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Παρασκευή 27 Απριλίου 2018

Feasibility study of postoperative adjuvant chemotherapy with S-1 in patients with biliary tract cancer

Abstract

Background

The role of adjuvant chemotherapy has not yet been established for patients with resected biliary tract cancer. S-1 has been shown to exert activity against advanced biliary tract cancer. Therefore, we evaluated the feasibility of adjuvant chemotherapy with S-1 in patients with resected biliary tract cancer.

Methods

Patients with complete macroscopic resection of intrahepatic/extrahepatic bile duct, gall bladder, or ampullary cancer were eligible. S-1 was administered orally twice daily for 4 weeks every 6 weeks, up to 4 cycles. The treatment was continued up to 24 weeks or until recurrence/appearance of unacceptable toxicity. The primary endpoint was the treatment completion rate, which was defined as the percentage of patients who received a relative dose intensity of ≥ 75%. This trial was registered as UMIN000004051.

Results

Thirty-three patients were enrolled between June 2010 and March 2011. The relative dose intensity was ≥ 75% in 27 patients representing a treatment completion rate of 81.8%. The most common grade 3/4 adverse event was neutropenia (18%). Grade 2 nausea or diarrhea was observed in 12%. The 3-year relapse-free survival rate was 39.4%. The 3-year survival rate was 54.5%.

Conclusion

Adjuvant chemotherapy with S-1 is feasible treatment in patients with resected biliary tract cancer. It is necessary to conduct a phase III study to confirm the efficacy of adjuvant therapy of S-1 in patients with resected BTC.



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Review of autopsy reports of deaths relating to fire in South Australia 2000–2015

Abstract

It has been noted there are gaps and inconsistencies in data pertaining to fire related deaths in Australia, which poses difficulties for analysis of national statistics. A search of post-mortem examination reports at Forensic Science SA from 2000 to 2015 revealed 275 cases regarded as fire related in which the body had been involved in a fire. The autopsy reports were evaluated to determine parameters including the location of the fire event, age and sex of victim, as well as the presence of soot in the airways and cherry-red coloration to the blood and/or organs, in addtion to toxicological levels of carboxyhemoglobin and alcohol. Fire events were clasified as structural, transportation or open air in type. Males were more commonly victims than females, especially in transportation fires, where males aged below 50 years were most at risk of death. Carboxyhemoglobin levels tended to be lower in victims of transportation fires. This study has confirmed that presence of soot in the respiratory tract and cherry-red coloration of a body retrieved from a fire are both linked to an increased level of blood carboxyhemoglobin. These findings significantly contribute to the documentation of fire deaths in Australia.



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In this issue



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Propuestas para la atención domiciliaria del siglo XXI

Xavier Bayona Huguet, Esther Limón Ramírez, Francisco Cegri Lombardo
Aten Primaria.2018;50:264-6

Texto completo - PDF

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Síntomas neuropsiquiátricos como factor de confusión en la detección de la demencia

David Córcoles, Angeles Malagón, Magdalena Bellsolà, Ana Gonzalez, Romina Cortizo, Jordi Leon, Antoni Bulbena, Victor Pérez, Luis M. Martín
Aten Primaria.2018;50:267-73

Resumen - Texto completo - PDF

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Primeros momentos del cuidado: el proceso de convertirse en cuidador de un familiar mayor dependiente

Lourdes Moral-Fernández, Antonio Frías-Osuna, Sara Moreno-Cámara, Pedro A. Palomino-Moral, Rafael del-Pino-Casado
Aten Primaria.2018;50:282-90

Resumen - Texto completo - PDF

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Conductas sexuales de riesgo y actividades preventivas frente al cáncer de cuello uterino en mujeres universitarias vacunadas frente al VPH

Ana Fernández-Feito, Raquel Antón-Fernández, María Paz-Zulueta
Aten Primaria.2018;50:291-8

Resumen - Texto completo - PDF

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Eficiencia en la prescripción enfermera en Andalucía. Un paso atrás en el sistema sanitario tras anulación por Real Decreto.

Juan José Ruiz Sánchez, Rocío Ruiz Calzado, Marcos Romero Sánchez
Aten Primaria.2018;50:299-305

Resumen - Texto completo - PDF

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Utilidad y fiabilidad de la ecografía clínica abdominal en medicina familiar (1): hígado, vías biliares y páncreas

Ignacio Manuel Sánchez Barrancos, Tomás Vegas Jiménez, Rafael Alonso Roca, Daniel Domínguez Tristancho, Francisco José Guerrero García, María del Carmen Rico López, Vicente Fernández Rodríguez
Aten Primaria.2018;50:306-15

Resumen - Texto completo - PDF

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El imperativo de la generación de enfoques más integradores y exhaustivos para encarar el desafío terapéutico que supone la multimorbilidad

Olga Gloria Barbón-Pérez, Iván Pimienta-Concepción
Aten Primaria.2018;50:316

Texto completo - PDF

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Tutor y residente en la rotación rural

José Luis Ponce Nolla, Tatia Santirso Benito, Miguel Ángel María Tablado
Aten Primaria.2018;50:317-8

Texto completo - PDF

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Hablando del dolor crónico

María Victoria García Espinosa
Aten Primaria.2018;50:318-9

Texto completo - PDF

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Multiple morbidity in primary care: The public and the private sector

Filipe Prazeres
Aten Primaria.2018;50:319-20

Full Text - PDF

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Thymidine phosphorylase: the unforeseen driver in colorectal cancer treatment?

Future Oncology, Ahead of Print.


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Trifluridine/tipiracil: an emerging strategy for the management of gastrointestinal cancers

Future Oncology, Ahead of Print.


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The current landscape of early drug development for patients with sarcoma in the immunotherapy era

Future Oncology, Ahead of Print.


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Letter to the Editor

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A rationally designed fully human EGFRvIII:CD3-targeted bispecific antibody redirects human T cells to treat patient-derived intracerebral malignant glioma

Purpose: Conventional therapy for malignant glioma (MG) fails to specifically target tumor cells. In contrast, substantial evidence indicates that if appropriately redirected, T cells can precisely eradicate tumors. Here we report the rational development of a fully-human bispecific antibody (hEGFRvIII-CD3 bi-scFv) that redirects human T cells to lyse MG expressing a tumor-specific mutation of the epidermal growth factor receptor (EGFRvIII). Experimental Design: We generated a panel of bispecific single-chain variable-fragments and optimized design through successive rounds of screening and refinement. We tested the ability of our lead construct to re-direct naïve T cells and induce target-cell specific lysis. To test for efficacy, we evaluated tumor growth and survival in xenogeneic and syngeneic models of glioma. Results: A highly-expressed bispecific antibody with specificity to CD3 and EGFRvIII was generated (hEGFRvIII-CD3 bi-scFv). Antibody-induced T cell activation, secretion of pro-inflammatory cytokines, and proliferation was robust and occurred exclusively in the presence of target antigen. hEGFRvIII-CD3 bi-scFv was potent and target-specific, mediating significant lysis of multiple MG cell lines and patient-derived MG samples. In both subcutaneous and orthotopic models, well-engrafted, patient-derived MG was effectively treated despite heterogeneity of EGFRvIII expression; intravenous hEGFRvIII-CD3 bi-scFv administration caused significant regression of tumor burden (p<0.0001) and significantly extended survival (p<0.0001). Similar efficacy was obtained in highly-infiltrative, syngeneic glioma models. Conclusions: We have developed a clinically-translatable bispecific antibody that redirects human T cells to safely and effectively treat MG. On the basis of these results, we have developed a clinical study of hEGFRvIII-CD3 bi-scFv for patients with EGFRvIII-positive MG.



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New Insights from Studies of Clonal Hematopoiesis

Clonal hematopoiesis (CH) describes an asymptomatic expansion of blood cells descended from a single hematopoietic stem cell. Recent studies have shown that CH increases in frequency with aging, and is often driven by somatic mutations in genes that are recurrently mutated in hematologic malignancies. When CH is associated with a mutation in a leukemia-associated gene at a variant allele frequency of 0.02 or greater, it is termed "clonal hematopoiesis of indeterminate potential" (CHIP).  CHIP has a 0.5-1% risk per year of progression to hematological neoplasia, and increases both all-cause mortality and the risk of myocardial infarction and ischemic stroke due to a pro-inflammatory interaction between clonally-derived leukocytes and vascular endothelium. CH frequently emerges in the context of immune-mediated marrow failure syndromes such as aplastic anemia, while CH emerging after cytotoxic cancer therapy is strongly associated with subsequent development of a therapy-related myeloid neoplasm, especially if a TP53 mutation is present.  However, risk factors for developing CH other than aging, marrow failure, and cytotoxic radiotherapy or chemotherapy are poorly defined.  In this review, we discuss the epidemiology, molecular mechanisms, and clinical consequences of this common and clinically important biological state.



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Paclitaxel Plasma Concentration After the First Infusion Predicts Treatment-Limiting Peripheral Neuropathy

Purpose: Paclitaxel exposure, specifically the maximum concentration (Cmax) and amount of time the concentration remains above 0.05 µM (Tc>0.05), have been associated with the occurrence of paclitaxel-induced peripheral neuropathy (PN). The objective of this study was to validate the relationship between paclitaxel exposure and PN.  Experimental Design: Patients with breast cancer receiving paclitaxel 80 mg/m2 x 12 weekly doses were enrolled in an observational clinical study (NCT02338115). Paclitaxel plasma concentration was measured at the end of, and 16-26 hours after, the first infusion to estimate Cmax and Tc>0.05. Patient-reported PN was collected via CIPN20 at each dose, and an 8-item sensory subscale (CIPN8) was used in the primary analysis to test for an association with Tc>0.05. Secondary analyses were conducted using Cmax as an alternative exposure parameter and testing either parameter with a secondary endpoint of the occurrence of PN-induced treatment disruption.   Results: In the 60 subjects included in the analysis, the increase in CIPN8 during treatment was associated with baseline CIPN8, cumulative dose, and relative dose intensity (p<0.05), but neither Tc>0.05 (p=0.27) nor Cmax (p=0.99). In analyses of the secondary endpoint, cumulative dose (odds ratio (OR)=1.46, 95% confidence interval (CI): 1.18-1.80, p=0.0008) and Tc>0.05 (OR=1.79, 95% CI: 1.06-3.01, p=0.029) or Cmax (OR=2.74, 95% CI: 1.45-5.20, p=0.002) were associated with PN-induced treatment disruption. Conclusions: Paclitaxel exposure is predictive of the occurrence of treatment-limiting PN in patients receiving weekly paclitaxel for breast cancer. Studies are warranted to determine whether exposure-guided dosing enhances treatment effectiveness and/or prevents PN in these patients. 



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Germline IKZF1 Variants Predispose Children to Developing B-ALL [Research Watch]

Germline DNA sequencing of 4,963 B-ALLs identified 28 IKZF1 variants, with 22 determined to be damaging.



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Single-Cell RNA Sequencing Reveals H3K27M Glioma Oncogenic Programs [Research Watch]

H3K27M+ gliomas display a unique oncogenic program and are driven by OPC-like glioma cells.



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Neoadjuvant Endpoints, Response Criteria Proposed [News in Brief]

Profusion of preoperative lung cancer trials prompts specialists to reconsider metrics of evaluation.



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SAMHD1 Mutations Disrupt Replication Fork Progression to Induce IFN [Research Watch]

SAMHD1 activates MRE11 exonuclease activity to prevent release of ssDNA from stalled replication forks.



