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Unconventional T-lymphocyte populations are emerging as important regulators of tumor immunity. Despite this, the role of TCRαβ+CD4−CD8−NK1.1− innate αβ T cells (iαβT) in pancreatic ductal adenocarcinoma (PDA) has not been explored. We found that iαβTs represent ∼10% of T lymphocytes infiltrating PDA in mice and humans. Intratumoral iαβTs express a distinct T-cell receptor repertoire and profoundly immunogenic phenotype compared with their peripheral counterparts and conventional lymphocytes. iαβTs comprised ∼75% of the total intratumoral IL17+ cells. Moreover, iαβT-cell adoptive transfer is protective in both murine models of PDA and human organotypic systems. We show that iαβT cells induce a CCR5-dependent immunogenic macrophage reprogramming, thereby enabling marked CD4+ and CD8+ T-cell expansion/activation and tumor protection. Collectively, iαβTs govern fundamental intratumoral cross-talk between innate and adaptive immune populations and are attractive therapeutic targets.Significance:We found that iαβTs are a profoundly activated T-cell subset in PDA that slow tumor growth in murine and human models of disease. iαβTs induce a CCR5-dependent immunogenic tumor-associated macrophage program, T-cell activation and expansion, and should be considered as novel targets for immunotherapy.See related commentary by Banerjee et al., p. 1164.This article is highlighted in the In This Issue feature, p. 1143

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HER2 (ERBB2) gene status serves as a strong predictive marker of response to HER2-targeted agents in invasive breast cancers, albeit with heterogeneous response. Our aim was to determine the distribution and prognosis of HER2 groups by fluorescent in situ hybridization (FISH) using the updated 2018 American Society of Clinical Oncology-College of American Pathologist (ASCO-CAP) guidelines. We identified 226 cases of equivocal or positive HER2 FISH invasive breast cancer (interpreted by ASCO-CAP guidelines at the time of reporting) who received HER2-targeted agents from 2006 to 2017. We subcategorized Group 1 further into three subgroups: low amplified (HER2/CEP17 ratio ≥ 2.0-2.99, mean HER2/cell 4.0-5.9), amplified (HER2/CEP17 ratio ≥ 2.0-2.99, mean HER2/cell ≥ 6), and excessive amplification (HER2/CEP17 ratio ≥ 3.0, mean HER2/cell ≥ 4.0). Outcomes studied were recurrence, metastasis, second breast primary, disease-specific survival (DSS), and overall survival (OS). Univariate analysis showed that the five categories of HER2 FISH were significantly associated with OS (p < 0.01), specifically higher HER2 amplification was associated with fewer deaths. HER2 FISH status also statistically significantly relates to DFS (p < 0.01) and metastasis (p = 0.01) but not with recurrence or second breast primary in our study. Tumor type and HER2 ISH Groups are independent predictors for both OS and DFS in our cohort. The proposed Group 1 subcategories were significantly associated with OS (p < 0.01) and DFS (p < 0.01), excessive HER2 amplification was associated with longer median survival. The Cox regression models showed better survival outcomes for the excessive amplification subgroup than the low amplified subgroup, with OS (hazard ratio = 0.63, 95% CI 0.42-0.93) and DFS (HR = 0.55, 95% CI 0.37-0.83). We demonstrated that in HER2 FISH Group 1 patients, high HER2 amplification was significantly associated with longer OS and DFS; these patients seem to benefit more from HER2-targeted regimens. We recommend reporting these Group 1 subcategories when assessing HER2 FISH.

