Evaluation of Technology-Enabled Monitoring of Patient-Reported Outcomes to Detect and Treat Toxic Effects Linked to Immune Checkpoint Inhibitors

IMPORTANCE

Immune checkpoint inhibitors can produce distinct toxic effects that require prompt recognition and timely management.

OBJECTIVE

To develop a technology-enabled, dynamically adaptive protocol that can provide the accurate information needed to inform specific remedies for immune toxic effects in patients treated with immune checkpoint inhibitors.

DESIGN, SETTING, AND PARTICIPANTS

An open-label cohort study was conducted at a single tertiary referral center from September 6, 2019, to September 3, 2020. The median follow-up duration was 63 (interquartile range, 35.5-122) days. Fifty patients with genitourinary cancers treated with immune checkpoint inhibitors were enrolled.

INTERVENTIONS

A fit-for-purpose electronic platform was developed to enable active patient and care team participation. A smartphone application downloaded onto patients' personal mobile devices prompted them to report their symptoms at least 3 times per week. The set of symptoms and associated queries were paired with alert thresholds for symptoms requiring clinical action.

MAIN OUTCOMES AND MEASURES

The primary end point of this interim analysis was feasibility, as measured by patient and care team adherence, and lack of increase in care team staffing. Operating characteristics were estimated for each symptom alert and used to dynamically adapt the alert thresholds to ensure sensitivity while reducing unnecessary alerts.

RESULTS

Of the 50 patients enrolled, 47 had at least 1 follow-up visit and were included in the analysis. Median age was 65 years (range, 37-86), 39 patients (83%) were men, and 39 patients (83%) had metastatic cancer, with the most common being urothelial cell carcinoma and renal cell carcinoma (22 [47%] patients each). After initial onboarding, no further care team training or additional care team staffing was required. Patients had a median study adherence rate of 74% (interquartile range, 60%-86%) and 73% of automated alerts were reviewed within 3 days by the clinic team. Symptoms with the highest positive predictive value for adverse events requiring acute intervention included dizziness (21%), nausea/vomiting (26%), and shortness of breath (14%). The symptoms most likely to result in unnecessary alerts were arthralgia and myalgia, fatigue, and cough.

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest an acceptable and fiscally sound method can be developed to create a dynamic learning system to detect and manage immune-related toxic effects.

Survey of Saliva Components and Virus Sensors for Prevention of COVID-19 and Infectious Diseases

The United States Centers for Disease Control and Prevention considers saliva contact the lead transmission means of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19). Saliva droplets or aerosols expelled by heavy breathing, talking, sneezing, and coughing may carry this virus. People in close distance may be exposed directly or indirectly to these droplets, especially those droplets that fall on surrounding surfaces and people may end up contracting COVID-19 after touching the mucosa tissue on their faces. It is of great interest to quickly and effectively detect the presence of SARS-CoV-2 in an environment, but the existing methods only work in laboratory settings, to the best of our knowledge. However, it may be possible to detect the presence of saliva in the environment and proceed with prevention measures. However, detecting saliva itself has not been documented in the literature. On the other hand, many sensors that detect different organic components in saliva to monitor a person's health and diagnose different diseases that range from diabetes to dental health have been proposed and they may be used to detect the presence of saliva. This paper surveys sensors that detect organic and inorganic components of human saliva. Humidity sensors are also considered in the detection of saliva because a large portion of saliva is water. Moreover, sensors that detect infectious viruses are also included as they may also be embedded into saliva sensors for a confirmation of the virus' presence. A classification of sensors by their working principle and the substance they detect is presented. This comparison lists their specifications, sample size, and sensitivity. Indications of which sensors are portable and suitable for field application are presented. This paper also discusses future research and challenges that must be resolved to realize practical saliva sensors. Such sensors may help minimize the spread of not only COVID-19 but also other infectious diseases.

