Embracing cancer complexity: Hallmarks of systemic disease

The last 50 years have witnessed extraordinary developments in understanding mechanisms of carcinogenesis, synthesized as the hallmarks of cancer. Despite this logical framework, our understanding of the molecular basis of systemic manifestations and the underlying causes of cancer-related death remains incomplete. Looking forward, elucidating how tumors interact with distant organs and how multifaceted environmental and physiological parameters impinge on tumors and their hosts will be crucial for advances in preventing and more effectively treating human cancers. In this perspective, we discuss complexities of cancer as a systemic disease, including tumor initiation and promotion, tumor micro- and immune macro-environments, aging, metabolism and obesity, cancer cachexia, circadian rhythms, nervous system interactions, tumor-related thrombosis, and the microbiome. Model systems incorporating human genetic variation will be essential to decipher the mechanistic basis of these phenomena and unravel gene-environment interactions, providing a modern synthesis of molecular oncology that is primed to prevent cancers and improve patient quality of life and cancer outcomes.

Progression free survival of myeloma patients who become IFE-negative correlates with the detection of residual monoclonal free light chain (FLC) by mass spectrometry

Deeper responses are associated with improved survival in patients being treated for myeloma. However, the sensitivity of the current blood-based assays is limited. Historical studies suggested that normalisation of the serum free light chain (FLC) ratio in patients who were negative by immunofixation electrophoresis (IFE) was associated with improved outcomes. However, recently this has been called into question. Mass spectrometry (MS)-based FLC assessments may offer a superior methodology for the detection of monoclonal FLC due to greater sensitivity. To test this hypothesis, all available samples from patients who were IFE negative after treatment with carfilzomib and lenalidomide-based induction and autologous stem cell transplantation (ASCT) in the Myeloma XI trial underwent FLC-MS testing. FLC-MS response assessments from post-induction, day+100 post-ASCT and six months post-maintenance randomisation were compared to serum FLC assay results. Almost 40% of patients had discordant results and 28.7% of patients with a normal FLC ratio had residual monoclonal FLC detectable by FLC-MS. FLC-MS positivity was associated with reduced progression-free survival (PFS) but an abnormal FLC ratio was not. This study demonstrates that FLC-MS provides a superior methodology for the detection of residual monoclonal FLC with FLC-MS positivity identifying IFE-negative patients who are at higher risk of early progression.

Closed-loop optogenetic control of the dynamics of neural activity in non-human primates

Electrical neurostimulation is effective in the treatment of neurological disorders, but associated recording artefacts generally limit its applications to open-loop stimuli. Real-time and continuous closed-loop control of brain activity can, however, be achieved by pairing concurrent electrical recordings and optogenetics. Here we show that closed-loop optogenetic stimulation with excitatory opsins enables the precise manipulation of neural dynamics in brain slices from transgenic mice and in anaesthetized non-human primates. The approach generates oscillations in quiescent tissue, enhances or suppresses endogenous patterns in active tissue and modulates seizure-like bursts elicited by the convulsant 4-aminopyridine. A nonlinear model of the phase-dependent effects of optical stimulation reproduced the modulation of cycles of local-field potentials associated with seizure oscillations, as evidenced by the systematic changes in the variability and entropy of the phase-space trajectories of seizures, which correlated with changes in their duration and intensity. We also show that closed-loop optogenetic neurostimulation could be delivered using intracortical optrodes incorporating light-emitting diodes. Closed-loop optogenetic approaches may be translatable to therapeutic applications in humans.

[Effect of a multimodal pain management protocol and age on wound healing after thermal disbudding of female German Holstein calves]

INTRODUCTION

Hot-iron disbudding of calves is a stressful and painful procedure and leaves a burn wound. Pain management procedures and the effects of hot-iron disbudding on biochemical markers of pain perception and stress response have been widely investigated in recent years. The aim of this study was to investigate the potential effects of pain management and age of the calf on the healing of burn wounds caused by disbudding. 327 healthy female German Holstein calves were included in this randomised, triple-blinded, prospective study. Calves were either disbudded at the age of four to 10 or 15 to 28 days using a gas-powered hot iron. Each calf was randomly allocated to one of nine possible treatment groups (BG). All calves received either the active ingredients to be tested (xylazine hydrochloride with 0.2 or 0.05 mg / kg body mass (BM) intramuscular for sedation, procaine hydrochloride (2 %) each 8 ml locally on both sides subcutaneously (SC) to the cornual nerves, meloxicam with 0,5 mg / kg BM SC for anti-inflammatory purposes) or an identical amount of saline solution (placebo). Calves in the group `thermE` and `ScheinE` received only placebo. In group `ScheinE` disbudding was simulated and in `thermE` it was carried out. The calves were clinically monitored starting one day before and ending 28 days after the procedure and the burn wounds were assessed. Both the rectal temperature and parameters of wound healing changed significantly during the study period and had characteristic profiles over time. Wound healing was not influenced by the different analgesic protocols, indicating that a multimodal analgesia does not pose a risk for wound healing after thermal disbudding. There were no observed differences between the age groups. The results of this study show, that disbudding of young calves and a multimodal pain management protocol does not affect wound healing in calves.

