Impact of Dosimetric Parameters on Local Control and Toxicity of Head and Neck SBRT

PURPOSE/OBJECTIVE(S)

SBRT is potentially useful as a local therapy for head and neck cancer patients who require re-irradiation, as well as those who may not be candidates for surgical resection or a lengthy course of conventionally fractionated radiation therapy. The objective of this study was to assess rates of local control with SBRT, as well as the impact of mucosal dosimetric parameters on rates of grade 3 or higher toxicity in patients treated with head and neck SBRT.

MATERIALS/METHODS

We retrospectively reviewed patients within our institution who underwent SBRT for cancers of the oral cavity and oropharynx between 2013 and 2022. Primary endpoints were local control (LC) and grade 3 or higher toxicity potentially attributable to SBRT, based on CTCAE 5.0. We analyzed the following endpoints as potential predictors of toxicity: 1) ratio of total oral mucosal volume/oral mucosal volume outside of PTV, 2) mean dose to oral mucosa, and 3) maximum dose to oral mucosa. We conducted regression analysis to determine predictors of local failure and severe toxicity. We estimated local control using Kaplan-Meier analysis.

RESULTS

We treated 66 tumors in 60 patients with a median age of 71 years. 41 patients (68.3%) had oral cavity cancer and 19 (31.6%) had oropharynx cancer. 64 tumors (97.0%) were squamous cell carcinomas. 32 tumors (48.5%) were previously irradiated. Mean PTV volume was 55 cc (range: 39.4-74.1 ccs). Median prescribed radiation dose was 40 Gy given in 5 biweekly fractions. A total of 51 patients received systemic therapy (platinum-based chemotherapy in 52%, Cetuximab in 38%). 10 patients (16.7%) additionally received immunotherapy, constituting 56% of 18 patients treated from 2019-2022. Median pain score at presentation was 3/10. Oral pain non-significantly increased between 3 weeks and 3 months after starting treatment and subsequently returned to baseline after SBRT (P = 0.227). Local control was 68.5%, at a median follow up of 9.8 months. In oral cavity tumors, 1- and 2-year local control rates were 78.7% and 43.1% respectively. 1- and 2-year rates of LC were 78.9% and 50.2% in oropharynx tumors. Grade 3 or higher toxicities were present in 18 patients (30.0%), including osteonecrosis in 6 (10.0%) and ulceration or extensive tissue necrosis in 12 (20.0%). No significant relationship was present between mucosal surface radiation doses and acute oral mucosa toxicity. On regression analysis for both local control and grade 3 or higher toxicity, we did not find any significant association with prior radiation, disease site, age, or PTV volume.

CONCLUSION

SBRT provided comparable local control for tumors of the oropharynx and oral cavity, with slightly higher 2-year local control in tumors of the oropharynx, and comparable rates of toxicity. We appreciated increased use of immunotherapy in our study population from 2019 onwards. We did not find any relationships between dosimetric parameters and rates of grade 3 or higher toxicity, or local control, though our analysis is limited by a small sample size.

Development of the Wheat Practical Haplotype Graph Database as a Resource for Genotyping Data Storage and Genotype Imputation

To improve the efficiency of high-density genotype data storage and imputation in bread wheat (Triticum aestivum L.), we applied the Practical Haplotype Graph (PHG) tool. The Wheat PHG database was built using whole-exome capture sequencing data from a diverse set of 65 wheat accessions. Population haplotypes were inferred for the reference genome intervals defined by the boundaries of the high-quality gene models. Missing genotypes in the inference panels, composed of wheat cultivars or recombinant inbred lines genotyped by exome capture, genotyping-by-sequencing (GBS), or whole-genome skim-seq sequencing approaches, were imputed using the Wheat PHG database. Though imputation accuracy varied depending on the method of sequencing and coverage depth, we found 92% imputation accuracy with 0.01× sequence coverage, which was slightly lower than the accuracy obtained using the 0.5× sequence coverage (96.6%). Compared to Beagle, on average, PHG imputation was ∼3.5% (P-value < 2 × 10⁻¹⁴) more accurate, and showed 27% higher accuracy at imputing a rare haplotype introgressed from a wild relative into wheat. We found reduced accuracy of imputation with independent 2× GBS data (88.6%), which increases to 89.2% with the inclusion of parental haplotypes in the database. The accuracy reduction with GBS is likely associated with the small overlap between GBS markers and the exome capture dataset, which was used for constructing PHG. The highest imputation accuracy was obtained with exome capture for the wheat D genome, which also showed the highest levels of linkage disequilibrium and proportion of identity-by-descent regions among accessions in the PHG database. We demonstrate that genetic mapping based on genotypes imputed using PHG identifies SNPs with a broader range of effect sizes that together explain a higher proportion of genetic variance for heading date and meiotic crossover rate compared to previous studies.

