BCL-W has a fundamental role in B cell survival and lymphomagenesis.

Compromised apoptotic signaling is a prerequisite for tumorigenesis. The design of effective therapies for cancer treatment depends on a comprehensive understanding of the mechanisms that govern cell survival. The antiapoptotic proteins of the BCL-2 family are key regulators of cell survival and are frequently overexpressed in malignancies, leading to increased cancer cell survival. Unlike BCL-2 and BCL-XL, the closest antiapoptotic relative BCL-W is required for spermatogenesis, but was considered dispensable for all other cell types. Here, however, we have exposed a critical role for BCL-W in B cell survival and lymphomagenesis. Loss of Bcl-w conferred sensitivity to growth factor deprivation-induced B cell apoptosis. Moreover, Bcl-w loss profoundly delayed MYC-mediated B cell lymphoma development due to increased MYC-induced B cell apoptosis. We also determined that MYC regulates BCL-W expression through its transcriptional regulation of specific miR. BCL-W expression was highly selected for in patient samples of Burkitt lymphoma (BL), with 88.5% expressing BCL-W. BCL-W knockdown in BL cell lines induced apoptosis, and its overexpression conferred resistance to BCL-2 family-targeting BH3 mimetics. Additionally, BCL-W was overexpressed in diffuse large B cell lymphoma and correlated with decreased patient survival. Collectively, our results reveal that BCL-W profoundly contributes to B cell lymphoma, and its expression could serve as a biomarker for diagnosis and aid in the development of better targeted therapies

Effect of interleukin-6 receptor blockade on surrogates of vascular risk in rheumatoid arthritis: MEASURE, a randomised, placebo-controlled study

Objectives The interleukin-6 receptor (IL-6R) blocker tocilizumab (TCZ) reduces inflammatory disease activity in rheumatoid arthritis (RA) but elevates lipid concentrations in some patients. We aimed to characterise the impact of IL-6R inhibition on established and novel risk factors in active RA. Methods Randomised, multicentre, two-part, phase III trial (24-week double-blind, 80-week open-label), MEASURE, evaluated lipid and lipoprotein levels, high-density lipoprotein (HDL) particle composition, markers of coagulation, thrombosis and vascular function by pulse wave velocity (PWV) in 132 patients with RA who received TCZ or placebo. Results Median total-cholesterol, low-density lipoprotein-cholesterol (LDL-C) and triglyceride levels increased in TCZ versus placebo recipients by week 12 (12.6% vs 1.7%, 28.1% vs 2.2%, 10.6% vs −1.9%, respectively; all p&#60;0.01). There were no significant differences in mean small LDL, mean oxidised LDL or total HDL-C concentrations. However, HDL-associated serum amyloid A content decreased in TCZ recipients. TCZ also induced reductions (&#60;30%) in secretory phospholipase A2-IIA, lipoprotein(a), fibrinogen and D-dimers and elevation of paraoxonase (all p&#60;0.0001 vs placebo). The ApoB/ApoA1 ratio remained stable over time in both groups. PWV decreases were greater with placebo than TCZ at 12 weeks (adjusted mean difference 0.79 m/s (95% CI 0.22 to 1.35; p=0.0067)). Conclusions These data provide the first detailed evidence for the modulation of lipoprotein particles and other surrogates of vascular risk with IL-6R inhibition. When compared with placebo, TCZ induced elevations in LDL-C but altered HDL particles towards an anti-inflammatory composition and favourably modified most, but not all, measured vascular risk surrogates. The net effect of such changes for cardiovascular risk requires determination.</p

Gravitational anomalies signaling the breakdown of classical gravity

Recent observations for three types of astrophysical systems severely challenge the GR plus dark matter scenario, showing a phenomenology which is what modified gravity theories predict. Stellar kinematics in the outskirts of globular clusters show the appearance of MOND type dynamics on crossing the $a_{0}$ threshold. Analysis shows a ``Tully-Fisher'' relation in these systems, a scaling of dispersion velocities with the fourth root of their masses. Secondly, an anomaly has been found at the unexpected scales of wide binaries in the solar neighbourhood. Binary orbital velocities cease to fall along Keplerian expectations, and settle at a constant value, exactly on crossing the $a_{0}$ threshold. Finally, the inferred infall velocity of the bullet cluster is inconsistent with the standard cosmological scenario, where much smaller limit encounter velocities appear. This stems from the escape velocity limit present in standard gravity; the ``bullet'' should not hit the ``target'' at more than the escape velocity of the joint system, as it very clearly did. These results are consistent with extended gravity, but would require rather contrived explanations under GR, each. Thus, observations now put us in a situation where modifications to gravity at low acceleration scales cease to be a matter of choice, to now become inevitable.Comment: 10 pages, 5 figures, Astrophysics and Space Science Proceedings 38, 4

Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical training (PROTECT) study

Objectives Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing. Method A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established. Results 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p&#60;0.001), surgical (p = &#60;0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p&#60;0.001), a greater number of prescribed medicines (p&#60;0.001) and the months December and June (p&#60;0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen. Conclusions Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.</p

