Photobiomodulation of Gingival Cells Challenged with Viable Oral Microbes

The oral cavity, a unique ecosystem harboring diverse microorganisms, maintains health through a balanced microflora. Disruption may lead to disease, emphasizing the protective role of gingival epithelial cells (GECs) in preventing harm from pathogenic oral microbes. Shifting GECs' response from proinflammatory to antimicrobial could be a novel strategy for periodontitis. Photobiomodulation therapy (PBMT), a nonpharmacologic host modulatory approach, is considered an alternative to drugs. While the host cell response induced by a single type of pathogen-associated molecular patterns (PAMPs) was widely studied, this model does not address the cellular response to intact microbes that exhibit multiple PAMPs that might modulate the response. Inspired by this, we developed an in vitro model that simulates direct interactions between host cells and intact pathogens and evaluated the effect of PBMT on the response of human gingival keratinocytes (HGKs) to challenge viable oral microbes at both the cellular and molecular levels. Our data demonstrated that LED pretreatment on microbially challenged HGKs with specific continuous wavelengths (red: 615 nm; near-infrared: 880 nm) induced the production of various antimicrobial peptides, enhanced cell viability and proliferation, promoted reactive oxygen species scavenging, and down-modulated proinflammatory activity. The data also suggest a potential explanation regarding the superior efficacy of near-infrared light treatment compared with red light in enhancing antimicrobial activity and reducing cellular inflammation of HGKs. Taken together, the findings suggest that PBMT enhances the overall barrier function of gingival epithelium while minimizing inflammation-mediated breakdown of the underlying structures.

Section E6.1-6.6 of the American College of Medical Genetics and Genomics (ACMG) Technical Laboratory Standards: Cytogenomic studies of acquired chromosomal abnormalities in neoplastic blood, bone marrow, and lymph nodes

Cytogenomic analyses of acquired clonal chromosomal abnormalities in neoplastic blood, bone marrow, and/or lymph nodes are instrumental in the clinical management of patients with hematologic neoplasms. Cytogenetic analyses assist in the diagnosis of such disorders and can provide important prognostic information. Furthermore, cytogenetic studies can provide crucial information regarding specific genetically defined subtypes of these neoplasms that may have targeted therapies. At time of relapse, cytogenetic analysis can confirm recurrence of the original neoplasm, detect clonal disease evolution, or uncover a new unrelated neoplastic process. This section deals specifically with the technical standards applicable to cytogenomic studies of acquired clonal chromosomal abnormalities in neoplastic blood, bone marrow, and/or lymph nodes. This updated Section E6.1-6.6 supersedes the previous Section E6 in Section E: Clinical Cytogenetics of the American College of Medical Genetics and Genomics Technical Standards for Clinical Genetics Laboratories.

The Number of Positive Lymph Nodes as Prognostic Factor in ypN1 Breast Cancer with Neoadjuvant Chemotherapy

PURPOSE/OBJECTIVE(S)

This study aimed to assess the ability of the number of positive lymph nodes (LNP) after neoadjuvant chemotherapy (NAC) to stratify prognosis even within the same ypN stage in breast cancer patients.

MATERIALS/METHODS

A 6,443 non-metastatic breast cancer patients with ypN1 disease after NAC following primary surgery were identified using the stage, stage evaluation field, treatment fields from Surveillance Epidemiology and End Results (SEER) database. Survival analysis was performed for overall survival (OS) using Kaplan-Meier plot and Cox proportional hazard models.

RESULTS

Of patients, 1,132(17.6%) had 3 positive lymph nodes (LNP3), 4,363 (67.7%) patients were T1/2 stage and 538 (8.35%) patients were downstage after treatment. LNP3 group had a significantly worse OS than LNP1/2 group (5yr OS, 74.2% vs. 80.9%, p <0.001). Similar results were observed in cause specific survival analysis (5yr OS, 79.8% vs. 85.2%, p <0.001). In subgroup analysis, there was a significant difference in OS between LNP1/2 and LNP3 group for HER2 or triple negative subtype, (p <0.001), T1/2 stage (p <0.001) and stable/downstage of N stage (p <0.001 and 0.019, respectively), but not for luminal A/B subtype and T3/4 (p = 0.126, 0.629 and 0.154, respectively). Regarding the number of examined lymph node (LNE), OS was significantly decreased in patients with LNE ≤5 in LNP3 group (p <0.001) but not in LNP1/2 group. In multivariable analysis, the prognostic significance of LNP3 remained (p <0.001) and the following factors were significantly related to the prolonged OS; Luminal A/B (p<0.001 and 0.001, respectively), T1/2 stage (p <0.001), N1 stage (p <0.001), LNE (≤5 vs. >5, p = 0.001) and receipt of radiotherapy (p = 0.012). Even when PS matching was performed, the OS of LNP was worse than that of LNP1/2.

CONCLUSION

LNP could more stratify the patients with ypN1 breast cancer after NAC. LNP3 is significantly associated with OS even after adjusting for other prognosticators. In particular, since there is a potential difference in the magnitude of the impact of LNP3 according to LNE, it is necessary to consider both of them together for decision-making.

Beyond the routine CBC: machine learning and statistical analyses identify research CBC parameter associations with myelodysplastic syndromes and specific underlying pathogenic variants

AIMS

Given the time, expense and clinical expertise required for a myelodysplastic syndrome (MDS) diagnosis, there is a clear need for a cost-effective screening laboratory test that can rapidly and accurately distinguish patients with cytopenias related to MDS from other causes.

METHODS

We measured conventional and research use only complete blood cell (CBC) parameters using the Sysmex XN-series haematology analyser in 102 MDS patients (70 patients with active MDS and 32 patients in remission), 43 patients with cytopenia without morphological evidence of MDS and 484 age-adjusted controls. A variety of algorithms, including random forest machine learning, were used to construct parameter-based models to predict the presence of MDS using both CBC and molecular data or CBC data alone and correlated individual pathogenic variants/genetic pathways with CBC parameters changes.

