The beneficial effect of early and prolonged kangaroo mother care on long-term neuro-developmental outcomes in low birth neonates - A cohort study

AIM

Kangaroo mother care (KMC) has immense short-term benefits, but data on long-term outcomes are scarce. Hence, this study aimed to compare the neurodevelopmental outcomes at 12 months of corrected age (CA) in infants <2000 g receiving early and prolonged KMC to a control group.

METHODS

This was a cohort study that was conducted from January 2017 to November 2018. All neonates<2000 g were eligible for the study. Neonates that received early initiation (<72 h of life) and prolonged KMC comprised the intervention group and were compared to neonates without the intervention. Bayley Scales of Infant and Toddler Development, Third edition (BSID-III) was done at 12 months of CA, and this was analysed using t-test and multi-linear regression analysis.

RESULTS

There were 75 neonates in the intervention and 69 in the control group. Baseline characteristics were comparable. We found higher composite scores for cognition (110.38 ± 9.89 vs. 105.44 ± 8.77, p value = 0.023), language (107.51 ± 10.72 vs. 101.05 ± 12.06, p value = 0.014) and adaptive behaviour (87.97 ± 9.97 vs. 80 ± 9.1, p value<0.001) in the early and prolonged KMC group in comparison to the control group.

CONCLUSION

Infants with early and prolonged KMC have better neurodevelopmental outcomes in terms of cognition, language and adaptive behaviour at 12 months of CA.

46 XY disorder of sex development (DSD) due to 5 alpha (SRD5A2) deficiency - Experience from a multidisciplinary Pediatric Gender Clinic

BACKGROUND

SRD5A2 deficiency leads to incomplete masculinization of individuals with a 46 XY karyotype. A definitive diagnosis in early infancy facilitates decisions concerning choice of sex of rearing and management.

AIM

To review the clinical presentation, diagnosis, treatment and outcome of children with 46 XY DSD due to SRD5A2 deficiency at a Paediatric Gender Clinic.

STUDY DESIGN AND METHODS

Retrospective review of cases of SRD5A2 deficiency (2000-15) managed with a standard protocol at a multidisciplinary clinic. Demographic data, clinical presentation, physical findings, investigations (hormonal profile, imaging, genitoscopy), psychological evaluation (child, family), medical and surgical management, outcome and follow up were collated and analyzed.

RESULTS

There were 12 cases aged 3 days-14 years at presentation, 3 had parental consanguinity. Eight were reared as males and 4 as females. Specialist referral was sought for hypospadias (5), atypical genitalia (5) or incongruent pubertal masculinization (2). All had chordee, symmetrical inguinoscrotal gonads, rugose labioscrotum and proximal hypospadias (perineoscrotal -9, perineal -3). Both pubertal cases had significant masculinization and no gynecomastia. The median testosterone/dihydrotestosterone ratio was 22.1(IQR-8.6-55.7). Despite a classical phenotype, four (2 prepubertal, 2 pubertal) had a ratio <10. Genitoscopy showed urogenital sinus remnant (4) and hypoplastic verumontanum (5). Sex reassignment was done in 4. Surgical management was staged and completed by 4 years in those with infantile presentation. Besides correction of chordee and urethroplasty in 11, other procedures included orchidopexy (5), excision of a urogenital sinus remnant (4) and correction of penoscrotal transposition (4). The urethroplasty was single staged in 3. All operated cases were followed up (mean age at last follow up - 10.63 years, mean follow up period - 7.25 years). The overall cosmetic result was satisfactory, but the phallic structure remained relatively small across prepubertal period. Uroflowmetry curves were normal in 9. All showed penile tumescence/erection and two peripubertal cases had typical secondary sexual characters. All cases, including those with sex reassignment, have a well-adjusted male psyche.

DISCUSSION AND CONCLUSION

The diagnosis, management and longitudinal follow up of cases of SRD5A2 deficiency at a multidisciplinary gender clinic is presented. Diagnostic dilemmas with low T/DHT ratios remained in a third of cases. Most were diagnosed in infancy and assigned a male sex of rearing, all underwent staged masculinizing genitoplasty. Those with sex reassignment also fared well with comprehensive management after family counseling.

