Detection of ubiquitous and heterogeneous mutations in cell-free DNA from patients with early-stage non-small-cell lung cancer

BACKGROUND

The aim of this pilot study was to assess whether both ubiquitous and heterogeneous somatic mutations could be detected in cell-free DNA (cfDNA) from patients with early-stage non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Three stage I and one stage II primary NSCLC tumors were subjected to multiregion whole-exome sequencing (WES) and validated with AmpliSeq. A subset of ubiquitous and heterogeneous single-nucleotide variants (SNVs) were chosen. Multiplexed PCR using custom-designed primers, coupled with next-generation sequencing (mPCR-NGS), was used to detect these SNVs in both tumor DNA and cfDNA isolated from plasma obtained before surgical resection of the tumors. The limit of detection for each assay was determined using cfDNA from 48 presumed-normal healthy volunteers.

RESULTS

Tumor DNA and plasma-derived cfDNA was successfully amplified and sequenced for 37/50 (74%) SNVs using the mPCR-NGS method. Twenty-five (68%) were ubiquitous and 12 (32%) were heterogeneous SNVs. Variant detection by mPCR-NGS and WES-AmpliSeq in tumor tissue was well correlated (R(2) = 0.8722, P < 0.0001). Sixteen (43%) out of 37 SNVs were detected in cfDNA. Twelve of these were ubiquitous SNVs with a variant allele frequency (VAF) range of 0.15-23.25%, and four of these were heterogeneous SNVs with a VAF range of 0.28-1.71%. There was a statistically significant linear relationship between the VAFs for tumor and cfDNA (R(2) = 0.5144; P = 0.0018). For all four patients, at least two variants were detected in plasma. The estimated number of copies of variant DNA present in each sample ranged from 5 to 524. The average number of variant copies required for detection (VCRD) was 3.16 (range: 0.2-7.6 copies).

CONCLUSIONS

The mPCR-NGS method revealed intratumor heterogeneity in early-stage NSCLC tumors, and was able to detect both ubiquitous and heterogeneous SNVs in cfDNA. Further validation of mPCR-NGS in cfDNA is required to define its potential use in clinical practice.

Biological therapies in moderate and severe psoriasis: perspectives and certainties

An inflammatory, proliferative condition with chronic evolution and systemic response, psoriasis, is positioned today among the most common inflammatory skin diseases affecting the Caucasian population worldwide. With a significant incidence, psoriasis has been increasingly defined as a disease with a major impact on the patient's life and the society to which he/she belongs. This paper conducts an analysis of the currently available therapies for the treatment of moderate and severe psoriasis, therapies with biological agents obtained through sophisticated genetic engineering technologies. Recent research and the increasing interest in therapeutic methods as complete and efficient as possible make us optimistic and confident in the future.

National registry of patients with juvenile idiopathic inflammatory myopathies in Hungary—Clinical characteristics and disease course of 44 patients with juvenile dermatomyositis

Idiopathic inflammatory myopathies (IIMs) are systemic autoimmune diseases characterized by chronic muscle inflammation resulting in progressive weakness and frequent involvement of internal organs, mainly the pulmonary, gastrointestinal and cardiac systems which considerably contribute to the morbidity and mortality of the IIMs. Aim of this study was to present clinical characteristics, disease course, frequency of relapses and survival in patients with juvenile dermatomyositis (DM). A national registry of patients with juvenile IIMs was elaborated by the authors in Hungary. We have summarized data of the register according to signs and symptoms, disease course, frequency of relapses and survival of patients with juvenile IIM. Analysis was performed using data of 44 patients with juvenile DM diagnosed between 1976 and 2004 according to Bohan and Peter's criteria. Survival probability was calculated by Kaplan-Meier method. Data of patients with juvenile DM were compared with data of 66 patients with adult DM. The most frequent cutaneous features were facial erythema and heliotrope rash. Extramuscular and extraskeletal manifestations of the disease were more frequent in adult patients. The most common extramuscular feature was arthralgia in both groups of patients with juvenile or adult DM. Cardiac manifestation of the disease was not observed in juvenile patients. Respiratory muscle involvement and interstitial lung disease (ILD) were more frequent among adult DM patients than cardiac manifestation of the myositis. In view of the disease course, the authors found that frequency of polycyclic and monophasic subtypes of the disease were mainly similar. The hazard of relapse was found higher during the first year after the remission. None of the juvenile patients died. Among adult patients four disease-specific deaths occurred. There was no correlation between relapse free survival and initial therapeutic regimen. Many of our patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed up for at least 2 years. Although we found favourable survival probability, further investigations are needed to assess functional outcome.

