Search

Introduction: The aim of this study was to investigate the influence of flowable composite intermediary liner on the microleakage between the tooth tissue and the packable composite resin. Materials and Methods: Forty mandibular molars, each prepared with two class II cavities were randomly divided in two groups: In group A one side was restored with Solitaire (KULZER); the other side was lined with Charisma flow (KULZER) and then restored with Solitaire. In group B one side was restored with Filtek p60 (3M); the other side was lined with Filtek flow (3M) and then restored with Filtek p60. Teeth were then thermocycled for 1000 cycle at 5o and 55o and immersed in a solution of 0.5% basic fuschin dye for 24 hours. Embedded specimens were sectioned longitudinally. Cervical and occlusal microleakage was measured by the extent of dye penetration. Results: Statistically in both groups, microleakge was more in the cavities that were not lined with flowable composites and the cervical margins showed more amount of microleakage as compared to occlusal margins with and without liner. Overall there was no significant difference in the amount of leakage among the two companies at cervical and occlusal margins, with and without flowable liner. Conclusion: Microleakge was more in the cavities that were not lined with flowable composites as compared to cavities lined with flowable composite both in occlusal and cervical margins. The cervical margins showed more amount of microleakage as compared to occlusal margins with and without liner. Keyword: Microleakge, Flowable composite, Packable composite.

Melanocytes that form stratum basale of skin epidermis express tyrosinase enzyme, which catalyzes initial two rate-limiting steps in the biotransformation of tyrosine into dark pigment called melanin. Even today, Tyrosinase inhibitors are among the promising candidates in cosmetic industry for skin-lightening formulations. Overexpression of tyrosinase causes excess melanin biosynthesis and deposition resulting in dark skin color. Moreover, localized overexpression of tyrosinase cause variety of hyperpigmentation disorders like melanoma, melasma, chloasma, dark patches, liver patches, etc. There has been a renewed interest in the natural products as main ingredients in the formulation of safe products for skin-whitening and treatment options for hyperpigmentation disorders. In the present communication, the results of our investigations on tyrosinase inhibition, modulation of intracellular tyrosinase and melanin levels in cultured B16F10 melanoma cells by Bacopa monnieri (L.) methanol extract (BME) are presented and discussed as safe option for skin lightening and to treat hyperpigmentation disorders. BME showed 11%, 29%, 54% and 80% inhibition of mushroom tyrosinase activity at an initial 100, 200, 400 and 600 μg of extract. Treatment of α-melanocyte stimulating hormone (α-MSH) stimulated cultured murine melanoma B16F10 cells with 100 μg/ml of the extract showed a decrease in the levels of cellular melanin and cellular tyrosinase content by 22% and 46% respectively. The cytotoxicity studies by MTT assay revealed that the LC50 of the BME is ≥1000 μg/ml in cultured mouse melanoma B16F10 and HEK293 cells.

The Nasopalatine Duct Cyst (NPDC) also commonly referred to as the anterior midline palatine cyst is a developmental cyst derived from the proliferation of embryonic epithelial remnants of nasopalatine duct. It is unique for the reason that it develops in only one location, which is the midline of anterior maxilla in close relationship to the nasopalatine canal. Radiographically, it presents as a well-demarcated ovoid or heart shaped cystic structure which is seen in close proximity to the apex of maxillary central incisors. Due to its anatomical location, it can be sometimes misdiagnosed as central giant cell granuloma, periapical cyst or follicular cyst. Chronic, large periapical lesions following traumatic injuries are challenging to diagnose and treat. The present case report described the successful management of a rare case of bilateral NPDC in a 30-year-old male patient, who gave a presentation closely mimicking that of an infected periapical cyst. The case was treated by both conventional endodontic therapy and surgical intervention. The NPDC tends to show a predilection in giving rise to squamous cell carcinomas which commonly occur in the anterior part of the maxilla. Therefore, cystic lesions seen in the premaxillary region require a thorough analysis so as to successfully treat the lesion and to avoid further complications that may arise due to a missed diagnosis.

Introduction: Oxidative stress plays a critical role in the progression of diabetes, arthritis, cancer, eryptosis, cardiovascular disease, and thrombosis. Currently, antioxidants from natural sources are in high demand due to their beneficial role in the management of said diseases. Aim: The purpose of the study was to evaluate the protective effect of sorghum protein buffer extract (SBE) on sodium nitrite-induced oxidative stress and thrombosis. Materials and methods: Protein characterization of SBE was done using SDS-PAGE. Oxidative stress in RBC was induced using sodium nitrite (NaNO2) and the key stress markers such as lipid peroxidation (LPO), protein carbonyl content (PCC), and the level of antioxidant enzymes (SOD and CAT) were measured. The anticoagulant effect of SBE was identified by employing in-vitro plasma recalcification time, activated partial thromboplastin time (APTT), prothrombin time (PT), and in-vivo mouse tail bleeding time. SBE antiplatelet activity was examined using agonist adenosine diphosphate (ADP) and epinephrine-induced platelet aggregation. Non-toxic property of SBE was identified using in-vitro direct haemolytic, haemorrhagic, and edema forming activities using experimental mice. Results: SBE revealed similar protein banding pattern under both reduced and non-reduced conditions on SDS-PAGE. Interestingly, SBE normalized the level of LPO, PCC, SOD, and CAT in stress-induced RBCs. Furthermore, SBE showed anticoagulant effect in platelet rich plasma by enhancing the clotting time from the control 250 s to 610 s and bleeding time from the control 200 s to more than 500 s (p Conclusions: This study demonstrates for the first time the anticoagulant, antiplatelet, and antioxidant properties of SBE. Thus, the observed results validate consumption of sorghum as good for health and well-being.

