Measuring the linear optical absorption coefficient by interferometry and the thermal lensing effect: a numerical analysis.

We report on a pump-probe thermal lensing method for measuring the linear absorption coefficient of liquids by using interferometry and numerical analysis. The method is based on interferograms generated when a localized photothermal effect is induced in the sample. The photothermal effect itself is induced by a pump beam impinging on a sample located on-axis of the probe beam, which is one of the paths of a Mach-Zehnder interferometer. A digital camera is employed as the acquisition device allowing the capture and storage of the experimental data. During the experiment, a total of three photographs are taken and stored on a personal computer, and by using an algorithm, the numerical analysis is done. Numerical analysis is subsequently used to calculate the photothermal phase difference and the normalized spatial distribution of the pump beam irradiance. Plotting the phase difference as a function of the spatial distribution of the pump beam produces a linear dependence from which the linear absorption coefficient is obtained. The sensitivity of the method (λ/1500) is validated using ethanol, methanol, and carbon disulfide.

IRF5 and IRF8 modulate the CAL-1 human plasmacytoid dendritic cell line response following TLR9 ligation.

Synthetic oligonucleotides (ODNs) containing CpG motifs stimulate human plasmacytoid dendritic cells (pDCs) to produce type-1 interferons (IFNs) and proinflammatory cytokines. Previous studies demonstrated that interferon regulatory factors (IRFs) play a central role in mediating CpG-induced pDC activation. This work explores the inverse effects of IRF5 and IRF8 (also known as IFN consensus sequence-binding protein) on CpG-dependent gene expression in the human CAL-1 pDC cell line. This cell line shares many of the phenotypic and functional properties of freshly isolated human pDCs. Results from RNA interference and microarray studies indicate that IRF5 upregulates TLR9-driven gene expression whereas IRF8 downregulates the same genes. Several findings support the conclusion that IRF8 inhibits TLR9-dependent gene expression by directly blocking the activity of IRF5. First, the inhibitory activity of IRF8 is only observed when IRF5 is present. Second, proximity ligation analysis shows that IRF8 and IRF5 colocalize within the cytoplasm of resting human pDCs and cotranslocate to the nucleus after CpG stimulation. Taken together, these findings suggest that IRF5 and IRF8, two transcription factors with opposing functions, control TLR9 signaling in human pDCs.

ß-Defensin 2 and 3 promote the uptake of self or CpG DNA, enhance IFN-α production by human plasmacytoid dendritic cells, and promote inflammation.

Alarmins are a group of structurally diverse host defense antimicrobial peptides that are important immune activators. In this article, we present a novel role for two potent alarmins, human ß-defensin 2 and 3 (HBD2 and 3), in promoting IFN-α production by human plasmacytoid dendritic cells. We demonstrate that HBD2 and 3 activate pDCs by enhancing the intracellular uptake of CpG and self DNA and promote DNA-induced IFN-α production in a TLR9-dependent manner. Both CpG and host DNA form aggregates that resemble DNA nets when combined with HBD2 and 3. Isothermal titration calorimetry studies to elucidate the nature of HBD3/CpG complexes demonstrate involvement of enthalpy-driven interactions, in addition to hydrophobic interactions, with the formation of complexes at a molar ratio of 2:1 defensin/CpG. The i.v. administration of HBD3/CpG complexes induced proinflammatory cytokines like IL-12, IFN-γ, IL-6, IFN-α, and IL-10 in serum, associated with an increased recruitment of APCs in the spleen. Subcutaneous injections of these complexes showed enhanced infiltration of inflammatory cells at the injection site, indicating a potential pathophysiological role for alarmin/DNA complexes in contributing to inflammation. Intraperitoneal immunization of HBD3/CpG complexes with OVA enhanced both cellular and humoral responses to OVA, compared with OVA/HBD3 or OVA/CPG alone, indicative of a much more potent adjuvant effect of the HBD3/CpG complexes. Thus, the ability of defensins to enhance cellular uptake of nucleic acids can lead to improved vaccine formulations by promoting their uptake by various cells, resulting in an enhanced immune response.

IRF-5 and NF-κB p50 co-regulate IFN-ß and IL-6 expression in TLR9-stimulated human plasmacytoid dendritic cells.

