Using K-Means Clustering to Identify Physician Clusters by Electronic Health Record Burden and Efficiency

Objectives: Electronic health records (EHRs) have transformed the way modern medicine is practiced, but they remain a major source of documentation burden among physicians. This study aims to use data from Signal, a tool provided by the Epic EHR, to analyze physician metadata in the Montefiore Health System via cluster analysis to assess EHR burden and efficiency. Methods: Data were obtained for a one-month period (July 2020) representing a return to normal operation post-telemedicine implementation. Six metrics from Signal were used to phenotype physicians: time on unscheduled days, pajama time, time outside of 7 AM to 7 PM, turnaround time, proficiency score, and visits closed the same day. k-Means clustering was employed to group physicians, and the clusters were assessed overall and by sex and specialty. Results: Our results demonstrate the partitioning of physicians into a higher-efficiency, lower-time outside of scheduled hours (TOSH) cluster and a lower-efficiency, higher-TOSH cluster even when stratified by sex and specialty. Intra-cluster comparisons showed general homogeneity of physician metrics with the exception of the higher-efficiency, lower-TOSH cluster when stratified by sex. Conclusions: Taken together, the clusters uniquely reflect the EHR efficiency-burden of the Montefiore Health System. Applying k-means clustering to readily available EHR data allows for a scalable, efficient, and adaptable approach of assessing physician EHR burden and efficiency, allowing health systems to examine documentation trends and target wellness interventions.

Maintenance of permanent sexual activity throughout the year in seasonal bucks using short photoperiodic cycles in open barns

Seasonality of reproductive activity in rams and bucks is the major constraint in temperate and subtropical zones. Rapid alternation between 1 month of short days and 1 month of long days (LD) over three years in lightproof buildings eliminates this seasonality. We examined if this would also work in open barns, using only supplementary light. Over two years, one group of bucks (n = 7) was subjected to alternate 1 month of LD and 1 month of permanent light (LD-LL) and another group (n = 7) to alternate 1 month of LD and 1 month of natural light (LD-NL). A simultaneous control group, used for both experiments (CG1, n = 6; CG2, n = 6), remained under natural photoperiod. BW, testis weight (TW), plasma testosterone (T) and cortisol (C) were evaluated in all bucks. CG1 and CG2 bucks showed identical dramatic seasonal variations in BW (stable or decreasing in summer), TW (from 85 ± 12 g in February to 127 ± 7 g in July) and T (from 2.7 ± 1.2 ng/mL in January-April to 24.3 ± 3.2 ng/mL in June-October). By contrast, BW of LD-LL and LD-NL bucks increased regularly during the experiment. From 5 and 9 months after the experiment onset, LD-LL and LD-NL bucks, respectively, maintained constant TW of 115 ± 5 g until the experiment end. After the first 3 months <5 ng/mL, T of LD-LL bucks remained constant (5-10 ng/mL) until the experiment end. By contrast, T of LD-NL bucks showed four periods of low (<5 ng/mL) and two periods of high concentrations (18.1 ± 2.6 and 11.9 ± 3.4 ng/mL). Plasma C remained low (5-8 ng/mL) and did not change with group or light treatment. These results show for the first time in any seasonal photoperiodic species that it is possible to maintain the sexual activity of males all year round in open buildings using alternating periods of LD and LL. By contrast, return to NL instead of LL every other month does not prevent seasonality in T concentration. These results raise interesting questions about the photoperiodic control of neuroendocrine regulation of seasonal sexual activity and suggest that these treatments can be used to manage males in open barns in farms and in artificial insemination centres. (Spanish and French versions of the full text are available as Supplementary Materials S1 and S2).

Ovarian cancer prevention by opportunistic salpingectomy is a new de facto standard in Germany

PURPOSE

The most prevalent and aggressive subtype of epithelial ovarian carcinoma (EOC), high-grade serous carcinoma (HGSC), originates in many cases from the fallopian tubes. Because of poor prognosis and lack of effective screening for early detection, opportunistic salpingectomy (OS) for prevention of EOC is being implemented into clinical routine in several countries worldwide. Taking the opportunity of a gynecological surgery in women at average cancer risk, extramural fallopian tubes are completely resected preserving the ovaries with their infundibulopelvic blood supply. Until recently, only 13 of the 130 national partner societies of the International Federation of Obstetrics and Gynecology (FIGO) have published a statement on OS. This study aimed to analyze the acceptance of OS in Germany.

METHODS

(1) Survey of German gynecologists in 2015 and 2022 by the Department of Gynecology of the Jena University Hospital in co-operation with the Department of Gynecology at Charité-University Medicine Berlin with support of NOGGO e. V. and AGO e. V. (2) Salpingectomy numbers in Germany for years 2005-2020 as retrieved from the Federal Statistical Office of Germany (Destatis).

RESULTS

(1) Survey: Number of participants was 203 in 2015 and 166 in 2022, respectively. Nearly all respondents (2015: 92%, 2022: 98%) have already performed bilateral salpingectomy without oophorectomy in combination with benign hysterectomy with the intention to reduce the risk for malignant (2015: 96%, 2022: 97%) and benign (2015: 47%, 2022: 38%) disorders. Compared to 2015 (56.6%), considerably more survey participants performed OS in > 50% or in all cases in 2022 (89.0%). Recommendation of OS for all women with completed family planning at benign pelvic surgery was approved by 68% in 2015 and 74% in 2022. (2) Case number analysis: In 2020, four times more cases of salpingectomy were reported by German public hospitals compared to 2005 (n = 50,398 vs. n = 12,286). Of all inpatient hysterectomies in German hospitals in 2020, 45% were combined with salpingectomy, and more than 65% in women at the age of 35 to 49 years.

CONCLUSION

Mounting scientific plausibility regarding involvement of fallopian tubes in the pathogenesis of EOC led to change of clinical acceptance of OS in many countries including in Germany. Case number data and widespread expert judgment demonstrate that OS has become a routine procedure in Germany and a de facto standard for primary prevention of EOC.

Sexually active male goats stimulate the endocrine and sexual activities of other males in seasonal sexual rest through the "buck-to-buck effect"

Male goats rendered sexually active by exposure to a photoperiodic treatment are more efficient than untreated goats in stimulating LH secretion and ovulation in seasonally anestrous goats. This phenomenon is called the "male effect." Here, we determined whether sexually active bucks are able to stimulate the endocrine and sexual activities of other bucks in seasonal sexual rest through the phenomenon that we called the "buck-to-buck effect." We used bucks rendered sexually active (SA) during sexual rest by exposure to 2.5 mo of artificial long days (16 h of light per d) and untreated, sexually inactive (SI) bucks. In Experiment 1, we determined the short-term (21 d) LH and testosterone responses of sexually inactive bucks joined with a SA or SI buck. In Experiment 2, we determined the long-term (60 d) testosterone and sexual behavior responses of sexually inactive bucks joined with 2 SA or SI bucks. In Experiment 3, we determined the efficacy of bucks initially exposed to the buck-to-buck effect, the SABB bucks, to thereafter induce a "classical" male effect in seasonally anestrous goats. In Experiments 1 and 2, there was an interaction between time and groups in LH and testosterone plasma concentrations (P < 0.01). In Experiment 1, plasma LH concentrations were greater in bucks joined with a SA buck than in those joined with an SI buck (P < 0.05). In Experiments 1 and 2, testosterone concentrations were greater in bucks joined with SA bucks than in those joined with SI bucks (P < 0.05). In addition, in Experiment 2, the sexually inactive bucks joined with SA bucks displayed more nudging than those joined with SI bucks (P < 0.001). In Experiment 3, kidding rates did not differ between females joined with SA (34 of 40: 85%) or SABB bucks (32 of 40: 80%; P > 0.05). We concluded that the endocrine and sexual activities of bucks during sexual rest can be stimulated by SA bucks. In addition, SABB bucks are able to stimulate the reproductive activity of seasonally anestrous goats.

