Foundation metrics for evaluating effectiveness of healthcare conversations powered by generative AI

Generative Artificial Intelligence is set to revolutionize healthcare delivery by transforming traditional patient care into a more personalized, efficient, and proactive process. Chatbots, serving as interactive conversational models, will probably drive this patient-centered transformation in healthcare. Through the provision of various services, including diagnosis, personalized lifestyle recommendations, dynamic scheduling of follow-ups, and mental health support, the objective is to substantially augment patient health outcomes, all the while mitigating the workload burden on healthcare providers. The life-critical nature of healthcare applications necessitates establishing a unified and comprehensive set of evaluation metrics for conversational models. Existing evaluation metrics proposed for various generic large language models (LLMs) demonstrate a lack of comprehension regarding medical and health concepts and their significance in promoting patients' well-being. Moreover, these metrics neglect pivotal user-centered aspects, including trust-building, ethics, personalization, empathy, user comprehension, and emotional support. The purpose of this paper is to explore state-of-the-art LLM-based evaluation metrics that are specifically applicable to the assessment of interactive conversational models in healthcare. Subsequently, we present a comprehensive set of evaluation metrics designed to thoroughly assess the performance of healthcare chatbots from an end-user perspective. These metrics encompass an evaluation of language processing abilities, impact on real-world clinical tasks, and effectiveness in user-interactive conversations. Finally, we engage in a discussion concerning the challenges associated with defining and implementing these metrics, with particular emphasis on confounding factors such as the target audience, evaluation methods, and prompt techniques involved in the evaluation process.

Exploring Lin28 proteins: Unravelling structure and functions with emphasis on nervous system malignancies

Cancer and stem cells share many characteristics related to self-renewal and differentiation. Both cell types express the same critical proteins that govern cellular stemness, which provide cancer cells with the growth and survival benefits of stem cells. LIN28 is an example of one such protein. LIN28 includes two main isoforms, LIN28A and LIN28B, with diverse physiological functions from tissue development to control of pluripotency. In addition to their physiological roles, LIN28A and LIN28B affect the progression of several cancers by regulating multiple cancer hallmarks. Altered expression levels of LIN28A and LIN28B have been proposed as diagnostic and/or prognostic markers for various malignancies. This review discusses the structure and modes of action of the different LIN28 proteins and examines their roles in regulating cancer hallmarks with a focus on malignancies of the nervous system. This review also highlights some gaps in the field that require further exploration to assess the potential of targeting LIN28 proteins for controlling cancer.

Multiomics analysis of adaptation to repeated DNA damage in prostate cancer cells

DNA damage is frequently utilized as the basis for cancer therapies; however, resistance to DNA damage remains one of the biggest challenges for successful treatment outcomes. Critically, the molecular drivers behind resistance are poorly understood. To address this question, we created an isogenic model of prostate cancer exhibiting more aggressive characteristics to better understand the molecular signatures associated with resistance and metastasis. 22Rv1 cells were repeatedly exposed to DNA damage daily for 6 weeks, similar to patient treatment regimes. Using Illumina Methylation EPIC arrays and RNA-seq, we compared DNA methylation and transcriptional profiles between the parental 22Rv1 cell line and the lineage exposed to prolonged DNA damage. Here we show that repeated DNA damage drives the molecular evolution of cancer cells to a more aggressive phenotype and identify molecular candidates behind this process. Total DNA methylation was increased while RNA-seq demonstrated these cells had dysregulated expression of genes involved in metabolism and the unfolded protein response (UPR) with Asparagine synthetase (ASNS) identified as central to this process. Despite the limited overlap between RNA-seq and DNA methylation, oxoglutarate dehydrogenase-like (OGDHL) was identified as altered in both data sets. Utilising a second approach we profiled the proteome in 22Rv1 cells following a single dose of radiotherapy. This analysis also highlighted the UPR in response to DNA damage. Together, these analyses identified dysregulation of metabolism and the UPR and identified ASNS and OGDHL as candidates for resistance to DNA damage. This work provides critical insight into molecular changes which underpin treatment resistance and metastasis.

ZotCare: a flexible, personalizable, and affordable mhealth service provider

The proliferation of Internet-connected health devices and the widespread availability of mobile connectivity have resulted in a wealth of reliable digital health data and the potential for delivering just-in-time interventions. However, leveraging these opportunities for health research requires the development and deployment of mobile health (mHealth) applications, which present significant technical challenges for researchers. While existing mHealth solutions have made progress in addressing some of these challenges, they often fall short in terms of time-to-use, affordability, and flexibility for personalization and adaptation. ZotCare aims to address these limitations by offering ready-to-use and flexible services, providing researchers with an accessible, cost-effective, and adaptable solution for their mHealth studies. This article focuses on ZotCare's service orchestration and highlights its capabilities in creating a programmable environment for mHealth research. Additionally, we showcase several successful research use cases that have utilized ZotCare, both in the past and in ongoing projects. Furthermore, we provide resources and information for researchers who are considering ZotCare as their mHealth research solution.

Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study

BACKGROUND

Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child.

OBJECTIVE

The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection.

METHODS

We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants' smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction.

RESULTS

The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness.

CONCLUSIONS

Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness.

Can Sleep Quality Attributes be Predicted from Physical Activity in Everyday Settings?

Sleep is crucial for physical, mental, and emotional well-being. Physical activity and sleep are known to be interrelated; however, limited research has been performed to investigate their interactions in long-term. Conventional studies have presented sleep quality prediction, focusing on a single sleep quality aspect, such as sleep efficiency. In addition, the relationship between daily physical activity and sleep quality has yet to be explored, despite physical activities being utilized in previous studies for sleep quality prediction. In this paper, we develop an Extreme Gradient boosting method to predict sleep duration, sleep efficiency, and deep sleep based on users' daily activity information collected from wearable devices. Our model is trained and tested using data collected with an OURA ring from 34 pregnant mothers for six months under free-living conditions. Our finding shows an accuracy of 90.58%, 95.38%, and 91.45% for sleep duration, efficiency, and deep sleep, respectively. Moreover, we assess the contribution of each physical activity parameter to the prediction results using the Shapley Additive Explanations method. Our results indicate that sedentary time is the most influential parameter for sleep duration prediction, while the inactive time feature (e.g., resting or lying down) has a strong negative relationship with sleep efficiency, and the pregnancy week is the most critical parameter for deep sleep prediction.

Objective Prediction of Next-Day's Affect Using Multimodal Physiological and Behavioral Data: Algorithm Development and Validation Study

BACKGROUND

Affective states are important aspects of healthy functioning; as such, monitoring and understanding affect is necessary for the assessment and treatment of mood-based disorders. Recent advancements in wearable technologies have increased the use of such tools in detecting and accurately estimating mental states (eg, affect, mood, and stress), offering comprehensive and continuous monitoring of individuals over time.

OBJECTIVE

Previous attempts to model an individual's mental state relied on subjective measurements or the inclusion of only a few objective monitoring modalities (eg, smartphones). This study aims to investigate the capacity of monitoring affect using fully objective measurements. We conducted a comparatively long-term (12-month) study with a holistic sampling of participants' moods, including 20 affective states.

METHODS

Longitudinal physiological data (eg, sleep and heart rate), as well as daily assessments of affect, were collected using 3 modalities (ie, smartphone, watch, and ring) from 20 college students over a year. We examined the difference between the distributions of data collected from each modality along with the differences between their rates of missingness. Out of the 20 participants, 7 provided us with 200 or more days' worth of data, and we used this for our predictive modeling setup. Distributions of positive affect (PA) and negative affect (NA) among the 7 selected participants were observed. For predictive modeling, we assessed the performance of different machine learning models, including random forests (RFs), support vector machines (SVMs), multilayer perceptron (MLP), and K-nearest neighbor (KNN). We also investigated the capability of each modality in predicting mood and the most important features of PA and NA RF models.

RESULTS

RF was the best-performing model in our analysis and performed mood and stress (nervousness) prediction with ~81% and ~72% accuracy, respectively. PA models resulted in better performance compared to NA. The order of the most important modalities in predicting PA and NA was the smart ring, phone, and watch, respectively. SHAP (Shapley Additive Explanations) analysis showed that sleep and activity-related features were the most impactful in predicting PA and NA.

CONCLUSIONS

Generic machine learning-based affect prediction models, trained with population data, outperform existing methods, which use the individual's historical information. Our findings indicated that our mood prediction method outperformed the existing methods. Additionally, we found that sleep and activity level were the most important features for predicting next-day PA and NA, respectively.