[Cortisol concentrations in sheep before, during and after sham foot trimming on a tilt table - the suitability of different matrices]

INTRODUCTION

Matrices that can be collected non-invasively for quantification of a stress response in sheep have received little attention in the veterinary literature. This study examines the suitability of blood, tears and saliva for determining a stress response in sheep undergoing sham foot trimming on a tilt table. The cortisol concentration of blood, tears and saliva and the concentration of cortisol metabolites in faeces were measured in 13 healthy Meat Merino ewes once a day for six days. Sham foot trimming on a tilt table was used as the stressor and was done during a one-hour period on day 4; cortisol concentrations of blood and tears were measured at 0, 10, 20, 30, 40 and 60 minutes. Cortisol concentrations of blood (maximum at 30 minutes) and tears (maximum at 40 minutes) increased during the procedure and then decreased. There were significant correlations between cortisol concentrations of blood and tears (p = 0,04) during sham foot trimming (area under the curve, 0 to 60 minutes). Over the entire 6-day study period, significant correlations were seen between the cortisol concentrations of blood and tears (r = 0,55; p.

Lipödem heute: Zwischen konservativer Therapie, Liposuktion und Adipositaschirurgie

Die zunehmende Prävalenz des Lipödems geht einher mit einer demografischen Zunahme der Adipositas per magna.

Konservative und operative Maßnahmen ermöglichen eine ausgeprägte Befund- und Beschwerdebesserung.

Die exakte Diagnose und Differenzierung zwischen therapiebedürftiger Adipositas und therapiebedürftigem Lipödem entscheiden über Erfolg und Misserfolg der eingeleiteten Therapie.

Nach konservativem Therapieversuch kann die operative Versorgung bei Ausbleiben einer entsprechenden Besserung durch Liposuktion oder adipositaschirurgische Intervention bei einem erheblichen Teil der Betroffenen die konservative Therapie reduzieren bzw. teilweise sogar ganz überflüssig machen.

TCERG1L allelic variation is associated with cisplatin-induced hearing loss in childhood cancer, a PanCareLIFE study

In children with cancer, the heterogeneity in ototoxicity occurrence after similar treatment suggests a role for genetic susceptibility. Using a genome-wide association study (GWAS) approach, we identified a genetic variant in TCERG1L (rs893507) to be associated with hearing loss in 390 non-cranial irradiated, cisplatin-treated children with cancer. These results were replicated in two independent, similarly treated cohorts (n = 192 and 188, respectively) (combined cohort: P = 5.3 × 10-10, OR 3.11, 95% CI 2.2-4.5). Modulating TCERG1L expression in cultured human cells revealed significantly altered cellular responses to cisplatin-induced cytokine secretion and toxicity. These results contribute to insights into the genetic and pathophysiological basis of cisplatin-induced ototoxicity.

Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE)

STUDY QUESTION

Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors?

SUMMARY ANSWER

Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively.

WHAT IS KNOWN ALREADY

Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce.

STUDY DESIGN, SIZE, DURATION

The current case-control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites.

MAIN RESULTS AND THE ROLE OF CHANCE

A positive dose-effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score > 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9-3.6) P < 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively.

LIMITATIONS, REASONS FOR CAUTION

Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results.

WIDER IMPLICATIONS OF THE FINDINGS

We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired.

STUDY FUNDING/COMPETING INTEREST(S)

This study has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests.

TRIAL REGISTRATION NUMBER

n/a.

[Thermographic monitoring of skin surface temperature associated with hot-iron disbudding in calves]

INTRODUCTION

The goal of this study was to determine the skin surface temperatures of the head using thermography in 28 German Holstein heifer calves at the time of hot iron disbudding. Calves were divided into group 1 (hot-iron disbudding, n = 14) and 2 (sham disbudding, n = 14). Thermographic measurements were made at eight locations of the head (area surrounding both horn buds, both horn buds, muzzle, mucous membranes of the muzzle, both eyes) at nine time points (- 60 min (basal value), time of disbudding, 5, 30, 60, 90, 120, 240 and 480 min after disbudding) using a high-end thermographic camera (ThermoPro TP8, Firma DIAS Infrared GmbH). The rectal temperature was measured 60 min before and 5, 240 and 480 min after disbudding. The statistical software SAS version 9.4 was used for analysis. Skin surface temperatures and rectal temperature correlated at several locations (rp ≥ 0.45; p ≤ 0.05). The maximum temperature (approx. 67 ºC) was measured at the horn buds immediately after the hot-iron procedure. By five and 30 min after hot-iron disbudding, the temperature of the horn buds had decreased by up to 50%, whereas the temperatures at the other locations had increased significantly (p.

