Bullying Among Tunisian Middle School Students: the Prevalence, Psychosocial Associated Factors and Perceived Involvement of Parents, Teachers and Classmates

BACKGROUND

Bullying is a serious public health concern remarkably common among youth. Involvement in bullying can lead to deleterious effect on the emotional well-being of pupils. The aim of this study was to assess the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior.

STUDY DESIGN

A cross-sectional study.

METHODS

We conducted this study in 2015 among a representative multistage sample of 1584 students enrolled in middle schools in the Region of Sousse using the revised Olweus Bully/Victim Questionnaire. It assesses the prevalence of bullying and covers qualitative details of bullying including psychosocial factors and perceived efforts of others to counteract bullying.

RESULTS

11.7% of respondents were classified as pure victims, 7.8% as pure bullies, 3.2% as bully-victims and 75.5% as bystanders. Compared to other groups, the bully-victims were less likely to report a feeling of empathy and liking school. They were more likely to be afraid of being bullied, aggressive and to have fewer friends in the class. Only 30.3% of the victims indicated that they told someone about being bullied. The majority of the middle school students perceived that classmates (54.1%) and teachers (39.5%) did nothing to counteract bullying.

CONCLUSIONS

Information about bullying is critical and must be gathered before effective intervention is planned. Parents, teachers and students should learn effective ways to handle the bullying problem since the most effective programs are comprehensive targeting students, schools, families and the community.

Cotylogaster basiri Siddiqi & Cable, 1960 (Aspidobothrea: Aspidogastridae) in Pogonias cromis (Linnaeus, 1766) (Perciformes: Sciaenidae): first report from Brazil

Abstract Up until now, there have been few studies of the helminth fauna of Brazilian populations of Pogonias cromis. In North America, P. cromis is known to be a definitive host of Cotylogaster basiri, although there have been no reports of any species of Cotylogaster infecting fish in Brazil. During necropsies of marine fish obtained from professional fisherman in the state of Rio Grande do Sul, Brazil, specimens of C. basiri were found in the intestine and rectum of P. cromis. In comparison with previous studies, differences were found in relation to the number of lobes in the buccal disc and the development of the biocellate larvae in the eggs of C. basiri. This is the first report of C. basiri in P. cromis from Brazil, contributing to the understanding of the helminth fauna of this fish from the coastal zone of Brazil.

Truncated p110 ERBB2 induces mammary epithelial cell migration, invasion and orthotopic xenograft formation, and is associated with loss of phosphorylated STAT5

Truncated-ERBB2 isoforms (t-ERBB2s), resulting from receptor proteolysis or alternative translation of the ERBB2 mRNA, exist in a subset of human breast tumors. t-ERBB2s lack the receptor extracellular domain targeted by therapeutic anti-ERBB2 antibodies and antibody–drug conjugates, including trastuzumab, trastuzumab-DM1 and pertuzumab. In clinical studies, expression of t-ERBB2 in breast tumors correlates with metastasis as well as trastuzumab resistance. By using a novel immuno-microarray method, we detect a significant t-ERBB2 fraction in 18 of 31 (58%) of immunohistochemistry (IHC)3+ ERBB2+ human tumor specimens, and further show that t-ERBB2 isoforms are phosphorylated in a subset of IHC3+ samples (10 of 31, 32%). We investigated t-ERBB2 biological activity via engineered expression of full-length and truncated ERBB2 isoforms in human mammary epithelial cells (HMECs), including HMEC and MCF10A cells. Expression of p110 t-ERBB2, but not p95m (m=membrane, also 648CTF) or intracellular ERBB2s, significantly enhanced cell migration and invasion in multiple cell types. In addition, only expression of the p110 isoform led to human breast epithelial cell (HMLE) xenograft formation in vivo. Expression of t-ERBB2s did not result in hyperactivation of the phosphoinositide kinase-3/AKT or mitogen-activated protein kinase signaling pathways in these cells; rather, phosphoproteomic array profiling revealed attenuation of phosphorylated signal transducer and activator of transcription 5 (STAT5) in p110-t-ERBB2-expressing cells compared to controls. Short hairpin-mediated silencing of STAT5 phenocopied p110-t-ERBB2-driven cell migration and invasion, while expression of constitutively active STAT5 reversed these effects. Thus, we provide novel evidence that (1) expression of p110 t-ERBB2 is sufficient for full transformation of HMEC, yielding in vivo xenograft formation, and (2) truncated p110 t-ERBB2 expression is associated with decreased phosphorylation of STAT5.

