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Purpose: The mainstay of treatment for basal cell carcinoma (BCC) is surgical excision, which can result in significant associated morbidity, particularly for patients with recurrent tumors. We previously conducted a drug repositioning screen using molecular data from human BCCs and identified histone deacetylase (HDAC) inhibitors as a potential treatment for BCC. Here we conduct the first proof-of-principle study of a topical pan-HDAC inhibitor, remetinostat, in human BCC. Patients and Methods: We conducted a phase II, open-label, single-arm, single-institution trial of a topical HDAC inhibitor. Participants with at least one BCC were recruited. All participants applied 1% remetinostat gel three times daily for 6 weeks, with measurements of tumor diameter conducted at baseline and week 8. Surgical excision of the remaining tumor was conducted at the end of the study and microscopic evaluation was performed. Results: Thirty-three per-protocol tumors from 25 participants were included in the analysis. The overall response rate, defined as the proportion of tumors achieving more than 30% decrease in the longest diameter from baseline to week 8, was 69.7% [90% confidence interval (CI), 54%–82.5%]. On pathologic examination, 54.8% of tumors demonstrated complete resolution. Pharmacodynamic analysis demonstrated similar levels of acetylated histone H3 in skin tissue before and after treatment, however, phosphorylation was increased. No systemic adverse events were reported. Conclusions: The HDAC inhibitor remetinostat is a well-tolerated and effective topical treatment for reducing BCC disease burden in a clinically significant manner. This provides in-human validation of HDAC inhibitors as a therapy for BCC.

Background: For tension pneumothorax, the UK recommendation is to use a 14 g, 5 cm cannula to decompress the chest. Advice around site selection differs between using the second intercostal space (ICS) mid-clavicular line or the fifth ICS near the mid-axillary line. The aim of this literature review is to determine the best approach for needle decompression using a standard 14 g, 5 cm cannula. Methods: A systematic search of multiple databases was conducted, using inclusion and exclusion criteria. Outcomes were tabulated to identify any trends between various criteria including success with a 5 cm cannula. Results: Thirty-one studies were found, of which four were included. Mean chest wall thickness was 35.8 mm at the anterior site and 39.7 mm at the lateral site. Overall success rates with a 5 cm catheter were on average 79.7% at the anterior and 80% at the lateral position. Conclusion: There is no significant difference in success between using the anterior or the lateral approach for needle decompression.

Purpose To investigate if children with cerebral palsy have sustained attendance and involvement in physical activities after completing physical activity interventions. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven databases were searched for the period 2001–2020 with hand-searching of pertinent reference lists. Criteria for study inclusion were participants aged 0–18 years and ≥50% with cerebral palsy; follow-up ≥1 month beyond completion of the physical activity intervention; and measurement of attendance and/or involvement in any physical activity post-intervention. Study selection, data extraction, and risk of bias assessments (Physiotherapy Evidence Database (PEDro) or tool for non-randomised studies) were completed independently by paired reviewers. Results were compiled by narrative synthesis. Results Thirteen studies were included (11 randomised controlled trials (RCTs), two non-randomised case series; intervention sample sizes: 6–34). All study participants had cerebral palsy and were aged 4–16.7 years. PEDro scores for the RCTs ranged from 5 to 10; 10 did not blind one or more therapist, participant, or assessor. Two case series showed high risk of bias. Twelve studies reported on attendance, with positive changes in three studies. At 4–14 weeks post-intervention, two studies demonstrated positive changes were maintained. Four studies included involvement outcomes; one reporting positive changes in physical activity involvement four weeks after intervention completion. Conclusions Physical activity attendance may be influenced by physical activity interventions in the short term, but more robust research designs are required to investigate whether gains can be sustained. Activity involvement, which may influence ongoing participation, is under-researched. Implications for Rehabilitation • Positive changes in attendance and involvement following physical activity interventions appear short term at best. • Physical activity interventions should have longer follow-up periods to determine the effect on sustained physical activity participation. • Careful selection and reporting of attendance and involvement outcome measures is required. • The optimal physical activity intervention to increase attendance or involvement in physical activities remains uncertain.

Background: Hidradenitis suppurativa (HS) is known to disproportionately affect patients of color; however, there is a paucity of evidence on how its disease profile varies between races and ethnic groups. Objective: Explore potential race-dependent differences in the disease profile of HS. Methods: A retrospective analysis was conducted on HS patients at Stanford Hospital and Clinics. Data were compared in terms of demographics, disease severity, and healthcare utilization between races in adults identified to have at least 2 encounters coded for HS. Validation was conducted using Optum's de-identified Clinformatics Data Mart Database of national insurance claims. Results: Our cohorts consisted of 939 HS patients seen at Stanford and 13,885 HS patients taken from the national dataset. Black and Hispanic patients had greater healthcare utilization compared to White patients. In addition, Hispanic patients at our institution also had significantly increased disease severity compared to their White counterparts (χ2 P = .009). Hispanic patients entered tertiary care at an earlier age (Stanford mean: 30.8 years for Hispanics vs 38.7 for Whites; P

Diet and exercise interventions may help reverse malnutrition and muscle wasting common in pancreatic cancer. We performed a scoping review to identify the knowledge gaps surrounding diet and exercise interventions. We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Theses and Dissertations, and Google Scholar using the umbrella terms of "pancreatic cancer," "diet/nutrition," and "exercise." Included were articles reporting on ambulatory adults with diagnosed pancreatic cancer. Excluded were studies examining prevention and/or risk, animal, or cell lines. Of the 15,708 articles identified, only 62 met the final inclusion criteria. Almost half of the articles were randomized controlled studies (n = 27). Most studies were from the United States (n = 20). The majority examined dietary interventions (n = 41), with 20 assessing the use of omega-3 fatty acids. Exercise interventions were reported in 13 studies, with 8 examining a diet and exercise intervention. Most studies were small and varied greatly in terms of study design, intervention, and outcomes. We identified 7 research gaps that should be addressed in future studies. This scoping review highlights the limited research examining the effect of diet and exercise interventions in ambulatory patients with pancreatic cancer.

