Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry

Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5-0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2-2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1-3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13-2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18-0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.

Sensitivity enhancement by multiple-contact cross-polarization under magic-angle spinning

Multiple-contact cross-polarization (MC-CP) is applied to powder samples of ferrocene and l-alanine under magic-angle spinning (MAS) conditions. The method is described analytically through the density matrix formalism. The combination of a two-step memory function approach and the Anderson-Weiss approximation is found to be particularly useful to derive approximate analytical solutions for single-contact Hartmann-Hahn CP (HHCP) and MC-CP dynamics under MAS. We show that the MC-CP sequence requiring no pulse-shape optimization yields higher polarizations at short contact times than optimized adiabatic passage through the HH condition CP (APHH-CP) when the MAS frequency is comparable to the heteronuclear dipolar coupling, i.e., when APHH-CP through a single sideband matching condition is impossible or difficult to perform. It is also shown that the MC-CP sideband HH conditions are generally much broader than for single-contact HHCP and that efficient polarization transfer at the centerband HH condition can be reintroduced by rotor-asynchronous multiple equilibrations-re-equilibrations with the proton spin bath. Boundary conditions for the successful use of the MC-CP experiment when relying on spin-lattice relaxation for repolarization are also examined.

Does decentralisation of tuberculosis care influence treatment outcomes? The case of Oromia Region, Ethiopia

SETTING

Oromia Region, Ethiopia.

OBJECTIVE

To investigate the effect of decentralised care on anti-tuberculosis treatment outcomes and identify factors affecting outcome among new smear-positive tuberculosis (TB) patients.

DESIGN

This was a retrospective cohort study comparing patients treated in the community during the continuation phase with those managed throughout treatment in health facilities. Data were collected from TB registers and patient cards using a pre-tested data capture form.

RESULTS

Of the 2226 new smear-positive TB patients registered from July 2010 to June 2012 who were included in the study, 1599 (72.6%) received treatment in health facilities, and the rest in the community. Overall treatment success was 94.7%. Patients treated in the community had comparable treatment success with those managed in health facilities (aOR 1.7, 95%CI 0.80-3.57). Missing doses (OR 0.22, 95%CI 0.08-0.55), supervision during the continuation phase (OR 2.6, 95%CI 1.34-5.05), positive sputum at month 2 (OR 0.07, 95%CI 0.04-0.13) and human immunodeficiency virus infection (OR 0.25, 95%CI 0.13-0.46) were independent predictors of treatment success.

CONCLUSION

Overall treatment success is high in new smear-positive TB patients in Oromia. Patients receiving treatment in the community during the continuation phase have treatment success comparable with that of patients managed in health facilities.

[Locoregional deformation pattern of the patellar cartilage after different loading types - high-resolution 3D-MRI volumetry at 3 T in-vivo]

PURPOSE

To analyze locoregional deformation patterns indicative of contact areas in patellar cartilage after different loading exercises.

MATERIALS AND METHODS

7 healthy patellae were examined in-vivo before and immediately after standardized loading (kneeling, squatting or knee bends) and after 90 minutes of rest using a sagittal 3D-T1-w FLASH WE sequence (22 msec/ 9.8 msec/ 15°/ 0.3 × 0.3 × 1.5 mm³) at 3 T. After cartilage segmentation and 3D reconstruction, voxel-based and global precision errors (PR) were calculated. The former were used to determine significant differences in local cartilage thickness. Voxel-based 2σ-thickness difference maps were calculated to visualize locoregional deformation patterns. Global changes in volume (Vol), mean thickness (mTh) and cartilage-bone-interface area (CBIA) were calculated.

RESULTS

The voxel-based PR depended on cartilage thickness (D) ranging from 0.12 - 0.35 mm. For D ≥ 1 mm the RF was < 0.31 mm (< voxel size), and for D ≥ 2 mm, the RF was < 0.22 mm. The global PR was 83 mm³ (2.4 %) for Vol, 0.06 mm (2.0 %) for mTh and 16 mm² (1.4 %) for CBIA. The focal cartilage deformation equaled 14 % of the local thickness reduction. The deformation areas were oval and located in the peripheral medial (more vertically oriented, all exercises) and caudo-lateral (more horizontally oriented, kneeling and knee bends) aspects of the patella and were least pronounced in knee bends. Significant changes for Vol/mTh ranged from 2.1 to 3.7 %.

CONCLUSION

This MRI-based study is the first to identify in-vivo voxel-based patellar cartilage deformation patterns indicating contact and loading zones after kneeling and squatting. These zones are anatomically and functionally plausible and may represent areas where stress induced degeneration and subsequent OA can originate. The data may facilitate understanding of individual knee loading properties and help to improve and validate biomechanical models for the knee.