Synthetic oligonucleotides (ODN) expressing CpG motifs mimic the ability of bacterial DNA to trigger the innate immune system via TLR9. Plasmacytoid dendritic cells (pDCs) make a critical contribution to the ensuing immune response. This work examines the induction of antiviral (IFN-ß) and pro-inflammatory (IL-6) cytokines by CpG-stimulated human pDCs and the human CAL-1 pDC cell line. Results show that interferon regulatory factor-5 (IRF-5) and NF-κB p50 are key co-regulators of IFN-ß and IL-6 expression following TLR9-mediated activation of human pDCs. The nuclear accumulation of IRF-1 was also observed, but this was a late event that was dependant on type 1 IFN and unrelated to the initiation of gene expression. IRF-8 was identified as a novel negative regulator of gene activation in CpG-stimulated pDCs. As variants of IRF-5 and IRF-8 were recently found to correlate with susceptibility to certain autoimmune diseases, these findings are relevant to our understanding of the pharmacologic effects of "K" ODN and the role of TLR9 ligation under physiologic, pathologic, and therapeutic conditions.

Thermal lensing approach based on parabolic approximation and Mach-Zehnder interferometer.

A thermal lensing approach based on parabolic approximation and Mach-Zehnder interferometer for measuring optical absorption and thermal diffusivity coefficients in pure solvents is described in this work. The approach combines the sensitivity of both thermal lensing methods and interferometry techniques. The photothermal effect is induced by a pump laser beam generating localized changes in the refractive index of the sample, which are observed as a shift in phase of the interference pattern. Each interference pattern is recorded by means of a digital camera and stored as digital images as a function of time. The images are then numerically processed to calculate the phase shifting map for a specific time. From each phase shifting map, the experimental phase difference as a function of time is calculated giving a phase-time transient, which is fitted to a mathematical model to estimate the optical absorption and thermal diffusivity of the sample. The experimental results show that the sensitivity is approximately λ/4800 for the minimum phase difference measured.

Wnt4 induces nephronic tubules in metanephric mesenchyme by a non-canonical mechanism.

Wnt4 and ß-catenin are both required for nephrogenesis, but studies using TCF-reporter mice suggest that canonical Wnt signaling is not activated in metanephric mesenchyme (MM) during its conversion to the epithelia of the nephron. To better define the role of Wnt signaling, we treated rat metanephric mesenchymal progenitors directly with recombinant Wnt proteins. These studies revealed that Wnt4 protein, which is required for nephron formation, induces tubule formation and differentiation markers Lim1 and E-cadherin in MM cells, but does not activate a TCF reporter or up regulate expression of canonical Wnt target gene Axin-2 and has little effect on the stabilization of ß-catenin or phosphorylation of disheveled-2. Furthermore, Wnt4 causes membrane localization of ZO-1 and occludin in tight junctions. To directly examine the role of ß-catenin/TCF-dependent transcription, we developed synthetic cell-permeable analogs of ß-catenin's helix C, which is required for transcriptional activation, in efforts to specifically inhibit canonical Wnt signaling. One inhibitor blocked TCF-dependent transcription and induced degradation of ß-catenin but did not affect tubule formation and stimulated the expression of Lim1 and E-cadherin. Since a canonical mechanism appears not to be operative in tubule formation, we assessed the involvement of the non-canonical Ca(2+)-dependent pathway. Treatment of MM cells with Wnt4 induced an influx of Ca(2+) and caused phosphorylation of CaMKII. Moreover, Ionomycin, a Ca(2+)-dependent pathway activator, stimulated tubule formation. These results demonstrate that the canonical Wnt pathway is not responsible for mesenchymal-epithelial transition (MET) in nephron formation and suggest that the non-canonical calcium/Wnt pathway mediates Wnt4-induced tubulogenesis in the kidney.

Long-Term Efficacy and Safety of Brigatinib in Crizotinib-Refractory ALK+ NSCLC: Final Results of the Phase 1/2 and Randomized Phase 2 (ALTA) Trials.

