Piloting co-developed behaviour change interventions to reduce exposure to air pollution and improve self-reported asthma-related health

BACKGROUND

Exposure to air pollution can exacerbate asthma with immediate and long-term health consequences. Behaviour changes can reduce exposure to air pollution, yet its 'invisible' nature often leaves individuals unaware of their exposure, complicating the identification of appropriate behaviour modifications. Moreover, making health behaviour changes can be challenging, necessitating additional support from healthcare professionals.

OBJECTIVE

This pilot study used personal exposure monitoring, data feedback, and co-developed behaviour change interventions with individuals with asthma, with the goal of reducing personal exposure to PM2.5 and subsequently improving asthma-related health.

METHODS

Twenty-eight participants conducted baseline exposure monitoring for one-week, simultaneously keeping asthma symptom and medication diaries (previously published in McCarron et al., 2023). Participants were then randomised into control (n = 8) or intervention (n = 9) groups. Intervention participants received PM2.5 exposure feedback and worked with researchers to co-develop behaviour change interventions based on a health behaviour change programme which they implemented during the follow-up monitoring week. Control group participants received no feedback or intervention during the study.

RESULTS

All interventions focused on the home environment. Intervention group participants reduced their at-home exposure by an average of 5.7 µg/m³ over the monitoring week (-23.0 to +3.2 µg/m³), whereas the control group had a reduction of 4.7 µg/m³ (-15.6 to +0.4 µg/m³). Furthermore, intervention group participants experienced a 4.6% decrease in participant-hours with reported asthma symptoms, while the control group saw a 0.5% increase. Similarly, the intervention group's asthma-related quality of life improved compared to the control group.

IMPACT STATEMENT

This pilot study investigated a novel behaviour change intervention, utilising personal exposure monitoring, data feedback, and co-developed interventions guided by a health behaviour change programme. The study aimed to reduce personal exposure to fine particulate matter (PM2.5) and improve self-reported asthma-related health. Conducting a randomised controlled trial with 28 participants, co-developed intervention successfully targeted exposure peaks within participants' home microenvironments, resulting in a reduction in at-home personal exposure to PM2.5 and improving self-reported asthma-related health. The study contributes valuable insights into the environmental exposure-health relationship and highlights the potential of the intervention for individual-level decision-making to protect human health.

"I have to stay inside …": Experiences of air pollution for people with asthma

Asthma, characterized by airway inflammation, sensitization and constriction, and leading to symptoms including cough and dyspnoea, affects millions of people globally. Air pollution is a known asthma trigger, yet how it is experienced is understudied and how individuals with asthma interact with air quality information and manage exacerbation risks is unclear. This study aimed to explore how people living with asthma in Scotland, UK, experienced and managed their asthma in relation to air pollution. We explored these issues with 36 participants using semi-structured interviews. We found that self-protection measures were influenced by place and sense of control (with the home being a "safe space"), and that the perception of clean(er) air had a liberating effect on outdoor activities. We discuss how these insights could shape air quality-related health advice in future.

Computed tomography-based radiomic markers are independent prognosticators of survival in advanced laryngeal cancer: a pilot study

OBJECTIVE

Advanced laryngeal cancers are clinically complex; there is a paucity of modern decision-making models to guide tumour-specific management. This pilot study aims to identify computed tomography-based radiomic features that may predict survival and enhance prognostication.

METHODS

Pre-biopsy, contrast-enhanced computed tomography scans were assembled from a retrospective cohort (n = 72) with advanced laryngeal cancers (T3 and T4). The LIFEx software was used for radiomic feature extraction. Two features: shape compacity (irregularity of tumour volume) and grey-level zone length matrix - grey-level non-uniformity (tumour heterogeneity) were selected via least absolute shrinkage and selection operator-based Cox regression and explored for prognostic potential.

RESULTS

A greater shape compacity (hazard ratio 2.89) and grey-level zone length matrix - grey-level non-uniformity (hazard ratio 1.64) were significantly associated with worse 5-year disease-specific survival (p < 0.05). Cox regression models yielded a superior C-index when incorporating radiomic features (0.759) versus clinicopathological variables alone (0.655).

CONCLUSIONS

Two radiomic features were identified as independent prognostic biomarkers. A multi-centre prospective study is necessary for further exploration. Integrated radiomic models may refine the treatment of advanced laryngeal cancers.

