AXL Is a Key Regulator of Inherent and Chemotherapy-Induced Invasion and Predicts a Poor Clinical Outcome in Early-Stage Colon Cancer

Purpose: Despite the use of 5-fluorouracil (5-FU)–based adjuvant treatments, a large proportion of patients with high-risk stage II/III colorectal cancer will relapse. Thus, novel therapeutic strategies are needed for early-stage colorectal cancer. Residual micrometastatic disease from the primary tumor is a major cause of patient relapse.

Experimental Design: To model colorectal cancer tumor cell invasion/metastasis, we have generated invasive (KRASMT/KRASWT/+chr3/p53-null) colorectal cancer cell subpopulations. Receptor tyrosine kinase (RTK) screens were used to identify novel proteins that underpin the migratory/invasive phenotype. Migration/invasion was assessed using the XCELLigence system. Tumors from patients with early-stage colorectal cancer (N = 336) were examined for AXL expression.

Results: Invasive colorectal cancer cell subpopulations showed a transition from an epithelial-to-mesenchymal like phenotype with significant increases in migration, invasion, colony-forming ability, and an attenuation of EGF receptor (EGFR)/HER2 autocrine signaling. RTK arrays showed significant increases in AXL levels in all invasive sublines. Importantly, 5-FU treatment resulted in significantly increased migration and invasion, and targeting AXL using pharmacologic inhibition or RNA interference (RNAi) approaches suppressed basal and 5-FU–induced migration and invasion. Significantly, high AXL mRNA and protein expression were found to be associated with poor overall survival in early-stage colorectal cancer tissues.

Conclusions: We have identified AXL as a poor prognostic marker and important mediator of cell migration/invasiveness in colorectal cancer. These findings provide support for the further investigation of AXL as a novel prognostic biomarker and therapeutic target in colorectal cancer, in particular in the adjuvant disease in which EGFR/VEGF–targeted therapies have failed.

Defining Target Volumes for Stereotactic Ablative Radiotherapy of Early-stage Lung Tumours:A Comparison of Three-dimensional F-fluorodeoxyglucose Positron Emission Tomography and Four-dimensional Computed Tomography

Aims: High local control rates are achieved in stage I lung cancer using stereotactic ablative radiotherapy. Target delineation is commonly based on four-dimensional computed tomography (CT) scans. Target volumes defined by positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional') F-fluorodeoxyglucose (F-FDG) PET/CT. Materials and methods: For 16 stage I non-small cell lung cancer tumours, six approaches for deriving PET target volumes were evaluated: manual contouring, standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV (35%SUV), 41% of SUV (41%SUV) and two different source to background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum intensity projection (MIP ITV). Volumetric and positional correlation was assessed using the Dice similarity coefficient (DSC). Results: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV = 0.63, 41%SUV = 0.57. SBR-1 = 0.52, SBR-2 = 0.49. PET-based target volumes were smaller than corresponding MIP ITVs. Conclusions: Conventional three-dimensional F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use (MIP ITV). Caution is required in using three-dimensional PET for motion encompassing target volume delineation. © 2012 The Royal College of Radiologists.

“Do You Want to See My Hornpipe?”: The Traditional Irish Dancing Body at Play in the Work of Jean Butler and Colin Dunne.

This chapter considers the radical re-imaginings of traditional Irish step dance in the recent works of Jean Butler and Colin Dunne. In Butler's Does She Take Sugar (2007) and Dunne's Out of Time (2008), the Irish step dancing body is separated from its historical roots in nationalism, from the exhibitionism required by the competitive form, and from the spectacularization of the commercialized theatrical format. In these works, which are both solo pieces performed by the choreographers themselves, the traditional form undergoes a critical interrogation in which the dancers attempt to depart from the determinacy of the traditional technique, while acknowledging its formation of their corporealities; the Irish step dance technique becomes a springboard for creative experimentation. In order to consider the importance of the creative potential revealed by these works, this chapter will contextualize them within the dance background from which they emerged, outlining the history of competitive step dancing in Ireland, the "modernization" of traditional Irish dance with the emergence of Riverdance (1994), and the experiments of Ireland's national folk theatre, Siamsa Tíre.