Introduction: We report brigatinib long-term efficacy and safety from phase 1/2 and phase 2 (ALTA) trials in ALK-rearrangement positive (ALK+) NSCLC. Methods: The phase 1/2 study evaluated brigatinib 30 to 300 mg/d in patients with advanced malignancies. ALTA randomized patients with crizotinib-refractory ALK+ NSCLC to brigatinib 90 mg once daily (arm A) or 180 mg once daily (7-d lead-in at 90 mg; arm B). Results: In the phase 1/2 study, 79 of 137 brigatinib-treated patients had ALK+ NSCLC; 71 were crizotinib pretreated. ALTA randomized 222 patients (n = 112 in arm A; n = 110 in arm B). Median follow-up at phase 1/2 study end (≈5.6 y after last patient enrolled) was 27.7 months; at ALTA study end (≈4.4 y after last patient enrolled), 19.6 months (A) and 28.3 months (B). Among patients with ALK+ NSCLC in the phase 1/2 study, median investigator-assessed progression-free survival (PFS) was 14.5 months (95% confidence interval [CI]: 10.8-21.2); median overall survival was 47.6 months (28.6-not reached). In ALTA, median investigator-assessed PFS was 9.2 months (7.4-11.1) in arm A and 15.6 months (11.1-18.5) in arm B; median independent review committee (IRC)-assessed PFS was 9.9 (7.4-12.8) and 16.7 (11.6-21.4) months, respectively; median overall survival was 25.9 (18.2-45.8) and 40.6 (32.5-not reached) months, respectively. Median intracranial PFS for patients with any brain metastases was 12.8 (9.2-18.4) months in arm A and 18.4 (12.6-23.9) months in arm B. No new safety signals were identified versus previous analyses. Conclusions: Brigatinib exhibited sustained long-term activity and PFS with manageable safety in patients with crizotinib-refractory ALK+ NSCLC.

An array-based method to identify multivalent inhibitors.

Carbohydrate-protein interactions play a critical role in a variety of biological processes, and agonists/antagonists of these interactions are useful as biological probes and therapeutic agents. Most carbohydrate-binding proteins achieve tight binding through formation of a multivalent complex. Therefore, both ligand structure and presentation contribute to recognition. Since there are many potential combinations of structure, spacing, and orientation to consider and the optimal one cannot be predicted, high-throughput approaches for analyzing carbohydrate-protein interactions and designing inhibitors are appealing. In this report, we develop a strategy to vary neoglycoprotein density on a surface of a glycan array. This feature of presentation was combined with variations in glycan structure and glycan density to produce an array with approximately 600 combinations of glycan structure and presentation. The unique array platform allows one to distinguish between different types of multivalent complexes on the array surface. To illustrate the advantages of this format, it was used to rapidly identify multivalent probes for various lectins. The new array was first tested with several plant lectins, including concanavalin A (conA), Vicia villosa isolectin B4 (VVL-B(4)), and Ricinus communis agglutinin (RCA120). Next, it was used to rapidly identify potent multivalent inhibitors of Pseudomonas aeruginosa lectin I (PA-IL), a key protein involved in opportunistic infections of P. aeruginosa , and mouse macrophage galactose-type lectin (mMGL-2), a protein expressed on antigen presenting cells that may be useful as a vaccine targeting receptor. An advantage of the approach is that structural information about the lectin/receptor is not required to obtain a multivalent inhibitor/probe.

Effects of hapten density on the induced antibody repertoire.

Small peptides and oligosaccharides are important antigens for the development of vaccines and the production of monoclonal antibodies. Because of their small size, peptides and oligosaccharides are non-immunogenic on their own and typically must be conjugated to a larger carrier protein to elicit an immune response. Selection of a suitable carrier protein, conjugation method, and hapten density are critical for generating an optimal immune response. We used a glycan array to compare the repertoire of antibodies induced after immunizing with either low or high-density conjugates of the tumor-associated Tn antigen. At high hapten density, a broader range of antibodies was induced, and reactivity to the clustered Tn antigen was observed. In contrast, antibodies induced by the low-density conjugate had narrower reactivity and did not bind the clustered Tn antigen.

Brigatinib in Patients With Crizotinib-Refractory Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer: A Randomized, Multicenter Phase II Trial.

