Quality Improvement in an Anaesthesiology and Intensive Care Unit Through Pain Assessment and Control.

The aim of the study is to determine whether the assessment of postoperative pain and timely measures to control it improve the quality of medical care in intensive care units (ICUs). To develop an improvement model with a focus on pain assessment and control. 151 patients were included in the study, divided into two groups: a retrospective group (RG)-60 patients and a prospective group (PG)-91 patients. A multimodal approach to pain control was applied to all patients. We administered the Critical Care Pain Observational Tool (CPOT) to PG upon admission to the ICU. Visual analog scale (VAS) for pain assessment was used in all non intubated patients in 6 hours intervals. In the PG, а model for improvement was applied using a PDSA (Plan, Do, Study/ Check, Act) cycle. The following indicators have been used: process, outcome, and balancing indicators. A survey of the PG was also conducted. The developed Model of improvement increased the VAS score reporting success rate from 40 to 95%, which allowed significantly better pain control. In PG the registered CPOT score was 1.71 ± 0.73. 90% of patients in PG have an average VAS score below 5 after the improvement model, while in RG-50% of patients, which is statistically significant (P < 0.001). There was no statistically significant difference in balancing indicators between the two groups. Conclusion: The conducted survey confirmed the positive effect of the model. Quality improvement in the ICU depends on accurate assessment of postoperative pain and timely and adequate treatment.

[Prognostic factors in patients with hematological malignancies and concomitant chronic hepatitis C].

The study evaluated the impact of HCV infection on the prognosis in patients with hematological malignancies. A total of 96 patients with anti-HCV antibodies were enrolled, with the age of 37.8 (3.0-81.0) years old, 39.6% had non-Hodgkin's lymphoma. Chronic hepatitis C (CHC) was diagnosed in 46.9% patients prior to malignancy development, in 38.5% patients simultaneously with malignancy, and in 14.6% patients during malignancy treatment. Clinical and biochemical signs of HCH were mild in most of the patients, minimal liver fibrosis (F0-1 by METAVIR system) was discovered in 47.3% patients, severe fibrosis or cirrhosis (F3-4) was diagnosed in 40% of participants. Only 20 (20.8%) of patients received antiviral therapy against HCV prior to enrollment. Regression analysis demonstrated that age >55 years old, late onset of antiviral therapy, and poor nutritional status were significant predictors of death from hematological malignancy. Survey conducted among physicians of hematological oncology hospitals in Saint-Petersburg revealed gaps in knowledge on presentation and risks of HCV infection, as well as on opportunities of modern antiviral therapy.

The possibility of diagnosing intrauterine infection by the content of nitrite and non-thiolate nitroso compounds in maternal blood plasma.

The aim of the study is to develop a method for early diagnosis of intrauterine infection (IUI). A study of markers of inflammation in the venous blood of 60 pregnant women was conducted. The study was followed by a retrospective assessment of the outcomes of pregnancies and childbirth. Of these, 33 patients with a gestation period of more than 37 weeks (full-term pregnancy) and, accordingly, 27 patients from whom the blood sample was taken at a period of less than 37 weeks - patients with the threat of premature birth (PB). PB is the main factor contributing to the development of IUI. 27 patients were diagnosed with premature rupture of the membranes (PROM). Of these, 15 are with the threat of PB. 8 of them had a diagnosed IUI. In all cases of diagnosed PROM, including those with IUI, the concentration of nitrite and nontiolate nitroso compounds (NO2-+RNO) in the mother's blood plasma was 2.3±1.2 µM, while normally it does not exceed 0.1 µM (p<0.001). Regardless of the duration of pregnancy. The use of antibiotics in the case of PROM contributed to the normalization of the concentration (NO2-+RNO). Therefore, increasing of this indicator is result of bacterial infection. Indications of other markers of inflammation: the number of leukocytes in venous blood and in a smear of vaginal contents, the level of C-RB did not significantly change in both PROM and IUI (p>0.1). Since the concentration index (NO2-+RNO) increased in almost all cases of PREM, unlike all other clinical and biochemical indicators used in modern medicine, there is an obvious sense of its use for the current monitoring of the health of pregnant women. But it is still impossible to say unequivocally about the possibility of monitoring the fetal health by concentration (NO2-+RNO) in the mother's blood.

