Educational Priorities for Providing End-of-Life Care: Parent Perspectives

OBJECTIVES

Partnership with parents is a tenet of pediatric medicine; however, initiatives to include parents in education and research have been limited. Through focus groups, we included parents at the beginning of curriculum development by asking them to identify the priorities, existing supports, and opportunities for improvement in their child's end-of-life (EOL) care.

METHODS

English and Spanish-speaking bereaved parents whose child had been cared for by the palliative care team and had died >18 months before the study initiation were invited to participate. In-person focus groups and a follow-up phone call were used to elicit opinions and capture a diversity of viewpoints. Themes were identified and clustered through an iterative analytic process.

RESULTS

Twenty-seven parents of 17 children participated, with the total sample size determined by thematic saturation. Four themes were identified as important to parents in their child's EOL care: (1) honoring the role of the parent, (2) having confidence in the care team, (3) receiving gestures of love and caring, and (4) navigating logistic challenges.

CONCLUSIONS

We asked parents to be partners in guiding priorities for health care education and professional development to improve pediatric EOL care. In addition to strengthening skills in communication, confidence in the team, and compassion, parents in this study identified a need for hospital staff to anticipate financial and social stressors and provide supportive resources more readily. Additionally, parents described clinical and nonclinical staff as providing support, suggesting that a multidisciplinary and interdisciplinary curriculum be developed to improve pediatric EOL care.

Enabling Precision Medicine in Cancer Care Through a Molecular Data Warehouse: The Moffitt Experience

PURPOSE

The use of genomics within cancer research and clinical oncology practice has become commonplace. Efforts such as The Cancer Genome Atlas have characterized the cancer genome and suggested a wealth of targets for implementing precision medicine strategies for patients with cancer. The data produced from research studies and clinical care have many potential secondary uses beyond their originally intended purpose. Effective storage, query, retrieval, and visualization of these data are essential to create an infrastructure to enable new discoveries in cancer research.

METHODS

Moffitt Cancer Center implemented a molecular data warehouse to complement the extensive enterprise clinical data warehouse (Health and Research Informatics). Seven different sequencing experiment types were included in the warehouse, with data from institutional research studies and clinical sequencing.

RESULTS

The implementation of the molecular warehouse involved the close collaboration of many teams with different expertise and a use case-focused approach. Cornerstones of project success included project planning, open communication, institutional buy-in, piloting the implementation, implementing custom solutions to address specific problems, data quality improvement, and data governance, unique aspects of which are featured here. We describe our experience in selecting, configuring, and loading molecular data into the molecular data warehouse. Specifically, we developed solutions for heterogeneous genomic sequencing cohorts (many different platforms) and integration with our existing clinical data warehouse.

CONCLUSION

The implementation was ultimately successful despite challenges encountered, many of which can be generalized to other research cancer centers.

Key features to ensure sustainability of a tele-oncology program at a national cancer center

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Background: Prior to COVID-19, there were few telehealth services offered in the oncology specialty area. During the pandemic, we at a national cancer center rapidly scaled our oncology telehealth program to meet the needs of our patients. At the peak of the pandemic, telehealth initially served as a risk-mitigation strategy providing continued care to our patients while socially distancing, yet additionally, we have embedded necessary processes in place to create a sustained a telehealth oncology program that encompasses a hybrid model including face to face visits augmented with telehealth visits, where appropriate. Here we describe the key telehealth program features that have enabled a national cancer center to evolve into a hybrid model of oncology care across its five geographically distinct hospitals. Methods: Transitioning into a sustainable hybrid telehealth model of care involves a foundation of clinical leadership and partnerships among multiple departments. The telehealth oncology program leaders collaborate with the operations, technology, finance, clinical care teams, and governance council to implement telehealth growth initiatives and nimbly troubleshoot and ameliorate issues. A concierge service provides telehealth readiness checks to ensure timely resolution of issues. Workflows are followed to standardize processes. Telehealth use-cases ensure patients who need on-site services keep their in-person appointments, allowing telehealth visits for symptom management to enhance patient outcomes. A provider education session includes training on telehealth technology and “webside manner” training to ensure we preserve the personal touch with our patients in each telehealth encounter. Program data is regularly collected and reviewed to track the program’s success and opportunities for improvement. Results: After the initial peak of telehealth visits driven by the COVID pandemic, we continue to see a sustained 10-fold increase in service volume versus Jan/Feb 2020. There were 25,328 total telehealth visits from Mar. 2020-Jan. 2021, 75 clinical trial visits between July-Dec. 2020, and 848 readiness check escalations from Nov. 2020-Dec. 2021. Service lines expanded from 2 to 33, including growing rural health partnerships and a home chemotherapy infusion model. Use-cases expanded to bridge to on-site care, rapid initial visits, preop/postop checks, symptom management, and surveillance. Press Ganey patient satisfaction rates are as high as 92% and 90% of providers reported overall satisfaction with the telehealth consultations. Conclusions: Our key program features have enabled the growth and success of our enterprise tele-oncology program. One of the most promising indicators of success is the positive provider and patient satisfaction rates. Telehealth provides an effective means to provide a bridge to onsite cancer care even for our complex oncology patients.