PD01-09: Identifying Novel Mechanisms of Resistance to Lapatinib in ERBB2+ Breast Cancer Cells through Whole Genome Mutational Analysis

Background: Overexpression of the epidermal growth factor receptor ERBB2 (HER2) is found in 20% of human breast cancers. Therapies targeting ERBB2 including trastuzumab and lapatinib have significantly improved the outlook for women with ERBB2+ breast cancer. However, resistance to these agents occurs frequently and remains a significant clinical problem. In the case of lapatinib resistance, the mechanism(s) of resistance remain poorly understood, since the current proposed rationale thought to limit lapatinib's anti-tumor effects has been difficult to reconcile with clinical data. Therefore, we hypothesize that novel mechanisms of resistance could be identified by mapping genomic variations in ERBB2+ cells with acquired resistance to lapatinib. The identification of such mutations may provide insights into mechanisms of resistance and may indicate therapeutic strategies to overcome lapatinib resistance in ERBB2+ breast cancer.

Material and Methods: SKBR3 breast cancer cells resistant to lapatinib were generated through serial passage by exposure of drug sensitive parental SKBR3 cells to increasing concentrations of lapatinib up to the peak plasma concentration observed in human subjects (2.6 uM (SK-lapR)). Multiple signaling pathways in lapatinib sensitive and resistant cells were interrogated by Reverse Phase Protein Array (RPPA) and western blot analysis. To identify genome wide somatic mutations, the Exome of lapatinib resistant and sensitive SKBR3 cells was sequenced utilizing next generation deep sequencing. Following exclusion of germline variants, the acquired gene mutations in lapatinib resistant SKBR3 cells were confirmed by DNA re-sequencing of PCR amplified DNA segments.

Results and Discussion: Analysis of activated signaling pathways in lapatinib resistant and sensitive SKBR3 cells did not confirm any of the previously proposed mechanisms of resistance. In particular, these cells show no activation of AKT or alternative receptor tyrosine kinases such as IGF-IR, ERBB3 or c-Met. However they exhibit sustained activation of mTORC1 and ERK1/2, as well as phosphorylation of STAT3, STAT5, rpS6 and CREB. Initial sequence analysis of exome and transcriptome reveals the presence of 76 single nucleotide variants/Indels differing between sensitive and resistant cells with 34/76 validated as true mutations present in the genome of lapatinib resistant SKBR3 cells, including mutations in LATS2, MAP3K5, SMAD3 and PDGFRA. This is the first exome sequence analysis to be reported which defines a drug resistant phenotype in ERBB2+ breast cancer. Ongoing work includes investigation of mutations as drug resistance mediators and analysis of copy number variations and gene fusions/translocations to systematically search for molecular alterations, with the goal of providing a rationale for the design of new combination therapies aimed at lapatinib resistance for ERBB2+ breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD01-09.

P2-01-25: Truncated p110 ERBB2 (CTF611) Increases Migration and Invasion of Breast Epithelial Cells by Inhibiting STAT5b Activation

Background: Truncated ERBB2 receptors are present in a subset of human ERBB2+ amplified/overexpressing breast tumors, and are associated with trastuzumab resistance, metastasis, and poor clinical prognosis. However, whether truncated ERBB2 receptors are drivers of metastasis has not been well defined. In this study, we examined effects of full-length (p185) and truncated (p110) ERBB2 on the migration and invasion of human mammary epithelial cells, including HMLE and MCF10A cells.

Material and Methods: Recombinant p185 and p110 ERBB2 were stably expressed in human mammary epithelial cells (HMLE) and MCF10A cells via retroviral vector. Expression of comparable levels of p185 and p110 in cells was confirmed by western blot. The phosphorylation states of downstream signaling proteins including STAT5 were assayed via phosphoproteomics and Collaborative Enzyme Enhanced Reactive (CEER™) immunoassay. The effects of the p110 constructs on cell migration and invasion were investigated by transwell assays. shRNA-encoding lentivirus was used for specific silencing of STAT5b in HMLE cells, and STAT5b silencing was confirmed at the protein level using western blot.

