Incidence and outcome of chronic graft-versus-host disease using National Institutes of Health consensus criteria.

Chronic graft-versus-host disease (cGVHD), a common complication after stem cell transplant (SCT), has an impact on morbidity and survival. Previous classification of cGVHD has not been reproducible or prognostic for nonrelapse mortality (NRM). Recently the National Institutes of Health (NIH) consensus criteria were proposed, but the ability of this classification to predict outcome of various subtypes of cGVHD is unknown. Patients (N = 110) undergoing an SCT for a hematologic malignancy and surviving until day 100 posttransplant from 2001 to 2003 were studied. The overall survival (OS) using a landmark analysis at day 100 was 44% versus 66% (no GVHD vs. GVHD, P = .026). The OS of patients with various types of GVHD as proposed by the NIH criteria were significantly different (P < .0001). In a univariate analyses, this was more apparent when patients with any acute features of GVHD were compared to classic cGVHD (3-year OS 46% vs. 68%, P = .033). The 3-year NRM for the entire cohort was 21%, and was not affected by presence or absence of GVHD or subtypes of GVHD. In a multivariable analysis, extensive cGVHD (hazard ratio [HR] 0.35, P = .015) and having any acute feature of GVHD after day 100 (HR 3.36, P = .0144) were significant independent predictors of survival. The OS with different NIH subtypes of GVHD after day 100 from SCT varies, and is superior for patients with classic cGVHD.     

Preferential incorporation of 3'-azido-2',3'-dideoxythymidine (azt) in telomeric sequences of cho cells

3'-Azido-2',3'-dideoxythymidine (AZT), the thymidine analogue used against human immunodeficiency virus 1 (HIV-1), exhibits bone marrow and blood toxicity in humans, presumably as the result of genotoxic mechanisms induced by incorporation of AZT into eukaryotic DNA. Preferential incorporation of AZT into telomeric regions of DNA of Chinese hamster ovary (CHO) cells has been previously demonstrated by immunofluorescence using anti-AZT antibodies. We quantitatively compared the amount of [H-3]-AZT bound to telomeric and non-telomeric sequences of CHO cell DNA. DNA from cells exposed to [H-3]-AZT was digested by a mixture of restriction enzymes, frequent cutters in the overall genome, without restriction sites in the telomeric repeat. As a result, the telomeric fraction (TF): isolated by separation columns, comprised longer sequences (> 2 kb) than the non-telomeric fraction (NTF). Radioactivity associated with each fraction revealed a three fold increase in [H-3]-AZT incorporated in the TF compared with the NTF. No preferential telomeric binding was detected for [H-3]-thymidine (Tdr) or [H-3]-5'bromodeoxyuridine (BrdU) in similar experiments or in DNA of AZT-treated mouse primary fibroblasts, cells with large telomeric repeats that lack telomerase. When the chromosomal ends of high molecular weight [H-3]-AZT-DNA were digested with Pal 31, the radioactivity was double in the TF compared with the NTF. Therefore incorporation of AZT in CHO immortalized cells but not in primary fibroblasts (that lack telomerase) indirectly shows that AZT incorporation could be telomerase-mediated.     

Megalophallus as a sequela of priapism in sickle cell anemia: use of blood oxygen level-dependent magnetic resonance imaging

Priapism is a common complication of sickle cell anemia. We report a little known sequela of priapism: painless megalophallus, with significant penile enlargement. The patient had had an intense episode of priapism 9 years previously and his penis remained enlarged. Blood oxygen level-dependent magnetic resonance imaging revealed enlarged, hypoxic corpora cavernosa. Megalophallus probably resulted from permanent loss of elasticity of the tunica albuginea due to severe engorgement during the episode of priapism. This sequela needs to be recognized by physicians because no intervention is necessary and sexual function seems to remain intact.     

Performance Evaluation of Time-Frequency Distributions for ECG Signal Analysis

The non-stationary and multi-frequency nature of biomedical signal activities makes the use of time-frequency distributions (TFDs) for analysis inevitable. Time-frequency analysis provides simultaneous interpretations in both time and frequency domain enabling comprehensive explanation, presentation and interpretation of electrocardiogram (ECG) signals. The diversity of TFDs and specific properties for each type show the need to determine the best TFD for ECG analysis. In this study, a performance evaluation of five TFDs in term of ECG abnormality detection is presented. The detection criteria based on extracted features from most important ECG signal components (QRS) to detect normal and abnormal cases. This is achieved by estimating its energy concentration magnitude using the TFDs. The TFDs analyse ECG signals in one-minute interval instead of conventional time domain approach that analyses based on beat or frame containing several beats. The MIT-BIH normal sinus rhythm ECG database total records of 18 long-term ECG sampled at 128 Hz have been analysed. The tested TFDs include Dual-Tree Wavelet Transform, Spectrogram, Pseudo Wigner-Ville, Choi-Williams, and Born-Jordan. Each record is divided into one-minute slots, which is not considered previously, and analysed. The sample periods (slots) are randomly selected ten minutes interval for each record. This result with 99.44% detection accuracy for 15,735 ECG beats shows that Choi-Williams distribution is most reliable to be used for heart problem detection especially in automated systems that provide continuous monitoring for long time duration.     

