Predicting Survival after Allogeneic Hematopoietic Cell Transplantation in Myelofibrosis : Performance of the Myelofibrosis Transplant Scoring System (MTSS) and Development of a New Prognostic Model

Accurate prognostic tools are crucial to assess the risk/benefit ratio of allogeneic hematopoietic cell transplantation (allo-HCT) in patients with myelofibrosis (MF). We aimed to evaluate the performance of the Myelofibrosis Transplant Scoring System (MTSS) and identify risk factors for survival in a multicenter series of 197 patients with MF undergoing allo-HCT. After a median follow-up of 3.1 years, 47% of patients had died, and the estimated 5-year survival rate was 51%. Projected 5-year risk of nonrelapse mortality and relapse incidence was 30% and 20%, respectively. Factors independently associated with increased mortality were a hematopoietic cell transplantation-specific comorbidity index (HCT-CI) ≥3 and receiving a graft from an HLA-mismatched unrelated donor or cord blood, whereas post-transplant cyclophosphamide (PT-Cy) was associated with improved survival. Donor type was the only parameter included in the MTSS model with independent prognostic value for survival. According to the MTSS, 3-year survival was 62%, 66%, 37%, and 17% for low-, intermediate-, high-, and very high-risk groups, respectively. By pooling together the low- and intermediate-risk groups, as well as the high- and very high-risk groups, we pinpointed 2 categories: standard risk and high risk (25% of the series). Three-year survival was 62% in standard-risk and 25% in high-risk categories (P <.001). We derived a risk score based on the 3 independent risk factors for survival in our series (donor type, HCT-CI, and PT-Cy). The corresponding 5-year survival for the low-, intermediate-, and high-risk categories was 79%, 55%, and 32%, respectively (P <.001). In conclusion, the MTSS model failed to clearly delineate 4 prognostic groups in our series but may still be useful to identify a subset of patients with poor outcome. We provide a simple prognostic scoring system for risk/benefit considerations before transplantation in patients with MF

Detection of kinase domain mutations in BCR::ABL1 leukemia by ultra-deep sequencing of genomic DNA

The screening of the BCR::ABL1 kinase domain (KD) mutation has become a routine analysis in case of warning/failure for chronic myeloid leukemia (CML) and B-cell precursor acute lymphoblastic leukemia (ALL) Philadelphia (Ph)-positive patients. In this study, we present a novel DNA-based next-generation sequencing (NGS) methodology for KD ABL1 mutation detection and monitoring with a 1.0E−4 sensitivity. This approach was validated with a well-stablished RNA-based nested NGS method. The correlation of both techniques for the quantification of ABL1 mutations was high (Pearson r = 0.858, p < 0.001), offering DNA-DeepNGS a sensitivity of 92% and specificity of 82%. The clinical impact was studied in a cohort of 129 patients (n = 67 for CML and n = 62 for B-ALL patients). A total of 162 samples (n = 86 CML and n = 76 B-ALL) were studied. Of them, 27 out of 86 harbored mutations (6 in warning and 21 in failure) for CML, and 13 out of 76 (2 diagnostic and 11 relapse samples) did in B-ALL patients. In addition, in four cases were detected mutation despite BCR::ABL1 < 1%. In conclusion, we were able to detect KD ABL1 mutations with a 1.0E−4 sensitivity by NGS using DNA as starting material even in patients with low levels of disease.Tis project was funded in part by CRIS CANCER FOUNDATION

Spatio‐temporal patterns of tree growth as related to carbon isotope fractionation in European forests under changing climate

