A systematic review of the literature reporting on remote monitoring epileptic seizure detection devices

BACKGROUND

Early detection and alert notification of an impending seizure for people with epilepsy have the potential to reduce Sudden Unexpected Death in Epilepsy (SUDEP). Current remote monitoring seizure detection devices for people with epilepsy are designed to support real-time monitoring of their vital health parameters linked to seizure alert notification. An understanding of the rapidly growing literature on remote seizure detection devices is essential to address the needs of people with epilepsy and their carers.

AIM

This review aims to examine the technical characteristics, device performance, user preference, and effectiveness of remote monitoring seizure detection devices.

METHODOLOGY

A systematic review referenced to PRISMA guidelines was used.

RESULTS

A total of 1095 papers were identified from the initial search with 30 papers included in the review. Sixteen non-invasive remote monitoring seizure detection devices are currently available. Such seizure detection devices were found to have inbuilt intelligent sensor functionality to monitor electroencephalography, muscle movement, and accelerometer-based motion movement for detecting seizures remotely. Current challenges of these devices for people with epilepsy include skin irritation due to the type of patch electrode used and false alarm notifications, particularly during physical activity. The tight-fitted accelerometer-type devices are reported as uncomfortable from a wearability perspective for long-term monitoring. Also, continuous recording of physiological signals and triggering alert notifications significantly reduce the battery life of the devices. The literature highlights that 3.2 out of 5 people with epilepsy are not using seizure detection devices because of the cost and appearance of the device.

CONCLUSION

Seizure detection devices can potentially reduce morbidity and mortality for people with epilepsy. Therefore, further collaboration of clinicians, technical experts, and researchers is needed for the future development of these devices. Finally, it is important to always take into consideration the expectations and requirements of people with epilepsy and their carers to facilitate the next generation of remote monitoring seizure detection devices.

Transient Radiographic Pseudoprogression Following Fractionated SBRT for Primary Renal Cell Carcinoma

PURPOSE/OBJECTIVE(S)

SBRT is an emerging treatment for patients with RCC who are not surgical candidates. Pooled analysis of an international consortium suggests promising short term local control. In the event of local failure, other ablative methods may be used to salvage these patients. Trends in radiographic surveillance are not well characterized post SBRT. In this study we observe a common transient increase in the tumor size followed by stability or decline in patients treated with fractionated SBRT on a phase II clinical protocol.

MATERIALS/METHODS

Radiographic studies of patients enrolled in a phase II clinical trial were reviewed for this report. Primary RCC tumors were treated using SBRT with two fractionation schema (48 Gy in 3 or 4 fractions) based on a 5 cm size threshold. Patients were followed with routine imaging per protocol at 3, 6, 12, 18, and 24 months post-treatment. Percent change in greatest dimension is analyzed over time and subsequently stratified by dose, baseline tumor diameter, and PTV. An increase in tumor size by 10% or greater followed by tumor shrinkage or stability was considered a transient increase.

RESULTS

From August of 2013 to December of 2022, 40 patients were enrolled in this trial with a median age of 77.5 and follow up of 18 months. 32 patients with at least two follow up images (minimum of 6 months post-SBRT) were included in the analysis. 26 of these patients were treated with 48 Gy in 3 fractions and 6 were treated with 48 Gy in 3 fractions. Median tumor size was 38.4 cc with a median diameter of 3.5 cm. 46.9% of patients experienced a transient increase with a median increase of 19.7% (range = 63.1, IQR = 13.9%-38.6%) of the pretreatment largest dimension. 66.7% of patients with tumors ≥ 5 cm experienced a transient increase vs. 42.3% of patients with tumors < 5cm. 56.3% of patients with PTV ≥ 38.4 cc experienced a transient increase vs. 40% of patients with a PTV < 38.4cc. Patients with PTV < 38.4 cc experienced a median 19% increase compared with the PTV ≥ 38.4 cc median increase of 37.5%. Most common transient increase was observed at 3 months post treatment. Of patients evaluated with CT scans, 50% experienced a transient increase, compared with 37.5% of those evaluated with MRI scans.

CONCLUSION

SBRT is a promising treatment for primary RCC, however radiographic surveillance of the disease post-treatment is not well characterized. In this study of patients enrolled in a Phase II protocol, there appears to be a transient radiographic increase in the size of primary tumors followed by stability and decline. Further investigations will guide the timing and need for salvage treatment for post- SBRT RCC.

Optimising psoriatic arthritis therapy with immunological methods to increase standard evaluation: the protocol of an open-label multicentre, parallel-group, two-arm randomised controlled study evaluation precision medicine approach in the treatment of psoriatic arthritis

INTRODUCTION

Psoriatic arthritis (PsA) affects around 150 000 people in the UK of whom around 50% require treatment with biologics. The most used biologics for PsA target tumour necrosis factor (TNF) or interleukin-17A (IL-17A). About 50% of patients respond to each, but it is not currently possible to predict response for individual patients, necessitating sequential treatment steps. A recent proof of concept study in PsA suggested that using peripheral immunophenotype to choose therapy could improve time to treatment response.This study will test the hypothesis, within an open-label parallel-group biomarker-stratified multicentre randomised controlled trial, which the baseline proportion of CD4+T cells with an activated type 17 immunophenotype (Th17 levels) predicts response to IL-17A or TNF inhibitors in PsA. Additional analyses will identify if the model can be refined by combining additional clinical and immunophenotypic factors. Statistical modelling will be used to predict the likely effectiveness of these approaches compared with standard care.

METHODS AND ANALYSIS

Patients with PsA eligible to start their first biologic as part of standard care are recruited and baseline blood tests are taken for immunophenotyping. Participants are stratified equally by Th17 levels and randomised 1:1 to receive either TNF (adalimumab) or IL-17A (secukinumab) inhibitors. The primary analysis will establish the interaction between baseline immunophenotype and treatment on the primary outcome (achievement of minimal disease activity criteria at week 24). In secondary analysis, modelling will identify if this prediction model can be optimised further by incorporating clinical phenotypes and additional immunophenotyping techniques.

ETHICS AND DISSEMINATION

Ethical approval for the study was granted by the North West Preston Research Ethics Committee (ref 21/NW/0016). Dissemination will be via conference presentations and peer-reviewed publications, aiming to impact on treatment guidelines.

TRIAL REGISTRATION NUMBER

ISRCTN17228602.

