised by motor changes including slowed or uncoordinated movements. Cognitive processes that drive movement planning and/or execution might contribute to these changes. We aimed to investigate the potential alterations to such cognitive mechanisms using an 'object affordance' paradigm. Object affordance refers to the observation that viewing an object modulates associated motor responses, presumably due to the automatic activation of a motor plan. We hypothesised that people with CRPS would show reduced object affordance effects for their affected compared to unaffected hand, and compared to pain-free controls. First, we validated an online object affordance task involving button press responses to everyday objects with handles, in pain-free participants (n = 63; Experiment 1). Object affordance was reflected by faster and more accurate responses when the object handle was aligned to the responding hand ("aligned") compared to when the handle was aligned to the other hand ("non-aligned"). These results were similar for the online task as when administered in person. Second, in a case-control study, we administered the online object affordance task to people with CRPS predominantly affecting the upper limb (n = 25), and age-matched pain-free controls (n = 68; Experiment 2). People with CRPS responded faster and more accurately in the aligned versus non-aligned condition (ie, an object affordance effect), both for the affected and unaffected hands. There were no differences to pain-free participants. Therefore, object affordance effects were seen in people with CRPS, providing no evidence for altered motor planning. PERSPECTIVE: This article presents research investigating cognitive processes related to motor planning in Complex Regional Pain Syndrome (CRPS). Using an online object affordance paradigm, validated in pain-free controls, the authors found that people with CRPS showed intact object affordance effects in the affected and unaffected hand, suggesting unaltered motor planning. DATA AVAILABILITY: The experiment materials, data, pre-processing scripts, and analysis scripts can be found via Open Science Framework (https://osf.io/nc825/files/osfstorage).

Folate hydrolase-1 (FOLH1) is a novel target for antibody-based brachytherapy in Merkel cell carcinoma

Backgrounds

Folate Hydrolase‐1 (FOLH1; PSMA) is a type II transmembrane protein, luminally expressed by solid tumour neo‐vasculature. Monoclonal antibody (mAb), J591, is a vehicle for mAb‐based brachytherapy in FOLH1+ cancers. Brachytherapy is a form of radiotherapy that involves placing a radioactive material a short distance from the target tissue (e.g., on the skin or internally); brachytherapy is commonly accomplished with the use of catheters, needles, metal seeds and antibody or small peptide conjugates. Herein, FOLH1 expression in primary (p) and metastatic (m) Merkel cell carcinoma (MCC) is characterized to determine its targeting potential for J591‐brachytherapy.

Materials & Methods

Paraffin sections from pMCC and mMCC were evaluated by immunohistochemistry for FOLH1. Monte Carlo simulation was performed using the physical properties of conjugated radioisotope lutetium‐177. Kaplan–Meier survival curves were calculated based on patient outcome data and FOLH1 expression.

Results

Eighty‐one MCC tumours were evaluated. 67% (54/81) of all cases, 77% (24/31) pMCC and 60% (30/50) mMCC tumours were FOLH1+. Monte Carlo simulation showed highly localized ionizing tracks of electrons emitted from the targeted neo‐vessel. 42% (34/81) of patients with FOLH1+/− MCC had available survival data for analysis. No significant differences in our limited data set were detected based on FOLH1 status (p = 0.4718; p = 0.6470), staining intensity score (p = 0.6966; p = 0.9841) or by grouping staining intensity scores (− and + vs. ++, +++, +++) (p = 0.8022; p = 0.8496) for MCC‐specific survival or recurrence free survival, respectively.

Conclusions

We report the first evidence of prevalent FOLH1 expression within MCC‐associated neo‐vessels, in 60‐77% of patients in a large MCC cohort. Given this data, and the need for alternatives to immune therapies it is appropriate to explore the safety and efficacy of FOLH1‐targeted brachytherapy for MCC.

What's already known about this topic?

We report the first evidence of prevalent folate hydrolase‐1 (FOLH1; also known as prostate‐specific membrane antigen) expression within MCC‐associated neovessels.

