Ukrainian refugee crisis: the experience of the Roman Local Health Authority “ASL Roma 1”

Problem

On February 24th, 2022, Ukraine was invaded by Russian forces, forcing many Ukrainians to flee from their homes as refugees. More than 55,000 Ukrainians have since arrived on Italian territory. In response to the humanitarian crisis, the Roman Local Health Authority “ASL Roma 1” provided socio-sanitary assistance through first reception centers to more than 7700 refugees, prioritizing people with high social vulnerability. Ukraine’s vaccine hesitancy and different epidemiological landscape represented a major hurdle to be overcome.

Practice

ASL Roma 1’s practice served to ensure infectious diseases prevention and control, as well as continuity of care for non-communicable diseases and mental health issues. It consisted of repurposing resources, such as COVID-19 Hubs and their personnel, stipulating Public-Private Partnerships and collaborations with the local Ukrainian community, massive training, creating a centralized multidisciplinary team (with Ukrainian members) and a dedicated database/IT system.

Results

ASL Roma 1 empowered local Ukrainian communities by providing equipment, medical and administrative staff and socio-sanitary assistance. Ukrainian volunteers helped bridge the cultural gap for essential service provision, such as COVID-19 screening, enrolment in the NHS, health and social orientation, vaccinations and a tailored care pathway. Thus, more than 7700 refugees were assisted, with 1830 COVID-19 vaccinations administered and 170 in critical conditions promptly receiving specialized care.

Lessons

The multidisciplinary and cross-cultural interaction between doctors, nurses, cultural mediators, social workers, and other key actors was essential in ensuring a holistic care pathway. Services catered to Ukrainian refugees need complete integration between primary and centralized care. Flexibility and resilience are fundamental to foster an ecosystem of innovation and optimization of healthcare provision on all levels, from local to supranational.

Key messages

• The multidisciplinary and cross-cultural interaction between all medical and non-medical key actors is essential in ensuring a holistic care pathway and complete social integration of asylum seekers.

• Health system flexibility, resilience and an ecosystem of innovation and optimization of healthcare provision on all levels are fundamental components of preparedness for future refugee crises.

Digital health technologies: a systematic review of their cost-effectiveness

Background

Digital health interventions have a potential to improve safety, efficacy and quality of care, reducing waste in healthcare costs. Despite premises, the evidence regarding cost and effectiveness of digital tools in health is scarce and limited.

Objectives: The aim of this systematic review is to summarize the evidence on cost-effectiveness of digital health interventions and to assess whether the studies meet the established quality criteria.

Methods

We queried PubMed, Scopus and Web of Science databases for articles in English published from 1 January 2016 to 31 December 2020 that performed economic evaluations of digital health technologies. The methodological rigorousness of studies was assessed with a well-established checklist (CHEERS). The incremental cost-effectiveness ratio (ICER)was calculated when the reviewed study reported related data but did not express the ICER.

Results

Searches identified 1476 results, 552 of which were selected for abstract and 35 were included in this review. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The qualitative analysis identified the economic and effectiveness evaluation of seven different types of interventions: fourteen studies on a new telemedicine service; five on telecounseling; five on teletherapy; two on telemonitoring; five on new mobile applications; two on m-health programs; one on digital platforms and one on electronic health records.

Conclusions

Findings on cost-effectiveness of digital interventions showed a growing body of evidence and suggested a generally favorable effect in terms of costs and health outcomes. However, due to the heterogeneity across study methods, the comparison between interventions still remains difficult. Further research based on a standardized approach is needed in order to methodically analyze incremental cost-effectiveness ratios, costs, and health benefits.

Key messages

Digital interventions suggested a favorable effect in terms of costs and health outcomes. Digital health interventions have a potential to improve safety, efficacy and quality of care.

