Ixazomib, daratumumab and low-dose dexamethasone in intermediate-fit patients with newly diagnosed multiple myeloma: an open-label phase 2 trial.

Background: The outcome of non-transplant eligible newly diagnosed multiple myeloma (NDMM) patients is heterogeneous, partly depending on frailty level. The aim of this study was to prospectively investigate the efficacy and safety of Ixazomib-Daratumumab-low-dose dexamethasone (Ixa-Dara-dex) in NDMM intermediate-fit patients. Methods: In this phase II multicenter HOVON-143 study, IMWG Frailty index based intermediate-fit patients, were treated with 9 induction cycles of Ixa-Dara-dex, followed by maintenance with ID for a maximum of 2 years. The primary endpoint was overall response rate on induction treatment. Patients were included from October 2017 until May 2019. Trial Registration Number: NTR6297. Findings: Sixty-five patients were included. Induction therapy resulted in an overall response rate of 71%. Early mortality was 1.5%. At a median follow-up of 41.0 months, median progression-free survival (PFS) was 18.2 months and 3-year overall survival 83%. Discontinuation of therapy occurred in 77% of patients, 49% due to progression, 9% due to toxicity, 8% due to incompliance, 3% due to sudden death and 8% due to other reasons. Dose modifications of ixazomib were required frequently (37% and 53% of patients during induction and maintenance, respectively), mainly due to, often low grade, polyneuropathy. During maintenance 23% of patients received daratumumab alone. Global quality of life (QoL) improved significantly and was clinically relevant, which persisted during maintenance treatment. Interpretation: Ixazomib-Daratumumab-low-dose dexamethasone as first line treatment in intermediate-fit NDMM patients is safe and improves global QoL. However, efficacy was limited, partly explained by ixazomib-induced toxicity, hampering long term tolerability of this 3-drug regimen. This highlights the need for more efficacious and tolerable regimens improving the outcome in vulnerable intermediate-fit patients. Funding: Janssen Pharmaceuticals, Takeda Pharmaceutical Company Limited.

Why are emergency medical technicians' coping strategies dysfunctional? Direct and indirect effects of resilience and perceived stress.

BACKGROUND: Emergency Medical Technicians (EMTs) are at high risk for traumatic disorders, and these disorders are more likely if they resort to dysfunctional coping. However, few studies have examined how dysfunctional coping can be decreased, specifically by comparing the impact of personal characteristics, such as resilience, and of occupational factors, such as stress. This study examines the contribution of resilience and perceived stress on EMTs' dysfunctional coping. METHODS: A total of 502 EMTs (66% men), with a job experience of approximately 8 years (SD = 3.84), answered the Resilience Scale (Self and Life Acceptance; Personal Competence; Total score), Brief Cope, and Anxiety Depression Stress Scales. RESULTS: EMTs reported high resilience, low stress and dysfunctional coping. Resilience dimensions, specifically self and life acceptance, and stress contributed to dysfunctional coping. Stress displayed the highest regression coefficient. The effect of self and life acceptance on dysfunctional coping was no longer significant when accounting for stress, revealing a full mediation effect. CONCLUSIONS: How EMTs perceive stress can mitigate the protective role of acceptance on the use of dysfunctional coping. These findings suggest EMTs' occupational training may benefit from focusing on how to manage stressful and critical incidents, as well as on how to cope with stress.

Genomic array as compared to karyotyping in myelodysplastic syndromes in a prospective clinical trial.

Karyotyping is considered as the gold standard in the genetic subclassification of myelodysplastic syndrome (MDS). Oligo/SNP-based genomic array profiling is a high-resolution tool that also enables genome wide analysis. We compared karyotyping with oligo/SNP-based array profiling in 104 MDS patients from the HOVON-89 study. Oligo/SNP-array identified all cytogenetically defined genomic lesions, except for subclones in two cases and balanced translocations in three cases. Conversely, oligo/SNP-based genomic array profiling had a higher success rate, showing 55 abnormal cases, while an abnormal karyotype was found in only 35 patients. In nine patients whose karyotyping was unsuccessful because of insufficient metaphases or failure, oligo/SNP-based array analysis was successful. Based on cytogenetic visible abnormalities as identified by oligo/SNP-based genomic array prognostic scores based on IPSS/-R were assigned. These prognostic scores were identical to the IPSS/-R scores as obtained with karyotyping in 95%-96% of the patients. In addition to the detection of cytogenetically defined lesions, oligo/SNP-based genomic profiling identified focal copy number abnormalities or regions of copy neutral loss of heterozygosity that were out of the scope of karyotyping and fluorescence in situ hybridization. Of interest, in 26 patients we demonstrated such cytogenetic invisible abnormalities. These abnormalities often involved regions that are recurrently affected in hematological malignancies, and may therefore be of clinical relevance. Our findings indicate that oligo/SNP-based genomic array can be used to identify the vast majority of recurrent cytogenetic abnormalities in MDS. Furthermore, oligo/SNP-based array profiling yields additional genetic abnormalities that may be of clinical importance.

