Unraveling the crosstalk between melanoma and immune cells in the tumor microenvironment

Cutaneous melanoma is the most common skin cancer with an incidence that has been rapidly increasing in the past decades. Melanomas are among the most immunogenic tumors and, as such, have the greatest potential to respond favorably to immunotherapy. However, like many cancers, melanomas acquire various suppressive mechanisms, which generally act in concert, to escape innate and adaptive immune detection and destruction. Intense research into the cellular and molecular events associated with melanomagenesis, which ultimately lead to immune suppression, has resulted in the discovery of new therapeutic targets and synergistic combinations of immunotherapy, targeted therapy and chemotherapy. Tremendous effort to determine efficacy of single and combination therapies in pre-clinical and clinical phase I-III trials has led to FDA-approval of several immunotherapeutic agents that could potentially be beneficial for aggressive, highly refractory, advanced and metastatic melanomas. The increasing availability of approved combination therapies for melanoma and more rapid assessment of patient tumors has increased the feasibility of personalized treatment to overcome patient and tumor heterogeneity and to achieve greater clinical benefit. Here, we review the evolution of the immune system during melanomagenesis, mechanisms exploited by melanoma to suppress anti-tumor immunity and methods that have been developed to restore immunity. We emphasize that an effective therapeutic strategy will require coordinate activation of tumor-specific immunity as well as increased recognition and accessibility of melanoma cells in primary tumors and distal metastases. This review integrates available knowledge on melanoma-specific immunity, molecular signaling pathways and molecular targeting strategies that could be utilized to envision therapeutics with broader application and greater efficacy for early stage and advanced metastatic melanoma.

Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review

INTRODUCTION

Tremor is the most common movement disorder, affecting 5.6% of the population with Parkinson's disease or essential tremor over the age of 65. Conventionally, tremor diseases like Parkinson's are treated with medication. An alternative non-invasive symptom treatment is the mechanical suppression of the oscillation movement. The purpose of this review is to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments.

METHOD

A systematic literature search was conducted by performing a keyword combination search of the title, abstract and keyword sections in the four databases Web of Science, MedLine, Scopus, and ProQuest. Initially, the retrieved articles were selected by title and abstract using selection criteria. The same criteria were then applied to the full publication text. After the selection process, relevant information on the retrieved orthoses was isolated, sorted and analysed systematically.

RESULTS

Forty-six papers, representing 21 orthoses, were identified and analysed according to the mechanical and ergonomic properties. The identified orthoses can be divided into 5 concepts and 16 functional prototypes, then subdivided further based upon their use of passive, semi-active, or active suppression mechanisms. Most of the orthoses concentrate on the wrist and elbow flexion and extension. They mainly rely on rigid structures and actuators while having tremor-suppression efficacies for tremorous subjects from 30 to 98% using power spectral density or other methods.

CONCLUSION

The comparison of tremor-suppression orthoses considered and mapped their various mechanical and ergonomic properties, including the degrees of freedom, weight, suppression characteristics, and efficacies. This review shows that most of the orthoses are bulky and heavy, with a non-adapted human-machine interface which can cause rejection by the user. The main challenge of the design of an effective, minimally intrusive and portable tremor-suppressing orthosis is the integration of compact, powerful, lightweight, and non-cumbersome suppression mechanisms. None of the existing prototypes combine all the desired characteristics. Future research should focus on novel suppression orthoses and mechanisms with compact dimensions and light weight in order to be less cumbersome while giving a good tremor-suppression performance.

Long-term antimicrobial suppression prevents treatment failure of streptococcal periprosthetic joint infection

OBJECTIVES

To evaluate the effect of oral antimicrobial suppression on the outcome of streptococcal periprosthetic joint infection (PJI).

METHODS

Consecutive patients with streptococcal PJI receiving antimicrobial suppression for >6 months were prospectively included and compared to a retrospective control group without suppression. Outcome was assessed with Kaplan-Meier analysis and compared by the log-rank Mantel-Cox test. Multivariate analysis was used to identify factors associated with treatment failure.

