Luck and the 'situations' of research

This research note uses material from interviews with senior scholars in the natural sciences to highlight, and start to explore, the role and nature of 'luck' in scientific careers. By examining this in the context of STS work on the nature of contemporary academia, we argue for the importance of taking luck seriously as we interrogate life and work in research.

Seasonal and ontological variation in diet and age-related differences in prey choice, by an insectivorous songbird

The diet of an individual animal is subject to change over time, both in response to short-term food fluctuations and over longer time scales as an individual ages and meets different challenges over its life cycle. A metabarcoding approach was used to elucidate the diet of different life stages of a migratory songbird, the Eurasian reed warbler (Acrocephalus scirpaceus) over the 2017 summer breeding season in Somerset, the United Kingdom. The feces of adult, juvenile, and nestling warblers were screened for invertebrate DNA, enabling the identification of prey species. Dietary analysis was coupled with monitoring of Diptera in the field using yellow sticky traps. Seasonal changes in warbler diet were subtle, whereas age class had a greater influence on overall diet composition. Age classes showed high dietary overlap, but significant dietary differences were mediated through the selection of prey; (i) from different taxonomic groups, (ii) with different habitat origins (aquatic vs. terrestrial), and (iii) of different average approximate sizes. Our results highlight the value of metabarcoding data for enhancing ecological studies of insectivores in dynamic environments.

STS and science communication: Reflecting on a relationship

This brief commentary considers the relation between science communication research and practice and the field of Science and Technology Studies (STS). It outlines some key aspects of STS approaches, from an emphasis on exploratory research to considerations of normativity and the political, and discusses what they can bring to science communication. It ends by arguing for methodological and disciplinary diversity in science communication research.

School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis

Background

Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.

Objective

The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.

Design

This study comprised a systematic review, a network meta-analysis and an economic evaluation.

Data sources

The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.

Main outcomes

The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.

Review methods

Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.

Results

A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.

Limitations

The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.

Conclusions

There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.

Future work

Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.

Study registration

This study is registered as PROSPERO CRD42016048184.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.

Atmospheres of science: Experiencing scientific mobility

This article uses notions of the atmospheric to engage with empirical material concerned with international mobility in science. It draws on recent conceptual work on atmospheres that frames them as allowing access to the affective qualities of everyday life and as 'productively nebulous': atmospheres exist between the local and the globally diffuse, the emergent and the staged, the intangible and the brutally present. Using atmospheric thinking, I devise 'apparatuses of attunement' to capture elusive aspects of life in science, as discussed in interviews with natural scientists about their experiences of international mobility. In particular I use ideas of the situation, atmospheric threads, and the staging of atmospheres to argue that scientists represent themselves as existing in between the particular and the general: they are never wholly at the mercy of the structures and expectations of globalized science, but are also never not in the grip of them. In closing I reflect on what this analysis reveals about the affective qualities of contemporary science, the forms of life being nurtured by the norms and expectations of research (policy), and the kinds of agency available to (these) scientists. The aim of the article is thus twofold: to demonstrate how concepts of atmospheres can be put to work in STS, and to contribute to research on international mobility in science and contemporary scientific careers.

Cost-Effectiveness of Different Formats for Delivery of Cognitive Behavioral Therapy for Depression: A Systematic Review Based Economic Model

OBJECTIVES

Cognitive behavioral therapy (CBT) is an effective treatment for depression. Different CBT delivery formats (face-to-face [F2F], multimedia, and hybrid) and intensities have been used to expand access to the treatment. The aim of this study is to estimate the long-term cost-effectiveness of different CBT delivery modes.

METHODS

A decision-analytic model was developed to evaluate the cost-effectiveness of different CBT delivery modes and variations in intensity in comparison with treatment as usual (TAU). The model covered an average treatment period of 4 months with a 5-year follow-up period. The model was populated using a systematic review of randomized controlled trials and various sources from the literature.

