Quadruplet Therapy in De Novo High-Volume Mixed Neuroendocrine Prostate Cancer Using 177Lu-PSMA: A Case Report

ABSTRACT

We present a case of de novo high-volume metastatic prostate cancer with high PSMA expression, partially PSMA-negative, using quadruplet therapy (PROMISE ver. 2 miTNM; miT4N2M1aM1b(dmi) PRIMARY score: 5, PSMA-expression score: 0-3). Because of our patient's partial PSMA negativity and after a multidisciplinary tumor board discussion, we decided to use a modified protocol involving doublet hormonal therapy along with 177Lu-PSMA and radiation therapy to address the PSMA-negative disease. The patient responded well to this treatment, but recurrence was ultimately inevitable. This case represents a typical example of mixed neuroendocrine prostate carcinoma and highlights its resistant phenotype in response to quadruplet therapy.

Female case with misdiagnosis of hemophilia A who underwent total knee arthroplasty: A case report

A female was diagnosed with hemophilia A. She had undergone bilateral total knee arthroplasty. She had a history of numerous hemorrhages including hemarthrosis. After further investigations, the diagnosis of von Willebrand disease type 2N was confirmed. The differential diagnoses for hemophilia A include von Willebrand disease, rare bleeding disorders, and severe platelet disorders.

Association of SMAD7 genetic markers and haplotypes with colorectal cancer risk

Purpose

Colorectal cancer (CRC) is one of the common cancers with a high mortality rate worldwide. In Iran, there has been a trend of increased incidence of colorectal cancer in the last three decades that necessitates the early diagnosis. Genetic factors have an influential role in its etiology along with the conventional risk factors such as age, diet, and lifestyle. Results from GWAS have shown significant associations between SMAD7 gene variants and risk of CRC. This study aimed to assess the association of certain polymorphisms as well as haplotypes of this gene and risk of colorectal cancer.

Methods and materials

This study was designed as a case–control association study. After obtaining ethical approval and informed consent, blood samples from 209 patients with colorectal cancer were collected and DNA was extracted. Four variants: rs4939827, rs34007497, rs8085824 and rs8088297 were genotyped using ARMS-PCR method.

Results

SMAD7 rs4939827 in the recessive and co-dominant models was associated with colorectal cancer risk [TT/CT + CC: OR = 2.90, 95%CI (1.38–6.09), p = 0.005; CC + TT/CT: OR = 1.66, 95%CI (1.00–2.75), p = 0.01]. Haplotype analysis indicated that some SNP combinations including two for-SNPs haplotypes of T-T-C-C and T-C-C-A were significantly associated with CRC risk.

Conclusion

Based on the identified association of SMAD7 gene variations and haplotypes with colorectal cancer risk in our population, genetic variations in this gene region may have a role in CRC development. This data may shed light on the genetic predisposition of CRC which involves different pathways including TGF-β.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12920-021-01150-3.

Molecular detection and prevalence of Rotavirus with acute gastroenteritis among the children of rural and urban areas

Rotavirus is the main infective agent of acute gastroenteritis (AGE) in children under the age of five years and causing significant morbidity as well as mortality throughout the world. The study was carried out to detect the prevalence rate, genotypes strain and risk factors of Rotavirus among the children of rural and urban areas of district Bannu Khyber Pakhtunkhwa Pakistan. A total of 180 stool samples were collected from children under the age of 5 years from two major hospitals of Bannu from January to December (2015). The samples were analyzed by Reverse-transcriptase Polymerase Chain Reaction (RT-PCR) for the detection of Rotavirus, positive samples were further processed for genotyping (G and P type) through specific PCR. Of the total, 41 (23%) samples were positive for Rotavirus. The most prevalent G genotypes found were: G3, G8, G9 (each 29%), followed by G10 (15%), and G11 (10%). Whereas the prevalent P genotypes were: P-8 (25%), P-4 and P-10 (each 20%), P-9 (15%), followed by P-6 and P-11 (each 10%). Moreover, Rotavirus infection was more prevalent in summer (23.73%) and winter (22.7%) than spring (20%) and autumn (21.4%). Rotavirus infection exhibited high frequency in June (14%), October (8%) and November (6%). It is concluded that Rotavirus is more prevalent in children and various genotypes (G and P) of Rotavirus are present in the study area. Lack of studies, awareness and rarer testing of Rotavirus are the principal reasons of virus prevalence in district Bannu, Pakistan.

Investigating the association between rs6983267 polymorphism and susceptibility to gastrointestinal cancers in Iranian population

Genome-wide association studies have revealed that some single nucleotide polymorphisms at 8q24, such as rs6983267, might be effective in susceptibility to various cancers in different populations. Therefore, rs6983267 might be useful as a marker for multiple cancers. In this study, we considered a population, including 478 gastrointestinal cancer cases from the Iranian population, to investigate the association between rs6983267 and susceptibility to gastrointestinal cancers. The samples were genotyped using the TaqMan real-time PCR method while 10% of them were also confirmed by sequencing. Higher frequency of G allele was associated with higher grades of tumors in esophageal cancer and the tumors located in the lower portion of the esophagus (OR 3.56; 95% CI 1.13-11.24; P = 0.03) and cardia (OR 5.24; 95% CI 1.26-21.83; P = 0.02), which both locations are involved in esophageal adenocarcinomas with poor prognosis. The results indicated that in the male subgroup, the rs6983267 GG genotype significantly enhanced the gastric cancer susceptibility (OR 4.76; 95% CI 1.57-14.45; P = 0.01). GG genotype also increased the risk of intestinal-type gastric cancer, located in non-cardia (OR 4.62; 95% CI 1.25-17.04; P = 0.02). Moreover, gastric cancer cases and controls with a family history of gastrointestinal tumors were mostly genotyped with the G allele (OR 3.61; 95% CI = 1.09-12.01; P = 0.04). There were no remarkable associations between rs6983267 and susceptibility to esophageal and colon cancers in the Iranian population. However, different genotypes of rs6983267 had significant correlations with tumor grade, cancer type, and family history of gastrointestinal cancers. Further investigations in a larger population and other ethnicities are required to confirm these results.

