Lipid peroxidation as risk factor for endothelial dysfunction in antiphospholipid syndrome patients

The aim of this study was to evaluate oxidative stress markers and it relations to endothelial damage as risk factor for thrombosis in patients with primary (PAPS) and secondary (SAPS) antiphospholipid syndrome (APS) in correlation to traditional risk factors. Flow-mediated (FMD) and nitroglycerine (NMD)-induced dilation of the brachial artery were studied in 140 APS patients (90 PAPS, 50 SAPS) and 40 controls matched by age, sex, and conventional risk factors for atherosclerosis. Markers of oxidative stress, lipid hydroperoxydes (LOOH), advanced oxidation protein products (AOPP), total sulfhydryl groups (tSHG), and paraoxonase 1 activity (PON1) were determined by spectrophotometric method. Oxidative stress dominates in APS patients. LOOH and AOPP correlate to lipid fractions (p < 0.05), unlike PON1, tSHG that correlated to antiphospholipid antibody positivity (p < 0.05). FMD was lower in APS patients comparing to controls (p < 0.001). Cholesterol is independent variable for FMD impairment in control group (p = 0.011); LOOH in PAPS (p = 0.004); LOOH, aCL, and triglycerides in SAPS patients (p = 0.009, p = 0.049, and p = 0.012, respectively). Combined predictive of aCL and LOOH is better for FMD impairment than LOOH alone in both PAPS and SAPS patients (AUC 0.727, p = 0.001, 95 % CI 0.616-0.837 and AUC 0.824, p˂0.001, 95 % CI 0.690-0.957, respectively). Lipid peroxidation is independent predictor for endothelial dysfunction in APS patients. We demonstrated synergistic effect of aCL and LOOH as risk for endothelial impairment in both PAPS and SAPS patients.

EFFICACY OF METAMITRON IN APPLE THINNING IN SERBIA

The thinning of fruits is a required pomotechnical measure in intensive fruit production which ensures the production of good quality fruits and high yields. Metamitron, known as inhibitor of photosynthesis, has been successfully used in the thinning of apple fruits. This study had the aim to determine the efficacy of metamitron on the thinning of apple fruits in the agroecological conditions of Serbia and to evaluate the possibility of its practical application. Two varieties of apples that are widely grown in Serbia, dared and Golden Delicious, have been chosen for this research. The experiments were carried out during 2011 and 2012 according to the EPPO PP 1/158 (3) method. Metamitron has shown a good efficacy in the thinning of apple fruits. The effect of metamitron on the thinning of apple fruits depends on multiple factors, pri- marily the application dose, time of application, apple variety, but also on the number of fruits developed. The best efficacy on the Idared variety was in plots where metamitron was applied at a dose of 1.1 kg ha⁻¹, once (in the growth stage when the fruits were 8 mm in diameter) or twice (in the growth stages when the fruits were 8 mm and 12 mm in diameter), when the number of developed fruits per tree is smaller, or 1.65 kg ha⁻¹ applied once when the fruits are 12 mm in size when a larger number of fruits per tree is developed. On the Golden Delicious variety, the best efficacy was in treatments when metamitron was applied twice (in the growth stages when the fruits were 8 mm and 12 mm in diameter) in quantities of 1.1 kg ha⁻¹, when less fruits per tree were formed or 1.65 kg ha⁻¹, applied once or twice when a larger number of fruits per tree were formed.

Only particular cytogenetic events are related to disease progression in sequential cytogenetic studies in myelodysplastic syndromes

We performed prospective sequential cytogenetic studies in 76 patients with myelodysplastic syndromes (MDS) followed up to 82 months. Their karyotypes were followed routinely, regardless of clinical status. The incidence of evolutive karyotypes was similar in patients with a normal karyotype at referral and in patients with clonal abnormalities at diagnosis (24.5 and 26.1%, respectively). We did not find association between karyotype evolution and leukemic transformation or reduced survival, since the majority of secondary cytogenetic changes in evolutive karyotypes of our patients were aberrations with good or intermediate prognosis. Therefore, we concluded that only particular cytogenetic events are related to disease progression, while others represent secondary changes of little biologic and prognostic significance.

