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Abstract B cell chronic lymphocytic leukaemia (B‐CLL) presenting with cutaneous infiltration is rare, and when it occurs, it presents most commonly on the head and neck. We present the case of an 80‐year‐old woman with a 2‐month history of erythema, swelling and pain affecting all her toes. She had a history of B‐CLL diagnosed 20 years previously that had remained stable under observation without treatment. A toe skin biopsy showed a diffuse infiltrate of lymphoid cells occupying the dermis composed of small mature lymphoid cells with a monotonous appearance. On immunohistochemistry, the neoplastic lymphoid cells stained positive for the B‐cell marker CD20. Overall, the morphology and immunophenotype were consistent with cutaneous involvement by chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL). We concluded that her symptoms were directly caused by skin infiltration of B‐CLL.

This study explored video-based decision-making and eye-movement behavior as a complementary method to assess the decision-making skills and knowledge of elite junior Australian Rules (AR) Football players. Performance was measured twice over an 18-month period. This approach tested a practical and reliable assessment of decision-making and game knowledge that does not contribute to physical training load. N = 59 participants were categorized based on their training age groups, U14 (N = 38, Mage13.37 ± 0.47) and U16 (N = 21, Mage14.80 ± 0.39). Participants watched 14 brief video clips and provided action choices while wearing eye-movement recording glasses that captured visual search patterns (e.g., fixations). Decision accuracy and speed of decision-making were also recorded. Participants with accurate decisions made significantly faster decisions compared to less skilled players (p

Abstract The emerging arena of space exploration has created opportunities to study cancer cell biology in the environments of microgravity and hypergravity. Studying cellular behavior in altered gravity conditions has allowed researchers to make observations of cell function that would otherwise remain unnoticed. The patient-derived QNS108 brain tumor initiating cell line (BTIC), isolated from glioblastoma (GBM) tissue, was launched on a suborbital, parabolic rocket flight conducted by EXOS Aerospace Systems & Technologies. All biologicals and appropriate ground controls were secured post-launch and transported back to our research facility. Cells from the rocket-flight and ground-based controls were isolated from the culture containers and expanded on adherent flasks for two weeks. In vitro migration, proliferation, and stemness assays were performed. Following cell expansion, male nude mice were intracranially injected with either ground-control (GC) or rocket-flight (RF) exposed cells to assess tumorigenic capacity (n = 5 per group). Patient-derived QNS108 BTICs exposed to RF displayed more aggressive tumor growth than the GC cells in vitro and in vivo. RF cells showed significantly higher migration (p

This study employs a custom hollow specimen setup to investigate the HE in API 5L X60 pipeline base and welded materials exposed to pure hydrogen and a 20% hydrogen–natural gas blend at 2.07 MPa. Results indicate embrittlement with increasing hydrogen concentration. The base material showed a hydrogen embrittlement index (HEI) of 11.6% at 20% hydrogen and 12.4% at 100% hydrogen. For the welded material, the HEI was 14.6% at 20% hydrogen and 18.0% at 100% hydrogen. Fractography analysis revealed that the base and welded materials exhibited typical ductile fracture features in the absence of hydrogen, transitioning to a mixture of quasi-cleavage and micro-void coalescence (MVC) features in hydrogen environments. Additionally, with hydrogen, increased formation of secondary cracks was observed. Notably, the study identified the Hydrogen-Enhanced Localized Plasticity (HELP) mechanism as a probable contributor to hydrogen-assisted fracture.