LIN28 expression and function in medulloblastoma

Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Current treatment modalities are not completely effective and can lead to severe neurological and cognitive adverse effects. In addition to urgently needing better treatment approaches, new diagnostic and prognostic biomarkers are required to improve the therapy outcomes of MB patients. The RNA-binding proteins, LIN28A and LIN28B, are known to regulate invasive phenotypes in many different cancer types. However, the expression and function of these proteins in MB had not been studied to date. This study identified the expression of LIN28A and LIN28B in MB patient samples and cell lines and assessed the effect of LIN28 inhibition on MB cell growth, metabolism and stemness. LIN28B expression was significantly upregulated in MB tissues compared to normal brain tissues. This upregulation, which was not observed in other brain tumors, was specific for the aggressive MB subgroups and correlated with patient survival and metastasis rates. Functionally, pharmacological inhibition of LIN28 activity concentration-dependently reduced LIN28B expression, as well as the growth of D283 MB cells. While LIN28 inhibition did not affect the levels of intracellular ATP, it reduced the expression of the stemness marker CD133 in D283 cells and the sphere formation of CHLA-01R cells. LIN28B, which is highly expressed in the human cerebellum during the first few months after birth, subsequently decreased with age. The results of this study highlight the potential of LIN28B as a diagnostic and prognostic marker for MB and open the possibility to utilize LIN28 as a pharmacological target to suppress MB cell growth and stemness.

Supporting lifestyle change in obese pregnant mothers through the wearable internet-of-things (SLIM) -intervention for overweight pregnant women: Study protocol for a quasi-experimental trial

OBJECTIVES

To assess, in terms of self-efficacy in weight management, the effectiveness of the SLIM lifestyle intervention among overweight or obese women during pregnancy and after delivery, and further to exploit machine learning and event mining approaches to build personalized models. Additionally, the aim is to evaluate the implementation of the SLIM intervention.

METHODS

This prospective trial, which is a non-randomized, quasi-experimental, pre-post intervention, includes an embedded mixed-method process evaluation. The SLIM Intervention is delivered by public health nurses (n = 9) working in maternity clinics. The public health nurses recruited overweight women (n = 54) at their first antenatal visit using convenience sampling. The core components of the intervention i.e. health technology, motivational interviewing, feedback, and goal setting, are utilized in antenatal visits in maternity clinics starting from gestational week 15 or less and continuing to 12 weeks after delivery. Mixed effect models are used to evaluate change over time in self-efficacy, weight management and weight change. Simple mediation models are used to assess calories consumed and moderate to vigorous physical activity (MVPA) as mediators between self-efficacy and weight change. Signal processing and machine learning techniques are exploited to extract events from the data collected via the Oura ring and smartphone-based questionnaires.

DISCUSSION

The SLIM intervention was developed in collaboration with overweight women and public health nurses working in maternity clinics. This study evaluates the effectiveness of the intervention among overweight women in increasing self-efficacy and achieving a healthy weight; thus, impacting the healthy lifestyle and long-term health of the whole family. The long-term objective is to contribute to women's health by supporting weight-management through behavior change via interventions conducted in maternity clinics.

TRIAL REGISTRATION

The trial was registered at the Clinicaltrials.gov register platform (ID NCT04826861) on 17 March 2021.

A comprehensive accuracy assessment of Samsung smartwatch heart rate and heart rate variability

BACKGROUND

Photoplethysmography (PPG) is a low-cost and easy-to-implement method to measure vital signs, including heart rate (HR) and pulse rate variability (PRV) which widely used as a substitute of heart rate variability (HRV). The method is used in various wearable devices. For example, Samsung smartwatches are PPG-based open-source wristbands used in remote well-being monitoring and fitness applications. However, PPG is highly susceptible to motion artifacts and environmental noise. A validation study is required to investigate the accuracy of PPG-based wearable devices in free-living conditions.

OBJECTIVE

We evaluate the accuracy of PPG signals-collected by the Samsung Gear Sport smartwatch in free-living conditions-in terms of HR and time-domain and frequency-domain HRV parameters against a medical-grade chest electrocardiogram (ECG) monitor.

METHODS

We conducted 24-hours monitoring using a Samsung Gear Sport smartwatch and a Shimmer3 ECG device. The monitoring included 28 participants (14 male and 14 female), where they engaged in their daily routines. We evaluated HR and HRV parameters during the sleep and awake time. The parameters extracted from the smartwatch were compared against the ECG reference. For the comparison, we employed the Pearson correlation coefficient, Bland-Altman plot, and linear regression methods.

RESULTS

We found a significantly high positive correlation between the smartwatch's and Shimmer ECG's HR, time-domain HRV, LF, and HF and a significant moderate positive correlation between the smartwatch's and shimmer ECG's LF/HF during sleep time. The mean biases of HR, time-domain HRV, and LF/HF were low, while the biases of LF and HF were moderate during sleep. The regression analysis showed low error variances of HR, AVNN, and pNN50, moderate error variances of SDNN, RMSSD, LF, and HF, and high error variances of LF/HF during sleep. During the awake time, there was a significantly high positive correlation of AVNN and a moderate positive correlation of HR, while the other parameters indicated significantly low positive correlations. RMSSD and SDNN showed low mean biases, and the other parameters had moderate mean biases. In addition, AVNN had moderate error variance while the other parameters indicated high error variances.

CONCLUSION

The Samsung smartwatch provides acceptable HR, time-domain HRV, LF, and HF parameters during sleep time. In contrast, during the awake time, AVNN and HR show satisfactory accuracy, and the other HRV parameters have high errors.

Comparison of Oura Smart Ring Against ActiGraph Accelerometer for Measurement of Physical Activity and Sedentary Time in a Free-Living Context

Smart rings, such as the Oura ring, might have potential in health monitoring. To be able to identify optimal devices for healthcare settings, validity studies are needed. The aim of this study was to compare the Oura smart ring estimates of steps and sedentary time with data from the ActiGraph accelerometer in a free-living context. A cross-sectional observational study design was used. A convenience sample of healthy adults (n = 42) participated in the study and wore an Oura smart ring and an ActiGraph accelerometer on the non-dominant hand continuously for 1 week. The participants completed a background questionnaire and filled out a daily log about their sleeping times and times when they did not wear the devices. The median age of the participants (n = 42) was 32 years (range, 18-46 years). In total, 191 (61% of the potential) days were compared. The Oura ring overestimated the step counts compared with the ActiGraph. The mean difference was 1416 steps (95% confidence interval, 739-2093 steps). Daily sedentary time was also overestimated by the ring; the mean difference was 17 minutes (95% confidence interval, -2 to 37 minutes). The use of the ring in nursing interventions needs to be considered.

Exploring access as a process of adaptation in a self-monitoring perinatal eHealth system: Mixed-method study from a socio-material perspective (Preprint)

BACKGROUND

The development and quality assurance of perinatal eHealth self-monitoring systems is an upcoming area of inquiry in health science. Building patient engagement into eHealth development as a core component has potential to guide process evaluation. Access, 1 attribute of patient engagement, is the focus of study here. Access to eHealth self-monitoring programs has the potential to influence pregnancy health and wellness outcomes. Little is known about how pregnant users' ability to obtain resources is influenced by their own adaptive activities and the mediating activities of eHealth systems during the process of real-world testing of these systems.

OBJECTIVE

Here, we examine the patient engagement process of access occurring during the adaptation of eHealth self-monitoring use from a sociomaterial perspective.

METHODS

In this mixed methods convergent evaluation design, we interviewed women about perceptions of the adaptation process of using an eHealth self-monitoring system. Deductive analysis was conducted guided by the definition of access as an attribute of patient engagement. After initial qualitative and quantitative data collection and analysis, participants were spilt based on their level of use of the eHealth system (physical wear time of self-monitoring device). Content analysis was then conducted according to user group, using a conceptual matrix developed from ontological perspectives of sociomateriality.

RESULTS

Pregnant users' adaptive activities and the mediation activities of the eHealth system represent a cocreation process that resulted in user group-specific characteristics of accessing and using the system. The high- and low-use groups experienced different personal adaptation and eHealth mediation during this process of cocreation. Differences were noted between high- and low-use groups, with the high-use group giving attention to developing skills in recording and interpreting data and the low-use group discussing the manual adding of activities to the system and how the system worked best for them when they used it in their mother tongue.

