Historical marine footprint for Atlantic Europe, 1500-2019

Over the last 500 years, Europe (excluding Russia) consumed over 2500 million tonnes of ocean biomass. This is based on detailed historical data that we provide for human consumption per capita which was stable from 1500 to 1899 and tripled in the twentieth century. In the last 300 years, cod and herring dominated human seafood consumption. Whaling for non-food uses peaked in the 1830s and declined as cetaceans became scarce. Seafood consumption increased rapidly after 1900, and by the late 1930s, annual marine consumption in Atlantic Europe reached 7 million tonnes of biomass, facilitated by the globalisation of whaling. Atlantic European consumption, including fishmeal for animal feed, peaked at more than 12 million tonnes annually in the 1970s, but declined thereafter. The marine footprint of Atlantic Europe was significant well before modern fisheries statistics commenced. Our findings can inform future assessments of ocean health and marine life's importance for human society.

Temperature changes of CoolSticks during simulated use

INTRODUCTION

Cold sensation is often used to check neuraxial anaesthesia and analgesia. One opportunity to reduce the carbon footprint of anaesthesia is to replace vapo-coolant sprays such as ethyl chloride with a reusable device called the CoolStick, which is cooled in a refrigerator between uses. We designed a study to investigate how long the CoolStick remains at its working temperature, which we defined as <15 °C.

METHOD

Experiments were undertaken using a thermocouple and digital temperature sensor attached to the CoolStick. We conducted two experiments to assess temperature changes following removal from the refrigerator for 10 min; the first investigated passive re-warming in the ambient theatre environment and the second investigated re-warming in simulated use. In our third experiment, we investigated the time taken to cool the device in the refrigerator, following use. Each experiment was repeated three times.

RESULTS

In the passive re-warming experiment, the mean CoolStick temperature was 7.3 °C at the start, and 14.3 °C after 10 min. In the simulated use experiment, the mean CoolStick temperature was 7.3 °C at the start, and 18.9 °C at 10 min. In the cooling experiment, the mean CoolStick temperature was 15 °C at the start and 7.6 °C at 40 min.

CONCLUSION

Our study indicates that it is feasible to use the CoolStick for providing cold sensation in clinical practice. Further study would be required to directly compare the effectiveness of the device to existing methods such as coolant sprays or ice in the clinical setting.

'Give us the real tools to do our jobs': views of UK stakeholders on the role of a public health objective for alcohol licensing

OBJECTIVES

This study ascertains the views of UK stakeholders on the actual, and possible, impact of a public health licensing objective in their day-to-day work.

STUDY DESIGN AND METHODS

Twenty-eight interviews were conducted with members of public health teams who were actively engaged in alcohol licensing in their local area between 2017 and 2019. Six teams were based in Scotland (where there is a public health licensing objective) and 14 in England (where there is no similar objective).

RESULTS

Scottish participants reported that while challenges remained in applying the public health licensing objective, progress had been made and the objective was beneficial to their work. Participants in England felt that an objective would increase the legitimacy, value and impact of their contributions. In both Scotland and England, constructive relationships between PHTs, licensing authorities and other key stakeholders were developing suggesting that PHTs could have a sustainable and positive role in licensing.

CONCLUSIONS

In many Scottish areas, the alcohol licensing system is evolving to take constructive account of its public health objective. In England, PHTs that have invested resources in engaging in this area have demonstrated an ability to work effectively within licensing systems. Strong support for the adoption of a public health licensing objective among these PHTs adds weights to calls for the UK Government to reconsider its previous decision not to introduce such an objective.

Fatal SARS in X-Linked Lymphoproliferative Disease Type 1: A Case Report

X-linked lymphoproliferative disease (XLP1) is an inborn error of immunity (IEI) with severe immune dysregulation caused by a mutation in the SH2D1A gene resulting in the absence or dysfunction of signaling lymphocytic activation molecule (SLAM)-associated protein (SAP). The severe acute respiratory syndrome (SARS) caused by SARS-coronavirus (CoV), a highly pathogenic CoV, has been shown to only cause mild diseases in Asian children. We report on a 5-year-old Nepalese boy with agammaglobulinemia and probable SARS who died of diffuse alveolar damage 22 days after admission amid the SARS outbreak. The index patient and his younger brother were genetically confirmed to have XLP1. In the current coronavirus disease 2019 (COVID-19) pandemic, most children also had mild disease only. Children with severe COVID-19 would warrant investigations for underlying IEI, particularly along the pathways leading to immune dysregulation.

