Capacity building to address antimicrobial resistance in remote Australia: The inaugural HOT NORTH Antimicrobial Academy

BACKGROUND

Rates of antimicrobial resistance (AMR) for some pathogens in Australia are considerably higher in rural and remote compared to urban regions. The inaugural Hot North Antimicrobial Academy was a 9-month educational programme aimed to build workforce knowledge and capacity in antimicrobial use, audit, stewardship, surveillance and drug resistance in remote primary health care.

METHODS

The Academy was advertised to Aboriginal and Torres Strait Islander, regional and remote healthcare workers. Participants were Aboriginal health practitioners, nurses, pharmacists and doctors from Queensland, Northern Territory, South Australia and Western Australia working in remote primary health care with a focus on Indigenous health. Due to COVID-19 restrictions, the Academy ran virtually from February-November 2021 using Microsoft Teams. The Academy was evaluated using surveys and yarning circles to assess impact and knowledge gain.

RESULTS

Participants and faculty from across Australia attended 19 lectures and mentorship sessions. Eleven participants commenced and eight (73%) completed the Academy. The Academy raised participants awareness of AMR guidelines, governance and generating change; built confidence in advocacy; grew knowledge about drug resistant infections; and created a community of AMR champions in Indigenous health.

CONCLUSION

The evaluation confirmed the Academy met the needs of participants, provided opportunities to move stewardship from tertiary hospitals into Indigenous and remote clinics and developed skills in research, audit, stewardship and advocacy for all involved. All sessions were recorded for future use, with facilitation by the National Aboriginal Community Controlled Health Organisation (NACCHO) in future years.

A18 DEVELOPMENT OF CHRONIC ILEITIS IN THE TNFΔARE MOUSE IS ASSOCIATED WITH A LOSS OF MESENTERIC LYVE1+ MACROPHAGES

Background

Crohn’s disease (CD) is a form of inflammatory bowel disease that causes transmural inflammation of any part of the gastrointestinal (GI) tract but preferentially the terminal ileum and/or the colon. This chronic inflammation is not limited to the GI tract but also affects the mesentery of inflamed regions where it induces the formation of tertiary lymphoid organs (TLOs). The homeostatic LYVE1+ macrophages (LYmΦ) have been identified in many different organs including the mesentery. They have been shown to typically align along blood vessels where they participate in the control of collagen deposition and during inflammation, regulate vascular permeability and immune cell recruitment. Here we investigate the role of the mesenteric LYmΦ in a transgenic model of CD, the TNFΔARE mouse which develops terminal ileitis over time and expresses similar mesenteric alterations (TLOs) as seen in CD.

Aims

To determine whether the mesenteric LYmΦ population is altered during the development of chronic inflammation in the TNFΔARE mouse and whether they participate in the development of TLOs.

Methods

Confocal immunofluorescent imaging of the terminal ileal mesentery of TNFΔARE mice and littermate controls were preformed to identify changes to the populations of LYmΦ during the development of chronic inflammation. Myeloperoxidase activity was used to assess terminal ileitis.

Results

During the initial stage of ileitis (8 weeks) LYmΦs are present across the terminal ileal mesentery in both TNFΔARE and age-matched WT littermate controls with a subpopulation aligning along the collecting lymphatic vessels of the mesentery (n=6). At 20 weeks, while the ileitis progresses, aggregates of CD45+ cells have formed within the TNFΔARE mice where LYmΦs also accumulate (n=5). At 28 weeks when the ileitis worsens, the LYmΦs are greatly reduced from the terminal ileal mesentery as well as from the CD45+ cell aggregates (n=5). WT littermate controls never develop large CD45+ cell aggregates (n=5 for each time point). Antibodies to the LYVE1 cytosolic and extracellular domains confirmed the loss of the LYVE1 receptor over receptor cleavage, however, there was no correlation of altered collagen-1 deposition within the mesentery at 28 weeks.

Conclusions

Here we show a spatial relationship between LYmΦs and collecting lymphatic vessels as well as a decrease in LYmΦs during the development of chronic ileitis in the TNFΔARE mouse. Whether they contribute to TLO formation, or their loss exacerbates terminal ileitis is still unknown and under current investigation.

