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Lima EABF, Song PN, Reeves K, Larimer B, Sorace AG, Yankeelov TE. Predicting response to combination evofosfamide and immunotherapy under hypoxic conditions in murine models of colon cancer. Math Biosci Eng 2023; 20:17625-17645. [PMID: 38052529 PMCID: PMC10703000 DOI: 10.3934/mbe.2023783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
The goal of this study is to develop a mathematical model that captures the interaction between evofosfamide, immunotherapy, and the hypoxic landscape of the tumor in the treatment of tumors. Recently, we showed that evofosfamide, a hypoxia-activated prodrug, can synergistically improve treatment outcomes when combined with immunotherapy, while evofosfamide alone showed no effects in an in vivo syngeneic model of colorectal cancer. However, the mechanisms behind the interaction between the tumor microenvironment in the context of oxygenation (hypoxic, normoxic), immunotherapy, and tumor cells are not fully understood. To begin to understand this issue, we develop a system of ordinary differential equations to simulate the growth and decline of tumors and their vascularization (oxygenation) in response to treatment with evofosfamide and immunotherapy (6 combinations of scenarios). The model is calibrated to data from in vivo experiments on mice implanted with colon adenocarcinoma cells and longitudinally imaged with [18F]-fluoromisonidazole ([18F]FMISO) positron emission tomography (PET) to quantify hypoxia. The results show that evofosfamide is able to rescue the immune response and sensitize hypoxic tumors to immunotherapy. In the hypoxic scenario, evofosfamide reduces tumor burden by $ 45.07 \pm 2.55 $%, compared to immunotherapy alone, as measured by tumor volume. The model accurately predicts the temporal evolution of five different treatment scenarios, including control, hypoxic tumors that received immunotherapy, normoxic tumors that received immunotherapy, evofosfamide alone, and hypoxic tumors that received combination immunotherapy and evofosfamide. The average concordance correlation coefficient (CCC) between predicted and observed tumor volume is $ 0.86 \pm 0.05 $. Interestingly, the model values to fit those five treatment arms was unable to accurately predict the response of normoxic tumors to combination evofosfamide and immunotherapy (CCC = $ -0.064 \pm 0.003 $). However, guided by the sensitivity analysis to rank the most influential parameters on the tumor volume, we found that increasing the tumor death rate due to immunotherapy by a factor of $ 18.6 \pm 9.3 $ increases CCC of $ 0.981 \pm 0.001 $. To the best of our knowledge, this is the first study to mathematically predict and describe the increased efficacy of immunotherapy following evofosfamide.
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Affiliation(s)
- Ernesto A. B. F. Lima
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Austin, TX 78712, USA
- Texas Advanced Computing Center, The University of Texas at Austin, 10100 Burnet Rd (R8700), Austin, TX 78758, USA
| | - Patrick N. Song
- Department of Radiology, The University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA
- Graduate Biomedical Sciences, The University of Alabama at Birmingham, 1075 13th St S, Birmingham, AL 35294, USA
| | - Kirsten Reeves
- Department of Radiology, The University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA
- Graduate Biomedical Sciences, The University of Alabama at Birmingham, 1075 13th St S, Birmingham, AL 35294, USA
| | - Benjamin Larimer
- Department of Radiology, The University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA
- O’Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, 1824 6th Ave S, Birmingham, AL 35233, USA
| | - Anna G. Sorace
- Department of Radiology, The University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA
- O’Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, 1824 6th Ave S, Birmingham, AL 35233, USA
- Department of Biomedical Engineering, The University of Alabama at Birmingham, 1075 13th St S, Birmingham, AL 35294, USA
| | - Thomas E. Yankeelov
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Austin, TX 78712, USA
- Department of Biomedical Engineering, The University of Texas at Austin, 1107 W. Dean Keeton St, Austin, TX 78712, USA
- Department of Diagnostic Medicine, The University of Texas at Austin, 1601 Trinity St Bldg B, Austin, TX 78712, USA
- Department of Oncology, The University of Texas at Austin, 1601 Trinity St Bldg B, Austin, TX 78712, USA
- Livestrong Cancer Institutes, Dell Medical School, The University of Texas at Austin, 623 W. 38th St Ste 300, Austin, TX 78705, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St Unit 1472, Houston, TX 77030, USA
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Lemaître F, Costalat G, Allinger J, Balestra C. Possible causes of narcosis-like symptoms in freedivers. Undersea Hyperb Med 2023; 50:85-93. [PMID: 37302073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
During deep-sea freediving, many freedivers describe symptoms fairly similar to what has been related to inert gas narcosis in scuba divers. This manuscript aims to present the potential mechanisms underlying these symptoms. First, known mechanisms of narcosis are summarized while scuba diving. Then, potential underlying mechanisms involving the toxicity of gases (nitrogen, carbon dioxide and oxygen) are presented in freedivers. As the symptoms are felt during ascent, nitrogen is likely not the only gas involved. Since freedivers are frequently exposed to hypercapnic hypoxia toward the end of the dive, it is proposed that carbon dioxide and oxygen gases both play a major role. Finally, a new "hemodynamic hypothesis" based on the diving reflex is proposed in freedivers. The underlying mechanisms are undoubtedly multifactorial and therefore require further research and a new descriptive name. We propose a new term for these types of symptoms: freediving transient cognitive impairment.
