TGFβ carrying exosomes in plasma: potential biomarkers of cancer progression in patients with head and neck squamous cell carcinoma

OBJECTIVES

Contributions of TGFβ to cancer progression are well documented. However, plasma TGFβ levels often do not correlate with clinicopathological data. We examine the role of TGFβ carried in exosomes isolated from murine and human plasma as a contributor to disease progression in head and neck squamous cell carcinoma (HNSCC).

MATERIALS AND METHODS

The 4-nitroquinoline-1-oxide (4-NQO) mouse model was used to study changes in TGFβ expression levels during oral carcinogenesis. In human HNSCC, TGFβ and Smad3 protein expression levels and TGFB1 gene expression were determined. Soluble TGFβ levels were evaluated by ELISA and TGFβ bioassays. Exosomes were isolated from plasma using size exclusion chromatography, and TGFβ content was quantified using bioassays and bioprinted microarrays.

RESULTS

During 4-NQO carcinogenesis, TGFβ levels in tumour tissues and in serum increased as the tumour progressed. The TGFβ content of circulating exosomes also increased. In HNSCC patients, TGFβ, Smad3 and TGFB1 were overexpressed in tumour tissues and correlated with increased soluble TGFβ levels. Neither TGFβ expression in tumours nor levels of soluble TGFβ correlated with clinicopathological data or survival. Only exosome-associated TGFβ reflected tumour progression and correlated with tumour size.

CONCLUSIONS

Circulating TGFβ+ exosomes in the plasma of patients with HNSCC emerge as potential non-invasive biomarkers of disease progression in HNSCC.

966 IMPROVING COMMUNICATION WITH RELATIVES IN THE COVID ERA - DEVELOPMENT OF A NEW SERVICE STANDARD

Background

Quality improvement project undertaken by the Ageing and Complex Medicine team to improve the quality and quantity of communication with patients’ relatives.

Introduction

Visitation restrictions at RAEI since the onset of the COVID pandemic have created barriers to effective communication between patients’ relatives and the medical team. Patients’ relatives were frequently receiving poorly structured information, incorrect information, or even no information. This problem was hospital wide and likely to have affected other trusts. It particularly affected elderly care wards, where the cohort of patients were often less able provide their relatives with updates themselves. We therefore agreed a service standard whereby the medical team would provide a medical update via phone to the patients’ next of kin within 24 hours of admission followed by twice weekly updates by any member of the wider MDT. Our aim was to improve the quality and quantity of communication with the patients’ relatives.

Method

So far 6 data capture cycles have seen us implement change in various ways such as utilisation of a white board to highlight when updates are due, a staff feedback survey to highlight barriers to providing the service and a relative feedback survey to evaluate their experience.

Results

Compared to baseline data we have seen an improvement in the quantity of relative updates with most cycles.

Conclusion

We have improved the quantity of relative updates and embedded it as established culture on Astley ward. Barriers to success include staffing levels, time burden, and low confidence levels amongst junior doctors. Cycle 7 will see implementation of a teaching session for new junior doctor cohorts to improve their confidence. I would like to share our learning and success with the wider hospital and see implementation of the service standard across all wards within the trust.

The use of cannabis and perceptions of its effect on fertility among infertility patients

STUDY QUESTION

What is the prevalence of cannabis use and the perceptions of its impact on fertility among infertility patients?

SUMMARY ANSWER

A total of 13% of infertility patients used cannabis within the last year, and current usage is associated with patient perceptions of negative effects of cannabis on fertility and pregnancy.

WHAT IS KNOWN ALREADY

Cannabis use is increasing among the general population and pregnant women, particularly in places where cannabis use is legal despite having known and potential negative effects on fertility and pregnancy.

STUDY DESIGN, SIZE, DURATION

A cross-sectional patient survey study was performed between July 2017 and September 2017. Patients attending a university-affiliated hospital-based fertility clinic (n = 290) were invited to complete a written survey. Inclusion criteria were limited to the ability to read English. There were no exclusion criteria.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Of the 290 patients approached, 270 (93%) agreed to participate. The questions covered demographics, cannabis usage, perceptions of the effect of cannabis on fertility and pregnancy, cessation of use due to infertility and personal history of disclosing cannabis use to healthcare providers (HCP).

