Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community

AIMS

Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK.

MATERIALS AND METHODS

All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported.

RESULTS

Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01).

CONCLUSION

Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

An evaluation of a common elements treatment approach for youth in Somali refugee camps

BACKGROUND

This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.

METHODS

This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.

RESULTS

Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d  =  1.37), externalizing (d  =  0.85), and posttraumatic stress (d  =  1.71), and improvements in well-being (d  =  0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.

CONCLUSIONS

This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.

Big Data in Drug Discovery

Interpretation of Big Data in the drug discovery community should enhance project timelines and reduce clinical attrition through improved early decision making. The issues we encounter start with the sheer volume of data and how we first ingest it before building an infrastructure to house it to make use of the data in an efficient and productive way. There are many problems associated with the data itself including general reproducibility, but often, it is the context surrounding an experiment that is critical to success. Help, in the form of artificial intelligence (AI), is required to understand and translate the context. On the back of natural language processing pipelines, AI is also used to prospectively generate new hypotheses by linking data together. We explain Big Data from the context of biology, chemistry and clinical trials, showcasing some of the impressive public domain sources and initiatives now available for interrogation.

Nanog Fluctuations in Embryonic Stem Cells Highlight the Problem of Measurement in Cell Biology

A number of important pluripotency regulators, including the transcription factor Nanog, are observed to fluctuate stochastically in individual embryonic stem cells. By transiently priming cells for commitment to different lineages, these fluctuations are thought to be important to the maintenance of, and exit from, pluripotency. However, because temporal changes in intracellular protein abundances cannot be measured directly in live cells, fluctuations are typically assessed using genetically engineered reporter cell lines that produce a fluorescent signal as a proxy for protein expression. Here, using a combination of mathematical modeling and experiment, we show that there are unforeseen ways in which widely used reporter strategies can systematically disturb the dynamics they are intended to monitor, sometimes giving profoundly misleading results. In the case of Nanog, we show how genetic reporters can compromise the behavior of important pluripotency-sustaining positive feedback loops, and induce a bifurcation in the underlying dynamics that gives rise to heterogeneous Nanog expression patterns in reporter cell lines that are not representative of the wild-type. These findings help explain the range of published observations of Nanog variability and highlight the problem of measurement in live cells.

Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

Objective:

Vascular involvement in the form of renal vein (RV) or inferior vena cava (IVC) thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus.

Materials and Methods:

In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD) presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1). There were no regional lymphadenopathy and the staging scans were negative.

Results:

The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR). The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC.

Conclusions:

As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center.

Accurate Reconstruction of Cell and Particle Tracks from 3D Live Imaging Data

Spatial structures often constrain the 3D movement of cells or particles in vivo, yet this information is obscured when microscopy data are analyzed using standard approaches. Here, we present methods, called unwrapping and Riemannian manifold learning, for mapping particle-tracking data along unseen and irregularly curved surfaces onto appropriate 2D representations. This is conceptually similar to the problem of reconstructing accurate geography from conventional Mercator maps, but our methods do not require prior knowledge of the environments' physical structure. Unwrapping and Riemannian manifold learning accurately recover the underlying 2D geometry from 3D imaging data without the need for fiducial marks. They outperform standard x-y projections, and unlike standard dimensionality reduction techniques, they also successfully detect both bias and persistence in cell migration modes. We demonstrate these features on simulated data and zebrafish and Drosophila in vivo immune cell trajectory datasets. Software packages that implement unwrapping and Riemannian manifold learning are provided.

