Mechanical and Optical Characterization of Single-shade Resin Composites Used in Posterior Teeth

OBJECTIVES

This study aimed to evaluate the optical and mechanical performance of two single-shade resin-based composites (RBCs) compared to those of a conventional RBC for restoring posterior teeth.

METHODS

Two single-shade RBCs, Omnichroma (Tukoyama) and Vittra Unique APS (FGM), and a conventional RBC, Filtek Z350XT shade A2 (3M Oral Care), were evaluated in this study. The optical shade-matching performance was measured using a spectrophotometer. The light emitted by VALO Grand (Ultradent) and transmitted through the 2.0-mm RBC specimens was evaluated using beam profiling. Knoop hardness (KH, N/mm2), degree of conversion (DC, %) at the top and bottom, flexural strength (FS, MPa), elastic modulus (E, GPa), postgel shrinkage (Shr, %), and shrinkage stress (MPa) were evaluated. Scanning electron microscopy (SEM) was used to characterize the filler. Data for FS, E, and Shr were analyzed by one-way analysis of variance (ANOVA) and KH and DC by repeated one-way ANOVA measurement followed by Tukey test (α=0.05). The modified von Mises stress values, light transmission, and SEM images were analyzed qualitatively.

RESULTS

All single-shade RBCs exhibited higher chromatic adaptation than the Filtek Z350XT (p<0.001). Omnichroma exhibited less color difference than Vittra Unique APS, irrespective of the shade. The light transmitted through Omnichroma and Vittra Unique APS increased during polymerization. KH and DC values were significantly reduced from the top to the bottom of the specimens for all RBCs (p<0.001); however, the ratio values were always higher than 80%. In general, all RBCs demonstrated similar mechanical properties. All RBCs exhibited a similar FS (p=0.083) and Shr value (p=0.144). Filtek Z350XT exhibited significantly higher E (p<0.001) than both single-shade RBCs. All RBCs exhibited similar shrinkage stress during restoration and similar residual stress during occlusal loading.

CONCLUSIONS

Single-shade Omnichroma and Vittra Unique APS increased light transmission during light-activation, demonstrating better chromatic adaptation than conventional Filtek Z350XT. In general, Omnichroma and Vittra Unique APS exhibited similar mechanical properties and shrinkage stress distributions as Filtek Z350XT during light-activation and occlusal loading.

Hablando at home: Examining the interactional resources of a bilingual autistic child

Daily language interactions predict child outcomes. For multilingual families who rear neurodiverse children and who may be minoritized for their language use, a dearth of research examines families' daily language interactions. Utilizing a language socialization framework and a case study methodology, 4,991 English and Spanish utterances from a 5-year old autistic child and his family were collected during naturally occurring interactions over 10 days. Utterances were analyzed for patterns of code-switching by speaker, activity setting, English or Spanish initial language, and code-switch function. Spanish was spoken in most activities. For reading, both languages were equally employed by the father. While participants used both languages across all activity settings, significant variations in code-switching type and function were observed by activity setting and speaker. We discuss implications for how home language resources can be integrated into autism interventions.

Biomass and enzymatic activities of marine bacteria in the presence of multiple metals

Marine environments are a repository for metals, and humans have enhanced this phenomenon over the years. Heavy metals are notoriously toxic due to their ability to biomagnify in the food chain and interact with cellular components. Nevertheless, some bacteria have physiological mechanisms that enable them to survive in impacted environments. This characteristic makes them important as biotechnological tools for environmental remediation. Thus, we isolated a bacterial consortium in Guanabara Bay (Brazil), a place with a long metal pollution history. To test the growth efficiency of this consortium in Cu-Zn-Pb-Ni-Cd medium, we measured the activity of key enzymes of microbial activity (esterases and dehydrogenase) under acidic (4.0) and neutral pH conditions, as well as the number of living cells, biopolymer production, and changes in microbial composition during metal exposure. Additionally, we calculated the predicted physiology based on microbial taxonomy. During the assay, a slight modification in bacterial composition was observed, with low abundance changes and little production of carbohydrates. Oceanobacillus chironomi, Halolactibacillus miurensis, and Alkaliphilus oremlandii were predominant in pH 7, despite O. chironomi and Tissierella creatinophila in pH 4, and T. creatinophila in Cu-Zn-Pb-Ni-Cd treatment. The metabolism represented by esterases and dehydrogenase enzymes suggested bacterial investment in esterases to capture nutrients and meet the energy demand in an environment with metal stress. Their metabolism potentially shifted to chemoheterotrophy and recycling nitrogenous compounds. Moreover, concomitantly, bacteria produced more lipids and proteins, suggesting extracellular polymeric substance production and growth in a metal-stressed environment. The isolated consortium showed promise for bioremediation of multimetal contamination and could be a valuable tool in future bioremediation programs.

