Measuring scattering distributions in scanning helium microscopy

A scanning helium microscope typically utilises a thermal energy helium atom beam, with an energy and wavelength (¡100meV, ∼0.05 nm) particularly sensitive to surface structure. An angular detector stage for a scanning helium microscope is presented that facilitates the in-situ measurement of scattering distributions from a sample. We begin by demonstrating typical elastic and inelastic scattering from ordered surfaces. We then go on to show the role of topography in diffuse scattering from disordered surfaces, observing deviations from simple cosine scattering. In total, these studies demonstrate the wealth of information that is encoded into the scattering distributions obtained with the technique.

Pooled DNA sequencing in hairy vetch (Vicia villosa Roth) reveals QTL for seed dormancy but not pod dehiscence

Introduction

Hairy vetch (Vicia villosa Roth) is a promising legume cover crop, but its use is limited by high rates of pod dehiscence and seed dormancy.

Methods

We used phenotypically contrasting pooled DNA samples (n=24 with 29-74 individuals per sample) from an ongoing cover crop breeding program across four environments (site-year combinations: Maryland 2020, Maryland 2022, Wisconsin 2021, Wisconsin 2022) to find genetic associations and genomic prediction accuracies for pod dehiscence and seed dormancy. We also combined pooled DNA sample genetic association results with the results of a prior genome-wide association study.

Results and discussion

Genomic prediction resulted in positive predictive abilities for both traits between environments and with an independent dataset (0.34-0.50), but reduced predictive ability for DNA pools with divergent seed dormancy in the Maryland environments (0.07-0.15). The pooled DNA samples found six significant (false discovery rate q-value<0.01) quantitative trait loci (QTL) for seed dormancy and four significant QTL for pod dehiscence. Unfortunately, the minor alleles of the pod dehiscence QTL increased the rate of pod dehiscence and are not useful for marker-assisted selection. When combined with a prior association study, sixteen seed dormancy QTL and zero pod dehiscence QTL were significant. Combining the association studies did not increase the detection of useful QTL.

Genome-wide association mapping in hairy vetch (Vicia villosa) discovers a large effect locus controlling seed dormancy

Hairy vetch (Vicia villosa Roth), a winter-hardy annual legume, is a promising cover crop. To fully leverage its potential, seed production and field performance of V. villosa must be improved to facilitate producer adoption. Two classic domestication traits, seed dormancy (hard seed) and dehiscence (pod shatter), are selection targets in an ongoing breeding program. This study reports a genome-wide association study of 1,019 V. villosa individuals evaluated at two sites (Knox City, Texas and Corvallis, Oregon) for the proportion of dormant seed, visual pod dehiscence scores, and two dehiscence surrogate measures (force to dehiscence and pod spiraling score). Trait performance varied between sites, but reliability (related to heritability) across sites was strong (dormant seed proportion: 0.68; dehiscence score: 0.61; spiraling score: 0.42; force to dehiscence: 0.41). A major locus controlling seed dormancy was found (q-value: 1.29 × 10-5; chromosome 1: position: 63611165), which can be used by breeding programs to rapidly reduce dormancy in breeding populations. No significant dehiscence score QTL was found, primarily due to the high dehiscence rates in Corvallis, Oregon. Since Oregon is a potentially major V. villosa seed production region, further dehiscence resistance screening is necessary.

PREVALENCE OF EHRLICHIA AND ANAPLASMA SPP. IN TICKS COLLECTED FROM CATTLE AND DEER IN ARKANSAS, USA

Bovine anaplasmosis, caused by Anaplasma marginale, is widespread in cattle in the southeast United States. The pathogen is biologically transmitted by Dermacentor spp. ticks, and mechanically transmitted by biting flies and via fomites. Despite high reported regional seroprevalence, Dermacentor spp. are rare on cattle in the southeast. To identify other putative An. marginale vectors, and to characterize cattle exposure to other tick-borne pathogens, we collected ticks from Arkansas cattle herds in 2020-2022. Recognizing that deer are important hosts for some of the same tick species that parasitize cattle, we also collected ticks from hunter-killed deer in the fall and winter of 2021. Ticks were screened for bacteria in the family Anaplasmataceae using qPCR. Positive samples were further amplified using a PCR assay targeting the groEL gene, and the resulting amplicons were sequenced for identification. A total of 3,794 ticks were collected, the majority of which were Amblyomma americanum. Amblyomma americanum was the most common species on cattle, and Ixodes scapularis was most common on deer. No ticks were positive for An. marginale, though Anaplasma phagocytophilum was detected in deer-collected I. scapularis, as well as in a single engorged Am. americanum from cattle. Amblyomma americanum from cattle were infected with Ehrlichia ewingii, Ehrilichia chaffeensis, and Panola Mountain Ehrlichia. Cattle in Arkansas are exposed to several ehrlichial pathogens and may also be exposed to An. phagocytophilum. The importance of these pathogens, particularly Panola Mountain Ehrlichia, in causing cattle disease in Arkansas deserves further study, as does the importance of mechanical transmission of An. marginale in bovine anaplasmosis epidemiology.

