Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma

Background

Melphalan is the most common conditioning regimen used prior to autologous stem cell transplant (ASCT); however, there are varying data on optimal melphalan timing prior to transplant for best safety and efficacy. Historically, ASCT conditioning consisted of melphalan 200 mg/m2 on day 2 (D-2) (48 h prior to ASCT), but many institutions have since adopted a melphalan protocol with administration on day 1 (D-1) (24 h prior to SCT) or split dosing over the 2 days. The optimal timing of melphalan has yet to be determined.

Methods

In this single-center retrospective study, we analyzed transplant outcomes for patients between March 2011 and September 2020 admitted for high-dose, single-agent melphalan 200 mg/m2 on D-1 vs. D-2. The primary outcomes were time to neutrophil and platelet engraftment. Secondary outcomes include incidence of hospital readmission within 30 days, 2-year progression-free survival, and 2-year overall survival.

Results

A total of 366 patients were studied (D-2 n = 269 and D-1 n = 97). The incidence of high-risk cytogenetics was similar between the two groups (37% vs. 40%). Median days to absolute neutrophil count engraftment was similar at 11 days in the D-2 and D-1 cohort (n = 269, range 0-14, IQR 11-11 vs. n = 97, range 0-14, IQR 11-12). Median days to platelet engraftment >20,000/mcL was 18 days for D-2 melphalan (range: 0-28, IQR 17-20) versus 19 days for D-1 melphalan (range: 0-32, IQR 17-21). Overall survival at 2 years post-transplant was similar in both cohorts (94%; p = 0.76), and PFS was 70% in D-2 compared with 78% in D-1 (p = 0.15). In a multivariable model including age and performance status, hospital readmission within 30 days of transplant was higher in the D-1 cohort (odds ratio 1.9; p = 0.01).

Conclusion

This study demonstrates similar neutrophil and platelet engraftment in D-1 and D-2 melphalan cohorts with similar 2-year PFS and OS. Either D-2 or D-1 melphalan dosing schedule is safe and effective.

Advances in NK cell therapy for hematologic malignancies: NK source, persistence and tumor targeting

Natural Killer (NK) cells yield promise in therapy of hematologic malignancies. The clinical experience with adoptively transferred allogeneic NK cells over past two decades has revealed safety and minimal risk of CRS or ICANS. Unlike T cells which have to be genetically altered to avoid graft vs host disease (GVHD), HLA mismatched NK cells can be infused without GVHD risk. This makes them ideal for the development of off-the-shelf products. In this review we focus on NK biology relevant to the cancer therapy, the trajectory of NK therapeutics for leukemia, lymphoma, and myeloma; and advantages of the NK cell platform. We will also discuss novel methods to enhance NK cell targeting, persistence, and function in the tumor microenvironment. The future of NK cell therapy depends on novel strategies to realize these qualities.

Quadruple gene-engineered natural killer cells enable multi-antigen targeting for durable antitumor activity against multiple myeloma

Allogeneic natural killer (NK) cell adoptive transfer is a promising treatment for several cancers but is less effective for the treatment of multiple myeloma. In this study, we report on quadruple gene-engineered induced pluripotent stem cell (iPSC)-derived NK cells designed for mass production from a renewable source and for dual targeting against multiple myeloma through the introduction of an NK cell-optimized chimeric antigen receptor (CAR) specific for B cell maturation antigen (BCMA) and a high affinity, non-cleavable CD16 to augment antibody-dependent cellular cytotoxicity when combined with therapeutic anti-CD38 antibodies. Additionally, these cells express a membrane-bound interleukin-15 fusion molecule to enhance function and persistence along with knock out of CD38 to prevent antibody-mediated fratricide and enhance NK cell metabolic fitness. In various preclinical models, including xenogeneic adoptive transfer models, quadruple gene-engineered NK cells consistently demonstrate durable antitumor activity independent of exogenous cytokine support. Results presented here support clinical translation of this off-the-shelf strategy for effective treatment of multiple myeloma.

