A novel induced pluripotent stem cell model of schwann cell differentiation reveals NF2 -related gene regulatory networks of the extracellular matrix

Schwann cells are vital to development and maintenance of the peripheral nervous system and their dysfunction has been implicated in a range of neurological and neoplastic disorders, including NF2 -related schwannomatosis. We have developed a novel human induced pluripotent stem cell (hiPSC) model for the study of Schwann cell differentiation in health and disease. We performed transcriptomic, immunofluorescence, and morphological analysis of hiPSC derived Schwann cell precursors (SPCs) and terminally differentiated Schwann-like cells (SLCs) representing distinct stages of development. To further validate our findings, we performed integrated, cross-species analyses across multiple external datasets at bulk and single cell resolution. Our hiPSC model of Schwann cell development shared overlapping gene expression signatures with human amniotic mesenchymal stem cell (hAMSCs) derived SLCs and in vivo mouse models, but also revealed unique features that may reflect species-specific aspects of Schwann cell biology. Moreover, we have identified gene co-expression modules that are dynamically regulated during hiPSC to SLC differentiation associated with ear and neural development, cell fate determination, the NF2 gene, and extracellular matrix (ECM) organization. By cross-referencing results between multiple datasets and analyses, we have identified potential new genes that are related to NF2 for further study including: ANXA1, CDH6, COL1A1, COL8A1, MFAP5, IGFBP5, FGF1, AHNAK, CDKN2B, LOX, CAV1 , and CAV2 . Our hiPSC model further provides a tractable platform for studying Schwann cell development in the context of human disease.

Patient awareness of the association between periodontal and systemic diseases in an academic setting

BACKGROUND

Periodontal diseases (PD) have been increasingly associated with several systemic conditions such as cardiovascular disease (CVD), diabetes mellitus (DM), rheumatoid arthritis (RA), and Alzheimer's disease (AD). This study aimed to gain insight into patients' awareness of the association between PD and systemic diseases.

METHODS

A survey was developed to analyze patient awareness of the association between PD and systemic diseases. Descriptive and categorical variables were summarized with counts and percentages. Chi-squared tests were used to evaluate differences between variables. A linear logistical regression model was used to assess the simultaneous, independent association between each variable.

RESULTS

Data from 161 completed surveys were analyzed. The majority of the participants (61.49%) reported awareness of symptoms of PD, but only 36.36% identified all its major symptoms. Individuals reporting awareness of the association between PD and systemic diseases was 48.4%, 31.7%, 14.9%, and 9.9% for CVD, DM, RA, and AD, respectively. Patients aged ≥51 years and males were more aware of the association between PD and CVD. Increased awareness of an association between PD and DM was observed among patients who had a higher frequency of dental visits and those with a self-reported history of DM.

CONCLUSIONS

This study provides insight that, even with the vast amount of scientific knowledge on the inter-relationships that exist between PD and systemic diseases, most patients are still unaware of these associations. This research identified that improvement of health literacy surrounding PD, their symptoms, and their association with systemic diseases may be warranted.

Predictors and timeline of spontaneous conversion to normal sinus rhythm: A single center retrospective cohort study of patients with symptomatic atrial fibrillation

INTRODUCTION

Annual healthcare expenditures associated with atrial fibrillation (AF) in the United States (US) continue to grow as more symptomatic patients present to emergency departments (ED). Predictors of spontaneous conversion to normal sinus rhythm (ScNSR) remain poorly understood, as well as the timeline of ScNSR remains unclear. We sought to 1) to assess the association of key demographics, anthropometric, and clinical factors to ScNSR and 2) to evaluate the timeline of ScNSR, and 3) determine clinical predictors of ScNSR.

METHODS

This single center, retrospective cohort study analyzed patients aged ≥18 years with symptomatic AF as diagnosed and evaluated through the ED of a rural tertiary care center in West Virginia from September 2015 to December 2018.

RESULTS

Our cohort consisted of 375 AF patients (mean age 65 years, 54% male). A total of 177 patients attained ScNSR either in the ED or after hospital admission with a mean conversion time of 14.7 h (±12). Onset of symptoms <24 hrs has strong positive association to ScNSR 3.97 (95% CI: 2.24-7.05; p < 0.0001). Male gender 0.55 (95% CI: 0.35-0.85; p = 0.007) and hypertension 0.48 (95% CI: 0.31-0.76; p = 0.002), showed a strong negative association to ScNSR. Of the patients that converted spontaneously (177), the majority, 136 (76.8%) achieved ScNSR within 24 h of ED triage without use of electrical or chemical cardioversion.

CONCLUSION

Most patients with AF in the ED converted spontaneously to sinus rhythm within the first 24 h which underscores the importance of earlier watchful waiting over interventions to achieve normal sinus rhythm (NSR).

Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial

Objective

To examine the combined effects of neuromuscular electrical stimulation-resistance training (NMES-RT) and functional electrical stimulation-lower extremity cycling (FES-LEC) compared to passive movement training (PMT) and FES-LEC in adults with SCI on (1) oxygen uptake (VO2), insulin sensitivity and glucose disposal in adults with SCI; (2) Metabolic and inflammatory biomarkers; (3) skeletal muscle, intramuscular fat (IMF) and visceral adipose tissue (VAT) cross-sectional areas (CSAs).

Materials and methods

Thirty-three participants with chronic SCI (AIS A-C) were randomized to 24 weeks of NMES-RT + FES or PMT + FES. The NMES-RT + FES group underwent 12 weeks of evoked surface NMES-RT using ankle weights followed by an additional 12 weeks of progressive FES-LEC. The control group, PMT + FES performed 12 weeks of passive leg extension movements followed by an additional 12 weeks of FES-LEC. Measurements were performed at baseline (BL; week 0), post-intervention 1 (P1; week 13) and post-intervention 2 (P2; week 25) and included FES-VO2 measurements, insulin sensitivity and glucose effectiveness using the intravenous glucose tolerance test; anthropometrics and whole and regional body composition assessment using dual energy x-ray absorptiometry (DXA) and magnetic resonance imaging to measure muscle, IMF and VAT CSAs.

Results

Twenty-seven participants completed both phases of the study. NMES-RT + FES group showed a trend of a greater VO2 peak in P1 [p = 0.08; but not in P2 (p = 0.25)] compared to PMT + FES. There was a time effect of both groups in leg VO2 peak. Neither intervention elicited significant changes in insulin, glucose, or inflammatory biomarkers. There were modest changes in leg lean mass following PMT + FES group. Robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA and knee extensor CSA were noted in the NMES-RT + FES group compared to PMT + FES at P1. PMT + FES resulted in muscle hypertrophy at P2. NMES-RT + FES resulted in a decrease in total VAT CSA at P1.

