Infection With Saprochaete Clavata in Children After Hematopoietic Cell Transplantation

Septic shock is a very rare manifestation of invasive fungal disease (IFD) in children after allogeneic hematopoietic cell transplantation (allo-HCT). The objective of this paper is analysis of two cases of pediatric patients with IFD caused by Saprochaete clavata after allo-HCT. Literature data on this infection in children and its outcome were also summarized. Infection with Saprochaete clavate presenting with symptoms of septic shock was being reported in 4 children, and 2 of them survived the infection. In conclusion, with quick diagnosis and quick treatment, the outcome of therapy of infection with Saprochaete clavata was successful.

Letermovir Prophylaxis for Cytomegalovirus Infection in Children After Hematopoietic Cell Transplantation

BACKGROUND/AIM

Cytomegalovirus (CMV) infection is one of the major causes of morbidity following hematopoietic cell transplantation (HCT). Allogeneic HCT (allo-HCT) recipients are at the highest risk of clinically significant CMV reactivation. While letermovir has been approved for prophylactic use in CMV seropositive adults, reports on pediatric data are very limited. The objective of the study was to examine the use of letermovir for prophylaxis from CMV infection in children undergoing allo-HCT in a single center.

PATIENTS AND METHODS

This retrospective matched-pair analysis study included 39 CMV-seropositive pediatric patients undergoing allo-HCT receiving letermovir as a primary prophylaxis for CMV infection on a compassionate-use basis (LMV group, n=13) or not (control group, n=26). There were no differences in basic characteristics between the analyzed groups. Among patients of the study group, 12 received primary prophylaxis with letermovir from day +1 after HCT. One patient, previously treated with ganciclovir received secondary prophylaxis from day +18.

RESULTS

Prophylactic dose of letermovir was adjusted to cyclosporine co-administration, varied in between 120-480 mg, and given orally, once daily. No CMV reactivation was observed during administration of letermovir. Cumulative incidence of CMV reactivation was significantly higher for the control group not receiving prophylaxis. Of the 13 patients of the study group, three died; however, deaths were not attributable to CMV infection. We did not observe any toxicities related to letermovir.

CONCLUSION

Our data support letermovir prophylaxis efficacy and safety in pediatric patients after allo-HCT. Compared with the historical group, prophylactic use of letermovir decreased the number of CMV reactivations in children.

Rhabdomyosarcoma in a Patient With Duchenne Muscular Dystrophy: A Possible Association

Duchenne muscular dystrophy (DMD), caused by a mutation in the DMD gene, is known to be associated with co-morbidities including cardiomyopathy, respiratory failure, neuromuscular scoliosis and intellectual disability. Animal studies have explored the susceptibility of dystrophin-deficient mice with the development of myogenic tumors. While there is adequate literature describing both DMD and rhabdomyosarcoma (RMS) separately, there has yet to be a comprehensive literature review investigating the possibility that patients with DMD may be at a higher risk of developing RMS and other myogenic tumors. We present the case of a pediatric patient with DMD who developed alveolar RMS and review the literature for susceptibility to development of myogenic tumors in cases of DMD gene mutation.

Acute Lymphoblastic Leukemia in Children: Better Transplant Outcomes After Total Body Irradiation-based Conditioning

BACKGROUND/AIM

Comparison of transplant outcomes in long-term follow-up of children after total body irradiation (TBI)- or chemotherapy-based conditioning allogeneic hematopoietic cell transplantation (allo-HCT).

PATIENTS AND METHODS

Patients undergoing allo-HCT for Acute lymphoblastic leukemia (ALL) conditioned either with TBI (n=55) or chemotherapy (n=84) were compared. The following transplant outcomes were analyzed: overall survival (OS), event-free survival (EFS), relapse incidence (RI), and graft-versus-host-disease (GVHD)-free-relapse-free survival (GRFS).

RESULTS

All analyzed long-term transplant outcomes were significantly better for patients conditioned with TBI at 2 years after transplant. OS at 2 years was 84% after TBI and 60.5% after chemotherapy-conditioning (p=0.005). Risk factor analysis showed that two factors, TBI-based conditioning and transplant in first remission of ALL, significantly improved OS, EFS, GRFS, and decreased RI.

CONCLUSION

TBI-based conditioning before allogeneic HCT in children with acute lymphoblastic leukemia provides significantly better transplant outcomes, when compared to chemotherapy-based conditioning.

Impact of CMV and EBV on Immune Recovery After Allogeneic Hematopoietic Cell Transplantation in Children

BACKGROUND/AIM

Immune recovery is a key factor in the management of patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study analyzed the factors contributing to immune reconstitution after allo-HSCT.

PATIENTS AND METHODS

Overall, 65 children with malignant or non-malignant diseases were included in multivariate analyses.

RESULTS

The following factors contributed to a faster immune recovery: peripheral blood as a stem cell source and reactivation of CMV infection for CD3⁺ and CD4⁺ lymphocyte subpopulations; reactivation of CMV infection for CD8⁺ subset; donor EBV-IgG⁺ and no EBV reactivation for CD19 lymphocytes; recipient age below 10 years and peripheral blood as a stem cell source for NK cells. For CD2 and CD4/CD8 ratio no factor was significant in multivariate analysis.

CONCLUSION

Patients receiving a graft from an EBV-IgG-positive donor and not having early EBV post-transplant viremia show faster recovery of the B-cells, while patients with early CMV-DNA-emia have a better re-establishment of T-cell subsets.

Transplant-related mortality and survival in children with malignancies treated with allogeneic hematopoietic stem cell transplantation. A multicenter analysis

The aim of the study was to assess the risk of TRM in pediatric patients treated for malignant disorders with allogeneic HSCT, according to different risk factors. The treatment outcome was analyzed in 299 pediatric patients treated in pediatric transplant departments from 2006 to 2015. To compare the outcome, patients were analyzed all together and in groups according to the diagnosis, age at transplant, donor type, disease status, stem cell source, and pediatric TRM score. At the end of the observation time, 82 patients were alive, 82 died, of which 40 due to transplant-related reasons. The most frequently observed causes of TRM were toxic complications effecting with organ failure (38%), followed by infections (26%), PTLD (14.3%), and GvHD (16.7%). There was no statistical difference in the incidence of TRM depending on stem cell source (P = .209) and primary diagnosis (P = .301). According to TRM score, TRM was significantly higher in high-risk group (P = .006). High-risk patients had lower survival comparing to low/intermediate group (P = .0001). OS did not differ between ALL, AML, and MDS/JMML groups. The study confirmed the utility of factors included in TRM score stratification in assessing the risk of transplant procedure in pediatric patients transplanted for malignancies.

