Osteoporosis management in hematologic stem cell transplant recipients: Executive summary.

BACKGROUND: Treatment advances have reduced the adverse events associated with hematopoietic stem cell transplant (HSCT) and led to an increased number of transplants performed. HSCT patients are living longer with concerns on long-term outcomes. Bone fragility and fracture are at the forefront for long-term morbidities post-HSCT. RESULTS: In HSCT recipients, evidence has accumulated to support recommendations for more extensive monitoring of bone fragility and more appropriate administration of osteoporosis pharmacotherapies for patients at high risk of bone loss and/or fracture. CONCLUSION: This executive summary reports and summarizes the main recommendations published previously, including bone assessment, dietary and lifestyle recommendations and osteoporosis medication.

Natural Enemies of the Harrisia Cactus Mealybug and Other Hypogeococcus Species (Hemiptera: Pseudococcidae) in Puerto Rico: Identification and Taxonomic Notes on Primary and Secondary Parasitoids.

Primary and secondary parasitoids of Hypogeococcus spp. (Hemiptera: Pseudococcidae) on Cactaceae, Amaranthaceae, and Portulacaceae were reported from field surveys conducted in Puerto Rico, USA, since 2009. Resident natural enemies of the Harrisia cactus mealybug (HCM), Hypogeococcus sp., which is devastating native cacti in Puerto Rico and threatening cacti in the adjacent Caribbean islands, were documented prior to the planned introductions of non-native biological control agents from South America against this pest. Two species of Encyrtidae (Hymenoptera: Chalcidoidea) were recorded as primary parasitoids of the HCM on Cactaceae: Leptomastidea hypogeococci Triapitsyn, which was the most common, and Anagyrus quilmes Triapitsyn, Logarzo & Aguirre. Another primary parasitoid, Acerophagus sp. near nubilipennis Dozier (Encyrtidae), was also reared from a different Hypogeococcus sp. on Amaranthaceae and Portulacaceae. Hyperparasitoids, usually via L. hypogeococci, included Prochiloneurus narendrani Noyes & Triapitsyn (Encyrtidae), Pachyneuron sp. (Hymenoptera: Pteromalidae), Chartocerus elongatus (Girault), and Chartocerus niger (Ashmead) (Hymenoptera: Signiphoridae). Cheiloneurus chrisiantorresi Triapitsyn sp. n. (Encyrtidae) is newly described and illustrated; its status as a suspect hyperparasitoid of Hypogeococcus sp. on Amaranthaceae and Portulacaceae, along with that of Cheiloneurus sp., will need to be verified. The recorded HCM predators include one species of Chamaemyiidae (Diptera), Leucopina bella (Loew), and three species of Coccinellidae (Coleoptera): Cryptolaemus montrouzieri Mulsant, Decadiomus austrinus (Gordon), and Scymnobius flavifrons (Melsheimer).

Bone management in hematologic stem cell transplant recipients.

Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.

Primary small cell carcinoma of the larynx. Survival time of 47 months. Case report.

Small cell carcinoma (SCC) of the larynx is a rare type of neuroendocrine carcinoma (NEC), few cases of which have been described in the literature. The prognosis for this type of carcinoma is poor, with a survival time typically not exceeding two years. We describe the case of a 54-year-old male patient with a primary tumor in the right ventricular band and a biopsy compatible with SCC. The patient underwent radiotherapy (RT) and concomitant chemotherapy (QT) and, after a relapse at 17 months, underwent total laryngectomy with bilateral neck dissection. The survival time was 47 months. Further studies are required to elucidate the possible causes of the better prognosis in some cases.

Rational molecular design enhancing the photonic performance of red-emitting perylene bisimide dyes.

We report the synthesis of novel multichromophoric organic architectures, where perylene red is decorated with BODIPY and/or hydroxycoumarin dyes acting as light harvesters and energy donors. The computationally-aided photophysical study of these molecular assemblies reveals a broadband absorption which, regardless of the excitation wavelength, leads solely to a bright red-edge emission from perylene bisimide after efficient intramolecular energy transfer hops. The increase of the absorbance of these molecular antennas at key pumping wavelengths enhances the laser action of the commercial perylene red. The herein applied strategy based on energy transfer dye lasers should boost the use of perylene-based dyes as active media for red-emitting lasers.

Coumarin-BODIPY hybrids by heteroatom linkage: versatile, tunable and photostable dye lasers for UV irradiation.

