Forged in the Fires of COVID-19: The Evolution of Systemic Therapy for Online Practice and Beyond

There has been a swift uptake in the use of teletherapy since the start of the COVID-19 pandemic, which has corresponded with an increase in clinical scholarship focused on conducting systemic therapy in an online format. A majority of this scholarship offers ideas for adapting therapeutic tasks developed around in-person contact for a remote format. The current article moves beyond adapting and offers ideas for remote systemic therapy that are born from our experiences of evolving through teletherapy. We begin by noting some of the significant differences between in-person therapy and teletherapy before describing how these differences can influence client presence and professionalism in session. Following this discussion, we offer ideas for how systemic therapists can enhance client presence, communicate the importance of the work, and inspire client initiative for change while working remotely

Clinical potential of oligonucleotide-based therapeutics in the respiratory system

The discovery of an ever-expanding plethora of coding and non-coding RNAs with nodal and causal roles in the regulation of lung physiology and disease is reinvigorating interest in the clinical utility of the oligonucleotide therapeutic class. This is strongly supported through recent advances in nucleic acids chemistry, synthetic oligonucleotide delivery and viral gene therapy that have succeeded in bringing to market at least three nucleic acid-based drugs. As a consequence, multiple new candidates such as RNA interference modulators, antisense, and splice switching compounds are now progressing through clinical evaluation. Here, manipulation of RNA for the treatment of lung disease is explored, with emphasis on robust pharmacological evidence aligned to the five pillars of drug development: exposure to the appropriate tissue, binding to the desired molecular target, evidence of the expected mode of action, activity in the relevant patient population and commercially viable value proposition

microRNA expression in the aging mouse lung

BACKGROUND: MicroRNAs (miRNAs) are a novel class of short double stranded RNA that mediate the post-transcriptional regulation of gene expression. Previous studies have implicated changes in miRNA expression in the regulation of development and the induction of diseases such as cancer. However, although miRNAs have been implicated in the process of aging in C. elegans, nothing is known of their role in mammalian tissues. RESULTS: To address this question, we have used a highly-sensitive, semi-quantitative RT-PCR based approach to measure the expression profile of 256 of the 493 currently identified miRNAs in the lungs from 6 month (adult) and 18 month (aged) old female BALB/c mice. We show that, despite the characteristic changes in anatomy and gene expression associated with lung aging, there were no significant changes in the expression of 256 miRNAs. CONCLUSION: Overall, these results show that miRNA transcription is unchanged during lung aging and suggests that stable expression of miRNAs might instead buffer age related changes in the expression of protein-encoding gene

The Flow Country: The peatlands of Caithness and Sutherland

This NCC publication is one of two which describes the nature conservation interest and importance of the Flow Country, in Caithness and Sutherland, northern Scotland. This area is now recognised as the largest expanse of blanket bog in Europe and the report provided the first global review of the extent of this peatland type. The Flow Country is of outstanding importance, both nationally and internationally. These peatlands are three times larger than any other in either Britain or Ireland. The scale and diversity of the habitat is unique, and the total size and range of bird species present, and other aspects of the fauna, is of international importance. At the time of publication, in the mid-1980s, this area was suffering from widespread afforestation. This 1988 review summarised NCC’s detailed surveys of peatland vegetation in the Flow Country, and is complementary to a 1987 publication Birds, bogs and forestry: the peatlands of Caithness and Sutherland which outlined the ornithological importance of this area, and documented and called for a halt to the destructive afforestation which was then occurring

Role of non-coding RNAs in maintaining primary airway smooth muscle cells

BACKGROUND: The airway smooth muscle (ASM) cell maintains its own proliferative rate and contributes to the inflammatory response in the airways, effects that are inhibited by corticosteroids, used in the treatment of airways diseases. OBJECTIVE: We determined the differential expression of mRNAs, microRNAs (miRNAs) and long noncoding RNA species (lncRNAs) in primary ASM cells following treatment with a corticosteroid, dexamethasone, and fetal calf serum (FCS). METHODS: mRNA, miRNA and lncRNA expression was measured by microarray and quantitative real-time PCR. RESULTS: A small number of miRNAs (including miR-150, −371-5p, −718, −940, −1181, −1207-5p, −1915, and −3663-3p) were decreased following exposure to dexamethasone and FCS. The mRNA targets of these miRNAs were increased in expression. The changes in mRNA expression were associated with regulation of ASM actin cytoskeleton. We also observed changes in expression of lncRNAs, including natural antisense, pseudogenes, intronic lncRNAs, and intergenic lncRNAs following dexamethasone and FCS. We confirmed the change in expression of three of these, LINC00882, LINC00883, PVT1, and its transcriptional activator, c-MYC. We propose that four of these lincRNAs (RP11-46A10.4, LINC00883, BCYRN1, and LINC00882) act as miRNA ‘sponges’ for 4 miRNAs (miR-150, −371-5p, −940, −1207-5p). CONCLUSION: This in-vitro model of primary ASM cell phenotype was associated with the regulation of several ncRNAs. Their identification allows for in-vitro functional experimentation to establish causality with the primary ASM phenotype, and in airway diseases such as asthma and chronic obstructive pulmonary disease (COPD)

Modern African nuclear detector laboratory: Development of state-of-the-art in-house detector facility at the University of the Western Cape

