Role of miRNAs in T-cell activation and Th17/Treg-cell imbalance in acquired aplastic anemia

BACKGROUND

Altered T-cell repertoire with an aberrant T-cell activation and imbalance of the Th17/Treg cells has been reported in acquired aplastic anemia (aAA). miRNAs are well known to orchestrate T-cell activation and differentiation, however, their role in aAA is poorly characterized. The study aimed at identifying the profile of miRNAs likely to be involved in T-cell activation and the Th17/Treg-cell imbalance in aAA, to explore newer therapeutic targets.

METHODS

Five milliliters peripheral blood samples from 30 patients of aAA and 15 healthy controls were subjected to flow cytometry for evaluating Th17- and Treg-cell subsets. The differential expression of 7 selected miRNAs viz; hsa-miR-126-3p, miR-146b-5p, miR-155-5p, miR-16, miR-17, miR-326, and miR-181c was evaluated in the PB-MNCs. Expression analysis of the miRNAs was performed using qRT-PCR and fold change was calculated by 2-ΔΔCt method. The alterations in the target genes of deregulated miRNAs were assessed by qRT-PCR. The targets studied included various transcription factors, cytokines, and downstream proteins.

RESULTS

The absolute CD3+ lymphocytes were significantly elevated in the PB of aAA patients when compared with healthy controls (p < 0.0035), however, the CD4:CD8 ratio was unperturbed. Th17: Treg-cell ratio was altered in aAA patients (9.1 vs. 3.7%, p value <0.05), which correlated positively with disease severity and the PNH positive aAA. Across all severities of aAA, altered expression of the 07 miRNAs was noted in comparison to controls; upregulation of miR-155 (FC-2.174, p-value-0.0001), miR-146 (FC-2.006, p-value-0.0001), and miR-17 (FC-3.1, p-value-0.0001), and downregulation of miR-126 (FC-0.329, p-value-0.0001), miR-181c (FC-0.317, p-value-0.0001), miR-16 (FC-0.348, p-value-0.0001), and miR-326 (FC-0.334, p-value-0.0001). Target study for these miRNAs revealed an increased expression of transcription factors responsible for Th1 and Th17 differentiation (T-bet, RORϒt, IL-17, IL-6, and IFN-ϒ), T-cell activation (NFκB, MYC, and PIK3R2), downregulation of FOX-P3, and other regulatory downstream molecules like SHIP-1, ETS-1, IRAK-1, TRAF-6, and PTEN.

CONCLUSION

The study for the first time highlights the plausible role of different miRNAs in deregulating the Th17/Treg-cell imbalance in aAA, and comprehensively suggest the role of altered NF-kB and mTOR pathways in aAA. The axis may be actively explored for development of newer therapeutic targets in aAA.

Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial

Importance

Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy.

Objective

To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity.

Design, Setting, and Participants

A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months.

Interventions

Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress.

Main Outcomes and Measures

The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life.

Results

The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events.

Conclusions and Relevance

In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration.

Trial Registration

anzctr.org.au Identifier: ACTRN12612000307808.

Research Note: Effect of dietary xylo-oligosaccharide on growth performance, intestinal histomorphology, and specific cecal bacteria in broiler chickens

This study was conducted to evaluate the prebiotic effect of xylo-oligosaccharide (XOS) supplemented in a corn-soybean meal (SBM) based conventional diet on growth performance, intestinal histomorphology, and quantification of specific bacteria in the ceca of broilers. A total of 240 d of hatch Cobb 500 male broiler chicks were randomly assigned to 4 dietary treatments (corn-SBM-based control diet) containing 0, 0.05, 0.1, and 0.2% XOS. The broilers were raised for 21 d in 6 replicate cages, each containing 10 birds. Growth performance parameters were obtained weekly. Additionally, small intestinal tissues were collected to evaluate histomorphometry and whole ceca were collected to quantify bacterial populations on D21. The results showed that inclusion of XOS has similar body weight (BW), body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) as the control group during the 21-day study. The results further indicate a tendency for the jejunum villus to crypt ratio (VH:CD) to increase in birds given 0.05 and 0.2% XOS (P = 0.08). Cecal bacteria quantification showed a linear increase in Bifidobacterium with increasing XOS levels (P < 0.0001) and a decrease Clostridium perfringens levels compared to birds fed the control diet (P < 0.0001). However, there were no differences in the total counts of Lactobacillus and E. coli. Together these results showed that while there were no differences in growth parameters up to 21 d, the histomorphology findings and the increase in Bifidobacterium, along with the reduction in C. perfringens observed in the XOS groups, suggest a beneficial impact of XOS inclusion on gut health. Further research with longer feeding periods and higher XOS levels should be conducted to explore potential positive effects on both growth and gut health parameters.

EARLY IMPLANT OUTCOMES IN ADULTS WITH DENTAL DECAY TREATED WITH PHOTODYNAMIC TREATMENT

A fast implant is a kind of implant to place in the cavity right away after dental extraction. These implants are shown to maintain cervical marrow and reduce the number of surgery operations required for patients. The Photodynamic treatment (PDT) uses antimicrobial processes to supplement nonsurgical periodontal therapy. Combined through the scaling and root planning (SRP), and PDT is more effective. This study aims to assess the effects of PDT on initial findings with dental implants (DI) placed in patients having gum disease with SRP against patients who do not at the 12-month follow-up point. An aggregate of 25 implants were inserted in 16 patients, 12 of whom were in the test group (TG) and 13 of whom were in the control group (CG). SRP is conducted toward rapid implant assignment in the control site, while PDT as an adjunct to SRP (SRP + PDT) is executed prior to instant implant insertion in test sites. At the beginning, 4 months, 8 months, and 12 months, gingival index, radiovisiographs, inquiring pocket intensity, clinical attachment level, and plaque index were obtained. Basic durability was assessed after implant insertion, and the recovery index was measured a week later. In this analysis, Analysis of Variance (ANOVA) technique is used to predict tooth decay earlier. The CG experienced 1.10 mm of mean marginal bone loss after the 12-month research period, compared to 0.97 mm for the (SRP + PDT) group. After reaching the CG and TG, the differences in plaque score and probe depth were noteworthy. Clinical indicators compared to the basis in a year revealed unquestionable improvement, including the probing depth gingival index, plaque index and clinical attachment level. Twelve months were spent monitoring the implants in both groups. The little bone loss improved, although it isn't clinically important. The endurance rate for rapid implants in the PDT grouping is the same as that of the group that underwent SRP. The impact of PTD is utilized as a supplement to SRP. Yet, the consequence is marginal. Because of the improved results with PDT, it is used successfully as an addition to SRP.

