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Because of its abstract nature, Albert Einstein's theory of general relativity is rarely present in school physics curricula. Although the educational community has started to investigate ways of bringing general relativity to classrooms, field-tested educational material is rare. Employing the model of educational reconstruction, we present a collaborative online learning environment that was introduced to final year students (18-19 years old) in six Norwegian upper secondary physics classrooms. Design-based research methods guided the development of the learning resources, which were based on a sociocultural view of learning and a historical-philosophical approach to teaching general relativity. To characterize students' learning from and interaction with the learning environment we analyzed focus group interviews and students' oral and written responses to assigned problems and discussion tasks. Our findings show how design choices on different levels can support or hinder understanding of general relativity, leading to the formulation of design principles that help to foster qualitative understanding and encourage collaborative learning. The results indicate that upper secondary students can obtain a qualitative understanding of general relativity when provided with appropriately designed learning resources and sufficient scaffolding of learning through interaction with teacher and peers.

Studies indicate that the failure of science education to meet the needs of the 21st century is to some extent due to the inability to incorporate scientific reasoning and higher order assessments in the school instruction. Though the outcomes of education seek higher-order thinking abilities there is a lack of high ability assessments in low-income nations. This study aimed to develop and validate Scientific Reasoning Progress Tool (SRPT) that measures students’ reasoning abilities. In this study, 40 items were developed, pilot-tested, and administered to 242 students from grade eight. The SRPT was a valid and reliable instrument. It was also found that the reasoning ability of grade 8 students’ is limited to the lower levels of reasoning. It is recommended that further study is essential through the adoption of the framework and the design to develop additional instruments and investigation of the progression of students’ scientific reasoning ability.

The purpose of this study was to explore grade eight students’ views in terms of different scientific reasoning progress levels. To explore students’ views, phenomenographic study was used. The qualitative analysis of students’ interviews elicited three major themes of students’ views about scientific reasoning progress levels: naïve, mixed, and scientific, along with the underlying ways of reasoning patterns. It was revealed that students think that scientific knowledge is static, fixed, universal, certain, and unchangeable. It is recommended that a need to consider an inquiry-based teaching in combination with the contextualized approach of nature of science in school science curriculum and classroom instruction to promote students’ scientific views on the nature of science and higher scientific reasoning abilities.

BackgroundGreater understanding of differential therapeutic sensitivity, specifically to immunotherapy, in small-cell lung cancer (SCLC) is required.MethodsWe explored SCLC heterogeneity through integrated molecular characterization of tumor tissue samples from 159 treatment-naive patients, utilizing genetic, epigenetic, transcriptional, and proteomic profiling, immunohistochemistry staining for multiple biologically relevant markers including transcriptional subtype-defining proteins, and spatial immune profiling using multiplex immunofluorescence.ResultsMulti-omics analysis confirmed high heterogeneity across/within neuroendocrine and non-neuroendocrine subtypes. Methylomics analysis identified four methylome clusters that may enhance subtype prediction, prognosis, and longitudinal monitoring of subtype evolution. Immunohistochemistry analysis showed high MHC-I expression in non-neuroendocrine subtypes, which have greatest potential benefit from adding immunotherapy to chemotherapy; high DLL3 expression associated with neuroendocrine subtypes and an immune-cold tumor microenvironment. Multiplex immunofluorescence demonstrated associations of MHC-I with spatial arrangement and phenotypic features of immune cells in the tumor microenvironment of high-MHC-I-expressing SCLC, providing mechanistic rationale for MHC-I as a potential biomarker of immunotherapy response.ConclusionsThis multimodal profiling analysis provides further insights into the biologic complexity of SCLC and highlights potential therapeutic vulnerabilities of distinct disease subtypes.