The impact of mesotrione on several microbiological activity of chernozem soil

The effect of mesotrione on microbiological activity in soil was investigated. Trials were set up in laboratory on chernozem soil (pH 7.0, organic matter 3.5%, sand 26%, silt 45%, clay 29%) at Surcin, Serbia. Mesotrione was added at rates 0.5 (field rate), 5, 25 i 50 mg/kg soil. Untreated soil served as control. Samples were collected for analysis 5, 20, 40 and 60 days after mesotrione application. The effects were assessed on bacteria abundance, fungi abundance, and dehydrogenase activity. Mesotrione was found to cause different effects on the soil microbial activity in soil and its influence depended on the rate of application and duration of activity. Mesotrione applied at 0.5 and 5 mg/kg soil did not have any effect on microbial activity. The higher herbicide doses (25 and 50 mg/kg) induced increasing activity from the 5th to 60th day. These experimental data indicated that mesotrione affected soil microbial activity, but the effects were only detected at higher doses far exceeding the recommended field rate.

Biological and clinical features of non-Hodgkin's lymphoma in the elderly

PURPOSE

The incidence of non-Hodgkin's lymphomas (NHLs) in elderly people has increased in recent years because the world population is getting older. The aim of this study was to compare the biological and clinical features in patients diagnosed with NHLs younger and older than 65 years, and the possible influence of age on the choice of optimal therapeutic approach.

METHODS

We retrospectively evaluated 193 patients with NHLs: 111 (68%) were <65 years and 82 (42%) ≥65 years. The following parameters were analysed: age, gender, clinical stage, International Prognostic Index (IPI), histological type, presence of B symptoms, disease localization, presence of bulky mass, Karnofsky performance status (PS), comorbidities, blood counts, liver and renal function and serum LDH.

RESULTS

Elderly patients had statistically more frequent indolent NHLs (p=0.036), IPI 3 and 4 (p<0.0001), presence of comorbidities (p<0.001), and less frequent presence of bulky disease (p7equals;0.043). Response to therapy was different in the 2 age groups: 29% of patients ≥65 years achieved complete remission (CR) in contrast to 71% of patients <65 years (p<0.001). The most frequent cause of death was disease progression (PD) (86% of younger patients and 71% of elderly patients (p7equals;0.150). Older patients died more frequently because of comorbidities compared younger ones (21 and 107percnt;, respectively; p=0.250), and had more complications of therapy (8.1 and 47percnt;, respectively (p=0.320). Overall survival (OS) was shorter in older patients in all lymphoma types: indolent lymphoma (36 vs. 17 months), aggressive (22 vs. 20 months) and very aggressive (14 vs. 1 months). Multivariate analysis showed that parameters for shorter survival in the elderly were Karnofsky PS <60, increased serum LDH and treatment toxicity.

CONCLUSION

In elderly NHLs patients, treatment response and survival are significantly poorer. Since older patients mostly died of PD, they should be treated with standard regimens and best supportive measures.

Influence of antiphospholipid antibody levels and type on thrombotic manifestations: results from the Serbian National Cohort Study

Repeated thromboses are the most frequent clinical manifestation of antiphospholipid syndrome (APS) in the presence of antiphospholipid antibodies (aPL). The objective of this study was to observe the prevalence and localization of thrombosis, and to investigate the importance of aPL type and level for thrombosis-related events in patients diagnosed with APS. These are the first results of patients enrolled in Serbian National Cohort Study which comprises 256 patients: 162 with primary antiphospholipid syndrome (PAPS) and 94 with APS associated with systemic lupus erythematosus (SLE). aPL analysis included detection of aCL (IgG/IgM), β(2)GPI, and lupus anticoagulant. Thrombosis was diagnosed in 119 (46.5%) patients, with higher prevalence in PAPS compared with SLE patients (51.2% and 38.3%, respectively, p = 0.045). There was similar prevalence of arterial thrombosis in PAPS and SLE groups (34.6% and 34%, respectively, p = 0.932) although venous thrombosis was more frequent in PAPS (25.9% and 8.5%, respectively, p = 0.001). Thrombosis was observed in 92 (55.8%) patients who had more than one type of antibody (category I), in 13 (41.9%) patients with category IIa, in 19 (46.3%) patients with category IIb, and in 73 (44.2%) patients with category IIc (p = 0.10). The patients with thrombosis were older than those without thrombosis (49.8 and 39.8 years, respectively, p = 0.001). Overall, older age was a risk factor for thrombosis. The prevalence of venous thrombosis was higher in the PAPS group, but with lower frequency than in literature data. Any aPL type and level is a risk factor for thrombosis.

