A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men

Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps

OBJECTIVE

Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.

METHODS

Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.

DATA SOURCES

We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using 'gamification' (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.

RESULTS

64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5-22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; r_s=0.23) or price (p=0.45; r_s=0.10).

CONCLUSIONS

Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.

TRIAL REGISTRATION NUMBER

CRD42015029841.

First case of Mycobacterium heckeshornense cavitary lung disease in the Latin America and Caribbean region

A case of cavitary pulmonary disease caused by Mycobacterium heckeshornense in Uruguay is described. This is the first case reported in the Latin America and Caribbean region, showing that this species is a worldwide opportunistic human pathogen.

SUMOylation regulates AKT1 activity

Serine threonine kinase AKT has a central role in the cell, controlling survival, proliferation, metabolism and angiogenesis. Deregulation of its activity underlies a wide range of pathological situations, including cancer. Here we show that AKT is post-translationally modified by the small ubiquitin-like modifier (SUMO) protein. Interestingly, neither SUMO conjugation nor activation of SUMOylated AKT is regulated by the classical AKT targeting to the cell membrane or by the phosphoinositide 3-kinase pathway. We demonstrate that SUMO induces the activation of AKT, whereas, conversely, down-modulation of the SUMO machinery diminishes AKT activation and cell proliferation. Furthermore, an AKT SUMOylation mutant shows reduced activation, and decreased anti-apoptotic and pro-tumoral activities in comparison with the wild-type protein. These results identify SUMO as a novel key regulator of AKT phosphorylation and activity.

Interaction of emodin, aloe-emodin, and rhein with human serum albumin: a fluorescence spectroscopic study

The interaction of the dihydroxyanthraquinones, emodin (1), aloe-emodin (2), and rhein (3) with human serum albumin (HSA) has been studied through fluorescence spectroscopy. Quenching studies and the association constant of the anthraquinoid compounds 1, 2, and 3 in the presence of HSA were estimated. The binding and quenching studies suggest that only emodin (1) may serve as a useful fluorescence probe for structure/function studies of different emodin binding proteins. No photoinduced binding was observed after irradiation of compounds 1, 2, and 3 in presence of human serum albumin.

On-line cryogenic trapping with microwave heating for the determination and speciation of arsenic by flow injection/hydride generation/atomic absorption spectrometry

An on-line flow injection-hydride generation/atomic absorption spectrometry method was developed for the preconcentration and selective determination of inorganic arsenic [As(III) and As(V)] and its methylated species. The separation of the arsenic species was performed by an automated pH-selective arsines generation technique, using sodium tetrahydroborate(III) as reductant. Each arsine was cryogenically trapped in a PTFE coil, knotted and sealed inside another wider diameter tube, through which liquid nitrogen was suctioned by negative pressure. Then, based on their different boiling points, the arsine species were selectively liberated by using a heating cycle of microwave radiation, followed by atomic absorption detection. A sample solution aliquot mixed with 1% citric acid was used for the determination of As(III) alone, while a second sample aliquot mixed with 2 mol l(-1) nitric acid was used for the quantitative determination of total inorganic arsenic, monomethylarsonic acid and dimethylarsinic acid. Based on 10 ml sample, the detection limits lie within the range 20-60 ng As l(-1), which are sufficiently low to detect the arsines-forming species in natural waters. These values are negatively affected by the reagents purity and background noise due to flame flickering, but the sensitivity can substantially be improved by increasing sample size or running several consecutive reactions.

Regulation of the tumor suppressor PTEN by SUMO

The crucial function of the PTEN tumor suppressor in multiple cellular processes suggests that its activity must be tightly controlled. Both, membrane association and a variety of post-translational modifications, such as acetylation, phosphorylation, and mono- and polyubiquitination, have been reported to regulate PTEN activity. Here, we demonstrated that PTEN is also post-translationally modified by the small ubiquitin-like proteins, small ubiquitin-related modifier 1 (SUMO1) and SUMO2. We identified lysine residue 266 and the major monoubiquitination site 289, both located within the C2 domain required for PTEN membrane association, as SUMO acceptors in PTEN. We demonstrated the existence of a crosstalk between PTEN SUMOylation and ubiquitination, with PTEN-SUMO1 showing a reduced capacity to form covalent interactions with monoubiquitin and accumulation of PTEN-SUMO2 conjugates after inhibition of the proteasome. Moreover, we found that virus infection induces PTEN SUMOylation and favors PTEN localization at the cell membrane. Finally, we demonstrated that SUMOylation contributes to the control of virus infection by PTEN.

