Abstract 801: Surprisingly conserved copy numbers from cell to cell within structurally complex tumors challenge the unstable genome hypothesis

Osteosarcoma is an aggressive disease that exhibits almost universal p53 inactivation and a high level of genomic complexity. The chaotic genome of most osteosarcomas has led many to assume that this complexity must accumulate under conditions of significant genomic/chromosomal instability. However, such conclusions have been drawn primarily from single-timepoint bulk-tumor analyses. More recent studies have questioned this assumption of chromosomal instability, hypothesizing that genomic complexity could arise from an early catastrophic event followed by faithful propagation of a highly complex, malignancy-promoting genome.

To determine whether osteosarcoma tumors show evidence of instability, we performed single-cell whole-genome sequencing of >14,000 osteosarcoma cells obtained from 15 distinct lesions resected from 8 individual patients. Using the CHISEL algorithm, we inferred allele- and haplotype-specific copy numbers from this sequencing data. To evaluate how the SCNA profiles changed during the evolutionary pressures associated with metastatic dissemination and therapy, we compared the single-cell SCNA profiles of paired samples collected from both primary sites and metastases and from pre-treatment and relapsed specimens. We likewise compared profiles of patient tumors propagated orthotopically in mouse tibias to those grown within the lung to evaluate for tissue-dependent emergence of rare subclones.

Despite extensive structural variations that give rise to highly complex patterns of SCNA, the cells within each tumor showed remarkably little heterogeneity. We found similar evidence of chromosomal stability when we reconstructed phylogenetic trees to identify the evolutionary relationships of cells collected from metastatic lesions or at relapse. Despite being evolutionarily distant, nearly all variants could be assigned to the trunk of the phylogenetic tree, with only modest changes occurring in the branches. This result suggests that nearly all SCNAs were acquired in an early event, followed by selection of advantageous patterns with subsequent preservation of that particular SCNA pattern. Analysis of bulk whole-genome sequencing from serially collected patient samples supports the preservation of SCNA profiles over time.

This work demonstrates the power of combining single-cell DNA sequencing with an allele- and haplotype-specific CNV inference algorithm. Our approach clarifies longstanding questions about the genetics of osteosarcoma initiation and progression, calling into question previous assumptions of genomic instability inferred from single-timepoint bulk sequencing data. These results suggest that an isolated, early catastrophic event, rather than sustained genomic instability, gives rise to the complex genome that characterizes osteosarcoma tumors.

Citation Format: Sanjana Rajan, Simone Zaccaria, Matthew Cannon, Maren Cam, Amy Gross, Benjamin Raphael, Ryan D. Roberts. Surprisingly conserved copy numbers from cell to cell within structurally complex tumors challenge the unstable genome hypothesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 801.

Spatially interacting phosphorylation sites and mutations in cancer

Advances in mass-spectrometry have generated increasingly large-scale proteomics datasets containing tens of thousands of phosphorylation sites (phosphosites) that require prioritization. We develop a bioinformatics tool called HotPho and systematically discover 3D co-clustering of phosphosites and cancer mutations on protein structures. HotPho identifies 474 such hybrid clusters containing 1255 co-clustering phosphosites, including RET p.S904/Y928, the conserved HRAS/KRAS p.Y96, and IDH1 p.Y139/IDH2 p.Y179 that are adjacent to recurrent mutations on protein structures not found by linear proximity approaches. Hybrid clusters, enriched in histone and kinase domains, frequently include expression-associated mutations experimentally shown as activating and conferring genetic dependency. Approximately 300 co-clustering phosphosites are verified in patient samples of 5 cancer types or previously implicated in cancer, including CTNNB1 p.S29/Y30, EGFR p.S720, MAPK1 p.S142, and PTPN12 p.S275. In summary, systematic 3D clustering analysis highlights nearly 3,000 likely functional mutations and over 1000 cancer phosphosites for downstream investigation and evaluation of potential clinical relevance.

Abstract 2872: Acquisition of drug resistance mutations during chemotherapy treatment in pediatric acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is a leading cause of cancer-associated death in children. To study the mechanisms of drug resistance in ALL, we performed whole-genome sequencing of diagnosis-relapse-germline trios from 103 Chinese patients and ultra-deep sequencing of 208 serial bone marrow samples from 17 of them. Relapse-specific somatic alterations were enriched in 12 genes (NR3C1, NR3C2, TP53, NT5C2, FPGS, CREBBP, MSH2, MSH6, PMS2, WHSC1, PRPS1, and PRPS2), which were predominantly involved in response to thiopurines, glucocorticoids, methotrexate, and other drugs. Four lines of evidence indicate that these resistance mutations frequently developed during treatment, rather than pre-existing at diagnosis. First, two novel, relapse-specific mutational signatures (novel signatures 1 and 2), most likely caused by chemotherapeutic regimens, were detected in 15% and 14% of relapsed cases, respectively. Drug resistance mutations frequently appeared at novel signature-associated trinucleotide contexts, indicating that chemotherapy may directly cause drug resistance mutations in ALL. The signatures were validated in NCI TARGET relapsed ALL samples, 2% and 23% of which harbored novel signatures 1 and 2, respectively. The varying signature prevalence between cohorts may reflect treatment differences. The novel signatures were not detected in >2,000 adult cancers from the PCAWG study. Novel signature 1 induced C>G transversions, particularly at GCC and TCT trinucleotides, and showed transcription-strand bias indicating guanine adducts. Novel signature 2 favored C>T and C>G mutations at CCG, and correlated with relapse-specific dinucleotide variants and structural variants, indicating an agent causing multiple mutation types. The drugs inducing these novel signatures are being explored in vitro. Second, mathematical modeling using growth curves of drug-resistant ALL indicated that drug resistance mutations occur, in some cases, long after diagnosis, during active treatment. Third, some patients acquired multiple drug resistance mutations sequentially through successive relapses, a finding inconsistent with their pre-existence at diagnosis. Indeed, 20% of relapses had multiple drug resistance mutations targeting different drug classes. Fourth, most relapsed ALLs derived from a subclone detected at diagnosis, which then evolved additional mutations, including drug resistance mutations, not detectable at diagnosis using 2000X targeted sequencing. Drug resistance mutations were often subclonal at relapse, suggesting later appearance. Together these data indicate that fully drug-resistant clones may not necessarily pre-exist at diagnosis in ALL, but may be acquired later during treatment. Thus, early intensive or targeted treatment strategies in slow responders may forestall the subsequent development of drug resistance mutations.