Postmortem Stability of SARS-CoV-2 in Mouse Lung Tissue

The infectivity of severe acute respiratory syndrome coronavirus 2 in deceased persons and organisms remains unclear. We studied transgenic K18 hACE2 mice to determine the kinetics of virus infectivity after host death. Five days after death, virus infectivity in the lung declined by >96% and RNA copies declined by 48.2%.

AB0682 RHEUMATOLOGY TEACHING IN TIMES OF COVID-19

Background:

The COVID-19 pandemic has affected the delivery of face-to-face teaching especially bedside teaching for medical students in the hospitals. Rheumatology outpatient clinics have mostly become virtual or telephone consultation clinics which prevent medical students from seeing patients in person. Students are deprived of the opportunities to take rheumatology history, examining patients and seeing signs of rheumatologic diseases. New adaptations have to be made to ensure equitability and that students still receive the relevant teaching in line with their learning curriculum and to help them prepare for their examinations.

Objectives:

Our aims are:

1)To adapt bedside teaching in the wards to simulated teaching in the classroom using trained simulated ‘patients’; and

2)To create simulation teaching of patient journeys in Objective Structured Clinical Examination (OSCE) format known as Clinically Observed Medical Education Tutorials (COMET) (Nair et al., 2001).

Methods:

1)For simulated teaching in the classroom, we have trained our teaching colleagues as simulated or standardized patients (SPs). We write up fictitious patient histories which simulate common presentations at rheumatology clinics. We train the SPs to give as accurate a history as possible and to simulate pains in different joints (e.g. pain at the metacarpophalangeal joints and proximal interphalangeal joints in rheumatoid arthritis) on clinical examinations. For clinical presentations that are not easily simulated, we use photographs of the relevant signs. This method is used not only as formative assessments but also as end-of-placement summative assessments.

2)COMET comprises 3 OSCE-style stations with a tutor each where the students perform different tasks based on a patient’s clinical problem (e.g. acute hot swollen joint). The first station is initial A-to-E assessment of the patient (using a simulator), followed by investigations and interpretations of lab results and imaging (station 2) and lastly, management (including prescribing medications) and communication skills (e.g. explain arthrocentesis to the patient).

Results:

The overall feedback from students is very positive. We use Likert scale to assess confidence level before and after the teaching session, and pre-session and post-session multiple choice questions to assess learning and knowledge gained.

Conclusion:

While simulated teaching cannot replace encounters with real patients, students do enjoy these sessions as they get to ‘experience’ a large variety of rheumatologic cases and practice their clinical skills which at times are limited with real patients due to reluctance and pain of the patients.

References:

[1]Nair, R., Morrissey, J., Carasco, D., Desilva, S. & Patel, V. (2001) COMET: Clinically Observed Medical Education Tutorial - a novel educational method in clinical skills. International Journal of Clinical Skills

[2]Van der Vleuten, C.P.M. & Swanson, D.B. (1990) Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med, 2: 58-76.

Disclosure of Interests:

None declared

Pathophysiology of infection with SARS-CoV-2-What is known and what remains a mystery

Coronavirus disease 2019 (COVID‐19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID‐19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre‐existing medical conditions and critical illness. Prior research on SARS‐Co‐V and NL63 was rapidly leveraged to identify angiotensin‐converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS‐CoV‐2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS‐CoV‐2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID‐19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin‐embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS‐CoV‐2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID‐19.

815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown

Introduction

The emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit.

Method

Data on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database.

Results

92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%).

There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10).

Conclusions

The lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.

Training in colorectal surgery in Europe and 20 years of the European Board of Surgical Qualification coloproctology examination

AIM

Training in colorectal surgery across Europe is not yet standardized. The European Board of Surgical Qualification (EBSQ) coloproctology examination has been held annually since 1998. The aims of this study were to illustrate the current situation of coloproctology specialization in Europe and to analyse the EBSQ examinations held over the last 20 years.

METHOD

A survey, focused on current training and education in colorectal surgery in Europe, was conducted among all national representatives of the European Society of Coloproctology (ESCP) in 2018. Candidate demographics (1998-2018) and the results of the EBSQ examination (2007-2018) were analysed.