A Literature Review of the Effects of Air Pollution on COVID-19 Health Outcomes Worldwide: Statistical Challenges and Data Visualization

Several peer-reviewed papers and reviews have examined the relationship between exposure to air pollution and COVID-19 spread and severity. However, many of the existing reviews on this topic do not extensively present the statistical challenges associated with this field, do not provide comprehensive guidelines for future researchers, and review only the results of a relatively small number of papers. We reviewed 139 papers, 127 of which reported a statistically significant positive association between air pollution and adverse COVID-19 health outcomes. Here, we summarize the evidence, describe the statistical challenges, and make recommendations for future research. To summarize the 139 papers with data from geographical locations around the world, we also present anopen-source data visualization tool that summarizes these studies and allows the research community to contribute evidence as new research papers are published.

691 ‘ARE YOU CONCERNED ABOUT ME TODAY’ - AN MDT APPROACH TO IMPROVING DELIRIUM RECOGNITION

Introduction

Delirium is a common neuropsychiatric syndrome that increases the likelihood of adverse outcomes for patients admitted to hospital. Delirium is preventable and treatable. Recognition of the syndrome is challenging. Our aim was to increase this recognition through robust inpatient screening, utilising a multi-disciplinary team (MDT) approach.

Method

Stakeholder analysis for a quality improvement project revealed that junior doctors were members of the team most likely to perform a 4AT. Plan, do, study, act (PDSA) cycles were carried out: 1. Junior doctor engagement 2. Verbal prompts in huddle 3. Healthcare assistant (HCA) questionnaires.

Results

Baseline data showed that on average 0.6% patients had new 4AT over one week on elderly care wards. Intervention 1 involved 4AT handouts given to junior doctors. Number of 4ATs was 3% of patients per week. Intervention 2 used prompts in the morning MDT huddle, asking about concerns for patients. This increased the number of patients having 4AT per week to 6.5%. HCAs did not attend huddles and were targeted in the third intervention. A questionnaire with delirium information and the subsequent question ‘are you concerned about this patient’ was placed in patient bedside folders. This gave opportunity for HCAs to escalate patients to huddle so 4ATs could be carried out. The questionnaire was completed for 62% of patients, but only 1.4% patients were flagged up and subsequently had 4AT. This time was complicated however by the wards becoming Covid-19 wards.

Conclusion

Delirium is common however there is missed opportunity for earlier identification. Utilising HCAs with bedside questionnaires was time efficient and ensured robust escalation to prompt further investigation. When incorporated into huddle this could lead to more delirium diagnoses if carried out over a longer period, outside of the Covid-19 pandemic and on a ward solely populated with elderly care patients.

Does timing of phytonutrient intake influence the suppression of postprandial oxidative stress? A systematic literature review

BACKGROUND

Postprandial oxidative stress markers in blood are generated transiently from various tissues and cells following high-fat and/or high-carbohydrate (HFHC) meals, and may be suppressed by certain phytonutrients, such as polyphenols and carotenoids. However, the transient presence of phytonutrients in circulation suggests that timing of consumption, relative to the meal, could be important. This systematic review investigates the effect of timing of phytonutrient intake on blood markers of postprandial oxidative processes.

METHOD

EMBASE, Medline, Scopus and Web of Science were searched up to December 2020. Eligible studies met the criteria: 1) healthy human adults; 2) phytonutrient(s) consumed in solid form within 24 h of a HFHC meal; 3) postprandial measurements of oxidative stress or antioxidants in blood; and 4) controlled study design. Cohen's d effect sizes were calculated to compare studies.

RESULTS

Nine studies, involving 256 participants, were included. Phytonutrients were consumed either at the same time, 1 h before, or the day (>12 h) before a HFHC meal. Significant decreases in blood markers - plasma lipid hydroperoxides, plasma malondialdehyde, serum sNox2-dp, serum 8-iso-PGF2α, platelet p47phox phosphorylation, and Keap-1 and p47phox protein levels in mononuclear cells (MNCs) - were observed where the phytonutrient was consumed together with the challenge meal (n = 4). Lack of any effect on oxidative stress markers was observed where phytonutrients were consumed with (n = 1), 1 h before (n = 1), and the day before (n = 2) the HFHC meal.

CONCLUSION

Phytonutrients consumed with a HFHC meal significantly suppressed some markers of oxidative stress in blood. Although there were only a limited number of studies, it appears that suppression appeared effective at the time of peak phytonutrient concentration in plasma. However, further studies are required to confirm the observations and systematically optimise the effect of timing.

Exploring user empowerment and service improvement within an Irish epilepsy service using Checkland's 'Soft Systems' approach

AIM

To illustrate the value of Checkland's 'Soft Systems' approach to explore and analyse the interaction of human and organisational factors that affect service delivery and patient experience in one specialist epilepsy service.

BACKGROUND

Checkland's approach is underutilized in relation to health service improvement. One epilepsy service in Ireland is used as an example to illustrate the value of his approach to improve service delivery, particularly when what needs to change is not clear.

METHOD

Checkland's 'Soft Systems' seven-stage approach was used collaboratively to explore patients' and clinicians' experience of service delivery and how to improve it.

RESULTS

The research identified the practice of empowerment affected the quality of the service experience. Checkland's concept of a human activity system was particularly pertinent in identifying this issue and providing a 'map' for change.

CONCLUSION

Wider inferences for the use of Checkland's approach by nurse managers are discussed, as is the value of using Checkland's approach to improve services.

IMPLICATIONS FOR NURSING MANAGEMENT

Checkland's 'Soft Systems' is an underutilized approach in health care that could be used by managers to initiate and embed change within a health care service.

Exploring Dimensions of Empowerment from the Patients' Perspective in One Specialist Epilepsy Service in Ireland

Empowerment is integral to patient-centered practice, particularly as this relates to people with chronic conditions, though operationally it is poorly understood in this context. Empowerment, therefore, as experienced by patients with a chronic condition needs exploration. This article reports the experience of empowerment by patients in one specialist epilepsy service in Ireland as an exemplar of broader issues affecting empowerment of patients with chronic conditions. A Frameworks Approach was used to analyze in-depth interviews with patients (n = 10) in one Irish epilepsy service. Analysis was further informed by nonparticipatory observation of service delivery. Results indicate that patients' negative experiences of empowerment appear to be derived from traditional social norms relating to clinician patient power dimensions and social stigma internalized by clinicians at an unconscious level. With this in mind, educational approaches based upon critical social theory may provide a framework and guide to enable services to engage with these issues and embrace empowerment of patients with chronic conditions within therapeutic engagement.

