Longitudinal Comparative Analysis of Circulating Tumor DNA and Matched Tumor Tissue DNA in Patients with Metastatic Colorectal Cancer Receiving Palliative First-Line Systemic Anti-Cancer Therapy

Purpose

This study aimed to compare tumor tissue DNA (ttDNA) and circulating tumor DNA (ctDNA) to explore the clinical applicability of ctDNA and to better understand clonal evolution in patients with metastatic colorectal cancer undergoing palliative first-line systemic therapy.

Materials and Methods

We performed targeted sequencing analysis of 88 cancer-associated genes using germline DNA, ctDNA at baseline (baseline-ctDNA), and ctDNA at progressive disease (PD-ctDNA). The results were compared with ttDNA data.

Results

Among 208 consecutively enrolled patients, we selected 84 (41 males; median age 59, range 35 to 90) with all four sample types available. A total of 202 driver mutations were found in 34 genes. ttDNA exhibited the highest mutation frequency (n=232), followed by baseline-ctDNA (n=155) and PD-ctDNA (n=117). Sequencing ctDNA alongside ttDNA revealed additional mutations in 40 patients (47.6%). PD-ctDNA detected 13 novel mutations in 10 patients (11.9%) compared to ttDNA and baseline-ctDNA. Notably, 7 mutations in 5 patients (6.0%) were missense or nonsense mutations in APC, TP53, SMAD4, and CDH1 genes. In baseline-ctDNA, higher maximal variant allele frequency (VAF) values (p=0.010) and higher VAF values of APC (p=0.012), TP53 (p=0.012), and KRAS (p=0.005) mutations were significantly associated with worse overall survival.

Conclusion

While ttDNA remains more sensitive than ctDNA, our ctDNA platform demonstrated validity and potential value when ttDNA was unavailable. Post-treatment analysis of PD-ctDNA unveiled new pathogenic mutations, signifying cancer's clonal evolution. Additionally, baseline-ctDNA's VAF values were prognostic after treatment.

Transient myocardial thickening after routine ovariohysterectomy in a 15-month-old Ragdoll cat

A 15-month-old female Ragdoll cat was evaluated for progressive lethargy, tachypnoea and increased respiratory effort for 1 week after routine ovariohysterectomy. Thoracic radiographs and an echocardiogram showed evidence of congestive heart failure and a hypertrophic cardiomyopathy phenotype, respectively. The maximum left ventricular wall thickness in end diastole was 6.2 mm. The serum cardiac troponin I concentration was 20.86 ng/mL. The cat was treated with furosemide and clopidogrel and discharged after 3 days. A repeat echocardiogram 2 weeks later showed complete resolution of the hypertrophic cardiomyopathy phenotype (maximum left ventricular wall thickness: 5.0 mm). A repeat cardiac troponin I concentration was 0.041 ng/mL. All cardiac medications were discontinued. A final recheck 4 weeks later revealed stable normal echocardiogram and further reduction in cardiac troponin I concentration to 0.004 ng/mL. This case report demonstrates that resolution of transient myocardial thickening can take 2 weeks after the echocardiographic diagnosis of left ventricular thickening.

5-aminosalicylic acid suppresses osteoarthritis through the OSCAR-PPARγ axis

Osteoarthritis (OA) is a progressive and irreversible degenerative joint disease that is characterized by cartilage destruction, osteophyte formation, subchondral bone remodeling, and synovitis. Despite affecting millions of patients, effective and safe disease-modifying osteoarthritis drugs are lacking. Here we reveal an unexpected role for the small molecule 5-aminosalicylic acid (5-ASA), which is used as an anti-inflammatory drug in ulcerative colitis. We show that 5-ASA competes with extracellular-matrix collagen-II to bind to osteoclast-associated receptor (OSCAR) on chondrocytes. Intra-articular 5-ASA injections ameliorate OA generated by surgery-induced medial-meniscus destabilization in male mice. Significantly, this effect is also observed when 5-ASA was administered well after OA onset. Moreover, mice with DMM-induced OA that are treated with 5-ASA at weeks 8-11 and sacrificed at week 12 have thicker cartilage than untreated mice that were sacrificed at week 8. Mechanistically, 5-ASA reverses OSCAR-mediated transcriptional repression of PPARγ in articular chondrocytes, thereby suppressing COX-2-related inflammation. It also improves chondrogenesis, strongly downregulates ECM catabolism, and promotes ECM anabolism. Our results suggest that 5-ASA could serve as a DMOAD.

HER2 amplification level by in situ hybridization predicts survival outcome in advanced HER2-positive breast cancer treated with pertuzumab, trastuzumab, and docetaxel regardless of HER2 IHC results

BACKGROUND

The role of HER2 amplification level in predicting the effectiveness of HER2-directed therapies has been established. However, its association with survival outcomes in advanced HER2-positive breast cancer treated with dual HER2-blockade remains unexplored.

METHODS

This is a single-center retrospective study of patients with advanced HER2-positive breast cancer treated with first-line pertuzumab, trastuzumab, and docetaxel. The primary objective was to ascertain the relationship between treatment outcomes and the level of HER2 amplification by in situ hybridization (ISH).

RESULTS

A total of 152 patients were included with a median follow-up duration of 50.0 months. Among the 78 patients who received ISH, a higher HER2/CEP17 ratio correlated significantly with longer PFS (HR 0.50, p = 0.022) and OS (HR 0.28, p = 0.014) when dichotomized by the median. A higher HER2 copy number also correlated significantly with better PFS (HR 0.35, p < 0.001) and OS (HR 0.27, p = 0.009). In multivariate analysis, the HER2/CEP17 ratio was an independent predictive factor for PFS (HR 0.66, p = 0.004) and potentially for OS (HR 0.64, p = 0.054), along with HER2 copy number (PFS HR 0.85, p = 0.004; OS HR 0.84, p = 0.049). Furthermore, the correlation between HER2 amplification level by ISH with PFS and OS was consistent across the HER2 IHC 1+/2+ and 3+ categories.

CONCLUSIONS

This is the first study to report that a higher level of HER2 amplification by ISH is associated with improved PFS and OS in advanced HER2-positive breast cancer treated with dual HER2-blockade. Notably, HER2 amplification level had a predictive role regardless of IHC results. Even in patients with HER2 protein expression of 3+, treatment outcome to HER2-directed therapy was dependent on the level of HER2 gene amplification.

Passivation effect on Cd0.95Mn0.05Te0.98Se0.02 radiation detection performance

CdTe-based detectors have the problem of Te-rich surface layers caused by Br etching, which is one of fabrication steps. Te-rich layer acts as a trapping center and serves as an additional source of charge carriers, thereby degrading transport property of charge carriers and enriching leakage current on surface of detector. To solve this problem, we introduced sodium hypochlorite (NaOCl) as a passivant, and investigated its effect on Cd0.95Mn0.05Te0.98Se0.02 (CMTS), by analyzing chemical state of surface and its performance. After passivation with NaOCl, the results of X-ray photoelectron spectroscopy (XPS) shows the formation of tellurium oxide and elimination of water on CMTS surface, and CMTS presented enhanced performance with Am-241 radioisotope. Consequently, it is demonstrated that the passivation with NaOCl reduces leakage current, compensates defect, and elevates transport of charge carriers, thereby decreasing charge loss of carriers and improving performance of CMTS detector.