Prevalence of insulin as a first-line therapy and associated factors in people with type 2 diabetes in German primary care practices

AIM

To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first-line therapy and the factors associated with this.

METHODS

This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti-hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first-line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first-line therapy.

RESULTS

A total of 7.1% of participants received insulin as a first-line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81-4.06], age > 80 years (OR 2.35, 95% CI 1.20-4.61) compared with age ≤ 40 years, HbA_1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81-4.95) compared with HbA_1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29-2.81), peripheral artery disease (OR 1.94, 95% CI 1.30-2.81), neurological complications (OR 1.45, 95% CI 1.00-2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08-1.25) and higher number of different drugs prescribed within 12 months prior-the index date (OR 1.09, 95% CI 1.05-1.12) were significantly associated with the probability of receiving insulin as a first-line therapy.

CONCLUSION

Insulin is rarely used as a first-line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first-line therapy is significantly influenced by diabetologist practice, age, HbA_1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy.

[Thermographic examination of head surface temperatures of calves under field conditions]

INTRODUCTION

Thermographic examination of 157 German Holstein heifer calves was performed to investigate the feasibility of this technique for on-farm recording of surface temperature of the head and to examine potential factors that affect the recordings. Baseline values were obtained from six defined locations on the head including both eyes, both horn buds, the muzzle and the mucous membrane of the muzzle using a high-end thermographic camera (ThermoPro TP8, Firma DIAS Infrared GmbH). Evaluation of the influence of various factors on thermographic measurements showed that ambient temperature had the largest effect on surface temperature of the head (regression coefficient, 0.10 to 0.32, p ≤ 0.01) whereas humidity had no effect (in t-test p ≥ 0.33 over all locations). There was a no correlation between rectal temperature and surface temperature (rp ≤ 0.05). The surface temperature decreased with increasing age of the calves (regression coefficient, - 0.42 to - 0.14, p ≤ 0.01). The agreement between double readings made shortly after one another was excellent at all locations (r ≥ 0.95). The emission of infrared energy varied among different locations; the most infrared energy was emitted by the eyes and the least by the muzzle. Paired locations (eyes and horn buds) had symmetric emission patterns of infrared energy. Measuring the surface temperature of the head of calves in their normal barn environment using a standardised protocol was feasible and thus could potentially be used for monitoring calves under field conditions.

An ultra-high vacuum scanning tunneling microscope operating at sub-Kelvin temperatures and high magnetic fields for spin-resolved measurements

We present the construction and performance of an ultra-low-temperature scanning tunneling microscope (STM), working in ultra-high vacuum (UHV) conditions and in high magnetic fields up to 9 T. The cryogenic environment of the STM is generated by a single-shot ³He magnet cryostat in combination with a ⁴He dewar system. At a base temperature (300 mK), the cryostat has an operation time of approximately 80 h. The special design of the microscope allows the transfer of the STM head from the cryostat to a UHV chamber system, where samples and STM tips can be easily exchanged. The UHV chambers are equipped with specific surface science treatment tools for the functionalization of samples and tips, including high-temperature treatments and thin film deposition. This, in particular, enables spin-resolved tunneling measurements. We present test measurements using well-known samples and tips based on superconductors and metallic materials such as LiFeAs, Nb, Fe, and W. The measurements demonstrate the outstanding performance of the STM with high spatial and energy resolution as well as the spin-resolved capability.

Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network

During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drugs classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.Leukemia accepted article preview online, 18 December 2017. doi:10.1038/leu.2017.353.

Inhibitors of PEX14 disrupt protein import into glycosomes and kill Trypanosoma parasites

The parasitic protists of the Trypanosoma genus infect humans and domestic mammals, causing severe mortality and huge economic losses. The most threatening trypanosomiasis is Chagas disease, affecting up to 12 million people in the Americas. We report a way to selectively kill Trypanosoma by blocking glycosomal/peroxisomal import that depends on the PEX14-PEX5 protein-protein interaction. We developed small molecules that efficiently disrupt the PEX14-PEX5 interaction. This results in mislocalization of glycosomal enzymes, causing metabolic catastrophe, and it kills the parasite. High-resolution x-ray structures and nuclear magnetic resonance data enabled the efficient design of inhibitors with trypanocidal activities comparable to approved medications. These results identify PEX14 as an "Achilles' heel" of the Trypanosoma suitable for the development of new therapies against trypanosomiases and provide the structural basis for their development.

