Defective mitochondria remodelling in B cells leads to an aged immune response

The B cell response in the germinal centre (GC) reaction requires a unique bioenergetic supply. Although mitochondria are remodelled upon antigen-mediated B cell receptor stimulation, mitochondrial function in B cells is still poorly understood. To gain a better understanding of the role of mitochondria in B cell function, here we generate mice with B cell-specific deficiency in Tfam, a transcription factor necessary for mitochondrial biogenesis. Tfam conditional knock-out (KO) mice display a blockage of the GC reaction and a bias of B cell differentiation towards memory B cells and aged-related B cells, hallmarks of an aged immune response. Unexpectedly, blocked GC reaction in Tfam KO mice is not caused by defects in the bioenergetic supply but is associated with a defect in the remodelling of the lysosomal compartment in B cells. Our results may thus describe a mitochondrial function for lysosome regulation and the downstream antigen presentation in B cells during the GC reaction, the dysruption of which is manifested as an aged immune response.

Characterization of Three Somatic Mutations in the 3'UTR of RRAS2 and Their Inverse Correlation with Lymphocytosis in Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is a hematologic malignancy characterized by progressive accumulation of a rare population of CD5+ B-lymphocytes in peripheral blood, bone marrow, and lymphoid tissues. CLL exhibits remarkable clinical heterogeneity, with some patients presenting with indolent disease and others progressing rapidly to aggressive CLL. The significant heterogeneity of CLL underscores the importance of identifying novel prognostic markers. Recently, the RAS-related gene RRAS2 has emerged as both a driver oncogene and a potential marker for CLL progression, with higher RRAS2 expression associated with poorer disease prognosis. Although missense somatic mutations in the coding sequence of RRAS2 have not been described in CLL, this study reports the frequent detection of three somatic mutations in the 3' untranslated region (3'UTR) affecting positions +26, +53, and +180 downstream of the stop codon in the mRNA. An inverse relationship was observed between these three somatic mutations and RRAS2 mRNA expression, which correlated with lower blood lymphocytosis. These findings highlight the importance of RRAS2 overexpression in CLL development and prognosis and point to somatic mutations in its 3'UTR as novel mechanistic clues. Our results may contribute to the development of targeted therapeutic strategies and improved risk stratification for CLL patients.

Neoadjuvant Radiation Therapy in the Treatment of Breast Cancer

PURPOSE/OBJECTIVE(S)

Radiation therapy improves locoregional control and increases breast cancer patient's survival. Its neoadjuvant setting is a rarely used alternative that favors tumor resectability and, in addition, allows immediate breast reconstruction. This study aims to characterize locally advanced breast cancer patients that were treated with neoadjuvant radiotherapy (naRT), its indications and results.

MATERIALS/METHODS

Medical records were reviewed retrospectively. All patients diagnosed with breast cancer treated with curative-intent naRT in a Chilean oncologic hospital between January 2017 and 2019 were included. Inflammatory breast cancer cases and sarcomas were excluded. We described demographic, clinical and treatment characteristics, naRT indications and outcomes.

RESULTS

Information was collected from 112 patients (98% women) referred from 7 public hospitals. The median age was 57 years [28-85 years]. At diagnosis, 78% corresponded to clinical stage cT4b, and 83% had cN+ axilla (axillary biopsy was performed in 44 cases, 35 were positive). 53% were classified as luminal B, 19% as triple negative, 17% as luminal A, and 11% as HER2 enriched. 98% of patients began treatment with neoadjuvant systemic therapy (91 patients received chemotherapy and 19 patients hormone therapy). naRT indications were: immediate breast reconstruction in 23% and contraindication or unsatisfactory response to systemic therapy in 77%. In 99% of naRT the dose was 45-50 Gy to the breast/chest wall and peripheral lymphatics. 86% of patients underwent surgery (14 patients did not undergo surgery due to disease progression or because they refused surgery and 2 patients were on the waiting list at the time of follow up). Immediate breast reconstruction was performed in 31 patients with a median age of 45 years, all of them were derived from 2 referral centers that suggest this altered sequence of treatments. Surgical biopsies of 96 patients were reviewed: 13% had pathological complete response in the breast/chest wall, 55% in the axilla, and 12% at both levels. 30% of post-surgical complications were reported in the subgroup of patients who continued follow-up in our institution (total of 47 patients). With a median follow-up of 29 months, 18% of the patients had died from breast cancer.

