In situ analysis of neuronal dynamics and positional cues in the patterning of nerve connections

Recently developed imaging techniques permit individual cells to be uniquely labeled and followed over time as development proceeds in intact vertebrate embryos. Small groups of cells in the developing eye rudiment of the frog Xenopus have been labeled with the vital dyes DiI, lysinated fluorescein dextran (LFD) or lysinated rhodamine dextran (LRD). Individual optic axons and their growth cones were clearly visible in the intact living animal using confocal microscopy or epifluorescence microscopy with a low light level video camera and computer-based video image enhancement. To follow the dynamics of single optic nerve fiber terminal arborizations, small groups of cells, or even single retinal ganglion cells, were labeled with DiI, and the resulting labeled optic nerve fibers were imaged using a confocal microscope. The images show a profound alteration in morphology from day to day, demonstrating that optic nerve terminal arborizations are dynamic structures constantly extending and retracting branches. To follow the topography of the developing projection and analyze the cues that guide its formation, small groups of eyebud cells from LFD- and LRD-labeled donor embryos were grafted to an unlabeled host in either a location equivalent to that from which they had been removed (homotopic grafts) or a non-equivalent location (heterotopic grafts). Axons from homotopic grafts projected to the tectum as expected from the adult topography of the retinotectal projection. Dorsoventral topography was present from the time that the optic nerve fibers were observable in the tectum, in agreement with previous work. Nasotemporal topography was subtle or absent for the first few days, and then slowly refined. The importance of positional cues was tested by performing heterotopic eyebud grafts, in which the labeled eyebud cells are grafted to inappropriate places in the host eyebud. The heterotopic grafts appeared to integrate with the ectopic site in the eyebud in a functional manner. They should, therefore, project to the tectum together with their new neighbors if neighbor interactions or activity-based cues were of primary importance in the initial patterning of the map. However, the experiments showed that the axons from heterotopic grafts always behaved in a fashion appropriate to their position of origin in the donor, regardless of their final position in the host. These observations indicate that small groups of eyebud cells (as small as a single cell) possess positional information that plays a dominant role in guiding the optic nerve fibers to their target sites in the tectum

Variability in Surgical Treatment of Spondylolisthesis Among Spine Surgeons

Background There are a multitude of treatments for low-grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach. Objective To identify the surgical treatment patterns for spondylolisthesis among United States spine surgeons. Methods 445 spine surgeons in the United States completed a survey of clinical/radiographic case scenarios on patients with lumbar spondylolisthesis with neurogenic claudication with (S+BP) or without (S−BP) associated mechanical back pain. Treatment options included decompression, laminectomy with posterolateral fusion, posterior lumbar interbody fusion, or none of the above. The primary outcome measure was the probability of 2 randomly chosen surgeons disagreeing on the treatment method. Results There was 64% disagreement (36% agreement) among surgeons for treatment of spondylolisthesis with mechanical back pain (S+BP) and 71% disagreement (29% agreement) for spondylolisthesis without mechanical back pain (S−BP). For S+BP, disagreement was 52% for those practicing 5 to 10 years versus 70% among those practicing more than 20 years. Orthopedic surgeons had greater disagreement than did neurosurgeons (76% vs. 56%) for S+BP. Greater clinical equipoise was seen for S−BP than for S+BP regardless of surgeon characteristics. For spondylolisthesis without mechanical back pain, neurosurgeons were significantly more likely to select decompression-only than were orthopedic surgeons, who more commonly selected fusion. Conclusions Clinical equipoise exists for the treatment of spondylolisthesis. Differences are greater when the patient presents without associated back pain. Surgeon case volume, practice duration, and specialty training influence operative decisions for a given pathologic condition. Recognizing this practice variation will hopefully lead to better evidence and practice guidelines for the optimal and most cost-effective treatment paradigms

Combining Clinical, Pathological, and Demographic Factors Refines Prognosis of Lung Cancer: A Population-Based Study

In the treatment of lung cancer, an accurate estimation of patient clinical outcome is essential for choosing an appropriate course of therapy. It is important to develop a prognostic stratification model which combines clinical, pathological and demographic factors for individualized clinical decision making.A total of 234,412 patients diagnosed with adenocarcinomas or squamous cell carcinomas of the lung or bronchus between 1988 and 2006 were retrieved from the SEER database to construct a prognostic model. A model was developed by estimating a Cox proportional hazards model on 500 bootstrapped samples. Two models, one using stage alone and another comprehensive model using additional covariates, were constructed. The comprehensive model consistently outperformed the model using stage alone in prognostic stratification and on Harrell's C, Nagelkerke's R(2), and Brier Scores in the whole patient population as well as in specific treatment modalities. Specifically, the comprehensive model generated different prognostic groups with distinct post-operative survival (log-rank P<0.001) within surgical stage IA and IB patients in Kaplan-Meier analyses. Two additional patient cohorts (n = 1,991) were used as an external validation, with the comprehensive model again outperforming the model using stage alone with regards to prognostic stratification and the three evaluated metrics.These results demonstrate the feasibility of constructing a precise prognostic model combining multiple clinical, pathologic, and demographic factors. The comprehensive model significantly improves individualized prognosis upon AJCC tumor staging and is robust across a range of treatment modalities, the spectrum of patient risk, and in novel patient cohorts

A Pan-cancer analysis reveals high-frequency genetic alterations in mediators of signaling by the tgf-β superfamily

