Psychological Impacts of Retained Bullets From the Perspective of Survivors

INTRODUCTION

Despite a high prevalence of retained bullet fragments (RBFs) after firearm related injury (FRI) there is limited data on the full spectrum of their consequences, particularly the psychological impacts on those injured. Further, the experiences of FRI survivors with RBFs are missing from existing literature. The objective of this study was to explore the psychological impacts of RBFs on individuals who have experienced recent FRI.

METHODS

Adult (18-65 years) survivors of FRI with radiographically confirmed RBFs were purposively selected from an urban Level 1 trauma center in Atlanta, Georgia, to participate in an in-depth interview. Interviews were conducted between March 2019 and February 2020. Thematic analysis was used to identify a range of psychological effects from RBFs.

RESULTS

Interviews from 24 FRI survivors were analyzed: the majority of participants were Black males (N = 22, 92%) with a mean age of 32 years whose FRI occurred ∼8.6 months prior to data collection. The psychological effects of RBFs were grouped into four categories: physical health (eg, pain, limited mobility), emotional well-being (eg, anger, fear), social isolation, and occupational welfare (eg, disability leading to inability to work). A range of coping mechanisms were also identified.

CONCLUSION

Survivors of FRI with RBFs experience a range of psychological impacts that are far-reaching and affect daily activities, mobility, pain and emotional wellbeing. Study results indicate a need for enhanced resources to support those with RBFs. Further, changes to clinical protocols are warranted on removal of RBFs and communication about the effects of leaving RBFs in situ.

Laser-direct-drive fusion target design with a high-Z gradient-density pusher shell

Laser-direct-drive fusion target designs with solid deuterium-tritium (DT) fuel, a high-Z gradient-density pusher shell (GDPS), and a Au-coated foam layer have been investigated through both 1D and 2D radiation-hydrodynamic simulations. Compared with conventional low-Z ablators and DT-push-on-DT targets, these GDPS targets possess certain advantages of being instability-resistant implosions that can be high adiabat (α≥8) and low hot-spot and pusher-shell convergence (CR_{hs}≈22 and CR_{PS}≈17), and have a low implosion velocity (v_{imp}<3×10^{7}cm/s). Using symmetric drive with laser energies of 1.9 to 2.5MJ, 1D lilac simulations of these GDPS implosions can result in neutron yields corresponding to ≳50-MJ energy, even with reduced laser absorption due to the cross-beam energy transfer (CBET) effect. Two-dimensional draco simulations show that these GDPS targets can still ignite and deliver neutron yields from 4 to ∼10MJ even if CBET is present, while traditional DT-push-on-DT targets normally fail due to the CBET-induced reduction of ablation pressure. If CBET is mitigated, these GDPS targets are expected to produce neutron yields of >20MJ at a driven laser energy of ∼2MJ. The key factors behind the robust ignition and moderate energy gain of such GDPS implosions are as follows: (1) The high initial density of the high-Z pusher shell can be placed at a very high adiabat while the DT fuel is maintained at a relatively low-entropy state; therefore, such implosions can still provide enough compression ρR>1g/cm^{2} for sufficient confinement; (2) the high-Z layer significantly reduces heat-conduction loss from the hot spot since thermal conductivity scales as ∼1/Z; and (3) possible radiation trapping may offer an additional advantage for reducing energy loss from such high-Z targets.

Empathy marketing during COVID-19 pandemic: decoding the impact and effectiveness on the brand image

For brands, empathy can create a customer persona, which can help in effectively targeting their consumers. In terms of marketing, however, it means asking what customers truly value rather than what will sell. Moreover, by creating content that evokes empathy, consumers are more likely to take action – sharing, responding, and even prompting change within their communities. Nevertheless, why are brands suddenly realizing the power of empathy? This is because consumers today are not only interested in passively consuming content. Instead, they actively seek out content that prompts a change in themselves and the world around them. This need of the hour made the brand realize the power of effective communication and hence the rise of empathy as a useful marketing tool. The research used a qualitative approach to understand the effectiveness of Empathy marketing during the pandemic hit time. Focus Group Discussions were conducted to understand the importance and relevance of empathy-based communication. The findings established that this type of communication is useful and helps the consumer create a positive brand image and a recall, but this may not directly impact or lead to a purchase decision.

