Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes

BACKGROUND

Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes.

METHODS

Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics.

RESULTS

Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified.

CONCLUSIONS

Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.

Deletion of NADPH oxidase 2 in chondrocytes exacerbates ethanol-mediated growth plate disruption in mice without major effects on bone architecture or gene expression

BACKGROUND

Excess reactive oxygen species generated by NADPH oxidase 2 (Nox2) in response to ethanol exposure mediate aspects of skeletal toxicity including increased osteoclast differentiation and activity. Because perturbation of chondrocyte differentiation in the growth plate by ethanol could be prevented by dietary antioxidants, we hypothesized that Nox2 in the growth plate was involved in ethanol-associated reductions in longitudinal bone growth.

METHODS

Nox2 conditional knockout mice were generated, where the essential catalytic subunit of Nox2, cytochrome B-245 beta chain (Cybb), is deleted in chondrocytes using a Cre-Lox model with Cre expressed from the collagen 2a1 promoter (Col2a1-Cre). Wild-type and Cre-Lox mice were fed an ethanol Lieber-DeCarli-based diet or pair-fed a control diet for 8 weeks.

RESULTS

Ethanol treatment significantly reduced the number of proliferating chondrocytes in the growth plate, enhanced bone marrow adiposity, shortened femurs, reduced body length, reduced cortical bone volume, and decreased mRNA levels of a number of osteoblast and chondrocyte genes. Conditional knockout of Nox2 enzymatic activity in chondrocytes did not consistently prevent any ethanol effects. Rather, knockout mice had fewer proliferating chondrocytes than wild-type mice in both the ethanol- and control-fed animals. Additional analysis of tibia samples from Nox4 knockout mice showed that loss of Nox4 activity also reduced the number of proliferating chondrocytes and altered chondrocyte size in the growth plate.

CONCLUSIONS

Although Nox enzymatic activity regulates growth plate development, ethanol-associated disruption of the growth plate morphology is independent of ethanol-mediated increases in Nox2 activity.

Geometric and topological approaches to shape variation in Ginkgo leaves

Leaf shape is a key plant trait that varies enormously. The range of applications for data on this trait requires frequent methodological development so that researchers have an up-to-date toolkit with which to quantify leaf shape. We generated a dataset of 468 leaves produced by Ginkgo biloba, and 24 fossil leaves produced by evolutionary relatives of extant Ginkgo. We quantified the shape of each leaf by developing a geometric method based on elastic curves and a topological method based on persistent homology. Our geometric method indicates that shape variation in modern leaves is dominated by leaf size, furrow depth and the angle of the two lobes at the leaf base that is also related to leaf width. Our topological method indicates that shape variation in modern leaves is dominated by leaf size and furrow depth. We have applied both methods to modern and fossil material: the methods are complementary, identifying similar primary patterns of variation, but also revealing different aspects of morphological variation. Our topological approach distinguishes long-shoot leaves from short-shoot leaves, both methods indicate that leaf shape influences or is at least related to leaf area, and both could be applied in palaeoclimatic and evolutionary studies of leaf shape.

[Predictive value of quantitative electroencephalogram in the poor outcome of children with non-traumatic disturbance of consciousness in pediatric intensive care unit]

