Triple dip La-Nina, unorthodox circulation and unusual spin in air quality of India

The recent La-Nina phase of the El Nino Southern Oscillation (ENSO) phenomenon unusually lasted for third consecutive year, has disturbed global weather and linked to Indian monsoon. However, our understanding on the linkages of such changes to regional air quality is poor. We hereby provide a mechanism that beyond just influencing the meteorology, the interactions between the ocean and the atmosphere during the retreating phase of the La-Niña produced secondary results that significantly influenced the normal distribution of air quality over India through disturbed large-scale wind patterns. The winter of 2022-23 that coincided with retreating phase of the unprecedented triple dip La-Niña, was marred by a mysterious trend in air quality in different climatological regions of India, not observed in recent decades. The unusually worst air quality over South-Western India, whereas relatively cleaner air over the highly polluted North India, where levels of most toxic pollutant (PM2.5) deviating up to about ±30 % from earlier years. The dominance of higher northerly wind in the transport level forces influx and relatively slower winds near the surface, trapping pollutants in peninsular India, thereby notably increasing PM2.5 concentration. In contrast, too feeble western disturbances, and unique wind patterns with the absence of rain and clouds and faster ventilation led to a significant improvement in air quality in the North. The observed findings are validated by the chemical-transport model when forced with the climatology of the previous year. The novelty of present research is that it provides an association of air quality with climate change. We demonstrate that the modulated large-scale wind patterns linked to climatic changes may have far-reaching consequences even at a local scale leading to unusual changes in the distribution of air pollutants, suggesting ever-stringent emission control actions.

Encapsulation efficiency and fatty acid analysis of chia seed oil microencapsulated by freeze-drying using combinations of wall material

Chia seed oil (CSO) was encapsulated using whey protein concentrate (WPC) and modified tapioca starch (MTS) through freeze-drying. A central composite design was used to evaluate the effect of independent variables (MTS:WPC ratio, homogenization pressure, and oil content). Encapsulation efficiency (EE) and α-linolenic acid content (ALA) were evaluated for all runs. The results showed that higher MTS ratios led to maximum ALA retention, while higher WPC ratios led to maximum EE. The optimized conditions resulted in high EE (97 %), ALA content (59.54 %), and a Ω-3:Ω-6 ratio (3.34). The fatty acid composition, oxidative and thermal stability showed that the MTS:WPC ratio of 25:75 was the best combination for encapsulating CSO. The encapsulated CSO with a balanced Ω-3:Ω-6 ratio can be used as a functional ingredient in foods for health benefits.

Investigating the effect of wall material and pressure homogenisation on encapsulation parameters and thermal stability in chia seed oil microcapsules

AIM

To evaluate the effect of different wall material (WM) matrices followed by homogenisation to encapsulate chia seed oil (CSO) using freeze drying technology.

METHODS

CSO was encapsulated using three ratios (100/0, 50/50, and 100/0) of two WM matrices: MTS/WPC (modified tapioca starch-whey protein concentrate) and MD/WPC (maltodextrin-whey protein concentrate). The evaluation included encapsulation efficiency (EE), oxidative stability, and α-linolenic acid (ALA) retention. Homogenised microcapsules (-H) were then assessed for storage and thermal stability, along with cumulative oil release.

RESULTS

The MD-WPC-H 50/50 microcapsules had superior EE (97.32%), higher ALA retention (60.2%), storage stability (up to 30 days), higher thermal stability (up to 700 °C), and desirable oil release in simulated condition.

CONCLUSION

Selecting suitable WM and homogenisation is key for improving EE, storage, thermal stability, and targeted release. The CSO microcapsule can serve as a functional ingredient to improve the quality of diverse food products.

Unleashing the bioactive potential of Capsicum chinense cv Bhut Jolokia: a comparison of microwave- and ultrasound-mediated extraction techniques for lipophilic capsaicin

This study investigated the extraction of capsaicin from Capsicum chinense cv Bhut Jolokia using rice bran oil (RBO) as a 'green solvent' via microwave- and ultrasound-mediated techniques (MME and UME) as an alternative to hazardous organic solvents. Extraction conditions were optimised using MME at 180 and 300 W for 2 and 8 min and UME at 300 and 400 W for 10 and 30 min. The maximum capsaicin yield obtained was 12.47 mg/mL, with a corresponding gamma oryzanol content of 8.46 mg/mL. The peroxide value of the extract (capsaicin-infused RBO) was found to be within permissible limits as per Codex Alimentarius specifications. Results strongly suggest the potential of RBO as a novel solvent for extraction of capsaicin. The capsaicin-enriched oil can be used as a functional food ingredient due to its health-promoting properties.

Every treasured drop! Blood transfusion requirements in very preterm neonates after implementation of blood conservation strategies: an observational analytical study

BACKGROUND

Certain morbidities are inevitable in preterm infants; the challenge lies in minimizing them. Anemia of prematurity is multifactorial. Therapy largely depends on adult red blood cell transfusions (RBCT); which inherently, are not without problems. Most literature in this respect are retrospective or evaluate individual stratagems to reduce RBCT.

