The prevalence and pattern of chemotherapy-induced peripheral neuropathy among women with breast cancer receiving care in a large community oncology practice

Purpose To describe the prevalence, severity, and risk factors of chemotherapy-induced peripheral neuropathy (CIPN) and its impact on function and quality of life (QOL) among women treated for breast cancer in a large U.S. Community Oncology practice. Methods Women previously treated with taxane-based chemotherapy for early-stage breast cancer completed the EORTC QLQ–C30, QLQ–BR23, and QLQ–CIPN20. Subscales are scored 0–100; higher scores indicate greater symptom severity. Pre-specified hypotheses were tested. Results 126 women with mean age 56.7 years (SD 11.8) were stage I–II (79.4%) or stage III (20.6%) at the time of the survey; 65.1% were White and 27.8% were Black or African American. The mean time since last taxane chemotherapy cycle was 144.9 weeks (SD 112.9). 73.0% reported having CIPN. QLQ–CIPN20 mean scores for the sensory, motor, and autonomic subscales were 18.9 (SD 23.1), 18.6 (SD 18.7), and 17.1 (SD 21.8), respectively. CIPN symptom severity was negatively correlated with global health status/QOL and physical and role functioning (range of r = -0.46 to -0.72). It was not associated with age, body mass index, diabetes, or cumulative taxane dosage, but was greater for Black or African American women (e.g., sensory, p<0.002). CIPN sensory impairment was marginally greater for patients treated with paclitaxel compared to docetaxel (p<0.064). Conclusions CIPN was prevalent in this community oncology practice and significantly impacts function and QOL. These data highlight the importance of developing methods to mitigate CIPN, and for screening for CIPN particularly among Black or African American women

The phosphoinositide-binding protein p40phox activates the NADPH oxidase during FcγIIA receptor–induced phagocytosis

Superoxide produced by the phagocyte reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is essential for host defense. Enzyme activation requires translocation of p67phox, p47phox, and Rac-GTP to flavocytochrome b558 in phagocyte membranes. To examine the regulation of phagocytosis-induced superoxide production, flavocytochrome b558, p47phox, p67phox, and the FcγIIA receptor were expressed from stable transgenes in COS7 cells. The resulting COSphoxFcγR cells produce high levels of superoxide when stimulated with phorbol ester and efficiently ingest immunoglobulin (Ig)G-coated erythrocytes, but phagocytosis did not activate the NADPH oxidase. COS7 cells lack p40phox, whose role in the NADPH oxidase is poorly understood. p40phox contains SH3 and phagocyte oxidase and Bem1p (PB1) domains that can mediate binding to p47phox and p67phox, respectively, along with a PX domain that binds to phosphatidylinositol-3-phosphate (PI(3)P), which is generated in phagosomal membranes. Expression of p40phox was sufficient to activate superoxide production in COSphoxFcγR phagosomes. FcγIIA-stimulated NADPH oxidase activity was abrogated by point mutations in p40phox that disrupt PI(3)P binding, or by simultaneous mutations in the SH3 and PB1 domains. Consistent with an essential role for PI(3)P in regulating the oxidase complex, phagosome NADPH oxidase activation in primary macrophages ingesting IgG-coated beads was inhibited by phosphatidylinositol 3 kinase inhibitors to a much greater extent than phagocytosis itself. Hence, this study identifies a role for p40phox and PI(3)P in coupling FcγR-mediated phagocytosis to activation of the NADPH oxidase

Talk Like an Electrician: Student Dialogue Mimicking Behavior in an Intelligent Tutoring System

Abstract. Students entering a new field must learn to speak the specialized language of that field. Previous research using automated measures of word overlap has found that students who modify their language to align more closely to a tutor&apos;s language show larger overall learning gains. We present an alternative approach that assesses syntactic as well as lexical alignment in a corpus of human-computer tutorial dialogue. We found distinctive patterns differentiating high and low achieving students. Our high achievers were most likely to mimic their own earlier statements and rarely made mistakes when mimicking the tutor. Low achievers were less likely to reuse their own successful sentence structures, and were more likely to make mistakes when trying to mimic the tutor. We argue that certain types of mimicking should be encouraged in tutorial dialogue systems, an important future research direction

Serum neurofilament light in familial Alzheimer disease: A marker of early neurodegeneration.

OBJECTIVES: To investigate whether serum neurofilament light (NfL) concentration is increased in familial Alzheimer disease (FAD), both pre and post symptom onset, and whether it is associated with markers of disease stage and severity. METHODS: We recruited 48 individuals from families with PSEN1 or APP mutations to a cross-sectional study: 18 had symptomatic Alzheimer disease (AD) and 30 were asymptomatic but at 50% risk of carrying a mutation. Serum NfL was measured using an ultrasensitive immunoassay on the single molecule array (Simoa) platform. Cognitive testing and MRI were performed; 33 participants had serial MRI, allowing calculation of atrophy rates. Genetic testing established mutation status. A generalized least squares regression model was used to compare serum NfL among symptomatic mutation carriers, presymptomatic carriers, and noncarriers, adjusting for age and sex. Spearman coefficients assessed associations between serum NfL and (1) estimated years to/from symptom onset (EYO), (2) cognitive measures, and (3) MRI measures of atrophy. RESULTS: Nineteen of the asymptomatic participants were mutation carriers (mean EYO -9.6); 11 were noncarriers. Compared with noncarriers, serum NfL concentration was higher in both symptomatic (p < 0.0001) and presymptomatic mutation carriers (p = 0.007). Across all mutation carriers, serum NfL correlated with EYO (ρ = 0.81, p < 0.0001) and multiple cognitive and imaging measures, including Mini-Mental State Examination (ρ = -0.62, p = 0.0001), Clinical Dementia Rating Scale sum of boxes (ρ = 0.79, p < 0.0001), baseline brain volume (ρ = -0.62, p = 0.0002), and whole-brain atrophy rate (ρ = 0.53, p = 0.01). CONCLUSIONS: Serum NfL concentration is increased in FAD prior to symptom onset and correlates with measures of disease stage and severity. Serum NfL may thus be a feasible biomarker of early AD-related neurodegeneration

