Loss of synergistic transcriptional feedback loops drives diverse B-cell cancers

BACKGROUND: The most common B-cell cancers, chronic lymphocytic leukemia/lymphoma (CLL), follicular and diffuse large B-cell (FL, DLBCL) lymphomas, have distinct clinical courses, yet overlapping cell-of-origin . Dynamic changes to the epigenome are essential regulators of B-cell differentiation. Therefore, we reasoned that these distinct cancers may be driven by shared mechanisms of disruption in transcriptional circuitry. METHODS: We compared purified malignant B-cells from 52 patients with normal B-cell subsets (germinal center centrocytes and centroblasts, naïve and memory B-cells) from 36 donor tonsils using \u3e325 high-resolution molecular profiling assays for histone modifications, open chromatin (ChIP-, FAIRE-seq), transcriptome (RNA-seq), transcription factor (TF) binding, and genome copy number (microarrays). FINDINGS: From the resulting data, we identified gains in active chromatin in enhancers/super-enhancers that likely promote unchecked B-cell receptor signaling, including one we validated near the immunoglobulin superfamily receptors FCMR and PIGR. More striking and pervasive was the profound loss of key B-cell identity TFs, tumor suppressors and their super-enhancers, including EBF1, OCT2(POU2F2), and RUNX3. Using a novel approach to identify transcriptional feedback, we showed that these core transcriptional circuitries are self-regulating. Their selective gain and loss form a complex, iterative, and interactive process that likely curbs B-cell maturation and spurs proliferation. INTERPRETATION: Our study is the first to map the transcriptional circuitry of the most common blood cancers. We demonstrate that a critical subset of B-cell TFs and their cognate enhancers form self-regulatory transcriptional feedback loops whose disruption is a shared mechanism underlying these diverse subtypes of B-cell lymphoma. FUNDING: National Institute of Health, Siteman Cancer Center, Barnes-Jewish Hospital Foundation, Doris Duke Foundation

Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies

<p>Abstract</p> <p>Background</p> <p>Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital.</p> <p>Methods</p> <p>From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge.</p> <p>Results</p> <p>Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs.</p> <p>Conclusion</p> <p>The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.</p

Managing the Effects of Noise From Ship Traffic, Seismic Surveying and Construction on Marine Mammals in Antarctica

© 2019 Erbe, Dähne, Gordon, Herata, Houser, Koschinski, Leaper, McCauley, Miller, Müller, Murray, Oswald, Scholik-Schlomer, Schuster, Van Opzeeland and Janik. The Protocol on Environmental Protection of the Antarctic Treaty stipulates that the protection of the Antarctic environment and associated ecosystems be fundamentally considered in the planning and conducting of all activities in the Antarctic Treaty area. One of the key pollutants created by human activities in the Antarctic is noise, which is primarily caused by ship traffic (from tourism, fisheries, and research), but also by geophysical research (e.g., seismic surveys) and by research station support activities (including construction). Arguably, amongst the species most vulnerable to noise are marine mammals since they specialize in using sound for communication, navigation and foraging, and therefore have evolved the highest auditory sensitivity among marine organisms. Reported effects of noise on marine mammals in lower-latitude oceans include stress, behavioral changes such as avoidance, auditory masking, hearing threshold shifts, and—in extreme cases—death. Eight mysticete species, 10 odontocete species, and six pinniped species occur south of 60°S (i.e., in the Southern or Antarctic Ocean). For many of these, the Southern Ocean is a key area for foraging and reproduction. Yet, little is known about how these species are affected by noise. We review the current prevalence of anthropogenic noise and the distribution of marine mammals in the Southern Ocean, and the current research gaps that prevent us from accurately assessing noise impacts on Antarctic marine mammals. A questionnaire given to 29 international experts on marine mammals revealed a variety of research needs. Those that received the highest rankings were (1) improved data on abundance and distribution of Antarctic marine mammals, (2) hearing data for Antarctic marine mammals, in particular a mysticete audiogram, and (3) an assessment of the effectiveness of various noise mitigation options. The management need with the highest score was a refinement of noise exposure criteria. Environmental evaluations are a requirement before conducting activities in the Antarctic. Because of a lack of scientific data on impacts, requirements and noise thresholds often vary between countries that conduct these evaluations, leading to different standards across countries. Addressing the identified research needs will help to implement informed and reasonable thresholds for noise production in the Antarctic and help to protect the Antarctic environment

Seasonal Differences In Biochemical Adaptation To Fasting In Juvenile And Subadult Steller Sea Lions (Eumetopias Jubatus)

Nine Steller sea lions (Eumetopias jubatus) aged 1.75-6 yr were experimentally fasted for 7-14 d during the breeding and non- breeding seasons to identify changes in plasma metabolites that are indicative of fasting and to determine whether the ability of sea lions to fast varies seasonally or with age. Although some animals approached the limit of their protein-sparing ability by the end of our fasting experiments, there was no sign of irreversible starvation biochemistry. Plasma blood urea nitrogen (BUN) concentrations decreased in all animals within the first week of fasting, reflecting a shift to a fasting-adapted state; however, significant increases in plasma BUN concentration at the end of the nonbreeding season fasts suggest that subadult Steller sea lions were not able to maintain a protein-sparing metabolism for a full 14 d during the nonbreeding season. In contrast, juveniles were able to enter protein sparing sooner during the nonbreeding season when they had slightly higher initial percent total body lipid stores than during the breeding season. Subadult and juvenile sea lions had low circulating ketone body concentrations compared with young sea lion pups, suggesting an age-related difference in how body reserves are utilized during fasting or how the resulting metabolites are circulated and catabolized. Our data suggest that metabolite concentrations from a single blood sample cannot be used to © 2009 by The University of Chicago

Recovery rates of bottlenose dolphin (\u3ci\u3eTursiops truncatus\u3c/i\u3e) carcasses estimated from stranding and survival rate data

Recovery of cetacean carcasses provides data on levels of human-caused mortality, but represents only a minimum count of impacts. Counts of stranded carcasses are negatively biased by factors that include at-sea scavenging, sinking, drift away from land, stranding in locations where detection is unlikely, and natural removal from beaches due to wave and tidal action prior to detection. We estimate the fraction of carcasses recovered for a population of coastal bottlenose dolphins (Tursiops truncatus), using abundance and survival rate data to estimate annual deaths in the population. Observed stranding numbers are compared to expected deaths to estimate the fraction of carcasses recovered. For the California coastal population of bottlenose dolphins, we estimate the fraction of carcasses recovered to be 0.25 (95% CI = 0.20– 0.33). During a 12 yr period, 327 animals (95% CI = 253–413) were expected to have died and been available for recovery, but only 83 carcasses attributed to this population were documented. Given the coastal habits of California coastal bottlenose dolphins, it is likely that carcass recovery rates of this population greatly exceed recovery rates of more pelagic dolphin species in the region