Prognostic significance of FLT3-ITD length in AML patients treated with intensive regimens

FLT3-ITD mutations are detected in approximately 25% of newly diagnosed adult acute myeloid leukemia (AML) patients and confer an adverse prognosis. The FLT3-ITD allelic ratio has clear prognostic value. Nevertheless, there are numerous manuscripts with contradictory results regarding the prognostic relevance of the length and insertion site (IS) of the FLT3-ITD fragment. We aimed to assess the prognostic impact of these variables on the complete remission (CR) rates, overall survival (OS) and relapse-free survival (RFS) of AML patients with FLT3-ITDmutations. We studied the FLT3-ITD length of 362 adult AML patients included in the PETHEMA AML registry. We tried to validate the thresholds of ITD length previously published (i.e., 39 bp and 70 bp) in intensively treated AML patients (n = 161). We also analyzed the mutational profile of 118 FLT3-ITD AML patients with an NGS panel of 39 genes and correlated mutational status with the length and IS of ITD. The AUC of the ROC curve of the ITD length for OS prediction was 0.504, and no differences were found when applying any of the thresholds for OS, RFS or CR rate. Only four out of 106 patients had ITD IS in the TKD1 domain. Our results, alongside previous publications, confirm that FLT3-ITD length lacks prognostic value and clinical applicability. © 2021, The Author(s)

Biblioteca Virtual en Salud de España: Herramienta de Acceso y Difusión de Información Científico Técnico en Salud

Se describe la herramienta Biblioteca Virtual en Salud deEspaña y su pertenencia a la Red de Bibliotecas Virtuales enSalud, cómo surgió el proyecto, cuáles son sus objetivos y seexplica de forma más amplia las fuentes que la integran: Basesde datos nacionales como el Índice Bibliográfico Español enCiencias de la Salud (IBECS), Bases de datos internacionalescomo MEDLINE y Literatura Latinoamericana de Ciencias dela Salud (LILACS), Catálogos colectivos como SeCS y C17,Publicaciones electrónicas entre las que se encuentran ScientificElectronic Library Online (SciELO) y monografías y boletines atexto completo, Terminología en Salud: Descriptores enCiencias de la Salud (DeCS), Localizador de Información enSalud (LIS-España: Sitios Saludables), Directorios y otrasfuentes de información

Indications for Digital Monitoring of Patients With Multiple Nevi: Recommendations from the International Dermoscopy Society

Introduction: In patients with multiple nevi, sequential imaging using total body skin photography (TBSP) coupled with digital dermoscopy (DD) documentation reduces unnecessary excisions and improves the early detection of melanoma. Correct patient selection is essential for optimizing the efficacy of this diagnostic approach. Objectives: The purpose of the study was to identify, via expert consensus, the best indications for TBSP and DD follow-up. Methods: This study was performed on behalf of the International Dermoscopy Society (IDS). We attained consensus by using an e-Delphi methodology. The panel of participants included international experts in dermoscopy. In each Delphi round, experts were asked to select from a list of indications for TBSP and DD. Results: Expert consensus was attained after 3 rounds of Delphi. Participants considered a total nevus count of 60 or more nevi or the presence of a CDKN2A mutation sufficient to refer the patient for digital monitoring. Patients with more than 40 nevi were only considered an indication in case of personal history of melanoma or red hair and/or a MC1R mutation or history of organ transplantation. Conclusions: Our recommendations support clinicians in choosing appropriate follow-up regimens for patients with multiple nevi and in applying the time-consuming procedure of sequential imaging more efficiently. Further studies and real-life data are needed to confirm the usefulness of this list of indications in clinical practice

Amyotrophic lateral sclerosis in Brazil: 1998 national survey Esclerose lateral amiotrófica no Brasil: registro nacional, 1998

