Direct identification of trypanosomatids by matrix-assisted laser desorption ionization-time of flight mass spectrometry (DIT MALDI-TOF MS)

Accurate and rapid determination of trypanosomatids is essential in epidemiological surveillance and therapeutic studies. Matrix-assisted laser desorption ionization/time of flight mass spectrometry (MALDI-TOF MS) has been shown to be a useful and powerful technique to identify bacteria, fungi, metazoa and human intact cells with applications in clinical settings. Here, we developed and optimized a MALDI-TOF MS method to profile trypanosomatids. trypanosomatid cells were deposited on a MALDI target plate followed by addition of matrix solution. The plate was then subjected to MALDI-TOF MS measurement to create reference mass spectra library and unknown samples were identified by pattern matching using the BioTyper software tool. Several m/z peaks reproducibly and uniquely identified trypanosomatids species showing the potentials of direct identification of trypanosomatids by MALDI-TOF MS. Moreover, this method discriminated different life stages of Trypanosoma cruzi, epimastigote and bloodstream trypomastigote and Trypanosoma brucei, procyclic and bloodstream. T. cruzi Discrete Typing Units (DTUs) were also discriminated in three clades. However, it was not possible to achieve enough resolution and software-assisted identification at the strain level. Overall, this study shows the importance of MALDI-TOF MS for the direct identification of trypanosomatids and opens new avenues for mass spectrometry-based detection of parasites in biofluids. Copyright © 2016 John Wiley & Sons, Ltd.

Development of the International Classification of Functioning, Disability and Health core sets for bipolar disorders: results of an international consensus process

PURPOSE

The International Classification of Functioning, Disability and Health (ICF) is a tool of the World Health Organization (WHO) designed to be a guide to identify and classify relevant domains of human experience affected by health conditions. The purpose of this article is to describe the process for the development of two Core Sets for bipolar disorder (BD) in the framework of the ICF. The Comprehensive ICF Core Set for BD intends to be a guide for multidisciplinary assessment of patients diagnosed with this condition, while the Brief ICF Core Set for BD will be useful when rating aspects of patient's experience for clinical practice or epidemiological studies.

METHODS

An international consensus conference involving a sample of experts with different professional backgrounds was performed using the nominal group technique. Various preparatory studies identified a set of 743 potential ICF categories to be included in the Core Sets.

RESULTS

A total of 38 ICF categories were selected to be included in the Comprehensive Core Set for BD. A total of 19 ICF categories from the Comprehensive Core Set were chosen as the most significant to constitute the Brief Core Set for BD.

CONCLUSIONS

The formal consensus process integrating evidence and expert opinion on the ICF led to the formal adoption of the ICF Core Sets for BD. The most important categories included are representative of the characteristics usually associated with BD. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings. Implications for Rehabilitation Bipolar disorder (BD) is a prevalent condition that has a great impact on people who suffer it, not only in health but also in daily functioning and quality of life. No standard has been defined so far regarding the problems in functioning of persons with BDs. The process described in this article defines the set of areas of functioning to be addressed in clinical assessments of persons with BD and establish the starting point for the development of condition-specific outcome measures.

Abstract P3-08-06: Triple Negative Breast Cancer and BRCA Status: Implications for Genetic Counseling

BACKGROUND: Controversy exists whether women newly diagnosed with triple negative breast cancer (TNBC) should be referred to genetic counseling as they may be more likely to be BRCA carriers. However, prior studies included small numbers of carriers and their results have had limited influence on practice guidelines. The objective of this study was to determine the association of breast cancer molecular subtype and BRCA status in a large group of medically insured women.

METHODS: We examined a cohort of 2,105 women with breast cancer history tested for BRCA mutations in a large California health plan from 1997–2011. BRCA test results were recorded in the health plan's clinical genetics registry. Of the 2,105 breast cancer patients, 249 were BRCA mutation carriers (143 BRCA1 carriers, and 106 BRCA2 carriers). We conducted data linkages of all patients with the health plan's NCI-SEER affiliated tumor registry and identified ER, PR, and HER2. HER2 status was also captured from pathology reports using natural language processing. ER, PR, and HER2 status were assessed by immunohistochemical or FISH techniques. Patients were classified into four main biologic subtypes: triple negative (ER−/PR−/HER2−); luminal A (ER+ and/or PR+/HER2−); luminal B (ER+ and/or PR+/HER2+); and HER2-enriched (HER2+/ER−). We examined the association between molecular subtypes (collapsed into TNBC vs. non TNBC categories) and BRCA1/2 mutation status using contingency table analyses. P-values (two-sided) were estimated using chi-square analysis. Multivariable logistic regression was used to estimated adjusted odds ratios (OR) and 95% confidence intervals.

