Macropolycytes: Severe stress time for neutrophils.

Macropolycytes are giant neutrophils found in a variety of benign and neoplastic conditions. Since megaloblastic anaemia is one of the recognised causes of macropolycytes, other blood film features of megaloblastic anaemia should be sought when they harbor hypersegmented nuclei. When they are hypolobulated and hypogranular, the occurrence of a myelodysplastic syndrome must be investigated. Finding macropolycytes in the context of a nonspecific reactive granulopoiesis is more questionable but is often associated with stressed myelopoiesis and/or granulocyte colony-stimulating factor therapy.

Idelalisib in a patient with refractory Waldenström's macroglobulinemia complicated by anuric renal failure: a case report.

BACKGROUND: Waldenström's macroglobulinemia is a rare B-cell lymphoma. The gold standard treatment for Waldenström's macroglobulinemia is an anti-CD20 antibody (rituximab) in combination with alkylating agents and dexamethasone. Treatment targeting the B-cell receptor such as ibrutinib (but not idelalisib) is currently approved for treatment of patients with relapsed or refractory Waldenström's macroglobulinemia. CASE PRESENTATION: We report a case of a 71-year-old white French man with Waldenström's macroglobulinemia who presented with acute renal failure and hyperviscosity syndrome. His Waldenström's macroglobulinemia was refractory to first-line treatment with rituximab, cyclophosphamide, and dexamethasone. Because of his hemorrhagic syndrome and medical history of recent myocardial infarction, we decided to treat him with idelalisib 150 mg twice daily instead of ibrutinib. We observed a very quick improvement in the patient's clinical status without need for dose adjustment. CONCLUSION: Our patient's case provides the first evidence, to the best of our knowledge, that idelalisib may be an efficient treatment option for patients with Waldenström's macroglobulinemia complicated by anuric renal failure and in whom ibrutinib is contraindicated.

Studying illicit drug trafficking on Darknet markets: Structure and organisation from a Canadian perspective.

Cryptomarkets are online marketplaces that are part of the Dark Web and mainly devoted to the sale of illicit drugs. They combine tools to ensure anonymity of participants with the delivery of products by mail to enable the development of illicit drug trafficking. Using data collected on eight cryptomarkets, this study provides an overview of the Canadian illicit drug market. It seeks to inform about the most prevalent illicit drugs vendors offer for sale and preferred destination countries. Moreover, the research gives an insight into the structure and organisation of distribution networks existing online. In particular, we provide information about how vendors are diversifying and replicating across marketplaces. We inform on the number of listings each vendor manages, the number of cryptomarkets they are active on and the products they offer. This research demonstrates the importance of online marketplaces in the context of illicit drug trafficking. It shows how the analysis of data available online may elicit knowledge on criminal activities. Such knowledge is mandatory to design efficient policy for monitoring or repressive purposes against anonymous marketplaces. Nevertheless, trafficking on Dark Net markets is difficult to analyse based only on digital data. A more holistic approach for investigating this crime problem should be developed. This should rely on a combined use and interpretation of digital and physical data within a single collaborative intelligence model.

Bayesian classification criterion for forensic multivariate data.

This study presents a classification criteria for two-class Cannabis seedlings. As the cultivation of drug type cannabis is forbidden in Switzerland, law enforcement authorities regularly ask laboratories to determine cannabis plant's chemotype from seized material in order to ascertain that the plantation is legal or not. In this study, the classification analysis is based on data obtained from the relative proportion of three major leaf compounds measured by gas-chromatography interfaced with mass spectrometry (GC-MS). The aim is to discriminate between drug type (illegal) and fiber type (legal) cannabis at an early stage of the growth. A Bayesian procedure is proposed: a Bayes factor is computed and classification is performed on the basis of the decision maker specifications (i.e. prior probability distributions on cannabis type and consequences of classification measured by losses). Classification rates are computed with two statistical models and results are compared. Sensitivity analysis is then performed to analyze the robustness of classification criteria.

