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BACKGROUND AND OBJECTIVES: To investigate CSF findings in relation to clinical and electrodiagnostic subtypes, severity, and outcome of Guillain-Barré syndrome (GBS) based on 1,500 patients in the International GBS Outcome Study. METHODS: Albuminocytologic dissociation (ACD) was defined as an increased protein level (>0.45 g/L) in the absence of elevated white cell count (4 days 84%. High CSF protein levels were associated with a demyelinating subtype, proximal or global muscle weakness, and a reduced likelihood of being able to run at week 2 (odds ratio [OR] 0.42, 95% CI 0.25-0.70; p = 0.001) and week 4 (OR 0.44, 95% CI 0.27-0.72; p = 0.001). Patients with the Miller Fisher syndrome, distal predominant weakness, and normal or equivocal nerve conduction studies were more likely to have lower CSF protein levels. CSF cell count was

Natural killer (NK) cells are innate lymphocytes with cytotoxic activity. Understanding the factors regulating cytotoxicity is crucial for improving NK-cell adoptive therapies. Here, we studied a previously unknown role of p35 (CDK5R1), a coactivator of cyclin-dependent kinase 5 (CDK5) in NK-cell function. p35 expression was thought to be neuronal-specific and the majority of studies are still focused on neuronal cells. Here, we show that CDK5 and p35 are expressed in NK cells and are kinase-active. NK cells from p35 knockout mice were analyzed and showed significantly increased cytotoxicity against murine cancer cells, while they did not show any differences in cell numbers or maturation stages. We confirmed this using human NK cells transduced with p35 short hairpin RNA (shRNA), showing similar increase in cytotoxicity against human cancer cells. Overexpression of p35 in NK cells resulted in moderate decrease in cytotoxicity, while expressing a kinase-dead mutant of CDK5 displayed increased cytotoxicity. Together, these data suggest that p35 negatively regulates NK-cell cytotoxicity. Surprisingly, we found that TGFβ, a known negative regulator of NK-cell cytotoxicity, induces p35 expression in NK cells. NK cells cultured with TGFβ exhibit reduced cytotoxicity, while NK cells transduced with p35 shRNA or mutant CDK5 expression exhibited partial reversal of this inhibitory effect pointing to an interesting hypothesis that p35 plays an important role in TGFβ-mediated NK-cell exhaustion. Significance: This study reports a role for p35 in NK-cell cytotoxicity and this might help to improve NK-cell adoptive therapy.

OBJECTIVE Patients with unruptured brain arteriovenous malformations (AVMs) may present with headaches, seizures, and/or neurological deficits. A smaller number of cases may be discovered incidentally. These lesions remain incompletely understood due to their sparse reporting. Herein, the authors describe the largest series to date comparing the presentation, angioarchitecture, and management of incidental versus symptomatic unruptured AVMs in children. METHODS The authors performed a retrospective analysis of patients who presented with brain AVMs from 1998 to 2022 at the University of California, San Francisco. Inclusion criteria were age ≤ 18 years at the time of presentation and an angiographically proven unruptured AVM that had been diagnosed postnatally. RESULTS Of 76 children with unruptured AVMs, 66 (86.8%) presented with headaches, seizures, and/or neurological deficit. Ten AVMs (13.1%) were incidentally discovered through unrelated disease workup (50%), cranial trauma (40%), or research study participation (10%). Compared with patients with symptomatic unruptured AVMs, patients with incidental unruptured AVMs had a smaller mean ± SD maximum nidus diameter (2.82 ± 1.1 vs 3.98 ± 1.52 cm, p = 0.025) and fewer had deep venous drainage (20% of patients vs 61%, p = 0.036). They also presented at an earlier age (10 ± 5.2 vs 13.5 ± 4 years, p = 0.043) and with longer duration to first treatment (541 ± 922 vs 196 ± 448 days, p = 0.005). During the observation period, 1 patient developed recurring headaches and demonstrated AVM nidus growth. Four AVMs greater than 3 cm in size or in a deep location were treated with radiosurgery. Six other AVMs were treated with resection, with 2 receiving preoperative embolization. Eight AVMs (80%) were obliterated on last follow-up. Postprocedural complications included 2 transient neurological deficits after resection and 1 case of delayed seizure development after radiosurgery. The mean follow-up period was 5.7 ± 5.7 years without any hemorrhage episodes. CONCLUSIONS A substantial proportion of pediatric patients with unruptured AVMs are discovered incidentally. With earlier presentation and more elementary angioarchitecture than symptomatic unruptured AVMs, these incidental lesions provide a snapshot into the natural history of AVM before symptom development or rupture.

