A region within the third extracellular loop of rat Aquaporin 6 precludes trafficking to plasma membrane in a heterologous cell line

The inability to over-express Aquaporin 6 (AQP6) in the plasma membrane of heterologous cells has hampered efforts to further characterize the function of this aquaglyceroporin membrane protein at atomic detail using crystallographic approaches. Using an Aquaporin 3-tGFP Reporter (AGR) system we have identified a region within loop C of AQP6 that is responsible for severely hampering plasma membrane expression. Serine substitution corroborated that amino acids present within AQP6^194–213 of AQP6 loop C contribute to intracellular endoplasmic reticulum (ER) retention. This intracellular retention signal may preclude proper plasma membrane trafficking and severely curtail expression of AQP6 in heterologous expression systems.

MTT Heterogeneity in Perfusion CT Imaging as a Predictor of Outcome after Aneurysmal SAH

BACKGROUND AND PURPOSE

Impairment of tissue oxygenation caused by inhomogeneous microscopic blood flow distribution, the so-called capillary transit time heterogeneity, is thought to contribute to delayed cerebral ischemia after aneurysmal SAH but has so far not been systematically evaluated in patients. We hypothesized that heterogeneity of the MTT, derived from CTP parameters, would give insight into the clinical course of patients with aneurysmal SAH and may identify patients at risk of poor outcome.

MATERIALS AND METHODS

We retrospectively analyzed the heterogeneity of the MTT using the coefficient of variation in CTP scans from 132 patients. A multivariable logistic regression model was used to model the dichotomized mRS outcome. Linear regression was used to eliminate variables with high linear dependence. T tests were used to compare the means of 2 groups. Furthermore, the time of the maximum coefficient of variation for MTT after bleeding was evaluated for correlation with the mRS after 6 months.

RESULTS

On average, each patient underwent 5.3 CTP scans during his or her stay. Patients with high coefficient of variation for MTT presented more often with higher modified Fisher (P = .011) and World Federation of Neurosurgical Societies grades (P = .014). A high coefficient of variation for MTT at days 3-21 after aneurysmal SAH correlated significantly with a worse mRS score after 6 months (P = .016). We found no correlation between the time of the maximum coefficient of variation for MTT after bleeding and the patients' outcomes after 6 months (P = .203).

CONCLUSIONS

Heterogeneity of MTT in CTP after aneurysmal SAH correlates with the patients' outcomes. Because the findings are in line with the pathophysiologic concept of the capillary transit time heterogeneity, future studies should seek to verify the coefficient of variation for MTT as a potential imaging biomarker for outcome.

Cancer Council NSW - Policy and Advocacy: “I Care For Palliative Care” Campaign to Increase Government Investment in Specialist Palliative Care Services

Background and context: I Care for Palliative Care Campaign was developed and delivered by the Cancer Council NSW between November 2015 and July 2017. This advocacy campaign was developed in recognition of the fact that the state had fewer palliative physicians and palliative care nurses than were needed to meet the palliative care demands of the NSW community. This meant that some people with life-limiting cancer were being denied quality of life and were unable to die in the place of their choosing. Moreover, Aboriginal people remained disadvantaged by limited access to specialist palliative care that fits with their community values, beliefs, rituals, heritage and place. Aim: The primary aim of the campaign was to secure additional funding from the NSW Government for an additional 10 FTE palliative physician positions; an extra 129 FTE palliative care nurse positions; and provision of culturally-appropriate specialist palliative care services to Aboriginal people. Strategy/Tactics: Various tactics were used, including collection and sharing of engaging community stories via media and online channels, mobilizing community support via training and events, and targeted engagement of key decision-makers and members of parliament (MPs), which took into consideration marginal electorates, personal experiences with cancer, and geography, noting the issue disproportionally impacts regional and rural communities. An online and offline “pledge” activity was also used, providing both the public and MPs with an opportunity to support the campaign. Program/Policy process: Meetings, the pledge activity, collection and presentation of stories and community-events were all incorporated into a program of activities over the campaign period to engage decision-makers and ultimately influence the policy-making process. Outcomes: An independent qualitative evaluation confirmed that the campaign was undoubtedly a success. It noted that the campaign created an environment in which the NSW government made a historic decision to provide an additional $100 million in funding for palliative care services over four years. Without the campaign, palliative care could well have lost out to other healthcare and government spending priorities. What was learned: The campaign confirmed the power of personal stories as an effective campaign tactic to influence decision-makers. Empowering volunteers to generate local media coverage also resulted in significantly greater coverage for the campaign. The “pledge” activity for MPs was also an effective tactic that brought together the issue, the politician and our brand. Aspects to be improved include simplifying our policy ask, evaluating the resources we invest in key decision makers versus less influential MPs, and assessing how we better integrate political context and political experts into our campaign planning and governance.