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Everolimus Enhances the Efficacy of Fulvestrant in ER+ Breast Cancer [Research Watch]

mTOR inhibition with everolimus extends progression-free survival in combination with fulvestrant.



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Blinatumomab Approval Expanded Based on MRD [News in Brief]

The decision marks the first time the agency has approved an ALL drug using minimal residual disease as an endpoint.



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Anti-GD2 CAR T Cells Are Potent in H3-K27M+ Diffuse Midline Gliomas [Research Watch]

The disialoganglioside GD2 is an immunotherapeutic target in H3-K27M+ diffuse midline gliomas.



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A Cloning-Free Method for CRISPR/Cas9-Mediated Genome Editing in Fission Yeast

The CRISPR/Cas9 system, which relies on RNA-guided DNA cleavage to induce site-specific DNA double-strand breaks, is a powerful tool for genome editing. This system has been successfully adapted for the fission yeast Schizosaccharomyces pombe by expressing Cas9 and the single-guide RNA (sgRNA) from a plasmid. In the procedures published to date, the cloning step that introduces a specific sgRNA target sequence into the plasmid is the most tedious and time-consuming. To increase the efficiency of applying the CRISPR/Cas9 system in fission yeast, we here developed a cloning-free procedure that uses gap repair in fission yeast cells to assemble two linear DNA fragments, a gapped Cas9-encoding plasmid and a PCR-amplified sgRNA insert, into a circular plasmid. Both fragments contain only a portion of the ura4 or bsdMX marker so that only the correctly assembled plasmid can confer uracil prototrophy or blasticidin resistance. We show that this gap-repair-based and cloning-free CRISPR/Cas9 procedure permits rapid and efficient point mutation knock-in, endogenous N-terminal tagging, and genomic sequence deletion in fission yeast.



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Ancestral State Reconstruction of the Apoptosis Machinery in the Common Ancestor of Eukaryotes

Apoptotic cell death is a type of eukaryotic cell death. In animals, it regulates development, is involved in cancer suppression, and causes cell death during pathological aging of neuronal cells in neurodegenerative diseases such as Alzheimer's. Mitochondrial apoptotic-like cell death, a form of primordial apoptosis, also occurs in unicellular organisms. Here, we ask the question why the apoptosis machinery has been acquired and maintained in unicellular organisms and attempt to answer it by performing ancestral state reconstruction. We found indications of an ancient evolutionary arms race between protomitochondria and host cells, leading to the establishment of the currently existing apoptotic pathways. According to this reconstruction, the ancestral protomitochondrial apoptosis machinery contained both caspases and metacaspases, four types of apoptosis induction factors (AIFs), both fungal and animal OMI/HTR proteases, and various apoptotic DNases. This leads to the prediction that in extant unicellular eukaryotes, the apoptotic factors are involved in mitochondrial respiration and their activity is needed exclusively in aerobic conditions. We test this prediction experimentally using yeast and find that a loss of the main apoptotic factors is beneficial under anaerobic conditions yet deleterious under aerobic conditions in the absence of lethal stimuli. We also point out potential medical implications of these findings.



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A High-Quality Reference Genome for the Invasive Mosquitofish Gambusia affinis Using a Chicago Library

The western mosquitofish, Gambusia affinis, is a freshwater poecilid fish native to the southeastern United States but with a global distribution due to widespread human introduction. Gambusia affinis has been used as a model species for a broad range of evolutionary and ecological studies. We sequenced the genome of a male G. affinis to facilitate genetic studies in diverse fields including invasion biology and comparative genetics. We generated Illumina short read data from paired-end libraries and in vitro proximity-ligation libraries. We obtained 54.9x coverage, N50 contig length of 17.6 kb, and N50 scaffold length of 6.65 Mb. Compared to two other species in the Poeciliidae family, G. affinis has slightly fewer genes that have shorter total, exon, and intron length on average. Using a set of universal single-copy orthologs in fish genomes, we found 95.5% of these genes were complete in the G. affinis assembly. The number of transposable elements in the G. affinis assembly is similar to those of closely related species. The high-quality genome sequence and annotations we report will be valuable resources for scientists to map the genetic architecture of traits of interest in this species.



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Anesthesiologists Report Drug Shortages Impacting Patient Care

FRIDAY, April 27, 2018 -- Almost all anesthesiologists report drug shortages, which have a negative impact on patient care, according to a report published by the American Society of Anesthesiologists (ASA). ASA members were surveyed informally to...

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Art Intervention May Be Beneficial for Cancer Patients

FRIDAY, April 27, 2018 -- A bedside visual art intervention may help with cancer patients' pain, anxiety, and mood, according to a study published online April 17 in the European Journal of Cancer Care. J.J. Saw, of the Mayo Clinic School of...

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Rural Childhood, Higher Education Cuts Later Life Dementia Risk

FRIDAY, April 27, 2018 -- The combination of a rural upbringing and higher education levels may be protective against dementia and Alzheimer's disease (AD) for African-Americans, according to a study published online April 16 in The Journals of...

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New Clinic Satisfaction Tool Provides Real-Time Feedback

THURSDAY, April 26, 2018 -- A new clinic satisfaction tool improves communication and provides real-time feedback, according to a study published online April 14 in Neurosurgery. Rasheedat T. Zakare-Fagbamila, from Duke University in Durham, N.C.,...

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Family-Based Treatment of Teen Eating Disorders Helpful

TUESDAY, April 24, 2018 -- Treatment outcomes for adolescents with eating disorders seem to correlate with family reports of perceived helpfulness of the family-based treatment (FBT) approach, according to a study published online April 10 in the...

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MYD88 L265P Mutation in Lymphoid Malignancies

Next-generation sequencing has revealed cancer genomic landscapes, in which over 100 driver genes that, when altered by intragenic mutations, can promote oncogenesis. MYD88 is a driver gene found in hematologic B-cell malignancies. A missense mutation (L265P) changing leucine at position 265 to proline in MYD88 is found in ∼90% of Waldenström macroglobulinemia (WM) cases and in significant portions of activated B-cell diffuse large B-cell lymphomas and IgM monoclonal gammopathy of undetermined significance. Few cancers such as WM have a single amino acid substitution in one gene like MYD88 L265P that occurs in ∼90% of cases, making WM paradigmatic for study of a single causative mutation in oncogenesis. In this review, we summarize the frequency and cancer spectrum of MYD88 L265P and its downstream effects in lymphoid cancers. Malignant B cells with MYD88 L265P are likely transformed from IgM-producing B cells either in response to T-cell–independent antigens or in response to protein antigens before class switching. We also discuss therapeutic strategies that include targeting Bruton tyrosine kinase and other kinases, interfering with the assembly of MYD88 and its interacting partners, and MYD88 L265P-specific peptide-based immunotherapy. Cancer Res; 78(10); 1–6. ©2018 AACR.

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Platinum-based neoadjuvant chemotherapy in BRCA1-positive breast cancer: a retrospective cohort analysis and literature review

Abstract

Background

There is increasing evidence of high platinum sensitivity in BRCA-associated breast cancer. However, evidence from randomized trials is lacking. The aim of this study was to analyze the results of platinum-based chemotherapy for BRCA1-positive breast cancer in a neoadjuvant setting.

Methods

A retrospective study was performed by obtaining information from patient files. The results were compared with the available data from a literature review.

Results

Twelve female patients with BRCA1 gene mutations who had stage I to III breast cancers were eligible for evaluation. They received platinum-based neoadjuvant chemotherapy between 2011 and 2016. Eleven patients received a combination of cisplatin and doxorubicin, and one patient received carboplatin and docetaxel. All patients underwent mastectomy after chemotherapy. Ten patients (83%) achieved pathological complete remission (pCR). The observed pCR rate was comparable to existing results found in similar studies.

Conclusion

The results of the study confirm the high pCR rate in BRCA1-positive breast cancer after platinum-based neoadjuvant chemotherapy. Larger randomized studies and longer follow-up times are necessary to evaluate the role of platinum-based therapies in BRCA1-positive breast cancer.



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Nurse Ratings of Dignity Deserve Dignity

The letter by Allard et al. discusses concerns regarding the multiple interpretations of dignity as a concept, and how multiple interpretations of dignity may influence our study conclusions.

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Good Death

"You hang 'round here long enough, you hear things." Don's words pass cracked and flat.

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Increase in chromogranin A- and serotonin-positive cells in pouch mucosa of patients with ulcerative colitis undergoing proctocolectomy

Inflammatory bowel disease (IBD) is associated with neuroendocrine cell hyperplasia.

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Endoscopic management of a colonic fistula communicating with a walled-off pancreatic necrosis



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Quality and Competence in Endoscopic Retrograde Cholangiopancreatography − where are we 50 years later?

Training in endoscopic retrograde cholangiopancreatography (ERCP) requires the development of technical, cognitive, and integrative skills well beyond those needed for standard endoscopic procedures. So far, there are limited data regarding what constitutes competency in ERCP, including achievement and maintenance. Recent studies have highlighted overall procedural numbers are not enough to warrant competency, although more is better. We performed a comprehensive literature search until June 2017 using predetermined search terms to identify relevant articles and summarized their results as a narrative review.

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Side-by-side stent deployment above the papilla to treat hepatic hilar obstruction using a new covered metal stent



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Evaluation of T cells in blood after a short gluten challenge for coeliac disease diagnosis

To diagnose coeliac disease (CD) in individuals on a gluten free diet (GFD), we aimed to assess the utility of detecting activated γd and CD8 T cells expressing gut-homing receptors after a short gluten challenge.

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Does cyst growth predict malignancy in branch duct intraductal papillary mucinous neoplasms? Results of a large multicenter experience

Cyst growth of BD-IPMNs on follow-up imaging remains a concerning sign.

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Telomerase regulation by the long non-coding RNA H19 in human acute promyelocytic leukemia cells

Abstract

Background

Since tumor growth requires reactivation of telomerase (hTERT), this enzyme is a challenging target for drug development. Therefore, it is of great interest to identify telomerase expression and activity regulators. Retinoids are well-known inducers of granulocytic maturation associated with hTERT repression in acute promyelocytic leukemia (APL) blasts. In a maturation-resistant APL cell line, we have previously identified a new pathway of retinoid-induced hTERT transcriptional repression independent of differentiation. Furthermore, we reported the isolation of a cell variant resistant to this repression. Those cell lines could serve as unique tools to identify new telomerase regulators.

Methods

Using a microarray approach we identified the long non-coding RNA, H19 as a potential candidate playing a role in telomerase regulation. Expression of H19, hTERT, and hTR were examined by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Telomerase activity was quantified by quantitative telomeric repeats amplification protocol (qTRAP). In vitro and in vivo assays were performed to investigate H19 function on telomerase expression and activity.

Results

We showed both in retinoid-treated cell lines and in APL patient cells an inverse relationship between the expression of H19 and the expression and activity of hTERT. Exploring the mechanistic link between H19 and hTERT regulation, we showed that H19 is able to impede telomerase function by disruption of the hTERT-hTR interaction.

Conclusions

This study identifies a new way of telomerase regulation through H19's involvement and thereby reveals a new function for this long non-coding RNA that can be targeted for therapeutic purpose.



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Safety of Combined Immunotherapy and Thoracic Radiation Therapy: Analysis of Three Single-Institutional Phase I/II Trials

The safety of combined immunotherapy and thoracic radiation therapy (iRT) has been understudied. We evaluated toxicities in patients receiving iRT from three single-institutional phase I/II trials and showed that administration of combined iRT is safe in the short-term.

