[Cervical CUP Syndrome: Diagnosis and Therapy]

In CUP syndrome (CUP = cancer of unknown primary) there are 1 or more metastases of a primary tumor that cannot be localized despite extensive diagnostics. CUP syndrome accounts for 5% of all human malignancies, making it one of the 10 most common forms of cancer. In addition to inflammatory lymph node enlargement and benign changes such as cervical cysts, lymph node metastases are among the most common cervical masses. Cervical CUP syndrome is a histologically confirmed cervical lymph node metastasis with an unknown primary tumor. In addition to anamnesis, clinical examination and histological confirmation, diagnostics include radiological imaging using PET-CT and panendoscopy with histological primary tumor search. Treatment options include surgical therapy with neck dissection and chemoradiotherapy.

Risk factors for immune-related adverse effects during CPI therapy in patients with head and neck malignancies - a single center study

Introduction

Checkpoint inhibitors, such as PD1 inhibitors, represent an important pillar in the therapy of advanced malignancies of the head and neck region. The most relevant complications are immune-related adverse effects (irAEs), which represent an immense burden for patients. Currently, no sufficient stratification measures are available to identify patients at increased risk of irAEs. The aim of this retrospective study was to examine whether demographic, histopathological, clinical, or laboratory values at the start of CPI therapy represent a risk factor for the later occurrence of autoimmune complications.

Material and methods

Data from 35 patients between 2018 and 2021 who received therapy with nivolumab or pembrolizumab for head and neck malignancy were analyzed and assessed for any associations with the subsequent occurrence of irAEs.

Results

IrAE developed in 37% of patients, with pneumonitis being the most common form (14%). Pneumonitis was found in patients with an average significantly lower T-stage of primary tumors. An increase in basophilic leukocytes was found in patients with dermatitis later in the course. When thyroiditis developed later, the patients had a higher CPS score and lower monocyte levels.

Discussion

Even though individual laboratory values at the beginning of therapy might show a statistical association with the later occurrence of irAEs, neither demographic, histopathological, nor laboratory chemistry values seem to be able to generate a sound and reliable risk profile for this type of complication. Therefore, patients need to be educated and sensitized to irAEs, and regular screening for irAEs should be carried out.

Rare Case of Tularemia With Preauricular Lymphadenopathy and Conjunctivitis in a 27-Year-Old Male Patient in Germany

Tularemia is a rare disease but shows an approximately 10-fold increase in reported cases over the last 15 years in Germany. Clinical symptoms of acute tularemia infection are various, which often delays diagnosis. This case report gives an overview of the clinical manifestations of acute tularemia and shows the importance of interdisciplinary work to shorten the time from the onset of symptoms to effective treatment in infection with Francisella tularensis. Since some cases of tularemia are life-threatening, early diagnosis is vital. This case report serves as a reminder that rare diseases need to be considered in cervical lymphadenopathy.

[Reconstruction of Head and Neck Defects after Cancer Surgery]

Cancer surgery in the head and neck region often results in complex defects. The reconstructive ladder was developed to guide treatment decisions. In the head and neck region the most straightforward reconstructive technique is often not the most suitable, because it is comprised of many functional and aesthetic subregions that lie close together. If primary closure, secondary wound healing or negative wound pressure therapy are not an option, skin grafting is the next step. Larger or aesthetically and functionally challenging defects are often reconstructed with flap surgery. It is distinguished between local or regional flaps that are rotated or transposed into the defect and distant flaps. The blood supply of local/regional flaps is either random pattern or axial pattern, distant flaps are pedicled or free flaps. The vessels of free flaps are connected to the blood supply in the defect by microvascular anastomoses. The radial forearm flap, the pectoralis major flap and the anterolateral thigh flap are the most common distant flaps in the head and neck region. Preoperative planning is the most important step in reconstructive surgery. The method of reconstruction must be suited to the functional and aesthetic requirements of the defect but also to the morbidity and compliance of the patient and the surgical expertise of the clinic. Not only immediate postoperative complications such as insufficient anastomosis, infections or hematoma but also later, mostly functional complications such as dysphagia or dyspnea must be taken into consideration when planning the reconstruction of a defect in the head and neck region.

Partial replacement of soybean meal with full-fat black soldier fly larvae meal in plant-based nursery diets did not influence fecal Escherichia coli colony forming units or improve fecal consistency when pigs were weaned into non-disinfected pens

At weaning, one hundred pigs (21 d of age; 6.96 ± 0.23 kg BW) were used to determine the effect of partially replacing soybean meal (SBM) in corn- and SBM-based nursery diets on growth performance, fecal scores, Escherichia coli (E. coli) colony forming units (CFU), and cecal mucosal microbial profile when weaned into non-disinfected nursery pens. Pens were randomly assigned to one of four dietary treatments (n = 5): high-complexity (contained highly digestible animal proteins and 10.8% SBM) with and without 3,000 ppm ZnO (HC + and HC-, respectively; representative of commercial diets), low-complexity (corn- and SBM-based; 31.8% SBM; LC), or LC with 30% inclusion of full-fat black soldier fly larvae meal (BSFLM) to partially replace SBM (LCFL; 8.0% SBM). Diets were fed for 14 d (phase I), followed by 4 wk of a common corn-SBM diet (phase II). Fecal E. coli CFU and cecal mucosal microbial 16s rRNA community profiles were assessed 7 d after weaning. During phase I, pigs fed LC and LCFL had lower average daily gains (P < 0.05) than pigs fed HC + and HC-, which were not different. Average daily feed intake was not different for pigs fed LC and LCFL, but lower than for pigs fed HC- (P < 0.001); pigs fed HC + had greater feed intake in phase I vs. all other treatment groups (P < 0.001). Upon nursery exit, only pigs fed LCFL had lower BW than pigs fed HC- (P < 0.05), with intermediate values observed for HC + and LC. Day 3 fecal scores were greater for pigs fed LCFL vs. HC + (P < 0.05) and day 7 E. coli CFU were greater for all treatment groups vs. HC + (P < 0.001). Pigs fed HC- (P < 0.01), LC (P < 0.05), and LCFL (P < 0.05) had lower alpha diversity for cecal mucosal microbiota compared to HC+. At the genus level, pigs fed LC had lower Lactobacillus relative abundance vs. pigs fed HC + (P < 0.01). Therefore, BSFLM can partially replace SBM without sacrificing growth performance vs. nursery pigs fed corn- and SBM-based diets, but both groups had reduced phase I growth performance vs. pigs fed highly digestible diets containing animal proteins when weaned into non-disinfected pens. The BSFLM did not influence fecal E. coli CFU or improve fecal consistency after weaning and therefore, is less effective at minimizing digestive upsets vs. HC + diets.

