Modulatory role of RNA helicases in MBNL-dependent alternative splicing regulation

Muscleblind-like splicing regulators (MBNLs) activate or repress the inclusion of alternative splicing (AS) events, enabling the developmental transition of fetal mRNA splicing isoforms to their adult forms. Herein, we sought to elaborate the mechanism by which MBNLs mediate AS related to biological processes. We evaluated the functional role of DEAD-box (DDX) RNA helicases, DDX5 and DDX17 in MBNL-dependent AS regulation. Whole-transcriptome analysis and validation approaches revealed a handful of MBNLs-dependent AS events to be affected by DDX5 and DDX17 in mostly an opposite manner. The opposite expression patterns of these two groups of factors during muscle development and coordination of fetal-to-adult splicing transition indicate the importance of these proteins at early stages of development. The identified pathways of how the helicases modulate MBNL splicing activity include DDX5 and DDX17-dependent changes in the ratio of MBNL splicing isoforms and most likely changes in accessibility of MBNL-binding sites. Another pathway involves the mode of action of the helicases independent of MBNL activity. These findings lead to a deeper understanding of the network of interdependencies between RNA-binding proteins and constitute a valuable element in the discussion on developmental homeostasis and pathological states in which the studied protein factors play a significant role.

Autistic traits in myotonic dystrophy type 1 due to MBNL inhibition and RNA mis-splicing

Tandem repeat expansions are enriched in autism spectrum disorder, including CTG expansion in the DMPK gene that underlines myotonic muscular dystrophy type 1. Although the clinical connection of autism to myotonic dystrophy is corroborated, the molecular links remained unknown. Here, we show a mechanistic path of autism via repeat expansion in myotonic dystrophy. We found that inhibition of muscleblind-like (MBNL) splicing factors by expanded CUG RNAs alerts the splicing of autism-risk genes during brain development especially a class of autism-relevant microexons. To provide in vivo evidence that the CTG expansion and MBNL inhibition axis leads to the presentation of autistic traits, we demonstrate that CTG expansion and MBNL-null mouse models recapitulate autism-relevant mis-splicing profiles and demonstrate social deficits. Our findings indicate that DMPK CTG expansion-associated autism arises from developmental mis-splicing. Understanding this pathomechanistic connection provides an opportunity for greater in-depth investigations of mechanistic threads in autism.

Delivering Bad News: Emotional Perspective and Coping Strategies of Medical Students

Purpose

The aim of our study was to analyze students' emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN).

Patients and Methods

291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience - whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA).

Results

Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy.

Conclusion

The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.

A cohort study reveals different dynamics of SARS-CoV-2-specific antibody formation after Comirnaty and Vaxzevria vaccination

The Coronavirus (COVID-19) Disease Pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has affected millions of people worldwide, prompting a collective effort from the global scientific community to develop a vaccine against it. This study purports to investigate the influence of factors such as sex, age, type of vaccination (Comirnaty, BNT162b2, Pfizer Inc. or Vaxzevria, ChAdOx1-S, Oxford/AstraZeneca), and time since vaccine administration on the process of antibody production. Both of them are based on the introduction of SARS-CoV-2 spike protein (S protein) to the body using different mechanisms (mRNA and recombinant adenovirus, respectively). S protein is responsible for host cell attachment and penetration via its receptor-binding domain (RBD domain). The level of anti-RBD IgG antibodies was tested with an ELISA-based immunodiagnostic assay in serum samples from a total of 1395 patients at 3 time points: before vaccination, after the first dose, and after the second dose. Our novel statistical model, the Generalized Additive Model, revealed variability in antibody production dynamics for both vaccines. Interestingly, no discernible variation in antibody levels between men and women was found. A nonlinear relationship between age and antibody production was observed, characterized by decreased antibody levels for people up to 30 and over 60 years of age, with a lack of correlation in the middle age range. Collectively, our findings further the understanding of the mechanism driving vaccine-induced immunity. Additionally, we propose the Generalized Additive Model as a standardized way of presenting data in similar research.

Applying Machine Learning to Construct a Model of Risk of Depression in Patients Following Cardiac Surgery with the Use of the SF-12 Survey

BACKGROUND

Depression is a common problem in patients with cardiovascular diseases. Identifying a risk factor model of depression has been postulated. A model of the risk of depression would provide a better understanding of this disorder in this population. We sought to construct a model of the risk factors of depression in patients following cardiac surgery, with the use of machine learning.

METHODS AND MEASURES

Two hundred and seventeen patients (65.4% men; mean age 65.14 years) were asked to complete the short form health survey-12 (SF-12v.2), three months after hospital discharge. Those at risk of depression were identified based on the SF-12 mental component summary (MCS). Centroid class principal component analysis (CCPCA) and the classification and regression tree (CART) were used to design a model.

RESULTS

A risk of depression was identified in 29.03% of patients. The following variables explained 82.53% of the variance in depression risk: vitality, limitation of activities due to emotional problems (role-emotional, RE), New York Heart Association (NYHA) class, and heart failure. Additionally, CART revealed that decreased vitality increased the risk of depression to 45.44% and an RE score > 68.75 increased it to 63.11%. In the group with an RE score < 68.75, the NYHA class increased the risk to 41.85%, and heart failure further increased it to 44.75%.

CONCLUSION

Assessing fatigue and vitality can help health professionals with identifying patients at risk of depression. In addition, assessing functional status and dimensions of fatigue, as well as the impact of emotional state on daily functioning, can help determine effective intervention options.

Medical or common knowledge? Knowledge of medical professionals on obesity diagnosis criteria and treatment

INTRODUCTION

Proper diagnosis of obesity and effective treatment requires an interdisciplinary healthcare approach. Nevertheless, obesity remains under-identified and under-treated. Academic knowledge concerning obesity pathology, diagnosis, and treatment is advancing, it is not clear whether this translates into clinical practice. The goal of the study was to assess the knowledge of Healthcare Professionals (HCPs) on obesity, and particularly on the criteria for diagnosis as well as for conservative and surgical treatment.

METHODS

This cross-sectional study was conducted among active HCPs (N = 184), including physicians, nurses, physiotherapists, and paramedics who had contact with adult patients with obesity. The proprietary research survey, implemented in an online tool, was used to assess knowledge on the diagnosis and treatment of obesity and self-assessment of that knowledge. The analysis was limited to the following: body mass index (BMI) definition, BMI values, visceral obesity definition, bariatric surgery indications, choice of treatment method, role of diet and physical activity, knowledge of obesity pharmacotherapy, length of obesity pharmacotherapy, financing of bariatric procedures, and goals of bariatric treatment. The correct answers were determined according to the Polish guidelines.

