Long time to diagnosis of medulloblastoma in children is not associated with decreased survival or with worse neurological outcome

Background

The long time to diagnosis of medulloblastoma, one of the most frequent brain tumors in children, is the source of painful remorse and sometimes lawsuits. We analyzed its consequences for tumor stage, survival, and sequelae.

Patients and Methods

This retrospective population-based cohort study included all cases of pediatric medulloblastoma from a region of France between 1990 and 2005. We collected the demographic, clinical, and tumor data and analyzed the relations between the interval from symptom onset until diagnosis, initial disease stage, survival, and neuropsychological and neurological outcome.

Results

The median interval from symptom onset until diagnosis for the 166 cases was 65 days (interquartile range 31–121, range 3–457). A long interval (defined as longer than the median) was associated with a lower frequency of metastasis in the univariate and multivariate analyses and with a larger tumor volume, desmoplastic histology, and longer survival in the univariate analysis, but not after adjustment for confounding factors. The time to diagnosis was significantly associated with IQ score among survivors. No significant relation was found between the time to diagnosis and neurological disability. In the 62 patients with metastases, a long prediagnosis interval was associated with a higher T stage, infiltration of the fourth ventricle floor, and incomplete surgical resection; it nonetheless did not influence survival significantly in this subgroup.

Conclusions

We found complex and often inverse relations between time to diagnosis of medulloblastoma in children and initial severity factors, survival, and neuropsychological and neurological outcome. This interval appears due more to the nature of the tumor and its progression than to parental or medical factors. These conclusions should be taken into account in the information provided to parents and in expert assessments produced for malpractice claims.     

Immune Phenotype and Body Condition in Roe Deer: Individuals with High Body Condition Have Different,Not Stronger Immunity

An efficient immunity is necessary for host survival, but entails energetic costs. When energy is limited, immunocompetence and body condition should co-vary positively among individuals and, depending on body condition, individuals should allocate more either in innate immunity or in adaptive response. We tested whether immune phenotype depends on body condition in large mammals, using data from two contrasted populations of roe deer Capreolus capreolus in France. Roe deer living at Chizé, a forest with poor habitat quality, were expected to show lower values for body condition and immune parameters than roe deer at Trois Fontaines, a forest with high habitat quality. From 285 blood samples collected between December 2009 and March 2011, we measured seven metabolic parameters and ten immunological parameters. A Principal Component Analysis showed that all indicators of body condition co-varied positively and were lowest at Chizé. Several immunological indicators correlated to body condition and differed between Trois Fontaines and Chizé. However, high body condition was not associated to a high average level of immunocompetence, but instead to high levels of indicators of acute inflammatory innate response, while low body condition was associated to high levels of monocytes and lymphocytes, possibly reflecting adaptive immunity. Limited data suggest that the difference between populations was not related to the presence of specific parasite species, however parasite exposure and stress have to be investigated to gain a more complete understanding of the determinants of immunity.     

Hepcidin-25 in chronic hemodialysis patients is related to residual kidney function and not to treatment with erythropoiesis stimulating agents

Hepcidin-25, the bioactive form of hepcidin, is a key regulator of iron homeostasis as it induces internalization and degradation of ferroportin, a cellular iron exporter on enterocytes, macrophages and hepatocytes. Hepcidin levels are increased in chronic hemodialysis (HD) patients, but as of yet, limited information on factors associated with hepcidin-25 in these patients is available. In the current cross-sectional study, potential patient-, laboratory- and treatment-related determinants of serum hepcidin-20 and -25, were assessed in a large cohort of stable, prevalent HD patients. Baseline data from 405 patients (62% male; age 63.7 ± 13.9 [mean SD]) enrolled in the CONvective TRAnsport STudy (CONTRAST; NCT00205556) were studied. Predialysis hepcidin concentrations were measured centrally with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Patient-, laboratory- and treatment related characteristics were entered in a backward multivariable linear regression model. Hepcidin-25 levels were independently and positively associated with ferritin (p<0.001), hsCRP (p<0.001) and the presence of diabetes (p = 0.02) and inversely with the estimated glomerular filtration rate (p = 0.01), absolute reticulocyte count (p = 0.02) and soluble transferrin receptor (p<0.001). Men had lower hepcidin-25 levels as compared to women (p = 0.03). Hepcidin-25 was not associated with the maintenance dose of erythropoiesis stimulating agents (ESA) or iron therapy. In conclusion, in the currently studied cohort of chronic HD patients, hepcidin-25 was a marker for iron stores and erythropoiesis and was associated with inflammation. Furthermore, hepcidin-25 levels were influenced by residual kidney function. Hepcidin-25 did not reflect ESA or iron dose in chronic stable HD patients on maintenance therapy. These results suggest that hepcidin is involved in the pathophysiological pathway of renal anemia and iron availability in these patients, but challenges its function as a clinical parameter for ESA resistance.     