Modeling the Atmospheric Boundary Layer Wind Response to Mesoscale Sea Surface Temperature Perturbations

The wind speed response to mesoscale SST variability is investigated over the Agulhas Return Current region of the Southern Ocean using the Weather Research and Forecasting (WRF) Model and the U.S. Navy Coupled Ocean–Atmosphere Mesoscale Prediction System (COAMPS) atmospheric model. The SST-induced wind response is assessed from eight simulations with different subgrid-scale vertical mixing parameterizations, validated using Quick Scatterometer (QuikSCAT) winds and satellite-based sea surface temperature (SST) observations on 0.25° grids. The satellite data produce a coupling coefficient of s[subscript U] = 0.42 m s⁻¹ °C⁻¹ for wind to mesoscale SST perturbations. The eight model configurations produce coupling coefficients varying from 0.31 to 0.56 m s⁻¹ °C⁻¹. Most closely matching QuikSCAT are a WRF simulation with the Grenier–Bretherton–McCaa (GBM) boundary layer mixing scheme (s[subscript U] = 0.40 m s⁻¹ °C⁻¹), and a COAMPS simulation with a form of Mellor–Yamada parameterization (s[subscript U] = 0.38 m s⁻¹ °C⁻¹). Model rankings based on coupling coefficients for wind stress, or for curl and divergence of vector winds and wind stress, are similar to that based on s[subscript U]. In all simulations, the atmospheric potential temperature response to local SST variations decreases gradually with height throughout the boundary layer (0–1.5 km). In contrast, the wind speed response to local SST perturbations decreases rapidly with height to near zero at 150–300 m. The simulated wind speed coupling coefficient is found to correlate well with the height-averaged turbulent eddy viscosity coefficient. The details of the vertical structure of the eddy viscosity depend on both the absolute magnitude of local SST perturbations, and the orientation of the surface wind to the SST gradient

Biological Misinterpretation of Transcriptional Signatures in Tumor Samples Can Unknowingly Undermine Mechanistic Understanding and Faithful Alignment with Preclinical Data

PURPOSE Precise mechanism-based gene expression signatures (GES) have been developed in appropriate in vitro and in vivo model systems, to identify important cancer-related signaling processes. However, some GESs originally developed to represent specific disease processes, primarily with an epithelial cell focus, are being applied to heterogeneous tumor samples where the expression of the genes in the signature may no longer be epithelial-specific. Therefore, unknowingly, even small changes in tumor stroma percentage can directly influence GESs, undermining the intended mechanistic signaling. EXPERIMENTAL DESIGN Using colorectal cancer as an exemplar, we deployed numerous orthogonal profiling methodologies, including laser capture microdissection, flow cytometry, bulk and multiregional biopsy clinical samples, single-cell RNA sequencing and finally spatial transcriptomics, to perform a comprehensive assessment of the potential for the most widely used GESs to be influenced, or confounded, by stromal content in tumor tissue. To complement this work, we generated a freely-available resource, ConfoundR; https://confoundr.qub.ac.uk/, that enables users to test the extent of stromal influence on an unlimited number of the genes/signatures simultaneously across colorectal, breast, pancreatic, ovarian and prostate cancer datasets. RESULTS Findings presented here demonstrate the clear potential for misinterpretation of the meaning of GESs, due to widespread stromal influences, which in-turn can undermine faithful alignment between clinical samples and preclinical data/models, particularly cell lines and organoids, or tumor models not fully recapitulating the stromal and immune microenvironment. CONCLUSIONS Efforts to faithfully align preclinical models of disease using phenotypically-designed GESs must ensure that the signatures themselves remain representative of the same biology when applied to clinical samples

Development of a Reliable Surgical Quality Assurance System for 2-stage Esophagectomy in Randomized Controlled Trials

Objective: The aim was to develop a reliable surgical quality assurance system for 2-stage esophagectomy. This development was conducted during the pilot phase of the multicenter ROMIO trial, collaborating with international experts. Summary of Background Data: There is evidence that the quality of surgical performance in randomized controlled trials influences clinical outcomes, quality of lymphadenectomy and loco-regional recurrence. Methods: Standardization of 2-stage esophagectomy was based on structured observations, semi-structured interviews, hierarchical task analysis, and a Delphi consensus process. This standardization provided the structure for the operation manual and video and photographic assessment tools. Reliability was examined using generalizability theory. Results: Hierarchical task analysis for 2-stage esophagectomy comprised fifty-four steps. Consensus (75%) agreement was reached on thirty-nine steps, whereas fifteen steps had a majority decision. An operation manual and record were created. A thirty five-item video assessment tool was developed that assessed the process (safety and efficiency) and quality of the end product (anatomy exposed and lymphadenectomy performed) of the operation. The quality of the end product section was used as a twenty seven-item photographic assessment tool. Thirty-one videos and fifty-three photographic series were submitted from the ROMIO pilot phase for assessment. The overall Gcoefficient for the video assessment tool was 0.744, and for the photographic assessment tool was 0.700. Conclusions: A reliable surgical quality assurance system for 2-stage esophagectomy has been developed for surgical oncology randomized controlled trials