Tissue phenotyping is foundational to understanding and assessing the cellular aspects of disease in organismal context and an important adjunct to molecular studies in the dissection of gene function, chemical effects, and disease. As a first step toward computational tissue phenotyping, we explore the potential of cellular phenotyping from 3-Dimensional (3D), 0.74 µm isotropic voxel resolution, whole zebrafish larval images derived from X-ray histotomography, a form of micro-CT customized for histopathology. As proof of principle towards computational tissue phenotyping of cells, we created a semi-automated mechanism for the segmentation of blood cells in the vascular spaces of zebrafish larvae, followed by modeling and extraction of quantitative geometric parameters. Manually segmented cells were used to train a random forest classifier for blood cells, enabling the use of a generalized cellular segmentation algorithm for the accurate segmentation of blood cells. These models were used to create an automated data segmentation and analysis pipeline to guide the steps in a 3D workflow including blood cell region prediction, cell boundary extraction, and statistical characterization of 3D geometric and cytological features. We were able to distinguish blood cells at two stages in development (4- and 5-days-post-fertilization) and wild-type vs.polA2 huli hutu(hht) mutants. The application of geometric modeling across cell types to and across organisms and sample types may comprise a valuable foundation for computational phenotyping that is more open, informative, rapid, objective, and reproducible.

Overexpression of kinase-dead CDK5 increases NK92 cytotoxicity while overexpression of p35 decreases cytotoxicity. A, Western blot analysis of protein from NK92 cells overexpressing CDK5 (OE CDK5), kinase-dead mutant CDK5 (OE CDK5-K33T), p35 (OE p35), or empty vector control (OE Ctrl). B, NK92 cells were plated in complete media with a starting count of 250,000 cells. Live cell count was obtained after 48 hours cell culture via trypan blue staining and manual counting on a hemocytometer. ns, not significant. Graphs display mean ± SD, n = 3 biological cultures, one-way ANOVA with Dunnett multiple comparisons test. C, NK92 cells were stained with Annexin V and PI and analyzed via flow cytometry. Percentage of cells staining positive for Annexin V and/or PI were graphed. Graphs display mean ± SD, n = 3 biological cultures. D, NK92 cells were fixed in 70% ethanol and stained with PI, then analyzed via flow cytometry. G0–G1, S, and G2–M phases of the cell cycle are indicated. E, NK92 cells (OE Ctrl, OE CDK5, OE CDK5-K33T) were cocultured with fluorescently-labeled Jeko-1 cells for 16 hours at different E:T ratios, followed by staining with PI and gating on labeled cancer cells to measure cancer cell death via flow cytometry. ****, P < 0.0001. Graph displays mean ± SD, n = 3 biological cocultures, two-way ANOVA with Dunnett multiple comparisons test. F, NK92 cells (OE Ctrl, OE p35) were cocultured with fluorescently-labeled Jeko-1 cells for 16 hours at 5:1 E:T ratio, followed by staining with PI and gating on labeled cancer cells to measure cancer cell death via flow cytometry. *, P < 0.05. Graph displays mean ± SD, n = 3 biological cocultures, unpaired two-tailed t test.