Funding Agencies

CCC

Room temperature laser power standard using a microfabricated, electrical substitution bolometer

The design and performance of a room temperature electrical substitution radiometer for use as an absolute standard for measuring continuous-wave laser power over a wide range of wavelengths, beam diameters, and powers are described. The standard achieves an accuracy of 0.46% (k = 2) for powers from 10 mW to 100 mW and 0.83% (k = 2) for powers from 1 mW to 10 mW and can accommodate laser beam diameters (1/e²) up to 11 mm and wavelengths from 300 nm to 2 μm. At low power levels, the uncertainty is dominated by sensitivity to fluctuations in the thermal environment. The core of the instrument is a planar, silicon microfabricated bolometer with vertically aligned carbon nanotube absorbers, commercial surface mount thermistors, and an integrated heater. Where possible, commercial electronics and components were used. The performance was validated by comparing it to a National Institute of Standards and Technology primary standard through a transfer standard silicon trap detector and by comparing it to the legacy "C-series" standards in operation at the U.S. Air Force Metrology and Calibration Division (AFMETCAL).

Observed psychopathology in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia

BACKGROUND

Children of parents with mood and psychotic disorders are at elevated risk for a range of behavioral and emotional problems. However, as the usual reporter of psychopathology in children is the parent, reports of early problems in children of parents with mood and psychotic disorders may be biased by the parents' own experience of mental illness and their mental state.

METHODS

Independent observers rated psychopathology using the Test Observation Form in 378 children and youth between the ages of 4 and 24 (mean = 11.01, s.d. = 4.40) who had a parent with major depressive disorder, bipolar disorder, schizophrenia, or no history of mood and psychotic disorders.

RESULTS

Observed attentional problems were elevated in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia (effect sizes ranging between 0.31 and 0.56). Oppositional behavior and language/thought problems showed variable degrees of elevation (effect sizes 0.17 to 0.57) across the three high-risk groups, with the greatest difficulties observed in offspring of parents with bipolar disorder. Observed anxiety was increased in offspring of parents with major depressive disorder and bipolar disorder (effect sizes 0.19 and 0.25 respectively) but not in offspring of parents with schizophrenia.

CONCLUSIONS

Our results suggest that externalizing problems and cognitive and language difficulties may represent a general manifestation of familial risk for mood and psychotic disorders, while anxiety may be a specific marker of liability for mood disorders. Observer assessment may improve early identification of risk and selection of youth who may benefit from targeted prevention.

Abstract P3-09-09: Assessing utility of breast cancer risk assessment tool in comparison to Tyrer-Cuzick model for determination of breast cancer risk and implications for chemoprevention

Background

Despite findings that the Tyrer-Cuzick (IBIS Breast Cancer Risk Evaluation Tool or TC) model is more predictive of breast cancer risk than the Gail model (NCI maintained Breast Cancer Risk Assessment Tool or BCRAT), BCRAT is commonly clinically used as per the United States Preventive Services Task Force (USPSTF), with a 5-year risk for breast cancer (BC) of greater than 3% on BCRAT, the benefits of preventive medication likely outweigh the risks. We aimed to compare the models, 1: to see if a 10 year risk estimate per the TC model reliably correlated with the 3% 5 year risk per BCRAT, and 2: to analyze the subset of patients with atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) who are known both to be at high risk for breast cancer and to benefit from chemoprevention. Our hypothesis is that BCRAT has limited utility in risk estimation, and the most comprehensive model for risk estimation and clinical decision making is TC.

Methods

200 women ages 35-64 women followed in benign breast clinic were included. Risk estimations were run using BCRAT, TC version 7 (v7) and TC version 8 (v8). A Pearson's Correlation test was conducted to investigate the relationship between the TC models and the BCRAT model. A p-value < 0.05 was considered statistically significant.

Results

Analysis showed a positive moderate-strength relationship between the TC v7 10-year risk and the 5-year BCRAT risk for this population (R = 0.468, P<0.001) and a positive moderate-strength relationship between the TC v8 10-year risk and the 5-year BCRAT risk (R = 0.550, P<0.001). A TC v7 risk of 8.09% (95% confidence interval (CI): 7.42-8.75) and a TC v8 risk of 8.54% (95% CI: 7.85-9.24) corresponded to a BCRAT risk of 3%. However, much error was present when assessing consistency and correlation between the models.

