An overview of osteopathy graduates' perceived preparedness at transition from educational environment to clinic environment one year after graduation: a cross sectional study

BACKGROUND

This study investigated perceived preparedness to practice, one year after graduation across osteopathic education institutions (OEIs) and explored possible differences between countries where osteopathy is regulated (Reg) and countries where it is not (Unreg).

METHODS

Two hundred forty-five graduates from 7 OEIs in 4 European countries, already assessed in a previous study, were contacted one year after their graduation to complete the survey. Survey tools included a questionnaire to assess perceived preparedness to practice: Association of American Medical Colleges (AAMC) questionnaire, and a questionnaire to collect socio-demographic information and practice characteristics.

RESULTS

One hundred sixty-eight graduates (68.6%) completed the survey. The AAMC mean score one year after the graduation (23.19; confidence interval 22.81-23.58) was significantly higher than in the previous study (17.58; 16.90-18.26) (p < 0.001). A difference was also found between Reg (23.49; 23.03-23.95) and Unreg (22.34; 21.74-22.94) (p = 0.004). Osteopaths with a previous healthcare degree scored significantly higher on AAMC score (25.53; 24.88-26.19) than osteopaths without a previous healthcare degree (22.33; 21.97-22.69) (p < 0.001). Regulation and a previous degree were the only significant independent variables in the most predictive multivariate linear model. The model had an r² = 0.33.

CONCLUSIONS

Graduates from OEIs where osteopathy is regulated felt significantly better prepared to practice than Unreg. Systematic information searches about graduates' perception of preparedness to practice, may enable OEIs to strengthen their existing curricula to ensure their graduates are effectively prepared to practice.

Autophagy deactivation is associated with severe prostatic inflammation in patients with lower urinary tract symptoms and benign prostatic hyperplasia

Autophagy is a conserved evolutionary process that allows cells to maintain macromolecular synthesis and energy homeostasis during starvation and stressful conditions. We prospectively evaluated the relationship between autophagy and prostatic inflammation in a series of transurethral prostatic resection samples. Inflammatory infiltrates were defined according to the standardized classification of chronic prostatitis of the National Institute of Health. The inflammatory score (IS score) was calculated. High IS score was defined as ≥7. Each sample was stained for anti-LC3B and for anti-P62/SQSTM1 and scored. High p62 or LC3B percentage was defined as >25%, whereas low was defined as <25% of cells with dots. We analyzed 94 specimens. Overall, 18/94 (19%) showed no sign of prostatic inflammation, whereas 76/94 (81%) presented inflammatory infiltrates. Inflammation was mild in 61/76 (80%), moderate/severe in 15/76 (20%). Patients with high p62 percentage were 62/94 (66%) while 32 (34%) showed low p62 percentage. Patients with high LC3B percentage were 37/94 (39%) while 57(61%) showed low LC3B percentage. Overall 42/94 (44%) patients presented a high p62 percentage and concomitant a low LC3B percentage. IS score was significantly higher in patients with a with high p62 percentage (median IS 7 (6/8) vs 5 (3/7); p= 0.04) and in patients with a low LC3B percentage (median IS 7 (6/8) vs 5 (3/7); p= 0.004) when compared to patients with a low p62 percentage or a high LC3B percentage respectively. On multivariate analysis, p62 (OR: 10.1, 95%CI: 2.6-38.6; p= 0,001) and LC3B expression (OR: 0.319; 95%CI: 0.112-0.907; p= 0.032) were independent predictors of a high IS. Here we present the first evidence of autophagy deregulation in prostatic inflammation. These results raise many questions about the mechanisms mediating the autophagy dysfunction and the links to prostatic inflammation that need to be addressed.

Antiproliferative Effects of 1α-OH-vitD3 in Malignant Melanoma: Potential Therapeutic implications

Early detection and surgery represent the mainstay of treatment for superficial melanoma, but for high risk lesions (Breslow’s thickness >0.75 mm) an effective adjuvant therapy is lacking. Vitamin D insufficiency plays a relevant role in cancer biology. The biological effects of 1α hydroxycholecalciferol on experimental melanoma models were investigated. 105 melanoma patients were checked for 25-hydroxycholecalciferol (circulating vitamin D) serum levels. Human derived melanoma cell lines and in vivo xenografts were used for studying 1α-hydroxycholecalciferol-mediated biological effects on cell proliferation and tumor growth. 99 out of 105 (94%) melanoma patients had insufficient 25-hydroxycholecalciferol serum levels. Interestingly among the six with vitamin D in the normal range, five had a diagnosis of in situ/microinvasive melanoma. Treatment with 1α-hydroxycholecalciferol induced antiproliferative effects on melanoma cells in vitro and in vivo, modulating the expression of cell cycle key regulatory molecules. Cell cycle arrest in G1 or G2 phase was invariably observed in vitamin D treated melanoma cells. The antiproliferative activity induced by 1α-hydroxycholecalciferol in experimental melanoma models, together with the discovery of insufficient 25-hydroxycholecalciferol serum levels in melanoma patients, provide the rationale for using vitamin D in melanoma adjuvant therapy, alone or in association with other therapeutic options.