Personal exposure to fine particulate matter (PM2.5) and self-reported asthma-related health

PM2.5 (fine particulate matter ≤2.5 μm in diameter) is a key pollutant that can produce acute asthma exacerbations and longer-term deterioration of respiratory health. Individual exposure to PM2.5 is unique and varies across microenvironments. Low-cost sensors (LCS) can collect data at a spatiotemporal resolution previously unattainable, allowing the study of exposures across microenvironments. The aim of this study is to investigate the acute effects of personal exposure to PM2.5 on self-reported asthma-related health. Twenty-eight non-smoking adults with asthma living in Scotland collected PM2.5 personal exposure data using LCS. Measurements were made at a 2-min time resolution for a period of 7 days as participants conducted their typical daily routines. Concurrently, participants were asked to keep a detailed time-activity diary, logging their activities and microenvironments, along with hourly information on their respiratory health and medication use. Health outcomes were modelled as a function of hourly PM2.5 concentration (plus 1- and 2-h lag) using generalized mixed-effects models adjusted for temperature and relative humidity. Personal exposures to PM2.5 varied across microenvironments, with the largest average microenvironmental exposure observed in private residences (11.5 ± 48.6 μg/m3) and lowest in the work microenvironment (2.9 ± 11.3 μg/m3). The most frequently reported asthma symptoms, wheezing, chest tightness and cough, were reported on 3.4%, 1.6% and 1.6% of participant-hours, respectively. The odds of reporting asthma symptoms increased per interquartile range (IQR) in PM2.5 exposure (odds ratio (OR) 1.29, 95% CI 1.07-1.54) for same-hour exposure. Despite this, no association was observed between reliever inhaler use (non-routine, non-exercise related) and PM2.5 exposure (OR 1.02, 95% CI 0.71-1.48). Current air quality monitoring practices are inadequate to detect acute asthma symptom prevalence resulting from PM2.5 exposure; to detect these requires high-resolution air quality data and health information collected in situ. Personal exposure monitoring could have significant implications for asthma self-management and clinical practice.

MATILDA.FT: A mesoscale simulation package for inhomogeneous soft matter

In this paper, we announce the public release of a massively parallel, graphics processing unit (GPU)-accelerated software, which is the first to combine both coarse-grained particle simulations and field-theoretic simulations in one simulation package. MATILDA.FT (Mesoscale, Accelerated, Theoretically Informed, Langevin, Dissipative particle dynamics, and Field Theory) was designed from the ground-up to run on CUDA-enabled GPUs with Thrust library acceleration, enabling it to harness the possibility of massive parallelism to efficiently simulate systems on a mesoscopic scale. It has been used to model a variety of systems, from polymer solutions and nanoparticle-polymer interfaces to coarse-grained peptide models and liquid crystals. MATILDA.FT is written in CUDA/C++ and is object oriented, making its source-code easy to understand and extend. Here, we present an overview of the currently available features, and the logic of parallel algorithms and methods. We provide the necessary theoretical background and present examples of systems simulated using MATILDA.FT as the simulation engine. The source code, along with the documentation, additional tools, and examples, can be found on the GitHub MATILDA.FT repository.

Public engagement with air quality data: using health behaviour change theory to support exposure-minimising behaviours

Exposure to air pollution prematurely kills 7 million people globally every year. Policy measures designed to reduce emissions of pollutants, improve ambient air and consequently reduce health impacts, can be effective, but are generally slow to generate change. Individual actions can therefore supplement policy measures and more immediately reduce people's exposure to air pollution. Air quality indices (AQI) are used globally (though not universally) to translate complex air quality data into a single unitless metric, which can be paired with advice to encourage behaviour change. Here we explore, with reference to health behaviour theories, why these are frequently insufficient to instigate individual change. We examine the health behaviour theoretical steps linking air quality data with reduced air pollution exposure and (consequently) improved public health, arguing that a combination of more 'personalised' air quality data and greater public engagement with these data will together better support individual action. Based on this, we present a novel framework, which, when used to shape air quality interventions, has the potential to yield more effective and sustainable interventions to reduce individual exposures and thus reduce the global public health burden of air pollution.

Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication

PURPOSE

Large hiatus hernias are relatively common and can be associated with adverse symptoms and serious complications. Operative repair is indicated in this patient group for symptom management and the prevention of morbidity. This study aimed to identify predictors of poor outcomes following laparoscopic hiatus hernia repair and fundoplication (LHHRaF) to aid in counselling potential surgical candidates.

METHODOLOGY

A retrospective analysis was performed from a prospectively maintained, multicentre database of patients who underwent LHHRaF between 2014 and 2020. Revision procedures were excluded. Hernia size was defined as the intraoperative percentage of intrathoracic stomach, estimated by the surgeon to the nearest 10%. Predictors of outcomes were determined using a prespecified multivariate logistic regression model.

RESULTS

625 patients underwent LHHRaF between 2014 and 2020 with 443 patients included. Median age was 65 years, 62.9% were female and 42.7% of patients had ≥ 50% intrathoracic stomach. In a multivariate regression model, intrathoracic stomach percentage was predictive of operative complications (P = 0.014, OR 1.05), post-operative complications (P = 0.026, OR 1.01) and higher comprehensive complication index score (P = 0.023, OR 1.04). At 12 months it was predictive of failure to improve symptomatic reflux (P = 0.008, OR 1.02) and persistent PPI requirement (P = 0.047, OR 1.02). Operative duration and blood loss were predicted by BMI (P = 0.004 and < 0.001), Type III/IV hernias (P = 0.045 and P = 0.005) and intrathoracic stomach percentage (P = 0.009 and P < 0.001). Post-operative length of stay was predicted by age (P < 0.001) and emergency presentation (P = 0.003).