Electroconvulsive Therapy’s use in Idiopathic Intracranial Hypertension with Mood Disorder: caution, promise, and progress

Introduction

Idiopathic Intracranial Hypertension (IIH) is a condition characterized by an increase of intracranial pressure (ICP) with no identifiable cause to date. One-half of patients who suffer from IIH have co-morbid mood disorders, such as Major Depressive Disorder (MDD), that can be refractory to pharmacologic treatment. Electroconvulsive Therapy (ECT) is a safe and effective treatment for treatment-refractory mood disorder, but possesses a relative contra-indication for IIH due to its theoretical increase in ICP. Can ECT become the gold-standard treatment modality for mood disorder from IIH?

Objectives

We aim to synthesize and summarize the state of the literature surrounding the intersection of ECT and IIH. We will present notable findings and propose avenues for future investigation.

Methods

We conducted a literature review using PubMed’s search function. Key terms that were queried are as follows: Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Benign Intracranial Hypertension, Mood Disorder, Major Depressive Disorder, ECT, Electroconvulsive Therapy.

Results

The prevailing theory of IIH and mood disorder centers around HPA axis dysfunction, which has been heavily theorized to be positively impacted with ECT. ECT itself may not increase the ICP, but the anesthesia might. The only two case reports in the literature presented safe and successful use of ECT’s in patients with IIH and MDD.

Conclusions

More data is needed to draw conclusions, as the literature surrounding ECT’s use in patients with IIH remains sparse. Further studies must explore whether ECT’s use in IIH remains effective. Through this, we may understand more about both IIH and ECT itself.

Disclosure

No significant relationships.

A Pilot Study Testing Intranasal Ketamine for the Treatment of Procedural Anxiety in Children Undergoing Laceration Repair

Identifying non-invasive methods for anxiolysis is becoming increasingly important in the pediatric emergency department (ED). Few studies have examined the use of intranasal (IN) ketamine for procedural anxiolysis. We aim to evaluate if IN ketamine provides satisfactory anxiolysis for patients undergoing laceration repair based on anxiety and sedation scoring. We also evaluated the feasibility of using IN ketamine in future trials based on its tolerability and side-effects. A pilot study evaluating IN ketamine in the treatment of procedural anxiety for patients, 2 years and older, weighing 40 kg or less, presenting to the pediatric ED with lacerations. The need for anxiolysis was defined by an elevated modified-Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) score. Patients received 5 mg/kg of IN ketamine in addition to topical anesthesia, mYPAS-SF scoring before and during the procedure, sedation scoring, adverse events, vital signs, age, weight, laceration size and location, and satisfaction surveys were recorded. Twenty-five patients were enrolled, with mean age of 61 ± 29.2 months and mean weight of 21 ± 6.4 kg. Lacerations were located on the face, extremities, and groin with mean size of 2.1 cm. A decrease in anxiety levels was observed, from median m-YPAS-SF score of 66.7 (62.50-80.2) to 33.3 (27.09-52.00), p < 0.001. Among the patients, 92% (n = 23) were less anxious during the procedure. IN ketamine appears to be safe and well-tolerated with a positive impact on procedural anxiety. A dosage of 5 mg/kg is a reasonable starting point, as 80% of patients had appropriate anxiolysis.

Emerging Catatonia and Psychosis in Resolving COVID-19 Infection in an Adolescent

Introduction

COVID-19 infection may lead to encephalopathy and various neurotrophic effects which can result in neuropsychiatric complications. Here, an asymptomatic adolescent female developed acute onset catatonia and psychosis manifesting during the resolution of Covid-19 infection.

