No abstract

Background:Current approaches for detecting circulating tumour cells (CTCs) in blood are dependent on CTC enrichment and are based either on surface epithelial markers on CTCs or on cell size differences. The objectives of this study were to develop and characterise an ultrasensitive multiplex fluorescent RNA in situ hybridisation (ISH)-based CTC detection system called CTCscope. This method detects a multitude of tumour-specific markers at single-cell level in blood.Methods:Healthy blood samples spiked with tumour cell lines were used as a model system for the development and initial characterisation of CTCscope. To demonstrate the feasibility of CTC detection in patient blood, duplicate blood samples were drawn from 45 metastatic breast cancer patients for analysis by CTCscope and the CellSearch system. The association of CTCs with the tumour marker CA15-3 and progression-free survival (PFS) were assessed.Results:CTCscope detected CTC transcripts of eight epithelial markers and three epithelial-mesenchymal-transition (EMT) markers for increased sensitivity. CTCscope was used to detect CTCs with minimal enrichment, and did not detect apoptotic or dead cells. In patient blood samples, CTCs detected by CellSearch, but not CTCscope, were positively correlated with CA15-3 levels. Circulating tumour cells detected by either CTCscope or CellSearch predicted PFS (CTCscope, HR (hazard ratio) 2.26, 95% CI 1.18–4.35, P=0.014; CellSearch, HR 2.50, 95% CI 1.27–4.90, P=0.008).Conclusion:CTCscope offers unique advantages over existing CTC detection approaches. By enumerating and characterising only viable CTCs, CTCscope provides additional prognostic and predictive information in therapy monitoring.

Thin films with tailored microstructures are an emerging class of materials with applications such as battery electrodes, organic electronics, and biosensors. Such thin film devices typically exhibit a multi-phase microstructure that is confined, and show large anisotropy. Current approaches to microstructure design focus on optimizing bulk properties, by tuning features that are statistically averaged over a representative volume. Here, we report a tool for morphogenesis posed as a graph-based optimization problem that evolves microstructures recognizing confinement and anisotropy constraints. We illustrate the approach by designing optimized morphologies for photovoltaic applications, and evolve an initial morphology into an optimized morphology exhibiting substantially improved short circuit current (68% improvement over a conventional bulk-heterojunction morphology). We show optimized morphologies across a range of thicknesses exhibiting self-similar behavior. Results suggest that thicker films (250 nm) can be used to harvest more incident energy. Our graph based morphogenesis is broadly applicable to microstructure-sensitive design of batteries, biosensors and related applications.

Intramedullary spinal cord metastases are a rare complication of malignancy, associated with a poor prognosis. We describe three cases with extensively pretreated advanced breast cancer developing intramedullary spinal cord metastases two of whom were receiving trastuzumab, one of whom was a male. As therapeutic advances increase overall survival for patients with metastatic breast cancer, patterns of disease are changing with improved systemic control. The incidence of intramedullary spinal cord metastases is likely to increase but management strategies remain unclear.