ABSTRACT
BACKGROUND: Among patients with renal cell carcinoma (RCC), bone and visceral metastases have a poor prognosis, while endocrine gland metastases have a more favorable prognosis. Gastrointestinal metastases (GIMs) are rare, and their prognosis is still poorly understood. OBJECTIVES: To report clinical presentations, patient characteristics, therapeutic strategies, and prognosis of GIMs from RCC. METHODS: We retrospectively collected data from RCC patients presenting GIMs, in 10 French GETUG centers, between 2000 and 2021. RESULTS: We identified 74 patients with 87 GIMs, mostly gastric or duodenal. The median age at GIM diagnosis was 69 years and 76% of patients already had other metastases. GIMs occurred after a median duration of 5.4 years (IC95%=[4.2-7.1]) and 1.9 years (IC95%=[1.2-3.8]) from RCC diagnosis and first metastasis, respectively. GIMs were symptomatic in 52 patients (70%), with anemia in 41 patients (55%) and/or gastrointestinal bleeding in 31 patients (42%). Only 22 asymptomatic patients (30%) were fortuitously diagnosed. GIM management consisted of systemic treatment only in 29 GIMs (33%), local treatment only in 23 GIMs (26%), and both local and systemic treatment in 18 GIMs (21%). For 17 GIMs (20%), there was no therapeutic modification. After diagnosis of GIM, median overall survival was 19 months. CONCLUSION: We report the largest retrospective cohort of GIMs in RCC patients. They should be suspected in case of anemia or gastrointestinal bleeding in any patient with a history of RCC. Their management varies widely depending on their location in the digestive tract and whether or not they are symptomatic.
Subject(s)
Anemia , Carcinoma, Renal Cell , Gastrointestinal Neoplasms , Kidney Neoplasms , Humans , Carcinoma, Renal Cell/drug therapy , Gastrointestinal Hemorrhage , Kidney Neoplasms/drug therapy , Retrospective Studies , AgedABSTRACT
This article aims to describe the multidisciplinary clinical management of an intrusive luxation case. The clinical case reports the management of crown fracture and intrusive luxation of permanent maxillary incisors. The clinical results and subjective outcomes four years after the trauma and after two years of post-treatment follow-up are presented. An 11-year-old female patient sought dental care at the local University after experiencing dental trauma. Crown fracture of tooth 8 and the intrusion and crown fracture of teeth 9 and 10 were clinically diagnosed. The multidisciplinary treatment performed involved: periodontal surgical procedures; orthodontic traction; endodontic treatment; dental bleaching; and esthetic resin composite restorations. After two years of follow-up, the clinical parameters of the restorations were satisfactory, as well as the periodontal and periapical status. Oral health-related quality of life was assessed before and after treatment using the OHIP-Aes instrument, with a significant improvement in quality of life after treatment. The multidisciplinary approach was an effective treatment for this case of intrusive luxation. The dentofacial function and esthetics were recovered and the patient's quality of life was improved.
Subject(s)
Tooth Avulsion , Tooth Fractures , Female , Humans , Child , Tooth Avulsion/etiology , Tooth Avulsion/therapy , Follow-Up Studies , Quality of Life , Tooth Fractures/therapy , Dental CareABSTRACT
BACKGROUND: Androgen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis. PATIENTS AND METHODS: Patients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes. RESULTS: Mean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044). CONCLUSIONS: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.
Subject(s)
COVID-19 , Cognitive Dysfunction , Prostatic Neoplasms , Androgen Antagonists/adverse effects , Androgens , Cognitive Dysfunction/complications , Cognitive Dysfunction/etiology , Communicable Disease Control , Humans , Male , Neon , Pandemics , Prospective Studies , Prostatic Neoplasms/complications , Prostatic Neoplasms/drug therapyABSTRACT
BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker. METHODS: This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed. RESULTS: The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). CONCLUSION: Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.
