A phase I study to evaluate the safety, pharmacokinetics, and pharmacodynamics of PF-06939999 (PRMT5 inhibitor) in patients with selected advanced or metastatic tumors with high incidence of splicing factor gene mutations

BACKGROUND

Protein arginine methyltransferase 5 (PRMT5) methylates multiple substrates dysregulated in cancer, including spliceosome machinery components. PF-06939999 is a selective small-molecule PRMT5 inhibitor.

PATIENTS AND METHODS

This phase I dose-escalation and -expansion trial (NCT03854227) enrolled patients with selected solid tumors. PF-06939999 was administered orally once or twice a day (q.d./b.i.d.) in 28-day cycles. The objectives were to evaluate PF-06939999 safety and tolerability to identify maximum tolerated dose (MTD) and recommended part 2 dose (RP2D), and assess pharmacokinetics (PK), pharmacodynamics [changes in plasma symmetric dimethylarginine (SDMA) levels], and antitumor activities.

RESULTS

In part 1 dose escalation, 28 patients received PF-06939999 (0.5 mg q.d. to 6 mg b.i.d.). Four of 24 (17%) patients reported dose-limiting toxicities: thrombocytopenia (n = 2, 6 mg b.i.d.), anemia (n = 1, 8 mg q.d.), and neutropenia (n = 1, 6 mg q.d.). PF-06939999 exposure increased with dose. Steady-state PK was achieved by day 15. Plasma SDMA was reduced at steady state (58%-88%). Modulation of plasma SDMA was dose dependent. No MTD was determined. In part 2 dose expansion, 26 patients received PF-06939999 6 mg q.d. (RP2D). Overall (part 1 + part 2), the most common grade ≥3 treatment-related adverse events included anemia (28%), thrombocytopenia/platelet count decreased (22%), fatigue (6%), and neutropenia (4%). Three patients (6.8%) had confirmed partial response (head and neck squamous cell carcinoma, n = 1; non-small-cell lung cancer, n = 2), and 19 (43.2%) had stable disease. No predictive biomarkers were identified.

CONCLUSIONS

PF-06939999 demonstrated a tolerable safety profile and objective clinical responses in a subset of patients, suggesting that PRMT5 is an interesting cancer target with clinical validation. However, no predictive biomarker was identified. The role of PRMT5 in cancer biology is complex and requires further preclinical, mechanistic investigation to identify predictive biomarkers for patient selection.

Novel mechanism of Clostridium butyricum alleviated coprophagy prevention-induced intestinal inflammation in rabbit

As bacteria synthesize nutrients primarily in the cecum, coprophagy is indispensable for supplying rabbits with essential nutrients. Recent research has demonstrated its pivotal role in maintaining intestinal microbiota homeostasis and immune regulation in rabbits, although the specific mechanism remains unknown. Here, we used coprophagy prevention (CP) to investigate the effects of coprophagy on the cecum homeostasis and microbiota in New Zealand white rabbits. Furthermore, whether supplementation of Clostridium butyricum (C. butyricum) may alleviate the cecum inflammation and apoptosis caused by CP was also explored. Four groups were randomly assigned: control (Con), sham-coprophagy prevention (SCP), coprophagy prevention (CP), and CP and C. butyricum addition (CPCB). Compared to Con and SCP, CP augmented cecum inflammation and apoptosis, as well as bacterial adhesion to the cecal epithelial mucosa, while decreasing the expression of tight junction proteins (ZO-1, occluding, and claudin-1). The relative abundance of short-chain fatty acids (SCFAs)-producing bacteria was significantly decreased in the CP group. Inversely, there was an increase in the Firmicutes/Bacteroidetes ratio and the relative abundance of Christensenellaceae_R-7_group. Additionally, CP increased the levels of Flagellin, IFN-γ, TNF-a, and IL-1β in cecum contents and promoted the expression of TLR5/MyD88/NF-κB pathway in cecum tissues. However, the CPCB group showed significant improvements in all parameters compared to the CP group. Dietary C. butyricum supplementation significantly increased the production of SCFAs, particularly butyric acid, triggering anti-inflammatory, tissue repairing, and barrier-protective responses. Notably, CPCB effectively mitigated CP-induced apoptosis and inflammation. In summary, CP disrupts the cecum epithelial barrier and induces inflammation in New Zealand white rabbits, but these effects can be alleviated by C. butyricum supplementation. This process appears to be largely associated with the TLR5/MyD88/NF-κB signaling pathway.

AI's deep dive into complex pediatric inguinal hernia issues: a challenge to traditional guidelines?

OBJECTIVE

This study utilized ChatGPT, an artificial intelligence program based on large language models, to explore controversial issues in pediatric inguinal hernia surgery and compare its responses with the guidelines of the European Association of Pediatric Surgeons (EUPSA).

METHODS

Six contentious issues raised by EUPSA were submitted to ChatGPT 4.0 for analysis, for which two independent responses were generated for each issue. These generated answers were subsequently compared with systematic reviews and guidelines. To ensure content accuracy and reliability, a content analysis was conducted, and expert evaluations were solicited for validation. Content analysis evaluated the consistency or discrepancy between ChatGPT 4.0's responses and the guidelines. An expert scoring method assess the quality, reliability, and applicability of responses. The TF-IDF model tested the stability and consistency of the two responses.

RESULTS

The responses generated by ChatGPT 4.0 were mostly consistent with the guidelines. However, some differences and contradictions were noted. The average quality score was 3.33, reliability score was 2.75, and applicability score was 3.46 (out of 5). The average similarity between the two responses was 0.72 (out of 1), Content analysis and expert ratings yielded consistent conclusions, enhancing the credibility of our research.

CONCLUSION

ChatGPT can provide valuable responses to clinical questions, but it has limitations and requires further improvement. It is recommended to combine ChatGPT with other reliable data sources to improve clinical practice and decision-making.

Academic clinician frontline-worker wellbeing and resilience during the COVID-19 pandemic experience: Were there gender differences?

Prior research suggests COVID-19 has amplified stress on Academic Clinician Frontline-Workers (ACFW). The aim of this paper is: (1) to better understand the experiences of ACFW during the COVID-19 pandemic including their mental-emotional wellbeing, academic productivity, clinical experiences, and (2) to examine any gender differences. A cross-sectional survey was administered to University of Minnesota/M Health Fairview systems' faculty February-June 2021. Of the 291 respondents, 156 were clinicians, with 91 (58 %) identifying as Frontline-Workers (ACFW). Faculty wellbeing was assessed using validated measures in addition to measures of productivity and sociodemographics. For example, ACFW reported a higher Work-Family Conflict (WFC) scores compared to non-ACFW (26.5 vs. 24.1, p = 0.057) but did not report higher Family-Work Conflict (FWC) scores (17.7 vs. 16.3, p = 0.302). Gender sub-analyses, revealed that women ACFW compared to men ACFW reported higher WFC scores (27.7 vs. 24.1, p = 0.021) and FWC (19.3 vs. 14.3, p = 0.004). Academically, ACFW reported submitting fewer grants and anticipated delays in promotion and tenure due to the COVID-19 (p = 0.035). Results suggest COVID-19 has exacerbated ACFW stress and gender inequities. Reports of anticipated delay in promotion for ACFW may pose a challenge for the long-term academic success of ACFW, especially women ACFW. In addition, women may experience higher FWC and WFC as compared to men. Schools of academic medicine should consider re-evaluating promotion/tenure processes and creating resources to support women ACFW as well as ACFW caregivers.