CONCLUSION

In a multivariate regression model, intrathoracic stomach percentage was predictive of operative and post-operative morbidity, PPI use, and failure to improve reflux symptoms at 12 months.

Short-term Endoscopic Outcomes of Balloon and Rigid Bronchoplasty in the Management of Benign Subglottic and Tracheal Stenosis

BACKGROUND

Endoscopic therapies are firmly established in the management algorithm of benign subglottic and tracheal stenosis (SGTS). The optimal dilation strategy, however, has yet to be elucidated. The objective of this study was to compare the efficacy and safety of balloon versus rigid bronchoplasty in the treatment of benign SGTS.

METHODS

De novo cases of benign SGTS at our institution over a 9-year period were retrospectively identified. Patients were divided into 2 groups based on the initial dilation strategy of balloon or rigid bronchoplasty. Demographics, clinical findings, concurrent interventions, lesion characteristics, and complications were analyzed. Two reviewers independently assigned an index and follow-up endoscopic stenosis grade for each case. The mean stenosis grade at follow-up in both groups was then calculated and compared.

RESULTS

Sixty-three patients with benign SGTS were included. Most stenoses in the rigid (80%) and balloon (63%) bronchoplasty groups were complex ( P =0.174). In addition, 94% (59/63) of index stenoses were classified as Cotton Myer Grade 3. At follow-up, no significant difference was found in the mean stenosis grade between dilation strategies (1.97 vs. 2.2, P =0.287). Furthermore, no procedural-related complications were observed in either group.

CONCLUSION

Balloon and rigid bronchoplasty are safe and effective endoscopic tools in the early management of benign SGTS. A multimodality approach centered around mucosal sparing techniques remains vitally important to the overall and likely long-term success of treating this challenging disease entity.

Epidemiology of Adult Pleural Disease in the United States

BACKGROUND

Comprehensive US epidemiologic data for adult pleural disease are not available.

RESEARCH QUESTION

What are the epidemiologic measures related to adult pleural disease in the United States?

STUDY DESIGN AND METHODS

Retrospective cohort study using Healthcare Utilization Project databases (2007-2016). Adults (≥ 18 years of age) with malignant pleural mesothelioma, malignant pleural effusion, nonmalignant pleural effusion, empyema, primary and secondary spontaneous pneumothorax, iatrogenic pneumothorax, and pleural TB were studied.

RESULTS

In 2016, ED treat-and-discharge (T&D) visits totaled 42,215, accounting for charges of $286.7 million. In 2016, a total of 361,270 hospitalizations occurred, resulting in national costs of $10.1 billion. A total of 64,174 readmissions contributed $1.16 billion in additional national costs. Nonmalignant pleural effusion constituted 85.5% of ED T&D visits, 63.5% of hospitalizations, and 66.3% of 30-day readmissions. Contemporary sex distribution (male to female ratio) in primary spontaneous pneumothorax (2.1:1) differs from older estimates (6.2:1). Decadal analyses of annual hospitalization rates/100,000 adult population (2007 vs 2016) showed a significant (P < .001) decrease for malignant pleural mesothelioma (1.3 vs 1.09, respectively), malignant pleural effusion (33.4 vs 31.9, respectively), iatrogenic pneumothorax (17.9 vs 13.9, respectively), and pleural TB (0.20 vs 0.09, respectively) and an increase for empyema (8.1 vs 11.1, respectively) and nonmalignant pleural effusion (78.1 vs 100.1, respectively). Empyema hospitalizations have high costs per case ($38,591) and length of stay (13.8 days). The mean proportion of readmissions attributed to a pleural cause varied widely: malignant pleural mesothelioma, 49%; malignant pleural effusion, 45%; nonmalignant pleural effusion, 31%; empyema, 27%; primary spontaneous pneumothorax, 27%; secondary spontaneous pneumothorax, 27%; and iatrogenic pneumothorax, 20%.

INTERPRETATION

Significant epidemiologic trends and changes in various pleural disease were observed. The analysis identifies multiple opportunities for improvement in management of pleural disease.

13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors

Introduction

In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought.

Method

A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate.

Results

A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p < 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university.

Conclusions

When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.

878 Comparing Treatment Outcomes for Unruptured Brain Arteriovenous Malformations: A Retrospective Cohort Study

Background

Unruptured brain arteriovenous malformations (bAVMs) carry a lifetime risk of haemorrhage. Treatment strategies include conservative management, microsurgical excision, endovascular treatment (EVT) and radiosurgery (SRS). Optimal treatment selection remains unclear.

Method

A single-centre retrospective cohort study of adult unruptured bAVMs (2007-2019). Patients who underwent intervention were propensity matched using baseline features (age, sex, size, deep drainage, eloquence, and Spetzler-Martin grade) with patients conservatively managed. Rates of neurological disability and mortality due to intervention or bleed were compared.

