Final outcomes analysis of the cell product SQZ-PBMC-HPV Phase 1 trial in incurable HPV16+ solid tumors shows improved overall survival in patients with increased CD8+ T cell tumor infiltration.

Cancer vaccines strive to induce robust, antigen-targeted, T-cell-mediated immune responses but have struggled to produce meaningful regression in solid tumors. An autologous cell vaccine, SQZ-PBMC-HPV, was developed by SQZ Biotechnologies using microfluidic squeezing technology to load PBMCs with HPV16 E6 and E7 antigens in HLA-A*02+ patients. The SQZ-PBMC-HPV-101 Phase 1 trial (NCT04084951) enrolled patients with incurable HPV16+ cancers. Here, we present a post hoc analysis of the relationship between Posttreatment CD8+ T cell infiltration and patient outcomes. SQZ-PBMC-HPV was administered as monotherapy every 3 weeks. Tumor samples were collected pre-dose and post-dose 4 weeks after treatment start. Biomarkers including CD8, MHC-I, E6, E7, GZMB, and Ki67 were evaluated by immunohistochemistry, immunofluorescence, and RNA in situ hybridization, and were correlated with clinical response, survival, and drug product composition. Eighteen patients had paired pre- and post-dose biopsies. Six (33%) had an increase in CD8+ T cell density in tumor parenchyma between screening and C2D8. Patients with increased CD8+ T cell density had improved disease control rate (66.7% vs 16.7%) and median overall survival (606.5 days vs 170.0 days, p = 0.0078). Drug product was significantly enriched for higher T cells and lower monocytes in the increased CD8+ T cell density group. In patients with incurable HPV16+ solid tumors treated with SQZ-PBMC-HPV, an increase in CD8+ T cell density within the tumor parenchyma was associated with superior disease control rate and overall survival. The product composition for patients with increased CD8+ T cell density was enriched for T cells.

Strategies to improve the success of fixed-time artificial insemination in the ewe.

During the sheep breeding season, ovulatory follicles vary widely in age at pessary removal impacting both the timing of oestrus and pregnancy rates following artificial insemination (AI). Ovulatory follicles that emerge between days 7 to 9 of the pessary period are associated with higher fertility whilst those that emerge earlier or later are associated with lower fertility. In this study, two strategies to improve the success of AI by controlling the development of the ovulatory follicle were examined. In the first, ewes were treated with PGF2α at either -12 and/or +6 days (experiment 1) or -27 days (experiment 2) relative to pessary insertion to control the time of emergence of the ovulatory follicle. In the second, ewes were treated with eCG (400 IU per ewe) at either 0 h, -6 h or -12 h relative to pessary removal (experiment 3) to improve the development of young ovulatory follicles. PGF2α administered on day -27 increased the percentage of pregnant ewes by 17.8% and the number of foetuses per 100 ewes inseminated by 33.9%. PGF2α treatment at other times had either no effect or reduced fertility. During the breeding season, treatment with eCG at -12 h improved the synchrony of oestrus, reduced the size of the ovulatory follicle but did not improve pregnancy rate compared with other treatments. Treatment had no effect during the non-breeding season, supporting earlier findings that the quality of young ovulatory follicles differs during the year. In conclusion, PGF2α treatment 27 days before pessary insertion provides a new and cheap strategy to improve the success of fixed-time AI programs.

Association Between Chronologic Age and Geriatric Assessment-Identified Impairments: Findings From the CARE Registry.

BACKGROUND: The NCCN Guidelines for Older Adult Oncology recommend that, when possible, older adults with cancer undergo a geriatric assessment (GA) to provide a comprehensive health appraisal to guide interventions and appropriate treatment selection. However, the association of age with GA-identified impairments (GA impairments) remains understudied and the appropriate age cutoff for using the GA remains unknown. PATIENTS AND METHODS: We designed a cross-sectional study using the Cancer and Aging Resilience Evaluation (CARE) registry of older adults with cancer. We included adults aged ≥60 years diagnosed with gastrointestinal malignancy who underwent a patient-reported GA prior to their initial consultation at the gastrointestinal oncology clinic. We noted the presence of GA impairments and frailty using Rockwood's deficit accumulation approach. We studied the relation between chronologic age and GA impairments/frailty using Spearman rank correlation and chi-square tests of trend. RESULTS: We identified 455 eligible older adults aged ≥60 years with gastrointestinal malignancies; the median age was 68 years (range, 64-74 years) and colorectal (33%) and pancreatic (24%) cancers were the most common cancer type. The correlation between chronologic age and number of geriatric impairments was weak and did not reach statistical significance (Spearman ρ, 0.07; P=.16). Furthermore, the prevalence of domain-specific impairments or frailty was comparable across the 3 age groups (60-64 years, 65-74 years, ≥75 years) with the exception of comorbidity burden. Notably, 61% of patients aged 60 to 64 years had ≥2 GA impairments and 35% had evidence of frailty, which was comparable to patients aged 65 to 74 years (66% and 36%, respectively) and ≥75 years (70% and 40%, respectively). CONCLUSIONS: Using chronologic age alone to identify which patients may benefit from GA is problematic. Future studies should identify screening tools that may identify patients at high risk of frailty and GA impairments.

