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1.
EMBO Rep ; 23(10): e54322, 2022 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-35999696

RESUMEN

The emergence of SARS-CoV-2 variants has exacerbated the COVID-19 global health crisis. Thus far, all variants carry mutations in the spike glycoprotein, which is a critical determinant of viral transmission being responsible for attachment, receptor engagement and membrane fusion, and an important target of immunity. Variants frequently bear truncations of flexible loops in the N-terminal domain (NTD) of spike; the functional importance of these modifications has remained poorly characterised. We demonstrate that NTD deletions are important for efficient entry by the Alpha and Omicron variants and that this correlates with spike stability. Phylogenetic analysis reveals extensive NTD loop length polymorphisms across the sarbecoviruses, setting an evolutionary precedent for loop remodelling. Guided by these analyses, we demonstrate that variations in NTD loop length, alone, are sufficient to modulate virus entry. We propose that variations in NTD loop length act to fine-tune spike; this may provide a mechanism for SARS-CoV-2 to navigate a complex selection landscape encompassing optimisation of essential functionality, immune-driven antigenic variation and ongoing adaptation to a new host.


Asunto(s)
COVID-19 , SARS-CoV-2 , COVID-19/genética , Humanos , Filogenia , SARS-CoV-2/genética , Glicoproteína de la Espiga del Coronavirus/genética
2.
Pediatr Dev Pathol ; 27(3): 260-265, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38098239

RESUMEN

Wilms tumor (WT) is the commonest cause of renal cancer in children. In Europe, a diagnosis is made for most cases on typical clinical and radiological findings, prior to pre-operative chemotherapy. Here, we describe a case of a young boy presenting with a large abdominal tumor, associated with raised serum alpha-fetoprotein (AFP) levels at diagnosis. Given the atypical features present, a biopsy was taken, and histology was consistent with WT, showing triphasic WT, with epithelial, stromal, and blastemal elements present, and positive WT1 and CD56 immunohistochemical staining. During pre-operative chemotherapy, serial serum AFP measurements showed further increases, despite a radiological response, before a subsequent fall to normal following nephrectomy. The resection specimen was comprised of ~55% and ~45% stromal and epithelial elements, respectively, with no anaplasia, but immunohistochemistry using AFP staining revealed positive mucinous intestinal epithelium, consistent with the serum AFP observations. The lack of correlation between tumor response and serum AFP levels in this case highlights a more general clinical unmet need to identify WT-specific circulating tumor markers.


Asunto(s)
Biomarcadores de Tumor , Neoplasias Renales , Tumor de Wilms , alfa-Fetoproteínas , Humanos , Tumor de Wilms/diagnóstico , Tumor de Wilms/patología , Tumor de Wilms/sangre , alfa-Fetoproteínas/análisis , alfa-Fetoproteínas/metabolismo , Masculino , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/análisis , Neoplasias Renales/diagnóstico , Neoplasias Renales/patología , Neoplasias Renales/sangre , Nefrectomía
3.
Br J Cancer ; 129(9): 1451-1461, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37789102

RESUMEN

BACKGROUND: MiR-371~373 and miR-302/367 cluster over-expression occurs in all malignant germ cell tumours (GCTs), regardless of age (paediatric/adult), site (gonadal/extragonadal), or subtype [seminoma, yolk sac tumour (YST), embryonal carcinoma (EC)]. Six of eight microRNAs from these clusters contain the seed sequence 'AAGUGC', determining mRNA targeting. Here we sought to identify the significance of these observations by targeting these microRNAs functionally. METHODS: We targeted miR-371~373 and/or miR-302/367 clusters in malignant GCT cell lines, using CRISPR-Cas9, gapmer primary miR-302/367 transcript inhibition, and peptide nucleic acid (PNA) or locked nucleic acid (LNA)-DNA inhibition targeting miR-302a-d-3p, and undertook relevant functional assays. RESULTS: MiR-302/367 cluster microRNAs made the largest contribution to AAGUGC seed abundance in malignant GCT cells, regardless of subtype (seminoma/YST/EC). Following the unsuccessful use of CRISPR-Cas9, gapmer, and PNA systems, LNA-DNA-based targeting resulted in growth inhibition in seminoma and YST cells. This was associated with the de-repression of multiple mRNAs targeted by AAGUGC seed-containing microRNAs, with pathway analysis confirming predominant disruption of Rho-GTPase signalling, vesicle organisation/transport, and cell cycle regulation, findings corroborated in clinical samples. Further LNA-DNA inhibitor studies confirmed direct cell cycle effects, with an increase of cells in G0/G1-phase and a decrease in S-phase. CONCLUSION: Targeting of specific miR-371~373 and miR-302/367 microRNAs in malignant GCTs demonstrated their functional significance, with growth inhibition mediated through cell cycle disruption.