Conclusion

NMES-RT yielded a greater peak leg VO2 and decrease in total VAT compared to PMT. The addition of 12 weeks of FES-LEC in both groups modestly impacted leg VO2 peak. The addition of FES-LEC to NMES-RT did not yield additional increases in muscle CSA, suggesting a ceiling effect on signaling pathways following NMES-RT.

Clinical trial registration

identifier NCT02660073.

Race and Age-Related PSA Testing Disparities in Spinal Cord Injured Men: Analysis of National Veterans Health Administration Data

Background

Prostate-specific antigen (PSA) testing remains controversial due to the debate about overdetection and overtreatment. Given the lack of published data regarding PSA testing rates in the population with spinal cord injury (SCI) within the US Department of Veterans Affairs (VA), there is concern for potential disparities and overtesting in this patient population. In this study, we sought to identify and evaluate national PSA testing rates in veterans with SCI.

Methods

Using the VA Informatics and Computing Infrastructure Corporate Data Warehouse, we extracted PSA testing data for all individuals with a diagnosis of SCI. Testing rates were calculated, analyzed by race and age, and stratified according to published American Urological Association guideline groupings for PSA testing.

Results

We identified 45,274 veterans at 129 VA medical centers with a diagnosis of SCI who had records of PSA testing in 2000 through 2017. Veterans who were only tested prior to SCI diagnosis were excluded. Final cohort data analysis included 37,243 veterans who cumulatively underwent 261,125 post-SCI PSA tests during the given time frame. Significant differences were found between African American veterans and other races veterans for all age groups (0.47 vs 0.46 tests per year, respectively, aged ≤ 39 years; 0.83 vs 0.77 tests per year, respectively, aged 40-54 years; 1.04 vs 1.00 tests per year, respectively, aged 55-69 years; and 1.08 vs 0.90 tests per year, respectively, aged ≥ 70 years; P < .001).

Conclusions

Significant differences exist in rates of PSA testing in persons with SCI based on age and race. High rates of testing were found in all age groups, especially for African American veterans aged ≥ 70 years.

Getting on the Same Page: A Quality Improvement Project to Enhance Nurse-to-Resident Communications and Reduce Overnight Sleep Interruptions

BACKGROUND

Many residency programs utilize "home call" residents who answer hospital communications and place orders from home. Often, residents are required to live nearby and arrive in-person if needed. Residents work normal daytime work hours while on home call, which can last several nights. This disrupts sleep and creates the potential for increased resident fatigue and patient safety issues.

OBJECTIVE

To implement and evaluate a novel program to reduce non-urgent overnight pages from nurses to home call physical medicine and rehabilitation (PM&R) residents between 11 pm and 6 am.

METHODS

At an inpatient acute rehabilitation unit in a tertiary care university teaching hospital, we implemented a 2-step prospective quality improvement study with interventions derived from nurse-physician meetings implemented 9 months apart in 2018 and 2019. The first intervention was a centralized nightly handoff sheet. The second intervention was to display suggested PRN medication lists in resident workrooms. The primary outcome measure was the percentage of nights with non-urgent pages between 11 pm and 6 am. Tracking urgent pages and 7-10 am emergent pages were used as balancing measures.

RESULTS

A total of 1835 text-based nursing pages (366 pre- and 1469 post-intervention) were received and categorized by content, urgency, and timing over a 17-month period. Post-intervention, there was a stable 25% decrease in nighttime non-urgent pages. The most common hour to be paged shifted from 11 pm to 8 pm. Pain, constipation, insomnia, and nausea were the most common complaints overnight.

CONCLUSIONS

By characterizing and studying nighttime pages, residents collaborated with nighttime nursing staff through structured meetings to reduce non-urgent nighttime pages for more than 1 year.

Unraveling COVID-19: A Large-Scale Characterization of 4.5 Million COVID-19 Cases Using CHARYBDIS

Purpose

Routinely collected real world data (RWD) have great utility in aiding the novel coronavirus disease (COVID-19) pandemic response. Here we present the international Observational Health Data Sciences and Informatics (OHDSI) Characterizing Health Associated Risks and Your Baseline Disease In SARS-COV-2 (CHARYBDIS) framework for standardisation and analysis of COVID-19 RWD.

Patients and Methods

We conducted a descriptive retrospective database study using a federated network of data partners in the United States, Europe (the Netherlands, Spain, the UK, Germany, France and Italy) and Asia (South Korea and China). The study protocol and analytical package were released on 11th June 2020 and are iteratively updated via GitHub. We identified three non-mutually exclusive cohorts of 4,537,153 individuals with a clinical COVID-19 diagnosis or positive test, 886,193 hospitalized with COVID-19, and 113,627 hospitalized with COVID-19 requiring intensive services.

Results

We aggregated over 22,000 unique characteristics describing patients with COVID-19. All comorbidities, symptoms, medications, and outcomes are described by cohort in aggregate counts and are readily available online. Globally, we observed similarities in the USA and Europe: more women diagnosed than men but more men hospitalized than women, most diagnosed cases between 25 and 60 years of age versus most hospitalized cases between 60 and 80 years of age. South Korea differed with more women than men hospitalized. Common comorbidities included type 2 diabetes, hypertension, chronic kidney disease and heart disease. Common presenting symptoms were dyspnea, cough and fever. Symptom data availability was more common in hospitalized cohorts than diagnosed.

Conclusion

We constructed a global, multi-centre view to describe trends in COVID-19 progression, management and evolution over time. By characterising baseline variability in patients and geography, our work provides critical context that may otherwise be misconstrued as data quality issues. This is important as we perform studies on adverse events of special interest in COVID-19 vaccine surveillance.

Characteristics and Outcomes of Over 300,000 Patients with COVID-19 and History of Cancer in the United States and Spain

BACKGROUND

We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza.

METHODS

We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes.

RESULTS

We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%-18% and 1%-14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin's lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza (n = 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events.

CONCLUSIONS

Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent.

IMPACT

This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.

Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study

OBJECTIVE

To investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.

DESIGN

Multinational network cohort study.

SETTING

Hospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.

PARTICIPANTS

303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.

MAIN OUTCOME MEASURES

Prescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.

RESULTS

Of the 303 264 patients included, 290 131 were from the US, 7599 from South Korea, 5230 from Spain, and 304 from China. 3455 drugs were identified. Common repurposed drugs were hydroxychloroquine (used in from <5 (<2%) patients in China to 2165 (85.1%) in Spain), azithromycin (from 15 (4.9%) in China to 1473 (57.9%) in Spain), combined lopinavir and ritonavir (from 156 (<2%) in the VA-OMOP US to 2,652 (34.9%) in South Korea and 1285 (50.5%) in Spain), and umifenovir (0% in the US, South Korea, and Spain and 238 (78.3%) in China). Use of adjunctive drugs varied greatly, with the five most used treatments being enoxaparin, fluoroquinolones, ceftriaxone, vitamin D, and corticosteroids. Hydroxychloroquine use increased rapidly from March to April 2020 but declined steeply in May to June and remained low for the rest of the year. The use of dexamethasone and corticosteroids increased steadily during 2020.

