Development of a prediction model to determine responders to conservative treatment in people with symptomatic hand osteoarthritis: A secondary analysis of a single-centre, randomised feasibility trial

BACKGROUND

Conservative treatments are beneficial for people with hand osteoarthritis (OA).

OBJECTIVE

It was the purpose of this study to develop and internally validate both a basic model and a more complex model that could predict responders to conservative treatments in people with hand OA.

DESIGN

This was a secondary analysis of a single-centre, randomised feasibility study.

METHODS

Fifty-nine participants (34 responders) with hand osteoarthritis were recruited from the general population. Participants were randomised to receive either advice alone, or advice in combination with blood flow restriction training (BFRT), or traditional high intensity training (HIT). Participants underwent supervised hand exercises three times per week for six weeks. The OMERACT-OARSI criteria were utilised to determine responders vs non responders to treatment at the end of six weeks. A basic logistic regression model (treatment type, expectations, adherence) and a more complex logistic regression model (basic model variables plus pain catastrophising and neuropathic pain features) were created. Discrimination ability, and calibration were assessed. Internal model validation through bootstrapping (200 repetitions) was utilised to calculate the prediction model optimism.

RESULTS

The results showed that the basic model presented with acceptable discrimination (optimism corrected c-statistic: 0.72, 95% CI 0.71-0.73) and calibration (slope = 1.41; intercept = 0.68). The more complex model had better discrimination but poorer calibration.

CONCLUSION

A prediction tool was created to provide an individualised estimate of treatment response in people with hand OA. Future studies will need to validate this model in other groups of patients.

TRIAL REGISTRATION

https://www.anzctr.org.au/- ACTRN12617001270303.

Neglect-like symptoms and their relationships with other clinical features in people with hand osteoarthritis: An exploratory study

BACKGROUND

Symptomatic hand osteoarthritis (OA) is a debilitating condition. Body schema impairments such as neglect-like symptoms have been previously reported in people with symptomatic hand OA, however, little is known about their clinical importance, or relationships with other clinical features.

OBJECTIVES

The aim of this cross-sectional study was to assess the prevalence of neglect-like symptoms in painful hand OA and their association with measures of depression, pain catastrophising, sleep quality, function, pain interference and pain duration whilst controlling for important covariates.

DESIGN

Secondary analysis of cross-sectional study.

METHODS

Logistic regression with age, sex, and worst pain intensity as covariates were utilised to assess differences between participants with and without neglect-like symptoms.

RESULTS

A total of 121 participants were recruited. Sixty-one percent of participants presented with neglect-like symptoms. Participants with longer pain duration had greater odds of presenting with neglect-like symptoms (OR: 1.10 95%CI: 1.01 to 1.19; p = 0.012). No difference was observed for depression, pain catastrophising, sleep quality, function, or pain interference.

CONCLUSIONS

A large proportion of participants with symptomatic hand OA reported neglect-like symptoms, the presence of which was associated with longer pain duration.

Heterogeneity of resting-state EEG features in juvenile myoclonic epilepsy and controls

Abnormal EEG features are a hallmark of epilepsy, and abnormal frequency and network features are apparent in EEGs from people with idiopathic generalized epilepsy in both ictal and interictal states. Here, we characterize differences in the resting-state EEG of individuals with juvenile myoclonic epilepsy and assess factors influencing the heterogeneity of EEG features. We collected EEG data from 147 participants with juvenile myoclonic epilepsy through the Biology of Juvenile Myoclonic Epilepsy study. Ninety-five control EEGs were acquired from two independent studies [Chowdhury et al. (2014) and EU-AIMS Longitudinal European Autism Project]. We extracted frequency and functional network-based features from 10 to 20 s epochs of resting-state EEG, including relative power spectral density, peak alpha frequency, network topology measures and brain network ictogenicity: a computational measure of the propensity of networks to generate seizure dynamics. We tested for differences between epilepsy and control EEGs using univariate, multivariable and receiver operating curve analysis. In addition, we explored the heterogeneity of EEG features within and between cohorts by testing for associations with potentially influential factors such as age, sex, epoch length and time, as well as testing for associations with clinical phenotypes including anti-seizure medication, and seizure characteristics in the epilepsy cohort. P-values were corrected for multiple comparisons. Univariate analysis showed significant differences in power spectral density in delta (2-5 Hz) (P = 0.0007, hedges' g = 0.55) and low-alpha (6-9 Hz) (P = 2.9 × 10-8, g = 0.80) frequency bands, peak alpha frequency (P = 0.000007, g = 0.66), functional network mean degree (P = 0.0006, g = 0.48) and brain network ictogenicity (P = 0.00006, g = 0.56) between epilepsy and controls. Since age (P = 0.009) and epoch length (P = 1.7 × 10-8) differed between the two groups and were potential confounders, we controlled for these covariates in multivariable analysis where disparities in EEG features between epilepsy and controls remained. Receiver operating curve analysis showed low-alpha power spectral density was optimal at distinguishing epilepsy from controls, with an area under the curve of 0.72. Lower average normalized clustering coefficient and shorter average normalized path length were associated with poorer seizure control in epilepsy patients. To conclude, individuals with juvenile myoclonic epilepsy have increased power of neural oscillatory activity at low-alpha frequencies, and increased brain network ictogenicity compared with controls, supporting evidence from studies in other epilepsies with considerable external validity. In addition, the impact of confounders on different frequency-based and network-based EEG features observed in this study highlights the need for careful consideration and control of these factors in future EEG research in idiopathic generalized epilepsy particularly for their use as biomarkers.

