Cost Study of the PlasmaJet Surgical Device Versus Conventional Cytoreductive Surgery in Patients With Advanced-Stage Ovarian Cancer.

PURPOSE: Adjuvant use of Neutral Argon Plasma (PlasmaJet Surgical Device) during cytoreductive surgery (CRS) for advanced-stage epithelial ovarian cancer improves surgical outcomes. The aim of this study is to examine the costs of adjuvant use of the PlasmaJet during surgery compared with conventional CRS in advanced-stage epithelial ovarian cancer. MATERIALS AND METHODS: The patients were randomly assigned to surgery with or without the PlasmaJet. Analysis of the intra- and extramural health care costs was performed. Costs were divided into three categories: costs of the diagnostic phase (T1), inpatient care up to discharge including costs of surgery (T2), and outpatient care including chemotherapy until 6 weeks after the last cycle of chemotherapy (T3). RESULTS: Overall, 327 patients underwent CRS (surgery with PlasmaJet: n = 157; conventional surgery: n = 170). The mean total health costs were significantly higher for CRS with adjuvant use of PlasmaJet compared with conventional CRS (€19,414 v €18,165, P = .017). Costs are divided into costs of the diagnostic phase (€2,034 v €1,974, P = .890), costs of inpatient care (€10,956 v €9,556, P = .003), and costs of outpatient care (€6,417 v €6,628, P = .147). CONCLUSION: Mean total health care costs of the use of PlasmaJet in CRS were significantly higher than those for conventional CRS. This difference is fully explained by the additional surgery costs of the use of PlasmaJet. However, surgery with the use of the PlasmaJet leads to a significantly higher percentage of complete CRS and a halving of stomas. A cost-effectiveness analysis will be performed once survival data are available (funded by ZonMw, Trial Register NL62035.078.17).

Angular Gyrus Involvement at Encoding and Retrieval Is Associated with Durable But Less Specific Memories.

After consolidation, information belonging to a mental schema is better remembered, but such memory can be less specific when it comes to details. A neuronal mechanism consistent with this behavioral pattern could result from a dynamic interaction that entails mediation by a specific cortical network with associated hippocampal disengagement. We now report that, in male and female adult human subjects, encoding and later consolidation of a series of objects embedded in a semantic schema was associated with a buildup of activity in the angular gyrus (AG) that predicted memory 24 h later. In parallel, the posterior hippocampus became less involved as schema objects were encoded successively. Hippocampal disengagement was related to an increase in falsely remembering objects that were not presented at encoding. During both encoding and retrieval, the AG and lateral occipital complex (LOC) became functionally connected and this interaction was beneficial for successful retrieval. Therefore, a network including the AG and LOC enhances the overnight retention of schema-related memories and their simultaneous detachment from the hippocampus reduces the specificity of the memory.SIGNIFICANCE STATEMENT This study provides the first empirical evidence on how the hippocampus and the neocortex interact dynamically when acquiring and then effectively retaining durable knowledge that is associated to preexisting knowledge, but they do so at the cost of memory specificity. This interaction is a fundamental mnemonic operation that has thus far been largely overlooked in memory research.

Transient medial prefrontal perturbation reduces false memory formation.

Knowledge extracted across previous experiences, or schemas, benefit encoding and retention of congruent information. However, they can also reduce specificity and augment memory for semantically related, but false information. A demonstration of the latter is given by the Deese-Roediger-McDermott (DRM) paradigm, where the studying of words that fit a common semantic schema are found to induce false memories for words that are congruent with the given schema, but were not studied. The medial prefrontal cortex (mPFC) has been ascribed the function of leveraging prior knowledge to influence encoding and retrieval, based on imaging and patient studies. Here, we used transcranial magnetic stimulation (TMS) to transiently perturb ongoing mPFC processing immediately before participants performed the DRM-task. We observed the predicted reduction in false recall of critical lures after mPFC perturbation, compared to two control groups, whereas veridical recall and recognition memory performance remained similar across groups. These data provide initial causal evidence for a role of the mPFC in biasing the assimilation of new memories and their consolidation as a function of prior knowledge.

Schematic memory components converge within angular gyrus during retrieval.