[Invasive mucormycosis affecting maxillofacial region in oncohematological patients undergoing chemotherapeutic treatment and transplantation of hematopoietic stem cells]. / Invazivnyi mukormikoz s porazheniem organov chelyustno-litsevoi oblasti u onkogematologicheskikh bol'nykh na fone khimioterapevticheskogo lecheniya i transplantatsii gemopoeticheskikh stvolovykh kletok.

The aim of the work is to attract the attention of specialists: dentists, oncologists, hematologists to thorough sanitation of the oral cavity of patients preparing for chemotherapy treatment, to transplantation of hematopoietic stem cells. Two clinical cases described in the article were observed at the R.M. Gorbacheva First Saint-Petersburg State Medical University from 2010 to 2019. They confirm the possibility of the occurrence of infectious complications with damage to the maxillofacial region caused by rare pathogens of invasive mycosis, which debuted as an odontogenic inflammatory process. The success of the treatment of Invasive Mycosis depends on early diagnosis and antimycotic therapy; active surgical tactics in relation to the affected tissues in a controlled course of the underlying disease and the restoration of effective hematopoiesis.

Contrasts between mucormycosis and aspergillosis in oncohematological patients.

In retrospective multicenter study from years 2007-2017, we evaluated 59 oncohematological patients with mucormycosis and 541 with invasive aspergillosis (IA). Mucormycosis developed more often in children and adolescents (P = .001), as well as after the emergence of graft versus host disease (P = .0001). Patients with mucormycosis had more severe neutropenia (88% vs 82%), the median duration was 30 versus 14 days (P = .0001) and lymphocytopenia (77% vs 65%), with a median duration (25 vs 14 days, P = .001) as compared to patients with IA. The lung infection was less frequent in patients with mucormycosis than in IA patients (73% vs 97%, P = .02), but more frequent was involvement of 2 or more organs (42% vs 8%, P = .001) and involvement of paranasal sinuses (15% vs 6%, P = .04). Typical clinical features of mucormycosis were localized pain syndrome (53% vs 5%, P = .0001), hemoptysis (32% vs 6%, P = .001), pleural effusion on lung CT scan (53% vs 7%, P = .003), lesions with destruction (38% vs 8%, P = .0001), and a "reverse halo" sign (17% vs 3%). The overall 12-week survival was significantly lower in patients with mucormycosis than for IA patients (49% vs 81%, P = .0001). In both groups unfavorable prognosis factors were ≥2 organs involvement (P = .0009), and concomitant bacterial or viral infection (P = .001, P = .008, respectively). In mucormycosis patients favorable prognosis factor was remission of underlying disease (P = .006).

Bifurcations of Coupled Electron-Phonon Modes in an Antiferromagnet Subjected to a Magnetic Field.

We report on a new effect caused by the electron-phonon coupling in a stoichiometric rare-earth antiferromagnetic crystal subjected to an external magnetic field, namely, the appearance of a nonzero gap in the spectrum of electronic excitations in an arbitrarily small field. The effect was registered in the low-temperature far-infrared (terahertz) reflection spectra of an easy-axis antiferromagnet PrFe_{3}(BO_{3})_{4} in magnetic fields B_{ext}∥c. Both paramagnetic and magnetically ordered phases (including a spin-flop one) were studied in magnetic fields up to 30 T, and two bifurcation points were observed. We show that the field behavior of the coupled modes can be successfully explained and modeled on the basis of the equation derived in the framework of the theory of coupled electron-phonon modes, with the same field-independent electron-phonon interaction constant |W|=14.8 cm^{-1}.

Changing the Properties of Multipotent Mesenchymal Stromal Cells by IFNγ Administration.

We studied changes in the population of human multipotent mesenchymal stromal cells activated by IFNγ. The cells were cultured under standard conditions; IFNγ was added in various concentrations for 4 h or over 2 passages. It was shown that the total cell production significantly decreased after long-term culturing with IFNγ, but 4-h exposure did not affect this parameter. After 4-h culturing, the expression levels of IDO1, CSF1, and IL-6 increased by 300, 7, and 2.4 times, respectively, and this increase persisted 1 and 2 days after removal of IFNγ from the culture medium. The expression of class I and II MHC (HLA) on cell surface practically did not change immediately after exposure to IFNγ, but during further culturing, HLA-ABC (MHC I) and HLA-DR (MHC II) expression significantly increased, which abolished the immune privilege in these cells, the property allowing clinical use of allogenic multipotent mesenchymal stromal cells. Multipotent mesenchymal stromal cells can suppress proliferation of lymphocytes. The degree of this suppression depends on individual properties of multipotent mesenchymal stromal cell donor. Treatment with IFNγ did not significantly affect the intensity of inhibition of lymphocyte proliferation by these cells.