Defining target volumes for stereotactic ablative radiotherapy of early-stage lung tumours: a comparison of three-dimensional 18F-fluorodeoxyglucose positron emission tomography and four-dimensional computed tomography.:PETCT versus 4DCT for SABR in Early Stage NSCLC

AIMS: High local control rates are achieved in stage I lung cancer using
stereotactic ablative radiotherapy. Target delineation is commonly based on
four-dimensional computed tomography (CT) scans. Target volumes defined by
positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional')
(18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT.

MATERIALS AND METHODS: For 16 stage I non-small cell lung cancer tumours, six
approaches for deriving PET target volumes were evaluated: manual contouring,
standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV
(35%SUV(MAX)), 41% of SUV(MAX) (41%SUV(MAX)) and two different source to
background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum
intensity projection (MIP(MOD) ITV). Volumetric and positional correlation was
assessed using the Dice similarity coefficient (DSC).

RESULTS: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP(MOD) ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV(MAX) = 0.63, 41%SUV(MAX) = 0.57. SBR-1 = 0.52, SBR-2 =0.49. PET-based target volumes were smaller than corresponding MIP ITVs.

CONCLUSIONS: Conventional three-dimensional (18)F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use
(MIP(MOD) ITV). Caution is required in using three-dimensional PET for motion
encompassing target volume delineation.

A multi-output two-stage locally regularized model construction method using the extreme learning machine

This paper investigates the construction of linear-in-the-parameters (LITP) models for multi-output regression problems. Most existing stepwise forward algorithms choose the regressor terms one by one, each time maximizing the model error reduction ratio. The drawback is that such procedures cannot guarantee a sparse model, especially under highly noisy learning conditions. The main objective of this paper is to improve the sparsity and generalization capability of a model for multi-output regression problems, while reducing the computational complexity. This is achieved by proposing a novel multi-output two-stage locally regularized model construction (MTLRMC) method using the extreme learning machine (ELM). In this new algorithm, the nonlinear parameters in each term, such as the width of the Gaussian function and the power of a polynomial term, are firstly determined by the ELM. An initial multi-output LITP model is then generated according to the termination criteria in the first stage. The significance of each selected regressor is checked and the insignificant ones are replaced at the second stage. The proposed method can produce an optimized compact model by using the regularized parameters. Further, to reduce the computational complexity, a proper regression context is used to allow fast implementation of the proposed method. Simulation results confirm the effectiveness of the proposed technique. © 2013 Elsevier B.V.

Seasonal and gestation stage associated differences in aflatoxin exposure in pregnant Gambian women

Objective: Aflatoxin is known to cross the placental barrier and exposures in utero could influence genomic programming, foetal growth and development, resulting in long-term health effects. We aimed to determine aflatoxin exposure in Gambian women at two stages of pregnancy and during the rainy and dry seasons.

Methods: We examined aflatoxin exposure in pregnant Gambian women at early (<16 weeks) and later (16 weeks onward) stages of pregnancy and at different times of the year, during the rainy (June to October 2009) or dry (November to May 2010) season, using aflatoxin–albumin adducts (AF-alb).

Results: Mean AF-alb was higher during the dry season than in the rainy season, in both early and later pregnancy although the difference was strongest in later pregnancy. There was a modest increase in AF-alb in later than early pregnancy (geometric mean 41.8 vs. 34.5 pg/mg, P < 0.05), but this was restricted to the dry season when exposures were generally higher.

Conclusions: The study confirmed that Gambian pregnant women were exposed to aflatoxin throughout the pregnancy, with higher levels in the dry season. There was some evidence in the dry season that women in later pregnancy had higher AF-alb levels than those in earlier pregnancy. Further research on the effects of exposure to this potent mutagen and carcinogen throughout pregnancy, including the epigenetic modification of foetal gene expression and impact on pre- and post-natal growth and development, are merited.

