Targeting Tri-Methyl-Histone H3 (Lys27) in Rectal Cancer: A Novel Strategy to Enhance Radiosensitivity and Predict Response to Neoadjuvant Therapy

PURPOSE/OBJECTIVE(S)

Tri-Methyl-Histone H3 (Lys27) is a modification of histone H3 involved in gene regulation and chromatin organization. It plays a crucial role in cell response to ionizing radiation and affects DNA damage repair, with altered levels being linked to decreased radiation sensitivity. Our hypothesis is that high levels of Tri-Methyl-Histone H3 (Lys27) in rectal tumors can predict response to neoadjuvant chemoradiation, and targeting SETD2, the histone methyltransferase responsible for adding the tri-methyl group to Lys27 of histone H3, may enhance radiosensitivity in rectal cancer cells.

MATERIALS/METHODS

Biopsy samples from 25 patients with locally advanced rectal adenocarcinoma (Stage II-III) were obtained for analysis. Immunohistochemistry (IHC) was used to evaluate Tri-Methyl-Histone H3 (Lys27) expression levels in the tumor biopsies. The staining intensity was scored semi-quantitatively. Samples with 100% positive staining were grouped as "Tri-Methyl-High," and all others were grouped as "Tri-Methyl-Low." Fisher's exact test was used to analyze the data to determine the correlation between Tri-Methyl-Histone H3 (Lys27) levels and response to neoadjuvant chemoradiation. The primary endpoint was either a sustained clinical complete response (cCR) at one year or a pathological complete response (pCR). To further understand the role of Tri-Methyl-Histone H3 (Lys27) in response to ionizing radiation (IR), clonogenic assays, γH2aX foci staining, and western blot analysis of DNA damage response proteins and histones were performed on two established human rectal cancer cell lines following either RNA inhibition (RNAi) or drug targeting of SETD2.

RESULTS

Twenty-five patients with rectal cancer had pre-treatment biopsies analyzed for Tri-Methyl-Histone H3 (Lys27) levels, 11 were classified as Tri-Methyl-High and 14 as Tri-Methyl-Low. The groups were well balanced in terms of age, sex, clinical T/N stage, and neoadjuvant treatment approach. The overall combined complete response (cCR/pCR) rate was 36%, while the rate for Tri-Methyl-High patients was 9% (1/11) compared to 57% (8/14) in Tri-Methyl-Low patients (p = 0.03). After treating two colorectal cancer cell lines (SW837 and HCT116) with IR (5 Gy) in vitro, Tri-Methyl-Histone H3 (Lys27) levels increased 3-fold. SETD2 RNAi reduced Tri-Methyl-Histone H3 (Lys27) and increased cell death when combined with IR. In vitro treatment with a novel SETD2 inhibitor, EZM0414, led to a 2-fold increase in DNA damage following IR (5 Gy) as measured by γH2aX foci staining. EZM0414 treatment showed a 37% improvement in the dose enhancement ratio.

CONCLUSION

Our study uncovers a new biomarker, Tri-Methyl-Histone H3 (Lys27), that could be used to predict response to neoadjuvant chemoradiation in rectal cancer patients. Our preclinical data indicates that targeting SETD2 to reduce Tri-Methyl-Histone H3 (Lys27) mediated DNA repair could improve the efficacy of radiation therapy for rectal cancer patients.

Study protocol of a prospective single-arm multicenter clinical study to assess the safety and performance of the aXess hemodialysis graft: The pivotal study

BACKGROUND

Arteriovenous grafts (AVGs) are used for patients deemed unsuitable for the creation of an autogenous arteriovenous fistula (AVF) or unable to await maturation of the AVF before starting hemodialysis. However, AVGs are prone to infection and thrombosis resulting in low long-term patency rates. The novel aXess Hemodialysis Graft consists of porous polymeric biomaterial allowing the infiltration by cells and the growth of neotissue, while the graft itself is gradually absorbed, ultimately resulting in a fully functional natural blood vessel. The Pivotal Study will examine the long-term effectiveness and safety of the aXess Hemodialysis Graft.

METHODS

The Pivotal Study is a prospective, single-arm, multicenter study that will be conducted in 110 subjects with end-stage renal disease who are not deemed suitable for the creation of an autogenous vascular access. The primary efficacy endpoint will be the primary patency rate at 6 months. The primary safety endpoint will be the freedom from device-related serious adverse events at 6 months. The secondary endpoints will include the procedural success rate, time to first cannulation, patency rates, the rate of access-related interventions to maintain patency, the freedom from device-related serious adverse events and the rate of access site infections. Patients will be followed for 60 months. An exploratory Health Economic and Outcomes Research sub-study will determine potential additional benefits of the aXess graft to patients, health care institutions, and reimbursement programs.