Citation Format: Benshang Li, Samuel W. Brady, Xiaotu Ma, Shuhong Shen, Yingchi Zhang, Yongjin Li, Yu Liu, Ningling Wang, Diane Flasch, Matthew Myers, Heather Mulder, Lixia Ding, Yanling Lu, Liqing Tian, Kohei Hagiwara, Ke Xu, Edgar Sioson, Tianyi Wang, Liu Yang, Jie Zhao, Hui Zhang, Ying Shao, Hongye Sun, Lele Sun, Jiaoyang Cai, Ting-Nien Lin, Lijuan Du, Fan Yang, Michael Rusch, Michael Edmonson, John Easton, Xiaofan Zhu, Jingliao Zhang, Cheng Cheng, Benjamin Raphael, Jingyan Tang, James Downing, Bin-Bing Zhou, Ching-Hon Pui, Jun Yang, Jinghui Zhang. Acquisition of drug resistance mutations during chemotherapy treatment in pediatric acute lymphoblastic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2872.

Pathogenic Germline Variants in 10,389 Adult Cancers

We conducted the largest investigation of predisposition variants in cancer to date, discovering 853 pathogenic or likely pathogenic variants in 8% of 10,389 cases from 33 cancer types. Twenty-one genes showed single or cross-cancer associations, including novel associations of SDHA in melanoma and PALB2 in stomach adenocarcinoma. The 659 predisposition variants and 18 additional large deletions in tumor suppressors, including ATM, BRCA1, and NF1, showed low gene expression and frequent (43%) loss of heterozygosity or biallelic two-hit events. We also discovered 33 such variants in oncogenes, including missenses in MET, RET, and PTPN11 associated with high gene expression. We nominated 47 additional predisposition variants from prioritized VUSs supported by multiple evidences involving case-control frequency, loss of heterozygosity, expression effect, and co-localization with mutations and modified residues. Our integrative approach links rare predisposition variants to functional consequences, informing future guidelines of variant classification and germline genetic testing in cancer.

Who Helps the Helpers? The Effects of a Disaster on the Rescue Workers

There is virtually no literature detailing the effects of a disaster on the rescue workers. This paper reports the results of a questionnaire survey conducted one month after the Granville rail disaster on ninety-five of the personnel involved in the rescue work and a follow-up on thirteen of them one year later. Seventy-seven of the ninety-five found the experience stressful; in particular, the feelings of helplessness engendered by the disaster, the magnitude of the destruction, the sight and smell of mutilated bodies, the anguish of relatives, and the need to work under pressure were items highlighted by the respondents. While only about 20 percent experienced specific psychological sequelae as a result of the disaster (depression, anxiety, insomnia), approximately 70 percent of the helpers showed evidence of being temporarily strained (half of them being over this by the end of one week). Thirty-five percent felt more positive about their own lives as a result of their involvement. The utility of debriefing sessions to assist workers to come to terms with and assimilate their experiences is discussed.

Performance evaluation of a novel personalized ventilation-personalized exhaust system for airborne infection control

In the context of airborne infection control, it is critical that the ventilation system is able to extract the contaminated exhaled air within the shortest possible time. To minimize the spread of contaminated air exhaled by occupants efficiently, a novel personalized ventilation (PV)-personalized exhaust (PE) system has been developed, which aims to exhaust the exhaled air as much as possible from around the infected person (IP). The PV-PE system was studied experimentally for a particular healthcare setting based on a typical consultation room geometry and four different medical consultation positions of an IP and a healthy person (HP). Experiments using two types of tracer gases were conducted to evaluate two types of PE: Top-PE and Shoulder-PE under two different background ventilation systems: Mixing Ventilation and Displacement Ventilation. Personalized exposure effectiveness, intake fraction (iF) and exposure reduction (ε) were used as indices to evaluate the PV-PE system. The results show that the combined PV-PE system for the HP achieves the lowest intake fraction; and the use of PE system for the IP alone shows much better performance than using PV system for the HP alone.