Lung cancer: Premalignant biology and medical prevention

Lung cancer (both adenocarcinoma and squamous cell) progress through a series of pre-malignant histologic changes before the development of invasive disease. Each of these carcinogenic cascades is defined by genetic and epigenetic alterations in pulmonary epithelial cells. Additionally, alterations in the immune response, progenitor cell function, mutational burden, and microenvironmental mediated survival of mutated clones contribute to the risk of pre-malignant lesions progressing to cancer. Medical preventions studies have been completed and current and future trials are informed by the improved understanding of pre-malignancy. This will lead to precision chemoprevention trials based on lesional biology and histologic characteristics.

Potential of engineered nanostructured biopolymer based coatings for perishable fruits with Coronavirus safety perspectives

Fresh fruits are prioritized needs in order to fulfill the required health benefits for human beings. However, some essential fruits are highly perishable with very short shelf-life during storage because of microbial growth and infections. Thus improvement of fruits shelf-life is a serious concern for their proper utlization without generation of huge amount of fruit-waste. Among various methods employed in extension of fruits shelf-life, design and fabrication of edible nanocoatings with antimicrobial activities have attracted considerable interest because of their enormous potential, novel functions, eco-friendly nature and good durability. In recent years, scientific communities have payed increased attention in the development of advanced antimicrobial edible coatings to prolong the postharvest shelf-life of fruits using hydrocolloids. In this review, we attempted to highlight the technical breakthrough and recent advancements in development of edible fruit coating by the application of various types of agro-industrial residues and different active nanomaterials incorporated into the coatings and their effects on shelf-life of perishable fruits. Improvements in highly desired functions such as antioxidant/antimicrobial activities and mechanical properties of edible coating to significantly control the gases (O₂/CO₂) permeation by the incorporation of nanoscale natural materials as well as metal nanoparticles are reviewed and discussed. In addition, by compiling recent knowledge, advantages of coatings on fruits for nutritional security during COVID-19 pandemic are also summarized along with the scientific challenges and insights for future developments in fabrication of engineered nanocoatings.

Utilization of thermal neutron induced in-situ chain reactions and the (n,p) reaction with fast neutrons for compositional characterization of lithium titanate

A methodology has been developed for the complete compositional characterization of lithium titanate (LTO) using neutron activation, which is quite challenging and no literature report is available so far. The concept of thermal neutron induced in-situ chain reactions ⁶Li(n,α)³H and ¹⁶O(³H,n)¹⁸F has been used for the determination of Li and O through the measurement of ¹⁸F activity. The method is capable of analyzing Li and O in percentage level as reported in the present analysis of two types of lithium titanate samples. Spectroscopic interference of the elements which can directly or indirectly affect the outcome, were evaluated meticulously. Determination of Ti was carried out using fast neutron activation through the product isotopes like ⁴⁷Sc, ⁴⁸Sc, generated via (n,p) nuclear reactions. Fast neutron activation methodology seems to be advantageous for Ti determination over thermal neutron activation, as it offers self validation through different isotopes and multiple gamma lines.

Interplay of Val66Met and BDNF methylation: effect on reward learning and cognitive performance in major depression

Background

There is a growing interest in the role of brain-derived neurotrophic factor (BDNF) in major depressive disorder (MDD). BDNF potentially exhibits opposite effects in the pathways linked to anhedonia and reward learning on the one hand and cognitive performance, on the other hand. However, the epigenetic mechanisms behind this remain unknown. In the present study, we aimed to investigate the interplay of DNA methylation of different BDNF exons and the common Val66Met polymorphism on anhedonia, reward learning and cognitive performance in MDD.