Systems Analysis of the Dynamic Inflammatory Response to Tissue Damage Reveals Spatiotemporal Properties of the Wound Attractant Gradient

In the acute inflammatory phase following tissue damage, cells of the innate immune system are rapidly recruited to sites of injury by pro-inflammatory mediators released at the wound site. Although advances in live imaging allow us to directly visualize this process in vivo, the precise identity and properties of the primary immune damage attractants remain unclear, as it is currently impossible to directly observe and accurately measure these signals in tissues. Here, we demonstrate that detailed information about the attractant signals can be extracted directly from the in vivo behavior of the responding immune cells. By applying inference-based computational approaches to analyze the in vivo dynamics of the Drosophila inflammatory response, we gain new detailed insight into the spatiotemporal properties of the attractant gradient. In particular, we show that the wound attractant is released by wound margin cells, rather than by the wounded tissue per se, and that it diffuses away from this source at rates far slower than those of previously implicated signals such as H₂O₂ and ATP, ruling out these fast mediators as the primary chemoattractant. We then predict, and experimentally test, how competing attractant signals might interact in space and time to regulate multi-step cell navigation in the complex environment of a healing wound, revealing a period of receptor desensitization after initial exposure to the damage attractant. Extending our analysis to model much larger wounds, we uncover a dynamic behavioral change in the responding immune cells in vivo that is prognostic of whether a wound will subsequently heal or not.

Video Abstract

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Computational modeling of in vivo inflammatory response to tissue damage is applied

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The model infers novel spatiotemporal properties of the wound attractant gradient

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Wound signal is released from the wound edge for 30 min and diffuses at 200 μm²/min

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Modeling two competing wounds reveals a period of immune cell desensitization

Great cities look small

Great cities connect people; failed cities isolate people. Despite the fundamental importance of physical, face-to-face social ties in the functioning of cities, these connectivity networks are not explicitly observed in their entirety. Attempts at estimating them often rely on unrealistic over-simplifications such as the assumption of spatial homogeneity. Here we propose a mathematical model of human interactions in terms of a local strategy of maximizing the number of beneficial connections attainable under the constraint of limited individual travelling-time budgets. By incorporating census and openly available online multi-modal transport data, we are able to characterize the connectivity of geometrically and topologically complex cities. Beyond providing a candidate measure of greatness, this model allows one to quantify and assess the impact of transport developments, population growth, and other infrastructure and demographic changes on a city. Supported by validations of gross domestic product and human immunodeficiency virus infection rates across US metropolitan areas, we illustrate the effect of changes in local and city-wide connectivities by considering the economic impact of two contemporary inter- and intra-city transport developments in the UK: High Speed 2 and London Crossrail. This derivation of the model suggests that the scaling of different urban indicators with population size has an explicitly mechanistic origin.

Goldstein-Kac telegraph processes with random speeds: Path probabilities, likelihoods, and reported Lévy flights

The Goldstein-Kac telegraph process describes the one-dimensional motion of particles with constant speed undergoing random changes in direction. Despite its resemblance to numerous real-world phenomena, the singular nature of the resultant spatial distribution of each particle precludes the possibility of any a posteriori empirical validation of this random-walk model from data. Here we show that by simply allowing for random speeds, the ballistic terms are regularized and that the diffusion component can be well-approximated via the unscented transform. The result is a computationally efficient yet robust evaluation of the full particle path probabilities and, hence, the parameter likelihoods of this generalized telegraph process. We demonstrate how a population diffusing under such a model can lead to non-Gaussian asymptotic spatial distributions, thereby mimicking the behavior of an ensemble of Lévy walkers.

[Treatment of invasive bladder cancer: robot-assisted radical cystectomy and intracorporeal urinary diversion]

PURPOSE

Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are only performed in a few centers of excellence worldwide. Functional and oncologic outcomes are comparable. We report on our experience with RARC and intracorporeal diversion.

PATIENTS AND METHODS

We retrospectively identified 86 RARCs in 72 men and 14 women (mean age 69.7 years). All patients underwent robot-assisted radical cystectomy and pelvic lymphadenectomy followed by intracorporeal urinary diversion using ileal conduit or neobladder. Of the 86 patients, 24 patients (28%) underwent intracorporeal ileal conduit and 62 patients (72%) underwent intracorporeal neobladder formation. A Studer pouch was created in all who underwent intracorporeal neobladder diversion. Cancer specific survival (CSS) and overall survival (OS) are reported.