Efficacy and safety of convalescent plasma therapy in severe COVID-19 patients with acute respiratory distress syndrome

Since SARS-CoV-2 infection is rapidly spreading all around the world, affecting many people and exhausting health care resources, therapeutic options must be quickly investigated in order to develop a safe and effective treatment. The present study was designed to evaluate the safety and efficacy of convalescent plasma (CP) for treating severe cases of COVID-19 who developed acute respiratory distress syndrome (ARDS). Among 64 confirmed cases of severe COVID-19 with ARDS in this study, 32 patients received CP besides first line treatment. Their clinical response and outcome in regard to disease severity and mortality rate were evaluated and compared with the other 32 patients in the control group who were historically matched while randomly chosen from previous patients with the same conditions except for receiving CP therapy. Analysis of the data was performed using SPSS software. Patients with plasma therapy showed improvements in their clinical outcomes including a reduction in disease severity in terms of SOFA and APACHE II scores, the length of ICU stay, need for noninvasive ventilation and intubation and also showed an increase in oxygenation. They also showed reduction in mortality which was statistically significant in less severe cases with mild or moderate ARDS. Early administration of the convalescent plasma could successfully contribute to the treatment of severe COVID-19 patients with mild or moderate ARDS at risk of progressing to critical state.

Interaction of perforin and granzyme B and HTLV-1 viral factors is associated with Adult T cell Leukemia development

Objective(s):

Human T cell leukaemia virus type 1 (HTLV-1) is associated with adult T cell leukaemia (ATL), a malignant lymphoproliferative disease that infects CD4 T cells. It is not clear why the majority of HTLV-1-infected individuals remain asymptomatic carries (ACs) and a minority develop ATL. Cellular immune response has a critical role in ATL and destroys malignant and HTLV-1-infected cells. Perforin and granzyme have important functional roles in apoptosis and destruction of infected cells. In the present study we examined the role of perforin and granzyme in ATL patients and ACs.

Materials and Methods:

Peripheral blood mononuclear cells (PBMCs) were isolated from ATL patients and ACs by using Ficoll-hypaque density centrifugation. RNA was extracted and cDNA was synthesized. A real-time PCR TaqMan method was designed and optimized for evaluation of perforin, granzyme, tax, and HBZ gene expression. HTLV-1 proviral load (PVL) was quantified in patients with ATL and ACs.

Results:

The mRNA expression of tax and HBZ was significantly higher in ATL patients than ACs (P=0.011 and P=0.0001,respectively). The HTLV-1 PVL was higher in ATL patients compared to with AC group (P=0.015). There was a significant increase in perforin gene expression in ACs compared with ATL patients (P=0.002). Furthermore, the expression of granzyme was also higher in ACs compared with ATL patients, and significant differences were observed between the two groups (P=0.036).

Conclusion:

Low expression of perforin and granzyme in ATL patients seems to influence the efficiency of CTL function and destruction of HTLV-1-infected cells, which might contribute to the disease pathogenesis.

AB0525 NATURAL HISTORY OF CRYOGLOBULINEMIA FROM 2000 TO 2018 FROM THE LABORATORY POINT OF VIEW: AN ANALYSIS OF CRYOGLOBULIN CHARACTERISTICS IN A SINGLE CENTER

Background:

Big data refers to large amounts of information. With today’s ever-improving technologies created by the automation and digitization, it becomes easier to convert data into relevant information, which can be used to provide better patient management, especially when it occurs a rare condition such as cryoglobulinemia (CRG).

CRG is due to an immunoglobulins (Ig) that precipitate at low temperatures. There are 3 types of CRG: type I: monoclonal Ig; type II: monoclonal Ig + polyclonal Ig; type III: 2 polyclonal Ig.

Objectives:

The aim of this study was to analyse the available data coming to the Department of Laboratory Medicine of Modena to describe the population of patients suffering of CRG.

Methods:

Data from the Modena Labs network were extracted by means of the software “Pagoda”, for statistical purposes, directly connected to the Laboratories Information System (LIS). Considered time period 2000-2018

Results:

The analysed samples were 28,847, 4901 (17%) of which positive to the cryoglobulins (CR) detection. The typing positive CR were 4190 (85%): type 1 7.8 %, type II 48.54% and type III 43.8% The positive samples belonged to 2528 patients. Patients were 1563 (62%) women, average age 66±16, and 965 (38%) men, average age 62±16. (female/male ratio = 1.62) No statistically significant difference regarding sex and age between the 3 types. The cryoglobulinemia phenomenon is quite complex and the typing of monoclonal, polyclonal components of the Ig classes and chains has made it possible to identify 41 possible combinationsOut of 115 patients with Type 1 cryoglobulin, 73% had a monoclonal IgM and 36% monoclonal IgG; 11.2% both monoclonal IgG and IgM. The к light chain was the most frequent: 55,6% IgM-k and 23,4% IgG-k vs 29% IgM-λ and 18.2% IgG-λ. Two patients had an IgA-k cryoglobulin.

Patients with Type 2 cryo were 781: monoclonal IgM-k 587 (75.1 %), 126 IgM-λ (16.1 %), 52 IgG-k (6.6 %), IgG-λ (5%), 1 IgA-λ; 2.8% had both IgG and IgM. Out of 1204 patients with Type 3 cryo, 74.8% had both polyclonal IgG and IgM, 13,8% had isolated IgM or IgG (9%); 4.8 % IgG-IgA-IgM together, both IgG and IgA in only 0,5% of patients. Almost the 50% (1255) of the patients had a diagnosis supporting the request of CR:

HCV, 604 (48%); chronic hepatitis, 177 (14%); rheumatologic disorder, 107 (9%); autoimmune diseases, 83 (7%), nephropathy, 80 (7%); others, 204 (15%).

