Epigenetic pathway inhibitors represent potential drugs for treating pancreatic and bronchial neuroendocrine tumors

Cancer is associated with alterations in epigenetic mechanisms such as histone modifications and methylation of DNA, and inhibitors targeting epigenetic mechanisms represent a novel class of anti-cancer drugs. Neuroendocrine tumors (NETs) of the pancreas (PNETs) and bronchus (BNETs), which may have 5-year survivals of <50% and as low as 5%, respectively, represent targets for such drugs, as >40% of PNETs and ~35% of BNETs have mutations of the multiple endocrine neoplasia type 1 (MEN1) gene, which encodes menin that modifies histones by interacting with histone methyltransferases. We assessed 9 inhibitors of epigenetic pathways, for their effects on proliferation, by CellTiter Blue assay, and apoptosis, by CaspaseGlo assay, using 1 PNET and 2 BNET cell lines. Two inhibitors, referred to as (+)-JQ1 (JQ1) and PFI-1, targeting the bromo and extra terminal (BET) protein family which bind acetylated histone residues, were most effective in decreasing proliferation (by 40-85%, P<0.001) and increasing apoptosis (by 2-3.6 fold, P<0.001) in all 3 NET cell lines. The anti-proliferative effects of JQ1 and PFI-1 remained present for at least 48 hours after removal of the compound. JQ1, but not PFI-1, had cell cycle effects, assessed by propidium iodide staining and flow cytometry, resulting in increased and decreased proportions of NET cells in G1, and S and G2 phases, respectively. RNA Sequencing analysis revealed that these JQ1 effects were associated with increased histone 2B expression, and likely mediated through altered activity of bromodomain-containing (Brd) proteins. Assessment of JQ1 in vivo, using a pancreatic beta cell-specific conditional Men1 knockout mouse model that develops PNETs, revealed that JQ1 significantly reduced proliferation (by ~50%, P<0.0005), assessed by bromodeoxyuridine incorporation, and increased apoptosis (by ~3 fold, P<0.0005), assessed by terminal deoxynucleotidyl transferase dUTP nick end labelling, of PNETs. Thus, our studies demonstrate that BET protein inhibitors may provide new treatments for NETs.

Family Perceptions and Provision of Analgesia for Acutely Painful Conditions in Children: A Multi-Centred Prospective Survey

BACKGROUND: More than two-thirds of children who present to the emergency department (ED) complain of pain. It is well known that children’s pain is poorly managed in the ED compared to their adult counterparts. With respect to analgesic administration in the ED, discrepancies exist between physician self-report and institutional audit. Patient refusal of analgesia is a likely explanation. There is good evidence that misconceptions and fears about analgesia in children are common among caregivers and may contribute to withholding pain medication. To date, no study has surveyed caregivers presenting the the ED to assess frequency of analgesic administration and reasons for withholding analgesia. We hypothesize that there will be a significant proportion of care-givers and patients that refuse pain medication in the ED. We also hypothesize that there will be a wide range of reasons for refusal. The insight we gain from this study will help nurses, clinical educators, and physicians provide the appropriate information to parents in an effort to target misconceptions and allay fears.

OBJECTIVES: Our objectives were to characterize the degree of care-giver and patient provision of analgesia prior to arrival, refusal of analgesia in the ED, and reasons behind their decision-making process. We hope to identify specific misconceptions, attitudes, or beliefs that impair the optimal provision of analgesia to children in the ED.

DESIGN/METHODS: A novel survey was designed by a focus group using an iterative approach and implemented over a 16-week period across two Canadian tertiary care paediatric EDs. We included a consecutive sample of caregivers of children aged 4-17 years with an acutely painful condition (headache, abdominal pain, injury, otitis, pharyngitis). Caregivers were asked to answer questions covering five domains: (i) demographics, (ii) analgesia prior to arrival (iii) analgesia offered in the ED and reasons for refusal, (iv) perceptions of analgesia, and (v) caregiver satisfaction at discharge. Children were asked to rate their pain on arrival and at discharge. The primary outcome was the frequency of caregiver provision of analgesia prior to arrival and the proportion of caregivers who accept the offer of analgesia offered in the ED.

