Natural disasters: a comprehensive study using EMDAT database 1995-2022

INTRODUCTION

The frequency, intensity, and geographical reach of natural disasters, fueled in part by factors such as climate change, population growth, and urbanization, have undeniably been escalating concerns around the world.

DESIGN AND METHODS

This is a retrospective analysis of natural disasters recorded in the Emergency Events Database from 1995 to 2022.

RESULTS

Between 1995 and 2022, 11,360 natural disasters occurred, with a mean of 398 per year. Asia experienced the most disasters (4390) and the highest number of casualties (918,198). Hydrological disasters were the most common subgroup (4969), while geophysical disasters led in terms of deaths (770,644). Biological disasters caused the most injuries (2544), particularly in Africa.

CONCLUSION

Recognizing the historical impacts of the various subtypes of natural disasters may help different regions better risk analyze and mitigate the unique risks associated with such events.

Endovascular management of a pulmonary artery pseudoaneurysm secondary to mucormycosis: A case report

The development of pulmonary artery pseudoaneurysm (PAP) secondary to pulmonary mucormycosis (PM) is exceedingly rare. Without immediate intervention, PAPs can result in life-threatening hemorrhage as these weakening vessels are prone to rupture. To avoid such an occurrence, procedures that restrict blood flow to the vulnerable region are typically performed. The present case study details the effective employment of endovascular coil embolization in treating a patient with PAP due to pulmonary mucormycosis.

Light-Responsive Elastin-Like Peptide-Based Targeted Nanoparticles for Enhanced Spheroid Penetration

We describe here a near infrared light-responsive elastin-like peptide (ELP)-based targeted nanoparticle (NP) that can rapidly switch its size from 120 to 25 nm upon photo-irradiation. Interestingly, the targeting function, which is crucial for effective cargo delivery, is preserved after transformation. The NPs are assembled from (targeted) diblock ELP micelles encapsulating photosensitizer TT1-monoblock ELP conjugates. Methionine residues in this monoblock are photo-oxidized by singlet oxygen generated from TT1, turning the ELPs hydrophilic and thus trigger NP dissociation. Phenylalanine residues from the diblocks then interact with TT1 via π-π stacking, inducing the re-formation of smaller NPs. Due to their small size and targeting function, the NPs penetrate deeper in spheroids and kill cancer cells more efficiently compared to the larger ones. This work could contribute to the design of "smart" nanomedicines with deeper penetration capacity for effective anticancer therapies.

Outcomes of Rural Men with Breast Cancer: A Multicenter Population Based Retrospective Cohort Study

Background: Breast cancer is rare in men. This population-based study aimed to determine outcomes of male breast cancer in relation to residence and other variables. Methods: In this retrospective cohort study, men diagnosed with breast cancer in Saskatchewan during 2000–2019 were evaluated. Cox proportional multivariable regression analyses were performed to determine the correlation between survival and clinicopathological and contextual factors. Results: One hundred-eight eligible patients with a median age of 69 years were identified. Of them, 16% had WHO performance status ≥ 2 and 61% were rural residents. The stage at diagnosis was as follows: stage 0, 7%; I, 31%; II, 42%; III, 11%; IV, 8%. Ninety-eight percent had hormone receptor-positive breast cancer. The median disease-free survival of urban patients was 97 (95% CI: 50–143) vs. 64 (46–82) months of rural patients (p = 0.29). The median OS of urban patients was 127 (94–159) vs. 93 (32–153) months for rural patients (p = 0.27). On multivariable analysis, performance status ≥ 2, hazard ratio (HR) 2.82 (1.14–6.94), lack of adjuvant systemic therapy, HR 2.47 (1.03–5.92), and node-positive disease, HR 2.32 (1.22–4.40) were significantly correlated with inferior disease-free survival in early-stage invasive breast cancer. Whereas stage IV disease, HR 7.8 (3.1–19.5), performance status ≥ 2, HR 3.25 (1.57–6.71), and age ≥ 65 years, HR 2.37 (1.13–5.0) were correlated with inferior overall survival in all stages. Conclusions: Although residence was not significantly correlated with outcomes, rural men had numerically inferior survival. Poor performance status, node-positive disease, and lack of adjuvant systemic therapy were correlated with inferior disease-free survival.

Distance-controlled surface-enhanced Raman spectroscopy of nanoparticles

Biological particles, e.g., viruses, lipid particles, and extracellular vesicles, are attracting significant research interest due to their role in biological processes and potential in practical applications, such as vaccines, diagnostics, and therapies. Their surface and interior contain many different molecules including lipids, nucleic acids, proteins, and carbohydrates. In this Letter, we show how distance-controlled surface-enhanced Raman spectroscopy (SERS) is a promising method to extract essential information from the spatial origin of the signal. This is a highly important parameter in the analysis of these biological particles. The principle of the method is demonstrated by using polystyrene (PS) beads as a biological particle model conjugated with gold nanospheres (AuNSs) functioning as distance-controlled SERS probes via biotin-streptavidin binding. By tuning the size of AuNSs, the Raman signal from the PS beads can be weakened while the signal from the biotin-streptavidin complex is enhanced.

T2-fluid attenuated inversion recovery mismatch in tumefactive multiple sclerosis

The T2-fluid attenuated inversion recovery (FLAIR) mismatch sign has been suggested as an imaging marker of isocitrate dehydrogenase-mutant 1p/19q non-codeleted gliomas with 100% specificity. Tumefactive demyelination is a common mimic of neoplasm that has led to unnecessary biopsies and even resections. We report a case of tumefactive multiple sclerosis in a 46-year-old male without prior symptomatic demyelinating episodes that demonstrates the T2-FLAIR mismatch sign. Our findings suggest the T2-FLAIR mismatch sign should not be used as a differential feature between glioma and tumefactive demyelination. Because typical isocitrate dehydrogenase-mutant 1p/19q non-codeleted gliomas typically do not demonstrate significant enhancement, such diagnosis should be reserved when post-contrast images are unavailable.

sCL-ST: Supervised Contrastive Learning with Semantic Transformations for Multiple Lead ECG Arrhythmia Classification

