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Background Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) are aggressive B-cell non-Hodgkin lymphomas (B-NHL) with a generally favorable prognosis after immunochemotherapy. The outcome of BL is superior to DLBCL. In 2016, a distinct group of lymphomas displaying characteristics of both BL and DLBCL (high grade B-cell lymphoma, HGBL) was introduced into the WHO classification. Histopathological discrimination of BL, DLBCL, and HGBL may be challenging. Data on the frequency of histopathological difficulties resulting in revision of the final diagnosis of BL/DLBCL/HGBL and its impact on the prognosis are limited. Methods We assessed histopathological features and clinical outcomes of 66 patients with suspected diagnosis of BL at the reporting institution between 2010 and 2020. Results The median age was 51 years (range 19-82) and final histopathological diagnosis revealed BL (n = 40), DLBCL (n = 12), or HGBL (n = 14). Patients with DLBCL and HGBL were either treated with DLBCL-directed (83.3% and 35.7%) or BL-directed (16.7% and 64.3%) protocols. Patients in whom diagnosis was revised from DLBCL to BL after initiation of DLBCL-directed treatment had a significantly inferior progression-free survival (PFS) than patients initially diagnosed with BL (p = 0.045), thus resembling rather the prognosis of DLBCL/HGBL. There was no difference between patients with DLBCL and HGBL, respectively, regarding PFS and OS (p = 0.38 and p = 0.27). Conclusion These results suggest that timely and precise histopathological diagnosis as well as reference histopathological review of the underlying lymphoma is critical to determine up-front treatment strategies. Consequently, selection of more aggressive treatment protocols in case of difficulties with discrimination between DLBCL/HGBL/BL may be a reasonable approach.

792 Background: Multi-gene hereditary cancer panels have revolutionized how patients with germline mutations are identified by testing multiple genes at the same time. Despite the availability of panel testing, many patients with a known familial mutation will only undergo single site genetic testing due to limitations in guideline recommendations and insurance coverage. This approach risks a failure to detect additional pathogenic variants and an inappropriate management of cancer risk. In our clinical experience, a subset of patients pursue multigene testing despite a known familial mutation. Our group has identified patients who carry more than one mutation and mutations that would have been missed if the patients had only undergone single site testing. We investigated the patients and families from our risk assessment clinic with multiple familial mutations and determined how medical management may have been changed due to the presence of multiple mutations in family. Methods: The Fox Chase Cancer Center Risk Assessment Program (RAP) Registry was queried to identify patients who carry more than one mutation. Pedigrees of patients and families identified with multiple germline mutations were reviewed. Screening management guidelines were determined from the most recent NCCN guidelines published at the time the patient tested (Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic and Genetic/Familial High-Risk Assessment: Colorectal). The RAP Registry is an IRB approved protocol (IRB 09-831). Results: 70 patients were found to carry at least 2 mutations (excluding patients with biallelic MUTYH mutations) since introducing multi-gene panel testing in 2014. The most common second mutation was the I1307K variant in the APC gene at 20% (14/70). We also identified 20 patients who would have received incomplete genetic risk assessment if they only underwent single site testing and screening management changed in 60% (12/20) of these patients. 35% (7/20) of these patients did not meet NCCN criteria for additional germline testing beyond single site testing. Conclusions: Multi-gene hereditary cancer panels identify patients and families with multiple germline mutations. Patients undergoing single site cascade testing are at risk of receiving inaccurate risk assessment based on incomplete ascertainment of germline cancer risks. Detection of additional actionable mutations will frequently lead to changes in medical management.