Artificial intelligence directed development of a digital twin to measure soft tissue shift during head and neck surgery

Digital twins derived from 3D scanning data were developed to measure soft tissue deformation in head and neck surgery by an artificial intelligence approach. This framework was applied suggesting feasibility of soft tissue shift detection as a hitherto unsolved problem. In a pig head cadaver model 104 soft tissue resection had been performed. The surface of the removed soft tissue (RTP) and the corresponding resection cavity (RC) was scanned (N = 416) to train an artificial intelligence (AI) with two different 3D object detectors (HoloLens 2; ArtecEva). An artificial tissue shift (TS) was created by changing the tissue temperature from 7,91±4,1°C to 36,37±1,28°C. Digital twins of RTP and RC in cold and warm conditions had been generated and volumes were calculated based on 3D surface meshes. Significant differences in number of vertices created by the different 3D scanners (HoloLens2 51313 vs. ArtecEva 21694, p<0.0001) hence result in differences in volume measurement of the RTC (p = 0.0015). A significant TS could be induced by changing the temperature of the tissue of RC (p = 0.0027) and RTP (p = <0.0001). RC showed more correlation in TS by heating than RTP with a volume increase of 3.1 μl or 9.09% (p = 0.449). Cadaver models are suitable for training a machine learning model for deformable registration through creation of a digital twin. Despite different point cloud densities, HoloLens and ArtecEva provide only slightly different estimates of volume. This means that both devices can be used for the task.TS can be simulated and measured by temperature change, in which RC and RTP react differently. This corresponds to the clinical behaviour of tumour and resection cavity during surgeries, which could be used for frozen section management and a range of other clinical applications.

In situ regeneration of nasal septal defects using acellular cartilage enhanced with platelet-derived growth factor

Nasal septum defects can currently only be reconstructed using autologous cartilage grafts. In this study, we examine the reconstruction of septal cartilage defects in a rabbit model using porcine decellularized nasal septal cartilage (DNSC) functionalized with recombinant platelet-derived growth factor-BB (PDFG-BB). The supportive function of the transplanted DNSC was estimated by the degree of septum deviation and shrinkage using magnetic resonance imaging (MRI). The biocompatibility of the transplanted scaffolds was evaluated by histology according to international standards. A study group with an autologous septal transplant was used as a reference. In situ regeneration of cartilage defects was assessed by histological evaluation 4 and 16 weeks following DNSC transplantation. A study group with non-functionalized DNSC was introduced for estimation of the effects of PDFG-BB functionalization. DNSC scaffolds provided sufficient structural support to the nasal septum, with no significant shrinkage or septal deviations as evaluated by the MRI. Biocompatibility analysis after 4 weeks revealed an increased inflammatory reaction of the surrounding tissue in response to DNSC as compared to the autologous transplants. The inflammatory reaction was, however, significantly attenuated after 16 weeks in the PDGF-BB group whereas only a slight improvement of the biocompatibility score was observed in the untreated group. In situ regeneration of septal cartilage, as evidenced by the degradation of the DNSC matrix and production of neocartilage, was observed in both experimental groups after 16 weeks but was more pronounced in the PDFG-BB group. Overall, DNSC provided structural support to the nasal septum and stimulated in situ regeneration of the cartilage tissue. Furthermore, PDFG-BB augmented the regenerative potential of DNSC and enhanced the healing process, as demonstrated by reduced inflammation after 16 weeks.

Targeted Treatment of HPV16-positive and -negative SCC Cells With Small Molecule Tyrosine Kinase Inhibitors and Everolimus Affects MMP2 and MMP14 Expression

BACKGROUND/AIM

The rise of targeted therapies in the treatment of head and neck squamous cell carcinoma (HNSCC) has considerably widened the treatment range. Matrix metalloproteinases (MMPs) are key regulators of the tumor development of many cancer entities, which makes them a promising target for new treatment options. We examined the expression patterns of MMP2 and MMP14 in human papillomavirus (HPV)-positive and -negative SCC lines after treatment with small molecule tyrosine kinase inhibitors (TKIs) and a mechanistic target of rapamycin (mTOR) inhibitor in vitro.

MATERIALS AND METHODS

Cells of two human HPV-negative cell lines (UMSCC-11A/-14C) and one HPV-positive cell line (CERV196) were incubated with 20 μmol/l of erlotinib, gefitinib, nilotinib, dasatinib, or everolimus for 24-96 h. Cell proliferation was assessed by proliferation assay and the protein concentrations of MMP2 and MMP14 by sandwich enzyme-linked immunosorbent assay. For statistical analysis, the results were compared with those of untreated SCC cells.

RESULTS

MMP2 and MMP14 were expressed in all three tested cell lines; expression levels were highest in the UMSCC-14C cell line. The tested TKIs significantly (p<0.05) reduced MMP2 expression in the UMSCC-14C cell line. In the HPV-positive cell line, the drugs led to an increase in MMP2 and MMP14 expression.

CONCLUSION

Dysregulations in MMP signaling are involved in tumorigenesis and metastasis of HNSCCs; MMP2 has been noted as a potential biomarker. The expression of MMP2 and MMP14 is influenced effectively by small molecule TKIs and everolimus. Based on our data, future research should concentrate on a better understanding of the interplay between tumor microenvironment and tumor cells in vitro and in vivo.

Prognostic Factors for the Therapeutic Performance of Cisplatin in Head and Neck Malignancies

Introduction

For squamous cell carcinoma of the head and neck (HNSCC), cisplatin is used as primary or adjuvant (radio)chemotherapy. In terms of dosage, two main regimens are used, weekly 40mg/m² or 3-weekly 100mg/m². For an optimal outcome, the highest possible cumulative total dose of cisplatin is aimed for. The selection of the scheme is patient-specific, but the factors for the selection of the optimal scheme have not yet been conclusively researched. The aim of this study was to find correlations between initial laboratory values and the cumulative total dose of cisplatin, as well as any correlations between early laboratory values or their dynamics and later laboratory values or their dynamics to provide support in the selection of the chemo regimen.

