The Early Development of Intravenous Apparatus

Modern anaesthetists rely on the intravenous route for administration of drugs and fluids. This paper traces the development of intravenous equipment from the first, tentative experiments with the intravenous route through to the first intravenous cannulas.

Unravelling the Mystery of Malignant Hyperthermia

Malignant hyperthermia was an unknown condition in 1960 although there had always been occasional patients who died mysteriously under anaesthesia. The nature of the disease became apparent when a young Melbourne man presented that year with a compound fracture and a family history of deaths under anaesthesia. He survived his anaesthetic due to the combined efforts of the anaesthetist and the surgeon. His family history was then investigated by the physicians. Over the next 20 years the cause of the disease was discovered and eventually a treatment was found. This article is based around a series of interviews with many of the participants in this story.

Abstract 2050: Tumor stage-dependent transcriptomic signatures of endothelial cells reveal an intense paracrine crosstalk in liver capillarization

Introduction:

The liver blood vessel network, consisting of liver sinusoidal endothelial cells (LSECs) and capillary endothelial cells (CECs), undergoes distinct modifications in the process of liver cancer development. The selective expansion of the CEC compartment is thereby the most prominent modification leading to a change of the predominant endothelial phenotype. An in depth molecular analysis of the dynamic vascular modifications in hepatocellular carcinoma (HCC) is however still missing.

Methods:

An inducible mouse model with hepatocyte-specific expression of constitutively active yes-associated protein (YAPS127A) was used for stage dependent purification of endothelial cells. Cell sorting allowed the subtyping of liver endothelial cells into LSECs (CD31+, CD146+, Lyve-1+) and CECs (CD31+, CD146+, Lyve-1-) followed by their consecutive transcriptomic analysis. Predicted paracrine interactions were functionally tested in the endothelial cell line SVEC4-10. Gene expression data of 242 HCC patients were used to confirm the findings in human HCC (Roessler et al. 2010).

Results

Immunofluorescence revealed a progressive replacement of LSECs by CECs in livers, hyperplastic lesions, and HCC derived from YAPS127A mice. FACS analysis confirmed the selective expansion of CECs from 4±2% in healthy livers to 37±16% in hepatomegaly to 61±30% in tumor-bearing livers. Expression profiling of CECs and LSECs revealed dynamic CEC-selective changes in early and late phases of hepatocarcinogenesis including an enrichment of migration specific pathways. Phylogenetic tree analysis of the gene set “cytokine –cytokine receptor interaction” displayed endothelial cell (EC)- and stage-specific secretion patterns suggesting a dynamic crosstalk between the EC populations. The promigratory role of the identified HGF/c-Met axis was confirmed in vitro by single cell tracking and spheroid sprouting. In vivo the inhibition through the c-Met inhibitor Cabozantinib led to a 67% reduction of CEC sprouting, in line with with decreased tumor cell proliferation. Human HCC gene expression data from 242 HCC patients confirmed the prognostic relevance of an identified 19 gene capillarization signature.

Conclusions

Our results illustrate a dynamic crosstalk between the two major EC populations in the process of liver tumor development, already detectable in early phases of capillarization. The identified HGF/c-Met axis represents an essential signal pathway in the process of arterial branch elongation and its inhibition through clinically relevant c-Met inhibitors may represent a promising approach to perturbate disease-associated capillarization.

References

Weiler SME, et al., Gastroenterology, 2017. 152(8): p. 2037-2051 e22

Roessler S, et al., Cancer Res. 2010 Dec 15;70(24):10202-12

Citation Format: Stefan Thomann, Sofia Weiler, Martin Dittmer, Daniel Kazdal, Simone Marquard, Stephanie Roessler, Carsten Sticht, Norbert Gretz, Carolin Mogler, Claudia Ball, Hanno Glimm, Eduard Ryschich, Peter Schirmacher, Kai Breuhahn. Tumor stage-dependent transcriptomic signatures of endothelial cells reveal an intense paracrine crosstalk in liver capillarization [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2050.

Functional Outcome Following Extensor Synovectomy and Excision of the Distal Ulna in Patients With Rheumatoid Arthritis

We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation ( P = 0.04), supination ( P = 0.03) and wrist extension ( P = 0.02), but a reduction in flexion ( P = 0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength ( P = 0.05) and reduction in wrist pain ( P = < 0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.

A new time and space resolved transmission spectrometer for research in inertial confinement fusion and radiation source development

We describe the design and function of a new time and space resolved x-ray spectrometer for use in Z-pinch inertial confinement fusion and radiation source development experiments. The spectrometer is designed to measure x-rays in the range of 0.5-1.5 Å (8-25 keV) with a spectral resolution λ/Δλ ∼ 400. The purpose of this spectrometer is to measure the time- and one-dimensional space-dependent electron temperature and density during stagnation. These relatively high photon energies are required to escape the dense plasma created at stagnation and to obtain sensitivity to electron temperatures ≳3 keV. The spectrometer is of the Cauchois type, employing a large 30 × 36 mm², transmissive quartz optic for which a novel solid beryllium holder was designed. The performance of the crystal was verified using offline tests, and the integrated system was tested using experiments on the Z pulsed power accelerator.

The accuracy of interpretation of emergency abdominal CT in adult patients who present with non-traumatic abdominal pain: results of a UK national audit

AIM

To evaluate major/minor discrepancy rates for provisional (initial) and addendum (supplementary senior review) emergency computed tomography (CT) reports in patients presenting with non-traumatic abdominal pain.