HER2 (ERBB2) gene status serves as a strong predictive marker of response to HER2-targeted agents in invasive breast cancers, albeit with heterogeneous response. Our aim was to determine the distribution and prognosis of HER2 groups by fluorescent in situ hybridization (FISH) using the updated 2018 American Society of Clinical Oncology-College of American Pathologist (ASCO-CAP) guidelines. We identified 226 cases of equivocal or positive HER2 FISH invasive breast cancer (interpreted by ASCO-CAP guidelines at the time of reporting) who received HER2-targeted agents from 2006 to 2017. We subcategorized Group 1 further into three subgroups: low amplified (HER2/CEP17 ratio ≥ 2.0-2.99, mean HER2/cell 4.0-5.9), amplified (HER2/CEP17 ratio ≥ 2.0-2.99, mean HER2/cell ≥ 6), and excessive amplification (HER2/CEP17 ratio ≥ 3.0, mean HER2/cell ≥ 4.0). Outcomes studied were recurrence, metastasis, second breast primary, disease-specific survival (DSS), and overall survival (OS). Univariate analysis showed that the five categories of HER2 FISH were significantly associated with OS (p 0.01), specifically higher HER2 amplification was associated with fewer deaths. HER2 FISH status also statistically significantly relates to DFS (p 0.01) and metastasis (p = 0.01) but not with recurrence or second breast primary in our study. Tumor type and HER2 ISH Groups are independent predictors for both OS and DFS in our cohort. The proposed Group 1 subcategories were significantly associated with OS (p 0.01) and DFS (p 0.01), excessive HER2 amplification was associated with longer median survival. The Cox regression models showed better survival outcomes for the excessive amplification subgroup than the low amplified subgroup, with OS (hazard ratio = 0.63, 95% CI 0.42-0.93) and DFS (HR = 0.55, 95% CI 0.37-0.83). We demonstrated that in HER2 FISH Group 1 patients, high HER2 amplification was significantly associated with longer OS and DFS; these patients seem to benefit more from HER2-targeted regimens. We recommend reporting these Group 1 subcategories when assessing HER2 FISH.

Background: Anemia in pregnant women, a significant cause of maternal and infant mortality and morbidity, has not been adequately studied in the population of Andaman and Nicobar Islands. In this regard, the study was conducted to document the prevalence and severity of anemia and its associated sociodemographic factors in pregnant women in Andaman and Nicobar Islands. Methods: The cross-sectional study was carried out at the Department of Obstetrics and Gynecology at G. B. Pant hospital over a period of 6 months. WHO guidelines were used to define and classify anemia as mild, moderate, or severe. A total of 786 pregnant women of age 12–40 years were included in the study. Data were collected by means of interviewer-administered questionnaire and complete blood count of venous blood. IBM SPSS version 21 was used for statistical analysis. Frequency tables and cross-tables were constructed. Corr elations were determined using Kendall's Tau-b, Pearson's r, and Spearman's rho coefficients. Results: Hemoglobin levels of the participants ranged from 4.4 to 15.0 g/dl. Anemia was observed in 50.9% of the sample. Prevalence and severity of anemia decreased with increasing educational levels of both husband and wife and increasing gestational age, and increased with increasing gravidity and parity. Conclusions: Awareness and education helped reduce the prevalence of anemia. Education of husband was seen to have a greater effect than education of wife. Wide coverage, systematic intervention, and disbursement of folic acid and iron supplements to pregnant women by subcenters and primary health centers prior to their visit to G. B. Pant Hospital were also effective.

