Multiple Autoimmune Propensity and B-Non-Hodgkin Lymphoma: Cause or Effect?

We report a case of multiple autoimmunity consisting of the presence of autoimmune haemolytic anaemia (AIHA), antimitochondrial antibodies (AMAs), and antiphospholipid antibodies (APLAbs) as the presenting manifestations of an extrahepatic B-non-Hodgkin lymphoma (B-NHL) in a 63-year-old woman. The patient presented with fatigue attributed to severe AIHA. Due to increased serum IgM and γ-GT levels, an investigation for AMA was performed, which proved positive with anti-M2 specificity. A prolongation of activated partial thromboplastin time (aPTT) led to the determination of APLAbs (lupus anticoagulant and other APLAbs) which were also positive. Bone marrow biopsy in combination with immmunohistochemical studies established the diagnosis of lymphoplasmacytic B-NHL. Ten months later, B-NHL was in remission while AMA and APLAbs were still positive. In conclusion, we documented the coexistence of multiple autoimmune reactions together with B-NHL highlighting the possible common pathogenetic pathways of the two entities

Successful Control of Acute Myelofibrosis with Lenalidomide

Acute panmyelosis with myelofibrosis (APMF) is a rare, fatal hematological neoplasm that is characterized by the acute onset of cytopenias and fibrosis in the bone marrow in the absence of splenomegaly or fibrosis-related morphological changes in the RBCs. We present the case of a 59-year-old female who presented with a two-month history of anemia, leucopenia and a normal platelet count. The marrow was heavily fibrotic, and no aspirate material could be obtained; the biopsy showed extensive infiltration with small to medium size megakaryocytes, dysplastic changes in the erythroid compartment, and left shift in the myeloid cells. The patient was treated for four months with anabolic steroids (Danazol), growth factors and received regular blood transfusions. At 4 months after diagnosis, the patient was started on Lenalidomide, 10 mg/day for a 21-d-course along with growth factor support. At 6 months after treatment, the patient was transfusion-independent, had normalized blood counts, and, at 32 months on continuous lenalidomide treatment, her needs for growth factor support have been minimized. Repeat bone marrow biopsies showed a patchy distribution of fibrosis with areas of normal cellularity and morphology. To our knowledge, this is the first case for a medication that could reverse the fatal outcome of APMF

Etiology of Anemia in Patients With Advanced Heart Failure

ObjectivesWe prospectively investigated the causes of anemia in patients with advanced congestive heart failure (CHF).BackgroundAnemia is common in patients with advanced CHF, and its etiology is generally considered to be multifactorial. However, despite its importance, precise information is lacking regarding the prevalence of putative etiologic factors.MethodsPatients who were hospitalized for decompensated advanced CHF and who were stabilized after their initial treatment underwent evaluation of “clinically significant” anemia, defined as a hemoglobin content <12 g/dl for men and <11.5 g/dl for women. Patients with a serum creatinine concentration >3 mg/dl or patients with concurrent diseases that are known to cause anemia were not included. The initial evaluation included measurements of vitamin B12, folic acid, thyroid-stimulating hormone, erythropoietin, lactate dehydrogenase, Coombs test, multiple fecal occult tests, and bone marrow aspiration. Patients without diagnosis by these methods underwent red cell mass measurement with 51Cr assay.ResultsThe mean age of the 37 patients was 57.9 ± 10.9 years and mean left ventricular ejection fraction 22.5 ± 5.9%. Iron deficiency anemia was confirmed by bone marrow aspiration in 27 patients (73%), 2 patients (5.4%) had dilutional anemia, and 1 patient (2.7%) had drug-induced anemia. No specific cause was identified in 7 patients (18.9%) who were considered to have “anemia of chronic disease.” Serum ferritin for the iron-deficient patients was not a reliable marker of iron deficiency in this population.ConclusionsIn this group of patients, iron deficiency was the most common cause of anemia. The iron status of patients with end-stage chronic CHF should be thoroughly evaluated and corrected before considering other therapeutic interventions

The anisotropy of granular materials

The effect of the anisotropy on the elastoplastic response of two dimensional packed samples of polygons is investigated here, using molecular dynamics simulation. We show a correlation between fabric coefficients, characterizing the anisotropy of the granular skeleton, and the anisotropy of the elastic response. We also study the anisotropy induced by shearing on the subnetwork of the sliding contacts. This anisotropy provides an explanation to some features of the plastic deformation of granular media.Comment: Submitted to PR

Progressive muscle relaxation as a supportive intervention for cancer patients undergoing chemotherapy: A systematic review