Physician Electronic Health Record Usage as Affected by the COVID-19 Pandemic

OBJECTIVES

To utilize metrics from physician action logs to analyze volume, physician efficiency and burden as impacted by telemedicine implementation during the COVID-19 (coronavirus disease 2019) pandemic, and physician characteristics such as gender, years since graduation, and specialty category.

METHODS

We selected 11 metrics from Epic Signal, a functionality of the Epic electronic health record (EHR). Metrics measuring time spent in the EHR outside working hours were used as a correlate for burden. We performed an analysis of these metrics among active physicians at our institution across three time periods-prepandemic and telehealth implementation (August 2019), postimplementation of telehealth (May 2020), and follow-up (July 2020)-and correlated them with physician characteristics.

RESULTS

Analysis of 495 physicians showed that after the start of the pandemic, physicians overall had fewer appointments per day, higher same day visit closure rates, and spent less time writing notes in the EHR outside 7 a.m. to 7 p.m. on patient scheduled days. Across all three time periods, male physicians had better EHR-defined "efficiency" measures and spent less time in the EHR outside working hours. Years since graduation only had modest associations with higher same day visit closure rates and appointments per day in May 2020. Specialty category was significantly associated with appointments per day and same day closure visit rates and also was a significant factor in the observed changes seen across the three time periods.

CONCLUSION

Utilizing EHR-generated reports may provide a scalable and nonintrusive way to monitor trends in physician usage and experience to help guide health systems in increasing productivity and reducing burnout.

Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

BACKGROUND: The second to fifth metacarpal fractures are immobilised with splints, plaster of Paris (POP) or buddy strapping for a period of time. However, no recent evidence-based splinting and immobilisation programme exists for the management thereof, leaving a gap in the literature to inform clinical practice. This review aimed to review, appraise and collate the literature on splints and immobilisation approaches used for second to fifth metacarpal fractures after surgical and conservative management in adults aged 20 to 59 years. METHODS: The review included experimental study designs, quasi-experimental studies, cohort studies and case-control studies from January 2008 to September 2018. Two reviewers independently screened, selected, appraised and extracted data from the included studies. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the reporting. Joanna Briggs Institute (jBl) critical appraisal tools were used to assess the risk of bias for each included study. RESULTS: Database searches generated 1 005 articles with ten additional articles found on Google Scholar. Ten articles were included: two randomised controlled trials (RCTs), one quasi-RCT, four prospective studies, one retrospective record review, one retrospective study and one comparative study with descriptive reporting of the results. CONCLUSION: High level 1b evidence suggests that no reduction, a soft wrap and buddy strapping for three weeks with early active finger and wrist mobilisation are effective for individuals who sustained boxer's fractures with < 70° angulation. To guide clinical practice, high-level research is needed to determine the immobilisation of second to fifth metacarpal fracture types. Level of evidence: Level 2

The burden of COVID-19 infection in a rural Tamil Nadu community

Background

There have been over 30 million cases of COVID-19 in India and over 430,000 deaths. Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in lower income, rural regions of India. We report on a study examining COVID-19 burden in a rural community in Tamil Nadu.

Methods

The study was undertaken in a population of approximately 130,000 people, served by the Rural Unit of Health and Social Affairs (RUHSA), a community health center of CMC, Vellore. We established and evaluated a COVID-19 PCR-testing programme for symptomatic patients—testing was offered to 350 individuals, and household members of test-positive cases were offered antibody testing. We also undertook two COVID-19 seroprevalence surveys in the same community, amongst 701 randomly-selected individuals.

Results

There were 182 positive tests in the symptomatic population (52.0%). Factors associated with test-positivity were older age, male gender, higher socioeconomic status (SES, as determined by occupation, education and housing), a history of diabetes, contact with a confirmed/suspected case and attending a gathering (such as a religious ceremony, festival or extended family gathering). Amongst test-positive cases, 3 (1.6%) died and 16 (8.8%) suffered a severe illness. Amongst 129 household contacts 40 (31.0%) tested positive. The two seroprevalence surveys showed positivity rates of 2.2% (July/Aug 2020) and 22.0% (Nov 2020). 40 tested positive (31.0%, 95% CI: 23.02 − 38.98). Our estimated infection-to-case ratio was 31.7.

Conclusions

A simple approach using community health workers and a community-based testing clinic can readily identify significant numbers of COVID-19 infections in Indian rural population. There appear, however, to be low rates of death and severe illness, although vulnerable groups may be under-represented in our sample. It’s vital these lower income, rural populations aren’t overlooked in ongoing pandemic monitoring and vaccine roll-out in India.

Influence of migrant background on patient preference and expectations in breast and gynecological malignancies (NOGGO-expression V study): results of a prospective multicentre study in 606 patients in Germany

Background

An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM).

Methods

This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients.

Results

A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors.

First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected.

Conclusions

Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08731-6.

Ethanol inactivation of orthonairoviruses in ixodid ticks

Ixodid ticks represent vectors and reservoirs for a broad range of zoonotic pathogens. Collected ticks from field studies are therefore usually stored in ethanol, which in higher concentrations effectively inactivates most of the known tick-borne pathogens. Although commonly practiced as gold standard for inactivation, hardly any scientific data demonstrate that ethanol sufficiently penetrates the comparatively thick cuticula of ticks. Therefore, Amblyomma hebraeum tick pools were stored for 21 days in ethanol (96%). Afterwards, the ethanol was removed and the ticks were homogenized. Quantitative ¹H-NMR spectroscopic analysis was applied to determine the residual concentration of ethanol inside the ticks. ¹H-NMR spectroscopic analysis revealed that ethanol constituted 28.3-42.6 mg of the total weight of three ticks in the pools (89.9-121.5 mg). In addition, the low-pathogenic Hazara orthonairovirus (HAZV) was used as a cell culture model for this study. The virus was exposed to ethanol concentrations between 0 and 60% and incubated under various temperature conditions for four time periods. Afterwards, the residual virus infectivity was determined by titration. Following ethanol exposure, HAZV did not grow in cells after 9 h of exposure to an ethanol concentration of 25%. These results demonstrate an extremely low ethanol resistance of the virus, which was generally in line with previously reported ethanol inactivation data for Crimean-Congo hemorrhagic fever orthonairovirus (CCHFV). After prolonged storage and impregnation, comparable ethanol concentrations are achieved in the ticks, indicating the suitability of this inactivation method also for Bunyaviruses in ticks. At the very least, a massive virus inactivation can be assumed. Definitive proof of virus inactivation would require a bioassay of ethanol-treated infected ticks under appropriate biosafety conditions.