METHODS

This observational analytical study was planned to compare need for RBCT, before and after institution of blood conservation strategies (BCS). All those ≤30 weeks gestation at birth during two-time epochs were included (Before BCS: retrospective; After BCS: prospective). BCS constituted of delayed cord clamping (DCC), strict sampling indications, micro-sampling with point-of-care testing (MS-POCT) and adherence to RBCT thresholds.

RESULTS

Of 45 enrolled neonates in each group, proportion of those requiring even 1 RBCT was significantly reduced after BCS [51.1% vs. 26.7%, p = 0.02, OR 0.35, 95%CI (0.14, 0.84)]. Calculated cumulative blood volume losses (35.3 ml vs. 21.9 ml) and loss per kilogram birth weight (35.3 ml/kg vs. 20.12 ml/kg) were significantly lower after BCS (p = 0.0036). Need for >1 RBCT, mean lowest Hb, mean maximum-hemoglobin drop, need for arterial lines were reduced. Adherence to RBCT thresholds were acceptably good in both time epochs. However, the compliance to DCC was low in both groups, identifying one area of focus with scope for massive improvement.

CONCLUSIONS

Need for RBCT transfusions largely attributable to reduced blood losses for lab analysis were reduced after BCS. Installation of in-house MS-POCT seemed to be the pivotal factor. Units that care for very preterm infants must make attempts to procure MS-POCT equipment.

Prognostic value of left ventricular chamber stiffness and heart failure in patients with severe aortic stenosis undergoing aortic valve replacement

Background

Increased left ventricular (LV) stiffness (LVStiffn) was shown to be associated with mortality in patients with severe aortic stenosis (AS), despite aortic valve replacement (AVR), and may contribute to future heart failure (HF) symptoms. The aim was to assess whether preoperative LVStiffn is a risk factor of HF in these patients.

Methods

A retrospective analysis was done in patients with severe AS who underwent AVR (93% surgical). LV end-diastolic pressure-volume relations (P=aVb) were reconstructed from LV end-diastolic volumes and estimated end-diastolic pressures (from E/e'); LVStiffn at 30 mmHg (CS30) and capacitance (V30) were then derived. Primary endpoint was development of symptomatic HF at >1 month post AVR.

Results

1,837 patients were studied (age 76±10 years, 62% males, LVEF 61±12%; Table). Mean CS30 was 2.2±1.3 mmHg/mL and V30 64±17 mL/m2. Patients with higher CS30 ≥3 mmHg/mL were older, more frequently female, and had more comorbidities. During a median follow-up of 5.0 [3.0–7.9] years, 607 (33%) patients developed HF. A higher CS30 (≥3 mmHg/mL), but not V30 (P=0.32), was associated with higher risk of HF events (HR 1.86 [95% CI 1.52–2.27], P<0.0001), along with other clinical and echo predictors (Table). In multivariate analysis, adjusting for age, sex, comorbidities, advanced NYHA class III–IV, creatinine >1.5 mg/dL, medication use, severity of AS, reduced LVEF <50%, diastolic dysfunction grade ≥2, right ventricular size and pulmonary hypertension, a higher CS30 ≥3 mmHg/mL remained independently associated with HF events (adjusted HR 1.61 [1.29–2.01], P<0.0001; Figure).

Conclusion

Increased LVStiffn in patients with severe AS undergoing AVR is associated with HF at follow-up, despite the benefits brought by AVR, and can help identify patients with poorer outcomes who may need closer monitoring/more intensive treatment of comorbidities

Funding Acknowledgement

Type of funding sources: None.

Machine learning predicts all-cause mortality in patients with severe aortic regurgitation

Funding Acknowledgements

Type of funding sources: None.

Background

Aortic regurgitation (AR) is a common valvular lesion associated with left ventricular (LV) enlargement and dysfunction and increased risk of death with onset of symptoms, significant LV enlargement, or systolic dysfunction. The current guidelines are based on symptoms, LV size and LV function to evaluate the candidacy for surgery in patients with severe AR.

Purpose

 We propose a machine-learning (ML) based algorithm to identify patients at risk for death from AR independent of aortic valve replacement (AVR) surgery (patients were censored at AVR event unless the operation occurred within 100 days of the first visit, in which case baseline AVR is included as a predictor).

Methods

The model was trained with 5-fold cross-validation on a dataset of 1035 patients. Model performance is reported on an independent dataset of 207 patients. Optimal predictive performance was observed with a Conditional Random Survival Forest model. A subset of 19 / 41 variables were selected for inclusion in the final model. Variable selection was performed with 10-fold cross validation using Random Survival Forest model; variables that were on an average selected by less than 6/10 splits were excluded.