Purpose Most crizotinib-treated patients with anaplastic lymphoma kinase gene ( ALK)-rearranged non-small-cell lung cancer (ALK-positive NSCLC) eventually experience disease progression. We evaluated two regimens of brigatinib, an investigational next-generation ALK inhibitor, in crizotinib-refractory ALK-positive NSCLC. Patients and Methods Patients were stratified by brain metastases and best response to crizotinib. They were randomly assigned (1:1) to oral brigatinib 90 mg once daily (arm A) or 180 mg once daily with a 7-day lead-in at 90 mg (180 mg once daily [with lead-in]; arm B). Investigator-assessed confirmed objective response rate (ORR) was the primary end point. Results Of 222 patients enrolled (arm A: n = 112, 109 treated; arm B: n = 110, 110 treated), 154 (69%) had baseline brain metastases and 164 of 222 (74%) had received prior chemotherapy. With 8.0-month median follow-up, investigator-assessed confirmed ORR was 45% (97.5% CI, 34% to 56%) in arm A and 54% (97.5% CI, 43% to 65%) in arm B. Investigator-assessed median progression-free survival was 9.2 months (95% CI, 7.4 to 15.6) and 12.9 months (95% CI, 11.1 to not reached) in arms A and B, respectively. Independent review committee-assessed intracranial ORR in patients with measurable brain metastases at baseline was 42% (11 of 26 patients) in arm A and 67% (12 of 18 patients) in arm B. Common treatment-emergent adverse events were nausea (arm A/B, 33%/40%), diarrhea (arm A/B, 19%/38%), headache (arm A/B, 28%/27%), and cough (arm A/B, 18%/34%), and were mainly grades 1 to 2. A subset of pulmonary adverse events with early onset (median onset: day 2) occurred in 14 of 219 treated patients (all grades, 6%; grade ≥ 3, 3%); none occurred after escalation to 180 mg in arm B. Seven of 14 patients were successfully retreated with brigatinib. Conclusion Brigatinib yielded substantial whole-body and intracranial responses as well as robust progression-free survival; 180 mg (with lead-in) showed consistently better efficacy than 90 mg, with acceptable safety.

Wound-healing assay.

The wound-healing assay is simple, inexpensive, and one of the earliest developed methods to study directional cell migration in vitro. This method mimics cell migration during wound healing in vivo. The basic steps involve creating a "wound" in a cell monolayer, capturing the images at the beginning and at regular intervals during cell migration to close the wound, and comparing the images to quantify the migration rate of the cells. It is particularly suitable for studies on the effects of cell-matrix and cell-cell interactions on cell migration. A variation of this method that tracks the migration of individual cells in the leading edge of the wound is also described in this chapter.

Nitric oxide-releasing prodrug triggers cancer cell death through deregulation of cellular redox balance.

JS-K is a nitric oxide (NO)-releasing prodrug of the O (2)-arylated diazeniumdiolate family that has demonstrated pronounced cytotoxicity and antitumor properties in a variety of cancer models both in vitro and in vivo. The current study of the metabolic actions of JS-K was undertaken to investigate mechanisms of its cytotoxicity. Consistent with model chemical reactions, the activating step in the metabolism of JS-K in the cell is the dearylation of the diazeniumdiolate by glutathione (GSH) via a nucleophilic aromatic substitution reaction. The resulting product (CEP/NO anion) spontaneously hydrolyzes, releasing two equivalents of NO. The GSH/GSSG redox couple is considered to be the major redox buffer of the cell, helping maintain a reducing environment under basal conditions. We have quantified the effects of JS-K on cellular GSH content, and show that JS-K markedly depletes GSH, due to JS-K's rapid uptake and cascading release of NO and reactive nitrogen species. The depletion of GSH results in alterations in the redox potential of the cellular environment, initiating MAPK stress signaling pathways, and inducing apoptosis. Microarray analysis confirmed signaling gene changes at the transcriptional level and revealed alteration in the expression of several genes crucial for maintenance of cellular redox homeostasis, as well as cell proliferation and survival, including MYC. Pre-treating cells with the known GSH precursor and nucleophilic reducing agent N-acetylcysteine prevented the signaling events that lead to apoptosis. These data indicate that multiplicative depletion of the reduced glutathione pool and deregulation of intracellular redox balance are important initial steps in the mechanism of JS-K's cytotoxic action.