CONCLUSIONS

Multiple drugs were used in the first few months of the covid-19 pandemic, with substantial geographical and temporal variation. Hydroxychloroquine, azithromycin, lopinavir-ritonavir, and umifenovir (in China only) were the most prescribed repurposed drugs. Antithrombotics, antibiotics, H2 receptor antagonists, and corticosteroids were often used as adjunctive treatments. Research is needed on the comparative risk and benefit of these treatments in the management of covid-19.

Unraveling COVID-19: a large-scale characterization of 4.5 million COVID-19 cases using CHARYBDIS

Background: Routinely collected real world data (RWD) have great utility in aiding the novel coronavirus disease (COVID-19) pandemic response [1,2]. Here we present the international Observational Health Data Sciences and Informatics (OHDSI) [3] Characterizing Health Associated Risks, and Your Baseline Disease In SARS-COV-2 (CHARYBDIS) framework for standardisation and analysis of COVID-19 RWD. Methods: We conducted a descriptive cohort study using a federated network of data partners in the United States, Europe (the Netherlands, Spain, the UK, Germany, France and Italy) and Asia (South Korea and China). The study protocol and analytical package were released on 11 th June 2020 and are iteratively updated via GitHub [4]. Findings: We identified three non-mutually exclusive cohorts of 4,537,153 individuals with a clinical COVID-19 diagnosis or positive test, 886,193 hospitalized with COVID-19 , and 113,627 hospitalized with COVID-19 requiring intensive services . All comorbidities, symptoms, medications, and outcomes are described by cohort in aggregate counts, and are available in an interactive website: https://data.ohdsi.org/Covid19CharacterizationCharybdis/. Interpretation: CHARYBDIS findings provide benchmarks that contribute to our understanding of COVID-19 progression, management and evolution over time. This can enable timely assessment of real-world outcomes of preventative and therapeutic options as they are introduced in clinical practice.

Impact of Traumatic Brain Injury on Clinical Institute Withdrawal Assessment Use in Trauma Patients: A Descriptive Study

BACKGROUND

Alcohol withdrawal syndrome (AWS) and traumatic brain injury (TBI) present with similar signs and symptoms, yet their treatment strategies differ greatly. AWS treatment includes the Clinical Institute Withdrawal Assessment (CIWA) protocol, which grades withdrawal signs and symptoms. A major purpose of CIWA is to guide the addition and titration of central nervous system (CNS) depressants, most commonly benzodiazepines. Conversely, best practice is to avoid these same CNS depressants in the setting of TBI. Thus, patients with TBI presenting with AWS risk may receive undesirable interventions that could worsen outcome.

OBJECTIVE

To describe the relationship of TBI diagnosis with CIWA protocol scores and intervention implementation.

DESIGN

Retrospective cohort observational study.

SETTING

Single university-based, level one trauma center.

PATIENTS

Three hundred seventy-five patients with head trauma or AWS classification, identified through the trauma center's trauma registry.

INTERVENTIONS

CIWA protocol and related medication use.

MAIN OUTCOME MEASURES

Frequency of elevated CIWA score, length of CIWA administration, and medication administration incidence were abstracted from patients' medical records.

RESULTS

The percentage of elevated CIWA scores increased significantly with TBI severity, from 4.5%(0-60) in the No TBI group, up to 12.5% (0-36) in the Mild TBI group, 27.1% (0-57) in the Moderate TBI group, and 50.0% (14-77) in the Severe TBI group. Nominally, lorazepam use showed a similar pattern of escalation with TBI severity, but it did not reach statistical significance. Haloperidol use did significantly escalate with higher TBI severity. No group differences were observed for total lorazepam equivalents or length on the CIWA protocol.

CONCLUSIONS

TBI diagnosis and higher TBI severity level correlate with higher CIWA scores, but neither increased nor decreased benzodiazepine usage was observed. Antipsychotic use did escalate with TBI diagnosis and severity. The risks versus benefits of minimizing benzodiazepines in patients with TBI who are at risk for AWS warrant future study.

Skeletal muscle hypertrophy and attenuation of cardio-metabolic risk factors (SHARC) using functional electrical stimulation-lower extremity cycling in persons with spinal cord injury: study protocol for a randomized clinical trial

Background

Persons with spinal cord injury (SCI) are at heightened risks of developing unfavorable cardiometabolic consequences due to physical inactivity. Functional electrical stimulation (FES) and surface neuromuscular electrical stimulation (NMES)-resistance training (RT) have emerged as effective rehabilitation methods that can exercise muscles below the level of injury and attenuate cardio-metabolic risk factors. Our aims are to determine the impact of 12 weeks of NMES + 12 weeks of FES-lower extremity cycling (LEC) compared to 12 weeks of passive movement + 12 weeks of FES-LEC on: (1) oxygen uptake (VO₂), insulin sensitivity, and glucose disposal in adults with SCI; (2) skeletal muscle size, intramuscular fat (IMF), and visceral adipose tissue (VAT); and (3) protein expression of energy metabolism, protein molecules involved in insulin signaling, muscle hypertrophy, and oxygen uptake and electron transport chain (ETC) activities.

Methods/Design

Forty-eight persons aged 18–65 years with chronic (> 1 year) SCI/D (AIS A-C) at the C5-L2 levels, equally sub-grouped by cervical or sub-cervical injury levels and time since injury, will be randomized into either the NMES + FES group or Passive + FES (control group). The NMES + FES group will undergo 12 weeks of evoked RT using twice-weekly NMES and ankle weights followed by twice-weekly progressive FES-LEC for an additional 12 weeks. The control group will undergo 12 weeks of passive movement followed by 12 weeks of progressive FES-LEC. Measurements will be performed at baseline (B; week 0), post-intervention 1 (P1; week 13), and post-intervention 2 (P2; week 25), and will include: VO₂ measurements, insulin sensitivity, and glucose effectiveness using intravenous glucose tolerance test; magnetic resonance imaging to measure muscle, IMF, and VAT areas; muscle biopsy to measure protein expression and intracellular signaling; and mitochondrial ETC function.

Discussion

Training through NMES + RT may evoke muscle hypertrophy and positively impact oxygen uptake, insulin sensitivity, and glucose effectiveness. This may result in beneficial outcomes on metabolic activity, body composition profile, mitochondrial ETC, and intracellular signaling related to insulin action and muscle hypertrophy. In the future, NMES-RT may be added to FES-LEC to improve the workloads achieved in the rehabilitation of persons with SCI and further decrease muscle wasting and cardio-metabolic risks.

Trial registration

ClinicalTrials.gov, NCT02660073. Registered on 21 Jan 2016.