Results

137 patients (mean age 48 years [SD = 16], males 64) were included; 34 (25%) EVT, 20 (15%) surgery, 31 (22%) SRS and 51 (37%) conservative. After a median follow-up of 49 months (IQR 23-75), rates of disability were as follows: surgery 35%, EVT 21%, SRS 13% and conservative 8%. Matched cohorts (intervention/conservative) were: surgery-19/18, SRS-30/22 and EVT-33/34. Comparison of disability rates across matched cohorts revealed no statistically significant differences (surgery p = 0.07, SRS p = 0.65 and EVT p = 0.11). Three conservatively managed patients died.

Conclusions

Unruptured bAVMs carry a significant risk of neurological morbidity, regardless of intervention choice. Treatment choice may have an impact on patient outcomes but requires investigation of stratified cohorts. Findings are consistent with the nuances of AVM treatment selection.

Using osmotic pressure simulations to test potentials for ions

This paper presents a new method to simulate the osmotic pressure of an ionic solution. Previous simulation methods confine ions between walls, and the osmotic pressure is inferred from the force required to maintain this confinement. In this work, we impose a harmonic potential on the ions to form a nonuniform concentration profile in the solution. As this profile arises from the force balance of the harmonic potential with the osmotic pressure, it can be used to determine the osmotic pressure across the entire concentration profile. This method can be performed without specialized programming, making it accessible to the general user. Using our method, we find that standard potentials for Na+ and Cl- ions need adjustments to be consistent with experimental osmotic pressure at high concentrations.

Systems Biology Markup Language (SBML) Level 3 Package: Distributions, Version 1, Release 1

Biological models often contain elements that have inexact numerical values, since they are based on values that are stochastic in nature or data that contains uncertainty. The Systems Biology Markup Language (SBML) Level 3 Core specification does not include an explicit mechanism to include inexact or stochastic values in a model, but it does provide a mechanism for SBML packages to extend the Core specification and add additional syntactic constructs. The SBML Distributions package for SBML Level 3 adds the necessary features to allow models to encode information about the distribution and uncertainty of values underlying a quantity.

Gallstones top to toe: what the radiologist needs to know

Gallstone-related disease can have significant associated morbidity and mortality worldwide. The incidence of gallstone-related disease in the Western world is on the increase. There are multiple different pathological manifestations of gallstone disease: the presentation, diagnosis and associated complications of which vary significantly depending on anatomical location. The role of imaging in gallstone-related disease is broad with radiology playing an essential role in the diagnosis, management and follow-up of gallstone-related pathologies. This paper distills the broad range of gallstone-related pathologies into an anatomical map, discussing the disease processes involved at each point along the biliary tree and reviewing the strengths and weaknesses of different imaging modalities for each distinct disease process.

Estimating the health impact of air pollution in Scotland, and the resulting benefits of reducing concentrations in city centres

Air pollution continues to be a key health issue in Scotland, despite recent improvements in concentrations. The Scottish Government published the Cleaner Air For Scotland strategy in 2015, and will introduce Low Emission Zones (LEZs) in the four major cities (Aberdeen, Dundee, Edinburgh and Glasgow) by 2020. However, there is no epidemiological evidence quantifying the current health impact of air pollution in Scotland, which this paper addresses. Additionally, we estimate the health benefits of reducing concentrations in city centres where most LEZs are located. We focus on cardio-respiratory disease and total non-accidental mortality outcomes, linking them to concentrations of both particulate (PM₁₀ and PM_2.5) and gaseous (NO₂ and NO_x) pollutants. Our two main findings are that: (i) all pollutants exhibit significant associations with respiratory disease but not cardiovascular disease; and (ii) reducing concentrations in city centres with low resident populations only provides a small health benefit.

Effects of an introduced, novel prey on diet and reproduction in the diet-specialist European Starling (Sturnus vulgaris)

Diet specialization has important consequences for how individuals or species deal with environmental change that causes changes in availability of prey species. We took advantage of a “natural experiment” — establishment of a commercial insect farm — that introduced a novel prey item, black soldier flies (Hermetia illucens (Linnaeus, 1758)), to the diet-specialist European Starling (Sturnus vulgaris Linnaeus, 1758). We investigated evidence for individual diet specialization (IDS) and the consequences of diet specialization and exploitation of novel prey on breeding productivity. In all 4 years of our study, tipulid larvae were the most common prey item. Soldier flies were not recorded in diets in 2013–2014; however, coincident with the establishment of the commercial insect farming operation, they comprised 22% and 30% of all prey items in the diets of European Starling females and males, respectively, in 2015. There was marked individual variation in use of soldier flies (4%–48% and 2%–70% in females and males, respectively), but we found little evidence of dichotomous IDS, i.e., where only some individuals have a specialized diet. We found no evidence for negative effects of use of soldier flies on breeding productivity: brood size at fledging and chick quality (mass, tarsus length) were independent of the number and proportion (%) of soldier flies returned to the nest.