Material and Methods

In this retrospective study, the clinical data and laboratory values, namely glomerular filtration rate (GFR), hemoglobin, albumin, leucocyte, erythrocyte and platelet count, over the course of time of 79 patients with HNSCC who had received chemotherapy with cisplatin in our clinic between 2018 and 2021 were evaluated.

Results

Patients on 3-weekly regimens achieved a higher mean cumulative total dose of cisplatin than patients on weekly regimens (214.18 ± 65.95 vs 183.33 ± 65.2 mg/m²). Significant positive correlations were seen for total cumulative dose of cisplatin with initial GFR (p=0.001, Pearson's r=0.364), initial hemoglobin (p=0.035, r=0.237), initial erythrocyte (p=0.002, r=0.337), and initial albumin (p=0.002, r=0.337). There were no significant correlations for initial leucocyte or platelets. Regarding the dynamics of the laboratory values under the first chemo administration, no correlation was found with later laboratory values or dynamics.

Discussion and Conclusion

As in other prospective studies, our retrospective analysis found a higher cumulative total dose in the 3-weekly regimen. As this seems to correlate positively with patient outcome, superiority of the 3-weekly regimen over the weekly regimen can be assumed. Functioning organ systems, especially of the bone marrow and kidneys, are associated with an increased cumulative total dose and can therefore be regarded as predictive factors. Regular monitoring of laboratory values is nevertheless essential throughout the entire course of chemotherapy.

Post-COVID-19 Impairment of the Senses of Smell, Taste, Hearing, and Balance

Background: Various symptoms have been associated with COVID-19, but little is known about the impacts of COVID-19 on the sensory system, risk factors, and the duration of symptoms. This study assesses olfactory, gustatory, hearing, and vestibular systems after COVID-19. Methods: This cross-sectional, single-center study involved 50 patients one to six months after COVID-19 and reports their patient records and the extent, onset, and duration of olfactory, gustatory, hearing, and balance disorders using questionnaires during and after COVID-19. Sensory symptoms were objectively studied using the following clinical tests after COVID-19 Sniffin’ Sticks, taste tests, tone/speech audiometry, and video head impulse test. Results: Post-COVID-19-patients were suffering from olfactory and gustatory impairment for up to six months. According to the Dizziness Handicap Inventory, balance disorders were less noticed: Overall, about 40% of the patients during COVID-19 and nearly all patients recovered within six months. After COVID-19, clinical tests revealed that 75% were suffering from hyposomnia/anosmia, and 20% of all patients reported mild hypogeusia for up to six months. Vestibular disorders and hearing impairment rarely/did not occur. Females were significantly more affected by sensory impairments than males. Conclusions: COVID-19 particularly caused olfactory and gustatory impairment; balance disorders were present too; vestibular and auditory symptoms were negligible.

The effects of creep feed composition and form and nursery diet complexity on small intestinal morphology and jejunal mucosa specific enzyme activities after weaning in pigs

Fifty-six litters from first-parity sows standardized to 12 piglets were used to determine the effects of creep feed composition and form and the provision of low- or high-complexity nursery diets on the evolution of small intestinal histomorphology and jejunal mucosa-specific enzyme activities postweaning. At 5 d of age, litters (initial bodyweight [BW] 2.31 ± 0.61 kg) were assigned to one of four creep feeding regimens (n = 14): 1) commercial creep feed (COM), 2) liquid milk replacer (LMR), 3) pelleted milk replacer (PMR), or 4) no creep feed (NO). At weaning (21 d of age), six pigs per litter were provided a HIGH- (contained highly digestible animal proteins) or LOW- (contained corn and soybean meal as main protein sources) complexity nursery diet (n = 7). At 21, 28, and 59 d of age, two pigs per pen (one castrated male and one female) were euthanized, and ileal and jejunal segments for histomorphological measurements and jejunal mucosal scrapings were collected to determine specific mucosa enzyme activities. At weaning, pigs provided COM had a greater ileal absorptive capacity (M) than LMR or NO, which were not different (14.1 vs. 10.4 and 10.5 ± 0.9 μm²; P < 0.05); PMR was intermediate. On days 28 and 59, M was not different among pigs regardless of creep feed treatments. Pigs fed LOW had reduced jejunal villus height (VH; P < 0.001) and M (P < 0.001) on day 28 vs. day 21. The VH and M were not different for pigs fed HIGH or LOW by the end of the nursery period. For all dietary treatments except COM-HIGH and COM-LOW, jejunal mucosal maltase-specific activity was not different between days 21 and 28 of age but greater on day 59 (P < 0.05). For pigs that received COM-HIGH, maltase-specific activity was not different between days 21 and 28 but greater on day 59 than day 28 (P < 0.05). For pigs that received COM-LOW, maltase-specific activity was not different between days 21, 28, and 59. Regardless of creep or nursery treatment, sucrase-specific activity was the greatest on day 59, followed by days 21 and 28 (P < 0.001), and lactase-specific activity was greater on day 21 than on days 28 and 59 (P < 0.001), which were not different. Therefore, pigs that provided LOW diet had greater villus atrophy and reduced M during the first week after weaning vs. pigs that provided HIGH, regardless of creep feeding regimen, but were able to recover by the end of the nursery period.

After weaning, the piglet digestive tract must adapt in order to effectively break down and absorb nutrients derived from plant-based ingredients, contributing to the postweaning growth lag. Feeding strategies applied both preweaning and postweaning with the intent to assist in intestinal adaptation have been developed; however, little work has been done examining the interaction between creep and nursery feeding strategies on intestinal histomorphology and jejunal mucosa-specific enzyme activities after weaning. In the current study, piglets that provided creep feed with higher starch content had greater jejunal mucosa maltase-specific enzyme activity and ileal absorptive capacity at weaning. However, these parameters were still negatively affected by weaning, regardless of nursery feeding strategy. Additionally, nursery diets with greater inclusion of soybean meal to replace animal protein sources (low complexity) exacerbated reductions in jejunal absorptive capacity. Conversely, by the end of the nursery period, there were no differences in intestinal histomorphology and jejunal mucosa-specific enzyme activities, regardless of creep or nursery feeding program. Therefore, exposing piglets to starch during creep feeding and reducing the inclusion of soybean meal in nursery diets improved intestinal morphology and mucosa disaccharidase activity directly following weaning, but benefits did not extend to the end of the nursery period.