Background The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale is commonly used by physicians and nurses in oncology, as it correlates with cancer morbidity, mortality, and complications from chemotherapy and can help direct clinical decisions and prognostication. This retrospective cohort study aimed to identify whether ECOG-PS scores rated by oncologist versus nurses differ in their ability to predict clinical outcomes. Materials and Methods Over 19 months, 32 oncologists and 41 chemotherapy nurses from a single academic comprehensive cancer center independently scored ECOG-PS (range: 0–5) for a random sample of 311 patients with cancer receiving chemotherapy. Logistic regression models were fit to evaluate the ability of nurse and physician ECOG-PS scores, as well as the nurse-physician ECOG-PS score difference (nurse minus physician), to predict the occurrence of chemotherapy toxicity (CTCAE v4, grade ≥3) and hospitalizations within 1 month from ECOG-PS ratings, as well as 6-month mortality or hospice referrals. Results Physician/nurse ECOG-PS agreement was 71% (Cohen's κ = 0.486, p < .0001). Nurse ECOG-PS scores had stronger odds ratio for 6-month mortality or hospice (odds ratio [OR], 3.29, p < .0001) than physician ECOG-PS scores (OR, 2.71, p = .001). Furthermore, ECOG-PS ratings by nurses, but not physicians, correlated with 1-month chemotherapy toxicity (OR, 1.44, p = .021) and 1-month hospitalizations (OR, 1.57, p = .041). Nurse-physician disagreement, but only when physicians gave “healthier” (lower) ratings, was also associated with worse outcomes (chemotherapy toxicity OR = 1.51, p = .045; 1-month hospitalization OR, 1.86, p = .037; 6-month mortality or hospice OR, 2.99, p < .0001). Conclusion Nurse ECOG-PS ratings seem more predictive of important outcomes than those of physicians, and physician-nurse disagreement in ECOG-PS ratings predicts worse outcomes; scoring by nurses may result in additional clinical benefit. Implications for Practice Nurse-rated Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores, compared with those rated by oncologists, better predicted hospitalizations and severe chemotherapy toxicity within 1 month from ECOG-PS assessment, as well as mortality or hospice referrals within 6 months. Physician-nurse disagreement in ECOG-PS scoring was associated with worse hospitalization, chemotherapy toxicity, and mortality and hospice referral rates. Rating performance statuses of patients with cancer by nurses instead or in addition to oncologists can result in additional clinical benefits, such as improved prognostication, as well as better informed clinical decision making regarding whether or not to administer chemotherapy, the need for additional supportive care, and goals of care discussions.

Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with high symptom burden. However, treatment decisions currently depend heavily on physician interpretation of clinical parameters and may not consider patients’ health preferences. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) initiative standardized a set of patient-reported outcomes for use in chronic diseases. This study identifies preference rankings among patients with PDAC and physicians for PROMIS domains and compares the priorities of patients and their providers. Methods: We condensed the 96 NIH PROMIS adult domains into 31 domains and created a Maximum Difference Scaling questionnaire. Domain preference scores were generated from the responses of patients with PDAC and physicians, which were compared using Maximum Difference Scaling software across demographic and clinical variables. Results: Participants included 135 patients with PDAC (53% male; median age, 68 years) and 54 physicians (76% male; median years of experience, 10). Patients selected physical functioning (PF) as their top priority, whereas physicians identified pain as most important. PF, ability to perform activities of daily living, and symptom management were within the top 5 domains for both patients and physicians, and varied only slightly across age, sex, and ethnicity. However, several domains were ranked significantly higher by patients than by physicians, including but not limited to PF; ability to do things for yourself, family, and friends; ability to interact with others to obtain help; and sleep quality. Physicians ranked pain, anxiety, and depression higher than patients did. Conclusions: Our findings suggest that patients with PDAC value PF and engaging in daily and social activities the most, whereas physicians prioritize symptoms such as pain. Patient-reported outcomes need to become more integrated into PDAC care and research to better identify unmet patient needs, inform treatment decisions, and develop therapies that address outcomes valued by patients.

Pancreatic cancer is the most lethal common cancer with an estimated 5-year survival rate of 6-7% (across all stages). The only potential curative therapy is surgical resection in those with localized disease. Adjuvant (postoperative) therapy confers a survival advantage over postoperative observation alone. Neoadjuvant (preoperative) therapy offers the potential to downstage initially unresectable tumors for resection, sterilize resection margins and decrease locoregional recurrence, and identify a subset of patients with aggressive disease for whom surgery will not be beneficial. Induction chemotherapy followed by consolidation chemoradiation is another recommended approach in those with locally advanced disease. For those who cannot be downstaged, cannot tolerate surgery, or were diagnosed with metastatic disease, treatment remains palliative with chemotherapy being a critical component of this approach. Recently, intensive combination chemotherapy has been shown to improve survival rates in comparison to gemcitabine alone in advanced disease. The past few decades have afforded an accumulation of high-level evidence regarding neoadjuvant, adjuvant and palliative therapies in pancreatic cancer. There are numerous reviews discussing recent retrospective studies, prospective studies and randomized controlled trials in each of these areas. However, reviews of optimal and recommended treatment strategies across all stages of pancreatic cancer that focus on the highest levels of hierarchical evidence, such as meta-analyses, are limited. The discussion of novel therapeutics is beyond the scope of this review. However, an extensive and the most current collection of meta-analyses of first-line systemic and locoregional treatment options for all stages of pancreatic cancer to date has been accumulated.