Results

The mean age of patients was 60 ± 17 years and 198 (18%) were females. The variables included in the models were age, end-diastolic volume, end systolic dimension, body surface area, ejection fraction, NYHA class, body mass index, diastolic blood pressure, bicuspid valve, regurgitant volume, filling pressure, mid ascending aorta diameter, mitral tissue early relaxation velocity, pulmonary artery systolic pressure, and comorbidities, and the relative variable importances averaged across five splits of cross validation in each repeat were evaluated (Figure). The predictive AUC for predicting survival of the best-performing model was 0.84 at 1 year, 0.86 at 2 years, and 0.87 overall, respectively.

Conclusion

Using commonly observed echo parameters and patient characteristics we successfully trained a ML model to predict survival in patients with severe AR. This technique could identify high-risk patients who would benefit from early intervention, thereby improving patient outcomes. Abstract Figure.

Pulmonary artery pulsatility index by echocardiography predicts mortality in patients with pulmonary hypertension

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary hypertension (PH) is a progressive pulmonary vascular disorder with an elevated mortality risk due to right ventricular failure. Pulmonary arterial pulsatility index (PAPi) based on invasively acquired parameters has emerged as a potentially valuable hemodynamic risk predictor. Whether non-invasively derived PAPi (PA pulse pressure/ RA pressure) is valuable is unclear.

Purpose

To assess whether PAPi measured non-invasively by transthoracic echocardiography acts as a prognostic hemodynamic biomarker of patient risk.

Methods

Consecutive patients undergoing transthoracic echocardiography for known or suspected PH over a one year period were included. PA systolic and diastolic pressure were estimated in standard fashion from peak tricuspid and end-pulmonary regurgitant Doppler profiles. Right atrial pressure was estimated based on 2D & Doppler assessment of the inferior vena cava  hepatic vein. In those patients with PH (mean PA pressure > 20 mm Hg), PAPi was divided into 3 groups based on prior publications with invasive data as <1.5, 1.5 to 3 and >3. Mortality was assessed over 5 years.

Results

Of 1,045 patients enrolled 64% had PH. Patients with the lowest PAPi (table) had higher NT-proBNP levels, larger right ventricles, worse right heart systolic function (cardiac output, TAPSE, systolic annular velocity, free wall systolic strain) and greater degrees of tricuspid regurgitation (Table). In patients with PH, PAPi was inversely associated with death (figure, p < 0.0001) with each group of PAPi correlating with incrementally worse survival. Patients with a PAPi of <1.5 had worst right heart size and dysfunction on echo (table) and worst survival (figure).

Conclusions

In patients with PH, low PAPi derived non-invasively by transthoracic echocardiography is associated with markers of right heart failure, right ventricular dysfunction and worse survival. PAPi could be incorporated into the conventional echo parameters reported in patients with known or suspected PH and maybe a useful predictor of outcome. Abstract Table  Abstract Figure

The five phenotypes of tricuspid regurgitation: insight from cluster analysis of clinical and echocardiographic variables

Funding Acknowledgements

Type of funding sources: None.

Background

Tricuspid regurgitation (TR) is a prevalent valvular lesion with three broad morphologic subtypes: primary due to intrinsic pathology of the valve or subvalvular apparatus; secondary due to pulmonary hypertension; and isolated TR associated with chronic atrial fibrillation. The complex pathophysiological, clinical and echocardiographic features between these subtypes require further investigation.

Purpose

We aimed to identify the different phenotypes of TR using cluster analysis, and determine differences (if present) in clinical outcomes associated with these phenotypes.

Methods

We included 13611 patients with ≥ moderate TR, either primary or secondary, in the final analyses. The demographic, clinical and echocardiographic data of these patients were evaluated using Ward’s minimum variance cluster analysis including a total of 38 variables. Survival analysis for all-cause mortality was performed using the Kaplan-Meier method, and groups were compared using the log-rank test.

Results

The mean age of patients was 72.5 ± 13.4 years, 7590 (56%) were females. The clustering identified 5 distinct phenotypes. Cluster 1 represented "low-risk TR" with lesser severity likely related to chronic atrial fibrillation. This cluster had less severe TR, normal sized right ventricle and fewer comorbidities. Clusters 2-5 represented "higher severity TR", "TR associated with lung disease", "TR associated with coronary artery disease and ischemic cardiomyopathy" and "TR associated with chronic kidney disease" respectively (Figure 1). Cluster 1 had the best overall survival, followed by clusters 2, 3 and 4, and lastly cluster 5, with the worst outcome (Figure 2).

Conclusions

Cluster analysis identifies 5 phenotypically distinct novel subgroups of TR with differences in all-cause mortality. This phenotype-based classification improves our understanding of interaction of different co-morbidities with this complex valve lesion and can inform clinical decision making. Abstract Figure. Cluster Dendrogram  Abstract Figure. Kaplan-Meier survival curves

Identifying entrustable professional activities for post-graduation in ENT: What should an ENT specialist be able to do?

BACKGROUND

Though regulatory bodies of medical education in India mandate post graduate medical education to be competency based, the implementation of the same has not kept pace. The present study aims to develop and propose a set of entrustable professional activities for a masters degree in the discipline of ENT. It also attempts to present it in the form of a portfolio.