Subject(s)
Carcinoma, Pancreatic Ductal , Pancreatic Neoplasms , Pancreatitis, Chronic , Biomarkers, Tumor , CA-19-9 Antigen , Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Pancreatic Ductal/pathology , Diagnosis, Differential , Glypicans , Humans , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pancreatitis, Chronic/diagnosis , Prospective Studies , Pancreatic NeoplasmsABSTRACT
Complete histopathologic tumor regression after neoadjuvant treatment is a well-known prognostic factor for survival among patients with adenocarcinomas of the esophagus and gastroesophageal junction. The aim of this international Delphi survey was to reach a consensus regarding the most useful tumor regression grading (TRG) system that could represent an international standard for histopathologic TRG grading of gastroesophageal carcinomas. Fifteen pathologists with special interest in esophageal and gastric pathology participated in the online survey. The initial questionnaire contained of 43 statements that addressed the following topics: (1) specimen processing, (2) gross examination, (3) cross sectioning, (4) staining, (5) Barrett's esophagus, (6) TRG systems, and (7) TRG in lymph node (LN). Participants rated the items using a 5-point Likert style scale and were encouraged to write comments for each statement. The expert panel recommended a 4-tiered TRG system for assessing the primary tumor: grade 1: No residual tumor (complete histopathologic tumor regression), grade 2: less than 10% residual tumor (near-complete regression), grade 3: 10%-50% residual tumor (partial regression), grade 4: greater than 50% residual tumor (minimal/no regression), combined with a 3-tiered system for grading therapeutic response in metastatic LNs: grade a: no residual tumor (complete histopathologic TRG), grade b: partial regression (tumor cells and regression), grade c: no regression (no sign of tumor response). This TRG grading system can be recommended as an international standard for histopathologic TRG grading in esophageal and gastroesophageal junction adenocarcinoma.
Subject(s)
Adenocarcinoma/pathology , Esophageal Neoplasms/pathology , Esophagogastric Junction/pathology , Neoplasm Grading/methods , Adenocarcinoma/therapy , Consensus , Delphi Technique , Esophageal Neoplasms/therapy , Humans , Neoadjuvant Therapy/methods , Specimen Handling/methods , Specimen Handling/standards , Treatment OutcomeABSTRACT
O abortamento na espécie equina é responsável por grandes perdas econômicas e, entre as possíveis causas, está a neosporose, uma enfermidade que nem sempre é investigada como provável diagnóstico. Assim, o objetivo deste trabalho foi relatar um caso de aborto equino aos 129 dias de gestação, resultante da infecção por Neospora spp.. Amostras sanguíneas da égua e do feto abortado foram enviadas para um laboratório especializado. À necrópsia, constatou-se edema gelatinoso e hemorrágico em subcutâneo, fígado ictérico e friável com autólise de alguns órgãos, como baço, rins e glândulas adrenais. Fragmentos dos órgãos coletados na necrópsia foram submetidos à histopatologia e à pesquisa de agentes infecciosos, em que se identificou hepatite e epicardite não purulentas e onfalite purulenta, bem como exame positivo para Neospora spp. pela técnica de reação em cadeia da polimerase (PCR) convencional e Nested. O soro sanguíneo obtido da égua foi submetido à pesquisa de Neospora spp. pela técnica de imunofluorescência indireta, de herpesvírus por soroneutralização em cultura de células e de Leptospira sp. por PCR, todas com resultados negativos. Dessa forma, é importante considerar a neosporose como diagnóstico diferencial em casos de abortamento e natimortalidade, uma vez que a presença de cães nas propriedades é extremamente comum, representando uma importante fonte de infecção.(AU)
Abortion in the equine species is responsible for major economic losses, and among the possible causes is neosporosis, a disease that is not always investigated as a probable diagnosis. Thus, the objective of this study was to report an abortion at 129 days of gestation resulting from Neospora spp. Blood samples from the mare and the aborted fetus were sent to a specialized laboratory. Under necropsy, gelatinous and hemorrhagic edema was detected in subcutaneous tissue, friable and jaundiced liver with autolysis in spleen, kidneys and adrenal glands. Fragments of the organs collected at necropsy were submitted to histopathology and infectious agent tests, which identified non-purulent hepatitis and epicarditis and purulent omphalitis. Also, a positive result for Neospora spp. by the conventional and nested Polymerase Chain Reaction (PCR) technique. Blood serum obtained from the mare was subjected to analyses to Neospora spp. by indirect immunofluorescence technique, herpesvirus by serum neutralization in cell culture and Leptospira sp. by PCR, all with negative results. Thus, it is important to consider neosporosis as a differential diagnosis in cases of abortion and stillbirth, since the presence of dogs in the properties is extremely common and represent an important source of infection.(AU)
