Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective.

OBJECTIVES: To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? METHODS: Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. RESULTS: The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. CONCLUSIONS: It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.

Long-lasting pro-inflammatory suppression of microglia by LPS-preconditioning is mediated by RelB-dependent epigenetic silencing.

Microglia, the innate immune cells of the central nervous system (CNS), react to endotoxins like bacterial lipopolysaccharides (LPS) with a pronounced inflammatory response. To avoid excess damage to the CNS, the microglia inflammatory response needs to be tightly regulated. Here we report that a single LPS challenge results in a prolonged blunted pro-inflammatory response to a subsequent LPS stimulation, both in primary microglia cultures (100 ng/ml) and in vivo after intraperitoneal (0.25 and 1mg/kg) or intracerebroventricular (5 µg) LPS administration. Chromatin immunoprecipitation (ChIP) experiments with primary microglia and microglia acutely isolated from mice showed that LPS preconditioning was accompanied by a reduction in active histone modifications AcH3 and H3K4me3 in the promoters of the IL-1ß and TNF-α genes. Furthermore, LPS preconditioning resulted in an increase in the amount of repressive histone modification H3K9me2 in the IL-1ß promoter. ChIP and knock-down experiments showed that NF-κB subunit RelB was bound to the IL-1ß promoter in preconditioned microglia and that RelB is required for the attenuated LPS response. In addition to a suppressed pro-inflammatory response, preconditioned primary microglia displayed enhanced phagocytic activity, increased outward potassium currents and nitric oxide production in response to a second LPS challenge. In vivo, a single i.p. LPS injection resulted in reduced performance in a spatial learning task 4 weeks later, indicating that a single inflammatory episode affected memory formation in these mice. Summarizing, we show that LPS-preconditioned microglia acquire an epigenetically regulated, immune-suppressed phenotype, possibly to prevent excessive damage to the central nervous system in case of recurrent (peripheral) inflammation.

Coupling between MRI-assessed regional aortic pulse wave velocity and diameters in patients with thoracic aortic aneurysm: a feasibility study.

AIMS: Thoracic aortic aneurysm (TAA) is potentially life-threatening and requires close follow-up to prevent aortic dissection. Aortic stiffness and size are considered to be coupled. Regional aortic stiffness in patients with TAA is unknown. We aimed to evaluate coupling between regional pulse wave velocity (PWV), a marker of vascular stiffness, and aortic diameter in TAA patients. METHODS: In 40 TAA patients (59 ± 13 years, 28 male), regional aortic diameters and regional PWV were assessed by 1.5 T MRI. The incidence of increased diameter and PWV were determined for five aortic segments (S1, ascending aorta; S2, aortic arch; S3, thoracic descending aorta; S4, suprarenal and S5, infrarenal abdominal aorta). In addition, coupling between regional PWV testing and aortic dilatation was evaluated and specificity and sensitivity were assessed. RESULTS: Aortic diameter was 44 ± 5 mm for the aortic root and 39 ± 5 mm for the ascending aorta. PWV was increased in 36 (19 %) aortic segments. Aortic diameter was increased in 28 (14 %) segments. Specificity of regional PWV testing for the prediction of increased regional diameter was ≥ 84 % in the descending thoracic to abdominal aorta and ≥ 68 % in the ascending aorta and aortic arch. CONCLUSION: Normal regional PWV is related to absence of increased diameter, with high specificity in the descending thoracic to abdominal aorta and moderate results in the ascending aorta and aortic arch.

In acute experimental autoimmune encephalomyelitis, infiltrating macrophages are immune activated, whereas microglia remain immune suppressed.