Controlling lactation oestrus: The final frontier for breeding herd management.

Lactation anoestrus limits the flexibility of modern pig production systems such that any increase in lactation length reduces farrowing frequency, and thus profit. This review focuses on post-partum development of the sow's reproductive system, the physiology of lactation anoestrus and how it can be overcome, as well as the fertility of sows mated while lactating. The propensity for sows to ovulate spontaneously while lactating is high (24-31%), and a high proportion of sows will ovulate rapidly and synchronously in response to combinations of altered suckling (split weaning, interrupted suckling), daily boar contact, exogenous gonadotrophins, and group housing. The apparent ease with which lactation anoestrus can be overcome represents an opportunity to uncouple sow mating from weaning, thus reducing the impact of lactation length on productivity. This is especially true when considering the benefits of the described stimulation methods on the reproductive performance (i.e., shorter weaning to oestrus intervals and higher litter sizes) of the low proportion of sows that maintain lactation anoestrus.

Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial.

BACKGROUND: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. METHODS: In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. FINDINGS: Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. INTERPRETATION: We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. FUNDING: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

Effect of split weaning on follicle development and oocyte quality in multiparous sows.

Increasing piglet weaning age while maintaining the reproductive efficiency of the breeding herd depends on being able to stimulate sows to ovulate during lactation without reducing subsequent pregnancy rates and litter sizes. Embryo survival is affected by the quality of the oocytes shed at ovulation, and oocyte quality is profoundly impacted by the follicular environment in which the oocyte matures. This study determined the effect of reducing suckled litter size from 11 to 7 piglets on day 18 of lactation on the ovarian follicular environment and oocyte developmental competence at day 21 of lactation. Thirty-nine, Large White X Landrace sows (parity 3.2 ± 0.2; mean ± SEM; range 2-6) had their litter size either maintained at 11 piglets (control); or reduced to seven piglets on day 18 of lactation (split wean (SW)). Sows were slaughtered on day 21 of lactation and ovaries were collected for analysis of follicular fluid composition and in vitro blastocyst development rates. There was no effect of split weaning on fertilisation rate and development to blastocyst stage; however, a greater proportion of blastocysts from control sows were classified as early blastocyst stage. Furthermore, follicular fluid concentrations of oestradiol were higher in SW sows. Together, these results indicate split weaning prior to mating in lactation alters the ovarian follicular environment and while blastocyst development rates were unaffected, embryos from control sows may be of poorer quality as indicated by a delay in development.

Effects of negative dietary cation-anion difference and calcidiol supplementation in transition diets fed to sows on piglet survival, piglet weight, and sow metabolism.

