Botulinum neurotoxin type A responders among children with spastic cerebral palsy: Pattern-specific effects

AIM

To identify short-term effects of botulinum neurotoxin type A (BoNT) injections on gait and clinical impairments, in children with spastic cerebral palsy (CP), based on baseline gait pattern-specific subgroups.

METHOD

Short-term effects of BoNT injections in the medial hamstrings and gastrocnemius were defined in a retrospective convenience sample of 117 children with CP (median age: 6 years 4 months; GMFCS I/II/III: 70/31/16; unilateral/bilateral: 56/61) who had received gait analyses before and 2 months post-BoNT. First, baseline gait patterns were classified. Statistical and meaningful changes were calculated between pre- and post-BoNT lower limb sagittal plane kinematic waveforms, the gait profile score, and non-dimensional spatiotemporal parameters for the entire sample and for pattern-specific subgroups. These gait waveforms per CP subgroup at pre- and post-BoNT were also compared to typically developing gait and composite scores for spasticity, weakness, and selectivity were compared between the two conditions.

RESULTS

Kinematic improvements post-BoNT were identified at the ankle and knee for the entire sample, and for subgroups with apparent equinus and jump gait. Limbs with baseline patterns of dropfoot and to a lesser extent true equinus showed clear improvements only at the ankle. In apparent equinus, jump gait, and dropfoot, spasticity improved post-BoNT, without leading to increased weakness or diminished selectivity. Compared to typical gait, knee and hip motion improved in the crouch gait subgroup post-BoNT.

CONCLUSION

This comprehensive analysis highlighted the importance of investigating BoNT effects on gait and clinical impairments according to baseline gait patterns. These findings may help identify good treatment responders.

Mathematical modeling for Delta and Omicron variant of SARS-CoV-2 transmission dynamics in Greece

A compartmental, epidemiological, mathematical model was developed in order to analyze the transmission dynamics of Delta and Omicron variant, of SARS-CoV-2, in Greece. The model was parameterized twice during the 4th and 5th wave of the pandemic. The 4th wave refers to the period during which the Delta variant was dominant (approximately July to December of 2021) and the 5th wave to the period during which the Omicron variant was dominant (approximately January to May of 2022), in accordance with the official data from the National Public Health Organization (NPHO). Fitting methods were applied to evaluate important parameters in connection with the transmission of the variants, as well as the social behavior of population during these periods of interest. Mathematical models revealed higher numbers of contagiousness and cases of asymptomatic disease during the Omicron variant period, but a decreased rate of hospitalization compared to the Delta period. Also, parameters related to the behavior of the population in Greece were also assessed. More specifically, the use of protective masks and the abidance of social distancing measures. Simulations revealed that over 5,000 deaths could have been avoided, if mask usage and social distancing were 20% more efficient, during the short period of the Delta and Omicron outbreak. Furthermore, the spread of the variants was assessed using viral load data. The data were recorded from PCR tests at 417 Army Equity Fund Hospital (NIMTS), in Athens and the Ct values from 746 patients with COVID-19 were processed, to explain transmission phenomena and disease severity in patients. The period when the Delta variant prevailed in the country, the average Ct value was calculated as 25.19 (range: 12.32-39.29), whereas during the period when the Omicron variant prevailed, the average Ct value was calculated as 28 (range: 14.41-39.36). In conclusion, our experimental study showed that the higher viral load, which is related to the Delta variant, may interpret the severity of the disease. However, no correlation was confirmed regarding contagiousness phenomena. The results of the model, Ct analysis and official data from NPHO are consistent.

Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosis

Laparoscopic transperitoneal technique for appendicovesicostomy was performed in a 5-year-old boy with a non-neurogenic neuropathic bladder using a transumbilical 5-mm port, two 3-mm working ports and a modified Shanfield anastomosis. Posterior extramucosal detrusorotomy and submucosal dissection was performed. The proximal appendix was spatulated and advanced into the bladder through a mucosal window using a U-stitch and fixed. The detrusor was then approximated creating an antirefluxing extramucosal tunnel. VQ plasty was fashioned for stoma formation. The procedure and postoperative period were uneventful. Clean intermittent catheterisation (CIC) was established subsequently and continued for the last 6 months. Our experience shows that appendix Mitrofanoff can be performed with minimal number and size of ports, resulting in a good cosmetic outcome. A simplified anastomosis makes it less cumbersome, and catheterisation is reliable as there is no mucosa-mucosa junction to negotiate.