CONCLUSIONS

A cocreation process between pregnant users and the eHealth system was identified, illustrating access as a useful core component of perinatal eHealth self-monitoring systems. Researchers and clinicians can observe reasons for why pregnant users access eHealth systems in unique ways based on their personal preferences, habits, and values. Mediation activities of the eHealth system and the different user adaptive activities represent a cocreation process between the users and the eHealth system that is necessary for the personalization of perinatal eHealth systems.

CSIG-31. T-TYPE CALCIUM CHANNEL BLOCKERS INDUCE METABOLIC ALTERATIONS AND APOPTOSIS IN MEDULLOBLASTOMA CELLS

Medulloblastoma (MB) is the most common malignant paediatric brain tumour. In our previous studies, in a screen of a panel of calcium channel modulators in our novel high-throughput 3D assay, we identified T-type (CaV3) channel inhibitors, mibefradil and NNC-55-0396 (NNC) as selective inhibitors of MB cell growth. Mibefradil was originally approved for the treatment of hypertension and angina pectoris, and recently successfully completed a Phase-I trial for recurrent high-grade glioma. NNC is an analogue of mibefradil with multiple advantages compared to mibefradil that makes it attractive for potential future clinical trials. T-type channels have a unique low voltage-dependent activation/inactivation, and many studies suggest that they have a direct regulatory role in controlling Ca2+ signalling in non-excitable tissues, including cancers. In this study, we characterized the effect of mibefradil and NNC on MB cells and elucidated their mechanism of action. This study demonstrates that the induction of toxicity in MB cells is selective to T-type but not to L-type Ca2+ channel inhibitors. Addition of CaV3 inhibitors to vincristine sensitised MB cells to this MB chemotherapeutic agent, suggesting an additive effect. Furthermore, CaV3 inhibitors induced cell death in MB cells via apoptosis. Supported by proteomics data and cellular assays, apoptotic cell death was associated with reduced mitochondrial membrane potential and reduced ATP levels, which suggests that both compounds alter the metabolism of MB cells. We also identified that CACNA1H (encoding the CaV3.2 protein) is significantly upregulated in aggressive Groups 3 and 4 MB patient samples, and its higher expression is associated with higher metastasis and lower patient survival rates. This study offers new insights into the action of mibefradil and NNC and will pave the way to test these molecules or their analogues in pre-clinical MB models alone and in combination with vincristine to assess their suitability as a potential MB therapy.

Personal mental health navigator: Harnessing the power of data, personal models, and health cybernetics to promote psychological well-being

Current digital mental healthcare solutions conventionally take on a reactive approach, requiring individuals to self-monitor and document existing symptoms. These solutions are unable to provide comprehensive, wrap-around, customized treatments that capture an individual’s holistic mental health model as it unfolds over time. Recognizing that each individual requires personally tailored mental health treatment, we introduce the notion of Personalized Mental Health Navigation (MHN): a cybernetic goal-based system that deploys a continuous loop of monitoring, estimation, and guidance to steer the individual towards mental flourishing. We present the core components of MHN that are premised on the importance of addressing an individual’s personal mental health state. Moreover, we provide an overview of the existing physical health navigation systems and highlight the requirements and challenges of deploying the navigational approach to the mental health domain.

Robust PPG Peak Detection Using Dilated Convolutional Neural Networks

Accurate peak determination from noise-corrupted photoplethysmogram (PPG) signal is the basis for further analysis of physiological quantities such as heart rate. Conventional methods are designed for noise-free PPG signals and are insufficient for PPG signals with low signal-to-noise ratio (SNR). This paper focuses on enhancing PPG noise-resiliency and proposes a robust peak detection algorithm for PPG signals distorted due to noise and motion artifact. Our algorithm is based on convolutional neural networks (CNNs) with dilated convolutions. We train and evaluate the proposed method using a dataset collected via smartwatches under free-living conditions in a home-based health monitoring application. A data generator is also developed to produce noisy PPG data used for model training and evaluation. The method performance is compared against other state-of-the-art methods and is tested with SNRs ranging from 0 to 45 dB. Our method outperforms the existing adaptive threshold, transform-based, and machine learning methods. The proposed method shows overall precision, recall, and F1-score of 82%, 80%, and 81% in all the SNR ranges. In contrast, the best results obtained by the existing methods are 78%, 80%, and 79%. The proposed method proves to be accurate for detecting PPG peaks even in the presence of noise.

PPG Signal Reconstruction Using Deep Convolutional Generative Adversarial Network

Photoplethysmography (PPG) is a non-invasive technique used in wearable devices to collect various vital signs, including heart rate and heart rate variability. The signal is highly susceptible to motion artifacts, which is inevitable in health monitoring and may lead to inaccurate decision-making. Studies in the literature proposed time series analysis, signal decomposition, and machine learning methods to reconstruct PPG signals or reduce noise. However, they are limited to short-term noisy signals or to noise caused by certain physical activities. In this paper, we propose a deep convolutional generative adversarial network (GAN) method to reconstruct distorted PPG signals. Our method exploits the temporal information extracted from the corrupted signal and preceding data to perform PPG reconstruction. The model is trained and tested using data collected by smartwatches in a home-based health monitoring application. We evaluate the proposed GAN method in comparison to three state-of-the-art PPG reconstruction methods. The evaluation includes noisy PPG signals with different durations and SNR values. The proposed method outperforms the other methods by obtaining the least error rates. The results indicate that the proposed method is effective for improving PPG signal quality to produce reliable heart rate and heart rate variability.

Trends in Heart Rate and Heart Rate Variability During Pregnancy and the 3-Month Postpartum Period: Continuous Monitoring in a Free-living Context

Background

Heart rate variability (HRV) is a noninvasive method that reflects the regulation of the autonomic nervous system. Altered HRV is associated with adverse mental or physical health complications. The autonomic nervous system also has a central role in physiological adaption during pregnancy, causing normal changes in HRV.

Objective

The aim of this study was to assess trends in heart rate (HR) and HRV parameters as a noninvasive method for remote maternal health monitoring during pregnancy and 3-month postpartum period.

Methods

A total of 58 pregnant women were monitored using an Internet of Things–based remote monitoring system during pregnancy and 3-month postpartum period. Pregnant women were asked to continuously wear Gear Sport smartwatch to monitor their HR and HRV extracted from photoplethysmogram (PPG) signals. In addition, a cross-platform mobile app was used to collect background and delivery-related information. We analyzed PPG signals collected during the night and discarded unreliable signals by applying a PPG quality assessment method to the collected signals. HR, HRV, and normalized HRV parameters were extracted from reliable signals. The normalization removed the effect of HR changes on HRV trends. Finally, we used hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters.

Results

HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P=.006). Time-domain HRV parameters, average normal interbeat intervals (IBIs; average normal IBIs [AVNN]), SD of normal IBIs (SDNN), root mean square of the successive difference of normal IBIs (RMSSD), normalized SDNN, and normalized RMSSD decreased significantly during the second trimester (P<.001). Then, AVNN, SDNN, RMSSD, and normalized SDNN increased significantly during the third trimester (with P=.002, P<.001, P<.001, and P<.001, respectively). Some of the frequency-domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF, decreased significantly during the second trimester (with P<.001, P<.001, and P=.003, respectively), and HF increased significantly during the third trimester (P=.007). In the postpartum period, normalized RMSSD decreased (P=.01), and the LF to HF ratio (LF/HF) increased significantly (P=.004).

Conclusions

Our study indicates the physiological changes during pregnancy and the postpartum period. We showed that HR increased and HRV parameters decreased as pregnancy proceeded, and the values returned to normal after delivery. Moreover, our results show that HR started to decrease, whereas time-domain HRV parameters and HF started to increase during the third trimester. The results also indicated that age was significantly associated with HRV parameters during pregnancy and postpartum period, whereas education level was associated with HRV parameters during the third trimester. In addition, our results demonstrate the possibility of continuous HRV monitoring in everyday life settings.

Accuracy Assessment of Oura Ring Nocturnal Heart Rate and Heart Rate Variability in Comparison With Electrocardiography in Time and Frequency Domains: Comprehensive Analysis

Background

Photoplethysmography is a noninvasive and low-cost method to remotely and continuously track vital signs. The Oura Ring is a compact photoplethysmography-based smart ring, which has recently drawn attention to remote health monitoring and wellness applications. The ring is used to acquire nocturnal heart rate (HR) and HR variability (HRV) parameters ubiquitously. However, these parameters are highly susceptible to motion artifacts and environmental noise. Therefore, a validity assessment of the parameters is required in everyday settings.

Objective

This study aims to evaluate the accuracy of HR and time domain and frequency domain HRV parameters collected by the Oura Ring against a medical grade chest electrocardiogram monitor.

