Advances in risk predictive performance of pre-symptomatic type 1 diabetes via the multiplex Antibody-Detection-by-Agglutination-PCR assay

Introduction

Achieving early diagnosis of pre-symptomatic type 1 diabetes is critical to reduce potentially life-threatening diabetic ketoacidosis (DKA) at symptom onset, link patients to FDA approved therapeutics that can delay disease progression and support novel interventional drugs development. The presence of two or more islet autoantibodies in pre-symptomatic type 1 diabetes patients indicates high-risk of progression to clinical manifestation.

Method

Herein, we characterized the capability of multiplex ADAP assay to predict type 1 diabetes progression. We obtained retrospective coded sera from a cohort of 48 progressors and 44 non-progressors from the NIDDK DPT-1 study.

Result

The multiplex ADAP assay and radiobinding assays had positive predictive value (PPV)/negative predictive value (NPV) of 68%/92% and 67%/66% respectively. The improved NPV stemmed from 12 progressors tested positive for multiple islet autoantibodies by multiplex ADAP assay but not by RBA. Furthermore, 6 out of these 12 patients tested positive for multiple islet autoantibodies by RBA in subsequent sampling events with a median delay of 2.8 years compared to multiplex ADAP assay.

Discussion

In summary, multiplex ADAP assay could be an ideal tool for type 1 diabetes risk testing due to its sample-sparing nature (4µL), non-radioactiveness, compatibility with widely available real-time qPCR instruments and favorable risk prediction capability.

Enhancing Clinical Accuracy in DIBH Pattern Detection with a Combined Ultrasonic and IR Sensor System

PURPOSE/OBJECTIVE(S)

This study aimed to develop a DIBH monitoring system using IR (Infrared- VL6180X Time of Flight) distance sensors and a microcontroller, and to demonstrate its functionality and performance in various irregular free and DIBH breathings from the left breast and lung patients.

MATERIALS/METHODS

A total of ten patients who performed DIBH breathing for treatment planning and optimized treatment delivery were randomly selected for the study. The breathing motion of the system was tested using an RPM (Real-Time Positioning Management) phantom. The IR sensors were interfaced with an Arduino microcontroller, and a body phantom was used to mimic the DIBH pattern on a CT scan. The detector holder was mounted perpendicularly between the xiphoid and umbilicus, with the ability to compensate for various patient body habitus and adapt to clinical setups. The plastic devices were 3D printed, and the sensors were mounted approximately 100mm apart to receive directed echo signals and prevent unwanted signals from scattering.

RESULTS

The IR sensor DIBH system was able to detect and record the patient's breathing pattern in real-time. The IR sensor showed better visualization of breathing rhythm with fewer fluctuations and reduced noise than the previous ultrasonic sensor system. The breathing amplitude and duration for the patients were compared to our treatment planning of Varian Eclipse and verified in TrueBeam's Breath-Hold Gating mode. The amplitude and duration from the primary study were measured to ±5mm, including 3mm sensor noise level and ±1.5 second.

CONCLUSION

The IR sensor DIBH system demonstrated better performance compared to the ultrasonic sensor, with a better visualization of breathing rhythm and reduced fluctuations and noise. It provided a clinically acceptable DIBH pattern for monitoring chest and abdominal motion in patients with irregular breathing. The findings of this study have the potential to enhance clinical accuracy in radiation therapy treatment planning and delivery for patients undergoing DIBH.

The perceived effects and comfort of various body armour systems on police officers while performing occupational tasks

Background

The nature of police work often necessitates use of Individual Light Armour Vests (ILAVs) for officer protection. Previous research has demonstrated various biomechanical and physical performance impacts of ILAVs, however, little knowledge exists on the individual officer’s perceptions of ILAV. The aim of this study was to investigate officers’ perceptions of the impacts of three different ILAVs and normal station wear whilst performing police occupational tasks.

Methods

A prospective, within subjects, repeated measures design was employed in which 11 serving police officers wore each of three different types of body armour (ILAV A, ILAV B or ILAV C) and normal station wear for a full day while performing tasks including a simulated victim drag, a patrol vehicle exit and a marksmanship shoot. Ratings of Perceived Exertion (RPE) and a Visual Analogue Scale (VAS; − 10 to + 10) were used to examine officer perceptions of each ILAV. Finally, officers were asked to indicate areas of both discomfort and comfort of each ILAV on a mannequin chart.