IL-6 is associated to IGF-1Ec upregulation and Ec peptide secretion, from prostate tumors

Background

Ec peptide (PEc), resulting from the proteolytic cleavage of the IGF-1Ec isoform, is involved in prostate cancer progression and metastasis, whereas in muscle tissue, it is associated with the mobilization of satellite cells prior to repair. Our aim is to determine the physiological conditions associated to the IGF-1Ec upregulation and PEc secretion in prostate tumors, as well as, the effect of tumor PEc on tumor repair.

Methods

IGF-1 (mature and isoforms) expression was examined by qRT-PCR, both in prostate cancer cells co-incubated with cells of the immune response (IR) and in tumors. PEc secretion was determined by Multiple Reaction Monitoring.

The effect of PEc, on mesenchymal stem cell (MSC) mobilization and repair, was examined using migration and invasion assays, FISH and immunohistochemistry (IHC). The JAK/STAT signaling pathway leading to the IGF1-Ec expression was examined by western blot analysis. Determination of the expression and localization of IL-6 and IGF-1Ec in prostate tumors was examined by qRT-PCR and by IHC.

Results

We documented that IL-6 secreted by IR cells activates the JAK2 and STAT3 pathway through IL-6 receptor in cancer cells, leading to the IGF-1Ec upregulation and PEc secretion, as well as to the IL-6 expression and secretion. The resulting PEc, apart from its oncogenic role, also mobilizes MSCs towards the tumor, thus promoting tumor repair.

Conclusions

IL-6 leads to the PEc secretion from prostate cancer cells. Apart from its oncogenic role, PEc is also involved in the mobilization of MSCs resulting in tumor repair.

Electronic supplementary material

The online version of this article (10.1186/s10020-018-0003-z) contains supplementary material, which is available to authorized users.

Validity of the Greek Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) among Greek adolescents

The aim of this study is to examine the validity of the Greek version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) in a sample of adolescent pupils. EDE-Q is a self- report instrument that assesses attitudes and behaviors related to Eating Disorders (EDs). A two-stage identification protocol has been applied to the 16 schools that agreed to participate in the present study. Initially, 2058 adolescents, in class under the supervision of one research assistant and one teacher, completed a Questionnaire on socio-demographic data, the Greek EDE-Q-6.0 and the Greek Eating Attitudes Test (EAT-26) while their weight and height were measured. Six-hundred and twenty six participants, who had scores on EAT-26≥20 and/or were underweight or overweight, were considered as "possible-cases" while the remaining 1432 pupils of the sample were thought as "non-possible cases". At the second stage, parents of 66 of the participants identified as possible-cases as well as parents of 72 participants from 358 controls randomly selected from the sample of "non-possible cases" agreed that their children would be examined by means of Best Estimate Diagnostic Procedure. Participants meeting DSM-IV-TR Eating Disorders criteria were identified. Receiver Operating Characteristics (ROC) analysis was applied to reveal EDE-Q's criterion validity. The kappa statistic test was used as measure of agreement between categorical variables at EDE-Q and at interview (the presence of objective binge eating episode, of self-induced vomiting, the use of laxatives and of excessive exercise). The Discriminant and Convergent validity were assessed using the non-parametric Mann-Whitney U test and by means of the Spearman's correlation coefficient, respectively. Nineteen cases of EDs were identified [one case of Anorexia Nervosa (AN), 13 cases of Eating Disorder Not Otherwise Specified (EDNOS), 5 cases of Binge Eating Disorder (BED)]. At the cut off point of 2.6125 on the EDE-Q's global scale the instrument screens with a sensitivity (Se) of 89.5% and a specificity (Sp) of 73.1%, a Positive Predictive Value (PPV) of 34.7% and a Negative Predictive Value (NPV) of 97.8% The same analyses for both sexes revealed a cut-off point of 2.612 for females and of 3.125 for males on the global EDE-Q-6.0 score (Se=84.62%, Sp=73.33% for females and Se=83.33%, Sp= 84.09% for males), yielding a PPV and a NPV of 35.5% and of 96.5% for females and 41.7% and 97.4% for males, respectively. A very low agreement level, between EDE-Q and interview, was observed regarding the presence of objective bulimic episodes (OBEs) [k=0.191 (SE=0.057)] and the unhealthy weight control behaviors [k=0.295 (SE=0.073)]. Positive correlations were found between EAT-26 and EDE-Q-6.0 for both global scale and subscales (rho=0.50-0.57). The results suggest that EDE-Q-6.0, when using its global score, appears to be a proper screening tool for assessing the core psychopathology of eating disorders in community samples in two-stage screening studies since it distinguishes very well the cases from the non-cases. However, the assessment of the presence and frequency of pathological behaviours which characterize EDs appears to be problematic since adolescents, especially the younger ones, misunderstood terms like large amount of food and loss of control or misinterpret the motivation for excessive exercise. Therefore, marked discrepancies were observed between pathological behaviors self-reported at questionnaire and those detected at interview. We may assume that giving participants more information regarding the definition of these concepts may increase the accuracy with which the participants report these behaviors.

