Challenges for quality and utilization of real-world data for diffuse large B-cell lymphoma in REALYSA, a LYSA cohort

ABSTRACT

Real-world data (RWD) are essential to complement clinical trial (CT) data, but major challenges remain, such as data quality. REal world dAta in LYmphoma and Survival in Adults (REALYSA) is a prospective noninterventional multicentric cohort started in 2018 that included patients newly diagnosed with lymphoma in France. Herein is a proof-of-concept analysis on patients with first-line diffuse large B-cell lymphoma (DLBCL) to (1) evaluate the capacity of the cohort to provide robust data through a multistep validation process; (2) assess the consistency of the results; and (3) conduct an exploratory transportability assessment of 2 recent phase 3 CTs (POLARIX and SENIOR). The analysis population comprised 645 patients with DLBCL included before 31 March 2021 who received immunochemotherapy and for whom 3589 queries were generated, resulting in high data completeness (<4% missing data). Median age was 66 years, with mostly advanced-stage disease and high international prognostic index (IPI) score. Treatments were mostly rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP 75%) and reduced dose R-CHOP (13%). Estimated 1-year event-free survival (EFS) and overall survival rates were 77.9% and 90.0%, respectively (median follow-up, 9.9 months). Regarding transportability, when applying the CT's main inclusion criteria (age, performance status, and IPI), outcomes seemed comparable between patients in REALYSA and standard arms of POLARIX (1-year progression-free survival 79.8% vs 79.8%) and SENIOR (1-year EFS, 64.5% vs 60.0%). With its rigorous data validation process, REALYSA provides high-quality RWD, thus constituting a platform for numerous scientific purposes. The REALYSA study was registered at www.clinicaltrials.gov as #NCT03869619.

Clinical presentation, outcome, and prognostic markers in patients with intravascular large B-cell lymphoma, a lymphoma study association (LYSA) retrospective study

BACKGROUND

Intravascular large B-cell lymphoma (lVLBCL) is a very rare type of large B-cell lymphoma.

METHODS

We conducted a retrospective study on IVLBCL patients treated from 2000 to 2016 in LYSA cooperative group centers.

RESULTS

Sixty-five patients were identified in 23 centers. Median age at diagnosis was 69 years (range 23-92). Thirty-four patients (64%) had an IPI score >3 and 40 patients (67%) had a performance status ≥2. The most frequent extra-nodal locations were bone marrow (n = 34; 52%), central nervous system (n = 25; 39%), and skin (n = 21; 33%). Nodal involvement and endocrine system were observed in 34% (n = 22) and 18% (n = 12) of all cases, respectively. Twenty-six patients (41%) had macrophage activation syndrome. Tumor cells were frequently CD5 positive (52%) with a non-germinal center origin (86%). BCL2 was expressed in 87% of all samples analyzed (n = 20) and 43% of patients had a MYC/BCL2 double expression. Fifty-six patients were treated with a regimen of chemotherapy containing rituximab, among whom 73% reached complete remission. The median progression-free survival (PFS) and median overall survival (OS) were 29.4 months and 63.8 months, respectively. History of autoimmune disorder (Hazard ratio [HR] 3.3 [1.4-7.8]; p < 0.01), nodal involvement (HR 2.6 [1.4-5.1]; p < 0.01), lack of anthracycline (HR 0.1 [0-0.4] for use; p < 0.001), or no intensification at first-line regimen (p = 0.02) were associated with worse PFS. High-dose methotrexate use was not associated with better PFS or OS.

CONCLUSIONS

Our study highlights the aggressive clinical picture of IVLBCL, in particular the frequency of macrophage activation syndrome, and the need for new therapies despite a response to R-CHOP-like regimen similar to non-intravascular diffuse large B-cell lymphomas.

[The effect of body mass index on outcome of body contouring surgeries]

BACKGROUND

The generalization of bariatric surgery interventions has led in recent years to an explosion in demand for body contouring surgeries. These operations can be followed by postoperative complications; and residual obesity, defined by a BMI≥30, is traditionally considered as a relative contraindication. The objective is to study the influence of a BMI≥30 on the risk of postoperative complications.

