Primary Needle Research Articles

“No-one just does drugs during business hours!”: evaluation of a 24/7 primary needle and syringe program in St Kilda, Australia

BackgroundPrimary needle and syringe programs (NSPs) have been integral for the prevention of blood-borne virus (BBV) transmission among people who inject drugs. Despite this, many people who inject drugs face barriers accessing these services, particularly after-hours when most services are closed. To our knowledge, the St Kilda NSP, in Melbourne, Victoria, is the only primary NSP providing 24/7 dedicated stand-alone face-to-face services for people who inject drugs in Australia. We conducted an evaluation of the St Kilda NSP to assess its role and effectiveness in meeting client needs.MethodsMixed research methods were used to conduct the evaluation. We analysed four quantitative data sets including the Victorian Needle and Syringe Program Information System data; NSP ‘snapshot’ survey data; and St Kilda NSP records of after-hours contacts and naloxone training events. Qualitative interviews were conducted with 20 purposively selected NSP clients, which were focused on individual needs, expectations and experiences accessing the service. Interviews were audio recorded and transcribed, and data were analysed thematically. A convergent research design was used to merge the five data sets.ResultsSt Kilda NSP had 39,898 service contacts in 2018; 72% of contacts occurred outside business hours. Similarly, of 1,185,000 sterile needles and syringes dispatched, 71% were distributed outside business hours. Participants described valuing the after-hours service because drug use patterns did not always align with standard NSP opening hours and after-hours access afforded anonymity when collecting injecting equipment. Narratives highlighted several additional benefits of the 24/7 service, including: access to safer sex equipment; material support; naloxone training; referrals to specialist services; face-to-face emotional and social support from a non-judging worker; and for women involved in sex work in particular, being able to seek refuge when feeling unsafe on the streets.ConclusionsOur study provides evidence of the social and health benefits (beyond that of preventing BBV transmission) that can be gained through the provision of 24/7 primary NSP services. Findings support the need for the establishment of after-hours primary NSPs in other areas of Australia where active street-based drug markets operate outside business hours and concentrated numbers of people who inject drugs live and spend time.

Purulent Skin and Soft Tissue Infections, Challenging the Practice of Incision and Drainage: A Scoping Review.

To generate a landscape of the current knowledge in the interventional management and outcomes of purulent skin and soft tissue infections. This study is a scoping review. Electronic searches were undertaken using CINAHL, Medline, Cochrane Library, British Nursing Index, Science Direct, the National Health Service knowledge and library hub, ClinicalTrials.gov, and MedNar. The population, concept, context framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were utilised, supporting a rigorous appraisal and synthesis of literature. Data Sources. The initial search and synthesis of literature were completed in January 2022 with repeat searches completed in March 2022 and July 2023. There were no imposed chronological parameters placed on the returned literature. Nineteen papers were reviewed. Incision and drainage with primary closure, needle aspiration, loop drainage, catheter drainage, and suction drainage are viable adjuncts or alternatives to the traditional surgical management of skin and soft tissue abscesses. Despite the empirically favourable alternatives to the incision and drainage technique demonstrated, this does not appear to be driving a change in clinical practice. Future research must now look to mixed and qualitative evidence to understand the causative mechanisms of incision and drainage and its ritualistic practice. Implications. Ritual surgical practices must be challenged if nurses are to improve the treatment and management of this patient group. This will lead to further practice innovation. Impact: This study explored the challenges posed to patients, clinicians, nurses, and stakeholders, resulting from the ritualistic practice of the incision and drainage technique in purulent skin or soft tissue abscesses. Empirically and holistically viable alternatives were identified, impacting all identified entities and recommending a wider holistic study. Reporting Method. Adherence to EQUATOR guidance was achieved through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Childhood pilomatrixoma mimicking malignant small round blue cell tumor with positivity for CD99: Potential pitfall in cytology.

