Primary diffuse large B-cell lymphoma of the head and neck in a Brazilian single-center study.

OBJECTIVES: Lymphomas represent around 10% of head and neck neoplasms, among which the diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype. In the present study, we characterized demographic parameters, anatomical sites, and survival rates of patients in a Brazilian cancer center. MATERIALS AND METHODS: Single-center retrospective epidemiological study of 243 head and neck DLBCL patients. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) activity, and treatment modality were obtained from electronic medical records. RESULTS: The most common primary head and neck tumor location in patients with DLBCL was Waldeyer's ring. Interestingly, age above 80 years, male gender, high LDH levels, and HIV positivity were significantly associated with shorter overall survival (OS) rates and increased risk of death. We further demonstrated that treatment had a protective effect, improving OS, and reducing risk of death. Notably, we found no benefit of combination of chemotherapy and radiotherapy versus isolated treatment modalities. CONCLUSION: The study showed that primary head and neck DLBCL is more incident in middle age and elderly patients with a small male patients' majority in a Brazilian population. Moreover, we observed a 3-year OS rate of almost 60% and multivariate analysis showed that treatment was the only protective factor.

Survival analysis and development of a prognostic nomogram for patients with malignant mesothelioma in different anatomic sites.

Background: Malignant mesothelioma (MMe) is a rare and fatal cancer with a poor prognosis. Our study aimed to compare the overall survival (OS) of MMe patients across various sites and develop a prognostic model to provide a foundation for individualized management of MMe patients. Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, 1,772 individuals with malignant mesothelioma (MMe) were identified. The X-tile software was used to identify the optimal cut-off point for continuous variables. The Kaplan-Meier method was employed to compare the survival of MMe across different sites. The Cox proportional hazards model was applied to identify the independent risk factors of overall survival (OS) and a nomogram was constructed. Results: In the survival analysis, MMe originating from the reproductive organs and hollow organs showed a relatively better prognosis than those originating from soft tissue, solid organs, and pleura. Age, gender, location, histological type, grade of differentiation, extent of disease, lymph node status, lymph node ratio (LNR), and chemotherapy were all found to be independent risk variables for the prognosis of MMe patients (P<0.05) in a multivariate Cox analysis and were included in the construction of nomogram. In the training and testing sets, the C-index of the nomogram was 0.701 and 0.665, respectively, and the area under the ROC curve (AUROC) of the 1-, 3-, and 5-year overall survival rate was 0.749, 0.797, 0.833 and 0.730, 0.800, 0.832, respectively. The calibration curve shows that the nomogram is well-calibrated. Conclusions: This is the first research to examine the prognosis of MMe patients based on the location. However, previous studies often focused on malignant pleural mesothelioma or malignant peritoneal mesothelioma with high incidence. Furthermore, a nomograph with good prediction efficiency was established according to the variables that influence patient survival outcomes, which provides us with a reference for clinical decision-making.

Prognostic nomogram for adenoid cystic carcinoma in different anatomic sites.

BACKGROUND: Adenoid cystic carcinoma (ACC) is a relatively uncommon tumor. The existing prediction model is limited to the head and neck. We aim to construct a prognostic nomogram combined with the clinical features and treatment options of ACC to predict the disease-specific survival (DSS) of patients diagnosed with ACC in different anatomic sites. METHODS: A novel predictive model was constructed using 1285 patients with ACC from the Surveillance, Epidemiology, and End Results (SEER) registry between 2010 and 2015. The performance of this model was externally validated using 118 patients with ACC in the West China Hospital, Sichuan University between 2010 and 2017. RESULTS: The prognostic model demonstrated that age, primary site, lymph node metastasis, distant metastasis, radiotherapy and surgery were independent factors for DSS. The validation of the model using an external cohort proved its reliability. CONCLUSION: The developed novel predictive model is shown to provide accurate and efficient predictive information for patients with ACC for different anatomic sites.

Impact of Antiretroviral Therapy Duration on HIV-1 Infection of T Cells within Anatomic Sites.

