Incidence of bacterial and fungal infections in Polish pediatric patients with acute lymphoblastic leukemia during the pandemic.

The most common complications related to the treatment of childhood acute lymphoblastic leukemia (ALL) are infections. The aim of the study was to analyze the incidence and mortality rates among pediatric patients with ALL who were treated in 17 Polish pediatric hematology centers in 2020-2021 during the pandemic. Additionally, we compared these results with those of our previous study, which we conducted in the years 2012-2017. The retrospective analysis included 460 patients aged 1-18 years with newly diagnosed ALL. In our study, 361/460 (78.5%) children were reported to have microbiologically documented bacterial infections during chemotherapy. Ten patients (2.8%) died due to sepsis. Fungal infections were reported in 99 children (21.5%), of whom five (5.1%) died due to the infection. We especially observed an increase in bacterial infections during the pandemic period compared to the previous study. The directions of our actions should be to consider antibiotic prophylaxis, shorten the duration of hospitalization, and educate parents and medical staff about complications (mainly infections) during anticancer therapy. It is necessary to continue clinical studies evaluating infection prophylaxis to improve outcomes in childhood ALL patients.

Real pandemic world results of pharmacokinetic-tailored personalized prophylaxis of bleeds in Polish children and adolescents with severe hemophilia A.

Introduction: In 2020, the new nationwide protocol of prophylaxis in Polish plasma-derived FVIII (pdFVIII) previously treated patients (PTPs) with severe hemophilia A (sHA) was introduced, resulting in the necessity of switching from pdFVIII to recombinant FVIII (octocog-alpha; rFVIII). The study aimed to: (1) assess the safety of switching from pdFVIII to rFVIII, (2) assess the safety and efficacy of pharmacokinetically based (PK-based) personalized prophylaxis in severe hemophilia A. Patients and methods: 151 children and adolescents receiving prophylaxis with a standard dose (40 U/kg 3 x weekly) of pdFVIII were included in this study. Annualized bleeding rate (ABR) and annualized joint bleeding rate (AJBR) were analyzed for all patients before enrollment. Using myPKFiT application, pharmacokinetic (PK) analysis followed by the selection of the optimal model of prophylaxis was performed in all patients. Two possible models of prophylaxis (standard-dose rFVIII versus PK-based rFVIII) were discussed, with parents leaving the choice to their decision. Parents reported all episodes of bleeds. Screening for inhibitor was performed every 3 months. ABR and AJBR were prospectively analyzed again after a minimum follow-up time of 26 weeks. Results: 141/151 (93.4%) patients completed the study. 34 patients decided to continue standard prophylaxis with rFVIII (Group I), whereas 107 were switched to PK-based prophylaxis (Group II). The risk of inhibitor development could be assessed in 137/151 (90.7%) patients. Only 2/137 (1.47%) patients (both on PK-based prophylaxis) developed low-titer inhibitor with its spontaneous elimination. The retrospective analysis of bleeds during the last 12 months of standard pdFVIII prophylaxis revealed that patients who decided to continue standard prophylaxis had historically lower ABR and AJBR than those who started PK-based personalized prophylaxis. After a minimum of 26 weeks, ABR and AJBR improved significantly in both groups. There was no significant difference in ABR and AJBR between Group I and Group II during the follow-up period. However, the rate of reduction of ABR and AJBR was higher in patients on PK-based personalized prophylaxis. Conclusion: (1) Switching from pdFVIII to rFVIII (octocog-alpha) in PTPs with sHA is safe, (2) PK-based personalized prophylaxis may decrease ABR and AJBR in children and adolescents with sHA.

Viral Infection Profile in Children Treated for Acute Lymphoblastic Leukemia-Results of Nationwide Study.

Viral infections can be a serious complication of therapy in children with acute lymphoblastic leukemia (ALL). In this study, we focused on the incidence and the profile of viral infection in children with ALL treated in 17 pediatric oncology centers in Poland in the two-year periods of 2018-2019 and 2020-2021. We also compared the frequency of viral infections in 2018-2019 to that in 2020-2021. In 2020-2021, a total of 192 children with ALL had a viral infection during intensive chemotherapy. A total number of 312 episodes of viral infections were diagnosed. The most common infections detected in the samples were: COVID-19 (23%), rhinovirus (18%), and respiratory syncytial virus (14%). COVID-19 and BK virus infections were the reason for the death 1% of all patients. In 2018-2019, a total of 53 ALL patients who had a viral infection were reported and 72 viral events were observed, mainly adenovirus (48.6%), rotavirus (31.9%), and herpes zoster (8.3%). No deaths were reported during this period. The cumulative incidence of viral infections in 2018-2019 was 10.4%, while for 2020-2021, it was 36.7%. In conclusion, a high incidence of COVID-19 infection was observed among pediatric patients with ALL in Poland. The mortality rate in our material was low. The viral profile in ALL children undergoing chemotherapy can be useful for clinicians to improve prophylactic and therapeutic strategies.

Artifact Correction in Short-Term HRV during Strenuous Physical Exercise.