[Plasma concentrations of beta-endorphins in the children of alcoholic patients]

BACKGROUND

Of the factors identified in different studies as the possible causes of alcoholism, heredity appears to be the most important. However, environmental factors can increase or decrease the risk of an individual developing alcohol dependence.

METHOD

To clarify the possible influence of heredity on alcoholism, we studied the plasma concentration of beta-endorphins in 25 families with alcoholic members: 27 children whose father was alcoholic and 7 whose father and mother were both alcoholics. The results were compared with finding in an age-matched control group of no-drinking adults and normal children in non-drinking families.

RESULTS

The children of alcoholic parents had significantly lower beta-endorphin levels (p < 0.001) than control individuals, and concentrations were especially low when both parents were alcoholics.

CONCLUSION

We conclude that plasma beta-endorphin concentration may have predictive value in identifying persons likely to become alcoholics.

Evidence of secondary structure by high-resolution magic angle spinning NMR spectroscopy of a bioactive peptide bound to different solid supports

The structure of the 19-amino acid peptide epitope, corresponding to the 141-159 sequence of capsid viral protein VP1 of foot-and-mouth disease virus (FMDV), bound to three different resins, namely, polystyrene-MBHA, PEGA, and POEPOP, has been determined by high-resolution magic angle spinning (HRMAS) NMR spectroscopy. A combination of homonuclear and heteronuclear bidimensional experiments was used for the complete peptide resonance assignment and the qualitative characterization of the peptide folding. The influence of the chemicophysical nature of the different polymers on the secondary structure of the covalently attached FMDV peptide was studied in detail. In the case of polystyrene-MBHA and polyacrylamide-PEGA resins, the analysis of the 2D spectra was hampered by missing signals and extensive overlaps, and only a propensity toward a peptide secondary structure could be derived from the assigned NOE correlations. When the FMDV peptide was linked to the polyoxyethylene-based POEPOP resin, it was found to adopt in dimethylformamide a helical conformation encompassing the C-terminal domain from residues 152 to 159. This conformation is very close to that of the free peptide previously analyzed in 2,2,2-trifluoroethanol. Our study clearly demonstrates that a regular helical structure can be adopted by a resin-bound bioactive peptide. Moreover, a change in the folding was observed when the same peptide-POEPOP conjugate was swollen in aqueous solution, displaying the same conformational features as the free peptide in water. The possibility of studying solid-supported ordered secondary structures by the HRMAS NMR technique in a wide range of solvents can be extended either to other biologically relevant peptides and proteins or to new synthetic oligomers.

Multistep synthesis of 2,5-diketopiperazines on different solid supports monitored by high resolution magic angle spinning NMR spectroscopy

The solid-phase synthesis of 2,5-diketopiperazines containing the trans-4-hydroxy-L-proline amino acid residue (Hyp) was performed on Ellman polystyrene, polyoxyethylene-polyoxypropylene (POEPOP), polystyrene-polyoxyethylene NovaSyn, and Wang resins, respectively. The reaction pathway allowed the introduction of different functional groups around the bicyclic scaffold in a combinatorial approach, and it generated mixtures of isomers. A detailed characterization of the single reaction steps by high resolution magic angle spinning (HRMAS) NMR spectroscopy was performed. The NMR spectral resolution of the resin-bound intermediates and final products was greatly influenced by the polymer matrix. The POEPOP resin permitted to obtain HRMAS NMR spectra with a resolution comparable with that of the spectra of the molecules in solution. Moreover, configurational and conformational isomers formed during the solid-phase reaction steps could be detected and easily assigned. Therefore, the combination of the HRMAS NMR technique with the use of nonaromatic resins may become an extremely powerful tool in solid-phase organic synthesis. This approach will allow the monitoring of multistep reactions and the conception of on-bead structural studies either on small molecules or on natural and/or synthetic oligomers.

Highly efficient, enantioselective synthesis of (+)-grandisol from a C2-symmetric bis(alpha,beta-butenolide)

[reaction: see text] A new, very efficient, enantioselective synthesis of the sexual attracting insect pheromone (+)-grandisol has been developed, in which the key step is the double [2 + 2] photocycloaddition of ethylene to a bis(alpha,beta-butenolide) readily available from D-mannitol. The C2 symmetry of the substrate and the appropriate protection of the central diol unit are the crucial features for the high diastereofacial discrimination during the cycloaddition process.