Development and evaluation of photon-counting Cd0.875Zn0.125Te0.98Se0.02 detector for measuring bone mineral density

Cadmium zinc telluride (CZT) has been actively researched and developed by researchers in various fields. In medical applications, especially photon-counting, CZT enables improved image quality, multi-material decomposition, and improved dose efficiency. Moreover, band gap engineering and selenium addition on CZT improved electrical, spectroscopic and structural properties, thereby supporting performance of CZT as a photon-counting detector. In this study, it is shown that Cd_0.875Zn_0.125Te_0.98Se_0.02 (CZTS) shows sufficient performance without loss of detection efficiency. We carried out a study involving the application of this CZTS on calculating bone mineral density (BMD) values, because this application has a novelty of new material for BMD sensor which follows the CdTe- or CdZnTe- based BMD detector. Anatomical images from different energy bins contained different information of attenuation although the images were taken in the same region at the same time. Moreover, calculated BMD values had a proper tendency depending on the amount of bone in that region. The final BMD value was 1.1972 g/cm², which is close to the real value of 1.2 g/cm². The introduction with a bone filter and a smaller pixel size will improve the accuracy and precision of photon-counting CZTS detectors for measuring BMD values. However, in this study the CZTS showed the feasibility that a photon-counting CZTS detector can help the measurement of BMD values and the diagnosis of osteoporosis.

Thin and hypokinetic myocardial segments in cats with cardiomyopathy

INTRODUCTION/OBJECTIVES

Thin and hypokinetic myocardial segments (THyMS) represent adverse ventricular (LV) remodeling in human hypertrophic cardiomyopathy. We describe the echocardiographic features and outcome in cats with THyMS, and in a subpopulation, the echocardiographic phenotype before LV wall thinning was detected (pre-THyMS).

ANIMALS

Eighty client-owned cats.

MATERIALS AND METHODS

Retrospective multicenter study. Clinical records were searched for cats with THyMS, defined as LV segment(s) with end-diastolic wall thickness (LVWT) <3 mm and hypokinesis in the presence of ≥one LV segment(s) with LVWT >4 mm and normal wall motion. When available, echocardiograms pre-THyMS were assessed. Survival time was defined as time from first presentation with THyMS to death.

RESULTS

Mean thickest LV wall segment (MaxLVWT) was 6.1 mm (95% CI 5.8-6.4 mm) and thinnest (MinLVWT) was 1.7 mm (95% CI 1.6-1.9 mm). The LV free wall was affected in 74%, apex in 13% and septum in 5%. Most cats (85%) presented with heart failure and/or arterial thromboembolism. Median circulating troponin I concentration was 1.4 ng/mL ([range 0.07-180 ng/mL]). Prior echocardiography results were available for 13/80 cats, a mean of 2.5 years pre-THyMS. In segments subsequently undergoing thinning, initial MaxLVWT measured 6.7 mm (95% CI 5.8-7.7 mm) vs. 1.9 mm (95% CI 1.5-2.4 mm) at last echocardiogram (P<0.0001). Survival data were available for 56/80 cats, median survival time after diagnosing THyMS was 153 days (95% CI 83-223 days). Cardiac histopathology in one cat revealed that THyMS was associated with severe transmural scarring.

CONCLUSIONS

Cats with THyMS had advanced cardiomyopathy and a poor prognosis.

Reduced-intensity conditioning versus myeloablative conditioning allogeneic stem cell transplantation for patients with myelofibrosis

Background

Allogeneic hematopoietic stem cell transplantation (alloSCT) is the sole curative option for myelofibrosis (MF). However, it is unknown as to which of the two, myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC), is a better preconditioning regimen.

Methods

Twenty-five patients with MF were treated with alloSCT, 12 of whom underwent RIC. Baseline characteristics, response to alloSCT, adverse events, including graft-versus-host disease (GVHD), and survival outcomes were reviewed.

Results

There was no difference in the neutrophil engraftment rate and time to engraftment between MAC vs. RIC. The time to platelet engraftment was significantly longer in the MAC group (median, 112.8 vs. 28.8 days for MAC vs. RIC, respectively, P=0.049). RIC was more advantageous in terms of achieving complete chimerism (38.5% vs. 83.3%, P=0.041). The incidence of acute GVHD was 84.6% (11 of 13) and 58.3% (7 of 12) in the MAC and RIC groups, respectively. The cumulative incidence of grade III‒IV acute GVHD was significantly higher in the MAC group than in the RIC group (P=0.03). No significant differences were observed in progression-free and overall survival. The 17-month probability of progression-free survival was 38.4% [95% confidence interval (CI), 19.3‒76.5] vs. 47.6% (95% CI, 25.7‒88.2) (P=0.21), and that of overall survival was 53.8% (95% CI, 32.5‒89.1) vs. 48.6% (95% CI, 26.8‒88.3) (P=0.85) for MAC vs. RIC, respectively.

Conclusion

RIC offers a significant advantage over MAC, even in younger patients with MF undergoing alloSCT, in terms of cell engraftment, rate of complete chimerism achievement, and incidence of acute GVHD.

Living Lab: Design a digital health intervention for healthy diet of ethnic minority adolescents

 

Eating habits cultivated during adolescence continue through adulthood, and can widen the health gap in adulthood for vulnerable ethnic minority adolescents (EMA). Living Lab is a methodological approach through which stakeholders co-create innovations as citizen scientists in real-life settings. This study aimed to design a digital health intervention (DHI) for enhancing the heathy diet of EMA using the Living Lab approach. The DHI’s content and strategies were derived through literature reviews and focus group interviews. The Living Lab was structured by using 5 principles: real-life setting, user engagement, multi-stakeholder participation, multi-method, and co-creation. It has four activity phases of discovering problems, exploring solutions, solving problems, and disseminating solutions putting more emphasis on the use of digital device and multiple stakeholders such as peers and teachers in co-ideation. DHI participants were grouped into equal proportions of EMA and Korean-ethnic peers. The DHI operates for 2 hours once a week for 4 weeks, with orientation and wrap-up sessions before and after the DHI. Each activity of the co-working process is designed by applying behavior change techniques such as prompts/cues, framing/reframing, and credible sources in a digital educational environment: creating content using Google Jamboard and Padlet, and working on the metaverse platform ZEP. The responses and feedback from the participants are received through an online reflection diary weekly. Usability and acceptability of digital technology are assessed by an online survey on completion of the DHI. The efficacy of DHI is assessed through the change in dietary behavior and food literacy. This study was designed to enable EMA recognize the harmful effects of an unhealthy diet and co-create solutions through dynamic activities in a digital environment. Further, it may serve to change the cultural sensitivity of native peers that influence the health choices of EMA.