The Long Shadow: Collateral Impact and Finding Resilience Amidst a Global Pandemic Pediatric Palliative Care Social Work During COVID-19

This manuscript illuminates the nuanced ways in which the COVID-19 pandemic has impacted the pediatric palliative care social work role and clinical care in caring for children with life-limiting illnesses and their families throughout the country. The authors discuss memorable moments, logistical impacts, telehealth usage, decision-making experiences, end of life care, bereavement practices, specialized interventions, and self-care. The paper concludes with lessons learned and practical recommendations for the future.

Effect of microbial fuel cell operation time on the disinfection efficacy of electrochemically synthesised catholyte from urine

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The MFC with the thickest ceramic membrane produced the best quality catholyte.

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MFC operation time contributes to the catholyte quality and killing properties.

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Catholyte from ceramic MFC (10 mm) reached pH 11 at day 42 and eradicated E. coli.

Microbial fuel cells (MFCs) offer an excellent solution to tackle some of the major challenges currently faced by humankind: sustainable energy sources, waste management and water stress. Besides treating wastewater and producing useful electricity from urine, ceramic MFCs can also generate biocidal catholyte in-situ. It has been proved that the electricity generation from the MFCs has a high impact in the catholyte composition. Therefore, the catholyte composition constantly changes while electricity is generated. However, these changes in catholyte composition with time has not yet been studied and that could highly contribute to the disinfection efficacy. In this work, the evolution of the catholyte generation and composition with the MFC operation time has been chemically and microbiologically evaluated, during 42 days. The results show an increase in pH and conductivity with the operation time, reaching pH 11.5. Flow cytometry and luminometer analyses of bioluminescent pathogenic E. coli exposed to the synthesised catholyte revealed killing properties against bacterial cells. A bio-electrochemical system, capable of electricity generation and simultaneous production of bactericidal catholyte from human urine is presented. The possibility to electrochemically generate in-situ a bacterial killing agent from urine, offers a great opportunity for water reuse and resource recovery for practical implementations.

Evaluation of artificial neural network algorithms for predicting the effect of the urine flow rate on the power performance of microbial fuel cells

Microbial fuel cell (MFC) power performance strongly depends on the biofilm growth, which in turn is affected by the feed flow rate. In this work, an artificial neural network (ANN) approach has been used to simulate the effect of the flow rate on the power output by ceramic MFCs fed with neat human urine. To this aim, three different second-order algorithms were used to train our network and then compared in terms of prediction accuracy and convergence time: Quasi-Newton, Levenberg-Marquardt, and Conjugate Gradient. The results showed that the three training algorithms were able to accurately simulate power production. Amongst all of them, the Levenberg-Marquardt was the one that presented the highest accuracy (R = 95%) and the fastest convergence (7.8 s). These results show that ANNs are useful and reliable tools for predicting energy harvesting from ceramic-MFCs under changeable flow rate conditions, which will facilitate the practical deployment of this technology.

Bibliotherapy and Bereavement: Harnessing the Power of Reading to Enhance Family Coping in Pediatric Palliative Care

Bibliotherapy is a therapeutic intervention that could potentially be utilized by pediatric palliative care social workers to aid in providing individualized support and adaptive coping techniques through end-of-life and bereavement. Multiple modalities of implementing bibliotherapy are considered, including applications in individual and group counseling. An institutionally supported bibliotherapy program that aims to provide therapeutic and recreational texts for patients, families and clinicians is described. Suggested guidelines and book titles for use in practice with bereaved siblings and families are provided alongside targeted description for use in clinical practice.