Bio-distribution and longevity of mesenchymal stromal cell derived membrane particles

Vesicle-based medicines hold great promise for therapy development but essential knowledge on the bio-distribution and longevity of vesicles after administration is lacking. We generated vesicles from the membranes of human mesenchymal stromal cells (MSC) and we demonstrated earlier that these so-called membrane particles (MP) mediate immunomodulatory and regenerative responses in target cells. In the present study we examined the bio-distribution and longevity of MP after intravenous administration in mice. While most vesicle tracking methods are based on imaging techniques, which require labeling of vesicles and can only detect dense accumulations of vesicles, we used proteomics analysis to detect the presence of MP-derived proteins in multiple organs and tissues. MP proteins were mainly present in plasma and leukocytes at 1 h after injection, indicating that MP - in contrast to whole MSC - do not accumulate in the lungs upon first passage but remain in circulation. After 24 h, MP proteins were still present in plasma but were most abundant in the liver. RNA sequencing of livers demonstrated that MP impact liver function and in particular induce metabolic pathways. These data provide a clear view of the bio-distribution and longevity of MP, which is likely extrapolatable to other types of vesicles, and demonstrate that MP circulate for up to 24 h and may be a tool for targeting the liver.

A Review of the EUSO-Balloon Pathfinder for the JEM-EUSO Program

EUSO-Balloon is a pathfinder for JEM-EUSO, the mission concept of a spaceborne observatory which is designed to observe Ultra-High Energy Cosmic Ray (UHECR)-induced Extensive Air Showers (EAS) by detecting their UltraViolet (UV) light tracks "from above." On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. After reaching a floating altitude of 38 km, EUSO-Balloon imaged the UV light in the wavelength range ∼290-500 nm for more than 5 hours using the key technologies of JEM-EUSO. The flight allowed a good understanding of the performance of the detector to be developed, giving insights into possible improvements to be applied to future missions. A detailed measurement of the photoelectron counts in different atmospheric and ground conditions was achieved. By means of the simulation of the instrument response and by assuming atmospheric models, the absolute intensity of diffuse light was estimated. The instrument detected hundreds of laser tracks with similar characteristics to EASs shot by a helicopter flying underneath. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. The reconstruction of the direction of the laser tracks was performed. In this work, a review of the main results obtained by EUSO-Balloon is presented as well as implications for future space-based observations of UHECRs.

Can straw-biochar mulching mitigate erosion of wildfire-degraded soils under extreme rainfall?

High severity wildfires cause a drastic alteration of soil carbon cycling - both oxidising and thermally altering soil organic matter (SOM) - and usually are followed by strong runoff and erosion events. To restore wildfire-degraded soils, SOM needs to be rebuilt while soil erosion is prevented. Post-fire straw mulching has been shown to mitigate soil erosion by providing a protective cover against rainsplash. However, SOM takes many decades or centuries to rebuilt naturally. Biochar, co-applied with straw to the soil surface can replace the SOM of the O-horizon, while the stabilised soil - by straw mulching - may gain in SOM naturally and by downward movement of biochar. We conducted a field study to test if straw-only and straw-biochar co-application could restore soils degraded by wildfire in one high burn severity (HBS) and one moderate burn severity (MBS) study area in southern Portugal and Spain, respectively, by monitoring erosion and SOM for the most intense rainfall period of the first post-fire year. Burned sites were characterized for soil and sediment physical properties, TOC content, SOM quality by thermogravimetry (DTG) and nuclear magnetic resonance (NMR ¹³C) spectroscopy. Straw-biochar mulching significantly reduced soil erosion by 76% and 65% in the HBS and MBS sites, respectively, in both cases similar to the erosion reduction by straw-only mulching. DTG and NMR ¹³C indicated that a relatively small proportion of the biochar eroded, i.e. 0.7%, indicating that co-application of straw with biochar may help restore the SOC lost in the wildfire in the medium term. The amount of SOM eroded was lower with straw-biochar mulching than in the untreated plots for both study areas. Straw-biochar mulching mitigates erosion of wildfire-degraded soils under extreme rainfall, while a relatively small proportion of the biochar is lost by erosion. Future studies need to monitor medium term effects.