The upcoming detector facility aims at developing new state-of-the-art particle detectors as well as providing hands-on training to postgraduate students using both analog and digital signal processing from nuclear radiation detectors. The project is two-fold and aims at developing: 1) ancillary detectors to be coupled with the new GAMKA array at iThemba LABS. Of particular interest to our group is the determination of nuclear shapes, which depend on the hyperfine splitting of magnetic substates; 2) PET scanners for cancer imaging using a cheaper technology. Performance of NaI(Tl) inorganic scintillator detectors has been evaluated using PIXIE-16 modules from XIA digital electronics. Gamma-ray energy spectra were acquired from 60Co and 137Cs radioactive sources to calculate the detector resolution as well as to optimize the digital parameters. The present study focuses on improving and optimizing the slow and fast filter parameters for NaI(Tl) detectors which can eventually be used in the list mode of data aquisition

Parental functioning during maintenance treatment for childhood acute lymphoblastic leukemia: Effects of treatment intensity and dexamethasone pulses

Background: During maintenance treatment, Dutch pediatric patients with medium-risk (MR) acute lymphoblastic leukemia (ALL) receive intravenous chemotherapy and cyclic dexamethasone. Dexamethasone affects child's sleep and behavior. Standard-risk (SR) patients only receive oral chemotherapy, without dexamethasone. Effects of stratified therapy on parents are not well known. This study compares parental sleep, distress and quality of life (QoL) with the general population, between MR and SR groups, and on- and off-dexamethasone (MR group). Procedure: One year after diagnosis, parents of MR patients completed the Medical Outcomes Study (MOS) sleep, distress thermometer for parents and Short Form-12 (SF-12) twice; once on-dexamethasone and once off-dexamethasone. SR parents completed one measurement. Sleep problems, distress and QoL scores (off-dexamethasone) were compared to reference values and between MR and SR. Score differences on- and off-dexamethasone were assessed by multilevel regression analysis. Results: Parents (80% mothers) of 121 patients (57% males; 75% MR, 25% SR) completed 191 measurements. Compared to reference values, parents reported more sleep disturbances, higher distress, and lower mental QoL. Additionally, MR parents reported clinical distress (score ≥ 4), whereas SR parents (on average) did not (mean 4.8 ± 2.4 vs 3.5 ± 2.4, P =.02). Within the MR group, outcomes did not significantly differ on- and off-dexamethasone. Conclusions: Parents of ALL patients report sleep problems, high distress, and QoL impairment. Within the MR group, parental functioning did not differ on- and off-dexamethasone. However, MR parents reported clinical distress more often than SR parents, possibly reflecting differences in prognostic estimates and treatment burden. This perhaps includes the overall strain of cyclic dexamethasone. This study highlights the need for psychosocial support throughout treatment, regardless of risk stratification

Transcriptome analysis shows activation of circulating CD8 T cells in patients with severe asthma

Background: Although previous studies have implicated tissue CD4 T cells in the development and maintenance of the inflammatory response in asthmatic patients, little is known about the role of CD8 T cells. There is now accumulating evidence that microRNAs and other noncoding RNAs are important regulators of T-cell function. Objectives: We sought to use transcriptomics to determine the activation state of circulating CD4 and CD8 T cells in patients with nonsevere and severe asthma. Methods: mRNA and noncoding RNA expression in circulating T cells was measured by means of microarray, quantitative real-time PCR, or both. Results: Comparison of mRNA expression showed widespread changes in the circulating CD8 but not CD4 T cells from patients with severe asthma. No changes were observed in the CD4 and CD8 T cells in patients with nonsevere asthma versus those in healthy control subjects. Bioinformatics analysis showed that the changes in CD8 T-cell mRNA expression were associated with multiple pathways involved in T-cell activation. As with mRNAs, we also observed widespread changes in expression of noncoding RNA species, including natural antisense, pseudogenes, intronic long noncoding RNAs (lncRNAs), and intergenic lncRNAs in CD8 T cells from patients with severe asthma. Measurement of the microRNA expression profile showed selective downregulation of miR-28-5p in CD8 T cells and reduction of miR-146a and miR-146b in both CD4 and CD8 T cells. Conclusions: Severe asthma is associated with the activation of circulating CD8 T cells but not CD4 T cells. This response is correlated with the downregulation of miR-146a/b and miR-28-5p, as well as changes in the expression of multiple species of lncRNA that might regulate CD8 T-cell function. © 2011 American Academy of Allergy, Asthma & Immunology

SOX9 predicts progression towards cirrhosis in patients while its loss protects against liver fibrosis

Fibrosis and organ failure is a common endpoint for many chronic liver diseases. Much is known about the upstream inflammatory mechanisms provoking fibrosis and downstream potential for tissue remodeling. However, less is known about the transcriptional regulation in vivo governing fibrotic matrix deposition by liver myofibroblasts. This gap in understanding has hampered molecular predictions of disease severity and clinical progression and restricted targets for antifibrotic drug development. In this study we show the prevalence of SOX9 in biopsies from patients with chronic liver disease correlated with fibrosis severity and accurately predicted disease progression towards cirrhosis. Inactivation of Sox9 in mice protected against both parenchymal and biliary fibrosis, improved liver function and ameliorated chronic inflammation. SOX9 was downstream of mechanosignaling factor, YAP1. These data demonstrate a role for SOX9 in liver fibrosis and open the way for the transcription factor and its dependent pathways as new diagnostic, prognostic and therapeutic targets in patients with liver fibrosis