Long-term outcomes of laparoscopic large hiatus hernia repair with nonabsorbable mesh

The use of mesh to augment suture repair of large hiatus hernias remains controversial. Repair with mesh may help reduce the recurrence rate of primary repair, but concerns about the potential for serious complications, such as mesh erosion or stricturing, continue to limit its use. We aim to evaluate the long-term outcome of primary hiatus hernia repair with lightweight polypropylene mesh (TiMesh) specifically looking at rates of clinical recurrence, dysphagia, and mesh-related complications. From a prospectively maintained database, 50 consecutive patients who underwent elective primary laparoscopic hiatal hernia repair with TiMesh between January 2005 and December 2007 were identified. Case notes and postoperative endoscopy reports were reviewed. Clinical outcomes were evaluated using a structured questionnaire, including a validated dysphagia score. Of the 50 patients identified, 36 (72%) were contactable for follow-up. At a median follow-up of 9 years, the majority of patients (97%) regarded their surgery as successful. Twelve patients (33%) reported a recurrence of their symptoms, but only 4 (11%) reported that their symptoms were as severe as prior to the surgery. There was no significant difference between pre- and postoperative dysphagia scores. Postoperative endoscopy reports were available for 32 patients at a median time point of 4 years postoperatively, none of which revealed any mesh-related complications. One patient had undergone a revision procedure for a recurrent hernia at another institution. In this series, primary repair of large hiatus hernia with nonabsorbable mesh was not associated with any adverse effects over time. Patient satisfaction with symptomatic outcome remained high in the long term.

Underdetection of comorbid drug use at acute psychiatric admission

Aims and Method

The ability of routine clinical practice to detect drug use at acute psychiatric admission was assessed by comparing the results of urinalysis with information on drug use extracted from patient records (n=112).

Results

Urinalysis detected drug use in 23% of the sample. Cannabis was the drug most frequently found. Of the cases of drug use positively identified by urinalysis, 54% were not identified in the notes. Some information on drug use proximal to admission was found in 40% of patient records. Patients asked about proximal drug use were younger than those not asked.

Clinical Implications

All patients should be asked about drug use.

Flexible polygon-mirror based laser scanning microscope platform for multiphoton in-vivo imaging

Commercial microscopy systems make use of tandem scanning i.e. either slow or fast scanning. We constructed, for the first time, an advanced control system capable of delivering a dynamic line scanning speed ranging from 2.7 kHz to 27 kHz and achieve variable frame rates from 5 Hz to 50 Hz (512 × 512). The dynamic scanning ability is digitally controlled by a new customized open-source software named PScan1.0. This permits manipulation of scanning rates either to gain higher fluorescence signal at slow frame rate without increasing laser power or increase frame rates to capture high speed events. By adjusting imaging speed from 40 Hz to 160 Hz, we capture a range of calcium waves and transient peaks from soma and dendrite of single fluorescence neuron (CAL-520AM). Motion artifacts arising from respiratory and cardiac motion in small animal imaging reduce quality of real-time images of single cells in-vivo. An image registration algorithm, integrated with PScan1.0, was shown to perform both real time and post-processed motion correction. The improvement is verified by quantification of blood flow rates. This work describes all the steps necessary to develop a high performance and flexible polygon-mirror based multiphoton microscope system for in-vivo biological imaging.

The role of interleukin-1β as a predictive biomarker and potential therapeutic target during clinical ex vivo lung perfusion

Background

Extended criteria donor lungs deemed unsuitable for immediate transplantation can be reconditioned using ex vivo lung perfusion (EVLP). Objective identification of which donor lungs can be successfully reconditioned and will function well post-operatively has not been established. This study assessed the predictive value of markers of inflammation and tissue injury in donor lungs undergoing EVLP as part of the DEVELOP-UK study.

Methods

Longitudinal samples of perfusate, bronchoalveolar lavage, and tissue from 42 human donor lungs undergoing clinical EVLP assessments were analyzed for markers of inflammation and tissue injury. Levels were compared according to EVLP success and post-transplant outcomes. Neutrophil adhesion to human pulmonary microvascular endothelial cells (HPMECs) conditioned with perfusates from EVLP assessments was investigated on a microfluidic platform.

Results

The most effective markers to differentiate between in-hospital survival and non-survival post-transplant were perfusate interleukin (IL)-1β (area under the curve = 1.00, p = 0.002) and tumor necrosis factor-α (area under the curve = 0.95, p = 0.006) after 30 minutes of EVLP. IL-1β levels in perfusate correlated with upregulation of intracellular adhesion molecule-1 in donor lung vasculature (R² = 0.68, p < 0.001) and to a lesser degree upregulation of intracellular adhesion molecule-1 (R² = 0.30, p = 0.001) and E-selectin (R² = 0.29, p = 0.001) in conditioned HPMECs and neutrophil adhesion to conditioned HPMECs (R² = 0.33, p < 0.001). Neutralization of IL-1β in perfusate effectively inhibited neutrophil adhesion to conditioned HPMECs (91% reduction, p = 0.002).