Clinical and histopathological study of angiogenesis in multiple myeloma

PURPOSE

Angiogenesis is an essential component in the growth and progression of multiple myeloma (MM). We studied the clinical significance of angiogenesis in patients with MM estimated by precise counting of the number of vessels (i.e. microvessel density, MVD) and compared these results with the results obtained using semi-quantitative grading of angiogenesis.

METHODS

Fifty-nine newly diagnosed cases of MM were analyzed with respect to clinical features, laboratory findings, histological features, angiogenesis parameters, and response to treatment. Bone marrow microvessels were examined using immunohistochemical staining for CD34. Bone marrow angiogenesis was estimated by two different methods. The mean number of vessels per area in each sample was characterized as the MVD. Microvessels were counted manually on light microscopy in 3 hot spots at ×400 magnification. Semiquantitative estimation of angiogenesis was based on visual assessment of slides at ×100 magnification. Each slide was assigned as low, intermediate or high intensity of angiogenesis.

RESULTS

The median MVD was 15 vessels per 3 hot spots (range 1-89). Intensity of angiogenesis was assigned as low in 24 (40.7%) patients, intermediate in 17 (28.8%) and high in 18 (30.5%). Significant correlation between intensity of angiogenesis (estimated using both methods) and histological grade, extent of bone marrow infiltration, proliferative activity of myeloma cells and poor survival was found. Semiquantitatively assessed intensity of angiogenesis additionally correlated with clinical stage. There was a statistically highly significant correlation between MVD and semi-quantitatively estimated intensity of angiogenesis (p <0.001).

CONCLUSION

Tumor-associated angiogenesis is an important prognostic feature in MM and should be routinely done on bone marrow biopsies of these patients. Simple semiquantitative grading of angiogenesis can be recommended for daily practice, as an alternative method for complicated and time-consuming estimation of MVD.

Biological implications of circulating CD34(+) cells in myelodysplastic syndromes

PURPOSE

to evaluate the biological and clinical significance of circulating CD34(+) cells in patients with myelodysplastic syndromes (MDS).

METHODS

the relative count of CD34(+) cells in peripheral blood was evaluated by flow cytometry and the results were recorded on the total number of mononuclear cells (MNCs). CD34(+) status was correlated with the percentage of circulating and bone marrow blasts, cytogenetic studies, CFU-GM colony growth, overall survival and transformation to acute myeloid leukemia (AML).

RESULTS

the number of MNC positive for anti-CD34 monoclonal antibody in the healthy control group ranged from 0.00% to 0.73%. Therefore, the cutoff value for overexpression of CD34 antigen on peripheral blood MNC of MDS patients was ≥ 1% (CD34(+) cases). The mean number of circulating CD34(+) MNCs in 30 MDS patients was significantly higher than in the control group (p=0.009). The proportion of circulating CD34(+) MNCs did not correlate with the blast count in the peripheral blood (r=0.282, p=0.131), neither with the blast count in the bone marrow. In contrast, the proportion of circulating CD34(+) cells in MDS patients was significantly correlated with the proportion of bone marrow CD34(+) cells (r=0.461, p=0.035). The proportion of circulating CD34(+) cells did not correspond to the percentage of blast count in the bone marrow, neither with the presence of cytogenetic abnormalities or abnormal growth of GM-progenitors. The median actuarial survival of 19 patients with elevated proportion of circulating CD34(+) cells was 16 months, as compared to >57 months in 11 patients with CD34(+) cells within normal range (p=0.16). Five patients with elevated proportion of circulating CD34(+) cells progressed to AML, as compared to only one of CD34(-)negative (CD34(-)) cases.

CONCLUSION

the presence of circulating CD34(+) cells is a common finding in MDS, but no significant correlations with clinical and/or biological features of the disease have been found.

Clinical implications of immunophenotypic abnormalities of bone marrow myeloid cell compartment in myelodysplastic syndromes

PURPOSE

to evaluate the biological and clinical implications of immunophenotypic abnormalities of bone marrow myeloid cell compartment in patients with primary myelodysplastic syndromes (MDS).

