Feeding a diet with corn distillers grain with solubles to dairy cows alters manure characteristics and ammonia and hydrogen sulfide emissions from manure

The objective of the experiment was to examine effects of a diet containing a high concentration (28.8% dry matter basis) of corn distillers grain with solubles on manure characteristics and NH3 and H2S emissions from dairy cow manure. Eighteen cows were blocked by parity and days in milk, and cows in each block were assigned to the following treatments: the control diet (CON) or CON with distillers grains with solubles at 28.8% (dry matter basis) replacing mainly soybean meal (DG). The experiment was conducted for 11 wk, and feces and urine from individual cows were collected over 3 d in wk 11 (a total of 8 spot samples per cow). Fecal or urine samples were composited by cow, and the composite feces and urine were analyzed for indigestible neutral detergent fiber and creatinine concentration, respectively, for individual cows to estimate total fecal and urine outputs. Immediately before the manure incubation, composited feces and urine were sampled to determine manure characteristics. Manure was reconstituted according to daily fecal and urine excretion estimated for individual cows. Individual manures were incubated using a continuous air flux multichamber system over 10 d to measure NH3 and H2S emissions. All data from 18 manures were analyzed using the Mixed procedure of SAS (SAS Institute Inc., Cary, NC). The ratio of feces to urine and the contents of manure total and volatile solids were not different among treatments. Urine from DG had lower pH and DG manure had lower N content and greater S content compared with CON. During the 10-d incubation, NH3 emission was considerably less for DG versus CON. The emission of H2S over 10 d for DG was greater compared with that for CON. After the incubation, manure pH and N and S concentrations were greater for DG versus CON. In conclusion, manure from cows fed a high-DG diet decreased urinary N contribution to manure N and lowered urine pH, which were the factors that caused the decrease in NH3 emission from DG manure. However, the DG diet increased dietary S concentration and increased S excretion in urine and feces. This increased H2S emission from DG manure during the 10-d manure incubation.

Endometrial development during the transition to menopause: preliminary associations with follicular dynamics

Objective: This study aimed to test the hypothesis that the development of functional luteal phase dominant follicles (LPDFs) is associated with increased endometrial growth as women transition to menopause.Methods: Endometrial thickness (ET), follicle development, and hormone production were characterized in ovulatory women of mid-reproductive age (MRA; 18-35 years, n = 10) and advanced reproductive age (ARA; 45-55 years, n = 16). Transvaginal ultrasonography was conducted every 1-3 days during one interovulatory interval to quantify ET and the diameters of follicles ≥2 mm. Blood was drawn at each visit to measure progesterone, estradiol, inhibin A, follicle stimulating hormone, and luteinizing hormone.Results: In the MRA group, ET was lower (8.87 vs. 10.1 mm) in women with typical versus no LPDFs, in association with greater luteal phase estradiol (91.1 vs. 48.8 ng/l). In the ARA group, luteal phase endometrial growth was greater (12.0 vs. 10.4 mm) in women with typical versus no LPDFs, in association with lower progesterone (10.7 vs. 13.8 μg/l; LPDF effect p < 0.1) and inhibin A (35.6 vs. 51.17 ng/l; p < 0.10).Conclusions: Preliminary findings suggest that ET may be increased in women who develop LPDFs, in association with reduced luteal phase progesterone and inhibin A, during the transition to menopause. Continued research is required to confirm these findings.

Antitumor Activity and Safety of Trastuzumab Deruxtecan in Patients With HER2-Low-Expressing Advanced Breast Cancer: Results From a Phase Ib Study

PURPOSE

Trastuzumab deruxtecan (T-DXd, formerly DS-8201a) is a novel human epidermal growth factor receptor 2 (HER2)-targeted antibody drug conjugate (ADC) with a topoisomerase I inhibitor payload. A dose escalation and expansion phase I study evaluated the safety and activity of T-DXd in patients with advanced HER2-expressing/mutated solid tumors. Here, results for T-DXd at the recommended doses for expansion (RDE) in patients with HER2-low (immunohistochemistry [IHC] 1+ or IHC 2+/in situ hybridization-) breast cancer (ClinicalTrials.gov identifier: NCT02564900) are reported.

PATIENTS AND METHODS

Eligible patients had advanced/metastatic HER2-low-expressing breast cancer refractory to standard therapies. The RDE of 5.4 or 6.4 mg/kg T-DXd were administered intravenously once every 3 weeks until withdrawal of consent, unacceptable toxicity, or progressive disease. Antitumor activity and safety were assessed.

RESULTS

Between August 2016 and August 2018, 54 patients were enrolled and received ≥ 1 dose of T-DXd at the RDE. Patients were extensively pretreated (median, 7.5 prior therapies). The confirmed objective response rate by independent central review was 20/54 (37.0%; 95% CI, 24.3% to 51.3%) with median duration of response of 10.4 months (95% CI, 8.8 month to not evaluable). Most patients (53/54; 98.1%) experienced ≥ 1 treatment-emergent adverse event (TEAE; grade ≥ 3; 34/54; 63.0%). Common (≥ 5%) grade ≥ 3 TEAEs included decreases in neutrophil, platelet, and WBC counts; anemia; hypokalemia; AST increase; decreased appetite; and diarrhea. Three patients treated at 6.4 mg/kg suffered fatal events associated with T-DXd-induced interstitial lung disease (ILD)/pneumonitis as determined by an independent adjudication committee.

CONCLUSION

The novel HER2-targeted ADC, T-DXd, demonstrated promising preliminary antitumor activity in patients with HER2-low breast cancer. Most toxicities were GI or hematologic in nature. ILD is an important identified risk and should be monitored closely and proactively managed.

Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer

BACKGROUND

Trastuzumab deruxtecan (DS-8201) is an antibody-drug conjugate composed of an anti-HER2 (human epidermal growth factor receptor 2) antibody, a cleavable tetrapeptide-based linker, and a cytotoxic topoisomerase I inhibitor. In a phase 1 dose-finding study, a majority of the patients with advanced HER2-positive breast cancer had a response to trastuzumab deruxtecan (median response duration, 20.7 months). The efficacy of trastuzumab deruxtecan in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab emtansine requires confirmation.

METHODS

In this two-part, open-label, single-group, multicenter, phase 2 study, we evaluated trastuzumab deruxtecan in adults with pathologically documented HER2-positive metastatic breast cancer who had received previous treatment with trastuzumab emtansine. In the first part of the study, we evaluated three different doses of trastuzumab deruxtecan to establish a recommended dose; in the second part, we evaluated the efficacy and safety of the recommended dose. The primary end point was the objective response, according to independent central review. Key secondary end points were the disease-control rate, clinical-benefit rate, duration of response and progression-free survival, and safety.

RESULTS

Overall, 184 patients who had undergone a median of six previous treatments received the recommended dose of trastuzumab deruxtecan (5.4 mg per kilogram of body weight). In the intention-to-treat analysis, a response to therapy was reported in 112 patients (60.9%; 95% confidence interval [CI], 53.4 to 68.0). The median duration of follow-up was 11.1 months (range, 0.7 to 19.9). The median response duration was 14.8 months (95% CI, 13.8 to 16.9), and the median duration of progression-free survival was 16.4 months (95% CI, 12.7 to not reached). During the study, the most common adverse events of grade 3 or higher were a decreased neutrophil count (in 20.7% of the patients), anemia (in 8.7%), and nausea (in 7.6%). On independent adjudication, the trial drug was associated with interstitial lung disease in 13.6% of the patients (grade 1 or 2, 10.9%; grade 3 or 4, 0.5%; and grade 5, 2.2%).

CONCLUSIONS

Trastuzumab deruxtecan showed durable antitumor activity in a pretreated patient population with HER2-positive metastatic breast cancer. In addition to nausea and myelosuppression, interstitial lung disease was observed in a subgroup of patients and requires attention to pulmonary symptoms and careful monitoring. (Funded by Daiichi Sankyo and AstraZeneca; DESTINY-Breast01 ClinicalTrials.gov number, NCT03248492.).

Early Detection of Endolymphatic Hydrops using the Auditory Nerve Overlapped Waveform (ANOW)

Endolymphatic hydrops is associated with low-frequency sensorineural hearing loss, with a large body of research dedicated to examining its putative causal role in low-frequency hearing loss. Investigations have been thwarted by the fact that hearing loss is measured in intact ears, but gold standard assessments of endolymphatic hydrops are made postmortem only; and that no objective low-frequency hearing measure has existed. Yet the association of endolymphatic hydrops with low-frequency hearing loss is so strong that it has been established as one of the important defining features for Ménière's disease, rendering it critical to detect endolymphatic hydrops early, regardless of whether it serves a causal role or is the result of other disease mechanisms. We surgically induced endolymphatic hydrops in guinea pigs and employed our recently developed objective neural measure of low-frequency hearing, the Auditory Nerve Overlapped Waveform (ANOW). Hearing loss and endolymphatic hydrops were assessed at various time points after surgery. The ANOW detected low-frequency hearing loss as early as the first day after surgery, well before endolymphatic hydrops was found histologically. The ANOW detected low-frequency hearing loss with perfect sensitivity and specificity in all ears after endolymphatic hydrops developed, where there was a strong linear relationship between degree of endolymphatic hydrops and severity of low-frequency hearing loss. Further, histological data demonstrated that endolymphatic hydrops is seen first in the high-frequency cochlear base, though the ANOW demonstrated that dysfunction begins in the low-frequency apical cochlear half. The results lay the groundwork for future investigations of the causal role of endolymphatic hydrops in low-frequency hearing loss.

82 Stage-specific expression of lineage marker genes and pluripotency marker distribution in porcine pre-implantation embryos

Lineage specification in pre-implantation embryos has been revealed, and it was expedited recently by single cell studies. However, data on expression marker genes and proteins in porcine embryos were still missing. We aimed to investigate the expression and distribution of marker genes and proteins, respectively, in IVF and parthenogenetically activated (PA) embryos. For this, cumulus-free oocytes were co-incubated with sperm in modified Tris-buffered medium (mTBM) for 5h and PA was performed using an electric pulse in activation medium. Following this, the embryos were incubated in porcine zygote medium 3 (PZM3). We first tested gene expression level of lineage candidates (internal control; β-actin). In IVF embryos (30, 25, 20, 15, 10, and 5 embryos pooled on Day 2, 3, 4, 5, 6, and 7; replicated 3 times), trophectoderm (TE)-specific genes (Dab2, Gata3) showed peaks on Day 4-5. Within the 2 genes, Dab2 had an earlier peak than Gata3. Inner cell mass (ICM) marker candidates (Nanog, Sox2, and Hnf4a) had diverse patterns. The Nanog and Sox2 genes had peak expression on Day 3. The Nanog expression dropped gradually, but Sox2 dropped suddenly on Day 4. Otherwise, Hnf4a expressed little in Day 3 and expression was sustained from Day 4 to 7. Primitive endoderm markers showed the highest expression on Day 4. We also checked expression level of ICM markers (Sox2, Oct4, and Nanog) in PA embryos (20, 20, 20, 10, and 5 embryos were pooled in 2, 4, 6-8 cells, morula, early, and late blastocyst stages; replicated 3 times). Expression of markers was similar (the highest in the 6-8-cell stage; at least 7.3-, 4.5-, and 3.7-fold compared with the other stages in Sox2, Oct4, and Nanog). We used analysis of variance and Tukey's test for statistical analysis. Following this, we conducted immunocytochemistry with both IVF and PA embryos (20 in each condition). Primary antibodies were treated overnight at 4°C and appropriate secondary antibodies were treated 1h at room temperature. In the case of IVF, well-known ICM markers (SOX2, OCT4, NANOG, and SOX17) showed restricted distribution in nuclei of ICM cells. However, DAB2 was distributed in the cytoplasm of TE cells. In PA embryos, SOX2 and NANOG distributions were similar to IVF. The OCT4 in ICM cells from morula to early blastocyst was restricted, but not in Day 7 embryos. In conclusion, marker genes showed diverse expression pattern in IVF, but all ICM-specific genes had a similar pattern in PA. Also, ICM marker proteins were restricted in nuclei of ICM cells only except Day 7 PA. Our results provide eye-opening information on marker contribution to lineage specification of porcine embryos. This work was supported by the National Research Foundation in Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032256, NRF-2019R1C1C1004514).