CONCLUSION

naRT is not only an option when systemic therapy is not a good alternative, but also favors resectability of locally advanced tumors making pathological complete response and immediate breast reconstruction possible in selected cases, obtaining an oncological and reconstructive objective in the same surgery.

Application of Comprehensive Genomic Profiling-Based Next-Generation Sequencing Assay to Improve Cancer Care in a Developing Country

PURPOSE

Identifying actionable oncogenic mutations have changed the therapeutic landscape in different types of tumors. This study investigated the utility of comprehensive genomic profiling (CGP), a hybrid capture-based next-generation sequencing (NGS) assay, in clinical practice in a developing country.

METHODS

In this retrospective cohort study, CGP was performed on clinical samples from patients with different solid tumors recruited between December 2016 and November 2020, using hybrid capture-based genomic profiling, at the individual treating physicians' request in the clinical care for therapy decisions. Kaplan-Meier survival curves were estimated to characterize the time-to-event variables.

RESULTS

Patients median age was 61 years (range: 14-87 years), and 64.7% were female. The most common histological diagnosis was lung primary tumors, with 90 patients corresponding to 52.9% of the samples (95% CI 45.4-60.4%). Actionable mutations with FDA-approved medications for specific alterations correspondent to tumoral histology were identified in 58 cases (46.4%), whereas other alterations were detected in 47 different samples (37.6%). The median overall survival was 15.5 months (95% CI 11.7 months-NR). Patients who were subjected to genomic evaluation at diagnosis reached a median overall survival of 18.3 months (95% CI 14.9 months-NR) compared to 14.1 months (95% CI 11.1 months-NR) in patients who obtained genomic evaluation after tumor progression and during standard treatment (P = .7).

CONCLUSION

CGP of different types of tumors identifies clinically relevant genomic alterations that have benefited from targeted therapy and improve cancer care in a developing country to guide personalized treatment to beneficial outcomes of cancer patients.

Overexpression of wild type RRAS2, without oncogenic mutations, drives chronic lymphocytic leukemia

Background

Chronic lymphocytic leukemia (CLL) is the most frequent, and still incurable, form of leukemia in the Western World. It is widely accepted that cancer results from an evolutionary process shaped by the acquisition of driver mutations which confer selective growth advantage to cells that harbor them. Clear examples are missense mutations in classic RAS genes (KRAS, HRAS and NRAS) that underlie the development of approximately 13% of human cancers. Although autonomous B cell antigen receptor (BCR) signaling is involved and mutations in many tumor suppressor genes and oncogenes have been identified, an oncogenic driver gene has not still been identified for CLL.

Methods

Conditional knock-in mice were generated to overexpress wild type RRAS2 and prove its driver role. RT-qPCR analysis of a human CLL sample cohort was carried out to measure RRAS2 transcriptional expression. Sanger DNA sequencing was used to identify a SNP in the 3’UTR region of RRAS2 in human CLL samples. RNAseq of murine CLL was carried out to identify activated pathways, molecular mechanisms and to pinpoint somatic mutations accompanying RRAS2 overexpression. Flow cytometry was used for phenotypic characterization and shRNA techniques to knockdown RRAS2 expression in human CLL.

Results

RRAS2 mRNA is found overexpressed in its wild type form in 82% of the human CLL samples analyzed (n = 178, mean and median = 5-fold) as well as in the explored metadata. A single nucleotide polymorphism (rs8570) in the 3’UTR of the RRAS2 mRNA has been identified in CLL patients, linking higher expression of RRAS2 with more aggressive disease. Deliberate overexpression of wild type RRAS2 in mice, but not an oncogenic Q72L mutation in the coding sequence, provokes the development of CLL. Overexpression of wild type RRAS2 in mice is accompanied by a strong convergent selection of somatic mutations in genes that have been identified in human CLL. R-RAS2 protein is physically bound to the BCR and mediates BCR signals in CLL.