RESULTS

Using the CBC parameters alone, our predictive model for active MDS showed a 0.86 receiver operating characteristic curve (ROC)/area under the ROC curve (AUC), with 0.87 sensitivity and 0.72 specificity; with the addition of the molecular and demographic status, the ROC/AUC improved to 0.93, sensitivity to 0.89 and specificity to 0.84. The most discriminatory MDS parameters were reflective of dysplastic neutrophil morphology, red cell count fragmentation and degree of platelet immaturity. Specific patterns of parameters were associated with individual gene pathogenic variants or affected pathways.

CONCLUSIONS

CBC research parameters can be used as an adjunct to the haematological workup of cytopenia(s) to help screen for patients with high likelihood of MDS.

First Measurement of Hard Exclusive π^{-}Δ^{++} Electroproduction Beam-Spin Asymmetries off the Proton

The polarized cross-section ratio σ_{LT^{'}}/σ_{0} from hard exclusive π^{-}Δ^{++} electroproduction off an unpolarized hydrogen target has been extracted based on beam-spin asymmetry measurements using a 10.2  GeV/10.6  GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. The study, which provides the first observation of this channel in the deep-inelastic regime, focuses on very forward-pion kinematics in the valence regime, and photon virtualities ranging from 1.5  GeV^{2} up to 7  GeV^{2}. The reaction provides a novel access to the d-quark content of the nucleon and to p→Δ^{++} transition generalized parton distributions. A comparison to existing results for hard exclusive π^{+}n and π^{0}p electroproduction is provided, which shows a clear impact of the excitation mechanism, encoded in transition generalized parton distributions, on the asymmetry.

First Measurement of Λ Electroproduction off Nuclei in the Current and Target Fragmentation Regions

We report results of Λ hyperon production in semi-inclusive deep-inelastic scattering off deuterium, carbon, iron, and lead targets obtained with the CLAS detector and the Continuous Electron Beam Accelerator Facility 5.014 GeV electron beam. These results represent the first measurements of the Λ multiplicity ratio and transverse momentum broadening as a function of the energy fraction (z) in the current and target fragmentation regions. The multiplicity ratio exhibits a strong suppression at high z and an enhancement at low z. The measured transverse momentum broadening is an order of magnitude greater than that seen for light mesons. This indicates that the propagating entity interacts very strongly with the nuclear medium, which suggests that propagation of diquark configurations in the nuclear medium takes place at least part of the time, even at high z. The trends of these results are qualitatively described by the Giessen Boltzmann-Uehling-Uhlenbeck transport model, particularly for the multiplicity ratios. These observations will potentially open a new era of studies of the structure of the nucleon as well as of strange baryons.

A165 FCGBP IN THE COLON IS SPATIALLY DEPENDENT ON MUC2 EXPRESSION AND IS DEGRADED IN DEXTRAN SULFATE SODIUM-INDUCED COLITIS

Background

The colonic mucus bilayer is an integral innate host defense mechanism that provides a physical barrier separating the lumen and its contents from the underlying epithelium. This essential barrier is produced by specialized secretory goblet cells of which Muc2 mucin is its primary product. IgG-Fc-binding protein (Fcgbp) is the second most abundant protein produced by goblet cells, which has a suggested function of crosslinking with Muc2 to stabilize the structural integrity of mucus. FCGBP is observed to decrease preceding the onset of inflammation in ulcerative colitis patients, leading to spatially distinct structural mucus weakening to contribute to the pathogenesis of the disease.

Purpose

Fcgbp is altered regionally in the gut and plays a role in the pathogenesis of dextran sulfate sodium (DSS)-induced colitis. The specific aims are:

To characterize the spatial expression of Muc2 and Fcgbp basally in goblet cells

To quantify alterations in Muc2 and Fcgbp in response to DSS-induced colitis and at restitution of disease

Method

mRNA and protein expression in Muc2^+/+ and Muc2^-/- C57BL/6 littermates were analyzed by RT-qPCR and Western blotting, respectively. Mucin granules were isolated from colonic goblet cells and the proteome quantified by liquid chromatography and tandem mass spectrometry (LC-MS/MS). Colitis was induced in Muc2^+/+ mice with 3.5% (w/v) DSS in tap water for five days, whereas Muc2^-/- littermates were given 1.5% (w/v) DSS in tap water for three days, ad libitum. Mice were given regular tap water for the remainder of the experiment to allow restitution of inflammation. Disease activity index (DAI) was scored based on weight loss. Mice were sacrificed at various time points up to 10 days, and colons excised and sectioned for histopathology analysis.

Result(s)

LC-MS/MS of mucin granules run under reducing and non-reducing conditions confirmed that Muc2 and Fcgbp were the most abundant proteins in mucin granules and were non-covalently bound to each other. mRNA and protein expression of Muc2 and Fcgbp were highly expressed in the mid colon, and regulation of Fcgbp was unaffected in Muc2^-/- littermates. In response to DSS-induced colitis in Muc2^+/+ mice, Muc2 transcription rapidly increased in all regions of the colon with highest expression in the mid colon. In contrast, Fcgbp transcription increased in the mid and distal colons and peaked during highest disease activity. Interestingly, Fcgbp protein expression was abrogated in the mid colon even at restitution. In Muc2^-/- mice, Fcgbp transcription decreased during disease onset but returned to normal levels following removal of DSS.

