Intra-individual stability of longitudinal urinary steroid profiles in Swedish athletes

The steroid module of the athlete biological passport (ABP) aims to detect doping with endogenous steroids by longitudinally monitoring epitestosterone (E), testosterone (T), and four metabolically related steroids and their ratios. There are large variations in the urinary levels of the androgen metabolites due to genetic polymorphisms, drug use, menstrual cycle, and other factors. In this study, we aimed to increase our understanding of the natural, within-individual variations of the established ABP markers in males and females over time, looking at samples collected both in and out-of-competition (IC/OOC). Urinary steroid profiles from 323 Swedish athletes, with at least five samples per athlete, were extracted from ADAMS together with information on type of sport, IC/OOC, and time of day. Data were analyzed using coefficient of variation (CV%) to examine within-subject variability and linear mixed effects models to estimate within-subject change in the metabolites over time. The metabolites and ratios expressed higher individual CV% in females (23–56) than in males (18–39). Samples taken OOC showed larger intra-individual variations than samples collected IC for most of the ABP metabolites in both sexes. The median concentrations were higher IC for some metabolites, particularly testosterone being 52% higher among females. Time of day influenced the intra-individual variation of the urinary steroid profile with decreases in androgen metabolites over time, if measured in evening versus daytime. These findings can aid in the testing strategies and interpretation of the steroidal module of ABP.     

Anxiety Sensitivity Prospectively Predicts Increased Acute Posttraumatic Stress and Related Symptoms After Sexual Assault

Anxiety sensitivity is a potential risk factor for posttraumatic stress symptoms (PTSS) and has been hypothesized to contribute to PTSS development. However, few prospective studies have evaluated whether anxiety sensitivity predicts PTSS. In a subsample of 48 women sexual assault survivors enrolled as part of a larger prospective observational study, elevated anxiety sensitivity measured via a brief assessment 1 week after experiencing a sexual assault was concurrently associated with PTSS at 1 week and prospectively predicted PTSS 6 weeks after the event, with small-to-medium effect sizes, η²_p = .10, even after covarying for trauma history. Heightened anxiety sensitivity at 1-week postevent also interacted with time to predict anxiety and depression both before and after sexual assault, with medium-to-large effect sizes, η_p² = .21– .24. This is consistent with research linking anxiety sensitivity to PTSS, but this was the first prospective study of which we are aware to demonstrate that anxiety sensitivity in the acute posttrauma period predicts PTSS among women who have recently experienced sexual assault. Future research should use the full Anxiety Sensitivity Index to replicate findings in a larger sample and explore whether targeting anxiety sensitivity could mitigate the development of PTSS in this vulnerable population.     

Changes in quality of life,health status and other patient-reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK-wide programme

We examined quality of life (QoL) and other patient-reported outcome measures (PROMs) in 95 simultaneous pancreas and kidney transplant (SPKT) recipients and 41 patients wait-listed for SPKT recruited to the UK Access to Transplantation and Transplant Outcome Measures (ATTOM) programme. Wait-listed patients transplanted within 12 months of recruitment (n = 22) were followed 12 months post-transplant and compared with those still wait-listed (n = 19) to examine pre- to post-transplant changes. Qualitative interviews with ten SPKT recipients 12 months post-transplant were analysed thematically. Cross-sectional analyses showed several better 12-month outcomes for SPKT recipients compared with those still wait-listed, a trend to better health utilities but no difference in diabetes-specific QoL or diabetes treatment satisfaction. Pre- to post-transplant, SPKT recipients showed improved treatment satisfaction, well-being, self-reported health, generic QoL and less negative impact on renal-specific QoL (ps < 0.05). Health utility values were better overall in transplant recipients and neither these nor diabetes-specific QoL changed significantly in either group. Pre-emptive transplant advantages seen in 12-month cross-sectional analyses disappeared when controlling for baseline values. Qualitative findings indicated diabetes complications, self-imposed blood glucose monitoring and dietary restrictions continued to impact QoL negatively post-transplant. Unrealistic expectations of SPKT caused some disappointment. Measuring condition-specific PROMs over time will help in demonstrating the benefits and limitations of SPKT.     