New synthetic nano-immunotherapy (OncoTherad®) for non-muscle invasive bladder cancer: Its synthesis, characterization and anticancer property

Bacillus Calmette-Guérin (BCG)-based intravesical immunotherapy has been applied as gold standard treatment for high-risk non-muscle invasive bladder cancer (NMIBC) for almost half a century. However, several patients with high-risk disease experience relapse, including those whose condition has worsened and who failed to respond to BCG. Non-significant therapeutic options have been developed for these at-risk patients, for many years. Immunotherapies have shown promising outcomes for bladder cancer treatment. Accordingly, our research group developed the OncoTherad® (MRB-CFI-1) immunotherapy, which has shown positive outcomes in NMIBC treatment. The aim of the current study is to describe, in details, the physicochemical features and potential action mechanisms of OncoTherad® nano-immunotherapy, based on toll-like receptor 4 (TLR4)-mediated interferon and on RANK/RANKL signaling pathways, in animal model with NMIBC. Based on the current findings, OncoTherad® nano-immunotherapy did not have genotoxic effect on the investigated model and did not show signs of limiting local and/or systemic toxicity at therapeutic doses. OncoTherad® nano-immunotherapy was more effective than the BCG treatment, since it reduced by 70% the malignancy rate. Furthermore, it was possible identifying an important action mechanism of OncoTherad®, which was based on the modulation of TLR4-mediated interferon and RANK/RANKL signaling pathways that, altogether, were essential to reduce malignancy rate. OncoTherad® mechanisms in these pathways helped preventing tumor recurrence.

The burden of ischaemic heart disease in Brazil from 1990 to 2019 and the association between temporal changes and socioeconomic level

Introduction

The burden of ischaemic heart disease (IHD) has declined in several countries, although IHD remains the leading cause of death globally. Brazil is a large country with high inequality in income distribution across different regions.

Purpose

This study sought to evaluate the burden of IHD in Brazil from 1990 to 2019, as well as the relationship between temporal changes and socioeconomic level of the Federative Units.

Methods

Estimates of prevalence, mortality, and disability-adjusted life-years (DALYs) due to IHD were retrieved from the Global Burden of Disease Study 2019. We used databases from the Ministry of Health of Brazil to obtain the number of hospitalisations from acute coronary syndrome (ACS) and acute myocardial infarction (AMI) in the context of the public service. The Socio-demographic Index (SDI), a composite indicator of income per capita, average educational attainment, and fertility rate in females younger than 25 years, was used as a measure of socioeconomic status. Rates with 95% uncertainty intervals are reported.

