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Previous studies have shown the reproducibility of the 2008 World Health Organization (WHO) classification in myelodysplastic syndromes (MDS), especially when multilineage dysplasia or excess of blasts are present. However, there are few data regarding the reproducibility of MDS with unilineage dysplasia. The revised International Prognostic Scoring System R-IPSS described two new morphological categories, distinguishing bone marrow (BM) blast cell count between 0-2 % and >2- < 5 %. This distinction is critical for establishing prognosis, but the reproducibility of this threshold is still not demonstrated. The objectives of our study were to explore the reliability of the 2008 WHO classification, regarding unilineage vs. multilineage dysplasia, by reviewing 110 cases previously diagnosed with MDS, and to study whether the threshold of ≤2 % BM blasts is reproducible among different observers. We used the same methodology as in our previous paper [Font et al. (2013) Ann Hematol 92:19-24], by encouraging investigators to include patients with <5 % BM blasts. Samples were collected from 11 hospitals and were evaluated by 11 morphologists. Each observer evaluated 20 samples, and each sample was analyzed independently by two morphologists. Discordance was observed in 36/108 suitable cases (33 %, kappa test 0.503). Diagnosis of MDS with unilineage dysplasia (refractory cytopenia with unilineage dysplasia (RCUD), refractory anemia with ring sideroblasts (RARS) or unclassifiable MDS) was assessed in 33 patients, by either of the two observers. We combined this series with the cases with RCUD or RARS included in our 2013 paper, thus obtaining 50 cases with unilineage dysplasia by at least one of the observers. The whole series showed very low agreement regarding RCUD (5/23, 21 %) and RARS (5/28, 18 %). Regarding BM blast count, the threshold of ≤2 % was not reproducible (discordance rate 32/108 cases, kappa test 0.277). Our study shows that among MDS WHO 2008 categories, interobserver discordance seems to be high in cases with unilineage dysplasia. We also illustrate that the threshold of ≤2 % BM blasts as settled by the R-IPSS may be not easy to reproduce by morphologists in real practice. [ABSTRACT FROM AUTHOR]

Background & Aims: Two new classification systems for the severity of acute pancreatitis (AP) have been proposed, the determinant-based classification (DBC) and a revision of the Atlanta classification (RAC). Our aim was to validate and compare these classification systems. Methods: We analyzed data from adult patients with AP (543 episodes of AP in 459 patients) who were admitted to Hospital General Universitario de Alicante from December 2007 to February 2013. Imaging results were reviewed, and the classification systems were validated and compared in terms of outcomes. Results: Pancreatic necrosis was present in 66 of the patients (12%), peripancreatic necrosis in 109 (20%), walled-off necrosis in 61 (11%), acute peripancreatic fluid collections in 98 (18%), and pseudocysts in 19 (4%). Transient and persistent organ failures were present in 31 patients (6%) and 21 patients (4%), respectively. Sixteen patients (3%) died. On the basis of the DBC, 386 (71%), 131 (24%), 23 (4%), and 3 (0.6%) patients were determined to have mild, moderate, severe, or critical AP, respectively. On the basis of the RAC, 363 patients (67%), 160 patients (30%), and 20 patients (4%) were determined to have mild, moderately severe, or severe AP, respectively. The different categories of severity for each classification system were associated with statistically significant and clinically relevant differences in length of hospital stay, need for admission to the intensive care unit, nutritional support, invasive treatment, and in-hospital mortality. In comparing similar categories between the classification systems, no significant differences were found. Conclusion: The DBC and the RAC accurately classify the severity of AP in subgroups of patients. [Copyright &y& Elsevier]

The emergence of cooperation in a model for an artificial farming society is studied here by the use of an agent-based model. The system is composed of an ensemble of N agents assumed to have equal access to water, whose availability fluctuates randomly in time. Each agent makes two decisions every sowing season regarding: (1) the type of crop mix to plant and (2) whether s/he joins, or not, a cooperative group that allocates water amongst farmers to maximize the production and share revenues equally. Results show that the degree to which farmers choose to cooperate has a strong dependency on the mean water availability. Cooperation seems to emerge as a way of adaptation to uncertain environments by which individual risk is minimized. [ABSTRACT FROM AUTHOR]