Identifying More Epidemic Clones during a Hospital Outbreak of Multidrug-Resistant Acinetobacter baumannii

Infections caused by multidrug-resistant bacteria are a major concern in hospitals. Current infection-control practices legitimately focus on hygiene and appropriate use of antibiotics. However, little is known about the intrinsic abilities of some bacterial strains to cause outbreaks. They can be measured at a population level by the pathogen’s transmission rate, i.e. the rate at which the pathogen is transmitted from colonized hosts to susceptible hosts, or its reproduction number, counting the number of secondary cases per infected/colonized host. We collected data covering a 20-month surveillance period for carriage of multidrug-resistant Acinetobacter baumannii (MDRAB) in a surgery ward. All isolates were subjected to molecular fingerprinting, and a cluster analysis of profiles was performed to identify clonal groups. We then applied stochastic transmission models to infer transmission rates of MDRAB and each MDRAB clone. Molecular fingerprinting indicated that 3 clonal complexes spread in the ward. A first model, not accounting for different clones, quantified the level of in-ward cross-transmission, with an estimated transmission rate of 0.03/day (95% credible interval [0.012–0.049]) and a single-admission reproduction number of 0.61 [0.30–1.02]. The second model, accounting for different clones, suggested an enhanced transmissibility of clone 3 (transmission rate 0.047/day [0.018–0.091], with a single-admission reproduction number of 0.81 [0.30–1.56]). Clones 1 and 2 had comparable transmission rates (respectively, 0.016 [0.001–0.045], 0.014 [0.001–0.045]). The method used is broadly applicable to other nosocomial pathogens, as long as surveillance data and genotyping information are available. Building on these results, more epidemic clones could be identified, and could lead to follow-up studies dissecting the functional basis for variation in transmissibility of MDRAB lineages.     

Pollen productivity estimates of key European plant taxa for quantitative reconstruction of past vegetation: a review

Information on the spatial distribution of past vegetation on local, regional and global scales is increasingly used within climate modelling, nature conservancy and archaeology. It is possible to obtain such information from fossil pollen records in lakes and bogs using the landscape reconstruction algorithm (LRA) and its two models, REVEALS and LOVE. These models assume that reliable pollen productivity estimates (PPEs) are available for the plant taxa involved in the quantitative reconstructions of past vegetation, and that PPEs are constant through time. This paper presents and discusses the PPEs for 15 tree and 18 herb taxa obtained in nine study areas of Europe. Observed differences in PPEs between regions may be explained by methodological issues and environmental variables, of which climate and related factors such as reproduction strategies and growth forms appear to be the most important. An evaluation of the PPEs at hand so far suggests that they can be used in modelling applications and quantitative reconstructions of past vegetation, provided that consideration of past environmental variability within the region is used to inform selection of PPEs, and bearing in mind that PPEs might have changed through time as a response to climate change. Application of a range of possible PPEs will allow a better evaluation of the results.     

Pollen productivity estimates and relevant source area of pollen for selected plant taxa in a pasture woodland landscape of the Jura Mountains (Switzerland)

Relevant source area of pollen (RSAP) and pollen productivity for 11 key taxa characteristic of the pasture woodland landscape of the Jura Mountains, Switzerland, were estimated using pollen assemblages from moss polsters at 20 sites. To obtain robust pollen productivity estimates (PPEs), we used vegetation survey data at a fine spatial-resolution (1 × 1 m²) and randomized locations for sampling sites, techniques rarely used in palynology. Three Extended R value (ERV) submodels and three distance-weighting methods for plant abundance calculation were applied. Different combinations of the submodels and distance-weighting methods provide slightly different estimates of RSAP and PPEs. Although ERV submodel 1 using 1/d (d = distance in meters) best fits the dataset, PPE values for heavy pollen types (e.g. Abies) were sensitive to the method used for distance-weighting. Taxon-specific distance-weighting methods, such as Prentice’s model, emphasize the intertaxonomic differences in pollen dispersal and deposition, and are thus theoretically sound. For the dataset obtained in this project, Prentice’s model was more appropriate than other distance-weighting methods to estimate PPEs. Most of the taxa have PPEs equal to (Fagus, Plantago media and Potentilla-type), or higher (Abies, Picea, Rubiaceae and Trollius europaeus) than Poaceae (PPE = 1). Acer, Cyperaceae, and Plantago montana-type are low pollen producers. This set of PPEs will be useful for reconstructing heterogeneous, mountainous pasture woodland landscapes from fossil pollen records. The RSAP for moss polsters in this semi-open landscape region is ca. 300 m.     