METHODS

A retrospective study was conducted on all patients who underwent body contouring surgery between 2014 and 2020 at the Arras Hospital Center. Major complication rates were compared in obese and non-obese patients.

RESULTS

Two hundred twenty-three patients were included, representing a total of 247 surgeries: 124 in the BMI<30 group and 123 in the BMI≥30 group. Sixteen surgeries were followed by at least one major complication, 6 in group I versus 10 in group II (RR=1.7 (0.6-4.5), NS, P=0.29). Therefore there were not significantly more major complications in obese patients.

CONCLUSION

The incidence of major complications following body contouring surgeries is not modified by the presence of a BMI greater than 30, subject to a precautionary procedure adapted to each patient. BMI is therefore not a sufficient criterion to contraindicate this type of surgery.

Thermoregulation at birth differs between piglets from two genetic lines divergent for residual feed intake

Thermoregulation is essential to piglets' neonatal survival. This study used infrared thermography (IRT) to assess thermoregulation abilities of piglets from two lines divergent for residual feed intake (RFI). At birth, morphology (weight, length, width and circumference), vigour (respiration, mobility and vocalisation), and rectal temperature were recorded from piglets of the 11th generation of the low RFI (LRFI, more efficient; n = 34) and the high RFI (HRFI, less efficient; n = 28) lines. Infrared thermography images were taken at 8, 15, 30 and 60 min post partum. Temperatures of the ear base and tip, and of the back (i.e. shoulders to rumps) were extracted (Thermacam Researcher Pro 2.0) and analysed with linear mixed models (SAS 9.4). Piglets had different average hourly weight gain (HRFI = 7.1 ± 1.3 g/h, LRFI = 3.6 ± 1.3 g/h; P < 0,001) but did not differ in morphology or vigour. All temperatures increased overtime. At birth, piglets' rectal temperature was correlated with the initial temperature of the ear base and the maximum back temperature (0.37 and 0.33, respectively; P < 0.05). High residual feed intake piglets had lower ear tip temperatures than LRFI piglets at 15 (24.7 ± 0.37 °C vs. 26.3 ± 0.36 °C, respectively; F1, 63.5 = 9.11, P < 0.005) and 30 min post partum (26.2 ± 0.47 °C vs. 27.6 ± 0.44 °C, respectively; F1, 66.9 = 4.52, P < 0.05). Moreover, thermal pattern of the ear tip differed between the two genetic lines. In conclusion, IRT allowed non-invasive assessment of piglets' thermoregulation abilities and indicated an influence of genetic selection for RFI on neonatal thermoregulation abilities.

Anticoagulant Activity of Sulfated Ulvan Isolated from the Green Macroalga Ulva rigida

(1) Background: Brown and red algal sulfated polysaccharides have been widely described as anticoagulant agents. However, data on green algae, especially on the Ulva genus, are limited. This study aimed at isolating ulvan from the green macroalga Ulva rigida using an acid- and solvent-free procedure, and investigating the effect of sulfate content on the anticoagulant activity of this polysaccharide. (2) Methods: The obtained ulvan fraction was chemically sulfated, leading to a doubling of the polysaccharide sulfate content in a second ulvan fraction. The potential anticoagulant activity of both ulvan fractions was then assessed using different assays, targeting the intrinsic and/or common (activated partial thromboplastin time), extrinsic (prothrombin time), and common (thrombin time) pathways, and the specific antithrombin-dependent pathway (anti-Xa and anti-IIa), of the coagulation cascade. Furthermore, their anticoagulant properties were compared to those of commercial anticoagulants: heparin and Lovenox®. (3) Results: The anticoagulant activity of the chemically-sulfated ulvan fraction was stronger than that of Lovenox® against both the intrinsic and extrinsic coagulation pathways. (4) Conclusion: The chemically-sulfated ulvan fraction could be a very interesting alternative to heparins, with different targets and a high anticoagulant activity.