A denture which is fabricated having adequate retention helps in patient's esthetic, physiological, and functional factors. The diagnostic assessment of the posterior palatal seal (PPS) and its placement is of pronounced significance. With an accurate recording of PPS area, we can establish the border seal in the posterior region of the maxillary denture. There are a number of dentures which have become unsuccessful due to the inadequate establishment of the posterior limit and an improper PPS. This article review focuses on the importance of the PPS and about different techniques associated with recording of it.

Objective: The current study assesses the fibrinogen and fibrin clot hydrolyzing activities of aqueous seed extract of Jackfruit (AqSEJ). Methods: The protein banding pattern of AqSEJ (100 μg) was analyzed on SDS-PAGE. The proteolytic activity of AqSEJ was confirmed by spectrophotometer and zymography experiments. Fibrinogen, fibrin and plasma protein hydrolyzing activities of AqSEJ were analyzed on SDS-PAGE under reduced conditions. Plasminogen activation and indirect hemolytic activities was analyzed using spectrophotometer. The non-toxic property of AqSEJ was tested by edema, hemorrhage in experimental mice. Results: AqSEJ exhibited proteolytic activity and the specific activity was found to be 1.04 units/mg/min. Furthermore, AqSEJ non-specifically hydrolyzed Aα, followed by Bβ and γ chains of human fibrinogen and specifically hydrolyzed α polymer and α chain of partially cross linked human fibrin clot without affecting β chain and γ-γ dimer even up to the tested dose of 30 μg for the incubation period of 8 hours. Importantly, AqSEJ did not hydrolyze other plasma proteins and devoid of plasminogen activation property. The proteolytic activity of AqSEJ was completely neutralized by PMSF and IAA, while EDTA, EGTA, 1,10-Phenanthroline did not, suggesting the presence of serine and cysteine family proteases. Moreover, AqSEJ did not cause edema and hemorrhage in experimental mice up to the tested dose of 200 μg and non-toxic to RBC cells. Conclusion: AqSEJ hydrolyzes fibrinogen and fibrin clot and non-toxic in nature. Hence, this work showcases the potential applications of Jack fruit seed proteases in the treatment of thrombotic disorders.

The current study explores the anticoagulant and fibrin clot-hydrolyzing properties of Momordica charantia seed extract (MCSE). MCSE hydrolyzed casein with the specific activity of 0.780â€Sunits/mg per min. Interestingly, it enhanced the clot formation process of citrated human plasma from control 146 to 432â€Ss. In addition, the intravenous injection of MCSE significantly prolonged the bleeding time in a dose-dependent manner from control 150 to more than 800â€Ss, and strengthened its anticoagulant activity. Interestingly, MCSE specifically prolonged the clotting time of only activated partial thromboplastin time, but not prothrombin time, and revealed the participation of MCSE in the intrinsic pathway of the blood coagulation cascade. Furthermore, MCSE completely hydrolyzed both AI± and BI² chains of the human fibrinogen and partially hydrolyzed the I³ chain. However, it hydrolyzed all the chains (I± polymer, I± chain, I² chain and I³-I³ dimmers) of partially cross-linked human fibrin clot. The proteolytic activity followed by the anticoagulant effect of the MCSE was completely abolished by the 1,10-phenanthroline and phenyl methyl sulphonyl fluoride, but iodoacetic acid, EDTA, and ethylene glycol-N,N,N′,N′-tetra acetic acid did not. Curiously, MCSE did not hydrolyze any other plasma proteins except the plasma fibrinogen. Moreover, MCSE was devoid of RBC lysis, edema and hemorrhagic properties, suggesting its nontoxic nature. Taken together, MCSE may be a valuable candidate in the treatment of blood clot/thrombotic disorders.

Background Pathologic complete response (pCR) to neoadjuvant chemotherapy (NCT) is considered a surrogate for improved survival. Platinum-containing NCT, particularly in patients with HER2+ and triple-negative breast cancers (TNBC) may increase pCR rates. Methods Tumor characteristics, pCR rates (no invasive disease in breast and lymph nodes), toxicities, and survival in patients who received carboplatin, a taxane, and trastuzumab (HER2+ disease) between April 2009 and December 2011, were reviewed. Results Thirty eight patients (39 tumors) completed a median of 4 cycles of NCT. Eighteen of 39 (46%) tumors were HER2+, 8/18 (44%) responded with pCR; 13/18 HER2+ tumors were HR+ (72%) and 4/13 (31%) had a pCR. Ten of 39 (26%) tumors were TNBC; 6/10 (60%) had a pCR. At a median of 25-months no recurrences were observed in patients with pCR. Conclusions Prospective studies of anthracycline-free platinum-containing NCT are warranted in LABC patients with HER2+ and TNBC.