Identification and Automated Delineation of Radioresistant Biological Tumor Volume in Nasopharyngeal Carcinoma Based on Magnetic Resonance Imaging Radiomics

PURPOSE/OBJECTIVE(S)

Widespread use of intensity modulated radiotherapy (IMRT) has improved the tumor control rate of nasopharyngeal carcinoma (NPC). However, nearly 20% of the patients with local-advanced NPC would relapse after precise irradiation and 80% of the recurrent lesions occur within the high dose field, suggesting that there are radiation-resistant cancer cell subsets within the tumor. In this context, identification and contouring of radiation resistance region of NPC for dose escalation at primary IMRT could be advantageous. In this work, we proposed a two-step radiomics workflow to predict local relapse and the recurrent region of NPC before primary IMRT.

MATERIALS/METHODS

In this single-center, retrospective study, pre-treatment magnetic resonance (MR) sequences of T1-weighted imaging (T1-w) and contrast-enhanced T1-weighted imaging (CET1-w) were collected from 800 patients of newly diagnosed and non-metastatic NPC between April 2009 and December 2015. The primary gross tumor volume (GTVp) of all patients and the actual recurrent lesion (GTVr) of patients who suffered from local recurrence were manually contoured for further analysis. A two-step complete radiomics workflow was designed to predict tumor recurrence and segment the region. First, least absolute shrinkage and selection operator (LASSO) was utilized for radiomics features selection of GTVp and support vector machine (SVM) was adopted to predict the recurrence. If the model predicts a recurrence, then the workflow utilizes an improved 3D U-Net to segment the recurrent region. Area under receiver operating characteristic curve (ROC-AUC) was used to evaluate the performance of tumor recurrence prediction, and Dice similarity coefficient (DSC) was used to assess the consistence between the actual and predicted GTVr.

RESULTS

Of 800 NPC patients, 95 (11.9%) patients developed in-field local recurrence. For recurrence risk prediction, the SVM ensemble model (T1-w+CET1-w) was selected for further application with higher sensitivity. The average ROC-AUC, specificity, sensitivity of the SVM ensemble model in a 5-fold cross-validation and in the independent test set of 160 patients were 0.922, 0.922, 0.777 and 0.928, 0.915, 0.737, respectively. Moreover, for recurrent region segmentation, the multi-modality (T1-w+CET1-w) model was superior to the single-modality (T1-w or CET1-w) model. In an independent test set of 15 patients, the DSC, sensitivity and 95% Hausdorff Distance between actual and predicted GTVr was 0.549±0.176, 0.696±0.118 and 9.813±4.788 which was superior to 0.444±0.188, 0.497±0.218 and 12.047±5.361 of original 3D U-Net.

CONCLUSION

The proposed two-step radiomics workflow showed a good performance in predicting tumor recurrence of NPC. The predicted location of the recurrence lesion was all accurate, but there was still a certain difference between the volume of the automated delineated and actual GTVr, which needed to be further optimized to be used as biological tumor volume.

Automated Contouring of Cervical Lymph Nodes and Clinical Target Volumes for Nasopharyngeal Carcinoma Based on Deep Learning and Experience Constraints

PURPOSE/OBJECTIVE(S)

Application of artificial intelligence (AI) for automated contouring of tumor volumes and organs at risk (OARs) for radiotherapy of nasopharyngeal carcinoma (NPC) leads to improved contouring accuracy and efficiency. However, few studies have involved the automated contouring of gross tumor volume of cervical lymph nodes (GTVn) and clinical target volumes (CTVs). In this work, we proposed an AI automated contouring tool for GTVn and CTVs for radiotherapy of NPC on the plain scans of planning compute tomography (CT).

MATERIALS/METHODS

In this retrospective study, plain scan datasets of planning CT covering the nasopharynx and neck from 139 patients with NPC between March 2022 and December 2022 were collected and divided into training, validation, and testing cohorts of 95, 24, and 20 patients, respectively. Ground truth contours of primary gross tumor volume (GTVp), GTVn (divided into GTVn_L in left neck and GTVn_R in right neck), CTVs (including high risk CTV1 contains GTVp and low risk CTV2 contains GTVp and cervical nodal levels) and OARs were delineated and were defined by consensus of two experts. We first proposed a three-dimensional (3D) U-net using GTVp and OARs as experience constrains to guide the automated delineation of GTVn and CTVs. The average Dice similarity coefficient (DSC) and average surface distance (ASD) were used to quantify the performance of the AI tool. Next, five prospective patients were enrolled for clinical evaluation of our AI tool. DSC between automated contours and radiation oncologist-revised contours and time consuming of the revision were record.

RESULTS

Clinical characteristics of 139 retrospective and 5 prospective patients are list in Table 1. In the independent testing set of 20 patients, our AI tool showed high performance in GTVn and CTVs contouring when compared with the ground truth contours. The mean DSC were 0.73 ± 0.07, 0.74 ± 0.05, 0.93 ± 0.03, and 0.88 ± 0.03, and the mean ASD were 1.01 ± 0.43 mm, 1.14 ± 0.61 mm, 0.51 ± 0.13 mm, 1.17 ± 0.43 mm for GTVn_L, GTVn_R, CTV1 and CTV2, respectively. In the five prospective patients, mean DSC were 0.74 ± 0.07, 0.74 ± 0.10, 0.95 ± 0.01 and 0.89 ± 0.04, respectively. The median time consuming for GTVn and CTVs revision was 2minutes and 10 seconds (range, 1 minutes to 3 minutes).

CONCLUSION

The proposed AI tool integrating clinical experience as constrains showed high accuracy for contouring GTVn and CTVs of NPC. With the assistance of AI contours, contouring efficiency could be probably increased, which is promising in online adaptive radiotherapy of NPC.

The axial and sagittal CT values of the 7th thoracic vertebrae in screening for osteoporosis and osteopenia

AIM

To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and sagittal vertebral CT measurements in predicting osteoporosis.

MATERIALS AND METHODS

Patients who underwent routine chest CT and dual-energy X-ray absorptiometry (DXA) within 1 month were included in this retrospective study. The CT attenuation values of different planes were compared. Logistic regression and receiver operating characteristic (ROC) were used to analyse the difference of each plane in the diagnosis of osteoporosis.

RESULTS

The study included 1,338 patients (mean age of 61.9±11.9; 54% female). The CT attenuation values decreased successively in the normal group, osteopenia group, and osteoporosis group. The paired t-test results showed that the mid-axial measurements were greater than mid-sagittal measurements, with a mean difference of 9 HU, the difference was statistically significant (p<0.001, 95% confidence interval [CI] = 7.8-10.1). For each one-unit reduction in mid-sagittal CT attenuation value, the risk of osteopenia or osteoporosis increased by 3.6%. To distinguish osteoporosis from non-osteoporosis (osteopenia + normal), the sensitivity was 90% and the specificity was 52.4% at the mid-sagittal threshold of 113.7 HU.

CONCLUSIONS

The CT attenuation values of mid-sagittal plane have higher diagnostic efficacy than axial planes in predicting osteoporosis. For patients with a sagittal CT attenuation value of <113.7 HU in the T7, further DXA examination is warranted.