The automatic classification of electrocardiogram (ECG) signals has played an important role in cardiovascular diseases diagnosis and prediction. With recent advancements in deep neural networks (DNNs), particularly Convolutional Neural Networks (CNNs), learning deep features automatically from the original data is becoming an effective and widespread approach in a variety of intelligent tasks including biomedical and health informatics. However, most of the existing approaches are trained on either 1D CNNs or 2D CNNs, and they suffer from the limitations of random phenomena (i.e. random initial weights). Furthermore, the ability to train such DNNs in a supervised manner in healthcare is often limited due to the scarcity of labeled training data. To address the problems of weight initialization and limited annotated data, in this work, we leverage recent self-supervised learning technique, namely, contrastive learning, and present supervised contrastive learning (sCL). Different from existing self-supervised contrastive learning approaches, which often generate false negatives because of random selection of negative anchors, our contrastive learning makes use of labeled data to pull the same class closer together and push different classes far apart to avoid potential false negatives. Furthermore, unlike other kinds of signals (e.g speech, image, video), ECG signal is sensitive to changes, and inappropriate transformation could directly affect diagnosis results. To deal with this issue, we present two semantic transformations, i.e. semantic split-join and semantic weighted peaks noise smoothing. The proposed deep neural network sCL-ST with supervised contrastive learning and semantic transformations is trained as an end-to-end framework for the multi-label classification of 12-lead ECGs. Our sCL-ST network contains two sub-networks i.e. pre-text task and down-stream task. Our experimental results have been evaluated on 12-lead PhysioNet 2020 dataset and shown that our proposed network outperforms the state-of-the-art existing approaches.

Euphonic: inelastic neutron scattering simulations from force constants and visualization tools for phonon properties

Interpretation of vibrational inelastic neutron scattering spectra of complex systems is frequently reliant on accompanying simulations from theoretical models. Ab initio codes can routinely generate force constants, but additional steps are required for direct comparison with experimental spectra. On modern spectrometers this is a computationally expensive task due to the large data volumes collected. In addition, workflows are frequently cumbersome as the simulation software and experimental data analysis software often do not easily interface to each other. Here a new package, Euphonic, is presented. Euphonic is a robust, easy to use and computationally efficient tool designed to be integrated into experimental software and able to interface directly with the force constant matrix output of ab initio codes.

Clinical Characteristics of Hospital Follow-up for Patients Hospitalized from SARS CoV-2 (COVID 19) in an Academic Outpatient Internal Medicine Clinic

Background:

As of July 2022, there have been more than 91.3 million cases of COVID-19 and nearly 1.03 million deaths in the United States alone. In addition, many people who survived COVID-19 had long-term symptoms, such as fatigue, dyspnea, loss of smell and taste, depression, and anxiety.

Objectives:

The purpose of our study is to evaluate the status of COVID-19 patients who were previously hospitalized.

Methods:

We conducted a single-center retrospective cohort study at Texas Tech University Health Sciences Center and its affiliated University Medical Center under IRB of L21-144. We included all patients hospitalized for COVID-19 and followed up in our Internal Medicine Clinic at any time between April 1, 2020, and April 1, 2021, and reviewed follow-up data for these patients after discharge.

Results:

A total of 128 patients were included; 59 (46%) were men, and 69 (54%) were women with an average age of 59.7 ± 14.8 years. Most of the patients (n = 78, 60.9%) identified their race as Hispanic or Latino origin; the next largest group was Caucasian (n = 29, 22.65%). The average number of days until post-hospitalization follow-up was 36 ± 38 days. The 50% of the patients (n = 64) used telemedicine for follow-up visits. Important comorbidities in these patients included diabetes (n = 84, 65.6%) and hypertension (n = 94, 73.4%). Thirty-four patients (26.6%) reported respiratory symptoms at their follow-up appointments, 24 patients (18.8%) reported constitutional symptoms, 12 patients (9.4%) reported GI symptoms, and 25 patients (19.5%) reported other symptoms, such as paresthesia, lower extremity edema, or psychological symptoms. After hospital discharge, 54 patients had follow-up chest x-rays, and 41 (75.9%) still had abnormal findings consistent with COVID-19 imaging characteristics. Follow-up laboratory tests identified 44 patients (77.2%, 57 tested) with elevated D-dimer levels, 44 patients (78.6%, 56 tested) with high ferritin levels, and 21patients (35.6%, 59 tested) with elevated troponin T HS levels.

Conclusion:

Long-lasting COVID-19 symptoms in these patients included respiratory symptoms (26.6%), constitutional symptoms (18.8%), GI symptoms (9.4%), and other symptoms, such as paresthesia, lower extremity edema, or psychological symptoms (19.5%). The rate of telehealth follow-up was 50%. Many patients had elevated inflammatory markers that will need follow up to determine the clinical implications.

Patient and Physician Satisfaction with Telemedicine in Cancer Care in Saskatchewan: A Cross-Sectional Study

Background: Telemedicine is a useful tool that connects patients to their care team remotely and improves access to medical care for rural residents. This study aimed to determine the telemedicine experience of both rural patients with cancer and their physicians, and to explore factors associated with a positive patient experience. Methods: In this cross-sectional study, cancer patients and physicians in Saskatchewan completed a paper-based survey composed of 32 items or an electronic survey of 18 items, respectively. Logistic regression analysis was performed to assess patient satisfaction in relation to various sociodemographic and cancer-related factors. Results: Overall, 25 physicians and 165 patients participated in the study. Among the physicians, 94% were confident in their telemedicine assessment, 58% agreed that telemedicine improved clinical efficiency, and 73% agreed that doctor−patient rapport was unimpaired with telemedicine. Of 165 patients, 61% had used telemedicine for the first time, 81% felt that their needs were met, 83% were satisfied with the quality of their care, and 88% had a positive experience. Overall, 83% patients vs. 45% physicians preferred telemedicine to a face-to-face clinic visit (p = 0.005). On univariate analysis, patients ≥ 65 years old had a greater positive telemedicine experience compared to patients < 65 years old (odds ratio 4.1 [1.2−13.8], p = 0.02). Conclusion: Both patients and physicians have a high rate of positive experiences with telemedicine. However, patients have a higher preference for telemedicine over face-to-face visits compared to physicians. In addition, elderly patients have more positive telemedicine experiences compared to younger patients.