Psychological aspects in children and parents of children with chronic kidney disease and their families

Pediatric chronic kidney disease (CKD) is a chronic illness that affects the overall quality of life of patients during childhood. This article highlights the psychological and social burden of CKD in patients and their families. Patients with CKD and their families require comprehensive treatment for psychosocial problems. Therefore, it is crucial for pediatricians to screen for these issues and refer patients and their families for therapy. Tools that are short, easy to administer, and easy to score, such as the Pediatric Quality of Life Inventory or the Childhood Depression Inventory, can be utilized during routine clinical appointments. Reducing the negative impact of CKD on the family will improve the well-being and coping skills of patients and their families.

Acupuncture-D" - Bilateral Pneumothoraces Following Dry Needling

Presentation A 24-year-old newly graduated junior doctor presented to the emergency department with acute onset chest pain, haemoptysis and exertional dyspnoea following a dry needling session. Diagnosis Chest x-ray showed bilateral pneumothoraces, worse on the right side. Treatment The bilateral pneumothoraces were treated conservatively with supplemental oxygen initially. On the second day of admission, repeat chest x-ray demonstrated a worsening right sided pneumothorax. While vitally stable, the patient however had become increasingly dyspnoeic, and a needle aspiration was performed on the right side with good effect. Conclusion The anatomical location targeted along with the patients low-normal BMI makes her high-risk when considering the skin-to-pleura distance. Although the incidence of pneumothorax is low, it is imperative that we improve awareness both for the treating physician and the diagnosing clinician. We must begin to fill the distinct lack in available literature surrounding the potential adverse effects of dry needling.

Parenting Style, Parental Personality, and Child Temperament in Children with Anxiety Disorders-A Clinical Study from India

BACKGROUND

Anxiety disorders are common in children and contribute to adverse developmental outcomes. Although etiological models of child anxiety have identified various environmental factors, very few studies in India have examined these factors in children presenting with anxiety disorders. Therefore, the present study was designed to examine parenting styles, parental personality, and child temperament in children with anxiety disorders in an Indian outpatient setting.

METHODS

In total, 42 children with anxiety disorders and 42 typically developing children, matched on age and gender, were screened using Child Behavior Checklist, Color Progressive Matrices, and Screen for Child Anxiety Related Emotional Disorders Parent version. Their parents were screened using Mini International Neuropsychiatric Interview 5.0, following which they filled the questionnaires for parenting styles, parent personality, and child temperament.

RESULTS

There were significant differences between the two groups on parenting style, parent personality, and child temperament. Anxiety disorder was positively associated with the father's permissiveness and negatively with the mother's authoritativeness and child's sociability. A combination of parenting styles and child temperament explained 69% of the variances in child anxiety disorders. There were significant associations between parental personality, child temperament, and parenting style. Parent and child characteristics explained 14%-46% of the variances in parenting styles.

CONCLUSION

Results of this study are generally consistent with Western studies outlining the influence of child temperament and parenting styles on child outcome and have important implications for clinical management of anxiety disorders.

Clinicians' Perspectives on Diagnostic Markers for Depression Among Adolescents in India: An Embedded Mixed-Methods Study

Limited research has investigated whether clinicians around the world find diagnostic criteria for depression that were originally developed in the West are useful with diverse populations. Using an embedded mixed-methods design in India, we examined (a) clinicians' and trainees' (n = 143) ratings of the usefulness of the criteria for Major Depressive Disorder (MDD) outlined in two major diagnostic systems (Diagnostic and Statistical Manual of Mental Disorders-5; DSM-5 and International Classification of Mental and Behavioral Disorders-Tenth Edition; ICD-10), and (b) narrative descriptions of clinical cases of adolescent depression and usefulness of diagnostic and screening instruments in day-to-day practice using semi-structured interviews in a subsample of clinicians (n = 24). Qualitative findings demonstrated that Indian clinicians identified markers of depression that were consistent with the current diagnostic manuals (affective, cognitive, somatic symptoms), and the numeric ratings suggested that clinicians found a majority of DSM-5 and ICD-10 criteria for MDD to be useful. However, Indian clinicians also identified additional markers of adolescent depression (i.e., interpersonal conflicts and issues, impairment in school-related functioning, anger-based symptoms, anxiety-based symptoms, additional somatic complaints not included in DSM-5 or ICD-10), highlighting the need to modify existing diagnostic criteria to be more inclusive. The findings suggest the need for culturally informed diagnostic practices that consider a wide range of clinical presentations of depression among adolescents worldwide.