Introduction After appearance of the novel Coronavirus 2019 in Wuhan, China, new epicenters of the now pandemic appeared nationally. The new Coronavirus disease 2019 (COVID-19) is associated with a syndrome of acute hypoxemic respiratory failure that can lead to admission to intensive care unit (ICU), invasive mechanical ventilation, and at times, death. The first two COVID-19 cases in the State of Michigan were reported in March 10, 2020. During the subsequent weeks, Michigan became one of the early national epicenters of the current COVID-19 pandemic. Early observational studies have suggested a correlation between susceptibility to COVID-19 infection and type A blood group, and furthermore, increased risk of respiratory failure and worse outcome. We conducted this retrospective study to evaluate the association between ABO blood groups and disease severity/mortality in hospitalized COVID-19 patients. Methods We reviewed the records of hospitalized patients with PCR-confirmed COVID-19 testing managed at Henry Ford Health System (HFHS) between March 10 and April 30, 2020. Henry Ford Health System (HFHS) serves inner city and metropolitan Detroit in Michigan, with diverse demographics including African American, Middle Eastern, and Caucasian populations. Age, gender, race, ABO blood groups, comorbidities, disease severity (defined as intensive care unit admission), intubation, and mortality variables were collected for 1488 eligible patients. Survival data was updated on July 15, 2020. Results were presented as median plus range, or percentages as indicated. In the univariate analysis, Student's t-test and Pearson's Chi-square/Fisher's exact test were used to determine the significance and odds ratio (OR) for the independent variables as related to outcome. A multivariate analysis was performed using logistic regression to identify the risk factors for mortality. A backward stepwise (Wald) selection model was performed, with significance level for removal from the model set at 0.1. All tests of significance were two-sided, and a p value of < 0.05 was regarded as significant. All statistical analyses were performed using SPSS (Statistical Package for Social Sciences) software, version 22 (SPSS Inc., Chicago, IL, USA). This study was approved by the Institutional Review Board of HFHS. Results 1488 hospitalized COVID-19 positive patients with available ABO blood group were included. The median age of patients was 68 years (Range 19-99 years); 801 (54%) were females. Most patients (n=856; 58%) were African Americans. 485 (32.6%) patients had blood group A, 276 (18.5%) had group B, 658 (44.2%) had group O, and 69 (4.6%) had group AB. 469 (31.5%) patients required ICU admission, 370 of whom were intubated. On last follow up, 411 (27.6%) patients were dead. ABO blood groups and Rhesus factor (D antigen) were not associated with the ICU admission, intubation, or mortality. Male gender, age ≥65 years, some underlying diseases such as obesity, coronary artery disease chronic obstructive pulmonary disease and malignancy were associated with increased mortality. African American patients were almost 40% less likely to die (OR = 0.56; 95% CI: 0.44-0.7; p < 0.001). Table 1 shows the parameters analyzed as predictors of mortality using univariate and multivariate logistic regression. Multivariate analysis showed that age (≥65 years) (OR = 4.27; 95% CI: 3.19-5.71; p < 0.001), male gender (OR = 1.57; 95% CI: 1.23-2.01; p < 0.001), Caucasian race (OR=1.46; 95% CI: 1.14-1.86; p = 0.003), and COPD (OR = 1.49; 95% CI: 1.09-2.04; p = 0.013) were associated with mortality. Conclusion According to our study, ABO blood groups and Rhesus factor did not correlate with disease severity, use of mechanical ventilation, or mortality in hospitalized COVID-19 patients. Elderly patients, male gender, patients with COPD were at increased risk of death. Contrary to perceived belief, African Americans were not at increased risk of mortality, compared to Caucasians with COVID-19 infection. Caucasians were more likely to die from COVID-19 infection. Disclosures No relevant conflicts of interest to declare.

Unconventional T-lymphocyte populations are emerging as important regulators of tumor immunity. Despite this, the role of TCRαβ+CD4−CD8−NK1.1− innate αβ T cells (iαβT) in pancreatic ductal adenocarcinoma (PDA) has not been explored. We found that iαβTs represent ∼10% of T lymphocytes infiltrating PDA in mice and humans. Intratumoral iαβTs express a distinct T-cell receptor repertoire and profoundly immunogenic phenotype compared with their peripheral counterparts and conventional lymphocytes. iαβTs comprised ∼75% of the total intratumoral IL17+ cells. Moreover, iαβT-cell adoptive transfer is protective in both murine models of PDA and human organotypic systems. We show that iαβT cells induce a CCR5-dependent immunogenic macrophage reprogramming, thereby enabling marked CD4+ and CD8+ T-cell expansion/activation and tumor protection. Collectively, iαβTs govern fundamental intratumoral cross-talk between innate and adaptive immune populations and are attractive therapeutic targets. Significance: We found that iαβTs are a profoundly activated T-cell subset in PDA that slow tumor growth in murine and human models of disease. iαβTs induce a CCR5-dependent immunogenic tumor-associated macrophage program, T-cell activation and expansion, and should be considered as novel targets for immunotherapy. See related commentary by Banerjee et al., p. 1164. This article is highlighted in the In This Issue feature, p. 1143

The rates of renal transplant for end stage renal disease are increasing worldwide. Vascular complications due to arterial thrombosis is seen only in less that 1% cases. We describe a case of 36 year old male who underwent a live-related renal transplant, whose post-operative period was complicated by juxta-anastomotic distal external iliac artery thrombosis. He was managed by thrombectomy and improved with complete recovery. Attention should be paid to anastomotic technique and prevention of formation of intimal flap. In case of arterial thrombosis, graft salvage can be attempted depending on the clinical scenario.