Genomics improves risk stratification of adults with T-cell acute lymphoblastic leukemia patients enrolled in measurable residual disease-oriented trials

Genetic information has been crucial to understand the pathogenesis of T-cell acute lymphoblastic leukemia (T-ALL) at diagnosis and at relapse, but still nowadays has a limited value in a clinical context. Few genetic markers are associated with the outcome of T-ALL patients, independently of measurable residual disease (MRD) status after therapy. In addition, the prognostic relevance of genetic features may be modulated by the specific treatment used. We analyzed the genetic profile of 145 T-ALL patients by targeted deep sequencing. Genomic information was integrated with the clinical-biological and survival data of a subset of 116 adult patients enrolled in two consecutive MRD-oriented trials of the Spanish PETHEMA (Programa Español de Tratamientos en Hematología) group. Genetic analysis revealed a mutational profile defined by DNMT3A/ N/KRAS/ MSH2/ U2AF1 gene mutations that identified refractory/resistant patients. Mutations in the DMNT3A gene were also found in the nonleukemic cell fraction of patients with T-ALL, revealing a possible mutational-driven clonal hematopoiesis event to prime T-ALL in elderly. The prognostic impact of this adverse genetic profile was independent of MRD status on day +35 of induction therapy. The combined WOG signature and MRD on day +35 allowed risk-stratification of T-ALL into standard or high-risk groups with significantly different 5-year overall survival (OS) (95% confidence interval [CI]) of 52% (37-67 %) and 17% (1-33%), respectively. These results confirm the relevance of the tumor genetic profile in predicting patient outcome in adult T-ALL and highlight the need for novel gene-targeted chemotherapeutic schedules to improve the OS of poor-prognosis T-ALL patients.

Overactive bladder symptom bother and health-related quality of life in patients with systemic lupus erythematosus and primary Sjögren syndrome

OBJECTIVE

The objective of this paper is to assess overactive bladder (OAB) symptom bother (SB) and health-related quality of life (HRQL) among patients with systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS).

METHODS

We recruited adult SLE and pSS patients and two groups of age- and sex-matched controls. We applied the OAB questionnaire-short form (OABq-SF) to all participants to assess SB and HRQL and collected clinical information relevant for OAB. We compared the OABq-SF scores for SB and HRQL between patients and controls using univariate and multivariate linear regression analysis.

RESULTS

We recruited 95 rheumatic patients (68 SLE, 27 pSS) and 231 controls. Compared to controls SLE patients showed higher OABq-SF SB scores (22.6 ± 20.4 vs 14.7 ± 17.0, p = 0.004) and lower HRQL scores (89.8 ± 15.8 vs 93.8 ± 11.4, p = 0.044). On multivariate analysis SLE was significantly associated with a higher SB score (ß-coefficient 7.13, p = 0.008) and tended to be associated with worse HRQL values (ß-coefficient -3.53, p = 0.055). Patients with pSS had numerically higher mean SB scores (22.8 ± 22.5 vs 16.2 ± 18.0, respectively, p = 0.107) and lower HRQL scores (91.0 ± 10.7 vs 93.2 ± 11.6, respectively, p = 0.369), although these differences were not statistically significant. Diagnosis of pSS was not significantly associated with SB or HRQL scores on univariate or multivariate analysis.

CONCLUSIONS

Patients with SLE have significantly worse OAB-SB and poorer HRQL compared to controls. A similar trend was seen for pSS patients, especially for SB. These findings suggest that clinically subtle OAB symptoms may be present in rheumatic patients for whom, later on, bladder pain syndrome may occur.

Attitudes of health care professionals toward people with intellectual disability: a comparison with the general population

BACKGROUND

Few studies have examined attitudes that may promote the social inclusion of persons with an intellectual disability (ID) among health care providers (HCPs). Yet these attitudes could impact the accessibility and quality of services provided to this population, as well as the general attitudes of HCPs. The objectives of this study were to (1) examine HCPs' pro-inclusion attitudes toward people with ID, (2) compare these to the general population's attitudes and (3) examine how HCPs' attitudes vary as a function of their socio-demographic characteristics.

METHOD

The Attitudes Toward Intellectual Disability Questionnaire was administered to 367 HCPs and a representative sample of the Québec population (N = 1605).