Post-severe Acute Respiratory Syndrome Coronavirus 2 Monoclonal Antibody Treatment Hospitalizations as a Sentinel for Emergence of Viral Variants in New York City

We partnered with the US Department of Health and Human Services to treat high-risk, nonadmitted coronavirus disease 2019 (COVID-19) patients with bamlanivimab in the Bronx, New York per Emergency Use Authorization criteria. Increasing posttreatment hospitalizations were observed monthly between December 2020 and March 2021 in parallel to the emergence of severe acute respiratory syndrome coronavirus 2 variants in New York City.

AB0024 IN VITRO CHARACTERIZATION OF CENERIMOD, A POTENT AND SELECTIVE SPHINGOSINE 1-PHOSPHATE RECEPTOR 1 (S1P1) MODULATOR IN PREVENTING MIGRATION OF NON-ACTIVATED AND ACTIVATED PRIMARY HUMAN B CELLS IN THE PRESENCE OR ABSENCE OF GLUCOCORTICOIDS

Background:

Cenerimod is a potent, selective, and orally active sphingosine 1-phosphate receptor 1 (S1P1) modulator that is currently being evaluated in a Phase 2b study in patients with systemic lupus erythematosus (SLE) (NCT03742037). S1P1 receptor modulators sequester circulating lymphocytes within lymph nodes, thereby reducing pathogenic autoimmune cells (including B lymphocytes) in the blood stream and in inflamed tissues. Extensive clinical experience has become available for the nonselective S1P receptor modulator fingolimod in relapsing forms of multiple sclerosis, supporting this therapeutic concept for the treatment of autoimmune disorders.

Objectives:

Although the effect of S1P-receptor modulators in reducing peripheral B cells is well documented1,2, the role of the S1P1 receptor on this cell type is only incompletely understood. In this study, the mode of action of cenerimod on primary human B cells was investigated in a series of in vitro experiments, including S1P1 receptor cell surface expression and chemotaxis towards S1P. Moreover, S1P1 expression following B cell activation in vitro was studied. As glucocorticoids (GC) are frequently used in the treatment of patients with autoimmune disorders including SLE, the potential influence of GC on the mode of action of cenerimod was evaluated.

Methods:

Primary human B lymphocytes from healthy donors were isolated from whole blood. In one set of experiments, cells were treated with different concentrations of cenerimod to measure S1P1 receptor internalization by flow cytometry. In a second set of experiments, isolated B cells were activated using different stimuli or left untreated. Cells were then analysed for S1P1 and CD69 cell surface expression and tested in a novel real-time S1P-mediated migration assay. In addition, the effect of physiological concentrations of GCs (prednisolone and prednisone) on cenerimod activity in preventing S1P mediated migration was tested.

Results:

In vitro, cenerimod led to a dose-dependent internalization of the S1P1 receptor on primary human B lymphocytes. Cenerimod also blocked migration of nonactivated and activated B lymphocytes towards S1P in a concentration-dependent manner, which is in line with the retention of lymphocytes in the lymph node and the reduction of circulating lymphocytes observed in the clinical setting. Upon B cell activation, which was monitored by CD69 upregulation, a simultaneous downregulation of S1P1 expression was detected, leading to less efficient S1P-directed cell migration. Importantly, physiological concentrations of GC did not affect the inhibitory activity of cenerimod on B cell migration.

Conclusion:

These results show that cenerimod, by modulating S1P1, blocks B lymphocyte migration towards its natural chemoattractant S1P and demonstrate compatibility of cenerimod with GC. These results are consistent with results of comparable experiments done previously using primary human T lymphocytes.

References:

[1]Nakamura M et al., Mult Scler. 2014 Sep; 20(10):1371-80.

[2]Strasser DS et al., RMD Open 2020;6:e001261.

Disclosure of Interests:

None declared

Natural Mucosal Barriers and COVID-19 in Children

COVID-19 is more benign in children compared to adults for unknown reasons. This contrasts with viruses such as influenza where disease manifestations are often more severe in children1. We hypothesized that a more robust early innate immune response to SARS-CoV-2 may protect against severe disease and compared clinical outcomes, viral copies and cellular gene and protein expression in nasopharyngeal swabs from 12 children and 27 adults upon presentation to the Emergency Department. SARS-CoV-2 copies were similar, but compared to adults, children displayed higher expression of genes associated with interferon signaling, NLRP3 inflammasome, and other innate pathways. Higher levels of IFN-alpha2, IFN-gamma, IP-10, IL-8, and IL-1beta were detected in nasal fluid in children versus adults. Anti-SARS-CoV-2 IgA and IgG were detected in nasal fluid from both groups and correlated negatively with mucosal IL-18. These findings suggest that a more robust innate immune response in children compared to adults contributes to favorable clinical outcomes.

Nutritional supplementation improves the sexual response of bucks exposed to long days in semi-extensive management and their ability to stimulate reproduction in goats

In confined management systems, well-nourished bucks rendered sexually active by exposure to long days are efficient in fertilizing out-of-season goats. However, underfeeding is common in semi-extensive management systems and may reduce the reproductive efficiency of bucks. The objective of the present study was to determine whether nutritional supplementation improved the sexual activity of bucks submitted to long days in semi-extensive management systems and their ability to stimulate the reproduction of goats in semi-extensive or confined conditions. In experiment 1, three groups of bucks were placed in different flocks and grazed daily with females for 7 h. Each day after grazing, males were separated from females and moved into open pens. One group did not receive any treatment (control group; n = 6). Two other groups were submitted to artificially long days from 15 November to 15 January. From 16 January, one group did not receive nutritional supplementation (long-day group; n = 5), whereas bucks from the other group each received 600 g of a commercial concentrate (long-day+supplementation group; n = 5). The fourth group was kept in confined conditions, exposed to long days and fed alfalfa hay (long-day confined group; n = 6). On 26 March, anovulatory goats from other flocks were assigned to four groups (n = 27 each) and confined separately in open pens. Three bucks of each group were housed with the females. Pregnancy rates were greater in the goats housed with the long-day group than those housed with the control group (P < 0.01). However, pregnancy rates did not differ between the long-day confined group (89%) and long-day+supplementation group (70%; P = 0.09), but these rates were greater than those from the long-day (37%) and control groups (0%; P < 0.05). In experiment 2, two groups of males (n = 3 each) were incorporated into two flocks under semi-extensive management and grazed daily with females for 7 h. One group of males did not receive any treatment (control group). The other group was submitted to long days and nutritional supplementation as in experiment 1 (long-day+supplementation group). Males remained with females during the whole study. The pregnancy rate was greater in the goats joined by males of the long-day+supplementation group (78%) than in those from the control group (0%; P < 0.001). We conclude that long days and nutritional supplementation improve the ability of bucks kept in semi-extensive management to stimulate reproduction of out-of-season goats in confined or semi-extensive management systems.