METHODS

Experts in the subject went through a series of activities including brainstorming, discussions and internal peer review to shortlist and enumerate EPAs.

RESULTS

335 EPAs were identified and are presented. They were further classified as per need and expected expertise.

CONCLUSION

The EPAs may serve as a guideline to medical colleges/institutions aiming to adopt competency based medical education in the post graduate curriculum in the subject of ENT.

COVID-19 and environmental -weather markers: Unfolding baseline levels and veracity of linkages in tropical India

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe due to its contagion nature. We hereby report the baseline permanent levels of two most toxic air pollutants in top ranked mega cities of India. This could be made possible for the first time due to the unprecedented COVID-19 lockdown emission scenario. The study also unfolds the association of COVID-19 with different environmental and weather markers. Although there are numerous confounding factors for the pandemic, we find a strong association of COVID-19 mortality with baseline PM_2.5 levels (80% correlation) to which the population is chronically exposed and may be considered as one of the critical factors. The COVID-19 morbidity is found to be moderately anti-correlated with maximum temperature during the pandemic period (-56%). Findings although preliminary but provide a first line of information for epidemiologists and may be useful for the development of effective health risk management policies.

Cigarettes and Straws: Late Positive Potential Modulation in Mental Illness and Nicotine Addiction

Tobacco use remains a major preventable cause of death worldwide, accumulating billions of dollars in healthcare spending annually in the U.S. alone. Evidence has found that among those addicted, individuals suffering with psychiatric illnesses are disproportionally abusing. To assess this disparity, our study observed event related potential (ERP) responses recorded with electroencephalogram (EEG) in chronic smokers with (MI; n=6) and without mental illness (NMI; n=6). We found that the MI group alone presented heightened late positive potential (LPP) responses while processing cigarette (addictive) stimuli compared to neutral images (t-value = 3.11 at Cz, 3.92 at Pz). Our study illustrates the significance of the LPP as a promising biomarker to assess tobacco addiction in individuals facing mental illness.

Parenteral Nutrition Ascites: Calamity from an Umbilical Vein Cannula

Umbilical vein catheterization is considered a critical requirement in preterm neonates for the administration of fluids and parenteral nutrition. However, inadvertent migration and malposition are known to cause complications that are often life-threatening. We describe a neonate with parenteral nutrition-associated lipid ascites owing to extravasation from an umbilical vein cannula. Fatality was averted due to prompt recognition and paracentesis that was therapeutic and confirmed the diagnosis as well.

3260Prognostic value of cardiac power reserve in patients with normal left ventricular ejection fraction undergoing exercise stress echocardiography

Background

Cardiac power output-to-mass (CPOM) ratio is a measure of myocardial performance that incorporates both pressure and flow output, normalized to left ventricular (LV) mass generating that cardiac work. Prior small studies have shown that CPOM predicts outcomes in patients with ischemic cardiomyopathy and reduced LV ejection fraction (EF). We sought to evaluate the prognostic significance of peak exercise CPOM and power reserve (increase from rest to peak exercise) in patients with normal EF.

Methods and results

Retrospective study in 24,783 patients (age 59±13 years, 45% females) with EF≥50% and no significant valve disease or right ventricular (RV) dysfunction, undergoing exercise stress echocardiography between 2004–2018. CPOM was calculated as previously described (0.222 x cardiac output x mean blood pressure / LV mass) and expressed in Watts/100g myocardium. Power reserve was calculated as difference in CPOM between peak stress and rest. All-cause mortality was the primary endpoint. Patients were divided into quartiles of power reserve. Patients with higher power reserve were younger, had higher blood pressure and heart rate, lower LV mass, and lower prevalence of prior myocardial infarction. (Table). During follow-up (median (IQR) 3.9 (0.6–8.3) years), 931 (3.8%) patients died. Progressively lower power reserve was associated with increasing mortality (Figure A). Compared to patients with abnormal stress test, patients with the lowest power reserve but otherwise normal stress test had the same survival as those with infarction/cardiomyopathy or ischemia on stress test (Figure B). Resting CPOM had lower predictive value. After adjusting for age, sex, METs achieved, ischemia/infarction on stress test results, and diastolic function grade, both peak exercise CPOM and power reserve were independent predictors of mortality (p<0.0001), incremental to conventional measures.

Conclusion

Cardiac power output and reserve measured during exercise stress echo provides independent prognostic information in patients with normal resting EF and no significant valve disease or RV dysfunction. The survival of patients with low power reserve but normal stress test was similar to patients with prior infarction/ cardiomyopathy or ischemia on stress test.