Genotyped HCV+ patients were 290 (48%), with the following results: 1b, 136 (47%); 2a/2c, 65 (22%); 3a, 26 (9%); others 63 (22%).

Conclusion:

The data show that CRG is a pathology which affects the elderly and especially women, as in autoimmune and rheumatological diseases. The predominant CRG type is the III and the most frequently related pathology to the request for CR is HCV+ and chronic hepatitis. The most common HCV genotype are 1b and 2a/2c The cryoglobulinemia phenomenon is complex and laboratory typing is intriguing.

Starting from this preliminary descriptive study, it will be possible, with the available data, to perform elaborations that allow to relate CRG with the diagnosis and verify the effect of therapy.

Big Data methods’ application represents an undeniable resource for public institutions when carrying out strategic decision-making processes.

Disclosure of Interests:

None declared

Complete sequence of human T cell leukemia virus type 1 in ATLL patients from Northeast Iran, Mashhad revealed a prematurely terminated protease and an elongated pX open reading frame III

To gain insight into the origin, evolution, dissemination and viral factors affecting HTLV-1-associated diseases, knowing the complete viral genome sequences is important. So far, no full-length HTLV-1 genome sequence has been reported from Iran. Here we report the complete nucleotide sequence of HTLV-1 viruses isolated from adult T cell leukemia/lymphoma (ATLL) patients from this region. The genome size of HTLV-1-MhD (Mashhad) was found to be 9036 bp and sequence analysis of the LTR region showed that it belongs to cosmopolitan subtype A. Comparing the sequences with isolates from another endemic area (HTLV-1ATK) revealed variations in the U3 region (~3.4%), while there was 99.1% and 97.0% similarity in R and U5 regions, respectively. The nucleotide sequences of HTLV-1 gag, pro and pol genes had a difference of 1.1% compared with HTLV-1 ATK with 16 nucleotides replaced in the gag and 27 in the pol regions. There was no variability in the amino acid sequences in the p24^gag, however three residues were different in the p19^gag and one in the p15^gag. The nucleotide sequence of env showed a divergence of 1.5% compared to ATK with 22-nucleotide variation. The HTLV-1-MhD Tax, p13, p30, and p12 had 99.1, 100, 98.8, and 98%, respectively similarity with the prototype strain. Four amino acid changes were detected in ORF1 and ORF2 products p12 and p30, respectively, while the p13 region showed 100% conservation. The nucleotide identity between the isolates of Mashhad and those isolated from France, Germany, China, Canada and Brazil was 99.1%, 99.2%, 97.9%, 99% and 99.3%, respectively. Four amino acid changes compared with HTLV-1ATK from Japan were detected in ORF1 and ORF2 products p12 and p30, respectively, while the p13 region showed 100% conservation. This data could provide information regarding the evolutionary history, phylogeny, origin of the virus and vaccine design.

Screening for Lynch Syndrome in Cases with Colorectal Carcinoma from Mashhad

INTRODUCTION

Lynch Syndrome (LS) is a genetically inherited autosomal disorder that increases the risk of many types of cancer, especially colorectal cancer (CRC). Identifying these subjects improves morbidity and mortality. We aimed to assess the prevalence of LS with both clinical criteria and universal strategy in Mashhad, Iran.

METHODS

In this retrospective study, we screened 322 patients with CRC between 2013 and 2016 in Mashhad, Iran. CRCs were screened based on Amsterdam II criteria, revised Bethesda guideline, and universal strategy. Information regarding the clinical criteria was obtained by interviewing the patients or, their families. Tumors were screened by pathologists with IHC staining of four Mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2). Tumors with absent IHC staining of MLH1 were tested for BRAF mutations to exclude sporadic CRCs.

RESULTS

Of 322 CRCs, 33 cases were found to be deficient-MMR; 22 of these had concurrent loss of MLH1 and PMS2, followed by concurrent loss of MSH2 and MSH6 in 8 CRCs. Twenty-two cases with a loss of MLH1 underwent testing for the BRAF mutation, 4 of which were recognized as a positive BRAF mutation. Finally, 29 CRCs were found as being positive screen for LS. Poor sensitivity (21.74%) was found for the Amsterdam II criteria and a poor positive predictive value (15.39%) for the revised Bethesda.

CONCLUSION

Application of clinical criteria may not be effective enough to identify LS and at least 2-antibody panel (PMS2, MSH6) should be conducted for newly diagnosed CRCs.

Rare case of atypical femoral fracture with blocked medullary canal associated with bisphosphonate therapy

Bisphosphonates are widely used for treatment of osteoporosis and its use is increasing in geriatric population. Atypical femoral fractures are associated with bisphosphonate therapy. We report an unusual case of femoral shaft fracture following bisphosphonate therapy where the femoral canal of the proximal and distal fracture fragments was blocked and its management.

Evaluation of the role of TAX, HBZ, and HTLV-1 proviral load on the survival of ATLL patients

BACKGROUND

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy with very poor prognosis and short survival, caused by the human T-lymphotropic virus type-1 (HTLV-1). The HTLV-1 biomarkers trans-activator x (TAX) and HTLV-1 basic leucine zipper factor (HBZ) are main oncogenes and life-threatening elements. This study aimed to assess the role of the TAX and HBZ genes and HTLV-1 proviral load (PVL) in the survival of patients with ATLL.

METHODS

Forty-three HTLV-1-infected individuals, including 18 asymptomatic carriers (AC) and 25 ATLL patients (ATLL), were evaluated between 2011 and 2015. The mRNA expression of TAX and HBZ and the HTLV-1 PVL were measured by quantitative PCR.

RESULTS

Significant differences in the mean expression levels of TAX and HBZ were observed between the two study groups (ATLL and AC, P=0.014 and P=0.000, respectively). In addition, the ATLL group showed a significantly higher PVL than AC (P=0.000). There was a significant negative relationship between PVL and survival among all study groups (P=0.047).