Development of a Sensitive and Reliable UHPLC-MS/MS Method for the Determination of Multiple Urinary Biomarkers of Mycotoxin Exposure

A variety of mycotoxins from different sources frequently contaminate farm products, presenting a potential toxicological concern for animals and human. Mycotoxin exposure has been the focus of attention for governments around the world. To date, biomarkers are used to monitor mycotoxin exposure and promote new understanding of their role in chronic diseases. The goal of this research was to develop and validate a sensitive UHPLC-MS/MS method using isotopically-labeled internal standards suitable for accurate determination of 18 mycotoxin biomarkers, including fumonisins, ochratoxins, Alternaria and emerging Fusarium mycotoxins (fumonisin B1, B2, and B3, hydrolyzed fumonisin B1 and B2, ochratoxin A, B, and alpha, alternariol, alternariol monomethyl ether, altenuene, tentoxin, tenuazonic acid, beauvericin, enniatin A, A1, B, and B1) in human urine. After enzymatic digestion with β-glucuronidase, human urine samples were cleaned up using HLB solid phase extraction cartridges prior to instrument analysis. The multi-mycotoxin and analyte-specific method was validated in-house, providing satisfactory results. The method provided good linearity in the tested concentration range (from LOQ up to 25-500 ng/mL for different analytes), with R2 from 0.997 to 0.999. The limits of quantitation varied from 0.0002 to 0.5 ng/mL for all analytes in urine. The recoveries for spiked samples were between 74.0% and 133%, with intra-day precision of 0.5%-8.7% and inter-day precision of 2.4%-13.4%. This method was applied to 60 urine samples collected from healthy volunteers in Beijing, and 10 biomarkers were found. At least one biomarker was found in all but one of the samples. The high sensitivity and accuracy of this method make it practical for human biomonitoring and mycotoxin exposure assessment.

In vivo online monitoring of testosterone-induced neuroplasticity in a female songbird

Adult neuroplasticity in the song control system of seasonal songbirds is largely driven by photoperiod-induced increases in testosterone. Prior studies of the relationships between testosterone, song performance and neuroplasticity used invasive techniques, which prevent analyzing the dynamic changes over time and often focus on pre-defined regions-of-interest instead of examining the entire brain. Here, we combined (i) in vivo diffusion tensor imaging (DTI) to assess structural neuroplasticity with (ii) repeated monitoring of song and (iii) measures of plasma testosterone concentrations in thirteen female photosensitive starlings (Sturnus vulgaris) who received a testosterone implant for 3 weeks. We observed fast (days) and slower (weeks) effects of testosterone on song behavior and structural neuroplasticity and determined how these effects correlate on a within-subject level, which suggested separate contributions of the song motor and anterior forebrain pathways in the development of song performance. Specifically, the increase in testosterone correlated with a rapid increase of song rate and RA volume, and with changes in Area X microstructure. After implant removal, these variables rapidly reverted to baseline levels. In contrast, the more gradual improvement of song quality was positively correlated with the fractional anisotropy values (DTI metric sensitive to white matter changes) of the HVC-RA tract and of the lamina mesopallialis, which contains fibers connecting the song control nuclei. Thus, we confirmed many of the previously reported testosterone-induced effects, like the increase in song control nuclei volume, but identified for the first time a more global picture of the spatio-temporal changes in brain plasticity.

CUSUM chart method for continuous monitoring of antifouling treatment of tubular heat exchangers in open-loop cooling seawater systems

A CUSUM chart method is presented as an alternative tool for continuous monitoring of an electromagnetic field-based (EMF) antifouling (AF) treatment of a heat exchanger cooled by seawater. During an initial experimental phase, biofilm growth was allowed in a heat exchanger formed of four tubes until sufficient growth had been established. In two of the tubes, continuous EMF treatment was then applied. The heat transfer resistance and heat duty (heat transfer per unit time) results showed that biofilm adhesion was reduced by the EMF treatment. EMF treatments resulted in a 35% improvement in the heat transfer resistance values. The proposed CUSUM chart method showed that the EMF treatment increased the useful life of the heat exchanger by ∼20 days. Thus, CUSUM charts proved to be an efficient tool for continuous monitoring of an AF treatment using data collected online and can also be used to reduce operation and maintenance costs.

