Breast-to-brain metastasis is exacerbated with chemotherapy through blood-cerebrospinal fluid barrier and induces Alzheimer's-like pathology

Control of breast-to-brain metastasis remains an urgent unmet clinical need. While chemotherapies are essential in reducing systemic tumor burden, they have been shown to promote non-brain metastatic invasiveness and drug-driven neurocognitive deficits through the formation of neurofibrillary tangles (NFT), independently. Now, in this study, we investigated the effect of chemotherapy on brain metastatic progression and promoting tumor-mediated NFT. Results show chemotherapies increase brain-barrier permeability and facilitate enhanced tumor infiltration, particularly through the blood-cerebrospinal fluid barrier (BCSFB). This is attributed to increased expression of matrix metalloproteinase 9 (MMP9) which, in turn, mediates loss of Claudin-6 within the choroid plexus cells of the BCSFB. Importantly, increased MMP9 activity in the choroid epithelium following chemotherapy results in cleavage and release of Tau from breast cancer cells. This cleaved Tau forms tumor-derived NFT that further destabilize the BCSFB. Our results underline for the first time the importance of the BCSFB as a vulnerable point of entry for brain-seeking tumor cells post-chemotherapy and indicate that tumor cells themselves contribute to Alzheimer's-like tauopathy.

"Give My Daughter the Shot!": A Content Analysis of the Depiction of Patients with Cancer Pain and Their Management in Hollywood Films

INTRODUCTION

Cinemeducation, the pedagogical use of films, has been used in a variety of clinical disciplines. To date, no studies have looked at the use of film depictions of cancer pain and its management in clinical education. We investigated how patients with cancer pain and their management are depicted in Hollywood films to determine whether there is content that would be amenable to use for cancer pain assessment and management education.

METHODS

A qualitative content analysis was performed. Films that contained characters with or references to cancer pain were searched for using the International Movie Database, the Literature Arts Medicine Database, the History of Medicine and Medical Humanities Database, and Medicine on Screen. After review, 4 films were identified for review and analysis.

RESULTS

Themes that emerged from the analysis concerned the films' depictions of characters with pain, their healthcare providers, the therapies used for pain management, and the setting in which pain management was provided.

CONCLUSIONS

This study demonstrates that patients with cancer pain are depicted in a compassionate manner. Pain management focused on the use of opioids. The settings in which patients received pain management was depicted as not being amenable to providing holistic care. This variety of topics related to pain management covered in the films make them amenable to use in cinemeducation. This study therefore forms the basis for future work developing film-based cancer education modules.

Popcorn in the pain clinic: a content analysis of the depiction of patients with chronic pain and their management in motion pictures

The watching of films is popular and accessible to broad segments of the population. The depiction of medical conditions in films has the potential to affect the public’s perception of them and contribute to stereotypes and stigma. We investigated how patients with chronic pain and their management are depicted in feature films. Films that contained characters with or references to chronic pain were searched for using databases such as the International Movie Database. Themes that emerged from the content analysis revolved around the films’ depictions of characters with pain, their health care providers, and therapies for pain management. Patients with chronic pain were depicted in various ways, including in manners that could elicit empathy from audiences or that might contribute to the development of negative stereotypes about them. The attitudes of health care professionals toward patients with chronic pain ranged from compassionate to dispassionate. Pain management was typically depicted as lacking in breadth or using multidisciplinary approaches with a focus on pharmacological management. The variety of topics related to chronic pain depicted in feature films lends to their use in medical education strategies to better inform health care professions trainees about chronic pain management.

Improving Financial Literacy Using the Medical Mini-MBA at a Canadian Medical School

Introduction

Financial literacy correlates with less debt and better retirement planning. Medical students, residents, and physicians often have poor financial literacy and large amounts of debt. We measured baseline financial literacy and whether it improved with the administration of a financial literacy course.

Methods

We created the Medical Mini-MBA,a six-week financial literacy course that targeted gaps in financial literacy among medical students and residents. Weekly topics included personal finance, investing, real estate and mortgage, physician billing and payment models, income and tax, and choosing a medical specialty. A 46-question financial literacy assessment was delivered to participants before and after the course.

Results

Of the 276 who participated in the course, 179 (64.86%) participated in the study. Participants who completed the course improved their financial literacy score by 10.10/46.00±5.12 (n=93, p<0.001). Self-assessment of financial literacy was positively correlated with financial literacy exam scores (r=0.366, p<0.001). Demographics such as gender, geography, education level, and first-degree relatives who are/were physicians had no effect on financial literacy scores.