Six weeks of resistance training (plus advice) vs advice only in hand osteoarthritis: A single-blind, randomised, controlled feasibility trial

BACKGROUND

People with hand osteoarthritis (OA) may benefit from resistance training interventions. To date the feasibility of a such interventions for symptomatic hand OA, as per international guidelines, is unknown.

OBJECTIVE

Determine the feasibility of a clinical trial comparing resistance training to an advice only control group in people with symptomatic hand OA.

DESIGN

Single-blind, randomised, controlled feasibility study.

METHODS

The American College of Rheumatology criteria for hand OA were utilised for inclusion. Participants were randomly allocated (1:1:1) to advice and blood flow restriction training (BFRT), advice and traditional high intensity training (HIT), or advice only (control). Participants receiving BFRT and HIT underwent supervised hand exercises three times a week for six weeks. Feasibility measures included recruitment rate, adherence, exercise induced pain, training acceptability, pain flares, and adverse events. Number of treatment responders, pain, grip strength, and hand function were also recorded.

RESULTS

In total, 191 participants were screened, 59 (31%) were included. Retention rate was 89% for BFRT and 79% for HIT. Exercise did not worsen pain following training sessions, and training acceptability was equal between groups. Pain flares occurred in 1.6% (BFRT) and 4% (HIT) out of all the training sessions. There was one adverse event in the HIT group, with the participants withdrawing from the study due to pain. The number of treatment responders, and improvements in pain, were greater with BFRT and HIT. Grip and function did not improve.

CONCLUSION

A clinical trial comparing resistance training to advice for people with symptomatic hand OA is feasible.

Psychosocial and pharmacologic interventions for methamphetamine addiction: protocol for a scoping review of the literature

BACKGROUND

Methamphetamine use and harms are rising rapidly. Management of patients with methamphetamine use disorder (MUD) and problematic methamphetamine use (PMU) is challenging, with no clearly established best approach; both psychosocial and pharmacologic interventions have been described. Furthermore, given the diversity of individuals that use methamphetamines, there is a need to assess evidence for treatments for subgroups including youths; gay, bisexual, and other men who have sex with men; individuals with mental health comorbidities; and individuals in correction services. Establishing awareness of the messages regarding treatment from recent clinical practice guidelines (CPG) in the field is also of value. The first study objective will be to establish a greater understanding of the methods, populations, and findings of controlled studies for psychosocial and pharmacologic treatments for MUD and PMU. Investigation of this information can help establish the potential for advanced syntheses of the evidence (such as network meta-analysis) to compare therapies for this condition and to identify gaps related to key populations where more primary research is needed. Summarizing the recommendations regarding treatment of MUD/PMU from recent CPGs and systematic reviews will be an important secondary objective.

METHODS

A scoping review will be performed. Using the OVID platform, MEDLINE, Embase, PsycINFO, and relevant Cochrane databases from EBM Reviews will be searched (from databases' inception onwards). Eligibility criteria will include individuals described as having MUD or PMU, with designs of interest including randomized trials, non-randomized trials, and controlled cohort studies with three or more months of follow-up; systematic reviews and CPGs will also be sought. Two reviewers (with support from automation tools) will independently screen all citations, full-text articles, and chart data. Different approaches to handling and summarizing the data will be implemented for each type of study design. Tables and graphics will be used to map evidence sources and identify evidence gaps.

