[Potentials and limits of aging cohort studies for geriatric psychiatry]

The sizeable number of population-based cohort studies of aging in Germany have provided highly valuable contributions for the specification of risk factors and predictors for frequent mental disorders in old age, especially dementia and depression. The results from these cohort studies enable the specification of mechanisms for the development of and preventative interventions for common mental disorders in old age. On the other hand, there is a significant paucity of clinical cohort studies investigating disease trajectories and possible markers for specific individualized interventions of frequent mental disorders in old age. In this article, we report selected key findings from cohort studies of aging and discuss novel approaches for the integration and harmonization of population-based and clinical cohort studies.

[Inpatient equivalent treatment : A new form of care also in gerontopsychiatry]

Seit 2018 ist es nach einer Novellierung des SGB V psychiatrischen Kliniken möglich, stationäre aufsuchende Behandlung im Lebensumfeld psychiatrisch Erkrankter zu realisieren. Dabei sind besondere Strukturmerkmale und Dokumentationspflichten zu beachten. So muss dem Behandlungsteam neben einem Mitglied der ärztlichen und der pflegerischen Berufsgruppe auch mindestens ein Mitglied einer dritten Berufsgruppe angehören (z. B. Ergotherapie, Sozialarbeit, Physiotherapie). Die Leistungsvergütung wird zwischen der jeweiligen Klinik und den Krankenkassen verhandelt und schließt, regional divergent, Abrechnungen nach Pauschalen, nach geleisteten Minuten oder gemischte Modelle ein. Aus psychiatrisch-psychotherapeutischer Sicht bietet die Behandlung gerontopsychiatrischer Patienten in ihrem Wohnumfeld und damit in ihren sozialen Kontexten viele Vorteile. Voraussetzung für ein Gelingen dieses Ansatzes ist ein auch in somatischen Erkrankungen erfahrenes und logistisch hochflexibles multiprofessionelles Behandlungsteam. Unter den Bedingungen der Coronapandemie stellen sich besondere Herausforderungen aufgrund der Besuchsverbote in Pflegeheimen und der mit aufsuchender Arbeit verbundenen Infektionsgefahr für Patienten und Mitglieder des Behandlungsteams.

18F-FDG-PET in guided dose-painting with intensity modulated radiotherapy in oropharyngeal tumours: A phase I study (FiGaRO)

BACKGROUND AND PURPOSE

The FiGaRO trial assessed the feasibility and safety of using an FDG-PET-based dose-painting technique to deliver a radiotherapy (RT) boostto the FDG-avid primary tumour in patients with locally advanced high and intermediate risk oropharyngeal cancer.

MATERIALS AND METHOD

Patients underwent a planning 18FDG-PET-CT scan, immobilised in the treatment position, after one cycle of induction chemotherapy. The volume of persistent FDG-avidity in the primary tumour was escalated to 71.5 Gy in30 fractions delivered using a simultaneous integrated boost Intensity Modulated RT (SIB-IMRT) technique. RT was delivered with concomitant Cisplatin following 2 cycles of induction chemotherapy. The primary outcome was the incidence of grade ≥ 3 late mucosal toxicity 12 months post-treatment, with an excess rate of >10% regarded as unacceptable.

RESULTS

Twenty-nine patients were included and twenty-four were treated between 2014 and 2018, in two UK centres. Median follow-up was 36 months (range 4-56 months). Pre-defined planning target volume objectives and organ at risk dose constraints were met in all cases. There were no incidents of acute grade 4 toxicity. There were 4 cases of grade ≥ 3 mucosal toxicity at 12 months post-treatment (19.1%). There were no cases of persistent mucosal ulceration at 12 months. Overall survival at 3-years was 87.5%, 92.9% for intermediate and 70.0% for high risk patients.

CONCLUSION

Late toxicity rates, although higher than anticipated, are comparable to contemporary published data for standard dose chemo-IMRT. Results suggest improved 3y survival rates for high risk patients. This approach merits further investigation. ClinicalTrials.gov Identifier: NCT02953197.

