CD38 promotes hematopoietic stem cell dormancy.

A subpopulation of deeply quiescent, so-called dormant hematopoietic stem cells (dHSCs) resides at the top of the hematopoietic hierarchy and serves as a reserve pool for HSCs. The state of dormancy protects the HSC pool from exhaustion throughout life; however, excessive dormancy may prevent an efficient response to hematological stresses. Despite the significance of dHSCs, the mechanisms maintaining their dormancy remain elusive. Here, we identify CD38 as a novel and broadly applicable surface marker for the enrichment of murine dHSCs. We demonstrate that cyclic adenosine diphosphate ribose (cADPR), the product of CD38 cyclase activity, regulates the expression of the transcription factor c-Fos by increasing the release of Ca2+ from the endoplasmic reticulum (ER). Subsequently, we uncover that c-Fos induces the expression of the cell cycle inhibitor p57Kip2 to drive HSC dormancy. Moreover, we found that CD38 ecto-enzymatic activity at the neighboring CD38-positive cells can promote human HSC quiescence. Together, CD38/cADPR/Ca2+/c-Fos/p57Kip2 axis maintains HSC dormancy. Pharmacological manipulations of this pathway can provide new strategies to improve the success of stem cell transplantation and blood regeneration after injury or disease.

Grape Pomace Polyphenols Reduce Acute Inflammatory Response Induced by Carrageenan in a Murine Model.

Grape pomace (GP), a by-product of wine production, contains bioactive polyphenols with potential health benefits. This study investigates the anti-inflammatory properties of a polyphenolic fraction derived from GP, obtained by ultrasound-microwave hybrid extraction and purified using ion-exchange chromatography. In the inflammation model, mice were divided into six groups: intact, carrageenan, indomethacin, and three GP polyphenols treatment groups. Paw edema was induced by subplantar injection of carrageenan, and the GP polyphenols were administered intraperitoneally at doses of 10, 20, and 40 mg/kg. The anti-inflammatory effect was evaluated by measuring paw volume, and expression of inflammatory markers: cyclooxygenase-2 (COX-2), myeloperoxidase (MPO), and cytokines (IL-1ß and IL-6), along with lipid peroxidation levels. The GP polyphenols significantly reduced paw edema and expression levels of COX-2, MPO, and cytokines in a dose-dependent manner effect, with the highest dose showing the greatest reduction. Additionally, lipid peroxidation levels were also decreased by GP polyphenols treatment at doses of 10 and 20 mg/kg. These findings suggest that ultrasound-microwave extraction combined with amberlite purification proved to be effective in obtaining a polyphenolic-rich fraction from GP. Thus, GP polyphenols may serve as a natural anti-inflammatory and antioxidant agent for treating inflammation and oxidative stress-related diseases.

Comparative study on the use of seasoned or unseasoned casks made of wood from different origins for the ageing of Sherry vinegar.

BACKGROUND: In the present study, the ageing process of Sherry vinegar in used (seasoned) or new casks made of chestnut, American oak, Spanish oak or French oak wood has been investigated, considering that no research has investigated whether this seasoning has a definite influence on the final composition of the aged beverage. The polyphenolic and volatile contents of the aged vinegars were determined and their sensory properties were evaluated. Different statistical tools were applied to the data collected. RESULTS: With respect to polyphenolic contents, ageing time was the most influential factor, followed by the seasoned-cask factor. The type of wood was only significant for gallic acid, p-hydroxybenzoic acid, methylfurfural, ethyl gallate, ferulic acid, coniferyl aldehyde and sinapaldehyde. Principal component analysis according to polyphenols did not allow the samples to be differentiated, whereas cluster analysis revealed a slight grouping trend according to ageing time and seasoning of the wood. In relation to volatile compounds, variance analysis revealed that, again, ageing time and cask-seasoning were the most significant factors, with the samples clustering according to these two parameters. Following the sensory study, a clear difference between seasoned and new cask vinegars could be established as a result of the high scores in olfactory quality obtained for those vinegars aged in new casks. This was probably because of an excess of the descriptor 'ethyl acetate' exhibited by seasoned-cask Sherry vinegars. CONCLUSION: The previous seasoning of the casks together with the ageing time conditioned the composition of the vinegars aged in casks of different botanical origin, which translated into differences at a sensory level. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Unveiling a Silent Obstructor: Phytobezoar in the Third Duodenal Segment.