[Laparoscopic radical cystectomy: innovations and classics].

INTRODUCTION: Radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer. To combine the advantages of minimally invasive interventions and the well-established open surgery, we attempted to reproduce as accurately as possible the technique of open radical cystectomy using a laparoscopic procedure. MATERIALS AND METHODS: The study comprised 35 patients (27 men and 8 women) with invasive bladder cancer who underwent laparoscopic radical cystectomy (LRC) between April 2013 and March 2016. The study included only patients with fully intra-corporal ileum conduits. RESULTS: The operating time averaged 378 min., the mean blood loss was 285 ml, the mean postoperative hospital stay was 12.4 days. Only 20% of patients needed postoperative opioid analgesia. Postoperative complications occurred in 11.4% of patients. The vast majority of them were successfully managed by minimally invasive methods. CONCLUSION: Laparoscopic radical cystectomy is a safe and effective treatment modality for invasive bladder cancer. However, more patients and a longer observation period are needed to recommend the method as a standard of care.

Antiferromagnetic Dichroism in a Complex Multisublattice Magnetoelectric CuB(2)O(4).

Magnetic control of the crystal chirality was announced by Saito et al. [Phys. Rev. Lett. 101, 117402 (2008)] on the ground of experiments in CuB(2)O(4). This claim has raised a sharp dispute in the literature because it seemed to contradict the fundamental symmetry principles. We settle this dispute on the basis of a high-resolution optical spectroscopy study of excitonic transitions in CuB(2)O(4). We find that a large sublattice-sensitive antiferromagnetic linear dichroism (LD) emerges at the Néel temperature T(N)=21 K and show how it could simulate a "magnetic-field control of the crystal chirality." We prove that the discovered LD is related microscopically to the magnetic Davydov splitting. This LD is highly sensitive to subtle changes in the spin subsystems, which allowed us to observe a splitting of the phase transition into an incommensurate magnetic phase into two transitions (T(1)(*)=8.5 and T(2)(*)=7.9 K) and to suggest elliptical spiral structures below T(1)(*), instead of a simple circular helix proposed earlier.

[Value of the index of transversal dislocation of the brain in neurosurgery].

The complex clinical and radiation examination was made in 135 victims with craniocerebral trauma and in 120 patients with primary tumors of the brain. All observations evaluated the index of transversal dislocation of the brain. It included derivative of volume parameter of intracranial supratentorial substratum, the value of dislocation of ventricular system and its width relatively to the septum pellucidum and at the same time the state of mind according to Glasgow coma scale. High diagnostic informativity of developed and certified index of transversal dislocation in dif- ferent intracranial pathology allowed using the index for more wide application.

Random strain effects in optical and EPR spectra of electron-nuclear excitations in CaWO4:Ho(3+) single crystals.

We study paramagnetic Ho(3+) centers in CaWO4, a promising material for applications in quantum electronics and quantum information devices. Oriented single crystals with nominal holmium concentrations 0.05, 0.5, and 1 at% were investigated at 4.2 K using EPR spectroscopy in the frequency range 37-850 GHz at temperatures 5-40 K and high-resolution optical transmission spectroscopy in the infrared and visible wave-length ranges. Along with the tetragonal Ho(3+) centers of the S4 point symmetry, four different types of low-symmetry centers were identified in the EPR spectra and their spectral parameters were determined. A well resolved hyperfine structure exhibiting holmium concentration dependent features was observed in optical spectra. Modeling of the spectra taking into account random lattice strains gave a possibility of reproducing satisfactorily the measured hyperfine structure of the EPR signals, in particular, at anticrossings of the electron-nuclear sublevels of the ground non-Kramers doublet, and the envelopes of the hyperfine structure of optical transitions. The widths of the probability distribution of random deformations related to the point lattice defects in the samples with different concentrations of the impurity Ho(3+) ions were estimated from a comparison of the simulated spectra with the experimental data.

Methanogens and methanogenesis in the rumens and ceca of lambs fed two different high-grain-content diets.