METHODS

analysis of cell surface antigen profiles was performed by flow cytometric immunophenotyping on bone marrow mononuclear cell (BMMNCs) specimens from 39 adult MDS patients and 5 healthy individuals. Expression of cell surface antigen profiles was correlated with FAB subtype, cytogenetics, CFU-GM colony growth, overall survival (OS) and leukemic transformation (LT).

RESULTS

expression levels of early differentiation and myelo-monocytic antigens (CD38, CD13, CD33, CD14 and CD15) on myeloid cell compartment of BMMCs were significantly higher in MDS patients in comparison to healthy control group, suggesting maturational left shift of bone marrow myeloid cell compartment in MDS. CD34 antigen expression was in a positive linear correlation with HLA-DR antigen expression (r=0.652; p=0.0004), and in negative correlation with the expression of CD11b and CD15 antigens (r=-0.48; p=0.014 and r=-0.564; p=0.0033, respectively). Myeloid antigen ratio (HLA-DR/CD11b) was 2.5 fold higher in patients with MDS in comparison to control group. Patients with advanced disease had significantly higher myeloid antigen ratio than patients with low risk MDS (p<0.05). The type of CFU-GM colony growth and the presence of chromosomal aberrations were unrelated to the proportion of CD34(+) cells and elevated myeloid ratio. Patients with elevated proportion of CD34(+) BMMNCs or elevated myeloid ratio had significantly shorter OS and higher LT rate in comparison to patients whose proportion of CD34(+) BMMNCs and myeloid ratio were within normal range.

CONCLUSION

the presence of abnormalities in antigen expression profiles of bone marrow myeloid cell compartment has clinical implication in MDS, with particular contribution in predicting the patient outcome. Elevated proportion of CD34(+) BMMNCs and elevated myeloid ratio of bone marrow myeloid compartment are useful immunophenotypic tools for estimation of prognosis in this very heterogeneous disorder group.

Acute Panmyelosis with Myelofibrosis: Clinical, Immunophenotypic and Cytogenetic Study of Twelve Cases

The clinical, cytogenetic, and immunophenotypic features in 12 adult patients with acute panmyelosis with myelofibrosis (APMF; ICD-0-3: 9931/3; C42.1) are reported (median age: 57 years; f/m = 1.4). The white cell count (WBC) was normal in 3 patients; 9 had leucopenia. The median hemoglobin value was 64.5 g/l, and median platelet count 12 x 10(9)/l. Bone marrow biopsy showed a hypercellular marrow in 10/12 patients with a significant infiltration of pathological blasts (range: 30 - 60%). All the cases had marked reticulin fibrosis. Immunophenotyping of bone marrow blast cells showed the expression of early (CD34) and lineage-unspecified antigens (HLA-DR) in 6/7, and 7/7 patients, respectively. "Early" myeloid antigens (CD13, CD33) were seen in 6/7 and 4/6 patients respectively. Monocyte antigen (CD14) was expressed in 3/7 patients. Megakaryocyte antigen (CD61) and erythroid cell antigen (GpA) were each expressed in only 1 patient. Two patients had expression of CD34, HLA-DR and "early" myeloid antigens by their bone marrow blast cells and 1 of these also had a co-expression of the antigens from a differentiated monocytic cell proliferation (lysozyme+, CD68+). Nonspecific chromosomal aberrations were recorded in 8/10 patients. The median survival was 2 months. These findings suggest an immature myeloid phenotype of blast cells in APMF. In 6/9 patients a leukemic cell differentiation into monocytic, megakaryocytic or erythroid lineage was also demonstrated.

Plasmacytoma of the lung: an indolent disease resistant to conventional myeloma treatment: report of a case

Solitary lung plasmacytoma is a rare form of plasma cell tumors. The case of a 56-yr-old man is presented, who had a massive tumor of the right pulmonary apex. Percutaneous transthoracic lung biopsy demonstrated a tumor-cell population consisting of mature plasma cells, proplasmacytes, and rare plasmablasts. Immunohistochemically, the cells were CD79a+, kappa+, cyclin D1-, p53-, MDR-. Proliferative index was low (number of Ki-67+ tumor cells was 8%). Serum and urine immunoelectrophoresis did not show the presence of paraprotein. Screening for multiple myeloma with skeletal X-ray survey and bone marrow biopsy were negative. Radiotherapy and chemotherapy with alkylating agents were ineffective. However, the course of the disease is indolent and the patient is well, alive, and with no signs of multiple myeloma >5 yr after the diagnosis was established. Some pathogenetic aspects of tumor resistance to conventional myeloma treatment in this case are discussed.

