Case report 706

In a patient with a disrupted silicone prosthesis, the presence of a swollen articulation should suggest the presence of silicone-induced reactive synovitis. Diagnosis of the entity rests on the identification of particulate matter by polarized microscopy and/or scanning electron microscopy--studies that will not be performed routinely unless the diagnosis is suggested preoperatively. The case presented is that of a 68-year-old woman in whom a silicone elastomer trapeziometacarpal prosthesis had been implanted 5 years previously. Painful swelling had ensued, and biopsy confirmed the diagnosis.     

Subunit interactions in mouse myeloma proteins with anti-galactan activity.

The interactions among the subunits of a unique set of mouse myeloma proteins having specificity for beta-D-(1,6) galactans has been studied by making homologous and heterologous recombinants of heavy and light chains. The recombinations were carried out by mixing together the desired heavy and light chains that had been separated on a Sephadex G-100 column in urea-acetic acid and renaturing the chains at near neutral pH. One homologous and six heterologous recombinants have been prepared. All the recombinants prepared possessed a four-chain native-like structure. The ligand binding activity and idiotypic specificity of the homologous recombinant were essentially indistinguishable from those of the original native protein. All the heterologous heavy-light chain combinations also led to the regeneration of functional binding sites. The affinity of the heterologous recombinants towards various galactose ligands was comparable to those of the native molecules. Furthermore, the ligand binding affinity of the recombinants was almost invariably closer to the Ka of the original protein that had a higher affinity. Idiotypic specificity of the heterologous recombinants paralleled that of the original protein that had contributed the heavy chain.     

A phase 2, randomized,double‐blind,placebo‐controlled study of siltuximab (anti‐IL‐6 mAb) and bortezomib versus bortezomib alone in patients with relapsed or refractory multiple myeloma

We compared the safety and efficacy of siltuximab (S), an anti‐interleukin‐6 chimeric monoclonal antibody, plus bortezomib (B) with placebo (plc) + B in patients with relapsed/refractory multiple myeloma in a randomized phase 2 study. Siltuximab was given by 6 mg/kg IV every 2 weeks. On progression, B was discontinued and high‐dose dexamethasone could be added to S/plc. Response and progression‐free survival (PFS) were analyzed pre‐dexamethasone by European Group for Blood and Marrow Transplantation (EBMT) criteria. For the 281 randomized patients, median PFS for S + B and plc + B was 8.0 and 7.6 months (HR 0.869, P = 0.345), overall response rate was 55 versus 47% (P = 0.213), complete response rate was 11 versus 7%, and median overall survival (OS) was 30.8 versus 36.8 months (HR 1.353, P = 0.103). Sustained suppression of C‐reactive protein, a marker reflective of inhibition of interleukin‐6 activity, was seen with S + B. Siltuximab did not affect B pharmacokinetics. Siltuximab/placebo discontinuation (75 versus 66%), grade ≥3 neutropenia (49 versus 29%), thrombocytopenia (48 versus 34%), and all‐grade infections (62 versus 49%) occurred more frequently with S + B. The addition of siltuximab to bortezomib did not appear to improve PFS or OS despite a numerical increase in response rate in patients with relapsed or refractory multiple myeloma. © 2014 Wiley Periodicals, Inc. Am. J. Hematol. 90:42–49, 2015. © 2014 Wiley Periodicals, Inc.     

BRCA1 alterations are associated with endometriosis,but BRCA2 alterations show no detectable endometriosis risk: a study in Indian population

Purpose

To investigate the role of genetic variations and expression alterations of BRCA1 and BRCA2 genes in the pathophysiology of endometriosis.

Methods

A genetic association study was conducted in 573 endometriosis cases and 490 controls of Indian origin. We genotyped 13 selected promoter SNPs of BRCA1 gene and 2 selected promoter SNPs of BRCA2 gene by PCR-sequencing analysis. In addition, to better understand genetic contributions to the pathophysiology of endometriosis, the expression pattern of BRCA1 & 2 was analyzed in the eutopic endometria of endometriosis cases and controls by western-blot and immunohistochemical analysis.