Proton pump inhibitors not associated with hypomagnesemia, regardless of dose or concomitant diuretic use

BACKGROUND AND AIM

Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide, with dramatic efficacy for upper gastrointestinal acid-related disorders. In recent years, however, the safety of long-term PPI use has been questioned. One issue based on scant and conflicting literature is the possibility of PPI-related hypomagnesemia. Our purpose was to assess for any clinically significant alteration in serum magnesium levels in large groups of patients taking different PPIs in varying doses, with or without diuretics.

METHODS

This was a retrospective review of patient records at time of hospitalization, from February 2012 to December 2014. Two thousand four hundred patients were randomly selected from a pool of 12 058 magnesium levels performed at or within 24 h of hospital admission. Patients were categorized in six groups based on outpatient PPI and/or diuretic use. The main outcome studied was hypomagnesemia, defined as serum magnesium level < 1.6 mg/dL.

RESULTS

Mean magnesium levels were normal in PPI users (1.84 ± 0.29 mg/dL [normal 1.6 to 2.5 mg/dL]) and PPI nonusers (1.85 ± 0.30 mg/dL), P = 0.40, and there was no statistical difference in the prevalence of hypomagnesemia (14.7% vs 15.1%, P = 0.77). In separate groups, there were also no significant differences in serum magnesium levels between those taking PPIs of varying doses, with or without concomitant diuretics, and those not taking PPIs or diuretics.

CONCLUSION

Regardless of PPI dosage or concomitant diuretics prescribed, magnesium levels were unaffected. Routine screening of serum magnesium in PPI patients appears unnecessary.

Abstract B096: CDCP1, a potential noninvasive biomarker in circulating tumor cells for treatment of prostate cancer with FAK inhibitors

Background: Tumor metastasis requires dynamic changes in cell adhesion mediated through beta 1-integrin and focal adhesion kinase (FAK). In particular, FAK is responsible for counteracting anoikis and promoting survival of CTCs. The Cub-Domain Containing Protein–1 (CDCP1) is a transmembrane glycoprotein expressed in epithelial cells that regulates cell adhesion. CDCP1 loss leads to activation of FAK in nonadherent cancer cells (na-PCC) (Spassov, 2011). As we demonstrated, another consequence of loss of CDCP1 is the inhibition of inside-out activation of beta 1-integrin in na-PCC, suggesting that FAK activation can occur in the absence of active beta 1-integrin. The main goal of this project is to determine how FAK becomes activated in na-PCC upon CDCP1 silencing and to establish that CDCP1 loss sensitizes to treatment with FAK inhibitors.

Methods: CTCs were collected from nine patients with castrate-resistant prostate cancer (CRPC) (Schehr, 2016). CTC mRNA was eluted and used for CDCP1 qPCR. CDCP1 was stably silenced in DU145 with short hairpins (Spassov, 2013). In the anoikis assay, 5 x 105 DU145 shControl and shCDCP1 cells were suspended on HEMA coated plates for up to 6 hrs. Western blot membranes were probed for pMAPK1/2, MAPK1/2, FAKpY397, FAKpY925, and FAK. For MTT assays, 5,000 DU145 shControl and shCDCP1 were incubated for 24 hrs on HEMA-coated 96-well plates in regular culture medium +/- Saracatinib, FAKi-PF573228 (kinase domain inhibitor) and FAKi-LGA (FAT domain inhibitor) and/or MEKi-PD98059. A kinase dead mutant of PIP5K-D316A from the Addgene PIP5K plasmid was generated by site directed mutagenesis.

Results: We find reduced CDCP1 expression in CTCs from patients with CRPC. Six patients did not express detectable CDCP1 mRNA in CTCs, 1 patient demonstrated CDCP1 expression at the limit of detection, and in 2 patients CDCP1 mRNA levels were above the limit of detection. Silencing CDCP1 in DU145 and PC3 cells results in 3.4-fold higher proliferation rates and 4.4-fold greater anchorage-independent growth rates. CDCP1-negative tumors grew in 100% of mice, versus 30% growth of CDCP1 positive control tumors. In na-PCC, CDCP1 silencing triggered FAK activation, as demonstrated by de novo pY397 and pY925. In addition, 73% of CDCP1-negative cells expressed FAK-stimulated pMAPK. FAK activation required a factor in human plasma and involved a trypsin-sensitive receptor in na-PCC. CDCP1 loss also conferred increased sensitivity to treatment with the PF573228 FAK-kinase inhibitor. At the 4uM concentration 98.1% of CDCP1-positive cells survived compared to 32.9% of CDCP1-silenced cells. An inhibitor treatment matrix showed a synergistic treatment effect of dual targeting of SRC, FAK, and MEK with up to 3-fold increased cytotoxicity of FAKi+SRCi or FAKi+MEKi. The largest treatment effect was observed when all 3 inhibitors were combined. To better understand the role of the FAK-MEK pathway in anoikis, a novel C-terminal FAT domain inhibitor was investigated and compared to PF573228. To determine the mechanism of FAK activation in na-PCC, we expressed a dominant negative PIP5K-D316A mutant. Expression of this mutant is expected to reduce CDCP1-induced FAK activation and also diminish SRC activity.

Conclusion: We discovered a synergistic treatment effect between FAK and SRC and/or MEK inhibition in CDCP1-negative nonadherent cells. Expression of pFAK and pMAPK downstream of CDCP1 loss overcomes anoikis and depends on a factor in human plasma. By silencing beta 1-integrin and activating FAK, CDCP1-negative cancer cells may gain easy access to the circulation and survive during the CTC phase of cancer dissemination. CDCP1 loss may serve as a biomarker to identify patients who benefit from treatment with FAK inhibitors.

Funding: This work was supported by Department of Defense Synergistic Idea Development Award W81XWH-08-1-0268.

Citation Format: Sara Pollan, Jamie Sperger, Joshua Lang, Fangjin Huang, Jie Zheng, Colm Morrissey, Anne E. Cress, Danislav Spassov, Mark Moasser, William Carter, Beatrice Knudsen. CDCP1, a potential noninvasive biomarker in circulating tumor cells for treatment of prostate cancer with FAK inhibitors [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr B096.

Abstract 148: Observational Study of Efficacy of Low-Dose Amiodarone

Importance: Atrial fibrillation (AF) is the most common rhythm abnormality of the heart and is projected to double between 2010 and 2030. Many patients with AF remain symptomatic after rate control with medications and hence need anti-arrhythmic medications to maintain sinus rhythm. Among the multiple medications to prevent AF recurrence, amiodarone (AM) is the most effective. AM and dofetilide are the only 2 medications approved to prevent recurrence of AF in patients with left ventricular dysfunction. Most papers considered “low dose” AM to be between 200 and 300 mg daily. Even a recent review in a major journal recommended maintaining sinus rhythm (SR) with AM 200 to 300 mg daily. Two very small studies from China showed AM 100 mg to be effective. A recent unpublished report by McGrew demonstrated the impressive effectiveness of 100 mg or less of AM to prevent recurrence of AF.

Objective: To determine the known AF free interval after first identification of receiving 100 mg AM or less to prevent recurrence of AF.

