Molecular Techniques and Gene Mutations in Myelodysplastic Syndromes

Sequencing technology, particularly next-generation sequencing, has highlighted the importance of gene mutations in myelodysplastic syndromes (MDSs). Mutations affecting DNA methylation, chromatin modification, RNA splicing, cohesin complex, and other pathways are present in most MDS cases and often have prognostic and clinical implications. Updated international diagnostic guidelines as well as the new International Prognostic Scoring System-Molecular incorporate molecular data into the diagnosis and prognostication of MDS. With whole-genome sequencing predicted to become the future standard of genetic evaluation, it is likely that MDS diagnosis and management will become increasingly personalized based on an individual's clinical and genomic profile.

P-778 High altitude significantly affects pregnancy, implantation, live birth, and miscarriage rates in patients subjected to in vitro fertilization procedures with donated oocytes

Study question

Is high altitude an important factor that affects the clinical outcomes in patients subjected toin vitrofertilization with donated oocytes?

Summary answer

Pregnancy, implantation, and live birth rates are significantly impacted by paternal chronic hypoxia in IVF procedures involving egg donors.

What is known already

High altitude is characterized by low temperatures, high UV radiation, and a hypoxic environment that significantly affect human physiology, including endocrine, cardiovascular, metabolic, and reproductive functions. Hypoxia can affect male reproduction differently, such as at the hormonal level, during spermatogenesis and gene expression. More importantly, hypoxia can affect key events during early embryo development, with time of exposure being the determining factor in the stage of fertilization and embryonic development in mammals.

Study design, size, duration

The following work is a retrospective nonrandomized study based on data from 85 IVF donor egg cycles performed at high altitude (Huancayo-Peru, 3,300 meter above sea level;n = 42) and at sea level (Guayaquil-Ecuador;n = 43) between July 2019 and December 2020. The same protocols of culture and embryo classification were used in both assisted reproduction laboratories.

Participants/materials, setting, methods

Anonymous oocytes donors (18-29 years old) underwent physical, gynecological and psychological examinations, with no family histories of hereditary or chromosomal diseases reported. According to seminal samples, IVF or ICSI was elected as the insemination procedure. Extended embryo culture until blastocyst stage was done in all procedures. Pregnancy, implantation, live birth, and miscarriage rates were compared between groups.

Main results and the role of chance

Out of a total of 983 included oocytes, 529 corresponded to high level patients; and 454, to sea level patients. Fertilization rates (95.1% vs 92.1%) and good-quality embryos at day 3 (79.7% vs 83.8%) were similar between high altitude and sea level groups (P > 0.05). The number of transferred embryos in recipients at high altitude was significantly higher compared to those transferred in recipients at sea level (1.90±0.29 vs 1.62±0.49) (P < 0.05). Blastocyst formation rates (39.3% vs 44.3%), pregnancy rates (61.9% vs 71.4%), implantation rates (48.8% vs 64.7%) and live birth rates per embryo transfer (46.3% vs 65.7%) were significantly lower in the patients at high altitude compared to those from sea level (P < 0.05). Significantly more miscarriages were observed at high altitude (23.1% vs 6.5%) (P < 0.05). Seminal parameters were similar between both evaluated groups.

Limitations, reasons for caution

The retrospective nature of this study and the small sample size may be reason for caution.

Wider implications of the findings

The negative effect of high altitude on reproduction has been shown previously in men, hypoxia could cause a degeneration in the germinal epithelium that affects spermatogenesis. We show that paternal chronic hypoxia affects preimplantation embryonic development, pregnancy, implantation, live birth, and miscarriage rates in IVF procedures using donated oocytes.

Trial registration number

not applicable

P-273 Oocyte competence is affected by Body Mass Index in women undergoing in vitro fertilization procedures

Study question

Is body mass index (BMI) an important factor that affects oocyte competence in patients subjected to in vitro fertilization procedures?

Summary answer

High BMI affects oocyte competence, causing abnormal blastocyst development, and reduced clinical outcomes. Overweight and obesity women needed more oocytes to obtain a gestational sac.