Methods

We conducted overnight home-based monitoring using an Oura Ring and a Shimmer3 electrocardiogram device. The nocturnal HR and HRV parameters of 35 healthy individuals were collected and assessed. We evaluated the parameters within 2 tests, that is, values collected from 5-minute recordings (ie, short-term HRV analysis) and the average values per night sleep. A linear regression method, the Pearson correlation coefficient, and the Bland–Altman plot were used to compare the measurements of the 2 devices.

Results

Our findings showed low mean biases of the HR and HRV parameters collected by the Oura Ring in both the 5-minute and average-per-night tests. In the 5-minute test, the error variances of the parameters were different. The parameters provided by the Oura Ring dashboard (ie, HR and root mean square of successive differences [RMSSD]) showed relatively low error variance compared with the HRV parameters extracted from the normal interbeat interval signals. The Pearson correlation coefficient tests (P<.001) indicated that HR, RMSSD, average of normal heart beat intervals (AVNN), and percentage of successive normal beat-to-beat intervals that differ by more than 50 ms (pNN50) had high positive correlations with the baseline values; SD of normal beat-to-beat intervals (SDNN) and high frequency (HF) had moderate positive correlations, and low frequency (LF) and LF:HF ratio had low positive correlations. The HR, RMSSD, AVNN, and pNN50 had narrow 95% CIs; however, SDNN, LF, HF, and LF:HF ratio had relatively wider 95% CIs. In contrast, the average-per-night test showed that the HR, RMSSD, SDNN, AVNN, pNN50, LF, and HF had high positive relationships (P<.001), and the LF:HF ratio had a moderate positive relationship (P<.001). The average-per-night test also indicated considerably lower error variances than the 5-minute test for the parameters.

Conclusions

The Oura Ring could accurately measure nocturnal HR and RMSSD in both the 5-minute and average-per-night tests. It provided acceptable nocturnal AVNN, pNN50, HF, and SDNN accuracy in the average-per-night test but not in the 5-minute test. In contrast, the LF and LF:HF ratio of the ring had high error rates in both tests.

Detection of COVID-19 Using Heart Rate and Blood Pressure: Lessons Learned from Patients with ARDS

The world has been affected by COVID-19 coronavirus. At the time of this study, the number of infected people in the United States is the highest globally (31.2 million infections). Within the infected population, patients diagnosed with acute respiratory distress syndrome (ARDS) are in more life-threatening circumstances, resulting in severe respiratory system failure. Various studies have investigated the infections to COVID-19 and ARDS by monitoring laboratory metrics and symptoms. Unfortunately, these methods are merely limited to clinical settings, and symptom-based methods are shown to be ineffective. In contrast, vital signs (e.g., heart rate) have been utilized to early-detect different respiratory diseases in ubiquitous health monitoring. We posit that such biomarkers are informative in identifying ARDS patients infected with COVID-19. In this study, we investigate the behavior of COVID-19 on ARDS patients by utilizing simple vital signs. We analyze the long-term daily logs of blood pressure (BP) and heart rate (HR) associated with 150 ARDS patients admitted to five University of California academic health centers (containing 77,972 samples for each vital sign) to distinguish subjects with COVID-19 positive and negative test results. In addition to the statistical analysis, we develop a deep neural network model to extract features from the longitudinal data. Our deep learning model is able to achieve 0.81 area under the curve (AUC) to classify the vital signs of ARDS patients infected with COVID-19 versus other ARDS diagnosed patients. Since our proposed model uses only the BP and HR, it would be possible to review data prior to the first reported cases in the U.S. to validate the presence or absence of COVID-19 in our communities prior to January 2020. In addition, by utilizing wearable devices, and monitoring vital signs of subjects in everyday settings it is possible to early-detect COVID-19 without visiting a hospital or a care site.

Immune checkpoints in targeted-immunotherapy of pancreatic cancer: New hope for clinical development

Immunotherapy has been recently considered as a promising alternative for cancer treatment. Indeed, targeting of immune checkpoint (ICP) strategies have shown significant success in human malignancies. However, despite remarkable success of cancer immunotherapy in pancreatic cancer (PCa), many of the developed immunotherapy methods show poor therapeutic outcomes in PCa with no or few effective treatment options thus far. In this process, immunosuppression in the tumor microenvironment (TME) is found to be the main obstacle to the effectiveness of antitumor immune response induced by an immunotherapy method. In this paper, the latest findings on the ICPs, which mediate immunosuppression in the TME have been reviewed. In addition, different approaches for targeting ICPs in the TME of PCa have been discussed. This review has also synopsized the cutting-edge advances in the latest studies to clinical applications of ICP-targeted therapy in PCa.

Pregnant women's daily patterns of well-being before and during the COVID-19 pandemic in Finland: Longitudinal monitoring through smartwatch technology

BACKGROUND

Technology enables the continuous monitoring of personal health parameter data during pregnancy regardless of the disruption of normal daily life patterns. Our research group has established a project investigating the usefulness of an Internet of Things-based system and smartwatch technology for monitoring women during pregnancy to explore variations in stress, physical activity and sleep. The aim of this study was to examine daily patterns of well-being in pregnant women before and during the national stay-at-home restrictions related to the COVID-19 pandemic in Finland.

METHODS

A longitudinal cohort study design was used to monitor pregnant women in their everyday settings. Two cohorts of pregnant women were recruited. In the first wave in January-December 2019, pregnant women with histories of preterm births (gestational weeks 22-36) or late miscarriages (gestational weeks 12-21); and in the second wave between October 2019 and March 2020, pregnant women with histories of full-term births (gestational weeks 37-42) and no pregnancy losses were recruited. The final sample size for this study was 38 pregnant women. The participants continuously used the Samsung Gear Sport smartwatch and their heart rate variability, and physical activity and sleep data were collected. Subjective stress, activity and sleep reports were collected using a smartphone application developed for this study. Data between February 12 to April 8, 2020 were included to cover four-week periods before and during the national stay-at-home restrictions. Hierarchical linear mixed models were exploited to analyze the trends in the outcome variables.

RESULTS

The pandemic-related restrictions were associated with changes in heart rate variability: the standard deviation of all normal inter-beat intervals (p = 0.034), low-frequency power (p = 0.040) and the low-frequency/high-frequency ratio (p = 0.013) increased compared with the weeks before the restrictions. Women's subjectively evaluated stress levels also increased significantly. Physical activity decreased when the restrictions were set and as pregnancy proceeded. The total sleep time also decreased as pregnancy proceeded, but pandemic-related restrictions were not associated with sleep. Daily rhythms changed in that the participants overall started to sleep later and woke up later.

CONCLUSIONS

The findings showed that Finnish pregnant women coped well with the pandemic-related restrictions and lockdown environment in terms of stress, physical activity and sleep.

Activation of the Ion Channel TRPV4 Induces Epithelial to Mesenchymal Transition in Breast Cancer Cells

Epithelial to mesenchymal transition (EMT) in cancer is important in therapeutic resistance and invasiveness. Calcium signaling is key to the induction of EMT in breast cancer cells. Although inhibition of specific calcium-permeable ion channels regulates the induction of a sub-set of EMT markers in breast cancer cells, it is still unclear if activation of a specific calcium channel can be a driver for the induction of EMT events. In this study, we exploited the availability of a selective pharmacological activator of the calcium-permeable ion channel TRPV4 to assess the direct role of calcium influx in EMT marker induction. Gene association studies revealed a link between TRPV4 and gene-ontologies associated with EMT and poorer relapse-free survival in lymph node-positive basal breast cancers. TRPV4 was an important component of the calcium influx phase induced in MDA-MB-468 breast cancer cells by the EMT inducer epidermal growth factor (EGF). Pharmacological activation of TRPV4 then drove the induction of a variety of EMT markers in breast cancer cells. These studies demonstrate that calcium influx through specific pathways appears to be sufficient to trigger EMT events.