Community Insights to Inform the Policy Positioning of Junk Food Marketing Reform in NSW, Australia

Background and context: In the lead up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current junk food marketing on government owned assets (including public transport) was identified as one of these priorities to reduce childhood obesity. Aim: •Understand how key audiences view overweight and obesity as a public health issue and specifically junk food marketing to children •Find new opportunities to progress CCNSW policy objectives by identifying additional key audiences in the general population; •Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and CCNSW's broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for restricting junk food marketing on government owned assets in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing communications and public engagement. Program/Policy process: CCNSW commissioned an independent external agency to conduct the research. The research used a mixed methodology that included two facilitated online focus groups of up to 20 people each, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread and constituted a mixture of general population and parents who are the main meal preparer in households. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Findings noted that unprompted, overweight and obesity is considered an important public health issue. The specific issue of childhood obesity is seen to be a personal family issue and the responsibility of parents. The provision of junk food by parents to children was seen as a driver of childhood obesity, but the role of junk food marketing and its regulation was not top-of-mind. When prompted, the idea of banning junk food advertising on public transport was an action that could be taken by government to tackle childhood obesity, with children perceived as being vulnerable and requiring protection.

Cancer Council New South Wales: Policy and Advocacy Report Community Insights to Inform the Policy Positioning of Tobacco Retailing Reform in NSW, Australia

Background and context: In the lead-up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current tobacco retailing was identified as one of these priorities. Aim: Understand how key audiences view current tobacco retailing laws and widespread tobacco availability in NSW; Find new opportunities to progress our policy objectives by identifying additional key audiences in the general population; Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and CCNSW's broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for reform of current tobacco retailing laws in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing communications and public engagement. Program/Policy process: CCNSW commissioned an independent external agency to conduct the research. The research used a mixed methodology that included a facilitated online focus group of up to 20 people, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread and constituted a mixture of general population, parents, hospitality workers and small business owners. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Findings noted that while cancer of all types is seen as a serious public health issue, cancer specifically resulting from smoking and tobacco use is not top-of-mind. It revealed the link between ease of access to tobacco products and increased usage is clearly understood, and there was support for further restricting where tobacco can be sold. The concept of a “retailer fee” to pay for the cost of antismoking initiatives received limited support, mostly driven by concern for smaller retailers. The most popular arguments were those which reinforced existing community beliefs, rather than challenging them.

Cancer Council New South Wales Policy and Advocacy Report: Community Insights to Inform the Policy Positioning of Smoke-Free Legislation Reform in NSW, Australia

Background and context: In the lead-up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current smoke-free laws was identified as one of these priorities. Aim: Understand how key audiences view current smoke-free laws and issues of exposure to second-hand smoke in NSW licensed venues; Find new opportunities to progress policy objectives by identifying additional key audiences in the general population; Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and our broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for the reform of current smoke-free laws in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing our communications and public engagement. Program/Policy process: Cancer Council NSW worked with an external agency to conduct the research. The research used a mixed methodology that included a facilitated online focus group of up to 20 people, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread. Targeted sampling to ensure participants visit a pub or club at least once per fortnight was also incorporated. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Preliminary findings noted that while smoking and related health issues is a key concern for participants, it is of greatest concern among those who are smokers, have previously smoked, or are close to someone who does. They revealed a high level of awareness of the meaning.

Single equalizer strategy with no information transfer for conflict escalation

In an iterated two-person game, for instance prisoner's dilemma or the snowdrift game, there exist strategies that force the payoffs of the opponents to be equal. These equalizer strategies form a subset of the more general zero-determinant strategies that unilaterally set the payoff of an opponent. A challenge in the attempts to understand the role of these strategies in the evolution of animal behavior is the lack of iterations in the fights for mating opportunities or territory control. We show that an arbitrary two-parameter strategy may possess a corresponding equalizer strategy which produces the same result: statistics of the fight outcomes in the contests with competitors are the same for each of these two strategies. Therefore, analyzing only the equalizer strategy space may be sufficient to predict animal behavior if nature, indeed, reduces (marginalizes) complex strategies to equalizer strategy space. The work's main finding is that there is a unique equalizer strategy that predicts fight outcomes without symmetric cooperation responses. The lack of symmetric cooperation responses is a common trait in conflict escalation contests that generally require a clear winner. In addition, this unique strategy does not assess information of the opponent's state. The method bypasses the standard analysis of evolutionary stability. The results fit well the observations of combat between male bowl and doily spiders and support an empirical assumption of the war of attrition model that the species use only information regarding their own state during conflict escalation.

Prenatal and adult androgen activities in alcohol dependence

OBJECTIVE

Alcohol dependence is more prevalent in men than in women. The evidence for how prenatal and adult androgens influence alcohol dependence is limited. We investigated the effects of prenatal and adult androgen activity on alcohol dependence. Moreover, we studied how the behaviours of pregnant women affect their children's prenatal androgen load.