Abstract A30: miRNA Regulators of Ovarian Cancer Metastasis that Predict Patient Outcomes

Serous ovarian cancer patients often succumb to aggressive metastatic disease, yet little is known about the behavior and genetics of ovarian cancer metastases. We selected 12 matched primary and omental metastatic serous epithelial ovarian tumors to identify the copy number, mRNA and miRNA expression differences. No significant recurring copy number changes were detected. In contrast, significant recurrence with the same expression changes in all or the large majority of patients was observed for many mRNAs and miRNAs. We identify almost 1,000 genes with recurring significant expression differences across the patient cohort suggesting common phenotypic features are selected from heterogeneous mixture of primary tumors. Genes differentially expressed between metastatic and primary tumors identify a poor prognosis subtype in primary tumors that robustly distinguishes high risk patients across multiple platforms in two large independent data sets. Multivariate analysis suggests that the expression signature is independent of residual disease, a common clinical risk factor. To gain insight into the regulation of these mRNAs, we measured the expression of 377 miRNAs using Taqman qPCR in matched primary and metastatic serous ovarian tumors. We identified 17 miRNAs with significant differential expression in primary and metastatic ovarian human tumors including miR-21, miR-31, and novel miRNAs previously not associated with metastasis. Many of these miRNAs have >10 fold expression differences across multiple patients. We confirmed that the expression differences originate from cancer cells for many of the miRNAs by in situ hybridization and laser capture microdissection of cancer cells from tumors followed by qPCR. We identify combinations of metastatic miRNAs with significantly stronger predictions of patient outcomes than random combinations of miRNAs in The Cancer Genome Atlas data. Some of these same miRNAs show the same expression changes in liver metastases compared to colorectal primary tumors. Ovarian cancer cells form multicellular aggregates, or spheroids, as they disseminate throughout the peritoneal cavity and we find that these metastatic miRNAs affect spheroid formation and growth. All 7 of the metastatic miRNAs expressed in two ovarian cancer cell lines are up-regulated in spheroids compared to monolayers, recapitulating the observations in human metastases compared to primary tumors, suggesting that similar adaptations required for 3D culture are needed to establish metastases. Interestingly, we find miR-31 promotes metastasis in ovarian cancer suggesting a context dependent function compared to breast cancer. miR-31 is up-regulated in metastases by qPCR and in situ hybridization, up-regulated in spheroids compared to monolayers and inhibition reduces spheroid size and viability using three different inhibitors without significant effects on monolayer growth. We have tested the function of 6 other metastatic miRNAs, which predict patient survival, using both gain and loss of function experiments. We find that many of the metastatic miRNAs mediate colony formation, mobility, and/or spheroid size, but do not significantly affect monolayer culture. Predicted targets negatively correlate with miRNA expression better than sets of random permutations in the tumors, and some of these targets negatively correlate with miRNAs in spheroids vs. monolayers. These metastatic miRNAs appear to promote metastasis in part by enhancing β-catenin signaling through repression of APC and suppressing apoptosis. Using miRNA expression profiles and functional studies, we have established the utility of spheroid cultures to examine these clinically relevant metastatic miRNAs. In sum, we have identified metastatic miRNAs, from one of the first miRNA profiles of metastases, critical for aggressive disease in ovarian, and perhaps other, cancers, with potential for biomarker and therapeutic development. We find that multiple miRNAs, many expressed in metastases and not in primary tumors in some patients, are likely important to drive metastasis by regulating multiple gene networks.

Citation Format: Alexander S. Brodsky, Hsin-Ta Wu, Souriya Vang, Benjamin Raphael, Laurent Brard. miRNA Regulators of Ovarian Cancer Metastasis that Predict Patient Outcomes [abstract]. In: Proceedings of the AACR Special Conference on Noncoding RNAs and Cancer; 2012 Jan 8-11; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(2 Suppl):Abstract nr A30.

A novel herpesvirus in 3 species of pheasants: mountain peacock pheasant (Polyplectron inopinatum), Malayan peacock pheasant (Polyplectron malacense), and Congo peafowl (Afropavo congensis)

The mountain peacock pheasant (Polyplectron inopinatum), the Malayan peacock pheasant (Polyplectron malacense), and the Congo peafowl (Afropavo congensis) are all listed as vulnerable to extinction under the International Union for Conservation of Nature Red List of Threatened Species. Here the authors report fatal infection with a novel herpesvirus in all 3 species of birds. DNA was extracted from the livers of birds with hepatocellular necrosis and intranuclear eosinophilic inclusions consistent with herpesvirus infection. Based on degenerate herpesvirus primers and polymerase chain reaction, 220- and 519-base pair products of the herpes DNA polymerase and DNA terminase genes, respectively, were amplified. Sequence analysis revealed that all birds were likely infected with the same virus. At the nucleotide level, the pheasant herpesvirus had 92% identity with gallid herpesvirus 3 and 77.7% identity with gallid herpesvirus 2. At the amino acid level, the herpes virus had 93.8% identity with gallid herpesvirus 3 and 89.4% identity with gallid herpesvirus 2. These findings indicate that the closest relative to this novel herpesvirus is gallid herpesvirus 3, a nonpathogenic virus used widely in a vaccine against Marek's disease. In situ hybridization using probes specific to the peacock pheasant herpesvirus DNA polymerase revealed strong intranuclear staining in the necrotic liver lesions of an infected Malayan peacock pheasant but no staining in normal liver from an uninfected bird. The phasianid herpesvirus reported here is a novel member of the genus Mardivirus of the subfamily Alphaherpesvirinae and is distinct from other galliform herpesviruses.

Factors associated with high psychological distress in horse industry participants during the 2007 Australian equine influenza outbreak and evidence of recovery after 1 year

This short report summarises data on the prevalence of high psychological distress in horse industry participants during the 2007 Australian equine influenza (EI) outbreak and the statistical analysis undertaken to identify the factors associated with this high psychological distress. In addition, follow-up data collected 1 year later are reported briefly.

