Abstract 4822: Immunophenotyping circulating tumor cells in patients with unknown primary

Metastasis is responsible for the majority of cancer-related deaths. A limiting step in metastasis is access to circulation, thus circulating tumor cells (CTCs) should be present in all patients with metastatic tumors, which may have both diagnostic and prognostic value. Accounting for only 3-5%, carcinoma of unknown primary (CUP) presents a challenge for clinicians in diagnosis and therapy. In 20 to 50% of CUP patients, the primary remains undiagnosed even after a full diagnostic work up. Tissue biopsy is the standard for diagnosis but there is need for improved methodology, including a non-invasive blood test that relies on CTC analysis. Our overall objective is to utilize CTCs to provide insight into systemic cancer progression and approaches to therapy, including a CTC blood test as a tool for diagnosis, prognosis and therapy. We hypothesize that real-time, single-cell immunophenotype profiling of CTC populations will inform diagnosis of tissue of origin, reveal prognostic markers such as stem-like properties and predict tumor aggressiveness. We have been developing a post-Veridex CTC analysis method using multiplexed Q-dot conjugated antibodies with the goal of detecting multiple markers in each single cell within a CTC population to aid in CUP diagnosis including tissue of origin. We have adapted this method for use in CTCs captured using the flexible micro spring array (FMSA) size-based CTC enrichment protocol and other approaches for capturing and immunophenotyping live CTCs. Further adaptation of this protocol enables the use of Dye-Light conjugated primary antibodies. For carcinomas we use cytokeratin 7 (CK7), cytokeratin 20 (CK20), thyroid transcription factor (TTF-1), estrogen receptor (ER; for female patients) and prostate specific antigen (PSA; for male patients) as a minimal set of markers for the identification of lung, colon, prostate and breast cancer. Successful validation of antibodies to these five markers has enabled multiplexing after DyLight conjugation in positive and negative cell lines. This approach is currently being tested in CTCs from patients and is being expanded to understand the biology of CTCs through an evaluation of EMT and stem cell markers. Successful application of our CTC-CUP protocol to CTCs in patient samples is expected to provide a noninvasive, relatively quick and inexpensive blood test that can be both diagnostic and prognostic, which may be a valuable adjunct to routine biopsy. Circulating tumor cells may provide insight into the mechanism of systemic cancer progression, the characteristics of metastatic founder cells and changes within these cells as cancer progresses, thereby impacting the efficacy and evaluation of cancer therapy.

Citation Format: Elizabeth M. Matthew, Lanlan Zhou, Bora Lim, Nicholas E. Lamparella, David T. Dicker, Jean-Nicolas Gallant, Monika Joshi, Sheldon L. Holder, Ramdane Harouaka, Siyang Zheng, Joseph J. Drabick, Cristina I. Truica, Zhaohai Yang, Wafik S. El-Deiry. Immunophenotyping circulating tumor cells in patients with unknown primary. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4822. doi:10.1158/1538-7445.AM2014-4822

Study of indoor radon distribution using measurements and CFD modeling

Measurement and/or prediction of indoor radon ((222)Rn) concentration are important due to the impact of radon on indoor air quality and consequent inhalation hazard. In recent times, computational fluid dynamics (CFD) based modeling has become the cost effective replacement of experimental methods for the prediction and visualization of indoor pollutant distribution. The aim of this study is to implement CFD based modeling for studying indoor radon gas distribution. This study focuses on comparison of experimentally measured and CFD modeling predicted spatial distribution of radon concentration for a model test room. The key inputs for simulation viz. radon exhalation rate and ventilation rate were measured as a part of this study. Validation experiments were performed by measuring radon concentration at different locations of test room using active (continuous radon monitor) and passive (pin-hole dosimeters) techniques. Modeling predictions have been found to be reasonably matching with the measurement results. The validated model can be used to understand and study factors affecting indoor radon distribution for more realistic indoor environment.