Diets that provide a negative dietary anion cation difference (DCAD) and supplement with a vitamin D metabolite 25-OH-D3 (calcidiol) may increase calcium availability at parturition, and enhance piglet survival and performance. This factorial study assessed the effects of DCAD, calcidiol (50 µg/kg), and parity (parity 1 or >1) and their interactions. Large White and Landrace sows (n = 328), parity 1 to 8 were randomly allocated in blocks to treatment diets from day 103 of gestation until day 3 postfarrow: 1) negative DCAD without calcidiol (negative DCAD + no CA), n = 84, 2) negative DCAD with calcidiol (negative DCAD + CA) n = 84, 3) positive DCAD without calcidiol (negative DCAD + no CA), n = 81, and 4) positive DCAD with calcidiol (positive DCAD + CA), n = 79. Negative DCAD diets were acidified with an anionic feed (2 kg/t) and magnesium sulfate (2 kg/t). All treatment diets contained cholecalciferol at 1,000 IU/kg. Dry sow diets contained 14.8% crude protein (CP), 5.4% crude fiber (CF), 0.8% Ca, and 83 mEq/kg DCAD. Treatment diets 1 and 2 contained 17.5% CP, 7.3% CF, 0.8% Ca, and -2 mEq/kg DCAD. Treatment diets 3 and 4 contained 17.4% CP, 7.4% CF, 0.8% Ca, and 68 mEq/kg DCAD. Before farrowing, all negative DCAD sows had lower urine pH than all sows fed a positive DCAD (5.66 ± 0.05 and 6.29 ± 0.05, respectively; P < 0.01); urinary pH was acidified for both DCAD treatments indicating metabolic acidification. The percentage of sows with stillborn piglets was not affected by DCAD, calcidiol, or parity alone but sows fed the negative DCAD + CA diet had a 28% reduction in odds of stillbirth compared to the negative DCAD + no CA diet and even lesser odds to the positive DCAD + CA diet. At day 1 after farrowing, blood gas, and mineral and metabolite concentrations were consistent with feeding a negative DCAD diet and that negative DCAD diets influence energy metabolism, as indicated by increased glucose, cholesterol, and osteocalcin concentrations and reduced nonesterified free fatty acids and 3-hydroxybutyrate concentrations. In the subsequent litter, total piglets born and born alive (14.7 ± 0.3 and 13.8 ± 0.3 piglets, respectively; P = 0.029) was greater for positive DCAD diets compared to negative DCAD diets; and there was an interaction between DCAD, calcidiol, and parity (P = 0.002). Feeding a negative DCAD diet influenced stillbirth, subsequent litter size, and metabolic responses at farrowing. More studies are needed to define optimal diets prefarrowing for sows.

The transition period between late gestation and lactation is critical to farrowing and successful lactation; sows with higher blood calcium have less risk of dystocia. We evaluated transition diets that provided a negative dietary cation­anion difference (DCAD) and supplemented with calcidiol (CA), both of which influence calcium metabolism. Purebred Landrace or Large White sows (n = 328) were enrolled in the experiment and selected sows that were either primiparous (n = 99) or multiparous (n = 229; average parity = 2.59 ± 1.51; parity range = 1 to 8) were fed a dry sow ration until day 103 of gestation and were then fed transition diets until day 3 postfarrowing in a factorial study. The diets were formulated to include 1) negative DCAD + no CA, 2) negative DCAD + CA, 3) positive DCAD + no CA, or 4) positive DCAD + CA. All diets induced a metabolic acidosis as indicated by urinary pH. Sows fed the negative DCAD with added calcidiol had a >28% reduction in odds of stillbirth over negative DCAD + no CA and positive DCAD + CA diets. Following weaning and re-mating, there were 0.9 more piglets born in the subsequent litter for both positive DCAD diets compared to negative DCAD diets. Blood gas, and mineral and metabolite concentrations provided evidence that negative DCAD diets positively influenced energy metabolism.

Split weaning improves pregnancy rate and embryo survival in sows mated in lactation.

Increasing piglet weaning age while maintaining the reproductive efficiency of the breeding herd depends on the ability to stimulate sows to ovulate during lactation without reducing subsequent pregnancy rates and litter sizes. The aim of this study was to determine if a reduction in piglet suckling load, either prior to or immediately after mating in lactation, altered ovarian follicle development and increased embryo survival to day 30 of gestation. Fifty-nine multiparous Large White x Landrace sows were allocated to one of three treatments; litter size maintained at 11 piglets (control); litter size reduced to seven piglets on day 18 of lactation (split wean (SW)); or litter size reduced to seven piglets at expression of lactation oestrus (oestrus split wean (OES SW)). The percentage of sows that expressed lactation oestrus did not differ between treatments (79.7 %; P > 0.05) and split weaning had minimal effects on ovarian follicle development. Pregnancy rates were higher for SW and OES SW sows, compared to control sows. Embryo survival to day 30 of gestation was higher for SW sows (73.7 %) compared with control (56.4 %) and OES SW sows (49.5 %; P < 0.05). In summary, weaning a portion of the litter prior to mating in lactation improved pregnancy rates and embryo survival.