The amount and nature of dietary starch are known to influence the extent and site of feed digestion in ruminants. However, how starch degradability may affect methanogenesis and methanogens along the ruminant's digestive tract is poorly understood. This study examined the diversity and metabolic activity of methanogens in the rumen and cecum of lambs receiving wheat or corn high-grain-content diets. Methane production in vivo and ex situ was also monitored. In vivo daily methane emissions (CH(4) g/day) were 36% (P < 0.05) lower in corn-fed lambs than in wheat-fed lambs. Ex situ methane production (µmol/h) was 4-fold higher for ruminal contents than for cecal contents (P < 0.01), while methanogens were 10-fold higher in the rumen than in the cecum (mcrA copy numbers; P < 0.01). Clone library analysis indicated that Methanobrevibacter was the dominant genus in both sites. Diet induced changes at the species level, as the Methanobrevibacter millerae-M. gottschalkii-M. smithii clade represented 78% of the sequences from the rumen of wheat-fed lambs and just about 52% of the sequences from the rumen of the corn-fed lambs. Diet did not affect mcrA expression in the rumen. In the cecum, however, expression was 4-fold and 2-fold lower than in the rumen for wheat- and corn-fed lambs, respectively. Though we had no direct evidence for compensation of reduced rumen methane production with higher cecum methanogenesis, the ecology of methanogens in the cecum should be better considered.

[Invasive mucormycosis in patients with hemoblastosis in St.-Petersburg].

Thirty four patients with mucormycosis in 10 hospitals of St. Petersburg were observed in 2004-2013. The most frequent underlying diseases of mucormycosis were acute leukoses (64%). In 100% of the patients mucormycosis developed as a nosocomial infection. The risk factors, etiology, basic clinical signs and strategy in the treatment of mucormycosis were analyzed.

Review: Reducing enteric methane emissions improves energy metabolism in livestock: is the tenet right?

The production of enteric methane in the gastrointestinal tract of livestock is considered as an energy loss in the equations for estimating energy metabolism in feeding systems. Therefore, the spared energy resulting from specific inhibition of methane emissions should be re-equilibrated with other factors of the equation. And, it is commonly assumed that net energy from feeds increases, thus benefitting production functions, particularly in ruminants due to the important production of methane in the rumen. Notwithstanding, we confirm in this work that inhibition of emissions in ruminants does not transpose into consistent improvements in production. Theoretical calculations of energy flows using experimental data show that the expected improvement in net energy for production is small and difficult to detect under the prevailing, moderate inhibition of methane production (≈25%) obtained using feed additives inhibiting methanogenesis. Importantly, the calculation of energy partitioning using canonical models might not be adequate when methanogenesis is inhibited. There is a lack of information on various parameters that play a role in energy partitioning and that may be affected under provoked abatement of methane. The formula used to calculate heat production based on respiratory exchanges should be validated when methanogenesis is inhibited. Also, a better understanding is needed of the effects of inhibition on fermentation products, fermentation heat, and microbial biomass. Inhibition induces the accumulation of H2, the main substrate used to produce methane, that has no energetic value for the host, and it is not extensively used by the majority of rumen microbes. Currently, the fate of this excess of H2 and its consequences on the microbiota and the host are not well known. All this additional information will provide a better account of energy transactions in ruminants when enteric methanogenesis is inhibited. Based on the available information, it is concluded that the claim that enteric methane inhibition will translate into more feed-efficient animals is not warranted.

Evaluating the effect of phenolic compounds as hydrogen acceptors when ruminal methanogenesis is inhibited in vitro - Part 1. Dairy cows.