Dynamic in vitro analysis of tractile forces of the anterior cruciate ligament (ACL) transplant using patellar and semitendinosus muscle tendon: a cadaver study

PURPOSE

The presented biomechanical study focused on the in vitro analysis of tractile forces working on the anterior cruciate ligament (ACL) and the ACL transplants, respectively, using a semitendinosus and/or patellar tendon during a passive flexion-extension movement (150-0°).

MATERIAL AND METHODS

Overall, 15 fresh frozen human knee joint pairs were examined. At first during arthroscopy, the tibial insertion of the ACL was drilled using a special hollow drill. Thereby, a bone cylinder was exposed at which a dynamometer was attached to enable for direct registration of tractile forces on the ACL via the connection between ACL-dynamometer and computer. The ACL transplant was fixed at the femur using a so-called endo-button, whereas the dynamometer was attached to the tibial end of the ACL transplant. The dynamic part of the examination was performed using the knee kinemator device developed by Plitz and Wirth et al. using different preload.

RESULTS

The curves of the tractile forces of the ACL were qualitatively homogeneous with only low force values in the middle flexion position, whereas during maximum flexion and extension the forces increased reaching a maximum in the 0° position. Also, in testing the ACL transplants a force decrease between 0 and 50° flexion was recognized with even greater forces resulting at the 150° position depending on the anterior position of the femoral drill channel for implanting the ACL transplant. The amount of pre-loading showed no influence on the form of the tractile force curve. However, by enhancing the preload to 70 N, the maximal force in the ACL transplant increased significantly.

CONCLUSION

The tractile forces assessed within the ACL during passive flexion movements between 10 and 90° were not greater than the forces measured in the ACL transplants. Thus, the clinical consequence is that in the early postoperative phase passive mobilization might be performed in this motion range without putting the ACL transplant at risk for damage.

Abstract 1475: Plasma circulating miRNAs: a new potential biomarker for prostate cancer diagnosis

MicroRNAs (miRNAs) are a class of small, non-coding, single-stranded RNAs that negatively regulate gene expression mainly binding to 3′-untranslated region (UTR) of target mRNAs at the post-transcriptional level.

Recent studies have demonstrated that aberrant expressions of miRNAs are closely associated with the development, invasion, metastasis and prognosis of various cancers including prostate cancer (PCa).

However, while the majority of miRNAs are found at the intracellular level, a significant number of miRNAs have been observed outside the cells, including various body fluids.

Circulating miRNAs act as ‘extracellular communication RNAs’ that could be particularly relevant in the context of neoplastic diseases and may be useful for early diagnosis as well as to predict the clinical outcome and the treatment response.

The aim of this study was to investigate the hypothesis that changes in circulating miRNAs represent potentially useful minimally invasive biomarkers for the diagnosis, staging and prediction of outcome in prostate cancer.

From 2012 onwards, consecutive men undergoing 12-core prostate biopsy at Sant’Andrea Hospital of Rome were enrolled into a prospective database. Indications for a prostatic biopsy were a PSA value ≥ 4 ng/ml and/or a positive digital rectal examination (DRE). We selected, as a training set, 32 patients with a mean age and PSA of 66.6 years (SD ±7.9) and 14.3 (range to 0,53-185) ng/ml, respectively. Among them 16 patients (50%) have cancer on biopsy; 8 with Gleason score 6; 3 with a Gleason score 7 and 5 with a Gleason score ≥8 and 16 patients (50%) are control individuals with non-neoplastic prostate disease (i.e. prostatitis). Profiling of microRNAs by deep sequencing allowed us to identify a “signature” of 27 microRNAs aberrant expressed in prostate cancer samples. Receiver-operator characteristics (ROC) curve analysis was used to evaluate the diagnostic accuracy of miRNAs for the final histopathological diagnosis of prostate cancer. An AUC of 0.77; 95%CI was observed for the diagnosis of prostate cancer using all 27 microRNAs, which is correlated with the Gleason score of the analyzed samples, while results to be independent from the respective values of serum PSA. Moreover, ROC curve analysis also highlighted a small subgroup consisting of 6 miRNAs with a high predictive power able to discriminate patients with prostate cancer (AUC = 0.805; 95%CI). This signature is under validation in an indipendent cohort of patients. These preliminary observations suggest that circulating miRNAs could represent promising biomarkers for non-invasive diagnosis in prostate cancer unrelated to PSA.

