Enhancing Quality of Life Through an Innovative, Multidisciplinary Model of Supportive Cancer Care and Rehabilitation

Background: Advancements in diagnosis and cancer treatment mean survival rates have improved but as a consequence many people are living with the adverse physical effects of complex treatments, financial hardship, work and relationship stress, and fear of recurrence. Person-centered, holistic care is required to help people maximize all aspects of their quality of life when living with and beyond their cancer, but debate continues around which models are economically sustainable and effective in achieving the desired outcomes. Maggie's ( www.maggiescentres.org ) is an innovative, multidisciplinary model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie's received 249,247 visits across the network of centres in the UK, Hong Kong and Tokyo. The Maggie's program is designed to incorporate evidence based psychoeducation techniques delivered by multidisciplinary oncology professionals; offer personalised and understandable treatment and lifestyle information; and maximize the opportunity for social-support. Outcome evaluation is embedded within the model of care. Aim: To illustrate the holistic Maggie's model using outcome data from “Managing Stress” and “Living with and after Prostate Cancer (LWAPC)” courses to provide examples of the impact Maggie´s makes in enhancing quality of life. Methods: A subset of participants in “Managing Stress” and “Living with and after Prostate Cancer” courses across the network of UK Maggie´s Centres completed pre and post course standardized questionnaires. Results: Participants in “Managing Stress” found significant improvements in overall psychological well-being and quality of life (QoL) (t(40)=3.28, P = .002) and significant improvements in their ability to tolerate uncertainty (t(47) = 3.23, P = .002). Participants in the LWAPC found significant improvements in overall prostate cancer specific QoL ( t(37)=3.603, P = .001), general well-being ( t(37)=2.61, P = .013), and emotional well-being ( t(37)=2.62, P = .013). Also, significant reductions were found in overall negative appraisal of life (t(52)=2.96, P = .005), overall health worries (t(52) 2.28, P = 0.27), worries about the future (t(52) = 2.85, P = .006) and uncertainty (t(52) = 3.89, P < .001). Conclusion: Globally, the supportive care needs of people affected by cancer are changing but the Maggie's model of care offers valuable lessons that can be generalized across varied support settings to meet these emerging needs.

The Relationship Between Psychological Flexibility, Value-Based Living and Emotional Well-Being in People Affected by Cancer

Background: Receiving a cancer diagnosis can have detrimental effects on an individual's psychological flexibility (ability to adapt constructively to reality), emotional well-being and ability to live aligned with personal values, for example, in relationships and work. Higher levels of psychological flexibility and emotional well-being are associated with better quality of life and lower psychological cancer-related distress. In turn, value-based living is positively associated with psychological flexibility and emotional well-being. There is, however, limited research specifically exploring the relationship between value-based living and emotional well-being within individuals affected by cancer. Maggie's Centres ( www.maggiescentres.org ) offer an innovative, multidisciplinary model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie's received 249,247 visits across the network of Centres in the UK, Hong Kong and Tokyo. Principles of ACT (acceptance and commitment therapy) are incorporated within the program of individual support, psychoeducational courses and groups to help people maximize their quality of life. Aim: To explore the associations between psychological flexibility, value-based living and emotional well-being in individuals affected by cancer. Methods: Sixty-five people, affected by a cancer diagnosis personally or in a family member, were recruited from four UK Maggie's Centres. Participants completed standardized questionnaires measuring psychological flexibility, valued-based living and emotional well-being. Results: Moderate positive associations were found between emotional well-being and psychological flexibility (r=.4750), as well as emotional well-being and valued-living (r=.37983). Psychological flexibility was also positively associated with valued living (r=.443474). Multiple regression analysis revealed a significant model (F(5,54)=9.35, P < .001), accounting for 41.4% of the variance in emotional well-being (adjusted R2 = .414). Both psychological flexibility (b=.357, P = .002) and valued-living (b=.337, P = .004) were predictors of emotional well-being across all ages, gender and time since diagnosis. Conclusion: The study provides support for the positive associations between psychological flexibility, valued-living and emotional well-being and indicates that psychological flexibility and valued-living may be predictors of emotional well-being. This was a small observational study, so conclusions about causation or change over time cannot be made. Longitudinal intervention studies need to explore the potential impact valued-living and psychological flexibility may have on emotional well-being in those affected by cancer, and so contribute to understanding the potential importance of encouraging valued-living as a therapeutic tool within cancer care.

Atrial GIRK Channels Mediate the Effects of Vagus Nerve Stimulation on Heart Rate Dynamics and Arrhythmogenesis

Diminished parasympathetic influence is central to the pathogenesis of cardiovascular diseases, including heart failure and hypertension. Stimulation of the vagus nerve has shown promise in treating cardiovascular disease, prompting renewed interest in understanding the signaling pathway(s) that mediate the vagal influence on cardiac physiology. Here, we evaluated the contribution of G protein-gated inwardly rectifying K+ (GIRK/Kir3) channels to the effect of vagus nerve stimulation (VNS) on heart rate (HR), HR variability (HRV), and arrhythmogenesis in anesthetized mice. As parasympathetic fibers innervate both atria and ventricle, and GIRK channels contribute to the cholinergic impact on atrial and ventricular myocytes, we collected in vivo electrocardiogram recordings from mice lacking either atrial or ventricular GIRK channels, during VNS. VNS decreased HR and increased HRV in control mice, in a muscarinic receptor-dependent manner. This effect was preserved in mice lacking ventricular GIRK channels, but was nearly completely absent in mice lacking GIRK channels in the atria. In addition, atrial-specific ablation of GIRK channels conferred resistance to arrhythmic episodes induced by VNS. These data indicate that atrial GIRK channels are the primary mediators of the impact of VNS on HR, HRV, and arrhythmogenesis in the anesthetized mouse.