MAIN RESULTS AND THE ROLE OF CHANCE

The results showed that 13% of respondents disclosed use of cannabis in the past year (past year users) and 38% had not used cannabis in the past year but had previously used cannabis (>1 year users) while 49% had never used cannabis (never users). Baseline demographics were similar for the three groups, but across four measures of fertility and pregnancy health, past-year users perceived less of a negative effect compared to >1 year users, and never users (P values of 0.02, 0.03, 0.01, <0.001 for questions on pregnancy, offspring health, male fertility and female fertility, respectively). Of past year users, 72% said they had or would disclose use to their HCP, but only 9.4% reported that their HCP had actually instructed them to discontinue use.

LIMITATIONS, REASONS FOR CAUTION

Self-reported patient surveys are subject to reporting bias and may not reflect actual use and perceptions.

WIDER IMPLICATIONS OF THE FINDINGS

This study suggests that cannabis use is common among infertility patients. Given the known negative impacts of cannabis on pregnancy, the authors would have expected informed infertility patients to cease cannabis use as part of their efforts to conceive. As the prevalence of cannabis use in the last year among infertility patients is similar to that in the general Canadian population, it is unclear whether the prevalence of cannabis use in the sample population merely reflects the average usage in society or, after taking into account those who reduced their usage to improve their fertility, is a factor contributing to infertility and thus prompting fertility referral. Given concern about the potential negative impact of cannabis use on fertility, and that only 9% of past year users had been instructed by an HCP to cease cannabis use, HCPs should consider the benefits of counselling about cannabis cessation for patients who are attempting to conceive. Future research should focus on analysing the effects of cannabis use on female fertility and determining whether a reduction in use among patients with infertility can improve conception rates.

STUDY FUNDING/COMPETING INTEREST(S)

Michelle Shin, Clinical Research Associate, is supported by the University of Toronto GREI Fellowship Fund, which is sponsored by unrestricted research grants from EMD Serono, Merck Canada and Ferring Pharmaceuticals. The authors have no potential conflicts of interest to disclose.

Functional neuroanatomy of interoceptive processing in children and adolescents: a pilot study

In adults, interoception – the sense of the physiological condition of the body - appears to influence emotion processing, cognition, behavior and various somatic and mental health disorders. Adults demonstrate frontal-insula-parietal-anterior cingulate cortex activation during the heartbeat detection task, a common interoceptive measure. Little, however, is known about the functional neuroanatomy underlying interoception in children. The current pilot study examined interoceptive processing in children and adolescents with fMRI while using the heartbeat detection task. Our main findings demonstrate that children as young as the age of six activate the left insula, cuneus, inferior parietal lobule and prefrontal regions. These findings are similar to those in adults when comparing heartbeat and tone detection conditions. Age was associated with increased activation within the dACC, orbital frontal cortex and the mid-inferior frontal gyri. Thus, our pilot study may provide important information about the neurodevelopment of interoceptive processing abilities in children and a task for future interoception neuroimaging studies in children.

Recent climatic events controlling the hydrological and the aquifer dynamics at arid areas: The case of Huasco River watershed, northern Chile

The investigation assesses the influence of recent climatic events in the water resources and the aquifer dynamics in the Huasco watershed by means of the analysis of precipitation, streamflow and piezometric levels during the last 50years. These hydrological and hydrogeological parameters were evaluated by an exploratory geostatistical analysis (semivariogram) and a spectral analysis (periodogram). Specifically, the hydrological and hydrogeological data analyses are organized according to three sub-basins, the Del Carmen River (Section I), the El Tránsito River (Section II), and the Huasco River (Section III). Data ranges for rainfall are from 1961 to 2015, for streamflow from 1964 to 2015, and for groundwater levels from 1969 to 2014, available from Water Authority of Chile. The analyses allowed the identification of cycles in the hydrological and hydrogeological records. The study area is located in a transient climatic fringe where the convergence of several climatic systems can be identified in the hydrological and hydrogeological records. Results indicate that the nival areas and the small glaciers are especially important to the recharge processes in the Huasco watershed during the spring-summer snowmelting. Water reservoirs in the main aquifer (Section III) and in the Santa Juana dam are highly sensitive to ENSO oscillation climatic patterns. The main climatic events that control this record are the El Niño and La Niña events. In addition, the climatic influence of the westerlies and the SE extratropical moisture were also identified. Spectral analysis identified the presence of a 22.9-yearcycle in piezometric levels of the alluvial aquifer of the Huasco River. This cycle is consistent with the 22-year Hale solar cycle, suggesting the existence of a solar forcing controlling the ENSO oscillations. Moreover, semivariogram and spectral analysis identified a 10.65-yearcycle and a 9.2-yearcycle in groundwater, respectively, which were attributed to the strong mode of ENSO oscillations.