What is known already

Overweight and obesity are systemic and tissue-specific conditions that lead to chronic inflammation and oxidative stress to produce an unregulated and persistent secretion of chemokines and cytokines, which are released into circulation inducing inflammatory responses in several tissues, including the ovaries. Cytokines, chemokines and adipokines play essential roles in steroidogenesis, follicular growth, cumulus expansion, and ovulation; however, alterations in their patterns of synthesis and secretion impair meiotic and cytoplasmic maturation of the oocyte, reducing its developmental competence for fertilization and pre-implantation development. Overweight or obese women had significantly lower clinical pregnancy and live birth rates and significantly higher miscarriage rates.

Study design, size, duration

The following work is a retrospective nonrandomized study that included a total of 1839 oocytes obtained from 201 IVF/ICSI non-donor cycles performed between January 2018 and December 2019.

Participants/materials, setting, methods

The oocytes were allocated according to BMI of patients in three groups: Normal group: 18.5-24.9 ( n =  608 oocytes), overweight group: 25.0-29.9 ( n =  832 oocytes) and obese group: ≥30.0 ( n =  399 oocytes). Extended embryo culture until blastocyst stage was done in all patients. Fertilization, development of blastocyst, transferred embryos, pregnancy and implantation rates were compared between groups. Number of oocytes needed to obtain a gestational sac (oocyte competence) were analyzed and compared by group.

Main results and the role of chance

Fertilization rates (87.7%, 85.3%, and 84.0%), and transferred embryos (1.84, 1.84, and 1.86) were similar between three evaluated groups. Blastocyst development rate (48.2%, 40.0%, and 40.1%), pregnancy rate (67.2%, 41.9%, and 39.5%), and implantation rate (53.7%, 31.8%, and 28.2%) were significantly reduced in women with overweight and obesity compared to women with normal weight ( P <  0.05). To obtain a gestational sac, 2.1 and 1.8 more oocytes were needed by obese and overweight women, respectively, than the control group, suggesting oocyte competence is negatively affected by higher BMI.

Limitations, reasons for caution

The retrospective nature of this study and the small sample size may be reasons for caution.

Wider implications of the findings

The findings in this study suggest that a weight above normal will progressively decrease oocyte competence thus, it is necessary to have a greater number of oocytes in patients with overweigh and obesity to have a gestational sac when compared with patients of normal weight.

Trial registration number

non applicable

Laboratory evaluation and prognostication among adults and children with CEBPA-mutant acute myeloid leukemia

CEBPA-mutant acute myeloid leukemia (AML) encompasses clinically and biologically distinct subtypes of AML in both adults and children. CEBPA-mutant AML may occur with monoallelic (moCEBPA) or biallelic (biCEBPA) mutations, which can be somatic or germline, with each entity impacting prognosis in unique ways. BiCEBPA AML is broadly associated with a favorable prognosis, but differences in the type and location of CEBPA mutations as well as the presence of additional leukemogenic mutations can lead to heterogeneity in survival. Concurrent FLT3-ITD mutations have a well-documented negative effect on survival in adult biCEBPA AML, whereas support for a negative prognostic effect of mutations in TET2, DNMT3A, WT1, CSF3R, ASXL1, and KIT is mixed. NPM1 and GATA2 mutations may have a positive prognostic impact. MoCEBPA AML has similar survival outcomes compared to AML with wild-type CEBPA, and risk stratification is determined by other cytogenetic and molecular findings. Germline CEBPA mutations may lead to familial biCEBPA AML after acquisition of second somatic CEBPA mutation, with variable penetrance and age. BiCEBPA AML in children is likely a favorable-risk diagnosis as it is in adults, but the role of a single CEBPA mutation and the impact of concurrent leukemogenic mutations are not clear in this population. Laboratory evaluation of the CEBPA gene includes PCR-based fragment-length analysis, Sanger sequencing, and next-generation sequencing. Phenotypic analysis using multiparameter flow cytometry can also provide additional data in evaluating CEBPA, helping to assess for the likelihood of mutation presence.