Murine Model for Preclinical Studies of Var2CSA-Mediated Pathology Associated with Malaria in Pregnancy.

Plasmodium falciparum infection during pregnancy leads to abortions, stillbirth, low birth weight, and maternal mortality. Infected erythrocytes (IEs) accumulate in the placenta by adhering to chondroitin sulfate A (CSA) via var2CSA protein exposed on the P. falciparum IE membrane. Plasmodium berghei IE infection in pregnant BALB/c mice is a model for severe placental malaria (PM). Here, we describe a transgenic P. berghei parasite expressing the full-length var2CSA extracellular region (domains DBL1X to DBL6ε) fused to a P. berghei exported protein (EMAP1) and characterize a var2CSA-based mouse model of PM. BALB/c mice were infected at midgestation with different doses of P. berghei-var2CSA (P. berghei-VAR) or P. berghei wild-type IEs. Infection with 10(4) P. berghei-VAR IEs induced a higher incidence of stillbirth and lower fetal weight than P. berghei At doses of 10(5) and 10(6) IEs, P. berghei-VAR-infected mice showed increased maternal mortality during pregnancy and fetal loss, respectively. Parasite loads in infected placentas were similar between parasite lines despite differences in maternal outcomes. Fetal weight loss normalized for parasitemia was higher in P. berghei-VAR-infected mice than in P. berghei-infected mice. In vitro assays showed that higher numbers of P. berghei-VAR IEs than P. berghei IEs adhered to placental tissue. Immunization of mice with P. berghei-VAR elicited IgG antibodies reactive to DBL1-6 recombinant protein, indicating that the topology of immunogenic epitopes is maintained between DBL1-6-EMAP1 on P. berghei-VAR and recombinant DBL1-6 (recDBL1-6). Our data suggested that impairments in pregnancy caused by P. berghei-VAR infection were attributable to var2CSA expression. This model provides a tool for preclinical evaluation of protection against PM induced by approaches that target var2CSA.

A multi-parameter imaging assay identifies different stages of ligand-induced androgen receptor activation.

Androgens exert their key function in development and maintenance of the male phenotype via the androgen receptor (AR). Ligand-activated ARs also play a role in prostate cancer. Despite initial success of treatment by testosterone depletion or blocking of androgen binding to the AR using antiandrogens, eventually all tumors escape to a therapy resistant stage. Development of novel therapies by other antagonistic ligands or compounds that target events subsequent to ligand binding is very important. Here, we validate a fluorescence resonance energy transfer (FRET) based imaging assay for ligand-induced AR activity, based on the conformational change in the AR caused by interaction between the FQNLF motif in the N-terminal domain and the cofactor binding groove in the ligand-binding domain (N/C-interaction). We test the assay using known agonistic and antagonistic ligands on wild type AR and specific AR mutants. Our data show a strong correlation between the ligand-induced AR N/C-interaction and transcriptional activity in wild type AR, but also in AR mutants with broadened ligand responsiveness. Moreover, we explore additional readouts of this assay that contribute to the understanding of the working mechanism of the ligands. Together, we present a sensitive assay that can be used to quantitatively assess the activity of agonistic and antagonistic AR ligands.

Acylated cyanoimido-complexes trans-[Mo(NCN){NCNC(O)R}(dppe)(2)]Cl and their reactions with electrophiles: chemical, electrochemical and theoretical study.