Key messages

• Digital-based intervention would be an effective way for vulnerable ethnic minority adolescents to engage in healthy diet.

• The Living Lab approach was used as an essential strategy to develop a digital health intervention to improve the healthy diet of ethnic minority adolescents.

Diverse perspectives on social determinants of multicultural adolescents: A focus group study

Background

As Korea transforms into a multicultural society, social vulnerability of the multicultural adolescents (MAs) puts them at risk for poor health and health disparities. However, there is shortage of evidence on social determinants of health (SDH), which refers to the circumstances of people from birth to death, which affects their health outcomes, for MAs. Thus, this study aims to explore the SDH of MAs from diverse stakeholders’ perspectives.

Methods

This qualitative study comprised 17 focus group interviews with 99 participants (MAs, peers, parents, teachers, neighbors, and community leaders), conducted from June to September 2020. The directed content analysis was conducted using the Minority Health and Health Disparities Research Framework with a high rigor level based on the four criteria of Lincoln and Guba’s trustworthiness.

Results

The participants addressed SDH of MAs in five domains: biological (vulnerability and mechanism); behavioral (health behavior, family/school/peer functioning, and policies and laws); physical/built environment (school/community environment); sociocultural environment (MAs'/parental sociodemographic, language proficiency, MAs'/parental acculturation, social network, and response to/interpersonal/local/societal structural discrimination); and health care system (insurance coverage, MAs'/parental health literacy, availability of services, and health care policies). However, limited SDH in biological and physical/built environment domains were identified.

Conclusions

SDH in sociocultural environment domain and interpersonal influence level were the most commonly addressed. Interpersonal discrimination of both MAs and parents were found to be the most important SDH. These findings suggest that future programs to enhance MAs’ health may be targeted toward reducing discrimination and involving their parents.

Key messages

• Sociocultural environment was found to be the most salient SDH domain to affect MAs’ health.

• SDH of MAs are linked to discrimination and their parents’ sociocultural aspects such as acculturation.

Assessment of aortic valve area on cardiac computed tomography and doppler echocardiography: differences and clinical significance in symptomatic bicuspid aortic stenosis

Backgrounds

This study aimed to investigate the differences and clinical significance of effective orifice area (EOA) on Doppler echocardiography and geometric orifice area (GOA) on cardiac computed tomography (CT) in bicuspid aortic stenosis (AS).

Methods

One-hundred sixty-three consecutive patients (age 64±10 years, 56.4% men) with symptomatic bicuspid AS who were referred for surgery and underwent both cardiac CT and echocardiography within 3 months were studied. For the aortic valve area, GOACT was measured by multiplanar CT planimetry, and EOAEcho was calculated by continuity equation with Doppler echocardiography. The associations of GOACT and EOAEcho with the patients' symptom scale, biomarkers, and left ventricular (LV) functional variables were comprehensively analyzed.

Results

There was a significant but modest correlation between EOAEcho and GOACT (r=0.604, p&lt;0.001). Both EOAEcho and GOACT revealed significant correlations with mean pressure gradient and peak transaortic velocity and the coefficients were higher in EOAEcho than GOACT. EOAEcho of 1.05 cm2 and GOACT of 1.25 cm2 correspond to the hemodynamic cut-off values for diagnosing severe AS. EOAEcho was well correlated with patients' symptom scale and log NT-pro BNP, but GOACT was not. In addition, EOAEcho showed higher correlation coefficient with estimated LV filling pressure and LV global longitudinal strain than GOACT.

Conclusions

Both EOAEcho and GOACT can be used to evaluate the severity of bicuspid AS, however, the threshold for GOACT for diagnosing severe AS should be applied higher than that for EOAEcho. EOAEcho tends to be more correlated with the patients' symptom degree, biomarkers, and LV functional variables than GOACT.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The Korean Cardiac Research Foundation

Characteristics and clinical implications of premature summation of early and late diastolic filling in patients without tachycardia

Backgrounds

The summation of early (E) and late diastolic filling (A) on mitral inflow Doppler even in the absence of tachycardia is often found during assessments of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A summation.

Methods

We identified 1,014 subjects who showed E-A summation and normal LV ejection fraction between January 2019 and June 2021 in two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A summation at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age, sex, and heart rate matched controls without E-A summation.

Results

The premature E-A summation group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to the current guidelines. That group showed prolonged isovolumic relaxation time (107.2±25.3 vs. 61.6±15.6 msec, p&lt;0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p&lt;0.001), lower LVEF (63.8±7.0 vs. 67.3±5.6%, p&lt;0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2 vs. 19.7±3.3%, p&lt;0.001) than controls. As the E-A summation occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002).

Conclusions

The premature E-A summation at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.

Funding Acknowledgement

Type of funding sources: None.

Entropic comparison of Landau-Zener and Demkov interactions in the phase space of a quadrupole billiard

We investigate two types of avoided crossings in a chaotic billiard within the framework of information theory. The Shannon entropy in the phase space for the Landau-Zener interaction increases as the center of the avoided crossing is approached, whereas for the Demkov interaction, the Shannon entropy decreases as the center of avoided crossing is passed by with an increase in the deformation parameter. This feature can provide a new indicator for scar formation. In addition, it is found that the Fisher information of the Landau-Zener interaction is significantly larger than that of the Demkov interaction.

Exopolysaccharide of Enterococcus faecium L15 promotes the osteogenic differentiation of human dental pulp stem cells via p38 MAPK pathway

Background

Bone has important functions in the body. Several researchers have reported that the polysaccharides and lipopolysaccharide derived from microbes can promote osteogenic differentiation of stem cells. Enterococcus faecium, a lactic acid bacterium (LAB), produces several bioactive metabolites and has been widely applied in the food and nutraceutical industries. The exopolysaccharide (EPS) from LAB has also been extensively examined for its postbiotic effects and for its in vivo and in vitro functionalities. However, studies on promoting bone differentiation using polysaccharides from LAB are lacking. Therefore, the purpose of this study was to investigate the effect of E. faecium L15 extract and EPS on osteogenic differentiation of human dental pulp stem cells (hDPSCs) and to identify the underlying mechanisms.

Methods

hDPSCs were obtained from dental pulp tissue, and L15 extract and EPS were isolated from L15. Gene and protein expression of the osteogenic differentiation markers were analyzed with qPCR and western blotting and the possible signaling pathways were also investigated using western blotting. Osteogenic differentiation potential was examined by alkaline phosphatase (ALP) staining and alizarin red s (ARS) staining. In addition, osteogenic differentiation potential of L15 EPS was explored in ex vivo culture of neonate murine calvaria.

