The role of canonical and non-canonical Hedgehog signaling in tumor progression in a mouse model of small cell lung cancer

Hedgehog (Hh) signaling regulates cell fate and self-renewal in development and cancer. Canonical Hh signaling is mediated by Hh ligand binding to the receptor Patched (Ptch), which in turn activates Gli-mediated transcription through Smoothened (Smo), the molecular target of the Hh pathway inhibitors used as cancer therapeutics. Small cell lung cancer (SCLC) is a common, aggressive malignancy with universally poor prognosis. Although preclinical studies have shown that Hh inhibitors block the self-renewal capacity of SCLC cells, the lack of activating pathway mutations have cast doubt over the significance of these observations. In particular, the existence of autocrine, ligand-dependent Hh signaling in SCLC has been disputed. In a conditional Tp53;Rb1 mutant mouse model of SCLC, we now demonstrate a requirement for the Hh ligand Sonic Hedgehog (Shh) for the progression of SCLC. Conversely, we show that conditional Shh overexpression activates canonical Hh signaling in SCLC cells, and markedly accelerates tumor progression. When compared to mouse SCLC tumors expressing an activating, ligand-independent Smo mutant, tumors overexpressing Shh exhibited marked chromosomal instability and Smoothened-independent upregulation of Cyclin B1, a putative non-canonical arm of the Hh pathway. In turn, we show that overexpression of Cyclin B1 induces chromosomal instability in mouse embryonic fibroblasts lacking both Tp53 and Rb1. These results provide strong support for an autocrine, ligand-dependent model of Hh signaling in SCLC pathogenesis, and reveal a novel role for non-canonical Hh signaling through the induction of chromosomal instability.

The quest for sustained multiple morbidity reduction in very low-birth-weight infants: the Antifragility project

OBJECTIVE

Can a comprehensive, explicitly directive evidence-based guideline for all therapies that might affect the major morbidities of very low-birth-weight (VLBW) infants help a neonatal intensive care unit (NICU) further improve generally favorable morbidity rates? Can Antifragility principles of provider adaptive growth from stressors, enhanced infant risk assessment and adherence to effective therapies minimize unproven treatments and reduce all morbidities?

STUDY DESIGN

Prospectively planned observational trial in VLBW infants: control group born October 2011 to September 2013 and study group October 2013 to September 2015. Multi-disciplinary evidence-based review assigned all NICU treatments into one of four distinct categories: (1) always employ this therapy for VLBW infants, (2) never use this therapy, (3) employ this questionable therapy thoughtfully, only in certain circumstances and (4) this therapy has insufficient evidence of efficacy and safety. Extensive staff education emphasized evidence-based potentially better practice (PBP) selection with compliance checks, appreciation of intertwined co-morbidities and prioritizing infant risk reduction strategies.

RESULTS

Control included 221 infants, mean (s.d.) age 29 (2.6) weeks, birth weight 1129 (257) g and Study included 197 infants, 29 (2.7) weeks, 1093 (292) g. One hundred and four distinct therapies were placed into categories 1 to 4, with 32 specific compliance checks. Overall mean compliance with the process checks during the second era was 70%, high: 100% (exclusive breast milk use), low: 24% (correct pulse oximetry alarm settings). Morbidity and mortality rates did not significantly change during the second era.

CONCLUSIONS

In our NICU with favorable morbidity rates, an expanded effort using a comprehensive therapy guideline for VLBW infants did not further improve outcomes. We need deeper understanding of continuous quality improvement (CQI) fundamentals, therapy compliance, co-morbidity relationships and enhanced sensitivity of risk assessment. Our innovative Antifragility PBP guideline could be useful to other NICUs seeking improvement in VLBW infant morbidities, as we offer a reasoned and concise template of a broad array of therapies categorized efficiently for transparency and review, designed to enhance responsible CQI decision-making.