Natural killer (NK) cells are innate lymphocytes with cytotoxic activity. Understanding the factors regulating cytotoxicity is crucial for improving NK-cell adoptive therapies. Here, we studied a previously unknown role of p35 (CDK5R1), a coactivator of cyclin-dependent kinase 5 (CDK5) in NK-cell function. p35 expression was thought to be neuronal-specific and the majority of studies are still focused on neuronal cells. Here, we show that CDK5 and p35 are expressed in NK cells and are kinase-active. NK cells from p35 knockout mice were analyzed and showed significantly increased cytotoxicity against murine cancer cells, while they did not show any differences in cell numbers or maturation stages. We confirmed this using human NK cells transduced with p35 short hairpin RNA (shRNA), showing similar increase in cytotoxicity against human cancer cells. Overexpression of p35 in NK cells resulted in moderate decrease in cytotoxicity, while expressing a kinase-dead mutant of CDK5 displayed increased cytotoxicity. Together, these data suggest that p35 negatively regulates NK-cell cytotoxicity. Surprisingly, we found that TGFβ, a known negative regulator of NK-cell cytotoxicity, induces p35 expression in NK cells. NK cells cultured with TGFβ exhibit reduced cytotoxicity, while NK cells transduced with p35 shRNA or mutant CDK5 expression exhibited partial reversal of this inhibitory effect pointing to an interesting hypothesis that p35 plays an important role in TGFβ-mediated NK-cell exhaustion.Significance:This study reports a role for p35 in NK-cell cytotoxicity and this might help to improve NK-cell adoptive therapy.

TGFβ induces p35 expression in a dose- and time-dependent manner. A, NK92 cells were incubated with fluorescently-labeled Jeko-1 cells and different concentrations of TGFβ for 16 hours. Cells were stained with PI and gated on labeled cancer cells via flow cytometry to measure cancer cell death. **, P < 0.01; ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, one-way ANOVA with Dunnett multiple comparisons test. B, NK92 cells were incubated with different concentrations of TGFβ in complete media for 48 hours. Protein was collected and analyzed via Western blot analysis. C, NK92 cells were incubated with 5 ng/mL TGFβ in complete media for 24 hours with or without the TGFβ receptor inhibitor EW-7197 (5 ng/mL). Protein was collected and analyzed via Western blot analysis. D, 1° NK cells were incubated in complete media with different concentrations of TGFβ and/or 5 ng/mL EW-7197 for 48 hours. Protein was collected and analyzed via Western blot analysis. E, 1° NK cells were cultured in cytokine-free media for 48 hours, followed by culture with either 200 U/mL IL2 or 5 ng/mL TGFβ. Protein lysate was collected at the indicated timepoints.

NK92 cells with p35 knockdown or CDK5-K33T overexpression mitigate TGFβ-induced inhibition of cytotoxicity. A, NK92 cells (shGFP or shp35) were cultured for 48 hours in the presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). They were then cocultured with fluorescently-labeled Jeko-1 cells at 5:1 E:T ratio for 16 hours in the continued presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). Cells were stained with PI and gated on labeled cells to measure cancer cell death. Average cytotoxicity percentage is overlaid on the corresponding bar. ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method. B, Supernatant from NK92 cell culture (shGFP or shp35) with or without Jeko cells was collected after 16 hours. Cytokine concentration was determined using a flow-based, multiplex human cytokine release assay. ns, not significant; *, P < 0.05; **, P < 0.01; ***, P < 0.001. Graphs display mean ± SD, n = 3 biological cocultures, multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method. C, NK92 cells (OE ctrl, OE CDK5, OE CDK5-K33T, or OE p35) were cultured for 48 hours in the presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). They were then cocultured with fluorescently-labeled Jeko-1 cells at 5:1 E:T ratio for 16 hours in the continued presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). Cells were stained with PI and gated on labeled cells to measure cancer cell death. Average cytotoxicity percentage is overlaid on the corresponding bar. **, P < 0.01; ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, two-way ANOVA with Tukey multiple comparisons test. D, Supernatant from NK92 cell culture (OE ctrl, OE CDK5, OE CDK5-K33T, or OE p35) with or without Jeko cells was collected after 16 hours. Cytokine concentration was determined using a flow-based, multiplex human cytokine release assay. *, P < 0.05; **, P < 0.01; ***, P < 0.001; ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, two-way ANOVA with Tukey multiple comparisons test.

