Reinvestigation of peroxisomal 3-ketoacyl-CoA thiolase deficiency: identification of the true defect at the level of d-bifunctional protein

In this report, we reinvestigate the only patient ever reported with a deficiency of peroxisomal 3-ketoacyl-CoA thiolase (THIO). At the time when they were described, the abnormalities in this patient, which included accumulation of very-long-chain fatty acids and the bile-acid intermediate trihydroxycholestanoic acid, were believed to be the logical consequence of a deficiency of the peroxisomal β-oxidation enzyme THIO. In light of the current knowledge of the peroxisomal β-oxidation system, however, the reported biochemical aberrations can no longer be explained by a deficiency of this thiolase. In this study, we show that the true defect in this patient is at the level of d-bifunctional protein (DBP). Immunoblot analysis revealed the absence of DBP in postmortem brain of the patient, whereas THIO was normally present. In addition, we found that the patient had a homozygous deletion of part of exon 3 and intron 3 of the DBP gene, resulting in skipping of exon 3 at the cDNA level. Our findings imply that the group of single–peroxisomal β-oxidation–enzyme deficiencies is limited to straight-chain acyl-CoA oxidase, DBP, and α-methylacyl-CoA racemase deficiency and that there is no longer evidence for the existence of THIO deficiency as a distinct clinical entity

How to Teach Engineering Ethics?: A Retrospective and Prospective Sketch of TU Delft’s Approach to Engineering Ethics Education

This paper provides a retrospective and prospective overview of TU Delft’s approach to engineering ethics education. For over twenty years, the Ethics and Philosophy of Technology Section at TU Delft has been at the forefront of engineering ethics education, offering education to a wide range of engineering and design students. The approach developed at TU Delft is deeply informed by the research of the Section, which is centered around Responsible Research and Innovation, Design for Values, and Risk Ethics. These theoretical approaches are premised on the notion that technologies are inherently value-laden, and as such contain the possibility of fostering or hindering moral values. Each of these approaches encourages students to take a proactive attitude with respect to their projects and profession, thinking creatively about – and taking responsibility for – how to both prevent harm and do good via the technologies they help develop. To explain how this is put into practice, this paper sketches a brief history of ethics teaching at TU Delft, outlines current activities, and presents future plans for Bachelor and Master’s level engineering ethics education at TU Delft.Ethics & Philosophy of TechnologyValues Technology and Innovatio

Bivalirudin started during emergency transport for primary PCI.

BACKGROUND: Bivalirudin, as compared with heparin and glycoprotein IIb/IIIa inhibitors, has been shown to reduce rates of bleeding and death in patients undergoing primary percutaneous coronary intervention (PCI). Whether these benefits persist in contemporary practice characterized by prehospital initiation of treatment, optional use of glycoprotein IIb/IIIa inhibitors and novel P2Y12 inhibitors, and radial-artery PCI access use is unknown. METHODS: We randomly assigned 2218 patients with ST-segment elevation myocardial infarction (STEMI) who were being transported for primary PCI to receive either bivalirudin or unfractionated or low-molecular-weight heparin with optional glycoprotein IIb/IIIa inhibitors (control group). The primary outcome at 30 days was a composite of death or major bleeding not associated with coronary-artery bypass grafting (CABG), and the principal secondary outcome was a composite of death, reinfarction, or non-CABG major bleeding. RESULTS: Bivalirudin, as compared with the control intervention, reduced the risk of the primary outcome (5.1% vs. 8.5%; relative risk, 0.60; 95% confidence interval [CI], 0.43 to 0.82; P=0.001) and the principal secondary outcome (6.6% vs. 9.2%; relative risk, 0.72; 95% CI, 0.54 to 0.96; P=0.02). Bivalirudin also reduced the risk of major bleeding (2.6% vs. 6.0%; relative risk, 0.43; 95% CI, 0.28 to 0.66; P<0.001). The risk of acute stent thrombosis was higher with bivalirudin (1.1% vs. 0.2%; relative risk, 6.11; 95% CI, 1.37 to 27.24; P=0.007). There was no significant difference in rates of death (2.9% vs. 3.1%) or reinfarction (1.7% vs. 0.9%). Results were consistent across subgroups of patients. CONCLUSIONS: Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis. (Funded by the Medicines Company; EUROMAX ClinicalTrials.gov number, NCT01087723.)

Excessive toxicity of cabozantinib in a phase II study in patients with recurrent and/or metastatic salivary gland cancer

AIM: Because the tyrosine kinases c-MET and vascular endothelial growth factor receptors (VEGFR) are often overexpressed in salivary gland cancer (SGC), this study evaluated the efficacy and safety of cabozantinib in patients with recurrent/metastatic (R/M) SGC. PATIENTS AND METHODS: A single-centre phase II study was conducted. Patients with immunohistochemical c-MET-positive R/M SGC were included in three cohorts: adenoid cystic carcinoma (ACC); salivary duct carcinoma (SDC) and other miscellaneous SGCs. No prior systemic treatments were required. Patients started cabozantinib 60 mg once daily. The primary outcome was the objective response rate (ORR). Secondary outcomes included survival, safety and quality of life. Per Simon-two-stage design, depending on efficacy, a maximum of 43 patients would be included. RESULTS: In total, 25 patients were included until premature closure owing to severe toxicity. Six patients (24%) had grade 3-5 wound complications, occurring at a median of 7.1 months on cabozantinib treatment (range 2.1-12.6). Remarkably, four of these six patients developed this complication in the area prior exposed to high-dose radiotherapy. Other grade ≥3 adverse events in >1 patient were hypertension (20%), diarrhoea (8%) and dehydration (8%). Twenty-one patients were evaluable for response; 1/15 ACC (ORR: 7%); 1/4 SDC and 0/2 patients with other miscellaneous SGC responded. Median progression-free survival was 9.4 months (95% confidence interval [CI] 7.4-11.4 months), 7.2 months (95%CI 0.0-15.1) and 6.9 months (95%CI 0.0-15.1), respectively. CONCLUSION: This study showed too many severe cabozantinib-associated wound complications in patients with SGC, especially in prior irradiated areas. Therefore, the study closed prematurely. The efficacy in the limited number of evaluable patients was low to moderate. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov: NCT03729297