Impact of PET/CT on initial staging, restaging and treatment management of anal cancer: a clinical case with literature review

Distant extrapelvic metastases appear in approximately in 10% of the patients with squamous cell anal cancer (SCAC) and survival depends on the treatment strategy. Exact staging leads to optimal planning of multimodality therapy and the adequate evaluation of treatment response can improve the prognosis of the disease. Diagnosis and staging of SCAC are commonly performed using contrast-enhanced computerized tomography(CT) and interpretation of the findings for tumor biological behavior. F18-fluoro-2 deoxy-D glucose positron emission tomography((18)F-FDG PET) reveals aspects of tumor function and allows metabolic measurements. Combined PET/CT scans permit exact localization with anatomical criteria of the hypermetabolic (18)F-FDG avid malignant lesions. We present a patient with SCAC in whom, according to PET/CT findings, the initial stage was changed from II (T2N0M0) to III A (T2N2M0). Radiation therapy (RT) and chemotherapy achieved a good therapeutic response but early follow up revealed new paraaortic lymph node (LN) metastases, as well as an uncommon left supraclavicular LN metastasis from the same primary carcinoma. The disease was restaged as stage IV (T2N2M1) and radiation therapy was substituted by chemotherapy.

Submandibular gland endoscopic resection: a cadaveric study

Recent advancement of head and neck surgery has been marked by the development of endoscopic and video-assisted minimally invasive surgery. This study reports the feasibility of endoscopic submandibular gland resection in human cadavers. Twelve submandibular gland resections were performed in six human cadavers. A 30 degrees angle endoscope and conventional surgical instruments were inserted through two 15 mm submandibular incisions. Dissection was carried out bluntly with scissors in an avascular plane superficial to the gland. No insufflation was needed since transcutaneous sutures lead to effective retraction. Facial vessels, the lingual nerve and Wharton's duct were identified and protected. Vascular ligatures were performed using surgical miniclips. After the procedure, an open submandibular dissection was performed to control the integrity of the anatomical structures. In all cases, the resection of the submandibular gland was successful without the need for an additional incision. Injuries of the facial artery and lingual nerve occurred when the procedure was carried out initially. The operative time decreased with training, from 120 min for the first cases to 35 min for the later ones. In conclusion, endoscopic submandibular gland resection is possible without major difficulty. Training and experience reduce the operative time and the complication rate.

A novel method for multiple alignment of sequences with repeated and shuffled elements

We describe ABA (A-Bruijn alignment), a new method for multiple alignment of biological sequences. The major difference between ABA and existing multiple alignment methods is that ABA represents an alignment as a directed graph, possibly containing cycles. This representation provides more flexibility than does a traditional alignment matrix or the recently introduced partial order alignment (POA) graph by allowing a larger class of evolutionary relationships between the aligned sequences. Our graph representation is particularly well-suited to the alignment of protein sequences with shuffled and/or repeated domain structure, and allows one to construct multiple alignments of proteins containing (1) domains that are not present in all proteins, (2) domains that are present in different orders in different proteins, and (3) domains that are present in multiple copies in some proteins. In addition, ABA is useful in the alignment of genomic sequences that contain duplications and inversions. We provide several examples illustrating the applications of ABA.

Mental health in complex emergencies

Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scientific evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies.

A uniform projection method for motif discovery in DNA sequences

Buhler and Tompa introduced the random projection algorithm for the motif discovery problem and demonstrated that this algorithm performs well on both simulated and biological samples. We describe a modification of the random projection algorithm, called the uniform projection algorithm, which utilizes a different choice of projections. We replace the random selection of projections by a greedy heuristic that approximately equalizes the coverage of the projections. We show that this change in selection of projections leads to improved performance on motif discovery problems. Furthermore, the uniform projection algorithm is directly applicable to other problems where the random projection algorithm has been used, including comparison of protein sequence databases.

[Congenital nasal pyriform aperture stenosis: a case report]

Congenital nasal pyriform aperture stenosis is a rare and poorly understood pathology. It's etiology is unknown. In cases with severe nasal airway obstruction, this anomaly may produce newborn respiratory destress similar to those seen in bilateral posterior choanal atresia. It can occur as an isolated anomaly or it can be associated with a dental anomaly, craniofacial, ophthalmological or central nervous system malformation. The diagnosis is made by physical examination. Computed tomography confirms the diagnosis. Magnetic resonance imaging of the brain and pituitary endocrine axis must be performed. In patients with severe obstruction, surgical correction is necessary. We describe the case of a 1-month-old child who needed surgical treatment with a sublabial approach for a congenital nasal pyriform aperture stenosis associated with a solitary maxillary central incisor. The follow-up (4 years) reveals normal nasal airway and facial growth.

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being

OBJECTIVE

To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems.

METHOD

The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours.

RESULTS

Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey.

CONCLUSION

Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

Prevalence of adverse life events, depression and suicidal thoughts and behaviour among a community sample of young people aged 15-24 years

OBJECTIVE

To provide prevalence data on several key mental health indicators for young people aged 15 to 24 years.

METHODS

A cross-sectional household survey, using telephone recruitment followed by a postal pencil-and-paper questionnaire. The overall response rate was 67.3%.