81 Linoleic acid required for reduction of apoptosis through nuclear transcription factor-kappa B during pig embryo development

Recent studies suggest that endogenous and exogenous free fatty acids play various important roles in mammalian oocyte and pre-implantation embryo development. Among fatty acids, linoleic acid (LA) has been reported to affect the apoptosis pathway via nuclear transcription factor-kappa B (NF-κB). The transcription factor NF-κB is a key modulator of apoptosis in a variety of cell types, but to date, this specific function of NF-κB has not been demonstrated in porcine pre-implantation embryos. To examine the effect of linoleic acid on invitro-produced parthenogenetic pig embryos, we treated LA by concentration (0, 10, 25, 50, and 100 µM) to identify developmental rate, NF-κB expression, and mRNA level of apoptotic-related genes. In addition, the mechanism was confirmed by examining the protein and mRNA expression of NF-kb and c-jun by immunostaining and quantitative PCR at the blastocyst stage. Linoleic acid had a positive effect on embryo development without toxicity at a certain concentration (25 µM), but toxicity was confirmed at higher (50-100μM) concentrations. Furthermore, it was confirmed that the concentration of NF-κB increased as the treatment concentration of LA increased, which was found to increase even at the concentration at which embryo development decreased. Previous studies have shown that the NF-κB pathway is involved in regulating anti- and pro-apoptotic gene expression. We also investigated the effects of LA on anti- (Bcl-xL, Mcl-1) and pro- (BAX1, TP53, Caspase3) apoptotic genes and NF-κB activation-related genes (RelA, JNK1, JNK2, IL-6) in porcine embryos. We have found that down-regulation of pro-apoptotic gene expression occurs in the LA-treated group. It was also found that Bcl-xL, one of the anti-apoptotic genes, was not affected by LA, which appears to be an effect of IL-6. In contrast, Mcl-1, an anti-apoptotic gene known not to be affected by IL-6, was found to have increased expression mRNA level in LA-treated pig embryos. Furthermore, through double-staining of apoptosis and immunocytochemistry, as the concentration of NF-kB level increases, the nuclear translocation of c-jun, the protein of which was also related with apoptosis, increased gradually depending on the LA concentration. These data could support that porcine embryo can use exogenous LA as a metabolic energy source. The data also demonstrate the important role of NF-kB in porcine early embryo development. Support was provided by the Korea Institute of Planning and Evaluation for Technology in Food, Agriculture, Forestry and Fisheries (IPET) through the Development of High Value-Added Food Technology program funded by the Ministry of Agriculture, Food and Rural Affairs (MAFRA, 118042-03-1-HD020).

Community exchange and time currencies: a systematic and in-depth thematic review of impact on public health outcomes

OBJECTIVES

Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population health and become part of a transformed place-based system of community health and social care. As non-monetary place-based approaches, Community Exchange/Time Currencies could improve social contact and cohesion, and help mobilise families, neighbourhoods, communities and their assets in beneficial ways for health. Despite this interest, the evidence base for health outcomes resulting from such initiatives is underdeveloped.

STUDY DESIGN

A systematic review.

METHODS

A literature review was conducted to identify evidence gaps and advance understanding of the potential of Community Exchange System. Studies were quality assessed, and evidence was synthesised on 'typology', population targeted and health-related and wider community outcomes.

RESULTS

The overall study quality was low, with few using objective measures of impact on health or well-being, and none reporting costs. Many drew on qualitative accounts of impact on health, well-being and broader community outcomes. Although many studies lacked methodological rigour, there was consistent evidence of positive impacts on key indicators of health and social capital, and the data have potential to inform theory.

CONCLUSIONS

Methodologies for capturing impacts are often insufficiently robust to inform policy requirements and economic assessment, and there remains a need for objective, systematic evaluation of Community Exchange and Time Currency systems. There is also a strong argument for deeper investigation of 'programme theories' underpinning these activities, to better understand what needs to be in place to trigger their potential for generating positive health and well-being outcomes.

