Lemur tyrosine kinase 2 (LMTK2) is a determinant of cell sensitivity to apoptosis by regulating the levels of the BCL2 family members

Using a high-throughput approach, we identified lemur tyrosine kinase 2 (LMTK2) as a novel determinant of cell sensitivity to TRAIL. LMTK2 is a poorly characterized serine/threonine kinase believed to play a role in endosomal membrane trafficking and neuronal physiology, and recently found to be mutated in diverse tumor types. We show that LMTK2 silencing sensitizes immortalized epithelial cells and cancer cells to TRAIL, and this phenomenon is accompanied by changes in the expression of BCL2 family members. In epithelial cells, LMTK2 targeting causes the down-regulation of the BCL2 and BCL-xL anti-apoptotic proteins and the reciprocal up-regulation of the pro-apoptotic protein BIM, while, in cancer cells, LMTK2 knock-down reduces BCL2 without increasing BIM levels. We provide evidence that both BIM and BCL2 proteins are regulated by LMTK2 in a GSK3β- and PP1A-dependent manner and that their perturbation, together with BCL-xL reduction, determines an increased sensitivity not only to TRAIL, but also to other compounds. Overall, our findings suggest a broad function of LMTK2 in the regulation of the apoptotic pathway and highlight LMTK2 as a novel candidate target to increase the cytotoxic activity of chemotherapeutic compounds.

Successful breastfeeding: a global intervention for a physiological process

In our perinatal unit we applied the ten steps of WHO/UNICEF for Baby Friendly Hospital Initiative and evaluated the percentage of exclusive (EBF) or complementary breastfeeding (CBF), and of formula fed (FF) healthy full-term infants (HFI) at hospital discharge (HD). HFI performing EBF at HD were 85.3%, a quite high value. At the age of 3 mths EBF percentage ranged between 59-62.4%, and at 6 mths it decreased to 51.7-37.7%. Customer satisfaction questionnaire at HD ranked "good" to "very good" in 92.8%. Causes of breastfeeding reduction with time and comparison with previous and actual situation in Italy and civilized countries are discussed.

Hepatitis C virus outbreak in a haemodialysis unit: learning from failures

The investigation of an outbreak of hepatitis C virus in an Italian haemodialysis (HD) centre showed that three patients acquired infection with the same strain, affecting a chronically hepatitis C virus (HCV)-infected patient receiving HD in the same room and during the same shifts. Through our observational analysis many possible modes of transmission were identified, but none could be definitively identified as the route of HCV spread in this small cluster. This outbreak confirms that repeated opportunities for nosocomial HCV transmission may occur among HD patients due to several breaches in the standard precautions for bloodborne infections by healthcare staff.

Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol

PURPOSE

To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan.

METHODS

A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs).

RESULTS

Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %.

CONCLUSION

According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.

The adolescent patient: parental responsibility, the right to be informed and the right to be heard

The increasing emphasis placed on patients' rights, in dentistry as well as in other areas, is also having repercussions on the structure of the relationship between health care staff, the under-age patient and his /her parents. The authors reflect about the decision-making process when the patient is a minor in the field of dentistry and underline the role of the parties involved (dentist, parents, under-age patient) in different circumstances (e.g. ordinary care or non-routine care; urgent situations; conflict between parents; refusal of the parents; disagreement between the parents and the child, refusal of the under-age patient; etc.). The Law must first ensure that the minors' needs for protection are met by awarding their parents the power and duty to care for them and, thus, also to take health care decisions in their interest. At the same time, domestic legislation and international legislation supports the need to give greater weight to minors' opinions as they approach the age of majority and, therefore, as they acquire a certain degree of maturity. The rights of under-age patients are safeguarded by actively involving them in the decision-making process, with particular reference to their right to information and right to be heard, to the extent that their age and understanding allow, with due consideration to the specific situation.

[Literature review and state of the art of the Italian law on medically assisted reproduction]

This article analyzes the current situation of medically assisted reproduction in Italy after the promulgation of Law 40 in 2004. This law is actually completely different from the origin version. The controversial points like reproduction for couples who bear genetic diseases, prohibition of heterologous fertilization, cryoconservation of the embryos, obligation to perform just one and contemporaneous implant of all the embryos produced, are today definitively erased. This new situation is due to the jurisprudence of the Italian Courts but especially to the changes introduced by the European Court of Human Rights and by the questions of constitutionality raised by some Italian Courts. After analysis of the legislation, the views of various authors are compared, and the weaknesses and strong points of the law are considered from the point of view of legal medicine, science and bioethics. After ten years of operation of this law Italy has returned to a situation that existed before the law. In fact the old law was only full of prohibitions. Now is possible to do heterologous fertilization and this article photographs the current situation of hospitals for assisted procreation in Italy. The work also comments on procreative tourism, a direct consequence of this law, and on the status of women, who must be the subject and not the object of the legislation.