DISCUSSION

The Pivotal study will examine the long-term performance and safety of the aXess Hemodialysis Graft and compare the outcome measures with historical data obtained with other graft types and autogenous AVFs. Potential advantages may include superior long-term patency rates and lower infection rates versus currently available AVGs and a shorter time to first cannulation compared to an autologous AVF. As such, the aXess Hemodialysis Graft may fulfill an unmet clinical need in the field of hemodialysis access.

Post-earthquake damage classification and assessment: case study of the residential buildings after the M w = 5 earthquake in Mila city, Northeast Algeria on August 7, 2020

On August 7th, 2020, a magnitude Mw = 5.0 earthquake shook 5 km north of Mila city center, northeast of Algeria, causing substantial damage directly to structures, and indirectly from induced impacts of landslides and rock falls, ultimately disrupt to everyday civilian life. Given the recent significant seismic occurrences in the region, a detailed and comprehensive examination and assessment of post-earthquake damage is critical to Algeria. This is primarily because masonry, concrete, and colonial-era structures are sensitive to horizontal motions caused by seismic waves, and because masonry and concrete structures constitute a substantial portion of today's Algeria's build environment. We present a post-earthquake investigation of the Mila earthquake, starting from the earthquake source, and a catalogue of buildings type, damage categorization, and failure patterns of residential structures in Mila's historic old town, where colonial-era brick buildings prevail. We find that structures that represent notable architectural achievements were severely damaged as a result of the earthquake. Data acquired during the immediate post-earthquake analysis was also evaluated and discussed. The graphical representations of the damages are detailed and complemented by photos. This seismic event has shown the fragility of Algeria's building stock, which must be addressed properly in future years. This study reports on an overall estimate of residential buildings in Mila's lower city, as well as an evaluation of the seismic vulnerability of three neighborhood towns (El-Kherba, Grareme-Gouga, and Azzeba). A generic database for graphical surveys and geometric research was developed and implemented making it possible to evaluate the shear strength on-site. The broad observations, collated data, and consequences were then loaded into the 3Muri structural verification program. Nonlinear static analysis was conducted to analyze probable failure paths and compare the real damage to the software results.

Risk management in water supply networks: Aveiro case study

Water supply networks are critical infrastructures essentials to health, safety, economic and social well-being which have to be maintained and preserved to ensure their proper functioning. Considering the importance of these critical infrastructures, the risks to which they are exposed and the consequences of such risks must be analysed. Thus, it is important that companies responsible for the management of these assets incorporate risk management in their activities. In the scope of risk management, this paper intends to identify the vulnerabilities of water supply infrastructures, by analysing the risks they are exposed and identifying the measures that need to be implemented or reinforced. Risk assessment methodologies were analysed to identify the advantages and disadvantages of each one. As a case study, the water supply network of the Aveiro municipality in mainland Portugal was used. This network was analysed resourcing ArcMap, ArcGIS desktop software, which allows a better understanding of the water supply network. Risk management was applied and the probability and possible consequences of six distinct categories of threats were determined in eight scenarios, allowing the development of risk maps concluding that all these scenarios are in a low or medium level of risk. To decrease the vulnerability of the water network, a set of plans and specific measures have to be developed.

Burnout syndrome among medical residents: A systematic review and meta-analysis

BACKGROUND

Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA).

OBJECTIVE

To estimate burnout among different medical residency specialties.

METHODS

A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included.

RESULTS

4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%.

CONCLUSION

The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties.

PROSPERO REGISTRATION

CRD42018090270.

Experimental Study of Rubberized Concrete Stress-Strain Behavior for Improving Constitutive Models

Inclusion of rubber into concrete changes its behavior and the established shape of its stress-strain curve. Existing constitutive stress-strain models for concrete are not valid in case of rubberized concrete, and currently available modified models require additional validation on a larger database of experimental results, with a wider set of influential parameters. By executing uniaxial compressive tests on concrete with rubber substituting 10%, 20%, 30%, and 40% of aggregate, it was possible to study and evaluate the influence of rubber content on its mechanical behavior. The stress-strain curve was investigated in its entirety, including compressive strength, elastic modulus, strains at significant levels of stress, and failure patterns. Experimental results indicated that increase of rubber content linearly decreases compressive strength and elastic modulus, but increases ductility. By comparing experimental stress-strain curves with those plotted using available constitutive stress-strain models it was concluded that they are inadequate for rubberized concrete with high rubber content. Based on determined deviations an improvement of an existing model was proposed, which provides better agreement with experimental curves. Obtained research results enabled important insights into correlations between rubber content and changes of the stress-strain curve required when utilizing nonlinear material properties.