RESULTS

Difficulties with interpersonal relationships are common causes of distress for young people, in particular problems with parents, problems with friends and relationship break-ups. Depressive symptomatology is common among young people with approximately one in eight males and one in four females reporting current depressive symptomatology. One in three young people reported that they had had suicidal thoughts at some time in the past, 1.2% of young people reported that they had made a plan on how to kill themselves in the four-week period prior to completing the survey and 6.9% of young people reported that they had tried to kill themselves at some time during their life time (4.2% of males and 9.0% of females).

CONCLUSIONS AND IMPLICATIONS

The prevalence figures for the various mental health indicators presented in this paper represent good baseline information upon which to examine the progress over time of interventions designed to improve the mental health of young people.

Gorillas with spondyloarthropathies express an MHC class I molecule with only limited sequence similarity to HLA-B27 that binds peptides with arginine at P2

The human MHC class I gene, HLA-B27, is a strong risk factor for susceptibility to a group of disorders termed spondyloarthropathies (SpAs). HLA-B27-transgenic rodents develop SpAs, implicating HLA-B27 in the etiology of these disorders. Several nonhuman primates, including gorillas, develop signs of SpAs indistinguishable from clinical signs of humans with SpAs. To determine whether SpAs in gorillas have a similar HLA-B27-related etiology, we analyzed the MHC class I molecules expressed in four affected gorillas. Gogo-B01, isolated from three of the animals, has only limited similarity to HLA-B27 at the end of the alpha1 domain. It differs by several residues in the B pocket, including differences at positions 45 and 67. However, the molecular model of Gogo-B*0101 is consistent with a requirement for positively charged residues at the second amino acid of peptides bound by the MHC class I molecule. Indeed, the peptide binding motif and sequence of individual ligands eluted from Gogo-B*0101 demonstrate that, like HLA-B27, this gorilla MHC class I molecule binds peptides with arginine at the second amino acid position of peptides bound by the MHC class I molecule. Furthermore, live cell binding assays show that Gogo-B*0101 can bind HLA-B27 ligands. Therefore, although most gorillas that develop SpAs express an MHC class I molecule with striking differences to HLA-B27, this molecule binds peptides similar to those bound by HLA-B27.

Measuring psychological adjustment to HIV infection

AIMS

A modified version of the Mental Adjustment to Cancer Scale (The Mental Adjustment to HIV Scale--MAHIVS) was used to evaluate patterns of psychological adjustment in response to HIV infection.

METHODS

A sample of 164 HIV positive homosexual/bisexual men were recruited across three Australian centers (79 asymptomatic (CDC II/III) and 85 symptomatic HIV infection (CDC IV)). Factor analysis of the MAHIVS was conducted and the predictive validity of the MAHIVS was investigated using the General Health Questionnaire, while The Diagnostic Interview Schedule was used to assess current and lifetime psychiatric disorder. Other measures of adjustment/coping were used to investigate the construct validity of the MAHIVS (neuroticism, locus of control, defense style).

RESULTS

Factor analysis of the MAHIVS detected four factors: Hopelessness, Fighting Spirit/Self Efficacy, Personal Control, and Minimization. Hopelessness and Fighting Spirit factors exhibited acceptable levels of internal consistency and validity, with significant correlations detected with psychological symptoms and significant association with other measures of psychological adjustment and personality. Fighting Spirit emerged as a potential indicator of psychological resilience, whereas Hopelessness was significantly associated with psychological symptoms and current major depression (but not past depression).

CONCLUSIONS

The findings indicate the validity of the MAHIVS and support the presence of common themes in the psychological adaptation to life-threatening illness that can be detected across disease categories and groups.

Prevention in psychiatry: Australian contributions

OBJECTIVE

To provide a historic context for developing a framework for preventive mental health research in Australia.

METHOD

A literature review was undertaken and references were selected for their relevance to describing the contributions of Australian researchers and clinicians to an epidemiological approach to mental health disorders, particularly schizophrenia.

RESULTS

Australian researchers and clinicians have made major innovative contributions to preventive mental health research.

CONCLUSIONS

Australian mental health services, in collaboration with academic departments, are in a highly favourable position to expand preventive research activities into schizophrenia.

Preventing PTSD in trauma survivors

This article highlights some of the core issues in the prevention of PTSD in trauma survivors. A review of some of the noteworthy research is presented along with new directions for research, training, education, and social planning efforts.

Alcohol consumption and psychological distress in recently widowed older men

OBJECTIVE

The relationship between severe adverse life events and subsequent health-related behaviour is not well established for older people. To address this issue, we studied self-reported alcohol consumption in recently widowed older men and matched married men.

METHOD

We carried out a double cohort study in community-residing men aged 65 years and over. Recently widowed men (n = 57; mean age = 74.5 years) were identified from the death records of their wives and assessed at 6 weeks, 6 months and 13 months post-bereavement. Matched married men (n = 57; mean age = 75.4 years) were identified from the electoral roll and assessed at similar intervals. Self-report measures of alcohol consumption, grief and state anxiety were employed.

RESULTS

Similar proportions of older widowers and married men reported that they consumed some alcohol, although recently widowed older men reported significantly greater frequency (chi2 = 4.64, df = 1, p = 0.031) and quantity (chi2 = 7.75, df = 1, p = 0.005) of alcohol consumption than matched married men. A significant minority of subjects reported hazardous levels of alcohol consumption with 18.9% of widowers and 8.3% of married men reporting that they drank five or more standard drinks per drinking day. However, among widowers, self-reported alcohol consumption was not significantly correlated with levels of either self-reported grief or state anxiety.

