bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac events and cardiac T2* in Egyptian children and young adults with β-thalassemia major taking deferoxamine
Authors: Elalfy Mohsen S. , Abdin Iman A. , El Safy Usama R. , Ibrahim Ahmed S. , Ebeid Fatma S. , Salem Doria S.
Published: July 2014

BACKGROUND AND OBJECTIVES:

Cardiac events and death are not uncommon in adults with β-thalassemia (β-TM) taking deferoxamine (DFO) monotherapy because of poor compliance and possibly the less effectiveness of DFO in controlling cardiac iron overload. We sought to assess compliance with DFO, the percentage of shift to other iron chelators, and the occurrence of cardiac siderosis, and cardiac events and death in β-TM patients on DFO monotherapy.

DESIGN AND SETTING:

Prospective, observational, 10-year follow-up of patients attending Ain Shams Thalassemia Unit, Cairo, Egypt.

METHODS:

For all β-TM patients aged 2-18 years attending the unit during January 1998 and taking DFO, we recorded all cardiac events (whether fatal or not) during January 2008. All patients still on DFO monotherapy and with a normal EKG and not showing symptoms or signs suggestive of heart failure (HF) were evaluated for cardiac siderosis by T2*.

RESULTS:

Of 412 patients, only 126 (31%) were still taking DFO monotherapy (only 43% of those were compliaant), 136 were taking combined DFO and deferiprone (DFP), 72 were taking DFP and 32 were taking deferasirox (DFX). Twenty-one were lost follow-up and 25 died (10 cardiac). Eight of ten cardiac deaths and 12 of 15 non-carddiac deaths were in the DFO monotherapy group. Those taking DFO monotherapy with no HF and left ventricular ejection fraction (LVEF) by T2* >56% had a median age of 19 years and 56% were males; cardiac T2* was <20 ms in 30 (22%); 10-20 ms in 20 (14.7%) and <10 ms in 10 (7.3%). LVEF ranged from 58%-76 % (median 64%). Forty percent of T2* patients <10 ms were compliant with DFO.

CONCLUSION:

Fifty-eight percent of patients on DFO monotherapy were noncompliant, but even compliance did not prevent severe cardiac siderosis and most cardiac events (whether fatal or not) that occurred in the DFO monotherapy group.
Cancer-related venous thromboembolism
Authors: Diab Abdurrahman I. Al
Published: July 2014

BACKGROUND:

Risk factors for cancer-associated VTE include certain cancer types (e.g. pancreatic adenocarcinoma), chemotherapy, and the use of erythropoiesis-stimulating agents, central venous catheters, and surgery. We studied the risk factors for cancer-associated VTE in our institution.

DESIGN AND SETTING:

Retrospective analysis of patients with solid cancers treated with chemotherapy at King Khalid University Hospital from 2000 to 2010.

METHODS:

We assessed risk factors responsible for VTE, including performance status, age, chemotherapy, use of erythropoietin (EPO), stage of disease and use of a central venous catheter. Patients with other co-morbidities such as diabetes were excluded.

RESULTS:

Forty-three (14%) of 306 patients were identified as having VTE, including 111 males and 195 females with a median age of 38 years (range, 13-18 years). Thirty-nine patients had proximal deep vein thrombosis (DVT) and, 4 had pulmonary embolism with no evidence of DVT. Of the 43 patients, 40 patients had stage III or IV disease at the time of VTE diagnosis. Thirty patients were taking erythropoietin (40 000 units/ week); 25 had a hemoglobin level higher than 12 g/dL. All patients were treated with low molecular weight (LM W) heparin and maintained on LM W heparin or warfarin for minimum of 6 months.

CONCLUSION:

VTE imposes a great risk to life in cancer patients. Risk factors include age more than 40 years, advanced cancer stage, chemotherapy, use of EPO for anemia and underuse of DVT prophylaxis.
Early versus late outset of lymphoproliferative disorders post-heart and lung transplantation
Authors: Khedmat Hossein , Taheri Saeed
Published: July 2014

BACKGROUND AND OBJECTIVES:

The presentation time of post-transplantation lymphoproliferative disorders (PTLD) are not well described because of the limited number of cases occurring at each center and lack of a reliable and unequivocal classification together with the absence of multi-institutional prospective studies. We gathered information on the histopathological and clinical features and prognosis of the disease in a very large number of heart and lung transplant recipients, with data from 27 previous reports, with an emphasis of time of presentation.

DESIGN AND SETTING:

Retrospective analysis of data for individual patients from published studies, entered into a database and reanalyzed.

METHODS:

A comprehensive review of the literature by PubMed and Google scholar was performed to find all data available reports on PTLD after heart and lung transplantation.

RESULTS:

Data from 288 PTLD patients after heart or lung transplantation from 27 reports were entered into analysis. Heart and lung recipients with early-onset PTLD compared with late-onset PTLD were significantly more likely to be of the B cell type (100% vs. 89.8%, respectively; P=.05). PTLD in patients with early onset was less likely to involve the skin (P=.05) and spleen (P=.015), but more frequently complications of the respiratory tract (P=.002). Morphology of PTLD lesions was significantly different between the two groups with a priority for late-onset PTLD to represent non-Hodgkin lesions (P=.009). No difference was found between the two groups in survival (P=.237). One and five-year survival rates for early-onset PTLD patients were 65% and 46%, respectively; compared to 53% and 41%, respectively, for the late-onset PTLD.