Abstract C041: Safety and pharmacokinetic results from a phase 1, multicenter, open-label study of [fam-] trastuzumab deruxtecan (T-DXd; DS-8201a) in subjects with advanced HER2-positive breast cancer

Background: Anti-HER2 therapies are beneficial for patients with HER2+ gastric or breast cancer (BC). [Fam-] trastuzumab deruxtecan (T-DXd; formerly DS-8201a) is an antibody-drug conjugate (ADC) composed of an anti-HER2 antibody (Ab) conjugated by a peptide-based cleavable linker to a novel exatecan-derived topoisomerase I inhibitor (MAAA-1181a). The phase 1 study (NCT02564900) of T-DXd conducted at study sites in the US and Japan showed a manageable safety profile at the recommended doses for expansion (5.4 and 6.4 mg/kg) and a confirmed objective response rate (ORR) of 59.5% in subjects with HER2+ BC; however, safety and pharmacokinetic (PK) analyses from other Asian populations are lacking. Methods: This is a phase 1, open-label study (NCT03368196) conducted at 2 sites in Taiwan. Eligible HER2+ BC subjects were ≥ 20 years of age and received T-DXd 6.4 mg/kg intravenously once every 3 weeks until unacceptable toxicity, progressive disease (PD), or withdrawal from the study. The primary objective was to assess the safety and tolerability of T-DXd. Secondary objectives included assessment of PK and efficacy and incidence of anti-drug Abs (ADA) against T-DXd. Results: All subjects (N = 12) were Asian and female with HER2+ BC (11 IHC3+; 1 IHC2+); median age was 55 y (range, 36-69 y). Prior HER2-directed treatments included trastuzumab (100%), pertuzumab (50%), T-DM1 (33%), and lapatinib (8.3%). At data cutoff (Sept 14, 2018), the median treatment duration was 20 wk (range, 12-24 wk), and treatment was ongoing in all 12 subjects. The ORR (complete response [CR] + partial response [PR]) among 11 evaluable subjects was 36.4% (95% CI, 10.9%-69.2%; all PR); the disease control rate (CR + PR + SD) was 100% (95% CI, 71.5%-100.0%). By data cutoff, all subjects experienced ≥ 1 treatment-emergent adverse event (TEAE; grade ≥ 3, 58.3%), none of which led to discontinuation. The most common TEAEs were nausea (58%), decreased platelet count (58%), increased aspartate aminotransferase (50%), decreased white blood cell count (42%), decreased appetite (33%), anemia (33%), and fatigue (25%). One drug-related serious AE (febrile neutropenia) occurred, and 2 TEAEs led to dose reductions (grade 3 febrile neutropenia and grade 4 decreased platelet count). One AE of special interest occurred (grade 1 LVEF decrease). No events of pulmonary toxicity occurred and no deaths were reported. At cycle 1, the mean maximum concentration (Cmax) and area under the curve (AUCtau) of T-DXd were 157 µg/mL (SD, 19.1) and 631 day•µg/mL (SD, 173), respectively; for MAAA-1181a, the Cmax was 11.9 ng/mL (3.79) and the AUC was 36.1 day•µg/mL (9.71). PK parameters of total anti-HER2 Ab were similar to those of T-DXd. Some accumulation of T-DXd (57%) was seen at cycle 3 (Cmax, 163 µg/mL [SD, 19.5]; AUCtau, 991 day•µg/mL [SD, 109]). These PK results were similar to those of T-DXd, total HER2 Ab, and MAAA-1181a reported in other studies in HER2+ BC. All subjects were negative for ADA at all assessments. Conclusions: This is the first report of the efficacy, safety, and PK of T-DXd in Taiwan; T-DXd showed a manageable safety profile with no new safety signals. Despite the small number of subjects, results were similar to those previously reported and provide additional evidence of the clinical benefit of T-DXd in subjects with HER2+ tumors.

Citation Format: Dwan-Ying Chang, Chia-Chi Lin, Tom Wei-Wu Chen, Ching-Hung Lin, Jih-Hsiang Lee, Ta-Chung Chao, Chun-Yu Liu, Issei Achiwa, Emi Kamiyama, Yasuyuki Okuda, Caleb Lee, Yee Chao. Safety and pharmacokinetic results from a phase 1, multicenter, open-label study of [fam-] trastuzumab deruxtecan (T-DXd; DS-8201a) in subjects with advanced HER2-positive breast cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C041. doi:10.1158/1535-7163.TARG-19-C041

Evaluation of Product Quality of Low-Salt Pork Sausage Using Prerigor Pork Ham

ObjectivesThe objective of this study was to develop pork sausages with reduced salt content using the pre-rigor pork ham to have similar product quality to regular-salt (1.5%) sausages.Materials and MethodsPork ham with pre-rigor (< 1 h after slaughter) and post-rigor (> 1 d after slaughter) were purchased at the local market. Sausages containing pre-rigor pork hams with various salt contents (0– ∼1.5%) were manufactured and compared to the post-rigor sausages with regular salt (1.5%). To confirm the states of pre-rigor and post-rigor, pH and temperature of pork hams were measured. The pH, color, cooking loss (CL, %), expressible moisture (EM, %), textural properties, lipid oxidation (TBAR), protein oxidation (VBN) of the sausages were measured, while the protein solubility and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) of meat batter were measured. The experiment design was one-way analysis of variance at a significant level of 0.05.ResultsThe pre-rigor ham had higher pH and temperature than the post-rigor ham, as expected. Protein solubility of pre-rigor sausages was higher than those with reduced salt concentrations (< 1.0%). However, no differences in CIE color values (L*, a*, b*), CL, TBARS, and VBN were observed among treatments. The EM (%) of pre-rigor sausages with 0.5 and 1.0% salt were similar to those with pre-rigor sausages with 1.5% salt. Textural properties of sausages were not different between pre-rigor with various salt levels (0.5∼1.5%) and post-rigor sausages with 1.5% salt. High intensity of myosin heavy chain band was shown in pre-rigor meat batters as compared to the post-rigor ones.ConclusionPre-rigor sausages containing 1.0% salt had similar characteristics to those with post-rigor with 1.5% salt. This result indicated that the amount of salt on sausages could be reduced by approximately one-third of regular-salt (1.5%) level without detrimental effects.