RESULTS

Half of the respondents (52.2%) were doctors, 20.7% were nurses, 19.0% were physiotherapists, and 8.2% were other medical professionals. Among questions related to knowledge on obesity, 67.1% of respondents provided correct answers, with respondents answering questions concerning obesity diagnosis correctly more frequently (70.1%) than those concerning methods of treatment (64.6%). The largest number of correct answers were related to the definition of BMI and normal BMI values. The smallest number of correct answers pertained to the diagnostic criteria for visceral obesity and pharmacological treatment of obesity. There were no statistically significant impact of a responder's knowledge levels on the obesity of different HCPs. Workplace and participation in training sessions were found to have the largest impact on the level of knowledge on obesity. HCPs own assessment of their knowledge on obesity was negatively correlated with their actual level of knowledge.

CONCLUSION

The prevalence of overweight and obesity implies that essentially every HCP has daily contact with patients with excessive body weight. Our research showed that 32.9% of HCPs did not have sufficient knowledge about how to diagnose and treat obesity.

Fatigue, Pro-Social Attitude and Quality of Life as Predictors of Empathy in Medical and Social-Oriented Students

Empathy is significant in professions that require establishing proper contact as a condition for providing help. Identifying factors related to empathy is important for understanding how to teach empathic behavior. The main goal of this study was to find variables related to empathy in a group of students from two universities: medical and social oriented (N = 1701). The study group consisted of female (81%) and male (19%) participants, aged between 18-20 (37%), 21-23 (49%), or 24 years and above (14%). A self-designed questionnaire was used to collect socio-demographical information, with additional questions (social self-esteem, prosocial attitude, subjective quality of life). Empathy was measured with the EQ-40, fatigue with CHFQ-PL, and stress with PSS-10. The results showed a statistically significant regression model for empathy. A high quality of life and having feelings of pleasure when helping other people allows to predict a high level of empathy, especially among females. Higher levels of fatigue and social self-esteem, the latter of which is measured here by the belief that you are more important than others, predicts lower empathy. There were no differences between students from two different kinds of universities when taking into consideration stress levels, subjective quality of life, and prosocial attitude. However, students from the medical university were more exhausted and more convinced that their value was greater than others, as compared to the students studying social sciences. When teaching empathic behavior, it is beneficial to attempt to maintain or restore students' well-being and reduce fatigue and to teach how to achieve such effects in the future. Learning the balance between compassion, willingness to help, and self-compassion also seems to be important.

Influence of Personal Experiences of Medical Students on Their Assessment of Delivering Bad News

BACKGROUND

We aimed to identify which attitudes and emotions accompany latter-year medical students as they experience situations where bad news is communicated.

METHODS

A cross-sectional study was conducted using the computer-assisted web interview (CAWI) methodology in a group of 321 fifth- and sixth-year medical students from 14 medical universities in Poland. Correlations were analyzed using Pearson's χ² test. For the categorical variables, subject profiles were analyzed using K-means clustering.

RESULTS

Students' self-assessments of their competence in delivering bad news (DBN) differed depending on the type of experience they had with it. More than half of the students had observed a situation of DBN (63.6%) and as many as 26.5% of the participants had received bad news themselves. These two groups were less likely to declare a lack of DBN-related skills (43.4% and 33.4%, respectively) than others. In this study, 9% of the students had personally delivered bad news. Only 13.4% of these students rated their DBN skills as insufficient. They were also the least likely to express concern regarding high levels of stress (29.6%) and anxiety (48%).

CONCLUSIONS

The ability to personally deliver bad medical news to a patient was the most effective form of gaining experience in DBN. Being a bearer of bad news may help students develop their own strategies for coping with difficult emotions and develop their professional competences, leading to improved medical care and patient comfort.

Comparing Students of Medical and Social Sciences in Terms of Self-Assessment of Perceived Stress, Quality of Life, and Personal Characteristics

The aim of this study was to compare medical and social sciences students’ outcomes in terms of self-perceived stress, quality of life, and personality traits. We put particular emphasis on external and internal differences in students of specific fields–medicine, nursing, psychology, and pedagogy. In a survey, 1,783 students from Medical University of Gdańsk and University of Gdańsk participated in our study, of whom 1,223 were included in the final statistical analysis. All of them were evaluated using valid and reliable questionnaires–TIPI-PL, PSS-10, and a one-item scale of quality of life. Stress turned out to have a negative effect on quality of life, regardless of the type of field of study. Moreover, students from different fields varied in terms of personality factors: conscientiousness, agreeableness, openness to experience, and emotional stability. In conclusion, many students regardless of their field suffer from high stress and report low quality of life, which potentially further affects their academic performance and social life.

The "CONNECT" Protocol: Delivering Bad News by Phone or Video Call

The COVID-19 pandemic has changed the principles of communication within the health-care setting. Communication skills as developed for use in the context of a direct and personal encounter have become insufficient. As a result, numerous health professionals came to believe they were not sufficiently prepared to deliver bad news in relation to medical care. The CONNECT protocol is a tool designed to help health-care professionals in the delivery of such messages. The name of the protocol is an acronym derived from C – context, O – organization, NN – near and niceties, E - emotions, C – counseling, T – taking care. The objective of the protocol is to improve the effectiveness of the delivery of bad news in relation to medical care by ensuring proper organization of the key elements of the encounter with the patient and/or their family.

Distribution of alternative untranslated regions within the mRNA of the CELF1 splicing factor affects its expression

CUG-binding protein, ELAV-like Family Member 1 (CELF1) plays an important role during the development of different tissues, such as striated muscle and brain tissue. CELF1 is an RNA-binding protein that regulates RNA metabolism processes, e.g., alternative splicing, and antagonizes other RNA-binding proteins, such as Muscleblind-like proteins (MBNLs). Abnormal activity of both classes of proteins plays a crucial role in the pathogenesis of myotonic dystrophy type 1 (DM1), the most common form of muscular dystrophy in adults. In this work, we show that alternative splicing of exons forming both the 5' and 3' untranslated regions (UTRs) of CELF1 mRNA is efficiently regulated during development and tissue differentiation and is disrupted in skeletal muscles in the context of DM1. Alternative splicing of the CELF1 5'UTR leads to translation of two potential protein isoforms that differ in the lengths of their N-terminal domains. We also show that the MBNL and CELF proteins regulate the distribution of mRNA splicing isoforms with different 5'UTRs and 3'UTRs and affect the CELF1 expression by changing its sensitivity to specific microRNAs or RNA-binding proteins. Together, our findings show the existence of different mechanisms of regulation of CELF1 expression through the distribution of various 5' and 3' UTR isoforms within CELF1 mRNA.