Pilomatrixoma is a relatively rare benign skin appendageal tumor, often presenting in the pediatric age group as a nodular lesion and most commonly involving the head and neck, making it amenable to primary fine needle aspiration (FNA) diagnosis. We report the clinical and histopathological findings of two cases of pilomatrixoma in children, both of which were initially misdiagnosed as small round blue cell tumors due to high cellularity and misinterpretation of the proliferating basaloid cells. Histopathology revealed basal cell proliferation and mitoses indicating that they were progressive, early lesions. The first case showed membranous positivity for CD99 which prompted a diagnosis of Ewing sarcoma. Awareness of the morphological spectrum including positivity for CD99 and careful evaluation of cell block histology could have averted the misdiagnosis. Pilomatrixoma should be included as an important differential diagnosis when faced with primitive-appearing cells on FNA, especially in children with mass lesions in the head and neck region.

Drops in needle production are early-warning signals of drought-triggered dieback in Scots pine

Key messageReconstruction of needle dynamics reveals prolonged drought legacy effects on crown condition that represent early warnings of drought-induced dieback in Scots pine.Understanding the mechanisms of drought-induced forest dieback and tree mortality is a priority for predicting forest responses to climate change. However, long-term information on drought impacts on crown dynamics and how it relates to tree water and carbon economy is still lacking. Comparing declining and non-declining Scots pines at the same site, we quantified primary and secondary growth and intrinsic water-use efficiency (WUEi). Further, we reconstructed the needle production and the annual total number of needles using the Needle Trace Method. Here, we reconstructed the apical needles through the assessment of 2460 longitudinal sections. We fitted partial least squares regression models to assess climate influence on primary and secondary growth and needle dynamics, and then linear mixed models using climate covariates and discerning between health status in the 1975–2016 period. Finally, we analyzed drought legacy effects applying a Bayesian hierarchical framework. We detected the highest differences between health tree classes in the annual total number of needles during the warm-dry 1980s. Declining trees responded more negatively to climate than non-declining conspecifics and showed a higher variability of drought legacy effects. We found significant drought legacy effects in the annual total number of needles up to 3 years after a drought. The warm, dry 1980s, that preceded the dieback, showed the highest δ13C values since the 1970s. Declining trees showed higher WUEi than non-declining trees from the 2000s onwards. Our study sheds light on the major role of needle dynamics in dieback episodes and illustrates how past drops in needle production may be interpreted as early warnings of drought-induced dieback in Scots pine.

Heteroblastic Foliage Affects the Accumulation of Non-Structural Carbohydrates and Biomass in Pinus massoniana (Lamb.) Seedlings

Pines have heteroblastic foliage (primary and secondary needles) during seedling stage, but how heteroblastic foliage affects carbon storage and biomass accumulation, contributing to seedling quality, is unclear. We investigated the influences of heteroblastic foliage on photosynthetic physiological characteristics, non-structural carbohydrate (NSC) and biomass accumulation in current-year seedlings; the key factors determining biomass accumulation were mainly determined by principal component screening, Spearman correlation, and path analysis. The results indicated that (1) primary needles have high photosynthetic pigments (chlorophyll a and total chlorophyll), net photosynthetic rates (Pn), the potential maximum photochemical efficiency (Fv/Fm), and leaf instantaneous water use efficiency (WUEi), whereas higher non-photochemical quenching (NPQ) suggested that sudden light increases induce the initiation of quenching mechanism in primary needles; additionally, secondary needles had a lower transpiration rate (Tr), limiting stomata (Ls), and light saturation point. (2) Secondary needles promoted soluble sugar (fructose and glucose) increases in leaves compared to that of primary needles and increased the leaf biomass accumulation (from 47.06% to 54.30%), enhancing the overall ability of photosynthetic organs; additionally, secondary needles can enhance the proportion of starch storage in the roots, and NSC accumulation was significantly increasing in the seedling leaves and roots. (3) Photosynthetic pigments (carotenoids, chlorophyll a, and total chlorophyll) had direct positive effects on primary needle seedling (PNS) biomass and promoted biomass by indirectly increasing soluble sugar synthesis in the stems. The Pn was the main physiological factor determining PNS biomass accumulation. In addition, the WUEi, Ls, and NPQ had direct negative effects on PNS biomass accumulation, inhibiting photosynthesis to limit seedling growth. Considering the functional traits in heteroblastic foliage is necessary when assessing different leaf types of Pinus massoniana (Lamb.) seedlings, in particular those threats implicated in light, water, and temperature relations. Our results can be beneficial to guide the establishment of seedling management and afforestation measures.