[Differential diagnosis of intraorbital masses - a narrative review]

OBJECTIVE

Intraorbital masses represent a condition that is frequently threatening for the visual system. A rigorous differential diagnosis is essential to promptly initiate appropriate therapy and optimize prognosis.

MATERIALS/METHODS

Narrative review of current literature and expert recommendations. For further illustration we describe the case of a 71-year-old male admitted to our department three months after sinus surgery. Postoperative intraorbital hematoma of the right orbit had been treated conservatively with antibiotics/corticosteroids, leading to a near-complete unilateral visual loss. The immediate surgical intervention aimed at decompression of the orbit and the optical nerve. Due to the delay, the intervention could not prevent formation of a lipogranuloma. Inflammatory phases associated with the lipogranuloma are successfully managed by conservative treatment based on multidisciplinary recommendations.

RESULTS

In the case reported, delay of surgical therapy acted as a cause of intraorbital lipogranuloma formation. Literature supports our recommendation of immediate surgical intervention in case of acute retrobulbar hematoma. Besides acute conditions, intraorbital masses can be a sign of systemic disease. In every case, a multidisciplinary therapeutic approach is required for adequate management.

CONCLUSIONS

Intraorbital masses can occur as a complication of trauma or e.g. sinus surgery. On the other hand they can be a sign of systemic disease. Timely diagnosis and treatment prevents from visual loss. That is why rigorous differential diagnosis is essential for every discipline managing intraorbital lesions.

Prevalence of subjective impairments of the sense of smell and taste in employees of retirement and nursing homes during SARS-CoV-2 pandemic

Aim

To investigate the usability of querying subjective impairments of the sense of smell and taste in order to improve pre‐test probability in testing for SARS‐CoV‐2. To achieve this, exploring the prevalence of these restrictions in the COVID‐19‐negative population, as well as nasal co‐symptoms.

Design

A cross‐sectional study was carried out as part of the secondary prophylaxis, following the STROBE guidelines of the EQUATOR network.

Methods

In total, 1,734 employees of retirement and nursing homes were tested for COVID‐19 and asked for subjective reduction or loss in the sense of smell and taste, furthermore about nasal co‐symptoms such as nasal obstruction and rhinorrhoea.

Results

All employees tested negative for COVID‐19. Subjective hyposmia and hypogeusia rarely occurred and were usually accompanied by other nasal symptoms such as nasal obstruction. Querying subjective hyposmia/anosmia or hypogeusia/ageusia appears to be a useful anamnestic instrument for the clinical assessment of the probability of SARS‐CoV‐2 infection.

[Professional teamwork and communication in the operating room-A narrative review]

BACKGROUND

A team in the operating room (OR) is a hierarchically structured, gender-mixed group of people belonging to different professional categories. Disparities in the objectives of the different team members under economic pressure to perform, are sources of potential conflict in the daily work routine. This may have a negative impact on patient safety and commercial efficiency of hospital management.

OBJECTIVE

The aim of this summary is to sensitize the reader to the complex of problems in daily life in the OR and to increase awareness of possible approaches to solve the difficulties in an OR. Problem solutions might be approached by improvement of communication and team building.

METHODS

Narrative review of current literature and expert recommendations by a literature search in PubMed and Medline; keywords included teamwork, communication, operating room, team building.

RESULTS AND CONCLUSION

Communication and teamwork in the OR are of immense importance for patient safety and the economic development of a hospital. Improvements in communication structure, among other things due to the implementation of a team time out and moderation from outside (OR manager) offer solutions to avoid conflicts in everyday clinical practice.

Expression of Connexin43 Stimulates Endothelial Angiogenesis Independently of Gap Junctional Communication In Vitro

Connexins (Cx) form gap junctions (GJ) and allow for intercellular communication. However, these proteins also modulate gene expression, growth, and cell migration. The downregulation of Cx43 impairs endothelial cell migration and angiogenetic potential. Conversely, endothelial Cx43 expression is upregulated in an in vivo angiogenesis model relying on hemodynamic forces. We studied the effects of Cx43 expression on tube formation and proliferation in HUVECs and examined its dependency on GJ communication. Expectedly, intercellular communication assessed by dye transfer was linked to Cx43 expression levels in HUVECs and was sensitive to a GJ blockade by the Cx43 mimetic peptide Gap27. The proliferation of HUVECs was not affected by Cx43 overexpression using Cx43 cDNA transfection, siRNA-mediated knockdown of Cx43, or the inhibition of GJ compared to the controls (transfection of an empty vector, scrambled siRNA, and the solvent). In contrast, endothelial tube and sprout formation in HUVECs was minimized after Cx43 knockdown and significantly enhanced after Cx43 overexpression. This was not affected by a GJ blockade (Gap27). We conclude that Cx43 expression positively modulates the angiogenic potential of endothelial cells independent of GJ communication. Since proliferation remained unaffected, we suggest that Cx43 protein may modulate endothelial cell migration, thereby supporting angiogenesis. The modulation of Cx43 expression may represent an exploitable principle for angiogenesis induction in clinical therapy.

Expression Patterns of CD44 and AREG Under Treatment With Selective Tyrosine Kinase Inhibitors in HPV+ and HPV- Squamous Cell Carcinoma

BACKGROUND

We investigated the expression patterns of cluster of differentiation (CD) 44 and amphiregulin (AREG), two signaling molecules essential for cell proliferation and differentiation, under the influence of selective tyrosine kinase inhibitors (TKIs) in human papillomavirus (HPV)⁺ and HPV^- squamous carcinoma cell lines.

MATERIALS AND METHODS

The protein expression of CD44 and AREG was determined by sandwich enzyme-linked immunosorbent assay in HPV^- cell lines UMSCC-11A and UMSCC-14C, and HPV⁺ CERV-196 cells after TKI treatment.

RESULTS

The expression of AREG and CD44 was dependent on the cell line's HPV status. AREG expression increased after incubation with nilotinib in HPV⁺ tumor cells. The expression of CD44 was significantly influenced by all drugs; its expression under selective epidermal growth factor receptor inhibition was mostly reduced, whereas nilotinib led to an exceptional increase of CD44 expression.

CONCLUSION

The selective drug treatment options significantly influenced the expression of CD44 and AREG in HPV^- and HPV⁺ tumor cells, constituting the need for personalized treatment options.