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4D cone beam CT-measured target motion underrepresents actual motion

Daily four-dimensional cone beam CT (4DCBCT) provides pre-treatment tumor motion information. We compared the real-time centroid motion of electromagnetic beacons ("target") in the lung with 4DCBCT measurements using two different reconstruction algorithms in combination with internal or external respiratory signals. Our results show that target motion is generally underrepresented in the 4DCBCT scans, and that there is no significant difference between the motion measured in 4DCBCT scans reconstructed using different algorithms and respiratory signals.

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Training in EUS and ERCP: standardizing methods to assess competence

Postgraduate interventional endoscopy fellowships were created in response to the burgeoning portfolio of therapeutic endoscopy.1,2 Many programs recognized that comprehensive training in ERCP and EUS could not be achieved within the 3-year curriculum of an Accreditation Council for Graduate Medical Education (ACGME)–accredited fellowship in gastroenterology, hepatology, and nutrition. Although these postgraduate fellowships initially focused on ERCP and/or EUS, these postgraduate fellowships have evolved to include various combinations of training in ERCP and EUS, complex endoscopic resection (eg, large polyp EMR and endoscopic submucosal dissection [ESD]), endoluminal stent placement, advanced closure techniques, and bariatric endoscopy.

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Screening for esophageal squamous cell carcinoma: recent advances



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Implications of Pharmacogenomics to the Management of IBS

The objectives are to review the role of pharmacogenomics in drug metabolism of medications typically used in patients with irritable bowel syndrome (IBS) focusing predominantly on cytochrome P450 metabolism. Other aims are to provide examples of genetic variation of receptors or intermediary pathways that are targets for IBS drugs and to critically appraise the situations where precision medicine is impacting health in IBS. Pharmacogenomics impacts both pharmacokinetics and pharmacodynamics. Although large clinical trials have not incorporated testing for genetic variations that could impact the efficacy of medications in IBS, there are therapeutic advantages to inclusion of pharmacogenomics testing for individual patients, as has been demonstrated particularly in the treatment with central neuromodulators in psychiatry practice.

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Insufficient Sleep and Incidence of Dental Caries in Deciduous Teeth among Children in Japan: A Population-Based Cohort Study

To examine whether late bedtime and short nighttime sleep duration at age 18 months are associated with risk of caries in deciduous teeth.

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A Link between Nutritional and Growth States in Pediatric Patients with Functional Gastrointestinal Disorders

To investigate nutritional status and growth status of pediatric patients with functional gastrointestinal disorders (FGIDs) and to examine the relationship between nutritional status and linear growth in these children.

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Increased Risk of Thrombosis Associated with Peripherally Inserted Central Catheters Compared with Conventional Central Venous Catheters in Children with Leukemia

To study the risk of catheter-associated thrombosis (CAT) between peripherally inserted central catheters (PICCs) and tunneled central venous catheters in children with leukemia.

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The Jones Criteria for the Diagnosis of Acute Rheumatic Fever: Updated but Not Abandoned

In June 1944, the Journal of the America Medical Association (JAMA) published "The Diagnosis of Rheumatic Fever" by T. Duckett Jones.1 Eventually known as the "Jones criteria," these benchmarks became the fundamental cornerstones for the clinical diagnosis of acute rheumatic fever (ARF). Since then, every medical student and most other primary health care professionals have memorized the 5 cardinal manifestations of ARF outlined by Jones even as the disease itself came under the control of modern medical care in most developed countries worldwide.

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Achieving Stability in Oxygenation: Servo-Controlled Oxygen Environment as a First Step to Fully Automated Oxygen Control?

Oxygen is one of the drugs most frequently administered to neonates, yet the way it is dosed has not changed much over the years: It largely depends on the tightness of the alarm levels chosen on the bedside monitor and the alertness of the bedside staff how closely oxygen levels are controlled.1 This seems odd given the data from the various oxygen trials performed in the last 10-15 years comparing a higher with a lower pulse oximeter saturation (oxygen saturation [SpO2])-target range.2-4 A small (3%) difference in mean SpO2 between the high and low SpO2-target group in these trials affected the rate of important outcomes such as mortality or necrotizing enterocolitis.

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Annual NAVIGATOR conference highlights achievements of two outstanding emergency telecommunicators

Brought to you by Priority Dispatch LAS VEGAS — The International Academies of Emergency Dispatch® (IAED™) has recognized the outstanding accomplishments of emergency dispatchers and the contributions of dedicated professionals at its annual NAVIGATOR conference, held April 24–26 at the Aria Resort and Casino in Las Vegas, Nevada. At the event, IAED officials presented awards to ...

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Virus Delivery of CRISPR Guides to the Murine Prostate for Gene Alteration

This protocol describes a newly established method for virus delivery to the murine prostate. Using either CRISPR/Cas9 technology, gene overexpression, or Cre recombinase delivery, the technique allows orthotopic alteration of gene expression and implements a novel mouse model for prostate cancer.

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Microinjection of Western Corn Rootworm, Diabrotica virgifera virgifera, Embryos for Germline Transformation, or CRISPR/Cas9 Genome Editing

Here we present protocols for collecting and microinjecting precellular western corn rootworm embryos for the purpose of performing functional-genomic assays such as germline transformation and CRISPR/Cas9-genome editing.

https://ift.tt/2HUeuPT

High Risk of Death After Major Diabetes-Related Amputations

FRIDAY, April 27, 2018 -- There is a high risk of postoperative mortality among patients undergoing lower-limb amputation, according to a study published online April 5 in Diabetes Care. Jason K. Gurney, Ph.D., from University of Otago in...

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Spermatogenesis Still Occurs in Men With Testicular Cancer

FRIDAY, April 27, 2018 -- Spermatogenesis occurs in most men with testicular cancer, often away from tumors, according to a study published online April 17 in BJU International. Jemma A. Moody, from King's College London, and colleagues...

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Sickle Cell Trait Not Linked to Stroke in African-Americans

FRIDAY, April 27, 2018 -- For African-Americans, sickle cell trait (SCT) seems not to be associated with the incidence of ischemic stroke, according to a meta-analysis published online April 23 in JAMA Neurology. Hyacinth I. Hyacinth, M.D., Ph.D.,...

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Dark Chocolate Can Improve Contrast Sensitivity, Visual Acuity

FRIDAY, April 27, 2018 -- Compared with milk chocolate, consumption of dark chocolate is associated with higher contrast sensitivity and visual acuity within two hours, according to a study published online April 26 in JAMA Ophthalmology. Jeff C....

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Knowledge Not Tied to Addictive Tanning Behavior in Millennials

FRIDAY, April 27, 2018 -- For millennials, sun protection knowledge is not associated with addictive tanning behavior, according to a recent study published in the Journal of Consumer Affairs. Amy Watson, Ph.D., from Oregon State...

https://ift.tt/2Hw4oFz

Previous Stroke Tied to Higher Risks in Aortic Valve Replacement

FRIDAY, April 27, 2018 -- For patients undergoing surgical aortic valve replacement (SAVR), previous stroke is a risk factor for recurrent ischemic stroke and major adverse cardiovascular events (MACE), according to a study published online April 25...

https://ift.tt/2r5l8bD

ALS by Physician May Improve Traumatic Arrest Outcomes

FRIDAY, April 27, 2018 -- For patients with traumatic out-of-hospital cardiac arrest (OHCA), pre-hospital advanced life support (ALS) provided by a physician is associated with increased likelihood of one-month survival, according to a study...

https://ift.tt/2HxbrxU

Long-Acting Reversible Contraceptives Good for Teens

FRIDAY, April 27, 2018 -- Long-acting reversible contraceptives (LARC) are suitable for use by adolescents, according to a Committee Opinion published in the May issue of Obstetrics & Gynecology. Noting that from 2006 to 2010, 82 percent of...

https://ift.tt/2r5l6Ax

Potentially Inappropriate Meds Use Prevalent in Cancer Patients

FRIDAY, April 27, 2018 -- Potentially inappropriate medication (PIM) use is relatively prevalent among patients with breast or colorectal cancer, though it is not associated with most adverse outcomes, according to a study published online April 24...

https://ift.tt/2HyXT57

Certain Anticholinergic Drugs Appear to Raise Dementia Risk

FRIDAY, April 27, 2018 -- Use of anticholinergic drugs may be tied to a future diagnosis of dementia, according to a study published online April 25 in The BMJ. Kathryn Richardson, Ph.D., from University of East Anglia in the United Kingdom, and...

https://ift.tt/2r3bUfW

Localization and classification of heart beats in phonocardiography signals —a comprehensive review

Phonocardiogram (PCG) signal represents recording of sounds and murmurs resulting from heart auscultation. Analysis of these PCG signals is critical in diagnosis of different heart diseases. Over the years, a ...

https://ift.tt/2I4q2ha

High-grade serous carcinoma with discordant p53 signature: report of a case with new insight regarding high-grade serous carcinogenesis

Although p53 signature, benign-appearing epithelial cells with p53 diffuse expression, is frequently found in the fallopian tubes, the clinical and pathological significance of this lesion in the case of high-...

https://ift.tt/2Hy0yry

Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence

Abstract

Background

Surgical results of GERD have mainly been reported from the Western countries, with a few reports found in Japan. We examined the surgical results of laparoscopic Toupet fundoplication and clarify the characteristics of recurrent cases.

Methods

The subjects included 375 patients who underwent laparoscopic Toupet fundoplication from June 1997 to December 2016 as the initial surgery. Patient characteristics, pathophysiology, and surgical results were examined. In addition, we compared the patient characteristics and pathophysiology of recurrent cases in comparison with non-recurrent cases.

Results

Age 59 (43–70) and male 211 (56.3%). The operation time was 141 min (113–180) and intraoperative complications were found to have onset in 13 subjects (3.5%). Dysphagia after surgery was found in 18 cases (4.8%). The A factor (the degree of hiatal hernia), P factor (the degree of esophagitis), and pH < 4 holding time significantly improved after surgery compared with prior to surgery (p < 0.001 for all), while the LES lengths and abdominal LES lengths were extended (p < 0.001 for each). Recurrence was found in 48 patients (15.1%) among the 318 patients for whom we could confirm the presence or absence of recurrence. The A factor, P factor, and pH < 4 holding time prior to surgery were, respectively, higher in the recurrence group (p = 0.031, p < 0.001, p < 0.001).