Asunto(s)
MicroARNs , Neoplasias de Células Germinales y Embrionarias , Seminoma , Neoplasias Testiculares , Masculino , Adulto , Humanos , Niño , MicroARNs/genética , Seminoma/genética , Neoplasias Testiculares/patología , Ciclo Celular , ADN
4.
Br J Haematol ; 202(5): 985-994, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37357529

RESUMEN

Anaplastic large-cell lymphoma (ALCL) is a T-cell malignancy predominantly driven by the oncogenic anaplastic lymphoma kinase (ALK), accounting for approximately 15% of all paediatric non-Hodgkin lymphoma. Patients with central nervous system (CNS) relapse are particularly difficult to treat with a 3-year overall survival of 49% and a median survival of 23.5 months. The second-generation ALK inhibitor brigatinib shows superior penetration of the blood-brain barrier unlike the first-generation drug crizotinib and has shown promising results in ALK+ non-small-cell lung cancer. However, the benefits of brigatinib in treating aggressive paediatric ALK+ ALCL are largely unknown. We established a patient-derived xenograft (PDX) resource from ALK+ ALCL patients at or before CNS relapse serving as models to facilitate the development of future therapies. We show in vivo that brigatinib is effective in inducing the remission of PDX models of crizotinib-resistant (ALK C1156Y, TP53 loss) ALCL and furthermore that it is superior to crizotinib as a second-line approach to the treatment of a standard chemotherapy relapsed/refractory ALCL PDX pointing to brigatinib as a future therapeutic option.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Linfoma Anaplásico de Células Grandes , Niño , Humanos , Quinasa de Linfoma Anaplásico , Crizotinib/farmacología , Crizotinib/uso terapéutico , Proteínas Tirosina Quinasas Receptoras/uso terapéutico , Linfoma Anaplásico de Células Grandes/tratamiento farmacológico , Linfoma Anaplásico de Células Grandes/patología , Xenoinjertos , Neoplasias Pulmonares/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Compuestos Organofosforados/farmacología , Compuestos Organofosforados/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico
5.
Opt Express ; 31(1): 287-300, 2023 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-36606967

RESUMEN

We present a distributed fiber sensor capable of discriminating between temperature and strain while performing low-noise, dynamic measurements. This was achieved by leveraging recent advances in Brillouin and Rayleigh based fiber sensors. In particular, we designed a hybrid sensor that combines a slope-assisted Brillouin optical time domain analysis system with a Rayleigh-scattering-based frequency scanning optical time domain reflectometry system. These sub-systems combine state-of-the-art sensitivity with the ability to perform both dynamic and quasi-static measurements. This enabled a hybrid system capable of temperature/strain discrimination with a quasi-static temperature resolution of 16 m°C and a strain resolution of 140 nɛ along 500 m of single mode fiber with 5 m spatial resolution. In contrast to previously reported techniques, this approach also enabled dynamic measurements with a bandwidth of 1.7 kHz and temperature (strain) noise spectral density of 0.54 m°C/√Hz (4.5 nɛ/√Hz) while temperature/strain cross-sensitivity was suppressed by at least 25 dB. This represents a dramatic improvement in measurement speed and sensitivity compared with existing techniques capable of temperature/strain discrimination in standard single mode fiber.

6.
Opt Express ; 31(13): 20651-20664, 2023 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-37381184

RESUMEN

Persistent wideband radio frequency (RF) surveillance and spectral analysis is increasingly important, driven by the proliferation of wireless communication and RADAR technology. However, conventional electronic approaches are limited by the ∼1 GHz bandwidth of real-time analog-to-digital converters (ADCs). While faster ADCs exist, high data rates prohibit continuous operation, limiting these approaches to acquiring short snapshots of the RF spectrum. In this work, we introduce an optical RF spectrum analyzer designed for continuous, wideband operation. Our approach encodes the RF spectrum as sidebands on an optical carrier and relies on a speckle spectrometer to measure these sidebands. To achieve the resolution and update rate required for RF analysis, we use Rayleigh backscattering in single-mode fiber to rapidly generate wavelength-dependent speckle patterns with MHz-level spectral correlation. We also introduce a dual-resolution scheme to mitigate the trade-off between resolution, bandwidth, and measurement rate. This optimized spectrometer design enables continuous, wideband (15 GHz) RF spectral analysis with MHz-level resolution and a fast update rate of 385 kHz. The entire system is constructed using fiber-coupled off-the-shelf-components, providing a powerful new approach for wideband RF detection and monitoring.