What does this study add?

Herein, FOLH1 expression in Merkel cell carcinoma neovasculature is validated, and the therapeutic mechanism of specific, systemic targeting of disseminated disease with antibody‐based brachytherapy, is defined.

Scale-up of electrokinetic permeable reactive barriers for the removal of organochlorine herbicide from spiked soils

This work aims to shed light on the scale-up a combined electrokinetic soil flushing process (EKSF) with permeable reactive barriers (PRB) for the treatment of soil spiked with clopyralid. To do this, remediation tests at lab (3.45 L), bench (175 L) and pilot (1400 L) scales have been carried out. The PRB selected was made of soil merged with particles of zero valent iron (ZVI) and granular activated carbon (GAC). Results show that PRB-EKSF involved electrokinetic transport and dehalogenation as the main mechanisms, while adsorption on GAC was not as relevant as initially expected. Clopyralid was not detected in the electrolyte wells and only in the pilot scale, significant amounts of clopyralid remained in the soil after 600 h of operation. Picolinic acid was the main dehalogenated product detected in the soil after treatment and mobilized by electro-osmosis, mostly to the cathodic well. The transport of volatile compounds into the atmosphere was promoted at pilot scale because of the larger soil surface exposed to the atmosphere and the electrical heating caused by ohmic losses and the larger interelectrode gap.

AB0384 IMPACT OF TEMPORAL ARTERY ULTRASOUND ON SURVIVAL OF PATIENTS WITH GIANT CELL ARTERITIS

Background:

Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults over 50 years of age. Its incidence increases with age, with a peak between 70-80 years and predominates in women, 3:1. It is a medical emergency that, if not diagnosed, can lead to irreversible complications. The delay in time from diagnosis to start of treatment is crucial to avoid possible serious outcomes on short, medium and long term. Survival in GCA is estimated between 60-90% at 5 years and 48-81% at 10 years. Efforts have been made to implement rapid diagnostic circuits to assess patients and initiate treatment without delay with good results both in reducing permanent vision loss and in reducing the costs of these patients due to emergency visits and admissions. The morbidity and mortality of this disease is high, but the use of efficient diagnostic strategies, such as ultrasound of superficial temporal arteries, has proven to be a useful, practical, cost-effective and, above all, quick tool to make the diagnostic approach.

Objectives:

Analyze the impact of early temporal artery ultrasound on survival for patients with GCA.

Methods:

Survival study of 48 patients with GCA, in two different “stages” in terms of diagnostic approach: Group A (n = 27), patients diagnosed between 2002 - 2011 using only ACR 1990 criteria and Group E (n = 21) diagnosed between 2010-2015 using ACR criteria and TAUS. TAUS was performed by Rheumatologists with extensive experience in ultrasound and within a period of no more than 7 days for these patients. The definitive diagnosis of GCA was based on the clinical criteria of the Rheumatologist within the clinical and analytical context and with the specific complementary examinations for each case (Ultrasound, PET-CT, biopsy). Demographic data, comorbidities, signs and symptoms at debut, analytical data, complementary examinations, treatment and evolution were obtained retrospectively through the electronic medical record of the patient, based on the database of our GCA cohort. A survival analysis was performed considering death as the main outcome. The statistic used was the Kaplan-Meier test. In addition, other complications related to treatment or pathology are collected.

Results:

The mean age at diagnosis of our patients was 79 + - 6 years, with a female: male ratio of 3: 1. The follow-up was between 2 and 16 years with a mean of 5.8 + - 3 years, until the last visit collected or until the outcome of death. Group A had a survival at 5 and 10 years of 53.4% and 36.7% respectively, while group E of 79.5% at both cut-off points. (Figure 1).

There is a significant difference between the survival of both groups, p <0.01, this being better in the group in which TAUS was implemented for rapid diagnosis (group E). The main causes of death were cardiovascular events, 30%, predominantly in group E (75%), and infection, 30%, predominantly in group A. The median from diagnosis to death was 3 years (range 1 - 13).