[Reliability of the Greek version of the eating disorder examination questionnaire (EDE-Q) in a sample of adolescent students]

The increasing prevalence of Eating Disorders over the last decades generates a growing interest of researchers and health care providers for their early detection through suitable questionnaires. The aim of the present study is to examine the reliability of the Greek version of EDE-Q 6.0 among secondary school adolescents. EDE-Q is a widely used self-report questionnaire that assesses the specific psychopathology of eating disorders. Its 6.0th version consists of 28 items. It yields two types of data: (a) four subscale scores (Restraint, Eating Concern, Shape Concern and Weight Concern) as well as a global score which is the average of the four subscale scores and (b) frequency data on key eating and compensatory behaviors (e.g. binge eating episodes, self-induced vomiting, excessive exercise). The sample comprises 257 secondary school students (133 girls and 124 boys) residents of north Evros-Greece, aged 16.1±1.4 years. The students completed the EDE-Q twice within a median interval of 34 days. In addition, their demographic data were collected and their weight and height were measured. The reliability of the EDE-Q was assessed by means of: (a) its internal consistency which was tested by Cronbach's alpha coefficient for each of the EDE-Q subscales as well as for the global score at both data collection times and (b) its test-retest reliability which was estimated by calculating: (1) intraclass correlation coefficients (ICCs) and Pearson's correlation coefficients (PCCs) for continuous variables (subscales and global score) and (2) Kendal's tau b coefficients for categorical variables (frequency of behavioral features). Cronbach's alphas indicating internal consistency of EDE-Q ranged from 0.71 to 0.91. ICCs and PCCs indicating the test-retest reliability of each subscale and the global score of the questionnaire ranged from 0.55 to 0.70 and from 0.58 to 0.73 respectively. Kendal tau b coefficients indicating the test-retest reliability of items assessing behavioral features ranged from 0.22 to 0.57. All the above correlations that concern the test-retest reliability of the EDE-Q were statistically significant at the 0.001 level. The Greek version of EDE-Q 6.0, standardized in a sample of secondary school students, presents adequate test-retest reliability and internal consistency as well.

Dexamethasone plus octreotide regimen increases anticancer effects of docetaxel on TRAMP-C1 prostate cancer model

AIM

The aim of this study was to evaluate whether the neoadjuvant use of the dexamethasone (DEX) plus octreotide (OCT) regimen can improve the direct anticancer effects of docetaxel (DOC) in the TRAMP-C1 prostate cancer model.

MATERIALS AND METHODS

TRAMP-C1 cells were first characterized for the expression of SSTR1-5 and then were inoculated onto the femur of C57Bl mice. Investigation protocols employed TRAMP-C1 cell proliferation and invasion assays, analysis of radiographic images of the bone lesions and overall survival of the diseased animals.

