Multiple BRAF Wild-Type Melanomas During Dabrafenib Treatment for Metastatic BRAF-Mutant Melanoma

IMPORTANCE

BRAF inhibitors have become the standard of care in metastatic BRAF-mutant melanomas. Compared with chemotherapies, BRAF inhibitors improve overall and disease-free survival and speed the recovery of symptomatic patients with metastatic disease. The most worrisome finding is the possible development of resistance to new malignant tumors.

OBSERVATIONS

A patient in her 30s developed massive BRAFV600E melanoma metastasis during her 30th week of pregnancy. After emergency cesarean delivery, oral dabrafenib treatment was initiated, and a partial radiologic response was confirmed within 1 month. At dermatologic digital follow-up aided by confocal microscopy 8 weeks after initiation of dabrafenib treatment, 4 melanomas were detected. Unfortunately, within the next month, the melanoma rapidly progressed. The 4 new melanomas were wild-type BRAFmelanomas, whereas the new metastasis carried a different BRAF mutation (S467L).

CONCLUSIONS AND RELEVANCE

Cutaneous malignant tumors are the most frequent adverse events of BRAF inhibitors; therefore, strict dermatologic surveillance in a referral center aided by digital follow-up is mandatory, especially when multiple nevi are present and these drugs are used in an adjuvant setting. In view of our findings, the pathogenesis of the development of new melanomas seems to be different from therapy resistance. Whether paradoxical RAF activation could explain these BRAF wild-type secondary malignant tumors is still unknown.

Biotechnological strategies to improve production of microbial poly-(3-hydroxybutyrate): a review of recent research work

Poly-(3-hydroxybutyrate) [P(3HB)] is a polyester synthesized as a carbon and energy reserve material by a wide number of bacteria. This polymer is characterized by its thermo-plastic properties similar to plastics derived from petrochemical industry, such as polyethylene and polypropylene. Furthermore, P(3HB) is an inert, biocompatible and biodegradable material which has been proposed for several uses in medical and biomedical areas. Currently, only few bacterial species such as Cupriavidus necator, Azohydromonas lata and recombinant Escherichia coli have been successfully used for P(3HB) production at industrial level. Nevertheless, in recent years, several fermentation strategies using other microbial models such as Azotobacter vinelandii, A. chroococcum, as well as some methane-utilizing species, have been developed in order to improve the P(3HB) production and also its mean molecular weight.

Alteraciones respiratorias durante el sueño e hipertensión pulmonar en niños con síndrome de Down a 2.640 metros de altura

INTRODUCCIÓN El síndrome de apnea-hipopnea de sueño (SAHS) está presente en 2% a 3% de la población pediátrica general con una frecuencia más alta en niños con trastornos genéticos. La prevalencia del SAHS en el síndrome de Down (SD) es mayor del 30%. Hay informes de mayor prevalencia de alteraciones respiratorias durante el sueño (ARS) a gran altura, especialmente durante el ascenso rápido. No hay estudios acerca de la frecuencia y características de las ARS y del SAHS en niños con SD que viven a gran altura.OBJETIVO Describir la frecuencia y características de las ARS, la frecuencia de hipertensión pulmonar (HTP) y el comportamiento de la saturación de oxígeno (SpO2) en la vigilia, el sueño y durante eventos en niños con SD en Bogotá, una ciudad situada a gran altura sobre el nivel del mar (2.640 m), de acuerdo con la edad y el índice de masa corporal (IMC). MÉTODOS Estudio descriptivo transversal. Se incluyeron todos los niños con SD con sospecha de ARS remitidos para polisomnograma (PSG) a la Fundación Neumológica Colombiana entre octubre del 2011 y enero del 2013. Se definieron tres grupos: apnea obstructiva, apnea obstructiva y central y sin apneas.RESULTADOS Se incluyeron 74 niños, 36,5% de ellos de sexo femenino, con edad media de 4 años. El 47,3% presentó apnea obstructiva, más frecuente en los mayores de 2 años; 35,1% apnea obstructiva y central, más frecuente en los menores de 2 años, y 17,6 % no presentó apneas. Saturación de oxígeno (SpO2) promedio en apnea obstructiva: 84,6%; en apnea obstructiva y central: 81,8% y en los sin apnea: 86,9% (p = 0,058); 23% presentaron obesidad, 16% con apnea obstructiva. 53 pacientes tuvieron ecocardiograma: 28% con HTP, 53,3% tuvieron apnea obstructiva y 26,7% apnea obstructiva y central, no hubo diferencias significativas. SpO2 promedio en pacientes con HTP: 88,3% durante la vigilia, 86,2% durante el sueño REM, 85,7% durante el sueño no REM, sin diferencia significativa comparada con la de pacientes sin HTP.CONCLUSIONES La desaturación está presente en los niños con SD independientemente del tipo de apnea. Los menores de 2 años presentan con mayor frecuencia apneas centrales asociadas a las apneas obstructivas. La obesidad en pacientes con SD no es un factor determinante de la presencia de apneas e HTP. No hubo diferencia estadísticamente significativa entre el grupo con HTP en cuanto a la frecuencia de apneas y el nivel de saturación de oxígeno en comparación con el grupo sin HTP.