A total of 36 patients were diagnosed with AH, 2 patients were diagnosed with LCIS and 7 patients were diagnosed with both AH and LCIS. 11 patients who had AH had an estimated 5-year risk per the BCRAT model of <3%. Two of these patients were pre-menopausal and African American and one was pre-menopausal and Hispanic. Of the remaining 8 patients, all were under the age of 60.

Of the 30 patients who had a BCRAT 5-year estimated risk of BC of >3% but no AH or LCIS, 12 had two first degree relatives with breast cancer and 16 had a first-degree relative with BC and at least two benign breast biopsies.

Conclusion

BCRAT is limited and caution is warranted with its use in assessing risk and for counseling around chemoprevention benefit. There is not reliable correlation between the 5 year BCRAT risk estimate and the 10 year TC risk estimate. Chemoprevention should be discussed for patients with AH, LCIS or 2+ first degree relatives with breast cancer. Further, BCRAT may underestimate risk in minority populations and others with AH. For a limited group of patients with moderate risk, dual modeling may be clinically useful in making chemopreventive recommendations.

Citation Format: Pederson HJ, Yanda C, Kline M, Stephens M, Goraya ST, Grobmyer SR, Kattan MW. Assessing utility of breast cancer risk assessment tool in comparison to Tyrer-Cuzick model for determination of breast cancer risk and implications for chemoprevention [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-09-09.

Abstract P4-06-04: Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing

Background. Triple negative breast cancer (TNBC) has been associated with a relatively high rate of germline BRCA1/2 deleterious mutations (11-20%). With use of panel testing, additional predisposition genes are being identified. Among Caucasian (CC) patients (pts), pathogenic germline variants in BRCA1/2 are mainly associated with TNBC. However, these may not fully explain the higher incidence of TNBC among African Americans (AA). Additionally, partly due to under-testing among AA, the distribution of predisposition genes for AA TNBC pts is unknown, and a greater proportion of germline alterations may be classified as a variant of uncertain significance (VUS). We hypothesized that additional clinically significant germline mutations in genes, other than in BRCA1/2, may explain the increased incidence of TNBC among AA, which may be better elucidated by panel testing.

Methods. A retrospective chart review was completed of all self-identified CC and AA TNBC pts who presented to two institutions from 10/2013 to 12/2016. A total of 596 pts were analyzed. 434 (73%) were CC and 162 (27%) were AA. Clinicopathologic features including histologic subtype, age, gender, bilateral disease and stage were examined. Patients were assessed for meeting the National Comprehensive Cancer Network (NCCN) criteria for genetic testing in TNBC, type of testing performed, and the results. The distribution of mutations in higher penetrance genes (BRCA1, BRCA2, and PALB2), pathogenic variants in other genes, and VUS in AA vs. CC were analyzed. Significance was determined using a two-tailed Fisher exact test with significance of p<0.05.

Results. 306/434 (71%) CC and 98/162 (60%) AA TNBC pts met criteria for genetic testing (p=0.023). For those who met NCCN criteria for testing, 216/306 (71%) CC and 66/98 (67%) AA TNBC pts underwent testing (p=0.61). For all pts, the average age of first diagnosis was 59.5 (SD 14) for CC vs. 62.4 (SD 12.9) for AA pts. For pts who underwent testing, regardless of meeting NCCN criteria, 18% (40/221) of CC vs.12% (8/68) of AA patients had a mutation in a higher penetrance gene (p=0.27), 1% (3/221) of CC vs. 3% (2/68) of AA had a mutation in other genes (BRIP1, Lynch genes; p=0.34), and 16% (36/221) of CC vs. 18% (12/68) of AA had a VUS (p=0.982). Of VUS, 42% (5/12) in AA vs. 19% (7/36) in CC were in higher penetrance breast cancer genes (p=0.14).