Objectives

Discuss differential diagnosis, medical workup, and initial treatment optimization for acute stabilization.

Methods

This 15-year-old female with no previous psychiatric history nor prodromal symptomatology was hospitalized secondary to Covid -19. During the immediate three-month recovery phase following resolution of Covid-19, the patient exhibited gradually increasing anxiety, paranoia, delusions, disorganized behavior, and weight loss leading to re-hospitalization secondary to catatonia. Negative workup included rapid strep test, urinalysis, chest and abdominal x-ray, EEG, and brain MRI. Lumbar puncture revealed elevated WBC of 18 but was unremarkable for NDMA receptor antibodies, CSF HSV, and encephalitis panel. IV steroids, IVIG, and Anakinra were all given without benefit. Inadequate response to olanzapine, clonidine, and lorazepam led to an Index Series of bilateral electroconvulsive therapy (ECT).

Results

The provisional diagnosis of psychotic disorder secondary to COVID-19 infection responded robustly regarding sleep, behavior, and affect by session #6, yet positive symptoms of psychosis persist. Ongoing ECT, psychopharmacology, and narrowing of the differential diagnosis continue.

Conclusions

As more COVID-19 cases evolve during the pandemic, potential post-infectious neuropsychiatric complications should be considered as potentially contributory and kept in a thoughtful differential diagnosis. Regardless of ultimate causation, the acute symptom profile responded robustly to an initial Index Series of ECT.

Disclosure

No significant relationships.

Late 1800s Fringe Electrotherapeutic Devices: Comparative Electrical Capabilities

Introduction

Desperation for cure led to 19^th century invention-- electrotherapeutic devices; replete with hyperbolic claims of cure-all, perceived ineffectiveness, and potential harm rendered the modality as quackery but were used in early brain stimulation, melancholia treatment, and cortex mapping. Here, antique devices are restored, and their electrophysiological qualities ascertained.

Objectives

Determine the comparative capabilities of these devices in delivering electrostimulation and compare with modern standards to understand possible electrophysiological sequelae.

Methods

Devices known as “medical batteries” were analyzed. Power delivery utilized a “voltaic battery”, simple circuit, and a conductor wrapped around an iron core. When the circuit is energized, the core is magnetized by direct current of the battery which induces an alternating current that electrifies probes used on the body. Due to their marked age, a common 9-volt battery was exchanged for the corrosive dry cell paste batteries. Electrical parameters were then measured.

Results

Table 1

Device	Frequency (Hz)	Resistance (Ohms)	Max Output (Amps)	Min Output (Amps)	Max Output (Volts)	Min Output (Volts)
Voltampa	2k – 12K	60	0.66	0.33	60V	20V
J.H. Bunnell & Co.’s No. 4 D.D.	7k-10k	50	6	0.4	300V	20V
Schall & Son (London)b	300-1200	40	10.5	2.75	420V	110V

Conclusions

Devices for electrotherapeutics ranged from anemic vibrations to dangerous tetany inducing shocks. Measuring the capabilities of these devices shows the robust yields possible if the original higher capacity batteries were utilized. The reality is, cure or not, the devices were surprisingly potent. It is interesting that, albeit unrefined, efficacious doses were available before modern electrification.

Disclosure

No significant relationships.

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Paradoxical Neuroethical Crisis of Agency and Identity in an Obsessive-Compulsive Disorder Deep Brain Stimulation Patient

Introduction

Deep Brain Stimulation is an increasingly viable, well-established treatment for medication refractory obsessive-compulsive disorder. Yet, its neuromodulatory effects on the brain have led to varying and opposing neuroethical debates about its potential influence on a range of phenomena such as human agency, sense of nonauthenticity and identity.

Objectives

Establish the importance of maintaining the psychotherapeutic alliance in a long-term DBS patient who reported minimal device side effect and no brain-technology interface interpersonal issues; yet struggled with a paradoxical phenomenon of psychic distress surrounding issues of agency and identity, not through device implantation, but through morphology of cognitions from negativistic interpersonal dynamics and spousal victim-blaming due to the necessity for such a device.

Methods

Case-report of a 60+-year-old gentleman with a history of childhood-onset, treatment refractory OCD with a 15-year history of bilateral DBS lead placed via a ventral caudate/ ventral striatum trajectory through the anterior limb of the internal capsule to the nucleus accumbens.