Mechanical and microstructural analysis of a AlSi-ZrO2 metal matrix composite using optimized artificial neural network and experimental data

Spray deposition methods has emerged as an alternative to powder metallurgy and ingot routes. This research aims to study the effect of flight distance as a potential key factor that changes the optimum percentage of aluminium silicon- zirconium oxide in terms of mechanical and microstructural properties. The alloy is sprayed at varying the flight distance from 320 mm to 480 mm. The composite were prepared by spray deposition technique and effects on microstructural properties were examined. The aluminium silicon- zirconium oxide composite was subjected to hot isostatic pressing for reducing the porosity of the deposit from 14.4% to 8.2%. A series of experimental study were carried out in the laboratory by varying the flight distance from 320 mm to 480 mm for aluminium silicon- zirconium oxide composite to characteristic loading. In this paper, an optimized artificial neural network using genetic algorithm are developed to predict the mechanical behaviour for aluminium silicon- zirconium oxide composites. Based on the experimental data, the ANN models were developed, trained and tested. The microstructure of the AlSi-ZrO2 composite consisted of finely divided globular shaped eutectic Si uniformly distributed in the Al matrix. With addition of zirconium oxide composition to AlSi alloy, the tensile strength and micro hardness increased from 123 MPa to 147 MPa and, 48 HV to 72 HV, respectively. The preferred flight distance for the current study is found to be 420 mm. Microstructural images obtained at flight distance consist of co-existing primary Si phase and needle like eutectic Si. The physical properties, such as tensile strength, compressive strength, yield strength, micro hardness and porosity of sprayed aluminium silicon- zirconium oxide can hence be adjusted by setting the optimized flight distance. The developed ANN-GA method proved to be accurate, reduced time and efficient to predict the numerous samples and it will help materials designers to design their future experiments effectively.

Risk factors of local recurrence following implant-based breast reconstruction in breast cancer patients

BackgroundThe number of patients desiring implant-based breast reconstruction has been increasing. While local recurrence is observed in patients with breast reconstruction, only a few reports have focused on the risk factors for local recurrence and the prognosis after developing local recurrence.MethodsWe analyzed 387 patients who underwent implant-based breast reconstruction during the period from 2004 to 2017 in Hiroshima City Hospital. We retrospectively examined the risk factors for local recurrence and the outcomes of patients developing such recurrence after implant-based breast reconstruction.ResultsThe median follow-up time was 59 months. The local recurrence rate was 3.1% (n = 12). The most common reason for detecting local recurrence was a palpable mass. Four patients with local recurrence had recurrence involving the skin just above the primary lesion and needle biopsy tract. All patients with local recurrence received surgery and systemic therapy and most patients received radiation therapy, all have remained free of new recurrence to date. Multivariate analysis showed lymphatic vessel invasion (HR, 6.63; 95% CI, 1.40–31.36; p = 0.017) and positive or < 2 mm vertical margin (HR, 9.72; 95%CI, 1.23–77.13; p = 0.047) to be associated with significantly increased risk of local recurrence.ConclusionsThe risk factors for local recurrence following implant-based breast reconstruction were lymphatic vessel invasion and positive or < 2 mm vertical margin. Removal of the skin just above the primary lesion and needle biopsy tract and adjuvant radiation therapy might improve local outcomes. Patients with local recurrence following implant-based breast reconstruction appear to have good outcomes with appropriate treatment.

The role of primary needle revision after Ahmed glaucoma valve (AGV) implantation.