Knowledge based recursive non-linear partial least squares (RNPLS)

Soft sensors driven by data are very common in industrial plants to perform indirect measurements of difficult to measure critical variables by using other variables that are relatively easier to obtain. The use of soft sensors implies some challenges, such as the colinearity of the predictor variables, the time-varying and possible non-linear nature of the industrial process. To deal with the first challenge, the partial least square (PLS) regression has been employed in many applications to model the linear relations between process variables, with noisy and highly correlated data. However, the PLS model needs to deal with the other two issues: the non-linear and time-varying characteristics of the processes. In this work, a new knowledge-based methodology for a recursive non-linear PLS algorithm (RNPLS) is systematized to deal with these issues. Here, the non-linear PLS algorithm is set up by carrying out the PLS regression over the augmented input matrix, which includes knowledge based non-linear transformations of some of the variables. This transformation depends on the system's nature, and takes into account the available knowledge about the process, which is provided by expert knowledge or emulated using software tools. Then, the recursive exponential weighted PLS is used to modify and adapt the model according to the process changes. This RNPLS algorithm has been tested using two case studies according to the available knowledge, a real industrial evaporation station of the sugar industry, where the expert knowledge about the process permits the formulation of the relationships, and a simulated wastewater treatment plant, where the necessary knowledge about the process is obtained by a software tool. The results show that the methodology involving knowledge regarding the process is able to adjust the process changes, providing highly accurate predictions.

Chronic stimulation drives human NK cell dysfunction and epigenetic reprograming

A population of Natural Killer (NK) cells expressing the activating receptor NKG2C and the maturation marker CD57 expands in response to human cytomegalovirus (HCMV) infection. CD3-CD56dimCD57+NKG2C+ NK cells are similar to CD8+ memory T cells with rapid and robust effector function upon re-stimulation, persistence, and epigenetic remodeling of the IFNG locus. Chronic antigen stimulation drives CD8+ memory T cell proliferation while also inducing genome-wide epigenetic reprograming and dysfunction. We hypothesized that chronic stimulation could similarly induce epigenetic reprograming and dysfunction in NK cells. Here we show that chronic stimulation of adaptive NK cells through NKG2C using plate-bound agonistic antibodies in combination with IL-15 drove robust proliferation and activation of CD3-CD56dimCD57+NKG2C+ NK cells while simultaneously inducing high expression of the checkpoint inhibitory receptors LAG-3 and PD-1. Marked induction of checkpoint inhibitory receptors was also observed on the surface of adaptive NK cells co-cultured with HCMV-infected endothelial cells. Chronically stimulated adaptive NK cells were dysfunctional when challenged with tumor targets. These cells exhibited a pattern of epigenetic reprograming, with genome-wide alterations in DNA methylation. Our study has important implications for cancer immunotherapy and suggest that exhausted NK cells could be targeted with inhibitory checkpoint receptor blockade.

Comparison of the state of Lithium-Sulphur and lithium-ion batteries applied to electromobility

The market share in electric vehicles (EV) is increasing. This trend is likely to continue due to the increased interest in reducing CO₂ emissions. The electric vehicle market evolution depends principally on the evolution of batteries capacity. As a consequence, automobile manufacturers focus their efforts on launching in the market EVs capable to compete with internal combustion engine vehicles (ICEV) in both performance and economic aspects. Although EVs are suitable for the day-to-day needs of the typical urban driver, their range is still lower than ICEV, because batteries are not able to store and supply enough energy to the vehicle and provide the same autonomy as ICEV. EV use mostly Lithium-ion (Li-ion) batteries but this technology is reaching its theoretical limit (200-250 Wh/kg). Although the research to improve Li-ion batteries is very active, other researches began to investigate alternative electrochemical energy storage systems with higher energy density. At present, the most promising technology is the Lithium-Sulphur (Li-S) battery. This paper presents a review of the state of art of Li-Sulphur battery on EVs compared to Li-ion ones, considering technical, modelling, environmental and economic aspects with the aim of depicting the challenges this technology has to overcome to substitute Li-ion in the near future. This study shows how the main drawbacks for Li-S concern are durability, self-discharge and battery modelling. However, from an environmental and economic point of view, Li-S technology presents many advantages over Li-ion.