Conclusions

The Medical Mini-MBA improved financial literacy at a Canadian medical school. Implementation of the coursemay equip medical students and residents for financial decisions. It avoids financial conflicts of interest and can supplement the medical curriculum.

Hazardous alcohol use and alcohol-related harm in rural and remote communities: a scoping review

Alcohol use is a major risk factor for death and disease worldwide and alcohol-related harms appear to be more prevalent in rural and remote, relative to urban, communities. This Review synthesised international research on rural-urban disparities in hazardous and harmful alcohol use and risk factors for these outcomes within rural and remote communities. 280 studies from 49 countries were included in the Scoping Review. Most studies (60%) found rural, relative to urban, residence to be associated with an increased likelihood of hazardous alcohol use or alcohol-related harm. This proportion increased between 1990 and 2019 and varied by country, age group, and outcome type, being highest in Australia, among young adults, and for more severe alcohol-related harms, such as drink driving and alcohol-related suicide. Improved public health strategies to reduce the burden of alcohol use in rural communities are required but their efficacy will depend on how well they are tailored to the unique needs of the region they are implemented in.

Swelling-Based Distributed Chemical Sensing with Standard Acrylate Coated Optical Fibers

Distributed chemical sensing is demonstrated using standard acrylate coated optical fibers. Swelling of the polymer coating induces strain in the fiber’s silica core provoking a local refractive index change which is detectable all along an optical fiber by advanced distributed sensing techniques. Thermal effects can be discriminated from strain using uncoated fiber segments, leading to more accurate strain readings. The concept has been validated by measuring strain responses of various aqueous and organic solvents and different chain length alkanes and blends thereof. Although demonstrated on a short range of two meters using optical frequency-domain reflectometry, the technique can be applied to many kilometer-long fiber installations. Low-cost and insensitive to corrosion and electromagnetic radiation, along with the possibility to interrogate thousands of independent measurement points along a single optical fiber, this novel technique is likely to find applications in environmental monitoring, food analysis, agriculture, water quality monitoring, or medical diagnostics.

AB0892 PREGNANCY AND LACTATION ASSOCIATED OSTEOPOROSIS: FIRST CASE SERIES IN IRAN

Background:

Osteoporosis is a common rheumatologic disorder in postmenopausal women which could lead to morbidities later in life. However, this condition has not been properly studied in premonapausal women.

During pregnancy, the fetus needs a total of 30 grams of calcium for its skeleton and during lactation, 200 mg of calcium is secreted in the breast milk per day which the mother acquires by doubling its intestinal absorption rate. If the calcium intake of the mother is not sufficient to satisfy the fetus’ needs, it will be provided by bone resorption, which will decrease the maternal calcium reserves [1].

Pregnancy and Lactation Associated Osteoporosis (PLAO) is a rare condition associated with pregnancy that should be considered in premenopausal women. The most commonly affected sites are the vertebrae and, more rarely, the hips, pubic rami and ribs [2].

An important complication of osteoporosis is fracture and a preemptive diagnosis and treatment thereof, can have drastic effects on the quality of life.

Objectives:

Our objective is to document the relevant risk factors, present signs and symptoms, course of illness, and response to treatment in three cases of PLAO. It is quite possible that osteoporosis in pregnancy

and lactation is more frequent than recognized, simply because it is only recognized when an-unexpected fracture occurs[3]. Thus, in this article we are presenting three cases that showcase the need for more rigorous research on PLAO risk factors, the need for screening in high risk patients, and the advantages of early detection in patients’ outcome.

Methods:

The clinical cases of the patients whose PLAO diagnoses had been confirmed by both a radiologist and a rheumatologist in the past year was extracted. Information related to demographic indices, clinical manifestations, and the treatment methods was evaluated and compared.

Results:

In the past year, three patients with a chief complaint of low-back pain have visited our clinic. The first, a 22-year-old woman with a nursing history of 2 months, the next one, a 31-year-old woman with a nursing history of 3 months, and the last, a 22-year-old woman with a nursing history of 4 months. All three patients had low back pain and tenderness. Two out of three patients had deficient vitamin D levels and the other had a normal one. All three patients had low BMD in lumbar vertebra and MRI imagings indicative of osteoporotic fracture.

Table 1.