RESULTS

Incremental cost-effectiveness ratios of treatments compared with the next best option after excluding all the dominated and extended dominated options are: £209/quality-adjusted life year (QALY) for 6 (sessions) × 30 (minutes) F2F-CBT versus TAU; £4 453/QALY for 8 × 30 F2F versus 6 × 30 F2F; £12 216/QALY for 8 × 60 F2F versus 8 × 30 F2F; and £43 072/QALY for 16 × 60 F2F versus 8 × 60 F2F. The treatment with the highest net monetary benefit for thresholds of £20 000 to £30 000/QALY was 8 × 30 F2F-CBT. Probabilistic sensitivity analysis illustrated 6 × 30 F2F-CBT had the highest probability (32.8%) of being cost-effective at £20 000/QALY; 16 × 60 F2F-CBT had the highest probability (31.0%) at £30 000/QALY.

CONCLUSIONS

All CBT delivery modes on top of TAU were found to be more cost-effective than TAU alone. Four F2F-CBT options (6 × 30, 8 × 30, 8 × 60, 16 × 60) are on the cost-effectiveness frontier. F2F-CBT with intensities of 6 × 30 and 16 × 60 had the highest probabilities of being cost-effective. The results, however, should be interpreted with caution owing to the high level of uncertainty.

School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis

BACKGROUND

Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available.

METHODS

We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184.

FINDINGS

1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively.

INTERPRETATION

Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here.

FUNDING

UK National Institute for Health Research.

The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis

Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.

An Ethics of the System: Talking to Scientists About Research Integrity

Research integrity and misconduct have recently risen to public attention as policy issues. Concern has arisen about divergence between this policy discourse and the language and concerns of scientists. This interview study, carried out in Denmark with a cohort of highly internationalised natural scientists, explores how researchers talk about integrity and good science. It finds, first, that these scientists were largely unaware of the Danish Code of Conduct for Responsible Conduct of Research and indifferent towards the value of such codes; second, that they presented an image of good science as nuanced and thereby as difficult to manage through abstracted, principle-based codes; and third, that they repeatedly pointed to systemic issues both as triggering misconduct and as ethical problems in and of themselves. Research integrity is framed as a part of wider moves to 'responsibilise' science; understood in these terms, resistance to codes of conduct and the representation of integrity as a problem of science as a whole can be seen as a rejection of a neoliberal individualisation of responsibility.

Synthesising quantitative evidence in systematic reviews of complex health interventions

Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced. We describe methods in three broad areas: non-quantitative approaches, including tabulation, narrative and graphical approaches; standard meta-analysis methods, including meta-regression to investigate study-level moderators of effect; and advanced synthesis methods, in which models allow exploration of intervention components, investigation of both moderators and mediators, examination of mechanisms, and exploration of complexities of the system. We offer guidance on the choice of approach that might be taken by people collating evidence in support of guideline development, and emphasise that the appropriate methods will depend on the purpose of the synthesis, the similarity of the studies included in the review, the level of detail available from the studies, the nature of the results reported in the studies, the expertise of the synthesis team and the resources available.

Experiments in engagement: Designing public engagement with science and technology for capacity building

Public engagement with science and technology is now widely used in science policy and communication. Touted as a means of enhancing democratic discussion of science and technology, analysis of public engagement with science and technology has shown that it is often weakly tied to scientific governance. In this article, we suggest that the notion of capacity building might be a way of reframing the democratic potential of public engagement with science and technology activities. Drawing on literatures from public policy and administration, we outline how public engagement with science and technology might build citizen capacity, before using the notion of capacity building to develop five principles for the design of public engagement with science and technology. We demonstrate the use of these principles through a discussion of the development and realization of the pilot for a large-scale public engagement with science and technology activity, the Futurescape City Tours, which was carried out in Arizona in 2012.