Methods: An observational retrospective chart review of randomly selected adult patients identified to be taking AM 100 mg for AF recurrence for at least 2 months at Charleston Area Medical Center (CAMC) or community clinics during January 1, 2008 to June 30, 2014.

Results: Fifty-one patients who were taking AM ≤ 100 mg were identified. Mean duration of apparent AF free continuous treatment was 25.2 ± 23.3 months. AM was decreased in 4% (2 of 51) patients and stopped in 31% (16 of 51) patients for AF recurrence, perceived side effect or unknown reasons. SR was maintained for 25.7 ± 27.7 months.

Conclusion: This small study showed that very low dose AM is commonly used in the community and appears to be an effective option for AF prophylaxis. It is important, the providers selecting medications to prevent recurrence of AF be aware of this option.

Abstract 144: Nuclear Stress Testing- Exercise vs. Chemical

Background: The incidence of coronary artery disease is increasing, resulting in a concurrent rise in cardiac stress testing which usually includes an exercise (ETT) or chemical stress test (CST) with nuclear imaging (SPECT). CST with imaging is recommended for those with the inability to exercise, a left bundle branch block (LBBB) or a paced rhythm at baseline. However, the proportionate use of CST with SPECT appears to be on the rise. The purpose of our study is to assess the frequency of ETT vs. CST with SPECT over the last 10 years.

Methods: This is a retrospective chart review of 854 adult patients at Charleston Area Medical Center (CAMC) who had a CST or ETT with SPECT from January 1, 2007 - April 30, 2016. The frequency of both stress tests, along with patient demographics, physical capabilities, the reason for performing the test, test results and 6 month outcomes were recorded.

Results: The proportion of ETT with SPECT between 2007-2008 was 70.4% (138 of 196) which decreased to 37.7% (75 of 199) between 2015-2016. However, within the same time frame the proportion of CST with SPECT increased from 29.6% (58 of 196) to 62.3% (124 of 199). In patients who had CST, 4.2% (14 of 311)had a LBBB, 9.7% (32 of 331) had a paced rhythm, 13.0% (43 of 331) had reported inability to exercise and 76.3% (171 of 331) had reported ability to ambulate without assistance. For 70.7% (234 of 331) patients, there was no reported reason for choosing CST over ETT with SPECT. Regadenoson was the vasodilator used most frequently for CST. When comparing outcomes in patients who had stress tests with SPECT, 8.8% (29 of 331) of patients who had CST versus 6.3% (33 of 523) who had ETT needed cardiac catheterization (p = 0.18) within 6 months, while 2.4% (8 of 331) of the CST patients versus 1.9% (10 of 523) of ETT patients (p=0.62) required revascularization within 6 months. In patients who had ETT, 81.8% (421 of 523) achieved greater than 85% maximum heart rate for age and 90.4% (473 of 523) achieved greater than 80% maximum heart rate for age.

Conclusion: There has been a marked increase in CST with SPECT performed at CAMC between 2007-2016. While most patients may have the physical capacity and baseline EKG characteristics to qualify for an ETT with SPECT, a clear explanation for this pattern remains unknown. A possible analysis of changes in patient characteristics over this time may provide some insight into this trend.

Abstract 164: Evaluation of Clinical and Social Factors for Patients Taking Very Low Dose of Beta Blockers for Systolic Heart Failure

Background: All guidelines agree that beta-blockers (BBs) should be used for patients with systolic heart failure (SHF) to improve survival. BBs are a class Ia indication for treatment of SHF based on 3 landmark clinical trials (CIBIS-II, COPERNICUS, and MERIT-HF). Despite recommendations, the doses of BBs prescribed are commonly less than target dose (TD). Underdosing of BBs is suggested by doses less than 50% of TD and/or sinus rate (SR) above 70 bpm whereas a very low dose of BB is 25% or less of the TD. Clinical and social factors including depression, dizziness, ability to walk without assistance, Morse Fall Scale score and living status, whether independently or in a care facility, could be likely reasons for patients receiving a very low dose of BB. Failure to achieve SR below 70 bpm might lead physicians to use ivabradine which is a relatively new and expensive medication and is a class IIa indication for SHF. The objective is to evaluate the clinical and social factors affecting underdosing of BBs between the two patient groups with ≤25% of TD vs >25% of TD.

Methods: A retrospective chart review was completed for SHF patients admitted to Charleston Area Medical Center from 2007 to 2016. Doses of BB, SR, and clinical/social factors were recorded. Patients over the age of 18 years with diagnosed SHF (EF<40%) and on BB treatment for more than 8 weeks prior to admission were included.

Results: An initial sample size of 254 patients with SHF was obtained. 65% (164 of 254) were on approved BBs. Of the patients on approved BBs, 71% (117 of 164) were receiving ≤ 25% of the TD and 29% (47 of 164) were receiving >25% of the TD. Mean SR on admission EKG was 85±19.5 in the ≤ 25% TD group, and 83±21.4 in the >25% TD group. Of the 164 patients on approved BB therapy, SR could only be recorded in 105 patients due to atrial pacing or atrial arrhythmias; and 82% (86 of 105) had a SR >70 bpm on their initial EKG. No statistically significant differences were identified between the two groups when reviewing the clinical and social factors.

Conclusions: This study will help enable cardiovascular clinicians to realize that although the use of BBs for SHF has improved dramatically since Get With The Guidelines; there is still marked underdosing of approved BB and inappropriate use of non-approved BB. We are unable to explain this practice based on the clinical and social factors that may have led to underdosing of BB. We found the mean dose of BBs to be 25% or less of TD in 71% (117 of 164) patients on approved BBs and only 18% (19 of 105) of these patients had SR <70bpm. Inappropriate dosing of BBs could potentially be responsible for worsening outcomes and possible overutilization of ivabradine.

Exposure to respirable silica among clay brick workers in Kathmandu valley, Nepal

Previous studies report high respirable silica exposures among clay brick workers globally; however, there are little data on exposures among workers in fixed chimney Bull's trench kilns, the predominant kiln type in Kathmandu valley, Nepal. We investigated respirable silica exposures among workers (N = 46) in five similar exposure groups (SEGs). Mean exposures were highest for red brick loading/carrying (331 μg/m³), followed by green brick stacking (223 μg/m³), fireman (102 μg/m³), coal crushing/carrying (92 μg/m³), and green brick molding (71 μg/m³). The average free silica content (13.8%) in the respirable dust fraction was similar to levels reported for clay brick workers employed in other types of kilns. Dust control measures and respiratory protection are recommended, with priority given to workers assigned to red brick loading and stacking and green brick stacking and carrying.

Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study

Background

Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence.

Methods

This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months.

Results

The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08–4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64–1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence.