Methods

We recruited 80 depressed patients and 58 age- and gender-matched healthy controls. Participants underwent clinical assessment including neuropsychological testing and a probabilistic reward task to assess reward learning. Val66Met polymorphism and DNA methylation of BDNF promoters I, IV and exon IX were assessed from whole blood derived DNA, using pyrosequencing.

Results

BDNF promoter I methylation was lower in MDD patients (p = 0.042) and was negatively associated with self-reported anhedonia. In depressed patients, both Val66Met polymorphism and DNA methylation of promoter I were significantly associated with reward bias (p < 0.050 and p = 0.040, respectively), without an interaction effect. On the other hand, methylation of exon IX had a negative impact on executive functioning (p = 0.002) and mediated the effect of Val66Met on this outcome in patients with MDD.

Conclusions

Our results provide the first evidence of Val66Met susceptibility to differential epigenetic regulation of BDNF exons in reward learning and executive functioning in MDD, which needs to be further explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13148-021-01136-z.

Utilization of unsaponifiable matter from rice bran oil fatty acid distillate for preparing an antioxidant-rich oleogel and evaluation of its properties

Rice bran oil fatty acid distillate (RBOFAD) is an important by-product obtained from the physical refining process. This fatty acid distillate contains high a amount of Unsaponifiable Matter (γ-oryzanol 3.27 gm/100gm UM; total tocopherol 10.93 mg/100 g UM; total phytosterol 21.81 g/100g UM; squalene 1.15 g/100 g UM and total fatty alcohol 73.34 g/100 g UM) and free fatty acids. Antioxidant-rich Oleogels were obtained from rice bran wax (RBW), rice bran oil fatty acid distillate (RBOFAD) and refined rice bran oil. The main objective of this study was to utilize the antioxidant-rich unsaponifiable matter of RBOFAD (UMRBOFAD) as an organogelator along with rice bran wax, which also acts as a good organogelator. Antioxidant-rich oleogel was prepared using UMRBFAD, ethylcellulose (EC) and RBW at 2%, 2%, 3% on weight basis, respectively, in refined rice bran oil and this antioxidant-rich oleogel was compared with rice bran oil oleogel using RBW at 7% on weight basis of rice bran oil. These oleogels were evaluated using a combination of techniques such as differential scanning calorimetry (DSC), polarized light microscopy (PLM), Viscosity, synchrotron radiation X-ray diffraction (SR-XRD) and FTIR Spectroscopy. The differential scanning calorimetry (DSC) measured the thermal properties of rice bran oil oleogel and high antioxidant-rich oleogel. Polarized light microscopy images revealed needle-like crystals for RBW. SR-XRD measurements were used for clarification of the crystal structures of the building blocks of these oleogels. The antioxidant activities of oleogels were evaluated involving DPPH and ABTS assays.

Bluetongue virus vaccine: conventional to modern approach

Bluetongue (BT) is an economically important, infectious and non-contagious disease of ruminant animals. BT disease is caused by bluetongue virus (BTV) of the genus Orbivirus (the family Reoviridae). BTV is transmitted by certain species of biting midges of the genus Culicoides. Although originally BT was restricted to African continent, now it is present in all the continents except Antarctica. Conventional BT vaccines such as live attenuated and inactivated vaccines showed different degree of success in BT control. However, conventional vaccines have certain disadvantages of reversion to virulent strain and frequent booster dose requirement. Several BT outbreaks in India and the rest of the world open a new insight for development of better vaccines. The development in molecular biology techniques allowed the development and validation of several modern vaccines such as subunit vaccine, recombinant vector vaccine, disabled infections single cycle (DISC) vaccine, differentiating infected from vaccinated animals (DIVA) approach etc. Most of these vaccines are considered as safer, having better protective immune response and provided cross-protective immunization against more than one serotype. Keywords: bluetongue virus; live vaccine; inactivated vaccine; DISC; recombinant vaccine.

