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Using pre-treatment gene expression, protein/phosphoprotein, and clinical data from the I-SPY2 neoadjuvant platform trial (NCT01042379), we create alternative breast cancer subtypes incorporating tumor biology beyond clinical hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status to better predict drug responses. We assess the predictive performance of mechanism-of-action biomarkers from ∼990 patients treated with 10 regimens targeting diverse biology. We explore >11 subtyping schemas and identify treatment-subtype pairs maximizing the pathologic complete response (pCR) rate over the population. The best performing schemas incorporate Immune, DNA repair, and HER2/Luminal phenotypes. Subsequent treatment allocation increases the overall pCR rate to 63% from 51% using HR/HER2-based treatment selection. pCR gains from reclassification and improved patient selection are highest in HR+ subsets (>15%). As new treatments are introduced, the subtyping schema determines the minimum response needed to show efficacy. This data platform provides an unprecedented resource and supports the usage of response-based subtypes to guide future treatment prioritization.

Precision medicine aims to use patient genomic, epigenomic, specific drug dose, and other data to define disease patterns that may potentially lead to an improved treatment outcome. Personalized dosing regimens based on tumor drug penetration can play a critical role in this approach. State-of-the-art techniques to measure tumor drug penetration focus on systemic exposure, tissue penetration, cellular or molecular engagement, and expression of pharmacological activity. Using in silico methods, this information can be integrated to bridge the gap between the therapeutic regimen and the pharmacological link with clinical outcome. These methodologies are described, and challenges ahead are discussed. Supported by many examples, this review shows how the combination of these techniques provides enhanced patient-specific information on drug accessibility at the tumor tissue level, target binding, and downstream pharmacology. Our vision of how to apply tumor drug penetration measurements offers a roadmap for the clinical implementation of precision dosing.

Phosphorylation networks intimately regulate mechanisms of response to therapies. Mapping the phospho-catalytic profile of kinases in cells or tissues remains a challenge. Here, we introduce a practical high-throughput system to measure the enzymatic activity of kinases using biological peptide targets as phospho-sensors to reveal kinase dependencies in tumour biopsies and cell lines. A 228-peptide screen was developed to detect the activity of >60 kinases, including ABLs, AKTs, CDKs and MAPKs. Focusing on BRAFV600E tumours, we found mechanisms of intrinsic resistance to BRAFV600E-targeted therapy in colorectal cancer, including targetable parallel activation of PDPK1 and PRKCA. Furthermore, mapping the phospho-catalytic signatures of melanoma specimens identifies RPS6KB1 and PIM1 as emerging druggable vulnerabilities predictive of poor outcome in BRAFV600E patients. The results show that therapeutic resistance can be caused by the concerted upregulation of interdependent pathways. Our kinase activity-mapping system is a versatile strategy that innovates the exploration of actionable kinases for precision medicine.

BackgroundPoly(ADP-ribose) polymerase inhibitors (PARPi), coupled to a DNA damaging agent is a promising approach to treating triple negative breast cancer (TNBC). However, not all patients respond; we hypothesize that non-response in some patients may be due to insufficient drug penetration. As a first step to testing this hypothesis, we quantified and visualized veliparib and carboplatin penetration in mouse xenograft TNBCs and patient blood samples.MethodsMDA-MB-231, HCC70 or MDA-MB-436 human TNBC cells were implanted in 41 beige SCID mice. Low dose (20 mg/kg) or high dose (60 mg/kg) veliparib was given three times daily for three days, with carboplatin (60 mg/kg) administered twice. In addition, blood samples were analyzed from 19 patients from a phase 1 study of carboplatin + PARPi talazoparib. Veliparib and carboplatin was quantified using liquid chromatography-mass spectrometry (LC-MS). Veliparib tissue penetration was visualized using matrix-assisted laser desorption/ionization mass spectrometric imaging (MALDI-MSI) and platinum adducts (covalent nuclear DNA-binding) were quantified using inductively coupled plasma-mass spectrometry (ICP-MS). Pharmacokinetic modeling and Pearson's correlation were used to explore associations between concentrations in plasma, tumor cells and peripheral blood mononuclear cells (PBMCs).ResultsVeliparib penetration in xenograft tumors was highly heterogeneous between and within tumors. Only 35% (CI 95% 26-44%), 74% (40-97%) and 46% (9-37%) of veliparib observed in plasma penetrated into MDA-MB-231, HCC70 and MDA-MB-436 cell-based xenografts, respectively. Within tumors, penetration heterogeneity was larger with the 60 mg/kg compared to the 20 mg/kg dose (RSD 155% versus 255%, P = 0.001). These tumor concentrations were predicted similar to clinical dosing levels, but predicted tumor concentrations were below half maximal concentration values as threshold of response. Xenograft veliparib concentrations correlated positively with platinum adduct formation (R 2 = 0.657), but no PARPi-platinum interaction was observed in patients' PBMCs. Platinum adduct formation was significantly higher in five gBRCA carriers (ratio of platinum in DNA in PBMCs/plasma 0.64% (IQR 0.60-1.16%) compared to nine non-carriers (ratio 0.29% (IQR 0.21-0.66%, P

Significance Statement: Neurofibromas, derived from perineural cells, are usually benign in the nervous system. Although neurofibromas are common in the head and neck, they rarely affect the external auditory canal (EAC), and few cases have been reported. We describe a case of a solitary EAC neurofibroma with otoscopy, radiological imaging, a surgical approach, and an uneventful outcome. [ABSTRACT FROM AUTHOR]

The article discusses the case of a patient with spontaneous temporomandibular joint (TMJ) herniation into the external auditory canal. Topics discussed include intermittent left-sided aural fullness presented by the patient, the results of otoscopy and high-resolution computed tomography of the temporal bone, and surgical reconstruction of the bony defect recommended to symptomatic patients.