Multiple sclerosis (MS) is an autoimmune demyelinating disorder of the central nervous system (CNS) characterized by loss of myelin accompanied by infiltration of T-lymphocytes and monocytes. Although it has been shown that these infiltrates are important for the progression of MS, the role of microglia, the resident macrophages of the CNS, remains ambiguous. Therefore, we have compared the phenotypes of microglia and macrophages in a mouse model for MS, experimental autoimmune encephalomyelitis (EAE). In order to properly discriminate between these two cell types, microglia were defined as CD11b(pos) CD45(int) Ly-6C(neg) , and infiltrated macrophages as CD11b(pos) CD45(high) Ly-6C(pos) . During clinical EAE, microglia displayed a weakly immune-activated phenotype, based on the expression of MHCII, co-stimulatory molecules (CD80, CD86, and CD40) and proinflammatory genes [interleukin-1ß (IL-1ß) and tumour necrosis factor- α (TNF-α)]. In contrast, CD11b(pos) CD45(high) Ly-6C(pos) infiltrated macrophages were strongly activated and could be divided into two populations Ly-6C(int) and Ly-6C(high) , respectively. Ly-6C(high) macrophages contained less myelin than Ly-6C(int) macrophages and expression levels of the proinflammatory cytokines IL-1ß and TNF-α were higher in Ly-6C(int) macrophages. Together, our data show that during clinical EAE, microglia are only weakly activated whereas infiltrated macrophages are highly immune reactive.

Exposure to inclined trunk postures in surgical staff.

In surgical staff, low-back pain (LBP) is prevalent and prolonged trunk inclination is hypothesized to be one of its potential causes. The aim of this study was to evaluate the magnitude and duration of trunk inclination in the sagittal plane of surgical assistants during surgical procedures. The three-dimensional trunk orientation was measured in 91 surgical assistants across four medical facilities during surgical procedures using an inertial measurement unit on the thorax. Per participant, Exposure Variation Analysis was used to evaluate the percentage of the total time of trunk inclination (< -10° (backward inclination); -10-10° (upright posture); 10-20° (light inclination); 20-30° (moderate inclination); >30° (strong inclination)) taking into account posture duration (< 10 s; 10-60 s; 60-300 s; > 300 s). Participants reported their LBP history and perceived low-back load during the procedure via a questionnaire. Participants were in an upright posture for 75% [63-84%] (median [interquartile range]) of the total surgery time (average surgery time: 174 min). Trunk inclination was beyond 20° and 30° for 4.3% [2.1-8.7%] and 1.5% [0.5-3.2%] of the surgery time, respectively. In most of the participants, the duration of trunk inclination beyond 20° or 30° was less than 60 s. Questionnaire response rate was 81%. Persistent or repeated LBP was reported by 49% of respondents, and was unrelated to the exposure to inclined trunk postures. It is concluded that other factors than prolonged trunk inclination, for instance handling of loads or prolonged standing may be causally related to the reported LBP in the investigated population.

The effect of back muscle fatigue on EMG and kinematics based estimation of low-back loads and active moments during manual lifting tasks.

This study investigated the effects of back muscle fatigue on the estimation of low-back loads and active low-back moments during lifting, using an EMG and kinematics based model calibrated with data from an unfatigued state. Fourteen participants performed lifting tasks in unfatigued and fatigued states. Fatigue was induced through semi-static forward bending. EMG, kinematics, and ground reaction forces were measured, and low-back loads were estimated using inverse dynamics and EMG-driven muscle model. A regression model was developed using data from a set of calibration lifts, and its accuracy was evaluated for unfatigued and fatigued lifts. During the fatigue-inducing task, the EMG amplitude increased by 2.8 %MVC, representing a 38% increase relative to the initial value. However, during the fatigued lifts, the peak EMG amplitude was found to be 1.6 %MVC higher than that observed during the unfatigued lifts, representing a mere 4% increase relative to the baseline unfatigued peak EMG amplitude. Kinematics and low-back load estimates remained unaffected. Regression model estimation errors remained unaffected for 5 kg lifts, but increased by no more than 5% of the peak active low-back moment for 15 kg lifts. We conclude that the regression-based estimation quality of active low-back moments can be maintained during periods of muscle fatigue, although errors may slightly increase for heavier loads.

Mannose-binding lectin (MBL) as prognostic factor in paediatric oncology patients.