CONCLUSION:

Due to a higher incidence of respiratory tract involvement in the early-onset PTLD patients and skin and spleen involvement in late-onset PTLD, we suggest that all heart/lung graft recipients should be evaluated for potential multiorgan disease based early or late presentation. Further multi-institutional prospective studies are needed to confirm our results.
Higher infused CD34+ cell dose and overall survival in patients undergoing in vivo T-cell depleted, but not t-cell repleted, allogeneic peripheral blood hematopoietic cell transplantation
Authors: Kanate Abraham Sebastian , Craig Michael , Cumpston Aaron , Saad Ayman , Hobbs Gerry , Leadmon Sonia , Bunner Pamela , Watkins Kathy , Bulian Deirdre , Gibson Laura , Abraham Jame , Remick Scot C. , Hamadani Mehdi
Published: July 2014

BACKGROUND AND OBJECTIVES:

Understanding the effect of cellular graft composition on allogeneic hematopoietic cell transplantation (AHCT) outcomes is an area of great interest. The objective of the study was to analyze the correlation between transplant-related outcomes and administered CD34+, CD3+, CD4+ and CD8+ cell doses in patients who had undergone peripheral blood, AHCT and received either in vivo T-cell depleted or T-cell replete allografts.

DESIGN AND SETTING:

Comparison of consecutive patients who underwent peripheral blood AHCT in our institution between January 2003 and December 2009.

PATIENTS AND METHODS:

The cohort of 149 patients was divided into two groups; non T-cell depleted (NTCD) (n=54) and T-cell depleted (TCD) (n=95). Study endpoints were overall survival (OS), progression free survival (PFS), engraftment kinetics (neutrophil and platelet recovery), incidence of acute graft versus host disease (acute GVHD), chronic GVHD, non relapse mortality (NRM) and disease relapse.

RESULTS:

Multivariate analysis showed that higher infused CD34+ cell dose improved OS (relative risk 0.58, 95% CI 0.34-0.98, P=.04), PFS (relative risk 0.59, 95% CI 0.35-1.00, P=.05) and NRM (relative risk 0.49, 95% CI 0.24-0.99, P=.048) in the TCD group. By multivariate analysis, there was no difference in engraftment, grades II-IV acute GVHD, extensive chronic GVHD and relapse in the two groups relative to the infused cell doses. There was a trend towards improved OS (relative risk 0.54, 95% CI 0.29-1.01, P=.05) with higher CD3+ cell dose in the TCD group.

CONCLUSION:

Our findings suggest that higher CD34+ cell dose imparts survival benefit only to in vivo TCD peripheral blood AHCT recipients.
A population-based study of the epidemiology and clinical features of adults with acute myeloid leukemia in Algeria
Authors: Bekadja Mohamed Amine , Hamladji Rose Marie , Belhani Meriem , Ardjoun Fatima Zohra , Abad Mohand Tayeb , Touhami Hadj , Ait-Ali Hocine , Zouaoui Zahia , Sidimansour Noureddine , Hamdi Selma , Grifi Fatiha , Mesli Naima , Saidi Mahdia , Mehalhal Nemra , Bachiri Aissa , Bouhass Rachid , Said Yousuf Mohamed , Midoun Nouri
Published: July 2014

BACKGROUND AND OBJECTIVES:

In Algeria, the Incidence of hematologic malignancies has been difficult to estimate for many years. Today, many hematological centers, including 14 university hospitals, have been developed in the entire north and have useful epidemiological data pertinent to acute myeloid leukemia (AML). We studied the incidence of AML and its subtypes, age distribution, geographic distribution and trends in the rate of diagnosis over the last 5 years in Algeria. Secondary goals were to study trends of referral of AML cases from various regions to specific centers to assess the needs for health infrastructure and change of current practices.

DESIGN AND SETTING:

Retrospective analysis of nationwide survey of all adult cases of AML (>16 years) diagnosed between 1 January 2006 and 31 December 2010.

PATIENTS AND METHODS:

A survey form was distributed to all departments of hematology at the 15 participating centers.

RESULTS:

The 1426 cases of AML diagnosed during the study period represented an annual incidence of 0.91/100000 persons with a male to female (M/F) ratio of 1:16 and a median age of 45 years (range, 16-82 years). Nationally, 20% of cases AML were diagnosed in the whole western region of the country, 47% in the central and 33% in the east. There was a trend of continuous increase in the rate with age and in the rate of diagnosis over the last 5 years. The most common subtype was M2, followed by M4 and M5.

CONCLUSION:

An overall increase in the number of AML patients diagnosed nationwide over the last five years indicates a need for additional health care resources including curative and therapy-intense strategies, such as stem cell transplant facilities to optimize outcome. The relatively younger age of patients compared to the Western countries may be due to the demographic composition of our population.
An approach to finding indications and contraindications for nephrectomy in post-transplant renal graft lymphomas
Authors: Gholipour-Shoiili Aghil , Gholipour-Shoiili Hani , Taheri Saeed
Published: July 2014

BACKGROUND AND OBJECTIVES:

Allograft involvement can occur in some renal transplant recipients who develop post-transplant lymphoproliferative disorders (PTLD). We aimed to find indications and/or contraindications for nephrectomy in renal allograft PTLD based on an outcome analysis of previous reports.

