Derivative chromosome 9 deletions in chronic myeloid leukaemia: Interpretation of atypical D-FISH pattern

Background/Aims: New molecular cytogenetic techniques are increasingly applied as a routine investigative tool in haematological malignancies, both at diagnosis and subsequent monitoring. This report describes the interpretation of atypical signal patterns encountered using BCR-ABL dual colour dual fusion fluorescence in situ hybridisation (D-FISH) translocation probes in chronic myeloid leukaemia (CML). Methods: Interphase FISH experiments were carried out using BCR-ABL D-FISH probes in 46 patients with CML at diagnosis and during subsequent disease monitoring. Atypical hybridisation signal patterns were characterised by molecular cytogenetic techniques and correlated with conventional karyotyping. Results: Two patients showed atypical interphase D-FISH patterns with one orange, one green, and one fusion (1O1G1F) signal. The presence of BCR-ABL gene fusion was documented by a dual colour single fusion (S-FISH) probe. The submicroscopic deletion of the ABL-BCR fusion gene on the derivative chromosome 9 in these cases was subsequently characterised by metaphase FISH on relocated G banded metaphases. Conclusions: Atypical interphase D-FISH patterns should not be interpreted in isolation and should be considered in conjunction with other cytogenetic or molecular genetic investigations.published_or_final_versio

L’intégration des évaluations de l’apprentissage autorégulé dans les activités d’évaluation dans les professions de la santé : un appel à l’action

How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which ‘core healthcare knowledge’ changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skilfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees’ capacity to engage in this strategic process. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.Dans quelle mesure les professionnels de la santé et les étudiants ont-ils été préparés aux exigences inévitables de nouveaux apprentissages qui se présenteront à eux à l’avenir? Étant donné la rapidité avec laquelle les « connaissances de base en matière de soins de santé » évoluent, les enseignants en médecine ont la responsabilité de vérifier si les étudiants ont développé la capacité d’autoréguler adéquatement leurs apprentissages. Ceux qui pratiquent efficacement l’apprentissage autorégulé (AAR) surveillent et contrôlent habilement leur cognition, leur motivation, leur comportement et leur environnement pour s’adapter à la nécessité de nouveaux apprentissages. Cependant, les programmes d’études médicales évaluent rarement la capacité des étudiants à s’engager dans ce processus stratégique. Dans cet exposé de position, nous plaidons en faveur d’un changement de paradigme vers une évaluation plus ciblée de l’AAR dans les formations doctorale et postdoctorale, ainsi que pour les activités d’évaluation. Plus précisément, nous explorons les résultats convaincants de l’emploi d’un mélange innovant de principes issus de la recherche en matière d’AAR et d’évaluations de la préparation à l’apprentissage futur. Nous proposons des recommandations pour une collaboration entre les responsables de la conception de programmes d’études, ceux de l’élaboration du cursus, ceux chargés de l’évaluation dans les programmes d’études prédoctorales et postdoctorales et les organismes responsables de l’octroi d’un titre de compétence en vue de créer des évaluations intégrées qui mesurent la méthode et la qualité de l’AAR chez les étudiants. Les programmes d’études tardent encore à traduire dans la pratique la reconnaissance de l’importance de l’apprentissage tout au long de la vie dans l’éducation médicale. Continuer à négliger ces compétences importantes ne ferait que nuire aux étudiants en médecine et potentiellement à leurs futurs patients

Non-myeloablative allogeneic peripheral stem cell transplantation for multiple myeloma