CARDIOMYOCYTE DNA CONTENT AND ITS LINK TO CSE/ H2S SYSTEM IN THE HEART OF EXPERIMENTAL DIABETIC RATS

One of the most common complication of diabetes mellitus (DM) is diabetic cardiomyopathy, which is associated with the development of inflammation, fibrosis and the induction of apoptosis. Hydrogen sulfide (H2S) has recently been shown to play an important role in the regulation of cardiac and vascular function. The role of the H2S system in the mechanisms of diabetic heart development remains uncertain. The aim of this work was to evaluate the effect of modulators of H2S system on the level of DNA fragmentation and H2S concentration in heart of rats with experimental diabetes mellitus. The experiment was performed on 40 white laboratory male rats (180-250 g), randomly divided into 4 groups (n=10): healthy (control), diabetes mellitus induced by streptozotocin (STZ), diabetes mellitus + propargylglycine, inhibitor of cystathionine gamma lyase (STZ + PPG), diabetes mellitus + NaHS, exogenous H2S donor (STZ + NaHS). The experimental DM was induced by a single intraperitoneal injection of streptozotocin (40 mg/kg). The animals from two groups (3rd and 4th groups) starting from 14th to 28th day after the injection of STZ were administered modulators of H2S system i/p once per day. D, L-propargylglycine was dosed at 50 mg/kg body weight, while NaHS · H2O - at 3 mg/kg body weight. H2S content in hearts was evaluated by spectrophotometry (Wilinski, 2011). DNA content was determined by flow cytometry (Partec PAS, Germany). The development of DM in rats was accompanied by a significant decrease in myocardial H2S concentration by 36.6% (p<0.05) compared with control. The administration of proparglyglycine led to an increase in H2S deficiency (29.4%, p<0.05) compared to the STZ group. The administration of NaHS resulted in a decrease in H2S deficiency (by 23.5%, p<0.05) compared to the STZ group. Flow cytometry showed that DM was accompanied by an increased apoptotic activity (increased number of myocardiocytes in the SUB- G0G1 phase by 11.4%, p<0.05), polyploidization (increased proportion of cells in the G2M phase by 32.1%, p<0.05) and proliferation (29.8% increase in S-phase cells, p<0.05) of heart cells compared with controls. The introduction of propargylglycine led to an increase in apoptosis (14.4%, p<0.05) compared with the STZ group. Whereas NaHS administration decreased the degree of apoptosis (12.3%, p<0.05), polyploidization (14.4%, p<0.05) and proliferation compared (26.2%, p<0.05) with untreated diabetes. Correlation analysis showed that impaired H2S metabolism is an important factor of disregulation of cell cycle in diabetic heart: a reliable inverse relationship was registered (r=-(0,69-83), p<0.01) between H2S level and the indicators of apoptosis activity, proliferation and polyploidization. Disintegration of the H2S/CSE system is associated with an increase in apoptosis activity, polyploidization, and proliferation of myocardiocytes in experimental DM. Modulation of H2S metabolism is a potential direction for the prevention of the development of cardiovascular complications of diabetes.

VALIDATION OF THE DIAGNOSTIC AND TREATMENT COMPLEX FOR PATIENTS WITH ORTHOGNATHIC DEFORMITIES AND PHONETIC DISORDERS

Recently, there has been a tendency for the growth of dentognathic deformities of various origins, accompanied by phonetic abnormalities. Aim - to increase the effectiveness of orthodontic treatment of dentognathic deformities, accompanied by phonetic disorders, by developing and justifying a set of diagnostic and therapeutic measures based on a multidisciplinary approach. The influence of the state of ENT organs on the formation of dentognathic deformities and phonetic disturbances is studied in 155 children. A clinical dental examination and orthodontic treatment is performed in 82 patients aged 6-12 years. Individual corrective speech therapy work has been carried out to overcome the defects of the phonological side of speech. A certain pathological "chain" of cause-effect relationships of dentognathic deformities with phonetic disorders and diseases of the ENT organs became the basis for a multidisciplinary approach to solving the problems identified. The qualitative and quantitative dependence of sound deterioration on the type of orthognathic deformities is established. A complex of diagnostic and therapeutic measures for patients with dental deformities accompanied by phonetic disorders, consisting of motivational, diagnostic and therapeutic blocks, has been developed and introduced into practice. The proposed complex of diagnostic and treatment measures made it possible to increase the efficiency of orthodontic treatment of children with dentognathic deformities with disturbances of sound pronunciation depending on the type of bite by means of a multidisciplinary approach involving an otolaryngologist, speech therapist, children's therapist and surgeon, which was confirmed in 86.6% of patients by the improvement of electromyography, anthropometric measurements of scanned models of jaws, cephalometry; the analysis of cone-beam computed tomography data showed a significant increase in the upper respiratory tract volume by 53.8±4.2%.