RESULTS

The mean operative time was 418.9 min (range 205-690 min) and blood loss was 380 ml (range 100-1000 ml). The mean hospital stay was 17.5 days (range 5-62 days). All the surgeries were completed with no open conversions. Minor complications (grade I and II) were reported in 23 patients, while major complications (grade III and above) were reported in 21 patients. The mean nodal yield was 20.3 (range 0-46). Positive margins were found in in 8%. The average follow-up was 31.5 months (range 3-52 months). Continence could be achieved in 88% of patients who received an intracorporeal neobladder. The cancer-specific survival (CSS) and overall survival (OS) were 80% and 70%, respectively.

CONCLUSION

RARC with intracorporeal diversion seems to be safe and reproducible in tertiary centers with robotic expertise. Operative times are acceptable and complications as well as functional and oncologic outcomes are comparable. Further standardization of RARC with intracorporeal diversion may lead to a wider adoption of the approach.

Random forests on distance matrices for imaging genetics studies

We propose a non-parametric regression methodology, Random Forests on Distance Matrices (RFDM), for detecting genetic variants associated to quantitative phenotypes, obtained using neuroimaging techniques, representing the human brain's structure or function. RFDM, which is an extension of decision forests, requires a distance matrix as the response that encodes all pair-wise phenotypic distances in the random sample. We discuss ways to learn such distances directly from the data using manifold learning techniques, and how to define such distances when the phenotypes are non-vectorial objects such as brain connectivity networks. We also describe an extension of RFDM to detect espistatic effects while keeping the computational complexity low. Extensive simulation results and an application to an imaging genetics study of Alzheimer's Disease are presented and discussed.

Information theory and signal transduction systems: from molecular information processing to network inference

Sensing and responding to the environment are two essential functions that all biological organisms need to master for survival and successful reproduction. Developmental processes are marshalled by a diverse set of signalling and control systems, ranging from systems with simple chemical inputs and outputs to complex molecular and cellular networks with non-linear dynamics. Information theory provides a powerful and convenient framework in which such systems can be studied; but it also provides the means to reconstruct the structure and dynamics of molecular interaction networks underlying physiological and developmental processes. Here we supply a brief description of its basic concepts and introduce some useful tools for systems and developmental biologists. Along with a brief but thorough theoretical primer, we demonstrate the wide applicability and biological application-specific nuances by way of different illustrative vignettes. In particular, we focus on the characterisation of biological information processing efficiency, examining cell-fate decision making processes, gene regulatory network reconstruction, and efficient signal transduction experimental design.

Cost analysis of a community pharmacy 'minor ailment scheme' across three primary care trusts in the North East of England

BACKGROUND

A large proportion of primary care medical consultations relate to minor ailments, placing a substantial burden on the UK National Health Service (NHS). In response, minor ailment schemes (MAS) have been introduced in several community pharmacies.

METHODS

Patients using MAS across three neighbouring primary care trusts were asked what action they would have taken if the MAS had not been in place. The net cost impact of the MAS was calculated using standard health-care reference costs. The observation period was one calendar month with annualized cost data.

RESULTS

During the observation period 396 patients used the MAS of whom 230 (58.1%) stated they would have made an appointment with their general practitioner (GP) if the MAS was not in place. A further 155 (39.1%) would have bought a medicine from the pharmacy. Other responses included attending the accident and emergency department at hospital (n= 2), consulting a health visitor (n= 1), or doing nothing (n= 8). The MAS is estimated to reduce local health-care costs by £6739 per month.

CONCLUSIONS

MAS release NHS resources (especially in relation to GP consultations) by preventing (or minimizing) patient use of alternative and more costly branches of the NHS.