RESULTS: Three hundred forty-four caregivers completed the survey. The majority were female (269/339, 79%), aged 36 years or older (256/340, 75%) with a post-secondary education (237/336, 71%). Most (309/339, 91%) reported being able to “tell when their child was in pain”. All respondents rated their child’s maximal pain related to the presenting condition as at least a 6/10. With regards to the primary outcome, 229/338 (68%) of caregivers reported that they did not treat their child’s pain prior to arrival in the ED. Of those who did treat their child’s pain, ibuprofen was the most commonly used analgesic (77/112, 69%). The most common reasons for withholding analgesia was a lack of time (80/210, 38%), fear of masking seriousness of child’s condition (49/210, 23%), fear of masking signs and symptoms (48/210, 23%), and a lack of analgesia at home (47/210, 22%). Analgesia was offered to 186/344 (45%) of children in the ED and the majority of caregivers 157/186 (84%) accepted the offer. The most common reason for not accepting analgesia in the ED was child refusal (15/20, 75%). Most, 231/338 (68%) of caregivers felt that their child’s pain was managed well in the ED.

CONCLUSION: This survey of caregiver perceptions surrounding analgesia for children with acutely painful conditions presenting to the pae-diatric ED suggests that most do not treat their child’s pain prior to arrival, despite high levels of pain. Misconceptions surrounding analgesia prior to arrival are common. Despite this, most caregivers accepted analgesia in the ED. Our results suggest that educational strategies should be directed at caregiver awareness of the impact of pain on children and the need for prompt analgesic therapy, even when an ED visit is planned.

Hallucinations and illusions in migraine in children and the Alice in Wonderland Syndrome

DESIGN

A prospective observational study over 1 year.

SETTING

A District General Hospital, and Child and Adolescent Mental Health Department.

PATIENTS

Children aged 8-18 years living in the catchment area of a district hospital service with any type of unexplained hallucinations or illusions associated with or without an established diagnosis of migraine.

RESULTS

The study identified nine children with a combination of migraine and a variety of hallucinations and illusions, including illusions of size, time, colour, body shape, movement and visual and auditory hallucination. An average of 10 symptoms (range 7-15) were reported.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

None.

CONCLUSIONS

It is important to recognise these symptoms to enable appropriate history taking and diagnosis. These symptoms are common and currently seem to go unrecognised and may pose diagnostic difficulties if onset is before typical migraine headaches occur.

Prospective study of factors influencing conditional discharge from a forensic hospital: the DUNDRUM-3 programme completion and DUNDRUM-4 recovery structured professional judgement instruments and risk

BACKGROUND

We set out to examine whether structured professional judgement instruments DUNDRUM-3 programme completion (D-3) and DUNDRUM-4 recovery (D-4) scales along with measures of risk, mental state and global function could distinguish between those forensic patients detained in a secure forensic hospital (not guilty by reason of insanity or unfit to stand trial) who were subsequently discharged by a mental health review board. We also examined the interaction between these measures and risk, need for therapeutic security and eventual conditional discharge.

METHODS

A naturalistic observational cohort study was carried out for 56 patients newly eligible for conditional discharge. Patients were rated using the D-3, D-4 and other scales including HCR-20, S-RAMM, START, SAPROF, PANSS and GAF and then observed over a period of twenty three months during which they were considered for conditional discharge by an independent Mental Health Review Board.

RESULTS

The D-3 distinguished which patients were subsequently discharged by the Mental Health Review board (AUC = 0.902, p < 0.001) as did the D-4 (AUC = 0.848, p < 0.001). Item to outcome analysis showed each item of the D-3 and D-4 scales performed significantly better than random. The HCR-20 also distinguished those later discharged (AUC = 0.838, p < 0.001) as did the S-RAMM, START, SAPROF, PANSS and GAF. The D-3 and D-4 scores remained significantly lower (better) for those discharged even when corrected for the HCR-20 total score. Item to outcome analyses and logistic regression analysis showed that the strongest antecedents of discharge were the GAF and the DUNDRUM-3 programme completion scores.