Systemic Therapy and Its Surgical Implications in Patients with Resectable Liver Colorectal Cancer Metastases. A Report from the Western Canadian Gastrointestinal Cancer Consensus Conference

The Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) convened virtually on 4 November 2021. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals, including surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals from across four Western Canadian provinces, British Columbia, Alberta, Saskatchewan, and Manitoba, who are involved in the care of patients with gastrointestinal cancer. They participated in presentation and discussion sessions for the purpose of developing recommendations on the role of systemic therapy and its optimal sequence in patients with resectable metastatic colorectal cancer.

Report from the Western Canadian Gastrointestinal Consensus Cancer Conference—Management of Total Neoadjuvant Therapy in Rectal Cancer

An educational session related to the Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held virtually on 14 October 2020. The WCGCCC is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba), who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists, radiologists, and allied health care professionals participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of total neoadjuvant therapy in rectal cancer.

Outcomes of patients with small intestine adenocarcinoma (SIA) in a Canadian province: A population-based cohort study

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Background: SIA is a rare cancer. Limited data is available about clinicopathological factors and interventions that correlate with its outcomes. The current study aims to determine outcomes of patients with SIA who were diagnosed in a Canadian province. Methods: In this retrospective population-based cohort study patients with biopsy proven SIA diagnosed during 2008-2017 in the province of Saskatchewan were assessed. A Cox Proportional multivariate regression analysis was performed to determine correlation between survival and exploratory factors. Results: 112 eligible patients with median age of 73 yrs and M:W 53: 59 were identified. 75% had a comorbid illness, 34% had a secondary cancer and 45% had WHO performance status (PS) < 2. Of 112 patients, 51 (46%) had early-stage disease and 61 (54%) had advanced-stage disease. Median neutrophil: lymphocyte (NLR) was 4.5. The median overall survival (mOS) in relation to stage of the disease were as follow: stage 1, 59 months, stage 2, 30 months, stage 3, 20 months and stage 4, 3 months (P < 0.001). The patients with early-stage disease had mOS of 36.0 months (95% CI: 8.0-64.0) vs. 3.0 months (1.74-4.26) with advanced disease (P < 0.0001). Of 21 patients with stage 3 disease their median disease-free survival was 26 months (23.1-28.9) with chemotherapy vs. 4 months (0.0-9.1) with no chemotherapy, p = 0.04. Patients with stage 4 disease who had surgery and or chemotherapy had mOS of 18 months (13.70-23.32) vs. 4 months (2.20-5.82) with chemotherapy alone p = 0.03. On univariate analysis age ≥70 yrs, WHO PS > 1, stage 4 disease, low albumin, elevated creatinine, high alkaline phosphatase, duodenal cancer, lack of surgery, and NLR of > 4.50 were significantly correlated with inferior survival. On multivariate analysis stage 4 disease, HR, 3.20 (95%CI:1.84-5.40), WHO PS > 1, HR, 2.22 (1.42-3.45), no surgery, HR, 2.10 (1.25-3.50), and NLR > 4.5, HR, 1.72 (1.10-2.71) were significantly correlated with inferior survival. Conclusions: Most patients with SIA were diagnosed with advanced-stage. In addition to advanced-stage disease and poor PS, lack of surgery and baseline LNR of > 4.5 were significantly correlated with inferior survival.

Two Opposing Functions of Angiotensin-Converting Enzyme (ACE) That Links Hypertension, Dementia, and Aging

A 2018 report from the American Heart Association shows that over 103 million American adults have hypertension. The angiotensin-converting enzyme (ACE) (EC 3.4.15.1) is a dipeptidyl carboxylase that, when inhibited, can reduce blood pressure through the renin–angiotensin system. ACE inhibitors are used as a first-line medication to be prescribed to treat hypertension, chronic kidney disease, and heart failure, among others. It has been suggested that ACE inhibitors can alleviate the symptoms in mouse models. Despite the benefits of ACE inhibitors, previous studies also have suggested that genetic variants of the ACE gene are risk factors for Alzheimer’s disease (AD) and other neurological diseases, while other variants are associated with reduced risk of AD. In mice, ACE overexpression in the brain reduces symptoms of the AD model systems. Thus, we find two opposing effects of ACE on health. To clarify the effects, we dissect the functions of ACE as follows: (1) angiotensin-converting enzyme that hydrolyzes angiotensin I to make angiotensin II in the renin–angiotensin system; (2) amyloid-degrading enzyme that hydrolyzes beta-amyloid, reducing amyloid toxicity. The efficacy of the ACE inhibitors is well established in humans, while the knowledge specific to AD remains to be open for further research. We provide an overview of ACE and inhibitors that link a wide variety of age-related comorbidities from hypertension to AD to aging. ACE also serves as an example of the middle-life crisis theory that assumes deleterious events during midlife, leading to age-related later events.

Diabetes and Cancer: Risk, Challenges, Management and Outcomes

BACKGROUND

Diabetes mellitus and cancer are commonly coexisting illnesses, and the global incidence and prevalence of both are rising. Cancer patients with diabetes face unique challenges. This review highlights the relationship between diabetes and cancer and various aspects of the management of diabetes in cancer patients.

METHODS

A literature search using keywords in PubMed was performed. Studies that were published in English prior to July 2021 were assessed and an overview of epidemiology, cancer risk, outcomes, treatment-related hyperglycemia and management of diabetes in cancer patients is provided.

RESULTS

Overall, 8-18% of cancer patients have diabetes as a comorbid medical condition. Diabetes is a risk factor for certain solid malignancies, such as pancreatic, liver, colon, breast, and endometrial cancer. Several novel targeted compounds and immunotherapies can cause hyperglycemia. Nevertheless, most patients undergoing cancer therapy can be managed with an appropriate glucose lowering agent without the need for discontinuation of cancer treatment. Evidence suggests that cancer patients with diabetes have higher cancer-related mortality; therefore, a multidisciplinary approach is important in the management of patients with diabetes and cancer for a better outcome.

