Current Transition Practice for Primary Immunodeficiencies and Autoinflammatory Diseases in Europe: a RITA-ERN Survey

BACKGROUND

Due to the absence of curative treatments for inborn errors of immunity (IEI), children born with IEI require long-term follow-up for disease manifestations and related complications that occur over the lifespan. Effective transition from pediatric to adult services is known to significantly improve adherence to treatment and long-term outcomes. It is currently not known what transition services are available for young people with IEI in Europe.

OBJECTIVE

To understand the prevalence and practice of transition services in Europe for young people with IEI, encompassing both primary immunodeficiencies (PID) and systemic autoinflammatory disorders (AID).

METHODS

A survey was generated by the European Reference Network on immunodeficiency, autoinflammatory, and autoimmune diseases Transition Working Group and electronically circulated, through professional networks, to pediatric centers across Europe looking after children with IEI.

RESULTS

Seventy-six responses were received from 52 centers, in 45 cities across 17 different countries. All services transitioned patients to adult services, mainly to specialist PID or AID centers, typically transferring up to ten patients to adult care each year. The transition process started at a median age of 16-18 years with transfer to the adult center occurring at a median age of 18-20 years. 75% of PID and 68% of AID centers held at least one joint appointment with pediatric and adult services prior to the transfer of care. Approximately 75% of PID and AID services reported having a defined transition process, but few centers reported national disease-specific transition guidelines to refer to.

CONCLUSIONS

Transition services for children with IEI in Europe are available in many countries but lack standardized guidelines to promote best practice.

HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of Hyperthermic intra-peritoneal chemotherapy (HIPEC) with Mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma

Background

Local relapse and peritoneal carcinomatosis (PC) for pT4 colon cancer is estimated in 15,6% and 36,7% for 12 months and 36 months from surgical resection respectively, achieving a 5 years overall survival of 6%. There are promising results using prophylactic HIPEC in this group of patients, and it is estimated that up to 26% of all T4 colon cancer could benefit from this treatment with a minimal morbidity. Adjuvant HIPEC is effective to avoid the possibility of peritoneal seeding after surgical resection. Taking into account these results and the cumulative experience in HIPEC use, we will lead a randomized controlled trial to determine the effectiveness and safety of adjuvant treatment with HIPEC vs. standard treatment in patients with colon cancer at high risk of peritoneal recurrence (pT4).

Methods/Design

The aim of this study is to determine the effectiveness and safety of adjuvant HIPEC in preventing the development of PC in patients with colon cancer with a high risk of peritoneal recurrence (cT4). This study will be carried out in 15 Spanish HIPEC centres. Eligible for inclusion are patients who underwent curative resection for cT4NxM0 stage colon cancer. After resection of the primary tumour, 200 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously after the primary resection. Mitomycin C will be used as chemotherapeutic agent, for 60 min at 42–43 °C. Primary endpoint is loco-regional control (LC) in months and the rate of loco-regional control (%LC) at 12 months and 36 months after resection.

Discussion

We assumed that adjuvant HIPEC will reduce the expected absolute risk of peritoneal recurrence from 36% to 18% at 36 months for T4 colon-rectal carcinoma.

Trial registration

NCT02614534 (clinicaltrial.gov) Nov-2015.

Study of high quality AlN layers grown on Si(111) substrates by plasma-assisted molecular beam epitaxy

High quality AlN layers with full widths at half maximum values of 10 arcmin and average surface roughness (rms) of 48Å were grown by molecular beam epitaxy on Si(111) substrates. A systematic study and optimization of the growth conditions was performed in order to use these AlN layers as buffers in the growth of GaN films. Atomic force microscopy (AFM) and X-ray diffraction (XRD) techniques were employed to determine the surface and structural quality of the layers. Best AlN films were obtained at high substrate temperatures (Tsubs>900°C) and III/V ratios close to stoichiometry. Growth conditions with III/V ratios beyond stoichiometry (Al-rich) did not further improve the crystal quality. In these cases a higher substrate temperature is needed to prevent condensation of Al on the surface. GaN films with full width at half maximum of 10 arcmin and improved optical properties were grown on top of optimized AlN buffer layers.