Age, JAK2(V617F) and SF3B1 mutations are the main predicting factors for survival in refractory anaemia with ring sideroblasts and marked thrombocytosis.

Refractory anaemia with ring sideroblasts (RARS) and marked thrombocytosis (RARS-T) is a provisional entity in the World Health Organisation 2008 classification and has previously been shown to have a high proportion of JAK2(V617F) (Janus Kinase 2) and SF3B1 (Splicing Factor 3B subunit 1) mutations. The purpose of the present study was to analyse the frequency of SF3B1 mutations in a large cohort of 111 patients with RARS-T and 33 patients with RARS and to explore the prognostic impact of SF3B1 mutational status on RARS-T. The frequency of SF3B1 mutations in RARS-T (96/111, 86.5%) and RARS (28/33, 84.8%) was similar. In RARS-T, median survival was better in SF3B1-mutated patients than in SF3B1-non-mutated patients (6.9 and 3.3 years, respectively, P=0.003). RARS can be differentiated from RARS-T by the frequency of JAK2(V617F) (0% vs 48.6%). In RARS-T patients, SF3B1 (P=0.021) and JAK2 mutations (P=0.016) were independent factors for a better prognosis. Altogether, our results confirm that RARS-T is an independent entity that should be recognised by the next World Health Organisation classification. The assessment of SF3B1 mutations is of prognostic interest in RARS-T patients. Younger age, JAK2(V617F) and SF3B1 mutations are the main predicting factors for survival in RARS-T.

Innovative methodology to transfer conventional GC-MS heroin profiling to UHPLC-MS/MS.

Nowadays, in forensic laboratories, heroin profiling is frequently carried out by gas chromatography coupled with mass spectrometry (GC-MS). This analytical technique is well established, provides good sensitivity and reproducibility, and allows the use of large databases. Despite those benefits, recently introduced analytical techniques, such as ultra-high-pressure liquid chromatography (UHPLC), could offer better chromatographic performance, which needs to be considered to increase the analysis throughput for heroin profiling. With the latter, chromatographic conditions were optimized through commercial modeling software and two atmospheric pressure ionization sources were evaluated. Data obtained from UHPLC-MS/MS were thus transferred, thanks to mathematical models to mimic GC-MS data. A calibration and a validation set of representative heroin samples were selected among the database to establish a transfer methodology and assess the models' abilities to transfer using principal component analysis and hierarchical classification analysis. These abilities were evaluated by computing the frequency of successful classification of UHPLC-MS/MS data among GC-MS database. Seven mathematical models were tested to adjust UHPLC-MS/MS data to GC-MS data. A simplified mathematical model was finally selected and offered a frequency of successful transfer equal to 95%.

Evaluation of mean sphered corpuscular volume for predicting hereditary spherocytosis.

Hereditary spherocytosis (HS) is a common red blood cell disorder. It has been shown that the mean sphered corpuscular volume (MSCV), an artificial volume, is always lower than the MCV in HS and also in some autoimmune haemolytic anaemia (AIHA). Our purpose was to assess the reliability of MSCV in routine practise, and its relevance in screening for HS. Comparison of MSCV and MCV was undertaken in a prospective study of 366 patients with anaemia. In addition, included were patients previously diagnosed to have HS (n = 33) or AIHA (n = 16). When MSCV was lower than MCV, a flow cytometric (FC) test for HS was performed. Delta (MCV-MSCV) values >9.6 fl were obtained for all HS patients. A wider spread of delta (MCV-MSCV) values was obtained for AIHA patients whose red cells gave FC test results negative for HS. In the ROC curve analysis, the determination of delta (MCV-MSCV) value has a 90.57% specificity and 100% sensitivity for HS. MSCV is a reliable automated parameter indicating possible HS. When a delta (MCV-MSCV) value is >9.6 fl, the FC test and the Coombs test are required in the differential diagnosis of HS and some AIHA.