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Affiliation(s)
- Frédéric Lemaître
- CETAPS EA 3832, Faculty of Sport Sciences, University of Rouen, France
- CRIOBE UAR 3278, CNRS-EPHE-UPVD, Mooréa, Polynésie Française (French Polynesia)
| | - Guillaume Costalat
- APERE Laboratory EA 3300, Faculty of Sport Sciences, University of Picardie Jules Verne, France
| | - Jérémie Allinger
- CETAPS EA 3832, Faculty of Sport Sciences, University of Rouen, France
| | - Costantino Balestra
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium
- Anatomical Research and Clinical Studies, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium
- DAN Europe Research Division (Roseto-Brussels), 1160 Brussels, Belgium
- Motor Sciences Department, Physical Activity Teaching Unit, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
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Yilmaz D, Tuzer M, Unlu MB. Assessing the therapeutic response of tumors to hypoxia-targeted prodrugs with an in silico approach. Math Biosci Eng 2022; 19:10941-10962. [PMID: 36124576 DOI: 10.3934/mbe.2022511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tumor hypoxia is commonly recognized as a condition stimulating the progress of the aggressive phenotype of tumor cells. Hypoxic tumor cells inhibit the delivery of cytotoxic drugs, causing hypoxic areas to receive insufficient amounts of anticancer agents, which results in adverse treatment responses. Being such an obstruction to conventional therapies for cancer, hypoxia might be considered a target to facilitate the efficacy of treatments in the resistive environment of tumor sites. In this regard, benefiting from prodrugs that selectively target hypoxic regions remains an effective approach. Additionally, combining hypoxia-activated prodrugs (HAPs) with conventional chemotherapeutic drugs has been used as a promising strategy to eradicate hypoxic cells. However, determining the appropriate sequencing and scheduling of the combination therapy is also of great importance in obtaining favorable results in anticancer therapy. Here, benefiting from a modeling approach, we study the efficacy of HAPs in combination with chemotherapeutic drugs on tumor growth and the treatment response. Different treatment schedules have been investigated to see the importance of determining the optimal schedule in combination therapy. The effectiveness of HAPs in varying hypoxic conditions has also been explored in the study. The model provides qualitative conclusions about the treatment response, as the maximal benefit is obtained from combination therapy with greater cell death for highly hypoxic tumors. It has also been observed that the antitumor effects of HAPs show a hypoxia-dependent profile.