Treatment of a dichloromethane solution of trans-[Mo(NCN){NCNC(O)R}(dppe)(2)]Cl [R = Me (1a), Et (1b)] (dppe = Ph(2)PCH(2)CH(2)PPh(2)) with HBF(4), [Et(3)O][BF(4)] or EtC(O)Cl gives trans-[Mo(NCN)Cl(dppe)(2)]X [X = BF(4) (2a) or Cl (2b)] and the corresponding acylcyanamides NCN(R')C(O)Et (R' = H, Et or C(O)Et). X-ray diffraction analysis of 2a (X = BF(4)) reveals a multiple-bond coordination of the cyanoimide ligand. Compounds 1 convert to the bis(cyanoimide) trans-[Mo(NCN)(2)(dppe)(2)] complex upon reaction with an excess of NaOMe (with formation of the respective ester). In an aprotic medium and at a Pt electrode, compounds 1 (R = Me, Et or Ph) undergo a cathodically induced isomerization. Full quantitative kinetic analysis of the voltammetric behaviour is presented and allows the determination of the first-order rate constants and the equilibrium constant of the trans to cis isomerization reaction. The mechanisms of electrophilic addition (protonation) to complexes 1 and the precursor trans-[Mo(NCN)(2)(dppe)(2)], as well as the electronic structures, nature of the coordination bonds and electrochemical behaviour of these species are investigated in detail by theoretical methods which indicate that the most probable sites of the proton attack are the oxygen atom of the acyl group and the terminal nitrogen atom, respectively.

Compartmentalization of androgen receptor protein-protein interactions in living cells.

Steroid receptors regulate gene expression in a ligand-dependent manner by binding specific DNA sequences. Ligand binding also changes the conformation of the ligand binding domain (LBD), allowing interaction with coregulators via LxxLL motifs. Androgen receptors (ARs) preferentially interact with coregulators containing LxxLL-related FxxLF motifs. The AR is regulated at an extra level by interaction of an FQNLF motif in the N-terminal domain with the C-terminal LBD (N/C interaction). Although it is generally recognized that AR coregulator and N/C interactions are essential for transcription regulation, their spatiotemporal organization is largely unknown. We performed simultaneous fluorescence resonance energy transfer and fluorescence redistribution after photobleaching measurements in living cells expressing ARs double tagged with yellow and cyan fluorescent proteins. We provide evidence that AR N/C interactions occur predominantly when ARs are mobile, possibly to prevent unfavorable or untimely cofactor interactions. N/C interactions are largely lost when AR transiently binds to DNA, predominantly in foci partly overlapping transcription sites. AR coregulator interactions occur preferentially when ARs are bound to DNA.

Restricted diffusion of DNA segments within the isolated Escherichia coli nucleoid.

To study the dynamics and organization of the DNA within isolated Escherichia coli nucleoids, we track the movement of a specific DNA region. Labeling of such a region is achieved using the Lac-O/Lac-I system. The Lac repressor-GFP fusion protein binds to the DNA section where tandem repeats of the Lac operator are inserted, which allows us to monitor the motion of the DNA. The movement of such a GFP spot is followed at 48 ms temporal resolution during 12s. The spots are found to diffuse within a confined space, so that the nucleoid appears to behave like a viscoelastic network. The distribution of the "particle" position in time can be fitted to a Gaussian function indicating that the motion of the particle is Brownian. An average self-diffusion constant Ds=0.12 microm(2) s-1 is derived via the time auto-correlation functions of the displacement and is compatible with the collective diffusion coefficient measured previously by dynamic light scattering. Restriction of a DNA sequence to a small region of the nucleoid is tentatively related to the existence of so-called supercoiling domains.

Multivariate allometry and myocardium abnormalities during experimental systemic nitric oxide blockage

Utilizamos alometria para avaliar dados numéricos experimentais oriundos do miocárdio de ratos machos jovens normais e induzidos à hipertensão. Os corações foram processados com uso de métodos histológicos de rotina. Para as quantificações miocárdicas, utilizamos um Sistema-Teste M-42. Quinze campos microscópicos aleatórios foram considerados. Os parâmetros utilizados foram: densidade volumétrica (Vv por cento); volume (V µm3) e peso cardíaco. O teste do c2 proposto por Anderson e o teste F proposto por Jolicoeur foram utilizados de forma a testar a hipótese isométrica na alometria multivariada. Os resultados na primeira análise demonstraram os autovalores do primeiro componente principal com proporções de 70,11 por cento. Os resultados relativos aos coeficientes mostraram o V nuclear com coeficiente maior que o ponto isométrico. Na segunda análise, os resultados mostraram os autovalores do primeiro componente principal com proporções de 75,68 por cento, usando três variáveis. Os resultados relativos aos coeficientes mostraram o Vv da matriz com coeficiente maior que o ponto isométrico. Na terceira análise, foram mostrados os autovalores do primeiro componente principal com proporções de 70,18 por cento, usando três variáveis. Os resultados relativos aos coeficientes mostraram o V nuclear com coeficiente maior que o ponto isométrico. Isso sugere que os núcleos dos miócitos possuem a maior variância entre as três variáveis avaliadas. Usando os testes c2 e F rejeitamos a hipótese isométrica. Assim, nós pudemos claramente identificar, no presente trabalho, o volume dos núcleos dos miócitos como o centro de crescimento defendido por Huxley. Concluindo, nossos dados mostram que, nessa hipertensão experimental, os miócitos apresentam intensas alterações nucleares, provavelmente envolvendo grandes atividades metabólicas. Em outras palavras, nossos dados sugerem que, para os pesquisadores interessados no modelo L-Name aos 21 dias de submissão, é importante enfatizar ...