Apoptosis-related Proteins Are Altered by Selective Tyrosine Kinase Inhibitors and Everolimus in HPV-dependent SCC

BACKGROUND

Head and neck squamous cell cancer (HNSCC) affects the oral cavity and the pharynx. The aim of the study was to investigate the effects of selective tyrosine kinase inhibitors (TKIs) erlotinib, gefitinib, nilotinib and dasatinib and the mammalian target of rapamycin (mTOR) inhibitor everolimus on the expression of apoptosis-related proteins caspase-3, FAS cluster of differentiation (CD)-95 and FAS ligand in human papilloma virus (HPV)-dependent squamous cancer.

MATERIALS AND METHODS

Two HPV-negative cell lines (UMSCC-11A/-14C) and one HPV-positive cell line (CERV196) were incubated with TKIs or everolimus and protein concentrations of target proteins were analyzed with enzyme-linked immunosorbent assay (ELISA).

RESULTS

Caspase-3 was affected by the tested TKIs in HPV-positive SCC, whereas FAS CD95 and FAS ligand were influenced in HPV-negative SCC.

DISCUSSION

This is the first study to analyze the influence of TKIs and everolimus on key proteins of apoptosis. Our results provide novel information contributing to a better understanding of the cell biology of HPV-dependent HNSCC and might contribute to the discovery of novel pharmaceutical treatment strategies for HNSCC.

FGF Expression in HPV16-positive and -negative SCC After Treatment With Small-molecule Tyrosine Kinase Inhibitors and Everolimus

BACKGROUND

Targeted therapies in the treatment of head and neck squamous cell carcinoma (HNSCC) are subject to extensive research. Different mutations of genes belonging to the fibroblast growth factor (FGF) family have been detected in HNSCC. In this study, we examined the expression of FGF1 and FGF2 after treatment with small-molecule tyrosine kinase inhibitors (TKIs) and an inhibitor of mechanistic target of rapamycin (mTOR) in vitro using human papillomavirus (HPV)-positive and -negative SCC lines.

MATERIALS AND METHODS

Cells of two human HPV-negative cell lines (UMSCC-11A/-14C) and one HPV-positive cell line (CERV196) were incubated with 20 μmol/l of erlotinib, gefitinib, nilotinib, dasatinib, or everolimus for 24-96 h. Cell proliferation was assessed by proliferation assay and the protein concentrations of FGF1 and FGF2 by sandwich enzyme-linked immunosorbent assay. For statistical analysis, the results were compared with those for untreated HPV-negative SCC cells.

RESULTS

FGF1 and FGF2 were detected in all three tested cell lines. The tested TKIs significantly (p<0.05 reduced) FGF1 expression in the UMSCC-11A cell line within the first 24 h. At later time points, the tested TKIs and everolimus significantly (p<0.05) increased FGF1 and FGF2 expression in HPV-negative and -positive cancer cell lines. The effect was stronger in the HPV-positive cell line.

CONCLUSION

Alterations in FGF signalling are considered to be relevant drivers of tumourigenesis in some HNSCCs. Our results show that the expression of FGF1 and -2 can be influenced effectively by small-molecule TKIs and everolimus. Based on our data, future research should include combinations of specific FGF inhibitors, mTOR inhibitors and other TKIs in the treatment of HNSCC and research on FGF-mediated drug escape mechanisms.

Augmented reality with HoloLens in parotid surgery: how to assess and to improve accuracy

PURPOSE

Augmented reality improves planning and execution of surgical procedures. The aim of this study was to evaluate the feasibility of a 3D augmented reality hologram in live parotic surgery. Another goal was to develop an accuracy measuring instrument and to determine the accuracy of the system.

METHODS

We created a software to build and manually align 2D and 3D augmented reality models generated from MRI data onto the patient during surgery using the HoloLens^® 1 (Microsoft Corporation, Redmond, USA). To assess the accuracy of the system, we developed a specific measuring tool applying a standard electromagnetic navigation device (Fiagon GmbH, Hennigsdorf, Germany).

RESULTS

The accuracy of our system was measured during real surgical procedures. Training of the experimenters and the use of fiducial markers significantly reduced the accuracy of holographic system (p = 0.0166 and p = 0.0132). Precision of the developed measuring system was very high with a mean error of the basic system of 1.3 mm. Feedback evaluation demonstrated 86% of participants agreed or strongly agreed that the HoloLens will play a role in surgical education. Furthermore, 80% of participants agreed or strongly agreed that the HoloLens is feasible to be introduced in clinical routine and will play a role within surgery in the future.

CONCLUSION

The use of fiducial markers and repeated training reduces the positional error between the hologram and the real structures. The developed measuring device under the use of the Fiagon navigation system is suitable to measure accuracies of holographic augmented reality images of the HoloLens.

Effect of Small-molecule Tyrosine Kinase Inhibitors on PDGF-AA/BB and PDGFRα/β Expression in SCC According to HPV16 Status

BACKGROUND

Despite extensive research into new treatment options, the prognosis for head and neck squamous cell carcinoma remains poor. Platelet-derived growth factor (PDGF) is up-regulated in HNSCC and expression levels decrease after surgery, suggesting its role in tumour development. The influence of HPV on the PDGF/PDGF receptor (PDGFR) pathway remains unclear. In this study, we investigated the effect of small-molecule tyrosine kinase inhibitors (TKIs) on the expression of PDGF and its receptor in vitro using squamous cancer cell lines with different human papillomavirus 16 (HPV16) status.

MATERIALS AND METHODS

Two human HPV16-negative cell lines (UMSCC-11A/-14C) and one HPV16-positive cell line (CERV196) were used. Tumour cells were incubated with 20 μmol/l of TKIs nilotinib, dasatinib, afatinib, gefitinib and erlotinib for 24-96 h. Cell proliferation was assessed via proliferation assay and protein concentrations of PDGF-AA and BB and PDGFRα and -β via sandwich enzyme-linked immunosorbent assay. For statistical analysis, the results were compared with those from an untreated negative control.

RESULTS

PDGF-AA/BB and PDGFRα/-β were detected in all three tested cell lines. The addition of TKI led to a significant (p<0.05) decrease of PDGF/PDGFR at different time points and cell lines. The strongest effects were seen for the expression of PDGF-AA, which was consistently inhibited by most drugs. The effects of the TKI were independent of the HPV status.

