Acute toxicity in patients with high-risk prostate cancer treated with stereotactic body radiation, with irradiation to the prostate and pelvic nodes

PURPOSE

Stereotactic body radiation therapy has been used for prostate cancer. However, the bulk of published studies on stereotactic body radiation therapy for prostate cancer has involved the irradiation of the prostate alone, without irradiation of the pelvic lymph nodes. We report our preliminary experience with this approach.

MATERIAL AND METHODS

The files of patients with biopsy-proven prostate cancer treated with stereotactic body radiation therapy in our institution were reviewed. Stereotactic body radiation was delivered with intensity modulated-volumetric arctherapy with daily image-guidance. The prostate planning target volume included the prostate plus a margin of 5mm in all directions. The pelvic planning target volume included pelvic nodes plus an expansion of 6 to 7mm in all directions. The prostate planning target volume received a total dose of 36.25Gy delivered in five fractions on alternate days. The nodal planning target volume received a dose of 25Gy in the same five fractions. Patients were followed during treatment, after 1, and 3 months and every 6 months thereafter. Gastrointestinal and genitourinary toxicity was prospectively graded according to Common Terminology Criteria for Adverse Events.

RESULTS

Among the 188 patients, 80 received stereotactic body radiation to the prostate and the pelvic nodes, while 108 received stereotactic body radiation to the prostate target only. Grade 2 acute gastrointestinal toxicity was 4% in both groups, and grade 2 acute genitourinary toxicity was 27% and 20% (P=0.9) for prostate only versus prostate and pelvis respectively. There was no grade 3 or higher acute gastrointestinal or genitourinary toxicity.

CONCLUSION

Stereotactic body radiation therapy in five fractions including the prostate and pelvic nodes, in patients with high-risk prostate cancer, has been feasible and safe in terms of acute toxicity.

Changes to women's childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women's planned birth and actual birth experiences during COVID-19 was associated with women's postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06-1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29-1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77-0.97]; p = 0.014). Changes to women's childbirth plans during the COVID-19 pandemic were common and associated with women's postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.

Long-Term Toxicity in Patients Receiving Radiotherapy for Ultracentral Stage I Non-Small Cell Lung Cancer - A Secondary Analysis of the LUSTRE Randomized Trial

PURPOSE/OBJECTIVE(S)

Hypofractionated and stereotactic body radiotherapy (SBRT) are increasingly used in the treatment of centrally located, early-stage non-small cell lung cancer (NSCLC), though there are concerns of increased morbidity and mortality in patients with ultracentral tumors (UC). We report on the long-term toxicity of patients with UC lung cancer treated on a prospective randomized clinical trial of SBRT versus conventionally hypofractionated radiotherapy (CRT) for stage I NSCLC (NCT01968941).

MATERIALS/METHODS

Patients with UC tumors, defined as those where the planning target volume directly overlaps with the proximal bronchial tree (PBT), were identified from the larger cohort of patients treated on the trial. These patients received either SBRT with 60 Gy in 8 fractions or CRT with 60 Gy in 15 fractions. The primary endpoint of this secondary analysis was development of any grade 3 or higher toxicity defined using CTCAE version 3.0. Secondary endpoints included local control, as well as dosimetric analysis of the PBT, using EQD2 with α/β ratio of 3 to assess the relationship between dose to the PBT and toxicity.

RESULTS

Twenty-nine patients were identified with UC tumors; 21 received SBRT and 8 received CRT. Median age was 72 years (range 55-88 years) and 59% were female. Median FEV1 was 1.46L (range 0.64-2.37L). Patients had either T1 (59%) or T2 (41%) lesions, with median tumor size 2.5cm (range 1.1-4.9cm). Most patients had histologically confirmed disease (squamous cell, n = 10; adenocarcinoma, n = 8; radiographically suspicious, n = 11). The median follow-up was 2.9 years (range 0.7-5.2 years). The 3-year local control rate of all patients was 88.3% (95% confidence interval: 75.7-100%). There were 3 patients with late (>3 months) grade 3 toxicity (bronchial stricture, chest pain, and atelectasis) and 1 patient with late grade 5 toxicity (bleeding/hemorrhage), all treated in the SBRT arm. Median EQD2 dose to PBT in patients with grade ≥3 late toxicity compared to the rest of the cohort was: Dmax, 132 vs 129 Gy; D0.1cc, 129 vs 119 Gy; D1cc, 124 vs 80 Gy; and D5cc, 83 vs 41 Gy. Median EQD2 volumetric doses in grade ≥3 patients (compared to the rest) to PBT were: V65 Gy, 9.7 vs 2.2cc; V80 Gy, 7.9 vs 1.1cc; V90 Gy, 6.2 vs 0.4cc; and V100 Gy, 4.8 vs 0.3cc. The single patient with grade 5 toxicity had the highest D5cc (116 Gy) and V100 Gy (7cc) among all patients.