Use of therapeutic caffeine in acute care postoperative and critical care settings: a scoping review

BACKGROUND

Caffeine is the most utilised psychoactive drug worldwide. However, caffeine withdrawal and the therapeutic use of caffeine in intensive care and in the perioperative period have not been well summarised. Our objective was to conduct a scoping review of caffeine withdrawal and use in the intensive care unit (ICU) and postoperative patients.

METHODS

PubMed, Embase, CINAHL Complete, Scopus and Web of Science were systematically searched for studies investigating the effects of caffeine withdrawal or administration in ICU patients and in the perioperative period. Areas of recent systematic review such as pain or post-dural puncture headache were not included in this review. Studies were limited to adults.

RESULTS

Of 2268 articles screened, 26 were included and grouped into two themes of caffeine use in in the perioperative period and in the ICU. Caffeine withdrawal in the postoperative period increases the incidence of headache, which can be effectively treated prophylactically with perioperative caffeine. There were no studies investigating caffeine withdrawal or effect on sleep wake cycles, daytime somnolence, or delirium in the intensive care setting. Administration of caffeine results in faster emergence from sedation and anaesthesia, particularly in individuals who are at high risk of post-extubation complications. There has only been one study investigating caffeine administration to facilitate post-anaesthetic emergence in ICU. Caffeine administration appears to be safe in moderate doses in the perioperative period and in the intensive care setting.

CONCLUSIONS

Although caffeine is widely used, there is a paucity of studies investigating withdrawal or therapeutic effects in patients admitted to ICU and further novel studies are a priority.

Fear of Childbirth among Pregnant Women Availing Antenatal Services in a Maternity Hospital in Rural Karnataka

BACKGROUND

Pregnancy, though joyful, may be a time of fear and anxiety. Twenty percent of pregnant women in developed nations report a fear of childbirth, and 6%-10% describe a severe fear that is crippling. This could lead to adverse maternal and fetal outcomes. Data on fear of childbirth among pregnant women are lacking in India and would help in incorporating measures to enhance routine antenatal care.

METHODOLOGY

With the objective of documenting fear of childbirth and associated factors, a cross-sectional study was conducted in rural Karnataka among women availing antenatal care services, using a face-validated 30 item questionnaire developed by the authors which was then scored to determine fear of childbirth.

RESULTS

Of 388 women studied, 45.4% (176) had a fear of childbirth. The commonest fears documented were: not feeling confident about childbirth, being afraid or tense about the process of childbirth, fear of labor pains, and fear of cesarean section. Teenage pregnancy, nulliparity, primigravida status, and having no living child were significantly associated with fear of childbirth.

CONCLUSION

Overall, 45.4% (176) of women had a fear of childbirth. It is important to identify and address the various fears of childbirth that women may have, as revealed by this study, with a view to providing information and reassurance to the mother, with the aim of improved maternal and fetal outcomes.

Development of norms for executive functions in typically-developing Indian urban preschool children and its association with nutritional status

Executive functions (EFs) are essential and important for achieving success in children's everyday lives and play a fundamental role in children's cognitive, academic, social, emotional and behavioral functioning. A cross-sectional study was carried out to develop age- and sex-specific norms for EFs using the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P) among 2- to 5-year-olds from urban Bangalore, India. In addition, the association between EFs and anthropometric measures, a marker of nutritional status, is also examined. Primary caregivers of 412 children, equally distributed by age and sex, participated. Raw scores for each domain and indices were converted to standard t-scores and percentiles were computed. A t-score at or above 63 corresponding to the 90th percentile was considered as the cutoff for executive dysfunction in this sample. The prevalence of executive dysfunction is 10% based on the Global Executive Composite score of the BRIEF-P. The cutoff score for identifying executive dysfunction using existing United States (US) norms is higher compared to the cutoff score obtained in the current study. Therefore, using US norms for Indian children could result in the prevalence of executive dysfunction been underestimated. Multiple linear regression analysis revealed that stunted and underweight children have significantly elevated EF scores after adjusting for age, sex and socioeconomic status (SES; p < .01). A greater understanding of EFs in preschool children is important for the early identification of executive dysfunction and implementing interventions to improve their future prospects. This study also shows that undernourished children are more likely to have executive dysfunction.