RESULTS

In Europe, there are currently 26 national colorectal societies, 27 national annual colorectal meetings, 16 national specialized training programmes and 13 national colorectal fellowships. Six countries have board certification in colorectal surgery and five a dedicated examination. During the last 20 years, 475 candidates from 29 countries, of whom 88 (19%) were women, passed the EBSQ examination. The pass rate was higher in younger applicants (< 42 years, P = 0.01). The success rate was higher for candidates with academic experience (more than five publications or presentations) and with an academic title (thesis) (P = 0.01).

CONCLUSION

Colorectal surgical training is still not standardized in Europe, although efforts have been made to recognize colorectal surgery as an independent speciality. The number of holders of the EBSQ Diploma has increased over the years, demonstrating the acceptance of the examination among European surgeons. Young candidates with an academic profile are the most successful.

Inventing the Grand Banks: A deep chart: Humanities GIS, Cartesian, and literary perceptions of the north-west Atlantic fishery ca 1500-1800

As a feature of the Fish Revolution (1400-1700), the early modern "invention" of the Grand Banks in literary and cartographical documents facilitated a massive and unprecedented extraction of cod from the waters of the north Atlantic and created the Cod/Sack trade Triangle. This overlapped with the southern Atlantic Slave, Sugar, and Tobacco Triangle to capitalise modern European and North American societies. In 1719, Pierre de Charlevoix claimed that the Grand Banks was "properly a mountain, hid under water," and noted its cod population "seems to equal that of the grains of sand which cover this bank." However, two centuries later in 1992, in the face of the collapse of the fishery, and fearing its extinction, a moratorium was placed on five centuries of harvesting Grand Banks cod. The invention and mining of its waters serves as a bellwether for the massive resource extractions of modernity that drive the current leviathan and "wicked problem" of global warming. The digital environmental humanities narrative of this study is parsed together from 83 pieces of Grand Banks charting from 1504 to 1833, which are juxtaposed through Humanities GIS applications with English and French cod-catch records kept between 1675 and 1831, letters regarding Cabot's 1497 voyage, Shakespeare's The Tempest (1611) and scientific essays by De Brahms (1772) and Franklin (1786).

Impact of pre-therapy glioblastoma multiforme microenvironment on clinical response to autologous CMV-specific T-cell therapy

Objectives

Clinical response to antibody-based immunotherapies targeting checkpoint inhibitors is critically dependent on the tumor immune microenvironment (TIME). However, the precise impact of the TIME on adoptive cellular immunotherapy remains unexplored. Here we have conducted a long-term follow-up analysis of patients with recurrent glioblastoma multiforme (GBM) who were treated with autologous CMV-specific T-cell therapy to delineate the potential impact of the TIME on their clinical response.

Methods

Multiplexed immunohistochemical analysis of CD3, PD-L1 and Sox-2 in GBM tissue biopsies obtained before autologous T-cell therapy was carried out and correlated with long-term survival of GBM patients adoptively treated with T-cell therapy.

Results

Tumor microenvironment analyses revealed that the pre-treatment cellular composition of the tumor tissue may influence the subsequent response to adoptive T-cell therapy. GBM patients who showed prolonged overall survival following T-cell therapy had a significantly lower number of tumor-infiltrating CD3⁺ T cells in recurrent tumors than that in patients with short-term survival. Furthermore, long-term surviving patients showed low or undetectable PD-L1 expression in tumor cells in recurrent GBM biopsies.

Conclusion

We hypothesise that lack of PD-L1-mediated immunosuppression in the TIME may allow efficient immune control following adoptive T-cell therapy. Future studies combining anti-PD-L1 or genetically modified T cells with PD-1 receptor knockdown could be considered to improve clinical responses in patients who have high PD-L1 expression in their tumors.

Dual therapy with renally adjusted lamivudine and dolutegravir: a switch strategy to manage comorbidity and toxicity in older, suppressed patients?

OBJECTIVES

The aim of the study was to evaluate the efficacy of dual therapy with lamivudine (3TC), with dose adjustment for renal function, and dolutegravir (DTG) in a subgroup of patients fully suppressed on treatment who were switched because of concerns about comorbidity and toxicity on their current triple drug regimen.

METHODS

A retrospective evaluation of clinical and pathological parameters from an electronic patient record from a single centre was carried out.