CONCLUSION

Stereotactic radiation with 60 Gy in 8 fractions for UC lung cancer provides good local control but carries an approximately 15-20% rate of late grade ≥3 toxicity. There appears to be a dosimetric association between toxicity and dose to the PBT. It may be more important to minimize volumetric PBT dose rather than maximum point dose to reduce risk of severe late toxicity.

Outcomes of Hypofractionated Radiotherapy with Induction or Sequential Chemotherapy for Unresectable Stage III Non-Small Cell Lung Cancer: Single Institution Experience

PURPOSE/OBJECTIVE(S)

The standard of care for unresectable stage III non-small cell lung cancer (NSCLC) patients not candidates for concurrent chemotherapy (CT) and radiotherapy (RT) is not well established. Hypofractionated RT (hRT) can be used after CT induction, or, as a bridge to sequential CT to offer a curative intent treatment regimen. Tumor and nodal proximity to mediastinal structures plays an important role regarding the degree of safe hypofractionation. There is limited published evidence related the benefits of hRT combined with induction or sequential CT among this group of patients. We analyzed the outcomes of stage III NSCLC receiving a hRT regimen of 52.5 Gy in 15 fractions alone, or with either induction or sequential CT.

MATERIALS/METHODS

In this retrospective review, patients with stage III NSCLC receiving hRT 52.5 Gy in 15 fractions between 2008 and 2020 were included for analysis. Patients were separated into three cohorts: i) hRT alone, ii) induction CT followed by hRT, and iii) hRT followed by sequential CT. Overall survival (OS) and radiation toxicity (CTCAE v5.0) were analyzed for all 3 cohorts. Patients for whom sequential chemotherapy was planned, but not delivered, were included in cohort ii) through intention-to-treat analysis. The OS at 2 years was statistically evaluated using a log-rank test with alpha set at 0.05.

RESULTS

Eighty-three patients met criteria for analysis with 35, 30, and 18 patients respectively in cohorts i), ii), and iii). Median age at treatment was 75 (43-91) with 53% of patients being men and 43% women. Tumor histology varied between adenocarcinoma (43%), squamous cell carcinoma (44%), and others (13%). The median/2-year OS for cohorts i), ii), and iii) was 8 mo/19%, 25 mo/50%, and 17 mo/72% respectively. OS between any chemotherapy and no chemotherapy was statistically significant (p = 6.1x10-7) while the timing of chemotherapy did not reach statistical significance (p = 0.15). RT was overall well tolerated with grade 1-2 fatigue being the most common side effect (81%), 1 patient had grade 3 pneumonitis, and 1 patient had a rib fracture.

CONCLUSION

Among patients with stage III NSCLCs, moderately hRT of 52.5 Gy in 15 fractions, with either induction or sequential CT appears to provide a survival advantage compared to hRT alone, with an acceptable side-effect profile. The 2-year OS reported here is similar to other published hRT regimens (SOCCAR trial) and conventional fractionation (RTOG0617). Conclusions are limited by the retrospective nature of the study, and the introduction of immunotherapy (IO) for stage III NSCLC in 2019 in Canada. Future work will focus on evaluating dosimetry, the impact of IO, and, patients not included in this analysis that also received this regimen (oligometastasis, locoregional failure, other stages).