Results

Officers perceived less effort was required for the victim drag whilst wearing ILAV B (RPE = 3.6/10) when compared to ILAV A, ILAV C and even station wear (RPE = 4.7/10, 4.0/10, 3.8/10, respectively). A positive impact on performance was perceived for ILAV B (VAS = + 0.26) when performing a patrol vehicle exit and sprint task but not for the other two ILAVs (VAS = − 3.58, − 0.55, − 0.85, respectively). Officers perceived a positive impact of ILAV B (VAS = + 2.7) and station wear (VAS = + 1.4) and a negative impact of ILAVs A and C (VAS = − 2.1, − 1.7 respectively) on marksmanship. Despite all armour types being criticized for discomfort, ILAV B received lower ratings of discomfort overall, and some positive comments regarding both comfort and performance.

Conclusions

Officers perceived ILAV B to have positive effects on task performance. It was also rated more comfortable than the other two, possibly due to a longer torso design which shifted load from the shoulders to the hips and pelvis. Officer perceptions of comfort and effects on occupational performance should be considered when designing and procuring armour systems. Although ILAVs may be similar, perceived impacts may vary between officers.

P3-14-26: The Effect of Biologic Subtype in Patients Treated with Neoadjuvant Chemotherapy: A UAB Experience

Purpose: Previous studies have suggested that the pre treatment clinical stage drives loco-regional recurrence (LRR), distant metastasis (DM) and survival in patients treated with neoadjuvant chemotherapy. This retrospective analysis was performed to look at the effect of biologic subtype on patient outcomes.

Methods: Between 1999 and 2005, 115 patients treated with neoadjuvant chemotherapy, surgery, and +/−radiation therapy at UAB were identified. Patient, tumor, and treatment characteristics were recorded. Pathologic complete response was defined as resolution of both invasive disease and DCIS in both the primary and nodal disease. Survival was measured using the Kaplan Meier statistics. Univariate and multivariate analyses of covariates associated with LRR, DM, progression-free (PFS) and overall survival (OS) were performed. Results: The mean age was 49 years, with a mean follow-up of 5.8 years. Subtype distribution was as follows: 52 luminal A, 17 luminal B, 36 triple negative, 9 Her2+ and one patient with an unknown biologic subtype. Distribution of clinical stage was as follows: 40 IIA, 34 IIB, 26 IIIA, 10 IIIB, and 5 IIIC. Tumors were down-staged following neoadjuvant therapy as follows: 18: pCR, 6: residual DCIS, 17: I, 38: IIA, 11: IIB, 13: IIIA, 5: IIIB, and 7: IIIC. Pre-treatment clinical stage did not significantly influence LRR, DM or progression free and overall survival; however, final pathologic T, N and group stage were associated with both progression free, p=0.003, 0.011, 0.005 and overall survival, p=0.02, 0.037, and 0.009. Complete resolution of tumor by mammographic or MR imaging to neoadjuvant chemotherapy, was associated with an increased overall survival, p=0.0025. Univariate analysis did not show a significant effect of biologic subtype, age, grade, use of radiation therapy or anti-hormonal therapy.

Discussion: In this retrospective series, response to chemotherapy and the final pathologic stage, representing the volume of residual disease, were important predictors of survival. Further study to determine factors predictive of chemotherapy response is needed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-26.

P3-07-06: Prognostic Utility of Upfront Nodal Staging Prior to Neoadjuvant Chemotherapy: The UAB Experience

Purpose: Controversy exists regarding the prognostic utility of upfront lymph node staging in patients receiving neoadjuvant chemotherapy. This retrospective study explores whether upfront verses outback nodal staging influenced locoregional control and survival endpoints. Methods: Between 1999 and 2005 one hundred and fifteen patients treated with neoadjuvant chemotherapy at UAB were identified. Patient, tumor, and treatment variables were recorded. Timing of nodal assessment was based on either surgeon preference or stipulated upfront per several clinical protocols. Survival was measured using the Kaplan Meier statistics. Univariate and multivariate analyses of covariates associated with local-regional control (LRC), progressionfree (PFS) and overall survival (OS) were performed. Results: Mean age was 49 years and mean follow-up was 5.8 years. Stage distribution was as follows: 40 IIA, 34 IIB, 26 IIIA, 10 IIIB, and 5 IIIC. Definitive surgery included breast conservation in 49 patients, total mastectomy in 21 and modified radical mastectomy in 44. Seventy-two patients had upfront nodal sampling before neoadjuvant therapy, 36 by fine needle assessment and the remainder by sentinel node biopsy. Forty-three patients had their nodal assessment following neoadjuvant chemotherapy. Of those with upfront nodal staging: forty nine patients had a positive nodal result and 23 had negative findings. In those that were sampled at the time of definitive surgery: 21 had positive results, 21 had a negative result, and 1 patient did not have any nodes in the specimen. One hundred five patients had post-operative radiation therapy. Overall there was no difference in LRC, PFS or OS outcomes between patients that had an upfront nodal staging procedure and those that had their nodes sampled at the time of definitive surgery. Patients achieving pCR had a non-significant trend towards improved overall survival (p=0.12). Final pathologic T, N and group stage were statistically significant in determining the progression free, p=0.003, 0.011, 0.005 and overall survival, p=0.02, 0.037, and 0.009. Lymphovascular space invasion was associated with progression free survival on univariate analysis, p=0.0179, but not multivariate analysis. Other covariates including age, biologic subtype, grade, type of chemotherapy, use of radiation therapy, radiation volume, time to complete radiation therapy, and use of hormonal therapy did not affect outcomes. Discussion: Upfront as compared with outback lymph node staging did not influence locoregional control or survival endpoints. Final pathologic stage and not initial clinical stage remains the most important prognostic factor associated with survival.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-06.