Home used, patient self-managed, brain-computer interface for the management of central neuropathic pain post spinal cord injury: usability study

BACKGROUND

Central Neuropathic Pain (CNP) is a frequent chronic condition in people with spinal cord injury (SCI). Previously, we showed that using laboratory brain-computer interface (BCI) technology for neurofeedback (NFB) training, it was possible to reduce CNP in people with SCI. In this study, we show results of patient self-managed treatment in their homes with a BCI-NFB using a consumer EEG device.

METHODS

Users: People with chronic SCI (17 M, 3 F, 50.6 ± 14.1 years old), and CNP ≥4 on a Visual Numerical Scale.

LOCATION

Laboratory training (up to 4 sessions) followed by home self-managed NFB. User Activity: Upregulating the EEG alpha band power by 10% above a threshold and at the same time downregulating the theta and upper beta (20-30 Hz) band power by 10% at electrode location C4. Technology: A consumer grade multichannel EEG headset (Epoch, Emotiv, USA), a tablet computer and custom made NFB software.

EVALUATION

EEG analysis, before and after NFB assessment, interviews and questionnaires.

RESULTS

Effectiveness: Out of 20 initially assessed participants, 15 took part in the study. Participants used the system for 6.9 ± 5.5 (median 4) weeks. Twelve participants regulated their brainwaves in a frequency specific manner and were most successful upregulating the alpha band power. However they typically upregulated power around their individual alpha peak (7.6 ± 0.8 Hz) that was lower than in people without CNP. The reduction in pain experienced was statistically significant in 12 and clinically significant (greater than 30%) in 8 participants. Efficiency: The donning was between 5 and 15 min, and approximately 10-20% of EEG data recorded in the home environment was noise. Participants were mildly stressed when self-administering NFB at home (2.4 on a scale 1-10). User satisfaction: Nine participants who completed the final assessment reported a high level of satisfaction (QUESQ, 4.5 ± 0.8), naming effectiveness, ease of use and comfort as main priorities. The main factors influencing frequency of NFB training were: health related issues, free time and pain intensity.

CONCLUSION

Portable NFB is a feasible solution for home-based self-managed treatment of CNP. Compared to pharmacological treatments, NFB has less side effects and provides users with active control over pain.

TRIAL REGISTRATION

GN15NE124 , Registered 9th June 2016.

Identification of a candidate gene for a QTL for spikelet number per spike on wheat chromosome arm 7AL by high-resolution genetic mapping