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Affiliation(s)
- Defne Yilmaz
- Department of Physics, Bogazici University, Istanbul 34342, Turkey
- Center for Life Sciences and Technologies, Bogazici University, Istanbul 34342, Turkey
| | - Mert Tuzer
- Department of Physics, Bogazici University, Istanbul 34342, Turkey
- Center for Life Sciences and Technologies, Bogazici University, Istanbul 34342, Turkey
| | - Mehmet Burcin Unlu
- Department of Physics, Bogazici University, Istanbul 34342, Turkey
- Center for Life Sciences and Technologies, Bogazici University, Istanbul 34342, Turkey
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 060-8648, Japan
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Shi Y, Huang X, Du Z, Tan J. Analysis of single-cell RNA-sequencing data identifies a hypoxic tumor subpopulation associated with poor prognosis in triple-negative breast cancer. Math Biosci Eng 2022; 19:5793-5812. [PMID: 35603379 DOI: 10.3934/mbe.2022271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Triple-negative breast cancer (TNBC) is an aggressive subtype of mammary carcinoma characterized by low expression levels of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Along with the rapid development of the single-cell RNA-sequencing (scRNA-seq) technology, the heterogeneity within the tumor microenvironment (TME) could be studied at a higher resolution level, facilitating an exploration of the mechanisms leading to poor prognosis during tumor progression. In previous studies, hypoxia was considered as an intrinsic characteristic of TME in solid tumors, which would activate downstream signaling pathways associated with angiogenesis and metastasis. Moreover, hypoxia-related genes (HRGs) based risk score models demonstrated nice performance in predicting the prognosis of TNBC patients. However, it is essential to further investigate the heterogeneity within hypoxic TME, such as intercellular communications. In the present study, utilizing single-sample Gene Set Enrichment Analysis (ssGSEA) and cell-cell communication analysis on the scRNA-seq data retrieved from Gene Expression Omnibus (GEO) database with accession number GSM4476488, we identified four tumor subpopulations with diverse functions, particularly a hypoxia-related one. Furthermore, results of cell-cell communication analysis revealed the dominant role of the hypoxic tumor subpopulation in angiogenesis- and metastasis-related signaling pathways as a signal sender. Consequently, regard the TNBC cohorts acquired from The Cancer Genome Atlas (TCGA) and GEO as train set and test set respectively, we constructed a risk score model with reliable capacity for the prediction of overall survival (OS), where ARTN and L1CAM were identified as risk factors promoting angiogenesis and metastasis of tumors. The expression of ARTN and L1CAM were further analyzed through tumor immune estimation resource (TIMER) platform. In conclusion, these two marker genes of the hypoxic tumor subpopulation played vital roles in tumor development, indicating poor prognosis in TNBC patients.
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Affiliation(s)
- Yi Shi
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Xiaoqian Huang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Zhaolan Du
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Jianjun Tan
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
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Lindholm P, Lund H, Blogg L, Gennser M. Profound hypercapnia but only moderate hypoxia found during underwater rugby play. Undersea Hyperb Med 2022; 49:367-372. [PMID: 36001569 DOI: 10.22462/05.06.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Underwater rugby is a team sport where players try to score points with a negatively buoyant ball while submerged in a swimming pool. Reports of syncope incidents at the Swedish Championships led to us to investigate end-tidal oxygen and carbon dioxide levels during simulated match play. METHODS Eight male underwater rugby club players of varying experience participated. Repetitive measurements were made while players were defending during simulated match play. Each time a player surfaced they exhaled through a mouthpiece connected to a flow meter and a gas analyzer to measure tidal volume, PETO2 and PETCO2. RESULTS Measurements were made over 12 dives, with an average dive duration of 18.5 seconds. The mean maximal PETCO2 across the eight participants was 10.0 kPa (~75 mmHg) (range, 9.1-11.7 [~68-88]). The corresponding mean minimum PETO2 was 7.6 kPa (~57 mmHg) (6.3-10.4 [~47-78)). PETCO2 drifted upward, with the mean upward change from the first to last dive for each participant being +1.8 (~13.5 mmHg) (SD 1.74) kPa. A similar trend for PETO2 was not detected, with a mean change of -0.1 (~0.75 mmHg) (SD 3.79) kPa. CONCLUSION Despite high PETCO2 values that were close to narcotic being recorded, these players seemed to regulate their urge to breathe based on hypoxia rather than hypercapnia.
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Affiliation(s)
- Peter Lindholm
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, California, US
| | - Henrik Lund
- Anestesikliniken, Sunderby Sjukhus, 971 80 Luleå, Sweden
| | - Lesley Blogg
- SLB Consulting, Home Park Barn, Kirkby Stephen, Cumbria, UK
| | - Mikael Gennser
- Swedish Aerospace Physiology Centre, Division of Environmental Physiology, Department of Biomedical Engineering and Health Systems; School of Engineering Sciences in Chemistry, Biotechnology and Health, Royal Institute of Technology, KTH, Stockholm, Sweden
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Strauss MB. The role of hyperbaric oxygen for acute traumatic ischemias. Undersea Hyperb Med 2022; 49:233-248. [PMID: 35580490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute traumatic ischemias are an array of disorders that range from crush injuries to compartment syndromes, from burns to frostbite and from threatened flaps to compromised reimplantations. Two unifying components common to these conditions are a history of trauma be it physical, thermal, or surgical coupled with ischemia to the traumatized tissues. Their pathophysiology resolves around the self-perpetuating cycle of edema and ischemia, and their severity represents a spectrum from mild, almost non-existent, to tissue death. Since ischemia is a fundamental component of the traumatic ischemias and hypoxia is a consequence of ischemia, hyperbaric oxygen is a logical intervention for those conditions where tissue survival, infection control and healing is at risk. Unfortunately, even with mechanisms of hyperbaric oxygen that strongly support its usefulness in traumatic ischemias coupled with supportive clinical data, clinicians are disinclined to utilize it for these conditions. This focuses on the orthopedic aspects of the traumatic ischemias, namely crush injury and compartment syndrome, and show how hyperbaric oxygen treatments can mitigate their severity.