To evaluate the efficacy and safety of primary needle revision after Ahmed Glaucoma Valve (AGV) implantation in comparison with glaucoma medication use. In this interventional case series, 23 eyes of 23 patients who underwent AGV implantation were enrolled. Needle revision was performed when the intraocular pressure was higher than the target pressure before glaucoma medications. Using a 30-gauge needle, the Tenon's capsule over the plate was incised and the bleb was reformed. Patients were examined on a postoperative day one, weekly (for four weeks), and every 1-3months. Two criteria were used to define cumulative success as a minimum 20% reduction in IOP and 5 <IOP ≤ 21mmHg (Criteria A) or 5 <IOP ≤ 18mmHg (Criteria B) without (Complete success) or with (Qualified success) glaucoma medication. In this pilot study, we enrolled 23 patients with a mean age of 53.8 ± 12.4years (25-78years) who underwent AGV implantation and a one-year follow-up period. The mean number of primary needle revision was 2.2 ± 1.6 (1-6). One year postoperatively, the cumulative success rate was 91.4% and 86.9% based on Criteria A and B, respectively. The average of preoperative IOP was 28.26 ± 8.86mmHg (range 15-46mmHg), reaching 13.78 ± 3.54mmHg (range 8-20) at the end of the one-year follow-up. (P < 0.001) The mean preoperative medication significantly decreased from a median of 4 (range 3-4) at baseline to 2 (range 1-4) after the one-year follow-up (P < 0.001). One patient experienced leakage over the plate, which was successfully treated via conservative management. This pilot study showed that primary needle revision is a safe and effective method for controlling IOP after AGV implantation with a lower need for medication.

Su1441 PRIMARY NEEDLE KNIFE SPHINCTEROTOMY FOR BILIARY ACCESS IN SELECTED PATIENTS WITH HIGH RISK FOR POST-ERCP PANCREATITIS: A PROSPECTIVE PRELIMINARY FEASIBILITY STUDY

Needle knife fistulotomy may be useful as the first line of procedure for biliary access to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) based on recent clinical data. We aimed to evaluate the safety, effectiveness, and feasibility of primary needle knife sphincterotomy (NKS) for biliary cannulation in patients with a high risk of PEP. A total of 40 patients who need ERCP using primary NKS for biliary disease in our institution between June 2018 and November 2019 were prospectively enrolled in this study. The procedures were conducted by two expert biliary endoscopists (S.J. and J.S.P.) who had experience of ERCPs. They had one or more of the following risk factors of PEP; young age (<50 years), female gender, normal common bile duct (CBD) diameter (≤9 mm), normal serum total bilirubin level (0.2-1.2 mg/dL), obesity (body mass index: >30), or history of pancreatitis. The success rate of biliary cannulation, time to biliary cannulation, and the occurrence rate of PEP, as well as other post-ERCP complications, were assessed. Of 40 patients enrolled, 34 patients underwent primary NKS. Nine patients had 1 risk factor of PEP, seven had 2, eight had 3, seven had 4, and three had 5. The success rate of CBD cannulation using NKS was 94.1% (32/34). The median time for biliary cannulation was 243 seconds (range, 32-1,514 seconds). None of the patients experienced post-ERCP pancreatitis, cholangitis, and perforation. One case of minor bleeding (2.9%, 1/34) and 1 asymptomatic hyperamylasemia (2.9%, 1/34) occurred. Primary NKS might be safe, effective and feasible for biliary access in patients with high risk for PEP if the procedure is performed by expert hands.

Abstract P4-06-06: Comparison of HER2, estrogen and progesterone receptor expression profiles of primary tumor and synchronous axillary lymph node metastases in 149 breast cancer patients - indicating tumoral heterogeneity

