Refining shape and size of silver nanoparticles using ion irradiation for enhanced and homogeneous SERS activity

We present green synthesis of silver nanoparticles in water using unirradiated and Ag15 + ion irradiated phytoextracts of Bergenia Ciliata leaf, Eupatorium adenophorum leaf, Rhododendron arboreum leaf and flower. The use of different plant extracts and their subsequent ion irradiation allow for successful refinement of nanoparticle size and morphology. Due to changes in reducing and capping agents the nanoparticle surface functionalization also varies which not only controls the morphology but also allows for surface oxidation and aggregation processes. In this work, we have synthesized silver nanoparticles which exhibit sizes in the range from 13 to 24 nm and having shapes like spherical, quasispherical, trigonal, hexagonal, cylindrical, dendritic assemblies, and porous nanoparticles. Owing to changes in the size and shape of the nanoparticles, their direct bandgap (2.05 eV - 2.48 eV) and local surface plasmon resonance (420 nm - 490 nm) could also be tuned. These nanoparticles are examined as SERS substrates, where their enhancement factors, limit of detection for methylene blue, and SERS substrate homogeneity have been tested. It has been observed the nanoparticles synthesized using unirradiated plant extracts present an enhancement factor of 106 with a limit of detection 10- 8 M. Whereas nanoparticles with refined morphology and shapes upon irradiation present high enhancement factors of >107 and detection limit down to 10- 9 M. In addition, uniformity in Raman spectra over the SERS substrates has been obtained for selected Ag NPs substrates synthesized using irradiated extracts with minimum relative standard deviation in enhancement factor < 12%.

Plummeting toxic contaminates from water through phycoremediation: Mechanism, influencing factors and future outlook to enhance the capacity of living and non-living algae

Freshwater habitats hold a unique role in the survival of all living organisms and supply water for drinking, irrigation, and life support activities. In recent decades, due to anthropogenic activities, deterioration in the water quality has been a long-lasting problem and challenge to the scientific fraternity. Although, these freshwater bodies have a bearable intrinsic capacity for pollution load however alarming increase in pollution limits the intrinsic capacities and requires additional technological interventions. The release of secondary pollutants from conventional interventions further needs revisiting the existing methodologies and asking for green interventions. Green interventions such as phycoremediation are natural, eco-friendly, economic, and energy-efficient alternatives and provide additional benefits such as nutrient recovery, biofuel production, and valuable secondary metabolites from polluted freshwater bodies. This systemic review in a nut-shell comprises the recent research insights on phycoremediation, technological implications, and influencing factors, and further discusses the associated mechanisms of metal ions biosorption by living and non-living algae, its advantages, and limitations. Besides, the article explores the possibility of future research prospects for applicability at a field scale that will help in the efficient utilization of resources, and improved ecological and health risks.

Impact of nonmalignant ascites on outcomes of open inguinal hernia repair in the USA

PURPOSE

Studies on inguinal hernia repair in patients with ascites are limited, small, and inconsistent, exacerbating a challenging clinical dilemma for surgeons. To fill this gap in the literature, this retrospective cohort study used a national US database to examine the impact of ascites on the outcomes of open inguinal herniorrhaphy.

METHODS

Patients who underwent open inguinal herniorrhaphy between 2005 and 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Two groups were defined by the presence or absence of nonmalignant preoperative ascites. Ascites patients were propensity matched 1:10 with non-ascites patients. Surgical outcomes at 30 days for the matched groups, stratified by electiveness of procedure, were compared, with the primary end points of mortality and the NSQIP composite outcome "serious complication".

RESULTS

The study included 682 patients with ascites. Compared to matched controls, those with ascites had significantly increased odds of mortality (OR 3.3, 95% CI 1.5-7.0) after elective repair, but not after nonelective repair. Ascites was associated with increased odds of serious complication after both elective (OR 1.7, 1.2-2.3) and nonelective (OR 2.0, 1.3-3.0) surgery. Among ascites patients, age ≥ 65 years was associated with increased mortality (risk-adjusted OR 3.8, 1.2-14.4) and serious complication (OR 2.2, 1.2-3.9).

CONCLUSION

In this largest study to date on patients with ascites undergoing open inguinal herniorrhaphy, ascites increased the odds of mortality after elective repair and of serious complication after elective and nonelective repair. Age ≥ 65 was a risk factor for poor outcome. Inguinal herniorrhaphy is fraught with complications in this population.

Harnessing Machine Learning in Early COVID-19 Detection and Prognosis: A Comprehensive Systematic Review

During the early phase of the COVID-19 pandemic, reverse transcriptase-polymerase chain reaction (RT-PCR) testing faced limitations, prompting the exploration of machine learning (ML) alternatives for diagnosis and prognosis. Providing a comprehensive appraisal of such decision support systems and their use in COVID-19 management can aid the medical community in making informed decisions during the risk assessment of their patients, especially in low-resource settings. Therefore, the objective of this study was to systematically review the studies that predicted the diagnosis of COVID-19 or the severity of the disease using ML. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), we conducted a literature search of MEDLINE (OVID), Scopus, EMBASE, and IEEE Xplore from January 1 to June 31, 2020. The outcomes were COVID-19 diagnosis or prognostic measures such as death, need for mechanical ventilation, admission, and acute respiratory distress syndrome. We included peer-reviewed observational studies, clinical trials, research letters, case series, and reports. We extracted data about the study's country, setting, sample size, data source, dataset, diagnostic or prognostic outcomes, prediction measures, type of ML model, and measures of diagnostic accuracy. Bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with the number CRD42020197109. The final records included for data extraction were 66. Forty-three (64%) studies used secondary data. The majority of studies were from Chinese authors (30%). Most of the literature (79%) relied on chest imaging for prediction, while the remainder used various laboratory indicators, including hematological, biochemical, and immunological markers. Thirteen studies explored predicting COVID-19 severity, while the rest predicted diagnosis. Seventy percent of the articles used deep learning models, while 30% used traditional ML algorithms. Most studies reported high sensitivity, specificity, and accuracy for the ML models (exceeding 90%). The overall concern about the risk of bias was "unclear" in 56% of the studies. This was mainly due to concerns about selection bias. ML may help identify COVID-19 patients in the early phase of the pandemic, particularly in the context of chest imaging. Although these studies reflect that these ML models exhibit high accuracy, the novelty of these models and the biases in dataset selection make using them as a replacement for the clinicians' cognitive decision-making questionable. Continued research is needed to enhance the robustness and reliability of ML systems in COVID-19 diagnosis and prognosis.

Overview of Early ChatGPT's Presence in Medical Literature: Insights From a Hybrid Literature Review by ChatGPT and Human Experts

ChatGPT, an artificial intelligence chatbot, has rapidly gained prominence in various domains, including medical education and healthcare literature. This hybrid narrative review, conducted collaboratively by human authors and ChatGPT, aims to summarize and synthesize the current knowledge of ChatGPT in the indexed medical literature during its initial four months. A search strategy was employed in PubMed and EuropePMC databases, yielding 65 and 110 papers, respectively. These papers focused on ChatGPT's impact on medical education, scientific research, medical writing, ethical considerations, diagnostic decision-making, automation potential, and criticisms. The findings indicate a growing body of literature on ChatGPT's applications and implications in healthcare, highlighting the need for further research to assess its effectiveness and ethical concerns.

Social media analytics and their applications to evaluate an activity in online health interventions using CRITIC and TOPSIS techniques

The usage of social media is increasing by leaps and bounds in our day-to-day lives. It affects daily routines and brings a lot of change in different departments like health and education systems during the COVID-19 pandemic. Healthcare research and practice have been significantly impacted by the astounding growth of social media. Social media are changing health information management in several ways, from offering appropriate ways to enhance healthcare professional contact and share health-related knowledge and experience to facilitating the development of innovative medical research and wisdom. Social media analytics (SMAs) are efficient and effective interaction instruments that can be useful for both patients and clinicians in health interventions. Moreover, a significant portion of those involved in clinical practices (such as clinicians, professional colleges, and departments of health) are unaware of the importance of social media, its potential applications in their daily lives, as well as the possible consequences and how these will be handled. In the presented study, we proposed MCDM-based approaches known as "Criteria Importance Through Inter Correlation" (CRITIC) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) in order to identify the effective alternative among several options and make a better decision. After extracting features from the literature review, we choose six significant and relevant features and assign weights to them using CRITIC techniques while utilizing the TOPSIS technique to rank the alternatives based on their performance values. After the implementation of both methods and evaluation procedure, it is determined that the alternative with the highest score is placed at the top and called the "best alternative," while the alternative with the lowest score is placed at the bottom and called the worst alternative. Finally, we suggest a variety of research initiatives and new research areas where the aforementioned procedures become extremely useful in evaluating SMAs and their uses in online health interventions.

A first principles study of a van der Waals heterostructure based on MS2 (M = Mo, W) and Janus CrSSe monolayers

The strategy of stacking two-dimensional materials for designing van der Waals heterostructures has gained tremendous attention in realizing innovative device applications in optoelectronics and renewable energy sources. Here, we performed the first principles calculations of the geometry, optoelectronic and photocatalytic performance of MS₂-CrSSe (M = Mo, W) vdW heterostructures. The mirror asymmetry in the Janus CrSSe system allows the designing of two models of the MS₂-CrSSe system by replacing S/Se atoms at opposite surfaces in CrSSe. The feasible configurations of both models of the MS₂-CrSSe system are found energetically, dynamically and thermally stable. The studied heterobilayers possess an indirect type-I band alignment, indicating that the recombination of photogenerated electrons and holes in the CrSSe monolayer is hence crucial for photodetectors and laser applications. Remarkably, a red-shift in the optical absorption spectra of MS₂-CrSSe makes them potential candidates for light harvesting applications. More interestingly, all heterobilayers (except W(Mo)S₂-CrSSe of model-I(II)) reveal appropriate band edge positions of the oxidation and reduction potentials of the photocatalysis of water dissociation into H⁺/H₂ and O₂/H₂O at pH = 0. These results shed light on the practical design of the MS₂-CrSSe system for efficient optoelectronic and photocatalytic water splitting applications.

