Minimal residual disease detection in childhood acute lymphoblastic leukaemia patients at multiple time-points reveals high levels of concordance between molecular and immunophenotypic approaches

In this single centre study of childhood acute lymphoblastic leukaemia (ALL) patients treated on the Medical Research Council UKALL 97/99 protocols, it was determined that minimal residual disease (MRD) detected by real time quantitative polymerase chain reaction (RQ-PCR) and 3-colour flow cytometry (FC) displayed high levels of qualitative concordance when evaluated at multiple time-points during treatment (93.38%), and a combined use of both approaches allowed a multi time-point evaluation of MRD kinetics for 90% (53/59) of the initial cohort. At diagnosis, MRD markers with sensitivity of at least 0.01% were identified by RQ-PCR detection of fusion gene transcripts, IGH/TRG rearrangements, and FC. Using a combined RQ-PCR and FC approach, the evaluation of 367 follow-up BM samples revealed that the detection of MRD >1% at Day 15 (P = 0.04), >0.01% at the end of induction (P = 0.02), >0.01% at the end of consolidation (P = 0.01), >0.01% prior to the first delayed intensification (P = 0.01), and >0.1% prior to the second delayed intensification and continued maintenance (P = 0.001) were all associated with relapse and, based on early time-points (end of induction and consolidation) a significant log-rank trend (P = 0.0091) was noted between survival curves for patients stratified into high, intermediate and low-risk MRD groups.

POINTS OF VIEW: Multi-Roling Performance in Ireland in the 1990s, Part 1 (Layering)

This series of posts will consider the acting techniques required for this style of performance with reference to four productions from the 1990s in which two actors took on multiple roles: Frank Pig Says Hello (1992), Co-Motion’s stage adaptation of Pat McCabe’s novel; The Butcher Boy, Corca Dorca’s production of Disco Pigs (1996) by Enda Walsh; DubbleJoint’s production of Stones in his Pockets by Marie Jones (1996) and its subsequent award-winning revival which I produced at Belfast’s Lyric Theatre in 1999; and Kabosh’s production of Mojo Mickybo by Owen McCafferty (1998). The discussion will focus primarily on my own empirical exploration of the demands multi-roling places on an actor through the direction of recent revivals of Mojo Mickybo for Belfast’s Chatterbox Theatre Company (2013) and Bedlam Productions (2015).

Clinical end points for drug treatment trials in BCR-ABL1-negative classic myeloproliferative neoplasms: consensus statements from European LeukemiaNET (ELN) and Internation Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT)

The discovery of somatic mutations, primarily JAK2V617F and CALR, in classic BCR-ABL1-negative myeloproliferative neoplasms (MPNs) has generated interest in the development of molecularly targeted therapies, whose accurate assessment requires a standardized framework. A working group, comprised of members from European LeukemiaNet (ELN) and International Working Group for MPN Research and Treatment (IWG-MRT), prepared consensus-based recommendations regarding trial design, patient selection and definition of relevant end points. Accordingly, a response able to capture the long-term effect of the drug should be selected as the end point of phase II trials aimed at developing new drugs for MPNs. A time-to-event, such as overall survival, or progression-free survival or both, as co-primary end points, should measure efficacy in phase III studies. New drugs should be tested for preventing disease progression in myelofibrosis patients with early disease in randomized studies, and a time to event, such as progression-free or event-free survival should be the primary end point. Phase III trials aimed at preventing vascular events in polycythemia vera and essential thrombocythemia should be based on a selection of the target population based on new prognostic factors, including JAK2 mutation. In conclusion, we recommended a format for clinical trials in MPNs that facilitates communication between academic investigators, regulatory agencies and drug companies.

POINTS OF VIEW: Multi-Roling Performance in Ireland in the 1990s, Part 2 (Characterisation)

The 1990s in Ireland saw a series of highly successful theatre productions in which actors played a multiplicity of roles. This has often been attributed to the economic exigencies of the times, but it also depended on the availability of flexible actors with the physical and psychological capacity to embody a wide range of identifiable characters within the one production.