Conclusions

Laparoscopic Toupet fundoplication for GERD could be performed safely, with a response rate as good as 85%. Compared with non-recurrent cases, preoperative clinical conditions such as esophageal hiatal hernia, reflux esophagitis, and acid reflux time were all advanced in recurrent cases.



https://ift.tt/2r2pt06

Biosemiotics Achievement Award for the Year 2017



https://ift.tt/2r35tKQ

Immunotherapy Drugs Expand Treatment Options for Advanced Lung Cancer

Results from a large clinical trial show combining an immune checkpoint inhibitor with chemotherapy helped some patients with advanced lung cancer live longer than chemotherapy alone. How will this change the lung cancer treatment landscape?



https://ift.tt/2vUsIeY

Type 1 Papillary Renal Cell Carcinoma Presenting as an Infected Benign Renal Cyst: an Uncommon Presentation

Abstract

We describe an unusual presentation of papillary renal cell carcinoma in a 40-year old male where radiological evaluation revealed a Bosniak type 2 cyst (probably benign), and clinical signs as well as symptoms also suggested an infected cyst l. However, on histopathological examination, an intra cystic type 1 papillary renal cell carcinoma was diagnosed. This is an extremely rare presentation of papillary renal cell carcinoma because it usually present as a heterogenous mass. Hence, even the radiologically benign cyst should be evaluated and managed cautiously.



https://ift.tt/2HAtz5V

Isolation and RNA Extraction of Neurons, Macrophages and Microglia from Larval Zebrafish Brains

57431fig1.jpg

We present a protocol to isolate neurons, macrophages and microglia from larval zebrafish brains under physiological and pathological conditions. Upon isolation, RNA is extracted from these cells to analyze their gene expression profile. This protocol allows for the collection of high-quality RNA for performing downstream analysis like qPCR and transcriptomics.

https://ift.tt/2r3G0Rh

Analyses of Mitochondrial Calcium Influx in Isolated Mitochondria and Cultured Cells

Here, we present two protocols for the measurement of mitochondrial Ca2+ influx in isolated mitochondria and cultured cells. For isolated mitochondria, we detail a plate reader-based Ca2+ import assay using the Ca2+ sensitive dye calcium green-5N. For cultured cells, we describe a confocal microscopy method using the Ca2+ dye Rhod-2/AM.

https://ift.tt/2HyBWij

Antidepressant and anxiolytic like effects of Urtica dioica leaves in streptozotocin induced diabetic mice

Abstract

The present study was aimed to investigate the effect of Urtica dioica Linn. (UD) extract against chronic diabetes mediated anxiogenic and depressive like behavior in mice. Streptozotocin (STZ) (50 mg/kg, i.p.) for 5 consecutive days was used to induce diabetes followed by treatment with UD leaves extract (50 mg/kg, p.o.) and rosiglitazone (ROSI) (5 mg/kg, p.o.) for 8 weeks. STZ induced chronic diabetes significantly induced anxiety and depressive like behavior in mice. Chronic diabetes significantly downregulated BDNF (p < 0.001), TrKB (p < 0.001), Cyclin D1 (p < 0.001), Bcl2 (p < 0.05) and autophagy7 (p < 0.001), while upregulated iNOS (p < 0.05) mRNA expression in the hippocampus as compared to control mice. In addition, chronic diabetes significantly increased the expression of TNF-α in CA1 (p < 0.001), CA2 (p < 0.01), CA3 (p < 0.001) and DG (p < 0.001) regions of hippocampus as compared to control mice. Chronic diabetes mediated neuronal damage in the CA2, CA3 and DG regions of hippocampus. Chronic administration of UD leaves extract significantly reversed diabetes mediated anxiogenic and depressive like behavior in mice. Further, UD treatment significantly upregulated BDNF (p < 0.01), TrKB (p < 0.001), Cyclin D1 (p < 0.001), Bcl2 (p < 0.01), autophagy5 (p < 0.01) and autophagy7 (p < 0.001), while downregulated iNOS (p < 0.05) mRNA expression in the hippocampus of diabetic mice. Concomitantly, UD administration significantly decreased the expression of TNF-α in hippocampal CA1 (p < 0.001), CA2 (p < 0.01), CA3 (p < 0.001) and DG (p < 0.001) regions of diabetic mice. Diabetes mediated neuronal damage and DNA fragmentation in the hippocampus was substantially attenuated following UD treatment. UD leaves extract might prove to be effective for diabetes mediated anxiety and depressive like behavior.



https://ift.tt/2KhIcwG

Microbial community and diversity in the feces of Sichuan takin (Budorcas taxicolor tibetana) as revealed by Illumina Miseq sequencing and quantitative real-time PCR

The Sichuan takin (Budorcas taxicolor tibetana) is a rare and endangered ruminant distributed in the eastern Himalayas. However, little information is available regarding the intestinal microbiota of the takin. I...

https://ift.tt/2JytrnU

Timing is everything: intraperitoneal chemotherapy after primary or interval debulking surgery for advanced ovarian cancer

Abstract

Purpose

To evaluate the outcomes of intraperitoneal chemotherapy (IP) compared with those of intravenous chemotherapy (IV) in patients with advanced ovarian cancer after neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) or primary debulking surgery (PDS).

Methods

Patients with advanced epithelial ovarian carcinoma treated with PDS or NACT and IDS from 2006 to 2015 were identified. Comparative statistics were used to evaluate covariates, and survival rates were calculated using the Kaplan–Meier method and compared with log-rank tests.

Results

Sixty-six patients received NACT followed by IDS with residual disease of ≤ 1 cm; 42 of these patients (63.6%) received IP therapy; and 24 patients (36.3%) had IV therapy only after IDS. The median progression-free survival (PFS) was 16.0 months in the IP group and 13.5 months in the IV group (p = 0.13). The estimated median overall survival (OS) was 64.0 months with IP and 50.0 months with IV (p = 0.44). During the same study period, 149 patients underwent optimal PDS after which 93 patients (62.4%) received IP and 56 patients (37.6%) were given IV chemotherapy. Patients after IP demonstrated improved survival outcomes when compared to patients after IV therapy. The median PFS was 28.0 months after IP and 16.5 months after IV (p = 0.0006), and the median OS was not reached for IP and 50.0 months after IV (p < 0.0001).

Conclusions

Although IP chemotherapy after PDS is associated with improved survival, IP therapy after NACT and IDS, despite high rates of completion, may not have the same degree of survival advantage over IV therapy.



https://ift.tt/2vRyI8b

A case report of giant pancreatic pseudocyst following acute pancreatitis: experience with endoscopic internal drainage

Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. A pseudocyst with the major diameter of 10 cm is termed as a giant cyst. Asymptomatic pseudo-cysts up...

https://ift.tt/2HAf6Ld

Factors associated with amputation among patients with diabetic foot ulcers in a Saudi population

A prospective study was conducted at the Armed Forces Hospital, Dhahran, Saudi Arabia, between January 2015 and December 2016 to identify the risk factors associated with amputation among diabetic foot ulcers ...

https://ift.tt/2r4NDXa

Assessment of temperatures in the vaccine cold chain in two provinces in Lao People’s Democratic Republic: a cross-sectional pilot study

All childhood vaccines, except the oral polio vaccine, should be kept at 2–8 °C, since the vaccine potency can be damaged by heat or freezing temperature. A temperature monitoring study conducted in 2008–2009 ...

https://ift.tt/2Hxz7lw

Combined CatWalk Index: an improved method to measure mouse motor function using the automated gait analysis system

Measuring motor function in mice is important for studying models of spinal cord injury (SCI) or other diseases. Several methods exist based on visual observation of mice moving in an open field. Though these ...

https://ift.tt/2r0j5pk

Photothermal treatment with EGFRmAb–AuNPs induces apoptosis in hypopharyngeal carcinoma cells via PI3K/AKT/mTOR and DNA damage response pathways

Abstract
Hypopharyngeal carcinoma (HC) is one of the most malignant tumors in the upper aerodigestive tract. Currently, there are no effective treatments for HC. Gold nanoparticles (AuNPs) are a promising tool that can be used for plasmonic photothermal therapy (PPTT), which refers to the use of electromagnetic radiation, most often in near infrared (NIR) region, for the treatment of various medical conditions including cancer. AuNPs have been proved to be a promising tool for NIR spectroscopy-mediated photothermal therapies. In this study, we chemically conjugated AuNPs with a monoclonal antibody (mAb) targeting the epidermal growth factor receptor (EGFR), a cell-surface receptor that is overexpressed in many cancers. We then assessed the effect of NIR photothermal treatment with the EGFRmAb–AuNPs in FaDu HC cells. Our data showed that nanoparticle conjugation with the EGFRmAb improved the specific targeting towards FaDu cells and reduced cytotoxicity towards normal (293 T) cells which do not overexpress the EGFR. A significant amount of our EGFRmAb-conjugated AuNPs could enter the nucleus. Moreover, the expression levels of double strand DNA break repair proteins, including p-ATR, p-CHK1, and p-CHK2 were increased following AuNPs treatment, indicating the presence of DNA damage. These findings suggest that the AuNPs can potentially disrupt genome integrity and induce apoptosis. In addition, EGFRmAb–AuNPs+NIR could induce FaDu cell apoptosis, accompanied by the inhibition of the PI3K/AKT/mTOR pathway and stimulation of DNA damage response. Based on these data, PPTT using the EGFRmAb–AuNPs could be a new promising treatment for HC.

https://ift.tt/2r4dI9v

Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis

Background and aims

Extrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferon-free antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating non-cirrhotic chronically infected individuals.

Methods

A systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.

Results

Data were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses.

Conclusion

Antiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies.



https://ift.tt/2Hx9aP7

Human gastric cancer modelling using organoids

Objective

Gastric cancer is the second leading cause of cancer-related deaths and the fifth most common malignancy worldwide. In this study, human and mouse gastric cancer organoids were generated to model the disease and perform drug testing to delineate treatment strategies.

Design

Human gastric cancer organoid cultures were established, samples classified according to their molecular profile and their response to conventional chemotherapeutics tested. Targeted treatment was performed according to specific druggable mutations. Mouse gastric cancer organoid cultures were generated carrying molecular subtype-specific alterations.

Results

Twenty human gastric cancer organoid cultures were established and four selected for a comprehensive in-depth analysis. Organoids demonstrated divergent growth characteristics and morphologies. Immunohistochemistry showed similar characteristics to the corresponding primary tissue. A divergent response to 5-fluoruracil, oxaliplatin, irinotecan, epirubicin and docetaxel treatment was observed. Whole genome sequencing revealed a mutational spectrum that corresponded to the previously identified microsatellite instable, genomic stable and chromosomal instable subtypes of gastric cancer. The mutational landscape allowed targeted therapy with trastuzumab for ERBB2 alterations and palbociclib for CDKN2A loss. Mouse cancer organoids carrying Kras and Tp53 or Apc and Cdh1 mutations were characterised and serve as model system to study the signalling of induced pathways.