We present an integromic analysis of gene alterations that modulate transforming growth factor β (TGF-β)-Smad-mediated signaling in 9,125 tumor samples across 33 cancer types in The Cancer Genome Atlas (TCGA). Focusing on genes that encode mediators and regulators of TGF-β signaling, we found at least one genomic alteration (mutation, homozygous deletion, or amplification) in 39% of samples, with highest frequencies in gastrointestinal cancers. We identified mutation hotspots in genes that encode TGF-β ligands (BMP5), receptors (TGFBR2, AVCR2A, and BMPR2), and Smads (SMAD2 and SMAD4). Alterations in the TGF-β superfamily correlated positively with expression of metastasis-associated genes and with decreased survival. Correlation analyses showed the contributions of mutation, amplification, deletion, DNA methylation, and miRNA expression to transcriptional activity of TGF-β signaling in each cancer type. This study provides a broad molecular perspective relevant for future functional and therapeutic studies of the diverse cancer pathways mediated by the TGF-β superfamily

Documenting the Natural History of Patients With Resected Stage II Adenocarcinoma of the Colon After Random Assignment to Adjuvant Treatment With Edrecolomab or Observation: Results From CALGB 9581

We conducted a randomized trial comparing adjuvant treatment with edrecolomab versus observation in patients with resected, low-risk, stage II colon cancer. This study also prospectively studied patient- and tumor-specific markers of treatment outcome

Viral escape from HIV-1 neutralizing antibodies drives increased plasma neutralization breadth through sequential recognition of multiple epitopes and immunotypes.

Identifying the targets of broadly neutralizing antibodies to HIV-1 and understanding how these antibodies develop remain important goals in the quest to rationally develop an HIV-1 vaccine. We previously identified a participant in the CAPRISA Acute Infection Cohort (CAP257) whose plasma neutralized 84% of heterologous viruses. In this study we showed that breadth in CAP257 was largely due to the sequential, transient ppearance of three distinct broadly neutralizing antibody specificities spanning the first 4.5 years of infection. The first specificity targeted an epitope in the V2 region of gp120 that was also recognized by strain-specific antibodies 7 weeks earlier. Specificity for the autologous virus was determined largely by a rare N167 antigenic variant of V2, with viral escape to the more common D167 immunotype coinciding with the development of the first wave of broadly neutralizing antibodies. Escape from these broadly neutralizing V2 antibodies through deletion of the glycan at N160 was associated with exposure of an epitope in the CD4 binding site that became the target for a second wave of broadly neutralizing antibodies. Neutralization by these CD4 binding site antibodies was almost entirely dependent on the glycan at position N276. Early viral escape mutations in the CD4 binding site drove an increase in wave two neutralization breadth, as this second wave of heterologous neutralization matured to recognize multiple immunotypes within this site. The third wave targeted a quaternary epitope that did not overlap any of the four known sites of vulnerability on the HIV-1 envelope and remains undefined. Altogether this study showed that the human immune system is capable of generating multiple broadly neutralizing antibodies in response to a constantly evolving viral population that exposes new targets as a consequence of escape from earlier neutralizing antibodies

Pattern Regulation in the Eyebud of Xenopus Studied with a Vital-Dye Fiber-Tracing Technique

Evidence for pattern regulation in the developing Xenopus visual system has previously been obtained after surgical manipulations of the eyebud early in development. In one experimental paradigm, a “compound” eye is produced by combining a nasal (anterior) half-eyebud with normal dorsoventral polarity and a temporal (posterior) half-eyebud with inverted dorsoventral polarity. The adult retinotectal projection from such compound eyes, as assayed by electrophysiological mapping techniques, shows normal dorsoventral polarity in both halves, indicating an apparent reversal in the polarity of the surgically-inverted half. We have utilized a fluorescent vital-dye fiber-tracing technique to investigate the early events in this regulatory process. The results show that the change in dorsoventral polarity is not due to cell movements in the eyebud after surgery. Interestingly, the experiments also demonstrate that the pattern of connections initially formed by the developing eye does not reflect the pattern regulation observed in the adult retinotectal map; instead, the temporal half of the eye projects to the tectum with inverted dorsoventral order. Thus, the regulation observed in the adult does not become evident in the pattern of the projection until after early larval development

Dynamic Aspects of Retinotectal Map Formation Revealed by a Vital-Dye Fiber-Tracing Technique

In the visual system of Xenopus laevis, the axons from the retinal ganglion cells of the eye form a topographic projection onto the optic tectum. Many studies have focused on revealing the mechanisms responsible for this precise and regular projection pattern. In contrast to the static view of the system that one might expect from examining the regularity of the projection, recent work on its regeneration and its changes during larval development indicate that part of the patterning process involves the dynamic behavior of optic fibers. Typically, anatomical and electrophysiological techniques have been used to obtain static views of the developing retinotectal projection which then must be compiled to provide a glimpse of any dynamic behavior. Here we report on experiments using a newly developed fiber tracing technique to directly follow the emergence of topography in the developing retinotectal projection. Defined halves of the developing eyebud were labeled with a vital fluorescent dye which fills the growing axons, and the projection of the labeled cells was followed for up to 2 weeks in individual animals. The experiments confirm that dorsal and ventral optic nerve fibers sort out into an ordered projection early in development. In contrast, nasal and temporal fibers initially overlap, and the same sets of prelabeled fibers then sort out into the adult topography over a period of days