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1.
Mol Breed ; 44(9): 60, 2024 Sep.
Article de Anglais | MEDLINE | ID: mdl-39267903

RÉSUMÉ

To ensure the nutritional needs of an expanding global population, it is crucial to optimize the growing capabilities and breeding values of fruit and vegetable crops. While genomic selection, initially implemented in animal breeding, holds tremendous potential, its utilization in fruit and vegetable crops remains underexplored. In this systematic review, we reviewed 63 articles covering genomic selection and its applications across 25 different types of fruit and vegetable crops over the last decade. The traits examined were directly related to the edible parts of the crops and carried significant economic importance. Comparative analysis with WHO/FAO data identified potential economic drivers underlying the study focus of some crops and highlighted crops with potential for further genomic selection research and application. Factors affecting genomic selection accuracy in fruit and vegetable studies are discussed and suggestions made to assist in their implementation into plant breeding schemes. Genetic gain in fruits and vegetables can be improved by utilizing genomic selection to improve selection intensity, accuracy, and integration of genetic variation. However, the reduction of breeding cycle times may not be beneficial in crops with shorter life cycles such as leafy greens as compared to fruit trees. There is an urgent need to integrate genomic selection methods into ongoing breeding programs and assess the actual genomic estimated breeding values of progeny resulting from these breeding programs against the prediction models. Supplementary Information: The online version contains supplementary material available at 10.1007/s11032-024-01497-2.

3.
Dev Cogn Neurosci ; 69: 101425, 2024 Oct.
Article de Anglais | MEDLINE | ID: mdl-39163782

RÉSUMÉ

Brain differences linked to autism spectrum disorder (ASD) can manifest before observable symptoms. Studying these early neural precursors in larger and more diverse cohorts is crucial for advancing our understanding of developmental pathways and potentially facilitating earlier identification. EEG is an ideal tool for investigating early neural differences in ASD, given its scalability and high tolerability in infant populations. In this context, we integrated EEG into an existing multi-site MRI study of infants with a higher familial likelihood of developing ASD. This paper describes the comprehensive protocol established to collect longitudinal, high-density EEG data from infants across five sites as part of the Infant Brain Imaging Study (IBIS) Network and reports interim feasibility and data quality results. We evaluated feasibility by measuring the percentage of infants from whom we successfully collected each EEG paradigm. The quality of task-free data was assessed based on the duration of EEG recordings remaining after artifact removal. Preliminary analyses revealed low data loss, with average in-session loss rates at 4.16 % and quality control loss rates at 11.66 %. Overall, the task-free data retention rate, accounting for both in-session issues and quality control, was 84.16 %, with high consistency across sites. The insights gained from this preliminary analysis highlight key sources of data attrition and provide practical considerations to guide similar research endeavors.


Sujet(s)
Trouble du spectre autistique , Encéphale , Électroencéphalographie , Imagerie par résonance magnétique , Humains , Électroencéphalographie/méthodes , Nourrisson , Mâle , Femelle , Trouble du spectre autistique/physiopathologie , Imagerie par résonance magnétique/méthodes , Exactitude des données , Études longitudinales , Études de faisabilité , Artéfacts
4.
Pathology ; 2024 Aug 03.
Article de Anglais | MEDLINE | ID: mdl-39168779

