Quantification of subclonal distributions of recurrent genomic aberrations in paired pre-treatment and relapse samples from patients with B-cell chronic lymphocytic leukemia

Genome-wide array approaches and sequencing analyses are powerful tools for identifying genetic aberrations in cancers, including leukemias and lymphomas. However, the clinical and biological significance of such aberrations and their subclonal distribution are poorly understood. Here, we present the first genome-wide array based study of pre-treatment and relapse samples from patients with B-cell chronic lymphocytic leukemia (B-CLL) that uses the computational statistical tool OncoSNP. We show that quantification of the proportion of copy number alterations (CNAs) and copy neutral loss of heterozygosity regions (cnLOHs) in each sample is feasible. Furthermore, we (i) reveal complex changes in the subclonal architecture of paired samples at relapse compared with pre-treatment, (ii) provide evidence supporting an association between increased genomic complexity and poor clinical outcome (iii) report previously undefined, recurrent CNA/cnLOH regions that expand or newly occur at relapse and therefore might harbor candidate driver genes of relapse and/or chemotherapy resistance. Our findings are likely to impact on future therapeutic strategies aimed towards selecting effective and individually tailored targeted therapies.

Bulk Ring-Opening Transesterification Polymerization of the Renewable δ-Decalactone Using an Organocatalyst

The bulk ring-opening polymerization of renewable δ-decalactone using 1,5,7-triazabicyclo[4.4.0]dec-5-ene was carried out at temperatures between 7 and 110 °C. The equilibrium monomer concentration for reactions within this temperature range was used to determine the polymerization thermodynamic parameters (ΔH_p = -17.1 ± 0.6 kJ mol^-1, ΔS_p = -54 ± 2 J mol^-1 K^-1) for δ-decalactone. The polymerization kinetics were established and high molar mass poly(δ-decalactone) was prepared with a glass transition temperature of -51 °C. Poly(δ-decalactone) samples with controlled molar mass and narrow molar mass distributions were realized by controlling the monomer conversion and initiator concentration. A high molar mass poly(lactide)-poly(δ-decalactone)-poly(lactide) triblock copolymer with a low polydispersity index was prepared by simple sequential addition of monomers. The product triblock exhibited two distinct glass transitions temperatures consistent with microphase segregation.

Arteriovenous fistula formation after a closed proximal tibial fracture in a child

Arteriovenous fistula formation after a closed extremity fracture is rare. We present the case of an 11-year-old boy who developed an arteriovenous fistula between the anterior tibial artery and popliteal vein after closed fractures of the proximal tibia and fibula. The fractures were treated by closed reduction and casting. A fistula was diagnosed 12 weeks after the injury. It was treated by embolisation with coils. Subsequent angiography and ultrasonography confirmed patency of the popliteal vein and anterior and posterior tibial and peroneal arteries, with no residual shunting through the fistula. The fractures healed uneventfully and he returned to full unrestricted activities 21 weeks after his injury.

Use of qualitative research to inform development of nutrition messages for low-income mothers of preschool children

OBJECTIVE

To develop and test nutrition messages and supporting content with low-income mothers for use with theory-based interventions addressing fruit and vegetable consumption and child-feeding practices.

DESIGN

Six formative and 6 evaluative focus groups explored message concepts and tested messages, respectively.

SETTING

Research facilities in Maryland, Texas, California, Florida, North Carolina, New York, Alabama, and Illinois.

PARTICIPANTS

Ninety-five low-income mothers of 2- to 5-year-old children; over half from households participating in a federal nutrition assistance program.

PHENOMENON OF INTEREST

Preference for and comprehension of nutrition messages.

ANALYSIS

Qualitative data analysis procedures to generate common themes from transcripts and observers' notes.

RESULTS

Messages on role modeling, cooking and eating together, having patience when introducing new food items, and allowing children to serve themselves were well received. Mothers preferred messages that emphasized their role as a teacher and noted benefits such as their children becoming more independent and learning new skills. Mothers commonly doubted children's ability to accurately report when they are "full" and disliked messages encouraging mothers to allow children to "decide" whether and how much to eat.

CONCLUSIONS AND IMPLICATIONS

This study generated 7 audience-tested messages for incorporation into nutrition education interventions targeting low-income mothers of preschool-age children.

Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand

AIMS

To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ).

METHODS

A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ.

RESULTS

All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs.

CONCLUSIONS

Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective.

Follow-up for Alzheimer patients: European Alzheimer Disease Consortium position paper

BACKGROUND AND PURPOSE

Alzheimer disease (AD) is one of the leading causes of dependence in the elderly. Providing care for patients with AD is complex and the type of care required depends on the stage of the disease and varies over time. The aim of this article is to discuss available care strategies once the AD diagnosis has been made and to propose a follow-up plan as standard of care at a European level.

METHODS

The proposals developed in this article stem from the collaborative work of a panel of multidisciplinary experts involved in the care of AD patients (European Alzheimer Disease Consortium) based on the results of published scientific studies and on their experience from clinical practice.

CONCLUSION

Suggestions for follow-up frequency and easily administered and scored assessment tools are provided, thereby increasing efficiency and quality of care for patients with Alzheimer disease.