Psychological health of postmenopausal women: a bibliometric analysis in the recent decade

The aim of this study is to analyze the publication trends on the psychological health of postmenopausal women by performing a bibliometric and visualization analysis that can be used as a foundation for understanding current and future research plans. Publications were retrieved from Dimensions database from 2012 to June 2022. VOSviewer software was used for data mining and visualization. A total of 1718 papers were selected by keyword search and delimiting criteria. To evaluate the productive nations, authors, journals, articles and frequent joint citations, citation analysis, author keyword co-occurrence analysis, co-authorship analysis and co-citation analysis were performed. Results depict that the USA contributed the most papers (n = 457). Maximum articles (n = 192) were published in 2021. The highest number of articles are published in Menopause: The Journal of the North American Menopause Society and Climacteric: The Journal of the International Menopause Society. Out of the top 10 contributing organizations in the field, six organizations were from the USA. R. Nappi of Italy is the most productive author with 20 articles and 1138 citations. From the point of average citations per article, H. Joffe has the highest score (71.5). The data reported in this analysis contribute to discussions about the development, growth and current state of psychological health of postmenopausal women as well as its impact. These findings offer helpful guidance for researchers in choosing their potential fields of study and integrating different approaches to solve complicated issues, finding potential co-authors and choosing the right institutions for supporting academic studies or collaborative research.

Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial

BACKGROUND

The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health.

OBJECTIVE

This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic.

METHODS

In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale-anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress.

FINDINGS

Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns.

CONCLUSIONS

This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics.

CLINICAL IMPLICATIONS

Strategies to improve positive affect may be useful to reduce mental health issues.

TRIAL REGISTRATION NUMBER

ACTRN12620000811909.

Evaluation of a dacitic (rhyolitic) tuff breccia use on performance, inflammatory, and antioxidant responses in broilers mildly challenged with Eimeria spp

The objective of the study was to investigate the effects of a dacitic tuff breccia (DTB) on Eimeria-infected broilers. A total of 600 one-day-old Cobb 500 male chickens were randomly assigned to 5 treatments with 10 replicates of 12 birds. Treatments were: an unchallenged control (UC), a challenged (CC) control (0% DTB), and 3 challenged groups with 0.125, 0.25, or 0.5% DTB. At d 14, birds in the CC and DTB groups were orally gavaged with mixed Eimeria spp., while the UC received water. Growth performance was evaluated during prechallenge, challenge, and postchallenge periods (0-14 d; 14-20 d; and 20-26 d, respectively). Gastrointestinal permeability was measured at 5 days postinfection (dpi). Intestinal histology and nutrient digestibility of dry matter (DM), crude protein (CP), and ileal digestible energy (IDE) were measured at 6 dpi. Liver activity of glutathione peroxidase (GSH-Px) was determined at 6 dpi, and concentrations of reduced (GSH) and oxidized glutathione (GSSG) were analyzed at 6 and 12 dpi. Data were analyzed using a linear mixed model analysis and Tukey's test (P ≤ 0.05). From 0 to 14 d, similar average daily gain (ADG) and average daily feed intake (ADFI, P > 0.05) were observed. Gain:feed ratio (GF) was higher in 0.125, 0.25, and 0.5% of DTB than the CC and UC (P < 0.001). From 14 to 20 d, the UC had the highest ADG, ADFI, and GF (P < 0.001). At 5 dpi, intestinal permeability was higher in the challenged groups than the UC. Additionally, the UC showed the highest apparent ileal digestibility of CP, whereas 0.125% DTB had higher CP digestibility than the CC and 0.5% DTB (P < 0.001). At 6 dpi, 0.125% DTB increased GSH-Px activity compared to the CC, 0.5% DTB, and UC (P < 0.001). At 12 dpi, 0.125% DTB showed increased GSH concentration compared to the CC, 0.25% DTB, and 0.5% DTB (P < 0.01). The mild coccidia infection negatively impacted growth performance, apparent ileal nutrient digestibility, intestinal histology, and gastrointestinal integrity in broilers. The use of 0.125% DTB exhibited potential in improving antioxidant responses, apparent ileal digestibility of CP, and growth performance.

Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomised clinical trial

BACKGROUND

Although exposure therapy is central in most front-line psychotherapies of post-traumatic stress disorder (PTSD), many patients do not respond to this treatment. We aimed to investigate the effects of brief aerobic exercise on the efficacy of exposure therapy in reducing the severity of PTSD.

METHODS

We did a single-blind, parallel, randomised controlled trial in Sydney, NSW, Australia. We included adults (aged ≥18 years) with clinician-diagnosed PTSD. We excluded participants aged 70 years or older, with imminent suicidal risk (reporting suicidal plan), presence of psychosis or substance dependence, history of moderate-to-severe traumatic brain injury, or presence of a physical disorder or impairment that might be exacerbated by aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine 90-min weekly sessions of exposure therapy for PTSD with 10 min aerobic exercise or to the control group of exposure therapy with 10 min passive stretching. The primary outcome was PTSD severity measured by the clinician-administered PTSD scale 2 (CAPS-2), independently assessed at baseline, 1 week after treatment, and 6 months after treatment (primary outcome timepoint).

FINDINGS

Between Dec 12, 2012, and July 25, 2018, we enrolled 130 participants with PTSD, with 65 (50%) participants randomly assigned to exposure therapy with exercise and 65 (50%) to exposure therapy with passive stretching, including 79 (61%) women and 51 (39%) men, with a mean age of 39·1 years (SD 14·4; range 18-69). 99 (76%) participants were White, 14 (11%) were Asian, and 17 (13%) were listed as other. At the 6-month follow-up assessment, participants in the exposure therapy with exercise group showed greater reductions in CAPS-2 scores relative to those in the exposure therapy with stretching group (mean difference 12·1 [95% CI 2·4-21·8]; p=0·023), which resulted in a moderate effect size of 0·6 (0·1-1·1). No adverse events associated with the intervention were reported. The trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864.