The Use of Augmented Reality to Raise Awareness of the Differences Between Osteoarthritis and Rheumatoid Arthritis

Arthritis is one of the most common disease states worldwide but is still publicly misunderstood and lacks engaging public awareness materials. Within the UK, the most prevalent types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). The two are commonly mistaken as the same disease but, in fact, have very different pathogenesis, symptoms and treatments. This chapter describes a study which aimed to assess whether an augmented reality (AR) application could be used to raise awareness about the difference between OA and RA.An application was created for Android tablets that included labelled 3D models, animations and AR scenes triggered from a poster. In total 11 adult participants tested the application taking part in a pretest and posttest which aim to measure the usability of the application and the acquisition of knowledge on OA and RA. A T-test was performed to assess the effectiveness of the application from the pretest and posttest questionnaire outcomes. Overall results were encouraging reporting a very significant acquisition of knowledge and a highly satisfactory user experience.

OP0255-PARE USING AN EDUCATIONAL APPLICATION TO FACILITATE UNDERSTANDING OF THE ANATOMY AND FUNCTION OF THE BRAIN AND TO EXPLORE THE EFFECTS OF CLINICAL FATIGUE FROM A PATIENT PERSPECTIVE

Background:

Rheumatic and musculoskeletal diseases are a group of devastating autoimmune disorders that all commonly share the debilitating symptom of fatigue. Despite the fact that fatigue can often cause some of the greatest impairments to quality of life, it is frequently reported by patients as the least successfully managed symptom of these conditions.

Fatigue is routinely misunderstood within the general population, with many people using the word fatigue as a synonym for tired. Fatigue is not the same as tiredness, which is a normal state that is experienced by most of the population, therefore it is important to help the general public understand what fatigue actually is and how it imposes consequences and limitations on those who suffer from it. To aid this understanding an educational application has been created to reinforce the patient perspective of living with fatigue. Furthermore, this application will also aid the understanding of brain anatomy and function, using Augmented Reality (AR), as research has now shown that brain function may be altered in the state of fatigue.

Currently, educational AR applications show great potential for increasing comprehension and understanding of complex concepts. AR expands user engagement by enhancing the learner’s enjoyment and enriching their learning environment. We hope to utilise this technology in the education of fatigue.

Objectives:

We aimed to create an AR application that has informative content designed to educate users on the topics of basic brain anatomy and function. Furthermore, we aimed to increase the users understanding of the complete impairment of fatigue by creating a short video that describes living with fatigue from the patient’s perspective.

Methods:

The application was created using medical scan dataset, a variety of 3D modelling software, and a game engine to create a functional and interactive augmented application. The short video regarding a patient’s perspective on living with fatigue was developed in collaboration with the Glasgow Arthritis Involvement Network patient partners. In order to determine if the application met its primary objectives a pilot test was conducted on 14 participants. After consenting to taking part in the study, individuals were guided through a pre-application test, the use of the application itself and finally a post-application test.

Results:

Initial results from the pilot test showed promise in the educational potential of the application. With regards to the questions pertaining to the brain anatomy, the percentage of questions answered correctly increased from 36% in the pre-test to 60% in the post-test. Furthermore, after using the application the participants reported a significant increase in their confidence for their answers. An additional six questions ascertained a participants perceptions of fatigue. From these questions, the answer that was most significantly changed after use of the application, was in relation to the impact that fatigue has on a patient’s quality of life (t-Test p=0.02). After use of the application participants’ opinions changed to reflect the fact that fatigue can completely impair a person’s quality of life, showing an increase in their understanding of the debilitating nature of fatigue.

Conclusion:

This research explored the development and effectiveness of an AR application that was centered around fatigue and basic neuroanatomy education within the general population. From the pilot test conducted we are able to report that the application was successful in delivering educational material about brain anatomy and was successful in increasing awareness about the impact that fatigue can have on an individual’s quality of life.

Figure 1.

Augmented brain model scene using brain model as trigger

Figure 2.

Example of material change upon selection of Occipital Lobe option

Acknowledgments:

The Glasgow Arthritis Involvement Network (GAIN)

Disclosure of Interests:

None declared

Retrospective Evaluation of Cycled Resin in Viral Clearance Studies-A Multiple Company Collaboration

The BioPhorum Development Group Viral Clearance Workstream performed a collaborative retrospective analysis to evaluate packed bed chromatographic resin performance after repeated cycling for two commonly used chromatography steps in biopharmaceutical manufacturing: protein A and anion exchange. Key variables evaluated in the assessment included virus type, resin type, number of reuse cycles, and virus challenge. In this retrospective analysis of viral clearance data on naïve versus cycled resin, powered by the availability of a decade's worth of accumulated industry data, clearance capability was not negatively impacted by resin cycling. This finding is consistent with publications showing that surrogates for viral clearance capabilities could be employed in lieu of testing the viral clearance of cycled resins for protein A and anion exchange chromatography. The rigorous analysis of the retrospective data supports the view that viral clearance studies for cycled resins are not necessary provided that appropriate cleaning methods are applied during repeated use of the chromatography columns.LAY ABSTRACT: The manufacturing processes for biopharmaceutical products often include reusable chromatographic resins that remove process- and product-related impurities as well as potential contaminating viruses. Typically, chromatography resin is "cycled" through repeated steps of resin conditioning, product purification, and resin cleaning. The cycling approach has been evaluated in both small- and full-scale studies that show the performance parameters are maintained. The ability to remove virus is demonstrated separately in a focused small-scale virus-spiking study that is resource-intensive and costly. This paper is a retrospective review of industry data comparing virus removal by naïve and repeatedly cycled resins that summarizes the viral clearance impact of re-using protein A and anion exchange chromatography resins. The key variables evaluated in the assessment included virus type, resin type, number of cycles, and virus challenge. In this retrospective analysis, it was found that the viral clearance capability is not negatively impacted by resin cycling. This finding is consistent with other publications and supports the view that viral clearance studies for cycled resins are not necessary if appropriate cleaning methods are applied during the repeated use of the chromatography columns.Abbreviations: AAV-2, Adeno-associated virus; A-MuLV, Amphotropic murine leukemia virus; AEX, Anion-exchange chromatography; B/E, Bind and elute; BVDV, Bovine viral diarrhea virus; C.P.G., Controlled pore glass; DEAE, Diethylaminoethanol; EMCV, Encephalomyocarditis virus; FT, Flow through; HAV, Hepatitis A virus; HSV-1, Herpes simplex virus type 1; LOD, Limit of detection; LOQ, Limit of quantification; LRF, Log10 reduction factor; mAb, Monoclonal antibody; MVM, Minute virus of mice; NaOH, Sodium hydroxide; PA, Protein A; PPV, Porcine parvovirus; QA, Quaternary amine; QP, Quaternized polyethyleneimine; qPCR, Quantitative polymerase chain reaction; Reo3, Reovirus type 3; SuHV-1, Suid herpesvirus; SV40, Simian virus 40; X-MuLV, Xenotropic murine leukemia virus.