CFD based simulation of thoron ((220)Rn) concentration in a delay chamber for mitigation application

The release of (220)Rn gas (conventionally referred to as thoron) is an issue of concern from the radiological point of view for occupational environments pertaining to the thorium fuel cycle. Studies for understanding its release and developing systems to control it are crucial for exposure control research. A thorough study of the "Delay Volume Technique" for mitigation of (220)Rn has been carried out. Experiments have been carried out with (220)Rn source and associated measurement system in a cubical chamber (delay chamber) of 0.5 m(3) volume. For different flow conditions and inlet-outlet positions, (220)Rn transmission factor has been obtained. Computational Fluid Dynamics (CFD) technique has been employed for these experimental conditions and the simulated transmission factors have been compared. The results show that the flow and the position of the inlet and outlet play an imperative role in the transportation, mixing and subsequent mitigation of thoron inside the chamber. Predictive capability of CFD technique for such delay volume experiments has been validated in this work. A comparison has been made with uniform mixing model and it is found that the results of simulation differ appreciably from that of uniform mixing model at the tested flow regime.

OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder

INTRODUCTION

A prespecified pooled analysis of two placebo-controlled, phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder (OAB) patients with urinary incontinence (UI).

METHODS

Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo, sparing the trigone. Change from baseline at week 12 in UI episodes/day, proportion of patients reporting a positive response ('greatly improved' or 'improved') on the treatment benefit scale (TBS), micturition and urgency were evaluated by number of prior anticholinergics (1, 2 or ≥ 3) and reason for their discontinuation (insufficient efficacy or side effects). Adverse events (AE) were assessed.

RESULTS

Patients had taken an average of 2.4 anticholinergics before study enrolment. OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo, regardless of the number of prior anticholinergics (-2.82 vs. -1.52 for one prior anticholinergic; -2.58 vs. -0.58 for two prior anticholinergics; and -2.92 vs. -0.73 for three or more prior anticholinergics; all p < 0.001). The proportion of TBS responders was higher with onabotulinumtoxinA vs. placebo (69.0% vs. 37.2% for one prior anticholinergic; 58.8% vs. 24.8% for two prior anticholinergics and 56.4% vs. 22.5% for three or more prior anticholinergics; all p < 0.001). Similar results were observed regardless of the reason for discontinuation. OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups. AEs were well tolerated, with a comparable incidence in all groups.

CONCLUSION

In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics, onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB. ClinicalTrials.gov: NCT00910845, NCT00910520.

Educational barriers of nurses caring for sick and at-risk infants in India

AIM

To gain ideas and information from healthcare providers to optimize the education and clinical practices of nurses caring for sick or at-risk newborns in India.

BACKGROUND

Improving infant survival has been identified as a Millennium Development Goals; however, India still faces many challenges with 3.1 million neonatal deaths and 2.6 million stillbirths annually. Skilled nursing care has been associated with decreased morbidity and mortality in newborns. However, core competencies in newborn care education and training are lacking for nurses.

METHODS

Qualitative data were collected from 12 focus groups with 101 newborn care providers from three areas of India as well as from a 2-day stakeholders' meeting. Data analysis was undertaken using descriptive and thematic content analysis.

RESULTS

Perceived challenges included limited manpower and high nurse turnover, lack of access to evidence-based orientation to newborn care and problems with access to appropriate learner-based, neonatal training. Relevant, ongoing education opportunities, led by nursing leaders were identified to be important solutions.

CONCLUSION

Findings provide insight into the current healthcare system in India with specific reference to the nursing care of at-risk newborns. There is a lack of existing resources to provide standardized and specific orientation curricula for nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policy makers in health and education need to: support and enact learner-based orientation and continuing educational opportunities as well as ongoing competency-based education programmes; encourage nurse leader involvement and support; and provide sustainable system-related supports. Nurses and other health providers need to work together to influence government policy.

The importance of planetary rotation period for ocean heat transport

The climate and, hence, potential habitability of a planet crucially depends on how its atmospheric and ocean circulation transports heat from warmer to cooler regions. However, previous studies of planetary climate have concentrated on modeling the dynamics of atmospheres, while dramatically simplifying the treatment of oceans, which neglects or misrepresents the effect of the ocean in the total heat transport. Even the majority of studies with a dynamic ocean have used a simple so-called aquaplanet that has no continental barriers, which is a configuration that dramatically changes the ocean dynamics. Here, the significance of the response of poleward ocean heat transport to planetary rotation period is shown with a simple meridional barrier--the simplest representation of any continental configuration. The poleward ocean heat transport increases significantly as the planetary rotation period is increased. The peak heat transport more than doubles when the rotation period is increased by a factor of ten. There are also significant changes to ocean temperature at depth, with implications for the carbon cycle. There is strong agreement between the model results and a scale analysis of the governing equations. This result highlights the importance of both planetary rotation period and the ocean circulation when considering planetary habitability.