Multilayering of Calcium Aerosol-OT at the Mica/Water Interface Studied with Neutron Reflection: Formation of a Condensed Lamellar Phase at the CMC

Using specular neutron reflection, the adsorption of sodium and calcium salts of the surfactant bis(2-ethylhexyl) sulfosuccinate (Aerosol-OT or AOT) has been studied at the mica/water interface at concentrations between 0.1 and 2 CMC. The pH dependence of the adsorption was also probed. No evidence of the adsorption of Na(AOT) was found even at the critical micelle concentration (CMC) while the calcium salt was found to adsorb significantly at concentrations of 0.5 CMC and above. This interesting and somewhat unexpected finding demonstrates that counterion identity may be used to tune the adsorption of anionic surfactants on anionic surfaces. At the CMC, three condensed bilayers of Ca(AOT)₂ were adsorbed at pH 7 and 9 and four bilayers adsorbed at pH 4. Multilayering at the CMC of Ca(AOT)₂ on the mica surface is an unusual feature of this surfactant/surface combination. Only single bilayer adsorption has been observed at other surfaces at the CMC. We suggest this arises from the high charge density of mica which must provide an excellent template for the surfactant.

Modelling water use efficiency in a dynamic environment: An example using Arabidopsis thaliana

Intrinsic water use efficiency (Wi), the ratio of net CO2 assimilation (A) over stomatal conductance to water vapour (gs), is a complex trait used to assess plant performance. Improving Wi could lead in theory to higher productivity or reduced water usage by the plant, but the physiological traits for improvement and their combined effects on Wi have not been clearly identified. Under fluctuating light intensity, the temporal response of gs is an order of magnitude slower than A, which results in rapid variations in Wi. Compared to traditional approaches, our new model scales stoma behaviour at the leaf level to predict gs and A during a diurnal period, reproducing natural fluctuations of light intensity, in order to dissect Wi into traits of interest. The results confirmed the importance of stomatal density and photosynthetic capacity on Wi but also revealed the importance of incomplete stomatal closure under dark conditions as well as stomatal sensitivity to light intensity. The observed continuous decrease of A and gs over the diurnal period was successfully described by negative feedback of the accumulation of photosynthetic products. Investigation into the impact of leaf anatomy on temporal responses of A, gs and Wi revealed that a high density of stomata produces the most rapid response of gs but may result in lower Wi.

The association between loss of ankle dorsiflexion range of movement, and hip adduction and internal rotation during a step down test

A pattern of excessive hip adduction and internal rotation with medial deviation of the knee has been associated with numerous musculo-skeletal dysfunctions. Research into the role that ankle dorsiflexion (DF) range of motion (ROM) play in lower limb kinematics is lacking. The objective of this cross-sectional, observational study was to investigate the relationship between ankle DF ROM, and hip adduction and hip internal rotation during a step-down test with and without heel elevation in a healthy female population. Hip and ankle ROM was measured kinematically using a ten-camera Optitrack motion analysis system. Thirty healthy female participants (mean age = 20.4 years; SD = 0.9 years) first performed a step-down test with the heel of the weight bearing foot flat on the step and then with the heel elevated on a platform. Ankle DF, hip adduction and hip internal rotation were measured kinematically for the supporting leg. Participants who had 17° or less of ankle DF ROM displayed significantly more hip adduction ROM (p = 0.001; Cohen's d effect size = 1.2) than the participants with more than 17° of DF during the step-down test. Participants with limited DF ROM showed a significant reduction in hip adduction ROM during the elevated-heel step-down test (p = 0.008). Hip internal rotation increased in both groups during the EHSD compared to the step-down test (p > 0.05) Reduced ankle DF ROM is associated with increased hip adduction utilised during the step-down test. Ankle DF should be taken into account when assessing patients with aberrant frontal plane lower limb alignment.

Promoting early presentation of breast cancer in women over 70 years old in general practice

BACKGROUND

Delay in presentation contributes to poorer survival of older women with breast cancer. Research has shown the effectiveness of the promoting early presentation (PEP) intervention when delivered by radiographers in the NHS Breast Screening Programme. This paper investigates the effectiveness of the intervention when delivered by practice nurses in general practice.

METHODS

The Breast Cancer Awareness Measure was used to compare participants' awareness of breast cancer before, 1 month after and 12 months after the delivery of the PEP intervention. Five hundred and fifty-six women aged over 70 years took part, 308 of whom returned all three surveys.