RESULTS

Of 69 streptococcal PJI episodes (37 knee, 31 hip and one shoulder PJI), 43 (62%) were caused by beta-hemolytic streptococci and 26 (38%) by viridans group streptococci. Debridement and prosthesis retention was performed in 27 (39%), one-stage exchange in 5 (7%), multi-stage exchange in 31 (44%) and prosthesis removal in 6 patients (9%). 24 patients (35%) were treated with antimicrobial suppression receiving oral amoxicillin (n = 22), doxycycline (n = 1) or clindamycin (n = 1). After a median follow-up of 13 months (range, 0.5-111 months), 38 of 65 patients (58%) were infection-free. Suppressive antimicrobial treatment was associated with higher success rate compared with no suppression (93% vs. 57%, p = 0.002), representing the only significant independent factor preventing treatment failure.

CONCLUSIONS

Long-term antimicrobial suppression was associated with significantly better treatment outcome and should be strongly considered in streptococcal PJI.

Suppression processes of anionic pollutants released from fly ash by various Ca additives

Harmful trace elements, which are initially included in the coal fly ash, have the potential to be leached when coal fly ash comes in contact with water. This causes a risk of pollutant species being released, considering the long lifetime of building structures where coal fly ash was applied. Some Ca additives effectively function to suppress the release of anionic pollutants; however, the detailed suppression processes remains unclear. In this work, the influences of various Ca additives on the released anionic pollutants (B, F, S, As, and Cr) was systematically investigated. According to the comprehensive results of solution data with the solid characterization, the 60% hydroxylated calcined dolomite (HCD 60) was the best Ca additive for the suppression of different anionic pollutants since this Ca source not only simply provides an alkaline reagent but also supplies MgO and Mg(OH)₂, which affect the phase transformation that accompanies with hydration. The phase transformation occurs from Ca(OH)₂ to ettringite via hydrocalumite, which is the most important suppression processes of released pollutants. The precipitation of Ca salts is another pathway to immobilize these pollutants. In this scheme, MgO and Mg(OH)₂ were proven to enhance the formation of ettringite and hydrocalumite, respectively.

Cognitive Reappraisal and Depression in Children with a Parent History of Depression

Although decades of research have documented that children whose parents have a history of Major Depressive Disorder (MDD) are at a higher risk of developing depression themselves, not all of these children go on to develop depression themselves, thus highlighting the need to understand potential moderators of risk. The current study examined whether child emotion regulation, specifically, the use of cognitive reappraisal and suppression, moderated the link between parent and child depression. We recruited 458 parents and their children between the ages of 7-11 from the community. The majority of children were Caucasian (74.2%) and approximately half were girls (46.1%). Among children with a parent history of MDD, those who reported using cognitive reappraisal more frequently were less likely to have a history of depressive diagnoses themselves and had higher current levels of positive affect. Although children's use of suppression was not associated with their levels of depressive symptoms among children with a parent history of MDD, higher levels of suppression were related to higher levels of depressive symptoms among children with no parent history of MDD. These findings suggest that, among children with a history of parent depression, children's use of cognitive reappraisal may influence their own risk for developing depression and highlights the potential utility of early interventions that focus on improving the use of emotion regulation strategies like cognitive reappraisal among children of depressed parents.

State and trait neural correlates of the balance between work and nonwork roles

Difficulty managing the demands of work and nonwork roles (often referred to in terms of managing balance) can be detrimental to psychological wellbeing and contribute to occupational burnout. The current study investigated the neural correlates of perceived satisfaction with this balance using both trait and state EEG alpha measures. EEG was recorded from 14 participants in full time employment (12 females, aged 35.1 ± 10.1 years) during a resting state and performance of an auditory oddball task; e-mail and messaging alert sounds were used as target stimuli. It was predicted that dissatisfaction with the balance between work and nonwork roles would be associated with increased resting alpha power, consistent with studies of burnout, and diminished alpha response to oddball distractors, consistent with difficulty suppressing automatic responses to work-related stimuli. Significant correlations between self-reported measures of work/nonwork balance and both resting, and task-related alpha responses, supported our predictions. Furthermore, an exploratory partial correlation between work and nonwork balance and resting EEG, controlling for task-related alpha response, suggested that the three variables were interrelated. We propose that dissatisfaction with work/nonwork balance is associated with a state hypervigilance to work-related cues, and a trait neural marker of fatigue, both symptomatic of lowered cognitive capacity.

