The Clinical Cell-Cycle Risk (CCR) Score Is Associated With Metastasis After Radiation Therapy and Provides Guidance on When to Forgo Combined Androgen Deprivation Therapy With Dose-Escalated Radiation.

PURPOSE: The clinical cell-cycle risk (CCR) score, which combines the University of California, San Francisco's Cancer of the Prostate Risk Assessment (CAPRA) and the cell cycle progression (CCP) molecular score, has been validated to be prognostic of disease progression for men with prostate cancer. This study evaluated the ability of the CCR score to prognosticate the risk of metastasis in men receiving dose-escalated radiation therapy (RT) with or without androgen deprivation therapy (ADT). METHODS AND MATERIALS: This retrospective, multi-institutional cohort study included men with localized National Comprehensive Cancer Network (NCCN) intermediate-, high-, and very high-risk prostate cancer (N = 741). Patients were treated with dose-escalated RT with or without ADT. The primary outcome was time to metastasis. RESULTS: The CCR score prognosticated metastasis with a hazard ratio (HR) per unit score of 2.22 (95% confidence interval [CI], 1.71-2.89; P < .001). The CCR score better prognosticated metastasis than NCCN risk group (CCR, P < .001; NCCN, P = .46), CAPRA score (CCR, P = .002; CAPRA, P = .59), or CCP score (CCR, P < .001; CCP, P = .59) alone. In bivariable analyses, CCR score remained highly prognostic when accounting for ADT versus no ADT (HR, 2.18; 95% CI, 1.61-2.96; P < .001), ADT duration as a continuous variable (HR, 2.11; 95% CI, 1.59-2.79; P < .001), or ADT given at or below the recommended duration for each NCCN risk group (HR, 2.19; 95% CI, 1.69-2.86; P < .001). Men with CCR scores below or above the multimodality threshold (CCR score, 2.112) had a 10-year risk of metastasis of 3.7% and 21.24%, respectively. Men with below-threshold scores receiving RT alone had a 10-year risk of metastasis of 3.7%, and for men receiving RT plus ADT, the 10-year risk of metastasis was also 3.7%. CONCLUSIONS: The CCR score accurately and precisely prognosticates metastasis and adds clinically actionable information relative to guideline-recommended therapies based on NCCN risk in men undergoing dose-escalated RT with or without ADT. For men with scores below the multimodality threshold, adding ADT may not significantly reduce their 10-year risk of metastasis.

Dextrose Prolotherapy for Symptomatic Knee Osteoarthritis: Feasibility, Acceptability, and Patient-Oriented Outcomes in a Pilot-Level Quality Improvement Project.

OBJECTIVES: Knee osteoarthritis (KOA) is a growing health problem with limited nonsurgical treatment options. Prolotherapy is an injection-based technique for chronic KOA pain; health plan coverage is limited, presenting an access barrier. A local health plan recently included coverage for prolotherapy for KOA, but uptake and treatment response in routine care are unknown. The authors conducted a pilot-level quality improvement (QI) project to explore the feasibility, acceptability, and effects of prolotherapy for painful KOA in a primary care setting. DESIGN: QI prospective case series. SETTING/LOCATION: Outpatient: invitation letters were sent to symptomatic KOA patients with a primary care provider whose health plan covered prolotherapy. SUBJECTS: Primary care patients with KOA. INTERVENTION: Intra- and extra-articular prolotherapy injections: patients received up to six prolotherapy sessions. OUTCOME MEASURES: Primary: Feasibility: response rate to invitation to utilize prolotherapy. Acceptability: patient adherence to, and satisfaction with, three or more prolotherapy sessions. Secondary: Survey based (the Western Ontario McMaster University Osteoarthritis Index, WOMAC, 0-100; EuroQOL 5-D). Objectively assessed: function (30-sec chair stand, 4 × 10 m walk, 9-step stair-climb), overall activity (ActiGraph wGT3X accelerometer), treadmill gait analysis, and preferred walking speed. Outcome analysis (paired t-test) was per protocol, comparing follow-up and baseline outcome data at ∼8 months. RESULTS: Thirty-nine patients were invited, 11 responded, and 7 patients (59.6 ± 9.3 years, 6 female) received 5.0 ± 1.1 prolotherapy sessions. Satisfaction was high. Their WOMAC scores improved by 27.6 ± 19.5 points (p = 0.02) at 8.4 months. Functional testing improved by 8.0 ± 3.6 sec (p = 0.003) in the 4 × 10 m walk. There were no group differences between baseline and follow-up in chair stand, stair-climb, accelerometry, or gait outcomes. Five patients increased their preferred walking speed (p = 0.001). CONCLUSIONS: These data suggest that prolotherapy in this primary care clinic is feasible and acceptable. Self-reported improvement is similar to that of efficacy studies; office-based, objectively assessed functional assessment can be performed. Further evaluation is warranted.