Key Points Question What are the prevalences of likely pathogenic or pathogenic (LP/P) germline variants in esophageal, gastroesophageal junction, and gastric cancers? Findings In this cross-sectional study of 515 patients, LP/P germline variants occurred in approximately one-fifth of patients with gastric cancer. Those with early-onset esophagogastic cancer (≤50 years of age at diagnosis) were significantly more likely to harbor an LP/P germline variant. Meaning The results of this study support germline testing in patients with gastric cancer and early-onset esophagogastric cancer., Importance Among patients with esophagogastric cancers, only individuals who present with known features of heritable cancer syndromes are referred for genetic testing. Broader testing might identify additional patients with germline alterations. Objectives To examine the prevalence of likely pathogenic or pathogenic (LP/P) germline alterations among patients with esophagogastric cancer and to assess associations between germline variant prevalence and demographic and clinicopathologic features. Design, Setting, and Participants This cross-sectional study was performed at a tertiary referral cancer center from January 1, 2014, to December 31, 2019, in 515 patients with esophagogastric cancer who consented to tumor and blood sequencing. Main Outcomes and Measures Presence or absence of LP/P variants in up to 88 genes associated with cancer predisposition syndromes as identified by targeted sequencing (Memorial Sloan Kettering–Integrated Mutation Profiling of Actionable Cancer Targets). Results Among 515 patients (median age, 59 years; range, 18-87 years; 368 [71.5%] male; 398 [77.3%] White), 243 (47.2%) had gastric cancer, 111 (21.6%) had gastroesophageal junction (GEJ) cancer, and 161 (31.3%) had esophageal cancer. A total of 48 patients with gastric cancer (19.8%), 16 (14.4%) with GEJ cancer, and 17 (10.6%) with esophageal cancer had LP/P germline variants. The number of LP/P variants in high- and moderate-penetrance genes was significantly higher in patients with gastric cancer (29 [11.9%]; 95% CI, 8.1%-16.7%) vs patients with esophageal cancer (8 [5.0%]; 95% CI, 2.2%-9.6%; P = .03), and the difference was greater for high-penetrance germline alterations in patients with gastric cancer (25 [10.3%]; 95% CI, 6.8%-14.8%) vs in patients with esophageal cancer (3 [1.9%]; 95% CI, 0.38%-5.3%; P = .001). The most frequent high- and moderate-penetrance LP/P alterations were in BRCA1/2 (14 [2.7%]), ATM (11 [2.1%]), CDH1 (6 [1.2%]), and MSH2 (4 [0.8%]). Those with early-onset disease (≤50 years of age at diagnosis) were more likely to harbor an LP/P germline variant (29 [21.0%]; 95% CI, 14.5%-28.8%) vs those with late-onset disease (patients >50 years of age at diagnosis) (52 [13.8%]; 95% CI, 10.5%-17.7%; P = .046). ATM LP/P variants occurred in 6 patients (4.3%; 95% CI, 1.6%-9.1%) with early-onset esophagogastric cancer vs 5 (1.3%; 95% CI, 0.4%-3.1%; P = .08) of those with late-onset esophagogastric cancer. Conclusions and Relevance These results suggest that pathogenic germline variants are enriched in gastric and early-onset esophagogastric cancer and that germline testing should be considered in these populations. The role of ATM alterations in esophagogastric cancer risk warrants further investigation., This genetic association study examines the prevalence of likely pathogenic or pathogenic germline alterations among patients with esophagogastric cancer and assesses associations between germline variant prevalence and demographic and clinicopathologic features.

The evolution of multi-resistant bacteria poses a major threat to our healthcare system worldwide. To address this serious public health issue, the speed and sensitivity of state-of-the-art antibiotic susceptibility testing (AST) such as broth dilution and disc diffusion methods need to be significantly improved to provide better patient care. With the ultimate goal of developing a fast and reliable alternative that outperforms current state-of-the-art procedures, a high-throughput, generally– in terms of bug drug combinations – applicable analytical protocol was developed employing Raman spectroscopy as non-destructive analysis tool to monitor the deuterium uptake of metabolically active bacteria and additionally extract chemical-specific information for bacteria and/or contaminant identification. Our AST is based on two reference strains representing Gram-negative (E. coli) and Gram-positive bacteria (E. faecalis), treated with a total of four different antibiotics. Apart from high sensitivity and specificity, time is the most crucial parameter in clinical diagnosis. Hence, bulk analysis of highly concentrated samples was favored over a single-cell approach to allow timeefficient, straight-forward sample preparation and investigation. The developed AST also comprises a preincubation step (bug-drug incubation prior to the addition of D2O containing medium) which is shown to be key for the development of a reliable test comprising Gram-positive and Gram-negative bacteria. 52 clinical isolates typical for urinary tract infection causing pathogens were investigated in a semi-automated setting showing good agreement with state-of-the-art analytics.

