Patients with STAT1 Gain-of-function Mutations Display Increased Apoptosis which is Reversed by the JAK Inhibitor Ruxolitinib

INTRODUCTION

The signal transducer and activator of transcription (STAT1) gain-of-function (GOF) syndrome accounts for most cases of chronic mucocutaneous candidiasis but is characterized by a broader clinical phenotype that may include bacterial, viral, or invasive fungal infections, autoimmunity, autoinflammatory manifestations, vascular complications, or malignancies. The severity of lymphopenia may vary and influence the infectious morbidity.

METHODS

In our cohort of seven STAT1-GOF patients, we investigated the mechanisms that may determine T lymphopenia, we characterized the interferon gene signature (IGS) and analyzed the effect of ruxolitinib in reverting the immune dysregulation.

RESULTS

STAT1-GOF patients exhibited increased T lymphocyte apoptosis that was significantly augmented in both resting conditions and following stimulation with mitogens and IFNα, as evaluated by flow cytometry by Annexin V/ Propidium iodide assay. The JAK inhibitor ruxolitinib significantly reduced the IFNα-induced hyperphosphorylation of STAT1 and reverted the stimulation-induced T-cell apoptosis, in vitro. In two adult STAT1-GOF patients, the JAKinib treatment ameliorated chronic mucocutaneous candidiasis and lymphopenia. Most STAT1-GOF patients, particularly those who had autoimmunity, presented increased IGS that significantly decreased in the two patients during ruxolitinib treatment.

CONCLUSION

In STAT1-GOF patients, T lymphocyte apoptosis is increased, and T lymphopenia may determine higher risk of severe infections. The JAKinib target therapy should be evaluated to treat severe chronic candidiasis and lymphopenia, and to downregulate the IFNs in patients with autoinflammatory or autoimmune manifestations.

The Inborn Errors of Immunity-Virtual Consultation System Platform in Service for the Italian Primary Immunodeficiency Network: Results from the Validation Phase

PURPOSE

Inborn errors of immunity (IEI) represent a heterogeneous group of rare genetically determined diseases. In some cases, patients present with complex or atypical phenotypes, not fulfilling the accepted diagnostic criteria for IEI and, thus, at high risk of misdiagnosis or diagnostic delay. This study aimed to validate a platform that, through the opinion of immunologist experts, improves the diagnostic process and the level of care of patients with atypical/complex IEI.

METHODS

Here, we describe the functioning of the IEI-Virtual Consultation System (VCS), an innovative platform created by the Italian Immunodeficiency Network (IPINet).

RESULTS

In the validation phase, from January 2020 to June 2021, 68 cases were entered on the IEI-VCS platform. A final diagnosis was achieved in 35/68 cases (51%, 95% CI 38.7 to 64.2). In 22 out of 35 solved cases, the diagnosis was confirmed by genetic analysis. In 3/35 cases, a diagnosis of secondary immunodeficiency was made. In the remaining 10 cases, an unequivocal clinical and immunological diagnosis was obtained, even though not substantiated by genetic analysis.

CONCLUSION

From our preliminary study, the VCS represents an innovative and useful system to improve the diagnostic process of patients with complex unsolved IEI disorders, with benefits both in terms of reduction of time of diagnosis and access to the required therapies. These results may help the functioning of other international platforms for the management of complex cases.

Longitudinal Characterization of Immune Response in a Cohort of Children Hospitalized with Multisystem Inflammatory Syndrome

BACKGROUND

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of SARS-CoV-2 infection caused by hyperactivation of the immune system.

METHODS

this is a retrospective analysis of clinical data, biochemical parameters, and immune cell subsets in 40 MIS-C patients from hospital admission to outpatient long-term follow-up.

RESULTS

MIS-C patients had elevated inflammatory markers, associated with T- and NK-cell lymphopenia, a profound depletion of dendritic cells, and altered monocyte phenotype at disease onset, while the subacute phase of the disease was characterized by a significant increase in T- and B-cell counts and a rapid decline in activated T cells and terminally differentiated B cells. Most of the immunological parameters returned to values close to the normal range during the remission phase (20-60 days after hospital admission). Nevertheless, we observed a significantly reduced ratio between recently generated and more differentiated CD8+ T- and B-cell subsets, which partially settled at longer-term follow-up determinations.

CONCLUSIONS

The characterization of lymphocyte distribution in different phases of MIS-C may help to understand the course of diseases that are associated with dysregulated immune responses and to calibrate prompt and targeted treatments.

