T-cell form of chronic lymphocytic leukaemia: a reaffirmation of its existence

Early in the 1980s three categories of T-cell chronic lymphocytic leukaemia were recognized: CD4⁺ CD8⁻ knobby type, CD4⁻ CD8⁺ azurophilic type and CD4⁺ CD8⁻ adult T-cell leukaemia (ATL) type. Both azurophilic and ATL types were later shown to be distinctive disorders, whereas the knobby type has been largely neglected and even considered non-existent by some authors. In this report we describe two patients with leukaemia of CD3⁺ CD4⁺ CD8⁻ post-thymic T lymphocytes presenting with marked lymphocytosis, generalized lymphadenopathy and hepatosplenomegaly. We believe that CLL of post-thymic T-lymphocytes is a distinct entity, and merits a separate designation from other T-cell leukaemias.     

Risk Factors of Transfusion in Anemia of Very Low Birth Weight Infants

Purpose

Anemia of prematurity is frequent in preterm infants, for which red blood cell (RBC) transfusion remains the treatment of choice. In this study, we attempted to evaluate the characteristics and risk factors of anemia of prematurity, and suggest ways to reduce anemia and the need for multiple transfusions.

Materials and Methods

Preterm infants weighing less than 1500 g (May 2008-May 2009) were divided into two groups depending on whether they received RBC transfusions (transfusion group and non transfusion group). Hemoglobin (Hb) concentration, phlebotomy blood loss, and the amount of RBC transfusion were analyzed. Risk factors of anemia and RBC transfusions were analyzed.

Results

Fifty infants that survived were enrolled in the present study: 39 in the transfusion group and 11 in the non transfusion group. Hb concentrations gradually decreased by eight weeks. In the transfusion group, gestational age and birth weight were smaller, bronchopulmonary dysplasia and sepsis were more frequent, full feeding was delayed, parenteral nutrition and days spent in the hospital were prolonged, and phlebotomy blood loss was greater than that in the non transfusion group.

Conclusion

Anemia of prematurity was correlated with increased laboratory blood loss, decreased birth weight, prolonged parenteral nutrition, and delayed body weight gain. Accordingly, reducing laboratory phlebotomy loss and parenteral nutrition, as well as improving body weight gain, may be beneficial to infants with anemia of prematurity.     

Deregulated cellular circuits driving immunoglobulins and complement consumption associate with the severity of COVID-19 patients

SARS-CoV-2 infection causes an abrupt response by the host immune system, which is largely responsible for the outcome of COVID-19. We investigated whether the specific immune responses in the peripheral blood of 276 patients were associated with the severity and progression of COVID-19. At admission, dramatic lymphopenia of T, B, and NK cells is associated with severity. Conversely, the proportion of B cells, plasmablasts, circulating follicular helper T cells (cTfh) and CD56^–CD16⁺ NK-cells increased. Regarding humoral immunity, levels of IgM, IgA, and IgG were unaffected, but when degrees of severity were considered, IgG was lower in severe patients. Compared to healthy donors, complement C3 and C4 protein levels were higher in mild and moderate, but not in severe patients, while the activation peptide of C5 (C5a) increased from the admission in every patient, regardless of their severity. Moreover, total IgG, the IgG1 and IgG3 isotypes, and C4 decreased from day 0 to day 10 in patients who were hospitalized for more than two weeks, but not in patients who were discharged earlier. Our study provides important clues to understand the immune response observed in COVID-19 patients, associating severity with an imbalanced humoral response, and identifying new targets for therapeutic intervention.     

It takes two to talk: Longitudinal associations among infant–mother attachment,maternal attachment representations,and mother–child emotion dialogues

Research on the attachment-dialogue link has largely focused on infant–mother attachment. This study investigated longitudinal associations between infant–mother attachment and maternal attachment representations and subsequent mother–child emotion dialogues (N = 50). Maternal attachment representations were assessed using the Adult Attachment Interview when children were 3 months, infant–mother attachment was assessed using the Strange Situation Procedure at 13 months, and mother–child emotion dialogues were assessed using the Autobiographical Emotional Events Dialogue at 3.5 years. Consistent with past research, the three organized categories of infant–mother attachment relationships were associated with later mother–child emotion dialogues. Disorganized attachment relationships were associated with a lack of consistent and coherent strategy during emotion dialogues. Autonomous mothers co-constructed coherent narratives with their children; Dismissing and Preoccupied mothers created stories that were less narratively organized. Although the Unresolved category was unrelated to classifications of types of mother–child discourse, mothers’ quality of contribution to the dialogues was marginally lower compared to the quality of their children’s contributions to the emotion discussion. Secure children showed highest levels of child cooperation and exploration. Autonomous mothers displayed highest levels of maternal sensitive guidance during emotion dialogues. We provide preliminary evidence for role reversal in dialogues between Preoccupied and Unresolved mothers and their children.     

Clarifying values: an updated review

Background

Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids.

Methods

Building on the International Patient Decision Aid Standards (IPDAS) Collaboration’s 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary.

Results

Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single “best” practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect.

Conclusions

Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness.