Cerebral versus Ocular Visual Impairment: The Impact on Developmental Neuroplasticity

Cortical/cerebral visual impairment (CVI) is clinically defined as significant visual dysfunction caused by injury to visual pathways and structures occurring during early perinatal development. Depending on the location and extent of damage, children with CVI often present with a myriad of visual deficits including decreased visual acuity and impaired visual field function. Most striking, however, are impairments in visual processing and attention which have a significant impact on learning, development, and independence. Within the educational arena, current evidence suggests that strategies designed for individuals with ocular visual impairment are not effective in the case of CVI. We propose that this variance may be related to differences in compensatory neuroplasticity related to the type of visual impairment, as well as underlying alterations in brain structural connectivity. We discuss the etiology and nature of visual impairments related to CVI, and how advanced neuroimaging techniques (i.e., diffusion-based imaging) may help uncover differences between ocular and cerebral causes of visual dysfunction. Revealing these differences may help in developing future strategies for the education and rehabilitation of individuals living with visual impairment

Metallicity of solar-type stars with debris discs and planets

Around 16% of the solar-like stars in our neighbourhood show IR-excesses due to debris discs and a fraction of them are known to host planets. We aim to determine in a homogeneous way the metallicity of a sample of stars with known debris discs and planets. Our analysis includes the calculation of the fundamental stellar parameters by applying the iron ionisation equilibrium conditions to several isolated Fe I and Fe II lines. The metallicity distributions of the different stellar samples suggest that there is a transition toward higher metallicities from stars with neither debris discs nor planets to stars hosting giant planets. Stars with debris discs and stars with neither debris nor planets follow a similar metallicity distribution, although the distribution of the first ones might be shifted towards higher metallicities. Stars with debris discs and planets have the same metallicity behaviour as stars hosting planets, irrespective of whether the planets are low-mass or gas giants. In the case of debris discs and giant planets, the planets are usually cool, -semimajor axis larger than 0.1 AU. The data also suggest that stars with debris discs and cool giant planets tend to have a low dust luminosity, and are among the less luminous debris discs known. We also find evidence of an anticorrelation between the luminosity of the dust and the planet eccentricity. Our data show that the presence of planets, not the debris disc, correlates with the stellar metallicity. The results confirm that core-accretion models represent suitable scenarios for debris disc and planet formation. Dynamical instabilities produced by eccentric giant planets could explain the suggested dust luminosity trends observed for stars with debris discs and planets.Comment: Accepted for publication by A&A, 17 pages, 10 figure

Prognostic importance of DNA from human papillomavirus in patients with oral squamous cell carcinoma

Survival of patients with oral squamous cell carcinoma (OSCC) is generally low, with the likelihood of locoregional recurrence or disease progression (LR/DP). Knowledge of prognostic factors for survival is key to achieving an understanding and increased survival. The present study aimed to identify prognostic factors for patients with OSCC, especially the presence of DNA from human papillomavirus (HPV). Retrospective cohort study including 119 patients with OSCC treated at the National Cancer Institute in Mexico City (2009-2013). Clinical information was obtained from patient records including LR/DP. Formalin-fixed, paraffin-embedded tissues were obtained and used for detecting DNA from different types of HPV. Potential prognostic factors for Overall Survival (OS) were analyzed using the Cox proportional hazards model. After model adjustment, factors associated with longer OS were a pre-treatment platelet count above 400,000/mm3 (HR=0.09, p=0.026) and response to primary treatment (HR=0.26, p=0.001). HPV DNA was present in 23 (19.3%) of the patients and importantly, type 16 found in 19 of them. Although survival of HPV-positive patients was longer, difference was not significant. However, among patients with LR/DP, HPV positivity was significantly associated with increased survival (HR=0.23, p=0.034). Importantly, survival was significantly different for HPV-positive patients with LR/DP > 6 months (HR=0.20, p=0.002), had higher absolute lymphocyte count at start of treatment (HR=0.50, p=0.028) or had local rescue treatment (HR=0.24, p=0.019). Although HPV positivity was not associated with a longer OS of OSCC patients, a better prognosis was significantly associated with HPV positivity and recurring or progressing disease, particularly with HPV type 16

Point-Of-Care CAR T-Cell Production (ARI-0001) Using a Closed Semi-automatic Bioreactor: Experience From an Academic Phase I Clinical Trial