DISCUSSION

This research will enhance awareness of evidence addressing the effects of psychosocial and pharmacologic interventions for MUD/PMU overall and in sub-populations, both in terms of recent CPGs/reviews and primary studies; inspection of the latter will also help establish the feasibility of future syntheses to compare treatments, such as network meta-analysis. SYSTEMATIC REVIEW PROTOCOL REGISTRATION: Open Science Framework ( https://osf.io/9wy8p ).

Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia

The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Ca_v2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca²⁺ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Ca_v2.2 in normal human neurodevelopment.

Screening questionnaires for substance abuse post brain injury: a review

OBJECTIVE

To assess the psychometric properties of the available assessment questionnaires for substance abuse studied within a brain injury population.

METHODS

A literature search was conducted on MEDLINE, PsycINFO, CINAHL, and Embase databases. Articles published in English from inception through March 2018 on the screening questionnaires used to identify substance abuse post brain injury were reviewed. Eligible primary studies had to include: adults (participants ≥18 years old) post brain injury; and report measures of diagnostic accuracy (e.g., sensitivity, specificity, and diagnostic odds ratio).

RESULTS

Six screening questionnaires were included: Alcohol Use Disorders Identification Test, Brief Michigan Alcohol Screening Test, CAGE, Drug Abuse Screening Test, Substance Abuse Screening Inventory and the Short Michigan Alcohol Screening Test (SMAST). All questionnaires, except the SMAST, used the Diagnostic and Statistical Manual of Mental Disorders as the criterion measure. While report measures of diagnostic accuracy were reported and summarized, none of the studies provided reliability information or subgroup analysis among those with brain injury.

CONCLUSIONS

Concerns of social desirability, population demographics, responsiveness to treatment effects, and administrative burden are important when selecting a questionnaire. Research examining the reliability of substance abuse screening questionnaires in the brain injury population is lacking and future research is warranted.

Label-free multimodal coherent anti-Stokes Raman scattering analysis of microparticles in unconstrained microfluidics

Fast, label-free optical identification and quantification of biomolecules and other relevant biological materials in microfluidic devices and the vascular system will play a major role in liquid biopsy and related diagnoses. An optical microscope probing simultaneously non-linear coherent anti-Stokes Raman scattering (CARS) and linear scattering (LS) was used to probe microparticles in aqueous solutions flowed unconstrained in microfluidic channels. Despite the optical complexity of these systems, where out-of-focus microparticles randomly impede CARS and LS, and where water CARS generates a substantial background, we demonstrate that in-focus microparticles can be individually and unambiguously detected when CARS and LS are co-analyzed. The ability to chemically discriminate microscale features in optically realistic flows supports the relevance of multimodal CARS platforms for liquid biopsy.

Twelve-year follow-up of chronic pain in twins: Changes in environmental and genetic influence over time

BACKGROUND

While genetic influences on chronic pain have been repeatedly demonstrated, we do not know whether these effects are stable or dynamic over time.

AIMS

To determine the temporal pattern of genetic and environmental effects to individual differences in chronic pain over 12 years, we use a sample of n = 961 female twins.

METHODS

Data on chronic pain were collected in 2004 (T1) and 2016 (T2) using the same comprehensive body map which divides the body into 31 distinct anatomical areas. Multivariate twin analyses for repeated measures were conducted to track changes in genetic and environmental influences.

RESULTS

Heritability for chronic pain was 63% at baseline and 55% at follow-up. The best-fitting AE Cholesky model revealed one genetic factor explaining 62% of variance in chronic pain at T1 and 11% at T2. No additional genetic factors explaining the variance in chronic pain at T2 could be detected. Furthermore, a unique environmental factor (E1) explaining 37% of the variance in chronic pain at T1 and 12% at T2 and an additional environmental factor (E2) explaining 77% of the variance at T2 were found.

CONCLUSION

We demonstrate for the first time that the same genetic influences are operative over time and that novel environmental factors are important in pain maintenance. The findings highlight the value of more in depth exploration of these non-shared environmental influences that could provide clues to the mechanisms behind remittance and/or maintenance of chronic pain. The identification of important environmental influences could point to novel therapeutic interventions in future.