The use of modelling and simulation approach in reconstructing past landscapes from fossil pollen data: a review and results from the POLLANDCAL network

Information on past land cover in terms of absolute areas of different landscape units (forest, open land, pasture land, cultivated land, etc.) at local to regional scales is needed to test hypotheses and answer questions related to climate change (e.g. feedbacks effects of land-cover change), archaeological research, and nature conservancy (e.g. management strategy). The palaeoecological technique best suited to achieve quantitative reconstruction of past vegetation is pollen analysis. A simulation approach developed by Sugita (the computer model POLLSCAPE) which uses models based on the theory of pollen analysis is presented together with examples of application. POLLSCAPE has been adopted as the central tool for POLLANDCAL (POLlen/LANdscape CALibration), an international research network focusing on this topic. The theory behind models of the pollen–vegetation relationship and POLLSCAPE is reviewed. The two model outputs which receive greatest attention in this paper are the relevant source area of pollen (RSAP) and pollen loading in mires and lakes. Six examples of application of POLLSCAPE are presented, each of which explores a possible use of the POLLANDCAL tools and a means of validating or evaluating the models with empirical data. The landscape and vegetation factors influencing the size of the RSAP, the importance of pollen productivity estimates (PPEs) for the model outputs, the detection of small and rare patches of plant taxa in pollen records, and quantitative reconstructions of past vegetation and landscapes are discussed on the basis of these examples. The simulation approach is seen to be useful both for exploring different vegetation/landscape scenarios and for refuting hypotheses.     

Characterization of lipid domains in reconstituted porcine lens membranes using EPR spin-labeling approaches

The physical properties of membranes derived from the total lipid extract of porcine lenses before and after the addition of cholesterol were investigated using EPR spin-labeling methods. Conventional EPR spectra and saturation-recovery curves indicate that the spin labels detect a single homogenous environment in membranes before the addition of cholesterol. After the addition of cholesterol (when cholesterol-to-phospholipid mole to mole ratio of 1.55-1.80 was achieved), two domains were detected by the discrimination by oxygen transport method using a cholesterol analogue spin label. The domains were assigned to a bulk phospholipid-cholesterol bilayer made of the total lipid mixture and to a cholesterol crystalline domain. Because the phospholipid analogue spin labels cannot partition into the pure cholesterol crystalline domain, they monitor properties of the phospholipid-cholesterol domain outside the pure cholesterol crystalline domain. Profiles of the order parameter, hydrophobicity, and oxygen transport parameter are identical within experimental error in this domain when measured in the absence and presence of a cholesterol crystalline domain. This indicates that both domains, the phospholipid-cholesterol bilayer and the pure cholesterol crystalline domain, can be treated as independent, weakly interacting membrane regions. The upper limit of the oxygen permeability coefficient across the cholesterol crystalline domain at 35 degrees C had a calculated value of 42.5 cm/s, indicating that the cholesterol crystalline domain can significantly reduce oxygen transport to the lens center. This work was undertaken to better elucidate the major factors that determine membrane resistance to oxygen transport across the lens lipid membrane, with special attention paid to the cholesterol crystalline domain.     

Life cycle period and activity of prey influence their susceptibility to predators

In a multi‐prey system, predators kill different kinds of prey according to their availability, where “availability” is a function of prey abundance and vulnerability (e.g. anti‐predator behavior). We hypothesized that prey availability changes seasonally, for instance because reproduction leads to a higher abundance of young in spring and summer or because changes in behavior such as during the mating season makes the prey periodically more vulnerable. We tested this hypothesis in a simple predator‐prey system in the Jura Mountains of Switzerland and France, where a single large mammalian predator, the Eurasian lynx, preys upon two ungulate species, the roe deer and the chamois. In 1996 and 1997 we were able to assign a total of 190 roe deer and 54 chamois killed by lynx to a specific age and sex class (males, females or juveniles). As expected, the proportion of juveniles killed varied considerably among periods, being at the highest from 1st of June to 15th of August. No significant seasonal differences were detected regarding the frequency of predation on males versus females. In particular, the interaction between species and period, expected because of different timing of the rutting period between roe deer and chamois, was not significant. Females were killed only slightly more often during gestation. The relationship between prey abundance and vulnerability is highly complex, as the lynx’ prey selection needs to be analyzed not only horizontally (changes of a specific prey category with season) but also vertically (an increase in the vulnerability of one category releases predation pressure on others). Second, we predicted that certain activities, such as feeding, expose prey to predation more than others. We found more chamois predated when feeding, whereas roe deer were predated mainly when ruminating. This interspecific discrepancy reflects differences either in the anti‐predator behavior of roe deer and chamois or in the relative time allocation to feeding and ruminating between the two species.     

ATP regulation of a large conductance voltage-gated cation channel in rough endoplasmic reticulum of rat hepatocytes

ATP-sensitive K⁺ channels play an important role in regulating membrane potential during metabolic stress. In this work we report the effect of ATP and ADP-Mg on a K⁺ channel present in the membrane of rough endoplasmic reticulum (RER) from rat hepatocytes incorporated into lipid bilayers. Channel activity was found to decrease in presence of ATP 100 μM on the cytoplasmic side and was totaly inhibited at ATP concentrations greater than 0.25 mM. The effect appeared voltage dependent, suggesting that the ATP binding site was becoming available upon channel opening. Channel activity was suppressed by the nonhydrolyzable ATP analog (ATPγS), ruling out a phosphorylation-based mechanism. Notably addition of 2.5 mM ADP-Mg to the cytosolic side increased the channel open probability at negative potentials. We conclude that the large conductance voltage-gated cation channel in RER of rat hepatocytes is an ATP and ADP sensitive channel likely to be involved in cellular processes such as Ca²⁺ signaling or control of membrane potential across the endoplasmic reticulum membrane.