Abstract Background: Tumor heterogeneity in terms of comparison between receptor expression profiles (ER, PR and HER2) of primary core needle biopsies (CNB) and definitive lymph node histo-pathologic examination is an evolving research field with unknown potential in terms of individual oncological treatment. Yet, heterogeneity is merely common as a different receptor expression between primary tumor versus metastatic disease. Thus, data on primary receptor heterogeneity between primary tumor and synchronous lymph node metastasis is rare. Primary aim of this trial is to present data on the epidemiologic aspect of tumor heterogeneity with synchronous lymph node metastases (LNM) in breast cancer patients. Methods: We retrospectively analyzed 149 consecutive patients with breast cancer and synchronous LNM who undergone oncologic surgery (sentinel lymph-node biopsy: 66,4%, axillary lymph-node dissection: 33,6%) between 2008 and 2018 at the university hospital Leipzig, Germany. Patients underwent operation without any preoperative therapy, with neoadjuvant chemotherapy or with neoadjuvant hormone therapy in 109 (73,2%), 30 (20,1%) and 10 (6,7%) cases, respectively. Formalin-fixed and paraffin-embedded (FFPE-material) were routinely examined immunohistochemically according to the ASCO/CAP guidelines using Ventana-platform. The results for ER, PR and HER2 were analyzed case-by-case comparing results from the CNB of the primary tumor within the breast and axillary LNM. Proliferative activity was determined by MIB-1 immunohistochemistry and according to well established guidelines, the tumors were grouped into the different intrinsic subtypes as luminal A and B, HER2-enriched and triple-negative by the different immunohistochemical staining results. Results: Median patient age was 61 years with most frequent tumor entity (75,8%) being an invasive-ductal adeno carcinoma. 115 (77,2%) patients had either a T1 or T2 stadium. Overall there were 61 (40,1%) patients who had at least one receptor change, with 16 patients with two receptor changes. The discordance rates between primary tumors and axillary LNM were 13,4% for HER2, 10,1% for ER and 28,2% for PR. Totally in 69 receptor changes the receptor was initially positive and changed to negative (receptor-loss), whilst in 8 cases a receptor was positive that was initially negative (receptor-gain). Out of 77 receptor changes, 18 were after neoadjuvant chemotherapy, 5 after neoadjuvant endocrine therapy and 54 changes were without any neoadjuvant treatment. Influencing factor in estrogen receptor changes in the competitive analysis was a younger age (p-value 0.01, medium age 51.27 years; PR receptor change, medium age: 60,88 years; HER2 receptor change: medium age: 61,65 years). Conclusions: Our results imply the high frequency of subtype differences between primary tumor and LNM. This could be explained by intra-tumor heterogeneity. Subtype changes should be taken into account for an optimal and individual treatment. Larger studies are necessary to validate these data and gain further information. Citation Format: Laura Weydandt, Anne Kreklau, Florian Oehme, Lars Christian Horn, Bahriye Aktas. Comparison of HER2, estrogen and progesterone receptor expression profiles of primary tumor and synchronous axillary lymph node metastases in 149 breast cancer patients - indicating tumoral heterogeneity [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-06-06.

P2.09-23 PD-L1 Expression of Paired Primary Resected Non Small Cell Carcinoma and Metastatic Lymph Node Fine Needle Aspirates

P2.09-23 PD-L1 Expression of Paired Primary Resected Non Small Cell Carcinoma and Metastatic Lymph Node Fine Needle Aspirates

Dealumination of MOR Zeolites with Different Crystal Morphologies

The process of dealumination of mordenites differing in morphology and crystal size obtained under identical conditions from reaction mixtures of similar composition has been studied. Parameters that have been chosen to change the morphology and crystal size are the dry matter concentration in the reaction mixture, the pH of the reaction mixture, the crystallization time, the presence of crystalline seeds, and agitation during the synthesis. Dealumination has been performed by heat treatment at 700°C followed by acid treatment. It has been shown that the stability of the mordenite crystal framework to dealumination depends on the thickness of the primary needle crystal, which forms the basis of large zeolite crystals, not on the size of the zeolite crystal as a whole. With a decrease in the average needle crystal thickness from 250 to 90 nm, the Si/Al molar ratio in the crystal lattice, determined from 29Si NMR data, increases from 6.8 to 9.5. The dealumination is accompanied by a change in the texture of large mordenite crystals associated with a decrease in the packing density of the primary needles.

Importance of Parathyroid Hormone Needle Aspiration Washout in Adenoma Localization in Primary Hyperparathyroidism.