Results

In 2019, the age-standardised prevalence rate of IHD was 1,709 (1,466–1,994) per 100,000 inhabitants. This rate remained stable from 1990 to 2019 (percent change: −1.1 [−2.6–0.5]). The estimate of deaths from IHD in 2019 was 171,246 (156,180–180,511), corresponding to 12% (11%-13%) of total deaths in the country (the leading cause) and 43% of all cardiovascular deaths. In 2019, the age-standardised mortality rate due to IHD was 75 (68–79) per 100,000. The unadjusted mortality rate due to IHD mildly increased from 2005 to 2019, while the age-standardised rate continuously decreased from 1990 to 2019 (cumulative percent change: −53 (−55 to −50, Figure 1). A negative correlation was observed between the change in age-standardised mortality rate from IHD in the period and the 2019 SDI (Figure 2). In 2019, the age-standardised DALY rate due to IHD was 1,563 (1,472–1,636) per 100,000. This DALY rate was equivalent to 5.7% (5.1%-6.3%) of total DALYs, meaning that IHD was the second most common cause of DALYs in Brazil in females and males. From 1990 to 2019, the crude DALY rate per 100,000 remained fairly stable, and the age- standardised DALY rate per 100,000 gradually declined (−50% [−52% to −48%]). There was a negative correlation between the change in age-standardised DALY rate from IHD in the period and the SDI (r2 0.59, p-value &lt;0.01). The number of hospital admissions for ACS remained stable from 2008 to 2019 (33 per 100,000 in 2019). The number of hospitalisations due to AMI increased from 25 per 100,000 in 2008 to 39 per 100,000 in 2019 (percent change: 52%).

Conclusions

While age-standardised mortality, DALY rates continuously decreased from 1990 to 2019, the burden of IHD in Brazil remains high, probably due to ageing and population growth. Reductions in age-standardised mortality, DALY rates over time tend to be more pronounced in more developed regions.

Funding Acknowledgement

Type of funding sources: None. Mortality rate (per 100,000)Change in mortality rate and SDI

Kidney transplantation from donation after circulatory death using abdominal normothermic oxygenated circulation: are the outcomes equivalent?

PURPOSE

To increase the pool of kidneys available for transplantation, a renewed interest in donation after circulatory death (DCD) has emerged. This study aims to determine the outcomes of kidney transplantation from DCD after abdominal normothermic oxygenated circulation (ANOR) support.

METHODS

From January 2016 to December 2018, 58 kidneys were implanted from uncontrolled DCD after ANOR support. We performed an observational prospective study, assessing graft function and cumulative incidence of surgical complications. A descriptive analysis was conducted. Potential determinants of the outcomes were evaluated, including donor and receptor gender and age, and warm and cold ischemia times. Regression coefficients (β) and odds ratio (OR) were calculated with 95% confidence intervals. A p-value < 0.05 was considered statistically significant. Statistical analysis was accomplished using Stata 11.0 software.

RESULTS

The median follow-up time was 31.2 months. Delayed graft function (DGF) was evident in 80%, with a mean Cr one month after transplantation of 1.81 mg/dL and 1.33 mg/dL after one year. Primary non-function (PNF) occurred in 5.2% of cases. Male donors were associated with a lower DGF (OR = 0.21, p < 0.05), and a higher donor age was a predictor of poorer graft function at one year (β = - 0.88, p < 0.05). Surgical complications occurred in 31% patients, predominantly vascular. Warm ischemia time superior to 60 min correlated with a higher risk of surgical complications (OR = 11.33, p < 0.05).

CONCLUSION

Kidney transplantation from DCD is a valuable option, allowing an improvement in the balance between patients waiting for a transplant and the available kidneys.

Role of E270 in pH- and metal-sensitivities of firefly luciferases

Firefly luciferases display a typical change in bioluminescence color to red at acidic pH, high temperatures and in the presence of heavy metals. Recently, the proton and metal sensing site responsible for the pH-sensitivity of firefly luciferases, which involves the salt bridges between E311-R337 and H310-E354, was identified. However, it is unclear what other residues contribute to the distinct degrees of pH-sensitivity observed in other firefly luciferases. A multialignment of primary structures of a large set of pH-sensitive and pH-insensitive beetle luciferases showed that the conserved E270 among adult firefly luciferases is substituted by Gly (railroad worms)/Gln (click-beetles) in pH-insensitive ones. Site-directed mutagenesis studies using Macrolampis sp2 and Amydetes vivianii firefly luciferases indeed showed that E270 is important for the pH-dependent activity and spectral profiles: the substitution E270A/G drastically decreases the spectral pH-sensitivity, and extends the activity profile above pH 9.0. These mutations also decrease the sensitivity to metals such as zinc, mercury and cadmium. Modelling studies showed that the residue E270 is located in a three-glutamate motif (269EEE271) at the N-terminal of α-helix-10. The results suggest that at acidic pH, the protonation of E270 carboxylate may extend a turn of the helix at the N-terminal, misaligning the pH-sensor and luciferin phenolate binding site residues: S286, I288 and E311. In contrast, the substitution of E270A/G may unwind a turn of the α-helix-10, indirectly increasing the interaction of the pH-sensor and other residues at the bottom of the luciferin binding site, stabilizing the green light emitting conformation.