Background Physical activity is an important outcome in oncology trials. Physical activity is commonly assessed using self-reported questionnaires, which are limited by recall and response biases. Recent advancements in wearable technology have provided oncologists with new opportunities to obtain real-time, objective physical activity data. The purpose of this review was to describe current uses of wearable activity monitors in oncology trials. Methods We searched Pubmed, Embase, and the Cochrane Central Register of Controlled Trials for oncology trials involving wearable activity monitors published between 2005 and 2016. We extracted details on study design, types of activity monitors used, and purpose for their use. We summarized activity monitor metrics including step counts, sleep and sedentary time, and time spent in moderate-to-vigorous activity. Results We identified 41 trials of which 26 (63%) involved cancer survivors (post-treatment) and 15 trials (37%) involved patients with active cancer. Most trials (65%) involved breast cancer patients. Wearable activity monitors were commonly used in exercise (54%) or behavioral (29%) trials. Cancer survivors take between 4660 and 11,000 steps/day and those undergoing treatment take 2885 to 8300 steps/day. Conclusion Wearable activity monitors are increasingly being used to obtain objective measures of physical activity in oncology trials. There is potential for their use to expand to evaluate and predict clinical outcomes such as survival, quality of life, and treatment tolerance in future studies. Currently, there remains a lack of standardization in the types of monitors being used and how their data are being collected, analyzed, and interpreted. Precis Recent advancements in wearable activity monitor technology have provided oncologists with new opportunities to monitor their patients' daily activity in real-world settings. The integration of wearable activity monitors into cancer care will help increase our understanding of the associations between physical activity and the prevention and management of the disease, in addition to other important cancer outcomes.

The culture conditions for the production of carrageenase were optimized using one-factor-at-a-time method combined with orthogonal array design. With the one-factor-at-a-time method revealed optimal conditions for carrageenase production were 24 h of fermentation period, 28 °C incubation temperature at pH 8.0 with NaNO3 as nitrogen source and carrageenan as carbon source in MMS media. Further optimization of carrgeenase production by using orthogonal experimental design L9 (34) with four factors, temperature, pH, NH4NO3 and carrageenan with their relevant levels revealed optimised conditions for carrageenase production were temperature of 28 °C, pH 8.0, 2 g L-1 NaNO3 and 2 g L-1 carrageenan. The order of the factors affecting the fermentation process was found to be temperature > pH > NaNO3 > carrageenan. The temperature played a significant role on the carrageenase production. Higher carrageenase yield with activity of 0.542 ±0.045 U ml-1 was obtained in the optimised medium when compared to those of basal medium. Carrageenase hydrolysed products of carrageenan were identified by LC-ESI-MS as neocarrabiose, neocarrabiose-4 sulfate, neocarratetraose, neocarratetraose-4 sulfate, anhydrogalactose, galactose, galactose-4 sulphate and sulphate

The culture conditions for the production of extracellular agarase by Pseudomonas aeruginosa ZSL-2 were optimized using One-Factor-At-A-Time combined with orthogonal array design. One-Factor-At-A-Time method investigates the effect of time, temperature, NaCl, carbon sources, nitrogen sources and pH on agarase production. The optimized culture conditions obtained from the statistical analysis were temperature of 30 °C, pH 8.5, NH4NO3 2 g L-1 and agar 3 g L-1. The L9 orthogonal array design was used to select the fermentation parameters influencing the yield of agarase. The order of the factors affecting the fermentation process was found to be NH4NO3 > pH > agar > temperature, with temperature playing a significant role on the agarase production (p < 0.10). The higher yields than those in basal media culture were obtained in the final optimized medium with activity of 0.439 ± 0.013 U ml-1. Extracellular agarase hydrolysed agar into a range of oligosaccharides which were analysed by LC-ESI-MS spectrometry as anhydrogalactose, galactose, agarobiose, agarotetrose and agarohexaose.

e15787 Background: Pancreatic cancer has multiple mechanisms to prevent immune recognition that lead to the creation of an immune suppressive tumor microenvironment. We hypothesize that sustained response against pancreatic cancer requires a coordinated approach that: 1. reverses the immune-suppressive tumor microenvironment, 2. induces immunogenic tumor cell death and 3. reengages NK and T-cell tumor response against a 4. cascade of tumor antigens. To test this hypothesis, we have developed a temporospatial approach that combines metronomic low-dose chemotherapy, SBRT, cryopreserved allogeneic NK cells, yeast and adenoviral tumor-associated antigen vaccines, an IL-15RαFc superagonist, and checkpoint inhibition. Methods: A phase 1b trial in patients with recurrent metastatic pancreatic cancer was initiated. Treatment occurred in 3-week cycles of low-dose chemotherapy (aldoxorubicin, cyclophosphamide, oxaliplatin, nab-paclitaxel, 5-FU/L), antiangiogenic therapy (bevacizumab), SBRT, allogeneic CD16 NK-92 cells (haNK), IL-15RαFc (N-803), adenoviral CEA vaccine, yeast Ras vaccine, and an IgG1 PD-L1 inhibitor, avelumab. The primary endpoint is incidence of treatment-related adverse events (TRAEs). Secondary endpoints include ORR, DCR, PFS, and OS. Results: 12 subjects with 3rd-line or greater metastatic pancreatic cancer were treated. All treatment was administered in an outpatient setting. AEs were primarily hematologic and managed by planned chemo dose reduction. Grade ≥3 TRAEs were observed in 9 out of 12 subjects, predominately chemotherapy-related neutropenia. 9 out of 12 subjects (75%) had a best response of stable disease (≥ 8 weeks). Median PFS is 7.1 months (4.4 – 8.8) and median OS is 8.2 months (5.7 – 9.7) with 1 subject continuing treatment. Conclusions: These preliminary data suggest that low-dose chemo-radiation combined with innate and adaptive immunotherapy can be administered safely in an outpatient setting. Preliminary OS of 8.2 months is encouraging for this heavily-pretreated population. Clinical trial information: NCT03586869.

