Websites about, not for, adolescents? A systematic analysis of online fertility preservation information for adolescent and young adult cancer patients

PURPOSE

Fertility preservation is an increasingly important topic in adolescent and young adult cancer survivorship, yet treatments remain under-utilized, possibly due to lack of awareness and understanding. The internet is widely used by adolescents and young adults and has been proposed to fill knowledge gaps and advance high-quality, more equitable care. As a first step, this study analyzed the quality of current fertility preservation resources online and identified opportunities for improvement.

METHODS

We conducted a systematic analysis of 500 websites to assess the quality, readability, and desirability of website features, and the inclusion of clinically relevant topics.

RESULTS

The majority of the 68 eligible websites were low quality, written at college reading levels, and included few features that younger patients find desirable. Websites mentioned more common fertility preservation treatments than promising experimental treatments, and could be improved with cost information, socioemotional impacts, and other equity-related fertility topics.

CONCLUSIONS

Currently, the majority of fertility preservation websites are about, but not for, adolescent and young adult patients. High-quality educational websites are needed that address outcomes that matter to teens and young adults, with a priority on solutions that prioritize equity.

IMPLICATIONS FOR CANCER SURVIVORS

Adolescent and young adult survivors have limited access to high-quality fertility preservation websites that are designed for their needs. There is a need for the development of fertility preservation websites that are clinically comprehensive, written at appropriate reading levels, inclusive, and desirable. We include specific recommendations that future researchers can use to develop websites that could better address AYA populations and improve the fertility preservation decision making process.

Websites about, not for, adolescents? A systematic analysis of online fertility preservation information for adolescent and young adult cancer patients

Purpose Fertility preservation is an increasingly important topic in adolescent and young adult cancer survivorship, yet treatments remain under-utilized, possibly due to lack of awareness and understanding. The internet is widely used by adolescents and young adults and has been proposed to fill knowledge gaps and advance high-quality, more equitable care. As a first step, this study analyzed the quality of current fertility preservation resources online and identified opportunities for improvement. Methods We conducted a systematic analysis of 500 websites to assess the quality, readability, and desirability of website features, and the inclusion of clinically relevant topics. Results The majority of the 68 eligible websites were low quality, written at college reading levels, and included few features that younger patients find desirable. Websites mentioned more common fertility preservation treatments than promising experimental treatments, and could be improved with cost information, socioemotional impacts, and other equity-related fertility topics. Conclusions Currently, the majority of fertility preservation websites are about, but not for, adolescent and young adult patients. High-quality educational websites are needed that address outcomes that matter to teens and young adults, with a priority on solutions that prioritize equity. Implications for Cancer Survivors: Adolescent and young adult survivors have limited access to high-quality fertility preservation websites that are designed for their needs. There is a need for the development of fertility preservation websites that are clinically comprehensive, written at appropriate reading levels, inclusive, and desirable. We include specific recommendations that future researchers can use to develop websites that could better address AYA populations and improve the fertility preservation decision making process.

Overall survival in patients with FIGO stage IVA cervical cancer

OBJECTIVE

FIGO stage IVA cervical cancer is a unique diagnosis that conveys a poor prognosis. Despite the use of PET/CT for staging, concurrent chemotherapy, and image-guided brachytherapy, overall survival (OS) in these patients is low. Treatment requires aggressive use of radiotherapy and chemotherapy. We report results of a prospective observational cohort study for patients with de novo stage IVA cervical cancer treated at a single institution.

METHODS

Patients with a new diagnosis of stage IVA cervical cancer treated at an academic institution between 1997 and 2020 were prospectively monitored. Staging was retroactively assigned using the 2018 FIGO staging system. All patients had a PET/CT prior to treatment and were treated with definitive intent radiotherapy with or without chemotherapy. The primary outcome of interest was OS. Secondary outcomes were local control, progression-free survival (PFS), and disease-specific survival (DSS).

RESULTS

32 patients with de novo stage IVA cervical cancer were treated with definitive intent radiotherapy. Median follow-up time was 4.27 years (1.31-10.35). 22/32 (69%) of patients received brachytherapy as a part of their definitive treatment, and 28/32 (88%) received chemotherapy concurrently with radiotherapy. 14/32 (44%) of patients had no evidence of disease at last follow-up. The 5-year local control, PFS, DFS, and OS estimates were 79%, 49%, 53%, and 48%, respectively. On multivariate analysis, complete metabolic response was associated with a statistically significant improvement in PFS (HR = 0.256, 95% CI = 0.078-0.836, p = 0.024) and OS (HR = 0.273, 95% CI 0.081-0.919).

