Interferon alpha 2 maintenance therapy may enable high rates of treatment discontinuation in chronic myeloid leukemia

A minority of chronic myeloid leukemia (CML) patients is capable of successfully discontinuing imatinib. Treatment modalities to increase this proportion are currently unknown. Here, we assessed the role of interferon alpha 2a (IFN) on therapy discontinuation in a previously reported cohort of 20 chronic phase CML patients who were treated upfront with IFN alpha plus imatinib followed by IFN monotherapy to maintain cytogenetic or molecular remission (MR) after imatinib discontinuation. After a median follow-up of 7.9 years (range, 5.2-12.2), relapse-free survival was 73% (8/11 patients) and 84% (5/6 patients) for patients who discontinued imatinib in major MR (MMR) and MR4/MR4.5, respectively. Ten patients discontinued IFN after a median of 4.5 years (range, 0.24-9.3). After a median of 2.8 years (range, 0.7-5.1), nine of them remain in ongoing treatment-free remission with MR5 (n=6) and MR4.5 (n=3). The four patients who still administer IFN are in stable MR5, MR4.5, MR4, and MMR, respectively. In conclusion, an IFN/imatinib induction treatment followed by a temporary IFN maintenance therapy may enable a high rate of treatment discontinuation in CML patients in at least MMR when stopping imatinib.

BDD Ordering Heuristics for Classical Planning

Symbolic search using binary decision diagrams (BDDs) can often save large amounts of memory due to its concise representation of state sets. A decisive factor for this method's success is the chosen variable ordering. Generally speaking, it is plausible that dependent variables should be brought close together in order to reduce BDD sizes. In planning, variable dependencies are typically captured by means of causal graphs, and in preceding work these were taken as the basis for finding BDD variable orderings. Starting from the observation that the two concepts of "dependency" are actually quite different, we introduce a framework for assessing the strength of variable ordering heuristics in sub-classes of planning. It turns out that, even for extremely simple planning tasks, causal graph based variable orders may be exponentially worse than optimal. Experimental results on a wide range of variable ordering variants corroborate our theoretical findings. Furthermore, we show that dynamic reordering is much more effective at reducing BDD size, but it is not cost-effective due to a prohibitive runtime overhead. We exhibit the potential of middle-ground techniques, running dynamic reordering until simple stopping criteria hold.

The value of three-dimensional printing modelling for surgical correction of orbital hypertelorism

Orbital hypertelorism is defined as an increased distance between both medial and lateral sides of the orbits. Most common causes are frontonasal malformations, craniofacial fissures, encephalocele and a miscellaneous group of various syndromic or chromosomal disorders. Surgical correction of orbital hypertelorism is still challenging. The present report describes a case of severe orbital hypertelorism of an 11-year-old boy, where surgical correction was planned using three-dimensional printing modelling. This approach allowed reducing time of surgery, accurately planning the location of the osteotomies and precontouring the osteosynthesis material. Three-dimensional models are very helpful tools in planning complex craniofacial operative procedures.

[Prevention of preterm birth by Shirodkar cerclage--clinical results of a retrospective analysis]

In spite of the continuous progress in prenatal care, 1 out of 10 babies is born too early--tendency rising worldwide. As a consequence of the heterogeneous aetiology of preterm birth, there is still no single and efficient interventional therapy. Cerclage is one option for pregnancies with cervical insufficiency, whereas the clinical benefit is discussed controversially. We analyzed in a retrospective study with 120 patients the effect of a cerclage intervention regarding pregnancy prolongation. Patients with cervical incompetence and Shirodkar cerclage were compared to those undergoing conservative treatment. As expected, gestational age at delivery was significantly lower after emergency cerclage (31 weeks) compared to prophylactic (36 weeks) and therapeutic cerclage (35 weeks). Prolongation differs significantly between the prophylactic (18 weeks), therapeutic (14 weeks) and emergency cerclage (10 weeks) groups. Conservative management achieved 8 weeks prolongation. Of note, particularly emergency cerclage in cases with advanced cervical incompetence resulted in a substantially higher pregnancy prolongation (10 weeks) compared to no intervention (one week). The efficiency of cerclage operations has to be assessed in a differentiated manner based on the clinical situation and indication. The clinical benefit depends strongly on proper patient selection.

Improving Delete Relaxation Heuristics Through Explicitly Represented Conjunctions

Heuristic functions based on the delete relaxation compute upper and lower bounds on the optimal delete-relaxation heuristic h+, and are of paramount importance in both optimal and satisficing planning. Here we introduce a principled and flexible technique for improving h+, by augmenting delete-relaxed planning tasks with a limited amount of delete information. This is done by introducing special fluents that explicitly represent conjunctions of fluents in the original planning task, rendering h+ the perfect heuristic h* in the limit. Previous work has introduced a method in which the growth of the task is potentially exponential in the number of conjunctions introduced. We formulate an alternative technique relying on conditional effects, limiting the growth of the task to be linear in this number. We show that this method still renders h+ the perfect heuristic h* in the limit. We propose techniques to find an informative set of conjunctions to be introduced in different settings, and analyze and extend existing methods for lower-bounding and upper-bounding h+ in the presence of conditional effects. We evaluate the resulting heuristic functions empirically on a set of IPC benchmarks, and show that they are sometimes much more informative than standard delete-relaxation heuristics.