Aspectos diagnósticos, evolutivos y terapéuticos de la leucemia mieloide crónica / Diagnostic, evolutive and therapeutic aspects of chronic myeloid leukemia

Introducción: la leucemia mieloide crónica (LMC) es un síndrome mieloproliferativo crónico caracterizado por la presencia de una alteración citogenética en las células proliferantes, el cromosoma Filadelfia (Ph), que da lugar a la formación de un gen híbrido BCR-ABL, fundamental en la patogénesis de la enfermedad. Objetivo: describir el comportamiento de esta enfermedad en los pacientes tratados en el Instituto de Hematología e Inmunología. Métodos: se estudiaron las características de esta enfermedad en sus aspectos diagnósticos, evolutivos y terapéuticos, en los pacientes atendidos desde marzo de 1974 hasta junio de 2012. Resultados: el grupo de edad que predominó para ambos sexos fue de 30 a 39 años. El 21 por ciento de los pacientes se encontraban asintomáticos en el momento del diagnóstico. La esplenomegalia fue el signo predominante en el 64 por ciento de los pacientes. Los hallazgos iniciales más significativos del hemograma consistieron en leucocitosis, basofilia y anemia. El 81 por ciento de los casos se encontraba en fase crónica al inicio de la enfermedad. La mayoría de los pacientes debutaron con niveles de LDH elevados. Se observó el cromosoma Filadelfia en el 68 por ciento de los pacientes a quienes se les realizó estudio citogenético. El estudio del reordenamiento del gen BCR/ABL se realizó en el 70 por ciento de los casos, siendo positivo en su totalidad. La media de supervivencia en relación con el tratamiento fue mayor en los pacientes tratados con mesilato de imatinib desde el momento del diagnóstico (11.7 años). La media de supervivencia global es de 11.44 años y la mediana es de 8.18 años. Conclusiones: todos los parámetros demográficos, clínicos, de laboratorio y terapéuticos coincidieron con lo descrito en la literatura, excepto la edad de aparición de la LMC que evidenció una disminución

Introduction: Chronic myeloid leukemia (CML) is a chronic myeloproliferative syndrome characterized by the presence of a citogenetic alteration in proliferant cells, the Philadelphia chromosome (Ph), giving rise the formation of a hybrid gene BCR-ABL, with a fundamental role in the pathogenesis of the disease. Objective: To describe the clinical behavior of the illness in patients treated at the Institute of Hematology and Immunology. Methods: Characteristics according to diagnose, evolution and therapeutic aspects of the patients treated at from March 1974 to June 2012 were studied. Results: The age group that prevailed for both sexes was 30-39 years; 21 percent of the patients were asintomatic at diagnosis. Splenomegaly was the predominant sign in 64 percent of the patients. The most significant initial discoveries on blood film were leucocytosis, basophillia and anemia; at debut 81 percent of the patients were in chronic phase. Most patients debuted with high levels of LDH. Ph chromosome was observed in 68 percent of individuals with cytogenetc studies. The BCR/ABL gene was detected in every patient with molecular studies. The mean of survival in relation to treatment was higher in patients treated with imatinib mesilate at diagnosis (11.7 years). The mean of global survival was 11.44 years with the median of 8.18 years. Conclusion: All demographic, clinical, laboratory and therapeutic parameters coincided with the literature with the exception of a lower age at onset of CML

Desarrollo normal del embarazo en dos pacientes con leucemia mieloide crónica tratadas con interferón-a / Normal development of pregnancy in two patients with chronic myeloid leukemia treated with alpha-interferon

La leucemia mieloide crónica (LMC) es un trastorno clonal que generalmente se diagnostica con facilidad porque las células leucémicas en más del 95 por ciento de los pacientes presentan una anomalía citogenética característica, el cromosoma Filadelfia (Ph). El embarazo no tiene un efecto adverso sobre la enfermedad, pero esta puede comprometer potencialmente la circulación placentaria por leucoestasis, puede provocar bajo peso al nacer, nacimiento prematuro y aumento de la mortalidad. El mesilato de Imatinib se usa como terapia de primeria línea en estos pacientes pero existen numerosos reportes sobre su acción teratogénica. El interferón-á es considerado la droga de elección en el tratamiento durante el embarazo. Se describen dos pacientes con diagnóstico de LMC y embarazo tratadas con interferón-a; la primera al diagnóstico de la enfermedad y la segunda a los 3 años de tratamiento con mesilato de Imatinib, el cual suspendió un mes antes de la gestación. Los dos embarazos se desarrollaron satisfactoriamente al igual que los fetos y nacieron dos niños con buena vitalidad que actualmente están sanos y con un desarrollo psicomotor normal

