Autoantibody status, neuroradiological and clinical findings in children with acute cerebellitis

BACKGROUND

Acute cerebellitis (AC) in children and adolescents is an inflammatory disease of the cerebellum due to viral or bacterial infections but also autoimmune-mediated processes.

OBJECTIVE

To investigate the frequency of autoantibodies in serum and CSF as well as the neuroradiological features in children with AC.

MATERIAL AND METHODS

Children presenting with symptoms suggestive of AC defined as acute/subacute onset of cerebellar symptoms and MRI evidence of cerebellar inflammation or additional CSF pleocytosis, positive oligoclonal bands (OCBs), and/or presence of autoantibodies in case of negative cerebellar MRI. Children fulfilling the above-mentioned criteria and a complete data set including clinical presentation, CSF studies, testing for neuronal/cerebellar and MOG antibodies as well as MRI scans performed at disease onset were eligible for this retrospective multicenter study.

RESULTS

36 patients fulfilled the inclusion criteria for AC (f:m = 14:22, median age 5.5 years). Ataxia was the most common cerebellar symptom present in 30/36 (83 %) in addition to dysmetria (15/36) or dysarthria (13/36). A substantial number of children (21/36) also had signs of encephalitis such as somnolence or seizures. In 10/36 (28 %) children the following autoantibodies (abs) were found: MOG-abs (n = 5) in serum, GFAPα-abs (n = 1) in CSF, GlyR-abs (n = 1) in CSF, mGluR1-abs (n = 1) in CSF and serum. In two further children, antibodies were detected only in serum (GlyR-abs, n = 1; GFAPα-abs, n = 1). MRI signal alterations in cerebellum were found in 30/36 children (83 %). Additional supra- and/or infratentorial lesions were present in 12/36 children, including all five children with MOG-abs. Outcome after a median follow-up of 3 months (range: 1 a 75) was favorable with an mRS ≤2 in 24/36 (67 %) after therapy. Antibody (ab)-positive children were significantly more likely to have a better outcome than ab-negative children (p = .022).

CONCLUSION

In nearly 30 % of children in our study with AC, a range of abs was found, underscoring that autoantibody testing in serum and CSF should be included in the work-up of a child with suspected AC. The detection of MOG-abs in AC does expand the MOGAD spectrum.

Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport

Increased participation and duration in sport has become commonplace for women with their involvement often including the transition to motherhood in the peak of their athletic careers. No rehabilitation models that assess the full spectrum of pregnancy to postpartum have been developed for women to assist in safe exercise progressions that reduce postpartum symptoms and optimize performance during the return to full activity. Referral to physical therapy both in the prenatal and postnatal period is currently not considered standard of care to reduce prevalence of symptoms such as musculoskeletal pain, diastasis recti, and pelvic floor dysfunction which may ultimately interfere with physical activity and performance. This commentary presents a timeline and suggested progression for exercise participation to improve awareness of the musculoskeletal changes that occur after labor and delivery. The concepts covered may increase the understanding of how to manage pregnant and postpartum athletes from a musculoskeletal perspective and serve as a starting point for establishing appropriate and guided rehabilitation for safe return to sport after childbirth.

Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy

BACKGROUND

Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients.

METHODS

Via a single-institution database, we reviewed the charts of HNC patients who underwent definitive or post-operative radiotherapy, from October 2013 to December 2020. Of these patients, 387 had provided baseline and post-treatment information regarding financial difficulty. In July 2018, a dedicated financial counselor was provided for radiation therapy patients and we subsequently examined the impact of FC on financial difficulty scores.

RESULTS

Following the hiring of a dedicated financial counselor, there was a significant increase in the proportion of patients receiving FC (5.3% vs. 62.7%, p < 0.0001). Compared with baseline scores, patients who did not undergo FC had a significant increase in reported financial difficulty at the end of treatment (p = 0.002). On the other hand, there was no difference in pre- and post-treatment scores in patients who had received FC (p = 0.588). After adjusting for gender and nodal status with a multiple linear regression model, FC was significantly associated with change in financial difficulty (β = -0.204 ± 0.096, p = 0.035). On average, patients who received FC had a 0.2 units lower change in financial difficulty score as compared with those with the same gender and nodal stage but without FC.