Results and Discussion: Expression of p110 ERBB2 increased cell migration (HMLE, p = 0.04; MCF10A, p< 0.01) and invasion (HMLE, p= 0.03) when compared to expression of p185. Furthermore, expression of p110 in HMLE cells was associated with reduced phosphorylation of STAT5b. shRNA mediated silencing of STAT5b was sufficient to increase the migration (p < 0.01) and invasion of HMLE cells, phenocopying the p110 driven effects on HMLE cells. In clinical studies, loss of activated STAT5 protein correlates with breast cancer progression and is a negative predictor of survival. By analyzing publicly available gene expression datasets, we found that STAT5b mRNA expression is also significantly decreased in breast cancer compared to normal breast tissues in several studies, as well as in ERBB2 amplified vs. nonamplified samples. To our knowledge, this is the first reported perturbation of STAT signaling by truncated ERBB2 receptor, and suggests a mechanism by which truncated p110 ERBB2 (CTF611) increases migration and invasion of breast epithelial cells. This study extends the available data regarding STAT5 loss in breast cancer progression.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-01-25.

Abstract P5-06-03: Truncated ERBB2 Receptors: Diagnostic and Therapeutic Targets

Background:

Patients with ERBB2+ breast cancer have aggressive disease and poor prognoses. It is now apparent that many ERBB2+ tumors also express truncated ERBB2 receptors (t-ERBB2s), namely p110 and p95. Increased expression of t-ERBB2s by breast tumors correlates with increased nodal involvement, distant metastasis, and poor clinical outcome in patients. Because t-ERBB2s lack the epitope bound by trastuzumab, expression of high levels of these isoforms may designate patients who would be better treated with alternative anti-ERBB2 therapy such as lapatinib; unfortunately, there is currently no clinical method to distinguish full-length p185- versus t-ERBB2 in patient tumor samples. Materials and Methods:

Recombinant forms of p185-, p110- and p95-ERBB2 were constructed using standard cloning techniques and expressed in human mammary epithelial cells (HMLE) via retroviral vector. The expression and subcellular localization of constructs were confirmed by western blot analysis and confocal microscopy. The ability of p185- and t-ERBB2 constructs to transform HMLE cells was evaluated using soft agar assays, and the effects on migration and invasion of these cells were investigated by transwell assays. Finally, the in vivo tumor formation by p185- vs. t-ERBB2 expressing cells was evaluated in immunodeficient mice. Additionally, a novel proximity-based antibody-capture method method to discern full-length versus t-ERBB2 in patient tumor samples was assessed (COPIA). Block tumors and fine-needle aspirates from patient tumor samples were used for quantifying total and phosphorylated ERBB2 receptors.

Results and Discussion:

Recombinant p185- and t-ERBB2 constructs were stably expressed in HMLE cells, and were correctly targeted to the cell membrane, as shown by confocal immunofluorescence microscopy and immunoblot. Expression of p110 t-ERBB2 increased migration and invasion of HMLE cells compared to p185 ERBB2 (P<0.0001), while p110, p95m and p185 ERBB2s were equally effective at enhancing anchorage-independent growth. In vivo, expression of p110 t-ERBB2 but not other isoforms led to increased tumor formation in mice compared to controls (P<0.005). No apparent phenotypes were elicited by expression of intracellular t-ERBB2 isoforms. Using COPIA testing, t-ERBB2 isoforms were detected in strongly ERBB2- positive tumors (16 of 31 samples, 52%) and were phosphorylated in 10 of 31 (32%). As expected, t-ERBB2s were not detected in ERBB2-negative tumor samples.

Truncated ERBB2s, particularly p110, may be major pathogenic drivers in ERBB2+ cancers. These isoforms may accelerate disease progression by promoting invasion and metastasis, and likely mediate resistance to trastuzumab and other therapies. Thus, t-ERBB2s represent attractive novel targets for diagnosis and treatment of ERBB2+ breast cancers.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-06-03.