MATERIALS AND METHODS

Ethical approval for this type of study is not required in the UK. All radiology departments with an approved lead for audit registered with the Royal College of Radiologists were invited to participate in this retrospective audit. The first 50 consecutive patients (25 surgical, 25 non-surgical) who underwent emergency abdominal CT for non-traumatic abdominal pain in 2013 were included. Statistical analyses were performed to identify organisational and report/patient-related variables that might be associated with major discrepancy.

RESULTS

One hundred and nine (58%) of 188 departments supplied data to the study with a total of 4,931 patients (2,568 surgical, 2,363 non-surgical). The audit standard for provisional report major discrepancy was achieved for registrars (target <10%, achieved 4.6%), for on-site consultants (target <5%, achieved 3.1%) and consultant addendum (target <5%, achieved 2.9%). Off-site reporters failed to meet the standard target (<5%, achieved 8.7% overall and 12.7% in surgical patients). The standard for patients coming to harm was not met in the surgical group (target <1%, achieved 1.5%) and was narrowly missed overall (target <1%, achieved 1%).

CONCLUSION

This study should be used to provide impetus to improve aspects of out-of-hours CT reporting. Clear benefits of CT interpretation/review by on-site and more senior (consultant) radiologists have been demonstrated.

Degradation of Performance Due to Sleep Deprivation: A Field Test

During a 72 h field test, two groups of elite, “ranger type” soldiers were evaluted five times (during the first 8 h, after 30 h of continuous field duty, after a rest period, after 30 more h of continuous field duty, and after a second rest). One group (7 soldiers) received two rests of 3 h each. The second group (6 soldiers) received two rests of 6 h each. Five military tasks (map reading, decoding messages, vehicle/aircraft recognition, assembly and disassembly of the M-16 rifle, and preparation of an AN/PRC radio for operation) were used. These tasks were considered by the commander to be representative of duties that the soldiers would do and were considered to be completely familiar to the soldiers. In addition, a peg into pegboard task and a subjective evaluation of fatigue questionnaire were given.

There was no significant effect of time or difference between the two groups. The soldiers completed these tasks of short duration (less than 3 min) without decreasing performance—even after extended periods of sleep loss. These performance results occurred even though subjectively the soldiers reported they were tired.

Abstract 2912: The AP-1 transcription factor JunB promotes multiple myeloma cell proliferation, survival and drug resistance in the bone marrow microenvironment

Introduction: The activator protein-1 (AP-1) transcription factor has been implicated in a multitude of physiologic processes, but also tumorigenesis. In multiple myeloma (MM), the role of AP-1 is largely unknown.

Experimental procedures: MM cell lines and primary tumor cells were co-cultured with primary bone marrow stromal cells (BMSCs) or BMSC lines. AP-1 expression was measured by western blot analysis and real-time PCR. AP-1 activation was determined using TransAM AP-1 assay kit. To investigate the upstream regulators of JunB, cytokine array and specific inhibitors were used followed by 3H-thymidine incorporation, western blot and TransAM AP-1 assays. To delineate the specific functional role of JunB in MM pathogenesis, we used pLKO.1- JunB shRNA (shJunB) and pLKO.1- scrambled shRNA (SCR) vectors for constitutive knockdown, as well as pMSCV-JunB-ER-IRES-GFP and empty vectors for inducible overexpression, together with 3H-thymidine incorporation, alamarBlue, flow cytometry and western blot analysis, as well as gene expression profiling (GEP). To evaluate the functional role of JunB in vivo, a MM xenograft mouse model was used.

Results: Co-cultures of MM cells with BMSCs rapidly and strongly induced sustained expression and activation of JunB, but not of other AP-1 family members. Induction of JunB was predominantly mediated by soluble factors secreted by BMSCs rather than direct MM-BMSC contact. Indeed, IL-6 stimulation of MM.1S cells resulted in rapid and strong upregulation of JunB. Conversely, anti-IL-6 receptor antibody tocilizumab blocked BMSC-induced JunB expression and activation. Pharmacologic inhibition identified the requirement of the MEK/ERK and NF-κB pathways for BMSC-induced JunB expression. Functionally, significant inhibition of proliferation was observed in MM cells carrying pLKO.1- shJunB, but not pLKO.1-SCR. Importantly, knockdown of other AP-1 family members had minor effects on MM cell proliferation. Moreover, GEP performed on MM.1S- shJunB cells co-cultured with BMSCs as well as data analysis of a patient cohort using Gene Set Enrichment Analysis (GSEA) suggested a key role for JunB in the regulation of Mcl-1 and c-Myc expression. Furthermore, knockdown of JunB overcame resistance of MM cells to dexamethasone. Conversely, 4-OHT treatment of MM cell lines transduced with JunB-ER but not control vector induced significant JunB/AP-1 luciferase activity and protected MM cells against bortezomib-induced apoptosis and ER stress. Confirming our in vitro data, preliminary results show significant inhibition of tumor growth in a xenograft mouse model inoculated with inducible Tet-shJunB-GFP but not Tet-SCR-GFP MM.1S cells upon treatment with doxycycline.

Conclusion: Taken together, our data demonstrate for the first time an important and surprising role of JunB/AP-1 in MM tumorigenesis and strongly propose it as a novel therapeutic target in MM.

Citation Format: Fengjuan Fan, Sonia Vallet, Muhammad Hasan Bashari, Mostafa Jarahian, Eugenio Morelli, Dirk Hose, Latifa Bakiri, Claudia Ball, Hanno Glimm, Martin Sattler, Hartmut Goldschmidt, Giovanni Tonon, Pierfrancesco Tassone, Erwin F. Wagner, Dirk Jäger, Klaus Podar. The AP-1 transcription factor JunB promotes multiple myeloma cell proliferation, survival and drug resistance in the bone marrow microenvironment. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2912.