Aim To decipher Europe-wide spatiotemporal patterns of forest growth dynamics and their associations with carbon isotope fractionation processes inferred from tree rings as modulated by climate warming. Location Europe and North Africa (30‒70°N, 10°W‒35°E). Time period 1901‒2003. Major taxa studied Temperate and Euro-Siberian trees. Methods We characterize changes in the relationship between tree growth and carbon isotope fractionation over the 20th century using a European network consisting of 20 site chronologies. Using indexed tree-ring widths (TRWi), we assess shifts in the temporal coherence of radial growth across sites (synchrony) for five forest ecosystems (Atlantic, Boreal, cold continental, Mediterranean and temperate). We also examine whether TRWi shows variable coupling with leaf-level gas exchange, inferred from indexed carbon isotope discrimination of tree-ring cellulose (Δ13Ci). Results We find spatial autocorrelation for TRWi and Δ13Ci extending over up to 1,000 km among forest stands. However, growth synchrony is not uniform across Europe, but increases along a latitudinal gradient concurrent with decreasing temperature and evapotranspiration. Latitudinal relationships between TRWi and Δ13Ci (changing from negative to positive southwards) point to drought impairing carbon uptake via stomatal regulation for water saving occurring at forests below 60°N in continental Europe. A rise in forest growth synchrony over the 20th century together with increasingly positive relationships between TRWi and Δ13Ci indicate intensifying drought impacts on tree performance. These effects are noticeable in drought-prone biomes (Mediterranean, temperate and cold continental). Main conclusions At the turn of this century, convergence in growth synchrony across European forest ecosystems is coupled with coordinated warming-induced drought effects on leaf physiology and tree growth spreading northwards. Such a tendency towards exacerbated moisture-sensitive growth and physiology could override positive effects of enhanced leaf intercellular CO2 concentrations, possibly resulting in Europe-wide declines of forest carbon gain in the coming decades

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Ontogenesis of lipids in chick embryo retina

Purpose. The effects of embryonic development on lipid composition in the retina were studied in 7, 11, 15, and 18-day-old chick embryos and newly hatched chicks. Methods. The proportions of phospholipids, free and esterified cholesterol, diacylglycerides, and free fatty acids were determined using the Iatroscan TLC/FID procedure. Gas chromatography and mass spectrometry were used to determine the fatty acid composition. Results. The major phospholipid species were phosphatidylethanolamine, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, lysophosphatidylcholine, and sphingomyelin. Concentrations of the analyzed components have been related to the chronology of concrete stages of retinal development. The fatty acid composition of the total lipids, (n-6):(n-3) and saturated:unsaturated fatty acid ratios, and other parameters are reported. The proportions of total saturated and total monounsaturated fatty acids decreased very little from day 7 to hatching, whereas total polyunsaturated fatty acids nearly doubled over the same period. The increase in C18:2(n-6) from day 11 onwards was not followed by a similar increase in C20:4(n-6), hence the C20:4 to C18:2 ratio decreased with age. Conclusions. The cholesterol:phospholipid ratio decreased from day 7 to day 15 and increased from day 15 to hatching. High proportions of esterified cholesterol, very probably originating in the retinal pigment epithelium, were also recorded. Total saturated and monounsaturated fatty acids decreased, while polyunsaturated fatty acids increased during the period of initial retinal growth

The Effect of Dehulling and Extrusion of Jackfruit Artocarpus heterophyllus Seeds on Digestibility and Antinutrients, in Tilapia (Oreochromis niloticus) Diets

In the present study, the effect of dehulling and extrusion of Jackfruit seeds Artocarpus heterophyllus, and apparent digestibility of dry matter and protein was evaluated in feeds for Nile tilapia Oreochromis niloticus. For the digestibility bioassay, organisms with an average weight of 12.6 ± 3.1 g were used. The evaluation of the digestibility coefficient in vivo was determined by using the indirect method of chromium oxide as a marker. The dehulled Jackfruit seeds caused a significant increase in protein and lipids, and a significant decrease in fiber and ash respectively. The extrusion process did not significantly affect protein, fiber, ash, and carbohydrate content of the extruded flour, but caused a significant decrease in the lipid content of Jackfruit seeds. The results indicate that the extrusion process caused a significant decrease in the content of phytic acid, tannins, trypsin inhibitors, and saponins. In relation to trypsin inhibitors, dehulling did not have a significant effect. On the other hand, the combination of the extrusion and dehulling process allowed a significant decrease of phytic acid and tannins, while the dehulled of seeds did not have a significant effect on the phytic acid content. The combination of the dehulled and extrusion process caused a significant decrease in trypsin inhibitors and saponins with respect to raw Jackfruit seeds. The combination of the extrusion and dehulling process caused a significant increase in ADM of diets prepared with 30% of Jackfruit flours. The combination of the process of extrusion and dehulling of Jackfruit seeds allowed a significant increase in ADP compared to the unprocessed seeds. We conclude that dehulled and extruded Jackfruit flours represent a potential low cost, highly available alternative to replace fishmeal in the production of food for tilapia Oreochromis niloticus