We present a case of obstruction in the third portion of the duodenum secondary to a phytobezoar in an adult patient with no surgical history and without a vegan diet. High intestinal obstruction due to a phytobezoar is rarely described in the literature, posing a diagnostic challenge when evaluating potential differentials in the emergency setting. Subsequently, we conduct a review focusing on tomographic findings and the surgical specimen, highlighting key points to consider when addressing such pathologies.

Stacked or Folded? Impact of Chelate Cooperativity on the Self-Assembly Pathway to Helical Nanotubes from Dinucleobase Monomers.

Self-assembled nanotubes exhibit impressive biological functions that have always inspired supramolecular scientists in their efforts to develop strategies to build such structures from small molecules through a bottom-up approach. One of these strategies employs molecules endowed with self-recognizing motifs at the edges, which can undergo either cyclization-stacking or folding-polymerization processes that lead to tubular architectures. Which of these self-assembly pathways is ultimately selected by these molecules is, however, often difficult to predict and even to evaluate experimentally. We show here a unique example of two structurally related molecules substituted with complementary nucleobases at the edges (i.e., G:C and A:U) for which the supramolecular pathway taken is determined by chelate cooperativity, that is, by their propensity to assemble in specific cyclic structures through Watson-Crick pairing. Because of chelate cooperativities that differ in several orders of magnitude, these molecules exhibit distinct supramolecular scenarios prior to their polymerization that generate self-assembled nanotubes with different internal monomer arrangements, either stacked or coiled, which lead at the same time to opposite helicities and chiroptical properties.

Peripheral expansion of myeloid-derived suppressor cells is related to disease activity and damage accrual in inflammatory myopathies.

OBJECTIVE: To assess the proportion of myeloid-derived suppressor cells (MDSCs), their expression of arginase-1 and programmed cell death ligand 1 (PD-L1) and their relationship with the clinical phenotype of patients with idiopathic inflammatory myopathies (IIMs). METHODS: We recruited 37 IIM adult patients and 10 healthy donors in Mexico City. We evaluated their clinical features, the proportion of MDSCs and their expression of PD-L1 and arginase-1 by flow cytometry. Polymorphonuclear (PMN)-MDSCs were defined as CD33dim, CD11b+ and CD66b+ while monocytic (M)-MDSCs were CD33+, CD11b+, HLA-DR- and CD14+. Serum cytokines were analysed with a multiplex assay. We compared the quantitative variables with the Kruskal-Wallis and Mann-Whitney U tests and assessed correlations with Spearman's ρ. RESULTS: Most patients had dermatomyositis [n = 30 (81.0%)]. IIM patients had a peripheral expansion of PMN-MDSCs and M-MDSCs with an enhanced expression of arginase-1 and PD-L1. Patients with active disease had a decreased percentage {median 1.75% [interquartile range (IQR) 0.31-5.50 vs 10.71 [3.16-15.58], P = 0.011} of M-MDSCs and a higher absolute number of PD-L1+ M-MDSCs [median 23.21 cells/mm3 (IQR 11.16-148.9) vs 5.95 (4.66-102.7), P = 0.046] with increased expression of PD-L1 [median 3136 arbitrary units (IQR 2258-4992) vs 1961 (1885-2335), P = 0.038]. PD-L1 expression in PMN-MDSCs correlated with the visual analogue scale of pulmonary disease activity (r = 0.34, P = 0.040) and damage (r = 0.36, P = 0.031), serum IL-5 (r = 0.55, P = 0.003), IL-6 (r = 0.46, P = 0.003), IL-8 (r = 0.53, P = 0.018), IL-10 (r = 0.48, P = 0.005) and GM-CSF (r = 0.48, P = 0.012). M-MDSCs negatively correlated with the skeletal Myositis Intention to Treat Index (r = -0.34, P = 0.038) and positively with IL-6 (r = 0.40, P = 0.045). CONCLUSION: MDSCs expressing arginase-1 and PD-L1 are expanded in IIM and correlate with disease activity, damage accrual and serum cytokines.