Variability in indigenous Pakistani tomato lines and worldwide reference collection for Tomato Mosaic Virus (ToMV) and Tomato Yellow Leaf Curl Virus (TYLCV) infection

Local and exotic germplasm of tomato remains a major source for genetic improvement. Assessment of such lines for biotic stresses particularly viral diseases are the most important criteria for selection in Pakistan, where Tomato Yellow Leaf Curl Virus (TYLCV) and Tomato Mosaic Virus (ToMV) are the major diseases/viruses. A set of 40 accessions (including indigenous Pakistani lines and exotic germplasm from Europe, the United States, and Asia) were evaluated for their resistance/infection response to ToMV with artificial inoculation under greenhouse conditions. Infection response was quantified through disease scoring and DAS-ELISA test (for ToMV). A subset of 24 lines, was further screened for TYLCV using disease scoring and TAS-ELISA. The tested lines showed significant variability for resistance to ToMV. Only one accession (Acc-17878) was resistant to the ToMV whereas seven accessions i.e. Acc-17890, AVR-261, CLN-312, AVR-321, EUR-333, CLN-352, and CLN-362 expressed resistance to TYLCV. Correlation between phenotypic evaluation was confirmed by the ELISA results in both diseases, although both tools complemented to assess the viral infection status. In future, tomato breeding programs must consider breeding for ToMV and TYLCV resistance (using identified germplasm in our study) so as to deliver virus resistant tomato varieties.

Effect of Agaricus blazei Murill on exploratory behavior of mice-model

Increased anxiety and depressive symptoms have reported to be its association with long term illness. Because of having unwanted effects of newly available drugs, patients administering anxiolytic drugs usually discontinue the treatment before they are completely recovered. Therefore, there is a serious need to develop new anxiolytic drugs. The anxiolytic effect of hydro-alcoholic extract of Agaricus blazei in animal models was assessed. 24 male mice (Mus musculus genus) were included in the study. Four groups were prepared and each group contained six animals. The groups were vehicle control, positive control (diazepam 1.0 mg/kg, i.p.) as well as two treatment groups receiving Agaricus blazei hydro-alcoholic extract at a dose of 136.50 mg/kg and 273.0 mg/kg orally. The Marble burying test, Nestlet shredding test and Light and Dark box test used to assess anxiolytic activity. Mice administered with diazepam 1.0 mg/kg, i.p. while hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) was administered via oral route which exhibited marked reduction in number of marbles-burying as compared to vehicle control group. Mice administered with diazepam 1.0 mg/kg, i.p. and Oral administration of hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) exhibited significant decrease in nestlet shredding in comparison to vehicle control group. The oral administration of hydro-alcoholic extract at a dose of 136.5mg/kg and 273mg/kg showed elevation in time spent in light box and was comparable to standard treated group while time spent by mice following oral administration of hydro-alcoholic extract of Agaricus blazei at a dose of 273.0 mg/kg also showed elevation and was found to be more near to standard treated group (diazepam 1 mg/kg, i.p.).

Can a virtual microbiology simulation be as effective as the traditional Wetlab for pharmacy student education?

BACKGROUND

Pharmacy practice education requires the development of proficiencies and an understanding of clinical microbiology. Learning in this area could be delivered using practical laboratory exercises, or potentially, simulation-based education. Simulation has previously successfully enhanced learning in health professional education. The current global climate due to COVID-19 has further highlighted the important role of technology-enhanced learning in delivering outcomes that meet the requisite learning objectives of a course. The aim of the present study was to compare the impact of a commercially available virtual microbiology simulation (VUMIE™) with a traditional wet laboratory (wetlab) on learner knowledge, skills and confidence in a second-year integrated pharmacotherapeutics course for Bachelor of Pharmacy students.

METHODS

A randomised, crossover study was employed to determine whether the simulation intervention (VUMIE™) improves learning outcomes (knowledge, skills and confidence) of pharmacy students, when compared to a traditional wetlab intervention. Each student completed three 1-2 h length sessions, for both the wetlab and VUMIE™ interventions (6 sessions total). Data was collected using surveys deployed at baseline (pre-interventions), post-intervention 1 or 2 (VUMIE™ or wetlab) and endpoint (post-interventions 1 and 2). Statistical analysis was conducted using SPSS Statistics 25 and Instat™ software.

RESULTS

Response rates were approximately 50% at initial survey and approximately 25% at endpoint survey. VUMIE™ produced higher post-intervention knowledge scores for the multiple-choice questions compared to the wetlab, however, the highest score was achieved at endpoint. Both interventions produced statistically significant differences for mean scores compared to baseline (pre-VUMIE™ and wetlab) across the domains of knowledge, skills and confidence. VUMIE™ produced higher post-intervention mean scores for knowledge, skills and confidence compared to post-intervention mean scores for the wetlab, however there was no statistical significance between the mean score for the two interventions, thus the VUMIE™ activity produced learning outcomes comparable to the wetlab activity.

CONCLUSION

These findings suggest VUMIE™ provides similar effects on students' knowledge, skills, and confidence as a wetlab. The simulation's implementation was not cost-prohibitive, provided students with a physically and psychologically safe learning environment, and the benefit of being able to repeat activities, supporting deliberate practice.

Body composition, growth performance and enzyme activities of Labeo rohita fed different commercial fish feeds

We have evaluated the effects of different fish feeds on the body composition, growth, and enzyme activities of Labeo rohita (Rohu). In total, 240 fishes between the average weights of 24.77±2.15g were studied. The treatments were applied in a completely randomized design, with 4 treatments of 60 fishes each. Treatments consisted of four different fish feeds [Oryza (T1), AMG (T2), Aqua (T3), and Supreme (T4)]. Body composition, growth performance, and enzyme activities were evaluated. There was a significant variation in performance of fishes fed with different type of feed; as fishes having Oryza feed showed the highest weight gain, specific growth rate (SGR), and best feed conversion ratio (FCR) as compared to other groups that were considered to be significant (P ≤ 0.05). High net weight gain was obtained in T4 when compared with T2 and T3. FCR value of T4 was less than T1 but higher than T2, T3 and T2, which showed the lowest values. The specific growth rate was recorded as average in T4, but T2 led a high SGR than T3. Similarly, crude protein level and digestive enzymes activity was recorded significantly highest in fed with Oryza (T1) as compared to AMG (T2), Aqua (T3), and Supreme (T4). Water quality parameters were recorded significant in all treatments except pH and DO of treatment (T1), significantly different from other treatments. It was concluded that Rohu (Labeo rohita) could show a promising growth rate and protease enzyme activity when fed with the Oryza feed of 25% protein.

Role of Intraperitoneal Normal Saline Instillation in Relieving Post-operative Pain Following Laparoscopic Cholecystectomy: A Quasi Experimental Study

Laparoscopic cholecystectomy has rapidly become the procedure of choice for the treatment of calculus cholecystitis for having clear advantage over open method in reducing surgical morbidity, postoperative pain and complication. But still patients undergoing laparoscopic cholecystectomy complain of considerable pain especially on first post-operative day necessitating use of better methods for postoperative analgesia. This quasi experimental study was done in Surgery Unit III, Mymensingh Medical College Hospital from July 2016 to June 2017 to assess the role of intraperitoneal normal saline instillation following laparoscopic cholecystectomy in relieving postoperative pain. In this study total 200 patients of calculus cholecystitis were enrolled according to inclusion and exclusion criteria and assigned equally into two groups by non-equivalent control group design. Both the control group and experimental group were managed according to the standard protocol and operated in routine operation theater. The experimental group (n=100) was additionally instilled with 25-30ml/kg body weight of normal saline at 37°C at the gallbladder bed and subdiaphragmatic space at the end of surgery and all the data were recorded in individual case record form. Among the sample most of the patients were between 25-60 years of ages with the peak age being between 43-51 years. Eighty one percent (81%) of the total patients were female with male female ratio being 1:5.25 in Control group and 1:3.54 in Experimental group. The VAS scores for visceral pain in experimental group were significantly less than that of control group at 6 hours (p<0.001), 12 hours (p<0.001), 24 hours (p<0.001) and 48 hours (p=0.026). The VAS scores for shoulder tip pain in experimental group were also significantly less than that of control group at 6 hours (p<0.001), 12 hours (p<0.018) and 24 hours (p=0.004). The administration of analgesics was also significantly less in the experimental group than in control group at 6 hours (p<0.001), 12 hours (p<0.001), 24 hours (p=0.313) and 48 hours (p=0.297) with no significant differences at 72 hours. The mean hospital stay in this study was 2.2±0.7 days in the control group and 2.1±0.8 days in the experimental group showing no significant difference (p>0.05). Intraperitoneal normal saline instillation following laparoscopic cholecystectomy may be an eminent choice for reducing postoperative pain improving patient's experience.

Genotyping for Dombrock blood group alleles in Northern Pakistani blood donors

Genotyping can be used to identify rare blood group antigens and to solve suspected blood group discrepancies, particularly when serologic methods are limited. Unfortunately, only a few such studies have been performed in Pakistan. The present study was conducted to determine the frequency of Dombrock blood group alleles by genotyping samples from blood donors from the north of Pakistan. Blood samples were taken with consent from 300 blood donors; DNA was extracted and tested for DO*01 and DO*02 alleles by sequence-specific primer polymerase chain reaction (PCR-SSP), followed by gel electrophoresis. Allele frequencies were calculated. The observed and expected genotype frequencies were compared using the χ² test. The allele frequencies for DO*01 and DO*02 were 0.40 and 0.60, respectively. Genotype frequencies were in Hardy-Weinberg equilibrium. This study in Pakistani blood donors provides Dombrock blood group allele frequencies by PCR-SSP. This approach is efficient and economical and can be applied in developing countries. The findings can contribute to the development of in-house red blood cell panels, identification of rare blood types, and establishment of a national rare blood donor program.

Genotyping can be used to identify rare blood group antigens and to solve suspected blood group discrepancies, particularly when serologic methods are limited. Unfortunately, only a few such studies have been performed in Pakistan. The present study was conducted to determine the frequency of Dombrock blood group alleles by genotyping samples from blood donors from the north of Pakistan. Blood samples were taken with consent from 300 blood donors; DNA was extracted and tested for DO*01 and DO*02 alleles by sequence-specific primer polymerase chain reaction (PCR-SSP), followed by gel electrophoresis. Allele frequencies were calculated. The observed and expected genotype frequencies were compared using the χ² test. The allele frequencies for DO*01 and DO*02 were 0.40 and 0.60, respectively. Genotype frequencies were in Hardy-Weinberg equilibrium. This study in Pakistani blood donors provides Dombrock blood group allele frequencies by PCR-SSP. This approach is efficient and economical and can be applied in developing countries. The findings can contribute to the development of in-house red blood cell panels, identification of rare blood types, and establishment of a national rare blood donor program.