Image

Conclusion(s)

This study demonstrates that in response to DSS, Fcgbp expression was spatially degraded at the onset of disease and remained low at restitution. The disappearance of Fcgbp in the mid colon of Muc2^+/+ littermates, despite Muc2 restoration, suggests that the mucus barrier remains structurally altered and functionally impaired at restitution. Supported by CIHR

Disclosure of Interest

None Declared

Observation of Correlations between Spin and Transverse Momenta in Back-to-Back Dihadron Production at CLAS12

We report the first measurements of deep inelastic scattering spin-dependent azimuthal asymmetries in back-to-back dihadron electroproduction in the deep inelastic scattering process. In this reaction, two hadrons are produced in opposite hemispheres along the z axis in the virtual photon-target nucleon center-of-mass frame, with the first hadron produced in the current-fragmentation region and the second in the target-fragmentation region. The data were taken with longitudinally polarized electron beams of 10.2 and 10.6 GeV incident on an unpolarized liquid-hydrogen target using the CLAS12 spectrometer at Jefferson Lab. Observed nonzero sinΔϕ modulations in ep→e^{'}pπ^{+}X events, where Δϕ is the difference of the azimuthal angles of the proton and pion in the virtual photon and target nucleon center-of-mass frame, indicate that correlations between the spin and transverse momenta of hadrons produced in the target- and current-fragmentation regions may be significant. The measured beam-spin asymmetries provide a first access in dihadron production to a previously unexplored leading-twist spin- and transverse-momentum-dependent fracture function. The fracture functions describe the hadronization of the target remnant after the hard scattering of a virtual photon off a quark in the target particle and provide a new avenue for studying nucleonic structure and hadronization.

RIB induced reactions: Studying astrophysical reactions with low-energy RI beam at CRIB

Astrophysical reactions involving radioactive isotopes (RI) often play an important role in high-temperature stellar environments. The experimental studies on the reaction rates for those are still limited mainly due to the technical difficulties in producing high-quality RI beams. A direct measurement of those reactions would be still challenging in many cases, however, we can make a reliable evaluation of the reaction rates by an indirect method or by studying the resonance prorerties. Here we ntroduce recent examples of experimental studies on such RI-involving astrophysical reactions, performed at Center for Nuclear Study, the University of Tokyo, using the low-energy RI beam separator CRIB. One is for the neutron-induced destruction reactions of 7Be in the Big-Bang nucleosynthesis, and the other is the study on the 22Mg(α, p) reaction relevant in X-ray bursts, which was performed with the resonant scattering method from the inverse reaction channel.

Epidemiology of Tuberculosis in Kazakhstan: Data from National Electronic Healthcare System 2014-2019

Background

Tuberculosis (TB) remains a global public health threat. WHO determined Kazakhstan as one of 18 high-priority countries for TB elimination in Europe, with reported TB incidence >20 cases per 100,000 population. There is a lack of comprehensive reseach of TB epidemiology in the country. This study aims to estimate the prevalence, incidence, mortality rates and survival hazard ratios of TB in Kazakhstan, using large-scale administrative health data records in 2014-2019.

Methods

This is a population-wide retrospective study assessing 150 thousand TB (ICD10: A15-A19) patients’ incidence, prevalence and mortality. Demographic factors, diagnoses and comorbidities were analyzed. Univariate, bivariate and multivariate statistical analyses were performed. Cox regression and Kaplan-Meier survival analysis have been done.

Results

Out of 150 thousand all TB patients, 61 percent were male and 94 percent had respiratory TB. During 2014-2019, the TB incidence, prevalence and mortality per 100K population declined (227-15.2), doubled (325.3-746.6) and increased (8.4-15.2), respectively. Age-specific TB incidence was lowest for 0-10 y.o., highest for 20 y.o. Being an old person, male, urban resident, retired, with HIV and diabetes was significantly associated with lower survival compared to a young, female, rural resident, employed, with no comorbidities.

Conclusions

This was the largest TB study in Kazakhstan, presenting the country’s TB by demographic groups, incidence, prevalence, mortality trends, and risk factors against survival.

Key messages

• During 2014-2019, the TB incidence, prevalence and mortality per 100K population declined (227-15.2), doubled (325.3-746.6) and increased (8.4-15.2), respectively.

• Being an old person, male, urban resident, retired, with HIV and diabetes was significantly associated with lower survival compared to a young, female, rural resident, employed, with no comorbidities.

Corporate economic performance and sustainability indices: a study based on the Dow Jones Sustainability Index

Sustainable investing recognizes companies’ role in solving some of the major sustainability challenges globally and that companies driving impactful sustainability agendas can be best positioned to grow, and one way to do this is through inclusion into a sustainability stock-market index. Current research has investigated the financial benefits of being included into sustainable indices and has found contrasting results. To expand on existing work, we report an analysis that aims at better understanding whether there is any negative economic impact related to participation in the sustainability index DJSI. To do this, we gained data on three financial indicators (market cap, net sales, and EBITDA) on five different non-related industries (Airlines, Aluminum, Apparel, Pharmaceuticals, and Forest Products). Ten companies in each industry were selected based on market-cap, with 5 being in-index and 5 being out. Although most indices’ rationale is to identify companies that are best-in-class performers in sustainability and economically, we report an unexpected conclusion of no obvious financial consequences from being part of sustainability index. Only one industry—forest products—had positive impacts of index-inclusion, and the other industries’ impacts were non-consequential. This indicates that sustainability indices may promote sustainable development with no financial impact.

POS0396 IDENTIFICATION OF DIFFERENTIALLY EXPRESSED GENES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background

Characterizing differentially expressed genes (DEGs) of systemic lupus erythematosus (SLE) is necessary to understand immunogenic interactions, and how several key immune genes were closely associated with the susceptibility of SLE.

Objectives

This study aimed to identify DEGs of SLE using gene expression-based computational methodologies to analyze disease-immune interactions, which affect the development and progression of SLE.

Methods

Twenty-six patients with SLE and 46 healthy controls were selected from the Gene Expression Omnibus database. The significantly enriched immune and virus related gene lists were computed and visualized by using the DEGs from the Gene Set Enrichment Analysis. Quantification of 38 immune cells were performed in determining the impact of immune cells on the virus mediated immunity in SLE by using ImmQaunt algorithm.

