Adolescent and young adult oncology

Cancer is the leading cause of death among the adolescent and young adult (AYA) population, excluding homicide, suicide, or unintentional injury. AYA patients should be managed by a multidisciplinary team of health care professionals who are well-versed in the specific developmental issues relevant to this patient population. The recommendations for age-appropriate care outlined in these NCCN Guidelines include psychosocial assessment, a discussion of infertility risks associated with treatment and options for fertility preservation, genetic and familial risk assessment for all patients after diagnosis, screening and monitoring of late effects in AYA cancer survivors after successful completion of therapy, and palliative care and end-of-life considerations for patients for whom curative therapy fails.     

Peripheral aberration measurements: elliptical pupil transformation and variations in horizontal coma across the visual field

Background: The aim was to determine the critical eccentricity at which two methods of elaborating peripheral wavefront measurements are significantly different and to characterise horizontal coma in healthy young adults. Methods: Peripheral aberrations were determined for 20 observers for central and eight peripheral gaze positions up to 20° using an IRX‐3 aberrometer. In one subject, additional measurements up to 40° were obtained. Two definitions of stretching coefficients were compared. The raw empirical data were compared with theoretical modelling. Results: For both 3.5 mm and 6.0 mm pupils, no significant differences were observed between recalculated and non‐recalculated elliptical pupils for both methods (p > 0.05) up to 20° eccentricity. For eccentricities greater than 20° and up to 40°, significant differences between circular and elliptical pupils at some eccentricities were apparent, which corresponded to theoretical models. Wide individual variations in horizontal coma across the peripheral field were observed. Conclusions: The data suggest that for eyes with average levels of aberrations, the elliptical transformation is of no practical importance for eccentricities up to 20°. In some cases the slope of horizontal coma was reversed compared with previous findings in normal eyes.     

Peripheral refraction and the development of refractive error: a review

It has been suggested that emmetropic and low‐hyperopic eyes in which the refractive error in the periphery of the visual field is relatively hyperopic with respect to the axial refraction may be at greater risk of developing myopia than eyes with similar refractions but relatively myopic peripheral refractive errors. The animal and human evidence to support this hypothesis is reviewed. The most persuasive studies are those in which emmetropization has been shown to occur in infant rhesus monkeys with ablated foveas but intact peripheral fields, and the demonstration that, in similar animals, lens‐induced relative peripheral hyperopia produces central axial myopia. Evidence for emmetropization in animals with severed optic nerves suggests that emmetropization is primarily controlled at the retinal level but that the higher levels of the visual system play a significant role in refining the process: there appear to be no directly equivalent human studies. Since any contribution of the higher centres to the control of refractive development must depend upon the sensitivity to defocus, the results of human studies of the changes in depth‐of‐focus across the field and of the contribution of the retinal periphery to the accommodation response are discussed. Although peripheral resolution is relatively insensitive to focus, this is not the case for detection. Moreover accommodation occurs to peripheral stimuli out to a field angle of at least 10 deg, and the presence of a peripheral stimulus can influence the accommodation to a central target. Although the basic hypothesis that a relatively hyperopic peripheral refractive error can drive the development of human myopia remains unproven, the available data support the possibility of an interaction between the states of focus on axis and in the periphery.     

Giant hanging melanoma of the eyelid skin

Cutaneous melanoma of the eyelid is a rare entity. We present a 53-year-old male who had a nevus on the left upper eyelid skin since childhood, which transformed into a huge ulcerated hanging mass in the same region. Excision of the mass was done and histopathology confirmed the diagnosis of nodular malignant melanoma. A small preauricular lymph node showed metastatic melanoma on fine needle aspiration cytology.     

High immunogenecity and erythrocyte-binding activity in the tryptophan-rich domain (TRD) of the 74-kDa Plasmodium vivax alanine-tryptophan-rich antigen (PvATRAg74)

Plasmodium vivax is the most widespread species of human malaria parasite affecting 70-80 million people worldwide each year. In recent years, some potential vaccine candidate antigens from P. vivax have been identified including tryptophan-rich antigens PvTRAg and PvTARAg55. We report here the identification and partial characterization of a 74 kDa P. vivax alanine-tryptophan-rich antigen (PvATRAg74) which is expressed by all asexual blood stages of the parasite. This protein contains two major domains, i.e. alanine-rich domain (ARD) in N-terminal region and the tryptophan-rich domain (TRD) at C-terminus. PvATRAg74 also contains variable numbers of octa-peptide repeats in the ARD region. The C-terminal PvATRAg74 containing TRD was highly conserved among 32 P. vivax isolates while N-terminal ARD showed genetic polymorphisms. The 36 kDa TRD was expressed in E. coli and named here as His6-TRD. The purified recombinant His6-TRD showed binding with uninfected human erythrocytes. This antigen was also recognized by all 38 P. vivax patients' sera on ELISA thus showing a very high seropositivity rates. In vitro stimulation of lymphocytes with purified His6-TRD indicated that it induced T cell immune response in majority (94%, n=16) of P. vivax exposed individuals. The stimulated T cells produced higher amount of IL-4 and IL-10 than IFN-gamma, TNF-alpha, and IL-12 indicating a Th2 type of response bias. Unlike PvTARAg55, this antigen is more immunogenic in humans and possesses the erythrocyte-binding activity. Immunogenecity of PvATRAg74 is similar to PvTRAg whose erythrocyte-binding activity still remains unknown.     

Rheumatic Fever in a 2-Year-Old Child

A 2-year-old boy with a history of presumed viral pharyngitis presented with rheumatic fever. The episode of pharyngitis was not treated with antibiotic at five years of age, physicians should be aware of the sequelae of untreated group A beta-hemolytic streptococcal pharyngitis.     

抗AGR2单克隆抗体18A4抑制细胞外AGR2诱导的肿瘤细胞活性

在两种自身不表达肿瘤相关蛋白AGR2的黑色素瘤细胞A375和B16-F10中加入AGR2以增强肿瘤细胞活性,观察以AGR2为靶点的单克隆抗体18A4对细胞外AGR2诱导的肿瘤细胞活性的抑制作用。用MTT法和克隆形成实验检测AGR2,18A4抗体单用和联合作用对细胞增殖能力的影响;流式细胞术检测AGR2,18A4抗体单用和联合作用对细胞周期的影响;划痕实验检测细胞迁移能力;鬼笔环肽染色检测细胞形态变化;Western blot和免疫荧光染色检测细胞内p53表达量。结果表明,单克隆抗体18A4能够抑制细胞外AGR2诱导的肿瘤细胞增殖速度加快,G₁/S细胞周期转化,迁移速度加快和细胞形态的变化。Western blot和免疫荧光染色检测发现在化疗药物阿霉素处理的细胞中,细胞外AGR2降低细胞内p53的表达量,而18A4能够抑制这一现象。实验结果表明18A4能够抑制细胞外AGR2诱导的多种肿瘤细胞活性,是一种潜在的抗肿瘤药物。