SULPHUR-CONTAINING AMINO ACIDS METABOLISM IN EXPERIMENTAL HYPER- AND HYPOTHYROIDISM IN RATS

Hyper- and hypothyroidism are some of the most common endocrinopathies that cause many metabolic disorders including amino acids metabolism. However, a specific molecular mechanism of thyroid hormones influence on sulphur-containing amino acids metabolism has not been established. The aim of our research was to investigate experimentally the influence of thyroid gland functional state on the main enzymatic systems of sulphur-containing amino acids metabolism in liver and kidneys, the content of homocysteine, cysteine and H2S in blood. The rats were administered with L-thyroxine and mercazolil to simulate the states of hyper- and hypothyroidism, which were confirmed by the content of fT3, fT4 and TSH in the blood. In liver and kidneys of the animals with hypothyroidism we observed the decrease in the activity of enzymes of remethylation cycle of S-adenosylmethioninsyntase, S-adenosylhomocysteinhyhdrolase, betaine-homocysteine methyltransferase. Suppression of transsulfuration transformation of homocysteine to cysteine in hypothyroidism was mainly due to the inhibition of cystathionine synthase activity of cystathionine-β-synthase, wherein cystathionase activity of cystathionine-γ-lyase was not changed. In animals with hypothyroidism we also noticed the inhibition of cysteine desulfunation reactions: the activity of enzymes of cystathionine-β-synthase, cystathionine-γ-lyase and cysteine aminotransferase significantly decreased in liver and kidneys. Experimental hyperthyroidism was accompanied by increase in activity of remethylation cycle enzymes, increase in cystationine synthase activity of cystathionine-β-synthase in liver and activity of these enzymes in kidneys. The simulation of hyperthyroidism led to the decrease of homocysteine concentration, and of hypothyroidism - to the increase of homocysteine and cysteine concentrations and reduced H2S content in blood of the animals. Thus, the significant risk factors for the development of atherosclerosis, endothelial dysfunction and hypercoagulation in hypothyroid conditions may be the disorders in the processes of remethylation, transsulfuration, and desulfuration of sulphur-containing amino acids in organs.

Visible-range hollow waveguides by guided buckling of Ta2O5/SiO2 multilayers

Hollow waveguides operating near 550 nm wavelength were fabricated by guided formation of delamination buckles within Ta₂O₅/SiO₂ multilayers. The fabrication process employed a pair of sequentially deposited 10-period Bragg mirrors separated by a patterned, low-adhesion fluorocarbon layer. Propagation loss as low as a few dB/cm was measured, consistent with theoretical predictions.

Air gap resonant tunneling bandpass filter and polarizer

We describe a bandpass filter based on resonant tunneling through an air layer in the frustrated total internal reflection regime, and show that the concept of induced transmission can be applied to the design of thin film matching stacks. Experimental results are reported for Si/SiO2-based devices exhibiting a polarization-dependent passband, with bandwidth on the order of 10 nm in the 1550 nm wavelength range, peak transmittance on the order of 80%, and optical density greater than 5 over most of the near infrared region.

Concentration and sources of polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) in surface soil near a municipal solid waste (MSW) landfill

Due to a continuous demand of land for infrastructural and residential development there is a public concern about the condition of surface soil near municipal solid waste landfills. A total of 12 surface (0-20 cm) soil samples from a territory near a landfill were collected and the concentration of 16 PAHs and 7 PCB congeners were investigated in these samples. Limits of detection were in the range of 0.038-1.2 μg/kg for PAHs and 0.025-0.041 μg/kg for PCBs. The total concentration of ∑ PAHs ranged from 892 to 3514 μg/kg with a mean of 1974 μg/kg. The total concentration of ∑ PCBs ranged from 2.5 to 12 μg/kg with a mean of 4.5 μg/kg. Data analyses allowed to state that the PAHs in surface soils near a landfill were principally from pyrogenic sources. Due to air transport, PAHs forming at the landfill are transported outside the landfill. PCB origin is not connected with the landfill. Aroclor 1242 can be the source of PCBs in several samples.