CONCLUSIONS

Hazardous alcohol consumption occurs commonly among recently widowed older men, but is not related to their levels of self-reported grief or psychological distress. Loss of spousal care and control may be an alternative explanation for this drinking behaviour. Older widowers should be regarded as a high-risk group for hazardous alcohol consumption and would be a suitable target group for preventive interventions.

Depressive symptoms and depressive episodes in recently widowed older men

Older widowers have high rates of completed suicide but have rarely been the subject of systematic inquiry. We investigated the prevalence of depressive symptoms and major depressive episodes (MDEs) in recently widowed older men over the first 13 months after bereavement. We employed a matched-pair longitudinal design and recruited subjects from a suburban community population. Fifty-seven recently widowed older men were identified from official death records and 57 matched married men were identified from the electoral roll. Subjects were assessed for the presence of current DSM-III-R MDEs using the Composite International Diagnostic Interview (CIDI), a fully structured psychiatric interview. Widowers were assessed at 6 weeks after bereavement (T1) and 13 months after bereavement (T2). Married men were assessed at similar intervals. At T1, seven widowers (12.3%) and no married men were found to have CIDI cases of current MDE. At T2, one widower (1.9%) and no married men were found to have CIDI cases of current MDE. Current MDE was not predicted by a past history of dysphoria. At T1, 14.0% (8/57) of widowers reported specific suicidal thoughts or actions. At T2, 15.4% (8/52) of widowers reported suicidal thoughts or actions. We conclude that health workers should monitor closely the clinical course of MDEs in recently widowed older men. Routine inquiry about suicidal ideation should be an essential component of the clinical assessment of recently widowed older men.

How does domestic violence affect women's mental health?

In this paper we compare the mental health of women who reported domestic violence and women who reported no abuse in their lifetime. A longitudinal study was conducted with women, 16 to 74 years (n = 358), who attended the emergency department of a major public hospital in Australia. Our aim was to investigate the nature of symptoms and pattern of mental illness associated with domestic violence. The results of the baseline data reported in this paper showed that women who experienced abuse as adults suffered more ill-effects to their mental health than women who did not experience such abuse; also that women who experienced both adult and child abuse suffered more ill-effects than women who experienced abuse either as an adult or child.

Oncocytoma of the eyelid: an aggressive benign tumor

OBJECTIVE

The authors report the case of an 83-year-old patient with a benign oncocytoma of the inferior eyelid.

DESIGN

INTERVENTIONal case report.

INTERVENTION

Treatment consisted of a large orbital exenteration followed by reconstruction with a pedicled temporalis muscle flap.

MAIN OUTCOME MEASURES

Histologic evaluation and clinical follow-up were measured.

RESULTS

After a year of follow-up, there was no sign of local recurrence.

CONCLUSIONS

Oncocytomas, even if benign, must be considered as very aggressive tumors and treated accordingly.

The impact of domestic violence on women's mental health

This longitudinal study aimed to establish a firmer scientific basis for recognition and treatment of post-traumatic psychiatric morbidity associated with domestic violence. The study used a sample of 335 women (mean age 45.5 years) recruited from the Royal Brisbane Hospital Emergency Department. This paper reports baseline data. The outcome measures of lifetime psychiatric diagnoses (DSM-111-R classification), showed that women who reported lifetime adult intimate abuse (n = 162) received significantly more diagnoses of generalised anxiety, dysthymia, depression, phobias, current harmful alcohol consumption and psychoactive drug dependence than those who reported no abuse ever (n = 173). Of the 191 women tested for lifetime post-traumatic stress disorder, those who reported lifetime abuse (n = 115) received significantly more diagnoses than those who reported no abuse (n = 76). Crude prevalence rates of psychiatric diagnoses for women who reported double abuse as child and adult were significantly higher than for women who reported adult intimate abuse only. Adjusted rates showed that doubly abused women had significantly greater risk of current harmful alcohol consumption and lifetime drug dependence than women who reported adult abuse only. A significant independent factor for lifetime psychiatric diagnoses was reporting abuse between a woman's parents. Measurement of the population attributable risk found that one-third of the psychiatric diagnoses were attributable to domestic violence.

Posttraumatic stress disorder in response to HIV infection

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Suicidal ideation, suicide attempts, and HIV infection

A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human immunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n = 85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n = 79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV-positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a lifetime history of infection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and highlight the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.

Psychiatric disorder in HIV infection

OBJECTIVE

This study aimed to investigate rates of psychiatric disorder in human immunodeficiency virus (HIV) infection, in an Australian sample of homosexual and bisexual men.

METHOD

A cross-sectional study of a total of 65 HIV sero-negative (HIV-) and 164 HIV sero-positive men (HIV+) (79 CDC stage II/III and 85 CDC stage IV) was conducted in three centres. Lifetime and current prevalence rates of psychiatric disorder were evaluated using the Diagnostic Interview Schedule Version IIIR (DIS-IIIR).

RESULTS

Elevated current and lifetime rates of major depression were detected in both HIV negative and HIV positive homosexual/bisexual men. Lifetime rates of alcohol abuse/dependence were significantly elevated in HIV positive men (CDC group IV) when compared with HIV negative men. Among the HIV positive group the majority of psychiatric disorders detected were preceded by a pre-HIV diagnosis of psychiatric disorder. Major depression represented the disorder most likely to have first onset after HIV infection diagnosis.

