A systematic review of the prevalence of pathogenic or likely pathogenic germline variants in individuals with FOXO1 fusion-positive rhabdomyosarcoma

Several cancer predisposition syndromes (CPS) are reported to predispose to rhabdomyosarcoma, most frequently in children with embryonal rhabdomyosarcoma. There are lingering questions over the role of CPS in individuals with alveolar rhabdomyosarcoma (ARMS), which are frequently driven by FOXO1 fusion oncoproteins. We conducted a systematic review to identify patients with FOXO1 fusion-positive ARMS (FP-ARMS) who underwent germline DNA sequencing. We estimated the prevalence of pathogenic/likely pathogenic (P/LP) variants in cancer predisposing genes (CPGs) and of CPSs. We included 19 publications reporting on 191 patients with FP-ARMS. P/LP variants in CPGs were identified in 26/191 (13.6%) patients, nine (4.9%) of which were associated with a CPS diagnosis. Evidence for causal associations between CPSs and FP-ARMS could not be assessed with available data from this review. Only one patient was affected with a CPS known to predispose to rhabdomyosarcoma, Li-Fraumeni syndrome. Typical CPS associations with rhabdomyosarcoma are rare, but not nonexistent, in patients with FP-ARMS. FOXO1 fusion status, alone, is insufficient for clinicians to rely on to distinguish between patients with/without CPS.

Multicenter real-world experience of the clinical efficacy and tolerance of pazopanib in high-risk pediatric solid tumors (PazoPed)

Pazopanib, a receptor tyrosine kinase inhibitor, exhibits anti-tumor activity in adult bone and soft-tissue sarcomas (STS), but has not yet been approved for pediatric tumors. The primary objective was to evaluate pazopanib efficacy when used alone or in combination with topotecan. This real-world multicenter retrospective study included patients with solid tumors, aged 25 years or less at the time of initial diagnosis, treated with pazopanib outside of a clinical trial. Nineteen patients were eligible for efficacy analysis: 14 bone tumors and 5 STS. At pazopanib initiation, the median age was 16.9 years, 18 patients had metastatic disease with a median of 2 prior therapeutic lines. With 6.2 months of median follow-up, no objective response was observed, but 10 patients (52.6%) had stable disease at 8 weeks and the 6-month disease control rate was 26.3%. The median progression free (PFS) and overall survival (OS) were 3.0 months and 6.2 months, respectively. Multivariate analysis showed an inverse relationship between the number of prior treatment lines and PFS and OS (hazard ratio = 1.73 (p = 0.04) and 1.76 (p = 0.03), respectively). Our study showed a potential tumor control activity of pazopanib in pediatric bone and soft tissue sarcomas. Further studies are warranted to determine the optimal timing and condition for pazopanib introduction to maximize the effect.

Assessing risk in the retail environment during the COVID-19 pandemic

The COVID-19 pandemic has caused unprecedented disruption, particularly in retail. Where essential demand cannot be fulfilled online, or where more stringent measures have been relaxed, customers must visit shop premises in person. This naturally gives rise to some risk of susceptible individuals (customers or staff) becoming infected. It is essential to minimize this risk as far as possible while retaining economic viability of the shop. We therefore explore and compare the spread of COVID-19 in different shopping situations involving person-to-person interactions: (i) free-flowing, unstructured shopping; (ii) structured shopping (e.g. a queue). We examine which of (i) or (ii) may be preferable for minimizing the spread of COVID-19 in a given shop, subject to constraints such as the geometry of the shop; compliance of the population to local guidelines; and additional safety measures which may be available to the organizers of the shop. We derive a series of conclusions, such as unidirectional free movement being preferable to bidirectional shopping, and that the number of servers should be maximized as long as they can be well protected from infection.

Assessment of florfenicol as a possible treatment for chlamydiosis in koalas (Phascolarctos cinereus)

OBJECTIVE

Because of limited availability of chloramphenicol to veterinary suppliers, a preliminary study was performed to predict whether an analogue, florfenicol, is an efficacious treatment for chlamydiosis in koalas.

METHODS

Florfenicol was administered to koalas with naturally occurring chlamydiosis at 20 mg/kg SC (n = 3) and at 5 mg/kg (n = 3) and 10 mg/kg (n = 3) IV. The estimated areas under the plasma concentration versus time curves (AUC) were compared with the minimum inhibitory concentration to inhibit Chlamydia pecorum. Clinical data were also examined from field trials conducted on koalas (n = 19) with naturally occurring chlamydiosis and treated with florfenicol at a range of dosages (5-20 mg/kg SC and 6-15 mg/kg IV). Florfenicol binding to proteins in plasma was also determined.