β^{+} Gamow-Teller Strengths from Unstable ^{14}O via the (d,^{2}He) Reaction in Inverse Kinematics

For the first time, the (d,^{2}He) reaction was successfully used in inverse kinematics to extract the Gamow-Teller transition strength in the β^{+} direction from an unstable nucleus. The new technique was made possible by the use of an active-target time-projection chamber and a magnetic spectrometer, and opens a path to addressing a range of scientific challenges, including in astrophysics and neutrino physics. In this Letter, the nucleus studied was ^{14}O, and the Gamow-Teller transition strength to ^{14}N was extracted up to an excitation energy of 22 MeV. The data were compared to shell-model and state-of-the-art coupled-cluster calculations. Shell-model calculations reproduce the measured Gamow-Teller strength distribution up to about 15 MeV reasonably well, after the application of a phenomenological quenching factor. In a significant step forward to better understand this quenching, the coupled-cluster calculation reproduces the full strength distribution well without such quenching, owing to the large model space, the inclusion of strong correlations, and the coupling of the weak interaction to two nucleons through two-body currents.

Long term longitudinal follow-up of an AD-HIES cohort: the impact of early diagnosis and enrollment to IPINet centers on the natural history of Job's syndrome

Job's syndrome, or autosomal dominant hyperimmunoglobulin E syndrome (AD-HIES, STAT3-Dominant Negative), is a rare inborn error of immunity (IEI) with multi-organ involvement and long-life post-infective damage. Longitudinal registries are of primary importance in improving our knowledge of the natural history and management of these rare disorders. This study aimed to describe the natural history of 30 Italian patients with AD-HIES recorded in the Italian network for primary immunodeficiency (IPINet) registry. This study shows the incidence of manifestations present at the time of diagnosis versus those that arose during follow up at a referral center for IEI. The mean time of diagnostic delay was 13.7 years, while the age of disease onset was < 12 months in 66.7% of patients. Respiratory complications, namely bronchiectasis and pneumatoceles, were present at diagnosis in 46.7% and 43.3% of patients, respectively. Antimicrobial prophylaxis resulted in a decrease in the incidence of pneumonia from 76.7% to 46.7%. At the time of diagnosis, skin involvement was present in 93.3% of the patients, including eczema (80.8%) and abscesses (66.7%). At the time of follow-up, under therapy, the prevalence of complications decreased: eczema and skin abscesses reduced to 63.3% and 56.7%, respectively. Antifungal prophylaxis decreased the incidence of mucocutaneous candidiasis from 70% to 56.7%. During the SARS-CoV-2 pandemic, seven patients developed COVID-19. Survival analyses showed that 27 out of 30 patients survived, while three patients died at ages of 28, 39, and 46 years as a consequence of lung bleeding, lymphoma, and sepsis, respectively. Analysis of a cumulative follow-up period of 278.7 patient-years showed that early diagnosis, adequate management at expertise centers for IEI, prophylactic antibiotics, and antifungal therapy improve outcomes and can positively influence the life expectancy of patients.

Design and construction of a novel energy-loss optical scintillation system (ELOSS) for heavy-ion particle identification

We present the development of a novel heavy-ion particle-identification (PID) device based on an energy-loss measurement to be implemented in the focal plane of the S800 spectrograph of the Facility for Rare Isotope Beams (FRIB). The new instrument consists of a multi-segmented optical detector [energy-loss optical scintillation system (ELOSS)] that is filled with xenon at pressures ranging from 400 to 800 Torr. The gas volume is surrounded by arrays of photomultiplier tubes and placed along the direction of the beam for recording the prompt scintillation light. The number of detected photons, which is proportional to the energy deposited by the beam particle along its track in the detector volume, allows one to identify the corresponding atomic number (Z). The ELOSS technology is expected to provide high-resolution ΔE measurements (≤0.6% σ) at a high counting rate (>50 kHz). In addition, it has the capability of providing timing information with around 150 ps resolution (σ) compared to the lack of useable timing information of the conventional ionization chamber relying on drifting charges. The development of fast, accurate ΔE measurement techniques for present and future nuclear science facilities will have a high impact on the design and implementation of rare-isotope beam experiments at FRIB and their scientific outcome. As such, ELOSS also represents a prototype for the development of PID detector systems of other planned and future spectrometers, such as the high rigidity spectrometer at FRIB.

Evidence of a Near-Threshold Resonance in ^{11}B Relevant to the β-Delayed Proton Emission of ^{11}Be

A narrow near-threshold proton-emitting resonance (E_{x}=11.4  MeV, J^{π}=1/2^{+}, and Γ_{p}=4.4  keV) was directly observed in ^{11}B via proton resonance scattering. This resonance was previously inferred in the β-delayed proton emission of the neutron halo nucleus ^{11}Be. The good agreement between both experimental results serves as a ground to confirm the existence of such exotic decay and the particular behavior of weakly bound nuclei coupled to the continuum. R-matrix analysis shows a sizable partial decay width for both, proton and α (Γ_{α}=11  keV) emission channels.