e15721 Background: PDA is associated with high symptom burden. However, treatment and palliation decisions currently weigh on physician interpretation of clinical parameters and may not consider patient values and preferences. The NIH PROMIS tool was created to capture various health domains through PROs. The objective of this study was to identify the most important PROMIS domains to PDA pts and physician providers. Methods: Using the 31 domains in NIH’s PROMIS, we conducted online surveys with PDA pts and PDA physicians from 17 academic centers. These domains are categorized into mental, physical, and social health. Values for the PRO domains were quantified using Maximum Differences Scaling (Sawtooth Software). Results: A total of 116 PDA pts (55% males, 45% females; median age: 68 years, range 42-95) and 33 physicians (78% males, 22% females; median years of experience: 15) completed the surveys. The top five domains identified by pts and providers are listed in the table. Physical functioning (PF), ability to perform activities of daily living (ADLs) and symptom management were among the top domains for both pts and physicians regardless of age, gender, resection status, or years of physician experience. However, social domains such as ability to do things for yourself, family, and friends, and interactions with family/friends were ranked significantly higher by pts versus pain, anxiety, and depression by physicians (p < 0.01). Conclusions: Our findings suggest PDA pts value PF and engaging in work and social activities while physicians focus more on pain, depression, and symptom management. PROs need to become more important endpoints in clinical trials to better inform treatment decisions and develop therapies that address the health priorities of pts. [Table: see text]

TPS463 Background: Pancreatic cancer has multiple mechanisms to prevent immune recognition that lead to the creation of an immune suppressive tumor microenvironment. We hypothesize that effective and sustained response against tumors requires a coordinated approach that: 1. reverses the immune-suppressive tumor microenvironment, 2. induces immunogenic tumor cell death and 3. reengages NK and T-cell tumor response against a 4. cascade of tumor antigens. To test this hypothesis, we developed the NANT Cancer Vaccine (NCV), which combines metronomic low-dose chemotherapy, radiotherapy and multifaceted immunotherapy. In proof-of-concept trials, the NCV was tested in 10 patients with 3rd-line or greater pancreatic cancer. These trials showed that the NCV could be safely administered in an outpatient setting, with AEs that were manageable by dose-reduction, and preliminary survival results that exceed the standard of care in this heavily-treated population. We believe these results warrant further research, and this abstract describes our newly-designed trial. Methods: A phase 1b, single-arm, open-label trial of the NANT Cancer Vaccine in patients with recurrent metastatic pancreatic cancer has been initiated. Treatment will occur in 3-week cycles of low-dose chemotherapy (aldoxorubicin, cyclophosphamide, oxaliplatin, nab-paclitaxel, 5-FU/L), antiangiogenic therapy (bevacizumab), SBRT, engineered allogeneic high affinity CD16 NK-92 cells (haNK), IL-15RαFc (N-803), adenoviral vector-based CEA vaccine (Ad-CEA), yeast vector-based RAS vaccine (Ye-RAS), and an IgG1 PD-L1 inhibitor, avelumab. The primary endpoint is incidence of treatment-related adverse events. Secondary endpoints include ORR, DCR, PFS, and OS. A maximum of 24 patients will be enrolled. Clinical trial information: NCT03586869.

The production of agar-oligosaccharides from agarose by free and immobilized agarase, obtained from a Pseudomonas aeruginosa AG LSL-11 was investigated and the activity, longevity and the operational stability of immobilized enzyme was compared with that of the free enzyme. The agar hydrolyzed products of free enzyme and immobilized enzyme were neoagarobiose, neoagarotetraose and neoagarohexaose as evidenced by LC-MS analysis. The immobilization of agarase was confirmed by SEM and also by the enzymatic transformation of agarose into agaroligosaccharides. The free agarase showed maximum activity at 40°C, whereas it’s immobilized counterpart showed maximum activity at 45oC, however, the optimum pH for both systems remained unchanged (pH 8.0). The relative activities of free agarase at pH 9.0 and 10.0 were 90 and 74%, respectively, whereas, the corresponding activities of the immobilized system were determined to be 97 and 90%. The stabilities of free agarase at pH 9.0 and 10.0 were 80 and 60% respectively, but for the immobilized system the respective residual activities were estimated to be 97 and 85%. Immobilized agarase appears to be more tolerant to high temperatures in terms of its activity and stability as it is compared to that of the free enzyme which retained 74 and 50.84% of relative activity at 55 and 60°C while, free agarase retained only 40 and 16.79% of its original activity. Furthermore, the immobilized agarase could be reused in batches efficiently for eight cycles, and could be stored for 3 months at 4°C as wet beads and for more than 6 months as dry beads.

The mandibular premolars and molars exhibit wide variations in the form of roots and root canals. A bilateral symmetry of three rooted mandibular first and second premolar and four rooted mandibular first and second molar in a same patient is a rare entity and one such case is presented in this case report.

Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network’s (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.