Multiple Myeloma (MM) is an incurable plasma cell malignancy, that despite an unprecedented increase in overall survival, lacks truly risk-adapted or targeted treatments. A proportion of patients with MM depend on BCL-2 for survival and recently the BCL-2 antagonist venetoclax has shown clinical efficacy and safety in t(11;14) and BCL-2 overexpressing MM. However, only a small proportion of MM patients rely on BCL-2 (~20%), there is a need to broaden the patient population outside of t(11;14) that can be treated with venetoclax. Therefore, we took an unbiased screening approach and screened epigenetic modifiers to enhance venetoclax sensitivity in two non-BCL-2 dependent MM cell lines. The demethylase inhibitor 5-azacytidine was one of the lead hits from the screen, and the enhanced cell killing of the combination was confirmed in additional MM cell lines. Using dynamic BH3 profiling and immunoprecipitations we identified the potential mechanism of synergy is due to increased NOXA expression, through the integrated stress response. Knockdown of PMAIP1 or PKR partially rescues cell death of the venetoclax and 5-azacytidine combination treatment. The addition of a steroid to the combination treatment did not enhance the cell death and interestingly we found enhanced death of the immune cells with steroid addition, suggesting that a steroid-sparing regimen may be more beneficial in MM. Lastly, we show for the first time in primary MM patient samples, that 5-azacytidine enhances the response to venetoclax ex-vivo, across diverse anti-apoptotic dependencies (BCL-2 or MCL-1) and diverse cytogenetic backgrounds. Overall, our data identifies 5-azacytidine and venetoclax as an effective treatment combination and this could be a tolerable steroid-sparing regimen, particularly for elderly MM patients.

Introduction The Core Outcome Measures for Improving Care (COM-IC) project aims to deliver practical recommendations on the selection and implementation of a suite of core outcomes to measure the effectiveness of interventions for dementia care.Methods and analysis COM-IC embeds a participatory action approach to using the Alignment–Harmonisation–Results framework for measuring dementia care in Australia. Using this framework, suitable core outcome measures will be identified, analysed, implemented and audited. The methods for analysing each stage will be codesigned with stakeholders, through the conduit of a Stakeholder Reference Group including people living with dementia, formal and informal carers, aged care industry representatives, researchers, clinicians and policy actors. The codesigned evaluation methods consider two key factors: feasibility and acceptability. These considerations will be tested during a 6-month feasibility study embedded in aged care industry partner organisations.Ethics and dissemination COM-IC has received ethical approval from The University of Queensland (HREC 2021/HE001932). Results will be disseminated through networks established over the project, and in accordance with both the publication schedule and requests from the Stakeholder Reference Group. Full access to publications and reports will be made available through UQ eSpace (https://espace.library.uq.edu.au/), an open access repository hosted by The University of Queensland.

Purpose: The purpose of this study was to evaluate the interobserver variability in the contouring of the gross tumor volume (GTV) on magnetic resonance (MR) imaging and computed tomography (CT) for colorectal liver metastases in the setting of SABR. Methods and Materials: Three expert radiation oncologists contoured 10 GTV volumes on 3 MR imaging sequences and on the CT image data set. Three metrics were chosen to evaluate the interobserver variability: the conformity index, the DICE coefficient, and the maximum Hausdorff distance (HDmax). Statistical analysis of the results was performed using a 1-sided permutation test. Results: For all 3 metrics, the MR liver acquisition volume acquisition (MR LAVA) showed the lowest interobserver variability. Analysis showed a significant difference (P < .01) in the mean DICE, an overlap metric, for MR LAVA (0.82) and CT (0.74). The HDmax that highlights boundary errors also showed a significant difference (P = .04) with MR LAVA having a lower mean HDmax (7.2 mm) compared with CT (5.7 mm). The mean HDmax for both MR single shot fast spin echo (SSFSE) (19.3 mm) and diffusion weighted image (9.5 mm) showed large interobserver variability with MR SSFSE having a mean HDmax of 19.3 mm. A volume comparison between MR LAVA and CT showed a significantly higher volume for small GTVs (

Abstract Herein we report 2D printing in microgravity of aqueous-based foams containing metal oxide nanoparticles. Such hierarchical foams have potential space applications, for example for in situ habitat repair work, or for UV shielding. Foam line patterns of a TiO2-containing foam have been printed onto glass substrates via Direct Foam Writing (DFW) under microgravity conditions through a parabolic aircraft flight. Initial characterization of the foam properties (printed foam line width, bubble size, etc.) are presented. It has been found that gravity plays a significant role in the process of direct foam writing. The foam spread less over the substrate when deposited in microgravity as compared to Earth gravity. This had a direct impact on the cross-sectional area and surface roughness of the printed lines. Additionally, the contact angle of deionized water on a film exposed to microgravity was higher than that of a film not exposed to microgravity, due to the increased surface roughness of films exposed to microgravity.