FLT3 ligand plasma levels have no impact on outcomes after allotransplant in acute leukemia

OBJECTIVE

This study was designed to assess the impact on outcomes of early soluble Fms-like tyrosine kinase 3 ligand concentrations (sFLc) in patients receiving an allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

METHODS

This was a prospective monocentric study including all allo-HSCT patients included in the previous FLAM/FLAL study (Peterlin et al., 2019). Blood samples collected before the start of conditioning then post-transplant were frozen, stored and tested by ELISA. The parameters considered were hematopoietic recoveries, Leukemia Free Survival and Overall Survival, acute and chronic GVHD, grade 3 or 4 acute and/or extensive chronic GVHD-free and relapse-free survival (GRFS).

RESULTS

Forty-one patients were included, a total of 179 samples were assayed for sFLc. There was no impact of sFLc levels (<=median vs> median) on acute and chronic GVHD incidences, LFS, OS nor GRFS.

CONCLUSION

At variance with induction results for AML (Peterlin et al., 2019) endogenous sFLc do not appear to be a prognostic marker at the time of or after allo-HSCT. Even though the results are negatives, this is, to the best of our knowledge, the only prospective series specifically addressing the question of sFLc impact after allo-HSCT in acute leukemias.

Influence of Donor Type (Sibling versus Matched Unrelated Donor versus Haploidentical Donor) on Outcomes after Clofarabine-Based Reduced-Intensity Conditioning Allograft for Myeloid Malignancies

Clofarabine-based reduced-intensity conditioning (RIC) regimens are well-established schedules for allograft in patients with myeloid malignancies. A retrospective study was conducted including all adults allografted in our department with such a regimen and disease with the aim to assess whether or not the donor type (matched sibling [MSD], matched unrelated [MUD], or haploidentical [haplo]) impacted outcomes. Between October 2009 and February 2018, 118 patients met the inclusion criteria. Thirty-six, 55, and 27 patients received a graft from an MSD, MUD, or haplo donor, respectively. Peripheral blood stem cells (PBSCs) were the source of graft for all patients. The median age of the entire cohort was 62 years (range, 20 to 73), and the median follow-up was 31 months (range, 4.5 to 106). All patients engrafted except 1 haplo recipient. Neutrophils (>.5 × 10⁹/L) and platelets (50 × 10⁹/L) recoveries were significantly delayed in the haplo group (P = .0003 and P < .0001) compared with MSD and MUD. Acute grades II to IV or III to IV graft-versus-host disease (GVHD) incidences were similar between the 3 groups as well as the incidence of moderate or severe chronic GVHD. Also, similar 2-year overall survival (OS; 64.7% versus 73.9% versus 60.2%, P = .39), disease-free survival (DFS; 57.7% versus 70.9% versus and 53.6%, P = .1), and GVHD relapse-free survival (37.9% versus 54.3% versus 38.9%, P = .23) were observed between MSD versus MUD versus haplo groups. The same was true when considering only acute myeloid leukemia (AML) cases. In multivariate analysis the type of donor remained independent of outcomes in this series, whereas myelodysplastic syndrome (versus AML), high disease risk index, and older donor (≥50 years) were associated with lower OS and DFS. These data suggest that haplo donors are an acceptable alternative for patients receiving a clofarabine-based RIC PBSC allograft for myeloid malignancies who lack an MSD or a MUD.

Pomalidomide, cyclophosphamide, and dexamethasone for relapsed/refractory multiple myeloma patients in a real-life setting: a single-center retrospective study

Pomalidomide dexamethasone is a standard of care for relapsed multiple myeloma (MM) patients who received at least two prior lines of therapy, including both lenalidomide and proteasome inhibitors (PI). We report here a real-life single-center series of 49 consecutive patients with relapsed and refractory MM treated with the triplet pomalidomide cyclophosphamide dexamethasone (PCD) combination. The median of prior lines of therapy was 3 and all patients were previously exposed to proteasome inhibitors and lenalidomide. The overall response rate was 76%, including 27% very good partial response or better. With a median follow-up of 16 months, the median progression-free survival (PFS) was 7.3 months and the median overall survival was not reached. Regarding safety, most frequent toxicity was hematologic, including 37% grade 3-4 cytopenias. Nine patients (18%) discontinued therapy due to adverse event. Our study confirms that PCD combination is feasible and results in favorable response rate and PFS in comparison with pomalidomide dexamethasone alone.