Murine NK cells from p35 k/o mice display heightened cytotoxicity. A, Murine splenocytes or bone marrow cells from WT or p35 k/o mice were stained for CD3 and NK1.1 and mixed with counting beads, then analyzed via flow cytometry. Gating on NK1.1+CD3− cells, as well as the counting beads, allowed determination of mNK concentration and the total mNK cell count in each compartment. ns, not significant. Graphs display mean ± SD, n = 3 mice, unpaired two-tailed t test. B, mNK cells were isolated from WT, p35 k/o, or p35 Het mice and cocultured with calcein AM-labeled B16F10 cells at different E:T ratios for 4 hours. Fluorescence intensity of supernatant corresponding to calcein release from dead cells was measured to calculate NK-mediated cytotoxicity. **, P < 0.01. Graphs display mean ± SD, n = 3 biological cocultures (n = 2 for WT 1:1 ratio, p35 k/o 1:1 ratio, and p35 k/o in WT versus p35 Het versus p35 k/o experiment), and multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method (WT vs. p35 k/o) or one-way ANOVA with Tukey multiple comparisons test (WT vs. p35 Het vs. p35 k/o). C, Murine splenocytes or bone marrow cells were stained for CD11b, CD27, CD3, and NK1.1 and analyzed via flow cytometry after gating on NK1.1+CD3− cells. Representative flow plots are shown. Percentages of mNK cells in each subset (CD11b+CD27−, CD11b−CD27+, and CD11b+CD27+) for each mouse were recorded and graphed. ns, not significant. Graphs display mean ± SD, n = 8 mice, multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method. D, Murine splenocytes were stained for CD3, NK1.1, and NKG2D, NKp46, NKG2A, 2B4, LY6C, or LY49C/F/I/H. Representative histograms of activating/inhibitory receptor expression are shown, gated on live NK1.1+CD3− cells. E, Isolated mNK cells pooled from multiple mice were seeded at a concentration of 2e6 cells/mL and cultured ex vivo in RPMI media supplemented with 1,000 U/mL IL2. An additional 1,000 U/mL IL2 was added 2 days later without changing the media, followed by collection of supernatant after culture for an additional 2 days. Cytokine concentration was determined using a flow-based, multiplex murine cytokine release assay. ns, not significant; *, P < 0.05; **, P < 0.01. Graphs display mean ± SD, n = 3 biological cultures, unpaired two-tailed t tests.

CDK5 knockdown inhibits NK92 survival while p35 knockdown increases NK92 cytotoxicity. A, qRT-PCR results using RNA isolated from NK92 cells transduced with p35 shRNA (shp35) or CDK5 shRNA (shCdk5) compared with shGFP control. GAPDH was used as the housekeeping gene. Graphs display mean ± SD, n = 3 technical replicates. B, Western blot analysis of protein from NK92 cells transduced with p35 shRNA (shp35) or negative control GFP shRNA (shGFP). C, Phase contrast microscopy of NK92 cells transduced with CDK5 shRNA or one of two p35 shRNA clones, compared with shGFP control. Images are 10x magnification; scale bar, 100 μm. D, NK92 cells were plated in complete media with a starting count of 250,000 cells. Live cell count was obtained after 48 hours cell culture via trypan blue staining and manual counting on a hemocytometer. ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cultures, one-way ANOVA with Dunnett multiple comparisons test. E, NK92 cells were stained with Annexin V and PI and analyzed via flow cytometry. Percentage of cells staining positive for Annexin V and/or PI were graphed. ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cultures, one-way ANOVA with Dunnett multiple comparisons test. F, NK92 cells were cocultured with fluorescently-labeled Jeko-1 cells for 16 hours to measure the effect of p35 knockdown on cytotoxicity. Cells were stained with PI and gated on the labeled cancer cells to measure cancer cell death. ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, two-way ANOVA with Dunnett multiple comparisons test.