The impact of retrieval suppression on conceptual implicit memory

When people suppress retrieval of episodic memories, it can induce forgetting on later direct tests of memory for those events. Recent reports indicate that suppressing retrieval affects less conscious, unintentional retrieval of unwanted memories as well, at least on perceptually-oriented indirect tests. In the current study we examined how suppressing retrieval affects conceptual implicit memory for the suppressed content, using a category verification task. Participants studied cue-target words pairs in which the targets were exemplars of 22 semantic categories, such as vegetables or occupations. They then repeatedly retrieved or suppressed the targets in response to the cues for some of those pairs. Afterwards, they were exposed to the targets intermixed with novel items, one at a time, and asked to verify the membership of each of the words in a semantic category, as quickly as possible. Judgment response times to studied words were faster than to unstudied exemplars, reflecting repetition priming, as has been previously observed. Strikingly, the beneficial effects of prior exposure on response time were eliminated for targets that had been suppressed. Follow-up explicit memory tests also demonstrated that retrieval suppression continued to disrupt episodic recall for the items that had been just been re-exposed on the category verification test. These findings support the contention that the effects of retrieval suppression are not limited to episodic memory, but also affect indirect expressions of those memories on conceptually oriented tests, raising the possibility that underlying semantic representations of suppressed content are affected.

Behavioral and neural correlates of memory suppression in PTSD

Previous work has shown that healthy individuals can actively suppress emotional memories through recruitment of the lateral prefrontal cortex. By contrast, individuals with posttraumatic stress disorder (PTSD) frequently experience unwanted memories of their traumatic experiences, even when making explicit efforts to avoid them. However, little is known regarding the behavioral and neural effects of memory suppression among individuals with PTSD. We examined memory suppression associated with PTSD using the Think-No-Think paradigm in an event-related functional magnetic resonance imaging (fMRI) study. We studied three groups: PTSD (n = 16), trauma exposure without PTSD (n = 19), and controls (i.e., no trauma exposure or PTSD; n = 13). There was a main effect of memory suppression such that participants remembered fewer face-picture pairs during the suppress condition than the remember condition. However, trauma-exposed participants (regardless of PTSD status) were less likely to successfully suppress memory than non-trauma-exposed controls. Neuroimaging data revealed that trauma-exposed individuals showed reduced activation in the right middle frontal gyrus during memory suppression. These results suggest that trauma exposure is associated with neural and behavioral disruptions in memory suppression and point to the possibility that difficulty in active suppression of memories may be just one of several likely factors contributing to the development of PTSD.

Liver-resident NK cells suppress autoimmune cholangitis and limit the proliferation of CD4+ T cells

Liver-resident NK cells are distinct from conventional NK cells and play an important role in the maintenance of liver homeostasis. How liver-resident NK cells participate in autoimmune cholangitis remains unclear. Here, we extensively investigated the impact of NK cells in the pathogenesis of autoimmune cholangitis utilizing the well-established dnTGFβRII cholangitis model, NK cell-deficient (Nfil3^-/-) mice, adoptive transfer and in vivo antibody-mediated NK cell depletion. Our data demonstrated that disease progression was associated with a significantly reduced frequency of hepatic NK cells. Depletion of NK cells resulted in exacerbated autoimmune cholangitis in dnTGFβRII mice. We further confirmed that the DX5^-CD11c^hi liver-resident NK cell subset colocalized with CD4⁺ T cells and inhibited CD4⁺ T cell proliferation. Gene expression microarray analysis demonstrated that liver-resident NK cells had a distinct gene expression pattern consisting of the increased expression of genes involved in negative regulatory functions in the context of the inflammatory microenvironment.

Higher trait reappraisal predicts stronger HPA axis habituation to repeated stress