Chemical pollution and toxicity of water samples from stream receiving leachate from controlled municipal solid waste (MSW) landfill

The present study was aimed to determine the impact of municipal waste landfill on the pollution level of surface waters, and to investigate whether the choice and number of physical and chemical parameters monitored are sufficient for determining the actual risk related to bioavailability and mobility of contaminants. In 2007-2012, water samples were collected from the stream flowing through the site at two sampling locations, i.e. before the stream׳s entry to the landfill, and at the stream outlet from the landfill. The impact of leachate on the quality of stream water was observed in all samples. In 2007-2010, high values of TOC and conductivity in samples collected down the stream from the landfill were observed; the toxicity of these samples was much greater than that of samples collected up the stream from the landfill. In 2010-2012, a significant decrease of conductivity and TOC was observed, which may be related to the modernization of the landfill. Three tests were used to evaluate the toxicity of sampled water. As a novelty the application of Phytotoxkit F™ for determining water toxicity should be considered. Microtox(®) showed the lowest sensitivity of evaluating the toxicity of water samples, while Phytotoxkit F™ showed the highest. High mortality rates of Thamnocephalus platyurus in Thamnotoxkit F™ test can be caused by high conductivity, high concentration of TOC or the presence of compounds which are not accounted for in the water quality monitoring program.

Wavelength interrogation of fiber Bragg grating sensors using tapered hollow Bragg waveguides

We describe an integrated system for wavelength interrogation, which uses tapered hollow Bragg waveguides coupled to an image sensor. Spectral shifts are extracted from the wavelength dependence of the light radiated at mode cutoff. Wavelength shifts as small as ~10  pm were resolved by employing a simple peak detection algorithm. Si/SiO₂-based cladding mirrors enable a potential operational range of several hundred nanometers in the 1550 nm wavelength region for a taper length of ~1  mm. Interrogation of a strain-tuned grating was accomplished using a broadband amplified spontaneous emission (ASE) source, and potential for single-chip interrogation of multiplexed sensor arrays is demonstrated.

Second malignancies

The secondary development of malignant tumors after the treatment of Hodgkin's disease has been termed the price of success, but is relevant also to other types of cancer and gives an opportunity to study mechanisms of carcinogenesis and tumor induction. The authors review here their experience with second malignant neoplasms (SMN) as well as the result of an extensive search of the recent literature. The primary malignancies discussed in this article include Hodgkin's disease, pediatric cancer, breast cancer, lung cancer and other types of tumors. The international literature was searched (Medline 1989-1995) for reports of SMN with special emphasis on risk factors and the molecular mechanisms of tumor induction. In Hodgkin's disease, a 3 to 5-fold elevated risk for SMN was recognized, with a 15-year cumulative incidence in the range of 11-18%. All types of malignancies have a statistically increased risk (leukemias, non-Hodgkin's lymphomas, solid tumors). The risk for leukemia is related to the intensity of treatment with alkylating agents. Some solid tumors like lung cancer or breast cancer are related to radiation therapy. Present-day treatments may carry a lower risk of inducing secondary malignancies than treatments in the past. For non-Hodgkin's lymphoma as primary malignancy, fewer data exist on SMN. In pediatric cancer, no general risk estimate can be given and the genetic influence is greater as a cause of SMN. The improved prognosis for acute lymphoblastic leukemia has led to a changing pattern of pediatric SMN. In head and neck- and in lung cancer, the same etiologic factors which cause the primary tumor may also cause SMN. SMN occur as part of familial cancer syndromes. Two types of treatment related leukemias (mostly AMLs) exist and can be recognized by cytogenetic and molecular analysis. A complete follow-up is necessary to fully appreciate the risk of second malignancy. The goal to prevent SMN must be reached without decreasing the cure rates of the primary tumor. New treatment approaches need to be carefully monitored for SMN. Improved tests of mutagenesis and molecular screening may help to recognize patients prone to develop SMN and permit to estimate certain types of risk. Screening and prevention strategies are useful in high-risk situations.

Updated survival and outcomes for older adults with inoperable stage III non-small-cell lung cancer treated with cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel: analysis of a phase III trial from the Hoosier Oncology Group (HOG) and US Oncology

BACKGROUND

Concurrent chemoradiation with etoposide and cisplatin (EP/XRT) is standard treatment for inoperable stage III locally advanced non-small-cell lung cancer (LA-NSCLC). Consolidation docetaxel (D; Taxotere) after EP/XRT resulted in increased toxicity but no improvement in survival compared with observation (O). We report updated survival for the entire study population and include an analysis of efficacy and tolerability of EP/XRT with or without D in patients aged ≥ 70 years.

PATIENTS AND METHODS

Hoosier Oncology Group LUN 01-24 enrolled 243 patients with LA-NSCLC and randomized 166 after EP/XRT to three cycles of D versus O. the trial was terminated after an analysis of the first 203 patients demonstrated futility of D.