Background Graft-versus-host disease (GVHD) is a significant cause of morbidity and mortality following allogeneic stem cell transplantation. These patients face unique challenges due to the complexity of GVHD which can affect multiple organ systems, and the toxicity of treatments. Despite the known impact on quality of life (QOL), qualitative data within the bone marrow transplantation (BMT) literature is rare, and there has been no qualitative work exploring patient experience of specialist healthcare provision for GVHD in the United Kingdom. Methods We conducted a primary explorative qualitative study of the experience of QOL issues and multidisciplinary care in patients with chronic GVHD following allogeneic stem cell transplantation. Eight patients were identified using convenience sampling from specialist BMT outpatient clinics. Following consent, patients were interviewed individually via telephone. Transcripts of interviews were analyzed using an inductive thematic approach. Results Mean participant age was 61-years-old (range 45–68), with a mean time post-transplant of 3 years at time of interview (range 3 months–15 years). Five key QOL themes were identified: (1) ‘Restricted as to what I can do’; (2) Troubling symptoms—‘you can sort of get GVHD anywhere’; (3) Confusion/uncertainty over GVHD symptoms—‘Is this the GVHD?’; (4) Unpredictable course and uncertainty about the future; and (5) Adapting to the sick role. In addition, four themes related to experience of service provision were identified: (1) personal care and close relationship with BMT nurses; (2) efficiency versus long waits—‘On the case straight away’; (3) information provision—‘went into it with a bit of a rosy view’; and (4) the role of support groups. Conclusions These qualitative data reflect the heterogeneity of experiences of the GVHD patient population, reflecting the need for a flexible and nuanced approach to patient care with emphasis on comprehensive information provision. We have identified the key role that BMT specialist nurses within the multidisciplinary team play in supporting patients. We advocate future research should focus on ways to meet the complex needs of this patient group and ensure that the personal care and close relationships are not lost in service redesigns embracing remote consultations.

Efficient, room temperature hyperpolarisation of exchangeable solvent protons combining parahydrogen (p-H2), ami-nopropyldiethoxymethylsilane (APDMS) and IrCl(COD)(IMES) to generate an active aminosilane-iridium complex, broadens the capabilities of SABRE-type hyperpolarisation of protons. A primary pool of hyperpolarised exchangeable protons transfers its hyperpolarisation to co-solutes with labile protons, partly overcoming the catalytic specificity of SABRE-type spin-transfer catalysis. The silane functionality of APDMS appears to be crucial to the improvement. Their role is unprecedented in p-H2-based hyperpolarisation of nuclear spins and promises to broaden applicability of ultra-sensitive solution-state NMR spectroscopy for the detection and elucidation of molecular behaviors otherwise unde-tectable at conventional sensitivity levels. doi: 10.1021/acs.jpcc.0c01149 Efficient, room temperature hyperpolarisation of exchangeable solvent protons combining parahydrogen (p-H2), ami-nopropyldiethoxymethylsilane (APDMS) and IrCl(COD)(IMES) to generate an active aminosilane-iridium complex, broadens the capabilities of SABRE-type hyperpolarisation of protons. A primary pool of hyperpolarised exchangeable protons transfers its hyperpolarisation to co-solutes with labile protons, partly overcoming the catalytic specificity of SABRE-type spin-transfer catalysis. The silane functionality of APDMS appears to be crucial to the improvement. Their role is unprecedented in p-H2-based hyperpolarisation of nuclear spins and promises to broaden applicability of ultra-sensitive solution-state NMR spectroscopy for the detection and elucidation of molecular behaviors otherwise unde-tectable at conventional sensitivity levels. ispartof: The Journal of Physical Chemistry C: Energy Conversion and Storage, Optical and Electronic Devices, Interfaces, Nanomaterials, and Hard Matter vol:124 issue:27 pages:14541-14549 status: published

At present, the politics of digital tools are predominantly discussed in terms of the data they collect, analyze, and circulate. Through my analysis of electronic ankle monitors’ visual characteris...

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent abscesses in the groin and flexural areas. HS is associated with a wide range of comorbidities that complicate the disease course. Although these comorbidities have been well described, it remains unclear how these comorbidities coassociate and whether comorbidity profiles affect disease trajectory. In addition, it is unknown how comorbidity associations are modulated by race and sex. In this comprehensive analysis of 77 million patients in a large US population–based cohort, we examined coassociation patterns among HS comorbidities and identified clinically relevant phenotypic subtypes within HS. We demonstrated that these subtypes not only differed among races, but also influenced clinical outcomes as measured by HS-related emergency department visits and cellulitis. Taken together, our findings provide key insights that elucidate the unique disease trajectories experienced by patients with HS and equip clinicians with a framework for risk stratification and improved targeted care in HS.

