Prognostic impact of pretreatment cell-free DNA concentration in newly diagnosed peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs) have a poor prognosis and, to date, there are no reliable predictive biomarkers of response. In this work we explored the prognostic impact of cell-free DNA (cfDNA) concentration in 75 newly diagnosed patients enrolled in a prospective multicenter study. Pre-treatment cfDNA was strongly associated with clinical risk factors and was identified as a superior predictor for shorter progression-free survival in multivariable analysis, outweighing canonical risk parameters. Furthermore, we identified a cfDNA value above which survival worsens. In conclusion, pre-treatment cfDNA concentration represents an easily usable predictive biomarker that is highly associated with survival of PTCL patients.

Kounis syndrome: an underestimated emergency

Summary

Background. Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the patients with diagnosis of anaphylaxis, we described clinical features, cardiological and allergological outcomes of patients evaluated in our allergy outpatient clinic. Methods. A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents. Results. We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to Hymenoptera stings, 5/9 to drugs). Conclusions. The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.

Expanding the product portfolio of carbon dioxide and hydrogen-based gas fermentation with an evolved strain of Clostridium carboxidivorans

CO2:H2-based gas fermentation with acetogenic Clostridium species are at an early stage of development. This work exploited the Adaptive Laboratory Evolution technique to improve the growth of C. carboxidivorans P7 on CO2 and H2. An adapted strain with decreased growth lag phase and improved biomass production was obtained. Genomic analysis revealed a conserved frameshift mutation in the catalytic subunit of the hexameric hydrogenase gene. The resulted truncated protein variant, most likely lacking its functionality, suggests that other hydrogenases might be more efficient for H2-based growth of this strain. Furthermore, the adapted strain generated hexanol as primary fermentation product. For the first time, hexanol was produced directly from CO2:H2 blend, achieving the highest maximum productivity reported so far via gas fermentation. Traces of valerate, pentanol, eptanol and octanol were observed in the fermentation broth. The adapted strain shows promising to enrich the product spectrum targetable by future gas fermentation processes.

Distinguishable DNA methylation defines a cardiac-specific epigenetic clock

BACKGROUND

The present study investigates whether epigenetic differences emerge in the heart of patients undergoing cardiac surgery for an aortic valvular replacement (AVR) or coronary artery bypass graft (CABG). An algorithm is also established to determine how the pathophysiological condition might influence the human biological cardiac age.

RESULTS

Blood samples and cardiac auricles were collected from patients who underwent cardiac procedures: 94 AVR and 289 CABG. The CpGs from three independent blood-derived biological clocks were selected to design a new blood- and the first cardiac-specific clocks. Specifically, 31 CpGs from six age-related genes, ELOVL2, EDARADD, ITGA2B, ASPA, PDE4C, and FHL2, were used to construct the tissue-tailored clocks. The best-fitting variables were combined to define new cardiac- and blood-tailored clocks validated through neural network analysis and elastic regression. In addition, telomere length (TL) was measured by qPCR. These new methods revealed a similarity between chronological and biological age in the blood and heart; the average TL was significantly higher in the heart than in the blood. In addition, the cardiac clock discriminated well between AVR and CABG and was sensitive to cardiovascular risk factors such as obesity and smoking. Moreover, the cardiac-specific clock identified an AVR patient's subgroup whose accelerated bioage correlated with the altered ventricular parameters, including left ventricular diastolic and systolic volume.

CONCLUSION

This study reports on applying a method to evaluate the cardiac biological age revealing epigenetic features that separate subgroups of AVR and CABG.

Improved Measurement of Solar Neutrinos from the Carbon-Nitrogen-Oxygen Cycle by Borexino and Its Implications for the Standard Solar Model