Figure 1.

Group A (red line) according to ACG 1990 criteria and Group B (green line) according to ACG criteria and implementing TAUS for rapid diagnosis

Conclusion:

The implementation of temporal artery ultrasound (TAUS) is associated with a significant improvement in the survival rate of patients with GCA and a reduction in treatment-related complications in patients who were diagnosed with ultrasound in less than 7 days compared to those diagnosed by the conventional healthcare attention routes.

References:

[1]Gonzalez-Gay MA, et al. Giant cell arteritis: epidemiology, diagnosis, and management. DOI: 10.1007/s11926-010-0135-9

[2]Patil P, et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. PMID: 26016758

[3]Breuer GS, et al. Survival of patients with giant cell arteritis: a controversial issue. PMID: 31969222

[4]Diamantopoulos AP, et al. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? 10.1093/rheumatology/kev289

Disclosure of Interests:

None declared

A Phase I/II Clinical Trial to evaluate the efficacy of baricitinib to prevent respiratory insufficiency progression in onco-hematological patients affected with COVID19: A structured summary of a study protocol for a randomised controlled trial

OBJECTIVES

Baricitinib is supposed to have a double effect on SARS-CoV2 infection. Firstly, it reduces the inflammatory response through the inhibition of the Januse-Kinase signalling transducer and activator of transcription (JAK-STAT) pathway. Moreover, it reduces the receptor mediated viral endocytosis by AP2-associated protein kinase 1 (AAK1) inhibition. We propose the use of baricinitib to prevent the progression of the respiratory insufficiency in SARS-CoV2 pneumonia in onco-haematological patients. In this phase Ib/II study, the primary objective in the safety cohort is to describe the incidence of severe adverse events associated with baricitinib administration. The primary objective of the randomized phase (baricitinib cohort versus standard of care cohort) is to evaluate the number of patients who did not require mechanical oxygen support since start of therapy until day +14 or discharge (whichever it comes first). The secondary objectives of the study (only randomized phase of the study) are represented by the comparison between the two arms of the study in terms of mortality and toxicity at day+30. Moreover, a description of the immunological related changes between the two arms of the study will be reported.

TRIAL DESIGN

The trial is a phase I/II study with a safety run-in cohort (phase 1) followed by an open label phase II randomized controlled trial with an experimental arm compared to a standard of care arm.

PARTICIPANTS

The study will be performed at the Institut Català d'Oncologia, a tertiary level oncological referral center in the Catalonia region (Spain). The eligibility criteria are: patients > 18 years affected by oncological diseases; ECOG performance status < 2 (Karnofsky score > 60%); a laboratory confirmed infection with SARS-CoV-2 by means of real -time PCR; radiological signs of low respiratory tract disease; absence of organ dysfunction (a total bilirubin within normal institutional limits, AST/ALT≤2.5 X institutional upper limit of normal, alkaline phosphatase ≤2.5 X institutional upper limit of normal, coagulation within normal institutional limits, creatinine clearance >30 mL/min/1.73 m² for patients with creatinine levels above institutional normal); absence of HIV infection; no active or latent HBV or HCV infection. The exclusion criteria are: patients with oncological diseases who are not candidates to receive any active oncological treatment; hemodynamic instability at time of study enrollment; impossibility to receive oral medication; medical history of recent or active pulmonary embolism or deep venous thrombosis or patients at high-risk of suffering them (surgical intervention, immobilization); multi organ failure, rapid worsening of respiratory function with requirement of fraction of inspired oxygen (FiO₂) > 50% or high-flow nasal cannula before initiation of study treatment; uncontrolled intercurrent illness (ongoing or severe active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements); allergy to one or more of study treatments; pregnant or breastfeeding women; positive pregnancy test in a pre-dose examination. Patients should have the ability to understand, and the willingness to sign, a written informed consent document; the willingness to accept randomization to any assigned treatment arm; and must agree not to enroll in another study of an investigational agent prior to completion of Day +28 of study. An electronic Case Report Form in the Research Electronic Data Capture (REDCap) platform will be used to collect the data of the trial. Removal from the study will apply in case of unacceptable adverse event(s), development of an intercurrent illness, condition or procedural complication, which could interfere with the patient's continued participation and voluntary patient withdrawal from study treatment (all patients are free to withdraw from participation in this study at any time, for any reasons, specified or unspecified, and without prejudice).

