Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study

BACKGROUND

Several reports have described Takotsubo syndrome (TTS) secondary to thyrotoxicosis. A complex interaction of central and peripheral catecholamines with thyroid homeostasis has been suggested. In this study, we analysed sequential thyroid hormone profiles during the acute phase of TTS.

METHODS

Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at predefined time points in 32 patients presenting with TTS or acute coronary syndrome (ACS, n = 16 in each group) in a 2-year period in two German university hospitals. Data were compared to age- and sex-matched controls (10 samples, each of 16 subjects), and an unsupervised machine learning (ML) algorithm identified patterns in the hormone signature. Subjects with thyroid disease and patients receiving amiodarone were excluded from follow-up.

RESULTS

Among patients with TTS, FT4 concentrations were significantly higher when compared to controls or ACS. Four subjects (25%) suffered from subclinical or overt thyrotoxicosis. Two additional patients developed subclinical or overt thyrotoxicosis during stay in hospital. In four subjects (25%), FT4 concentrations were increased, despite nonsuppressed TSH concentration, representing an elevated set point of thyroid homeostasis. The thyroid hormone profile was normal in only six patients (38%) presenting with TTS.

CONCLUSION

Abnormal thyroid function is frequent in patients with TTS. Primary hyperthyroidism and an elevated set point of thyroid homeostasis are common in TTS, suggesting a stress-dependent endocrine response or type 2 thyroid allostasis. Thyroid function may be a worthwhile target in treating or preventing TTS.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

[Equine dentistry: Survey on Swiss horse owners]

INTRODUCTION

The interest in equine dentistry has significantly increased in the last 15 years. On the part of the veterinarians as well as of the horse owners there is a strong attention to the topic. The aim of the questionnaire was to investigate amongst horse owners what their level of information and preferences about dental treatment are and how they are implemented. The questionnaire was translated into the three national languages and included 20 questions about level and sources of information, frequency of treatments and the horse owner's stance over sedation of the animals. With a return rate of 45% (1'466 of 3'250 sent questionnaires) significant conclusions could be drawn. Horse owners showed a strong demand for clarification regarding tooth problems, the causes, consequences and methods of treatment. More than half of the owners considered themselves not well informed. The treating person was in 66.7% a veterinarian with a special education. Horse owners indicated that information circulated most frequently by word of mouth recommendations and they explicitly wished information from professional and reliable sources. The questionnaire provided a clear result about current equine dental treatments. We suggest that they should be performed by veterinarians only with a special education.

Evaluation of a standardised radiographic technique of the equine hoof

Radiography of the equine hoof is often used to obtain a diagnosis. Quantitative interpretation, especially for research purposes requires high quality and accuracy of radiographs. The purpose of this study was to describe and evaluate a radiographic technique for the lateromedial (LM) and the dorsopalmar (DP) view of the equine hoof. Ten radiographs for each view from one cadaver limb and from both front feet in a standing horse were taken in order to assess repeatability of the radiographic technique. The method requires easy to use adjustable and portable equipment and strictly defined external radio opaque markers on the hoof capsule. The digitalised radiographs were processed and analysed with the software package Metron PX, measuring 13 parameters in the LM view and 10 parameters in the DP view, respectively. Results show that with few exceptions measurements of these parameters revealed a coefficient of variation that was smaller than 0.05. It was concluded that this easy to use standardised radiographic technique ensures excellent accuracy and repeatability for both the LM and DP view. Hence, this method provides an adequate tool for quantitative assessment of the equine hoof, inter- and intraindividually.

Bilateral iatrogenic [corrected] maxillary fractures after dental treatment in two aged horses

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fractures during or after routine dental treatment are rare, but can occur, especially in older horses. Appropriate sedation and, if necessary, regional nerve blocks might reduce the risk of iatrogenic fractures of the maxilla. General anesthesia must be considered for tooth extraction in horses that are difficult to restrain.

[Surgical treatment of canker involving all hoofs in a warmblood gelding]

The following case report describes the treatment of canker in a 14 years old warmblood gelding. The horse showed the typical appearance with caseous surface and early detachment of the superficial horn layers. The histological results show a severe degradation in the germinal layer of the epidermis of the frog. Surgical therapy under general anaesthesia was performed. On all limbs a tourniquet was applied and all abnormal tissue in the region of the frog and also the subdermal tissue underneath were removed. Postoperatively the horse was treated with hoof bandages for 2 weeks. Treatment plates were than applied on all hoofs. During the following weeks the wounds were topically treated with Giessner Mischung 2 an astringent, desinfectant powder. The powder contains jodophorm, zincoxyde, tanninic acid, metronidazole. After 5 months the frog showed a complete cover with strong horn material and without any signs of recrudescence.