CONCLUSIONS

Structured professional judgement instruments should improve the quality, consistency and transparency of clinical recommendations and decision making at mental health review boards. Further research is required to determine whether the DUNDRUM-3 programme completion and DUNDRUM-4 recovery instruments predict those who are or are not recalled or re-offend after conditional discharge.

Inhibition of smooth muscle cell proliferation by adiponectin requires proteolytic conversion to its globular form

Accelerated atherosclerosis is the primary cardiovascular manifestation of diabetes and correlates inversely with levels of circulating adiponectin, an anti-atherosclerotic adipokine that declines in diabetes. We therefore initiated a study to examine the mechanisms by which adiponectin, a hormone released from adipose tissue, influences the proliferation of vascular smooth muscle cells (SMCs). Addition of adiponectin to quiescent porcine coronary artery SMCs increased both protein and DNA synthesis and concurrently activated ERK1/2 and Akt. By contrast, globular adiponectin, a truncated form of this protein, exhibited anti-mitogenic properties as indicated by the inhibition of protein and DNA synthesis in SMCs stimulated with platelet-derived growth factor (PDGF). Whereas globular adiponectin did not stimulate growth-related signal transduction pathways, it was able to block the PDGF-dependent phosphorylation of eukaryotic elongation factor 2 kinase, a regulator of protein synthesis. Proteolysis of adiponectin with trypsin, which produces globular adiponectin, reversed the growth-stimulating actions of the undigested protein. As the existence of globular adiponectin remains controversial, western blotting was used to establish its presence in rat serum. We found that globular adiponectin was detectable in rat serum, but this result was not obtained with all antibodies. The contrasting properties of adiponectin and its globular form with respect to SMC proliferation suggest that protection against atherosclerosis may therefore be mediated, in part, by the level of globular adiponectin.

THE LEPIDOPTERA OF BERMUDA: THEIR FOOD PLANTS, BIOGEOGRAPHY, AND MEANS OF DISPERSAL

The 183 species of Lepidoptera recorded from Bermuda are discussed with respect to their world distribution, origin, long-range dispersal capability, host plants, nomenclature, and the circumstances of their occurrence in Bermuda; most are illustrated. Fifty-nine species are reported from Bermuda for the first time; Oenobotys invinacealis Ferguson (Pyralidae) and Tetanolita mynesalis inaequalis Ferguson (Noctuidae) are described as new. Four new genus–species combinations and four new synonymies are proposed.The Bermuda islands have a distressed fauna dominated by introduced pest species and migrants from the North American mainland and Caribbean Region. About 125 of the 183 recorded species are thought to be established residents; the remainder are assumed to be vagrants. Of approximately 50 resident species identified as probably indigenous, 11 species and three subspecies are endemic, and one of these, Semiothisa ochrifascia (Warren), is believed extinct.All Bermudian Lepidoptera are of American origin except the few introduced Old World species that are nearly cosmopolitan. Like Norfolk Island, Australia, Bermuda has a supersaturated lepidopterous fauna — more recorded species than its land area might support, which can be explained only by a high incidence of migrants and transients. This migratory component is explained relative to long-range movements of the same or congeneric species elsewhere; and hypotheses are proposed concerning the natural history of long-range dispersal in eastern North America and the ability of these moths to reach Bermuda. From a list of 113 species of Lepidoptera identified as frequent south–north migrants on the mainland, 76 are recorded from Bermuda. These include 38 of the 40 best-known cutworm moths of the eastern United States. It is argued that such moths reach Bermuda repeatedly without man's assistance and must regularly travel similar distances in North America.

Conjugated linoleic acid improves blood pressure by increasing adiponectin and endothelial nitric oxide synthase activity

Conjugated linoleic acid (CLA) has been reported to reduce blood pressure in obese insulin-resistant rats, but its mechanism of action has not been identified. The objective of this study was to determine whether CLA isomers can reduce obesity-related hypertension in the fa/fa Zucker rat in relation to adiponectin production and endothelial nitric oxide synthase (eNOS) activation. Obese fa/fa Zucker rats were randomly assigned to one of four groups: (1) cis-9,trans-11-CLA, (2) trans-10,cis-12 (t10,c12)-CLA, (3) control or (4) captopril. After 8 weeks, systolic blood pressure increased 30% in control obese rats. This increase was attenuated 11%-13% in the t10,c12-CLA isomer and captopril groups, respectively. The t10,c12-CLA isomer concurrently elevated adiponectin levels in both plasma and adipose tissue and increased phosphorylated eNOS in adipose tissue as well as the aorta. Although a direct effect of CLA was not observed in cultured endothelial cells, direct adiponectin treatment increased phosphorylation of eNOS. Endothelial nitric oxide synthase phosphorylation was also increased in adipose of fa/fa Zucker rats infused with adiponectin in parallel with improvements in blood pressure. Our results suggest that the t10,c12-CLA isomer attenuates development of obesity-related hypertension, at least in part, by stimulating adiponectin production, which subsequently activates vascular eNOS.

BioWeld® Tube and surgical glue for experimental sutureless venous microanastomosis

Background

The medial wall of mammalian veins is generally thin and fragile compared with the thick muscle seen in arteries. This makes venous microanastomoses time consuming and challenging. This study aimed to determine the feasibility and effectiveness of using the BioWeld® Tube in conjunction with a surgical glue (butyl-2-cyanoacrylate) in performing sutureless venous microanastomoses.

Methods

The feasibility and effectiveness of microvascular anastomoses in a rabbit jugular vein model were investigated in six animals, using the BioWeld® Tube in conjunction with butyl-2-cyanoacrylate surgical glue. Patency and tissue repair mechanisms at the anastomotic site were assessed 1 week after the procedure.

Results

All anastomoses remained patent at 1 week. Muscle necrosis occurred only in areas where the tissue was subject to the fold-and-bond procedure.

Conclusion

The study showed the feasibility and short-term effectiveness of the BioWeld® Tube in facilitating venous anastomoses.

Artery of percheron infarction: imaging patterns and clinical spectrum

BACKGROUND AND PURPOSE

Occlusion of the AOP results in a characteristic pattern of ischemia: bilateral paramedian thalamus with or without midbrain involvement. Although the classic imaging findings are often recognized, only a few small case series and isolated cases of AOP infarction have been reported. The purpose of this study was to characterize the complete imaging spectrum of AOP infarction on the basis of a large series of cases obtained from multiple institutions.

MATERIALS AND METHODS

Imaging and clinical data of 37 patients with AOP infarction from 2000 to 2009 were reviewed retrospectively. The primary imaging criterion for inclusion was an abnormal signal intensity on MR imaging and/or hypoattenuation on CT involving distinct arterial zones of the bilateral paramedian thalami with or without rostral midbrain involvement. Patients were excluded if there was a neoplastic, infectious, or inflammatory etiology.

RESULTS

We identified 4 ischemic patterns of AOP infarction: 1) bilateral paramedian thalamic with midbrain (43%), 2) bilateral paramedian thalamic without midbrain (38%), 3) bilateral paramedian thalamic with anterior thalamus and midbrain (14%), and 4) bilateral paramedian thalamic with anterior thalamus without midbrain (5%). A previously unreported finding (the "V" sign) on FLAIR and DWI sequences was identified in 67% of cases of AOP infarction with midbrain involvement and supports the diagnosis when present.

CONCLUSIONS

The 4 distinct patterns of ischemia identified in our large case series, along with the midbrain V sign, should improve recognition of AOP infarction and assist with the neurologic evaluation and management of patients with thalamic strokes.