Abstract P4-01-05: Lapatinib Resistance Confers Cross-Resistance to Microtubule Inhibitors in ErbB2-Overexpressing Breast Cancer Cells

ErbB2 gene amplification occurs in approximately 20% of all breast cancers and is associated with an aggressive subtype with poor clinical prognosis. Acquired resistance to erbB2-targeted therapies is a common occurance even in patients who show an initial clinical response to trastuzumab or lapatinib-based regimens. Optimal treatment for relapsed disease following erbB2 targeted therapies has not been defined. Therefore, we sought to evaluate whether cytotoxic agents have cross-resistance to lapatinib in cell lines that have acquired resistance to lapatinib. Here we established a model of acquired lapatinib resistance derived from erbB2 overexpressing breast cancer cell lines, BT474 and SKBR3. Lapatinib resistant cell lines, BTLapR and SKLapR, were generated by growth in the continuous presence of 2.6 uM lapatinib (peak plasma concentration in human subjects) resulting in IC50 of 4.72 uM (BTLapR) and 0.083 uM (BT474) (P<0.0001). IC50 of SKLapR and SKBR3 were 17.72 uM and 0.1637 uM (P<0.0001), respectively. Next, resulting cells were treated with different classes of chemotherapeutics (2 taxanes, 2 vinca-alkaloids, 1 epothilone, 1 anthracycline, 1 antimetabolite, 2 platinums, and 1 alkylating agent) in order to address cross-resistance to lapatinib. BT474 and BTLapR as well as SKBR3 and SKLapR were exposed to each chemotherapeutic agent and cell viability was evaluated at 72h using a cell proliferation assay (AlamarBlue®). We found that BTLapR was significantly cross-resistant to 5 microtubule inhibitors (paclitaxel, docetaxel, vinorelbine, vinblastine, and ixabepilone), but SKLapR was not (shown in table below).

IC 50 of Significant Drugs on Lapatinib Resistant BT474 cells

Previous studies have shown that resistance to lapatinib can switch cell survival signaling from the erbB2 to ER pathway, and that ER signaling can stimulate beta III tubulin expression. We therefore hypothesize the differential responses to microtubule inhibitors in BTLapR and SKLapR might be explained by the fact that BT474 has both estrogen (ER) and progesterone receptor (PR), but SKBR3 express neither. Moreover, beta-III tubulin is known to be a key resistance mechanism of microtubule inhibition. Western blot analysis of baseline protein expression in both acquired lapatinib-resistant and parental cells indicates that ER signaling is involved in stimulating beta III tubulin and is linked to the development of resistance to microtubule inhibitors. These findings point to a potential mechanism to address cross resistance between lapatinib and microtubule-interacting agents, which could have potential clinical implications when considering salvage therapies following lapatinib treatment.

Truncated p95erbB2 Isoforms Are Capable of Transforming Human Mammary Epithelial Cells

Background:Objective clinical response to trastuzumab monotherapy in erbB2-amplified first line metastatic breast cancer is 34% (Vogel, et al., JCO 20: 719-26, 2002). Amongst patients who respond, most develop resistance (defined by disease progression on trastuzumab). One proposed mechanism of trastuzumab resistance is proteolytic cleavage of erbB2 receptor from its full-length (p185) form into truncated, constitutively active p95. Increased expression of p95erbB2 correlates with increased nodal involvement and poor clinical outcome. Because p95erbB2 lacks the trastuzumab binding epitope, expression may designate patients who would be suitable for treatment with erbB2 kinase inhibitors.Materials and Methods:Recombinant p185erbB2 and p95erbB2 constructs were stably expressed in several cell types via retroviral vector. Additionally, an intracellular form of p95erbB2 that arises via alternative translation and an intracellular p95erbB2 construct containing two copies of a nuclear localization sequence were also expressed. Expression and proper subcellular localization of constructs were confirmed by cell fractionation, western blot analysis and confocal microscopy. Transformation of human mammary epithelial (HMEC) and NIH3T3 cells by p185erbB2 and p95erbB2 isoforms was evaluated by anchorage independent growth using a quantitative fluorescent soft agar assay, and effects on migration and invasion of these cells were investigated by wound-healing and transwell assays. Cells transfected with oncogenic Ras or empty vector were used as positive and negative controls in these experiments.Results and Discussion:Recombinant p185erbB2 and p95erbB2 constructs were stably expressed in HMEC and NIH3T3 cells, and were correctly directed to the cell membrane; nuclear targeted intracellular p95erbB2 was correctly localized to the cell nucleus. Both p185 erbB2 and membrane-bound truncated p95erbB2 were sufficient to transform HMEC cells as compared to empty vector control transfected cells [mean fluorescence intensity empty vector control 2480 ± 464 (1 standard deviation); mean fluorescence intensity p185erbB2 9208 ± 2528, p= 0.0106; mean fluorescence intensity p95erbB2 6615 ± 1588, p= 0.0124)] as was the positive control oncogenic Ras (mean fluorescence intensity 4350 ± 433, p=0.0069). Interestingly, nuclear-targeted p95erbB2 was also sufficient to transform HMEC cells (mean fluorescence intensity 6492 ± 818, p=0.0018). These data support the hypothesis that truncated p95erbB2 species may be major pathogenic drivers in erbB2-amplified cancers. P95erbB2 therefore represents an attractive target for diagnosis and treatment of erbB2+ breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3136.