Extramedullary multiple myeloma (or extramedullary disease, EMD) is an aggressive form of multiple myeloma (MM) that occurs when malignant plasma cells become independent of the bone marrow microenvironment. This may occur alongside MM diagnosis or in later stages of relapse and confers an extremely poor prognosis. In the era of novel agents and anti-myeloma therapies, the incidence of EMD is increasing, making this a more prevalent and challenging cohort of patients. Therefore, understanding the underlying mechanisms of bone marrow escape and EMD driver events is increasingly urgent. The role of genomics in MM has been studied extensively; however, much less is known about the genetic background of EMD. Recently there has been an increased focus on driver events for the establishment of distant EMD sites. Generally, high-risk cytogenetic abnormalities and gene signatures are associated with EMD, alongside mutations in RAS signalling pathways. More recently, changes in epigenetic regulation have also been documented, specifically the hypermethylation of DNA promoter regions. Therefore, the focus of this review is to summarize and discuss what is currently known about the genetic background of EMD in MM.

Exploration of eye-movement behaviors of humans can provide insight into the processes used to inform and make decisions, with a large body of research revealing general trends, especially in the sporting context. Despite this some questions remain within the sport context particularly for elite groups engaged in diverse sports, and the potential for this information to provide for training, development, and performance. Therefore, the purpose of this study was to examine the critical fixation points and durations associated with superior decision-making within an elite group of Australian Rules football players. To achieve this eye-movement behavior (fixations) and associated decision-making skills of (N = 27; Mage = 25.0 ± 3.7 yrs) elite Australian Rules (AR) football players were measured while they watched game-based video clips. The most skilled players made significantly faster decisions compared to less skilled players (p < 0.001), who also had significantly shorter total fixation duration (p < 0.0001). Further, analysis showed that the most skilled players spent more time fixating on potential options within an area of interest (p = 0.003). Thus, within a group of highly skilled group of athletes, distinctions can be made on perceptual-cognitive skills, for outcome decisions and decision processes. That is, skilled decision-makers appear to have more efficient visual search strategies, which may help them process visual information more effectively. Further, examination of these behaviors may aid sport science and coaching staff identify the process that can be refined to increase player ability between and within various teams.

Limited data exists to show the correlation of (tumour protein 53) TP53 mutation detected by Next generation sequencing (NGS) and the presence/absence of deletions of 17p13 detected by FISH. The study which is the largest series to date includes 2332 CLL patients referred for analysis of del(17p) by FISH and TP53 mutations by NGS before treatment. Using a 10% variant allele frequency (VAF) threshold, cases were segregated into high burden mutations (≥10%) and low burden mutations (

An important challenge for primary or secondary analysis of cytometry data is how to facilitate productive collaboration between domain and quantitative experts. Domain experts in cytometry laboratories and core facilities increasingly recognize the need for automated workflows in the face of increasing data complexity, but by and large, still conduct all analysis using traditional applications, predominantly FlowJo. To a large extent, this cuts domain experts off from the rapidly growing library of Single Cell Data Science algorithms available, curtailing the potential contributions of these experts to the validation and interpretation of results. To address this challenge, we developed FlowKit, a Gating-ML 2.0-compliant Python package that can read and write FCS files and FlowJo workspaces. We present examples of the use of FlowKit for constructing reporting and analysis workflows, including round-tripping results to and from FlowJo for joint analysis by both domain and quantitative experts.