Background The absence of the putative DNA/RNA helicase Schlafen11 (SLFN11) is thought to cause resistance to DNA-damaging agents (DDAs) and PARP inhibitors. Methods We developed and validated a clinically applicable SLFN11 immunohistochemistry assay and retrospectively correlated SLFN11 tumour levels to patient outcome to the standard of care therapies and olaparib maintenance. Results High SLFN11 associated with improved prognosis to the first-line treatment with DDAs platinum-plus-etoposide in SCLC patients, but was not strongly linked to paclitaxel–platinum response in ovarian cancer patients. Multivariate analysis of patients with relapsed platinum-sensitive ovarian cancer from the randomised, placebo-controlled Phase II olaparib maintenance Study19 showed SLFN11 tumour levels associated with sensitivity to olaparib. Study19 patients with high SLFN11 had a lower progression-free survival (PFS) hazard ratio compared to patients with low SLFN11, although both groups had the benefit of olaparib over placebo. Whilst caveated by small sample size, this trend was maintained for PFS, but not overall survival, when adjusting for BRCA status across the olaparib and placebo treatment groups, a key driver of PARP inhibitor sensitivity. Conclusion We provide clinical evidence supporting the role of SLFN11 as a DDA therapy selection biomarker in SCLC and highlight the need for further clinical investigation into SLFN11 as a PARP inhibitor predictive biomarker.

Despite the success of current medical and surgical management of ischemic heart disease, a growing number of patients have diffuse obstructive coronary artery disease that is not amenable to coronary-artery bypass grafting or catheter-based interventions. This problem has stimulated interest in developing alternative therapeutic approaches. Early attempts at indirect myocardial revascularization had limited success. Beck's use of omentopexy, reported in 1935, 1 and Vinberg's use of thoracic-artery implantation, reported in 1954, 2 were attempts to provide direct myocardial perfusion and were based on the description by Wearn et al., in 1933, 3 of a sinusoidal network in the human heart. In 1965, Sen . . .