New Antarctic Gravity Anomaly Grid for Enhanced Geodetic and Geophysical Studies in Antarctica

Gravity surveying is challenging in Antarctica because of its hostile environment and inaccessibility. Nevertheless, many ground-based, airborne and shipborne gravity campaigns have been completed by the geophysical and geodetic communities since the 1980s. We present the first modern Antarctic-wide gravity data compilation derived from 13 million data points covering an area of 10 million km², which corresponds to 73% coverage of the continent. The remove-compute-restore technique was applied for gridding, which facilitated levelling of the different gravity datasets with respect to an Earth Gravity Model derived from satellite data alone. The resulting free-air and Bouguer gravity anomaly grids of 10 km resolution are publicly available. These grids will enable new high-resolution combined Earth Gravity Models to be derived and represent a major step forward towards solving the geodetic polar data gap problem. They provide a new tool to investigate continental-scale lithospheric structure and geological evolution of Antarctica.

[Optic neuropathy after retrobulbar neuritis in multiple sclerosis: are optical coherence tomography and magnetic resonance imaging useful and necessary follow-up parameters?]

BACKGROUND

This study evaluated whether progressive optic neuropathy (ON) is commonly found after retrobulbar neuritis and whether optical coherence tomography (OCT) is a useful tool for follow-up of patients with multiple sclerosis (MS).

METHODS

An observational study of 86 MS patients (currently treated with immunomodulation) with a past medical history of ON was carried out. Patients were assessed in 2010 and 2012 using the expanded disability status scale (EDSS), visual acuity, visual evoked potentials (VEP) and OCT but magnetic resonance imaging (MRI) was performed only in 2012.

RESULTS

In this study 16 men and 70 women with a mean age of 41.6 and 43.8 years, respectively, were evaluated (28 patients post bilateral and 58 patients post unilateral ON including 114 eyes post-ON and 58 eyes without previous ON). Visual acuity and VEPs improved or remained the same over the study period. Visual acuity, VEPs, retinal nerve fiber layer (RNFL) thickness and macular volume were significantly worse in eyes post-ON compared to eyes without previous ON. The RNFL significantly decreased over the study period in eyes post-ON from an average of 79.9 ± 13.3 μm to 77.0 ± 12.9 μm (p < 0.0001) and eyes without previous ON from 89.5 ± 12.9 μm to 86.0 ± 12.5 μm (p < 0.0001). The number of VEPs and RNFL thickness were significantly correlated with visual acuity in all eyes. In patients after unilateral ON the brain atrophy parameters corpus callosum index (CCI) and cella media index (CMI) were negatively correlated with the EDSS.

CONCLUSION

Initially MS often begins with an episode of ON which can be stabilized by immunomodulation. A mild progressive ON was generally detectable in this study but severe progressive ON was rarely observed. The OCT measurements showed no better correlation than the VEPs with visual acuity; however, OCT can be applied for confirmation of atypical ON. The corpus callosum index seems to be best associated with the degree of disability while, as already described in the literature, the number of T2 lesions is not well correlated with disability, probably due to the small-world network function of the brain and the position of the lesions in areas with no clinical relevance.

Breast cancer survivors’ motivation to perform preventive health behaviors: An application of the protection motivation theory

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Background: Little is known about what motivates breast cancer survivors to engage in preventive health behaviors to prevent recurrence of breast cancer. The primary objective was to assess how survivors’ fear of recurrence, spirituality, and perceptions of risk and coping appraisal were associated with their motivation to perform healthy lifestyle and cancer screening behaviors.