Results

Thirty nine upregulated and 57 downregulated were identified in SLE patient compared to the healthy controls. Upregulated genes were significantly implicated in Gene Ontology gene sets as cytokine mediated signaling, secretion, and exocytosis in immune response pathways. In addition, these genes were enriched in hepatitis C, influenza A, measles, Epstein–Barr virus, and herpes simplex virus 1 infection in Kyoto Encyclopedia of Genes and Genomes pathways. Especially, FCGR1A, IRF7, OAS2, CAMP, MX1, OAS3, OAS1, DEFA3, ISG15, and RSAD2 were involved in virus mediated SLE mechanism, and the expression for OAS1, OAS2, and IRF7 was closely associated with the quantities of colony forming unit-monocyte and colony forming unit-granulocyte.

Conclusion

Identifying virus mediated SLE genes and quantifies of immune cells were used to understand the pathological process and perform early diagnosis of SLE, and will lead to clinical tools for treating SLEs in patients.

References

[1]Ghodke-Puranik Y and Niewold TB. Immunogenetics of systemic lupus erythematosus: A comprehensive review. J Autoimmun 2015; 64: 125-136.

[2]Teruel M and Alarcón-Riquelme ME. The genetic basis of systemic lupus erythematosus: What are the risk factors and what have we learned. J Autoimmun 2016; 74: 161-175.

[3]Lauwerys BR, Hachulla E, Spertini F, et al. Down-regulation of interferon signature in systemic lupus erythematosus patients by active immunization with interferon alpha-kinoid. Arthritis Rheum 2013; 65: 447-456.

[4]Frishberg A, Brodt A, Steuerman Y and Gat-Viks I. ImmQuant: a user-friendly tool for inferring immune cell-type composition from gene-expression data. Bioinformatics 2016; 32: 3842-3843.

Disclosure of Interests

None declared.

Angiographically Occult Subarachnoid Hemorrhage: Yield of Repeat Angiography, Influence of Initial CT Bleed Pattern, and Sources of Diagnostic Error in 242 Consecutive Patients

BACKGROUND AND PURPOSE

Nearly 20% of patients with spontaneous SAH have no definitive source on initial DSA. The purpose of this study was to investigate the timing and yield of repeat DSA, to clarify the influence of initial CT bleed pattern, and to characterize sources of diagnostic error in this scenario.

MATERIALS AND METHODS

We evaluated the yield of repeat DSA and clinical outcomes stratified by hemorrhage pattern on CT in consecutive patients with nontraumatic SAH with negative initial DSA findings at a referral center. Cases in which the culprit lesion was subsequently diagnosed were classified as physiologically occult (ie, undetectable) on the initial DSA, despite adequate technique and interpretation or misdiagnosed due to operator-dependent error.

RESULTS

Two hundred forty-two of 1163 (20.8%) patients with spontaneous SAH had negative initial DSA findings between 2009 and 2018. The SAH CT pattern was nonperimesencephalic (41%), perimesencephalic (36%), sulcal (18%), and CT-negative (5%). Repeat DSA in 135/242 patients (55.8%) revealed a source in 10 patients (7.4%): 4 saccular aneurysms, 4 atypical aneurysms, and 2 arteriovenous shunts. The overall yield of repeat DSA was 11.3% with nonperimesencephalic and 2.2% for perimesencephalic patterns. The yield of the second and third DSAs with a nonperimesencephalic pattern was 7.7% and 12%, respectively. Physiologically occult lesions accounted for 6/242 (2.5%) and operator-dependent errors accounted for 7/242 (2.9%) of all angiographically occult lesions on the first DSA.

CONCLUSIONS

Atypical aneurysms and small arteriovenous shunts are important causes of SAH negative on angiography. Improving DSAs technique can modestly reduce the need for repeat DSA; however, a small fraction of SAH sources remain occult despite adequate technique. These findings support the practice of repeating DSA in patients with a nonperimesencephalic SAH pattern.

Experimental studies on astrophysical reactions at the low-energy RI beam separator CRIB

Experimental studies on astrophysical reactions involving radioactive isotopes (RI) often accompany technical challenges. Studies on such nuclear reactions have been conducted at the low-energy RI beam separator CRIB, operated by Center for Nuclear Study, the University of Tokyo. We discuss two cases of astrophysical reaction studies at CRIB; one is for the 7Be+n reactions which may affect the primordial 7Li abundance in the Big-Bang nucleosynthesis, and the other is for the 22Mg(α, p) reaction relevantin X-raybursts.

A43 HIGH MUC2 MUCIN BIOSYNTHESIS BY GOBLET CELLS UNDER METABOLIC STRESS PRODUCE ELEVATED LEVELS OF PRO-INFLAMMATORY CYTOKINES

Background

The colonic mucus bilayer is an integral innate host defense mechanism that houses the commensal gut microbiota whilst protecting the underlying mucosa against harmful pathogens. This essential barrier is generated via a highly ER stressful mechanism by goblet cells that produce MUC2 mucin. Goblet cells also produce a variety of proteins and peptides as well as pro-inflammatory cytokines that interact with and activate other arms of the innate immune system. In ulcerative and infectious colitis, goblet cells hyper secrete mucus and become depleted of their mucin stores. However, it is not known if other proteins or pro-inflammatory responses are altered in mucin-depleted goblet cells. Here, we elucidated the molecular mechanisms that regulate pro-inflammatory responses in WT and CRISPR/Cas9 MUC2 KO human goblet cells.