RESULTS

The triple combination treatment scheme showed significant anticancer effects, in both proliferation and invasion assays, compared to any single agent treatment scheme. DOC treatment following the neoadjuvant administration of DEX plus OCT regimen improved significantly the anticancer effects both on the grading of the bone lesions and on the overall survival of the diseased animals.

CONCLUSION

Our data suggest that the neoadjuvant administration of DEX plus OCT regimen can improve the anticancer effects of DOC on the TRAMP-C1 model.

Expression of IGF-1 isoforms after exercise-induced muscle damage in humans: characterization of the MGF E peptide actions in vitro

Different insulin-like growth factor-1 (IGF-1) isoforms, namely IGF-1Ea, IGF-1Eb and IGF-1Ec (MGF), have been proposed to have various functions in muscle repair and growth. To gain insight into the potentially differential actions of IGF-1 isoforms in the regulation of muscle regeneration, we assessed the time course of their expressions at both mRNA and protein levels after exercise-induced muscle damage in humans. In addition, we characterized mature IGF-1 and synthetic MGF E peptide signalling in C2C12 myoblast-like cells in vitro. Ten healthy male volunteers were subjected to exercise-induced muscle damage and biopsy samples were taken from the exercised muscles before and 6 h, 2, 5 and 16 days post exercise. Muscle damage was documented by specific functional and biochemical responses post exercise. PCR-based analyses of muscle biopsy samples revealed a rapid and transient up-regulation of MGF mRNA expression which was followed by a prolonged increase of IGF-1Ea and IGF-1Eb mRNA expression (p<0.05). Patterns similar to those for mRNA expression were detected for MGF and IGF-1Ea expression at the protein level. The action of synthetic MGF E peptide differed from that of mature IGF-1 since its proliferative effect on C2C12 myoblast-like cells was not blocked by an anti-IGF-1 receptor neutralizing antibody and it did not phosphorylate Akt. Therefore, we conclude that the differential expression profile of IGF-1 isoforms in vivo and the possible IGF-1R - independent MGF E peptide signalling in skeletal muscle-like cells in vitro support the notion that tissue-specific mRNA expression of MGF isoform produces mature IGF-1 and MGF E peptides which possibly act as distinct mitogens in skeletal muscle regeneration.

Analysis of apoptosis regulatory genes expression in the bone marrow (BM) of adult de novo Myelodysplastic Syndromes (MDS)

The aim of the present study was to examine caspases, granzyme B and bcl-2 family mRNA expression and the degree of apoptosis in the bone marrow (BM) of 46 Myelodysplastic Syndromes (MDS) and to correlate our findings with clinical parameters. The degree of apoptosis was determined by Annexin V, whereas expression of genes was determined using a multiprobe RNase Protection System. A positive correlation was found between caspases 8, 5, 3, 2, 1 and the level of apoptosis. bfl1 and mcl1 levels were significantly higher in patients with BM blasts >5%. Cases with ratio of bid expression >1 compared to normal pool were associated with IPSS values < or =1.

[Morning glory disc anomaly und frontonasal dysplasia]

Morning glory disc anomaly (MGDA) is a rare congenital malformation of the optic disc, which can be associated with midline craniofacial abnormalities, such as basal encephalocele. A female neonate presented with MGDA in the right eye, pendular nystagmus, hypertelorism, a flattened nasal root and cleft lip and palate. MRI revealed a basal encephalocele, agenesis of the corpus callosum and ventricular enlargement. MGDA combined with midline facial clefting should always lead to the suspicion of a basal encephalocele.

Regulation of the mGluR5, EAAT1 and GS expression by glucocorticoids in MG-63 osteoblast-like osteosarcoma cells

INTRODUCTION

Growth factors, cytokines, sex steroid hormones and glucocorticoids have differential and complex effects on skeletal metabolism. Recently, the presence of the glutamatergic (Glu) system in bone cells has provided new evidence for its possible role in bone physiology. Consequently, we have investigated the regulation of certain components of the Glu system by glucocorticoids in MG-63 osteoblast-like osteosarcoma cells, in vitro.

MATERIALS AND METHODS

We characterized the effects of dexamethasone on the expression of the mGluR5, EAAT1 and GS, at mRNA and protein level, using relative quantitative RTPCR and Western blot analysis, respectively.