Some antimethanogenic feed additives for ruminants promote rumen dihydrogen (H2) accumulation potentially affecting the optimal fermentation of diets. We hypothesised that combining an H2 acceptor with a methanogenesis inhibitor can decrease rumen H2 build-up and improve the production of metabolites that can be useful for the host ruminant. We performed three in vitro incubation experiments using rumen fluid from lactating Holstein cows: Experiment 1 examined the effect of phenolic compounds (phenol, catechol, resorcinol, hydroquinone, pyrogallol, phloroglucinol, and gallic acid) at 0, 2, 4, and 6 mM on ruminal fermentation for 24 h; Experiment 2 examined the combined effect of each phenolic compound from Experiment 1 at 6 mM with two different methanogenesis inhibitors (Asparagopsis taxiformis or 2-bromoethanesulfonate (BES)) for 24 h incubation; Experiment 3 examined the effect of a selected phenolic compound, phloroglucinol, with or without BES over a longer term using sequential incubations for seven days. Results from Experiment 1 showed that phenolic compounds, independently of the dose, did not negatively affect rumen fermentation, whereas results from Experiment 2 showed that phenolic compounds did not decrease H2 accumulation or modify CH4 production when methanogenesis was decreased by up to 75% by inhibitors. In Experiment 3, after three sequential incubations, phloroglucinol combined with BES decreased H2 accumulation by 72% and further inhibited CH4 production, compared to BES alone. Interestingly, supplementation with phloroglucinol (alone or in combination with the CH4 inhibitor) decreased CH4 production by 99% and the abundance of methanogenic archaea, with just a nominal increase in H2 accumulation. Supplementation of phloroglucinol also increased total volatile fatty acid (VFA), acetate, butyrate, and total gas production, and decreased ammonia concentration. This study indicates that some phenolic compounds, particularly phloroglucinol, which are naturally found in plants, could improve VFA production, decrease H2 accumulation and synergistically decrease CH4 production in the presence of antimethanogenic compounds.

Evaluating the effect of phenolic compounds as hydrogen acceptors when ruminal methanogenesis is inhibited in vitro - Part 2. Dairy goats.

Most mitigation strategies to reduce enteric methane (CH4) production in the rumen induce an excess of rumen dihydrogen (H2) that is expelled and consequently not redirected to the synthesis of metabolites that can be utilised by the ruminant. We hypothesised that phenolic compounds can be potential H2 acceptors when added to the diet, as they can be degraded to compounds that may be beneficial for the animal, using part of the H2 available when ruminal methanogenesis is inhibited. We performed four in vitro incubation experiments using rumen inoculum from Murciano-Granadina adult goats: Experiment 1 examined the inhibitory potential of Asparagopsis taxiformis (AT) at different concentrations (0, 1, 2, 3, 4 and 5% of the substrate on a DM basis) in 24 h incubations; Experiment 2 investigated the effect of a wide range of phenolic compounds (phenol, catechol, resorcinol, hydroquinone, pyrogallol, phloroglucinol, gallic acid and formic acid) at different doses (0, 2, 4, and 6 mM) on rumen fermentation for 24 h; Experiment 3 evaluated the combined effect of each phenolic compound at 6 mM with AT at 2% DM in sequential batch cultures for 5 days; and Experiment 4 examined the dose-response effect of phloroglucinol at different concentrations (0, 6, 16, 26 and 36 mM) combined with AT in sequential batch cultures for 5 days. Results from Experiment 1 confirmed that AT at 2% DM substantially inhibited CH4 production while significantly increasing H2 accumulation and decreasing the acetate:propionate ratio. Results from Experiment 2 showed that phenolic compounds did not negatively affect rumen fermentation at any dose. In Experiment 3, each phenolic compound at 6 mM combined with AT at 2% DM inhibited CH4 production. Phloroglucinol numerically decreased H2 accumulation and significantly increased total gas production (TGP), volatile fatty acid (VFA) production and the acetate:propionate ratio. In Experiment 4, phloroglucinol at increasing doses supplemented with AT at 2% DM significantly decreased H2 accumulation and the abundances of archaea, protozoa and fungi abundances, and increased TGP, total VFA production and the acetate:propionate ratio in a dose-dependent way. In conclusion, combined treatment with AT and phloroglucinol was successful to mitigate CH4 production while preventing the accumulation of H2, leading to an increase in acetate and total VFA production and therefore an improvement in rumen fermentation in goats.

Beneficial effects of probiotics in upper respiratory tract infections and their mechanical actions to antagonize pathogens.

Probiotics are live micro-organisms with beneficial effects on human health, which have the ability to counteract infections at different locations of the body. Clinical trials have shown that probiotics can be used as preventive and therapeutic agents in upper respiratory tract infections (URTIs) and otitis. Their mechanical properties allow them to aggregate and to compete with pathogens for nutrients, space and attachment to host cells. Consequently, they can directly antagonize pathogens and thus exert beneficial effects without directly affecting the metabolism of the host. An overview of the probiotics with such traits, tested up to date in clinical trials for the prevention or treatment of URTIs and otitis, is presented in this review. Their mechanical properties in the respiratory tract as well as at other locations are also cited. Species with interesting in vitro properties towards pharyngeal cells or against common respiratory pathogens have also been included. The potential safety risks of the cited species are then discussed. This review could be of help in the screening of probiotic strains with specific mechanical properties susceptible to have positive effects in clinical trials against URTIs.