SIGNIFICANCE

The variability in chronic pain is mainly explained by new environmental factors influencing incidence, aggravation and/or chronic pain remission. Integration of these findings may provide a useful conceptual framework for the treatment and prevention of pain and pain chronification.

The Microevolution and Epidemiology of Staphylococcus aureus Colonization during Atopic Eczema Disease Flare

Staphylococcus aureus is an opportunistic pathogen and variable component of the human microbiota. A characteristic of atopic eczema (AE) is colonization by S. aureus, with exacerbations associated with an increased bacterial burden of the organism. Despite this, the origins and genetic diversity of S. aureus colonizing individual patients during AE disease flares is poorly understood. To examine the microevolution of S. aureus colonization, we deep sequenced S. aureus populations from nine children with moderate to severe AE and 18 non-atopic children asymptomatically carrying S. aureus nasally. Colonization by clonal S. aureus populations was observed in both AE patients and control participants, with all but one of the individuals carrying colonies belonging to a single sequence type. Phylogenetic analysis showed that disease flares were associated with the clonal expansion of the S. aureus population, occurring over a period of weeks to months. There was a significant difference in the genetic backgrounds of S. aureus colonizing AE cases versus controls (Fisher exact test, P = 0.03). Examination of intra-host genetic heterogeneity of the colonizing S. aureus populations identified evidence of within-host selection in the AE patients, with AE variants being potentially selectively advantageous for intracellular persistence and treatment resistance.

The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma

INTRODUCTION

The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM.

METHODS

Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical M0 (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases.

RESULTS

Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation-generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1).

CONCLUSIONS

This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings.

The IASLC Mesothelioma Staging Project: Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma

INTRODUCTION

The current T component for malignant pleural mesothelioma (MPM) has been predominantly informed by surgical data sets and consensus. The International Association for the Study of Lung Cancer undertook revision of the seventh edition of the staging system for MPM with the goal of developing recommendations for the eighth edition.

METHODS

Data elements including detailed T descriptors were developed by consensus. Tumor thickness at three pleural levels was also recorded. An electronic data capture system was established to facilitate data submission.

RESULTS

A total of 3519 cases were submitted to the database. Of those eligible for T-component analysis, 509 cases had only clinical staging, 836 cases had only surgical staging, and 642 cases had both available. Survival was examined for T categories according to the current seventh edition staging system. There was clear separation between all clinically staged categories except T1a versus T1b (hazard ratio = 0.99, p = 0.95) and T3 versus T4 (hazard ratio = 1.22, p = 0.09), although the numbers of T4 cases were small. Pathological staging failed to demonstrate a survival difference between adjacent categories with the exception of T3 versus T4. Performance improved with collapse of T1a and T1b into a single T1 category; no current descriptors were shifted or eliminated. Tumor thickness and nodular or rindlike morphology were significantly associated with survival.

CONCLUSIONS

A recommendation to collapse both clinical and pathological T1a and T1b into a T1 classification will be made for the eighth edition staging system. Simple measurement of pleural thickness has prognostic significance and should be examined further with a view to incorporation into future staging.

A protein-truncating R179X variant in RNF186 confers protection against ulcerative colitis

Protein-truncating variants protective against human disease provide in vivo validation of therapeutic targets. Here we used targeted sequencing to conduct a search for protein-truncating variants conferring protection against inflammatory bowel disease exploiting knowledge of common variants associated with the same disease. Through replication genotyping and imputation we found that a predicted protein-truncating variant (rs36095412, p.R179X, genotyped in 11,148 ulcerative colitis patients and 295,446 controls, MAF=up to 0.78%) in RNF186, a single-exon ring finger E3 ligase with strong colonic expression, protects against ulcerative colitis (overall P=6.89 × 10(-7), odds ratio=0.30). We further demonstrate that the truncated protein exhibits reduced expression and altered subcellular localization, suggesting the protective mechanism may reside in the loss of an interaction or function via mislocalization and/or loss of an essential transmembrane domain.