Image processing and machine learning in the morphological analysis of blood cells

INTRODUCTION

This review focuses on how image processing and machine learning can be useful for the morphological characterization and automatic recognition of cell images captured from peripheral blood smears.

METHODS

The basics of the 3 core elements (segmentation, quantitative features, and classification) are outlined, and recent literature is discussed. Although red blood cells are a significant part of this context, this study focuses on malignant lymphoid cells and blast cells.

RESULTS

There is no doubt that these technologies may help the cytologist to perform efficient, objective, and fast morphological analysis of blood cells. They may also help in the interpretation of some morphological features and may serve as learning and survey tools.

CONCLUSION

Although research is still needed, it is important to define screening strategies to exploit the potential of image-based automatic recognition systems integrated in the daily routine of laboratories along with other analysis methodologies.

Characterization and automatic screening of reactive and abnormal neoplastic B lymphoid cells from peripheral blood

INTRODUCTION

The objective was to advance in the automatic, image-based, characterization and recognition of a heterogeneous set of lymphoid cells from peripheral blood, including normal, reactive, and five groups of abnormal lymphocytes: hairy cells, mantle cells, follicular lymphoma, chronic lymphocytic leukemia, and prolymphocytes.

METHODS

A number of 4389 images from 105 patients were selected by pathologists, based on morphologic visual appearance, from patients whose diagnosis was confirmed by all the remaining complementary tests. Besides geometry, new color and texture features were extracted using six alternative color spaces to obtain rich information to characterize the cell groups. The recognition system was designed using support vector machines trained with the whole image set.

RESULTS

In the experimental tests, individual sets of images from 21 new patients were analyzed by the trained recognition system and compared with the true diagnosis. An overall recognition accuracy of 97.67% was achieved when the cell screening was performed into three groups: normal lymphocytes, abnormal lymphoid cells, and reactive lymphocytes. The accuracy of the whole experimental study was 91.23% when considering the further discrimination of the abnormal lymphoid cells into the specific five groups.

CONCLUSION

The excellent automatic screening of the three groups of normal, reactive, and abnormal lymphocytes is useful as it discriminates between malignancy and not malignancy. The discrimination of the five groups of abnormal lymphoid cells is encouraging toward the idea that the system could be an automated image-based screening method to identify blood involvement by a variety of B lymphomas.

Standardization of haematology critical results management in adults: an International Council for Standardization in Haematology, ICSH, survey and recommendations

INTRODUCTION

These recommendations are intended to develop a consensus in the previously published papers as to which parameters and what values should be considered critical. A practical guide on the standardization of critical results management in haematology laboratories would be beneficial as part of good laboratory and clinical practice and for use by laboratory-accrediting agencies.

METHODS

A working group with members from Europe, America, Australasia and Asia was formed by International Council for Standardization in Haematology. A pattern of practice survey of 21 questions was distributed in 2014, and the data were collected electronically by Survey Monkey. The mode, or most commonly occurring value, was selected as the threshold for the upper and lower alert limits for critical results reporting.

RESULTS

A total of 666 laboratories submitted data to this study and, of these, 499 submitted complete responses. Full blood count critical results alert thresholds, morphology findings that trigger critical result notification, critical results alert list, notification process and maintenance of critical results management protocol are described. This international survey provided a snapshot of the current practice worldwide and has identified the existence of considerable heterogeneity of critical results management.

CONCLUSION

The recommendations in this study represent a consensus of good laboratory practice. They are intended to encourage the implementation of a standardized critical results management protocol in the laboratory.