Evaluation of Positive B- and T-Cell Gene Rearrangement Studies in Patients With Negative Morphology, Flow Cytometry, and Immunohistochemistry

CONTEXT.—

The significance of positive immunoglobulin (IG) or T-cell receptor (TCR) gene rearrangement studies in the context of otherwise normal ancillary findings is unknown.

OBJECTIVE.—

To examine long-term hematologic outcomes of individuals with positive gene rearrangement studies with otherwise unremarkable blood or bone marrow studies in parallel.

DESIGN.—

Data from patients who underwent IG or TCR gene rearrangement testing at the authors' affiliated Veterans Affairs Hospital January 1, 2013 to July 6, 2018 were extracted from medical records. Date of testing, specimen source, and morphologic, flow cytometric, immunohistochemical, and cytogenetic characterization of the tissue source were recorded. Gene rearrangement results were categorized as test positive/phenotype positive (T+/P+), test positive/phenotype negative (T+/P-), test negative/phenotype negative (T-/P-), or test negative/phenotype positive (T-/P+) based on comparison to other studies and/or final diagnosis. Patient records were reviewed for subsequent diagnosis of hematologic malignancy for patients with positive gene rearrangements but no other evidence for a disease process.

RESULTS.—

A total of 136 patients with 203 gene rearrangement studies were analyzed. For TCR studies, there were 2 T+/P- and 1 T-/P+ results in 47 peripheral blood assays, as well as 7 T+/P- and 1 T-/P+ results in 54 bone marrow assays. Regarding IG studies, 3 T+/P- and 12 T-/P+ results in 99 bone marrow studies were identified. None of the 12 patients with T+/P- TCR or IG gene rearrangement studies later developed a lymphoproliferative disorder.

CONCLUSIONS.—

Positive IG/TCR gene rearrangement studies in the context of otherwise negative bone marrow or peripheral blood findings are not predictive of lymphoproliferative disorders.

The utility and limitations of B- and T-cell gene rearrangement studies in evaluating lymphoproliferative disorders

A hallmark of lymphoid malignancies is the presence of a monoclonal lymphocyte population. Monoclonality of B- and T-cell populations can be established through immunoglobulin (IG) or T-cell receptor (TCR) gene rearrangement analysis, respectively. The biological rationale of IG and TCR gene rearrangement analysis is that due to the extensive combinatorial repertoire made possible by V(D)J recombination in lymphocytes, it is unlikely that any substantive lymphocyte population would share the same IG or TCR gene rearrangement pattern unless there is an underlying neoplastic or reactive origin. Modern IG and TCR gene rearrangement analysis is typically performed by polymerase chain reaction (PCR) using commercially available primer sets followed by gel capillary electrophoresis. This process is highly sensitive in the detection of nearly all lymphoid malignancies. Several pitfalls and limitations, both biological and technical, apply to IG/TCR gene rearrangement analysis, but these can be minimised with high quality controls, performance of assays in duplicate, and adherence to strict criteria for interpreting and reporting results. Next generation sequencing (NGS) will likely replace PCR based methods of IG/TCR gene rearrangement analysis but is not yet widespread due to the absence of standardised protocols and multicentre validation.

Trauma exposure and stress-related disorders in African-American women with diabetes mellitus

OBJECTIVE

The purpose of the study was to assess demographic features, rates of trauma exposure, prevalence of post-traumatic stress and depressive symptoms in a group of urban, low-income, African-American women with type 1 or type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

We conducted a survey of (n = 290) low-income, African-American women seeking care in the diabetes clinic of an urban hospital and collected data on the demographic characteristics, childhood and nonchildhood abuse trauma exposure, and the severity of post-traumatic stress and depressive symptoms using the Post-traumatic Stress Disorder (PTSD) Symptom Scale (PSS) and the Beck Depression Inventory (BDI). In a subset of women with type 2 diabetes (n = 96), we assessed haemoglobin A1c to examine the relationship between psychopathology and glycaemic control.

