The use of portable electronic devices as an evaluation tool in the clinical setting

The Portable Electronic Device (PED) is emerging as an effective tool which can aid in evidence-based practice along with supporting the educational needs of both clinical and classroom training (Honeybourne, 2006; Applegate, 2010). Specific types of PED’s may include personal digital assistants, smart phones, iTouch, iPads, laptops and tablets (Figure 1). Research on the use of mobile devices has been conducted in fields such as medicine and nursing; however, there is little research in the field of radiation science. More research is needed to determine how these devices can be used as an instructional aid and competency assessment tool for radiation science students (Applegate, 2010)

HPV-related cancers: case studies and treatment

Human Papillomavirus (HPV) is associated with more than 150 viruses.1 HPV is an infection of the basal epithelium and transmission can occur either by direct contact or during childbirth. More than 50% of sexually active people will be infected with some form of HPV during their lifetime.2 Two categories of sexually transmitted HPV include low-risk HPVs, which are not cancer causing, and high-risk, or oncogenic HPVs, which can lead to a cancer diagnosis. Malignancies found to be associated with HPV infection include cervical, vaginal, vulvar, penile and anal cancers as well as cancers of the oropharynx. Treatment of HPV-related cancers often includes surgery, chemotherapy and radiation therapy. Health education and prevention is necessary to reduce cancers related to HPV infections. Education on abstinence and vaccinations are two methods proven to be effective. The role of the health care provider is to educate adolescents regarding the risk of sexually transmitted disease and ways to protect themselves from HPV-related cancers such as the cases reviewed in this exhibit

The use of simulation in the clinical education of radiation science students

Radiation science education students are considered to be adult learners. According to Fanning & Gaba, adults learn best through experiential learning.1 Experiential learning actively engages the student by providing them with the ability to participate and play a role in the acquisition of knowledge.1 Simulation in medical education is a practical approach which allows adults to learn experientially. The goal of simulation is not to substitute for actual clinical experience, but to replicate these clinical scenarios for the purpose of assessment of skill and feedback of the activity.2 Reform in education and medicine, along with the pressures associated with patient safety, have promoted the utilization of simulation in medical education. Team-based learning and inter-professional collaboration can also be fostered in a simulated setting.3 There are many approaches to simulated clinical education; three current methods will be addressed in this exhibit. These three methods include: Utilization of a clinical skills lab manikin Virtual simulation Use of Standardized Patients Cognitive, psychomotor and affective learning domains can all be evaluating by using any of these three types of simulation methods

Avoiding bowel toxicity in the treatment of the renal surgical bed

Renal cell carcinoma (RCC) is the most common cancer associated with the kidney. RCC accounts for approximately 3% of all adult malignancies with the incidence increasing by almost 2% per year.1,2 Radical nephrectomy is the standard of treatment for patients with localized disease; however approximately 30% of patients present with metastasis.2 The use of radiation therapy is most often limited to post-operative cases when residual tumor is identified or for symptomatic relief of metastatic disease. Definitive radiation treatment is not commonly indicated due to the low tolerance to radiation of surrounding abdominal structures such as the small bowel, ipsilateral kidney, and spinal cord. For patients diagnosed with left-sided RCC, the main dose limiting structure is the small bowel. The following case study will focus on avoiding bowel toxicity with the use of post-operative radiation therapy for the treatment of a Stage III left-sided renal cell carcinoma

Cardiac metastasis

Metastatic cardiac lesions are often clinically silent, and incidence may be determined more accurately upon autopsy.1 Cardiac metastases have been identified by autopsy in up to 20% of patients who succumbed to cancer. Malignant melanoma, leukemia, and lymphoma are the most common primary cancers to spread to the heart; however, these cases of metastasis have decreased with improved chemotherapy regimens.2 Few reports of cardiac metastasis due to colon cancer were found in the literature. This exhibit illustrates the case of a 65-year-old female patient with presumed metastatic disease to the heart from a primary colon malignancy

Using mlearning in the education of radiation science students

Radiation science is a highly visual field that is constantly evolving due to technological advances. Technology has significantly improved almost all aspects of the field over the past 10-15 years. These advances in technology have also played a significant role in the education of radiation science students didactically and clinically. The enormous increase in the capabilities of information technology provides the opportunity for educators to dramatically change their way of teaching.1 mLearning or mobile learning involves the use of mobile devices (i.e. personal digital assistants, smart phones, iPhones, iTouch, iPad, laptops and tablets) to enhance teaching and learning. The most significant advantage of mLearning is the mobility of the technology which allows for unlimited, immediate and continuous access to course materials. The goal of this initial research is to discuss the implementation of mobile learning, specifically through the use of the Apple iTouch, into the education of radiation science students

Genomic organization and evolution of double minutes/homogeneously staining regions with MYC amplification in human cancer

