Non-anaplastic peripheral T cell lymphoma in children and adolescents-an international review of 143 cases.

Peripheral T cell lymphomas (PTCL) are rare in children and adolescents, and data about outcome and treatment results are scarce. The present study is a joint, international, retrospective analysis of 143 reported cases of non-anaplastic PTCL in patients <19 years of age, with a focus on treatment and outcome features. One hundred forty-three patients, between 0.3 and 18.7 years old, diagnosed between 2000 and 2015 were included in the study. PTCL not otherwise specified was the largest subgroup, followed by extranodal NK/T cell lymphoma, hepatosplenic T cell lymphoma (HS TCL), and subcutaneous panniculitis-like T cell lymphoma (SP TCL). Probability of overall survival (pOS) at 5 years for the whole group was 0.56 ± 0.05, and probability of event-free survival was (pEFS) 0.45 ± 0.05. Patients with SP TCL had a good outcome with 5-year pOS of 0.78 ± 0.1 while patients with HS TCL were reported with 5-year pOS of only 0.13 ± 0.12. Twenty-five percent of the patients were reported to have a pre-existing condition, and this group had a dismal outcome with 5-year pOS of 0.29 ± 0.09. The distribution of non-anaplastic PTCL subtypes in pediatric and adolescent patients differs from what is reported in adult patients. Overall outcome depends on the subtype with some doing better than others. Pre-existing conditions are frequent and associated with poor outcomes. There is a clear need for subtype-based treatment recommendations for children and adolescents with PTCL.

[Execution and quality of attention paid to medical doctoral theses at the faculty of medicine at the University of Würzburg as seen by the doctoral candidates in their 5th and 6th year of study]. / Bearbeitung und Betreuungsqualität medizinischer Dissertationen an der Medizinischen Fakultät Würzburg aus der Sicht von Promovenden des 5. und 6. Studienjahres.

BACKGROUND AND OBJECTIVE: The significance of a doctoral thesis in medicine has been discussed controversially among medical students and faculty members. We examined in a brief but comprehensive study how medical students evaluate their research activities and whether or not alternative thesis models should be implemented. METHODS: A questionnaire comprising 50 questions was evaluated from 160 5th and 6th year medical students at the University of Wuerzburg. RESULTS: Almost two-thirds of our interviewees started working on a thesis project at the beginning of the 4th year of study. 59 % of our participants reported to have neglected the regular study and 56 % said to have prolonged the regular study due to the work on a thesis. Despite considerable variation, the median time spent weekly on a thesis project was 10 hours, independent of where the students worked. The median grade of satisfaction during the whole thesis was rated at 6.5 as assessed on an analogous scale from 1-10 (very satisfied). The research results from 94 students contributed to 164 articles (already published or in press) and the results of 110 students were presented at scientific meetings. Only 50 % of our interviewees were pleased with their published output and the importance of student research activities for the overall German biomedical research was rated 4.4 as assessed on an analogous scale from 1-10 (very important). 70 % of our interviewees preferred defined research periods and 47 % would apply for dual-degree research programmes. The scientific significance of a MD thesis in comparison to a PhD thesis was rated at 2.1 on an analogous scale from 1-5 (5 = equally significant). CONCLUSION: The current German research model might be modified and defined research periods and dual-degree research programmes as a one possible alternative should be considered.

[Neonatal alloimmune thrombocytopenia with hemorrhagic infarction of the right hemisphere]. / Neonatale Alloimmunthrombozytopenie mit hämorrhagischer Infarzierung der rechten Hemisphäre.

Alloimmune thrombocytopenia is the most common cause of severe thrombocytopenia (< 20 000/microliter) in otherwise healthy neonates. The diagnosis is usually made in the diagnostic workup of neonatal hemorrhage. If diagnosis and therapy are delayed the consequences for the affected child can be deleterious. Case report of a full-term neonate with the clinical symptoms of severe hemorrhage and hemorrhagic infarction of the right hemisphere due to neonatal alloimmune thrombocytopenia. While the plasmatic coagulation parameters were unaffected, we detected severe neonatal thrombocytopenia and anemia and identified alloimmune antibodies against the child's thrombocytes in the mother's serum. The antibodies were specific against the platelet antigen HPA-1a. Transfusion of HPA-1a-negative thrombocytes stabilized the platelet count. Anemia was treated by erythrocyte transfusion. Unfortunately, the patient exhibited, most likely intrauterine, intracranial hemorrhage and infarction of the right hemisphere, the most dreaded complication of neonatal alloimmune thrombocytopenia. The identification of severe thrombocytopenia causing the hemorrhage allowed us to start substituting thrombocytes without any delay. The previous diagnosis of alloimmune thrombocytopenia should lead to monitoring a subsequent pregnancy in a specialized unit allowing fetal blood sampling and intrauterine thrombocyte substitution if necessary.This case report exemplifies the symptoms and treatment of neonatal alloimmune thrombocytopenia. The differential diagnosis for a neonate showing clinical signs of hemorrhage should include alloimmune thrombocytopenia which can then be treated adequately. The diagnosis should also lead to careful monitoring of subsequent pregnancies.