Modelling the energy harvesting from ceramic-based microbial fuel cells by using a fuzzy logic approach

Microbial fuel cells (MFCs) is a promising technology that is able to simultaneously produce bioenergy and treat wastewater. Their potential large-scale application is still limited by the need of optimising their power density. The aim of this study is to simulate the absolute power output by ceramic-based MFCs fed with human urine by using a fuzzy inference system in order to maximise the energy harvesting. For this purpose, membrane thickness, anode area and external resistance, were varied by running a 27-parameter combination in triplicate with a total number of 81 assays performed. Performance indices such as R² and variance account for (VAF) were employed in order to compare the accuracy of the fuzzy inference system designed with that obtained by using nonlinear multivariable regression. R² and VAF were calculated as 94.85% and 94.41% for the fuzzy inference system and 79.72% and 65.19% for the nonlinear multivariable regression model, respectively. As a result, these indices revealed that the prediction of the absolute power output by ceramic-based MFCs of the fuzzy-based systems is more reliable than the nonlinear multivariable regression approach. The analysis of the response surface obtained by the fuzzy inference system determines that the maximum absolute power output by the air-breathing set-up studied is 450  μ W when the anode area ranged from 160 to 200 cm², the external loading is approximately 900 Ω and a membrane thickness of 1.6 mm, taking into account that the results also confirm that the latter parameter does not show a significant effect on the power output in the range of values studied.

Response of ceramic microbial fuel cells to direct anodic airflow and novel hydrogel cathodes

The presence of air in the anode chamber of microbial fuel cells (MFCs) might be unavoidable in some applications. This study purposely exposed the anodic biofilm to air for sustained cycles using ceramic cylindrical MFCs. A method for improving oxygen uptake at the cathode by utilising hydrogel was also trialled. MFCs only dropped by 2 mV in response to the influx of air. At higher air-flow rates (up to 1.1 L/h) after 43-45 h, power did eventually decrease because chemical oxygen demand (COD) was being consumed (up to 96% reduction), but recovered immediately with fresh feedstock, highlighting no permanent damage to the biofilm. Two months after the application of hydrogel to the cathode chamber, MFC power increased 182%, due to better contact between cathode and ceramic surface. The results suggest a novel way of improving MFC performance using hydrogels, and demonstrates the robustness of the electro-active biofilm both during and following exposure to air.

A patient tumour-on-a-chip system for personalised investigation of radiotherapy based treatment regimens

Development of personalised cancer models to predict response to radiation would benefit patient care; particularly in malignancies where treatment resistance is prevalent. Herein, a robust, easy to use, tumour-on-a-chip platform which maintains precision cut head and neck cancer for the purpose of ex vivo irradiation is described. The device utilises sintered discs to separate the biopsy and medium, mimicking in vivo microvascular flow and diffusion, maintaining tissue viability for 68 h. Integrity of tissues is demonstrated by the low levels of lactate dehydrogenase release and retained histology, accompanied by assessment of cell viability by trypan blue exclusion and flow cytometry; fluid dynamic modelling validates culture conditions. An irradiation jig is described for reproducible delivery of clinically-relevant doses (5 × 2 Gy) to newly-presenting primary tumours (n = 12); the addition of concurrent cisplatin is also investigated (n = 8) with response analysed by immunohistochemistry. Fractionated irradiation reduced proliferation (BrdU, p = 0.0064), increased DNA damage (ƴH2AX, p = 0.0043) and caspase-dependent apoptosis (caspase-cleaved cytokeratin-18) compared to control; caspase-dependent apoptosis was further increased by concurrent cisplatin compared to control (p = 0.0063). This is a proof of principle study showing the response of cancer tissue to irradiation ex vivo in a bespoke system. The novel platform described has the potential to personalise treatment for patients in a cost-effective manner with applicability to any solid tumour.

