RESUMEN
The histone methyltransferase EZH2 has an essential role in the development of follicular lymphoma (FL). Recurrent gain-of-function mutations in EZH2 have been described in 25% of FL patients and induce aberrant methylation of histone H3 lysine 27 (H3K27). We evaluated the role of EZH2 genomic gains in FL biology. Using RNA sequencing, Sanger sequencing and SNP-arrays, the mutation status, copy-number and gene-expression profiles of EZH2 were assessed in a cohort of 159 FL patients from the PRIMA trial. Immunohistochemical (IHC) EZH2 expression (n=55) and H3K27 methylation (n=63) profiles were also evaluated. In total, 37% of patients (59/159) harbored an alteration in the EZH2 gene (mutation n=46, gain n=23). Both types of alterations were associated with highly similar transcriptional changes, with increased proliferation programs. An H3K27me3/me2 IHC score fully distinguished mutated from wild-type samples, showing its applicability as surrogate for EZH2 mutation analysis. However, this score did not predict the presence of gains at the EZH2 locus. The presence of an EZH2 genetic alteration was an independent factor associated with a longer progression-free survival (hazard ratio 0.58, 95% confidence interval 0.36-0.93, P=0.025). We propose that the copy-number status of EZH2 should also be considered when evaluating patient stratification and selecting patients for EZH2 inhibitor-targeted therapies.
Asunto(s)
Proteína Potenciadora del Homólogo Zeste 2/genética , N-Metiltransferasa de Histona-Lisina/genética , Linfoma Folicular/genética , Adulto , Anciano , Línea Celular Tumoral , Supervivencia sin Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica/genética , Histona Metiltransferasas , Humanos , Linfoma Folicular/tratamiento farmacológico , Linfoma Folicular/patología , Masculino , Metilación/efectos de los fármacos , Persona de Mediana Edad , Mutación/genética , Polimorfismo de Nucleótido Simple/genética , Análisis de Secuencia de ARNRESUMEN
A case of intestinal gas explosion during the course of carcinologic surgery in a 51-year-old patient is reported. This accident, often dramatic, has become exceptional since the use of mannitol for colonic preparation has disappeared. This incident occurred during the course of a total pelvic exenteration performed under general anaesthesia with inhalation of both a mixture oxygen-nitrous oxide and volatile agents. The colon incision with an electrocautery was contemporaneous with a violent deflagration accountable for organic lesions. This case report reminds us that the risk of a dangerous explosion persists in relation with surgical, anaesthetic and individual risk factors.
Asunto(s)
Adenocarcinoma/cirugía , Anestesia por Inhalación/efectos adversos , Neoplasias Colorrectales/cirugía , Explosiones , Anestésicos por Inhalación , Diuréticos Osmóticos/uso terapéutico , Electrocoagulación/efectos adversos , Humanos , Masculino , Manitol/uso terapéutico , Persona de Mediana Edad , Óxido Nitroso , Oxígeno , Exenteración PélvicaRESUMEN
We report a case of a probable interaction between sufentanil and naltrexone, an oral long acting opioid antagonist, prescribed for maintenance of abstinence in alcoholics and opioid addicts. The interaction resulted in an antagonisation of the effects of sufentanil and the necessity to increase the dosage. Anaesthetists should be aware of this potential drug interaction.
Asunto(s)
Alcoholismo/rehabilitación , Analgésicos Opioides , Anestesia Intravenosa , Anestésicos Intravenosos , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Sustancias/rehabilitación , Sufentanilo , Analgésicos Opioides/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Interacciones Farmacológicas , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Sufentanilo/administración & dosificaciónRESUMEN
1. Adult children of alcoholics are frequently found within the population of clients on inpatient psychiatric units. The percentage of this population is greater than the occurrence of ACoAs in the general population. 2. Nursing staff can assist these clients in a therapeutic way by becoming familiar with the types of issues these clients present and the behaviors they manifest. These issues should be reflected in treatment planning. 3. Anger, abuse, guilt, and grief form the core issues that ACoAs must deal with in therapeutic ways during psychiatric hospitalization.