Ascorbic acid is an excellent reducing power and antioxidant metabolite that participates in various biochemical reactionslike metabolism of tyrosine, tryptophan and catecholamines, serotonin, biosynthesis of nitric oxide (NO), protects DNAand proteins from potential free radical damage. For humans, it is an essential vitamin which must be supplied throughexogenous sources and diet, whose latent and chronic deficiency causes various patho-physiological, non-communicable,degenerative and metabolic complications whereas, acute deficiency was implicated with vascular damage, tissue damageand scurvy. The purpose of the study is to enhance ascorbic acid content in commonly eaten food grains as fruits and vegetables,which are good sources of ascorbic acid, due to their soaring prices have become unaffordable for the people of low income groups. This is the first report wherein, we have made an attempt to enhance the ascorbic acid content of a yellowcolored mung bean cultivar by simple house-hold processing technique. The ascorbic acid content of 100 g of dry seedsand 12 hr rehydrated seeds were estimated to 27 mg whereas, the germinating seeds have shown an increase in the ascorbicacid content to 114 mg per 100 g seeds.. The processing of mung bean seeds by sprouting has been shown to increase theascorbic acid content by 4.2 fold as compared to that of unprocessed dry seeds. The ascorbic acid content of 100g mungbean seeds was found to be twice the value of recommended dietary allowance, thus mung bean sprouts of yellow cultivarseeds appears to be an excellent source to mitigate various pathologies.

Polyphenols are bioactive compounds, mainly concentrated in seed coats, which play an important role in human nutrition. Ten samples of mung bean (Phaseolus aureus L.), including three yellow cultivars representing a broad range of varietal characteristics, such as color and seed weight, were analyzed for their polyphenol content. The effect of dehulling on the polyphenol content was studied. The concentration of total polyphenols was found to be in the range of 280 mg to 356 mg/100 g whole seeds, 702 mg to 1296 mg/100 g seed coat, and 172 mg to 286 mg/100 g cotyledons. Most of the polyphenols were concentrated in the seed coat. The average polyphenol content of yellow cultivars was found to be higher than the green cultivars, except in ‘China Mung’. The acidic methanol extract polyphenols constitute about 75% and methanolic extract polyphenols about 25% of the total polyphenols. Dehulling reduced polyphenol content significantly (p < .01) by 14% to 52%. Yellow cultivars contained more seed coat polypheno...

248 Background: The Eastern Cooperative Oncology Group Performance Status (ECOG) scale is commonly used in the clinical and research setting, and has been shown to correlate with cancer morbidity, mortality, and tolerance to chemotherapy. ECOG is frequently rated by physicians (MDs) and nurses (RNs), and MD-RN ECOG score agreement varies widely in the literature. It remains unclear whether MD and RN ECOG scores differ in their ability to predict clinical outcomes. Methods: As part of a quality initiative at Cedars-Sinai Cancer Center, oncologists and chemotherapy RNs independently scored ECOGs for a random sample of 309 patients with various solid malignancies, on one or more visits, for a total of 506 pairs of ECOG scores. MD/RN interrater agreement was evaluated using the Cohen's kappa coefficient. Logistic regression models were fit to evaluate the ability of RN and MD ECOG scores, as well as the RN-MD score difference, to predict the occurrence of chemotoxicity (CTCAE v4, grade≳3) and hospitalizations within 1 month from ECOG ratings as well as 6-month mortality/hospice referrals. Results: The agreement among 506 ECOG MD/RN pairs was 71% (Kappa = 0.485, p < 0.0001). RN ECOGs had a stronger odds ratio (OR) for 6-month mortality/hospice (OR = 3.55, CI 2.2-5.7) compared to MD ECOGs (OR = 2.99, CI 1.67-5.3). RN ECOG scores also significantly correlated with one-month chemotoxicity (OR = 1.39, CI 1.02-1.90), but MD ECOGs did not. Both MD and RN ECOG scores did not significantly correlate with 1-month hospitalizations. The magnitude of RN to MD ECOG score difference was also positively associated with 6-month mortality/hospice (OR = 3.42, CI 1.87-6.3), but not with 1-month hospitalization or chemotoxicity. Conclusions: Our findings suggest that RN-rated ECOGs may be stronger predictors of chemotoxicity and 6-month mortality/hospice compared to MD ECOGs. Furthermore, the magnitude of difference between ECOG MD and RN ratings was associated with increased mortality/hospice rates, specifically when the MD rating was “healthier” than that of the RN. As ECOG scores are frequently used for prognostication and to inform treatment decisions, ECOG scoring by RNs may result in additional clinical benefit.