Dendritic cells phenotype fitting under hypoxia or lipopolysaccharide; adenosine 5'-triphosphate-binding cassette transporters far beyond an efflux pump

This study examines adenosine 5'-triphosphate-binding cassette (ABC) transporters as a potential therapeutic target in dendritic cell (DC) modulation under hypoxia and lipopolysaccharide (LPS). Functional capacity of dendritic cells (DCs) (mixed lymphocyte reaction: MLR) and maturation of iDCs were evaluated in the presence or absence of specific ABC-transporter inhibitors. Monocyte-derived DCs were cultured in the presence of interleukin (IL)-4/granulocyte-macrophage colony-stimulating factor (GM-CSF). Their maturation under hypoxia or LPS conditions was evaluated by assessing the expression of maturation phenotypes using flow cytometry. The effect of ABC transporters on DC maturation was determined using specific inhibitors for multi-drug resistance (MDR1) and multi-drug resistance proteins (MRPs). Depending on their maturation status to elicit T cell alloresponses, the functional capacity of DCs was studied by MLR. Mature DCs showed higher P-glycoprotein (Pgp) expression with confocal microscopy. Up-regulation of maturation markers was observed in hypoxia and LPS-DC, defining two different DC subpopulation profiles, plasmacytoid versus conventional-like, respectively, and different cytokine release T helper type 2 (Th2) versus Th1, depending on the stimuli. Furthermore, hypoxia-DCs induced more B lymphocyte proliferation than control-iDC (56% versus 9%), while LPS-DCs induced more CD8-lymphocyte proliferation (67% versus 16%). ABC transporter-inhibitors strongly abrogated DC maturation [half maximal inhibitory concentration (IC50 ): P-glycoprotein inhibition using valspodar (PSC833) 5 μM, CAS 115104-28-4 (MK571) 50 μM and probenecid 2·5 μM], induced significantly less lymphocyte proliferation and reduced cytokine release compared with stimulated-DCs without inhibitors. We conclude that diverse stimuli, hypoxia or LPS induce different profiles in the maturation and functionality of DC. Pgp appears to play a role in these DC events. Thus, ABC-transporters emerge as potential targets in immunosuppressive therapies interfering with DCs maturation, thereby abrogating innate immune response when it is activated after ischaemia.

Concurrent Koro and Cotard syndromes in a Spanish male patient with a psychotic depression and cerebrovascular disease

Koro and Cotard syndromes are uncommon conditions described in a variety of psychiatric and medical disorders. The authors report the third case of a simultaneous presentation of both syndromes, in a 62-year-old inpatient Spanish male with major depressive disorder with psychotic features, parkinsonism and cognitive impairment. A discussion of the literature and the possible relationship between both syndromes and other neuropsychiatric disorders are presented.

Impact of a functional KIR2DS4 allele on heterosexual HIV-1 transmission among discordant Zambian couples

Killer cell immunoglobulin-like receptors (KIRs) and their HLA ligands interact to regulate natural killer (NK) cell function. KIR gene content and allelic variations are reported to influence human immunodeficiency virus (HIV)-1 infection and pathogenesis. We investigated the impact of KIR genes on heterosexual HIV-1 transmission among 566 discordant couples from Lusaka, Zambia. KIR2DS4*001, the only allele of KIR2DS4 known to encode a functional activating receptor, was associated with relatively high viral load for HIV-1 in index (HIV-1 seroprevalent) partners (β [standard error (SE)], .17 [.8] log₁₀; P = .04) and with accelerated transmission of HIV-1 to cohabiting seronegative partners (relative hazard [RH], 2.00; P = .004). The latter association was independent of the direction of transmission (male-to-female or female-to-male), genital ulcers, and carriage of the putative ligand (HLA-Cw*04). No KIR-gene variant in the initially seronegative partners was associated with HIV-1 acquisition or early viral load following seroconversion. Further analysis of NK cell function should clarify the role of KIR2DS4*001 in HIV-1 transmission.

[Impact of the summer 2003 heat wave on the activity of two psychiatric emergency departments]

INTRODUCTION

Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves.

METHODS

We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals.

RESULTS

No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item "dangerousness toward others" (part of the SPI scale) scored significantly higher during the heat waves.

CONCLUSIONS

There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon.