A New Method for Modulation, Control and Power Boosting in Microbial Fuel Cells

Microbial fuel cells (MFCs) are energy transducers, which through the metabolic reactions of facultative anaerobic microorganisms, transform the energy in organic matter directly into electricity. Extrinsic parameters such as hydraulic retention time, fuel quality (type and concentration) and physicochemical environment of electrodes and biofilms (e.g., temperature, pH, salinity, and redox), can all influence system efficiency. This work proposes that MFCs can be "fine-tuned" by adjustment of any of the physicochemical conditions including redox potential; in this context, an entirely novel method was investigated as a practical means of tuning, modulating and monitoring the redox potential within the electrode chambers. The method uses additional electrodes - known as 3^rd and 4^th-pins for anode and cathode chambers, respectively - which can be used in individual units, modules, cascades or stacks, for optimising the production of a large variety of chemicals, as well as biomass, water and power. The results have shown that the power output modulation resulted in an up to 79% and 33% increase, when connected via 3^rd and 4^th pins, respectively. Apart from power improvement, this study also demonstrated a method of open circuit potential (OCP) sensing, by using the same additional electrodes to both monitor and control the MFC signal in real time.

Erratum: "A microfluidic chip based model for the study of full thickness human intestinal tissue using dual flow" [Biomicrofluidics , 064101 (2016)]

[This corrects the article DOI: 10.1063/1.4964813.].

Study on the Organoleptic Intensity Scale for Measuring Oral Malodor

The 0–5 organoleptic scale is used widely in breath research and in trials to measure the efficacy of anti-odor agents. However, the precise relationship between odor scores and gas concentrations of target odorants is unknown. The purpose of this study was to relate mean organoleptic scores from odor judges (n = 7) for pure odorants (n = 8) representative of those found in oral malodor. Judges used a common 0–5 scale to report the odor intensity of sample sets in random order of concentration. Regression analysis of data showed that odor score was proportional to the log concentration of odorant, and comparison of slopes showed H2S to be the most significant in terms of odor power. Detection thresholds (mol.dm−3) were: Skatole (7.2 × 10−13) < methylmercaptan (1.0 × 10−11) < trimethylamine (1.8 × 10−11) < isovalerate (1.8 × 10−11) < butyrate (2.3 × 10−10) < hydrogen sulphide (6.4 × 10−10) < putrescine (9.1 × 10−10) < dimethyl disulphide (5.9 × 10−8). The study demonstrates the exponential nature of the olfactory response and shows that any single compound’s contribution to malodor depends on odor power and threshold in addition to concentration.

A microfluidic chip based model for the study of full thickness human intestinal tissue using dual flow

The study of inflammatory bowel disease, including Ulcerative Colitis and Crohn's Disease, has relied largely upon the use of animal or cell culture models; neither of which can represent all aspects of the human pathophysiology. Presented herein is a dual flow microfluidic device which holds full thickness human intestinal tissue in a known orientation. The luminal and serosal sides are independently perfused ex vivo with nutrients with simultaneous waste removal for up to 72 h. The microfluidic device maintains the viability and integrity of the tissue as demonstrated through Haematoxylin & Eosin staining, immunohistochemistry and release of lactate dehydrogenase. In addition, the inflammatory state remains in the tissue after perfusion on the device as determined by measuring calprotectin levels. It is anticipated that this human model will be extremely useful for studying the biology and testing novel interventions in diseased tissue.

Microalgae as substrate in low cost terracotta-based microbial fuel cells: Novel application of the catholyte produced

In this work, the by-product generated during the operation of cylindrical MFCs, made out of terracotta material, is investigated as a feasible means of degrading live microalgae for the first time. In addition to the low cost materials of this design, the reuse of the solution produced in the cathode renders the technology truly green and capable of generating bioenergy. In this study, the effect of a light/dark cycle or dark conditions only on the digestion of live microalgae with the catholyte is investigated. The results show that a combination of light/dark improves degradation and allows algae to be used as substrate in the anode. The addition of 12.5mL of a 1:1 mix of catholyte and microalgae (pre-digested over 5days under light/dark) to the anode, increases the power generation from 7μW to 44μW once all the organic matter in the anode had been depleted.

PO-48 - Assessment of the procoagulant potential state of tumour-MP in cancer patients

INTRODUCTION

The venous thromboembolism is considered one of the highest risk factor in cancer patients for instance ovarian and pancreas. This hypercoagulability state is believed to be caused by tumour cells that can produce a variety of procaogulant factors including tissue factor (TF) bearing microparticles (MP). Chemotherapy is an independent risk factor for venous thromboembolism (VTE) in patients and it can leads to coagulation activation and may increase microparticles that can increase risk of thrombosis.