B-52 Improvements in Cognitive Functioning in Inactive Professional Fighters

Objective

Repetitive head injuries common in combat sports have been associated with increased risk for cognitive dysfunction. Interestingly, the Professional Fighter’s Brain Health Study (PFBHS) team has observed improvements in fighters’ cognitive performance following their transition to inactive fighting status. As this phenomenon was explored, it was hypothesized that fighters’ cognitive performance will initially improve following their discontinuation of fighting.

Methods

Longitudinal demographic, fighting history, and cognitive functioning data from 31 fighters who discontinued fighting during their participation in the PFBHS. Cognitive functioning was assessed via CNS Vital Signs and C3/iComet computerized batteries. Number of professional fights, as well as inactive fighting status, was determined using published professional online records. Fighters were considered inactive if they had gone two or more years without a professional match.

Results

Paired-samples t test was conducted to evaluate cognitive functioning in fighters at time 1 (actively fighting) and time 2 (inactive fighting status). When comparing cognitive function at across time points, performance on CNS Vital Signs measures of verbal memory, processing speed, psychomotor speed, and reaction time, as well as C3/iComet measures of set-shifting and complex reaction time, significantly improved at time 2 (all p’s < 0.05). Interestingly, performance did not improve across time points on a C3/iComet measure of processing speed (Trailmaking Test Part A).

Conclusions

Cognitive performance improved on most measures when fighters transitioned to inactive fighting status. Given the limited sample size, future analysis is necessary to evaluate the relationship between fighting status and cognitive performance in a larger sample size.

B-59 Prevalence of Pseudobulbar Affect Symptoms in Professional Fighters

Objective

Pseudobulbar Affect (PBA) is defined as dysregulation of emotional expression and is characterized by sudden, uncontrollable, laughing and/or crying that is discordant with the present mood or social context. This study sought to establish the prevalence of PBA symptoms in individuals with a high incidence of sports-related head injuries and explore the relationship between two rating scales designed to measure PBA symptoms.

Methods

Sixty-three professional fighters (age: M = 44.7, SD = 10.0; 98% male) underwent neurological and neuropsychological assessment including completion of the Pathological Laughing and Crying Scale (PLCS) and the Center for Neurologic Study – Lability Scale (CNS-LS). Diagnostic criteria for PBA were reviewed during the neurological exam to establish the prevalence of the clinical syndrome. Prevalence statistics for item endorsement on the rating scales and diagnostic status were calculated. To investigate the rate of agreement between rating scales, concordance correlation coefficient (CCC) and root mean square difference (RMSD) were calculated.

Results

Eleven percent of participants met clinical criteria for PBA diagnosis, 25% of participants endorsed clinically significant PBA symptoms on the CNS-LS (M = 10.9, SD = 4.9), and 8% endorsed significant symptoms on the PLCS (M = 3.1, SD = 6.5). The rating scales were significantly positively correlated (r = .58; p < .01), though overall agreement was low (CCC = 0.55; RMSD = 5.4).

Conclusions

This study demonstrates that the prevalence of PBA symptoms in a sample of professional fighters is not uncommon. Although both the CNS-LS and PCLS are designed to measure PBA symptoms, they appear to be measuring unique aspects of PBA that may provide complimentary, rather than redundant information.

C-03 The sensitivity and specificity of the Montreal Cognitive Assessment is Age Dependent for Amyloid Positivity in a Mixed Clinical Sample

Objective

The Montreal Cognitive Assessment (MoCA) is a widely-used screening tool for neurodegenerative disorders. Despite widespread use, there have been few investigations into correlations between MoCA and biomarkers of Alzheimer's disease pathology. This study examined the relationship between MoCA performance and the presence of amyloid as detected by positron emission tomography (PET).

Methods

Sensitivity and specificity for the total MoCA score were determined for 76 individuals (26 amyloid-negative, 50 amyloid- positive) who were between the ages of 55 and 90 and diagnosed with MCI or mild dementia with a CDR score of 0-1 and were participating in a longitudinal, observational study at the Cleveland Clinic Lou Ruvo Center for Brain Health. All individuals underwent an amyloid PET scan and cognitive screening.

Results

Sensitivity and specificity for the total score were determined using amyloid positivity as the standard. A cutpoint of 25 yielded the best balance between sensitivity and specificity (74% and 74%, respectively). A total score of 27 was required to achieve 90% sensitivity to identify amyloid positive individuals (i.e. only a 10% risk that individuals with a score of 28-30 have a positive scan). A score of 26 was required in individuals over the age of 75.

Conclusions

With the emergence of new diagnostic biomarkers, there is need to define the utility of affordable, widely-available screening tools. In this mixed clinical sample, the MoCA score showed good sensitivity for detecting amyloid pathology but with low specificity. Thus a total MoCA score of 28 is needed to confidently rule out risk for AD pathology.

C-02 An Unbiased Biomarker Approach to Neuropsychological, Behavioral, and Psychiatric Symptoms in a Mixed Clinical Sample

Objective

Suspected Non-Alzheimer’s Pathology (SNAPs) are individuals who present with a cognitive syndrome meeting clinical criteria for Alzheimer’s disease (AD) but are found to lack underlying AD pathology. Current clinical criteria for AD lack specificity in predicting underlying neurodegenerative pathology. With the advent of amyloid positron emission tomography (PET) the presence of amyloid pathology can now be identified in vivo. Using a biomarker-based approach, we aimed to characterize the neuropsychological, behavioral, and psychiatric profile of SNAPs in contrast to those with AD pathology (APs).

Method

76 individuals (26 amyloid-negative [SNAPs], 50 amyloid- positive [APs]) completed neuropsychological testing and a PET amyloid scan as a part of a longitudinal observational study at the Cleveland Clinic LRCBH. Individuals meeting NIA-A criteria for MCI or mild AD with a Clinical Dementia Rating score of .05 -1 were included. Amyloid status was determined via clinical read of two clinicians trained in reading amyloid scans (neuroradiologist and neuropsychiatrist). Independent samples t tests assessed group differences between SNAPs and APs across cognitive, behavioral, and psychiatric measures.

Results

Mini-Mental State Examination scores were equivalent between SNAPs and APs. SNAPs performed significantly better on measures of verbal and nonverbal memory, set-shifting, and semantic fluency, as well as aspects of processing speed and working memory (all p’s < .05). Additionally, SNAPs endorsed more RBD symptoms (p < .05). No significant group differences were observed across neuropsychiatric or functional measures.