Affective learning in adults with intellectual disability: an experiment using evaluative conditioning

BACKGROUND

Evaluative conditioning is a form of affective learning in which initially neutral stimuli acquire an affective value through association with negative or positive stimuli. Recent research shows an important role for cognitive resources in this type of learning. This form of affective learning has rarely been studied in intellectual disability (ID).

METHOD

We examined evaluative conditioning in 16 adults with mild to moderate ID compared to age- and gender-matched control participants. Neutral shapes and symbols were repeatedly paired with positive, neutral or negative unconditioned stimuli (faces or International Affective Picture System images). There was also an extinction phase.

RESULTS

There was significant acquisition of conditioning in both groups. Stimuli paired with positive images were evaluated more positively, and stimuli paired with negative images were evaluated more negatively. Post-extinction ratings however show that these novel affective associations were not maintained by individuals with ID as much as by individuals in the control group.

CONCLUSIONS

We conclude that ID modulates some aspects of affective learning but not necessarily initial preference acquisition.

Are You Sure? Confidence about the Satiating Capacity of a Food Affects Subsequent Food Intake

Expectations about a food’s satiating capacity predict self-selected portion size, food intake and food choice. However, two individuals might have a similar expectation, but one might be extremely confident while the other might be guessing. It is unclear whether confidence about an expectation affects adjustments in energy intake at a subsequent meal. In a randomized cross-over design, 24 subjects participated in three separate breakfast sessions, and were served a low-energy-dense preload (53 kcal/100 g), a high-energy-dense preload (94 kcal/100 g), or no preload. Subjects received ambiguous information about the preload’s satiating capacity and rated how confident they were about their expected satiation before consuming the preload in its entirety. They were served an ad libitum test meal 30 min later. Confidence ratings were negatively associated with energy compensation after consuming the high-energy-dense preload (r = −0.61; p = 0.001). The same relationship was evident after consuming the low-energy-dense preload, but only after controlling for dietary restraint, hunger prior to, and liking of the test meal (p = 0.03). Our results suggest that confidence modifies short-term controls of food intake by affecting energy compensation. These results merit consideration because imprecise caloric compensation has been identified as a potential risk factor for a positive energy balance and weight gain.

Crafting the group: Care in research management

This article reports findings from an interview study with group leaders and principal investigators in Denmark, the United Kingdom and the United States. Taking as our starting point current interest in the need to enhance 'responsible research and innovation', we suggest that these debates can be developed through attention to the talk and practices of scientists. Specifically, we chart the ways in which interview talk represented research management and leadership as processes of caring craftwork. Interviewees framed the group as the primary focus of their attention (and responsibilities), and as something to be tended and crafted; further, this process required a set of affective skills deployed flexibly in response to the needs of individuals. Through exploring the presence of notions of care in the talk of principal investigators and group leaders, we discuss the relation between care and craft, reflect on the potential implications of the promotion of a culture of care and suggest how mundane scientific understandings of responsibility might relate to a wider discussion of responsible research and innovation.

The rules of engagement: Power and interaction in dialogue events

This article reflects on the "dialogic turn," focusing on one analytical framework for understanding the wide range of processes that fall under the rubric of engagement. The notion of power-in-interaction is explored using a case study of informal dialogue, the Dana Centre, London. Using this framework I argue that we can understand public engagement events as hallmarked by conflict, but that this conflict emerges not in differing assessments of the value of different forms of knowledge but around the very form of a dialogue event; similarly, I suggest that the content of talk indicates that imposed hierarchies are continually re-negotiated. In concluding I reflect on some implications of using power in the analysis of engagement.