DESIGN AND SETTING:

A comprehensive search of Pubmed and Google scholar was performed to find reports of different treatment strategies addressing PTLD occurring within the allograft after renal transplantation.

PATIENTS AND METHODS:

Patients who underwent nephrectomy due to kidney allograft localization by PTLD were categorized as the case group, and renal recipients with kidney PTLD for whom nonsurgical treatment modalities were used served as controls.

RESULTS:

Survival analysis demonstrated that patients with renal allograft involvement who underwent allograft nephrectomy had a significantly better outcome compared to patients for whom a non-surgical approach was used (P=.03). In patients with disseminated PTLD, nephrectomy was not useful (P>.1). Patients with simultaneous kidney and lung complications by PTLD benefitted from nephrectomy.

CONCLUSIONS:

We found that patients with renal graft complication with disseminated PTLD do not benefit from nephrectomy, which can be considered the only contraindication. However, some particular PTLD colocalizations were not as likely to adversely affect the benefit of nephrectomy in these patients, and these can be considered indications for the procedure. Future multicenter studies are needed to confirm our results.
Cyclophosphamide plus total body irradiation compared with busulfan plus cyclophosphamide as a conditioning regimen prior to hematopoietic stem cell transplantation in patients with leukemia
Authors: Gupta Tejpal , Kannan Sadhana , Dantkale Vandana , Laskar Siddharta
Published: July 2014

BACKGROUND AND OBJECTIVES:

Cyclophosphamide plus total body irradiation (CYTBI) and oral busulfan plus cyclophosphamide (BUCY) are commonly used conditioning regimens prior to allogeneic hematopoietic stem cell transplantation (HSCT) in patients with leukemia. However, there is conflicting data on the superiority of one regimen over the other. Our aim was to critically appraise and synthesize available evidence regarding the efficacy and safety of CYTBI compared to BUCY as a conditioning regimen.

DESIGN AND SETTING:

systematic review and meta-analysis of randomized, controlled trials (RCTS) comparing BUCY with CYTBI.

METHODS:

We did a systematic search of the indexed medical literature using appropriate keywords to identify potentially relevant articles. The primary outcome of interest was efficacy measured by overall survival (OS) and disease-free survival (DFS). Acute and late toxicity were secondary endpoints. Meta-analysis was attempted only on RCTs. A relative risk or risk ratio (RR) and 95% confidence interval (CI) was calculated for each outcome in the meta-analysis.

RESULTS:

Fifteen non-randomized comparative studies involving 6280 patients were included in a narrative review without attempting a pooled analysis, in view of the potential for significant bias. outcome data from seven RCTs involving 730 patients randomly assigned to either CYTBI or BUCY was pooled using meta-analytic methods. CYTBI was associated with a modest but non-significant reduction in all cause mortality (RR=0.82, 95%CI: 0.64-1.05; P=.12) and relapse of leukemia (RR=0.89, 95%CI: 0.72-1.10; P=.28). Transplant-related mortality (TRM) was significantly lesser with CYTBI compared to oral BUCY (RR-0.53, 95%CI: 0.31-0.90; P=.02). The cumulative incidence of major complications was not significantly different between the two regimens, but specific complications varied according to the conditioning regimen. TBI-based regimens were associated with more severe late effects on growth and development in children.

CONCLUSION:

Th is analysis represents the largest comparative analyses of CYTBi with BUCY as a conditioning regimen prior to HSCT in the indexed medical literature. Conditioning regimen and disease (type and setting) can significantly affect outcomes. TRM is significantly lesser with CYTBi, but this does not translate into a significant survival benefit. There remain valid concerns regarding the late effects of TBI, particularly in children. Although not overly superior, the weight of evidence favors CYTBI over BuCY as a first choice-conditioning regimen in patients with leukemia.
Evidence for the use PET for radiation therapy planning in patients with cervical cancer
Authors: Salem Ahmed , Salem Abdel-Fattah , Al-Ibraheem Akram , Lataifeh Isam , Almousa Abdelatief , Jaradat Imad
Published: July 2014

BACKGROUND AND OBJECTIVE:

In recent years, the role of positron emission tomography (PET) In the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer.

DESIGN AND SETTING:

Systematic l iterature review.

METHODS:

Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography (CT) in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review.

RESULTS:

PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered paraaortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy (IMRT) allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of “adaptive” brachytherapy in cervical cancer.

CONCLUSIONS:

Th is review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure.
Primary anaplastic large cell lymphoma of trachea with subcutaneous emphysema and progressive dyspnea
Authors: Khodadad Kian , Karimi Shirin , Arab Mehrdad , Esfahani-Monfared Zahra
Published: July 2014

Primary anaplastic large cell lymphoma of the trachea is a rare tumor. Common complaints are dyspnea and cough that could mimic a partially refractory asthma in some cases. We report a 16-year-old female with an anaplastic large cell lymphoma (null cell type) in which tracheal involvement was presented with life-threatening airway obstruction and subcutaneous emphysema. After debulking the tumor by endobronchial curettage, the patient was treated with chemotherapy followed by local radiotherapy. She had no evidence of local or distant recurrence after 25 months. Primary anaplastic large cell lymphoma of the trachea is a rare life-threatening disease. Nevertheless, this condition has a good prognosis if diagnosed immediately and treated with chemotherapy and radiotherapy.
How we assess adequacy of fine-needle aspiration materials intended for flow cytometric analysis
Authors: Brahimi Mohamed , Arabi Abdessamad , Soltan Badra Enta , Osmani Soufi , Benradouane Hanane , Bey Mohamed , Yafour Nabile , Benzineb Brahim , Attaf Fadela , Seddiki Ismaa , Rahal Siham , Bekadja Mohamed Amine
Published: July 2014

