Disease course, frequency of relapses and survival of 73 patients with juvenile or adult dermatomyositis

Objective Our aim is to present the disease course, frequency of relapses and survival of juvenile and adult dermatomyositis (JDM/DM) patients. Methods Analysis was performed using data on 73 patients. The median follow-up for 38 JDM patients was 32 months and 78 months for 35 adult DM patients. Results 23/38 JDM patients (60%) had monophasic, 12/38 (31.6%) had polycyclic and 3138 (7.9%) had chronic disease. Among children treated only with glucocorticoids, 12/20 (60%) had monophasic and 8/20 (40%) had polycyclic disease. 10/17 (58.8%) children, who required second-line immunosuppressive agents, had monophasic and 4/17 (23.5%) had polycyclic disease. 18/35 DM (51.4%) patients had monophasic, 13/35 (37.1%) had polycyclic, 1/35 (2.9%) had chronic disease and 3135 (8.6%) had fulminant myositis. Among DM patients requiring only glucocorticoids, 12/20 (60%) were monophasic and 8/20 (40%) were polycyclic. In patients requiring second-line immunosuppressive agents, 6/15 patients (40%) had monophasic and 5/15 (33.3%) had polycyclic disease. Among patients with polycyclic disease, the risk of relapse was higher during first year than later in the disease course. None of the JDM patients have died, while 4 disease-specific deaths occurred in adult patients. There was no significant difference between the survival of JDM and DM patients. Discussion There was no correlation between relapse-free survival and the initial therapeutic regimen. Many of our patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed for at least 2 years. Although we found a favourable survival rate, further investigations are needed to assess functional outcome

A Study of Memetic Search with Multi-parent Combination for UBQP

We present a multi-parent hybrid genetic–tabu algorithm (denoted by GTA) for the Unconstrained Binary Quadratic Programming (UBQP) problem, by incorporating tabu search into the framework of genetic algorithm. In this paper, we propose a new multi-parent combination operator for generating offspring solutions. A pool updating strategy based on a quality-and-distance criterion is used to manage the population. Experimental comparisons with leading methods for the UBQP problem on 25 large public instances demonstrate the efficacy of our proposed algorithm in terms of both solution quality and computational efficiency

Lineage Diversion of T Cell Receptor Transgenic Thymocytes Revealed by Lineage Fate Mapping

Background: The binding of the T cell receptor (TCR) to major histocompatibility complex (MHC) molecules in the thymus determines fates of $TCR\alpha\beta$ lymphocytes that subsequently home to secondary lymphoid tissue. TCR transgenic models have been used to study thymic selection and lineage commitment. Most TCR transgenic mice express the rearranged $TCR\alpha\beta$ prematurely at the double negative stage and abnormal TCRαβ populations of T cells that are not easily detected in non-transgenic mice have been found in secondary lymphoid tissue of TCR transgenic mice. Methodology and Principal Findings: To determine developmental pathways of TCR-transgenic thymocytes, we used Cre-LoxP-mediated fate mapping and show here that premature expression of a transgenic $TCR\alpha\beta$ diverts some developing thymocytes to a developmental pathway which resembles that of gamma delta cells. We found that most peripheral T cells with the HY-TCR in male mice have bypassed the RORγt-positive $CD4^{+}8^{+}$ (double positive, DP) stage to accumulate either as $CD4^{-}8^{-}$ (double negative, DN) or as $CD8\alpha^{+}$ T cells in lymph nodes or gut epithelium. Likewise, DN $TCR\alpha\beta$ cells in lymphoid tissue of female mice were not derived from DP thymocytes. Conclusion: The results further support the hypothesis that the premature expression of the $TCR\alpha\beta$ can divert DN thymocytes into gamma delta lineage cells

Gyermekkori Langerhans-sejtes histiocytosissal szerzett magyarországi tapasztalataink

BACKGROUND: Langerhans cell histiocytosis (LCH) in children is relatively rare, and the long-term analysis of therapy results has not been done yet in Hungary. PURPOSE: In this review we summarise the incidence, clinical features, prognostic risk factors and treatment results of children's LCH in Hungary, using data from the National Childhood Cancer Registry in Hungary in a 20-year period between 1981 and 2000. RESULTS: From January 1981 to December 2000, 111 children under 18 years of age were newly diagnosed with LCH in Hungary. The male-female ratio was 1.36:1, the mean age: 4 years 11 months. The minimal and median follow-up time was 3.48 years and 10.98 years respectively. 38 children had single-system disease, while in 73 cases we found systemic dissemination already at the time of diagnosis. Twenty-two patients were treated only by local surgery, 7 by surgery with local irradiation and 5 children received only local irradiation. In two cases remission was obtained with local steroid administration. 75 patient received chemotherapy. During the twenty years 14 children died, 9 due to the progression of the disease. Sixteen of the 111 patients had relapse with a mean of 2.16+/-1.29 years after the first diagnosis. Three patients with relapse got chemotherapy generally used in lymphoma and remission was achieved. The overall survival of all patients (n=111) was 88.3+/-3.1% at 5 years and 87.3+/-3.2% at 10 and 20 years. CONCLUSION: Childhood LCH is a well treatable disease and the survival rate is high. Even disseminated diseases have a quite good prognosis in childhood

An algorithm for the capacitated vehicle routing problem with route balancing

Evolutionary algorithm, Multi-objective optimization, Explicit collective memory, Combinatorial optimization, CVRP,

Could primary care dietary intervention combined with lifestyle changes be effective in the cardiovascular prevention?

Obesity is an important risk factor of cardiovascular diseases. Dietary intervention combined with life style changes were implemented in other countries and proved to be effective. Previously, there were no similar Hungarian experiences.The aim of our study was to screen overweight and obese patients in primary care settings, to involve them in an interventional program and to analyse the expected changes in the laboratory and anthropometric parameters.From 29 primary care practices, 2489 overweight or obese patients were recruited between April of 2004 and 2006.The characteristics of living circumstances, life style, eating and exercise habits were explored by questionnaire. Regular energy intake was counted and compared to estimated requirements. Metabolic and anthropometric parameters were measured. Experienced multi-disciplinary staff was involved, including internist, family physicians, dietetitian, experienced nurses and physical instructors. The interventions were: dietary (recommendation of low calorie diet) and increasing physical activity.One year later the body mass index decreased significantly by 0.56 kg m−2 average and remained about the same by the end of the second year. There was only a small decrease in waist circumference. The rest systolic blood pressure decreased significantly on average 5.9 mmHg by the end of the first year, while decrease in resting diastolic blood pressure was less. All metabolic parameters, except HDL-cholesterol decreased significantly: total cholesterol: by 0.23 mmol l−1, trigliceride: by 0.18 mmol l−1, blood glucose: by 0.15 mmol l−1. Primary care intervention proved to be effective. Better outcomes would be expected, when more resources, more focus in the media, more support from health authorities and sufficient manpower was available