SIRT1 stabilizes PML promoting its sumoylation

SIRT1, the closest mammalian homolog of yeast Sir2, is an NAD(+)-dependent deacetylase with relevant functions in cancer, aging, and metabolism among other processes. SIRT1 has a diffuse nuclear localization but is recruited to the PML nuclear bodies (PML-NBs) after PML upregulation. However, the functions of SIRT1 in the PML-NBs are unknown. In this study we show that primary mouse embryo fibroblasts lacking SIRT1 contain reduced PML protein levels that are increased after reintroduction of SIRT1. In addition, overexpression of SIRT1 in HEK-293 cells increases the amount of PML protein whereas knockdown of SIRT1 reduces the size and number of PML-NBs and the levels of PML protein in HeLa cells. SIRT1 stimulates PML sumoylation in vitro and in vivo in a deacetylase-independent manner. Importantly, the absence of SIRT1 reduces the apoptotic response of vesicular stomatitis virus-infected cells and favors the extent of this PML-sensitive virus replication. These results show a novel function of SIRT1 in the control of PML and PML-NBs.

Performance of the Ogawa-Kudoh method for isolation of mycobacteria in a laboratory with large-scale workload

In Uruguay (population 3,323,906; notified tuberculosis incidence 18.4/100,000), virtually all 30,000 samples yearly collected for mycobacterial culture countrywide are processed in a central laboratory. An average of 110 samples are routinely shipped daily and maintained 48-96 hours at room temperature until cultured on Löwenstein-Jensen slants using the standard NALC-NaOH decontamination procedure. The much simpler Kudoh decontamination/culture method -swab and Ogawa (acidified) medium- was compared with NALC-NaOH/Löwenstein-Jensen for isolation of mycobacteria from sputa under routine conditions. To this aim, 784 sputum samples were cultured by both methods in the summertime. Gross agreement was 0.99, kappa: 1. Kudoh performance was as follows: sensitivity 100% and accuracy 98.9%. Assays using a modified culture medium, different decontamination times and NaOH concentrations showed the versatility of this procedure. Thus, the Kudoh method is suitable for culturing mycobacteria from naturally contaminated samples even when processing is deferred two to four days after collection.

Auxiliary tools in tuberculosis. The hemolysis in pleural fluids underestimate the values of adenosine deaminase activity determined by the method of Giusti

The increase of adenosine deaminase (ADA) activity in pleural fluids (PF) is considered a useful tool in the diagnosis of pleural tuberculosis. It is known that numerous photometric methods are interfered by the hemolysis, as a result, hemolyzed specimens -or with blood- received in the laboratory are frequently rejected. In order to establish if the values of ADA were affected by the hemolysis or blood, ADA was determined in individual and pooled PF samples with the aggregate of erythrocyte lysate (H) or hemolyzed whole blood (HWB) from 312 mg/l to 12 g/l (final concentrations of hemoglobin in the samples), and plasma in appropriate dilutions. Negative interferences were caused by the H and HWB, starting already of 500 mg/l with relative errors until 50% in some cases, depending on the ADA activity. Increments of hemoglobin increased the negative interference. The aggregate of plasma increased slightly the ADA activity although it was insufficient for neutralize the negative effect of hemolysis. The clinical significance of the negative interference is in relation to the amount of hemoglobin present in the sample and the ADA activity. Near the cutoff (40 U/l) this interference can lead to discard erroneously the diagnosis of pleural tuberculosis.

Photodegradation and in vitro phototoxicity of aceclofenac

Aceclofenac (Airtal) (1) is a photoallergic and phototoxic anti-inflammatory and analgesic agent. This drug is photolabile under aerobic and anaerobic conditions. Irradiation of an ethanol-solution of aceclofenac under oxygen or argon at 290-320 nm affords via decarboxlation compound 2 as the main isolated and spectroscopically identified photoproduct, besides hydroxylamine derivates 3 and 4. A radical intermediate was evidenced spectrophotometrically with GSH and DTNB, as well as by the dimerization of cysteine. Red blood cell lysis photosensitized by 1-4 was investigated. Furthermore, in a lipid-photoperoxidation test with linoleic acid the in vitro phototoxicity of aceclofenac was also verified. The photoinduced generation of peroxide by compound 1 was determined during the irradiation in presence of NADPH by chemiluminescence. In relation to the photoallergic activity of this drug, the interaction of aceclofenac with human serum albumin (HSA) has been studied through fluorescence spectroscopy. No photoinduced binding was observed after irradiation of compounds 1 in the presence of human serum albumin.

Características clínico-biológicas de las púrpuras trombocitopénicas trombóticas tratadas entre los años 1983-2006 en el Hospital General Universitario de Alicante

OBJECTIVE

Our study aimed to evaluate the patients diagnosed of thrombotic thrombocytopenic purpura in our hospital during the last 23 years.

METHODS

We have made a retrospective study of the clinical records of 25 patients diagnosed of TTP between 1983-2005, describing the clinical, epidemiological and laboratory data.

RESULTS

Twenty-five cases were diagnosed. Mean age was 39 years, 64% women and 36% men, 44% had suffered headaches, 4% fever, 32% neurological focality, 12% renal disorders, 36% hemorrhagic disease and 16% thromboembolic disease. TTP etiology was: 72% idiopathic, 8% pregnancy, 4% Human Immunodeficiency Virus, 4% myasthenia gravis, 4% pulmonary neoplasm and 4% puerperium. Medium hemoglobin level was 9 g/dl, leucocytes 8700/mm3 and platelets 12000/mm3. Patients received a median of 5 plasmapheresis. Mean time to relapse was two months. Other treatments for TTP were aspirin (16%), cyclosporine (4%), vincristine (4%) and splenectomy (4%).