Heart rate variability (HRV) analysis can be a useful tool to detect underlying heart or even general health problems. Currently, such analysis is usually performed in controlled or semi-controlled conditions. Since many of the typical HRV measures are sensitive to data quality, manual artifact correction is common in literature, both as an exclusive method or in addition to various filters. With proliferation of Personal Monitoring Devices with continuous HRV analysis an opportunity opens for HRV analysis in a new setting. However, current artifact correction approaches have several limitations that hamper the analysis of real-life HRV data. To address this issue we propose an algorithm for automated artifact correction that has a minimal impact on HRV measures, but can handle more artifacts than existing solutions. We verify this algorithm based on two datasets. One collected during a recreational bicycle race and another one in a laboratory, both using a PMD in form of a GPS watch. Data include direct measurement of electrical myocardial signals using chest straps and direct measurements of power using a crank sensor (in case of race dataset), both paired with the watch. Early results suggest that the algorithm can correct more artifacts than existing solutions without a need for manual support or parameter tuning. At the same time, the error introduced to HRV measures for peak correction and shorter gaps is similar to the best existing solution (Kubios-inspired threshold-based cubic interpolation) and better than commonly used median filter. For longer gaps, cubic interpolation can in some cases result in lower error in HRV measures, but the shape of the curve it generates matches ground truth worse than our algorithm. It might suggest that further development of the proposed algorithm may also improve these results.

Extended approach to sum of absolute differences method for improved identification of periods in biomedical time series.

Time series are a common data type in biomedical applications. Examples include heart rate, power output, and ECG. One of the typical analysis methods is to determine longest period a subject spent over a given heart rate threshold. While it might seem simple to find and measure such periods, biomedical data are often subject to significant noise and physiological artifacts. As a result, simple threshold calculations might not provide correct or expected results. A common way to improve such calculations is to use moving average filter. Length of the window is often determined using sum of absolute differences for various windows sizes. However, for real life biomedical data such approach might lead to extremely long windows that undesirably remove physiological information from the data. In this paper, we:•propose a new approach to finding windows length using zero-points of third gradient (jerk) of Sum of Absolute Differences method;•demonstrate how these points can be used to determine periods and area over a given threshold with and without uncertainty.We demonstrate validity of this approach on the PAMAP2 Physical Activity Monitoring Data Set, an open dataset from the UCI Machine Learning Repository, as well as on the PhysioNet Simultaneous Physiological Measurements dataset. It shows that first zero-point usually falls at around 8 and 5 second window length respectively, while second zero-point usually falls between 16 and 24 and 8-16 s respectively. The value for the first zero-point can remove simple measurement errors when data are recorded once every few seconds. The value for the second zero-point corresponds well with what is known about physiological response of heart to changing load.

Allosteric modulation of nucleoporin assemblies by intrinsically disordered regions.

Intrinsically disordered regions (IDRs) of proteins are implicated in key macromolecular interactions. However, the molecular forces underlying IDR function within multicomponent assemblies remain elusive. By combining thermodynamic and structural data, we have discovered an allostery-based mechanism regulating the soluble core region of the nuclear pore complex (NPC) composed of nucleoporins Nup53, Nic96, and Nup157. We have identified distinct IDRs in Nup53 that are functionally coupled when binding to partner nucleoporins and karyopherins (Kaps) involved in NPC assembly and nucleocytoplasmic transport. We show that the Nup53·Kap121 complex forms an ensemble of structures that destabilize Nup53 hub interactions. Our study provides a molecular framework for understanding how disordered and folded domains communicate within macromolecular complexes.

Substrate Affinity and Specificity of the ScSth1p Bromodomain Are Fine-Tuned for Versatile Histone Recognition.

Bromodomains recognize a wide range of acetylated lysines in histones and other nuclear proteins. Substrate specificity is critical for their biological function and arises from unique acetyl-lysine binding sites formed by variable loop regions. Here, we analyzed substrate affinity and specificity of the yeast ScSth1p bromodomain, an essential component of the "Remodels the Structure of Chromatin" complex, and found that the wild-type bromodomain preferentially recognizes H3K14ac and H4K20ac peptides. Mutagenesis studies-guided by our crystal structure determined at 2.7-Å resolution-revealed loop residues Ser1276 and Trp1338 as key determinants for such interactions. Strikingly, point mutations of each of these residues substantially increased peptide binding affinity and selectivity, respectively. Our data demonstrate that the ScSth1p bromodomain is not optimized for binding to an individual acetylation mark, but fine-tuned for interactions with several such modifications, consistent with the versatile and multivalent nature of histone recognition by reader modules such as bromodomains.

On the strongly correlated electron hydride Ce2Ni2MgH7.7.

The intermediate valence compound Ce 2Ni 2Mg absorbs irreversibly hydrogen when exposed under 1 MPa of H 2 pressure at room temperature. The resulting hydride Ce 2Ni 2MgH 7.7 is stable in air and crystallizes as the deuteride La 2Ni 2MgD 8 in a monoclinic structure (space group P2 1 /c) with the unit cell parameters a = 11.7620(2), b = 7.7687(2), and c = 11.8969(2) A and beta = 92.75 degrees . The H-insertion in Ce 2Ni 2Mg induces a structural transition from a tetragonal to a monoclinic symmetry with an unit cell volume expansion Delta V m/ V m approximately 24.9%. The investigation of the hydride by magnetization, electrical resistivity, and specific heat measurements indicates a change from an intermediate valence behavior to a non-magnetic strongly correlated electron system. This transition results from a change of the coupling constant J cf between 4f(Ce) and conduction electrons induced by the hydrogenation.