Cellular Automata with Synthetic Image A Secure Image Communication with Transform Domain

    Image encryption has attained a great attention due to the necessity to safeguard confidential images. Digital documents, site images, battlefield photographs, etc. need a secure approach for sharing in an open channel. Hardware – software co-design is a better option for exploiting unique features to cipher the confidential images. Cellular automata (CA) and synthetic image influenced transform domain approach for image encryption is proposed in this paper. The digital image is initially divided into four subsections by applying integer wavelet transform. Confusion is accomplished on low – low section of the transformed image using CA rules 90 and 150. The first level of diffusion with consecutive XORing operation of image pixels is initiated by CA rule 42. A synthetic random key image is developed by extracting true random bits generated by Cyclone V field programmable gate array 5CSEMA5F31C6. This random image plays an important role in second level of diffusion. The proposed confusion and two level diffusion assisted image encryption approach has been validated through the entropy, correlation, histogram, number of pixels change rate, unified average change intensity, contrast and encryption quality analyses.

Abstract P5-05-01: Metabolic enzyme PFKFB4 activates transcriptional coactivator SRC-3 to drive aggressive metastatic breast cancer

Background: Metabolic rewiring is one of the central hallmarks of cancer progression and survival to support anabolic and energetic demands. Tumor cells constantly alter their metabolic state in response to oncogenic stimuli, nutrient availability, and interaction with immune cells however the precise regulation that precedes the metabolic alteration is poorly understood. Here we report a direct interaction of glycolytic enzyme PFKFB4 with transcriptional coregulator SRC-3. PFKFB4 functions as a critical regulator of Warburg effect and our study reveals that upon glucose stimulation PFKFB4 activates SRC-3 driving an invasive-metastatic breast cancer.

Methods: Molecular experiments were performed to understand the transcriptional activation of SRC-3 by PFKFB4 enzyme. Chromatin immunoprecipitation and gene expression studies were performed to investigate the functions of PFKFB4/SRC-3 crosstalk on transcriptional regulation. Metabolomics and isotope tracing studies were performed to identify the metabolic adaptations regulated by PFKFB4/SRC-3 in breast tumors. PFKFB4-knockout was established using CRISPR-Cas9 system and functional studies were carried out to define its role in tumor cell proliferation, invasion-migration, and breast to lung metastasis. Human breast tumor samples were evaluated to identify the clinical importance of PFKFB4/SRC-3 crosstalk in patients.

Results:Molecular studies revealed that PFKFB4 enzyme phosphorylates SRC-3 at serine 857 (S857) enhancing its transcriptional activity, whereas either suppression of PFKFB4 or ectopic expression of a phosphorylation-deficient SRC-3 mutant S857A (SRC-3S857A) significantly abolished SRC-3-mediated transcriptional output (p&lt;0.000001). Functionally, PFKFB4-driven SRC-3 activation drives glucose flux towards the pentose phosphate pathway enabling purine synthesis by transcriptionally upregulating the expression of enzyme transketolase (TKT). Deletion of PFKFB4 by CRISPR-Cas9 system resulted in significantly reduced proliferation (p&lt;0.05) and migration-invasion (p&lt;0.001) compared to wildtype breast tumor cells. Ablation of SRC-3 or PFKFB4 suppressed in vivo breast tumor growth and prevents metastasis to the lung from an orthotopic setting (p&lt;0.0001). PFKFB4 and phosphorylated SRC-3 levels are significantly increased in breast tumors (p=0.02), whereas, in patients with the basal subtype, PFKFB4 and SRC-3 drive a common protein signature that correlates with the poor survival of TNBC patients (p=0.03).

Conclusion:Our data suggest that the Warburg pathway enzyme PFKFB4 acts as a molecular fulcrum that couples sugar metabolism to transcriptional activation by stimulating SRC-3 to promote aggressive metastatic tumors. It also provides first evidence how Warburg pathway drives aggressive breast tumorigenesis by directly activating powerful oncogene SRC-3. Our work suggests that targeting the PFKFB4–SRC-3 axis may be therapeutically valuable in breast tumors that are notably dependent on glucose metabolism.

(This work is funded by grants from Susan G. Komen and NCI to S.D.)

Citation Format: Dasgupta S, Anand V, John H, Sawant Dessai A, Katsuta E, Takabe K, O'Malley B. Metabolic enzyme PFKFB4 activates transcriptional coactivator SRC-3 to drive aggressive metastatic 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 P5-05-01.

Abstract P2-02-04: CD73 expression regulated by estrogen signaling associates with poor prognosis in estrogen receptor (ER)-positive breast cancer

Introduction: CD73, a cell surface enzyme, catalyzes the generation of adenosine from ATP and ADP in the tumor microenvironment along with CD39. Accumulated extracellular adenosine functions as immune-suppressor, and also binds to adenosine receptors which promotes angiogenesis and cell proliferation that results in accelerate cancer progression. However, the clinical significance and molecular function of CD73 expression in breast cancer remains unclear.

Methods: Utilizing publicly available breast cancer cohorts of The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), clinical significance as well as underlying mechanisms were investigated. Molecular experiments were carried out in MCF7 cells, ER-positive breast cancer cell line, to investigate the role of estrogen signaling on CD73/CD39 expression.