Undergoing stress can be advantageous when it leads to adaptation and growth; however, failure of the hypothalamic-pituitary-adrenal (HPA) axis to habituate (i.e., nonhabituation) involves continuing to become highly activated in response to repeated exposure of the same stimulus and is considered maladaptive. Although 50-75% of individuals assessed in a laboratory exhibit adaptive habituation to repeated stress, variability in habituation suggests psychological processes used in response to stress may play a role, such as emotion regulation (ER). Nonetheless, no research to date has investigated whether ER strategies affect HPA axis habituation. We investigated whether tendency to use two ER strategies, reappraisal and suppression, influenced HPA axis habituation among 84 healthy young adults (60.7% female; M_age = 24.8 years, SD = 6.0) exposed to a standardized experimental stress paradigm on two consecutive days. HPA axis stress responses were assessed using salivary cortisol concentrations. We also examined whether non-manipulated state ER strategies (i.e., those used by the participant during and following the stressor on the first day) modulated HPA axis habituation over and above trait-use in a subsample (N = 60). Trait, but not state, reappraisal was associated with stronger HPA axis habituation. Neither trait nor state suppression were significantly associated with HPA axis habituation. These findings expand our current understanding of how ER can affect stress-related health outcomes and suggest habitual reappraisal plays an important role in adaption of the HPA axis to stress.

The V2 protein encoded by a monopartite begomovirus is a suppressor of both post-transcriptional and transcriptional gene silencing activity

Papaya leaf curl virus (PaLCuV) is a begomovirus (genus Begomovirus; family Geminiviridae) with a monopartite genome that is usually associated with beta- and alphasatellites in plants. Geminiviruses are DNA viruses with small circular genomes that occur as minichromosomes in the nucleus and are susceptible to post-transcriptional gene silencing (PTGS) and transcriptional gene silencing (TGS). Transient expression of the PaLCuV V2 (PV2) protein together with the green fluorescent protein (GFP) in Nicotiana benthamiana resulted in enhanced levels of GFP fluorescence and GFP mRNA, indicative of suppression of PTGS. Expression of PV2 from a Potato virus X vector restored GFP expression in N. benthamiana plants harbouring a transcriptionally silenced GFP transgene, indicative of suppression of TGS. The results show that the PV2 protein encoded by PaLCuV has both suppressor of PTGS and TGS activity and is an important factor in overcoming host RNA-silencing based defenses.

Dendritic Cells Treated with Exogenous Indoleamine 2,3-Dioxygenase Maintain an Immature Phenotype and Suppress Antigen-specific T cell Proliferation

Indoleamine 2,3-dioxygenase (IDO), an intracellular enzyme responsible for catalyzing the rate limiting step of tryptophan catabolism, plays a critical role in immune cell suppression and tolerance. Indoleamine 2,3-dioxygenase-mediated depletion of the essential amino acid tryptophan increases susceptibility of T cells to apoptosis, while kynurenine and its downstream metabolites, such as 3-hydroxyanthranilic acid and quinolinic acid, have a direct cytotoxic effect on conventional effector T cells. Additionally, IDO-expressing antigen presenting cells (APCs) induce proliferation of regulatory T cells. When expressed by an APC, the immunosuppressive effects of IDO may act directly on the APC as well as indirectly upon local T cells. One approach to elicit immune tolerance or reduce inflammation therefore is to promote expression of IDO. However, this approach is constrained by several factors including the potential for deleterious biologic effects of conventional IDO-inducing agents such as interferon gamma (IFNγ), and the potential limitations of constitutive gene transfection. Alternatively, direct action of recombinant IDO enzyme supplied exogenously as a potential therapeutic in the extracellular space has not been investigated previously, and is the focus of this work. Results indicate exogenous recombinant human IDO supplementation influences murine dendritic cell (DC) maturation and ability to suppress antigen specific T cell proliferation. Following treatment, DCs were refractory to maturation by LPS as defined by co-stimulatory molecule expression (CD80 and CD86) and major histocompatibility complex II (MHC-II) expression. Dendritic cells exhibited skewing toward an anti-inflammatory cytokine release profile, with reduced secretion of IL-12p70 and maintained basal level of secreted IL-10. Notably, IDO-treated DCs suppressed proliferation of ovalbumin (OVA) antigen-specific CD4⁺ and CD8⁺ T cells in the presence of cognate antigen presentation in a manner dependent on active enzyme, as introduction of IDO inhibitor 1-methyl-tryptophan, restored T cell proliferation. Defined media experiments indicate a cumulative role for both tryptophan depletion and kynurenine presence, in the suppressive programming of DCs. In sum, we report that exogenously supplied IDO maintains immunoregulatory function on DCs, suggesting that IDO may have potential as a therapeutic protein for suppressive programming with application toward inflammation and tolerance.