Pharmacological stress test for myocardial ischemia when Adenosine is contraindicated: prospective documentation of side effects in over 700 patients with COPD or bronchial asthma

Background

In the face of an increasingly elder population, physical exercise tests become less feasible with an increasing need for pharmacological stress tests, preferably with imaging techniques. For myocardial stress tests provoking myocardial ischemia, vasodilator stress is most frequently used. Whereas Dipyridamole should be obsolete, the predominant drug applied within this context is Adenosine for myocardial scintigraphy, magnetic resonance imaging and FFR. Adenosine, however, is contraindicated in patients with COPD or bronchial asthma, predominantly due to a possible exacerbation of bronchospasm or other pulmonary side effects. In contrast, Regadenoson, was especially developed as a highly selective A2A receptor agonist to circumvent these problems.

Methods

Regadenoson was applied with the standard injection dose of 400 μg in 780 consecutive patients with a history of COPD or bronchial asthma for SPECT myocardial perfusion scintigraphy. 12% of the patients had a preexisting first degree AV-block. Blood pressure, heart rate and possible side effects were prospectively monitored and documented for 10 minutes after the injection.

Results

The mean age was 70.8±8.9 years, 52% of the patients were female, 48% were male. 69% had a history of COPD and 31% of bronchial asthma. The maximum increase in heart rate was significant from 66.1±8.1 to 98.3±17.4 bpm. The maximum decrease in systolic blood pressure was significant from 124.3±12.9 to 117.3±24.7 mmHg. Most frequent side effects were a feeling if increased breathing (73%), headache (22%), feeling of warmth (22%), pressure in the stomach (17%) and pressure in the chest (16%). Complications: only 1 patient (without preexisting first degree AV-block) developed a systolic drop in blood pressure from 107 to 60 mmHg with transient severe dyspnoea. No induction of bronchospasm or other pulmonary side effects were observed.

Conclusion

In patients with COPD or bronchial asthma undergoing a pharmacological stress test, Adenosine is contraindicated due to its – potentially severe – pulmonary side effects, Regadenoson is the vasodilator of choice in these patients. In our series, no severe complication was observed – even not in patients with a preexisting first degree AV-block.

Funding Acknowledgement

Type of funding source: None

Usefulness of the coronary artery calcium (CAC) score for statin prescription in primary prevention: results in over 16.000 assessments

Background

The latest AHA/ACC cholesterol guidelines on primary prevention of coronary artery disease (CAD) recommend the use of the CAC-score to help in decision making for not using or using statins: If the CAC-score is 0, it is reasonable to withhold statin therapy (as long as higher conditions are absent). If CAC-score is 1 - 99, it is reasonable to initate statin therapy for patients ≥55 years of age. If the CAC-score is ≥100, it is reasonable to initiate statin therapy. Therefore, in the present analysis, we assessed the impact of these guidelines in everyday cardiology practice.

Methods

We analysed our data base with 16083 assessments of the CAC-score in persons with no known coronary or other cardiovascular disease and no exercise-dependent chest pain or shortness of breath. The CAC-score was determined with a multi-slice CT. Using the “step-and-shoot” acquisition protocol, the average dose was around 1 mSv.

Results

In the total group, a CAC-score of 0 was found in 35%, a CAC-score of &gt;0 up to &lt;100 in 36% and ≥100 in 29%. The percentage of the above mentioned 3 CAC-score groups depending on age and gender are listed in table 1.

Conclusion

With the support of the CAC-score, a prescription of statins can be avoided in up to appr. 60% of middle-aged male and up to appr. 80% of middle-aged female persons. On the other hand, the use of statin is reasonable in appr. two thirds of higher-aged male and one third of higher-aged female persons for primary prevention.

Funding Acknowledgement

Type of funding source: None

Is it time to reconsider the relative weight of sociosexual relationships compared with photoperiod in the control of reproduction of small ruminant females?

In goats and sheep from the temperate and subtropical latitudes, the breeding season lasts from early autumn to late winter, whereas the anestrous season lasts from late winter to late summer. In prepubertal or postpartum females, the duration of the quiescent period depends mainly on the season of parturition and of nursing duration. In both situations, the ovulatory activity starts only during the breeding season. Photoperiod has been generally considered as a major regulator of all these periods of reproductive activity/inactivity in female sheep and goats (ie puberty, seasonal anestrus, postpartum anestrus). In particular, regarding seasonal anestrus, the sociosexual interactions between males and females have been considered to have only a modulatory role, limited to few weeks preceding the onset or after the offset of the breeding season. Nonetheless, we recently showed that the use of sexually active males plays a crucial role to trigger ovulatory and estrous activities during the anestrous season and also in prepubertal and postpartum females. In fact, in females exposed to sexually active males, puberty is strikingly advanced in comparison with females exposed to sexually inactive castrated males or to isolated females (6 mo vs 7.5 mo). Most females (>85%) exposed during the anestrous season to sexually active males ovulated, whereas a low proportion of them ovulated when in contact with sexually inactive males (<10%). Interestingly, the presence of these sexually active males allows females to ovulate all the year round and prevents the seasonal decrease of LH plasma concentrations in ovariectomized females treated with an estradiol implant. Finally, the presence of sexually active males triggers ovulation in postpartum anestrous females nursing their offspring. All these findings show that sexually active males can play an important role to reduce anestrous periods. We need, therefore, to reconsider the relative weight of sociosexual relationships, compared with photoperiod, in the management of reproduction of goat does and ewes.

THU0008 DEVELOPMENT OF A NOVEL TRANSLATIONAL IN SILICO INDICATION DISCOVERY FRAMEWORK: EXEMPLIFIED BY THE CLINICAL COMPOUND CENERIMOD

Background:

To explore the full therapeutic spectrum of a drug it is crucial to consider its potential effectiveness in all diseases. Serendipitous clinical observations have often shown that approved drugs and those in development to be efficacious in indications different to those originally tested for. Traditional approaches to match a drug candidate with possible indications are mostly based on matching drug mechanistic knowledge with disease pathophysiology. Proof-of-concept trials or elaborate pre-clinical studies in animal models do not allow for a broad assessment due to high costs and slow progress. Gene expression changes in patients or animal models represent a good proxy to comprehensively assess both disease and drug effects. Furthermore, this data type can be integrated with a plethora of publicly available data.

Objectives:

Generation of a novel in silico framework to support the selection and expansion of potential indications which associate with a compound or approved drug. The framework was exemplified by the clinical compound cenerimod, a potent, selective, and orally active sphingosine-1-phosphate receptor 1 modulator (Piali et al., 2017).