Effects of feeding a negative dietary cation and anion difference diet to twin-bearing Merino ewes in late gestation on parturition outcomes.

In Australia, dystocia is responsible for 53% of lamb mortalities, and calcium deficiencies may be a contributing factor. A negative dietary cation-anion difference (DCAD) diet can increase calcium concentrations in sheep. Therefore, this study aimed to investigate the effects of a negative DCAD diet on metabolic state, mineral status, and parturition duration in ewes compared with those fed a positive DCAD diet. At approximately day 130 of gestation (dG), 71 twin-bearing ewes were placed in the following treatment groups; ewes receiving a positive DCAD TMR (total mixed ration; DCAD of total diet = 281.8 mEq/kg DM; n = 35) and twin-bearing ewes receiving a negative DCAD TMR (DCAD of total diet = -89.0 mEq/kg DM; n = 36). Urine and blood were sampled on dG 130, 140, and 145, and blood was also sampled at the onset of parturition and 4 h postpartum. Urine was analyzed for pH and blood was analyzed for metabolites, mineral concentration, and acid-base balance. Lambs' liveweight, rectal temperature, blood glucose and lactate, and body morphology were measured. Serum phosphate concentrations at dG 145 were significantly lower for negative DCAD ewes compared with positive DCAD ewes (1.9 ±â€…0.1 vs. 2.1 ±â€…0.1 mmol/L, P = 0.047). Ionized calcium (P = 0.09) and serum magnesium (P = 0.09) prepartum were marginally greater in the negative DCAD ewes (1.35 ±â€…0.06 and 1.06 ±â€…0.03 mmol/L, respectively) compared with the positive DCAD ewes (1.18 ±â€…0.08 and 0.98 ±â€…0.04 mmol/L, respectively). Urine pH was lower in the negative DCAD ewes compared with positive DCAD ewes at both dG 140 (7.38 ±â€…0.17 vs. and 8.10 ±â€…0.19. P = 0.01) and dG 145 (and 7.20 ±â€…0.19 vs. 8.25. P < 0.01). The birth interval between the first the second-born lamb was shorter in the negative DCAD ewes compared with the positive DCAD ewes (P = 0.02), but no differences in lamb survival or lamb viability (P > 0.05) were seen. The negative DCAD diet reduced parturition duration, most likely due to the marginally greater ionized calcium and magnesium concentrations. Despite this improvement, the negative DCAD ewes did not reach urinary acidification, indicating that the marginally significant greater ionized calcium and serum magnesium concentrations were due to the magnesium in the diets and not metabolic acidosis. Further research testing a negative DCAD diet that can achieve the target urine pH is required to determine whether this diet can decrease parturition duration and improve lamb viability.

Calcium deficiencies during late gestation can cause difficult births in sheep and contribute to ewe and lamb deaths. We evaluated a diet that provided a negative dietary cation and anion difference (DCAD) which can influence calcium metabolism. Twin-bearing Merino ewes were fed either a positive DCAD diet (n = 35) or a negative DCAD diet (n = 36) at day 130 of gestation until 3 d postpartum. The ewes that were fed a negative DCAD diet had a shorter birth interval between the first and second-born lamb. The mineral concentrations provided evidence that the negative DCAD diets positively influence ionized calcium and magnesium concentrations prepartum. The negative DCAD diet did not induce a metabolic acidosis as indicated by urinary pH, which implies the positive outcomes on mineral status were not due to dietary acidification.

Negative dietary cation and anion difference supplementation of twin-bearing Merino ewes grazing pasture in late gestation did not affect lamb growth or survival.