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Affiliation(s)
- Michael B Strauss
- Memorial Care Long Beach Memorial Medical Center, Long Beach, California U.S
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Farrell J, Natoli MJ, Brown GJ, Yook A, Lance RM. Testing of full face snorkel masks to examine recreational snorkeler deaths. Undersea Hyperb Med 2022; 49:29-42. [PMID: 35226974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A recent rise in snorkeling-related deaths in Hawaii has inspired several bans on full face snorkel masks (FFSMs). However, while there are theories to explain the deaths, little physiological data exists about the way the FFSMs provide gas to an exercising subject. To evaluate the safety of the FFSM concept, this study was designed to test how use of a full face snorkel mask (FFSM) may be physiologically different than use of a conventional snorkel, and to assess if any of those differences could lead to increased risk for the snorkeler. Ten (10) volunteer human subjects were tested using a variety of commercially available FFSMs, with real-time monitoring of blood oxygen saturation (SpO2), inspired airway pressure, and inspired and expired levels of carbon dioxide and oxygen. Two of the three FFSM design types were shown not to function as advertised, but none of the masks provided physiologically problematic gas supplies to the snorkelers. While this testing yielded no conclusive "smoking gun" to explain the snorkeler deaths, some of the mask models showed patterns of increasing breathing resistance with water intrusion because of a shared design characteristic, and this increased resistance could potentially create elevated levels of respiratory distress to snorkelers during real-world use.
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Affiliation(s)
- Jane Farrell
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, NC U.S
| | - Michael J Natoli
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, NC U.S
| | - Gregory J Brown
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, NC U.S
| | - Adam Yook
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC U.S
- Office of Information Technology, Duke University, Durham, NC U.S
| | - Rachel M Lance
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, NC U.S
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Zhang Y, Yang J, Li J. Clinical application of hyperbaric oxygen therapy in China: A 2020 baseline survey. Undersea Hyperb Med 2022; 49:179-190. [PMID: 35580485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This is the first nationwide survey to obtain baseline information on the clinical application of hyperbaric oxygen (HBO2) therapy in China. The findings provide a reference for future management and policy formulation research. METHODS This questionnaire-based survey was implemented using an online survey tool. The survey assessed six aspects related to HBO2 practice: characteristics of institutions, departments/units, chambers, practitioners, treatment capacity, and scientific research. RESULTS Subjects were 1,924 institutions (2,699 HBO2 chambers and 11,266 practitioners) from 31 provinces, municipalities, and autonomous regions in mainland China. The findings showed that most institutions (86.9%) were public hospitals and 70.0% of chambers were air pressurized. The numbers of newly built HBO2 departments/units and chambers have gradually increased over the last five decades. We found that 70.8% of HBO2 departments/units were independent, most non-independent HBO2 units were affiliated to rehabilitation departments, and 88.1% of institutions had 24-hour emergency treatment capacity. Most institutions (44.5%) had 1,001 to 5,000 annual therapy sessions. In 2019, three conditions most frequently treated across the institutions were cerebrovascular diseases, carbon monoxide poisoning, and central nervous system injury. We identified the following shortcomings: shortage of doctors and (particularly) technicians; imbalances in emergency capacity, treatment facilities, and staff composition among institutions of different classifications; and little high-quality scientific research. CONCLUSION Chinese HBO2 therapy is flourishing. With the growth in emergency capacity, Chinese HBO2 and rehabilitation medicine are developing in a coordinated way. However, several shortcomings require addressing in future work.