Aims

Hypothesis: MUC2 biosynthesis and production augment pro-inflammatory responses in goblet cells. The specific aims are:

1. To determine the pro-inflammatory responses in WT and MUC2KO goblet cells

2. To determine if the MAPK signaling pathway is altered in WT and MUC2KO goblet cells

Methods

mRNA and protein expression of various pro-inflammatory chemokines/cytokines in WT and CRISPR/Cas9 MUC2KO LS174T goblet cells were analyzed by RT-qPCR and 15-plex Luminex array. IL-22 was used to alleviate ER stress, as quantified by the expression of stress proteins by Western blotting. To determine differences in pro-inflammatory cytokine release, cells were stimulated with phorbol myristate acetate (PMA, positive control), live Entamoeba histolytica (Eh), and lysed soluble amebic proteins (SAP). MAPK signaling was enumerated by specific pharmacological inhibitors and analyzed by Western blotting.

Results

Basally and in response to live Eh, WT goblet cells expressed high levels of the metabolic stress proteins, ATF4, GRP78, and CHOP as compared to MUC2KO cells. In response to PMA, live Eh, and SAP, WT cells expressed high levels of mRNA transcripts and secreted significant amounts of the pro-inflammatory chemokines, monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), and interleukin-13 (IL-13) as compared to MUC2KO cells. Reducing ER stress with IL-22 significantly augmented IL-8 protein release in both WT and MUC2KO cells. Signaling via the ERK MAPK pathway was elevated in WT whereas in MUC2KO goblet the response was delayed.

Conclusions

This study demonstrates that high MUC2 mucin biosynthesis regulates the expression and secretion of the pro-inflammatory cytokines MCP-1, IL-8, and IL-13. Mechanistically, MUC2 induced metabolic stress regulated MAPK activity for high output pro-inflammatory responses as compared to MUC2KO goblet cells.

Funding Agencies

CIHR

Multidimensional, High Precision Measurements of Beam Single Spin Asymmetries in Semi-inclusive π^{+} Electroproduction off Protons in the Valence Region

High precision measurements of the polarized electron beam-spin asymmetry in semi-inclusive deep inelastic scattering (SIDIS) from the proton have been performed using a 10.6 GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. We report here a high precision multidimensional study of single π^{+} SIDIS data over a large kinematic range in Bjorken x, fractional energy, and transverse momentum of the hadron as well as photon virtualities Q^{2} ranging from 1-7  GeV^{2}. In particular, the structure function ratio F_{LU}^{sinϕ}/F_{UU} has been determined, where F_{LU}^{sinϕ} is a twist-3 quantity that can reveal novel aspects of emergent hadron mass and quark-gluon correlations within the nucleon. The data's impact on the evolving understanding of the underlying reaction mechanisms and their kinematic variation is explored using theoretical models for the different contributing transverse momentum dependent parton distribution functions.

Totally Implantable Oxygen Generator (TIOG) for Hypoxia and Hypoxemia

Hypoxia and hypoxemia are the conditions when oxygen is depleted from the cell due to, for example, respiratory failure, cancer, etc. While the current therapy brought reasonable clinical outcomes, its systematic nature of oxygen delivery can be compromised by a significant dropout and side effects. This paper presents a totally implantable oxygen generator (TIOG) for localized, highly controllable, real-time, and targeted oxygen delivery.

METHODS

The TIOG system, an ultra-low power implantable wireless platform, is built using off-the-shelf components. The TIOG can be remotely operated to enable a tailored oxygen delivery based on electrolysis with a precisely controlled electrical signal (i.e., current level, frequency, and duty cycle).

RESULTS

The in vitro experiments demonstrate that the TIOG could deliver oxygen with a rate of 9.27 ± 1.9 µmol/L/min with the pulsed electrical current (800 µA, 600 µs pulse or 6% duty cycle with 10 ms period). The system could also suppress chlorine generation under the safety guideline (5 mg/L). Operating at 433 MHz ISM band, the TIOG could be wirelessly controlled from up to 600 cm distance with a 0%-bit error rate (BER) and 0%-packet error rate (PER). A single charge of the battery could operate the system for up to 3.3 hr, which can be wirelessly recharged for long-term operation.

CONCLUSION

The longevity of the TIOG system enables ambulatory oxygen therapy in a much longer-term than current practice.

Improved Λp Elastic Scattering Cross Sections between 0.9 and 2.0 GeV/c as a Main Ingredient of the Neutron Star Equation of State

Strange matter is believed to exist in the cores of neutron stars based on simple kinematics. If this is true, then hyperon-nucleon interactions will play a significant part in the neutron star equation of state. Yet, compared to other elastic scattering processes, there is very little data on Λ-N scattering. This experiment utilized the CEBAF Large Acceptance Spectrometer (CLAS) detector to study the Λp→Λp elastic scattering cross section in the incident Λ momentum range 0.9-2.0  GeV/c. These are the first data on this reaction since the 1970s. The new cross sections have significantly better accuracy and precision than the existing world data, and the techniques developed here can also be used in future experiments.

First Measurement of Timelike Compton Scattering

We present the first measurement of the timelike Compton scattering process, γp→p^{'}γ^{*}(γ^{*}→e^{+}e^{-}), obtained with the CLAS12 detector at Jefferson Lab. The photon beam polarization and the decay lepton angular asymmetries are reported in the range of timelike photon virtualities 2.25<Q^{'2}<9  GeV^{2}, squared momentum transferred 0.1<-t<0.8  GeV^{2}, and average total center-of-mass energy squared s=14.5  GeV^{2}. The photon beam polarization asymmetry, similar to the beam-spin asymmetry in deep virtual Compton scattering, is sensitive to the imaginary part of the Compton form factors and provides a way to test the universality of the generalized parton distributions. The angular asymmetry of the decay leptons accesses the real part of the Compton form factors and thus the D-term in the parametrization of the generalized parton distributions.