Phenotype of NK Cells Determined on the Basis of Selected Immunological Parameters in Children Treated due to Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL) is the most frequent pediatric malignancy. The chemotherapy for ALL is associated with a profound secondary immune deficiency.We evaluated the number and phenotype of natural killer (NK) cells at diagnosis, after the intensive chemotherapy and following the completion of the entire treatment for patients with ALL. The fraction, absolute number, and percentage of NK cells expressing interferon-γ were determined in full blood samples. The fraction of NK cells expressing CD158a, CD158b, perforin, A, B, and K granzymes was examined in isolated NK cells.We have shown that patients assessed at ALL diagnosis showed significantly lower values of the fraction of NK cells and percentage of NK cells with the granzyme A expression. Additionally, the absolute number of NK cells, the expression of CD158a, CD158b, perforin, and granzyme A were significantly lower in patients who completed intensive chemotherapy. Also, there was a significantly higher fraction of NK cells expressing granzyme K in patients who completed the therapy.Abnormalities of NK cells were found at all stages of the treatment; however, the most pronounced changes were found at the end of intensive chemotherapy.

Nanovehicles as a novel target strategy for hyperthermic intraperitoneal chemotherapy: a multidisciplinary study of peritoneal carcinomatosis

In general, detection of peritoneal carcinomatosis (PC) occurs at the late stage when there is no treatment option. In the present study, we designed novel drug delivery systems that are functionalized with anti-CD133 antibodies. The C1, C2 and C3 complexes with cisplatin were introduced into nanotubes, either physically or chemically. The complexes were reacted with anti-CD133 antibody to form the labeled product of A0-o-CX-chem-CD133. Cytotoxicity screening of all the complexes was performed on CHO cells. Data showed that both C2 and C3 Pt-complexes are more cytotoxic than C1. Flow-cytometry analysis showed that nanotubes conjugated to CD133 antibody have the ability to target cells expressing the CD133 antigen which is responsible for the emergence of resistance to chemotherapy and disease recurrence. The shortest survival rate was observed in the control mice group (K3) where no hyperthermic intraperitoneal chemotherapy procedures were used. On the other hand, the longest median survival rate was observed in the group treated with A0-o-C1-chem-CD133. In summary, we designed a novel drug delivery system based on carbon nanotubes loaded with Pt-prodrugs and functionalized with anti-CD133 antibodies. Our data demonstrates the effectiveness of the new drug delivery system and provides a novel therapeutic modality in the treatment of melanoma.

Palifermin in children undergoing autologous stem cell transplantation: a matched-pair analysis

BACKGROUND

Keratinocyte growth factor (palifermin) is used for prevention of mucositis in adults following autologous and allogeneic hematopoietic stem cell transplantation (HSCT). It is known that palifermin decreases length of initial hospital stay, mean number of days of total parenteral nutrition (TPN) and the use of opioids for pain control in oral mucositis in adults. There are limited data evaluating palifermin use in children following autologous HSCT.

AIM

The objective of the present study was the analysis of efficacy and safety of palifermin in children undergoing auto-HSCT.

PATIENTS AND METHODS

This matched-pair analysis study included 62 pediatric patients undergoing first auto-HSCT receiving palifermin on a compassionate-use basis (study group, n=31) or not (control group, n=31).

RESULTS

Palifermin decreased the incidence of severe (grade 3-4 WHO) oral mucositis (p=0.041), length of hospitalization (p=0.047) and contributed to the shorter duration of oral mucositis (p=0.035) and lower incidence of clinically or microbiologically documented infections (p=0.038). There were no differences between groups in opioid use, neutrophil and platelet recovery, TPN use and gastrointestinal hemorrhage.

CONCLUSION

Palifermin decreases the incidence and severity of oral mucositis in children undergoing autologous HSCT.

Is the poly (L- lactide- co- caprolactone) nanofibrous membrane suitable for urinary bladder regeneration?

The purpose of this study was to compare: a new five-layered poly (L-lactide-co-caprolactone) (PLC) membrane and small intestinal submucosa (SIS) as a control in rat urinary bladder wall regeneration. The five-layered poly (L-lactide-co-caprolactone) membrane was prepared by an electrospinning process. Adipose tissue was harvested from five 8-week old male Wistar rats. Adipose derived stem cells (ADSCs) were seeded in a density of 3×10(6) cells/cm2 onto PLC membrane and SIS scaffolds, and cultured for 5-7 days in the stem cell culture medium. Twenty male Wistar rats were randomly divided into five equal groups. Augmentation cystoplasty was performed in a previously created dome defect. Groups: (I) PLC+ 3×10(6)ADSCs; (II) SIS+ 3×10(6)ADSCs; (III) PLC; (IV) SIS; (V) control. Cystography was performed after three months. The reconstructed urinary bladders were evaluated in H&E and Masson's trichrome staining. Regeneration of all components of the normal urinary bladder wall was observed in bladders augmented with cell-seeded SIS matrices. The urinary bladders augmented with SIS matrices without cells showed fibrosis and graft contraction. Bladder augmentation with the PLC membrane led to numerous undesirable events including: bladder wall perforation, fistula or diverticula formation, and incorporation of the reconstructed wall into the bladder lumen. The new five-layered poly (L-lactide-co-caprolactone) membrane possesses poorer potential for regenerating the urinary bladder wall compared with SIS scaffold.

Carboplatin and sodium butyrate, separate--yes, but combined--never

With the object of improving the effectiveness of a malignant melanoma's treatment and a patients' quality of life, there is a serious need to identify new anticancer compounds, for example, among naturally derived compounds such as sodium butyrate. The aim of this study was to assess the combined impact of carboplatin (C) and sodium butyrate on the B16 melanoma viability by in vitro. B16 cell line was exposed to various concentrations of carboplatin (0.001-10 micromol/L) and sodium butyrate (1 to 100 mmol/L) for 24 h. LC10, LC50 and LC90 values were calculated. The influence of carboplatin and sodium butyrate on the cell cycle and apoptosis was assessed. Additionally, magnetic stem cell sorting was performed, positive melanoma CD133 cells were isolated and the effects of carboplatin and sodium butyrate on cell viability with heterogeneous population of melanoma cells (CD133+/CD133-) was compared. For carboplatin LC50 and LC90 were 1.2 micromol/L and 4.58 pmol/L, respectively. For sodium butyrate LC50 and LC90 were 65.73 mmol/L and 275.06 mmol/L. The value for LC10 could not be determined. Sodium butyrate at the highest concentration (100.0 mmol/L) resulted in only 57.36% mortality of cells. A synergistic effect of both compounds was observed in low concentrations of sodium butyrate and carboplatin. That synergism disappeared at concentrations corresponding to LC50. At the concentration corresponding to LC50 C and high concentration of sodium butyrate, a decrease of cell numbers in phase G2/M was observed (r = -0.97). Cells were arrested in phase G1/G0 and S. The presented results exclude the possibility of the combined application of sodium butyrate and carboplatin in cancer therapy.

Comparison of prognostic value of in vitro drug resistance and bone marrow residual disease on day 15 of therapy in childhood acute lymphoblastic leukemia

AIM

The analysis of the prognostic impact of residual disease at day 15 of induction therapy, individual tumor response testing (ITRT) at diagnosis, initial factors and initial therapy response to the risk of relapse in children with precursor B-cell acute lymphoblastic leukemia (ALL).