Synthesis of 2-Mercapto-(2-Oxoindolin-3-Ylidene)Acetonitriles from 3-(4-Chloro-5H-1,2,3-Dithiazol-5-Ylidene)Indolin-2-ones

Alkylidene oxindoles are important functional moieties and building blocks in pharmaceutical and synthetic chemistry. Our interest in biologically active compounds focused our studies on the synthesis of novel oxindoles, bearing on the exocyclic double bond at the C8, CN, and S groups. Extending the potential applications of Appel’s salt, we developed a new synthetic approach by investigating the reactions of C5-substituted 2-oxindoles with 4,5-dichloro-1,2,3-dithiazolium chloride (Appel’s salt) to give original (Z)-3-(4-chloro-5H-1,2,3-dithiazol-5-ylidene)indolin-2-one derivatives, and new 2-mercapto-(2-oxoindolin-3-ylidene)acetonitriles via a dithiazole ring-opening reaction. The work described in this article represents further applications of Appel’s salt in the conception of novel heterocyclic rings, in an effort to access original bioactive compounds. Fifteen new compounds were prepared and fully characterized.

Safety of ixazomib for the treatment of multiple myeloma

INTRODUCTION

Despite a major positive impact of proteasome inhibitors (PI), such as bortezomib and carfilzomib, on the survival of patients with multiple myeloma (MM) over the last few years, their use in clinical practice is limited by the development of drug resistance, significant side-effects or constraining administration schedules. Ixazomib is the first, and for now the only, oral PI, which was approved by the US Food and Drug Administration in 2015 and by the European Medicines Agency in 2016. Areas covered: In this review, we provide an overview of the preclinical and early-phase studies of ixazomib used as single-agent and in combination. Furthermore, we discuss the results of a recently published pivotal trial, which evaluated the safety profile and clinical benefit of the combination of ixazomib, lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in 722 patients with relapsed/refractory MM. Expert opinion: Ixazomib combines the comfort of oral administration, substantial clinical efficacy and a good safety profile with manageable side-effects, which mainly comprise low-grade hematological, digestive or cutaneous events, and the agent will therefore play an active part in long-term treatment strategies, both as single agent and as part of combination regimens. Ongoing phase III trials are currently defining its place in first-line, maintenance and relapse settings.

Clinical characteristics and prognostic factors of plasmablastic lymphoma patients: analysis of 135 patients from the LYSA group

Background

Plasmablastic lymphoma (PBL), initially described in 1997 in the oral cavity of HIV positive patients, is now recognized as a distinct aggressive and rare entity of diffuse large B-cells lymphoma by the World Health Organization (WHO) classification. Since the original description, others cases have been reported. However, these are largely derived from case reports or small series limiting any definitive conclusions on clinical characteristics and outcome.

Patients and methods

The clinical, biological, pathological features and outcome of a cohort including 135 patients with PBL, from LYSA centers in France and Belgium, were reported and analyzed.

Results

The median age was 58 years, with a male predominance. The cohort was divided into 56 HIV-positive patients, 17 post-transplant patients and 62 HIV-negative/non-transplanted patients. Within HIV-negative/non-transplanted, a relative immunosuppression was found in most cases (systemic inflammatory disease, history of cancer, increased age associated with weakened immune system). We have also described a new subtype, PBL arising in a chronic localized inflammatory site, without any sign of immunosuppression. At presentation, 19% of patients showed oral involvement. Immunophenotype showed CD138 positivity in 88% of cases and CD20 negativity in 90% of cases. Chemotherapy was administered to 80% of patients, with a complete response (CR) rate of 55%. The median overall survival (OS) was 32 months. In univariate analysis, HIV positive status showed better OS when compared with HIV negative status. In multivariate analysis, International Prognostic Index score, chemotherapy and CR were associated with survival benefit.

Conclusion(s)

This cohort, the largest reported to date, increases the spectrum of knowledge on PBL, rarely described. However, specific guidelines to clarify treatment are lacking, and may improve the poor prognosis of this rare disease.