Quality of Life Results of Addition of Androgen Deprivation Therapy and Pelvic Lymph Node Treatment to Prostate Bed Salvage Radiotherapy: NRG Oncology/RTOG 0534 SPPORT

PURPOSE/OBJECTIVE(S)

Report the quality of life (QOL) analysis of the SPPORT trial of men with a detectable prostate specific antigen (PSA) after prostatectomy for prostate cancer randomized to (Arm 1) salvage prostate bed radiotherapy (PBRT), (Arm 2) 4-6 months of short-term androgen deprivation therapy (STADT) + PBRT, and (Arm 3) pelvic lymph node radiotherapy (PLNRT) + STADT + PBRT. Primary analysis established a benefit of adding PLNRT and STADT to PBRT. There was higher short term but no statistically significant difference in long term adverse events with the exception of blood or bone marrow events.

MATERIALS/METHODS

QOL endpoints were assessed at baseline, 6 weeks after RT start, 1 and 5 years, including Expanded Prostate Cancer Index Composite (EPIC) (bowel, urinary, sexual, and hormonal domains), Hopkins Symptom Checklist (HSCL-25) (depressive symptoms), and the EuroQol (EQ-5D) (health state weights used in quality adjusted life years (QALYs). In addition to statistical significance, differences in scores were assessed using 0.5 standard deviation (SD) as the criterion for clinical importance. Difference among arms was assessed using pairwise t-tests, Fisher's exact test, and mixed effects regression modeling. To control for multiplicity, the p-value required for statistical significance is p<0.025.

RESULTS

Six hundred forty-four patients consented to QOL, about 210 on each arm. Baseline characteristics were not significantly different among arms: 81% were white and 54% <65 years. For EPIC, bowel domain scores decreased at 6 weeks post-RT then increased by years 1 and 5, although not to baseline levels. One clinically significant difference in bowel scores was Arm 3 vs. Arm 1 at 6 weeks. For the urinary domain, scores decreased at 6 weeks post-RT and remained below baseline at 1 and 5 years, but there were no significant differences among arms. For the sexual domain, there were statistically significant differences between arms at 6 weeks and 1 year with patients receiving STADT exhibiting poorer sexual QOL scores. By year 5 the differences were no longer significant. A similar pattern was seen for the hormonal domain. For HSCL-25, differences at 6 weeks were statistically but not clinically significant, and there were no significant differences at the later time points. Comparisons of QALYs for overall survival over an 8-year horizon showed no significant group differences, with a mean of about 7.8 in each arm. Regarding freedom from progression, QALY means were 5.7, 6.5, and 7.4 years for Arms 1, 2, and 3, respectively, with a significant difference between Arms 3 and 1 (p = <.001) favoring the more intensive treatment.

CONCLUSION

While QOL generally declined among all arms at 6 weeks post RT, there were no clinically significant differences in QOL among arms at 5 years. QALYs for freedom from progression favored STADT + PLNRT + PBRT for salvage treatment of prostate cancer.

Relaxation intervention to improve diabetic foot ulcer healing: Results from a pilot randomized controlled study

This pilot randomised controlled study (RCT) aimed to assess the feasibility and acceptability of a progressive muscle relaxation with guided imagery intervention (experimental group [EG]) compared to a neutral guided imagery placebo (active control group [ACG]) and standard care to diabetic foot ulcer [DFU] treatment (passive control group [PCG]), to decide on the need for a definitive RCT. Diabetic foot patients with one or two chronic DFU and significant levels of stress/anxiety/depression were recruited and assessed during a period of 6 months, at three moments. Primary outcomes: feasibility rates and satisfaction with relaxation sessions. Secondary outcomes: DFU healing score, DFU-related quality of life (DFUQoL), physical and mental HRQoL, stress and emotional distress, DFU representations, arterial blood pressure, and heart rate. A total of 146 patients completed the baseline (T0) assessment with 54 participants presenting significant distress being randomised into three groups. Patients were assessed 2 months post-intervention (T1) and 4 months after T1 (T2). Feasibility rates showed reduced values on eligibility, recruitment and inclusion in the study, although with an acceptable rate of refusal lower than 10%. On average, participants reported being satisfied with relaxation sessions and recommended them to other patients. Differences between groups showed that, at T1, PCG participants reported higher levels of stress than those from EG and ACG. Within-group differences showed improvements in stress, distress, DFUQoL and DFU extent over time only in EG and ACG. Only EG showed significant changes in DFU representations at T1. The results suggest that relaxation may be a promising coping strategy to deal with DFU distress and an important adjuvant therapy for DFU healing, supporting the implementation of a definitive RCT.

Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis

PURPOSE

Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes).

METHODS

Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included.

RESULTS

This meta-analysis included 16 studies whose differences were related to the need of reoperation (p < 0.01) and the duration of surgery (p = 0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intra-abdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min).

CONCLUSIONS

The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.

Standardized Platelet-Rich Fibrin (PRF) from canine and feline origin: An analysis on its secretome pattern and architectural structure

Platelet-rich fibrin (PRF) has been incorporated in surgical procedures to promote tissue and bone healing, particularly in human medicine. The rationale for the use of platelet-based products stems from the fact that platelets, after being activated, release growth factors (GFs) and other active molecules such as cytokines, that modulate inflammation and tissue repair. Although PRF has been advanced as a therapeutic treatment for veterinary use, namely in canine and feline patients (following human medicine developments), to our knowledge a full characterization of PRF therapeutic effectors has never been performed. Herein, we studied the biological properties and release profile of GFs and other cytokines throughout ten days in in vitro culture conditions, in order to investigate the potential therapeutic ability of PRF for canine and feline practice. A protocol for obtaining PRF from whole blood without anti-coagulant from both species was optimized, originating large and homogenous PRF clots. Then, PRF clots obtained from four dogs and four cats were incubated in culture medium to assess the temporal release of platelet-derived growth factor-BB (PDGF-BB), vascular endothelial factor-A (VEGF-A), transforming growth factor β-1 (TGF-β1), and interleukin-8 (IL-8). Furthermore, morphological characterization of PRF clots, fresh and after 10 days of incubation, was performed by histology and high-resolution field emission electron scanning microscopy. In standard culture conditions, PRF clots from both species released PDGF-BB, TGF- β1 and VEGF-A, in a sustained manner, up to day 10. Moreover, PRF presents an initial burst release of IL-8, a mediator of inflammatory response which plays a key role in neutrophil recruitment and degranulation. Overall, our findings show that PRF clots may be an efficient therapeutic strategy in canine and feline clinical practice, accelerating the local healing mechanism, through the sustained delivery of signalling molecules involved in the healing cascade.

Work-family conflicts, cognitive appraisal, and burnout: Testing the mediation effect with structural equation modelling

Work-family conflict constitutes an important source of occupational stress predicting teachers' burnout, and cognitive variables have shown to be core structures in explaining human adaptation to stress. Nevertheless, the role of cognitive appraisal needs to be fully analysed to comprehend how it can mediate the relationship between stress and burnout. In order to understand the potential mediation of cognitive appraisal in the relationship between stress and burnout, we adopted conceptual models of stress that highlighted the value of cognitive appraisal on positive and negative reactions to work demands. Also, we analysed the potential moderation of sex and age in the relationship between work-family conflict, cognitive appraisal, and burnout due to inconsistent findings on how these personal variables can interfere on these relations. In this study, we used structural equation modelling (SEM) to test the mediating of cognitive appraisal in the relationship between work-family conflicts and burnout. A survey with measures of work-family conflicts, cognitive appraisal, and burnout was administered to the participants consisting of 438 Portuguese teachers from kindergarten through high school, aged between 28 and 67 years (M = 46.85; SD = 7.88), 304 of whom were females (69.41%). The results confirmed that cognitive appraisal partially mediated the relationship between work-family conflict and burnout. The mediation effect of cognitive appraisal on the relationship between work-family conflict and burnout was invariant regardless of teachers' sex or age. In sum, cognitive appraisal should be considered in order to understand teachers' adaptation to work.