Localization of organic cation transporters OCT1 and OCT2 in rat kidney.

Renal excretion and reabsorption of organic cations are mediated by electrogenic and electroneutral organic cation transporters, which belong to a recently discovered family of polyspecific transporters. These transporters are electrogenic and exhibit differences in substrate specificity. In rat, the renal expression of the polyspecific cation transporters rOCT1 and rOCT2 was investigated. By in situ hybridization, significant amounts of both rOCT1 and rOCT2 mRNA were detected in S1, S2, and S3 segments of proximal tubules. By immunohistochemistry, expression of the rOCT1 protein was mainly observed in S1 and S2 segments of proximal tubules, with lower expression levels in the S3 segments. At variance, rOCT2 protein was mainly expressed in the S2 and S3 segments. Both transporters were localized to the basolateral cell membrane. Neither rOCT1 nor rOCT2 was detected in the vasculature, the glomeruli, and nephron segments other than proximal tubules. The data suggest that rOCT1 and rOCT2 are responsible for basolateral cation uptake in the proximal tubule, which represents the first step in cation secretion.

The German medical dissertation--time to change?

German medical students must conduct a research project and write a dissertation in order to receive the title "Doctor." However, the dissertation is not required to graduate, enter a residency, or practice medicine. About 90% of practicing physicians hold the title "Doctor"; a career in academic medicine almost always requires it. Although no convincing evidence supports the usefulness of the dissertation, many regard its completion as important to maintaining a high level of scientific competence and patient care. In recent years, the number of successfully completed dissertations has declined. Lack of time during medical school, the perceived irrelevance of the dissertation to medical practice, and the poor design of many projects may be at least part of the problem. There is also increasing evidence that conducting research frequently delays graduation and may affect clinical skills because students working on projects attend fewer classes, ward rounds, and clinical tutorials and do not spent sufficient time preparing for examinations. The scientific value of students' research has also been criticized; critics point out that students do not have enough time or experience to critically analyze methods and data, and they often are not properly supervised. European unification will probably lead to standardized requirements for medical education and research. The authors hope this will eliminate the dissertation requirement in Germany.

Why German medical students abandon dissertations.

In Germany, conducting a research project followed by writing a thesis is necessary to receive the title "Doctor" but is not necessary to work as a physician. To determine the reasons that students abandon their dissertations, we conducted and analyzed a survey among 160 fifth and sixth-year medical students at the University of Wuerzburg. Fifteen of 160 respondents (9%) reported to have stopped working on their original project before starting their current replacement thesis research project. Among these 15, the major reasons for abandoning the original research project were: seven (47%) reported lack of supervision, three (20%) reported no recognizable progress, and another three (20%) reported an unacceptable burden of work. Unfamiliarity with experimental methods led two students (13%) to stop working on their original research project. Close supervision and a thorough training remain necessary to prevent students from abandoning medical dissertations and thus should be an essential part of every research project in which medical students are involved.

Membrane localization of the electrogenic cation transporter rOCT1 in rat liver.

The polyspecific cation transporter rOCT1 in the rat was the first identified member of a new protein family with 12 presumed membrane-spanning alpha-helices and two large hydrophilic loops. Previous studies showed that rOCT1 is mainly expressed in liver and mediates electrogenic uptake of small organic cations into cells. Antibodies against partial sequences of rOCT1 were raised and their specificity was verified. Immunohistochemistry with rat liver and Western blots with isolated membranes showed that rOCT1 is localized within sinusoidal membranes of hepatocytes. Antibody reactions were also performed with intact and permeabilized human embryonic kidney cells that were stably transfected with rOCT1. They showed that the large hydrophilic loop after the first alpha-helix of rOCT1 is located extracellularly, while the C-terminus is located intracellularly. Translational regulation is suggested since the message of rOCT1 was distributed throughout the liver lobuli, whereas rOCT1 protein was observed only in hepatocytes surrounding the central veins.