Many articles have been published on the subject of FNA, highlighting the usefulness of flow cytometry in the diagnosis and classification of lymphomas. But occasionally, flow cytometric evaluation fails to detect an abnormal population in a FNA specimen involved by lymphoid neoplasm. sampling errors (poor viability, peripheral blood contamination and hypocellular specimens) are the major reasons of this failure. In our laboratory we use a simple, fast and cost-effective approach to assess adequacy of FNA materials and in this paper, we describe this procedure with giving some examples of interpretations of our results.
Long-term survival of a patient with multiple abdominal metastasis from endometrial carcinoma treated with multi-portal conformal re-irradiation and chemotherapy
Authors: Koukourakis Michael I. , Papadopoulou Aikaterini , Kyrgias George
Published: July 2014

A patient with recurrent endometrial cancer with multiple abdominal and pelvic tumoral masses was treated with re-irradiation combined with liposomal doxorubicin and oxaliplatin. A multiple field conformal technique was used to deliver a highly accelerated and hypofractionated scheme (15 fractions of 3.5 Gy, within 19 days). Complete response was confirmed four months after therapy. Four years later a lung metastasis appeared and was again treated with a similar course of therapy, once again resulting in a complete response. It is suggested that in the era of modern image-guided radiotherapy patients with endometrial cancer who have relapsed within or outside the loco-regional area, should be carefully assessed for an eventual gross tumor eradication using high-dose localized radiotherapy, leaving as the only target of chemotherapy the microscopic undetectable disease.
Viral-associated thrombotic microangiopathies
Authors: da Silva Rodrigo Lopes
Published: July 2014

Thrombotic microangiopathies encompass a group of disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia associated with hyaline thrombi (comprised primarily of platelet aggregates in the microcirculation), and varying degrees of end-organ failure. Many primary (genetic) and secondary etiological predisposing factors have been described—namely pregnancy, autoimmune disorders, cancer, drugs and antineoplastic therapy, bone marrow transplantation/solid organ transplantation, and infections. In the setting of infectious diseases, the association with shiga or shiga-like exotoxin of Escherichia coli 0157:H7 or shigella dysenteriae type 1-induced typical hemolytic uremic syndrome is well known. Recently however, an increasing body of evidence suggests that viruses may also play an important role as trigger factors in the pathogenesis of thrombotic microangiopathies. This is a comprehensive review focusing on the current understanding of viral associated/induced endothelial stimulation and damage that ultimately leads to the development of this life-threatening multisystemic disorder.
Very late onset lymphoproliferative disorders occurring over 10 years post-renal transplantation
Authors: Khedmat Hossein , Taheri Saeed
Published: July 2014

BACKGROUND AND OBJECTIVES:

Knowledge of the significance of post-transplant lymphoproliferative disorders (PTLD) that occur “very late” or more 10 years after renal transplantation is limited. Thus, we analysed and compared characteristics and prognosis of the disease in renal transplant patients with very late onset PTLD vs. early- and late-onset PTLD.

DESIGN AND SETTING:

Retrospective study of data obtained from comprehensive search of medical literature

PATIENTS AND METHODS:

We searched for available data using the Pubmed and Google scholar search engines for reports of lymphoproliferative disorders occurring in renal transplant patients by disease presentation time.

RESULTS:

We analyzed data from 27 studies that included 303 patients with lymphoproliferative disorders after renal transplantation. Renal graft recipients with very late onset PTLD were significantly less likely to be under mycophenolate mofetil (MMF)- and/or tacrolimus (FK-506) (vs. azathioprine) -based immunosuppression (P=.035) and less likely to have a history of antibody induction immunosuppression (P<.001). Compared to “early onset” disease, “very late” onset PTLD is more likely to develop in older patients (P=.032). Survival analysis did not show any difference in outcome (P=.5). No organ involvement priority was found for this patient group (P>.1 for all).

CONCLUSIONS:

Older renal transplant patients are at increased risk for development of very late onset PTLD, and should be strictly followed. Further multi-institutional prospective studies are needed to confirm our results.
Rosai-Dorfman disease of the paranasal sinuses and orbit
Authors: Khan Afaq Ahmad , Siraj Fouzia , Rai Devinder , Aggarwal Shyam
Published: July 2014

Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a benign indolent disorder, characterized by enlarged lymph nodes filled with histiocytes. Extranodal involvement is uncommon. The disease rarely affects the nose and paranasal sinuses. We report a case that presented with a right nasal mass, extending into all the paranasal sinuses and right orbit without any accompanying lymphadenopathy. Because of the absence of lymphadenopathy it posed a diagnostic challenge until the pathology was confirmed on histopathological examination.
Post-dengue fever severe aplastic anemia
Authors: Ramzan Mohammed , PrakashYadav Satya , Sachdeva Anupam
Published: July 2014