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Affiliation(s)
- Yi Zhang
- Hyperbaric Oxygen Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Yang
- Hyperbaric Oxygen Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinsheng Li
- Teaching Office, Aeronautical Hygiene,Aeronautical Medical Department, Fourth Military Medical University, Xian,China
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Tan L, Cheng D, Wen J, Huang K, Zhang Q. Identification of prognostic hypoxia-related genes signature on the tumor microenvironment in esophageal cancer. Math Biosci Eng 2021; 18:7743-7758. [PMID: 34814273 DOI: 10.3934/mbe.2021384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hypoxia is a crucial factor in the development of esophageal cancer. The relationship between hypoxia and immune status in the esophageal cancer microenvironment is becoming increasingly important in clinical practice. This study aims to clarify and investigate the possible connection between immunotherapy and hypoxia in esophageal cancer. METHODS The Cancer Genome Atlas databases are used to find two types of esophageal cancer cases. Cox regressions analyses are used to screen genes for hypoxia-related traits. After that, the genetic signature is validated by survival analysis and the construction of ROC curves. GSEA is used to compare differences in enrichment in the two groups and is followed by the CIBERSORT tool to investigate a potentially relevant correlation between immune cells and gene signatures. RESULTS We found that the esophageal adenocarcinoma hypoxia model contains 3 genes (PGK1, PGM1, SLC2A3), and the esophageal squamous cell carcinoma hypoxia model contains 2 genes (EGFR, ATF3). The findings demonstrated that the survival rate of patients in the high-risk group is lower than in the lower-risk group. Furthermore, we find that three kinds of immune cells (memory activated CD4+ T cells, activated mast cells, and M2 macrophages) have a marked infiltration in the tissues of patients in the high-risk group. Moreover, we find that PD-L1 and CD244 are highly expressed in high-risk groups. CONCLUSIONS Our data demonstrate that oxygen deprivation is correlated with prognosis and the incidence of immune cell infiltration in patients with both types of esophageal cancer, which provides an immunological perspective for the development of personalized therapy.
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Affiliation(s)
- Linlin Tan
- The Affiliated People's Hospital of Ningbo University, Cardiothoracic Surgery Department, Ningbo, Zhejiang, China
| | - Dingzhuo Cheng
- Ningbo NO6. Hospital, Neurosurgery Department, Ningbo, Zhejiang, China
| | - Jianbo Wen
- The Affiliated People's Hospital of Ningbo University, Cardiothoracic Surgery Department, Ningbo, Zhejiang, China
| | - Kefeng Huang
- The Affiliated People's Hospital of Ningbo University, Cardiothoracic Surgery Department, Ningbo, Zhejiang, China
| | - Qin Zhang
- The Affiliated People's Hospital of Ningbo University, Cardiothoracic Surgery Department, Ningbo, Zhejiang, China
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Biloborodova T, Scislo L, Skarga-Bandurova I, Sachenko A, Molgad A, Povoroznjuk O, Yevsieiva Y. Fetal ECG signal processing and identification of hypoxic pregnancy conditions in-utero. Math Biosci Eng 2021; 18:4919-4942. [PMID: 34198472 DOI: 10.3934/mbe.2021250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The fetal heart rate (fHR) variability and fetal electrocardiogram (fECG) are considered the most important sources of information about fetal wellbeing. Non-invasive fetal monitoring and analysis of fECG are paramount for clinical trials. They enable examining the fetal health status and detecting the heart rate changes associated with insufficient oxygenation to cut the likelihood of hypoxic fetal injury. Despite the fact that significant advances have been achieved in electrocardiography and adult ECG signal processing, the analysis of fECG is still in its infancy. Due to accurate fetal morphology extraction techniques have not been properly developed, many areas require particular attention on the way of fully understanding the changes in variability in the fetus and implementation of the non-invasive techniques suitable for remote home care which is increasingly in demand for high-risk pregnancy monitoring. In this paper, we introduce an integrated approach for fECG signal extraction and processing based on various methods for fetal welfare investigation and hypoxia risk estimation. To the best of our knowledge, this is the first attempt to introduce the auto-generated risk scoring in fECG to achieve early warning on fetus' safety and provide the physician with additional information about the possible fetal complications. The proposed method includes the following stages: fECG extraction, fHR and fetal heart rate variability (fHRV) calculation, hypoxia index (HI) evaluation and risk estimation. The extracted signals were examined by assessing Signal to Noise Ratio (SNR) and mean square error (MSE) values. The results obtained demonstrated great potential, but more profound research and validation, as well as a consistent clinical study, are needed before implementation into the hospital and at-home monitoring.