Dichlorophenyl piperazines, including a recently-approved atypical antipsychotic, are potent inhibitors of DHCR7, the last enzyme in cholesterol biosynthesis

While antipsychotic medications provide important relief from debilitating psychotic symptoms, they also have significant adverse side effects, which might have relevant impact on human health. Several research studies, including ours, have shown that commonly used antipsychotics such as haloperidol and aripiprazole affect cholesterol biosynthesis at the conversion of 7-dehydrocholesterol (7-DHC) to cholesterol. This transformation is promoted by the enzyme DHCR7 and its inhibition causes increases in plasma and tissue levels of 7-DHC. The inhibition of this enzymatic step by mutations in the Dhcr7 gene leads to Smith-Lemli-Opitz syndrome, a devastating human condition that can be replicated in rats by small molecule inhibitors of DHCR7. The fact that two compounds, brexpiprazole and cariprazine, that were recently approved by the FDA have substructural elements in common with the DHCR7 inhibitor aripiprazole, prompted us to evaluate the effect of brexpiprazole and cariprazine on cholesterol biosynthesis. We report that cariprazine affects levels of 7-DHC and cholesterol in cell culture incubations at concentrations as low as 5 nM. Furthermore, a common metabolite of cariprazine and aripiprazole, 2,3-(dichlorophenyl) piperazine, inhibits DHCR7 activity at concentrations comparable to those of the potent teratogen AY9944. The cell culture experiments were corroborated in mice in studies showing that treatment with cariprazine elevated 7-DHC in brain and serum. The consequences of sterol inhibition by antipsychotics in the developing nervous system and the safety of their use during pregnancy remains to be established.

The influences of the M2R-GIRK4-RGS6 dependent parasympathetic pathway on electrophysiological properties of the mouse heart

A large body of work has established the prominent roles of the atrial M₂R-I_KACh signaling pathway, and the negative regulatory protein RGS6, in modulating critical aspects of parasympathetic influence on cardiac function, including pace-making, heart rate (HR) variability (HRV), and atrial arrhythmogenesis. Despite increasing evidence of its innervation of the ventricles, and the expression of M₂R, I_KACh channel subunits, and RGS6 in ventricle, the effects of parasympathetic modulation on ventricular electrophysiology are less clear. The main objective of our study was to investigate the contribution of M₂R-I_KACh signaling pathway elements in murine ventricular electrophysiology, using in-vivo ECG measurements, isolated whole-heart optical mapping and constitutive knockout mice lacking I_KACh (Girk4^–/–) or RGS6 (Rgs6^-/-). Consistent with previous findings, mice lacking GIRK4 exhibited diminished HR and HRV responses to the cholinergic agonist carbachol (CCh), and resistance to CCh-induced arrhythmic episodes. In line with its role as a negative regulator of atrial M₂R-I_KACh signaling, loss of RGS6 correlated with a mild resting bradycardia, enhanced HR and HRV responses to CCh, and increased propensity for arrhythmic episodes. Interestingly, ventricles from mice lacking GIRK4 or RGS6 both exhibited increased action potential duration (APD) at baseline, and APD was prolonged by CCh across all genotypes. Similarly, CCh significantly increased the slope of APD restitution in all genotypes. There was no impact of genotype or CCh on either conduction velocity or heterogeneity. Our data suggests that altered parasympathetic signaling through the M₂R-I_KACh pathway can affect ventricular electrophysiological properties distinct from its influence on atrial physiology.

The Accessibility of Pronominal Antecedents as a Function of Episode Shifts in Narrative Text

One of the characteristics of connected discourse is that entities introduced are often referred to again at a later point. Such anaphoric reference clearly necessitates a memory representation of the prior text, so that the new reference can be established as coreferential with the old. In this paper, a distinction is made between people introduced in a narrative who depend upon a particular setting in order to be interpreted (scenario-dependent entities), and those who do not (main characters). It is argued that the availability of representations of these two types of character in working memory will depend upon whether the text indicates a change in setting to have occurred. Two experiments are described which show that dependent entities become less available if a change has occurred, while main characters are not so affected. The first study uses incidence of mention in a passage continuation procedure as an index of availability, while the second uses reading time and question-answering latencies. The experiments rule out any simple view that availability depends only upon how far back in the text a character was mentioned, and illustrate how passage of time in a narrative serves as a cue for recognizing the end of an episode.