INTERPRETATION

Brief aerobic exercise has the potential to augment long-term gains of exposure therapy for PTSD, which accords with evidence from studies in animals and humans on the role of exercise in modulating the extinction learning processes. This strategy might offer a simple and affordable means to augment treatment gains for exposure therapy in people with PTSD.

FUNDING

Australian National Health and Medical Research Council.

Habituation of distress during exposure and its relationship to treatment outcome in post-traumatic stress disorder and prolonged grief disorder

Background: Reliving distressing memories is a core component of treatments for post-traumatic stress disorder (PTSD) and prolonged grief disorder (PGD). There is little understanding of how reliving these memories functions in the treatment of these disorders.Objective: This study investigated whether reliving functions comparably in the treatment of PTSD and PGD, and whether it is comparably related to treatment outcome.Method: This study conducted a reanalysis of patients with either PTSD (n = 55) or PGD (n = 45) who underwent treatments that comprised at least four sessions of reliving memories of either their traumatic experience or the loss of the deceased person.Results: PTSD participants displayed greater habituation of distress across sessions during reliving than PGD participants. Between-session reduction in distress during reliving was associated with symptom remission in PTSD, but this pattern was not observed in PGD.Conclusion: This pattern of findings indicates that although reliving appears to be a useful strategy for treating both PTSD and PGD, this strategy does not function comparably in the two conditions and may involve distinct mechanisms.

DATaR: Depth Augmented Target Redetection using Kernelized Correlation Filter

Unlike deep learning which requires large training datasets, correlation filter-based trackers like Kernelized Correlation Filter (KCF) use implicit properties of tracked images (circulant structure) for training in real time. Despite their popularity in tracking applications, there exists significant drawbacks of the tracker in cases like occlusions and out-of-view scenarios. This paper attempts to address some of these drawbacks with a novel RGB-D Kernel Correlation tracker in target re-detection. Our target re-detection framework not only re-detects the target in challenging scenarios but also intelligently adapts to avoid any boundary issues. Our results are experimentally evaluated using (a) standard dataset and (b) real time using the Microsoft Kinect V2 sensor. We believe this work will set the basis for improvement in the effectiveness of kernel-based correlation filter trackers and will further the development of a more robust tracker.

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Effect of nurse-led lifestyle modification follow up program on health outcomes and quality of life among post myocardial infarction patients: a randomized controlled trial

Funding Acknowledgements

Type of funding sources: None.

Background

India has among the world's highest burden of cardiovascular disease, potentially contributed by myocardial infarction. Despite growing trouble, there are no known post-discharge programs & randomized trials reporting health status outcomes & quality of life among post-myocardial infarction patients. Cardiac rehabilitation programs reduce mortality, therefore, it is crucial to understand the local burden of the disease, common challenges, public perceptions, develop timely & effective interventional programs.

Purpose

This study aimed to evaluate the effect of a nurse-led lifestyle modification follow-up program on health outcomes & quality of life among post-myocardial infarction patients.

Methods

A two-arm randomized controlled trial was adopted & 104 post-myocardial infarction patients were recruited from August to December 2021. An equal number of participants were randomly assigned to intervention & control group by random number table generator. The control group patients received routine care, while the intervention group was provided routine care along with a nurse-led lifestyle modification follow-up program(health education, educational booklet, & telephone follow- up). A low-cost intervention based on information-motivation-behavioural skill model was developed. It was designed according to the needs of patients to know their risk factors, help patients establish a knowledge base, & adapt to the post-illness lifestyle changes. Data were assessed & compared by using the demographic datasheet, health outcomes datasheet, & MacNew heart disease quality of life questionnaire. All evaluations were conducted at baseline after 12 weeks post-discharge, by face-to-face interview & biophysiological measurements.

Results

The nurse-led lifestyle modification follow-up program was convenient for clinical application. The intervention group showed a appreciable improvement in low density lipoprotein(p=0.045), systolic blood pressure(p=0.009), diastolic blood pressure(p=0.044), body mass index(p=0.043), and NT ProBNP(p=0.007). The program effectively improved the lifestyle behaviours thereby considerably improving the quality of life in all the subscales-physical, emotional & social (p&lt;0.001) after 12 weeks of discharge.

Conclusion

In the Indian context, it is a novel & extensive approach to improve access to health care and emphasizes post-discharge self-management. The greatest benefit of this program was allowing the intervention group participants to consult with us immediately. Since lifestyles vary among different individuals, we considered individuality when providing education & involving them in implementation of an intervention to enhance their confidence & ultimately achieve optimal health outcomes & quality of life. The findings of this study are important for health care professionals caring for post-myocardial infarction patients & direct incorporation of such programs into routine practice to reduce morbidity & mortality.

Hypercalcemia with methotrexate pneumonitis: A rare, important and intriguing adverse event

Methotrexate leading to hypercalcaemia is a rarely reported adverse event. We present three elderly patients with inflammatory arthritis who developed hypercalcemia probably due to methotrexate-induced granulomatous pneumonitis. All patients presented with worsening non-productive cough with dyspnea, nausea, loss of appetite, and confusion. Their clinical and radiologic features were consistent with methotrexate-induced pneumonitis. On evaluation, all patients concurrently had hypercalcemia with normal 25OH D3, and low PTH with markedly elevated levels of 1,25OH D3 seen in two patients. In all three patients, hypercalcemia and pneumonia responded to hydration, corticosteroids, and methotrexate withdrawal. There was no relapse of symptoms on long term follow-up. In these three patients with inflammatory arthritis, methotrexate-induced pneumonitis led to symptomatic hypercalcemia. Unless hypercalcemia is looked for and treated in this setting, the morbidity can be high.

AB1108 IMPACT OF THE FIRST WAVE OF THE COVID 19 PANDEMIC ON HEALTHCARE ACCESSIBILITY, DISEASE BEHAVIOUR, ANXIETY, AND PHYSICAL ACTIVITY IN RHEUMATIC DISEASE PATIENTS: AN ONLINE SURVEY AND POTENTIAL SOLUTIONS

Background

Coronavirus Disease (covid 19) negatively impacted psychosocial health, health care accessibility and exercise regimen but problem’s scope and potential solutions remain elusive. We conducted a patient based online survey to understand these impacts and discussed potential solutions.

Objectives

Assess impact of Covid 19 on rheumatological disease status, accessibility to health care, patient anxiety and behavior and continuation of physical activity during pandemic.