RESULTS

Of the overall sample, 61.7% reported exposure to trauma in their lifetime, and 30.4% and 29.3% had current PTSD and MDD, respectively. Exposure to both childhood and nonchildhood abuse trauma was associated with an increased PTSD and depressive symptom severity (P's < .05). PTSD diagnosis, but not depression, was associated with increased haemoglobin A1c (P = .002).

CONCLUSIONS

These data document high levels of trauma exposure, PTSD and depressive symptoms in diabetic African-American women treated in a specialty clinic of an urban hospital setting. Furthermore, these data indicate that the presence of PTSD is negatively associated with glycaemic control.

Evaluation of Positive T- and B-Cell Gene Rearrangement Studies Among Patients Without a Definitive Diagnosis by Other Assays

In the evaluation of bone marrow (BM) and peripheral blood (PB) for hematologic malignancy, positive immunoglobulin heavy chain (IG) or T-cell receptor (TCR) gene rearrangement results may be detected despite unrevealing results from morphologic, flow cytometric, immunohistochemical (IHC), and/or cytogenetic studies. The significance of positive rearrangement studies in the context of otherwise normal ancillary findings is unknown, and as such, we hypothesized that gene rearrangement studies may be predictive of an emerging B- or T-cell clone in the absence of other abnormal laboratory tests. Data from all patients who underwent IG or TCR gene rearrangement testing at the authors’ affiliated VA hospital between January 1, 2013, and July 6, 2018, were extracted from the electronic medical record. Date of testing; specimen source; and morphologic, flow cytometric, IHC, and cytogenetic characterization of the tissue source were recorded from pathology reports. Gene rearrangement results were categorized as true positive, false positive, false negative, or true negative. Lastly, patient records were reviewed for subsequent diagnosis of hematologic malignancy in patients with positive gene rearrangement results with negative ancillary testing. A total of 136 patients, who had 203 gene rearrangement studies (50 PB and 153 BM), were analyzed. In TCR studies, there were 2 false positives and 1 false negative in 47 PB assays, as well as 7 false positives and 1 false negative in 54 BM assays. Regarding IG studies, 3 false positives and 12 false negatives in 99 BM studies were identified. Sensitivity and specificity, respectively, were calculated for PB TCR studies (94% and 93%), BM IG studies (71% and 95%), and BM TCR studies (92% and 83%). Analysis of PB IG gene rearrangement studies was not performed due to the small number of tests (3; all true negative). None of the 12 patients with false-positive IG/TCR gene rearrangement studies later developed a lymphoproliferative disorder, although 2 patients were later diagnosed with acute myeloid leukemia. Of the 14 false negatives, 10 (71%) were related to a diagnosis of plasma cell neoplasms. Results from the present study suggest that positive IG/TCR gene rearrangement studies are not predictive of lymphoproliferative disorders in the context of otherwise negative BM or PB findings. As such, when faced with equivocal pathology reports, clinicians can be practically advised that isolated positive IG/TCR gene rearrangement results may not indicate the need for closer surveillance.

The differential effects of PTSD, MDD, and dissociation on CRP in trauma-exposed women

OBJECTIVE

C-reactive protein (CRP), a marker of systemic inflammation, has been associated with psychiatric disorders including major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Some research suggests that exposure to trauma can trigger increased activity in the inflammatory system. Dissociation is associated with chronic trauma exposure and may be an important factor in understanding the risk for psychiatric outcomes associated with inflammation. The main objective of the current study was to understand how CRP was related to trauma, dissociation, PTSD and MDD in a sample of 55 traumatized African American women with type 2 diabetes mellitus recruited from an urban hospital.

METHOD

High sensitivity CRP (hsCRP) was assayed through blood samples; psychiatric disorders were assessed with structured clinical interviews, dissociation was assessed with the Multiscale Dissociation Inventory, and exposure to trauma in childhood and adulthood was assessed with the Childhood Trauma Questionnaire and the Traumatic Events Inventory, respectively.

