Patient-reported outcomes during and after definitive chemoradiotherapy for oesophageal cancer

BACKGROUND

Limited data describe patient-reported outcomes (PROs) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT). The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab. The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT that are presented here.

METHODS

Patients undergoing CRT±cetuximab within the SCOPE-1 trial (258 patients from 36 UK centres) completed generic-, disease- and treatment-specific health-related quality of life (HRQL) questionnaires (EORTC QLQ-C30, QLQ-OES18, Dermatology Life-Quality Index (DLQI)) at baseline and at 7, 13, 24, 52 and 104 weeks. Mean EORTC functional scale scores (>15 point change significant), DLQI scores (>4 point change significant) and proportions of patients (>15% significant) with 'minimal' or 'severe' symptoms are presented.

RESULTS

Questionnaire response rates were good. At baseline, EORTC functional scores were high (>75%) and few symptoms were reported except for severe problems with fatigue, insomnia and eating-related symptoms (e.g., appetite loss, dysphagia, dry mouth) in both groups(>15%). Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life, physical, role and social function significantly deteriorated and more problems with fatigue, dyspnoea, appetite loss and trouble with taste were reported. Recovery occurred by 6 months (except severe fatigue and insomnia in >15% of patients) and maintained at follow-up with no differences between groups.

CONCLUSIONS

CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL; however, recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia. The data suggest that the HRQL recovery after definitive CRT is quicker, and there is little lasting deficit compared with treatment including surgery. These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer.

Sex differences in children's investment in peers

It is hypothesized from within an evolutionary framework that females should be less invested in peer relations than males. Investment was operationalized as enjoyment in Study 1 and as preference for interaction in Study 2. In the first study, four- and six-year-old children's enjoyment of peer interaction was observed in 26 groups of same-sex peers. Girls were rated as enjoying their interactions significantly less than boys. In the second study, six- and nine-year-old children were interviewed about the individuals with whom they spend time in their homes and neighborhoods and about the individuals who participate in their favorite activities. The proportion of individuals named by children who were peers was significantly lower for girls than boys both in children's neighborhoods and in children's favorite activities. Results strongly support the hypothesis that females and males have evolved differential preferences for interaction with peers.

Spermatozoa of Sminthopsis murina (Mammalia: Metatheria) exhibit an unusually high degree of chromatin stability in the absence of disulphide bonding in protamine 1

Although all but a single genus (Planigale) of the metatheria so far examined contain no cysteine residues in protamine 1, we report a remarkable level of chromatin stability in the spermatozoa of the common dunnart, Sminthopsis murina. S. murina cauda epididymal spermatozoa and somatic epithelial cells were exposed to a combination of graded treatments to lyse sperm protein and induce sperm DNA damage via standard freeze-thaw protocols and post-thaw incubation at 37°C for 48h, exposure to sodium nitroprusside (SNP) and the enzyme AluI restriction endonuclease. Sperm DNA fragmentation was assessed using the comet assay and sperm chromatin dispersal test. Although S. murina somatic cells showed DNA fragmentation following protein lysis and after treatment with all the protocols specifically designed to induce chromatin damage, sperm DNA fragmentation was only observed following moderate to severe proteolytic exposure and treatment with the restriction endonuclease; there was also an increase in the baseline halo of spermatozoa treated with an aggressive reducing agent, but no corresponding evidence of fragmented DNA, suggesting that cysteine residues may be functioning to conform tertiary and/or quaternary chromatin structure. Given that the protamine 1 of S. murina contains no cysteine, we suggest that the source of these residues is possibly the histone fraction of the chromatin and that the high level of stability is potentially related to prolonged sperm survival in the female's reproductive tract.

A preliminary study of recombinant human interferon-α-2a activity against rabies virus in murine model

Rabies remains an important public health problem in the world due to uncontrolled enzootic rabies. Although rabies associated fatalities may be prevented with timely immunoprophylaxis, but till date a therapeutic molecule has remained elusive. We investigated the role of rhuIFN α-2a in murine model challenged with rabies virus. Titre of 10(4.25) LD50/0.03 ml of 10% w/v RV CVS stock suspension were obtained. Based on 1LD50 titre, challenge dose of 50 LD 50 was administered along with rhuIFN α-2a with pre-exposure (primed) and post-exposure with the rabies virus. Both showed increased survival time as compared with the virus controls. These findings suggest that the rhuIFN α-2a might have some anti-viral activity, which can be used for the treatment of rabies infection. Further research on the efficacy of interferon along with anti-viral drugs for the treatment will be helpful in designing combination therapy against the disease.