Each year in Australia, 53% of lamb mortalities are attributed to dystocia, with subclinical maternal calcium deficiencies likely contributing to dystocia rates. A negative dietary cation and anion difference (DCAD) diet has increased circulating calcium in sheep. Therefore, this study aimed to investigate the effects of supplementing twin-bearing, grazing ewes with a negative DCAD partial mixed ration (PMR) during late gestation on ewe calcium and magnesium concentrations and subsequent lamb growth and survival. On day 120 of gestation (dG), blood samples were collected from 115 twin-bearing Merino ewes and analyzed for glucose, ketone bodies, pH, ionized calcium, and serum calcium and magnesium. On dG 130, ewes were moved into lambing paddocks and placed in the following 2 treatment groups; ewes receiving a positive DCAD PMR (DCAD = 287 mEq/kg DM; n = 58) and ewes receiving a negative DCAD PMR (DCAD = -125 mEq/kg DM; n = 57) fed as a PMR. On dG 140, a blood and urine sample were collected. The urine was tested for pH. Pasture samples were taken on dG 133 and 149 and tested for DCAD and mineral content. When a lamb was 6 to 18 h old, survival, vigor score, liveweight (LW), rectal temperature, blood glucose, and body morphology were recorded. At 10 d of age, lamb LW and survival were recorded and a milk sample was collected from ewes. At 44 d of age, lamb LW and survival were recorded. The DCAD of the pastures across the 6 paddocks ranged from 598 to 893 mEq/kg DM. There were no differences in lamb survival, weight, or viability at any timepoint (P > 0.05). There were no differences in mineral status, metabolic state, or acid-base balance between the positive and negative DCAD-supplemented ewes (P > 0.05) during supplementation (dG 140). Supplementing a negative DCAD diet to ewes grazing pasture during late gestation did not improve lamb survival. The blood and urine pH of the negative DCAD-supplemented ewes indicated a mild metabolic acidosis was not reached due to the high DCAD of the pastures. Further research needs to take careful consideration of the DCAD of pasture when designing a negative DCAD supplement in order for it to be effective.

In Australia, 53% of lamb deaths annually are caused by birthing difficulties, otherwise known as dystocia. Calcium and magnesium deficiencies in ewes during late gestation are suspected to be causing cases of dystocia. We evaluated a supplement that provided a negative dietary cation and anion difference (DCAD) which can influence calcium metabolism, and in turn, may reduce lamb death rates. Grazing twin-bearing Merino ewes were provided either a positive DCAD supplement (n = 58) or a negative DCAD supplement (n = 57) at day 130 of gestation until 2.3 ±â€…0.2 d postpartum. Negative DCAD supplementation did not improve ewe calcium and magnesium concentrations or lamb survival, weight, or viability. The DCAD of the pastures was too high for the negative DCAD supplement to induce a metabolic acidosis as indicated by the urinary pH, which may explain the lack of improvement in mineral status.

Effects of short and long - term nutrition and progesterone supplementation on the success of fixed - time artificial insemination in the ewe.

The success of fixed - time artificial insemination (AI) in the ewe is variable due to poor synchrony of estrus. We examined the effects of long-term nutrition (LTN; low, medium, high - 6 months), short-term nutrition (STN; 1.0 M, 1.5 M - 14 days) and progesterone supplementation (P; single pessary, replacement on Day 9) on synchrony and reproductive outcomes. High LTN advanced (P < 0.05) estrus, increased (P = 0.06) pregnancy (range 71.1 - 81.1%) and improved (P < 0.01) litter size (range 1.30 - 1.50). STN increased (P < 0.05) pregnancy (79.0 versus 72.3%) but not litter size or timing of estrus. A LTN x STN interaction (P < 0.01) for time of estrus indicates that the effects of LTN were moderated by STN depending on the level of LTN. Pessary replacement delayed (P < 0.05) the onset of estrus, improved synchrony but did not affect pregnancy or litter size. High LTN increased (P < 0.05) the number of large (≥ 3.8 mm) and medium - size follicles (2.0 - 3.7 mm) but the diameter of large follicles tended to be reduced (P = 0.08) on Day 12. STN did not affect follicle number or size whilst P reduced (P < 0.05) the diameter of large follicles on Day 12 (4.83 versus 5.10 mm) and increased the number of medium - size follicles (3.56 versus 2.74 mm). In conclusion, both LTN and STN are major sources of variability in AI programs whilst pessary replacement has potential to reduce variability.

Maternal Supplementation with Dietary Betaine during Late Gestation Increased Ewe Plasma Creatine and Lamb Thermoregulation under Field Conditions.