BackgroundSmall cell lung cancer (SCLC) is an aggressive and largely immune-cold cancer type, for which chemotherapy combined with Immuno-oncology (IO) therapies is providing benefit only in a subgroup of patients. SCLC is a highly heterogeneous cancer with at least four major subtypes.1 Among them, the ‘inflamed’ subtype is characterized by an inflamed immune gene signature and high expression of MHC class I (MHC-I) antigen presentation and shows the greatest benefit from the addition of IO treatment to chemotherapy,2 suggesting that MHC-I could serve as a biomarker for IO therapies. Here, we aimed to assess the spatial characteristics of immune cells in MHC-I high SCLC cases to investigate and support its role as a potential biomarker for IO therapies.MethodsWe combined a computational pathology approach with multiplex immunofluorescence (mIF) to profile the SCLC tumor microenvironment (TME). To this end, 126 SCLC formalin-fixed, paraffin-embedded tissue samples were stained with two mIF panels consisting of six markers each: (A) PanCK, CD8, CD68, PD-1, PD-L1, and Ki67; (B) CD20, NKp46, CD1c, CD66b, ICOS, and FOXP3. Based on these panels, we investigated the location and phenotype of each cell in the tumor center and within the stroma and tumor parenchyma. Additional slides from the same tissue blocks were immunohistochemically stained with MHC-I and scored by pathologists. Starting from the observation that high MHC-I expression was associated with higher densities of CD8+ T-cells,3 we further explored the TME characteristics of MHC-I SCLC cases.ResultsBeyond higher densities of CD8+ cytotoxic T-cells, we observed higher densities of FOXP3+ regulatory T-cells, and ICOS+ T-cells in the tumor center of MHC-I high cases. Considering the role of MHC-I in antigen presentation and T-cell activation, we investigated the proportion of CD8;PD-1;Ki67+ T-cells out of all CD8+ cells. Of note, we observed a compelling association of a high proportion of CD8;PD-1;Ki67+ T-cells with high MHC-I. This effect was particularly prominent in the tumor parenchyma and absent in the stroma, revealing an association with functionally relevant presentation of tumor antigens by MHC-I on SCLC tumor cells. Interestingly, we did not observe alterations in other immune cell populations like myeloid dendritic cells, macrophages, and granulocytes.ConclusionsWe utilized computational pathology to comprehensively profile the composition and spatial arrangement of the TME in inflamed SCLC cases defined by high MHC-I expression. Our findings provide the functional rationale for MHC-I as a biomarker for a potentially increased response to IO therapies.4 ReferencesGay CM, Stewart CA, Park EM, Diao L, Groves SM, Heeke S, Nabet BY, Fujimoto J, Solis LM, Lu W, Xi Y, Cardnell RJ, Wang Q, Fabbri G, Cargill KR, Vokes NI, Ramkumar K, Zhang B, Della Corte CM, Robson P, Swisher SG, Roth JA, Glisson BS, Shames DS, Wistuba II, Wang J, Quaranta V, Minna J, Heymach JV, Byers LA. Patterns of transcription factor programs and immune pathway activation define four major subtypes of SCLC with distinct therapeutic vulnerabilities. Cancer Cell. 2021 Mar 8;39(3):346–360.e7. doi: 10.1016/j.ccell.2020.12.014. Epub 2021 Jan 21. PMID: 33482121; PMCID: PMC8143037.Mahadevan NR, Knelson EH, Wolff JO, Vajdi A, Saigí M, Campisi M, Hong D, Thai TC, Piel B, Han S, Reinhold BB, Duke-Cohan JS, Poitras MJ, Taus LJ, Lizotte PH, Portell A, Quadros V, Santucci AD, Murayama T, Cañadas I, Kitajima S, Akitsu A, Fridrikh M, Watanabe H, Reardon B, Gokhale PC, Paweletz CP, Awad MM, Van Allen EM, Lako A, Wang XT, Chen B, Hong F, Sholl LM, Tolstorukov MY, Pfaff K, Jänne PA, Gjini E, Edwards R, Rodig S, Reinherz EL, Oser MG, Barbie DA. Intrinsic Immunogenicity of Small Cell Lung Carcinoma Revealed by Its Cellular Plasticity. Cancer Discov. 2021 Aug;11(8):1952–1969. doi: 10.1158/2159–8290.CD-20–0913. Epub 2021 Mar 11. PMID: 33707236; PMCID: PMC8338750.Vuko M, Xie M, Gavaldon MA, Segerer F, Spitzmueller A, Hessel H, Testori M, Zimmermann J, Surace M, Heininen-Brown M, Canales JR, Saran S, Angell H, Schmidt G, Sade H, Barrett C, Schick M, Fabbri G. 155 MHC class I antigen presentation is associated with an inflamed SCLC tumor microenvironment characterized by a higher density of cytotoxic T-cells in closer proximity to tumor cells. Journal for ImmunoTherapy of Cancer 2022;10:doi: 10.1136/jitc-2022-SITC2022.0155Rudin CM, Balli D, Lai WV, Richards AL, Nguyen E, Egger JV, Choudhury NJ, Sen T, Chow A, Poirier JT, Geese WJ, Hellmann MD, Forslund A. Clinical benefit from immunotherapy in patients with small cell lung cancer is associated with tumor capacity for antigen presentation. J Thorac Oncol. 2023 May 18:S1556–0864(23)00554–3. doi: 10.1016/j.jtho.2023.05.008. Epub ahead of print. PMID: 37210008.Ethics ApprovalAll samples from which data in this report were generated, were obtained from an internal repository. All protocols, amendments, and participant informed consent documents were approved by the appropriate institutional review boards.