METHOD

We quantified prenatal androgen markers (e.g., second-to-fourth finger length ratio [2D : 4D]) and blood androgens in 200 early-abstinent alcohol-dependent in-patients and 240 controls (2013-2015, including a 12-month follow-up). We also surveyed 134 women during pregnancy (2005-2007) and measured the 2D : 4D of their children (2013-2016).

RESULTS

The prenatal androgen loads were higher in the male alcohol-dependent patients compared to the controls (lower 2D : 4D, P = 0.004) and correlated positively with the patients' liver transaminase activities (P < 0.001) and alcohol withdrawal severity (P = 0.019). Higher prenatal androgen loads and increasing androgen levels during withdrawal predicted earlier and more frequent 12-month hospital readmission in alcohol-dependent patients (P < 0.005). Moreover, stress levels (P = 0.002), alcohol (P = 0.010) and tobacco consumption (P = 0.017), and lifetime stressors (P = 0.019) of women during pregnancy related positively to their children's prenatal androgen loads (lower 2D : 4D).

CONCLUSION

Androgen activities in alcohol-dependent patients and behaviours of pregnant women represent novel preventive and therapeutic targets of alcohol dependence.

Iron limitation of microbial phosphorus acquisition in the tropical North Atlantic

In certain regions of the predominantly nitrogen limited ocean, microbes can become co-limited by phosphorus. Within such regions, a proportion of the dissolved organic phosphorus pool can be accessed by microbes employing a variety of alkaline phosphatase (APase) enzymes. In contrast to the PhoA family of APases that utilize zinc as a cofactor, the recent discovery of iron as a cofactor in the more widespread PhoX and PhoD implies the potential for a biochemically dependant interplay between oceanic zinc, iron and phosphorus cycles. Here we demonstrate enhanced natural community APase activity following iron amendment within the low zinc and moderately low iron Western North Atlantic. In contrast we find no evidence for trace metal limitation of APase activity beneath the Saharan dust plume in the Eastern Atlantic. Such intermittent iron limitation of microbial phosphorus acquisition provides an additional facet in the argument for iron controlling the coupling between oceanic nitrogen and phosphorus cycles.

Colorectal cancer resection in the Australian nonagenarian patient

AIM

The nonagenarian population is a rapidly growing segment of the Australian population. Surgical resection continues to offer the best chance of long-term survival in colorectal cancer. The primary aims of the present study were to evaluate the 30-day mortality and survival of Australian patients ≥ 90 years of age undergoing surgical resection for colorectal cancer in our health service. The secondary aims were to examine the clinicopathological characteristics of the patients and their tumours.

METHOD

All patients ≥ 90 years of age undergoing surgical resection for colorectal cancer from 1998 to 2012 were identified in a centralized multihospital database. Key clinicopathological data, 30-day mortality and long-term overall survival were recorded for each patient.

RESULTS

There were 121 patients identified of median age 91 years, 74% of whom were female. The median tumour size was 40 mm, and 51% of operations were carried out as an emergency. The TNM stage was Stage I/II in 57%, Stage III in 40% and Stage IV in 3%. The 30-day mortality was 6.6% (eight of 121) and the 1-, 3- and 5-year overall survival rates were 82.6%, 50.2% and 32.3%, respectively.

CONCLUSION

Surgical resection in the nonagenarian patient has an acceptable mortality and offers good overall survival.

Lithium-induced acute intermittent dystonia in a patient with schizoaffective disorder

While lithium is well known for its neurotoxicity, there are very few publications about lithium-induced acute dystonic reaction. We are presenting a clinical case of lithium-induced acute intermittent dystonic reaction in a patient with schizoaffective disorder (SAD). The patient is a 69-year-old African-American male with a long history of SAD, who was treated for many years with ziprasidone and divalproex and was admitted with SAD exacerbation. Due to increased QTC interval, we switched patient to lurasidone. After 2 weeks, due to increased ammonia level, divalproex was switched to lithium (600 mg loading dose and then 450 mg twice/day). Three days later, patient developed a series of intermittent episodes of acute dystonia, manifested as mutism, dysarthria, upper and lower extremity muscle rigidity, dysphagia, and tremor (Table 1). Dystonic reactions responded to benztropine. Eventually, lithium was discontinued and patient did well on a combination of carbamazepine and olanzapine. In this case, we would like to emphasize not only the intermittent but also the atypical presentation of acute dystonic reactions with involvement of large muscle groups, the resemblance to NMS, and a “spectrum” of dystonic reactions rather than one clear-cut presentation. We can only speculate the role lurasidone played in this presentation but reoccurrence of dysarthria on day 54 after lithium was restarted points to its major role.

Table not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.