Methods

Google form (18-question) based questionnaire was sent via SMS/WhatsApp in Aug 2020, at height of first pandemic and responses were collected over next month.

Results

Only 339 /2700 patients (12.5 %) responded to the survey. Other authors (1)(2) have observed a similar low response rate to online surveys. We recognise questionnaires with fewer questions tend to generate more responses, which should be considered critical in constructing future health-related surveys. Patients’ global assessment of their disease score was 7/10, with 0 representing the worst disease status and10 representing best disease status, also 1/3 patients not felt need for rheumatological consultation during six months (March 2020- Aug 2020) of lockdown. These may imply adequate rheumatic disease control over long periods and during subsequent waves of pandemic, rheumatology patients can be shielded by avoiding non-urgent hospital follow up visits. Significant number of patients (20%) were unable to contact their rheumatologist, implying a significant impact of covid 19 and lockdown on rheumatology care, as suggested by other authors (1). As expected, there was switch to tele consultancy mode of communication, with 22 per cent of patients already using it within 3 months of its introduction, which appears to be a good indicator of future adaptability and feasibility of teleconsultation. Identifying specific profile of patients during physical consultation who can be easily managed via teleconsultation, may reduce unnecessary hospital visits while also improving healthcare delivery. 1/3 of our patients had anxiety about disease flare, and 41 %were concerned about increased risk of covid 19 infection as they were on immunosuppressive medications as noted by other authors (3). Improving access to health care and increasing public awareness could help alleviate this anxiety. Reaching out to isolated rheumatology patients through SMS / educational video may improve the sense of health security. Contrary to our expectations, overall medication adherence was reasonable, likely due to be management of supply chains by local authorities .15% completely stopped exercising and 25% reduced their exercise regimen by 50%. Shifting to home-based exercise, educational videos on physical therapy and online teleconsultation with physiotherapists could overall have positive impact.

Conclusion

Covid 19 has significantly impacted rheumatological patients in terms of increased anxiety, decreased healthcare accessibility and decreased exercise and physical activities. Modifications in teleconsultation methodology are needed in the future. Patients’ anxiety can be alleviated by educating them through digital and social media platforms and enrolling them in online patient support groups.

References

[1]Ganapati A, Padiyar S, Nair A, et al. Impact of COVID-19 Pandemic and Resultant Lockdown in India on Patients with Chronic Rheumatic Diseases: An Online Survey. Indian J Rheumatol. 2021;16(1):30. doi:10.4103/injr.injr_231_20

[2]McKee P, Irvine A, Riddell C, Ball E. IMPACT OF THE COVID PANDEMIC ON RHEUMATOLOGY PATIENTS IN NORTHERN IRELAND - A WEB BASED CROSS-SECTIONAL SURVEY OF PATIENT REPORTED OUTCOMES. Ulster Med J. 2021;90(3):197

[3]Hammad MAH, Eissa M, Dawa GA. Impact of coronavirus disease 2019 (COVID-19) pandemic on attitude, behavior, and mental health of patients with rheumatic diseases. Egypt Rheumatol Rehabil. 2020;47(1). doi:10.1186/s43166-020-00045-y

Disclosure of Interests

None declared

Axin2+ PDL Cells Directly Contribute to New Alveolar Bone Formation in Response to Orthodontic Tension Force

Wnt-β-catenin signaling plays a key role in orthodontic tooth movement (OTM), a common clinical practice for malocclusion correction. However, its targeted periodontal ligament (PDL) progenitor cells remain largely unclear. In this study, we first showed a synchronized increase in Wnt-β-catenin levels and Axin2+ PDL progenitor cell numbers during OTM using immunostaining of β-catenin in wild-type mice and X-gal staining in the Axin2-LacZ knock-in line. Next, we demonstrated time-dependent increases in Axin2+ PDL progenitors and their progeny cell numbers within PDL and alveolar bones during OTM using a one-time tamoxifen-induced Axin2 tracing line (Axin2CreERT2/+; R26RtdTomato/+). Coimmunostaining images displayed both early and late bone markers (such as RUNX2 and DMP1) in the Axin2Lin PDL cells. Conversely, ablation of Axin2+ PDL cells via one-time tamoxifen-induced diphtheria toxin subunit A (DTA) led to a drastic decrease in osteogenic activity (as reflected by alkaline phosphatase) in PDL and alveolar bone. There was also a decrease in new bone mass and a significant reduction in the mineral apposition rate on both the control side (to a moderate degree) and the OTM side (to a severe degree). Thus, we conclude that the Axin2+ PDL cells (the Wnt-targeted key cells) are highly sensitive to orthodontic tension force and play a critical role in OTM-induced PDL expansion and alveolar bone formation. Future drug development targeting the Axin2+ PDL progenitor cells may accelerate alveolar bone formation during orthodontic treatment.

199 The Influence of Pre-Operative Factors on Patient Length of Stay After Total Knee Replacement

Aim

This study aims to assess the impact of pre-operative factors on the length of stay in patients following total knee replacement at our institution.

Method

A total of 478 patients following total knee replacement between January 2017-Decemeber 2019 are included in this study. All patients underwent total knee replacement with a medial rotating total knee prosthesis (MRK; Matt Ortho UK).

Data for each patient was collated retrospectively and included the following: Patient demographics (age and sex), American Society of Anaesthesiology (ASA) score, pre-operative range of movement (ROM), Body Mass Index (BMI), and pre-operative haemoglobin. Each factor was then compared with the length of stay for all 478 patients. Statistical significance was sort for each pre-operative factor for both men and women.

Results

Our cohort of patients includes 291 females and 187 males. Patients ranged from 39 to 90 years with an average age of 68. The average BMI of the cohort was 31.3(18.6–56.56) and the average ASA grade was 2.

Preoperative hemoglobin and the Age of the patient at the time of surgery were the only two factors which had a statistically significant impact on the length of hospital stay (p&lt;0.05). BMI, Pre- operative range of motion and ASA scores had no statistically significant effect on the length of hospital stay in our cohort.

Conclusions

Low pre-operative hemoglobin and increasing age have significant effects on length of stay after total knee replacement. The BMI, pre-operative range of movement and ASA scores do not influence the length of hospital stay.

