Prostate cancer - evidence of exercise and nutrition trial (PrEvENT):Study protocol for a randomised controlled feasibility trial

Background: A growing body of observational evidence suggests that nutritional and physical activity interventions are associated with beneficial outcomes for men with prostate cancer, including brisk walking, lycopene intake, increased fruit and vegetable intake and reduced dairy consumption. However, randomised controlled trial data are limited. The ‘Prostate Cancer: Evidence of Exercise and Nutrition Trial’ investigates the feasibility of recruiting and randomising men diagnosed with localised prostate cancer and eligible for radical prostatectomy to interventions that modify nutrition and physical activity. The primary outcomes are randomisation rates and adherence to the interventions at 6 months following randomisation. The secondary outcomes are intervention tolerability, trial retention, change in prostate specific antigen level, change in diet, change in general physical activity levels, insulin-like growth factor levels, and a range of related outcomes, including quality of life measures. Methods/design: The trial is factorial, randomising men to both a physical activity (brisk walking or control) and nutritional (lycopene supplementation or increased fruit and vegetables with reduced dairy consumption or control) intervention. The trial has two phases: men are enrolled into a cohort study prior to radical prostatectomy, and then consented after radical prostatectomy into a randomised controlled trial. Data are collected at four time points (cohort baseline, true trial baseline and 3 and 6 months post-randomisation). Discussion: The Prostate Cancer: Evidence of Exercise and Nutrition Trial aims to determine whether men with localised prostate cancer who are scheduled for radical prostatectomy can be recruited into a cohort and subsequently randomised to a 6-month nutrition and physical activity intervention trial. If successful, this feasibility trial will inform a larger trial to investigate whether this population will gain clinical benefit from long-term nutritional and physical activity interventions post-surgery. Prostate Cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) is registered on the ISRCTN registry, ref number ISRCTN99048944. Date of registration 17 November 2014.10 page(s

Sertoli cells modulate testicular vascular network development, structure and function to influence circulating testosterone concentrations in adult male mice

The testicular vasculature forms a complex network, providing oxygenation, micronutrients, and waste clearance from the testis. The vasculature is also instrumental to testis function because it is both the route by which gonadotropins are delivered to the testis and by which T is transported away to target organs. Whether Sertoli cells play a role in regulating the testicular vasculature in postnatal life has never been unequivocally demonstrated. In this study we used models of acute Sertoli cell ablation and acute germ cell ablation to address whether Sertoli cells actively influence vascular structure and function in the adult testis. Our findings suggest that Sertoli cells play a key role in supporting the structure of the testicular vasculature. Ablating Sertoli cells (and germ cells) or germ cells alone results in a similar reduction in testis size, yet only the specific loss of Sertoli cells leads to a reduction in total intratesticular vascular volume, the number of vascular branches, and the numbers of small microvessels; loss of germ cells alone has no effect on the testicular vasculature. These perturbations to the testicular vasculature leads to a reduction in fluid exchange between the vasculature and testicular interstitium, which reduces gonadotropin-stimulated circulating T concentrations, indicative of reduced Leydig cell stimulation and/or reduced secretion of T into the vasculature. These findings describe a new paradigm by which the transport of hormones and other factors into and out of the testis may be influenced by Sertoli cells and highlights these cells as potential targets for enhancing this endocrine relationship. The testicular vasculature forms a complex capillary bed, interdigitating between the seminiferous tubules to provide oxygenation, delivery of micronutrients, and clearance of waste from the testis. Impairment of the testicular vasculature, for example, the reduction in venous drainage observed in cases of varicocele, causes intratesticular hypoxia and germ cell apoptosis (1). The vasculature is also instrumental to the endocrine function of the testis because it is the route by which pituitary gonadotropins are delivered to the testis to support T production and spermatogenesis (2). Conversely, alongside the lymphatic system, the vascular system is important for transport of T to other body systems; a reduced testis and vascular volume is associated with a reduction in circulating T concentrations (3). Our understanding of the mechanisms by which the testis controls local vascular function in adulthood is extremely limited. There is some evidence that testicular mast cells can influence vascular blood flow through release of 5-hydroxytryptamine (4), but perhaps the most well-studied factor influencing testicular vascular function is T. T is a well-established regulator of testicular vasomotion (rhythmical contraction and relaxation of blood vessels, independent of heartbeat) (5, 6) via direct T-mediated activation of the androgen receptor in smooth muscle cells of the testicular vasculature (7). Speculation that Sertoli cells may influence the testicular vasculature is supported by some indirect evidence (5) and in vitro studies (8), but confirmation of a direct role for Sertoli cells in the regulation of the testicular vasculature in vivo has never been demonstrated unequivocally. Recently we developed a unique model system that uses diphtheria toxin to specifically and acutely ablate Sertoli cells from the testis (9, 10). This model has revealed several important, yet previously unknown, roles that Sertoli cells play in neonatal and adult life (reviewed in reference 11). In this study we used models of acute Sertoli cell ablation and acute germ cell ablation, to address whether Sertoli cells actively influence vascular function in the adult testis. Our findings suggest that Sertoli cells play a key role in supporting the structure of the testicular vasculature and describe a new paradigm by which the transport of hormones and other factors into and out of the testis can be influenced by Sertoli cells and highlights these cells as potential targets for enhancing this endocrine relationship

