Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus disease after allogeneic hematopoietic stem cell transplantation

BACKGROUND

Currently, acyclovir (ACV) at 1000 mg/day is widely used as prophylaxis in the early phase of hematopoietic stem cell transplant (HSCT) in Japan. However, low-dose ACV (200 mg/day) has been shown to prevent varicella zoster virus reactivation in the middle and late phases of HSCT.

METHODS

Therefore, in this study, we decreased the dose of ACV to 200 mg/day in the early phase after HSCT. We analyzed 93 consecutive herpes simplex virus (HSV)-seropositive patients who underwent allogeneic HSCT for the first time in our center between June 2007 and December 2011.

RESULTS

Before August 2009, 38 patients received oral ACV at 1000 mg/day (ACV1000) until day 35 after HSCT, whereas 55 patients received oral ACV at 200 mg/day (ACV200) after September 2009. We compared the cumulative incidence of HSV infection in the 2 groups. Oral ACV was changed to intravenous administration because of intolerance in 66% and 45% of the patients in the ACV1000 and ACV200 groups, respectively (P = 0.060). The probability of severe stomatitis (Bearman grade II-III) was 76% and 60% in the ACV1000 and ACV200 groups, respectively (P = 0.12). The number of patients who developed HSV disease before day 100 after HSCT was 0 in the ACV1000 group and 2 in the ACV200 group, with a cumulative incidence of 3.6% (P = 0.43). HSV disease in the latter 2 patients was limited to the lips and tongue and was successfully treated with ACV or valacyclovir at a treatment dose.

CONCLUSION

ACV at 200 mg/day appeared to be effective for preventing HSV disease in the early phase after HSCT.

Electrospun composite nanofiber yarns containing oriented graphene nanoribbons

The graphene nanoribbon (GNR)/carbon composite nanofiber yarns were prepared by electrospinning from poly(acrylonitrile) (PAN) containing graphene oxide nanoribbons (GONRs), and successive twisting and carbonization. The electrospinning process can exert directional shear force coupling with the external electric field to the flow of the spinning solution. During electrospinning, the well-dispersed GONRs were highly oriented along the fiber axis in an electrified thin liquid jet. The addition of GONRs at a low weight fraction significantly improved the mechanical properties of the composite nanofiber yarns. In addition, the carbonization of the matrix polymer enhanced not only the mechanical but also the electrical properties of the composites. The electrical conductivity of the carbonized composite yarns containing 0.5 wt % GONR showed the maximum value of 165 S cm(-1). It is larger than the maximum value of the reported electrospun carbon composite yarns. Interestingly, it is higher than the conductivities of both the PAN-based pristine CNF yarns (77 S cm(-1)) and the monolayer GNRs (54 S cm(-1)). These results and Raman spectroscopy supported the hypothesis that the oriented GONRs contained in the PAN nanofibers effectively functioned as not only the 1-D nanofiller but also the nanoplatelet promoter of stabilization and template agent for the carbonization.

Malformation surveillance and maternal drug exposure: the MADRE project

A project implemented within the framework of the International Clearinghouse for Birth Defect Monitoring Systems is named MADRE: MAlformation DRug Exposure surveillance. The idea is to survey the simultaneous occurrence of malformations and first-trimester drug exposures. In a 2-year period 1990-91, this has yielded 1448 infants known to have been exposed to drugs and that are known to have malformations. Cases have been reported by eight programs: Australia, Central-East France, Israel, Italy IPIMC, Italy IMER, Japan Red Cross Hospitals, Japan Maternal Health and Welfare, and South America. By searching this databank for associations between drugs and malformations, specific relationships can be detected.The 9th revision of the WHO International Classification of Diseases, adapted by the British Paediatric Association, known as ICD9/BPA is used for coding malformations. This is a hierarchical system with 5 digits as the maximum level of specification of each malformation.The ATC (Anatomical Therapeutic Chemical) classifications system is used for coding drugs. This is a multiple level, hierarchical classification with up to 7 digits for specifying each drug.Up to five drugs and malformations are coded for each case using ATC and ICD9/BPA classifications, and all observed drug-malformation pairs form the basis for the analysis. For each drug-malformation combination where three or more cases are observed, a set of 2×2 tables is formed and analyzed as in case-control studies. The odds ratio for the pair, stratified for program, gives the relative risk for the malformation in question, comparing use of the specific drug with all other drugs.Well known or controversial associations were tested in the collected material, and at this stage only one new association is suggested, that is between cardiac defects and maternal treatment with thyroid hormones. This finding has to be further explored with new data.