Results

The calcium deposition and ALP activity were enhanced by addition of L15 extract or EPS. The expression levels of RUNX2, ALP, and COL1A1 mRNA and the protein expression levels of RUNX2, ALP, and BMP4 were increased in hDPSCs treated with the L15 extract or EPS. The L15 EPS treatment enhanced phosphorylation of the p38 mitogen-activated protein kinase (MAPK). The L15 EPS-induced increases in RUNX2, ALP, and BMP4 expression were suppressed by the p38 MAPK inhibitor SB203580. The promoting effect of L15 EPS on osteogenic differentiation was not only seen in hDPSCs, but also in osteoblast precursors. ALP activity and the expression of RUNX2, ALP, and COL1A1 increased in the L15 EPS-treated osteoblast precursors. In addition, L15 EPS increased bone thickness of neonate murine calvaria in ex vivo culture.

Conclusions

The stimulatory effect of L15 extract and EPS on osteogenic differentiation occurred through the p38 MAPK pathway, and L15 EPS enhanced new bone formation in neonate murine calvaria. These data suggest that L15 EPS has therapeutic potential applicable to bone regeneration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-022-03151-0.

Abstract 5538: Functional characterization of TU2218, ALK5 and VEGFR2 dual inhibitor, on in vitro tumor immunity-mimetic systems

High level of plasma TGF-β is significantly correlated with poor outcomes with approved immune-oncology therapeutics. Poor clinical results for ALK5 inhibitors and bifunctional fusion protein targeting TGF-β and PD-L1 are also being reported in several clinical trials. Therefore, a novel therapeutic with superior efficacy differentiated from previous TGF-β modulators will demonstrate significant clinical outcomes in combination with immuno-oncology therapeutics. In TME, TGF-β and VEGF synergistically induce eradication of immunogenic tumors. Therefore, a dual-inhibitor targeting both ALK5 and VEGFR2 has high potential to demonstrate effective clinical efficacy against TGF-β- and VEGF-enriched tumors as a single or combination treatment. TU2218 is a highly potent, orally available inhibitor against ALK5 and VEGFR2 with an IC50 of 1.2 nM and 4.9 nM respectively. In a human PBMC assay, 0.5-1 μM TU2218 treatment significantly enhanced IFN-γ production or IFN-γ-producing T lymphocytes number by TGF-β-driven immunosuppression, but vactosertib, galunisertib and TGF-β neutralizing antibody did not have significant effects. In a human regulatory T cells assay, CD4+CD25+ Tregs suppressed the proliferation of naïve CD4+CD25- T cells after TCR triggering. In contrast, 0.5 μM TU2218 treated Tregs completely reversed the TCR-mediated proliferation of CD4+CD25- T cells. In addition, the immunomodulatory activity of TU2218 was analyzed on the co-culture system of cancer cells with human PBMC. In this assay, MCF-7 and HT-1080 displayed strong inhibitory effects on IFN-γ secretion of human PBMC, but TU2218 completely restored IFN-γ production compared with the poor effect of either vactosertib or TGF-β neutralizing antibody. In an NK assay, TGF-β reduced the level of surface proteins of NKG2D and NKp30 on CD56dim and CD56bright human primary NK cells and NK92 cell lines. TU2218 treatment completely reversed not only the inhibitory effect of TGF-β on the expression of NKG2D but also TGF-β-driven impairment of NK cytolytic activity for K562 cell lines on the co-culture system. Results show TU2218 possesses potent anti-cancer immune activities through boosting T and NK immunity as well as blocking Treg activity, implicating the mechanism of overcoming immune tolerance and reversing immunosuppression in TME. These effects of TU2218 in human immune cells would be a basis for novel combination options to develop promising therapeutics for patients with advanced cancer.

Citation Format: Nam-Hoon Kim, Seong-Ho Kang, Jihyun Lee, Seung-Hyun Kim, Chan-Hee Yu, Jae Won Choi, Soyoun Ahn, Jeongmin Seo, Hun-Taek Kim. Functional characterization of TU2218, ALK5 and VEGFR2 dual inhibitor, on in vitro tumor immunity-mimetic systems [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 5538.

Nanoscale pattern formation on silicon surfaces bombarded with a krypton ion beam: experiments and simulations

The nanoscale patterns produced by bombardment of the (100) surface of silicon with a 2 keV Kr ion beam are investigated both experimentally and theoretically. In our experiments, we find that the patterns observed at high ion fluences depend sensitively on the angle of incidence Θ. For Θ values between 74° and 85°, we observe five decidedly different kinds of morphologies, including triangular nanostructures traversed by parallel-mode ripples, long parallel ridges decorated by short-wavelength ripples, and a remarkable mesh-like morphology. In contrast, only parallel-mode ripples are present for low ion fluences except for Θ = 85°. Our simulations show that triangular nanostructures that closely resemble those in our experiments emerge if a linearly dispersive term and a conserved Kuramoto-Sivashinsky nonlinearity are appended to the usual equation of motion. We find ridges traversed by ripples, on the other hand, in simulations of the Harrison-Pearson-Bradley equation (Harrisonet al2017Phys. Rev.E96032804). For Θ = 85°, the solid surface is apparently stable and simulations of an anisotropic Edwards-Wilkinson equation yield surfaces similar to those seen in our experiments. Explaining the other two kinds of patterns we find in our experiments remains a challenge for future theoretical work.

The impact of free vaccination policies under the Korean Influenza National Immunization Program: Trends in influenza vaccination rates in South Korea from 2010 to 2019

Background

Annual vaccination for influenza is recommended for high-risk populations for its high morbidity and mortality. South Korea provides free influenza vaccination to some target groups under the National Immunization Program (NIP), and discrepantly high vaccination rates are observed in such populations. In this study, we analyzed the trends in influenza vaccination rates and evaluated the impact of the recent expansion of financial coverage to children ≤12 years and pregnant women.

Methods

We conducted a cross-sectional study with nationwide survey data from Korea National Health and Nutrition Examination Survey (KNHANES). From 2010 to 2019, we evaluated the trends in influenza vaccination rates of the following four target groups: children ≤12 years, adults ≥65 years, pregnant women, and people with chronic diseases.

Results

In total, 80,861 individuals were analyzed. From 2017 to 2019, the vaccination coverage of children ≤12 years increased from 66.2% to 83.1%; pregnant women from 44.1% to 68.5% (comparing the mean of 2010–2017 and 2018–2019, P <0.001 for both). The elderly ≥65 years showed the highest rates (85.8% in 2019), while people with chronic diseases marked the lowest (41.9% in 2019). People with liver diseases showed the lowest vaccination rate of 27.8%, while that of other common diseases ranged between 31.7–44.1%.

Conclusion

The discrepancy between target groups corresponds to their financial coverage under NIP. The recent expansion of financial aids to children ≤12 years and pregnant women was followed by significant increases in vaccination rates in both groups. We suggest that free vaccination policy is one of the most effective strategies to enhance vaccination coverage, and we call for its expansion to other under-vaccinated target groups, especially people with chronic diseases.