Conclusion. More CC than AA TNBC pts met criteria for genetic testing. This difference may in part be explained by the later age at diagnosis for AA given that age is a major factor in determining genetic testing. Broadening eligibility for testing in AA may help to identify more patients with an underlying genetic predisposition to TNBC. No difference was seen in the frequency of higher penetrance genes, other genes, and VUS between AA and CC pts. However, important non-BRCA genes were identified with panel testing in both AA and CC pts. In addition to broadening testing criteria for existing multi-gene panels, further genetic analysis may be necessary to explain the predisposition to TNBC in AA pts. To our knowledge, this is the first report of evaluation of predisposition genes among AA TNBC pts using germline panel testing.

Citation Format: Nizialek EA, Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Eng C, Mitchell A, Pederson H, Vinayak S. Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-04.

Abstract P4-10-13: Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing

Background

Under-utilization of genetic counseling and testing among African-American (AA) women with breast cancer (BC) has been reported in previous studies, and there are concerns that disparities may widen with further genomic advances. Our objective was to compare AA and Caucasian (CC) patients with triple-negative breast cancer (TNBC) with regards to referral for genetic counseling, patterns of genetic testing, and patient-compliance with genetic counseling recommendations. We chose TNBC since a majority of these patients would qualify for genetic counseling ± testing. We also analyzed for differences between the two races in prevalence of deleterious BC-associated mutations, stage of BC on presentation, and surgical choices.

Methods

In this retrospective medical records-based observational study, we included all patients in our tumor registry with TNBC diagnosed between 09/01/2013 and 02/28/2017. Race, clinical characteristics and details pertaining to genetic counseling and testing were recorded. X2 test was used to compare categorical variables. A p-value < 0.05 was considered significant.

Results

477 patients -358 CC and 96 AA- with TNBC were included. Mean age was 60.3 years. 331 patients met National Comprehensive Cancer Network (NCCN) criteria for genetic counseling - of these, 85.5% had genetic consult order placed, 72.8% attended counseling, and 71.9% underwent genetic testing (multigene panel testing 55.0%, BRCA 1/2 testing 39.9%, single-site testing 2.5%, and multisite-3 testing 2.5%). Between CC and AA, no significant differences were found in the proportion of qualifying patients who had referral for genetic counseling (84.7 vs 87.7%, p=0.562), attended counseling (72.2% vs 73.7%, p=0.816), or underwent genetic testing (72.1% vs 70.1%, p=0.764). The choices of type of genetic tests were also not significantly different between the two groups (p=0.349). Though the prevalence of highly penetrant mutations in breast cancer-associated genes trended to be higher among CC than AA (14.1% vs 9.5%), this difference did not reach statistical significance (p=0.429). In our population, stage of TNBC at presentation was comparable between the two races – 80.4% of CC presented with stage I or II disease compared to 80.2% of AA (p=0.931). The two groups were also comparable with regards to the choices of breast surgery and reconstruction, as shown in the table.

  CaucasiansAfrican-Americansp-valueSurgery TypePartial Mastectomy154(47.4%)38(44.7%)0.317 Unilateral Mastectomy101(31.1%)35(41.2%) Bilateral Mastectomy70(21.5%)12(14.1%)ReconstructionYes96(56.1%)24(51.1%)0.535 No75(43.9%)23(48.9%)Reconstruction TypeImplant87(90.6%)19(79.2%)0.118 Tissue Flap9(9.4%)5(20.8%)

Conclusions

Contrary to previous reports, in this cohort of TNBC patients, we did not identify significant disparities between AA and CC in patterns of referral for genetic counseling, in patient compliance with testing or in type of testing performed. Also, no significant differences were found between the two races in choices of breast surgery or reconstruction. As a caveat, with an overall insured rate of ˜97% across our network, the uninsured population may have been under-represented by our cohort.

Citation Format: Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Pederson HJ. Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-13.

Associations between xerostomia and health status indicators in the elderly

Aims: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health.

Method: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant’s residence.

Results: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively. Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Selfreported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health.

Conclusion: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.