RÉSUMÉ

Antinuclear antibody (ANA) detection by indirect immunofluorescence (IIF) is instrumental in the evaluation of systemic autoimmune diseases (SADs). The dense fine speckled (DFS) ANA staining predominantly associates with anti-DFS70, an autoantibody that is thought to exclude the presence of SAD. However, the DFS pattern may mask the presence of other ANA patterns that may be clinically relevant. Our laboratory uses the HEp2010 substrate which contains both HEp2 and liver substates. The aim of this study was to determine whether negative liver nucleus immunofluorescence could exclude the presence of antibodies to extractable nuclear antigens (ENA) in sera with DFS-like patterns. One hundred consecutive sera samples suspicious for DFS pattern, along with 15 sera of control patterns (positive metaphase bars) were included in the study. Each sample was examined separately on HEp2010 (Euroimmun) and liver by two independent readers. Anti-DFS70 was assessed by line and chemiluminescent immunoassays. DFS-like sera were more likely to be liver nucleus-negative compared with control sera. Of the liver-negative sera, 61/64 (95.3%) were deemed anti-ENA negative. Using the liver substrate in the evaluation of anti-ENA had a sensitivity of 90.0% and a negative predictive value of 95.4%. In our cohort, concurrent evaluation of sera with the liver substrate helped rule out the presence of other anti-ENA. This technique may be a safeguard for DFS-like ANA patterns that may mask underlying anti-ENA on IIF.

5.
Int J Rheum Dis ; 27(8): e15313, 2024 Aug.
Article de Anglais | MEDLINE | ID: mdl-39187995

RÉSUMÉ

Sjögren's disease is one of the most common systemic autoimmune diseases with hallmark features of sicca (dryness) symptoms of the eyes and mouth. There are a variety of ways to quantify xerostomia. α-Amylase is an enzyme secreted by the pancreas and salivary glands. While not specific to salivary glands, it may be measured as a surrogate marker of their output. Therefore, in this short investigation, we determined if there were any associations of serum α-amylase with subjective and objective markers of xerostomia. This investigation found a correlation between objective and subjective markers of xerostomia and α-amylase which suggests that measuring this analyte is a novel adjunct to qualifying xerostomia in the clinic.


Sujet(s)
Marqueurs biologiques , Syndrome de Gougerot-Sjögren , Xérostomie , Humains , Xérostomie/sang , Xérostomie/étiologie , Xérostomie/diagnostic , Syndrome de Gougerot-Sjögren/sang , Syndrome de Gougerot-Sjögren/diagnostic , Syndrome de Gougerot-Sjögren/complications , Marqueurs biologiques/sang , Femelle , Adulte d'âge moyen , Mâle , alpha-Amylases/sang , Valeur prédictive des tests , Adulte , Sujet âgé
6.
J Natl Cancer Inst ; 2024 Aug 10.
Article de Anglais | MEDLINE | ID: mdl-39128018

RÉSUMÉ

We evaluated differences in long-term outcomes of invasive lobular carcinoma (ILC) vs breast cancers of no special type (NST) treated with anthracycline-based adjuvant chemotherapy using 4 National Surgical Adjuvant Breast and Bowel Project (NSABP) randomized phase III trials (B-22, B-25, B-28, B-30). Our cohort included 11,251 patients with NST and 1,231 with ILC. Patients with ILC were older, had larger and more often estrogen receptor-positive tumors, and more positive lymph nodes. During early follow-up (0-5 years), patients with ILC had fewer recurrences (HR: 0.797; 95% confidence interval [CI] 0.685-0.929) and deaths (HR: 0.756; 95% CI 0.623-0.917). After 5 years patients with ILC had more recurrences (HR: 1.30; 95% CI 1.085-1.558) and deaths (HR: 1.044; 95% CI 0.898-1.214). Conditional probability analysis showed significant interactions between time-period and histologic type for recurrences (p < .001) and deaths (p < .001). Patients with ILC have elevated risk of late recurrence and death compared to patients with NST.