Integration of tools and social science into food safety risk assessments

The European Food Risk Assessment (EU-FORA) Fellowship work programme 'Integration of tools and social science into food safety risk assessments' was proposed and delivered by the Food Standards Agency (FSA), UK. The Food Standards Agency is a non-ministerial government department of the UK, responsible for protecting public health in relation to food in England, Wales and Northern Ireland. The programme was tailored to several different activities to provide an overview of the different tools that can be employed in food safety risk assessment also accounting for the interaction between risk assessment and social science. In order to structure the proposed work, the programme was split into four modules to run over the 12-month period of 'learning-by-doing'. In the first module, the fellow was introduced to Microbiological Risk Assessment (MRA), in the second to Chemical Risk Assessment (CRA), in the third to Social Science, and finally, in the fourth to the Risk Prioritization Tools and Networks in UK - National Dietary Data (NDNS), collection methodology, coding and analysis. The fellow was assigned to the Risk Assessment Unit within the Science, Evidence and Research Department which brings together specialist expertise from Microbiological, Chemical Risk Assessment, and Analytics Units, under one department together with additional staff from the food allergy and radiological risk assessment fields. The aim was to be fully integrated in the organisation's work gaining first-hand experience, increase knowledge of scientific aspects relevant to food safety risk assessment, and more importantly, to enhance network connection activities in the EU food risk assessment environment.

Abstract 90: Inducing and targeting senescence in HPV-negative head and neck squamous cancer cells

Background: The loss of normal cell cycle regulation via disruption of CDKN2A in HPV-negative (-) head and neck squamous cell carcinoma (HNSCC) is universal. Targeting CDK4/6 with a specific inhibitor, such as palbociclib, is therefore a logical strategy in this disease. Previous work has demonstrated that CDK4/6 inhibition leads to cell cycle arrest and senescence in cancer cells, and specifically HPV(-) HNSCC. Recent studies have also shown that the BCL-xL inhibitor, ABT-263 (navitoclax), effectively targets senescent cells. This study aimed to evaluate the efficacy and mechanism of a combination approach utilizing palbociclib and ABT-263 in HNSCC.

Methods: Three HPV (-) HNSCC cell lines (CAL27, HN31, PCI15B) were treated with palbociclib. Cresyl violet staining and annexin V apoptosis assays were used to assess cell viability in response to palbociclib, navitoclax, or the combination of the two drugs. Senescence following treatment with palbociclib was measured using β-galactosidase expression on western blot analysis, as well as via immunofluorescence staining assessed and quantified using confocal microscopy. Levels of BCL-xL were also measured using these methods.

Results: Following treatment with palbociclib, all cell lines exhibited phenotypic evidence of senescence, and protein expression of β-galactosidase was significantly increased compared to untreated controls (mean fold change ± SD: CAL27 2.67±0.26; HN31 1.79±0.41; PCI15B 1.26±0.15). Protein expression of BCL-xL was concurrently increased under these conditions (mean fold change ± SD: CAL27 1.57±0.04; HN31 1.58±0.39; PCI15B 1.33±0.17). Immunofluorescent staining was also used to determine if cells exhibiting senescence specifically demonstrated higher BCL-xL expression. Co-expression of β-galactosidase and BCL-xL showed a strong positive correlation (CAL27 r = 0.94, p < 0.0001; HN31 r = 0.94, p < 0.0001; PCI15B r = 0.71, p < 0.0001). Treatment with the combination of palbociclib and navitoclax resulted in significantly decreased survival compared to each agent alone in all HNSCC cell lines tested (data summarized for the cell line panel: mean percent survival, navitoclax 76.40%; palbociclib 38.76%; combination 16.74%). Annexin V apoptosis assay also revealed that there was a significant increase in apoptosis observed in all cell lines tested comparing each agent to combination treatment (data summarized for the cell line panel: mean percent apoptotic cells, navitoclax 35.53%; palbociclib 29.95%; combination 60.98%). Apoptosis with combination of palbociclib and navitoclax approached or exceeded levels achieved with staurosporine treated controls.

Conclusions: Palbociclib treatment leads to consistent induction of senescence in HPV (-) HNSCC. Adding a senolytic agent, such as the BCL-xL inhibitor ABT-263 (navitoclax) appears to be an effective strategy which holds promise in this disease.

Citation Format: Nicholas Gadsden, Carlos Thomas, Daniel Li, Nitisha Shrivastava, Nicolas Schlecht, Michael Prystowsky, Jeffrey Segall, Thomas Ow. Inducing and targeting senescence in HPV-negative head and neck squamous cancer cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 90.