Phenotypic characterization of a pediatric cohort with cystinuria and usefulness of newborn screening.

BACKGROUND: Cystinuria is an inherited metabolic disease involving the defective transport of cystine and the dibasic amino acids in the renal proximal tubules that causes the formation of stones in the urinary system. In our regional child health program, cystinuria is included in newborn metabolic screening. Our objectives are the phenotypic characterization of our cystinuric pediatric cohort and to present our experience in neonatal cystinuria screening. METHODS: The study of clinical cases of pediatric patients diagnosed with cystinuria over a period of 32 years. All patients were studied at demographic, clinical, laboratory, radiological, and therapeutic levels. RESULTS: We diagnosed 86 pediatric patients with cystinuria; 36% of them had the homozygous biochemical phenotype. 95.3% of the patients were detected by neonatal metabolic screening. We performed urine biochemical analyses of parents with additional diagnoses of 63 adult patients. The mean follow-up time was 16.8 ± 8.5 years. 11.6% of patients developed one or more episodes of urinary tract infection during that period. Chronic kidney disease, proteinuria, and hypertension were uncommon (1.2%). 10.5% developed kidney stones at the mean age of presentation of 7.78 ± 7.6 years; 33% were recurrent. The risk of developing lithiasis was higher for homozygous biochemical-phenotype patients. Hypercalciuria was a significant risk factor in the development of lithiasis. CONCLUSIONS: Our clinical data suggest that diagnosing cystinuria through neonatal screening could be a useful strategy for the detection of presymptomatic cases, in order to establish preventive measures, as well as for the detection of relatives at risk. A higher resolution version of the Graphical abstract is available as Supplementary information.

Thermodynamic characterization of LF, H, and mineral soil layers from oak forest ecosystems: Exploring the role of proximate analysis.

Studying the thermodynamic properties of soil organic matter is a developing field that involves the measurement of the energy stored by the soil. Quantifying soil energy content is still challenging despite different methodological approaches are available to calculate that value. One of the options is the proximate analysis following the guidelines for the energetic characterization of biomass. However, proximate analyses are still unexplored for soils. In this paper, we investigate the potential of this analysis to contribute to study soil from a thermodynamic perspective. With that goal, 31 soil samples collected in mature oak forests following a depth transect were used for elemental, thermal and proximate analysis. Proximate analyses and energetic characterization were performed by simultaneous thermogravimetry and differential scanning calorimetry. These methods allowed fragmentation of the soil organic matter in water content, volatile matter, fixed carbon, and ash, as well as the quantification of the soil organic matter and energy content. Pearson's correlation showed significant relations among the proximate, the elemental components of soils and the energy. The equations relating all of these variables were calculated for soils from oak forests by partial least squares analysis. Equations representing the relationship between energy and the proximate fractions provide an additional alternative to calculate the heat of combustion of the soil organic matter. This value is the essential step for the thermodynamic characterization of soils.

Breaking the Mold: Epigenetics and Genomics Approaches Addressing Novel Treatments and Chemoresponse in TGCT Patients.