Plasma-induced signatures reveal an extracellular milieu possessing an immunoregulatory bias in treatment-naive paediatric inflammatory bowel disease

The inflammatory state associated with Crohn's disease (CD) and ulcerative colitis (UC) remains incompletely defined. To understand more clearly the extracellular milieu associated with inflammatory bowel disease (IBD), we employed a bioassay whereby plasma of treatment naive paediatric IBD patients (n = 22 CD, n = 15 UC) and unrelated healthy controls (uHC, n = 10) were used to induce transcriptional responses in a healthy leucocyte population. After culture, gene expression was measured comprehensively with microarrays and analysed. Relative to uHC, plasma of CD and UC patients induced distinct responses consisting, respectively, of 985 and 895 regulated transcripts [|log2 ratio| ≥ 0·5 (1·4-fold); false discovery rates (FDR) ≤ 0·01]. The CD:uHC and UC:uHC signatures shared a non-random, commonly regulated, intersection of 656 transcripts (χ(2)  = P < 0·001) and were highly correlative [Pearson's correlation coefficient = 0·96, 95% confidence interval (CI) = 0.96, 0.97]. Despite sharing common genetic susceptibility loci, the IBD signature correlated negatively with that driven by plasma of type 1 diabetes (T1D) patients (Pearson's correlation coefficient = -0·51). Ontological analyses revealed the presence of an immunoregulatory plasma milieu in IBD, as transcripts for cytokines/chemokines, receptors and signalling molecules consistent with immune activation were under-expressed relative to uHC and T1D plasma. Multiplex enzyme-linked immunosorbent assay (ELISA) and receptor blockade studies confirmed transforming growth factor (TGF)-β and interleukin (IL)-10 as contributors to the IBD signature. Analysis of CD patient signatures detected a subset of transcripts associated with responsiveness to 6-mercaptopurine treatment. Through plasma-induced signature analysis, we have defined a unique, partially TGF-β/IL-10-dependent immunoregulatory signature associated with IBD that may prove useful in predicting therapeutic responsiveness.

Transfusion-associated dyspnea--shadow or substance?

New Zealand Blood Service Haemovigilance uses International Society of Blood Transfusion/International Haemovigilance Network definitions to categorize transfusion reactions (TR). Transfusion-associated dyspnoea (TAD) is a category for TR with respiratory features (TRRF) that do not fit definitive entities. TRRF, including TAD, are clinically significant. TR classified as TAD were reviewed. We found that many TAD may have been transfusion-associated circulatory overload. Better information in TR reports and refining TR diagnostic criteria may result in less misclassification of TRRF. TAD may represent mild, atypical or overlap entities, and there may be a residuum of cases with currently unexplained pathophysiology.

Imaging pancreas transplants

Pancreas transplants are performed in multiple centres across the UK with good graft survival rates. This places an increasing demand on radiology services, particularly as the complication rates are not insignificant. The imaging appearances of pancreas transplants and their complications can be difficult to interpret. This review provides an illustrative journey through the anatomical appearances of a graft and the imaging appearances of complications, as a reference tool for radiologists.

Nitric oxide levels following perfusion differ in donation after circulatory death and donation after brain death transplants

Affiliated to the Association of Surgeons in Training and the British Transplantation Society, the Carrel Club is the transplant trainee surgical society. The Carrel Club held a joint meeting with the Chapter of Transplant Surgeons, a subsidiary organisation of the British Transplantation Society, at the Manchester Hilton Hotel on 31 January and 1 February 2013. As part of the meeting, ten abstracts were presented. A selection is printed below. The winner of the Best Presentation award was Mr Mownah.

Duration of ultrashort pulses in the presence of spatio-temporal coupling

We report on a simple method allowing one to decompose the duration of arbitrary ultrashort light pulses, potentially distorted by space-time coupling, into four elementary durations. Such a decomposition shows that, in linear optics, a spatio-temporal pulse can be stretched with respect to its Fourier limit by only three independent phenomena: nonlinear frequency dependence of the spectral phase over the whole spatial extent of the pulse, spectral amplitude inhomogeneities in space, and spectral phase inhomogeneities in space. We illustrate such a decomposition using numerical simulations of complex spatio-temporal femtosecond and attosecond pulses. Finally we show that the contribution of two of these three effects to the pulse duration is measurable without any spectral phase characterization.