Understanding the impact of antiretroviral therapy (ART) duration on HIV-infected cells is critical for developing successful curative strategies. To address this issue, we conducted a cross-sectional/inter-participant genetic characterization of HIV-1 RNA from pre- and on-therapy plasmas and HIV-1 DNA from CD4+ T cell subsets derived from peripheral blood (PB), lymph node (LN), and gut tissues of 26 participants after 3 to 17.8 years of ART. Our studies revealed in four acute/early participants who had paired PB and LN samples a substantial reduction in the proportion of HIV-infected cells per year on therapy within the LN. Extrapolation to all 12 acute/early participants estimated a much smaller reduction in the proportion of HIV-1-infected cells within LNs per year on therapy that was similar to that in the participants treated during chronic infection. LN-derived effector memory T (TEM) cells contained HIV-1 DNA that was genetically identical to viral sequences derived from pre- and on-therapy plasma samples. The proportion of identical HIV-1 DNA sequences increased within PB-derived TEM cells. However, the infection frequency of TEM cells in PB was stable, indicating that cellular proliferation that compensates for T cell loss over time contributes to HIV-1 persistence. This study suggests that ART reduces HIV-infected T cells and that clonal expansion of HIV-infected cells maintains viral persistence. Importantly, LN-derived TEM cells are a probable source of HIV-1 genomes capable of producing infectious HIV-1 and should be targeted by future curative strategies.IMPORTANCE HIV-1 persists as an integrated genome in CD4+ memory T cells during effective therapy, and cessation of current treatments results in resumption of viral replication. To date, the impact of antiretroviral therapy duration on HIV-infected CD4+ T cells and the mechanisms of viral persistence in different anatomic sites is not clearly elucidated. In the current study, we found that treatment duration was associated with a reduction in HIV-infected T cells. Our genetic analyses revealed that CD4+ effector memory T (TEM) cells derived from the lymph node appeared to contain provirus that was genetically identical to plasma-derived virions. Moreover, we found that cellular proliferation counterbalanced the decay of HIV-infected cells throughout therapy. The contribution of cellular proliferation to viral persistence is particularly significant in TEM cells. Our study emphasizes the importance of HIV-1 intervention and provides new insights into the location of memory T cells infected with HIV-1 DNA, which is capable of contributing to viremia.

The Prevalence of Sensitive Skin.

Sensitive skin has been described as unpleasant sensory responses to stimuli that should not provoke such sensations. Objectively measurable signs of irritation are not always present in individuals with sensitive skin, however, subjective sensory effects such as, itching, burning, stinging, tightness, and dryness, are consistently present. Given the subjective nature of the phenomenon known as sensitive skin, surveys have been a popular approach to evaluating the prevalence of this condition among the general population, and a number of them have been conducted worldwide. Overall, ~60-70% of women and 50-60% of men report having some degree of sensitive skin. However, there are differences between populations in various geographies, and perceptions of sensitive skin at specific anatomic sites. This article is a review of survey data on the prevalence of self-declared sensitive skin in various geographies, among different gender and age groups, and at various anatomic sites. In addition, we review the factors that may contribute to sensitive skin, and the physiological characteristics associated with this condition, including impaired barrier function and heightened neural reactions.

Prevalence, Concordance, and Transmission of Human Papillomavirus Infection Among Heterosexual Couples in Liuzhou, China: An Observational Perspective Study.