Attitudes of Medical Professionals Towards Discrimination of Patients with Obesity

Purpose

Many studies show that discriminatory practices are common in healthcare institutions, also in the form of medical staff’s inappropriate behaviour. Weight stigma may not only become a source of unpleasant experience for the patients but also cause them to withdraw from the treatment, which may further exacerbate their condition.

Patients and Methods

In a nationwide study, we asked 184 medical professionals, about their experiences and opinions on the discrimination of patients with obesity. The study was conducted in 2020, with the use of CAWI method, based on an original survey created for this study.

Results

Most of the medical professionals (68.5%) estimated that the problem of worse attitudes towards patients suffering from obesity is a common phenomenon. About 48.4% witnessed medical staff’s discriminatory behaviours. The most frequent forms of inappropriate behaviours pertained to interpersonal relations – mocking the appearance (96.6%), looks of disgust and repulsion (96.2%), lack of reaction to offensive remarks (92.0%) or scaring a patient with the necessity to lose weight (57.7%). The participants of the study pointed to limited access to dedicated medical equipment (62.4%) as a discriminatory systemic limitation.

Conclusion

Discrimination of patients with obesity is a social issue, which also occurs within the health care system. Limited access to medical resources, gaps in knowledge of obesity and an insufficient level of soft skills in health care professionals are the key deficiencies, which hinder effective treatment.

Intensity, dynamics and deficiencies of empathy in medical and non-medical students

BACKGROUND

Empathy is an important competence in the professional development of medical students. The purpose of our study was to compare the levels and scales of empathy in people studying in different educational strategies.

METHODS

The study was conducted between April 2019 and March 2020. Medicine, nursing, midwifery, physiotherapy, psychology, pedagogy and sociology students were the participants of this study. University students preparing for medical professions (n = 1001) and students of programs unrelated to medicine (n = 700) underwent the Empathy Quotient test (EQ-40). We have compared results in both study groups with the use of the distribution of density, analysis of variance and student's t-test.

RESULTS

The average results received by students of the university preparing for medical professions were lower (M = 42.6) than those of the non-medical university students (M = 45.3) and the differences between the universities turned out to be statistically important (t = - 5.15, df = 1699, p < 0.001). As many as 14.6% of the students in the 1st EQ class were preparing for various medical professions while 9% studied social sciences. 18.2% of all medical programme students (n = 412) manifested the lowest empathy class. Our research has revealed that the students with Asperger profile (AP) and high-functioning autism (HFA) studied at universities preparing for medical professions (n = 18) more frequently than at non-medical universities (n = 5).

CONCLUSIONS

We have noticed a serious indicator of erosion in the levels of empathy in medical students and an increase in the number of people with AP and HFA. Empathy decreases in students after the third year of their studies, regardless of the kind of university. We recommend an introduction of career counselling when specialization is being chosen.

The ROS-generating photosensitizer-free NaYF4:Yb,Tm@SiO2upconverting nanoparticles for photodynamic therapy application

In this work we adapt rare-earth-ion-doped NaYF₄nanoparticles coated with a silicon oxide shell (NaYF₄:20%Yb,0.2%Tm@SiO₂) for biological and medical applications (for example, imaging of cancer cells and therapy at the nano level). The wide upconversion emission range under 980 nm excitation allows one to use the nanoparticles for cancer cell (4T1) photodynamic therapy (PDT) without a photosensitizer. The reactive oxygen species (ROS) are generated by Tm/Yb ion upconversion emission (blue and UV light). Thein vitroPDT was tested on 4T1 cells incubated with NaYF₄:20%Yb,0.2%Tm@SiO₂nanoparticles and irradiated with NIR light. After 24 h, cell viability decreased to below 10%, demonstrating very good treatment efficiency. High modification susceptibility of the SiO₂shell allows for attachment of biological molecules (specific antibodies). In this work we attached the anti-human IgG antibody to silane-PEG-NHS-modified NaYF₄:20%Yb,0.2%Tm@SiO₂nanoparticles and a specifically marked membrane model by bio-conjugation. Thus, it was possible to perform a selective search (a high-quality optical method with a very low-level organic background) and eventually damage the targeted cancer cells. The study focuses on therapeutic properties of NaYF₄:20%Yb,0.2%Tm@SiO₂nanoparticles and demonstrates, upon biological functionalization, their potential for targeted therapy.

Cyclic mismatch binding ligands interact with disease-associated CGG trinucleotide repeats in RNA and suppress their translation

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder caused by a limited expansion of CGG repeats in the FMR1 gene. Degeneration of neurons in FXTAS cell models can be triggered by accumulation of polyglycine protein (FMRpolyG), a by-product of translation initiated upstream to the repeats. Specific aims of our work included testing if naphthyridine-based molecules could (i) block FMRpolyG synthesis by binding to CGG repeats in RNA, (ii) reverse pathological alterations in affected cells and (iii) preserve the content of FMRP, translated from the same FMR1 mRNA. We demonstrate that cyclic mismatch binding ligand CMBL4c binds to RNA structure formed by CGG repeats and attenuates translation of FMRpolyG and formation of nuclear inclusions in cells transfected with vectors expressing RNA with expanded CGG repeats. Moreover, our results indicate that CMBL4c delivery can reduce FMRpolyG-mediated cytotoxicity and apoptosis. Importantly, its therapeutic potential is also observed once the inclusions are already formed. We also show that CMBL4c-driven FMRpolyG loss is accompanied by partial FMRP reduction. As complete loss of FMRP induces FXS in children, future experiments should aim at evaluation of CMBL4c therapeutic intervention in differentiated tissues, in which FMRpolyG translation inhibition might outweigh adverse effects related to FMRP depletion.

Unfavorable Medical Diagnosis - Oncological Patients' Experiences and Preferences

The study aims at analyzing the experiences of Polish patients who received an unfavorable medical diagnosis. In order to reach a random group of patients with an unfavorable diagnosis, we started cooperating with 19 independent patient organizations and associations. A nationwide study, based on a self-constructed e-survey questionnaire, was carried out with the use of the CAWI method. Three hundred and fourteen patients in total participated in the study, all of whom had received an unfavorable diagnosis, including 119 oncological patients and 195 suffering from other chronic diseases. This paper focuses on the analysis of the opinions expressed by oncological patients. It also highlights the differences in oncological and non-oncological patients' reactions to an unfavorable diagnosis. Caution and tactfulness displayed by a physician while conveying an unfavorable diagnosis were assessed negatively by 36% of the respondents, 8 in 10 oncological patients claim that Polish doctors are insufficiently prepared to communicate bad news. As far as the model of the physician-patient relationship is concerned, over half of the surveyed (59%) prefers partnership, 18% opts for an informative model, 16% chooses a model based on dialogue and empathy and 7% is in favor of a paternalistic model. We have demonstrated that the very location where diagnosis is conveyed affects the quality of medical communication: patients visiting a private doctor's office have a better chance to express their doubts than the ones treated at a hospital or a public outpatient clinic. The majority of oncological patients, especially individuals under the age of 40, prefer shared decision-making.