Pilot production of ulvans from Ulva sp. and their effects on hyaluronan and collagen production in cultured dermal fibroblasts

Ulvans from Ulva sp. were tested for their potential cosmetic properties on human dermal fibroblasts. The crude ulvans (ULVAN-01, 57kDa), extracted using a patented acid- and solvent-free process, were subjected to depolymerization using ion exchange resin to obtain a low molecular weight ulvan (ULVAN-DEP, 4kDa). The biochemical characterization and UHPLC-HRMS analyses of these extracted ulvans showed that they were of high purity and predominantly composed of a repeated ulvanobiouronic acid disaccharide. Fibroblast proliferation, as well as hyaluronan and collagen release were assessed, demonstrating that ULVAN-01 reduced fibroblast proliferation rate while ULVAN-DEP had no significant effect. Both ulvans were ineffective to induce collagen production but induced a significant increase in hyaluronan production, with a strong influence of the molecular weight. Thus, crude and depolymerized ulvans had different metabolic activities on dermal fibroblasts, which makes them promising to envisage further development in the skin care field.

UPLC-MSE profiling of Phytoplankton metabolites: application to the identification of pigments and structural analysis of metabolites in Porphyridium purpureum

A fast and high-resolution UPLC-MS^E analysis was used to identify phytoplankton pigments in an ethanol extract of Porphyridium purpureum (Pp) devoid of phycobiliproteins. In a first step, 22 standard pigments were analyzed by UPLC-MS^E to build a database including retention time and accurate masses of parent and fragment ions. Using this database, seven pigments or derivatives previously reported in Pp were unequivocally identified: β,β-carotene, chlorophyll a, zeaxanthin, chlorophyllide a, pheophorbide a, pheophytin a, and cryptoxanthin. Minor amounts of Divinyl chlorophyll a, a chemotaxonomic pigment marker for prochlorophytes, were also unequivocally identified using the database. Additional analysis of ionization and fragmentation patterns indicated the presence of ions that could correspond to hydroxylated derivatives of chlorophyll a and pheophytin a, produced during the ethanolic extraction, as well as previously described galactosyldiacylglycerols, the thylakoid coenzyme plastoquinone, and gracilamide B, a molecule previously reported in the red seaweed Gracillaria asiatica. These data point to UPLC-MS^E as an efficient technique to identify phytoplankton pigments for which standards are available, and demonstrate its major interest as a complementary method for the structural elucidation of ionizable marine molecules.

Characterization of the colistin (polymyxin E1 and E2) biosynthetic gene cluster

Colistin is a mixture of polymyxin E1 and E2, bactericidal pentacationic lipopeptides used to treat infections caused by Gram-negative pathogens such as Pseudomonas aeruginosa and Klebsiella pneumoniae. Industrial production of colistin is obtained by a fermentation process of the natural producer Paenibacillus polymyxa var colistinus. NonRibosomal peptide synthetases (NRPS) coding the biosynthesis of polymyxins A, B and P have been recently described, rendering thereof the improvement of their production possible. However, the colistin biosynthesis pathway was not published so far. In this study, a Paenibacillus alvei has been identified by biochemical (Api 50 CH system) and molecular (16S rDNA sequencing) methods. Its culture supernatant displayed inhibitory activity against Gram-negative bacteria (P. aeruginosa, K. pneumoniae, Salmonella spp.). Two polymyxins, E1 and E2, were recovered from the supernatant and were characterized by high resolution LC-MS. A genomic library (960 clones) was constructed to identify the gene cluster responsible for biosynthesis of polymyxins. Selection of the clones harbouring the sequences of interest was obtained by a simple PCR-based screening. We used primers targeting NRPS sequences leading to the incorporation of amino acids present in polymyxins E. The sequences from three clones of interest were assembled on 50.4 kb. Thus, five open reading frames corresponding to a new NRPS gene cluster of 41 kb were identified. In silico, analyses revealed the presence of three NRPS implicated in the biosynthesis of polymyxins E. This work provides insightful information on colistin biosynthesis and might contribute to future drug developments in this group of antibiotics.