Methods:

A total of ~13’000 public patient gene expression datasets from ~140 diseases were evaluated against cenerimod gene expression data generated in mouse disease models. To improve comparability of studies across platforms and species, computer algorithms (neural networks) were trained and employed to reduce noise within the data sets and improve signal. The predicted response to cenerimod for individual patients was contrasted against clinical patient characteristics.

Results:

The neural network algorithm efficiently reduced experimental noise and improved sensitivity in the gene expression data. The results predicted cenerimod to be efficacious in several auto-immune diseases foremost SLE. Additionally, focused analysis on individual patients rather than disease cohorts revealed potential determinants predictive of maximal clinical response, with the highest predicted clinical response for cenerimod in patients with severe inflammatory endotype and/or high SLE Disease Activity Index (SLEDAI).

Conclusion:

Combining preclinical compound data with the wealth of public disease gene expression data, provides great potential to support indication selection. The novel in silico framework identified SLE as a prime potential indication for cenerimod and supported the cenerimod phase 2b clinical trial in patients with SLE (CARE study,NCT03742037).

References:

[1]Piali, L., Birker-Robaczewska, M., Lescop, C., Froidevaux, S., Schmitz, N., Morrison, K., … Nayler, O. (2017). Cenerimod, a novel selective S1P1 receptor modulator with unique signaling properties. Pharmacology Research & Perspectives, 5(6), 1–12.https://doi.org/10.1002/prp2.370

Disclosure of Interests:

Dominik Hartl Shareholder of: Idorsia shares, Employee of: Idorsia employee, Marcel Keller Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Axel Klenk Shareholder of: Idorsia option/shares, Employee of: Idorsia employee, Mark Murphy Shareholder of: Idorsia shares and stock options, Employee of: Idorsia employee, Marianne Martinic Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Gabin Pierlot Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Peter Groenen Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Daniel Strasser Shareholder of: Idorsia options/shares, Employee of: Idorsia employee

SAT0165 PRECLINICAL AND CLINICAL CHARACTERIZATION OF CENERIMOD, A POTENT, SELECTIVE, AND ORALLY ACTIVE SPHINGOSINE-1-PHOSPHATE RECEPTOR 1 MODULATOR IN SLE

Background:

SLE is an autoimmune disease characterized by aberrant lymphocyte activation and autoantibody production. In SLE, autoreactive lymphocytes migrate from lymphoid organs into the blood, and subsequently into tissue. This leads to systemic and multiorgan inflammation and pathology resulting in significant morbidity and mortality. Lymphocyte migration is a tightly controlled process driven by chemokine gradients. The chemotactic gradient across the vascular barrier established by sphingosine-1-phosphate (S1P) orchestrates egress of lymphocytes out of peripheral lymphoid organs into the blood. Cenerimod is a potent, selective, and orally active S1P receptor 1 (S1P1) receptor modulator that induces receptor internalization and thereby prevents lymphocyte egress from lymphoid organs into the blood [1].

Objectives:

In-depth preclinical and clinical characterization of cenerimod in modulating SLE.

Methods:

Lymphocytes from patients with SLE and healthy subjects were assessed for cenerimod-induced S1P1receptor internalization. Efficacy of cenerimod was evaluated in the MRL/lpr lupus mouse model. In a 12-week phase 2 clinical trial in patients with SLE treated with multiple doses of cenerimod (NCT02472795), lymphocyte subsets and inflammatory biomarkers were characterized.

Results:

Cenerimod was potent and efficacious at inducing S1P1receptor internalization in T and B lymphocytes with an EC50of 15 nM in both healthy subjects and patients with SLE. In lupus-like MRL/lpr mice treated with cenerimod, circulating T and B lymphocytes were reduced, which resulted in reduced immune infiltrates into tissue, reduced autoantibody production and inflammation, decreased proteinuria, and increased survival. In patients with SLE treated with cenerimod for 12 weeks, a dose-dependent reduction of circulating T cells (95%), B cells (90%), and antibody-secreting cells (85%) was evident. Furthermore, a reduction in anti-dsDNA antibodies and IFN-α, associated with an inflammatory phenotype, was observed.

Conclusion:

Cenerimod was potent and efficacious in reducing S1P1receptor surface expression on lymphocytesin vitro, and in reducing circulating T and B lymphocyte populations, including antibody-secreting cells, and in decreasing inflammatory biomarkers in patients with SLEin vivo. Furthermore, cenerimod significantly ameliorated systemic and organ-specific autoimmunity in a mouse model of SLE. These results support the further investigation of the clinical efficacy and safety of cenerimod in the ongoing phase 2b clinical trial (NCT03742037).

References:

[1]Piali L, Birker-Robaczewska M, Lescop C, Froidevaux S, Schmitz N, Morrison K, et al. Cenerimod, a novel selective S1P1 receptor modulator with unique signaling properties. Pharmacol Res Perspect. 2017 Dec; 5(6).

Acknowledgments:

This research was funded by Idorsia Pharmaceuticals Ltd

Disclosure of Interests:

Daniel Strasser Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Estelle Gerossier Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Virginie Sippel Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Ursula Grieder Shareholder of: Idorsia options/shares, Employee of: Idorsia, Andrea Kieninger: None declared, Gabin Pierlot Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Hervé Farine Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Paulina Kulig Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Marcel Keller Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Sylvie Froidevaux Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Marten Trendelenburg Grant/research support from: Idorsia Pharmaceuticals Ltd, Novartis Institute of Biomedical Research, F. Hoffmann-La Roche Ltd, Marianne Martinic Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Mark Murphy Shareholder of: Idorsia shares and stock options, Employee of: Idorsia employee

Male effect using photostimulated bucks and nutritional supplementation advance puberty in goats under semi-extensive management

Well-nourished spring-born female goats reach puberty in the autumn of the same year. Contrastingly, undernourished spring-born females reach puberty in the autumn of the following year. Therefore, in this study, we reared female goats (undernourished) under semi-extensive management and determined whether the introduction of photostimulated, sexually active males, advances puberty in these females, and whether nutritional supplementation increases the proportion of kidding females. Goats were born on March 30 and weaned at 2 months of age. Then, they grazed natural vegetation from 10:00 to 18:00 each day. Starting in December, two groups did not receive feed supplementation after grazing, whereas two other groups received 600 g daily supplements of a commercial concentrate. In April, one non-supplemented (n = 10) and other supplemented groups (n = 11) were moved indoors and kept in separate pens, where they were joined with sexually active bucks (n = 1 per group). Males were rotated daily between groups for 7 days. Other non-supplemented (n = 8) and supplemented groups (n = 11) were not joined with males. Most of the female goats under study reached puberty (70-100%). However, in supplemented and non-supplemented groups joined with males, puberty commenced much earlier (April) than in those non-exposed to males (September) (P < 0.001). The proportion of pregnant goats did not differ between groups joined with males (P > 0.05), but the proportion of goats that kidded was higher in supplemented (7/11) than in non-supplemented goats (2/10) (P < 0.05). In conclusion, in spring-born goats, the male effect using sexually active males advanced puberty, and nutritional supplementation increased the proportion of kidding goats in females reared under semi-extensive management.