CONCLUSIONS

Future studies are required to better understand the underlying mechanism between the risk of cancer and diabetes. Furthermore, high-quality prospective studies evaluating management of diabetes in cancer patients using innovative tools are needed. A patient-centered approach is important in cancer patients with diabetes to avoid adverse outcomes.

Report from the 21st Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Calgary, Alberta; 20-21 September 2019

The 21st annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Calgary, Alberta, 20-21 September 2019. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists, pathologists, radiologists, and allied health care professionals such as dietitians and nurses participated in presentation and discussion sessions to develop the recommendations presented here. This consensus statement addresses current issues in the management of hepato-pancreato-biliary (HPB) cancers.

Rate of Curative Surgery in Real-world Patients with Unresectable Metastatic Colorectal Cancer Treated with FOLFOXIRI ± Bevacizumab: A Western Canadian Province Experience

BACKGROUND

Recent evidence from randomized trials suggests that FOLFOXIRI (fluorouracil, oxaliplatin, and irinotecan) ± bevacizumab is associated with higher response rates, with the potential for conversion of unresectable to resectable disease in metastatic colorectal cancer (mCRC). However, limited evidence is available on the efficacy and safety of this regimen in real-world patients with mCRC. The current study aims to evaluate the conversion rate and safety of FOLFOXIRI ± bevacizumab in real-world patients with unresectable mCRC.

METHODS

In this retrospective multicenter population-based cohort study, patients who were diagnosed with unresectable mCRC between January 2015 and December 2018 in Saskatchewan and received FOLFOXIRI ± bevacizumab were assessed. Kaplan-Meier survival methods and the log-rank test were performed.

RESULTS

A total of 28 eligible patients with a median age of 51 years (interquartile range 39-60) and a male:female ratio of 11:17 were identified; 39% had rectal cancer, 46% had extrahepatic disease, and 46% had bilobar liver metastases. Overall, 63% of the patients had a positive response to FOLFOXIRI ± bevacizumab and 53% underwent metastasectomy. Of all patients 60% had grade 3/4 toxicity and 32% required hospital admission. No treatment-related mortality was noted. After 4 years, 50% of the patients were alive. Median progression-free survival of patients who underwent surgery was 18 months (95% CI 11.3-24.7) versus 11 months (4-18.1) without surgery (p = 0.28). Median overall survival of patients with surgery was 33 months (17.5-48.5) versus 16 months (8.3-23.7) without surgery (p = 0.03).

CONCLUSION

The current study suggests that FOLFOXIRI ± bevacizumab therapy in real-world patients with mCRC is associated with a high rate of conversion from unresectable to resectable metastatic disease. Patients with metastasectomy had better survival.

Conversion from unresectable to resectable liver metastases in real-world patients with liver-only metastatic colorectal cancer (mCRC) treated with FOLFOXIRI plus bevacizumab: The Conversion trial

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Background: Patients with mCRC generally have a limited life expectancy, however, a small number of patients with liver-only mCRC could be cured following metastasectomy. In highly selected patients with mCRC, FOLFOXIRI (5FU, oxaliplatin, and irinotecan) plus bev results in high response rates. However, very limited evidence is available about efficacy of this regimen in real-world patients with liver-only mCRC. Furthermore, there is paucity of biomarkers that predict liver metastasectomy in such patients. The current study aims a) to evaluate rate of conversion from unresectable to resectable liver metastases in real-world patients with liver-only mCRC following FOLFOXIRI-bev, b) to identify predictive markers including an early PET-FDG response that correlate with curative surgery, & c) to determine disease control rate, overall survival, quality of life, treatment toxicities, and cost-effectiveness of surgery. Methods: In this pragmatic phase 2 study, 37 patients with liver-only unresectable mCRC who are deemed eligible for FOLFOXIRI-bev by their oncologist will be recruited at the two major cancer centers in Saskatchewan. Patients will receive FOLFOXIRI-bev every two weeks for a total of 12 cycles and will undergo periodic imaging tests. The resectability of liver metastases will be determined by a multidisciplinary team. For those patients who are not able to undergo a curative surgery, a doublet chemotherapy regimen ±bev will be continued at the discretion of treating oncologist. . The prognostic and predictive value of mutations in specific genes involved in cell proliferation, cell death resistance, angiogenesis, and invasion in colorectal cancer along with the relationship between the abundance and characteristics of exRNA and conversion rate and survival will be assessed. Logistic regression and Cox proportional analyses will be performed to assess correlation between an eight-week FDG-PET/CT response to chemotherapy and other biomarkers and rate of removal of metastases and survival, respectively. This pragmatic study will help to determine conversion rate in real-world patients with FOLFOXIRI plus bev and role of early FDG-PET/CT scan response and other biomarkers in predicting metastasectomy along with cost-effectiveness of this approach. Clinical trial information: NCT03401294.

Does the time from diagnostic biopsy to neoadjuvant chemotherapy affect the rate of pathologic complete response in stages I-III breast cancer?

Background

Studies in the adjuvant setting suggest that the timing of breast cancer diagnosis, surgery, and chemotherapy might affect outcomes. In the neoadjuvant setting, data exploring whether expeditious neoadjuvant chemotherapy (nac) after diagnosis improves the rate of pathologic complete response (pcr) in breast cancer are limited.

Methods

Patients who received nac and completed treatment between May 2012 and December 2018 were identified from a prospectively collected database at BC Cancer. Time from diagnosis to start of nac was calculated. Patients were grouped into those who did and did not experience a pcr, and those who started nac within 28 days or after 28 days [time to nac (ttn)]. The association between pcr and ttn was tested using logistic regression.

Results

In the time period studied, 482 patients who received nac were identified. After exclusions, 421 patients met the eligibility criteria. Median time from biopsy to chemotherapy was 33 days (range: 7-140 days). In 149 patients (35.4%), nac was received within 28 days of diagnosis (range: 7-28 days); in 272 patients (64.6%), it was received after more than 28 days (range: 29-140 days). The overall pcr rate was 31.8%. A trend toward a higher pcr rate, although not statistically significant, was observed in the group that initiated chemotherapy within 28 days (34.2% vs. 30.5%, p = 0.43). In the logistic regression model, rates of pcr were associated with receptor status, but not age, stage, or ttn.