Development of a High-throughput Agar Colony Formation Assay to Identify Drug Candidates against Medulloblastoma

Medulloblastoma (MB) is the most common malignant childhood brain cancer. High-risk MB tumours have a high incidence of metastasis and result in poor patient survival. Drug screens, commonly used to identify potential novel therapeutic agents against MB, focus on 2D cell proliferation and viability assays given that these assays are easily adaptable to high-throughput regimes. However, 2D models fail to address invasive characteristics that are crucial to MB metastasis and are thus not representative of tumour growth in vivo. In this study, we developed a 3D 384-well agar colony formation assay using MB cells of molecular subgroup 3 that is associated with the highest level of metastasis. Two fluorescence substrates, resazurin and glycyl-phenylalanyl-aminofluorocoumarin (GF-AFC) that measure cell viability via distinct mechanisms were used to assess the growth of MB cells in the agar matrix. The assay was optimised for seeding density, growth period, substrate incubation time and homogeneity of the fluorescent signals within individual wells. Our data demonstrate the feasibility to multiplex the two fluorescent substrates without detectable signal interference. This assay was validated by assessing the concentration-dependent effect of two commonly used chemotherapeutic agents clinically used for MB treatment, vincristine and lomustine. Subsequently, a panel of plasma membrane calcium channel modulators was screened for their effect on the 3D growth of D341 MB cells, which identified modulators of T-type voltage gated and ORAI calcium channels as selective growth modulators. Overall, this 3D assay provides a reproducible, time and cost-effective assay for high-throughput screening to identify potential drugs against MB.

Sleep Tracking of a Commercially Available Smart Ring and Smartwatch Against Medical-Grade Actigraphy in Everyday Settings: Instrument Validation Study

BACKGROUND

Assessment of sleep quality is essential to address poor sleep quality and understand changes. Owing to the advances in the Internet of Things and wearable technologies, sleep monitoring under free-living conditions has become feasible and practicable. Smart rings and smartwatches can be employed to perform mid- or long-term home-based sleep monitoring. However, the validity of such wearables should be investigated in terms of sleep parameters. Sleep validation studies are mostly limited to short-term laboratory tests; there is a need for a study to assess the sleep attributes of wearables in everyday settings, where users engage in their daily routines.

OBJECTIVE

This study aims to evaluate the sleep parameters of the Oura ring along with the Samsung Gear Sport watch in comparison with a medically approved actigraphy device in a midterm everyday setting, where users engage in their daily routines.

METHODS

We conducted home-based sleep monitoring in which the sleep parameters of 45 healthy individuals (23 women and 22 men) were tracked for 7 days. Total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO) of the ring and watch were assessed using paired t tests, Bland-Altman plots, and Pearson correlation. The parameters were also investigated considering the gender of the participants as a dependent variable.

RESULTS

We found significant correlations between the ring's and actigraphy's TST (r=0.86; P<.001), WASO (r=0.41; P<.001), and SE (r=0.47; P<.001). Comparing the watch with actigraphy showed a significant correlation in TST (r=0.59; P<.001). The mean differences in TST, WASO, and SE of the ring and actigraphy were within satisfactory ranges, although there were significant differences between the parameters (P<.001); TST and SE mean differences were also within satisfactory ranges for the watch, and the WASO was slightly higher than the range (31.27, SD 35.15). However, the mean differences of the parameters between the watch and actigraphy were considerably higher than those of the ring. The watch also showed a significant difference in TST (P<.001) between female and male groups.

CONCLUSIONS

In a sample population of healthy adults, the sleep parameters of both the Oura ring and Samsung watch have acceptable mean differences and indicate significant correlations with actigraphy, but the ring outperforms the watch in terms of the nonstaging sleep parameters.

Endogenous Anti-Cancer Candidates in GPCR, ER Stress, and EMT

The majority of cellular responses to external stimuli are mediated by receptors such as G protein-coupled receptors (GPCRs) and systems including endoplasmic reticulum stress (ER stress). Since GPCR signalling is pivotal in numerous malignancies, they are widely targeted by a number of clinical drugs. Cancer cells often negatively modulate GPCRs in order to survive, proliferate and to disseminate. Similarly, numerous branches of the unfolded protein response (UPR) act as pro-survival mediators and are involved in promoting cancer progression via mechanisms such as epithelial to mesenchymal transition (EMT). However, there are a few proteins among these groups which impede deleterious effects by orchestrating the pro-apoptotic phenomenon and paving a therapeutic pathway. The present review exposes and discusses such critical mechanisms and some of the key processes involved in carcinogenesis.

Distinct pharmacological profiles of ORAI1, ORAI2, and ORAI3 channels

The ubiquitous Ca²⁺ release-activated Ca²⁺ (CRAC) channel is crucial to many physiological functions. Both gain and loss of CRAC function is linked to disease. While ORAI1 is a crucial subunit of CRAC channels, recent evidence suggests that ORAI2 and ORAI3 heteromerize with ORAI1 to form native CRAC channels. Furthermore, ORAI2 and ORAI3 can form CRAC channels independently of ORAI1, suggesting diverse native CRAC stoichiometries. Yet, most available CRAC modifiers are presumed to target ORAI1 with little knowledge of their effects on ORAI2/3 or heteromers of ORAIs. Here, we used ORAI1/2/3 triple-null cells to express individual ORAI1, ORAI2, ORAI3 or ORAI1/2/3 concatemers. We reveal that GSK-7975A and BTP2 essentially abrogate ORAI1 and ORAI2 activity while causing only a partial inhibition of ORAI3. Interestingly, Synta66 abrogated ORAI1 channel function, while potentiating ORAI2 with no effect on ORAI3. CRAC channel activities mediated by concatenated ORAI1-1, ORAI1-2 and ORAI1-3 dimers were inhibited by Synta66, while ORAI2-3 dimers were unaffected. The CRAC enhancer IA65 significantly potentiated ORAI1 and ORAI1-1 activity with marginal effects on other ORAIs. Further, we characterized the profiles of individual ORAI isoforms in the presence of Gd³⁺ (5μM), 2-APB (5 μM and 50 μM), as well as changes in intracellular and extracellular pH. Our data reveal unique pharmacological features of ORAI isoforms expressed in an ORAI-null background and provide new insights into ORAI isoform selectivity of widely used CRAC pharmacological compounds.

Comparative In Vitro Toxicology of Novel Cytoprotective Short-Chain Naphthoquinones

Short-chain quinones (SCQs) have been identified as potential drug candidates against mitochondrial dysfunction, which largely depends on the reversible redox characteristics of the active quinone core. We recently identified 11 naphthoquinone derivatives, 1–11, from a library of SCQs that demonstrated enhanced cytoprotection and improved metabolic stability compared to the clinically used benzoquinone idebenone. Since the toxicity properties of our promising SCQs were unknown, this study developed multiplex methods and generated detailed toxicity profiles from 11 endpoint measurements using the human hepatocarcinoma cell line HepG2. Overall, the toxicity profiles were largely comparable across different assays, with simple standard assays showing increased sensitivity compared to commercial toxicity assays. Within the 11 naphthoquinones tested, the L-phenylalanine derivative 4 consistently demonstrated the lowest toxicity across all assays. The results of this study not only provide useful information about the toxicity features of SCQs but will also enable the progression of the most promising drug candidates towards their clinical use.

Continuous 7-Month Internet of Things-Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study

BACKGROUND

Monitoring during pregnancy is vital to ensure the mother's and infant's health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments.

OBJECTIVE

This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)-based monitoring system.

METHODS

This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period.

RESULTS

Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI -0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period.

CONCLUSIONS

The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up.

EMT signaling: potential contribution of CRISPR/Cas gene editing

Epithelial to mesenchymal transition (EMT) is a complex plastic and reversible cellular process that has critical roles in diverse physiological and pathological phenomena. EMT is involved in embryonic development, organogenesis and tissue repair, as well as in fibrosis, cancer metastasis and drug resistance. In recent years, the ability to edit the genome using the clustered regularly interspaced palindromic repeats (CRISPR) and associated protein (Cas) system has greatly contributed to identify or validate critical genes in pathway signaling. This review delineates the complex EMT networks and discusses recent studies that have used CRISPR/Cas technology to further advance our understanding of the EMT process.

Ca2+ mediates extracellular vesicle biogenesis through alternate pathways in malignancy

Extracellular vesicles (EVs) are small membrane vesicles that serve as important intercellular signalling intermediaries in both malignant and non-malignant cells. For EVs formed by the plasma membrane, their biogenesis is characterized by an increase in intracellular calcium followed by successive membrane and cytoskeletal changes. EV-production is significantly higher in malignant cells relative to non-malignant cells and previous work suggests this is dependent on increased calcium mobilization and activity of calpain. However, calcium-signalling pathways involved in malignant and non-malignant EV biogenesis remain unexplored. Here we demonstrate; malignant cells have high basal production of plasma membrane EVs compared to non-malignant cells and this is driven by a calcium–calpain dependent pathway. Resting vesiculation in malignant cells occurs via mobilization of calcium from endoplasmic reticulum (ER) stores rather than from the activity of plasma membrane calcium channels. In the event of ER store depletion however, the store-operated calcium entry (SOCE) pathway is activated to restore ER calcium stores. Depleting both ER calcium stores and blocking SOCE, inhibits EV biogenesis. In contrast, calcium signalling pathways are not activated in resting non-malignant cells. Consequently, these cells are relatively low vesiculators in the resting state. Following cellular activation however, an increase in cytosolic calcium and activation of calpain increase in EV biogenesis. These findings contribute to furthering our understanding of extracellular vesicle biogenesis. As EVs are key mediators in the intercellular transfer of deleterious cancer traits such as cancer multidrug resistance (MDR), understanding the molecular mechanisms governing their biogenesis in cancer is the crucial first step in finding novel therapeutic targets that circumvent EV-mediated MDR.