RESULTS

We confirmed the induction of GS expression by dexamethasone published previously. In addition, we documented for the first time the expression of the mGluR5 and EAAT1 in MG-63 cells, as well as the ability of dexamethasone to upregulate the expression of the mGluR5 and EAAT1 in the MG-63 cells.

CONCLUSIONS

Components of the glutamatergic system may play a role in bone pathophysiology.

[Myotonic dystrophy Curschmann-Steinert]

BACKGROUND

Myotonic dystrophy Curschmann-Steinert is a multisystemic disorder inherited as an autosomal dominant trait. Characteristic clinical findings are muscular weakness and distal atrophy of the extremities, myotonia and myopathic facies. Ophthalmological symptoms may include cataract, ptosis and intraocular hypotension. Cardiac conduction defects, endocrine disturbances, respiratory insufficiency and gastrointestinal affection appear quite often in the course of the disease. Because of the great diversity of symptoms and the variable clinical presentation the disease may be overlooked.

CASE REPORT

In January 2006, a 58-year-old woman presented with progressive vision loss on both eyes, lumbal discomfort and pain, as well as a gradual weakness of the right leg. Ophthalmological evaluation revealed a star-shaped posterior subcapsular cataract, subtle ptosis on both eyes and weakness of the eyelid closure. Morphologically we observed a lack of facial expression manifesting as a myopathic facies and a moderate cachexia. Neurological findings included muscle weakness and atrophy in the extremities as well as of the sternocleidomastoid and temporal muscles a slight dysarthrophony and gait disturbance. Furthermore, an increase of the creatine kinase levels in the blood was detected. Electromyography (EMG) showed signs of a myopathic process in the proximal muscles of the lower extremities (right and left vastus medialis muscle). Although no typical myotonic discharges were recorded in the EMG, molecular testing confirmed the clinical suspicion of myotonic dystrophy type Curschmann-Steinert.

CONCLUSIONS

The combination of a myotonic muscle disorder with ophthalmological, and probably cardiac, abdominal and pulmonary symptoms, especially respiratory insufficiency and sleep apnoea should lead to the suspicion of a myotonic dystrophy. Due to the high incidence of ocular manifestations, especially of the typical myotonic cataract, an ophthalmological investigation is essential for a straightforward diagnostic procedure.

Survival improvement of young patients, aged 16-23, with Hodgkin lymphoma (HL) during the last three decades

The prognostic factors, treatments and outcomes of 55 young adults (16-23 years old) with Hodgkin lymphoma (HL) treated in the Second Department of Internal Medicine Propaedeutic, Medical Oncology Unit, Athens University, over the past 25 years, are reviewed. Patients were treated with the chemotherapy regimens available at each time period which were MOPP (Group A; 1978-1987), MOPP/ABVD (Group B; 1988-1993) and BEACOPP or ABVD (Group C; 1994-2003). The eligible patients, received radiotherapy (RT) according to treatment consensus. Additionally, the patients were retrospectively divided according to risk factors (abnormal erythrocyte sedimentation rate (ESR), bulky mediastinal disease, > 3 involved nodes and extranodal involvement) into low [stage I/II; five patients (9%)], intermediate [stage III with adverse prognostic factors; 18 patients (33%)] and high risk categories [stages IIB bulky and III/IV; 32 patients (58%)]. A total of 21 (38%) patients experienced relapse (three intermediate and 19 high risk). The 5-year survival and the 5-year event free survival (EFS) figures were Group A: 65% and 53%, Group B: 80% and 65%, Group C: 100% and 88.5%, respectively, the improvements between Group B and C were statistically significant (p = 0.04 and p = 0.005, respectively) among the three time periods. The overall survival (OS) and EFS differed significantly between intermediate and high risk categories (OS: p = 0.04, EFS: p = 0.005). The sequential use of RT did not influence OS and EFS but there was a trend of improvement with RT in the later periods. Survival of young patients with HL is significantly improving most probably due to improved chemotherapy treatment and understanding of the risk factors. Current controversial issues surrounding this disease, including the role of radiotherapy, positron emission tomography (PET), bone marrow biopsy and stem cell transplantation are discussed.

