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Carroll TM, Chadwick JA, Owen RP, White MJ, Kaplinsky J, Peneva I, Frangou A, Xie PF, Chang J, Roth A, Amess B, James SA, Rei M, Fuchs HS, McCann KJ, Omiyale AO, Jacobs BA, Lord SR, Norris-Bulpitt S, Dobbie ST, Griffiths L, Ramirez KA, Ricciardi T, Macri MJ, Ryan A, Venhaus RR, Van den Eynde BJ, Karydis I, Schuster-Böckler B, Middleton MR, Lu X. Tumor monocyte content predicts immunochemotherapy outcomes in esophageal adenocarcinoma. Cancer Cell 2023; 41:1222-1241.e7. [PMID: 37433281 DOI: 10.1016/j.ccell.2023.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 04/07/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
For inoperable esophageal adenocarcinoma (EAC), identifying patients likely to benefit from recently approved immunochemotherapy (ICI+CTX) treatments remains a key challenge. We address this using a uniquely designed window-of-opportunity trial (LUD2015-005), in which 35 inoperable EAC patients received first-line immune checkpoint inhibitors for four weeks (ICI-4W), followed by ICI+CTX. Comprehensive biomarker profiling, including generation of a 65,000-cell single-cell RNA-sequencing atlas of esophageal cancer, as well as multi-timepoint transcriptomic profiling of EAC during ICI-4W, reveals a novel T cell inflammation signature (INCITE) whose upregulation correlates with ICI-induced tumor shrinkage. Deconvolution of pre-treatment gastro-esophageal cancer transcriptomes using our single-cell atlas identifies high tumor monocyte content (TMC) as an unexpected ICI+CTX-specific predictor of greater overall survival (OS) in LUD2015-005 patients and of ICI response in prevalent gastric cancer subtypes from independent cohorts. Tumor mutational burden is an additional independent and additive predictor of LUD2015-005 OS. TMC can improve patient selection for emerging ICI+CTX therapies in gastro-esophageal cancer.
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Affiliation(s)
- Thomas M Carroll
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Joseph A Chadwick
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Richard P Owen
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Michael J White
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Joseph Kaplinsky
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Iliana Peneva
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Anna Frangou
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Phil F Xie
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Jaeho Chang
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Andrew Roth
- Department of Pathology and Molecular Medicine, University of British Columbia, Vancouver, Canada; Department of Computer Science, University of British Columbia, Vancouver, Canada; Department of Molecular Oncology, BC Cancer, Vancouver, Canada
| | - Bob Amess
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Sabrina A James
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Margarida Rei
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Hannah S Fuchs
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Katy J McCann
- Cancer Research UK Southampton Experimental Cancer Medicine Centre, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ayo O Omiyale
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | | | - Simon R Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - Stewart Norris-Bulpitt
- Early Phase Clinical Trials Unit, Cancer & Haematology Centre, Churchill Hospital, Oxford, UK
| | - Sam T Dobbie
- Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, UK
| | - Lucinda Griffiths
- Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Benoit J Van den Eynde
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK; Ludwig Institute for Cancer Research, Brussels, Belgium; de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Ioannis Karydis
- Cancer Sciences Unit, University of Southampton and Cancer Care Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Mark R Middleton
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK; Department of Oncology, University of Oxford, Oxford, UK; Early Phase Clinical Trials Unit, Cancer & Haematology Centre, Churchill Hospital, Oxford, UK.
| | - Xin Lu
- Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
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Carroll TM, Chadwick JA, Owen RP, White MJ, Kaplinsky J, Peneva I, Frangou A, Chang J, Xie PF, Roth A, Amess B, Lou H, McCann KJ, Berridge G, Fischer R, Phetsouphanh C, Omiyale AO, Jacobs BA, Ahern D, Lord SR, Norris-Bulpitt S, Dobbie ST, Griffiths L, Ramirez KA, Ricciardi T, Macri MJ, Ryan A, Venhaus RR, Van den Eynde BJ, Karydis I, Kessler BM, Schuster-Böckler B, Middleton MR, Lu X. Abstract 1247: Comprehensive molecular profiling to predict first-line immunochemotherapy outcomes in inoperable esophageal adenocarcinoma. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
For patients with inoperable esophageal adenocarcinoma (EAC), prognosis on conventional chemotherapy (CTX) remains poor. In 2021, the FDA approved two αPD-1 immune checkpoint inhibitors (ICI) for addition to fluoropyrimidine/platinum-containing CTX in this first-line setting. As ICI+CTX enters the clinic, understanding ICI responses and predicting which patients will benefit from ICI addition are key challenges. To address these challenges, we assessed clinical and molecular profiles from the experimental LUD2015-005 trial (NCT02735239, EudraCT 2015-005298-19). Treatment consisted of an initial four-week ICI-only window with durvalumab (αPD-L1) with or without a single dose of tremelimumab (αCTLA-4), followed by 6 cycles of ICI+CTX (CapOx). 38 inoperable patients received treatment (35 EAC; 3 ESCC); median overall survival (OS) and progression-free survival (PFS) were 13.4 and 9.3 months, respectively. All patients reported at least one treatment emergent adverse event (TEAE), with 29 (76.3%) reporting grade 3 or higher TEAEs. EAC patients with available samples (n = 33) were taken forward for biomarker analysis, using tumor and adjacent normal biopsies collected at pre-treatment (PreTx), after four weeks of ICI-only (ICI-4W), and at the end of ICI+CTX (PostTx).