A randomised controlled pilot and feasibility study of music therapy for improving the quality of life of hospice inpatients

Background

Evidence about the effectiveness of music therapy for improving the quality of life of palliative care patients is positive but weak in terms of risk of bias.

Methods

This study aimed to determine the feasibility of a randomised controlled trial to evaluate the effectiveness of music therapy for improving the quality of life of hospice inpatients, as measured by the McGill Quality of Life questionnaire. Objectives included recruitment of 52 participants over 12?months and provision of data to support the calculation of the required sample size for a definitive randomised trial, taking into account the retention rates of recruited participants; and evaluation of the viability of the intervention and the acceptability of the assessment tool. The design was a single-centre, researcher-blinded randomised pilot and feasibility study involving two parallel groups. Participants were recruited from one inpatient hospice unit in Northern Ireland. Eligibility criteria were an Eastern Cooperative Oncology Group performance status of two or lower and an Abbreviated Mental Test score of seven or more. Consenting patients were randomly allocated to the intervention or control group using a 1:1 allocation ratio. The intervention group received up to six individual music therapy sessions over 3 weeks in addition to usual care. The control group received usual care only.

Results

Fifty one participants were recruited over 12?months. Twenty five were allocated to the intervention group and 26 to the control group. Seventy one percent of participants were lost to follow up by week 3, the proposed primary endpoint. The primary endpoint was moved from week 3, when 71% were lost to follow up to week 1, when 33% were lost. The McGill Quality of Life questionnaire was generally acceptable to participants. In order to detect a small to moderate effect size of 0.3, a fully powered study would require the recruitment of 698 participants.

Conclusions

A Phase III randomised controlled trial to evaluate the effectiveness of music therapy in improving the quality of life of hospice inpatients is feasible.

Trial registration

ClinicalTrials.gov: NCT02791048. Registered 6 June 2016.

     

Dysfunction of Mesenchymal Stem Cells Isolated from Metabolic Syndrome and Type 2 Diabetic Patients as Result of Oxidative Stress and Autophagy may Limit Their Potential Therapeutic Use

Mesenchymal stem cells (MSC) have become a promising tool for therapeutic intervention. Their unique features, including self-renewal, multipotency and immunomodulatory properties draw the worldwide attention of researchers and physicians with respect to their application in disease treatment. However, the environment (so-called niche) from which MSCs are isolated may determine their usefulness. Many studies indicated the involvement of MSCs in ageing and disease. In this review, we have focused on how type 2 diabetes (T2D) and metabolic syndrome (MS) affect MSC properties, and thus limit their therapeutic potential. Herein, we mainly focus on apoptosis, autophagy and mitochondria deterioration processes that indirectly affect MSC fate. Based on the data presented, special attention should be paid when considering autologous MSC therapy in T2D or MS treatments, as their therapeutic potential may be restricted.     

Distinct Biomarker Profiles in Ex Vivo T Cell Depletion Graft Manipulation Strategies: CD34+ Selection versus CD3+/19+ Depletion in Matched Sibling Allogeneic Peripheral Blood Stem Cell Transplantation

Various approaches have been developed for ex vivo T cell depletion in allogeneic stem cell transplantation to prevent graft-versus-host disease (GVHD). Direct comparisons of T cell depletion strategies have not been well studied, however. We evaluated cellular and plasma biomarkers in 2 different graft manipulation strategies, CD3⁺CD19⁺ cell depletion (CD3/19D) versus CD34⁺ selection (CD34S), and their associations with clinical outcomes. Identical conditions, including the myeloablative preparative regimen, HLA-identical sibling donor, GVHD prophylaxis, and graft source, were used in the 2 cohorts. Major clinical outcomes were similar in the 2 groups in terms of overall survival, nonrelapse mortality, and cumulative incidence of relapse; however, the cumulative incidence of acute GVHD trended to be higher in the CD3/19D cohort compared with the CD34S cohort. A distinct biomarker profile was noted in the CD3/19D cohort: higher levels of ST2, impaired Helios^? FoxP3⁺Treg reconstitution, and rapid reconstitution of naïve, Th2, and Th17 CD4 cells in the early post-transplantation period. In vitro graft replication studies confirmed that CD3/19D disproportionately depleted Tregs and other CD4 subset repertoires in the graft. This study confirms the utility of biomarker monitoring, which can be directly correlated with biological consequences and possible future therapeutic indications.     