BackgroundPrimary hyperparathyroidism is an endocrine disease characterized by excessive secretion of parathyroid hormone and hypercalcemia. Although scintigraphy is commonly used for pre-operative localization, it does not always localize the parathyroid lesion. In such patients, ultrasonography can visualize the suspected lesion and needle washout sample for parathyroid hormone titer can be used to confirm parathyroid tissue. The aim of this study was to investigate the accuracy of the parathyroid hormone needle aspiration washout method in detecting the localization of parathyroid adenoma.Material/MethodsPatients with primary hyperparathyroidism who underwent surgery between 2010 and 2017 at the Dicle University Medical Faculty Hospital were retrospectively evaluated using medical records. Patients undergoing parathyroid hormone needle aspiration washout were performed in the suspected lesion were included in the study. Accompanied by ultrasonography, the suspected area was penetrated with needle, and negative aspiration was performed. Pre-operative scintigraphic data of patients were evaluated. Patients with positive scintigraphy, negative scintigraphy or patients who did not undergo scintigraphy were included in our study. Demographic data were presented as continuous data means ± standard deviation. Categorical variables were presented as frequency and percentage.ResultsForty-nine patients (female/male, 40/9) who underwent parathyroid hormone needle aspiration washout were included in the study. Parathyroid hormone washout result was positive in 47 patients (47/49) and negative in 2 patients (2/49), sensitivity/positive predictive value (PPV) 95.91%. Twenty-six patients who had negative/suspicious scintigraphic results were diagnosed using the parathyroid hormone needle aspiration washout method (24/26, 92.3% accuracy). Parathyroid hormone needle aspiration washout without scintigraphy was performed in 13 patients (13/13, 100% accuracy).ConclusionsParathyroid adenoma localization can be easily done using parathyroid hormone needle aspiration washout in centers experienced in adenoma localization in primary hyperparathyroidism cases in which scintigraphic results are negative or scintigraphy cannot be performed. We believe that primary parathyroid hormone needle aspiration washout can be a new localization method for adenoma localization.

Abstract PD6-02: Immunological differences between primary and metastatic breast cancer

Abstract Background: Little is known about how the immune microenvironment of breast cancer evolves during disease progression. Immunological differences between primary and metastatic lesions may explain discordant results of clinical trials that showed low tumor response rates with immune checkpoint therapy in metastatic breast cancer but high rates of pathologic complete response in early stage disease. The goal of this project was to examine TIL counts, PD-L1 protein expression and immune gene mRNA expression in primary tumors (P) and metastatic lesions (M). Methods: FFPE blocks of primary breast cancers and core needle biopsies of matching distant metastases from 54 patients (n=104 samples). TIL count was assessed on H&amp;E slides for 39 paired tissues and is reported as % of TIL in the stroma. PD-L1 protein expression was detected with immunohistochemistry (IHC, E1L3N antibody) in 36 pairs, samples with &amp;gt; 1% cells showing staining were considered PD-L1 positive which was determined separately for tumor and stroma. The expression of 770 immune-related genes was measured using the Nanostring PanCancer Immune Gene Panel in 31 P and 17 M, including 10 paired cases. Genes were organized into 14 immune cell type (total T, Th1, Treg, Total CD8, exhausted CD8, Cytotoxic T, B, NK, NK-CD56, Mast cell, CD45, Dendritic cell, macrophage, neutrophil) and 22 immune function metagenes. Differences in mean expression in P and M were assessed using Fisher exact and Mann-Whitney tests without adjustment for multiple comparisons due to overlap in metagene membership. Results: Mean TIL counts (14% vs 20%, p=0.026) and stromal PD-L1 positivity by IHC (14% vs 54%, p=0.004) were significantly lower in M. PD-L1 positivity in tumor cells was similar (25% in M vs 42%, in P p=0.14). The total TIL gene expression score (2.48 vs 2.8 p=0.018) and all immune cell type metagenes, except neutrophils, had lower absolute expression levels in M. The relative abundance of neutrophils (0.035 vs -0.38, p=0.0001) and macrophages (0.62 vs 0.38 p=0.0013) increased in M. Among the 22 immune function metagenes, T, B and NK cell functions, cytotoxicity, chemokine and TNF superfamily expression, regulation and pathogen defense were significantly lower in M and none showed significantly increased expression in M. Pro-inflammatory/immune-activating cytokines of IL-6, CCL-5,-12,-19,-22 and CXCL-5,-9,-10,-11 were all significantly lower in M. The greatest drop was seen for CXCL-9 (2243 vs 422, p&amp;lt;0.0001) and CCL-19 (2537 vs 309, p&amp;lt;0.0001). No cytokine showed increased expression in M. Only 6 immune genes (C7, GPI, MAPK1, TAB1, TLR5, PVR) showed significantly higher (p&amp;lt;0.05) expression in M, the greatest increase was for Complement C7 (member of the terminal complement pathway membrane attack complex; 484 vs 3499, p=0.03) and GPI (glucose 6-phosphate isomerase that induces immunoglobulin secretion; 1967 vs 3011, p=0.01). Conclusions: Breast cancer metastases exist in an attenuated immune microenvironment. Most immune cell subtypes, immune functions, and immune-associated gene expression are lower in M compared to P, consistent with immune escape. Metastatic lesions have higher relative abundance of macrophages and neutrophils, which suggest new therapeutic opportunities. Citation Format: Szekely B, Bossuyt V, Li X, Baine M, Silber A, Sanft T, Hofstatter E, Mougalian S, Baghwagar S, Neumeister V, Pelekanou V, Hatzis C, Pusztai L. Immunological differences between primary and metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD6-02.