Background Strasberg proposed classifying subtotal cholecystectomy techniques into fenestrating (fSC) and reconstituting (rSC) subtypes. The aim of this study is to compare our outcomes of laparoscopic subtotal cholecystectomies of both subtypes against laparoscopic total cholecystectomy (TC) in difficult emergency laparoscopic cholecystectomies. Methods Patients undergoing emergency laparoscopic cholecystectomy were identified over 2 years and all Nassar scale 3 and 4 cholecystectomies were included for analysis. Results 108 fSC and 24 rSC were compared against 317 TC. Patients undergoing fSC and rSC were older and more likely to be male. fSC (128 min) and rSC (141 min) recorded longer median operative times than TC (109). Post-operative ERCP was more common after rSC (16.7%). Patients undergoing fSC (2 days) and rSC (3.5 days) had longer post-operative stays. Bile leaks were more likely in fSC (9.3%) and rSC (8.3%) compared to TC (1.9%), Long term morbidity was higher in the rSC group (12.5% vs 10%). And these were solely due to gallbladder remnant complications. Conclusion Laparoscopic fSC and rSC techniques are associated with a higher rate of bile leaks and rSC has more long term morbidty as compared to TC.

OBJECTIVE Pediatric brain arteriovenous malformations (AVMs) are the leading cause of spontaneous intracranial hemorrhage (SICH) in children. Although the incidence of SICH is low in pediatric populations, such events cause substantial morbidity. The recently created Ruptured Arteriovenous Malformation Grading Scale (RAGS) is proposed as a reliable and novel grading system to specifically serve as a predictor of clinical outcomes in patients following AVM rupture, similar to the Hunt and Hess (HH) grade for ruptured aneurysms. While these data are promising, pediatric patients were notably absent from the original study validating the RAGS. Therefore, correlation of the RAGS score with clinical outcomes following AVM rupture in individuals younger than 18 years of age using the RAGS score is needed. The objective of this study was to validate the RAGS in a cohort of pediatric patients with AVMs who presented with hemorrhage, thereby demonstrating the score’s generalizability, and expanding its external validity. METHODS A cohort of children with ruptured AVMs were retrospectively reviewed. Using disability, measured by the modified Rankin Scale (mRS), as the response variable, the area under the receiver operating characteristic curve (AUROC) was calculated for patients based on their RAGS scores for three time periods. The AUROC values were then compared with those generated by two commonly used clinical grading systems, the HH classification and Glasgow Coma Scale. RESULTS A total of 81 children who presented with ruptured AVMs were included in the study, with a mean follow-up duration of 4 years. The RAGS score outperformed other clinical grading scales in predicting mRS scores, with AUROC values of 0.81, 0.82, and 0.81 at three distinct follow-up periods. CONCLUSIONS The RAGS score correlated well with the clinical outcome after AVM rupture in pediatric patients. Additional validation studies across multiple treatment centers are needed to further demonstrate the generalizability of the scoring system.

Supplementary Methods, Figures 1-4, Table 1 from Simultaneous Visualization of Protumorigenic Src and MT1-MMP Activities with Fluorescence Resonance Energy Transfer

Supplementary Figure 1 from Membrane Type-1 Matrix Metalloproteinase Confers Aneuploidy and Tumorigenicity on Mammary Epithelial Cells

Supplementary Movie 3 from Simultaneous Visualization of Protumorigenic Src and MT1-MMP Activities with Fluorescence Resonance Energy Transfer

Supplementary Table 1 from Membrane Type-1 Matrix Metalloproteinase Confers Aneuploidy and Tumorigenicity on Mammary Epithelial Cells

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Supplemental Figures. This file contains supplemental figures concerning analysis of megakaryocyte progenitor and erythroid progenitor analysis in the leukemia marrow, platelet and megakaryocyte progenitor analysis after DBZ treatment of leukemia mice, as well as CXCL12 promoter CHIP analysis