Influence of Brassica spp. rapeseed and canola meal, and supplementation of bioactive compound (AITC) on growth performance, intestinal-permeability, oocyst shedding, lesion score, histomorphology, and gene expression of broilers challenged with E. maxima

This study was performed to investigate the effect of feeding Brassica spp. including full-fat rapeseed, canola meal, and allyl isothiocyanate (AITC) to broiler chicken challenged with E. maxima. A total of 576 one-day old male broiler chicks were completely randomized to 8 treatments with 6 replicated cages and 12 birds per cage. The treatment diets consisted of nonchallenge control (NC, corn-SBM based diet), challenge control (CC), 10% rapeseed (10RS), 30% rapeseed (30RS), 20% canola (20CLM), 40% canola (40CLM), 500 ppm AITC (500AITC), and 1,000 ppm AITC (1000AITC). At d 14, all birds were challenged, except NC group, with a subclinical dose of E. maxima. Intestinal permeability was conducted on 5 d post-infection (dpi) and for oocyst shedding 5 to 6 dpi feces were pooled and collected. On 6 dpi, growth performance, lesion score, histomorphology, and gene expression were measured. The growth performance result showed that 10RS and 30RS groups had lower BW, BWG, FI, and higher FCR (P < 0.0001). During the challenge and overall periods, NC group had highest BW, BWG, and FI, and lowest FCR. The inclusion of canola meal showed lower performance during prechallenge period but was able to catch up BWG during challenge period. The AITC levels showed similar growth performance to CC group. Intestinal permeability for 20CLM, 40CLM, 500AITC and 1000AITC was similar to NC group, whereas CC, 10RS, and 30RS had higher permeability compared to NC (P < 0.0001). Oocyst shedding was significantly lower for 40CLM and NC, whereas all other treatments had higher oocyst shedding (P < 0.0001). All the challenged treatment groups had higher lesion score and microscore than NC (P < 0.0001). Histomorphology data showed that jejunum villus height (VH) for 1000AITC was similar to NC group, whereas CC group had the lowest VH (P = 0.01). The 30RS group had lower VH: crypt depth (CD) ratio in the jejunum and ileum. The gene expression at 6 dpi for claudin1, occludin, IL2, IL6, GLUT5, EAAT, BoAT, and LAT1 was significantly changed among the treatments. The results suggest that 30RS retards growth performance and deteriorate gut health during coccidiosis and should not be fed to chicken during the starter phase. Canola meal showed decline in growth prechallenge but maintained growth and intestinal health during the challenge period at 40% inclusion. AITC at 1,000 ppm showed similar growth as control group, but with improved gut health during the challenge period. Canola meal could be a good alternative to SBM especially during coccidiosis, whereas AITC needs to be tested vigorously in animal feeding regime.

Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial

INTRODUCTION

Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic.

OBJECTIVE

We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic.

METHODS

In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles (n = 120) or enhanced usual care (EUC, n = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress.

RESULTS

Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], p = 0.01; effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009; effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears.

CONCLUSIONS

This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.

Influence of rapeseed, canola meal and glucosinolate metabolite (AITC) as potential antimicrobials: effects on growth performance, and gut health in Salmonella Typhimurium challenged broiler chickens

Poultry is the major sources of foodborne salmonellosis. Antibiotic resistance and a surge in zoonotic diseases warrant the use of natural alternatives. Glucosinolates (GLs) are naturally occurring antimicrobial compounds in rapeseed and canola. This study investigated the effect of feeding rapeseed, canola meal, and allyl isothiocyanate (AITC; Brassica secondary metabolites) on growth performance (GP), gut health, and the potential antimicrobial activity against nalidixic acid-resistant Salmonella Typhimurium (STNR) in chickens. A total of 640 one-day-old male Cobb 500 broilers were randomly allocated to 8 treatments with 8 replicated cages and 10 birds per cage. Dietary treatments were nonchallenge control (NC, corn-SBM based), challenge (Salmonella) control (CC), 10% rapeseed (10RS), 30% rapeseed (30RS), 20% canola meal (20CLM), 40% canola meal (40CLM), 500 ppm AITC (500AITC), and 1,500 ppm AITC (1500AITC). On d 1, all the birds except NC were orally challenged with STNR (7 log CFU/bird). The chickens were reared for 21 d, and their FI and BW were recorded weekly. Salmonella cecal colonization and fecal shedding were quantified, whereas organ translocation (OT) of STNR to the spleen, liver, and kidney was tested on 0, 3, 6, 13, and 20-d postchallenge (dpc). Data were subjected to one-way ANOVA, and the means were separated by Duncan's test, except mortality and OT data analyzed after transformation by square root of (n +1) (P < 0.05). Overall, feeding 30RS resulted in reduced BW (P = 0.003), BWG (P = 0.003), and FI (P = 0.001) compared to CC, 500AITC, and 1500AITC. Similarly, feeding 20CLM resulted in lower BW and BWG compared to CC (P < 0.05) and increased FCR compared to 1500AITC (P = 0.03). Feeding CC resulted in higher mortality compared to NC and 30RS (P = 0.03). Cecal colonization of STNR was reduced (P < 0.0001) for 30RS on 6 dpc and 500AITC on 6 and 13 dpc (P < 0.0001). Although no difference in gut permeability was observed 6 dpc (P > 0.05), OT of STNR population was the highest for CC in the spleen (P = 0.05). In the liver, 10RS showed reduced OT compared to 20CLM on 13 dpc (P = 0.03), whereas 30RS showed the lowest OT on 6 dpc in the kidney. Fecal shedding was lowest for 30RS on 6 dpc (P = 0.004). Histomorphology showed 30RS had the highest duodenum (P = 0.01) and jejunum (P = 0.02) villus height (VH) and VH to crypt depth (CD) ratio compared to the other treatments, whereas 1500AITC showed similar results to 30RS. Both 30RS and 1500AITC contained comparatively higher functional GL metabolites and were able to maintain gut health. Including higher levels of rapeseed or AITC in poultry feed can reduce Salmonella colonization in the feces and their translocation to other organs.