A Developmental Perspective on Processing Semantic Context: Preliminary Evidence from Sentential Auditory Word Repetition in School-Aged Children

The current investigation examined the developmental changes involved in processing semantic context in auditorily presented sentences, as well as underlying attentional and suppression mechanisms. Thirty-nine typically developing school-aged children aged 6;0-14;0 years participated in the current cross-sectional sentential auditory word repetition study. Component processes involved in auditory word recognition were examined and their respective developmental trajectories systematically delineated. Experimental manipulations included semantic congruity (congruous, incongruous), sentence constraint (high, low), cloze probability (high, low), and processing mode. High sentence constraints elicited top-down pre-potency type effects, which resulted in active suppression of anticipated cloze words and longer naming latencies of perceived cloze words when violated with conflicting bottom-up information. In addition, developmental changes in component processes reflected underlying changes in attention, with evidence that suppression mechanisms remained relatively constant with age. Findings are interpreted in line with the Trace (McClelland and Elman in Cogn Psychol 18(1):1-86, 1986) model of auditory word recognition.

Mild Depression in Low Back Pain: the Interaction of Thought Suppression and Stress Plays a Role, Especially in Female Patients

PURPOSE

Mild depression has been shown as a precursor and as a consequence of low back pain, even in early phases of acute or subacute pain. Chronic daily life stress as well as dysfunctional pain-related cognitions such as thought suppression (TS) seem to play a role in the pain-depression cycle; however, the mechanisms of these associations are less understood. Experimentally induced TS, conceived as the attempt to directly suppress sensations such as pain, has been shown to paradoxically cause a delayed and non-volitional return of the suppressed thoughts and sensations and to increase affective distress. These dysfunctional processes are supposed to increase under high cognitive load, such as high stress.

METHOD

In the present cross-sectional study, we for the first time sought to examine a possible interaction between habitual TS and stress on depression in N = 177 patients with subacute low back pain (SLBP), using the following questionnaires: Subscale Thought Suppression from Avoidance-Endurance Questionnaire, Beck Depression Inventory, and Kiel Interview of Subjective Situation. A three-way ANOVA was conducted with two groups of TS (high/low), stress (high/low) and sex as independent factors and depression as dependent.

RESULTS

Results indicated a significant three-way interaction with highest depression scores in female patients showing high TS and high stress. Overall main effects for sex and stress indicated higher depression in women and in highly stressed patients.

CONCLUSION

Our findings support the hypothesis that TS heightens depressive mood under conditions of high cognitive load especially in female patients with SLBP indicating a special vulnerability for depressive mood in women with SLBP.

Measuring CTLA-4-Dependent Suppressive Function in Regulatory T Cells

Regulatory T cells (Treg) have a central role in controlling the activation of self-reactive T cells and maintaining peripheral tolerance in our body. Many effector mechanisms for Treg function have been described including a role for the protein CTLA-4 which is constitutively expressed by these cells. Despite its importance, there is currently little consensus in the methods and protocols for studying CTLA-4 function, which is partially due to debate over CTLA-4 function itself. In this chapter, we outline protocols used in our lab to study CTLA-4 function, which have been generated based on the observation that CTLA-4 acts to physically remove and degrade its ligands expressed by antigen presenting cells. Accordingly, we provide protocols for isolation of human monocytes and their differentiation into dendritic cells (DC), purification of conventional and regulatory T-cell populations, and the assembly of CTLA-4-dependent Treg suppression assays. We hope that this will offer a reliable platform for dissecting the biology of CTLA-4 on Treg and for testing reagents aimed at modulating CTLA-4 function. Such assays are increasingly vital for the study of immune function in both healthy individuals and patients with a variety of autoimmune and immune dysregulation syndromes.

Suppression resource decisions are the dominant influence on containment of Australian forest and grass fires

Fire agencies aim to contain wildfires before they impact on life, property and infrastructure and to reduce the risk of damage to the environment. Despite the large cost of suppression, there are few data on the success of suppression efforts under varying weather, fuel and resource scenarios. We examined over 2200 forest and 4600 grass fires in New South Wales, Australia to determine the dominant influences on the containment of wildfires. A random forest modelling approach was used to analyse the effect of a range of human and environmental factors. The number of suppression resources per area of fire were the dominant influence on the containment of both forest and grass fires. As fire weather conditions worsened the probability of containment decreased across all fires and as fuel loads and slope increased the probability of containment decreased for forest fires. Environmental controls limit the effectiveness of wildfire management. However, results suggest investment in suppression resources and strategic fuel management will increase the probability of containment.