Short antisense oligonucleotides alleviate the pleiotropic toxicity of RNA harboring expanded CGG repeats

Fragile X-associated tremor/ataxia syndrome (FXTAS) is an incurable neurodegenerative disorder caused by expansion of CGG repeats in the FMR1 5'UTR. The RNA containing expanded CGG repeats (rCGG^exp) causes cell damage by interaction with complementary DNA, forming R-loop structures, sequestration of nuclear proteins involved in RNA metabolism and initiation of translation of polyglycine-containing protein (FMRpolyG), which forms nuclear insoluble inclusions. Here we show the therapeutic potential of short antisense oligonucleotide steric blockers (ASOs) targeting directly the rCGG^exp. In nuclei of FXTAS cells ASOs affect R-loop formation and correct miRNA biogenesis and alternative splicing, indicating that nuclear proteins are released from toxic sequestration. In cytoplasm, ASOs significantly decrease the biosynthesis and accumulation of FMRpolyG. Delivery of ASO into a brain of FXTAS mouse model reduces formation of inclusions, improves motor behavior and corrects gene expression profile with marginal signs of toxicity after a few weeks from a treatment.

MEF2C shapes the microtranscriptome during differentiation of skeletal muscles

Myocyte enhancer factor 2C (MEF2C) is a transcription factor that regulates heart and skeletal muscle differentiation and growth. Several protein-encoding genes were identified as targets of this factor; however, little is known about its contribution to the microtranscriptome composition and dynamics in myogenic programs. In this report, we aimed to address this question. Deep sequencing of small RNAs of human muscle cells revealed a set of microRNAs (miRNAs), including several muscle-specific miRNAs, that are sensitive to MEF2C depletion. As expected, in cells with knockdown of MEF2C, we found mostly downregulated miRNAs; nevertheless, as much as one-third of altered miRNAs were upregulated. The majority of these changes are driven by transcription efficiency. Moreover, we found that MEF2C affects nontemplated 3′-end nucleotide addition of miRNAs, mainly oligouridylation. The rate of these modifications is associated with the level of TUT4 which mediates RNA 3′-uridylation. Finally, we found that a quarter of miRNAs which significantly changed upon differentiation of human skeletal myoblasts is inversely altered in MEF2C deficient cells. We concluded that MEF2C is an essential factor regulating both the quantity and quality of the microtranscriptome, leaving an imprint on the stability and perhaps specificity of many miRNAs during the differentiation of muscle cells.

Doctors' attitudes in the situation of delivering bad news: patients' experience and expectations

INTRODUCTION

The purpose of our research was to find out patients' preferences concerning their doctors' attitudes and behaviour as they deliver bad news to them.

MATERIAL AND METHODS

In national research conducted from February to October 2017 using the computer-assisted web interview (CAWI) technique, we studied the statements of 314 adult patients who had received bad medical news from their doctors. Seventy-nine per cent of them were women and 21% were men. Fifty-nine per cent had higher education and 33% had secondary education. A specially designed closed question survey was used as a tool to collect the data.

RESULTS

Most of the patients (59.6%) expected a doctor-patient relationship based on partnership and collective decisions concerning further treatment. Patients wanted their doctors to be honest with them, to provide them with solid information and an opportunity to ask questions and discuss the suggested solutions. Less than 2 out of 10 patients expected "an empathy specialist". The patients who evaluated their doctors' behaviour and the way bad news was delivered to them negatively were more likely to change doctors or terminate their treatment.

CONCLUSIONS

The doctor-patient relationship when an unfavourable diagnosis is being communicated is an important aspect, which defines the way people who participate in this difficult situation behave and communicate. Doctors' behaviour during DBN should meet the patients' expectations. Such an attitude guarantees trust towards doctors and results in more positive evaluations on them. Most importantly, it translates directly into the patients' therapeutic behaviours and treatment effects.

An Integration of a Peristaltic Pump-Based Extruder into a 3D Bioprinter Dedicated to Hydrogels

The 3D printing technologies used for medical applications are mostly based on paste extruders. These are designed for high capacity, and thus often feature large material reservoirs and large diameter nozzles. A major challenge for most 3D printing platforms is a compromise between speed, accuracy, and/or volume/mass of moving elements. To address these issues, we integrated a peristaltic pump into a bioprinter. That allowed for combining the most important requirements: high precision, a large material reservoir, and safety of biological material. The system of a fully heated nozzle and a cooled print bed were developed to maintain the optimal hydrogel temperature and crosslinking speed. Our modifications of the bioprinter design improved the mechanical properties of the printouts and their accuracy while maintaining the maximal survival rate of cells and increasing the capacity of the bioink reservoir.

Intrinsic Regulatory Role of RNA Structural Arrangement in Alternative Splicing Control

Alternative splicing is a highly sophisticated process, playing a significant role in posttranscriptional gene expression and underlying the diversity and complexity of organisms. Its regulation is multilayered, including an intrinsic role of RNA structural arrangement which undergoes time- and tissue-specific alterations. In this review, we describe the principles of RNA structural arrangement and briefly decipher its cis- and trans-acting cellular modulators which serve as crucial determinants of biological functionality of the RNA structure. Subsequently, we engage in a discussion about the RNA structure-mediated mechanisms of alternative splicing regulation. On one hand, the impairment of formation of optimal RNA structures may have critical consequences for the splicing outcome and further contribute to understanding the pathomechanism of severe disorders. On the other hand, the structural aspects of RNA became significant features taken into consideration in the endeavor of finding potential therapeutic treatments. Both aspects have been addressed by us emphasizing the importance of ongoing studies in both fields.

AON-induced splice-switching and DMPK pre-mRNA degradation as potential therapeutic approaches for Myotonic Dystrophy type 1

Expansion of an unstable CTG repeat in the 3′UTR of the DMPK gene causes Myotonic Dystrophy type 1 (DM1). CUG-expanded DMPK transcripts (CUG^exp) sequester Muscleblind-like (MBNL) alternative splicing regulators in ribonuclear inclusions (foci), leading to abnormalities in RNA processing and splicing. To alleviate the burden of CUG^exp, we tested therapeutic approach utilizing antisense oligonucleotides (AONs)-mediated DMPK splice-switching and degradation of mutated pre-mRNA. Experimental design involved: (i) skipping of selected constitutive exons to induce frameshifting and decay of toxic mRNAs by an RNA surveillance mechanism, and (ii) exclusion of the alternative exon 15 (e15) carrying CUG^exp from DMPK mRNA. While first strategy failed to stimulate DMPK mRNA decay, exclusion of e15 enhanced DMPK nuclear export but triggered accumulation of potentially harmful spliced out pre-mRNA fragment containing CUG^exp. Neutralization of this fragment with antisense gapmers complementary to intronic sequences preceding e15 failed to diminish DM1-specific spliceopathy due to AONs’ chemistry-related toxicity. However, intronic gapmers alone reduced the level of DMPK mRNA and mitigated DM1-related cellular phenotypes including spliceopathy and nuclear foci. Thus, a combination of the correct chemistry and experimental approach should be carefully considered to design a safe AON-based therapeutic strategy for DM1.