The use of virtual reality (VR) amidst the COVID-19 pandemic has been paramount. Typically, radiography students are exposed to a range of learning methods; notably, lectures, tutorials, technical positioning sessions, coupled with the attendance of practice placements. Yet, our sudden need for social distancing, isolation, and for some, strict lockdown measures, required change within our academic delivery. The sudden need for virtual change in higher education has been felt worldwide and although the utility of VR in radiography has been used prior to COVID-19, it has never been used as a supplementary tool for clinical placement. In response, this commentary provides us with an opportunity to explore the appropriateness of VR in future years and what it may mean of prospective students. This commentary not only highlights our reliance on VR but identifies how it kept abreast with quality standards. This enables critical reflection on whether a ‘new educational normal’ or ‘new educational abnormal’ can take place in the higher education setting, in radiography, and perhaps healthcare education in general following the COVID-19 pandemic.

Ex vivo expansion conditions used to generate T cells for immunotherapy are thought to adopt metabolic phenotypes that impede therapeutic efficacy in vivo. The comparison of five different culture media used for clinical T cell expansion revealed unique optima based on different output variables including proliferation, differentiation, function, activation and mitochondrial phenotypes. T cells adapted their metabolism to match their media expansion condition as shown by glucose and glutamine uptake, and patterns of glucose isotope labeling. However, adoption of these metabolic phenotypes was uncoupled to T cell function. Furthermore, T cell products cultured in ascites from ovarian cancer patients displayed suppressed mitochondrial activity and function irrespective of the ex vivo expansion media. In one case, culturing in ascites resulted in increased glucose uptake which was insufficient to rescue T cell function. Thus, ex vivo T cell expansion conditions have profound impacts on metabolism and function.

Significance: Wound healing involves the phasic production of growth factors (GFs) and cytokines to progress an acute wound to a resolved scar. Dysregulation of these proteins contributes to both wound chronicity and excessive scarring. Direct supplementation of GFs and cytokines for treatment of healing and scarring complications has, however, been disappointing. Failings likely relate to an inability to deliver recombinant proteins at physiologically relevant levels to an environment conducive to healing. Recent Advances: Inspired by the extracellular matrix, natural biomaterials have been developed that resemble human skin, and are capable of delivering bioactives. Hybrid biomaterials made using multiple polymers, fabrication methods, and proteins are proving efficacious in animal models of acute and impaired wound healing. Critical Issues: For clinical translation, these delivery systems must be tailored for specific wound indications and the correct phase of healing. GFs and cytokines must be delivered in a controlled manner that will target specific healing or scarring impairments. Preclinical assessment in clinically relevant animal models of impaired or excessive healing is critical. Future Directions: Clinical success will likely depend on the GF or cytokine selected, their compatibility with the chosen biomaterial(s), degradation rate of the fabricated system, and the degree of control over release kinetics. Further testing is essential to assess which wound indications are most suited to specific delivery systems and to prove whether they provide superior efficacy over direct protein therapies.

Simple Summary Basal cell carcinoma is the most common human cancer worldwide. The molecular basis of BCC involves an interplay of inherited genetic susceptibility and somatic mutations, commonly induced by exposure to UV radiation. In this review, we outline the currently known germline and somatic mutations implicated in the pathogenesis of BCC with particular attention paid toward affected molecular pathways. We also discuss polymorphisms and associated phenotypic traits in addition to active areas of BCC research. We finally provide a brief overview of existing non-surgical treatments and emerging targeted therapeutics for BCC such as Hedgehog pathway inhibitors, immune modulators, and histone deacetylase inhibitors. Abstract Basal cell carcinoma (BCC) is a significant public health concern, with more than 3 million cases occurring each year in the United States, and with an increasing incidence. The molecular basis of BCC is complex, involving an interplay of inherited genetic susceptibility, including single nucleotide polymorphisms and genetic syndromes, and sporadic somatic mutations, often induced by carcinogenic exposure to UV radiation. This review outlines the currently known germline and somatic mutations implicated in the pathogenesis of BCC, including the key molecular pathways affected by these mutations, which drive oncogenesis. With advances in next generation sequencing and our understanding of the molecular genetics of BCC, established and emerging targeted therapeutics are offering new avenues for the non-surgical treatment of BCC. These agents, including Hedgehog pathway inhibitors, immune modulators, and histone deacetylase inhibitors, will also be discussed.

BACKGROUND:Numbers of academic medicine trainees have been declining internationally. Many countries have taken differing approaches to improving recruitment, with some having established pathways. In the UK, the academic foundation programme (AFP) is one such pathway aimed towards those interested in an academic medical career. Variation exists amongst universities with respect to application and success rates. As a group of AFP doctors, we aimed to explore these issues. Numbers of academic medicine trainees have been declining internationally METHODS: We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP. It was evaluated via pre- and post-course questionnaires using a Likert scale, ranging from 1 to 5. We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP RESULTS: A total of 150 attendees were present from 16 different medical schools; 95% (143/150) of the attendees filled in both questionnaires. Attendees appeared unaware of the stages involved in the application process and felt underprepared. Following the course, learners reported median scores (with interquartile limits) that demonstrated increased overall knowledge, from 2 (1) to 4 (1) (p

Problem Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care. Aims To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia. Method We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings. Results Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing. Implications This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.

Problem The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Aim Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Methods Purposive sampling and convergent interviews explored participants’ communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Setting and participants Clinicians who provided maternity care at a tertiary referral hospital (n = 13) in Queensland, Australia, and general practitioners (n = 16) who provided maternity shared care with that hospital between December 2012 and July 2013. Findings Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Conclusion Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up.