Conclusions

Donor lungs develop a detectable and discriminatory pro-inflammatory signature in perfusate during EVLP. Blocking the IL-1β pathway during EVLP may reduce endothelial activation and subsequent neutrophil adhesion on reperfusion; this requires further investigation in vivo.

The impact of human papillomavirus type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two-centre observational study

OBJECTIVE

To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy.

DESIGN

A two-centre observational study including vaccinated and unvaccinated women.

SETTING

Colposcopy clinics serving two health regions in Scotland, UK.

POPULATION

A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening.

METHODS

Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features.

MAIN OUTCOME MEASURES

Colposcopic features, HPV genotypes, mRNA expression, and cervical histology.

RESULTS

The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated).

CONCLUSIONS

In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines.

TWEETABLE ABSTRACT

Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+.

Fatigue in primary Sjögren's syndrome is associated with lower levels of proinflammatory cytokines

Objectives

This article reports relationships between serum cytokine levels and patient-reported levels of fatigue, in the chronic immunological condition primary Sjögren's syndrome (pSS).

Methods

Blood levels of 24 cytokines were measured in 159 patients with pSS from the United Kingdom Primary Sjögren's Syndrome Registry and 28 healthy non-fatigued controls. Differences between cytokines in cases and controls were evaluated using Wilcoxon test. Patient-reported scores for fatigue were evaluated, classified according to severity and compared with cytokine levels using analysis of variance. Logistic regression was used to determine the most important predictors of fatigue levels.

Results

14 cytokines were significantly higher in patients with pSS (n=159) compared to non-fatigued healthy controls (n=28). While serum levels were elevated in patients with pSS compared to healthy controls, unexpectedly, the levels of 4 proinflammatory cytokines—interferon-γ-induced protein-10 (IP-10) (p=0.019), tumour necrosis factor-α (p=0.046), lymphotoxin-α (p=0.034) and interferon-γ (IFN-γ) (p=0.022)—were inversely related to patient-reported levels of fatigue. A regression model predicting fatigue levels in pSS based on cytokine levels, disease-specific and clinical parameters, as well as anxiety, pain and depression, revealed IP-10, IFN-γ (both inversely), pain and depression (both positively) as the most important predictors of fatigue. This model correctly predicts fatigue levels with reasonable (67%) accuracy.

Conclusions

Cytokines, pain and depression appear to be the most powerful predictors of fatigue in pSS. Our data challenge the notion that proinflammatory cytokines directly mediate fatigue in chronic immunological conditions. Instead, we hypothesise that mechanisms regulating inflammatory responses may be important.

Primary Spontaneous Pneumothorax in Menstruating Women Has High Recurrence

BACKGROUND

Primary spontaneous pneumothorax (PSP) is treated on the basis of studies that have predominantly consisted of tall male subjects. Here, we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population.

METHODS

Men and menstruating women, aged 18 to 55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009 and 2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence.

RESULTS

The median age of women (n = 33) and men (n = 183) was 33.4 and 31.6 years, respectively. In women, 9 (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 women (64%) with median follow-up of 14 months, and they were treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) than left PSP (56%, p = 0.02). Four women (12%) presented with recurrent tension pneumothorax within 6 months. Eight patients (24%) had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to experience recurrence that was treated with pleurodesis. Classical endometrial glands were not found in any biopsy specimens obtained during the thoracoscopy. In contrast to female subjects, only 8 average-statured men (4.4%) had recurrence (p < 0.001) with a median follow-up of 16 months.

CONCLUSIONS

PSP in healthy average-statured menstruating women has high recurrence compared with male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy.

Exposure to environmentally-relevant levels of ozone negatively influence pollen and fruit development

A combination of in vitro and in vivo studies on tomato (Lycopersicon esculentum Mill. cv. Triton) revealed that environmentally-relevant levels of ozone (O3) pollution adversely affected pollen germination, germ tube growth and pollen-stigma interactions - pollen originating from plants raised in charcoal-Purafil(®) filtered air (CFA) exhibited reduced germ tube development on the stigma of plants exposed to environmentally-relevant levels of O3. The O3-induced decline in in vivo pollen viability was reflected in increased numbers of non-fertilized and fertilized non-viable ovules in immature fruit. Negative effects of O3 on fertilization occurred regardless of the timing of exposure, with reductions in ovule viability evident in O3 × CFA and CFA × O3 crossed plants. This suggests O3-induced reductions in fertilization were associated with reduced pollen viability and/or ovule development. Fruit born on trusses independently exposed to 100 nmol mol(-1) O3 (10 h d(-1)) from flowering exhibited a decline in seed number and this was reflected in a marked decline in the weight and size of individual fruit - a clear demonstration of the direct consequence of the effects of the pollutant on reproductive processes. Ozone exposure also resulted in shifts in the starch and ascorbic acid (Vitamin C) content of fruit that were consistent with accelerated ripening. The findings of this study draw attention to the need for greater consideration of, and possibly the adoption of weightings for the direct impacts of O3, and potentially other gaseous pollutants, on reproductive biology during 'risk assessment' exercises.