A high-resolution genetic map combined with haplotype analyses identified a wheat ortholog of rice gene APO1 as the best candidate gene for a 7AL locus affecting spikelet number per spike. A better understanding of the genes controlling differences in wheat grain yield components can accelerate the improvements required to satisfy future food demands. In this study, we identified a promising candidate gene underlying a quantitative trait locus (QTL) on wheat chromosome arm 7AL regulating spikelet number per spike (SNS). We used large heterogeneous inbred families ( > 10,000 plants) from two crosses to map the 7AL QTL to an 87-kb region (674,019,191-674,106,327 bp, RefSeq v1.0) containing two complete and two partial genes. In this region, we found three major haplotypes that were designated as H1, H2 and H3. The H2 haplotype contributed the high-SNS allele in both H1 × H2 and H2 × H3 segregating populations. The ancestral H3 haplotype is frequent in wild emmer (48%) but rare (~ 1%) in cultivated wheats. By contrast, the H1 and H2 haplotypes became predominant in modern cultivated durum and common wheat, respectively. Among the four candidate genes, only TraesCS7A02G481600 showed a non-synonymous polymorphism that differentiated H2 from the other two haplotypes. This gene, designated here as WHEAT ORTHOLOG OF APO1 (WAPO1), is an ortholog of the rice gene ABERRANT PANICLE ORGANIZATION 1 (APO1), which affects spikelet number. Taken together, the high-resolution genetic map, the association between polymorphisms in the different mapping populations with differences in SNS, and the known role of orthologous genes in other grass species suggest that WAPO-A1 is the most likely candidate gene for the 7AL SNS QTL among the four genes identified in the candidate gene region.

A dust-enshrouded tidal disruption event with a resolved radio jet in a galaxy merger

Tidal disruption events (TDEs) are transient flares produced when a star is ripped apart by the gravitational field of a supermassive black hole (SMBH). We have observed a transient source in the western nucleus of the merging galaxy pair Arp 299 that radiated >1.5 × 10⁵² erg at infrared and radio wavelengths but was not luminous at optical or x-ray wavelengths. We interpret this as a TDE with much of its emission reradiated at infrared wavelengths by dust. Efficient reprocessing by dense gas and dust may explain the difference between theoretical predictions and observed luminosities of TDEs. The radio observations resolve an expanding and decelerating jet, probing the jet formation and evolution around a SMBH.

Uncovering the Genetic Architecture of Seed Weight and Size in Intermediate Wheatgrass through Linkage and Association Mapping

Intermediate wheatgrass [IWG; (Host) Barkworth & D.R. Dewey subsp. ] is being developed as a new perennial grain crop that has a large allohexaploid genome similar to that of wheat ( L.). Breeding for increased seed weight is one of the primary goals for improving grain yield of IWG. As a new crop, however, the genetic architecture of seed weight and size has not been characterized, and selective breeding of IWG may be more intricate than wheat because of its self-incompatible mating system and perennial growth habit. Here, seed weight, seed area size, seed width, and seed length were evaluated across multiple years, in a heterogeneous breeding population comprised of 1126 genets and two clonally replicated biparental populations comprised of 172 and 265 genets. Among 10,171 DNA markers discovered using genotyping-by-sequencing (GBS) in the breeding population, 4731 markers were present in a consensus genetic map previously constructed using seven full-sib populations. Thirty-three quantitative trait loci (QTL) associated with seed weight and size were identified using association mapping (AM), of which 23 were verified using linkage mapping in the biparental populations. About 37.6% of seed weight variation in the breeding population was explained by 15 QTL, 12 of which also contributed to either seed length or seed width. When performing either phenotypic selection or genomic selection for seed weight, we observed the frequency of favorable QTL alleles were increased to >46%. Thus, by combining AM and genomic selection, we can effectively select the favorable QTL alleles for seed weight and size in IWG breeding populations.

An evaluation of the experiences of guide dog owners visiting Scottish veterinary practices

Guide dogs and their owners will visit a veterinary practice at least twice a year. The aim of this study was to evaluate what guide dog owners thought about these visits, in order to identify areas of good practice which could be incorporated into the undergraduate curriculum. Nine guide dog owners volunteered to take part in the study and were interviewed by the primary researcher. Thematic analysis was carried out and several themes were identified: good experiences were highlighted where staff had an understanding of visual impairment and the work of a guide dog; the importance of good communication skills involving the owner in the consultation; the need for veterinary professionals to understand the bond between an owner and guide dog; how medication and information could be provided in a user-friendly format for someone affected by a visual impairment and concerns about costs and decision making for veterinary treatment. This work highlights the importance for veterinary staff to talk to, empathise with and understand the individual circumstances of their clients and identifies areas that should be included in veterinary education to better prepare students for the workplace.