Locking compression plate osteosynthesis of complicated mandibular fractures in six horses

Complicated mandibular fractures were recognised in one foal, one pony and four horses. The foal was two months old while the adult animals ranged in age from 12 to 24 years. Three horses had a unilateral horizontal ramus fracture. Two fractures were open and one was closed. Comminution was present in one of these patients while the other two horses had marked displacement of the fragments. Two suffered from comminuted fractures of the horizontal and vertical ramus of the mandible. One of these patients had open and infected fractures. One foal had a bilateral horizontal ramus fracture with marked periosteal 'new bone' formation and malalignement which required corrective osteotomy. Each horse underwent locking compression plate (LCP) osteosynthesis consisting of open fracture reduction and application of one to three 4.5/5.0 mm LCP at the ventral, lateral or caudal aspect of the mandible under fluoroscopic control. Two 3.5 mm LCP were used in the foal. Plate fixation was supported by application of a cerclage wire construct between the incisor and premolar teeth in most patients. Complete fracture healing, with an excellent functional and cosmetic outcome, was achieved in all of the patients. Complications encountered included seroma formation, screw and wire breakage, as well as implant and apical tooth root infections. The LCP was removed after fracture healing had occurred in four patients.

[Do hoof cracks represent a superficial hoof-problem?]

Fifty-four horses with hoof cracks were referred to the Equine Hospital of the University of Zurich, for treatment. The horses were admitted because of lameness or other symptoms caused by the cracks. Deep or complicated quarter cracks were the most common type of cracks diagnosed. Poor conformation and abnormal hoof shape were the most important causes of hoof crack development, whereas injury to the coronary band was a less frequently encountered cause. Effective treatment of this problem includes corrective shoeing, removing horn from the weight-bearing surface as well as from the crack with a Dremel tool and immobilization of the borders of the crack. However, even with such a therapy, the recurrence rate of hoof cracks was with 20% very high.

Die Kunst des Hufbeschlags - zwischen Empirie und Wissenschaft

To correctly shoe a horse requires the farriers to have a good working knowledge of postural anomalies and movement patterns, as well as of the different concepts of horseshoeing and to be able to apply the appropriate technique to every individual horse they shoe. The correct technique for specific problem cases is frequently a subject of debate amongst specialists and many theories would benefit from objective gait analyses. The case study presented examines the influence of different shoeing conditions on selected gait analysis parameters. The measurements were conducted on a Warmblood mare: (A) shod with long toes, (B) properly trimmed without shoes, (C) conventionally shod with rolled toes and finally (D) shod using the 4-point technique. Data on force-, time- and distance parameters were recorded using an instrumented treadmill. First contact and breakover of the hooves were documented using high-speed videography. A long toe resulted in a prolongation of the breakover time and, therefore, in a prolongation of the second half of the stance phase. Additionally, the prolonged stance duration associated with an unaltered force impulse, led to decreased force peaks. It was possible to objectively record differences between the trimmed, unshod foot, the shod long-toe and the shod rolled toe configurations. The differences between the rolled toe and the 4 point shoe however, were minimal. Gait analysis is a technique well suited for objective evaluation of different shoeing techniques under standardised conditions.

Self-diffusion of (31)Si and (71)Ge in relaxed Si(0.20)Ge(0.80) layers

Self-diffusion of implanted (31)Si and (71)Ge in relaxed Si(0.20)Ge(0.80) layers has been studied in the temperature range 730-950 degrees C by means of a modified radiotracer technique. The temperature dependences of the diffusion coefficients were found to be Arrhenius-type with activation enthalpies of 3.6 eV and 3.5 eV and preexponential factors of 7.5 x 10(-3) m(2) s(-1) and 8.1 x 10(-3) m(2) s(-1) for (31)Si and (71)Ge , respectively. These results suggest that, as in Ge, in Si(0.20)Ge(0.80) both (31)Si and (71)Ge diffuse via a vacancy mechanism. Since in Si(0.20)Ge(0.80) (71)Ge diffuses only slightly faster than (31)Si , in self-diffusion studies on Si-Ge (71)Ge radioisotopes may be used as substitutes for the "uncomfortably" short-lived (31)Si radiotracer atoms.