BackgroundHead and neck squamous cell carcinoma (HNSCC) is composed of a heterogeneous group of tumors arising trough environmental carcinogens or infection by human papillomavirus (HPV). Treatment interventions such as immunotherapy and targeted therapy have shown clinical benefit in HNSCC patients. Despite these encouraging results, resistance to treatment is still observed in the majority of patients. Additionally, clinical effectiveness of treatment options has also been shown to be associated with HPV status. Here we investigate the tumoral and peripheral landscape of HPV(-) vs. HPV(+) head and neck cancers to identify features able to expand treatment options for patients with Viral- and Carcinogen-Driven Head and Neck Cancer.MethodsBiopsies and serum samples derived from 502 primary and metastatic HNSCC patients were leveraged for genomic, proteomic and immunochemistry evaluations. Tumor biopsies from HNSCC patients commercially obtained (n=143) or derived from patients enrolled in CP1108 trial (n=19, NCT01693562) were profiled by gene expression. Primary tumor biopsies (N=198) from HNSCC have been assessed by Whole Exome Sequence (WES). Expression of immune markers including CD8, NKp46 was evaluated by immunohistochemistry (IHC) on 186 and 214 tumors biopsies, respectively. The expression of 80 immune related soluble factors was evaluated in serum derived from n=285 patients of HNSCC enrolled in EAGLE (NCT02369874), a randomized, open-label, study assessing Durvalumab and Tremelimumab vs. Standard of Care (SoC). Statistical comparison between HPV(+) vs. HPV (-) samples were conducted using R software.ResultsPatients with HPV(-) vs. HPV(+) HNSCC were characterized by worse prognosis. Increased levels of immunosuppressive factors including VEGF (p=0.01), IL-8 (p=0.02), IL6 (p=0.07) and macrophages chemo attractive factor CCL4 (p=0.07) was observed in the serum of HPV(-) vs HPV(+) HNSCC patients. In the tumor microenvironment, higher mRNA expression of immune signatures associated with MDSC, Cancer Associated Fibroblast (CAF), and Metalloproteinase (MMP) was observed in HPV(-) vs. HPV (+) HNSCC patients. In contrast, HNSCC HPV(+) patients were characterized by increased mRNA expression of DC signatures and IFNg related genes (i.e. CXCL9). No differential infiltration of T and NK cells (CD8+ and NKp46+) were found in HPV (-) vs. HPV(+) patients. Enrichments of mutations in EGFR, and DNA repair genes (PMS1, POLK, ATM) was observed in HPV(+) patients. On the contrary, enrichments of mutations in TP53 was observed in HPV(-) patients.ConclusionsDeep evaluation of tumoral and peripheral landscape of viral- versus carcinogen-driven HNSCC might help understanding differential outcome of treatments regimens in HPV(+) vs HPV (-) HNSCC thus leading to novel therapeutic interventions.Trial RegistrationNCT01693562,NCT02369874Ethics ApprovalThe study was approved by Astrazeneca.ConsentPatients provided written consent to perform evalutions here described.