Objective: To explore the predictive value of quantitative electroencephalogram (qEEG) in the poor outcome of children with non-traumatic disturbance of consciousness (DoC) in the pediatric intensive care unit (PICU). Methods: A prospective study was conducted. From January 2019 to May 2019, a total of 62 patients aged from 1 month to 11 years with non-traumatic DoC in the PICU of the First Affiliated Hospital of Bengbu Medical College were enrolled. Bedside monitoring with NicoletOne monitor was performed within 24 hours after admission, and qEEG parameters, including amplitude-integrated electroencephalogram (aEEG), relative alpha variability (RAV), relative band power (RBP), and spectral entropy (SE) were recorded. The state of consciousness was assessed with modified pediatric Glasgow coma scale (MPGCS) before monitoring. According to the pediatric cerebral performance category score at 1 year after discharge, the enrolled subjects were divided into good and poor outcome groups. The association between these variables and the poor outcome was analyzed by univariate and multivariate logistic regression analysis, and the predictive performance was analyzed by receiver operator characteristic (ROC) curve. Results: There were 39 males and 23 females, with the age of 12.0 (5.8, 24.0) months. Fifty patients (81%) were in the good outcome group and 12 patients (19%) in the poor outcome group. The univariate Logistic regression analysis showed that age (OR=1.037, 95%CI 1.001-1.074, P=0.041), severe abnormal aEEG (OR=128.000, 95%CI 10.274-1 594.656, P<0.01), RAV (OR=0.877, 95%CI 0.810-0.949, P=0.001), SE (OR=0.892, 95%CI 0.814-0.978, P=0.015), and MPGCS score (OR=0.511, 95%CI 0.349-0.747, P=0.001) were significantly associated with the poor outcome. However, the multivariate Logistic regression analysis showed that only severe abnormal aEEG (OR=315.692, 95%CI 6.091-16 362.298, P=0.004) and RAV (OR=0.808, 95%CI 0.664-0.983, P=0.033) were significantly associated with the poor outcome. The area under the curve (AUC) of the aEEG and RAV in predicting the poor outcome were 0.848 (95%CI 0.735-0.927, P<0.01) and 0.847 (95%CI 0.733-0.926, P<0.01), respectively. The optimal cut-off value was severe abnormal for the aEEG and 38% for the RAV, with sensitivity of 67% and 83%, specificity of 98% and 84%, positive predictive value of 89% and 55%, negative predictive value of 92% and 95%, and Youden index of 0.647 and 0.673, respectively. The AUC of the novel combined index of aEEG and RAV for predicting the poor outcome was 0.974 (95%CI 0.898-0.998, P<0.01). Conclusions: The aEEG and RAV are reliable predictors for the poor outcome of children with non-traumatic DoC, and the novel combined index of aEEG and RAV can improve the predictive performance. The qEEG can be used as a routine method for outcome assessment due to its good objectivity.

[Extraction of the antioxidative substances from Chinese rose and its antioxidative effect on lard]

The antioxidative effect of extracts from Chinese rose was measured with Na2S2O3-I2 titrimetric method by using lard as substrates. It was found that the antioxidative activities of the Chinese rose extracts retrieved by 95% ethanol solution were the highest, and the activities were strengthened with the increase of dosage. Citric acid and amino acid showed synergistic effects in antioxidative activities with extracts of Chinese rose. Ascorbic acid and alpha-tocophrol also showed strong synergistic antioxidative effect with the extracts of Chinese rose. The combined antioxidative activities were higher than the activity of tea polyphenols, and almost as good as that of tertiary butyl P-dihydroxy bengene(TBHQ).

PCNA interacts with hHus1/hRad9 in response to DNA damage and replication inhibition

The hHus1 and several hRad proteins are involved in the control of DNA integrity checkpoints, although the mechanisms underlying these processes are unknown. Using a yeast two-hybrid system to detect protein-protein interactions, we found that human proliferating cell nuclear antigen (PCNA), a protein known to function in both DNA replication and repair, interacts with the human checkpoint-related protein Hus1 (hHus1). In human skin fibroblast cells, exposure to ionizing radiation of hydroxyurea triggers translocation of hHus1 from the cytosol to the nucleus, where it associates with PCNA as well as another checkpoint protein, hRad9. This nuclear translocation and the complex formation or hHus1 with PCNA and hRad9 correlate closely with changes in cell cycle distribution in response to radiation exposure. These results suggest that this multi-protein complex may be important for coordinating cell-cycle progression, DNA replication and repair of damaged DNA.