PATIENTS AND METHODS

A total of 87 children were tested at diagnosis for ITRT and for persistence of blasts in bone marrow at day 15 (BML15>0.5%) and were followed-up in long-term analysis.

RESULTS

The probability of disease-free survival (pDFS) was significantly better for patients with an ITRT profile showing sensitivity to prednisolone, vincristine, daunorubicin, and L-asparaginase. Patients with BML15>0.5% had higher ITRT for prednisolone, daunorubicin, L-asparaginase, and etoposide. Three factors had predictive impact for relapse: BML15>0.5%, ITRT for prednisolone and high combined ITRT profile for prednisolone, vincristine and L-asparaginase (PVA score).

CONCLUSION

Persistence of blasts in bone marrow at day 15, ITRT showing resistance to prednisolone and high PVA score were the strongest and comparable prognostic factors predicting relapse in childhood ALL.

Individualized tumor response testing profile has a prognostic value in childhood acute leukemias: multicenter non-interventional long-term follow-up study

A total number of 817 children with acute lymphoblastic leukemia (ALL) and 181 with acute myeloblastic leukemia (AML) were assessed for individualized tumor response testing (ITRT) profile as a prognostic factor in long-term follow-up. For each patient, ITRT, initial response to therapy and long-term outcome were assessed. In initial ALL, an impact on long-term response was shown in ITRT for 13 drugs, while in initial AML only for cytarabine. For patients with ALL, a combined five-drug ITRT profile for prednisolone, l-asparaginase, vincristine, cytarabine and daunorubicin or doxorubicin had predictive value for probability of disease-free survival (pDFS) in univariate analysis, whereas in multivariate analysis, bone marrow response by day 33 was the only prognostic factor. For patients with AML, no factor had prognostic value for pDFS in univariate analysis, while ITRT to cytarabine almost reached significance. In conclusion, ITRT can possibly be regarded as a risk factor in childhood acute leukemias.

Intrathecal therapy with rituximab in central nervous system involvement of post-transplant lymphoproliferative disorder

Post-transplant lymphoproliferative disorder (PTLD) caused by Epstein-Barr virus (EBV) is a severe complication in high-risk allogeneic hematopoietic stem cell transplant (HSCT) recipients. Central nervous system (CNS) involvement of PTLD is a very rare event in patients with HSCT. As no established standard therapy in CNS-EBV-PTLD is available, the aim of this study was analysis of the safety and efficacy of intrathecal rituximab therapy in a group of eight children and adolescents with CNS-EBV-PTLD. Seven patients responded to therapy: all clinical symptoms and EBV-DNA viral load resolved after a median 2 (range: 1-7) doses of rituximab. However, some magnetic resonance imaging (MRI) changes in brain scan persisted in two patients. In all patients, except one, no adverse events of the therapy were observed. In conclusion, intrathecal rituximab administration seems to be an effective and safe method of treatment of CNS-EBV-PTLD in pediatric stem cell recipients. We recommend this treatment modality for further investigation.

Altered intestinal microcirculation is the critical event in the development of necrotizing enterocolitis

PURPOSE

The pathophysiology of necrotizing enterocolitis (NEC) includes prematurity, enteral feeds, hypoxia, and hypothermia. We hypothesized that vasoconstriction of the neonatal intestinal microvasculature is the essential mechanistic event in NEC and that these microvascular changes correlate with alterations in mediators of inflammation.

METHODS

Sprague-Dawley rat pups were separated into groups by litter. Necrotizing enterocolitis was induced in experimental groups, whereas control animals were delivered vaginally and dam fed. Neonatal pups underwent intravital videomicroscopy of the terminal ileum with particular attention to the inflow and premucosal arterioles. Reverse transcriptase-polymerase chain reaction was performed to evaluate for messenger RNA of mediators of inflammation.

RESULTS

Necrotizing enterocolitis animals demonstrated statistically significant smaller inflow and premucosal arterioles than control animals (P < .05). Necrotizing enterocolitis animals had an altered intestinal arteriolar flow with a distinct "stop-and-go" pattern, suggesting severe vascular dysfunction. Reverse transcriptase-polymerase chain reaction confirmed elevation of Toll-like receptor 4 (P = .01) and high-mobility group box protein 1 (P = .001) in the ileum of animals with NEC.

CONCLUSION

Intestinal arterioles were significantly smaller at baseline in animals with NEC compared with controls, and expression of inflammatory mediators was increased in animals with NEC. This represents a novel method of defining the pathophysiology of NEC and allows real-time evaluation of novel vasoactive strategies to treat NEC.

Prognostic value of persistent peripheral blood and bone marrow lymphoblasts on day 15 of therapy in childhood acute lymphoblastic leukemia as detected by flow cytometry

AIM

The predictive value of residual disease measured by flow cytometry at day 15 of induction therapy was analyzed in 182 children treated for acute lymphoblastic leukemia (ALL).

MATERIALS AND METHODS

Peripheral blood (PB) and bone marrow were assessed for leukemia cells by morphology and flow cytometry at days 0, 8, and 15.

RESULTS

Absolute blast count (ABC) >200/μl in PB by day 15 assessed by flow cytometry predicted a lower probability of disease free survival (pDFS) (p=0.056). Patients with bone marrow lymphoblast (BML)>0.5% had a lower pDFS (p=0.002). Cumulative relapse incidence for patients with BML<0.5% was 8.9% vs. 47.1% (OR=4.6, p=0.036). In common/pre-B-ALL patients aged >10 years with BML>0.5%, pDFS value was significantly lower. In the multivariate analysis, the only significant factor with adverse prognostic value for pDFS was BML>0.5% (HR=5.3 p=0.030).

CONCLUSION

BML>0.5% analyzed by flow cytometry at day 15 is possibly the strongest prognostic factor in pediatric ALL.

[Analysis of the immunological reconstitution, effectiveness and safety of vaccination in children with cancer]

The aim of this study was an assessment of immunologic reconstitution, efficiency and safety of vaccination performed in course of oncological treatment and after the therapy.

PATIENTS

129 children aged 1 month-19,5 years with diagnosis of leukemia or lymphoma (74,4%) or a solid tumor (25,6%). Immune status was evaluated 6 months after cessation of treatment in order to plan active immunization. Effectiveness of vaccination against hepatitis B was performed too. PATIENTS who did not complete immunization against hepatitis B at the time of diagnosis continued vaccination according to the scheme 0-1-6 months, the others were given one doubled dose. In 90,7% patients complete immune reconstitution was observed and both mandatory and optional immunization was then resumed. In 5,4% of children vaccination with live vaccines was suspended due to moderate immune deficiencies. In 3,9% of patients severe immune deficiencies were diagnosed and vaccination was abandoned. At diagnosis of cancer double vaccine doses against hepatitis B were given to 94,6% of patients, while 5,4% continued standard vaccination scheme. After anticancer therapy anti-HBs titer >100 IU/ml was observed in 55%, 10-100 IU/ml in 26% and <10 IU/ml in 18,6% of patients. One case of HBV infection was noted. Neither adverse reactions after immunization nor life-threatening infections the patients were vaccinated against was noted. Our Immunization protocol adopted in the study seem to be efficient and safe.