Supplemental Figure Legends

More than half of T-cell acute lymphoblastic leukemia (T-ALL) patients harbor gain-of-function mutations in the intracellular domain of Notch1. Diffuse infiltration of the bone marrow commonly occurs in T-ALL and relapsed B-cell acute lymphoblastic leukemia patients, and is associated with worse prognosis. However, the mechanism of leukemia outgrowth in the marrow and the resulting biologic impact on hematopoiesis are poorly understood. Here, we investigated targetable cellular and molecular abnormalities in leukemia marrow stroma responsible for the suppression of normal hematopoiesis using a T-ALL mouse model and human T-ALL xenografts. We found that actively proliferating leukemia cells inhibited normal hematopoietic stem and progenitor cell (HSPC) proliferation and homing to the perivascular region. In addition, leukemia development was accompanied by the suppression of the endosteum-lining osteoblast population. We further demonstrated that aberrant Notch activation in the stroma plays an important role in negatively regulating the expression of CXLC12 on osteoblasts and their differentiation. Notch blockade reversed attenuated HSPC cycling, leukemia-associated abnormal blood lineage distribution, and thrombocytopenia as well as recovered osteoblast and HSPC abundance and improved the hematopoietic-supportive functions of osteoblasts. Finally, we confirmed that reduced osteoblast frequency and enhanced Notch signaling were also features of the marrow stroma of human ALL tissues. Collectively, our findings suggest that therapeutically targeting the leukemia-infiltrated hematopoietic niche may restore HSPC homeostasis and improve the outcome of ALL patients. Cancer Res; 76(6); 1641–52. ©2016 AACR.

Supplementary Movie 2 from Simultaneous Visualization of Protumorigenic Src and MT1-MMP Activities with Fluorescence Resonance Energy Transfer

Invasion-promoting MT1-MMP is directly linked to tumorigenesis and metastasis. Our studies led us to identify those genes, the expression of which is universally linked to MT1-MMP in multiple tumor types. Genome-wide expression profiling of MT1-MMP–overexpressing versus MT1-MMP–silenced cancer cells and a further data mining analysis of the preexisting expression database of 190 human tumors of 14 cancer types led us to identify 11 genes, the expression of which correlated firmly and universally with that of MT1-MMP (P < 0.00001). These genes included regulators of energy metabolism (NNT), trafficking and membrane fusion (SLCO2A1 and ANXA7), signaling and transcription (NR3C1, JAG1, PI3Kδ, and CK2α), chromatin rearrangement (SMARCA1), cell division (STK38/NDR1), apoptosis (DAPK1), and mRNA splicing (SNRPB2). Our subsequent extensive analysis of cultured cells, tumor xenografts, and cancer patient biopsies supported our data mining. Our results suggest that transcriptional reprogramming of the specific downstream genes, which themselves are associated with tumorigenesis, represents a distinctive “molecular signature” of the proteolytically active MT1-MMP. We suggest that the transactivation activity of MT1-MMP contributes to the promigratory cell phenotype, which is induced by this tumorigenic proteinase. The activated downstream gene network then begins functioning in unison with MT1-MMP to rework the signaling, transport, cell division, energy metabolism, and other critical cell functions and to commit the cell to migration, invasion, and, consequently, tumorigenesis. [Cancer Res 2008;68(11):4086–96]

Supplementary Table 4 from Molecular Signature of MT1-MMP: Transactivation of the Downstream Universal Gene Network in Cancer

Supplementary Movie 1 from Simultaneous Visualization of Protumorigenic Src and MT1-MMP Activities with Fluorescence Resonance Energy Transfer

An elevated expression of membrane type-1 matrix metalloproteinase (MT1-MMP) is closely associated with multiple malignancies. Recently, we discovered that recycled MT1-MMP was trafficked along the tubulin cytoskeleton into the centrosomal compartment and cleaved the integral centrosomal protein pericentrin-2. These events correlated with the induction of chromosome instability and aneuploidy in nonmalignant Madine-Darby canine kidney cells. Accordingly, we hypothesized that MT1-MMP is an oncogene that promotes malignant transformation of normal cells rather than just an enzyme that supports growth of preexisting tumors. To prove our hypothesis, we transfected normal 184B5 human mammary epithelial cells with MT1-MMP (184B5-MT1 cells). MT1-MMP was colocalized with pericentrin in the centrosomal compartment and especially in the midbody of dividing cells. 184B5-MT1 cells acquired the ability to activate MMP-2, to cleave pericentrin, and to invade the Matrigel matrix. 184B5-MT1 cells exhibited aneuploidy, and they were efficient in generating tumors in the orthotopic xenograft model in immunodeficient mice. Because of the absence of tumor angiogenesis and the resulting insufficient blood supply, the tumors then regressed with significant accompanying necrosis. Gene array studies confirmed a significant up-regulation of oncogenes and tumorigenic genes but not the angiogenesis-promoting genes in 184B5-MT1 cells. We believe that our data point to a novel function of MT1-MMP in the initial stages of malignant transformation and to new and hitherto unknown transition mechanism from normalcy to malignancy. (Cancer Res 2006; 66(21): 10460-5)