Radical prostatectomy in the treatment of prostate cancer. The experience of the Urology Clinic of Prof. Dr. Th. Burghele Clinical Hospital

INTRODUCTION

radical prostatectomy remains a real challenge for most of the urologists. Our study's objective is bringing into discussion the main aspects related to the technique we use, the intra and post-operatory complications, as well as the short-term analysis of the results in PC treatment using RP in the Prof. Dr. Th. Burghele Clinical Hospital - Clinic of Urology.

MATERIAL AND METHODS

between 1999 and 2007, 59 patients with PC, aged 48-74, were operated in our clinic. We began to recommend prostate biopsy (PB) to all patients with PSA higher than 4 ng/ml and, in the last years, higher than 2,5 ng/ml. A change in our attitude is related to the PB. At the beginning, we tried to perform "targeted" punctions, ultrasound guided especially in suspect zones, afterwards, we performed randomised punctions at all the patients, no matter the aspect of TRUS and we have increased the number of punctions accordingly to the prostate volume (minimum 6 punctions, maximum 12). The most used was the 10 core punction. The T classification, according to the clinical diagnosis, of the 59 operated patients: T1 cT1 a-b--4 cases; cT1 c--39 cases; T2 cT2 a--12 cases; cT2 b-c--4 cases. The RP surgical technique was the classic one, described by P.C. Walsh--the first surgical step, in all cases was lymphadenectomy.

RESULTS

of all the patients that went through RP, 56 cases are still in our records. We can consider healed 24 patients with PC, followed for 3 years post-surgery, because they had no need of therapy and the PSA is maintained below 0.02 ng/ml. The Gleason score--between the pre-operatory established diagnosis by punction and the anatomic-pathological examination of the piece, there were some differences: the concordance was in 48% of the cases; in 39% of the patients, the biopsy specimen had a lower Gleason score than the surgery specimen, and in 13% a higher score, the most common error was caused by sampling. The correlation between the pre-operatory evaluated clinical stage and the pathological clinical stage was of 57%. The most important late postoperative complications of RP were: urinary incontinence and erectile dysfunction. In our study, we have recorded late postoperative: complete urinary incontinence in 4 cases (6.7%), erection was maintained after bilateral preservation of neurovascular bandelets in 90% of cases and after unilateral preservation in 71% of cases. Due to the short following period, we can't say if the operated patients by us had a benefit regarding the general surviving period; The personalized interpretation of the increase of serum PSA levels after surgery represents a possible problem regarding the indication of complementary treatment.

Pregnancy outcome in idiopathic inflammatory myopathy

The aim of our study was to assess the prevalence and outcome of pregnancy in idiopathic inflammatory myopathy patients who became pregnant after the onset of the disease. Female idiopathic inflammatory myopathy patients (173) were included in our study. The patients' charts and clinical data were retrospectively analyzed. One hundred and four female idiopathic inflammatory myopathy patients had 186 pregnancies, but only nine of these patients (4 polymyositis-PM, 5 dermatomyositis-DM) became pregnant after the onset of the disease. Nine patients with pregnancies after the disease onset had 14 gravidities. Six pregnancies resulted in normal deliveries, two ended in prematurity, six ended in abortions (two induced abortions). Regarding the four patients (3 PM, 1 DM) with active disease at the time of pregnancy, two pregnancies ended in prematurity, four ended in spontaneous abortion and one healthy baby delivered. The other five patients (2 PM, 3 DM) with the disease in remission had uneventful pregnancies and healthy babies were delivered. Treatment was not required during pregnancy in case of two dermatomyositis patients with long lasting remission. New onset dermatomyositis developed in one patient in her pregnancy's third trimester. The mean weight of newborns in the active myositis cases was 2,193 (1,680-2,700) g; while in patients with remission was 3,167 (2,800-3,800) g. The active maternal disease in idiopathic inflammatory myopathy (IIM) might result intrauterin retardation and death. Disease activity in active and new-onset cases could be controlled by increasing the dose of corticosteroid.

Disease course, frequency of relapses and survival of 73 patients with juvenile or adult dermatomyositis

OBJECTIVE

Our aim is to present the disease course, frequency of relapses and survival of juvenile and adult dermatomyositis (JDM/DM) patients.

METHODS

Analysis was performed using data on 73 patients. The median follow-up for 38 JDM patients was 32 months and 78 months for 35 adult DM patients.