THE EFFECT OF ANTIBACTERIAL DRUGS ON THE FECAL FLORA OF MICE

Oral administration of penicillin, terramycin, or chloramphenicol to NCS mice rapidly brought about profound changes in their fecal flora. The lactobacilli disappeared completely, whereas the numbers of enterococci and Gram-negative bacilli reached very high levels. In contrast, no effect on the fecal flora could be detected following administration of isoniazid in any amount. The intensity and duration of the effects on the fecal flora were related to the type of drug and to the amount of it administered. Chloramphenicol produced disturbances which were less profound and of shorter duration than those produced by penicillin or terramycin. The duration of the disturbances in the fecal flora produced by antibacterial drugs was markedly conditioned by the nutritional regimen. The fecal flora returned to its pretreatment state (large numbers of lactobacilli, few enterococci, and few Gram-negative bacilli) within less than 4 weeks after discontinuing the drug when the mice were fed a complex diet of ill defined composition (commercial pellets). Contrariwise, the fecal flora remained markedly different from that of control mice when the animals were fed semisynthetic diets containing as source of protein either 15 per cent casein or 15 per cent wheat gluten (both supplemented with cystine); or 15 per cent wheat gluten supplemented with lysine, threonine, and cystine. The fecal flora of mice treated with penicillin contained large numbers of lactose-fermenting Gram-negative bacilli, not found in the untreated animals. These lactose fermenters persisted for several months after discontinuance of the drug in mice fed either the casein or gluten diets, but they disappeared rapidly from mice fed pellets. Similar results, although less striking, were obtained with Swiss mice from colonies maintained under usual conditions, and therefore having a fecal flora more complex than that of NCS mice.

A likelihood-based trait-model-free approach for linkage detection of binary trait

Trait-model-free (or "allele-sharing") approach to linkage analysis is a popular tool in genetic mapping of complex traits, because of the absence of explicit assumptions about the underlying mode of inheritance of the trait. The likelihood framework introduced by Kong and Cox (1997, American Journal of Human Genetics 61, 1179-1188) allows calculation of accurate p-values and LOD scores to test for linkage between a genomic region and a trait. Their method relies on the specification of a model for the trait-dependent segregation of marker alleles at a genomic region linked to the trait. Here we propose a new such model that is motivated by the desire to extract as much information as possible from extended pedigrees containing data from individuals related over several generations. However, our model is also applicable to smaller pedigrees, and has some attractive features compared with existing models (Kong and Cox, 1997), including the fact that it incorporates information on both affected and unaffected individuals. We illustrate the proposed model on simulated and real data, and compare its performance with the existing approach (Kong and Cox, 1997). The proposed approach is implemented in the program lm_ibdtests within the framework of MORGAN 2.8 (http://www.stat.washington.edu/thompson/Genepi/MORGAN/Morgan.shtml).

Comparative Biomarker Analysis in 523 Matched Male and Female Breast Cancers

Incidence rates of male breast cancer (MBC) are rising. MBC etiology is poorly understood with most of our current knowledge regarding its biology, natural history and treatment extrapolated from our knowledge of female breast cancer (FBC). Retrospective studies on MBC have suffered from small numbers of cases available from any one centre thus a significant problem in studying this disease is accruing sufficiently large numbers to allow comparative analysis of possible prognostic markers. Using a co-ordinated multi-centre approach, the aim of this study was to conduct the first large scale study to address the relevance of the expression of recognised biomarkers in FBC in the same disease in males. Five hundred and twenty three cases were obtained retrospectively and assimilated into TMAs, including 260 MBCs and 263 cases of stage-matched FBCs. MBC comprised 21 grade 1, 121 grade 2, 68 grade 3, 50 unknown, mean age 67 (range 39-90) with 167 ductal, 4 lobular, 10 papillary, 10, mucinous, 4 DCIS, 1 mixed and 64 unknown. FBC comprised 29 grade 1, 140 grade 2, 94 grade, mean age 58 (range 27-92) with 220 ductal, 23 lobular, 14 mixed and 6 unknown. Four µm TMA sections were analysed using the following biomarkers: hormone receptors (ERα, ERβ1, ERβ2, ERβ5, total PR, PRA, PRB, AR), apoptosis markers (p53, bcl2), basal (CK5/6, CK14) and luminal epithelial markers (CK18, CK19), E-cadherin and HER2. Biomarkers were scored according to published criteria; for ERβ isoforms both nuclear and cytoplasmic immunoreactivity was determined Statistical analysis was conducted using SPSS. Luminal A (ERα+, and/or PR+, HER2-) was seen in 93% of MBC vs. 84% of FBC, Luminal B (ERα+, and/or PR+, HER2+) or HER2 subgroup (ERα-, PR-, HER2+) was not seen in MBC but found in 6% and 2% of FBC, respectively. Basal-like tumours (ERα-, PR-, HER2-, CK5/6+) were infrequent (MBC 2%, FBC 1%) and in MBC these tumours also expressed ERβ isoforms. No differences were observed in grade, stage or LN status between genders. Univariate analysis showed ERα, ERβ1, ERβ5, PRA, AR, p53 were significantly associated with FBC while cytoplasmic ERβ2, bcl2 and e-cadherin were associated with MBC (all P&lt;0.001). Although membranous HER2 was not seen in MBC, many cases displayed nuclear staining. Biomarker profile with respect to clinical outcome is on-going. This work has shown the luminal A phenotype is common in MBC and that gender-specific biomarkers are expressed. As MBC is becoming more common, this information may be useful in identifying biomarkers which might affect outcome.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2109.