RESULTS

Correlational results showed a significant association between higher concentrations of hsCRP and child abuse (p < 0.05), overall dissociation severity (p < 0.001), and PTSD symptoms (p < 0.01). ANOVA results showed significantly higher levels of hsCRP in those with current MDD, current PTSD, and remitted PTSD. A hierarchical linear regression model demonstrated a significant association between dissociation symptoms and greater hsCRP levels independent of childhood abuse, PTSD, and MDD (R²∆ = 0.11, p = 0.001) and independent of emotion dysregulation (p < 0.05).

CONCLUSION

These findings suggest that dissociation symptoms among those with a history of trauma may be particularly associated with higher levels of inflammation.

13C NMR spectroscopy of heterocycles: 1-phenyl-3-aryl/t-butyl-5-arylpyrazoles

A series of chalcones 1–12 were converted to pyrazolines (1Pi–12Pi) by reaction with phenylhydrazine followed by DDQ oxidation to produce the corresponding pyrazoles (1Pz–12Pz). Three 1-phenyl-3-t-butyl-5-arylpyrazoles (13Pz–15Pz) were synthesized using an analogous approach. Molecular modeling studies predicted the 5-aryl group of the pyrazoles for both series to have a torsion angle of 52°–54° whereas the 1-phenyl group was predicted to have 35°–37° torsion angles. The 3-aryl group was predicted to be essentially coplanar (−3°) with the pyrazole system in the first series. 13C NMR data for both series, 1Pz–12Pz and 13Pz–15Pz, were collected in DMSO-d6 at 50°C. A plot of the C4 chemical shifts for 1Pz–12Pz versus Hammet constants for 5-aryl substituents yielded a very good linear correlation (R2=0.96) with a slope of 1.5. The chemical shift data for C4 showed little or no dependence on 3-aryl substituents. The result for 13Pz–15Pz, despite only three points, was consistent with the first series results and yielded a ρ value of 2.0. Distal transmission of substituent effects (5-aryl groups) to C4 of the pyrazole system was reduced by roughly 50–60% of that of the analogous planar isoxazole system, but are not consistent with results for the similarly twisted 4-bromoisoxazoles.

Abstract POSTER-CTRL-1205: Neurocognitive evaluation of a cognitive training intervention in ovarian and gynecologic cancer survivors

Purpose: Our prior work indicates that a group-based cognitive training intervention can improve memory and attention in cancer survivors. This study examined potential for training transfer on two cognitive tasks and corresponding changes in neural activation patterns as measured by fMRI prior to and following the cognitive training intervention.

Methods: Seven gynecologic cancer (ovarian, breast, uterine) survivors (mean age: 64 years, mean time since primary treatment: 7.2 years) underwent a 7-week cognitive rehabilitation intervention delivered in group format. Participants were evaluated with a comprehensive cognitive battery and two experimental cognitive tasks prior to and following treatment. A word pair task required participants to learn pairs of words and later indicate whether words had been seen before (Item condition) or whether words had been paired together at learning (Relational condition). A verbal working memory task required participants to learn a set of 3, 5, or 7 letters and confirm or deny the presence of a probe letter. Participants also underwent fMRI scanning during word pair and verbal working memory tasks prior to and following treatment.

Results: Participants showed significant improvement following intervention in accuracy in the Relational condition, in which strong associations between presented word pairs were required for successful performance, t(3)=5.21, p&lt; .05. By contrast, accuracy did not increase significantly in the Item condition following intervention, t(3)=.48, p=.66). There was also a significant improvement in accuracy for the intermediate load (5-item) condition of the verbal working memory task following intervention, t(3)=4.17, p&lt;.05. fMRI analyses revealed activation in a frontoparietal network during both the word pairs and verbal working memory tasks. Future analyses will investigate changes in recruitment of this network following intervention.