INTERVENTION AND COMPARATOR

Treatment will be administered on an inpatient basis. We will compare the experimental treatment with baricitinib plus the institutional standard of care compared with the standard of care alone. During the phase I, we will define the dose-limiting toxicity of baricitinib and the dose to be used in the phase 2 part of the study. The starting baricitinib dose will be an oral tablet 4 mg-once daily which can be reduced to 2 mg depending on the observed toxicity. The minimum duration of therapy will be 5 days and it can be extended to 7 days. The standard of care will include the following therapies. Antibiotics will be individualized based on clinical suspicion, including the management of febrile neutropenia. Prophylaxis of thromboembolic disease will be administered to all participants. Remdesivir administration will be considered only in patients with severe pneumonia (SatO₂ <94%) with less than 7 days of onset of symptoms and with supplemental oxygen requirements but not using high-flow nasal cannula, non-invasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). In the randomized phase, tocilizumab or interferon will not be allowed in the experimental arm. Tocilizumab can be used in patients in the standard of care arm at the discretion of the investigator. If it is prescribed it will be used according to the following criteria: patients who, according to his baseline clinical condition, would be an ICU tributary, interstitial pneumonia with severe respiratory failure, patients who are not on mechanical ventilation or ECMO and who are still progressing with corticoid treatment or if they are not candidates for corticosteroids. Mild ARDS (PAFI <300 mmHg) with radiological or blood gases deterioration that meets at least one of the following criteria: CRP >100mg/L D-Dimer >1,000μg/L LDH >400U/L Ferritin >700ng/ml Interleukin 6 ≥40ng/L. The use of tocilizumab is not recommended if there are AST/ALT values greater than 10 times the upper limit of normal, neutrophils <500 cells/mm3, sepsis due to other pathogens other than SARS-CoV-2, presence of comorbidity that can lead to a poor prognosis, complicated diverticulitis or intestinal perforation, ongoing skin infection. The dose will be that recommended by the Spanish Medicine Agency in patients ≥75Kg: 600mg dose whereas in patients <75kg: 400mg dose. Exceptionally, a second infusion can be assessed 12 hours after the first in those patients who experience a worsening of laboratory parameters after a first favourable response. The use of corticosteroids will be recommended in patients who have had symptoms for more than 7 days and who meet all the following criteria: need for oxygen support, non-invasive or invasive mechanical ventilation, acute respiratory failure or rapid deterioration of gas exchange, appearance or worsening of bilateral alveolar-interstitial infiltrates at the radiological level. In case of indication, it is recommended: dexamethasone 6mg/d p.o. or iv for 10 days or methylprednisolone 32mg/d orally or 30mg iv for 10 days or prednisone 40mg day p.o. for 10 days.

MAIN OUTCOMES

Phase 1 part: to describe the toxicity profile of baricitinib in COVID19 oncological patients during the 5-7 day treatment period and until day +14 or discharge (whichever it comes first). Phase 2 part: to describe the number of patients in the experimental arm that will not require mechanical oxygen support compared to the standard of care arm until day +14 or discharge (whichever it comes first).

RANDOMISATION

For the phase 2 of the study, the allocation ratio will be 1:1. Randomization process will be carried out electronically through the REDcap platform ( https://www.project-redcap.org/ ) BLINDING (MASKING): This is an open label study. No blinding will be performed.

