Utilidad de cinco tejidos para discriminar variantes somáticas y germinales en neoplasias mieloides

CO-091 Introducción: Los síndromes hereditarios están adquiriendo una gran importancia en el panorama de las hemopatías malignas. De hecho, la revisión de 2016 de la OMS ha incluido una sección sobre predisposición germinal a neoplasias mieloides (NM). Distinguir entre una neoplasia mieloide de predisposición hereditaria (NMPH) de una NM esporádica es crucial por su impacto en el seguimiento de estos pacientes, así como en el de sus familiares sanos. La generalización de técnicas como la NGS en el estudio inicial de pacientes con NM ha puesto de manifiesto que un porcentaje no desdeñable de pacientes podrían tener variantes de origen germinal. Sin embargo, para su diagnóstico, se precisa de la confirmación de la naturaleza de la variante en un tejido no hematopoyético, sin que exista un consenso sobre el tejido a utilizar. Métodos: Nos propusimos evaluar cinco tejidos (fibroblastos de médula ósea, fibroblastos de piel, folículos pilosos, frotis bucal y células CD3+) en cuanto a su capacidad de discriminar si las variantes sospechosas eran de origen somático o germinal. El estudio se realizó en una cohorte de 299 pacientes a los que en algún momento del curso de la enfermedad se les hizo un panel de NGS Pan-Mieloide (PMP, 48 genes), que incluye 22 genes descritos en la literatura como relacionados con NMPH, incluyendo los recomendados por la OMS (ANKRD26, CEBPA, DDX41, ETV6, GATA2, RUNX1). De los 299 pacientes, 100 portaban variantes en algunos de esos 22 genes, que presentaban una frecuencia alélica (VAF) ~ 50%. Recolectamos un total de 21 muestras de tejidos ..

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Polymorphisms in nitric oxide synthase and endothelin genes among children with obstructive sleep apnea

BACKGROUND: Obstructive sleep apnea (OSA) is associated with adverse and interdependent cognitive and cardiovascular consequences. Increasing evidence suggests that nitric oxide synthase (NOS) and endothelin family (EDN) genes underlie mechanistic aspects of OSA-associated morbidities. We aimed to identify single nucleotide polymorphisms (SNPs) in the NOS family (3 isoforms), and EDN family (3 isoforms) to identify potential associations of these SNPs in children with OSA. METHODS: A pediatric community cohort (ages 5–10 years) enriched for snoring underwent overnight polysomnographic (NPSG) and a fasting morning blood draw. The diagnostic criteria for OSA were an obstructive apnea-hypopnea Index (AHI) >2/h total sleep time (TST), snoring during the night, and a nadir oxyhemoglobin saturation <92%. Control children were defined as non-snoring children with AHI <2/h TST (NOSA). Endothelial function was assessed using a modified post-occlusive hyperemic test. The time to peak reperfusion (Tmax) was considered as the indicator for normal endothelial function (NEF; Tmax<45 sec), or ED (Tmax≥45 sec). Genomic DNA from peripheral blood was extracted and allelic frequencies were assessed for, NOS1 (209 SNPs), NOS2 (122 SNPs), NOS3 (50 SNPs), EDN1 (43 SNPs), EDN2 (48 SNPs), EDN3 (14 SNPs), endothelin receptor A, EDNRA, (27 SNPs), and endothelin receptor B, EDNRB (23 SNPs) using a custom SNPs array. The relative frequencies of NOS-1,-2, and −3, and EDN-1,-2,-3,-EDNRA, and-EDNRB genotypes were evaluated in 608 subjects [128 with OSA, and 480 without OSA (NOSA)]. Furthermore, subjects with OSA were divided into 2 subgroups: OSA with normal endothelial function (OSA-NEF), and OSA with endothelial dysfunction (OSA-ED). Linkage disequilibrium was analyzed using Haploview version 4.2 software. RESULTS: For NOSA vs. OSA groups, 15 differentially distributed SNPs for NOS1 gene, and 1 SNP for NOS3 emerged, while 4 SNPs for EDN1 and 1 SNP for both EDN2 and EDN3 were identified. However, in the smaller sub-group for whom endothelial function was available, none of the significant SNPs was retained due to lack of statistical power. CONCLUSIONS: Differences in the distribution of polymorphisms among NOS and EDN gene families suggest that these SNPs could play a contributory role in the pathophysiology and risk of OSA-induced cardiovascular morbidity. Thus, analysis of genotype-phenotype interactions in children with OSA may assist in the formulation of categorical risk estimates