Does medicine still show an unresolved discrimination against women? Experience in two European university hospitals

Have invisible barriers for women been broken in 2007, or do we still have to break through medicine's glass ceiling? Data from two of the most prestigious university hospitals in Barcelona with 700-800 beds, Hospital Clínic (HC) and Hospital de la Santa Creu i Sant Pau (HSCSP) address this issue. In the HSCSP, 87% of the department chairs are men and 85% of the department unit chiefs are also men. With respect to women, only 5 (13%) are in the top position (department chair) and 4 (15%) are department unit chiefs. Similar statistics are also found at the HC: 87% of the department chairs and 89% of the department unit chiefs are men. Currently, only 6 women (13%) are in the top position and 6 (11%) are department unit chiefs. Analysis of the 2002 data of internal promotions in HC showed that for the first level (senior specialist) sex distribution was similar. Nevertheless, for the second level (consultant) only 25% were women, and for the top level (senior consultant) only 8% were women. These proportions have not changed in 2007 in spite of a 10% increase in leadership positions during this period. Similar proportions were found in HSCSP where 68% of the top promotions were held by men. The data obtained from these two different medical institutions in Barcelona are probably representative of other hospitals in Spain. It would be ethically desirable to have males and females in leadership positions in the medical profession.

Diagnostic Stability and Clinical Characteristics in First-episode Psychosis

Introduction:

Diagnostic stability in first-episode psychosis shows a wide variability between studies. Amini and cols reported a 50% rate of patients schizophreniform disorder shifting to schizophrenia during the first 12 months period. We report the preliminary follow-up results of our recently ongoing first- episode psychosis unit.

Methods:

Forty-six patients admitted for a first-episode psichosis to our Inpatient Psychiatric Unit from January 2006 to January 2008 were recruited. Clinical and socio-demographic characteristics were registered during admission period and during the follow-up period.

Results:

At admission 52% of the first-episode subjects had a diagnosis of psychosis NOS and 32% a schizophreniform disorder diagnosis. after discharge, most of the patients (72%) had a diagnosis of schizophreniform disorder, 16% psychosis NOS and 8% brief psychotic disorder. Six months later, half of the followed-up patients had a schizophreniform disorder diagnosis, and 23% had a diagnosis of schizophrenia. 30% of the patients were drop-outs, mainly referred to other out-patient services. Patients shifting to schizophrenia were younger, predominantly male (75% vs 50% in non-schizophrenia shift), had a lower proportion of university studies and presented a longer hospitalization period at admission. No differences in familial history of psychosis and cannabis use were found. after one-year follow-up period, 50% preserved a schizophreniform disorder diagnosis and 30% were diagnosed as schizophrenia.

Conclusions:

Schizophrenia spectrum disorders have a high stability in first-episode psychosis during first year follow-up. as in previous studies, male gender is one of the factors that best predicts the shift to schizophrenia.

Metal accumulation in cattle raised in a serpentine-soil area: relationship between metal concentrations in soil, forage and animal tissues

Soils developed on serpentine rocks contain high levels of heavy metals such as copper (Cu), nickel (Ni) and chromium (Cr), and are deficient in some macronutrients. The crops and pasture grown on these soils may accumulate high levels of metals, which constitute a potential health hazard for cattle. The aim of this study was to evaluate Cr, Ni and Cu accumulation in cattle raised in a serpentine area in Southwest Europe (Galicia, NW Spain). Samples of liver, kidney and muscle of 41 animals aged 8-12 months were collected at slaughter. Representative samples of soil and forage were taken from 10 farms. Samples were acid-digested and metal concentrations determined by ICP-MS (Cr and Ni) and ICP-AES (Cu). The concentrations of the metals in soils and forage were in the range of those found in serpentine soils in other areas. Accumulation of Cr in animal tissues was generally low and within the normal range. However, 20% of the animals had toxic levels of Ni in kidney and 32% of the animals had liver Cu levels above the acceptable range. Serpentine soils had a significant effect on Ni and Cu accumulation in cattle, and a relatively high percentage of the animals showed tissue levels of Ni and Cu indicative of risk of toxicity.