Evidence for the role of cognitive resources in flavour-flavour evaluative conditioning

One way that dis/likes are formed is through evaluative conditioning (EC). In two experiments we investigated the role of cognitive resources in flavour-flavour conditioning. Both experiments employed an EC procedure in which three novel flavoured conditioned stimuli (CSs) were consumed. One was consumed with a pleasant unconditioned stimulus (US; CS+ sugar), one with an aversive US (CS+ saline), and a third with plain water (CS-). Half of participants in each experiment performed a cognitive load task during conditioning. We measured EC using self-reported measures of liking (Experiments 1 and 2) and an indirect measure of liking: drink pick-up latency (Experiment 2). In both experiments, differential EC was observed in the no cognitive load condition but not in the cognitive load condition. This pattern of results was observed in self-reported measures of liking as well as in the drink pick-up latency data. Results from both experiments show that EC occurs only when there are sufficient cognitive resources available. The fact that this was observed using both self-reported and indirect measures suggests that insufficient cognitive resources affect learning itself rather than merely obstructing reporting.

The pre-hospital epidemiology and management of spinal cord injuries in New South Wales: 2004-2008

CONTEXT

Patients who have sustained a traumatic spinal cord injury require appropriate management in the immediate post-injury period for both survival and to reduce the chances of costly and disabling permanent neurological deficits. Emerging time-critical neuroprotective therapies require the prompt recognition and transfer of patients to a specialised centre for early intervention.

METHODS

The Ambulance Research Institute, with the New South Wales State Spinal Cord Injury Service retrospectively linked prehospital data to spinal cord injury unit (SCIU) outcome data for all 324 patients transported by ambulance and subsequently admitted to a SCIU with a persisting traumatic spinal cord injury (SCI) between January 2004 and June 2008, with the aim of identifying factors that impact on the provision of timely and appropriate care.

RESULTS

Paramedics appropriately managed 88% of SCI patients. Only 4.9% of patients had initial vital signs potentially indicative of neurological injury. The median time to a SCIU was 12h, with 60% of patients undergoing multiple transfers. The odds of reaching a SCIU in over 24h were 1.71 times greater for patients injured in a major city (95% CI 1.00-2.90) in comparison to other areas of NSW. More SCI patients with multiple trauma experienced delays in reaching a SCIU (59%), compared to patients with isolated SCI (40%; p=0.039). Patients initially transported to a designated major trauma centre were more likely to be delayed in reaching a SCIU, regardless of whether their injury was an isolated SCI or associated with multiple trauma, compared with other patients. Patients who took greater than 24h to reach a SCIU were 2.5 times more likely to develop a secondary complication (95% CI 1.51-4.17, p=0.0004). Patients who sustained their SCI as a result of a low fall were older and less likely to have their SCI identified and treated early, with less than half of this group reaching a SCIU within 24h compared with other SCI patients (OR 0.42, 95% CI 0.19-0.93, p=0.004).

CONCLUSION

Early recognition, appropriate prehospital management, triage, timely and appropriate interfacility transfers of all SCI patients are critical for access to specialised care and reducing preventable complications. Elderly fallers present particular challenges to early identification.

A comparative genomic analysis between human breast cancer and paired tumor lines derived from transplanation of tumor biopsies into NOD/SCID mice

