Clinicopathological Impact of FOXM1 and MMP-9 Immunohistochemical Expression in Different Grades of Intracranial Meningioma.

OBJECTIVES: To find predictive biomarkers for recurrence and progression of meningioma. BACKGROUND: Despite great advances in meningioma treatment, the prognosis remained unfavorable due to the high recurrence rate. METHODS: In this study, we evaluated the immunohistochemical expression of FOXM1, MMP-9, and Ki67 in 50 cases of intracranial meningioma to detect its potential role in meningioma progression, recurrence, and patients' survival. RESULTS: Strong FOXM1 expression was detected in 20% of the cases and was significantly associated with meningioma grade ( P = 0.002) and peritumoral brain edema (PTBE; P <0.001). Strong MMP-9 expression was noted in 32% of the cases and was significantly associated with meningioma grade and PTBE ( P <0.001, P <0.001, respectively). High Ki67 was noted in 50% and significantly associated with tumor grade and PTBE ( P <0.001, P = 0.002, respectively). The follow-up period revealed that meningiomas with strong FOXM1, strong MMP-9, and high Ki67 expression were associated with tumor recurrence, shorter OS, and recurrence-free survival. Furthermore, up-regulation of FOXM1 and MMP-9 expression had a significant relation with poor clinical response to the therapy ( P = 0.010, P = 0. 001, respectively). However, high Ki67 cases were more sensitive to clinical therapy ( P = 0.005). CONCLUSION: Strong FOXM1, strong MMP-9, and high Ki67 in meningiomas indicate highly aggressive tumors with a shortened survival rate, dismal outcome, and high risk of recurrence after the standard protocol of therapy.

Modified round block technique for peripherally located early cancer breast, a technique that fits for all quadrants.

Round block technique (RBT) is an oncoplastic technique used in periareolar lesions, particularly in breasts with moderate ptosis or hypertrophy. However, it has some drawbacks including the possibility of late-onset scar widening, change in areolar shape, and asymmetry of the breasts. Moreover, it is hard to be performed with tumors located in periphery of breast. Modified round block technique (MRBT) is a new technique described to overcome these problems. A circumferential periareolar incision was made around the areola followed by subcutaneous dissection to the entire breast. Wide local excision (WLE) could then easily be performed with a good field of view, the breast tumor was excised with an acceptable macroscopic safety margin, and specimens were marked with orienting sutures for intraoperative frozen section. Remodeling of the breast was done, a close suction drain was placed, and the wound was narrowed with a nonabsorbable purse-string suture and attached to the NAC with continuous subcuticular absorbable suture. This study was conducted on 144 female patients diagnosed with breast cancer. The median size of the tumor was 2 cm, the majority of the patients (66.7%) had moderate breast size (cup B) and the median distance of the tumor from NAC was 7 cm. Patients' satisfaction was assessed according to Harvard scale and good to excellent results were found in 88.8% of the patients. There were no postoperative changes in areolar shape or position. Complications in the form of hematoma, wound dehiscence, and infection were encountered in 25% of the patients. Modified round block technique is an oncoplastic technique that permits excision of peripherally located breast cancer without excision of periareolar skin and it is suitable for all quadrant tumors. It also avoids the scar which occurs after ordinary breast-conserving surgery.

Ixodes ricinus as a vector of Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum and Babesia microti in urban and suburban forests.

In the suburban and urban forests in the cities of Gdansk, Sopot and Gdynia (northern Poland), Ixodes ricinus ticks should be considered as the vector of pathogenic microorganisms that may cause significant diseases in wild and domestic animals and humans. These microorganisms include etiologic agents of Lyme disease, human anaplasmosis (HA) and babesiosis: Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum and Babesia microti, respectively. DNA extracts from 701 ticks collected in 15 localities were examined by PCR for the simultaneous detection of these 3 pathogens. Overall, 14 % were infected with A. phagocytophilum followed by 12.4 % with B. burgdorferi s.l. and 2.3 % with B. microti. In total, the percentage of infected females (32.9 %) was 2.4 times higher than in males (13.7 %) and 3.2 times higher than in nymphs (10.3 %). Among adult ticks (n = 303), 8.3 % were dually infected with A. phagocytophilum and B. burgdorferi s.l., 2.0 % with the agent of human anaplasmosis and B. microti and 0.3 % with borreliae and B. microti.