Twin lamb mortality is a significant economic problem impacting the Australian sheep industry. Maternal betaine supplementation improved lamb vigour and early post-natal survival when ewes and lambs were housed indoors, suggesting that betaine may be beneficial to feed under extensive pasture systems. This study investigated whether maternal betaine supplementation during late gestation would improve Merino twin lamb live weight, thermoregulation, vigour and survival to weaning under field conditions. Ewes received dietary betaine at either 0 g/day (CTL; n = 115) or 4 g/day from day 110 of gestation (dG 110) until ~49 days post-partum (pp) (BET; n = 115). Measures indicative of lamb viability and survival were collected within 4-24 h of birth and at ~49 days pp and ~93 days pp. BET ewes had higher creatine and creatinine concentrations at dG 130 than CTL ewes (p < 0.05). BET lambs had a higher rectal temperature within 4-24 h following birth than CTL lambs (p < 0.05). CTL lambs were heavier at ~49 days pp and grew faster from birth to ~49 days pp than BET lambs (both p < 0.05). The time taken after release from the researcher to first suckling was quicker in the CTL lambs than BET lambs (p < 0.05). This study demonstrated that supplementing betaine increased creatine concentration in twin-bearing ewes and thermoregulatory capacity in neonatal lambs under extensive grazing systems.

Heat stress from current and predicted increases in temperature impairs lambing rates and birth weights in the Australian sheep flock.

Livestock heat stress threatens production, particularly in semi-arid, arid and tropical regions. Using established temperature thresholds for sheep, we modelled +1 °C and +3 °C temperature increases over the historical baseline, estimating that 2.1 million potential lambs are lost annually due to heat stress alone, increasing to 2.5 and 3.3 million, respectively, as temperatures rise. Heat stress poses risks at key periods of the reproductive cycle, with consequences across the Australian sheep flock.

Ovarian follicle dynamics in ewes treated with intra-vaginal progesterone pessaries. 1. Follicle waves and parameters of the estrous cycle.

Progesterone treatment for synchrony of estrus is standard in sheep artificial insemination (AI) programs but can be associated with poor outcomes. Potential for improvement exists through a better understanding of the interactions between follicle development, luteal regression, emergence of the ovulatory follicle and timing of estrus. These interactions were examined by comparing progesterone-treated (Day 1 = day of pessary insertion) and naturally cycling ewes (Day 1 = day after estrus) at three times of the year (Autumn, Spring equinox and late Spring). Observations were made from Day 1 until the day of ovulation. Compared with the natural cycle, progesterone treatment (300 mg intra-vaginal pessary for 14 d) reduced the number of follicle waves (2.2 ± 0.18 versus 2.8 ± 0.12; P < 0.05) and increased the length of the ovulatory wave (8.6 ± 0.45 versus 6.6 ± 0.42 d; P < 0.05). The number of follicles per wave, the inter-wave interval and ovulation rate were not affected. However, progesterone treatment induced (P < 0.05) an earlier luteolysis (9.7 ± 0.51 versus 15.4 ± 0.49 d after Day 1), an earlier emergence of the ovulatory follicle (7.5 ± 0.48 versus 11.4 ± 0.46 d after Day 1) and an earlier onset of estrus (26.1 ± 2.95 versus 53.3 ± 2.84 h after Day 14). Time of year also influenced the response to progesterone treatment. In Autumn compared with the Spring equinox and late Spring, there was a reduction (P < 0.05) in follicle wave number (2.4 ± 0.21 versus 2.5 ± 0.29 versus 3.0 ± 0.20 respectively), follicles per wave (2.6 ± 0.27 versus 3.5 ± 0.25 versus 3.2 ± 0.20 respectively), ovulation rate (1.6 ± 0.12 versus 1.9 ± 0.12 versus 2.0 ± 0.10 respectively) and the inter-wave interval was longer (5.3 ± 0.40 versus 4.0 ± 0.32 versus 3.8 ± 0.27 d respectively; P < 0.05). Time of year also influenced (P < 0.05) the time of luteolysis (earliest in late Spring), emergence of the ovulatory follicle (earliest in Autumn) and onset of estrus (earliest in Autumn). It is concluded that (1) the effects of progesterone treatment on follicle waves are relatively minor, (2) the effects of treatment on timing of luteolysis, emergence of the ovulatory follicle and onset of estrus are all significant although the effects on AI outcomes remain to be determined and (3) time of year has a minimal effect on follicle waves but a more significant effect on other parameters of the estrous cycle. A better understanding of these complexities will assist in the development of improved protocols for synchrony of estrus.

A molecular guide to systemic therapy in salivary gland carcinoma.