Callous-Unemotional Traits Moderate Anticipated Guilt and Wrongness Judgments to Everyday Moral Transgressions in Adolescents

Callous-unemotional (CU) traits observed during childhood and adolescence are thought to be precursors of psychopathic traits in adulthood. Adults with high levels of psychopathic traits typically present antisocial behavior. Such behavior can be indicative of atypical moral processing. Evidence suggests that moral dysfunction in these individuals may stem from a disruption of affective components of moral processing rather than from an inability to compute moral judgments per se. No study to date has tested if the dissociation between affective and cognitive dimensions of moral processing linked to psychopathic traits in adulthood is also linked to CU traits during development. Here, 47 typically developing adolescents with varying levels of CU traits completed a novel, animated cartoon task depicting everyday moral transgressions and indicated how they would feel in such situations and how morally wrong the situations were. Adolescents with higher CU traits reported reduced anticipated guilt and wrongness appraisals of the transgressions. However, our key finding was a significant interaction between CU traits and anticipated guilt in predicting wrongness judgments. The strength of the association between anticipated guilt and wrongness judgement was significantly weaker for those with higher levels of CU traits. This evidence extends our knowledge on the cognitive-affective processing deficits that may underlie moral dysfunction in youth who are at heightened risk for antisocial behavior and psychopathy in adulthood. Future longitudinal research is required to elucidate whether there is an increased dissociation between different components of moral processing from adolescence to adulthood for those with high psychopathic traits.

Internal and External Factors Underlying Variations in Adolescents' Daily Optimal Experiences

This study investigated how the internal psychological states (i.e., challenge-skill perception, positive and negative affect, and effortless attention) and contextual features (i.e., activity and company) of momentary experiences relate to optimal experience in adolescents' lives. Data were collected from 245 Portuguese adolescents (14-19 years old, 63% female) by using the experience sampling method. Multilevel modeling revealed that challenge-skill and positive affect were positively associated with optimal experience, while negative affect was negatively associated with optimal experience. Effortless attention mediated the associations between internal states and optimal experience, while activity and company only moderated some of these associations. These findings will inform practitioners about the factors that should be addressed in interventions with adolescents to promote optimal experiences in their lives.

Biofunctional Nanofibrous Substrate for Local TNF-Capturing as a Strategy to Control Inflammation in Arthritic Joints

Rheumatoid arthritis (RA) is an autoimmune disease that affects the synovial cavity of joints, and its pathogenesis is associated with an increased expression of pro-inflammatory cytokines, namely tumour necrosis factor-alpha (TNF-α). It has been clinically shown to have an adequate response to systemic administration of TNF-α inhibitors, although with many shortcomings. To overcome such limitations, the immobilization of a TNF-α antibody on a nanofibrous substrate to promote a localized action is herein proposed. By using this approach, the antibody has its maximum therapeutic efficacy and a prolonged therapeutic benefit, avoiding the systemic side-effects associated with conventional biological agents' therapies. To technically achieve such a purpose, the surface of electrospun nanofibers is initially activated and functionalized, allowing TNF-α antibody immobilization at a maximum concentration of 6 µg/mL. Experimental results evidence that the biofunctionalized nanofibrous substrate is effective in achieving a sustained capture of soluble TNF-α over time. Moreover, cell biology assays demonstrate that this system has no deleterious effect over human articular chondrocytes metabolism and activity. Therefore, the developed TNF-capturing system may represent a potential therapeutic approach for the local management of severely affected joints.

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease

AIM

To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients.

METHODS

A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality.

RESULTS

Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r²-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05).

CONCLUSION

This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.

Influence of PDLA nanoparticles size on drug release and interaction with cells

Polymeric nanoparticles (NPs) are strong candidates for the development of systemic and targeted drug delivery applications. Their size is a determinant property since it defines the NP-cell interactions, drug loading capacity, and release kinetics. Herein, poly(d,l-lactic acid) (PDLA) NPs were produced by the nanoprecipitation method, in which the influence of type and concentration of surfactant as well as PDLA concentration were assessed. The adjustment of these parameters allowed the successful production of NPs with defined medium sizes, ranging from 80 to 460 nm. The surface charge of the different NPs populations was consistently negative. Prednisolone was effectively entrapped and released from NPs with statistically different medium sizes (i.e., 80 or 120 nm). Release profiles indicate that these systems were able to deliver appropriate amounts of drug with potential applicability in the treatment of inflammatory conditions. Both NPs populations were cytocompatible with human endothelial and fibroblastic cells, in the range of concentrations tested (0.187-0.784 mg/mL). However, confocal microscopy revealed that within the range of sizes tested in our experiments, NPs presenting a medium size of 120 nm were able to be internalized in endothelial cells. In summary, this study demonstrates the optimization of the processing conditions to obtain PDLA NPs with narrow size ranges, and with promising performance for the treatment of inflammatory diseases. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 482-493, 2019.