Results

Years later he was only minimally improved above baseline; yet now with a few-years increasing degree of distress over a perceived atrophy of his capabilities that he felt was validated through what he described as his failure of artificial bionics. Extensive device setting re-optimization did not improve efficacy and with supportive therapy, the DBS device was weaned, and turned off.

Conclusions

The following year the therapeutic foci were on interpersonal identity, existential acceptance of breakthrough symptoms, and engagement of spouse into marital counseling leading to subsequent resolution of distress with improved quality of life.

Disclosure

No significant relationships.

Efficacy of color lenses in abolishing photosensitivity: Beyond the one-type-fits-all approach?

OBJECTIVE

Red-light filtering lenses represent an additional option to medication in photosensitive epilepsy. Blue lenses (Clarlet Z1 F133) can dramatically reduce seizure frequency, with a substantial restriction in luminance that can limit their applicability in daily life. We investigated the efficacy of 4 blue lenses with higher transmittance and reduced chromatic distortion in abolishing the photoparoxysmal EEG response (PPR) compared to the gold-standard Z1 lenses.

METHODS

We reviewed EEG data during photic-and pattern stimulation in 19 consecutive patients (6-39 years) with photosensitivity (PS). Stimulation was performed at baseline and while wearing Z1 and the four new lenses. Lenses were tested in the same session by asking the patient to wear them in a sequentially randomized fashion while stimulating again with the most provocative photic/pattern stimuli. The primary outcome was the change in the initial PPR observed for each lens, categorized as no change, reduction, and abolition.

RESULTS

Photosensitivity was detected in 17 subjects (89.5%); pattern sensitivity (PtS) was identified in 14 patients (73.7%). The highest percentages of PPR abolition/reduction were observed with Z1, for both PS and PtS. Regarding the new lenses, B1 + G1 offered the best rates, followed by B1 + G2. B1 + G3 and B1 showed lower efficacy rates, particularly for PtS. In the comparative analysis, no significant differences in PPR suppression were detected between the five lenses for PS. For PtS, the capacity of Z1 for PPR abolition was significantly higher compared with B1 + G3 and B1.

CONCLUSIONS

This preliminary study suggests efficacy of the new group of blue lenses with potentially greater tolerability, particularly in regions with fewer sunlight hours during winter. In line with the current trend for personalized approach to treatment, this study suggests that in some patients there might be scope in extending the testing to offer the lens with the higher transmittance effective in abolishing the PPR.

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

Background

Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term.

Purpose

To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs.

Methods

SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR.

Results

In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&lt;0.001), CABG (11% v 2%, p&lt;0.001) and a diagnosis of STEMI (21% v 5%, p&lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&lt;0.001), statins (91% 73%, p&lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&lt;0.001) than non-attendees.

Conclusions

Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

Maternal mental health and partner delivered massage: a pilot study

Background

Mental health problems place a significant burden on the health system and are an important public health issue. Many pregnant women experience anxiety and depression, which can negatively impact health outcomes for both mother and baby. Partner-delivered massage may provide a cost effective and accessible approach to support the mental wellbeing of pregnant women.

Methods

A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with a self-directed stress management program (control), for pregnant women with mild anxiety. Women attended an initial workshop at 28-32 weeks gestation, followed by the completion of either the self-directed massage or stress management program. Qualitative feasibility and acceptability data (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21).

Results

14 women/partner dyads attended the partner- delivered massage group and 13 women attended the self-directed stress management group. Participants from both groups reported the programs were feasible and acceptable. Mean scores on all DASS-21 subscales significantly decreased over time in both the intervention and the control group.

Conclusions

The partner-delivered massage program was feasible and acceptable. Both programs decreased women's symptoms of anxiety, depression and stress, with no significant between-group differences identified. An adequately powered, experimental study is needed to determine the effectiveness of partner-delivered relaxation massage.

Key messages

Many women experience anxiety and depression during pregnancy and this can have a negative impact on both mother and baby. Partner-delivered relaxation massage, at least once a week in the third trimester, may help reduce women’s symptoms of anxiety, depression and stress.

The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis

OBJECTIVE

To critically appraise and synthesize the best available evidence on the effectiveness of massage to reduce antenatal women's anxiety and/ or depression.

DESIGN

Systematic review with meta-analysis PARTICIPANTS, INTERVENTIONS: Pregnant women over the age of 18 years who receive massage interventions.