CONCLUSIONS

PTT incidence in our region has increased in recent years, probably due to an increase in the immigrant population not included in the census, among the most relevant reasons. In our study, renal disorders and presence of fever were less frequently described than in other reports. There was no correlation between the number of plasmapheresis and likelihood of relapse. Most relapses were in idiopathic TTP.

Impact of protein kinase PKR in cell biology: from antiviral to antiproliferative action

The double-stranded RNA-dependent protein kinase PKR is a critical mediator of the antiproliferative and antiviral effects exerted by interferons. Not only is PKR an effector molecule on the cellular response to double-stranded RNA, but it also integrates signals in response to Toll-like receptor activation, growth factors, and diverse cellular stresses. In this review, we provide a detailed picture on how signaling downstream of PKR unfolds and what are the ultimate consequences for the cell fate. PKR activation affects both transcription and translation. PKR phosphorylation of the alpha subunit of eukaryotic initiation factor 2 results in a blockade on translation initiation. However, PKR cannot avoid the translation of some cellular and viral mRNAs bearing special features in their 5' untranslated regions. In addition, PKR affects diverse transcriptional factors such as interferon regulatory factor 1, STATs, p53, activating transcription factor 3, and NF-kappaB. In particular, how PKR triggers a cascade of events involving IKK phosphorylation of IkappaB and NF-kappaB nuclear translocation has been intensively studied. At the cellular and organism levels PKR exerts antiproliferative effects, and it is a key antiviral agent. A point of convergence in both effects is that PKR activation results in apoptosis induction. The extent and strength of the antiviral action of PKR are clearly understood by the findings that unrelated viral proteins of animal viruses have evolved to inhibit PKR action by using diverse strategies. The case for the pathological consequences of the antiproliferative action of PKR is less understood, but therapeutic strategies aimed at targeting PKR are beginning to offer promising results.

Outcome of patients with acute promyelocytic leukemia failing to front-line treatment with all-trans retinoic acid and anthracycline-based chemotherapy (PETHEMA protocols LPA96 and LPA99): benefit of an early intervention

To determine prognosis of acute promyelocytic leukemia (APL) failing to front-line therapy with all-trans retinoic acid (ATRA) and anthracyclines, outcome of 52 patients (32 M/20 F; age: 37, 3-72) included in PETHEMA trials LPA96 and LPA99 who presented with either molecular failure (MOLrel, n=16) or hematological relapse (HEMrel, n=36) was analyzed. Salvage therapy consisted of ATRA and high-dose ara-C-based chemotherapy (HDAC) in most cases (83%), followed by stem-cell transplantation (autologous, 18; allogeneic, 10; syngeneic, 1). Fourteen patients with MOLrel (88%) achieved second molecular complete response (molCR), whereas 81% HEMrel patients responded to second-line treatment, with 58% molCR. After median follow-up of 45 months, four MOLrel and 18 HEMrel patients, respectively, experienced a second relapse. Outcome after MOLrel compared favorably to HEMrel, with longer survival (5-year survival: 64+/-14 vs 24+/-8%, P=0.01) and lower relapse risk (5-year relapse risk: 30+/-13 vs 64+/-9%; P=0.044). Additionally, age <or=40 and male gender were favorable variables for survival, whereas molecular response predicted longer leukemia-free survival. In conclusion, early institution of salvage therapy at molecular failure, before onset of hematological relapse, is beneficial in APL. Moreover, given the poor outcome of HEMrel managed with ATRA and HDAC, use of alternative therapeutic strategies in this setting is warranted.

Differential expression of NF-kappaB pathway genes among peripheral T-cell lymphomas

Nuclear factor kappa B (NF-kappaB) is one important pathway in T-cell proliferation and survival. In a previously reported microarray study, we found NF-kappaB pathway genes differentially expressed between peripheral (PTCL) and lymphoblastic lymphomas. Here, we investigated the expression of NF-kappaB pathway genes using cDNA microarrays in a group of 62 PTCL and in reactive lymph nodes. We found two different subgroups of PTCL based on the expression of NF-kappaB pathway genes. One-third of PTCL showed clearly reduced expression of NF-kappaB genes, while the other group was characterized by high expression of these genes. This distinction was found among all T-cell lymphoma categories analyzed (PTCL unspecified, angioimmunoblastic, cutaneous and natural killer/T lymphomas) with the exception of anaplastic lymphomas (ALCL), which were characterized by reduced NF-kappaB expression in anaplastic cells. Quantitative RT-PCR and immunohistochemical analysis of NF-kappaB-p65 protein confirmed these differences among PTCL subgroups. Importantly, we found that differentiation between NF-kappaB-positive and -negative PTCL could be of clinical interest. The expression profile associated to reduced expression of NF-kappaB genes was significantly associated with shorter survival of patients and seems to be an independent prognostic factor in a multivariate analysis.