Conclusions: Cancer survivors show evidence of specific transfer of memory skills following a group-based cognitive training intervention as demonstrated by improvement on the word memory task- relational item. In addition, there was a trend toward improvement on a working memory task. Neuroimaging results suggest frontoparietal network involvement for the cognitive task as well as some indication of a more efficient neural response following training. These results suggest that cognitive training may have a beneficial impact on both behavioral measures of cognition as well as neural activation markers.

Citation Format: H. Gray, M. K. Askren Thomas, K. Anderson, D. David, A. Singh, K. Murphy, S. Willis, H. Mendoza, M.M. Cherrier. Neurocognitive evaluation of a cognitive training intervention in ovarian and gynecologic cancer survivors [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-CTRL-1205.

Assessment of the abiotic and biotic effects of sodium metabisulphite pulses discharged from desalination plant chemical treatments on seagrass (Cymodocea nodosa) habitats in the Canary Islands

Reverse osmosis membranes at many desalination plants are disinfected by periodic shock treatments with sodium metabisulphite, which have potentially toxic effects to the environment for marine life, although no empirical and experimental evidence for this is yet available. The aim of this study was to characterise for the first time, the physico-chemical modification of the marine environment and its biological effects, caused by hypersaline plumes during these membrane cleaning treatments. The case study was the Maspalomas II desalination plant, located in the south of Gran Canaria (Canary Islands, Spain). Toxicity bioassays were performed on marine species characteristic for the infralittoral soft bottoms influenced by the brine plume (Synodus synodus and Cymodocea nodosa), and revealed a high sensitivity to short-term exposure to low sodium metabisulphite concentrations. The corrective measure of incorporating a diffusion system with Venturi Eductors reduced nearly all the areas of influence, virtually eliminating the impact of the disinfectant.

Sterol carrier protein 2 gene transfer changes lipid metabolism and enterohepatic sterol circulation in mice

BACKGROUND & AIMS

Sterol carrier protein 2 (SCP-2) enhances sterol cycling and facilitates cholesterol translocation between intracellular organelles and plasma membrane in cultured cells, including hepatocytes. We examined the role of SCP-2 in hepatic cholesterol and lipid trafficking through the sinusoidal and canalicular secretory pathways of the liver in vivo.

METHODS

Recombinant adenovirus-mediated SCP-2 gene transfer was used to obtain hepatic overexpression of SCP-2 in C57BL/6 mice.

RESULTS

SCP-2 overexpression in the mouse liver resulted in an 8-fold increase of SCP-2 protein levels and determined various effects on lipid metabolism. It decreased high-density lipoprotein cholesterol and increased low-density lipoprotein (LDL) cholesterol concentrations. The expressions of hepatic LDL receptor, apolipoprotein (apo) A-I, apoB, and apoE were decreased. SCP-2 overexpression also increased hepatic cholesterol concentration, associated with decreased cholesterol neosynthesis. Increased biliary cholesterol and bile acid secretion, bile acid pool size, and intestinal cholesterol absorption were also observed.

CONCLUSIONS

These results indicate that modulation of SCP-2 expression in the liver determines important modifications on lipoprotein metabolism, hepatic cholesterol synthesis and storage, biliary lipid secretion, bile acid metabolism, and intestinal cholesterol absorption.

Risk factors and pathogenesis of cholesterol gallstones: state of the art

The aim of this article is to present an update of selected aspects of the pathogenesis and risk factors of cholesterol gallstones, a highly prevalent Western disease. The etiology of cholesterol cholelithiasis is considered to be multifactorial, with interaction of genetic and environmental factors. Mechanisms of cholesterol lithogenesis include biliary cholesterol hypersecretion, supersaturation and crystallization, stone formation and growth, and bile stasis within the gallbladder. Each of these various steps could be under genetic control and/or be influenced through intermediate pathogenic steps linked to a variety of environmental factors.