Regional analysis of pediatric admissions with complex chronic conditions in mainland Portugal

Background

The expected rise in the number of children living longer with complex chronic conditions (CCC) and the social relevance of this group prompt the study of the patterns of their inpatient care utilization. We aimed to compare the utilization of inpatient care by children with CCC between regions of mainland Portugal.

Methods

Observational longitudinal retrospective study using anonymized administrative data for mainland Portuguese public hospitals. We selected admissions within the pediatric age limit (&lt;18yo), 2011-15. The variable of interest was the patient region of residence [Alentejo, Algarve, Centre, Lisbon Metropolitan Area (Lisbon MA), or North]. Variables related to condition (number and categories of CCC) and to care utilization [admission type, hospital type (I- community, II- regional, III- tertiary & university, IV- specialized), inpatient days, expenses] were described by region.

Results

A total of 64,918 pediatric admissions with CCC were included (ranging from 2,839 to 23,194 by region). The percentage of admissions with 2 or more CCC ranged from 16% to 22%. Haematologic & Immunologic and Metabolic categories were the ones with the highest range between regions (8%-19%; 5%-10%); the smallest range was seen in Cardiovascular (15%-18%). Urgent admissions ranged from 48% to 70%. Hospital type varied considerably, especially for type II (8%-69%). Median length of stay was 4-5 days, and median expense ranged from €1,256 to €1,467.

Conclusions

The utilization of inpatient care by children with CCC in mainland Portugal varied by region, mainly on type of admission, type of hospital, and distribution of CCC categories. Possible explanatory factors may include differences in CCC prevalence, patterns of care, and available care in each region.

Key messages

Differences in the percentage of urgent admissions require further analysis, aiming at reducing the disruption that healthcare needs may cause in the life of children with CCC and their families. There are considerable differences in the type of hospital where children with CCC in each region receive care. Healthcare system must ensure appropriate resources are available where needed.

Molecular identification of Ehrlichia sp. in a beef cattle from brazilian Cerrado - case report

ABSTRACT Ehrlichia infections in cattle are frequent in Africa but have also been reported in Brazil and North America. This paper reports natural infection by Ehrlichia sp. associated with Babesia bigemina and Anaplasma marginale in a calf in the municipality of Campo Grande, state of Mato Grosso do Sul, Brazil, presenting polioencephalomalacia. The molecular evidence, based on a fragment of the dsb gene, indicates a species of Ehrlichia genetically related to Ehrlichia canis and other species of the genus found in the tick Rhipicephalus (Boophilus) microplus and a calf from Brazil (99 to 100% identity). It was not possible to associate the clinical signs with Ehrlichia infection due to co-infections and histological evidence of another disease. However, the circulation of the bacteria in bovines in Brazilian Cerrado was confirmed and more attention should be given to clinical suspicion of tick-borne pathogens in cattle to clarify the pathogenic potential of Ehrlichia sp.

Phrixotrix luciferase and 6'-aminoluciferins reveal a larger luciferin phenolate binding site and provide novel far-red combinations for bioimaging purposes