Enterotoxigenic methicillin resistant Staphylococcus aureus contamination in salted fish from Gwadar Balochistan

Staphylococcus aureus is an important foodborne pathogen associated to food intoxication and other multiple infections in human being. Its presence in salted food is a serious issue due to its salt tolerance potential. A study was conducted to analyze the presence of enterotoxins producing drug resistance S. aureus in salted sea fish from Gwadar. Freshly persevered samples (n=50) of salted fish were subjected to analyze the presence of S. aureus using 16S rRNA and Nuc genes primers. The isolates were then evaluated for drug resistance and enterotoxins producing potential using specific primers for MecA (methicillin resistance gene), (SEA) staphylococcal enterotoxin A and (SEB) staphylococcal enterotoxin B genes. Total 13/50 (26%) of the samples were found positive for the presence of S. aureus, preliminary confirmed with biochemical profiling and finally with the help of target genes presence. The isolates were found showing 100% resistant to methicillin, which were molecularly confirmed by the presence of MecA gene present in genome. The isolates 5/13 (38%) were positive for SEA and 3/13 (23%) for SEB genes, whereas 2/13 (15%) were confirmed having both SEA and SEB genes in its genome. It was also confirmed that all the isolates were capable to form biofilm over the glass surfaces. It was concluded that the study confirmed the presence of enterotoxigenic methicillin resistance Staphylococcus aurous (MRSA) in salted fish product, that poses gross food safety concern. Preventive and control measures are necessary to handle this serious food safety concern.

Elucidating antiviral activity of Curcuma longa against H9 N2 influenza virus using embryonated chicken egg model

Curcumin is a potent antimicrobial herb used traditionally as a spice in culinary. This study was designed to evaluate the antiviral effects of curcuma longa extract against H₉ influenza virus. A total of 60 embryonated eggs were equally divided into 5 groups with 12 eggs in each group. Group 1 (G1) served as uninfected negative control. Whereas Group 2 (G2) was kept as positive control infected with known virus @ 0.2 ml with 10^-9.3 EID₅₀. Group 3 (G3) was offered Curcuma longa @ 0.2 mg/0.2 ml and H₉N₂ virus (@ 0.2 ml with 10^-9.3 EID₅₀. Similarly, Group 4 (G4) was inoculated with extract of Curcuma longa @ 0.2 mg/0.2 ml per egg, whereas Group 5 (G5) was given Ribazole @ 0.2 ml/ egg. The crude extract and virus were administered on the 15^th day of incubation and were checked after every 24 hours up to 96th hour post inoculation by random selection of 3 eggs. Death and survival rate were noted in all groups. Gross and histopathological lesions were also observed. Results revealed that Curcuma longa extract had significantly (p<0.05) reduced the mortality rate of embryos infected with H₉N₂ virus. In G3, increased lymphocytes and mild fatty changes were seen in liver. Whereas, mature RBCs, plasma cells and some lymphoblast's were observed in Spleen. Similarly, the bursa follicles were with lymphocytic aggregation. The G4 (Curcuma longa) and G5 (Ribazole) were with maximum embryo survival after 48 and 72 h post inoculation. This study revealed potential antiviral activity of Curcuma longa against H9N2 influenza viruses and can be opted as alternative to antibiotics and antiviral drugs to minimize the antimicrobial resistance in human and animal population.

Molecular detection of Mycoplasma gallisepticum in different poultry breeds of Abbottabad and Rawalpindi, Pakistan

The poultry sector in Pakistan is contributing mainly in bridging gap between demand and supply for protein. Mycoplasma gallisepticum is an emerging bacterium causing serious problems in poultry industry of Pakistan. A cross-sectional study was conducted to evaluate the M. gallisepticum load in poultry populated regions of Pakistan. Total 600 serum and 600 swab samples were collected, 200 from each broiler, layers and breeders poultry in Rawalpindi and Abbottabad districts. Serum samples were analyzed through ELISA for seroprevalence. Swabs were cultured on Frey's medium followed by PCR and partial mgc2 gene sequencing. Results of seroprevalence of M. gallisepticum showed that layers (75%, n=150) are more positive as compared to breeders (70%, n=140) and broilers (50%, n=100). Typical colonies of the M. gallisepticum were observed in breeder (26.5%), followed by layer (21%) and broilers (9%). A total of 37.1% (n=42) samples were identified positive through PCR out of total 113 cultured based positive samples. A total of six M. gallisepticum isolates of current study showed 98-99 percent similarity with previously reported isolates on the basis of mgc2 gene partial sequencing. The M. gallisepticum was found highly prevalent in different poultry breads. Results of this study would add into basic data and provide a direction for livestock sector to strengthen a control strategy for mycoplasmosis in poultry farms.

The impact of fluence dependent 120 MeV Ag swift heavy ion irradiation on the changes in structural, electronic, and optical properties of AgInSe2 nano-crystalline thin films for optoelectronic applications

Swift heavy ion (SHI) irradiation in thin films significantly modifies the structure and related properties in a controlled manner. In the present study, the 120 MeV Ag ion irradiation on AgInSe₂ nanoparticle thin films prepared by the thermal evaporation method and the induced modifications in the structure and other properties are being discussed. The ion irradiation led to the suppression of GIXRD and Raman peaks with increasing ion fluence, which indicated amorphization of the AgInSe₂ structure along the path of 120 MeV Ag ions. The Poisson's fitting of the ion fluence dependence of the normalized area under the GIXRD peak of AgInSe₂ gave the radius of the ion track as 5.8 nm. Microstructural analysis using FESEM revealed a broad bi-modal distribution of particles with mean particle sizes of 67.5 nm and 159 nm in the pristine film. The ion irradiation led to the development of uniform particles on the film surface with a mean size of 36 nm at high ion fluences. The composition of the film was checked by the energy dispersive X-ray fluorescence (EDXRF) spectrometer. The UV-visible spectroscopy revealed the increase of the electronic bandgap of AgInSe₂ films with an increase in ion fluence due to quantum confinement. The Hall measurement and EDXRF studies showed that the unirradiated and irradiated AgInSe₂ films have n-type conductivity and vary with the ion fluence. The changes in the films were tuned with different ion fluence and are favorable for both optical and electronic applications.

Swift heavy ion (SHI) irradiation in thin films significantly modifies the structure and related properties in a controlled manner.

Knowledge, attitudes, and perceptions related to telemedicine among young doctors and nursing staff at the King Abdul-Aziz University Hospital Jeddah, KSA

Objective

To investigate the knowledge, perceptions, and attitude of young doctors and nurses at Kind Abdulaziz University Hospital (KAUH) Jeddah, KSA, regarding the effectiveness of telemedicine in dealing with the patients for either follow-up or continuous monitoring of chronic diseases.

Material and Methods

This prospective cross-sectional study was carried out on the young doctors and nursing staff at KAUH. An online questionnaire addressing all the required fields, i.e., background essential demography, perceptions, acceptance, and knowledge regarding telemedicine's utility, was sent to the targeted population of health care workers. Completed responses were analyzed statistically as per study objectives.

Results

The response rate in our study was 85%. A total of 335 participants responded to our questionnaire. One hundred seventy-one (51.1%) were doctors, whereas one hundred sixty-four (48.9%) were the nursing staff. Among doctors, 50 (29.4%) were recent graduates, whereas, in the nursing side, 77 (46.7%) were the senior nursing students. The knowledge and attitude of the young nursing staff were relatively better than the senior staff taking part in the study and the trends were found statistically significant.

Conclusion

Our study participants, being young, were enthusiastic, had good knowledge regarding the advantages and limitations of telemedicine in managing the selected groups of patients. Their perception and attitude were quite positive. This is an encouraging trend in the promotion of telemedicine as an established way of managing patients with special requirements in an effective way. The ongoing COVID-19 pandemic has highlighted the importance of telemedicine in emergencies to protect both patients and health care workers by reducing chronic patients' avoidable hospital visits.

Modified team-based and blended learning perception: a cohort study among medical students at King Saud University

BACKGROUND & OBJECTIVE

Medical schools have evolved toward competency-based education and active learner-centered strategies. Medical informatics course was introduced in 2011 in the 3rd year at the College of Medicine (CoM), King Saud University (KSU), to enhance future medical graduates with technological and information competencies. Modified team-based learning and blended learning were emphasized using face-to-face lectures, various e-learning technologies, workshop and seminars. The current study's main objective was to assess students' perceptions towards blended and modified team-based learning at the CoM in KSU.

METHODS

A survey was distributed to medical students in three consecutive years: 2017-2019. The survey contains items regarding student perception of various types of blended learning techniques applied in the course. The survey was administered using i-Clicker; an interactive device that enables students to answer survey questions. Descriptive statistics were used to examine the perception of students on these blended learning dimensions investigated.

RESULTS

Seven-hundred and one student responded to the questionnaire (male; 69.5%, female 30.5%). Out of which, 59.1% of students found team interactions positively supported discussions and asked questions freely, and 48.1% expressed that working in groups facilitated their learning process. However, 56.0% of students chose face-to-face lectures as the most preferred class activities followed by discussion 23.8%. More than 78% of participants agree that online quizzes are good experience and enjoyable. Grade center where students can check for marks and attendance also received high perception (66.3%).

CONCLUSION

Introducing modified team-based and blended-learning are considered challenging, and therefore, investigating their perceptions can provide useful insights into how these methods could be used more effectively. The blended-learning technique is highly essential in teaching medical informatics to overcome challenges faced due to a large number of students and the need for various exposures to reach the course's learning goals. Moreover, it is noticed that students were engaged in face-to-face and online activities, furthermore, modified team-based learning reported facilitating learning and asking questions without embarrassment.

Students' Feedback about Feedback; Have our PBL tutors started the shift towards a dialogic ask-tell-ask approach?

Objective:

A paradigm shift towards a PBL bidirectional dialogic feedback can enhance learners’ performance. This study aimed to investigate undergraduate medical students’ perceptions of their PBL feedback.

Methods:

We sent e-mail invitations to a web-based survey to year one and two students at College of Medicine, King Saud University. Items included the process, content, and benefits of PBL feedback.

Results:

Of 209 respondents, 110 (53%) were first and 99 (47%) were second-year students. About 50% agreed that the feedback was regularly provided at scheduled timing and 72% perceived feedback environment as non-threatening. Agreement rates that the tutors asked students first to assess their performance, tell them what went well, what the areas for improvement are and develop with them an improvement plan were 59%, 61%, 61% and 52%, respectively. 61% agreed that tutors judged performance not personality. More year one students significantly agreed that the PBL feedback helped them to improve their knowledge acquisition and non-technical skills.