MEASUREMENTS AND FINDINGS

Eight studies were included in the review; seven were randomized controlled trials. Data were collected via pregnant women's self-reported ratings of anxiety or depression using validated tools. Meta-analysis of four studies revealed a moderate effect of massage therapy on women's depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) (MD = -5.95, 95%CI = -8.11 to -3.80, I² = 0%) compared with usual care. A moderate effect of massage interventions on women's anxiety were also found based on five studies using various measures (SMD = -0.59, 95%CI = -1.06 to -0.12, I² = 75%) when compared with usual care. However, none of the trials had a low risk of bias.

KEY CONCLUSIONS

Non-pharmacologic treatments for mental health symptoms are an important option for women to use during pregnancy. As shown in meta-analysed data, massage therapy might be more effective in reducing pregnant women's anxiety and depression than usual care, although the current results may be prone to bias. Further high-quality research is required to fully evaluate the impact of massage therapy on pregnant women's mental health symptoms in the immediate and also longer term.

IMPLICATIONS FOR PRACTICE

Massage therapy may be an acceptable and feasible approach for pregnant women to employ to reduce their anxiety and depressive symptoms. More research evidence examining the safety and effectiveness of massage is required before practice recommendations can be made.

Dielectric-Backed Aperture Resonators for X-Band in vivo EPR Nail Dosimetry

A new resonator for X-band in vivo EPR nail dosimetry, the dielectric-backed aperture resonator (DAR), is developed based on rectangular TE₁₀₂ geometry. This novel geometry for surface spectroscopy improves at least a factor of 20 compared to a traditional non-backed aperture resonator. Such an increase in EPR sensitivity is achieved by using a non-resonant dielectric slab, placed on the aperture inside the cavity. The dielectric slab provides an increased magnetic field at the aperture and sample, while minimizing sensitive aperture resonance conditions. This work also introduces a DAR semi-spherical (SS)-TE₀₁₁ geometry. The SS-TE₀₁₁ geometry is attractive due to having twice the incident magnetic field at the aperture for a fixed input power. It has been shown that DAR provides sufficient sensitivity to make biologically relevant measurements both in vitro and in vivo Although in vivo tests have shown some effects of physiological motions that suggest the necessity of a more robust finger holder, equivalent dosimetry sensitivity of approximately 1.4 Gy has been demonstrated.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Abstract P4-02-12: Breast MRI: Enhancing pre-operative planning in women with newly diagnosed breast cancer

Hypothesis:

Preoperative breast MRIs in newly diagnosed breast cancer patients may lead to additional findings, including larger disease involvement, thus leading to a change in the operative plan. This information can led to better surgical planning and decreased rates of surgical re-excisions.

Methods:

This was a single surgeon, single institution, retrospective analysis of women with newly-diagnosed breast cancer who had surgery between December 2013 and December 2014. A total of ninety-six patients underwent preoperative breast MRI. Exclusion criteria were patient's refusal of MRI or surgery, contraindication to MRI based on implants or body habitus, and male patients.

Results:

Overall, breast MRI most closely correlated to pathological tumor size (gold standard). MRI had a 64% correlation with pathology size, whereas mammography and ultrasound correlation were 44% and 43% respectively. As breast density increased, MRI correlation to pathologic tumor size improved. For breast density between 25-50%, tumor size by MRI correlated with pathology size in 27% of patients, mammogram correlation was 33% and ultrasound was 12%. When breast density increased to 51-75%, MRI correlation improved to 92%, whereas mammogram correlation was 56% and ultrasound was 68%. The majority of patients fell within these two density categories; correlation for breast density &lt;25% and &gt;75% were not statistically significant. Of the breast biopsies preformed for MRI abnormalities not otherwise identified by mammography or ultrasound, 42% were positive for invasive cancer or DCIS. Thirty-eight percent of patients had a change in operative plan based on their MRI findings. Of the ninety-six patients, nine were changed from breast conserving surgery to mastectomy, and 29 underwent a larger area of resection than planned prior to MRI, due to findings of more extensive disease on MRI not otherwise appreciated by mammography or ultrasound.

Conclusion:

Pre-operative MRI played a significant role in the pre-surgical evaluation of patients with newly diagnosed breast cancer. In our series, breast MRI demonstrated better correlation with extent of disease compared to other imaging modalities. This is turn enhanced patient and surgeon decision making and led to more precise pre-operative surgical planning.