KIF14 binds tightly to microtubules and adopts a rigor-like conformation

The mitotic kinesin motor protein KIF14 is essential for cytokinesis during cell division and has been implicated in cerebral development and a variety of human cancers. Here we show that the mouse KIF14 motor domain binds tightly to microtubules and does not display typical nucleotide-dependent changes in this affinity. It also has robust ATPase activity but very slow motility. A crystal structure of the ADP-bound form of the KIF14 motor domain reveals a dramatically opened ATP-binding pocket, as if ready to exchange its bound ADP for Mg·ATP. In this state, the central β-sheet is twisted ~10° beyond the maximal amount observed in other kinesins. This configuration has only been seen in the nucleotide-free states of myosins-known as the "rigor-like" state. Fitting of this atomic model to electron density maps from cryo-electron microscopy indicates a distinct binding configuration of the motor domain to microtubules. We postulate that these properties of KIF14 are well suited for stabilizing midbody microtubules during cytokinesis.

Heat-Induced Changes in the Photochemical Centres and the Protein Secondary Structures of Photosystem II Studied by Variable Fluorescence and Difference FT-IR Spectroscopy

Variable fluorescence (Fv), i.e., Fv = Fm - F0 where F0 is the minimal fluorescence and Fm the maximum fluorescence, and difference Fourier transform infrared (FT-IR) spectroscopy were used to study the effect of heat stress in the 25-55 °C range on photosystem II (PSII) structure and function. First, the Fv intensity reflects accurately the changes in the number of open photochemical centers in PSII. Secondly, the use of Fv in combination with FT-IR spectroscopy can disclose structure-function correlations in the heat inactivation of the PSII complex. Analysis of the midpoint temperatures of thermal denaturation, i.e., 50% inactivation, reported so far in investigations of the thylakoid membrane components has revealed that most of the thermal transitions attributed to PSII are in the 39 -46 °C range. In this work, it is shown specifically that the midpoint temperature of PSII inactivation is at about 40 °C. Moreover, it was clearly demonstrated that the heat-induced changes above 40 °C are the result of a marked decrease in the number of open photochemical centers in PSII. It was also seen that above this same temperature the loss of photochemical centers has its structural counterpart in overall modifications of the secondary structures of the PSII proteins resulting from the decrease in the α-helix content concomitant with the increase in extended chain (β-strand) conformations. In brief, a novel finding reported here is that the number of open photochemical centers in PSII is dependent on a dynamic equilibrium between the contents of the PSII proteins in α-helix and extended chains (β-strands), but not in β-sheets and β-turn structures except for the antiparallel-β-sheet conformations. This therefore associates the thermal inactivation of the photochemical centers in photosystem II with distinct conformational changes in the proteins of the PSII supramolecular complex. In the particular context of the present study, these findings constitute a significant contribution to the investigation of structure-function correlations in the photosynthetic membrane. In a broader context, this information might be essential for the comprehension of the molecular arrangements or local structure order that are involved directly or indirectly in biological catalysis

NPHP3 mutations are associated with neonatal onset multiorgan polycystic disease in two siblings

Two siblings with a severe multiorgan polycystic disease presenting in the neonatal period were identified. Their genetic testing identified compound heterozygous NPHP3 gene mutations, parents being heterozygous carriers. The mutations included a splice-site (c.958-2A>G) and a missense mutation (c.2342G>A; p.G781D), both being extremely rare. NPHP3 encodes for nephrocystin 3 present on the cilia-centrosome complex. We hypothesize that these mutations lead to defective cilia-based signaling, required for normal development of the renal, pancreatic, biliary and portal system. This report outlines a rare neonatal ciliopathy presentation of NPHP3 mutations leading to severe multiorgan failure in two siblings.

Kar3Vik1 mechanochemistry is inhibited by mutation or deletion of the C terminus of the Vik1 subunit