Expression III: patients' expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries

Backround

The primary aim of this study was to investigate information needs and treatment preferences of patients with ovarian cancer, focusing especially on physician-patient relationship and treatment.

Patients and methods

A questionnaire was developed based on the experiences of the national German survey 'Expression II', and was provided to patients with ovarian cancer either at initial diagnosis or with recurrent disease via Internet (online-version) or as print-out-version.

Results

From December 2009 to October 2012, a total of 1830 patients with ovarian cancer from eight European countries (Austria, Belgium, France, Germany, Italy, Poland, Romania, Spain) participated, 902 (49.3%) after initial diagnosis and 731 (39.9%) with recurrent ovarian cancer. The median age was 58 years (range 17-89). Nearly all patients (96.2%) had experienced upfront surgery followed by first-line chemotherapy (91.8%). The majority of patients were satisfied with the completeness and comprehensibility of the explanation about the diagnosis and treatment options. The three most important aspects, identified by patients to improve the treatment for ovarian cancer included: 'the therapy should not induce alopecia' (42%), 'there must be more done to counter fatigue' (34.5%) and 'the therapy should be more effective' (29.7%). Out of 659 (36%) patients, who were offered participation in a clinical trial, 476 (26%) were included.

Conclusion

This study underlines the high need of patients with ovarian cancer for all details concerning treatment options irrespective of their cultural background, the stage of disease and the patient's age. Increased information requirements regarding potential side effects and treatment alternatives were recorded. Besides the need for more effective therapy, alopecia and fatigue are the most important side effects of concern to patients.

Continuous presence of females in estrus does not prevent seasonal inhibition of LH and androgen concentrations in bucks

In male goats, being in permanent visual contact with females in estrus does not prevent seasonal variation in certain endocrine hormone levels and sexual activities. In this study, we tested whether continuous and full contact with females in estrus prevented seasonal endocrinological variation in bucks. In 1 experiment (Exp. 1), we verified that the sudden introduction of goats in estrus increased the plasma concentrations of androgen in bucks during the nonbreeding season under our experimental conditions. In another experiment (Exp. 2), we tested the ability of estrous goats to prevent seasonal inhibition of LH and androgen secretions in bucks kept in permanent and full contact with them. In Exp. 1, 3 groups of bucks (n = 5 in each group) were isolated from females from the months of July to January. On January 27, one group continued being isolated from females; a second group was exposed to ovariectomized, untreated goats; and a third group was exposed to ovariectomized goats with induced estrus. Plasma androgen concentrations were determined every 2 h from 8 h before to 8 h after the introduction of females. The introduction of estrus-induced goats significantly increased androgen concentrations, which were higher than in the isolated bucks, as well as in those exposed to untreated goats (P < 0.05). In Exp. 2 (n = 5 per group), one group of bucks was isolated from females from October to July, whereas two other groups remained in contact with ovariectomized goats, either untreated or regularly induced to estrus. In the three groups of bucks, plasma concentrations of LH were determined once during the months of October, February, March, and June, whereas androgen concentrations were determined weekly from October to July. The mean plasma LH and androgen concentrations were low and did not differ among the groups of bucks during the normal seasonal period of sexual inactivity (P > 0.05). We conclude that full contact and sexual interactions with estrus-induced goats failed to stop the seasonality of LH and androgen plasma concentrations of bucks, although bucks could respond to the introduction of females by acute increases in plasma LH and androgen.

Highly precocious activation of reproductive function in autumn-born goats (Capra hircus) by exposure to sexually active bucks

Goats are seasonal breeders with the main cue controlling the timing of breeding season being photoperiod. Hence, the season of birth impacts puberty onset: spring-born goats reach puberty in autumn, at 7 mo of age, whereas autumn-born goats reach puberty at 1 yr during the next reproductive season. The aim of this study was to determine whether exposure of autumn-born young females to sexually active males could counteract the delay in puberty onset observed in autumn-born goats. Females exposed to sexually active males (n = 8) reached puberty earlier than isolated females (n = 8), with exposed females ovulating at a mean age of 3.5 mo. To our knowledge, such precocious puberty onset obtained through social stimulation has never been described in the literature. Moreover, those exposed females exhibited estrus behavior for most ovulations. Our results indicate that in goats born out of season, exposure to sexually active bucks is a really efficient approach to induce early puberty, suggesting that social interactions could have a crucial impact on the regulation of pubertal transition.

Light-induced sexually active rams prevent the seasonal inhibition of luteinizing-hormone in ovariectomized estradiol-implanted ewes

The effect of the continuous presence of sexually active Rasa Aragonesa rams on the plasma luteinizing-hormone (LH) concentrations of ewes was studied from November to May. Light-treated rams were rendered sexually active (SA rams) by exposure to 2 months of artificially long days (16 h light/8 h dark) in one of two groups from either 1 November (SAR1, n = 3) or 1 December (SAR2, n = 3). Rams (n = 6) in a Control group were kept under the natural photoperiod. Thirty ewes were ovariectomized in September and implanted with a subcutaneous implant (l = 15 mm) that contained estradiol-17β. One group of ewes (SAR; n = 10) was housed with control rams from 1 October to 15 February before being housed with SAR1 rams from 16 February to 31 March, and with SAR2 rams from 1 April to 31 May. A second group of ewes (C; n = 10) remained with control rams throughout the experiment, and a third group was kept isolated from rams throughout the experiment (ISO; n = 10). Blood samples were collected weekly from November to May, and plasma LH concentrations were measured. In the breeding season (November-February), plasma LH concentrations of ewes did not differ significantly between groups (SAR: 2.00 ± 0.34; C: 1.88 ± 0.16; ISO: 1.67 ± 0.51 ng/ml). From March to May (seasonal anestrus), however, LH plasma concentrations decreased in the C and ISO groups (1.30 ± 0.20 and 0.48 ± 0.04 ng/ml, respectively), but remained at the same level as in the breeding season in the SAR group (2.30 ± 0.17 ng/ml; P < 0.001). Significant differences (P < 0.01) between groups were observed from March onwards: LH concentrations were highest in SAR ewes (P < 0.001) and lowest in the ISO ewes. In conclusion, the continuous presence of sexually active rams prevented the seasonal decrease in plasma LH concentrations, probably by preventing the seasonal negative feedback of estradiol on LH secretion.

A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer

PURPOSE

To evaluate the practice patterns among centers and physicians worldwide regarding sentinel lymph node biopsies (SLNB) in cervical cancer (CC) patients.

METHOD

A validated 35-item questionnaire regarding SLNB in CC supported by the Gynecologic Cancer Intergroup (GCIG), and sponsored by the North-Eastern German Society of Gynaecologic-Oncology (NOGGO) was sent to all major gynecological cancer societies across the globe for further distribution from October 2015 and continued for a period of 7 months.