Norms for developmental milestones using VABS-II and association with anthropometric measures among apparently healthy urban Indian preschool children

Assessment of developmental milestones based on locally developed norms is critical for accurate estimate of overall development of a child's cognitive, behavioral, social, and emotional development. A cross-sectional study was done to develop age specific norms for developmental milestones using Vineland Adaptive Behavior Scales (VABS-II) (Sparrow, Cicchetti, & Balla, 2005) for apparently healthy children from 2 to 5 years from urban Bangalore, India, and to examine its association with anthropometric measures. Mothers (or caregivers) of 412 children participated in the study. Age-specific norms using inferential norming method and adaptive levels for all domains and subdomains were derived. Low adaptive level, also called delayed developmental milestone, was observed in 2.3% of the children, specifically 2.7% in motor and daily living skills and 2.4% in communication skills. When these children were assessed on the existing U.S. norms, there was a significant overestimation of delayed development in socialization and motor skills, whereas delay in communication and daily living skills were underestimated (all p < .01). Multiple linear regression revealed that stunted and underweight children had significantly lower developmental scores for communication and motor skills compared with normal children (β coefficient ranges from 2.6-5.3; all p < .01). In the absence of Indian normative data for VABS-II in preschool children, the prevalence of developmental delay could either be under- or overestimated using Western norms. Thus, locally referenced norms are critical for reliable assessments of development in children. Stunted and underweight children are more likely to have poorer developmental scores compared with healthy children. (PsycINFO Database Record

A cross-sectional study of dentine sensitivity in periodontitis patients in Trinidad and Tobago

OBJECTIVE

This cross-sectional study aimed to determine the prevalence, distribution and associated factors of dentine sensitivity (DS) among periodontitis patients in Trinidad.

METHODS

Sequential patients meeting the periodontitis criteria (BPE 4/4*) were included and completed a questionnaire on DS prior to a full periodontal examination. Clinically elicited symptoms of DS and presence of cervical tooth wear were recorded.

RESULTS

DS prevalence was 73.1% (n = 130; mean age 50 years). Mean number of sensitive teeth increased with increased severity of gingival recession. Most common initiating factors of DS were cold stimuli (70.5%), brushing (25.3%) and sour food (11.6%). Correlations were obtained for DS and race, toothbrush texture hardness, cervical tooth wear and gingival recession severity (P < 0.05; binary logistic regression). Cervical tooth wear was recorded in 46.3% of DS patients. Full-mouth plaque scores (FMPS) and full-mouth bleeding scores (FMBS) were statistically significantly (P < 0.05; Mann-Whitney U) test lower for DS versus non-DS patients. Patients reported a low usage (27.4%) and satisfaction (53.8%) rating for desensitizing agents.

CONCLUSIONS

The high prevalence of DS was comparable to other studies on periodontitis patients. Progressive periodontal disease and toothbrush abrasion were possible aetiological factors for DS in this study. Knowledge of local dietary practices and the role of acidic (sour) foods in eliciting DS may aid in management. The high prevalence of cervical tooth wear and the lower FMPS and FMBS among DS patients may reflect more aggressive tooth brushing. DS does not seem to be a limitation to plaque control in DS versus non-DS patients in this study.