Constraining the ^{30}P(p, γ)^{31}S Reaction Rate in ONe Novae via the Weak, Low-Energy, β-Delayed Proton Decay of ^{31}Cl

The ^{30}P(p,γ)^{31}S reaction plays an important role in understanding the nucleosynthesis of A≥30 nuclides in oxygen-neon novae. The Gaseous Detector with Germanium Tagging was used to measure ^{31}Cl β-delayed proton decay through the key J^{π}=3/2^{+}, 260-keV resonance. The intensity I_{βp}^{260}=8.3_{-0.9}^{+1.2}×10^{-6} represents the weakest β-delayed, charged-particle emission ever measured below 400 keV, resulting in a proton branching ratio of Γ_{p}/Γ=2.5_{-0.3}^{+0.4}×10^{-4}. By combining this measurement with shell-model calculations for Γ_{γ} and past work on other resonances, the total ^{30}P(p,γ)^{31}S rate has been determined with reduced uncertainty. The new rate has been used in hydrodynamic simulations to model the composition of nova ejecta, leading to a concrete prediction of ^{30}Si:^{28}Si excesses in presolar nova grains and the calibration of nuclear thermometers.

Pathogenesis of Autoimmune Cytopenias in Inborn Errors of Immunity Revealing Novel Therapeutic Targets

Autoimmune diseases are usually associated with environmental triggers and genetic predisposition. However, a few number of autoimmune diseases has a monogenic cause, mostly in children. These diseases may be the expression, isolated or associated with other symptoms, of an underlying inborn error of immunity (IEI). Autoimmune cytopenias (AICs), including immune thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AIHA), autoimmune neutropenia (AN), and Evans’ syndrome (ES) are common presentations of immunological diseases in the pediatric age, with at least 65% of cases of ES genetically determined. Autoimmune cytopenias in IEI have often a more severe, chronic, and relapsing course. Treatment refractoriness also characterizes autoimmune cytopenia with a monogenic cause, such as IEI. The mechanisms underlying autoimmune cytopenias in IEI include cellular or humoral autoimmunity, immune dysregulation in cases of hemophagocytosis or lymphoproliferation with or without splenic sequestration, bone marrow failure, myelodysplasia, or secondary myelosuppression. Genetic characterization of autoimmune cytopenias is of fundamental importance as an early diagnosis improves the outcome and allows the setting up of a targeted therapy, such as CTLA-4 IgG fusion protein (Abatacept), small molecule inhibitors (JAK-inhibitors), or gene therapy. Currently, gene therapy represents one of the most attractive targeted therapeutic approaches to treat selected inborn errors of immunity. Even in the absence of specific targeted therapies, however, whole exome genetic testing (WES) for children with chronic multilineage cytopenias should be considered as an early diagnostic tool for disease diagnosis and genetic counseling.

Design of a custom-made device for real-time optical measurement of differential mineral concentrations in three-dimensional scaffolds for bone tissue engineering

Monitoring bone tissue engineered (TEed) constructs during their maturation is important to ensure the quality of applied protocols. Several destructive, mainly histochemical, methods are conventionally used to this aim, requiring the sacrifice of the investigated samples. This implies (i) to plan several scaffold replicates, (ii) expensive and time consuming procedures and (iii) to infer the maturity level of a given tissue construct from a cognate replica. To solve these issues, non-destructive techniques such as light spectroscopy-based methods have been reported to be useful. Here, a miniaturized and inexpensive custom-made spectrometer device is proposed to enable the non-destructive analysis of hydrogel scaffolds. Testing involved samples with a differential amount of calcium salt. When compared to a reference standard device, this custom-made spectrometer demonstrates the ability to perform measurements without requiring elaborate sample preparation and/or a complex instrumentation. This preliminary study shows the feasibility of light spectroscopy-based methods as useful for the non-destructive analysis of TEed constructs. Based on these results, this custom-made spectrometer device appears as a useful option to perform real-time/in-line analysis. Finally, this device can be considered as a component that can be easily integrated on board of recently prototyped bioreactor systems, for the monitoring of TEed constructs during their conditioning.