Abstract #41

Background: Successful preclinical studies of experimental anticancer agents require model systems that recapitulate breast cancer biology and genomic abnormalities as accurately as possible. The use of primary human tumor explants engrafted into the humanized mammary fat pad of NOD SCID mice (HIM technique for "human in mouse") is promising in this regard, but the evidence that the genomic profile of the tumor is stable during serial translatation of human tumors into mice and between mouse passages has not beeen clearly demonstrated.
 Methods: 4th mammary glands of NOD/SCID mice were humanized by removing mouse mammary epithelia and implanting immortalized human breast fibroblasts. Human breast tumor tissues were dissociated into single cell suspensions and injected into the “humanized” mammary fat pads of NOD/SCID mice. Patient tumors were micro-dissected from the surrounding normal tissue by laser capture microdissection and tumor RNA and DNA was isolated. In addition, tumor RNA and DNA was isolated from xenografts at passage 1, 2, and 3. Agilent 4 x 44K whole genome expression array and 244K array-based comparative genomic hybridization (aCGH) was performed on established xenografts (passage 1-3) as well as the original tumor samples. Exon 9 and 20 of PIK3CA and exon 4 to 9 of TP53 were targeted for mutation detection since these genes are commonly mutated in human breast cancer.
 Results: To date, eight HIM tumor lines have been successfully established and serially passaged. The HIM number and source of tumor are as follows: HIM2 (primary tumor); HIM 3 (primary tumor); HIM 4 (abdominal wall metastasis); HIM 5 (brain metastasis from the patient used to establish HIM 2); HIM6 (primary breast cancer); HIM7 (chest wall metastasis); HIM 8 (chest wall metastasis); HIM9 (chest wall metastasis). Passage 3 HIM tumors serially transplanted in NOD/SCID mice have similar histopathological features to their original human counterparts (HCP). Sequence analyses of the eight HIM lines reveals mutations in the TP53 gene in three tumor lines and a mutation in PIK3CA gene in one tumor line that are also present in the HCP. aCGH analysis, where available, also demonstated that the positions of the major gene amplifications and deletions in HIM lines are also consistent with the HCP. Furthermore, aCGH shows that genomic structure of the grafts are stable with passage. Immunohistochemistry shows that HIM8 and its HCP are positive for HER2. Molecular subtyping by PAM50 gene list indicates that HIM 2 – 8 tumor lines and their HCP are basal type breast cancer. HIM9 tumor line and its HCP are luminal subtypes, although the proliferation signature was activated in the mouse graft.
 Conclusions: The HIM mouse system faithfully reproduces the genotypic features of the respective HCP's and is therefore a valuable research engine for the preclinical development of biomarkers, imaging techniques and for the assessment of novel therapeutic approaches, particularly for Basal-type breast cancer.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 41.

Expression of the WASP verprolin-homologues (WAVE members) in human breast cancer

BACKGROUND

The WASP family proteins have been indicated to play a vital role in the formation of membrane protrusions required for cell locomotion. WAVE proteins are an important subfamily that also plays a crucial role in actin polymerisation, which is vital to cell migration. However, not much is known about the clinical significance of this subfamily in cancers. We report, for the first time, the expression of the WAVE molecules, at protein and mRNA levels, in human breast cancer.

MATERIALS AND METHODS

The expression of the 3 WAVE molecules at the mRNA and protein levels in a cohort of 122 human breast cancers and 32 normal breast tissues were analysed and correlated with the patients' pathological and clinical information as well as outcome (120 months follow-up).

RESULTS

All 3 WAVE molecules were detected in mammary tissues. WAVE2 transcripts were expressed in high levels in all breast tumours. Over-expression of WAVE2 was seen in node-positive cases as well as in moderately and poorly differentiated tumours. Also, high levels of WAVE2 expression were associated with death due to disease (p = 0.02) at follow-up. No distinct associations were found between the WAVE1 and WAVE3 transcripts and the breast cancer cells.

A selenopyrylium photosensitizer for photodynamic therapy related in structure to the antitumor agent AA1 with potent in vivo activity and no long-term skin photosensitization