Results: In treatment naïve TCGA cohort, CD73 expression level was significantly lower in ER-positive breast cancers compared to ER-negative tumors. Higher CD73 expression was associated with worse overall survival in whole cohort (p=0.021) and ER-positive tumors (p=0.003), but not in ER-negative tumors. Gene Set Enrichment Analysis revealed that estrogen response gene sets (Early; NES=-1.57, p=0.043, Late; NES=-1.61, p=0.021) were significantly enriched in CD73 low expressing ER-positive tumors, suggesting estrogen signaling may repress CD73 expression. To test this hypothesis, we analyzed the expression of CD73 and CD39 in MCF7 cells treated with estrogen, tamoxifen or both. Our data revealed that estrogen treatment suppressed CD73 and CD39 expression, whereas tamoxifen treatment enhanced expression of the genes. These findings suggest that CD73 and CD39 gene expression is suppressed by estrogen signaling, whereas binding of ER antagonists such as tamoxifen can remove the repressive effect on gene expression. On the other hand, epithelial-mesenchymal transition (EMT) (Normalized Enrichment Score; NES=2.41, p&lt;0.001) and angiogenesis (NES=2.33, p&lt;0.001) gene sets were significantly enriched in CD73 high expressing ER-positive tumors. CIBERSORT, which is an algorithm to estimate infiltrating immune cells by gene expression, demonstrated that CD73 high expressing ER-positive tumors have less infiltrating CD8-positive T cells, memory B cells and plasma cells, implying that CD73 high expressing tumors have immune suppressive environment, which is in agreement with the notion that CD73 high tumors are immunosuppressive. Finally, we found that CD73 expression was significantly elevated post-chemotherapy compared to tumors prior to the treatment (p=0.007), and CD73 high expression patients showed worse relapse-free survival in neoadjuvant chemotherapy patients cohort (p=0.003).

Conclusion: Molecular studies revealed that CD73 expression is regulated by estrogen signaling. Increased expression of CD73 significantly correlates with worse outcomes in ER-positive breast cancer patients. This may be due to upregulated pro-metastatic gene signatures such as EMT and angiogenesis as well as less infiltration of anti-cancer immune cells by adenosine generated by CD73 in the tumor microenvironment. Our data reveals an intriguing mechanism which may be responsible for recurrence and metastasis of ER-positive breast cancer.

Citation Format: Katsuta E, Anand V, Yan L, Dasgupta S, Takabe K. CD73 expression regulated by estrogen signaling associates with poor prognosis in estrogen receptor (ER)-positive 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 P2-02-04.

Retraction notice to: "Characteristics of recursive backstepping algorithm and active damping of oscillations in feedback linearization for electromechanical system with extended stability analysis and perturbation rejection" [ISA Trans. 64C (2016) 365-372]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted by agreement between the authors and the Editor-in-Chief. A request by the authors to add additional authors to the paper after publication resulted in an agreement to retract the paper by the Authors and Editor-in-Chief.

Characteristics of recursive backstepping algorithm and active damping of oscillations in feedback linearization for electromechanical system with extended stability analysis and perturbation rejection

In this paper, a technique for estimation of state variables and control of a class of electromechanical system is proposed. Initially, an attempt is made on rudimentary pole placement technique for the control of rotor position and angular velocity profiles of Permanent Magnet Stepper Motor. Later, an alternative approach is analyzed using feedback linearization method to reduce the error in tracking performances. A damping control scheme was additionally incorporated into the feedback linearization system in order to nullify the persistent oscillations present in the system. Furthermore, a robust backstepping controller with high efficacy is put forth to enhance the overall performance and to carry out disturbance rejection. The predominant advantage of this control technique is that it does not require the DQ Transformation of the motor dynamics. A Lyapunov candidate was employed to ensure global asymptotical stability criterion. Also, a nonlinear observer is presented to estimate the unknown states namely load torque and rotor angular velocity, even under load uncertainty conditions. Finally, the performances of all the aforementioned control schemes and estimation techniques are compared and analyzed extensively through simulation.

Laser tympanic neurectomy for post-cochlear implant pain: A new technique

OBJECTIVES

To present the case histories and management by LASER tympanic neurectomy of two patients who presented with pain as their only symptom after cochlear implantation, avoiding the need for device removal.

CLINICAL PRESENTATION

Two of our patients presented with otalgia, which appeared 6 months after cochlear implantation and resulted in their refusing to use the device. The pain was not controlled by repeated remapping or medical management. Neither patient showed evidence of infection or inflammation around their device. X-rays showed that there were no extracochlear electrodes or evidence of extrusion. One patient had current leakage from two electrodes, which were switched off, but the pain persisted.

INTERVENTION

Both patients received an intratympanic injection of 1 ml of 0.5% Bupivacaine to anaesthetize the tympanic plexus in the middle ear and were then observed for a day, found to have relief of their pain and were able to use the implant with audiological benefit for this short time, until the effect of the anaesthetic had worn off. Therefore we planned and performed a tympanic neurectomy on both patients using CO2 laser.

CONCLUSION

Tympanic neurectomy removed the pain in two cochlear implant patients who presented with pain which was present only when the implant was switched on.