Background: Many cancer patients use a wide variety of techniques to improve their physical and mental well-being, including relaxation therapy and, specifically, Progressive Muscle Relaxation (PMR). However, there is no strong evidence that supports the efficacy of this technique. Objective: Our aim was to review the evidence regarding the use of PMR as a supportive intervention for cancer patients undergoing chemotherapeutic treatment. Method: Six databases were electronically searched: AMED, the Cochrane Library, MEDLINE, PsychINFO, Scopus, and the Web of Science. After removing duplicates, 700 publications were screened and 57 identified as potentially relevant. The flow of information from record identification to study inclusion was conducted in accordance with the PRISMA statement. Original articles published in peer-reviewed journals that studied the use of PMR as an intervention, were randomized or included a matched control group, and that included patients receiving chemotherapy were included. Studies that combined PMR with other interventions were excluded. The methodological quality of included trials was assessed using the Jadad Scale and the CONSORT guidelines. Results: A total of 5 of the 57 papers fulfilled the preset criteria and were included in our systematic review. Our findings indicate that PMR might improve comfort and reduce the anxiety levels and side effects caused by chemotherapy, with the exception of vomiting. Nonetheless, the quality of all the included studies was extremely low. Significance of results: There is evidence that PMR might have a few benefits for patients undergoing chemotherapy. Still, the small number of studies included and their poor quality limit the significance of our results. Despite the fact that pharmaceutical approaches for controlling side effects might be reaching their full potential and that there might be further usefulness for such integrative treatments as PMR, the need to run more high-quality trials testing the efficacy of this technique is warranted before suggesting its adoption as part of standard cancer care. © 2017 Cambridge University Press

Exergames and implications on quality of life in pediatric oncology patients: A preliminary qualitative study

The purpose of the study was to investigate the effect of exergames on the quality of life of three pediatric oncology patients and their attitudes towards participation in physical activity after the end of the program. In the present study volunteered three pediatric oncology patients, aged from five to six years old, who had been diagnosed with cancer and were staying at the hostel of the Association of Friends of Children with Cancer "Storgi" of Thessaloniki in Greece. A 12-week exercise program was implemented. Frequency of attendance was 3 times a week, while duration was thirty minutes per training session. The exergames «Kinect sports», «Kinect sports-season 2» and «Kinect Adventures» were used. Data were collected via observations and individual interviews with the cancer patients, with one of their parents and a staff member of the hostel. Our findings indicate that exercise through digital interactive games improved the childrens’ overall quality of life regarding the parameters physical functioning, psychological functioning and social relations in the hostel. Moreover, through their participation in this program they had the intention to continue exercising with exergames and to participate in exercise programs in a realistic environment after their cancer treatment. In conclusion, exergaming is an adjunct treatment for achieving a better quality of life, which gives motivation to the patients to participate in regular physical activity and do not follow a sedentary lifestyle during the phase of cancer treatment. © JPES

Aberrant methylation of c-myc and c-fos protooncogenes and p53 tumor suppressor gene in myelodysplastic syndromes and acute non-lymphocytic leukemia

Purpose: Aberrant methylation, as an epigenetic phenomenon, may precede and regulate the expression of genes involved in transformation mechanisms that lead to leukemogenesis of hemopoietic cells. The genes involved mostly encode transcription factors and cell cycle specific inhibitors. The aim of this project was to study the DNA methylation pattern of c-myc, c-fos and p53 in myelodysplastic syndromes (MDS) and in acute non-lymphocytic leukemias (ANLL). Patients and methods: DNA was isolated from the monocyte cell layer harvested from bone marrow or peripheral blood samples of 44 patients suffering from MDS and ANLL. Genomic DNA was digested with methylation-specific enzymes, and was electrophoresed and hybridized with probes specift for human c-myc, c-fos and p53 genes. Results: In MDS, the c-myc gene in exons 2 and 3 was regionally hypomethylated, whereas exon 2 in ANLL was hypermethylated and exon 3 hypomethylated. The c-fos gene was hypomethylated in ANLL type 4 and presented aberrant hypomethylation in the different types of MDS. The p53 anti-oncogene appeared extensively hypomethylated in MDS. Conclusion: Aberrant DNA methylation pattern of the c-myc, c-fos and p53 tumor suppressor gene seems to be a primary event in the transformation process from myelodysplasia to acute leukemia, affecting their expression, and, consequently, altering the proliferation, differentiation or apoptosis of hemopoietic precursor cells. The p53 hypomethylation predisposes to critical mutations that enhance the transformation process of myelodysplasia to leukemia. The recognition of altered methylation of these genes in myelodysplasia may have prognostic implications and may lead to novel therapeutic modalities. © 2003 Zerbinis Medical Publications

Perceived Βenefits of a Τherapeutic Εxercise program through digital interactive games among children with cancer

Introduction: Clinical treatments against cancer disease, contribute decisively to the deterioration of physical and mental well-being of pediatric oncology patients, however exercise has been proposed as a safe, non-pharmacological intervention strategy for pediatric populations suffering from chronic diseases, which affects positively the quality of life of patients. Purpose: The purpose of this study was to identify perceived benefits associated with participation in a therapeutic exercise program through digital interactive games among children who have been diagnosed with cancer. Material and Method: A total of six children, aged from five to nine years old, boys and girls, who were staying at the hostel of the Association of Friends of Children with Cancer "Storgi" in Thessaloniki, participated in a 12-week therapeutic exercise program, with the use of the Xbox Kinect™ console. The frequency of attendance was 3 times per week, while the duration of each training session was set at 30 minutes. Data were collected using a combination of observations and individual interviews with the children, one of their parents and a staff member of the hostel. Results: From the qualitative data analysis four major themes were aroused: (a) enhancement of social skills, (b) decreased cancer related fatigue, (c) positive emotions, (d) control of negative feelings. Conclusions: The involvement of cancer patients in a therapeutic exercise program that combines exercise with digital interactive games plays a vital role in strengthening the child's social skills, reducing the perceived fatigue, enhancing positive emotions, as well as decreasing the negative psychological effects due to cancer treatment. © 2019, Hellenic Nurses Association. All rights reserved