Mytilidae as model organisms in the marine ecotoxicology of pharmaceuticals - A review

Growing production and consumption of pharmaceuticals is a global problem. Due to insufficient data on the concentration and distribution of pharmaceuticals in the marine environment, there are no appropriate legal regulations concerning their emission. In order to understand all aspects of the fate of pharmaceuticals in the marine environment and their effect on marine biota, it is necessary to find the most appropriate model organism for this purpose. This paper presents an overview of the ecotoxicological studies of pharmaceuticals, regarding the assessment of Mytilidae as suitable organisms for biomonitoring programs and toxicity tests. The use of mussels in the monitoring of pharmaceuticals allows the observation of changes in the concentration and distribution of these compounds. This in turn gives valuable information on the amount of pharmaceutical pollutants released into the environment in different areas. In this context, information necessary for the assessment of risks related to pharmaceuticals in the marine environment are provided based on what effective management procedures can be developed. However, the accumulation capacity of individual Mytilidae species, the bioavailability of pharmaceuticals and their biological effects should be further scrutinized.

Silicone wristbands integrate dermal and inhalation exposures to semi-volatile organic compounds (SVOCs)

Silicone wristbands are being increasingly used to assess human exposure to semi-volatile organic compounds (SVOCs). However, it is unclear what exposure pathways wristbands integrate. To test the hypothesis that wristbands integrate inhalation and dermal exposures, we measured 38 chemicals from four compound groups (PAHs, PBDEs, nBFRs, and OPEs) in silicone wristbands and brooches, active air samples (Occupational Safety and Health Administration Versatile Sampler or OVS cartridge), and hand wipes from 10 adults during a 72-hour period. Phenanthrene, BDE-47, 2‑ethylhexyl 2,3,4,5‑tetrabromobenzoate (EHTBB), tris[(2R)‑1‑chloro‑2‑propyl] phosphate (TCIPP), and tris(1,3‑dichloro‑2‑propyl) phosphate (TDCIPP) were the predominant compounds in all four matrices. In a linear regression analysis, the compound levels in OVS were positively associated with those in wristbands and brooches for nBFRs and OPEs, but not for PAHs and PBDEs. The compound levels in wristbands were positively associated with those in hand wipes and brooches for all chemicals. The regressions between the levels in wristbands and OVS or brooches combined with the levels in hand wipes showed stronger, supporting the hypothesis that wristbands captured inhalation and dermal exposure pathways.

Optimized extraction of inorganic arsenic species from a foliose lichen biomonitor

To assess the two most toxicologically relevant species of As, namely arsenite (As(III)) and arsenate (As(V)), chromatographic separations often require two separate chromatographic columns to address the co-elution of arsenobetaine (AsB) with As(III). This issue is typically observed using conventional isocratic methods on anion exchange columns, increasing cost and analysis time. Here, we optimize the extraction of inorganic As from a lichen air biomonitor and develop an isocratic method for the chromatographic separation of five common As species on a PRP X-100 anion exchange column, resulting in the complete baseline separation of all species under study. This method was then applied to lichen biomonitors from an urban and rural site to demonstrate its use. In order of abundance, the various arsenic species in lichens from the urban site in South Africa were As(V) > As(III) > AsB > dimethylarsinic acid (DMA) > monomethylarsonic acid (MMA), and As(V) > AsB > As(III) > DMA > MMA for the rural site, where MMA was present in extremely low, non-quantifiable concentrations in lichens from both sites. Total concentrations of As were higher in samples from the urban site (6.43 ± 0.25 μg/g) than in those from the rural site (1.87 ± 0.05 μg/g), with an overall extraction efficiency of 19% and 40%, respectively. The optimized method utilized relatively inexpensive solvents and is therefore low-cost and eco-friendly in comparison with conventional chromatographic techniques. This is the first study which addresses the optimized extraction and characterization of As species in a South African lichen biomonitor of air pollution. Graphical abstract .