Beam particle identification and tagging of incompletely stripped heavy beams with HEIST

A challenge preventing successful inverse kinematics measurements with heavy nuclei that are not fully stripped is identifying and tagging the beam particles. For this purpose, the HEavy ISotope Tagger (HEIST) has been developed. HEIST utilizes two micro-channel plate timing detectors to measure the time-of-flight, a multi-sampling ion chamber to measure energy loss, and a high-purity germanium detector to identify isomer decays and calibrate the isotope identification system. HEIST has successfully identified ¹⁹⁸Pb and other nearby nuclei at energies of about 75 MeV/A. In the experiment discussed, a typical cut containing 89% of all ¹⁹⁸Pb⁸⁰⁺ in the beam had a purity of 86%. We examine the issues of charge state contamination. The observed charge state populations of these ions are presented and, using an adjusted beam energy, are well described by the charge state model GLOBAL.

Development and validation of an in-silico tool for the study of therapeutic agents in 3D cell cultures

Computational models constitute a fundamental asset for cancer research and drug R&D, as they provide controlled environments for testing of hypotheses and are characterized by the total knowledge of the system. These features are particularly useful for 3D cell culture models where a complex interaction among cells and their environments ensues. In this work, we present a programmable simulator capable of reproducing the behavior of cells cultured in 3D scaffolds and their response to pharmacological treatment. This system will be shown to be able to accurately describe the temporal evolution of the density of a population of MDA-MB-231 cells following their treatment with different concentrations of doxorubicin, together with a newly described drug-resistance mechanism and potential re-sensitization strategy. An extensive technical description of this model will be coupled to its experimental validation and to an analysis aimed at identifying which variables and behaviors account for differences in the response to treatment. Comprehensively, this work contributes to the growing field of integrated in-silico/in-vitro analysis of biological processes which has great potential for both the increase of our scientific knowledge and the development of novel, more effective treatments.

First Direct Measurement of ^{22}Mg(α,p)^{25}Al and Implications for X-Ray Burst Model-Observation Comparisons

Type-I x-ray bursts can reveal the properties of an accreting neutron star system when compared with astrophysics model calculations. However, model results are sensitive to a handful of uncertain nuclear reaction rates, such as ^{22}Mg(α,p). We report the first direct measurement of ^{22}Mg(α,p), performed with the Active Target Time Projection Chamber. The corresponding astrophysical reaction rate is orders of magnitude larger than determined from a previous indirect measurement in a broad temperature range. Our new measurement suggests a less-compact neutron star in the source GS1826-24.

Prevalence of Immunological Defects in a Cohort of 97 Rubinstein-Taybi Syndrome Patients

Although recurrent infections in Rubinstein-Taybi syndrome (RSTS) are common, and probably multifactorial, immunological abnormalities have not been extensively described with only isolated cases or small case series of immune deficiency and dysregulation having been reported. The objective of this study was to investigate primary immunodeficiency (PID) and immune dysregulation in an international cohort of patients with RSTS. All published cases of RSTS were identified. The corresponding authors and researchers involved in the diagnosis of inborn errors of immunity or genetic syndromes were contacted to obtain up-to-date clinical and immunological information. Ninety-seven RSTS patients were identified. For 45 patients, we retrieved data from the published reports while for 52 patients, a clinical update was provided. Recurrent or severe infections, autoimmune/autoinflammatory complications, and lymphoproliferation were observed in 72.1%, 12.3%, and 8.2% of patients. Syndromic immunodeficiency was diagnosed in 46.4% of individuals. Despite the broad heterogeneity of immunodeficiency disorders, antibody defects were observed in 11.3% of subjects. In particular, these patients presented hypogammaglobulinemia associated with low B cell counts and reduction of switched memory B cell numbers. Immunoglobulin replacement therapy, antibiotic prophylaxis, and immunosuppressive treatment were employed in 16.4%, 8.2%, and 9.8% of patients, respectively. Manifestations of immune dysfunctions, affecting mostly B cells, are more common than previously recognized in patients with RSTS. Full immunological assessment is warranted in these patients, who may require detailed investigation and specific supportive treatment. Graphical Abstract.

Erratum: Direct Observation of Proton Emission in ^{11}Be [Phys. Rev. Lett. 123, 082501 (2019)]

This corrects the article DOI: 10.1103/PhysRevLett.123.082501.

Direct Observation of Proton Emission in ^{11}Be

The elusive β^{-}p^{+} decay was observed in ^{11}Be by directly measuring the emitted protons and their energy distribution for the first time with the prototype Active Target Time Projection Chamber in an experiment performed at ISAC-TRIUMF. The measured β^{-}p^{+} branching ratio is orders of magnitude larger than any previous theoretical model predicted. This can be explained by the presence of a narrow resonance in ^{11}B above the proton separation energy.