Selection of reference genes for quantitative studies in acute myeloid leukaemia

INTRODUCTION

Quantitative polymerase chain reaction (qPCR) is commonly used in the investigation of acute myeloid leukaemias (AML). Stable reference genes (RG) are essential for accurate and reliable reporting but no standard method for selection has been endorsed.

MATERIALS AND METHODS

We evaluated simple statistics and published model-based approaches. Multiplex-qPCR was conducted to determine the expression of 24 candidate RG in AMLs (N=9). Singleplex-qPCR was carried out on selected RG (SRP14, B2M and ATP5B) and genes of interest in AML (N=15) and healthy controls, HC (N=12).

RESULTS

RG expression levels in AML samples were highly variable and coefficient of variance (CV) ranged from 0.37% to 10.17%. Analysis using GeNorm and Normfinder listed different orders of most stable genes but the top seven (ACTB, UBE2D2, B2M, NF45, RPL37A, GK, QARS) were the same. In singleplex-qPCR, SRP14 maintained the lowest CV in AML samples. B2M, one of most stable reference genes in AML, was expressed near significantly different in AML and HC. GeNorm selected ATP5B+SRP14 while Normfinder chose SRP14+B2M as the best two RG in combination. The median expressions of combined RG genes in AML compared to HC were less significantly different than individually implying smaller expression variation after combination. Genes of interest normalised with RG in combination or individually, displayed significantly different expression patterns.

CONCLUSIONS

The selection of best reference gene in qPCR must consider all sample sets. Model-based approaches are important in large candidate gene analysis. This study showed combination of RG SRP14+B2M was the most suitable normalisation factor for qPCR analysis of AML and healthy individuals.

An interview project with native American people: a community-based study to identify actionable steps to reduce health disparities

OBJECTIVES

The primary objective of this study was to work with tribal communities to define and develop their own healthcare services and strategies for positive change regarding injection drug use, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) infection. The secondary objective of this study was to incorporate community capacity building strategies to develop and sustain programming and resources to optimize tribal communities' responsiveness to reduce health disparities.

STUDY DESIGN

Semi-structured qualitative interviews.

METHODS

Interviews were guided by community-based participatory research (CBPR) principles to create programs, projects, and policy recommendations meaningful to American Indian and Alaska Native (AI/AN) people.

RESULTS

The study generated a formative understanding of the context of AI/AN people who inject drugs (PWID) in three distinct AI/AN communities as well as developed local capacity for future programming, projects, and policy.

CONCLUSIONS

This study confirms CBPR methods should be part of an iterative cycle to inform policy and programs. CBPR has helped strengthen local research capacity and has formed ongoing relationships between study investigators, local liaisons, and the community that will be essential for next phases of program design and policy implementation. This cycle of CBPR could be replicated in other tribal communities to bring awareness of the opioid epidemic and its effects and to prioritize local indigenous and community-led responses.

Identifying research priorities for psychosocial support programs in humanitarian settings

BACKGROUND

Given the range and reach of psychosocial support (PSS) interventions in humanitarian settings, within the continuum of mental health and psychosocial support services, evaluation of their impact is critical. Understanding stakeholders' perspectives on which PSS interventions of unknown effectiveness warrant rigorous evaluation is essential to identify research priorities. This project aimed to facilitate a process with stakeholders to reach consensus on PSS interventions that are of high priority for further research based on existing evidence and stakeholders' opinions.

METHODS

Interviews with 109 stakeholders working on PSS programming in humanitarian settings served as the foundation for two in-person regional meetings and four webinars. Nominal Group Technique (NGT) was used to develop a priority PSS program list. The top five priorities from each meeting were combined for a final online survey distributed globally.

RESULTS

Seventy participants across six meetings contributed to the prioritization process. Eighty-seven individuals completed the final online survey. 'Community based PSS' was the top-ranked research priority, followed by PSS integrated into basic services, providing PSS to caregivers to improve child wellbeing, PSS-focused gender-based violence programming, and classroom-based PSS interventions.

CONCLUSIONS

NGT and online surveys were effective methods to engage stakeholders in a priority setting exercise to development a research agenda. Information from this stage of the project will be combined with findings from a concurrent systematic review to form the base of a second phase of work, which will include the development and implementation of a research strategy to strengthen the evidence base for those prioritized interventions.

2379Endothelial cell derived extracellular vesicles mediate immune cell deployment from the spleen and transcriptional programming following acute myocardial infarction

Background

Acute myocardial infarction (AMI) induces transcriptional activation of monocyte en route to the injured myocardium, possibly through interactions involving plasma liberated extracellular vesicles (EVs), which are enriched for proteins and microRNAs (miRNAs) post-AMI. Neutrophils are the first immune cells to arrive at sites of injury and mediate further damage to the ischaemic myocardium. Here, we describe neutrophil-deployment from the spleen in AMI and by endothelial cell (EC) derived-EVs.

Methods

Patients presenting AMI provided informed consent as part of the Oxford Acute Myocardial Infarction Study (OxAMI). Plasma EV were isolated by differential ultra-centrifugation (120,000g, 2 hours) followed by washing and characterised for: morphology using transmission electron microscopy (TEM), size and concentration profiling by Nanoparticle Tracking Analysis, EV markers (TSG101, ALIX, CD9, HSP70) by western blot, and miRNAs by RT-qPCR. Mouse and human EC were used in vitro to derive EC-EV under control conditions or after inflammatory stimulation with tumour necrosis factor-alpha (TNF-α) (10ng/mL) and from CRISPR-edited miRNA-126 knock-out ECs. EC-EVs were tail vein injected into wild-type mice or exposed to primary human peripheral blood neutrophils in vitro.