Mental schemas form associative knowledge structures that can promote the encoding and consolidation of new and related information. Schemas are facilitated by a distributed system that stores components separately, presumably in the form of inter-connected neocortical representations. During retrieval, these components need to be recombined into one representation, but where exactly such recombination takes place is unclear. Thus, we asked where different schema components are neuronally represented and converge during retrieval. Subjects acquired and retrieved two well-controlled, rule-based schema structures during fMRI on consecutive days. Schema retrieval was associated with midline, medial-temporal, and parietal processing. We identified the multi-voxel representations of different schema components, which converged within the angular gyrus during retrieval. Critically, convergence only happened after 24-hour-consolidation and during a transfer test where schema material was applied to novel but related trials. Therefore, the angular gyrus appears to recombine consolidated schema components into one memory representation.

Identification of genes transcriptionally responsive to the loss of MLL fusions in MLL-rearranged acute lymphoblastic leukemia.

INTRODUCTION: MLL-rearranged acute lymphoblastic leukemia (ALL) in infants (<1 year) is characterized by high relapse rates and a dismal prognosis. To facilitate the discovery of novel therapeutic targets, we here searched for genes directly influenced by the repression of various MLL fusions. METHODS: For this, we performed gene expression profiling after siRNA-mediated repression of MLL-AF4, MLL-ENL, and AF4-MLL in MLL-rearranged ALL cell line models. The obtained results were compared with various already established gene signatures including those consisting of known MLL-AF4 target genes, or those associated with primary MLL-rearranged infant ALL samples. RESULTS: Genes that were down-regulated in response to the repression of MLL-AF4 and MLL-ENL appeared characteristically expressed in primary MLL-rearranged infant ALL samples, and often represented known MLL-AF4 targets genes. Genes that were up-regulated in response to the repression of MLL-AF4 and MLL-ENL often represented genes typically silenced by promoter hypermethylation in MLL-rearranged infant ALL. Genes that were affected in response to the repression of AF4-MLL showed significant enrichment in gene expression profiles associated with AF4-MLL expressing t(4;11)+ infant ALL patient samples. CONCLUSION: We conclude that the here identified genes readily responsive to the loss of MLL fusion expression potentially represent attractive therapeutic targets and may provide additional insights in MLL-rearranged acute leukemias.

MLL fusion-driven activation of CDK6 potentiates proliferation in MLL-rearranged infant ALL.

Acute lymphoblastic leukemia in infants (< 1 year-of-age) is characterized by a high incidence of MLL rearrangements. Recently, direct targets of the MLL fusion protein have been identified. However, functional validation of the identified targets remained unacknowledged. In this study, we identify CDK6 as a direct target of the MLL fusion protein and an important player in the proliferation advantage of MLL-rearranged leukemia. CDK6 mRNA was significantly higher expressed in MLL-rearranged infant ALL patients compared with MLL wild-type ALL patients (P < 0.001). Decrease of MLL-AF4 and MLL-ENL fusion mRNA expression by siRNAs resulted in downregulation of CDK6, affirming a direct relationship between the presence of the MLL fusion and CDK6 expression. Knockdown of CDK6 itself significantly inhibited proliferation in the MLL-AF4-positive cell line SEM, whereas knockdown of the highly homologous gene CDK4 had virtually no effect on the cell cycle. Furthermore, we show in vitro sensitivity of MLL-rearranged leukemia cell lines to the CDK4/6-inhibitor PD0332991, inducing a remarkable G 1 arrest, and downregulation of its downstream targets pRB1 and EZH2. We therefore conclude that CDK6 is indeed a direct target of MLL fusion proteins, playing an important role in the proliferation advantage of MLL-rearranged ALL cells.

Task- and experience-dependent cortical selectivity to features informative for categorization.