CONCLUSIONS

Providing a dedicated financial counselor significantly increased the proportion of HNC receiving FC, resulting in the stabilization of financial difficulty scores post-treatment. Based on a multiple linear regression model, FC was independently associated with reduced financial difficulty. The employment of a financial counselor may be a viable, hospital-based approach to begin to address FT in HNC.

A cross-sectional analysis of muscle density and physical function in head and neck cancer patients

e18597

Background: Head and neck cancer (HNC) is a debilitating disease that affects tens of thousands each year and both the disease and its treatment can cause long-term morbidity. HNC patients with greater physical function at baseline may better withstand both disease and treatment, therefore we hypothesized that baseline physical function is associated with baseline skeletal muscle density (SMD). Methods: A cross-sectional study of existing medical records was conducted. SMD was classified using pre-treatment PET-CT scans and interpreted using Sliceomatic software, and pre-treatment physical function assessed in three ways: hand grip strength, timed up and go, and short physical performance battery. Linear regression models were utilized to assess the association between SMD and each measure of physical function, with adjustment for muscle mass, sex and cancer stage in the hand grip strength model and adjustment for muscle mass and age in both the timed up and go, and short physical performance battery models. Results: The sample of 90 HNC patients, was mostly white, male, former smokers with an average BMI of 28 kg/m2. In adjusted models that included men only, we observed that for every Hounsfield unit increase in SMD there was a 0.08 increase in SPPB score (p=0.005), a 0.31 kg increase in hand grip strength (p=0.04), and a 0.13 second decrease in timed up and go (p=0.0007). In adjusted models that included women only, we observed that for every Hounsfield unit increase in SMD there was a 0.03 decrease in SPPB score (p=0.75), a 0.12 kg increase in hand grip strength (p=0.65), and a 0.01 second increase in timed up and go (p=0.84). Conclusions: Baseline physical function is associated with higher baseline physical SMD. Larger studies involving a more women are needed to replicate these findings and to further examine the potential role of effect modification by both sex and muscle mass.

Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy

Simple Summary

Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies.

Abstract

Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.

Frailty Status and Dependence in Head and Neck Cancer Patients Receiving Concurrent Chemoradiation

Date Presented 03/26/20

This exploratory study found frailty and instrumental activities of daily living (IADL) performance worsen for head and neck cancer patients after radiation treatment. A moderate negative correlation was identified between frailty status and IADL performance. This conclusion indicates a need for OT services to address and reduce functional deficits in this population.

Primary Author and Speaker: Cheryl Porzi

Additional Authors and Speakers: Jennetta Siracuse, Kerry Bourke, Ashley Evans

Contributing Authors: Kathryn Eberle Cohen, Elizabeth Wendel, Anurag Singh, Andrew Ray

Practice, attitude and knowledge of Dutch paediatric oncologists regarding female fertility

BACKGROUND

Chemotherapy and radiotherapy for childhood cancer can result in a decreased reproductive function. It is therefore important that paediatric oncologists discuss the possible impact of treatment on female fertility and available fertility preservation options with their patients. However, it is unknown what Dutch paediatric oncologists know about of the effect of cancer treatment on female fertility, whether or not they address this issue in clinical practice, what their attitudes are towards addressing fertility after cancer treatment and fertility preservation options, and to what extent they require additional information resources.

METHODS

In this nationwide quantitative cross-sectional study a survey was sent to all registered paediatric oncologists in the Netherlands (n=64).

RESULTS

Thirty-seven paediatric oncologists participated (participation rate 58%). Fertility issues were discussed with patients and/or parents by 97%. Of the paediatric oncologists, 54-76% were aware of possibilities for fertility preservation; however only <25% reported a moderate or high confidence in their knowledge of these techniques. Paediatric oncologists stated that they had little resources to counsel their patients and 92% found educational resources not completely sufficient.

CONCLUSION

Paediatric oncologists are well aware of the effect that cancer treatment may have on female fertility and their responsibility to counsel their patients and/or the parents on this issue. They do not (yet) possess the knowledge to sufficiently counsel these patients and, if needed, do not frequently refer them to a fertility specialist.