Bortezomib for the treatment of multiple myeloma patients

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of bortezomib for the treatment of multiple myeloma patients at first relapse and beyond, in accordance with the licensed indication, based upon the evidence submission from Ortho Biotech to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The outcomes stated in the manufacturer's definition of the decision problem were time to disease progression, response rate, survival and quality of life. The literature searches for clinical and cost-effectiveness studies were adequate and the one randomised controlled trial (RCT) included was of reasonable quality. Results from the RCT suggest that bortezomib increases survival and time to disease progression compared with high-dose dexamethasone (HDD) in multiple myeloma patients who have had a relapse after one to three treatments. Cost-effectiveness analysis based on the same trial and an observational study was reasonable and gave an estimated cost per life-year gained of 30,750 pounds, which ranged from 27,957 pounds to 36,747 pounds on sensitivity analysis. An attempt was made to replicate the results of the manufacturer's model and to compare the results to the Kaplan-Meier survival curve presented in the manufacturer's submission. In addition, a one-way sensitivity analysis and a probabilistic sensitivity analysis were undertaken, as well as additional scenario analyses. Based on these analyses the ERG suggests that the cost-effectiveness results presented in the manufacturer's submission may underestimate the cost per life-year gained for bortezomib therapy (versus high-dose dexamethasone) when potential UK practice and scenarios are considered. The guidance issued by NICE in June 2006 as a result of the STA states that bortezomib monotherapy for the treatment of relapsed multiple myeloma is clinically effective compared with HDD but has not been shown to be cost-effective and is not recommended for the treatment of progressive multiple myeloma in patients who have received at least one previous therapy and who have undergone, or are unsuitable for, bone marrow transplantation.

Bortezomib for the treatment of multiple myeloma patients

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of bortezomib for the treatment of multiple myeloma patients at first relapse and beyond, in accordance with the licensed indication, based upon the evidence submission from Ortho Biotech to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The outcomes stated in the manufacturer’s definition of the decision problem were time to disease progression, response rate, survival and quality of life. The literature searches for clinical and cost-effectiveness studies were adequate and the one randomised controlled trial (RCT) included was of reasonable quality. Results from the RCT suggest that bortezomib increases survival and time to disease progression compared with high-dose dexamethasone (HDD) in multiple myeloma patients who have had a relapse after one to three treatments. Cost-effectiveness analysis based on the same trial and an observational study was reasonable and gave an estimated cost per life-year gained of £30,750, which ranged from £27,957 to £36,747 on sensitivity analysis. An attempt was made to replicate the results of the manufacturer’s model and to compare the results to the Kaplan–Meier survival curve presented in the manufacturer’s submission. In addition, a one-way sensitivity analysis and a probabilistic sensitivity analysis were undertaken, as well as additional scenario analyses. Based on these analyses the ERG suggests that the cost-effectiveness results presented in the manufacturer’s submission may underestimate the cost per life-year gained for bortezomib therapy (versus high-dose dexamethasone) when potential UK practice and scenarios are considered. The guidance issued by NICE in June 2006 as a result of the STA states that bortezomib monotherapy for the treatment of relapsed multiple myeloma is clinically effective compared with HDD but has not been shown to be cost-effective and is not recommended for the treatment of progressive multiple myeloma in patients who have received at least one previous therapy and who have undergone, or are unsuitable for, bone marrow transplantation.