We present an improved measurement of the carbon-nitrogen-oxygen (CNO) solar neutrino interaction rate at Earth obtained with the complete Borexino Phase-III dataset. The measured rate, R_{CNO}=6.7_{-0.8}^{+2.0}  counts/(day×100  tonnes), allows us to exclude the absence of the CNO signal with about 7σ C.L. The correspondent CNO neutrino flux is 6.6_{-0.9}^{+2.0}×10^{8}  cm^{-2} s^{-1}, taking into account the neutrino flavor conversion. We use the new CNO measurement to evaluate the C and N abundances in the Sun with respect to the H abundance for the first time with solar neutrinos. Our result of N_{CN}=(5.78_{-1.00}^{+1.86})×10^{-4} displays a ∼2σ tension with the "low-metallicity" spectroscopic photospheric measurements. Furthermore, our result used together with the ^{7}Be and ^{8}B solar neutrino fluxes, also measured by Borexino, permits us to disfavor at 3.1σ C.L. the "low-metallicity" standard solar model B16-AGSS09met as an alternative to the "high-metallicity" standard solar model B16-GS98.

First Directional Measurement of Sub-MeV Solar Neutrinos with Borexino

We report the measurement of sub-MeV solar neutrinos through the use of their associated Cherenkov radiation, performed with the Borexino detector at the Laboratori Nazionali del Gran Sasso. The measurement is achieved using a novel technique that correlates individual photon hits of events to the known position of the Sun. In an energy window between 0.54 to 0.74 MeV, selected using the dominant scintillation light, we have measured 10 887_{-2103}^{+2386}(stat)±947(syst) (68% confidence interval) solar neutrinos out of 19 904 total events. This corresponds to a ^{7}Be neutrino interaction rate of 51.6_{-12.5}^{+13.9}  counts/(day·100  ton), which is in agreement with the standard solar model predictions and the previous spectroscopic results of Borexino. The no-neutrino hypothesis can be excluded with >5σ confidence level. For the first time, we have demonstrated the possibility of utilizing the directional Cherenkov information for sub-MeV solar neutrinos, in a large-scale, high light yield liquid scintillator detector. This measurement provides an experimental proof of principle for future hybrid event reconstruction using both Cherenkov and scintillation signatures simultaneously.

Production and persistence of specific antibodies in COVID-19 patients with hematologic malignancies: role of rituximab

The ability of patients with hematologic malignancies (HM) to develop an effective humoral immune response after COVID-19 is unknown. A prospective study was performed to monitor the immune response to SARS-CoV-2 of patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), chronic lymphoproliferative disorders (CLD), multiple myeloma (MM), or myelodysplastic/myeloproliferative syndromes (MDS/MPN). Antibody (Ab) levels to the SARS-CoV-2 nucleocapsid (N) and spike (S) protein were measured at +1, +3, +6 months after nasal swabs became PCR-negative. Forty-five patients (9 FL, 8 DLBCL, 8 CLD, 10 MM, 10 MDS/MPS) and 18 controls were studied. Mean anti-N and anti-S-Ab levels were similar between HM patients and controls, and shared the same behavior, with anti-N Ab levels declining at +6 months and anti-S-Ab remaining stable. Seroconversion rates were lower in HM patients than in controls. In lymphoma patients mean Ab levels and seroconversion rates were lower than in other HM patients, primarily because all nine patients who had received rituximab within 6 months before COVID-19 failed to produce anti-N and anti-S-Ab. Only one patient requiring hematological treatment after COVID-19 lost seropositivity after 6 months. No reinfections were observed. These results may inform vaccination policies and clinical management of HM patients.

Survival in HIV-infected patients with lymphoma according to the choice of antiretroviral treatment: an observational multicentre study

OBJECTIVES

Lymphoproliferative disorders are often observed in HIV-positive patients. Combination antiretroviral treatment (cART) during antineoplastic chemotherapy is beneficial, but little is known about the clinical outcome according to different antiretroviral combinations. The aim of the study was to address this gap in current knowledge.

METHODS

A retrospective study was conducted in five large Italian centres for the period from 1998 to 2015; HIV-positive patients diagnosed with lymphoma were included and demographic, clinical and therapeutic variables were recorded and associated with clinical outcomes. Bivariate and multivariate analyses were performed, including Cox proportional hazard models for survival.