Conclusions

In the neoadjuvant setting, we observed no difference in the rate of pcr in patients who started nac within 28 days or after 28 days.

The prognostic and predictive role of 21-gene recurrence scores in hormone receptor-positive early-stage breast cancer

Over the past two decades, gene expression profiling of breast cancer has emerged as an important tool in early-stage breast cancer management. The approach provides important information on underlying biological mechanisms, breast cancer classification, future risk potential of developing recurrent metastatic disease, and provides beneficial clues for adjuvant chemotherapy in hormone receptor (HR) positive breast cancer. Of the commercially available genomic tests for breast cancer, the prognostic and predictive value of 21-gene recurrence score tests have been validated using both retrospective data and prospective clinical trials. In this paper, we reviewed the current evidence on 21-gene expression profiles for HR-positive HER2-negative early-stage breast cancer management. We show that current evidence supports endocrine therapy alone as an appropriate adjuvant systemic therapy for approximately 70% of women with HR-positive, HER2-negative, node-negative breast cancer. Evolving evidence also suggests that 21-gene recurrence scores have predictive values for node-positive breast cancer and that chemotherapy can be avoided in more than half of women with nodes 1 to 3 positive HR-positive breast cancer. Furthermore, retrospective data also supports the predictive role of 21-gene recurrence scores for adjuvant radiation therapy. A prospective trial in this area is ongoing.

Rate of conversion from unresectable to resectable metastatic colorectal cancer (mCRC) in real-world patients (RWP) treated with FOLFIXIRI ± bevacizumab: A population-based retrospective cohort study

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Background: Recent evidence from randomized trials suggests that FOLFOXIRI (5FU, oxaliplatin, and irinotecan) ± bevacizumab is associated with higher response rates with a potential for conversion of unresectable to resectable disease in mCRC. Yet limited evidence is available about efficacy and safety of this regimen in RWP with mCRC. The current study aims to evaluate conversion rate and safety of FOLFOXIRI ± bevacizumab in RWP with unresectable mCRC. Methods: Each year about 175 patients are diagnosed with mCRC in Saskatchewan. Patients who were diagnosed with unresectable mCRC between Jan 2015 to Dec 2018 and received FOLFOXIRI ±bevacizumab were assessed. Kaplan Meier survival methods and log rank test were performed. Logistic regression analysis was performed to assess factors correlate with conversion. Results: 28 eligible patients with median age of 51 yrs (IQR:39-60) and M:F of 11:16 were identified. 42% patients had a comorbid illness, and 43% had WHO performance status of 0. 39% had rectal cancer, 46% had extrahepatic disease and 46% had bilobar liver metastases. 58% patients had a positive response to therapy, 60% had grade 3/4 toxicity & 32% required hospital admission. No treatment-related mortality was noted. 54% patients underwent metastasectomy (liver 73%, peritoneum and or ovaries 20%, lung 6%). 68% had primary tumor resection, 29% received rectal radiation, 21% had ablation and 18% had second surgery for recurrence. At 4 years 50% patients are alive. Median progression free survival of patients who underwent surgery is 18 (95%CI:11.3-24.7) vs. 11 months (4-18.1) without surgery (P = 0.28). Median overall survival of patients with surgery is 33 (17.5-48.5) vs. 16 months (8.3-23.7) without surgery (P = 0.03). Positive response to treatment is correlated with conversion (odd ratio 21.7, p = 0.002). Conclusions: In the real world setting younger patients with good performance status received FOLFIRINOX ± bevacizumab. Despite high rates of toxicity, more than half of patients were able to undergo surgery. A positive response to treatment significantly correlates with metastasectomy.

Abstract P4-08-27: The 21-gene Recurrence® (RS) Score assay in estrogen receptor positive node negative breast cancer: Real-world chemotherapy usage and patient characteristics within the intermediate and high-risk RS category

Background:

The Oncotype Dx, a 21-gene recurrence score (RS) assay, has been validated as a prognostic tool in early-stage, hormone receptor-positive, HER2-negative breast cancer. A RS of ≥ 31 is predictive for chemotherapy benefit. However, it has not been clearly established whether more intensive chemotherapy regimens for these patients provide further benefit and whether higher RS stratifications (≥41) influence treatment decisions.

Methods:

From the prospective British Columbia (BC) Breast Cancer Outcomes Unit database, we identified patients with N0 disease who received Oncotype Dx testing from May 2010 to December 2016. Patients with previous or synchronous breast cancer, and patients treated with neoadjuvant chemotherapy were excluded. Groups were defined that had an Oncotype Dx RS of 31-40 and ≥ 41. Demographic characteristics and type of chemotherapy received were collected. Additional subgroups were defined for patients who had a RS of 21-25 and who were ≤ 50 years old and &gt; 50 years old.

Results:

We identified 1,202 patients who received Oncotype Dx testing over the time period studied, with 14.8% (n=178) having a RS of ≥ 31. Among these high-risk patients, the median age was 58 (range 34-79), 90% received hormonal therapy and 85% received chemotherapy. In this cohort, 46% received docetaxel and cyclophosphamide for 4 cycles and 28% received 3rd generation chemotherapy. The use of 3rd generation chemotherapy in patients with a RS of ≥ 41 was significantly higher than in patients with RS between 31-40 (39% vs 22%, p = 0.006). Among patients who had a RS of 21-25 and who were ≤ 50 years old (n = 49), 53% received chemotherapy. Of patients who had a RS of 21-25 and who were &gt; 50 years old (n = 127), 16% received chemotherapy.

Conclusions:

Among patients with a RS ≥ 31, decisions regarding chemotherapy usage were heterogeneous with docetaxel and cyclophosphamide for 4 cycles being the most commonly used regimen. However, in those with a RS ≥ 41, 3rd generation chemotherapy was preferred. Patients with a RS between 21-25 and who were ≤ 50 years old received more chemotherapy than patients who were &gt; 50 years old.