RESULTS: TNBC subtype was strongly associated with BRCA status (P < 0.0001). Women with TNBC tumors were five-fold more likely to be BRCA carriers than women who had non-TNBC breast tumors (OR = 5.6, 95% CI: 4.1–7.5). Specifically, the association of TNBC with BRCA1 was more robust (OR = 12.2, 95% CI: 8.3–17.9). Adjusting for age and stage of breast cancer diagnosis and race/ethnicity did not materially modify the association between TNBC and BRCA1 status. TNBC was not associated with BRCA2 status (OR = 1.6, 95% CI: 0.9–2.7).

Functioning and disability in bipolar disorders: a systematic review of literature using the ICF as a reference

OBJECTIVES

To systematically identify and examine the frequency of use of concepts contained in outcome variables across bipolar disorder (BD) studies using the International Classification of Functioning, Disability and Health (ICF) as a reference.

METHODS

Original studies published between 2000 and 2006 were located on the MEDLINE and PsycINFO databases and selected according to predetermined criteria. Outcome variables were extracted, and concepts contained therein were linked to the ICF.

RESULTS

A total of 109 final studies were included. The concepts contained in these studies were linked to 145 different ICF categories. ICF category b152, emotional functions, was the most frequently represented category, appearing in 94% of the publications, followed by b126, temperament and personality functions (73%). E110, products or substances for personal consumption, and e580, health services, systems, and policies, appeared in 68% of the studies.

CONCLUSIONS

The present systematic review reflects the research focus of the literature on BD in recent years. Most of the studies performed concentrate on body functions rather than activities and participation domains. Experimental studies are mostly pharmacological, reflecting the need to study nonpharmacological interventions. Furthermore, our study shows that outcome variables used in studies with persons with BD can, to a large extent, be mapped to the ICF.

HER2/ER subtypes associated with patient and tumor factors and predicted survival among participants in a retrospective breast cancer cohort study in Southern California

Abstract #3099

Background: Molecular marker expression analyses have led to the identification of unique breast cancer subtypes that have clinical and prognostic importance. Using data from a large population-based breast cancer cohort, we report results examining combined HER2/neu and estrogen receptor (ER) subtype distribution in relation to patient and tumor characteristics as well as breast cancer specific survival.
 Methods: We conducted a retrospective cohort study of 1,645 female members of a large managed care organization newly diagnosed with invasive breast cancer from 1988 to 1995. We collected patient, tumor, treatment, and outcome information from medical records and electronic cancer registry files. We used immunohistochemistry techniques to evaluate gene expression of specific molecular markers including HER2/neu and estrogen receptor (ER). We examined prevalence of markers as well as odds ratios (OR) and 95% confidence intervals (CI) comparing outcomes by marker expression.
 Results: Women with HER2+/ER- tumors were more likely to have been diagnosed at a younger age (less than age 60) than women with luminal A subtype (HER2-, ER+ and/or PR+) tumors (65.5% versus 47.8%, P<0.0001). A higher proportion of women with HER2+/ER- tumors were other than white race compared with women with luminal A subtype (21.8% versus 11.6%, P=0.007). Women with luminal B (HER2+, ER+ and/or PR+) or basal-like (HER2-, ER-, PR) subtype tumors were similarly more likely to be older at diagnosis and from minority backgrounds than women with luminal A subtype. Family history of breast cancer was not clearly associated with HER2/ER subtype. Women with luminal A tumors were more likely to be diagnosed with stage 1 disease than women with other tumor subtypes (luminal A: 56.3%; luminal B: 38.9%; basal-like: 38.1%; HER2+/ER-: 25.5%; P<0.0001). Residual tumor in surgical margins was not associated with HER2/ER subtype. Compared with women with luminal A tumors, women with HER2+/ER- tumors were much more likely to die of their cancers overall (OR=6.5, CI=3.5-11.9), and by stage (stage 1: OR=11.5, CI=2.6-50.3; stage 2: OR=3.8, CI=1.6-9.2; stage 3/4: OR=9.0, CI=1.1-77.2). Odds of breast cancer death, overall and by stage, was also increased for women with luminal B and basal-like subtype tumors compared with women having luminal A subtype.
 Conclusions: HER2/ER subtype was clearly associated with patient as well as tumor characteristics in this large cohort of breast cancer patients. Specific tumor subtypes (HER2+/ER-, luminal B, and basal-like) were also associated with increased likelihood of dying of breast cancer. Further work is warranted to define treatment strategies by molecular subtypes.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3099.