Predicting the digestible energy of corn determined with growing swine from nutrient composition and cross-species measurements

The DE values of corn grain for pigs will differ among corn sources. More accurate prediction of DE may improve diet formulation and reduce diet cost. Corn grain sources ( = 83) were assayed with growing swine (20 kg) in DE experiments with total collection of feces, with 3-wk-old broiler chick in nitrogen-corrected apparent ME (AME) trials and with cecectomized adult roosters in nitrogen-corrected true ME (TME) studies. Additional AME data for the corn grain source set was generated based on an existing near-infrared transmittance prediction model (near-infrared transmittance-predicted AME [NIT-AME]). Corn source nutrient composition was determined by wet chemistry methods. These data were then used to 1) test the accuracy of predicting swine DE of individual corn sources based on available literature equations and nutrient composition and 2) develop models for predicting DE of sources from nutrient composition and the cross-species information gathered above (AME, NIT-AME, and TME). The overall measured DE, AME, NIT-AME, and TME values were 4,105 ± 11, 4,006 ± 10, 4,004 ± 10, and 4,086 ± 12 kcal/kg DM, respectively. Prediction models were developed using 80% of the corn grain sources; the remaining 20% was reserved for validation of the developed prediction equation. Literature equations based on nutrient composition proved imprecise for predicting corn DE; the root mean square error of prediction ranged from 105 to 331 kcal/kg, an equivalent of 2.6 to 8.8% error. Yet among the corn composition traits, 4-variable models developed in the current study provided adequate prediction of DE (model ranging from 0.76 to 0.79 and root mean square error [RMSE] of 50 kcal/kg). When prediction equations were tested using the validation set, these models had a 1 to 1.2% error of prediction. Simple linear equations from AME, NIT-AME, or TME provided an accurate prediction of DE for individual sources ( ranged from 0.65 to 0.73 and RMSE ranged from 50 to 61 kcal/kg). Percentage error of prediction based on the validation data set was greater (1.4%) for the TME model than for the NIT-AME or AME models (1 and 1.2%, respectively), indicating that swine DE values could be accurately predicted by using AME or NIT-AME. In conclusion, regression equations developed from broiler measurements or from analyzed nutrient composition proved adequate to reliably predict the DE of commercially available corn hybrids for growing pigs.

Large-scale discovery of novel genetic causes of developmental disorders

Despite three decades of successful, predominantly phenotype-driven discovery of the genetic causes of monogenic disorders, up to half of children with severe developmental disorders of probable genetic origin remain without a genetic diagnosis. Particularly challenging are those disorders rare enough to have eluded recognition as a discrete clinical entity, those with highly variable clinical manifestations, and those that are difficult to distinguish from other, very similar, disorders. Here we demonstrate the power of using an unbiased genotype-driven approach to identify subsets of patients with similar disorders. By studying 1,133 children with severe, undiagnosed developmental disorders, and their parents, using a combination of exome sequencing and array-based detection of chromosomal rearrangements, we discovered 12 novel genes associated with developmental disorders. These newly implicated genes increase by 10% (from 28% to 31%) the proportion of children that could be diagnosed. Clustering of missense mutations in six of these newly implicated genes suggests that normal development is being perturbed by an activating or dominant-negative mechanism. Our findings demonstrate the value of adopting a comprehensive strategy, both genome-wide and nationwide, to elucidate the underlying causes of rare genetic disorders.

Comparison of broiler performance and carcass yields when fed diets containing genetically modified canola meal from event DP-Ø73496-4, near-isogenic canola meal, or commercial canola meals

Genetically modified (GM) canola (Brassica napus L.) line containing event DP-Ø73496-4 (hereafter referred to as 73496 canola) was produced by the insertion of the glyphosate acetyltransferase (gat4621) gene derived from Bacillus licheniformis. Expression of the GAT4621 protein present in 73496 canola plants confers in planta tolerance to the herbicidal active ingredient glyphosate. The objective of this study was to compare the nutritional performance of broiler chickens fed canola meal from 73496 canola seed with that of broiler chickens fed non-GM canola meal in a 42-d feeding trial. Diets were prepared using meal processed from seed from unsprayed 73496 plants or from plants sprayed with an in-field application of glyphosate herbicide [73496(S)]. For comparison, additional diets were produced with canola meal obtained from the non-GM near-isogenic control or non-GM commercial reference DuPont Pioneer brand varieties 42H72, 42H73, 46A65, and 44A89. Diets were fed to Ross 708 broilers (n = 120/group, 50% male and 50% female) in 3 phases: starter and grower phases containing 10 or 20% canola meal, respectively, and a finisher phase with a common corn-soybean meal diet without any canola meal. No statistically significant differences were observed in growth performance measures or organ and carcass yields between broilers consuming diets produced with canola meal from unsprayed or sprayed 73496 seed and those consuming diets produced with canola meal from control seed. Additionally, all performance, organ, and carcass measures from control, 73496, and 73496(S) canola treatment groups were within tolerance intervals constructed using data from the reference canola groups. It was concluded from these results that meal processed from 73496 canola seed (unsprayed plants or plants sprayed with glyphosate) was nutritionally equivalent to meal processed from non-GM near-isogenic control canola seed.