Conclusion:

Many of our PBL tutors have started the shift to a dialogic bi-directional feedback. We recommend continuing the faculty development efforts, peer-reviewing, and seeking student’s feedback within the academic quality satisfaction surveys.

Probing the Effects of Strong Electromagnetic Fields with Charge-Dependent Directed Flow in Pb-Pb Collisions at the LHC

The first measurement at the LHC of charge-dependent directed flow (v_{1}) relative to the spectator plane is presented for Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV. Results are reported for charged hadrons and D^{0} mesons for the transverse momentum intervals p_{T}>0.2  GeV/c and 3<p_{T}<6  GeV/c in the 5%-40% and 10%-40% centrality classes, respectively. The difference between the positively and negatively charged hadron v_{1} has a positive slope as a function of pseudorapidity η, dΔv_{1}/dη=[1.68±0.49(stat)±0.41(syst)]×10^{-4}. The same measurement for D^{0} and D[over ¯]^{0} mesons yields a positive value dΔv_{1}/dη=[4.9±1.7(stat)±0.6(syst)]×10^{-1}, which is about 3 orders of magnitude larger than the one of the charged hadrons. These measurements can provide new insights into the effects of the strong electromagnetic field and the initial tilt of matter created in noncentral heavy ion collisions on the dynamics of light (u, d, and s) and heavy (c) quarks. The large difference between the observed Δv_{1} of charged hadrons and D^{0} mesons may reflect different sensitivity of the charm and light quarks to the early time dynamics of a heavy ion collision. These observations challenge some recent theoretical calculations, which predicted a negative and an order of magnitude smaller value of dΔv_{1}/dη for both light flavor and charmed hadrons.

Evidence of Spin-Orbital Angular Momentum Interactions in Relativistic Heavy-Ion Collisions

The first evidence of spin alignment of vector mesons (K^{*0} and ϕ) in heavy-ion collisions at the Large Hadron Collider (LHC) is reported. The spin density matrix element ρ_{00} is measured at midrapidity (|y|<0.5) in Pb-Pb collisions at a center-of-mass energy (sqrt[s_{NN}]) of 2.76 TeV with the ALICE detector. ρ_{00} values are found to be less than 1/3 (1/3 implies no spin alignment) at low transverse momentum (p_{T}<2  GeV/c) for K^{*0} and ϕ at a level of 3σ and 2σ, respectively. No significant spin alignment is observed for the K_{S}^{0} meson (spin=0) in Pb-Pb collisions and for the vector mesons in pp collisions. The measured spin alignment is unexpectedly large but qualitatively consistent with the expectation from models which attribute it to a polarization of quarks in the presence of angular momentum in heavy-ion collisions and a subsequent hadronization by the process of recombination.

Scattering Studies with Low-Energy Kaon-Proton Femtoscopy in Proton-Proton Collisions at the LHC

The study of the strength and behavior of the antikaon-nucleon (K[over ¯]N) interaction constitutes one of the key focuses of the strangeness sector in low-energy quantum chromodynamics (QCD). In this Letter a unique high-precision measurement of the strong interaction between kaons and protons, close and above the kinematic threshold, is presented. The femtoscopic measurements of the correlation function at low pair-frame relative momentum of (K^{+}p⊕K^{-}p[over ¯]) and (K^{-}p⊕K^{+}p[over ¯]) pairs measured in pp collisions at sqrt[s]=5, 7, and 13 TeV are reported. A structure observed around a relative momentum of 58  MeV/c in the measured correlation function of (K^{-}p⊕K^{+}p[over ¯]) with a significance of 4.4σ constitutes the first experimental evidence for the opening of the (K[over ¯]^{0}n⊕K^{0}n[over ¯]) isospin breaking channel due to the mass difference between charged and neutral kaons. The measured correlation functions have been compared to Jülich and Kyoto models in addition to the Coulomb potential. The high-precision data at low relative momenta presented in this work prove femtoscopy to be a powerful complementary tool to scattering experiments and provide new constraints above the K[over ¯]N threshold for low-energy QCD chiral models.

Abstract ES3-2: Sooner or later: considering risk over time, and implications for management

Cancer risk management revolves around the following important areas: genetic evaluation, surveillance recommendations, risk-reducing options, and lifestyle modification. Aspects of time are important for all of these areas, with the possible exception of lifestyle modification. For genetic evaluation, age at onset of affected individuals is a key parameter. Decisions about surveillance and risk-reducing strategies are based on age, and time-dependent estimates of cancer risk, with the most commonly-used time-frames being 5 years, 10 years, and remaining lifetime (to age 85 or 90). However, little attention is generally given to the time-frame of the benefit. For example, surveillance recommendations are based on lifetime risk when in fact the benefit (as defined by cancer detection success) cannot exceed the lead-time of the test. On the other hand, risk reduction (particularly with medication) is often presented based on risk estimated over the next 5 years. As more women are designated high risk, given increased prevalence of MRI surveillance and subsequent biopsies, and increased use of genetic testing with identification of moderate penetrance genetic variants, the question of risk thresholds that should be used for recommendations related to risk management become increasingly important. Surveillance recommendations: Remaining lifetime risk (RLR) estimates for women in their 40s generally project over 40 years or more. However, validation of these very long-term projections remains questionable, and validation is most robust for the 10-year time-frame (PMID 25956172). The lead-time gained with MRI surveillance has been estimated at 1-2 years for carriers of BRCA 1/2 mutations, and 4 years for non-carriers with positive family history of breast cancer (PMID 25820931) The predicted mean preclinical detectable phase (i.e. the time during which a cancer is screen-detectable) is estimated to be 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2 (PMID 22744338). Similar estimates for non-carrier women at increased familial risk are unlikely to be longer than 10 years. Therefore, given the greater reliability of 10-year risk estimates, it appears most reasonable to make recommendations for intensified screening based on 10-year risk rather than RLR. Recommendations for use of risk-reducing medications (RR-meds): In contrast to screening, have been made to non-carrier high risk women based on 5-year risk estimates of 1.7% or greater. Acceptance of medications has been low for a variety of reasons, one of which is the seemingly small risk conveyed by a 5-year risk estimates. Here, it would seem reasonable to extend the time-frame over which risk is calculated, since the protective benefit of tamoxifen is known to extend to ~15 years, and is likely to be in the same range for aromatase inhibitors. New ASCO guidelines on use of RR-meds now includes 10-year estimates of 3% with the NCI BCRAT, or 5% with the Tyrer-Cuzick. In summary, the use of 10-year risk estimates would simplify the management counseling of women at increased risk of breast cancer for both practitioner and patient, and place it on a better evidence base than the use of RLR or the 5-year interval.

Citation Format: SA Khan. Sooner or later: considering risk over time, and implications for management [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr ES3-2.

Measurement of ϒ(1S) Elliptic Flow at Forward Rapidity in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The first measurement of the ϒ(1S) elliptic flow coefficient (v_{2}) is performed at forward rapidity (2.5<y<4) in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The results are obtained with the scalar product method and are reported as a function of transverse momentum (p_{T}) up to 15  GeV/c in the 5%-60% centrality interval. The measured ϒ(1S)v_{2} is consistent with 0 and with the small positive values predicted by transport models within uncertainties. The v_{2} coefficient in 2<p_{T}<15  GeV/c is lower than that of inclusive J/ψ mesons in the same p_{T} interval by 2.6 standard deviations. These results, combined with earlier suppression measurements, are in agreement with a scenario in which the ϒ(1S) production in Pb-Pb collisions at LHC energies is dominated by dissociation limited to the early stage of the collision, whereas in the J/ψ case there is substantial experimental evidence of an additional regeneration component.

Evaluation of bioherbicidal potential of Carica papaya leaves

Due to increased number of herbicide resistant weeds, it is needed to explore the allelopathic potential of plants as an alternative. The research was conducted to investigate allelopathic effects of Carica papaya L. leaf powder and aqueous extract on seeds as well as pre-germinated seeds of Avena fatua L., Helianthus annuus L., Rumex dentatus L., Zea mays L. and Triticum aestivum L. on filter paper and soil in Weed Management Program Laboratory, Department of Plant and Environmental Protection at PARC Institute of Advanced Studies in Agriculture, National Agriculture Research Centre, Islamabad, Pakistan. Germination percentage (%), radicle length (cm) and plumule length (cm) were parameters observed for 'Plant leaf powder bioassay' and 'Aqueous extract method'. Most significant growth inhibition was observed in A. fatua seedlings in filter paper method. A. fatua radicle length was reduced by C. papaya aqueous extract (80%) and leaf powder (89%) bioassays. Plumule length was reduced under the influence of aqueous extract (57-73%) and powdered material (59-77%). The inhibitory effects on other test species were in sequence of H. annuus followed by Z. mays and R. dentatus. The aqueous extract showed non-significant effect on wheat seed germination, radicle and plumule growth. It is suggested that C. papaya aqueous extract can be used as source of weed management in wheat crop.

An outbreak of Japanese encephalitis in a non-endemic region of north-east India

Background There are few comprehensive reports of epidemic Japanese encephalitis in a previously unaffected region. We report our experience of a first-ever outbreak of it in Sonitpur District, Assam, India, with 45 laboratorycon confirmed cases at a single hospital. Method Between 2 July and 11 August 2008, patients meeting the WHO definition of acute encephalitis syndrome were assessed in a single hospital and had tests including blood and cerebrospinal fluid for Japanese encephalitis antibody titres. Results Ninety-six cases meeting the definition of acute encephalitis syndrome were identified with 45 cases of Japanese encephalitis confirmed by cerebrospinal fluid or blood results. For Japanese encephalitis positive patients, mean age was 36 (range 4-80). Of the 45, 11 (24%) died and a further 21 (47%) had significant residual deficits. Focal neurological signs (40%) and seizures (25%) were common. Conclusion An effective Japanese encephalitis vaccine is the key intervention for limiting the population impact of this disease. Identification of these cases led to a district-wide mass vaccination campaign.