First confirmation of Pseudogymnoascus destructans in British bats and hibernacula

White-nose syndrome (WNS) is a fatal fungal infection of bats in North America caused by Pseudogymnoascus destructans. P. destructans has been confirmed in Continental Europe but not associated with mass mortality. Its presence in Great Britain was unknown. Opportunistic sampling of bats in GB began during the winter of 2009. Any dead bats or samples from live bats with visible fungal growths were submitted to the Animal Health and Veterinary Laboratories Agency for culture. Active surveillance by targeted environmental sampling of hibernacula was carried out during the winter of 2012/2013. Six hibernacula were selected by their proximity to Continental Europe. Five samples, a combination of surface swabs or sediment samples, were collected. These were sent to the Center for Microbial Genetics and Genomics, Northern Arizona University, for P. destructans PCR. Forty-eight incidents were investigated between March 2009 and July 2013. They consisted of 46 bat carcases and 31 other samples. A suspected P. destructans isolate was cultured from a live Daubenton's bat (Myotis daubentonii) sampled in February 2013. This isolate was confirmed by the Mycology Reference Laboratory, Bristol (Public Health England), as P. destructans. A variety of fungi were isolated from the rest but all were considered to be saprophytic or incidental. P. destructans was also confirmed by the Center for Microbial Genetics and Genomics in five of the six sites surveyed.

The influence of central neuropathic pain in paraplegic patients on performance of a motor imagery based Brain Computer Interface

•

Motor imagery based BCI-classifier built on EEG data of paraplegic patients, gives higher classification accuracy in patients with central neuropathic pain compared to patients with no chronic pain.

•

Higher BCI classification accuracy in paraplegic patients with central neuropathic pain is accompanied with stronger event related desynchronisation during motor imagery.

•

BCI classification accuracy between feet and a hand was comparable with classification accuracy between hands, in all three groups of participants.

Objective

The aim of this study was to test how the presence of central neuropathic pain (CNP) influences the performance of a motor imagery based Brain Computer Interface (BCI).

Methods

In this electroencephalography (EEG) based study, we tested BCI classification accuracy and analysed event related desynchronisation (ERD) in 3 groups of volunteers during imagined movements of their arms and legs. The groups comprised of nine able-bodied people, ten paraplegic patients with CNP (lower abdomen and legs) and nine paraplegic patients without CNP. We tested two types of classifiers: a 3 channel bipolar montage and classifiers based on common spatial patterns (CSPs), with varying number of channels and CSPs.

Results

Paraplegic patients with CNP achieved higher classification accuracy and had stronger ERD than paraplegic patients with no pain for all classifier configurations. Highest 2-class classification accuracy was achieved for CSP classifier covering wider cortical area: 82 ± 7% for patients with CNP, 82 ± 4% for able-bodied and 78 ± 5% for patients with no pain.

Conclusion

Presence of CNP improves BCI classification accuracy due to stronger and more distinct ERD.

Significance

Results of the study show that CNP is an important confounding factor influencing the performance of motor imagery based BCI based on ERD.

Immune response of blue mussels (Mytilus edulis) in spawning period following exposure to metals

Not available

Decrease in phagocytosis capacity of hemocyte during spawning in Mytilus edulis: a pilot study

Not available

Extensive perinephric abscess complicated by herpes simplex virus 1 reactivation

A 43-year-old man, admitted with a swollen right thigh, was diagnosed with a deep vein thrombosis. On day 6 he became septic. A CT scan demonstrated a right-sided hydronephrosis and a large retroperitoneal collection. Blood cultures and perinephric pus grew Escherichia coli resistant to amoxicillin only. On day 12 a vesicular rash appeared on the neck and herpes simplex virus 1 (HSV-1) grew on culture. On day 15 an upper leg collection was seen on CT scan. Thigh tissue specimens grew extended-spectrum beta-lactamase (ESBL) producing E coli and HSV-1 was also detected by polymerase chain reaction in the tissue. On day 18 the patient died. This case illustrates an unusual presentation and complication of a perinephric abscess. In critically ill patients herpes simplex reactivation and emergence of multiresistant organisms may occur resulting in treatment failure.