How the unique luciferase of Phrixothrix hirtus (PxRE) railroad worm catalyzes the emission of red bioluminescence using the same luciferin of fireflies, remains a mystery. Although PxRE luciferase is a very attractive tool for bioanalysis and bioimaging in hemoglobin rich tissues, it displays lower quantum yield (15%) when compared to green emitting luciferases (>40%). To identify which parts of PxRE luciferin binding site (LBS) determine bioluminescence color, and to develop brighter and more red-shifted emitting luciferases, we compared the effects of site-directed mutagenesis and of larger 6′-substituted aminoluciferin analogues (6′-morpholino- and 6′-pyrrolidinyl-LH) on the bioluminescence properties of PxRE and green-yellow emitting beetle luciferases. The effects of mutations in the benzothiazolyl and thiazolyl parts of PxRE LBS on the K_M and catalytic efficiencies, indicated their importance for luciferin binding and catalysis. However, the absence of effects on the bioluminescence spectrum indicated a less interactive LBS in PxRE during light emission. Mutations at the bottom of LBS of PxRE blue-shifted the spectra and increased catalytic efficiency, suggesting that lack of interactions of this part of LBS with excited oxyluciferin phenolate underlie red light emission. The much higher bioluminescence activity and red-shifted spectra of PxRE luciferase with 6′-morpholino- (634 nm) and 6′-pyrrolidinyl-luciferins (644 nm), when compared to other beetle luciferases, revealed a larger luciferin phenolate binding pocket. The size and orientation of the side-chains of L/I/H348 are critical for amino-analogues accommodation and modulate bioluminescence color, affecting the interactions and mobility of excited oxyluciferin phenolate. The PxRE luciferase and 6′-aminoluciferins provide potential far-red combinations for bioimaging applications.

An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest

AIM

To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA).

METHODS

Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of ∼1.5 million inhabitants, between October-2016 and May-2018. 65 year old or younger patients without significant bleeding or comorbidities with witnessed nonasystolic cardiac arrests were triaged to ECPR if they had a reversible cause and high quality CPR lasting < 60 min. Otherwise they were considered for uDCDD after a ten minute no touch period using normothermic regional perfusion.

RESULTS

58 patients were included, of which 41 (71%) were OHCA and 18 (31%) had ECPR initiated. Median age was 52 (IQR 45-56) years. Cannulation was successful in 49/58 (84%) cases. Compared to ECPR, patients referred for uDCDD were more frequently OHCA (90 vs. 28%), had bystander CPR (28 vs. 83%) and prolonged low-flow period (40 (35-50) vs. 60 (49-78) min). Survival to hospital discharge with full neurological recovery (cerebral performance category 1) occurred in 6/18 (33%) ECPR patients. uDCDD resulted in transplantation of 44 kidneys.

CONCLUSIONS

An integrated program for rCA consisting of a formal pathway to uDCDD referral in ECPR ineligible patients is feasible. ECPR-referred patients had a reasonable survival with full neurologic recovery. Successful kidney transplantation was achieved with uDCDD.

Metalloproteomics Approach to Analyze Mercury in Breast Milk and Hair Samples of Lactating Women in Communities of the Amazon Basin, Brazil

Mercury is a potentially toxic element that is present in the environment of the Brazilian Amazon and is responsible for adverse health effects in humans. This study sought to assess possible protein biomarkers of mercury exposure in breast milk samples from lactating women in the Madeira and Negro Rivers in the Brazilian Amazon. The mercury content of hair samples of lactating women was determined, and the proteome of breast milk samples was obtained using two-dimensional electrophoresis after protein precipitation with acetone. Mercury measurements of protein spots obtained via protein fractionation were performed by graphite furnace atomic absorption spectrometry (GFAAS), and it was observed that mercury is linked to proteins with molecular masses in the range of 14-26 kDa. The total mercury concentration was also determined by GFAAS in unprocessed milk, lyophilized milk, and protein pellets, with the purpose of determining the mercury mass balance in relation to the concentration of this element in milk and pellets. Approximately 85 to 97% of mercury present in the lyophilized milk from samples of lactating women of the Madeira River is bound in the protein fraction. From lactating women of the Negro River, approximately 49% of the total mercury is bound in the protein fraction, and a difference of 51% is bound in the lipid fraction.

Accelerated subcutaneous immunotherapy in pediatric population - Systematic review

BACKGROUND

Accelerated subcutaneous immunotherapy (SCIT) schedules represent an alternative to conventional SCIT, providing immunotherapy benefits in a shorter period of time. The objectives of this systematic review were to assess clinical and immunological efficacy as well as safety of accelerated SCIT build-up schedules for the treatment of respiratory allergy in pediatric patients.