Comparison of patient doses in interventional radiology procedures performed in two large hospitals in Greece

Purpose of the study was to determine patient doses in the most common interventional radiology (IR) procedures performed in two large Greek hospitals. A total of 164 patients who underwent 4 types of IR procedures were studied. Fluoroscopy time, total exposure time, number of frames, number of runs, radiation field size, and cumulative dose-area product (DAP) were recorded. The median DAP values for carotid arteriography and lower limb arteriography were 66 and 123 Gy cm2 for hospital 'A' and 21 and 49 Gy cm2 for hospital 'B'. For the cerebral arteriographies performed in hospital 'A', the median DAP was 116 Gy cm2, while for the hepatic embolizations performed in hospital 'B', it was 104 Gy cm2. The DAP values observed in hospital 'A' for carotid arteriography and lower limb arteriography were almost three times than those of hospital 'B'. From the data analysis, it is evident that dose optimization in hospital 'A' should be pursued through revision of the techniques used.

Assessment of brown adipose tissue activity in rats by 99mTc-sestamibi uptake

Brown adipose tissue (BAT) physiology and imaging have recently attracted considerable attention. BAT is characterized both by enhanced perfusion and increased mitochondrial activity. (99m)Tc-sestamibi is a lipophilic cationic tracer that concentrates in mitochondria. Data on the accumulation of (99m)Tc-sestamibi in BAT are currently lacking. This study investigates the in vivo (99m)Tc-sestamibi uptake in rat BAT. (99m)Tc-sestamibi was administered in male Wistar rats of various age and body size. (99m)Tc-sestamibi uptake was measured in vitro in BAT and white fat (WF) together with cytochrome c oxidase activity. Both (99m)Tc-sestamibi uptake and cytochrome c oxidase activity were higher in BAT than in WF (P<0.05). (99m)Tc-Sestamibi uptake in both BAT and WF was negatively related to body weight (r = -0.96 and -0.89, respectively) as was the BAT/WF uptake ratio (r = -0.85). These data show a higher (99m)Tc-sestamibi uptake in BAT compared to WF, in agreement with the high mitochondrial content and respiratory activity of the former. The strong negative correlation between (99m)Tc-sestamibi uptake in BAT and body weight (negative allometry), is in accordance to increased needs of thermogenesis in smaller animals. Implications of increased (99m)Tc-sestamibi uptake in BAT in radionuclide imaging are also discussed.

Gastric emptying after semi-solid food in multiple system atrophy and Parkinson disease

BACKGROUND

Gastrointestinal symptoms such as nausea, abdominal pain, and bloating are frequent complaints in patients with Parkinson disease (PD) and in patients with multiple system atrophy (MSA), and may be associated with delayed gastric emptying (GE). Although several GE studies in patients with PD have been performed, scant data exist in patients with MSA.

METHODS

We assessed GE half-times (T50) in 12 patients with MSA and compared them with those of 12 patients with PD and 12 age-matched healthy controls.GE was estimated scintigraphically using the left anterior oblique method after ingestion of a (99m)Tc colloid-labeled balanced semi-solid meal (yogurt). GE data were obtained every 15 minutes until there was complete emptying of the stomach. Blood pressure, heart rate, plasma glucose and glucosylated hemoglobin were regularly determined.

RESULTS

Reproducibility of the GE technique was excellent (Bland-Altman analysis, limits of agreement: -2.3 to 2.8). T50 was longer in MSA (82+/-3.4 min) and in PD (90.6+/-3.9 min) patients compared with controls (46.2+/-0.7) (two-way ANOVA, p<0.0001). T50 did not differ between patients with MSA and those with PD. No correlation existed between T50 and age, duration of the disease, magnitude of postprandial hypotension, levels of plasma glucose and glucosylated hemoglobin (Kendall's tau, p>0.05).

CONCLUSIONS

Our results suggest that patients with MSA have GE rates similar to those of patients with PD, but slower than healthy age matched individuals. It remains to be investigated whether gastrointestinal dysfunction in MSA is related to both brain and peripheral pathology, as is presumed for PD.