NUMBERS TO BE RANDOMISED (SAMPLE SIZE)

The first part of the study (safety run-in cohort) will consist in the enrollment of 6 to 12 patients. In this population, we will test the toxicity of the experimental treatment. An incidence of severe adverse events grade 3-4 (graded by Common Terminology Criteria for Adverse Events v.5.0) inferior than 33% will be considered sufficient to follow with the next part of the study. The second part of the study we will perform an interim analysis of efficacy at first 64 assessed patients and a definitive one will analyze 128 assessed patients. Interim and definitive tests will be performed considering in both cases an alpha error of 0.05. We consider for the control arm this rate is expected to be 0.60 and for the experimental arm of 0.80. Considering this data, a superiority test to prove a difference of 0.20 with an overall alpha error of 0.10 and a beta error of 0.2 will be performed. Considering a 5% of dropout rate, it is expected that a total of 136 patients, 68 for each study arm, will be required to complete study accrual.

TRIAL STATUS

Version 5.0. 14^th October 2020 Recruitment started on the 16^th of December 2020. Expected end of recruitment is June 2021.

TRIAL REGISTRATION

AEMPs: 20-0356 EudraCT: 2020-001789-12, https://www.clinicaltrialsregister.eu/ctr-search/search (Not publically available as Phase I trial) Clinical trials: BARCOVID19, https://www.clinicaltrials.gov/ (In progress) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol."

COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings

Aim

The aim of this paper is to describe the clinical features of COVID‐19‐related encephalopathy and their metabolic correlates using brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) imaging.

Background and purpose

A variety of neurological manifestations have been reported in association with COVID‐19. COVID‐19‐related encephalopathy has seldom been reported and studied.

Methods

We report four cases of COVID‐19‐related encephalopathy. The diagnosis was made in patients with confirmed COVID‐19 who presented with new‐onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2‐desoxy‐2‐fluoro‐D‐glucose (FDG)‐positron‐emission tomography (PET)/computed tomography (CT) (FDG‐PET/CT).

Results

The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID‐19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS‐CoV‐2 RT‐PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG‐PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy.

Conclusions

Despite varied clinical presentations, all patients presented with a consistent FDG‐PET pattern, which may reflect an immune mechanism.

Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson)

La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.

Electrokinetic-Fenton for the remediation low hydraulic conductivity soil contaminated with petroleum

The use of electrokinetic Fenton (EK Fenton) process, as promising soil remediation approach, was investigated by using an iron electrode with different supporting electrolytes (tap water, H₂O₂, and citric acid) to depollute soil spiked with petroleum where kaolin was selected as low hydraulic conductivity. The results clearly confirm that, the combination of electrokinetic remediation (EK) and Fenton technologies, is an efficient oxidizing approach for removing hydrocarbons from this kind of soil. In fact, the electrokinetic Fenton reactions and the control of the soil pH conditions by adding citric acid enhanced the oxidation process because the addition of the H₂O₂ with iron electrode resulted in higher removal efficiencies (89%) for total petroleum hydrocarbons (TPHs). These figures allowed to confirm that EK Fenton process with pH control contributed for the transport of H₂O₂ and Fe²⁺ ions in the soil by electromigration and eletro-osmotic phenomena. Conversely, no control of pH conditions when only EK was applied, achieved lower hydrocarbons removal (27%) after 15 d of treatment due to the precipitation of iron ions. Finally, the efficiency of the EK Fenton remediation prevented the generation of secondary effluent with higher organic content, avoiding its treatment by other advanced oxidation process.

Phase II study of high-sensitivity genotyping of KRAS, NRAS, BRAF and PIK3CA to ultra-select metastatic colorectal cancer patients for panitumumab plus FOLFIRI: the ULTRA trial

BACKGROUND

Several studies show the importance of accurately quantifying not only KRAS and other low-abundant mutations because benefits of anti-EGFR therapies may depend on certain sensitivity thresholds. We assessed whether ultra-selection of patients using a high-sensitive digital PCR (dPCR) to determine KRAS, NRAS, BRAF and PIK3CA status can improve clinical outcomes of panitumumab plus FOLFIRI.