Deficiency of mannose-binding lectin (MBL) has been suggested to influence duration of febrile neutropenia and prognosis in paediatric oncology patients. However, there is no consensus on the definition of MBL deficiency. In a cohort of children with cancer, we investigated (i) how to determine MBL deficiency and (ii) whether MBL is a prognostic factor for disease severity. In 222 paediatric oncology patients, 92 healthy children and 194 healthy adults, MBL plasma levels and MBL2 genotype (wild-type: A, variant: O) were determined. Event-free survival (EFS), overall survival (OS) and paediatric intensive care unit (PICU) admissions were recorded prospectively. In febrile neutropenic patients admitted to the PICU, disease severity was assessed by clinical, microbiological and laboratory parameters. An optimal cut-off value for MBL deficiency was determined to be < 0·20 µg/ml. Wild-type MBL2 genotype patients, including the XA/XA haplotype, had increased MBL levels compared to healthy individuals. MBL deficiency was associated with decreased EFS (P = 0·03), but not with need for PICU admission. A trend for a twice increased frequency of septic shock (80% versus 38%, P = 0·14), multiple organ failure (40% versus 17%, P = 0·27) and death (40% versus 21%, P = 0·27) was observed in the absence of microbiological findings. MBL deficiency was associated with decreased EFS and possibly with an increased severity of disease during PICU admission after febrile neutropenia in the absence of any association with microbiological findings. These findings suggest prognosis to be worse in MBL-deficient compared to MBL-sufficient paediatric oncology patients.

Transcriptional profiling of macaque microglia reveals an evolutionary preserved gene expression program.

Microglia are tissue-resident macrophages of the central nervous system (CNS), and important for CNS development and homeostasis. In the adult CNS, microglia monitor environmental changes and react to tissue damage, cellular debris, and pathogens. Here, we present a gene expression profile of purified microglia isolated from the rhesus macaque, a non-human primate, that consists of 666 transcripts. The macaque microglia transcriptome was intersected with the transcriptional programs of microglia from mouse, zebrafish, and human CNS tissues, to determine (dis)similarities. This revealed an extensive overlap of 342 genes between the transcriptional profile of macaque and human microglia, and showed that the gene expression profile of zebrafish is most distant when compared to other species. Furthermore, an evolutionair core based on the overlapping gene expression signature from all four species was identified. This study presents a macaque microglia transcriptomics profile, and identifies a gene expression program in microglia that is preserved across species, underscoring their CNS-tailored tissue macrophage functions as innate immune cells with CNS-surveilling properties.

Interspecies radiative transition in warm and superdense plasma mixtures.

Superdense plasmas widely exist in planetary interiors and astrophysical objects such as brown-dwarf cores and white dwarfs. How atoms behave under such extreme-density conditions is not yet well understood, even in single-species plasmas. Here, we apply thermal density functional theory to investigate the radiation spectra of superdense iron-zinc plasma mixtures at mass densities of ρ = 250 to 2000 g cm-3 and temperatures of kT = 50 to 100 eV, accessible by double-shell-target implosions. Our ab initio calculations reveal two extreme atomic-physics phenomena-firstly, an interspecies radiative transition; and, secondly, the breaking down of the dipole-selection rule for radiative transitions in isolated atoms. Our first-principles calculations predict that for superdense plasma mixtures, both interatomic radiative transitions and dipole-forbidden transitions can become comparable to the normal intra-atomic Kα-emission signal. These physics phenomena were not previously considered in detail for extreme high-density plasma mixtures at super-high energy densities.

Human fetal microglia acquire homeostatic immune-sensing properties early in development.

Microglia, immune cells of the central nervous system (CNS), are important for tissue development and maintenance and are implicated in CNS disease, but we lack understanding of human fetal microglia development. Single-cell gene expression and bulk chromatin profiles of microglia at 9 to 18 gestational weeks (GWs) of human fetal development were generated. Microglia were heterogeneous at all studied GWs. Microglia start to mature during this developmental period and increasingly resemble adult microglia with CNS-surveilling properties. Chromatin accessibility increases during development with associated transcriptional networks reflective of adult microglia. Thus, during early fetal development, microglia progress toward a more mature, immune-sensing competent phenotype, and this might render the developing human CNS vulnerable to environmental perturbations during early pregnancy.

Low mannose-binding lectin (MBL) levels in neonates with pneumonia and sepsis.

