Early cost-utility analysis of genetically guided therapy for patients with drug-resistant epilepsy

OBJECTIVE

Existing gene panels were developed to understand the etiology of epilepsy, and further benefits will arise from an effective pharmacogenomics panel for personalizing therapy and achieving seizure control. Our study assessed the cost-effectiveness of a pharmacogenomics panel for patients with drug-resistant epilepsy, compared with usual care.

METHODS

A cost-utility analysis was employed using a discrete event simulation model. The microsimulation model aggregated the costs and benefits of genetically guided treatment versus usual care for 5000 simulated patients. The 10-year model combined data from various sources including genomic databases on prevalence of variants, population-level pharmaceutical claims on antiseizure medications, published long-term therapy retention rates, patient-level cost data, and systematic reviews. Incremental cost per quality-adjusted life-year (QALY) gained was computed. Deterministic and probabilistic sensitivity analyses were undertaken to address uncertainty in model parameters.

RESULTS

The mean cost of the genetically guided treatment option was AU$98 199 compared with AU$95 386 for usual care. Corresponding mean QALYs were 4.67 compared with 4.28 for genetically guided and usual care strategies, respectively. The incremental cost per QALY gained was AU$7381. In probabilistic sensitivity analyses, the incremental cost per QALY gained was AU$6321 (95% uncertainty interval = AU$3604-AU$9621), with a 100% likelihood of being cost-effective in the Australian health care system. The most influential drivers of the findings were the monthly health care costs associated with reduced seizures, costs when seizures continued, and the quality-of-life estimates under genetically guided and usual care strategies.

SIGNIFICANCE

This early economic evaluation of a pharmacogenomics panel to guide treatment for drug-resistant epilepsy could potentially be cost-effective in the Australian health care system. Clinical trial evidence is necessary to confirm these findings.

Evaluation of a quasi-dimeric eugenol derivative as repellent against the stored grain insect pest Sitophilus oryzae (Coleoptera Curculionidae)

BACKGROUND

Essential oils (EOs) and their chemical components are often proposed as an alternative to synthetic pesticides for pest control of foodstuff insect pests. However, their low persistence and strong, spicy odour, make them poorly suitable for use to protect food. Modification of the EOs components molecules increases their molecular weight and reduce their volatility. However, the effectiveness of such modified molecules has, so far, not been tested against stored food insect pests. In this study, the intensity and the duration of the repellence against the insect pest Sitophilus oryzae of a recently synthesized quasi-dimeric eugenol derivative (ED) (C₁₈ H₂₀ O₄ ) were compared to those of eugenol and three eugenol related compounds. The hypothesis tested was that by its higher molecular weight and two functional groups the ED would overcome the low persistence and strong and spicy odour drawback of eugenol without compromising the repellence against insects.

RESULTS

The insect behavioural tests showed a greater repellence and persistence of ED than eugenol and the three eugenol related compounds against S. oryzae. The sensory analysis of ED by panel test indicated that ED is significantly less odorous than eugenol without any spicy nor balsamic nuances in its smell profile.

CONCLUSIONS

Because of its high repellence against insects and its low smell intensity for humans, ED could represent a valid repellent for the control of foodstuffs insect pests. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Gene Panel Testing for Breast Cancer Reveals Differential Effect of Prior BRCA1/2 Probability

Whilst panel testing of an extended group of genes including BRCA1/2 is commonplace, these studies have not been subdivided by histiotype or by a priori BRCA1/2 probability. Patients with a breast cancer diagnosis undergoing extended panel testing were assessed for frequency of actionable variants in breast cancer genes other than BRCA1/2 by histiotype and Manchester score (MS) to reflect a priori BRCA1/2 likelihood. Rates were adjusted by prior testing for BRCA1/2 in an extended series. 95/1398 (6.3%) who underwent panel testing were found to be positive for actionable non-BRCA1/2 breast/ovarian cancer genes (ATM, BARD1, CDH1, CHEK2, PALB2, PTEN, RAD51C, RAD51D, TP53). As expected, PALB2, CHEK2 and ATM were predominant with 80-(5.3%). The highest rate occurred in Grade-3 ER+/HER2- breast cancers-(9.6%). Rates of non-BRCA actionable genes was fairly constant over all likelihoods of BRCA1/2 but adjusted rates were three times higher with MS < 9 (BRCA1/2 = 1.5%, other = 4.7%), but was only 1.6% compared to 79.3% with MS ≥ 40. Although rates of detection of non-BRCA actionable genes are relatively constant across BRCA1/2 likelihoods this disguises an overall adjusted low frequency in high-likelihood families which have been heavily pre-tested for BRCA1/2. Any loss of detection sensitivity for BRCA1/2 actionable variants in breast cancer panels should lead to bespoke BRCA1/2 testing being conducted first.