CONCLUSION

The HTLV-1 PVL and expression of TAX and HBZ were higher in the ATLL group than in the AC group. Moreover, a higher PVL was associated with shorter survival time among all ATLL subjects. Therefore, measurement of PVL, TAX, and HBZ may be beneficial for monitoring and predicting HTLV-1-infection outcomes, and PVL may be useful for prognosis assessment of ATLL patients. This research demonstrates the possible correlation between these virological markers and survival in ATLL patients.

Assessment of HTLV-1 proviral load, LAT, BIM, c-FOS and RAD51 gene expression in adult T cell leukemia/lymphoma

Adult T cell leukemia/lymphoma (ATLL) is a life-threatening malignancy of HTLV-1 infected Th lymphocytes. In the present study host-virus interactions were investigated by assessment of HTLV-1 proviral load (PVL) and host gene expression. A cross-sectional study was carried out on 18 ATLL, 10 HAM/TSP patients and 18 HTLV-1 asymptomatic carriers (ACs). DNA and mRNA of the peripheral blood mononuclear cells were extracted for PVL and LAT, BIM, c-FOS and RAD51 gene expression measurement using qRT-PCR. The mean PVL in ATLL patients was 11,430 ± 3770 copies/10⁴ which was statistically higher than ACs, 530 ± 119 copies/10⁴, (p < 0.001). The expression of BIM, and c-FOS in ATLL patients were higher than HTLV-1 ACs; however, there were no statistically significant differences. The expression of RAD51 as an essential player on DNA repair showed around 160 times increase in ATLL group (166 ± 95) compared to ACs (1.04 ± 0.34) which is statistically significant (p < 0.001). Interestingly, there was a positive correlation between RAD51 expression and HTLV-PVL. The expression of LAT as a central adaptor in TCR signaling interestingly was around 36 times higher in ATLL group than ACs (ATLL; 41.33 ± 19.91 vs. ACs; 1.15 ± 0.22, p < 0.001). This finding showed that TCR signaling pathway mainly provides the growth factors for transformed cells. Furthermore, the overexpression of RAD51 which has been induced in HTLV-1 infected cells as a consequence of virus replication is not able to overcome the DNA damage toward cell transformation.

PO-03 - Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in Non Hodgkin Lymphoma (NHL). A pooled data analysis of twelve clinical trials of Fondazione Italiana Linfomi (FIL)

BACKGROUND

Recent studies show that the risk of VTE in NHL pts is similar to that observed in high risk solid tumors (i.e. pancreatic, ovarian cancer). VTE in NHL occurs in most cases within three months from diagnosis and can have substantial impact on treatment delivery and outcome as well as on quality of life. However few data are available on potential predictors.

AIMS

To better clarify the epidemiology of early (within six months from treatment start) VTE in NHL we conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk.

PATIENTS AND METHODS

From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. For 9 studies study period included the entire trial population was included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. VTE definition and grading was stated according to standard criteria of toxicity (CTCAE V4.0). Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. This pooled data analysis was approved by local IRB.

RESULTS

Overall, 1,717 patients belonging to 12 studies were evaluated. Eight were phase I/II or II (25% of pts) and 4 phase III (75% of pts). M/F ratio was 1.41, Median age was 57, (IQ range (IQR) 49-66). Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25 (IQR 22-28). Median Hb, WBC and platelets counts were 13g/dl) (IQR 11.5-14.2), 7.1*10^(9)/l (IQR 5.6-10.3), 224*10^(9)/l (IQR 169-298), respectively. 1189 pts were evaluable Khorana score: 58% low risk, 30% intermediate risk, 12% were high risk. Human erythropoetin support was given to 9% of patients. All pts received Rituximab. Planned therapeutic programs included ASCT in 27% of pts, conventional chemotherapy in 67% a conventional chemotherapy plus lenalidomide in 6%. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%), including 21 grade III-IV VTE (18 pts). None was fatal. Median time from study enrolment to VTE was 63 days (IQR: 35-110). Considering death as a competitive event the 6 months cumulative incidence of VTE was 2,2% in low risk Khorana score, 4.5% (95%IC: 2.3-6.7) in intermediate and 6.6% (95%IC: 2.4-10.8) in high risk (p=0.012) (figure 1). Khorana score was predictive also for grade III-IV events as they were 0,7% (95% CI:0.1-1.4) in low risk and 2.0% (95% CI:0.8-3.3) in intermediate-high risk (p=0.048). The results were similar also after excluding lenalidomide containing studies. The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score (intermediate risk adjHR=1.96; 95%IC: 0.84-4.56 and high risk adjHR=3.81; 95%IC: 1.51-9.58) and DLCL-B histotype (adjHR=2.58; 95% CI: 1.01-6.55) were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE (OR=1.85; 95% CI: 1.23-2.79).

CONCLUSIONS

Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL. Prospective validation including also patients not eligible for clinical trials is needed.

Enhanced inhibitory control by neuropeptide Y Y5 receptor blockade in rats

RATIONALE

The neuropeptide Y (NPY) system acts in synergy with the classic neurotransmitters to regulate a large variety of functions including autonomic, affective, and cognitive processes. Research on the effects of NPY in the central nervous system has focused on food intake control and affective processes, but growing evidence of NPY involvement in attention-deficit/hyperactivity disorder (ADHD) and other psychiatric conditions motivated the present study.

OBJECTIVES

We tested the effects of the novel and highly selective NPY Y5 receptor antagonist Lu AE00654 on impulsivity and the underlying cortico-striatal circuitry in rats to further explore the possible involvement of the NPY system in pathologies characterized by inattention and impulsive behavior.