Browsing affects intra-ring carbon allocation in species with contrasting wood anatomy

Current knowledge on tree carbon (C) allocation to wood is particularly scarce in plants subjected to disturbance factors, such as browsing, which affects forest regeneration worldwide and has an impact on the C balance of trees. Furthermore, quantifying the degree to which tree rings are formed from freshly assimilated vs. stored carbohydrates is highly relevant for our understanding of tree C allocation. We used (13)C labelling to quantify seasonal allocation of stored C to wood formation in two species with contrasting wood anatomy: Betula pubescens Ehrh. (diffuse-porous) and Quercus petraea [Matt.] Liebl. (ring-porous). Clipping treatments (66% shoot removal, and unclipped) were applied to analyse the effect of browsing on C allocation into tree rings, plus the effects on tree growth, architecture, ring width and non-structural carbohydrates (NSCs). The relative contribution of stored C to wood formation was greater in the ring-porous (55-70%) than in the diffuse-porous species (35-60%), although each species followed different seasonal trends. Clipping did not cause a significant depletion of C stores in either species. Nonetheless, a significant increase in the proportion of stored C allocated to earlywood growth was observed in clipped birches, and this could be explained through changes in tree architecture after clipping. The size of C pools across tree species seems to be important in determining the variability of seasonal C allocation patterns to wood and their sensibility to disturbances such as browsing. Our results indicate that the observed changes in C allocation to earlywood in birch were not related to variations in the amount or concentration of NSC stores, but to changes in the seasonal availability of recently assimilated C caused by modifications in tree architecture after browsing.

Control of gene expression by CpG island methylation in normal cells

The role of DNA methylation in the control of mammalian gene expression has been the subject of intensive research in recent years, partly due to the critical role of CpG island methylation in the inactivation of tumour suppressor genes during the development of cancer. However, this research has also helped elucidate the role that DNA methylation plays in normal cells. At present, it is also clear that DNA methylation forms an important part of the normal cell-regulatory processes that govern gene transcription. Methylation, targeted at CpG islands, is an important part of the mechanisms that govern X-chromosome inactivation; it is also essential for the maintenance of imprinted genes and, at least in some cases, is critical in determining the cell-type-specific expression patterns of genes. Study of these examples will be important in identifying the mechanisms that control targeting of DNA methylation and how these processes are disrupted during disease pathogenesis.

A role for mismatch repair in control of DNA ploidy following DNA damage

Many reports have shown a link between mismatch repair (MMR) deficiency and loss of normal cell cycle control, particularly loss of G2 arrest. However almost all of these studies utilized transformed cell lines, and thus the involvement of other genes in this phenotype cannot be excluded. We have examined the effects of cisplatin treatment on primary embryo fibroblasts (MEFs) derived from mice in which the MMR gene Msh2 had been inactivated (Msh2(-/-)). This analysis determined that both primary Msh2(-/-) and wild type (WT) fibroblasts exhibited an essentially identical G2 arrest following cisplatin treatment. Similarly, we observed a cisplatin-induced G2 arrest in immortalized MMR deficient (Mlh1(-/-) and Pms2(-/-)) and WT MEFs. p53 deficient primary MEFs (p53(-/-)) exhibited both a clear G2 arrest and an increase in cells with a DNA content of 8N in response to cisplatin. When the Msh2 and p53 defects were combined (p53(-/-)/Msh2(-/-)) the G2 arrest was essentially identical to the p53(-/-) fibroblasts. However, the p53(-/-)/Msh2(-/-) fibroblasts demonstrated a further increase in cells with an 8N DNA content, above that seen in the p53(-/-) fibroblasts. These results suggest that loss of MMR on its own is not enough to overcome G2 arrest following exposure to cisplatin but does play a role in preventing polyploidization, or aberrant DNA reduplication, in the absence of functional p53.