Screening and Stability Analysis of Reference Genes for Gene Expression Normalization in Hybrid Yellow Catfish (Pelteobagrus fulvidraco ♀ × Pelteobagrus vachelli ♂) Fed Diets Containing Different Soybean Meal Levels

In this study, we screened the expression stability of six reference genes (18S rRNA, β-actin, GAPDH, EF1a, B2M, and HPRT1) in hybrid yellow catfish (n = 6), considering the SBM levels, sampling time points, and different tissues. Four different statistical programs, BestKeeper, NormFinder, Genorm, and Delta Ct, combined with a method that comprehensively considered all results, were used to evaluate the expression stability of these reference genes systematically. The results showed that SBM levels significantly impacted the expression stability of most of the reference genes studied and that this impact was time-, dose-, and tissue-dependent. The expression stability of these six reference genes varied depending on tissue, sampling time point, and SBM dosage. Additionally, more variations were found among different tissues than among different SBM levels or sampling time points. Due to its high expression, 18S rRNA was excluded from the list of candidate reference genes. β-actin and GAPDH in the liver and β-actin, HPRT1 and EF1a in the intestine were the most stable reference genes when SBM levels were considered. HPRT1, and EF1a in tissues sampled at 2 W and EF1a and β-actin in tissues sampled at 4 and 6 W were proposed as two stable reference genes when different tissues were considered. When the sampling time points were considered, β-actin, EF1a, and HPRT1 were the top three stable reference genes in the intestine. In contrast, β-actin and B2M are the most stable reference genes in the liver. In summary, β-actin, EF1a, and HPRT1 were the more stable reference genes in this study. The stability of reference genes depends on the tissues, sampling time points, and SBM diet levels in hybrid yellow catfish. Therefore, attention should be paid to these factors before selecting suitable reference genes for normalizing the target genes.

Mercury intoxication disrupts tonic signaling in B cells, and may promote autoimmunity due to abnormal phosphorylation of STIM-1 and other autoimmunity risk associated phosphoproteins involved in BCR signaling

Epidemiological studies link exposure to mercury with autoimmune disease. Unfortunately, in spite of considerable effort, no generally accepted mechanistic understanding of how mercury functions with respect to the etiology of autoimmune disease is currently available. Nevertheless, autoimmune disease often arises because of defective B cell signaling. Because B cell signaling is dependent on phosphorylation cascades, in this report, we have focused on how mercury intoxication alters phosphorylation of B cell proteins in antigen-non stimulated (tonic) mouse (BALB/c) splenic B cells. Specifically, we utilized mass spectrometric techniques to conduct a comprehensive unbiased global analysis of the effect of inorganic mercury (Hg2+) on the entire B cell phosphoproteome. We found that the effects were pleotropic in the sense that large numbers of pathways were impacted. However, confirming our earlier work, we found that the B cell signaling pathway stood out from the rest, in that phosphoproteins which had sites which were affected by Hg2+, exhibited a much higher degree of connectivity, than components of other pathways. Further analysis showed that many of these BCR pathway proteins had been previously linked to autoimmune disease. Finally, dose response analysis of these BCR pathway proteins showed STIM1_S575, and NFAT2_S259 are the two most Hg2+ sensitive of these sites. Because STIM1_S575 controls the ability of STIM1 to regulate internal Ca2+, we speculate that STIM1 may be the initial point of disruption, where Hg2+ interferes with B cell signaling leading to systemic autoimmunity, with the molecular effects pleiotropically propagated throughout the cell by virtue of Ca2+ dysregulation.

Evolution of the clinical simulation approach to assess digital health technologies

Coronavirus 2019 (COVID-19) has catalysed digital transformation in the health space. However, it remains a challenge to generate timely and cost-effective evidence for digital health technologies (DHTs) to ensure their safety and efficacy. Traditional methods, such as randomised controlled trials (RCTs), are ill-suited for assessing DHTs for reasons of speed, agility, cost and context. Clinical simulation using high-fidelity synthetic patient cases is emerging as a promising yet underexplored method to evaluate DHTs. It offers several advantages, including conducting remote multi-site testing at low cost, inclusion of high-risk patient profiles that are usually excluded from RCTs and adaptability to different local clinical settings. This article shares some of the insights from studies using clinical simulation conducted at the Institute of Global Health Innovation (IGHI) at Imperial College London and describes the evolution of this approach as well as future opportunities.

[Correlation between gene polymorphisms of killer cell immunoglobulin-like receptors and their ligands and Graves' disease]

Objective: To explore the relationship between gene polymorphism of killer cell immunoglobulin-like receptor (KIR) and its ligand-specific human leukocyte antigen C (HLA-C) and Graves' disease (GD). Methods: Case-control study. A total of 118 unrelated GD patients (GD group) admitted to Shandong Provincial Hospital from January 2011 to December 2017 and 108 age-and sex-matched healthy controls (healthy control group) were included. The KIR genotype and its ligand HLA-C allele were detected by polymerase chain reaction sequence-specific primers (PCR-SSP). The distribution of KIR/HLA-C gene combination in GD patients and control population was analyzed to explore its association with the occurrence of GD. Results: In GD group, there were 29 males and 89 females, aged (38±14) years. In the healthy control group, there were 28 males and 80 females, aged (37±13) years. Compared with the healthy control group, the occurrence frequency of HLA-Cw01 was higher in GD group[36.4%(43/118) vs 18.5%(20/108), P=0.003], and the occurrence frequency of HLA-Cw03 and HLA-Cw06 was lower in GD group[11.9%(14/118) vs 39.8%(43/108), P<0.001; 9.3%(11/118) vs 18.5%(20/108), P=0.045]. The frequency of KIR2DL1/HLA-C2 gene combination in GD group was lower than that in control group [17.8%(21/118) vs 34.3%(37/108), P=0.005]. Logistic regression analysis showed that KIR2DL1/HLA-C2 gene combination was a protective factor for GD occurrence (OR=0.308, 95%CI: 0.126-0.752, P=0.010). Conclusions: The polymorphism of KIR/HLA-C gene is related to GD. The low expression of KIR2DL1/HLA-C2 in GD patients may be a protective factor for GD.

Analysis of sentiment changes in online messages of depression patients before and during the COVID-19 epidemic based on BERT+BiLSTM

With the development of the Internet, more and more people prefer to confide their sentiments in the virtual world, especially those with depression. The social media where people with depression collectively leave messages is called the “Tree Hole”. The purpose of this article is to support the “Tree Hole” rescue volunteers to help patients with depression, especially after the outbreak of COVID-19 and other major events, to guide the crisis intervention of patients with depression. Based on the message data of “Tree Hole” named “Zou Fan”, this paper used a deep learning model and sentiment scoring algorithm to analyze the fluctuation characteristics sentiment of user’s message in different time dimensions. Through detailed investigation of the research results, we found that the number of “Tree Hole” messages in multiple time dimensions is positively correlated to emotion. The longer the “Tree Hole” is formed, the more negative the emotion is, and the outbreak of COVID-19 and other major events have obvious effects on the emotion of the messages. In order to improve the efficiency of “Tree Hole” rescue, volunteers should focus on the long-formed “Tree Hole” and the user groups that are active in the early morning. This research is of great significance for the emotional guidance of online mental health patients, especially the crisis intervention for depression patients after the outbreak of COVID-19 and other major events.

Microbiome-Metabolome Analysis of the Immune Microenvironment of the Cecal Contents, Soft Feces, and Hard Feces of Hyplus Rabbits

The intestinal microbiota and its metabolites play vital roles in host growth, development, and immune regulation. This study analyzed the microbial community distribution and the cytokine and short-chain fatty acid (SCFA) content of cecal contents (Con group), soft feces (SF group), and hard feces (HF group) of 60-day-old Hyplus rabbits and verified the effect of soft feces on the cecal immune microenvironment by coprophagy prevention (CP). The results showed that there were significant differences in the levels of phylum and genus composition, cytokines, and SCFAs among the Con group, SF group, and HF group. The correlation analysis of cytokines and SCFAs with differential microbial communities showed that Muribaculaceae, Ruminococcaceae_UCG-014, Ruminococcaceae_NK4A214_group, and Christensenellaceae_R-7_Group are closely related to cytokines and SCFAs. After CP treatment, the contents of propionic acid, butyric acid, IL-4, and IL-10 in cecum decreased significantly, whereas TNF-α and IL-1β increased significantly. Moreover, the inhibition of coprophagy led to the downregulation of the expression levels of tight junction proteins (Claudin-1, Occludin, and ZO-1) related to intestinal inflammation and intestinal barrier function, and the ring-like structure of ZO-1 was disrupted. In conclusion, coprophagy can not only help rabbits obtain more probiotics and SCFAs but also play an essential role in improving the immune microenvironment of cecum.