Potential of dual spray injectors for optimising the noise emission of gasoline partially premixed combustion in a 2-stroke HSDI CI engine

This paper evaluates the potential advantages of introducing a new injector concept with a dual set of orifices in a 2-stroke engine operating with gasoline partially premixed combustion (PPC gasoline), specially in terms of combustion noise reduction. The injector is based on a configuration with two concentric needle valves and dual actuators, which allows to switch among two independent crowns of holes. The first set of orifices is controlled by the primary needle valve while an additional needle valve manages the secondary holes crown. Moreover, both valves are coupled with the two actuators separately, providing enhanced selective control over injection with an extra degree of freedom. In this investigation, a combination of Computational Fluid Dynamics (CFD) simulations and the Design of Experiments (DoE) technique is proposed with the specific purpose of optimizing this new injector configuration. In addition to determining the most convenient design, this method is extremely useful to establish cause/effect relationships between the injection design parameters and their impact on the engine performance and emissions. Results show how this solution could increase the operating range of the PPC gasoline concept by improving the combustion stability while acoustic emissions are reduced.

Young people at risk of transitioning to injecting: what do they know about where to get sterile needles?

ABSTRACTThis article focuses on young people at risk of transitioning to injecting and explores what they know about where to obtain sterile needles. We used cross-sectional survey data collected from 210 at-risk young people. While a third (34.3%) of participants thought they knew where to obtain sterile needles, fewer (24.3%) could correctly identify a service and the sources most commonly identified – hospitals (27.8%) and pharmacies (25.0%) – were not specifically needle distribution services. Multivariate analysis identified that recent contact with social and health services had no impact on whether participants knew where to get sterile equipment. This suggests that needle distribution policies might focus less on getting young people to visit primary needle distribution sites, which they know little about, and more on improving services that they already know about – hospitals and pharmacies – or finding ways of bringing sterile needles to them, such as through peer distribution.

Adding-On a Brief Skill-Based HIV Prevention Psychoeducation to Needle and Syringe Programs: A Randomized Controlled Trial

Background: It is estimated that there are 180,000 people who inject drugs (PWID) in Iran. To reduce HIV-related high-risk behaviours among PWID, primary needle and syringe programs (NSPs) are delivered through drop-in centres (DICs) in Iran since 2002, but there is a paucity of research on the differential effectiveness of psychosocial components of NSPs on high-risk injection and sexual behaviours of drug users. Objectives: The current study aimed to examine the effectiveness of adding-on a brief skill-based HIV prevention psychoeducation on HIV-related high-risk behaviours among clients of two drop-in centres (DICs) in Tehran, Iran. Materials and Methods: One hundred and twenty consecutive clients with the mean age of 34 years who met diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) criteria for opioid dependence were selected and randomly assigned into intervention and control groups. Demographic data, history of drug abuse, high-risk sexual behaviours and drug-related behaviours were gathered using a researcher-made questionnaire. The intervention group received two brief sessions of skill-based HIV prevention psychoeducation added on routine needle and syringe program; while the control group received routine services. The two groups were followed in months one and three, respectively. Results: The intervention group showed significantly more reduction in high risk injecting behaviours including average number of daily injections (F = 4.32, P < 0.05), number of injections during the last month (F = 11.45, P < 0.05), and number of times using syringes used by another person (F = 4.27, P < 0.05). The intervention group showed significantly greater reductions on some measures of sexual behaviours compared to the control group. These measures included the number of sex partners (F = 4.43, P < 0.05), the number of sex partners whom they had unprotected sex with (F = 3.20, P < 0.05) and the number of new sex partners (F = 3.58, P < 0.05). Conclusions: The study results indicated that adding-on a brief skill-based HIV prevention psychoeducation consisted of two individual sessions to routine NSP could significantly increase its effectiveness. The importance of integration of HIV prevention psychoeducation programs within routine harm reduction services was discussed.