Performance of an AnMBR pilot plant treating high-strength lipid wastewater: biological and filtration processes

The performance of an anaerobic membrane bioreactor (AnMBR) treating wastewater with high levels of oil and grease content from a snacks factory is studied and its effectiveness is demonstrated. The relation between the reversible and the irreversible fouling rate and the fouling propensity of the fatty matter were evaluated under a subcritical flux of 7.9 and 8.3 L/m(2) h. Low Oil and Grease (O&G) concentrations of 500 mg/L produced an irreversible fouling rate of only 0.09 mbar/d, while the fouling rate was between 0.96 and 3.95 mbar/d for an average O&G concentration of 6 g/L. In spite of the significant increase in filtration resistance from 0.31 to 6.08 × 10(12) m(-1) after 40 days of continuous operation, the critical flux level hardly decreased from 11.1 to 9.7 L/(m(2) h). With regard to the biological process, after a start-up period with an organic loading rate (OLR) of below 2 kg COD/(m(3) d), the system was able to treat wastewater between 4.6 and 36 g O&G/L and the system remained stable for OLR at around 17 kg COD/(m(3) d) for 2.8 d, without inhibitory signals. Acclimated sludge quickly reached maximum methane production and digested substrate with high oil and grease content, observing an increase in palmitic acid the first days and constant levels of propionic acid while fatty acids were in the medium.

Climatic spatial variability in Extremadura (Spain) based on viticultural bioclimatic indices

The evaluation of general suitability for viticulture in wine regions requires a knowledge of the spatial variation in temperature, which is also used to assess different grapevine cultivars and to delimit appropriate zones for winegrape production. However, usually temperature data and methods applied to properly delineate homogeneous areas are not adequate to generate accurate maps.With the aim of providing an analysis using four temperature-based indices, quantifying their spatial variability, and representing the spatial pattern of each index throughout Extremadura, one of the most important Spanish wine regions, temperature data from 117 meteorological stations, considering the 1980–2011 period, were utilized. The statistical properties of each index were assessed and, later, they were mapped by means of an integrated geographic information system (GIS) and a multivariate geostatistics (regression-kriging) approach. Results show that heat-sum temperature indices were highly related to the more simple growing season temperature; however, temperature regime differences varied upon which index was employed. The spatial variability of climate within Extremaduran natural regions (NR) is significant; although the warmer conditions predominate, some NR have part of their territory by up to eight climate classes. This information enables a better understanding of the viticulture suitability within each NR and delineating homogeneous zones. The use of consistent bioclimatic indices and an advanced geostatistical algorithm have made it possible to delimit and compare within-region climates and also enabled comparisons of Extremaduran NR with others worlwide, which should be taken into account to select varieties and assess the possibilities of producing new wines.

Effects of energy drink major bioactive compounds on the performance of young adults in fitness and cognitive tests: a randomized controlled trial

Background

The consumption of beverages containing caffeine and taurine before exercising has been associated with increased physical and psychological performances and has been promoted to support the emotional state and provide vitality to consumers. However, there are contradictory results on these issues, it is not clear the effect of every major compound in relation to the whole effect of the beverages and there is a lack in knowledge about their degree of safety for consumption.

Methods

This study used a double-blind, placebo controlled, randomized, crossover design. Fourteen male volunteer soldiers from the Colombian army performed different tests to measure their cardiorespiratory fitness (VO₂max and maximum heart rate), time to exhaustion, strength (isometric strength), power (vertical jump), concentration (Grid test) and memory (Digits test) after drinking 250 ml of one of the following beverages: one with 80 mg caffeine, one with 1000 mg taurine, one with 80 mg caffeine plus 1000 mg taurine, a commercial energy drink (Red Bull®) or a placebo drink. Subjects were caffeine-consumers that avoided caffeine during the day of evaluation. All beverages were matched in flavor and other organoleptic properties to the commercial one, were bottled in dark plastic bottles and were administered in identical conditions to the participants. Differences between treatments were assessed using repeated measures and analysis of variance.

Results

The mean ± SD values of VO₂max, maximum heart rate, time to exhaustion, right handgrip strength, left handgrip strength, vertical jump, Grid test and Digits test were 61.3 ± 6.2 ml/kg.min, 196 ± 6.8 beats per min, 17 ± 1.2 min, 56.8 ± 6.6 kgf, 53.1 ± 5.9 kgf, 41.1 ± 3.8 cm, 19.9 ± 5.9 observed digits and 10.9 ± 3.1 remembered digits after drinking a placebo drink. Comparisons among the commercial drink, caffeine, taurine, caffeine plus taurine and placebo treatments did not show statistically differences in the results of the performed tests. No adverse effects were reported by the participants.