Hyperbilirubinemia in the early phase after allogeneic HSCT: prognostic significance of the alkaline phosphatase/total bilirubin ratio

Hyperbilirubinemia in the early phase after allogeneic hematopoietic SCT (HSCT) is due to various causes. One of the most important causes of hyperbilirubinemia is veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS). However, the prognosis of patients who are clinically diagnosed as SOS varies. We retrospectively evaluated 82 patients who underwent their first allogeneic HSCT. GVHD prophylaxis was a combination of short-term MTX and CsA (n=77) or tacrolimus (n=5). Thirty-three patients developed hyperbilirubinemia, with a bilirubin level of at least 2 mg/dL, within 20 days after HSCT. Of these patients, 24 were diagnosed as VOD/SOS using the modified Seattle criteria. Twenty-six recovered to a bilirubin level of <2 mg/dL. We focused on the serum alkaline phosphatase/total bilirubin ratio (ALP/TB) at the onset of hyperbilirubinemia and found that it significantly predicted the recovery from hyperbilirubinemia. OS was significantly higher in patients with a lower ALP/TB ratio (P=0.00056). In addition, a lower ALP/TB ratio was associated with better survival even in patients who were clinically diagnosed as SOS (P<0.001). The ALP/TB ratio at the onset of hyperbilirubinemia may be a useful predictor for the prognosis of hyperbilirubinemia and SOS early after HSCT.

Varicella zoster virus meningoencephalitis after allogeneic hematopoietic stem cell transplantation

Although the reactivation of varicella zoster virus (VZV) is a common complication after allogeneic hematopoietic stem cell transplantation (HSCT), VZV meningoencephalitis is a rare life-threatening infectious disease after HSCT. We describe here a patient who developed VZV meningoencephalitis 2 years after human leukocyte antigen-matched unrelated HSCT for acute myeloblastic leukemia. She developed chronic graft-versus-host disease, and cyclosporine (CSA) was continued until 17 months after HSCT. Low-dose acyclovir (ACV) at 200 mg/day was administered to prevent the reactivation of VZV from day -7 to the termination of CSA. At 22 months, she suddenly developed fever, loss of consciousness, and seizure, with generalized skin rash. A high level of VZV DNA was detected in her cerebrospinal fluid (CSF). She was diagnosed to have VZV meningoencephalitis. Intravenous ACV at 30 mg/kg/day was given for 2 months. Although loss of consciousness was quickly resolved, some neurologic symptoms persisted. She did not have any known risk factors for VZV reactivation. Therefore, we should keep in mind that any HSCT recipient may develop VZV meningoencephalitis, and examination of CSF for VZV infection with an empiric administration of ACV may be recommended for HSCT recipients with central nervous system symptoms, even in the absence of skin manifestations.

A novel polymeric chemosensor: dual colorimetric detection of metal ions through click synthesis

A highly colored polystyrene derivative bearing side chain chromophores composed of dialkylanilino donor and cyano-based acceptor groups, prepared by atom-economic click postfunctionalization, displays the dual colorimetric detection behavior of several metal ions based on the specific interactions with different nitrogen atoms. Hard to borderline metal ions, such as Fe(3+) , Fe(2+) , and Sn(2+) , are always recognized by the dialkylanilino nitrogen atom, resulting in a decrease in the charge-transfer (CT) band intensity of the donor-acceptor chromophores. On the other hand, the recognition site of a soft metal ion of Ag(+) is the cyano nitrogen atom due to the readily formed multivalent coordination, which produces a bathochromic shift of the CT band.

Stabilization of organic field-effect transistors by tert-butyl groups in dibenzotetrathiafulvalene derivatives

For a material for organic thin-film transistors, not only high mobility but also low threshold voltage and long-term stability are important requirements. In order to realize these properties, materials with relatively large oxidation potentials, namely weak donors, have been designed as p-channel organic semiconductors. Here we propose a different strategy; transistor properties of dibenzotetrathiafulvalene (DBTTF) are significantly improved by the introduction of tert-butyl groups. Although this chemical modification does not much change the ionization potential, small threshold voltage and stability over several months are attained together with the improved mobility, probably due to some kind of passivation effect of the bulky tert-butyl groups. In contrast, the systematic fluorine substitution rapidly diminishes the transistor performance. There are two kinds of herringbone structures with much different dihedral angles of about 50° and 130°, and the tert-butyl compound falls into the former category.