Effect of metformin and flutamide on insulin, lipogenic and androgen-estrogen signaling, and cardiometabolic risk in a PCOS-prone metabolic syndrome rodent model

Polycystic ovary syndrome (PCOS) is highly associated with cardiometabolic risk and the metabolic syndrome (MetS), predisposing women to increased risk of developing type 2 diabetes and cardiovascular disease. Metformin is commonly used to treat insulin resistance-glucose intolerance, and flutamide, an androgen receptor (AR) antagonist, is used to target hyperandrogenemia and dyslipidemia. Currently, the physiological mechanism of action of these treatments on androgen, lipidogenic, and insulin signaling pathways remains unclear in PCOS. The aim of this study was to investigate the effects and mechanisms of action of metformin and flutamide on plasma lipid-apolipoprotein (Apo)B-lipoprotein and insulin-glucose metabolism, and endocrine-reproductive indices in a PCOS-prone MetS rodent model. PCOS-prone rodents were treated with metformin (300 mg/kg body wt), flutamide (30 mg/kg body wt), or metformin + flutamide combination treatment for 6 wk. Metformin was shown to improve fasting insulin and HOMA-IR, whereas flutamide and combination treatment were shown to reduce plasma triglycerides, ApoB48, and ApoB100, and this was associated with decreased intestinal secretion of ApoB48/triglyceride. Flutamide and metformin were shown to reduce plasma androgen indices and to improve ovarian primary and preovulatory follicle frequency. Metformin treatment increased hepatic estrogen receptor (ER)α, and metformin-flutamide decreased intestinal AR and increased ERα mRNA expression. Metformin-flutamide treatment upregulated hepatic and intestinal insulin signaling, including insulin receptor, MAPK1, and AKT2. In conclusion, cardiometabolic risk factors, in particular ApoB-hypertriglyceridemia, are independently modulated via the AR, and understanding the contribution of AR and insulin-signaling pathways further may facilitate the development of targeted interventions in high-risk women with PCOS and MetS.

Isolation of the unsaponifiable matter (squalene, phytosterols, tocopherols, γ-oryzanol and fatty alcohols) from a fatty acid distillate of rice bran oil

Rice bran oil is characterized by its unique composition of unsaponifiable matter such as oryzanol, squalene, sterols, tocopherols and fatty alcohols. Rice bran oil fatty acid distillate (RBOFAD) is an important by-product of physical refining plants. In the present study, an appropriate fractionation methodology is proposed for isolating the unsaponifiable matter into two fractions, squalene, phytosterols and fatty alcohols as fraction 1; tocopherols and γ- oryzanol as fraction 2. The two fractions together constitute the total unsaponifiable matter in the RBOFAD. The individual unsaponifiable matter components (γ-oryzanol 1.78g/100g, squalene 209.63 mg/100g, tocopherol 2.45mg/100g, total phytosterols 3.79g/100g and fatty alcohols 94.23g/100g) were isolated from RBOFAD by combining a chemical esterification process and liquid-liquid extraction process with 95% ethanol which extracted tocopherol, γ-oryzanol, sterols, squalene, FFA, monoglycerides; later with hexane extraction of the alkaline phase to remove squalene, sterols and fatty alcohols. The alkaline salts of tocopherols and γ-oryzanol are decomposed by the acidification and extraction of the unsaponifiable matter with n-hexane.

Survival and prognostic factors for glioblastoma multiforme: Retrospective single-institutional study

INTRODUCTION

Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults. The standard management has been maximum surgical resection followed by adjuvant radiotherapy with concurrent chemotherapy followed by adjuvant chemotherapy. Although the survival rate of patients with GBM has improved with recent advancements in treatment, the prognosis remains generally poor. The median survival rates are in the range of 9-12 months and 2-year survival rates are in the range of 8%-12%.

MATERIALS AND METHODS

A single-institution retrospective review of 61 patients of GBM from 2012 to 2014. Data regarding patient factors, disease factors, and treatment factors were collected and survival has been calculated.