7.
Endocrinology ; 165(10)2024 Aug 27.
Article de Anglais | MEDLINE | ID: mdl-39207954

RÉSUMÉ

Breast cancer is a leading cause of female mortality and despite advancements in personalized therapeutics, metastatic disease largely remains incurable due to drug resistance. The estrogen receptor (ER, ESR1) is expressed in two-thirds of all breast cancer, and under endocrine stress, somatic ESR1 mutations arise in approximately 30% of cases that result in endocrine resistance. We and others reported ESR1 fusions as a mechanism of ER-mediated endocrine resistance. ER fusions, which retain the activation function 1- and DNA-binding domains, harbor ESR1 exons 1 to 6 fused to an in-frame gene partner resulting in loss of the ER ligand-binding domain (LBD). We demonstrate that in a no-special type (invasive ductal carcinoma [IDC]-NST) and an invasive lobular carcinoma (ILC) cell line, ER fusions exhibit robust hyperactivation of canonical ER signaling pathways independent of estradiol or antiendocrine therapies. We employ cell line models stably overexpressing ER fusions with concurrent endogenous ER knockdown to minimize endogenous ER influence. Cell lines exhibited shared transcriptomic enrichment in pathways known to be drivers of metastatic disease, notably MYC signaling. Cells expressing the 3' fusion partners SOX9 and YAP1 consistently demonstrated enhanced growth and cell survival. ILC cells expressing the DAB2 fusion led to enhanced growth, survival, and migration, phenotypes not appreciated in the IDC-NST DAB2 model. Herein, we report that cell line activity is subtype-, fusion-, and assay-specific, suggesting that LBD loss, the fusion partner, and the cellular landscape all influence fusion activities. Therefore, it will be critical to assess fusion frequency in the context of the clinicopathology.


Sujet(s)
Tumeurs du sein , Récepteur alpha des oestrogènes , Humains , Tumeurs du sein/génétique , Tumeurs du sein/anatomopathologie , Tumeurs du sein/métabolisme , Femelle , Récepteur alpha des oestrogènes/génétique , Récepteur alpha des oestrogènes/métabolisme , Lignée cellulaire tumorale , Phénotype , Protéines de signalisation YAP/génétique , Protéines de signalisation YAP/métabolisme , Facteur de transcription SOX-9/génétique , Facteur de transcription SOX-9/métabolisme , Carcinome canalaire du sein/génétique , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/métabolisme , Protéines de fusion oncogènes/génétique , Protéines de fusion oncogènes/métabolisme , Transduction du signal/génétique , Carcinome lobulaire/génétique , Carcinome lobulaire/métabolisme , Carcinome lobulaire/anatomopathologie , Facteurs de transcription/génétique , Facteurs de transcription/métabolisme , Régulation de l'expression des gènes tumoraux , Protéines adaptatrices de la transduction du signal/génétique , Protéines adaptatrices de la transduction du signal/métabolisme , Ligands , Prolifération cellulaire/génétique
8.
Nat Med ; 30(9): 2499-2507, 2024 Sep.
Article de Anglais | MEDLINE | ID: mdl-39147831

RÉSUMÉ

Cancer-associated venous thromboembolism (VTE) is a major source of oncologic cost, morbidity and mortality. Identifying high-risk patients for prophylactic anticoagulation is challenging and adds to clinician burden. Circulating tumor DNA (ctDNA) sequencing assays ('liquid biopsies') are widely implemented, but their utility for VTE prognostication is unknown. Here we analyzed three plasma sequencing cohorts: a pan-cancer discovery cohort of 4,141 patients with non-small cell lung cancer (NSCLC) or breast, pancreatic and other cancers; a prospective validation cohort consisting of 1,426 patients with the same cancer types; and an international generalizability cohort of 463 patients with advanced NSCLC. ctDNA detection was associated with VTE independent of clinical and radiographic features. A machine learning model trained on liquid biopsy data outperformed previous risk scores (discovery, validation and generalizability c-indices 0.74, 0.73 and 0.67, respectively, versus 0.57, 0.61 and 0.54 for the Khorana score). In real-world data, anticoagulation was associated with lower VTE rates if ctDNA was detected (n = 2,522, adjusted hazard ratio (HR) = 0.50, 95% confidence interval (CI): 0.30-0.81); ctDNA- patients (n = 1,619) did not benefit from anticoagulation (adjusted HR = 0.89, 95% CI: 0.40-2.0). These results provide preliminary evidence that liquid biopsies may improve VTE risk stratification in addition to clinical parameters. Interventional, randomized prospective studies are needed to confirm the clinical utility of liquid biopsies for guiding anticoagulation in patients with cancer.