Muscleblind-like 2 controls the hypoxia response of cancer cells

Hypoxia is a hallmark of solid cancers, supporting proliferation, angiogenesis, and escape from apoptosis. There is still limited understanding of how cancer cells adapt to hypoxic conditions and survive. We analyzed transcriptome changes of human lung and breast cancer cells under chronic hypoxia. Hypoxia induced highly concordant changes in transcript abundance, but divergent splicing responses, underlining the cell type-specificity of alternative splicing programs. While RNA-binding proteins were predominantly reduced, hypoxia specifically induced muscleblind-like protein 2 (MBNL2). Strikingly, MBNL2 induction was critical for hypoxia adaptation by controlling the transcript abundance of hypoxia response genes, such as vascular endothelial growth factor A (VEGFA) MBNL2 depletion reduced the proliferation and migration of cancer cells, demonstrating an important role of MBNL2 as cancer driver. Hypoxia control is specific for MBNL2 and not shared by its paralog MBNL1. Thus, our study revealed MBNL2 as central mediator of cancer cell responses to hypoxia, regulating the expression and alternative splicing of hypoxia-induced genes.

Detection of Si doping in the AlN/GaN MQW using Super X - EDS measurements

A multiple-quantum-well structure consisting of 40 periods of AlN/GaN:Si was investigated using a transmission electron microscope equipped with energy-dispersive X-ray spectroscopy. The thicknesses of the AlN barriers and the GaN quantum wells were 4 nm and 6 nm, respectively. The QW layers were doped with Si to a concentration of 1.3×10¹⁹cm^-3 (0.012 % at). The procedure for quantifying such a doping level using AlN as a standard is presented. The EDS results (0.013 % at) are compared with secondary ion mass spectrometry measurements (0.05 % at).

Experience of Polish Patients with Obesity in Contacts with Medical Professionals

PURPOSE

Discrimination and stigmatization of patients with obesity are a commonly occurring social problem. The purpose of our research was to analyze the scale of the experience including medical staff's improper behaviours towards patients with obesity in Poland.

PATIENTS AND METHODS

In a completed national study, we studied the statements of 621 adult patients who suffer from obesity. An original closed question survey was used as a tool to collect the data. Patients were informed about the possibility to participate in the study through social media, medical institutions and patient foundations.

RESULTS

As many as 82.6% have experienced improper behaviours. Usually, it came from doctors (90%), nurses and midwives (51%), people who operated medical equipment (24%), nutritionists (14%) and paramedics (9%). Exactly 81% of the respondents pointed to unpleasant and judgmental comments as the most frequent form of improper behaviour which they have encountered mainly during diagnostic tests, palpation or procedures.

CONCLUSION

There is an urgent need for developing national strategies connected with care for individuals with higher body weight. Introducing dedicated solutions in this field may contribute to increasing the quality of health care and reducing stigmatizing behaviours.

MBNL splicing activity depends on RNA binding site structural context

Muscleblind-like (MBNL) proteins are conserved RNA-binding factors involved in alternative splicing (AS) regulation during development. While AS is controlled by distribution of MBNL paralogs and isoforms, the affinity of these proteins for specific RNA-binding regions and their location within transcripts, it is currently unclear how RNA structure impacts MBNL-mediated AS regulation. Here, we defined the RNA structural determinants affecting MBNL-dependent AS activity using both cellular and biochemical assays. While enhanced inclusion of MBNL-regulated alternative exons is controlled by the arrangement and number of MBNL binding sites within unstructured RNA, when these sites are embedded in a RNA hairpin MBNL binds preferentially to one side of stem region. Surprisingly, binding of MBNL proteins to RNA targets did not entirely correlate with AS efficiency. Moreover, comparison of MBNL proteins revealed structure-dependent competitive behavior between the paralogs. Our results showed that the structure of targeted RNAs is a prevalent component of the mechanism of alternative splicing regulation by MBNLs.

Global Increase in Circular RNA Levels in Myotonic Dystrophy

Splicing aberrations induced as a consequence of the sequestration of muscleblind-like splicing factors on the dystrophia myotonica protein kinase transcript, which contains expanded CUG repeats, present a major pathomechanism of myotonic dystrophy type 1 (DM1). As muscleblind-like factors may also be important factors involved in the biogenesis of circular RNAs (circRNAs), we hypothesized that the level of circRNAs would be decreased in DM1. To test this hypothesis, we selected 20 well-validated circRNAs and analyzed their levels in several experimental systems (e.g., cell lines, DM muscle tissues, and a mouse model of DM1) using droplet digital PCR assays. We also explored the global level of circRNAs using two RNA-Seq datasets of DM1 muscle samples. Contrary to our original hypothesis, our results consistently showed a global increase in circRNA levels in DM1, and we identified numerous circRNAs that were increased in DM1. We also identified many genes (including muscle-specific genes) giving rise to numerous (>10) circRNAs. Thus, this study is the first to show an increase in global circRNA levels in DM1. We also provided preliminary results showing the association of circRNA level with muscle weakness and alternative splicing changes that are biomarkers of DM1 severity.

Direct Measurement of Hyperfine Shifts and Radio Frequency Manipulation of Nuclear Spins in Individual CdTe/ZnTe Quantum Dots

We achieve direct detection of electron hyperfine shifts in individual CdTe/ZnTe quantum dots. For the previously inaccessible regime of strong magnetic fields B_{z}≳0.1  T, we demonstrate robust polarization of a few-hundred-particle nuclear spin bath, with an optical initialization time of ∼1  ms and polarization lifetime exceeding ∼1  s. Nuclear magnetic resonance spectroscopy of individual dots reveals strong electron-nuclear interactions characterized by Knight fields |B_{e}|≳50  mT, an order of magnitude stronger than in III-V semiconductor quantum dots. Our studies confirm II-VI semiconductor quantum dots as a promising platform for hybrid electron-nuclear spin qubit registers, combining the excellent optical properties comparable to III-V dots and the dilute nuclear spin environment similar to group-IV semiconductors.

