Hematopoietic stem cell transplantation does not increase the risk of infection-related complications for pediatric patients with Hodgkin and non-Hodgkin lymphomas: A multicenter nationwide study

BACKGROUND

Hodgkin (HL) and non-Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%-30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second-line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear.

OBJECTIVE

The aim of this population-based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL.

PATIENTS AND METHODS

We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second-line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally.

RESULTS

Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram-positives were predominant. The rate of multidrug-resistant bacteria was high, especially for Gram-negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection-related mortality was comparable for each group.

CONCLUSIONS

The incidence of IC was comparable during first- and second-line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.

Fibrinogen alpha and beta gene polymorphisms in pediatric stroke--case-control and family based study

BACKGROUND/PURPOSE

Data on the role of the -455G > A polymorphism of the gene encoding β fibrinogen subunit (FGB) and the Thr312Ala polymorphism of the gene for the α fibrinogen subunit (FGA) in childhood ischemic stroke are insufficient. Therefore the aim of the study was to evaluate a possible association between these two polymorphisms and arterial ischemic stroke.

METHODS

The study group consisted of 85 children after ischemic stroke, 146 of their parents and 159 controls. Both polymorphisms were genotyped using the restriction fragment length polymorphism method. Two study designs were used: a case-control model and a family-based transmission-disequilibrium test. Statistica 7.1 and EpiInfo 6 softwares were used in all analyses.

RESULTS

In the TDT test, a tendency to a higher transmission of the 312Ala allele of the FGA gene and the -455A allele of the FGB gene was observed, however, it was statistically non-significant. The frequencies of alleles and genotypes of both FGA and FGB genes polymorphisms did not differentiate children from both groups also in the case-control model. Additive or synergistic effects between FGA and FGB genes polymorphisms were not observed.

CONCLUSION

An analysis of the results obtained in this study and a critical review of previously published data indicate that examined gene polymorphisms are not related to ischemic stroke in children.

Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence

BACKGROUND

Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnostic investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assessments and persistent neurologic symptoms.

METHODS

143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years.

RESULTS

All 143 patients had normal initial examinations, brain MRI scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervical cord, n = 126; 88.1%; thoracic cord, n = 58; 40.6%). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1%), somatosensory evoked potentials, SSEP (4.9%), and brainstem auditory evoked potentials, BAEP (2.8%). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1%) and spinal cord imaging (cervical cord n = 57; 52.3%; thoracic cord n = 32; 29.4%) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS.

CONCLUSIONS

PATIENTS

and clinicians may be reassured that persistent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.

Selectin glycoprotein ligands

Lectin selectins and their counter-receptors participate in discontinuous cell-cell interactions concurrent with leukocyte tethering and rolling on endothelium, which, in consequence, leads to leukocyte penetration to lymphatic organs and generation of inflammation sites. Counter-receptors are glycoproteins in which carbohydrate units, the direct selectin ligands, are built into the polypeptide framework. In this review, the distribution, structure and function of the main ligands and counter-receptors for P-, L- and E-selectins known so far, have been discussed. The common biosynthetic pathway of sialyl-Lewis x and sulpho-sialyl-Lewis x determinants of selectin ligands has been described.

Selectin glycoprotein ligands

Lectin selectins and their counter-receptors participate in discontinuous cell-cell interactions concurrent with leukocyte tethering and rolling on endothelium, which, in consequence, leads to leukocyte penetration to lymphatic organs and generation of inflammation sites. Counter-receptors are glycoproteins in which carbohydrate units, the direct selectin ligands, are built into the polypeptide framework. In this review, the distribution, structure and function of the main ligands and counter-receptors for P-, L- and E-selectins known so far, have been discussed. The common biosynthetic pathway of sialyl-Lewis x and sulpho-sialyl-Lewis x determinants of selectin ligands has been described.

In vitro effects of ethanolamine on insulin secretion

The effects of ethanolamine on insulin secretion by the perfused rat pancreas were examined. During the second phase of glucose-induced insulin secretion 5-minute perfusions of ethanolamine at final concentrations of 0.1, 1 and 10 mM inhibited insulin release in a dose-related manner. When given throughout the experiment the highest dose of ethanolamine markedly suppressed both phases of glucose-induced insulin release. The inhibitory effect of ethanolamine was blunted in the presence of phentolamine. It is concluded that ethanolamine inhibits glucose-induced insulin secretion by the perfused rat pancreas and that alpha-adrenergic receptors play a role in its actions on insulin output.

Anxiety and self-concept of learning disabled children

This study compares anxiety and self-concept among learning disabled children and their nondisabled peers. On—hundred learning disabled (LD) and 118 nondisabled children participated in the study which demonstrated significantly higher anxiety and lower self-concept in the first group. The differences emphasized the self-dissatisfaction of the LD group and their pawning related anxiety. Therapeutic implications of the results are discussed.

Contradictory Or Complementary? Reassessment Of Two Competing Theories Of The Structure Of Attitudes

The theories of Kerlinger and Eysenck on the nature of the dimensions underlying social attitudes are discussed. Integrating principles from both theories, an alternative approach to the issue is suggested and tested on the domain of attitudes towards education in relation to personality. The results of a multivariate analysis support Kerlinger's concept of the duality (vs. bipolarity) of the attitudinal domain, as well as Eysenck's theory about the reflection of personality on attitudes.

The Common Space of Personality Traits and Vocational Interests

Investigated relationships between personality traits and vocational interests. Cattell's (Research and Consultations Center of Educational Personnel, 1976) CAQ Part I and the Ramak interest inventory (Meir, 1975) based upon Roe's (1956) occupational classification system were administered to a sample of 397 university applicants. Canonical Correlation Analysis and Smallest Space Analysis were used to test two hypotheses (a) relationships exist between personality traits and vocational interests; and (b) personality traits which characterize occupational profiles are arranged in circular order corresponding to the configuration Of the vocational fields which represent those occupations. Both hypotheses were supported by the data.

Dimensions of Jewish-American identity

The main problem posed in this study is: What are the content and structure of Jewish and American identity? The Jewish-American Identity Scale, which was adapted and refined for this study, was administered in 1971 to four samples, totaling 1006 Jewish-American college students from various parts of the United States. Initially, factor analysis was applied to the separate samples. Intersample comparisons of factor structures indicated a high degree of congruency; consequently, the samples were combined for subsequent analyses. Factor analysis of the test scores demonstrated that most of the common factor variance was appropriated by two relatively orthogonal factors. Items dealing with American identity and those dealing with Jewish identity had medium to high loadings on the two respective factors. These findings supported the hypothesis of the duality and the orthogonality of dimensions of Jewish and American identity, and cast doubt on the notion forwarded by some researchers that Jewish-American identity forms a bipolar continuum.