Non-Hodgkin's lymphomas in Greece according to the WHO classification of lymphoid neoplasms. A retrospective analysis of 810 cases

The purpose of this retrospective study, the largest unselected series in our country, was to illustrate the clinicopathological features of non-Hodgkin's lymphoma (NHL) classified according to the World Health Organization (WHO) classification of lymphoid neoplasms. A retrospective analysis was conducted and clinical features of histological subtypes were established in 810 patients (age > or = 15 years) with NHL who were treated at 8 major centers representative of Greece. There were 435 males and 375 females 95% of them aged >30 years. B symptoms were present in 34% of the patients, while 45.3% had stages I-II and 54.6% had stages III-IV. LDH was increased in 37% of the patients. B cell lymphomas formed 88% of the cases whereas T cell lymphomas formed 12% of the total. Indolent lymphomas accounted for 31.1%, aggressive ones for 66.7% and very aggressive ones for 2.4% of all NHLs. Among indolent lymphomas extranodal ones (MALT B cell lymphoma) were the most common subset while follicular lymphoma grade I and II and small lymphocytic ones presented with equal frequency. Among the aggressive lymphomas diffuse large cell lymphoma (DLCL) was the most common subtype; this entity along with large-cell immunoblastic lymphomas accounted for 45.2% of all B cell lymphomas. Among the T cell lymphomas, peripheral T cell lymphomas and anaplastic large cell lymphomas of the T/null-cell type were the most common subtypes. The most common extranodal presentation was the gastrointestinal tract (GI). Next in frequency were primary extranodal NHL of the head and neck region. MALT B cell lymphomas were found in almost half of the patients with GI tract NHL, whereas in all other extranodal places DLCL was the predominant histological subtype. The median survival for indolent and aggressive NHL was 123.5 and 55.5 months, respectively. This is the first report of a large series of malignant lymphomas in Greece using the WHO classification. It appears that there are no significant differences between NHL in Greece and other large series as far as clinical and extranodal presentation is concerned. The frequency of follicular lymphoma in the current study is comparable to that reported from Asian countries and mainland Europe, but lower than that of US and Northern European series. There were no important differences in the incidence of the remaining histological subtypes between Greece and other European countries.

A novel p27 gene mutation in a case of unclassified myeloproliferative disorder

P27 encodes a member of Cip/Kip family of cyclin dependent kinase inhibitors, the inactivation of which has been implicated in the pathogenesis of various hematological neoplasias. We report on a novel point mutation of this gene identified in a case of unclassified myeloproliferative syndrome consisting of a T --> C transversion at 821bp of p27 exon 1, resulting in a Ile --> Thr substitution at codon 119. The analysis of larger number of cases as well as the effect of this mutation on protein's function will help to clarify its significance in the pathogenesis of myeloproliferative syndromes.

The prevalence of hepatitis C and hepatitis G virus infection in patients with B cell non-Hodgkin lymphomas in Greece: a Hellenic Cooperative Oncology Group Study

Our aim was to investigate the association between chronic hepatitis C virus (HCV) infection and B cell non-Hodgkin lymphoma (NHL) in the Greek population. We studied 120 patients (70 men and 50 women, mean age 59 years) diagnosed with NHL. One hundred and eight had B cell NHL (90%) and 12 had T cell NHL (10%). The presence of anti-HCV antibodies in patients and controls was investigated using the monoclonal enzymatic immunoassay (MEIA) method. The detection of HCV RNA and hepatitis G virus (HGV) RNA in patients with B cell NHL and anti-HCV-positive controls was performed using an RT-PCR technique. Anti-HCV antibodies were present in only 2 of the 108 patients with B cell NHL (1.9%), while the prevalence of HCV infection in the healthy population was 0.6%, and in patients with various solid tumors treated with chemotherapy, it was 0.99%. Ten of the 108 B cell NHL patients (9.26%) were diagnosed as HGV RNA positive, while the prevalence of HGV infection in 285 Greek blood donors was 0.7%. Our findings do not confirm a strong association between HCV infection and B cell NHL for Greek patients. The increased prevalence of HGV infection detected in patients with NHL could imply the potential participation of HGV in the pathogenesis of NHL.