Supplementary Figure 1 from Molecular Signature of MT1-MMP: Transactivation of the Downstream Universal Gene Network in Cancer

Supplementary Table 3 from Molecular Signature of MT1-MMP: Transactivation of the Downstream Universal Gene Network in Cancer

Supplementary Table 2 from Molecular Signature of MT1-MMP: Transactivation of the Downstream Universal Gene Network in Cancer

Supplementary Movie 4 from Simultaneous Visualization of Protumorigenic Src and MT1-MMP Activities with Fluorescence Resonance Energy Transfer

Supplemental Materials and Methods This file contains detailed methods of IHC, WB, CHIP assay, luciferase reporter assay, qRT-PCR and 2-photon imaging analysis and etc.

Supplementary Table 1 from Molecular Signature of MT1-MMP: Transactivation of the Downstream Universal Gene Network in Cancer

Modern cutting edge technologies of chemical synthesis enable the production of unique nanostructures with excess energy and high reactivity. Uncontrolled use of such materials in the food industry and pharmacology entail a risk for the development of a nanotoxicity crisis. Using the methods of tensometry, mechanokinetic analysis, biochemical methods, and bioinformatics, the current study showed that chronic (for six months) intragastrical burdening of rats with aqueous nanocolloids (AN) ZnO and TiO2 caused violations of the pacemaker-dependent mechanisms of regulation of spontaneous and neurotransmitter-induced contractions of the gastrointestinal tract (GIT) smooth muscles (SMs), and transformed the contraction efficiency indices (AU, in Alexandria units). Under the same conditions, the fundamental principle of distribution of physiologically relevant differences in the numeric values of the mechanokinetic parameters of spontaneous SM contractions between different parts of GIT is violated, which can potentially cause its pathological changes. Using molecular docking, typical bonds in the interfaces of the interaction of these nanomaterials with myosin II, a component of the contractile apparatus of smooth muscle cells (SMC) were investigated. In this connection, the study addressed the question of possible competitive relations between ZnO and TiO2 nanoparticles and actin molecules for binding sites on the myosin II actin-interaction interface. In addition, using biochemical methods, it was shown that chronic long-term exposure to nanocolloids causes changes in the primary active ion transport systems of cell plasma membranes, the activity of marker liver enzymes and disrupts the blood plasma lipid profile, which indicates the hepatotoxic effect of these nanocolloids.

Fetal hemoglobin (HbF) is a physiologic variant of the adult hemoglobin (HbA) protein. It is primarily present in the fetus. HbA has a lower oxygen affinity than HbF. A newborn’s hemoglobin transitions from HbF to HbA with 70% HbF at 40 weeks’ gestational age to almost 0% at 6 months after birth. Transfusion with HbA blood or premature birth can affect the rate and timing of this transition. The change in proportion of HbF will affect the degree of oxygen saturation of hemoglobin for a given partial pressure of oxygen due to the difference in the oxygen-hemoglobin dissociation curve. A thorough history and careful evaluation of monitoring devices allow the anesthesiologist to optimize oxygen delivery perioperatively.