Enrichment of canalicular membrane with cholesterol and sphingomyelin prevents bile salt-induced hepatic damage

These studies were undertaken to characterize the role of plasma membrane cholesterol in canalicular secretory functions and hepatocyte integrity against intravenous taurocholate administration. Cholesterol and sphingomyelin concentrations and cholesterol/phospholipid ratios were significantly increased in canalicular membranes of diosgenin-fed rats, suggesting a more resistant structure against solubilization by taurocholate. During taurocholate infusion, control rats had significantly decreased bile flow, whereas diosgenin-fed animals maintained bile flow. Maximal cholesterol output increased by 176% in diosgenin-fed rats, suggesting an increased precursor pool of biliary cholesterol in these animals. Maximal phospholipid output only increased by 43% in diosgenin-fed rats, whereas bile salt output remained at control levels. The kinetics of glutamic oxalacetic transaminase, lactic dehydrogenase, and alkaline phosphatase activities in bile showed a significantly faster release in control than in diosgenin-fed rats. After 30 min of intravenous taurocholate infusion, necrotic hepatocytes were significantly increased in control animals. Preservation of bile secretory functions and hepatocellular cytoprotection by diosgenin against the intravenous infusion of toxic doses of taurocholate was associated with an increased concentration of cholesterol and sphingomyelin in the canalicular membrane. The increase of biliary cholesterol output induced by diosgenin was correlated to the enhanced concentration of cholesterol in the canalicular membrane.

[Mutations of the p53 suppressor gene in gastric adenocarcinoma]

BACKGROUND

We have shown numeric alterations such as hyperploidy and hypoploidy with loss of chromosome 17 in primary gastric cancer. This chromosome maps p53 suppressor gene that induces the transcription of genes related to cellular cycle control, DNA synthesis and repair, cellular differentiation and apoptosis.

AIM

To analyze, at a molecular level, the possible alterations of p53 suppressor gene in samples of gastric cancer and non tumoral mucosa.

MATERIAL AND METHODS

Tissue samples of gastric carcinoma and non tumoral gastric mucosa coming from 26 patients subjected to a total gastrectomy were analyzed. The mutation of p53 suppressor gene exons 7 to 9 were determined using a conformational polymorphism analysis in single strands of the gene and indirect sequencing in some cases.

RESULTS

Alterations in p53 gene were found in 77% of tumoral and 19% of non tumoral samples. T insertions in codons 260, 317 and 321, G insertion in codon 328 and G-T transvertion in codon 302 were found. Aminoacid sequence analysis of p53 protein obtained with sequencing data showed that T insertion in codon 260 could translate three erroneous aminoacids after the mutation and produce a truncated protein due to the creation of a stop codon. No associations between alterations of p53 gene and clinical or pathological variables such as age, sex, tumor localization, histological type and presence of lymph node metastases were observed.

CONCLUSIONS

Mutations of p53 suppressor gene are frequent in gastric carcinoma.

[Sweet's syndrome. Presentation of six cases and review of the literature]

The acute febrile neutrophilic dermatosis or Sweet syndrome, initially described in 1964 by Robert Sweet (1). It is characterized fever, neutrophilic leucocytosis, abrupt appearance of erythematous, painful, cutaneous plaquets and dense dermal infiltrate consisting of mature neutrophils without vasculitis sings. Malignancy has been described in the 10-15% of the reported cases. We report our series of 6 patients diagnosticated of this illness in our department. One of this patients has Sweet syndrome associated with a malignancy disorder. All of them had diagnostic criteria of the described disease and had good response to corticotherapy. We also report a bibliographic review of this infrequent syndrome.

Pituitary and adrenals are required for hyperglycemic reflex initiated by stimulation of CBR with cyanide

We have previously shown that stimulation of carotid body receptors (CBR) with sodium cyanide (NaCN) elicits a rapid hyperglycemic reflex. Here we explore whether the pituitary and adrenals, two glands involved in glucose homeostasis, are necessary for this reflex. Experiments were performed on anesthetized rats that were artificially ventilated. Measurements of hepatic venous-arterial glucose difference indicated that CBR stimulation with a bolus of 5 micrograms/100 g NaCN produced an immediate increase in the output of glucose by the liver. The same dose of NaCN failed to increase hepatic output of glucose in rats with bilateral adrenalectomy or in rats 1 wk after surgical removal of neurohypophysis. Reflex glucose output by the liver was maintained after adenohypophysectomy or in adrenalectomized rats after adrenal autotransplantation to epiploon. Measurements of epinephrine in plasma and in the grafted adrenal tissue showed that the adrenal autograft can store and secrete catecholamines Immunocytochemical observations indicated that the grafted adrenals retain medullary cells. These results indicate that neurohypophysis and adrenals are necessary for the hyperglycemic reflex initiated by CBR stimulation with NaCN and that the participation of these two organs in this reflex is probably humoral.