RESULTS

Median survival time (MST) for the overall study population was 21.5 months, and 3-, 4-, and 5-year survival rates were 30.7%, 18.0%, and 13.9%, respectively. No differences in MST or 3-year survival were noted between D and O arms. Older patients had similar MST (17.1 versus 22.8 months for younger patients, P = 0.15) but higher rates of grade 3/4 toxicity and hospitalization during induction.

CONCLUSIONS

Consolidation docetaxel after EP/XRT does not improve survival in LA-NSCLC. Fit older adults with LA-NSCLC benefit from concurrent chemoradiation similarly as younger patients but experience higher rates of hospitalization and toxicity.

Sim1 haploinsufficiency causes hyperphagia, obesity and reduction of the paraventricular nucleus of the hypothalamus

The bHLH-PAS transcription factor SIM1 is required for the development of the paraventricular nucleus (PVN) of the hypothalamus. Mice homozygous for a null allele of Sim1 (Sim1(-/-)) lack a PVN and die perinatally. In contrast, we show here that Sim1 heterozygous mice are viable but develop early-onset obesity, with increased linear growth, hyperinsulinemia and hyperleptinemia. Sim1(+/-) mice are hyperphagic but their energy expenditure is not decreased, distinguishing them from other mouse models of early-onset obesity such as deficiencies in leptin and melanocortin receptor 4. Quantitative histological comparison with normal littermates showed that the PVN of Sim1(+/-) mice contains on average 24% fewer cells without a selective loss of any identifiable major cell type. Since acquired lesions in the PVN also induce increased appetite without a decrease in energy expenditure, we propose that abnormalities of PVN development cause the obesity of Sim1(+/-) mice. Severe obesity was described recently in a patient with a balanced translocation disrupting SIM1. Pathways controlling the development of the PVN thus have the potential to cause obesity in both mice and humans.

Multilocular fat cells in WAT of CL-316243-treated rats derive directly from white adipocytes

Multilocular, mitochondria-rich adipocytes appear in white adipose tissue (WAT) of rats treated with the beta3-adrenoceptor agonist, CL-316243 (CL). Objectives were to determine whether these multilocular adipocytes derived from cells that already existed in the WAT or from proliferation of precursor cells and whether new mitochondria contained in them were typical brown adipocyte mitochondria. Use of 5-bromodeoxyuridine to identify cells that had undergone mitosis during the CL treatment showed that most multilocular cells derived from cells already present in the WAT. Morphological techniques showed that at least a subpopulation of unilocular adipocytes underwent conversion to multilocular mitochondria-rich adipocytes. A small proportion of multilocular adipocytes ( approximately 8%) was positive for UCP1 by immunohistochemistry. Biochemical techniques showed that mitochondrial protein recovered from WAT increased 10-fold and protein isolated from brown adipose tissue (BAT) doubled in CL-treated rats. Stained gels showed a different protein composition of new mitochondria isolated from WAT from that of mitochondria isolated from BAT. Western blotting showed new mitochondria in WAT to contain both UCP1, but at a much lower concentration than in BAT mitochondria, and UCP3, at a higher concentration than that in BAT mitochondria. We hypothesize that multilocular adipocytes present at 7 days of CL treatment have two origins. First, most come from convertible unilocular adipocytes that become multilocular and make many mitochondria that contain UCP3. Second, some come from a cell that gives rise to more typical brown adipocytes that express UCP1.

A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up

The purpose of this study was to provide 1 year follow-up data to a previous paper that compared single-session (SS) treatment to treatment-as-needed (TAN) outcomes for mild traumatic brain injury (MTBI) survivors at 3 months post-injury. Participants were 105 adults with MTBI who were recruited from consecutive admissions to two hospital emergency wards, and randomly assigned to either the SS or TAN modality. No group differences in outcome were evident at 12 months post-injury. As well, improvements seen in the groups after 3 months were maintained at 12 months. As improvements between 3 and 12 months were negligible, self-reported improvement after a treated MTBI typically occurred within the first 3 months. Brief educational intervention given soon after MTBI appears to be as helpful as more intensive treatment for most MTBI survivors for at least 12 months post-injury.