[The acute pulmonary renal syndrome: An unusual presentation of granulomatosis with polyangiitis]

INTRODUCTION

We report a case of acute pulmonary renal syndrome mimicking septic shock, which led to the diagnosis of granulomatosis with polyangiitis.

CASE REPORT

A 70-year-old man was hospitalized because of acute kidney injury and acute respiratory distress syndrome with diffuse alveolar hemorrhage associated with a serum procalcitonin level of 18 μg/L. Initially, septic shock was suspected and antibiotic therapy was started. The absence of microbiological isolates and the patient's rapid clinical deterioration prompted laboratory testing for autoimmune disease, which confirmed the diagnosis of granulomatosis with polyangiitis. Immunosuppressive therapy was promptly initiated with corticosteroids, cyclophosphamide and several plasma exchanges, which resulted in a rapid clinical improvement and ICU discharge.

CONCLUSIONS

Granulomatosis with polyangiitis is a systemic necrotizing vasculitis with antineutrophil cytoplasmic antibodies, which can present with acute pulmonary renal syndrome, combining acute respiratory distress syndrome and acute kidney injury. This misleading presentation must prompt an autoimmune disease testing in order to yield an early diagnosis of a vasculitis, allowing for timely initiation of immunosuppressive treatment. Serum procalcitonin levels can be markedly elevated and this must not override the possibility of a vasculitis where the patient shows a compatible symptomatology.

Delivery of tidal volume from four anaesthesia ventilators during volume-controlled ventilation: a bench study

BACKGROUND

Tidal volume (V(T)) must be accurately delivered by anaesthesia ventilators in the volume-controlled ventilation mode in order for lung protective ventilation to be effective. However, the impact of fresh gas flow (FGF) and lung mechanics on delivery of V(T) by the newest anaesthesia ventilators has not been reported.

METHODS

We measured delivered V(T) (V(TI)) from four anaesthesia ventilators (Aisys™, Flow-i™, Primus™, and Zeus™) on a pneumatic test lung set with three combinations of lung compliance (C, ml cm H2O(-1)) and resistance (R, cm H2O litre(-1) s(-2)): C60R5, C30R5, C60R20. For each CR, three FGF rates (0.5, 3, 10 litre min(-1)) were investigated at three set V(T)s (300, 500, 800 ml) and two values of PEEP (0 and 10 cm H2O). The volume error = [(V(TI) - V(Tset))/V(Tset)] ×100 was computed in body temperature and pressure-saturated conditions and compared using analysis of variance.

RESULTS

For each CR and each set V(T), the absolute value of the volume error significantly declined from Aisys™ to Flow-i™, Zeus™, and Primus™. For C60R5, these values were 12.5% for Aisys™, 5% for Flow-i™ and Zeus™, and 0% for Primus™. With an increase in FGF, absolute values of the volume error increased only for Aisys™ and Zeus™. However, in C30R5, the volume error was minimal at mid-FGF for Aisys™. The results were similar at PEEP 10 cm H2O.

CONCLUSIONS

Under experimental conditions, the volume error differed significantly between the four new anaesthesia ventilators tested and was influenced by FGF, although this effect may not be clinically relevant.

[Postoperative pain trajectories to identify risk of chronic postsurgical pain in living donors for liver transplantation]

OBJECTIVES

To assess pain trajectories in predicting risk of chronic postoperative pain (CPP) after liver resection for living donor transplantation.

STUDY DESIGN

Retrospective analysis of patients undergoing liver resection for living donor transplantation during 3years.

PATIENTS AND METHODS

After recording perioperative data, patients presenting CPP at 3months were separated from patients without postsurgical pain problem in order to build a pain trajectory for liver donor patients without CPP. Postoperative course of liver donors with CPP was then compared to that standard pain trajectory.

RESULTS

Sixty-five patients (30 females, 35 males) were included. Epidural analgesia was used in 66%; others received autocontrolled analgesia by morphine. Severe acute pain was expressed by 11% and 37% at rest and movement respectively on the first day. Chronic pain involved six patients without any link with gender or type of analgesia. Analysis of pain trajectories shown that these patients presented either higher initial pain at day 1 or positive slopes with worsening of pain.