Novel genetic susceptibility loci for diabetic end-stage renal disease identified through robust naive Bayes classification

Aims/hypothesis: Diabetic nephropathy is a major diabetic complication, and diabetes is the leading cause of end-stage renal disease (ESRD). Family studies suggest a hereditary component for diabetic nephropathy. However, only a few genes have been associated with diabetic nephropathy or ESRD in diabetic patients. Our aim was to detect novel genetic variants associated with diabetic nephropathy and ESRD. Methods: We exploited a novel algorithm, ‘Bag of Naive Bayes’, whose marker selection strategy is complementary to that of conventional genome-wide association models based on univariate association tests. The analysis was performed on a genome-wide association study of 3,464 patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study and subsequently replicated with 4,263 type 1 diabetes patients from the Steno Diabetes Centre, the All Ireland-Warren 3-Genetics of Kidneys in Diabetes UK collection (UK–Republic of Ireland) and the Genetics of Kidneys in Diabetes US Study (GoKinD US). Results: Five genetic loci (WNT4/ZBTB40-rs12137135, RGMA/MCTP2-rs17709344, MAPRE1P2-rs1670754, SEMA6D/SLC24A5-rs12917114 and SIK1-rs2838302) were associated with ESRD in the FinnDiane study. An association between ESRD and rs17709344, tagging the previously identified rs12437854 and located between the RGMA and MCTP2 genes, was replicated in independent case–control cohorts. rs12917114 near SEMA6D was associated with ESRD in the replication cohorts under the genotypic model (p < 0.05), and rs12137135 upstream of WNT4 was associated with ESRD in Steno. Conclusions/interpretation: This study supports the previously identified findings on the RGMA/MCTP2 region and suggests novel susceptibility loci for ESRD. This highlights the importance of applying complementary statistical methods to detect novel genetic variants in diabetic nephropathy and, in general, in complex diseases.

Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: A safe and effective technique in risk-reducing and therapeutic mastectomy

Introduction: Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.

Methods and results: A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.

Conclusion: One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Home Is Where the Self Is: Monodrama, Journey-Play Structure, and the Modernist Fairy Tale

The first decade of the twentieth century witnessed the creation of two of the most beloved works of children’s literature ever produced. L. Frank Baum’s 1900 novel The Wizard of Oz and Maurice Maeterlinck’s 1908 play each gave rise to many adaptations, including, well beloved film versions, and both have become a deeply ingrained part of the cultural memory and construction of childhood in both Europe and the United States. And while these works are deeply original in content and detail, the structure of these works harkens back to the form of the journey play (traceable, on some level, back to the medieval morality play Everyman), a form that had undergone a considerable revival in the second half of the nineteenth century in the work of writers such as Henrik Ibsen and August Strindberg. This article explores the structural and conceptual links between Baum and Maeterlinck’s children’s classics, Ibsen’s Norwegian folk play Peer Gynt, and August Strindberg’s Lucky Per’s Journey and The Road to Damascus, Part I. In these works, the protagonists, disenchanted with their homes or current situations, set out on an epic journey in which they come upon characters and situations that act as commentary upon their situations before the journey. Ultimately, the characters return to where they started, with the journey seeming to have been a dream or merely a pointless excursion. But in these journeys of self-discovery, the protagonist that emerges at the end has undergone a significant transformation, a process at the heart of all of these works.

Performance Evaluation of Two-Stage Electrokinetic Washing as Soil Remediation Method for Lead Removal using Different Wash Solutions

The study explores the application of a two-stage electrokinetic washing system on remediation of lead (Pb) contaminated soil. The process involved an initial soil washing, followed by an electrokinetic process. The use of electrokinetic process in soil washing not only provided additional driving force for transporting the desorbed Pb away from the soil but also reduced the high usage of wash solution. In this study, the effect of NaNO3, HNO3, citric acid and EDTA as wash solutions on two-stage electrokinetic washing system were evaluated. The results revealed that a two-stage electrokinetic washing process enhanced Pb removal efficiency by 2.52-9.08% and 4.98-20.45% in comparison to a normal electrokinetic process and normal washing process, respectively. Low pH and adequate current were the most important criteria in the removal process as they provided superior desorption and transport properties. The effect of chelating by EDTA was less dominant as it delayed the removal process by forming a transport loop in anode region between Pb ion and complexes. HNO3 was not suitable as wash solution in electrokinetic washing in spite of offering highest removal efficiency as it caused pH fluctuation in the cathode chamber, corroded graphite anode and showed high power consumption. In contrast, citric acid not only yielded high Pb removal efficiency with low power consumption but also maintained a low soil: solution ratio of 1 g: <1 mL, stable pH and electrode integrity. Possible transport mechanisms for Pb under each wash solution are also discussed in this work.

A decrease in bulk water and mannitol and accumulation of trehalose and trehalose-based oligosaccharides define a two-stage maturation process towards extreme stress resistance in ascospores of Neosartorya fischeri (Aspergillus fischeri)