Aminophosphine ligands as a privileged platform for development of antitumoral ruthenium(ii) arene complexes

The potential utility of aminophosphine ligands in both high-throughput testing and rational design of new anticancer metallodrugs.

New oral targeted therapies for metastatic breast cancer disrupt the traditional patients' management-A healthcare providers' view

Although a cure still cannot be expected for metastatic breast cancer, thanks to progressive advances in treatments, life expectancy has been increasing over the past 15 years. This study aims to present the impact on the organisation of patients' management of newly released oral targeted therapies dedicated to metastatic breast cancer and the obstacles to their diffusion. Our work is based on the analysis of 40 semi-structured interviews, conducted with oncology healthcare professionals in three regions of France (2015-2016). It shows three main results. First, the prescription of an oral targeted therapy requires greater collaboration between healthcare professionals than traditional intravenous oncology drugs, which may be challenging. Second, there remain many barriers to the dissemination of oral targeted therapies. Third, taking an oral targeted therapy keeps the patient away from the hospital facility and asks for a strong therapeutic alliance. The management of oral targeted therapies is time-consuming for medical oncologists and disrupts the traditional care pathway. The multiplication of actors involved in patients' management reinforces the slowdown in the deployment and acceptance of therapeutic innovations. More players equal a higher risk of slowdown. Questioning and re-designing hospital organisation and management modalities towards this type of care are critical.

Factors Affecting Resilience in Children Exposed to Violence

Exposure to violence puts children at risk for developing a variety of problems, including depression, anxiety, and conduct problems. The extent to which children's individual, family, school, and peer group characteristics influence resilient responses to violence exposure was investigated amongst Grade 6 students living in a high-violence community in Cape Town. The majority (68.44%) reported both witnessing and being a victim of violence. Both witnessing and victimisation by violence were found to be positively associated with anxiety and depression, but only victimisation was positively associated with conduct problems. Peer delinquency was positively associated with both depression and conduct problems. Involvement in conventional after-school activities was negatively associated with anxiety, and school support was negatively associated with both depression and conduct problems. No association was identified between parent support and any of anxiety, depression, or conduct problems. However, this latter finding may be related to measurement problems, or to participants' reports that they were most likely to be victimised in their homes (rather than at school or in the neighbourhood). While this study is limited by its cross-sectional nature, it implies that key sites for intervention are after-school activities, school support, peer delinquency, and home life.

[Non-metastatic triple-negative breast cancer in 2016: Definitions and management]

Triple-negative breast cancer (TN), as defined by the triple negativity in immunohistochemistry: the absence of estrogen receptor, progesterone receptor and the absence of overexpression or amplification of HER2, corresponds to 15 % of invasive breast cancers. This is a very heterogeneous group of tumors both at the genomic and transcriptomic level and at morphological, clinical and prognostic level. Although there are some good prognosis forms, the majority of TN tumors is characterized by a poor prognosis with a greater frequency of visceral metastases and a maximum risk of relapse in the first two years after diagnosis. Systemic adjuvant treatment with chemotherapy is almost always indicated. The surgical treatment and radiotherapy treatment should be comparable to the other subtypes and obey the same rules of oncologic surgery. TN tumors are not associated with a higher risk of locoregional relapse after conservative treatment and adjuvant radiotherapy. Optimization of systemic therapies is currently and for the last decade a challenge. A number of targeted therapies and efficiency biomarkers identification of these targeted therapies is essential to allow significant progress in optimizing systemic therapy for these tumors.

Association between Rome III Diagnostic Criteria and Treatment Failure in Children Brought for Emergency Department Care

BACKGROUND: Many children diagnosed with functional constipation (FC) in the ED in fact meet Rome III criteria for irritable bowel syndrome constipaion subtype (IBS-C). The frequency of this misdiagnosis and its relation to outcomes is unknown.

OBJECTIVES: To determine if treatment failure frequency differs based on Rome III diagnostic criteria classification in a cohort of ED children diagnosed by treating physicians as having constipation.

DESIGN/METHODS: We performed a prospective cohort study of children 1 month – 18 years of age who were diagnosed with or were treated as FC in a pediatric ED. ED chart data was abstracted and a follow-up call was performed 7 days post-ED visit to enable the completion of the ROME III functional intestinal disorder questionnaire, confirm treatments administered, and enable symptom resolution assessment. 'Adequate therapy' was defined in accordance with ESPGHAN/NASPGHAN consensus guidelines. Treatment failure was defined by ≥2 of the following: persistence of presenting symptom(s), bowel movement frequency <1 every other day, pain or difficulty passing stools, abdominal pain between bowel movements, and/or persistence of the ED chief complaint.