This second of two posts considers the acting techniques required for this style of performance in relation to the differentiation of one character from another. The discussion will focus primarily on my own empirical exploration of the demands multi-roling places on an actor through the direction of recent revivals of Mojo Mickybo for Belfast’s Chatterbox Theatre Company (2013) and Bedlam Productions (2015).

Auditory cueing in Parkinson's patients with freezing of gait. What matters most: action-relevance or cue-continuity?

Gait disturbances are a common feature of Parkinson’s disease, one of the most severe being freezing of gait. Sensory cueing is a common method used to facilitate stepping in people with Parkinson’s. Recent work has shown that, compared to walking to a metronome, Parkinson’s patients without freezing of gait (nFOG) showed reduced gait variability when imitating recorded sounds of footsteps made on gravel. However, it is not known if these benefits are realised through the continuity of the acoustic information or the action-relevance. Furthermore, no study has examined if these benefits extend to PD with freezing of gait. We prepared four different auditory cues (varying in action-relevance and acoustic continuity) and asked 19 Parkinson’s patients (10 nFOG, 9 with freezing of gait (FOG)) to step in place to each cue. Results showed a superiority of action-relevant cues (regardless of cue-continuity) for inducing reductions in Step coefficient of variation (CV). Acoustic continuity was associated with a significant reduction in Swing CV. Neither cue-continuity nor action-relevance was independently sufficient to increase the time spent stepping before freezing. However, combining both attributes in the same cue did yield significant improvements. This study demonstrates the potential of using action-sounds as sensory cues for Parkinson’s patients with freezing of gait. We suggest that the improvements shown might be considered audio-motor ‘priming’ (i.e., listening to the sounds of footsteps will engage sensorimotor circuitry relevant to the production of that same action, thus effectively bypassing the defective basal ganglia).

Degradação do perfil bioquímico de um concentrado de Nannochloropsis sp. durante o seu período de validade

As algas do género Nannochloropsis são microalgas marinhas que apresentam um perfil bioquímico único, principalmente no que é respeitante a lípidos, e uma vasta gama de compostos bioativos que possibilitam a sua aplicabilidade comercial em várias áreas biotecnológicas, destacando-se a alimentação e nutrição humana, indústria cosmética e farmacêutica, produção de biocombustíveis e a sua utilização em aquacultura. Em aquacultura, são usadas maioritariamente microalgas vivas, cuja produção representa elevados custos. Tem havido assim uma pesquisa de dietas alternativas, entre as quais os concentrados de microalgas se apresentam promissores. Os desafios atuais das empresas produtoras de concentrados de microalgas prendem-se com a conservação e armazenamento destes concentrados. Assim, neste trabalho foi proposto o estudo da influência da refrigeração, congelação e adição de conservantes a PhytoBloom Green Formula®, concentrado de Nannochloropsis sp. comercializado pela empresa Necton S.A., com o objetivo de averiguar a variação de parâmetros bioquímicos e organoléticos com a exposição do concentrado aos diferentes métodos de conservação. Pretendia-se assim observar se estes processos podem ser usados para aumentar o tempo de prateleira do concentrado em estudo. Para tal, foram avaliadas amostras recolhidas em três pontos temporais e analisados os seguintes parâmetros: perfil de ácidos gordos, quantificação de hidroperóxidos lipídicos, quantificação espectrofotométrica de clorofila a e carotenóides, bem como parâmetros organoléticos. Inicialmente, foi efetuada uma avaliação de diferentes parâmetros organoléticos, não se observando variações relevantes entre amostras das diferentes condições. Assim, foi posteriormente realizada a avaliação bioquímica. Primeiramente, foi efetuada a quantificação de ácidos gordos por GC-FID das diferentes amostras, nas quais não se observou diferenças significativas entre as condições experimentais. Foi também efetuado um ensaio de FOX II, que permitiu avaliar o grau de peroxidação lipídica de cada amostra por quantificação de hidroperóxidos lipídicos formados. As amostras nas quais houve adição de conservantes apresentaram um teor menor de hidropéroxidos lipídicos, permitindo inferir que a ação dos conservantes com propriedades antioxidantes permitiu uma melhor conservação da amostra. Quando se determinou a concentração de clorofila a e de carotenóides verificou-se que, em ambos os casos, a congelação conduziu a uma estabilização da concentração destes pigmentos. No entanto, os melhores resultados foram obtidos usando a combinação de congelação com adição de conservantes. Estes resultados, embora promissores, carecem de uma confirmação por um novo estudo, completando com análises com maior rigor e sensibilidade associados, no sentido de se verificar qual o método mais vantajoso para a extensão do tempo de prateleira de PhytoBloom Green Formula®.