Validation of the International Trauma Questionnaire-Child and Adolescent Version (ITQ-CA) in a Chinese mental health service seeking adolescent sample

BACKGROUND

The International Trauma Questionnaire-Child and Adolescent version (ITQ-CA) is a self-report measure that assesses posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on the diagnostic formulation of the 11th version of the International Classification of Diseases (ICD-11). This study aimed to provide a Chinese translation and psychometric evaluation of the ITQ-CA using a sample of mental-health service seeking adolescents in Mainland China.

METHODS

The ITQ-CA was translated and back-translated from English to simplified Chinese and finalized with consensus from an expert panel. Adolescents ages 12-17 were recruited via convenience sampling from an outpatient psychiatric clinic in Mainland China. Participants completed the ITQ-CA; measures of four criterion variables (depression, anxiety, stress, adverse childhood experiences); and the PTSD Checklist for DSM-5 (PCL-5). Construct validity, concurrent validity, and comparison of PTSD caseness between ICD-11 and DSM-5 measures were assessed.

RESULTS

The final sample consisted of 111 Chinese adolescents (78% female; mean age of 15.23), all diagnosed with a major depressive disorder. Confirmatory factor analysis indicated the two-factor second-order model provided optimal fit. All criterion variables were positively and significant correlated with the six ITQ-CA symptom cluster summed scores. In the present sample, 69 participants (62.16%) met symptom criteria for ICD-PTSD or CPTSD using the ITQ-CA, and 73 participants (65.77%) met caseness for DSM-5 PTSD using the PCL-5. Rates of PTSD symptom cluster endorsement and caseness deriving from both diagnostic systems were comparable.

CONCLUSIONS

The Chinese ITQ-CA has acceptable psychometric properties and confers additional benefits in identifying complex presentations of trauma-related responses in younger people seeking mental health services.

[The influence of differential parenting in early life on the physical and mental health of middle-aged and elderly women]

Objective: To explore the influence of differential parenting in early life on the physical and mental health of middle-aged and elderly women, and analyze the mediating effect of early life health. Methods: Based on 8 204 women aged 45-84 years from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, the life course survey data of CHARLS 2014 were matched by ID number. Logistic regression analysis models were used to analyze the direct impact of differential parenting in early life on chronic diseases and depression of middle-aged and elderly women, and the KHB method was used to analyze the mediating effect of early life health. Results: The prevalence of chronic diseases in middle-aged and elderly women was 81.05% and the detection rate of depression among them was 41.46%. After adjusting for other confounding factors, parents' preference for boys in early life increased the possibility of chronic diseases of middle-aged and elderly women by 18.2% (OR=1.182, 95%CI: 1.013-1.381). Compared with the women whose parents had no differential upbringing in early life, the parents' preference for boys or brothers/sisters in early life increased the possibility of depression in middle-aged and elderly women by 16.1% (OR=1.161, 95%CI:1.030-1.309) and 17.4% (OR=1.174, 95%CI:1.032-1.336),respectly. Early life health was one of the mediating factors that parents' preference for brothers and sisters could affect the mental health status of middle-aged and elderly women, and the mediating effect accounted for 8.603% of the total effect. Conclusion: Differential parenting in early life may have an impact on the physical and mental health of middle-aged and elderly women. Differential parenting could affect the early life health status of women, and then affect the mental health in their middle and old age.

Association between awareness of vulnerability and disaster preparedness in an infrastructure-resilient city: a population-based study

OBJECTIVES

Factors associated with an individual's awareness of vulnerability can be modified by the infrastructure of a city. These factors may impact disaster preparedness among local populations in an infrastructure-resilient city, which further influences the health risks of various population subgroups.

STUDY DESIGN

This was a population-based study.

METHODS

Four population subgroups, which have previously been reported to be related to awareness of vulnerability (i.e. past experiences, sociodemographic deprivation, poor housing conditions and family medical needs), were analysed for their impacts on disaster preparedness. Validated population-based phone interviews (n = 856) were conducted in Hong Kong. Three types of disaster preparedness were studied: (1) physical preparedness; (2) social preparedness; and (3) education preparedness.

RESULTS

Previous experience of social hazards, accidental hazards and epidemics increased disaster preparedness among the local population. Specifically, experiences of accidental hazards and social hazards were positively associated with physical preparedness (odds ratios 1.626, 95% confidence interval [95% CI] 1.215, 2.172) and 1.501 [95% CI 1.114, 2.024], respectively). However, experiences of natural hazards did not increase preparedness, even in Hong Kong, which is a city with high 'disaster resilience' because of its well-developed infrastructure. Moreover, individuals with a low educational level or low income had lower education preparedness, unmarried individuals had lower social preparedness, and poor housing conditions of non-private-housing households had negative associations with education preparedness. These findings partially align with local disaster responses to the 2018 Typhoon Mangkhut, the 2019 social unrest and the 2020 COVID-19 pandemic, all of which were observed after the 2018 survey reported in this study.

CONCLUSIONS

Social and environmental interventions should be targeted to marginalised subpopulations through location-based community strategies to encourage increased environmental knowledge and participation in disaster preparedness activities.

[Effect of childhood living environment sanitation on chronic diseases in middle-aged and elderly rural residents]

Objective: To explore the effect of childhood living environment sanitation on the prevalence of chronic diseases in middle-aged and elderly rural residents and test the mediating product of childhood health status. Methods: Based on the data of 12 506 rural residents jointly interviewed by the latest survey of China Health and Retirement Longitudinal Survey (CHARLS) in 2018 and the life course survey in 2014, the χ² test, Rank sum test, logistic regression analysis model, Propensity score weighting method, negative binomial regression model and KHB analysis method were used for analysis. Results: After adjusting for other confounding factors, compared with rural residents with better living environment sanitation in childhood, the risk of asthma in middle-aged and elderly rural residents with poor childhood living environment sanitation increased by 23.7% (OR=1.237,95%CI: 1.060-1.445), and the risk of liver disease, kidney disease, and digestive system disease increased by 16.4% (OR=1.164,95%CI: 1.006-1.347) and 22.4% (OR=1.224,95%CI: 1.083-1.383) and 19.6% (OR=1.196,95%CI: 1.103-1.296), the possibility of dyslipidemia and heart disease increased by 26.6% (OR=1.266,95%CI: 1.153-1.390) and 13.6% (OR=1.136,95%CI: 1.031-1.253). The negative binomial regression model analysis results show that, on average, the number of chronic diseases of middle-aged and elderly rural residents with poor living environment sanitation in childhood is 0.176 more than that of middle-aged and elderly rural residents with better living environment sanitation in childhood. Childhood health status played an intermediary role of 7.143%. Conclusion: There is a statistical correlation between residential environmental sanitation in childhood and the prevalence and number of chronic diseases in middle-aged and elderly rural residents. Childhood health status plays a partial intermediary role. Attention should be paid to the construction and management of rural residents' residential environment to provide a clean and hygienic growth environment for children and adolescents to promote the health of rural residents in the whole life cycle.