Oncogenic KRAS sensitizes premalignant, but not malignant cells, to Noxa-dependent apoptosis through the activation of the MEK/ERK pathway

KRAS is mutated in about 20-25% of all human cancers and especially in pancreatic, lung and colorectal tumors. Oncogenic KRAS stimulates several pro-survival pathways, but it also triggers the trans-activation of pro-apoptotic genes. In our work, we show that G13D mutations of KRAS activate the MAPK pathway, and ERK2, but not ERK1, up-regulates Noxa basal levels. Accordingly, premalignant epithelial cells are sensitized to various cytotoxic compounds in a Noxa-dependent manner. In contrast to these findings, colorectal cancer cell sensitivity to treatment is independent of KRAS status and Noxa levels are not up-regulated in the presence of mutated KRAS despite the fact that ERK2 still promotes Noxa expression. We therefore speculated that other survival pathways are counteracting the pro-apoptotic effect of mutated KRAS and found that the inhibition of AKT restores sensitivity to treatment, especially in presence of oncogenic KRAS. In conclusion, our work suggests that the pharmacological inhibition of the pathways triggered by mutated KRAS could also switch off its oncogene-activated pro-apoptotic stimulation. On the contrary, the combination of chemotherapy to inhibitors of specific pro-survival pathways, such as the one controlled by AKT, could enhance treatment efficacy by exploiting the pro-death stimulation derived by oncogene activation.

Cancer cell-autonomous TRAIL-R signaling promotes KRAS-driven cancer progression, invasion, and metastasis

Many cancers harbor oncogenic mutations of KRAS. Effectors mediating cancer progression, invasion, and metastasis in KRAS-mutated cancers are only incompletely understood. Here we identify cancer cell-expressed murine TRAIL-R, whose main function ascribed so far has been the induction of apoptosis as a crucial mediator of KRAS-driven cancer progression, invasion, and metastasis and in vivo Rac-1 activation. Cancer cell-restricted genetic ablation of murine TRAIL-R in autochthonous KRAS-driven models of non-small-cell lung cancer (NSCLC) and pancreatic ductal adenocarcinoma (PDAC) reduces tumor growth, blunts metastasis, and prolongs survival by inhibiting cancer cell-autonomous migration, proliferation, and invasion. Consistent with this, high TRAIL-R2 expression correlates with invasion of human PDAC into lymph vessels and with shortened metastasis-free survival of KRAS-mutated colorectal cancer patients.

Cardiorespiratory of land and water walking on a non motorized treadmill

AIM

This study was designed to assess submaximal cardiac and pulmonary demand imposed by walking on a non motorized treadmill in land and in water condition.

METHODS

Eight healthy young subjects (mean age, body mass and height: 26.5 ± 2.8 years; 66.7 ± 9.60 kg; 172 ± 8.07 cm) performed one maximal treadmill running test on land and a submaximal incremental test (treadmill speed 2, 3, 4 km.h-1; 5 minutes step duration; 15 minutes total duration) in land (L) at 2, 3, 4 km.h-1 (L2, L3, L4) and in water (W) at 2, 3, 4 km.h-1 (W2, W3, W4). Individual stride frequency at any given submaximal walking speed on land was used to perform comparable water tests. Heart rate (HR) and oxygen consumption (VO₂) were continuously measured during the tests.

RESULTS

Rest heart rate (%max) decreased immediately after water immersion [land HR(%max) 42 b.min-1±3; water HR(%max) 36 b.min-1 ± 5, P<0.05] while the other physiological parameters were comparable between land and water condition [land VO2(%max) 9.44 mL.Kg.min-1 ± 1.54; water VO₂(%max) 7.75 ml.Kg.min-1 ± 2.4, p>0.05; land ventilation [VE(%max)] 8.71 L.min-1 ± 2.37; water VE(%max) 7.67 L.min-1 ± 2.79, p>0.05; land respiratory exchange ratio (RER) 0.77 ± 0.5 water RER 0.75 ± 0.07, P>0.05]. During exercise at 2, 3 and 4 Km.h⁻¹, reserve heart rate [HRR (%max)] was higher during water walking (W2 35 ± 10; W3 54 ± 11; W4 76 ± 9 b.min⁻¹) than during land walking (L2 23 ± 5; L3 39 ± 7; L4 58 ± 8 b.min-1, P<0.05). VO₂and VE were not different.

CONCLUSION

The findings suggest that water walking on a non motorized treadmill elicits similar VO₂but higher HR than land walking; this factor should be considered when prescribing exercise intensity in water using heart rate.

Investigating psoriasis awareness among patients in Italy: validation of a questionnaire

OBJECTIVE

Psoriasis can have a profound impact on quality of life (QoL) and an awareness of the processes of the disease and its treatment is important in coping with symptoms. Patients do not always understand the potential consequences of their disease and the wide range of effective treatment strategies now available. We designed and validated a questionnaire to investigate patient awareness and understanding of psoriasis including pathogenesis, diagnosis, prognosis and treatment.

PATIENTS AND METHODS

This was a multicentre, cross-sectional investigation involving 14 psoriasis referral centres in Italy. The focus group technique was used by a panel of experts in psoriasis, to draw-up a list of questions exploring pathogenesis, diagnosis, prognosis, factors influencing clinical course of psoriasis as well as QoL issues and sources of information on their condition. Psychometric properties of the questionnaire were tested on a sample of 240 adult patients with psoriasis (including treatment-naïve and -experienced patients).

RESULTS

The mean age of patients was 50.3±14.9 years and 34.2% were female. The median time from diagnosis was 13.7 years (IQR 7.3-23.2). The Cronbach alpha was 0.77 and all items showed higher correlations within their own dimensions than to other dimensions. Each domain of awareness was well represented by a single dimension. Mean overall awareness was 59.7±13.1 on a 100-point scale.

CONCLUSIONS

Our questionnaire was valid in assessing patient awareness in five relevant areas of psoriasis, and can be useful in both the clinical setting and research studies to evaluate patients' knowledge of psoriasis better, with the final aim of reducing the burden of this chronic condition.