BACKGROUND: Knowledge of human papillomavirus (HPV) transmission dynamics, which have important public health implications for designing HPV vaccination strategies, is scarce in undeveloped areas. METHODS: From May to July 2014, 390 couples were enrolled from the general population in Liuzhou, China. Exfoliated cells from male penis shaft/glans penis/coronary sulcus (PGC) and perianal/anal canal (PA) sites and from female vaginal, vulvar, and PA sites were collected biannually for 1 year. RESULTS: The HPV type-specific concordance rate between couples was 15.5% (95% confidence interval [CI], 8.5%-25.0%). For anogenital HPV transmission, the male-to-female transmission rate (11.5 [95% CI, 4.3-30.7] per 1000 person-months) was similar to the female-to-male transmission rate (11.3 [95% CI, 5.9-21.7] per 1000 person-months). The concordance rates between male PGC site and female vaginal, vulvar, and PA sites were 20.0%, 21.8%, and 14.9%, respectively, which were significantly higher than expected by chance. Infections transmitted from males to females seemed mainly originated from male genital sites, whereas for female-to-male transmission, the vaginal, vulvar, and PA sites might be all involved. CONCLUSIONS: Among the heterosexual couples with relatively conservative sexual behavior, the anogenital HPV transmission rate for females to males is similar to that of males to females. In addition to the vagina and vulva, the female PA site is also an important reservoir for HPV transmission.

Survival analysis of patients with invasive extramammary Paget disease: implications of anatomic sites.

BACKGROUND: Extramammary Paget disease (EMPD) is a rare malignant dermatosis with poorly defined outcomes. We investigated clinical characteristics of invasive EMPD at different anatomic sites and by subject demographics to determine prognostic factors for overall survival (OS). METHODS: All patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) program, 1973-2013, of the U.S. National Cancer Institute. Patients with invasive EMPD of skin, vulva/labia, vagina, scrotum/penis, or other sites were included. After excluding patients with unknown radiation status, data of 2001 patients were analyzed. Primary endpoint was EMPD mortality by anatomic sites. Independent variables included patients' demographic data, concurrent malignancy (ie, non-EMPD related cancers), tumor size, distant metastasis, and surgery and/or radiation or not. RESULTS: Multivariate regression analysis showed that mortality was significantly higher in patients with vaginal EMPD than in patients with vulvar/labial EMPD (adjusted hazard ratio [aHR] = 3.26, p < 0.001). Patients with distant metastasis had higher mortality than those without (aHR = 3.36, p < 0.001). Patients who received surgery had significantly lower mortality than those who did not receive surgery (aHR = 0.77, p = 0.030), and those treated with radiation had significantly higher mortality than those who did not receive radiation (aHR = 1.60, p = 0.002). Older age was associated with significantly increased mortality (aHR = 1.09, p < 0.001), and mortality was significantly higher in males than in females (aHR = 1.42, p = 0.008). CONCLUSIONS: In conclusion, among EMPD patients, mortality is higher in patients with vaginal EMPD than in those with vulvar/labial EMPD and higher in those who are older, those with concurrent malignancy or distant metastasis. Mortality is also higher in males than in females. Surgery is a protective factor and radiation is a risk factor for OS. Greater understanding of EMPD clinical characteristics, and considering EMPD in differential diagnosis of chronic genital and perianal dermatoses may provide support for early EMPD diagnosis and definitive surgical treatment.

Euthanasia of Cattle: Practical Considerations and Application.

Acceptable methods for the euthanasia of cattle include overdose of an anesthetic, gunshot and captive bolt. The use of anesthetics for euthanasia is costly and complicates carcass disposal. These issues can be avoided by use of a physical method such as gunshot or captive bolt; however, each requires that certain conditions be met to assure an immediate loss of consciousness and death. For example, the caliber of firearm and type of bullet are important considerations when gunshot is used. When captive bolt is used, a penetrating captive bolt loaded with the appropriate powder charge and accompanied by a follow up (adjunctive) step to assure death are required. The success of physical methods also requires careful selection of the anatomic site for entry of a “free bullet” or “bolt” in the case of penetrating captive bolt. Disease eradication plans for animal health emergencies necessitate methods of euthanasia that will facilitate rapid and efficient depopulation of animals while preserving their welfare to the greatest extent possible. A portable pneumatic captive bolt device has been developed and validated as effective for use in mass depopulation scenarios. Finally, while most tend to focus on the technical aspects of euthanasia, it is extremely important that no one forget the human cost for those who may be required to perform the task of euthanasia on a regular basis. Symptoms including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals.