Linking amino and hydroxycoumarins to BODIPYs through the amino or hydroxyl group lets the easy construction of unprecedented photostable coumarin-BODIPY hybrids with broadened and enhanced absorption in the UV spectral region, and outstanding wavelength-tunable laser action within the green-to-red spectral region (∼520-680 nm). These laser dyes allow the generation of a valuable tunable UV (∼260-350 nm) laser source by frequency doubling, which is essential to study accurately the photochemistry of biological molecules under solar irradiation. The tunability is achieved by selecting the substitution pattern of the hybrid. Key factors are the linking heteroatom (nitrogen vs. oxygen), the number of coumarin units joined to the BODIPY framework and the involved linking positions.

Outcome and toxicity using helical tomotherapy for craniospinal irradiation in pediatric medulloblastoma.

PURPOSE: The objective of this study is to evaluate the tolerability and outcome of craniospinal irradiation (CSI) with helical tomotherapy (HT) in the treatment of medulloblastoma. METHODS: We evaluated 19 consecutive patients with primary medulloblastoma who were treated with HT from 2007 through 2010. HT regimens to the neuroaxis included: 23.4 Gy at 1.8 Gy/fraction (N = 10), 36 Gy at 1.8 Gy/fraction (N = 7), and 39 Gy bid at 1.3 Gy/fraction (N = 2). The tumor bed received 54-60 Gy. Potential associations between patient, treatment, and toxicity factors and overall survival (OS) were assessed in univariate analyses using the Cox proportional hazards model. Spearman's rank correlation coefficient was used to correlate potential risk factors with the grade of acute toxicity. RESULTS: The median age at diagnosis was 5 years (range 2-14) and the median follow-up for alive patients (N = 14) 40 months (range 10-62). Two- and three-year overall survival was 75 and 68 %, respectively. The most common acute toxicity was hematological (79 %), being grade 2 and grade 3 in 4 (21 %) and 11 (58 %) cases, respectively. No grade ≥2 late toxicities were observed. Higher grades of acute body toxicity were found in older children (P = 0.004). Longer time between diagnosis and radiation therapy was correlated with shorter OS (P = 0.03). In addition, higher grades of acute thrombocytopenia were associated with shorter OS (P = 0.03). CONCLUSIONS: CSI delivered with HT for medulloblastoma is well tolerated with low rates of severe acute toxicity. Further research is necessary to assess late toxicity with a longer follow-up.

Prognostic factors for overall survival in paediatric patients with Ewing sarcoma of bone treated according to multidisciplinary protocol.

BACKGROUND: The purpose of this study is to assess the outcome of patients with Ewing sarcoma (EWS) of the bone and to identify prognostic factors. MATERIALS AND METHODS: Seventy-seven patients younger than 18 years old, diagnosed with EWS of the bone between 1979 and 2009, were analysed retrospectively. Four different protocols of chemotherapy were used successively. Local treatment consisted of surgery (N=32), radiotherapy (N=20) and a combination of both (N=19). RESULTS: The median age at diagnosis was 10 years old (range, 2-17) and the median follow-up for survivors 8.6 years (range, 1-18.8). Thirty-two relapses occurred (21 distant, 5 local and 6 both). The 2- and 5-year overall survival rates were 70% and 51%, respectively. Multivariate analysis showed four significant independent predictors for death: age ≥14 years old (HR: 5.06; p=0.019), lack of complete response (HR: 8.04; p<0.001), tumour volume ≥150 ml (HR: 2.21; p=0.045) and distant recurrences (HR: 1.45; p=0.001). CONCLUSIONS: Outcome of EWS of bone is influenced by many clinical and treatment-correlated variables. Criteria to stratify patients should include all the variables that have shown prognostic significance. The development of novel therapies should target these high-risk groups.

Health related quality of life and late side effects of long-term survivors of Ewing's sarcoma of bone.

PURPOSE: The data examining the Health Related Quality of Life (HRQOL) after definitive treatment for Ewing's sarcoma (EWS) is sparse. The objective of this study was to assess the HRQOL and late side effects in EWS of bone survivors treated in the past 2 decades. METHODS: Seventeen long-term (≥ 5 years) EWS survivors (age range, 11-27 years) treated from 1990 to 2004 completed the EORTC-QLQ-C30. We compared the HRQOL of our data set with a reference group of cancer survivors and also with the general population. Musculoskeletal late treatment toxicity was also evaluated. The Mann-Whitney and Wilcoxon tests were used for analyses. RESULTS: EWS survivors of our series reported significantly better global, physical, role and cognitive HRQOL and less symptoms of fatigue, pain and insomnia than the normative sample of cancer survivors. Moreover, the HRQOL was equivalent to the general population, with the exception of social functioning. Additionally, patients with tumor location in the extremities did not report significant HRQOL differences compared with those with tumor at other locations. Common chronic grade 2 side effects were generalized muscle weakness (23%) and decreased joint range of motion (23%). Only one patient experienced musculoskeletal chronic grade 3 toxicity. CONCLUSION: Our findings suggest that EWS survivors treated in the modern era do not experience lower HRQOL than other cancer survivors. Rather, the HRQOL appears to be equivalent to the general population. Further and larger studies are needed to confirm these results.