The 1989 and 2015 outbursts of V404 Cygni: a global study of wind-related optical features

The black hole transient V404 Cygni exhibited a bright outburst in June 2015 that was intensively followed over a wide range of wavelengths. Our team obtained high time resolution optical spectroscopy (~90 s), which included a detailed coverage of the most active phase of the event. We present a database consisting of 651 optical spectra obtained during this event, that we combine with 58 spectra gathered during the fainter December 2015 sequel outburst, as well as with 57 spectra from the 1989 event. We previously reported the discovery of wind-related features (P-Cygni and broad-wing line profiles) during both 2015 outbursts. Here, we build diagnostic diagrams that enable us to study the evolution of typical emission line parameters, such as line fluxes and equivalent widths, and develop a technique to systematically detect outflow signatures. We find that these are present throughout the outburst, even at very low optical fluxes, and that both types of outflow features are observed simultaneously in some spectra, confirming the idea of a common origin. We also show that the nebular phases depict loop patterns in many diagnostic diagrams, while P-Cygni profiles are highly variable on time-scales of minutes. The comparison between the three outbursts reveals that the spectra obtained during June and December 2015 share many similarities, while those from 1989 exhibit narrower emission lines and lower wind terminal velocities. The diagnostic diagrams presented in this work have been produced using standard measurement techniques and thus may be applied to other active low-mass X-ray binaries.Comment: Accepted for publication in MNRAS. 23 pages paper, plus a 9 pages appendix with extra tables and figures. 18 figures are included in the paper and 8 in the appendi

Imaging angiogenesis in patients with head and neck squamous cell carcinomas by [68Ga]Ga-DOTA-E-[c(RGDfK)]2 PET/CT

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Stage-Specific Inhibition of MHC Class I Presentation by the Epstein-Barr Virus BNLF2a Protein during Virus Lytic Cycle

gamma-herpesvirus Epstein-Barr virus (EBV) persists for life in infected individuals despite the presence of a strong immune response. During the lytic cycle of EBV many viral proteins are expressed, potentially allowing virally infected cells to be recognized and eliminated by CD8+ T cells. We have recently identified an immune evasion protein encoded by EBV, BNLF2a, which is expressed in early phase lytic replication and inhibits peptide- and ATP-binding functions of the transporter associated with antigen processing. Ectopic expression of BNLF2a causes decreased surface MHC class I expression and inhibits the presentation of indicator antigens to CD8+ T cells. Here we sought to examine the influence of BNLF2a when expressed naturally during EBV lytic replication. We generated a BNLF2a-deleted recombinant EBV (ΔBNLF2a) and compared the ability of ΔBNLF2a and wild-type EBV-transformed B cell lines to be recognized by CD8+ T cell clones specific for EBV-encoded immediate early, early and late lytic antigens. Epitopes derived from immediate early and early expressed proteins were better recognized when presented by ΔBNLF2a transformed cells compared to wild-type virus transformants. However, recognition of late antigens by CD8+ T cells remained equally poor when presented by both wild-type and ΔBNLF2a cell targets. Analysis of BNLF2a and target protein expression kinetics showed that although BNLF2a is expressed during early phase replication, it is expressed at a time when there is an upregulation of immediate early proteins and initiation of early protein synthesis. Interestingly, BNLF2a protein expression was found to be lost by late lytic cycle yet ΔBNLF2a-transformed cells in late stage replication downregulated surface MHC class I to a similar extent as wild-type EBV-transformed cells. These data show that BNLF2a-mediated expression is stage-specific, affecting presentation of immediate early and early proteins, and that other evasion mechanisms operate later in the lytic cycle

Gestión del modelo de desinstitucionalización de adultos con alteraciones mentales en el sistema público de la Provincia de Buenos Aires

La alteración de la salud mental constituye un problema socio-sanitario. Las ciencias de la salud consideran modelos de causalidad multifactoriales con determinantes sociales. No se observa en esta investigación la inclusión de la Ciencia Administrativa como interdisciplina. Su incorporación permitiría integrar conocimientos administrativos para un eficaz y eficiente desempeño en las organizaciones de salud mental. Las fallas de planificación como proceso central en la formulación de estrategias constituyen un común denominador de los modelos descriptos. Los resultados encontrados, como indicadores del valor giro programa, 5 años de permanencia (rango 1 – 20); y producto del análisis cualitativo (respuestas a entrevistas) 6 años (máxima permanencia 26-27 años) afirman un bajo rendimiento de los programas existentes. Se observó contradicción en los modelos para compatibilizar el control del rendimiento con la autonomía de las diferentes divisiones, sistemas cerrados instrumentales de la sede central, responsables de las actividades dependientes de más de un coordinador con desempeño simultáneo en subproyectos sin conseguir resultados aceptables. La propuesta del nuevo modelo de gestión es una intervención de tipo social fragmentaria, sistematizada e incremental. Propone un rediseño de los procesos con la revisión de los recursos disponibles para alcanzar aumento del valor giro-paciente para la externación con reinserción social.Facultad de Ciencias Económica