Gravitropism and Lateral Root Emergence are Dependent on the Trans-Golgi Network Protein TNO1

The trans-Golgi network (TGN) is a dynamic organelle that functions as a relay station for receiving endocytosed cargo, directing secretory cargo, and trafficking to the vacuole. TGN-localized SYP41-interacting protein (TNO1) is a large, TGN-localized, coiled-coil protein that associates with the membrane fusion protein SYP41, a target SNARE, and is required for efficient protein trafficking to the vacuole. Here, we show that a tno1 mutant has auxin transport-related defects. Mutant roots have delayed lateral root emergence, decreased gravitropic bending of plant organs and increased sensitivity to the auxin analog 2,4-dichlorophenoxyacetic acid and the natural auxin 3-indoleacetic acid. Auxin asymmetry at the tips of elongating stage II lateral roots was reduced in the tno1 mutant, suggesting a role for TNO1 in cellular auxin transport during lateral root emergence. During gravistimulation, tno1 roots exhibited delayed auxin transport from the columella to the basal epidermal cells. Endocytosis to the TGN was unaffected in the mutant, indicating that bulk endocytic defects are not responsible for the observed phenotypes. Together these studies demonstrate a role for TNO1 in mediating auxin responses during root development and gravistimulation, potentially through trafficking of auxin transport proteins.

Metabolite pattern ofCysticercus cellulosaemetacestode from different predilection sites of swine using proton magnetic resonance spectroscopy

Cysticercosis due to Taenia solium is one of the most common public health problems in various regions of the world. We have performed prolon magnetic resonance spectroscopy (1H MRS) experiments of the fluid aspirated from cysticerci excised from skeletal muscle (n = 16) and brain (n = 9) of infected swine to compare the metabolite pattern of cysticerci in different predilection sites. Perchloric acid extract of cysticercus cysts excised from skeletal muscles (n = 16) was also prepared to ascertain water-soluble, low molecular weight metabolites using 1H MRS. Absolute quantification and statistical analysis of different metabolites was done to look for any significant differences in different locations of cysts. The metabolite pattern of cysticerci was found to be similar in the various predilection sites. Metabolites observed were leucine, valine, alanine, lysine, glycine, lipid contents, lactate, glutamate, acetate, succinate, creatine, choline, and glucose. Concentration of creatine in cysticercus fluid of cysts removed from the muscle was found to be significantly higher (p = 0.001) than the cysts located in the brain. We conclude that the metabolite pattern in the cysticerci is not influenced by the surrounding tissue location; however concentration of certain metabolites may depend upon the tissue location.

Urinary TIMP-1 and MMP-2 levels detect the presence of pancreatic malignancies

Background:

A majority of patients with pancreatic malignancies, including both pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumours (pNETs), present with advanced disease due to a lack of specific symptoms and current diagnostic limitations, making this disease extremely difficult to detect. Our goal was to determine whether urinary matrix metalloproteases (uMMPs) and/or their endogenous inhibitors, urinary tissue inhibitor of metalloproteases (uTIMPs), could be detected in the urine of patients with pancreatic malignancies and whether they may serve as independent predictors of disease status.

Methods:

Retrospective analyses of urine samples (n=139) from PDAC and pNET patients as well as age- and sex-matched controls were conducted. Urinary MMP-2 and uTIMP-1 levels were determined using ELISA and zymography. Biomarker expression in tumour and normal pancreatic tissues was analysed via immunohistochemistry (IHC).

Results:

Multivariable logistic regression analyses indicated that, when controlling for age and sex, uMMP-2 (P<0.0001) and uTIMP-1 (P<0.0001) but not uMMP-9, were significant independent predictors for distinguishing between PDAC patients and healthy controls. Our data also indicated that uMMP-2 was an independent predictor of the presence of pNET. In addition, uTIMP-1 levels could differentiate the two cancer groups, PDAC and pNET, respectively. Immunohistochemistry analysis confirmed that MMP-2 and TIMP-1 protein expression is significantly upregulated in PDAC tissue compared with the normal pancreas.

Conclusions:

Taken together, our results suggest that the detection of uMMP-2 and uTIMP-1 may have diagnostic value in the detection of pancreatic malignancies and that uTIMP-1 may be useful in distinguishing between pancreatic adenocarcinoma and neuroendocrine tumours.