RESULTS

Results indicated that at least half of HCPs displayed positive attitudes, that is, attitudes that are compatible with notions of social inclusion and equal rights, toward individuals with ID. Positive attitudes were less frequently observed for the Interaction and the Sensitivity or tenderness factors measured by the Attitudes Toward Intellectual Disability Questionnaire. In comparison with the general population, HCPs exhibited more positive attitudes on the Knowledge of causes and Sensitivity or tenderness factors and less positive attitudes on the Interaction factor. HCPs who regarded themselves as more knowledgeable about ID and those who reported higher quality contacts or interactions with persons with ID expressed attitudes that were more favourable toward social inclusion.

CONCLUSIONS

In addition to providing general knowledge about ID and the specific health care needs of individuals with ID, training programmes should also promote interactions with this population. Further studies are needed to document HCPs' pro-inclusion attitudes toward people with ID and to assess the impact of interventions on these attitudes.

Associations of wheat with pea can reduce aphid infestations

Increasing plant diversity within crops can be beneficial for pest control. In this field study, the effects of two wheat and pea associations (mixed cropping and strip cropping) on aphid populations were compared with pure stands of both crops by observations on tillers and plants. Pea was more susceptible to infestations than wheat. As expected, the density of aphid colonies was significantly higher in pure stands during the main occurrence periods, compared with associations. Additionally, flying beneficials, such as not only aphidophagous adult ladybirds but also parasitoid, hoverfly and lacewing species that feed on aphids at the larval stage, were monitored using yellow pan traps. At specific times of the sampling season, ladybirds and hoverflies were significantly more abundant in the pure stand of pea and wheat, respectively, compared with associations. Few parasitoids and lacewings were trapped. This study showed that increasing plant diversity within crops by associating cultivated species can reduce aphid infestations, since host plants are more difficult to locate. However, additional methods are needed to attract more efficiently adult beneficials into wheat and pea associations.

[Tuberculosis unit: case study of 10 years of activity (1999-2009)]

INTRODUCTION

The Pulmonology Service of a Central Hospital in Lisbon created a Unit dedicated to the treatment of tuberculosis (TB).

OBJECTIVES

Casuistic analysis and assessment of the predictive factors for in-hospital mortality, over a 10-years period.

MATERIAL/METHODS

Retrospective study, from April 1999 to September 2009, through the Statistical Package for the Social Sciences application for binary logistic regression.

RESULTS

In a total of 1917 patients, most were male (n=1450; 76%), Caucasian (76.6%), with an average age of 43±15.2 years, and 19.8% were immigrants. The retreatments were responsible for 26% of the hospitalizations. The presence of comorbidities was detected in 85.7%, particularly HIV infection (34.7%). The multidrug-resistant (MDR) and the extensively drug resistant (XDR) TB occurred in 6.6% and 6.8%, respectively. The average delay was 28.5±54.8 days, with the mortality rate at 8.6%. The mortality risk was more significant amongst men (OR 1.8; 95%CI 1.16-2.90; p<0.01), in patients with HIV infection (OR 3.7; 95%CI 2.47-5.49; p<0.001), and amongst those who presented MDR TB (OR 2.5; 95%CI 1.24-5.15; p<0.01) and XDR TB (OR 5.5; 95%CI 3.14-9.58; p<0.001).

CONCLUSIONS

A high percentage of patients presented comorbidities, namely HIV infection. The main factors associated with mortality were HIV infection, XDR TB and MDR TB.

Microsatellite instability in Lactuca sativa chronically exposed to cadmium

Cadmium (Cd) is a cytotoxic, mutagenic and carcinogenic metal. Mutagenesis is indicative of genetic instability and can be assayed by use of microsatellite markers (simple sequence repeats, SSRs). These are tandem-repeated tracts of DNA composed of units that are 1-6 base pairs (bp) long, spread throughout the genome and highly polymorphic. SSRs can be used in the detection of genomic DNA damage and/or mutational events (e.g. deletions, insertions, point mutations). In order to study chronic exposure to cadmium, Lactuca sativa L. seeds were germinated in distilled water and grown on modified Hoagland's medium, both supplemented with 0, 10 and 100microM Cd(NO(3))(2). After 28 days of exposure, the plants were harvested to assess shoot and root length and accumulation of cadmium. DNA was extracted from young and expanded leaves and roots in order to analyse microsatellite instability (MSI). Mutagenic effects of cadmium were evaluated on nine microsatellite loci. No MSI was found in leaves, but a 2-bp deletion in one lettuce root SSR was detected among the SSRs that were analysed. Thus, SSR analyses may provide a complementary tool in the assessment of different genotoxic effects of compounds on plants.

