Differentiation between rebound thymic hyperplasia and thymic relapse after chemotherapy in pediatric Hodgkin lymphoma

Background

Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum.

Methods

After completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated.

Results

After CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth.

Conclusion

Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH.     

Hair cortisol in pregnancy interacts with maternal depressive symptoms to predict maternal disrupted interaction with her infant at 4 months

Disrupted maternal interaction in early infancy is associated with maladaptive child outcomes. Thus, identifying early risk factors for disrupted interaction is an important challenge. Research suggests that maternal depressive symptoms and maternal cortisol dysregulation are associated with disrupted maternal interaction, but both factors have rarely been considered together as independent or interactive predictors of disrupted interaction. In a sample of 51 women, hair cortisol concentrations (HCC) and depressive symptoms were assessed during pregnancy, and depressive symptoms were assessed again at 4-month postpartum. Maternal disrupted interaction was assessed during the Still-Face Paradigm at 4 months. Results indicated that HCC and depressive symptoms interacted to predict both maternal withdrawing and inappropriate/intrusive interaction. Withdrawing interaction was associated with high levels of HCC in pregnancy in the context of high depressive symptoms at 4 months; inappropriate/intrusive interaction was associated with high levels of HCC in the context of low depressive symptoms. Thus, high HCC potentiated both forms of disrupted interaction. Results raised questions about the meaning of very low reported depressive symptoms, and underscored the importance of chronic stress physiology and maternal depressed mood as risk factors for distinct forms of maternal disrupted interaction, both of which are deleterious for infant development.     

Serotonin transporter polymorphism and borderline or antisocial traits among low-income young adults

OBJECTIVES: The short allele of the serotonin transporter linked polymorphic region, 5HTTLPR has been associated with anxiety, major depressive disorder and suicidality. The impulsive self- and other-damaging behaviors seen in borderline personality disorder and antisocial personality disorder also have substantial comorbidity with depression but are associated with more severe environmental stressors. This study tested the hypothesis of an association between the short allele of the 5HTTLPR and borderline or antisocial traits in young adulthood. METHODS: The 5HTTLPR was genotyped among 96 young adults from low to moderate income families (62 adults without and 34 adults with borderline personality disorder or antisocial personality disorder traits). Traits of borderline and antisocial personality disorders were assessed with the Structured Clinical Interview for Diagnosis-Axis II. RESULTS: The number of short 5HTTLPR alleles were significantly related to incidence of borderline personality disorder or antisocial personality disorder traits and also to each set of traits independently. Male sex and quality of care in infancy were also associated with incidence of borderline personality disorder and antisocial personality disorder traits but did not account for the association with the short allele. Depressive disorders were not associated with the short allele in this sample. CONCLUSIONS: Young adults of lower socioeconomic status who carry the short 5HTTLPR allele may be especially vulnerable to developing antisocial or borderline traits by young adulthood.     

Cortisol response to interpersonal stress in young adults with borderline personality disorder: a pilot study.

Hypothalamic-pituitary-adrenal axis dysregulation after stress was found to be associated with borderline personality disorder (BPD). Nine female BPD young adults and 12 control subjects were investigated for stress reactivity and recovery after an interpersonal conflict discussion with their mothers. BPD subjects showed a delayed cortisol response after psychosocial stress.     

Protection of mice from methotrexate toxicity by ex vivo transduction using lentivirus vectors expressing drug-resistant dihydrofolate reductase

Methotrexate (MTX) dose-escalation studies were conducted in C57BL/6 mice to determine the chemoprotective effect of transplantation using bone marrow transduced with lentivirus vectors expressing a drug-resistant variant of murine dihydrofolate reductase (DHFR). Methotrexate-resistant dihydrofolate reductase [tyrosine-22 (Tyr22)DHFR] and enhanced green fluorescent protein (GFP) coding sequences were inserted into self-inactivating lentiviral vectors as part of a genetic fusion or within the context of a bicistronic expression cassette. MTX-treated animals that received Tyr22DHFR-transduced marrow recovered to normal hematocrit levels by 3 weeks post-transplant and exhibited significant GFP marking in myeloid and lymphoid lineage-derived peripheral blood mononuclear cells (PBMCs). In contrast, MTX-treated animals transplanted with control GFP-transduced marrow exhibited extremely reduced hematocrits with severe marrow hypoplasia and did not survive MTX dose escalation. To minimize cell manipulation, we treated unfractionated marrow in an overnight exposure. Transduction at a multiplicity of infection of 10 resulted in up to 11% vector-modified PBMCs in primary recipients and successful repopulation of secondary recipients with vector-marked cells. Experimental cohorts exhibited sustained proviral expression with stable GFP fluorescence intensity. These results demonstrate the effectiveness of lentivirus vectors for chemoprotection in a well developed animal model, with the potential for further preclinical development toward human application.     

Sexuality,aging, and the education of health professionals

Expansion of medical personnel's knowledge of sexuality, especially for the aged, has progressed minimally from 1950s' tendencies toward avoiding the topic or fatalism in reflecting on it. Some progress has been made from past emphases on “plumbing” and most medical schools now provide at least some course work on sexuality. A reality of inconsistent content and teaching methodology persists, however, and its product is still widely viewed by sexuality educators as inadequate. This paper reviews research on academic programs preparing medical and health professionals for dealing with issues of sexuality.     

Two Cases of Partial Hepatectomy for Malignant Melanoma

Background

While the liver is a frequent site of metastatic spread for malignant cutaneous as well as malignant ocular melanoma, isolated hepatic metastases without evidence of systemic disease is rare. Hepatic resection has been proposed as a therapeutic and potentially curative procedure in metastatic melanoma patients with isolated hepatic metastases.

Objective

To report two metastatic melanoma patients with isolated hepatic metastases treated with partial hepatectomy. In addition, the literature is reviewed and the management and efficacy of surgical excision for isolated hepatic disease in the setting of malignant melanoma is discussed.

Case Report

A 34-year-old woman with metastatic cutaneous melanoma and a 55-year-old man with metastatic ocular melanoma are presented. Both patients developed isolated hepatic metastases detected during routine surveillance following resection of their primary disease and underwent partial hepatectomy.

Conclusion

In select cases, partial hepatectomy is an efficacious and potentially curative treatment for metastatic melanoma patients with isolated hepatic metastases.