Genomic innovations, transcriptional plasticity and gene loss underlying the evolution and divergence of two highly polyphagous and invasive Helicoverpa pest species

BACKGROUND

Helicoverpa armigera and Helicoverpa zea are major caterpillar pests of Old and New World agriculture, respectively. Both, particularly H. armigera, are extremely polyphagous, and H. armigera has developed resistance to many insecticides. Here we use comparative genomics, transcriptomics and resequencing to elucidate the genetic basis for their properties as pests.

RESULTS

We find that, prior to their divergence about 1.5 Mya, the H. armigera/H. zea lineage had accumulated up to more than 100 more members of specific detoxification and digestion gene families and more than 100 extra gustatory receptor genes, compared to other lepidopterans with narrower host ranges. The two genomes remain very similar in gene content and order, but H. armigera is more polymorphic overall, and H. zea has lost several detoxification genes, as well as about 50 gustatory receptor genes. It also lacks certain genes and alleles conferring insecticide resistance found in H. armigera. Non-synonymous sites in the expanded gene families above are rapidly diverging, both between paralogues and between orthologues in the two species. Whole genome transcriptomic analyses of H. armigera larvae show widely divergent responses to different host plants, including responses among many of the duplicated detoxification and digestion genes.

CONCLUSIONS

The extreme polyphagy of the two heliothines is associated with extensive amplification and neofunctionalisation of genes involved in host finding and use, coupled with versatile transcriptional responses on different hosts. H. armigera's invasion of the Americas in recent years means that hybridisation could generate populations that are both locally adapted and insecticide resistant.

Walking Responses of Tribolium castaneum (Coleoptera: Tenebrionidae) to Its Aggregation Pheromone and Odors of Wheat Infestations

The red flour beetle, Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae), is a worldwide pest of stored grains. Using "Y"-tube olfactometry we studied the response of T. castaneum to odors from simulated wheat infestations containing conspecifics, and infestations containing the lesser grain borer, Rhyzopertha dominica (F.) (Coleoptera: Bostrichidae), and the granary weevil Sitophilus granarius (L.) (Coleoptera: Curculionidae). Tribolium castaneum larvae were significantly attracted to odors from all three test species. Tribolium castaneum adults were attracted to grains infested by R. dominica and flour infested by T. castaneum but repelled from grains infested by S. granarius. Further behavioral analysis with pheromones showed that T. castaneum were significantly attracted to their aggregation pheromone, dimethyldecanal (DMD), but not to the R. dominica aggregation pheromone, a mixture of dominicalure 1 and 2. Female T. castaneum adults were attracted to ∼50-fold less DMD than larvae and 100-fold less than male adults, suggesting they are more sensitive to DMD. This study improves our understanding of T. castaneum behaviors to infested grain volatile compounds and pheromones, and may help develop new control methods for grain pest species.

GIRK2 splice variants and neuronal G protein-gated K+ channels: implications for channel function and behavior

Many neurotransmitters directly inhibit neurons by activating G protein-gated inwardly rectifying K⁺ (GIRK) channels, thereby moderating the influence of excitatory input on neuronal excitability. While most neuronal GIRK channels are formed by GIRK1 and GIRK2 subunits, distinct GIRK2 isoforms generated by alternative splicing have been identified. Here, we compared the trafficking and function of two isoforms (GIRK2a and GIRK2c) expressed individually in hippocampal pyramidal neurons lacking GIRK2. GIRK2a and GIRK2c supported comparable somato-dendritic GIRK currents in Girk2^−/− pyramidal neurons, although GIRK2c achieved a more uniform subcellular distribution in pyramidal neurons and supported inhibitory postsynaptic currents in distal dendrites better than GIRK2a. While over-expression of either isoform in dorsal CA1 pyramidal neurons restored contextual fear learning in a conditional Girk2^−/− mouse line, GIRK2a also enhanced cue fear learning. Collectively, these data indicate that GIRK2 isoform balance within a neuron can impact the processing of afferent inhibitory input and associated behavior.

Nontuberculous mycobacteria in gastrostomy fed patients with cystic fibrosis

Multi-drug resistant Mycobacterium abscessus complex (MABSC) is a form of Nontuberculous mycobacteria (NTM) of special, international concern in Cystic Fibrosis (CF). We hypothesised that gastric juice and percutaneous endoscopic gastrostomy (PEG) feeding devices might yield MABSC isolates. Gastric juice and sputa from sixteen adult PEG fed CF patients and five replaced PEG tubes were studied. Bacterial and fungal isolates were cultured. Mycobacterium were identified by rpoB, sodA and hsp65 gene sequencing and strain typed using variable number tandem repeat. Bacteria and/or fungi grew from all gastric juice, sputa and PEG samples. MABSC were detected in 7 patients. Five had MABSC in their sputum. Two had an identical MABSC strain in their sputum and gastric juice and one had the same strain isolated from their PEG tube and sputum. Two patients who were sputum sample negative had MABSC isolated in their gastric juice or PEG tube. MABSC were therefore identified for the first time from a gastric sample in a minority of patients. We conclude that gastric juice and PEG-tubes may be a potential source of MABSC isolates in CF patients, and these findings warrant further study.