Clinical introductionA healthy 8-year-old boy presented to the ED with acute left shoulder pain. He had been playing football and his left arm was pulled by an opposition team member. He fell to the ground and landed on his left shoulder causing pain. On examination after analgesia, active and passive movement of the shoulder joint was possible in all directions but range of motion was limited by pain. There was no visible swelling or bruising throughout the shoulder girdle. A radiograph of the shoulder was obtained (figure 1).Figure 1Plain radiograph of the left shoulder.QuestionWhat radiographic finding is seen for this patient?Glenohumeral lipohaemarthrosis.Acromioclavicular joint disruption.Intra-articular gas.Intra-articular loose body.

Biliary tract cancers, including intra- and extra-hepatic cholangiocarcinoma as well as gallbladder cancer, are associated with poor prognosis and the majority of patients present with advanced-stage, non-resectable disease at diagnosis. Biliary tract cancer may develop through an accumulation of genetic and epigenetic alterations and can be influenced by microbial exposure. Furthermore, the liver and biliary tract are exposed to the gastrointestinal microbiome through the gut-liver axis. The availability of next-generation sequencing technology has led to an increase in studies investigating the relationship between microbiota and human disease. In particular, the interplay between the microbiome, the tumour micro-environment and response to systemic therapy is a prospering area of interest. Given the poor outcomes for patients with biliary tract cancer, this emerging field of research, through which new biomarkers may be identified, offers potential as a tool for early diagnosis, prognostication or even as a future therapeutic target. This review summarises the available evidence on the microbiome environment in patients with biliary tract cancer, including a discussion around confounding factors, implications for therapy and proposed future directions.

Bottom-up mass spectrometry-based protein analysis methods employing protease digestion are routinely used to identify and characterize proteins with high specificity and sensitivity. Method performance is generally measured by sequence coverage capability and the total number of characteristic peptides identified, when compared to predicted databases. Limitations to commonly used solvent-based digestion methods currently employed include long digestion times (18-24 h or more), leading to protease autolysis, which also precludes automation, decreases sensitivity, and increases both intra- and inter-day performance variability. This report describes the development and validation of a simple, 5 min tryptic denaturing organic digestion (DOD) method for use with tandem mass spectrometry in bottom-up protein identification and characterization. It has been evaluated across select protein toxins and diagnostic clinical protein targets, substantially improving digestion performance when compared to other solution-based and enzyme-immobilized methods. The method was compared to two currently used bottom-up methods, the 24 h filter-aided sample prep (FASP) and Flash Digest (1 and 4 h) methods. Single proteins used to compare the methods included the ricin light chain, ricin heavy chain, ricin holotoxin, serotype A Clostridium botulinum toxin, Staphylococcus enterotoxin B, ribonuclease A, and thyroglobulin. In tests, across the proteins investigated, the 5 min DOD digestion method resulted in sequence coverages ranging from 55 to 100%, with relatively high reproducibility and precision; results were better than or equal to FASP method results and were greatly enhanced when compared to Flash method results. Importantly, DOD method intra- and inter-day precision was much improved as compared to results for both FASP and Flash digestions. These data indicated that the DOD method, when compared to the FASP and Flash Digest methods, dramatically reduced digestion time, while maintaining or improving the ability to detect and characterize targeted proteins, and reduced analytical variability for tryptic digestion, resulting in markedly faster and more precise analyses.

Purpose: At diagnosis, colorectal cancer presents with synchronous peritoneal metastasis in up to 10% of patients. The peritoneum is poorly characterized with respect to its superspecialized microenvironment. Our aim was to describe the differences between peritoneal metastases and their matched primary tumors excised simultaneously at the time of surgery. Also, we tested the hypothesis of these differences being present in primary colorectal tumors and having prognostic capacity. Experimental Design: We report a comprehensive analysis of 30 samples from peritoneal metastasis with their matched colorectal cancer primaries obtained during cytoreductive surgery. We tested and validated the prognostic value of our findings in a pooled series of 660 colorectal cancer primary samples with overall survival (OS) information and 743 samples with disease-free survival (DFS) information from publicly available databases. Results: We identified 20 genes dysregulated in peritoneal metastasis that promote an early increasing role of “stemness” in conjunction with tumor-favorable inflammatory changes. When adjusted for age, gender, and stage, the 20-gene peritoneal signature proved to have prognostic value for both OS [adjusted HR for the high-risk group (vs. low-risk) 2.32 (95% confidence interval, CI, 1.69–3.19; P < 0.0001)] and for DFS [adjusted HR 2.08 (95% CI, 1.50–2.91; P < 0.0001)]. Conclusions: Our findings indicated that the activation of “stemness” pathways and adaptation to the peritoneal-specific environment are key to early stages of peritoneal carcinomatosis. The in silico analysis suggested that this 20-gene peritoneal signature may hold prognostic information with potential for development of new precision medicine strategies in this setting.

