Immunoglobulin and T cell receptor gene configuration in acute lymphoblastic leukemia of infancy

We examined immunoglobulin (Ig) heavy chain, K light chain, and T cell receptor (TCR) gamma and beta gene configuration in the leukemic cells from a series of infants aged less than 1 year with acute lymphoblastic leukemia (ALL). Each of these 11 cases demonstrated leukemic cell surface antigens that have been correlated with a B cell precursor phenotype. Of the 11, lymphoblasts of 4 retained the germline configuration of both Ig and TCR loci, whereas 7 had rearranged the Ig heavy chain gene. Two of these seven showed light chain gene rearrangement. TCB beta chain rearrangement had occurred in only one of the 11 patients' tumors. No TCR gamma chain rearrangements were identified. These results are in contrast to earlier studies of B cell precursor ALL in children in which Ig heavy chain gene rearrangements were evident in every case and approximately 40% showed Ig light chain rearrangement as well. In addition, 45% of cases of B cell precursor ALL of children had rearranged their gamma TCR genes, and 20% had rearranged beta. These data suggest that ALL in infancy represents an earlier stage of B cell development than is found in B cell precursor ALL of children. ALL in the infant age group has been associated with the worst prognosis of all patients with ALL. This study suggests that the disease in infants differs not only clinically, but also at the molecular genetic level, from the disease in children.     

A study on the feasibility of delivering a psychologically informed ward-based intervention on an acute mental health ward

Acute mental health inpatient wards have been criticized for being nontherapeutic. The study aimed to test the feasibility of delivering a psychologically informed intervention in these settings. This single-arm study evaluated the feasibility of clinical psychologists delivering a ward-based psychological service model over a 6-month period on two acute mental health wards. Data were gathered to assess trial design parameters and the feasibility of gathering patient/staff outcome data. Psychologists were able to deliver key elements of the intervention. Baseline staff and patient participant recruitment targets were met. However, there was significant patient attrition at follow-up, with incorrect contact details on discharge being the primary reason. Implementation of a ward-based psychological intervention appears feasible when implemented flexibly. It is feasible to recruit staff and patient participants and to collect staff outcome measures over a 6-month period. However, greater efforts need to be taken to trace patient movement following discharge.     

Implications of Withaferin A in neurological disorders

正Extract from the medicinal herb Withania somnifera(WS),commonly known as Ashwagandha, has therapeutic implications in various conditions such as infection, inflammation, cancer, stress, neurodegenerative diseases, heart disease, diabetes, and others. Withaferin A(WA), a relatively nontoxic steroidal lactone     

Incidence and Predictors of Acute Psychological Distress and Dissociation After Motor Vehicle Collision: A Cross-Sectional Study

Objective: We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC). Method: In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics. Results: The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r = .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery. Conclusion: There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae.     

Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre

Introduction

Epidural anaesthesia (EA) has been the accepted standard for postoperative analgesia in open abdominal surgery. However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery.

Methods

A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners.

Results

The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion.

Conclusions

The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.     

TUMOUR PRESENTING AS A RETROSTERNAL ABSCESS FOLLOWING MEDIAN STERNOTOMY

A 73-year-old lady, who underwent coronary artery bypass grafting eight months previously, presented with rigors and chest pain. The upper sternum was tender, swollen and erythematous, suggesting a retrosternal abscess. Radiological investigation supported the clinical diagnosis. Local infections following median sternotomy are uncommon, most being early and superficial. Late infections are very uncommon, and should suggest alternative pathology. Following open surgical drainage, histology showed the mass to be a poorly differentiated adenocarcinoma. The primary tumour was never found.