7.
Pediatr Blood Cancer ; 70(8): e30426, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37243320

RESUMEN

BACKGROUND/OBJECTIVES: Surgery is the mainstay of therapy for children with ovarian immature teratoma (IT), whereas adults receive adjuvant chemotherapy, except those with stage-I, grade-1 disease. In Brazil, children with metastatic ovarian IT received postoperative chemotherapy. This practice variation allowed evaluation of the value of chemotherapy, by comparison of Brazilian patients with those in the United States and United Kingdom. DESIGN/METHODS: From the Malignant Germ Cell International Consortium data commons, data on ovarian IT patients from two recently added Brazilian trials (TCG-99/TCG-2008) were compared with data from US/UK (INT-0106/GC-2) trials. Primary outcome measure was event-free (EFS) and overall survival (OS). RESULTS: Forty-two Brazilian patients were included (stage I: 27, stage II: 4, stage III: 8, stage IV: 3). Twenty-nine patients had surgery alone, whereas 13 patients received postoperative chemotherapy. The EFS and OS for entire cohort was 0.80 (95% CI: 0.64-0.89) and 0.97 (0.84-0.99). There was no difference in relapse risk based on stage, grade, or receipt of chemotherapy. Comparing the Brazilian cohort with 98 patients in US/UK cohort (stage I: 59, stage II: 12, stage III: 27), there was no difference in EFS and OS across all stages, despite 87% of stage II-IV Brazilian patients receiving postoperative chemotherapy compared with only 13% of US/UK patients. The EFS and OS for Brazilian compared with US/UK cohort was stage I: 88% versus 98% (p = .05), stage II-IV EFS: 67% versus 79% (p = .32), stage II-IV OS: 93% versus 97% (p = .44); amongst grade-3 patients, there was no difference in EFS or OS. CONCLUSION: Addition of postoperative chemotherapy did not improve outcome in children with ovarian IT, even at higher grade or stage, compared with surgery alone.


Asunto(s)
Neoplasias Ováricas , Teratoma , Adulto , Femenino , Humanos , Niño , Estados Unidos , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/patología , Teratoma/tratamiento farmacológico , Teratoma/patología , Quimioterapia Adyuvante
8.
J Infect Dis ; 226(2): 357-365, 2022 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-35184187

RESUMEN

BACKGROUND: Cytomegalovirus (CMV) is an important opportunistic pathogen after transplantation. Some virological variation in transplant recipients is explained by donor and recipient CMV serostatus, but not all. Circadian variability of herpesviruses has been described, so we investigated the effect of time of day of transplantation on posttransplant CMV viremia. METHODS: We performed a retrospective analysis of 1517 patients receiving liver or kidney allografts at a single center from 2002 to 2018. All patients were given preemptive therapy with CMV viremia monitoring after transplantation. Circulatory arrest and reperfusion time of donor organ were categorized into 4 periods. Patients were divided into serostatus groups based on previous CMV infection in donor and recipient. CMV viremia parameters were compared between time categories for each group. Factor analysis of mixed data was used to interrogate this complex data set. RESULTS: Live-donor transplant recipients were less likely to develop viremia than recipients of deceased-donor organs (48% vs 61%; P < .001). After controlling for this, there was no evidence of time of day of transplantation affecting CMV parameters in any serostatus group, by logistic regression or factor analysis of mixed data. DISCUSSION: We found no evidence for a circadian effect of transplantation on CMV viremia, but these novel results warrant confirmation by other centers.