OBJECTIVES: To assess the epidemiologic characteristics of amyotrophic lateral sclerosis (ALS) in Brazil in 1998. METHOD: Structured Clinical Report Forms (CRFs) sent to 2,505 Brazilian neurologists from January to September 1998 to be filled with demographic and clinical data regarding any ALS patient seen at any time during that year. RESULTS: Five hundred and forty CRFs were returned by 168 neurologists. Data on 443 patients meeting the criteria of probable or definite ALS according to El Escorial definition were analysed: 63 probable (14.2%) and 380 definite (85.8%). Two hundred and fifty-nine (58.5%) of the patients were male, mean age of onset was 52. Spinal onset occurred in 306 patients (69%); bulbar onset in 82 (18.5%), and both in 52 (11.7%). Twenty-six (5.9%) had a family history of ALS. Two hundred and fifty-nine (58.6%) were seen by private practitioners, and 178 (40.2%) at a hospital clinic. Age-ajusted incidence shows a peak incidence at the 65-74 years old range. CONCLUSIONS: The disease's characteristics are similar to those described in international studies, except for age of onset (Brazilian patients are younger). This difference is not confirmed when figures are age-adjusted.<br>OBJETIVOS: Avaliar as características epidemiológicas da esclerose lateral amiotrófica (ELA) no Brasil durante o ano de 1998. MÉTODO: Formulários estruturados enviados a 2.505 neurologistas brasileiros de janeiro a setembro de 1998 para serem preenchidos com dados demográficos e clínicos de todos os pacientes com ELA atendidos no ano de 1998. RESULTADOS: Quinhentos e quarenta formulários retornaram, enviados por 168 neurologistas. Dados sobre 443 pacientes que se enquadravam nos critérios de ELA provável ou definida de acordo com El Escorial foram analisados: 63 provável (14,2%) e 380 definida (85,8%). Duzentos e cinquenta (58,5%) eram do sexo masculino. A idade média de aparecimento dos primeiros sintomas foi de 52 anos. O início em membros ocorreu em 306 pacientes (69%), bulbar em 82 (18,5%) e generallizada em 52 (11,7%). Vinte e seis (5,9%) tinham história familiar. Duzentos e cinquenta e nove (58,6%) foram atendidos em clínicas ou consultórios, e 178 (40,2%) em ambulatório de hospital. Ajustando para a distribuição da população brasileira segundo faixa etária, a maior incidência ocorre entre 65 e 74 anos de idade. CONCLUSÕES: As características epidemiológicas da doença são semelhantes àquelas descritas em estudos internacionais, exceto para idade dos primeiros sintomas (pacientes brasileiros são mais jovens). Esta diferença desaparece quando os valores são ajustados para idade

Observation of the Suppression of the Flux of Cosmic Rays above 4 x 10^19 eV

The energy spectrum of cosmic rays above 2.5×1018eV, derived from 20000 events recorded at the Pierre Auger Observatory, is described. The spectral index γ of the particle flux, JE-γ, at energies between 4×1018eV and 4×1019eV is 2.69±0.02(stat)±0.06(syst), steepening to 4.2±0.4(stat)±0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min

Upper Limit on the Diffuse Flux of UHE tau neutrinos from the Pierre Auger Observatory.

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau-neutrinos $\nu_\tau$ that interact in the Earth's crust. Tau leptons from $\nu_\tau$ charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 is used to place an upper limit on the diffuse flux of $\nu_\tau$ at EeV energies. Assuming an $E_\nu^{-2}$ differential energy spectrum the limit set at 90 % C.L. is $E_\nu^{2} \mathrm{d}N_{\nu_\tau}/\mathrm{d}E_{\nu} < 1.3 \times 10^{-7}$ GeV cm$^{-2}$ s$^{-1}$ sr$^{-1}$ in the energy range $2\times10^{17} \mathrm{eV} < E_\nu < 2\times10^{19}$ eV.Comment: 14 pages, 3 figure

Correlation of the highest-energy cosmic rays with nearby extragalactic objects

Using data collected at the Pierre Auger Observatory during the past 3.7 years, we demonstrated a correlation between the arrival directions of cosmic rays with energy above 6 × 1019 electron volts and the positions of active galactic nuclei (AGN) lying within ∼75 megaparsecs. We rejected the hypothesis of an isotropic distribution of these cosmic rays with at least a 99% confidence level from a prescribed a priori test. The correlation we observed is compatible with the hypothesis that the highest-energy particles originate from nearby extragalactic sources whose flux has not been substantially reduced by interaction with the cosmic background radiation. AGN or objects having a similar spatial distribution are possible sources