e21689 Background: Patients with advanced cancer experience significant distress. Timely identification and treatment of distress can improve outcomes and quality of life. Domains of distress (i.e. pain, fatigue, physical function) can be assessed using patient reported outcome (PRO) questionnaires. However, PROs can be burdensome to patients, particularly when performed serially. Given the relationship between physical activity and sleep with domains of distress, wearable activity monitors may assist in the real-time detection of distress in advanced cancer patients. Methods: We conducted a prospective, observational study at Cedars-Sinai Medical Center and enrolled patients with measurable stage 3+ cancer, ≥18yr, English speaking, ambulatory, with a smartphone, and prognosis of > 3 months. Patients wore a Fitbit Charge HR continuously through 3 consecutive clinic visits, and completed NIH PROMIS tools (Physical Function, Pain, Sleep, Fatigue, and Emotional Distress) during visits. Fitbits recorded average daily step counts, stairs climbed, and sleep time. We conducted regression analyses that adjusted for baseline confounding variables and accounted for correlated responses. Results: 35 patients (Mean age 62; 53% males; 82% GI cancers) were evaluated. Patients had ECOG PS of 0 (20%), 1 (40%), 2 (23%), and 3(17%). The table below displays regression coefficients for steps, floors, and sleep in each PROMIS distress domain. Conclusions: There is a significant association between steps and floors climbed with multiple domains of distress and physical functioning. The lack of association between total sleep time and these PROs, may suggest that other metrics of sleep quality (i.e. awakenings), may be more relevant. These findings support further exploration of wearable data as a continuously monitored PRO surrogate in advanced cancer patients; wearable data should be further validated for use in both clinical and therapeutic trial settings. Clinical trial information: NCT02659358. [Table: see text]

6571 Background: Performance status (PS) is assessed to inform treatment decisions and predict outcomes in cancer. PS is often evaluated using ECOG or KPS scales, limited by their subjective and static nature. Wearable activity monitors provide oncologists with the opportunity to obtain continuous objective data on patients’ daily activity including steps, stairs climbed, and sleep. We evaluated the association between wearable activity monitor data, PS, and clinical outcomes. Methods: Patients with advanced cancer were enrolled in a prospective, observational study conducted at Cedars-Sinai Medical Center. Patients wore a Fitbit Charge HR for 3 consecutive clinic visits. ECOG/KPS were rated by treating physicians and serious adverse events (AE, clinically relevant grade 3+ by CTCAE v4), hospitalizations, and 6-month survival were collected. Correlations between PS and activity metrics were calculated. Multivariable regression models were fit to predict AEs and hospitalizations with activity data. The association between activity metrics and time to death was evaluated using survival analysis. Results: 35 patients (median age 62 years, 53% male) were evaluated. Most had gastrointestinal cancers (82%). Patients had ECOG PS of 0 (20%), 1 (40%), 2 (23%), and 3(17%). There were 10 (29%) pts with serious AEs, 14 (40%) hospitalizations, and 11 (31%) deaths. Average daily steps were significantly correlated with ECOG PS and KPS (r=0.73 and 0.70, respectively). Relationships between activity metrics, AEs, hospitalizations, and overall survival (OS) are displayed in the table below. Conclusions: We found a significant association between wearable activity monitor data and the risk of AEs, hospitalization and death. There is a strong correlation between step counts and KPS/ECOG PS. The potential of wearable activity data to predict outcomes and supplement PS assessment should be explored in future studies. Clinical trial information: NCT02659358. [Table: see text]

TPS6631Background: Oncologists assess patient (Pt) performance status (PS) to inform appropriate chemotherapy (Ct) decisions. Eastern Cooperative Oncology Group PS (ECOG-PS, range 0-5) and Karnofsk...

e21598Background: Wearable technology is increasingly being used in CTs to monitor physical activity (PA). WAMs contain multi-sensor systems which track steps, metabolic equivalents (METs), calorie...

228 Background: ECOG-PS is a widely implemented scale in oncology to assess performance status (PS). Higher scores are associated with poorer tolerance to higher-intensity chemotherapy (Ct). While professional societies recommend limiting Ct in patients with solid tumors and poor PS, the practice remains pervasive. To reduce this practice, in 2014 the Cedars-Sinai (CS) cancer quality committee developed a quality initiative (QI) requiring oncologists to indicate ECOG-PS on IV chemotherapy orders, with a structured hard-stop to evaluate patients with ECOG-PS≥3. Previously ECOG-PS was not required. Ct nurses also scored ECOG-PS, though their evaluation was not reported back to oncologists, and did not affect Ct decisions. Earlier studies have suggested a bias for oncologists to rate the ECOG-PS more positively than nurses when evaluating the same patient. Methods: 1084 of the total 12,259 Ct orders activated from 3/1/14-2/28/15 in a CS infusion center were randomly audited for ECOG-PS scoring by MD and RN for quality assurance. Completion and concordance rates for ECOG-PS were determined. Results: 93% and 83% of charts documented MD and RN ECOG-PS, respectively. 827 charts had both MD and RN ECOG-PS scores. Concordance rates, and discordance directionality are described in the Table. Conclusions: This QI achieved high rates of ECOG-PS documentation by oncologists, and low rates of Ct administration to patients with ECOG-PS≥3. MD/RN concordance rates were similar to those described in the literature. Interestingly, and in stark contrast to previous studies, MDs were more likely to score ECOG-PS as poorer compared to RNs in solid tumor discordant cases. [Table: see text]

241 Background: Pancreatic adenocarcinoma is the 4th leading cause of cancer death in the US. It is predicted to become the 2nd leading cause by 2030. Advanced disease at diagnosis is common. Fewer than 20% of patients having long-term disease control. Given the high prevalence of physical and psychosocial needs, a quality initiative that embedded a PC physician in a pancreatic cancer program was initiated. Methods: From June 2015-October 2015, all stage III/IV pancreatic adenocarcinoma patients were referred for palliative consultation. * The PC physician was introduced as a supportive care medicine provider; a part of the comprehensive pancreas cancer program. *Other resources (ie RN, SW, Chaplain, RD) deployed as indicated *Patients seen initially and at least every 2 months * ESAS, PHQ2, and spiritual screens performed regularly * Data collected regarding symptom trajectory, resource utilization; and timing/place of death. Results: N=17. Conclusions: PSP demonstrated the ability of a PC provider to be effectively accepted and integrated into a pancreas program. Results suggest a benefit in the standardization of symptom screening/ intervention, and a possible favorable impact on healthcare resource utilization. Outcomes will continue to be tracked and compared with patients in the larger cancer community. Further study is indicated to assess the scalability and impact of this model of integrated care. [Table: see text]