Conclusions

Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

Identifying Ancient Settlement Patterns through LiDAR in the Mosquitia Region of Honduras

The Mosquitia ecosystem of Honduras occupies the fulcrum between the American continents and as such constitutes a critical region for understanding past patterns of socio-political development and interaction. Heavy vegetation, rugged topography, and remoteness have limited scientific investigation. This paper presents prehistoric patterns of settlement and landuse for a critical valley within the Mosquitia derived from airborne LiDAR scanning and field investigation. We show that (i) though today the valley is a wilderness it was densely inhabited in the past; (ii) that this population was organized into a three-tiered system composed of 19 settlements dominated by a city; and, (iii) that this occupation was embedded within a human engineered landscape. We also add to a growing body of literature that demonstrates the utility of LiDAR as means for rapid cultural assessments in undocumented regions for analysis and conservation. Our ultimate hope is for our work to promote protections to safeguard the unique and critically endangered Mosquitia ecosystem and other similar areas in need of preservation.

Medical management of aortic coarctation is feasible & durable in selected patients: a case report & literature review

Long-term survival in patients with complete aortic coarctation (AC) without surgical repair has not been well characterized and is rarely documented. We report a case of an 84 year old male with complete aortic coarctation with history of hypertension for more than 40 years. Since the diagnosis was made in early 1950's medical treatment to control hypertension was initiated as patient was deemed high risk for surgical intervention. He has survived to the age of 84 years with minimal medical problems. This report also reviews the few documented cases of prolonged survival in patients with aortic coarctation. This report demonstrates that prolonged survival is possible in patients with documented complete coarctation and awareness of this report may influence the decision to use medical treatment for selected elderly patients with high risk of mortality associated with surgical repair.

Prenatal diagnosis of fetal encephalomalacia after maternal diabetic ketoacidosis

Introduction Encephalomalacia in a developing fetus is a rare and devastating neurological finding on radiologic imaging. Maternal diabetic ketoacidosis (DKA) can lead to metabolic and vascular derangements which can cause fetal encephalomalacia. Case We report the case of a 27-year-old pregnant woman with White's Class C diabetes mellitus who presented in the 25th week of gestation with DKA. Four weeks after her discharge, marked fetal cerebral ventriculomegaly was noted on ultrasound. A subsequent fetal magnetic resonance imaging (MRI) demonstrated extensive, symmetric cystic encephalomalacia, primarily involving both cerebral hemispheres. The pregnancy was continued with close fetal and maternal surveillance. The patient underwent a repeat cesarean delivery in her 37th week. The infant had a 1 month neonatal intensive care unit stay with care rendered by a multiple disciplinary team of pediatric subspecialists. The postnatal course was complicated by global hypotonia, poor feeding, delayed development and ultimately required anticonvulsants for recurrent seizures. He died at the age of 9 months from aspiration during a seizure. Discussion Although the maternal mortality from DKA has declined, DKA still confers significant neurological fetal morbidity to its survivors.

Development and pilot testing of an online intervention to support young couples' coping and adjustment to breast cancer

Couplelinks is an original, professionally facilitated online intervention tailored to the unique challenges facing young women with breast cancer and their male partners. The purpose of this evaluation was to determine the feasibility and acceptability of the intervention and areas for improvement. Sixteen couples were sequentially enrolled over an 18-month period. Couples provided feedback via a treatment satisfaction survey, and post-treatment interviews with a sub-group of participants. Qualitative information was analysed for themes relevant to the program's acceptability, perceived benefits and limitations, and directions for improvement. Of the 16 couples who enrolled, six completed four modules or less, and 10 completed the entire program. Completers reported satisfaction with the program overall, as well as with the website useability and professional facilitation. Reported benefits were: enhanced communication and self-other knowledge; creation of opportunities for meaningful, cancer-related discussion; affirmation of relationship strengths; and a greater sense of closeness between partners. The main reported limitation was how program participation disrupted the couple's usual routine. Themes related to non-completion suggest that partners with particularly elevated relational or illness-related distress, or with differential levels of motivation, are less likely to finish. These findings have led to targeted improvements to the website and intervention protocol.

Medical management in the acute hip fracture patient: a comprehensive review for the internist

Each year, more than 250,000 Americans will suffer a broken hip from a fall from no more than standing height. The National Osteoporosis Foundation estimates that more than 500,000 acute hip fractures will occur annually by the year 2040. The costs associated with this healthcare phenomenon are staggering and will continue to increase with an aging population.Hospitalists routinely comanage orthopedic patients as either consultants or as primary physicians in the hospital setting. A unique set of problems exists in this population. Among them are perioperative cardiac risk, perioperative anemia from acute blood loss, venous thromboembolism prophylaxis, and problems with the timing of surgery. It is imperative that hospitalists understand the orthopedic surgeon's point of view in managing these particular problems and become familiar with the evidence supporting or refuting treatment modalities related to these subject areas. In addition, an understanding of the anatomy and surgical options and complications related to each type of fracture allows the hospitalist to become familiar with postoperative rehabilitation needs. It cannot be overstated that addressing hip fracture prevention must be a part of every patient's perioperative care because the incidence of a repeat fracture is significant. Morbidity related to the fracture and comorbidities also need close examination.This article aims to provide a solid understanding of the issues associated with the acute hip fracture population to enhance practice and allow for the best outcome for patients.

Abstract 1526: Alterations in extracellular matrix modulate AR-regulated transcription in prostate cancer cells

Introduction: The androgen receptor is a key driver of prostate cancer progression. During progression of prostate cancer alterations to the extracellular matrix occur, including changes in expression of the heterotrimeric glycoprotein laminin (LM), which may alter signaling through the androgen receptor.

Purpose: To determine if altered expression of laminin chains affects prostate cancer cell behavior and whether, in androgen receptor (AR) positive lines, AR-regulated transcription is affected by different matrices.

Methods: We exposed prostate cancer cell lines (LNCaP, LNCaP C4-2, PC3, and DU145) to different extracellular matrix proteins (fibronectin, collagen I and IV, and laminin 111) as well as to mixed matrices (Matrigel™–LM111 and col IV; and LM-rich prostate cancer derived matrices–LM332, 511 and the LM alpha 4, alpha 4 beta 2, or beta 2 chains). We measured adhesion and proliferation on these different matrices and as well as changes in mRNA expression for AR-regulated genes in the LNCaP lines following exposure to the various matrices.

Results: Initially we examined what endogenous laminins the prostate cancer cell lines produced and deposited to determine what they might contribute to the exogenous ECMs tested. When grown on uncoated plastic, we found no expression of LM332 by any of the prostate cancer lines used. Cytoplasmic expression of the LM β1γ1 chains was detected in the lines, but deposition of these laminin chains did not occur. We concluded that these lines are not significantly contributing laminins to the ECM. When exposed to the test ECMs, these prostate cancer lines demonstrated increased adhesion to LM-rich PCa-derived matrices, compared with MatrigelTM, fibronectin, or collagen. An inhibitory integrin beta 1 antibody blocked adhesion to LM-rich PCa-derived matrices by &lt;50%, whereas the same antibody blocked adhesion to fibronectin, collagen, LM111, and Matrigel by &gt;90%, suggesting that additional integrins are involved in adhesion to the LM-rich PCa-derived matrices. When these prostate cancer lines were grown on ECM from LM-rich PCa-derived matrices, increased proliferation resulted compared with proliferation on other ECM components. Exposure of the AR positive LNCaP cells to the different ECM components altered expression of AR-regulated genes, including PSA, TMPRSS2, and IGF-IR. The LM-rich PCa-derived matrices increased expression of these genes compared with exposure to fibronectin, collagen, Matrigel™, and uncoated wells.