Intravoxel incoherent motion diffusion-weighted imaging as a quantitative tool for evaluating disease activity in patients with axial spondyloarthritis

AIM

To determine the correlations between four quantitative magnetic resonance imaging (MRI) parameters derived from intravoxel incoherent motion diffusion-weighted images (IVIM DWI) and the semi-quantitative Spondyloarthritis Research Consortium of Canada (SPARCC) score of the sacroiliac joint (SIJ) and five clinical activity indices in patients with axial spondyloarthritis (axSpA).

AND METHODS

A total of 75 patients with axSpA and complete clinical activity indices and SIJ MRI were enrolled to this prospective study. Univariable and multivariable linear regression analyses were performed to evaluate correlations between MRI parameters and clinical activity indices after controlling for confounders. All data were further analysed using Pearson's correlation coefficients (r).

RESULTS

Only pure diffusion coefficient (D) and incoherent perfusion related microcirculation (D∗) were found to be independently positively correlated with several clinical activity indices (all p<0.05). Positive correlations were observed between D and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Patient Global Assessment (PGA), extent of influence of pain, with r of 0.605, 0.402, 0.319, and 0.485 (all p<0.0125). D∗ correlated positively with BASDAI, BASFI, and PGA (r=0.436, 0.356, 0.301, respectively; all p<0.0125).

CONCLUSION

D and D∗ derived from IVIM DWI could be associated with some disease activity indices in patients with axSpA; apparent diffusion coefficient (ADC) and SPARCC scores were not correlated with these indices. IVIM DWI may be a useful tool for the quantitative assessment of disease activity in patients with axSpA.

Economic impact of digital tumor board software: An evaluation of cost savings using real-world data

e18794

Background: Multidisciplinary tumor boards (MTB) provide an interdisciplinary approach for decision-making in cancer care and are an integral part of cancer treatment plans. MTBs are widely considered the “gold standard” in cancer care delivery and are required for accreditation by the American College of Surgeons on Cancer Program. Preparing for MTBs is time-consuming and labor-intensive. We have previously published the largest real-world study of a digital solution (NAVIFY), showing significant decreases in the case preparation time compared to traditional methods.1 We now extend that study to evaluate the economic impact on costs of MTBs in an academic setting. Methods: The NAVIFY Tumor Board solution was introduced at the University of Missouri Health Care (MU) in 2018. Data was collected in three tumor boards (Breast, ENT, and GI) for pre- and post- NAVIFY implementation as previously published1 . For the current study, raw data was collected and preprocessed to obtain eight pertinent variables. A retrospective pre-post analysis was used to evaluate the economic effectiveness of NAVIFY. Using the salary data collected from publicly available sources, the average personnel cost/case (nurse navigator, radiology, pathology and genetic counseling) was analyzed for each tumor board for pre and post stable integration of NAVIFY. In addition, a system-wide cost projection study and payback analysis were also performed based on 12 tumor boards. Results: The average personnel cost/case after integration of NAVIFY showed a savings of 40% in breast MTB, 52% for ENT MTB, and 6% for GI MTB. Both Breast and ENT were considered to be the optimal use of the software after implementation. Using these two tumor boards, the average total personnel cost/case pre-NAVIFY was $93.20 and $49.55 post integration. Annual system-wide cost projections showed an annual savings of $299,614. Discounted payback period analysis showed a payback period of 0.17 years. Conclusions: Implementation of NAVIFY digital tumor board solution showed a significant impact on the total cost of tumor board preparation with overall a decrease in personnel cost/case of 53% with ideal implementation. The comparatively slight decrease in GI could be explained by an increase in cases reviewed from an average of 8 to 11 pre vs post NAVIFY requiring increased radiologist time, and poor user adoption by surgeons. In conclusion, implementation of a digital tumor board software provides significant savings in case preparation costs, second to decreased time costs of personnel. While not evaluated in this study, these cost savings do not take into account the increased potential clinical revenue that may also accompany the improved efficiency on provider time. References 1. Hammer RD, etal. Digital Tumor Board Solutions Have Significant Impact on Case Preparation. JCO Clin Cancer Inform. 2020 Aug;4:757-768.

A remote evaluation of NAVIFY guidelines using simulation-based research methods

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Background: This pilot study was designed to explore the use of remote simulation-based research methods to assess NAVIFY Guidelines, including data collection procedures. NAVIFY Guidelines is a software application that digitizes NCCN Guidelines and allows the user to navigate guidelines in a stepwise manner to support clinical decisions. The application has been designed to simplify access and improve adherence to guidelines in the management of oncology patients. Methods: A total of 10 board-certified oncologists were recruited to participate from large academic centers (5), community hospitals (3) and specialist oncology centers (2). Each oncologist reviewed clinical information for 10 synthetic breast cancer patient cases (i.e., 100 case reviews). The cases were developed by a medical oncologist, a surgical oncologist, a radiologist and a histopathologist. Participants were tasked to select the most appropriate clinical decision as per guidelines in two conditions: 1) using a PDF of the NCCN Guidelines (control), and 2) using NAVIFY Guidelines (experimental). Outcome measures were compared across conditions. Sessions were conducted via Google Meet, with participants using the share screen feature to allow the session to be recorded. The cognitive burden of each method was measured via a psychometric test conducted before and after each method (the Stroop Colour and Word Test). After each session, a post-simulation survey gathered feedback on 1) study methods, 2) use of synthetic patient cases, 3) workload effort required (via the NASA Task Load Index), and 4) usability of NAVIFY Guidelines (via the System Usability Scale). A short interview was conducted after each session to gather feedback on the benefits and challenges of using NAVIFY Guidelines and to discuss the participant’s experience of the simulation session. Results: All data collection procedures were successful including 1) assessment of time taken to reach a clinical decision, 2) psychometric testing, 3) survey data, and 4) user feedback. All participants felt the synthetic patient cases were either ‘very similar’ (7 of 10) or ‘somewhat similar’ (3 of 10) to cases seen in routine clinical practice, and the majority felt the task completed during the sessions was ‘very similar’ (3 of 10) or ‘somewhat similar’ (4 of 10). Conclusions: Remote evaluations can be conducted quickly helping to keep pace with product development cycles. The method is easily repeated therefore supporting evaluation of product development over time. In addition, managing simulations remotely enables the possibility of simultaneous evaluations across multiple geographies, and the use of synthetic patient data eliminates data protection concerns. This study suggests that simulation-based research can be used to assess digital health solutions remotely in a timely fashion.

Evaluation of a clinical decision support tool for matching cancer patients to clinical trials using simulation-based research

There is a growing need for alternative methodologies to evaluate digital health solutions in a short timeframe and at relatively low cost. Simulation-based research (SBR) methods have been proposed as an alternative methodology for evaluating digital health solutions; however, few studies have described the applicability of SBR methods to evaluate such solutions. This study used SBR to evaluate the feasibility and user experience of a clinical decision support (CDS) tool used for matching cancer patients to clinical trials. Twenty-five clinicians and research staff were recruited to match 10 synthetic patient cases to clinical trials using both the CDS tool and publicly available online trial databases. Participants were significantly more likely to report having sufficient time (p = 0.020) and to require less mental effort (p = 0.001) to complete trial matching with the CDS tool. Participants required less time for trial matching using the CDS tool, but the difference was not significant (p = 0.093). Most participants reported that they had sufficient guidance to participate in the simulations (96%). This study demonstrates the use of SBR methods is a feasible approach to evaluate digital health solutions and to collect valuable user feedback without the need for implementation in clinical practice. Further research is required to demonstrate the feasibility of using SBR to conduct remote evaluations of digital health solutions.