Methods: A reliable and valid questionnaire was developed. An a priori power analysis indicated that a minimum of 386 completed surveys were needed for adequate statistical power. Based on an estimated 50% return rate, the investigators randomly selected a state-wide sample of 800 survivors from Ohio. A 3-wave mailing was used to increase response rate.

Results: 559 surveys were completed (72%). Respondents with higher perceived risks of recurrence were more motivated to perform healthy lifestyle behaviors than those with lower perceived risks (t=2.51, df=521, p=.039). Most (>70%) agreed that healthy lifestyle behaviors such as regular exercise reduce one’s risk of recurrence. Only 43% exercised regularly. Only 54% reported their doctor discussed how to reduce the risk of recurrence. Survivors who were satisfied with their physician’s communication exercised more regularly than those who were not satisfied (chi-square =13.09, p=.016, df=5). Cancer survivors with a high level of motivation and high level of behavioral intentions were more likely to be engaging in preventive health and cancer screening behaviors. Higher levels of spirituality were positively correlated with a higher level of motivation to engage in preventive health behaviors (r=.345, n=468, p<0.001).

Conclusions: This study provides strong evidence that the Protection-Motivation Theory (PMT) helps to explain certain factors that impact survivors’ motivation and behavioral intentions to engage in healthy lifestyle behaviors and follow up screening tests. When developing programs for breast cancer survivors, health professionals should consider incorporating spirituality, fear of recurrence, and the constructs of the PMT.

Electrical Properties and Power Considerations of a Piezoelectric Actuator

This paper assesses the electrical characteristics of piezoelectric wafers for use in aeronautical applications such as active noise control in aircraft. Determination of capacitive behavior and power consumption is necessary to optimize the system configuration and to design efficient driving electronics. Empirical relations are developed from experimental data to predict the capacitance and loss tangent of a PZT5A ceramic as nonlinear functions of both applied peak voltage and driving frequency. Power consumed by the PZT is the rate of energy required to excite the piezoelectric system along with power dissipated due to dielectric loss and mechanical and structural damping. Overall power consumption is thus quantified as a function of peak applied voltage and driving frequency. It was demonstrated that by incorporating the variation of capacitance and power loss with voltage and frequency, satisfactory estimates of power requirements can be obtained. These relations allow general guidelines in selection and application of piezoelectric actuators and driving electronics for active control applications.

Inhibition of ryanodine receptor 1 in fast skeletal muscle fibers induces a fast-to-slow muscle fiber type transition

Skeletal muscle fiber type is regulated by innervation-induced cell signaling including calcium release mechanisms that lead to transcriptional activation of fiber type-specific genes. Avian fast pectoralis major (PM) and slow medial adductor (MA) muscles differentially control expression of the slow myosin heavy chain 2 (slow MyHC2) gene. We report here that slow MyHC2 gene expression in fast PM muscle fibers is repressed by endogenous activity of the ryanodine receptor 1 (RyR1). Inhibition of RyR1 with ryanodine led to expression of the slow MyHC2 gene in innervated PM muscle fibers in vitro. Administration of ryanodine to innervated PM muscle fibers also decreased protein kinase C (PKC) activity, the reduction of which is necessary for slow MyHC2 gene expression in both PM and MA muscle fibers. Furthermore, RyR1 inhibition increased slow MyHC2 promoter activity in innervated PM muscle fibers and enhanced transcriptional activities of nuclear factor of activated T cells (NFAT) and myocyte enhancer factor 2 (MEF2), as well as their interactions with their respective binding sites of the slow MyHC2 promoter. These results indicate that RyR1 activity in innervated fast PM muscle fibers contributes to the cell type-specific repression of slow muscle specific genes.