A new selective pharmacological enhancer of the Orai1 Ca2+ channel reveals roles for Orai1 in smooth and skeletal muscle functions

Store operated calcium (Ca²⁺) entry is an important homeostatic mechanism in cells, whereby the release of Ca²⁺ from intracellular endoplasmic reticulum stores triggers the activation of a Ca²⁺ influx pathway. Mediated by Orai1, this Ca²⁺ influx has specific and essential roles in biological processes as diverse as lactation to immunity. Although pharmacological inhibitors of this Ca²⁺ influx mechanism have helped to define the role of store operated Ca²⁺ entry in many cellular events, the lack of isoform specific modulators and activators of Orai1 has limited our full understanding of these processes. Here we report the identification and synthesis of an Orai1 activity enhancer that concurrently potentiated Orai1 Ca²⁺ -dependent inactivation (CDI). This unique enhancer of Orai1 had only a modest effect on Orai3 with weak inhibitory effects at high concentrations in intact MCF-7 breast cancer cells. The Orai1 enhancer heightened vascular smooth muscle cell migration induced by platelet-derived growth factor and the unique store operated Ca²⁺ entry pathway present in skeletal muscle cells. These studies show that IA65 is an exemplar for the translation and development of Orai isoform selective agents. The ability of IA65 to activate CDI demonstrates that agents can be developed that can enhance Orai1-mediated Ca²⁺ influx but avoid the cytotoxicity associated with sustained Orai1 activation. IA65 and/or future analogues with similar Orai1 and CDI activating properties could be fine tuners of physiological processes important in specific disease states, such as cellular migration and immune cell function.

ORAI1 and ORAI3 in Breast Cancer Molecular Subtypes and the Identification of ORAI3 as a Hypoxia Sensitive Gene and a Regulator of Hypoxia Responses

The remodeling of specific calcium-permeable ion channels is a feature of some breast cancer subtypes. ORAI1 is a protein that forms a calcium-permeable ion channel responsible for store-operated calcium entry (SOCE) in a variety of cell types. ORAI3, a related isoform, is not a regulator of SOCE in most cell types. However, ORAI3 does control SOCE in many estrogen receptor-positive breast cancer cell lines, where it also controls proliferation. ORAI1 is a well-characterized regulator of the proliferation and migration of many basal breast cancer cells; however, the role of ORAI3 in these types of breast cancer cells remains unclear. Here, we sought to define ORAI1 and ORAI3 expression in breast cancer cell lines of different molecular subtypes and assess the potential role and regulation of ORAI3 in basal breast cancer cells. Our study demonstrates that elevated ORAI1 is a feature of basal-like breast cancers, while elevated ORAI3 is a feature of luminal breast cancers. Intriguingly, we found that ORAI3 is over-expressed in the mesenchymal subtype of triple-negative breast cancer. Given this, we assessed ORAI3 levels in the presence of two inducers of the mesenchymal phenotype, hypoxia and epidermal growth factor (EGF). Hypoxia induced ORAI3 levels in basal breast cancer cell lines through a pathway involving hypoxia-inducible factor-1 alpha (HIF1α. The silencing of ORAI3 attenuated hypoxia-associated phosphorylation of the EGF receptor (EGFR) and the expression of genes associated with cell migration and inflammatory/immune responses in the MDA-MB-468 model of basal breast cancer. Although elevated ORAI3 levels were not associated with survival; basal, estrogen receptor-negative and triple-negative breast cancers with high ORAI3 and low ORAI1 levels were associated with poorer clinical outcomes. This study defines ORAI3 as a potential fine-tuner for processes relevant to the progression of basal breast cancers.

Calcium Signaling in Brain Cancers: Roles and Therapeutic Targeting

Calcium signaling, in addition to its numerous physiological roles, is also implicated in several pathological conditions including cancer. An increasing body of evidence suggest critical roles of calcium signaling in the promotion of different aspects of cancer, including cell proliferation, therapy resistance and metastatic-related processes. In many cases, this is associated with altered expression and/or activity of some calcium channels and pumps. Brain cancers have also been the subject of many of these studies. In addition to diverse roles of calcium signals in normal brain function, a number of proteins involved in calcium transport are implicated to have specific roles in some brain cancers including gliomas, medulloblastoma, neuroblastoma and meningioma. This review discusses research that has been conducted so far to understand diverse roles of Ca²⁺-transporting proteins in the progression of brain cancers, as well as any attempts to target these proteins towards a therapeutic approach for the control of brain cancers. Finally, some knowledge gaps in the field that may need to be further considered are also discussed.

Feasibility of smart wristbands for continuous monitoring during pregnancy and one month after birth

Background

Smart wristbands enable the continuous monitoring of health parameters, for example, in maternity care. Understanding the feasibility and acceptability of these devices in an authentic context is essential. The aim of this study was to evaluate the feasibility of using a smart wristband to collect continuous activity, sleep and heart rate data from the beginning of the second trimester until one month postpartum.

Methods

The feasibility of a smart wristband was tested prospectively through pregnancy in nulliparous women (n = 20). The outcomes measured were the wear time of the device and the participants’ experiences with the smart wristband. The data were collected from the wristbands, phone interviews, questionnaires, and electronic patient records. The quantitative data were analyzed with hierarchical linear mixed models for repeated measures, and qualitative data were analyzed using content analysis.

Results

Participants (n = 20) were recruited at a median of 12.9 weeks of gestation. They used the smart wristbands for an average of 182 days during the seven-month study period. The daily use of the devices was similar during the second (17.9 h, 95% CI 15.2 to 20.7) and third trimesters (16.7 h, 95% CI 13.8 to 19.5) but decreased during the postpartum period (14.4 h, 95% CI 11.4 to 17.4, p = 0.0079). Participants who could not wear smart wristbands at work used the device 300 min less per day than did those with no use limitations. Eight of the participants did not wear the devices or wore them only occasionally after giving birth. Nineteen participants reported that the smart wristband did not have any permanent effects on their behavior. Problems with charging and synchronizing the devices, perceiving the devices as uncomfortable, or viewing the data as unreliable, and the fear of scratching their babies with the devices were the main reasons for not using the smart wristbands.

Conclusions

A smart wristband is a feasible tool for continuous monitoring during pregnancy. However, the daily use decreased after birth. The results of this study may support the planning of future studies and help with overcoming barriers related to the use of smart wristbands on pregnant women.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2187-9) contains supplementary material, which is available to authorized users.

Pharmacological inhibition of store-operated calcium entry in MDA-MB-468 basal A breast cancer cells: consequences on calcium signalling, cell migration and proliferation

Store-operated Ca2+ entry is a pathway that is remodelled in a variety of cancers, and altered expression of the components of store-operated Ca2+ entry is a feature of breast cancer cells of the basal molecular subtype. Studies of store-operated Ca2+ entry in breast cancer cells have used non-specific pharmacological inhibitors, complete depletion of intracellular Ca2+ stores and have mostly focused on MDA-MB-231 cells (a basal B breast cancer cell line). These studies compared the effects of the selective store-operated Ca2+ entry inhibitors Synta66 and YM58483 (also known as BTP2) on global cytosolic free Ca2+ ([Ca2+]CYT) changes induced by physiological stimuli in a different breast cancer basal cell line model, MDA-MB-468. The effects of these agents on proliferation as well as serum and epidermal growth factor (EGF) induced migration were also assessed. Activation with the purinergic receptor activator adenosine triphosphate, produced a sustained increase in [Ca2+]CYT that was entirely dependent on store-operated Ca2+ entry. The protease activated receptor 2 activator, trypsin, and EGF also produced Ca2+ influx that was sensitive to both Synta66 and YM58483. Serum-activated migration of MDA-MB-468 breast cancer cells was sensitive to both store-operated Ca2+ inhibitors. However, proliferation and EGF-activated migration was differentially affected by Synta66 and YM58483. These studies highlight the need to define the exact mechanisms of action of different store-operated calcium entry inhibitors and the impact of such differences in the control of tumour progression pathways.