METHODS

Studies were located by searching PubMed, using "immunotherapy" and "desensitization" as keywords. The selection of studies, published from January 1st, 2006, to December 31th, 2015, was performed in two stages: screening of titles and abstracts, and assessment of the full papers identified as relevant, considering the inclusion criteria. Data were extracted in a standardized way and synthesized qualitatively to assess efficacy and safety of accelerated schedules in respiratory allergy.

RESULTS

Eleven trials were included: two evaluated rush SCIT and nine assessed cluster SCIT. This review demonstrated that rush and cluster schedules are clinically and immunological efficacious, with faster effect than conventional schedules. No relevant difference with respect to clinical outcomes was noticed between subgroups (pediatric, adult and mixed populations). Regarding safety, most local adverse reactions were mild and there were neither life-threatening systemic reactions nor fatal events. No relevant differences in the incidence and severity of either local or systemic reactions between the accelerated schedule group and control group were registered.

CONCLUSIONS

Accelerated SCIT build-up schedules are effective in the treatment of respiratory allergy in pediatric patients, representing a safe alternative to the conventional schedules with the advantage of achieving clinical effectiveness sooner.

Local Intraarterial Thrombolysis in the Carotid Territory

A new series of 142 patients treated by local intraarterial thrombolysis is presented. After haemorrhage was ruled out by CT, all patients had an emergency angiogram. Patients with occlusion of the lenticulostriate arteries were not treated after the sixth hour (79 cases). Patients without involvement of these arteries were treated up to the 12th hour (61 cases).

This selection led to a dramatic reduction of pos-thrombolysis intraparenchymatous haemorrhage (0.7%) compared to other series. All deaths (7 cases) were related to vasogenic oedema due to incomplete reduction of infarcted cerebral volume, in most cases (4 cases) in intracerebral extension of a cervical internal carotid occlusion.

Digitized parenchymography proved to be a reliable technique to document the exact location and extent of brain ischaemia before and after thrombolysis. It also allows a prognosis of spontaneous recovery without using thrombolysis. By reducing the infarcted cerebral volume, local intraarterial thrombolysis seems beneficial to the patient as long as a strict selection based on the angiographic location of the occlusion and the time delay is respected.

Abundance of Harpy and Crested Eagles from a reservoir-impact area in the Low- and Mid-Xingu River

In the Brazilian Amazon, two monospecific genera, the Harpy Eagle and Crested Eagle have low densities and are classified by IUCN as Near Threatened due to habitat loss, deforestation, habitat degradation and hunting. In this study, we evaluate occurrence of these large raptors using the environmental surveys database from Belo Monte Hydroelectric Power Plant. Integrating the dataset from two methods, we plotted a distribution map along the Xingu River, including records over a 276-km stretch of river. Terrestrial surveys (RAPELD method) were more efficient for detecting large raptors than standardized aquatic surveys, although the latter were complementary in areas without modules. About 53% of the records were obtained during activities of wildlife rescue/flushing, vegetation suppression or in transit. Between 2012 and 2014, four Harpy Eagles were removed from the wild; two shooting victims, one injured by collision with power lines and one hit by a vehicle. Also, seven nests were mapped. The mean distance between Harpy Eagle records was 15 km along the river channel, with a mean of 20 km between nests near the channel, which allowed us to estimate 20 possible pairs using the alluvial forest, riverine forest and forest fragments. Territories of another ten pairs will probably be affected by inundation of the Volta Grande channel, which is far from the main river. The average distance between Crested Eagle records was 16 km along the river channel. The only nest found was 1.3 km away from a Harpy Eagle nest. The remnant forests are under threat of being replaced by cattle pastures, so we recommend that permanently protected riparian vegetation borders (APP) be guaranteed, and that forest fragments within 5 km of the river be conserved to maintain eagle populations.