Objective. To present an institution's 2-year experience of non-myeloablative allogeneic stem cell transplantation among Chinese patients. Design. Retrospective study. Setting. Bone marrow transplantation unit at a university hospital, Hong Kong. Patients. Ten patients with multiple myeloma who received non-myeloablative allogeneic stem cell transplantation between March 2000 and October 2002. Intervention. Fludarabine (90 mg/m 2) and total body irradiation (300 cGy) were given as conditioning regimens, followed by non-myeloablative allogeneic stem cell transplantation. Main outcome measures. Engraftment, regimen-related toxicity, treatment-related mortality (in the first 100 days), incidence of graft-versus-host disease, chimerism, disease response, and survival rate. Results. All 10 patients had active disease before transplantation. The donors were eight human leukocyte antigen-matched siblings, a mismatched sibling, and a matched daughter. Satisfactory engraftment before day 21 was achieved without early treatment-related mortality. Five patients developed full donor chimerism by day 28 and three other patients had 100% donor chimerism by day 100. Acute graft-versus-host disease developed in six patients (five with grade III and one with grade IV disease), and chronic graft-versus-host disease developed in eight patients (four with extensive disease). Complete remission and partial response were achieved in three and four patients, respectively. Three patients did not respond to treatment, and one case of relapse was observed. Only one patient, who had shown a partial response, received donor lymphocyte infusion; seven patients received thalidomide for graft-versus-host disease with or without graft-versus-myeloma effect. All patients were alive after a median follow-up of 1 year. Conclusion. Non-myeloablative allogeneic stem cell transplantation for multiple myeloma is effective, has low toxicity, and results in low treatment-related mortality. Studies of more cases with longer follow-up durations are required.published_or_final_versio

Single-channel electroencephalographic recording in children with developmental coordination disorder: Validity and influence of eye blink artifacts

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Raf/MEK/MAPK signaling stimulates the nuclear translocation and transactivating activity of FOXM1c

The forkhead box (FOX) transcription factor FOXM1 is ubiquitously expressed in proliferating cells. FOXM1 expression peaks at the G2/M phase of the cell cycle and its functional deficiency in mice leads to defects in mitosis. To investigate the role of FOXM1 in the cell cycle, we used synchronized hTERT-BJ1 fibroblasts to examine the cell cycle-dependent regulation of FOXM1 function. We observed that FOXM1 is localized mainly in the cytoplasm in cells at late-G1 and S phases. Nuclear translocation occurs just before entry into the G2/M phase and is associated with phosphorylation of FOXM1. Consistent with the dependency of FOXM1 function on mitogenic signals, nuclear translocation of FOXM1 requires activity of the Raf/MEK/MAPK signaling pathway and is enhanced by the MAPK activator aurintricarboxylic acid. This activating effect was suppressed by the MEK1/2 inhibitor U0126. In transient reporter assays, constitutively active MEK1 enhances the transactivating effect of FOXM1c, but not FOXM1b, on the cyclin B1 promoter. RT-PCR analysis confirmed that different cell lines and tissues predominantly express the FOXM1c transcript. Mutations of two ERK1/2 target sequences within FOXM1c completely abolish the MEK1 enhancing effect, suggesting a direct link between Raf/MEK/MAPK signaling and FOXM1 function. Importantly, inhibition of Raf/MEK/MAPK signaling by U0126 led to suppression of FOXM1 target gene expression and delayed progression through G2/M, verifying the functional relevance of FOXM1 activation by MEK1. In summary, we provide the first evidence that Raf/MEK/MAPK signaling exerts its G2/M regulatory effect via FOXM1c.published_or_final_versio

Day-ahead allocation of operation reserve in composite power systems with large-scale centralized wind farms

This paper focuses on the day-ahead allocation of operation reserve considering wind power prediction error and network transmission constraints in a composite power system. A two-level model that solves the allocation problem is presented. The upper model allocates operation reserve among subsystems from the economic point of view. In the upper model, transmission constraints of tielines are formulated to represent limited reserve support from the neighboring system due to wind power fluctuation. The lower model evaluates the system on the reserve schedule from the reliability point of view. In the lower model, the reliability evaluation of composite power system is performed by using Monte Carlo simulation in a multi-area system. Wind power prediction errors and tieline constraints are incorporated. The reserve requirements in the upper model are iteratively adjusted by the resulting reliability indices from the lower model. Thus, the reserve allocation is gradually optimized until the system achieves the balance between reliability and economy. A modified two-area reliability test system (RTS) is analyzed to demonstrate the validity of the method.This work was supported by National Natural Science Foundation of China (No. 51277141) and National High Technology Research and Development Program of China (863 Program) (No. 2011AA05A103)