A184 REPURPOSING DRUGS FOR SPLEEN TYROSINE KINASE (SYK) PEDIATRIC PATIENTS USING HIGH-THROUGHPUT SCREENING

Background

Spleen Tyrosine Kinase (SYK) is a cytosolic, non-receptor tyrosine kinase with an imperative role in immune and non-immune processes. Recently, we identified six gain-of-function SYK variants in patients that presented multi-organ inflammation and immune dysregulation. The SYK variants displayed constitutive SYK phosphorylation in human embryonic kidney (HEK) 293T, colonic epithelial cells (SW480), and in knock-in heterozygous SYK mice. These observations mark SYK as a therapeutic target for autoimmune diseases.

Phenotype drug discovery accelerates this process and can be done successfully with an appropriate phenotype. A possible phenotype displayed by SYK variants is SYK phosphorylation, as high-throughput screening can identify hit compounds that reduce the constitutive activation of phosphorylated SYK (p-SYK).

Aims

Aim 1: Determine the screening phenotype with wildtype (WT) and SYK S550Y variant in HEK293T cells. Recently, we observed increased phosphorylation in gain-of-function SYK variants We hypothesize that we can use phosphorylated-SYK (p-SYK) levels to identify hit compounds that can decrease the kinase activity in these variants. With stable transfected SYK WT and SYK S550Y HEK293T cell-line, protein analyses will be completed to characterize the appropriate screening phenotype.

Aim 2

Establish an assay for high-throughput drug screening. We will utilize homogenous time-resolved fluorescence (HTRF) assay. The signal measured from HTRF is positively proportional to the level of p-SYK; therefore, we expect that S550Y cells will have a higher signal than the WT.

Aim 3

Validate hit compounds in HEK293T and zebrafish. We will create a dose-response curve with the hit compounds in in vitro and in vivo models.

Methods

We will use stable transfection to established overexpressing SYK WT and S550Y HEK293T cells. We will apply homogenous time-resolved fluorescence (HTRF) to quantify p-SYK levels during the drug screening.

Results

Protein analyses have verified high expression of p-SYK in stable transfected HEK293T cells. No stimulation was required, as the cells showed an increased phosphorylation level at baseline. Downstream signaling partners such as p-ERK and p-JNK of the MAPK pathway displayed an upregulation. This suggests that the sustained activation of p-SYK may consequently affect cellular processes and contribute to the clinical manifestations observed in patients.

Conclusions

This research study will identify hit compounds that can produce a safe and effective biological response in pediatric patients with gain-of-function SYK variants. Personalizing medicine throughout high-throughput drug screening can accelerate drug repurposing for pediatric patients with multiple systemic diseases and immune dysregulation.

Funding Agencies

None

[Dihydromyricetin reverses Herceptin resistance by up-regulating miR-98-5p and inhibiting IGF1R/HER2 dimer formation in SKBR3 cells]

OBJECTIVE

To explore the effect of dihydromyricetin on the expression of miR-98-5p and its mechanism in the development of Herceptin resistance in SKBR3 cells.

METHODS

The expression of IGF2 and miR-98-5p and their interaction relationship were analyzed by bioinformatics analysis through TargetScan online databases. SKBR3 cells and drug-resistant SKBR3-R cells were cultured in cell experiments. Xenograft tumor mice were constructed by SKBR3 and SKBR3-R cells. Proteins were detected by western blotting and immunohistochemistry. Transfected cells were constructed by shRNA lentivirus vectors. RT-QPCR was used to detect RNA. Cell proliferation was detected by MTS method. Cell jnvasion was detected by Transwell assay. Luciferase reporting assays were used to verify RNA interactions. IGF-1R/HER2 heterodimer was determined by immunocoprecipitation.

RESULTS

The expression of IGF2, p-IGF1R, p-Akt and p-S6K in SKBR3-R cells were significantly higher than those in SKBR3 cells, while the expression of PTEN protein was lower in SKBR3-R cells (P < 0.05). IGF1R/HER2 heterodimer in SKBR3-R cells was significantly increased (P < 0.01).The expression of IGF2 and invasion ability were significantly reduced while transfected with miR-98-5p in SKBR3-R cells (P < 0.05), but the IGF2 mRNA were no difference in both cells (P > 0.05). The expression of miR-98-5p was up-regulated and IGF2 was decreased in drug-resistant xenograft tumor mice after feeding with dihydromyricetin, and the tumor became more sensitivity to Herceptin (P < 0.05).

CONCLUSION

Dihydromyricetin could induce the expression of miR-98-5p, which binds to IGF2 mRNA to reduce IGF2 expression, inhibit the IGF-1R/HER2 formation, thereby reversing cell resistance to Herceptin in SKBR3-R cells.

Seed bulb size influences the effects of exogenous brassinolide on yield and quality of Pinellia ternata

In recent years, natural Pinellia ternata populations of have gradually been exhausted, while the cultivated yield has been limited due to lack of research and uncertain climate condition. Therefore, it is necessary to explore methods of improving yield and quality in P. ternata using brassinolide (BR) treatments and choice of a suitable seed bulb size. This article reports the effects of BR and two seed bulb sizes (diameter: 0.5-1.0 cm and 1.0-1.5 cm) on active and nutrient components and antioxidant activity in P. ternata. The experiment included six levels of BR (0, 0.05, 0.10, 0.50, 1.00 and 2.00 mg l^-1 ). The tuber yield of the two seed bulb sizes and bulbil yield of small seed bulbs increased 5.67%, 22.66% and 69.23% by day 105 after 0.50 mg l^-1 BR treatment, compared with the control. On day 105, only 0.05 mg l^-1 BR increased scores in principal components analysis (PCA) in tubers of small seed bulbs by 167.29%, and 0.05 and 0.50 mg l^-1 BR increased PCA score in bulbils of large seed bulbs by 145.66% and 252.97%, respectively, compared with the control. Significant BR × seed bulb size interactions were found on yield and quality of P. ternata. The results indicate that BR effects on yield and quality of tubers and bulbils of P. ternata are not only related to BR concentration but also to seed bulb size.

Digital Tumor Board Solutions Have Significant Impact on Case Preparation

PURPOSE

Multidisciplinary tumor boards (TBs) are the gold standard for decision-making in cancer care. Variability in preparation, conduction, and impact is widely reported. The benefit of digital technologies to support TBs is unknown. This study evaluated the impact of the NAVIFY Tumor Board solution (NTB) on TB preparation time across multiple user groups in 4 cancer categories: breast, GI, head and neck (ie, ear, nose, and throat, or ENT), and hematopathology.

METHODS

This prospective study evaluated TB preparation time in multiple phases pre- and post-NTB implementation at an academic health care center. TB preparation times were recorded for multiple weeks using a digital time tracker.

RESULTS

Preparation times for 59 breast, 61 GI, 36 ENT, and 71 hematopathology cancer TBs comparing a pre-NTB phase to 3 phases of NTB implementation were evaluated between February 2018 and July 2019. NTB resulted in significant reductions in overall preparation time (30%) across 3 TBs pre-NTB compared with the final post-NTB implementation phase. In the breast TB, NTB reduced overall preparation time by 28%, with a 76% decrease in standard deviation (SD). In the GI TB, a 23% reduction in average preparation time was observed for all users, with a 48% decrease in SD. In the ENT TB, a 33% reduction in average preparation time was observed for all users, with a 73% decrease in SD. The hematopathology TB, which was the cocreation partner and initial adopter of the solution, showed variable results.

CONCLUSION

This study showed a significant impact of a digital solution on time preparation for TBs across multiple users and different TBs, reflecting the generalizability of the NTB. Adoption of such a solution could improve the efficiency of TBs and have a direct economic impact on hospitals.

Adherence to antihypertensive medications for secondary prevention of cardiovascular disease events: a dose-response meta-analysis

OBJECTIVES

The aim of the study was to explore the association between adherence to antihypertensive medications (AHMs) and the risk of recurrence of cardiovascular disease (CVD) events in patients with a history of CVD events from cohort studies.