Autism spectrum disorder: FRAXE mutation, a rare etiology

Autism spectrum disorder (ASD) is characterized by impaired social interaction and communication, restricted interests and repetitive behaviors. Fragile X E is associated with X-linked non-specific mild intellectual disability (ID) and with behavioral problems. Most of the known genetic causes of ASD are also causes of ID, implying that these two identities share common genetic bases. We present a child with an ASD with a normal range of intelligence quotient, that later evolved to compulsive behavior. FRAXE locus analysis by polymerase chain reaction revealed a complete mutation of the FMR 2 gene. This report stresses the importance of clinicians being aware of the association between a full mutation of FMR2 and ASD associated with compulsive behavior despite normal intellectual level.

ASXL1 and DNMT3A mutation in a cytogenetically normal B3 thymoma

The molecular drivers of thymoma are poorly understood. Outside of the identification of rarely occurring epidermal growth factor receptor and v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog mutations via candidate gene sequencing, mutations in common cancer genes have yet to be observed. Only a single thymoma genome sequence has been previously reported, with no mutations in known cancer genes identified. Thus, we attempted to identify somatic driver mutations in a cytogenetically normal thymoma. A stage IVB type B3 thymoma from a 47-year-old male of Asian descent with no history of myasthenia gravis or other autoimmune condition was genomically evaluated. Exome sequencing and low-pass whole-genome sequencing was performed to identify somatic point mutations, copy number changes and structural variants. Mutations in known tumor suppressors DNMT3A (p.G728D) and ASXL1 (p.E657fs), consistent with mutations of known consequence in acute myeloid leukemia, were identified. Contrary to a previous report, this finding suggests the genetic etiology of thymomas may not be fundamentally distinct from other tumor types. Rather, these findings suggest that further sequencing of cytogenetically normal thymoma samples should reveal the specific molecular drivers of thymoma.

Sirolimus-based graft-versus-host disease prophylaxis promotes the in vivo expansion of regulatory T cells and permits peripheral blood stem cell transplantation from haploidentical donors

Hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA) haploidentical family donors is a promising therapeutic option for high-risk hematologic malignancies. Here we explored in 121 patients, mostly with advanced stage diseases, a sirolimus-based, calcineurin-inhibitor-free prophylaxis of graft-versus-host disease (GvHD) to allow the infusion of unmanipulated peripheral blood stem cell (PBSC) grafts from partially HLA-matched family donors (TrRaMM study, Eudract 2007-5477-54). Conditioning regimen was based on treosulfan and fludarabine, and GvHD prophylaxis on antithymocyte globulin Fresenius (ATG-F), rituximab and oral administration of sirolimus and mycophenolate. Neutrophil and platelet engraftment occurred in median at 17 and 19 days after HSCT, respectively, and full donor chimerism was documented in patients' bone marrow since the first post-transplant evaluation. T-cell immune reconstitution was rapid, and high frequencies of circulating functional T-regulatory cells (Treg) were documented during sirolimus prophylaxis. Incidence of acute GvHD grade II-IV was 35%, and occurrence and severity correlated negatively with Treg frequency. Chronic GvHD incidence was 47%. At 3 years after HSCT, transpant-related mortality was 31%, relapse incidence 48% and overall survival 25%. In conclusion, GvHD prophylaxis with sirolimus-mycophenolate-ATG-F-rituximab promotes a rapid immune reconstitution skewed toward Tregs, allowing the infusion of unmanipulated haploidentical PBSC grafts.

Recent advances in Schistosoma genomics

Schistosome research has entered the genomic era with the publications reporting the Schistosoma mansoni and Schistosoma japonicum genomes. Schistosome genomics is motivated by the need for new control tools. However, much can also be learned about the biology of Schistosoma, which is a tractable experimental model. In this article, we review the recent achievements in the field of schistosome research and discuss future perspectives on genomics and how it can be integrated in a usable format, on the genetic mapping and how it has improved the genome assembly and provided new research approaches, on how epigenetics provides interesting insights into the biology of the species and on new functional genomics tools that will contribute to the understanding of the function of genes, many of which are parasite- or taxon specific.