Volatile Profile of Two-Phase Olive Pomace (Alperujo) by HS-SPME-GC-MS as a Key to Defining Volatile Markers of Sensory Defects Caused by Biological Phenomena in Virgin Olive Oil

An olive pomace from the two-phase decanter stored in different conditions was used as a model to simulate the detrimental biological phenomena occurring during olive oil processing and storage. A group of EVOO and defective oils were also analyzed. The volatile fraction was studied with HS-SPME-GC-MS; 127 volatiles were identified (55 of which tentatively identified) and evaluated over time. Seven volatiles were tentatively identified for the first time in olive oil; the role of C6 alcohols in detrimental biological phenomena was highlighted. Suitable volatile markers for defects of microbiological origin were defined, particularly the fusty/muddy sediment. They were then applied to olive oils with different quality categories; one of the markers was able to discriminate among EVOOs and all the defective samples, including the borderline ones. The marker was constituted by the sum of concentrations of 10 esters, 4 alcohols, 1 ketone, and 1 α-hydroxy-ketone but no carboxylic acids.

Supporting the Sensory Panel to Grade Virgin Olive Oils: An In-House-Validated Screening Tool by Volatile Fingerprinting and Chemometrics

The commercial category of virgin olive oil is currently assigned on the basis of chemical-physical and sensory parameters following official methods. Considering the limited number of samples that can be analysed daily by a sensory panel, an instrumental screening tool could be supportive by reducing the assessors’ workload and improving their performance. The present work aims to in-house validate a screening strategy consisting of two sequential binary partial least squares-discriminant analysis (PLS-DA) models that was suggested to be successful in a proof-of-concept study. This approach is based on the volatile fraction fingerprint obtained by HS-SPME–GC–MS from more than 300 virgin olive oils from two crop seasons graded by six different sensory panels into extra virgin, virgin or lampante categories. Uncertainty ranges were set for the binary classification models according to sensitivity and specificity by means of receiver operating characteristics (ROC) curves, aiming to identify boundary samples. Thereby, performing the screening approach, only the virgin olive oils classified as uncertain (23.3%) would be assessed by a sensory panel, while the rest would be directly classified into a given commercial category (78.9% of correct classification). The sensory panel’s workload would be reduced to less than one-third of the samples. A highly reliable classification of samples would be achieved (84.0%) by combining the proposed screening tool with the reference method (panel test) for the assessment of uncertain samples.

Non-invasive diagnosis of endometriosis and moderate-severe endometriosis with serum CA125, endocan, YKL-40, and copeptin quadruple panel

Considering the complex pathogenesis of endometriosis, which is associated with many cellular or molecular processes, such as proliferation, angiogenesis, inflammation, we evaluated the diagnostic value of a quadruple panel of serum markers CA125, endocan, YKL-40 and copeptin, for the prediction of endometriosis and moderate - severe endometriosis. Seventy women with endometriosis and 70 women without endometriosis were evaluated. Serum CA125, endocan, copeptin and YKL-40 levels were significantly increased in women with endometriosis compared to the women without endometriosis and in the minimal - mild endometriosis group compared to the no-endometriosis group. YKL-40, endocan and copeptin levels were significantly increased in the moderate - severe endometriosis group compared to the mild -moderate endometriosis group but the difference in CA125 levels remained non-significant. The quadruple panel score had an AUC of 0.954, a sensitivity of 96.5% and specificity of 84.6% for prediction of moderate - severe endometriosis. Zero or one positive marker had a sensitivity of 91.4% and specificity of 88.57% to rule out endometriosis. In conclusion, a quadruple panel of serum markers-CA125, endocan, YKL-40, and copeptin may be beneficial for the diagnosis of endometriosis and especially moderate - severe endometriosis. Further studies are needed to prove the efficacy of this panel.Impact statementWhat is already known on this subject? Many serum markers including CA125 have been investigated so far and suggested to be associated with endometriosis. However, none of these markers is sensitive and specific enough to diagnose endometriosis.What do the results of this study add? A quadruple panel score (CA125, endocan, YKL-4 and copeptin) had an AUC of 0.954, a sensitivity of 96.5% and specificity of 84.6% for prediction of moderate - severe endometriosis.What are the implications of these findings for clinical practice and/or further research? A high score may be beneficial to warn the surgeon about the risk of moderate to severe endometriosis if the patient will be operated anyway. A negative test of the quadruple panel may show high odds that there is no endometriosis which may prevent unnecessary surgery.