Mechanisms of Hemolysis-Associated Platelet Activation

Background Intravascular hemolysis occurs after blood transfusion, in hemolytic anemias, and in other conditions, and is associated with hypercoagulable states. Hemolysis has been shown to potently activate platelets in vitro and in vivo, and several mechanisms have been suggested to account for this, including: (i) direct activation by hemoglobin (Hb); (ii) increase in reactive oxygen species (ROS); (iii) scavenging of nitric oxide (NO) by released Hb; and (iv) release of intraerythrocytic ADP. Objective To elucidate the mechanism of hemolysis-mediated platelet activation. Methods We used flow cytometry to detect PAC-1 binding to activated platelets for in vitro experiments, and a Siemens\u27 Advia 120 hematology system to assess platelet aggregation by using platelet counts from in vivo experiments in a rodent model. Results We found that Hb did not directly activate platelets. However, ADP bound to Hb could cause platelet activation. Furthermore, platelet activation caused by shearing of red blood cells (RBCs) was reduced in the presence of apyrase, which metabolizes ADP to AMP. The use of ROS scavengers did not affect platelet activation. We also found that cell-free Hb enhanced platelet activation by abrogating the inhibitory effect of NO on platelet activation. In vivo infusions of ADP and purified (ADP-free) Hb, as well as hemolysate, resulted in platelet aggregation, as shown by decreased platelet counts. Conclusion Two primary mechanisms account for RBC hemolysis-associated platelet activation: ADP release, which activates platelets; and cell-free Hb release, which enhances platelet activation by lowering NO bioavailability

Police, public, and offender perceptions of body-worn video: a single jurisdictional multiple-perspective analysis

Objectives. Police, public, and offender survey responses from a single jurisdiction give a multiple-perspective insight into the use of body-worn video (BWV) cameras by police. Methods. Police attitudinal data was collected from before (n = 190), during (n = 139), and at the conclusion (n = 221) of a BWV implementation trial. Public attitudes were collected at the conclusion of the BWV implementation trial via online survey (n = 995 respondents) and intercept survey (n = 428 respondents). Offender attitudes (n = 302) were collected in police custody over a 6-month period immediately preceding the BWV trial. Results. The extent to which police felt BWV influenced their behavior tempered during the trial. All three perspectives were supportive of the use of BWV. The public who had encountered BWV-wearing officers and the offender sample indicated limited belief that BWV would reduce bad behavior. There was also clear contention about the policy and practice decisions around recording. Conclusions. These findings have significance for BWV trials, commenting on the importance of (a) collecting police attitudes at multiple points, (b) separating the attitudes of public who did encounter police wearing BWV, and (c) data collection and policy for evaluation outcomes

Getz Ice Shelf melt enhanced by freshwater discharge from beneath the West Antarctic Ice Sheet

Antarctica's Getz Ice Shelf has been rapidly thinning in recent years, producing more meltwater than any other ice shelf in the world. The influx of fresh water is known to substantially influence ocean circulation and biological productivity, but relatively little is known about the factors controlling basal melt rate or how basal melt is spatially distributed beneath the ice shelf. Also unknown is the relative importance of subglacial discharge from the grounded ice sheet in contributing to the export of fresh water from the ice shelf cavity. Here we compare the observed spatial distribution of basal melt rate to a new sub-ice-shelf bathymetry map inferred from airborne gravity surveys and to locations of subglacial discharge from the grounded ice sheet. We find that melt rates are high where bathymetric troughs provide a pathway for warm Circumpolar Deep Water to enter the ice shelf cavity and that melting is enhanced where subglacial discharge fresh water flows across the grounding line. This is the first study to address the relative importance of meltwater production of the Getz Ice Shelf from both ocean and subglacial sources.publishedVersio

Free 25-Hydroxyvitamin D: Impact of Vitamin D Binding Protein Assays on Racial-Genotypic Associations

Context: Total 25-hydroxyvitamin D (25OHD) is a marker of vitamin D status and is lower in African Americans than in whites. Whether this difference holds for free 25OHOD (f25OHD) is unclear, considering reported genetic-racial differences in vitamin D binding protein (DBP) used to calculate f25OHD.  Objectives: Our objective was to assess racial-geographic differences in f25OHD and to understand inconsistencies in racial associations with DBP and calculated f25OHD.  Design: This study used a cross-sectional design.  Setting: The general community in the United States, United Kingdom, and The Gambia were included in this study.  Participants: Men in Osteoporotic Fractures in Men and Medical Research Council studies (N = 1057) were included.  Exposures: Total 25OHD concentration, race, and DBP (GC) genotype exposures were included.  Outcome Measures: Directly measured f25OHD, DBP assessed by proteomics, monoclonal and polyclonal immunoassays, and calculated f25OHD were the outcome measures.  Results: Total 25OHD correlated strongly with directly measured f25OHD (Spearman r = 0.84). Measured by monoclonal assay, mean DBP in African-ancestry subjects was approximately 50% lower than in whites, whereas DBP measured by polyclonal DBP antibodies or proteomic methods was not lower in African-ancestry. Calculated f25OHD (using polyclonal DBP assays) correlated strongly with directly measured f25OHD (r = 0.80–0.83). Free 25OHD, measured or calculated from polyclonal DBP assays, reflected total 25OHD concentration irrespective of race and was lower in African Americans than in US whites.  Conclusions: Previously reported racial differences in DBP concentration are likely from monoclonal assay bias, as there was no racial difference in DBP concentration by other methods. This confirms the poor vitamin D status of many African-Americans and the utility of total 25OHD in assessing vitamin D in the general population