Application of ion pair chromatography coupled with mass spectrometry to assess antisense oligonucleotides concentrations in living cells

Antisense oligonucleotides (ASOs) are synthetic bioactive compounds used as therapeutic agents in clinical trials. They act by binding to complementary sequences of the targeted nucleic acids in cells. Assessing the efficiency of ASO delivery to cells or tissues and the stability of these compounds in different biological systems is important. To answer these questions, we developed a new, quick and reliable method to determine the concentrations of different types of ASOs in treated cells. Ultra-high performance liquid chromatography coupled with mass spectrometry was used for the first time for the separation and determination of the studied compounds in total RNA extracts. To develop a method with the highest possible sensitivity, a central composite design was used to comprehensively optimize the MS parameters. Moreover, the effects of the type and concentration of the ion pair reagent on sensitivity were also examined. Finally, a mobile phase containing methanol, hexafluoroisopropanol and N,N-dimethylbutylamine was selected. The optimized method allowed good linearity, accuracy, precision and sensitivity of ASO detection. Next, these compounds were delivered into cells via transfection at a concentration of 25 nM or 125 nM in 1 mL of cell culture medium. After 48 hours, total RNA was isolated from the treated cells and analyzed with the use of the newly developed method. For the cells treated with a higher concentration of ASO composed of phosphorothioate 2'-O-methyl RNA units, the concentration in solution was 0.96 ± 0.06 μM, while in the case of shorter ASO composed of locked nucleic acid units, it was 0.72 ± 0.06 μM in the total RNA extract.

MBNL1 alternative splicing isoforms play opposing roles in cancer

MBNL1 proteins lacking exon 7 (−ex7) are antisurvival factors with tumor suppressive role that cancer cells tend to down-regulate in favor of MBNL +ex7 isoforms.

The extent of and the oncogenic role played by alternative splicing (AS) in cancer are well documented. Nonetheless, only few studies have attempted to dissect individual gene function at an isoform level. Here, we focus on the AS of splicing factors during prostate cancer progression, as these factors are known to undergo extensive AS and have the potential to affect hundreds of downstream genes. We identified exon 7 (ex7) in the MBNL1 (Muscleblind-like 1) transcript as being the most differentially included exon in cancer, both in cell lines and in patients' samples. In contrast, MBNL1 overall expression was down-regulated, consistently with its described role as a tumor suppressor. This observation holds true in the majority of cancer types analyzed. We first identified components associated to the U2 splicing complex (SF3B1, SF3A1, and PHF5A) as required for efficient ex7 inclusion and we confirmed that this exon is fundamental for MBNL1 protein homodimerization. We next used splice-switching antisense oligonucleotides (AONs) or siRNAs to compare the effect of MBNL1 splicing isoform switching with knockdown. We report that whereas the absence of MBNL1 is tolerated in cancer cells, the expression of isoforms lacking ex7 (MBNL1 Δex7) induces DNA damage and inhibits cell viability and migration, acting as dominant negative proteins. Our data demonstrate the importance of studying gene function at the level of alternative spliced isoforms and support our conclusion that MBNL1 Δex7 proteins are antisurvival factors with a defined tumor suppressive role that cancer cells tend to down-regulate in favor of MBNL +ex7 isoforms.

Methods for determination of stagnation in pneumatic ventricular assist devices

Background:

A pneumatic paediatric ventricular assist device developed at the Foundation of Cardiac Surgery Development, Zabrze, equipped with valves based on J. Moll’s design, with later modifications introduced at the Institute of Turbomachinery, Lodz University of Technology, was tested numerically and experimentally. The main aim of those investigations was to detect stagnation zones within the ventricular assist device and indicate advantages and limitations of both approaches.

Methods:

In the numerical transient test, a motion of the diaphragm and discs was simulated. Two different methods were used to illustrate stagnation zones in the ventricular assist device. The flow pattern inside the chamber was represented by velocity contours and vectors to validate the results using images obtained in the laser particle image velocimetry experiment.

Results:

The experimental light-based method implied problems with proper illumination of regions in the wall vicinity. High-resolution flow data and other important parameters as stagnation regions or flow patterns in regions not accessible for light in the particle image velocimetry method are derived in the numerical solution. However, computations of a single case are much more time-consuming if compared to a single experiment conducted on a well-calibrated stand.

Conclusion:

The resulting main vortexes in the central part of the pump chamber and the velocity magnitudes are correlated in both methods, which are complementary and when used together offer better insight into the flow structure inside the ventricular assist device and enable a deeper analysis of the results.

Experimental investigations of the aerated polymethylmethacrylate-based vertebral cement flow in capillaries

Introduction:

A constant growth in the population suffering from osteoporotic vertebral weakening is observed. As a result, vertebroplasty procedures become more and more common. Unfortunately, they may be associated with several complications occurring during bone cement injection, including its leakage or overheating of tissues. Despite several experimental studies, there is a lack of data related to random aeration of the bone cement. Therefore, the main objective of the following investigations was to emphasize that random aeration of the bone cement, and, consequently, a compressibility factor, could not be treated as a negligible factor during the vertebroplasty procedure and had to be taken into account in the development of the mathematical model.

Materials and methods:

A special test rig to reproduce the vertebroplasty procedure was designed and built. The authors conducted numerous experiments on polymethylmethacrylate-based bone cement flows, analyzing different flow conditions, such as volume flow rate and flow channel diameter. Time periods of the flow front between characteristic sections and pressures (differential and gauge) were measured.

Results:

All investigations revealed that bone cements mixed in special mixing kits were characterized by a random level of aeration which led to varied flow parameters. Comparing the experimental results with the theoretical values of the continuity equation, the highest difference in the flow duration reached 140%.

Discussion:

It has been proven that the aeration of the bone cement alters the flow dynamics. Therefore, much more data are required for statistical analysis to validate a mathematical model of the bone cement flow.