CONCLUSION

Acute postoperative pain is a risk factor of developing CPP. Identification of those people by pain trajectories can be useful to treat them early.

[Self-perception and life satisfaction in video game addiction in young adolescents (11-14 years old)]

INTRODUCTION

Video games are part of our society's major entertainments. This is now a global industry that covers the preferential activity of adolescents. But for some, the practice goes beyond a game and becomes an addictive functioning. Clinical practice is then faced with a new problem. It is important to understand the special bond that develops between a player and his/her video game in order to understand the addictive process.

BACKGROUND

The game consists of a virtual world, a graphical construction that is a simulation of reality and which reinvents the laws that govern it. It also consists of a character embodied by the player who controls it: the avatar. Through the virtual world and avatar, the game offers the player a virtual personification that matches his/her expectations and projected ideal. The avatar allows the subject to compensate, or even to modify some aspects of the Self and thus enhance his/her perception of him/herself; the virtual life become more satisfying than real life.

OBJECTIVES

The aim of this research is to propose, from the study of the relationship between psychosocial variables (self-perception and life satisfaction) and the adolescent's practice of video games, elements of construction of an explanatory model of video gambling addiction.

METHODS

The population of this research is composed of 74 adolescents aged 11-14 years (m(age)=12.78 and SD=0.921). Fourteen are identified as addicted to video games by the results of the Game Addiction Scale. The quantitative methodology allows measurement of the different psychosocial variables which appear important in the addictive process. The instruments used are: the Game Addiction Scale, the Self-Perception Profile and the Satisfaction with Life Scale.

RESULTS

The results show that adolescents addicted to video games see their virtual and current Self as being less proficient than other teenagers. Furthermore, teenagers addicted to video games see their virtual Self as more proficient and adapted to the environment than their current Self. Moreover, adolescents addicted perceive their lives as less satisfying than others'. Hence, virtual life is perceived as more satisfying than real life among teenagers addicted to video games. Finally, this virtual experience is thus one of the factors that explain the addiction to video games. Through the game, the teenager can "live" a new version of him/herself, becoming secondarily alienating. The virtual world supplants real life and becomes the source of a clash of identity.

[The role of temperament and emotional awareness in risk taking in adolescents]

INTRODUCTION

Risk-taking behaviors among adolescents are now considered as a real public health issue. To investigate for potential vulnerability factors, adolescent risk-taking behavior can be analyzed from several different perspectives, based on biological, social or psychological variables. Risk-taking theories based on temperamental dimensions examine individual differences in propensity for engaging in such behaviors, whereas others focused on emotional processing disorder such as alexithymia or anhedonia with diverse conclusions. The aim of this study was to investigate the relationship between risk taking and two levels of psychological functioning: personality with reference to Cloninger's model of personality, and emotion with reference to Lane and Schwartz's level of emotional awareness theory.

METHOD

The sample consisted in 488 adolescents (m(age)=14.93, SD=1.44) with 257 boys (m(age)=15, SD=1.51) and 231 girls (m(age)=14.52, SD=1.23) who completed a set of three inventories: the Youth Risk Behavior Surveillance Scale (YRBSS), the Tridimensional Personality Questionnaire, and the Level of Emotional Awareness Scale. Risk-taking behaviors were also assessed indirectly with regards to teachers or school educators' evaluation.

RESULTS

Moderate to weak significant correlations were found between temperament dimensions and risk-taking, and between level of emotional awareness and risk-taking. A positive moderate correlation was observed between novelty and risk-taking, whereas a negative weak correlation was observed between harm avoidance and risk-taking. Level of emotional awareness shows moderate negative correlations with risk-taking, as the two self and others dimensions. Finally, a model including the four temperament and the two emotional awareness dimensions was tested with risk-taking as the outcome variable. It accounted for 33% of the total variance (R(2)=0.33; F=30.78, p<0.0001), with novelty seeking (p<0.0001), self (p<0.0001) and others (p=0.0001), and level of emotional awareness as significant criteria.