Expression profiling stratifies mesothelioma tumors and signifies deregulation of spindle checkpoint pathway and microtubule network with therapeutic implications

BACKGROUND

Malignant pleural mesothelioma (MPM) is a lethal neoplasm exhibiting resistance to most treatment regimens and requires effective therapeutic options. Though an effective strategy in many cancer, targeted therapy is relatively unexplored in MPM because the therapeutically important oncogenic pathways and networks in MPM are largely unknown.

MATERIALS AND METHODS

We carried out gene expression microarray profiling of 53 surgically resected MPMs tumors along with paired normal tissue. We also carried out whole transcriptomic sequence (RNA-seq) analysis on eight tumor specimens. Taqman-based quantitative Reverse-transcription polymerase chain reaction (qRT-PCR), western analysis and immunohistochemistry (IHC) analysis of mitotic arrest deficient-like 1 (MAD2L1) was carried out on tissue specimens. Cell viability assays of MPM cell lines were carried out to assess sensitivity to specific small molecule inhibitors.

RESULTS

Bioinformatics analysis of the microarray data followed by pathway analysis revealed that the mitotic spindle assembly checkpoint (MSAC) pathway was most significantly altered in MPM tumors with upregulation of 18 component genes, including MAD2L1 gene. We validated the microarray data for MAD2L1 expression using quantitative qRT-PCR and western blot analysis on tissue lysates. Additionally, we analyzed expression of the MAD2L1 protein by IHC using an independent tissue microarray set of 80 MPM tissue samples. Robust clustering of gene expression data revealed three novel subgroups of tumors, with unique expression profiles, and showed differential expression of MSAC pathway genes. Network analysis of the microarray data showed the cytoskeleton/spindle microtubules network was the second-most significantly affected network. We also demonstrate that a nontaxane small molecule inhibitor, epothilone B, targeting the microtubules have great efficacy in decreasing viability of 14 MPM cell lines.

CONCLUSIONS

Overall, our findings show that MPM tumors have significant deregulation of the MSAC pathway and the microtubule network, it can be classified into three novel molecular subgroups of potential therapeutic importance and epothilone B is a promising therapeutic agent for MPM.

The use of supportive observations within an inpatient mental health unit for older people and dilemma of using the Mental Health Act (2007) or the Mental Capacity Act (2005) in England and Wales

In England and Wales the interface between the Mental Capacity Act 2005 (MCA) and Mental Health Act 2007 (MHA) is frequently encountered in mental health practice. In services involving older adults many service users will have cognitive impairment and dementias in some instances with behavioural and psychological symptoms of dementia and assessments regarding their mental capacity to make decisions are frequently required. Service users with these illnesses are admitted to psychiatric wards and occasionally nursed under 'close observations' in order to maintain their safety and that of others. The concepts of 'complete and effective control' which may be exercised by ward staff in these circumstances, and the resulting 'loss of autonomy under supervision and control' must be understood in consideration of whether a 'deprivation of liberty' should ensue, particularly when they do not have mental capacity to make decisions about the observations. The observation policy must clearly delineate the different forms of nursing observations possible e.g. close, constant, intermediate, general etc. to avoid confusion among staff members implementing the observation plan. Various dilemmas and management of such dilemmas concerning the use of MCA 2005, MHA 2007 and observation policies has been discussed in this paper. Nursing staff working in both psychiatric and acute hospitals need training in concepts of MCA 2005, MHA 2007 and Deprivation of Liberty Safeguards.