Multi-layer thick gas electron multiplier (M-THGEM): A new MPGD structure for high-gain operation at low-pressure

The operating principle and performances of the Multi-layer Thick Gaseous Electron Multiplier (M-THGEM) are presented. The M-THGEM is a novel hole-type gaseous electron multiplier produced by multi-layer printed circuit board technology; it consists of a densely perforated assembly of multiple insulating substrate sheets (e.g., FR-4), sandwiched between thin metallic-electrode layers. The electron avalanche processes occur along the successive multiplication stages within the M-THGEM holes, under the action of strong dipole fields resulting from the application of suitable potential differences between the electrodes. The present work focuses on the investigation of two different geometries: a two-layer M-THGEM (either as single or double-cascade detector) and a single three-layer M-THGEM element, tested in various low-pressure He-based gas mixtures. The intrinsically robust confinement of the avalanche volume within the M-THGEM holes provides an efficient reduction of the photon-induced secondary effects, resulting in a high-gain operation over a broad pressure range, even in pure elemental gas. The operational principle, main properties (maximum achievable gain, long-term stability, energy resolution, etc.) under different irradiation conditions, as well as capabilities and potential applications are presented and discussed.

A novel fast-neutron detector concept for energy-selective imaging and imaging spectroscopy

We present and discuss the operational principle of a new fast-neutron detector concept suitable for either energy-selective imaging or for imaging spectroscopy. The detector is comprised of a series of energy-selective stacks of converter foils immersed in a noble-gas based mixture, coupled to a position-sensitive charge readout. Each foil in the various stacks is made of two layers of different thicknesses, fastened together: a hydrogen-rich (plastic) layer for neutron-to-proton conversion, and a hydrogen-free coating to selectively stop/absorb the recoil protons below a certain energy cut-off. The neutron-induced recoil protons, that escape the converter foils, release ionization electrons in the gas gaps between consecutive foils. The electrons are then drifted towards and localized by a position-sensitive charge amplification and readout stage. Comparison of the images detected by stacks with different energy cut-offs allows energy-selective imaging. Neutron energy spectrometry is realized by analyzing the responses of a sufficient large number of stacks of different energy response and unfolding techniques. In this paper, we present the results of computer simulation studies and discuss the expected performance of the new detector concept. Potential applications in various fields are also briefly discussed, in particularly, the application of energy-selective fast-neutron imaging for nuclear safeguards application, with the aim of determining the plutonium content in Mixed Oxide (MOX) fuels.

High-frame rate imaging of two-phase flow in a thin rectangular channel using fast neutrons

We have demonstrated the feasibility of performing high-frame-rate, fast neutron radiography of air-water two-phase flows in a thin channel with rectangular cross section. The experiments have been carried out at the accelerator facility of the Physikalisch-Technische Bundesanstalt. A polychromatic, high-intensity fast neutron beam with average energy of 6 MeV was produced by 11.5 MeV deuterons hitting a thick Be target. Image sequences down to 10 ms exposure times were obtained using a fast-neutron imaging detector developed in the context of fast-neutron resonance imaging. Different two-phase flow regimes such as bubbly slug and churn flows have been examined. Two phase flow parameters like the volumetric gas fraction, bubble size and mean bubble velocities have been measured. The first results are promising, improvements for future experiments are also discussed.

Development of a cold-neutron imaging detector based on thick gaseous electron multiplier

We present the results of our recent studies on a cold-neutron imaging detector prototype based on THick Gaseous Electron Multiplier (THGEM). The detector consists of a thin Boron layer, for neutron-to-charged particle conversion, coupled to two THGEM electrodes in cascade for charge amplification and a position-sensitive charge-readout anode. The detector operates in Ne∕(5%)CF4, at atmospheric pressure, in a stable condition at a gain of around 10(4). Due to the geometrical structure of the detector elements (THGEM geometry and charge read-out anode), the image of detector active area shows a large inhomogeneity, corrected using a dedicated flat-filed correction algorithm. The prototype provides a detection efficiency of 5% and an effective spatial resolution of the order of 1.3 mm.

Fast bedside measurement of blood count and C-reactive protein in newborns compared with conventional methods

BACKGROUND

Abnormal complete blood count (CBC) and high plasma C-reactive protein (CRP) are associated with neonatal infections and could be helpful in the diagnosis of neonatal sepsis and to monitor the antibiotic treatment.

OBJECTIVES

The aim of this work is to evaluate and compare the performance of a bedside analyzer for blood count and C-reactive protein (CRP) with a conventional analyzer in a neonatal population.

METHODS

150 capillary or venous blood samples of term and preterm newborns were processed on an ABX-MicrosCRP200 analyzer and on a SysmexXE2100 (conventional hematology analyzer) for CBC, leukocyte differential, reticulocytes, and nucleated red blood cells (NRBC); high-sensitivity CRP (hs-CRP) was performed on a ModularPE. The differences between complete blood count and CRP were regressed against their means and assessed by means of intra-class-correlation.