Analysis of Breakthrough Reactions in 1,143 Desensitization Procedures in a Single Tertiary Hospital Using a One-Bag Desensitization Protocol

Background

Drug desensitization is helpful for patients who have experienced significant hypersensitivity reactions (HSRs) to antineoplastic agents. One-bag desensitization protocols, attracting attention in recent years, need to be validated on their safety and efficacy in a large number.

Methods

One-bag desensitization procedures conducted from 2018 to 2020 were analyzed; their outcomes and the risk factors for breakthrough reactions (BTRs) were assessed in desensitization procedures to major drug types (platins, taxanes, and monoclonal antibodies).

Results

A total of 1,143 procedures of one-bag desensitization were performed in 228 patients with 99% completion rate. BTRs occurred in 26% of the total desensitization procedures—34% in platins, 12% in taxanes, and 18% in mAbs. BTR occurrence rate decreased along the desensitization process with 80% of BTRs occurring within the 6th desensitization attempts. Severe BTR occurred more frequently with severe initial HSRs (1% in mild to moderate initial HSRs vs. 16% in severe). Severe initial HSR was also a significant risk factor for moderate to severe BTR in platins (odds ratio 1.56, 95% confidence interval [CI] 1.06–2.29, p = 0.025). The use of steroid was also associated with lower occurrence of moderate to severe BTR (odds ratio 0.50, 95% CI 0.35–0.72, p < 0.001).

Conclusion

Most patients with HSRs to antineoplastic agents can safely receive chemotherapy through a one-bag desensitization protocol. Further studies on each drug with larger sample size can help verify the risk factors of BTRs and evaluate the efficacy of steroid premedication in improving the safety of desensitization in high-risk patients.

Desensitization for the prevention of drug hypersensitivity reactions

Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a full therapeutic dose. It can be used as a therapeutic strategy for patients with drug hypersensitivity when no comparable alternatives are available. Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood. However, the attenuation of various intracellular signals in target cells is an area of active research, such as high-affinity IgE receptor (FcεRI) internalization, anti-drug IgG4 blocking antibody, altered signaling pathways in mast cells and basophils, and reduced Ca2+ influx. Agents commonly requiring desensitization include antineoplastic agents, antibiotics, antituberculous agents, and aspirin/nonsteroidal antiinflammatory drugs. Various desensitization protocols (rapid or slow, multi-bag or one-bag, with different target doses) have been proposed for each drug. An appropriate protocol should be selected with the appropriate concentration, dosage, dosing interval, and route of administration. In addition, the protocol should be adjusted with consideration of the severity of the initial reaction, the characteristics of the drug itself, as well as the frequency, pattern, and degree of breakthrough reactions.

Association between preconditioning absolute lymphocyte count and transplant outcomes in patients undergoing matched unrelated donor allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning and anti-thymocyte globulin

Background:

Allogeneic stem cell transplantation (alloSCT) offers cure chance for various hematologic malignancies, but graft-versus-host disease (GVHD) remains a major impediment. Anti-thymocyte globulin (ATG) is used for prophylactic T-cell depletion and GVHD prevention, but there are no clear guidelines for the optimal dosing of ATG. It is suspected that for patients with low absolute lymphocyte counts (ALCs), current weight-based dosing of ATG can be excessive, which can result in profound T-cell depletion and poor transplant outcome.

Methods:

The objective of the study is to evaluate the association of low preconditioning ALC with outcomes in patients undergoing matched unrelated donor (MUD) alloSCT with reduced-intensity conditioning (RIC) and ATG. We conducted a single-center retrospective longitudinal cohort study of acute leukemia and myelodysplastic syndrome patients over 18 years old undergoing alloSCT. In total, 64 patients were included and dichotomized into lower ALC and higher ALC groups with the cutoff of 500/μl on D-7.

Results:

Patients with preconditioning ALC <500/μl were associated with shorter overall survival (OS) and higher infectious mortality. The incidence of acute GVHD and moderate-severe chronic GVHD as well as relapse rates did not differ according to preconditioning ALC. In multivariate analyses, low preconditioning ALC was recognized as an independent adverse prognostic factor for OS.

Conclusion:

Patients with lower ALC are exposed to excessive dose of ATG, leading to profound T-cell depletion that results in higher infectious mortality and shorter OS. Our results call for the implementation of more creative dosing regimens for patients with low preconditioning ALC.

Anterior mitral valve leaflet length in cats with hypertrophic cardiomyopathy

INTRODUCTION

Anterior mitral valve leaflet (AMVL) elongation is a recognised feature of hypertrophic cardiomyopathy (HCM). However, whether AMVL elongation precedes left ventricular hypertrophy in cats is currently unknown. The aim of this study was to explore the risk of developing an HCM phenotype in cats with an elongated AMVL.

ANIMALS

FIFTY-FIVE APPARENTLY HEALTHY CATS WITH A NORMAL BASELINE ECHOCARDIOGRAM AND A FOLLOW-UP ECHOCARDIOGRAM AT >ONE YEAR.

MATERIALS AND METHODS

This was a retrospective longitudinal study. Cats at the baseline were grouped based on whether or not they developed an HCM phenotype at follow-up. AMVL length and left atrial and left ventricular dimensions were measured from two-dimensional images.

RESULTS

The median follow-up period of the study population was 5.4 years (25th and 75th quartile, 2.7-6.7 years). During this time, 17 cats (30.9%) developed an HCM phenotype. At the baseline, cats that subsequently developed an HCM phenotype had greater AMVL length (9.4 mm [25th and 75th quartile, 9.0-10.6 mm] vs. 8.5 mm [25th and 75th quartile, 7.6-9.1 mm], P < 0.0001) and maximal left ventricular wall thickness (4.5 mm [25th and 75th quartile, 4.1-4.7 mm] vs. 4.0 mm [25th and 75th quartile, 3.7-4.6 mm], P = 0.007) than those that did not. Multiple logistic regression analysis confirmed that both baseline variables were independent predictors for development of an HCM phenotype.

CONCLUSIONS

The AMVL length was greater in cats that subsequently developed left ventricular hypertrophy. Further studies investigating the clinical application of AMVL in the natural history of feline HCM are warranted.

Enterococcus faecium L-15 Extract Enhances the Self-Renewal and Proliferation of Mouse Skin-Derived Precursor Cells

Lactic acid bacteria (LAB) in the gastrointestinal tract have beneficial health effects. LAB activate the proliferation of intestinal stem cells and speed the recovery of damaged intestinal cells, but little is known about effect of LAB on other adult stem cells. In this study, a cell-free extract of Enterococcus faecium L-15 (L15) was exposed to mouse skin-derived precursor cells (SKPs), and the changes in characteristics associated with proliferation and self-renewal capacity were investigated. L15 increased the size of the spheres and the proliferation rate of SKPs. Cell cycle analysis revealed that cells in the S-phase increased after treatment with L15. In the L15-treated group, the total number of spheres significantly increased. The expression level of pluripotency marker genes also increased, while the mesenchymal lineage-related differentiation marker genes significantly decreased in the L15-treated group. The PI3K/Akt signaling pathway was activated by L15 in SKPs. These results indicate that L15 enhances proliferation and self-renewal of SKPs and may be used as a supplement for stem cell maintenance or application of stem cell therapy. This is the first report to investigate the functional effects of E. faecium on the proliferation and self-renewal capacity of SKPs.