Asunto(s)
Infecciones por Citomegalovirus , Trasplante de Órganos , Antivirales/uso terapéutico , Ritmo Circadiano , Citomegalovirus , Humanos , Trasplante de Órganos/efectos adversos , Estudios Retrospectivos , Carga Viral , Viremia/etiología
9.
Lancet Oncol ; 23(5): e218-e228, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35489353

RESUMEN

Homogeneous and common objective disease assessments and standardised response criteria are important for better international clinical trials for CNS germ cell tumours. Currently, European protocols differ from those of North America (the USA and Canada) in terms of criteria to assess radiological disease response. An international working group of the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group was therefore established to review existing literature and current practices, identify major challenges regarding imaging assessment, and develop consensus recommendations for imaging response assessment for patients with CNS germ cell tumours. New clinical imaging standards were defined for the most common sites of CNS germ cell tumour and for the definition of locoregional extension. These new standards will allow the evaluation of response to therapy in patients with CNS germ cell tumours to be more consistent, and facilitate direct comparison of treatment outcomes across international studies.


Asunto(s)
Neoplasias Encefálicas , Neoplasias de Células Germinales y Embrionarias , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/terapia , Niño , Consenso , Diagnóstico por Imagen , Humanos , Neoplasias de Células Germinales y Embrionarias/diagnóstico por imagen , Neoplasias de Células Germinales y Embrionarias/terapia , Resultado del Tratamiento
10.
Br J Cancer ; 127(1): 137-144, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35449451

RESUMEN

BACKGROUND: Whole-genome sequencing (WGS) of cancers is becoming an accepted component of oncological care, and NHS England is currently rolling out WGS for all children with cancer. This approach was piloted during the 100,000 genomes (100 K) project. Here we share the experience of the East of England Genomic Medicine Centre (East-GMC), reporting the feasibility and clinical utility of centralised WGS for individual children locally. METHODS: Non-consecutive children with solid tumours were recruited into the pilot 100 K project at our Genomic Medicine Centre. Variant catalogues were returned for local scrutiny and appraisal at dedicated genomic tumour advisory boards with an emphasis on a detailed exploration of potential clinical value. RESULTS: Thirty-six children, representing one-sixth of the national 100 K cohort, were recruited through our Genomic Medicine Centre. The diagnoses encompassed 23 different solid tumour types and WGS provided clinical utility, beyond standard-of-care assays, by refining (2/36) or changing (4/36) diagnoses, providing prognostic information (8/36), defining pathogenic germline mutations (1/36) or revealing novel therapeutic opportunities (8/36). CONCLUSION: Our findings demonstrate the feasibility and clinical value of centralised WGS for children with cancer. WGS offered additional clinical value, especially in diagnostic terms. However, our experience highlights the need for local expertise in scrutinising and clinically interpreting centrally derived variant calls for individual children.


Asunto(s)
Neoplasias , Medicina Estatal , Niño , Estudios de Factibilidad , Mutación de Línea Germinal , Humanos , Neoplasias/genética , Secuenciación Completa del Genoma
11.
Br J Cancer ; 127(9): 1577-1583, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36229581

RESUMEN

Germ cell tumours (GCTs) are a heterogeneous group of rare neoplasms that present in different anatomical sites and across a wide spectrum of patient ages from birth through to adulthood. Once these strata are applied, cohort numbers become modest, hindering inferences regarding management and therapeutic advances. Moreover, patients with GCTs are treated by different medical professionals including paediatric oncologists, neuro-oncologists, medical oncologists, neurosurgeons, gynaecological oncologists, surgeons, and urologists. Silos of care have thus formed, further hampering knowledge dissemination between specialists. Dedicated biobank specimen collection is therefore critical to foster continuous growth in our understanding of similarities and differences by age, gender, and site, particularly for rare cancers such as GCTs. Here, the Malignant Germ Cell International Consortium provides a framework to create a sustainable, global research infrastructure that facilitates acquisition of tissue and liquid biopsies together with matched clinical data sets that reflect the diversity of GCTs. Such an effort would create an invaluable repository of clinical and biological data which can underpin international collaborations that span professional boundaries, translate into clinical practice, and ultimately impact patient outcomes.


Asunto(s)
Neoplasias de Células Germinales y Embrionarias , Neoplasias Testiculares , Niño , Humanos , Adulto , Masculino , Investigación Biomédica Traslacional , Neoplasias de Células Germinales y Embrionarias/terapia , Neoplasias Testiculares/patología
12.
Pediatr Blood Cancer ; 69(1): e29359, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34520101

RESUMEN

BACKGROUND: Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient. METHODS: Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m2 intravenously, or 4 mg/m2 for moderate count suppression, delivered weekly). We describe two such patients treated using this approach. RESULTS: A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well. CONCLUSION: Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.