RESULTS

The intra-class-correlation for white blood cell (WBC) was 0.98, for hemoglobin 0.97, for hematocrit 0.96, for mean corpuscular volume 0.95, and for platelet 0.98. ABX-MicrosCRP200 overestimated the WBC (+1.27 x 10(3)/microL; p < 0.001), hematocrit (+1.80%; p < 0.001), and platelet (+13.55 x 10(3)/microL; p < 0.001). The intra-class-correlation for CRP was high (0.97), without systematic difference between the two values (p = 0.64).

CONCLUSIONS

The agreement between the two methods was high for both tests. However, the SD of the difference for WBC and platelet could be clinically important in leukopenic or thrombocytopenic newborns.

New prospective for non-invasive detection, grading, size evaluation, and tumor location of prostate cancer

BACKGROUND

PSA blood test and other present screening tools fail to provide the required sensitivity and specificity and, at early stages, lack correlation with tumor grade, volume, and location. Thus alternative approaches are highly desired. We present and assess a novel method for PCa detection, grading, volume evaluation and tumor location, based on non-invasive zinc concentration mapping in the gland by means of a dedicated rectal probe.

METHODS

Zinc-concentration values measured in histologically examined tissue fragments from needle biopsy of 598 patients were analyzed. They were used to generate computer simulated zinc-concentration maps, further analyzed with image-processing tools. The tumor detection performances versus Gleason grade were assessed.

RESULTS

A significant increase of zinc depletion with increasing Gleason pattern (grade) classification was established. Tumor detection performance in zinc-concentration maps progressively improves with the cancer's first component score. Reliable information on the location, size and Gleason-grade combination of the lesion can be extracted for clinically relevant volumes.

CONCLUSIONS

Zinc depletion in the prostate peripheral zone is the basis for a novel, non-invasive PCa detection, localization, volume evaluation and grading method. Its realization and application as a pre-biopsy and pre-treatment examination, or a follow-up tool, relies on the development of a dedicated transrectal probe. It should have significant impact on biopsy effectiveness, point at a possible extraprostatic extension and provide critical data for focal treatment. The information on tumor grade and distribution may have an important impact on disease management.

Evaluating the cancer detection and grading potential of prostatic-zinc imaging: a simulation study

The present work deals with the analysis of prostatic-zinc-concentration images. The goal is to evaluate potential clinically relevant information that can be extracted from such images. In the absence of experimental images, synthetic ones are produced from clinically measured zinc-concentration distributions in certified benign and cancerous tissue samples, classified by the lesion grade. We describe the method for producing the images and model the effect of counting statistics noise. We present in detail the image analysis, which is based on a combination of standard image processing and segmentation tools, optimized for this particular application. The information on lowest zinc value obtained from the image analysis is translated to clinical data such as tumour presence, location, size and grade. Their confidence is evaluated with the help of standard statistical tools such as receiver operating characteristic analysis. The present work predicts a potential for detecting small prostate-cancer lesions, of grade (4+3) and above, with very good specificity and sensitivity. The present analysis further provides data on the pixel size and image counting statistics requested from the trans-rectal probe that will record in vivo prostatic-zinc maps in patients.

Clinical assessment of the cancer diagnostic value of prostatic zinc: a comprehensive needle-biopsy study

BACKGROUND

The correlation between Zinc concentration in the prostate's peripheral zone to the onset or presence of malignant process needs to be evaluated in detail.

METHODS

Zinc concentration was measured in approximately 1-4 mm3 segments of fresh needle-biopsy cores, with X-ray fluorescence, and correlated with the histological findings of these tissue segments.

RESULTS

Local Zinc concentration is correlated with the presence of cancer (PCa); the higher the Gleason score the greater the Local Zinc depletion. The Zinc value averaged over the entire extracted tissue is specific only to Gleason score 8-9 PCa. The results refer to patients avoiding Zinc-rich supplements since those show elevated prostatic Zinc concentration in identified cancer tissue. A computer simulation analysis of randomly located 0.03-3.3 cm3 lesions, with particular Gleason score and the measured Local Zinc concentration, revealed a potential diagnostic approach definitely superior to PSA, with sensitivity to the tumor grade and with excellent detection capability for Gleason score >6. Further clinical studies have been designed, both on full prostates after radical prostatectomy as well as on biopsy cores at higher resolution, to establish the accuracy of the method for Gleason score = 6.