Force production by kinesins has been linked to structural rearrangements of the N and C termini of their motor domain upon nucleotide binding. In recent crystal structures, the Kar3-associated protein Vik1 shows unexpected homology to these conformational states even though it lacks a nucleotide-binding site. This conservation infers a degree of commonality in the function of the N- and C-terminal regions during the mechanochemical cycle of all kinesins and kinesin-related proteins. We tested this inference by examining the functional effects on Kar3Vik1 of mutating or deleting residues in Vik1 that are involved in stabilizing the C terminus against the core and N terminus of the Vik1 motor homology domain (MHD). Point mutations at two moderately conserved residues near the Vik1 C terminus impaired microtubule gliding and microtubule-stimulated ATP turnover by Kar3Vik1. Deletion of the seven C-terminal residues inhibited Kar3Vik1 motility much more drastically. Interestingly, none of the point mutants seemed to perturb the ability of Kar3Vik1 to bind microtubules, whereas the C-terminal truncation mutant did. Molecular dynamics simulations of these C-terminal mutants showed distinct root mean square fluctuations in the N-terminal region of the Vik1 MHD that connects it to Kar3. Here, the degree of motion in the N-terminal portion of Vik1 highly correlated with that in the C terminus. These observations suggest that the N and C termini of the Vik1 MHD form a discrete folding motif that is part of a communication pathway to the nucleotide-binding site of Kar3.

Communication between radial nerve and medial cutaneous nerve of forearm

Radial nerve is usually a branch of the posterior cord of the brachial plexus. It innervates triceps, anconeous, brachialis, brachioradialis, extensor carpi radialis longus muscles and gives the posterior cutaneous nerve of the arm, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of forearm; without exhibiting any communication with the medial cutaneous nerve of forearm or any other nerve. We report communication between the radial nerve and medial cutaneous nerve of forearm on the left side in a 58-year-old male cadaver. The right sided structures were found to be normal. Neurosurgeons should keep such variations in mind while performing the surgeries of axilla and upper arm.

Inca - interparietal bones in neurocranium of human skulls in central India

Inca bones are accessory bones found in neurocranium of human skulls. Occurrence of Inca bones is rare as compared to other inter sutural bones such as wormian bones. These Inca ossicles are regarded as variants of the normal. The reporting of such occurrences is inadequate from Central India.

Objectives:

To find the incidence of Inca variants in Central India.

Materials and Methods:

In the present study, 380 dried adult human skulls were examined. All specimen samples were procured from various Medical colleges of Central India. They were analyzed for gross incidence, sexual dimorphism and number of fragments of Inca bones.

Results:

Gross incidence of Inca bones was found to be 1.315 %. Incidence rate was higher in male skulls than female skulls (male: 1.428%; female: 1.176%). The Inca bones frequently occurred signally. Out of the five observed Inca ossicles, two were fragmented.

Conclusions:

This data gives idea regarding gross incidence, sexual dimorphism and number of fragments of Inca bones in neurocranium of human skulls from Central India. The knowledge of this variable is useful for neurosurgeons, anthropologists and radiologists.

High-resolution structure of the Tiam1 PHn-CC-Ex domain

The T-lymphoma and metastasis gene 1 (TIAM1) encodes a guanine nucleotide-exchange factor protein (Tiam1) that is specific for the Rho-family GTPase Rac1 and is important for cell polarity, migration and adhesion. Tiam1 is a large multi-domain protein that contains several protein-protein binding domains that are important for regulating cellular function. The PHn-CC-Ex domain is critical for plasma-membrane association and interactions with protein-scaffold proteins (e.g. Par3b, spinophilin, IRSp53 and JIP2) that direct Tiam1-Rac1 signaling specificity. It was determined that the coiled-coil domain of Par3b binds the PHn-CC-Ex domain with a dissociation constant of ≈ 30 µM. Moreover, the structures of two variants of the Tiam1 PHn-CC-Ex domain were solved at resolutions of 1.98 and 2.15 Å, respectively. The structures indicate that the PHn, CC and Ex regions form independent subdomains that together provide an integrated platform for binding partner proteins. Small-angle X-ray scattering (SAXS) data indicate that the Tiam1 PHn-CC-Ex domain is monomeric in solution and that the solution and crystal structures are very similar. Together, these data provide the foundation necessary to elucidate the structural mechanism of the PHn-CC-Ex/scaffold interactions that are critical for Tiam1-Rac1 signaling specificity.

A novel pathway spatiotemporally activates Rac1 and redox signaling in response to fluid shear stress

The GEF Tiam1 acts as a novel molecular link to the VE-cadherin–p67phox–Par3 polarity complex, leading to localized activation of Rac1 and NADPH oxidase in response to fluid flow.