Quantitative Evaluation of Toxic Polyglycine Biosynthesis and Aggregation in Cell Models Expressing Expanded CGG Repeats

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder caused by expanded CGG (CGG^exp) trinucleotides in the 5′UTR of the FMR1 gene encoding fragile X mental retardation protein (FMRP). The patients, with the number of the repeats ranging from 55 to 200, show specific manifestation of clinical symptoms that include intention tremor, gait ataxia, cognitive deficits, and brain atrophy. Accumulation of toxic polyglycine (FMRpolyG), a by-product of the CGG^exp repeat-associated non-ATG (RAN) translation, is considered to be one of the main factors triggering neurodegenerative processes in FXTAS patients. Nevertheless, the nature of the FMRpolyG-induced cell damage, especially in the context of its soluble and inclusion-associated forms, is still elusive. Targeting either biosynthesis, cellular stability or aggregation capacity of toxic FMRpolyG could be considered as a potential therapeutic strategy for FXTAS. Therefore, we tested a variety of quantitative methods based on forced expression of genetic constructs carrying CGG^exp repeats in the context of the FMR1 5′UTR fused to GFP, mCherry or Firefly luciferase gene in or out of frame to the polyglycine encoding sequence. We show that FMRpolyG translation either from native or an AUG-induced start codon as well as the translation yield of the FMRP open reading frame equivalent located downstream of the CGG^exp element can be effectively estimated using fluorescence microscopy, flow cytometry or luciferase assay. We also quantitatively estimated soluble fraction and insoluble form of FMRpolyG aggregated in foci using an electrophoretic separation of cell lysates and fluorescence microscopy, respectively. Importantly, we show that dependent on a fusion tag, FMRpolyG has a different potential for aggregate formation. Our established protocols enable sensitive tracking of FMRP and FMRpolyG quantitative and qualitative changes after treatment with potential therapeutic agents for FXTAS. Furthermore, they can be modified for application to other RAN translation- and aggregation-related diseases.

Quantitative Methods to Monitor RNA Biomarkers in Myotonic Dystrophy

Myotonic dystrophy type 1 (DM1) and type 2 (DM2) are human neuromuscular disorders associated with mutations of simple repetitive sequences in affected genes. The abnormal expansion of CTG repeats in the 3'-UTR of the DMPK gene elicits DM1, whereas elongated CCTG repeats in intron 1 of ZNF9/CNBP triggers DM2. Pathogenesis of both disorders is manifested by nuclear retention of expanded repeat-containing RNAs and aberrant alternative splicing. The precise determination of absolute numbers of mutant RNA molecules is important for a better understanding of disease complexity and for accurate evaluation of the efficacy of therapeutic drugs. We present two quantitative methods, Multiplex Ligation-Dependent Probe Amplification and droplet digital PCR, for studying the mutant DMPK transcript (DMPK^expRNA) and the aberrant alternative splicing in DM1 and DM2 human tissues and cells. We demonstrate that in DM1, the DMPK^expRNA is detected in higher copy number than its normal counterpart. Moreover, the absolute number of the mutant transcript indicates its low abundance with only a few copies per cell in DM1 fibroblasts. Most importantly, in conjunction with fluorescence in-situ hybridization experiments, our results suggest that in DM1 fibroblasts, the vast majority of nuclear RNA foci consist of a few molecules of DMPK^expRNA.

Design of a "Mini" Nucleic Acid Probe for Cooperative Binding of an RNA-Repeated Transcript Associated with Myotonic Dystrophy Type 1

Toxic RNAs containing expanded trinucleotide repeats are the cause of many neuromuscular disorders, one being myotonic dystrophy type 1 (DM1). DM1 is triggered by CTG-repeat expansion in the 3'-untranslated region of the DMPK gene, resulting in a toxic gain of RNA function through sequestration of MBNL1 protein, among others. Herein, we report the development of a relatively short miniPEG-γ peptide nucleic acid probe, two triplet repeats in length, containing terminal pyrene moieties, that is capable of binding rCUG repeats in a sequence-specific and selective manner. The newly designed probe can discriminate the pathogenic rCUG^exp from the wild-type transcript and disrupt the rCUG^exp-MBNL1 complex. The work provides a proof of concept for the development of relatively short nucleic acid probes for targeting RNA-repeat expansions associated with DM1 and other related neuromuscular disorders.

Delivering bad news: patient's perspective and opinions

PURPOSE

The aim of our research was to gain knowledge about patients' opinions, experiences, and preferences with regard to the way the news is being delivered to them.

MATERIALS AND METHODS

Detailed research was carried out on a group of 314 patients using the CAWI (Computer-Assisted Web Interview) technique. Adult responders who had earlier received bad news were questioned about their opinion about the way the doctor acted while delivering bad news and how he did it.

RESULTS

Patients, who define the following aspects of their visit as negative/lacking: 1) doctor's behavior in the moment of delivering bad news, 2) amount of time devoted to the visit, 3) lack of doctor's attention, 4) usage of medical terminology, 5) doctor's honesty, 6) emotional and cognitive support from the doctor, more often tend to change the doctor in charge of their therapy or decide to cease the medical treatment.

CONCLUSION

Doctors' behavior and the way they deliver news to patients are key elements that strongly influence patients' future therapy. It makes an impact on patient's decision whether to continue or cease the treatment. In the first case, it also leads the patient to choose to continue the treatment under the guidance of the same specialist or to find another one. The data that we acquired and that we will discuss below will form the basis for editing a communication protocol concerning delivering bad news. It is necessary to create such a protocol in order to improve the quality of communication with patients, especially as regards delivering bad news to them.

CONTACT – communication protocol for family practitioners and specialists

Introduction. Ability to gather and process medical data serves as a basic tool of doctor’s work, which can be improved by applying communication protocols. In most cases, however, instructions presented by such models are too general and do not take into account patients’ preferences. Material and Methods. The study was carried out in the form of an electronic questionairre sent to a randomly chosen group of adult patients (N = 967). It consisted of close-ended questions about the quality of communication skills of family practitioners and specialists working at outpatient clinics and health centers.  Results. Only 21% of patients claimed that the appointment started on time. 51% mentioned disruptions during the meeting, mainly by a third party (34%). A considerable majority of physicians carried out the interview in a manner that was understood by patients, nevertheless 56.6% of the respondents felt underinformed as far as the nature of their illness was concerned – these objections were mostly expressed by patients suffering from chronic diseases. Conclusions. Our research shows that a proper organization of work as well as observing the principles of appropriate clinical communication can facilitate doctors’ performance, and thus increase both the level of patients’ satisfaction and the quality of medical services.

Hybrid splicing minigene and antisense oligonucleotides as efficient tools to determine functional protein/RNA interactions

Alternative splicing is a complex process that provides a high diversity of proteins from a limited number of protein-coding genes. It is governed by multiple regulatory factors, including RNA-binding proteins (RBPs), that bind to specific RNA sequences embedded in a specific structure. The ability to predict RNA-binding regions recognized by RBPs using whole-transcriptome approaches can deliver a multitude of data, including false-positive hits. Therefore, validation of the global results is indispensable. Here, we report the development of an efficient and rapid approach based on a modular hybrid minigene combined with antisense oligonucleotides to enable verification of functional RBP-binding sites within intronic and exonic sequences of regulated pre-mRNA. This approach also provides valuable information regarding the regulatory properties of pre-mRNA, including the RNA secondary structure context. We also show that the developed approach can be used to effectively identify or better characterize the inhibitory properties of potential therapeutic agents for myotonic dystrophy, which is caused by sequestration of specific RBPs, known as muscleblind-like proteins, by mutated RNA with expanded CUG repeats.