AIM

Therefore, our current hypothesis is that this increased risk of VTE is due to release of tumour MP into the blood. To further investigate this mechanism an ex-vivo microfluidic model system was developed wherein tumour spheroids were grown and transferred onto a microfluidic chip and assessed, under flow conditions, for procoagulant activity (PCA).

MATERIALS AND METHODS

Tumour spheroids from pancreatic cancer cell line AsPC1 and human glioblastoma cell line U87 were generated using the liquid overlay method in a 96-well plate, then transferred to a microfluidic chip, designed with a trap within the device to immobilise the spheroid. The procoagulant potential of cell-free supernatant was measured using a prothrombin time clotting assay. Procoagulant activity was assessed under flow rate of 3.0 μL min-1 for 6 hours.

RESULTS

Several tumour cell lines (A2780, SKOV3, MIA Paca2, AsPC1 and U87) were assessed for PCA of media (MP associated) and then subsequently assessed for spheroid formation. Prothrombin time of cell-free media was A2780: 794s, SKOV3: 203.4s, MIA Paca2: 412s, AsPC1: 69s and U87: 50.3s. The pancreatic cell line AsPC-1 and glioblastoma cell line U87 were selected for further study on the basis of relatively high PCA and ability to form stable spheroids. When transferred to a microfluidic chip, AsPC1 tumour spheroids showed a slowing of PCA of media over a 6-hour period from 36.6 to 309s. U87 tumour spheroids showed a reduction in PCA of media over a 6-hour period from 51.3 to 108.9s.

CONCLUSIONS

This is the first report of tumour spheroids maintained in a microfluidic device and then subsequently assessed for PCA. Tumour spheroids of AsPC1 were shown to produce continuous procaogulant activity and this is presumably due to tumour microparticle release. This new model system offers a way to assess tumour associated PCA under flow conditions.

Daily reduction of oral malodor with the use of a sonic tongue brush combined with an antibacterial tongue spray in a randomized cross-over clinical investigation

The objective of this clinical investigation was to test the effectiveness on breath odor of a newly designed sonic tongue brush (TongueCare+, TC). It consists of a soft silicone brush optimally designed based on the tongue's anatomy to remove bacterial biofilm from the tongue's complex surface, and it is coupled with a sonic power toothbrush handle. TC was used in combination with an antibacterial tongue spray (BreathRx, BRx) containing 0.09% cetylpyridinium chloride and 0.7% zinc gluconate. A total of 21 participants with oral malodor exceeding the threshold for recognition took part in this cross-over clinical investigation, which consisted of a single use of four treatment arms with one week washout period in between. The treatments consisted of: (1) TC  +  BRx, (2) TC  +  water, (3) BRx and (4) water. Malodor levels and bacterial density were monitored up to 6 h by organoleptic scoring and selective plating, respectively. The organoleptic score and bacterial density were significantly lower after using TC  +  BRx compared to all alternative treatments at all time points. A significant decrease in both parameters was detected after a single use of TC  +  BRx, from levels characteristic of high oral malodor, to barely noticeable levels after treatment and this was maintained up to 6 h. Moreover, we identified a significant positive correlation between bacterial density and organoleptic score, confirming that bacterial tongue biofilm is the root cause of oral malodor in these subjects. The results of this clinical investigation demonstrated that the combined treatment of a sonic tongue brush with the antibacterial tongue spray is able to deliver more than 6 h of fresh breath following a single use. The clinical investigation was registered at the ISRCTN registry under study identification number ISRCTN38199132.

Self sufficient wireless transmitter powered by foot-pumped urine operating wearable MFC

The first self-sufficient system, powered by a wearable energy generator based on microbial fuel cell (MFC) technology is introduced. MFCs made from compliant material were developed in the frame of a pair of socks, which was fed by urine via a manual gaiting pump. The simple and single loop cardiovascular fish circulatory system was used as the inspiration for the design of the manual pump. A wireless programmable communication module, engineered to operate within the range of the generated electricity, was employed, which opens a new avenue for research in the utilisation of waste products for powering portable as well as wearable electronics.

