Novel prognostic molecular factors: a quantum leap in the field of chronic lymphocytic leukemia

Cytogenetic lesions do not completely explain clinical heterogeneity of chronic lymphocytic leukemia (CLL). The 2016 revision of the World Health Organization classification 2008 indicated that molecular lesions of TP53, NOTCH1, SF3B1 and BIRC3 have potential clinical relevance and could be integrated into an updated risk profile. The negative clinical implications of TP53 disruptions are well constituted and patients with these mutations should be considered for novel, small molecule signal transduction inhibitors therapies. Mutations of NOTCH1, SF3B1 and BIRC3 are associated with poor prognosis. Patients with mutated SF3B1 or NOTCH1 genes present shorter time to first treatment compared to unmutated group. NOTCH1 mutations are related to a high risk of Richter’s syndrome transformation, especially in case of TP53 disruptions’ coexistence. Large studies on MYD88 mutations in CLL have not explained clearly their clinical importance.The aim of this paper is to provide a comprehensive review on novel molecular aberrations identified in CLL.

Trigeminal neuralgia: new classification and diagnostic grading for practice and research

Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain

Validation of LC/MS/MS method for assessment of the "in vitro" activity of the selected rat cytochrome P450 isoenzymes : application to early drug metabolism screening

A sensitive and specific liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for simultaneous determination of seven metabolites of CYP450 model substrates (acetaminophen, 4-hydroxytolbutamide, 4í-hydroxymephenytoin, 1-hydroxybufuralol, 6-hydroxychlorzoxazone, 1í- and 4í-hydroxymidazolam) in rat liver microsomes was developed. The assay used Kinetex analytical column and a gradient mobile phase consistent of acetonitrile and water with addition of 0.1% formic acid. The analysis was performed in selected reaction monitoring (SRM) mode both in positive and negative (for 6-hydroxychlorzoxazone) mode. The method was validated over the concentration ranges of 10-2000 ng/mL for 4í-hydroxymephenytoin and 4-hydroxytolbutamide, 50-2000 ng/mL for 1-hydroxybufuralol and 25-2000 ng/mL for the rest of the analytes. The intra- and inter-day precision (2-12%) and accuracy (93-119%) were within the limits set by the FDA and EMA guidelines. The developed method was successfully applied to assess the activity of selected CYP450 isoenzymes in rat liver microsomes after addition of ketoconazole

Validation of LC/MS/MS method for assessment of the "in vitro" activity of selected rat cytochrome P450 isoenzymes : application to early drug metabolism screening

A sensitive and specific liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for simultaneous determination of seven metabolites of CYP450 model substrates (acetaminophen, 4-hydroxytolbutamide, 4'-hydroxymephenytoin, 1-hydroxybufuralol, 6-hydroxychlorzoxazone. 1'-and 4-hydroxymidazolam) in rat liver microsomes was developed. The assay used Kinetex analytical column and a gradient mobile phase consistent of acetonitrile and water with addition of 0.1\% formic acid. The analysis was performed in selected reaction monitoring (SRM) mode both in positive and negative (for 6-hydroxychlorzoxazone) mode. The method was validated over the concentration ranges of 10-2000 ng/mL for 4-hydroxymephenytoin and 4-hydroxytolbutamide, 50-2000 ng/mL for 1-hydroxybufuralol and 25-2000 ng/mL for the rest of the analytes. The intra- and inter-day precision (2-12%) and accuracy (93-119%) were within the limits set by the FDA and EMA guidelines. The developed method was successfully applied to assess the activity of selected CYP450 isoenzymes in rat liver microsomes after addition of ketoconazole

Future Directions for Surgical Trial Designs in Trigeminal Neuralgia

Key points: 1. There is no high quality comparative effectiveness research for surgery versus pharmacological management or for different surgical techniques. 2. High quality evidence (randomised controlled trials) is required to inform routine decision making for patients with TN and their consultants. 3. The design and conduct of surgery trials using the standard design has numerous challenges (patient preferences, clinician preferences, clinically meaningful outcome measures, learning curves for surgical techniques, irreversibility of results). 4. The ‘cohort multiple RCT’ design is an innovative alternative design that provides both long term observational data and a facility for quick and efficient conduct of multiple trials. Unlike standard trials, patient information and consent replicate that found in routine healthcare wherever possible. 5. Embedding multiple trials within a cohort of patients with a diagnosis of TN would enable the quick and efficient identification and recruitment of patients to trials of a variety of interventions, and help provide the information that patients and clinicians require

Where and When Bacterial Chromosome Replication Starts: A Single Cell Perspective

Bacterial chromosomes have a single, unique replication origin (named oriC), from which DNA synthesis starts. This study describes methods of visualizing oriC regions and the chromosome replication in single living bacterial cells in real-time. This review also discusses the impact of live cell imaging techniques on understanding of chromosome replication dynamics, particularly at the initiation step, in different species of bacteria