Background aims Cord blood (CB) transplants with co-infusion of third-party donor (TPD) mobilized hematopoietic stem cells (MHSC) have been shown to result in 'bridge' engraftment with prompt neutrophil recovery and high final rates of CB engraftment and full chimerism. This strategy overcomes the limitation posed by low cellularity of CB units for unrelated transplants in adults. Enhancement of adaptive immunity reconstitution without increasing risks of graft-versus-host disease (GvHD) is required to optimize results further. Our objectives were to evaluate co-infusion of mesenchymal stromal cells (MSC) from the same TPD regarding tolerance, CB engraftment and effects on acute (a)GvHD, both preventive and therapeutic. Methods Ex vivo-expanded bone marrow MSC were infused at the time of the transplant or the in case of refractory aGvHD. Results Nine patients received 1.04-2.15×106/kg (median 1.20) MSC immediately after CB and TPD MHSC. Neither immediate adverse side-effects nor significant differences regarding CB engraftment or aGvHD development were observed. Four patients developed grade II aGvHD, refractory to steroids in two. These reached complete remission after therapeutic infusions of MSC. Conclusions In recipients of 'dual CB/TPD MHSC transplants', MSC infusions were therapeutically effective for severe aGvHD but no significant differences in CB engraftment and incidence of severe aGvHD were observed following their prophylactic use. Although results of this study alone cannot conclusively determine the application of MSC in CB transplantation, we believe that, in this setting, the best use of MSC could be as pre-emptive treatment for aGvHD. [ABSTRACT FROM AUTHOR]

Background/Aims: Surveillance programmes (SPs) for hepatocellular carcinoma (HCC) in patients with cirrhosis intend to diagnose the tumour in its early stages when an effective therapy can be applied. The aims of this study have been to compare the survival of patients with HCC being diagnosed or not in SPs, and to establish a more accurate profile of the best target population. Methods: From January 1996 to June 2005, 290 patients with HCC were included. The relationship between being diagnosed or not in an SP and survival has been analysed in a univariate analysis. Pretreatment variables found to be significant predictors of survival in univariate analysis were included in a multivariate analysis. Results: The mean survival for patients diagnosed in SPs (27 months, 16.6–37.4) was significantly longer than in patients being diagnosed out of these programmes (6 months, 2.6–9.4) ( P=0.001). Child–Pugh class A [β 1.4, 95% confidence interval (CI) 1.14–1.78; P=0.0002] and being diagnosed in SPs (β 0.4, 95% CI 0.3–0.6; P=0.0003) became the only independent predictive factors of longer survival. Conclusions: SPs for HCC allow the detection of small tumours and the application of intention-to-cure therapies, which improves survival. However, these programmes do not improve prognosis in patients with advanced cirrhosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case study of a 60-year-old man diagnosed with visceral leishmaniasis (VL) following hematopoietic stem cell transplantation.

Glycoside hydrolase family 31 (GH31) is a diversified family of anomer-retaining α-glycoside hydrolases, such as α-glucosidase and α-xylosidase, among others. Recently, GH31 α- N -acetylgalactosaminidases (Nag31s) have been identified to hydrolyze the core of mucin-type O -glycans and the crystal structure of a gut bacterium Enterococcus faecalis Nag31 has been reported. However, the mechanisms of substrate specificity and hydrolysis of Nag31s are not well investigated. Herein, we show that E. faecalis Nag31 has the ability to release N -acetylgalactosamine (GalNAc) from O -glycoproteins, such as fetuin and mucin, but has low activity against Tn antigen. Mutational analysis and crystal structures of the Michaelis complexes reveal that residues of the active site work in concert with their conformational changes to act on only α- N -acetylgalactosaminides. Docking simulations using GalNAc-attached peptides suggest that the enzyme mainly recognizes GalNAc and side chains of Ser/Thr, but not strictly other peptide residues. Moreover, quantum mechanics calculations indicate that the enzyme preferred p -nitrophenyl α- N -acetylgalactosaminide to Tn antigen and that the hydrolysis progresses through a conformational itinerary, 4 C 1 → 1 S 3 → 4 C 1 , in GalNAc of substrates. Our results provide novel insights into the diversification of the sugar recognition and hydrolytic mechanisms of GH31 enzymes. [Display omitted] • EfGH31 released N -acetylgalactosamine from fetuin and bovine submaxillary mucin. • Crystal structures of EfGH31 complexed with substrates were determined. • The active site residues important for hydrolysis and substrate-binding were identified. • QM calculation revealed its conformational itinerary and reactivity. [ABSTRACT FROM AUTHOR]

This work presents experimental and computational studies on ZnO formation after decomposition of a sol-gel precursor containing ethanolamine and Zn(II) acetate. The structural modifications suffered during decomposition of the monomeric and dimeric Zn(II) complexes formed, containing bidentate deprotonated ethanolamine and acetato ligands, have been described experimentally and explained via Car-Parrinello Molecular Dynamics. Additional metadynamics simulations provide an overview of the dimer evolution by the cleavage of the Zn–N bond, the structural changes produced and their effects on the Zn(II) environment. The results provide conclusive evidence of the relevance of ethanolamine used as a stabilizer in the formation of ZnO. [ABSTRACT FROM AUTHOR]