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Affiliation(s)
- Tetiana Biloborodova
- Department of Computer Science and Engineering, Volodymyr Dahl East Ukrainian National University, 43 Donetska Street, Severodonetsk 93400, Ukraine
| | - Lukasz Scislo
- Faculty of Electrical and Computer Engineering, Cracow University of Technology, Warszawska 24 Street, Cracow 31155, Poland
| | - Inna Skarga-Bandurova
- School of Engineering, Computing and Mathematics, Oxford Brookes University, Wheatley Campus, Oxford, OX33 1HX, UK
| | - Anatoliy Sachenko
- Department of Informatics, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom 26600, Poland
- Research Institute for Intelligent Computer Systems, West Ukrainian National University, Ternopil 46009, Ukraine
| | - Agnieszka Molgad
- Department of Informatics, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom 26600, Poland
| | - Oksana Povoroznjuk
- Department of Computer Engineering and Programming, National Technical University "Kharkiv Polytechnic Institute," 2 Kyrpychova Street, Kharkiv 61002, Ukraine
| | - Yelyzaveta Yevsieiva
- School of Medicine, V. N. Karazin Kharkiv National University, 4 Svobody Square, Kharkiv 61002, Ukraine
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Wheelock CE, Hess HW, Stooks J, Schwob J, Johnson BD, Schlader ZJ, Clemency BM, St James E, Hostler D. Respiratory muscle training and exercise ventilation while diving at altitude. Undersea Hyperb Med 2021; 48:107-117. [PMID: 33975401 DOI: 10.22462/03.04.2021.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Pre-dive altitude exposure may increase respiratory fatigue and subsequently augment exercise ventilation at depth. This study examined pre-dive altitude exposure and the efficacy of resistance respiratory muscle training (RMT) on respiratory fatigue while diving at altitude. METHODS Ten men (26±5 years; VO2peak: 39.8±3.3 mL• kg-1•min-1) performed three dives; one control (ground level) and two simulated altitude dives (3,658 m) to 17 msw, relative to ground level, before and after four weeks of resistance RMT. Subjects performed pulmonary function testing (e.g., inspiratory [PI] and expiratory [PE] pressure testing) pre- and post-RMT and during dive visits. During each dive, subjects exercised for 18 minutes at 55% VO2peak, and ventilation (VE), breathing frequency (ƒb,), tidal volume (VT) and rating of perceived exertion (RPE) were measured. RESULTS Pre-dive altitude exposure reduced PI before diving (p=0.03), but had no effect on exercise VE, ƒb, or VT at depth. At the end of the dive in the pre-RMT condition, RPE was lower (p=0.01) compared to control. RMT increased PI and PE (p<0.01). PE was reduced from baseline after diving at altitude (p<0.03) and this was abated after RMT. RMT did not improve VE or VT at depth, but decreased ƒb (p=0.01) and RPE (p=0.048) during the final minutes of exercise. CONCLUSION Acute altitude exposure pre- and post-dive induces decrements in PI and PE before and after diving, but does not seem to influence ventilation at depth. RMT reduced ƒb and RPE during exercise at depth, and may be useful to reduce work of breathing and respiratory fatigue during dives at altitude.
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Affiliation(s)
- Courtney E Wheelock
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Hayden W Hess
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Jocelyn Stooks
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Jacqueline Schwob
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Brian M Clemency
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - EriKa St James
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
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UHMS Position Statement: Hyperbaric Oxygen (HBO2) for COVID-19 Patients. Undersea Hyperb Med 2020; 47:297-8. [PMID: 32574446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There have been numerous recent inquiries regarding use of hyperbaric oxygen (HBO2) for patients with COVID-19. Questions have been raised pertinent to two possible mechanisms for HBO2 in this clinical context. The UHMS Hyperbaric Oxygen Therapy Committee, UHMS Executive Committee, with collaborative input from multiple senior UHMS members and researchers have drafted this position statement.