Teaching Learning Methodology in Times of COVID-19 Pandemic: A Case Study

The Education system in India underwent a major change due to the sudden lockdown announced by the Government in view of COVID – 19 pandemic. Both teachers and students had to shift to online mode in a very short time period. The present study analysis the positive and negative aspect of this online mode of education and measures adopted by teachers to maintain the flow of education along with attendance. The sur- vey was conducted at JSS Academy of Technical Education, Noida. More than 100 teachers and students participated in the survey conducted. Also experienced faculty came up with sug- gestions and ideas to improve the online mode of education in view of such pandemic situations. Two teachers who were also teaching kids at an NGO school running in the campus prem- ises shared their view on what efforts they took to let education reach the kids at the NGO as digital divide was the main prob- lem there. Such findings will help in designing a future teach- ing model to cope with pandemic situations and not let educa- tion suffer.

Discovery of novel inhibitors targeting Plasmodium knowlesi dihydrofolate reductase using molecular docking and molecular dynamics simulation

Plasmodium knowlesi, recognized as the fifth Plasmodium parasite, is the least studied malaria parasite. It is a significant cause of morbidity and mortality in the South-East Asia region. Enzymes of folate synthesis, especially dihydrofolate reductase (DHFR), is a well-approved drug target in other Plasmodium species, but its role in Plasmodium knowlesi is poorly studied. This work characterizes PkDHFR as a drug target and identifies inhibitors that can withstand the upcoming problem of resistance. The 3D structure of the PkDHFR target is modelled using comparative modelling, and further, it is refined and validated using energy minimization and torsional angle analysis methods. We extracted 13 compounds from DrugBank and ZINC databases using the "target similarity search" criteria. These compounds were categorized based on their binding affinity (-4.49 to -10.08 kcal/mol) and pose prediction against the active site of PkDHFR. Later on, the top 5 PkDHFR-compound complexes with high or equivalent binding affinity to its natural ligand (dihydrofolate) have undergone for dynamics. The simulation experiments reveal the higher stability of DB00563-PkDHFR complex and less conformational fluctuations and share a similar degree of compactness throughout the simulation trajectory. The MM/GBSA calculation of free energy of DB00563 is also the least (-72.84 kcal/mol) compared to others. Furthermore, the flexible side chain of DB00563 can bind and block the active site of PkDHFR more efficiently. Thus, the identified drug may be considered as a potential candidate for treating P. knowlesi malaria.

Factors influencing local and distant recurrence following resection of periampullary cancer

BACKGROUND

Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences.

METHODS

This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed.

RESULTS

Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM.

CONCLUSION

Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.

A contribution to the earthworm diversity (Clitellata, Moniligastridae) of Kerala, a component of the Western Ghats biodiversity hotspot, India, using integrated taxonomy

Earthworms (Clitellata, Moniligastridae) of Chaliyar River Malappuram, Eravikulam National Park, Neyyar Wildlife Sanctuary, Parambikulam Tiger Reserve, Peppara Wildlife Sanctuary, Periyar National Park, Shendurney Wildlife Sanctuary and Wayanad Forest, Kerala, a component of the hotspot of Western Ghats, India, were studied by the standard method of taxonomy, and their DNA barcode signatures using the mitochondrial gene cytochrome c oxidase I (COI) were generated for the first time. This study represents eleven species of earthworms of the family Moniligastridae: Drawida brunnea Stephenson, Drawida circumpapillata Aiyer, Drawida ghatensis Michaelsen, Drawida impertusa Stephenson, Drawida nilamburensis (Bourne), Drawida robusta (Bourne), Drawida scandens Rao, Drawida travancorense Michaelsen, Moniligaster aiyeri Gates, Moniligaster deshayesi Perrier, and Moniligaster gravelyi (Stephenson). In the phylogenetic analysis all the species were recovered in both neighbour–joining (NJ) and maximum likelihood (ML) trees with high clade support. The average K2P distance within and between species was 1.2 % and 22 %, whereas the clear barcode gap of 2–5 % was suggested by barcode gap analysis (BGA) of studied species, reflecting the accuracy of characterization. The study presents the first step in the molecular characterization of the native earthworm family Moniligastridae of India. Data published through GBIF (Doi: 10.15470/l2nlhz)

Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial

Background

Globally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19.

Methods

A single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19.

Discussion

The trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care.

Trial registration

This trial was prospectively registered on the ANZCTR on 14/4/20 (ACTRN12620000468921).

Effect of Information, Education, and Communication activity on health literacy of cardiovascular diseases among school-going adolescents in Delhi

BACKGROUND

Heart attack and stroke account for >80% of deaths due to cardio-vascular diseases (CVDs) in India. Adolescents are the most susceptible group to adopt risky behaviors causing CVDs such as use of tobacco and alcohol, sedentary lifestyle, and unhealthy diet. This study was conducted to assess the health literacy of CVDs such as heart attack and stroke among school-going adolescents and change in health literacy after different information, education, and communication (IEC) activities.

MATERIALS AND METHODS

It was a school-based interventional study conducted in two schools among students of classes 6, 7, and 8. The educational interventions were done in the form of pamphlets, posters, and lectures on heart attack and stroke. The postintervention data were collected 2 weeks after the first intervention and 3 months after the last intervention.

RESULTS

There were a higher proportion of students with satisfactory level of knowledge of heart attack and stroke both at 2 weeks and 3 months after the interventions in both the schools, and the results were statistically significant (P < 0.05).

CONCLUSION

The health literacy regarding CVDs has improved when compared to baseline after IEC activities among school-going adolescents.

Challenges in Sensors Technology for Industry 4.0 for Futuristic Metrological Applications

The current advances and innovations in sensor technologies attributed to Industry 4.0 serve as the backbone for the inclusive growth of industry and ramping up the economy of any country. Industry 4.0 was basically conceptualized by introducing the Internet of Things (IoT) and Information and Communication technologies (ICT) that serve as an interface between digital and physical world through the fusion of smart sensors. The role of smart sensors and IoT-enabled industrial infrastructure is pivotal for adapting to the advanced technologies based on fusion of smart sensors. Digital meteorological traceability and uses of intelligent sensors, instrumentation and machinery in Industry 4.0, Smart Cities, Digital India and AtmaNirbhar Bharat missions of the government of India, are not only highly important but also in huge demand, which is going to increase manifolds in the years to come. The present paper is an attempt to provide a terse review and perspectives related to the advanced technological developments in this field and the challenges therein.

Spontaneous Pneumothorax: Follow up Treatment Outcome in a Tertiary Care Center of Eastern Nepal

Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care. Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center. Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software. Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality. Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences.