Testicular germ-cell tumors (TGCT) have been widely recognized for their outstanding survival rates, commonly attributed to their high sensitivity to cisplatin-based therapies. Despite this, a subset of patients develops cisplatin resistance, for whom additional therapeutic options are unsuccessful, and ~20% of them will die from disease progression at an early age. Several efforts have been made trying to find the molecular bases of cisplatin resistance. However, this phenomenon is still not fully understood, which has limited the development of efficient biomarkers and precision medicine approaches as an alternative that could improve the clinical outcomes of these patients. With the aim of providing an integrative landscape, we review the most recent genomic and epigenomic features attributed to chemoresponse in TGCT patients, highlighting how we can seek to combat cisplatin resistance through the same mechanisms by which TGCTs are particularly hypersensitive to therapy. In this regard, we explore ongoing treatment directions for resistant TGCT and novel targets to guide future clinical trials. Through our exploration of recent findings, we conclude that epidrugs are promising treatments that could help to restore cisplatin sensitivity in resistant tumors, shedding light on potential avenues for better prognosis for the benefit of the patients.

Indication-prescription study for the management of conjunctivitis in a Colombian population.

PURPOSE: Conjunctivitis is one of the most common ocular pathologies. Its treatment depends on its etiology, but an excessive use of antibiotics and corticosteroids, which in many cases are contraindicated, has been described. The objective was to describe the prescription patterns of medications used to treat conjunctivitis in a Colombian population. METHODS: This was a cross-sectional study on the pharmacological treatment of patients diagnosed with conjunctivitis between April 1, 2020, and March 31, 2021; based on a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian Health System. Some sociodemographic and pharmacological variables and comorbidities were considered. A descriptive analysis was performed. RESULTS: A total of 8708 patients were identified; they had a median age of 44.7 years, and 59.3% were women. The most common causes of conjunctivitis were unspecified (53.1%) and allergic (37.4%). The most commonly used drug was olopatadine (26.1%), followed by dexamethasone with neomycin and polymyxin B (25.0%). A total of 97.0% of the patients received ophthalmic prescriptions, while 12.8% received systemic medications. Glucocorticoids (40.3%), antibiotics (37.7%) and antihistamines (31.7%) were the most commonly used groups of ophthalmic drugs. Glucocorticoids and ophthalmic antibiotics were the medications most frequently prescribed by general practitioners for the treatment of viral or bacterial conjunctivitis. CONCLUSIONS: Many patients with conjunctivitis are not being managed according to the recommendations of clinical practice guidelines, which highlights that the widespread use of antibiotics with ophthalmic glucocorticoids could be considered potentially inappropriate prescriptions in many cases.

Self-Sorting Governed by Chelate Cooperativity.

Self-sorting phenomena are the basis of manifold relevant (bio)chemical processes where a set of molecules is able to interact with no interference from other sets and are ruled by a number of codes that are programmed in molecular structures. In this work, we study, the relevance of chelate cooperativity as a code for achieving high self-sorting fidelities. In particular, we establish qualitative and quantitative relationships between the cooperativity of a cyclic system and the self-sorting fidelity when combined with other molecules that share identical geometry and/or binding interactions. We demonstrate that only systems displaying sufficiently strong chelate cooperativity can achieve quantitative narcissistic self-sorting fidelities either by dictating the distribution of cyclic species in complex mixtures or by ruling the competition between the intra- and intermolecular versions of a noncovalent interaction.

Clinical and genetic characterization of a cohort of proteinuric patients with biallelic CUBN variants.

BACKGROUND: Proteinuria is a well-known risk factor for progressive kidney impairment. Recently, C-terminal cubilin (CUBN) variants have been associated with isolated proteinuria without progression of kidney disease. METHODS: Genetic testing of 347 families with proteinuria of suspected monogenic cause was performed by next-generation sequencing of a custom-designed kidney disease gene panel. Families with CUBN biallelic proteinuria-causing variants were studied at the clinical, genetic, laboratory and pathologic levels. RESULTS: Twelve families (15 patients) bearing homozygous or compound heterozygous proteinuria-causing variants in the C-terminal CUBN gene were identified, representing 3.5% of the total cohort. We identified 14 different sequence variants, five of which were novel. The median age at diagnosis of proteinuria was 4 years (range 9 months to 44 years), and in most cases proteinuria was detected incidentally. Thirteen patients had moderate to severe proteinuria at diagnosis without nephrotic syndrome. These patients showed lack of response to angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) treatment, normal kidney biopsy and preservation of normal kidney function over time. The two remaining patients presented a more severe phenotype, likely caused by associated comorbidities. CONCLUSIONS: Identification of C-terminal pathogenic CUBN variants is diagnostic of an entity characterized by glomerular proteinuria, normal kidney histology and lack of response to ACEi/ARB treatment. This study adds evidence and increases awareness about albuminuria caused by C-terminal variants in the CUBN gene, which is a benign condition usually diagnosed in childhood with preserved renal function until adulthood.