Sujet(s)
ADN tumoral circulant , Tumeurs , Thromboembolisme veineux , Humains , Biopsie liquide , Thromboembolisme veineux/génétique , Thromboembolisme veineux/étiologie , Thromboembolisme veineux/sang , ADN tumoral circulant/sang , ADN tumoral circulant/génétique , Femelle , Mâle , Adulte d'âge moyen , Tumeurs/complications , Tumeurs/génétique , Tumeurs/sang , Tumeurs/anatomopathologie , Sujet âgé , Apprentissage machine , Études prospectives , Carcinome pulmonaire non à petites cellules/génétique , Carcinome pulmonaire non à petites cellules/sang , Carcinome pulmonaire non à petites cellules/complications , Carcinome pulmonaire non à petites cellules/anatomopathologie , Pronostic , Anticoagulants/usage thérapeutique , Adulte
9.
Mol Biol Cell ; 35(10): ar133, 2024 Oct 01.
Article de Anglais | MEDLINE | ID: mdl-39196658

RÉSUMÉ

Dysregulated actin cytoskeleton gives rise to aberrant cell motility and metastatic spread of tumor cells. This study evaluates the effect of overexpression of wild-type versus functional mutants of MRTF-A on migration and invasion of breast cancer (BC) cells. Our studies indicate that SRF's interaction is critical for MRTF-A-induced promotion of both two-dimensional and three-dimensional cell migration, while the SAP-domain function is important selectively for three-dimensional cell migration. Increased MRTF-A activity is associated with more effective membrane protrusion, a phenotype that is attributed predominantly to SRF's interaction with MRTF. We demonstrate formin-family protein mDia2 as an important mediator of MRTF-stimulated actin polymerization at the leading edge and cell migration. Multiplexed quantitative immunohistochemistry and transcriptome analyses of clinical BC specimens further demonstrate a positive correlation between nuclear localization of MRTF with malignant traits of cancer cells and enrichment of MRTF-SRF gene signature in pair-matched distant metastases versus primary tumors. In conclusion, this study establishes a novel mechanism of MRTF-dependent regulation of cell migration and provides evidence for the association between MRTF activity and increased malignancy in human BC, justifying future development of specific small molecule inhibitors of the MRTF-SRF transcriptional complex as potential therapeutic agents in BC.


Sujet(s)
Tumeurs du sein , Mouvement cellulaire , Formines , Transactivateurs , Humains , Tumeurs du sein/métabolisme , Tumeurs du sein/anatomopathologie , Tumeurs du sein/génétique , Formines/métabolisme , Femelle , Transactivateurs/métabolisme , Lignée cellulaire tumorale , Régulation de l'expression des gènes tumoraux , Cytosquelette d'actine/métabolisme , Actines/métabolisme , Facteur de réponse au sérum/métabolisme , Protéines adaptatrices de la transduction du signal/métabolisme , Protéines adaptatrices de la transduction du signal/génétique
10.
Res Sq ; 2024 Aug 13.
Article de Anglais | MEDLINE | ID: mdl-39184073

RÉSUMÉ

Understanding interplay of breast cancer and microenvironment is critical. Here, we identified two transcriptomic subtypes and five immune infiltration patterns from RNA-seq and multiplex immunohistochemistry from 21 ER+/HER2- invasive lobular breast cancers. The proliferative subtype associated with increased immune infiltration especially by immunosuppressive regulatory T-cells and macrophages. We also defined a TAM-Low signature, which associated with lower infiltration of proliferative, pro-inflammatory TAM, and improved outcome in patients with ER+ tumors.