Intermittent load implementation in microbial fuel cells improves power performance

This study reports on the response of small-scale MFCs to intermittent loading, in terms of power output over time. The aim was to understand the evolution with time of power output under different duty cycles, in conditions close to practical implementation. Inexpensive ceramic membranes were compared to cation exchange membranes, under continuous flow and with a pre-digester connected. Results show that at the minute-scale, all the duty cycles investigated, produced 78% higher power bursts from the MFCs (500μW) than when under continuous loading (280μW). These results were recorded from MFCs employing ceramic membranes, whereas the difference in performance for MFCs employing commercially available cation-exchange-membranes was insignificant. When normalising to daily energy production, only specific duty cycles produced more power than continuous loading. Furthermore, the introduction of a pre-digester increased the MFC power outputs 10-fold, thus confirming that separating fermentation from electro-active respiration, significantly enhances the system performance.

Effect of resection of localized pancreaticobiliary adenocarcinoma on angiogenic markers and tissue factor related pro-thrombotic and pro-angiogenic activity

In this study, 52 patients were studied to elucidate the relative impact of resection of localized pancreaticobiliary adenocarcinoma (PBC) on circulating factors of tumour-associated angiogenesis e.g. tissue factor bearing microparticles (TFMP) and vascular endothelial growth factor (VEGF) and their clinicopathological significance to angiogenesis markers in cancer tissue from PBC patients. Angiogenesis array analysis on serum samples revealed that surgical resection of tumour lesion in PBC patients affects the levels of a panel of angiogenesis-related molecules, including VEGF that was verified by ELISA to significantly reduce (median & IQR: 1003(369-2000) vs. 457(159-834) pg/ml; p<0.05). Correspondingly, a significant decrease in the angiogenic activity (decreased capillary tube formation; p<0.05) of serum samples after the surgery was also found. Despite a decrease in number of circulating TFMP after surgery, this did not reach statistical significance; there was a significant reduction in pro-coagulant activity (prolonged prothrombin time, p<0.001) post-operatively. In addition, the activity of total microparticles (MP activity assay, p<0.05) was decreased significantly. Immunohistochemical staining of tumour tissue revealed a strong correlation between the microvessel density (MVD) and VEGF expression. Also, higher levels of circulating TFMP or TF related activity (prothrombin time) correlated significantly with TF expression and MVD on tumour tissues from PBC patients. These findings suggest that in pancreaticobiliary adenocarcinoma TF related angiogenesis drivers are equally significant to VEGF ones, raising the clinical question of whether the effectiveness of angiogenesis targeting studies could be improved through the 'dual' targeting of these pathways in PBC.

Imaging COX-2 expression in cancer using PET/SPECT radioligands: current status and future directions

The role of cyclooxygenase (COX)-2 as a driving force in early tumourigenesis and the current interest in the combination of COX-2 inhibitors with standard therapy in clinical trials creates an urgent need to establish clinically relevant diagnostic tests for COX-2 expression. Molecular imaging using small-molecule probes radiolabelled for both positron emission tomography (PET) and single photon emission computed tomography (SPECT) offers the potential to meet this need, providing a minimally invasive readout for the whole disease burden. This review summarises current approaches to the radiolabelling of small-molecule COX-2 inhibitors and their analogues for PET and SPECT imaging, and gives an overview of their biological evaluation and likely success of clinical application.

Halitosis management by the general dental practitioner--results of an international consensus workshop

Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis or a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients' breath odor concerns and general guidelines on regimens for the treatment of halitosis.

Markers of cell division cycle in glioblastoma: significance in prediction of treatment response and patient prognosis

OBJECTIVE

To investigate whether expression of regulatory components of the cell division cycle can be used independently to predict survival and response to adjuvant therapy in glioblastomas.

METHOD

A tissue micro-array, constructed using glioblastomas (n = 66), was stained using antibodies against minichromosome maintenance protein-2 (Mcm-2), expressed throughout the cell-division cycle; geminin, a protein that prevents re-initiation of DNA replication; and cyclin A, an S-phase cyclin. A semi-quantitative labelling index (LI) was calculated using an average of 18 high-power fields (hpf) in three replicate cores. The patients were divided into two groups: Group 1 (n = 50) underwent surgery and radiotherapy with 24 patients receiving temozolomide, and Group 2 (n = 16) received surgical treatment only.