Childhood maltreatment and perceived stress in young adults: The role of emotion regulation strategies, self-efficacy, and resilience

Childhood maltreatment has many deleterious outcomes; however, trait resilience as well as emotion regulation strategies, including suppression and reappraisal, may mediate between childhood maltreatment and later perceived stress. For this study, 267 college students (183 females and 84 males; M age = 19.77, SD = 2.29) completed self-report measures of parental psychological and physical maltreatment, parental emotion neglect, habitual use of suppression and reappraisal strategies, emotion regulation self-efficacy, trait resilience, and recent perceived stress. Analyses were conducted to investigate gender-specific associations. In females, both suppression and reappraisal mediated the relationship between maternal/paternal emotional neglect and perceived stress, and suppression also mediated the relationship between maternal psychological maltreatment and perceived stress. Trait resilience mediated the relationships of all three types of maternal maltreatment, paternal psychological maltreatment, and paternal emotional neglect with perceived stress in females. There were no significant mediation effects in males. Thus, interventions aiming at reducing perceived stress associated with maternal or paternal emotional neglect or maternal psychological maltreatment in women may benefit from targeting both suppression and reappraisal. Such interventions may also be enhanced by efforts to strengthen trait resilience.

Statistical regularities modulate attentional capture independent of search strategy

An earlier study using the additional singleton task showed that statistical regularities regarding the distractor location can cause an attentional bias that affects the amount of attentional capture by distractors and the efficiency of selection of targets. The distractor singleton was systematically present more often in one location than in all other locations. The present study investigated whether this bias also occurs when observers adopt a feature search mode, i.e., when they search for a specific feature (circle) between elements with different shapes, while ignoring a colored distractor singleton. It is assumed that in feature search, observers can ignore distractors in a top-down way and as such one expects that statistical regularities about the distractor location should not play a role. Contrary to this prediction, we found that even in feature search, both attentional capture by the distractors and the efficiency of selecting the target were impacted by these statistical regularities. Moreover, statistical regularities regarding the feature value of the distractor (its color) had no effect on the amount of capture or the efficiency of selection. We claim that statistical regularities cause passive lingering biases of attention such that on the priority map, the location containing a high probability distractor competes less for attention than locations that are less likely to contain distractors.

PHA eludes macrophage suppression to activate CD8+ T cells

Tumors may include a high proportion of immune modulatory cells and molecules that restrain the anti-cancer response. Activation of T cells to eliminate cancer cells within the immune-suppressive tumor microenvironment remains a challenge. We have shown that C57BL/6 J peritoneal cell culture models features of macrophage-dense tumors as TCR ligation fails to activate T cells unless IFNγ is neutralized or iNOS is inhibited. We tested other forms of T cell activation and found phytohemagglutinin (PHA) distinctive in the ability to markedly expand CD8 T cells in this model. IFNγ or iNOS inhibition was not necessary for this response. PHA triggered less IFNγ production and inhibitory PD-L1 expression than TCR ligation. Macrophages and CD44^hi T cells bound PHA. Spleen T cell responses to PHA were markedly enhanced by the addition of peritoneal cells revealing that macrophages enhance T cell expansion. That PHA increases CD8 T cell responses within macrophage-dense culture suggests this mitogen might enhance anti-tumor immunity.

New Insights Into the Biology of CD8 Regulatory T Cells

Regulatory T cells are central mediators of immune regulation and play an essential role in the maintenance of immune homeostasis in the steady state and under pathophysiological conditions. Disruption of CD8 Treg-dependent recognition of Qa-1-restricted self-antigens can result in dysregulated immune responses, tissue damage, autoimmune disease and cancer. Recent progress in studies on regulatory T cells of the CD8 lineage has provided new biological insight into this specialized regulatory T cell subpopulation. Identification of the Helios transcription factor as an essential control element for the differentiation and function of CD8 regulatory T cells has led to a better understanding of the unique genetic program of these cells. Recent analyses of T-cell receptor usage and antigen recognition by Qa-1-restricted CD8 Treg have provided additional insight into the unusual biological function of this regulatory CD8 lineage. Here we summarize recent advances in our understanding of CD8 regulatory T cells with emphasis on lineage commitment, differentiation and stability.