The functionalization of natural polymer-coated gold nanoparticles to carry bFGF to promote tissue regeneration

A schematic of the preparation of natural polymer-coated AuNPs for monitoring tissue regeneration stimulated by bFGF.

Electrospun Nanofibrous Meshes Cultured With Wharton's Jelly Stem Cell: An Alternative for Cartilage Regeneration, Without the Need of Growth Factors

Many efforts are being directed worldwide to the treatment of OA-focal lesions. The majority of those efforts comprise either the refinement of surgical techniques or combinations of biomaterials with various autologous cells. Herein, we tested electrospun polycaprolactone (PCL) nanofibrous meshes for cartilage tissue engineering. For that, articular chondrocytes (hACs) isolated from human osteoarthritic joints and Wharton's Jelly Stem Cells (hWJSCs) are cultured on electrospun nanofiber meshes, without adding external growth factors. We observed higher glycosaminoglycans production and higher over-expression of cartilage-related genes from hWJSCs cultured with basal medium, when compared to hACs isolated from osteoarthritic joints. Moreover, the presence of sulfated proteoglycans and collagen type II is observed on both types of cell cultures. We believe that this effect is due to either the electrospun nanofibers topography or the intrinsic chondrogenic differentiation potential of hWJSCs. Therefore, we propose the electrospun nanofibrous scaffolds in combination with hWJSCs as a viable alternative to the commercial membranes used in autologous chondrogenic regeneration approaches.

The effect of data exchange protocols on decision support systems for heart sounds

Heart auscultation is one of the basic exams performed during a patient physical examination, but it is also one that has a high skill ceiling. Decision support systems can provide physicians with a tool that can help to reduce the demanding skill requirements of this exam. Nevertheless, this second opinion needs to be delivered in a timely interval in order to be truly useful for a physician. To do this we need not only optimized algorithms, but also a well designed system. In this paper, we have studied how two different data exchange protocols, that define how data should be transferred from an acquisition to a process module, can impact the celerity of delivering second opinion to a physician. With data collected from real exams, acquired in a field hospital initiative in Brazil, we recreated two use cases that allowed us to measure performance in the form of time and resources spent, as well as power consumption. Results have shown that different data exchange protocols can have a significant impact on a decision support system response time.

Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study

Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

Assessment of bone healing ability of calcium phosphate cements loaded with platelet lysate in rat calvarial defects

Injectable calcium phosphate cements have been used as a valid alternative to autologous bone grafts for bone augmentation with the additional advantage of enabling minimally invasive implantation procedures and for perfectly fitting the tissue defect. Nevertheless, they have low biodegradability and lack adequate biochemical signaling to promote bone healing and remodeling. In previous in vitro studies, we observed that the incorporation of platelet lysate directly into the cement paste or loaded in hyaluronic acid microspheres allowed to modulate the cement degradation and the in vitro expression of osteogenic markers in seeded human adipose derived stem cells. The present study aimed at investigating the possible effect of this system in new bone formation when implanted in calvarial bilateral defects in rats. Different formulations were assessed, namely plain calcium phosphate cements, calcium phosphate cements loaded with human platelet lysate, hybrid injectable formulations composed of the calcium phosphate cement incorporating hyaluronin acid non-loaded microparticles (20% hyaluronin acid) or with particles loaded with platelet lysate. The degradability and new bone regrowth were evaluated in terms of mineral volume in the defect, measured by micro-computed tomography and histomorphometric analysis upon 4, 8 and 12 weeks of implantation. We observed that the incorporation of hyaluronin acid microspheres induced an overly rapid cement degradation, impairing the osteoconductive properties of the cement composites. Moreover, the incorporation of platelet lysate induced higher bone healing than the materials without platelet lysate, up to four weeks after surgery. Nevertheless, this effect was not found to be significant when compared to the one observed in the sham-treated group.