A variable stiffness mechanism for steerable percutaneous instruments: integration in a needle

Needles are advanced tools commonly used in minimally invasive medical procedures. The accurate manoeuvrability of flexible needles through soft tissues is strongly determined by variations in tissue stiffness, which affects the needle-tissue interaction and thus causes needle deflection. This work presents a variable stiffness mechanism for percutaneous needles capable of compensating for variations in tissue stiffness and undesirable trajectory changes. It is composed of compliant segments and rigid plates alternately connected in series and longitudinally crossed by four cables. The tensioning of the cables allows the omnidirectional steering of the tip and the stiffness tuning of the needle. The mechanism was tested separately under different working conditions, demonstrating a capability to exert up to 3.6 N. Afterwards, the mechanism was integrated into a needle, and the overall device was tested in gelatine phantoms simulating the stiffness of biological tissues. The needle demonstrated the capability to vary deflection (from 11.6 to 4.4 mm) and adapt to the inhomogeneity of the phantoms (from 21 to 80 kPa) depending on the activation of the variable stiffness mechanism.

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Graphical abstract ?

     

Mixtures of opposing phosphorylations within hexamers precisely time feedback in the cyanobacterial circadian clock

Circadian oscillations are generated by the purified cyanobacterial clock proteins, KaiA, KaiB, and KaiC, through rhythmic interactions that depend on multisite phosphorylation of KaiC. However, the mechanisms that allow these phosphorylation reactions to robustly control the timing of oscillations over a range of protein stoichiometries are not clear. We show that when KaiC hexamers consist of a mixture of differentially phosphorylated subunits, the two phosphorylation sites have opposing effects on the ability of each hexamer to bind to the negative regulator KaiB. We likewise show that the ability of the positive regulator KaiA to act on KaiC depends on the phosphorylation state of the hexamer and that KaiA and KaiB recognize alternative allosteric states of the KaiC ring. Using mathematical models with kinetic parameters taken from experimental data, we find that antagonism of the two KaiC phosphorylation sites generates an ultrasensitive switch in negative feedback strength necessary for stable circadian oscillations over a range of component concentrations. Similar strategies based on opposing modifications may be used to support robustness in other timing systems and in cellular signaling more generally.Circadian clocks are biological timing systems that allow organisms to anticipate and prepare for daily changes in the environment. A hallmark of a circadian oscillator is its ability to drive self-sustained rhythms in gene expression and behavior with a period close to 24 h, even in the absence of environmental cues (1). A general challenge for the biochemical machinery that generates rhythms is to precisely define the duration of the day in the face of perturbations, including fluctuations in the cellular abundance of the molecular components. The importance of maintaining precise circadian timing is underscored by experiments showing that mismatch between the clock period and the rhythms in the external environment results in health problems and fitness defects (2, 3).Although circadian clocks are found across all kingdoms of life, the Kai oscillator from cyanobacteria presents a uniquely powerful model system to study the design principles inherent in the molecular interactions that generate rhythms. A mixture of the purified proteins KaiA, KaiB, and KaiC results in stable oscillations in the phosphorylation state of KaiC in vitro that persist for many days and share many of the properties of circadian clocks in vivo (4–6). In particular, the oscillator can successfully generate near–24-h rhythms over a range of concentrations of the clock proteins both in vivo and in vitro (7–9), so fine-tuning of gene expression is not needed to support a functional clock. Much has been learned about the behavior of the isolated Kai proteins, including the determination of high-resolution crystal structures of all three components (10–12). A critical challenge that remains is to understand how the properties of the Kai proteins are integrated together in the full system to generate precisely timed rhythms.KaiC appears to be the central