DISCUSSION

As hypothesized, temperamental dispositions of novelty seeking and harm avoidance, associated with weak emotional awareness, were associated with risk-taking. They may be considered as vulnerability factors for adolescents to engage in risk-taking behaviors. Several propositions may explain our results. First, risk-taking might be considered as an attempt to struggle against a sensation of emptiness due to a lack of emotion. Second, it may tend to replace emotion by sensations, which could be more controlled. Third, it could be an attempt - without success - to construct the complexity of subjective emotional experience.

Depressive Symptoms and Emotion in Adolescence: A Developmental-Functionalist View

Adolescent depressive symptoms are recognized as having number of consequences on academic and social achievement (Glied & Pine, 2002). Many studies highlighted the specific implication of emotion regulation deficits to explain depression or affective disorders (Garnefski & Kraaij, 2006). Despite these findings, little studies focused on the relations between emotional deficits (such as low emotional awareness) and subjective emotional intensity in adolescent depressive symptoms. The aim of this study was to examine the relationships between emotion awareness as defined by Lane & Schwartz (1987), subjective emotional intensity, and depressive symptoms. We hypothesized that lack of emotional awareness associated to strong emotional intensity may explain depressive symptoms among adolescents.

448 adolescents (age: 15.54 years 0.66) were administered the following self report questionnaires:•

In vivo gene expression in granulosa cells during pig terminal follicular development

Ovarian antral follicular development is clearly dependent on pituitary gonadotrophins FSH and LH. Although the endocrine mechanism that controls ovarian folliculogenesis leading to ovulation is quite well understood, the detailed mechanisms and molecular determinants in the different follicular compartments remain to be clarified. The aim of this study was to identify the genes differentially expressed in pig granulosa cells along the terminal ovarian follicle growth, to gain a comprehensive view of these molecular mechanisms. First, we developed a specific micro-array using cDNAs from suppression subtractive hybridization libraries (345 contigs) obtained by comparison of three follicle size classes: small, medium and large antral healthy follicles. In a second step, a transcriptomic analysis using cDNA probes from these three follicle classes identified 79 differentially expressed transcripts along the terminal follicular growth and 26 predictive genes of size classes. The differential expression of 18 genes has been controlled using real-time PCR experiments validating the micro-array analysis. Finally, the integration of the data using Ingenuity Pathways Analysis identified five gene networks providing descriptive elements of the terminal follicular development. Specifically, we observed: (1) the down-expression of ribosomal protein genes, (2) the genes involved in lipid metabolism and (3) the down-expression of cell morphology and ion-binding genes. In conclusion, this study gives new insight into the gene expression during pig terminal follicular growth in vivo and suggested, in particular, a morphological change in pig granulosa cells accompanying terminal follicular growth.

Opportunities and challenges in applying genomics to the study of oogenesis and folliculogenesis in farm animals

Ovarian oogenesis and folliculogenesis are complex and coordinated biological processes which require a series of events that induce morphological and functional changes within the follicle, leading to cell differentiation and oocyte development. In this context, the challenge of the researchers is to describe the dynamics of gene expression in the different compartments and their interactions during the follicular programme. In recent years, high-throughput arrays have become a powerful tool with which to compare the whole population of transcripts in a single experiment. Here, we review the challenges of applying genomics to this model in farm animal species. The first limitation lies in limited the availability of biological material, which makes the study of the follicle compartments (oocyte, granulosa cells and thecal cells) or early embryo much more difficult. The concept of observing all transcripts at once is very attractive but despite progress in sequencing, the genome annotation remains very incomplete in non-model species. Particularly, oogenesis and early embryo development relate to the high proportion of unknown expressed sequence tags. Then, it is important to consider post-transcriptional and translational regulation to understand the role of these genes. Ultimately, these new inferred insights will still have to be validated by functional approaches. In addition toin vitroorex vivofunctional approaches, both ‘natural mutant’ ewe models and RNA interference represent, at the moment, the best hope for functional genomics. Advances in our understanding of reproductive physiology should be facilitated by gene expression data exchange and translation into a better understanding of the underlying biological phenomena.