Theoretical study of two-dimensional COSY experiments for S = 7/2 spins: application to (59)Co in the tetrahedral cluster HFeCo(3)(CO)(11)PPh(2)H

The first investigation and analysis of (59)Co 2D NMR homonuclear chemical shift correlation spectra are reported for the tetrahedral mixed-metal cluster HFeCo(3)(CO)(11)PPh(2)H. For this cluster in solution, the (59)Co 2D COSY and DQF COSY NMR spectra prove the existence of a scalar coupling between (59)Co nuclei. In order to obtain a value of this coupling, the 2D COSY and DQF COSY NMR spectra for a three-spin 7/2 AX(2) system have been simulated by numerical density matrix calculations. The comparison between experimental and theoretical 2D NMR spectra gives a spin-coupling constant |(1)J((59)Co - (59)Co)| = (115 +/- 20) Hz for this cluster. Experimental measurements of T(1) and of the line widths for cobalt 59 as well as theoretical (59)Co 1D NMR spectra are reported and support our findings.

19F/29Si distance determination in fluoride-containing octadecasil by Hartmann-Hahn cross-polarization under fast magic-angle spinning

19F/29Si Hartmann-Hahn continuous wave cross-polarization (CP) has been applied under fast magic-angle spinning (MAS) to a powder sample of octadecasil. Strong oscillations occur during CP on a sideband matching condition between the isolated 29Si-19F spin pairs formed by the silicons in the D4R units and the fluoride anions. The magnitude of the dipolar coupling constant was deduced directly from the line-splitting between the intense singularities of the Pake-like patterns obtained by Fourier transformation of the oscillatory polarization transfer. The corresponding Si-F internuclear distance, r = 2.62 +/- 0.05 A, is found to be in very good agreement with the X-ray crystal structure and the value of 2.69 +/- 0.04 A recently reported from rotational echo double resonance (REDOR) and transferred echo double resonance (TEDOR) nuclear magnetic resonance (NMR) experiments. Furthermore, the CP technique is still reliable under fast MAS where both REDOR and TEDOR sequences suffer from severe artefacts due to finite pulse lengths. In octadecasil, a spinning frequency of approximately 14 kHz is shown to be necessary for an effective suppression of 19F-19F spin diffusion. The influences of experimental missettings and radiofrequency (RF) field inhomogeneity are taken into account.

Origin of the residual NMR linewidth of a peptide bound to a resin under magic angle spinning

The tetrapeptide Ala-lle-Gly-Met bound to a Wang resin via the methionine residue was studied by NMR under MAS conditions and compared to the same peptide in solution. The bound peptide exhibits average linewidths superior to those observed for the peptide in solution. The origin of the residual NMR linewidth observed for the bound form was investigated. The dynamics of the peptide is shown to be only marginally responsible for the increased linewidth; the major cause of the line broadening appears to be nonaveraged magnetic susceptibility differences.

Application of rotor-synchronized amplitude-modulated cross-polarization in a 13C-1H spin pair under fast magic-angle spinning

Rotor-synchronized amplitude-modulated Hartmann-Hahn cross-polarization has been applied under fast magic-angle spinning to a powder sample of ferrocene. The influence on the cross-polarization process of the heteronuclear double quantum (flop-flop) transitions induced by the amplitude modulation for low ratios of the radiofrequency-field strength to the spinning speed is studied in details. The experimental data are in good agreement with theoretical calculations for a two-spin <SGMLEXP TYPE="INLINE">12 system, although the intensity of the double quantum transitions is observed to be significantly smaller than expected. Moreover, it is shown that an efficient polarization transfer at the Hartmann-Hahn centerband matching condition as well as a broadening of the matching conditions is obtained by an appropriate partial scaling of the effective radiofrequency fields which minimizes the destructive effect of double quantum cross-polarization. Copyright 1998 Academic Press.

Differential Line Broadening in the Presence of Quadrupolar-CSA Interference

The formalism for calculating the lineshape of a spin 1/2 J-coupled to a high-spin nucleus undergoing quadrupolar and chemical shift anisotropy (CSA) relaxations is derived in the case where the tensors of both interactions are noncoincident and nonaxial. The expressions show that the CSA-quadrupolar interference term which is responsible for the asymmetry of lines involves a term depending on tensorial parameters. The effect of this term on the lineshapes is discussed with respect to three cases, namely coincident-axially symmetric, noncoincident-axially symmetric, and general noncoincident quadrupolar and CSA tensors. These cases are considered in the analysis of the lineshape of the 1H-decoupled spectra of the 31P nucleus J-coupled to the 59Co nucleus encountered in the tetrahedral cluster HFeCo3(CO)11PPh2H. Copyright 1998 Academic Press.