Reversible shape evolution of Ge islands on Si(001)

The evolution of strained Ge/Si(001) islands during exposure to a Si flux was investigated by scanning tunneling microscopy. Dome islands display appreciable shape changes at Si coverages as low as 0.5 monolayer. With increasing coverage, they transform into [105]-faceted pyramids, and eventually into stepped mounds with steps parallel to the <110> directions. These morphological changes are induced by alloying and represent a complete reversal of those previously observed during Ge island growth. The results are interpreted with a simple model in which the equilibrium shape of an island mainly depends on its volume and composition.

Studies on modified estrogens: towards the synthesis of novel 14,15-cyclopropa[a]estra-1,3,5(10),8-tetraenes

To improve the ratio of non-hormonal to hormonal activity, estrogens 3 and 4 were modified at various molecule positions. Isomerization of the 14 alpha,15 alpha-methylene bridge, controlled 3-methoxy group cleavage with respect to the 14 alpha,15 alpha-methylene bridge stereochemistry, reduction of the 8-double bond, and substitution of the oxyfunctionality at C-17 by a methylene and a difluoromethylene moiety were in the focus. As a result of in vivo and in vitro tests, compounds 27 and 29 were selected as potential follow-up candidates of lead 3.

Prepro-orexin and orexin receptor mRNAs are differentially expressed in peripheral tissues of male and female rats

Orexins are produced specifically by neurons located in the lateral hypothalamus. Recent results suggested peripheral actions of orexins. Therefore, we analyzed the mRNA expression of prepro-orexin and the orexin receptor subtypes OX(1) and OX(2) in peripheral rat tissues. Using real-time quantitative RT-PCR we detected significant amounts of prepro-orexin mRNA in testis, but not in ovaries. OX(1) receptor mRNA was highly expressed in the brain and at lower levels in the pituitary gland. Only small amounts of OX(1) receptor mRNA were found in other tissues such as kidney, adrenal, thyroid, testis, ovaries, and jejunum. Very high levels of OX(2) receptor mRNA, 4-fold higher than in brain, were found in adrenal glands of male rats. Low amounts of OX(2) receptor mRNA were present in lung and pituitary. In adrenal glands, OX(2) receptor mRNA was localized in the zona glomerulosa and reticularis by in situ hybridization, indicating a role in adrenal steroid synthesis and/or release. OX(1) receptor mRNA in the pituitary and OX(2) receptor mRNA in the adrenal gland were much higher in male than in female rats. In the hypothalamus, OX(1) receptor mRNA was slightly elevated in female rats. The differential mRNA expression of orexin receptor subtypes in peripheral organs indicates discrete peripheral effects of orexins and the existence of a peripheral orexin system. This is supported by the detection of orexin A in rat plasma. Moreover, the sexually dimorphic expression of OX(1) and OX(2) receptors in the hypothalamus, pituitary, and adrenal glands suggests gender-specific roles of orexins in the control of endocrine functions.

Orexin (hypocretin) gene expression in rat ependymal cells

The expression of prepro-orexin (PPO) mRNA in the rat brain was investigated by in situ hybridization histochemistry. In the lateral and posterior hypothalamic areas, which are considered to produce exclusively PPO mRNA, we found high levels of PPO mRNA expressions. We also localized PPO mRNA hybridization signals at lower levels around the lateral ventricles, the third and fourth ventricle. Cellular analysis by emulsion autoradiography revealed the expression of PPO mRNA in the ependymal cell layer. Our results demonstrate that beside the lateral and posterior hypothalamus PPO mRNA is expressed in ependymal cells.

D(A) steps and 2D islands of double layer height in the SiGe(001) system

The surfaces of step graded, partially relaxed Si(1-x)Ge(x)/Si(001) buffers were studied by scanning tunneling microscopy. The surface slips along <110> forming the crosshatch pattern, consisting of bunches of D(A) steps of double layer height. The D(A) steps are present in regions of large surface gradients close to the slips, as well as in planar regions between the slips. These regions are also characterized by the appearance of 2D islands of double layer height. The observations can be explained by assuming the strain due to the misfit dislocations to be locally anisotropic. Anisotropic misfit strain and efficient strain relaxation by the ( 2x8) Ge reconstruction were identified as the main factors causing the unusual step structure.

Comparison of the efficacy and tolerability of a paracetamol/codeine fixed-dose combination with tramadol in patients with refractory chronic back pain

Fifty-five patients suffering from refractory chronic back pain took part in a double-blind, multiple-dose, randomised, cross-over study to compare the efficacy and tolerability of a fixed-dose capsule preparation containing 500 mg paracetamol (CAS 103-90-2) and 30 mg codeine phosphate 1/2 H2O (CAS 41444-62-6) (talvosilen forte, test preparation) with a reference capsule preparation containing 50 mg tramadol hydrochloride (CAS 22204-88-2), in a regimen of two capsules 8-hourly. There were two treatment periods of up to 7 days each. Cross-over took place, without washout, at the end of 7 days, or sooner if patients were unable to tolerate the first treatment. The test preparation was at least as efficacious as the reference in the treatment of back pain (81% of patients experienced good or satisfactory pain relief). 81% of patients tolerated the test well compared to only 69% receiving the reference, as per protocol analysis. The results of this study suggest that the test product is at least as efficacious as tramadol in the treatment of patients with refractory chronic back pain, whilst being better tolerated.