CONCLUSIONS

Lifetime rates of major depression were elevated in this sample of HIV-negative and HIV-positive men. In the HIV-positive men, psychiatric disorder was significantly associated with the presence of lifetime psychiatric disorder prior to HIV infection diagnosis. The findings indicate the importance of evaluation of psychiatric history prior to HIV infection and the clinical significance of depressive syndromes in this population.

A longitudinal study comparing bereavement phenomena in recently bereaved spouses, adult children and parents

OBJECTIVE

The study investigated previous research findings and clinical impressions which indicated that the intensity of grief for parents who had lost a child was likely to be higher than that for widows/widowers, who in turn were likely to have more intense reactions than adult children losing a parent.

METHOD

In order to compare the intensities of the bereavement reactions among representative community samples of bereaved spouses (n = 44), adult children (n = 40) and parents (n = 36), and to follow the course of such phenomena, a detailed Bereavement Questionnaire was administered at four time points over a 13-month period following the loss.

RESULTS

Measures based on items central to the construct of bereavement showed significant time and group differences in accordance with the proposed hypothesis. More global items associated with the construct of resolution showed a significant time effect, but without significant group differences.

CONCLUSIONS

Evidence from this study supports the hypothesis that in non-clinical, community-based populations the frequency with which core bereavement phenomena are experienced is in the order: bereaved parents > bereaved spouses > bereaved adult children.

Hormonal treatment and psychological function during the menopausal transition: an evaluation of the effects of conjugated estrogens/cyclic medroxyprogesterone acetate

OBJECTIVE

To investigate the effect of hormone treatment on psychosocial distress of women during the menopausal transition (aged 40-52 years, still menstruating and with minor symptoms), in a study carefully designed to reduce bias and placebo effect.

METHODS

The study was randomized, controlled by placebo, blinded to the subject, investigators and biostatistician, crossed-over after 6 months, and evaluated by a 77-item questionnaire every month for 12 months. The medication tested was continuous conjugated estrogens (Premarin) and cyclic medroxyprogesterone acetate (Provera).

RESULTS

Of an eligible 105 apparently healthy women, recruited by advertisement, 83 completed the questionnaires for the study. Randomization was successful. While there was a substantial variation over time in the change of scores for all the psychosocial outcomes, there was no significant difference between active and placebo treatment when order of treatment allocation was ignored. However, a strong and consistent effect of the order of treatment allocation for many of the scores was found; in particular, the effect of active treatment was substantially stronger when it was administered second. Positive effects of active treatment were found for the score for the overall symptom rating test (p < 0.009) and its components of depression and feeling of inadequacy (p = 0.011; p = 0.001, respectively).

CONCLUSIONS

The use of hormones, given as a continuous estrogen and cyclic progestogen formulation after a formal calibration/run-in period, may have a beneficial effect on psychosocial distress experienced by women towards the end of their reproductive function.

Psychological distress and bereavement

Some 115 bereaved subjects (43 spouses, 39 adult children, and 33 parents) were followed-up prospectively over 12 months following the acute bereavement period. They completed the Zung Depression Scale, Spielberger's State and Trait Anxiety Measure, the GHQ-28, and Eysenck's Personality Inventory at four time points. With the exception of EPI-Extroversion, there was a significant decrease in all scores over the period encompassing the study. There were no differences between the three groups on any of the psychological variables measured. Scores on the Zung Depression Scale, state and trait anxiety, and neuroticism correlated significantly with a measure of core bereavement phenomenology, the Core Bereavement Items, at each time point for each group.

Impact of an education program about domestic violence on nurses and doctors in an Australian emergency department

OBJECTIVE

To increase the knowledge of nurses and doctors in an emergency department about the topic of domestic violence; to change any negative practices and attitudes toward victims; to increase knowledge of the referral processes for psychosocial aspects of domestic violence; and to increase knowledge of community resources for domestic violence victims.

METHODS

Identical knowledge, attitude, and practice surveys were conducted with nurses and doctors in an emergency department before and after an educational intervention program about domestic violence. A matched-pair analysis of those respondents who answered both pretest and posttest surveys was conducted to measure the impact of the program on nurses and doctors.

RESULTS

Nurses and doctors had a reasonable knowledge of the topic of domestic violence before the education program (correct answers: nurses, 61.6%; doctors, 63.4%). However, the program had a positive impact on their knowledge (correct answers posttest: nurses, 71.5%; doctors, 72.4%), with more significant changes for nurses than for doctors. The program affected both nurses' and doctors' attitudes (of 10 positive attitudinal statements: pretest, 7.9; posttest, 8.6). On both the pretest and posttest, nurses and doctors did not subscribe to a number of the myths about domestic violence that have been described in the domestic violence literature. These findings should be treated with caution because of the low response rates to the surveys from doctors (28.0%, n = 20) and nurses (53.0%, n = 48).

DISCUSSION

Further research is needed into the beliefs and practices of nurses and doctors about domestic violence. The impact of this education program highlights the necessity for introducing training programs for health professionals on domestic violence problems.

The psychological symptoms of conjugal bereavement in elderly men over the first 13 months

OBJECTIVE

The purpose of this study was to investigate the psychological symptoms experienced by recently widowed older men. It was hypothesized that conjugal bereavement in this group would be characterized by a mixture of depression, anxiety and loneliness.

DESIGN

Double cohort study.

SETTING

Suburban community population of Brisbane, Australia.

PARTICIPANTS

Consecutive widowers (65+ years; N = 57) identified from official death records. Married men (65+ years; N = 57) identified from the electoral roll. Widowers interviewed at 6 weeks, 6 months and 13 months post-bereavement. Married men interviewed at similar intervals.