Effect of acute alcohol intoxication on the opioid system in humans

We investigated the possible relations between the endogenous opioid system and acute alcoholic intoxication in 21 subjects, of whom 13 were drinkers who came to the emergency service with evident symptoms of drunkenness, and 8 were nondrinkers who consumed 1 g alcohol per kg body weight over a short period. Different patterns of changes were found in the two groups for plasma concentrations of beta-endorphin and adrenocorticotropic hormone. In drinkers, plasma levels of both substances increased, whereas in nondrinkers both concentrations decreased, the declines being especially notable 15, 30, and 45 min after ingestion. We found no differences between the two groups in plasma cortisol concentrations. The different levels of these substances may reflect differences in drinking behavior between the two groups.

Plasma concentrations of beta-endorphin, adrenocorticotropic hormone, and cortisol in drinking and abstinent chronic alcoholics

Previous studies of the relationship between the endogenous opioid system and alcohol consumption have reported contradictory results. To shed light on this connection, we compared plasma concentrations of beta-endorphin, adrenocorticotropic hormone, and cortisol in 70 alcoholic persons after different periods of abstinence and a group of 80 control subjects. Plasma beta-endorphin was decreased in alcoholics (18.61 +/- 1.38 vs. 39.31 +/- 3.44 pg/ml), even after more than 10 years' abstinence. This effect may mediated by the tetrahydroisoquinoline system, and may thus result from chronic alcohol consumption. On the other hand, lowered circulating concentrations of beta-endorphin may be a cause, rather than an effect, of alcoholism. Plasma levels of adrenocorticotropic hormone and cortisol did not differ in alcoholics and controls (19.29 +/- 1.66 vs. 13.27 +/- 1.85 pg/ml for ACTH, 20.37 +/- 0.78 vs. 17.22 +/- 0.64 ng/ml for cortisol), and thus appear to have no relation with chronic alcohol consumption.

Classification of alcoholics on the basis of plasma beta-endorphin concentration

Recent findings suggest that a genetic deficit in opioid may be a biological marker of alcoholism. In other words, decreased plasma concentrations of opioids may be a predisposing factor, rather than a consequence, of alcohol consumption. We attempted to classify 88 randomly chosen individuals as alcoholics or nonalcoholics on the basis of plasma concentration of beta-endorphins. This criterion had a sensitivity of 73.30% and a specificity of 79.45%. Its positive predictive value was 42.30%, and its negative predictive value was 93.55%.

Plasma beta-endorphin levels in chronic alcoholics

In order to test the possible relationship between the chronic consumption of alcohol and the opioid system, we have measured the plasma levels of beta-endorphin in a group of 31 alcoholic patients and compared the results with those of a control group of 16 subjects. Our results show that chronic consumption of alcohol induces a significant decrease in beta-endorphin (beta-end) plasma levels regardless of either the disease suffered by the alcoholic patient or of the time of abstinence studied (one month maximum). Thus we believe that the beta-end decrease may well be due to the patients' alcoholism and that it might be mediated by the tetrahydroisoquinoline system, or be a cause of alcoholism rather than a consequence.

Effect of intrathecal morphine during labor on maternal plasma beta-endorphin levels

Plasma beta-endorphin was measured in 16 patients in labor prior to and after complete onset of analgesia with 1 mg of morphine administered intrathecally. Human beta-endorphin levels were determined by radioimmunoassay following silicic acid extraction of plasma samples and separation of the beta-endorphin fraction by gel chromatography. Plasma beta-endorphin levels decreased significantly (p less than 0.005) after intrathecal morphine from 76 +/- 9.7 to 46.3 +/- 9.1 fmol/ml (mean +/- SE), possibly because of decreased pituitary beta-endorphin secretion in response to alleviation of labor pain.

Fetal and maternal cardiovascular effects of atropine and glycopyrrolate

This study compared the effects of intravenous atropine and glycopyrrolate on maternal and fetal heart rates and variability, maternal blood pressure, and uterine activity in 20 normal full-term parturients in labor. Group 1 (N = 10) received 0.005 mg/kg of glycopyrrolate, and group 2 (N = 10) received 0.01 mg/kg of atropine. There were no statistically significant changes in fetal heart rates or variability in either group. Uterine activity increased in a normal manner as labor progressed. Maternal heart rate increased significantly and essentially equally in all patients in both groups ranging from 15 to 78 beats/min and a mean (+/- SD) of 36 +/- 16 in group 1 and from 15 to 65 beats/min with a mean of 35 +/- 17 in group 2. There were no statistically significant changes in maternal blood pressure in either group.