Pharmacokinetics and metabolic pattern after intravenous infusion and oral administration to healthy subjects

Meloxicam [4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H- 1,2-benzothiazine-3-carboxamide-1,1-dioxide] is a new nonsteroidal antiinflammatory drug belonging to the enolic acid group. In a crossover study, 30 mg 14C-labeled meloxicam was administered to four male healthy volunteers as a short-term infusion and as an oral solution. The objectives of the study were to determine the mode of elimination, the excretion balance, the in vivo binding characteristics to serum proteins, and to investigate the metabolic pattern in plasma, urine, and feces. A comparison of plasma concentration measurements of unchanged drug by a specific HPLC assay and total radioactivity by liquid scintillation counting revealed a very close conformity. Over 90% of the plasma radioactivity was represented by unchanged drug. Its terminal and dominant half-life of elimination from plasma, as determined from plasma and urinary data in this study, ranged from 12 to 17 hr in the volunteers. The serum protein binding of the radioactivity from in vivo samples was very high (99.1-99.7%). The excretion balance was complete after 6 days. Average urinary excretion of 14C-radioactivity accounted for 43% of the dose, with the remainder appearing with the feces. Meloxicam was extensively metabolized, with only traces of the drug appearing unchanged in urine and feces. The main metabolites were formed by hydroxylation and further oxidation of the methyl group of the thiazolyl moiety. In addition, two further metabolites were found, particularly in urine. Altogether, > 95% of the dose excreted could be accounted for by the metabolites identified or the parent compound itself.

Spontaneous perforation of the ureter: a rare complication of urolithiasis

The spontaneous rupture of the ureter is a rare condition. A case of a girl is reported with a spontaneous perforation caused by ureteral and renal calculi. The concomitant urinoma was drained and the ureter splinted with a double-J catheter. The calculi were destroyed by extracorporal piezoelectric lithotripsy without anesthesia.

Congenital intracranial cysts: clinical findings, diagnosis, treatment and follow-up. A multicenter, retrospective long-term evaluation of 72 children

A multicenter, retrospective evaluation of 72 children born between 1973 and 1987 with intracranial cysts was performed: 37 had an arachnoid cyst, 25 a Dandy-Walker malformation and 10 a porencephalic cyst. The following criteria were evaluated: history, clinical findings, diagnostic work-up (neuroradiology, CSF and intracystic pressures), surgical therapy and follow-up (outcome and cyst volumes).

Regulation of insulin-like growth factor I messenger ribonucleic acid levels by serum in cultured rat fibroblasts

Fibroblasts represent one of the in vivo sites of extrahepatic insulin-like growth factor I (IGF-I) production. In this study, cultured fibroblasts prepared from the skin of neonatal rats were used as a model to assess the role of serum in regulating IGF-I messenger RNA (mRNA) levels. IGF-I mRNA, as demonstrated by Northern blot analysis, was present in the cultured fibroblasts, and serum free media which was conditioned by fibroblasts for 20 h contained 108 pg/ml of immunoreactive IGF-I. Fetal calf serum (FCS) decreased steady state IGF-I mRNA levels, as measured by solution hybridization/RNase protection assay, in fibroblasts in a time- and dose-dependent fashion. Incubation of fibroblasts for 18 h in the presence of 0.3%, 0.6%, or 1% FCS decreased IGF-I mRNA levels to 76%, 56%, and 46% of the levels present in control cells which were maintained in serum free media with 0.25% BSA. Maximal inhibition to approximately 20% of control levels was seen with 4-10% FCS. In contrast, basic fibroblast growth factor and beta-actin mRNA levels increased 2- and 4-fold, respectively, with increasing concentrations of FCS. Treatment of the cells with 10 micrograms/ml cycloheximide resulted in partial abrogation of the inhibitory effect of FCS while protein synthesis in the cells was decreased to 6% of control levels. The addition of 2 micrograms/ml of insulin or 15-100 ng/ml of IGF-I to the fibroblasts did not reproduce the inhibitory effect of FCS. Finally, the inhibitory factor(s) present in the FCS was partially removed/inactivated by charcoal stripping or heat inactivating the serum, but delipidation of the FCS by chloroform extraction had no effect on the inhibitory effect of FCS. In summary, FCS contains a factor(s) that decreases IGF-I mRNA levels in cultured fibroblasts in a time- and dose-dependent fashion. The partial abrogation of the inhibitory effect of FCS with cycloheximide treatment suggests that this effect is at least partially dependent upon new protein synthesis. Furthermore, the studies using delipidated, heat-inactivated, and charcoal-stripped serum suggest that the inhibitory factor(s) is a peptide.