Clinical utility of genetic testing in early-onset kidney disease: seven genes are the main players.

BACKGROUND: Inherited kidney diseases are one of the leading causes of chronic kidney disease (CKD) that manifests before the age of 30 years. Precise clinical diagnosis of early-onset CKD is complicated due to the high phenotypic overlap, but genetic testing is a powerful diagnostic tool. We aimed to develop a genetic testing strategy to maximize the diagnostic yield for patients presenting with early-onset CKD and to determine the prevalence of the main causative genes. METHODS: We performed genetic testing of 460 patients with early-onset CKD of suspected monogenic cause using next-generation sequencing of a custom-designed kidney disease gene panel in addition to targeted screening for c.428dupC MUC1. RESULTS: We achieved a global diagnostic yield of 65% (300/460), which varied depending on the clinical diagnostic group: 77% in cystic kidney diseases, 76% in tubulopathies, 67% in autosomal dominant tubulointerstitial kidney disease, 61% in glomerulopathies and 38% in congenital anomalies of the kidney and urinary tract. Among the 300 genetically diagnosed patients, the clinical diagnosis was confirmed in 77%, a specific diagnosis within a clinical diagnostic group was identified in 15%, and 7% of cases were reclassified. Of the 64 causative genes identified in our cohort, 7 (COL4A3, COL4A4, COL4A5, HNF1B, PKD1, PKD2 and PKHD1) accounted for 66% (198/300) of the genetically diagnosed patients. CONCLUSIONS: Two-thirds of patients with early-onset CKD in this cohort had a genetic cause. Just seven genes were responsible for the majority of diagnoses. Establishing a genetic diagnosis is crucial to define the precise aetiology of CKD, which allows accurate genetic counselling and improved patient management.

Safety of biological therapy in elderly patients with severe asthma.

OBJECTIVE: To assess the safety of biological therapy for severe T2 asthma (omalizumab, mepolizumab, benralizumab and reslizumab) under real-life conditions in elderly patients older than 70 years. METHODS: Retrospective data collection including clinical characteristics, comorbidities, treatment, disease control and adverse events (AE) of all patients with severe asthma on biological therapy older than 70 years seen in the Severe Asthma Unit of our hospital. RESULTS: Of 147 patients with severe asthma being treated with biologics, 21 patients older than 70 years were included. The median age of these patients was 76.3 years (range 71-86) and the majority were women (n = 18, 85.7%). There were 9 patients (42.9%) who experienced an AE related to biological treatment. Four (44.4%) were in treatment with omalizumab, two (22.2%) with mepolizumab, two patients (22.2%) with reslizumab and one (11.1%) with benralizumab. The median FEV1 (%) was 66%. These patients had a considerably higher body mass index (BMI). No significant differences were found for any other variable. Most of the AE reported were considered mild with the exception of one case of systemic AE (anaphylaxis) associated with omalizumab. CONCLUSION: This study indicates that the prescription of biological therapy in elderly patients with severe asthma seems to be safe. More evidence is needed in this particular population.

Changes in health-related quality of life after orthognathic surgery: a multicenter study.