Transplant Physicians’ Attitudes on Candidacy for Allogeneic Hematopoietic Cell Transplantation (HCT) in Older Patients: The Need for a Standardized Geriatric Assessment (GA) Tool

Background Despite improvements in conditioning regimens and supportive care having expanded the curative potential of HCT, underutilization of HCT in older adults persists (Bhatt VR et al, BMT 2017). Therefore, we conducted a survey of transplant physicians (TP) to determine their perceptions of the impact of older age (≥60 years) on HCT candidacy and utilization of tools to gauge candidacy. Methods We conducted a 23-item, online cross-sectional survey of adult physicians recruited from the Center for International Blood and Marrow Transplant Research between May and July 2019. Results 175/770 (22.7%) TP completed the survey; majority of respondents were 41-60 years old, male, and practicing in a teaching hospital. Over 75% were at centers performing ≥50 HCT per year. When considering regimen intensity, most (96%, n=168) had an upper age limit (UAL) for using a myeloablative regimen (MAC), with only 29 physicians (17%) stating they would consider MAC for patients ≥70 years. In contrast, when considering a reduced intensity/non-myeloablative conditioning (RIC/NMA), 8%, (n=13), 54% (n=93), and 20% (n=35) stated that age 70, 75, and 80 years respectively would be the UAL to use this approach, with 18% (n=31) reporting no UAL. TP agreed that Karnofsky Performance Score (KPS) could exclude older pts for HCT, with 39.1% (n=66), 42.6% (n=72), and 11.4% (n=20) requiring KPS of ≥70, 80, and 90, respectively. The majority (n=92, 52.5%) indicated an HCT-comorbidity index threshold for exclusion, mostly ranging from ≥3 to ≥ 5. Almost all (89.7%) endorsed the need for a better health assessment of pre-HCT vulnerabilities to guide candidacy for pts ≥60 with varied assessments being utilized beyond KPS (Figure 1). However, the majority of centers rarely (33.1%) or never (45.7%) utilize a dedicated geriatrician/geriatric-oncologist to assess alloHCT candidates ≥60 yrs. The largest barriers to performing GA included uncertainty about which tools to use, lack of knowledge and training, and lack of appropriate clinical support staff (Figure 2). Approximately half (n=78, 45%) endorsed GA now routinely influences candidacy. Conclusions The vast majority of TP will consider RIC/NMA alloHCT for patients ≥70 years. However, there is heterogeneity in assessing candidacy. Incorporation of GA into a standardized and easily applied health assessment tool for risk stratification is an unmet need. The recently opened BMT CTN 1704 may aid in addressing this gap

Solid-state and solution phase reactivity of 10-hydroxy-10,9-boroxophenanthrene: a model building block for self-assembly processes

The relative stability of 10-hydroxy-10,9-boroxophenathrene and its electrophilic reactivity are traced through experiment and calculations to the partially aromatic character of the boron-containing heterocyclic ring. The electrophilic reactivity of 10-hydroxy-10,9-boroxophenathrene towards itself in the solid state and towards other nucleophiles in solution is described. The mechanism of the solid-state reaction has been characterised by both X-ray diffraction and thermal analysis. In solution, however, 10-hydroxy-10,9-boroxophenathrene does not react with itself, although it does react rapidly and reversibly with benzylic alcohols in solution, even at low temperatures. This selective and reversible reaction is ideal for use in self-assembly processes

Development of a semi-automated database for adult congenital heart disease patients

Background: Databases for Congenital Heart Disease (CHD) are effective in delivering accessible datasets ready for statistical inference. Data collection hitherto has however been labour and time intensive and has required substantial financial support to ensure sustainability. We propose here creation and piloting of a semiautomated technique for data extraction from clinic letters to populate a clinical database. Methods: PDF formatted clinic letters stored in a local folder, through a series of algorithms underwent data extraction, pre-processing and analysis. Specific patient information (diagnoses, diagnostic complexity, interventions, arrhythmia, medications, and demographic data) was processed into text files and structured data tables, used to populate a database. A specific data validation schema was pre-defined to verify and accommodate the information populating the database. Unsupervised learning in the form of a dimensionality reduction technique was used to project data into two dimensions and visualise their intrinsic structure in relation to the diagnosis, medication, intervention, and ESC classification lists of disease complexity. Nine-three randomly selected letters were manually reviewed for accuracy. Results: 1409 consecutive outpatient clinic letters were used to populate the Scottish Adult Congenital Cardiac Database. Mean patient age was 35.4yrs, 47.6% female with 698, 49.5% having moderately complex, 369, 26.1% greatly complex, and 284, 20.1%, mildly complexity lesions. Individual diagnoses were successfully extracted in 96.95%, and demographic data was extracted in 100% of letters. Data extraction, database upload, data analysis and visualisation took 571 seconds (9.51 minutes). Manual data extraction in the categories of diagnoses, intervention and medications yielded accuracy of the computer algorithm in 94%, 93%, and 93% respectively. Conclusions: Semi-automated data extraction from clinic letters into a database can be successfully achieved with a high degree of accuracy and efficiency