Distinctive tics suppression network in Gilles de la Tourette syndrome distinguished from suppression of natural urges using multimodal imaging

Background and objectives

Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder characterized by tics. A hallmark of GTS is the ability to voluntarily suppress tics. Our aim was to distinguish the neural circuits involved in the voluntary suppression of ocular tics in GTS patients from blink suppression in healthy subjects.

Methods

Fifteen GTS patients and 22 healthy control subjects were included in a multimodal study using eye-tracker recordings during functional MRI (fMRI). The ability to suppress tics/blinks was compared both on subjective (self-rating) and objective (eye-tracker) performance. For fMRI analysis we used a novel designed performance-adapted block design analysis of tic/blink suppression and release based on eye-tracker monitoring.

Results

We found that the subjective self-reported ability to suppress tics or blinks showed no significant correlation with objective task performance. In GTS during successful suppression of tics, the dorsal anterior cingulate cortex and associated limbic areas showed increased activation. During successful suppression of eye blinks in healthy subjects, the right ventrolateral prefrontal cortex and supplementary and cingulate motor areas showed increased activation.

Conclusions

These findings demonstrate that GTS patients use a characteristic limbic suppression strategy. In contrast, control subjects use the voluntary sensorimotor circuits and the classical ‘stop’ network to suppress natural urges. The employment of different neural suppression networks provides support for cognitive behavioral therapy in GTS.

•

Neural networks of tic suppression are specific and differ from blink suppression.

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Tourette patients employ a limbic suppression strategy to suppress tics.

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Controls use sensorimotor circuits and ‘stop’ networks for blink suppression.

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Objective task performance is highly recommended during functional MRI of tics.

Distraction-suppression effect on osteosarcoma

Osteosarcoma is the most common primary malignant bone tumor. It occurs mainly in children and adolescents. In patients with open growth plate, epiphyseal distraction is used to separate the uninvolved epiphysis from adjacent tumor. This helps preserve the growth potential and restore joint and limb function to a great extent. Interestingly, epiphyseal distraction also appears to inhibit the proliferation of osteosarcoma tumor cells and to increase sensitivity to chemotherapy. Tumor interstitial pressure (TIP) is often elevated in the microenvironment of most solid tumors, including osteosarcoma. Elevated TIP can promote the proliferation, invasion, and migration ability of osteosarcoma cells and also decrease the uptake and distribution of chemotherapeutic agents. Studies have confirmed that the sustained volumetric strain produced in distracted tissue decreases TIP; it stretches extracellular matrix, decreases interstitial density, and increases vessel diameter. We hypothesize that lowering of TIP during the period of epiphyseal distraction inhibits the proliferation and invasion of osteosarcoma cell and, at the same time, increases blood perfusion in the tumor and thus enhances uptake and distribution of chemotherapy agents. If the hypothesis is proved to be true, distraction of tumor segment could be a novel supplementary treatment for osteosarcoma by manipulation of TIP.

Systematic re-evaluation of intraoperative motor-evoked potential suppression in scoliosis surgery

Background

Motor- (MEP) and somatosensory-evoked potentials (SSEP) are susceptible to the effects of intraoperative environmental factors.

Methods

Over a 5-year period, 250 patients with adolescent idiopathic scoliosis (AIS) who underwent corrective surgery with IOM were retrospectively analyzed for MEP suppression (MEPS).

Results

Our results show that four distinct groups of MEPS were encountered over the study period. All 12 patients did not sustain any neurological deficits postoperatively. However, comparison of groups 1 and 2 suggests that neither the duration of anesthesia nor speed of surgical or anesthetic intervention were associated with recovery to a level beyond the criteria for MEPS. For group 3, spontaneous MEPS recovery despite the lack of surgical intervention suggests that anesthetic intervention may play a role in this process. However, spontaneous MEPS recovery was also seen in group 4, suggesting that in certain circumstances, both surgical and anesthetic intervention was not required. In addition, neither the duration of time to the first surgical manoeuver nor the duration of surgical manoeuver to MEPS were related to recovery of MEPS. None of the patients had suppression of SSEPs intraoperatively.