Summary: Alterations in laminins during progression of prostate cancer affect cancer cell adhesion and proliferation. Further, exposure to LM-rich matrices increased expression of growth promoting AR-regulated genes, which may, in part, modulate cancer cell migration and proliferation.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1526. doi:10.1158/1538-7445.AM2011-1526

Abstract 2329: Alterations in laminin expression modulate prostate cancer cell behavior through changes in integrin and insulin-like growth factor receptor actions

Introduction: During development of primary prostate carcinomas alterations to the extracellular matrix occur, including a loss of laminin 332 (LM332) and one of its cell surface receptors, β4 integrin. There are few published studies on what the laminin composition of metastases may be or how alterations in laminin expression affect prostate cancer cell behavior. Expression of the insulin-like growth factor receptor (IGF-IR) also is altered in prostate cancer progression and some studies suggest cross-talk between integrins and IGF-IR.

Purpose: To determine if laminin and integrin expression is altered in prostate cancer metastases and how these alterations affect prostate cancer cell behavior in light of the interactions between integrins and IGF-IR.

Methods: We performed immunofluorescent (IF) staining on tissue samples of primary PCa and metastases. We also used various prostate cancer cell lines, including M12 cells transfected with the LMα4, β2, or α4β2 chains, to perform adhesion, migration, and proliferation assays in the presence of inhibitory integrin and IGF-IR antibodies.

Results: Our IF staining demonstrated that in addition to a loss in LM332 expression, the LMα4 and β2 chains were absent from the prostate basal membrane in primary prostate tumors. Expression of the LMα5 and β1γ1 chains was retained in primary tumors as well as in lymph node metastases. We saw a loss of β4 integrin in primary tumors as well as in metastatic cancer, but α6 and β1 integrins were retained; in lymph node mets, α2 and α3 integrins also were expressed.

For M12 laminin cells, enhanced adhesion to both collagen and fibronectin was further increased by treatment with the inhibitory IGF-IR antibody A12. An inhibitory β1 integrin antibody, but not individual alpha integrin antibodies, blocked this enhancement. Inhibitory β1 as well as alpha integrin antibodies blocked adhesion of the empty-vector control cells. Similar results were obtained for cell migration studies using a scratch-assay. Staining of cells following exposure to A12 showed there was an increase in LM332 and LMβ1γ1 expression compared to untreated cells, which may account for the increased adhesion and migration following A12 treatment.

We then examined laminin expression of various prostate cancer cell lines: LNCaP, LNCaP C4-2, PC3, and DU145. We found no expression of LM332 in any of these lines. Cytoplasmic expression of the LMβ1γ1 and LMβ2 (LNCaP lines) chains was detected, but deposition of these laminins was not present. These lines demonstrated increased adhesion to laminin-rich ECM compared with adhesion to fibronectin or collagen. And these lines showed enhanced proliferation when grown on laminin-rich ECM from the M12 laminin cells.

Summary: Alterations in laminins affect the adhesion, migration, and proliferation of prostate cancer cells, in part, through integrin and IGF-IR actions.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2329.

Suppressor of cytokine signalling 1 (SOCS1) is a physiological regulator of the asthma response

BACKGROUND

The molecular determinants of the severity and persistence of allergic asthma remain poorly understood. Suppressor of cytokine signalling 1 (SOCS1) is a negative regulator of IL-4-dependent pathways in vitro and might therefore control T-helper type 2 (Th2) immunity associated traits, such as IgE levels, mucin production, IL-5 and IL-13 induction, and eosinophilic mucosal inflammation, which are implicated in allergic asthma.

OBJECTIVE

To investigate the role of SOCS1 in regulating Th2-associated disease traits in a murine sub-chronic aeroallergen-driven asthma model.

METHODS

Following sensitization and challenge with ovalbumin (OVA), bronchoalveolar lavage and serum were collected from mice lacking the Socs1 gene on an IFN-gamma null background (Socs1(-/-)Ifngamma(-/-)). The composition of infiltrating cells in the lung, serum IgE and IgG1 levels and cytokine levels were analysed.

RESULTS

Serum IgE levels and infiltrating eosinophils were considerably increased in the lungs of OVA-treated Socs1(-/-)Ifngamma(-/-) mice compared with Ifngamma(-/-) and C57BL/6 controls. Expression of the Th2 cytokines, IL-4, IL-5 and IL-13 was increased in CD4+ cells and lung tissue from OVA-treated Socs1(-/-)Ifngamma(-/-) mice. IgE, IL-5 levels and infiltrating eosinophils were also elevated in saline-treated Socs1(-/-)Ifngamma(-/-) mice, suggesting that in the absence of SOCS1, mice are already biased towards a Th2 response. It is at present unclear whether the elevated cytokine levels are sufficient to result in the exacerbated Th2 response to OVA challenge or whether enhanced intra-cellular signalling also contributes. Surprisingly, of the various IL-4/IL-13 responsive genes tested, only Arginase I appeared to be modestly up-regulated in the lungs of OVA-treated Socs1(-/-)Ifngamma(-/-) mice, suggesting that regulation by SOCS1 occurs primarily in haematopoietic cells and not in the airway epithelium.

CONCLUSIONS

Together these results indicate that SOCS1 is an important regulator of the Th2 response.