Microinflammation induces endothelial damage in hemodialysis patients: the role of convective transport

Cardiovascular complications are a major cause of mortality in hemodialysis patients. On-line hemofiltration combines convective clearance for removing large solutes with diffusion to remove small solutes and is associated with a significant reduction of inflammation and improved patient survival. We compared on-line hemofiltration to high-flux hemodialysis (HF-HD) in patients in a sequential manner. At baseline, 15 stable patients on HF-HD as compared with five control subjects showed significant increases in CD14+CD16+ cells, endothelial microparticles, and endothelial progenitor cells (EPCs). After 4 months of on-line hemofiltration, the number of CD14+CD16+ cells, microparticles, and EPCs decreased. After returning to HF-HD for 4 months, all measured parameters returned to their respective baseline values. The number of CD14+CD16+ cells correlated with both endothelial microparticles and EPCs. We conclude that on-line hemofiltration attenuates endothelial dysfunction possibly by decreasing microinflammation. This effect may be directly caused by a modulatory effect of on-line hemofiltration on proinflammatory cells or by a complex interaction that encompasses a wider removal of uremic toxins.

[Digital computerized absorptiometry in the diagnosis of osteoporosis in a group of the severely mentally retarded]

BACKGROUND

The loss of bone mass after a certain age is a physiological fact that, in certain circumstances, is capable of inducing osteoporosis. In the diagnostic strategies for this condition, densitometry is a well-accepted technique now widely used. On patients with severe mental retardation, a number of circumstances come into play and may foster a greater frequency of osteoporosis. GOAL AND SCOPE OF STUDY: The goal of the study is to identify the bone mineral density values in a group of severe mentally retarded individuals using a digital densitometry technique in order to compare these with the general population and investigate the possible influence on these values of certain clinical variables and therapeutic regimens.

VOLUNTEERS

One hundred and ninety-two patients of both sexes and treated at an institution devoted to the study and care of severely mentally retarded individuals.

ACTIONS TAKEN

In all cases, the bone mineral density value has been obtained by means of digital densitometry using a compact desktop system using dual X-ray absorption measurement technology The data obtained have been contrasted with sex, age, degree of mobility and anti-epilepsy or sedative medication.

RESULTS

In the population under study, the bone mineral density is significantly lower than that of the general population: 25% present osteopenia and 22% osteoporosis. These results are associated with the fact that they move little and are regularly taking phenobarbital medication. The population with Down's syndrome is also seen to be a group at risk.

CONCLUSIONS

Osteoporosis is frequent among severe mentally retarded patients. The greatest risk is associated with insufficient mobility, Down's syndrome and regular medication with phenobarbital. Digital densitometry is a simple procedure that may be useful to identify the true dimension of this problem and the efficacy of the various preventive or curative procedures put forward.

Cell surface human alpha-L-fucosidase

The acid alpha-L-fucosidase is usually found as a soluble component of lysosomes where fucoglycoconjugates are degraded. In the present investigation, we have demonstrated the existence of a cell surface protein with enzymatic alpha-L-fucosidase activity that crossreacts specifically with a rabbit anti-(alpha-L-fucosidase) Ig. By different approaches, this alpha-L-fucosidase, which represents 10-20% of the total cellular fucosidase activity, was detected in all the tested human cells (hemopoietic, epithelial, mesenchymal). Two bands of approximately 43-49 kDa were observed, although theoretical data support the possibility of having the same genetic origin that the known 50 to 55-kDa Mr alpha-L-fucosidase. We speculate about an alternative traffic pathway for the plasma membrane alpha-L-fucosidase to work on the rapid turnover of glycoproteins.

Apolipoprotein D expression in endometrial carcinomas

BACKGROUND

Apolipoprotein D is a protein component of the human plasma lipid transport system but is also associated with a more favorable prognosis in breast cancer and ovarian cancer women. This study was undertaken to examine the tumoral expression of apolipoprotein D in endometrial cancer and to analyze the possible correlation with tumor and patients characteristics as well as androgen receptors and its prognostic significance.

METHODS

Immunohistochemical evaluation was used to examine apolipoprotein D expression in paraffin blocks from 58 endometrial carcinomas.