Conclusion

The consumption of caffeine (80 mg) and taurine (1000 mg) or their combination does not increase the physical and cognitive ability in young adults during exercise.

Diversity of foliar endophytic fungi from the medicinal plant Sapindus saponaria L. and their localization by scanning electron microscopy

Endophytic fungi inhabit vegetable tissues or organs, without causing them any harm. Endophytes can co-evolve with plant hosts and possess species-specific interactions. They can protect the plant from insect attacks and diseases, and are also able to produce substances of biotechnological interest. In folk medicine, the bark, roots and fruits of Sapindus saponaria is used to produce substances with anxiolytic, astringent, diuretic and expectorant properties, as well as tonics, blood depuratives and cough medicine. This study evaluated the diversity of endophytic fungi present in the leaves of S. saponaria L. and observed the colonization of host plants by endophytes, using light and scanning electron microscopy. We verified that these fungi are found in intercellular and intracellular spaces. The genera of some isolates of S. saponaria were identified mainly by sequencing of ITS region of rDNA and, when possible, also by their microscopic features, as follows: Cochliobolus, Alternaria, Curvularia, Phomopsis, Diaporthe and Phoma. Phylogenetic analysis showed the existence of genetic variability of the genera Phomopsis and Diaporthe and interspecific variation among the Curvularia, Alternaria and Phoma, belonging to family Pleosporaceae.

Survival of renal transplantation patients older than 60 years: a single-center experience

BACKGROUND

Elderly patients are the fastest growing population requiring renal replacement therapy. It has been stated that renal transplantation may be the best treatment option for these patients. However, it has been observed that older patients have a higher mortality rate than those who are younger. Yet the factors that determine post-transplantation outcomes in this population remain poorly defined. The aims of this study were to evaluate the graft and patient survival in kidney transplant recipients who are older than 60 years of age to identify relevant predictive factors.

METHODS

In this population-based retrospective cohort study of 201 kidney transplantations performed in elderly patients from January 2002 throughout June 2009, we estimated the 1-,3-,and 5-year patients and graft survival rates. We also evaluated the complications and the predictors of poor outcomes. Survival times were analyzed using the Kaplan-Meier method and survival differences assessed with Mantel-Cox log rank-test. We performed a Cox proportional hazards regression models to evaluate the impact of baseline and treatment characteristics on patient and graft survival.

RESULTS

Graft and patient survival rates at 1, 3, and 5 years were 76.4%, 71.3%, and 54.3%, and 78.2%, 73.8%, and 56.4%, respectively. Graft survival rates censored for patient death with a functioning graft were 93.1, 92.1, and 89%. Patient survival rates differed between diabetic and nondiabetic subjects at 1, 3 and 5 years (69.5% versus 83.6%; 59.8% versus 72.3%; 43.6% versus 65.7%; P = .008). On multivariate analysis, the factors associated with patients survival were diabetes mellitus (hazard ratio [HR] 2.058, 95% confidence interval [CI] 1.173-3.611, P = .012) and the 1-month serum creatinine value was > 1.6 mg/dL (HR 2.108 for each point increase, 95% CI 1.521-2.921, P = .000). Furthermore, there was an insignificant trend forward an association between active or past smoker and lower patient survival (HR 1.689, 95% CI 0.937-3.043, P = .08). The main causes of graft loss were patient death (79.5%). acute rejection (6.8%), and chronic allograft nephropathy (5.5%).

CONCLUSION

Renal transplantation can be performed safely and with acceptable outcomes in elderly patients after appropriate clinical evaluation. The grafts show excellent survival albeit that deaths with a functional graft continue to be an important issue.

Dermoscopic rosettes as a clue for pigmented incipient melanoma

The rosette structure is a dermoscopic sign visible under polarized light, characterized by 4 white points arranged as a 4-leaf clover. It has been mainly described in facial sun-damaged skin and actinic keratosis, although it has also been found in squamous and basal cell carcinomas, and in 2 cases of hypomelanotic melanomas. We describe 2 different cases of pigmented incipient melanomas with the presence of multiple rosettes and shiny white structures on dermoscopy. In the reflectance confocal microscope they exhibit a disarranged epidermal architecture with atypical and dendritic cells. Histological examination showed focal hyperkeratosis and a normal corneal layer presented alternatively. To our knowledge this is the first description of rosette structures in pigmented melanomas. Based on a proper dermoscopic- confocal-histopathological correlation, we hypothesize that rosettes could correspond to optic phenomena due to changes in the superficial epidermal reaction and in the acrosyringia.