11.
bioRxiv ; 2024 Jul 02.
Article de Anglais | MEDLINE | ID: mdl-39005294

RÉSUMÉ

Endocrine therapies targeting the estrogen receptor (ER/ESR1) are the cornerstone to treat ER-positive breast cancers patients, but resistance often limits their effectiveness. Understanding the molecular mechanisms is thus key to optimize the existing drugs and to develop new ER-modulators. Notable progress has been made although the fragmented way data is reported has reduced their potential impact. Here, we introduce EstroGene2.0, an expanded database of its precursor 1.0 version. EstroGene2.0 focusses on response and resistance to endocrine therapies in breast cancer models. Incorporating multi-omic profiling of 361 experiments from 212 studies across 28 cell lines, a user-friendly browser offers comprehensive data visualization and metadata mining capabilities (https://estrogeneii.web.app/). Taking advantage of the harmonized data collection, our follow-up meta-analysis revealed substantial diversity in response to different classes of ER-modulators including SERMs, SERDs, SERCA and LDD/PROTAC. Notably, endocrine resistant models exhibit a spectrum of transcriptomic alterations including a contra-directional shift in ER and interferon signaling, which is recapitulated clinically. Furthermore, dissecting multiple ESR1-mutant cell models revealed the different clinical relevance of genome-edited versus ectopic overexpression model engineering and identified high-confidence mutant-ER targets, such as NPY1R. These examples demonstrate how EstroGene2.0 helps investigate breast cancer's response to endocrine therapies and explore resistance mechanisms.

12.
J Low Temp Phys ; 216(1-2): 352-362, 2024.
Article de Anglais | MEDLINE | ID: mdl-39070768

RÉSUMÉ

Cosmic microwave background (CMB) experiments have deployed focal planes with O ( 10 4 ) transition edge sensor (TES) bolometers cooled to sub-Kelvin temperatures by multiplexing the readout of many TES channels onto a single pair of wires. Digital Frequency-domain Multiplexing (DfMux) is a multiplexing technique used in many CMB polarization experiments, such as the Simons Array, SPT-3 G, and EBEX. The DfMux system studied here uses LC filters with resonant frequencies ranging from 1.5 to 4.5 MHz connected to an array of TESs. Each detector has an amplitude-modulated carrier tone at the resonant frequency of its accompanying LC resonator. The signal is recovered via quadrature demodulation where the in-phase (I) component of the demodulated current is in phase with the complex admittance of the circuit and the quadrature (Q) component is orthogonal to I. Observed excess current noise in the Q component is consistent with fluctuations in the resonant frequency. This noise has been shown to be non-orthogonal to the phase of the detector's responsivity. We present a detailed analysis of the phase of responsivity of the TES and noise sources in our DfMux readout system. Further, we investigate how modifications to the TES operating resistance and bias frequency can affect the phase of noise relative to the phase of the detector responsivity, using data from Simons Array to evaluate our predictions. We find that both the phase of responsivity and phase of noise are functions of the two tuning parameters, which can be purposefully selected to maximize signal-to-noise (SNR) ratio.

13.
Proc Natl Acad Sci U S A ; 121(31): e2322068121, 2024 Jul 30.
Article de Anglais | MEDLINE | ID: mdl-39042692

RÉSUMÉ

Mixed invasive ductal and lobular carcinoma (MDLC) is a rare histologic subtype of breast cancer displaying both E-cadherin positive ductal and E-cadherin negative lobular morphologies within the same tumor, posing challenges with regard to anticipated clinical management. It remains unclear whether these distinct morphologies also have distinct biology and risk of recurrence. Our spatially resolved transcriptomic, genomic, and single-cell profiling revealed clinically significant differences between ductal and lobular tumor regions including distinct intrinsic subtype heterogeneity - e.g., MDLC with triple-negative breast cancer (TNBC) or basal ductal and estrogen receptor positive (ER+) luminal lobular regions, distinct enrichment of cell cycle arrest/senescence and oncogenic (ER and MYC) signatures, genetic and epigenetic CDH1 inactivation in lobular but not ductal regions, and single-cell ductal and lobular subpopulations with unique oncogenic signatures further highlighting intraregional heterogeneity. Altogether, we demonstrated that the intratumoral morphological/histological heterogeneity within MDLC is underpinned by intrinsic subtype and oncogenic heterogeneity which may result in prognostic uncertainty and therapeutic dilemma.