RESULTS

Florfenicol was not detectable in plasma 24 h post-administration at 20 mg/kg SC. The estimated AUC_0-24 h following administration at 10 mg/kg IV suggests florfenicol might be effective against Chlamydia spp. via this route. Florfenicol binding to plasma proteins was 13.0% (± 0.30 SEM). After treatment with florfenicol in field trials, 5 of 19 koalas (26%) were released without further treatment, 4 with no long-term follow-up; 6 (32%) required additional treatment with chloramphenicol to resolve chlamydiosis; 7 (36%) failed to clinically improve, of which 3 had clinical signs and/or necropsy findings suggestive of antibiotic-related gastrointestinal dysbiosis; another koala died within minutes of florfenicol administered IV at 7 mg/kg.

CONCLUSION

When administered at dosages tolerable in the field, florfenicol is a problematic treatment for chlamydiosis based on equivocal outcomes and plasma concentrations below those that inhibit the pathogen.

A model of cooperation between complementary and allopathic medicine in a primary care setting

This paper describes an acupuncture and osteopathy service offered free of charge to patients at a National Health Service general practice. The background to the setting up of this service, its organization, funding, aims and philosophy, and the ethical and legal implications for the general practitioners whose patients are treated by complementary therapists are discussed. This service provides a model of cooperation between allopathic and complementary medicine in a primary care setting and could be copied elsewhere.

Relationship between in utero development of the mouse liver and tumor development following transplacental exposure to ethylnitrosourea

Pregnant C3HeB/FeJ mice were treated with ethylnitrosourea (ENU) on one of gestation Days 10, 13, or 15 to determine if ENU treatment at different stages of gestation would result in morphological or quantitative differences in liver tumors induced in the offspring. Liver tumors were counted and measured 6 mo after treatment with ENU. Foci of cellular alteration were identified histologically and counted. Liver tumor number and foci of cellular alteration increased as a function of increasing dose and age at the time of ENU treatment. An inverse relationship between age at the time of treatment and the size of liver tumors was found. The mean tumor volume of male mice exposed on Day 10 of gestation was 123-fold larger than for spontaneous tumors observed in controls. The differences between mean liver tumor volume in mice which had been exposed to ENU on Days 10, 13, or 15 of gestation appeared to be associated with the exponential growth of the fetus during this period of gestation. Unique, large, multinodular foci of cellular alteration were found in mice treated on Day 10 of gestation. The relationship between the stage of gestation and the size of chemically induced liver tumors in these mice is similar to previous observations with transplacentally induced lung tumors in C3HeB/FeJ mice. This indicates that developmentally regulated cell proliferation occurring at the time of carcinogen exposure may affect the subsequent extent of tumor development in both the liver and lung. Therefore, cells transformed during early development may result in tumors that pose a greater biological hazard than those transformed in later development.

Effect of gestational development of lung tumor size and morphology in the mouse

Pregnant C3HeB/FeJ mice were treated with ethylnitrosourea (ENU) on one of gestation Days 10, 13, or 15 to determine if ENU treatment at different stages of gestation would result in qualitative or quantitative differences in lung tumors induced in the offspring. Lung tumors were counted and measured 6 mo after treatment with ENU. Offspring of mice treated with ENU on Day 10 of gestation had a small increase in lung tumors while those treated on gestation Day 13 or 15 had significantly more tumors than controls and 6- to 8-fold more tumors than the treated mothers. An inverse relationship between age at the time of treatment and lung tumor size was found. The mean lung tumor volume of mice exposed on Day 10 of gestation was 167-fold larger than that of mice exposed to ENU as adults. The difference between mean lung tumor volume in mice which had been exposed to ENU on Day 10, 13, or 15 of gestation appeared to be associated with the exponential growth of the fetus during this period of gestation. Lung tumors induced on Days 10 and 13 of gestation were irregular in contour and were multinodular. Sixty-five to 85% of the lung tumors in offspring treated during gestation versus 20% in mice treated as adults had a papillary morphology. These differences in tumor size and morphology indicate that cells transformed during early development may pose a greater biological hazard than cells transformed in older animals.

Value of immunoglobulin E (IgE) in the private practice of allergy. Eight years experience: 1973-1981

In private practice the majority of patients evaluated by allergists are truly atopic. To assess the clinical value of determining the serum level of immunoglobulin E (IgE) in such patients the records of an individual private allergist were reviewed and all new patients were evaluated. Over an eight year period 7,000 new patients were seen and 5,500 measurements of IgE were performed. An elevated serum IgE value was indicative of the atopic state with few false positives. Successful immunotherapy as determined by patient reports, the decreased use of medications and reduced clinical visits was correlated positively with a decrease in serum IgE levels. This was true regardless of the initial value of the IgE. Unsatisfactory results in immunotherapy were often accompanied by an increase in IgE levels. Serial determinations of serum IgE levels over several years of treatment are of value in the evaluation of allergic patients in private practice.