1107 Arousal And Sleepiness In Opioid Use Disorder Compared To Insomnia Disorder With And Without Comorbid Psychiatric Conditions

Introduction

Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID).

Methods

We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S.

Results

No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group.

Conclusion

OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population.

Support

Junior Faculty Development Program, Penn State College of Medicine

Drops That Change Their Mind: Spontaneous Reversal from Spreading to Retraction

A liquid drop may spread faster on surfaces when surfactants are added. Here we show that after some time the spreading in such systems can, under certain conditions, spontaneously reverse to retraction and the droplet pulls itself back, receding from areas it has just recently wetted, elevating its center of mass in a jerklike motion. The duration from drop placement to the onset of retraction ranges from hours to less than a second primarily as a function of surfactant concentration. When the retraction is asymmetric, it results in drop motion, and when it is symmetric, the mass of the drop collects itself on its spot. This phenomenon, which was predicted theoretically in 2014, is apparently a general one for drops with surfactants; however, other factors, such as evaporation and contamination, prevented its observance so far.

Mechanical and Fracture Peculiarities of Polypropylene-Based Functionally Graded Materials Manufactured via Injection Molding

This research presents the investigation of mechanical and thermal characteristics as well as fracture toughness of Polypropylene (PP) based functionally graded materials (FGMs) and compares them vis-a-vis PP based homogeneous composites and neat PP. FGMs and homogeneous composites are fabricated with 15 wt.% and 30 wt.% glass fiber-reinforced PP. The gradient of fiber distribution in functionally graded materials is verified by scanning electron microscope analysis and ignition loss test. Findings of this work reveal that FGMs outperform neat PP and homogeneous composites. Tensile, flexural and compression strength of FGMs are found to be better as compared to neat PP and homogeneous composites. Fracture toughness and thermal conductivity are also found higher for FGMs. The performance of fabricated composites is optimized by using the VlseKriterijuska Optimizacija I Komoromisno Resenje (VIKOR) method.

Abstract P6-19-05: Clinical characteristics and survival of patients with male breast cancer: The Mayo Clinic experience

Background:

Male breast cancer (MBC) is rare, and usually managed by extrapolation from female breast cancer. We report on the characteristics and survival outcomes of MBC patients from Mayo Clinic Rochester (MCR).

Methods:

Medical records of MBC patients treated at MCR during a 25-year period (1990-2015) were reviewed. Demographic variables, tumor characteristics, recurrences, and overall survival (OS) were collected. Progression free survival (PFS) and OS were estimated by the Kaplan-Meier method. Multivariate Cox-proportional hazard regression was used to identify predictors of OS.

Results:

One hundred sixty-seven patients were included in the final analysis, with a median follow-up of 58 months after diagnosis. Baseline characteristics are presented in Table 1. Eighty percent of patients with ER-positive tumors received endocrine therapy. Among men with stage I-III disease, approximately 90% underwent mastectomy, and 44% received adjuvant chemotherapy.

The 5-year locoregional and distant recurrence rates for patients with stage I-III disease were 4.4% and 21.5%, respectively. The 5-year PFS and OS for patients with stage I-III disease were 65.5% and 80.1%, respectively. In a multivariate analysis assessing predictors of OS in patients with stage I-III disease, older age (HR 1.05; 95% CI: 1.02 – 1.09), stage II (HR 11.06; 95% CI: 3.84 – 31.85) or stage III disease (HR 14.74; 95% CI (3.99 – 54.45), and omission of surgery (HR 45.33; 95% CI: 3.97 – 517.32) were associated with poorer OS, while endocrine therapy (HR 0.21, 95% CI: 0.09 – 0.51) was associated with better OS. ER, PR, HER2 and grade were not independently prognostic.

The median OS for stage IV patients was 10 months, though this 11-man cohort was too small to allow assessment of prognostic factors in advanced male breast cancer.

Conclusions:

MBC remains an understudied condition. Prognostic factors in this stage I-III disease are consistent with those identified in other MBC retrospective cohorts. Prospective studies are needed to better understand the unique clinical features of MBC, and to improve outcomes, particularly for advanced disease.

Table 1:Baseline characteristics N=167  Median age at diagnosis (Years)64.4  Ethnicity/Race: Caucasian131 (78.4%)African American4 (2.4%)Other or unknown32 (19.2%)  Overall AJCC 7th edition stage: Stage I39 (23.4%)Stage II80 (47.9%)Stage III32 (19.2%)Stage IV11 (6.6%)Unknown5 (3.0%)  Grade: 18 (4.8%)247 (28.1%)3101 (60.5%)Unknown12 (7.1%)  ER status: Negative8 (4.8%)Positive153 (91.6%)Unknown6 (3.6%)  PR status: Negative17 (10.2%)Positive141 (84.4%)Unknown9 (5.4%)  HER-2 status: Negative70 (41.9%)Positive12 (7.2%)Unknown85 (50.9%)

Citation Format: Yadav S, Leon-Ferre RA, Jimenez RE, Hawse JR, Hieken TJ, Couch FJ, Boughey JC, Ruddy KJ. Clinical characteristics and survival of patients with male breast cancer: The Mayo Clinic experience [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 P6-19-05.

Abstract P3-09-02: CRISPR-Cas9 mediated BRCA1 mutation in primary cells: Mutation efficiency and effects

Background: Germline mutations in Breast Cancer Associated (BRCA) 1 or 2 genes confer an increased risk of the development of breast and ovarian cancer. Germline mutation is followed by somatic loss of heterozygosity (LOH) resulting in biallelic inactivation. BRCA1 is involved in multiple homeostatic functions including control of chromatin organization, gene transcription, protein stability and cell division. Recent studies have demonstrated heterogeneity in LOH within and between premalignant and malignant breast tissues of BRCA1 mutation carriers. We hypothesize that LOH does not have a unitary effect on phenotype but differs by the function that is abrogated.

Methods: To test our hypothesis, we adopted CRISPR-Cas9 gene editing technology. The guide RNAs for targeting the exon sequence in the RING finger, nuclear export signal (NES), nuclear localization signal (NLS) and BRCA1 C Terminus (BRCT) domain/motif of BRCA1 were designed and synthesized. MCF10A cells were transfected with a complex of guide RNA and Cas9 protein (RNP) to cause in/del mutation. The mutation was analyzed by both T7E1 assay, and an innovative and more precise method developed in our lab that utilizes linked nucleic acids (LNA) and qPCR. Proliferation and apoptosis assays were performed using the transfected cells. Organoids prepared from BRCA1 mutation carriers also were transfected with RNPs and the mutation burden determined.