RESULTS

A low dose of Lu AE00654 (0.03 mg/kg) selectively facilitated response inhibition as measured by the stop-signal task, whereas no effects were found at higher doses (0.3 and 3 mg/kg). Systemic administration of Lu AE00654 also enhanced the inhibitory influence of the dorsal frontal cortex on neurons in the caudate-putamen, this fronto-striatal circuitry being implicated in the executive control of behavior. Finally, by locally injecting a Y5 agonist, we observed reciprocal activation between dorsal frontal cortex and caudate-putamen neurons. Importantly, the effects of the Y5 agonist were attenuated by pretreatment with Lu AE00654, confirming the presence of Y5 binding sites modulating functional interactions within frontal-subcortical circuits.

CONCLUSIONS

These results suggest that the NPY system modulates inhibitory neurotransmission in brain areas important for impulse control, and may be relevant for the treatment of pathologies such as ADHD and drug abuse.

Noradrenergic versus dopaminergic modulation of impulsivity, attention and monitoring behaviour in rats performing the stop-signal task: possible relevance to ADHD

RATIONALE

Deficient response inhibition is a prominent feature of many pathological conditions characterised by impulsive and compulsive behaviour. Clinically effective doses of catecholamine reuptake inhibitors are able to improve such inhibitory deficits as measured by the stop-signal task (SST) in humans and other animals. However, the precise therapeutic mode of action of these compounds in terms of their relative effects on dopamine (DA) and noradrenaline (NA) systems in prefrontal cortical and striatal regions mediating attention and cognitive control remains unclear.

OBJECTIVES

We sought to fractionate the effects of global catecholaminergic manipulations on SST performance by using receptor-specific compounds for NA or DA. The results are described in terms of the effects of modulating specific receptor subtypes on various behavioural measures such as response inhibition, perseveration, sustained attention, error monitoring and motivation.

RESULTS

Blockade of α2-adrenoceptors improved sustained attention and response inhibition, whereas α1 and β1/2 adrenergic receptor antagonists disrupted go performance and sustained attention, respectively. No relevant effects were obtained after targeting DA D1, D2 or D4 receptors, while both a D3 receptor agonist and antagonist improved post-error slowing and compulsive nose-poke behaviour, though generally impairing other task measures.

CONCLUSIONS

Our results suggest that the use of specific pharmacological agents targeting α2 and β noradrenergic receptors may improve existing treatments for attentional deficits and impulsivity, whereas DA D3 receptors may modulate error monitoring and perseverative behaviour.

Risk for second malignancies in non-Hodgkin's lymphoma survivors: a meta-analysis

BACKGROUND

Late side-effects are becoming an important issue in non-Hodgkin's lymphoma (NHL) survivors. We intended to estimate pooled relative risk (RR) of secondary malignant neoplasms (SMNs), to evaluate site-associated RR and the impact of different treatments.

DESIGN

We carried out an electronic search of Medline and EMBASE seeking articles investigating the risk of SMNs and reporting RR measures. The studies were evaluated for heterogeneity before meta-analysis and for publication bias. Pooled RRs were estimated using fixed- and random-effects models.

RESULTS

A total of 23 studies met the inclusion criteria. Pooled RRs of SMNs overall and for solid tumors were 1.88 and 1.32, respectively. We found an excess of risk for several specific cancer sites. Radiotherapy alone did not increase the risk for SMNs, while chemotherapy and combined treatments augmented the RR. Regression analyses revealed a positive significant association for all SMNs with total body irradiation, and for solid SMNs with younger age. No publication bias was observed.

CONCLUSIONS

Our results indicate that NHL patients experience a higher risk for SMNs than the general population and that various treatments have different impact on RR. More information will be necessary to evaluate possible interactions with genetic susceptibility and environmental exposure.

Animal models of ADHD

Studies employing animal models of attention-deficit/hyperactivity disorder (ADHD) present clear inherent advantages over human studies. Animal models are invaluable tools for the study of underlying neurochemical, neuropathological and genetic alterations that cause ADHD, because they allow relatively fast, rigorous hypothesis testing and invasive manipulations as well as selective breeding. Moreover, especially for ADHD, animal models with good predictive validity would allow the assessment of potential new therapeutics. In this chapter, we describe and comment on the most frequently used animal models of ADHD that have been created by genetic, neurochemical and physical alterations in rodents. We then discuss that an emerging and promising direction of the field is the analysis of individual behavioural differences among a normal population of animals. Subjects presenting extreme characteristics related to ADHD can be studied, thereby avoiding some of the problems that are found in other models, such as functional recovery and unnecessary assumptions about aetiology. This approach is justified by the theoretical need to consider human ADHD as the extreme part of a spectrum of characteristics that are distributed normally in the general population, as opposed to the predominant view of ADHD as a separate pathological category.

Topical capsaicin therapy for uremic pruritus in patients on hemodialysis

INTRODUCTION

Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis.

MATERIALS AND METHODS

This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared.

RESULTS

Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 +/- 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 +/- 6.3, which was reduced to 6.4 +/- 3.9, 4.7 +/- 3.1, 3.2 +/- 2.9, and 2.5 +/- 2.5 on weeks 1 to 4, respectively (P < .001). In the placebo group, pruritus score before treatment was 15.0 +/- 6.0 on average, and it was 11.7 +/- 5.8, 9.4 +/- 5.9, 7.9 +/- 5.5, and 7.2 +/- 5.5, respectively, on weeks 1 to 4 (P < .001). There was no significant difference in pruritus scores before the treatment between the two groups, but after each week, the difference was significant (P < .001). Repeated measurement test showed that decreasing in pruritus severity in the capsaicin group was more than that in the placebo group during treatment period (P < .001).

CONCLUSIONS

Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease.

