Validation of the grip test and human activity profile for evaluation of physical performance during the intermediate phase after allogeneic hematopoietic stem cell transplantation.

OBJECTIVES: The aims of the presented study were to validate tools evaluating physical functioning (PF) after allogeneic hematopoietic stem cell transplantation (alloHSCT) and to analyze the impact of the clinical course on PF. METHODS: Forty patients undergoing alloHSCT were enrolled in a prospective trial which included evaluation of muscle strength (grip test, CITEC dynamometer), endurance (2-min walk test), anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Modified Fatigue Impact Scale and Brief Fatigue Inventory), and physical activity (Human Activity Profile--HAP) before (t1) and 1 (t2) and 3 (t3) months after alloHSCT. RESULTS: At t2, all patients showed a 6 % (p = 0.02) loss of muscle strength which was higher in patients with acute graft-versus-host disease (aGVHD) (12 %). While patients without aGVHD recovered at t3, the loss of muscle strength was progressive in patients with aGVHD. The grip test results correlated with the results of detailed measurement of muscle strength by CITEC dynamometer (r = 0.4-0.8, p = 0.05-0.001). Moreover, the HAP scores correlated with physical performance. CONCLUSION: The results demonstrate that loss of PF occurs during the first month followed by a regain during the subsequent 2 months in the absence of aGVHD. The HAP and the grip test may serve as surrogate marker for the strength loss in the course of aGVHD.

Perforation of the superior vena cava - a rare complication of central venous catheters.

BACKGROUND: Central venous catheters (CVC) guarantee a reliable venous access and are an indispensable part of the therapy in patients with hematologic malignancies. On the other hand, they contribute significantly to the therapy-related morbidity in this group of patients. The most common complications are catheter-associated infections or thromboses. Here we report on the rare, but potentially life-threatening case of a vessel wall perforation by a CVC. CASE REPORT: A 29-year-old female with newly diagnosed acute lymphoblastic leukemia had a CVC inserted via the left subclavian vein. After two weeks she complained about acute chest pain. Radiology revealed right-sided pleural effusion which was due to a vena cava superior vessel wall perforation by the CVC. Chemotherapy extravasation was excluded by pleural fluid analyses. CONCLUSION: A vessel wall perforation by a CVC is a rare and often late CVC complication with usually unspecific symptoms. Especially patients with leftsided, large-bore catheters are at risk. Awareness of this complication and immediate therapy are essential. We discuss the possible mechanisms and treatment options of this rare CVC complication.

Expression of the human TPT1 gene coding for translationally controlled tumor protein (TCTP) is regulated by CREB transcription factors.

Re-evaluation of genomic and cDNA data revealed that the human TPT1 gene coding for the translationally controlled tumor protein (TCTP) consists of at least 4211 base pairs. It is transcribed into two transcripts of about 0.8 and 1.2 kb, which contain the same coding region and 5'-UTR, but differ in the length of 3'-UTRs by the use of alternative polyadenylation signals. 459 bp promoter sequences were analyzed by theoretical evaluation, reporter-gene assays, gelshift and footprinting experiments to search for transcription factor binding sites. The promoter contains two highly conserved CRE sites between -50 and -89 in close vicinity to a TATA-box at -30. Supershift assays identified CREB I and Fra II of the CREB/ATF1/AP1 family as factors interacting with the CRE/AP1 site. A 3-5-fold stimulation of TCTP synthesis by forskolin and phorbolester in T24 cells and promoter-reporter experiments using CRE-deletion constructs suggested a transcriptional control by cAMP signaling via phosphorylation dependent activation of CRE/CREB interaction.

Identification of dialysis patients with panel-reactive memory T cells before kidney transplantation using an allogeneic cell bank.

Donor-reactive cellular sensitization does not routinely suggest humoral sensitization and vice versa, but both predict poor kidney transplant outcome. Irrespective of donor reactivity, panel-reactive antibody (PRA) screening identifies patients who are at enhanced risk. Therefore, it was hypothesized that panel-reactive memory T cell reactivity (PRT) might be an additional risk assessment factor of dialysis patients who are on the transplant waiting list. IFN-gamma-enzyme-linked immunosorbent spot memory T cell frequencies were determined in 10 healthy volunteers and 41 hemodialysis patients using for stimulation an allogeneic cell bank (ACB) from 17 healthy individuals who represented the most frequent white HLA antigens. Positive responses to ACB were analogous to PRA defined as percentage of positive assays of the ACB sets. Hemodialysis patients expressed higher PRT levels compared with healthy volunteers. Five of 10 PRT++ patients were PRA negative, and only four of 10 PRA++ patients exhibited PRT reactivity, suggesting independence of humoral and cellular sensitization. Pretransplantation PRT testing of recipients might improve individual risk assessment to make individualized therapy decisions.