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Abstract
Simulated flight in a hypobaric chamber is a fundamental component in the physiological training of aviators. Although rare, there is always a risk of decompression sickness (DCS) in trainees during hypobaric hypoxia training. In this study we aimed to determine the incidence of altitude-induced DCS and the symptoms manifested in trainees and inside chamber observers (ICOs) during the training sessions. We retrospectively reviewed the records of DCS cases during the period of January 1, 2011, and October 1, 2018. The records of 6,657 trainees and 615 ICOs were evaluated. The gender distribution in 6,657 trainees was 6,578 (98.81%) male and 79 (1.19%) female. The numbers of DCS cases in trainees and ICOs were six (0.09%) and two (0.33%), respectively [(ICOs versus trainees - odds ratio (OR): 3.574; 95% CI 0.720-17.744; (p > 0.05)]. All ICOs were male; no DCS incident was observed among female trainees. Recompression treatments were applied on site, and complete recovery was achieved in all cases. Overall DCS incidence was found to be 0.11% among the 7,193 male subjects, which included trainees and ICOs. The higher incidence of DCS in ICOs was attributed to the physical activities performed at altitudes by ICOs. In such training, established instructions have to be strictly followed by physicians, ICOs and trainees. All trainees and ICOs should be aware of the symptoms and signs of DCS, and medical support including a recompression facility, should be provided on site during hypobaric hypoxia training.
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Affiliation(s)
- Erdinc Ercan
- Department of Aerospace Medicine, Faculty of Medicine, Health Science University Turkey, Eskisehir, Turkey
| | - A Engin Demir
- Department of Aerospace Medicine, Faculty of Medicine, Health Science University Turkey, Eskisehir, Turkey
| | - Eda Sabaner
- Department of Aerospace Medicine, Faculty of Medicine, Health Science University Turkey, Eskisehir, Turkey
| | - Akin Savas Toklu
- Department of Underwater and Hyperbaric Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Saturska H, Shulhai А, Levchuk R, Potikha N, Usynskyi R. Medical and social issues of cardiovascular diseases and their solution based on the experimental study of myocardial fibrosis. Wiad Lek 2019; 72:35-39. [PMID: 30796859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Introduction: The prevalence and incidence of cardiovascular diseases have been attracting considerable attention in recent decades. This is partly due to the fact that myocardial fibrosis is the major consequence of the most nosological units of cardiovascular diseases. We believe that early pathogenic therapy of myocardial fibrosis should be taken into consideration as a solution to this issue. The change of the connective tissue metabolism in myocardium is the central chain in pathogenesis of diffuse ischemic necrotic cardiosclerosis (DINC) occurs after repeated epinephrine injury of myocardial tissues. The aim: The present study establishes that use of metabolic therapy by trimetazidine (TM) has a protective effect on myocardium repeatedly damaged by epinephrine in hight concentration during the development of DINC in rats with different resistance to hypoxia. PATIENTS AND METHODS Materials and methods: Using the method of hypobaric hypoxia, male albino rats were divided into three groups due to their different resistance to hypoxia. Each group was divided into four equal subgroups: control group, DINC group (2 times repeated injections of epinephrine hydrotartrate (0,5 mg/kg body weight) and calcium gluconate (5 mg/ kg body weight), control group introdused with trimetazidine dihydrochloride (10 mg/kg body weight), DINC treated with TM group (2 times repeated injections of epinephrine hydrotartrate (0,5 mg/kg body weight) and calcium gluconate (5 mg/kg body weight) group introduced with TM (10 mg/kg body weight) for all period of observation. The concentration of protein-bound oxyproline in homogenate of myocardium was determined at 7, 14 and 30 days after the modelling pathology and the histological examination of Masson trichrome staining of myocardium was performed. RESULTS Results: Experimental modeling of DINC increased the concentration of protein-bound oxyproline in homogenate of myocardium at 7, 14 and 30 days after the modelling pathology, as well as accompanied by metabolic imbalances in diffuse connective tissue elements, which are rich in collagens. Experimental modeling of DINC+TM increased the concentration of protein-bound oxyproline in blood serum significantly less intensive. CONCLUSION Conclusions: The intensity of metabolic imbalances in diffuse connective tissue elements of myocardium is the highest in the low resistant animals to hypoxia. Those results are confirmed by histological examination of the myocardium of rats with different resistance to hypoxia. Fibrotic regions in myocardium are rich in collagens. It has been revealed that the most pronounced therapeutic effect of TM is observed in animals with low resistance to hypoxia, slightly less - in animals with medium resistance to hypoxia, and the lowest - in animals with high resistance to hypoxia.