T3 and the thyroid hormone beta-receptor agonist GC-1 differentially affect metabolic capacity and oxidative damage in rat tissues

We compared the changes in tissue aerobic metabolism and oxidative damage elicited by hypothyroid rat treatment with T3 and its analog GC-1. Aerobic capacities, evaluated by cytochrome oxidase activities, were increased more by T3 than by GC-1. Furthermore, the response of the tissues to T3 was similar, whereas the response to GC-1 was high in liver, low in muscle and scarce in heart. Both treatments induced increases in ADP-stimulated O2 consumption, which were consistent with those in aerobic capacities. However, unlike T3, GC-1 differentially affected pyruvate/malate- and succinate-supported respiration, suggesting that respiratory chain components do not respond as a unit to GC-1 stimulation. According to the positive relationship between electron carrier levels and rates of mitochondrial generation of oxidative species, the most extensive damage to lipids and proteins was found in T3-treated rats. Examination of antioxidant enzyme activities and scavenger levels did not clarify whether oxidative damage extent also depended on different antioxidant system effectiveness. Conversely, the analysis of parameters determining tissue susceptibility to oxidants showed that pro-oxidant capacity was lower in GC-1- than in T3-treated rats, while antioxidant capacity was similar in treatment groups. Interestingly, both agonists decreased serum cholesterol levels, but only GC-1 restored euthyroid values of heart rate and indices of tissue oxidative damage, indicating that GC-1 is able to lower cholesterolemia, bypassing detrimental effects of T3.

Involvement of PGC-1, NRF-1, and NRF-2 in metabolic response by rat liver to hormonal and environmental signals

We studied liver oxidative capacity and O2 consumption in hypothyroid rats treated for 10 days with T4, or T3, or treated for 10 days with T3 and exposed to cold for the last 2 days. The metabolic response of homogenates and mitochondria indicated that all treatments increased the synthesis of respiratory chain components, whereas only the cold-induced mitochondrial proliferation. Determination of mRNA and protein expression of transcription factor activators, such as NRF-1 and NRF-2, and coactivators, such as PGC-1, showed that mRNA levels, except PGC-1 ones, were not related to aerobic capacities. Conversely, a strong correlation was found between cytochrome oxidase activity and PGC-1 or NRF-2 protein levels. Such a correlation was not found for NRF-1. Our results strongly support the view that in rat liver PGC-1 and NRFs are responsible for the iodothyronine-induced increases in respiratory chain components, whereas their role in cold-induced mitochondrial proliferation needs to be further on clarified.

Rapid alpha spectroscopy of evaporated liquid residues for emergency response

A new method for alpha spectroscopy of evaporated water residues was developed, consisting of evaporation of drinking water, flaming of the planchets, and alpha-spectroscopic measurements using a grid ionization chamber. The method can identify and quantify radioactivity concentrations > or =3 mBq L-1 in a matter of several hours, whereas determination of sub-mBq L-1 levels is achievable in 1 day. Detailed investigations of flaming of the planchets, the humidity effect, and alpha spectroscopy of thick sources are described. A three-dimensional calibration of the method was performed using standards containing 238U, 230Th, 239Pu, 241Am, and 244Cm radionuclides. In addition to its application to evaporated drinking water, this calibration is common for any environmental sample that can be prepared as a uniform layer, such as the residues from surface water, acidic washing or leaching from materials, as well as biological fluids such as urine. The developed method serves as a fast identifying or screening technique for emergency response involving alpha radioactivity.

Management of clinical radial nerve palsy with closed fracture shaft of humerus--a postal questionnaire survey

The management of radial nerve palsy associated with fracture shaft of humerus is still a matter of debate. Various studies based on surgical and conservative management of this clinical problem have shown good results. After a recent systematic review by Shao et al. we felt that it was timely to survey the current practice among trauma and orthopaedic surgeons in England. Postal questionnaires were sent to orthopaedic surgeons in the north of England. The response rate was 64%. The survey showed that surgeons still differ in the ways of management of radial nerve palsy associated with fracture shaft of humerus, with a slightly higher percentage of surgeons preferring conservative treatment. The study also reveals the current practice of immobilisation, investigations and the duration of expectant treatment before surgical exploration among surgeons in the north of England.

Household knowledge and practices of newborn and maternal health in Haripur district, Pakistan

OBJECTIVE

To learn about household maternal and newborn health knowledge and practices to aid the design of newborn programming within Save the Children's Haripur Program.

STUDY DESIGN

In April, we conducted 43 semi-structured interviews (SSIs) and 34 focus group discussions among men, women of reproductive age and health service providers; in September, we added 21 SSIs among new mothers, new fathers and dais. Two investigators analyzed the findings according to themes within six care types: antenatal, delivery, immediate newborn, routine postpartum, special maternal and special newborn.

RESULT

Findings indicated poor maternal diet and antenatal care-seeking. Home delivery with an untrained dai was the norm. Respondents knew about benefits of clean delivery, but rarely put knowledge into practice. Knowledge and practices for maintaining the newborn's warmth were good. Delayed initiation of breastfeeding, avoidance of colostrum and prelacteal feeding were almost universal. Unhygienic cord care, including an unclean cut and application of ghee on the cord-stump, was the norm. After delivery, mothers often maintained low fluid intake but otherwise reported healthy nutritional practices. Knowledge of some danger signs in newborns was common, but timely action upon recognition was not.

CONCLUSION

Although the findings illustrate some beneficial practices, many reported practices are harmful to the newborn. These findings, consistent with the sparse existing data in Pakistan, inform program interventions for household-level behavioral change.

Role of mitochondria in exercise-induced oxidative stress in skeletal muscle from hyperthyroid rats

Previous study showed that exercise induces higher oxidative damage and respiratory capacity reduction in hyperthyroid than in euthyroid skeletal muscle. Because impaired cell function can result from mitochondrial dysfunction, we evaluated the changes induced by exercise in oxygen consumption of skeletal muscle mitochondria from euthyroid and hyperthyroid rats. The mitochondrial function was related with indices of oxidative damage and nitric oxide production, scavenger levels and mitochondrial ROS production rates. Our results show that exercise increased state 4 and decreased state 3 respiration, and the highest changes happened in hyperthyroid preparations. This was consistent with the observation that oxidative damage and NO(*) derivative content were increased by T(3) administration and exercise, reaching the highest levels in hyperthyroid exercised rats. Our results also indicate that the high mitochondrial oxidative damage induced by T(3) and exercise is due to enhanced ROS production, which is dependent on increases in mitochondrial content and reduction degree, respectively, of autoxidizable electron carriers.