Conclusion

We generated human and mouse gastric cancer organoids modelling typical characteristics and altered pathways of human gastric cancer. Successful interference with activated pathways demonstrates their potential usefulness as living biomarkers for therapy response testing.



https://ift.tt/2r3pC3h

Engineering 'Golden' Fluorescence by Selective Pressure Incorporation of Non-canonical Amino Acids and Protein Analysis by Mass Spectrometry and Fluorescence

Synthetic biology enables the engineering of proteins with unprecedented properties using the co-translational insertion of non-canonical amino acids. Here, we presented how a spectrally red-shifted variant of a GFP-type fluorophore with novel fluorescence spectroscopic properties, termed "gold" fluorescent protein (GdFP), is produced in E. coli via selective pressure incorporation (SPI).

https://ift.tt/2I7LTVa

Synthesis of Platinum-nickel Nanowires and Optimization for Oxygen Reduction Performance

56667fig1.jpg

  The protocol describes the synthesis and electrochemical testing of platinum-nickel nanowires. Nanowires were synthesized by the galvanic displacement of a nickel nanowire template. Post-synthesis processing, including hydrogen annealing, acid leaching, and oxygen annealing were used to optimize nanowire performance and durability in the oxygen reduction reaction.

https://ift.tt/2FmdOhb

Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results

Annals of Neurology, EarlyView.


https://ift.tt/2Jy2GAh

Pulsara named one of Montana High Tech Business Alliance’s 12 High Growth companies to watch in 2018

BOZEMAN, Mont. — The spotlight is being shone once again on Pulsara, recently named one of Montana High Tech Business Alliance's 12 High Growth companies to watch in 2018. Pulsara is excited to be recognized as one of Montana's rising stars among over 500 high-tech companies in the state. Pulsara is a healthcare product that securely enables all members of a patient care team — ...

https://ift.tt/2FounZw

Relationship between movement time and hip moment impulse in the sagittal plane during sit-to-stand movement: a combined experimental and computer simulation study

The association between repetitive hip moment impulse and the progression of hip osteoarthritis is a recently recognized area of study. A sit-to-stand movement is essential for daily life and requires hip exte...

https://ift.tt/2vUsTqJ

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review

Proximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative trea...

https://ift.tt/2HTKUu1

Fluoride varnish in the primary dentition can prevent caries

Regular use of fluoride varnish can prevent caries in primary teeth. Advantages or disadvantages regarding further patient-relevant outcomes remain unclear due to a lack of data.

https://ift.tt/2HV1CZN

A German‐Jewish refugee in Vichy France 1939–1941. Arno Motulsky's memoir of life in the internment camps at St. Cyprien and Gurs

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I4A2ak

The phenotypic spectrum of Xia‐Gibbs syndrome

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2FmvQiY

Functional independence of Taiwanese children with Prader–Willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I3aDhh

Neurodevelopmental outcome in 22q11.2 deletion syndrome and management

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2FpYgZO

38th Annual David W. Smith Workshop on Malformations and Morphogenesis: Abstracts of the 2017 Annual Meeting

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I2mEn2

The ontogeny of Robin sequence

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2FmvPeY

X‐linked intellectual disability update 2017

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I3DMJb

Delayed peak response of cortisol to insulin tolerance test in patients with Prader–Willi syndrome

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2FlKY0c

KBG syndrome patient due to 16q24.3 microdeletion presenting with a paratesticular rhabdoid tumor: Coincidence or cancer predisposition?

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I4rQXt

Mutations in SZT2 result in early‐onset epileptic encephalopathy and leukoencephalopathy

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2Fm1a1D

Expanding the phenotype of congenital central hypoventilation syndrome impacts management decisions

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I4Z5tY

An assessment of health, social, communication, and daily living skills of adults with down syndrome

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2FmOtDz

Association of 17q24.2‐q24.3 deletions with recognizable phenotype and short telomeres

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2I4Z4pU

Arno G. Motulsky, 1923–2018, Luck and Service

American Journal of Medical Genetics Part A, EarlyView.


https://ift.tt/2FmkcoC

Case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito

Creutzfeldt-Jakob disease is a rare and fatal neurodegenerative disorder that affects mammals and humans. The prevalence of this disease in the United States is 0.5 to 1 per million inhabitants. So far in Ecua...

https://ift.tt/2r3Surq

Pleocytosis in a patient with relapsing polychondritis accompanied by meningoencephalitis: a case report

Relapsing polychondritis (RP) is an uncommon immune-related disease with unknown causes. It is characterized by inflammation of cartilaginous or non-cartilaginous structures, such as the ears, nose, respirator...

https://ift.tt/2HxhB0K

High resolution magnetic resonance imaging in pathogenesis diagnosis of single lenticulostriate infarction with nonstenotic middle cerebral artery, a retrospective study

It is usually difficult to identify stroke pathogenesis for single lenticulostriate infarction with nonstenotic middle cerebral artery (MCA). Our aim is to differentiate the two pathogeneses, non-branch athero...

https://ift.tt/2r3Sqba

Case of convulsive seizure developing during electroretinographic recordings: a case report

To present our findings in a case of convulsive seizures and loss of consciousness that developed during recording electroretinograms (ERG).

https://ift.tt/2HvOLOu

Creutzfeldt-Jakob disease with Alzheimer pathology, presenting with status epilepticus following repeated partial seizures: a case report and literature review

Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease. Common first symptoms are dementia, cerebellar ataxia, visual disturbance, and psychiatric symptoms. Seizure as the first symptom of CJD is...

https://ift.tt/2r4LKts

Antischistosomal and anti-inflammatory activity of garlic and allicin compared with that of praziquantel in vivo

Schistosomiasis is an acute and chronic zoonotic parasitic disease caused by trematode worms. The host inflammatory response to schistosome eggs leads to perioval granulomata formation, mainly in the liver and...

https://ift.tt/2HvXy2V

There is more to septic shock than arterial hypotension and elevated lactate levels: another appeal to rethink current resuscitation strategies!



https://ift.tt/2Kmo4JY

An update on the clinical evidence that supports biosimilar approvals in Europe

British Journal of Clinical Pharmacology, EarlyView.


https://ift.tt/2KjUt3N

Adenocarcinoma arising in sigmoid colon neovagina 53 years after construction

Abstract

Background

In view of the rarity of vaginal agenesis, malignancy arising in the neovagina is extremely rare.

Case presentation

Here, we report a 76-year-old female with an adenocarcinoma arising in the sigmoid colon neovagina which was constructed 53 years ago for congenital vaginal agenesis. Vaginal endoscopy to examine vaginal bleeding revealed a protruding lesion occupying three quarters of the lumen in the vicinity of anastomosis of the residual vagina and sigmoid colon. Transvaginal ultrasonography revealed the muscularis propria layer (hypoechoic fourth layer) to be interrupted. CT revealed no distant metastasis. Total pelvic exenteration was performed based on the diagnosis of neovaginal cancer at the anastomosis site. The 45-mm tumor showed well-differentiated adenocarcinoma with a mucinous adenocarcinoma component. Immunohistochemistry showed no p16-overexpressing tumor cells, suggesting the lack of human papilloma virus infection.

Conclusions

Although rare, clinicians should be aware of cancer that arises in the ectopic intestine when anastomosed with other organs.



https://ift.tt/2KlJLtt

Increased Soluble CD137 Levels and CD4+ T‐Cell‐Associated Expression of CD137 in Acute Atherothrombotic Stroke

Clinical and Translational Science, EarlyView.


https://ift.tt/2HCvLKl

Global Standards to Expedite Learning From Medical Research Data

Clinical and Translational Science, EarlyView.


https://ift.tt/2HUTyZ1

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

Clinical and Translational Science, EarlyView.


https://ift.tt/2HAcp8u

Can Graphics Tell Lies? A Tutorial on How To Visualize Your Data

Clinical and Translational Science, EarlyView.


https://ift.tt/2HS3pPz

Differential diagnosis between a granuloma and radicular cyst: effectiveness of magnetic resonance imaging

International Endodontic Journal, EarlyView.


https://ift.tt/2vRzIZT

Review article: therapeutic bile acids and the risks for hepatotoxicity

Alimentary Pharmacology &Therapeutics, EarlyView.


https://ift.tt/2vWjuio

Using the chronic kidney disease guidelines to evaluate the renal safety of tenofovir disoproxil fumarate in hepatitis B patients

Alimentary Pharmacology &Therapeutics, EarlyView.


https://ift.tt/2r2SpoD

A pilot single arm observational study of sofosbuvir/ledipasvir (200 + 45 mg) in 6‐ to 12‐ year old children

Alimentary Pharmacology &Therapeutics, EarlyView.


https://ift.tt/2HCoA4Q

Systematic review with meta‐analysis: endoscopic and histologic placebo rates in induction and maintenance trials of ulcerative colitis

Alimentary Pharmacology &Therapeutics, EarlyView.


https://ift.tt/2r3Te0q

Safety and efficacy of pasireotide in dumping syndrome—results from a phase 2, multicentre study

Alimentary Pharmacology &Therapeutics, EarlyView.


https://ift.tt/2vRFlHM

Maternal residential pesticide use and risk of childhood leukemia in Costa Rica

International Journal of Cancer, EarlyView.


https://ift.tt/2I34vWi

Pre‐diagnostic blood immune markers, incidence and progression of B‐cell lymphoma and multiple myeloma: Univariate and functionally informed multivariate analyses

International Journal of Cancer, EarlyView.


https://ift.tt/2Fmnw2R

Gunshot victim reunites with paramedics at Congressional baseball practice

By EMS1 Staff ALEXANDRIA, Va. — A lobbyist who was shot at the GOP congressional baseball team practice last June reunited with the paramedics who saved him. WTOP reported that paramedic Chad Shade and now-retired paramedic Fiona Apple reunited with Tyson Foods lobbyist Matt Mika at the first practice since the incident at Eugene Simpson Field, where James Hodgkinson opened fire near the third ...

https://ift.tt/2HVruER

A New Treatment Modality for Rheumatoid Arthritis: Combined Photothermal and Photodynamic Therapy Using Cu7.2S4 Nanoparticles

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2HzOLJ6

Contact Lenses for Color Blindness

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2r5uUva

Hydrophobic Patterning‐Based 3D Microfluidic Cell Culture Assay

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2HBkWrE

In Vitro Tissue‐Engineered Skeletal Muscle Models for Studying Muscle Physiology and Disease

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2r3Hew8

Gas‐Stabilizing Gold Nanocones for Acoustically Mediated Drug Delivery

Advanced Healthcare Materials, EarlyView.


https://ift.tt/2HAuDGU

Evaluating clinical effectiveness of 13-valent pneumococcal conjugate vaccination against pneumonia among middle-aged and older adults in Catalonia: results from the EPIVAC cohort study

Benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness of PCV13 vaccination in preventing hospitalisation from pneumonia...

https://ift.tt/2r4AWLU

Determinants of CD4 cell count change and time-to default from HAART; a comparison of separate and joint models

HIV has the most serious effects in Sub-Saharan African countries as compared to countries in other parts of the world. As part of these countries, Ethiopia has been affected significantly by the disease, and ...

https://ift.tt/2Hx91PS

A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses

To understand the impact of weather on infectious diseases, information on weather parameters at patient locations is needed, but this is not always accessible due to confidentiality or data availability. Weat...

https://ift.tt/2r44KIq

Live attenuated Salmonella typhimurium vaccines delivering SaEsxA and SaEsxB via type III secretion system confer protection against Staphylococcus aureus infection

Staphylococcus aureus (S. aureus) causes a wide range of infectious diseases in human and animals. The emergence of antibiotic-resistant strains demands novel strategies for prophylactic vaccine development. In t...

https://ift.tt/2Hx8M7q

The magnitude of antibiotic resistance to Helicobacter pylori in Africa and identified mutations which confer resistance to antibiotics: systematic review and meta-analysis

Worldwide Helicobacter pylori (H.pylori) treatment is of great challenge due to increased antibiotic resistance. The burden of H. pylori antibiotic resistance in Africa is high with unclear information regarding ...

https://ift.tt/2r670z3

Evaluation of plasma microRNA-122, high-mobility group box 1 and keratin-18 concentrations to stratify acute gallstone disease: a pilot observational cohort study in an emergency general surgery unit

Objective

To obtain pilot data to evaluate the discriminatory power of biomarkers microRNA-122 (miR-122), high-mobility group box 1 (HMGB1), full-length keratin-18 (flk-18) and caspase-cleaved keratin-18 (cck-18) in plasma to identify potential biliary complications that may require acute intervention.

Design

An observational biomarker cohort pilot study.

Setting

In a Scottish University teaching hospital for 12 months beginning on 3 September 2014.

Participants

Blood samples were collected from adults (≥16 years old) referred with acute biliary-type symptoms who have presented to hospital within 24 hours prior were recruited. Patients unable or refused to give informed consent or were transferred from a hospital outside the National Health Service regional trust were excluded.