Subject(s)
Animals , Female , Neospora/isolation & purification , Abortion, Veterinary/diagnosis , Aborted Fetus/microbiology , Horses/microbiology , Polymerase Chain Reaction/veterinaryABSTRACT
BACKGROUND: The literature on the prognostic relevance of signet-ring cell (SRC) histology in gastric cancer (GC) is controversial which is most likely related to inconsistent SRC classification based on haematoxylin-eosin staining. We hypothesised that mucin stains can consistently identify SRC-GC and predict GC patient outcome. METHODS: We performed a comprehensive literature review on mucin stains in SRC-GC and characterised the mucin expression in 851 Caucasian GC and 410 Asian GC using Alcian Blue (AB)-Periodic Acid-Schiff (PAS), MUC2 (intestinal-type mucin), and MUC5AC (gastric-type mucin). The relationship between mucin expression and histological phenotype [poorly cohesive (PC) including proportion of SRCs, non-poorly cohesive (non-PC), or mucinous (MC)], clinicopathological variables, and patient outcome was analysed. RESULTS: Depending on mucin expression and cut-offs, the positivity rates of SRC-GC reported in the literature varied from 6 to 100%. Patients with MUC2 positive SRC-GC or SRC-GC with (gastro)intestinal phenotype had poorest outcome. In our cohort study, PC with ≥ 10% SRCs expressed more frequently MUC2, MUC5AC, and ABPAS (p < 0.001, p = 0.004 and p < 0.001, respectively). Caucasians with AB positive GC or combined ABPAS-MUC2 positive and MUC5AC negative had poorest outcome (all p = 0.002). This association was not seen in Asian patients. CONCLUSIONS: This is the first study to suggest that mucin stains do not help to differentiate between SRC-GC and non-SRC-GC. However, mucin stains appear to be able to identify GC patients with different outcome. To our surprise, the relationship between outcome and mucin expression seems to differ between Caucasian and Asian GC patients which warrants further investigations.
Subject(s)
Asian People/statistics & numerical data , Carcinoma, Signet Ring Cell/pathology , Esophageal Neoplasms/pathology , Mucin-1/metabolism , Stomach Neoplasms/pathology , White People/statistics & numerical data , Aged , Carcinoma, Signet Ring Cell/ethnology , Carcinoma, Signet Ring Cell/metabolism , Carcinoma, Signet Ring Cell/therapy , Cohort Studies , Combined Modality Therapy , Esophageal Neoplasms/ethnology , Esophageal Neoplasms/metabolism , Esophageal Neoplasms/therapy , Female , Humans , Male , Middle Aged , Prognosis , Stomach Neoplasms/ethnology , Stomach Neoplasms/metabolism , Stomach Neoplasms/therapy , Survival RateABSTRACT
INTRODUCTION: Regional lymph node metastasis is an important prognostic factor for patients with gastric cancer. Occult tumour cells (OTCs), including either micrometastases (MMs) or isolated tumour cells (ITCs), may be a key factor in the development of cancer recurrence in pN0 patients. AIMS: We aimed to determine the frequency and prognostic significance for disease recurrence of OTCs. MATERIALS AND METHODS: This retrospective cohort study included all consecutive patients with pN0 gastric adenocarcinoma between January 2000 and December 2011 (n = 73). Immunohistochemistry using the pan-cytokeratin antibody AE1/AE3 was used to detect OTCs in 1257 isolated lymph nodes. RESULTS: OTCs were identified in 30 patients (41%), including 20 cases with MMs (27%) and 10 cases with ITCs (14%). Disease recurrence and cancer-related death were observed in 24 (33%) and 20 patients (27%), respectively, and both were significantly associated with the detection of OTCs. A significant difference was also observed for the mean survival time between patients with OTCs and those without OTCs [100 vs 158 months (p = 0.015)]. The presence of OTCs was statistically significantly associated with the Lauren classification, tumour size and lymphatic permeation. Multivariate analyses revealed that only age, T stage and the presence of ITCs in lymph nodes were independent factors for recurrence. The presence of ITCs increased the risk for recurrence by 11.1-fold. CONCLUSIONS: In a significant proportion of patients diagnosed as stage pN0, OTCs may be identified in lymph nodes if carefully searched for, which can negatively affect their prognosis. The presence of ITCs was found to be an independent factor for recurrence and after proper validation should be considered during lymph node assessment for prognosis definition.