Hemodynamic forces regulate embryonic organ development, hematopoiesis, vascular remodeling, and atherogenesis. The mechanosensory stimulus of blood flow initiates a complex network of intracellular pathways, including activation of Rac1 GTPase, establishment of endothelial cell (EC) polarity, and redox signaling. The activity of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase can be modulated by the GTP/GDP state of Rac1; however, the molecular mechanisms of Rac1 activation by flow are poorly understood. Here, we identify a novel polarity complex that directs localized Rac1 activation required for downstream reactive oxygen species (ROS) production. Vav2 is required for Rac1 GTP loading, whereas, surprisingly, Tiam1 functions as an adaptor in a VE-cadherin–p67phox–Par3 polarity complex that directs localized activation of Rac1. Furthermore, loss of Tiam1 led to the disruption of redox signaling both in vitro and in vivo. Our results describe a novel molecular cascade that regulates redox signaling by the coordinated regulation of Rac1 and by linking components of the polarity complex to the NADPH oxidase.

Transmission and reflection of the fundamental Lamb modes in a metallic plate with a semi-infinite horizontal crack

Numerical simulations were carried out to quantify the reflection and transmission characteristics of the fundamental Lamb modes propagating in aluminium sub-plates, which are formed due to a semi-infinite horizontal crack. It was observed that, a Lamb mode propagating in a sub-plate when incident at the edge of a crack, undergoes reflection and transmits through the main plate, as well as the other sub-plate. The mode transmitted through the sub-plate has been termed the 'Turning Lamb Mode' (TLM). Furthermore, a mode converted mode also propagates along with the TLM. This mode has been termed the 'Mode Converted Turning Lamb Mode' (MCTLM). Reflection and transmission characteristics of the fundamental Lamb modes in aluminium sub-plates were studied at frequencies 150 kHz, 175 kHz, and 200 kHz. Experiments conducted to validate the observations made in numerical simulations, confirmed that the transmission and reflection characteristics depend on the thickness ratio. From this study it is surmised that when a Lamb mode propagates through a plate containing horizontal crack, the TLM and the MCTLM start propagating from one sub-plate to the other at the rear edge of the crack and amplitude of these modes depends on the location of the crack across the plate thickness.

The utility of periodic acid schiff with diastase and alcian blue stains on fine needle aspirates of breast and salivary gland neoplasms

Background:

Fine needle aspiration cytology (FNAC) is extensively used in the diagnosis of various clinically palpable lesions of breast and salivary glands. Much interest has been gained in mucosubstances produced in tumors arising from these organs.

Aims:

To evaluate the utility of Periodic acid Schiff with diastase (PAS-D) and Alcian blue (AB) staining pattern on fine needle aspirates of breast and salivary gland neoplasms.

Materials and Methods:

Seventy-five cases of different neoplasm of breast and salivary gland were studied. The staining pattern of PAS-D and AB stains on smears of these neoplasm were observed.

Results:

Among cases of neoplasms of breast, intracytoplasmic PAS-D positive globules were restricted to carcinoma except in one case where PAS-D-positive globules were seen in fibroadenoma. The background substance of both mucinous carcinoma and fibroadenoma with myxoid change stained positive with PAS-D, but the pattern was different. The cases of pleomorphic adenoma and mucoepidermoid carcinoma of salivary gland showed intracytoplasmic PAS-D-positive globules. The cases of pleomorphic adenoma showed stromal positivity which was not seen in basal cell adenoma on smears.

Conclusion:

Intracytoplasmic PAS-D-positive globules may be useful in differentiating benign and malignant lesions of breast. The presence of PAS-D positive granules are useful in differentiating various lesions of salivary glands. AB staining of stromal fragments in pleomorphic adenoma is useful in differentiating it from basal cell adenoma.

Small-cell lung cancer: an update on targeted therapies

Lung cancer is the leading cause of cancer-related deaths world-wide and small-cell lung cancer (SCLC) accounts for up to 25% of lung cancer deaths. There has been a considerable amount of research in the understanding of the depth of biology of SCLC and utilizing this knowledge to develop targeted approaches. The treatment of SCLC remains a challenge, despite remarkable initial efficacy to combination chemotherapy and radiation therapy. The response is usually short-lived and the prognosis of SCLC has not changed over the past few decades, necessitating the critical need for evaluating novel agents/therapies. Several signaling pathways have been found to be activated in SCLC tumor cells, forming a rationale for blocking some of the drugable targets. Molecular changes and biological markers have been identified but remain to be validated. Novel and targeted agents have been evaluated but without much success. Increasing understanding of the biology and potential clinical evaluation of biomarkers will pave the way for more effective treatments.