Results

Patients presenting with AMI (N=15) have significantly more plasma EV at time of injury vs a 6-month follow-up measurement (2.2-fold more, P=0.008). Plasma EVs at the time of AMI presentation correlate significantly with the extent of ischaemic injury (R=0.046, P=0.006) and plasma neutrophils (R=0.37, P=0.017). Experimental AMI in wild-type mice induced a significant increase in peripheral blood neutrophils and a simultaneous reduction in splenic-neutrophils, suggesting splenic-neutrophil deployment (P=0.004). Human plasma EV are enriched for vascular cell adhesion molecule-1 (VCAM-1) and EC-associated miR-126 post-AMI (Akbar et al 2017). miRNA-126-mRNA targets are significantly over represented when compared to neutrophil Gene Ontology terms for: degranulation (P<0.001), activation (P<0.001), chemotaxis (P=0.008) and migration (P=0.008). Human and mouse EC release more EV after inflammatory stimulation and show enrichment for miRNA-126. CRISPR-edited miRNA-126 deficient human EC express more VCAM-1 (P<0.001) and release more EC-EVs (P<0.001). EC-EV exposure to primary human neutrophils alters inflammatory gene expression (IL-6 (P<0.05), CCL7 (P<0.001) and CCL18 (P<0.001)). EC-EV tail vein injected into wild-type mice mobilise splenic-neutrophils to peripheral blood (P<0.001).

Conclusions

Neutrophil deployment from the spleen is a novel finding in acute injury and interactions with EC-EV may mediate their splenic liberation and transcriptional programming following AMI, en route to the injured myocardium. The splenic neutrophil reserve may be a novel therapeutic target in AMI to modulate the inflammatory response before recruitment of cells to sites of injury.

Acknowledgement/Funding

British Heart Foundation Project Grant and Centre for Research Excellence Awards (RE/13/1/30181), Nuffield Benefaction for Medicine and ISSF

Radiation dose to the lens from CT of the head in young people

AIM

To determine cumulative scan frequencies and estimate lens dose for paediatric computed tomography (CT) head examinations in the context of potential cataract risk.

MATERIALS AND METHODS

The cumulative number of head-region CT examinations among a cohort of 410,997 children and young adults who underwent CT in the UK between 1985 and 2014 was calculated. Images from a sample of these head examinations (n=668) were reviewed to determine the level of eye inclusion. Lens dose per scan was estimated using the computer program, NCICT V1.0, for different levels of eye inclusion and exposure settings typical of past and present clinical practice.

RESULTS

In total 284,878 patients underwent 448,108 head-region CT examinations. The majority of patients (72%) had a single recorded head-region examination. A small subset (∼1%, n=2,494) underwent ≥10 examinations, while 0.1% (n=387) underwent ≥20. The lens was included within the imaged region for 57% of reviewed routine head examinations. In many cases, this appeared to be intentional, i.e. protocol driven. In others, there appeared to have been an attempt to exclude the eyes through gantry angulation. Estimated lens doses were 20-75 mGy (mean: 47 mGy) where the eye was fully included within the examination range and 2-7 mGy (mean: 3.1 mGy) where the lens was fully excluded. Potential cumulative lens doses ranged from ∼3 mGy to ∼4,700 mGy, with 2,335 patients potentially receiving >500 mGy.

CONCLUSION

The majority of young people will receive cumulative lens doses well below 500 mGy, meaning the risk of cataract induction is likely to be very small.

194SGLT-2 inhibitors versus GLP-1 receptor agonists and risk of mortality, chronic kidney disease and hospitalisation for heart failure in patients with type 2 diabetes

Background

Two promising classes of second-line glucose-lowering drugs, the sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), have both been shown to lower the risk of cardiovascular (CV) outcomes in patients with type 2 diabetes, however no head-to-head comparisons exist.

Purpose

The aim of this study was to examine the risk of CV and all-cause mortality, incident chronic kidney disease (CKD) and hospitalisation for heart failure (HF) in association with SGLT-2i versus GLP-1RA use.

Methods

New users of SGLT-2i and GLP-1RA, with no prior use of drugs from the comparison class, were identified between 2012–2016, using individual-level linkage of Danish nationwide registries. The absolute risk of CV was calculated using the Aalen-Johansen Estimator with non-CV mortality as competing risk. The hazard ratios (HR) of CV and all-cause mortality, incident CKD and hospitalisation for HF were estimated using Cox regression and adjusted for age, sex, diabetes duration and other outcome specific risk factors.

Results

The study included a total of 8,304 SGLT-2i users (median age: 63 years [interquartile range (IQR): 54–70], males: 63%, dapagliflozin: 60.5%, empagliflozin: 36.5%) and 13,318 GLP-1RA users (median age: 60 years [IQR: 50–68], males: 54%, liraglutide: 97.4%) with a median follow-up time of 2.0 [(IQR): 1.5–2.9] years and 3.6 [IQR: 2.1–5.0] years, respectively. At baseline 29% of SGLT-2i and 30% of GLP-1RA users had CV disease. The absolute risks are shown in Figure 1. Compared with GLP-1RA, initiation of SGLT-2i was in adjusted analyses associated with a lower risk of CV mortality (HR: 0.49 [confidence interval (CI): 0.37–0.65]), all-cause mortality [HR: 0.79 [CI: 0.68–0.93], incident CKD (HR: 0.42 [CI: 0.34–0.53] and hospitalisation for HF (HR: 0.68 [CI: 0.59–0.78]).