Nickel adsorption by sodium polyacrylate-grafted activated carbon

A novel sodium polyacrylate grafted activated carbon was produced by using gamma radiation to increase the number of functional groups on the surface. After irradiation the capacity for nickel adsorption was studied and found to have increased from 44.1 to 55.7 mg g(-1). X-ray absorption spectroscopy showed that the adsorbed nickel on activated carbon and irradiation-grafted activated carbon was coordinated with 6 oxygen atoms at 2.04-2.06 A. It is proposed that this grafting technique could be applied to other adsorbents to increase the efficiency of metal adsorption.

Duration of self assessed benefit of cataract extraction: a long term study

AIM

To investigate how long patients' improved visual function lasts after a cataract extraction.

METHODS

Patients' self assessed visual function was evaluated using the Catquest questionnaire both before and 6 months after a cataract extraction. The study population consisted of 615 patients undergoing a cataract extraction during 1995-2002. A final follow up with a new questionnaire was performed in 2003, between 1 year and 8 years after surgery.

RESULTS

445 (72.4%) patients were alive at follow up and agreed to participate in the study. The number of subjects still showing improved visual function after surgery decreased with longer follow up. After 7 years, 80% had improved visual function compared with before surgery. 50% of all originally operated subjects were alive 7 years postoperatively and enjoyed better visual function than they had done before surgery. Ocular co-morbidity in the operated eye or self assessed poor visual function before surgery was significantly related to deteriorated visual function at follow up.

CONCLUSION

The number of subjects who experienced improved visual function after a cataract extraction decreased over the course of time postoperatively. Presence of ocular co-morbidity was significantly related to worsened function.

c-jun and multistage carcinogenesis: association of overexpression of introduced c-jun with progression toward a neoplastic endpoint in mouse JB6 cells sensitive to tumor promoter-induced transformation

Tumor promoters such as 12-O-tetradecanoylphorbol-13-acetate (TPA) and epidermal growth factor (EGF) induce neoplastic transformation, elevated c-jun protein expression, and activator protein-1 (AP-1)-dependent gene expression in JB6 mouse epidermal cells sensitive to tumor promoters (clone 415a P+ cells). In contrast, JB6 cells resistant to tumor promoter-induced transformation (clone 307b P- cells) exhibit a greatly reduced TPA or EGF inducible c-jun expression and AP-1 activity. We have recently shown that induced AP-1 is necessary for tumor promoter-induced transformation of P+ cells because introduction of a dominant negative c-jun mutant into P+ cells inhibits both AP-1 dependent transactivation and the transformation response to tumor promoter. The intent of the investigation presented here was to test the hypothesis that elevation of AP-1 activity is sufficient to cause progression to the P+ phenotype in P- cells or to the transformed phenotype in P+ cells. Clonally derived P+ and P- recipient cells transfected with a human c-jun expression construct and overexpressing c-jun protein were tested for progression by assaying for constitutive or inducible anchorage independent phenotype and nude-mouse tumorigenicity. Overexpression of c-jun did not produce progression in P- cells but did increase the probability of progression in P+ cells (two of five transfectant cell lines progressed to the tumor phenotype). In addition, c-jun overexpression did not increase AP-1 activity in any of the P-/c-jun transfectants or in the two of five P+/c-jun transfectants that acquired the transformed phenotype. The P+/c-jun transfectants that showed elevated AP-1 activity did not progress to the tumor phenotype, demonstrating that an increase in AP-1 activity is insufficient for this progression. Since P(+)-to-tumor phenotype progression occurred in cells overexpressing c-jun but not AP-1, we propose that P(+)-to-transformed phenotype progression is c-jun dependent and AP-1 independent.

Progression toward tumor cell phenotype is enhanced by overexpression of a mutant p53 tumor-suppressor gene isolated from nasopharyngeal carcinoma