 RS 31-40 (n=116)RS ≥ 41 (n=62)RS ≥ 31 (n=178)Median age58.0 (range, 36-79)57.5 (range 34-78)58.0 (range 34-79)Pre-menopausal28.4%29.0%28.7%Hormonal therapy93.1%83.9%89.9%Chemotherapy86.2%82.3%84.8%DCx4 (1)54.3% (n=63/116) Median age 59.0 (range, 36 – 78)30.6% (n=19/62) Median age 64.0 (range, 42 – 78)46.1% (n=82/178) Median age 59.5 (range, 36 – 78)3rd generation chemo (2)21.6% (n=25/116) Median age 56.0 (range, 39 – 79)38.7% (n=24/62) Median age 52.0 (range, 34 – 76)27.5% (n=49/178) Median age 54.0 (range, 34 – 79)Other chemo10.3% (n=12/116) Median age 57.5 (range, 52 – 78)12.9% (n=8/62) Median age 64.0 (range, 42 – 72)11.2% (n=20/178) Median age 58.5 (range, 42 – 78)(1) Docetaxel and cyclophosphamide, 4 cycles (2) Anthracycline and Taxane containing regimens, 6 cycles or 8 cycles

Citation Format: Le D, Chia S, Simmons C, Speers C, Gondara L, Nichol A, Lohrisch C, Gelmon KA. The 21-gene Recurrence® (RS) Score assay in estrogen receptor positive node negative breast cancer: Real-world chemotherapy usage and patient characteristics within the intermediate and high-risk RS category [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-27.

The integrated National NeuroAIDS Tissue Consortium database: a rich platform for neuroHIV research

Herein we present major updates to the National NeuroAIDS Tissue Consortium (NNTC) database. The NNTC's ongoing multisite clinical research study was established to facilitate access to ante-mortem and post-mortem data, tissues and biofluids for the neurohuman immunodeficiency virus (HIV) research community. Recently, the NNTC has expanded to include data from the central nervous system HIV Antiretroviral Therapy Effects Research (CHARTER) study. The data and biospecimens from CHARTER and NNTC cohorts are available to qualified researchers upon request. Data generated by requestors using NNTC biospecimens and tissues are returned to the NNTC upon the conclusion of requestors' work, and this external, experimental data are annotated and curated in the publically accessible NNTC database, thereby extending the utility of each case. A flexible and extensible database ontology allows the integration of disparate data sets, including external experimental data, clinical neuropsychological and neuromedical testing data, tissue pathology and neuroimaging data.

The Impact of the Complexing Cation on the Sensitivity of the Collisional-Induced Dissociation Spectra to Fatty Acid Position for a Set of YXY/YYX-type Triglycerides

RATIONAL

The development of an automated platform for the positional analysis of triglycerides based on electrospray tandem mass spectrometry continues to be pursued. This work compares the positional sensitivities of the collisional-induced dissociation spectra for a representative set of YXY/YYX triglycerides using ammonium, silver, sodium and lithium as complexing agents.

METHODS

A set of triglycerides were synthesized and analyzed by electrospray tandem mass spectrometry using an ion trap mass spectrometer. Using different salt additives, the product ion spectra of the corresponding parent ions for twelve systems of the form YXY/YYX, where Y and X represent C16:0 , C18:1(c-9), C18:2(cc-9,12) and C20:4(cccc-5,8,11,14) , were collected. The data was used to prepare two-point calibration plots for each of the twelve positional isomer systems using each of the four complexing agents.

RESULTS

The positional sensitivities for all twelve positional isomer systems were robust for both the sodium and lithium TAG adducts. The CID data for both the sodium and lithium TAG adducts are much less sensitive to the degree of unsaturation and double bond position of the fatty acids constituents than the CID data for the ammonium adducts.

CONCLUSION

Using sodium or lithium TAG adducts may be advantageous for the development of an accurate predictive model for performing positional analysis of complex TAG mixtures based on electrospray tandem mass spectrometry. Ammonium adducts are likely complicated by the ability of the ammonium ion to provide extra stability to some parent ions through hydrogen bond-like interactions.

Travel distance and use of salvage palliative chemotherapy in patients with metastatic colorectal cancer

Background

Salvage palliative chemotherapy in metastatic colorectal cancer has been associated with significant improvement in survival. However, not all patients receive all available therapies. Travel burden can affect patient access and use of future therapy. The present study aims to determine relationship between travel distance (TD) and salvage palliative chemotherapy in patients with metastatic colorectal cancer.

Method

A patient cohort diagnosed with metastatic colorectal cancer during 2006-2010 in the province of Saskatchewan, Canada was studied. Logistic regression analyses were performed to assess relationship between travel distance and subsequent line therapies.

Results

The median age of 264 eligible patients was 62 years [interquartile range (IQR): 53-72]. The patients who received salvage systemic therapy had a median distance to travel of 60.0 km (IQR: 4.7-144) compared with 88.1 km (IQR: 4.8-189) if they did not receive second- or third-line therapy (P=0.06). In multivariate analysis distance to the cancer center <100 km, odds ratio (OR) 1.69 (95% CI: 1.003-2.84), no metastasectomy, OR 1.89 (95% CI: 1.03-3.46), and absence of comorbid illness as per Charlson comorbid index, OR 1.45 (95% CI: 1.19-1.77) were correlated with the use of second- and subsequent line therapies.

Conclusions

Our result revealed that travel distance to the cancer center greater than 100 km was associated less frequent use of second or subsequent line therapies in patients with metastatic colorectal cancer.