Salivary gland carcinomas (SGC) are a rare and variable group of head and neck cancers with historically poor response to cytotoxic chemotherapy and immunotherapy in the recurrent, advanced, and metastatic settings. In the last decade, a number of targetable molecular alterations have been identified in SGCs including HER2 upregulation, androgen receptor overexpression, Notch receptor activation, NTRK gene fusions, and RET alterations which have dramatically improved treatment outcomes in this disease. Here, we review the landscape of precision therapy in SGC including current options for systemic management, ongoing clinical trials, and promising future directions.

Ovarian follicle dynamics in ewes treated with intra-vaginal progesterone pessaries. 2. Factors affecting timing of estrus and reproductive outcomes following artificial insemination.

This study extends observations on the effects of intra-vaginal progesterone treatment on the relationships between the time of luteolysis, emergence of the ovulatory follicle, timing of estrus and ewe fertility. Observations were made in progesterone - treated ewes in autumn, the spring equinox and late spring (Experiment 1, Data set 1) and in progesterone - treated ewes and naturally cycling ewes in autumn and the spring equinox (Experiment 1, Data set 2). In Data set 1, the day of emergence of both the first and second ovulatory follicle was positively related to the day luteal regression within each season. In turn, the day of emergence influenced the timing of estrus by means of a season by day of luteal regression interaction (P < 0.001) indicating that the relationship was positive in autumn and the spring equinox but negative in late spring. In autumn, older ovulatory follicles were associated with an earlier onset of estrus compared with younger ovulatory follicles. In late spring, this relationship was reversed and was influenced by whether or not ewes were cycling at the time of pessary insertion. In Data set 2, the relationship between the day of follicle emergence and luteal regression was influenced by a treatment by day of regression interaction indicating the relationship was positive in treated ewes and negative in naturally cycling ewes. Timing of estrus was positively related (P < 0.001) to both the day of luteal regression and the day of follicle emergence (P < 0.05), with both relationships being stronger in naturally cycling ewes than in treated ewes. In Experiment 2, pregnancy rate following artificial insemination in autumn was highest (90.2%) when luteolysis occurred during Days 7-9 of the pessary period compared with Days 1-6 (77.8%, P = 0.16), 10 to 12 (68.8%, P < 0.05) or Days ≥13 (71.2%, P < 0.05). Timing of estrus was not affected. The mean diameter of ovulatory follicles that emerged during Days 7-9 was larger on Day 12 (5.8 ± 0.13 mm) compared with other periods (range 4.7 ± 0.05 to 5.6 ± 0.14 mm). This study provides two potential strategies to improve the success of AI programs. Firstly, appropriately timed treatment with PGF2α to control the time of emergence of ovulatory follicles and, secondly, earlier treatment with eCG to improve the development of ovulatory follicles that emerge late in the pessary period. Each is likely to be influenced by season and the cyclical status of the ewe.

A continuing clinical education course to maintain clinical competencies and foster new clinical knowledge during the graduate school years of MD-PhD training.

Introduction: Most students in MD-PhD programs take a leave of absence from medical school to complete PhD training, which promotes a natural loss of clinical skills and knowledge and could negatively impact a student's long-term clinical knowledge. To address this concern, clinical refresher courses in the final year of PhD training have traditionally been used; however, effectiveness of such courses versus a longitudinal clinical course spanning all PhD training years is unclear. Methods: The University of Alabama at Birmingham MD-PhD Program implemented a comprehensive continuing clinical education (CCE) course spanning PhD training years that features three course components: (1) clinical skills; (2) clinical knowledge; and (3) specialty exposure activities. To evaluate course effectiveness, data from an anonymous student survey completed at the end of each semester were analyzed. Results: Five hundred and ninety-seven surveys were completed by MD-PhD students from fall 2014 to 2022. Survey responses indicated that the majority of students found the course helpful to: maintain clinical skills and knowledge (544/597, 91% and 559/597, 94%; respectively), gain exposure to clinical specialties (568/597, 95%), and prepare them for responsibilities during clinical clerkships. During semesters following lockdowns from the COVID-19 pandemic, there were significant drops in students' perceived preparedness. Conclusions: Positive student survey feedback and improved preparedness to return to clinic after development of the course suggests the CCE course is a useful approach to maintain clinical knowledge during research training.

The programmed death ligand 1 interactome demonstrates bidirectional signaling coordinating immune suppression and cancer progression in head and neck squamous cell carcinoma.