Mutant alleles of Schizosaccharomyces pombe rad9(+) alter hydroxyurea resistance, radioresistance and checkpoint control

Schizosaccharomyces pombe rad9 mutations can render cells sensitive to hydroxyurea (HU), gamma-rays and UV light and eliminate associated checkpoint controls. In vitro mutagenesis was performed on S.pombe rad9 and altered alleles were transplaced into the genome to ascertain the functional significance of five groups of evolutionarily conserved amino acids. Most targeted regions were changed to alanines, whereas rad9-S3 encodes a protein devoid of 22 amino acids normally present in yeast but absent from mammalian Rad9 proteins. We examined whether these rad9 alleles confer radiation and HU sensitivity and whether the sensitivities correlate with checkpoint control deficiencies. One rad9 mutant allele was fully active, whereas four others demonstrated partial loss of function. rad9-S1, which contains alterations in a BH3-like domain, conferred HU resistance but increased sensitivity to gamma-rays and UV light, without affecting checkpoint controls. rad9-S2 reduced gamma-ray sensitivity marginally, without altering other phenotypes. Two alleles, rad9-S4 and rad9-S5, reduced HU sensitivity, radiosensitivity and caused aberrant checkpoint function. HU-induced checkpoint control could not be uncoupled from drug resistance. These results establish unique as well as overlapping functional domains within Rad9p and provide evidence that requirements of the protein for promoting resistance to radiation and HU are not identical.

Physical interactions among human checkpoint control proteins HUS1p, RAD1p, and RAD9p, and implications for the regulation of cell cycle progression

Schizosaccharomyces pombe hus1 promotes radioresistance and hydroxyurea resistance, as well as S and G2 phase checkpoint control. We isolated a human cDNA homologous to hus1, called HUS1. The major focus of this report is on a detailed analysis of the physical interactions of the HUS1-encoded protein and two other checkpoint control proteins, RAD1p and RAD9p, implicated in the cellular response to DNA damage. We found that HUS1p interacts with itself and the N-terminal region of RAD1p. In contrast, the C-terminal portion of the checkpoint protein RAD9p is essential for interacting with HUS1p and the C-terminal region of RAD1p. Since the N-terminal portion of RAD9p was previously demonstrated to participate in apoptosis, this protein likely has at least two functional domains, one that regulates programmed cell death and another that regulates cell cycle checkpoint control. Truncated versions of HUS1p are unable to bind RAD1p, RAD9p, or another HUS1p molecule. RAD1p-RAD1p and RAD9p-RAD9p interactions can be demonstrated by coimmunoprecipitation, but not by two-hybrid analysis, suggesting that the proteins associate as part of a complex but do not interact directly. Northern blot analysis indicates that HUS1 is expressed in different tissues, but the mRNA is most predominant in testis where high levels of RAD1 and RAD9 message have been detected. These studies suggest that HUS1p, RAD9p, and RAD1p form a complex in human cells and may function in a meiotic checkpoint in addition to the cell cycle delays induced by incomplete DNA replication or DNA damage.

Human homologue of S. pombe Rad9 interacts with BCL-2/BCL-xL and promotes apoptosis

DNA damage induces apoptosis through a signalling pathway that can be suppressed by the BCL-2 protein, but the mechanism by which DNA damage does this is unknown. Here, using yeast two-hybrid and co-immunoprecipitation studies, we show that RAD9, a human protein involved in the control of a cell-cycle checkpoint, interacts with the anti-apoptotic Bcl-2-family proteins BCL-2 and BCL-x L, but not with the pro-apoptotic BAX and BAD. When overexpressed in mammalian cells, RAD9 induces apoptosis that can be blocked by BCL-2 or BCL-x L. Conversely, antisense RAD9 RNA suppresses cell death induced by methyl methanesulphonate. These findings indicate that RAD9 may have a new role in regulating apoptosis after DNA damage, in addition to its previously described checkpoint-control and other radioresistance-promoting functions.

