Eculizumab for Gemcitabine-Induced Hemolytic Uremic Syndrome: A Novel Therapy for an Emerging Condition

Introduction Atypical hemolytic uremic syndrome (aHUS), a thrombotic microangiopathy (TMA), is a disease characterized by hemolytic anemia, thrombocytopenia, and renal impairment. Gemcitabine, a commonly used chemotherapy, is emerging as a cause of aHUS. Although rare, the morbidity and mortality can be significant. Few studies have explored the use of eculizumab, an anti-C5 monoclonal antibody as a potential therapy for gemcitabine-induced aHUS. Case Presentation A 45 year old Caucasian male with metastatic urothelial carcinoma was started on weekly gemcitabine (1000 mg/m2 per dose) to treat recurrent disease. During his seventh cycle, he was hospitalized for hypertension, acute kidney injury, and anemia. Laboratory data at that time revealed a hemoglobin of 6.2 g/dL (reference range 14.0-17.0 g/dL) and a platelet count of 70 x 109/L (reference range 140-400x 109/L). Hemolysis was suggested by an elevated lactate dehydrogenase (LDH) of 420 IU/L (reference range 125-240 IU/L), undetectable haptoglobin, and the presence of schistocytes on the peripheral smear (see Figure 1). Creatinine was elevated to 2.8 mg/dL (reference range 0.7-1.4 mg/dL) and an ADAMTS-13 (A disintegrin and metalloproteinase with a thromboSpondin type 1 motif, member 13) returned as normal. The patient was diagnosed with gemcitabineinduced aHUS. Gemcitabine was discontinued, and the patient was started on steroids. Two weeks later, he presented with generalized tonic-clonic seizures, uncontrolled hypertension, and worsening renal failure. His labs on admission showed continued hemolysis and thrombocytopenia. In light of the patient’s poor response to steroids, the decision was made to start eculizumab

A glycosyl transferase family 43 protein involved in xylan biosynthesis is associated with straw digestibility in Brachypodium distachyon

The recalcitrance of secondary plant cell walls to digestion constrains biomass use for the production of sustainable bioproducts and for animal feed. We screened a population of Brachypodium recombinant inbred lines (RILs) for cell wall digestibility using commercial cellulases and detected a quantitative trait locus (QTL) associated with this trait. Examination of the chromosomal region associated with this QTL revealed a candidate gene that encodes a putative glycosyl transferase family (GT) 43 protein, orthologue of IRX14 in Arabidopsis, and hence predicted to be involved in the biosynthesis of xylan. Arabinoxylans form the major matrix polysaccharides in cell walls of grasses, such as Brachypodium. The parental lines of the RIL population carry alternative nonsynonymous polymorphisms in the BdGT43A gene, which were inherited in the RIL progeny in a manner compatible with a causative role in the variation in straw digestibility. In order to validate the implied role of our candidate gene in affecting straw digestibility, we used RNA interference to lower the expression levels of the BdGT43A gene in Brachypodium. The biomass of the silenced lines showed higher digestibility supporting a causative role of the BdGT43A gene, suggesting that it might form a good target for improving straw digestibility in crops

Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences

Expectant parents report negative experiences of receiving unexpected news via ultrasound. There is a need to improve communication in this setting, but a lack of understanding on how to achieve this. This systematic review aimed to synthesise findings from qualitative studies exploring experiences of expectant parents or healthcare professionals when a fetal abnormality or unexpected finding was identified via ultrasound. MEDLINE, EMBASE, CINAHL and PsycINFO were searched using three blocks of terms (fetal abnormalities; ultrasound; experiences). Qualitative studies exploring the disclosure of pregnancy complications during ultrasound examinations were included and analysed using meta‐ethnographic synthesis. The review was conducted according to PRISMA and eMERGe guidelines. The review identified 28 studies. News delivered via ultrasound can be viewed as a journey involving five phases (expectations of ultrasound scans; discovery; shock; decisions and planning; adaptation). How well this is navigated depends upon the extent to which information needs and support needs are met. Ultrasound is a uniquely challenging situation to communicate difficult news as there is the potential for news to be communicated immediately. Care quality could be improved by the provision of written information and the use of correct terminology to describe abnormalities