Conclusion(s)

Differences in an individual’s neuropsychological, behavioral, and psychiatric profile in consideration with a biomarker approach may provide key insights and afford greater diagnostic clarity.

Relationship Between Verbal Fluency Performance, Fight Exposure, and Subcortical Region Brain Volumes in Professional Fighters

Purpose

Verbal fluency performance has been shown to be sensitive to preclinical cognitive changes in neurodegenerative diseases and may detect early, trauma-related cognitive and volumetric changes amongst professional fighters. Baseline verbal fluency performance and volumes of relevant subcortical brain structures were expected to decline as number of professional fights (NoPF) increased, while controlling for education.

Methods

Baseline letter and semantic fluency performance, NoPF, and structural brain imaging from 548 active and retired fighters who participated in the Professional Fighters Brain Health Study were considered. ANCOVAs were conducted to assess differences in verbal fluency performance by NOPF, while controlling for years of education. Number of professional fights were stratified into low (0-20 fights), medium (21-40 fights), and high (41 or more fights).

Results

Semantic fluency performance differed across the three levels of NoPF (F(2, 542)=4.56; p<.02). In addition, significant positive correlations between semantic fluency performance and volumes in the following regions were observed: left thalamus, left putamen, left pallidum, bilateral caudates, bilateral amygdalae, bilateral hippocampi, and bilateral accumbens (all p’s<.05). In contrast, letter fluency performance was not significantly associated with NoPF or volumes of relevant subcortical brain structures (all p’s>.05).

Conclusion

Semantic fluency may be low-cost, easy-to-administer harbinger of emerging cognitive dysfunction and lower volumes in related subcortical brain regions. Additional assessment of clinical utility is necessary.

Pharmacokinetic properties of phytochemicals in Hypericum perforatum influence efficacy of regulating oxidative stress

BACKGROUND

Hypericum perforatum is used in ethnopharmacology and has recently become popular in conventional medicine for treatment of mild to moderate depression. The abundance of potentially functional phytochemicals and their broader utilizations in traditional medicine suggests that ingestion of H. perforatum may impart additional secondary health benefits.

HYPOTHESIS/PURPOSE

Considering that many phytochemicals are known to display antioxidant activity, it was hypothesized that H. perforatum ingestion may inhibit oxidative stress and inflammation (OSI) which occurs in transient cycles following exercise and consumption of meals. The aim of this study was to explore the pharmacokinetics of H. perforatum phytochemicals after ingestion to predict the absorption timing of putative medicinal phytochemicals.

STUDY DESIGN/METHODS

In silico analyses of previously published plant extract phytochemical profiles were performed, wherein the Phytochemical Absorption Prediction (PCAP) model was used to predict the pharmacokinetics of phytochemicals. The predicted times for phytochemicals to reach maximum plasma concentration (T_max), and associated antioxidant activities, were compared to prior clinical in vivo studies to assess the accuracy and applicability of predictions.

RESULTS

The PCAP model identified that phytochemicals with antioxidant activity concurrently accumulate in plasma with T_max in the range of 1.6-2.3 h after ingestion. Comparison with previously published results identified that attenuation of OSI following H. perforatum ingestion aligns with the predicted T_max of antioxidant phytochemicals.

CONCLUSION

Based on these results it is therefore recommended that H. perforatum administration occurs 2 h before meals to provide optimal secondary health benefits associated with inhibition of postprandial stress. Additionally, these results highlight the use of in silico analyses to inform ingestion time and optimize the health benefits from ingestion of plant-based foods and medicines.

Abstract P3-10-13: Dual targeting of androgen receptor and IKK alpha is a potential therapeutic strategy for triple negative breast cancer

Background

There are limited treatments for triple negative breast cancer (TNBC) patients and an unmet need for targeted approaches in these patients. In the last 4-5 years, the prevalence of high androgen receptor (AR) expression in TNBCs has been noted in up to 50% of tumors suggesting it has clinical relevance. The non-canonical NF-kB pathway is also upregulated in this patient group and it has been reported that that there is crosstalk between these pathways. Therefore the aim of this study was to examine the expression of IKKα and AR in breast cancer tissue samples, to assess if combining these markers increased prognostic power.

Methods

Immunohistochemistry was performed on tissue microarray of 410 patients to assess proteins level of IKK alpha and AR. Protein expression levels were assessed using the weighted histoscore (WHS) method. The median was employed as the cut off for IKK alpha and 1% as cut off for AR. Expression was analyzed for associations with cancer-specific survival (CSS) and recurrence-free survival (RFS).

Results

In a cohort of 370 breast cancers nether AR nor IKK alpha alone or combined were associated with CSS or RFS. Stratifying patients by ER status did not impact CSS or RFS. However, in TNBC patients (n=82) high expression of AR was associated with shorter CSS (HR 2.55 95 CI 1.61-5.59, p=0.013). To assess if combining AR and IKK alpha increased prognostic power, AR and IKK alpha were combined into a single score: 0= low expression of both or high expression of one and 1= high expression of both. In the full cohort or when stratified by ER status the score was not associated with CSS or RFS, however in TNBC the combined score potentiated the effect observed with AR alone, (HR 1.68 95 CI 1.20-2.33, p=0.001). Patient CSS was stratified from 11.5 years to 4.6 years and was independently associated with CSS when compared with common clinicopathological factors (HR 1.56 95CI 1.11-2.21, p=0.011). In addition, the combined score was associated with decrease radiotherapy use (p=0.032), increased recurrence rate (p=0.014), decreased cytotoxic T cells (p=0.007), B cells (p=0.043) and macrophages (p=0.037).

Conclusions

A combined AR and IKK alpha score is an independent prognostic classification for patients with TNBC. Patients with high expression of both AR and IKK alpha a significantly reduced survival and were immune cell cold. This study suggests that this patient group will not benefit from immunotherapy but dual targeting with anti-androgens and IKK alpha selective inhibitors could offer a novel therapeutic strategy for this patient group.

Citation Format: Roseweir AK, Khongthong P, Dickson K, Bennett L, Edwards J. Dual targeting of androgen receptor and IKK alpha is a potential therapeutic strategy for triple negative breast cancer [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 P3-10-13.