Biophenolic Compounds Influence the In-Mouth Perceived Intensity of Virgin Olive Oil Flavours and Off-Flavours

In this study, the influence of phenolic compounds on the sensory scores attributed to extra virgin olive oil (EVOO) by panel test was investigated. Two model olive oils (MOOs) with identical concentrations of volatile compounds, differing only in the amount of biophenols (297 vs. 511 mg kg⁻¹), were analysed by two official panels and by SPME-GC/MS. Six other MOOs set up by the two previous models were also tested and analysed. They were formulated separately with the addition of three off-flavours (‘rancid’, ‘winey–vinegary’ and ‘fusty–muddy’). While high levels of EVOO phenolic compounds did not produce any effect on the headspace concentration of volatile compounds, they did affect the scores of both positive and negative sensory attributes of EVOO, due to the well-known in-mouth interactions between EVOO phenols, saliva and volatile compounds. In particular, a decrease of about 39% in the positive fruity score was found in the presence of a higher concentration of phenols. Regarding EVOO off-flavours, the higher level of phenolic compounds decreased by about 23% the score of ‘fusty–muddy’ defect and increased the score of ‘winey–vinegary’ defect about 733%. No important effect of EVOO phenolics on the perceived intensity of the ‘rancid’ defect was found. These findings could be helpful in explaining some discrepancies of panel test responses observed during extra virgin olive oil shelf life.

Production of low-calorie apricot nectar sweetened with stevia: Impact on qualitative, sensory, and nutritional profiles

This study aimed to develop a low-calorie apricot nectar by replacing sucrose with different amount of Stevia rebaudiana bertoni (Rebaudioside A, 98%). Stevia has become very popular as sweetener for the production of low-calorie products but its addition could be a challenge for industry, since it could modify sensory features of the product and consumers' acceptance. To this end, apricot nectars without sugar, with sucrose 10%, and with different amounts of stevia were produced and evaluated for microbiological quality using the pour-plate technique, and physicochemical (pH, TTA, and a w) and nutritional (moisture, fat, protein, carbohydrates, and ash) characteristics. Furthermore, a sensory analysis of the samples was performed by a panel of trained judges using quantitative descriptive analysis. The effect of stevia addiction on the consumers' acceptance was investigated by 102 consumers of fruit juices that evaluated the overall acceptability of the samples using a structured 9-point hedonic scale. Levels of microbial groups in nectars were under the detection limit confirming a good hygienic practice within the production. Nectars produced with stevia resulted in significant reduction in caloric value from 86 kcal (nectar with 10% sucrose) to 49 kcal (nectars with stevia), without altering its typicality. Different sensory profiles among samples were pointed out; all the products are liked, but with a different level of pleasantness. The study highlighted that the apricot nectars with 0.07% stevia are characterized for sweet and liquorice aroma notes and received the same level of consumer acceptability of nectars produced with 10% sucrose.

Alignment and Proficiency of Virgin Olive Oil Sensory Panels: The OLEUM Approach

A set of 334 commercial virgin olive oil (VOO) samples were evaluated by six sensory panels during the H2020 OLEUM project. Sensory data were elaborated with two main objectives: (i) to classify and characterize samples in order to use them for possible correlations with physical–chemical data and (ii) to monitor and improve the performance of panels. After revision of the IOC guidelines in 2018, this work represents the first published attempt to verify some of the recommended quality control tools to increase harmonization among panels. Specifically, a new “decision tree” scheme was developed, and some IOC quality control procedures were applied. The adoption of these tools allowed for reliable classification of 289 of 334 VOOs; for the remaining 45, misalignments between panels of first (on the category, 21 cases) or second type (on the main perceived defect, 24 cases) occurred. In these cases, a “formative reassessment” was necessary. At the end, 329 of 334 VOOs (98.5%) were classified, thus confirming the effectiveness of this approach to achieve a better proficiency. The panels showed good performance, but the need to adopt new reference materials that are stable and reproducible to improve the panel’s skills and agreement also emerged.

New Volatile Molecular Markers of Rancidity in Virgin Olive Oils under Nonaccelerated Oxidative Storage Conditions

Evolution of the volatile profile of two extra-virgin olive oils with very different fatty acid composition (monounsaturated fatty acid/polyunsaturated fatty acid ratio) stored in several nonaccelerated oxidative conditions was studied by a validated headspace solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS) method. The role of C8 volatile compounds in oxidative processes was highlighted, and controversial aspects regarding the origin of some volatiles were clarified. Specific volatile markers for rancidity were proposed: sum of pentanal, hexanal, nonanal, E-2-heptenal, propanoic acid, and hexanoic acid for oils stored in the dark; sum of pentanal, heptanal, nonanal, decanal, E-2-heptenal, E-2-decenal, E,E-hepta-2,4-dienal, and E,E-deca-2,4-dienal, octane for oils stored under light exposure; sum of pentanal, nonanal, decanal, E-2-heptenal, E-2-decenal, E,E-hepta-2,4-dienal, nonan-1-ol, propanoic acid, octane, 6-methylhept-5-en-2-one, and oct-1-en-3-ol for oils stored under light exposure with oxygen in headspace. A simplified marker (sum of pentanal, nonanal and E-2-heptenal) suitable for all conditions was also proposed.