MBNL expression in autoregulatory feedback loops

Muscleblind-like (MBNL) proteins bind to hundreds of pre- and mature mRNAs to regulate their alternative splicing, alternative polyadenylation, stability and subcellular localization. Once MBNLs are withheld from transcript regulation, cellular machineries generate products inapt for precise embryonal/adult developmental tasks and myotonic dystrophy, a devastating multi-systemic genetic disorder, develops. We have recently demonstrated that all three MBNL paralogs are capable of fine-tuning cellular content of one of the three MBNL paralogs, MBNL1, by binding to the first coding exon (e1) of its pre-mRNA. Intriguingly, this autoregulatory feedback loop grounded on alternative splicing of e1 appears to play a crucial role in delaying the onset of myotonic dystrophy. Here, we describe this process in the context of other autoregulatory and regulatory loops that maintain the content and diverse functions of MBNL proteins at optimal level in health and disease, thus supporting the overall cellular homeostasis.

Autoregulation of MBNL1 function by exon 1 exclusion from MBNL1 transcript

Muscleblind-like proteins (MBNLs) are regulators of RNA metabolism. During tissue differentiation the level of MBNLs increases, while their functional insufficiency plays a crucial role in myotonic dystrophy (DM). Deep sequencing of RNA molecules cross-linked to immunoprecipitated protein particles (CLIP-seq) revealed that MBNL1 binds to MBNL1 exon 1 (e1) encoding both the major part of 5΄UTR and an amino-terminal region of MBNL1 protein. We tested several hypotheses regarding the possible autoregulatory function of MBNL1 binding to its own transcript. Our data indicate that MBNLs induce skipping of e1 from precursor MBNL1 mRNA and that e1 exclusion may impact transcript association with polysomes and translation. Furthermore, e1-deficient protein isoform lacking the first two zinc fingers is highly unstable and its EGFP fusion protein has severely compromised splicing activity. We also show that MBNL1 can be transcribed from three different promoters and that the transcription initiation site determines the mode of e1 regulation. Taken together, we demonstrate that MBNL proteins control steady-state levels of MBNL1 through an interaction with e1 in its precursor mRNA. Insights from our study open a new avenue in therapies against DM based on manipulation of the transcription initiation site and e1 splicing of MBNL1 mRNA.

Mammalian cell defence mechanisms against the cytotoxicity of NaYF4:(Er,Yb,Gd) nanoparticles

Water-soluble upconversion nanoparticles (UCNPs), based on polyvinylpyrrolidone (PVP)-coated NaYF₄:Er³⁺,Yb³⁺,Gd³⁺, with various concentrations of Gd³⁺ ions and relatively high upconversion efficiencies, were synthesized. The internalization and cytotoxicity of the thus obtained UCNPs were evaluated in three cell lines (HeLa, HEK293 and astrocytes). No cytotoxicity was observed even at concentrations of UCNPs up to 50 μg ml^-1. The fate of the UCNPs within the cells was studied by examining their upconversion emission spectra with confocal microscopy and confirming these observations with transmission electron microscopy. It was found that the cellular uptake of the UCNPs occurred primarily by clathrin-mediated endocytosis, whereas they were secreted from the cells via lysosomal exocytosis. The results of this study, focused on the mechanisms of the cellular uptake, localization and secretion of UCNPs, demonstrate, for the first time, the co-localization of UCNPs within discrete cell organelles.

Patients' Expectations as to Doctors' Behaviors During Appointed Visits

Numerous guidelines for students and medical professionals provide the instructions of proper behavior during encounters with patients in a doctor's office. However, they quite often do not consider cultural differences that may affect the doctor-patient relationship. In our study we analyzed Polish patients' expectations (N = 976) for their physicians' actual behavior. We compared our results with analogue studies performed in the United States. We determined that patient expectations concerning a desirable form of verbal and nonverbal communication with a physician vary to a considerable degree. Relatively universal, however, is the wish that the doctors introduce themselves and apply personalized forms of contact.

Mechanistic determinants of MBNL activity

Muscleblind-like (MBNL) proteins are critical RNA processing factors in development. MBNL activity is disrupted in the neuromuscular disease myotonic dystrophy type 1 (DM1), due to the instability of a non-coding microsatellite in the DMPK gene and the expression of CUG expansion (CUG^exp) RNAs. Pathogenic interactions between MBNL and CUG^exp RNA lead to the formation of nuclear complexes termed foci and prevent MBNL function in pre-mRNA processing. The existence of multiple MBNL genes, as well as multiple protein isoforms, raises the question of whether different MBNL proteins possess unique or redundant functions. To address this question, we coexpressed three MBNL paralogs in cells at equivalent levels and characterized both specific and redundant roles of these proteins in alternative splicing and RNA foci dynamics. When coexpressed in the same cells, MBNL1, MBNL2 and MBNL3 bind the same RNA motifs with different affinities. While MBNL1 demonstrated the highest splicing activity, MBNL3 showed the lowest. When forming RNA foci, MBNL1 is the most mobile paralog, while MBNL3 is rather static and the most densely packed on CUG^exp RNA. Therefore, our results demonstrate that MBNL paralogs and gene-specific isoforms possess inherent functional differences, an outcome that could be enlisted to improve therapeutic strategies for DM1.

Delivering bad news by physicians – Polish reality check

Introduction. Disclosing unfavorable information is a very important moment in both diagnostic and therapeutic processes. It is also a highly stress‑inducing factor, both among patients and physicians. During our research we tried to establish how exactly bad news is communicated to patients and the amount of stress that Polish physicians are under in such situations.Material and Methods. Quantitative research was conducted in a university clinical hospital. With the use of an anonymous questionnaire, physicians (n = 100) from oncology, internal diseases, cardiac surgery, gynecology, obstetrics, and urology clinics were asked about the sources and the intensity of stress involved in BBN (Breaking Bad News). Similarly, patients (n = 378) of said clinics were asked to evaluate the relationships they had with their doctors. Results. Most (66.7%) clinicians declared they always conveyed unfavorable information to their patients fully and in detail. Exactly 50.0% admitted they were experiencing high or very high level of stress while doing so. They were mostly (56.1%) anxious about depriving their patients of hope and (38.5%) feared they were letting their patients down. 37.3% of clinicians were afraid of emotional response. Significantly fewer physicians (43%) than patients (84.6%) were of the opinion that all of the medical orders must be followed to the letter.Conclusions. Results suggest that BBN was a stressful experience for physicians. It was mostly related to the fear of disrupting the patient's well‑being. Low level of effective communication was caused by the insufficiency of BBN skills. Social and cultural aspects also played a role.