Statistical modelling coupled with LC-MS analysis to predict human upper intestinal absorption of phytochemical mixtures

A diet rich in phytochemicals confers benefits for health by reducing the risk of chronic diseases via regulation of oxidative stress and inflammation (OSI). For optimal protective bio-efficacy, the time required for phytochemicals and their metabolites to reach maximal plasma concentrations (T_max) should be synchronised with the time of increased OSI. A statistical model has been reported to predict T_max of individual phytochemicals based on molecular mass and lipophilicity. We report the application of the model for predicting the absorption profile of an uncharacterised phytochemical mixture, herein referred to as the 'functional fingerprint'. First, chemical profiles of phytochemical extracts were acquired using liquid chromatography mass spectrometry (LC-MS), then the molecular features for respective components were used to predict their plasma absorption maximum, based on molecular mass and lipophilicity. This method of 'functional fingerprinting' of plant extracts represents a novel tool for understanding and optimising the health efficacy of plant extracts.

A NEW SEMI-EMPIRICAL AMBIENT TO EFFECTIVE DOSE CONVERSION MODEL FOR THE PREDICTIVE CODE FOR AIRCREW RADIATION EXPOSURE (PCAIRE)

The Predictive Code for Aircrew Radiation Exposure (PCAIRE) is a semi-empirical code that estimates both ambient dose equivalent, based on years of on-board measurements, and effective dose to aircrew. Currently, PCAIRE estimates effective dose by converting the ambient dose equivalent to effective dose (E/H) using a model that is based on radiation transport calculations and on the radiation weighting factors recommended in International Commission on Radiological Protection (ICRP) 60. In this study, a new semi-empirical E/H model is proposed to replace the existing transport calculation models. The new model is based on flight data measured using a tissue-equivalent proportional counter (TEPC). The measured flight TEPC data are separated into a low- and a high-lineal-energy spectrum using an amplitude-weighted ¹³⁷Cs TEPC spectrum. The high-lineal-energy spectrum is determined by subtracting the low-lineal-energy spectrum from the measured flight TEPC spectrum. With knowledge of E/H for the low- and high-lineal-energy spectra, the total E/H is estimated for a given flight altitude and geographic location. The semi-empirical E/H model also uses new radiation weighting factors to align the model with the most recent ICRP 103 recommendations. The ICRP 103-based semi-empirical effective dose model predicts that there is a ∼30 % reduction in dose in comparison with the ICRP 60-based model. Furthermore, the ambient dose equivalent is now a more conservative dose estimate for jet aircraft altitudes in the range of 7-13 km (FL230-430). This new semi-empirical E/H model is validated against E/H predicted from a Monte Carlo N-Particle transport code simulation of cosmic ray propagation through the Earth's atmosphere. Its implementation allows PCAIRE to provide an accurate semi-empirical estimate of the effective dose.

Extractable low mass proteins <30kDa from peanut display elevated antigenicity (IgG-binding) and allergenicity (IgE-binding) in vitro and are attenuated by thermal reactivity with non-peanut food ingredients

Human allergic reactions to peanut proteins and the associated risk of life-threatening anaphylaxis requires vigilant management of peanuts in food processing. Processed forms of peanuts with attenuated antigenicity and less severe immunogenic responses may lower the risk. Molecular subfractions of raw (UP), blanched (BP) and roasted (RP) peanuts were prepared including water-insoluble (P1), water-soluble high mass (>30kDa, P2) and water-soluble low mass (<30kDa, P3) fractions. Products were screened by measuring binding to IgG (polyclonal antibody against peanut allergen) and IgE (sera from peanut-allergic donors, RAST>3). The results showed that IgE titres were highest for total extracts of RP, particularly for P3 fractions of UP and RP, and were affected by further heating. Antigenicity was also modulated by heating in the presence of either peanut oil or non-peanut food ingredients (lactose, coconut oil). Results support several alternative methods for regulating peanut antigenicity using food processing approaches but require further substantiation in larger numbers of allergic and control donor sera.

Anti-inflammatory activity of cinnamon (C. zeylanicum and C. cassia) extracts - identification of E-cinnamaldehyde and o-methoxy cinnamaldehyde as the most potent bioactive compounds

Chronic inflammation is a contributing factor in many age-related diseases. In a previous study, we have shown that Sri Lankan cinnamon (C. zeylanicum) was one of the most potent anti-inflammatory foods out of 115 foods tested. However, knowledge about the exact nature of the anti-inflammatory compounds and their distribution in the two major cinnamon species used for human consumption is limited. The aim of this investigation was to determine the anti-inflammatory activity of C. zeylanicum and C. cassia and elucidate their main phytochemical compounds. When extracts were tested in LPS and IFN-γ activated RAW 264.7 macrophages, most of the anti-inflammatory activity, measured by down-regulation of nitric oxide and TNF-α production, was observed in the organic extracts. The most abundant compounds in these extracts were E-cinnamaldehyde and o-methoxycinnamaldehyde. The highest concentration of E-cinnamaldehyde was found in the DCM extract of C. zeylanicum or C. cassia (31 and 34 mg g(-1) of cinnamon, respectively). When these and other constituents were tested for their anti-inflammatory activity in RAW 264.7 and J774A.1 macrophages, the most potent compounds were E-cinnamaldehyde and o-methoxycinnamaldehyde, which exhibited IC₅₀ values for NO with RAW 264.7 cells of 55 ± 9 μM (7.3 ± 1.2 μg mL(-1)) and 35 ± 9 μM (5.7 ± 1.5 μg mL(-1)), respectively; and IC₅₀ values for TNF-α of 63 ± 9 μM (8.3 ± 1.2 μg mL(-1)) and 78 ± 16 μM (12.6 ± 2.6 μg mL(-1)), respectively. If therapeutic concentrations can be achieved in target tissues, cinnamon and its components may be useful in the treatment of age-related inflammatory conditions.

The potential of critical social theory as an educational framework for people with epilepsy

Effective education can support people with epilepsy to develop the attributes and skills required to function as equal partners with clinical service providers, make informed decisions, and competently self-manage their healthcare. However, despite knowledge deficits, unmet information needs, and a poor sense of empowerment, the study of education for people with epilepsy is often neglected and is a poorly understood component of holistic practice within epilepsy healthcare. Historically, the only debate with regard to education and people with epilepsy has been guided either within a positivist or within a constructivist philosophy. We argue that new pedagogies are warranted, recognizing the views of people with epilepsy regarding their illness. Therefore, this paper explores the potential of an educational framework for people with epilepsy based upon critical social theory (CST). By utilizing a CST approach for education, people with epilepsy are engaged with as active 'participants'. This is a key difference that distinguishes CST from other metatheoretical frameworks. It has the potential to support people with epilepsy to acquire the skills and confidence to manage the biopsychosocial challenges associated with their condition.