Dengue fever has rarely been reported as an etiology for aplastic anemia. An 8-year-old girl was admitted with fever, myalgia and petechiae. Dengue virus IgM antibodies were positive. she recovered completely, but her thrombocytopenia persisted. Six weeks later she became pancytopenic. A bone marrow aspirate and biopsy showed severe aplastic anemia. She was treated with antithymocytic immunoglobulin, methylprednisolone and cyclosporine. She became transfusion independent 6 months later. Dengue-virus induced aplastic anemia is a rare entity, but it must be identified early for better outcome. immunosuppressive therapy can induce remission.
Targeting the HER2 Receptor in Metastatic Breast Cancer
Authors: Orphanos George , Kountourakis Panteleimon
Published: July 2014

The advent of targeted therapies has revolutionized the treatment of certain types of cancer. Identification of molecular targets on cancer cells has led to the design of novel drugs, which either used as single agents or in combination with chemotherapy, has prolonged survival in metastatic disease, or contributed to curative treatment in the adjuvant setting. A literature review was conducted to identify and present current knowledge on the molecular function of the HER2 receptor, its role in the pathogenesis of breast cancer and anti-HER2 targeted drugs in use or under development. Many molecular targets have been identified in breast cancer, with the HER family of receptors being the ones most extensively studied. Trastuzumab and lapatinib target the HER2 receptor and are approved drugs for the treatment of metastatic breast cancer. several other targeted agents, including T-DM1, pertuzumab, neratinib, afatinib and ertumaxomab, are currently being tested in vivo as well as in clinical studies. The use of targeted therapies in metastatic breast cancer has improved prognosis, increased survival and dramatically changed the way we treat breast cancer patients today.
Addition of amifostine to the CHOP regimen in elderly patients with aggressive non-Hodgkin lymphoma
Authors: Gómez Henry L. , Samanéz César , Campana Frank , Neciosup Silvia P. , Vera Luis , Casanova Luis , Leon Jorge , Flores Claudio , de Mendoza Fernando Hurtado , Casteñeda Carlos A. , Pinto Joseph A. , Vallejos Carlos S.
Published: July 2014

BACKGROUND AND OBJECTIVES:

We report the 8-year follow-up of 34 patients aged ≥ 69 years old with NHL included in a phase llb open-label randomized parallel groups study to evaluate the effectiveness of amifostine in preventing the toxicity of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP regime).

PATIENTS AND METHODS:

Patients were randomized to receive classical CHOP (cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 1.4 mg/m2 [maximum 2 mg] on day 1 and prednisone 100 mg/day for 5 days) or CHOP plus amifostine (6 cycles of amifostine 910 mg/m2 on day 1). Efficacy (time to progression, TTP; disease-free survival, DFS; overall survival, OS) and toxicity endpoints were evaluated.

RESULTS:

Thirty-four patients were randomized to A-CHOP (n=18) or CHOP (n=16). Patients with A-CHOP vs CHOP had significantly lower toxicity; neutropenia grade 4 ocurred in 13/92 (13%) vs 23/85 (27%, P=0.007) cycles, febrile neutropenia in 3/92 A-CHOP (3%) vs 8/85 (10%, P=.056) CHOP cycles, hospitalization for toxicity in 4/92 (4%) A-CHOP vs 11/85 (13%, P=.05) CHOP cycles. Median hospitalization stay for toxicity was 5 days with A-CHOP vs 8 days with CHOP (P=.05). There were no significant differences at 8 years in TTP (A-CHOP, 48.9% vs chop, 36.3%; P=.65), dfs (A-CHOP, 72.9% vs chop 55.6%; P=.50) and OS (A-CHOP, 44.3% vs CHOP, 54.4%). There was no long-term toxicity of clinical interest. The only prognostic factor identified to 8 years was the international Prognostic index (IPI low/low intermediate risk vs high intermediate/high risk; HR=2.98; CI 95%:1.01-8.77; P=.048).

CONCLUSION:

These results show that amifostine can be added to the standard CHOP treatment schedule with less acute toxicity and without influencing the outcome.
The effect of low altitude on blood count parameters
Authors: Al-Sweedan Suleimman A , Alhaj Moath
Published: July 2014

BACKGROUND AND OBJECTIVES:

High altitude has an effect on blood count parameters, but low altitude (especially below sea level) has not been studied.

DESIGN AND SETTING:

A cross-sectional study of aymptomatic subjects aged between 18 to 35 years of age who had reported to the blood bank at the King Abdullah university Hospital (KAUH/Irbid and Ministry of Health, Jordan, during the period between January 2010 to June 2011 for blood donation.

METHODS:

Hematological values were compared in healthy adult blood donors living in areas 200 to 300 meters below sea level and areas 500 to 1500 meters above sea level. The study population consisted of 800 females and 666 males aged between 18 to 35 years.

RESULTS:

The mean values for hemoglobin level, mean corpuscular volume and leukocyte counts were significantly higher in people living above sea level than in people living below sea level (P<.0001), whereas platelet count and red cell distribution width were significantly higher in people living below sea level than in people living above sea level (P<.0001).