Degradação do perfil bioquímico de um concentrado de Nannochloropsis sp. durante o seu período de validade

As algas do género Nannochloropsis são microalgas marinhas que apresentam um perfil bioquímico único, principalmente no que é respeitante a lípidos, e uma vasta gama de compostos bioativos que possibilitam a sua aplicabilidade comercial em várias áreas biotecnológicas, destacando-se a alimentação e nutrição humana, indústria cosmética e farmacêutica, produção de biocombustíveis e a sua utilização em aquacultura. Em aquacultura, são usadas maioritariamente microalgas vivas, cuja produção representa elevados custos. Tem havido assim uma pesquisa de dietas alternativas, entre as quais os concentrados de microalgas se apresentam promissores. Os desafios atuais das empresas produtoras de concentrados de microalgas prendem-se com a conservação e armazenamento destes concentrados. Assim, neste trabalho foi proposto o estudo da influência da refrigeração, congelação e adição de conservantes a PhytoBloom Green Formula®, concentrado de Nannochloropsis sp. comercializado pela empresa Necton S.A., com o objetivo de averiguar a variação de parâmetros bioquímicos e organoléticos com a exposição do concentrado aos diferentes métodos de conservação. Pretendia-se assim observar se estes processos podem ser usados para aumentar o tempo de prateleira do concentrado em estudo. Para tal, foram avaliadas amostras recolhidas em três pontos temporais e analisados os seguintes parâmetros: perfil de ácidos gordos, quantificação de hidroperóxidos lipídicos, quantificação espectrofotométrica de clorofila a e carotenóides, bem como parâmetros organoléticos. Inicialmente, foi efetuada uma avaliação de diferentes parâmetros organoléticos, não se observando variações relevantes entre amostras das diferentes condições. Assim, foi posteriormente realizada a avaliação bioquímica. Primeiramente, foi efetuada a quantificação de ácidos gordos por GC-FID das diferentes amostras, nas quais não se observou diferenças significativas entre as condições experimentais. Foi também efetuado um ensaio de FOX II, que permitiu avaliar o grau de peroxidação lipídica de cada amostra por quantificação de hidroperóxidos lipídicos formados. As amostras nas quais houve adição de conservantes apresentaram um teor menor de hidropéroxidos lipídicos, permitindo inferir que a ação dos conservantes com propriedades antioxidantes permitiu uma melhor conservação da amostra. Quando se determinou a concentração de clorofila a e de carotenóides verificou-se que, em ambos os casos, a congelação conduziu a uma estabilização da concentração destes pigmentos. No entanto, os melhores resultados foram obtidos usando a combinação de congelação com adição de conservantes. Estes resultados, embora promissores, carecem de uma confirmação por um novo estudo, completando com análises com maior rigor e sensibilidade associados, no sentido de se verificar qual o método mais vantajoso para a extensão do tempo de prateleira de PhytoBloom Green Formula®.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

Selling points

The South Carolina Education Lottery publishes a monthly newsletter for lottery retailers with information about new and ending games, success stories, profiles of game winners, events, and calendars.

The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles

DESIGN: A randomized controlled trial.OB JECTIVE: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. BACKGROUND : Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. METHODS: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P =.003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. CONCLUSIONS: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. LEVEL OF EVIDENCE : Therapy, level 1b. J Orthop Sports Phys Ther 2010;40(5):310-317. doi:10.2519/jospt.2010.3257. KEYWORDSDS: cervical manipulation, muscle trigger points, neck, TMJ, upper cervical.