Twists and turns from "tumor in tumor" profiling: surveillance of chronic lymphocytic leukemia (CLL) leads to detection of a lung adenocarcinoma, whose genomic characterization alters the original hematologic diagnosis

Comprehensive characterization of somatic genomic alterations has led to fundamental shifts in our understanding of tumor biology. In clinical practice, these studies can lead to modifications of diagnosis and/or specific treatment implications, fulfilling the promise of personalized medicine. Herein, we describe a 78-yr-old woman under surveillance for long-standing untreated chronic lymphocytic leukemia (CLL). Molecular studies from a peripheral blood specimen revealed a TP53 p.V157F mutation, whereas karyotype and fluorescence in situ hybridization (FISH) identified a 17p deletion, trisomy 12, and no evidence of IGH-CCND1 rearrangement. Positron emission tomography-computed tomography scan identified multistation intra-abdominal lymphadenopathy and a pulmonary nodule, and subsequent pulmonary wedge resection confirmed the presence of a concurrent lung adenocarcinoma. Targeted next-generation sequencing of the lung tumor identified an EGFR in-frame exon 19 deletion, two TP53 mutations (p.P152Q, p.V157F), and, unexpectedly, a IGH-CCND1 rearrangement. Follow-up immunohistochemistry (IHC) studies demonstrated a cyclin D1–positive lymphoid aggregate within the lung adenocarcinoma. The presence of the TP53 p.V157F mutation in the lung resection, detection of an IGH-CCND1 rearrangement, and cyclin D1 positivity by IHC led to revision of the patient's hematologic diagnosis and confirmed the extranodal presence of mantle cell lymphoma within the lung mass, thus representing a “tumor in tumor.” Manual review of the sequencing data suggested the IGH-CCND1 rearrangement occurred via an insertional event, whose size precluded detection by original FISH studies. Thus, routine imaging for this patient's known hematologic malignancy led to detection of an unexpected solid tumor, whose subsequent precision medicine studies in the solid tumor redefined the original hematological diagnosis.

Effect of HIV infection on pre- and post-liver transplant mortality in patients with organ failure

OBJECTIVES

Organ failure (OF), a leading cause of death in HIV-positive individuals, is common in patients undergoing liver transplantation (LT). We examined the impact of HIV infection on pre- and post-LT mortalities in cirrhotic patients stratified by the number and type of OFs.

METHODS

We performed a cross-sectional study and a retrospective cohort study using the US National Inpatient Sample (NIS) and the United Network for Organ Sharing (UNOS) registry data, respectively. Patients who had not yet undergone LT from the NIS database (2010-2014) and patients undergoing LT from the UNOS database (2003-2016) were included in the study.

RESULTS

Analysis of patients (201 348) from the NIS database showed that one [adjusted odds ratio (aOR) 1.531; 95% confidence interval (CI) 1.160-2.023], two (aOR 1.624; 95% CI 1.266-2.083) or three or more OFs (aOR 1.349; 95% CI 1.165-1.562) were associated with higher pre-LT mortality in HIV-infected patients compared with HIV-negative patients with the corresponding number of OFs. In patients without OF, HIV infection was not associated with increased pre-LT mortality. UNOS data for patients undergoing LT (38 942) showed that the presence of two or more OFs was associated with increased post-LT 1-year mortality in HIV-infected patients compared with non-HIV-infected patients with the corresponding number of OFs (aOR 2.342; 95% CI 1.576-3.480). However, in patients with no OF or only one OF, HIV infection was not associated with increased post-LT 1-year mortality (aOR 1.372; 95% CI 0.911-2.068).

CONCLUSIONS

The results of this study emphasize the importance of preventing OF development, and justify LT for HIV-infected patients with no or only one OF.

Observation of Beam Spin Asymmetries in the Process ep→e^{'}π^{+}π^{-}X with CLAS12

The observation of beam spin asymmetries in two-pion production in semi-inclusive deep inelastic scattering off an unpolarized proton target is reported. The data presented here were taken in the fall of 2018 with the CLAS12 spectrometer using a 10.6 GeV longitudinally spin-polarized electron beam delivered by CEBAF at JLab. The measured asymmetries provide the first opportunity to extract the parton distribution function e(x), which provides information about the interaction between gluons and quarks, in a collinear framework that offers cleaner access than previous measurements. The asymmetries also constitute the first ever signal sensitive to the helicity-dependent two-pion fragmentation function G_{1}^{⊥}. A clear sign change is observed around the ρ mass that appears in model calculations and is indicative of the dependence of the produced pions on the helicity of the fragmenting quark.

Remote Monitoring of Heart Transplant Recipients during the COVID-19 Pandemic

Purpose

The COVID-19 pandemic created significant challenges in monitoring heart transplant (HT) recipients for rejection due to efforts to minimize contact with the hospital setting. The aim of this study was to evaluate the safety and efficacy of transitioning HT patients to home phlebotomy and a monitoring protocol based on gene expression profiling (GEP) and donor derived cell free DNA (ddcfDNA).

Methods

A single-center cohort study that prospectively enrolled consecutive HT patients who were transitioned to a remote monitoring protocol employing home phlebotomy and non-invasive surveillance for rejection. Patients were enrolled starting at 2 months post-HT. Positive GEP values were defined as ≥32 (up to 6 months post-HT) and ≥34 (> 6 months post-HT). A positive ddcfDNA score was defined as >0.12%. A positive biopsy was defined as grade ≥1B/1R

Results

246 HT patients were enrolled and followed for a minimum of 3 months. Mean age was 56±14, 71.5% were male, and median time from transplant was 2.7 years. The average distance of patients from the hospital was 25.6 miles. 359 blood tests were drawn for detection of GEP and ddcfDNA and 102 biopsies performed (Figure). Among 32 patients who had negative results on both tests and had a biopsy, 0 had a positive biopsy. Of 25 patients who had positive results on both tests and had a biopsy, 3 (12%) had a positive biopsy. The biopsy positivity rate in patients who were GEP+/ddcfDNA- was 6% and in patients who were GEP-/ddcfDNA+ was 8%. None of the positive biopsies were associated with hemodynamic compromise. 15 (6%) of patients were admitted due to allograft rejection during the study period. There were no deaths.