Root growth movements: waving and skewing

Roots anchor a plant in the soil, acquire nutrition and respond to environmental cues. Roots perform these functions using intricate movements and a variety of pathways have been implicated in mediating their growth patterns. These include endogenous genetic factors, perception of multiple environmental stimuli, signaling pathways interacting with hormonal dynamics and cellular processes of rapid cell elongation. In this review we attempt to consolidate our understanding of two specific types of root movements, waving and skewing, that arise on the surface of growth media, and how they are regulated by various genes and factors. These include crucial factors that are part of a complex nexus of processes including polar auxin transport and cytoskeletal dynamics. This knowledge can be extrapolated in the future for engineering plants with root architecture better suited for different soil and growth conditions such as abiotic stresses or even extended spaceflight. Technological innovations and interdisciplinary approaches promise to allow the tracking of root movements on a much finer scale, thus helping to expedite the discovery of more nodes in the regulation of root waving and skewing and movement in general.

Temperature effects on nitrogen form uptake by seedling roots of three contrasting conifers

Plant species may show a preference for uptake of particular nitrogen (N) forms, but little is known about how N form preference is influenced by soil temperature. Potential future changes in soil N form availability and plant N form preference in warmer soils might shift competitive interactions among forest tree species. We compared the N uptake and growth of three conifer species from contrasting environments grown at rhizosphere temperatures of 10, 16 or 20 °C and supplied with ammonium (NH4 (+)) or nitrate (NO3 (-)) or a mix of arginine and alanine. Short-term N uptake was assessed using ion-selective microelectrodes and application of (15)N, and long-term uptake was assessed by plant N status. Species exhibited preferences for particular N forms, and these preferences related to the N form most available in native soils. Specifically, Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) showed a preference for nitrate (a N form commonly found in warmer areas), Sitka spruce (Picea sitchensis (Bong.) Carr.) preferred ammonium (a N form abundant in cold soils) and Engelmann spruce (Picea engelmannii Parry ex Engelm.) showed a preference for ammonium and organic N (organic N is often abundant in cold soils). Relative N form preference, as indicated by plant growth, changed with temperature in some species, indicating that these species could acclimate to changing rhizosphere temperatures. Understanding how conifers utilize available soil nutrients at different temperatures can help to predict species' future performance as soil temperatures rise.

A feasibility study testing four hypotheses with phase II outcomes in advanced colorectal cancer (MRC FOCUS3): a model for randomised controlled trials in the era of personalised medicine?

BACKGROUND

Molecular characteristics of cancer vary between individuals. In future, most trials will require assessment of biomarkers to allocate patients into enriched populations in which targeted therapies are more likely to be effective. The MRC FOCUS3 trial is a feasibility study to assess key elements in the planning of such studies.

PATIENTS AND METHODS

Patients with advanced colorectal cancer were registered from 24 centres between February 2010 and April 2011. With their consent, patients' tumour samples were analysed for KRAS/BRAF oncogene mutation status and topoisomerase 1 (topo-1) immunohistochemistry. Patients were then classified into one of four molecular strata; within each strata patients were randomised to one of two hypothesis-driven experimental therapies or a common control arm (FOLFIRI chemotherapy). A 4-stage suite of patient information sheets (PISs) was developed to avoid patient overload.

RESULTS

A total of 332 patients were registered, 244 randomised. Among randomised patients, biomarker results were provided within 10 working days (w.d.) in 71%, 15 w.d. in 91% and 20 w.d. in 99%. DNA mutation analysis was 100% concordant between two laboratories. Over 90% of participants reported excellent understanding of all aspects of the trial. In this randomised phase II setting, omission of irinotecan in the low topo-1 group was associated with increased response rate and addition of cetuximab in the KRAS, BRAF wild-type cohort was associated with longer progression-free survival.

CONCLUSIONS

Patient samples can be collected and analysed within workable time frames and with reproducible mutation results. Complex multi-arm designs are acceptable to patients with good PIS. Randomisation within each cohort provides outcome data that can inform clinical practice.