Immunohistochemical analysis of cyclin D1 and p53 in multiple myeloma: relationship to proliferative activity and prognostic significance

Conflicting data are reported on the clinical significance of cyclin D1 deregulation in multiple myeloma. The aim of this study was to evaluate the incidence and prognostic significance of cyclin D1 expression and p53 mutations in multiple myeloma, as well as the relationship of their expression with selected clinical data, histological features, and proliferative activity of myeloma cells. We analyzed bone marrow biopsy specimens obtained from 59 patients with newly diagnosed multiple myeloma. Expression of cyclin D1 and p53 was analyzed using standard immunohistochemical method of B5-fixed and routinely processed paraffin-embedded bone marrow specimens. Cyclin D1 was overexpressed in 14/59 (27%) and p53 in 5/59 (8.5%) specimens. There was no significant correlation between cyclin D1 overexpression and age, gender, clinical stage (Durie-Salmon classification), extent of osteolytic lesions, type of monoclonal protein, hemoglobin concentration, platelet count, serum concentration of creatinine, calcium, C-reactive protein, and beta2-microglobulin. No association was observed between the expression of cyclin D1 and the extent of bone marrow infiltration, histological grade, proliferative activity index (measured with Ki-67 immunoreactivity) and response to therapy. No significant difference was observed regarding overall survival between cyclin D1 positive and cyclin D1 negative patients (29 vs 36 mo, p = 0.76). Results of this study did not revealed prognostic significance of cyclin D1 overexpression in multiple myeloma. Mutations of p53 gene are rare events in myeloma, suggesting their limited role in the pathogenesis of the disease.

Additional chromosome aberrations in acute promyelocytic leukemia: characteristics and prognostic influence

Patients with acute promyelocytic leukemia (APL) show other chromosome aberrations in addition to t(15;17) but their influence on the clinical outcome is still unclear. We have cytogeneticaly analyzed 43 APL patients with t(15;17)(q22;q21), treated with all-trans-retinoic acid (ATRA) according to the recommendations of the European APL 91 Group. Additional chromosome aberrations were observed in 14/43 patients (33%) studied at initial diagnosis. These patients were designed as 'complex' karyotype group and were compared to patients with t(15;17) asa sole cytogenetic abnormality ('simple' karyotype group). The 'complex' group had significantly lower platelet count and fibrinogen level and fewer cases without significant DIC at diagnosis than the 'simple' group. Comparison of 'simple' and 'complex' groups showed significant difference in complete remission rate (76% vs 35.7%, P = 0.0148) and early death rate (24% vs 64.3%, P = 0.0141). Survival analysis showed that the presence of additional chromosome abnormalities and significant DIC had an adverse effects on prognosis (P = 0.036 and P = 0.041, respectively), independent on other prognostic factors. These data indicate more aggressive biological nature of leukemic cells in patients with additional chromosome aberrations. Supplementary therapeutic strategies may be required for this subgroup of APL patients.

Characterization of CD13 and CD33 surface antigen-negative acute myeloid leukemia

From a cohort of 220 adults with newly diagnosed acute myeloid leukemia (AML), 8 (3.6%) exhibited a rare variant of aberrant membrane phenotype. It was characterized with typical myeloid morphologic and cytochemical patterns and absence of myeloid associated antigens (CD13, CD33, CD14, glycophorin A, CD61). According to the French-American-British criteria, disease in 5 patients was classified as M1 and in 3 patients as M2. CD34, CD38, HLA-DR, and CD45 were strongly expressed in 4 of 5, 3 of 3, 8 of 8, and 3 of 3 analyzed cases, respectively. CD7 antigen was strongly expressed in 4 of 6 patients. Except for predominance of male sex and high frequency of CD7 antigen expression, no other remarkable clinical or biologic characteristics were noted. Detected variant of AML with the unusual membrane phenotype (CD34+, HLA-DR-positive, CD38+, CD45+, CD7+) might represent an example of extreme asynchrony in sequences of morphologic and immunologic maturation or abnormal epitope expression on leukemic cell membrane molecules CD13 and CD33. Although the clinical significance of this AML variant is unclear, the existence of such cases demonstrates the continued need for simultaneous cytochemical and immunologic studies in the evaluation of acute leukemias.