Introduction : Deaf individuals in Colombia possess the distinctive trait of communicating with others through Colombian Sign Language (LSC) and encounter communication challenges when accessing health services due to their affiliation with a linguistic and cultural minority. Objectives : To describe the experiences of Deaf individuals in communicative processes during dental care. Methodology: A qualitative study was conducted involving 32 Deaf individuals, both male and female, of legal age, who participated in individual and group interviews. Throughout these interviews, participants shared instances of their experiences in dental consultations. Data were coded, categorized, and relationship maps were developed for analysis. Results were communicated to participants through educational material in sign language. Results : Participants narrate the challenges faced in autonomously accessing health services, as well as their experience of being uninformed during care. They also highlight opportunities for receiving dignified and quality care, necessitating transformations in services, healthcare professionals, and higher education institutions within the context of Deaf culture. Conclusions : Communicative processes in the interaction between dentists and Deaf individuals present an opportunity to better comprehend the Deaf experience in healthcare, question the normalcy in healthcare provision, and recognize the importance of addressing differences. [ABSTRACT FROM AUTHOR]

The processes involved in the assembly of zinc acetate dihydrate {Zn(CH 3 COO) 2 ·2H 2 O} and ethanolamine (H 2 NCH 2 CH 2 OH), with or without 2-methoxyethanol as solvent, have been analysed by infrared spectra, mass spectrometry, nuclear magnetic resonance, powder X-ray diffraction and computational studies. Thermal evolution of the mixtures was characterized by thermoanalytical and structural techniques (thermogravimetry, differential thermal analysis, differential scanning calorimetry, X-ray diffraction and X-Ray photoelectron spectroscopy). Computational studies together with experiments served to thoroughly describe the precursor and its decomposition. The thermal decomposition of the mixture and its transformation into crystalline ZnO take place in a temperature range between 50 and 450 °C through different processes. With solvent, the processes need temperatures 90 °C higher with respect to the mixture without solvent, and ZnO arises at 250 °C. [ABSTRACT FROM AUTHOR]

Tapentadol (TAP) and oxycodone/naloxone (OXN) potentially offer an improved opioid tolerability. However, real-world studies in chronic non-cancer pain (CNCP) remain scarce. Our aim was to compare effectiveness and security in daily pain practice, together with the influence of pharmacogenetic markers. An observational study was developed with ambulatory test cases under TAP (n = 194) or OXN (n = 175) prescription with controls (prescribed with other opioids (control), n = 216) CNCP patients. Pain intensity and relief, quality of life, morphine equivalent daily doses (MEDD), concomitant analgesic drugs, adverse events (AEs), hospital frequentation and genetic variants of OPRM1 (rs1799971, A118G) and COMT (rs4680, G472A) genes, were analysed. Test CNCP cases evidenced a significantly higher pain relief predictable due to pain intensity and quality of life (R2 = 0.3), in front of controls. Here, OXN achieved the greatest pain relief under a 28% higher MEDD, 8–13% higher use of pregabalin and duloxetine, and 23% more prescription change due to pain, compared to TAP. Whilst, TAP yielded a better tolerability due the lower number of 4 [0–6] AEs/patient, in front of OXN. Furthermore, OXN COMT-AA homozygotes evidenced higher rates of erythema and vomiting, especially in females. CNCP real-world patients achieved higher pain relief than other traditional opioids with a better tolerability for TAP. Further research is necessary to clarify the potential influence of COMT and sex on OXN side-effects. [ABSTRACT FROM AUTHOR]

The most abundant N6-methyladenosine (m6A) modification on mRNAs is installed non-stoichiometrically across transcripts, with 5′ untranslated regions (5′ UTRs) being the least conductive. 5′ UTRs are essential for translation initiation, yet the molecular mechanisms orchestrated by m6A remain poorly understood. Here, we combined structural, biochemical, and single-molecule approaches and show that at the most common position, a single m6A does not affect translation yields, the kinetics of translation initiation complex assembly, or start codon recognition both under permissive growth and following exposure to oxidative stress. Cryoelectron microscopy (cryo-EM) structures of the late preinitiation complex reveal that m6A purine ring established stacking interactions with an arginine side chain of the initiation factor eIF2α, although with only a marginal energy contribution, as estimated computationally. These findings provide molecular insights into m6A interactions with the initiation complex and suggest that the subtle stabilization is unlikely to affect the translation dynamics under homeostatic conditions or stress. [Display omitted] • m6A in the close proximity of the start codon does not affect translation yields • Single m6A in the 5′ UTR does not alter initiation complex assembly kinetics • m6A establishes stacking interactions with an arginine side chain of eIF2α • The stacking interactions between m6A and Arg(eIF2α) have marginal energetic contribution Guca et al. use an integrative approach, including functional, structural, single-molecule, and computational approaches, and show that a single m6A in the 5′ UTR does not affect translation dynamics under homeostatic conditions or stress. They observe interactions between m6A with an arginine side chain of eIF2α, although with only a marginal energy contribution. [ABSTRACT FROM AUTHOR]