We investigated whether deficiency of mannose-binding lectin (MBL), a component of innate immunity, is associated with neonatal pneumonia and sepsis during the first 72 h, i.e. early onset, and during the first month after birth. In 88 neonatal intensive care patients (71 premature), MBL2 genotype and MBL plasma levels at birth were determined prospectively by Taqman analysis and enzyme-linked immunosorbent assay, respectively. Thirty-five neonates (40%) had low, i.e.

The role of mannose-binding lectin (MBL) in paediatric oncology patients with febrile neutropenia.

Children with cancer often have fever during chemotherapy-induced neutropenia, but only some develop serious infectious complications. Mannose-binding lectin (MBL) deficiency might increase infection susceptibility in these children. MBL genotype and phenotype were prospectively determined in 110 paediatric oncology patients. During febrile neutropenia, MBL concentrations were measured longitudinally in time. MBL genotype and phenotype were correlated to clinical and laboratory parameters. Structural exon-1 MBL2 mutations and the LX promoter polymorphism lead to deficient MBL concentrations. The capacity to increase MBL concentrations during febrile neutropenia was associated with MBL2 genotype. Infectious parameters did not differ between MBL-deficient and MBL-sufficient neutropenic children (n = 66). In contrast, MBL-sufficient patients had a greater risk of Intensive Care admittance (Relative Risk 1.6, 95% Confidence Interval 1.3-2.0, P = 0.04). MBL-deficient neutropenic children did not have more severe infections. However, most patients (61%) were severely neutropenic (<100 cells/microL), compromising the opsonophagocytic effector function of MBL. MBL substitution might still be beneficial in patients with phagocytic activity.

Flipped-Class Pedagogy Enhances Student Metacognition and Collaborative-Learning Strategies in Higher Education But Effect Does Not Persist.

In flipped-class pedagogy, students prepare themselves at home before lectures, often by watching short video clips of the course contents. The aim of this study was to investigate the effects of flipped classes on motivation and learning strategies in higher education using a controlled, pre- and posttest approach. The same students were followed in a traditional course and in a course in which flipped classes were substituted for part of the traditional lectures. On the basis of the validated Motivated Strategies for Learning Questionnaire (MSLQ), we found that flipped-class pedagogy enhanced the MSLQ components critical thinking, task value, and peer learning. However, the effects of flipped classes were not long-lasting. We therefore propose repeated use of flipped classes in a curriculum to make effects on metacognition and collaborative-learning strategies sustainable.

Expression of interleukin-1 beta in rat dorsal root ganglia.

The expression of interleukin-1beta was examined in dorsal root ganglion (DRG) neurons from adult rats using non-radioactive in situ hybridization and immunocytochemistry. At all spinal levels, approximately 70% of the DRG neurons appeared to express IL-1beta mRNA; about 80% of these DRG neurons actually appeared to produce the IL-1beta protein at markedly varying levels. The expression of IL-1beta was found in large as well as in intermediate diameter sensory neurons but only sporadically in the population of small sensory neurons. The population of IL-1beta immunopositive sensory neurons included most of the large calretinin-positive Ia afferents, but only a few of the small substance P/CGRP positive sensory neurons. In situ hybridization staining for the detection of type 1 IL-1 receptor showed expression of this receptor by most of the sensory neurons as well as by supportive glial-like cells, presumably satellite cells. The functional significance of IL-1beta in the DRG neurons needs to be elucidated, but we speculate that IL-1beta produced by DRG neurons may be an auto/paracrine signalling molecule in sensory transmission.

Selective expression of neurotrophin-3 messenger RNA in muscle spindles of the rat.