Open-lung biopsy in patients with undiagnosed lung lesions referred at a tertiary cancer center is safe and reveals noncancerous, noninfectious entities as the most common diagnoses

We evaluated the diagnostic yield of open-lung biopsies (OLBs) in a large tertiary cancer center to determine the role of infectious diseases as causes of undiagnosed pulmonary lesions. All consecutive adult patients with either single or multiple pulmonary nodules or masses who underwent a diagnostic OLB over a period of 10 years (1998-2007) were retrospectively identified. Their risk factors for malignancy and clinical and radiological characteristics were reviewed, and their postoperative complications were assessed. We evaluated 155 patients with a median age of 57 years (range, 19-83 years). We identified infectious etiologies in 29 patients (19 %). The most common diagnosis in this group was histoplasmosis (12 [41 %]), followed by nontuberculous mycobacterial infection (7 [24 %]) and aspergillosis (4 [14 %]). The majority of the 126 remaining patients had nonmalignant diagnoses, the most prevalent being nonspecific granuloma (26 %), whereas only 17 % had malignant diagnoses. We observed no significant differences among the patients with infectious, malignant, or both noninfectious and nonmalignant final diagnoses regarding their demographic, laboratory, and clinical characteristics. Six percent of the patients had at least one post-OLB complication, and the post-OLB mortality rate was 1 %. OLB is a safe diagnostic procedure which frequently identifies a wide variety of infectious and inflammatory diseases.

Comparison of broiler performance and carcass yields when fed transgenic maize grain containing event DP-O9814O-6 and processed fractions from transgenic soybeans containing event DP-356O43-5

The performance of broilers fed diets containing maize grain from event DP-Ø9814Ø-6 (98140; gat4621 and zm-hra genes) and processed fractions (meal, hulls, and oil) from soybeans containing event DP-356Ø43-5 (356043; gat4601 and gm-hra genes) was evaluated in a 42-d feeding study. Diets were produced with nontransgenic maize grain and soybean fractions from controls with comparable genetic backgrounds to 98140 and 356043 (control), 98140 maize and 356043 soybean (98140 + 356043), or 3 commercially available nontransgenic maize and soybean combinations. Ross 708 broilers (n = 120/group; 50% male, 50% female) were fed diets in 3 phases: starter (d 0 to 21), grower (d 22 to 35), and finisher (d 36 to 42). Starter diets contained (on average) 63% maize and 28% soybean meal, grower diets 66% maize and 26% soybean meal, and finisher diets 72% maize and 21% soybean meal; soybean hulls and oils were held constant at 1.0 and 0.5%, respectively, across all diets in all phases. Weight gain, feed intake, and mortality-adjusted feed efficiency were calculated for d 0 to 42. Standard organ and carcass yield data were collected on d 42. Data were analyzed using a mixed model ANOVA with differences between control and 98140 + 356043 group means considered significant at P < 0.05. Reference group data were used only to estimate experimental variability and to generate tolerance intervals. No significant differences were observed in weight gain, mortality, mortality-adjusted feed efficiency, organ yields, or carcass yields between broilers consuming diets produced with 98140 + 356043 and those consuming diets produced with control maize and soybean fractions. All values of response variables evaluated in the control and 98140 + 356043 groups fell within calculated tolerance intervals. Based on these results, it was concluded that the combination of genetically modified 98140 maize and 356043 soybean fractions was nutritionally equivalent to nontransgenic maize and soybean controls with comparable genetic backgrounds.

Malignant clival chordoma with postoperative cutaneous metastases

The authors report the case of a chordoma with malignant cytologic features, presenting as a mass lesion in the clival and infratemporal region at the level of the craniocervical junction in an 8-year-old female. Following gross resection of the mass, the patient subsequently developed distant subcutaneous and peritoneal metastases from the lesion. The rare histologic features, the surgical approach to the lesion, and the follow-up management of this unique case are discussed.

Minimally invasive esophagectomy versus open esophagectomy, a symptom assessment study

Minimally invasive esophagectomy (MIE) is used with hope to decrease the morbidity associated with an open esophagectomy. Reflux and dumping syndromes are the most important functional complaints in patients after esophagectomy. This study compares the functional benefits of MIE with open esophagectomy. The study enrolled patients who underwent either minimally invasive or open esophagectomy for cancer between 2004 and 2009. No patients in the MIE group had a pyloroplasty or myotomy. Each patient in the MIE group was paired to a patient in the open esophagectomy group via propensity matching. Matching variables included age, race, gender, preoperative treatment, history of prior cancer, American Society of Anesthesiologists Risk Scale, performance status, clinical stage, body mass index, histology, level of anastomosis, and time elapsed since surgery. The patients were asked to answer 26 questions about their reflux and dumping using validated questionnaires. A total of 181 patients were included in the study. From this group, 44 pairs of patients were created and used for the analysis. The median follow-up was 12.1 months for the MIE group and 18.3 months for the open group. The reflux score was slightly worse in the MIE group (5.5 versus 3.5, P= 0.021). There was no difference in the dumping symptoms between the two groups. The most common complaints seen in the dumping questionnaire in almost one-third of all patients were early satiety, abdominal discomfort, nausea, and diarrhea. Of the patients, 77% were satisfied or very satisfied with their condition in the MIE group compared with 93% in the open group (P= 0.287). Reflux, dumping, and overall satisfaction after MIE without pyloroplasty are comparable with those obtained after open esophagectomy with a pyloric drainage procedure.