RESULTS

A total of 399 patients were included in the study. The most common types of lymphoma were diffuse large B-cell lymphoma (DLCLB; n = 164), Hodgkin lymphoma (HL; n = 99) and Burkitt lymphoma (BL; n = 57), followed by plasmablastic lymphoma (PBL; n = 38), T-cell lymphoma (TCL; n = 17), indolent lymphoma (n = 10) and other less common types (n = 14). cART was given to 327 (out of 387 evaluable) patients: in 216 subjects it was protease inhibitor (PI)-based, in 73 it was nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and in 18 it was integrase strand transfer inhibitor (INSTI)-based (the remaining 20 individuals received other regimens). The 5-year overall survival was 57.5% (52.8% for DLCLB, 67.8% for HL, 42.3% for BL, 60.6% for PBL and 64.7% for TCL). PI-based ART compared with other compounds was associated with worse survival in non-Hodgkin lymphoma (NHL) and HL patients combined (P ≤ 0.001) and in NHL patients alone (P < 0.001); grade 3-4 haematological toxicities were more commonly observed in PI-treated individuals. Lymphoma diagnosis in recent years, better immunovirological status, lower lymphoma stage and better prognostic indexes were associated with better survival.

CONCLUSIONS

PI-based cART while on chemotherapy was associated with worse overall survival and more frequent haematological complications in HIV-positive patients with lymphoma.

Researches about Knowledge of Self-Examination and some Problems about Breast Cancer

A research on the degree of knowledge about the problem of breast self-examination was carried out in a group of 500 women in the Out-patients Department of the Cancer Institute in Milan.

The women were given a questionnaire to fill up at home and to return at the moment of the medical examination.

The analysis of data showed that, though the level of education of the subjects was fairly good, the knowledge and the practise of the periodical self-examination as a method for an early diagnosis was very low. 70% of the women declared to have some knowledge about the method, but only 9% declared to practise it regularly.

Usefulness of Breast Self-Examination for an Early Detection of Breast Cancer. Results of a Study on 500 Breast Cancer Patients and 652 Controls

The knowledge and practice of breast self-examination (BSE) was investigated among 500 women with operable breast tumors between 35 and 64 years of age (all successively operated) and 652 healthy women, matched with the previous group for 5-year age groups from 35 to 54 years. Only 39.9 % of breast cancer women and 34.5 % of the controls practiced BSE, and only a third of these did it monthly. Such practice tends to progressively decrease, starting from 45 years, and it is used less frequently by the women with a poor education and those in a lower economic bracket. Among the 500 breast cancer patients, those who practiced the self-examination had a higher number of tumors with a diameter no greater than 2 cm and a lower number with a diameter larger than 4 cm. In addition, in this group the percentage of unaffected axillary lymph nodes (N–) was 58.8 % compared to 48.8 % for the group that did not practice self-examination, and the percentage of the cases with more than 3 metastatic lymph nodes (N+ > 3) was 20.0 % in the first group and 27.3 % of the second one. These differences are statistically significant. The correlation between tumor diameter and the histologic lymph node stage is equally evident, since there is a progressive reduction in N– cases and a contemporary progressive increase in N+ (> 3) cases with increasing breast tumor diameter. Therefore, we can infer that the lack of practice of BSE causes a diagnostic and therapeutic delay, which is responsible for aggravation of the prognosis.

An Analysis of 800 Breast Cancer Patients Relapsed after Radical Mastectomy

The chronology of first recurrences, their topographic distribution and survival from mastectomy were retrospectively studied in a series of 800 mastectomized women with special reference to the relationship between these data and treatment delay, T N categories and free interval. Visceral metastases were more frequent in patients under 50 years, whereas local recurrences were more common in patients over 50. The average free interval was 26 months (over 5 years in 18% of cases) and seemed to be influenced little by the treament delay or by tumor size; it was shorter in patients under 50 years and shorter still in patients with lymph node involvement at operation. A similar correlation exists between these parameters and survival. The 5 year survival rate of the 800 cases with recurrence was 52%, which is quite different from the rate generally indicated for surgical cases, and much higher than the rate for the natural history of untreated breast cancer. The survival rate in cases with first metastases confined to the soft tissues is much higher than in those with bone and/or with visceral metastases. The survival after recurrence proves to be significantly influenced by the length of the free interval, but much more by the presence or absence of regional lymph node involvement, so that the lymph nodes status (N–- or N+) turns out to be a prognostic item of primary importance, even after the onset of recurrence.