Abstract P4-11-04: The Influence of Radiation on Survival in Patients with Triple Negative Stage II Breast Cancer

Background: Prospective trials of locally advanced breast cancer patients treated with adjuvant radiation (RT) have demonstrated a survival advantage; however, use of postmastectomy RT in stage II patients is controversial. This study explores the possibility that patients with aggressive variant molecular subtypes [triple receptor negative (TN)] treated with modern chemotherapy, may experience a survival benefit from adjuvant RT.

Methods: Billing codes for all breast cancer patients treated with chemotherapy between 1/1998 and 5/2005 at the University of Alabama at Birmingham were reviewed to comprehensively capture all Stage II and III patients with intact data. Patient, tumor, and treatment related variables were recorded and patients were divided into 3 molecular subtypes based on receptor status: hormone receptor (HR) positive, Her2 negative; HR+/− , Her2+; and TN. Kaplan Meier curves to assess survival were performed by dividing the TN group into 2 groups: those who did or did not receive adjuvant RT.

Results: 409 patients with stage II-III disease with were identified. Out of this group, 81 patients had TN breast cancer (60 Stage II and 21 Stage III). RT data was known in 79 of these patients. Median age was 49 years. Median follow-up was 72 months. Thirty-seven stage II and 18 stage III patients received adjuvant RT. Of the stage II patients who received radiation, 25 underwent lumpectomy and 11 underwent mastectomy. Stage II patients who received adjuvant RT had a statistically significant improvement in DFS (p=0.03), and had a trend towards improvement in OS (p=0.07) when compared with those who did not receive adjuvant RT. There was no significant difference in survival for the stage III patients with use of RT, however numbers in this group were small. Conclusion: Adjuvant RT was associated with an improvement in DFS and a trend towards improvement in OS in patients with Stage II, TN breast cancers treated with modern chemotherapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-04.

Abstract P5-10-19: The Influence of Time to Completion of Chemotherapy on Survival in Patients with Triple Negative Stage III Breast Cancer

Background: Neoadjuvant chemotherapy is increasingly delivered to facilitate breast conserving surgery through tumor downstaging. Prospective trials of neoadjuvant chemotherapy from the NSABP suggest no difference in survival outcomes in patients receiving neoadjuvant versus adjuvant therapy; however, subset analysis in 2 combined trials (B-18 and B-27) demonstrated a trend in DFS improvement in young patients (<50 yrs), who often have more aggressive variant tumors. This study explores the possibility that patients with aggressive variant molecular subtypes [triple receptor negative (TN)] treated with modern chemotherapy, may significantly benefit from earlier completion of drug delivery. Methods: Billing codes for all breast cancer patients treated with chemotherapy between 1/1998 and 5/2005 at the University of Alabama at Birmingham were reviewed to comprehensively capture all Stage II and III patients with intact data. Patient, tumor, and treatment related variables were recorded and patients were divided to 4 molecular subtypes based on receptor status: hormone receptor (HR) positive, Her2 negative; HR+/− , Her2+; and triple receptor negative (TN). Kaplan Meier curves to assess survival were performed by dividing the TN group into 2 groups: those completing chemotherapy ≥5 vs > 5 months from diagnosis. Results: 409 patients with Stage II-III disease with were identified: 124 received neoadjuvant and 285 received adjuvant chemotherapy. Out of this group, 81 patients had TN breast cancer (60 Stage II and 21 Stage III). Median age was 49 years. Median follow-up was 72 months. Chemotherapy consisted of adriamycin, taxol and cytoxan for a median of 9 cycles. Stage III patients who completed chemotherapy within 5 months had a statistically significant improvement in OS and DFS (p=0.03), and had a trend towards improvement in DMFS (p=0.10) when compared with those who took longer than 5 months to complete chemotherapy. Conclusion: Completion of chemotherapy in a shorter time interval in patients with Stage III, TN breast cancers was associated with an improvement in DFS and OS. Consideration of timing of chemotherapy warrants further study.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-19.