Figure 1

Conclusion

SGLT-2i use was associated with a significantly lower risk of CV and all-cause mortality, incident CKD and hospitalisation for HF in comparison with GLP-1RA use.

Acknowledgement/Funding

The Danish Heart Foundation (18-R125-A8381-22082)

Effects of supplementing rumen-protected lysine and methionine during prepartum and postpartum periods on performance of dairy cows

An experiment was conducted to examine effects of prepartum, postpartum, or continuous prepartum and postpartum supply of rumen-protected lysine (RPLys) and rumen-protected methionine (RPMet) on performance and blood metabolites of transition cows. The experiment consisted of a prepartum (3 wk), postpartum (3 wk), and carryover (10 wk) period. Eighty-eight prepartum cows (36 primiparous and 52 multiparous cows) were blocked by parity and expected calving date and assigned to 1 of 4 treatments arranged factorially. Treatments were a prepartum diet (12% crude protein on a dry matter basis) without (Pre-) or with supplemental RPLys (10 g of digestible Lys/cow per day) and RPMet (4 g of digestible Met/cow per day; Pre+) followed by postpartum diets (16% crude protein on a dry matter basis) without (Post-) or with supplemental RPLys (26 g of digestible Lys/cow per day) and RPMet (11 g of digestible Met/cow per day; Post+). Prepartum, only 2 treatments were applied, but postpartum cows received treatments of Pre-Post-, Pre-Post+, Pre+Post-, or Pre+Post+. During the prepartum period, treatment did not affect dry matter intake and body weight. During the postpartum period, milk protein content was greater (3.23 vs. 3.11%) for Post+ compared with Post- independent of prepartum treatment. However, dry matter intake, body weight, milk yield, and yields of milk components were not affected by Post+ versus Post-. No effects of prepartum treatment or interactions between pre- and postpartum treatments were observed on postpartum performance of cows. No effects of pre- and postpartum supplementation of RPLys and RPMet on performance during the carryover period were found except prepartum supplementation of RPLys and RPMet decreased somatic cell count (4.60 vs. 4.83; log₁₀ transformed) compared with Pre- in the postpartum period and this effect continued during the carryover period [i.e., 4.42 and 4.55 (log₁₀ transformed) for Pre+ and Pre-, respectively]. Prepartum supplementation of RPLys and RPMet increased or tended to increase plasma concentration of Lys, Met, and branched-chain AA compared with Pre- in prepartum cows. Cows on Post+ tended to have greater plasma Lys concentration compared with Post-, but plasma Met concentration was not affected. Health events of postpartum cows were not affected by treatments. In conclusion, we did not observe positive effects of supplementing with RPLys and RPMet on performance of prepartum and postpartum cows. However, prepartum supply of RPLys and RPMet may have potential to improve udder health and immune status of fresh cows.

P14.30 Treatment outcomes of newly-diagnosed glioblastoma multiforme (GBM) by O6-methylguanine DNA methyltransferase promoter (MGMT) status: a multi-country study

INTRODUCTION

This study evaluated the relationship of MGMT status with first-line (1L) treatment outcomes of patients with newly-diagnosed GBM in France, Germany, Italy, Spain, the UK (EU5), and Canada.

MATERIALS AND METHODS

Medical oncologists and neuro-oncologists across EU5 and Canada completed a point in time, cross-sectional survey for the next 8 GBM patients seen between May and July 2016 within EU5 and Canada. All results apart from time to progression (TTP) were presented for patients receiving 1L active drug treatment. TTP was calculated from initiation of 1L treatment to initiation of second-line treatment. Results presented are statistically significant (p<0.05) unless otherwise specified. Bases vary depending on data availability.

RESULTS

A total of 241 physicians reported on 1747 patients with GBM. 875 were receiving 1L active drug treatment at time of survey. Mean age was 59.7 years (median=61) and 34.6% were women. Mean life expectancy was 14.9 months (median=12) at diagnosis and mean TTP was 8.5 months (median=7.3). Surgery was performed in 62% of patients (n=546) prior to 1L drug treatment; 38% of patients (n=329) had no surgery. Patients with surgery had a higher life expectancy at diagnosis vs patients with no surgery prior to 1L (mean=16.4 vs 12.2 months; median=15.0 vs 12.0). Patients who received corticosteroids (n=524) vs no corticosteroids during radiotherapy (n=64) had a shorter life expectancy at diagnosis (mean=15.0 vs 16.8 months, p=0.07; median=12.5 vs 13.9) and were more likely to have 8 or more inpatient days due to GBM (21% vs 8%, p=0.07) in the last 3 months prior to the survey. 62% of patients (n=541) had an MGMT-status recorded (tested: methylated or unmethylated), and 38% (n=334) were untested/ awaiting results (untested) at 1L. MGMT-tested patients had better life expectancy at diagnosis (mean=16.1 vs 12.9 months; median=15.0 vs 12.0) and longer TTP (mean=8.9 vs 7.8 months; median=7.8 vs 6.4) than untested patients. Among MGMT-tested patients, 58% were methylated and 42% were unmethylated. Methylated patients had similar life expectancy at diagnosis (mean=15.9 vs 16.3 months, p=0.85; median=15.0 vs 15.0) and TTP (mean=9.0 vs 8.8 months, p=0.42; median=8.0 vs 7.5) as unmethylated patients.

CONCLUSIONS

This analysis provides valuable insights into the 1L treatment outcomes of GBM patients in EU5 and Canada. Patients who did not undergo surgery had worse treatment outcomes. Steroid use appears to be associated with worse outcomes and higher healthcare resource utilization. Patient treatment outcomes varied depending on whether they are MGMT tested.