Investigations of Anisotropic Flow Using Multiparticle Azimuthal Correlations in pp, p-Pb, Xe-Xe, and Pb-Pb Collisions at the LHC

Measurements of anisotropic flow coefficients (v_{n}) and their cross-correlations using two- and multiparticle cumulant methods are reported in collisions of pp at sqrt[s]=13  TeV, p-Pb at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, Xe-Xe at sqrt[s_{NN}]=5.44  TeV, and Pb-Pb at sqrt[s_{NN}]=5.02  TeV recorded with the ALICE detector. The multiplicity dependence of v_{n} is studied in a very wide range from 20 to 3000 particles produced in the midrapidity region |η|<0.8 for the transverse momentum range 0.2<p_{T}<3.0  GeV/c. An ordering of the coefficients v_{2}>v_{3}>v_{4} is found in pp and p-Pb collisions, similar to that seen in large collision systems, while a weak v_{2} multiplicity dependence is observed relative to nucleus-nucleus collisions in the same multiplicity range. Using a novel subevent method, v_{2} measured with four-particle cumulants is found to be compatible with that from six-particle cumulants in pp and p-Pb collisions. The magnitude of the correlation between v_{n}^{2} and v_{m}^{2}, evaluated with the symmetric cumulants SC(m,n) is observed to be positive at all multiplicities for v_{2} and v_{4}, while for v_{2} and v_{3} it is negative and changes sign for multiplicities below 100, which may indicate a different v_{n} fluctuation pattern in this multiplicity range. The observed long-range multiparticle azimuthal correlations in high multiplicity pp and p-Pb collisions can neither be described by pythia 8 nor by impact-parameter-Glasma, music, and ultrarelativistic quantum molecular dynamics model calculations, and hence, provide new insights into the understanding of collective effects in small collision systems.

First Observation of an Attractive Interaction between a Proton and a Cascade Baryon

This Letter presents the first experimental observation of the attractive strong interaction between a proton and a multistrange baryon (hyperon) Ξ^{-}. The result is extracted from two-particle correlations of combined p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} pairs measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC with ALICE. The measured correlation function is compared with the prediction obtained assuming only an attractive Coulomb interaction and a standard deviation in the range [3.6, 5.3] is found. Since the measured p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} correlation is significantly enhanced with respect to the Coulomb prediction, the presence of an additional, strong, attractive interaction is evident. The data are compatible with recent lattice calculations by the HAL-QCD Collaboration, with a standard deviation in the range [1.8, 3.7]. The lattice potential predicts a shallow repulsive Ξ^{-} interaction within pure neutron matter and this implies stiffer equations of state for neutron-rich matter including hyperons. Implications of the strong interaction for the modeling of neutron stars are discussed.

Assessing a thermal spike model of swift heavy ion-matter interactions via Pd1-xNix/Si interface mixing

The thermal spike model (TSM), a widely accepted mechanism of swift heavy ion (SHI)-matter interactions, provides explanation for various SHI induced effects, including mixing across interfaces. We assess the validity of the model via tuning the electron-phonon coupling strength (G) by taking a series Pd_1-xNi_x of a completely solid soluble binary, and then observing Pd_1-xNi_x/Si interface mixing induced by a combination of 100 MeV Au ion irradiation and 4 keV Ar ion sputtering. If the TSM truly describes the SHI-matter interaction mechanism, any non-linearity in x-variation of G must also result in a similar non-linearity in the x-dependence of mixing. Experimentally, the extent of mixing has been parametrized by the irradiation induced change Δσ² in variances of Pd and Ni depth profiles derived from XPS. Computationally, G determined using density functional theory has been used to solve the equations appropriate to the TSM, and then an equivalent quantity L², proportional to Δσ², has been calculated. Both Δσ²(x) and L²(x) show non-linearities, albeit in slightly dissimilar ways, leading to a conjecture that the present work at least does not invalidate the TSM.

Azimuthal Anisotropy of Heavy-Flavor Decay Electrons in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Angular correlations between heavy-flavor decay electrons and charged particles at midrapidity (|η|<0.8) are measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is carried out for the 0%-20% (high) and 60%-100% (low) multiplicity ranges. The jet contribution in the correlation distribution from high-multiplicity events is removed by subtracting the distribution from low-multiplicity events. An azimuthal modulation remains after removing the jet contribution, similar to previous observations in two-particle angular correlation measurements for light-flavor hadrons. A Fourier decomposition of the modulation results in a positive second-order coefficient (v_{2}) for heavy-flavor decay electrons in the transverse momentum interval 1.5<p_{T}<4  GeV/c in high-multiplicity events, with a significance larger than 5σ. The results are compared with those of charged particles at midrapidity and those of inclusive muons at forward rapidity. The v_{2} measurement of open heavy-flavor particles at midrapidity in small collision systems could provide crucial information to help interpret the anisotropies observed in such systems.

Abstract P6-21-12: Local transdermal therapy (LTT): Drug permeation and distribution of telapristone acetate (TPA) in a pre-surgical window study of women undergoing mastectomy

Background: Low uptake and poor adherence to oral drugs for breast cancer prevention and ductal carcinoma in situ has led to an interest in local routes of delivery with the intent of decreasing systemic exposure and reducing toxicity. LTT has emerged as a possible alternative; previous studies have shown selectively higher concentrations in the breast than in the serum with this delivery route. A question related to LTT is whether or not the drug will permeate and distribute throughout the breast, as is expected with oral delivery.

Methods: We conducted a double-blind study of oral versus LTT delivery of the selective progesterone receptor modulator, telapristone acetate (TPA), in a presurgical window setting, enrolling 82 women planning therapeutic or prophylactic mastectomy. We randomized 67 women 1:1, to oral TPA 12 mg daily, or gel TPA applied to both breasts daily (12 mg/breast), for 4 weeks ±1 week. Mastectomy specimens were sampled at 5 non-tumor locations as well as the tumor and lymph node when available. Samples were split in two: drug concentration (conc.) assay using LC-MS/MS and histological evaluation of tissue composition (fat, fibrous stroma, epithelium). The primary endpoint was mean drug conc. across all breast locations (anticipating that the gel would deliver a mean concentration that was &gt;50% of the mean in the oral group). A secondary endpoint was the drug distribution pattern across the breast, expecting that the distribution would be similar. The tumor sample was saved for biomarker assays related to TPA action; these are ongoing, for a pre-planned pooled analysis of data with NCT01800422 (reported in SABCS abstract 851863).

Results: Of 63 evaluable women (33 oral and 30 gel group), 27 had unilateral and 36 had bilateral mastectomy. The mean drug conc. in the oral group was 166.3 ng/G (SE 11.7), and in the gel group was 10.6 ng/G (SE 10.8), (p&lt;.0001). The conc. was variable across the 7 locations tested in both groups. High concentrations were found in the superficial and deep central locations, retroareolar and lateral locations ranked in the middle, and the medial location was discrepant, being high in the oral and low in the gel group. The variation in drug concentration across all locations was not significantly different between groups (Kolmogorov-Smirnov p=0.99). Among women with bilateral mastectomy, drug concentrations were similar between breasts in both oral and gel groups. In the gel group, despite low TPA concentrations, there was evidence of drug metabolism. The major metabolite, CDB 4453 was detectable in 192/193 samples with detectable parent drug. Analysis of drug concentration adjusted for tissue composition is ongoing.

Conclusions: The gel formulation of TPA did not permeate the skin well. However, the drug delivered to the breast was distributed throughout the breast, similar to the oral delivery route, with the highest concentration in the deep central location. These drug distribution data are novel; drug distribution at multiple locations throughout the breast has not previously been shown. Further work is needed to understand breast distribution with formulations known to have good dermal permeation.

Citation Format: Lee O, Pilewskie M, Xu Y, Benante K, Blanco L, Helenowski I, Tull MB, Muzzio M, Jovanovic B, Karlan S, Hansen N, Bethke K, Kulkarni S, Perloff M, Dimond EP, Heckman-Stoddard BM, Khan SA. Local transdermal therapy (LTT): Drug permeation and distribution of telapristone acetate (TPA) in a pre-surgical window study of women undergoing mastectomy [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 P6-21-12.

Abstract OT1-04-01: A phase IIB pre-surgical trial of oral tamoxifen (TAM) versus transdermal 4-hydroxytamoxifen (4-OHT) in women with DCIS of the breast

Background

Ductal carcinoma in situ (DCIS) is diagnosed in 60,000 women annually in the US. TAM is proven to reduce risk of local recurrence and new primary breast cancer in women with estrogen receptor (ER) positive DCIS. However, acceptance of TAM has been low, primarily because of toxicity related to systemic exposure. Local delivery to the breast is an attractive alternative since low systemic levels could minimize toxicity. 4-OHT is an active metabolite of TAM. When formulated as a gel and applied to the breast skin, it is well tolerated, and results in 4-OHT breast tissue drug levels comparable oral TAM. In small pilot studies, its anti-proliferative effects on invasive breast tumors and DCIS are also similar to oral TAM [Lee O, et al. PMID 25028506]. The goal of our study is to validate these results in preparation for a Phase III trial of 4-OHT gel in comparison to oral TAM.

Methods

We are conducting a randomized, double-blinded, placebo-controlled, Phase IIB pre-surgical trial to demonstrate that daily application of 4-OHT gel will result in a reduction in the Ki-67 labeling index of DCIS lesions that is not inferior to that seen in women receiving daily oral TAM 20 mg daily. Ki-67 of the base-line diagnostic core needle biopsy will be compared to that of the therapeutic surgical excision sample after oral TAM or 4-OHT gel for 8 ± 2 weeks. Secondary endpoints include changes in Oncotype DCIS-Score, IHC markers (CD68, COX2, p16), hormone levels, coagulation markers, drug concentration in the plasma and breast tissue, the fraction of women with no residual DCIS in the surgical sample, and experienced symptoms. 100 women (assuming 20% non-evaluable samples or compliance issues) with DCIS (10% ER-positive) will be enrolled across six institutions into two intervention arms: oral TAM 20 mg daily, placebo gel and 4-OHT gel 4mg daily (2mg/breast), placebo capsule. All participants will be evaluable for toxicity from their first dose. All samples from all participants who receive drug will be evaluated and included in the primary analysis, which will be based on intent to treat principle. To date 15 of 100 participants have been enrolled across six institutions including: Northwestern University in Chicago, IL, St. Elizabeth Healthcare in Edgewood, KY, Duke University Medical Center in Durham, NC, Cleveland Clinic in Cleveland, OH, Memorial Sloan Kettering Cancer Center in New York, NY, and Mayo Clinic in Rochester, MN. Since study open, 69 potential participants have been contacted, 52 did not consent for screening, 17consented for screening, 2 are pending consent, and 15 have started study intervention. The most common reasons potential participants chose not to consent are wanting to schedule surgery as soon as possible, attitudes toward medical research, and current use of a prohibited concomitant medication such as a potent inhibitor of tamoxifen metabolism or exogenous sex steroid.

Funding Source: NCI Contract # HHSN2612201200035I.