Subject(s)
Lymph Nodes , Stomach Neoplasms , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging , Prognosis , Retrospective Studies , Stomach Neoplasms/pathologyABSTRACT
INTRODUCTION: Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS: To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS: We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS: The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS: There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.
Subject(s)
Aortic Valve/surgery , Cardiac Surgical Procedures/methods , Endocarditis/surgery , Heart Valve Prosthesis/adverse effects , Hospital Mortality/trends , Aged , Aged, 80 and over , Aortic Valve/microbiology , Aortic Valve/pathology , Atrial Fibrillation/epidemiology , Atrial Fibrillation/etiology , Atrial Fibrillation/mortality , Cardiac Surgical Procedures/statistics & numerical data , Case-Control Studies , Endocarditis/microbiology , Endocarditis/mortality , Endocarditis/pathology , Female , Heart Failure/epidemiology , Heart Failure/mortality , Heart Failure/surgery , Heart Valve Prosthesis/statistics & numerical data , Humans , Male , Middle Aged , Predictive Value of Tests , Prognosis , Prosthesis-Related Infections/complications , Retrospective Studies , Shock, Cardiogenic/epidemiology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/mortality , Staphylococcus/isolation & purification , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/mortalitySubject(s)
Gastrointestinal Neoplasms , Genetic Predisposition to Disease , Health Planning Guidelines , Humans , Combined Modality Therapy , Follow-Up Studies , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/genetics , Gastrointestinal Neoplasms/therapy , Prognosis , Societies, MedicalABSTRACT
BACKGROUND AND AIMS: Golimumab has an established exposure-response relationship in patients with ulcerative colitis [UC]. However, the association of serum golimumab trough levels [TL] with objective markers of disease activity, such as endoscopic and histological activity scores and concentrations of biomarkers, remains less understood. This report describes the relationship of serum golimumab TL at the end of the induction period [Week 6] with clinical, endoscopic, histological, and biomarker parameters. METHODS: This was an open-label, uncontrolled, prospective and interventional study. Moderate to severely active UC patients naïve to biologic therapy were treated with golimumab. Serum golimumab TL and faecal calprotectin levels were measured at baseline [Week 0 of induction] and Week 6. RESULTS: A total of 34 patients completed the induction phase [Week 6] and were included in this analysis. Overall, 47.1% and 14.7% of patients achieved clinical response and remission with significantly higher serum golimumab TL in patients with early response or remission [3.7 µg/mL vs 1.3 µg/mL, p = 0.0013; and 3.1 µg/mL vs 1.7 µg/mL, p = 0.0164, respectively]. In addition, golimumab TL were significantly higher in patients achieving histological remission [4.2 µg/mL vs 1.7 µg/mL, p = 0.0049]. Week 6 golimumab TL were inversely correlated with the total Mayo score [rs = -0.546; p = 0.0008], the Mayo endoscopic subscore [rs = -0.381; p = 0.0262], the Geboes histological activity score [rs = -0.464; p = 0.0057], and faecal calprotectin levels [rs = -0.497; p = 0.0044]. CONCLUSIONS: A higher early exposure to golimumab is associated with a better objective response in active UC patients and appears to drive the outcome at Week 6.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/blood , Colitis, Ulcerative/drug therapy , Adult , Biomarkers/analysis , C-Reactive Protein/analysis , Colitis, Ulcerative/pathology , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Endoscopy, Gastrointestinal , Feces/chemistry , Female , Gastrointestinal Agents/administration & dosage , Gastrointestinal Agents/blood , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Leukocyte L1 Antigen Complex/analysis , Male , Portugal , Prospective Studies , Remission InductionABSTRACT
The authors would like to correct the error in the publication of the original article. The surname and given names of the authors were swapped in the "Acknowledgements". The corrected detail is given below.