RESULTS

A total of twenty (34%) tumors stained positively. Staining was localized in tumor cells. No significant correlation was found between apo D expression and patients or tumor characteristics and androgen receptor status. In addition, apolipoprotein D expression was not associated with patient prognosis.

CONCLUSIONS

Apolipoprotein D is expressed by a significant percentage of endometrial carcinomas without apparent association with other clinicopathologic parameters or with outcome of patients.

Na(+):K(+):ATPase mRNA expression in the kidney during adaptation to sodium intake and furosemide treatment

Nephron tubular epithelium possesses the capacity of adaptation to any salt ingestion condition. The mechanism of adaptation is due in part to an increase in the activity of Na(+):K(+):ATPase at the basolateral membrane. The goal of the present study was to analyze the long-term regulation of the Na(+):K(+):ATPase alpha(1)-subunit mRNA expression during changes in NaCl metabolism. Male Wistar rats given a normal, high, or low NaCl diet, and intraperitoneal administration of the loop diuretic furosemide from 12 h to 7 days were studied. Rats were kept in metabolic cages 4 days before and throughout the study to determine daily urinary electrolyte excretion and osmolarity. At the end of each experimental period, creatinine clearance and serum electrolytes were also measured. Total RNA was extracted from each individual cortex or outer medulla and from pooled inner medullas using the guanidine/cesium chloride method. Na(+):K(+):ATPase alpha(1)-subunit mRNA expression was assessed by nonradioactive dot-blot analysis. Experimental maneuvers were well tolerated and all groups developed the appropriate renal response to each experimental condition. Urinary sodium excretion was significantly higher in rats administered a high sodium diet or furosemide and lower in rats treated with a low sodium diet after 7 days of treatment. Glomerular filtration rate was similar among all groups. However, the level of expression of the Na(+):K(+):ATPase alpha(1)-subunit did not change in any model. Nephron adaptation to the modification in NaCl intake or furosemide administration over 7 days did not include changes in Na(+):K(+):ATPase alpha(1)-subunit mRNA levels.

Expression and clinical significance of apolipoprotein D in epithelial ovarian carcinomas

OBJECTIVE

Apolipoprotein D is a protein component of the human plasma lipid transport system but is also associated with a more favorable prognosis in women with breast cancer. This retrospective study was undertaken to examine the tumoral expression of apolipoprotein D in epithelial ovarian cancer and to analyze the possible correlation with tumor and patient characteristics as well as androgen receptors and their prognostic significance.

METHODS

Immunohistochemical evaluation was used to examine apolipoprotein D expression in paraffin blocks from 68 epithelial ovarian carcinomas.

RESULTS

A total of 18 (26.4%) tumors stained positively. No significant correlation was found between apolipoprotein D expression and patient or tumor characteristics and androgen receptor status. However, apolipoprotein D expression was significantly associated with prognosis in patients with residual tumor greater than 1 cm. Thus, patients with apolipoprotein-D-negative tumors had a poorer overall survival than those with apolipoprotein-D-positive tumors (P = 0.039). In addition, multivariate analysis demonstrated that apolipoprotein D expression was an independent prognostic factor with initial tumor size in this group of patients (P = 0.005).

CONCLUSIONS

Our results led us to consider the existence of apolipoprotein D expression by a significative percentage of ovarian carcinomas, and this protein expression might be of clinical usefulness for identifying lesions with different evolution.

Induction of peroxiredoxins in transplanted livers and demonstration of their in vitro cytoprotection activity

Peroxiredoxin (Prx)-I and -II belong to a new class of antioxidants. Here, we report that they are induced by ischemia/reperfusion (I/R) in transplanted livers. Hypothesizing that Prxs are induced to protect liver from oxidative damage, we transduced these human genes into murine NIH-3T3 cells. The overexpressed Prxs made the cells more resistant to t-butylhydroperoxide-induced apoptosis. These results indicate that Prx-I and Prx-II are induced by the transplantation process and can protect cells against oxidant damage in tissue culture. Thus, proper genetic manipulations of Prxs may be useful in increasing the success rate of organ transplantation.