In this study, we bridge the gap between monkey electrophysiological recordings that showed selective responses to informative features and human fMRI data that demonstrated increased and selective responses to trained objects. Human participants trained with computer-generated fish stimuli. For each participant, two features of the fish were informative for category membership and two features were uninformative. After training, participants showed higher perceptual sensitivity to the informative dimensions. An fMRI adaptation paradigm revealed that during categorization the right inferior frontal gyrus and occipitotemporal cortex were selectively responsive to the informative features. These selective cortical responses were experience dependent; they were not present for the entire trained object, but specific for those features that were informative for categorization. Responses in the inferior frontal gyrus showed category selectivity. Moreover, selectivity to the informative features correlated with performance on the categorization task during scanning. This all suggests that the frontal cortex is involved in actively categorizing objects and that it uses informative features to do so while ignoring those features that do not contribute category information. Occipitotemporal cortex also showed selectivity to the informative features during the categorization task. Interestingly, this area showed a positive correlation of performance during training and selectivity to the informative features and a negative correlation with selectivity to the uninformative features. This indicates that training enhanced sensitivity to trained items and decreased sensitivity to uninformative features. The absence of sensitivity for informative features during a color change detection task indicates that there is a strong component of task-related processing of these features.

Diagnosis and management of neonatal leukaemia.

Leukaemia in neonates (infants <1 month) is rare, whereby neonatal acute myeloid leukaemia (AML) is more frequent than neonatal acute lymphoblastic leukaemia (ALL). High mortality rates are observed, though AML has a better prognosis than ALL. Neonatal leukaemia is typically presented with hepatosplenomegaly, leukaemia cutis and/or hyperleucocytosis. Congenital infections should be ruled out before diagnosis. Rearrangement of the MLL gene is the most frequently occurring genetic aberration. Treatment includes intensive multi-agent chemotherapy, usually with age-related dose adjustments next to supportive care. Treatment intensification for ALL could be indicated in the future as the dismal prognosis is subject to high relapse rates in ALL.

Category training induces cross-modal object representations in the adult human brain.

The formation of cross-modal object representations was investigated using a novel paradigm that was previously successful in establishing unimodal visual category learning in monkeys and humans. The stimulus set consisted of six categories of bird shapes and sounds that were morphed to create different exemplars of each category. Subjects learned new cross-modal bird categories using a one-back task. Over time, the subjects became faster and more accurate in categorizing the birds. After 3 days of training, subjects were scanned while passively viewing and listening to trained and novel bird types. Stimulus blocks consisted of bird sounds only, bird pictures only, matching pictures and sounds (cross-modal congruent), and mismatching pictures and sounds (cross-modal incongruent). fMRI data showed unimodal and cross-modal training effects in the right fusiform gyrus. In addition, the left STS showed cross-modal training effects in the absence of unimodal training effects. Importantly, for both the right fusiform gyrus and the left STS, the newly formed cross-modal representation was specific for the trained categories. Learning did not generalize to incongruent combinations of learned sounds and shapes; their response did not differ from the response to novel cross-modal bird types. Moreover, responses were larger for congruent than for incongruent cross-modal bird types in the right fusiform gyrus and STS, providing further evidence that categorization training induced the formation of meaningful cross-modal object representations.

Gene expression profiling-based dissection of MLL translocated and MLL germline acute lymphoblastic leukemia in infants.

Acute lymphoblastic leukemia (ALL) in infants (< 1 year) is characterized by a poor prognosis and a high incidence of MLL translocations. Several studies demonstrated the unique gene expression profile associated with MLL-rearranged ALL, but generally small cohorts were analyzed as uniform patient groups regardless of the type of MLL translocation, whereas the analysis of translocation-negative infant ALL remained unacknowledged. Here we generated and analyzed primary infant ALL expression profiles (n = 73) typified by translocations t(4;11), t(11;19), and t(9;11), or the absence of MLL translocations. Our data show that MLL germline infant ALL specifies a gene expression pattern that is different from both MLL-rearranged infant ALL and pediatric precursor B-ALL. Moreover, we demonstrate that, apart from a fundamental signature shared by all MLL-rearranged infant ALL samples, each type of MLL translocation is associated with a translocation-specific gene expression signature. Finally, we show the existence of 2 distinct subgroups among t(4;11)-positive infant ALL cases characterized by the absence or presence of HOXA expression, and that patients lacking HOXA expression are at extreme high risk of disease relapse. These gene expression profiles should provide important novel insights in the complex biology of MLL-rearranged infant ALL and boost our progress in finding novel therapeutic solutions.

Formation of category representations in superior temporal sulcus.

