Alterations in regulatory T cells and immune checkpoint molecules in pancreatic cancer patients receiving FOLFIRINOX or gemcitabine plus nab-paclitaxel

Purpose

This pilot study aimed on generating insight on alterations in circulating immune cells during the use of FOLFIRINOX and gemcitabine/nab-paclitaxel in pancreatic ductal adenocarcinoma (PDAC).

Patients and methods

Peripheral blood mononuclear cells were isolated before and 30 days after initiation of chemotherapy from 20 patients with advanced PDAC. Regulatory T cells (FoxP3+) and immune checkpoints (PD-1 and TIM-3) were analyzed by flow cytometry and immunological changes were correlated with clinical outcome.

Results

Heterogeneous changes during chemotherapy were observed in circulating T-cell subpopulations with a pronounced effect on PD-1+ CD4+/CD8+ T cells. An increase in FoxP3+ or PD-1+ T cells had no significant effect on survival. An increase in TIM3+/CD8+ (but not TIM3+/CD4+) T cells was associated with a significant inferior outcome: median progression-free survival in the subgroup with an increase of TIM-3+/CD8+ T cells was 6.0 compared to 14.0 months in patients with a decrease/no change (p = 0.026); corresponding median overall survival was 13.0 and 20.0 months (p = 0.011), respectively.

Conclusions

Chemotherapy with FOLFIRNOX or gemcitabine/nab-paclitaxel induces variable changes in circulating T-cell populations that may provide prognostic information in PDAC.

Impact of an oral health education intervention among a group of patients with eating disorders (anorexia nervosa and bulimia nervosa)

BACKGROUND

It is recognized that eating disorders are serious psychosocial illnesses that affect many adolescents and adults. A pre and post survey study was developed to assess demographics, oral health knowledge and self-image of patients with eating disorders participating in a hospital-based eating disorder clinic using an original oral health education program. The program's aim is to change the self-image and oral health practices of patients with anorexia-binge eating/purging (AN-BP) and bulimia nervosa (BN) disorders.

METHODS

A pre-survey was completed by each study participant prior to attending the three educational sessions over a six-week period. A post survey questionnaire was completed after participation in all the educational presentations. Forty-six patients attended all three educational sessions and completed the pre and post-questionnaires.

RESULTS

Most patients knew in advance that AN-BP and BN behavior can cause erosion of the teeth but only 30% knew the most likely location for the erosion to occur. But, following completion of the educational interventions, 73% answered the location correctly. Patients who reported going to the dentist regularly were significantly more likely to respond that their teeth/mouth had a positive effect on how they looked to themselves and to others, their general health, and their general happiness. Positive responses to the effect of the teeth/mouth on kissing and romantic relationships were also significantly higher for those who go to the dentist regularly compared to those who do not.

CONCLUSIONS

There is a need to further understand AN-BP and BP patients' oral health knowledge and self-image perceptions as it relates to their smile (teeth, mouth) to assist in developing a standardized oral health program for eating disorder centers to implement into their daily curricula. A dental team member in an interdisciplinary eating disorder treatment team is important. Including an oral health education program improves patients' oral hygiene and oral health knowledge, as well as provides a supportive environment to empower the patients to take control of their overall oral health.

TRIAL REGISTRATION

This study was retrospectively registered on April 18, 2019 in ClinicalTrials.gov, Identifier: NCT03921632.

Studying Gastric Lipase Adsorption Onto Phospholipid Monolayers by Surface Tensiometry, Ellipsometry, and Atomic Force Microscopy

The access to kinetic parameters of lipolytic enzyme adsorption onto lipids is essential for a better understanding of the overall catalytic process carried out by these interfacial enzymes. Gastric lipase, for instance, shows an apparent optimum activity on triglycerides (TAG) at acidic pH, which is controlled by its pH-dependent adsorption at lipid-water interfaces. Since gastric lipase acts on TAG droplets covered by phospholipids, but does not hydrolyze these lipids, phospholipid monolayers spread at the air-water interfaces can be used as biomimetic interfaces to study lipase adsorption and penetration through the phospholipid layer, independently from the catalytic activity. The adsorption of recombinant dog gastric lipase (rDGL) onto 1,2-dilauroyl-sn-glycero-3-phosphocholine (DLPC) monolayers can be monitored by surface tensiometry at various enzyme concentrations, pHs, and surface pressures (Π). These experimental data and the use of Langmuir adsorption isotherm and Verger-de Haas' lipase kinetics models further allow estimating various parameters including the adsorption equilibrium constant (K_Ads), the interfacial concentration [Formula: see text] , the molar fraction [Formula: see text] (Φ_E*(%), mol%), and the molecular area [Formula: see text] of rDGL adsorbed onto the DLPC monolayer under various conditions. Additional insight into rDGL adsorption/insertion on phospholipid monolayers can be obtained by combining ellipsometry, Langmuir-Blodgett film transfer, and atomic force microscopy. When using multicomponent phospholipid monolayers with phase separation, these techniques allow to visualizing how rDGL preferentially partitions toward liquid expanded phase and at phase boundaries, gets adsorbed at various levels of insertion and impacts on the lateral organization of lipids.

Evidence-based practice and clinical work assessment

Despite the growing emphasis for evidence-based practice, there are barriers to adopting this paradigm. These include (1) the lack of consistent method to measure clinical work, (2) task orientation in current measurement methods, and (3) a lack of awareness among staff nurses about evidence-based practice. In addition, clinical unit cultures are perceived as barriers and often described as cultures of "habit and opinion." Three conceptual models are discussed as a method to assist clinicians in conducting an evidenced-based clinical work assessment to advance evidence-based practice.