Test of the Social Cognitive Model of Well-Being in Spanish College Students

The social cognitive model of well-being was tested in a sample of 373 college students in Spain. Participants completed measures of academic self-efficacy, environmental support, goal progress, academic satisfaction and stress, trait positive affect, and overall life satisfaction. A path analysis indicated that the model fit the data well and accounted for substantial portions of the variance in academic domain satisfaction, academic stress, and life satisfaction, though a few path coefficients (e.g., from positive affect and environmental support to academic stress) were nonsignificant. We consider the findings in relation to prior tests of the well-being model and discuss implications for practice and future research.

Stress and Psychological Health: Testing the Mediating Role of Cognitive Appraisal

This study tested the mediating role of primary (e.g., threat and challenge perceptions) and secondary (e.g., coping potential and control perception) cognitive appraisal in the relationship between occupational stress and psychological health. This mediation was tested using a cross-sectional study based on self-reported measures. The total sample consisted of 2,302 nurses, 1,895 females (82.3%) and 407 males (17.7%), who completed an evaluation protocol with measures of occupational stress, cognitive appraisal, and psychological health. To test the mediating role of cognitive appraisal in the relationship between cognitive appraisal and psychological health, we used Structural Equation Modeling (SEM). The results confirmed that primary and secondary cognitive appraisals partially mediated the relationship between occupational stress and psychological health; however, the direct effects of stress on psychological health cannot be ignored. The findings indicated that cognitive appraisal is an important underlying mechanism in explaining adaptation at work.

Dual release of a hydrophilic and a hydrophobic osteogenic factor from a single liposome

Dual release of growth/differentiation factors from liposomes induced osteogenic differentiation of mesenchymal stem cells.

Hierarchical scaffolds enhance osteogenic differentiation of human Wharton's jelly derived stem cells

Hierarchical structures, constituted by polymeric nano and microfibers, have been considered promising scaffolds for tissue engineering strategies, mainly because they mimic, in some way, the complexity and nanoscale detail observed in real organs. The chondrogenic potential of these scaffolds has been previously demonstrated, but their osteogenic potential is not yet corroborated. In order to assess if a hierarchical structure, with nanoscale details incorporated, is an improved scaffold for bone tissue regeneration, we evaluate cell adhesion, proliferation, and osteogenic differentiation of human Wharton's jelly derived stem cells (hWJSCs), seeded into hierarchical fibrous scaffolds. Biological data corroborates that hierarchical fibrous scaffolds show an enhanced cell entrapment when compared to rapid prototyped scaffolds without nanofibers. Furthermore, upregulation of bone specific genes and calcium phosphate deposition confirms the successful osteogenic differentiation of hWJSCs on these scaffolds. These results support our hypothesis that a scaffold with hierarchical structure, in conjugation with hWJSCs, represents a possible feasible strategy for bone tissue engineering applications.

Instructive nanofibrous scaffold comprising runt-related transcription factor 2 gene delivery for bone tissue engineering

Inducer molecules capable of regulating mesenchymal stem cell differentiation into specific lineages have proven effective in basic science and in preclinical studies. Runt-related transcription factor 2 (RUNX2) is considered to be the central gene involved in the osteoblast phenotype induction, which may be advantageous for inducing bone tissue regeneration. This work envisions the development of a platform for gene delivery, combining liposomes as gene delivery devices, with electrospun nanofiber mesh (NFM) as a tissue engineering scaffold. pDNA-loaded liposomes were immobilized at the surface of functionalized polycaprolactone (PCL) NFM. Human bone-marrow-derived mesenchymal stem cells (hBMSCs) cultured on RUNX2-loaded liposomes immobilized at the surface of electrospun PCL NFM showed enhanced levels of metabolic activity and total protein synthesis. RUNX2-loaded liposomes immobilized at the surface of electrospun PCL NFMs induce a long-term gene expression of eGFP and RUNX2 by cultured hBMSCs. Furthermore, osteogenic differentiation of hBMSCs was also achieved by the overexpression of other osteogenic markers in medium free of osteogenic supplementation. These findings demonstrate that surface immobilization of RUNX2 plasmid onto elestrospun PCL NFM can produce long-term gene expression in vitro, which may be employed to enhance the osteoinductive properties of scaffolds used for bone tissue engineering strategies.