Associations between levels of insulin-like growth factor 1 and sinusoidal obstruction syndrome after allogeneic haematopoietic stem cell transplantation

Allogeneic myeloablative haematopoietic stem cell transplantation (HSCT) is challenged by severe adverse events, as cytotoxic effects of the conditioning may result in systemic inflammation, leaky epithelial barriers and organ toxicities, contributing to treatment-related morbidity and mortality. We hypothesised that insulin-like growth factor-1 (IGF-1), a mediator of growth and proliferation of various tissues, may attenuate chemotherapy-induced tissue damage after HSCT. We prospectively measured plasma levels of IGF-1 and its binding protein 3 (IGFBP-3) in 41 patients undergoing myeloablative HSCT. IGF-1 and IGFBP-3 levels were inversely correlated with C-reactive protein and interleukin-6 levels post HSCT. In multivariate analyses, low levels of IGF-1 and IGFBP-3 before conditioning were associated with increased risk of developing sinusoidal obstruction syndrome (SOS; OR=5.00 per 1 SDS decrease in IGF-1 (95% CI: 1.45-16.67), P=0.011 and OR=5.00 (1.37-20.00), P=0.015, respectively). Furthermore, low pre-transplant levels of IGF-1 and IGFBP-3 were associated with increased fluid retention during the first 21 days post transplant (OR=7.69 (95% CI: 1.59-33.33), P=0.012, and OR=2.94 (1.03-8.33), P=0.045). These data suggest that high levels of IGF-1 and IGFBP-3 may have a protective effect against fluid retention and SOS, possibly by attenuating systemic inflammation, and may prove useful as predictive biomarkers of SOS.

T cell reconstitution in allogeneic haematopoietic stem cell transplantation: prognostic significance of plasma interleukin-7

Infections and acute graft-versus-host disease (aGVHD) are major causes of treatment-related mortality and morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). Both complications depend on reconstitution of the T-lymphocyte population based on donor T cells. Although it is well established that Interleukin-7 (IL-7) is a cytokine essential for de novo T cell development in the thymus and homoeostatic peripheral expansion of T cells, associations between circulating levels of IL-7 and T cell reconstitution following HSCT have not been investigated previously. We prospectively measured IL-7 levels in 81 patients undergoing myeloablative HSCT with either sibling donor or an unrelated donor. Plasma IL-7 levels peaked at day +7 post-transplant (1.3-82.4 pg/ml), at the time of maximal lymphopaenia. In multivariate analysis, peak levels of IL-7 were significantly higher in patients treated with anti-thymocyte globulin (ATG) compared with those not treated with ATG (P = 0.0079). IL-7 levels at day +7 were negatively associated with T cell counts at day +30 to +60 (at day +60: CD3(+) : β = -10.6 × 10(6) cells/l, P = 0.0030; CD8(+) : β = -8.4 × 10(6) cells/l, P = 0.061; CD4(+) : β = -2.1 × 10(6) cells/l, P = 0.062) in multivariate analyses. In adults, high IL-7 levels were associated with increased risk of grade II-IV aGVHD (OR = 5.4, P = 0.036) and reduced overall survival (P = 0.046). The present data indicate that high plasma levels of IL-7 in the early post-transplant period are predictive for slow T cell reconstitution, increased risk of aGVHD and increased mortality following HSCT.

Run-aways im Neutralgas

The motion of electrons as determined by the field acceleration and the elastic and inelastic collisions with the gas atoms is calculated from the BOLTZMANN equation. We derive the average velocity and the scattering ellipsoid as a function of time. For particles starting from rest there exists always a critical electric field Ec depending on pressure and temperature. Below this critical value electrons approach the stationary drift process. Above the critical value the electrons do not reach a stationary state, they “run away”. For a finite initial velocity ν0 and a field below the critical value Ec the particles are either accelerated to drift, or decelerated to drift, or “run away”, depending on the value ν0. From a calculation of the scattering parameters we find for E > Ec a focussing effect in the velocity space which increases with field strength. Also the relaxation time for the drift process and the stopping power for electron beams can be calculated. Applications to the glow discharge are discussed.

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Bronchiolitis obliterans (BO) following allogeneic haematopoietic SCT (HSCT) is a serious complication affecting 1.7-26% of the patients, with a reported mortality rate of 21-100%. It is considered a manifestation of chronic graft-versus-host disease, but our knowledge of aetiology and pathogenesis is still limited. Diagnostic criteria are being developed, and will allow more uniform and comparable research activities between centres. At present, no randomised controlled trials have been completed that could demonstrate an effective treatment. Steroids in combination with other immunosuppressive drugs still constitute the backbone of the treatment strategy, and results from our and other centres suggest that monthly infusions of high-dose pulse i.v. methylprednisolone (HDPM) might stabilise the disease and hinder progression. This article provides an overview of the current evidence regarding treatment options for BO and presents the treatment results with HDPM in a paediatric national HSCT-cohort.