Assessment of ploidy stability of the somatic embryogenesis process in Quercus suber L. using flow cytometry

Flow cytometry analyses were used to verify the ploidy stability of Quercus suber L. somatic embryogenesis process. Leaf explants of two adult cork oak trees (QsG0 and QsG5) of the North of Portugal were inoculated on MS medium with 2,4-D and zeatin. After 3 months, calluses with embryogenic structures were isolated and transferred to fresh MS medium without growth regulators and somatic embryo evolution was followed. Morphologically normal somatic embryos (with two cotyledons) and abnormal somatic embryos (with one or three cotyledons) were used in this assay. Flow cytometry combined with propidium iodide staining was employed to estimate DNA ploidy levels and nuclear DNA content of somatic embryos and leaves from mother plants. No significant differences (P< or =0.05) were detected among embryos, and between the embryos and the mother plants. Also, after conversion of these embryos, no significant morphological differences were observed among the somatic embryo-derived plants. These results and further studies using converted plantlet leaves and embryogenic callus tissue indicate that embryo cultures and converted plantlets were stable with regard to ploidy level. As no major somaclonal variation was detected our primary goal of "true-to-type" propagation of cork oak using somatic embryogenesis was assured at this level. The estimation of the 2C nuclear DNA content for this species is similar to the previously obtained value.

Analysis of the genetic stability of Eucalyptus globulus Labill. somatic embryos by flow cytometry

Flow cytometry was used to measure the nuclear DNA content of Eucalyptus globulus Labill. somatic and zygotic embryos and leaves in order to determine if somatic embryogenesis induces DNA content and ploidy changes in this species. Mature zygotic embryos derived from open-pollination orchard families were collected from a location in the centre of Portugal. One group was kept for nuclear DNA content and ploidy analysis, and the other group was used for establishing embryogenic cultures. Mature zygotic embryos were grown on Murashige and Skoog (MS) medium supplemented with 3% (w/v) sucrose and 3 mg l(-1) alpha-naphthaleneacetic acid (NAA) for 3 weeks and then transferred to MS medium without growth regulators. Globular somatic embryos from approximately 8-month-old embryogenic cultures were used in the assay. DNA ploidy levels and the nuclear DNA content of mature zygotic embryos, somatic embryos and leaves from the mother field tree were determined using flow cytometry combined with propidium iodide staining. Zygotic embryos had a nuclear DNA content of 1.32 pg/2C, somatic embryos had a nuclear DNA content of 1.39 pg/2C and leaves from the field tree had a nuclear DNA content of 1.40 pg/2C. The values estimated for the somatic embryos and mother plant did not differ statistically from each other (P < or = 0.05), but both differed from those of the zygotic embryos (P < or = 0.05). These results clearly indicate that no changes were induced during the embryogenic process. However, the differences found between the field plants and zygotic embryos did suggest that some aspects must be evaluated carefully, as propidium iodide fluorescence may potentially be influenced by the presence of secondary compounds (e.g. anthocyanins, tannins) in E. globulus somatic embryos and mature leaves. Therefore we believe that the somatic embryogenesis methodology used did not induce major genetic changes in the somatic embryos and that our primary goal of "true-to-type" propagation was assured.

[Dyspepsia in general practice consultation]

An observational descriptive transversal study was carried out to analyse the clinical log-books of the patients with dyspeptic complaints in the General Practice consultation of Fernão de Magalhães Heath Center, during 1994. The aim of the study was to assess: the distribution of dyspeptic categories; the association of dyspepsia groups and the selected variables; the identified risk factors; the clinical investigation and its relationship with the age groups, as well as prescription in the General Practice consultations. The results of the study show that: functional dyspepsia is more frequent than organic; females have functional dyspepsia more frequently, with a statistically significant difference; there are more consultations with dyspeptic complaints among the elderly; about 50% of the patients with dyspeptic symptoms were investigated and two thirds were above forty-five years of age; the prescribed medication was similar to that recommended.