Background and AimWhen exceeding the homeostatic range, manganese (Mn) might cause neurotoxicity, characteristic of the pathophysiology of several neurological diseases. Although the underlying mechanism of its neurotoxicity remains unclear, Mn-induced oxidative stress contributes to disease etiology. DNA damage caused by oxidative stress may further trigger dysregulation of DNA-damage-induced poly(ADP-ribosyl)ation (PARylation), which is of central importance especially for neuronal homeostasis. Accordingly, this study was designed to assess in the genetically traceable in vivo model Caenorhabditis elegans the role of PARylation as well as the consequences of loss of pme-1 or pme-2 (orthologues of PARP1 and PARP2) in Mn-induced toxicity.MethodsA specific and sensitive isotope-dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed to quantify PARylation in worms. Next to monitoring the PAR level, pme-1 and pme-2 gene expression as well as Mn-induced oxidative stress was studied in wildtype worms and the pme deletion mutants.Results and ConclusionWhile Mn failed to induce PARylation in wildtype worms, toxic doses of Mn led to PAR-induction in pme-1-deficient worms, due to an increased gene expression of pme-2 in the pme-1 deletion mutants. However, this effect could not be observed at sub-toxic Mn doses as well as upon longer incubation times. Regarding Mn-induced oxidative stress, the deletion mutants did not show hypersensitivity. Taken together, this study characterizes worms to model PAR inhibition and addresses the consequences for Mn-induced oxidative stress in genetically manipulated worms. published

ACO2 is a mitochondrial protein, which is critically involved in the function of the tricarboxylic acid cycle (TCA), the maintenance of iron homeostasis, oxidative stress defense and the integrity of mitochondrial DNA (mtDNA). Mutations in the ACO2 gene were identified in patients suffering from a broad range of symptoms, including optic nerve atrophy, cortical atrophy, cerebellar atrophy, hypotonia, seizures and intellectual disabilities. In the present study, we identified a heterozygous 51 bp deletion (c.1699_1749del51) in ACO2 in a family with autosomal dominant inherited isolated optic atrophy. A complementation assay using aco1-deficient yeast revealed a growth defect for the mutant ACO2 variant substantiating a pathogenic effect of the deletion. We used patient-derived fibroblasts to characterize cellular phenotypes and found a decrease of ACO2 protein levels, while ACO2 enzyme activity was not affected compared to two age- and gender-matched control lines. Several parameters of mitochondrial function, including mitochondrial morphology, mitochondrial membrane potential or mitochondrial superoxide production, were not changed under baseline conditions. However, basal respiration, maximal respiration, and spare respiratory capacity were reduced in mutant cells. Furthermore, we observed a reduction of mtDNA copy number and reduced mtDNA transcription levels in ACO2-mutant fibroblasts. Inducing oxidative stress led to an increased susceptibility for cell death in ACO2-mutant fibroblasts compared to controls. Our study reveals that a monoallelic mutation in ACO2 is sufficient to promote mitochondrial dysfunction and increased vulnerability to oxidative stress as main drivers of cell death related to optic nerve atrophy.