Results: Since single cell clones of the transfected MCF10A cells could not be selected and expanded, a pool of transfected cells was used for the analyses. T7E1 assay and qPCR analysis using LNAs demonstrated the presence of the mutations. A standard curve was created to enable the calculation of the mutation burden. IncuCyte analysis revealed increased proliferation and apoptosis, induced by irradiation, in cells with the mutation in Exon 10, where the extent of increase varied from 11% to 48% depending on the degree of mutation. In contrast, cells with the mutation in Exon 5 displayed diminished proliferation with no change in apoptosis. That mutations in exon10 and 5 have distinct biological effects when compared to the mutations in other exons is intriguing, and modification of binding proteins will be investigated. Organoids generated from BRCA1 mutation carriers (primary and nonmalignant cells) were able to be successfully transfected using the NEON electroporation system. Mutations were introduced by the CRISPR-Cas9 system and their extent quantified by our LNA-mediated qPCR method.

Conclusions: CRISPR-Cas9-mediated gene editing of BRCA1 in MCF10A resulted in a change in the proliferation rate and the extent of apoptosis that is dependent on the location of the de novo mutation within the gene. The development of a novel method, LNA-mediated qPCR, provides quantitative information regarding the mutations that may be used to correlate mutation burden with biological functional change. Successful establishment of this BRCA1 tumorigenesis model has provided us with a method to test other putative tumor suppressors.

Citation Format: Choi MR, Yadav S, Shidfar A, Khan SA, Clare SE. CRISPR-Cas9 mediated BRCA1 mutation in primary cells: Mutation efficiency and effects [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-09-02.

Abstract P2-02-06: Deregulated lipid metabolism fuels the genesis of estrogen receptor negative breast cancer

Background:

There are no targeted pharmacologic interventions currently available for the prevention of hormone receptor negative breast cancer. Primary prevention with endocrine agents decreases the risk of ER positive disease with no effect against ER negative (ER-) disease. Thus, there is a compelling need to identify women at high risk for ER-negative breast cancer and to uncover the molecular mechanisms involved in its genesis. Our recent observation that a set of lipid metabolism (LiMe) genes are over-expressed in the contralateral unaffected breasts of women with unilateral ER- breast cancer suggests the novel hypothesis that specific lipid metabolism pathways in the breast produce a physiological milieu favoring the development of ER- breast cancer. We are now testing the specific hypothesis that lipids are the source of the acetyl-coA that is utilized to acetylate histones, an epigenetic modification that reprograms transcription.

Methods:

We developed an in-vitro model that relies on octanoic acid, a medium chain fatty acid that freely diffuses though the plasma and mitochondrial membranes. MCF-10A cells were plated and allowed to adhere overnight and then exposed to an increasing dose of sodium octanoate for 24 hours in complete media. Acetylation of Lysine 9 of Histone 3 (H3K9) was analyzed by Western blot and RNA was extracted for qPCR and RNA-seq. Chromatin packing density at the nanoscale was quantified bypartial wave spectroscopic (PWS) microscopy. Mammary organoids were prepared from breast tissue by collagenase digestion and similarly treated.

Results:

We found a striking, dose-dependent increase of H3K9 acetylation in octanoate treated MCF-10A cells. The acetylation is specific to the lipids as no acetylation was observed in cells treated with the same concentration of the alcohol 1,4-Cyclohexanedimethanol. RNA-Seq revealed the differential expression of LiMe genes together with a significant upregulation of Hedgehog and Notch signaling pathways. Individual genes from various pathways were further verified by qPCR which revealed, for example, a four-fold increase in SHH expression and 25-fold increase in DLL4. The expression of two of the previously identified LiMe genes, HMGCS2 and ACSL3, was increased four-fold in the octanoate treated MCF10A cells. We repeated the octanoate treatment in organoids and found similar effects. PWS in live cells showed a dose-dependent increase in chromatin packing scaling (D) in cells exposed to octanoate, suggesting that accessibility of chromatin to transcription factors is increased upon fatty acid treatment.

Conclusion:

A lipid rich microenvironment affects metabolism in ER- MCF10A cells and stimulates pro-neoplastic signaling via histone modifications. This supports our hypothesis that perturbed lipid metabolism plays an important role in the development of ER- breast cancer. Further mechanistic studies will determine if the genes differentially expressed in cell culture are also differentially expressed in antecedent benign breast biopsies from women eventually diagnosed with ER+ and ER- cancer.

Citation Format: Yadav S, Choi M, VanDerway D, Bauer G, Backman V, Khan SA, Clare SE. Deregulated lipid metabolism fuels the genesis of estrogen receptor negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-02-06.

Deep Attention Models for Human Tracking Using RGBD

Visual tracking performance has long been limited by the lack of better appearance models. These models fail either where they tend to change rapidly, like in motion-based tracking, or where accurate information of the object may not be available, like in color camouflage (where background and foreground colors are similar). This paper proposes a robust, adaptive appearance model which works accurately in situations of color camouflage, even in the presence of complex natural objects. The proposed model includes depth as an additional feature in a hierarchical modular neural framework for online object tracking. The model adapts to the confusing appearance by identifying the stable property of depth between the target and the surrounding object(s). The depth complements the existing RGB features in scenarios when RGB features fail to adapt, hence becoming unstable over a long duration of time. The parameters of the model are learned efficiently in the Deep network, which consists of three modules: (1) The spatial attention layer, which discards the majority of the background by selecting a region containing the object of interest; (2) the appearance attention layer, which extracts appearance and spatial information about the tracked object; and (3) the state estimation layer, which enables the framework to predict future object appearance and location. Three different models were trained and tested to analyze the effect of depth along with RGB information. Also, a model is proposed to utilize only depth as a standalone input for tracking purposes. The proposed models were also evaluated in real-time using KinectV2 and showed very promising results. The results of our proposed network structures and their comparison with the state-of-the-art RGB tracking model demonstrate that adding depth significantly improves the accuracy of tracking in a more challenging environment (i.e., cluttered and camouflaged environments). Furthermore, the results of depth-based models showed that depth data can provide enough information for accurate tracking, even without RGB information.