Contraception usage over the age of 40 in Polish female population aged 45 – 54

OBJECTIVE

Analysis of particular contraception method usage over the age of 40 as declared by Polish women aged 45-54 according to their education level and place of residence.

METHOD

The research was conducted with help of a standardized questionnaire in a Polish nationwide representative sample of women aged 45-54 years (n = 1083) in April 2004.

RESULTS

28% of sexually active women over 40 years old did not use any contraception methods. Most of them were country dwellers (41%), a lower proportion lived in small/moderate towns (27%), and a significantly lower percentage was made by big city dwellers (14%). Among the most popular contraception methods the respondents indicated coitus interruptus (32%), condoms (30%) and the calendar method (26%). Oral contraception was used by 12% of women.

CONCLUSION

A considerable percentage of sexually active women aged more than 40 years do not use any contraception method at all or use unreliable methods. Highly reliable methods (condoms, contraception pills) are much more popular among city dwellers. Contraception pills are used by twice as many city dwellers as rural dwellers (16% versus 8%) and by 12% of women from small/moderate towns. Rates of condom usage are also differentiated and vary from 42% in big cities to 26-27% in rural areas and small/moderate towns. Although poor availability of the contraception pill might explain some differences in its usage, it is difficult to quote this factor in the case of condoms.

Influence of two Pt(IV) complexes on viability, apoptosis and cell cycle of B16 mouse melanoma tumors

Several platinum(IV) complexes are showing considerable promise in initial trials, producing reactive intermediates that then interact with DNA.

AIM

To perform in vitro study of two new platinum(IV) complexes cytotoxic effect on B16 mouse melanoma cells.

METHODS

PtCl(4)(dbtp)(2) and PtCl(2)(6mp)(2) complexes were prepared. PtCl(4)(dbtp)(2) was created as modification of PtCl(4)(dmtp) test previously. Apoptosis and necrosis were examined using flow cytometry, upon Annexin V/PI staining.

RESULTS

LC(10), LC(50) and LC(90) parameters established for PtCl(4)(dbtp)(2) were as following: 2.6, 17.0, 58.0 mumol/L. However LC(10) and LC(50) established for PtCl(2)(6mp)(2) were 1.2 and 14.0 micromol/l respectively. The both complexes induced apoptosis. PtCl(2)(6mp)(2) induced cell cycle arrest in G0/G1, while PtCl(4)(dbtp)(2) - in S-phase.

CONCLUSIONS

PtCl(4)(dbtp)(2) appeared to be more cytotoxic against B16 cells than PtCl(2)(6mp)(2). Apoptosis was the main mechanism of cell loss in cultures incubated with both tested complexes.

[KIR-NKAT2 expression and monocytoid dendritic cells transformation in children diagnosed for immune deficiency: a pilot study]

BACKGROUND

KIR-NKAT2 receptor, present on NK (natural killer) cells, is responsible for recognition of human leukocyte antigen C (HLA-C) on cells infected with different types of viruses. Its presence might contribute to disabling in elimination of infected cells and causing chronic infection. Another unknown parameter related to functionality of the immune system might be monocyte ability to form dendritic cells.

OBJECTIVES

To answer the question if impaired expression of KIR-NKAT2 or diminished ability to monocytoid dendritic cell formation is a cause of recurrent infections in children with no evident immunodeficiences or after splenectomy?

PATIENTS AND METHODS

A study was performed in 38 children diagnosed for immune deficiencies due to recurrent infections, splenectomy, humoral or cellular deficiencies. Mononuclear cells were isolated from peripheral blood. Monocytes and NK cells were isolated by SuperMACS device. An expression of KIR-NKAT2 on NK cells was determined by flow cytometry. Isolated monocytes were cultured for 7-14 days on enriched Methocult medium in order to stimulate monocytoid dendritic cell transformation. CD83 and CD206 expression was assayed before culture and after 7-14 days by flow cytometry.

RESULTS

The KIR-NKAT2 expression was present in 31/38 patients. Monocytes of 37/38 patients has begun transformation into dendritic cells after 7 days of culture, although a large variability of expression was observed. In splenectomized patients a trend towards higher KIR-NKAT2 expression and lower transformation of dendritic cells was revealed. No other subgroup of patients with significantly altered expression of analyzed receptors was detected.

CONCLUSIONS

Immunological defects, related to incorrect function of NK cells caused by disturbed expression of KIR-NKAT2 receptors, or impairment monocyte ability for transformation to dendritic cells, seems to be irresponsible for susceptibility for infections. Splenectomy might be an important risk factor disturbing mechanisms of immunologic function, also with respect to analyzed parameters, however this aspect requires further studies.

Primary hepatic carcinoid tumor in children

Primary carcinoid tumors of the liver are rare, with fewer than 60 cases currently reported in the English literature. We present the evaluation and management of a solid hepatic tumor in a 14-year-old boy. Intraoperative biopsy was indeterminant for malignant potential, and the patient underwent complete resection by left hepatic lobectomy. Final histopathologic evaluation of the mass revealed a carcinoid tumor. Extensive endoscopic and radiologic workup revealed no other primary source. The patient recovered well from surgery and is currently free of disease 32 months after initial resection. Review of the literature suggests that primary hepatic carcinoid tumors are particularly rare in children. As the liver is frequently a site for carcinoid metastasis from the gastrointestinal tract, any patient with a suspected primary hepatic carcinoid tumor must undergo an extensive search for an extrahepatic primary site. These tumors are typically indolent but may metastasize. In addition, medical therapy is of limited benefit in reducing tumor bulk. The mainstay for treatment of primary hepatic carcinoid tumors is surgical resection, and these tumors carry a more favorable prognosis than other primary hepatic malignancies and metastatic carcinoid. Follow-up is long-term, as these tumors can recur many years after initial resection.

[Efficacy and toxicity of intravenous busulfan-based conditioning treatment before hAematopoietic stem cell transplantation in children: preliminary report]

BACKGROUND

An intravenous form of busulfan has been developed to replace oral busulfan in conditioning treatment prior to haematopoietic stem cell transplantation (HSCT).

AIM

Retrospective evaluation of the efficacy and safety of iv busulfan in paediatric patients.

METHODS

A total number of 33 patients entered the study: 11 patients received intravenous Bu-based conditioning before HSCT (group A; 3 allo, 8 auto); 22 patients received oral Bu-based conditioning (group B; 5 allo, 17 auto). The median age was 5.3 (1.5-20) years. An intravenous dosing of busulfan based on body weight was used. Patients were conditioned with BuCy+/-Vp+/-ATG or BuMel protocols. Cyclosporin+/-methotrexate were used for GVHD prophylaxis during allo-HSCT.