Recommendations of a group of experts for the pathological assessment of tumour regression of liver metastases of colorectal cancer and damage of non-tumour liver tissue after neoadjuvant therapy

Colorectal cancer (CRC) incidence has increased during the past decades in Spain, being the first malignant tumour in incidence. Observed mortality for CRC is mainly due to liver and lung metastases. The only curative treatment is surgery; new surgical techniques and neoadjuvant treatments have increased the number of surgery candidate patients. Patients should be managed with a multidisciplinary approach that includes imaging techniques, chemotherapy, surgery and pathological assessment. As an answer to this approach, a group of pathology experts interested on CRC liver metastases aimed to review the diagnosis and prognosis of liver mestastases and developed practical recommendations for its assessment. The expert group revised the current literature and prepared questions to be discussed based on available evidence and on their clinical practise. As a result, recommendations for the assessment of tumour regression of liver metastases are proposed, which could be implemented in oncology centres allowing assessment standardisation for these patients. Prospective multi-center studies to evaluate these recommendations validity will further contribute to improve the standard care of CRC liver metastases patients.

C-erbB-2 oncoprotein content in colorectal cancer and in surrounding mucosa: relationship with clinicopathologic parameters and prognostic significance

BACKGROUND

c-erbB-2 is a transmembrane signaling molecule closely related in structure to the epidermal-growth-factor receptor (EGFR) but biologically distinct from it. c-erbB-2 has been implicated in cell transformation and tumor pathogenesis, but very little is known about its content and clinical significance in colorectal cancer.

AIMS

To evaluate the c-erbB-2 content in colorectal cancer and its possible relationship with clinicopathologic parameters from tumors and prognostic significance.

METHODS

Membranous and cytologic c-erbB-2 oncoprotein contents were examined by an immunoenzymatic assay in tumors and paired normal surrounding mucosa samples from 131 colorectal cancer patients. In addition, survival analysis were prospectively performed in a subgroup of 69 consecutive patients with resectable colorectal carcinomas, who underwent a mean follow-up period of 28 months.

RESULTS

In the overall group of patients, c-erbB-2 levels were significantly higher in membranous than in cytosolic samples, in neoplastic tissues (5,830.4 +/- 1085.3 vs. 934.2 +/- 107.5 NHU/mg protein; p < 0.0001) and in surrounding normal mucosa samples (5,257.8 +/- 646.3 vs. 837.4 +/- 187.4 NHU/mg protein; p < 0.0001). Nevertheless, a significant positive relation was found between membranous and cytosolic oncoprotein levels in these two paired sets (p < 0.0001, for both). There were no significant differences in membranous or cytosolic c-erbB-2 protein levels between neoplastic tissues and surrounding mucosa samples in this overall group of patients. In addition, the results did not show significant correlations of these oncoprotein contents with clinicopathologic parameters from tumors such as location, stage, histologic grade, and DNA content or S-phase fraction. However, the results indicated that low membranous c-erbB-2 content (< 4,500 NHU/mg protein) in tumors predict shorter relapse-free survival and overall survival (p < 0.05, for both) in resectable colorectal cancer patients.

CONCLUSIONS

There are a wide variability of both membranous and cytologic c-erbB-2 contents in colorectal carcinomas, which seems to correspond to the biological heterogeneity of these tumors. In addition, our results also demonstrate that high membranous c-erbB-2 levels are associated with lesions of favorable evolution in resectable colorectal cancer patients.

[The determination of arterial pressure by the physician or the nurse: its relation to ambulatory pressure and left ventricular mass. The MAPA-Madrid Group. Monitorización Ambulatoria de la Presión Arterial (Ambulatory Monitoring of Arterial Pressure)]

BACKGROUND

In the present study we evaluated the influence of the observer's status--physician or nurse--on blood pressure levels and the relationship among clinic blood pressure measurement with ambulatory blood pressure and left ventricle mass.