The mechanism for generating double minutes chromosomes (dmin) and homogeneously staining regions (hsr) in cancer is still poorly understood. Through an integrated approach combining next-generation sequencing, single nucleotide polymorphism array, fluorescent in situ hybridization and polymerase chain reaction-based techniques, we inferred the fine structure of MYC-containing dmin/hsr amplicons harboring sequences from several different chromosomes in seven tumor cell lines, and characterized an unprecedented number of hsr insertion sites. Local chromosome shattering involving a single-step catastrophic event (chromothripsis) was recently proposed to explain clustered chromosomal rearrangements and genomic amplifications in cancer. Our bioinformatics analyses based on the listed criteria to define chromothripsis led us to exclude it as the driving force underlying amplicon genesis in our samples. Instead, the finding of coexisting heterogeneous amplicons, differing in their complexity and chromosome content, in cell lines derived from the same tumor indicated the occurrence of a multi-step evolutionary process in the genesis of dmin/hsr. Our integrated approach allowed us to gather a complete view of the complex chromosome rearrangements occurring within MYC amplicons, suggesting that more than one model may be invoked to explain the origin of dmin/hsr in cancer. Finally, we identified PVT1 as a target of fusion events, confirming its role as breakpoint hotspot in MYC amplification

Reliable assessment of telomere maintenance mechanisms in neuroblastoma

BACKGROUND: Telomere maintenance mechanisms (TMM) are a hallmark of high-risk neuroblastoma, and are conferred by activation of telomerase or alternative lengthening of telomeres (ALT). However, detection of TMM is not yet part of the clinical routine, and consensus on TMM detection, especially on ALT assessment, remains to be achieved. METHODS: Whole genome sequencing (WGS) data of 68 primary neuroblastoma samples were analyzed. Telomere length was calculated from WGS data or by telomere restriction fragment analysis (n = 39). ALT was assessed by C-circle assay (CCA, n = 67) and detection of ALT-associated PML nuclear bodies (APB) by combined fluorescence in situ hybridization and immunofluorescence staining (n = 68). RNA sequencing was performed (n = 64) to determine expression of TERT and telomeric long non-coding RNA (TERRA). Telomerase activity was examined by telomerase repeat amplification protocol (TRAP, n = 15). RESULTS: Tumors were considered as telomerase-positive if they harbored a TERT rearrangement, MYCN amplification or high TERT expression (45.6%, 31/68), and ALT-positive if they were positive for APB and CCA (19.1%, 13/68). If all these markers were absent, tumors were considered TMM-negative (25.0%, 17/68). According to these criteria, the majority of samples were classified unambiguously (89.7%, 61/68). Assessment of additional ALT-associated parameters clarified the TMM status of the remaining seven cases with high likelihood: ALT-positive tumors had higher TERRA expression, longer telomeres, more telomere insertions, a characteristic pattern of telomere variant repeats, and were associated with ATRX mutations. CONCLUSIONS: We here propose a workflow to reliably detect TMM in neuroblastoma. We show that unambiguous classification is feasible following a stepwise approach that determines both, activation of telomerase and ALT. The workflow proposed in this study can be used in clinical routine and provides a framework to systematically and reliably determine telomere maintenance mechanisms for risk stratification and treatment allocation of neuroblastoma patients

JMJD6 is a tumorigenic factor and therapeutic target in neuroblastoma

Chromosome 17q21-ter is commonly gained in neuroblastoma, but it is unclear which gene in the region is important for tumorigenesis. The JMJD6 gene at 17q21-ter activates gene transcription. Here we show that JMJD6 forms protein complexes with N-Myc and BRD4, and is important for E2F2, N-Myc and c-Myc transcription. Knocking down JMJD6 reduces neuroblastoma cell proliferation and survival in vitro and tumor progression in mice, and high levels of JMJD6 expression in human neuroblastoma tissues independently predict poor patient prognosis. In addition, JMJD6 gene is associated with transcriptional super-enhancers. Combination therapy with the CDK7/super-enhancer inhibitor THZ1 and the histone deacetylase inhibitor panobinostat synergistically reduces JMJD6, E2F2, N-Myc, c-Myc expression, induces apoptosis in vitro and leads to neuroblastoma tumor regression in mice, which are significantly reversed by forced JMJD6 over-expression. Our findings therefore identify JMJD6 as a neuroblastoma tumorigenesis factor, and the combination therapy as a treatment strategy

Comparative study of unsupervised dimension reduction techniques for the visualization of microarray gene expression data

<p>Abstract</p> <p>Background</p> <p>Visualization of DNA microarray data in two or three dimensional spaces is an important exploratory analysis step in order to detect quality issues or to generate new hypotheses. Principal Component Analysis (PCA) is a widely used linear method to define the mapping between the high-dimensional data and its low-dimensional representation. During the last decade, many new nonlinear methods for dimension reduction have been proposed, but it is still unclear how well these methods capture the underlying structure of microarray gene expression data. In this study, we assessed the performance of the PCA approach and of six nonlinear dimension reduction methods, namely Kernel PCA, Locally Linear Embedding, Isomap, Diffusion Maps, Laplacian Eigenmaps and Maximum Variance Unfolding, in terms of visualization of microarray data.</p> <p>Results</p> <p>A systematic benchmark, consisting of Support Vector Machine classification, cluster validation and noise evaluations was applied to ten microarray and several simulated datasets. Significant differences between PCA and most of the nonlinear methods were observed in two and three dimensional target spaces. With an increasing number of dimensions and an increasing number of differentially expressed genes, all methods showed similar performance. PCA and Diffusion Maps responded less sensitive to noise than the other nonlinear methods.</p> <p>Conclusions</p> <p>Locally Linear Embedding and Isomap showed a superior performance on all datasets. In very low-dimensional representations and with few differentially expressed genes, these two methods preserve more of the underlying structure of the data than PCA, and thus are favorable alternatives for the visualization of microarray data.</p