RESULTS

A total of 61 patients with GBM were analyzed. GBM is commonly seen in sixth decade of life. Male to female ratio is 2.6:1. The right side of the brain is commonly involved with right frontal lobe being the most common site. The median follow-up was 4.6 months. The median survival of our patients was 8 months. The 1-year and 2-year survival rates were 20% and 3.27%, respectively.

CONCLUSIONS

The overall survival and prognosis in patients with GBM remains poor despite of constant research and studies. Concurrent chemoradiotherapy followed by adjuvant chemotherapy with temozolomide should be used after maximal resection to improve the survival.

Organic-Inorganic Composite Films Based on Gd3Ga3Al2O12:Ce Scintillator Nanoparticles for X-ray Imaging Applications

Organic-inorganic nanocomposite self-standing films of Gd₃Ga₃Al₂O₁₂ (GGAG) uniformly dispersed in poly(methyl methacrylate) (PMMA) and polystyrene polymer are prepared for radiography application. GGAG:Ce nanoscintillator has been chosen because of its high light output and fast decay time. The nanopowder of GGAG is synthesized by coprecipitation method and dispersed in the polymer matrix by a simple blending technique. The nanocomposite films of thickness in the range of 150-450 μm with a very high inorganic content is achieved by this technique. These films are characterized by their uniformity, optical absorption, photoluminescence, and radioluminescence. These films are further tested for their application in radiography by recording X-ray images using a commercially available charge-coupled device camera. A resolution of 10 lp/mm is obtained using GGAG:PMMA composite film with 50% loading, confirming their application in imaging devices.

Biofilm forming ability of Sphingomonas paucimobilis isolated from community drinking water systems on plumbing materials used in water distribution

Sphingomonas paucimobilis, an oligotroph, is well recognized for its potential for biofilm formation. The present study explored the biofilm forming ability of a strain isolated from municipal drinking water on plumbing materials. The intensity of biofilm formation of this strain on different plumbing materials was examined by using 1 × 1 cm² pieces of six different pipe materials, i.e. polyvinyl chloride (PVC), polypropylene (PP), polyethylene (PE), aluminium (Al), copper (Cu) and rubber (R) and observing by staining with the chemical chromophore, Calcofluor. To understand whether biofilm formation occurs under flow through conditions, a laboratory-scale simulated distribution system, comprised of the above materials was fabricated. Biofilm samples were collected from the designed system at different biofilm ages (10, 40 and 90 hours old) and enumerated. The results indicated that the biofilm formation occurred on all plumbing materials with Cu and R as exceptions. The intensity of biofilm formation was found to be maximum on PVC followed by PP and PE. We also demonstrated the chemical chromophore (Calcofluor) successfully for rapid and easy visual detection of biofilms, validated by scanning electron microscope (SEM) analysis of the plumbing materials. Chlorination has little effect in preventing biofilm development.

Monitoring of biofilm aging in a Sphingomonas sp. strain from public drinking water sites through changes in capacitance

This study reports the applicability of a capacitance-based technique for evaluating the biofilm progression of Sphingomonas sp. One hundred and forty isolates of Sphingomonas were screened from public drinking water sites, and one potential strain with biofilm-forming ability was used for the study. The biofilm production by this strain was established in microtiter plates and aluminum coupons. The standard biofilm-forming strain Sphingomonas terrae MTCC 7766 was used for comparison. Changes in biofilm were analyzed by energy-dispersive X-ray spectroscopy (EDX) and scanning electron microscope (SEM). Capacitance values were measured at 1, 100 and 200 kHz frequency; however, 1 kHz was selected since resulted in reproducible values, which could be correlated to biofilm age measured as dry weight over a time of 96 h (4 days) depicting the biofilm growth/progression over time. The EDX, SEM and capacitance values obtained in parallel indicated the related physiological profile usually displayed by biofilms upon growth, suggesting authenticity to the observed capacitance profile. The results of this study demonstrated the feasibility of a capacitance-based method for analyzing biofilm development/progression by Sphingomonas sp. and suggested a simple approach for developing an online system to detect biofilms by this opportunistic pathogen of concern in drinking water.