RESULTS

23/38 JDM patients (60%) had monophasic, 12/38 (31.6%) had polycyclic and 3/38 (7.9%) had chronic disease. Among children treated only with glucocorticoids, 12/20 (60%) had monophasic and 8/20 (40%) had polycyclic disease. 10/17 (58.8%) children, who required second-line immunosuppressive agents, had monophasic and 4/17 (23.5%) had polycyclic disease. 18/35 DM (51.4%) patients had monophasic, 13/35 (37.1%) had polycyclic, 1/35 (2.9%) had chronic disease and 3/35 (8.6%) had fulminant myositis. Among DM patients requiring only glucocorticoids, 12/20 (60%) were monophasic and 8/20 (40%) were polycyclic. In patients requiring second-line immunosuppressive agents, 6/15 patients (40%) had monophasic and 5/15 (33.3%) had polycyclic disease. Among patients with polycyclic disease, the risk of relapse was higher during first year than later in the disease course. None of the JDM patients have died, while 4 disease-specific deaths occurred in adult patients. There was no significant difference between the survival of JDM and DM patients.

DISCUSSION

There was no correlation between relapse-free survival and the initial therapeutic regimen. Many of our patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed for at least 2 years. Although we found a favourable survival rate, further investigations are needed to assess functional outcome.

Functional outcome and quality of life in adult patients with idiopathic inflammatory myositis

OBJECTIVES

To present the outcome of patients with idiopathic inflammatory myositis, focusing on functional ability and quality of life.

METHODS

Analysis was performed using data from 105 adult patients with definitive polymyositis, dermatomyositis or overlap myositis, who were followed up at a single centre. The diagnosis was made between 1979 and 2000 based on Bohan and Peter's criteria. Functional ability was assessed after a minimum follow-up of 3 yr with the Health Assessment Questionnaire Disability Index (HAQDI) and quality of life was measured with the Short Form 36-item questionnaire (SF-36).

RESULTS

Fifteen patients in our cohort died and 87 participated in the evaluation of functional outcome. Functional ability after a median follow-up of 107.1 months (range 36.4-273.3) was heterogeneous. The median HAQDI score was 0.875 (range 0-2.875). Polyphasic or chronic-progressive disease course, osteoporosis and long-term follow-up were predictive of higher HAQDI scores. In terms of quality of life, significant differences from population norms were shown in all domains of the SF-36. There were no significant differences in the SF-36 scores among the patients according to clinicopathological subset or disease course.

CONCLUSIONS

Although the mortality of our cohort was favourable, myositis continues to have a great impact on life in the medium and long term. The present work indicates that myositis patients have a significantly poorer quality of life than the normal population, but there was no difference among the patients according to clinicopathological subsets.

[Dermatologic preparations with erythromycin--the correlation of the pharmaceutical form-therapeutic effect]

Erythromycin associated with progesterone and A vitamin has been included in three dermatological pharmaceutical forms: a lotion, a L/H emulsion and a L/H nonionogenic ointment. Aspect of these preparations has been noticed for a 90 days period. pH and electrical conductance were also determined during this interval. All the formulations mentioned above revealed insignificant variations of these parameters proving an appreciable physico-chemical stability. Clinical investigative studies in juvenile acne, showed efficiency, particularly for the emulsion form.

[Evolution of splenic lympho-reticular populations during the immune response "in vitro" in the chick (author's transl)]

The different types of cell population in organotypic cultures of spleen from chicken immunized with Salmonella paratyphi B were enumerated. The kinetics of immunoglobulin and of antiflagellar antibody synthesis followed the cellular variations observed. Two phases were generally observed: one was characterized by a considerable decrease in small and medium-sized lymphocytes by a lytic process and the appearance, by transformation and/or multiplication, of a large population of hyperactive macrophages. The IgM and IgG synthesized between the 2nd and 9th days only partially consisted of antiflagellar antibodies; some were synthesized probably by large basophilic cells and others by the few plasma cells which were observed, generally isolated on the prints. The second phase, from the 11th to the 21st day, manifested a narrower antibody specificity in that all the IgG, the only immunoglobulin synthesized during this period, might be entirely absorbed by the antigen and corresponded to the proliferation of a new lymphoreticular population. A close cellular cooperation seemed to occur at this stage between these two types of population, the macrophages appearing to stimulate lymphopoiesis. Colonies of plasma cells, characteristic of this phase, appeared from the 13th day. These two phases were separated around the 9th day be a brief period of cellular depression. Although the transformations, the contacts and the islets observed among the lympho-reticular populations indicated their plasticity and their capacity for change during the reaction, it must be noted that there was no in vitro example of antibody synthesis occurring without the simultaneous presence of lymphocytes, macrophages and pyroninophile cells.