RESULTS: 929 potentially eligible children were identified; 237 were excluded. We failed to contact 162 patients and 17 refused consent. 513 (74%) completed day 7 follow up – 227 (44%) met FC ROME III criteria, 119 (23%) met IBS-C criteria and 167 (33%) did not meet IBS-C or FC criteria and were classified as ‘other’. Mean age was 6.1±3.9 years. Treatment failure occurred in 69 (30%) FC patients, 50 (43%) of those with IBS-C, and 41 (25%) of ‘other’ group; P=0.007. These differences persisted when only those receiving ‘adequate therapy’ (n=308) were included: 41 (28%) of FC and 16 (22%) of those in the ‘other’ group had persistent symptoms compared to 37 (43%) of IBS-C patients; P=0.008. Kaplan-Meier analysis revealed greater symptom persistence in children with IBS-C compared to those with FC (P<0.001). Those classified as FC were more likely to have abdominal distension (P=0.05) and tenderness (P=0.04) compared to the IBS-C.

CONCLUSION: Children diagnosed with constipation in an ED who fulfill ROME III irritable bowel syndrome (constipation subtype) criteria have a higher treatment failure rate at day 7 compared to functional constipation even when including only those who received adequate functinal constipation therapy. ROME III criteria can be employed to identify children with irritable bowel syndrome; such children might benefit from diagnosis specific therapy.

Greatly reduced risk of EBV reactivation in rituximab-experienced recipients of alemtuzumab-conditioned allogeneic HSCT

EBV-associated post-transplant lymphoproliferative disease (PTLD) remains an important complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT). We retrospectively analysed the incidence and risk factors for EBV reactivation in 186 adult patients undergoing consecutive allo-HSCT with alemtuzumab T-cell depletion at a single centre. The cumulative incidence of EBV reactivation was 48% (confidence interval (CI) 41-55%) by 1 year, with an incidence of high-level EBV reactivation of 18% (CI 13-24%); 8 patients were concurrently diagnosed with PTLD. Amongst patients with high-level reactivation 31/38 (82%) developed this within only 2 weeks of first EBV qPCR positivity. In univariate analysis age⩾50 years was associated with significantly increased risk of EBV reactivation (hazard ratio (HR) 1.54, CI 1.02-2.31; P=0.039). Furthermore, a diagnosis of non-Hodgkin lymphoma (NHL) was associated with greatly reduced risk of reactivation (HR 0.10, CI 0.03-0.33; P=0.0001) and this was confirmed in multivariate testing. Importantly, rituximab therapy within 6 months prior to allo-HSCT was also highly predictive for lack of EBV reactivation (HR 0.18, CI 0.07-0.48; P=0.001) although confounding with NHL was apparent. Our data emphasise the risk of PTLD associated with alemtuzumab. Furthermore, we report the clinically important observation that rituximab, administered in the peri-transplant period, may provide effective prophylaxis for PTLD.

Isolation of a Wickerhamomyces anomalus yeast strain from the sandfly Phlebotomus perniciosus, displaying the killer phenotype

The yeast Wickerhamomyces anomalus has been studied for its wide biotechnological potential, mainly for applications in the food industry. Different strains of W. anomalus have been isolated from diverse habitats and recently from insects, including mosquitoes of medical importance. This paper reports the isolation and phylogenetic characterization of W. anomalus from laboratory-reared adults and larvae of Phlebotomus perniciosus (Diptera: Psychodidae), a main phlebotomine vector of human and canine leishmaniasis. Of 65 yeast strains isolated from P. perniciosus, 15 strains were identified as W. anomalus; one of these was tested for the killer phenotype and demonstrated inhibitory activity against four yeast sensitive strains, as reported for mosquito-isolated strains. The association between P. perniciosus and W. anomalus deserves further investigation in order to explore the possibility that this yeast may exert inhibitory/killing activity against Leishmania spp.

Disrupted nitric oxide signaling due to GUCY1A3 mutations increases risk for moyamoya disease, achalasia and hypertension

Moyamoya disease (MMD) is a progressive vasculopathy characterized by occlusion of the terminal portion of the internal carotid arteries and its branches, and the formation of compensatory moyamoya collateral vessels. Homozygous mutations in GUCY1A3 have been reported as a cause of MMD and achalasia. Probands (n = 96) from unrelated families underwent sequencing of GUCY1A3. Functional studies were performed to confirm the pathogenicity of identified GUCY1A3 variants. Two affected individuals from the unrelated families were found to have compound heterozygous mutations in GUCY1A3. MM041 was diagnosed with achalasia at 4 years of age, hypertension and MMD at 18 years of age. MM149 was diagnosed with MMD and hypertension at the age of 20 months. Both individuals carry one allele that is predicted to lead to haploinsufficiency and a second allele that is predicted to produce a mutated protein. Biochemical studies of one of these alleles, GUCY1A3 Cys517Tyr, showed that the mutant protein (a subunit of soluble guanylate cyclase) has a significantly blunted signaling response with exposure to nitric oxide (NO). GUCY1A3 missense and haploinsufficiency mutations disrupt NO signaling leading to MMD and hypertension, with or without achalasia.

Fasting C-peptide and Related Parameters Characterizing Insulin Secretory Capacity for Correctly Classifying Diabetes Type and for Predicting Insulin Requirement in Patients with Type 2 Diabetes

BACKGROUND/AIMS

C-peptide allows estimation of insulin secretion even in the presence of insulin treatment. C-peptide may be suitable for the differential diagnosis of type 1 and type 2 diabetes, and, within type 2 diabetes, of insulin-requiring vs. non-insulin-requiring patients. Relating C-peptide concentrations to ambient glucose levels might improve its diagnostic potential.