Biological response of hepatomas to an extract of Fagopyrum esculentum M. (buckwheat) is not mediated by inositols or rutin

Buckwheat contains d-chiro-inositol (D-CI) and myo-inositol (MI), possible insulin-mimetic compounds; thus, this study investigated the insulin-mimetic activities of a buckwheat concentrate (BWC), D-CI, and MI on insulin signal transduction pathways and glucose uptake with H4IIE rat hepatoma cells. BWC stimulated phosphorylation of p42/44 extracellular-related kinase (p42/44 ERK) and its downstream target, p70(S6K), on Thr(421). In contrast, D-CI, MI, rutin, or its agylcone form, quercetin, did not activate these signal transduction proteins. Phosphorylation of p38 mitogen-activated protein kinase (p38 MAPK), another target of insulin, was also up-regulated upon BWC treatment. The effects of BWC on glucose uptake were subsequently investigated using H4IIE cells. Insulin and D-CI stimulated glucose uptake, whereas BWC inhibited basal and insulin-stimulated glucose uptake. Although results from this work suggest that BWC has insulin-mimetic effects on select protein phosphorylation events in H4IIE cells, D-CI and MI were not the active components responsible for the observed effects. The inhibition of glucose uptake by BWC suggests that buckwheat may affect hepatic glucose metabolism, possibly by inhibiting glucose flux. Furthermore, the fact that D-CI and MI stimulated glucose uptake in H4IIE cells suggests that other compounds are responsible for inhibition of glucose uptake by BWC.

IGF-1 receptor transactivation mediates Src-dependent cortactin phosphorylation in response to angiotensin IIThis article is one of a selection of papers published in a special issue celebrating the 125th anniversary of the Faculty of Medicine at the University of Manitoba

Release of angiotensin II (Ang II) after vascular injury promotes tissue repair by stimulating phenotypic modulation of smooth muscle cells, which enables cell proliferation and migration. This process requires cytoskeleton remodeling, which involves cortactin, a scaffold protein that is phosphorylated by Src kinase in response to Ang II. Since insulin-like growth factor (IGF)-1 receptor transactivation mediates intracellular signals originating from the Ang II type 1 (AT1) receptor in a Src kinase-dependent manner, we examined whether IGF-1 receptor transactivation was also required for cortactin phosphorylation. Treatment of quiescent smooth muscle cells with Ang II resulted in both cortactin phosphorylation and its translocation to the plasma membrane. Both events were prevented by 1-(1,1-dimethylethyl)-1-(4-methylphenyl)-1H-pyrazolo(3,4-d)pyrimidin-4-amine (PP1), a Src kinase inhibitor, and by AG1024, an inhibitor of the IGF-1 receptor tyrosine kinase. Additionally, PP1 and AG1024 blocked the association of cortactin with actin-related protein (Arp) 3, an actin nucleation factor. These results indicate that Src kinase and the IGF-1 receptor kinase are necessary for activating cortactin. Phosphorylation of Src kinase in Ang II-treated cells was subsequently examined and was shown to be prevented by AG1024. Furthermore, Src kinase phosphorylation was blocked by inhibitors of protein kinase C (PKC), but not by inhibitors of phosphatidylinositol (PI) 3-kinase. These data establish that IGF-1 receptor transactivation is required for Src kinase-mediated cortactin phosphorylation and cytoskeletal reorganization in response to Ang II.

Are there more bowel symptoms in children with autism compared to normal children and children with other developmental and neurological disorders?: A case control study

There is considerable controversy as to whether there is an association between bowel disorders and autism. Using a bowel symptom questionnaire we compared 51 children with autism spectrum disorder with control groups of 35 children from special school and 112 from mainstream school. There was a significant difference in the reporting of certain bowel symptoms (constipation, diarrhoea, flatulence) and food faddiness between the autism group and the mainstream school control group. There was no significant difference between the autism group and children in the special schools except for faddiness, which is an autism specific symptom and not a bowel symptom. This study confirms previously reported findings of an increase in bowel symptoms in children with autism. It would appear, however, that this is not specifically associated with autism as bowel symptoms were reported in similar frequency to a comparison group of children with other developmental and neurological disorders.