RNA helicase DDX3: a novel therapeutic target in Ewing sarcoma

RNA helicase DDX3 has oncogenic activity in breast and lung cancers and is required for translation of complex mRNA transcripts, including those encoding key cell-cycle regulatory proteins. We sought to determine the expression and function of DDX3 in sarcoma cells, and to investigate the antitumor activity of a novel small molecule DDX3 inhibitor, RK-33. Utilizing various sarcoma cell lines, xenografts and human tissue microarrays, we measured DDX3 expression at the mRNA and protein levels, and evaluated cytotoxicity of RK-33 in sarcoma cell lines. To study the role of DDX3 in Ewing sarcoma, we generated stable DDX3-knockdown Ewing sarcoma cell lines using DDX3-specific small hairpin RNA (shRNA), and assessed oncogenic activity. DDX3-knockdown and RK-33-treated Ewing sarcoma cells were compared with wild-type cells using an isobaric mass-tag quantitative proteomics approach to identify target proteins impacted by DDX3 inhibition. Overall, we found high expression of DDX3 in numerous human sarcoma subtypes compared with non-malignant mesenchymal cells, and knockdown of DDX3 by RNA interference inhibited oncogenic activity in Ewing sarcoma cells. Treatment with RK-33 was preferentially cytotoxic to sarcoma cells, including chemotherapy-resistant Ewing sarcoma stem cells, while sparing non-malignant cells. Sensitivity to RK-33 correlated with DDX3 protein expression. Growth of human Ewing sarcoma xenografts expressing high DDX3 was inhibited by RK-33 treatment in mice, without overt toxicity. DDX3 inhibition altered the Ewing sarcoma cellular proteome, especially proteins involved in DNA replication, mRNA translation and proteasome function. These data support further investigation of the role of DDX3 in sarcomas, advancement of RK-33 to Ewing sarcoma clinical trials and development of RNA helicase inhibition as a novel anti-neoplastic strategy.

Issues related to obtaining intelligence quotient-matched controls in autism research

BACKGROUND

Intelligence Quotient (IQ) is considered to be an index of global cognitive functioning and has traditionally been used as a fulcral measure in case-control studies in neuro-developmental disorders such as autism.

AIM

The aim is to highlight the issues of "matching for IQ" with controls in autism research.

MATERIALS AND METHODS

Percentile scores on the Coloured Progressive Matrices of 20 children with autism in the age range of 5 to 12 years have been graphically compared with 21 age matched typically developing children.

RESULTS AND CONCLUSIONS

The percentile scores of the so-called high functioning children with autism from special schools were well below that of typically developing children. There are many challenges when using IQ in case-control studies of autism. Alternative approaches need to be considered.

IQ in Autism: Is there an Alternative Global Cognitive Index?

BACKGROUND

Intelligence quotient (IQ) but not the core symptoms have been known to predict outcomes in autism. Besides resource issues in India, assessing IQ in presence of autistic symptoms is challenging in general.

MATERIALS AND METHODS

In a pilot study, we explored different global indices of development in 30 children with confirmed autism. These included Wechsler intelligence scale for children or Wechsler preprimary scale of intelligence-revised (n = 10), Raven's progressive matrices (RPM) (n = 10), Vineland adaptive behavior scales II, parent report version (VABS) (n = 30) and teacher's estimate of mental age (TIQ) (n = 30). Three subgroups (Group A) with Wechsler's scales derived IQ (WISIQ), (Group B) with RPM derived IQ and (Group C) those without a formal IQ measure were compared.

RESULTS

All groups were comparable on age and their scores on Childhood Autism Rating Scale and Indian Scale for Assessment of Autism Adaptive behavior composite scores (Ad Bh composite) derived from VABS and WISIQ showed significant correlations with each other in Group A; TIQ significantly correlated with Ad Bh composite scores, but not with the WISIQ, although the latter two scores themselves did not significantly differ from each other. RPM consistently overestimated children's performance compared to Ad Bh composite or TIQ in Group B, but the Ad Bh composite and TIQ were themselves significantly correlated. In Group C, there were poor correlations between Ad Bh composite and TIQ. The Ad Bh composite score in this group was significantly different from the other two groups.

CONCLUSION

There is a need to fine tune the assessment for global cognitive measures in autism and explore their real world importance.

A comparison of two forms of teaching instruction: video vs. live lecture for education in clinical periodontology

INTRODUCTION

This crossover controlled study aimed to compare the knowledge and skill attained by third-year dental students in three clinical exercises in the discipline of periodontology through video and live lecture instruction.

METHODS

Students (n = 35) segregated into two group either viewed a video or attended a live lecture repeated over three clinical teaching sessions. Pre-test and post-test written assessments were completed and comparisons between video and live lecture done (analysis of variance, P < 0.05). Students were assessed on clinic by a simple checklist. A questionnaire was administered after all three sessions to determine preferences and opinions on video and live lecture.

RESULTS

For the combined three sessions, both video (n = 48) and live lecture (n = 47) groups attained similar mean pre-test scores. The mean post-test score was statistically significantly greater (P = 0.049) for the live lecture (74.9%, SD 14.9) compared to the video group (68.6%, SD 16.3). All students attained clinical proficiency via the simple checklist. In adding to their clinical skill, more students favoured video (97%) vs. live lecture (78.8%). Most students (97%) favoured a future combination of video and lecture.