Prospects and Problems of Cancer Genome Analysis for Establishing Cancer Precision Medicine

The genome represents a design for creating the body, with each one being different. In cancer genomic medicine, many genes are simultaneously examined using mainly cancer tissues (the oncogene panel test), and gene mutations are revealed. Cancer treatments are then initiated according to each individual's constitution and medical condition based on gene mutations. A system for cancer genome medical treatment is currently being developed. In the treatment of several types of cancer, the "oncogene test with an oncogene companion diagnosis" is already being performed as a standard test using cancer tissue to detect one or more gene mutations. On June 1, 2019, the cancer gene panel test was covered by the national health insurance system in Japan, and a system to initiate cancer genome medical treatment has begun. The prospects and problems associated with cancer genome medicine are discussed herein.

A Multi-Methodological Protocol to Characterize PDO Olive Oils

An analytical approach including Panel Test, Isotope Ratio Mass Spectrometry (IRMS) and Nuclear Magnetic Resonance (NMR) spectroscopy was proposed to characterize Italian “Colline Pontine” PDO olive oils (40 samples) of two consecutive crop years. Our approach has evidenced the high quality of these olive oils. Only 6 of 40 olive oils samples were defined as “defective” by the official Panel Test due to the detection of negative sensory attributes. The low variability of isotopic data monitored by IRMS confirmed that the olive oil samples all came from a limited geographical area. NMR spectra did not evidence any chemical composition anomaly in the investigated samples. In order to assess the influence of harvesting year over the olive oil chemical composition, the NMR analysis was extended to other 22 olive oil samples of a third harvesting year. NMR data were submitted to two different statistical methods, namely, analysis of variance (ANOVA) and principal component analysis (PCA) allowing olive oils of three consecutive harvesting years to be grouped.

Sensory profiling and consumer acceptability of new dark cocoa bars containing Tuscan autochthonous food products

A new set of cocoa bars named Toscolata^® were developed containing top‐quality extra virgin olive oil, dried apples cultivars, and chestnut flour. The present work has been conducted to define the sensory profile of these products through tasting by trained experts and consumers to study the acceptability, preference, and quality perception. The four sensorial profiles of the bars differed in the level of persistence, bitterness, aromaticity, acidity, astringency, and tastiness. In particular, the sour attribute could be traced to the presence of dried apple. Bars containing apple and chestnut flour obtained higher acceptance ratings, compared to those with extra virgin olive oil. The bar with chestnut flour was preferred by consumers who considered it to be sweeter due to the presence of natural sugars, which lowered the bitter sensation of cocoa. These results showed that the selection of the preferred bar by consumers was mainly based on the level of bitterness and, in particular, elderly consumers expressed a strong preference for the sweetest product. As far as we know, this is the first study comparing the results of a panel of expert tasters with that of consumers in the tasting of dark chocolate.

Search for an index for the taste of Japanese Black cattle beef by panel testing and chemical composition analysis

To search for an index for chemical composition related to superior taste in Japanese Black beef, we conducted panel tests and analyzed the chemical composition of seven beef brands. Thirty-five sirloin beefs from five heifers were used in this study, sold under seven beef brands graded as more than A4 on the Japanese Meat Grade scale. The chemical composition analyses assessed both raw and roasted meat, the latter of which was roasted under the same conditions as those used for the panel test. Results of the panel test and chemical composition analyses revealed that fatty acid composition, sugar content, adenosine triphosphage (ATP)-related compounds, amino acid composition and odor composition in the sirloin meat differed among beef brands. Furthermore, the correlations of chemical compositions between roasted and raw meat were significantly high. Sugar content and ATP-related compounds in roasted meat were significantly correlated with the item 'overall evaluation' of the panel test. ATP-related compounds, such as inosinic acid, carnosine and taurine, in roasted and raw meat were correlated significantly with the item 'umami intensity' of the panel test. These results suggest that the composition of these components is important for an index related to the overall evaluation of beef.

Test ordering pattern at the chemical pathology laboratory, hospital universiti sains malaysia

The utilization of the chemical laboratory resources at the Hospital Sains Malaysia was evaluated. More than 100,000 test requests received and performed over a 12-month period, were analyzed retrospectively. The analysis conducted included the abnormal results obtained, the degree of duplication of tests, and the extent of test-panel ordering. It was found that a relatively moderate degree of over-ordering was evident. The findings suggested that the main reasons for over-ordering were the use of panel tests of ordering, in addition to a small, yet significant degree of duplication. Strategies for cutting down the test ordering have been reviewed and discussed.