Analysis of prognostic factors for melanoma patients.

Introduction. Melanoma is the most dangerous form of skin cancer. Morbidity from melanoma is increasing every year. Previous studies have revealed that there are some demographic and clinical factors having effect on melanoma survival prognosis. Aim of the study. Purpose of our study was to assess melanoma survival depending on prognostic factors, such as age, sex, stage, depth, histology and anatomical site. Materials and methods. We investigated melanoma-specific survival up to 10 years in 85 primary cases of melanoma from diagnosis at the National Cancer Institute in 2006. Analysis was performed for one-, five-, and ten-year survival. The data were processed with Microsoft Excel, data analysis was conducted using SPSS® software. Results. Melanomas diagnosed at stage IV or thicker than 4.00 mm had lower survival (five-year survival: 12.5% and 26.66%, respectively). A significant survival difference was observed among the different stages (p = 0.003) and different depths (p = 0.049) of melanoma. Ten-year survival was 32% for men and 61% for women, but melanoma-specific survival dependent on sex did not have a statistically significant difference (p = 0.121). In persons diagnosed at the age of 65 or older, ten-year survival was lower than in those of 40-64 years of age and in the age group of 15-39 years (44.44% and 26.66%, respectively), but melanoma-specific survival in different age groups did not have a statistically significant difference (p = 0.455). Back/breast skin melanoma had lower ten-year survival (37.03%) than other anatomic sites. Nodular melanoma had the poorest five-year and ten-year melanoma-specific survival among histological subtypes (51.67% and 38.75%). The differences between melanoma localizations (p = 0.457) and histological types (p = 0.364) were not statistically significant. Conclusions. Lower melanoma-specific survival rates were observed among patients diagnosed at a late stage, older age, and when melanomas were thicker than 4.00 mm. Female and younger patients had better melanoma-specific survival than men and older people, and these differences were statistically significant. Melanoma diagnosed at an early stage and of a small depth had higher survival rates. Back/breast skin melanoma had poorer prognosis than other anatomic sites. Nodular melanoma had the lowest melanoma-specific survival, while superficial spreading or lentigo maligna had the best prognosis among histological subtypes. However, differences in melanoma survival in different sex and age groups, localizations and histological types were not statistically significant.

Prevalence and Concordance of Cutaneous Beta Human Papillomavirus Infection at Mucosal and Cutaneous Sites.

Background: Cutaneous beta human papillomavirus (HPV) infection across cutaneous and mucosal tissues within individuals has not been examined. Methods: A subcohort of men (n = 87) participating in the HPV Infection in Men (HIM) study provided eyebrow hairs, forearm skin swabs, genital skin swabs, oral rinse samples, and anal swabs. Beta-HPV DNA in the 5 tissues was detected using a multiplex assay, and site-specific beta-HPV prevalence was examined. Results: Any beta-HPV was most prevalent in genital skin (81.6%), followed by forearm skin (64.4%), eyebrow hairs (60.9%), oral mucosa (35.6%), and anal mucosa (33.3%). Most prevalent beta-HPV types included HPV-38 (beta-2) in both genital skin (32.2%) and eyebrow hairs (16.1%), HPV-12 (beta-1) in forearm skin (23%) and oral mucosa (9.2%), and HPV-76 (beta-3) in anal mucosa (14.9%). Concordance of any beta-HPV infection was greater (31.0%) across the 3 keratinized tissue sites (genital skin, eyebrow hairs, forearm skin) than across the 2 mucosal sites (anal and oral mucosa, 6.9%). Conclusions: Prevalence of beta-HPV varied by anatomic site of infection. Biological properties of beta-HPV types detected at mucosal sites and their role in disease pathogenesis should be examined.

Trends in the diagnosis and clinical features of melanoma in situ (MIS) in US men and women: A prospective, observational study.