Primary outcome measures

To evaluate whether circulating miR-122, HMGB1, flk-18 and cck-18 can discriminate between people with and without gallstone disease and uncomplicated from complicated gallstone disease during the first 24 hours of hospital admission.

Results

300 patients were screened of which 285 patients were included. Plasma miR-122, cck-18 and flk-18 concentrations were increased in patients with gallstones compared with those without (miR-122: median: 2.89x104 copies/mL vs 0.90x104 copies/mL (p<0.001); cck-18: 121.2 U/L vs 103.5 U/L (p=0.031); flk-18: 252.4 U/L vs 145.1 U/L (p<0.001)). Uncomplicated gallstone disease was associated with higher miR-122 and cck-18 concentrations than complicated disease (miR-122: 5.72x104 copies/mL vs 2.26x104 copies/mL (p=0.023); cck-18: 139.7 U/L vs 113.6 U/L (p=0.047)). There was no significant difference in HMGB1 concentration between patients with and without gallstones (p=0.559). Separation between groups for all biomarkers was modest.

Conclusion

miR-122 and keratin-18 plasma concentrations are elevated in patients with gallstones. However, this result is confounded by the association between biomarker concentrations, age and gender. In this pilot study, miR-122 and keratin-18 were not sufficiently discriminatory to be progressed as clinically useful biomarkers in this context.



https://ift.tt/2Hv2aGp

Should empiric antibiotic therapy be withheld when aetiology of preterm birth is non-infectious? A protocol for a systematic review

Introduction

Preterm birth (PTB) at <37 weeks of gestation is the leading cause of perinatal morbidity and mortality in developed countries. The traditional approach has been based on the assumption that PTB is primarily a result of intrauterine infection, which triggers preterm labour and puts the newborn at risk of early onset sepsis (EOS). We are currently experiencing a rise in prematurity that results from maternal and fetal diseases unrelated to infection. We have designed a systematic review to assess whether chemoprophylaxis should be withheld when the aetiology of preterm birth is non-infectious.

Methods and analysis

Our study will focus on studies evaluating EOS in preterm infants. We will conduct a comprehensive search of literature available up to 28 February 2018. An information specialist will search for eligible studies in Medline (Ovid interface, 1948 and onwards), Embase (Ovid interface, 1980 onwards) and the Cochrane Central Register of Controlled Trials (Wiley interface, current issue). We will search databases and registries including records of ongoing research, conference proceedings and thesis (clinical trials, WHO International Clinical Trials Registry Platform). Two authors will independently extract data from eligible studies and assess risk of bias. For continuous outcomes, which follow discrete distribution, mean difference will be calculated. Dichotomous data will be presented using risk ratios, while count data will be expressed using rate ratios. Time-to-event outcomes will be reported as HRs. All estimates will be presented together with 95% CI. Studies comparable with respect to methodology and reporting the same outcomes will be combined in a meta-analysis.

Ethics and dissemination

Our systematic review does not require approval from the research and ethics board. We will use the findings to prepare a future multicentre randomised control trial in order to establish safe and adequate antibiotics policies for preterm infants, based on the aetiology of PTB.

PROSPERO registration number

CRD42016029707.



https://ift.tt/2r40Mj0

Incidence of major complications after percutaneous native renal biopsies in adults from low-income to middle-income countries: a protocol for systematic review and meta-analysis

Introduction

Kidney biopsy is an essential tool for guiding clinicians towards diagnoses, treatment and determining prognosis in renal disease. However, the procedure can be marred by various complications. The reported occurrence of complications varies among countries or regions and is also affected by several clinical and technical factors. This systematic review and meta-analysis aims to evaluate the incidence of major complications after percutaneous native renal biopsy in low-income to middle-income countries (LMICs).

Methods and analysis

We will include studies of populations from LMIC as per World Bank 2017 country list. Relevant abstracts published from 1 January 1980 to 30 December 2017 will be searched in PubMed, Cochrane, Excerpta Medica Database (Embase) and African Journals Online, without language restriction. Two reviewers will independently screen, select studies, extract data and assess the risk of bias in each study. A third reviewer will arbitrate in cases of disagreements. The study-specific estimates will be pooled through a random-effects model meta-analysis to obtain an overall summary estimate of the incidence of major complications across studies. Clinical and statistical heterogeneity will be evaluated by Cochrane's Q statistic. Funnel-plot analysis and Egger's test will be used to assess publication bias. Results will be presented by geographical region and income group.

Ethics and dissemination

This study will use published data. Therefore, there is no requirement for ethical approval. This systematic review and meta-analysis is expected to inform healthcare workers and providers about the occurrence of major complications following renal biopsies and highlight possible actions needed to improve the safety of the procedure in LMICs. The final report will be published as an original article in a peer-reviewed journal. Findings will also be presented at a conference and submitted to relevant health authorities.

PROSPERO registration number

CRD42017077656.



https://ift.tt/2HzED7h

Financial impact of injury in older workers: use of a national retrospective e-cohort to compare income patterns over 3 years in a universal injury compensation scheme

Objective

The study aims to quantify the impact of injury on the financial well-being of older workers. The hypothesis was that injured older workers have substantially reduced income from work following injury, but that New Zealand's (NZ) universal injury compensation scheme mitigates the difference for total income.

Design, setting and participants

An e-cohort of 617 722 workers aged 45–64 years old was created using de-identified linked administrative data in NZ's Integrated Data Infrastructure. Person-level data from numerous government agencies were used to compare 21 639 with an injury-related entitlement claim in 2009 with the remaining 596 133. Event date was the date of injury, or for the comparison group, a randomly selected date in 2009.

Primary and secondary outcome measures

Geometric mean ratios (GMRs) were used to compare income from work and total income from all taxable sources between those injured and the comparison group. Adjusted GMRs estimated income differences up to 36 months following the event date.

Results

Differences in total income increased over time. In the third year, those injured received 6.7% less (adjusted GMR 0.933 (95% CI 0.925 to 0.941)) than the comparison group, equivalent to an average loss of $NZ2628. Restricting to income from work, those injured received 29.2% less than the comparison group at 3 years (adjusted GMR 0.708 (95% CI 0.686 to 0.730)). For both men and women, those injured at 45–49 years consistently had the greatest relative income loss compared with those aged 50–54, 55–59 or 60–64 years.

Conclusions

Although the substantial impacts of injury on income were mainly mitigated by public income transfers, relative losses in income in those aged 45–64 years increased in the 3 years following injury. Policies focused on adequate compensation and reducing the time away from employment could reduce these financial impacts in older workers.



https://ift.tt/2r3UEax

Decline of adolescent smoking in Ireland 1995-2015: trend analysis and associated factors

Objectives

The study examines trends in smoking among Irish adolescents aged 15–16 years between 1995 and 2015 and the factors associated with their smoking behaviours between 2007 and 2015.

Methods

Data were obtained from the European School Survey Project on Alcohol and Other Drugs Ireland between 1995 and 2015. To examine the gender gap, two-sample proportion tests were used. Multivariate logistic regression was performed to examine the factors associated with smoking behaviours. Dependent variable is whether a respondent is a smoker in last 30 days. Independent variables include gender, survey years, perceived ease of access to cigarettes, perceived risk of smoking, perceived relative wealth, parental monitoring, maternal relationship, family structure, truancy and peer smoking.

Results

Smoking prevalence has dropped from 41% in 1995 to 13% in 2015. The prevalence was much higher among girls than boys in 1995. The gender gap was closed by 2015. Multivariate regression results show that peer smoking, perceived access to cigarettes, perceived risks of smoking, parental monitoring, truancy, maternal relationship, perceived relative wealth and family structure were all significantly associated with adolescent smoking, and some of the factors had different effects for female and male students.

Conclusion

Ireland has successfully achieved a considerable decrease of adolescent smoking from 1995 to 2015, during which various tobacco control policies have been implemented. In addition, the gender gap on adolescent smoking has been closed during the period. Adolescent smoking could be further improved through strengthening enforcement on adolescent access to cigarettes and maintaining a high-intensity tobacco control media campaign targeting adolescents. Parents could also contribute by enhancing monitoring.



https://ift.tt/2Hx73Pp

Hospitalisation cost analysis on hip fracture in China: a multicentre study among 73 tertiary hospitals

Objective

To describe and analyse the hospitalisation cost of patients with hip fracture under the influence of various factors and to provide references for Chinese national medical insurance policy.

Materials and methods

All data were collected from the Chinese National Medical Data Centre database, which contained the hospitalisation data of 73 tertiary hospitals from 24 provinces. The included patients were first hospitalised with the main diagnosis of femoral neck or intertrochanteric fracture, and were discharged between 1 January 2014 and 31 December 2015. Secondary hospitalisation, multiple trauma or pathologic fracture (except for osteoporotic fracture) patients or patients with missing data were excluded. The impact of various factors on the cost was investigated using analysis of variance and multivariable linear regression analysis. The Gross Domestic Product per capita and average annual disposable income were obtained from the website of the National Bureau of Statistics.

Results

27 205 cases were included in the study. The mean cost of all patients was ¥53 440. 60–69 years age group had a significantly higher cost compared with 80 years and above age group. The mean cost of femoral neck fractures was lower than that of the patients with intertrochanteric fractures; the mean cost of hip replacement was higher than that of internal fixation, which showed a strong effect of the surgical approach to the cost. Patients in low-income provinces spent less than those in high-income provinces, while the gap between high-income and middle-income provinces were relatively small.

Conclusion

The hospitalisation cost of hip fracture has become a great burden to the patients' families. The Chinese medical insurance policy may need further consideration of the demographic and economic factors.



https://ift.tt/2r5fSoo

Evaluating the long-term consequences of air pollution in early life: geographical correlations between coal consumption in 1951/1952 and current mortality in England and Wales

Objective

To evaluate associations between early life air pollution and subsequent mortality.

Design

Geographical study.

Setting

Local government districts within England and Wales.

Exposure

Routinely collected geographical data on the use of coal and related solid fuels in 1951–1952 were used as an index of air pollution.

Main outcome measures

We evaluated the relationship between these data and both all-cause and disease-specific mortality among men and women aged 35–74 years in local government districts between 1993 and 2012.

Results

Domestic (household) coal consumption had the most powerful associations with mortality. There were strong correlations between domestic coal use and all-cause mortality (relative risk per SD increase in fuel use 1.124, 95% CI 1.123 to 1.126), and respiratory (1.238, 95% CI 1.234 to 1.242), cardiovascular (1.138, 95% CI 1.136 to 1.140) and cancer mortality (1.073, 95% CI 1.071 to 1.075). These effects persisted after adjustment for socioeconomic indicators in 1951, current socioeconomic indicators and current pollution levels.

Conclusion

Coal was the major cause of pollution in the UK until the Clean Air Act of 1956 led to a rapid decline in consumption. These data suggest that coal-based pollution, experienced over 60 years ago in early life, affects human health now by increasing mortality from a wide variety of diseases.



https://ift.tt/2Hx69Co

Efficacy and safety of faecal microbiota transplantation in patients with psoriatic arthritis: protocol for a 6-month, double-blind, randomised, placebo-controlled trial

Introduction

An unbalanced intestinal microbiota may mediate activation of the inflammatory pathways seen in psoriatic arthritis (PsA). A randomised, placebo-controlled trial of faecal microbiota transplantation (FMT) infused into the small intestine of patients with PsA with active peripheral disease who are non-responsive to methotrexate (MTX) treatment will be conducted. The objective is to explore clinical aspects associated with FMT performed in patients with PsA.