OBJECTIVE: To evaluate changes in general and oral health-related quality of life (HRQoL) in patients with dentofacial deformity undergoing orthognathic surgery, and whether these changes vary according to type of deformity. MATERIAL AND METHODS: This is a prospective longitudinal multicenter study of patients with dentofacial deformities (n = 90). The Orthognathic Quality of Life Questionnaire (OQLQ), Oral Health Impact Profile (OHIP-14), and Short-Form Health Survey version2 (SF-36v2) were self-completed by patients before surgery, 3 and 6 months after orthognathic surgery. Change was tested using paired t-test, and compared between Class II and Class III of dentofacial deformity by unpaired t-test. The magnitude of change was examined estimating the standardized response mean (SRM). RESULTS: The OQLQ and OHIP-14 showed statistically significant improvements 6 months after surgery, compared with the pre-surgical evaluation, but the SF-36v2 only in the physical component summary. The SRM was large in OQLQ oral function (-1.11) and dentofacial facial aesthetics (-0.76) dimensions, and moderate in most of OHIP-14 dimensions. Differences in mean change between Class II and III were statistically significant for global scores of OQLQ (-10.08 vs -20.30, p = 0.0271) and OHIP-14 (-3.79 vs -10.56, p = 0.0144). CONCLUSIONS: A significant improvement was observed in oral HRQoL and in the physical component of general health in patients with dentofacial deformities Class II and III after orthognathic surgery. Improvement was greater among Class III than in Class II patients. CLINICAL RELEVANCE: These results provide patients, oral health care professionals, and planners with valuable information to make evidence-based decisions and facilitate shared clinical decision-making, taking into account the patients' perspective.

ECG Patient Simulator Based on Mathematical Models.

In this work, we propose a versatile, low-cost, and tunable electronic device to generate realistic electrocardiogram (ECG) waveforms, capable of simulating ECG of patients within a wide range of possibilities. A visual analysis of the clinical ECG register provides the cardiologist with vital physiological information to determine the patient's heart condition. Because of its clinical significance, there is a strong interest in algorithms and medical ECG measuring devices that acquire, preserve, and process ECG recordings with high fidelity. Bearing this in mind, the proposed electronic device is based on four different mathematical models describing macroscopic heartbeat dynamics with ordinary differential equations. Firstly, we produce full 12-lead ECG profiles by implementing a model comprising a network of heterogeneous oscillators. Then, we implement a discretized reaction-diffusion model in our electronic device to reproduce ECG waveforms from various rhythm disorders. Finally, in order to show the versatility and capabilities of our system, we include two additional models, a ring of three coupled oscillators and a model based on a quasiperiodic motion, which can reproduce a wide range of pathological conditions. With this, the proposed device can reproduce around thirty-two cardiac rhythms with the possibility of exploring different parameter values to simulate new arrhythmias with the same hardware. Our system, which is a hybrid analog-digital circuit, generates realistic ECG signals through digital-to-analog converters whose amplitudes and waveforms are controlled through an interactive and friendly graphic interface. Our ECG patient simulator arises as a promising platform for assessing the performance of electrocardiograph equipment and ECG signal processing software in clinical trials. Additionally the produced 12-lead profiles can be tested in patient monitoring systems.

The Ultrasound-Assisted Extraction of Polyphenols from Mexican Firecracker (Hamelia patens Jacq.): Evaluation of Bioactivities and Identification of Phytochemicals by HPLC-ESI-MS.