Mixed dinitrogen-organocyanamide complexes of molybdenum(0) and their protic conversion into hydrazide and amidoazavinylidene derivatives.

Organocyanamides, Ntbd1;CNR(2) (R = Me or Et), react with trans-[Mo(N(2))(2)(dppe)(2)] (1, dppe = Ph(2)PCH(2)CH(2)PPh(2)), in THF, to give the first mixed molybdenum dinitrogen-cyanamide complexes trans-[Mo(N(2))(NCNR(2))(dppe)(2)] (R = Me 2a or Et 2b) which are selectively protonated at N(2) by HBF(4) to yield the hydrazide(2-) complexes trans-[Mo(NNH(2))(NCNR(2))(dppe)(2)][BF(4)](2) (R = Me, 3a, or Et, 3b). On treatment with Ag[BF(4)], oxidation and metal fluorination occur, and the ligating cyanamide undergoes an unprecedented beta-protonation at the unsaturated C atom to form trans-[MoF(NCHNR(2))(dppe)(2)][BF(4)](2) (R = Me, 4a, or Et, 4b) compounds which present the novel amidoazavinylidene (or amidomethyleneamide) ligands. Complexes 4 are also formed from the corresponding compounds 3, with liberation of ammonia and hydrazine. The crystal structure of 2b was determined by single-crystal X-ray diffraction analysis which indicates that the N atom of the amide group has a trigonal planar geometry.

Lúpus eritematoso sistêmico em paciente do sexo masculino / Erythematosus systemic lupus in male patient

Os autores apresentam um caso de LES em homem de 21 anos, pardo, que abriu seu quadro clínico com febre de origem obscura associada à poliadenopatia genelarizada e esplenomegalia. Havia história pregressa de pericardite, que mereceu tratamento empírico para tuberculose. Por tratar-se de doença mais comum em mulheres, houve atraso no diagnóstico

The relationship between ovarian structure and serum insulin, insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP-1 and IGFBP-3) levels in premature pubarche.

The aim of this study was to determine serum insulin, insulin-like growth factor-I (IGF-I) and its binding proteins (IGFBP-1 and IGFBP-3) levels and their relationship with androgen levels and ovarian structure in 23 girls with premature pubarche (PP). Fasting levels of testosterone, dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), androstenedione (delta4A), sex hormone binding globulin (SHBG), glucose (G), insulin (I), IGF-I, IGFBP-1, IGFBP-3 were measured. Androgens or steroid hormone levels > 3 SD of normal postpubertal levels were considered as an exaggerated response to the ACTH test. The fasting I to G ratio (FIGR) was calculated and FIGR > 22 was suggestive of insulin resistance (IR). A pelvic ultrasound (US) was carried out and the ovarian structure was divided into five classes (c): c1--homogeneous, c2--microcystic, c3--multicystic, c4--polycystic and c5--follicular. The girls with PP were divided into two groups according to the main ovarian classes observed: PPc1 (n = 6) and PPc2 (n = 15). The FIGR showed IR in 44% of patients. The androgens, SHBG, G, I, FIGR, IGF-I and IGFBP-1 levels were similar among the groups (PPc1 vs PPc2). An exaggerated response to ACTH was more common and IGFBP-3 levels were higher in the PPc2 than in the PPc1 group (p = 0.04). Regression analysis revealed that I was correlated with DHEAS (r = -0.43, p = 0.04) and IGFBP-1 (r = -0.51, p = 0.01); IGF-I was correlated with DHEA (r = -0.42, p = 0.05), delta4A (r = -0.47, p = 0.02), SHBG (r = -0.43, p = 0.04), IGFBP-1 (r = -0.61, p = 0.002) and IGFBP-3 (r = 0.56, p = 0.005); IGFBP-1 was correlated with SHBG (r = 0.56, p = 0.005). These findings suggest that there might be interactions between the insulin-IGF-I-IGFBPs system and hyperandrogenism. However, the possible causal role of adrenal androgen hypersecretion on the insulin-IGF-I-IGFBPs axis and ovarian structure in girls with PP remains to be established. Since studies reveal that IGFBP-3 levels could be a negative predictor for insulin sensitivity throughout puberty, we hypothesize that girls with PP and microcystic ovaries are at risk of developing IR in the course of normal puberty.