Excitation power dependent population pathways and absolute quantum yields of upconversion nanoparticles in different solvents

The rational design of brighter upconversion nanoparticles (UCNPs) requires a better understanding of the radiationless deactivation pathways in these materials. Here, we demonstrate the potential of excitation power density (P)-dependent studies of upconversion (UC) luminescence intensities, slope factors, and absolute quantum yields (Φ_UC) of popular β-NaYF₄:20% Yb³⁺,2% Er³⁺ UCNPs of different surface chemistries in organic solvents, D₂O, and water as a tool to gain deeper insight into the UC mechanism including population and deactivation pathways particularly of the red emission. Our measurements, covering a P regime of three orders of magnitude, reveal a strong difference of the P-dependence of the ratio of the green and red luminescence bands (I_g/r) in water and organic solvents and P-dependent population pathways of the different emissive energy levels of Er³⁺. In summary, we provide experimental evidence for three photon processes in UCNPs, particularly for the red emission. Moreover, we demonstrate changes in the excited population dynamics via bi- and triphotonic processes dependent on the environment, surface chemistry, and P, and validate our findings theoretically.

Mesenchymal Stem Cells Acquire Characteristics of Cells in the Periodontal Ligament in vitro

Mesenchymal stem cells differentiate into multiple types of cells derived from mesenchyme. Periodontal ligament cells are primarily derived from mesenchyme; thus, we expected mesenchymal stem cells to differentiate into periodontal ligament. Using a combination of immunohistochemistry and in situ hybridization on co-cultures of mesenchymal stem cells and periodontal ligament, we observed a significant increase in mesenchymal stem cells’ expression of osteocalcin and osteopontin and a significant decrease in expression of bone sialoprotein, characteristics of periodontal ligament in vivo. Increased osteopontin and osteocalcin and decreased bone sialoprotein expression was detected within 7 days and maintained through 21 days of co-culture. We conclude that contact or factors from periodontal ligament induced mesenchymal stem cells to obtain periodontal-ligament-like characteristics. Importantly, analysis of the data suggests the feasibility of utilizing mesenchymal stem cells in clinical applications for repairing and/or regenerating periodontal tissue.

[Secondary plastic and reconstructive measures following deep-dermal burn injuries : Negligent use of bioethanol]

One representative case of burns caused by the negligent use of bioethanol, which was treated at our burns centre is used to illustrate the severity and depth of the burn injuries as well as the complexity of the further long-term course of treatment including complex secondary-reconstructive techniques.

Genetic factors influencing the risk of multiple myeloma bone disease

A major complication of multiple myeloma (MM) is the development of osteolytic lesions, fractures and bone pain. To identify genetic variants influencing the development of MM bone disease (MBD), we analyzed MM patients of European ancestry (totaling 3774), which had been radiologically surveyed for MBD. Each patient had been genotyped for ~6 00 000 single-nucleotide polymorphisms with genotypes for six million common variants imputed using 1000 Genomes Project and UK10K as reference. We identified a locus at 8q24.12 for MBD (rs4407910, OPG/TNFRSF11B, odds ratio=1.38, P=4.09 × 10(-9)) and a promising association at 19q13.43 (rs74676832, odds ratio=1.97, P=9.33 × 10(-7)). Our findings demonstrate that germline variation influences MBD and highlights the importance of RANK/RANKL/OPG pathway in MBD development. These findings will contribute to the development of future strategies for prevention of MBD in the early precancerous phases of MM.

Comprehensive antibiotic susceptibility profiling of Chilean Piscirickettsia salmonis field isolates

Antibiotics have been extensively used against infections produced by Piscirickettsia salmonis, a fish pathogen and causative agent of piscirickettsiosis and one of the major concerns for the Chilean salmon industry. Therefore, the emergence of resistant phenotypes is to be expected. With the aim of obtaining a landscape of the antimicrobial resistance of P. salmonis in Chile, the susceptibility profiles for quinolones, florfenicol and oxytetracycline (OTC) of 292 field isolates derived from main rearing areas, different hosts and collected over 5 years were assessed. The results allowed for the determination of epidemiological cut-off values that were used to characterize the pathogen population. This work represents the first large-scale field study addressing the antimicrobial susceptibility of P. salmonis, providing evidence of the existence of resistant types with a high incidence of resistance to quinolones. Remarkably, despite the amounts and frequency of therapies, our results disclosed that the issue of resistance to florfenicol and OTC is still in the onset.

Test of Electric Charge Conservation with Borexino

Borexino is a liquid scintillation detector located deep underground at the Laboratori Nazionali del Gran Sasso (LNGS, Italy). Thanks to the unmatched radio purity of the scintillator, and to the well understood detector response at low energy, a new limit on the stability of the electron for decay into a neutrino and a single monoenergetic photon was obtained. This new bound, τ≥6.6×10^{28}  yr at 90% C.L., is 2 orders of magnitude better than the previous limit.