The inhaled route is still a relatively novel route for delivering biologics and poses additional challenges to those encountered with inhaled small molecules, further complicating the design and interpretation of toxicology studies. A working group formed to summarize the current knowledge of inhaled biologics across industry and to analyze data collated from an anonymized cross-industry survey comprising 12 inhaled biologic case studies (18 individual inhalation toxicity studies on monoclonal antibodies, fragment antibodies, domain antibodies, oligonucleotides, and proteins/peptides). The output of this working group provides valuable insights into the issues faced when conducting toxicology studies with inhaled biologics, including common technical considerations on aerosol generation, use of young and sexually mature nonhuman primates, pharmacokinetic/pharmacodynamic modeling, exposure and immunogenicity assessment, maximum dose setting, and no observed adverse effect levels determination. Although the current data set is too small to allow firm conclusions, testing of novel biologics remains an active area and is likely to remain so for molecules where delivery via the inhaled route is beneficial. In the future, it is hoped others will continue to share their experiences and build on the conclusions of this review to further improve our understanding of these complex issues and, ultimately, facilitate the safe introduction of inhaled biologics into clinical use.

MNA contributes to the immune suppression of T cells and represents a potential immunotherapy target to treat human cancer., Immune regulatory metabolites are key features of the tumor microenvironment (TME), yet with a few exceptions, their identities remain largely unknown. Here, we profiled tumor and T cells from tumor and ascites of patients with high-grade serous carcinoma (HGSC) to uncover the metabolomes of these distinct TME compartments. Cells within the ascites and tumor had pervasive metabolite differences, with a notable enrichment in 1-methylnicotinamide (MNA) in T cells infiltrating the tumor compared with ascites. Despite the elevated levels of MNA in T cells, the expression of nicotinamide N-methyltransferase, the enzyme that catalyzes the transfer of a methyl group from S-adenosylmethionine to nicotinamide, was restricted to fibroblasts and tumor cells. Functionally, MNA induces T cells to secrete the tumor-promoting cytokine tumor necrosis factor alpha. Thus, TME-derived MNA contributes to the immune modulation of T cells and represents a potential immunotherapy target to treat human cancer.

A short-cut review of the literature was carried out to examine the benefits of caffeine as an analgesic adjunct in tension-type and migraine-type headache. Six papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that caffeine provides effective analgesia as an adjunctive treatment in the management of secondary headache syndromes.

Background Weight loss increases survivorship following breast cancer diagnosis. However, most breast cancer survivors (BCS) do not meet diet and exercise recommendations. Aim The purpose of this study was to explore the barriers and facilitators of BCS who had lymphedema and who participated in a 22‐week weight loss lifestyle intervention. Methods and results Participants completed semi‐structured interviews about barriers and facilitators to intervention adherence. Interviews were transcribed verbatim and a thematic analysis was conducted. Participants (n = 17) were 62 ± 8.0 years of age with a mean body mass index of 34.0 ± 7.1 kg/m2. Four themes emerged: (1) facilitators of intervention adherence, (2) barriers of intervention adherence, (3) continuation of healthy habits post intervention, and (4) recommendations for intervention improvements. Facilitators of intervention adherence were education, social support, routine, motivation, goal‐setting, meal‐provisioning, self‐awareness, and supervised exercise. Barriers to intervention adherence were personal life, health, meal dissatisfaction, seasonality, unchallenging exercises, and exercising alone. All women planned to continue the acquired healthy habits post intervention. Recommendations to improve the study included addressing the exercise regime, meal‐provisioning, and dietary intake monitoring methods. Conclusion Future strategies to engage BCS in weight loss interventions should promote group exercise, offer individualized meal‐provisioning and exercise regimes, provide transition tools, and allow participants to choose their self‐monitoring method.

More than 100 monoclonal antibodies (mAbs) are in industrial and clinical development to treat myriad diseases. Accurate quantification of mAbs in complex media, derived from industrial and patient samples, is vital to determine production efficiency or pharmacokinetic properties. To date, mAb quantification requires time and labor-intensive assays. Herein, we report a novel dual-affinity ratiometric quenching (DARQ) assay, which combines selective biorecognition and quenching of fluorescence signals for rapid and sensitive quantification of therapeutic monoclonal antibodies (mAbs). The reported assay relies on the affinity complexation of the target mAb by the corresponding antigens and Protein L (PrL, which targets the Fab region of the antibody), respectively, labeled with fluorescein and rhodamine. Within the affinity complex, the mAb acts as a scaffold framing the labeled affinity tags (PrL and antigen) in a molecular proximity that results in ratiometric quenching of their fluorescence emission. Notably, the decrease in fluorescence emission intensity is linearly dependent upon mAb concentration in solution. Control experiments conducted with one affinity tag only, two tags labeled with equal fluorophores, or two tags labeled with fluorophores of discrete absorbance and emission bands exhibited significantly reduced effect. The assay was evaluated in noncompetitive (pure mAb) and competitive conditions (mAb in a Chinese Hamster Ovary (CHO) cell culture harvest). The "DARQ" assay is highly reproducible (coefficient of variation ∼0.8-0.7%) and rapid (5 min), and its sensitivity (∼0.2-0.5 ng·mL-1), limit of detection (75-119 ng·mL-1), and dynamic range (300-1600 ng·mL-1) are independent of the presence of CHO host cell proteins.