Angiopoietin-1 and keratinocyte growth factor restore the impaired alveolar fluid clearance induced by influenza H5N1 virus infection

Poster Session: Novel TherapeuticsBackground: Acute respiratory distress syndrome (ARDS) caused by high pathogenic avian influenza (HPAI) H5N1 virus infection has resulted in severe illness and high mortality rates among patients. Patients with ARDS are often characterized by impaired alveolar fluid clearance and alveolar edema. An understanding of the mechanism responsible for human alveolar edema will lead to the development of novel therapeutic treatments for ARDS patients. We hypothesized that the paracrine soluble factors angiopoietin-1 (Ang-1) and keratinocyte growth factor (KGF) can resolve alveolar fluid clearance by up-regulating the expression of major sodium and chloride transporters impaired by HPAI H5N1 virus infection. Materials and Methods: Human alveolar epithelial cells grown on transwell inserts were infected with HPAI H5N1 (A/HK/483/97) and low pathogenic avian influenza (LPAI) H1N1 (A/HK/54/98) viruses at MOI 0.1 or incubated with conditioned culture medium containing Ang-1 and/or KGF. At 24 and 48 h post-infection, the rate of alveolar fluid transport and protein permeability across the alveolar epithelium was measured. Protein expression of sodium and chloride transporters (Na-K-ATPase, CFTR, and epithelial sodium channel alpha subunit) was measured by qPCR, ELISA, and Western blot. Results: HPAI H5N1 (A/HK/483/97) virus infection significantly reduced net alveolar fluid transport and protein permeability when compared with H1N1 (A/HK/54/98) virus infection at 24 h post-infection and further reduced it at 48 h post-infection. This reduction in alveolar fluid clearance was associated with a substantial reduction in protein expression of Na-K-ATPase, CFTR, and epithelial sodium channel alpha subunit. The influenza virus–infected cells treated with Ang-1 and KGF restored the impaired alveolar edema fluid clearance and protein permeability after HPAI H5N1 virus infection. Furthermore, the paracrine soluble factors Ang-1 and KGF up-regulated the protein expression of the major sodium and chloride transporters resulting from the HPAI influenza virus infection. Conclusions: The paracrine soluble factors Ang-1 and KGF play an important role in maintaining human alveolar fluid clearance by up-regulating the sodium and chloride transporting systems in human alveolar epithelium. This study enriches the understanding of the development of ARDS in human H5N1 disease and may aid in the development of possible therapeutic applications.published_or_final_versio

Tyrosine kinase inhibitor STI571 in the treatment of Philadelphia chromosome positive leukaemia relapsing from myeloablative stem cell transplantation

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A comparative study of clinical presentation and risk factors for adverse outcome in patients hospitalised with acute respiratory disease due to MERS coronavirus or other causes

Middle East Respiratory syndrome (MERS) first emerged in Saudi Arabia in 2012 and remains a global health concern. The objective of this study was to compare the clinical features and risk factors for adverse outcome in patients with RT-PCR confirmed MERS and in those with acute respiratory disease who were MERS-CoV negative, presenting to the King Fahad Medical City (KFMC) in Riyadh between October 2012 and May 2014. The demographics, clinical and laboratory characteristics and clinical outcomes of patients with RT-PCR confirmed MERS-CoV infection was compared with those testing negative MERS-CoV PCR. Health care workers (HCW) with MERS were compared with MERS patients who were not health care workers. One hundred and fifty nine patients were eligible for inclusion. Forty eight tested positive for MERS CoV, 44 (92%) being hospital acquired infections and 23 were HCW. There were 111 MERS-CoV negative patients with acute respiratory illnesses included in this study as 'negative controls'. Patient with confirmed MERS-CoV infection were not clinically distinguishable from those with negative MERS-CoV RT-PCR results although diarrhoea was commoner in MERS patients. A high level of suspicion in initiating laboratory tests for MERS-CoV is therefore indicated. Variables associated with adverse outcome were older age and diabetes as a co-morbid illness. Interestingly, co-morbid illnesses other than diabetes were not significantly associated with poor outcome. Health care workers with MERS had a markedly better clinical outcome compared to non HCW MERS patients.published_or_final_versio