P14.36 Treatment patterns by O6-methylguanine DNA methyltransferase promoter (MGMT) status in newly-diagnosed glioblastoma multiforme (GBM): a multi-country chart review study

INTRODUCTION

This study explored the relationship between MGMT testing and treatment patterns of patients with newly-diagnosed GBM from France, Germany, Italy, Spain, the UK (EU5), and Canada.

MATERIALS AND METHODS

Medical oncologists and neuro-oncologists across EU5 and Canada completed a point in time, cross-sectional survey for the next eight GBM patients seen between May and July 2016 (GBM Disease-specific ProgrammeTM). Statistically significant differences (p<0.05) between groups are presented.

RESULTS

A total of 241 physicians reported on 1,747 GBM patients. 1L patients had mean age 59.7 years (SD=12.3) and 36% were female. Of 1,113 (64%) patients who had an MGMT test performed with results recorded (tested), 58% (n=651) were methylated and 42% (n=462) were unmethylated. The remaining 634 patients (36%) were MGMT untested or awaiting MGMT results at time of survey (untested). Overall, 63% of patients received surgery prior to their 1L drug therapy, 78% received radiotherapy (RT; mean 4.3 sessions) in conjunction with 1L drug therapy, 90% received corticosteroids during RT, and 89% received temozolomide (TMZ). Patients who received corticosteroids during RT received similar drug treatments to those that did not, but were less likely to receive surgery prior to 1L treatment (65% vs 83%). MGMT-tested patients were more likely to receive surgery (66% vs 57%) and RT (81% vs 71%) than untested patients. Tested patients were also more likely to receive TMZ (92% vs 83%), and less likely to receive procarbazine+/lomustine+/vincristine (PCV; 3% vs 7%) or other chemotherapies (5% vs 11%). For 1L patients that experienced side effects, the most common effects included fatigue (74%), nausea (60%), and appetite loss (59%). Untested patients were more likely to stop their 1L drug treatment due to progression/recurrence of GBM (44% vs 36%). Patients who received surgery prior to 1L treatment were more likely to receive TMZ than those who did not (93% vs 82%). Among MGMT tested patients at 1L, methylated patients were more likely to receive RT (84% vs 78%) and TMZ (95% vs 89%) than unmethylated patients, and less likely to receive PCV (2% vs 5%) or other chemotherapy (4% vs 7%). Methylated patients with reported treatment-related side effects were less likely to experience dehydration (0% vs 10%), loss of strength/unusual weakness (5% vs 25%), memory problems (16% vs 35%), and nausea (51% vs 75%).

CONCLUSIONS

More than one-third of GBM patients in EU5 and Canada are not tested for MGMT-methylation. Untested patients are less likely to receive standard treatments than tested patients. Generally, TMZ is used in most patients regardless of MGMT testing and status. MGMT-methylated patients are more likely to receive standard treatments and experience fewer side effects than MGMT-unmethylated patients.

Predicting the Debonding of CAD/CAM Composite Resin Crowns with AI

A preventive measure for debonding has not been established and is highly desirable to improve the survival rate of computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin (CR) crowns. The aim of this study was to assess the usefulness of deep learning with a convolution neural network (CNN) method to predict the debonding probability of CAD/CAM CR crowns from 2-dimensional images captured from 3-dimensional (3D) stereolithography models of a die scanned by a 3D oral scanner. All cases of CAD/CAM CR crowns were manufactured from April 2014 to November 2015 at the Division of Prosthodontics, Osaka University Dental Hospital (Ethical Review Board at Osaka University, approval H27-E11). The data set consisted of a total of 24 cases: 12 trouble-free and 12 debonding as known labels. A total of 8,640 images were randomly divided into 6,480 training and validation images and 2,160 test images. Deep learning with a CNN method was conducted to develop a learning model to predict the debonding probability. The prediction accuracy, precision, recall, F-measure, receiver operating characteristic, and area under the curve of the learning model were assessed for the test images. Also, the mean calculation time was measured during the prediction for the test images. The prediction accuracy, precision, recall, and F-measure values of deep learning with a CNN method for the prediction of the debonding probability were 98.5%, 97.0%, 100%, and 0.985, respectively. The mean calculation time was 2 ms/step for 2,160 test images. The area under the curve was 0.998. Artificial intelligence (AI) technology-that is, the deep learning with a CNN method established in this study-demonstrated considerably good performance in terms of predicting the debonding probability of a CAD/CAM CR crown with 3D stereolithography models of a die scanned from patients.

Automatic matching of computed tomography and stereolithography data

BACKGROUND AND OBJECTIVE

Computed tomography (CT) is one of the most frequently used medical imaging methods. An important application area of CT is dental implants, which require precise inspection and analysis of oral structures. Since CT provides a precise 3D model of the teeth, bones and nerves, it can be used as a surgical guide for dental implants. Along with CT, optical 3D images called stereolithography (STL) have also been widely used. STL images obtained from optical 3D images can be used to show the 3D surfaces of oral structures. Since CT data and STL data deploy different technologies to obtain dental information, we can obtain more accurate dental implants by combining the two datasets. Since the two datasets are acquired by using different sensors, the datasets need to be registered.

METHODS

An automatic matching algorithm is proposed for CT and STL image registration, which is based on depth maps and maximum intensity projection. Then, fine tuning was performed based on volume matching.

RESULTS

When applied to real-world databases, the proposed method provided an average matching error of 2.7 mm for the upper jaw and 2.3 mm for the lower jaw with an average processing time of about 19 s.

CONCLUSIONS

The proposed method performs accurate registration of CT and STL.