Effect of nitrogen supply and defoliation on loss of organic compounds from roots of Festuca rubra

The aim of this study was to determine the effects of N-supply and defoliation on rhizodeposition from Festuca rubra, in the context of whole-plant C- partitioning and root morphology. Plants were grown for 36 d in axenic sand microcosms continuously percolated with nutrient solutions of either high or low N concentration (2 mM or 0.01 mM NH(4)NO(3), respectively). The effects of partial defoliation at weekly intervals were determined at high and low N. At low N, dry matter accumulation in roots and shoots was reduced significantly (P<0.001), with proportionately increased partitioning to roots, in comparison with the high N treatment. Root morphology was also affected by N-treatment; at low N, lower biomass production was offset by increased specific root length (P<0.001), reducing the magnitude of the significant (P=0.002) increase in total root length at high N. Cumulative release of organic C from roots of F: rubra over the experimental period was not altered significantly by N-treatment. However, as a proportion of net C-assimilation, rhizodeposition was significantly (P<0.001) greater at low N than at high N. Defoliation transiently (3-5 d) increased the release of soluble organic compounds from roots at each N-supply rate, and increased significantly (P<0.001) cumulative rhizodeposition over the experimental period. These effects of N-supply and defoliation on rhizodeposition are of importance in understanding interactions between plant and microbial productivity in grazed grasslands, and in interpretation of concurrent effects on microbially driven nutrient cycling processes in these systems.

Rivastigmine: a review

The acetylcholinesterase inhibitors are the first useful and useable drugs for palliative treatment of dementia of the Alzheimer type. This article reviews the second-generation carbamate cholinesterase inhibitor, rivastigmine (EXELON, Novartis, Basel) whose distinctive pharmacology is not only of immediate clinical relevance but also the key to some tantalizing therapeutic possibilities.

Cortical cell fluxes and transport to the stele in excised root segments of Allium cepa L. : IV. Calcium as affected by its external concentration

From compartmental analysis of radioisotope elutin measurements, fluxes of Ca(2+) were estimated for cortical cells in root segments of onion, Allium cepa L., relative to complete nutrient solutions containing a range of calcium concentrations ([Ca0]) from 2 μeq l(-1) to 20 meq l(-1), increasing in 10-fold steps for Ca(2+). Except for the calcium counter-ion (usually NO 3 (-) , sometimes Cl(-) at the highest [Ca0]), the composition of the nutrient solution was other-wise the same at all calcium concentrations. Compartmental analysis indicated that the cytoplasm had a high content of exchangeable Ca(2+) but, in the light of evidence from animal studies, ionic activity of calcium in the cytoplasm was assumed to be no greater than 0.002 μeq ml(-1). With the Ussing-Teorell flux equation as the criterion, it was concluded that at all values of [Ca0] tested, Ca(2+) entered the cytoplasm passively and was actively pumped back into the external solution. Entry of calcium to the vacuole from the cytoplasm was active in all cases. The conclusions regarding the character of ion transport across the plasmalemma were the same as when the whole calcium content of the cytoplasm was taken to contribute to the ionic activity. However, the electrochemical activity gradient was very much steeper than formerly estimated. Calcium was transported to the stele in proportion to the calcium content of the cytoplasm and moved in the xylem almost exclusively in the basipetal direction.

Cortical cell fluxes and transport to the stele in excised root segments of Allium cepa L. : III. Magnesium

From compartmental analysis of radioisotope elution measurements, concentrations and fluxes of Mg(2+) were estimated for cortical cells in root segments of onion, Allium cepa L., relative to a complete nutrient solution containing 0.25 mM Mg(2+). Five compartments for Mg(2+) in the cortex were found and, in order of increasing rates of exchange, identified with the vacuoles and the cytoplasm of the cortical parenchyma, the Donnan free space, the water free space, and the superficial film of solution on the segments. With the Ussing-Teorell flux ratio equation as the criterion, it was concluded that Mg(2+) entered the cytoplasm passively and was actively pumped back across the plasmalemma. Mg(2+) concentration in the vacuole could be estimated only as lying between wide limits (1.3 to 14.3 μeq ml(-1)), but whatever the concentration within this range, it was concluded that Mg(2+) was passively distributed across the tonoplast. Net flux was zero and the vacuolar concentration commensurate with this was found to be 6.6 μeq ml(-1). The transported fraction of total efflux, appearing at the segment cut ends, was estimated separately. Magnesium was found to be transported almost exclusively in the basipetal direction.