Sujet(s)
Tumeurs du sein , Carcinome canalaire du sein , Carcinome lobulaire , Mutation , Humains , Femelle , Carcinome lobulaire/génétique , Carcinome lobulaire/anatomopathologie , Carcinome lobulaire/métabolisme , Carcinome canalaire du sein/génétique , Carcinome canalaire du sein/anatomopathologie , Carcinome canalaire du sein/métabolisme , Tumeurs du sein/génétique , Tumeurs du sein/anatomopathologie , Tumeurs du sein/métabolisme , Tumeurs du sein/classification , Cadhérines/génétique , Cadhérines/métabolisme , Régulation de l'expression des gènes tumoraux , Marqueurs biologiques tumoraux/génétique , Marqueurs biologiques tumoraux/métabolisme , Tumeurs du sein triple-négatives/génétique , Tumeurs du sein triple-négatives/anatomopathologie , Tumeurs du sein triple-négatives/métabolisme , Transcriptome , Analyse de profil d'expression de gènes/méthodes
14.
Oncol Nurs Forum ; 51(4): 391-403, 2024 Jun 14.
Article de Anglais | MEDLINE | ID: mdl-38950095

RÉSUMÉ

OBJECTIVES: To phenotype the psychoneurologic (PN) symptom cluster in individuals with metastatic breast cancer and associate those phenotypes with individual characteristics and cancer genomic variables from circulating tumor DNA. SAMPLE & SETTING: This study included 201 individuals with metastatic breast cancer recruited in western Pennsylvania. METHODS & VARIABLES: A descriptive, cross-sectional design was used. Symptom data were collected via the MD Anderson Symptom Inventory, and cancer genomic data were collected via ultra-low-pass whole-genome sequencing of circulating tumor DNA from participant blood. RESULTS: Three distinct PN symptom phenotypes were described in a population with metastatic breast cancer: mild symptoms, moderate symptoms, and severe mood-related symptoms. Breast cancer TP53 deletion was significantly associated with membership in a moderate to severe symptoms phenotype (p = 0.013). IMPLICATIONS FOR NURSING: Specific cancer genomic changes associated with increased genomic instability may be predictive of PN symptoms. This finding may enable proactive treatment or reveal new therapeutic targets for symptom management.


Sujet(s)
Tumeurs du sein , Instabilité du génome , Humains , Femelle , Tumeurs du sein/psychologie , Tumeurs du sein/génétique , Tumeurs du sein/complications , Adulte d'âge moyen , Études transversales , Sujet âgé , Adulte , Pennsylvanie , Sujet âgé de 80 ans ou plus
15.
Multisens Res ; 37(4-5): 317-340, 2024 Jul 03.
Article de Anglais | MEDLINE | ID: mdl-39043382

RÉSUMÉ

The ability to leverage visual cues in speech perception - especially in noisy backgrounds - is well established from infancy to adulthood. Yet, the developmental trajectory of audiovisual benefits stays a topic of debate. The inconsistency in findings can be attributed to relatively small sample sizes or tasks that are not appropriate for given age groups. We designed an audiovisual speech perception task that was cognitively and linguistically age-appropriate from preschool to adolescence and recruited a large sample ( N = 161) of children (age 4-15). We found that even the youngest children show reliable speech perception benefits when provided with visual cues and that these benefits are consistent throughout development when auditory and visual signals match. Individual variability is explained by how the child experiences their speech-in-noise performance rather than the quality of the signal itself. This underscores the importance of visual speech for young children who are regularly in noisy environments like classrooms and playgrounds.