Social and contextual factors and their relationship with the use of palliative chemotherapy in patients with metastatic colorectal cancer (mCRC): A retrospective cohort study

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Background: Although there is evidence that social and contextual factors such as living alone are associated with outcomes in cancer patients, little is known about their influence on the use of palliative chemotherapy in mCRC. We previously reported various patient-and tumor-related factors that correlate with the use of palliative chemotherapy in mCRC (Oncology. 2015;88:289). In this study we examine social and contextual factors including marital status, having children and distance to cancer center for their association with the use of chemotherapy in patients with mCRC. Methods: A cohort of 569 patients with mCRC diagnosed from 2006-2010 in Saskatchewan was evaluated. Logistic regression analyses were performed to assess relationship between the use of chemotherapy and various variables. Results: Median age was 69 yrs (IQR 59-77) and M:F was 59:41. 326 (57%) patients received chemotherapy. Significant differences were noted between the chemotherapy vs. no chemotherapy groups with respect to median age (62 vs. 76 year, p < 0.001), WHO performance status (PS) > 1 (18 vs. 58%, p < 0.001), comorbid illness (24 vs 63%, p < 0.001), low albumin (61 vs. 89%, p < 0.001), anemia (61 vs. 87%, p < 0.001), elevated alkaline phosphatase (53 vs. 84% < 0.001), elevated creatinine (6 vs. 11%, p = 0.025), hyponatremia (20 vs. 14%, p = 0.03), primary tumor resection (61 vs 47%, p = 0.001), metastasectomy (21 vs. 9%, p < 0.001), mean distance to cancer center (98.7±113.6 vs. 127.8±124.6 km, p < 0.001), married/partnered (67 vs 33%, p < 0.001), and having children (64 vs. 36%, p < 0.001), respectively. On multivariate logistic regression analysis after adjustment of other variables, WHO PS > 1 (HR 5.1; 95%CI: 3.1-81.), not having children (3.3, 1.78-6.2, < 0.001), elevated alkaline phosphatase (HR 2.9; 95%CI: 1.8-4.8), and low albumin (HR 2.2; 95%CI: 1.2-3.8), were correlated with low rates of chemotherapy. Marital status or travel distance did not correlate with use of chemotherapy. Conclusions: Our results show that use of chemotherapy in patients with mCRC significantly varies in those with and without children. Future study are required to explore this difference.

Endotoxin Removal from Whole Blood by a Novel Adsorption Resin: Efficiency and Hemocompatibility

The structural component of Gram- bacteria, endotoxin (ET), induces the release of endogenous mediators of sepsis. Attempts to remove these downstream molecules in vivo, have not improved survival. However, extracorporeal strategies such as continuous renal replacement therapy or therapeutic plasmapheresis have shown benefit. We are presenting an affinity-based extracorporeal technology for the removal of ET from whole blood. The small-scale device contains an adsorbent that removed 75% of ET present in whole blood. This affinity resin displayed good hemocompatibility regarding the coagulation pathway. Minimal platelet, neutrophil and complement activation were observed. There was also no evidence of consumption of coagulation factors or cell loss. In as much as ET participates in both the inflammatory and coagulation abnormalities in sepsis, this method represents an efficient and hemocompatible way to remove ET from whole blood, which, in an extracorporeal setting, may improve the outcome of sepsis.

Classification of Huntington Disease using Acoustic and Lexical Features

Speech is a critical biomarker for Huntington Disease (HD), with changes in speech increasing in severity as the disease progresses. Speech analyses are currently conducted using either transcriptions created manually by trained professionals or using global rating scales. Manual transcription is both expensive and time-consuming and global rating scales may lack sufficient sensitivity and fidelity [1]. Ultimately, what is needed is an unobtrusive measure that can cheaply and continuously track disease progression. We present first steps towards the development of such a system, demonstrating the ability to automatically differentiate between healthy controls and individuals with HD using speech cues. The results provide evidence that objective analyses can be used to support clinical diagnoses, moving towards the tracking of symptomatology outside of laboratory and clinical environments.

Primary Tumor Location and Survival in the General Population With Metastatic Colorectal Cancer

BACKGROUND

Recent evidence from clinical trials suggests that primary tumor location in patients with metastatic colorectal cancer correlates with differential outcomes, and patients with tumors originating in the right side of the colon have inferior survival. We conducted a large population-based cohort study using individual patient data to confirm the prognostic importance of primary tumor location in the general population with metastatic colorectal cancer.

METHODS

A cohort of 1947 patients who were diagnosed with metastatic colorectal cancer from 1992 to 2010 was studied. Ascending and transverse colon cancers were defined as right-sided tumors. Cox proportional multivariate analyses were done to determine prognostic significance of primary tumor location.

RESULTS

The median age was 70 years (interquartile range, 60-78 years), and the male to female ratio was 1.3:1. Twenty-nine percent had World Health Organization performance status of > 1. Seven-hundred and seventy (39%) patients had right-sided tumors, and 908 (47%) received chemotherapy. The median overall survival of patients with right-sided tumors was 14 months (95% confidence interval [CI], 12.7-15.3 months) compared with 20.5 months (95% CI, 18.5-22.5 months) of patients with left-sided tumors (P < .001). On multivariate analysis, right-sided tumors (hazard ratio [HR], 1.40; 95% CI, 1.20-1.60), no metastasectomy (HR, 2.40; 95% CI, 1.90-2.90), intact primary tumor (HR, 1.60; 95% CI, 1.32-1.90), an elevated carcinoembryonic antigen level (HR, 1.54; 95% CI, 1.30-1.90), lack of combination chemotherapy (HR, 1.52; 95% CI, 1.31-1.80), stage IVb disease (HR, 1.50; 95% CI, 1.17-1.86), leukocytosis (HR, 1.44; 95% CI, 1.28-1.73), and World Health Organization performance status > 1 (HR, 1.30; 95% CI, 1.10-1.55) were correlated with inferior survival.

CONCLUSIONS

Our results confirm that individuals with metastatic colorectal cancer and right-sided tumors who received chemotherapy have inferior survival independent of other known prognostic variables. Future studies are required to understand the underlying pathophysiology.