Chronic myeloid leukemia (CML) is a clonal dysfunction with easy diagnosis since more than 95 percent of the leukemia cells present a citogenetic chromosome Philadelphia (Ph) anomaly. The pregnancy has no adverse effect on the illness, but the leucoestasis potentially can commit the placental circulation and cause underweight born, premature birth and the increase of mortality. The imatinib mesylate is the first line therapy for the disease but there are numerous reports about its teratogenic action. The alpha-interferon is the drug of election for treatment during pregnancy. Two patients with CML and pregnancy treated with alpha-interferon are described. The first one treated at diagnosis and the second one after 3 years of treatment with imatinib mesylate which was suspended one month before. The two pregnancies developed satisfactorily same as the fetuses and two children were born with good vitality and healthy with normal psychomotor development

Anticuerpo monoclonal humanizado itolizumab (anti-cd6) en síndromes linfoproliferativos cd 6+. Experiencia preliminar / Itolizumab humanized monoclonal antibody (anti-cd6) in patients with cd6+ lymphoproliferative disorders. Preliminary experience

Introducción: la molécula CD6 es una glicoproteína de membrana considerada un antígeno de diferenciación leucocitario. El anticuerpo monoclonal humanizado itolizumab (anti-CD6) reconoce la molécula CD6 humana en las células mononucleares periféricas malignas de pacientes con leucemia linfocítica crónica- B y en los linfocitos de lesiones cutáneas de pacientes con linfoma T cutáneo. Objetivo: exponer los resultados preliminares de tres pacientes con leucemia linfocítica crónica-B tratados con el itolizumab, con dosis de 0.8 mg/kg/dosis semanal por 12 semanas. Métodos: la evaluación de la toxicidad asociada a la administración del itolizumab se realizó según Common Terminology Criteria for Adverse Events, versión 3.0, y la evaluación del beneficio clínico se definió según los criterios de respuesta, previamente establecidos por el National Cancer Institute Work Group, en remisión completa, remisión parcial, enfermedad estable, progresión y recaída. La evaluación de la respuesta se realizó después de haber recibido 6 administraciones del itolizumab (semana 7), después de haber recibido las 12 administraciones del itolizumab (semana 13), 6 semanas después de la última dosis (semana 18) y 12 semanas después de la última dosis (semana 24). Los datos de cada paciente se recogieron en las historias clínicas. Resultados: se evaluó la seguridad de la administración del producto en pacientes con síndromes linfoproliferativos CD6+ y se obtuvieron evidencias preliminares del efecto terapéutico de dicho fármaco. Conclusiones: en el 100 por ciento de los pacientes incluidos se reportó la aparición de fiebre y escalofríos relacionados con la primera infusión. No se observaron efectos adversos serios. Todos los pacientes evaluados tuvieron al menos alguna mejoría clínica o hematológica...

CD6 molecule is a membrane glycoprotein considered a leukocyte differentiation antigen. Itolizumab, humanized monoclonal antibody (anti-CD6) recognizes the human CD6 molecule in malignant peripheral mononuclear cells of patients with B-cell chronic lymphocytic leukemia and in lymphocytes of cutaneous lesions in patients with cutaneous T- cell lymphoma. We describe preliminary results of 3 patients with B-cell chronic lymphocytic leukemia treated with itolizumab at a weekly dose of 0.8mg/kg/dose for 12 weeks. Product administration safety was evaluated in patients with CD6+ lymphoproliferative disorders and preliminary evidence of therapeutic effect of the drug was obtained. In 100 percent of the patients the onset of fever and chills associated to the first infusion were reported. No serious adverse effects were observed. All patients evaluated had at least some clinical or hematological improvement...

Síndrome de hiperviscosidad en pacientes con mieloma múltiple / Hyperviscosity syndrome in patients with multiple myeloma