Adenosine A1 receptor mediated suppression of adrenal activity in near-term fetal sheep

Activation of the hypothalamic-pituitary-adrenal (HPA) axis is a critical response to perinatal hypoxia. Recent data show that adenosine appears to inhibit baseline levels of fetal cortisol and to restrict the increase in ACTH and cortisol during moderate hypoxia. Because adenosine increases substantially during profound asphyxia, it is possible, but untested, that counterintuitively it might restrict the HPA response to more severe insults. It is unclear which receptors mediate the effects of adenosine on the HPA axis; however, adenosine A1 receptor activation is important for adaptation to hypoxia. We therefore investigated whether adenosine A1 receptor blockade modulates ACTH and cortisol levels in fetal sheep at 118 to 126 days gestation, randomly allocated to receive an intravenous infusion of either vehicle (vehicle-occlusion, n = 7) or 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, an A1 receptor antagonist, DPCPX-occlusion, n = 7) infused 60 min before and during 10 min of umbilical cord occlusion, or infusion of DPCPX for 70 min without occlusion (DPCPX-sham, n = 6). Experiments were terminated after 72 h. Fetal ACTH levels increased significantly ( P < 0.01) during occlusion, but not sham occlusion, and returned to baseline values by 60 min after occlusion. In the vehicle-occlusion group, fetal cortisol and cortisone plasma levels increased significantly ( P < 0.05) 60 min after the occlusion and returned to baseline values by 24 h. In contrast, there was a marked increase in both fetal cortisol and cortisone during DPCPX infusion before occlusion to a level greater even than the maximum rise seen after occlusion alone. This increase was sustained after occlusion, with increased cortisol levels compared with occlusion alone up to 72 h. In conclusion, fetal cortisol concentrations are suppressed by adenosine A1 receptor activity, largely though a direct adrenal mechanism. This suppression can be partially overcome by supraphysiological stimuli such as asphyxia.

Natural attenuation of a plume from an emplaced coal tar creosote source over 14 years

An emplaced source of coal tar creosote within the sandy Borden research aquifer has documented the long-term (5140 days) natural attenuation for this complex mixture. Plumes of dissolved chemicals were produced by the essentially horizontal groundwater flowing at about 9 cm/day. Eleven chemicals have been extensively sampled seven times using a monitoring network of approximately 280, 14-point multilevel samplers. A model of source dissolution using Raoult's Law adequately predicted the dissolution of 9 of 11 compounds. Mass transformation has limited the extent of the plumes as groundwater has flowed more than 500 m, yet the plumes are no longer than 50 m. Phenol and xylenes have been removed and naphthalene has attenuated from its maximum extent on day 1357. Some compound plumes have reached an apparent steady state and the plumes of other compounds (dibenzofuran and phenanthrene) are expected to continue to expand due to an increasing mass flux and limited degradation potential. Biotransformation is the major process controlling natural attenuation at the site. The greatest organic mass lost is associated with the high solubility compounds. However, the majority of the mass loss for most compounds has occurred in the source zone. Oxygen is the main electron acceptor, yet the amount of organics lost cannot be accounted for by aerobic mineralization or partial mineralization alone. The complex evolution of these plumes has been well documented but understanding the controlling biotransformation processes is still elusive. This study has shown that anticipating bioattenuation patterns should only be considered at the broadest scale. Generally, the greatest mass loss is associated with those compounds that have a high solubility and low partitioning coefficients.