ABSTRACT
BACKGROUND AND AIMS: Clinicopathological characteristics of gastric cancer (GC) are changing, especially in the West with a decreasing incidence of distal, intestinal-type tumours and the corresponding increasing proportion of tumours with Laurén diffuse or WHO poorly cohesive (PC) including signet ring cell (SRC) histology. To accurately assess the behaviour and the prognosis of these GC subtypes, the standardization of pathological definitions is needed. METHODS: A multidisciplinary expert team belonging to the European Chapter of International Gastric Cancer Association (IGCA) identified 11 topics on pathological classifications used for PC and SRC GC. The topics were debated during a dedicated Workshop held in Verona in March 2017. Then, through a Delphi method, consensus statements for each topic were elaborated. RESULTS: A consensus was reached on the need to classify gastric carcinoma according to the most recent edition of the WHO classification which is currently WHO 2010. Moreover, to standardize the definition of SRC carcinomas, the proposal that only WHO PC carcinomas with more than 90% poorly cohesive cells having signet ring cell morphology have to be classified as SRC carcinomas was made. All other PC non-SRC types have to be further subdivided into PC carcinomas with SRC component (< 90% but > 10% SRCs) and PC carcinomas not otherwise specified (< 10% SRCs). CONCLUSION: The reported statements clarify some debated topics on pathological classifications used for PC and SRC GC. As such, this consensus classification would allow the generation of evidence on biological and prognostic differences between these GC subtypes.
Subject(s)
Carcinoma, Signet Ring Cell/classification , Carcinoma, Signet Ring Cell/pathology , Stomach Neoplasms/classification , Stomach Neoplasms/pathology , HumansABSTRACT
Liver cirrhosis is associated with a wide range of cardiovascular abnormalities including hyperdynamic circulation and cirrhotic cardiomyopathy. The pathogenic mechanisms of these cardiovascular changes are multifactorial and include vascular dysregulations. AIM: The present study tested the hypothesis that the systemic vascular hyporesponsiveness in thioacetamide (TAA)-induced liver injury model is dependent on nitric oxide (NO) and cyclooxygenase (COX) derivatives. MAIN METHODS: Wistar rats were treated with TAA for eight weeks to induce liver injury. KEY FINDINGS: The maximal contractile response in concentration-effect curves to phenylephrine was decreased in aorta from TAA-treated rats, but no differences were found in aorta without endothelium, suggesting an endothelium-dependent mechanism in decreased contractile response. There was no difference in the contractile response with and without L-NAME (N(ω)-nitro-l-arginine methyl ester) in rats with liver injury, showing that the TAA treatment impairs NO synthesis. Pre-incubation of the aorta with indomethacin, a COX-inhibitor, normalized the reduced contractile response to phenylephrine in arteries from TAA group. Also, COX-2 and iNOS (inducible nitric oxide syntase) protein expression was increased in aorta from TAA group compared to control group. Animals submitted to TAA treatment had a reduction in systolic blood pressure. Our findings demonstrated that liver injury induced by TAA caused a decrease in aortic contractile response by a COX-dependent mechanism but not by NO release. Also, it was demonstrated an inflammatory process in the aorta of TAA-treated rats by increased expression of COX-2 and iNOS. SIGNIFICANCE: Therefore, there is an essential contribution of COX-2 activation in extra-hepatic vascular dysfunction and inflammation present in cirrhosis induced by TAA.