Oral intake of Lactobacillus plantarum L-14 extract alleviates TLR2- and AMPK-mediated obesity-associated disorders in high-fat-diet-induced obese C57BL/6J mice

OBJECTIVES

Whether periodic oral intake of postbiotics positively affects weight regulation and prevents obesity-associated diseases in vivo is unclear. This study evaluated the action mechanism of Lactobacillus plantarum L-14 (KTCT13497BP) extract and the effects of its periodic oral intake in a high-fat-diet (HFD) mouse model.

MATERIALS AND METHODS

Mouse pre-adipocyte 3T3-L1 cells and human bone marrow mesenchymal stem cells (hBM-MSC) were treated with L-14 extract every 2 days during adipogenic differentiation, and the mechanism underlying anti-adipogenic effects was analysed at cellular and molecular levels. L-14 extract was orally administrated to HFD-feeding C57BL/6J mice every 2 days for 7 weeks. White adipose tissue was collected and weighed, and liver and blood serum were analysed. The anti-adipogenic mechanism of exopolysaccharide (EPS) isolated from L-14 extract was also analysed using Toll-like receptor 2 (TLR2) inhibitor C29.

RESULTS

L-14 extract inhibited 3T3-L1 and hBM-MSC differentiation into mature adipocytes by upregulating AMPK signalling pathway in the early stage of adipogenic differentiation. The weight of the HFD + L-14 group (31.51 ± 1.96 g) was significantly different from that of the HFD group (35.14 ± 3.18 g). L-14 extract also significantly decreased the serum triacylglycerol/high-density lipoprotein cholesterol ratio (an insulin resistance marker) and steatohepatitis. In addition, EPS activated the AMPK signalling pathway by interacting with TLR2, consequently inhibiting adipogenesis.

CONCLUSIONS

EPS from L-14 extract inhibits adipogenesis via TLR2 and AMPK signalling pathways, and oral intake of L-14 extract improves obesity and obesity-associated diseases in vivo. Therefore, EPS can be used to prevent and treat obesity and metabolic disorders.

A Flash-Induced Robust Cu Electrode on Glass Substrates and Its Application for Thin-Film μLEDs

A robust Cu conductor on a glass substrate for thin-film μLEDs using the flash-induced chemical/physical interlocking between Cu and glass is reported. During millisecond light irradiation, CuO nanoparticles (NPs) on the display substrate are transformed into a conductive Cu film by reduction and sintering. At the same time, intensive heating at the boundary of CuO NPs and glass chemically induces the formation of an ultrathin Cu₂ O interlayer within the Cu/glass interface for strong adhesion. Cu nanointerlocking occurs by transient glass softening and interface fluctuation to increase the contact area. Owing to these flash-induced interfacial interactions, the flash-activated Cu electrode exhibits an adhesion energy of 10 J m^-2 , which is five times higher than that of vacuum-deposited Cu. An AlGaInP thin-film vertical μLED (VLED) forms an electrical interconnection with the flash-induced Cu electrode via an ACF bonding process, resulting in a high optical power density of 41 mW mm^-2 . The Cu conductor enables reliable VLED operation regardless of harsh thermal stress and moisture infiltration under a high-temperature storage test, temperature humidity test, and thermal shock test. 50 × 50 VLED arrays transferred onto the flash-induced robust Cu electrode show high illumination yield and uniform distribution of forward voltage, peak wavelength, and device temperature.

Exopolysaccharide Isolated from Lactobacillus plantarum L-14 Has Anti-Inflammatory Effects via the Toll-Like Receptor 4 Pathway in LPS-Induced RAW 264.7 Cells

Inflammation is a biological response of the immune system to defend the body from negative stimulation. However, the excessive inflammatory response can damage host tissues and pose serious threats. Exopolysaccharide (EPS), one of the postbiotics, is secreted from lactic acid bacteria. Although many studies have described the beneficial effects of EPS, such as its anti-inflammatory and anti-oxidant effects, its underlying mechanisms have remained to be poorly understood. Thus, we identified that EPS obtained from Lactobacillus plantarum L-14 was a homogeneous polysaccharide primarily comprised of glucose. To examine these anti-inflammatory effects, an inflammatory response was induced by lipopolysaccharide (LPS) administration to mouse macrophage RAW 264.7 cells that were pretreated with EPS. The anti-inflammatory effects of EPS were identified by analyzing the changes within inflammatory markers at the molecular level. We demonstrate here that EPS suppressed proinflammatory mediators, such as cyclooxygenase-2, interleukin-6, tumor necrosis factor-α, and interleukin-1β, and downregulated the expression of an inducible nitric oxide synthase known to lead to oxidative stress. It was also confirmed that EPS had anti-inflammatory effects by blocking the interaction of LPS with Toll-like receptor 4 (TLR4), as demonstrated by using the known TLR4 inhibitor TAK-242. In addition, we found that EPS itself could suppress the expression of TLR4. Consequently, our data suggest that EPS can be a potential target for the development of natural product-derived medicine for treating inflammatory diseases related to TLR4.

Differences in the clinical characteristics and long-term outcome of peripartum tako-tsubo cardiomyopathy and peripartum cardiomyopathy

Background

Some peripartum-associated cardiomyopathy patients present similarly to those of tako-tsubo cardiomyopathy (TCM), little is known about the clinical course of peripartum TCM.

Purpose

To know clinicial characteristics and outcomes of peripartum TCM, in comparison with peripartum cardiomyopathy (PPCM)

Methods and results

Of 31 pregnancy-associated cardiomyopathy patients in a tertiary hospital, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-missed death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 76.2%, p=0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricle (LV) dysfunction. LV ejection fraction greater than 30% on the initial echocardiogram independently predicted early echocardiographic recovery of left ventricular systolic function (odds ratio 331.33, 95% confidence interval 3.87–28402.60, p=0.011). There was no difference between the two groups in terms of the rate of adverse clinical events at 3 years of follow-up (PPCM group: 26.3% [5/19] vs. TCM group: 33.3% [3/9], p=0.750).

Conclusions

One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.

Kaplan-Meier survival curves for death,

Funding Acknowledgement

Type of funding source: None

1067 Replicative and Non-Replicative Nightmares in the Development of Posttraumatic Stress Disorder

Introduction

Nightmares are a frequent and disturbing symptom of posttraumatic stress disorder (PTSD). They are associated with sleep disruption and increased psychopathology. There is growing evidence that different types of nightmares may differ in their effects on psychopathology. Previous findings suggest that nightmares that are close replications of the experienced traumatic event might be especially important in the development of PTSD. This study investigated trauma-related (replicative) and non-trauma-related (non-replicative) nightmares as predictors of PTSD in a civilian sample.