CONCLUSIONS

These data demonstrate a robust OS in patients with stage IVA cervical cancer when treated with definitive chemoradiotherapy.

Hormone and receptor activator of NF-κB (RANK) pathway gene expression in plasma and mammographic breast density in postmenopausal women

Background

Hormones impact breast tissue proliferation. Studies investigating the associations of circulating hormone levels with mammographic breast density have reported conflicting results. Due to the limited number of studies, we investigated the associations of hormone gene expression as well as their downstream mediators within the plasma with mammographic breast density in postmenopausal women.

Methods

We recruited postmenopausal women at their annual screening mammogram at Washington University School of Medicine, St. Louis. We used the NanoString nCounter platform to quantify gene expression of hormones (prolactin, progesterone receptor (PGR), estrogen receptor 1 (ESR1), signal transducer and activator of transcription (STAT1 and STAT5), and receptor activator of nuclear factor-kB (RANK) pathway markers (RANK, RANKL, osteoprotegerin, TNFRSF18, and TNFRSF13B) in plasma. We used Volpara to measure volumetric percent density, dense volume, and non-dense volume. Linear regression models, adjusted for confounders, were used to evaluate associations between gene expression (linear fold change) and mammographic breast density.

Results

One unit increase in ESR1, RANK, and TNFRSF18 gene expression was associated with 8% (95% CI 0–15%, p value = 0.05), 10% (95% CI 0–20%, p value = 0.04) and % (95% CI 0–9%, p value = 0.04) higher volumetric percent density, respectively. There were no associations between gene expression of other markers and volumetric percent density. One unit increase in osteoprotegerin and PGR gene expression was associated with 12% (95% CI 4–19%, p value = 0.003) and 7% (95% CI 0–13%, p value = 0.04) lower non-dense volume, respectively.

Conclusion

These findings provide new insight on the associations of plasma hormonal and RANK pathway gene expression with mammographic breast density in postmenopausal women and require confirmation in other studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13058-022-01522-2.

Multifunctional Thio-Stabilized Gold Nanoparticles for Near-Infrared Fluorescence Detection and Imaging of Activated Caspase-3

Background

Gold nanoparticles (AuNPs) are commonly used in nanomedicine because of their unique spectral properties, chemical and biological stability, and ability to quench the fluorescence of organic dyes attached to their surfaces. However, the utility of spherical AuNPs for activatable fluorescence sensing of molecular processes have been confined to resonance-matched fluorophores in the 500 nm to 600 nm spectral range to maximize dye fluorescence quenching efficiency. Expanding the repertoire of fluorophore systems into the NIR fluorescence regimen with emission >800 nm will facilitate the analysis of multiple biological events with high detection sensitivity.

Objective

The primary goal of this study is to determine if spherical AuNP-induced radiative rate suppression of non-resonant near-infrared (NIR) fluorescent probes can serve as a versatile nanoconstruct for highly sensitive detection and imaging of activated caspase-3 in aqueous media and cancer cells. This required the development of activatable NIR fluorescence sensors of caspase-3 designed to overcome the nonspecific degradation and release of the surface coatings in aqueous media.

Method

We harnessed the fluorescence-quenching properties and multivalency of spherical AuNPs to develop AuNP-templated activatable NIR fluorescent probes to detect activated caspase-3, an intracellular reporter of early cell death. Freshly AuNPs were coated with a multifunctional NIR fluorescent dye-labeled peptide (LS422) consisting of an RGD peptide sequence that targets α_vβ₃-integrin protein (α_vβ₃) on the surface of cancer cells to mediate the uptake and internalization of the sensors in tumor cells; a DEVD peptide sequence for reporting the induction of cell death through caspase-3 mediated NIR fluorescence enhancement; and a multidentate hexacysteine sequence for enhancing self-assembly and stabilizing the multifunctional construct on AuNPs. The integrin binding affinity of LS422 and caspase-3 kinetics were determined by a radioligand competitive binding and fluorogenic peptide assays, respectively. Detection of intracellular caspase-3, cell viability, and the internalization of LS422 in cancer cells were determined by confocal NIR fluorescence spectroscopy and microscopy.