RESULTS

There were no virological failures in 52 patients with a median age of 60.5 years. The median duration of follow-on dual therapy was 2.29 years (28 months; range 1.10-3.34 years). In 25 of 52 (48%) cases, the dose of 3TC was adjusted taking into account reduced renal function, and none of these patients experienced virological failure. Four additional patients discontinued early, because of side effects of the switch, with no failure.

CONCLUSIONS

This retrospective review suggests that 3TC and DTG may be effective in controlling viral load in older patients with comorbidities. This regimen appears to be a useful option in the context of comorbidities (including renal impairment) and polypharmacy in older patients. However, this review has been conducted in one centre and in a small population of patients. Therefore, further multicentre trials involving larger populations of patients are needed.

A Novel Synthetic Compound, Bismuth Zinc Citrate, Could Potentially Reduce Cisplatin-Induced Toxicity Without Compromising the Anticancer Effect Through Enhanced Expression of Antioxidant Protein

Cisplatin is a common anticancer drug, but it comes with significant nephrotoxicity. Further cisplatin-induced oxidative stress contributes to the pathogenesis of the nephrotoxicity. A new compound, BiZn, can potentially prevent this complication. We verified our postulation by in vitro and in vivo models. From our findings, BiZn did not affect cisplatin-induced cytotoxicity on neuroblastoma cells under both in vitro and in vivo settings. However, BiZn significantly reduced the blood urea nitrogen and creatinine levels in cisplatin-treated mice. Under the lethal dosage of cisplatin, co-treatment of BiZn significantly increased the survival rate. BiZn stimulated antioxidant proteins metallothionein (MT) and glutathione (GSH) generation from kidney cells and minimized cisplatin-induced apoptosis. Knocking down MT-IIA and inhibiting GSH abolished such protection. In conclusion, pretreatment of BiZn decreased cisplatin-induced renal toxicity without affecting its antitumor activity. BiZn-induced antioxidant proteins MT and GSH may contribute to the renal protection effect.

Session 3: Many ways to organ preserve the rectum but which is correct?

From the patient's perspective, cancer cure with full preservation of function is a crucial goal. There are many advances that have emerged which may make this possible in a greater proportion of patients without compromising oncological outcomes. Professor Tekkis reviews the options and evidence to date for 'organ preservation' and the expert panel discuss the implications for current and future patient care.

Session 3: Beyond TME and radiotherapy MRI evaluation of rectal cancer treatment response

Magnetic resonance imaging plays an increasingly important role in evaluating the effect of cancer treatment. Imaging alone cannot predict pathological complete response and imaging interpretation should be combined with clinical information and endoscopy findings to predict complete response. Professor Blomqvist reviews current and future imaging techniques and whether the quantitative can add significant or important prognostic information over the current qualitative techniques.

Session 3: Intra-operative radiotherapy - creating new surgical boundaries

In patients with advanced and recurrent colorectal cancer, surgical resection with clear margins is the greatest challenge and is limited by known anatomical constraints. Preoperative or intra-operative assessment of the limits of surgical dissection may help to explore the possibility of improving resectability through either targeted external beam radiotherapy or intra-operative radiotherapy. Professor Chang reviews the evidence base and potential advantages and disadvantages of this approach, whilst the expert panel agree a consensus on the evidence for assessment and therapy of such patients.

Session 3: Beyond the boundaries of Total Mesorectal Excision - where surgeons fear to tread

Approximately 10-15% of patients present with an advanced rectal cancer that extends beyond the conventional total mesorectal excision (TME) planes. In such cases extending the surgery to ensure resection with clear margins (R0 resection) is essential in order to achieve long-term cure. Professor Holm describes the techniques of beyond-TME exenterative surgery, the methods of patient selection and outcomes.

The Alloplastic Organisation: Balancing Flexibility and Stability in a Turbulent Environment

‘Men of age object too much, consult too long, adventure too little, repent too soon, and seldom drive business home to the full period, but content themselves with a mediocrity of success. Young men, in the conduct and manage of actions, embrace more than they can hold; stir more than they can quiet; fly to the end, without consideration of the means and degrees; pursue some few principles which they have chanced upon absurdly; use extreme remedies at first; and, that which doubleth all errors, will not acknowledge or retract them; like an unready horse, that will neither stop nor turn.’