Cationic chalcogenopyrylium dyes 5 were synthesized in six steps from p-aminophenylacetylene (9), have absorption maxima in methanol of 623, 654, and 680 nm for thio-, seleno-, and telluropyrylium dyes, respectively, and generate singlet oxygen with quantum yields [Phi((1)O(2))] of 0.013, 0.029, and 0.030, respectively. Selenopyrylium dye 5-Se was phototoxic to cultured murine Colo-26 and Molt-4 cells. Initial acute toxicity studies in vivo demonstrate that, at 29 mg (62 micromol)/kg, no toxicity was observed with 5-Se in animals followed for 90 days under normal vivarium conditions. In animals given 10 mg/kg of 5-Se via intravenous injection, 2-8 nmol of 5-Se/g of tumor was found at 3, 6, and 24 h postinjection. Animals bearing R3230AC rat mammary adenocarcinomas were treated with 10 mg/kg of 5-Se via tail-vein injection and with 720 J cm(-2) of 570-750-nm light from a filtered tungsten lamp at 200 mW cm(-2) (24 h postinjection of 5-Se). Treated animals gave a tumor-doubling time of 9 +/- 4 days, which is a 300% increase in tumor-doubling time relative to the 3 +/- 2 days for untreated dark controls. Mechanistically, the mitochondria appear to be a target. In cultured R3230AC rat mammary adenocarcinoma cells treated with 0.1 and 1.0 microM 5-Se and light, mitochondrial cytochrome c oxidase activity was inhibited relative to cytochrome c oxidase activity in untreated cells. Irradiation of isolated mitochondrial suspensions treated with 10 microM dye 5-Se inhibited cytochrome c oxidase activity. The degree of enzyme inhibition was abated in a reduced oxygen environment. Superoxide dismutase, at a final concentration of 30 U, did not alter the photosensitized inhibition of mitochondrial cytochrome c oxidase by dye 5-Se. The data suggest that singlet oxygen may play a major role in the photosensitized inhibition of mitochondrial cytochrome c oxidase.

Water-soluble, core-modified porphyrins as novel, longer-wavelength-absorbing sensitizers for photodynamic therapy

Water-soluble, core-modified 5,10,15, 20-tetrakis(4-sulfonatophenyl)-21,23-dithiaporphyrin (1) and 5,10,15, 20-tetrakis(4-sulfonatophenyl)-21,23-diselenaporphyrin (2) were prepared as the tetrasodium salts by the sulfonation of 5,10,15, 20-tetraphenyl-21,23-dithiaporphyrin (3) and -21, 23-diselenaporphyrin (4), respectively, with sulfuric acid. Compounds 3 and 4 were prepared by the condensation of pyrrole with either 2,5-bis(phenylhydroxymethyl)thiophene (5) or 2, 5-bis(phenylhydroxymethyl)selenophene (6) in propionic acid. The addition of benzaldehyde to 2,5-dilithiothiophene or 2, 5-dilithioselenophene gives 5 or 6, respectively, as a nearly equimolar mixture of meso- and d,l-diastereomers. Careful crystallization of 5 gives a single diastereomer by removing the crystalline product from the equilibrating mixture of diastereomers in solution. Photodynamic therapy (PDT) with 1 has an LD(50) of less than 25 microg/mL against Colo-26 cells in culture and exhibits a lethal dose for 90% or more at concentrations greater than 50 microg/mL. In contrast, PDT with 5,10,15, 20-tetrakis(4-sulfonatophenyl)porphyrin (TPPS(4)) requires concentrations of greater than 100 microg/mL to achieve LD(50). Neither 1 nor TPPS(4) shows significant photoactivity against the murine T-cell line, MOLT-4, above the dark toxicity. Sensitizer 1 shows no toxicity or side effects in BALB/c mice observed for 30 days following a single intravenous injection of 10 mg (9.1 micromol)/kg. Distribution studies show that sensitizer 1 accumulates in the tumors of BALB/c mice bearing Colo-26 or EMT-6 tumors with sensitizer concentration roughly doubling as the dosage of 1 increased from 5 to 10 mg/kg. In vivo studies show that PDT with sensitizer 1 at both 3.25 and 10 mg/kg with 135 J cm(-2) of 694-nm light is effective against Colo-26 tumors in BALB/c mice.