PATIENTS AND METHODS

Cross sectional study performed in seven primary care centers. Participating physicians and nurses were trained for blood pressure measurement prior to the study and subsequently retrained at 3 month intervals during the study. Patients included in the study were 122 subjects with mild to moderate hypertension who underwent the following study protocol: a) measurement of clinic blood pressure by physician and nurse, in an independent fashion, on 3 visits; b) clinic-epidemiologic questionnaire; c) conventional hematological and biochemical study; d) electrocardiogram; e) 24-hour ambulatory blood pressure monitoring, f) M-mode and Doppler echocardiography (only in 58 subjects).

RESULTS

Nurse-measured blood pressure levels were higher than those determined by physicians (mean differences: 3.9 [6.7] mmHg in systolic blood pressure and 2.6 [5.4] mmHg in diastolic blood pressure). The blood pressure level differences between the two observers were higher in female patients and subjects with low educational level, independently of the observer's gender. Nurse-measured blood pressure was more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure.

CONCLUSIONS

Nurse-measured blood pressure levels are lower than those determined by physicians and more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure. These data support that nurses, instead of doctors, should routinely measure blood pressure in primary care centers.

Genetic analysis of turbot pathogenic Streptococcus parauberis strains by ribotyping and random amplified polymorphic DNA

Ribotyping and RAPD profiling of a collection of 18 Streptococcus parauberis strains isolated from diseased turbot in Galicia (NW Spain) was performed in order to analyze the possible genetic variability within this bacterial fish pathogen. In addition, the value of this technique for intraspecific classification and epidemiological studies was evaluated. Ribopatterns of DNA digested with three endonucleases and hybridized with a cDNA probe complementary to highly conserved sequences in the 16S and 23S rRNA genes showed a great homogeneity among the turbot isolates. Compared with ribotyping, RAPD appeared to be a reliable and fast technique for discriminating between isolates of S. parauberis on the basis of their farm of isolation and, therefore, represents a powerful tool for epidemiological studies of this fish pathogen.

[Puerperal thrombophlebitis and the ovarian vein with extension to the inferior vena cava]

PURPOSE

To assess US, CT and MR findings in women having puerperal ovarian vein thrombosis with clot protrusion into the inferior vena cava.

PATIENTS, MATERIAL AND METHODS

We retrospectively reviewed the duplex US (n = 9), CT (n = 5) and MR (n = 5) examinations of 9 patients with 8 right ovarian vein thrombosis, and one left ovarian vein thrombosis.

RESULTS

US findings allowed for the diagnosis of ovarian vein thrombosis in all patients in showing enlarged tubular echogenic thrombus within the retroperitoneum with clot protrusion in the IVC in all cases. CT scan and MRI demonstrated ovarian vein thrombosis in all the cases in which it was performed but failed to show a mobile thrombus within the IVC in one patient.

CONCLUSION

Duplex US is a reliable technique to show puerperal ovarian vein thrombosis and its extension to the IVC. CT scan and MR imaging can be used to precise the extension to the IVC.

Zinc toxicity in the fish Cnesterodon decemmaculatus in the Paraná River and Río de La Plata Estuary

Acute static tests were performed to assess Zn toxicity on adults of Cnesterodon decemmaculatus (not sexed), a neotropical fish of wide distribution in the Río de la Plata basin. Tests were carried out with ZnCl2 dissolved in natural waters from the Lower Paraná River, the Río de la Plata Estuary, reconstituted waters of similar composition, tap and distilled waters. Median lethal concentration at 24 h was positively correlated to conductivity and the concentrations of Ca2+, Mg2+, and HCO3- (r=0.99, 0.96, 0.97, 0.99, p<0.05, respectively), being higher at the Río de la Plata Estuary (61.2 mg l(-1)) than at the Lower Paraná River (35.3 mg l(-1)). Contaminant load in the natural waters tested was similar at both sites, being Zn concentration 40 and 44 microg l(-1), respectively. An assay with reconstituted water of similar alkalinity to the estuary showed a simultaneous decrease in HCO3- and dissolved Zn, while the Zn speciation, predicted with a computer program, suggested that Zn2+ precipitated as ZnCO3. The effect of Ca2+ on Zn toxicity is also discussed. Zn toxicity was higher in the Río de la Plata Estuary water than in synthetic water of similar ionic composition (24-h LC50 = 93.2 mg l(-1)), suggesting the synergistic effect of other toxic pollutants such as metals, present in the former which were absent in the later.