Regulation of skeletal muscle fiber type and slow myosin heavy chain 2 gene expression by inositol trisphosphate receptor 1

Innervation-dependent signaling cascades that control activation of downstream transcription factors regulate expression of skeletal muscle fiber type-specific genes. Many of the innervation-regulated signaling cascades in skeletal muscle are dependent on intracellular calcium and the mechanisms by which calcium is released from the sarcoplasmic reticulum (SR). We report that the inositol trisphosphate receptor 1 (IP3R1), responsible for calcium release from the SR as a slow wave, was more abundant in fast contracting compared to slow contracting avian muscle fibers. Furthermore, inhibition of IP3R1 activity by 2-aminoethoxydiphenylborate (2-APB) and xestospongin D induced a fiber type transition and expression of the slow myosin heavy chain 2 (slow MyHC2) gene in innervated fast muscle fibers. Activation of the slow MyHC2 promoter by IP3R1 inhibition was accompanied by a reduction in protein kinase C activity. In addition, inhibition of IP3R1 activity resulted in a reduction of nuclear factor of activated T cells (NFAT)-dependent transcription and nuclear localization, indicating that IP3R1 activity regulated NFAT transcription factor activity in skeletal muscle fibers. Myocyte enhancer factor 2 (MEF2)-dependent transcriptional activity was increased by innervation, but unaffected by IP3R1 activity. The results indicate that IP3R1 activity regulates muscle fiber type-specific gene expression in innervated muscle fibers.

Innervation-dependent and fiber type-specific transcriptional regulation of the slow myosin heavy chain 2 promoter in avian skeletal muscle fibers

Skeletal muscle fiber type is regulated, in part, by innervation leading to transcriptional regulation of fiber type-specific genes. Here, we report the initial characterization of the transcriptional regulation of the slow myosin heavy chain 2 (MyHC2) promoter in innervated and noninnervated slow medial adductor (MA) and fast pectoralis major (PM) muscle fibers in cell culture. The proximal 1358 bp of slow MyHC2 upstream DNA contains a functional E-box and binding sites for myocyte enhancer factor 2 (MEF2) and nuclear factor of activated T cells (NFAT). Mutagenesis studies indicated that both MEF2 and NFAT binding sites are required for innervation-induced slow MyHC2 promoter activity in MA muscle fibers. However, MEF2 transcription factor activity was unaffected by innervation and did not demonstrate fiber type-specific interactions with the slow MyHC2 MEF2 binding site. NFAT transcription factor activity did increase in innervated MA muscle fibers and not in PM muscle fibers, indicating innervation and muscle fiber type-specific regulation. However, transfection of constitutively active NFAT indicated that NFAT is insufficient to induce slow MyHC2 gene expression in either fast PM or slow MA muscle fibers without innervation. These results indicate the requirement for MEF2 and NFAT in innervation-induced slow MyHC2 gene expression and suggest that additional innervation-dependent and fiber type-specific control of slow MyHC2 gene expression resides in MA and PM muscle fibers, respectively.

The IPEM code of practice for electron dosimetry for radiotherapy beams of initial energy from 4 to 25 MeV based on an absorbed dose to water calibration

This report contains the recommendations of the Electron Dosimetry Working Party of the UK Institute of Physics and Engineering in Medicine (IPEM). The recommendations consist of a code of practice for electron dosimetry for radiotherapy beams of initial energy from 4 to 25 MeV. The code is based on the absorbed dose to water calibration service for electron beams provided by the UK standards laboratory, the National Physical Laboratory (NPL). This supplies direct N(D,w) calibration factors, traceable to a calorimetric primary standard, at specified reference depths over a range of electron energies up to approximately 20 MeV. Electron beam quality is specified in terms of R(50,D), the depth in water along the beam central axis at which the dose is 50% of the maximum. The reference depth for any given beam at the NPL for chamber calibration and also for measurements for calibration of clinical beams is 0.6R(50.D) - 0.1 cm in water. Designated chambers are graphite-walled Farmer-type cylindrical chambers and the NACP- and Roos-type parallel-plate chambers. The practical code provides methods to determine the absorbed dose to water under reference conditions and also guidance on methods to transfer this dose to non-reference points and to other irradiation conditions. It also gives procedures and data for extending up to higher energies above the range where direct calibration factors are currently available. The practical procedures are supplemented by comprehensive appendices giving discussion of the background to the formalism and the sources and values of any data required. The electron dosimetry code improves consistency with the similar UK approach to megavoltage photon dosimetry, in use since 1990. It provides reduced uncertainties, approaching 1% standard uncertainty in optimal conditions, and a simpler formalism than previous air kerma calibration based recommendations for electron dosimetry.