Citation Format: Carr B, Lamb LC, Zarfos K, Weigert J, Singh R. Breast MRI: Enhancing pre-operative planning in women with newly diagnosed breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-12.

Geophysical imaging reveals topographic stress control of bedrock weathering

Bedrock fracture systems facilitate weathering, allowing fresh mineral surfaces to interact with corrosive waters and biota from Earth's surface, while simultaneously promoting drainage of chemically equilibrated fluids. We show that topographic perturbations to regional stress fields explain bedrock fracture distributions, as revealed by seismic velocity and electrical resistivity surveys from three landscapes. The base of the fracture-rich zone mirrors surface topography where the ratio of horizontal compressive tectonic stresses to near-surface gravitational stresses is relatively large, and it parallels the surface topography where the ratio is relatively small. Three-dimensional stress calculations predict these results, suggesting that tectonic stresses interact with topography to influence bedrock disaggregation, groundwater flow, chemical weathering, and the depth of the "critical zone" in which many biogeochemical processes occur.

The DEXLIFE study methods: identifying novel candidate biomarkers that predict progression to type 2 diabetes in high risk individuals

The incidence of type 2 diabetes (T2D) is rapidly increasing worldwide and T2D is likely to affect 592 million people in 2035 if the current rate of progression is continued. Today, patients are diagnosed with T2D based on elevated blood glucose, either directly or indirectly (HbA1c). However, the information on disease progression is limited. Therefore, there is a need to identify novel early markers of glucose intolerance that reflect the underlying biology and the overall physiological, metabolic and clinical characteristics of progression towards diabetes. In the DEXLIFE study, several clinical cohorts provide the basis for a series of clinical, physiological and mechanistic investigations in combination with a range of--omic technologies to construct a detailed metabolic profile of high-risk individuals across multiple cohorts. In addition, an exercise and dietary intervention study is conducted, that will assess the impact on both plasma biomarkers and specific functional tissue-based markers. The DEXLIFE study will provide novel diagnostic and predictive biomarkers which may not only effectively detect the progression towards diabetes in high risk individuals but also predict responsiveness to lifestyle interventions known to be effective in the prevention of diabetes.

Gemcitabine-based transcatheter arterial chemoembolization for unresectable cholangiocarcinoma in thirty-eight patients: Single institutional experience

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Background: Survival for patients with unresectable cholangiocarcinoma is reported to be 5–8 months. Systemic chemotherapy has been disappointing and not shown to significantly improve survival. Transcatheter arterial chemoembolization (TACE) has been shown to prolong survival in hepatocellular carcinoma patients but experience with cholangiocarcinoma is limited. We report our experience with the well-tolerated drug gemcitabine. Methods: Thirty-eight patients with unresectable cholangiocarcinoma were treated with one or more cycles of gemcitabine-based TACE between 2001 and 2005 at our institution. Follow-up imaging was performed on all patients after each TACE procedure. Regimens of TACE included: gemcitabine only (16), gemcitabine followed by cisplatin (2), gemcitabine followed by oxaliplatin (5), gemcitabine and cisplatin (12), and gemcitabine and cisplatin followed by oxaliplatin (3). Actual survival is reported, as 35 of 38 have died from disease (92%). Results: Patients were 57.5 years of age (range 36–87) and a median of 3 treatments (range 1–10) were administered. Median survival from time of first treatment was 10.3 months. Patients receiving gemcitabine followed by cisplatin or oxaliplatin had improved survival (mean 16.5 and 10.5 months respectively) when compared to gemcitabine alone (mean 6 months). Patients receiving gemcitabine and cisplatin as a combination had improved survival (mean 13.4 months) compared to single agent gemcitabine. Patients who progressed on gemcitabine and cisplatin and then received oxaliplatin also showed improved survival (mean 14.3 months) compared to gemcitabine only. Neutropenia, thrombocytopenia and hyperbilirubinemia were the most common toxicities observed. Three patients in the entire series exhibited grade 3 thrombocytopenia while seven patients had grade 3 and one had grade 4 bilirubin levels. Conclusions: This series provides evidence in favor of TACE rather than historically reported alternatives such as systemic chemotherapy or chemotherapy/RT. Our results suggest that gemcitabine based TACE is well tolerated and perhaps best delivered as a combination therapy for patients with unresectable cholangiocarcinoma.

No significant financial relationships to disclose.