[Neurodegenerative changes in rat hippocampal areas during the pentylenetetrazole kindling development].

The development of pentylenetetrazole-induced kindling is accompanied by neurodegeneration and neuronal loss in different areas of the hippocampus. However, the data on neurodegeneration development in the dentate gyrus remain controversial. In our study that was performed on 20 Wistar male rats, it was found that the process of neuronal loss was expressed unequally along the dentate gyrus. By the end of pentylenetetrazole kindling development, degenerating cells were present in the superior and inferior blades of the dentate gyrus, whereas the neuronal density in these areas was not reduced. On the other hand, in the angle of the dentate gyrus neuronal loss was already detected at the very early stages of kindling development. These findings allow to suggest a functional heterogeneity of a population of granule cells in relation to their susceptibility to seizure-induced injury.

[The incidence of postoperative myocardial infarction and the left ventricular function in patients with type 2 diabetes mellitus after recanalization of chronic coronary occlusions].

AIM: To study the effects of intracoronary administration of the ischemic preconditioning (IP) trigger adenosine on the reduced incidence of percutaneous coronary intervention (PCI)-associated myocardial infarction (MI) and left ventricular (LV) systolic and contractile function in patients with type 2 diabetes mellitus (DM) during recanalization of chronic coronary occlusions (CCO). SUBJECTS AND METHODS: The patients were divided into 4 groups: 1) 45 patients without DM who received intracoronary placebo infusion; 2) 51 patients without DM who had 10 mg intracoronary adenosine during PCI; 3) 34 patients with type 2 DM who had intracoronary adenosine during PCI; 4) 37 with type 2 DM who received intracoronary placebo. Troponin I and the MB fraction of creatine phosphokinase were measured an hour before and 18-24 hours and 5 days after PCI. The authors estimated the incidence of PCI-associated MI according to the ESC/ACCF/AHA/WHF (2007) criteria and the time course of changes in LV ejection fraction (EF) and end-systolic volume (ESV) and end-diastolic volume, impaired LV local contractility index (ILVLCI) in 167 patients with CCO 1 day and 1 and 12 months after PCI. RESULTS: There was an improvement in myocardial systolic and contractile function after recanalization and stenting for CCO. The intracoronary adenosine groups showed significantly reduced incidence of PCI-associated MI, increased LV EF, and decreased LV ESV and ILVLCI as compared to the placebo groups. CONCLUSION: The intracoronary injection of the IP trigger adenosine is an effective and safe method to improve LV systolic and contractile function in patients with CCO and type 2 DM.

[Complex chromosome damages in patients with recurrent acute leukemias after allogeneic hematopoietic stem cell transplantations].

AIM: To study the pattern of complex chromosome damages (CCD) in acute leukemias (AL) and their place in the development of post-transplant recurrences (PTR) of AL. MATERIALS AND METHODS: Cytogenetic and partially molecular biological studies of bone marrow cells were conducted in 10 patients with PTR. Of them, 6 patients were diagnosed as having acute lymphoblastic leukemia (ALL), including T-ALL and Ph-positive ALL in 2 and 4 patients, respectively; and 4 patients had acute non-lymphoblastic leukemia (ANLL), including one case secondarily induced by previous polychemotherapy (PCT) and irradiation. The standard G-band staining technique complemented by multicolor fluorescence in situ hybridization in one of the cases was used. RESULTS: It was shown that CCD had the similar pattern in 4 patients before transplantation and in PTR, progressed in 4 more patients, was absent or unnoticed in the early stage of the disease. The other recurrent chromosomal abnormalities that are worthy of notice are as follows: a) the presence of two Ph chromosomes in the cells of two of the 4 patients with Ph+ ALL; b) the frequent involvement of chromosome pairs 9, 19, 5, and 7 into the numerical and structural rearrangements. CONCLUSION: The important feature of PTR of AL is cellular CCDs, a portion of which is clearly related to previous PCT and may be of pathogenetic value for the development of recurrences.