FRANCIS BACON

‘To ensure a balanced age structure should be one of the main concerns of manager manpower planning. There must be enough older men to ensure opportunities for younger men, enough younger men to ensure continuity; enough older men to provide experience and enough younger men to provide drive. Age structure of management is like the metabolism of the human body; unless it is balanced all constitutional processes are diseased.’

PETER DRUCKER

Squamous Cell Carcinoma of the Anal Transitional Zone after Ileal Pouch Surgery for Ulcerative Colitis: Systematic Review and Treatment Perspectives

BACKGROUND

Few cases of pouch-related cancers have been reported in ulcerative colitis (UC), and squamous cell carcinoma (SCC) is very rare.

METHOD

A systematic review of the literature was performed to identify all unequivocal cases of pouch-related SCC in UC patients.

RESULTS

Eight cases of SCC developing after ileal pouch-anal anastomosis (IPAA) have been observed since 1978. Two arose from the pouch mucosa and 6 from below. The pooled cumulative incidence of SCC is below 0.06% after IPAA. Many patients had neoplasia on the preoperative specimen, but squamous metaplasia of the pouch or anorectal mucosa may have an important role in SCC. These patients are rarely offered chemoradiation therapy and the outcome is poor. Selected patients with SCC located close to the pouch outlet can be treated with chemoradiation prior to consideration of surgery and salvage their pouch. A chemoradiation regimen is suggested to avoid pouch excision in these patients.

CONCLUSIONS

SCC is rare after pouch surgery but associated with extremely poor survival. Very low SCC can be managed with chemoradiation treatment, preserving the pouch and avoiding surgery, even in older patients. The role of pouch metaplasia, surveillance frequency, and treatment modalities after IPAA need further studying.

Pre-emptive and therapeutic adoptive immunotherapy for nasopharyngeal carcinoma: Phenotype and effector function of T cells impact on clinical response

Adoptive T cell therapy has emerged as a powerful strategy to treat human cancers especially haematological malignancies. Extension of these therapies to solid cancers remains a significant challenge especially in the context of defining immunological correlates of clinical responses. Here we describe results from a clinical study investigating autologous Epstein-Barr virus (EBV)-specific T cells generated using a novel AdE1-LMPpoly vector to treat patients with nasopharyngeal carcinoma (NPC) either pre-emptively in at-risk patients with no or minimal residual disease (N/MRD) or therapeutically in patients with active recurrent/metastatic disease (ARMD). Tolerability, safety and efficacy, including progression-free survival (PFS) and overall survival (OS), were evaluated following adoptive T-cell immunotherapy. Twenty-nine patients, including 20 with ARMD and nine with N/MRD, successfully completed T-cell therapy. After a median follow-up of 18.5 months, the median PFS was 5.5 months (95% CI 2.1 to 9.0 months) and the median OS was 38.1 months (95% CI 17.2 months to not reached). Post-immunotherapy analyses revealed that disease stabilization in ARMD patients was significantly associated with the functional and phenotypic composition of in vitro-expanded T cell immunotherapy. These included a higher proportion of effector CD8⁺ T-cells and an increased number of EBV-specific T-cells with broader antigen specificity. These observations indicate that adoptive immunotherapy with AdE1-LMPpoly-expanded T cells stabilizes relapsed, refractory NPC without significant toxicity. Promising clinical outcomes in N/MRD patients further suggest a potential role for this approach as a consolidation treatment following first-line chemotherapy.

Between Experience and Knowledge

Much has been written on what is taught in MBA courses, and legs on how it is taught and the kinds of learning that are encouraged. This paper offers an analysis of different types of learning and their place within an MBA programme; it considers some of the dilemmas for staff and students between analogue and digital learning; between learning about ideas and learning how to do things; between learning about techniques and learning how to learn; and between learning by acquaintance and learning by description. Within these dilemmas it considers the connection between the experience that managers bring to an MBA course, the frameworks and theories that are offered to them within the course, and the merged knowledge and experience that they take from the course, which should enable them to learn more rapidly from experience in the future. The paper describes one particular educational device that has proved effective in enabling MBA students to integrate their knowledge and experience.