Proteinase-activated receptor 2 modulates OA-related pain, cartilage and bone pathology

OBJECTIVE

Proteinase-activated receptor 2 (PAR2) deficiency protects against cartilage degradation in experimental osteoarthritis (OA). The wider impact of this pathway upon OA-associated pathologies such as osteophyte formation and pain is unknown. Herein, we investigated early temporal bone and cartilage changes in experimental OA in order to further elucidate the role of PAR2 in OA pathogenesis.

METHODS

OA was induced in wild-type (WT) and PAR2-deficient (PAR2^-/-) mice by destabilisation of the medial meniscus (DMM). Inflammation, cartilage degradation and bone changes were monitored using histology and microCT. In gene rescue experiments, PAR2^-/- mice were intra-articularly injected with human PAR2 (hPAR2)-expressing adenovirus. Dynamic weight bearing was used as a surrogate of OA-related pain.

RESULTS

Osteophytes formed within 7 days post-DMM in WT mice but osteosclerosis was only evident from 14 days post induction. Importantly, PAR2 was expressed in the proliferative/hypertrophic chondrocytes present within osteophytes. In PAR2^-/- mice, osteophytes developed significantly less frequently but, when present, were smaller and of greater density; no osteosclerosis was observed in these mice up to day 28. The pattern of weight bearing was altered in PAR2^-/- mice, suggesting reduced pain perception. The expression of hPAR2 in PAR2^-/- mice recapitulated osteophyte formation and cartilage damage similar to that observed in WT mice. However, osteosclerosis was absent, consistent with lack of hPAR2 expression in subchondral bone.

CONCLUSIONS

This study clearly demonstrates PAR2 plays a critical role, via chondrocytes, in osteophyte development and subchondral bone changes, which occur prior to PAR2-mediated cartilage damage. The latter likely occurs independently of OA-related bone changes.

Pregnancy outcomes in cystic fibrosis: a 10-year experience from a UK centre

BACKGROUND

Cystic fibrosis manifests as a multisystem disease, despite this female fertility is relatively preserved with levels approaching that of the non-cystic fibrosis population. We reviewed pregnancies in cystic fibrosis patients over a 10-year period from a UK adult cystic fibrosis centre by considering maternal and fetal outcomes.

METHODS

We conducted a retrospective case-note review of pregnancies during 2003-2013 using respiratory and obstetric records.

RESULTS

We observed moderate falls in lung function immediately after delivery, which persisted at 12 months postpartum. We found that a decline in lung function at delivery was a marker for further decline in function during the subsequent postpartum period. We found baseline lung function was predictive of gestational age at delivery. We observed a high incidence of haemoptysis.

CONCLUSION

Consistent with current guidance we found pregnancy is feasible and well tolerated in the majority of patients with cystic fibrosis. There was a high incidence of haemoptysis, which warrants further study.

Epilepsy services in Ireland: 'A survey of people with epilepsy in relation to satisfaction, preferences and information provision'

BACKGROUND

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland.

METHOD

A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre.

RESULTS

Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted.

CONCLUSION

This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision.

Bacopa monnieri (L.) exerts anti-inflammatory effects on cells of the innate immune system in vitro

Bacopa monnieri (L., BM) is a traditional Ayurvedic medicinal herb recognised for its efficacy in relieving acute pain and inflammation, as related to selective inhibition of cyclo-oxygenase-2 (COX-2) enzyme and consequent reduction in COX-2-mediated prostanoid mediators. BM is also associated with cognitive enhancing (nootropic) activity including improving memory free recall, observed after prolonged intake (>3 months). It is likely that the time frame required to exert an effect in the brain reflects regulation by BM of chronic inflammation and oxidative stress associated with aging and chronic diseases, and other polypharmacological effects. We report down-regulation by BM of NO and TNF-α in stimulated RAW 246.7 macrophages and of IFN-γ in stimulated human blood cells. Furthermore, in human blood cells, IL-10 was slightly elevated indicating polarisation towards a regulatory T cell phenotype. These results provide further supportive evidence to justify the clinical evaluation of BM for managing diseases involving chronic systemic and brain inflammation driven by the innate immune system.

An inpatient observation and comparison of the bennett's I.p.p.R. And aerosol methods of administering salbutamol

Compared with aerosol administration the Bennett's Intermittent Positive Pressure Respirator (I.P.P.R.) has been the most favoured method of Salbutamol administration in hospitals for the treatment of asthma or Chronic Obstructive Airways Disease (C.O.A.D.).

Vitamin D2-enriched button mushroom (Agaricus bisporus) improves memory in both wild type and APPswe/PS1dE9 transgenic mice

Vitamin D deficiency is widespread, affecting over 30% of adult Australians, and increasing up to 80% for at-risk groups including the elderly (age>65). The role for Vitamin D in development of the central nervous system is supported by the association between Vitamin D deficiency and incidence of neurological and psychiatric disorders including Alzheimer's disease (AD). A reported positive relationship between Vitamin D status and cognitive performance suggests that restoring Vitamin D status might provide a cognitive benefit to those with Vitamin D deficiency. Mushrooms are a rich source of ergosterol, which can be converted to Vitamin D2 by treatment with UV light, presenting a new and convenient dietary source of Vitamin D2. We hypothesised that Vitamin D2-enriched mushrooms (VDM) could prevent the cognitive and pathological abnormalities associated with dementia. Two month old wild type (B6C3) and AD transgenic (APPSwe/PS1dE9) mice were fed a diet either deficient in Vitamin D2 or a diet which was supplemented with VDM, containing 1±0.2 µg/kg (∼54 IU/kg) vitamin D2, for 7 months. Effects of the dietary intervention on memory were assessed pre- and post-feeding. Brain sections were evaluated for amyloid β (Aβ) plaque loads and inflammation biomarkers using immuno-histochemical methods. Plasma vitamin D metabolites, Aβ40, Aβ42, calcium, protein and cholesterol were measured using biochemical assays. Compared with mice on the control diet, VDM-fed wild type and AD transgenic mice displayed improved learning and memory, had significantly reduced amyloid plaque load and glial fibrillary acidic protein, and elevated interleukin-10 in the brain. The results suggest that VDM might provide a dietary source of Vitamin D2 and other bioactives for preventing memory-impairment in dementia. This study supports the need for a randomised clinical trial to determine whether or not VDM consumption can benefit cognitive performance in the wider population.