Relaxed rotational and scrunching changes in P266L mutant of T7 RNA polymerase reduce short abortive RNAs while delaying transition into elongation

Abortive cycling is a universal feature of transcription initiation catalyzed by DNA-dependent RNA polymerases (RNAP). In bacteriophage T7 RNAP, mutation of proline 266 to leucine (P266L) in the C-linker region connecting the N-terminal promoter binding domain with the C-terminal catalytic domain drastically reduces short abortive products (4–7 nt) while marginally increasing long abortives (9–11 nt). Here we have investigated the transcription initiation pathway of P266L with the goal of understanding the mechanistic basis for short and long abortive synthesis. We show that the P266L mutation does not alter the affinity for the promoter, mildly affects promoter opening, and increases the +1/+2 GTP K_d by 2-fold. However, unlike wild-type T7 RNAP that undergoes stepwise rotation of the promoter binding domain and DNA scrunching during initial transcription, the P266L mutant does not undergo coupled rotational/scrunching movements until 7 nt RNA synthesis. The lack of rotation/scrunching correlates with greater stabilities of the initiation complexes of the P266L and decreased short abortive products. The results indicate that the increased flexibility in the C-linker due to P266L mutation enables T7 RNAP to absorb the stress from the growing RNA:DNA hybrid thereby decreasing short abortive products. Increased C-linker flexibility, however, has an adverse effect of delaying the transition into elongation by 1–2 nt, which gives rise to long abortive products. However, a mutation in the upstream promoter region greatly decreases long abortive products in P266L reactions, rendering the combination of P266L and A-15C promoter a desirable pair for efficient in vitro transcription for RNA production. We conclude that the conformational rigidity in the C-linker region conferred by the proline at position 266 is responsible for the undesirable short abortive products, but the rigidity is critical for efficient promoter clearance and transition into elongation.

An observational study of complications in chickenpox with special reference to unusual complications in an apex infectious disease hospital, Kolkata, India

BACKGROUND

Chickenpox can cause serious complications and even death in persons without any risk factors.

AIMS

To observe the different complications with special reference to unusual complications of chickenpox and their outcomes.

MATERIALS AND METHODS

The present study was a prospective observational study where 300 patients suffering from chickenpox were evaluated with special reference to unusual complications and outcomes.

RESULTS

The usual complications of chickenpox commonly observed were acute hepatitis in 30 (10%) and cerebellar ataxia in 22 patients (7.3%), whereas common unusual complications were acute pancreatitis in 45 (15%), hemorrhagic rash in 10 (3.3%), Guillain-Barrι syndrome in 4 (1.3%), disseminated intravascular coagulation in 4 (1.3%), necrotizing fasciitis in 4 (1.3%), and acute renal failure in 3 patients (1%). It had been observed that most of these unusual complications occurred in patients without any risk factor. A total of 18 patients (6%) died in this study and of them 12 patients (4%) died due to unusual complications.

CONCLUSIONS

Compulsory childhood varicella vaccination including vaccination of risk groups and susceptible individuals are all essential to reduce the incidence of chickenpox, associated complications, and subsequent death.

Influence of body mass index on low back pain

Low back pain (LBP) is a common problem affecting 70% of the population in the developed countries and prevalence is also increasing in the developing countries. We conducted a clinic based cross-sectional study in the city of Dhaka and Chittagong during the period of January 2009 to December 2011. Participants (n=357) were interviewed and examined through a structured questionnaire after a non purposive sampling to explore the influence of body mass index (BMI) on LBP. BMI was assessed by the equation weight (Kg)/hight² (m²) and LBP was assessed by modified visual analogue scale. Association between LBP and BMI was tested by Chi-square test. Among 357 patients the incidence of LBP was common in the age group between 40-59 years and it was 172(48.17%) followed by 60-79, 20-39 and ≥80 years group with 21.29%, 17.65% and 12.89% respectively. Female presented more with LBP, i.e. 196(54.91%) than the male 161(45.09%). The more study population was found to have BMI within normal range, i.e. 167(46.78%). This was followed by overweight group which amounted 137(38.37%) while the obese group was the least, i.e. 53(14.85%). Maximum study population presented with severe LBP which amounted 140(39.22%) while others presented with moderate and mild LBP and amounting 118(33.05%) and 99(27.73%) respectively. Among the normal BMI group most patient presented with mild pain (n=82) followed by moderate (n=55) and severe (n=30) pain. Participants with overweight presents with severe pain mostly (n=58) but obese participants presented with severe low back pain (n=25). Statistically the association of LBP with BMI was found to be highly significant (p<0.0001). In this study, 137(46.78%) participants of normal BMI presented with LBP but majorities (n=82) presented with mild LBP and overweight and obese participants mostly presented with severe LBP. On the basis of these findings, careful evaluation of risk factors and deliberate assessment of the therapeutic as well as preventive measure for the management of patient of LBP is highly recommended.