Temperature-dependent feeding: lack of role for leptin and defect in brown adipose tissue-ablated obese mice

The objective was to characterize the ability of control and transgenic brown adipose tissue (BAT)-ablated uncoupling protein diphtheria toxin A chain (UCP-DTA) mice to adjust food intake in relation to changes in environmental temperature and to assess the involvement of leptin in this adjustment. We measured serum leptin in mice from a previous study of UCP-DTA mice raised at thermoneutrality (35 degrees C) or at the usual rearing temperature (24 degrees C) from weaning [Melnyk, A., M. -E. Harper, and J. Himms-Hagen. Am. J. Physiol, 272 (Regulatory Integrative Comp. Physiol. 41): R1088-R1093, 1997] and extended the study by acclimating control and obese UCP-DTA mice at 18 wk of age to cold (14 degrees C) for up to 14 days. Leptin levels did not change in control mice at 14 degrees C; however, food intake increased threefold within 1 day and remained at this level. Serum leptin level was elevated in UCP-DTA mice at 24 degrees C compared with control mice at 24 degrees C; this elevated level decreased within 1 day at 14 degrees C and was not different from the level in control mice by 14 days. Food intake of UCP-DTA mice that were hyperphagic at 24 degrees C did not change during 7 days at 14 degrees C, then increased slowly. Similar low leptin levels were present in control mice raised at 24 or 35 degrees C and in UCP-DTA mice raised at 35 degrees C. Food intake of control mice raised at 24 degrees C was two times that of control mice raised at 35 degrees C. UCP-DTA mice raised at 35 degrees C ate the same low amount as control mice raised at 35 degrees C. UCP-DTA mice at 24 degrees C were hyperphagic relative to control mice at 24 degrees C yet had elevated leptin levels in their serum. Two principal conclusions are drawn. First, adjustment of food intake over a fourfold range by control mice acclimated to temperatures from 35 down to 14 degrees C is independent of changes in serum leptin levels. Second, this adjustment of food intake in relation to temperature is defective in the UCP-DTA mouse; the defect leads to hyperphagia at 24 degrees C and a failure to increase food intake as rapidly as control mice when exposed to 14 degrees C. Because lack of UCP-1-mediated thermogenesis in BAT of knockout mice is known not to induce hyperphagia, we propose that deficiency of UCP-1-expressing brown adipocytes in BAT of UCP-DTA mice results in lack of a satiety factor, secreted by these cells in BAT of control mice in inverse relationship to sympathetic nervous system activity.

Evaluation of the Revised European-American Lymphoma classification confirms the clinical relevance of immunophenotype in 560 cases of aggressive non-Hodgkin's lymphoma

The Revised European-American Lymphoma (REAL) classification has been criticized for its emphasis on the unproven clinical relevance of immunophenotype. A worse prognosis for peripheral T-cell non-Hodgkin's lymphomas (PTCLs) has been inconsistently reported in part because the definition of PTCL has been imprecise (eg, T-cell-rich B-cell non-Hodgkin's lymphomas [TCRBCLs] have been misdiagnosed as PTCLs in the past) and because its correlation with other known prognostic factors has not been studied by multivariate analysis. We analyzed six protocols from 1984 to 1995 with Working Formulation intermediate grade and immunoblastic lymphomas (exclusive of mantle cell) and selected only those cases in which immunophenotyping was performed and was conclusive. Of a total of 560 evaluable patients, 68 were PTCLs (12%) and the remaining 492 (88%) were B-cell non-Hodgkin's lymphomas, including 16 TCRBCLs (3% of total). The 5-year failure-free survival (FFS) for PTCLs and B-cell large-cell lymphomas (BCLCLs) is 38% and 55%, respectively (P < .0001) and the 5-year overall survival (OS) is 39% and 262%, respectively (P < .001). The M.D. Anderson prognostic tumor score (MDATS) and International Prognostic Index (IPI) for all patients was calculated. With MDATS of less than 3 (good prognosis), the 5-year FFS for PTCL and BCLCL is 56% and 69%, respectively (P = .01), and the 5-year OS is 64% and 77%, respectively (P = .06). With MDATS of greater than 2 (poor prognosis), 5-year FFS for PTCL and BCLCL is 26% and 38%, respectively (P = .03), and the 5-year OS is 24% and 41%, respectively (P = .02). With an IPI of less than 3 (good prognosis), the 5-year FFS for PTCL and BCLCL is 49% and 64%, respectively (P = .001), and the 5-year OS is 55% and 71%, respectively (P = .013). With an IPI greater than 2 (poor prognosis), the 5-year FFS for PTCL and BCLCL is 11% and 35%, respectively (P = .044), and the 5-year OS is 10% and 40%, respectively (P = .011). Multivariate analysis shows that MDATS, IPI, and T-cell phenotype are totally independent and are the most significant predictors of FFS and OS. The 68 PTCLs include 45 PTCLs unspecified, 10 Ki-1 anaplastic (ALCL), 8 angioimmunoblastic, and 5 angiocentric lymphomas. Angiocentrics were usually refractory (1 of 5 remissions only). ALCL rarely relapsed late. We conclude that the immunophenotypic basis of the REAL classification is clinically relevant and that, although other prognostic features also influence outcome, the T-cell phenotype still remains an independent and significant prognostic factor.

