BackgroundObesity is associated with tumor aggressiveness and disease-specific mortality for more than 15 defined malignancies, including prostate cancer. Preclinical studies suggest that weight loss from caloric restriction and increased physical activity may suppress hormonal, energy-sensing, and inflammatory factors that drive neoplastic progression; however, exact mechanisms are yet to be determined, and experiments in humans are limited.MethodsWe conducted a randomized controlled trial among 40 overweight or obese, newly-diagnosed prostate cancer patients who elected prostatectomy to explore feasibility of a presurgical weight loss intervention that promoted a weight loss of roughly one kg. week−1 via caloric restriction and physical activity, as well as to assess effects on tumor biology and circulating biomarkers. Measures of feasibility (accrual, retention, adherence, and safety) were primary endpoints. Exploratory aims were directed at the intervention’s effect on tumor proliferation (Ki-67) and other tumor markers (activated caspase-3, insulin and androgen receptors, VEGF, TNFβ, NFκB, and 4E-BP1), circulating biomarkers (PSA, insulin, glucose, VEGF, TNFβ, leptin, SHBG, and testosterone), lymphocytic gene expression of corresponding factors and cellular bioenergetics in neutrophils, and effects on the gut microbiome. Consenting patients were randomized in a 1:1 ratio to either: 1) weight loss via a healthful, guidelines-based diet and exercise regimen; or 2) a wait-list control. While biological testing is currently ongoing, this paper details our methods and feasibility outcomes.ResultsThe accrual target was met after screening 101 cases (enrollment rate: 39.6 %). Other outcomes included a retention rate of 85 %, excellent adherence (95 %), and no serious reported adverse events. No significant differences by age, race, or weight status were noted between enrollees vs. non-enrollees. The most common reasons for non-participation were “too busy” (30 %), medical exclusions (21 %), and “distance” (16 %).ConclusionsPresurgical trials offer a means to study the impact of diet and exercise interventions directly on tumor tissue, and other host factors that are feasible and safe, though modifications are needed to conduct trials within an abbreviated period of time and via distance medicine-based approaches. Pre-surgical trials are critical to elucidate the impact of lifestyle interventions on specific mechanisms that mediate carcinogenesis and which can be used subsequently as therapeutic targets.Trial registrationNCT01886677

This paper details the development, implementation and evaluation of the South Lanarkshire Framework for Supporting Children with Severe and Profound Learning Needs (“The Framework”). The document assists Scottish schools in taking forward the Curriculum for Excellence for this group of learners and in building capacity amongst staff. The guidance and resources place emphasis on the identification of relevant and individualised learning outcomes and on teaching approaches which promote pupils’ development in key areas. Seven Additional Support Needs (ASN) establishments in South Lanarkshire completed a pre- and post- audit of curricular practice and 24 staff completed an evaluative questionnaire. Eight staff also participated in semi-structured interviews. Analyses indicated that the Framework has influenced teachers in terms of their mind-set, practice and ability to set appropriate targets. Responses also suggested that the document has led to increased collaboration amongst staff and has been shared positively with parents. The findings are discussed in relation to implications for practice and future research directions.

We report a case of a 37-pound scrotal leiomyosarcoma. The literature is reviewed, and the presentation, diagnosis, treatment and survival of patients with scrotal leiomyosarcoma are discussed.

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