Application of a stable carbon isotope for identifying Broussonetia papyrifera pollen

The objective of this study was to investigate whether δ¹³C values can be used to identify pollen specie in the atmosphere. A Burkard 7-day recording volumetric spore trap was used to collected pollens in the atmosphere in Tainan City, Taiwan, from January 2 to December 28, 2006, and a light microscope was used to identify the pollen species and concentrations. A Burkard cyclone sampler was used to collect particulate matter and an elemental analyzer with an isotope ratio mass spectrometer was used to analyze the δ¹³C values. Our data showed that the predominate pollen specie in the atmosphere was Broussonetia papyrifera pollen and that the annual average concentration was 27 grains/m³ (pollen season, 36; nonpollen season, 9 grains/m³). The average δ¹³C value was - 26.19‰ for particulate matter in the atmosphere (pollen season, - 26.00‰; nonpollen season, - 26.28‰). No significant association was observed between δ¹³C values and Broussonetia papyrifera pollen concentrations. However, the δ¹³C value in the atmosphere was associated with the levels of Broussonetia papyrifera pollen among the samples with a diameter of particulate matter smaller than 10 μm at a level lower than 40 μg/m³. In addition, the relative contribution of Broussonetia papyrifera pollen to the carbon in the atmosphere using a two end-member mixing models was found to be associated with the Broussonetia papyrifera pollen concentration. In summary, our study suggested that δ¹³C values can be applied in the assessment of Broussonetia papyrifera pollen specie under specific conditions in the atmosphere.

Assessment of Personal Occupational Exposure to Radiofrequency Electromagnetic Fields in Libraries and Media Libraries, Using Calibrated On-Body Exposimeters

Background and Objectives: With the spread of Wifi networks, safety concerns have arisen, with complaints of somatic disorders, notably in traditional libraries and media libraries. The aim of the present study was to describe the conditions and levels of exposure to radiofrequency electromagnetic fields in the real-life occupational conditions of those working in traditional libraries and media libraries. Methods: Dynamic measurements, using an exposimeter, were taken in 20 radiofrequency bands from 88 to 5850 MHz. The activity of 28 library workers was analyzed on a space-time budget. An audit of exposure sources and static measurements enabled the work-places to be mapped. Results: In seven libraries, 78,858 samples were taken over the 20 radiofrequency bands from 88 to 5850 MHz. Exposure was described for 28 working days. The median total field was 0.071 V/m (10th percentile: 0.022 V/m, 90th percentile: 0.534 V/m) and for Wifi the median field was 0.005 V/m (10th percentile: 0.005 V/m, 90th percentile: 0.028 V/m). Median individual exposure to Wifi frequency waves ranged from 0.005 to 0.040 V/m. Conclusions: Overall, the occupational exposure in this sector was close to the exposure in the general population. Peaks were due to the use of walkie-talkies by security staff. Exposure due to external sources depended on geographic location. Exposure in this occupation is well below the general occupational exposure levels, notably as regards Wifi.

The Comet Assay in Human Biomonitoring

Human biomonitoring studies aim to identify potential exposures to environmental, occupational, or lifestyle toxicants in human populations and are commonly used by public health decision makers to predict disease risk. The Comet assay measures changes in genomic stability and is one of the most reliable biomarkers to indicate early biological effects and therefore accepted by various governmental regulatory agencies. The appeal of the Comet assay lies in its relative simplicity, rapidity, sensitivity, and economic efficiency. Furthermore, the assay is known for its broad versatility, as it can be applied to virtually any human cell and easily adapted in order to detect particular biomarkers of interest, such as DNA repair capacity or single and double-strand breaks. In a standard experiment, isolated single cells are first embedded in agarose, and then lysed in high-salt solutions in order to remove all cellular contents except the DNA attached to a nuclear scaffold. Subsequent electrophoresis results in accumulation of undamaged DNA sequences at the proximity of the nuclear scaffold, while damaged sequences migrate toward the anode. When visualized with fluorochromes, these migrated DNA fragments resemble a Comet tail and can be quantified for their intensity and shape according to internationally drafted guidelines.