The effect of paternal methyl-group donor intake on offspring DNA methylation and birth weight

Most nutritional studies on the development of children focus on mother-infant interactions. Maternal nutrition is critically involved in the growth and development of the fetus, but what about the father? The aim is to investigate the effects of paternal methyl-group donor intake (methionine, folate, betaine, choline) on paternal and offspring global DNA (hydroxy)methylation, offspring IGF2 DMR DNA methylation, and birth weight. Questionnaires, 7-day estimated dietary records, whole blood samples, and anthropometric measurements from 74 fathers were obtained. A total of 51 cord blood samples were collected and birth weight was obtained. DNA methylation status was measured using liquid chromatography-tandem mass spectrometry (global DNA (hydroxy)methylation) and pyrosequencing (IGF2 DMR methylation). Paternal betaine intake was positively associated with paternal global DNA hydroxymethylation (0.028% per 100 mg betaine increase, 95% CI: 0.003, 0.053, P=0.03) and cord blood global DNA methylation (0.679% per 100 mg betaine increase, 95% CI: 0.057, 1.302, P=0.03). Paternal methionine intake was positively associated with CpG1 (0.336% per 100 mg methionine increase, 95% CI: 0.103, 0.569, P=0.006), and mean CpG (0.201% per 100 mg methionine increase, 95% CI: 0.001, 0.402, P=0.049) methylation of the IGF2 DMR in cord blood. Further, a negative association between birth weight/birth weight-for-gestational age z-score and paternal betaine/methionine intake was found. In addition, a positive association between choline and birth weight/birth weight-for-gestational age z-score was also observed. Our data indicate a potential impact of paternal methyl-group donor intake on paternal global DNA hydroxymethylation, offspring global and IGF2 DMR DNA methylation, and prenatal growth.

Characterization and toxicity of a phosphate-binding exobiopolymer produced by Acinetobacter haemolyticus MG606

A novel, phosphate-binding exobiopolymer (EBP) produced by Acinetobacter haemolyticus MG606 was characterized and its biocompatibility evaluated in RAW 264.7 cells and in mice. EBP was identified as a 50 kDa heteropolysaccharide composed of pentose and hexose sugars. EBP exhibited cytotoxicity, stimulation of free radical production and loss of mitochondrial and lysosomal integrity in RAW 264.7 cells at 500 μg/mL concentration while lower concentrations exhibited no significant (p > 0.05) effect on these parameters. EBP exhibited dose-dependent mortality, body weight reduction, hypothermia and clinical signs of toxicity in mice following intraperitoneal administration. The LD₅₀ of EBP was determined to be 92.31 mg/kg. Overall, the results of our study suggest that composition of EBP produced by A. haemolyticus MG606 is distinct from EBP produced by other Acinetobacter spp. The high biocompatibility supports application of EBP as a safe biosorbent for phosphate remediation.

Antimicrobial efficacy and safety of mucoadhesive exopolymer produced by Acinetobacter haemolyticus

This study evaluated five extracellular polymers of bacterial origin possessing mucoadhesive properties for their antimicrobial properties and toxicological characteristics. Of the five tested mucoadhesive biopolymers, the extracellular polymer produced by a strain of Acinetobacter haemolyticus exhibited broad antimicrobial efficacy towards Yersinia enterocolitica, Salmonella typhimurium, Listeria monocytogenes, Escherichia coli O157:H7 and Bacillus subtilis. Significant (p<0.05) inhibition of gram negative bacterial pathogens followed by gram positives were observed with the biopolymer at a dose of 40-60μg ml-1 at ambient temperature. The cytotoxicity under in vitro conditions and oral toxicity in murine models was also evaluated. The biopolymer did not elicit either haemolytic activity or toxicity in RAW 264.7 cell lines. Haemotological, histopathological and general examinations indicated no adverse effects in Swiss albino mice fed with the biopolymer (120mg kg-1 body weight-1 day1) over a period of 30 days. These results suggested that the biopolymer was well tolerated without any signs of toxicity and may have several potential biomedical applications where disinfection is desired.