Development of semi-automated devices that can reduce the hands-on time and standardize the production of clinical-grade CAR T-cells, such as CliniMACS Prodigy from Miltenyi, is key to facilitate the development of CAR T-cell therapies, especially in academic institutions. However, the feasibility of manufacturing CAR T-cell products from heavily pre-treated patients with this system has not been demonstrated yet. Here we report and characterize the production of 28 CAR T-cell products in the context of a phase I clinical trial for CD19+ B-cell malignancies (NCT03144583). The system includes CD4-CD8 cell selection, lentiviral transduction and T-cell expansion using IL-7/IL-15. Twenty-seven out of 28 CAR T-cell products manufactured met the full list of specifications and were considered valid products. Ex vivo cell expansion lasted an average of 8.5 days and had a mean transduction rate of 30.6 ± 13.44%. All products obtained presented cytotoxic activity against CD19+ cells and were proficient in the secretion of pro-inflammatory cytokines. Expansion kinetics was slower in patient's cells compared to healthy donor's cells. However, product potency was comparable. CAR T-cell subset phenotype was highly variable among patients and largely determined by the initial product. TCM and TEM were the predominant T-cell phenotypes obtained. 38.7% of CAR T-cells obtained presented a TN or TCM phenotype, in average, which are the subsets capable of establishing a long-lasting T-cell memory in patients. An in-depth analysis to identify individual factors contributing to the optimal T-cell phenotype revealed that ex vivo cell expansion leads to reduced numbers of TN, TSCM, and TEFF cells, while TCM cells increase, both due to cell expansion and CAR-expression. Overall, our results show for the first time that clinical-grade production of CAR T-cells for heavily pre-treated patients using CliniMACS Prodigy system is feasible, and that the obtained products meet the current quality standards of the field. Reduced ex vivo expansion may yield CAR T-cell products with increased persistence in vivo

Development of a Novel Anti-CD19 Chimeric Antigen Receptor : A Paradigm for an Affordable CAR T Cell Production at Academic Institutions

Genetically modifying autologous T cells to express an anti-CD19 chimeric antigen receptor (CAR) has shown impressive response rates for the treatment of CD19+ B cell malignancies in several clinical trials (CTs). Making this treatment available to our patients prompted us to develop a novel CART19 based on our own anti-CD19 antibody (A3B1), followed by CD8 hinge and transmembrane region, 4-1BB- and CD3z-signaling domains. We show that A3B1 CAR T cells are highly cytotoxic and specific against CD19+ cells in vitro, inducing secretion of pro-inflammatory cytokines and CAR T cell proliferation. In vivo, A3B1 CAR T cells are able to fully control disease progression in an NOD.Cg-Prkdc Il2rd/SzJ (NSG) xenograph B-ALL mouse model. Based on the pre-clinical data, we conclude that our CART19 is clearly functional against CD19+ cells, to a level similar to other CAR19s currently being used in the clinic. Concurrently, we describe the implementation of our CAR T cell production system, using lentiviral vector and CliniMACS Prodigy, within a medium-sized academic institution. The results of the validation phase show our system is robust and reproducible, while maintaining a low cost that is affordable for academic institutions. Our model can serve as a paradigm for similar institutions, and it may help to make CAR T cell treatment available to all patients

Involvement of Noradrenergic Transmission in the PVN on CREB Activation, TORC1 Levels, and Pituitary-Adrenal Axis Activity during Morphine Withdrawal

Experimental and clinical findings have shown that administration of adrenoceptor antagonists alleviated different aspects of drug withdrawal and dependence. The present study tested the hypothesis that changes in CREB activation and phosphorylated TORC1 levels in the hypothalamic paraventricular nucleus (PVN) after naloxone-precipitated morphine withdrawal as well as the HPA axis activity arises from α1- and/or β-adrenoceptor activation. The effects of morphine dependence and withdrawal on CREB phosphorylation (pCREB), phosphorylated TORC1 (pTORC1), and HPA axis response were measured by Western-blot, immunohistochemistry and radioimmunoassay in rats pretreated with prazosin (α1-adrenoceptor antagonist) or propranolol (β-adrenoceptor antagonist). In addition, the effects of morphine withdrawal on MHPG (the main NA metabolite at the central nervous system) and NA content and turnover were evaluated by HPLC. We found an increase in MHPG and NA turnover in morphine-withdrawn rats, which were accompanied by increased pCREB immunoreactivity and plasma corticosterone concentrations. Levels of the inactive form of TORC1 (pTORC1) were decreased during withdrawal. Prazosin but not propranolol blocked the rise in pCREB level and the decrease in pTORC1 immunoreactivity. In addition, the HPA axis response to morphine withdrawal was attenuated in prazosin-pretreated rats. Present results suggest that, during acute morphine withdrawal, NA may control the HPA axis activity through CREB activation at the PVN level. We concluded that the combined increase in CREB phosphorylation and decrease in pTORC1 levels might represent, in part, two of the mechanisms of CREB activation at the PVN during morphine withdrawal

Frequency and characteristics of familial melanoma in Spain: The FAM-GEM-1 Study

Similar to that observed in other countries, familial melanoma accounts for 6.6% of melanoma diagnoses in Spain. Although no differences in the multivariate analysis were found, some better prognosis factors, such as Breslow index, seem more frequent in familial melanoma, which reflect a better early detection marker and/or a different biological behavior

Correlations between the stellar, planetary, and debris components of exoplanet systems observed by <i>Herschel</i>