Background Immune regulatory metabolites are key features of the tumor microenvironment (TME), yet with a few exceptions, their identities remain largely unknown. Importantly, little is known about the heterogeneity of metabolites that are present or absent in specimens from human tumors and immune compartments. Methods Here, we profiled tumor and T cells from tumor and ascites of patients with high-grade serous carcinoma (HGSC) to uncover the metabolomes of these distinct TME compartments. We devised a stringent and robust protocol to enrich cell populations from surgically resected samples in patients with HGSC. We conducted mass spectrometry-based analysis and developed machine learning tools to highlight novel metabolites that are present in different cellular lineages of the tumor. Results Cells within the ascites and tumor had pervasive metabolite differences, with a striking enrichment in 1-methylnicotinamide (MNA) in T cells infiltrating the tumor compared to ascites. Despite the elevated levels of MNA in T cells, the expression of nicotinamide N-methyltransferase, the enzyme that catalyzes the transfer of a methyl group from S-adenosylmethionine to nicotinamide, was restricted to fibroblasts and tumor cells. T cells treated with MNA stimulated secretion of the tumor promoting cytokine tumor necrosis factor alpha. Conclusions Our studies provide the first catalogue of metabolites in patient-derived tumors and T cells. We found that TME-derived MNA contributes to the immune modulation of T cells and represents a potential immunotherapy target to treat human cancer. Ethics Approval This study was approved by the University of British Columbia and BC Cancer Research Ethics Board (H07-00463). Consent Written informed consent was obtained from the patient to use the results of this study for educational purposes including publications. A copy of the written consent is on file and available for review by the Editor of this journal.

Welcome to the June 2020 issue of The British Student Doctor.

Immune regulatory metabolites are key features of the tumor microenvironment (TME), yet with a few notable exceptions, their identities remain largely unknown. We uncovered the immune regulatory metabolic states and metabolomes of sorted tumor and stromal, CD4+, and CD8+ cells from the tumor and ascites of patients with high-grade serous ovarian cancer (HGSC) using high-dimensional flow cytometry and metabolomics supplemented with single cell RNA sequencing. Flow cytometry revealed that tumor cells show a consistently greater uptake of glucose than T cells, but similar mitochondrial activity. Cells within the ascites and tumor had pervasive metabolite differences, with a striking enrichment in 1-methylnicotinamide (MNA) in T cells infiltrating the tumor compared to ascites. Despite the elevated levels of MNA in T cells, the expression of nicotinamide N-methyltransferase, the gene encoding the enzyme that catalyses the transfer of a methyl group from S-adenosylmethionine to nicotinamide, was restricted to fibroblasts and tumor cells. Treatment of T cells with MNA resulted in an increase in T cell-mediated secretion of the tumor promoting cytokine tumor necrosis factor alpha. Thus, the TME-derived metabolite MNA contributes to an alternative and non-cell autonomous mechanism of immune modulation of T cells in HGSC. Collectively, uncovering the tumor-T cell metabolome may reveal metabolic vulnerabilities that can be exploited using T cell-based immunotherapies to treat human cancer.

Predictive biomarkers aid selection of personalized therapy targeted to molecular alterations within an individual's tumor. Patients' responses to targeted therapies are commonly followed by treatment resistance. Here, we survey liquid biopsies as alternatives to tumor biopsies to assess predictive and therapy response biomarkers. We examine the potential of liquid biopsies to meet the challenges of minimal residual disease monitoring after curative intent treatment for earlier detection of disease recurrence. We focus on blood, the most commonly collected minimally invasive clinical sample, and on the two most widely studied assays, circulating tumor DNA and circulating tumor cells.

Bispecific monoclonal antibodies (BsAbs) are engineered proteins with multiple functionalities and properties. The “bi-specificity” of these complex biopharmaceuticals is a key characteristic for the development of novel and more effective therapeutic strategies. The high structural complexity of BsAbs poses a challenge to the analytical methods needed for their characterization. Modifications of the BsAb structure, resulting from enzymatic and non-enzymatic processes, further complicate the analysis. An important example of the latter type of modification is glycation, which can occur in the manufacturing process, during storage in the formulation or in vivo after application of the drug. Glycation affects the structure, function, and stability of monoclonal antibodies, and consequently, a detailed analysis of glycation levels is required. Mass spectrometry (MS) plays a key role in the structural characterization of monoclonal antibodies and top-down, middle-up and middle-down MS approaches are increasingly used for the analysis of modifications. Here, we apply a novel middle-up strategy, based on IdeS digestion and matrix-assisted laser desorption ionization (MALDI) Fourier transform ion cyclotron resonance (FT-ICR) MS, to analyze all six different BsAb subunits in a single highresolution mass spectrum, namely two light chains, two half fragment crystallizable regions and two Fd’ regions, thus avoiding upfront chromatography. This method was used to monitor glycation changes during a 168 h forced-glycation experiment. In addition, hot spot glycation sites were localized using top-down and middle-down MALDI-in-source decay FT-ICR MS, which provided complementary information compared to standard bottom-up MS.

Surgical stress results in a significant reduction in natural killer (NK) cell cytotoxicity (NKC), which has been linked to postoperative cancer metastases. However, few studies have measured the impact of surgical stress upon NK cell IFNγ secretion (NKA), a cytokine with essential roles in controlling infection and metastases. The objective of this study was to investigate the impact of surgical stress on NKA in colorectal cancer (CRC) surgery patients. Peripheral blood was collected from CRC surgery patients (n = 42) preoperatively and on postoperative day (POD) 1, 3, 5, 28, and 56. Healthy donor blood (n = 27) was collected for controls. We assessed NKA by production of IFNγ following whole blood cytokine stimulation, NKC by 51Cr-release assay, and immune cell profiling by flow cytometry. The mean reduction in NKA on POD1 compared with baseline was 83.1% (standard deviation 25.2%; confidence interval 75–91), and therefore the study met the primary endpoint of demonstrating a > 75% decrease in a cohort of CRC surgery patients (p