PATIENTS/METHODS

The diagnostic value (a) fasting C-peptide, (b) C-peptide/glucose ratios, and (c) the HOMA-ßC-peptide-index for predicting a diagnosis of type 1 (vs. type 2) diabetes were assessed.

SETTING

Specialised hospital for the care of diabetic patients (inpatient treatment). 303 patients with type 1 diabetes and 841 patients with type 2 diabetes.

MAIN OUTCOME MEASURE

Odds ratios and 95% confidence intervals for a clinical diagnosis of type 1 diabetes or for insulin treatment by deciles of (a) fasting C-peptide, (b) C-peptide/glucose ratios, and (c) HOMA-ßC-peptide-index.

RESULTS

Low C-peptide concentrations were associated with a high odds ratio for type 1 diabetes and vice versa (p<0.0001). Concentrations of 0.13-0.36 nmol/l did not discriminate. C-peptide/glucose ratios or HOMA-ßC-Peptide did not perform better. The ability of all 3 parameters to predict the necessity for insulin treatment within the population of type 2-diabetic patients was low.

CONCLUSIONS

Fasting C-peptide and derived parameters help to differentiate type 1 from type 2 diabetes, but there is a range of C-peptide concentrations that does not help discriminate. Relating C-peptide to glucose did not improve diagnostic accuracy. C-peptide does not help predicting a need for insulin treatment in patients with type 2 diabetes.

Inflammation in induced sputum after aluminium oxide exposure: an experimental chamber study

INTRODUCTION

Workers in aluminium production are exposed to a complex mixture of particles and gases potentially harmful to the airways, among them aluminium oxide (Al2O3). With the use of an exposure chamber, we aimed to examine the effects of short-term controlled exposure to Al2O3 on lung function and inflammatory markers in healthy volunteers.

METHODS

15 men (age 19-31) were exposed in random order to clean air or Al2O3 particles (3.8-4.0 mg/m(3)) for 2 h including 30 min exercise (stationary bike, 75 W). The permissible exposure level (PEL) for Al2O3 by Occupational Safety and Health Administration, USA, is 5 mg/m(3) time weighted average (TWA). Sham and particle exposures were separated by at least 2 weeks. Spirometry was carried out, and induced sputum and blood samples were collected 48 h before and 4 and 24 h after exposure.

RESULTS

Levels of sputum neutrophils (mean (±SEM)) was increased 24 h post-Al2O3 vs pre-Al2O3 exposure (43% (4) vs 31% (4), p=0.01) and the protein level of interleukin (IL)-8 had a 4.8 (0.9)-fold change increase 24 h after exposure (p<0.01). Following Al2O3 exposure, gene signatures in sputum were significantly increased related to several pathways.

CONCLUSIONS

The present study suggests that controlled exposure to Al2O3 particles at levels below PEL (TWA) induces airway inflammation in healthy humans marked by elevated neutrophils and elevated IL-8. In addition, increased expression of genes associated with several biological processes was observed in sputum. Interestingly, inhaled Al2O3-induced effects were localised to the airways and not systemic.

Palladium nanoparticles stabilised by cinchona-based alkaloids in glycerol: efficient catalysts for surface assisted processes

Cinchona-based alkaloids led to well-dispersed palladium nanoparticles in neat glycerol, leading to efficient eco-friendly catalytic phases in hydrogenations and hydrodehalogenations.

Pediatric bacterial meningitis in French Guiana

OBJECTIVE

Controlling vaccine-preventable infectious diseases is a public health priority in French Guiana but there is currently no epidemiological data on pediatric bacterial meningitis in this overseas department. Our aim was to describe data related to pediatric bacterial meningitis in French Guiana and compare it with that of metropolitan France.

METHODS

We conducted a multicenter retrospective study from 2000 to 2010 to describe the clinical picture, biological data, epidemiology, and outcome of pediatric bacterial meningitis case patients in French Guiana.

RESULTS

The median age of bacterial meningitis patients was 6months [0-15] and the sex ratio 1.06. We observed a total of 60 bacterial meningitis case patients. Most presented with pneumococcal meningitis (24 patients; 40%); 11 with Haemophilus influenzae type b meningitis (23%), five with group B streptococcal meningitis (8.5%), and five others (8.5%) with staphylococcal meningitis (three patients presented with coagulase-negative staphylococci and two with Staphylococcus aureus). Only one patient presented with group B meningococcal meningitis, an 18-month-old infant. We recorded 14 deaths (overall case fatality: 23%); eight were due to Streptococcus pneumoniae (case fatality: 33%). The overall sequelae rate was 28%. It was 32% for patients presenting with pneumococcal meningitis. We observed that 38% of children who had never been vaccinated were infected by a vaccine-preventable bacterium. We observed many differences in the distribution of the bacteria and in the patients' prognosis when comparing the French Guiana data with that of metropolitan France.

CONCLUSION

Improving vaccination coverage would decrease the incidence of H. influenzae meningitis.