PATIENTS AND METHODS

This was a single-arm phase II trial that analysed 38 KRAS, NRAS, BRAF and PIK3CA hotspots in tumour tissues of irinotecan-resistant metastatic colorectal cancer patients who received panitumumab plus FOLFIRI until disease progression or early withdrawal. Mutation profiles were identified by nanofluidic dPCR and correlated with clinical outcomes (ORR, overall response rate; PFS, progression-free survival; OS, overall survival) using cut-offs from 0% to 5%. A quantitative PCR (qPCR) analysis was also performed.

RESULTS

Seventy-two evaluable patients were enrolled. RAS (KRAS/NRAS) mutations were detected in 23 (32%) patients and RAS/BRAF mutations in 25 (35%) by dPCR, while they were detected in 7 (10%) and 11 (15%) patients, respectively, by qPCR. PIK3CA mutations were not considered in the analyses as they were only detected in 2 (3%) patients by dPCR and in 1 (1%) patient by qPCR. The use of different dPCR cut-offs for RAS (KRAS/NRAS) and RAS/BRAF analyses translated into differential clinical outcomes. The highest ORR, PFS and OS in wild-type patients with their lowest values in patients with mutations were achieved with a 5% cut-off. We observed similar outcomes in RAS/BRAF wild-type and mutant patients defined by qPCR.

CONCLUSIONS

High-sensitive dPCR accurately identified patients with KRAS, NRAS, BRAF and PIK3CA mutations. The optimal RAS/BRAF mutational cut-off for outcome prediction is 5%, which explains that the predictive performance of qPCR was not improved by dPCR. The biological and clinical implications of low-frequent mutated alleles warrant further investigations.

CLINICALTRIALS.GOV NUMBER

NCT01704703.

EUDRACT NUMBER

2012-001955-38.

Techno-economic analysis of the scale-up process of electrochemically-assisted soil remediation

This work presents a techno-economic study of the scaling-up of the electrochemically-assisted soil remediation (EASR) process of polluted soil. Four scales have been selected for the study: laboratory, bench, pilot and prototype, with a capacity of treating a volume of soil of 1 × 10^-4, 2 × 10^-3, 0.11 and 21.76 m³, respectively. This study analyses the technical information produced by studies carried out at each scale, and informs about the fixed costs (construction of the electrokinetic remediation reactor, installation of auxiliary services and purchase of analytical equipment) and variable costs (start-up, operation and dismantling of the test) derived from running a test at each of the evaluated scales. The information discussed in based on the experience gained with many evaluations carried out over the last decade at these scales. This information can provide useful guidance for developing a scaling-up of the EASR for many researchers starting on the evaluation of this important environmental remediation technology.

Enhanced electrokinetic remediation of polluted soils by anolyte pH conditioning

In the treatment of a polluted soil, the pH has a strong impact on the development of different physicochemical processes as precipitation/dissolution, adsorption/desorption or ionic exchange. In addition, the pH determines the chemical speciation of the compounds present in the system and, consequently, it conditions the transport processes by which those compounds will move. This question has aroused great interest in the development of pH control technologies coupled to soil remediation processes. In electrokinetic remediation processes, pH has usually been controlled by catholyte pH conditioning with acid solutions, applied to cases of heavy metals pollution. However, this method is not effective with pollutants that can be dissociated in anionic species. In this context, this paper presents a study of the electrokinetic remediation of soils polluted with 2,4-Dichlorophenoxyacetic acid, a common polar pesticide, enhanced with an anolyte pH conditioning strategy. A numerical study is proposed to evaluate the effectiveness of the strategy. Several numerical tests have been carried out for NaOH solutions with different concentrations as pH conditioning fluid. The results show that the anolyte pH conditioning strategy makes it possible to control the pH of the soil and, consequently, the chemical speciation of pollutant species. Thus, it is possible to achieve an important flux of pesticide into the anolyte compartment (electro-migration of anionic species and diffusive transport of acid species). This way, it possible to maximise the pesticide accumulation in this compartment, allowing a much more effective removal of pollutants from the soil than without the anolyte pH conditioning strategy.