CONCLUSION:

We found a significant difference in hematological parameters in healthy adults living above and below sea level. The hematological values presented here are from a large, representative population sample and the first report of people living below sea level.
Allogeneic stem cell transplantation for acute myeloid leukemia with del(7q) following untreated chronic lymphocytic leukemia
Authors: DeFilipp Zachariah , V. Huynh Donny , fazal Salman , Sahovic Entezam
Published: July 2014

The development of hematologic malignancy in the presence of chronic lymphocytic leukemia (CLL) is rare. We present a case of acute myeloid leukemia (AML) with del(7q) occurring in a patient with a 4-year history of untreated CLL. Application of flow cytometry and immunohistochemistry allowed for characterization of two distinct coexisting malignant cell populations. After undergoing induction and consolidation chemotherapy, the patient achieved complete remission of AML with the persistence of CLL. Allogeneic transplantation was pursued given his unfavorable cytogenetics. Subsequent matched unrelated donor allogeneic stem cell transplantation resulted in full engraftment and complete remission, with no evidence of AML or CLL. Due to a scarcity of reported cases, insight into treatment and prognosis in cases of concurrent AML and CLL is limited. However, prognosis seems dependent on the chemosen-sitivity of AML. CLL did not have a detrimental effect on treatment or transplant outcome in our case. This is the first reported case of concomitant de novo AML and CLL to undergo allogeneic transplantation. The patient remained in complete hematologic and cytogenetic remission of both malignancies over a year after transplantation.
Lymphoproliferative disorders in pediatric liver allograft recipients
Authors: Khedmat Hossein , Taheri Saeed
Published: July 2014

BACKGROUND AND OBJECTIVES:

Due to the limited incidence of posttransplant lymphoproliferative disorders (PTLD) in pediatric liver graft recipients, there is a scarcity of data on the characteristics of the disease in this population. We aimed to analyze the special features and behavior of PTLD arising after pediatric liver transplantation.

DESIGN:

A comprehensive search of the literature was conducted for the available data on PTLD in pediatric liver recipients pediatric PTLD through a search of Pubmed and Google scholar using appropriate terms.

METHODS:

We sought data on liver recipients younger than 18 years of age at the time of transplantation. From 51 reports, 43 fulfilled the inclusion criteria. overall 250 cases of PTLD (212 pediatric PTLD) were found from 43 reports. Data on pediatric patients was compared to adults.

RESULTS:

Pediatric PTLD lesions were more likely of the polymorphic type (P=.004) and polyclonal (when age cut-off was defined at 12 years; P=.023). Remission rates, metastasis frequency and organ involvements were not different between the groups (P>.1 for all). survival analysis showed no disparity between pediatric PTLD and adult patients (P>.1); but when data was reanalyzed for patients surviving at least 4 months post diagnosis, the log rank test showed that pediatric patients have a superior outcome compared to adults (P=.045).

CONCLUSIONS:

Pediatric liver recipients developing PTLD have relatively better disease presentation and behavior than that in adults. stomach involvement was also more frequently seen in patients younger than 12 years, and should be more intensively evaluated. Future studies with a prospective approach and larger population size are needed for confirming our results.
TEM analysis of the internal structures and mineralogy of Asian dust particles and the implications for optical modeling
Authors: Jeong G. Y. , Nousiainen T.
Published: July 2014

Abstract. Mineral dust interacts with incoming/outgoing electromagnetic radiation in the atmosphere. This interaction depends on the microphysical properties of the dust particles, including size, mineral composition, external morphology, and internal structure. Ideally all of these properties should be accounted for in the remote sensing of dust, the modeling of single-scattering properties, and radiative effect assessment. There have been many reports on the microphysical characterizations of mineral dust, but no investigations of the internal structures of individual dust particles. We explored the interiors of Asian dust particles using the combined application of focused ion beam thin-slice preparation and high-resolution transmission electron microscopy. The results showed that individual dust particles consisted of numerous mineral grains, which were organized into several types of internal structure: single and polycrystalline cores of quartz, feldspars, calcite, and amphibole often with oriented clay coatings; individual clay agglomerates of nano-thin clay platelets showing preferred to random orientations common with coarser mineral inclusions; and platy coarse phyllosilicates (muscovite, biotite, and chlorite). Micron to submicron pores were scattered throughout the interior of particles. Clays in the coatings and agglomerates were dominated by nano-thin platelets of the clay minerals of illite–smectite series including illite, smectite, and their mixed layers with subordinate kaolinite and clay-sized chlorite. Submicron iron oxide grains, dominantly goethite, were distributed throughout the clay agglomerates and coatings. Unlike the common assumptions and simplifications, we found that the analyzed dust particles were irregularly shaped with birefringent, polycrystalline, and polymineralic heterogeneous compositions. Accounting for this structural and mineralogical makeup may improve the remote sensing retrieval of dust and the evaluation of radiation effects, but will also require sophisticated single-scattering modeling. In particular, the observed internal structures of dust particles such as clay coatings, preferred orientation, embedded grains in clays, and pores, have the potential to considerably impact on the light scattering by dust particles. The distribution and size of structural components with contrasting dielectric properties, such as iron oxides, should also be explicitly accounted for.
Impacts of new particle formation on aerosol cloud condensation nuclei (CCN) activity in Shanghai: case study
Authors: Leng C. , Zhang Q. , Zhang D. , Zhang H. , Xu C. , Li X. , Kong L. , Tao J. , Cheng T. , Zhang R. , Chen J. , Qiao L. , Lou S. , Wang H. , Chen C.
Published: July 2014