Leveraging electronic tablets for general pediatric care: a pilot study

BACKGROUND

We have previously shown that a scan-able paper based interface linked to a computerized clinical decision support system (CDSS) can effectively screen patients in pediatric waiting rooms and support the physician using evidence based care guidelines at the time of clinical encounter. However, the use of scan-able paper based interface has many inherent limitations including lacking real time communication with the CDSS and being prone to human and system errors. An electronic tablet based user interface can not only overcome these limitations, but may also support advanced functionality for clinical and research use. However, use of such devices for pediatric care is not well studied in clinical settings.

OBJECTIVE

In this pilot study, we enhance our pediatric CDSS with an electronic tablet based user interface and evaluate it for usability as well as for changes in patient questionnaire completion rates.

METHODS

Child Health Improvement through Computers Leveraging Electronic Tablets or CHICLET is an electronic tablet based user interface. It is developed to augment the existing scan-able paper interface to our CDSS. For the purposes of this study, we deployed CHICLET in one outpatient pediatric clinic. Usability factors for CHICLET were evaluated via caregiver and staff surveys.

RESULTS

When compared to the scan-able paper based interface, we observed an 18% increase or 30% relative increase in question completion rates using CHICLET. This difference was statistically significant. Caregivers and staff survey results were positive for using CHICLET in clinical environment.

CONCLUSIONS

Electronic tablets are a viable interface for capturing patient self-report in pediatric waiting rooms. We further hypothesize that the use of electronic tablet based interfaces will drive advances in computerized clinical decision support and create opportunities for patient engagement.

Post Kala azar dermal leishmaniasis (PKDL) presenting with ulcerated chronic paronychia like lesion

A 50-year-old lady, resident of urban Bihar, presented with inflamed proximal nail fold of a single digit for one and half months. The lesion on distal finger was remarkable for ulceration. Mucocutaneous examination revealed multiple hypopigmented macules and patches, notable for absence of scaling. The presence of ulceration was not consistent with chronic paronychia, hence, she was asked for biopsy. She declined and opted for trial of antibiotic and anti-fungal treatment. At two weeks of follow up, no improvement was noted at all. At the same time, she developed multiple juicy papules in perioral area and on neck. She tested positive by rK 39 tests. Histopathology from periungual area showed LD body. She was diagnosed as Post Kala-azar dermal leishmaniasis and was treated with miltefosine 50 mg twice daily for three months, resulting in complete resolution of all lesions.

A compact high-performance low-field NMR apparatus for measurements on fluids at very high pressures and temperatures

We discuss an innovative new high-performance apparatus for performing low-field Nuclear Magnetic Resonance (NMR) relaxation times and diffusion measurements on fluids at very high pressures and high temperatures. The apparatus sensor design and electronics specifications allow for dual deployment either in a fluid sampling well logging tool or in a laboratory. The sensor and electronics were designed to function in both environments. This paper discusses the use of the apparatus in a laboratory environment. The operating temperature and pressure limits, and the signal-to-noise ratio (SNR) of the new system exceed by a very wide margin what is currently possible. This major breakthrough was made possible by a revolutionary new sensor design that breaks many of the rules of conventional high pressure NMR sensor design. A metallic sample holder capable of operating at high pressures and temperatures is provided to contain the fluid under study. The sample holder has been successfully tested for operation up to 36 Kpsi. A solenoid coil wound on a slotted titanium frame sits inside the metallic sample holder and serves as an antenna to transmit RF pulses and receive NMR signals. The metal sample holder is sandwiched between a pair of gradient coils which provide a linear field gradient for pulsed field gradient diffusion measurements. The assembly sits in the bore of a low-gradient permanent magnet. The system can operate over a wide frequency range without the need for tuning the antenna to the Larmor frequency. The SNR measured on a water sample at room temperature is more than 15 times greater than that of the commercial low-field system in our laboratory. Thus, the new system provides for data acquisition more than 200 times faster than was previously possible. Laboratory NMR measurements of relaxations times and diffusion coefficients performed at pressures up to 25 Kpsi and at temperatures up to 175 °C with crude oils enlivened with dissolved hydrocarbon gases (referred to as "live oils") are shown. This is the first time low-field NMR measurements have been performed at such high temperatures and pressures on live crude oil samples. We discuss the details of the apparatus design, tuning, calibration, and operation. NMR data acquired at multiple temperatures and pressures on a live oil sample are discussed.

Augmented telomerase activity and reduced telomere length in parthenium-induced contact dermatitis

BACKGROUND

Parthenium dermatitis is a common chronic inflammatory disease with activated T lymphocytes that recognize the antigens, which leads to proliferation and differentiation. Telomeres and telomerase play an important role in the regulation of life span of the cell. Telomere length maintained by telomerase, are specialized repeats present at the end of chromosomes which protect it from degradation, end-to-end fusion and are important for integrity of chromosomes.

OBJECTIVES

The aim of this study was to measure telomerase activity and telomere length in Peripheral blood mononuclear cell (PBMC), CD4(+) and CD8(+) T lymphocytes from parthenium dermatitis patients.