RESULTS

The intervention was associated with increased awareness of non-lump breast symptoms and reported breast check frequency. There was a marked increase in breast cancer awareness which persisted for 12 months. Less than 5% of women were classified as 'breast cancer aware' before the intervention, rising to over 25% 1 month afterwards. This percentage dropped slightly after 1 year to just below 20%.

CONCLUSION

Delivery of the PEP intervention in general practice was very effective at raising the awareness of breast cancer among older women. Primary care settings are well placed to enhance the reach of this kind of intervention to at-risk women.

Trends in the 15D health-related quality of life over the first year following diagnosis of head and neck cancer

Management of head and neck cancer influences both physical and mental wellbeing. Measuring the health-related quality of life (HRQoL) is important, as various treatment modalities are associated with significant morbidity and mortality. In this prospective cohort study, we tested the feasibility of the generic 15D HRQoL instrument in 214 head and neck cancer patients managed with surgery, definitive (chemo)radiotherapy, or with combined modality treatment. HRQoL was assessed at baseline and three times after treatment onset during 1 year, and compared with that of general population standardized for age and sex. At baseline, the patients' mean 15D score was significantly worse compared with general population. Overall HRQoL was at lowest at 3 months after treatment onset, it gradually improved towards 12 months but never reached baseline levels. The dimensions "vitality", "distress", "depression" and "sexual activity" showed marked deterioration at 3 months after the treatment onset, but improved gradually during 12 months. The 15D instrument seems useful for evaluation of HRQoL of head and neck cancer patients. Dimensions reflecting mental wellbeing improved gradually after 3 months, but they seldom reached baseline levels. The support for patients at the time of diagnosis, during treatment, and recovery is emphasized.

On or off pump coronary bypass? Insight from matched and principal component analyses of 8779 operations

AIM

The aim of this paper was to compare the clinical impact of the different myocardial protection strategies in coronary artery bypass grafting (CABG) patients to facilitate decision-making for use of on- or off-pump technique.

METHODS

Prospectively collected data for primary CABG patients between April 1, 1996 and December 30, 2010 (N.=8779) were analyzed. Early adverse cardiac and cerebrovascular events (ACCE) and late survival were compared between on-pump; cardioplegia (CPA, N.=3862, 44%), cross-clamp fibrillation (XCF, N.=3751, 43%), and off-pump (N.=1166, 13%) myocardial protection. Second, clinical profiling for the risk of ACCE with each strategy was performed using principal component analysis. Finally, a 1:1 matched cohort comparison of 1055 patients was done.

RESULTS

There were vast differences in baseline characteristics between groups. Significantly fewer grafts per patient were constructed using off-pump. There were no remarkable differences in operative mortality and 10-year survival rates between the groups after restrictive matching. Principal component analysis identified high risk profiles; factor 1 (ejection fraction 30-50%, prior myocardial infarction, non-elective operation), and factors 4 (hypertension, hypercholesterolemia, Body Mass Index >30 kg/m2) and 5 (female, octogenarian, left main stem disease) to be strongly associated with ACCE after on-pump CABG while lower risk profiles; factors 5 and 6 (extracardiac arteriopathy, prior stroke) were associated with ACCE after off-pump CABG.

CONCLUSION

Comparatively, on-pump techniques were associated with greater risk of adverse events in "high risk" patients defined by clinical characteristics, while off-pump was associated with increased risk of adverse events in "low risk" patients.

Anaerobic digestion of food waste through the operation of a mesophilic two-phase pilot scale digester--assessment of variable loadings on system performance

Single and two-phase operations were compared at mesophilic operating conditions using a digester system consisting of three 5-m(3) reactors treating food waste generated daily within the university campus kitchens. When normalizing the methane production to the daily feedstock characteristics, significantly greater methane was produced during two-phase mesophilic digestion compared to the single-stage operation (methane yield of 380 vs 446-L CH4 kg VS(-1); 359 vs 481-L CH4 kg COD(-1) removed for single vs two stage operation). The fermentation reactor could be maintained reliably even under very low loading rates (0.79±0.16 kg COD m(-3) d(-1)) maintaining a steady state pH of 5.2.