[Acute sinusitis, bacteremia and meningitis caused by group F beta-hemolytic Streptococcus]

A 32-year old man without immunodepression developed sinusitis followed by acute pyogenic meningitis and beta-hemolytic Streptococcus group F bacteremia. Amplicillin treatment produced a favorable outcome with sequela of righ neurosensorial deafness. Beta-hemolytic Streptococcus group F meningitis, sinusitis and bacteremia is a rare association.

[HELLP syndrome: case report and review of the literature]

The case of a 32-years-old primipara in her thirty-second week of pregnancy who presented acute epigastric pain, citopenia, elevation in hepatic enzymes and analytical signs of hemolysis is presented. Ultrasonography demonstrated multiple hyperechogenic nodular images in the liver leading to a wide differential diagnosis. Liver biopsy findings, together with the mentioned clinico-biological alterations were indicative of the HELLP syndrome. Following caesarean, the patient presented rapid and total, symptomatic and analytical, improvement. Based on this case, a review of this entity in the literature and its prognostic implications and possible therapeutic approaches are reported.

[Dysphagia as an unusual form of presentation of malignant pleural mesothelioma]

Dysphagia is an unusual presenting symptom as of extradigestive tumors. Malignant mesothelioma, is a rare tumor localized in the pleural cavity in 80% of all cases and it rarely appears with dysphagia as first symptom. We describe the case of a 74-year-old woman admitted with progressive dysphagia for solid and liquid food, atypical epigastric pain, with in conclusive endoscopic and radiologic studies. Nuclear Magnetic Resonance established the diagnostic suspicion of malignant mesothelioma which was confirmed by the histologic study of a biopsy taken by thoracotomy. We think of interest to report this case of paraesophageal mesothelioma because of its unusual localization and presentation.

[Muscular tumors of the digestive tract: an analysis of 53 cases]

We present 53 cases of gastrointestinal smooth tumors (43 leiomyomas and 10 leiomyosarcomas) which have being diagnosed in Virgen del Camino Hospital during a period of 17 years. The aim of the research is to know the incidence of such tumors, their clinical presentation, the usefulness of radiologic and endoscopic studies for their diagnosis, as soon as to make a bibliographic revision of new diagnostic and therapeutic methods. This kind of tumor had an incidence of 3.1 cases per year. The symptomatology because of which the patients consulted depended on the location and the size of the tumors, though 18% of the cases were asymptomatic and were found in surgical operations. Endoscopic biopsy had a diagnostic sensibility of 28%; it didn't obstruct later exeresis. It has to be emphasized that, according to our bibliographic revision, there is a growing importance of endoscopic echography, not only as for diagnosis, but also as for non surgical treatment of this kind of tumor. Endoscopic resection can be a valid alternative for exeresis of small tumors (less than 2 cm according to some authors); haemorrhage is the most frequent complication, though it can be easily controlled.

[Hepatic markers (Ac-HVA-IgM and AcHBc-IgM) in cases of infectious hepatitis in Dominican children]

The presence of IgM antibodies for the HVA and HBc antigens in 90 children of 15 or less years with acute hepatitis were investigated, finding that 62% (58) were positive for HVA, 8.9% (8) for HBc and 27.8% (25) did not show antibodies for HVA or HBc (non-A non-B hepatitis); comments are made on some clinical and epidemiological findings such as a higher frequency of blood transfusions in HNANB, more males in HB and HNANB, and more hepatomegaly and liver sensitivity in HNANB.