Conclusions

The results indicate that overexpression of wild type RRAS2 is behind the development of CLL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12943-022-01496-x.

Autologous Dendritic Cells in Combination With Chemotherapy Restore Responsiveness of T Cells in Breast Cancer Patients: A Single-Arm Phase I/II Trial

Introduction

Animal studies and preclinical studies in cancer patients suggest that the induction of immunogenic cell death (ICD) by neoadjuvant chemotherapy with doxorubicin and cyclophosphamide (NAC-AC) recovers the functional performance of the immune system. This could favor immunotherapy schemes such as the administration of antigen-free autologous dendritic cells (DCs) in combination with NAC-AC to profit as cryptic vaccine immunogenicity of treated tumors.

Objective

To explore the safety and immunogenicity of autologous antigen-free DCs administered to breast cancer patients (BCPs) in combination with NAC-AC.

Materials and Methods

A phase I/II cohort clinical trial was performed with 20 BCPs treated with NAC-AC [nine who received DCs and 11 who did not (control group)]. The occurrence of adverse effects and the functional performance of lymphocytes from BCPs before and after four cycles of NAC-AC receiving DCs or not were assessed using flow cytometry and compared with that from healthy donors (HDs). Flow cytometry analysis using manual and automated algorithms led us to examine functional performance and frequency of different lymphocyte compartments in response to a stimulus in vitro. This study was registered at clinicaltrials.gov (NCT03450044).

Results

No grade II or higher adverse effects were observed associated with the transfer of DCs to patients during NAC-AC. Interestingly, in response to the in vitro stimulation, deficient phosphorylation of Zap70 and AKT proteins observed before chemotherapy in most patients’ CD4 T cells significantly recovered after NAC-AC only in patients who received DCs.

Conclusions

The transfer of autologous DCs in combination with NAC-AC in BCPs is a safe procedure. That, in BCPs, the administration of DCs in combination with NAC-AC favors the recovery of the functional capacity of T cells suggests that this combination may potentiate the adjuvant effect of ICD induced by NAC-AC on T cells and, hence, potentiate the immunogenicity of tumors as cryptic vaccines.

Contrasting SARS-CoV-2 RNA copies and clinical symptoms in a large cohort of Colombian patients during the first wave of the COVID-19 pandemic

BACKGROUND

There is limited and controverting evidence looking at possible associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copies and patient variables in large cohorts of symptomatic and asymptomatic patients.

METHODS

We studied 2275 symptomatic and asymptomatic patients from Colombia with coronavirus disease 2019 (COVID-19) and analyzed the associations between RT-PCR cycle threshold (Ct) value with gender, age, comorbidities, symptomatology, and disease severity.

RESULTS

15.4 % of the samples (n = 428) reported at least one comorbidity. There were 2011 symptomatic cases (72.4 %), being the most common reported symptom cough (57.2 %, n = 1586). Respiratory distress was present in 21.4 % of patients (n = 595), and 435 patients (15.6 %) required hospital admission. We observed that patients with no prior medical history harbored higher RNA copies than patients with comorbidities (p = 0.02). No significant differences in RNA copies were observed between symptomatic and asymptomatic patients (p = 0.82). Strong correlations were detected between Ct values and the presence of odynophagia (p = 0.03), diarrhea (p = 0.04), and headache (p = 0.0008). An inverse association was found between RNA copy number and markers of disease severity, namely, respiratory distress (P < 0.0001) and hospitalization requirement (P < 0.0001).

CONCLUSIONS

SARS-CoV-2 RT-PCR cycle thresholds reveal strong associations with a prior medical history, specific symptomatology, and disease severity markers. Further research controlling potential confounding variables needs to be conducted to evaluate the nature and usefulness of these associations in managing COVID-19 patients.

A nearby transiting rocky exoplanet that is suitable for atmospheric investigation

Spectroscopy of transiting exoplanets can be used to investigate their atmospheric properties and habitability. Combining radial velocity (RV) and transit data provides additional information on exoplanet physical properties. We detect a transiting rocky planet with an orbital period of 1.467 days around the nearby red dwarf star Gliese 486. The planet Gliese 486 b is 2.81 Earth masses and 1.31 Earth radii, with uncertainties of 5%, as determined from RV data and photometric light curves. The host star is at a distance of ~8.1 parsecs, has a J-band magnitude of ~7.2, and is observable from both hemispheres of Earth. On the basis of these properties and the planet's short orbital period and high equilibrium temperature, we show that this terrestrial planet is suitable for emission and transit spectroscopy.