Abstract. New particle formation (NPF) events and their impacts on cloud condensation nuclei (CCN) were investigated using continuous measurements collected in urban Shanghai from 1 to 30 April 2012. During the campaign, NPF occurred in 8 out of the 30 days and enhanced CCN number concentration (NCCN) by a actor of 1.2–1.8, depending on supersaturation (SS). The NPF event on 3 April 2012 was chosen as an example to investigate the NPF influence on CCN activity. In this NPF event, secondary aerosols were produced continuously and increased PM2.5 mass concentration at a~rate of 4.33 μg cm−3 h−1, and the growth rate (GR) and formation rate (FR) were on average 5 nm h−1 and 0.36 cm−3 s−1, respectively. The newly formed particles grew quickly from nucleation mode (10–20 nm) into CCN size range. NCCN increased rapidly at SS of 0.4–1.0% but weakly at SS of 0.2%. Correspondingly, aerosol CCN activities (fractions of activated aerosol particles in total aerosols, NCCN / NCN) were significantly enhanced from 0.24–0.60 to 0.30–0.91 at SS of 0.2–1.0% due to the NPF. On the basis of the κ-Köhler theory, aerosol size distributions and chemical composition measured simultaneously were used to predict NCCN. There was a good agreement between the predicted and measured NCCN (R2 = 0.96, Npredicted / Nmeasured = 1.04). This study reveals that NPF exerts large impacts on aerosol particle abundance and size spectra, thus significantly promotes NCCN and aerosol CCN activity in this urban environment. The GR of NPF is the key factor controlling the newly formed particles to become CCN at all SS levels, whereas the FR is an effective factor only under high SS (e.g. 1.0%) conditions.
Comparison of continuous in-situ CO2 observations at Jungfraujoch using two different measurement techniques
Authors: Schibig M. F. , Steinbacher M. , Buchmann B. , van der Laan-Luijkx I. T. , van der Laan S. , Ranjan S. , Leuenberger M. C.
Published: July 2014

Abstract. Since 2004, atmospheric carbon dioxide (CO2) is measured at the High Altitude Research Station Jungfraujoch by the division of Climate and Environmental Physics at the University of Bern (KUP) using a nondispersive infrared gas analyzer (NDIR) in combination with a paramagnetic O2 analyzer. In January 2010, CO2 measurements based on cavity ring down spectroscopy (CRDS) as part of the Swiss National Air Pollution Monitoring Network have been added by the Swiss Federal Laboratories for Materials Science and Technology (Empa). To ensure a smooth transition – a prerequisite when merging two datasets e.g. for trend determinations – the two measurement systems run in parallel for several years. Such a long-term intercomparison also allows identifying potential offsets between the two datasets and getting information about the compatibility of the two systems on different time scales. A good agreement of the seasonality as well as for the short-term variations was observed and to a lesser extent for trend calculations mainly due to the short common period. However, the comparison revealed some issues related to the stability of the calibration gases of the KUP system and their assigned CO2 mole fraction. It was possible to adapt an improved calibration strategy based on standard gas determinations, which lead to better agreement between the two data sets. By excluding periods with technical problems and bad calibration gas cylinders, the average hourly difference (CRDS − NDIR) of the two systems is −0.03 ppm ± 0.25 ppm. Although the difference of the two datasets is in line with the compatibility goal of ±0.1 ppm of the World Meteorological Organization (WMO), the standard deviation is still too high. A significant part of this uncertainty originates from the necessity to switch the KUP system frequently (every 12 min) for 6 min from ambient air to a working gas in order to correct short-term variations of the O2 measurement system. Allowing additionally for signal stabilization after switching the sample, an effective data coverage of only 1/6 for the KUP system is achieved while the Empa system has a nearly complete data coverage. Additionally, different internal volumes and flow rates between the two systems may affect observed differences.
Radiation sensitivity tests of the HARMONIE 37h1 NWP model
Authors: Nielsen K. P. , Gleeson E. , Rontu L.
Published: July 2014

Abstract. When short-wave (SW) radiation fluxes modelled with a numerical weather prediction (NWP) model or climate model do not match observed SW fluxes it can be challenging to find the cause of the differences. Several elements in the model affect SW fluxes. This necessitates individual testing of each of the physical processes in the NWP model. Here we present a focused study of the SW radiation schemes in the HIRLAM (HIgh Resolution Limited Area Model) Aladin Regional Mesoscale Operational NWP In Europe (HARMONIE) model, which is the primary NWP model used and developed by several National Weather Services in Europe. Detailed calculations have been made with the DISORT model run in the libRadtran framework, which is a collection of state-of-the-art radiative transfer software and data sets. These are used to test the NWP radiation calculations. Both models are given the same atmospheric properties as input. We also perform a separate test of cloud liquid optical property parameterisations with Mie calculations. This leads us to introduce a new parameterisation for calculating these properties. In addition, we show that the results of a simpler radiation scheme, introduced into HARMONIE, compare well with those of the comprehensive default parameterisations. The methodology applied here may be used for testing radiation schemes in other NWP or climate models.
Data assimilation experiments using the diffusive back and forth nudging for the NEMO ocean model
Authors: Ruggiero G. A. , Ourmières Y. , Cosme E. , Blum J. , Auroux D. , Verron J.
Published: July 2014