Proteolytic activity during cortical development is distinct from that involved in hypoxic ischemic injury

Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases involved in brain development and the etiology of adult cerebral injuries. In this study, we determined the MMP-2 and 9 responses following hypoxic ischemia (HI) injury in the developing brain. First, we characterized the developmental changes of MMP activity in the rat brain from embryonic day 18 (E18) to postnatal day 120 (P120). MMP-2 activity was high from E18 to P3 and decreased with age (P< or =0.001), while MMP-9 activity was not detectable. MMP-2 immunoreactivity was closely associated with differentiating cortical plate and subplate neurons. Next, we characterized the proteolytic changes after unilateral HI brain injury in 3- (P3) and 21- (P21) day-old rats. Zymography revealed that in the P21 rat brain, MMP-9 activity (150 and 92 kDa forms) was increased at 6 h and remained elevated 24 h post-injury in the ipsilateral injured hemisphere (P< or =0.001), whereas there was a gradual increase in MMP-2 (65 kDa) activity, reaching a peak at 5 days (P< or =0.001). Similarly, quantitative real time polymerase chain reaction (qRT-PCR) indicated significant elevations in MMP-9 and MMP-2 mRNA expression in the injured cortex (P< or =0.05) and hippocampus (P< or =0.05) at 1 and 5 days post-injury, respectively in the P21 rat brain. In the P3 rat brain, zymography results revealed that both pro (92 kDa) and cleaved (87 kDa) MMP-9 activities were upregulated in the ipsilateral injured hemisphere from 6 h to 1 day after injury (P< or =0.001). In contrast, cleaved MMP-2 (60 kDa) was only moderately upregulated at 6 h (P< or =0.01), while pro MMP-2 (65 kDa) levels were unaffected. MMP-9 mRNA expression was also increased at 6 h (P< or =0.05) following injury at P3, whereas MMP-2 expression remained unchanged compared with the uninjured contralateral hemisphere. Immunohistochemistry indicated that MMP-9 protein expression was localized predominantly to neurons and peri-vascular astrocytes in the affected regions at early time points, whereas MMP-2 was present on reactive astrocytes surrounding the infarct at later time points. Together, these results indicate that MMP-2 may be primarily associated with the development and differentiation of cortical plate neurons and wound recovery processes. Conversely, MMP-9 appeared to be associated with more acute processes during the period of lesion development.

Cisplatin alters nitric oxide synthase levels in human ovarian cancer cells: involvement in p53 regulation and cisplatin resistance

The present study determines if (1) basal protein levels of nitric oxide (NO) synthases (eNOS, iNOS, and nNOS) are different in cisplatin-sensitive (OV2008) and counterpart cisplatin-resistant (C13^*) human ovarian cancer cells, (2) cisplatin alters NOS levels, (3) NO donor causes apoptosis and p53 upregulation, (4) NO donor sensitises C13^* cells to cisplatin via p53 upregulation (determined by p53 siRNA gene-knockdown), and (5) inhibition of endogenous NOS alters cisplatin-induced apoptosis. Basal iNOS levels were higher in OV2008 cells than in C13^* cells. Cisplatin upregulated iNOS, but dramatically reduced eNOS and nNOS, in OV2008 cells only. Failure of cisplatin to upregulate iNOS and downregulate eNOS/nNOS in cisplatin-resistant C13^* cells may be an aetiological factor in the development of resistance. The NO donor S-nitroso-N-acetylpenicillamine (SNAP) increased p53 protein levels and induced apoptosis in both cell types, and enhanced cisplatin-induced apoptosis in C13^* cells in a p53-dependent manner (i.e., enhancement blocked by p53 siRNA). Specific iNOS inhibitor 1400W partially blocked cisplatin-induced apoptosis in OV2008 cells. In cisplatin-resistant C13^* cells, blocking all NOSs with N^G-amino-L-arginine dramatically changed these cells from cisplatin-resistant to cisplatin-sensitive, greatly potentiating cisplatin-induced apoptosis. The data suggest important roles for the three NOSs in regulating chemoresistance to cisplatin in ovarian cancer cells.