Abstract CT136: Therapeutic and prophylactic AdE1-LMPpoly-based adoptive T-cell immunotherapy for Epstein-Barr virus-associated nasopharyngeal carcinoma

Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) is endemic in regions of South-East Asia, with incidence as high as 25-50 cases per 100,000 people in southern China. While current standard therapy is curative for a subset with stage I or II disease, a high proportion of patients relapse and many patients are still initially diagnosed with advanced stage III or IV disease, where overall 5-year survival is significantly reduced. EBV-specific immunotherapy has been successfully used in the treatment of post-transplant lymphomas and may have the potential application to improve outcomes in NPC patients. We have designed the AdE1-LMPpoly vector to promote rapid expansion of CD8+ T cells specific for the latent membrane proteins (LMP) 1&2 and EBV nuclear antigen 1 (EBNA1) expressed in NPC. We recruited a total of 52 NPC patients, including 42 patients with refractory stage IV NPC disease and 11 at-risk patients with no or minimal residual disease (referred to as N/MRD patients). Of these, 6 patients with refractory disease were withdrawn prior to the commencement of T cell manufacture. Using AdE1-LMpoly, we successfully expanded autologous EBV-specific T cells from 35 NPC patients, while 11 patients showed no or minimal expansion of antigen-specific T cells. Thirty patients, including 21 patients with active disease and nine N/MRD patients, successfully completed autologous T cell therapy defined by the administration of at least two cycles of immunotherapy. None of these patients showed treatment-related grade 3, 4, or 5 adverse events as per the NCI Common Terminology Criteria for Adverse Events. The time to progression in patients with refractory stage IV NPC disease ranged from 6 to 456 days from the time of first T cell infusion, with a median time to progression of 63 days, while median progression-free survival in N/MRD patients was 527 days. Refractory patients showed a median survival of 478 days following recruitment, while all N/MRD patients remain alive. The median overall survival for a corresponding refractory stage IV disease cohort during the study period from the same institute was 309 days. Our study suggests that autologous EBV-specific T cells are a safe novel treatment option for NPC patients, and may offer better clinical benefit for patients, particularly when T cell therapy is administered during the early stages of the disease.

Citation Format: Corey Smith, Andrea Schuessler, Janice Tsang, Leone Beagley, Victor Lee, Ben Panizza, Sandro Porceddu, John Nicholls, Dora Kwong, Rajiv Khanna. Therapeutic and prophylactic AdE1-LMPpoly-based adoptive T-cell immunotherapy for Epstein-Barr virus-associated nasopharyngeal carcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT136.

Perception of Slope and Distance in Photographs and in the Real World

We report a series of experiments in which spatial judgments of the real world were compared with equivalent judgments of photographs of the real-world scenes. In experiment 1, subjects judged the angle from the horizontal of natural slopes. Judgments of slope correlated with true slope (r=0.88) but judgments were in general overestimates. Equivalent judgments of slope in photographs again correlated with true slope (r=0.91) but judgments tended to be overestimates for small angles (6°) and underestimates for larger angles (up to 25°). In experiment 2 slope judgments were made under laboratory conditions rather than in the natural world. The slopes, which were viewed monocularly, varied from 5° – 45°, and were either plain, or textured, or included perspective information (a rectangle drawn on the surface) or had both texture and perspective. Judgments were overestimates, but the correlation with true slope was high (r=0.97). Slopes with either texture or perspective were judged more accurately than plain slopes, but combining texture and perspective information conferred no further benefit. Judgment of the angle of the same slopes in photographs produced similar results, but the degree of overestimation (closer to the vertical) was greater than for the real slopes. In experiment 3, subjects either judged the distance of landmarks ranging from 200 m to 5000 m from the observation point, or judged distance to the landmarks in photographs. In both cases subjects' judgments were well described by a power function with exponents close to one. Although there are large individual differences, subjects' judgments of slope and distance are accurate to a scale factor, and photographs yield similar judgments to real scenes.

Chinese family with diffuse oesophageal leiomyomatosis: a new COL4A5/COL4A6 deletion and a case of gonosomal mosaicism

BACKGROUND

Diffuse oesophageal leiomyomatosis (DOL) is a rare disorder characterized by tumorous overgrowth of the muscular wall of the oesophagus. DOL is present in 5 % of Alport syndrome (AS) patients. AS is a rare hereditary disease that involves varying degrees of hearing impairment, ocular changes and progressive glomerulonephritis leading to renal failure. In DOL-AS patients, the genetic defect consists of a deletion involving the COL4A5 and COL4A6 genes on the X chromosome.