RESULTS

The LIs (median +/- IQR) for Group 1 were as follows: Mcm-2, 36.7% (22.9%-51.8%); geminin, 7.8% (5.8%-10.5%); and cyclin A, 4.2% (2.4%-6.9%). Elevated LIs, higher than the median, for geminin and cyclin A correlated with prolonged survival when the tumours received adjuvant therapy (Kaplan-Meier curves, p = 0.0046 and p = 0.0063 for geminin and cyclin A, respectively). Linear regression analysis revealed positive correlations with survival for Mcm-2 (p = 0.0376), geminin (p = 0.0006) and cyclin A (p = 0.004). In Group 2, there was no relationship between the patient survival and the LI for any marker.

CONCLUSIONS

Geminin and cyclin A, each show potential as independent prognostic markers in glioblastomas receiving adjuvant therapy. This may reflect the fact that both geminin and cyclin A estimate proliferating tumour cell subpopulations sensitive to radio/chemotherapy. These markers could provide valuable prognostic information, even in small biopsies, especially if combined with O(6)MGMT expression and 1p;19q deletion status.

Effects of sulphate addition and sulphide inhibition on microbial fuel cells

The effects of adding sulphate in: (i) standard activated sludge microbial fuel cells (MFCs) and (ii) larger-scale leachate-treating columns - both as individual units and as a system connected in cascade - are reported. S-replete power output was ∼2-fold higher than that of the S-deplete MFC. Furthermore, the effects of evolved sulphide (S(2-)) inhibition were investigated. The overall decrease in power output from the sulphide inhibitor (Na(2)MoO(4)) additions was 83% for the S-replete and 90% for the S-deplete. The second phase with the leachate treating units shows an improvement of 32-86% (depended on leachate strength) in current output as a result of adding sulphate. When leachate column MFCs were connected fluidically in series, the amount of Na(2)SO(4) made available downstream was decreasing (increase in power was 99%, 40% and 12% for columns in cascade). Results demonstrated the beneficial effects of added sulphur sources to both activated sludge and leachate-treating MFCs.

Tissue factor expression determines tumour cell coagulation kinetics

INTRODUCTION

Cancers are associated with varying degrees of an increased risk of venous thromboembotic events (VTE) occurring. This increased risk is tumour driven and associated with tumour expression of tissue factor (TF) and tumour-derived microparticles (MP). In this study, cancer cell lines from phenotypically distinct tumours were assessed for cell surface TF expression and prothrombin time (PT) taken as a measure of procoagulant potential.

METHODS

Breast (T47D, MCF-7), colorectal (Colo320 and LoVo), head and neck (USCC 11b, 12, 81b and SIHN-011A) and pancreatic tumour cell lines (ASPC-1 and CFPAC-1) were assessed for TF expression by flow cytometry and relative mean fluorescence determined. Procoagulant potential of the cells was then determined by PT assay.

RESULTS

Cell-supported coagulation was shown to be cell number dependent, defined by a logarithmic relationship that was consistent across all cell lines. Single cell PT was determined for each cell line from the slope of a logarithmically transformed data plot. A near linear relationship was observed between TF expression and single cell clotting time where a higher expression of TF results in a proportionally faster PT (P < 0.001).

CONCLUSIONS

This study shows that across a range of tumour sites a consistent relationship is seen between procoagulant potential and both cell number and TF cell surface expression.

Intraluminal thrombus has a selective influence on matrix metalloproteinases and their inhibitors (tissue inhibitors of matrix metalloproteinases) in the wall of abdominal aortic aneurysms

BACKGROUND

The influence of intraluminal thrombus (ILT) on the proteolytic environment within the wall of an abdominal aortic aneurysm (AAA) is unknown. This is the first study to examine the correlation between ILT thickness and the levels of matrix metalloproteinases (MMPs) and their natural inhibitors (tissue inhibitors of matrix metalloproteinases [TIMPs]) within the adjacent AAA wall.

METHODS

Thirty-five patients undergoing elective repair of AAAs were studied. A single full-thickness infrarenal aortic sample was obtained uniformly from the arteriotomy site from each patient. All samples were snap frozen and analyzed for total and active MMP 2, 8, and 9 and TIMP 1 and 2. Thrombus thickness at the specimen site was measured on the preoperative contrast computed tomographic angiograms.