Sujet(s)
Perception de la parole , Perception visuelle , Humains , Enfant d'âge préscolaire , Perception de la parole/physiologie , Femelle , Mâle , Adolescent , Perception visuelle/physiologie , Enfant , Stimulation acoustique , Signaux , Bruit , Stimulation lumineuse , Développement de l'enfant/physiologie
16.
NPJ Breast Cancer ; 10(1): 61, 2024 Jul 20.
Article de Anglais | MEDLINE | ID: mdl-39033157

RÉSUMÉ

There is growing awareness of the unique etiology, biology, and clinical presentation of invasive lobular breast cancer (ILC), but additional research is needed to ensure translation of findings into management and treatment guidelines. We conducted a survey with input from breast cancer physicians, laboratory-based researchers, and patients to analyze the current understanding of ILC, and identify consensus research questions. 1774 participants from 66 countries respondents self-identified as clinicians (N = 413), researchers (N = 376), and breast cancer patients and advocates (N = 1120), with some belonging to more than one category. The majority of physicians reported being very/extremely (41%) to moderately (42%) confident in describing the differences between ILC and invasive breast cancer of no special type (NST). Knowledge of histology was seen as important (73%) and as affecting treatment decisions (51%), and most agreed that refining treatment guidelines would be valuable (76%). 85% of clinicians have never powered a clinical trial to allow subset analysis for histological subtypes, but the majority would consider it, and would participate in an ILC clinical trials consortium. The majority of laboratory researchers, reported being and very/extremely (48%) to moderately (29%) confident in describing differences between ILC and NST. They reported that ILCs are inadequately presented in large genomic data sets, and that ILC models are insufficient. The majority have adequate access to tissue or blood from patients with ILC. The majority of patients and advocates (52%) thought that their health care providers did not sufficiently explain the unique features of ILC. They identified improvement of ILC screening/early detection, and identification of better imaging tools as top research priorities. In contrast, both researchers and clinicians identified understanding of endocrine resistance and identifying novel drugs that can be tested in clinical trials as top research priority. In summary, we have gathered information from an international community of physicians, researchers, and patients/advocates that we expect will lay the foundation for a community-informed collaborative research agenda, with the goal of improving management and personalizing treatment for patients with ILC.

17.
JAMA Surg ; 2024 Jul 17.
Article de Anglais | MEDLINE | ID: mdl-39018053

RÉSUMÉ

Importance: Choosing Wisely recommendations advocate against routine use of axillary staging in older women with early-stage, clinically node-negative (cN0), hormone receptor-positive (HR+), and HER2-negative breast cancer. However, rates of sentinel lymph node biopsy (SLNB) in this population remain persistently high. Objective: To evaluate whether an electronic health record (EHR)-based nudge intervention targeting surgeons in their first outpatient visit with patients meeting Choosing Wisely criteria decreases rates of SLNB. Design, Setting, and Participants: This nonrandomized controlled trial was a hybrid type 1 effectiveness-implementation study with subsequent postintervention semistructured interviews and lasted from October 2021 to October 2023. Data came from EHRs at 8 outpatient clinics within an integrated health care system; participants included 7 breast surgical oncologists. Data were collected for female patients meeting Choosing Wisely criteria for omission of SLNB (aged ≥70 years with cT1 and cT2, cN0, HR+/HER2- breast cancer). The study included a 12-month preintervention control period; baseline surveys assessing perceived acceptability, appropriateness, and feasibility of the designed intervention; and a 12-month intervention period. Intervention: A column nudge was embedded into the surgeon's schedule in the EHR identifying patients meeting Choosing Wisely criteria for potential SLNB omission. Main Outcomes and Measures: The primary outcome was rate of SLNB following nudge deployment into the EHR. Results: Similar baseline demographic and tumor characteristics were observed before (control period, n = 194) and after (intervention period, n = 193) nudge deployment. Patients in both the control and intervention period had a median (IQR) age of 75 (72-79) years. Compared with the control period, unadjusted rates of SLNB decreased by 23.1 percentage points (46.9% SLNB rate prenudge to 23.8% after; 95% CI, -32.9 to -13.8) in the intervention period. An interrupted time series model showed a reduction in the rate of SLNB following nudge deployment (adjusted odds ratio, 0.26; 95% CI, 0.07 to 0.90; P = .03). The participating surgeons scored the intervention highly on acceptability, appropriateness, and feasibility. Dominant themes from semistructured interviews indicated that the intervention helped remind the surgeons of potential Choosing Wisely applicability without the need for additional clicks or actions on the day of the patient visit, which facilitated use. Conclusions and Relevance: This study showed that a nudge intervention in the EHR significantly decreased low-value axillary surgery in older women with early-stage, cN0, HR+/HER2- breast cancer. This user-friendly and easily implementable EHR-based intervention could be a beneficial approach for decreasing low-value care in other practice settings or patient populations. Trial Registration: ClinicalTrials.gov Identifier: NCT06006910.