BACKGROUND: The programmed cell death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) are validated cancer targets; however, emerging mechanisms and impact of PD-L1 intracellular signaling on cancer behavior are poorly understood. METHODS: We investigated the cancer cell intrinsic role of PD-L1 in multiple patient-derived models in vitro and in vivo. PD-L1 overexpression, knockdown, and PD-L1 intracellular domain (PD-L1-ICD) deletion (Δ260-290PD-L1) models were assessed for key cancer properties: clonogenicity, motility, invasion, and immune evasion. To determine how PD-L1 transduces signals intracellularly, we used the BioID2 platform to identify the PD-L1 intracellular interactome. Both human papillomavirus-positive and negative patient-derived xenografts were implanted in NOD-scid-gamma and humanized mouse models to investigate the effects of recombinant PD-1, anti-PD-L1, and anti-signal transducer and activator of transcription 3 (STAT3) in vivo. RESULTS: PD-L1 intracellular signaling increased clonogenicity, motility, and invasiveness in multiple head and neck squamous cell carcinoma (HNSCC) models, and PD-1 binding enhanced these effects. Protein proximity labeling revealed the PD-L1 interactome, distinct for unbound and bound PD-1, which initiated cancer cell-intrinsic signaling. PD-L1 binding partners interleukin enhancer binding factors 2 and 3 (ILF2-ILF3) transduced their effect through STAT3. Δ260-290PD-L1 disrupted signaling and reversed pro-growth properties. In humanized HNSCC in vivo models bearing T-cells, PD-1 binding triggered PD-L1 signaling, and dual PD-L1 and STAT3 inhibition were required to achieve tumor control. CONCLUSIONS: Upon PD-1 binding, the PD-L1 extracellular and intracellular domains exert a synchronized effect to promote immune evasion by inhibiting T-cell function while simultaneously enhancing cancer cell-invasive properties.

Fostering a diverse regional community of physician-scientist trainees.

Among the many academic challenges faced by dual-degree MD-PhD students is access to professional support networks designed to overcome the unique academic and personal barriers to physician-scientist training. In the current study, we hypothesized that regional access to a student MD-PhD conference, termed the Southeastern Medical Scientist Symposium (SEMSS), would enhance medical and/or graduate training by fostering such relationships between physician-scientist trainees, doing so by discussing both the challenges of physician-scientist training and effective strategies to overcome them. In the current study, we used a mixed-methods approach to evaluate the overall usefulness of SEMSS over a ten-year period (2010-2020) to identify key areas of particular benefit to trainees. The authors used conference registration data to compile self-reported demographic and regional attendance, followed by a post-conference survey to gauge attendee satisfaction. Over the reporting period, SEMSS was attended by equivalent proportions of MD-PhD and undergraduate students, among which were a high-percentage of students from underrepresented minority (URM) groups relative to the national MD-PhD applicant pool; nearly one-third of URM students attendees later matriculated into MD-PhD programs, far exceeding the national MD-PhD matriculation rate. Among the benefits reported by students were "opportunities to network with peers" and opportunities to learn about the physician-scientist career track. Therefore, we therefore propose regional MD-PhD conferences as an effective model to promote diversity within the physician-scientist training pipeline.

Supplementary Tryptophan Fed to Sows Prior to and after Farrowing to Improve Piglet Growth and Survival.

Tryptophan indirectly increases plasma calcium levels, which may improve sow health, and melatonin production, which may improve piglet survival when supplemented during late gestation and lactation. It was hypothesised that tryptophan would increase piglet survival and increase sow circulating melatonin and calcium. Seventy-two multiparous (Landrace x Large White) sows were allocated to either control (0.16% tryptophan; n = 24), low tryptophan (0.42%; n = 24) or high tryptophan (0.56%; n = 24). Piglet viability measures consisted of weights, behaviour, meconium staining, rectal temperature, blood glucose and serum immunoglobulin G concentration. Blood samples collected from sows were analysed for melatonin (two daytime and three night-time samples; n = 17) and calcium (two samples pre- and post-farrowing; n = 14). Both tryptophan treatments increased piglet survival compared to the control group (p < 0.001). Tryptophan had no effect on piglet viability (p > 0.05) and no effect on sow plasma melatonin and calcium concentrations compared with the control group (p > 0.05) except at 21:00 when low tryptophan sows had higher melatonin concentration compared with high tryptophan (p = 0.011). Further research to understand the mediating effects of tryptophan (particularly 5-hydroxytryptophan) on piglet survival, including sow behaviour, is warranted.