MEASURES

Bereavement Phenomenology Questionnaire (BPQ), a 22-item self-report measure employing a four-point response scale to rate the frequency of phenomena over the previous fortnight. Zung Self-rating Depression Scale (SDS). State component of the Spielberger State/Trait Anxiety Inventory (STAI). Revised UCLA Loneliness Scale (ULS). 28-item General Health Questionnaire (GHQ).

RESULTS

Widowers reported more state anxiety and general psychological distress, but not more depression or loneliness, than matched married men over the first 13 months post-bereavement. Widowers also reported more sleep disturbance and thoughts of death and suicide than married men. Level of state anxiety was strongly correlated with intensity of grief, but not with age, income, education, occupational prestige, cognitive function, duration of wife's final illness or expectedness of wife's death.

CONCLUSIONS

The main hypothesis was not supported, as anxiety symptoms were the predominant clinical feature of recent conjugal bereavement among older men. The nature of these anxiety symptoms requires further investigation in recently widowed older persons.

Domestic violence in the Emergency Department: 2. Detection by doctors and nurses

This study was conducted in 1991 and 1992 to determine the detection rates of domestic violence victims by doctors and nurses at the Emergency Department (ED) of Royal Brisbane Hospital, a major public hospital in Australia. The objective was to determine the outcome of an education program about domestic violence conducted in 1991 for doctors and nurses in the ED. As part of two case-control studies, the self-reports of those who disclosed domestic violence on a screening questionnaire were compared with the recording of domestic violence on each individual medical record. Subjects were drawn from two screening studies carried out 1 year apart which were conducted to assess the prevalence of domestic violence among attendees at the ED. An education program about domestic violence was conducted for doctors and nurses in the ED between the two screening studies. The examination of the medical records showed that detection rates of victims of domestic violence were unchanged between the two case-control studies. Both studies found that 50.0% of those who reported the experience of domestic violence within the 24 hours prior to index presentation, on the screening questionnaire in the prevalence studies, were recorded as such in their medical records. The low detection rates indicate the requirement for doctors and nurses to receive appropriate training to identify and record the psychosocial aspects of domestic violence victims. As well as training, referral systems need to be set in place to address the psychosocial aspects of domestic violence victims.

Measuring core bereavement phenomena

As part of a longitudinal study of bereavement phenomena in three groups, bereaved spouses, bereaved adult children and bereaved parents, scale development was carried out using a pool of bereavement phenomenology questions administered prospectively. The items were derived from the literature, in particular studies dealing with the measurement of grief/bereavement, as well as from clinical experience. Factor analysis of theoretically grouped items produced seven subscales, three of which tapped frequently experienced phenomena in the bereaved. These three subscales formed the basis of a single measure, labelled the Core Bereavement Items (CBI), which demonstrated high reliability and sound face and discriminant validity. Preliminary analysis suggested that the CBI will prove to be a reliable and valid instrument with respect to the measure of core bereavement phenomena in commonly bereaved groups in Western society.

Domestic violence in the Emergency Department: I. Two case-control studies of victims

The object of this study was to compare the diagnoses and characteristics of self-reported domestic violence victims with a random sample of nonvictim controls who were selected from attendees at the Emergency Department (ED) of a major public hospital in Australia. Comparisons were made at index presentation and for the 5 years prior to index presentation. Subjects were drawn from two screening studies carried out 1 year apart which were conducted to assess the prevalence of domestic violence among attendees at the ED. From these groups, the medical records of all individuals who had disclosed domestic violence were examined and compared with the medical records of a random sample of nondisclosers, matched for age (+/- 10 years), sex, and type of entry into the ED (acute vs nonacute). The two case-control studies, conducted 12 months apart, showed that there were statistically significant differences between the diagnoses and characteristics of victims and nonvictims. Victims made more visits to the ED and Outpatients' Department than nonvictims; victims had more psychiatric index presentations; more victims had evidence of treatment of psychiatric conditions, both as inpatients and outpatients, in the previous 5 years than nonvictims; victims had greater rates of attempted suicide and alcohol problems than nonvictims at index presentation and for the previous 5 years. The findings indicate the need for the prevention and treatment of psychiatric conditions of domestic violence victims, including drug and alcohol problems and suicidal ideation. The findings form the basis of hypotheses for further studies to investigate the association between domestic violence and psychiatric illness.

Lesion location and poststroke depression

This study examined whether stroke lesions involving left hemisphere prefrontal or basal ganglia structures are associated with poststroke depression. A consecutive series of first-ever stroke patients with single small lesions on CT scan were examined for the presence and severity of poststroke depressive disorder. Lesions involving left prefrontal or basal ganglia structures were compared with other left hemisphere lesions and all right hemisphere lesions. Forty-one patients were examined. Patients with lesions involving left hemisphere prefrontal or basal ganglia structures had a higher frequency of depressive disorder (9/12; 75%) than other left hemisphere lesions (1/12; 8%) or those with right hemisphere lesions (5/17; 29%), P = 0.002. These findings suggest that damage to neural pathways within left hemisphere prefrontal or basal ganglia structures is associated with depressed mood following stroke.

Managing HIV. Part 7: Professional issues. 7.7 HIV care: the impact on the doctor

Managing patients with HIV raises complex clinical, ethical and personal challenges. "Burnout" threatens the overcommitted doctor who is not prepared to take preventive measures.