“No pain, no gainz”? Performance and image-enhancing drugs, health effects and information seeking

Background: A range of indicators point to an international increase in the prevalence of performance and image-enhancing drugs (PIEDs) use, predominantly among young men. Attention to PIEDs-related benefits, adverse health effects, information and health service access are needed. Methods: A cross-sectional survey of 605 men who inject PIEDs was conducted at nine primary needle and syringe programme locations across five local health districts in Sydney. Results: Among anabolic–androgenic steroids (AAS) users (n = 564), anger, rage or irritability (27%, 95%CI: 23.4–30.6) and sexual or genital problems (26.4%, 95%CI: 22.9–30.0) were the most commonly reported adverse health effects. Taking regular, longer breaks between AAS cycles were associated with reduced reports of some adverse effects. Approaching two-thirds of participants had told a doctor about using PIEDs (63.1%, 95%CI: 59.1–67.1). However, as length of time since first injecting PIEDs increased, participants’ perceptions of doctors as reliable information sources decreased (rho = −0.10, p = 0.04). Reliance on lay information sources was very common, particularly among people who spoke languages other than English. Conclusions: This study supports providing information on cycle lengths and break periods as part of standard PIEDs-related harm reduction guidelines. Safe injecting and dosage education through peer networks or steroid clinics may be useful strategies.

Benefits and barriers to expanding the availability of take-home naloxone in Australia: A qualitative interview study with service providers

Aims: To investigate the perspectives and experiences of service providers regarding provision of take-home naloxone to people who use opioids in Victoria, Australia. Methods: Content analysis of qualitative semi-structured interviews with 15 service providers who are either involved with take-home naloxone programs or whose work brings them in contact with people who use opioids. Findings: Statements about take-home naloxone were universally positive. Both direct and indirect benefits of take-home naloxone were described. Alongside potential reductions in opioid overdose-related harms, service providers highlighted the empowering effects of providing people who use opioids with take-home naloxone. No significant risks were described. Service providers supported the expansion of naloxone availability, but also identified several intertwined barriers to doing so. Key among these were costs, current regulations and scheduling, availability of prescribers and stigma related to illicit and injecting drug use. Conclusions: Expanding the availability of naloxone is a key component of strategies to reduce harms associated with opioid overdose. Our article provides Australian evidence of the successful operational implementation of peer-to-peer THN delivery within a range of drug primary health services and needle syringe programs. Further research is required to better understand the implications of and impediments to scale-up of this potentially life-saving public health intervention.

Pine afforestation changes more strongly community structure than ecosystem functioning in grassland mountain streams

In the past decades, afforestation of grassland landscapes has gained importance both as an economic activity and a mechanism to mitigate anthropogenic carbon emissions. This study evaluates the effect of pine afforestation on grassland streams analyzing changes in two integrative ecological indicators: leaf litter breakdown and primary production. We compare those results with changes in structural attributes of benthic biota (primary producers and invertebrates). Six contiguous first-order streams were selected in the upper basin of the Ctalamochita river (Córdoba, Argentina): three reference streams draining grasslands and three streams draining Pinus elliottii afforestations. Two in situ experiments were performed to compare leaf litter breakdown and primary production between grassland and afforested streams. Additionally, invertebrate assemblages in leaf litter and riffles, and periphyton standing stock were sampled and assessed. Nine out of 26 structural indicators showed differences between stream types but indicators measuring changes at the basal level of the food web (i.e. detritus and primary producers) were less sensitive than those recording changes in consumers. Our attempt to measure direction and magnitude of changes on stream functioning following afforestation was halted by our simple implemented methodology (i.e. leaf pack method for leaf litter decay and biofilm accrual on natural stone substrates for primary production assessments); only 1 out of 4 indicators differed. We argue that the lack of strong differences in elemental measurements of primary production and needle decay between afforested and grassland streams resulted from compensating opposing forces controlling such processes, i.e. higher grazing vs. higher sunlight in grassland streams and higher shredding vs. lower microbial decomposition mediated by lower temperature in afforested streams. Attributes related to the invertebrate compartment showed the highest sensitivity to afforestation, emphasizing their value as biological indicators of stream ecological integrity.