Synthesis and evaluation of chalcogenopyrylium dyes as potential sensitizers for the photodynamic therapy of cancer

A series of thiopyrylium (2), selenopyrylium (3), and telluropyrylium dyes (4) was prepared via the addition of Grignard reagents to either 2, 6-di(4-dimethylamino)phenylchalcogenopyran-4-ones (5a) or 2-[4-(dimethylamino)phenyl]-6-phenylchalcogenopyran-4-ones (5b) followed by elimination and ion exchange to give the chloride salts. The absorption spectra and quantum yields for singlet oxygen generation of these dyes suggested that the dyes would have utility as sensitizers for PDT. Selenopyrylium dyes 3a and 3d with quantum yields for singlet oxygen generation of 0.040 and 0.045, respectively, were phototoxic to Colo-26 cells in culture. The toxicity of the dyes 2-4 was evaluated in clonogenic assays of human carcinoma cell lines. Importantly, the presence of a sulfur, selenium, or tellurium heteroatom in the molecules had no predictable impact on the toxicity of any particular dye set. Substituents at the 2-, 4-, and 6-positions of the dye had a much greater impact on cytotoxicity. The IC(50) values determined in the clonogenic assays did not correlate with chemical properties in the dye molecules such as reduction potential or lipophilicity. Initial in vivo toxicity studies showed no toxicity for these dyes at dosages between 7.2 and 38 micromol/kg in BALB/c mice.

Recombinant human osteogenic protein 1 is a potent stimulator of the synthesis of cartilage proteoglycans and collagens by human articular chondrocytes

OBJECTIVE

To study the effects of recombinant human osteogenic protein-1 (rHuOP-1; bone morphogenetic protein-7) on proteoglycan and collagen synthesis by human articular chondrocytes.

METHODS

Articular chondrocytes from fetal, adolescent, and adult human donors were cultured in alginate beads for 4 days in a mixture of Ham's F-12, Dulbecco's modified Eagle's medium, 10% fetal bovine serum (FBS), then for an additional 3-10 days in the presence and absence of rHuOP-1, with and without FBS. Chondrocyte synthetic activity was measured as the amount of incorporation of 35S-sulfate into proteoglycans and 3H-proline into hydroxyproline. Sieve chromatography and sodium dodecyl sulfate-polyacrylamide gel electrophoresis were performed to identify specific proteoglycans and collagens.

RESULTS

Recombinant human OP-1 markedly stimulated the synthesis of proteoglycans (mostly aggrecan) and collagens (predominantly type II) by all chondrocyte preparations. This did not require the presence of FBS and was associated with continued expression of the chondrocyte phenotype.

CONCLUSION

Recombinant human OP-1 is a more potent stimulator of the synthesis of cartilage-specific molecules by human articular chondrocytes than are other factors tested for comparison, including TGF beta 1 and activin A.

Doxycycline inhibits type X collagen synthesis in avian hypertrophic chondrocyte cultures

Doxycycline, a member of the tetracycline family, has been shown to reduce a type X collagen epitope as detected by immunohistochemistry with a monoclonal antibody in an avian explant culture system (). It was also shown to decrease collagenase and gelatinase activities and thus matrix degradation. This study investigates the effect of doxycycline on type X collagen synthesis in monolayer cultures of hypertrophic chondrocytes. Protein synthesis was evaluated by radioisotopic labeling during doxycycline, tetracycline, or minocycline treatment. Radiolabeled proteins were analyzed by gel electrophoresis, and total collagen was quantitated by hydroxyproline analysis. Additionally, the synthesis of type X collagen was measured by immunoprecipitation. Doxycycline was found to inhibit type X production more effectively than either of the other tetracyclines at comparable dose levels. Furthermore, type X collagen was inhibited more than other collagens, non-collagenous proteins and proteoglycans, with maximal inhibition at 80 microg/ml and an IC50 of 7 microg/ml. This inhibition by doxycycline was specific for type X collagen at 10 microg/ml, and the pattern was distinct from cycloheximide, a recognized inhibitor of protein translation. This suppression of type X collagen could not be overcome by excess extracellular calcium, conditions that have been demonstrated to induce synthesis of this protein (2).