Citation Format: Simona Giglio, Cosimo De Nunzio, Roberto Cirombella, Stefano Volinia, Emidio Luciani, Andrea Tubaro, Andrea Vecchione. Plasma circulating miRNAs: a new potential biomarker for prostate cancer diagnosis. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1475. doi:10.1158/1538-7445.AM2014-1475

The loss of the p53 activator HIPK2 is responsible for galectin-3 overexpression in well differentiated thyroid carcinomas

Background

Galectin-3 (Gal-3) is an anti-apoptotic molecule involved in thyroid cells transformation. It is specifically overexpressed in thyroid tumour cells and is currently used as a preoperative diagnostic marker of thyroid malignancy. Gal-3 expression is downregulated by wt-p53 at the transcriptional level. In well-differentiated thyroid carcinomas (WDTCs) there is an unexplained paradoxical concomitant expression of Gal-3 and wt-p53. HIPK2 is a co-regulator of different transcription factors, and modulates basic cellular processes mainly through the activation of wt-p53. Since we demonstrated that HIPK2 is involved in p53-mediated Gal-3 downregulation, we asked whether HIPK2 deficiency might be responsible for such paradoxical Gal-3 overexpression in WDTC.

Methodology/Principal Findings

We analyzed HIPK2 protein and mRNA levels, as well as loss of heterozygosity (LOH) at the HIPK2 locus (7q32-34), in thyroid tissue samples. HIPK2 protein levels were high in all follicular hyperplasias (FHs) analyzed. Conversely, HIPK2 was undetectable in 91.7% of papillary thyroid carcinomas (PTCs) and in 60.0% of follicular thyroid carcinomas (FTCs). HIPK2 mRNA levels were upregulated in FH compared to normal thyroid tissue (NTT), while PTC showed mean HIPK2 mRNA levels lower than FH and, in 61.5% of cases, also lower than NTT. We found LOH at HIPK-2 gene locus in 37.5% of PTCs, 14.3% of FTCs and 18.2% of follicular adenomas. To causally link these data with Gal-3 upregulation, we performed in vitro experiments, using the PTC-derived K1 cells, in which HIPK2 expression was manipulated by RNA interference (RNAi) or plasmid-mediated overexpression. HIPK2 RNAi was associated with Gal-3 upregulation, while HIPK2 overexpression with Gal-3 downregulation.

Conclusions/Significance

Our results indicate that HIPK2 expression and function are impaired in WDTCs, in particular in PTCs, and that this event explains Gal-3 overexpression typically observed in these types of tumours. Therefore, HIPK2 can be considered as a new tumour suppressor gene for thyroid cancers.

Gal-3 is stimulated by gain-of-function p53 mutations and modulates chemoresistance in anaplastic thyroid carcinomas

Galectin-3 (Gal-3) is an anti-apoptotic molecule of the beta-galactoside-binding lectin family. Gal-3 is down-regulated by wt-p53 and this repression is required for p53-induced apoptosis. Since poorly differentiated thyroid carcinomas (PDTCs) and anaplastic thyroid carcinomas (ATCs) frequently harbour p53 mutations, we asked whether Gal-3 expression and activity could be influenced by such mutations in these tumours. We found a positive correlation between Gal-3 expression and p53 mutation in human thyroids and in thyroid carcinoma cell lines (TCCLs) harbouring different p53 mutations. Gal-3 was over-expressed in most ATCs and TCCLs, especially those with the most frequently detected p53 mutation (p53(R273H)). Over-expression of p53(R273H) in two p53-null cells (SAOS-2 and SW-1736) as well as in two wt-p53-carrying TCCLs (TPC-1 and K1), stimulated Gal-3 expression, while interference with p53(R273H) endogenous expression in ARO cells down-regulated Gal-3 expression. Conversely, over-expression of wt-p53 in ARO cells restored the inhibitory effect on Gal-3 expression. ARO cells are highly resistant to apoptosis and express both p53 and Gal-3, which are increased upon cisplatin treatment. Interference with Gal-3 expression in these cells stimulated their chemosensitivity. In conclusion, gain-of-function p53 mutant acquires the de novo ability to stimulate Gal-3 expression and to increase chemoresistance in ATCs.

[The participatory approach to injury prevention appeared to be an useful tool of safety education and ergonomic improvement]

Participatory techniques have been adopted in vigilance of Civitavecchia's port activities, in order to control and remove injury causes. Injuries were studied by small participatory groups of port workers. As an example, seafastening operations were analyzed. The project team encouraged the workers to design ergonomic measures, or to modify work organization. Workers made suggestions and presented their points of view, that were reported to management for implementation.