STUDY DESIGN

This is a dose-response meta-analysis.

METHODS

PubMed and Embase databases were searched up to March 4, 2021, to identify English-language reports of cohort studies that assessed the association of AHM adherence with risk of recurrence of CVD events. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using a fixed- or random-effects model. Restricted cubic splines were used to evaluate the possible linear or non-linear association.

RESULTS

We included nine cohort studies (54,349 patients) in the present meta-analysis. The pooled RR of CVD events was 0.66 (95% CI, 0.54-0.78) for the highest versus lowest AHM adherence category. We did not find any evidence of non-linearity association between AHM adherence and risk of CVD events (P_{non-linearity} = 0.534); for patients with a history of CVD events, the risk of CVD events was reduced by 9% for each 20% increase in AHM adherence (RR, 0.91; 95% CI, 0.85-0.97). The results of sensitivity analysis and subgroup analysis were virtually unchanged.

CONCLUSIONS

The high level of adherence to AHM is an effective strategy for preventing recurrence of CVD events. Patients with a history of CVD events should adhere to AHM.

The evaluation of a digital solution to improve the implementation of NCCN guidelines

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Background: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are the most commonly used guidelines in the US and globally, and aim to improve and facilitate quality, effective, efficient and accessible cancer care. The guidelines are constantly updated, as such, the number, scope, length and detail have continuously increased, which has placed challenges for clinicians to remain up to date. Solutions are highly needed to improve the usability and implementation of the NCCN Guidelines. The NAVIFY Guidelines application was developed to provide digitised NCCN Guidelines, to facilitate navigation, and to enable the real-time capture of clinical decisions, including reasons for deviation from guidelines. We assessed the usability and performance of the NAVIFY Guidelines application. Methods: A 60-minute remote, semi-structured interview and task-based user test was undertaken with 10 medical oncologists from diverse geographies (6 US, 2 UK, 2 Germany). No participants had prior experience with the digital solution. Participants tested the experience of using the NAVIFY Guidelines application on their computer by completing tasks for one of 3 tumor types (breast, lung or AML). Screen and audio activities were recorded via Zoom. At the end of the test, participants were asked to rate the performance of NAVIFY Guidelines and complete statements on a System Usability Scale (SUS) questionnaire. Results: NAVIFY Guidelines SUS score was on average 82.3 (80.8 – 84.0), classified as A score (i.e., excellent; NPS [net promoter score]: promoter level). Success ratings across all 6 tasks was 86%, as shown in Table1. The overall impression from participants was largely positive. "Ease of use" was the most salient theme followed by “logical structure” and the “value of being integrated with patient data”. Participants identified that the key value of NAVIFY Guidelines was improving communication between the care team and improving the documentation of guideline adherence. 3 participants saw the potential in teaching settings. Conclusions: NAVIFY Guidelines has been developed to support clinicians to apply the latest clinical recommendations, improve the documentation of decisions and to facilitate better communication between specialists, and with patients. Preliminary research has shown that NAVIFY Guidelines has excellent usability (score A) & high NPS. Overall NAVIFY Guidelines was perceived as easy to use, valuable to improve communication between care teams and helpful at easing documentation burdens.

An assessment of the NAVIFY clinical trial match application using clinical simulation-based research methods

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Background: Cancer clinical trials require matching patients to strict, and sometimes lengthy, eligibility criteria. NAVIFY Clinical Trial Match (CTM) is a digital solution that uses data on an individual patient’s condition, genomic alterations and institution’s postal code to automatically find suitable clinical trials. We assessed the efficiency, accuracy and cognitive burden of NAVIFY CTM on matching patients to cancer clinical trials in the UK. Methods: 10 clinicians (8 medical doctors, 2 clinical trial practitioners) participated. Synthetic patient cases were developed with input from two oncologists, a histopathologist and a radiologist. Participants were instructed to identify appropriate trials for five patients using the NAVIFY CTM and five patients with the legacy approach (i.e. online trial databases) within one hour. For each method, participants were advised to approach the exercise with the level of scrutiny employed in a normal clinical setting. The efficiency, quality, and cognitive burden of trial matching was measured for each participant. The quality of trial matches was independently scored by an oncologist who did not participate in the simulations. The cognitive burden was measured subjectively, via a single-item questionnaire used to measure mental effort (Paas scale), and objectively, via Stroop test before and after each method. A survey was also conducted. Results: Efficiency: Participants completed the trial matching more efficiently using NAVIFY CTM, with trial matches completed on average one minute and 42 seconds faster using the digital solution (n = 73 matches) compared with the most commonly used online trial database, ClinicalTrials.gov (n = 52). Participants were more likely to ‘completely agree’ that they had enough time to complete the task using the NAVIFY CTM (70%) compared to online trial databases (40%). Quality of the matches: On the survey, more participants reported that trial suggestions were ‘mostly relevant’ for NAVIFY CTM (70%) compared with ClinicalTrials.gov (30%). The quality of trial matches was the same for both methods (as scored independently by an oncologist). Cognitive burden: On the subjective measure of cognitive burden, more participants required ‘low’ or ‘rather low’ mental effort to use NAVIFY CTM (50%) compared to online trial databases (7%). On the objective measure, there is a seemingly less pronounced Stroop effect (often interpreted as higher mental agility) using NAVIFY CTM vs. legacy approach. Conclusions: Preliminary findings suggest that, compared to online trial databases, the NAVIFY CTM can reduce the amount of time to match patients to clinical trials, provide more relevant trial suggestions, and decrease self-reported mental effort for the decision-maker.

A167 UNDERSTANDING THE IMPACT OF DOWNSTREAM OF KINASE 4 (DOK4) DAMAGING GENETIC VARIANTS IN THE PATHOGENESIS OF PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD)

Background

IBD is a chronic inflammatory disorder of the gastrointestinal (GI) tract whose precise pathological mechanisms remain elusive. It is thought that in pediatric IBD, pathogenic exposure does not appear sufficient to cause disease, thus genetic variations are critical to disease pathogenesis. The Muise Lab uses genetic sequencing of patients with IBD from all over the world to identify crucial genetic variations that are critical to IBD development.

We report two patients with IBD from unrelated families with mutations in DOK4. Both patients had profound extra-intestinal disease complicating their IBD.

Downstream of kinase (DOK) proteins are a family of adaptor molecules that are important in regulating cell signaling, especially in immune cells. They are known to suppress MAPK and PI3K/AKT pathways, whose dysregulation result in cancer. DOK4 has not been extensively studied, but research suggests that this gene produces two isoforms. It is known to have negative regulatory effects on immune cell activation but is also expressed across various other tissues, where its function is yet to be determined.

Aims

We hypothesize that these variations in DOK4 lead to immune cell dysregulation, which manifests in both gastrointestinal and systemic chronic inflammatory disease. Through this study, we aim to elucidate the mechanism of novel genetic defects in DOK4.

Methods

It will be critical to understand how variants within both patients are contributing to the onset of IBD through in vitro studies. Therefore, we will characterize and quantify how changes in expression of DOK4 alters essential cell signaling pathways. We have established immortalized cell lines from patients bearing these mutations to specifically characterize potential immune defects. We will also be using knock out cell models to understand the effect of loss of function of DOK4 in different cell types.

Results

Preliminary data shows variation in expression of the protein within patient peripheral blood mononuclear cells (PBMCs) compared to a healthy donor. Overexpression in HEK293T cells shows changes in MAPK and NFkB signaling.

Conclusions

With this study, we hope to identify new therapeutic targets for patients with DOK4 mutations.