BACKGROUND The cold pressor test (CPT) involves acute hand or foot exposure to cold water. CPT hyper-responders have unique traits, including risk of hypertension and a greater vasoconstrictor reserve and g force tolerance compared to hypo-responders. The purpose of this study was to uncover differences in cardiovascular and sympathetic biomarkers between responder types. METHODS Healthy volunteers (N = 30) submerged one hand into cold water (3.3 ± 0.8°C) for 5 min. Blood pressure, heart rate, cardiac output, and cardiac parameters were recorded using an automated monitor, impedance cardiography, and a beat-to-beat monitoring system. We analyzed for salivary α-amylase (SαA), which is a convenient biomarker of the sympathetic nervous system. Subjects were stratified post hoc into hyper-responders (≥ 22 mmHg) and hypo-responders (< 22 mmHg) based on change in systolic blood pressure during CPT. RESULTS Hyper-responders had a significantly lower baseline heart rate (64 ± 7 bpm), cardiac output (5.6 ± 0.9 L · min-1), and SαA (60 ± 37 U · mL-1) compared to hypo-responders (73 ± 9 bpm, 6.9 ± 1.3 L · min-1, 165 ± 122 U · mL-1). During the cold immersion, hyper-responders had significantly higher systolic blood pressure (150 ± 14 mmHg), diastolic blood pressure (91 ± 10 mmHg), mean arterial pressure (129 ± 17 mmHg), and systemic vascular resistance (1780 ± 640 dyn · s-1 · cm-5) than hypo-responders (130 ± 14 mmHg, 81 ± 10 mmHg, 110 ± 9 mmHg, 1290 ± 220 dyn · s-1 · cm-5). The change in systolic blood pressure correlated with baseline SαA (r = -0.455, P = 0.011) and baseline heart rate (r = -0.374, P = 0.042). DISCUSSION Baseline characteristics influenced by sympathetic tone such as SαA, heart rate, and cardiac output are indicative of responses to CPT. Our data supports the use of baseline values to predict blood pressure response to acute cold exposure and indicates an intrinsic difference between CPT responder phenotypes.Youssef M, Ghassemi A, Carvajal Gonczi CM, Kugathasan TA, Kilgour RD, Darlington PJ. Low baseline sympathetic tone correlates to a greater blood pressure change in the cold pressor test. Aerosp Med Hum Perform. 2018; 89(6):503-509.

Traditionally mental health and substance abuse disorders have been treated less generously than medical/surgical benefits in employment-provided health plans and health insurance contracts. That changed with the Mental Health Parity and Addiction Equity Act of 2008 as amended and extended by the Affordable Care Act of 2010 (Obamacare). It has been found that parity has not added significantly to health plan cost. The parity concept now applies to health plans and insurance contracts throughout the United States. This article examines that legislative development and the attending regulations and enforcement efforts. The Trump administration has vowed to repeal the Affordable Care Act, and it has already weakened it. If it succeeds, it will also weaken the Mental Health Parity and Addiction Equity Act and its parity requirements. That would be regrettable requirements.

Species differences between domestic cats (Felis catus) and dogs (Canis familiaris) has led to differences in their ability to digest, absorb and metabolize carbohydrates through poorly characterized mechanisms. The current study aimed to first examine biopsied small intestine, pancreas, liver and skeletal muscle from laboratory beagles and domestic cats for mRNA expression of key enzymes involved in starch digestion (amylase), glucose transport (sodium-dependent SGLTs and -independent glucose transporters, GLUT) and glucose metabolism (hexokinase and glucokinase). Cats had lower mRNA expression of most genes examined in almost all tissues compared to dogs (p < 0.05). Next, postprandial glucose, insulin, methylglyoxal (a toxic glucose metabolite) and d-lactate (metabolite of methylglyoxal) after single feedings of different starch sources were tested in fasted dogs and cats. After feeding pure glucose, peak postprandial blood glucose and methylglyoxal were surprisingly similar between dogs and cats, except cats had a longer time to peak and a greater area under the curve consistent with lower glycolytic enzyme expression. After feeding starches or whole diets to dogs, postprandial glycemic response, glycemic index, insulin, methylglyoxal and d-lactate followed reported glycemic index trends in humans. In contrast, cats showed very low to negligible postprandial glycemic responses and low insulin after feeding different starch sources, but not whole diets, with no relationship to methylglyoxal or d-lactate. Thus, the concept of glycemic index appears valid in dogs, but not cats. Differences in amylase, glucose transporters, and glycolytic enzymes are consistent with species differences in starch and glucose handling between cats and dogs.

Extra-Pulmonary NeuroEndocrine Carcinomas (EP-NECs) are aggressive tumours (Ki-67>20%, poorly differentiated morphology), with a median overall survival Citation Format: Melissa Frizziero, Elaine Kilgour, Kathryn Simpson, Kristopher Frese, Juan W. Valle, Mairéad G. McNamara, Caroline Dive. Liquid biopsy-based precision medicine for extra-pulmonary neuroendocrine carcinomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 601.