Pleural Gas Analysis for Detection of Alveolopleural Fistulae

PURPOSE

Visual inspection (VI) of bubbles in the chest drainage unit does not differentiate a true leak of alveolopleural fistula (APF) from a false leak. We hypothesized that detection of elevated levels of carbon dioxide, increase in oxygen content, or both, in pleural gas upon the administration of supplemental oxygen would accurately identify APF.

DESCRIPTION

Prospective study comparing pleural gas analysis (GA) with VI to detect APF after surgical lobectomy (n = 50).

EVALUATION

APF was found in 22 (44%) patients at the time of analysis. VI revealed air bubbles in 31 (62%) patients, indicating the presence of APF, of whom 12 (38.7%) were false leaks. VI failed to identify APF in 3 (6%) patients that resulted in post-tube removal pneumothorax. By contrast, GA accurately demonstrated APF in 21 patients, with only one false negative and no false positives. GA demonstrated better sensitivity (95.5% vs 86.4%), specificity (100% vs 57.1%), positive predictive value (100% vs 61.3%), and negative predictive value (96.6% vs 84.2%) compared to VI.

CONCLUSIONS

Pleural gas analysis is an effective technique to detect APF and can facilitate timely and safe chest tube removal.

Quality of life after total and subtotal gastrectomy for gastric carcinoma

BACKGROUND

There remains debate as to whether quality of life (QoL) is better for patients following sub-total gastrectomy (SG) or total gastrectomy (TG) for cancer. Both have similar survival rates provided an R0 resection is performed and in many series the morbidity and mortality after TG is higher than SG. The aim of this study was to evaluate the QoL in patients after TG and SG for cancer.

METHOD

All surviving patients who had undergone TG or SG between 1994 and 2009 were identified from a prospectively collected database and sent the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30 v.3) and the gastric module (QLQ-STO22).

RESULTS

From a total of 261 patients who had undergone TG or SG in the study period, 91 were still alive and 53 responded. There was no significant difference between the QoL between TG and SG based on functional scales and global health status. However dysphagia and eating restrictions were significantly worse in the TG group.

CONCLUSION

This study has demonstrated that there is no difference in overall QoL in patients with TG or SG although eating restrictions and dysphagia are worse after TG.

P3-01-10: DMBA-Breast Cancer in Diet Induced Obesity (DIO) and Lean Mice Is Related to Leptin Signaling

Introduction: Leptin, the major adipokine released by adipose tissue, is strongly linked to obesity related-cancers. We have shown previously that inhibition of leptin signaling with pegylated leptin peptide receptor antagonist 2 (PEG-LPrA2) negatively impacted human xenograft and syngeneic mouse breast cancer growth as well as VEGF/VEGFR2 levels [1,2].

Objective: We hypothesize that leptin signaling is essential for 7,12-dimethylbenz[A]anthracene (DMBA)-mammary tumor (MT) particularly in obese mice.

Methods: The study investigated the potential of PEG-LPrA2 to prevent MT in lean and diet-induced-obesity (DIO)-C57BL/6J female mice treated with 1 mg/dose/weekly for 6 weeks of DMBA. Obesity was induced by feeding DIO-mice (95% obese mice after 5 weeks) with high fat diet (PDI-1; 45% Kcal from fat). Lean mice were fed a normal diet (PDI-1; 5% Kcal from fat). PEG-LPrA2 was administered intravenously. Lean and DIO-mice received either one or two PEG-LPrA2 dose/week (50 ml/0.1 mM) two weeks prior to DMBA to test its preventative potential through the end point (32 weeks). Control mice received saline injections.

Results: Obesity was positively correlated to the development of DMBA-MT in mice. MTs were found in 17% of lean control and 69% of DIO-control mice. Notably, PEG-LPrA2 prevented the onset of DMBA-MT in lean (one and two doses: 0% tumor-bearing mice) and DIO-mice (one-dose, 29% and two-dose 0% MT). PEG-LPrA2 treatment did not alter body weight nor food intake in lean or DIO-mice. VEGF levels were significant higher (32 fold) in control DIO-mice. PEG-LPrA2 inhibition of leptin signaling decreased tumor levels of Notch ligands (Jagged-1 & DLL-4), receptors (Notch 1–4) and target genes (Survivin and Hey2) and reduced OB-R, IL-1R tI, VEGF/VEGFR2, bcl-2, HIF-1a and NFκB (p50 and p105).