The human brain contains cortical areas specialized in representing object categories. Visual experience is known to change the responses in these category-selective areas of the brain. However, little is known about how category training specifically affects cortical category selectivity. Here, we investigated the experience-dependent formation of object categories using an fMRI adaptation paradigm. Outside the scanner, subjects were trained to categorize artificial bird types into arbitrary categories (jungle birds and desert birds). After training, neuronal populations in the occipito-temporal cortex, such as the fusiform and the lateral occipital gyrus, were highly sensitive to perceptual stimulus differences. This sensitivity was not present for novel birds, indicating experience-related changes in neuronal representations. Neurons in STS showed category selectivity. A release from adaptation in STS was only observed when two birds in a pair crossed the category boundary. This dissociation could not be explained by perceptual similarities because the physical difference between birds from the same side of the category boundary and between birds from opposite sides of the category boundary was equal. Together, the occipito-temporal cortex and the STS have the properties suitable for a system that can both generalize across stimuli and discriminate between them.

Outcome of congenital acute lymphoblastic leukemia treated on the Interfant-99 protocol.

Acute lymphoblastic leukemia (ALL) diagnosed in the first month of life (congenital ALL) is very rare. Although congenital ALL is often assumed to be fatal, no studies have been published on outcome except for case reports. The present study reports the outcome of 30 patients with congenital ALL treated with the uniform Interfant-99 protocol, a hybrid regimen combining ALL treatment with elements designed for treatment of acute myeloid leukemia. Congenital ALL was characterized by a higher white blood cell count and a strong trend for higher incidence of MLL rearrangements and CD10-negative B-lineage ALL compared with older infants. Induction failure rate was 13% and not significantly different from that in older infants (7%, P = .14), but relapse rate was significantly higher in congenital ALL patients (2-year cumulative incidence [SE] was 60.0 [9.3] vs 34.2 [2.3], P < .001). Two-year event-free survival and survival of congenital ALL patients treated with this protocol was 20% (SE 9.1%). Early death in complete remission and treatment delays resulting from toxicity were not different. The survival of 17% after last follow-up, combined with a toxicity profile comparable with that in older infants, justifies treating congenital ALL with curative intent. This trial was registered at www.clinicaltrials.gov as no. NCT 00015873, and at www.controlled-trials.com as no. ISRCTN24251487.

Birds of a feather flock together: experience-driven formation of visual object categories in human ventral temporal cortex.

The present functional magnetic resonance imaging study provides direct evidence on visual object-category formation in the human brain. Although brain imaging has demonstrated object-category specific representations in the occipitotemporal cortex, the crucial question of how the brain acquires this knowledge has remained unresolved. We designed a stimulus set consisting of six highly similar bird types that can hardly be distinguished without training. All bird types were morphed with one another to create different exemplars of each category. After visual training, fMRI showed that responses in the right fusiform gyrus were larger for bird types for which a discrete category-boundary was established as compared with not-trained bird types. Importantly, compared with not-trained bird types, right fusiform responses were smaller for visually similar birds to which subjects were exposed during training but for which no category-boundary was learned. These data provide evidence for experience-induced shaping of occipitotemporal responses that are involved in category learning in the human brain.

Theta responses are involved in lexical-semantic retrieval during language processing.

Oscillatory neuronal dynamics, observed in the human electroencephalogram (EEG) during language processing, have been related to the dynamic formation of functionally coherent networks that serve the role of integrating the different sources of information needed for understanding the linguistic input. To further explore the functional role of oscillatory synchrony during language processing, we quantified event-related EEG power changes induced by the presentation of open-class (OC) words and closed-class (CC) words in a wide range of frequencies (from 1 to 30 Hz), while subjects read a short story. Word presentation induced three oscillatory components: a theta power increase (4-7 Hz), an alpha power decrease (10-12 Hz), and a beta power decrease (16-21 Hz). Whereas the alpha and beta responses showed mainly quantitative differences between the two word classes, the theta responses showed qualitative differences between OC words and CC words: A theta power increase was found over left temporal areas for OC words, but not for CC words. The left temporal theta increase may index the activation of a network involved in retrieving the lexical-semantic properties of the OC items.