RESULTS

One hundred and sixty-one institutions from around the world participated. One hundred and six (66%) of the participants were from university centers and 111 (69%) were gynecologic oncologists. One hundred and fifty-two (97%) performed lymphadenectomy (LNE) and 147 (94%) did so systematically; 97 (60%) used SLNB, due to lower morbidity (73%), reliability (55%) and time-saving (27%). In cases of positive SLNB (pN+), 39% of respondents stopped the operation and sent the patient for chemoradiation (CRT), 45% completed pelvic and paraaortic LNE, whereas 26% went on to perform a radical hysterectomy (RH) and systematic pelvic and paraaortic LNE. In case of negative SLNB (pN0), 39% of institutions still performed a systematic pelvic and paraaortic LNE.

CONCLUSION

In this survey worldwide, SLNB adoption is an encouraging 60%, yet ample differences exist regarding strategy, and to a lower extent the techniques used. Lack of experience is the most common reason SLNB is not performed. Efforts to increase surgical education on SLNB technique and multicenter prospective trials providing evidence-based guidelines are warranted.

Patients' perspectives towards malignant ascites: results of a prospective observational trial regarding expectations, characteristics and quality of life-a study of the North-Eastern-German Society of Gynecological Oncology

PURPOSE

Malignant ascites (MA) is a frequent and common symptom in (gyneco-) oncological patients. The present trial evaluated and assessed patients' characteristics, clinical features and the possible influence of MA on QoL measurements.

METHODS

A prospective observational trial was conducted from Oct 2013 until Nov 2016. Therefore an interdisciplinary questionnaire was developed. Overall 250 patients with histological confirmed MA were included with different cancer entities (gynecological, gastrointestinal). The correlation of MA caused symptoms and QoL measurements was assessed using Kendall's tau b. Multivariable logistic regression models were applied to analyze the risks of symptoms or severe limitation in daily activities.

RESULTS

125 questionnaires could be analyzed. The majority of patients with MA had diagnosis of ovarian cancer (68.8%) and were under current cancer treatment (57.6%), mostly chemotherapy. Over 50% reported abdominal tension as major symptom, around 56% of the patients had MA when cancer was firstly diagnosed. Regression analysis showed that patients with MA above 2l were significantly more likely to be harmed in everyday activities. However, the age, gender, type of malignancy and the current treatment (chemotherapy vs. no chemotherapy) had no significant influence.

CONCLUSION

MA has a significantly impact on QoL measurements in cancer patients and might influence everyday activities including basic needs like eating, walking and body care. There is a high need for more information and education of patients with MA.

Progesterone doses of 5, 3 or 1 mg do not prevent short ovulatory cycles in goats exposed to photo-stimulated bucks

The aim of this study was to determine whether lower doses than 25 mg of progesterone reduce the frequency of short ovulatory cycles in seasonal anestrous goats exposed to sexually active bucks. Females from the control group were given an im dose of 2 mL olive oil (n = 9). Females from the experimental groups were given an im dose of 1 mg (n = 15), 3 mg (n = 16), 5 mg (n = 15) or 25 mg (n = 16) of progesterone diluted in 2 mL olive oil, 48 h prior exposition to bucks (n = 1 per group). Males were daily switched among groups, and they remained with goats during 21 days. The proportion of goats that ovulated was high (≥87%), and was not different among groups (P > 0.05). In contrast, the proportion of goats that displayed short ovulatory cycles differed among groups (P < 0.05). Indeed, the proportion of goats displaying short ovulatory cycles was lower in those treated with 25 mg (12%) than in those from the control (78%), 1 mg (85%), 3 mg (50%), or 5 mg (71%) groups (P < 0.05), but there were no differences among these last four groups (P > 0.05). Finally, the percentage of kidding females (≥40%) and the number of kids born per female (≥1.4) did not differ among groups (P > 0.05). In conclusion, an im dose of 25 mg of progesterone was more effective than 5, 3 or 1 mg to avoid the short ovulatory cycles in seasonal anestrous goats exposed to the male effect.

Abstract P1-13-01: Final results of the ASG1-3 study, a randomized phase III study comparing a standard dose chemotherapy with epirubicin/cyclophosphamide and paclitaxel with a dose dense regimen with epirubicin and paclitaxel

Background

Dose dense chemotherapy (DDT) has shown improvements of disease-free survival (DFS) and overall survival for primary breast cancer patients with a high risk of relapse. There are much less data about the effect of DDT in patients with intermediate risk of recurrence (1-3 positive axillary lymph nodes). Aim of this prospectively randomized trial was to investigate the superiority of a DDT schedule over a standard chemotherapy (ST) in primary breast cancer patients with 1-3 positive axillary lymph nodes.

Methods

The ASG1-3 study is a prospectively randomized, open label phase III study of the Adjuvant Study Group of the NOGGO association. Patients were eligible for the trial, if they had a primary invasive breast cancer (pT1-3) with 1-3 positive axillary lymph nodes and no evidence of distant metastases. Patients were randomized to an adjuvant therapy with either 4 cycles epirubicin (90mg/m2 body surface area, BSA) and cyclophosphamide (600mg/m2 BSA) q3w, followed by 4 cycles of paclitaxel (175mg/m2 BSA) referred to as ST or to a therapy with 4 cycles of epicubicin (120 mg/m2 BSA) q2w and primary G-CSF support followed by 4 cycles of paclitaxel (175mg/m2 BSA) q2w and primary G-CSF support referred to as DDT. Trastuzumab was not given in this study. The study was designed to show an increase of 70% DFS (ST) to 80% DFS (DDT) 5 years after randomization. Comparisons were conducted using Kaplan Meier estimates, log rank tests and Cox regression analyses. In an exploratory way, subgroup analyses were performed for HER2, hormone receptor status and grading using Cox regression models with interaction terms.

Results

A total of 936 patients were eligible for survival analysis, of which 465 were randomized to ST and 471 to DDT from 2001 to 2004. Patient characteristics were mainly well balanced, with patients being 52.5/52.1 years old, 71.9/78.1% being hormone receptor positive, 24.4/24.6% being HER2 positive and 38.6/38.8% having a tumor grade of 3 in the ST arm and DDT arm respectively. 53 events occurred after ST and 46 after DDT. Adjusted hazard ratio (HR) was 0.87 (95%CI: 0.57-1.35; p=0.54). 5 year DFS rates were 85% (ST) vs. 87% (DDT). Hematological toxicities were the most common grade 3 or 4 adverse events. Grade 3/4 neutropenia occurred in 57.2 vs. 28.0%, grade 3/4 anemia in 15.3% vs. 17.1% and grade 3 /4 pain symptoms were seen in 13.2 vs. 12.4% of the patients in the ST arm vs. DDT arm respectively. Other grade 3/4 toxicities were less frequent than 10%. Subgroup analysis showed a significant interaction (p&lt;0.001) between HER2 status and randomization arm with regard to DFS. In HER2 negative patients the HR was 1.53 (95%CI: 0.91-2.59), whereas in HER2 positive patients the HR was 0.22 (95%CI: 0.09-0.55). Patients with HER2 positive disease and DDT had a similar prognosis like HER2 negative patients.