CONCLUSION

Proteins of this pathway can effectively be inhibited by small molecule TKIs. PDGF-AA seems to be a promising target for future studies with selective TKIs.

Effect of algae or fish oil supplementation and porcine maternal stress on the adrenal transcriptome of male offspring fed a low-quality protein diet

Offspring adrenal function may be negatively affected in utero by maternal stressors such as microbial infection. Maternal supplementation with immunomodulatory compounds such as omega-3 polyunsaturated fatty acids (n-3 PUFA) may help minimize the adverse effects of maternal stress on fetal hypothalamic-pituitary-adrenal development and improve offspring health. Presently, n-3 PUFA sources are primarily fish-based, but n-3 PUFA microalgae (AL) may be an alternative. Previously, it was determined that maternal AL or fish oil (FO) supplementation to sows, in addition to maternal stress induced by Escherichia coli lipopolysaccharide (LPS) challenge appeared to have a greater influence on the stress response of male offspring compared to females. To further elaborate on these findings, this study assessed the effects of maternal AL or FO supplementation combined with a maternal LPS challenge on adrenal gene expression in male offspring fed a nursery diet containing low-quality protein sources. Forty-eight sows were fed gestation diets starting on gestation day (gd) 75 containing either 3.12% AL, 3.1% FO, or a control diet containing 1.89% corn oil. On gd 112, half the sows in each treatment were administered 10 ​μg/kg LPS i.m. Piglets were weaned at 21 days of age onto a common low-quality plant-based protein diet, and one week after weaning, four piglets per sow were administered 40 ​μg/kg LPS i.m. Two hours later, the piglets were euthanized to obtain adrenal tissue, and total RNA was extracted to carry out transcriptome analysis using the Affymetrix GeneChip WT Plus assay and subsequent validation by real-time PCR. Analysis revealed that adrenal steroidogenesis, fatty acid metabolism and immune function were significantly influenced by maternal diet and stress. Increased expression of immune-related genes including lymphocyte antigen 96, TLR-2 and NF-κB suggests that maternal AL supplementation may increase offspring sensitivity to inflammation after weaning. Decreased expression of lymphocyte antigen 96 in male offspring from sows receiving maternal LPS challenge also suggests a possible role of maternal stress in diminishing the offspring immune response to immune stress challenge. Increased expression of the genes encoding the 11BHSD2 enzyme in offspring from sows fed FO may also reduce the magnitude of the stress response. These data provide insight to the immune and metabolic mechanisms that may be influenced by maternal diet and stress.

•

Expression of adrenal steroidogenesis genes were influenced by maternal treatment.

•

Expression of lipid metabolism genes and immune function genes were enriched.

•

Maternal algae supplementation may increase offspring sensitivity to inflammation.

•

Maternal stress may reduce the offspring immune response to immune challenges.

•

Maternal fish oil supplementation may reduce the offspring stress response.

Parity and dietary energy allowance during gestation influence piglet energy status and serum insulin-like growth factor 1 at birth

Over- or under-supplying energy by 15% to gestating sows had minimum consequences for piglet chemical body composition or energy storage (liver and muscle glycogen) at birth, when estimated amino acid requirements were met. Providing gestating sows with energy 15% below versus 15% above requirements increased piglet serum insulin-like growth factor 1 (IGF-1) concentrations at birth (P < 0.05). Piglets from first versus second parity sows had lower serum IGF-1 but greater liver glycogen and body fat. Precisely matching the estimated energy and nutrient requirements throughout gestation and across parities likely improves piglet quality; over-supplying energy appears most detrimental for piglet IGF-1 serum concentrations at birth.

Challenges in the comparative study of empathy and related phenomena in animals

The aim of this review is to discuss recent arguments and findings in the comparative study of empathy. Based on a multidisciplinary approach including psychology and ethology, we review the non-human animal literature concerning theoretical frameworks, methodology, and research outcomes. One specific objective is to highlight discrepancies between theory and empirical findings, and to discuss ambiguities present in current data and their interpretation. In particular, we focus on emotional contagion and its experimental investigation, and on consolation and targeted helping as measures for sympathy. Additionally, we address the feasibility of comparing across species with behavioural data alone. One main conclusion of our review is that animal research on empathy still faces the challenge of closing the gap between theoretical concepts and empirical evidence. To advance our knowledge, we propose to focus more on the emotional basis of empathy, rather than on possibly ambiguous behavioural indicators, and we provide suggestions to overcome the limitations of previous research .

2D THz spectroscopic investigation of ballistic conduction-band electron dynamics in InSb

Using reflective cross-polarized 2D THz time-domain spectroscopy in the range of 1-12 THz, we follow the trajectory of the out-of-equilibrium electron population in the low-bandgap semiconductor InSb. The 2D THz spectra show a set of distinct features at combinations of the plasma-edge and vibration frequencies. Using finite difference time domain simulations combined with a tight binding model of the band structure, we assign these features to electronic nonlinearities and show that the nonlinear response in the first picoseconds is dominated by coherent ballistic motion of the electrons. We demonstrate that this technique can be used to investigate the landscape of the band curvature near the Γ-point, as illustrated by the observation of anisotropy in the (100)-plane.

Identification of macrolide- and rifampicin-resistant Rhodococcus equi in environmental samples from equine breeding farms in central Kentucky during 2018

Rhodococcus equi causes severe pneumonia in foals and is most often recognized in people as an opportunistic pathogen. Longitudinal studies examining antimicrobial-resistant R. equi from environmental samples are lacking. We hypothesized that antimicrobial-resistant R. equi would be detectable in the ground (pasture soil or stall bedding) and air at breeding farms with previous documentation of foals infected with resistant isolates, and that concentrations of resistant isolates would increase over time during the foaling season. In this prospective cohort study, ground and air samples were collected from stalls and paddocks in January, March, May and July of 2018 at 10 horse-breeding farms with history of foal pneumonia attributed to macrolide- or Rifampicin-resistant R. equi. Environmental samples were cultured in the presence and absence of macrolides and Rifampicin to select for resistant organisms. Data were analyzed with linear mixed-effects and Hurdle models. Concentrations of total R. equi in bedding or air of stalls were significantly (P < 0.05) higher in January than other months. The proportion of resistant R. equi in soil samples from paddocks was significantly (P < 0.05) higher than stall bedding during all months. For each month, air samples from paddocks had a significantly (P < 0.05) higher proportion of resistant isolates than those from stalls. Fifty-five percent of resistant soil isolates and 34% of resistant air isolates were considered virulent by identification of the vapA gene. Concentrations of resistant R. equi isolates did not increase over time during the foaling season. Antimicrobial-resistant R. equi can persist in the environment at farms with a history of pneumonia caused by resistant R. equi infections, and exposure to resistant isolates in paddocks and stalls appears stable during the foaling season. Resistant isolates in the environment not only pose a risk for disease but also can serve as a repository for dissemination of resistance genes.