Citation Format: Benante KA, Xu Y, Tull MB, Segura AJ, Alber KM, Kalinichenko K, Hou L, Jovanovic B, Perloff M, Heckman-Stoddard B, Dimond E, Khan SA. A phase IIB pre-surgical trial of oral tamoxifen (TAM) versus transdermal 4-hydroxytamoxifen (4-OHT) in women with DCIS of the breast [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 OT1-04-01.

Abstract P3-09-02: CRISPR-Cas9 mediated BRCA1 mutation in primary cells: Mutation efficiency and effects

Background: Germline mutations in Breast Cancer Associated (BRCA) 1 or 2 genes confer an increased risk of the development of breast and ovarian cancer. Germline mutation is followed by somatic loss of heterozygosity (LOH) resulting in biallelic inactivation. BRCA1 is involved in multiple homeostatic functions including control of chromatin organization, gene transcription, protein stability and cell division. Recent studies have demonstrated heterogeneity in LOH within and between premalignant and malignant breast tissues of BRCA1 mutation carriers. We hypothesize that LOH does not have a unitary effect on phenotype but differs by the function that is abrogated.

Methods: To test our hypothesis, we adopted CRISPR-Cas9 gene editing technology. The guide RNAs for targeting the exon sequence in the RING finger, nuclear export signal (NES), nuclear localization signal (NLS) and BRCA1 C Terminus (BRCT) domain/motif of BRCA1 were designed and synthesized. MCF10A cells were transfected with a complex of guide RNA and Cas9 protein (RNP) to cause in/del mutation. The mutation was analyzed by both T7E1 assay, and an innovative and more precise method developed in our lab that utilizes linked nucleic acids (LNA) and qPCR. Proliferation and apoptosis assays were performed using the transfected cells. Organoids prepared from BRCA1 mutation carriers also were transfected with RNPs and the mutation burden determined.

Results: Since single cell clones of the transfected MCF10A cells could not be selected and expanded, a pool of transfected cells was used for the analyses. T7E1 assay and qPCR analysis using LNAs demonstrated the presence of the mutations. A standard curve was created to enable the calculation of the mutation burden. IncuCyte analysis revealed increased proliferation and apoptosis, induced by irradiation, in cells with the mutation in Exon 10, where the extent of increase varied from 11% to 48% depending on the degree of mutation. In contrast, cells with the mutation in Exon 5 displayed diminished proliferation with no change in apoptosis. That mutations in exon10 and 5 have distinct biological effects when compared to the mutations in other exons is intriguing, and modification of binding proteins will be investigated. Organoids generated from BRCA1 mutation carriers (primary and nonmalignant cells) were able to be successfully transfected using the NEON electroporation system. Mutations were introduced by the CRISPR-Cas9 system and their extent quantified by our LNA-mediated qPCR method.

Conclusions: CRISPR-Cas9-mediated gene editing of BRCA1 in MCF10A resulted in a change in the proliferation rate and the extent of apoptosis that is dependent on the location of the de novo mutation within the gene. The development of a novel method, LNA-mediated qPCR, provides quantitative information regarding the mutations that may be used to correlate mutation burden with biological functional change. Successful establishment of this BRCA1 tumorigenesis model has provided us with a method to test other putative tumor suppressors.

Citation Format: Choi MR, Yadav S, Shidfar A, Khan SA, Clare SE. CRISPR-Cas9 mediated BRCA1 mutation in primary cells: Mutation efficiency and effects [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 P3-09-02.

Abstract P3-06-06: Novel breast cancer mutational signatures

Background: Our understanding of the biological processes that generate somatic mutations in breast cancer has increased markedly over the past five years. Using the catalog of somatic mutations present in cancer genomes, over 30 “mutational signatures” have been produced. While these provide important insights into the processes responsible for somatic mutation, gaps remain, and the etiology of several signatures remains unknown.

Methods: We have developed a new method in which the specific nucleotide change (e.g., C&gt;T), the codon that each mutation falls in (e.g., GCT), the position in the codon (e.g., 2), and the nucleotides immediately 5' and 3' of the mutation (e.g., 5': C; 3': G) are all considered. The summary of these mutation characteristics forms a mutational profile for each tissue sample. Putting multiple samples' profiles together forms a sparse matrix with the number of samples as rows and the mutation characteristics as columns. Nonsmooth nonnegative matrix factorization was then applied to enable the discovery of intrinsic patterns in this sparse matrix.

Results: Using somatic mutations identified in 1017 breast cancer tissues from The Cancer Genome Atlas (TCGA), we have identified four mutational signatures. Signature A correlates with the well-defined APOBEC signatures and signature B with the “aging” signature, which is the result 5-methylcytosine hydrolysis. Signature C and signature D are potentially new signatures. Signature D is enriched with C:G&gt;A:T mutations; these mostly occur in the middle position of codons, and are enriched with GG(CC) either 5' or 3' of the mutation's sequence context. G&gt;T mutations are known to occur as a consequence of oxidative damage that is not repaired. Guanines are vulnerable as they have the highest vertical oxidation potential of the nucleobases. The 5' guanines in GG sites are especially reactive. We hypothesize that Signature D results from oxidative mutagenesis.

When correlated with clinical phenotypes, the basal subtype is clearly enriched for tumors with the Signature D mutation pattern (exposure level is in 169 basal tumors and in 797 non-basal tumors, p=&lt;0.01), suggesting an etiologic link with basal-like breast cancer. G&gt;T somatic mutations in breast cancer mainly take place during cell replication rather than during transcription. In the normal breast, epithelial cell replication occurs during the luteal phase of the menstrual cycle and during pregnancy, primarily under the direction of progesterone (P). P binds to its receptor (PR) in a subpopulation of PR positive cells where it initiates the transcription of genes including RANKL, with resultant paracrine stimulation (through RANK), of the NF-κB signaling pathway in neighboring cells. The four RANKL genes (TOP2A, MKI67, PBK, CDK1), defined by Nolan et al., are all positively associated with the signature D (P-values &lt; 0.05), suggesting that this type of mutagenesis is associated with RANKL pathway upregulation.

Conclusions: We have identified a potentially new somatic mutational signature, which we have designated as Signature D, which appears to result from exposure of DNA to oxidative stress during replication. It is associated with the basal subtype of breast cancer as well as RANKL- NF-κB pathway upregulation.

Citation Format: Zeng Z, Vo AH, Luo Y, Khan SA, Clare SE. Novel breast cancer mutational signatures [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 P3-06-06.

Abstract P2-02-06: Deregulated lipid metabolism fuels the genesis of estrogen receptor negative breast cancer

Background:

There are no targeted pharmacologic interventions currently available for the prevention of hormone receptor negative breast cancer. Primary prevention with endocrine agents decreases the risk of ER positive disease with no effect against ER negative (ER-) disease. Thus, there is a compelling need to identify women at high risk for ER-negative breast cancer and to uncover the molecular mechanisms involved in its genesis. Our recent observation that a set of lipid metabolism (LiMe) genes are over-expressed in the contralateral unaffected breasts of women with unilateral ER- breast cancer suggests the novel hypothesis that specific lipid metabolism pathways in the breast produce a physiological milieu favoring the development of ER- breast cancer. We are now testing the specific hypothesis that lipids are the source of the acetyl-coA that is utilized to acetylate histones, an epigenetic modification that reprograms transcription.

Methods:

We developed an in-vitro model that relies on octanoic acid, a medium chain fatty acid that freely diffuses though the plasma and mitochondrial membranes. MCF-10A cells were plated and allowed to adhere overnight and then exposed to an increasing dose of sodium octanoate for 24 hours in complete media. Acetylation of Lysine 9 of Histone 3 (H3K9) was analyzed by Western blot and RNA was extracted for qPCR and RNA-seq. Chromatin packing density at the nanoscale was quantified bypartial wave spectroscopic (PWS) microscopy. Mammary organoids were prepared from breast tissue by collagenase digestion and similarly treated.

Results:

We found a striking, dose-dependent increase of H3K9 acetylation in octanoate treated MCF-10A cells. The acetylation is specific to the lipids as no acetylation was observed in cells treated with the same concentration of the alcohol 1,4-Cyclohexanedimethanol. RNA-Seq revealed the differential expression of LiMe genes together with a significant upregulation of Hedgehog and Notch signaling pathways. Individual genes from various pathways were further verified by qPCR which revealed, for example, a four-fold increase in SHH expression and 25-fold increase in DLL4. The expression of two of the previously identified LiMe genes, HMGCS2 and ACSL3, was increased four-fold in the octanoate treated MCF10A cells. We repeated the octanoate treatment in organoids and found similar effects. PWS in live cells showed a dose-dependent increase in chromatin packing scaling (D) in cells exposed to octanoate, suggesting that accessibility of chromatin to transcription factors is increased upon fatty acid treatment.

Conclusion:

A lipid rich microenvironment affects metabolism in ER- MCF10A cells and stimulates pro-neoplastic signaling via histone modifications. This supports our hypothesis that perturbed lipid metabolism plays an important role in the development of ER- breast cancer. Further mechanistic studies will determine if the genes differentially expressed in cell culture are also differentially expressed in antecedent benign breast biopsies from women eventually diagnosed with ER+ and ER- cancer.

Citation Format: Yadav S, Choi M, VanDerway D, Bauer G, Backman V, Khan SA, Clare SE. Deregulated lipid metabolism fuels the genesis of estrogen receptor negative breast cancer [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 P2-02-06.

Abstract P5-04-02: Progesterone receptor (PR) antagonism by telapristone acetate (TPA): A randomized, placebo-controlled phase IIB pre-surgical window trial in women with stage 0-II breast cancer

Background: In vitro and preclinical data indicate that TPA, a selective PR modulator, has activity against hormone-sensitive early breast cancer. We conducted a pre-surgical window trial of oral TPA in Stage 0-II breast cancer to assess the effect of TPA on suppression of cell proliferation (Ki67), and on differential gene expression in responsive and non-responsive tumors.

Methods: We enrolled 70 pre and postmenopausal women into a 1:1 randomized, double-blind, placebo-controlled trial of oral TPA 12mg (Repros Therapeutics Inc.) for 2-10 weeks. The primary endpoint was Ki67 labelling, comparing diagnostic core needle biopsy to post-therapy surgical specimens. Ki67 changes were quantitated by dual immunohistochemistry (Ki67/pan-cytokeratin) and image analysis (Aperio ImageScope and Definiens Tissue Studio®). RNA-sequencing (using RNA extracted from the paraffin blocks) was performed with Illumina TruSeq RNA Coding Access method. Differential gene expression pre-post therapy was assessed, followed by Gene Set Enrichment Analysis for pathway analysis. Ki67 changes from baseline were tested with Paired signed-rank test. For gene expression analysis, p values were calculated by Wald test and adjusted for multiple comparisons by Benjamini-Hochberg method (adjusted p &lt;0.05 and 2-fold gene expression cut-off).