Trend analysis and regional tumor incidence in Germany for testicular cancer between 2003 and 2014

BACKGROUND

Testicular germ cell tumor (TGCT) is one the most common solid tumors in men between the age of 15 and 35 with an overall incidence rate of 1-1.5 %. Epidemiologic studies have demonstrated different incidence patterns in western civilized countries with overall rising incidence trends.

OBJECTIVE

To analyze differences in regional tumor incidence rates for TGCT and perform a trend analysis for TGCT between 2003 and 2014 in Germany.

MATERIAL AND METHODS

TGCT cases in Germany which were diagnosed between 2003 and 2014 were provided by the Robert-Koch-Institute, Berlin. For statistical analysis, cluster and spatial scan tests according to Kulldorff were used for cases with seminoma and non-seminoma. Results are presented in administrative districts and graphically illustrated. We performed a trend-analysis in order to evaluate age-adjusted incidence trends in Germany. Tests were two-sided with a level of significance of α=0.05.

RESULTS

In total we included 35,066 patients. Overall, 22,634 cases had newly diagnosed seminoma and 12,432 were diagnosed as non-seminoma. Maximum incidence of seminoma and non-seminoma was observed for age-group 38-40 years and 26-28 years, respectively. No second peak for the incidences of seminoma and non-seminoma with respect to age were observed. Cluster analysis revealed areas with high and low incidence rates as well as slightly different spatial distribution in Germany between seminoma and nonseminoma. Furthermore, there was no significant increase in age-adjusted incidence rates over the reviewed time period in both cohorts.

DISCUSSION

In this study differences in reginal tumor incidence rates for seminoma and non-seminoma are reported with both tumor entities revealing distinct clusters. Furthermore, tumor incidence trends for seminoma and nonseminoma between 2003 and 2014 were stable which might indicate the beginning of a plateau phase for TGCT incidence rates in Germany.

CONCLUSION

In this analysis we were able to identify regions with significantly higher tumor incidence rates for both seminoma and non-seminoma which were specific for these two subtypes. Furthermore, trend analysis revealed a steady incidence rate for testicular cancer in Germany.

Coherent transport through a Majorana island in an Aharonov-Bohm interferometer

Majorana zero modes are leading candidates for topological quantum computation due to non-local qubit encoding and non-abelian exchange statistics. Spatially separated Majorana modes are expected to allow phase-coherent single-electron transport through a topological superconducting island via a mechanism referred to as teleportation. Here we experimentally investigate such a system by patterning an elongated epitaxial InAs-Al island embedded in an Aharonov-Bohm interferometer. With increasing parallel magnetic field, a discrete sub-gap state in the island is lowered to zero energy yielding persistent 1e-periodic Coulomb blockade conductance peaks (e is the elementary charge). In this condition, conductance through the interferometer is observed to oscillate in a perpendicular magnetic field with a flux period of h/e (h is Planck’s constant), indicating coherent transport of single electrons through the islands, a signature of electron teleportation via Majorana modes.

Theories predict teleportation of phase-coherent single electrons through a topological superconducting island. Here, the authors report persistent Coulomb blockade conductance peaks due to coherent transport of single electrons through patterned InAs-Al islands embedded in an Aharonov-Bohm interferometer.

Relating Andreev Bound States and Supercurrents in Hybrid Josephson Junctions

We demonstrate concomitant measurement of phase-dependent critical current and Andreev bound state spectrum in a highly transmissive InAs Josephson junction embedded in a dc superconducting quantum interference device (SQUID). Tunneling spectroscopy reveals Andreev bound states with near unity transmission probability. A nonsinusoidal current-phase relation is derived from the Andreev spectrum, showing excellent agreement with the one extracted from the SQUID critical current. Both measurements are reconciled within a short junction model where multiple Andreev bound states, with various transmission probabilities, contribute to the entire supercurrent flowing in the junction.

Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham

AIM

We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach.

METHOD

FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018.