Abstract P6-07-01: Multigene profiling to identify clinically relevant actionable mutations in breast cancer: An Indian study

Background: Numerous chemotherapeutic agents are available against breast cancer (BC), but a vast majority of patients diagnosed with this disease still develop treatment resistance and eventually succumb to disease. It remains an unmet need to identify specific molecular defects against which targeted therapy are available for improving clinical outcomes in BC. Our study aims to identify frequent hotspot mutations in BCs and determine their clinical impact.

Methods: 200 women with BC(early diagnosed and/or metastatic) aged 26-75 yrs (median age 50.5yrs) diagnosed at HCG from April 2013-15 were consented to be profiled by targeted deep sequencing for hotspot mutations in 48 cancer-related genes using Illumina's TSCAP panel and MiSeq technology in an IRB-approved prospective study in a CLIA compliant laboratory. All the cases had pathology review for stage, histological type, hormonal status and Ki67. The average coverage across 220 hot spots was greater than 1000X. Data was processed using Strand Avadis NGS™. Mutations identified in the tumor were assessed for 'actionability' i.e. response to therapy and impact on prognosis. Results: Somatic variants were detected in 75% of cases with direct impact on therapy or prognosis. Genetic aberrations were identified in PI3K/AKT/ mTOR signalling pathway in substantial fraction (27%) of breast cancer cases, out of which 17% had PIK3CA activating mutations,13 and 5 cases had PTEN and AKT deletions or truncating mutations respectively. Aberration in this pathway was more prevalent in HR+ve (53%) and HER2-ve including TNBC (61%) than in HR+/HER2+ve tumors (10.6%) of IDC histology. However, no correlation was found with stage and Ki67 index of the tumor. Notably 80% of BC cases presented with liver metastasis at the time of diagnosis were detected with PIK3CA mutation indicating its role as a surrogate marker of organ specific metastasis. PIK3CA was found to be co mutated with p53 in 16 cases (9%) of which 4 cases showed npCR post NACT. Also disruptive and non-disruptive mutations in TP53 alone were found in 25% of BC, varying widely among different histologies. A follow up of few cases showed shorter PFS and poor outcome in resected BC treated with NACT indicating its robust prognostic value in NACT setting. Furthermore, two patients were detected with cKIT mutations indicating sensitivity to imatinib and therefore enrolled on a clinical trial. The other variants were found in RB1(n=8),Her2 (n=2),FGFR amplification(n=1), KRAS(n=2),NRAS(n=3)CDH1(n=1),FBXW7(n=2) and EGFR(n=1).All these variants detected indicated resistance to conventional therapy and suggested sensitivity to available targeted therapy, either approved or in clinical trials. The response and outcome are being monitored in about 20 (10%) patients who have been enrolled in clinical trials and receiving mutation specific targeted therapy. Conclusions: This study confirms the utility of multigene profiling in early diagnosed and advanced BC patients, to stratify them on their molecular profile who could potentially benefit from targeted therapy. Prospective studies and randomized clinical trials are ongoing to confirm the independent prognostic and therapeutic value of the mutations in a larger cohort of Indian population.

Citation Format: Ghosh M, Sheela ML, Choudhury S, Bahadur U, Patil S, Satheesh CT, Murugan K, Nayak R, Sridhar PS, Rao N, Mahesh B, Shashidhara HP, Krishnamoorthy N, Gupta V, Sankaran S, Subramanian K, Ajaikumar BS. Multigene profiling to identify clinically relevant actionable mutations in breast cancer: An Indian study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-07-01.