Abstract Background The purpose of this study was to investigate the relationship among work stress, sex life satisfaction, and mental health of married nurses. Demographic information, work stress, sex life satisfaction, sexual desire and mental health measured using the Chinese Health Questionnaire, data were collected from 100 married nurses in Taiwan. Findings Sex life satisfaction and age were negatively correlated, but sex life satisfaction and sexual desire were positively correlated. The mental health of over-committed nursing staff was not affected. Higher reward for effort was positively correlated with sex life satisfaction. Conclusions No matter whether job stress was high or low, receiving a higher reward for effort led to better sex life satisfaction, which had a satisfying positive effect on the nurses' lives. To improve nursing care quality at the hospital, nursing administrators should assist nurses in confronting work stress via positive adjustment, which is associated with the nurses’ sexual harmony, and quality of life.

Recurrent miscarriage is used to refer to more than three pregnancy failures before 20 weeks of gestation. Defective trophoblast cell growth and invasion are frequently observed in recurrent miscarriage. Several microRNAs (miRs), including miR-155-5p, are aberrantly upregulated in recurrent miscarriage; however, the underlying molecular mechanisms remain unclear. The centrosome orchestrates microtubule networks and coordinates cell cycle progression. In addition, it is a base for primary cilia, which are antenna-like organelles that coordinate signaling during development and growth. Thus, deficiencies in centrosomal functions can lead to several disease, such as breast cancer and microcephaly. In the present study, the signaling cascades were analyzed by western blotting, and the centrosome and primary cilia were observed and analyzed by immunofluorescence staining. The results showed that overexpression of miR-155-5p induced centrosome amplification and blocked primary cilia formation in trophoblast cells. Notably, centrosome amplification inhibited trophoblast cell growth by upregulating apoptotic cleaved-caspase 3 and cleaved-poly (ADP-ribose) polymerase in miR-155-5p-overexpressing trophoblast cells. In addition, overexpression of miR-155-5p inhibited primary cilia formation, thereby inhibiting epithelial-mesenchymal transition and trophoblast cell invasion. All phenotypes could be rescued when cells were co-transfected with the miR-155-5p inhibitor, thus supporting the role of miR-155-5p in centrosomal functions. It was also found that miR-155-5p activated autophagy, whereas disruption of autophagy via the depletion of autophagy-related 16-like 1 alleviated miR-155-5p-induced apoptosis and restored trophoblast cell invasion. In conclusion, the present study indicated a novel role of miR-55-5p in mediating centrosomal function in recurrent miscarriage. [ABSTRACT FROM AUTHOR]

Background: Interstitial cystitis (IC) is a silent challenge for patients. Various symptoms related to IC are causes of physical disability and mental distress. Purpose: This study investigated the relationships between clinical symptoms, bladder condition and patient perceptions. Methods: This study enrolled 107 patients diagnosed with interstitial cystitis at a medical center in eastern Taiwan and employed a cross-sectional design. Patient medical charts were reviewed. Structural questionnaires were used to collect data. Results: Participants with a high symptom problem index had poor bladder compliance, severe glomerulation and high visual analog scale (VAS) scores. There was a positive correlation between Hunner's ulcer and a high VAS score. Patients with severe lower urinary symptoms, low competency and severe glomerulation earned significantly higher patient perception of bladder condition scores. Conclusions / Implications for Practice: This study found significant correlations between clinical symptoms, bladder condition and patient perceptions. This study may help enhance nursing staff knowledge of IC clinical symptoms so that they may provide appropriate interventions and education to improve patient self-care abilities and life quality. [ABSTRACT FROM AUTHOR]

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Background: Interstitial cystitis (IC) is a silent challenge for patients. Various symptoms related to IC are causes of physical disability and mental distress., Purpose: This study investigated the relationships between clinical symptoms, bladder condition and patient perceptions., Methods: This study enrolled 107 patients diagnosed with interstitial cystitis at a medical center in eastern Taiwan and employed a cross-sectional design. Patient medical charts were reviewed. Structural questionnaires were used to collect data., Results: Participants with a high symptom problem index had poor bladder compliance, severe glomerulation and high visual analog scale (VAS) scores. There was a positive correlation between Hunner's ulcer and a high VAS score. Patients with severe lower urinary symptoms, low competency and severe glomerulation earned significantly higher patient perception of bladder condition scores., Conclusions/implications for Practice: This study found significant correlations between clinical symptoms, bladder condition and patient perceptions. This study may help enhance nursing staff knowledge of IC clinical symptoms so that they may provide appropriate interventions and education to improve patient self-care abilities and life quality.