RESULTS

Patients in group A were younger (p=0.005), received comparable amount of MNC and CD34 cells. The median time of neutrophil engraftment was similar in both groups: 12 (10-19) vs 12.5 (10-25) days, while platelet recovery was shorter in group A: 11.5 (7-30) vs 14 (9-187) days (p=0.019). Severe stomatitis occurred in 5/11 patients in group A and in 19/22 patients in group B (p=0.033). Additional analgesics were required, respectively, by 5/11 and 17/22 patients (p=0.117). There were no significant differences in a/cGVHD, gastrointestinal reaction, hepatic toxicity, occurrence of infections and haemorrhagic cystitis between the two groups. With a median follow-up of 9 months in group A and 12 months in group B, 8 (72.7%) patients in group A and 15 (68,2%) patients in group B were alive. 9/10 deaths were related to disease relapse. With this short follow up, the probability of relapse and overall survival were comparable in both groups.

CONCLUSIONS

The intravenous Bu-based conditioning treatment before HSCT for paediatric patients has a favorable toxicity profile. It has the potential to accelerate haematological reconstitution and to improve survival and engraftment in children undergoing HSCT. The i.v. administration is convenient, favouring its more widespread application. Further studies are needed.

[Skin biopsy in diagnosis of chronic graft-versus-host disease in patients after allogeneic haematopoietic stem cell transplantation: pathologist's point of view on quantitative scoring system]

BACKGROUND

Pathology diagnosis of chronic graft-versus-host-disease (GVHD) after allogeneic haematopoietic stem cell transplantation (allo-HSCT) is an important issue in clinical follow-up, in spite of frequent difficulties in interpretation., related to dynamic changes occurring in the skin during the disease, as well as to sequelae of basic disease and immunosuppressive therapy. Recently presented Consensus NIH (National Health Institute, Bethesda, USA) of histopathologic (HP) analysis is still complex and intrinsically divergent, thus clinically difficult to implement.

OBJECTIVE

Analysis of clinical value of histological evaluation results of skin biopsy in children after allo-HSCT and its correlation with clinical status.

PATIENTS AND METHODS

Ten skin biopsies were taken from 7 patients (4 boys, 3 girls, age 3-15 years) after allo-HSCT (6 MFD, 1 MMUD) and analyzed after hematoxylin/eosine and immunohistochemical (CD3, CD45T, CD20) staining. Pathology analysis was based on commonly accepted criteria enabling simple and unambiguous interpretation. Results were compared with clinical data and indications for immunosuppressive therapy.

RESULTS

It was found that reliable and coherent interpretation can be made when following parameters were taken into account: 1. in epithelium: the presence of apoptosis, archetypical changes and vacuolar degeneration in the basilar layer, presence of CD3/CD45 in the epidermis; 2. in the dermis: the extent of collagenization, presence of melanophages and lymphocyte infiltrations; 3. in the eccrine glands epithelium: eccrine glands atrophy and presence of lymphocytes.

CONCLUSIONS

A new scoring system of skin biopsy analysis in patients with chronic GVHD based on the modified NIH Consensus was proposed. The preliminary clinical value of histological results was assessed. Skin biopsy evaluation based on limited qualitative and quantitative analysis of lymphocyte infiltrates together with studies on intensity of apoptosis, collagenization and archetypical changes is a valuable diagnostic method complementary to clinical records, enabling easier undertaking of therapeutic decisions.

[G-CSF - primed bone marrow as a stem-cell source for allogeneic bone marrow transplantation in children]

BACKGROUND

Cell dose is one of the most important factors contributing to transplant success. Collection of G-CSF-stimulated haematopoietic stem cells from peripheral blood in adults belongs to standard procedures in transplantology. The data on collection of G-CSF-stimulated bone marrow, both in adults and children, are lacking.

OBJECTIVE

Analysis of the possibility and safety of use of G-CSF-stimulated haematopoietic stem cells from bone marrow in paediatric allogeneic sibling donor setting.

PATIENTS AND METHODS

The prospective study included 10 children aged 3-17 years (median 13 years). Donors (aged 5-30 years, median 13 years; including 7/10 aged <18 years) were given subcutaneous G-CSF as 5 03BC g/kg/24 h for 2-4 days before bone marrow collection. Follow-up lasted 0.3-2.1 years.

RESULTS

In none of the donors any serious adverse effects related to G-CSF or stem cell collection were observed. Median number of transplanted mononuclear cells (MNC) and CD3 4 cells was 10 x 10;8/ /kg (range, 5-12.7 x 10;8/kg) and 1.7 x 10;6/kg (range, 0.5-4.7 x 10;6/kg), respectively. All patients had granulocyte and platelet recovery with median time 16 days (range, 11-23 days) i 16 days (range, 12- -39 days), respectively. Overall, 4/10 patients had acute graft-versus-host disease (GVHD) > or =2 degrees and 2/10 patients had chronic GVHD (1 localized and 1 systemic). Higher cell-dose was not related to higher risk of acute or chronic GVHD. One-year probability of event-free-survival was 51.4%.

CONCLUSIONS

Collecting G-CSF primed bone marrow from paediatric donors is a safe and promising concept, and may help to obtain higher MNC and CD 34 cell dose from the donor. Benefits to recipient may occur related to faster engraftment after myeloablative transplantation without increasing the risk of GVHD. This concept requires further studies to evaluate this approach.

The proapoptotic influence of AgNO3 on human keratinocytes and fibroblasts in vitro, the impact for burned patient management

It was shown that ointments containing silver compounds delay wound healing and increase the risk of hypertrophic scarring in burned patients. The aim of the study was to establish the influence of AgNO3 on cell viability and apoptosis of keratinocytes and fibroblasts in vitro. Foreskin was used to establish primary human keratinocyte and fibroblasts cell cultures. Keratynocytes grew in DMEM/Ham's-12 at 3:1 ratio, supplemented with 10% FBS, EGF, insulin, transferin, triiodothyronine and hydrocortisone. Fibroblasts were cultured in DMEM with addition of 10% FBS. The influence of AgNO3 on keratinocyte and fibroblast cultures was evaluated by fluorescence microscopy and flow cytometry. Double staining with Annexin V-FITC and propidium iodide was performed. The AgNO3 at lower concentration (3 and 15 x 10(-4) M/dm3) than used for patient's treatment (31 x 10(-4) M/dm3) revealed to be toxic and trigger apoptosis in human keratinocytes and fibroblasts. The ointments containing nitrates should be used with caution especially in conditions where the epithelial layer is destroyed. The nitrate can negatively affect wound healing.

Choroid plexus carcinoma

Choroid plexus carcinoma is an uncommon neoplasm of the central nervous system most commonly found in the pediatric population. It is associated with a dismal prognosis, especially if incompletely resected. Accurate histopathologic diagnosis is imperative, and this neoplasm should always be included in the differential diagnosis of a papillary intraventricular tumor. Histopathologic features include blurring of papillary architecture, layers of neoplastic choroid plexus epithelial cells with pleomorphic nuclei, increased nuclear-to-cytoplasmic ratio, increased mitotic activity, areas of necrosis, and brain invasion. Current accepted treatment is gross total surgical resection of the tumor as the goal. Use of adjuvant chemotherapy is controversial at this time; however, it is considered in some cases.