RESULTS

Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2-110 days); however, 1.3% of returned kits could not be analysed. FIT results ≥ 150.0 μg haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi-square 167.1, P < 0.0001). FIT results ≥ 10.0 μg Hb/g faeces identified patients with significantly higher risk of significant noncancer bowel pathology (24.1% vs 4.9%, chi-square 73.6, P < 0.0001) and FIT results < 4.0 μg Hb/g faeces identified a group more likely to have non-CRC pathology (5.1% vs 2.4%, chi-square 3.9, P < 0.05). The CRC detection rate in 531 patients investigated after a FIT result of < 4.0 μg Hb/g faeces was 0.2%. In 899 investigated patients, a FIT result with a threshold of 4.0 μg Hb/g faeces had sensitivity 97.2% (85.5-99.9% CI), specificity 61.4% (58.1-64.7% CI), negative predictive value 99.8% (98.7-100.0% CI) and positive predictive value 9.5% (8.7-10.4% CI).

CONCLUSION

A symptomatic pathway incorporating FIT is feasible and appears more clinically effective than pathways based on age and symptoms alone.

[Intertriginous psoriasis]

Intertriginous psoriasis is a variant of psoriasis that is associated with inflammatory lesions in skin folds. Patients often feel ashamed, are subjected to stigmatization, social isolation, or experience mental health issues. There is no general consensus on the definition of intertriginous psoriasis. Depending on the definition used, the prevalence varies substantially. Due to the particular location of skin lesions, therapeutic management is very challenging. Mild symptoms can be treated with topical corticosteroids or topical immunomodulators. There are encouraging data demonstrating the efficacy of ixekizumab, possibly charting the way for it to become a systemic treatment option.

25 A Pilot Implementation of Providing Enhanced Support to Care Homes within A Primary Care Network

Introduction

People living with severe frailty in care homes are vulnerable to frequent non-elective hospital attendances. However provision of enhanced healthcare support to care home residents can reduce this risk and increase quality of life for residents.1 The framework for enhanced health in care homes (EHCH) summarises best practice in this area and provides guidance for implementing services.2

Methods

This study was a pilot implementation of the EHCH framework based on a Primary Care and Specialist Frailty Multidisciplinary Team (MDT) and delivered on a Primary Care Network (PCN) footprint. The MDT targeted five care homes in a PCN area with historically high levels of non-elective attendances. The model of care was based on the principle of anticipatory care planning, training and support for care home staff to understand and implement plans.

Results

Over the pilot period of 9 months, non-elective attendances from the 5 homes reduced by 27% compared to the previous year, which was a significant reduction (p&lt;0.042). There was variation between the homes in the reduction in non-elective attendances with the greatest impact seen in the homes that had the highest level of attendance at training and engagement in the care planning process. Feedback received from the care home staff indicated that they felt more confident to refer to the care plans and had alternative options to calling 999. A quality audit of the care plans completed as part of the pilot revealed a number of additional training needs for clinicians completing the plans to ensure consistency of recoding. This training was delivered following the pilot period.

Conclusions

The pilot demonstrated that the EHCH framework could be successfully implemented on a PCN footprint. Analysis shows this implementation coincided with a reduction in non-elective attendances from the targeted homes. Further analysis is required to compare the impact in different homes and to understand contributing factors. The pilot implementation provides helpful information to inform PCN development.

References

1. Lloyd T, Wolters A and Steveton A (2014) The impact of providing enhanced support for care home residents in Rushcliffe: Health Foundation consideration of findings from the Improvement Analytics Unit. The Health Foundation.

2. NHS England (2016) The framework for enhanced health in care homes.

Design and development of Ionization Profile Monitor for the Cryogenic sections of the ESS Linac

Saclay CEA/IRFU is working for the delivery of five Non-Invasive Profile Monitors in the frame of the in-kind contribution agreement signed with the European Spallation Source. Neutrons will be produced by spallation reactions of 2 GeV proton beam impinging on a Tungsten target. To accelerate protons a powerful linear accelerator of 5MW is under construction. Diagnostic devices are mandatory tools for the tuning and protection of the machine. The non-invasive profile monitors provide a measurement of the beam profile in transverse directions to the beam propagation. This project raises several physical and technical challenges including low signal detection of ions or electrons, profile distortions induced by the beam Space Charge effect and non-uniformities of electric field. Simulation and model of the critical aspects of the detector have been performed in order to prove the performance and the feasibility of the detector. A series of prototypes has been built with different readout types, and tested in real conditions at the 3MeV proton accelerator IPHI. All of them show some advantages and drawbacks revealed by the tests in real beam conditions. In this paper we present the results of the tests for the various configuration readout systems to agree with the model and simulation of the detector. In concluding remarks, we will discuss the performance of the prototypes and point out the camerabased one to be the more suitable for the final design.