Methods

Participants were recruited from the general public of the greater Boston area. The sample consisted of 108 participants who had experienced a psychological trauma in the past 2 years (e.g. sexual or physical assaults and accidents). The criteria for PTSD were met by 49% of participants. PTSD diagnosis was assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Non-Patient Edition. Participants received an Actiwatch 2 (Philips Respironics, Bend, OR) and a sleep diary for sleep measurements over an average of 14 consecutive nights. The diary included a prospective nightmare assessment and an item assessing the relatedness of each nightmare to traumatic events. Logistic regression analyses were performed with PTSD as the categorical outcome variable.

Results

Our analyses showed that replicative nightmares were the only statistically significant predictor of PTSD (OR = 1.2, p = .027), while controlling for age, sex, time since the traumatic event, and actigraphy total sleep time and minutes awake after sleep onset. All of these variables, including non-replicative nightmares, did not significantly predict PTSD in our analyses.

Conclusion

This study confirms and adds to the existing knowledge of nightmares and the importance of the degree to which they replicate the trauma in the development of PTSD. These findings underline the potential role of specific nightmare treatments after traumatic events, with a special focus on replicative nightmares.

Support

R01MH109638

0065 Initial Findings on Associations Between Sleep and Clinical Measures with Neural Activations Accompanying Fear Conditioning and Extinction in Trauma-Exposed Individuals

Introduction

We examined associations of sleep and hyperarousal with neural responses to a fear conditioning and extinction protocol in trauma-exposed individuals. We hypothesized, greater hyperarousal, poorer sleep quality and more nightmares would accompany greater activation of the salience network (associated with fear) and lesser activation of the prefrontal cortex (PFC; associated with fear regulation) throughout this protocol.

Methods

Persons exposed to trauma within the past 2 years (N=119, 43 with Post-traumatic stress disorder; PTSD) completed the PTSD Checklist-5 (PCL-5), two weeks of actigraphy and sleep/nightmare diaries, and a 2-day fear-conditioning and extinction protocol during fMRI. Hyperarousal items from PCL-5, sleep quality, and nightmare frequency were used to predict fMRI contrasts representing (1) initial activations to reinforced conditioned stimuli (CS+) during fear conditioning, (2) change in neural activation to CS+s across extinction learning, and, (3) after 24 hours (extinction recall), selective activation to an extinguished (CS+E) versus an un-extinguished CS+.

Results

During fear conditioning, hyperarousal was positively correlated with activation to the CS+ in the right lateral PFC, whereas nightmare frequency was negatively correlated with activations in bilateral orbitofrontal cortex (OFC). Across extinction learning, sleep onset latency (SOL) was negatively correlated with increased activation to CS+ in bilateral insular and dorsal and middle anterior cingulate cortices (salience regions). At extinction recall, nightmare frequency was negatively correlated with selective activation to the CS+E in the left insular cortex.

Conclusion

Except that fewer nightmares predicted greater OFC activation during fear conditioning, results did not support hypothesized relationships of hyperarousal, poor sleep and nightmares with increased salience network and decreased PFC activation to fear-related stimuli.

Support

Funding: R01MH109638

1081 Associations Among REM Density And Parasympathetic Activity, Nightmares, And Hyperarousal In Trauma-exposed Individuals

Introduction

Individuals with posttraumatic stress disorder (PTSD) exhibit autonomic hyperarousal and nightmares. We hypothesized that REM density (REMD) and REM heart rate variability would predict self-reported hyperarousal, nightmares, and PTSD diagnosis in trauma-exposed individuals.

Methods

Ninety-nine individuals (aged 18-40, 68 females) exposed to a DSM-5 PTSD criterion-A trauma within the past two years (48 meeting PTSD criteria) completed a night of ambulatory polysomnography (PSG) preceded by an acclimation night. REMD in scored sleep recordings were computed using the Matlab program written by Benjamin Yetton. Indices of parasympathetic tone during REM were computed using Kubios software and included Average Root Mean Square of the Successive Differences (RMSSD) and High Frequency power (HFpower). Participants completed two weeks of sleep diaries with nightmare questionnaire and completed the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5). Hyperarousal-item scores were computed from the PCL-5 without the sleep item (PCLhyp) and from the CAPS-5 (CAPShyp), and these scores (with their sleep items) were combined into a Composite Hyperarousal Index (CHI). Nightmare rate was the proportion of sleep diaries reporting a nightmare. Simple regressions measured associations among REMD, REM parasympathetic indices, hyperarousal measures, and nightmare rate.

Results

REMD did not significantly predict PTSD diagnosis or hyperarousal scores but did predict decreased parasympathetic activity for both RMSSD (p= 0.002, R= -0.316) and HFpower (p= 0.016 R= -0.250). REMD predicted increased nightmare rate (p= 0.011 R= 0.262). Parasympathetic tone was negatively correlated with CAPShyp, PCLhyp, and CHI for both RMSSD (p= 0.04, 0.011, &lt;0.000, respectively) and HFpower (p= 0.051, 0.021, 0.010, respectively). Lower parasympathetic tone also predicted PTSD diagnosis with both RMSSD (p=0.012, t=2.559) and HFpower (p=0.010, t=2.627), but did not predict nightmare rate.

Conclusion

REMD predicted decreased parasympathetic tone and higher nightmare rate. Parasympathetic tone, but not REMD, predicted hyperarousal and PTSD diagnosis.

Support

R01MH109638

1071 Subjective Measures Of Hyperarousal Predict Subjective Longitudinal And Retrospective Measures Of Sleep Quality In Individuals Exposed To Trauma

Introduction

Hyperarousal and disturbed sleep are intrinsic symptoms of posttraumatic stress disorder (PTSD). We explored whether self-reported indices of hyperarousal predict longitudinally measured objective, subjective, and retrospective evaluations of sleep quality in trauma-exposed individuals.

Methods

Individuals exposed to a DSM-5 PTSD Criterion-A traumatic event within the past two years (N=130, 91 females), aged 18-40 (mean 24.43, SD 5.30), 51.54% of whom met DSM-5 criteria for PTSD, completed 14 days of actigraphy and sleep diaries. Participants also completed the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale (CAPS-5), published Hyperarousal (HAS) and Hypervigilance (HVQ) scales, and the Pittsburgh Sleep Quality Index (PSQI) (N=108-125 for different scales). Mean total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and sleep midpoint were calculated from actigraphy and subjective SOL, SE, number of awakenings, and time spent awake from diaries. Simple regressions were used to predict associations of the PCL-5, HAS, and HVQ scores with measures of sleep quality.