Conclusion

Using a remote monitoring protocol with home phlebotomy and noninvasive rejection surveillance was feasible and safe in HT recipients. In this cohort, the combination of negative GEP and ddcfDNA scores was accurate at predicting a lack of allograft rejection.

A24 FCGBP MAINTAINS MUC2 MUCUS STRUCTURAL INTEGRITY BY STABILIZING THE MUCUS LAYER IN RESPONSE TO THE COLONIC PATHOGEN, ENTAMOEBA HISTOLYTICA

Background

MUC2 mucin is the major component of the colonic mucus bilayer that serves as the first line of innate host defense against pathogens while supporting a healthy microbiota and regulating epithelial barrier function. Proteomic studies of colonic mucus have identified various mucus-associated proteins. One of the most abundant is FCGBP, similar to MUC2 mucin, but its interaction with MUC2 or function is not known. Here, we elucidated FCGBP functional role in stabilizing MUC2 mucus and in innate host defence against Entamoeba histolytica (Eh).

Aims

Hypothesis: MUC2 mucin and FCGBP are coordinately produced and play an important role in innate host defense. The specific aims are:

1. To determine if FCGBP alters the structural integrity of the mucus layer

2. To determine the role of FCGBP in Eh infection

Methods

FCGBP mRNA and protein expression induced by Eh, in WT and FCGBP CRISPR/Cas9 LS174T goblet cells were analysed by RT-PCR and Western blotting. To compare integrity of the mucus layer, fluorescent Eh and 1μM fluorescent beads were inoculated on WT and KO monolayers and adherent Eh and bead penetrability analyzed. To quantify MUC2 and FCGBP degradation by Eh, purified MUC2 and recombinant FCGBP were incubated with Eh proteases (SPs) and Western blotted using highly specific antibodies against various regions of the proteins.

Results

In response to live Eh, FCGBP and MUC2 mRNA and protein expressions were significantly increased in a time-dependent manner. Surprisingly, FCGBP KO cells elicited robust expression of pro-inflammatory cytokine mRNA and protein as compared to WT cells. More fluorescent Eh were attached to the mucus layer of FCGBP KO cells as compared to WT or MUC2 KO cells. Fluorescent beads penetrated further towards the epithelial cell surface in KO as compared to WT cells. Interestingly, while both MUC2 and FCGBP from purified polymeric mucins were degraded by Eh SPs, FCGBP cleavage occurred at a faster rate than MUC2. Degradation of FCGBP and MUC2 was mediated by EhCP-A5 cysteine proteinase using purified MUC2 and recombinant FCGBP.

Conclusions

In WT goblet cells, FCGBP and MUC2 were upregulated temporally in response to Eh. The increase in pro-inflammatory cytokine expression in FCGBP KO cells in response to Eh suggests that Eh directly interacted with the cell surface suggesting an impaired protective mucus layer. In support of this, fluorescent beads penetrated the mucus layer close to the cell surface and more Eh were attached to FCGBP KO mucus demonstrating that FCGBP was critical in providing structural integrity of the mucus layer. In response to Eh, FCGBP degradation was a prerequisite for MUC2 cleavage, providing direct evidence that FCGBP and MUC2 interactions conferred biophysical properties of the protective functions of the mucus gel.

Funding Agencies

CIHR

Photoproduction of the f_{2}(1270) Meson Using the CLAS Detector

The quark structure of the f_{2}(1270) meson has, for many years, been assumed to be a pure quark-antiquark (qq[over ¯]) resonance with quantum numbers J^{PC}=2^{++}. Recently, it was proposed that the f_{2}(1270) is a molecular state made from the attractive interaction of two ρ mesons. Such a state would be expected to decay strongly to final states with charged pions due to the dominant decay ρ→π^{+}π^{-}, whereas decay to two neutral pions would likely be suppressed. Here, we measure for the first time the reaction γp→π^{0}π^{0}p, using the CEBAF Large Acceptance Spectrometer detector at Jefferson Lab for incident beam energies between 3.6 and 5.4 GeV. Differential cross sections, dσ/dt, for f_{2}(1270) photoproduction are extracted with good precision due to low backgrounds and are compared to theoretical calculations.

Associations of serum monocyte-to-high-density lipoprotein cholesterol ratio with digital ulcers and skin fibrosis in patients with systemic sclerosis

Objective: To investigate the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and clinical manifestations in patients with systemic sclerosis (SSc).Method: This was a cross-sectional analysis of a cohort study comprising 111 female SSc patients recruited from a tertiary care rheumatology centre. We also assessed 222 age-matched female healthy controls. Serum MHR was measured in all study participants. Digital ulcer (DU) was defined as an active or healed ulceration, and the magnitude of skin fibrosis was determined according to the modified Rodnan skin score (mRSS).Results: The mean age and median disease duration in patients with SSc were 56.3 years and 98 months, respectively. The MHR in SSc patients was significantly higher than that in controls. DU was found in 35 patients (31.5%) with SSc (active in 12 and healed in 23), and the median mRSS was 8. SSc patients with DU had a significantly higher median MHR than those without (11.43 vs 7.62, p < 0.001), and MHR significantly positively correlated with mRSS (ρ = 0.289, p = 0.002). Multivariable logistic regression revealed that an elevated MHR was independently associated with increased risk of DU (odds ratio = 1.21; 95% confidence interval = 1.07-1.35; p = 0.002). In the multivariable linear regression analysis, higher MHR showed a significant association with increased log-transformed mRSS (unstandardized β = 0.052, p = 0.003).Conclusion: Our findings suggest that the MHR could be serve as a potential biomarker of the risk of DU and advanced skin fibrosis in patients with SSc.