Progenitor cells are responsible for formation of human prostate epithelium primary cultures

AIM

To analyze cell viability and morphology of primary cell cultures from CD133 immunolabeled and sorted cells from epithelium of patients suffering from benign prostate hyperplasia (BPH).

METHODS

Cells obtained from 5 patients were divided in two fractions. First fraction (CD133+/CD133-) was cultivated in DMEM with 10% FBS. Second fraction was mixed with CD133 microbeads and immunomagnetically divided into CD133+ and CD133- fractions. These cells were cultivated and followed-up for 2 weeks. Cells were stained for Annexin V FITC/propidium iodide.

RESULTS

Seventy CD133+/CD133- cultures, thirty-one of CD133+ and thirty-one of CD133- cells were established. There were 5-fold and 3-fold increase of CD133+/CD133- and CD133+ cell number after 2 weeks, respectively. CD133+/CD133- and CD133+ monolayers displayed epithelial-like morphology and cytokeratine expression. CD133- cultures collapsed. Cell viability within CD133+ and CD133- populations was 90.1-/+6.3% and 24.3-/+6.2%, respectively. Apoptotic index was 9.0-/+6.1% and 28.5-/+23.8% within CD133+ and CD133- cultures, respectively.

CONCLUSIONS

CD133 separated human primary epithelial cell cultures displayed differences in morphology, viability and apoptosis occurrence. Immunomagnetic sorting can be recommended in each in vitro experiments with primary cell cultures in order to provide more objective results.

Activity of bortezomib in adult de novo and relapsed acute myeloid leukemia

BACKGROUND

Bortezomib is an inhibitor of proteasome and NF-kappaB, with activity in various solid tumors and hematological malignancies.

AIM

The aim of the study was the analysis of in vitro drug resistance to bortezomib and other anticancer drugs in de novo and relapsed adult acute myeloid leukemia (AML).

PATIENTS AND METHODS

The leukemic cells of 46 adult patients with AML were tested for the in vitro drug resistance profile. The group included 20 de novo and 26 relapsed AML patients, among whom, 12 relapsed after allogeneic hematopoietic stem cell transplantation (HSCT) and 4 after autologous HSCT. The MTT assay was performed for 21 drugs. Expression of P-glycoprotein (PGP), multidrug resistance-associated protein-1 (MRP1) and lung resistance protein (LRP) proteins was measured by flow cytometry.

RESULTS

No significant differences in drug resistance were found for all tested drugs between de novo and relapsed AML samples, while expression of PGP, MRP1 and LRP was higher in relapsed patients. Patients with refractory or relapsed disease, had higher resistance of myeloblasts to cyclophosphamide (RR = 2.4, p = 0.050), and better sensitivity to busulfan (RR = 0.4, p = 0.054) and topotecan (RR = 0.4, p = 0.031). Those who have died due to refractory/relapsed disease (n = 16) had better sensitivity to bortezomib (RR = 0.6, p = 0.046) and treosulfan (RR = 0.1, p = 0.018).

CONCLUSION

In vitro drug resistance in relapsed adult AML is comparable to that in de novo disease. Activity in vitro of bortezomib might be a rationale for its use in refractory/relapsed AML adult patients.

Predictive value of multidrug resistance proteins and cellular drug resistance in childhood relapsed acute lymphoblastic leukemia

PURPOSE

Cellular resistance in childhood acute leukemias might be related to profile and function of multidrug resistance proteins and apoptosis regulating proteins. The aims of the study were: (1) analysis of expression of MRP1, PGP1, LRP, BCL-2 and p53 proteins; (2) correlation with ex vivo drug resistance, and (3) analysis of their prognostic impact on clinical outcome in childhood acute lymphoblastic (ALL) and acute myeloid (AML) leukemia.

METHODS

Total number of 787 children diagnosed for initial ALL (n = 527), relapsed ALL (n = 104), initial AML (n = 133) and relapsed AML (n = 23) were included into the study. Mean follow-up period was 3.5 years. Drug resistance for up to 30 anticancer agents was performed by the MTT assay. Expression of all proteins was tested by flow cytometry.

RESULTS

Both initial AML and relapsed ALL samples showed higher drug resistance than initial ALL samples. No significant differences were found in drug resistance between initial and relapsed AML samples. The presence of multidrug resistance and apoptosis proteins had no impact on pDFS in iALL and iAML, however strong trend towards adverse prognostic impact of MRP1, PGP and LRP on pDFS in rALL was observed. The same trend was observed for each of analyzed co-expressions of tested multidrug resistance proteins.

CONCLUSIONS

The phenomenon of cellular drug resistance in childhood acute leukemias is multifactorial and plays an important role in response to therapy. Expression of MRP1, PGP and LRP proteins, as well as their co-expression play possible role in childhood relapsed ALL.

The influence of alpha1-antagonist on the expression pattern of TNF receptor family in primary culture of prostate epithelial cells from BPH patients

Doxazosin triggers apoptosis via an imprecisely defined receptor mechanism that is related to tumor necrosis factor receptors (TNFRs). The aim of this study was to determine CD95, TNFR-1, TNFR-2, CD40 expression in primary prostate epithelial cultures incubated with doxazosin. Epithelial cultures were cultivated from 10 benign prostate hyperplasia patients. The cells were incubated with 20, 50 and 80 microM of doxazosin. Apoptosis was confirmed by fluorescence microscopy and flow cytometry. The cells were analyzed for expression of FAS, CD40, TNFR-1 and TNFR-2 by flow cytometry. Early apoptotic cells were present in all groups. A positive correlation was noticed between doxazosin dose and TNFR-1-, -2-positive cells. A decrease of CD40-positive cell population was observed in the lowest concentration. A decrease of mean fluorescence intensity signal of CD40 and CD95 was observed in the lowest concentration. Doxazosin-triggered apoptosis was dose-independent. The initiation of apoptosis was a result of receptors 'crosstalk' rather than a single receptor pathway activation. TNF receptor self-assembly process should be checked as a potential mechanism leading to apoptosis after doxazosin treatment.

Fludarabine, treosulfan and etoposide sensitivity and the outcome of hematopoietic stem cell transplantation in childhood acute myeloid leukemia

BACKGROUND

The prognostic role of the ex vivo drug resistance profile has not yet been proved in childhood acute myeloid leukemia (AML). The aim of the study was the analysis of the impact of the ex vivo drug resistance profile in a cohort of 44 children with AML undergoing hematopoietic stem cell transplantation (HSCT).

PATIENTS AND METHODS

Myeloblasts for drug resistance testing were obtained from the bone marrow either on diagnosis or at relapse, before the HSCT procedure and were tested by the MTT assay.