Background: The genetic hallmark of BL is MYC gene rearrangement. However, due to histopathological, immunohistochemical and cytogenetic similarities, differentiation from Diffuse Large B-Cell Lymphoma (DLBCL) remains challenging in some cases. Although being suspected to negatively influence outcomes, detection of high expression of BCL2 and MYC (double expressor) as well as rearrangements of MYC and BCL2 and/or BCL6 (double/triple hit) did not lead to confirmation of different therapeutic approaches in DLBCL yet. The recent update of the World Health Organization (WHO) classification of lymphoid neoplasms has thus established a category termed High-Grade B-Cell Lymphoma (HGBL), defined by a distinct morphology and/or presence of double/triple hit status. While BL displays favorable outcomes in clinical routine upon treatment with intensive immunochemotherapeutic regimens, clear evidence regarding the optimal therapeutic approach for HGBL remains limited and the diagnostic discrimination of BL and HGBL can be challenging, too. Moreover, data on the frequency of revisions of the diagnosis of BL to DLBCL or HGBL and its impact on treatment and outcome are sparse. Methods: All consecutive patients managed with histopathological suspected diagnosis of BL upon preliminary assessment at the reporting institution between December 2010 and July 2020 were identified. Final diagnosis of the respective aggressive B-Cell lymphoma was grouped according to the most recent WHO classification and divided into four subgroups: a) BL, b) revision from DLBCL to BL, c) DLBCL, d) HGBL. General patient characteristics as well as response to treatment in Computed Tomography (CT) or Positron Emission Tomography (PET) (evaluation by individual investigator), information regarding survival supported by the register of deaths in North-Rhine Westphalia and the date of last follow-up were collected from individual patient files. Results: Overall, we identified n=66 patients with suspected diagnosis of BL within the preliminary assessment. Final histopathological results confirmed n=31 patients as BL (Group A), while n=23 patients were described as showing features of both BL and DLBCL (Uncertain & Grey-zone, Group D). Additionally, in n=12 patients the final diagnosis was revised either from DLBCL to BL (n=9, Group B) or B-ALL/BL to DLBCL (n=3, Group C). Regarding the reference histopathological reviews (RHR) and the latest version of the WHO classification of lymphoid neoplasms, all patients from Group C and Group D were finally classified as either DLBCL (n=12) or HGBL (n=14). In total, n=13 patients had revision of the final diagnosis, either upon receipt of RHR (n=8) or repeated biopsy upon progressive disease (PD) (n=5). When comparing patients with revised diagnosis due to PD or RHR, a median of six (range 4-8) and two (range 1-2) cycles of systemic therapy were applied prior to revision, respectively. Regarding outcomes, 2/5 patients (40%) with revised diagnosis upon PD and 7/8 patients (87,5%) with revised diagnosis upon RHR were alive at the time of last follow-up (median follow-up 15,07 months), respectively (Fig 1). Patients suffering from BL (Group A) displayed a significantly increased progression-free survival (PFS) compared to all other groups (p=0.034). In contrast, patients whose diagnosis was revised from DLBCL to BL after initiation of treatment with DLBCL protocols had an inferior PFS than patients initially diagnosed with BL (p=0.045) that was comparable to patients with the final diagnosis of DLBCL or HGBL. Two-year overall survival was generally favorable in all groups, ranging from almost 60% (HGBL) to 86,2% (BL) without showing statistically significant differences (p=0.2). Conclusion In conclusion, timely and precise histopathological diagnostic procedures seem to play a critical role for optimizing treatment strategies of BL, HGBL and high-risk DLBCL upfront. Since administration of BL treatment protocols seems feasible in clinical routine and may result in favorable results not only in BL but as well in HGBL, these results might encourage its upfront usage in doubtful situations regarding histopathological results. However, with only a small number of patients being evaluable in the present analysis, controlled clinical trials are necessary to confirm these trends. Figure 1 Figure 1. Disclosures Heger: Novartis: Research Funding; Gilead: Other: Travel funding. Gödel: Gilead: Other: Personal fees / travel support; Novartis: Other: Travel support. Balke-Want: Novartis: Research Funding. Simon: Gilead: Other: Travel support. Bröckelmann: BMS: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; MSD: Research Funding; BeiGene: Research Funding. Von Tresckow: Amgen: Consultancy, Honoraria; AstraZeneca: Honoraria, Other: Congress and travel support; AbbVie: Other: Congress and travel support; BMS-Celgene: Consultancy, Honoraria, Other: Congress and travel support; Kite-Gilead: Consultancy, Honoraria; MSD: Consultancy, Honoraria, Other: Congress and travel support, Research Funding; Novartis: Consultancy, Honoraria, Other: Congress and travel support, Research Funding; Pentixafarm: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Other, Research Funding.