Abstract. The Diffusive Back and Forth Nudging (DBFN) is an easy-to-implement iterative data assimilation method based on the well-known Nudging method. It consists in a sequence of forward and backward model integrations, within a given time window, both of them using a feedback term to the observations. Therefore in the DBFN, the Nudging asymptotic behavior is translated into an infinite number of iterations within a bounded time domain. In this method, the backward integration is carried out thanks to what is called backward model, which is basically the forward model with reversed time step sign. To maintain numeral stability the diffusion terms also have their sign reversed, giving a diffusive character to the algorithm. In this article the DBFN performance to control a primitive equation ocean model is investigated. In this kind of model non-resolved scales are modeled by diffusion operators which dissipate energy that cascade from large to small scales. Thus, in this article the DBFN approximations and their consequences on the data assimilation system set-up are analyzed. Our main result is that the DBFN may provide results which are comparable to those produced by a 4Dvar implementation with a much simpler implementation and a shorter CPU time for convergence.
Ice-dynamic projections of the Greenland ice sheet in response to atmospheric and oceanic warming
Authors: Fürst J. J. , Goelzer H. , Huybrechts P.
Published: July 2014

Abstract. Continuing global warming will have a strong impact on the Greenland ice sheet in the coming centuries. During the last decade, both increased surface melting and enhanced ice discharge from calving glaciers have contributed 0.6 ± 0.1 mm yr−1 to global sea-level rise, roughly in shares of respectively 60 and 40 per cent. Here we use a higher-order ice flow model, initialised to the present state, to simulate future ice volume changes driven by both atmospheric and oceanic temperature changes. For these projections, the ice flow model accounts for runoff-induced basal lubrication and ocean warming-induced discharge increase at the marine margins. For a suite of ten Atmosphere and Ocean General Circulation Models and four Representative Concentration Pathway scenarios, the projected sea-level rise lies in the range of +1.4 to +16.6 cm by the year 2100. For two low emission scenarios, the projections are conducted up to 2300. Ice loss rates are found to either abate when the warming already peaks in this century, allowing to preserve the ice sheet in a geometry close to the present-day state, or to remain at a constant level over three hundred years under moderate warming. The volume loss is predominantly caused by increased surface melting as the contribution from enhanced ice discharge decreases over time and is self-limited by thinning and retreat of the marine margin reducing the ice–ocean contact area. The effect of enhanced basal lubrication on the volume evolution is found to be negligible on centennial time scales. The presented projections show that the observed rates of volume change over the last decades cannot simply be extrapolated over the 21st century on account of a different balance of processes causing ice loss over time. The results also indicate that the largest source of uncertainty arises from the surface mass balance and the underlying climate change projections, and not from ice dynamics.
Future permafrost conditions along environmental gradients in Zackenberg, Greenland
Authors: Westermann S. , Elberling B. , Højlund Pedersen S. , Stendel M. , Hansen B. U. , Liston G. E.
Published: July 2014

Abstract. The future development of ground temperatures in permafrost areas is determined by a number of factors varying on different spatial and temporal scales. For sound projections of impacts of permafrost thaw, scaling procedures are of paramount importance. We present numerical simulations of present and future ground temperatures at 10 m resolution for a 4 km long transect across the lower Zackenberg valley in NE Greenland. The results are based on stepwise downscaling of General Circulation Model-derived future projections using observational data, snow redistribution modeling, remote sensing data and a ground thermal model. Comparison to in-situ measurements of thaw depths at two CALM sites and 10 m ground temperatures in two boreholes suggest agreement within 0.10 m for the maximum thaw depth and 1°C for annual average ground temperature. Until 2100, modeled ground temperatures at 10 m depth warm by about 5° and the active layer thickness increases by about 30%, in conjunction with a warming of average near-surface summer soil temperatures by 2°. While permafrost remains thermally stable until 2100 in most model grid cells, the thaw threshold is exceeded for a few model years and grid cells at the end of this century. The ensemble of all 10 m model grid cells highlights the significant spatial variability of the ground thermal regime which is not accessible in traditional coarse-scale modeling approaches.
RECENT ADVANCEMENTS IN RUBBER NANOCOMPOSITES
Authors: Galimberti Maurizio , Cipolletti Valeria , Musto Sara , Cioppa Serena , Peli Giulia , Mauro Marco , Gaetano Guerra , Agnelli Silvia , Theonis Riccò , Kumar Vineet
Published: July 2014

Nanocomposites were prepared via melt blending, based on organically modified clays (OC), carbon nanotubes (CNT), and graphitic nanofillers made by a few layers of graphene (nanoG). In particular, nanocomposites based on a hybrid filler system, with a nanostructured filler such as carbon black (CB), are examined. It is shown that low crystalline order in the interlayer space of a layered nanofiller (such as OC and nanoG) leads to easier delamination. Nanofillers give rise to filler networking at low concentration, particularly in the presence of CB. Hybrid filler systems lead to nanocomposites' having initial moduli that are much higher than those calculated through the sum of the initial modulus of composites containing either only CB or only the nanofiller. Nanofillers enhance the matrix modulus by a multiplication factor that depends only on the nanofiller type and content, regardless of whether the matrix is a neat or a CB-filled polymer. Furthermore, the filler–polymer interfacial area is shown to be a parameter able to correlate the mechanical behavior of both nano-CNT and nanostructured (CB) fillers. By plotting values of the composite initial modulus versus the filler–polymer interfacial area, points due to CB, CNT, and the hybrid CB-CNT system lie on the same curve.