Methods and analysis

This trial is a randomised, two-centre stratified, double-blind (patient, care provider and outcome assessor), placebo-controlled, parallel-group study. Eighty patients will be included and randomised (1:1) to either placebo (saline) or FMT provided from an anonymous healthy donor. Throughout the study, both groups will continue the weekly self-administered subcutaneous MTX treatment, remaining on the preinclusion dosage (15–25 mg/week). The clinical measures of psoriasis and PsA disease activity used include the Short (2-page) Health Assessment Questionnaire, the Dermatology Quality of Life Index, the Spondyloarthritis Research Consortium of Canada Enthesitis Index, the Psoriasis Area Severity Index, a dactylitis digit count, a swollen/tender joint count (66/68), plasma C reactive protein as well as visual analogue scales for pain, fatigue and patient and physician global assessments. The primary end point is the proportion of patients who experience treatment failure during the 6-month trial period. The number of adverse events will be registered throughout the study.

Ethics and dissemination

This is a proof-of-concept clinical trial and will be performed in agreement with Good Clinical Practice standards. Approvals have been obtained from the local Ethics Committee (DK-S-20150080) and the Danish Data Protection Agency (15/41684). The study has commenced in May 2017. Dissemination will be through presentations at national and international conferences and through publications in international peer-reviewed journal(s).

Trial registration number

NCT03058900; Pre-results.



https://ift.tt/2r3UBeR

Public performance reporting and hospital choice: a cross-sectional study of patients undergoing cancer surgery in the Australian private healthcare sector

Objectives

National mandatory public performance reporting (PPR) for Australian public hospitals, including measures of cancer surgery waiting times, was introduced in 2011. PPR is voluntary for private hospitals. The aims of this study were to assess whether PPR of hospital data is used by patients with breast, bowel or lung cancer when selecting a hospital for elective surgery and how PPR could be improved to meet their information needs.

Design

A national cross-sectional postal questionnaire.

Setting

Australian private healthcare sector.

Participants

Private patients with breast, bowel or lung cancer who attended a public or private hospital for elective surgery (n=243) in 2016.

Outcome measures

Patients' choice of hospital, use of PPR information and preferred areas of PPR information. Descriptive and conventional qualitative content analyses were conducted.

Results

Two hundred and twenty-eight respondents (94%) attended a private hospital. Almost half could choose a hospital. Choice of hospital was not influenced by PPR data (92% unaware) but by their specialist (90%). Respondents considered PPR to be important (71%) but they did not want to see the information, preferring their general practitioners (GPs) to tell them about it (40%). Respondents considered surgery costs (59%), complications (58%) and recovery success rates (57%) to be important areas of information that should be publicly reported. Almost half suggested that quality indicators should be reported at the individual clinician level. Analysis of the open-ended questions identified four themes: (1) decision-making factors; (2) data credibility; (3) unmet information needs and (4) unintended consequences.

Conclusions

PPR of hospital data had no substantial impact on patients' choice of hospital. Nonetheless, many respondents expressed interest in using it in future. To increase PPR awareness and usability, personalised and integrated information on cost and quality of hospitals is required. Dissemination of PPR information via specialists and GPs could assist patients to interpret the data and support decision-making.



https://ift.tt/2Hx6xAX

Evaluation of the feasibility and performance of early warning scores to identify patients at risk of adverse outcomes in a low-middle income country setting

Objective

This study describes the availability of core parameters for Early Warning Scores (EWS), evaluates the ability of selected EWS to identify patients at risk of death or other adverse outcome and describes the burden of triggering that front-line staff would experience if implemented.

Design

Longitudinal observational cohort study.

Setting

District General Hospital Monaragala.

Participants

All adult (age >17 years) admitted patients.

Main outcome measures

Existing physiological parameters, adverse outcomes and survival status at hospital discharge were extracted daily from existing paper records for all patients over an 8-month period.

Statistical analysis

Discrimination for selected aggregate weighted track and trigger systems (AWTTS) was assessed by the area under the receiver operating characteristic (AUROC) curve.

Performance of EWS are further evaluated at time points during admission and across diagnostic groups. The burden of trigger to correctly identify patients who died was evaluated using positive predictive value (PPV).

Results

Of the 16 386 patients included, 502 (3.06%) had one or more adverse outcomes (cardiac arrests, unplanned intensive care unit admissions and transfers). Availability of physiological parameters on admission ranged from 90.97% (95% CI 90.52% to 91.40%) for heart rate to 23.94% (95% CI 23.29% to 24.60%) for oxygen saturation. Ability to discriminate death on admission was less than 0.81 (AUROC) for all selected EWS. Performance of the best performing of the EWS varied depending on admission diagnosis, and was diminished at 24 hours prior to event. PPV was low (10.44%).

Conclusion

There is limited observation reporting in this setting. Indiscriminate application of EWS to all patients admitted to wards in this setting may result in an unnecessary burden of monitoring and may detract from clinician care of sicker patients. Physiological parameters in combination with diagnosis may have a place when applied on admission to help identify patients for whom increased vital sign monitoring may not be beneficial. Further research is required to understand the priorities and cues that influence monitoring of ward patients.

Trial registration number

NCT02523456.



https://ift.tt/2r89DR0

The relationship between sleep duration and fruit/vegetable intakes in UK adults: a cross-sectional study from the National Diet and Nutrition Survey

Objectives

There is increasing evidence to suggest an association between sleep and diet. The aim of the present study was to examine the association between sleep duration and fruit/vegetable (FV) intakes and their associated biomarkers in UK adults.

Design

Cross-sectional.

Setting

Data from The National Diet and Nutrition Survey.

Participants

1612 adults aged 19–65 years were included, pregnant/breastfeeding women were excluded from the analyses.

Outcome measures

Sleep duration was assessed by self-report, and diet was assessed by 4-day food diaries, disaggregation of foods containing FV into their components was conducted to determine total FV intakes. Sleep duration was divided into: short (<7 hours/day), reference (7–8 hours/day) and long (>8 hours/day) sleep periods. Multiple regression adjusting for confounders was used for analyses where sleep duration was the exposure and FV intakes and their associated biomarkers were the outcomes. Restricted cubic spline models were developed to explore potential non-linear associations.

Results

In adjusted models, long sleepers (LS) consumed on average 28 (95% CI –50 to –6, p=0.01) g/day less of total FV compared to reference sleepers (RS), whereas short sleepers (SS) consumed 24 g/day less (95% CI –42 to –6, p=0.006) and had lower levels of FV biomarkers (total carotenoids, β-carotene and lycopene) compared to RS. Restricted cubic spline models showed that the association between sleep duration and FV intakes was non-linear (p<0.001) with RS having the highest intakes compared to SS and LS. The associations between sleep duration and plasma total carotenoids (p=0.0035), plasma vitamin C (p=0.009) and lycopene (p<0.001) were non-linear with RS having the highest levels.

Conclusions

These findings show a link between sleep duration and FV consumption. This may have important implications for lifestyle and behavioural change policy.



https://ift.tt/2HvWN9V

A modified Delphi study towards developing a guideline to inform policy on fetal alcohol spectrum disorders in South Africa: a study protocol

Introduction

Maternal alcohol consumption during pregnancy can result in mental and physical birth defects in individuals. These birth defects are usually described as fetal alcohol spectrum disorders (FASDs). With an estimated 183–259 per 1000 children born with FASDs, South Africa is identified to have the highest prevalence of FASDs in the world. Nevertheless, there is a lack of appropriate policies, guidelines and interventions addressing the issues around FASDs. This protocol outlines a proposed process for developing a guideline to inform policies on FASDs.

Methods and analysis

This process will have three phases. Phase I will be carried out in three steps; we plan to conduct a document review of available policies on the prevention and management of FASDs and update the existing systematic review on FASDs interventions. The aim of the two reviews is to explore the availability and content of existing policies and global interventions on FASDs. In addition, we will conduct two exploratory qualitative studies to obtain the perspectives of various stakeholders on the existing or possible guidelines and policies for the management of FASDs and available interventions and services. In phase II, we will aggregate the findings of the previous phase to develop a prototype guideline. In phase III, using the developed prototype, we will apply the Delphi approach with experts on FASDs, soliciting their opinions on the nature and content of the proposed guidelines for policies. The information gathered will be used to modify the prototype to formulate a policy guideline on FASDs. The data will be analysed using thematic analysis and narrative synthesis.

Ethics and dissemination

Ethical clearance has been obtained from the ethics committee of the university and governmental departments. The findings will be disseminated through publications and the guideline will be submitted to relevant departments.



https://ift.tt/2r5fOFa

Characteristics of value-based health and social care from organisations perspectives (OrgValue): a mixed-methods study protocol

Introduction

Health and social care systems are under pressure to organise care around patients' needs with constrained resources. Several studies reveal that care is constantly challenged by balancing economic requirements against individual patients' preferences and needs. Therefore, value-based health and social care aims to facilitate patient-centredness while taking the resources spent into consideration. The OrgValue project examines the implementation of patient-centredness while considering the health and social care organisations' resource orientation in the model region of the city of Cologne, Germany.

Methods and analysis

First, the implementation status of patient-centredness as well as its facilitators and barriers—also in terms of resource orientation—will be assessed through face-to-face interviews with decision-makers (at least n=18) from health and social care organisations (HSCOs) in Cologne. Second, patients' understanding of patient-centredness and their preferences and needs will be revealed by conducting face-to-face interviews (at least n=15). Third, the qualitative results will provide the basis for a quantitative survey of decision-makers from all HSCOs in Cologne, which will include questions on patient-centredness, resource orientation and determinants of implementation. Fourth, qualitative interviews with decision-makers from different types of HSCOs will be conducted to develop a uniform measurement instrument on the cost and service structure of HSCOs.

Ethics and dissemination

For all collected data, the relevant data protection regulations will be adhered to. Consultation and a positive vote from the ethics committee of the Medical Faculty of the University of Cologne have been obtained. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include a feedback report as well as research and development workshops for the organisations with the aim of initiating organisational learning and organisational development, presenting results in publications and at conferences, and public relations.