A clinical and neurophysiological motor signature of Unverricht-Lundborg disease

OBJECTIVES

Unverricht-Lundborg disease (ULD) is the most common form of progressive myoclonus epilepsy. Cerebellar dysfunction may appear over time, contributing along with myoclonus to motor disability. The purpose of the present work was to clarify the motor and neurophysiological characteristics of ULD patients.

METHODS

Nine patients with genetically proven ULD were evaluated clinically (medical history collected from patient charts, the Scale for the Assessment and Rating of Ataxia and Unified Myoclonus Rating Scale). Neurophysiological investigations included EEG, surface polymyography, long-loop C-reflexes, somatosensory evoked potentials, EEG jerk-locked back-averaging (JLBA) and oculomotor recordings. All patients underwent brain MRI. Non-parametric Mann-Whitney tests were used to compare ULD patients' oculomotor parameters with those of a matched group of healthy volunteers (HV).

RESULTS

Myoclonus was activated by action but was virtually absent at rest and poorly induced by stimuli. Positive myoclonus was multifocal, often rhythmic and of brief duration, with top-down pyramidal temporospatial propagation. Cortical neurophysiology revealed a transient wave preceding myoclonus on EEG JLBA (n=8), enlarged somatosensory evoked potentials (n=7) and positive long-loop C-reflexes at rest (n=5). Compared with HV, ULD patients demonstrated decreased saccadic gain, increased gain dispersion and a higher frequency of hypermetric saccades associated with decreased peak velocity.

CONCLUSION

A homogeneous motor pattern was delineated that may represent a ULD clinical and neurophysiological signature. Clinical and neurophysiological findings confirmed the pure cortical origin of the permanent myoclonus. Also, oculomotor findings shed new light on ULD pathophysiology by evidencing combined midbrain and cerebellar dysfunction.

Abstract P4-21-32: Treatment of early HER2-positive breast cancer in trastuzumab era in everyday clinical practice: An overview after 10 years of its approval

Introduction: The addition of Trastuzumab(T) to chemotherapy (CT) revolutionized HER2-positive breast cancer(BC) and changed its natural history. We reviewed the efficacy of T outside clinical trials in a cancer comprehensive center.

Methods: Ambiespective and descriptive study was conducted in Catalan Institute of Oncology (ICO-Barcelona). Estimates of progression-free survival (PFS) and overall survival (OS) were obtained with the Kaplan-Meier method and compared with LogRank test. The association of clinic-pathological variables and outcome was studied by χ2and Cox proportional hazard analysis.

Results: 430 consecutive early HER2-positive BC patients (pts) were treated with adjuvant/neoadjuvant T and CT from Jan 2005 to Dec 2012. Pt basal characteristics are reported in Table 1. Neoadjuvant treatment was administrated in 230pts (54%) and in 200 (46%) in adjuvancy. Pathological complete response (pCR) in breast and nodes (ypT0/isypN0) was achieved in 48% of pts, with higher rates in hormone receptor (HR)-negative pts (62 vs 37% p=0.0005). Median duration of T: 10.6 months (m). 28%pts treated with neoadjuvant T+CT who achieved a pCR did not receive adjuvant T. Treatment discontinuation: 38pts (8.8%): 27pts due to cardiac toxicity and 4 relapsed during adjuvant T. In 87%pts, neoadjuvant CT was based on anthracyclines(A) and taxanes. Adjuvant CT: A and taxanes in 57.4%; 14%pts FAC, 15.4% A-CMF and 12% TCH. At a median follow-up of 70m (3-135), 44pts (10.4%) had relapsed: 33pts with distant M1, 9pts with only loco-regional disease and 2pts contralateral HER2-positive BC. M1 location: 46% visceral, 34% bone/lymph nodes and 20% in central nervous system (CNS). PFS was 23.4m(0-88); median OS was not reached; estimated 10 years-OS was 86.5%. Pts treated with A and taxanes had a significantly better OS compared to those treated with other CT (113 vs 98m, p= 0.009). Kaplan-Meier curve showed numerically higher relapses at 10 years in HR-positive pts (83 vs 90% p=0.8). Pts with pCR had significantly better OS (113 vs 104m, p=0.006). Pts with CNS-metastases had a significantly worse OS (13 vs 26m,p=0,02) and those with HR-negative (49 vs 24m, p= 0.033).