The objective of the present work was to optimize the extraction of phytochemicals from Hamelia patens Jacq. by ultrasound-assisted extraction. Taguchi L9 orthogonal array was used to evaluate the factors solid/liquid ratio (1:8, 1:12, and 1:16), extraction time (10, 20, and 30 min), and ethanol concentration (0, 35, and 70%). Total polyphenols were the response variable. Chromatographic fractionation using Amberlite XAD-16 was carried out and the total polyphenols, flavonoids, and condensed tannins were quantified. The redox potential, the reduction of the 2,2-diphenyl-1-picrylhydrazyl (DPPH), and the lipid oxidation inhibition were determined. Anti-bacterial activity was evaluated. The phytochemicals were identified by liquid chromatography coupled to mass spectrometry. Optimal extraction conditions were a solid/liquid ratio of 1:16, ethanol of 35%, and 10 min of ultrasound-assisted extraction. Maximum polyphenol content in the crude extract was 1689.976 ± 86.430 mg of gallic acid equivalents (GAE)/100 g of dried plant material. The purified fraction showed a total polyphenols content of 3552.84 ± 7.25 mg of GAE, flavonoids 1316.17 ± 0.27 mg of catechin equivalents, and condensed tannins 1694.87 ± 22.21 mg of procyanidin B1 equivalents, all per 100 g of purified fraction. Its redox potential was 553.93 ± 1.22 mV, reducing 63.08 ± 0.42% of DPPH radical and inhibiting 77.78 ± 2.78% of lipid oxidation. The polyphenols demonstrated antibacterial activity against Escherichia coli, Klebsiella pneumonia, and Enterococcus faecalis. The HPLC-ESI-MS analysis revealed the presence of coumarins, hydroxycinnamic acids, and flavonoids.

Image-derived modeling of nucleus strain amplification associated with chromatin heterogeneity.

Beyond the critical role of cell nuclei in gene expression and DNA replication, they also have a significant influence on cell mechanosensation and migration. Nuclear stiffness can impact force transmission and, furthermore, act as a physical barrier to translocation across tight spaces. As such, it is of wide interest to accurately characterize nucleus mechanical behavior. In this study, we present a computational investigation of the in situ deformation of a heterogeneous chondrocyte nucleus. A methodology is developed to accurately reconstruct a three-dimensional finite-element model of a cell nucleus from confocal microscopy. By incorporating the reconstructed nucleus into a chondrocyte model embedded in pericellular and extracellular matrix, we explore the relationship between spatially heterogeneous nuclear DNA content, shear stiffness, and resultant shear strain. We simulate an externally applied extracellular matrix shear deformation and compute intranuclear strain distributions, which are directly compared with corresponding experimentally measured distributions. Simulations suggest that the mechanical behavior of the nucleus is highly heterogeneous, with a nonlinear relationship between experimentally measured grayscale values and corresponding local shear moduli (µn). Three distinct phases are identified within the nucleus: a low-stiffness mRNA-rich interchromatin phase (0.17 kPa ≤ µn ≤ 0.63 kPa), an intermediate-stiffness euchromatin phase (1.48 kPa ≤ µn ≤ 2.7 kPa), and a high-stiffness heterochromatin phase (3.58 kPa ≤ µn ≤ 4.0 kPa). Our simulations also indicate that disruption of the nuclear envelope associated with lamin A/C depletion significantly increases nuclear strain in regions of low DNA concentration. We further investigate a phenotypic shift of chondrocytes to fibroblast-like cells, a signature for osteoarthritic cartilage, by increasing the contractility of the actin cytoskeleton to a level associated with fibroblasts. Peak nucleus strains increase by 35% compared to control, with the nucleus becoming more ellipsoidal. Our findings may have broad implications for current understanding of how local DNA concentrations and associated strain amplification can impact cell mechanotransduction and drive cell behavior in development, migration, and tumorigenesis.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial.

BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.

Dinucleoside-Based Macrocycles Displaying Unusually Large Chelate Cooperativities.

High-fidelity production of a single self-assembled species in competition with others relies on achieving strong chelate cooperativities, which can be quantified by the effective molarity parameter. Therefore, supramolecular systems displaying very high effective molarities are reliably formed in a wide range of experimental conditions and exhibit "all-or-none" phenomena, meaning that the assembly is either fully formed or fully dissociated into the corresponding monomeric components. We summarize here our efforts in the study and characterization of one of these synthetic systems exhibiting record chelate cooperativities: the self-assembly of rod-like dinucleoside molecules into tetrameric macrocycles through hydrogen-bonding Watson-Crick interactions.