CASE PRESENTATION

We report a two-generation family (4 individuals; parents and two children, one male and one female) with two members (mother and son) affected with oesophageal leiomyomatosis. Signs of potential renal failure, which characterizes AS, were only apparent in the index patient (son) 2 years and three months after the initial diagnosis of DOL. Blood DNA from the four family members were submitted to exome sequencing and array genotyping to perform a genome wide screening for disease causal single nucleotide (SN) and copy number (CN) variations. Analyses revealed a new 40kb deletion encompassing from intron 2 of COL4A5 to intron 1 of COL4A6 at Xq22.3. The breakpoints were also identified. Possible confounding pathogenic exonic variants in genes known to be involved in other extracellular matrices disorders were also shared by the two affected individuals. Meticulous analysis of the maternal DNA revealed a case of gonosomal mosaicism.

CONCLUSIONS

This is the first report of gonadosomal mosaicism associated to DOL-AS.

PARP1 is overexpressed in nasopharyngeal carcinoma and its inhibition enhances radiotherapy

Nasopharyngeal carcinoma is a rare but highly invasive cancer. As options of agents for effective combination chemoradiotherapy for advanced nasopharyngeal carcinoma are limited, novel therapeutic approaches are desperately needed. The ubiquitin ligase CHFR is known to target PARP1 for degradation and is epigenetically inactivated in nasopharyngeal carcinoma. We present evidence that PARP1 protein is indeed overexpressed in nasopharyngeal carcinoma cells in comparison with immortalized normal nasopharyngeal epithelial cells. Tissue microarray analysis also indicated that PARP1 protein is significantly elevated in primary nasopharyngeal carcinoma tissues, with strong correlation with all stages of nasopharyngeal carcinoma development. We found that the PARP inhibitor AZD2281 (olaparib) increased DNA damage, cell-cycle arrest, and apoptosis in nasopharyngeal carcinoma cells challenged with ionizing radiation or temozolomide. Isobologram analysis confirmed that the cytotoxicity triggered by AZD2281 and DNA-damaging agents was synergistic. Finally, AZD2281 also enhanced the tumor-inhibitory effects of ionizing radiation in animal xenograft models. These observations implicate that PARP1 overexpression is an early event in nasopharyngeal carcinoma development and provide a molecular basis of using PARP inhibitors to potentiate treatment of nasopharyngeal carcinoma with radio- and chemotherapy.

Restorative proctocolectomy in patients with ulcerative colitis: a cross-sectional Danish population study on function and quality of life

AIM

The study evaluated function and quality of life (QoL) in all patients having restorative proctocolectomy (RPC) in Denmark for ulcerative colitis (UC) from 1980 to 2010. Inclusion of all patients in one country has never previously been achieved.

METHOD

All patients who had had a RPC in Denmark, from the first case in 1980 to the last case in 2010, were studied. A cross-sectional questionnaire survey was performed, and function and QoL were assessed using a standardized questionnaire - the Short-Form 36 (SF36) - and the inflammatory bowel disease questionnaire (IBDQ).

RESULTS

The median duration of follow up was 11 (range, 1-30) years. Apart from deaths, pouch failures and research protection, data on function and QoL were obtained from 1047 (85%) of 1229 patients who had a functioning pouch at the time of the investigation. More female patients than male patients experienced urgency (56% vs 44%, P = 0.0021). The median number of bowel movements per 24 h was 7 (range, 1-23) in female patients and 6 (range, 1-20) in male patients (P < 0.001). Pad usage was more frequent among female patients than among male patients (62% vs 38%, P < 0.001). A higher incidence of major incontinence (P = 0.009) and use of pads (P = 0.01) was found among patients who had been operated on 21-30 years previously compared with those operated on 11-20 years previously. The prevalence of urgency was higher in patients who received surgery 0-10 years previously compared with 11-20 years previously (P = 0.009). The total IBDQ score was higher in male patients than in female patients (P < 0.001). Male patients scored higher in five of eight SF36 domains (P < 0.001).

CONCLUSION

Female patients had more urgency, a higher frequency of defaecation and higher pad usage. This was associated with a reduced QoL. Nevertheless, RPC resulted in good function and a high degree of satisfaction in most patients.