DISCUSSION

While students were deemed clinically competent via a simple checklist, the live lecture group performed better than the video group via the in-depth post-test assessment. Students had a preference for video and would like it integrated in the lecture rather than act as a substitute for the lecture.

CONCLUSION

The use of video alone in clinical periodontology training may have limitations unless supplemented by appropriate learning activities.

Twist contributes to hormone resistance in breast cancer by downregulating estrogen receptor-α

The role of estrogen receptor-α (ER) in breast cancer development, and as a primary clinical marker for breast cancer prognosis, has been well documented. In this study, we identified the oncogenic protein, TWIST1 (Twist), which is overexpressed in high-grade breast cancers, as a potential negative regulator of ER expression. Functional characterization of ER regulation by Twist was performed using Twist low (MCF-7, T-47D) and Twist high (Hs 578T, MDA-MB-231, MCF-7/Twist) expressing cell lines. All Twist high expressing cell lines exhibited low ER transcript and protein levels. By chromatin immunoprecipitation and promoter assays, we demonstrated that Twist could directly bind to E-boxes in the ER promoter and significantly downregulate ER promoter activity in vitro. Functionally, Twist overexpression caused estrogen-independent proliferation of breast cells, and promoted hormone resistance to the selective estrogen receptor modulator tamoxifen and selective estrogen receptor down-regulator fulvestrant. Importantly, this effect was reversible on downregulating Twist. In addition, orthotopic tumors generated in mice using MCF-7/Twist cells were resistant to tamoxifen. These tumors had high vascular volume and permeability surface area, as determined by magnetic resonance imaging (MRI). Mechanistically, Twist recruited DNA methyltransferase 3B (DNMT3B) to the ER promoter, leading to a significantly higher degree of ER promoter methylation compared with parental cells. Furthermore, we demonstrated by co-immunoprecipitation that Twist interacted with histone deacetylase 1 (HDAC1) at the ER promoter, causing histone deacetylation and chromatin condensation, further reducing ER transcript levels. Functional re-expression of ER was achieved using the demethylating agent, 5-azacytidine, and the HDAC inhibitor, valproic acid. Finally, an inverse relationship was observed between Twist and ER expression in human breast tumors. In summary, the regulation of ER by Twist could be an underlying mechanism for the loss of ER activity observed in breast tumors, and may contribute to the generation of hormone-resistant, ER-negative breast cancer.

Effect of Reduced Exposure Times on the Microhardness of Nanocomposites Polymerized by QTH and Second-generation LED Curing Lights

Reduced polymerization times suggested with newer generation LED-curing lights may not be suitable to ensure sufficient conversion of all types of nanocomposites at depths of 2 mm.

Children of men with alcohol dependence: Psychopathology, neurodevelopment and family environment

BACKGROUND

Children of people with alcohol dependence (COAs) are at high risk for behavioral and cognitive problems.

AIM

Aim of this study was to compare the nature and extent of these problems in children of men with and without alcohol dependence.

MATERIALS AND METHODS

32 children (17 in study group and 15 controls) were evaluated for psychopathology, neurodevelopment, cognitive functioning and family environment. Tools used were: Socio-demographic data sheet, Malin's Intelligence Scale for Indian Children (MISIC), Child Behavior Checklist, Trail Making Test, Neurodevelopment Scale and the Family Environment Scale.

RESULTS

Children of men with alcohol dependence had higher externalizing than internalizing scores. Children of alcohol-dependent fathers had higher scores on the neurodevelopment scale and lower scores on the performance scale of the MISIC than the children in control group. These children also made more errors on the Trail Making Test. The family environment of COAs was characterized by lack of independence for its members, greater perceived control and lack of adequate cultural and intellectual activities.

CONCLUSION

Our findings suggest that children of men with alcohol dependence have difficulties with frontal lobe functions and neurodevelopmental tasks. There are also difficulties in the family, which are related to alcohol consumption by the father.