Hyaluronic acid production with Corynebacterium glutamicum: effect of media composition on yield and molecular weight

AIMS

Corynebacterium glutamicum was tested as an alternative host for heterologous production of hyaluronic acid (HA).

METHODS AND RESULTS

A set of expression vectors containing hasA, encoding HA synthase from Streptococcus equi subsp. zooepidemicus, alone or in combination with genes encoding enzymes for HA precursor production (hasB, hasC, glmU from Pseudomonas putida KT2440) or bacterial haemoglobin (vgb from Vitreoscilla sp.) was constructed. Recombinant Coryne. glutamicum strains were cultivated in two different minimal media, CGXII and MEK700. HA was isolated from the culture broth by ethanol precipitation or ultrafiltration. Analyses of the isolated HA revealed that overall production was higher in CGXII medium (1241 mg l(-1)) than in MEK700 medium (363 mg l(-1)), but molecular weight of the product was higher in MEK700 (>1·4 MDa) than in CGXII (<270 kDa). Coexpression of hasB, hasC or glmU had no effect on HA yield and did not improve molecular weight of the product. Coexpression of vgb lowered HA yield about 1·5-fold and did not affect molecular weight of the product. Microscopy of negative-stained cultures revealed that Coryne. glutamicum produces no distinct HA capsule.

CONCLUSIONS

Regulation of cell growth and gene expression level of hasA are reasonable starting points for controlling the molecular weight of HA produced by Coryne. glutamicum.

SIGNIFICANCE AND IMPACT OF THE STUDY

Corynebacterium glutamicum has a great potential as an alternative production host for HA. The fact that Coryne. glutamicum produces no distinct HA capsule facilitates HA isolation and improves overall yield.

48Ca+249Bk fusion reaction leading to element Z = 117: long-lived α-decaying 270Db and discovery of 266Lr

The superheavy element with atomic number Z=117 was produced as an evaporation residue in the (48)Ca+(249)Bk fusion reaction at the gas-filled recoil separator TASCA at GSI Darmstadt, Germany. The radioactive decay of evaporation residues and their α-decay products was studied using a detection setup that allowed measuring decays of single atomic nuclei with half-lives between sub-μs and a few days. Two decay chains comprising seven α decays and a spontaneous fission each were identified and are assigned to the isotope (294)117 and its decay products. A hitherto unknown α-decay branch in (270)Db (Z = 105) was observed, which populated the new isotope (266)Lr (Z = 103). The identification of the long-lived (T(1/2) = 1.0(-0.4)(+1.9) h) α-emitter (270)Db marks an important step towards the observation of even more long-lived nuclei of superheavy elements located on an "island of stability."

[Predictive value of the sFlt1/PlGF ratio for the diagnosis of preeclampsia in high-risk patients]

BACKGROUND

A dysbalance of proangiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase 1 (sFlt-1)] proteins is known to cause the symptoms of preeclampsia (PE), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) or intrauterine growth restriction (IUGR). An increased sFlt-1/PlGF ratio ≥85 is considered a reliable diagnostic marker. Altered sFlt1 and PlGF concentrations can be detected several weeks prior to the onset of clinical symptoms. In this study we analysed the role of the sFlt1/PlGF ratio as a predictive marker for preeclampsia in a high-risk patient group.

PATIENTS AND MATERIALS

We prospectively included 68 singleton pregnancies with at least one risk factor for PE, HELLP syndrome or IUGR. During the study the patients were divided into one group with symptoms (patient group) and one group without symptoms (control group) for the above-mentioned diseases. The sFlt1/PlGF ratios were measured on admission and during the course of pregnancy.

RESULTS

During pregnancy 41% of patients developed PE, HELLP syndrome or IUGR. An increase of the absolute value of the sFlt1/PlGF ratio ≥85 was only observed in the patient group and was found to be a predictive factor for PE, HELLP syndrome or IUGR at 25+0 to 31+0 weeks of gestation (p=0.005) and after 35+0 weeks of gestation (p=0.044). Alterations of the sFlt1/PlGF ratio were observed in all patients but were higher in the patient group from 7-10 weeks prior to delivery and with the highest peak 0-2 weeks prior to delivery. Compared to the control group (mean±SD 66.9±134) absolute values of sFlt1/PlGF ratio were significantly (p=0.021) increased 0-2 weeks prior to delivery in the patient group (mean±SD 393.3±147.4). An increase of the sFlt1/PlGF ratio ≥85 0-2 weeks before delivery has shown to be predictive for one of the mentioned diseases (p=0.025).

CONCLUSIONS

In high-risk patients the sFlt1/PlGF ratio can be used for an individual risk assessment with regard to PE, HELLP syndrome or IUGR. Serial measurements permit a risk-adapted prenatal care of these patients.