White matter (WM) is injured in most strokes, which contributes to functional deficits during recovery. Casein kinase 2 (CK2) is a protein kinase that is expressed in brain, including WM. To assess the impact of CK2 inhibition on axon recovery following oxygen glucose deprivation (OGD), mouse optic nerves (MONs), which are pure WM tracts, were subjected to OGD with or without the selective CK2 inhibitor CX-4945. CX-4945 application preserved axon function during OGD and promoted axon function recovery when applied before or after OGD. This protective effect of CK2 inhibition correlated with preservation of oligodendrocytes and conservation of axon structure and axonal mitochondria. To investigate the pertinent downstream signaling pathways, siRNA targeting the CK2α subunit identified CDK5 and AKT as downstream molecules. Consequently, MK-2206 and roscovitine, which are selective AKT and CDK5 inhibitors, respectively, protected young and aging WM function only when applied before OGD. However, a novel pan-AKT allosteric inhibitor, ARQ-092, which targets both the inactive and active conformations of AKT, conferred protection to young and aging axons when applied before or after OGD. These results suggest that AKT and CDK5 signaling contribute to the WM functional protection conferred by CK2 inhibition during ischemia, while inhibition of activated AKT signaling plays the primary role in post-ischemic protection conferred by CK2 inhibition in WM independent of age. CK2 inhibitors are currently being used in clinical trials for cancer patients; therefore, our results will provide rationale for repurposing these drugs as therapeutic options for stroke patients by adding novel targets.

Abstract Background Emergency medicine practice in the UK and Ireland offers a junior and middle grade doctor great learning opportunities that force engagement with multiple specialties, life-saving procedures, exposure to a myriad of patient presentations, and opportunities for best practices in medicine. Main body The emergency department (ED) can be a hectic and dynamic environment; communication from the ED to specialists is essential to ensure best clinical outcomes for patients. The “per rectal” (PR) or “digital rectal exam” (DRE) can be a very difficult diagnostic test for even the most skilled operator to discern pathological versus normal; we propose this is especially the case in the emergency department patient population. Some specialists require this exam performed by an unskilled junior doctor with varying results prior to reviewing a referred and sick patient. The PR/DRE benefits may be limited in the ED setting for some pathologies, and the result of the exam may have limited impact in the overall treatment plan in the ED. Conclusion This short paper reviews the indications, benefits, shortfalls, and limitations of the PR/DRE in the emergency department setting and offers novel alternatives to maximize best practice, ensure best clinical outcomes for patients, and, to first, do no harm.

Abstract Relapse of FLT3‐mutated acute myeloid leukemia (AML) following allogeneic stem cell transplantation is associated with poor survival. The clinical utility of sorafenib monotherapy in this setting is described in a patient presenting as leukemia cutis.

Nicotine dependence is an addiction to tobacco products and a global public health concern. Association between the SLC6A4 polymorphisms and nicotine dependence is controversial. Two variable number tandem repeat (VNTR) domains, termed HTTLPR and STin2, in the SLC6A4 gene are well characterized transcriptional regulatory elements. Their polymorphism in the copy number of the repeat correlates with the particular personality and psychiatric traits. We analyzed nicotine dependence in 1,804 participants from Central Vietnam. The Fagerström Test (FTND) was used to evaluate the nicotine dependence and PCR was used to determine the SLC6A4 HTTLPR and STin2 VNTRs. The HTTLPR VNTR was associated with difficulties to refrain from smoking in a prohibiting environment. The STIn2 10/10 genotype was associated with (1) years of smoking, (2) difficulties to quit the first cigarette, and (3) higher number of cigarettes smoked per day (CPD). Stratification analysis was used to find the genetic interaction between these two VNTRs in nicotine dependence as they may synergistically regulate the SLC6A4 expression. Smokers with the S/S HTTLPR genotypes showed a much stronger association between STin2 10/10 variant and CPD. This finding is consistent with the molecular evidence for the functional interaction between HTTLPR and STin2 in cell line models, where STin2 has described as a stronger expressional regulator. Similarly, we found that STin2 is a much stronger modifier of smoking with 10/10 genotype related to higher nicotine dependence. The present study supports genetic interaction between HTTLPR and STin2 VNTRs in the regulation of nicotine dependence with the dominance of the STin2 effects. This finding could be explained by their differential effect on the SLC6A4 expression.