Results

Narrow size AuNPs (13 nm) were prepared and characterized by transmission electron microscopy and dynamic light scattering. When assembled on the AuNPs, the binding constant of LS422 for α_vβ₃ improved 11-fold from 13.2 nM to 1.2 nM. Whereas the catalytic turnover of caspase-3 by LS422-AuNPs was similar to the reference fluorogenic peptide, the binding affinity for the enzyme increased by a factor of 2. Unlike the α_vβ₃ positive, but caspase-3 negative breast cancer MCF-7 cells, treatment of the α_vβ₃ and caspase-3 positive lung cancer A549 cells with Paclitaxel showed significant fluorescence enhancement within 30 minutes, which correlated with caspase-3 specific activation of LS422-AuNPs fluorescence. Incorporation of a 3.5 mW NIR laser source into our spectrofluorometer increased the detection sensitivity by an order of magnitude (limit of detection ~0.1 nM of cypate) and significantly decreased the signal noise relative to a xenon lamp. This gain in sensitivity enabled the detection of substrate hydrolysis at a broad range of inhibitor concentrations without photobleaching the cypate dye.

Conclusion

The multifunctional AuNPs demonstrate the use of a non-resonant quenching strategy to design activatable NIR fluorescence molecular probes. The nanoconstruct offers a selective reporting method for detecting activated caspase-3, imaging of cell viability, identifying dying cells, and visualizing the functional status of intracellular enzymes. Performing these tasks with NIR fluorescent probes creates an opportunity to translate the in vitro and cellular analysis of enzymes into in vivo interrogation of their functional status using deep tissue penetrating NIR fluorescence analytical methods.

Magnesium improves cisplatin-mediated tumor killing while protecting against cisplatin-induced nephrotoxicity

Approximately 30% of all cancer patients treated with cisplatin, a widely used broad-spectrum chemotherapeutic agent, experience acute kidney injury (AKI). Almost all patients receiving cisplatin have magnesium (Mg) losses, which are proposed to aggravate AKI. Currently, there are no methods to successfully treat or prevent cisplatin-AKI. Whereas Mg supplementation has been shown to reduce AKI in experimental models and several small clinical trials, the effects of Mg status on tumor outcomes in immunocompetent tumor-bearing mice and humans have not been investigated. The purpose of this study was to further examine the effects of Mg deficiency (±Mg supplementation) on cisplatin-mediated AKI and tumor killing in immunocompetent mice bearing CT26 colon tumors. Using a model where cisplatin alone (20 mg/kg cumulative dose) produced minimal kidney injury, Mg deficiency significantly worsened cisplatin-mediated AKI, as determined by biochemical markers (blood urea nitrogen and plasma creatinine) and histological renal changes, as well as markers of renal oxidative stress, inflammation, and apoptosis. By contrast, Mg supplementation blocked cisplatin-induced kidney injury. Using LLC-PK₁ renal epithelial cells, we observed that Mg deficiency or inhibition of Mg uptake significantly enhanced cisplatin-induced cytotoxicity, whereas Mg supplementation protected against cytotoxicity. However, neither Mg deficiency nor inhibition of Mg uptake impaired cisplatin-mediated killing of CT26 tumor cells in vitro. Mg deficiency was associated with significantly larger CT26 tumors in BALB/c mice when compared with normal-fed control mice, and Mg deficiency significantly reduced cisplatin-mediated tumor killing in vivo. Finally, Mg supplementation did not compromise cisplatin's anti-tumor efficacy in vivo.

Soil-Air Mercury Flux near a Large Industrial Emission Source before and after Closure (Flin Flon, Manitoba, Canada)

Prior to its closure, the base-metal smelter in Flin Flon, Manitoba, Canada was one of the North America's largest mercury (Hg) emission sources. Our project objective was to understand the exchange of Hg between the soil and the air before and after the smelter closure. Field and laboratory Hg flux measurements were conducted to identify the controlling variables and used for spatial and temporal scaling. Study results showed that deposition from the smelter resulted in the surrounding soil being enriched in Hg (up to 99 μg g(-1)) as well as other metals. During the period of smelter operation, air concentrations were elevated (30 ± 19 ng m(-3)), and the soil was a net Hg sink (daily flux: -3.8 ng m(-2) h(-1)). Following the smelter closure, air Hg(0) concentrations were reduced, and the soils had large emissions (daily flux: 108 ng m(-2) h(-1)). The annual scaling of soil Hg emissions following the smelter closure indicated that the landscape impacted by smelter deposition emitted or re-emitted almost 100 kg per year. Elevated soil Hg concentrations and emissions are predicted to continue for hundreds of years before background concentrations are re-established. Overall, the results indicate that legacy Hg deposition will continue to cycle in the environment long after point-source reductions.