The expression of neurotrophin-3 messenger RNA was studied by in situ hybridization in rat muscle spindles from the first embryonic stages of their formation until their mature appearance in adult animals. The first expression of neurotrophin-3 messenger RNA in developing muscles was observed at E19 in the firstly formed intrafusal fiber, the nuclear bag2 fiber. High levels of neurotrophin messenger RNA were found in the equatorial region of these intrafusal fibers in thin lines of cytoplasma around and between the packed-up nuclei. From E21 on, neurotrophin-3 messenger RNA was also present in the nuclear bag1 type intrafusal fiber. The expression of neurotrophin-3 messenger RNA in nuclear chain fibers, which were found in muscle spindles from day 6 after birth, was low and insignificant in comparison to the expression in the nuclear bag fibers. After completion of muscle spindle formation around the third week after birth, high levels of neurotrophin-3 messenger RNA remained present in the intrafusal fibers throughout life. During the entire period of muscle formation, examined from E15 on, as well as in mature muscles, no neurotrophin-3 messenger RNA could be detected in extrafusal fibers by in situ hybridization. The exclusive intramuscular expression of neurotrophin-3 messenger RNA in intrafusal fibers during development as well as in mature stages suggests the involvement of neurotrophin-3 in the formation and the maintenance of muscle spindles.

Expression of the low affinity neurotrophin receptor p75 in spinal motoneurons in a transgenic mouse model for amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is a lethal neurodegenerative disorder involving motoneuron loss in the cortex, brainstem and spinal cord, resulting in progressive paralysis. Aberrant neurotrophin signalling via the low affinity neurotrophin receptor p75 has been suggested to be involved in the motoneuron death by the activation of apoptotic pathways. In order to investigate the involvement of neurotrophin receptor p75 in the amyotrophic lateral sclerosis related motoneuron degeneration process, we have studied the expression of this receptor in the spinal cord of transgenic mice carrying a mutated human Cu, Zn superoxide dismutase gene. Mutations in the superoxide dismutase gene are one of the genetic causes for familiar amyotrophic lateras sclerosis and human superoxide dismutase-1 transgenic mice develop symptoms and pathology similar to those in human amyotrophic lateras sclerosis. Our study shows that in these mice, spinal motoneurons, which normally do not contain the neurotrophin receptor p75 receptor, express this receptor during the progress of the disease. Expression of the neurotrophin receptor p75 receptor coincides with the expression of activating transcription factor 3, a member of the activating transcription factor/cyclic AMP family of stress transcription factors. Only a minority of these spinal motoneurons actually showed co-expression of neurotrophin receptor p75 with caspase-3 activity, suggesting that expression of the neurotrophin receptor p75 receptor is not directly related to the execution phase of the apoptosis process.

Expression of calcium-binding proteins in the neurotrophin-3-dependent subpopulation of rat embryonic dorsal root ganglion cells in culture.

In this study we have examined the calcium-binding protein expression in rat embryonic (E16) dorsal root ganglia (DRG) neurons in vitro in the presence of neurotrophin-3 (NT-3). A comparison was made with the expression of calcium-binding proteins in DRG subpopulations that depended in vitro on nerve growth factor (NGF) or brain-derived neurotrophic factor (BDNF). Our results show that NT-3 promotes the survival of a DRG subpopulation of which over 75% expresses parvalbumin (PV). The majority of these PV-positive NT-3-dependent DRG neurons were large 'type A' neurons. Expression of calbindin-D28k (CaBP) and calretinin (Calr) in the NT-3-dependent DRG population was seen in smaller fractions (between 12 and 17%) of the surviving DRG neurons and in both type A and B neurons. The preferential expression of PV in NT-3-dependent type A neurons is unique in comparison to the expression of PV and the other calcium-binding proteins in DRG neurons surviving in vitro in the presence of NGF or BDNF.

Neurotrophin-3 mRNA expression in rat intrafusal muscle fibres after denervation and reinnervation.

We have studied the regulation of the expression of neurotrophin-3 (NT-3) mRNA in neonatal and adult rat muscle spindles after denervation and after denervation followed by reinnervation. Denervation of the intrafusal fibres did not result in an upregulation of the NT-3 mRNA expression but decreased this expression below the detection limit of the in situ hybridization method. Reinnervation of intrafusal fibres restored the NT-3 mRNA expression. The results suggest that the expression of NT-3 mRNA in postnatal muscle spindles is controlled by neuronal factors. The intrafusal fibre derived NT-3 may act as an instructive, feedback messenger for innervating neurons and may play a role in stabilizing and maintaining functional neuromuscular connections.