Studies Directed Towards the Total Synthesis of Anticapsin and Related Compounds. IV. Competitive Reaction of Amino and Carboxy Substituents in the Halohydrination of 2-Aminobicyclo[2.2.2]oct-5-ene-2-carboxylic Acid Derivatives

Bromohydrination of benzyl (1RS,2SR,4SR)-2-benzyloxycarbonylamino-1-trimethylsilyloxy-bicyclo[2.2.2]oct-5-ene-2-carboxylate (6a) and the (1RS,2RS,4SR)- diastereomer (6b) with N- bromoacetamide in aqueous dioxan has been investigated. These reactions are highly regio-and stereo-selective and give the corresponding bromohydrins (9a) and (9b), but in moderate to low yield. These bromohydrins have the necessary stereochemistry for conversion into anticapsin. The other products from the reaction are tricyclic compounds formed by capture of the anti- bromonium cation intermediates or resultant bromohydrins by interaction with the proximal protected carboxy and amino groups within the molecules. Thus the carbolactone (11) is formed from the endo -adduct (6a), and the carbonimidic acid derivative (12) and the cyclic urethane (13) are formed from the exo-adduct (6b). Cleavage of the trimethylsilyl group from the tricyclic compound (12) gives benzyl (1RS,2RS,3RS,7RS,8RS)-5-benzyloxy-2-bromo-8-hydroxy-4-oxa-6-azatricyclo[5.3.1.03,8]undec-5-ene-7-carboxylate(14), the structure of which was determined by X-ray diffraction methods and refined to a residual of 0.035 for 1549 independent observed reflections. The crystals of (14) are monoclinic, P21/c, a 12.954(3), b 6.197(3), c 26.784(7) Ǻ, β 95.33(2)°, Z 4. Reactions attempting to generate iodohydrins from the alkenes (6) were also highly regioselective and gave detrimethylsilylated iodo analogues of (11) and (13).

Systemic lupus erythematosus and the obstetrical patient--implications for the anaesthetist

Systemic lupus erythematosus (SLE) is a multisystem, chronic inflammatory disease characterized by autoantibody production. The disease is most frequently found in women of childbearing age and therefore may co-exist with pregnancy. The clinical manifestations of the disease are variable and depend on the severity of damage to organ systems such as musculoskeletal, renal, haematological, neurological, cardiac, and respiratory. Many patients require drugs such as aspirin or prednisone. The pregnant patient may experience exacerbations of the disease, neonatal loss, and obstetrical complications such as pre-eclampsia. Patients with the Lupus Anticoagulant are at risk for an abnormal perinatal course. The anaesthetic management will depend on the patient's clinical status and the well-being of the fetus. The patient should be examined to determine the extent of end organ damage, current medications, and the health of the fetus. Laboratory investigations such as a coagulation screen and tests of renal function should be performed before anaesthetic intervention if time permits. A multidisciplinary approach to care of the patient and resources to manage complications are essential to optimize the outcome for both mother and newborn.

Alprazolam in the treatment of panic disorders

An open clinical trial of alprazolam therapy of patients with panic disorder or agoraphobia with panic attacks was undertaken to clarify certain issues not resolved by previous studies. These included the proportion of patients who significantly improve with alprazolam; the relative time courses for improvement in panic attacks, anticipatory anxiety, and phobic avoidance; whether successful alprazolam treatment alters vulnerability to panic with sodium lactate infusion; and what factors predict response to alprazolam in panic patients. Thirty patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks completed a 12-week open clinical trial, and 22 were considered responders. In responders, panic attacks showed rapid improvement, whereas improvement of anticipatory anxiety and phobic avoidance was more variable. Successful alprazolam therapy appeared to block lactate vulnerability. High pretreatment Hamilton Anxiety Scale scores were associated with poor treatment response. The data suggest that alprazolam is an effective treatment for panic disorder and agoraphobia with panic attacks, and acts by directly blocking panic attacks.