Context. Stars form surrounded by gas- and dust-rich protoplanetary discs. Generally, these discs dissipate over a few (3–10) Myr, leaving a faint tenuous debris disc composed of second-generation dust produced by the attrition of larger bodies formed in the protoplanetary disc. Giant planets detected in radial velocity and transit surveys of main-sequence stars also form within the protoplanetary disc, whilst super-Earths now detectable may form once the gas has dissipated. Our own solar system, with its eight planets and two debris belts, is a prime example of an end state of this process. Aims. The Herschel DEBRIS, DUNES, and GT programmes observed 37 exoplanet host stars within 25 pc at 70, 100, and 160 μm with the sensitivity to detect far-infrared excess emission at flux density levels only an order of magnitude greater than that of the solar system’s Edgeworth-Kuiper belt. Here we present an analysis of that sample, using it to more accurately determine the (possible) level of dust emission from these exoplanet host stars and thereafter determine the links between the various components of these exoplanetary systems through statistical analysis. Methods. We have fitted the flux densities measured from recent Herschel observations with a simple two parameter (Td, LIR/L⋆) black-body model (or to the 3σ upper limits at 100 μm). From this uniform approach we calculated the fractional luminosity, radial extent and dust temperature. We then plotted the calculated dust luminosity or upper limits against the stellar properties, e.g. effective temperature, metallicity, and age, and identified correlations between these parameters. Results. A total of eleven debris discs are identified around the 37 stars in the sample. An incidence of ten cool debris discs around the Sun-like exoplanet host stars (29 ± 9%) is consistent with the detection rate found by DUNES (20.2 ± 2.0%). For the debris disc systems, the dust temperatures range from 20 to 80 K, and fractional luminosities (LIR/L⋆) between 2.4 ×10-6 and 4.1 ×10-4. In the case of non-detections, we calculated typical 3σ upper limits to the dust fractional luminosities of a few ×10-6. Conclusions. We recover the previously identified correlation between stellar metallicity and hot-Jupiter planets in our data set. We find a correlation between the increased presence of dust, lower planet masses, and lower stellar metallicities. This confirms the recently identified correlation between cold debris discs and low-mass planets in the context of planet formation by core accretion

A switch from canonical to noncanonical autophagy shapes B cell responses

Autophagy is important in a variety of cellular and pathophysiological situations; however, its role in immune responses remains elusive. Here, we show that among B cells, germinal center (GC) cells exhibited the highest rate of autophagy during viral infection. In contrast to mechanistic target of rapamycin complex 1–dependent canonical autophagy, GC B cell autophagy occurred predominantly through a noncanonical pathway. B cell stimulation was sufficient to down-regulate canonical autophagy transiently while triggering noncanonical autophagy. Genetic ablation of WD repeat domain, phosphoinositide–interacting protein 2 in B cells alone enhanced this noncanonical autophagy, resulting in changes of mitochondrial homeostasis and alterations in GC and antibody-secreting cells. Thus, B cell activation prompts a temporal switch from canonical to noncanonical autophagy that is important in controlling B cell differentiation and fate.We thank the flow cytometry and biological resource units at the Francis Crick Institute for their help. We are grateful to P. Stevenson (University of Queensland, Brisbane, Australia) for the MuHV-4 mice; H. W. Virgin (Washington University School of Medicine, St. Louis, MO, USA); K. Maloy (Sir William Dunn School of Pathology, University of Oxford, UK) for providing the Atg16L1-floxed mice; M. Reth (Max Planck Institute, Freiburg, Germany) for the Mb1-Cre mice; H. Zhang (Institute of Biophysics, Chinese Academy of Sciences, Beijing, China) for providing WIPI2-KO mice; and K. Okkenhaug (Babraham Institute, Cambridge, UK) for Vps34-IN1. We thank all members of the Lymphocyte Biology Laboratory for support and critical discussion. This work was supported by the Francis Crick Institute, which receives its core funding from Cancer Research UK (FC001035, FC001187, FC001136), the UK Medical Research Council (FC001035, FC001187, FC001136), and the Wellcome Trust (FC001035, FC001187, FC001136); The Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery of the National Institutes of Health (UM1AI100663); the Phillip T. and Susan M. Ragon Institute Foundation; a Marie Sklodowska-Curie individual postdoctoral fellowship (N.M.-M.); Abroad Doctoral Fellowships; Scholarships Chile granted by Comisión Nacional de Investigación Científica y Tecnológica (CONICYT) (P.M.); the Institute Pasteur–Fondazione Cenci Bolognetti (F.G.); a long-term European Molecular Biology Organization (EMBO) fellowship (N.M.-M. and S.A.); and a German Research Foundation grant (S.J.K.).Peer reviewe

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.</p> <p>Method/design</p> <p>This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion.</p> <p>The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling.</p> <p>The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN83365316">ISRCTN83365316</a></p