Background: Trypanosoma cruzi, the agent of Chagas disease, is a protozoan parasite transmitted to humans by blood-sucking triatomine vectors. However, and despite its utmost biological and epidemiological relevance, T. cruzi development inside the digestive tract of the insect remains a poorly understood process. Methods/Principle findings: Here we showed that Gp35/50 kDa mucins, the major surface glycoproteins from T. cruzi insect-dwelling forms, are involved in parasite attachment to the internal cuticle of the triatomine rectal ampoule, a critical step leading to its differentiation into mammal-infective forms. Experimental evidence supporting this conclusion could be summarized as follows: i) native and recombinant Gp35/50 kDa mucins directly interacted with hindgut tissues from Triatoma infestans, as assessed by indirect immunofluorescence assays; ii) transgenic epimastigotes over-expressing Gp35/50 kDa mucins on their surface coat exhibited improved attachment rates (~2–3 fold) to such tissues as compared to appropriate transgenic controls and/or wild-type counterparts; and iii) certain chemically synthesized compounds derived from Gp35/50 kDa mucins were able to specifically interfere with epimastigote attachment to the inner lining of T. infestans rectal ampoules in ex vivo binding assays, most likely by competing with or directly blocking insect receptor(s). A solvent-exposed peptide (smugS peptide) from the Gp35/50 kDa mucins protein scaffolds and a branched, Galf-containing trisaccharide (Galfβ1–4[Galpβ1–6]GlcNAcα) from their O-linked glycans were identified as main adhesion determinants for these molecules. Interestingly, exogenous addition of a synthetic Galfβ1–4[Galpβ1–6]GlcNAcα derivative or of oligosaccharides containing this structure impaired the attachment of Dm28c but not of CL Brener epimastigotes to triatomine hindgut tissues; which correlates with the presence of Galf residues on the Gp35/50 kDa mucins’ O-glycans on the former but not the latter parasite clone. Conclusion/Significance: These results provide novel insights into the mechanisms underlying T. cruzi-triatomine interplay, and indicate that inter-strain variations in the O-glycosylation of Gp35/50 kDa mucins may lead to differences in parasite differentiation and hence, in parasite transmissibility to the mammalian host. Most importantly, our findings point to Gp35/50 kDa mucins and/or the Galf biosynthetic pathway, which is absent in mammals and insects, as appealing targets for the development of T. cruzi transmission-blocking strategies. [ABSTRACT FROM AUTHOR]

We present the clinical case of a patient who, having been referred for surgery on two-stage hepatectomy, could not have a conventional portal embolization performed as an intermediate step in order to be able to resection the whole of the hepatic illness she was suffering. During right portal embolization (PE), the portography revealed minimal flow in the left portal vein, without thrombosis or stenosis. Given the risk of serious hepatic insufficiency, the embolization procedure was ruled out. Our option was to perform a portal embolization in two stages: initial PE of the right posterior branch, and subsequently, right anterior branch PE. After that, the liver resection could be completed. [ABSTRACT FROM AUTHOR]

Objective, Methods, and Results. To reduce the period of posttransplant neutropenia and related early morbidity and mortality of cord blood (CB) transplants, we assessed the feasibility of co-infusion of a low number of highly purified peripheral blood CD34+ cells from a related haploidentical donor with a CB graft. Between March 1999 and May 2002, 11 patients with high-risk hematologic malignancies were transplanted using this strategy. The seven patients who received a haploidentical peripheral blood graft and a CB graft from a sibling (6) or the father (1) had prompt recovery (9–17 days, median 10) of the absolute neutrophil count (ANC) to greater than 0.5×109/L. Analysis of DNA polymorphisms showed initial predominance of the haploidentical genotype both in granulocytes and in mononuclear cells, and subsequent progressive replacement by cells of CB genotype until final complete CB chimerism was achieved by patients who survived for sufficient periods of time. The four patients who received maternal haploidentical cells had no significant contribution of these to blood leukocytes, although complete CB chimerism was achieved by three of them and two reached engraftment of the CB on days +20 and +36. Morbidity due to early bacterial or fungal infections was remarkably low in patients with prompt ANC recovery.Conclusion. Our data show that co-infusion of a CB unit and a low number of haploidentical CD34+ cells may result in a shortened period of posttransplant neutropenia. This is likely the result of prompt and transient engraftment of the haploidentical hematopoietic stem cells that may provide the patient antimicrobial protection until the later engraftment of the CBhematopoietic stem cells. [Copyright &y& Elsevier]