BACKGROUND: The incidence of melanoma in situ (MIS) is increasing, but little is known about its clinical and epidemiologic features. OBJECTIVE: We sought to determine trends in diagnosis and clinical features of MIS. METHODS: Incident cases of melanoma were collected prospectively from the Nurses' Health Study (1976-2010) and Health Professionals Follow-up Study (1986-2010). RESULTS: MIS incidence increased from 2 to 42 per 100,000 person-year among women, and from 11 to 73 per 100,000 person-year among men, exceeding the rate of increase of invasive melanomas. Melanoma mortality initially increased during the follow-up period then plateaued. Men were more likely than women to develop in situ melanomas on the upper half of the body (P < .001). Invasive melanomas were diagnosed at a younger age than MIS (P < .001), and were more likely to be found on the lower extremities than MIS (P < .001). LIMITATIONS: This is a strictly descriptive study without examination into mechanisms. CONCLUSION: We found epidemiologic and clinical differences for in situ and invasive melanomas, which support further examination into the variations in etiologic pathways. The lack of improvement in mortality despite the increase in detection of in situ relative to invasive lesions further highlights the need to improve invasive melanoma-specific clinical screening features.

A retrospective study of 51,781 adult oral and maxillofacial biopsies.

BACKGROUND: Few studies have compared patient and anatomic characteristics across the broad scope of oral and maxillofacial disease seen in dental clinics. The authors conducted a study to make these comparisons by surveying a large sample of histologically diagnosed oral and maxillofacial lesions in a US adult population. METHODS: A total of 51,781 specimens biopsied from 51,781 adult patients were received by an oral pathology service over 13 years (2001-2015) and analyzed. A description of patients' sex and age at diagnosis, as well as the anatomic site of biopsy was given for diagnoses of 10 oral disease types, including malignant neoplasm, benign neoplasm, infectious, reactive, potentially malignant, developmental, healthy tissue, immune dysfunction, physical trauma, and other. RESULTS: The authors reported reactive lesions were the most prevalent disease type found in the sample (74.9%). Malignant diagnoses comprised 1.97% of all biopsies. The 3 most prevalent diagnoses in this study included benign keratosis, chronic apical periodontitis, and radicular cyst. Different anatomic sites, patient age groups, and sexes show different distributions of disease. CONCLUSIONS: Certain disease types and diagnoses were found to have a higher prevalence by sex, among particular age groups, and in certain anatomic sites. PRACTICAL IMPLICATIONS: This information provides clinicians with a detailed and broad scope of the variety of oral and maxillofacial lesions processed at an oral pathology service and may assist practitioners in forming clinical impressions and differential diagnoses.

Species distribution and in vitro fluconazole susceptibility of clinical Candida isolates in a Brazilian tertiary-care hospital over a 3-year period / Distribuição de espécies e suscetibilidade in vitro ao fluconazol de isolados clínicos de Candida em um hospital terciário brasileiro num período de três anos

INTRODUCTION: In this study, we aimed at identifying Candida isolates obtained from blood, urine, tracheal secretion, and nail/skin lesions from cases attended at the Hospital Universitário de Londrina over a 3-year period and at evaluating fluconazole susceptibilities of the isolates. METHODS: Candida isolates were identified by polymerase chain reaction (PCR) using species-specific forward primers. The in vitro fluconazole susceptibility test was performed according to EUCAST-AFST reference procedure. RESULTS: Isolates were obtained from urine (53.4 percent), blood cultures (19.2 percent), tracheal secretion (17.8 percent), and nail/skin lesions (9.6 percent). When urine samples were considered, prevalence was similar in women (45.5 percent) and in men (54.5 percent) and was high in the age group >61 years than that in younger ones. For blood samples, prevalence was high in neonates (35 percent) and advanced ages (22.5 percent). For nail and skin samples, prevalence was higher in women (71.4 percent) than in men (28.6 percent). Candida albicans was the most frequently isolated in the hospital, but Candida species other than C. albicans accounted for 64 percent of isolates, including predominantly Candida tropicalis (33.2 percent) and Candida parapsilosis (19.2 percent). The trend for non-albicans Candida as the predominant species was noted from all clinical specimens, except from urine samples. All Candida isolates were considered susceptible in vitro to fluconazole with the exception of isolates belonging to the intrinsically less-susceptible species C. glabrata. CONCLUSIONS: Non-albicans Candida species were more frequently isolated in the hospital. Fluconazole resistance was a rare finding in our study.