Transcriptomic comparison of paired PreTx and ICI-4W EAC biopsies (n = 28) revealed ICI-induced upregulation of a novel T-cell inflammation signature (termed INCITE). Stronger INCITE upregulation correlated with greater tumor shrinkage during the ICI-only window, and tumors with minimal INCITE upregulation showed markers of ICI resistance, including Innate PD-1 Resistance (IPRES). Despite correlation with ICI-only responses, INCITE changes were not associated with overall ICI+CTX outcomes.
To find predictive biomarkers of ICI+CTX outcomes, we conducted comprehensive genomic and transcriptomic profiling of PreTx EAC biopsies (n = 33). First, we generated a novel 65,000 cell scRNA-seq dataset and designed a deconvolution workflow to resolve tumor cell composition. Unexpectedly, monocyte composition was strongly linked with greater overall survival (OS) (HR: 0.40 [0.23-0.69]; p = 0.001; FDR = 0.047). Coding tumor mutational burden (TMB) was also associated with improved OS (HR: 0.50 [0.28-0.89]; p = 0.019). Multivariate modelling suggested monocyte composition and TMB were independent and complementary predictors of outcomes. Neither factor was associated with outcomes in a TCGA cohort of EAC patients not treated with ICI, suggesting these biomarkers may be specific to ICI or ICI+CTX.
Our findings suggest monocyte composition and TMB may identify EAC patients likely to benefit from ICI+CTX. INCITE upregulation may also serve as a useful monitor of ICI efficacy. These timely findings further our understanding of ICI response and resistance and may help inform patient selection for ICI+CTX.
Citation Format: Thomas M. Carroll, Joseph A. Chadwick, Richard P. Owen, Michael J. White, Joseph Kaplinsky, Iliana Peneva, Anna Frangou, Jaeho Chang, Phil F. Xie, Andrew Roth, Bob Amess, Hantao Lou, Katy J. McCann, Georgina Berridge, Roman Fischer, Chansavath Phetsouphanh, Ayo O. Omiyale, Brittany-Amber Jacobs, David Ahern, Simon R. Lord, Stewart Norris-Bulpitt, Sam T. Dobbie, Lucinda Griffiths, Kristen Aufiero Ramirez, Toni Ricciardi, Mary J. Macri, Aileen Ryan, Ralph R. Venhaus, Benoit J. Van den Eynde, Ioannis Karydis, Benedikt M. Kessler, Benjamin Schuster-Böckler, Mark R. Middleton, Xin Lu. Comprehensive molecular profiling to predict first-line immunochemotherapy outcomes in inoperable esophageal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1247.