Trial registration number

DRKS00011925.



https://ift.tt/2HvkGyw

Sphingosine kinase 1 promotes liver fibrosis by preventing miR‐19b‐3p‐mediated inhibition of CCR2

Hepatology, EarlyView.


https://ift.tt/2HwdpKH

Na+‐taurocholate cotransporting polypeptide inhibition has hepatoprotective effects in cholestasis in mice

Hepatology, EarlyView.


https://ift.tt/2qZorlB

Deployment of carboxymethyl cellulose sheets to prevent esophageal stricture after full circumferential endoscopic submucosal dissection: A porcine model

Digestive Endoscopy, EarlyView.


https://ift.tt/2HuFfex

Imprinting Chirality onto the Electronic States of Colloidal Perovskite Nanoplatelets

Advanced Materials, EarlyView.


https://ift.tt/2I4QerU

Bioinspired Stimuli‐Responsive Color‐Changing Systems

Advanced Materials, EarlyView.


https://ift.tt/2Fk5vlS

Structural and Chemical Changes to CH3NH3PbI3 Induced by Electron and Gallium Ion Beams

Advanced Materials, EarlyView.


https://ift.tt/2I53UDB

Metal‐Halide Perovskites for Gate Dielectrics in Field‐Effect Transistors and Photodetectors Enabled by PMMA Lift‐Off Process

Advanced Materials, EarlyView.


https://ift.tt/2Fk5Uoo

Aligning Solution‐Derived Carbon Nanotube Film with Full Surface Coverage for High‐Performance Electronics Applications

Advanced Materials, EarlyView.


https://ift.tt/2I69NAs

Automated identification of structurally heterogeneous and patentable antiproliferative hits as potential tubulin inhibitors

Chemical Biology &Drug Design, EarlyView.


https://ift.tt/2HYpfRl

Improving classical scoring functions using random forest: The non‐additivity of free energy terms’ contributions in binding

Chemical Biology &Drug Design, EarlyView.


https://ift.tt/2Hy93CQ

Oil Absorption of Potato Slices Pre‐Dried by Three Kinds of Methods

European Journal of Lipid Science and Technology, EarlyView.


https://ift.tt/2I586TI

Lipid Oxidation Derived Aldehydes and Oxysterols Between Health and Disease

European Journal of Lipid Science and Technology, EarlyView.


https://ift.tt/2FmNaEx

Survival and clinical outcomes of patients with melanoma brain metastasis in the era of checkpoint inhibitors and targeted therapies

Abstract

Background

Melanoma brain metastasis is associated with an extremely poor prognosis, with a median overall survival of 4–5 months. Since 2011, the overall survival of patients with stage IV melanoma has been significantly improved with the advent of new targeted therapies and checkpoint inhibitors. We analyze the survival outcomes of patients diagnosed with brain metastasis after the introduction of these novel drugs.

Methods

We performed a retrospective analysis of our melanoma center database and identified 79 patients with brain metastasis between 2011 and 2015.

Results

The median time from primary melanoma diagnosis to brain metastasis was 3.2 years. The median overall survival duration from the time of initial brain metastasis was 12.8 months. Following a diagnosis of brain metastasis, 39 (49.4%), 28 (35.4%), and 24 (30.4%) patients were treated with anti-CTLA-4 antibody, anti-PD-1 antibody, or BRAF inhibitors (with or without a MEK inhibitor), with a median overall survival of 19.2 months, 37.9 months and 12.7 months, respectively. Factors associated with significantly reduced overall survival included male sex, cerebellar metastasis, higher number of brain lesions, and treatment with whole-brain radiation therapy. Factors associated with significantly longer overall survival included treatment with craniotomy, stereotactic radiosurgery, or with anti-PD-1 antibody after initial diagnosis of brain metastasis.

Conclusions

These results show a significant improvement in the overall survival of patients with melanoma brain metastasis in the era of novel therapies. In addition, they suggest the activity of anti-PD-1 therapy specifically in the setting of brain metastasis.



https://ift.tt/2HCrPcx

Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities

Abstract

Background

In the United States, race and socioeconomic status are well known predictors of adverse outcomes in several different cancers. Existing evidence suggests that race and socioeconomic status may impact survival in soft tissue sarcoma (STS). We investigated the National Cancer Database (NCDB), which contains several socioeconomic and medical variables and contains the largest sarcoma patient registry to date. Our goal was to determine the impact of race, ethnicity and socioeconomic status on patient survival in patients with soft tissue sarcoma of the extremities (STS-E).

Methods

We retrospectively analyzed 14,067 STS-E patients in the NCDB from 1998 through 2012. Patients were stratified based on race, ethnicity and socioeconomic status. Univariate and multivariate analyses were used to correlate specific outcomes and survival measures with these factors. Then, long-term survival between groups was evaluated using the Kaplan-Meier (KM) method with comparisons based on the log-rank test. Multiple variables were analyzed between two groups.

Results

Of the 14,067 patients analyzed, 84.9% were white, 11% were black and 4.1% were Asian. Black patients were significantly more likely (7.18% vs 5.65% vs 4.47%) than white or Asian patients to receive amputation (p = 0.027). Black patients were also less likely to have either an above-median education level or an above-median income level (p < 0.001). In addition, black patients were more likely to be uninsured (p < 0.001) and more likely to have a higher Charleson Comorbidity Score than white or Asian patients. Tumors were larger in size upon presentation in black patients than in white or Asian patients (p < 0.001). Black patients had significantly poorer overall survival than did white or Asian patients (p < 0.001) with a KM 5-year survival of 61.4% vs 66.9% and 69.9% respectively, and a 24% higher independent likelihood of dying in a multivariate analysis.

Conclusion

This large database review reveals concerning trends in black patients with STS-E. These include larger tumors, poorer resources, a greater likelihood of amputation, and poorer survival than white and Asian patients. Future studies are warranted to help ensure adequate access to effective treatment for all patients.



https://ift.tt/2r5TZWX

Distribution of human papilloma virus genotype prevalence in invasive cervical carcinomas and precancerous lesions in the Yangtze River Delta area, China

Abstract

Background

This study aimed to provide more information for cancer prevention strategies by determining the distribution of human papilloma virus (HPV) genotype prevalence in invasive cervical carcinoma (ICC) and precancerous lesion patients in the Yangtze River Delta area in China.

Methods

This multi-centre descriptive cross-sectional study involves four university hospitals in the Jiangzhehu area. Women with histologically confirmed cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3 or ICC who were diagnosed and treated in the four selected hospitals between February 2012 and April 2014 were eligible for recruitment. The average age of the patients was 40.93 ± 11.87 years old, among whom the youngest was 17 years old and the oldest was 76 years old.Those with immunodeficiency diseases or a previous history of cancer or CIN were excluded. HPV genotyping was performed by a central laboratory. The distribution and age and disease specificity of the HPV genotype prevalence were analysed.

Results

Of the 2181 collected samples, 251 were ICC and 1930 were CIN. The mean age of cervical cancer and CIN patients was 40.93 ± 11.8 years (range, 17–76 years). The five most commonly identified HPV types in each lesion class were as follows: CIN1: 52, 58, 16, 33, and CP; CIN2: 16, 58, 52, 33, and 31; CIN3: 16, 58, 33, 52, and 31; and ICC: 16, 58, 18, 52, and 33. CIN1 had an earlier age of onset (30–40 years) than CIN2, CIN3, and cervical cancer. The age of onset of cervical cancer exhibited two peaks at 40–44 and 50–54 years of age. In all infected patients, the frequency of HPV infection with a single type was 62.9%, and with multiple types, it was 38.1%. There was no difference in the frequencies of multiple types amongst the different cervical lesions.

Conclusions

The most prevalent genotypes in the investigated area (52, 58, 16 and 18) justify the necessity of anti-HPV vaccination in teenagers and young girls under 24 years old in the Yangtze River Delta area in China. Infection with multiple high-risk HPV types versus single infection does not increase the risk for ≥ CIN2 in ICC development.



https://ift.tt/2vXGEEO

Validation of the SNACOR clinical scoring system after transarterial chemoembolisation in patients with hepatocellular carcinoma

Abstract

Background

Transarterial chemoembolisation is the standard of care for intermediate stage (BCLC B) hepatocellular carcinoma, but it is challenging to decide when to repeat or stop treatment. Here we performed the first external validation of the SNACOR (tumour Size and Number, baseline Alpha-fetoprotein, Child-Pugh and Objective radiological Response) risk prediction model.

Methods

A total of 1030 patients with hepatocellular carcinoma underwent transarterial chemoembolisation at our tertiary referral centre from January 2000 to December 2016. We determined the following variables that were needed to calculate the SNACOR at baseline: tumour size and number, alpha-fetoprotein level, Child-Pugh class, and objective radiological response after the first transarterial chemoembolisation. Overall survival, time-dependent area under receiver-operating characteristic curves, Harrell's C-index, and the integrated Brier score were calculated to assess predictive ability. Finally, multivariate analysis was performed to identify independent predictors of survival.

Results

The study included 268 patients. Low, intermediate, and high SNACOR scores predicted a median survival of 31.5, 19.9, and 9.2 months, respectively. The areas under the receiver-operating characteristic curve for overall survival were 0.641, 0.633, and 0.609 at 1, 3, and 6 years, respectively. Harrell's C-index was 0.59, and the integrated Brier Score was 0.175. Independent predictors of survival included tumour size (P < 0.001), baseline alpha-fetoprotein level (P < 0.001) and Child-Pugh class (P < 0.004). Objective radiological response (P = 0.821) and tumour number (P = 0.127) were not additional independent predictors of survival.

Conclusions

The SNACOR risk prediction model can be used to identify patients with a dismal prognosis after the first transarterial chemoembolisation who are unlikely to benefit from further transarterial chemoembolisation. However, Harrell's C-index showed only moderate performance. Accordingly, this risk prediction model can only serve as one of several components used to make the decision about whether to repeat treatment.



https://ift.tt/2r3vbig

HPV-16 E7 expression up-regulates phospholipase D activity and promotes rapamycin resistance in a pRB-dependent manner

Abstract

Background

Human Papillomavirus (HPV) infection is the main risk factor for the development and progression of cervical cancer. HPV-16 E6 and E7 expression is essential for induction and maintenance of the transformed phenotype. These oncoproteins interfere with the function of several intracellular proteins, including those controlling the PI3K/AKT/mTOR pathway in which Phospolipase D (PLD) and Phosphatidic acid (PA) play a critical role.

Methods

PLD activity was measured in primary human keratinocytes transduced with retroviruses expressing HPV-16 E6, E7 or E7 mutants. The cytostatic effect of rapamycin, a well-known mTOR inhibitor with potential clinical applications, was evaluated in monolayer and organotypic cultures.

Results

HPV-16 E7 expression in primary human keratinocytes leads to an increase in PLD expression and activity. Moreover, this activation is dependent on the ability of HPV-16 E7 to induce retinoblastoma protein (pRb) degradation. We also show that cells expressing HPV-16 E7 or silenced for pRb acquire resistance to the antiproliferative effect of rapamycin.

Conclusion

This is the first indication that HPV oncoproteins can affect PLD activity. Since PA can interfere with the ability of rapamycin to bind mTOR, the use of combined strategies to target mTOR and PLD activity might be considered to treat HPV-related malignancies.



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Development of a computational promoter with highly efficient expression in tumors

Abstract

Background

Gene therapy is a potent method to increase the therapeutic efficacy against cancer. However, a gene that is specifically expressed in the tumor area has not been identified. In addition, nonspecific expression of therapeutic genes in normal tissues may cause side effects that can harm the patients' health. Certain promoters have been reported to drive therapeutic gene expression specifically in cancer cells; however, low expression levels of the target gene are a problem for providing good therapeutic efficacy. Therefore, a specific and highly expressive promoter is needed for cancer gene therapy.

Methods

Bioinformatics approaches were utilized to analyze transcription factors (TFs) from high-throughput data. Reverse transcription polymerase chain reaction, western blotting and cell transfection were applied for the measurement of mRNA, protein expression and activity. C57BL/6JNarl mice were injected with pD5-hrGFP to evaluate the expression of TFs.

Results

We analyzed bioinformatics data and identified three TFs, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), cyclic AMP response element binding protein (CREB), and hypoxia-inducible factor-1α (HIF-1α), that are highly active in tumor cells. Here, we constructed a novel mini-promoter, D5, that is composed of the binding sites of the three TFs. The results show that the D5 promoter specifically drives therapeutic gene expression in tumor tissues and that the strength of the D5 promoter is directly proportional to tumor size.

Conclusions

Our results show that bioinformatics may be a good tool for the selection of appropriate TFs and for the design of specific mini-promoters to improve cancer gene therapy.



https://ift.tt/2r2O199