CONCLUSIONS

The PCa diagnostic potential of Local Zinc concentration is confirmed and there is indication that the amount of Zinc depletion could be used as a measure of the Gleason score of the tumor. Local Zinc concentration mapping has the potential to improve patient selection for biopsy, biopsy site selection and local therapy (e.g., Cryotherapy, Brachytherapy) site selection.

The assessment of path linearity in swimming: a pilot study

The lateral-medial displacement (LF) and the overall drift from a straight path (DT) were quantified and compared in 5 top-level (TLS) and 5 low-level (LLS) crawl swimmers. Sixteen repetitions of 25-m crawl at increasing intensity were performed and videotaped. The performances were divided into 3 intensities (< 80 %, 80 - 90 % and > 90 % of maximal speed). LF was expressed as overlength swum (OLS) and coefficient of variation (CV) of the Z-component movement. OLS revealed a significant main effect for swimmer level (p < 0.01), intensity (p < 0.01) and their interaction (0.48, 0.37, 0.31-m for TLS and 0.47, 0.43, 0.44-m for LLS, p < 0.05). CV was significantly higher in LLS at the lowest (0.69 vs. 0.22, p < 0.05) and highest intensity (0.71 vs. 0.33, p < 0.05). DT, expressed as the slope of the linear regression of position data vs. time, was significantly higher in LLS only at the highest intensity (0.025 vs. 0.013, p < 0.05). The amount of dissipated energy due to LF, quantified by means of discrete Fourier analysis, revealed a difference only when the 0 - 5 Hz and 5 - 10 Hz spectral windows were analysed separately. While LF has a practical significance since it contributes to increase drag, DT is negligible at least for short-distance events.

Depression After Lung Transplantation: Causes and Treatment

During the postoperative course of lung transplantation, patients may experience depressive symptoms that negatively influence their ability to cope with the new organ, their adherence to rehabilitation and pharmacologic therapy, and their overall quality of life (QoL). To date, no review has explored the causes of depression following transplantation or the efficacy and safety of therapeutic interventions in this patient group. We conducted a comprehensive 1966-2006 MEDLINE, EMBASE, and PsycINFO search for studies of the causes and treatments of depression in lung transplant recipients. We identified 25 studies of variable methodologic quality. Depression rates are high among candidates for lung transplantation. In the short term, after surgery depressive symptoms remain low with an improvement in QoL, whereas in the long term (>3 years), the decline of functional status is associated with a dramatic increase in such symptomatology. Personality disorders, coping strategies, stressful life events, physical complications, corticosteroid medications, age, gender, and psychosocial support all play a central role in causing depressive states in lung transplant recipients. Serotonin reuptake inhibitors (SSRIs) and new-generation antidepressants (mirtazapine) represent the best therapeutic choices for this group of patients. The risk of serious drug-drug interactions should be carefully monitored by experienced clinicians. Complementary therapies and psychoeducational intervention also help recipients to strengthen their coping strategies, offering further advantages after transplantation. Additional well-conducted randomized controlled trials are needed to clarify the epidemiologic course of depression following lung transplantation and to tailor effective pharmacologic or psychological interventions accordingly.

[PCBs cause necrosis of L6C5 myoblasts]

Polychlorinated biphenyls (PCBs) are structurally related to dioxins, widely used in the past in various industrial applications and daily used products. Although PCBs production was discontinued more than twenty years ago, their chemical stability and high lipophilicity make them persistent pollutants and dangerous occupational contaminants. Skeletal muscle is an important site of PCB accumulation. Our previous results about the effects of PCBs on L6C5 myoblasts, showed that "low concentrations" (< 10 microg/ml) of these compounds inhibit in vitro myogenic differentiation in a concentration-dependent fashion, while toxic effects only begin to be evident at PCB concentrations > or = 10 microg/ml. In the present paper we wondered if the observed cell mortality is due to necrosis or if it depends on the activation of programmed cell death mechanisms (apoptosis). Using different methods of analysis, we have observed that PCBs cause necrosis of myogenic cells and that such effect is related to the employed concentrations and to the time of exposure (EC50 approximately = 50 microg/ml). Our results may help to explain the creatin kinase elevation, observed in the blood of patients acutely exposed to high concentrations of PCBs, as the consequence of a necrotic damage of the skeletal muscle. It will be therefore interesting to evaluate the presence of muscular damages in the chronic exposures to PCBs.

Elevation of serum copper levels in Alzheimer's disease

OBJECTIVE

To determine whether serum trace metals and oxidative species are related to abnormal cognition in AD.