Objetivos: el mieloma múltiple es una enfermedad de distribución universal. Se determinaron la frecuencia, las características y el tratamiento del síndrome de hiperviscosidad como complicación de esta enfermedad. Método: se realizó un estudio descriptivo retrospectivo que incluyó a 31 pacientes con el diagnóstico de mieloma múltiple atendidos en el servicio de adultos del Instituto de Hematología e Inmunología desde enero del 2007 a junio del 2011. Resultados: la edad media fue de 61 años con un predominio del sexo masculino y el color de la piel blanca. Los pacientes se presentaron con anemia, eritrosedimentación acelerada, hiperproteinemia, hipoalbuminemia, hipergammaglobulinemia, una infiltración media de la médula ósea por células plasmáticas de 63.2 porciento y una viscosidad sérica media de 2.93. El síndrome de hiperviscosidad se observó en 4 (12.9 porciento) pacientes. Las manifestaciones clínicas principales del síndrome de hiperviscosidad fueron los síntomas generales y los síntomas neurológicos y se presentaron con cifras de viscosidad sérica iguales o superiores a 4.5. La proteína monoclonal identificada como responsable del síndrome de hiperviscosidad fue la IgA y la viscosidad sérica fue proporcional a las concentraciones de la paraproteína (p<0.01). Conclusión: el síndrome de hiperviscosidad se presentó en los pacientes estudiados con similares características a lo reportado por otros autores. La plasmaféresis y la quimioterapia fueron los pilares del tratamiento con resultados satisfactorios

Objectives: multiple myeloma is a disease of worldwide distribution. We determined frequency, characteristics and treatment of hyperviscosity syndrome as a complication of this condition. Method: we conducted a retrospective study involving 31 patients with a diagnosis of multiple myeloma treated at the Adult Hematology Service of the Institute of Hematology and Immunology from January 2007 to June 2011. Results: mean age was 61 years with a male predominance and slight predominance in caucasians. The patients presented with anemia, high erythrosedimentation rate, hyperproteinemia, hypoalbuminemia, hypergammaglobulinemia, a median infiltration of bone marrow by plasma cells of 63.2percent and an average serum viscosity of 2.93. Hyperviscosity syndrome was observed in 4 (12.9 percent) patients. The main clinical manifestations of hyperviscosity syndrome were general symptoms and neurological symptoms and presented with serum viscosity at or above 4.5. The monoclonal protein identified as the responsible of the hyperviscosity syndrome was IgA and viscosity was proportional to the concentrations of the paraprotein (p <0.01). Conclusion: the hyperviscosity syndrome is presented in the studied patients with similar characteristics to those reported by other authors. Plasmapheresis and chemotherapy were the mainstays of treatment with satisfactory results

Caracterización clínica y de laboratorio del mieloma múltiple en el Instituto de Hematología e Inmunología / Clinical and laboratory characterization of multiple myeloma at the Institute of Hematology and Immunology

Introducción: el mieloma múltiple es una enfermedad de distribución universal, con mayor incidencia en regiones de Europa y América. Objetivos: describir las características demográficas, los parámetros clínicos y de laboratorio, la sobrevida libre de eventos y la sobrevida global, así como los factores pronósticos de los pacientes con esta enfermedad atendidos en el Instituto de Hematología e Inmunología. Método: se realizó un estudio descriptivo retrospectivo que incluyó 88 pacientes con el diagnóstico de mieloma múltiple atendidos en el Servicio de Adultos del Instituto de Hematología e Inmunología desde el año 2000 hasta el 2010. Resultados: la edad promedio fue de 60,7 años; fue más frecuente en el sexo masculino y en los pacientes con el color de la piel blanca. Los dolores óseos, la astenia y la palidez cutáneo-mucosa fueron los hallazgos principales al inicio de la enfermedad. La anemia, la eritrosedimentación acelerada, las cifras elevadas de creatinina, hipoalbuminemia e hipergammaglobulinemia fueron las manifestaciones de laboratorio más llamativas en el momento del diagnóstico. La sobrevida global fue de 5,2 años y la sobrevida libre de eventos de 3,3 años. Los pacientes que no respondieron al primer esquema de inducción tuvieron una sobrevida más corta (p < 0,01), al igual que los pacientes con una cifra inicial de hemoglobina inferior a 8 g/dL (p = 0,043) y una albúmina menor de 30 g/L (p = 0,035). Conclusión: las características del grupo de pacientes estudiados no difieren de los hallazgos realizados por otros autores

Introduction: multiple myeloma is a disease of worldwide distribution with higher incidence in regions of Europe and America. Objectives: we describe the demographic characteristics of the patients with this disease, the clinical and laboratory parameters, event-free survival and overall survival and prognostic factors. Method: a retrospective study was made which included 88 patients diagnosed with multiple myeloma treated at the Adult Service in the Institute of Hematology and Immunology from 2000 to 2010. Results: mean age was 60,7 years and the disease was more frequent in males and Caucasian patients. Bone pain, fatigue and pallor were the main findings early in the disease. Anemia, erythrocyte sedimentation rate, high levels of creatinine, hypoalbuminemia and hypergammaglobulinemia were the most striking laboratory findings at diagnosis. Overall survival was 5,2 years and the event-free survival was 3,3 years. Patients who did not respond to the first induction scheme had a shorter survival (p < 0,01), as well as patients with a baseline hemoglobin below 8 g/dL (p = 0,043) and a lower albumin 30 g/L (p = 0,035). Conclusion: the characteristics of this group of patients did not differ from the findings of other authors