BackgroundSmall cell lung cancer (SCLC) is generally known to exclude immune cells and durable responses to immunotherapies are rare. Only very few biomarkers to inform immuno-oncology (IO) treatments are established in clinical practice thus far. Recently, four major SCLC subtypes (SCLC-A, SCLC-N, SCLC-P and SCLC-I) were described. Whereas the first three are characterized by activation of specific transcription factors, the SCLC-I (inflamed) subtype is characterized by an inflamed gene signature, high expression of MHC class I (MHC-I) antigen presentation and shows the greatest benefit from addition of immunotherapy to chemotherapy treatment [1,2]. Importantly, MHC-I is epigenetically silenced in the vast majority of SCLC and the presence of MHC-I could serve as a biomarker for the identification of SCLC-I cases. [2]. Here, we aimed to assess the biology of MHC-I high SCLC cases to investigate its role as a biomarker to inform cancer immunotherapies.MethodsWe combined the power of artificial intelligence (AI)-driven computational pathology with multiplex immunofluorescence (mIF) to gain critical insight into the tumor microenvironment (TME) of SCLC. 125 SCLC formalin-fixed, paraffin-embedded tissue samples were stained with a mIF panel consisting of six markers: PanCK, CD8, CD68, PD-1, PD-L1, and Ki67. We assessed the phenotype and spatial location of each cell in the pathologist-annotated tumor center and within the AI-segmented stroma and tumor epithelium. Pathologists classified immunohistochemically stained MHC-I slides from the same tissue blocks as MHC-I high, medium, or low according to their H-scores (low: ≤30; medium: 31–139; high: ≥140). TME characteristics between those groups were compared.ResultsIn all measured regions, we found higher densities of CD8+ and particularly PD-1/CD8 double positive T-cells in the MHC-I high group. Moreover, we observed the highest proportion of PD-1 positivity among cytotoxic T-cells in the tumor epithelium of MHC-I high samples, which also showed a high density of PD-L1+ tumor cells. Average distance of PD-1+ T-cells to their nearest tumor cell was lowest in the MHC-I high group. In the same group, an average of 19.3% of tumor cells in the epithelium had at least one PD-1+ T-cell within a 50 µm radius, while in the MHC-I low group this average was only 8.9%.ConclusionsWe utilized cutting-edge computational pathology to establish MHC-I as orchestrator of the composition and spatial arrangement of an inflamed SCLC TME. Beyond that, our findings corroborate the role of MHC-I as a potential biomarker for inflamed SCLC cases, which benefit most from cancer immunotherapies.ReferencesGay CM, Stewart CA, Park EM, Diao L, Groves SM, Heeke S, Nabet BY, Fujimoto J, Solis LM, Lu W, Xi Y, Cardnell RJ, Wang Q, Fabbri G, Cargill KR, Vokes NI, Ramkumar K, Zhang B, Della Corte CM, Robson P, Swisher SG, Roth JA, Glisson BS, Shames DS, Wistuba II, Wang J, Quaranta V, Minna J, Heymach JV, Byers LA. Patterns of transcription factor programs and immune pathway activation define four major subtypes of SCLC with distinct therapeutic vulnerabilities. Cancer Cell. 2021 Mar 8;39(3):346–360.e7. doi: 10.1016/j.ccell.2020.12.014. Epub 2021 Jan 21. PMID: 33482121; PMCID: PMC8143037.Mahadevan NR, Knelson EH, Wolff JO, Vajdi A, Saigí M, Campisi M, Hong D, Thai TC, Piel B, Han S, Reinhold BB, Duke-Cohan JS, Poitras MJ, Taus LJ, Lizotte PH, Portell A, Quadros V, Santucci AD, Murayama T, Cañadas I, Kitajima S, Akitsu A, Fridrikh M, Watanabe H, Reardon B, Gokhale PC, Paweletz CP, Awad MM, Van Allen EM, Lako A, Wang XT, Chen B, Hong F, Sholl LM, Tolstorukov MY, Pfaff K, Jänne PA, Gjini E, Edwards R, Rodig S, Reinherz EL, Oser MG, Barbie DA. Intrinsic Immunogenicity of Small Cell Lung Carcinoma Revealed by Its Cellular Plasticity. Cancer Discov. 2021 Aug;11(8):1952–1969. doi: 10.1158/2159-8290.CD-20-0913. Epub 2021 Mar 11. PMID: 33707236; PMCID: PMC8338750.Ethics ApprovalAll samples from which data in this report were generated, were obtained from an internal repository. All protocols, amendments, and participant informed consent documents were approved by the appropriate institutional review boards.

To identify nutritional and weight gain limitations associated with retinopathy of prematurity (ROP) severity among very preterm newborns. 1180 infants <28 weeks GA at birth with ROP examination results were grouped and analyzed by quartile of weekly total calorie, carbohydrate, protein, and lipid intake, as well as growth velocity between postnatal days 7 and 28 (adjusted for GA and birth weight Z-score). ROP was categorized by development of no, mild (

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