275 Background: Molecular differences in solid tumors have been shown to correlate with heterogeneity of response. Unfortunately, minimal data exists in pancreatic ductal adenocarcinoma (PDA). Next generation sequencing (NGS) may provide genetic signatures that allow prognostic stratification and predict response to targeted therapy. Methods: DNA was extracted from biopsy specimens of 64 patients (pts) with PDA at Cedars-Sinai Medical Center. DNA sequencing was performed for 3,769 exons of 236 cancer-related genes plus 47 introns from 19 genes to an average depth of 1000X using the Illumina HiSeq 2000 platform (Foundation Medicine, Cambridge, MA). We report all genetic alterations including those classified as variants of unknown significance (VUS) as these may potentially be important for further study. Results: 94% of our patients had KRAS mutations, SMAD(39%) P53 (69%), and CDKN2A (48%). 17% of the pts had all 4 mutations. 4.6% had none. MLL and ARID genes, both involved in chromatin remodeling, were altered in (45%) and (35%) of the patients respectively. Alterations in MLL2 (22%) have been previously described. Interestingly, we also identified mutations in MLL3 (15%) and MLL (8%) of patients. We also identified an equal frequency of mutations in ARID1A mutations (17%) and ARID 1B (17%). ATM (19%) and ATR (11%) genes involved in double stranded DNA repair were mutated in a total of 30%. BRCA1 (12.5%) and BRCA2 (14%) were mutated in 26.5%, and PALB2 in another 2%. PMS2 (mismatch repair) was also mutated in 9% of patients. In total 67% of patients had alterations in one of these DNA repair pathways. There were a number of other genes noted to harbor mutations in greater than 10% of patients including BCOR, which is known to interact with MLL and seen in acute leukemia, FANC complex, GPR124 (angiogenesis), as well IRS2, PIK3A in the akt-PIK pathway. Conclusions: NGS in a cohort of advanced pancreatic cancer patients identified novel alterations in genes associated with chromatin modeling and DNA repair. These pathways may serve as potential avenues for targeted therapy in pancreatic cancer.

The optimization of solid-substrate medium and fermentation conditions for the production of enzyme carrageenase by a Pseudomonas aeruginosa ZSL-2 was achieved for the first time by employing an orthogonal array testing strategy (OATS). Of the four different substrates tested, wheat bran showed maximum production of carrageenase enzyme. The factors that influence the solid-substrate fermentation (SSF) conditions such as, moisture content, moistening agent, temperature, pH, inoculum size, additional carbon source and the fermentation period for the production of enzyme were studied by one-factor at a time and also by L9(34) an orthogonal array method. The maximal production of k-carragenase (7.44 U/g) dry bacterial bran was achieved at moisture level 1:2.5 (w/v; wheat bran to moisture level), moistening agent IV, inoculum size (10%), temperature 37°C and 48 h of fermentation. The effects of various parameters like medium, inoculum size, temperature, moistening agent, moisture level, incubation period, and supplementation of other carbon sources on the production of carrageenase by SSF using OATS is investigated and the results are presented and discussed.

190 Background: Increasing emphasis is being placed on reducing hospital readmission (readm) rates. Reduction of hospital readm remains a challenge, especially among the oncology population. Identifying patients (pts) at increased risk can assist with developing targeted interventions. Methods: From 1/1/11 to 12/31/12, an interdisciplinary team consisting of medical oncologists, hospitalist physician and NP, QI specialist, and case manager prospectively reviewed the medical oncology inpatient census on a biweekly basis to identify pts at risk for readm. Pts with any of the following conditions were considered at high risk for readm: significant pain, wounds, intestinal obstruction, refractory neutropenia despite GCSF, elderly/frail, unstable housing, patient/family non-compliance, rapid cancer progression, refusal of appropriate hospice care, and stalled care plans. These criteria were based upon previous years’ anecdotal experience. Interdisciplinary interventions to address these conditions were identified and initiated. Results: 272 pts were assessed during these sessions. Each session took on average 60 minutes. 69 pts (25%) were deemed to have at least one high risk factor. Chart review revealed that 6 died in the hospital and 13 were discharged to hospice. No pts on hospice were readmitted. Of the remaining 50 high risk pts, 14 (28%) and 25 (50%) pts were readmitted within 14 days and 30 days, respectively. Conclusions: This interdisciplinary team model seems to have a fair predictive value in identifying pts at higher risk for readmission. However, it is time and labor intensive. Enrollment of appropriate high risk pts in hospice mitigates this risk. Given the current emphasis on decreasing readm and the increased cost/penalties associated with readm, the next step will be to pilot cost-effective interventions for pts with these high risk factors. Potential interventions which we have instituted include follow-up calls, social service referrals, intensive family/pt education, clinic appointments within 3 days of discharge, greater coordination with primary care physicians, and more effective hospice discussions. Supported by CA 62505.