Eating flowers? Exploring attitudes and consumers' representation of edible flowers

Edible flowers have gained more attention in recent years thanks to their perceived health benefits. Despite this attention, it seems that edible flowers are not popularized for consumption in South America, being considered unfamiliar for some cultures from this continent. In this context, the general goal of the present study was to investigate the three dimensions of social representation theory, the representational field, the information and the attitude of the two conditions of edible flowers: a more general "food made with flowers" and more directional product "yoghurt made with flowers", using Brazilian consumers. To achieve this goal, a free word association task was applied. A total of 549 consumers participated in this study. Participants were divided into two conditions, in which the inductor expressions for the free word association task changed: (a) food products made with flowers and (b) yoghurt made with flowers. Results showed a very positive attitude to both situations, and consumers associated Food products made with flowers to "health care" while the central core of yoghurt made with flowers reflected the innovative condition of this product, supported here by their unpredictable character (information generated).

Acute upper limb ischemia, a rare presentation of giant cell arteritis

Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.

On-farm Campylobacter and Escherichia coli in commercial broiler chickens: Re-used bedding does not influence Campylobacter emergence and levels across sequential farming cycles

Limitations in quality bedding material have resulted in the growing need to re-use litter during broiler farming in some countries, which can be of concern from a food-safety perspective. The aim of this study was to compare the Campylobacter levels in ceca and litter across three litter treatments under commercial farming conditions. The litter treatments were (a) the use of new litter after each farming cycle; (b) an Australian partial litter re-use practice; and (c) a full litter re-use practice. The study was carried out on two farms over two years (Farm 1, from 2009–2010 and Farm 2, from 2010–2011), across three sheds (35,000 to 40,000 chickens/shed) on each farm, adopting three different litter treatments across six commercial cycles. A random sampling design was adopted to test litter and ceca for Campylobacter and Escherichia coli, prior to commercial first thin-out and final pick-up. Campylobacter levels varied little across litter practices and farming cycles on each farm and were in the range of log 8.0–9.0 CFU/g in ceca and log 4.0–6.0 MPN/g for litter. Similarly the E. coli in ceca were ∼log 7.0 CFU/g. At first thin-out and final pick-up, the statistical analysis for both litter and ceca showed that the three-way interaction (treatments by farms by times) was highly significant (P < 0.01), indicating that the patterns of Campylobacter emergence/presence across time vary between the farms, cycles and pickups. The emergence and levels of both organisms were not influenced by litter treatments across the six farming cycles on both farms. Either C. jejuni or C. coli could be the dominant species across litter and ceca, and this phenomenon could not be attributed to specific litter treatments. Irrespective of the litter treatments in place, cycle 2 on Farm 2 remained Campylobacter-free. These outcomes suggest that litter treatments did not directly influence the time of emergence and levels of Campylobacter and E. coli during commercial farming.

[Reconstructive surgery of the large intrathoracic veins, four case reports]

The resection and reconstruction of the large venous vessels of the chest is a procedure intended to treat the symptoms of venous hypertension caused by the Superior Vena Cava Syndrome and to allow resection of mediastinal tumors that invade the superior vena cava (SVC) and the left and right innominate veins. We report four clinical cases of mediastinal tumors involving the large intrathoracic venous vessels, submitted to surgery between 2010 and 2013. In all cases our purpose was to completely resect the tumor. We intended to evaluate the surgical results in terms of improvement of symptoms, complications of the procedures, permeability of the bypasses in the short and medium term and mortality rates. We used ringed ePTFE grafts to perform the following vascular reconstructions: - Y configuration bypass from the left subclavian vein and the left internal jugular vein to the left inominate vein; - two bypasses from the top of the left innominate vein to the right atrial appendage; - bypass from the left innominate vein to the right atrial appendage and a bypass from the right innominate vein to the SVC. All patients were discharged, and all the bypasses were patent at discharge and after 30 days . There were two cases of late thrombosis, but patients remained asymptomatic. Our series shows the feasibility of these technically complex surgeries, which are an excellent example of the benefits of multidisciplinary collaboration between vascular and thoracic surgeons.

Pre- and posttransplant monitoring of alloantibodies by complement-dependent cytotoxicity and luminex methodologies in liver transplantation

BACKGROUND

This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors.

METHODS

Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay).

RESULTS

The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017).

CONCLUSION

Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.

Benefits, challenges and impact of teleconsultation - a literature review

Teleconsultation involves the use of technology so that the medical professionals and patients can interact with each other bringing health to where ever it is needed. Although it has been demonstrated to be feasible and effective its sustainability remains an important question. This paper presents the results of a literature review on teleconsultation, based on the Portuguese context. Although Portugal has some successful projects, a national or international conjoint effort would be more fruitful. Technologically it gets lets costly to provide teleconsultation, as pervasive computing grows. The gap of benefits between teleconsultation and regular consultation will diminish as patients grow fonder into technology.The economic value of this type of consultation remains a difficult subject, so a small budget economic analysis, based on a break-even method, is suggested. This analysis conducted on Finland shows that teleconsultation can be cost-effective.