Characteristics of males over 50 years who present with a fracture: epidemiology and underlying risk factors

Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in fractures of the ankle and 57.8% in those of the hip. The main risk factors associated with osteoporosis were smoking (47.4%), alcohol excess (36.2%), body mass index < 21 (12.8%) and a family history of osteoporosis (8.4%). Immobility, smoking, self-reported alcohol excess, a low body mass index, age >/=72 and loss in height were significantly more common among men with fractures of the hip than in those with fractures elsewhere.

The adequacy of dietary fibre intake in 5-8 year old children

Despite its health implications, the fibre intake of Irish children is unknown. The North/South Ireland Food Consumption Survey indicated that 77% of Irish adults do not consume adequate fibre and surveys of children and adolescents in Canada and Sweden have confirmed suboptimal fibre intake in these groups. This study undertook to assess fibre intake and the incidence of constipation in Irish children aged 5-8 years. Children admitted to hospital with an acute self-limiting medical illness were included in the study. Three day food diaries were recorded on discharge from hospital. The presence of constipation was ascertained Seventy six per cent of 135 children s diets did not contain adequate fibre. The incidence of constipation was 13.6% in those with inadequate fibre intake as opposed to 6% in those with adequate fibre intake. Poor dietary fibre needs to be addressed in the context of health promotion and disease prevention involving parents, health care professionals and government public policy.

Outcome after surgery for fracture of the hip in patients aged over 95 years

Despite the increase in numbers of the extreme elderly, little data is available regarding their outcome after surgery for fracture of the hip. We performed a prospective study of 50 patients aged 95 years and over who underwent this procedure. Outcome measures included morbidity, mortality, hospital stay, residential and walking status. Comparison was made with a control group of 200 consecutive patients aged less than 95 years who had a similar operation. The mortality at 28 and 120 days was higher (p = 0.005, p = 0.001) in the patients over 95 years. However, the one-year cumulative post-operative mortality was neither significantly different between the two groups (p = 0.229) nor from the standardised mortality rate for the age-matched population (p = 0.445). Predictors of mortality included the ASA grade, the number of comorbid medical conditions and active medical problems on admission. Patients over 95 were unlikely to recover their independence and at a mean follow-up of 29.3 months (12.1 to 48) 96% required permanent institutional care.

Regulation of p53 and suppression of apoptosis by the soluble guanylyl cyclase/cGMP pathway in human ovarian cancer cells

Dysregulated apoptosis plays a critical role in the development of a number of aberrant cellular processes, including tumorigenesis and chemoresistance. However, the mechanisms that govern the normal apoptotic program are not completely understood. Soluble guanylyl cyclase (sGC) and cyclic guanosine monophosphate (cGMP) promote mammalian cell viability via an unknown mechanism and p53 status is a key determinant of cell fate in human ovarian cancer cells. Whether an interaction exists between these two determinants of cell fate is unknown. We hypothesized that basal sGC activity reduces p53 content and attenuates p53-dependent apoptosis in human ovarian cancer cells. Suppression of sGC activity with the specific inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) lowered cGMP content, and increased p53 protein content and induced apoptosis in three ovarian cancer cell lines, effects which were attenuated by the cGMP analog 8-Br-cGMP and by Atrial Natriuretic Factor, an activator of particulate guanylyl cyclase, which circumvent the inhibition of sGC. ODQ prolonged p53 half-life, induced phosphorylation of p53 on Ser15, and upregulated the p53-dependent gene products p21, murine double minute-2, and the proapoptotic, p53-responsive gene product Bax. ODQ activated caspase-3, and ODQ-induced apoptosis was inhibited by overexpression of X-linked inhibitor of apoptosis Protein. Pretreatment with the specific p53 inhibitor pifithrin or downregulation of p53 using a specific small inhibitory RNA significantly attenuated ODQ-induced apoptosis. Moreover, ODQ-induced upregulation of p21 and Bax and ODQ-induced apoptosis were significantly reduced in a p53 mutant cell line relative to the wild-type parental cell line. Thus, the current study establishes that basal sGC/cGMP activity regulates p53 protein stability, content, and function, possibly by altering p53 phosphorylation and stabilization, and promotes cell survival in part through regulation of caspase-3 and p53.