An SAR study of hydroxy-trifluoromethylpyrazolines as inhibitors of Orai1-mediated store operated Ca2+ entry in MDA-MB-231 breast cancer cells using a convenient Fluorescence Imaging Plate Reader assay

The proteins Orai1 and STIM1 control store-operated Ca²⁺ entry (SOCE) into cells. SOCE is important for migration, invasion and metastasis of MDA-MB-231 human triple negative breast cancer (TNBC) cells and has been proposed as a target for cancer drug discovery. Two hit compounds from a medium throughput screen, displayed encouraging inhibition of SOCE in MDA-MB-231 cells, as measured by a Fluorescence Imaging Plate Reader (FLIPR) Ca²⁺ assay. Following NMR spectroscopic analysis of these hits and reassignment of their structures as 5-hydroxy-5-trifluoromethylpyrazolines, a series of analogues was prepared via thermal condensation reactions between substituted acylhydrazones and trifluoromethyl 1,3-dicarbonyl arenes. Structure-activity relationship (SAR) studies showed that small lipophilic substituents at the 2- and 3-positions of the RHS and 2-, 3- and 4-postions of the LHS terminal benzene rings improved activity, resulting in a novel class of potent and selective inhibitors of SOCE.

Assessment of CXC ligand 12-mediated calcium signalling and its regulators in basal-like breast cancer cells

CXC ligand (L)12 is a chemokine implicated in the migration, invasion and metastasis of cancer cells via interaction with its receptors CXC chemokine receptor (CXCR)4 and CXCR7. In the present study, CXCL12-mediated Ca²⁺ signalling was compared with two basal-like breast cancer cell lines, MDA-MB-231 and MDA-MB-468, which demonstrate distinct metastatic potential. CXCL12 treatment induced Ca²⁺ responses in the more metastatic MDA-MB-231 cells but not in the less metastatic MDA-MB-468 cells. Assessment of mRNA levels of CXCL12 receptors and their potential modulators in both cell lines revealed that CXCR4 and CXCR7 levels were increased in MDA-MB-231 cells compared with MDA-MB-468 cells. Cluster of differentiation (CD)24, the negative regulator of CXCL12 responses, demonstrated increased expression in MDA-MB-468 cells compared with MDA-MB-231 cells, and the two cell lines expressed comparable levels of hypoxia-inducible factor (HIF)2α, a CXCR4 regulator. Induction of epithelial-mesenchymal transition (EMT) by epidermal growth factor exhibited opposite effects on CXCR4 mRNA levels compared with hypoxia-induced EMT. Neither EMT inducer exhibited an effect on CXCR7 expression, however hypoxia increased HIF2α expression levels in MDA-MB-468 cells. Analysis of the gene expression profiles of breast tumours revealed that the highest expression levels of CXCR4 and CXCR7 were in the Claudin-Low molecular subtype, which is markedly associated with EMT features.

TRPC1 is a differential regulator of hypoxia-mediated events and Akt signalling in PTEN-deficient breast cancer cells

Hypoxia is a feature of the tumour microenvironment that promotes invasiveness, resistance to chemotherapeutics and cell survival. Our studies identify the transient receptor potential canonical-1 (TRPC1) ion channel as a key component of responses to hypoxia in breast cancer cells. This regulation includes control of specific epithelial to mesenchymal transition (EMT) events and hypoxia-mediated activation of signalling pathways such as activation of the EGFR, STAT3 and the autophagy marker LC3B, through hypoxia-inducible factor-1α (HIF1α)-dependent and -independent mechanisms. TRPC1 regulated HIF1α levels in PTEN-deficient MDA-MB-468 and HCC1569 breast cancer cell lines. This regulation arises from effects on the constitutive translation of HIF1α under normoxic conditions via an Akt-dependent pathway. In further support of the role of TRPC1 in EMT, its expression is closely associated with EMT- and metastasis-related genes in breast tumours, and is enhanced in basal B breast cancer cell lines. TRPC1 expression is also significantly prognostic for basal breast cancers, particularly those classified as lymph node positive. The defined roles of TRPC1 identified here could be therapeutically exploited for the control of oncogenic pathways in breast cancer cells.

The Internet of Things for basic nursing care-A scoping review

BACKGROUND

The novel technology of the Internet of Things (IoT) connects objects to the Internet and its most advanced applications refine obtained data for the user. We propose that Internet of Things technology can be used to promote basic nursing care in the hospital environment by improving the quality of care and patient safety.

OBJECTIVES

To introduce the concept of Internet of Things to nursing audience by exploring the state of the art of Internet of Things based technology for basic nursing care in the hospital environment.

DATA SOURCES AND REVIEW METHODS

Scoping review methodology following Arksey & O'Malley's stages from one to five were used to explore the extent, range, and nature of current literature. We searched eight databases using predefined search terms. A total of 5030 retrievals were found which were screened for duplications and relevancy to the study topic. 265 papers were chosen for closer screening of the abstracts and 93 for full text evaluation. 62 papers were selected for the review. The constructs of the papers, the Internet of Things based innovations and the themes of basic nursing care in hospital environment were identified.

RESULTS

Most of the papers included in the review were peer-reviewed proceedings of technological conferences or articles published in technological journals. The Internet of Things based innovations were presented in methodology papers or tested in case studies and usability assessments. Innovations were identified in several topics in four basic nursing care activities: comprehensive assessment, periodical clinical reassessment, activities of daily living and care management.

CONCLUSIONS

Internet of Things technology is providing innovations for the use of basic nursing care although the innovations are emerging and still in early stages. Internet of things is yet vaguely adopted in nursing. The possibilities of the Internet of Things are not yet exploited as well as they could. Nursing science might benefit from deeper involvement in engineering research in the area of health.

Evaluation of known and novel inhibitors of Orai1-mediated store operated Ca2+ entry in MDA-MB-231 breast cancer cells using a Fluorescence Imaging Plate Reader assay

The Orai1 Ca²⁺ permeable ion channel is an important component of store operated Ca²⁺ entry (SOCE) in cells. It's over-expression in basal molecular subtype breast cancers has been linked with poor prognosis, making it a potential target for drug development. We pharmacologically characterised a number of reported inhibitors of SOCE in MDA-MB-231 breast cancer cells using a convenient Fluorescence Imaging Plate Reader (FLIPR) assay, and show that the rank order of their potencies in this assay is the same as those reported in a wide range of published assays. The assay was also used in a screening project seeking novel inhibitors. Following a broad literature survey of classes of calcium channel inhibitors we used simplified ligand structures to query the ZINC on-line database, and following two iterations of refinement selected a novel Orai1-selective dichlorophenyltriazole hit compound. Analogues of this were synthesized and evaluated in the FLIPR assay to develop structure-activity relationships (SAR) for the three domains of the hit; triazole (head), dichlorophenyl (body) and substituted phenyl (tail). For this series, the results suggested the need for a lipophilic tail domain and an out-of-plane twist between the body and tail domains.

Plasma membrane ion channels and epithelial to mesenchymal transition in cancer cells

A variety of studies have suggested that epithelial to mesenchymal transition (EMT) may be important in the progression of cancer in patients through metastasis and/or therapeutic resistance. A number of pathways have been investigated in EMT in cancer cells. Recently, changes in plasma membrane ion channel expression as a consequence of EMT have been reported. Other studies have identified specific ion channels able to regulate aspects of EMT induction. The utility of plasma membrane ion channels as targets for pharmacological modulation make them attractive for therapeutic approaches to target EMT. In this review, we provide an overview of some of the key plasma membrane ion channel types and highlight some of the studies that are beginning to define changes in plasma membrane ion channels as a consequence of EMT and also their possible roles in EMT induction.