Although transformation of the myeloproliferative neoplasms (MPNs) to acute myeloid leukemia (AML) is well documented, development of an MPN in patients previously treated for, and in remission from, AML is exceedingly rare. A case is described in which a patient was successfully treated for AML and in whom a JAK2 V617F-positive MPN was diagnosed after seven years in remission. Retrospective evaluation of the JAK2 V617F detected a low allele burden at AML diagnosis and following one course of induction chemotherapy. This putative chemoresistant clone subsequently expanded over the intervening seven years, resulting in a hematologically overt MPN. As AML relapse has not occurred, the MPN may have arose in a separate initiating cell from that of the AML. Alternatively, both malignancies possibly evolved from a common precursor defined by a predisposition mutation with divergent evolution into MPN through acquisition of the JAK2 V617F and AML through acquisition of different mutations. This case emphasizes the protracted time frame from acquisition of a disease-driving mutation to overt MPN and further underscores the clonal complexity in MPN evolution.

We propose a framework for the systematic analysis of mobile phone data to identify relevant mobility profiles in a population. The proposed framework allows finding distinct human mobility profiles based on the digital trace of mobile phone users characterized by a Matrix of Individual Trajectories (IT-Matrix). This matrix gathers a consistent and regularized description of individual trajectories that enables multi-scale representations along time and space, which can be used to extract aggregated indicators such as a dynamic multi-scale population count. Unsupervised clustering of individual trajectories generates mobility profiles (clusters of similar individual trajectories) which characterize relevant group behaviors preserving optimal aggregation levels for detailed and privacy-secured mobility characterization. The application of the proposed framework is illustrated by analyzing fully anonymized data on human mobility from mobile phones in Senegal at the arrondissement level over a calendar year. The analysis of monthly mobility patterns at the livelihood zone resolution resulted in the discovery and characterization of seasonal mobility profiles related with economic activities, agricultural calendars and rainfalls. The use of these mobility profiles could support the timely identification of mobility changes in vulnerable populations in response to external shocks (such as natural disasters, civil conflicts or sudden increases of food prices) to monitor food security.

In spring of 2012, students and staff at the First Faculty of Medicine at Charles University in Prague invited distinguished public health stakeholders and experts to engage in a Global Health Forum. The forum lasted an afternoon, was academically and clinically engaging and offered students and medical faculty a venue to discuss the most pressing global public health concerns. Main outcomes from the forum included describing outstanding public issues in public health policy and prevention, infectious disease and public health systems raised by the speakers, stakeholders and attendees. One major result of this forum is the establishment of the Prague Center for Global Health – an interdepartmental and interdisciplinary research collaborative to further the discussion and much needed field and academic research in global public health. The Prague Center for Global Health will include multiple international research centers and main function and results will include new courses at the university, publications based on best practices and research and a venue to learn, share and create in the academic space.

Preconditioning with moderate oxidative stress (e.g., moderate bright light or mild hypoxia) can induce changes in retinal tissue that protect photoreceptors from a subsequent dose of lethal oxidative stress. The mechanism underlying this induced protection is likely a general mechanism of endogenous protection which has been demonstrated in heart and brain using ischemia and reperfusion. While multiple factors like bFGF, CNTF, LIF and BDNF have been hypothesized to play a role in preconditioning-induced endogenous neuroprotection, it has not yet been demonstrated which factors or receptors are playing an essential role. Using quantitative PCR techniques we provide evidence that in the retina, LIFR activating cytokines leukemia inhibitory factor (LIF), cardiotrophin-1 (CT-1) and cardiotrophin like cytokine (CLC) are strongly upregulated in response to preconditioning with bright cyclic light leading to robust activation of signal transducer and activator of transcription-3 (STAT3) in a time-dependent manner. Further, we found that blocking LIFR activation during preconditioning using a LIFR antagonist (LIF05) attenuated the induced STAT3 activation and also resulted in reduced preconditioning-induced protection of the retinal photoreceptors. These data demonstrate that LIFR and its ligands play an essential role in endogenous neuroprotective mechanisms triggered by preconditioning-induced stress.