A giant exoplanet orbiting a very-low-mass star challenges planet formation models

Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.

Interaction model between quercetin (3,5,7,3p,4p-pentahidroxiflavone) and human shock thermic factor (HFS)

INTRODUCTION. The expression of the HSP stress inducted are regulated by the Shock Thermic Factor (HSF), that exists in an inactive form as a monomer and when it becomes a trimer can make a bind to DNA activating the HSP transcription.OBJECTIVE. Design a computational model that helps elucidate possible interactions between quercetin fl avonoid and proteins such as HSF-1.METHODOLOGY. To observe how the quercetin possibly affects the timerization of HFS, we make an homology model of the human shock factor (HFS-1), obtaining a high structural homology model with the same protein in Kluyveromyces lactis, this model was used to make docking with the fl avonoid quercetin ( 3,5,7,3p,4p-pentahidroxifl avone).RESULTS AND CONCLUSION. The doking result shows that the quercetin docks to a loop (wing), that is important in the protein-protein interaction, possibly affecting they’re trimerization.

Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection

BACKGROUND

It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/μL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression.

METHODS

The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation.

RESULTS

A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL.

CONCLUSIONS

From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.

Effects of the genetic pattern defined by low-density lipoprotein receptor and IL28B genotypes on the outcome of hepatitis C virus infection

The aim of this study was to assess the impact of the genetic pattern (GP) defined by the single nucleotide polymorphisms (SNPs) rs14158 of low-density lipoprotein receptor (LDLR) and rs12979860 of interleukin-28B (IL28B) genes on the outcome and features of hepatitis C virus (HCV) infection in patients with and without human immunodeficiency virus (HIV) coinfection. 314 HIV/HCV-coinfected and 109 HCV-monoinfected patients treated with pegylated interferon (Peg-IFN) plus ribavirin (RBV), as well as 51 patients with HCV spontaneous clearance (SC), were included. Variations in both SNPs were determined by the TaqMan polymerase chain reaction (PCR) assay. In the 286 patients chronically infected by HCV genotypes 1 or 4, both rs14158 CC and rs12979860 CC were associated with a higher rate of sustained virological response (SVR), and these effects were complementary in both HCV-monoinfected and HIV/HCV-coinfected patients. Thus, 24 % of patients with rs14158/rs12979860 TT-TC/TT-TC, 33 % with TT-TC/CC, 44.2 % with CC/TT-TC, and 75.8 % harboring CC/CC attained SVR (p < 0.001). SC was associated with the IL28B genotype (66.7 % CC in SC vs. 42.6 % among those with chronic infection, p < 0.001) but not with the LDLR genotype. There was no association between GP and the plasma level of alanine aminotransferase (ALT) or the presence of advanced fibrosis. There is a complementary effect between the IL28B and LDLR genotypes on the probability of achieving SVR after Peg-IFN/RBV therapy in patients with HCV 1 or 4. Thus, the predictive value of IL28B genotype is modulated by the LDLR genotype in both HCV-monoinfected and HIV/HCV-coinfected patients. This complementary effect of both genotypes is also observed on the plasma levels of low-density lipoprotein cholesterol (LDL-C).

Enzyme Activities and Chemical Changes in Wet Olive Cake after Treatment with Pleurotus ostreatus or Eisenia fetida