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Affiliation(s)
- Thomas M. Carroll
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Joseph A. Chadwick
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Richard P. Owen
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Michael J. White
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Joseph Kaplinsky
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Iliana Peneva
- 2Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Anna Frangou
- 3Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Jaeho Chang
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Phil F. Xie
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Andrew Roth
- 4Department of Molecular Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Bob Amess
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Hantao Lou
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | - Katy J. McCann
- 5Cancer Research UK Southampton Experimental Cancer Medicine Centre, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Georgina Berridge
- 6Target Discovery Institute, Centre for Medicines Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Roman Fischer
- 6Target Discovery Institute, Centre for Medicines Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Ayo O. Omiyale
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
| | | | - David Ahern
- 7Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Simon R. Lord
- 8Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Stewart Norris-Bulpitt
- 9Early Phase Clinical Trials Unit, Cancer & Haematology Centre, Churchill Hospital, Oxford, United Kingdom
| | - Sam T. Dobbie
- 10Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Lucinda Griffiths
- 10Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | - Ioannis Karydis
- 12Cancer Sciences Unit, University of Southampton and Cancer Care Group, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Benedikt M. Kessler
- 6Target Discovery Institute, Centre for Medicines Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Mark R. Middleton
- 8Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Xin Lu
- 1Ludwig Institute of Cancer Research, University of Oxford, Oxford, United Kingdom
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de Lange A, Prodjinotho UF, Tomes H, Hagen J, Jacobs BA, Smith K, Horsnell W, Sikasunge C, Hockman D, Selkirk ME, Prazeres da Costa C, Raimondo JV. Taenia larvae possess distinct acetylcholinesterase profiles with implications for host cholinergic signalling. PLoS Negl Trop Dis 2020; 14:e0008966. [PMID: 33347447 PMCID: PMC7785214 DOI: 10.1371/journal.pntd.0008966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/05/2021] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
Larvae of the cestodes Taenia solium and Taenia crassiceps infect the central nervous system of humans. Taenia solium larvae in the brain cause neurocysticercosis, the leading cause of adult-acquired epilepsy worldwide. Relatively little is understood about how cestode-derived products modulate host neural and immune signalling. Acetylcholinesterases, a class of enzyme that breaks down acetylcholine, are produced by a host of parasitic worms to aid their survival in the host. Acetylcholine is an important signalling molecule in both the human nervous and immune systems, with powerful modulatory effects on the excitability of cortical networks. Therefore, it is important to establish whether cestode derived acetylcholinesterases may alter host neuronal cholinergic signalling. Here we make use of multiple techniques to profile acetylcholinesterase activity in different extracts of both Taenia crassiceps and Taenia solium larvae. We find that the larvae of both species contain substantial acetylcholinesterase activity. However, acetylcholinesterase activity is lower in Taenia solium as compared to Taenia crassiceps larvae. Further, whilst we observed acetylcholinesterase activity in all fractions of Taenia crassiceps larvae, including on the membrane surface and in the excreted/secreted extracts, we could not identify acetylcholinesterases on the membrane surface or in the excreted/secreted extracts of Taenia solium larvae. Bioinformatic analysis revealed conservation of the functional protein domains in the Taenia solium acetylcholinesterases, when compared to the homologous human sequence. Finally, using whole-cell patch clamp recordings in rat hippocampal brain slice cultures, we demonstrate that Taenia larval derived acetylcholinesterases can break down acetylcholine at a concentration which induces changes in neuronal signalling. Together, these findings highlight the possibility that Taenia larval acetylcholinesterases can interfere with cholinergic signalling in the host, potentially contributing to pathogenesis in neurocysticercosis. Infection of the human nervous system with larvae of the parasite Taenia solium is a significant cause of acquired epilepsy worldwide. Despite this, the precise cellular and molecular mechanisms underlying epileptogenesis in neurocysticercosis remain unclear. Acetylcholinesterases are a family of enzymes widely produced by helminthic parasites. These enzymes facilitate the breakdown of acetylcholine, which is also a major neurotransmitter in the human nervous system. If T. solium larvae produce acetylcholinesterases, this could potentially disrupt host cholinergic signalling, which may in turn contribute to seizures and epilepsy. We therefore set out to investigate the presence and activity of acetylcholinesterases in T. solium larvae, as well as in Taenia crassiceps larvae, a species commonly used as a model parasite in neurocysticercosis research. We found that both T. crassiceps and T. solium larvae produce acetylcholinesterases with substantial activity and that the functional protein domains in the Taenia solium acetylcholinesterases have great similarity to those of human acetylcholinesterases. We further demonstrate that the acetylcholinesterase activity in the products of these parasites is sufficient to break down acetylcholine at a concentration which induces changes in neuronal signalling in an ex vivo brain slice model. This study provides evidence that Taenia larvae produce acetylcholinesterases and that these can potentially interfere with cholinergic signalling in the host and contribute to pathogenesis in neurocysticercosis.