METHODS

The study includes 50 patients of parthenium dermatitis confirmed by patch testing and 50 healthy controls. Telomerase activity was measured using the telomere repeat amplification protocol using PCR-ELISA kit. Telomere length was measured by using Telo TAGGG Telomere Length Assay Kit.

RESULTS

Significantly elevated levels of telomerase activity was observed in PBMC, CD4(+) and CD8(+) T cells of parthenium dermatitis patients as compared with healthy controls. However, significantly reduced telomere length in PBMC, CD4(+) and CD8(+) T cells have been found in patients than healthy subjects, but there was no difference between CD4(+) and CD8(+) T cells in patients.

CONCLUSION

This study might have provided insight into the role of telomerase in parthenium dermatitis that is characterized by the recruitment of T lymphocytes, which play an important role in this inflammatory disease. The augmented telomerase activity and reduced terminal restriction fragment length might be explored as a potential diagnostic/prognostic marker for parthenium dermatitis in future.

Understanding why clinicians answer or ignore clinical decision support prompts

INTRODUCTION

The identification of key factors influencing responses to prompts and reminders within a computer decision support system (CDSS) has not been widely studied. The aim of this study was to evaluate why clinicians routinely answer certain prompts while others are ignored.

METHODS

We utilized data collected from a CDSS developed by our research group--the Child Health Improvement through Computer Automation (CHICA) system. The main outcome of interest was whether a clinician responded to a prompt.

RESULTS

This study found that, as expected, some clinics and physicians were more likely to address prompts than others. However, we also found clinicians are more likely to address prompts for younger patients and when the prompts address more serious issues. The most striking finding was that the position of a prompt was a significant predictor of the likelihood of the prompt being addressed, even after controlling for other factors. Prompts at the top of the page were significantly more likely to be answered than the ones on the bottom.

CONCLUSIONS

This study detailed a number of factors that are associated with physicians following clinical decision support prompts. This information could be instrumental in designing better interventions and more successful clinical decision support systems in the future.

Crico Arytenoid Joint Fixation in Diffuse Idiopathic Skeletal Hyperostosis (DISH): A Case Report

Advanced form of diffuse idiopathic skeletal hyperostosis or Forestier's disease can induce dysphagia and significant airway symptoms such as hoarseness, snoring, dyspnoea on exertion and laryngeal stridor. We have discussed the diagnosis and management of an unusual case with respiratory distress due to left cricoarytenoid joint fixation and right vocal cord paresis in conjunction with skeletal pathology.

Patterns of left ventricular hypertrophy in chronic kidney disease: an echocardiographic evaluation

BACKGROUND

We evaluated the chronic kidney disease (CKD) patients having different degree of uremia for the prevalence of Left Ventricular Hypertrophy (LVH), different patterns of left Ventricular Hypertrophy by echocardiographic variables to define the most sensitive and powerful predictor of cardiovascular disease (CVD) and premature morbidity and mortality.

METHODS

We used clinical and biochemical data from the prospective study done by us to evaluate "The Echocardiographic assessment of cardiac functions in patients with chronic kidney disease". The diagnosis of CKD was made on the basis of serum creatinine (sCr) concentration of more than 1.5 mg/dl, persistent and with no evidence of recovery over a period of 3 months. Glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease (MDRD) equation and cut-off for CKD was taken to be < 60 ml/min/1.73 m2 as per existing guidelines. The study population consisted of a total of 75 subjects divided into three groups of 25 subjects each, all between the age of 20-65 yrs:

GROUP A

Healthy normal controls (sCr < 1.5 mg/dl);

GROUP B

Patients with mild to moderate CKD (sCr 1.5 - 6.0 mg/dl); GROUP C: Patients with severe CKD (sCr > 6.0 mg/dl).

RESULTS

A progressive rise in prevalence of LVH was observed with the severity of kidney disease from 64% (mild/ moderate CKD group) to 96% (severe CKD group) and higher prevalence of LVH in females than males in the severe CKD group. The mean LVMI in both the groups of CKD was significantly higher than the healthy controls (76.62 +/- 10.97). Also, mean LVMI in severe CKD (139.23 +/- 17.47) patients was significantly higher than in mild/moderate CKD (114.91 +/- 15.20) patients. The prevalence of concentric remodeling in both the CKD groups was alike (20%). While that of concentric hypertrophy in severe CKD patients (68%) was significantly higher than in mild/moderate CKD group (40%) (p < 0.05), but no significant difference was observed for eccentric pattern of hypertrophy between the two CKD groups. This suggests that concentric hypertrophy is more prevalent in CKD patients.

CONCLUSIONS

The mean left ventricular mass index (LVMI) showed a proportionate increase with the severity of renal failure and a progressive rise with increase in severity of disease. Patients of CKD groups revealed occurrence of concentric remodeling which is a predictor of high vulnerability for progressing into concentric and eccentric hypertrophy. Hence early medical intervention may reverse the concentric remodeling, thereby preventing the advancement to concentric or eccentric LVH.