Extraction without tooling around — The first comprehensive description of the foraging- and socio-ecology of wild Goffin’s cockatoos (Cacatua goffiniana)

When tested under laboratory conditions, Goffin’s cockatoos (Cacatua goffiniana) demonstrate numerous sophisticated cognitive skills. Most importantly, this species has shown the ability to manufacture and use tools. However, little is known about the ecology of these cockatoos, endemic to the Tanimbar Islands in Indonesia. Here we provide first insights into the feeding- and socio-ecology of the wild Goffin’s cockatoos and propose potential links between their behaviour in natural settings and their advanced problem-solving capacities shown in captivity. Observational data suggests that Goffin’s cockatoos rely on a large variety of partially seasonal resources. Furthermore, several food types require different extraction techniques. These ecological and behavioural characteristics fall in line with current hypotheses regarding the evolution of complex cognition and innovativeness. We discuss how the efficiency of (extractive) foraging may preclude tool use in wild Goffin’s cockatoos, even though the corresponding cognitive and ecological prerequisites seem to be present.

Tool making cockatoos adjust the lengths but not the widths of their tools to function

The ability to innovatively use or even manufacture different tools depending on a current situation can be silhouetted against examples of stereotyped, inborn tool use/manufacture and is thus often associated to advanced cognitive processing. In this study we confronted non-specialized, yet innovative tool making birds, Goffin's cockatoos (Cacatua goffiniana), with an apparatus featuring an out-of-reach food reward that could be placed at different distances from a tool opening. Alternatively, the food stayed at a constant distance but the tool opening in the front of the apparatus had different diameters. We used a novel material for tool manufacture (cardboard) that demanded an incrementally increased manufacturing effort from the actor, depending on the length of the tool required. We found that our subjects used two strategies to succeed in this tasks: either by making carboard-stripe tools using the full length of the material sheets originally offered or by adjusting the lengths of their tools to different goal distances. Subjects also discarded cardboard stripes that were too short to reach the goal prior to use and discarded longer pieces when the goal was further away than when it was close. Nevertheless, likely due to morphological constraints, the birds failed to adjust the widths of their tools depending on the diameter of the tool opening.

The repeatability of cognitive performance: a meta-analysis

Behavioural and cognitive processes play important roles in mediating an individual's interactions with its environment. Yet, while there is a vast literature on repeatable individual differences in behaviour, relatively little is known about the repeatability of cognitive performance. To further our understanding of the evolution of cognition, we gathered 44 studies on individual performance of 25 species across six animal classes and used meta-analysis to assess whether cognitive performance is repeatable. We compared repeatability (R) in performance (1) on the same task presented at different times (temporal repeatability), and (2) on different tasks that measured the same putative cognitive ability (contextual repeatability). We also addressed whether R estimates were influenced by seven extrinsic factors (moderators): type of cognitive performance measurement, type of cognitive task, delay between tests, origin of the subjects, experimental context, taxonomic class and publication status. We found support for both temporal and contextual repeatability of cognitive performance, with mean R estimates ranging between 0.15 and 0.28. Repeatability estimates were mostly influenced by the type of cognitive performance measures and publication status. Our findings highlight the widespread occurrence of consistent inter-individual variation in cognition across a range of taxa which, like behaviour, may be associated with fitness outcomes.This article is part of the theme issue 'Causes and consequences of individual differences in cognitive abilities'.

Accuracy of predicting chemical body composition of gilts and sows

Physical and chemical body composition of gilts and parity 3 sows were used to determine current prediction equation accuracy and propose alternative prediction equations that incorporate additional variables. Longissimus dorsi muscle depth and parity can be combined with body weight and backfat to improve gilt and sow body composition prediction.

Variability in daily urinary nitrogen excretion of gestating gilts does not affect estimates of nitrogen retention

Daily urinary nitrogen excretion (UN, g d−1) was quantified in gestating gilts during 5 d nitrogen (N) balance periods. Abbreviated collection days (<22 h) can be used in N balance calculations when extrapolated to reflect a complete 24 h collection. Variation in daily UN did not affect overall N retention calculations.

Emergence of coexisting ordered states in active matter systems

Active systems can produce a far greater variety of ordered patterns than conventional equilibrium systems. In particular, transitions between disorder and either polar- or nematically ordered phases have been predicted and observed in two-dimensional active systems. However, coexistence between phases of different types of order has not been reported. We demonstrate the emergence of dynamic coexistence of ordered states with fluctuating nematic and polar symmetry in an actomyosin motility assay. Combining experiments with agent-based simulations, we identify sufficiently weak interactions that lack a clear alignment symmetry as a prerequisite for coexistence. Thus, the symmetry of macroscopic order becomes an emergent and dynamic property of the active system. These results provide a pathway by which living systems can express different types of order by using identical building blocks.

Contrasting plant height can improve the control of rain-borne diseases in wheat cultivar mixture: modelling splash dispersal in 3-D canopies

Background and Aims

Growing cultivars differing by their disease resistance level together (cultivar mixtures) can reduce the propagation of diseases. Although architectural characteristics of cultivars are little considered in mixture design, they could have an effect on disease, in particular through spore dispersal by rain splash, which occurs over short distances. The objective of this work was to assess the impact of plant height of wheat cultivars in mixtures on splash dispersal of Zymoseptoria tritici, which causes septoria tritici leaf blotch.

Methods

We used a modelling approach involving an explicit description of canopy architecture and splash dispersal processes. The dispersal model computed raindrop interception by a virtual canopy as well as the production, transport and interception of splash droplets carrying inoculum. We designed 3-D virtual canopies composed of susceptible and resistant plants, according to field measurements at the flowering stage. In numerical experiments, we tested different heights of virtual cultivars making up binary mixtures to assess the influence of this architectural trait on dispersal patterns of spore-carrying droplets.