The brain and behavioral correlates of motor-related analgesia (MRA)

The human motor system has the capacity to act as an internal form of analgesia. Since the discovery of the potential influence of motor systems on analgesia in rodent models, clinical applications of targeting the motor system for analgesia have been implemented. However, a neurobiological basis for motor activation's effects on analgesia is not well defined. Motor-related analgesia (MRA) is a phenomenon wherein a decrease in pain symptoms can be achieved through either indirect or direct activation of the motor axis. To date, research has focused on (a) evaluating the pain-motor interaction as one focused on the acute protection from painful stimuli; (b) motor cortex stimulation for chronic pain; or (c) exercise as a method of improving chronic pain in animal and human models. This review evaluates (1) current knowledge surrounding how pain interferes with canonical neurological performance throughout the motor axis; and (2) the physiological basis for motor-related analgesia as a means to reduce pain symptom loads for patients. A proposal for future research directions is provided.

Extraction of Beam-Spin Asymmetries from the Hard Exclusive π^{+} Channel off Protons in a Wide Range of Kinematics

We have measured beam-spin asymmetries to extract the sinϕ moment A_{LU}^{sinϕ} from the hard exclusive e[over →]p→e^{'}nπ^{+} reaction above the resonance region, for the first time with nearly full coverage from forward to backward angles in the center of mass. The A_{LU}^{sinϕ} moment has been measured up to 6.6  GeV^{2} in -t, covering the kinematic regimes of generalized parton distributions (GPD) and baryon-to-meson transition distribution amplitudes (TDA) at the same time. The experimental results in very forward kinematics demonstrate the sensitivity to chiral-odd and chiral-even GPDs. In very backward kinematics where the TDA framework is applicable, we found A_{LU}^{sinϕ} to be negative, while a sign change was observed near 90° in the center of mass. The unique results presented in this Letter will provide critical constraints to establish reaction mechanisms that can help to further develop the GPD and TDA frameworks.

Arytenoid Subluxation Reduction Using 28-Jackson Dilator

Arytenoid dislocation and subluxations commonly are reduced surgically using Holinger and straight Miller-3 laryngoscopes. We present a case of arytenoid cartilage subluxation returned to good position using a 28-Jackson dilator. A 66-year-old man was diagnosed previously with right vocal fold paresis and left vocal fold paralysis following a motor vehicle accident that required a 14-day intubation and tracheotomy maintained for 3 weeks. Evaluation by strobovideolaryngoscopy 3 months following the accident showed severe left vocal fold hypomotility and arytenoid height disparity; laryngeal electromyography showed only mild-to-moderate decreased recruitment in laryngeal muscles. No abnormalities were appreciated on neck computed tomography. Upon palpation of both arytenoid cartilages in the operating room, the left joint was found to be subluxed anteriorly and immobile. A 28-Jackson dilator was used to mobilize and reduce the left arytenoid cartilage, and steroid was injected into the cricothyroid joint. Increased mobility was obtained in the operating room and the patient reported significant improvement in his voice. Six months later, we saw improvement in arytenoid height disparity and left vocal fold movement, better glottic closure, and voice handicap index was improved. A 28-Jackson dilator can be used to manipulate the cricoarytenoid joint without trauma to the vocal process.

Using search engine data to gauge public interest in mental health, politics and violence in the context of mass shootings

Despite significant potential for providing insight to private perceptions and behaviors, search engine data has yet to be utilized as a means of gauging the U.S. public’s interest and understanding of mental health in the context of gun violence and politics. An analysis of Google Trends revealed that Mental health searches increased in volume starting in the beginning of the current decade. Notably, both “mental health” and “gun(s)” were searched with greater frequency the week after the mass shooting events occurred. Related searches after the event also observed a significant increase in interest in mental health and gun regulation, legal reform, mass shootings, and gun(s). Results suggest that the American public’s perception of mental illness increasingly incorporates associations with themes of violence and politics, which becomes more apparent surrounding mass shooting events. Future studies are needed to determine implications for stigmatization of vulnerable groups, and possible relations to media coverage.

A Prospective Cohort Study of Bisphenol A Exposure from Dental Treatment

Laboratory studies show that bisphenol A (BPA) leaches from bisphenol A-glycidyl methacrylate (bisGMA)-based dental materials. We aimed to quantify the extent to which children are exposed to BPA from dental treatment with bisGMA materials, by amount of treatment and type of sedation. We hypothesized that posttreatment urinary BPA (uBPA) concentrations would be higher among patients with more surfaces treated with bisGMA-based materials and among patients receiving general anesthesia compared with pretreatment concentrations. We conducted a prospective cohort study in 211 children, 4 to 12 y old, who had no prior resin-based dental treatment. We measured uBPA concentrations twice before treatment and at 2 d and 1, 4, and 16 wk posttreatment. We abstracted treatment data (surfaces treated) from the chart. We generated descriptive statistics and compared pre- and posttreatment uBPA concentrations using generalized estimating equations. Participants were 51% female, 46% non-White, and 74% publicly insured. The median age was 6 y. The mean number of tooth surfaces exposed to BisGMA materials (composites/sealants) was 7.5 (SD 5.3). Overall, uBPA concentrations were 86% higher (95% confidence interval [CI] 42% to 143%, P < 0.001) at 2 d posttreatment compared with pretreatment concentrations. The uBPA concentrations 2 d posttreatment versus pretreatment tended to be higher (112%, 95% CI 53% to 194%) among those receiving treatment on >4 surfaces than those receiving treatment on ≤4 surfaces (50%, 95% CI -2% to 130%). Two days after treatment, uBPA was significantly higher than pretreatment concentrations in children receiving nitrous oxide but not in those receiving general anesthesia. Among all findings, uBPA concentrations returned to baseline by 4 wk. Children experience short-term increases in BPA from dental treatment. The impact of relatively high, short-term BPA exposure on child health is unknown. Given the widespread use of BisGMA-based dental materials and that chronic low-dose BPA exposure may adversely affect child health, strategies that minimize BPA exposure could potentially improve child health.