A laboratory experiment was conducted to evaluate the enzyme activities and chemical changes recorded in a recalcitrant phenolic-rich waste after treatment with Pleurotus ostreatus or Eisenia fetida. The waste used was wet olive cake (alperujo in Spanish), a waste produced in huge amounts by the olive oil industry. Both P. ostreatus and E. fetida were very effective in removing phenolic compounds, the initial concentration in the wet olive cake being reduced in both cases by around 90%. Laccase and manganese peroxidase activities were measured in the growth medium of P. ostreatus, and catechol 2,3 dioxygenase activity was only detected in the waste treated with Eisenia; these could be the main factors responsible for the oxidation of phenolic compounds. Increases of dehydrogenase and beta-glucosidase activities were detected in the degraded wet olive cake by fungi or earthworms. In comparison with the natural wet olive cake, the degraded products had lower total organic carbon and humic acid contents but were rich in nitrogen and other nutrients, having lower C:N ratios. In addition, the toxicity of the wet olive cake against the seeds of Lepidium sativum significantly decreased after degradation. The low toxicity as well as moderate stability and maturity recorded in the wet olive cake treated with P. ostreatus or E. fetida imply that these products could be used as soil amendments.

Cuidados del recién nacido prematuro en casa: Intervención educativa aplicando el modelo de autocuidado de Dorothea Orem

Para el desarrollo de este estudio se contó con la evaluación preliminar de los conocimientos de un grupo de 20 madres cuyos hijos estuvieron hospitalizados en la unidad de recién nacidos del Hospital de San José durante el segundo semestre del 2003. Los criterios de inclusión fueron: madres cuyos hijos habían superado la fase crítica de la enfermedad, madres de recién nacidos con pesos entre 1.200 y 2.000 g y madres con edades entre 18 y 35 años. Posteriormente, durante el segundo semestre del 2004 se seleccionó un grupo de 20 madres con los mismos criterios de inclusión a quienes se les dictó un programa educativo sobre los cuidados del niño prematuro en casa. Una vez desarrollado el programa se hizo comparación entre los dos grupos. El presente estudio es de tipo comparativo transversal entre un grupo intervenido y uno no intervenido y tiene como objetivo evaluar la influencia de un programa educativo sobre los cuidados niño prematuro en casa, aplicando el modelo de autocuidado de Dorothea Orem . La comparación entre los dos grupos se realizó aplicando una prueba de diferencia de proporciones con un nivel de significancia del 0.05. Los resultados obtenidos confirmaron la hipótesis planteada, por lo que se considera que el programa educativo fue para el grupo de madres significativo en cuanto a la obtención de conocimientos.

[Fever of unknown origin in patients with HIV infection]

BACKGROUND

The aim of the study was to describe the etiology and clinical characteristics of fever of uncertain origin (FUO) among HIV-infected patients.

METHODS

Prospective analysis of 35 episodes of FUO in HIV-infected patients from Balearic Islands that were studied through established guidelines.

RESULTS

Most patients were at advanced stages of HIV-1 infection (mean CD4 cell count, 60/mm3). Mean duration of fever until diagnosis was 57 days. Average time of hospitalization until etiological diagnosis of FUO was 26 days (range: 8-127 days). The cause of FUO was identified in 33 cases (94%). Tuberculosis accounted for 18 cases (51%) and visceral leishmaniasis for 8 cases (23%). Other opportunistic infections were the cause of FUO in 8 cases (17%). In one patient, fever was due to Kaposi's sarcoma. Two patients died while febrile, without and identified etiology. Four patients had more than one cause that could contribute to FUO. Imaging techniques that yielded more diagnostic information were abdominal ultrasonography and serial chest X-ray. Leishmania serology and tuberculin skin test showed a high specificity but low sensitivities. Invasive procedures with a highest diagnostic field were fine needle aspirate of lymph nodes, and liver biopsy.

CONCLUSIONS

FUO is more frequent in advanced stages of HIV disease. In our area, FUO is caused primarily by endemic opportunistic infections specially TB and visceral leishmaniasis, and rarely can be attributable to HIV or neoplastic diseases.