Molecular cloning and tissue-specific expression of Mrad9, a murine orthologue of the Schizosaccharomyces pombe rad9+ checkpoint control gene

We have isolated a murine cDNA, Mrad9, that is orthologous to the fission yeast rad9+ and human HRAD9 genes. Mrad9 encodes a 389 amino acid long, 42,032 Dalton protein that is 27% identical and 56% similar to Rad9p, and 82% identical and 88% similar to HRAD9, at the amino acid level. Expression of the Mrad9 cDNA in Schizosaccharomyces pombe rad9::ura4+ cells restores nearly wild-type levels of hydroxyurea resistance and early S phase checkpoint control to mutant fission yeast cell populations. However, UV resistance is only minimally restored, and mutant cells remain sensitive to gamma radiation. Mrad9 genomic DNA was isolated from a mouse 129/SvEv library. The Mrad9 gene was local ized to a 15-kbp genomic DNA fragment, and contains 10 exons separated by 9 introns. Northern blot analysis indicates that the gene is expressed in many different tissues of the adult mouse, but the mRNA is most abundant in the heart and present at very low levels in the liver. These studies demonstrate the existence of a murine orthologue of the fission yeast rad9+ gene and underscore at least the partial evolutionary conservation of rad9+-dependent checkpoint control mechanisms.

Levels of 70-kDa heat shock protein through the cell cycle in several mammalian cell lines

Seven different cell lines were analyzed by flow cytometry to evaluate the variation in heat shock protein hsp70 through the cell cycle. Inducible (hsp72) or both constitutive and inducible (hsp70) heat shock proteins were measured with monoclonal antibodies, and the cell cycle distribution was simultaneously measured with propidium iodide. Cell lines analyzed were Rat-1, Hr-24 (Rat-1 transfected with human hsp 72 gene), CHO (Chinese hamster ovary), C3H-10T1/2, AG1522 (normal human foreskin), GM2149 (normal human female skin), and Hela. None of the cell lines had a substantial variation in hsp72 or hsp70 levels through the cell cycle if they were not heated. In contrast, after chronic heating at 42.0 degrees C for 7.5 h, different cell lines had different patterns of hsp72 or hsp70 through the cell cycle. These results demonstrate that the level of hsp70 is not regulated differentially through the cell cycle in a variety of mammalian cell lines under normal unheated conditions. However, heat shock does induce cell-cycle-specific regulation of hsp70, which varies for different cell lines.

Schizosaccharomyces pombe rad23 is allelic with swi10, a mating-type switching/radioresistance gene that shares sequence homology with human and mouse ERCC1

Schizosaccharomyces pombe (Sp) rad23-1 mutant cells are extremely sensitive to UV light and ionizing radiation. A genomic DNA fragment that contains wild-type (wt) rad23 has been cloned. The DNA sequence of this cloned gene has been determined and was found to be identical to the previously characterized mating-type switching/radioresistance gene, swi10. Complementation tests between rad23-1 and swi10-154 mutant cells exclusively produce UV-sensitive progeny and confirm that these two genes are allelic. The DNA sequences of rad23-1 and swi10-154 reveal that each contains a single, unique point mutation. In rad23-1, Glu231 changes to a stop codon, resulting in the production of a truncated protein. In swi10-154, a G to A transition mutation is within a splice consensus sequence for intron 1. Therefore, the corresponding mRNA is incapable of being processed appropriately.

Cell cycle variation of Hsp70 levels in HeLa cells at 37 degrees C and after a heat shock