Pure red cell aplasia evolving through the hyperfibrotic myelodysplastic syndrome to the acute myeloid leukemia: some pathogenetic aspects

The authors report a 58-year-old female who originally presented with acquired pure red cell aplasia (PRCA). At diagnosis, the karyotype was normal, the serum erythropoietin level was highly elevated and no T-cell mediated inhibition of erythropoiesis was demonstrated in coculture studies. Conventional immunosuppressive therapy proved ineffective. A year later a diagnosis of hyperfibrotic myelodysplastic syndrome was assessed. The sequential bone marrow examinations in the course of the three years showed a progressive increase in bone marrow fibrosis, erythroid hyperplasia and dysmegakaryocytopoiesis, terminating in the acute myeloid leukemia. This sequence of the events included the appearance of del(5)(q13q33), four years after setting a diagnosis of PRCA. The authors suggest that the absence of both cytogenetic abnormality and the signs of dyshematopoiesis at the diagnosis of PRCA does not exclude ultimately a "clonal" category of the disease. Thus, repeated hematological and cytogenetical reevaluations are recommended.

Severe hypercalcaemia and extensive osteolytic lesions in an adult patient with T cell acute lymphoblastic leukaemia

Hypercalcaemia is a rare feature of acute lymphoblastic leukaemia (ALL) in adults, particularly of the T cell type. We report on a 24-year-old patient with T-ALL, who presented with symptoms of hypercalcaemia (vomitus, acute renal failure), bone pain, extensive osteolytic lesions and normal white cell count without circulating blasts. An increased serum tumor necrosis factor (TNF-alpha) concentration of 35 pg/ml was found; it remained elevated at 52 pg/ml four weeks later, after having achieved haematological remission. Serum concentrations of IL-1beta, IL-6 and IL-2 were within the control range. The pathophysiology of hypercalcaemia in malignancy and possible mediators of bone resorption, in particular TNF-alpha, are discussed.

Familial Myelodysplastic Syndrome/Acute Myeloid Leukaemia With Monosomy 7: Report of a New Kindred

Familial juvenile myeloid disorders are uncommon, but better understanding of their basis may lead to crucial advances in the study of leukemogenesis. We report a family with three siblings who died of myelodysplasia and/or acute myeloid leukemia at the age of 10, 11 and 16 years, respectively. Two children died of a fulminant generalized varicella. No somatic constitutional abnormalities were found and histories of exposure to common environmental or occupational mutagens were unremarkable. One of the two tested patients had monosomy of the chromosome 7 in all examined metaphases. Therefore, the clinical and genetic findings are consistent with the "Familial Monosomy 7". A constitutional pericentric inversion of chromosome 9 (p11q13) was detected in the karyotype of the father and both analyzed siblings. In addition, clustering of breast cancer was observed in maternal relatives. As the mode of inheritance and the molecular basis of this disease remain obscure, we believe that it is important to report new cases and attempt to study them as thoroughly as possible. We discuss possible mechanisms of familial tendency to myeloid malignancies.

Successful treatment of refractory pure red cell aplasia secondary to chronic lymphocytic leukaemia with cyclosporine A: correlation between clinical and in vitro effects

This report presents the case of a patient with PRCA in CLL where in vitro culture studies correlated well with successful CS-A treatment. Before initiating CS-A therapy, coculture studies showed that T-cells from peripheral blood of the patient suppressed the formation of CFU-E and BFU-E colonies by normal bone marrow cells. Normal erythropoiesis reappeared in the bone marrow of the patient 3 weeks after the start of CS-A therapy. At this time, cocultures demonstrated that peripheral blood T-cells no longer inhibited the growth of normal BFU-E, although there was persistent suppression of CFU-E. Six months later the patient was in stable remission from PRCA on maintenance therapy with CS-A. Moreover, cocultures showed no T-cell inhibition of normal BFU-E or CFU-E colony formation. The strong correlation between in vitro culture studies and a beneficial clinical outcome observed in this case suggests that in vitro cultures could be used to monitor CS-A treatment in patients with PRCA in CLL.