Phase I/II trial combining the HDAC inhibitor, valproic acid (VPA) and FEC100 (5-fluorouracil, epirubicin and cyclophosphamide) in locally advanced/metastatic breast cancer

1065

Background: Cell culture and xenograft studies suggest a synergistic interaction between histone deacetylase inhibitors (HDACi) and topoisomerase (topo) inhibitors, as well as other DNA targeting agents. Methods: In this phase I/II study, we determined the effects of escalating doses of VPA on the clinical efficacy and tolerability of epirubicin. The phase I part was open to patients will all solid tumors. A limited phase II part at the maximum tolerated dose (MTD) of VPA enrolled 10 breast cancer patients and incorporated the breast cancer regimen FEC100 (5-fluorouracil, epirubicin, cyclophosphamide (600/100/600 mg/m2)). VPA was given on days 1–3 prior to epirubicin/FEC100 in 3-week cycles. HDAC expression, histone acetylation and topo II expression were evaluated in pre-and post-VPA peripheral blood mononuclear cells and tumor samples. Results: Fifty-four (44 in phase I and 10 in phase II) patients [median age 55 (39–78)] received VPA (mg/kg/day): 15, 30, 45, 60, 75, 90, 100, 120, 140 and 160. Tumor types included: breast (10+10), melanoma (11), lung (6), sarcoma (2), GYN (2), GI (5) and others (8). Dose-limiting toxicities included somnolence, confusion and febrile neutropenia. No exacerbation of FEC100/epirubicin-related toxicities was observed. Objective responses in the phase I part 9/41 (22%) were seen across different tumor types despite a median number of 3 (0–6) prior regimens with stable disease/minor response in 16/41 (39%). In the breast-specific phase II part, partial responses to date were seen in 4/8 (50%) and stable disease in 2/8 (25%), progression in 1/8 (12.5%), 1/8 (12.5%) patients withdrew consent. All breast cancer patients with a response/stable disease received the maximal number of seven cycles. VPA plasma concentrations correlated with VPA dose. There was a positive correlation between histone acetylation and VPA dose as well as plasma levels in PBMC and further correlated with those in tumors. Conclusion: A sequence-specific combination of VPA and FEC100 in breast cancer is highly active without exacerbation of chemotherapy-induced toxicities. A neoadjuvant phase II trial using VPA (120 mg/kg) -> FEC100 in patients with early stage breast cancer is ongoing.

[Table: see text]

The selective neurotoxicity produced by 3-chloropropanediol in the rat is not a result of energy deprivation

The biochemical mechanism of toxicity of the experimental astrocyte neurotoxicant and food contaminant S-3-chloro-1,2-propanediol (3-CPD) has been proposed to be via inhibition of glyceraldehyde-3-phosphate dehydrogenase (GAPDH). We have confirmed this action in liver, which shows inhibition to 6.0+/-0.7% control at the neuropathic dose of 140 mg/kg. However, GAPDH activity in brain only fell to a minimum of 54+/-24% control, and the concentrations of lactate and pyruvate (the downstream products of GAPDH), showed no pre-neuropathic decreases in 3-CPD susceptible brain tissue. There was no inhibition of GAPDH activity in primary astrocyte cultures at sub-cytotoxic exposures. We therefore sought alternative mechanisms to explain its toxicity to astrocytes. We were able to show that 3-CPD is a substrate for glutathione-S-transferase and also that, after bioactivation by alcohol dehydrogenase, it generates an irreversible inhibitor of glutathione reductase. In addition, incubation of brain slices from the 3-CPD-vulnerable inferior colliculus produces a depletion of glutathione and an inhibition of glutathione-S-transferase that is not seen in equivalent slices taken from the 3-CPD-resistant occipital neocortex. A smaller but significant and similarly regionally selective decrease in glutathione content is also seen in vivo. We conclude that 3-CPD does not produce its astrocytic toxicity via energy deprivation, and suggest that selective bioactivation and consequent disruption of redox state is a more likely mechanism.

Classical positioning decreases the cross-sectional area of the subclavian vein

BACKGROUND

The classic position for subclavian venipuncture is the Trendelenberg position, with the head turned away and placement of a shoulder roll (SR). The purpose of this study was to determine whether this position results in the largest cross-sectional area (CSA) of the subclavian vein (SV).

METHODS

Adult volunteers underwent ultrasound imaging of the right SV in supine and Trendelenberg positioning in the following four head and shoulder positions: head neutral with the chin midline (NL), head turned away (TA), head neutral with an SR, and head TA with an SR (TA/SR). The mean CSA of the SV in each position was calculated. Statistical significance was determined using Student's t, Wilcoxon signed rank, and Bonferroni test.

RESULTS

Eighteen adults participated in the study. Trendelenberg positioning significantly increased the CSA of the SV in all positions except NL compared to supine positioning (P < .03). An SR significantly decreased SV CSA in all positions. The largest SV CSA was obtained in the TA/Trendelenberg position (1.41 +/- .06 cm(2)). The classic positioning for subclavian cannulation, TA/SR/Trendelenberg, resulted in a significantly smaller CSA than TA/Trendelenberg position (1.27 +/- .06 cm(2), 15% reduction, P < .01).

CONCLUSIONS

The classic recommended maneuvers of turning the head and placing an SR significantly reduce the CSA of the SV. Positioning patients in Trendelenberg with the head turned away without an SR optimizes SV size. Positioning patients in this manner may serve to reduce the morbidity associated with percutaneous access of the SV.

Children's acquisition and retention of safety skills: the Lifeskills program

OBJECTIVES

Assessment of safety skills performance and knowledge, to evaluate the education offered by the Lifeskills "Learning for Living" village, Bristol, UK which emphasizes interactive learning-by-doing.

DESIGN

Two quasi-experimental matched control group studies. Study 1: knowledge and performance three months post-intervention. Study 2: knowledge pre-intervention and post-intervention at three time points, to distinguish between immediate learning and longer term retention.

SETTING

The Lifeskills training village, Bristol, UK; primary schools in four education authorities in the area.

PARTICIPANTS

Study 1: 145 children aged 10-11 years; 109 from the Lifeskills program, 36 control. Study 2: 671 children aged 10-11 years; 511 Lifeskills, 160 control.

OUTCOME MEASURES

Three areas (road, home, and fire safety). Five performance tests: observation of children's safety skills. Five knowledge tests: pictorial quiz.

RESULTS

Study 1: Lifeskills/intervention children did better than control children on performance and knowledge tests. The knowledge-performance correlation was r = 0.51. Study 2: intervention children did better than control children immediately after the intervention and three months later on all five knowledge tests. On three tests the intervention group showed retention of knowledge from immediately post-intervention to three months, but on two tests there was some loss. This loss was primarily among children from scholastically lower achieving schools. In all other respects the intervention was equally successful for boys and girls, and for children from higher and lower achieving schools.

CONCLUSIONS

The Lifeskills package improved both knowledge and performance but had shortcomings. Complexity of material did not affect knowledge acquisition but did affect its retention.

The effect of interfacial roughness on the normal incidence bandgap of one-dimensional photonic crystals

As discussed previously, interfacial roughness in one-dimensional photonic crystals (1DPCs) can have a significant effect on their normal reflectivity at the quarter-wave tuned wavelength. We report additional finite-difference time-domain (FDTD) simulations that reveal the effect of interfacial roughness on the normal-incidence reflectivity at several other wavelengths within the photonic bandgaps of various 1DPC quarter-wave stacks. The results predict that both a narrowing and red-shifting of the bandgaps will occur due to the roughness features. These FDTD results are compared to results obtained when the homogenization approximation is applied to the same structures. The homogenization approximation reproduces the FDTD results, revealing that this approximation is applicable to roughened 1DPCs within the parameter range tested (rms roughnesses < 20% and rms wavelengths < 50% of the photonic crystal periodicity) across the entire normal incidence bandgap.