18.
BMC Bioinformatics ; 25(1): 220, 2024 Jun 19.
Article de Anglais | MEDLINE | ID: mdl-38898383

RÉSUMÉ

Multi-omics sequencing is poised to revolutionize clinical care in the coming decade. However, there is a lack of effective and interpretable genome-wide modeling methods for the rational selection of patients for personalized interventions. To address this, we present iGenSig-Rx, an integral genomic signature-based approach, as a transparent tool for modeling therapeutic response using clinical trial datasets. This method adeptly addresses challenges related to cross-dataset modeling by capitalizing on high-dimensional redundant genomic features, analogous to reinforcing building pillars with redundant steel rods. Moreover, it integrates adaptive penalization of feature redundancy on a per-sample basis to prevent score flattening and mitigate overfitting. We then developed a purpose-built R package to implement this method for modeling clinical trial datasets. When applied to genomic datasets for HER2 targeted therapies, iGenSig-Rx model demonstrates consistent and reliable predictive power across four independent clinical trials. More importantly, the iGenSig-Rx model offers the level of transparency much needed for clinical application, allowing for clear explanations as to how the predictions are produced, how the features contribute to the prediction, and what are the key underlying pathways. We anticipate that iGenSig-Rx, as an interpretable class of multi-omics modeling methods, will find broad applications in big-data based precision oncology. The R package is available: https://github.com/wangxlab/iGenSig-Rx .


Sujet(s)
Génomique , Tumeurs , Humains , Génomique/méthodes , Tumeurs/génétique , Tumeurs/thérapie , Médecine de précision/méthodes , Récepteur ErbB-2/génétique , Récepteur ErbB-2/métabolisme , Logiciel , Multi-omique
20.
bioRxiv ; 2024 Jun 16.
Article de Anglais | MEDLINE | ID: mdl-38915645

RÉSUMÉ

Mixed invasive ductal and lobular carcinoma (MDLC) is a rare histologic subtype of breast cancer displaying both E-cadherin positive ductal and E-cadherin negative lobular morphologies within the same tumor, posing challenges with regard to anticipated clinical management. It remains unclear whether these distinct morphologies also have distinct biology and risk of recurrence. Our spatially-resolved transcriptomic, genomic, and single-cell profiling revealed clinically significant differences between ductal and lobular tumor regions including distinct intrinsic subtype heterogeneity (e.g., MDLC with TNBC/basal ductal and ER+/luminal lobular regions), distinct enrichment of senescence/dormancy and oncogenic (ER and MYC) signatures, genetic and epigenetic CDH1 inactivation in lobular, but not ductal regions, and single-cell ductal and lobular sub-populations with unique oncogenic signatures further highlighting intra-regional heterogeneity. Altogether, we demonstrated that the intra-tumoral morphological/histological heterogeneity within MDLC is underpinned by intrinsic subtype and oncogenic heterogeneity which may result in prognostic uncertainty and therapeutic dilemma. Significance: MDLC displays both ductal and lobular tumor regions. Our multi-omic profiling approach revealed that these morphologically distinct tumor regions harbor distinct intrinsic subtypes and oncogenic features that may cause prognostic uncertainty and therapeutic dilemma. Thus histopathological/molecular profiling of individual tumor regions may guide clinical decision making and benefit patients with MDLC, particularly in the advanced setting where there is increased reliance on next generation sequencing.

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