[Autologous peripheral stem cell transplantation in children]

19 children between 3 and 23 years underwent 79 leukapheres for collection of blood stem cells. In children suffering from acute lymphoblastic leukemia (ALL), Non Hodgkin's Lymphoma (NHL) and Ewing's Sarcoma (ES) we collected 6.87 x 10(4) CFU-GM/kg (range 2,65-21.7), if collections were started with the first platelet rise. In children with peripheral primitive neuroectodermal tumors (PNET) and neuroblastoma (NBL) we gained only 1.20 x 10(4) CFU-GM/kg (range 0.09-2.24). 17 children received high dose chemoradiotherapy and peripheral stem cell +/- bone marrow rescue. 9 suffered from solid tumors, 8 from hematopoietic malignancies. 9 were transfused with peripheral stem cells only, 8 received bone marrow in addition. Time to reach 0.5 x 10(9)/l granulocytes was very short-median 31 days (12-65), in 4 children receiving more than 5 x 10(4) CFU-GM/kg 12 to 13 days, only. On January 31st, 1989 6/17 children are alive in complete remission after a median observation time of 14.5 months (3-26) after autologous stem cell transfusion, one child is alive in "no remission", 7 died with relapse, 3 died because of infections (2 x aspergillosis, 1 x pseudomonas septicemia). The collection of blood derived stem cells by leukaphereses was well tolerated even in very small children and easily repeatable. With optimal timing high stem cell numbers were obtainable, resulting in a very short duration of posttransplant granulocytopenia.

[Congenital hydrocephalus--an analysis of the course of pregnancy, prenatal studies and labor]

An analysis of the pool of our patients revealed few disturbances during pregnancy. In two cases the malformations were possibly due to drugs. Prenatal sonographic diagnostics were performed in one-third of the cases or documented: in 60% of the investigated cases a hydrocephalus was found, this being only 20% of the whole pool. The major part of the births were performed by Caesarean section, mainly because of a prolongation of the birth directly or indirectly due to the large circumference of the head. The hereditary trait of associated malformations and malformations of the central nervous system was frequent. Therefore, we advocate a better prenatal work-up and a birth by planned Caesarean section.

[Bioequivalence of piracetam following acute administration of an oral solution or two tablet formulations in volunteers]

In an open, non-randomized 3-way cross-over study, the bioavailability of 2-oxo-pyrrolidine-1-acetamide (piracetam, Encetrop) from two solid oral formulations and one liquid formulation was tested in 8 healthy male volunteers. The area under the concentration time curve, which is defined to be a measurement for bioequivalence among the three tested galenic formulations correlated very well with the area under the effect intensity-time curve, which was estimated in the same volunteers using electro-physiological methods. The different methods of estimation of bioequivalence show similarity between both solid galenic formulations, while the liquid form exhibits superiority in respect to the oral solid formulations.

[Cooperative studies in the treatment of acute lymphoblastic leukemia in children in Austria--report of 10 years' experience]

437 children with acute lymphoblastic leukaemia (ALL) have been treated at 9 different institutions in Austria utilizing common protocols and central registration between 1974 and 1984. 227 patients (132 boys and 95 girls, group I) were treated between 1974 and 1980 using 3 consecutive protocols (KMK, O 76, A 78), which were essentially derived from the Memphis studies VII and VIII. Patients with a high risk of relapse were treated according to the LSA 2-L2 protocol. 210 patients (112 boys and 98 girls, group II) were consecutively treated following the BFM protocols 76/79 and 81/83. In this group, treatment intensity was adjusted to the initially determined individual risk of relapse (BFM risk score or risk factor). To date, the life table analysis demonstrates that the probability of continuous complete remission for patients in group II is 60% after 5 and 3 years (BFM 76/79 and BFM 81/83, respectively), whereas group I reaches a level of 37.3%. The prognostic difference between risk and non-risk patients in both studies of group II was eliminated. Despite a higher morbidity and non-leukaemia-related mortality in group II, the therapeutic success can be attributed to the intensification of induction therapy.