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Affiliation(s)
- Anja de Lange
- Division of Cell Biology, Department of Human Biology and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ulrich Fabien Prodjinotho
- Institute for Medical Microbiology, Immunology and Hygiene, Centre for Global Health, Technical University Munich (TUM), Munich, Germany
| | - Hayley Tomes
- Division of Cell Biology, Department of Human Biology and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jana Hagen
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Brittany-Amber Jacobs
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Katherine Smith
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - William Horsnell
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
- Laboratory of Experimental and Molecular Immunology and Neurogenetics (INEM), UMR 7355 CNRS-University of Orleans, Orleans, France
| | - Chummy Sikasunge
- School of Veterinary Medicine, Department of Paraclinicals, University of Zambia, Lusaka, Zambia
| | - Dorit Hockman
- Division of Cell Biology, Department of Human Biology and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Murray E. Selkirk
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Centre for Global Health, Technical University Munich (TUM), Munich, Germany
| | - Joseph Valentino Raimondo
- Division of Cell Biology, Department of Human Biology and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Jacobs BA, Prince S, Smith KA. Gastrointestinal Nematode-Derived Antigens Alter Colorectal Cancer Cell Proliferation and Migration through Regulation of Cell Cycle and Epithelial-Mesenchymal Transition Proteins. Int J Mol Sci 2020; 21:ijms21217845. [PMID: 33105843 PMCID: PMC7660063 DOI: 10.3390/ijms21217845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/02/2022] Open
Abstract
As the global incidences of colorectal cancer rises, there is a growing importance in understanding the interaction between external factors, such as common infections, on the initiation and progression of this disease. While certain helminth infections have been shown to alter the severity and risk of developing colitis-associated colorectal cancer, whether these parasites can directly affect colorectal cancer progression is unknown. Here, we made use of murine and human colorectal cancer cell lines to demonstrate that exposure to antigens derived from the gastrointestinal nematode Heligmosomoides polygyrus significantly reduced colorectal cancer cell proliferation in vitro. Using a range of approaches, we demonstrate that antigen-dependent reductions in cancer cell proliferation and viability are associated with increased expression of the critical cell cycle regulators p53 and p21. Interestingly, H. polygyrus-derived antigens significantly increased murine colorectal cancer cell migration, which was associated with an increased expression of the adherens junction protein β-catenin, whereas the opposite was true for human colorectal cancer cells. Together, these findings demonstrate that antigens derived from a gastrointestinal nematode can significantly alter colorectal cancer cell behavior. Further in-depth analysis may reveal novel candidates for targeting and treating late-stage cancer.
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Affiliation(s)
- Brittany-Amber Jacobs
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa;
| | - Sharon Prince
- Department of Human Biology, University of Cape Town, Cape Town 7925, South Africa;
| | - Katherine Ann Smith
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa;
- School of Medicine, Cardiff University, Cardiff CF14 3XN, UK
- Correspondence: ; Tel.: +44-2920-874-303
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Young CC, Jacobs BA, Clavette K, Mark DH, Guse CE. Serial sevens: not the most effective test of mental status in high school athletes. Clin J Sport Med 1997; 7:196-8. [PMID: 9262887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions: the serial sevens test, the serial threes test, and recitation of months of year in reverse order (MOYR). PARTICIPANTS High school student athletes in grades 9, 10, 11, and 12 having sports preparticipation physical examinations. The initial study tested 522 consecutive athletes. The follow-up study tested 109 consecutive athletes. INTERVENTION The athletes of the initial group were asked to perform a serial sevens test, followed by a serial threes test, and finally to recite the MOYR. The second group was asked to perform the same tests in a random order. MAIN OUTCOME MEASURES Participants were given 1-min time limits for each test, with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake. RESULTS For the initial group, 51.3% successfully performed serial sevens, 78.7% successfully performed serial threes, and 89.5% successfully recited the MOYR. For the second group, 52.7% successfully performed serial sevens, 78.1% successfully performed serial threes, and 88.9% successfully recited the MOYR. The pass rates were significantly different for both groups. The pass rates were similar for both sexes, all grade levels, and all sports in both test groups. Participants, both overall and in all subgroups, failed serial sevens more often than serial threes and MOYR (p < 0.001 for the initial group; p < 0.0001 for the second group). They failed serial threes more often than MOYR (p < 0.001 for the initial group; p < 0.01 for the second group). CONCLUSIONS The percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion; the test lacks specificity. The percentage of athletes passing the MOYR was greatest, perhaps making this a better sideline test than the traditional serial sevens test. However, testing needs to be done in injured athletes before clinical application can be recommended.
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Affiliation(s)
- C C Young
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee 53226, USA
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Abstract
A method for real time recording of video information on a disk by means of a laser beam is described. The laser beam is focused on a rotating substrate, covered with a thin film of positive photoresist. During exposure the laser beam is intensity modulated by means of an electrooptic modulator driven by the encoded video signal. After etching away the exposed areas of photoresist a master disk is obtained with pits, containing the video information in their periodicity and length. Such a master disk will serve as the source for generating submasters, stampers, etc. for the production of a large number of replicas as is usually done in the phonograph record industry.
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