Vitamin E attenuates cold-induced rat liver oxidative damage reducing H2O2 mitochondrial release

Vitamin E is a major chain-breaking antioxidant which is able to reduce liver oxidative damage without modifying aerobic capacity in T(3)-treated rats. We investigated whether vitamin E has similar effects in hyperthyroid state induced by cold exposure. Cold exposure increased aerobic capacity and O(2) consumption in homogenates and mitochondria and tissue mitochondrial protein content. Vitamin E did not modify aerobic capacity and mitochondrial protein content of cold liver, but increased ADP-stimulated respiration of liver preparations. Succinate-supported H(2)O(2) release rates were increased by cold during basal and stimulated respiration, whereas the pyruvate/malate-supported ones increased only during basal respiration. Vitamin administration to cold-exposed rats decreased H(2)O(2) release rates with both substrates during basal respiration. This effect reduced ROS flow from mitochondria to cytosol, limiting liver oxidative damage. Cold exposure also increased mitochondrial capacity to remove H(2)O(2), which was reduced by vitamin treatment, showing that the antioxidant also lowers H(2)O(2) production rate. The different effects of cold exposure and vitamin treatment on H(2)O(2) generation were also found in the presence of respiration inhibitors. Although this can suggest that the cold and vitamin induce opposite changes in mitochondrial content of autoxidizable electron carriers, it is likely that vitamin effect is due to its capacity to scavenge superoxide radical. Finally, vitamin E reduced mitochondrial oxidative damage and susceptibility to oxidants, and prevented Ca(2+)-induced swelling elicited by cold. In the whole, our results suggest that vitamin E is able to maintain aerobic capacity and attenuate oxidative stress of hepatic tissue in cold-exposed rats modifying mitochondrial population characteristics.

Is endoscopic ultrasound clinically useful for follow-up of gastric lymphoma?

BACKGROUND

Endoscopic ultrasound (EUS) is considered the best technique for locoregional staging at diagnosis but its role in the follow-up of patients with gastric lymphoma after organ-conserving strategies has not been established.

DESIGN AND METHODS

We retrospectively evaluated 23 patients with primary gastric lymphoma treated with a stomach-conservative approach. Sixteen of them were affected by MALT lymphoma and seven by diffuse large-B-cell lymphoma (DLBCL). Five patients were treated with Helicobacter pylori (HP) eradication therapy alone (omeprazole + amoxicillin + clarithromycin); eight patients received a treatment including HP eradication and chemotherapy and the remaining 10 patients were treated with chemotherapy alone.

RESULTS

At the end of treatment, a complete remission was documented in 21 (91%) patients by endoscopy with biopsy (E-Bx) but in only seven (30%) patients by EUS. A total of 99 evaluations with both EUS and E-Bx were evaluated and we found concordance between the two methods in 33 occasions (33%) only. No significant difference on the percentage of concordance was recorded between MALT and DLBCL. After a median follow-up of 36.5 months we have not observed any relapse in 12 patients (six DLBCL and six MALT) with a persistent positive EUS but negative E-Bx.

CONCLUSIONS

Although the length of follow-up cannot exclude late relapse, we think that in restaging and follow-up of gastric lymphoma, EUS seems not to be a reliable tool if it is abnormal and E-Bx still remains the gold standard. Therefore, after conventional conservative treatment, persistence of EUS abnormality with a negative histology should not be considered as a clinically relevant persistence of disease and should not be a reason for further treatment.

[Management of multiple myeloma]

Multiple myeloma (MM) remains an incurable malignancy, the median overal survival of patients receiving conventional chemotherapy being only 36-60 months. MGUS can evolve to MM in a percentage of 0.6-3% per year. The therapeutic management of multiple myeloma (MM) for the last several decades has mainly involved regimens based on use of glucocorticoids and cytotoxic chemotherapeutics. Melphaln and Prednisone (MP) are recognized as the classic treatment of MM. In patients candidate to bone marrow transplantation, VAD (Vincrisrine, Adriamicin, Dexamethasone) regimen is more indicated because it does not cause stem cell injury. High dose chemotherapy and and Autologous stem cells transplantation represent the best treatment for patients with MM who are younger than 65 years and free of severe comorbidities. Thalidomide alone or in combination with steroids has significant activity in multiple myeloma (MM). After the role of thalidomide in the management of patients with advanced or refractory MM had been established, many studies are evaluating the efficacy and toxicity of thalidomide as first-line therapy for patients with newly diagnosed disease. Recent studies have enhanced our understanding of disease pathogenesis and also provided the framework for a new treatment paradigm targeting the MM cell in its bone marrow microenvironment to overcome drug resistance and improve patient outcome. Clinical trials are confirming the remarkable activity and improved tolerability of some of the new agents identified through this paradigm.

Experimental investigation of mass efficiency curve for alpha radioactivity counting using a gas-proportional detector

Gross alpha counting of evaporated water residues offers a simple method for screening alpha radioactivity in water for both public health and emergency purposes. The evaporation process for water has been improved by using a combination of roughening of the surface of counting planchettes, two-stage evaporation, and temperature-controlled block heating. The efficiency of the gas-proportional detector for alpha-particle detection in water residues was studied as a function of sample mass-thickness in the range between 0.1 and 13 mg cm(-2). The effect of alpha energy on the efficiency, as well as moisture absorption on the samples, were studied using (230)Th, (238)U, (239)Pu, (241)Am, and (244)Cm radionuclides. Also, alpha-to-beta crosstalk was investigated as a function of sample mass for (230)Th, (238)U, (239)Pu, (241)Am, and (244)Cm. The improved method can also be applied for gross alpha detection in biological fluids.