Intersatellite range monitoring using optical interferometry

We report on an interferometer designed to provide 1-10 nm/square root(Hz) displacement measurement resolution, in the range 0.01 Hz to 1 Hz, while in low Earth orbit. The interferometer comprises two units, each with its own laser and in separate satellites, which would be in the same orbit separated by approximately 50 km. We discuss the requirements on the interferometer subsystem and describe the optical transponder distance measurement, including a phase locking method to generate a heterodyne beat signal between the two lasers. Design, fabrication, and testing of a "flightlike" engineering model interferometer is outlined, and results from environmental and performance tests are reported.

Soil monitoring in Europe: a review of existing systems and requirements for harmonisation

Official frameworks for soil monitoring exist in most member states of the European Union. However, the uniformity of methodologies and the scope of actual monitoring are variable between national systems. This review identifies the differences between existing systems, and describes options for harmonising soil monitoring in the Member States and some neighbouring countries of the European Union. The present geographical coverage is uneven between and within countries. In general, national and regional networks are much denser in northern and eastern regions than in southern Europe. The median coverage in the 50 km x 50 km EMEP cells applied all over the European Union, is 300 km(2) for one monitoring site. Achieving such minimum density for the European Union would require 4100 new sites, mainly located in southern countries (Italy, Spain, Greece), parts of Poland, Germany, the Baltic countries, Norway, Finland and France. Options are discussed for harmonisation of site density, considering various risk area and soil quality indicator requirements.

Particulate debris collected during carotid stenting: are we missing something?

Particulate and histopathologic examination of atherosclerotic material collected during carotid artery stenting is presented, illustrating the limitations of current knowledge regarding the use of distal protection devices (DPD) during this novel vascular intervention.

Angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma) occurring within multiple deep lymph nodes and presenting with weight loss and raised CA-125 levels

We report a case of angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma) involving multiple deep mediastinal, abdominal and intramammary lymph nodes in a 52-year-old woman with weight loss and raised CA-125 levels. The unusual clinical presentation with raised CA-125 levels and its occurrence within multiple deep visceral lymph nodes has never been reported in literature.

Lymphomatoid papulosis in a patient with atopic eczema on long-term ciclosporin therapy

We report a 36-year-old man with atopic eczema who developed lymphomatoid papulosis while taking ciclosporin. Latent membrane protein 1 and in situ hybridization for Epstein-Barr virus were negative. There are only two reports in the literature of patients taking ciclosporin to control atopic eczema who developed primary cutaneous CD30+ T-cell lymphoproliferative disorders. The development of T-cell lymphoproliferative disorders including lymphomas is well described in patients with solid organ transplants who are taking ciclosporin. Also, it has been noted in patients taking ciclosporin for rheumatological conditions or psoriasis.

Gene expression in the hippocampus of inbred alcohol-preferring and -nonpreferring rats

The hippocampus is sensitive to the effects of ethanol and appears to have a role in the development of alcohol tolerance. The objective of this study was to test the hypothesis that there are innate differences in gene expression in the hippocampus of inbred alcohol-preferring (iP) and -nonpreferring (iNP) rats that may contribute to differences in sensitivity to ethanol and/or in the development of tolerance. Affymetrix microarrays were used to measure gene expression in the hippocampus of alcohol-naive male iP and iNP rats in two experiments (n=4 and 6 per strain in the two experiments). Combining data from the two experiments, there were 137 probesets representing 129 genes that significantly differed (P < or = 0.01); 62 probesets differed at P < or = 0.001. Among the 36% of the genes that were expressed more in the iP than iNP rat at this level of significance, many were involved in cell growth and adhesion, cellular stress reduction and anti-oxidation, protein trafficking, regulation of gene expression, synaptic function and metabolism. Among the 64% of the genes that had lower expression in the hippocampus of iP than iNP rats were genes involved in metabolic pathways, cellular signaling systems, protein trafficking, cell death and neurotransmission. Overall, the data indicate that there are significant innate differences in gene expression in the hippocampus between iP and iNP rats, some of which might contribute to the differences observed in the development of alcohol tolerance between the selectively bred P and NP lines.