We recently reported the detection of a heterozygous G-->C point mutation at codon 280 of p53 in nasopharyngeal carcinoma, which causes an Arg-->Thr substitution. To test whether this mutant p53 has gained function as an oncogene, we overexpressed the mutant p53 in nontumorigenic cells of two model systems: (i) human Saos-2 cells lacking endogenous p53 and (ii) mouse JB6 variants that bear endogenous wild-type p53. Although they have no growth advantage over the neomycin controls in monolayer culture, human Saos-2 transfectants overexpressing mutant p53 do show enhanced progression to tumor cell phenotype, as assayed by anchorage-independent growth and in vivo tumorigenicity. The enhancement is seen only in transfectants expressing higher levels of p53 protein. In the mouse JB6 system, the mutant p53 functions dominantly in the presence of endogenous wild-type p53 to enhance progression of preneoplastic promotion-sensitive cells toward anchorage-independent phenotype. Mouse JB6 transfectants of mutant p53 are, however, not tumorigenic in nude mice. We conclude from these studies that the G-->C point mutation of p53 at codon 280 is a gain-of-function mutation that appears to operate dominantly and that the mutant p53-thr280 has only moderate oncogenic activity. This mutation may cooperate with other yet-to-be isolated genes in the genesis of nasopharyngeal carcinoma.

Responses of preneoplastic epidermal cells to tumor promoters and growth factors: use of promoter-resistant variants for mechanism studies

The JB6 mouse epidermal cell model system is being used to study the mechanism of promotion of transformation. Promotion of anchorage independence in JB6 cells occurs in response to second-stage but not first-stage promoters, and is inhibited by inhibitors of second-stage not first-stage promotion. A number of variants that are resistant to the phorbol diester TPA have been derived. Some are resistant to plateau density mitogenic stimulation by TPA; others are resistant to promotion of anchorage independence by TPA. Some of the mitogen-resistant variants were promotable by TPA, thus ruling out a requirement for TPA mitogenesis in promotion of transformation in JB6 cells. TPA promotable clones were also sensitive to mezerein and EGF while the TPA nonpromotable variants were also resistant to mezerein and EGF, suggesting that sensitivity to promoters in these JB6 cells is determined at a level distal to receptor binding. Promotion sensitivity did not require available EGF receptors since two TPA promotable variants were EGF receptorless. The mitogenic response of JB6 cells to TPA may however be mediated by EGF since four of four mitogen-resistant variants showed low to zero levels of EGF binding. Tumor promoting phorbol esters produce specific changes in cellular gangliosides. Certain of these changes occur in promotable but not nonpromotable variants of JB6 cells, suggesting that ganglioside changes may be involved in the process of promotion of transformation.

Enhanced proliferation of endogenous virus in Chinese hamster cells associated with microtubules and the mitotic apparatus of the host cell

Chinese hamster ovary cells harbour intracytoplasmic virus-like particles of type A which are closely associated with sites of microtubule formation. We report here the enhanced proliferation of these particles and their release at the cell membrane by using either 5-bromodeoxyuridine or dibutyryl cyclic AMP. The extracellular mature particles are similar in morphology to retroviruses of type B. Close association of the type A virus precursors with microtubule organizing centres, i.e. kinetochores, centrioles and basal bodies, and with microtubules per se, is confirmed by studying the effects of the microtubule inhibitors Colcemid and vincristine sulphate. The role of microtubules in the activation and transport of the intracytoplasmic type A particles is discussed.

Ultrastructural studies on the replication of herpes virus ateles-73 in owl monkey kidney cells

The replicative cycle of herpesvirus ateles, strain 73 (HVA-73), was examined in the electron microscope and compared to that of other herpesviruses known to be oncogenic. A relatively slow replicative cycle of HVA-73 in owl monkey kidney (OMK) cells allowed us to distinguish cytoplasmic and nuclear stages of replication, comprising virus uptake, transport, maturation, and extrusion. Virus uptake was observed within 10 hours of infection and occurred both as a result of fusion between virus and cell membranes and by phagocytosis. Morphologic evidence for the transfer of viral DNA from nuclecapsids to the nucleus at the nuclear membrane is presented. This is shown by the location of numerous empty capsids in front of nuclear pores early during infection. Towards the end of the eclipse phase, at about 48 hougs after infection, two different types of nuclear inclusion bodies were observed. Progeny nucleocapsids were detected in the nucleus at the same time. The envelopment of nucleocapsids occurred both at the nuclear membrane and at proliferating Golgi lamellae in the cytoplasm. Each site of envelopment is associated with the maturation of a characteristic, morphologically distinguishable virus particle. The assembly of HVA-73 resembled that of other oncogenic herpesviruses.