Conclusions: Present data strongly suggest that leptin signaling is essential for DMBA-induced MT in the context of obesity. Overall, the effective chemoprevention of DMBA-MT by PEG-LPrA2 treatment in DIO and lean mice reinforces the potential use of leptin signaling inhibition for breast cancer prevention. These observations are most significant for obese populations showing higher levels of leptin and incidence of breast cancer. [This work was supported in part by NIH/NCI1SC1CA138658-02; NIH/ARRA/3SC1CA138658-02S1 and the Georgia Cancer Coalition Distinguished Cancer Scholar Award (to RRGP); CREDO (MSCR) 2R25RR017694-06A1 to L.S.C; the Morehouse School of Medicine (MSM) MBRS RISE Program (NIH/NIGMS 506 GM08248) to T.Z.M; and facilities and support services at Morehouse School of Medicine (NIH RR03034 and 1C06 RR18386)].

References:

[1] Gonzalez RR, Chefils S, Escobar M, et al. Leptin signaling promotes the growth of mammary tumors and increases the expression of vascular endothelial growth factor (VEGF) and its receptor type two (VEGF-R2). J Biol Chem 2006, 281(36): 26320–26328.

[2] Gonzalez RR, Watters A, Xu, Y, et al. Leptin-signaling inhibition results in efficient anti-tumor activity in estrogen receptor positive or negative breast cancer. Breast Cancer Res 2009, 11:R36.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-01-10.

P5-06-10: Leptin Signaling Impacts Notch and Wnt Crosstalk in Breast Cancer

Background: Triple negative breast cancer (TNBC: ER-, PR- and Her2/neu-) is an aggressive form of the disease that disproportionately affects women of color, has an early onset, and is associated with poor survival and a resistance to common therapeutic treatments. We have previously demonstrated an association between the adipocytokine leptin and Notch signaling pathways in breast cancer. Notch participates in a crosstalk relationship with many signaling pathways involved in carcinogenesis, including Wnt and leptin, which could in turn increase tumor burden and cell survival of MMTV-Wnt1 obese mice. We hypothesize that leptin signaling crosstalk with Notch and Wnt is instrumental in the development of drug-resistant features (increased survival and proliferation) of TNBC.

Objective: The aim of this study was to determine whether leptin mediated crosstalk of the Notch and Wnt pathways has a differential impact on TNBC compared to ER+ cells.

Materials & Methods: ER+ MCF-7 and TNBC-MDA MB-231 cells (96-well plate; 1×104 cells/well) were serum deprived for 24 hours and treated with varying doses of Doxorubicin and Cisplastin for 24h in conjunction with pharmacological doses of leptin, leptin peptide antagonist (LPrA2), Wnt agonist (Wnt-1) and antagonist (Wif-1). Cell proliferation was measured via WST assay. The effect of the various treatments on the activation of Wnt (total/pβ-catenin), Notch (Notch 1–4 and JAG1/Dll-4 and targets survivin/Hey2), and leptin (STAT3 and targets VEGF/VEGFR-2) signaling pathways were measured using western blot and ELISA. β-Catenin levels were also investigated by IHC in DMBA-breast cancer samples from lean and DIO (diet-induced obese mice) mice treated with LPrA2. Apoptosis was also measured.

Results: Leptin increased the levels of beta-catenin mainly in TNBC cells. This leptin-induced effect was also detected in breast tumors from DIO-mice. Interestingly, leptin increased survival (bcl-2 and Caspase-3 activation)/proliferation (cell number and Cyclin D1), expression of Notch and attenuated the detrimental effects of Doxorubicin and Cisplastin on breast cancer cells. Wnt-1 had similar but less pronounced effects compared to leptin. We also observed differences in Notch expression. Moreover, MDA MB-231 cells showed decreased response to Wnt1 in the presence of leptin.

Conclusions: Our findings suggest that leptin could play a negative role in TNBC by increasing drug-resistance through its crosstalk with Wnt and Notch signaling pathways. This may imply that obesity, characterized by elevated leptin levels, could negatively affect the outcome of TBNC treatment. Taken together, this data supports the theory that inhibition of leptin signaling could be a novel way to prevent and treat TBNC, particularly in the context of obesity and abnormal Wnt and Notch signaling. [This work was supported in part by NIH/NCI1SC1CA138658-02; NIH/ARRA/3SC1CA138658-02S1 and the Georgia Cancer Coalition Distinguished Cancer Scholar Award (to RRGP); CREDO (MSCR) 2R25RR017694-06A1 (to L.S.C); NIGMS506GM08248 and NCRR 5P20RR11104 (to T.Z.M); and facilities and support services at MSM (NIH RR03034 and 1C06 RR18386)].

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-06-10.

Central airways obstruction due to Aspergillus fumigatus after lung transplantation

Aspergillus fumigatus may affect immunocompromised lung transplant patients in many ways. We report a new pulmonary manifestation of A fumigatus in 3 patients who underwent bilateral lung transplantation. All 3 subjects developed rapid decreases in pulmonary function and were found to have large central airways obstruction with thick plugs of mucus, heavily laden with Aspergillus species. All 3 patients presented with atypical features of Aspergillus infection, but all responded to treatments with either steroids, anti-fungals or both.