Results

Our results revealed significant association between BRCA1 rs71361504 (−/GTT) SNP and endometriosis risk in Indian women (P < 0.0001), while the remaining SNPs of both BRCA1 & 2 genes showed no difference between cases and controls. Western-blot and immunohistochemical analysis revealed significantly decreased BRCA1 expression levels in eutopic endometria of patients compared with controls (P < 0.05). Furthermore, nuclear BRCA1 was frequently lost compared with cytoplasmic BRCA1 in eutopic endometria of patients. Expression of BRCA2 did not differ between patients and controls.

Conclusions

BRCA1 rs71361504 SNP may modify the endometriosis risk in Indian women. In addition, decreased expression of BRCA1 may play an important role in the pathophysiology of endometriosis. The analysis of BRCA1 genetic variants and/or expression might help to identify patients at high risk for disease outcome.

Electronic supplementary material

The online version of this article (doi:10.1007/s10815-014-0379-9) contains supplementary material, which is available to authorized users.     

Community engagement and pediatric disaster readiness in a large urban disaster resource hospital network: the case of "The Great California ShakeOut"

We examined the response of 11 Los Angeles County (LAC) hospitals designated as Disaster Resource Centers (DRCs) to a statewide, earthquake preparedness drill, LAC's most comprehensive earthquake disaster drill to date. Semistructured interviews were conducted with the coordinators of 11 of the 14 LAC DRCs within 3 weeks of the drill. Interviews were transcribed and thematic analysis was supported by analytical software (Atlas.ti). Except for one pediatric specialty DRC, most DRCs did little to fully test their institutions' capacity to manage pediatric patients. Few DRCs included children as mock victims. Little or no attention was focused on pediatric triage and other pediatric clinical, psychosocial, and resource issues. Respondents maintained that community readiness is hampered by compartmentalizing the preparedness planning, training, and drilling. Without a mandate to coordinate with other agencies, few DRCs reported coordination with other community entities. Those that did were in smaller submunicipalities within LAC. Community coordination is critical to effective response to disasters, yet disaster preparedness planning and drills are most often uncoordinated and compartmentalized. Drills and training need to be transdisciplinary and coordinated with other community entities likely to play a role in pediatric disaster management.     

Immunoassay analysis of proteins in gingival crevicular fluid samples from resorbing teeth

Objective:To carry out an immunoassay analysis of biomarkers expressed in gingival crevicular fluid (GCF) with the main goal of finding a useful diagnostic pattern to distinguish between resorbing deciduous teeth and nonresorbing controls.Materials and Methods:A split-mouth design was used in this study with a total of 22 GCF samples collected from 11 patients in the mixed dentition. For each child, one deciduous molar with radiographic evidence of root resorption was used as the test tooth whereas the contralateral first permanent molar with formed roots was used as the control tooth. Samples were processed with immunoassays using a panel of selected biomarkers including interleukin-1 beta (IL-1b), interleukin-1 receptor antagonist (IL-1RA), nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG), matrix metalloproteinase-9 (MMP-9), and dentin sialoprotein (DSP).Results:There were no statistically significant differences in levels of IL-1b, OPG, and MMP-9 between test and control sites (P > .05). IL-1RA was the only biomarker to show a significant down-regulation (P  =  .04) in GCF samples collected from resorbing teeth. RANKL data showed a heavily skewed distribution and was deemed unreliable. Only one deciduous GCF sample had detectable levels of DSP; therefore, no further statistical calculation was applicable because of the limited amount of data for this biomarker.Conclusions:This study indicated that IL1-RA is down-regulated in GCF from resorbing primary molars, thus suggesting this cytokine as a potential analyte to be included in a panel that can discriminate between resorbing and nonresorbing teeth.