Key Results

Inoculum interception decreased exponentially with the height relative to the main inoculum source (lower diseased leaves of susceptible plants), and little inoculum was intercepted further than 40 cm above the inoculum source. Consequently, tall plants intercepted less inoculum than smaller ones. Plants with twice the standard height intercepted 33 % less inoculum than standard height plants. In cases when the height of suscpeptible plants was doubled, inoculum interception by resistant leaves was 40 % higher. This physical barrier to spore-carrying droplet trajectories reduced inoculum interception by tall susceptible plants and was modulated by plant height differences between cultivars of a binary mixture.

Conclusions

These results suggest that mixture effects on spore dispersal could be modulated by an adequate choice of architectural characteristics of cultivars. In particular, even small differences in plant height could reduce spore dispersal.

Clinical Evaluation of a New High-Flux Cellulose Acetate Membrane

One major goal of dialysis therapy has become the removal of ß2-microglobulin (ß2-m). The interdialytic elimination of ß2-m was studied using a newly developed high-flux cellulose acetate (CA) membrane.

The results show that high-flux CA dialyzers offer better biocompatibility than classical Cuprophan or high-flux Cuprophan devices, with regard to leukopenia, C3a desarg generation, and elastase release from polymorphonuclear (PMN) leukocytes. Compared to high-flux CA membranes, high-flux PMMA membranes induce less C3a desarg formation but comparable leukopenia. High-flux PMMA membranes, however cause greater leukocyte stimulation than CA as demonstrated by more PMN elastase release during hemodialysis.

Using high-flux CA or high-flux PMMA membranes, serum ß2-m levels decreased 32% during dialysis. Serum ß2-m dropped 10% with high-flux Cuprophan membranes, but remained unchanged with conventional Cuprophan dialyzers.

Sieving coefficients for ß2-microglobulin (ß2-m) were virtually zero with classical Cuprophan and 0.66 with high-flux cellulose acetate membranes. High-flux membranes made of Cuprophan and PMMA gave coefficients of 0.25 and 0.45, respectively. This indicates the high removal capacity of the new CA-membrane for substances with high molecular weight.

This high-flux CA membrane thus appears to combine a good degree of biocompatibility with a high capacity for ß2-m removal.

Minimization of Hemolysis in Centrifugal Blood Pumps: Influence of Different Geometries

Centrifugal blood pumps are of substantial importance for intraoperative extracorporeal circulation and for temporary cardiac assist. Their development and improvement raises many specific questions, especially on mechanical blood properties, flow distribution, and the resulting biocompatibility. In this comprehensive study the influence of various pump geometries on blood trauma was investigated. For this purpose analytical calculations, hydrodynamic performance, numerical simulation, in vitro hemolysis tests and in vivo experiments were used. The gap between rotor and housing was found to be crucial showing a distinct minimum of hemolysis at a gap of 1.5 mm (in vitro increase of plasma free hemoglobin per 100 ml plasma an hour: ΔfHb/hour = 2.4±0.83 mg%/h at 1.5 mm versus 12 ± 2.2 mg%/h at 2.5 mm; p < 0.05). Housing diameter and shape of the vanes were of less importance for blood traumatization (d = 60 mm: ΔfHb/hour = 6.36 ± 1.8 mg%/h; d = 70 mm: fHb = 7.1 ± 1.9 mg%/h; straight radial vanes: 5.2 ± 1.8 mg%/h; straight inclined vanes: 6.8 ± 1.2 mg%/h; flexed vanes: 6.1 ± 2.0 mg%/h). Three animal experiments confirmed the optimization of geometry, with a mean fHb of 2.5 to 3.2 mg% in steady state. Hydrodynamic efficiency revealed to be a necessary, but not a sufficient and sensitive criterion for hemolysis minimization (e.g. changes of η < 10% for changes of fHb > 500%). Numerical simulation gives an improved insight in flow distribution, but can not yet be applied for quantification of blood trauma. The study supports theories on mechanical hemolysis predicting a hemolysis at shear levels of less than 500N/m2 depending on exposure time.

With the methods used it was possible to develop a pump with very low hemolysis potential. For further reduction of blood trauma and correlated thrombus formation basic studies on cell damage in recirculating blood and also advanced flow studies in rotary pumps would be desirable.

In Vitro Thrombogenicity Testing of Artificial Organs

Thromboembolic complications remain as one of the main problems for blood contacting artificial organs such as heart valves, bloodpumps and others. In vitro evaluation of thrombogenesis in prototypes has not previously been part of the standard evaluation of these devices. In comparison to hemolysis testing, evaluation of the thrombogenic potential is more difficult to perform because of the complexity of the blood coagulation system. We present an in vitro testing procedure that allows the accelerated examination of the thrombogenic potential of different types of blood pumps. Additionally, first results are presented that indicate the reliability of the accelerated clotting test for mechanical heart valves. Results for the centrifugal pump BioMedicus and two microaxial pumps have shown typical thrombus formation at locations such as bearings.

The results indicate that the accelerated clotting test is an excellent addition to the much more expensive animal testing of artificial organs or assist devices. In vitro testing permits studies of thrombus formation to be performed at an early stage and at low costs and also facilitates a more precise investigation of device areas known to be potential hot spots for thrombus formation.

Microspheres Based Detoxification System: In Vitro Study and Mathematical Estimation of Filter Performance

Because of the closed plasma (secondary) circuit in the Microspheres based Detoxification System (MDS), a convective blood purification system, the same amount of filtrated plasma is backfiltrated into the blood circuit. Therefore, there is no direct way to determine the ultrafiltrate production rate, which is an important factor of efficiency. The only possible way to estimate the filtration properties of the filter is to consider pressure values. In this study the pressure distribution in the filter was investigated in vitro. To explain the results and to calculate inaccessible parameters, a mathematical model was estabilshed which also considered the asymmetric behaviour of the filter membrane. The result was a linear pressure gradient, agreement with the measurements was reasonably good (calculated primary pressure loss differes <13% from measured value when using mean measured filter resistance as model parameter). Linear pressure distribution offers the possibility of easily calculating the filtration length, a parameter which can be used to estimate the filter condition. The comparison between calculated filtration and backfiltration rates offers an instrument of control for these values.