Resistência à insulina na pubarca precose: relaçäo com os androgênios / Insulin resistance in early puberty: relation with the androgens

O objetivo deste estudo foi descrever o perfil da insulina e determinar sua relação com o hiperandrogenismo na pubarca precoce. (PP). Avaliamos 23 meninas com PP devido à adrenarca precoce e 5 controles (C) pré-puberais normais (7,3 +/- 1,1 x 7,1 +/- 1,8 anos). Os níveis de sulfato de deidroepiandrosterona (SDHEA), testosterona (T) e globulina ligadora dos hormônios sexuais (SHBG) foram medidos. 0 índice de massa corporal (IMC) e o índice do androgênio livre (IAL) foram calculados. 0 teste oral de tolerância à glicose (G) foi realizado; sendo calculadas a relação de jejum da insulina (I) pela G (FIGR= I/G) e as áreas abaixo das curvas da G e I (AACG e AACI). A FIGR > 22 foi considerada como sugestiva de resistência a I (RI). 0 IMC foi maior na PP do que nos C: 18,8 +/- 3,0 x 15,5 +/- 1,6, p= 0,03. Os níveis de SDHEA (71,7 +/- 40,6 x 34,2 +/- 6,9ng/dl, p= 0,02), T (0,41 +/- 0,4 x 0, 17 +/- 0,1 nmol/L p= 0,02) e IAL (0,73 +/- 0,7 x 0,17 +/- 0,04, p= 0,001) foram maiores na PP, enquanto a SHBG (63,7 +/- 23,1 x 110,2 +/- 23,9nmol/L p= 0,0006) foi menor. A FIGR foi sugestiva de RI em 44 por cento dos casos de PP, mas os níveis de G, I, a AACG, a AACI e a FIGR foram semelhantes aos C. Na PP foi observada correlação inversa entre SDHEA e I (r = -0,43, p= 0,04) e entre SHBG e IMC (r = -0,74, p = 0,0001) e AACI (r=-0,36, p= 0,09). A AACI mostrou uma correlação positiva com o IMC (r=0,56, p= 0,006) e a FIGR (r= 0,86, p= 0,0001). Embora o hiperandrogenismo adrenal possa não ter um efeito adverso sobre a sensibilidade à I na infância, como demonstrado pela correlação inversa entre o SDHEA e a I em meninas com PP, a presença da FIGR sugestiva de RI foi relativamente comum, permanecendo incerta a relação entre os níveis dos androgênios adrenais e a sensibilidade à insulina.

Assistência de enfermagem ao paciente com dor

Trata-se de uma experiência de ensino-aprendizagem inovadora na graduaçäo de enfermeiros. Um grupo de alunas, orientadas por uma professora, elaboraram e executaram um projeto de prestaçäo de assistência sistematizada a pacientes hospitalizados que apresentaram queixa de dor. A administraçäo de analgésicos p. n. r.*** foi utilizada somente após explorarem-se outras alternativas de cuidados de enfermagem. Os resultados mostraram que em 27 queixas de dor, somente 4 necessitaram da droga terapêutica

Escala de Avaliação de Desempenho para Instrutores e Professores

Este artigo apresenta uma Escala de Avaliação de Desempenho para Instrutores e Professores, visando atender a uma maior recionalização do treinamento de instrutores e/ou professores na Marinha do Brasil. A escala, composta de 29 itens definidos operacionalmente e distribuídos segundo 4 módulos e 4 gradações definidas operacionalmente, foi aplicada em 35 instrutores da Marinha, tendo apresentado alta fidedignidade, bem como validade por meio da utilização de um critério externo (AU)