Results: Among 61 evaluable women, (29 placebo and 32 TPA) 97% of tumors were ER or PR positive and 91% were ER and PR positive (balanced across arms). A significant 6% decrease in mean %Ki67 was seen in the TPA arm (p= 0.003). When stratified by menopause, the significance held in premenopausal women (n= 22, p= 0.03) but not in postmenopausal women (n=10, p= 0.08). However, a Ki67 decrease (4%) was also observed in placebo group (p = 0.04); this was non-significant after pre- postmenopausal stratification. Overall, differential gene expression analysis showed no significant modulation of genes in either group. Using a pre-specified response parameter (50% relative reduction in Ki67), we identified 12/32 (38%) “responders” in the TPA, and 9/29 (31%) in the placebo arm. In sub-group analysis of these responders, we found 103 genes to be significantly modulated by treatment in the TPA “responders”, but saw no significant change in any gene expression in placebo “responders”. Gene set enrichment analysis for the 103 genes showed that TPA blocked the progression of cell cycle genes (PTTG1, PLK1, UBE2C, HIST1H3F, PSMD3, and etc.) and suppressed PGR and ERBB2 expression. In a pre-planned pooled analysis, these results will be combined with NCT02314156, reported in SABCS abstract 851790.

Conclusions: An anti-proliferative (Ki67) signal of TPA was observed in early stage breast cancer patients, but interpretation was limited by placebo group changes. The TPA group demonstrated differential suppression of proliferation-related genes among Ki67 responders, but the placebo group did not. Ongoing analysis will examine signatures related to stemness, metastasis, and immune suppression (potentially better endpoints in trials targeting P signaling). These analyses may help us select the right population and the right biomarkers for future trials.

Citation Format: Lee O, Sullivan ME, Xu Y, Shidfar A, Ivancic D, Zeng Z, Singhal H, Helenowski I, Jovanovic B, Hansen N, Bethke K, Gann P, Gradishar WJ, Clare SE, Khan SA. Progesterone receptor (PR) antagonism by telapristone acetate (TPA): A randomized, placebo-controlled phase IIB pre-surgical window trial in women with stage 0-II breast cancer [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 P5-04-02.

Building a cloud-based data sharing model for the Saudi national registry for implantable medical devices: Results of a readiness assessment

BACKGROUND

Implantable medical device registries are used as a medium to conduct post-marketing surveillance. Little information is available on the development and implementation of implantable biomedical device registries in general and specifically in Saudi Arabia and the Middle East.

OBJECTIVES

This study presents the experiences of building an implantable medical device registry in the Kingdom of Saudi Arabia. The work specifically addresses the early experiences of the Saudi Food and Drug Authority in the planning and development of a data sharing model for the implementation of a medical device registry at different hospital sites within the country.

METHODS

A two-year case study in which 60 health professionals from 5 hospitals in Saudi Arabia participated in a readiness assessment survey. The readiness assessment examined system-level capacity, hospital workflow and operations, clinical staff-level engagement, and technological assessment as they relate to the implementation of the Implantable Medical Device Registry (IMDR). Both subjective and objective data were collected as part of the readiness assessment survey at each hospital site. Data was collected from participants either individually or as part of a group at each hospital site. Using Microsoft Excel, Microsoft Word, flip charts, and back-and-forth discussion, the data was descriptively summarized and synthesized to provide an overview of hospital readiness for IMDR implementation.

RESULTS

Results show that there are large differences among Saudi hospitals in terms of their readiness for IMDR implementation due to a variety of factors relating to differences in hospital-wide organizational systems, clinical practice, technological infrastructure, and data sharing capabilities. Each of the hospitals surveyed in this study had differences in how clinical biomedical implantation policies and procedures were utilized. Manual entry into the cloud-based IMDR was recommended as the most optimal data sharing model that would mitigate the differences between hospital readiness for IMDR implementation.

CONCLUSION

Registries play a major role in monitoring the effectiveness of implantable biomedical devices. National standardized policies, enforced regulations, and information technology infrastructure are needed to achieve this goal. Furthermore, due to differences in hospital readiness, building a cloud-based registry system through manual data entry into the IMDR was found to be the most appropriate data sharing model that can be implemented at the national level.

Adiposity Results in Metabolic and Inflammation Differences in Premenopausal and Postmenopausal Women Consistent with the Difference in Breast Cancer Risk

Obesity is associated with increased risk of breast cancer in postmenopausal but not in premenopausal women. Many factors may be responsible for this difference. The aim of this study was to determine the mechanisms by which the genes related to the AMPK pathway, inflammation, and estrogen actions are affected by adiposity in breast tissue with the objective of identifying differences that may explain the different breast cancer risk in premenopausal and postmenopausal women. Random fine needle aspirates (rFNAs) of breast tissue were collected from 57 premenopausal and 55 postmenopausal women and were classified as normal weight, overweight, or obese. Expression levels of 21 target genes were determined using a TaqMan Low Density Array procedure. Breast tissue estradiol levels were measured by a liquid chromatography-tandem mass spectrometry procedure, and serum estradiol and follicle-stimulating hormone (FSH) were measured by a radioimmunoassay and an enzyme-linked immunosorbent assay, respectively. We found that in postmenopausal women, serum and tissue estradiol levels were increased in those who were overweight, and serum FSH levels were decreased in obese status. Interestingly, RPS6KB1, an AMPK downstream-responsive gene for protein synthesis and cell growth, and estrogen receptor α (encoded by the ESR1 gene) and its target gene GATA3 were significantly decreased in rFNA of premenopausal, obese women. In postmenopausal women, RPS6KB1, ESR1, and GATA3 expression remained unchanged in relation to adiposity. However, prostaglandin-endoperoxide synthase 2 (PTGS2), cyclin D1 (CCND1), and another ESR1 target gene, TFF1, were elevated in rFNA of obese postmenopausal women. Thus, as bodyweight increases, gene expression is indicative of increased proliferation in postmenopausal women but decreased proliferation in premenopausal women. Overall, our data reveal a novel process by which obesity promotes the risk of breast cancer in postmenopausal but not premenopausal women.

Irradiation-Induced Compositional Effects on Human Bone After Extracorporeal Therapy for Bone Sarcoma

The present study investigates Raman scattering of human bone irradiated with 50 Gy single dose during therapeutic treatment of Ewing and Osteosarcoma. Bone quality was evaluated via mineral-to-matrix ratio, degree of crystallinity, change in amount of calcium, and carbonate substitution. Alteration in collagen and its cross-links was quantified through second-derivative deconvolution of Amide I peak. A dose of 50 Gy radiation leads to almost 50% loss of mineral content, while maintaining mineral crystallinity, and small changes in carbonate substitution. Deconvolution of Amide I suggested modifications in collagen structure via increase in amount of enzymatic trivalent cross-linking (p < 0.05). Overall irradiation led to detrimental effect on bone quality via changes in its composition, consequently reducing its elastic modulus with increased plasticity. The study thus quantifies effect of single-dose 50 Gy radiation on human bone, which in turn is necessary for designing improved radiation dosage during ECRT and for better understanding post-operative care.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Is VEGF under-expressed in Indian children with Perthes disease?

BACKGROUND

The role of vascular endothelial growth factor (VEGF) after ischaemic necrosis of the femoral head in Legg-Calve-Perthes disease (LCPD) has not been adequately studied in humans, especially in Indian population. Therefore, we aimed to evaluate the serum levels of VEGF-A in Indian children with various stages of LCPD and compare them with those of an age- and sex-matched control group of healthy children.

METHODS

In this case-control study, we enrolled 42 children (below 14 years age) suffering from LCPD and 21 age- and sex-matched healthy controls. Patients were classified radiographically according to Waldenstrom's classification. Serum VEGF-A was estimated by sandwich enzyme-linked immunosorbent assay technique. The serum values were compared between the patient group and the control group, as well as between the Waldenstrom subgroups. Results were expressed as means with ranges or median with interquartile range.

RESULTS

The mean age in the patient as well as the control group was 9 years (range 4-13 years). The median value (interquartile range) of serum VEGF-A was 162.5 pg/ml (673.75 pg/ml) in the patient group and 652 pg/ml (190.5 pg/ml) in the control group (p = 0.013). When compared between lower Waldenstrom stages (initial stage + stage of fragmentation) and higher Waldenstrom stages (re-ossification stage + stage of healing), the mean values of serum VEGF-A were 464.7 pg/ml (range 0-2211 pg/ml) and 301.1 pg/ml (range 0-1910 pg/ml), respectively (p = 0.305).

CONCLUSIONS

VEGF is under-expressed in Indian children suffering from LCPD. As VEGF acts as a key regulator of endochondral ossification, our finding may open new therapeutic approaches to the disease. Also, serum VEGF may act as a valuable marker for the follow-up of the disease. Our study also provides baseline data about serum VEGF-A levels in Indian cohort of LCPD patients. Future multi-centre studies are warranted with a larger sample size to fully appreciate the patho-physiological changes in VEGF occurring in LCPD.

D-Meson Azimuthal Anisotropy in Midcentral Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The azimuthal anisotropy coefficient v_{2} of prompt D^{0}, D^{+}, D^{*+}, and D_{s}^{+} mesons was measured in midcentral (30%-50% centrality class) Pb-Pb collisions at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, with the ALICE detector at the LHC. The D mesons were reconstructed via their hadronic decays at midrapidity, |y|<0.8, in the transverse momentum interval 1<p_{T}<24  GeV/c. The measured D-meson v_{2} has similar values as that of charged pions. The D_{s}^{+} v_{2}, measured for the first time, is found to be compatible with that of nonstrange D mesons. The measurements are compared with theoretical calculations of charm-quark transport in a hydrodynamically expanding medium and have the potential to constrain medium parameters.