INTRODUÇÃO: Neste estudo objetivamos a identificação de isolados de Candida obtidos de sangue, urina, secreção traqueal e de lesões de unha/pele, de casos atendidos no Hospital Universitário de Londrina num período de três anos. Avaliamos também a suscetibilidade dos isolados ao fluconazol. MÉTODOS: Os isolados de Candida foram identificados pela reação em cadeia da polimerase (RCP) usando oligonucleotídeos iniciadores espécie-específicos. O teste de suscetibilidade in vitro ao fluconazol foi realizado segundo o procedimento de referência EUCAST-AFST. RESULTADOS: Isolados foram obtidos de urina (53,4 por cento), sangue (19,2 por cento), secreção traqueal (17,8 por cento) e lesões de unha/pele (9,6 por cento). Considerando as amostras de urina, a prevalência foi similar em mulheres (45,5 por cento) e em homens (54,5 por cento) e foi alta no grupo de idade > 61 anos do que em grupos mais jovens. Para amostras de sangue a prevalência foi alta em neonatos (35 por cento) e idades avançadas (22,5 por cento). Para amostras de unha e pele a prevalência foi maior em mulheres (71,4 por cento) do que em homens (28,6 por cento). Candida albicans foi a mais frequentemente isolada no hospital, mas outras espécies de Candida corresponderam a 64 por cento dos isolados, incluindo predominantemente Candida tropicalis (33,2 por cento) e Candida parapsilosis (19,2 por cento). A tendência de Candida não-albicans como espécie predominante foi observada para todas as amostras clínicas, exceto para amostras de urina. Todos isolados de Candida foram considerados suscetíveis, in vitro, ao fluconazol com exceção dos isolados pertencentes às espécies intrinsecamente menos suscetíveis C. glabrata. CONCLUSÕES: Espécies de Candida não-albicans foram mais frequentemente isoladas no hospital. Resistência ao fluconazol foi rara no nosso estudo.

Obesity and Physical Activity Related to Colorectal Adenoma by Anatomic Sites in Korea / 한국역학회지

Although the etiology of colorectal adenoma is not yet clear, numerous epidemiologic studies of colorectal adenoma(precursors of cancer) have shown a positive association with obesity and an inverse association with physical activity. The difference of the possible association of colorectal adenoma with body mass index(BMI= wt(kg)/ht2(m2) and physical activity(kcal/day) according to anatomic sites and gender was investigated in this case-control study. Between July 1994 and october 1998, 345 cases of patients(male 181, female 164) with pathologically confirmed incident colorectal adenoma and 1655 control subjects(male 598, female 1,057) were collected from Our Lady of Mercy Hospital, The Catholic University of Korea. After colonoscopy, self-reported weight and height, together with measures of intensity and time of exercise and lifetime job activity was obtained by the interviewers. Site- and gender-specific odds ratios relative to the lowest tertile of BMI and physical activity were determined using unconditional logistic regression after adjusting for potential confounders. Compared with subjects in the lowest terile of body mass index, multivariate-adjusted odds ratio of right colon for male and female in highest tertile were 1.49(95% CI:0.74-3.01) and 1.96(95% CI:0.93-4.15), respectively. Compared with subjects in the lowest tertile of physical activity, multivariate-adjusted odds ratio of right colon for male and female in highest tertile were 0.66(95% CI:0.35-1.26) and 0.83(95% CI:0.50-1.39), respectively. These results support a positive association between body mass index and occurrence or progression of adenoma in left colon and physical activity is associated with an elevated risk of right colon.