METHODS

The authors studied serum peroxides, copper, iron, transferrin, and antioxidant capacity in 79 patients with AD (mean age 74.3 years; 25 men, 54 women) and in 76 cognitively normal individuals (mean age 70.1 years; 33 men, 43 women). The relation of these oxidative and trace metals to APOE epsilon4 allele frequency, neuropsychological performance, and cerebrovascular or atrophic burden, as estimated by brain MRI and ultrasonography of cerebral vessels, was evaluated.

RESULTS

Copper level was higher (p < 0.001) in subjects with AD than control subjects (specificity = 95%, sensitivity = 60%) with a cutoff serum level of 16 micro mol/L (1.02 mg/L). An increase of 1 micro mol/L in serum copper accounted for 80% of the risk of having AD and correlated with poor neuropsychological performance and medial temporal lobe atrophy (p < 0.03). Antioxidant capacity decreased and correlated with medial temporal lobe atrophy (p < 0.009) and with APOE epsilon4 allele (p = 0.004).

CONCLUSIONS

Copper may play a role in neurodegenerative processes in AD, and serum copper measurement may prove to be a peripheral diagnostic marker for AD.

d-penicillamine reduces serum oxidative stress in Alzheimer's disease patients

BACKGROUND

Several lines of evidence address the emerging role for copper in Alzheimer's disease (AD) for sustaining oxidative mechanisms. Studies indicate that peripheral markers of oxidative stress in AD patients could be informative about the pathophysiology of this brain condition. Here, we present a pilot study examining the efficacy of the copper-chelating agent d-penicillamine in reducing oxidative stress in AD patients.

DESIGN

Serum levels of copper sampled in AD patients and healthy controls indicate a copper homeostasis imbalance in AD. On this basis, 34 AD patients were enrolled in a 6-month, double-blind, placebo-controlled trial with the copper d-penicillamine-chelating agent. Nine patients for each group completed the trial. Oxidative stress, trace metals and clinical parameters were evaluated.

RESULTS

At the start of the study (t0) total peroxides and copper serum content of AD patients were higher (P < 0.0001, P < 0.0001, respectively) and antioxidants were lower (P < 0.05) than in healthy controls. Copper and peroxides were correlated in the AD population (Pearson's r = 0.61, P < 0.001). After treatment with d-penicillamine, the extent of oxidative stress (P < 0.05) was decreased, but no difference was observed in the rate of cognitive decline.

CONCLUSION

Data from this pilot study suggest that copper could play a role in the production of peroxides in AD, and that d-penicillamine has an effect in reducing oxidative damage, however, results are still inconclusive in terms of drug efficacy on the clinical progression of AD. Studies with larger cohorts are needed to elucidate the real effectiveness of d-penicillamine treatment in AD.

Spreading the clinical information system: which users are satisfied?

The present study deals with the assessment of the perceived usefulness and perceived ease of use of the clinical core of the HIS we are building, and progressively spreading into the medical centre, through the use of two questionnaires. The differences in subjective perception among clinical units and professional roles have been analyzed. Results show that the system, in use on a mandatory basis, has been accepted. Most of the users are satisfied, and probable removable causes of dissatisfaction have been identified.

Assessing users' satisfaction through perception of usefulness and ease of use in the daily interaction with a hospital information system

The present study deals with the assessment of the subjective perception of the clinical core of the hospital information system (HIS) we are building. This HIS is not in use on a voluntary basis, but physicians and nurses use it for all the aspects of their inpatient care that have been informatized. Two questionnaires, aimed at the assessment of users perceived usefulness and ease of use of information technology, were utilized to: obtain feedback of the actual users' satisfaction as a predictive factor for the future life of the system, assess the real influence of the often-mentioned problems of age and unfamiliarity with computers of potential users, learn about the aspects which would enhance users' acceptance. The analysis of answers to the questionnaires has indicated a substantially positive perception of the system in terms of both usefulness and ease of use. This constitutes a good reason to keep on investing in the project. Even though this study has the intrinsic limit of the small dimension of the inquired population (53 users, equivalent to 98% of the personnel of the assessed clinical units), our data confirm the inconsistency of the relationship between perception of usefulness and age, and show "unfamiliarity with computers" as commonplace. On the other hand, it seems that the keystone for usefulness perception is the knowledge the users have of the system. An effort by the technical personnel in establishing a broader collaboration with the users, and in providing more exhaustive training and support may well be worthwhile.

Interaction and dialogue between the users and the patient record core of hospital information system: looking for a solution

The lack of good user interface, in terms of both modality of dialogue and system behaviour is the major impediment to the acceptance and routine use of the computer based patient record (CPR) core of a hospital information system. We describe here the adopted approach to face the daily users' needs, overcoming the pitfalls of the paper based patient record (PPR), and giving the physicians an exhaustive modality for CPR inspection.