[Anticoagulation in hemodialysis with a single dose of low molecular weight heparin]

The aim of this work was to compare the benefits and problems of low molecular weight heparin use in chronic hemodialysis, compared to conventional heparin. We studied 35 patients that received low molecular weight heparin (Enoxaparine, molecular weight 4000) during 115 consecutive hemodialysis procedures and conventional heparin during the subsequent 35 procedures. We assess the heparin dose, partial thromboplastin time before dialysis and at 3 and 120 min during the procedure, arterio-venous fistula compression time, clot formation in the circuit and residual volume of filters. Median total dose of conventional heparin was 6289 U (range 3000-10000) compared to 5555 U (range 2000-8000) of low molecular weight heparin. When the dose was calculated per kg of body weight, it was lower for low molecular weight heparin than for conventional heparin (87.8 U (range 33-100) vs 100 U (range 50-176)). Partial thromboplastin time achieved was lower with low molecular weight heparin, compared with conventional heparin, at 3 (64.26 vs 125.2 sec) and 120 min (39.1 vs 84.45 sec). Clot formation, arteriovenous fistula compression time and residual volume of filters were similar for both types of heparin. It is concluded that a single dose of low molecular weight heparin simplifies anticoagulation during hemodialysis, modifies less the partial thromboplastin time and does not alter filter re-utilization.

[Sclerotherapy with 75% ethanol in the control of hemorrhage caused by peptic ulcer disease]

We present our experience using ethanol as sclerosant of non-variceal bleeding lesions of the upper digestive tract and the result of its hemostatic effect when compared with patients who received conventional medical treatment. Since January 1989, 48 patients admitted with active bleeding or signs of high risk for rebleeding (clot or visible vessel) were submitted to sclerosis. The historic control group included patients admitted before 1989, being both groups comparable in clinical and endoscopic characteristics. Surgery was performed in 5 cases of the sclerosis group (10.4%) versus 14 of the control group (37.8%). Five of the patients in the sclerotherapy group died, one of them due to upper G.I. bleeding as the primary cause. We dit not observe a statistically significant difference in hospital stay, transfusion requirements or mortality. There were no complications as a result of the method. Sclerotherapy was not immediately effective in 2 patients; three patients who rebled were subject to new sclerosis, which was effective in controlling bleeding in two of them. In conclusion, sclerosis is a safe and effective method to achieve hemostasis, diminishing the re-bleeding and the need for surgery in cases of digestive bleeding due to peptic ulcer disease. Future studies using larger samples could show decrease in mortality.

[Clinical and prognostic factors of mortality in upper digestive hemorrhage]

In order to investigate prognostic factors we prospectively followed 741 patients with upper gastrointestinal bleeding (UGIB). Eleven variables were identified with mortality predictive value. Hematemesis, age of 50 y/o, more than 120 heart beat/minute, 3 or more units of pack red blood cells, esophageal varices, cirrhotic liver and renal failure had independent predictive value. Our findings could help to identify high risk patients.

[Upper gastrointestinal hemorrhage. Prospective analysis of 741 cases]

A prospective study was performed to evaluate the epidemiological characteristics and clinical outcome of patients with upper digestive bleeding. Between April 1987 and May 1993, 741 patients, 517 men and 224 women, with a mean age of 50.48 years (range, 12 to 94) were admitted to the emergency department with this diagnosis. The chief complaint was tarry stool (88.4%). A total of 717 patients underwent endoscopic examination within a mean time of 17.2 hours of arrival at the emergency department. Duodenal ulcers were found in 216 (35.9%) patients, gastric ulcer in 240 (32.4%), gastritis in 74 (10%), esophageal varices in 38 (5.1%), and other causes in 121 patients (16.5%). 478 required blood transfusion (range of 1 to 15 blood units transfused). 80.4% of patients who died necessitated transfusion versus 62.5% of the patients who had a satisfactory outcome. A total of 672 cases (92%) were managed with medical therapy. In 90 cases (12.2%) endoscopic injection treatment with 75% alcohol was performed. 60 patients (8.18%) had surgical therapy, 81.7% of whom underwent emergency operation to arrest bleeding. The global mortality was 10.6% (78 of 741 patients), compared to 18.3% in patients who were operated. The highest mortality occurred in patients with esophageal varices. We conclude that peptic ulcer is still the mayor cause of upper digestive bleeding. The high mortality found in patients who required surgical therapy creates the need to select those patients who may get benefits of alternate therapies which may improve the outcome.

Intradermal nevus associated with epidermoid cyst in the mucous membrane of the cheek

A case of epidermoid cyst associated with an unusual amelanotic intradermal nevus, with structures identical to Meissner's tactile corpuscles, is reported. The possible relationship and the origin of both lesions are discussed.