Janus kinases and Src family kinases in the regulation of EGF-induced vimentin expression in MDA-MB-468 breast cancer cells

Epithelial-mesenchymal transition (EMT) is an important process associated with the metastasis of breast cancer cells. Members of the Janus kinases (JAKs) and Src family kinases (SFKs) are implicated in the regulation of an invasive phenotype in various cancer cell types. Using the pharmacological inhibitors JAK Inhibitor I (a pan-JAK inhibitor) and PP2 we investigated the role of the JAKs and SFKs, respectively, in the regulation of EMT markers in the MDA-MB-468 breast cancer cell line model of epidermal growth factor (EGF)-induced EMT. We identified selective inhibition of EGF induction of the mesenchymal marker vimentin by PP2 and JAK Inhibitor I. The effect of JAK Inhibitor I on vimentin protein induction occurred at a concentration lower than that required to significantly inhibit EGF-mediated signal transducer and activator of transcription 3 (STAT3)-phosphorylation, suggesting involvement of a STAT3-independent mechanism of EGF-induced vimentin regulation by JAKs. Despite our identification of a role for the JAK family in EGF-induced vimentin protein expression, siRNA-mediated silencing of each member of the JAK family was unable to phenocopy pharmacological inhibition, indicating potential redundancy among the JAK family members in this pathway. While SFKs and JAKs do not represent global regulators of the EMT phenotype, our findings have identified a role for members of these signaling pathways in the regulation of EGF-induced vimentin expression in the MDA-MB-468 breast cancer cell line.

Altered purinergic receptor-Ca²⁺ signaling associated with hypoxia-induced epithelial-mesenchymal transition in breast cancer cells

Hypoxia is a feature of the microenvironment of many cancers and can trigger epithelial-mesenchymal transition (EMT), a process by which cells acquire a more invasive phenotype with enriched survival. A remodeling of adenosine 5'-triphosphate (ATP)-induced Ca(2+) signaling via purinergic receptors is associated with epidermal growth factor (EGF)-induced EMT in MDA-MB-468 breast cancer cells. Here, we assessed ATP-mediated Ca(2+) signaling in a model of hypoxia-induced EMT in MDA-MB-468 cells. Like EGF, hypoxia treatment (1% O2) was also associated with a significant reduction in the sensitivity of MDA-MB-468 cells to ATP (EC50 of 0.5 μM for normoxic cells versus EC50 of 5.8 μM for hypoxic cells). Assessment of mRNA levels of a panel of P2X and P2Y purinergic receptors following hypoxia revealed a change in levels of a suite of purinergic receptors. P2X4, P2X5, P2X7, P2Y1 and P2Y11 mRNAs decreased with hypoxia, whereas P2Y6 mRNA increased. Up-regulation of P2Y6 was a common feature of both growth factor- and hypoxia-induced models of EMT. P2Y6 levels were also significantly increased in basal-like breast tumors compared to other subtypes and breast cancer patients with higher P2Y6 levels showed reduced overall survival rates. P2Y6 siRNA-mediated silencing and the P2Y6 pharmacological inhibitor MRS2578 reduced hypoxia-induced vimentin protein expression in MDA-MB-468 cells. P2Y6 inhibition also reduced the migration of mesenchymal-like MDA-MB-231 breast cancer cells. The up-regulation of P2Y6 appears to be a common feature of the mesenchymal phenotype of breast cancer cells and inhibition of this receptor may represent a novel therapeutic target in breast cancer metastasis.

Abstract P2-07-05: A potential role for Janus protein tyrosine kinases in the regulation of epithelial-mesenchymal transition in a model of epidermal growth factor induced breast cancer epithelial-mesenchymal transition

Background. Epithelial-mesenchymal transition (EMT), a process whereby tumorigenic epithelial cells acquire an invasive and migratory phenotype, is an important event in the invasion-metastasis cascade. As such, intracellular signaling pathways involved in the regulation of EMT represent potential therapeutic targets in the treatment and prevention of invasive cancer subtypes. The calcium ion, a highly versatile intracellular messenger, plays an important role in processes important in tumorigenesis including invasion and metastasis, and altered calcium signaling has been identified in various cancers. We recently identified that activation of signal transducer and activator of transcription 3 (STAT3) and expression of specific EMT markers in the MDA-MB-468 cell line model of epidermal growth factor (EGF) induced EMT display some calcium dependence. While the calcium permeable ion channel TRPM7 was shown to partially regulate this STAT3 activation and vimentin expression, the precise mechanisms of their regulation are not yet fully understood. The aim of this research was to investigate the upstream intracellular signaling pathway involved in EGF stimulated STAT3 activation and the subsequent induction of EMT in this model.

Methods. MDA-MB-468 basal-like breast cancer cells were pre-treated for 1 hr with the Janus protein tyrosine kinase (JAK) inhibitor, JAK inhibitor I (1 and 10 μM), or the Src family tyrosine kinase inhibitor, PP2 (0.1, 1 and 10 μM), followed by stimulation with EGF (50 ng/mL) for 10 or 20 min, and 24 h to assess effects on STAT3 activation and/or EMT marker expression, respectively. Total cellular protein was isolated following inhibitor treatment ± EGF stimulation, and the level of phosphorylated STAT3 (10 or 20 min) or vimentin protein expression (24 h), was analyzed using Western blotting. Cellular RNA was isolated following inhibitor treatment ± EGF stimulation and levels of vimentin mRNA (24 h) were assessed using real time RT-PCR.

Results. Treatment of MDA-MB-468 breast cancer cells with JAK inhibitor I resulted in a significant decrease in EGF stimulated STAT3 phosphorylation, while inhibition of Src family tyrosine kinases with PP2 also significantly decreased EGF stimulated STAT3 phosphorylation. In addition to its effects on STAT3 phosphorylation, pre-treatment of MDA-MB-468 cells with JAK inhibitor I also appeared to decrease EGF-induced vimentin protein and mRNA expression, indicating a potential role for Janus protein tyrosine kinases in the induction of EMT in this model.

Conclusions. Janus protein tyrosine kinase signaling appears to play a role in the regulation of STAT3 activation, and the induction of the EMT marker vimentin in the MDA-MB-468 cell line model of EGF-induced EMT. Future studies will focus on investigating the specific JAK family member(s) involved in the EGF-STAT3 signaling pathway, as well as the nexus between calcium and identified regulators of EGF stimulated STAT3 activation, and EMT marker expression, in this model of breast cancer EMT.

Citation Format: Teneale A Stewart, Iman Azimi, Felicity M Davis, Erik W Thompson, Andrew J Brooks, Sarah J Roberts-Thomson, Gregory R Monteith. A potential role for Janus protein tyrosine kinases in the regulation of epithelial-mesenchymal transition in a model of epidermal growth factor induced breast cancer epithelial-mesenchymal transition [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-07-05.

Calcium influx pathways in breast cancer: opportunities for pharmacological intervention

Ca(2+) influx through Ca(2+) permeable ion channels is a key trigger and regulator of a diverse set of cellular events, such as neurotransmitter release and muscle contraction. Ca(2+) influx is also a regulator of processes relevant to cancer, including cellular proliferation and migration. This review focuses on calcium influx in breast cancer cells as well as the potential for pharmacological modulators of specific Ca(2+) influx channels to represent future agents for breast cancer therapy. Altered expression of specific calcium permeable ion channels is present in some breast cancers. In some cases, such changes can be related to breast cancer subtype and even prognosis. In vitro and in vivo models have now helped identify specific Ca(2+) channels that play important roles in the proliferation and invasiveness of breast cancer cells. However, some aspects of our understanding of Ca(2+) influx in breast cancer still require further study. These include identifying the mechanisms responsible for altered expression and the most effective therapeutic strategy to target breast cancer cells through specific Ca(2+) channels. The role of Ca(2+) influx in processes beyond breast cancer cell proliferation and migration should become the focus of studies in the next decade.

Assessment of ORAI1-mediated basal calcium influx in mammary epithelial cells

BACKGROUND

The entry of calcium ions into mammary gland epithelial cells is one of the least well-understood processes in the transport of calcium into milk during lactation. The store-operated calcium entry channel ORAI1, has been suggested as a potential mechanism for the entry of Ca(2+) into mammary gland epithelial cells from the maternal blood supply during lactation. The down regulation of the canonical ORAI1 activator STIM1 during lactation suggests that other known ORAI activators such as STIM2 and SPCA2 may be important during lactation.

RESULTS

Differentiation of HC11 mammary gland epithelial cells was associated with enhanced basal Ca(2+) influx. Silencing of Orai1 abolished this enhancement of Ca(2+) influx. Stim2 had a modest effect on Ca(2+) influx in this in vitro model of lactation, whereas Stim1 and Spca2 silencing had no effect. Despite pronounced increases in Spca2 mRNA during lactation there was no change in the generation of the alternative splice product generated by Mist1, which increases during lactation.

CONCLUSIONS

These studies support the hypothesis that lactation is associated with a remodelling of Ca(2+) influx and this is associated with enhancement of basal Ca(2+) influx. This enhanced Ca(2+) influx appears to occur through the calcium channel Orai1.