Asunto(s)
Neoplasias Encefálicas , Germinoma , Neoplasias de Células Germinales y Embrionarias , Vinblastina , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , COVID-19 , Carboplatino/uso terapéutico , Niño , Etopósido/uso terapéutico , Femenino , Germinoma/tratamiento farmacológico , Germinoma/radioterapia , Humanos , Masculino , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/radioterapia , Pandemias , Vinblastina/uso terapéutico
13.
J Pediatr Hematol Oncol ; 44(3): e736-e739, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-34001797

RESUMEN

BACKGROUND: Adrenal masses are rare in children and most commonly present with clinical features of virilization in the absence of activation of the pituitary axis-gonadotrophin-independent precocious puberty. OBSERVATIONS: We report an unusual case of a 7-year-old girl who presented with clinical signs suggestive of exposure to both androgens and estrogens. Imaging revealed a left-sided adrenal mass with no evidence of metastasis. She underwent successful laparoscopic unilateral adrenalectomy. Histology confirmed an adrenal adenoma. CONCLUSION: We conclude that adrenocortical tumors should be considered in children presenting with gonadotrophin-independent precocious puberty and raised estrogens.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Adenoma Corticosuprarrenal , Pubertad Precoz , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/cirugía , Adenoma Corticosuprarrenal/diagnóstico , Adenoma Corticosuprarrenal/cirugía , Niño , Estrógenos , Femenino , Humanos , Pubertad Precoz/diagnóstico , Pubertad Precoz/etiología
14.
Pediatr Dev Pathol ; 25(2): 168-173, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34428078

RESUMEN

Hodgkin lymphoma (HL) can present with extra-nodal disease, but spinal cord compression is exceptionally rare. We describe a 15-year-old presenting with hip/back pain with normal initial examination. Persistent pain and raised inflammatory markers prompted further investigation with MRI, which revealed an epidural mass causing spinal cord compression. On examination, there was no palpable lymphadenopathy or cauda equina syndrome, but absent lower limb reflexes were noted. Following multidisciplinary discussion, it was determined that cauda equina syndrome was imminent and therefore surgical debulking was undertaken, both to prevent this complication and establish a diagnosis. At surgery, the tumor was highly vascular. Frozen section confirmed lesional material. Following surgery, and given the frozen section findings, a short course of steroids was commenced to reduce any peri-surgical edema. Unfortunately, histopathology was ultimately non-diagnostic, due to failure of immunohistochemistry on technically challenging material. Consequently, ultrasound-guided excision biopsy of a (non-palpable) cervical lymph node was performed five days later; histopathology showed typical effacement of the normal architecture and a conspicuous population of CD15/CD30-positive larger pale cells present, confirming nodular sclerosis classic HL, despite recent steroids. We review the available literature for HL presenting with spinal cord compression and describe the challenges for diagnosis and initial management in such cases.


Asunto(s)
Síndrome de Cauda Equina , Enfermedad de Hodgkin , Compresión de la Médula Espinal , Adolescente , Síndrome de Cauda Equina/complicaciones , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/diagnóstico , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Compresión de la Médula Espinal/complicaciones , Compresión de la Médula Espinal/etiología
15.
Cancer ; 127(2): 193-202, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33079404

RESUMEN

BACKGROUND: Adolescents with extracranial metastatic germ cell tumors (GCTs) are often treated with regimens developed for children, but their clinical characteristics more closely resemble those of young adult patients. This study was designed to determine event-free survival (EFS) for adolescents with GCTs and compared them with children and young adults. METHODS: An individual patient database of 11 GCT trials was assembled: 8 conducted by pediatric cooperative groups and 3 conducted by an adult group. Male patients aged 0 to 30 years with metastatic, nonseminomatous, malignant GCTs of the testis, retroperitoneum, or mediastinum who were treated with platinum-based chemotherapy were included. The age groups were categorized as children (0 to <11 years), adolescents (11 to <18 years), and young adults (18 to ≤30 years). The study compared EFS and adjusted for risk group by using Cox proportional hazards analysis. RESULTS: From a total of 2024 individual records, 593 patients met the inclusion criteria: 90 were children, 109 were adolescents, and 394 were young adults. The 5-year EFS rate was lower for adolescents (72%; 95% confidence interval [CI], 62%-79%) than children (90%; 95% CI, 81%-95%; P = .003) or young adults (88%; 95% CI, 84%-91%; P = .0002). The International Germ Cell Cancer Collaborative Group risk group was associated with EFS in the adolescent age group (P = .0020). After adjustments for risk group, the difference in EFS between adolescents and children remained significant (hazard ratio, 0.30; P = .001). CONCLUSIONS: EFS for adolescent patients with metastatic GCTs was similar to that for young adults but significantly worse than for that children. This finding highlights the importance of coordinating initiatives across clinical trial organizations to improve outcomes for adolescents and young adults. LAY SUMMARY: Adolescent males with metastatic germ cell tumors (GCTs) are frequently treated with regimens developed for children. In this study, a large data set of male patients with metastatic GCTs across different age groups has been built to understand the outcomes of adolescent patients in comparison with children and young adults. The results suggest that adolescent males with metastatic GCTs have worse results than children and are more similar to young adults with GCTs. Therefore, the treatment of adolescents with GCTs should resemble therapeutic approaches for young adults.


Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Metástasis Linfática/tratamiento farmacológico , Neoplasias del Mediastino/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias Retroperitoneales/tratamiento farmacológico , Neoplasias Testiculares/tratamiento farmacológico , Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Masculino , Supervivencia sin Progresión , Estudios Retrospectivos , Adulto Joven
16.
J Urol ; 205(1): 137-144, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856980

RESUMEN

PURPOSE: Current serum tumor markers for testicular germ cell tumor are limited by low sensitivity. Growing evidence supports the use of circulating miR-371a-3p as a superior marker for malignant (viable) germ cell tumor management. We evaluated the real-world application of serum miR-371a-3p levels in detecting viable germ cell tumor among patients undergoing partial or radical orchiectomy. MATERIALS AND METHODS: Serum samples were collected from 69 consecutive patients before orchiectomy. Performance characteristics of serum miR-371a-3p were compared with conventional serum tumor markers (⍺-fetoprotein/ß-human chorionic gonadotropin/lactate dehydrogenase) between patients with viable germ cell tumor and those without viable germ cell tumor on orchiectomy pathology. Relative miR-371a-3p levels were correlated with clinical course. The Kruskal-Wallis test and linear and ordinal regression models were used for analysis. RESULTS: For detecting viable germ cell tumor, combined conventional serum tumor markers had a specificity of 100%, sensitivity of 58% and AUC of 0.79. The miR-371a-3p test showed a specificity of 100%, sensitivity of 93% and AUC of 0.978. Median relative expression of miR-371a-3p in viable germ cell tumor cases was more than 6,800-fold higher than in those lacking viable germ cell tumor. miR-371a-3p levels correlated with composite stage (p=0.006) and, among composite stage I cases, independently associated with embryonal carcinoma percentage (p=0.0012) and tumor diameter (p <0.0001). Six patients underwent orchiectomy after chemotherapy and were correctly predicted to have presence or absence of viable germ cell tumor by the miR-371a-3p test. CONCLUSIONS: If validated, the miR-371a-3p test can be used in conjunction with conventional serum tumor markers to aid clinical decision making. A positive miR-371a-3p test in patients after preoperative chemotherapy or with solitary testes could potentially guide subsequent orchiectomy or observation.


Asunto(s)
Biomarcadores de Tumor/sangre , MicroARN Circulante/sangre , MicroARNs/sangre , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Orquiectomía , Neoplasias Testiculares/diagnóstico , Adulto , Estudios de Casos y Controles , Quimioterapia Adyuvante , Toma de Decisiones Clínicas/métodos , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/sangre , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapia , Periodo Preoperatorio , Neoplasias Testiculares/sangre , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia , Testículo/patología , Testículo/cirugía , Espera Vigilante
17.
Neuropathol Appl Neurobiol ; 47(6): 882-888, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-33534137

RESUMEN

In a case of astroblastoma, methylation analysis was uninformative, with no clustering with known CNS-HGNET-MN1 cases. Whole genome sequencing however identified a novel MN1-GTSE1 gene fusion (image), confirming the diagnosis of astroblastoma, as well as an EWSR1-PATZ1 gene fusion. Whole genome sequencing, alongside methylation profiling and conventional neuropathology, will continue to lead to improved diagnostics and prognostication for children with brain tumours.