Subject(s)
Aorta, Thoracic/pathology , Chemical and Drug Induced Liver Injury/physiopathology , Cyclooxygenase 2/metabolism , Endothelium, Vascular/pathology , Thioacetamide/toxicity , Vascular Diseases/etiology , Animals , Aorta, Thoracic/enzymology , Blood Pressure , Chemical and Drug Induced Liver Injury/etiology , Endothelium, Vascular/enzymology , Male , Nitric Oxide/metabolism , Rats , Rats, Wistar , Vascular Diseases/enzymologyABSTRACT
BACKGROUND: Anal squamous intraepithelial lesions (ASIL) are precancerous lesions of anal squamous cell carcinoma, with a higher prevalence in immunosuppressed patients. There are some studies in kidney transplant recipients, but there is no information regarding prevalence in liver transplantation. Our aim was to evaluate the prevalence of ASIL in this setting. METHODS: Prospective case-control study involving liver transplant recipients without any other known risk factor for ASIL (n=59), which were compared with a healthy control group (n=57). All were submitted to anal cytology and high-resolution anoscopy was performed in those with abnormal results. RESULTS: Ten (17%) of liver transplant recipients had abnormal cytological results, seven patients had atypical squamous cells of undetermined significance (ASC-US), one patient had atypical squamous cells that cannot exclude high-grade (ASC-H) and two patients had high-grade squamous intraepithelial lesions (HSIL). In the control group, one patient (2%) had an ASC-US result (P=0.005). Anal squamous intraepithelial lesions were confirmed in 7 out of 10 of liver transplant patients and 0 out of 1 in the controls (P=0.013) by high-resolution anoscopy with biopsies. Current smoking was the only risk factor for abnormal cytology (odds ratio=5.87, 95% confidence intervals=1.22-28.12, P=0.027). CONCLUSIONS: Liver transplant patients have a higher risk of ASIL. Screening should be considered, especially in smokers.
Subject(s)
Anal Canal/pathology , Anus Neoplasms/epidemiology , Liver Transplantation , Precancerous Conditions/epidemiology , Precancerous Conditions/pathology , Adult , Aged , Anus Neoplasms/pathology , Biopsy , Case-Control Studies , Endoscopy, Gastrointestinal , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , SmokingABSTRACT
Superparamagnetic magnetite nanoparticles have been synthesized by a highly reproducible polyvinyl alcohol (PVA)-based modified sol-gel process using water as the only solvent. The synthesis method has proven to be effective, time and cost saving and environmental friendly, resulting in PVA-coated magnetite nanoparticles as direct product from the synthesis, without any special atmosphere or further thermal treatment. X-ray diffraction and transmission electron microscopy revealed that the biocompatible PVA-coating prevents the nanoparticle agglomeration, giving rise to spherical crystals with sizes of 6.8nm (as-cast) and 9.5nm (heat treated) with great control over size and shape with narrow size distribution. Complementary compositional and magnetic characterizations were employed in order to study the surface chemistry and magnetic behavior of the samples, respectively. Cytotoxicity endpoints including no observed adverse effect concentration (NOAEC), 50% lethal concentration (LC50) and total lethal concentration (TLC) of the tested materials on cell viability were determined after 3, 24 and 48h of exposure. The PVA coating improved the biocompatibility of the synthesized magnetite nanoparticles showing good cell viability and low cytotoxicity effects on the MTT assay performed on BHK cells. Preliminary assessment of nanoparticles in vivo effects, performed after 48h on Balb/c mice, exposed to a range of different sub-lethal doses, showed their capacity to penetrate in liver and kidneys with no significant morphological alterations in both organs.
Subject(s)
Magnetite Nanoparticles , Animals , Magnetics , Microscopy, Electron, Transmission , Polyvinyl Alcohol , X-Ray DiffractionABSTRACT
Macrophages are frequently identified in solid tumors, playing important roles in cancer progression. Their remarkable plasticity makes them very sensitive to environmental factors, including the extracellular matrix (ECM). In the present work, we investigated the impact of human colorectal tumor matrices on macrophage polarization and on macrophage-mediated cancer cell invasion. Accordingly, we developed an innovative 3D-organotypic model, based on the decellularization of normal and tumor tissues derived from colorectal cancer patients' surgical resections. Extensive characterization of these scaffolds revealed that DNA and other cell constituents were efficiently removed, while native tissue characteristics, namely major ECM components, architecture and mechanical properties, were preserved. Notably, normal and tumor decellularized matrices distinctly promoted macrophage polarization, with macrophages in tumor matrices differentiating towards an anti-inflammatory M2-like phenotype (higher IL-10, TGF-ß and CCL18 and lower CCR7 and TNF expression). Matrigel invasion assays revealed that tumor ECM-educated macrophages efficiently stimulated cancer cell invasion through a mechanism involving CCL18. Notably, the high expression of this chemokine at the invasive front of human colorectal tumors correlated with advanced tumor staging. Our approach evidences that normal and tumor decellularized matrices constitute excellent scaffolds when trying to recreate complex microenvironments to understand basic mechanisms of disease or therapeutic resistance.