Red-edge-wavelength finely-tunable laser action from new BODIPY dyes.

New BODIPY dyes with two 4-formylphenyl, 4-(2,2-dimethoxycarbonylvinyl)phenyl and 4-(2,2-dicyanovinyl)phenyl groups at the 3- and 5-positions have been successfully designed and synthesized via palladium-catalyzed coupling reaction or Knoevenagel-type condensations. Structural modification of the BODIPY core via conjugation-extending residues significantly affects the spectroscopy and photophysical properties of the BODIPY fluorophore. These substituents cause the largest bathochromic shift in both absorption and emission spectra, which are shifted toward the red compared to its 4-phenylsubstituted analogue. Additionally, the fluorescence quantum yields and the Stokes shifts are also significantly higher than the corresponding phenyl-substituted dye. New BODIPY dyes have a high laser photostability, superior to that of commercial dyes with laser emission in the same spectral region, such as Perylene Red and Rhodamine 640. The substitution introduced in these derivatives allows to obtain tunable laser emission with a bandwidth of 0.15 cm(-1) and a tuning range of up to 50 nm. So with these three dyes it is possible to cover the spectral range 590-680 nm in a continuous way and with stable laser emission and small linewidth.

Physical properties of extruded products from three Mexican common beans (Phaseolus vulgaris L.) cultivars.

The physical properties of extruded products from three Mexican common bean cultivars were investigated. Common bean cultivars Flor de Mayo, Pinto Villa and Bayo Victoria from the same harvesting season (2006) were used in this work. Beans were milled and the flour was hydrated to 24, 26 and 28 g of water/100 g of dry weight. Two temperatures, 130 degrees C and 165 degrees C at the end of the extruder barrel without die, were experimented. Common bean flour extrudates were evaluated for water absorption index (WAI), water absorption capacity (WAC), oil absorption capacity (OAC), and emulsifying capacity (EC). Flor de Mayo extrudates showed the highest WAC and WAI values. Thus starch from Flor de Mayo beans showed minor restricted water availability. In all cases, the OAC of extruded products was lower than the crude bean flour. The EC for Bayo Victoria flour increased as a consequence of the extrusion process. The EC for Flor de Mayo was higher at lower temperature and lower moisture content than Pinto Villa and Bayo Victoria beans. EC behavior of Pinto Villa was similar to Bayo cultivar. These results indicate that it is possible to produce new extruded products with good physical properties from these common bean cultivars.

Fístula traqueoesofágica en un paciente con cáncer de esófago y prótesis / Tracheo-esophageal fistula in a patient with esophageal cancer and stent

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[18-FDG-PET in a case of recurrent malignant schwannoma]. / Diagnóstico de recurrencia mediante FDG-PET en un caso clínico de schwannoma maligno.

The peripheral nerve sarcoma, also called malignant schwannoma, is originally a soft tissue sarcoma. It is mainly located in the peripheral sheath nerve of the limbs and usually infiltrates the nerve fibres. We present the case of a thirty year old woman with a malignant schwannoma in her left leg sciatic nerve who had been treated on several occasions. An 18-FDG positron emission tomography was performed to evaluate the management of the patient. It showed regional recurrence, which required leg amputation. The pathological result has confirmed the PET diagnosis. PET can be a useful technique to detect recurrence for this kind of tumor, mainly in patients who have been previously radiated when the MRI is insufficient to perform a differential diagnosis between postirradiation fibrosis and tumoral recurrence, allowing for suitable therapeutic management of the patient.

[Langerhans's cell histiocytosis in otorhinolaryngology]. / Histiocitosis de células de Langerhans en O.R.L.

Langerhans's cell histiocytosis (LCH) is an uncommon disease characterized by an accumulation of abnormal histiocytes, together lymphocytes and eosinophils in various organs and tissues. The head and neck are frequent sites of initial presentation. We present two cases of LCH with otorhinolaryngologic symptoms. Current recommendations for diagnosis, evaluation and treatment of LCH are also discussed.