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Affiliation(s)
- Hanna Saturska
- I. YA. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - Аrkadii Shulhai
- I. YA. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - Rostyslav Levchuk
- I. YA. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - Nataliya Potikha
- I. YA. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
| | - Ruslan Usynskyi
- I. YA. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine
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Di Pumpo F, Ruffino G, Malacarne P. Pulse oximeter to detect peripheral oxygen saturation in underwater rebreather ECCR diver: a preliminary study. Undersea Hyperb Med 2019; 46:1-6. [PMID: 31154680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hypoxia is one of the main problems an underwater diver may have to face. The probability of experiencing hypoxia is related to the type of dive and the equipment used. Hypoxia in diving is a potentially fatal event for the diver, as it can lead to the loss of brain functions and consequently to the loss of breathing control, all in the absence of specific premonitory symptoms. It is a risk that may be encountered more frequently by divers who use a closed-circuit rebreather (CCR). For those who use this type of equipment, hypoxia is usually the most frequent cause of death [1]. Our study was aimed at the detection of peripheral oxygen saturation in order to identify, in the future, a preclinical hypoxic condition. We combined the use of pulse oximetry with two forehead sensors on an underwater diver subject who was using an electronic closed-circuit rebreather (ECCR). Despite the known limits of this method and the preliminary status of these findings [2], the recorded data show a clear validity in the use of pulse oximetry in immersion for the detection of peripheral oxygen saturation. In the future, the pulse oximeter could become part of the instrumentation of the diver who uses CCR gear. The device could easily be implemented in these rebreathers. The possibility of being able to perform a basic instrumental analysis means that the diver can become more quickly aware of imminent hypoxia, characterized by the absence of clearly identifiable warning symptoms, and can put in place all the correct procedures for an emergency ascent, avoiding serious consequences.
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Affiliation(s)
- Fabio Di Pumpo
- Italian Navy Medical Service Naval Academy, Livorno, Italy
| | - Giovanni Ruffino
- Italian Navy Medical Service COMSUBIN Varignano, Le Grazie, La Spezia, Italy
| | - Paolo Malacarne
- Unit of Anesthesia and Resuscitation, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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RodrÍguez-Zamora L, Engan HK, Lodin-Sundström A, Schagatay F, Iglesias X, Rodríguez FA, Schagatay E. Blood lactate accumulation during competitive freediving and synchronized swimming. Undersea Hyperb Med 2018; 45:55-63. [PMID: 29571233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A number of competitive water sports are performed while breath-holding (apnea). Such performances put large demands on the anaerobic system, but the study of lactate accumulation in apneic sports is limited. We therefore aimed to determine and compare the net lactate accumulation (NLA) during competition events in six disciplines of competitive freediving (FD) and three disciplines of synchronized swimming (SSW). The FD disciplines were: static apnea (STA; n = 14); dynamic apnea (DYN; n = 19); dynamic apnea no fins (DNF; n = 16); constant weight (CWT; n = 12); constant weight no fins (CNF; n = 8); free immersion (FIM; n =10). The SSW disciplines were solo (n = 21), duet (n = 31) and team (n = 34). Capillary blood lactate concentration was measured before and three minutes after competition performances, and apneic duration and performance variables were recorded. In all nine disciplines NLA was observed. The highest mean (SD) NLA (mmol·L-1) was found in CNF at 6.3 (2.2), followed by CWT at 5.9 (2.3) and SSW solo at 5 (1.9). STA showed the lowest NLA 0.7 (0.7) mmol·L-1 compared to all other disciplines (P ⟨ 0.001). The NLA recorded shows that sports involving apnea involve high levels of anaerobic activity. The highest NLA was related to both work done by large muscle groups and long apneic periods, suggesting that NLA is influenced by both the type of work and apnea duration, with lower NLA in SSW due to shorter apneic episodes with intermittent breathing.
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Affiliation(s)
- Lara RodrÍguez-Zamora
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - Harald K Engan
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- LHL Health Röros Rehabilitation, The Norwegian Heart and Lung Patient Organization, Norway
| | | | - Fanny Schagatay
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Xavier Iglesias
- INEFC - Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya, Universitat de Barcelona, Barcelona, Spain
| | - Ferran A Rodríguez
- INEFC - Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya, Universitat de Barcelona, Barcelona, Spain
| | - Erika Schagatay
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
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