Magnesium protects against cisplatin-induced acute kidney injury by regulating platinum accumulation

Despite its success as a potent antineoplastic agent, ∼25% of patients receiving cisplatin experience acute kidney injury (AKI) and must discontinue therapy. Impaired magnesium homeostasis has been linked to cisplatin-mediated AKI, and because magnesium deficiency is widespread, we examined the effect of magnesium deficiency and replacement on cisplatin-induced AKI in physiologically relevant older female mice. Magnesium deficiency significantly increased cisplatin-associated weight loss and markers of renal damage (plasma blood urea nitrogen and creatinine), histological changes, inflammation, and renal cell apoptosis and modulated signaling pathways (e.g., ERK1/2, p53, and STAT3). Conversely, these damaging effects were reversed by magnesium. Magnesium deficiency alone significantly induced basal and cisplatin-mediated oxidative stress, whereas magnesium replacement attenuated these effects. Similar results were observed using cisplatin-treated LLC-PK1 renal epithelial cells exposed to various magnesium concentrations. Magnesium deficiency significantly amplified renal platinum accumulation, whereas magnesium replacement blocked the augmented platinum accumulation after magnesium deficiency. Increased renal platinum accumulation during magnesium deficiency was accompanied by reduced renal efflux transporter expression, which was reversed by magnesium replacement. These findings demonstrate the role of magnesium in regulating cisplatin-induced AKI by enhancing oxidative stress and thus promoting cisplatin-mediated damage. Additional in vitro experiments using ovarian, breast, and lung cancer cell lines showed that magnesium supplementation did not compromise cisplatin's chemotherapeutic efficacy. Finally, because no consistently successful therapy to prevent or treat cisplatin-mediated AKI is available for humans, these results support developing more conservative magnesium replacement guidelines for reducing cisplatin-induced AKI in cancer patients at risk for magnesium deficiency.

Impact of closing Canada's largest point-source of mercury emissions on local atmospheric mercury concentrations

The Flin Flon, Manitoba copper smelter was Canada's largest point source of mercury emissions until its closure in 2010 after ~80 years of operation. The objective of this study was to understand the variables controlling the local ground-level air mercury concentrations before and after this major point source reduction. Total gaseous mercury (TGM) in air, mercury in precipitation, and other ancillary meteorological and air quality parameters were measured pre- and postsmelter closure, and mercury speciation measurements in air were collected postclosure. The results showed that TGM was significantly elevated during the time period when the smelter operated (4.1 ± 3.7 ng m(-3)), decreased only 20% during the year following its closure, and remained ~2-fold above background levels. Similar trends were observed for mercury concentrations in precipitation. Several lines of evidence indicated that while smelter stack emissions would occasionally mix down to the surface resulting in large spikes in TGM concentrations (up to 61 ng m(-3)), the largest contributor to elevated TGM concentrations before and after smelter closure was from surface-air fluxes from mercury-enriched soils and/or tailings. These findings highlight the ability of legacy mercury, deposited to local landscapes over decades from industrial activities, to significantly affect local air concentrations via emissions/re-emissions.

Ambient air total gaseous mercury concentrations in the vicinity of coal-fired power plants in Alberta, Canada

The Lake Wabamun area, in Alberta, is unique within Canada as there are four coal-fired power plants within a 500 km(2) area. Continuous monitoring of ambient total gaseous mercury (TGM) concentrations in the Lake Wabamun area was undertaken at two sites, Genesee and Meadows. The data were analyzed in order to characterise the effect of the coal-fired power plants on the regional TGM. Mean concentrations of 1.57 ng/m(3) for Genesee and 1.50 ng/m(3) for Meadows were comparable to other Canadian sites. Maximum concentrations of 9.50 ng/m(3) and 4.43 ng/m(3) were comparable to maxima recorded at Canadian sites influenced by anthropogenic sources. The Genesee site was directly affected by the coal-fired power plants with the occurrence of northwest winds, and this was evident by episodes of elevated TGM, NO(x) and SO(2) concentrations. NO(x)/TGM and SO(2)/TGM ratios of 21.71 and 19.98 microg/ng, respectively, were characteristic of the episodic events from the northwest wind direction. AERMOD modeling predicted that coal-fired power plant TGM emissions under normal operating conditions can influence hourly ground-level concentrations by 0.46-1.19 ng/m(3)(.) The effect of changes in coal-fired power plant electricity production on the ambient TGM concentrations was also investigated, and was useful in describing some of the episodes.

Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging

BACKGROUND

Previous studies have shown that gated single photon emission computed tomography (SPECT) technetium 99-labeled sestamibi imaging provides accurate and reproducible measurement of left ventricular (LV) ejection fraction (EF), wall motion, and thickening. This study examined the reliability of gated SPECT sestamibi imaging in measuring LV end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV).

METHODS AND RESULTS

Gated SPECT measurements were compared with an independent nongeometric method based on thermodilution SV and first-pass radionuclide angiographic EF (using a multicrystal gamma camera). Twenty-four patients aged 58+/-11 years underwent cardiac catheterization and coronary angiography for evaluation of chest pain syndromes. None had primary valvular disease, intracardiac shunts, or atrial fibrillation.

RESULTS

The correlation between the two methods were as follows: EDV: r = 0.89, P<.001; ESV: r = .938, P<.001; SV: r = 0.577, P<.001. Bland-Altman plots showed mean differences (+/-standard deviation [SD]) for EDV of -14.3+/-33.3 mL, for ESV of -0.4+/-23.7 mL, and for SV of -13.9+/-15.2 mL. The reproducibility of measuring EDV and ESV by gated SPECT was very high (r = 0.99 each).

CONCLUSION

Gated 99mTc-labeled sestamibi SPECT provides reproducible LV volume measurements. With validation of volume measurement, gated SPECT provides comprehensive assessment of regional and global LV function. This information is important in many patient groups such as those with ischemic cardiomyopathy, concomitant coronary and valve disease, and those who have had myocardial infarction. It will also be useful to assess the incremental value of LV volumes in risk assessment.

Clinical management of patients with nonsustained ventricular tachycardia: what do we really know?

The management of patients with nonsustained ventricular tachycardia remains one of the most difficult tasks facing the practicing cardiologist. This common arrhythmia is a marker for death and morbid events in patients with a variety of forms of heart disease, but there is as yet no conclusive evidence that its suppression confers benefit. This paper will review the methods now available to risk stratify patients who have repetitive forms on electrocardiographic monitoring, their advantages and limitations. We will also review some of the trials which have attempted to prove that arrhythmia suppression improves survival. Finally, we will try to provide some recommendations to the clinician, based on what we know about this common arrhythmia. Though we will concentrate our attention on ischemic heart disease, we will briefly discuss the preferred management of patients with other forms of heart disease in whom the presence of nonsustained ventricular tachycardia has prognostic significance. We would like to emphasize that this is a rapidly changing field, and that treatment approaches will necessarily change, based on the results of ongoing clinical trials. The physician must not rigidly adhere to any treatment policy, but rather alter his or her approach based on the development of new information.

Effects of caffeine administration on food and water consumption under various experimental conditions

The effects of caffeine on food and water intake was assessed in rats maintained under several experimental conditions. In Experiment 1, caffeine, 3.125, 6.25, 12.5, 25.0, 50.0 or 100.0 mg/kg was injected into 23 hr food deprived, 23 hr water deprived or ad lib animals. In Experiment 2, animals were adapted to a 21 hr food deprivation schedule and administered the same doses of caffeine as were used in Experiment 1. Results indicate that caffeine both enhances and decreases food and water intake and that the effects observed depend on the experimental circumstances.

Academic achievement as a function of specific and global measures of self-concept

This study examined the correlations between academic achievement and factor specific, as well as global, measures of self-concept for 314 fourth and sixth grade boys and girls divided into grade level groups with and without Spanish surnames. The Primary Self-Concept Inventory was used to measure self-concept on six scales: physical size, emotional state, peer acceptance, helpfulness, success, and student-self. A global self-concept score was derived by totaling the scores on the six scales. Achievement was measured as total score on the Comprehensive Tests of Basic Skills. The two specific measures of self-concept that were most reflective of school performance, success and student-self, tended to show low positive correlations with achievement. The remaining specific measures, as well as the global measure, tended to show no relationship to achievement. These results suggest that an area specific model of self-concept is more useful than a global or undifferentiated model. Further, the low correlations between school related self-concept and achievement suggest that, as a group, students frequently have rather inaccurate academic self-concepts.