Anemia drepanocítica y embarazo. Experiencia en el Instituto de Hematología e Inmunología, Cuba / Sickle cell disease and pregnancy. Experience at the Instituto de Hematologia e Inmunología, Cuba

El embarazo en la anemia drepanocítica (AD) es considerado una situación de alto riesgo por la alta incidencia de la morbimortalidad materno-fetal. En Cuba, el programa de atención integral a las embarazadas se incluye desde el nivel primario de salud y la captación se realiza antes de las 12 sem de gestación y los partos son institucionales. Todas las embarazadas con AD en La Habana son atendidas en el Instituto de Hematología e Inmunología (IHI) por un equipo multidisciplinario y los partos se realizan en el Servicio de Obstetricia del Hospital General Docente Enrique Cabrera . Desde enero del año 2000 hasta diciembre del 2009, 68 embarazadas con AD fueron atendidas por un equipo multidisciplinario. La frecuencia de las consultas fue quincenal hasta las 32 sem de la gestación y posteriormente semanal hasta la sem 36 en que fueron ingresadas; el embarazo se interrumpió en la semana 38. Las pacientes que presentaron algún evento fueron hospitalizadas y en ellas la interrupción se realizó en la semana 36 si el feto era viable. El bienestar fetal fue evaluado desde la semana 28 cada 2 semana hasta el nacimiento. No se realizaron transfusiones ni exanguinotransfusiones profilácticas y solo fueron indicadas según los criterios del equipo médico tratante; 16 pacientes recibieron transfusiones de glóbulos y la exanguinotransfusión se realizo en 4, todas en el tercer trimestre del embarazo. En 47 pacientes se realizó cesárea y siempre por indicación obstétrica; 17 recién nacidos tuvieron bajo peso pero solo uno tuvo un conteo de Apgar bajo. Ocurrieron 2 muertes fetales y una neonatal; se reportó una muerte materna

Pregnancy in women with sickle cell disease (SCD) is a high-risk situation associated with increased incidence of maternal and fetal morbidity and mortality. In Cuba, the maternal care program includes the primary level and the gestational age at booking is before the 12 week of gestation and all deliveries are institutional. All pregnant women with SCD in La Habana are attended at the Institute of Hematology and Immunology (IHI) by a multidisciplinary team and labor takes place at the obstetrics service of the General Hospital next to the IHI. From January 2000 to December 2009, 68 pregnant women with SCD were attended in labor; the frequency of the visits is every two weeks from gestational age at booking until week 32 of pregnancy and weekly until week 36 when they are hospitalized, in week 38 induction of labor is made. Patients were hospitalized upon the appearance of any event and in such cases induction of labor was made in week 36, if fetus was mature. The fetal well-being was evaluated starting from week 28 and every two weeks until childbirth. Non prophylactic blood transfusion or prophylactic exchange transfusions were indicated as this depends on the criteria of attending team; only 16 patients presented alert signs of requiring blood transfusion, 4 requiring blood exchange transfusions. All these procedures were carried out in the third trimester of pregnancy; 47 patients required caesarea indicated by the obstetrician; 17 newborns were underweight but only one with low apgar score. Two fetal deaths occurred and one new born had early neonatal death. Only one maternal death was reported

Coherent anti-stokes Raman scattering microscopy: a biological review.

Microscopic imaging of cells and tissues are generated by the interaction of light with either the sample itself or contrast agents that label the sample. Most contrast agents, however, alter the cell in order to introduce molecular labels, complicating live cell imaging. The interaction of light from multiple laser sources has given rise to microscopy, based on Raman scattering or vibrational resonance, which demonstrates selectivity to specific chemical bonds while imaging unmodified live cells. Here, we discuss the nonlinear optical technique of coherent anti-Stokes Raman scattering (CARS) microscopy, its instrumentation, and its status in live cell imaging.