Funding Agencies

CIHRThe Leona M. and Harry B. Helmsley Charitable Trust

Estimation of Patient Eye-Lens Dose During Neuro-Interventional Procedures using a Dense Neural Network (DNN)

The patient's eye-lens dose changes for each projection view during fluoroscopically-guided neuro-interventional procedures. Monte-Carlo (MC) simulation can be done to estimate lens dose but MC cannot be done in real-time to give feedback to the interventionalist. Deep learning (DL) models were investigated to estimate patient-lens dose for given exposure conditions to give real-time updates. MC simulations were done using a Zubal computational phantom to create a dataset of eye-lens dose values for training the DL models. Six geometric parameters (entrance-field size, LAO gantry angulation, patient x, y, z head position relative to the beam isocenter, and whether patient's right or left eye) were varied for the simulations. The dose for each combination of parameters was expressed as lens dose per entrance air kerma (mGy/Gy). Geometric parameter combinations associated with high-dose values were sampled more finely to generate more high-dose values for training purposes. Additionally, dose at intermediate parameter values was calculated by MC in order to validate the interpolation capabilities of DL. Data was split into training, validation and testing sets. Stacked models and median algorithms were implemented to create more robust models. Model performance was evaluated using mean absolute percentage error (MAPE). The goal for this DL model is that it be implemented into the Dose Tracking System (DTS) developed by our group. This would allow the DTS to infer the patient's eye-lens dose for real-time feedback and eliminate the need for a large database of pre-calculated values with interpolation capabilities.

Association of iodine-related knowledge, attitudes and behaviours with urinary iodine excretion in pregnant women with mild iodine deficiency

BACKGROUND

Subsequent to the implementation of the universal salt iodisation policy, China has all but eliminated the iodine deficiency disorders. However, pregnant women are still experiencing mild iodine deficiency. The present study explored factors that could relate to mild iodine deficiency in pregnant women.

METHODS

In total, 2400 pregnant women were enrolled using a multistage, stratified, random sampling method in Shanghai. Data were collected via a standardised questionnaire. The urine samples and household cooking salt samples were collected for the detection of urinary iodine and salt iodine concentrations.

RESULTS

The median urinary iodine concentration (MUIC) was 148.0 μg L^-1 for all participants, and 155.0 μg L^-1 , 151.0 μg L^-1 and 139.6 μg L^-1 in the first, second and third trimesters. The MUIC in the third trimester was significantly lower than that of the first trimester (P < 0.05). The usage rates of iodised salt and qualified-iodised salt were 71.5% and 59.4%, respectively. Iodine-related knowledge score composition ratio was significantly different between the high and low UIC groups (P < 0.05). Participants' MUIC increased significantly with the increases in iodine-related knowledge score (P < 0.001). The third trimester was a significant risk factor for high UIC, whereas high iodine-related knowledge score, actively learning dietary knowledge and having a habit of consuming iodine-rich food were significant protective factors for high UIC (P < 0.05).

CONCLUSIONS

Iodine level is adequate among pregnant women in Shanghai during the first and the second trimesters, although it is is insufficient in the third trimester. Good iodine-related knowledge, attitudes and behaviours are important for pregnant women with respect to maintaining adequate urinary iodine.

High level of CD10 expression is associated with poor overall survival in patients with head and neck cancer

CD10 is a common zinc-dependent metalloid protease that is expressed in numerous tissues, including malignant cells. Genomic alterations of CD10 are frequently observed in haematopoietic and non-haematopoietic tumours. In the present study, we analysed the CD10 expression in head and neck squamous cell carcinoma (HNSCC) and its association with tumour prognosis using bioinformatic analysis and explored the potential of a CD10-driven signalling pathway in a tumour-immune microenvironment. Briefly, data mining analysis showed strengthened CD10 expression in HNSCC patients. High CD10 expression was associated with unfavourable overall survival (OS) and recurrence-free survival (RFS). In addition, the correlation between CD10 expression and interleukin (IL)-6/IL-8-mediated M1 macrophage activity could potentially explain the poor prognosis of HNSCC. Among 692 genes co-expressed with CD10 in HNSCC, Rap1 signalling pathway, regulation of actin cytoskeleton, protein digestion and absorption, proteoglycans in cancer, PI3K-Akt signalling pathway, focal adhesion and extracellular matrix-receptor interaction were the candidate signalling pathways driven by the CD10 gene. Further investigation of immune-associated signalling pathways regulated by CD10 may be beneficial to improve the prognosis of HNSCC patients by immunotherapy.

[Clinical features of patients with hypertrophic obstructive cardiomyopathy combining obstructive sleep apnea]

Objective: To investigate the clinical features of patients with hypertrophic obstructive cardiomyopathy (HOCM) combined with obstructive sleep apnea (OSA). Methods: From 2010 to 2018, a total of 299 patients who were diagnosed with hypertrophic cardiomyopathy and underwent sleep monitoring at Fuwai Hospital were retrospectively analyzed. General clinical features, data of echocardiography, and sleep breathing parameters were recorded. OSA was diagnosed by apnea-hypopnea index ≥ 5 events/hour. Clinical characteristics were compared between patients with and without OSA. Results: A total of 156 (52.2%) HOCM patients were diagnosed with OSA. Compared with patients without OSA, patients with OSA were older((54±10) years vs (45±14) years, P<0.001), had a higher body mass index ((27±3) kg/m(2) vs (25±3) kg/m(2), P<0.001), a higher prevalence of hypertension (54.4% (85/156) vs 21.0% (30/143), P<0.001), hyperlipidemia (37.2% (58/156) vs 13.3% (19/143), P<0.001) and smoking history (48.1% (75/156) vs 35.0% (50/143), P=0.022). Patients with OSA also had a higher incidence of New York Heart Association functional class Ⅱ or Ⅲ (P=0.017), atrial fibrillation (P=0.005), and higher levels of systolic and diastolic blood pressure, fast glucose and high-sensitive c-reactive protein (all P<0.001). Left ventricular end-diastolic diameter as well as ascending aorta diameter in patients with OSA were also greater than those without OSA (both P<0.001). Apnea-hypopnea index (AHI) value positively correlated with left ventricular end-diastolic diameter (r=0.346), ascending aorta diameter (r=0.357) and high-sensitive c-reactive protein (r=0.230) (all P<0.001). Conclusions: A high prevalence of OSA occurs in patients with HOCM. Severity of OSA correlates with cardiac remodeling and serum inflammatory factor level. As for HOCM patients, clinicians should actively monitor the sleep breathing parameters in order to recognize and treat potential OSA, thereby improving the prognosis of patients with HOCM.

Enhancement of bone perfusion through cortical perforations to improve healing of medication-related osteonecrosis of the jaw: a retrospective study

Medication-related osteonecrosis of the jaw (MRONJ) is generally difficult to treat. So far, no optimal strategy for MRONJ has been established. The aim of this study was to determine whether a new surgical technique, i.e. curettage with cortical perforations of healthy adjacent bone that enhances bone perfusion would be more effective than standard curettage in treating patients with MRONJ. Twenty-eight MRONJ patients who underwent curettage treatment with or without cortical perforation technique at our institution between June 2014 and May 2016 were included in this retrospective study. Ten cases treated using cortical perforation technique were completely cured after primary wound closure with mucoperiosteal flap. During a long-term follow-up, two cases from the cortical perforation group relapsed at the mandibular sites 6 and 40 months post-operation, respectively, while in the control group, 77.8% (14/18) cases relapsed due to infected mucosa fistula or bone exposure 1-3 months after treatment. It was concluded that the new treatment approach might be more effective in treating patients with MRONJ caused by antiresorptive drugs. However, more extensive randomized trials are needed to further evaluate its efficacy in clinic.