Primary tumor location and survival in general population with metastatic colorectal cancer (mCRC)

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Background: Recent evidence from clinical trials suggests that location of the primary tumor in patients with mCRC correlates with differential outcomes and patients with tumors originating in the right side of colon have inferior survival. This large population-based cohort study using individual patient data was performed to confirm this findings in general population with mCRC. Methods: A cohort of 1947 patients who were diagnosed with synchronous mCRC from 1992-2010 was studied. Ascending and transverse colon cancers were defined as right-sided tumors (RT) and remainder tumors were define as left-sided tumors (LT). Cox proportional multivariate analyses were done to determine prognostic significance of primary tumor location and to adjust other prognostic variables including age, Charlson comorbid index (CCI) and WHO performance status (PS) in patients treated with chemotherapy. Results: Median age was 70 years (IQR: 60-78) and M:F was 1.3:1. Mean CCI was 9.7±1.4 and 29% had WHO PS of > 1. 770 (39%) patients had RT and 37% had stage IVb disease. 908 (47%) received chemotherapy and of those 44% received modern chemotherapy. Significant differences were noted between the groups with RT and LT with respect to age, WHO PS, CCI, liver metastases, mucinous tumor, grade, smoking history, and primary tumor resection. Median overall survival of patients with RT was 14 (95%CI: 12.7-15.3) months compared with 20.5 (95%CI: 18.5-22.5) of patients with LT (p < 0.001). On multivariate analysis following variables were correlated with inferior survival: Right-sided tumors, hazard ratio (HR) 1.40 (95%CI: 1.20-1.60); no primary tumor resection, HR 1.60 (95%CI: 1.32-1.90); no metastasectomy, HR 2.40 (95%CI: 1.90-2.90); not using modern chemotherapy, HR 1.52 (95%CI: 1.31-1.80); leukocytosis, HR 1.44 (95%CI: 1.28-1.73); elevated CEA, HR 1.54 (95%CI: 1.30-1.90); WHO PS > 1, HR 1.30 (95%CI: 1.10-1.55); and stage IVb disease, HR 1.50 (95%CI: 1.17-1.86). Tests for interaction were negative. Conclusions: Our results confirm that patients with RT who received chemotherapy have inferior survival independent of other known prognostic variables. Future studies are required to understand underlying pathophysiology.

A Case Report on Suspected Levamisole-Induced Pseudovasculitis

INTRODUCTION

Levamisole-induced pseudovasculitis should be considered in patients with inconsistent anti-neutrophil cytoplasmic antibodies (ANCA) pattern and history of cocaine use.

CASE PRESENTATION

A 50-year-old man presented to the emergency department with symptoms of bilateral pulmonary emboli. His hospital course was complicated by multiple end organ failure, which improved dramatically with prednisone. Although he was diagnosed previously with granulomatosis with polyangiitis due to positive proteinase 3 (PR3), myeloperoxidase (MPO), perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) and cytoplasmic anti-neutrophil cytoplasmic antibodies (C-ANCA) markers, his longstanding cocaine use and history of skin ulcers, thrombotic events, and febrile illnesses suggested a diagnosis of levamisole-induced pseudovasculitis instead.

DISCUSSION

Differentiating between vasculitides can be challenging due to similar clinical and laboratory findings. To differentiate the two, biopsies should be obtained. The absence of granulomas or leukocytoclasia, and the presence of vasculopathic purpura, should guide clinicians toward pseudovasculitis.

CONCLUSION

It is important to maintain a high index of suspicion for pseudovasculitis because long-term corticosteroid use to treat granulomatosis with polyangiitis can lead to detrimental effects.

[Relationship between crown form of upper central incisors and papilla filling in Chinese Han-nationality youth]

OBJECTIVE

To explore a crown form classification method for upper central incisor which is more objective and scientific than traditional classification method based on the standardized photography technique. To analyze the relationship between crown form of upper central incisors and papilla filling in periodontally healthy Chinese Han-nationality youth.

METHODS

In the study, 180 periodontally healthy Chinese youth ( 75 males, and 105 females ) aged 20-30 (24.3±4.5) years were included. With the standardized upper central incisor photography technique, pictures of 360 upper central incisors were obtained. Each tooth was classified as triangular, ovoid or square by 13 experienced specialist majors in prothodontics independently and the final classification result was decided by most evaluators in order to ensure objectivity. The standardized digital photo was also used to evaluate the gingival papilla filling situation. The papilla filling result was recorded as present or absent according to naked eye observation. The papilla filling rates of different crown forms were analyzed. Statistical analyses were performed with SPSS 19.0.

RESULTS

The proportions of triangle, ovoid and square forms of upper central incisor in Chinese Han-nationality youth were 31.4% (113/360), 37.2% (134/360) and 31.4% (113/360 ), respectively, and no statistical difference was found between the males and females. Average κ value between each two evaluators was 0.381. Average κ value was raised up to 0.563 when compared with the final classification result. In the study, 24 upper central incisors without contact were excluded, and the papilla filling rates of triangle, ovoid and square crown were 56.4% (62/110), 69.6% (87/125), 76.2% (77/101) separately. The papilla filling rate of square form was higher (P=0.007).

CONCLUSION

The proportion of clinical crown form of upper central incisor in Chinese Han-nationality youth is obtained. Compared with triangle form, square form is found to favor a gingival papilla that fills the interproximal embrasure space. The consistency of the present classification method for upper central incisor is not satisfying, which indicates that a new classification method, more scientific and objective than the present one, is to be found.

Ambient Sound-Based Collaborative Localization of Indeterministic Devices

Localization is essential in wireless sensor networks. To our knowledge, no prior work has utilized low-cost devices for collaborative localization based on only ambient sound, without the support of local infrastructure. The reason may be the fact that most low-cost devices are indeterministic and suffer from uncertain input latencies. This uncertainty makes accurate localization challenging. Therefore, we present a collaborative localization algorithm (Cooperative Localization on Android with ambient Sound Sources (CLASS)) that simultaneously localizes the position of indeterministic devices and ambient sound sources without local infrastructure. The CLASS algorithm deals with the uncertainty by splitting the devices into subsets so that outliers can be removed from the time difference of arrival values and localization results. Since Android is indeterministic, we select Android devices to evaluate our approach. The algorithm is evaluated with an outdoor experiment and achieves a mean Root Mean Square Error (RMSE) of 2.18 m with a standard deviation of 0.22 m. Estimated directions towards the sound sources have a mean RMSE of 17.5° and a standard deviation of 2.3°. These results show that it is feasible to simultaneously achieve a relative positioning of both devices and sound sources with sufficient accuracy, even when using non-deterministic devices and platforms, such as Android.