The expression of the 72 kD inducible heat shock protein (hsp72) has been reported to be cell cycle associated in unheated, synchronized HeLa cells. In this study, flow cytometry was used to investigate hsp72 levels through the cell cycle in HeLa cells by dual labeling with propidium iodide and antibodies against hsp72. The entire cell cycle distribution of hsp72 could be measured in a single sample of asynchronously growing cells. For unheated cells, the level of hsp72 increased about 30% from G1 to S phase, with about a 65% increase in G2/M, probably due to cell size differences. Neither mitotic selection nor serum stimulation induced a higher level of hsp72 than in the control cells. Western blot analysis of hsp72 from Hoechst-stained cells sorted from G1, mid-S, or G2/M showed that G1 cells had the lowest level of hsp72, with about a 30% increase in S phase and a 60% increase in G2/M, in good agreement with the flow cytometry results. These data conflict with previous reports by other laboratories which showed a 3-fold higher level of hsp72 in S phase than in G1 or G2. In contrast, heat shock (both acute and chronic) led to a non-uniform increase in hsp72 through the cell cycle. Most cells in mid S phase had high levels of hsp72, and a larger range in the levels of hsp72 were found in G1 and late S/G2/M phase cells.

Expression of hsp70 induced in CHO cells by 45.0 degrees C hyperthermia is cell cycle associated and DNA synthesis dependent

In response to a heat shock, the synthesis of heat shock proteins with a molecular weight of 72 kD (hsp72) is induced. To determine whether hsp72 expression in Chinese hamster ovary (CHO) cells is cell cycle associated, flow cytometry was used to measure DNA content and heat shock protein levels simultaneously. After 10 min at 45.0 degrees C and incubation at 37 degrees C for several hours, hsp72 was induced to a high level in early S phase. Inhibitors of DNA synthesis, aphidicolin, and 1-beta-D-arabinofuranosylcytosine (araC), suppressed the induction of hsp72 but did not inhibit it completely. Hsp73 (constitutive hsp70) was also induced by heat shock, but the induction was uniform through the cell cycle and it was not suppressed by araC.

Low pH suppresses synthesis of heat-shock proteins and thermotolerance

Chinese hamster ovary (CHO) cells heated for 10 min at 45 degrees C became thermotolerant to a second heat exposure at either pH 7.3 or 6.6. However, low pH delayed the development of thermotolerance and suppressed the rate of synthesis of all proteins, including heat-shock proteins (HSPs). Low-pH-tolerant mutant CHO cells (PHV2) in pH 6.6 medium were also delayed in both the development of thermotolerance and protein synthesis, though less than CHO cells in pH 6.6 medium. The rate of synthesis of inducible HSP-70 under the three conditions paralleled the kinetics of the development of thermotolerance. The intracellular pH (pHi) of CHO cells in pH 6.6 medium, whether heated or not, was far lower than CHO cells in pH 7.3 medium, and the pHi of PHV2 cells in pH 6.6 medium was close to that of CHO cells in pH 7.3 medium after the initial heat shock. Amiloride enhanced the effect of low-pH medium on pHi HSP synthesis and development of thermotolerance. The concentration of HSP-70 was also measured by flow cytometry. The level of HSP-70 was not altered within the first 4 h after a 10-min 45.0 degrees C initial heat treatment during which the major portion of thermotolerance developed, though the level of HSP-70 increased rapidly after 4 h. Low pH caused a further delay in the increase in HSP-70. We conclude that low-pH medium may inhibit the synthesis of HSPs in part by lowering pHi, but the delay and suppression of development of thermotolerance is not primarily due to the inhibition of HSP synthesis.

Measurement of intracellular pH using flow cytometry with carboxy-SNARF-1

The new intracellular pH (pH(i)) dye carboxy-seminaphthorhodafluor (SNARF-1) was compared to the established dye 2,3-dicyanohydroquinone (DCH) using flow cytometry. Both dyes give high-resolution pH(i) measurements. SNARF-1 remains trapped within cells much longer than DCH, so that pH(i) can be monitored during and after treatments with chemicals or hyperthermia. The toxicity of the dyes is similar, and both dyes can be used at concentrations that result in low toxicity to cells. Adequate staining of cells with SNARF-1 is dependent on the cell concentration. The absolute pHi values indicated by SNARF-1 are higher than values measured with DCH. However, the trends measured by both dyes are consistent, and both are useful for making pH(i) measurements.