An assessment of the clinical efficacy of intranasal desmopressin spray in the treatment of renal colic

OBJECTIVES

To assess the efficacy of desmopressin nasal spray compared with diclofenac given intramuscularly in patients with acute renal colic caused by urolithiasis.

PATIENTS AND METHODS

The study included 61 patients randomized into three different groups; group A received desmopressin (40 microg, nasal spray), group B diclofenac (75 mg) intramuscularly and group C, both desmopressin and diclofenac. Pain was assessed using a visual analogue scale (a 10-cm horizontal scale ranging from 'no pain' to 'unbearable pain') at baseline, 10, 20 and 30 min after administering the treatments.

RESULTS

On admission, the pain level was the same in all three groups. At 10 min the pain decreased in all groups to a level that was not significantly different. At 20 min groups B and C had similar mean pain levels (3.7), whereas in group A it was 5.0. At 30 min, groups B and C scored 2-3, and group A 5.6. All three treatments were equally effective at 10 and 20 min but at 30 min there was a stabilization/slight increase in pain level in group A.

CONCLUSIONS

Desmopressin has several advantages, e.g. ease of administration, simplicity of delivery and apparent lack of side-effects, which makes it suitable for ambulatory use. Desmopressin acts rapidly and seems to be effective in both single and combined therapy with diclofenac; it decreases the need for a second treatment and increases the analgesic effect of diclofenac. Some patients responded well to desmopressin, with rapid and complete pain relief. These results indicate that desmopressin may be used to treat renal colic either alone or combined, increasing the analgesic effect of other drugs. More studies are needed to validate and confirm the results; it would also be useful to determine factors that may identify the subgroup of patients who respond quickly and with almost complete pain relief.

The role of laparoscopic surgery in the management of endometrial cancer

OBJECTIVE

To assess the place of laparoscopically assisted vaginal hysterectomy in the treatment of endometrial cancer.

DESIGN

A retrospective uncontrolled case series.

SETTING

Gynaecological Oncology Department, Queen Elizabeth Hospital, Gateshead.

POPULATION

Women with endometrial cancer referred to this centre from August 1992 to August 1997.

MAIN OUTCOME MEASURES

Success of laparoscopically assisted vaginal hysterectomy, operative morbidity, and the length of hospital stay.

RESULTS

Laparoscopically assisted vaginal hysterectomy was successful in 35 of 40 women (88%). Five women required laparotomy. Two women sustained injury to the inferior epigastric vessels. One sustained injury to the small intestine requiring later laparotomy and three women required a blood transfusion. The mean hospital stay was 3 x 3 days (SD 1 x 5). Three women died of the disease within one year of their operation.

CONCLUSION

Laparoscopically assisted vaginal hysterectomy is a feasible treatment for endometrial cancer. It can be performed successfully in high risk population who are medically unfit and overweight. However, a larger randomised study is required to assess the morbidity compared with the traditional open approach.

Preoperative description of severe acetabular defects caused by failed total hip replacement

PURPOSE

The reconstruction of severe acetabular defects, caused by failed hip prostheses, is difficult and complex. Current radiographic descriptions of the defects are inadequate. We sought to more accurately describe remaining bone and improve surgical planning using 3D physical models based on CT data.

METHOD

Nineteen patients (20 hips) with failed total hip replacements and severe acetabular defects were selected. Plain radiography and CT were performed. Solid 3D physical models of each pelvis were constructed using the CT data. Bone loss in structurally important regions was measured from radiographs, models, and intraoperative observation. Comparisons were made of the radiograph-based and model-based bone loss measurements, surgical plans, and interobserver variability.

RESULTS

There was no statistical difference between the model-based measurements and the intraoperative measurements. Radiographs statistically underestimated bone loss by at least 20% (p < 0.01). Interobserver bone loss grading was poor for the radiograph-based measurements (kappa = 0.06) but was substantial for the model-based measurements (kappa = 0.73). In only half the cases was prosthesis type correctly selected based on radiographs. Model-based planning selected the correct prosthesis type in all cases.