Nutritional equivalency evaluation of transgenic maize grain from event DP-O9814O-6 and transgenic soybeans containing event DP-356O43-5: laying hen performance and egg quality measures

The objective of this study was to compare the nutritional performance of laying hens fed maize grain from event DP-Ø9814Ø-6 (98140; gat4621 and zm-hra genes) and processed soybean meal from soybeans containing event DP-356Ø43-5 (356043; gat4601 and gm-hra genes), individually or in combination, with the performance of hens fed diets containing nontransgenic maize and soybean meal. Healthy pullets (n = 216) placed in cages (3 hens/cage) were randomly assigned to 9 dietary treatments (8 cages/treatment): nontransgenic controls 1, 2, and 3 (comparable genetic background controls for 98140, 356043, and 98140 + 356043, respectively); reference 1, reference 2, and reference 3 (commercially available nontransgenic maize-soybean meal sources); and 98140 (test 1), 356043 (test 2), and 98140 + 356043 (test 3). The experiment was divided into three 4-wk phases (24 to 28 wk, 28 to 32 wk, and 32 to 36 wk of age), during which time hens were fed mash diets. Performance (BW, feed intake, and egg production) and egg quality data were collected. Data were analyzed using a mixed model ANOVA; differences between the control and respective test group means were considered significant at P < 0.05. Data generated from the reference groups were used only in the estimation of experimental variability and in generating the tolerance interval. Body weight and BW gain, egg production, and production efficiency for hens fed the test diets were similar to the respective values for hens fed the corresponding control diets. Haugh unit measures and egg component weights were similar between the respective test and control groups, and no differences were observed in quality grades or crack measures. All observed values of the control and test groups were within the calculated tolerance intervals. This research indicates that the performance and egg quality of hens fed diets containing 98140 maize grain, 356043 soybean meal, or a combination of the 2 was comparable with that of hens fed diets formulated with nontransgenic maize grain or soybean meal control diets with comparable genetic backgrounds.

Evaluation of the nutritional equivalency of soybean meal with the genetically modified trait DP-3O5423-1 when fed to laying hens

An experiment using 336 Hy-Line W-36 Single Comb White Leghorn hens was conducted to evaluate transgenic soybeans containing the gm-fad2-1 gene fragment and the gm-hra gene. Transcription of the gm-fad2-1 gene fragment results in an increased level of oleic acid (18:1) in the seed, and expression of the soybean acetolactate synthase protein (GM-HRA) encoded by the modified gm-hra gene, is used as a selectable marker during transformation. Pullets (20 wk of age) were placed in cage lots (7 hens/cage, 2 cages/lot) and were randomly assigned to 1 of 4 corn-soybean meal dietary treatments (6 lots/treatment) formulated with the following soybean meals: nontransgenic near-isoline control (control), nontransgenic commercial reference soybean meal A (92M72), nontransgenic commercial reference soybean meal B (93B15), or transgenic soybean meal produced from soybeans containing event DP-3Ø5423-1 (305423). Weeks 20 to 24 were a preconditioning period, and the 4 experimental diets were then fed from 25 to 36 wk of age. Differences between the 305423 and control group means were evaluated, with statistical significance at P < 0.05. Body weight, hen-day egg production, egg mass, feed consumption, and feed efficiency for hens fed the 305423 soybean meal were not significantly different from the respective values for hens fed diets formulated with the near-isoline soybean meal. Likewise, egg component weights, Haugh unit measures, and egg weights were similar regardless of the soybean meal source. This research indicates that performance of hens fed diets containing 305423 soybean meal, as measured by egg production and egg quality, was similar to that of hens fed diets formulated with the near-isoline control and commercial soybean meals.