Raising at thermoneutrality prevents obesity and hyperphagia in BAT-ablated transgenic mice

Transgenic mice with ablation of brown adipocytes induced by brown adipocyte-specific expression of diphtheria toxin A chain (DTA) driven by the uncoupling protein (UCP) promoter (UCP-DTA mice) become obese and hyperphagic (Lowell, B. B., V. S. Susulic, A. Hamann, J. A. Lawitts, J. Himms-Hagen, B. B. Boyer, L. P. Kozak, and J. S. Flier. Nature 366: 740-742, 1993). A deficit in energy expenditure for brown adipose tissue (BAT) thermogenesis in these mice is presumed to contribute to the development of obesity. The objective of the present study was to obviate any deficit in BAT thermogenesis by raising transgenic and control mice at thermoneutrality (35 degrees C), where both would have equally inactive BAT, to see whether this would prevent the obesity and the hyperphagia. Transgenic and control mice were raised from weaning (3 wk of age) to 8 wk of age at either 24 or 35 degrees C. Raising at 35 degrees C completely prevented development of obesity of UCP-DTA mice, as indicated by their normal carcass fat, normal weights of four major white adipose tissue depots, and normal size of white adipocytes. As seen before, transgenic mice raised at 24 degrees C had excess weight gain by 6 wk of age and by 8 wk had doubled carcass fat, an obesity characterized by increased white adipocyte size with no increase in number of adipocytes. The treatment also prevented hyperphagia of UCP-DTA mice, consistent with the hypothesized role of BAT thermogenesis in control of thermoregulatory feeding (Himms-Hagen, J. Proc. Soc. Exp. Biol. Med. 208: 159-169, 1995). UCP-DTA mice thus differ from genetically obese mice (ob/ob, db/db) for which raising at thermoneutrality is known not to prevent either the obesity or the hyperphagia. Both the obesity and the hyperphagia of UCP-DTA mice appear to be due to their deficit in BAT thermogenesis.

Ukrain therapy in a frontal anaplastic grade III astrocytoma (case report)

Ukrain, a semisynthetic thiophosphoric acid compound of alkaloid chelidonine from Chelidonium majus L. (1) causes regression of various tumours. Among other effects, its action seems to depend on the stimulation of the immune system which very often is deficient in cancer patients. Its use in a patient with subtotal extirpation of a frontal anaplastic grade III astrocytoma seems to have reduced growth speed significantly.

Combined therapy with Ukrain and chemotherapy in ovarian cancer (case report)

A patient with adenocarcinoma in the right ovary with lymphangitis carcinomatosa, staged as G II-G III pT3, pNX, pMX, was treated after palliative surgery by chemotherapy and, simultaneously, with Ukrain. Two and a half years after treatment the patient is without any signs of tumour recurrence. Her condition is excellent.

Lethal tracheal dissolution during treatment for thyroid lymphoma

Background - A case of primary thyroid T cell lymphoma leading to lethal tracheal perforation during chemotherapy is described.

Resistance to aging-associated obesity in capsaicin-desensitized rats one year after treatment

Previous studies demonstrated reduced weight of abdominal white adipose tissue depots and of carcass fat in capsaicin-desensitized (Cap-Des) rats up to 8 months after treatment. The objective of the present study was to find out whether aging-associated obesity and hyperplasia of retroperitoneal white adipose tissue was prevented in older (13.5 months old) Cap-Des rats, one year after treatment with Cap (done when they were 1.5 months old). The prevalence of obesity is known to increase in rats by this age. Abdominal white adipose tissue depots weighed less in old Cap-Des rats, both epididymal (9% less) and retroperitoneal (30% less). The number of mature white adipocytes was 28% less in the retroperitoneal depot but was not significantly different in the epididymal depot. Adipocyte size was not different. Carcass fat was less, both total and as percent of body weight. Food intake was normal for their reduced body size. The exponential increase in retroperitoneal white adipose tissue weight characteristic of aging rats that are becoming obese was virtually absent in Cap-Des rats. We conclude that lack of function of capsaicin-sensitive afferent autonomic nerves, known to be destroyed in Cap-Des rats, results in an alteration in energy balance conducive to leanness. We suggest that the attenuated age-associated increase in circulating CGRP (derived mainly from capsaicin-sensitive nerves) in the Cap-Des rat results in a lower degree of aging-associated insulin-resistance, hence in a lesser degree of obesity.