General and pregnancy-relatedcharacteristics of the case studies

VariablesCase 1Case 2Case 3Age223122Nursing duration2 months3months4monthsBMD(lumbar spine)-3.6-3.5-3.1Vitamin D level12.6(ng/ml)31.6(ng/ml)8(ng/ml)FractureT12,L1T4,5,6,7,10,L2L1,2,3,4,5

Conclusion:

Since the symptoms of PLAO are often confused with pain in other low-back pain conditions associated with pregnancy, PLAO is a mostly overlooked diagnosis[4]. It is only recognized when an unexpected fracture occurs [3]Therefore, high risk patients with less severe symptoms are usually not diagnosed and thusly, should undergo a proper screening test, so that they are recognized early and the morbid sequelae are averted.

References:

[1]Kovacs, C. S., and S. H. Ralston. “Presentation and Management of Osteoporosis Presenting in Association with Pregnancy or Lactation.”Osteoporosis International, vol. 26, no. 9, 2015, pp. 2223–2241., doi:10.1007/s00198-015-3149-3.

[2]Gregorio, Silvana Di, et al. “Osteoporosis with Vertebral Fractures Associated with Pregnancy and Lactation.”Nutrition, vol. 16, no. 11-12, 2000, pp. 1052–1055., doi:10.1016/s0899-9007(00)00430-5.

[3]Bartl, Reiner, and Christoph Bartl. “The Osteoporosis Manual.” 2019, doi:10.1007/978-3-030-00731-7.

[4]Eroglu, Semra, et al. “Evaluation of Bone Mineral Density and Its Associated Factors in Postpartum Women.”Taiwanese Journal of Obstetrics and Gynecology, vol. 58, no. 6, 2019, pp. 801–804., doi:10.1016/j.tjog.2019.09.013.

Disclosure of Interests:

None declared

Immunomodulation in systemic lupus erythematosus: induction of M2 population in monocyte-derived macrophages by pioglitazone

Macrophages have recently gained attention in systemic lupus erythematosus (SLE) pathogenesis for their role in the anti-inflammatory clearance of apoptotic cells. The M1/M2 polarization of macrophages improves efferocytic capability. Peroxisome proliferator-activated receptor γ is proposed to function in the expansion of the M2 subpopulation. Pioglitazone is a peroxisome proliferator-activated receptor γ agonist with a variety of anti-inflammatory effects. In this paper, we investigated the ex vivo alterations of monocyte-derived macrophages of 15 newly diagnosed SLE patients and 10 normal subjects triggered by apoptotic cells among SLE patients following pioglitazone treatment. The phagocytosis capacity of macrophages and M1/M2 polarization (CD86/CD163) was evaluated. The supernatants were also analyzed for the expression of interleukin (IL)-10, IL-12, transforming growth factor β1 and TNF-α. The mRNA expression of IL-1β and mannose receptor C-type 1 were also quantified among treated and non-treated monocyte-derived macrophages. We found that efferocytosis is defective among monocyte-derived macrophages of SLE patients and might be a major underlying mechanism involved in the sustained inflammation. Pioglitazone could enhance alternative activation of monocyte-derived macrophages and consequently immunomodulation in these patients.

Investigating the atomic level influencing factors of glass forming ability in NiAl and CuZr metallic glasses

Bulk metallic glasses are a relatively new class of amorphous metal alloy which possess unique mechanical and magnetic properties. The specific concentrations and combinations of alloy elements needed to prevent crystallization during melt quenching remains poorly understood. A correlation between atomic properties that can explain some of the previously identified glass forming ability (GFA) anomalies of the NiAl and CuZr systems has been identified, with these findings likely extensible to other transition metal-transition metal and transition metal-metalloid (TM-M) alloy classes as a whole. In this work, molecular dynamics simulation methods are utilized to study thermodynamic, kinetic, and structural properties of equiatomic CuZr and NiAl metallic glasses in an attempt to further understand the underlying connections between glass forming ability, nature of atomic level bonding, short and medium range ordering, and the evolution of structure and relaxation properties in the disordered phase. The anomalous breakdown of the fragility parameter as a useful GFA indicator in TM-M alloy systems is addressed through an in-depth investigation of bulk stiffness properties and the evolution of (pseudo)Gruneisen parameters over the quench domain, with the efficacy of other common glass forming ability indicators similarly being analyzed through direct computation in respective CuZr and NiAl systems. Comparison of fractional liquid-crystal density differences in the two systems revealed 2-3 times higher values for the NiAl system, providing further support for its efficacy as a general purpose GFA indicator.