Abstract P6-06-06: Comprehensive analysis of BRCA (BRCAm) and other germline mutations (GRm) with a clinicopathological association in breast cancer: An Indian study

Background: BRCAm and other GRm testing using next generation sequencing (NGS) in early diagnosed and/or metastatic breast cancer (BC) helps in the identification of both unambiguously defined deleterious mutations and sequence variants of unknown clinical significance (VUS). The early detection of these mutations in the proband and the family members help in risk stratification and instituting effective monitoring, surveillance and disease management strategies.

Methods: Out of total 200 patients diagnosed with BC (April 2013-15) 77 unrelated individuals were consented to be profiled by NGS on MiSeq platform using TruSight Cancer panel (consisting of 94 genes including 13 genes highly associated with risk of inherited breast and/or ovarian cancer) in an IRB-approved prospective study in a CLIA compliant laboratory. Paired end sequencing was done with an average coverage of &gt; 450X. Data was processed using STRAND software and interpreted using "Strand Omics" platform. The paired tumor samples were analysed for pathological stage, histological type and hormonal status.

Results: GRm were detected in 61 cases (79%). Among all mutations detected, BRCA1/2 were found in 51% (31% in BRCA1, 20% in BRCA2) of cases. BRCA1 was found to be co-mutated with BRCA2 in 2 cases. Out of 37 deleterious mutations in BRCA1/2 genes only 10 were reported to be pathogenic (6 in BRCA1 and 4 in BRCA2) and rest were VUS. Mutation frequencies were higher among high grade IDC with HER2-ve tumors including TNBC (53%, p&lt;0.05) with an early onset of the disease. TNBC with BRCAm were found to have no/incomplete pCR on conventional TAC regimen , subsequently started with platinum therapy and the outcome being monitored. Interestingly, 4 BRCA1 mutations including 3 non-sense and 1 frameshift mutation were found in two unrelated individuals suggesting them to be founder mutations in Indian population. The other GRm frequency (alone/ co-mutated with BRCA) was also found to be significantly high (49%) and include BRIP1, CHEK2, ERCC2, CDH1, SDHB, APC, MSH6, TP53, PALB2 and RAD51C. Stratification based on age of diagnosis(dx) showed a detection rate significantly higher in the age group of 25-50 yrs (74%) as compared to the 50-75 yrs (26%). Also a strong association of GRm status with the family history(Hx) of BC in 1st or 2nd degree relatives was indicated.

Table 1: Correlation of GRm with Dx and HxGenen%Age at dx(yrs)Family Hx (Yes=Y, No=N,Unknown=UK)BRCA1193125-50 (n=23) 50-75(n=8)Y(n=13) N(n=3) UK(n=3)BRCA2122025-50(n=21) 50-75(n=9)Y(n=8) N(n=2) UK(n=2)PALB211.7&gt;50YCHEK258.825-50 (n=4) 50-75(n=1)YATM610.525-50 (n=4) 50-75(n=2)Y(n=5) N(n=1)RAD5111.7&lt;50Y

Conclusions: Our study in a small cohort clearly highlighted the significance of germline testing and classifying the variant in larger cohort of BC patients with a strong family Hx of cancer particularly in BRCA1/2 positive families , and in women &lt;50yrs for early detection and risk assessment. The study also indicates BRCAm to be an important contributor to the etiology of high grade HER2-/ TNBC in Indian patients. Expanded testing of this subtype is warranted to impact management of the disease with PARP inhibitors and/or platinum therapy.

Citation Format: Ghosh M, ML S, Upasana M, Chodhury S, Mannan AU, Southekal S, Manjima C, Patil S, Murugan K, Mahesh B, Nayak R, Sridhar PSS, Rao N, Krishnamoorthy N, Gupta V, Satheesh CT, Subramanian K, Ajaikumar BS. Comprehensive analysis of BRCA (BRCAm) and other germline mutations (GRm) with a clinicopathological association in breast cancer: An Indian study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-06-06.