[Hybrid repair of the aortic arch. Santa Marta Hospital initial experience]

OBJECTIVES

To retrospectively review the hybrid treatment of the aortic arch with supra-aortic debranching and endo- vascular stent-graft repair in a single institution.

METHODS

From 2007 to 2010, all patients submitted to aortic debranching procedures were entered into a prospective database analysis. For the present study, only patients with sealing zones 0 and 1, according to the Ishimaru classification, were included. Procedure-related morbimortality was analysed for the open and endovascular procedures.

RESULTS

During the study period, we electively performed 6 total aortic debranching and 4 partial aortic debranching procedures in 10 patients. According to the etiology the indications were: 6 aortic arch aneurysms, 2 post-dissection aneurysms, 1 false aneurysm and 1 type I endoleak following TEVAR. The proximal sealing zone was Ishimaru zone 0 in six patients and zone 1 in four patients. The TEVAR procedure was delayed in all patients with a completion success of 80% (1 patient died from ruptured aortic aneurysm; 1 patient denied the second procedure and was lost to follow-up). The 30d mortality rate was 10% (patient mentioned above). The main morbidity was: 1 axillar venous thrombosis, 1 case of subclinical myocardial infarction, 1 case of terminal renal insufficiency and 1 case of prolonged ventilation. No permanent cerebral or peripheral neurologic deficit was noted.

CONCLUSIONS

The hybrid repair of the aortic arch is a feasible and reproducible procedure, and our results are similar to the previously published series. Medium and long-term results are necessary to confirm whether the technique can be regarded as a safe alternative to open surgery in high-risk patients.

Dynamic Structural Health Monitoring of slender structures using optical sensors

In this paper we summarize the research activities at the Instituto de Telecomunicações—Pólo de Aveiro and University of Aveiro, in the field of fiber Bragg grating based sensors and their applications in dynamic measurements for Structural Health Monitoring of slender structures such as towers. In this work we describe the implementation of an optical biaxial accelerometer based on fiber Bragg gratings inscribed on optical fibers. The proof-of-concept was done with the dynamic monitoring of a reinforced concrete structure and a slender metallic telecommunication tower. Those structures were found to be suitable to demonstrate the feasibility of FBG accelerometers to obtain the structures' natural frequencies, which are the key parameters in Structural Health Monitoring and in the calibration of numerical models used to simulate the structure behavior.

Etiology of bronchiolitis in a hospitalized pediatric population: prospective multicenter study

Background

In 2006, bronchiolitis due to adenovirus nosocomial infections resulted in the closure of a pediatric department in northern Portugal.

Objectives

To determine the etiology of bronchiolitis in northern Portugal.

Study design

It was a prospective multicenter study on the etiology of bronchiolitis during the respiratory syncytial virus (RSV) season (November–April). Children ≤24 months of age admitted for a first wheezing episode were included. Nasopharyngeal specimens were analyzed by an indirect immunofluorescent-antibody assay (IFA) for RSV, adenovirus (HAdV), parainfluenza (PIV) 1–3 and influenza (IV) A and B and by polymerase chain reaction (PCR) or reverse transcription-PCR for the same viruses and for human metapneumovirus (hMPV), bocavirus (HBoV), rhinovirus (HRV), coronaviruses (229/E; NL63; OC43; HKU1) and enterovirus.

Results

During this period, 253 children were included, 249 IFA analyses and 207 PCRs were performed. IFA detected RSV in 58.1%; PCR increased it to 66.7%. IFA detected HAdV in 3.2%, PCR 10.0%. PCR detected IV A in 5; IV B in 2; PIV 1 in 6, PIV 2 in 4 and PIV 3 in 11 cases. HBoV, as single agent in 2 cases, and HRV were positive in 8 samples and hMPV in 11. With this virus panel, 19.7% remained without etiology.

Conclusions

The most frequent agent was RSV, followed by HAdV. PCR can be cost-effective and more accurate than IFA, which is crucial for HAdV that may be associated with significant mortality (IFA alone did not detect 2/3 of the cases).

[Endovascular aortic procedures]

The authors report a retrospective analysis of all the aortic endovascular procedures performed in the Department until November 2009. The series includes a total of 302 patients, 246 of them having an elective treatment of an abdominal aortic aneurysm; 33 underwent an emergency treatment of an abdominal aortic aneurysm; and the remainder 23 patients had an endovascular procedure of the thoracic aorta. The aim of the study was dedicated at the evaluation of the epidemiologic characteristics of the patients, including associated and co-morbid entities, as well as the evaluation of the results, especially the early 30 days post-operative mortality and major morbidity.