Using interaction graphs for analysing the therapy process

BACKGROUND

Therapy processes are complex dynamical systems where several variables are constantly interacting with each other. In general, the underlying mechanisms are difficult to assess. Our approach is to identify the dependency structure of relevant variables within the therapy process using interaction graphs. These are instruments for multivariate time series which are based on the analysis of partial spectral coherences. We used interaction graphs in order to investigate the therapy process of a multimodal therapy concept for fibromyalgia patients. Our main hypothesis was that self-efficacy plays a central role in the therapy process.

METHODS

Patients kept an electronic diary for 13 weeks. Pain intensity, depression, sleep quality, anxiety and self-efficacy were assessed via visual analogue scales. The resulting multivariate time series were aggregated over individuals, and partial spectral coherences between each pair of the variables were calculated. From the partial coherences, interaction graphs were plotted.

RESULTS

Within the resulting graphical model, self-efficacy was strongly related to pain intensity, depression and sleep quality. All other relations were substantially weaker. There was no direct relationship between pain intensity and sleep quality.

CONCLUSIONS

The relations between two variables within the therapy process are mainly induced by self-efficacy. Interaction graphs can be used to pool time series data of several patients and thus to assess the common underlying dependency structure of a group of patients. The graphical representation is easily comprehensible and allows to distinguish between direct and indirect relationships.

Partizipative Entscheidungsfindung PEF) mit chronischen Schmerzpatienten

Fibromyalgia syndrome (FMS) is an exemplary condition of chronic widespread pain that is difficult to control and often leads to frustration and resignation on the part of both the patient and the doctor. Shared decision making (SDM) could be a means to facilitate doctor-patient interaction and might therefore influence therapeutic decisions taken. We conducted a prospective study to evaluate the effects of SDM with FMS patients. We developed a communication train-ing program for physicians and a computer-based information tool on FMS for patients. The study included 133 FMS patients. Intervention group I (IG I) was treated by communication-trained doctors and had access to a computer-based information tool on FMS,intervention group II (IG II) was treated by standard doctors and received the information tool, and the control group (CG) was treated by standard doctors and got no additional information. All three groups we-re offered the same evidence-based treatment options for FMS. Patients of the IGs were more willing to become involved in exercise, to enroll in integrated group therapy for FMS patients (IGTF), and to take analgesics. Patients of the CG preferred anti-depressants. More patients from IG II and CG opted for relaxation techniques. Patients in IG I and IG II choose significantly more therapeutic options than patients in the CG. SDM is one means to increase FMS patients' readiness for treatment. Especially the element of providing sufficient medical information seems to account for this effect. The readiness to enroll in physical activities, to take analgesics, and to participate in psychotherapeutic elements was most likely to be raised through SDM.

Psychosoziale Faktoren bei einer Fibromyalgiepatientin

OBJECTIVE

Fibromyalgia syndrome (FMS) is a condition of chronic widespread pain. In its process of chronification psychosocial factors play an important role. A multimodal treatment including integrated group therapy has been proved to be effective. Yet little attention has been paid so far to the exact sequence of changes and interrelation between psychosocial factors, functional capacity, and level of pain under integrated group therapy for FMS patients.

METHODS

One FMS patient was exemplarily monitored with an electronic diary over 13 weeks while undergoing integrated group therapy. On a daily basis we assessed the level of pain, functional capacity, and other disease-related variables (anxiety, depression, quality of sleep, self-efficacy) via visual analog scales. By the means of multivariate time series analysis the timing of changes in psychosocial factors and their effects on perceived functional capacity was identified.

RESULTS

Under integrated group therapy all assessed variables gradually changed in the predicted way. Pain, depression, anxiety could be reduced, whereas self-efficacy, quality of sleep, and functional capacity improved. 71% of the variance could be explained by the multiple regression model. Self-efficacy was, beside pain intensity and depression, an important predictor for functional capacity on the same day. High self-efficacy correlated negatively with the level of functional capacity 3 days later.

CONCLUSION

Integrated group therapy proved to be effective. Self-efficacy played an important role regarding the improvement of functional capacity. Depicting the exact timing of changes in the assessed variables helped to detect patterns of influence and indicate directions for further treatment.

Design and test of a simple high-temperature laser microrefractometer

The design of a laser microrefractometer that is suitable for temperature-dependent measurements is described. The refractive index of methylene iodide is measured in the temperature range of 22-92 °C for laser wavelengths covering almost the entire visible range of the spectrum: 442, 488, 515, 543, 594, and 633 nm. A detailed analysis of the temperature-related experimental error is made.

Divinylsulphone-activated agarose. Formation of stable and non-leaking affinity matrices by immobilization of immunoglobulins and other proteins

Divinylsulphone-activated agarose is an attractive alternative to several of the activated supports usually used. Unlike CNBr-activated gels, it does not leak the immobilized protein at high pH. It reacts readily with proteins at near-neutral pH (unlike the epoxy-activated supports). Generally, divinylsulphone-activated agarose reacts with amino, hydroxyl, and sulphydryl groups, thus allowing immobilization of a wide spectrum of ligands. Moreover, it is available in an aqueous suspension free of organic solvents and neither requires time-consuming swelling nor washing.