Support for adults with autism spectrum disorder without intellectual impairment: Systematic review.

Adults with autism spectrum disorder without intellectual impairment may benefit from a range of support services. This article presents the results of a systematic review assessing the effectiveness of supportive interventions for adults with autism spectrum disorder without intellectual impairment. A total of 32 studies were included; most focused on younger male participants. Although evidence was lacking for most types of intervention, employment programmes and social skills training were found to be effective for more proximal outcomes such as social skills. Evidence that any intervention improves mental health or well-being was very limited. Most interventions focused on mitigating specific deficits, rather than on providing broader support. Further research is needed on the effectiveness of supportive interventions such as advocacy and mentoring.

Construction of reference chromosome-scale pseudomolecules for potato: integrating the potato genome with genetic and physical maps.

The genome of potato, a major global food crop, was recently sequenced. The work presented here details the integration of the potato reference genome (DM) with a new sequence-tagged site marker-based linkage map and other physical and genetic maps of potato and the closely related species tomato. Primary anchoring of the DM genome assembly was accomplished by the use of a diploid segregating population, which was genotyped with several types of molecular genetic markers to construct a new ~936 cM linkage map comprising 2469 marker loci. In silico anchoring approaches used genetic and physical maps from the diploid potato genotype RH89-039-16 (RH) and tomato. This combined approach has allowed 951 superscaffolds to be ordered into pseudomolecules corresponding to the 12 potato chromosomes. These pseudomolecules represent 674 Mb (~93%) of the 723 Mb genome assembly and 37,482 (~96%) of the 39,031 predicted genes. The superscaffold order and orientation within the pseudomolecules are closely collinear with independently constructed high density linkage maps. Comparisons between marker distribution and physical location reveal regions of greater and lesser recombination, as well as regions exhibiting significant segregation distortion. The work presented here has led to a greatly improved ordering of the potato reference genome superscaffolds into chromosomal "pseudomolecules".

Identification and characterization of miRNA transcriptome in potato by high-throughput sequencing.

Micro RNAs (miRNAs) represent a class of short, non-coding, endogenous RNAs which play important roles in post-transcriptional regulation of gene expression. While the diverse functions of miRNAs in model plants have been well studied, the impact of miRNAs in crop plant biology is poorly understood. Here we used high-throughput sequencing and bioinformatics analysis to analyze miRNAs in the tuber bearing crop potato (Solanum tuberosum). Small RNAs were analysed from leaf and stolon tissues. 28 conserved miRNA families were found and potato-specific miRNAs were identified and validated by RNA gel blot hybridization. The size, origin and predicted targets of conserved and potato specific miRNAs are described. The large number of miRNAs and complex population of small RNAs in potato suggest important roles for these non-coding RNAs in diverse physiological and metabolic pathways.

Vitamin D3 supplementation, low-risk prostate cancer, and health disparities.

Vitamin D promotes the differentiation of prostate cancer cells, raising the possibility that vitamin D deficiency over time may contribute to the progression from subclinical prostate cancer to clinical disease. Since low-risk prostate cancers are monitored over time in an effort to determine which progress into clinically important, more aggressive cancers, they provide an excellent model in which to study, over an extended period of time, the effects of enhancing vitamin D status and related changes in tumor progression. This is particularly relevant to African-American men, who exhibit a high prevalence of vitamin D deficiency as well as higher incidence of prostate cancer and higher mortality rates from prostate cancer than Caucasians. Our research team has recently completed an open-label clinical trial aimed at assessing the safety and potential efficacy of vitamin D3 supplementation at 4000 international units (IU) per day for one year in subjects diagnosed with early stage, low-risk prostate cancer. The results of this clinical study suggest that supplementation with vitamin D3 at 4000IU per day may benefit patients with early stage, low-risk prostate cancer on active surveillance, because of the improved outcome (a decreased number of positive cores at repeat biopsy) in more than half of the subjects enrolled in the trial. We also observed that, after one year of supplementation, there was no difference in circulating levels of vitamin D between African-American and Caucasian subjects who completed the study. These clinical results also suggest that robust and sustained vitamin D3 supplementation can reduce prostate cancer-related health disparities in African-American men and that these health disparities are at least in part the result of widespread hypovitaminosis D within the African-American population. This article is part of a Special Issue entitled 'Vitamin D Workshop'.

Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance.

CONTEXT: We wanted to investigate vitamin D in low-risk prostate cancer. OBJECTIVES: The objective of the study was to determine whether vitamin D(3) supplementation at 4000 IU/d for 1 yr is safe and would result in a decrease in serum levels of prostate-specific antigen (PSA) or in the rate of progression. DESIGN: In this open-label clinical trial (Investigational New Drug 77,839), subjects were followed up until repeat biopsy. SETTING: All subjects were enrolled through the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, both in Charleston, SC. PATIENTS AND OTHER PARTICIPANTS: All subjects had a diagnosis of low-risk prostate cancer. Fifty-two subjects were enrolled in the study, 48 completed 1 yr of supplementation, and 44 could be analyzed for both safety and efficacy objectives. INTERVENTION: The intervention included vitamin D(3) soft gels (4000 IU). MAIN OUTCOME MEASURES: Adverse events were monitored throughout the study. PSA serum levels were measured at entry and every 2 months for 1 yr. Biopsy procedures were performed before enrollment (for eligibility) and after 1 yr of supplementation. RESULTS: No adverse events associated with vitamin D(3) supplementation were observed. No significant changes in PSA levels were observed. However, 24 of 44 subjects (55%) showed a decrease in the number of positive cores or decrease in Gleason score; five subjects (11%) showed no change; 15 subjects (34%) showed an increase in the number of positive cores or Gleason score. CONCLUSION: Patients with low-risk prostate cancer under active surveillance may benefit from vitamin D(3) supplementation at 4000 IU/d.

Changes in gene expression during meristem activation processes in Solanum tuberosum with a focus on the regulation of an auxin response factor gene.

A suppression subtractive hybridization approach (SSH) was used to generate a cDNA library enriched in clones representing genes that are up-regulated in the potato tuber apical bud on dormancy release. The sequences of cDNAs representing 385 different genes were determined. This study focuses on the characterization of one of these cDNAs. On the basis of sequence similarity, the cDNA was identified as encoding a member of the auxin response factor family (ARF6). The expression pattern of potato ARF6 was determined by in situ hybridization. In apical tuber buds in the early stages of sprouting, relatively high levels of ARF6-specific transcripts were detected, especially in the peripheral zones of the tunica and corpus of the apical meristems. Expression was also detected in procambial and early vascular tissues, both subtending the meristem and in adjacent leaf primordia. By contrast, in dormant buds no expression of ARF6 could be detected. The expression pattern was also determined during the tuberization process; steady-state expression levels decreased c. 10-fold in the apical region as tuberization proceeded. In non-growing buds, exhibiting correlative inhibition, ARF6-specific transcript levels were relatively low, but rapidly increased when apical dominance was removed by excision of the apical bud. The effects of gibberellin and auxin on axillary bud growth and ARF6 expression are described.

Self-defense and martial arts evaluation for college women: preliminary validation of perceptions of dangerous situations scale.

Martial arts and self-defense programs train fearful people, especially women, to be more competent and confident to defend themselves in dangerous situations. However, there are no validated instruments to evaluate the effectiveness of programs purporting to teach self-protection. The Perceptions of Dangerous Situations Scale (PDSS), composed of fear, likelihood and confidence subscales, was developed and validated for university women. Participants were 368 university women, ages 17 to 45 years (M age = 20.7 years). Content validity of the PDSS was established through an expert panel, and construct validity was established through principal components analysis and determination of instructional sensitivity. Reliability was established through alpha coefficients. The PDSS, when used with university women, offers promising measurement opportunities in self-defense and martial arts settings.

Purpose-in-life and breast health behavior in Hispanic and Anglo women.

Hispanic and Anglo women differ in their practice of breast health behavior. A likely factor is differences in purpose-in-life (PIL) that influence motivation to achieve goals. To determine the relationship between PIL and breast health behavior, the PIL Test was modified and translated into Spanish, and the Breast Health Behavior Questionnaire (BHBQ) was generated. Both Spanish and English versions of the PIL Test and the BHBQ were measured in 40 Spanish and 40 Anglo women ages 20 to 49. Cronbach's alpha for the PIL Test were .86 for the English version and .72 for the Spanish; Cronbach's alpha for the BHBQ were .78 for the English and .70 for the Spanish version. There was a significant relationship between PIL and breast health behaviors in Anglo women but not in Hispanic women. Findings suggest further study of PIL in Hispanic women and may indicate a need for teaching the benefits of self-regulation to maintain health.