RESULTS

Children who relapsed after transplantation showed higher ex vivo resistance of the leukemic blasts to etoposide, mercaptopurine, thioguanine, fludarabine, mitoxantrone and treosulfan than those who stayed in remission. Despite being nondiscriminative, the combined ex vivo drug resistance profile to fludarabine, treosulfan and etoposide (FTE score) was the strongest prognostic factor by multivariate analysis.

CONCLUSION

The combined drug resistance profile to fludarabine, treosulfan and etoposide may be useful for better stratification of children with AML undergoing stem cell transplantation or to indicate the necessity for additional post-transplant therapy.

Expression of cyclin A in human leukemia cell line HL-60 following treatment with doxorubicin and etoposide: the potential involvement of cyclin A in apoptosis

We investigated expression of cyclin A in HL-60 cells after induction of apoptosis with doxorubicin and etoposide. Following apoptotic trigger, both cells arrested in G2/M phase of the cell cycle and changes in morphology were noticed. Moreover, compared to control, the number of cells with cyclin A expression was changed and translocation of this protein from the nucleus to the cytoplasm was observed. The decrease in the number of cells with cyclin A expression, followed by the increase, and cyclin A distribution throughout the cell, appeared to be dose-dependent. Cells treated with lower doses of doxorubicin and etoposide as well as the untreated cells were found to have cyclin A scattered mainly throughout the nucleus. However, immunogold labeling of cyclin A in both cell lines treated with 5- and 10-microM doses of doxorubicin, and 20 and 200 microM of etoposide was observed more often in the cytoplasm than in the nucleus. Cells with features of apoptosis with bodies resembling micro-nuclei labeled with gold particles for cyclin A were recognized. However, the small amount of giant cells was also seen. These results suggest that cyclin A expression is linked to cell death pathways.

[High-dose therapy followed by auto HSCT in children--with advanced neuroblastoma in four transplant centres in Poland]

AIM OF THE STUDY

Posttransplant morbidity and clinical outcome in children with advanced neuroblastoma (NBL) who underwent megachemotherapy followed by HSCT were investigated.

PATIENTS AND METHODS

In the study 73 children with advanced NBL treated in four Departments of Paediatric Haematology and Oncology in Lublin, Kraków, Wrocław and Bydgoszcz from 1995 to 2004 were analysed. Median age of children was 4.9 years (range 1.8 to 15). Reinfusion of CD34 cells followed myeloablative chemotherapy with Busulfan / Melfalan in 58 patients; Treosulfan / Melfalan in 2 patients; Melfalan / VP16/ Carbo in 9 patient, Melfalan alone in 3 patients and Thiotepa /CTX/ Carbo in 1 patient. Stem cells from peripheral blood were used in 57 cases, bone marrow in 10 patients, bone marrow and peripheral blood in 6 patients.

RESULTS

41/73 (56%) children are alive with median follow up 12 months (range 3 to 68 months), 29 children are in complete remission (CR), 12 patients are in partial remission (PR). 32/73 (44%) children died, 26 of them due to progressive disease; six children died due to posttransplantation complications. Overall survival (OS) at median observation time 12 months is 0.65; disease free survival (DFS) is 0.58. Probability of 5-year OS and DFS in the group of children transplanted in first partial/complete remission are 0.42 and 0.4 respectively.

CONCLUSIONS

Treatment with megachemotherapy followed by autoHSCT in patients with advanced neuroblastoma has not many adverse effects. Probabilities of 5-year OS and DFS are higher in the group of transplanted children in 1 partial/complete remission than in children transplanted after relapse.

[Megachemotherapy and autologous hematopoietic stem cell transplantation in children with solid tumours excluding neuroblastoma--experience of Polish paediatric centres]

AIM OF THE STUDY was to present the experience of four Polish transplantation centres (Wroclaw, Bydgoszcz, Kraków and Lublin) with use of megachemotherapy (MCT) and autologous hematopoietic stem cell transplantation (autoHSCT) in children with high risk solid tumours.

PATIENTS AND METHODS

Between 1994 and 2005 in 67 patients, whose age ranged form 1.5 to 20 years, 74 procedures of megachemotherapy and auto HSCT were performed. 25 children were treated for Ewing Sarcoma, 13 for rhabdomyosarcoma embryonale (RMS), 7 for germinal tumours, 6 for medulloblastoma, 4 for PNET, 4 for Wilm's tumours, 2 for glioblastoma and single patients with mesenchymoma, astrocytoma, ependymoma, angioblastoma, carcinoma ovarian and carcinoma embryonale glutei. Most common megachemotherapy protocols consisted of: Melphalan, Etopozyd i Carboplatin (MEC)--applied in 24 children and Busulfan plus Melphalan (Bu Mel) administered in 19 patients. In 29 children MCH was introduced in first complete remission, in 14 the procedure was performed in second or subsequent remission and 24 patients did not achieve remission before megachemotherapy was started.

RESULTS

30 children are alive (44%), 28 of them in complete remission of disease. 23 out of 29 (79%) patients were transplanted in first complete remission and median observation time in that group is 29 months (range 2-74 months). Only 5 out of 38 children transplanted in second complete remission or without complete remission survived. 39 patients relapsed at a median time 11 months after MCT and 37 of them subsequently died of disease at a median time of 16 months. One toxic death was noted--it was a boy, transplanted with progressive disease.

CONCLUSIONS

1. Megachemotherapy with autologous stem cell can rescue children with high risk solid tumours. It is a safe procedure especially when performed in remission. 2. Children with resistant or relapsed solid tumours are unlikely to benefit from megachemotherapy.

Anti-HBs profiles in children treated for neoplastic disease who had been vaccinated against hepatitis B postnatally or as infants

Children with cancer are a risk group for hepatitis B virus (HBV) infection. In Poland, the initiation of a national HBV vaccination programme in neonates and infants in 1995 has contributed to the prevention of HBV infection in children treated for neoplastic diseases. The objective of this study was to analyse the anti-HBs pattern and occurrence of HBV infections in children with cancer who had been vaccinated during infancy. The study included 96 children divided into three groups: Group A, children who had received a full vaccination course with an initial level of anti-HBs >/=100 IU/L; Group B, children who had received a full vaccination course with anti-HBs <100 IU/L, for whom an additional dose of vaccine was administered; and Group C, children who had further immunoprophylaxis because they did not complete the vaccination course before cancer diagnosis. A protective level of anti-HBs after the full vaccination programme was found in 80.5% of children after three months, 74.2% after six months, 61.5% after 12 months and 78.6% after 18 months. Among children who produced antibodies, a slow decrease in the level of anti-HBs was observed. It was still protective during follow-up in Group A, but occasionally fell below 100 IU/L in Group B. In Group C, five of 11 subjects had a protective level of anti-HBs throughout follow-up. Of 28 children who showed the presence of HBsAg during follow-up, 23 eradicated the virus. In children with cancer vaccinated against HBV according to the vaccination schedule, the immune response maintains a protective level of anti-HBs in more than 60% of cases, despite immunosuppression.