hub of timing information in the oscillator. Each KaiC molecule consists of two AAA+ family ATPase domains that consume the free energy of ATP hydrolysis to drive oscillations. Like many other members of this family, KaiC forms hexamers, and the enzymatic active sites are formed at the subunit interfaces where nucleotides are bound. The C-terminal, or CII, domain of KaiC has additional phosphotransferase activities that are unusual for the AAA+ family: it can phosphorylate and dephosphorylate two residues near the subunit interface, Ser431 and Thr432 (13). KaiC autokinase and autophosphatase activities occur at the same active site (14, 15). In isolation, KaiC has high phosphatase activity, but the enzyme is pushed toward kinase activity by the activator protein KaiA, which interacts directly with the KaiC C-terminal tail (16, 17). Roughly speaking, kinase activity predominates during the day, and phosphatase activity predominates during the night (18). Thus, understanding the feedback mechanisms that generate a precise time delay between these modes is crucial to understanding timing in the oscillator (19).Inactivation of KaiA and a transition from kinase to phosphatase mode occur when KaiB•KaiC complexes form, closing a negative feedback loop by sequestering KaiA in a ternary complex and leaving it unable to act on other KaiC molecules (20, 21). By temporarily removing KaiA molecules from their activating role, this molecular titration mechanism may act to synchronize the activity of all KaiC hexamers in the reaction (20, 22, 23). Phosphorylation and dephosphorylation proceed in a strongly ordered fashion so that in response to a change in KaiA activity, Thr432 is (de)phosphorylated first, followed later by Ser431 (18, 20, 21). It is known that phosphorylated Ser431 is important for allowing the formation of KaiB•KaiC complexes. However, recent work has made it clear that the binding of KaiB involves both KaiC domains—in particular, the slow ATPase activity of the N-terminal CI domain, which is not phosphorylated, is required for KaiB interaction (24, 25).Because of the importance of precisely timing negative feedback via KaiB•KaiC complex formation for generating appropriate rhythms (22), we wanted to understand the role of phosphorylation of the KaiC hexamer in controlling this process. The involvement of both KaiC domains suggests that information about phosphorylation in CII is communicated allosterically through changes in hexamer structure to the CI domain, potentially through ring–ring stacking interactions (24, 26). We therefore hypothesized that the KaiC phosphorylation sites on each subunit might act as allosteric regulators in the context of a hexameric ring so that phosphorylation of one subunit would alter the ability of all other subunits in the ring to engage with KaiA and KaiB, providing a cooperative mechanism to control the timing of these interactions.We conducted a series of biochemical experiments and perturbations to study the effect of altering the status of each phosphorylation site on the KaiC hexamer. To interpret these results, we then developed a mathematical model analogous to classical models of allosteric transitions in multimeric proteins. We constrain the kinetic parameters in this model using experimental measurements of rate constants, allowing us to compare the predictions of the model directly with data. We conclude that maintenance of circadian timing over a range of protein concentrations requires an effectively ultrasensitive switch in each KaiC hexamer from an exclusively KaiA-binding state to a state that can bind to KaiB as phosphorylation proceeds. This effect requires that KaiC hexamers consist of mixtures of differentially phosphorylated subunits, as would be produced by stochastic autophosphorylation of a hexamer. Ultrasensitivity results from opposing effects of phosphorylation on Thr432 and Ser431 in controlling a concerted transition within a given KaiC hexamer. Including this mechanism in the model is necessary to explain the experimentally observed tolerance of the system to altered protein concentrations.     

Rehabilitation Engineering & Assistive Technology Society (RESNA) position on the application of wheelchair standing devices: 2013 current state of the literature

This article, approved by the Rehabilitation Engineering & Assistive Technology Society of North America Board of Directors on December 23, 2013, shares typical clinical applications and provides evidence from the literature supporting the use of wheelchair standers.