Repression of slow myosin heavy chain 2 gene expression in fast skeletal muscle fibers by muscarinic acetylcholine receptor and G(alpha)q signaling

Gene expression in skeletal muscle fibers is regulated by innervation and intrinsic fiber properties. To determine the mechanism of repression of slow MyHC2 expression in innervated fast pectoralis major (PM) fibers, we investigated the function of the muscarinic acetylcholine receptor (mAchR) and G(alpha)q. Both mAchR and G(alpha)q are abundant in medial adductor (MA) and PM fibers, and mAchR and G(alpha)q interact in these fibers. Whereas innervation of PM fibers was insufficient to induce slow MyHC2 expression, inhibition of mAchR activity with atropine in innervated PM fibers induced slow MyHC2 expression. Increased G(alpha)q activity repressed slow MyHC2 expression to nondetectable levels in innervated MA fibers. Reduced mAchR activity decreased PKC activity in PM fibers, and increased G(alpha)q activity increased PKC activity in PM and MA fibers. Decreased PKC activity in atropine-treated innervated PM fibers correlated with slow MyHC2 expression. These data suggest that slow MyHC2 repression in innervated fast PM fibers is mediated by cell signaling involving mAchRs, G(alpha)q, and PKC.

HTLV antibody screening using mini-pools

At the present time, the UK blood transfusion services do not screen blood donations for anti-HTLV. This presentation describes a pilot study to ascertain the feasibility of HTLV antibody screening using mini-pools and also provides an estimate of HTLV prevalence within our donor population in Scotland and Northern Ireland. The Abbott/Murex HTLV I/II GE80/81 ELISA was selected for the trial. Thirty confirmed HTLV positive library samples were tested at various dilutions and five were shown to be nonreactive at a dilution of 1:100. Residues of mini-pools (of up to 95 individual donations) prepared for HCV NAT testing were tested with the Abbott/Murex GE80/81 assay. Of 6666 mini-pools (equivalent to 570 609 donations) tested, six were repeatedly reactive. All six mini-pools were confirmed HTLV antibody positive by line immunoassay. Four were confirmed to be HTLV-I positive, one HTLV-II positive and one HTLV positive (unable to type). Dilutions (1:100) of the five HTLV "nonreactive" positive samples were included in each test plate and used to determine a grey-zone cut-off. Using this grey-zone system an additional six (0.09%) mini-pool samples gave repeatedly reactive grey-zone results, none of which were confirmed. The minimum Scottish/Irish HTLV donor prevalence was shown to be 1:95 000.

A novel keratocan mutation causing autosomal recessive cornea plana

PURPOSE

Mutations in keratocan (KERA), a small leucine-rich proteoglycan, have recently been shown to be responsible for cases of autosomal recessive cornea plana (CNA2). A consanguineous pedigree in which cornea plana cosegregated with microphthalmia was investigated by linkage analysis and direct sequencing.

METHODS

Linkage was sought to polymorphic microsatellite markers distributed around the CNA2 and microphthalmia loci (arCMIC, adCMIC, NNO1, and CHX10) using PCR and nondenaturing polyacrylamide gel electrophoresis before KERA was directly sequenced for mutations.

RESULTS

Positive lod scores were obtained with markers encompassing the CNA2 locus, the maximum two-point lod scores of 2.18 at recombination fraction theta = 0 was obtained with markers D12S95 and D12S327. Mutation screening of KERA revealed a novel single-nucleotide substitution at codon 215, which results in the substitution of lysine for threonine at the start of a highly conserved leucine-rich repeat motif. Structural modeling predicts that the motifs are stacked into an arched beta-sheet array and that the effect of the mutation is to alter the length and position of one of these motifs.

CONCLUSIONS

This report describes a novel mutation in KERA that alters a highly conserved motif and is predicted to affect the tertiary structure of the molecule. Normal corneal function is dependent on the regular spacing of collagen fibrils, and the predicted alteration of the tertiary structure of KERA is the probable mechanism of the cornea plana phenotype.