RESULTS

There was a statistically significant correlation between ILT thickness, concentration of TIMP 1, and active concentration of MMP 9. MMP 2 (active and total) and TIMP 2 demonstrated a positive correlation with ILT thickness, although not statistically significant.

CONCLUSION

In this novel study, we found a significant positive correlation of ILT thickness with active MMP 9 and TIMP 1 concentration in the adjacent AAA wall, and this may have implications for AAA expansion and eventual rupture.

Halitology (breath odour: aetiopathogenesis and management)

This article reviews the aetiopathogenesis of halitosis (oral malodour) and management. Halitosis is any disagreeable breath odour. In most patients, the odour originates from the oral cavity. In some patients, it has an extra-oral aetiology and, in a few, metabolic anomalies are responsible. In other patients complaining of malodour, this is imagined rather than real. Volatile sulphur compounds (VSCs) and other elements appear largely responsible for the malodour. Predisposing factors include poor oral hygiene, hyposalivation, dental appliances, gingival and periodontal disease and mucosal disease. The first step in assessment is objective measurement to determine whether malodour is present. If present, the oral or extra-oral origin should be determined, because the latter requires medical investigation and support in therapy, as is also the case where the malodour is imagined rather than real. Oral malodour is managed largely by oral health improvement, plus use of one or more of the wide range of antimalodour therapies, and sometimes also with use of a malodour counteractive. Emergent treatments include probiotics and vaccines targeted against causal micro-organisms or their products.

Comparison of advertising strategies between the indoor tanning and tobacco industries

The indoor tanning industry is large and continues to grow, with 2007 domestic sales in excess of $5 billion. Advertising is central to shaping the consumer's perception of indoor tanning as well as driving industry demand. This article aims to identify key drivers of consumer appeal by comparing tanning advertising strategies to those used by tobacco marketers. Tobacco advertising was selected as a reference framework because it is both well documented and designed to promote a product with known health hazards. Two thousand advertisements from 4 large tobacco advertisement databases were analyzed for type of advertisement strategy used, and 4 advertising method categories were devised to incorporate the maximum number of advertisements reviewed. Subsequently, contemporary tanning advertisements were collected from industry magazines and salon websites and evaluated relative to the identified strategy profiles. Both industries have relied on similar advertising strategies, including mitigating health concerns, appealing to a sense of social acceptance, emphasizing psychotropic effects, and targeting specific population segments. This examination is a small observational study, which was conducted without rigorous statistical analysis, and which is limited both by the number of advertisements and by advertising strategies examined. Given the strong parallels between tobacco and tanning advertising methodologies, further consumer education and investigation into the public health risks of indoor tanning is needed.

Differences in cytokine levels due to gender in colorectal cancer patients

INTRODUCTION

Female gender is associated with longer survival after treatment for colorectal cancer (CRC). Reasons behind this phenomenon are not entirely clear. In addition, higher interleukin-6 (IL-6) and interleukin-1 (IL-1) levels have been found to be associated with poorer prognosis in CRC patients. The aim of this study was to investigate if cytokine levels were different in male and female CRC patients.

METHODS

Pre- and post-operative levels of IL-1, interleukin-1 receptor antagonist (IL-1ra), IL-6 and tumour necrosis factor-alpha (TNF-alpha) were measured using standard solid phase sandwich ELISA in 104 consecutive eligible patients undergoing elective resection for CRC.

RESULTS

Seventy (67.3%) participants were male and the mean age of the group was 67.6years (standard deviation 10.4years, range 39-86years). Pre-operative IL-1beta and post-operative IL-6 levels were significantly higher in males compared with females (U=486.5, p=0.03, U=424, p=0.04), values approaching statistical significance were obtained for pre-operative IL-6 (U=508.5, p=0.06) and post-operative IL-1beta (U=448, p=0.07). Differences in the levels of TNF-alpha and IL-1ra were not statistically significant. Multiple regression analysis using TNM stage as a covariate, showed that gender was an independent predictor of post-operative IL-6 levels (p=0.04).

CONCLUSION

IL-1beta and IL-6 levels were significantly higher in men than in women. This provides evidence of a possible link between gender and cytokine levels in patients with colorectal cancer.