Context-specific food-based approach for ensuring nutrition security in developing countries: a review

Sustainable food strategies for meeting nutrient needs in developing countries are not well established. The available evidence shows that more than one-third of the world’s population is facing under-nutrition, of which the most affected individuals are children and mothers from poor countries. In most developing countries, losses resulting from malnutrition are between 3 and 16% of the gross domestic product. This burden is far larger than the donor-driven and government programmes can tackle alone. As such, an innovative approach, which is independent and not donor-based, is needed to reduce the burden of malnutrition in low-income countries. In this review, we describe a context specific food-based approach for addressing malnutrition in developing countries. The approach deploys the hybrid public–private delivery model that enables cost sharing and efficiency gains in resource-poor countries. The model influences players to consider consumers’ perspectives, which often are neglected and truly engage them as key stakeholders.     

Advanced Psychometric Methods for Developing and Evaluating Cut-Point-Based Indicators

In this study, we offer some advice on the use of empirical techniques to create categorical indicators from responses to multiple survey questions that ostensibly compose scales. We discuss the use of advanced psychometric methods, including confirmatory factor analysis for ordered categorical measures (CFA-OCM) and item response theory (IRT), to expand 12 previously published criteria for cut-point development and evaluation offered by Moore et al. (Indicators of Child Well-Being: The Promise for Positive Youth Development. Annals of the American Academy of Political and Social Science. Special Issue: Positive Development: Realizing the Potential of Youth. 591:125–145, 2004). We present an application of this advice by developing categorical cut-points for the social skills and behavior problems subscales of the U.S. National Survey of Children’s Health (NSCH) Social Competence Scale. We used data from the 2007 NSCH, a large cross-sectional, random-digit-dial telephone survey of a representative sample of the noninstitutionalized population of U.S. children 0–17 years of age. Parents of children aged 6 to 17 years (n = 63,364) responded to 4 questions about their children’s behavior problems and 4 questions about their children’s positive social skills. IRT analyses indicated that IRT model-based scores of +1.8 and −0.7 provided suitable high and low cut-points, respectively, for the behavior problems subscale. These cut-points had marginal reliabilities of 0.70 and 0.67 respectively, and corresponded to raw subscale scores of 13 and 8 IRT analyses indicated that an IRT model-based score of −1.8 provided a suitable cut-point for identifying children with low levels of positive social skills. This cut-point had a marginal reliability of 0.63 and corresponded to a raw subscale score of 13. For both subscales and cut-point sets, frequency distributions demonstrated that the cut-points identified sufficient proportions of children generally as well as within demographic subgroups. Our findings indicate that analysts can use raw subscale scores and cut-points of 13 and 8 to identify children with high, moderate, and low levels of behavior problems. Our results demonstrate that, for the positive social skills subscale, the subscale’s psychometric properties only support a single cut-point of 13 that identifies children with low levels of positive social skills. Our study highlights the iterative, empirically-based process that cut-point development should follow and shows the value of modern test theory-based psychometric methods to inform this process.     

Low rates of anti-recipient isohemagglutinins in ABO incompatible hematopoietic stem cell transplants

IntroductionIsohemagglutinins occur naturally and form in an 'opposite' (antigen-negative) pattern to a patient’s ABO blood type. Patients undergoing minor and bidirectional ABO incompatible hematopoietic stem cell transplantation (HSCT) may demonstrate detectable antibodies against their native blood type. In this study, we sought to characterize the rates of such antibody formation and evaluate the clinical significance of our findings.Materials and MethodsAn internal database of HSCT patients at an academic medical center was queried for ABO incompatible transplant patients from 2009-2019. Serum typing results, clinical histories, and laboratory data were compiled and reviewed.ResultsA total of 182 minor and bidirectional ABO incompatible HSCT patients were identified. Anti-recipient isohemagglutinins were found in 9% (16/182) of the HSCT patients. The rate was higher in patients with minor incompatibility (12%: 15/127) versus bidirectional ABO incompatibility (2%: 1/55) (p = 0.04). No anti-recipient isohemagglutinins were identified in umbilical cord HSCT patients (0%: 0/7). Serologic agglutination reactions of recipient isohemagglutinins were overall mostly weak (13/16 weak + to 1+). There was a trend towards a higher rate of acute graft-versus-host-disease in patients with anti-recipient isohemagglutinins compared to those without (75% vs. 53%; p = 0.12), though not statistically significant. Rates of alloimmunization to minor red cell antigens were similar between the two groups. Few patients showed laboratory evidence of hemolysis at 12 months follow up.Discussion and conclusionsAnti-recipient isohemagglutinins occur at low rates in ABO incompatible HSCT and are significantly more common in minor ABO incompatible transplant compared to bidirectional transplants. Larger cohort studies are needed to better understand the relationship between anti-recipient isohemagglutinins and HSCT outcomes.     

Development of 18 novel polymorphic microsatellite markers for the mysid crustacean Mesopodopsis orientalis

Conservation Genetics Resources - We have developed microsatellite DNA markers for Mesopodopsis orientalis (Tattersall 1908), a widely distributed mysid crustacean in shallow waters of the coastal...