Substance P, encoded by the Tac1 gene, is involved in neurogenic inflammation and hyperalgesia via neurokinin 1 (NK1) receptor activation. Its non-neuronal counterpart, hemokinin-1, which is derived from the Tac4 gene, is also a potent NK1 agonist. Although hemokinin-1 has been described as a tachykinin of distinct origin and function compared to SP, its role in inflammatory and pain processes has not yet been elucidated in such detail. In this study, we analysed the involvement of tachykinins derived from the Tac1 and Tac4 genes, as well as the NK1 receptor in chronic arthritis of the mouse.Complete Freund's Adjuvant was injected intraplantarly and into the tail of Tac1(-/-), Tac4(-/-), Tacr1(-/-) (NK1 receptor deficient) and Tac1(-/-/)Tac4(-/-) mice. Paw volume was measured by plethysmometry and mechanosensitivity using dynamic plantar aesthesiometry over a time period of 21 days. Semiquantitative histopathological scoring and ELISA measurement of IL-1β concentrations of the tibiotarsal joints were performed.Mechanical hyperalgesia was significantly reduced from day 11 in Tac4(-/-) and Tacr1(-/-) animals, while paw swelling was not altered in any strain. Inflammatory histopathological alterations (synovial swelling, leukocyte infiltration, cartilage destruction, bone damage) and IL-1β concentration in the joint homogenates were significantly smaller in Tac4(-/-) and Tac1(-/-/)Tac4(-/-) mice.Hemokinin-1, but not substance P increases inflammation and hyperalgesia in the late phase of adjuvant-induced arthritis. While NK1 receptors mediate its antihyperalgesic actions, the involvement of another receptor in histopathological changes and IL-1β production is suggested.

The use of standard dose low molecular weight heparin (LMWH) to anticoagulate women with mechanical valves in pregnancy is associated with morbidity and mortality. We conducted a prospective audit of the use of adjusted dose high intensity LMWH in 12 pregnancies in 11 women with prosthetic heart valves. LMWH ± low-dose aspirin was started at therapeutic-dose with monitoring of anti-Xa levels to achieve a target level of 1.0–1.2 IU/mL (0.8–1.2 in the first 3/12 pregnancies). This necessitated a mean increase in the dose of LMWH of 54.4% (SD±33.2) over initial dose. Eleven of 12 pregnancies resulted in live births, with one intrauterine fetal death at 37 weeks. One non-fatal valve thrombosis occurred at 26 weeks gestation associated with subtherapeutic anti-Xa levels. Three patients experienced major bleeding. This regime provides a therapeutic option for women with mechanical heart valves during pregnancy, provided anti-Xa levels are kept within the target range. These patients require close surveillance for bleeding and thrombotic complications within a multi-disciplinary setting.

Oncoplastic breast surgery (OPBS) has been shown to increase breastconserving surgery with improved oncologic and cosmetic outcomes, but access to OPBS in Canada varies greatly. This article summarizes the impact of introducing OPBS in a community hospital. All breast oncology surgery cases performed before and after the introduction of OPBS by a single surgeon were reviewed. After implementing OPBS in our centre, breast conservation increased from 30% to 50%, and the positive margin rate decreased from 25% to 10%. The completion mastectomy rate was lower in patients who received OPBS, and this group had a slightly higher readmission rate for postoperative hematoma. This review suggests OPBS can be performed safely in the community setting with appropriate training and improve outcomes in breast surgery for patients in smaller centres., Breast-conserving surgery (BCS) has emerged as the gold standard for most women with early-stage breast cancer; however, eligibility for BCS can be limited by several factors. Oncoplastic breast surgery (OPBS) [...]