Purpose Rigid occipitocervical (O-C) instrumentation can reduce the anterior pathology and has a high fusion rate in children with craniovertebral instability. Typically, axis (C2) screw fixation utilizes C1–C2 transarticular screws or C2 pars screws. However, anatomic variation may preclude these screw types due to the size of fixation elements or by placing the vertebral artery at risk for injury. Pediatric C2 translaminar screw fixation has low risk of vertebral artery injury and may be used when the anatomy is otherwise unsuitable for C1–C2 transarticular screws or C2 pars screws. Methods We retrospectively reviewed a neurosurgical database at UCSF Benioff Children’s Hospital Oakland for patients who had undergone a cervical spinal fusion that utilized translaminar screws for occipitocervical instrumentation between 2002 and 2020. We then reviewed the operative records to determine the parameters of C2 screw fixations performed. Demographic and all other relevant clinical data were then recorded. Results Twenty-five patients ranging from 2 to 18 years of age underwent O-C fusion, with a total of 43 translaminar screws at C2 placed. Twenty-three patients were fused (92%) after initial surgery with a mean follow-up of 43 months. Two patients, both with Down syndrome, had a nonunion. Another 2 patients had a superficial wound dehiscence that required wound revision. One patient died of unknown cause 7 months after surgery. One patient developed an adjacent-level kyphosis. Conclusion When performing occipitocervical instrumentation in the pediatric population, C2 translaminar screw fixation is an effective option to other methods of C2 screw fixation dependent on anatomic feasibility.

Patients with percutaneous coronary interventions undergoing procedures often require interruptions in their dual antiplatelet therapy. Periprocedural bridging is considered for patients at high thrombotic risk using intravenous cangrelor, a reversible P2Y12 inhibitor with a short half-life, or eptifibatide, a glycoprotein IIb/IIIa inhibitor, with a slightly longer half-life but less costly alternative. This study aims to assess the safety and efficacy of cangrelor compared with eptifibatide when used in a periprocedural setting. The primary outcome of this retrospective cohort study was the incidence of bleeding events defined by the global use of strategies to open occluded coronary arteries criteria, and the secondary outcomes include the transfusion requirements, inpatient major cardiac adverse events, and cost savings per patient. A total of 75 patients were included who were bridged to procedures (cangrelor, n = 50; eptifibatide, n = 25). There were no significant differences in overall bleeding events defined by global use of strategies to open occluded coronary arteries criteria: mild bleeding [8% (n= 4) vs. 8% (n= 2); P = 0.68], moderate bleeding [28% (n = 14) vs. 48% (n = 12); P = 0.07), and severe bleeding [8% (n = 4) vs. 8% (n = 2); P = 0.25] between cangrelor and eptifibatide. The composite inpatient major cardiac adverse events were also similar between cangrelor and eptifibatide [10% (n = 10) vs. 8% (n = 8); P = 0.78]. The average cost savings per each cangrelor patient on the equivalent duration of eptifibatide was calculated out to be $5824 per patient. Cangrelor and eptifibatide were similar in terms of safety and efficacy when used as a bridge in patients with recent coronary stents, but considerable cost savings could be made if cangrelor was substituted for by eptifibatide in select patients. Further studies are needed to determine its applicability specifically in patients at high thrombotic and hemorrhagic risk.

INTRODUCTIONTo promote service uptake and reduce maternal deaths, a policy was implemented under Ghana’s National Health Insurance Scheme in 2008. This study explored the benefits and limitations of the policy, health system challenges, and community-level challenges resulting in suggestions to mitigate the challenges.METHODSThe study design was cross-sectional, utilizing qualitative data collection. It was carried out in the Kassena-Nankana East Municipality, Ghana, involving in-depth interviews (IDIs) with directors of Ghana Health Service and facility managers. A total of eight IDIs were conducted. Data were transcribed, read, and analyzed based on themes which were presented using key quotes.RESULTSThe policy promoted the use of services. Nonetheless, challenges existed as a result of limited service coverage, inadequate human resources and infrastructure, lack of medications and equipment, lack of transport, and the influence of religion, culture, and family members. There was a need to strategize so that women with a low socioeconomic status would receive service over those of a high socioeconomic status. Other suggestions included the inclusion of family planning services, accreditation of private facilities, provision of a shift system for specialists to move to rural areas, and provision of incentives for health personnel in rural areas. It was also suggested that health personnel make known their challenges as well as to provide education on women’s rights and service expectations. The provision of transport vouchers to women as well as alternative arrangements to be made with private transport owners were also suggested.CONCLUSIONImplementing the suggestions may improve service provision and utilization leading to the reduction of maternal deaths and contributing towards achieving universal health coverage.