Conclusion

In the overall population a statistically significant improvement of DFS could not be shown for the DDT arm. In patients with HER2 positive breast cancer DDT chemotherapy improved the disease-free survival to a prognosis which was similar to patients with HER2 negative disease.

Citation Format: Fasching PA, Eggemann H, Krocker J, Häberle L, Volz B, Kleine-Tebbe A, Blohmer J-U, Kittel K, Hufnagel M, Janni W, Emons G, Simon E, Köhler U, Thomssen C, Kohls A, Beckmann MW, Hielscher C, Krabisch P, Zeiser T, Brodkorb T, Baier F, Nabieva N, Kellner S, Untch M, Stadie S, Budner M, Breitbach G-P, Keller M, Stickeler E, Kühn T, Tolkmitt M, Belau AK, Schmidt M, Ulm K, Kümmel S. Final results of the ASG1-3 study, a randomized phase III study comparing a standard dose chemotherapy with epirubicin/cyclophosphamide and paclitaxel with a dose dense regimen with epirubicin and paclitaxel [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 P1-13-01.

Abstract OT1-12-03: RESCUE: Reaching for Evidence-baSed Chemotherapy Use in Endocrine sensitive breast cancer - A prospective health care study on risk assessment by the clinicomolecular test EndoPredict® and long-term patient outcome in early luminal breast cancer

Background: In node negative and 1-3 positive nodes breast cancer patients with hormone receptor positive (HR+), HER2-negative (HER2-) early-stage breast cancer the indication for chemotherapy is based on clinical and pathologic risk stratification (tumor size, nodal status, grading, quantitative ER, progesterone receptor and Ki67). For further decision-making, the EndoPredict test, which combines a molecular signature with the clinical risk factors tumor size and nodal status, stratifies patients into “low risk" or “high risk” groups. Level I-B- evidence demonstrates, that EndoPredict predicts the 10 year cumulative risk of relapse and metastases in patients with HR+/HER2- primary breast cancer with endocrine treatment.

Aim: In the RESCUE-Trial we document distant metastasis-free survival (DMFS), disease free survival (DFS) and overall survival (OS) events in patients who had an EndoPredict test. The primary objective is to show that 10-year DMFS of patients tested as “low risk” by EndoPredict and treated with adjuvant endocrine therapy alone is &gt;90 %. Secondary endpoints among others include DMFS, DFS, OS in patients with EPclin “low risk” versus “high risk”. Also the proportion of patients whose treatment was concordant and non-concordant with EndoPredict test results, will be analyzed for survival. The prognostic performance of classical prognostic factors (like tumor size, nodal status, grading, quantitative ER, progesterone receptor and Ki67 level) with respect to survival will also be assessed.

Eligibility: Patient with HR+/HER2- primary invasive breast cancer stage I/II and T1 to T3 with 0 to 3 positive lymph nodes will be eligible, if they had an EndoPredict test within three months before inclusion.

Methods: The EndoPredict test results, tumor board decision and anti-tumor therapy will be assessed. After one year, annually (for 10 years), patients will be evaluated for treatment compliance, recurrence, metastases, and survival. The primary endpoint will be analyzed by a Kaplan-Meyer estimate for which a one-sided lower 95 % confidence interval will be given. Several secondary endpoints will be assessed in three interim analyses after completion of the 1st, 3rd, 5th year and then finally after 10 years.

Accrual: Start of accrual is planned for July 2018. At least 26 sites in Germany and one site in Switzerland will be active.

Sponsor: The study is sponsored by the North-Eastern-German Society of Gynecological Oncology (NOGGO) e.V.

Contact Information: For further information, contact NOGGO via studies@noggo.de or the leading physician Dr. Johannes Ettl via johannes.ettl@tum.de.

Citation Format: Ettl J, Blohmer J-U, Denkert C, Keller M, Klein E, Kronenwett R, Neuser P, Paepke S, Schade-Brittinger C, Schnuppe K, Untch M, Wittenberg M, Kiechle M. RESCUE: Reaching for Evidence-baSed Chemotherapy Use in Endocrine sensitive breast cancer - A prospective health care study on risk assessment by the clinicomolecular test EndoPredict® and long-term patient outcome in early luminal 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 OT1-12-03.

Initial Characterization of Transgenic Mice Overexpressing Human Histamine H2 Receptors

In an integrative approach, we studied the role of histamine H₂ receptors in the mouse heart. We noted that histamine, added cumulatively to the organ bath, failed to affect the force of contraction in left atrial preparations and did not change spontaneous heart rate in right atrial preparations from wild-type mice. By contrast, in the same preparations from mice that overexpressed the human H₂ receptor in a cardiac-specific way, histamine exerted concentration- and time-dependent positive inotropic and positive chronotropic effects. Messenger RNA of the human H₂ receptor was only detected in transgenic mice. Likewise, immunohistology and autoradiography only gave signals in transgenic but not in wild-type cardiac preparations. Similarly, a positive inotropic and positive chronotropic effect was observed with histamine in echocardiography of living transgenic mice and isolated perfused hearts (Langendorff preparation). Phosphorylation of phospholamban was increased in atrial and ventricular preparations from transgenic mice, but not in wild-type animals. The effects of histamine were mimicked by dimaprit and amthamine and antagonized by cimetidine. In summary, we generated a new model to study the physiologic and pathophysiologic cardiac role of the human H₂ receptor.

Photochromic peptidic NPY Y4 receptor ligands

Photoresponsive NPY Y₄R ligands, containing an azobenzene, azopyrazole, diethienylethene or a fulgimide chromophore were prepared to explore structural requirements of Y₄R agonists on Y₄R binding.

Native insectary plants support populations of predatory arthropods for Australian vineyards

We provide a summary of two recent studies that investigated the role that three native insectary plants can play in promoting predatory arthropods, and thereby to enhance biological control of vineyard pests in Australia. Native plants are preferred as supplementary flora, as they are locally-adapted to Australia's climatic conditions. Stands of mature Bursaria spinosa, Leptospermum continentale and Rytidosperma ssp. located adjacent to, or in vineyards, in South Australia were sampled for arthropods in 2013/14. Grapevines were also sampled to explore relationships between each plant and associated arthropods using common diversity indices. Twenty seven thousand and ninety-one individual invertebrate specimens were collected, comprising 20 orders and 287 morphospecies. These were categorised into functional groups of predators, herbivores and other. Predatory arthropods dominated the diversity of morphospecies present on each plant. The richness of predator morphospecies across all plant types was nearly double the number found in association with grapevines. It may be possible to increase the functional diversity of predatory arthropods by more than 3x when either B. spinosa or L. continentale is present versus grapevines only, and increase the net number of predator morphospecies by around 27% when Rytidosperma ssp. are planted in combination with grapevines. The selected plants provide a suitable habitat to support diverse and functional populations of predatory arthropods. The opportunity to plant selected native insectary species could help wine grape growers save time and resources by producing fruit with lower pest incidence, while enhancing biodiversity associated with vineyards.