Asunto(s)
Neoplasias Encefálicas/genética , Fusión Génica/genética , Factores de Transcripción de Tipo Kruppel/genética , Proteínas Asociadas a Microtúbulos/genética , Neoplasias Neuroepiteliales/genética , Proteínas Represoras/genética , Transactivadores/genética , Proteínas Supresoras de Tumor/genética , Adolescente , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patología , Femenino , Humanos , Neoplasias Neuroepiteliales/diagnóstico , Neoplasias Neuroepiteliales/patología
18.
BJU Int ; 128(1): 57-64, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33124175

RESUMEN

OBJECTIVES: To determine whether utilisation of a serum microRNA (miRNA) test could improve treatment appropriateness and cost-effectiveness for patients with Stage I non-seminomatous germ cell tumours (NSGCTs). PATIENTS AND METHODS: A decision tree model was built to investigate treatment course, clinical and cost outcomes for patients with Stage IA (T1N0M0S0) and IB (T2-4N0M0S0) NSGCT. The model compared outcomes and cost of standard approach using histopathology, conventional serum tumour markers and radiographic staging (standard model) to a miRNA-based approach using the standard model + post-orchidectomy serum miR-371a-3p (marker model). Probabilities of expected treatment and outcomes were based on presence/absence of cancer upon entering into the model. Overtreatment was defined as adjuvant chemotherapy or primary retroperitoneal lymph node dissection in a patient without cancer. Undertreatment was defined as initial surveillance for a patient with cancer. RESULTS: Utilising the miRNA marker-based approach, 26% of patients avoid overtreatment and 8% avoid undertreatment in Stage IA NSGCT; 27% avoid overtreatment and 23% avoid undertreatment in Stage IB disease. Appropriate treatment decision-making increased from 65% to 94% and 50% to 92% for Stage IA and IB, respectively. The miRNA-based approach remained cost-effective over a wide range of performance characteristics with savings of ~$1400 (American dollars)/patient for both Stage IA and IB disease. CONCLUSION: A miRNA-based approach may potentially select patients with Stage I NSGCT for correct treatment in a cost-effective manner. Identification of residual teratoma-only remains an issue. Prospective studies are necessary to validate these findings.


Asunto(s)
MicroARN Circulante/sangre , MicroARNs/sangre , Neoplasias de Células Germinales y Embrionarias/sangre , Neoplasias Testiculares/sangre , Costos y Análisis de Costo , Árboles de Decisión , Humanos , Masculino , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/economía , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapia , Neoplasias Testiculares/economía , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia , Resultado del Tratamiento
19.
Opt Express ; 28(10): 14638-14647, 2020 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-32403501

RESUMEN

We present a low-noise distributed acoustic sensor using enhanced backscattering fiber with a series of localized reflectors. The point reflectors were inscribed in a standard telecom fiber in a fully automated system by focusing an ultra-fast laser through the fiber cladding. The inscribed reflectors provided a reflectance of -53 dB, significantly higher than the Rayleigh backscattering level of -70 dB/m, despite adding only 0.01 dB of loss per 100 reflection points. We constructed a coherent φ-OTDR system using a double-pulse architecture to probe the enhanced backscattering fiber. Using this system, we found that the point reflectors enabled an average phase noise of -91 dB (re rad2/Hz), 20 dB lower than sensors formed using Rayleigh backscattering in the same fiber. The sensors are immune to interference fading, exhibit a high degree of linearity, and demonstrate excellent non-local signal suppression (>50 dB). This work illustrates the potential for low-cost enhanced backscattering fiber to enable low-noise, long-range distributed acoustic sensing.

20.
Opt Lett ; 45(18): 5226-5229, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32932497

RESUMEN

We report an amplitude-measuring Rayleigh-based sensor that uses a series of frequency-shifted pulses to extract quantitative distributed strain measurements. By using frequency multiplexing, we are able to inject a train of 10 pulses into the fiber at once. This allows us to use a higher average input power than standard phase-sensitive optical time domain reflectometry systems, improving the sensitivity. The sensor recovers the strain by tracking the time-dependent amplitude of the Rayleigh backscattered light from all 10 pulses. This approach enables a sensor with a noise floor of 1.5pε/√Hz over 10 km of fiber with 12 m spatial resolution, a 5 kHz bandwidth, and a dynamic range of 80 dB at 1 kHz. The sensor exhibits a high degree of linearity and is immune to interference fading.

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