Background Individuals with hypertrophic cardiomyopathy (HCM), even when asymptomatic, are at‐risk for sudden cardiac death and stroke from arrhythmias, making it imperative to identify individuals affected by this familial disorder. Consensus guidelines recommend that first‐degree relatives (FDRs) of a person with HCM undergo serial cardiovascular evaluations. Methods We determined the uptake of family screening in patients with HCM and developed an online video intervention to facilitate family communication and screening. Family screening and genetic testing data were collected through a prospective quality improvement initiative, a standardized clinical assessment and management plan (SCAMP), utilized in an established cardiovascular genetics clinic. Patients were prescribed an online video if screening of their FDRs was incomplete and a pilot study on video utilization and family communication was conducted. Results Two‐hundred and sixteen probands with HCM were enrolled in SCAMP Phase I and 190 were enrolled in SCAMP Phase II. In both phases, probands reported that 51% of FDRs had been screened (382/749 in Phase I, 258/504 in Phase II). Twenty patients participated in a pilot study on video utilization and family communication. Nine participants reported watching the video and six participants reported sharing the video with relatives; however only one participant reported sharing the video with relatives who were not yet aware of the diagnosis of HCM in the family. Conclusion Despite care in a specialized cardiovascular genetics clinic, approximately one half of FDRs of patients with HCM remained unscreened. Online interventions and videos may serve as supplemental tools for patients communicating genetic risk information to relatives.

Item does not contain fulltext Developmental and epileptic encephalopathies (DEEs) are severe neurodevelopmental disorders often beginning in infancy or early childhood that are characterized by intractable seizures, abundant epileptiform activity on EEG, and developmental impairment or regression. CACNA1E is highly expressed in the central nervous system and encodes the alpha1-subunit of the voltage-gated CaV2.3 channel, which conducts high voltage-activated R-type calcium currents that initiate synaptic transmission. Using next-generation sequencing techniques, we identified de novo CACNA1E variants in 30 individuals with DEE, characterized by refractory infantile-onset seizures, severe hypotonia, and profound developmental impairment, often with congenital contractures, macrocephaly, hyperkinetic movement disorders, and early death. Most of the 14, partially recurring, variants cluster within the cytoplasmic ends of all four S6 segments, which form the presumed CaV2.3 channel activation gate. Functional analysis of several S6 variants revealed consistent gain-of-function effects comprising facilitated voltage-dependent activation and slowed inactivation. Another variant located in the domain II S4-S5 linker results in facilitated activation and increased current density. Five participants achieved seizure freedom on the anti-epileptic drug topiramate, which blocks R-type calcium channels. We establish pathogenic variants in CACNA1E as a cause of DEEs and suggest facilitated R-type calcium currents as a disease mechanism for human epilepsy and developmental disorders.

The Devonian carbonate platform (Obj-2) of the Kharyaga field (Russia) has been operated by Total since 1999 and produces 42° API oil, rich in H2S. A multidisciplinary (sedimentological, structural, stratigraphic, and geomechanical modeling) and multiscale study was made of the field, integrating seismic, micro-resistivity log, and core data to characterize the reservoir. The Kharyaga carbonate platform is characterized by complex relationships among sea-level variations, subsidence, and sedimentation rates. The field is divided into a platform edge (barrier zone) in the southern area, and back barrier and lagoon environments to the north, each characterized by different facies distribution and dynamic behavior. The platform shelf and the reef flat show dome-shaped thrombolites; the back barrier is characterized by grainstone shoals associated with columnar stromatolites, whereas the lagoon comprises peloidal wackestones and packstones associated with laminated fenestral stromatolites. Significant and prolonged subsidence, in both the lagoon and the platform edge, is associated with partial emergence of the platform reef, as shown by karst development. Seismic interpretation highlighted both underlying north-south structures and syndepositional east-west collapse faults along the southern barrier edge. Two-dimensional and three-dimensional sedimentological modeling of the Obj-2, calibrated by well data and core analyses, allowed the simulation of alternative scenarios to explain the evolution of the carbonate platform during the Devonian and suggested the observed facies distribution is compatible with the presence of a fixed outer platform edge represented by east-west faults. The carbonate platform of the Kharyaga field exhibits complex behavior; hydrocarbon (HC) accumulation and flow is controlled by the interplay of primary porosity, karst distribution, and structural discontinuities (faults and fractures). Besides the role of the karstification, this paper mainly focuses on the role played by tectonic structures on the evolution of the carbonate platform and on the HC flow. From drill stem test data, east-west faults and karsts are considered as major permeability heterogeneities, but interference tests showed more complex fluid pathways at the smaller scale. Microresistivity images show dominant northeast-southwest and northwest-southeast fracture sets in the central barrier, forming an interconnected flow network with the seismic faults. Geomechanical modeling suggests that these fractures are subseismic structures linked to inherited, deep-seated faults active at the time of fracturing, in addition to the listric reservoir faults.