Three-hour paclitaxel infusion in patients with refractory and relapsed non-Hodgkin's lymphoma

PURPOSE

Paclitaxel (Taxol; Bristol-Myers Squibb Co, Princeton, NJ) is a novel antimicrotubule agent with anti-tumor activity against ovarian and breast carcinomas. Its activity when administered as a 3-hour intravenous infusion in patients with relapsed non-Hodgkin's lymphoma (NHL) has not been studied.

PATIENTS AND METHODS

Patients with relapsed NHL were treated with a 3-hour infusion of 200 mg/m2 of Taxol every 3 weeks in an outpatient setting. All patients received premedication (dexamethasone, diphenhydramine, and cimetidine) to prevent allergic reactions. Responses were assessed after two courses of therapy, and patients who achieved at least partial remission (PR) continued to receive Taxol for a maximum of eight courses.

RESULTS

Of 60 eligible patients, 54 (90%) were assessable for treatment toxicity and 53 (88%) were for treatment response (22 with primary refractory and 31 with relapsed disease). Twelve patients (23%) achieved a PR (n = 6) or complete remission (CR; n = 6) (95% confidence interval, 12% to 36%). Responses were observed in intermediate-grade (31%), low-grade (14%), and mantle-cell (17%) lymphomas. In the intermediate-grade lymphomas, there was a trend for a higher response rate in relapsed versus primary refractory disease (54% v 13%; P = .08). Treatment-related toxicity included alopecia (100%), peripheral neuropathy (37%), myalgia or arthralgia (25%), and neutropenic fever (11%). None of the patients had allergic reactions or cardiac toxicity.

CONCLUSION

At this dose and schedule, Taxol is an active agent in patients with relapsed NHL and can be safely administered in an outpatient setting. Combination programs with Taxol should be investigated for treatment of NHL.

Congenital polyvalvular cardiac disease without chromosomal abnormalities

Congenital polyvalvular cardiac disease has been reported in association with trisomies 18, 13, and 15. Ninety-three percent of trisomy 18 patients have polyvalvular disease, and 34% have all four valves involved. Four cases of polyvalvular disease without chromosomal abnormalities were studied and compared to polyvalvular disease with trisomy. In these four cases, all four valves were markedly abnormal with nodularity and reductant tissue; one aortic and two pulmonary valves were bicuspid; and one aortic, two tricuspid, and three mitral valves were unicuspid. The chordae tendineae were generally abbreviated and papillary muscles were hypoplastic. Microscopically, the valves had spongiosis, vacuolar degeneration, and a decrease in elastic fibers. Multiple other cardiac anomalies were present in each case. Three of the four cases also had significant extracardiac anomalies, which were lethal in two cases. The fourth case with no other anomalies had a history of maternal tobacco, alcohol, and cocaine abuse, with the latter being detected in fetal urine after birth. There does not appear to be a significant difference between polyvalvular disease with and without trisomy. Polyvalvular disease is usually not an isolated disorder but is associated with other intra- and extracardiac anomalies.

T-cell acute lymphoblastic leukemia with t(1;18)(p36;q22)

An 8-year-old white boy with a T-cell acute lymphoblastic leukemia (T-ALL) developed chromosomal abnormalities t(1;18)(p36;q22) and del (6)(q21) at the first bone marrow relapse. Rearrangements of the chromosome region 1p36 have been reported previously in adults with T-ALL.

Complex translocations in a patient with chronic myelocytic leukemia: t(9;22;17) and t(10;18;19) after two failed bone marrow transplantations

A 6-year-old white boy with chronic myelogenous leukemia (CML) (adult type) developed complex translocations after a bone marrow transplant (BMT): t(9;22;17)(q34;q11;p12) t(10;18;19)(p11;q11;p12) and in the accelerated phase. The patient relapsed after his BMT and underwent a second BMT after a documented blast crisis. The previous karyotypic translocations persisted.