Noise levels in dental schools

OBJECTIVE

To measure and analyse noise levels in the learning-teaching activities at the Dental School of the University of Porto (Portugal).

MATERIALS AND METHODS

Sound levels were measured in five different practice areas and laboratories, selected as representative of a variety of learning-teaching activities. The noise levels were determined using a precision sound level meter that was positioned at ear level and at 1 m distance from the operator.

RESULTS

The noise levels registered vary between 60 and 99 dB(A) and are similar to the data of other international studies. The results recorded differences in sound levels when the equipment was merely turned on and during cutting operations. Differences between brand new and used equipment were also noted. It appears that hearing damage risk may be lesser amongst dentists who use brand new equipment.

CONCLUSION

The noise levels detected in this study are considered to be close to the limit of risk of hearing loss.

In-plane electronic speckle pattern of interference (ESPI) with optical fibre system applied to the study of the human jaw

The standard illumination set-up for measurement of in-plane displacement in electronic speckle pattern of interference (ESPI) requires the use of two oblique coherent beams for the illumination of the object. These two beams define a direction in the plane perpendicular to the optical axis in which the displacement can be measured, while in the perpendicular direction the interferometer has no sensitivity. In this paper, a new ESPI system for the measurement of in-plane displacements is used. The novelty presented by this assembly is the use of optical fibres to split and guide the light beams. In this way, it is possible to vary with great precision and ease the direction of the projected beams and, consequently, the direction of the plane in which the displacements undergone by the object can be studied. This set-up makes possible the study of objects with complex geometries, which have deformations with unknown symmetry. We present results obtained with this interferometer applied to the study of the mechanical behaviour of the human jaw.

A three-dimensional numerical simulation of mandible fracture reduction with screwed miniplates

A three-dimensional finite element model of a fractured human mandible treated with plating technique was developed to simulate and to study the biomechanical loads and the stress field distribution. Biomechanical properties of bone have been thoroughly investigated experimentally. In this work, using the finite element method, complete clinical conditions (after surgical reduction, post-operatory period, complete healing period) were simulated. The mandible fracture was located in the symphysis region and one or two titanium miniplates, fixed with monocortical screws, were evaluated. The behaviour of a reduced human mandible with screwed miniplates, as well as its complete healing, is investigated and described.

The mechanical behaviour of human mandibles studied by electronic speckle pattern interferometry

An understanding of the mechanical behaviour of the human mandible during mastication may be useful in several specific medical fields that examine the maxillofacial area. In this research, the Electronic Speckle Pattern Interferometry Optical Technique was applied to study a dry mandible under external stress. Two images of the mandible, i.e. an image of the relaxed mandible and another of the mandible under stress, were processed using this technique and provided information concerning the most stressed areas of the bone. The advantage of interferometric analysis is that it can be carried out in real time on a mandible to which progressively greater stress has been applied. This research may be of value in maxillofacial surgery, for example, in the diagnosis and treatment of fractured mandibles, and in oral surgery and orthodontics, where it can provide information concerning stress dispersion when an osteointegrated implant or orthodontic appliance is placed in the mouth. One of the most important conclusions to be drawn from the experiments of tension, compression, and in- and out-of-plane deformations is that the capability of the mandible to bend is superior to its capability to stretch. Several quantitative results support this conclusion.