Conclusion: In everyday clinical practice, recurrences after adjuvant/neoadjuvant trastuzumab in HER2-positive BC were less than described in the T-pivotals trials, with 10% of recurrences at a median of FU of 70m. In our series, estimated 10 years-OS was 86.5%. Pts treated with A and taxanes had a significantly better OS as well as those pts who achieved a pCR. On the contrary, pts with CNS M1 and those with HR-negative had worse prognosis.

Table 1Median age51.9y (27-83)Stage I/II/III106 (25%)/ 226 (52%)/ 97 (23%)HR Positive/ Negative249 (58%)/181 (42%)

Citation Format: Ortega A, Domenech M, Falo C, Gil M, Stradella A, Fernandez A, Morilla I, Villanueva R, Castany R, Vazquez S, Molina K, Bergamino M, Navarro V, Pernas S. Treatment of early HER2-positive breast cancer in trastuzumab era in everyday clinical practice: An overview after 10 years of its approval [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 P4-21-32.

Scale-up of the electrokinetic fence technology for the removal of pesticides. Part II: Does size matter for removal of herbicides?

This work reports results of the application of electrokinetic fence technology in a 32 m³ -prototype which contains soil polluted with 2,4-D and oxyfluorfen, focusing on the evaluation of the mechanisms that describe the removal of these two herbicides and comparing results to those obtained in smaller plants: a pilot-scale mockup (175 L) and a lab-scale soil column (1 L). Results show that electric heating of soil (coupled with the increase in the volatility) is the key to explain the removal of pollutants in the largest scale facility while electrokinetic transport processes are the primary mechanisms that explain the removal of herbicides in the lab-scale plant. 2-D and 3-D maps of the temperature and pollutant concentrations are used in the discussion of results trying to give light about the mechanisms and about how the size of the setup can lead to different conclusions, despite the same processes are occurring in the soil.

Scale-up of the electrokinetic fence technology for the removal of pesticides. Part I: Some notes about the transport of inorganic species

This work describes the application electrokinetic fence technology to a soil polluted with herbicides in a large prototype containing 32 m³ of soil. It compares performance in this large facility with results previously obtained in a pilot-scale mockup (175 L) and with results obtained in a lab-scale soil column (1 L), all of them operated under the same driving force: an electric field of 1.0 V cm^-1. Within this wide context, this work focuses on the effect on inorganic species contained in soil and describes the main processes occurring in the prototype facility, as well as the differences observed respect to the lower scale plants. Thus, despite the same processes can be described in the three plants, important differences are observed in the evolution of the current intensity, moisture and conductivity. They can be related to the less important electroosmotic fluxes in the larger facilities and to the very different distances between electrodes, which lead to very different distribution of species and even to a very different evolution of the resulting current intensity. 2-D maps of the main species at different relevant moments of the test are discussed and important information is drawn from them. Ions depletion from soil appears as a very important problem which should be prevented if the effect of natural bioremediation and/or phytoremediation on the removal or organics aims to be accounted.

In situ studies of NO reduction by H2 over Pt using surface X-ray diffraction and transmission electron microscopy

Exposure to H₂ induces faceting of the Pt nanoparticle, while exposure to NO induces rounding of the nanoparticle.