Conclusion

This study suggests that in susceptible individuals, MEPS may rarely occur unpredictably, independent of surgical or anesthetic intervention. However, our findings favor anesthetic before surgical intervention as a proposed protocol. Early recognition of MEPS is important to prevent false positives in the course of IOM for spinal surgery.

Challenging surgical dogma in the management of proximal esophageal atresia with distal tracheoesophageal fistula: Outcomes from the Midwest Pediatric Surgery Consortium

PURPOSE

Perioperative management of infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) is frequently based on surgeon experience and dogma rather than evidence-based guidelines. This study examines whether commonly perceived important aspects of practice affect outcome in a contemporary multi-institutional cohort of patients undergoing primary repair for the most common type of esophageal atresia anomaly, proximal EA with distal TEF.

METHODS

The Midwest Pediatric Surgery Consortium conducted a multicenter, retrospective study examining selected outcomes on infants diagnosed with proximal EA with distal TEF who underwent primary repair over a 5-year period (2009-2014), with a minimum 1-year follow up, across 11 centers.

RESULTS

292 patients with proximal EA and distal TEF who underwent primary repair were reviewed. The overall mortality was 6% and was significantly associated with the presence of congenital heart disease (OR 4.82, p=0.005). Postoperative complications occurred in 181 (62%) infants, including: anastomotic stricture requiring intervention (n=127; 43%); anastomotic leak (n=54; 18%); recurrent fistula (n=15; 5%); vocal cord paralysis/paresis (n=14; 5%); and esophageal dehiscence (n=5; 2%). Placement of a transanastomotic tube was associated with an increase in esophageal stricture formation (OR 2.2, p=0.01). Acid suppression was not associated with altered rates of stricture, leak or pneumonia (all p>0.1). Placement of interposing prosthetic material between the esophageal and tracheal suture lines was associated with an increased leak rate (OR 4.7, p<0.001), but no difference in the incidence of recurrent fistula (p=0.3). Empiric postoperative antibiotics for >24h were used in 193 patients (66%) with no difference in rates of infection, shock or death when compared to antibiotic use ≤24h (all p>0.3). Hospital volume was not associated with postoperative complication rates (p>0.08). Routine postoperative esophagram obtained on day 5 resulted in no delayed/missed anastomotic leaks or a difference in anastomotic leak rate as compared to esophagrams obtained on day 7.

CONCLUSION

Morbidity after primary repair of proximal EA and distal TEF patients is substantial, and many common practices do not appear to reduce complications. Specifically, this large retrospective series does not support the use of prophylactic antibiotics beyond 24h and empiric acid suppression may not prevent complications. Use of a transanastomotic tube was associated with higher rates of stricture, and interposition of prosthetic material was associated with higher leak rates. Routine postoperative esophagram can be safely obtained on day 5 resulting in earlier initiation of oral feeds.

STUDY TYPE

Treatment study.

LEVEL OF EVIDENCE

III.

Binocular vision adaptively suppresses delayed monocular signals

A neutral density filter placed before one eye will produce a dichoptic imbalance in luminance, which attenuates responses to visual stimuli and lags neural signals from retina to cortex in the filtered eye. When stimuli are presented to both the filtered and unfiltered eye (i.e., binocularly), neural responses show little attenuation and no lag compared with their baseline counterpart. This suggests that binocular visual mechanisms must suppress the attenuated and delayed input from the filtered eye; however, the mechanisms involved remain unclear. Here, we used a Steady-State Visual Evoked Potential (SSVEP) technique to measure neural responses to monocularly and binocularly presented stimuli while observers wore an ND filter in front of their dominant eye. These data were well-described by a binocular summation model, which received the sinusoidal contrast modulation of the stimulus as input. We incorporated the influence of the ND filter with an impulse response function, which adjusted the input magnitude and phase in a biophysically plausible manner. The model captured the increase in attenuation and lag of neural signals for stimuli presented to the filtered eye as a function of filter strength, while also generating the filter phase-invariant responses from binocular presentation for EEG and psychophysical data. These results clarify how binocular visual mechanisms-specifically interocular suppression-can suppress the delayed and attenuated signals from the filtered eye and maintain normal neural signals under imbalanced luminance conditions.