In vitro sensitivity of leukemic cells to nucleoside derivatives in childhood acute leukemias: good activity in leukemic relapses

Nucleoside analogues such as fludarabine and cladribine are used in therapy of indolent lymphomas and leukemias in adults, while cytarabine is used mainly in protocols for acute leukemias. Mechanisms of their activity is based on inhibition of enzymes involved in DNA, RNA and protein synthesis. The objective of the study was the analysis of in vitro cellular drug sensitivity in childhood acute lymphoblastic (ALL) and myeloid (AML) leukemia. Isolated leukemic cells obtained from 264 patients, including 152 initial ALL, 45 relapsed ALL, 54 initial AML and 13 relapsed AML were tested for cytotoxicity for fludarabine, cladribine, and cytarabine by the MTT assay. Drug concentration lethal to 50% of tested cells was regarded as a value of drug resistance. Three tested nucleoside analogues showed highest cytotoxicity against initial ALL samples. Samples of relapsed ALL and initial AML were more resistant than ALL de novo ones. Unexpectedly, no differences were observed between initial and relapsed AML samples for all tested drugs, what suggests that nucleoside analogues are active drugs in relapsed AML, which is commonly regarded as a resistant disease. All tested drugs presented significant cross-resistance in each of analyzed subgroups. In summary, tested nucleoside analogues presented relatively good activity against childhood leukemias at relapse stage.

Autoimmune hemolytic anemia with giant cell hepatitis: case report and review of the literature

Autoimmune hemolytic anemia (AIHA) with giant cell hepatitis (GCH) is an uncommon disease in children and is associated with an aggressive and often fatal course. The authors describe a 4-month-old girl who presented with AIHA and elevated liver enzymes. A liver biopsy was consistent with GCH. She was successfully treated with anti-CD20 antibody (rituximab)-containing therapy after failing initial immune suppression therapy. The authors also review the literature for similar cases.

[Biomechanical tests for type II SLAP lesions of the shoulder joint before and after arthroscopic repair]

Superior labral anterior-to-posterior (SLAP) lesions can cause shoulder pain partly by causing glenohumeral instability. The purpose of this study was to examine the effect of a simulated type II SLAP lesion and subsequent repair on glenohumeral translation of the vented shoulder. In eight cadaver joints, a robotic/UFS testing system was used to measure joint translation by applying an anterior, posterior, or inferior load of 50 N to each shoulder. The "apprehension tests" for anterior and posterior instability were simulated by applying an anterior load of 50 N with an external rotation torque of 3 Nm or a posterior load of 50 N with an internal rotation torque of 3 Nm. Each loading condition was applied at 30 degrees and 60 degrees of glenohumeral abduction with a constant joint compressive load (44 N) to the intact, simulated SLAP lesion, and repaired shoulder. Repair of the type II SLAP was then performed by placing a Suretac through the labrum both anterior and posterior to the biceps anchor and testing was repeated. ANOVA was used to compare translation of the intact joint, the joint after the type II SLAP lesion had been simulated, and after repair. At 30 degrees of abduction, anterior translation of the intact vented shoulder joint from anterior loading was 18.7+/-8.5 mm and increased to 26.2+/-6.5 mm after simulation of the type II SLAP lesion ( p< or =0.05). The arthroscopic repair did not restore anterior translation (23.9+/-8.6 mm) to the same degree as the intact joint ( p> or =0.05). At 60 degrees of abduction, anterior translation of 16.6+/-9.6mm in the intact joint was not significantly increased at 19.4+/-10.1 after simulation of the type II SLAP lesion ( p=0.0527). AP loading also resulted in inferior translation. At 30 degrees of abduction it was 3.8+/-4.0 mm in the intact joint and increased to 8.5+/-5.4 mm after the type II SLAP lesion ( p< or =0.05. After repair the inferior translation decreased significantly to 6.7+/-5.3 mm ( p< or =0.05). Although inferior translations were less at 60 degrees of abduction, results were similar to those at 30 degrees after repair. There were no significant increases in translation after SI/AP combined external rotation torque or posterior-anterior combined internal rotation torque loading. In this study the repair of a type II SLAP lesion only partially restored translations to the same degree as an intact vented shoulder joint. Therefore, improved repair techniques or an anteroinferior capsulolabral procedure in addition to the type II SLAP lesion repair might be needed to restore normal joint function.

Cross-resistance to five glucocorticoids in childhood acute lymphoblastic and non-lymphoblastic leukemia samples tested by the MTT assay: preliminary report

In vitro antileukemic activity of five glucocorticoids and their cross-resistance pattern in childhood acute lymphoblastic and non-lymphoblastic leukemia were determined by means of the MTT assay in 25 leukemia cell samples of childhood acute leukemias. The equivalent antileukemic concentrations of the drugs tested were: 34 microM hydrocortisone (HC), 8 microM prednisolone (PRE), 1.5 microM methylprednisolone (MPR), 0.44 microM dexamethasone (DX) and 0.22 microM betamethasone (BET). In comparison with initial ALL cell samples, the relapsed ALL group was more resistant to PRE (38-fold, p = 0.044), DX (> 34-fold, p = 0.04), MPR (38-fold), BET (45-fold) and HC (33-fold). The AML cell samples were even more resistant to: PRE (> 85-fold, p = 0.001), DX (> 34-fold, p = 0.004), MPR (> 69-fold, p = 0.036), BET (> 69-fold, p = 0.038) and HC (54-fold, p = 0.059) when compared with ALL on initial diagnosis. A significant cross-resistance among all the glucocorticoids used was found. Only in some individual cases the cross-resistance was less pronounced.

The influence of intracellular idarubicin and daunorubicin levels on drug cytotoxicity in childhood acute leukemia

Uptake and efflux of two anthracyclines, idarubicin (IDA) and daunorubicin (DNR), was studied in childhood acute leukemia samples. A comparison of IDA and DNR transport phenomena in relation to drug cytotoxicity and expression of P-glycoprotein (PGP) was made. Intracellular content of IDA/DNR was determined by flow cytometry using the fluorescent properties of the drugs. In vitro drug cytotoxicity was measured by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay. PGP expression was analysed by flow cytometry. The uptake and efflux rates were non-significantly higher for IDA than DNR. There were no differences between three types of leukemia with respect to drug content during accumulation and retention. After correction for the cell volume, intracellular concentration of both drugs in each moment of uptake and efflux was significantly lower in relapsed ALL and AML samples in comparison with initial ALL cells. Efflux, but not uptake, of both drugs was inversely correlated with PGP expression and IDA, but not DNR, cytotoxicity. The cytotoxicity was correlated with drug accumulation for both drugs and with drug retention for IDA. In conclusion, it seems that (1) intracellular content was related to the lipophilic properties of the drugs rather than to the type of leukemia, (2) decreased intracellular concentration of both drugs might have an impact on compromised therapy results in AML and relapsed ALL children, (3) IDA presents higher cytotoxicity, which possibly might be decreased by the presence of PGP. These results might have a practical impact on the rational design of new chemotherapy protocols.