Low-background gamma spectrometry for environmental radioactivity

Development and performance of a low-background gamma-ray spectrometer are described. The spectrometer consists of a 131% efficient Ge detector in U-type configuration. The passive shielding consists of ultrapure lead of 6" thickness. A top muon guard is used as an active shielding. The spectrometer and shielding are positioned inside a steel room made of 6"-thick pre-World War II iron. The steel room is located underground with 33 m of water-equivalent overburden. The total integrated background rate in the energy range 50-2,700 keV was measured at 0.068 counts per second per 100 cm3 Ge volume. The spectrometer serves as a reference instrument for low-level and highly accurate environmental radioactivity measurements. One specific application of 228Ra determination in drinking water is described. With a 1 l water sample, 1-step chemical procedure, and 1,000 min counting time, a detection limit Ld = 20 mBq/l (0.55 pCi/l) was reached, which meets the EPA mandated limit of 1 pCi/l. Methods of upgrading the spectrometer as well as the predicted improvements in 228Ra detection, including direct counting of water without chemical processing, are discussed.

Risk factors for hepatitis C virus infection in male adults in Rawalpindi-Islamabad, Pakistan

OBJECTIVE

To identify risk factors associated with HCV infection in Islamabad-Rawalpindi.

METHODS

Fifty-seven cases and 180 controls were enrolled from various departments of the nine major hospitals of the Rawalpindi-Islamabad during July-September 1998. Cases were enzyme-linked immunosorbent assay (ELISA) positive for antibodies to HCV (anti-HCV), aged 20-70 years, and residents of Islamabad or Rawalpindi division. Controls were anti-HCV ELISA negatives of the same age range and from the same area. A structured questionnaire was used to collect data on demographic variables and potential risk factors, which was analysed by logistic regression to calculate crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (CI) for risk factors.

RESULTS

The final multivariate logistic regression model revealed that after adjusting for age, cases were more likely to have received therapeutic injections in the past 10 years (1-10 vs. 0 therapeutic injections; adjusted OR=2.8, 95% CI: 1.1-7.1; > 10 vs. 0 therapeutic injections; adjusted OR=3.1, 95% CI: 1.2-7.9) and were significantly more likely to have daily face (adjusted OR=5.1, 95% CI: 1.5-17.0) and armpit shaves (adjusted OR=2.9, 95% CI: 1.3-6.5) by a barber.

CONCLUSION

HCV control and prevention programs in this region should include safe injection practices and educate men about the risk of HCV infection from contaminated instruments used by barbers.

Comparison of safety of glucose oral rehydration solution and maize oral rehydration therapy for home management of diarrhoea in Kenya

Safety margins and variability in the composition of glucose and maize-based oral rehydration therapy (ORT) prepared by mothers in a rural district of Western Kenya, are reported here. In a 2-year longitudinal field study, packets containing glucose ORS and a home solution made with maize and table salts, were provided to the mothers of 6180 children in Kakamega District in two separate sub-locations. Experienced and trained field workers supported by community registered nurses provided training for the preparation and use of ORT during weekly visits to every household. On four occasions separated by 4-6 months, a 5 per cent random sampling was done of the home-prepared solutions actually used for the treatment of children with diarrhoea. The water used for preparing ORT was also sampled. Samples of 174 glucose-based ORT, 148 maize-salt ORT, and 201 samples of water were analysed. Only 2 per cent of the maize-based ORT were above 120 meq/1 sodium (i.e., the safe range of sodium concentration) compared to 17.8 per cent for glucose solutions (p < 0.001). Home water samples contained substantial amounts of salt, which could unpredictably affect the final composition of the ORT solutions. We conclude that maize-salt ORT had a better margin of safety than glucose-based ORS.

Analysis of heavy metals in atmospheric particulates in relation to their bioaccumulation in explanted Pseudevernia furfuracea thalli

Lichens explants and airborne particulates were analysed for Cr, Zn, Cd, Pb, Ni, Fe, Mn and Cu content in a rural site in the province of Vercelli (Piedmont, N. Italy). Thalli of the fruticose lichen Pseudevernia furfuracea were collected from an uncontaminated area and exposed for one year using two different techniques. Particulates were collected using a continuously operating particulate sampler set up near the lichens explanted throughout the experiment survey. The results confirm both the importance of assessing contamination in rural areas corroborated by the analysis of the presence of the heavy metals in particulates in relation to the main wind directions and the validity of this lichen as biomonitor of airborne metal pollution, although meaningful differences were pointed out between the two different techniques of exposure. The significant correlation between most of the metals accumulated by lichens and the metal air concentrations shows a good evidence of their ability to represent atmospheric contamination.

Bangladeshi rural mothers prepare safer rice oral rehydration solution

Mothers in rural Bangladesh were trained to prepare and use either Rice-ORS (R-ORS) or Glucose-ORS (G-ORS) solutions to treat children with diarrhoea. Families were provided with either G-ORS or R-ORS of the same electrolyte composition through a depot holder. Subsequently, random samples of solutions actually used for treatment by the mothers were collected from homes by field workers. A total of 227 R-ORS and 239 G-ORS samples were analysed. The sodium concentration in about 90% of the samples had a safe range (50-120 mmol/l). Only 4% of R-ORS solutions were above 120 mmol/l in sodium concentration, while 12% of G-ORS solutions exceeded these limits (p < 0.0025). R-ORS (after acid hydrolysis) provided significantly higher glucose (257 +/- 42 mmol/l) for active but safe absorption compared to G-ORS (115 +/- 39 mmol/l). To make R-ORS liquid enough to drink requires addition of sufficient water, preventing the risk of higher sodium concentration. Unlike rice starch, glucose is a highly soluble substance. It is thus possible to prepare a drinkable solution containing dangerously high concentrations of both sodium and glucose, but this can be minimized by more intensive training of the mothers.