Heyan Xiao

© 2015 by the American Society of Nephrology.Background and objectives The Centers for Medicare & Medicaid Services requires that dialysis centers informnewpatients of their transplant options and document compliance using theCMS-2728Medical Evidence Form. This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators of their centers’ quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates. Design, setting, participants, & measurements Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in theHeartland Kidney Network in 2009–2011; educators at these centers completed a survey describing their transplant educational practices. Educators’ own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centerswas examined using multivariable negative binomial regression. Results According to Form-2728, 77% of patients were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves, most commonly reported giving oral recommendations to begin transplant evaluation and referrals to external transplant education programs. Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities had higher transplant wait-listing rates. ConclusionsWhile most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.

Aneuploidy with chromosome instability is a cancer hallmark. We studied chromosome 7 copy number variation in gliomas and in primary cultures derived from them. We found tumor heterogeneity with cells having Chr7-CNV commonly occurs in gliomas, with a higher percentage of cells in high-grade gliomas carrying more than 2 copies of Chr7, as compared to low-grade gliomas. Interestingly, all Chr7-aneuploid cell types in the parental culture of established glioma cell lines reappeared in single-cell-derived subcultures. We then characterized the biology of three syngeneic glioma cultures dominated by different Chr7-aneuploid cell types. We found phenotypic divergence for cells following Chr7 missegregation, which benefited overall tumor growth in vitro and in vivo. Mathematical modeling suggested the involvement of chromosome instability and interactions among cell subpopulations in restoring the optimal equilibrium of tumor cell types. Both our experimental data and mathematical modeling demonstrated that the complexity of tumor heterogeneity could be enhanced by the existence of chromosomes with structural abnormality, in addition to their mis-segregations. Overall, our findings show, for the first time, the involvement of chromosome instability in maintaining tumor heterogeneity, which underlies the enhanced growth, persistence and treatment resistance of cancers. © 2013 Hu et al.