Heat-stable components of wood ear mushroom, Auricularia polytricha (higher Basidiomycetes), inhibit in vitro activity of beta secretase (BACE1)

The consumption of mushrooms has been linked with protection against dementia, including Alzheimer's disease (AD), by several biological pathways including inhibiting beta-site APP-cleaving enzyme (BACE1), which is responsible for releasing toxic β-amyloid peptide in the brain. We have investigated the capacity of several medicinal mushroom species-Auricularia polytricha (wood ear mushroom), Agaricus bisporus (button mushroom), Flammulina velutipes (winter or enoki mushroom), and Lentinus edodes (shiitake mushroom)-in the regulation of BACE1. Mushrooms were subjected to a generic food-compatible processing method to detect process-stable or process-modified products; the effects of processing were interpreted to infer the chemical classes associated with bioactivity. We have shown previously that in addition to enzyme inhibition, in the presence of the BACE1 proenzyme, heteropolymeric species such as heparin can activate BACE1 by modulating access to the catalytic site. We observed both inhibitory and activating components of the various mushrooms. Only BACE1 inhibitory species were detected in unprocessed and processed forms of A. polytricha, whereas the dominant extracted species from A. bisporus, F. velutipes, and L. edodese were activators of BACE1. It is not known whether activating species were masking the presence of inhibitory species in A. bisporus, F. velutipes, and L. edodes. Inhibitory species were attributed to hispidin-derived polyphenols, whereas activating species were attributed to soluble polysaccharides and possibly low-mass Maillard products produced during processing. Larger molecular BACE1-activating species are unlikely to be bioavailable to brain in contrast with possible brain bioavailability of smaller, lipophilic hispidins.

Determination of anti-inflammatory activities of standardised preparations of plant- and mushroom-based foods

PURPOSE

Chronic inflammatory processes contribute to the pathogenesis of many age-related diseases. In search of anti-inflammatory foods, we have systematically screened a variety of common dietary plants and mushrooms for their anti-inflammatory activity.

METHODS

A selection of 115 samples was prepared by a generic food-compatible processing method involving heating. These products were tested for their anti-inflammatory activity in murine N11 microglia and RAW 264.7 macrophages, using nitric oxide (NO) and tumour necrosis factor-α (TNF-α) as pro-inflammatory readouts.

RESULTS

Ten food samples including lime zest, English breakfast tea, honey-brown mushroom, button mushroom, oyster mushroom, cinnamon and cloves inhibited NO production in N11 microglia, with IC50 values below 0.5 mg/ml. The most active samples were onion, oregano and red sweet potato, exhibiting IC50 values below 0.1 mg/ml. When these ten food preparations were retested in RAW 264.7 macrophages, they all inhibited NO production similar to the results obtained in N11 microglia. In addition, English breakfast tea leaves, oyster mushroom, onion, cinnamon and button mushroom preparations suppressed TNF-α production, exhibiting IC50 values below 0.5 mg/ml in RAW 264.7 macrophages.

CONCLUSION

In summary, anti-inflammatory activity in these food samples survived 'cooking'. Provided that individual bioavailability allows active compounds to reach therapeutic levels in target tissues, these foods may be useful in limiting inflammation in a variety of age-related inflammatory diseases. Furthermore, these foods could be a source for the discovery of novel anti-inflammatory drugs.

NFκB signalling is upregulated in a subset of castrate-resistant prostate cancer patients and correlates with disease progression

BACKGROUND

Cell line models suggest that activation of NFκB is associated with progression of prostate cancer. This pathway may be a therapeutic target if these observations translate to clinical specimens.

METHODS

Immunohistochemistry measured NFκBp65 (p65), NFκBp65 nuclear localisation signal (NLS), NFκBp65 phosphorylated at ser 276 (p65(ser276)), NFκBp65 phosphorylated at ser 536 (p65(ser536)), IκBα phosphorylated at ser 32/36 (pIκBα(ser32/36)) and MMP-9 protein expression in 61 matched hormone naive prostate cancer (HNPC) and castrate-resistant prostate cancer (CRPC) tumours. Animal and cell models were used to investigate the role of NFκB inhibition in prostate carcinogenesis.

RESULTS

In HNPC tumours, NLS expression significantly associated with a shorter time to disease recurrence and disease-specific death. In CRPC tumours p65, pIκBα(ser32/36) and MMP-9 expression significantly associated with shorter time to death from disease recurrence and shorter disease-specific death. MMP-9 and pIκBα(ser32/36) expression significantly associated with metastases at recurrence and were independent of Gleason sum and prostate-specific antigen at recurrence. Expression of phosphorylated Akt was associated with increased p65 activation in mouse models and inhibition of NFκB in LNCaP cells significantly reduced cellular proliferation and induced apoptosis.

CONCLUSION

These results provide further evidence that the NFκB pathway could be exploited as a target for CRPC.

Modulation of amyloid-β 1-42 structure and toxicity by proline-rich whey peptides

A proline-rich peptide product prepared from bovine whey protein that was enriched in several hydrophobic amino acids including proline (whey proline-rich peptide, wPRP) was shown to modulate the folding pathway of human amyloid beta peptide 1-42 (Aβ42) into oligomers. Concentration-dependent changes in ThT-binding to Ab42 by wPRP indicated suppression of oligomerisation, that was supported by Transmission Electron Microscopy. Suppression of β-sheet and specifically, anti-parallel β-sheet structures by wPRP was demonstrated by ATR-FTIR spectroscopy, where evidence for capacity of wPRP to dissociate pre-existing β-sheet structures in Aβ42 was also apparent. Suppression of anti-parallel β-sheets of oligomeric Aβ42 was associated with rescue of yeast and SH-SY5Y neuronal cells providing important evidence for the association between anti-parallel β-sheet structure and oligomer toxicity. It was proposed that the interaction of wPRP with Aβ42 interfered with the anti-parallel folding pathway of oligomeric Aβ42 and ultimately produced 'off-pathway' structures of lowered total β-sheet content, with attenuated cellular toxicity.

CURRENT PRACTICE IN RENAL ANAEMIA MANAGEMENT: TWO MULTINATIONAL SURVEYS

The European Best Practice Guidelines recommend that 85% of patients with standard causes of chronic renal failure should achieve a target haemoglobin concentration of > or = 11 g/dL. However, patient outcomes need to be improved as many patients respond suboptimally to treatment and fail to reach these targets. Two multinational surveys of nursing practice in the management of renal anaemia in northern (with comparative data from Australia) and southern Europe were conducted. The aim was to assess variations in the role and amount of responsibility delegated to nurses in renal units throughout Europe and Australia. Patient care could be optimised by developing formal training and educational programmes for nephrology nurses and this has already occurred in many units in the UK.