A Case of Postmastectomy Lymphangiosarcoma

A case of postmastectomy lymphangiosarcoma of the arm, arising 13 years after the operation, is described. A singular character of the case was the absence of lymphedema in the affected arm.

Description and Trial of a Clinical Diagnostic Index for the early Diagnosis of Mammary Carcinoma

A method of clinical investigation has been developed for the early diagnosis of mammary carcinoma based on the scoring of 10 Symptomatologie features of mammary nodules of doubtful malignancy. These features are: variations in size, consistency, form, surface, limits, mobility, protrusion, pain on pressure, presence and nature of secretion from the nipple, nature of axillary lymph nodes. Each feature is scored +2, + 1, 0, −1 or −2 according to whether it points to a malignant, doubtful or benign lesion, +2 and −2 indicating a more definite degree one way or the other. The number emerging from the algebric sum of the ten scores is rated as the complex score or clinical diagnostic index. The validity of the method was tested in 93 cases of clinically doubtful mammary nodules later subjected to histologic examination. The method yielded the right answer in 91 % (compared with 80 % for mammography) and false negatives in 2.2 % (compared with 15 %) of the 46 cases of mammary carcinoma. It yielded the right answer in 48.9 % (compared with 42.5 % for mammography) and 34 % false positives (same percentage as for mammography) of the 47 benign lesions. Thermography, used in about four-fifths of the cases, showed a much lower success rate. The combined outcome of clinical diagnostic index and mammography made it possible to avoid the preliminary classification of carcinomas as benign lesions. It was therefore concluded that the method is useful in uncertain mammary nodules, though the results of a larger trial, now in progress, must be awaited before expressing a definite verdict.

Further Trial of Clinical Diagnostic Index for the Malignancy Diagnosis of Mammary Nodules

The results of a further trial of a clinical diagnostic index (CDI) for ill-defined mammary nodules, based on the algebrical results of positive numerical values (for a suspect feature), or negative numerical values (for non suspect feature), attributed to 10 characteristic semeiological features, previously described, are reported. 222 nodules were clinically examined, all subsequently subjected to mammography and 188 of them to ther-mograpy; they were then operated and examined histologically. Of 106 malignant nodules the accuracy of the CDI was 88.6 % with 4.7 % false negatives; for mammography 65 % with 21.7 % false negatives; for termography (out of 87 cases) 66.6 with 23 % false negatives. The accuracy in 116 benign nodules was 45.6 % for the CDI, 32.7 % for mammography and 29.7 % for termography (out of 101 cases). In three cases of malignant nodules in women below 35 years of age, all three examinations gave negative results. The relations between the diagnostic errors of the three examinations, as well as the dimensions and histo-type of the nodules are also considered. It may be concluded, that the CDI is a simple rapid and highly accurate clinical investigation for early diagnosis of mammary carcinoma.

Recent Borexino results and perspectives of the SOX measurement

Borexino is a liquid scintillator detector sited underground in the Laboratori Nazionali del Gran Sasso (Italy). Its physics program, until the end of this year, is focussed on the study of solar neutrinos, in particular from the Beryllium, pp, pep and CNO fusion reactions. Knowing the reaction chains in the sun provides insights towards physics disciplines such as astrophysics (star physics, star formation, etc.), astroparticle and particle physics. Phase II started in 2011 and its aim is to improve the phase I results, in particular the measurements of the neutrino fluxes from the pep and CNO processes. By the end of this year, data taking from the sun will be over and a new project is scheduled to launch: Short distance Oscillation with boreXino (SOX), which uses a Cerium source for neutrinos (100÷150 kCi of activity) and aims to confirm or rule out the presence of sterile neutrinos. This particle is hypothesised to justify the reactor, Gallium and LSND anomalies found and can reject extensions to the standard model. The work presented is a summary of the solar neutrino results achieved so far, which lead not only to a precise study of the processes in the sun, but also to more Standard Model oriented measurements (such as the stability of the charge, i.e. the life time of the electron). Furthermore, the perspectives of the SOX program are discussed showing the experiment sensitivity to a fourth neutrino state covering almost entirely 3σ of the preferred region of the anomalous neutrino experiments, and additional applications of the detector such as the study of geo-neutrinos.