First report of Chikungunya virus circulation during a dengue outbreak in Arunachal Pradesh, a Northeastern state of India

Dengue has become a major public health problem in Pasighat, Arunachal Pradesh since 2012 outbreak. This region is rich in Aedes mosquitoes, the common vector for Dengue and Chikungunya (CHIK), however, active surveillance of CHIK is lacking in this part of India. Therefore, this study has been undertaken to detect the presence of CHIKV infection during 2014 and 2015 dengue outbreak in Arunachal Pradesh. A total of 116 (52 during 2014 and 64 during 2015 outbreak) dengue negative serum samples were collected from General Hospital, Pasighat and were screened for the presence of CHIK IgM antibodies. All the samples were further processed for CHIKV RNA detection by RT-PCR using specific primers. Phylogenetic tree was constructed by Neighbor Joining method using Kimura-2 parameter model. A total of 8 samples were found to be positive for IgM antibodies. RT-PCR showed CHIKV RNA positivity in 2 samples. Both of these samples belonged to 2014 outbreak. Phylogenetic tree revealed that the CHIKV circulating during the outbreak belonged to Eastern, Central and Southern African genotype. Sequence analysis showed two uniform nucleotide substitutions. Circulation of CHIKV masked by dengue is reported from this study. Therefore, CHIKV diagnosis should be made as a routine test in areas where dengue is already endemic so as to prevent misdiagnosis of the disease and to check its accomplishment before commencing an outbreak.

Abstract P6-07-09: Attenuation of progesterone driven mammary stem cell expansion by telapristone acetate

Purpose: The interplay of the ovarian hormones estradiol (E2) and progesterone (P4) contributes to the development of breast cancer, potentially aided by P4-induced expansion in mammary stem cells as observed in diestrous phase in mice, as well as the luteal phase and during pregnancy in women. Telapristone Acetate (TPA), a selective progesterone receptor modulator (SPRM), exhibits a protective effect against mammary carcinogenesis in rodents. TPA has been shown to display a more specific PR blockade and less toxicity when compared to RU486. We have examined the mammary stem cell pool expansion upon exposure to E2+P4 in mice and compared its attenuation by both TPA and RU486.

Methods: 8 week old female ovariectomized FVB mice weighing above 20g, were randomized into 4 treatment groups: sham (skin incision only, no pellets), E2+P4, E2+P4+Telapristone Acetate (TPA), E2P4+ Mifepristone (RU486). Eight experimental replicates were performed. At age 10 weeks, the mice were implanted with subcutaneous 30-day release pellets of E2 and P4 (0.3 mg E2 & 30.0 mg P4), E2P4+TPA (30.0 mg) and E2P4+RU486 (30.3 mg) in either flank. The mice were euthanized at day 15 of treatment. Single cell suspensions of the 4th inguinal mammary gland pair and one thoracic gland were prepared and labeled with cell surface markers. Lineage negative mammary gland cells were sorted into luminal and basal population subsets. The basal cell niche was identified as CD24+CD49fhi, the mammary stem cells (MaSC) within this niche are identified by CD61+CD49fhi. The cells were sorted on BD FACSAria 5-Laser and the data was analyzed using BD FACSDIVA.The D'Agostino-Pearson test was performed to determine the normal distribution and once normal distribution was confirmed one-way ANOVA (repeated measures) was performed to examine differences in percent cell populations with Tukey test for post-hoc analysis.

Results: The mammary stem cells (MaSC, CD61+CD49fhi) within the basal cell (CD24+CD49fhi) niche showed significant expansion at day 15 in mice implanted with Estrogen and Progesterone 30-day release pellet compared to sham (64.2%, 45.07% respectively; p=0.0392). This expansion was significantly attenuated in both TPA (-38.21%, p=0.011) and RU486 (-34.30%, p=0.002) treated mice compared to MaSC in mice treated with E2+P4 alone (+45.07%). Simultaneously, luminal progenitor cells (CD61+CD49flo) show a marked reduction in E2+P4 treated mice compared to sham (17.77%, 45.54%, respectively; p=0.0375). Luminal mature cells (CD61-CD49flo) show an expansion in E2+P4 treated mice compared to sham (82.23%, 54.41% respectively; %, p=0.0371). TPA significantly (58.40 %, p=0.061) suppresses LM cells expansion observed in the E2+P4 group. TPA and RU486 show significant suppression of the MaSC population in mouse mammary gland compared to the EP-treated mice.

Conclusion: TPA and RU486 alter the P4 driven changes in mammary gland cellular composition and in a manner consistent with the hypothesis that they will inhibit hormone-induced tumorigenesis in the mammary gland. To gain a better insight into this phenomenon, a high throughput transcriptomic profiling (RNASeq) of mammary stem cells isolated from the treatment groups is being performed.

Citation Format: Ranjan M, Lee O, Sun L, Karavites L, Clare S, Khan SA. Attenuation of progesterone driven mammary stem cell expansion by telapristone acetate [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-07-09.

Abstract P5-14-01: Telapristone acetate abrogates PR-dependent paracrine-mediated mammary cell proliferation

Background: Blockade of the progesterone (P)-progesterone receptor (PR) axis is a novel but untested strategy for breast cancer prevention. We report preclinical data evaluating telapristone acetate (TPA) compared with mifepristone (MFP), the prototype PR-antagonist. We hypothesize that the progesterone-PR blockade by TPA will inhibit PR-dependent paracrine expression (RANKL, WNT4, ID4, and calcitonin) attenuating cell proliferation and abrogating side branching and alveoli formation of mammary glands induced by hormones similar in extent or superior to MFP.

Methods:Adult virgin FVB mice at 12 weeks of age were randomized to four treatment groups: no treatment control, EP (0.3 mg E + 30 mg P), EP + TPA (30mg), and EP + MFP (30mg). Hormone and drug pellets were subcutaneously implanted in flank area between the neck and shoulder. After 28-day treatments, the mice were euthanized to collect mammary glands, and processed as mammary whole mounts and as formalin-fixed paraffin embedding (FFPE) specimens. We evaluated cell proliferation (Ki67) by immunohistochemistry. Total RNA was extracted from FFPE specimens and the Nanostring nCounter assay was utilized to assess paracrine gene expression. The Mann Whitney test was used to calculate statistical significance (p&lt;0.05).

Results: We observed a considerable increase in side branches and alveoli in EP treatment group compared to the controls. The growth of the mammary gland stimulated by EP treatment was corroborated by a significant increase in Ki67 compared to control mice (median 41% vs 24%, respectively, p &lt; 0.0001). Both TPA and MFP treatment abrogated side branching and alveoli formation and significantly reduced median Ki67 to 1/3 of that of control mice having endogenous estrus cycle hormone levels (24%, 8%, and 9% for control, EP+TPA and EP+MFP groups, respectively).TPA induced greater Ki67 reduction than MFP (7.5 ± 1.9% vs. 9.4 ± 1.9%, p= 0.04). As expected, EP treatment upregulated the RANKL expression compared to the control group while the administration of TPA and MFP significantly inhibited the RANKL expression stimulated by EP treatment. The mRNA expression measurement revealed that Rankl expression was 18 fold increased by EP treatment but completely inhibited by TPA and MFP treatment (p&lt;0.001 for both drugs). Similarly the Rank expression was increased two-fold by EP treatment (p&lt; 0.05) but down-regulated by TPA and MFP treatment (p&lt;0.01 for both drugs). We observed significant upregulation of Wnt4, and Calca expression by EP treatment compared to controls (p&lt;0.01 for both). Id4 expression showed the same trend but the change was non-significant. The addition of TPA completely opposed the hormone-stimulated increase of three paracrine molecules (Wnt4, Calca, and Id4) to a level below control group (p&lt; 0.001 for all).

Conclusions: We have demonstrated that TPA abrogates cell proliferation induced by exogenous EP hormones in an ovary intact mouse model. The blockade of PR-P binding was evident by complete inhibition of paracrine expression (not only RANKL/RANK expression but also WNT4, Calcitonin, and ID4 expression). TPA was efficacious as MFP in opposing paracrine-induced mammary cell proliferation, and warrants further testing in a breast cancer prevention trial.

Citation Format: Lee O, Sun L, Karavites LC, Clare SE, Khan SA. Telapristone acetate abrogates PR-dependent paracrine-mediated mammary cell proliferation [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-14-01.

Abstract ES11-2: Local therapy of limited disease in ABC: what is the evidence?

Surgery and radiotherapy have been used as adjunctive treatments for women with Stage IV breast cancer and a low volume of disease, for many years. This encompasses patients with intact or recurrent disease at the primary site, as well as those with oligometastatic distant disease. The evidence to support local therapy (LT) approaches in this group of patients is largely retrospective, although randomized trials are ongoing. For patients with an intact primary tumor, over 20 retrospective analyses suggest that women undergoing primary site LT (PSLT) experience longer survival than those whose primary tumor receives no LT, with one meta-analysis of these data reporting a hazard ratio (HR) of 0.69 (95%CI 0.63, 0.77). However, a concern about selection bias as the explanation for this apparent benefit has led to several randomized trials. Two of these were reported recently, with mixed results. The design and the results of the two completed trials were different. In Mumbai, India (NCT00193778), initial therapy consisted of chemotherapy followed by randomization to PSLT or not; results showed no overall survival difference, but local control was improved in the PSLT arm. In Turkey, MF07-01 randomized Stage IV patients to PSLT or not, followed by usual systemic therapy; results suggest an improvement in overall survival at 5 years for women in the PSLT arm. Two other randomized trials are ongoing, both designed with initial systemic therapy. In the meantime, existing data do not clearly support the use of PSLT as a means of improved survival, but the local control advantage was clear in both trials, and therefore PSLT may be offered to women whose primary tumors do not respond well to systemic therapy.

For women with oligometastatic disease, the data supporting LT measures is again retrospective, and consists of small, highly selected series. However, interest in LT approaches spans back many decades, and studies suggest that various strategies of surgery, radiotherapy, and more recently stereotactic body radiotherapy (SBRT), are associated with prolonged survival. The distant sites that have been subjected to these approaches include isolated metastases in lung, liver, bone, and brain. For isolated lung lesions in particular, resection also allows a clear distinction between primary and metastatic disease, since a large fraction of solitary lung lesions may in fact be primary lung tumors. In the liver, small retrospective series of highly selected patients undergoing resection suggest that longer-than-expected median survival can be observed in patients with limited disease and a long disease-free interval. Minimally invasive ablation techniques are being used with similar intent. For osseous sites, retrospective analyses of high-dose radiotherapy with ablative intent reflect similar caveats and similar results to the data on lung and liver. An important ongoing trial (NCT02364557) is randomizing women with a controlled primary tumor site and ≤2 metastatic lesions that are amenable to treatment with SBRT or surgery, to usual care or usual care with the addition LT to distant sites that must be separated by a distance of &gt;5 cm. These ongoing studies will bring much-needed clarity to the role pf LT approaches to both the primary site and limited distant disease.

Citation Format: Khan SA. Local therapy of limited disease in ABC: what is the evidence? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr ES11-2.