Lung cancer is the leading cause of cancer mortality. Great advances in non-small cell lung cancer therapy have been seen in the last decade, beginning with the success in treating lung cancer harboring EGFR mutations and ALK-gene rearrangements. The potential of these biomarker-driven therapies has propelled research in biomarker targeted approaches to the forefront of lung cancer research. The successful development of immunotherapeutic agents targeting PD-L1 and PD-1 with an associated non-genomic biomarker has opened a new front in the effort for targeted approaches. Although early-phase lung cancer studies have hinted at the potential to use biomarkers to select patients for allocation to treatment in the conduct of clinical trials, data from late-phase studies have tempered expectations. The data leave unclear the wisdom of routinely restricting enrollment on lung cancer clinical trials to biomarker restricted populations, particularly non-genomic biomarkers.

The Edmonton Regional Palliative Care Program was established to increase access to palliative care for terminal cancer patients in the region. Inpatient care is delivered, in decreasing order of distress, at the tertiary palliative care unit, by consult teams in acute care facilities, and in hospices. We reviewed the admission data for all patients discharged from the program between November 1, 1997, and October 31, 1998, in order to determine if demographical and clinical variables suggested appropriate use of the three levels of care. Patients admitted to the tertiary palliative care unit were significantly younger than those admitted to acute care of hospices (61 years versus 68 years and 71 years respectively, p

This paper presents an integrated Geosciences and Reservoir work approach used for complex fractured and karstified carbonate Kharyaga field. Synthesis is fulfilled for all available data, such as seismic interpretation, static well data, well tests etc. It has been launched on Kharyaga field mid 2012. Kharyaga field is a NW-SE elongated anticline lying 60km north of the Artic polar Circle, in Nenets Autonomous Territory on Kolva regional swell. Total E&P Russie (TEPR) is operating Object 2 and 3 of this field. The Object 2 accumulation, subject of this study, is characterised by oil bearing Devonian carbonate reservoir with a gross thickness of 160–250m with high vertical and lateral heteregenity. Current production from Object 2 is around 23 kbopd. The purpose of the synthesis is to create new and more reliable geological and dynamic models in order to better optimize next development phase and fine tune production profiles estimation. Geosciences and Reservoir synthesis imply the following: gathering all available information starting from newly reprocessed seismic data, various static well data and ending by well tests and production history over the whole life of the field,depth analysis and putting in coherence of all information in order to better address the various heterogeneity scales and reservoir characterization. There are two main challenges related to characterization of existing heterogeneities: defining the fault pattern including sub seismic faults, understanding karst and fractures distribution,defining vertical and lateral sedimentary heterogeneity as well as reservoir extension. Many experts and specialists are involved in this synthesis. The joint approach between geologist and geophysicist, based on tectno-stratigraphic timing and stress field combined with seismic attributes and thickness map, allowed to proposed a new fault pattern which honors FMI data and dynamic interference tests recorded during the 14 years of field production. Interpretation of newly reprocessed seismic data helped the sedimentologists in inter-well correlation. Looking just at seismic amplitudes cubes, it was possible to propose a new sedimentary model and change inter-well correlation accordingly. This led to the updated vision of the reservoir.