Interleukin-6 induces an epithelial-mesenchymal transition phenotype in human breast cancer cells

Breast tumor interleukin-6 (IL-6) levels increase with tumor grade, and elevated serum IL-6 correlates with poor breast cancer patient survival. Epithelial-mesenchymal transition (EMT) phenotypes such as impaired E-cadherin expression or aberrant Vimentin induction are associated with enhanced metastasis and unfavorable clinical outcome in breast cancer. Despite this fact, few tumor microenvironment-derived extracellular signaling factors capable of provoking such a phenotypic transition have been identified. In this study, we showed that IL-6 promoted E-cadherin repression among a panel of estrogen receptor-alpha-positive human breast cancer cells. Furthermore, ectopic stable IL-6 expressing MCF-7 breast adenocarcinoma cells (MCF-7(IL-6)) exhibited an EMT phenotype characterized by impaired E-cadherin expression and induction of Vimentin, N-cadherin, Snail and Twist. MCF-7(IL-6) cells formed xenograft tumors that displayed loss of E-cadherin, robust Vimentin induction, increased proliferative indices, advanced tumor grade and undifferentiated histology. Finally, we showed aberrant IL-6 production and STAT3 activation in MCF-7 cells that constitutively express Twist, a metastatic regulator and direct transcriptional repressor of E-cadherin. To our knowledge, this is the first study that shows IL-6 as an inducer of an EMT phenotype in breast cancer cells and implicates its potential to promote breast cancer metastasis.

Cardiovascular diagnostics mining on Borneo island: from labour-intensive to prototype

Mining for medical data poses different challenges compared with mining other types of data. The wide range of imaging modalities of medical data leads to data integration and compatibility issues. The analysis of imaging modalities is further complicated by the different format and attributes used by the different imaging equipment by different vendors. Human factors such as interest of adapting data mining into diagnosis and planning process raised the difficulty of engaging the users into the development of a practical and useful data miner. Requirement engineering technique prototyping further enhanced the engagement of users towards the data-miner. Data from different equipment and different vendors are also merged for efficient data analysis and subsequently charting and reporting. We have also successfully engaged the medical doctors into believing the data miner's capability after they reviewed and walkthrough the prototype.

Hypoxia-induced human endonuclease G expression suppresses tumor growth in a xenograft model

We have developed a hypoxia-inducible gene therapy approach for the expression of the mature form of human endonuclease G to facilitate cell death in hypoxic regions of the tumor. The chimeric therapeutic gene is placed under the control of a hypoxia response element based promoter and contains a translocation motif linked in frame to an oxygen-dependent degradation domain and the endonuclease G gene. Transient expression of the chimeric therapeutic gene in breast and prostate cancer cell lines resulted in efficient cell death under hypoxia-mimetic conditions. Stable MDA-MB-435 cells expressing the chimeric therapeutic gene under 1% O2 showed an increase in stable HIF-1alpha protein levels and synthesis of the endonuclease G protein in a time-dependent manner. In normoxic conditions, these stable transgenic cells exhibited no change in growth rate, invasion and motility when compared to parental cells. Moreover, xenografts generated using the transgenic cells exhibited highly significant suppression of tumor growth in a preclinical cancer model compared to the parental cell line. Thus, the hypoxia-modulated endonuclease G expression has the potential to be used as a gene-based-therapy system to kill malignant cells within hypoxic regions of tumors.

Oncogenic role of DDX3 in breast cancer biogenesis

Benzo[a]pyrene diol epoxide (BPDE), the active metabolite of benzo[a]pyrene present in tobacco smoke, is a major cancer-causing compound. To evaluate the effects of BPDE on human breast epithelial cells, we exposed an immortalized human breast cell line, MCF 10A, to BPDE and characterized the gene expression pattern. Of the differential genes expressed, we found consistent activation of DDX3, a member of the DEAD box RNA helicase family. Overexpression of DDX3 in MCF 10A cells induced an epithelial-mesenchymal-like transformation, exhibited increased motility and invasive properties, and formed colonies in soft-agar assays. Besides the altered phenotype, MCF 10A-DDX3 cells repressed E-cadherin expression as demonstrated by both immunoblots and by E-cadherin promoter-reporter assays. In addition, an in vivo association of DDX3 and the E-cadherin promoter was demonstrated by chromatin immunoprecipitation assays. Collectively, these results demonstrate that the activation of DDX3 by BPDE, can promote growth, proliferation and neoplastic transformation of breast epithelial cells.