SCLC is a highly aggressive neuroendocrine tumor with dismal prognosis. Inability to detect SCLC early renders surgical resections a rare event, limiting investigation of the early stages of tumor development. We sought to address this challenge using a genetically engineered mouse model (GEMM) to investigate how the innate immune system responds to SCLC development. The RPM (Rb1fl/fl, p53fl/fl, MycLSL/LSL) SCLC GEMM was selected to characterize the local immune microenvironment throughout the process of tumor development. Following tumor induction using an intranasally installed Cre bearing adenovirus, lung tissue was collected and analyzed using multi-parametric flow cytometry to assess changes in innate immune cell populations. Induction of SCLC resulted in late stage disease being present in animals approximately 7 weeks after virus exposure. Flow cytometric analysis of immune cell populations of the whole lung showed no significant differences in the overall levels of immune cell types, although an upwards trend in the levels of neutrophils in tumor-bearing mice was observed. The most significant finding was a decrease in the expression levels of major histocompatibility complex class II (MHCII) in both alveolar and interstitial macrophage populations. Further characterization, including separate analysis of the two interstitial macrophage subpopulations described by Chakarov et al. (Science 2019), and Schyns et al. (Nature Communications 2019), showed significant drops in levels of MHCII in all populations as measured by median fluorescent intensity (MFI) (p=0.004 in alveolar macrophages, p=0.0148 in vascular supporting CD206+ve interstitial macrophages, and p=0.0027 in CD206-ve interstitial macrophages). The striking difference between the changes seen in these populations was that alveolar and CD206+ve interstitial macrophages both showed a downward shift in MHCII expression as a whole, while CD206-ve macrophages acquired a novel population completely negative for MHCII accounting for approx. half of the CD206-ve macrophage subpopulation. The development of SCLC has been found to result in all macrophage subtypes expressing lower levels of MHCII, pointing towards a more immunosuppressive immune environment. The population of CD206-ve MHCII-ve interstitial macrophages is of particular interest, as it is contrary to the currently described interstitial macrophage phenotypes. A more in-depth characterization of all macrophage populations in the mouse lung, including their precise phenotype and localization is currently underway using CyTOF and IHC approaches. The precise timings of the observed changes are being elucidated through analysis of a disease time-course ranging from very early stage to late stage disease, in order to better understand the process of SCLC development. Citation Format: Jakub Chudziak, Melanie Galvin, Antonia Banyard, Kathryn L. Simpson, Kristopher K. Frese, Elaine Kilgour, Tracy Hussell, Caroline Dive. Study of innate immune responses during small cell lung cancer (SCLC) development [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1769.

Art galleries are becoming more inclusive in their activities for those with specific needs. The interdisciplinary team on an inpatient behavioural health unit collaborated with artist-educators at the Art Gallery of Hamilton (Ontario, Canada) to create an arts-based programme. ‘Artful Moments’ involved using a combination of art appreciation and hands-on art making activities and took place on the unit at the hospital and at the art gallery. A pilot study of eight participants and their care partners who attended the programme is presented. The purpose of the study was to determine if ‘Artful Moments’ facilitated positive engagement ‘in the moment’ for persons in the middle-to-late stages of dementia. The perception of the programme’s impact from their care partners’ perspectives, as well as their satisfaction with the programme is also reported. Extensive education of art gallery staff and clinical staff preceded the programming, with each team sharing expertise with the other. Sessions (n = 27) took place about twice per month. Data were collected through systematic structured observations of patient participants during the activities and through surveys of care partners. Persons with dementia maintained interest, though not necessarily pleasure, during art appreciation and art making, rarely became sad or anxious, and never became angry. Generally the care partners felt that participants enjoyed the experience, and often they were surprised by the very positive response of the participants. Successful engagement was attributed to a dementia-friendly environment; supportive communication strategies; and a suitable, well-planned activity.

Antibody drug conjugates (ADCs) are an important class of therapeutic molecule currently being used to treat HER2-positive metastatic breast cancer, relapsed or refractory Hodgkin lymphoma, systemic anaplastic large cell lymphoma, relapsed or refractory B-cell precursor acute lymphoblastic leukemia and acute myeloid leukemia. An ADC typically consists of a small molecule or peptide-based cytotoxic moiety covalently linked, via lysine or cysteine residues, to amonoclonal antibody (mAb) scaffold. Mass spectrometric (MS) characterization of these molecules afford highly accurate molecular weight (MW) and drug-to-antibody ratio (DAR) determination, and is typically performed using orthogonal acceleration time-of-flight (oa-ToF) analysers and more recently Orbitrap instruments. Herein we describe for the first time the use of a 15 Tesla solariX Fourier transform ion cyclotron mass spectrometer to characterize an IgG1 mAb molecule conjugated with biotin via native lysine and cysteine residues, under native-MS and solution conditions. The cysteine biotin conjugates remained fully intact, demonstrating the ability of the FT-ICR to maintain the noncovalent interactions and efficiently transmit labile protein complexes. Native-MS was acquired and is displayed in magnitude mode using a symmetric Hann apodisation function. Baseline separation is achieved on all covalent biotin additions, for each charge state, for both the lysine and cysteine biotin-conjugates. Average DAR values obtained by native-MS for the lysine conjugate are compared to those derived by denaturing reversed phase liquid chromatography using an oa-ToF MS system (1.56 ±0.02 versus 2.24 ±0.02 for a 5-molar equivalent and 3.99 ±0.09 versus 4.43 ±0.01 for a 10-molar equivalent, respectively). Increased DAR value accuracy can be obtained for the higher biotin load, when using standard ESI conditions as opposed to nanoESI native-MS conditions. Both denatured LC-MS and native-MS spectral data were deconvoluted using a parsimonious based algorithm, without the need for parameter adjustment.