CONCLUSION

The physical models were substantially more accurate than radiographs for measuring acetabular defects and for surgical planning.

Chronic administration of NMDA glycine partial agonists induces tolerance in the Porsolt swim test

The Porsolt swim test (PST) was used to assess behavioral effects following acute or chronic treatment with two N-methyl-D-aspartate (NMDA) glycine partial agonists, 1-aminocyclopropanecarboxylic acid (ACPC), and D-cycloserine (DCS). Consistent with previous findings in mice, single intravenous doses of ACPC in rats produced a significant, dose-dependent reduction in immobility in the PST compared to saline. Single dose DCS also elicited significant dose-dependent reductions in PST immobility times. Single-dose ACPC or DCS (200 mg/kg) reduced immobility (p < 0.05) by 26 or 30%, respectively, compared to saline. However, multiple dosing with either ACPC or DCS (6 daily doses, 200 mg/kg) produced an apparent behavioral adaptation, as the immobility data were indistinguishable from chronic saline administration. Moreover, pretreatment with a 5-day course of ACPC or DCS promoted the development of a behavioral cross-tolerance following a sixth dose of DCS or ACPC, respectively. The development of a behavioral tolerance in the PST following chronic therapy of these drugs appears to be a general feature of glycine partial agonists. In toto, these findings support the hypothesis that chronic administration of NMDA glycine partial agonists produces a behavioral tolerance putatively through an adaptation of the NMDA receptor complex.

Immunochemical characterization of type A botulinum neurotoxin in its purified and complexed forms

Immunochemical reactivities of type A botulinum neurotoxin to polyclonal antibodies raised against the neurotoxin complex toxoid have been investigated using enzyme-linked immunosorbent assay (ELISA) and with a fiberoptic immunosensor. The complex contains a group of complexing proteins in addition to the neurotoxin itself. Neurotoxin specific immunoglobulin G (IgG), purified from the IgG raised against the complex using an affinity column, showed a two-fold increase in reactivity with purified neurotoxin compared to the neurotoxin in the complex. Antibodies against the whole complex reacted approximately five times better with the complex than with the neurotoxin, suggesting that the detection of the neurotoxin complex may be more sensitive. Considering the fact that the amount of the complexing proteins and neurotoxin appears to be in a 4:1 ratio, a five-fold higher reactivity could suggest a 25-fold higher detectability of the neurotoxin in the complex. ELISA binding curves of complexing proteins and purified neurotoxin with antibodies raised against the whole complex indicated the complexing proteins to have significantly higher antigenicity. Furthermore, IgG fraction with or without the neurotoxin specific antibodies reacted almost equally to the neurotoxin complex, again suggesting higher immunogenicity of the complexing proteins. Increased binding of the complexing proteins versus the purified neurotoxin to antibodies against the complex and thus immunogenicity was also observed in the binding curves generated using a fiberoptic immunosensor.

Effect of direct control of electroosmosis on peptide and protein separations in capillary electrophoresis

The separations of peptide and protein mixtures in capillary zone electrophoresis (CZE) at various solution conditions were studied with the direct control of electroosmosis. The zeta potential at the aqueous/capillary interface and the resulted electroosmosis in the presence of an electric field were directly controlled by using an additional electric field applied from outside of the capillary. The controlled electroosmotic flow affected the migration time and zone resolution of peptide and protein mixtures. The changes in the magnitude and polarity of the zeta potential caused the various degrees of peptide and protein adsorption onto the capillary through the electrostatic interactions. The separation efficiencies of peptide and protein mixtures were enhanced due to the reduction in peptide and protein adsorption at the capillary wall. The direct manipulations of the separation efficiency and resolution of peptide and protein mixtures in CZE were demonstrated by simply controlling the zeta potential and the electroosmotic flow with the application of an external electric field.

[Renal cell carcinoma and Reiter's syndrome]

A case of a prolonged febrile syndrome in a 41-year old man is presented. A renal tumor and a seronegative spondylitis associated with a Reiter's syndrome were disclosed together. The authors did not find any reference to an eventual relation between these two diseases.