Results

Hyperarousal indices predicted diary but not actigraphy measures of sleep quality. Longer diary-reported SOL was predicted by higher scores for: PCL-5 total score (R=0.290, p=0.001), PCL-5 hyperarousal items without the sleep item (R=0.261, p=0.004), and HAS without sleep items (R=0.220, p=0.016). Diary-reported number of awakenings and wake time after sleep onset were predicted by higher HAS scores without the sleep question: (R=0.373, p&lt;0.001; r=0.352, p&lt;0.001). Similarly, all hyperarousal indices significantly predicted PSQI global score (PCL-5: R=0.482, p&lt;0.001; PCL-5 hyperarousal: R=0.389, p&lt;0.001; HVQ: R=0.214, p=0.017; HAS without sleep question: R=0.415, p&lt;0.001).

Conclusion

Self-reported hyperarousal measures predict subjective longitudinal (especially SOL) and retrospective measures, but not objective measurements of sleep quality. Similar discrepancies between self-reported and objective measures of sleep quality have been reported in patients with insomnia disorder. Cognitive-behavioral therapy for insomnia may be especially effective in treating post-traumatic sleep disturbances.

Support

R01MH109638

Long-term biological variability and the generation of a new reference interval for plasma N-terminal pro-B-type natriuretic peptide in Labrador retrievers

OBJECTIVES

First, to investigate the biological variability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in healthy Labrador retrievers and compare this with current laboratory recommendations for dilated cardiomyopathy screening. Second, to calculate a breed-specific reference interval and validate it in a retrospective cohort.

MATERIALS AND METHODS

Plasma NT-proBNP was measured in 51 clinically healthy Labrador retrievers at 0, 2, 4, 6 and 8 weeks. Coefficient of variation for individual dogs over time, the coefficient of variation for the group at each time point and the index of individuality were calculated. A reference interval was derived and tested on a clinical dataset available from four UK cardiology referral centres.

RESULTS

Median NT-proBNP was 865 pmol/L (315 to 2064 pmol/L). Mean individual coefficient of variation was 19% (95% CI: 16 to 21%) and group coefficient of variation was 43% (95% CI: 41 to 46%), with index of individuality at 0.44. The breed-specific reference interval was 275 to 2100 pmol/L. In the validation group, 93% of NT-proBNP measurements from healthy dogs were within the reference interval. NT-proBNP measurements exceeded the reference interval in 82% of dogs with dilated cardiomyopathy. The upper bound of the reference interval (2100 pmol/L) had a positive predictive value of 90% and a negative predictive value of 87% for identification of dilated cardiomyopathy in this population.

CLINICAL SIGNIFICANCE

Breed-specific reference intervals might improve the diagnostic accuracy of NT-proBNP measurement. Applying the currently recommended general cut-off value to Labradors is likely to result in frequent false positives and diagnosis would be improved by application of the new breed-specific reference interval calculated here.

Automatic matching of computed tomography and stereolithography data

BACKGROUND AND OBJECTIVE

Computed tomography (CT) is one of the most frequently used medical imaging methods. An important application area of CT is dental implants, which require precise inspection and analysis of oral structures. Since CT provides a precise 3D model of the teeth, bones and nerves, it can be used as a surgical guide for dental implants. Along with CT, optical 3D images called stereolithography (STL) have also been widely used. STL images obtained from optical 3D images can be used to show the 3D surfaces of oral structures. Since CT data and STL data deploy different technologies to obtain dental information, we can obtain more accurate dental implants by combining the two datasets. Since the two datasets are acquired by using different sensors, the datasets need to be registered.

METHODS

An automatic matching algorithm is proposed for CT and STL image registration, which is based on depth maps and maximum intensity projection. Then, fine tuning was performed based on volume matching.

RESULTS

When applied to real-world databases, the proposed method provided an average matching error of 2.7 mm for the upper jaw and 2.3 mm for the lower jaw with an average processing time of about 19 s.

CONCLUSIONS

The proposed method performs accurate registration of CT and STL.

Abstract P3-13-01: Application of supine MRI-based 3D printing breast surgical guide for precision breast-conserving surgery

Background

If the size of the tumor is large, neoadjuvant systemic therapy (NST) is performed to reduce the size of the tumor and to conserve the breast. It is known that magnetic resonance imaging is more accurate than mammography (MMG) or ultrasonography (USG) in determining the area of residual cancer in breast-conserving surgery (BSG) after NST. However, there are some problems when performing BCS using MRI. Because the posture of MRI test is different from the posture at surgery, it is difficult to accurately mark the area of the tumor observed in MRI. Neoadjuvant systemic therapy reduces tumor size and often makes it difficult to detect the original tumor area on preoperative MRI. Even if the tumor is not visible in the image, the cancer cells may remain, so it is important to accurately indicate the extent of the initial tumor and remove it. Until now, however, there has been no way to accurately mark past breast tumors in the breast. We have developed a breast surgical guide (BSG) that can mark a range of tumor directly on the breast using three-dimensional printing technology based on supine MRI. This study analyzed the results of patients who underwent BCS using a 3D printing breast surgical guide (3D-BSG) based on supine MRI.

Methods

This trial was designed as a prospective single-institution cohort study. Our study protocol was approved by the Institutional Review Board of Asan Medical Center, Seoul, Korea (IRB No. 2016-1237). Patients who were expected to undergo BCS after NST were enrolled in this study and supine MRI was performed before and after NST. From MRI images, morphological shapes of breasts and tumors were modeled. The prepared digital model was saved in stereolithography file format and then exported to a 3D printer. 3D-BSG is designed to be able to mark the skin and attach the dye injecting column to mark the around the tumor. The breast tissue was removed with blue dye on the basis of the border. To obtain tumor free margin, intraoperative frozen sections were identified in several cavities and re-excision was performed if tumor positive.

Results

Between January 2016 and May 2017, 50 patients were enrolled in the study. BCS was applied to 40 patients, except for those who were rejected or mastectomy. Complete remission was observed in 15 patients after NST. Four patients had tumor positive on resection margins on frozen biopsy during operation, two with IDC and two with DCIS. Re-excision was performed in these patients and tumor negative margin was confirmed in all patients in the final pathology results. The median size of the long axis of the tumor was 1.7 cm (range, 0.5 to 4.5 cm) and the median size of the long axis of the removed breast tissue was 5.1 cm (range, 2.3 to 8.1 cm). The distance between tumor and resection margin was 1.2 cm (range, 0.1 to 4.8 cm)..

Conclusions

In BCS, the application of the supine MRI based 3D-BSG showed low rates of positive margins. Unlike conventional localization techniques, application of 3D-BSG does not cause pain to the patient, has no radiation exposure, and has no time required for the localization procedure, so it will be helpful for patients in BCS in the future.

Citation Format: Ko B, Kim N, Seo J, Kim H, Gong G, Kim S, Son B, Ahn SH. Application of supine MRI-based 3D printing breast surgical guide for precision breast-conserving surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-01.