CD163+ tumor-associated macrophage accumulation in breast cancer patients reflects both local differentiation signals and systemic skewing of monocytes.

OBJECTIVES: The accumulation of tumor-associated macrophages (TAMs) is correlated with poor clinical outcome, but the mechanisms governing their differentiation from circulating monocytes remain unclear in humans. METHODS: Using multicolor flow cytometry, we evaluated TAMs phenotype in 93 breast cancer (BC) patients. Furthermore, monocytes from healthy donors were cultured in the presence of supernatants from dilacerated primary tumors to investigate their differentiation into macrophages (MΦ) in vitro. Additionally, we used transcriptomic analysis to evaluate BC patients' blood monocytes profiles. RESULTS: We observed that high intra-tumor CD163-expressing TAM density is predictive of reduced survival in BC patients. In vitro, M-CSF, TGF-ß and VEGF from primary tumor supernatants skewed the differentiation of healthy donor blood monocytes towards CD163highCD86lowIL-10high M2-like MΦ that strongly suppressed CD4+ T-cell expansion via PD-L1 and IL-10. In addition, blood monocytes from about 40% of BC patients displayed an altered response to in vitro stimulation, being refractory to type-1 MΦ (M1-MΦ) differentiation and secreting higher amounts of immunosuppressive, metastatic-related and angiogenic cytokines. Aside from showing that monocyte transcriptome is significantly altered by the presence of BC, we also demonstrated an overall metabolic de-activation in refractory monocytes of BC patients. In contrast, monocytes from sensitive BC patients undergoing normal M1-MΦ differentiation showed up-regulation of IFN-response genes and had no signs of metabolic alteration. CONCLUSION: Altogether, our results suggest that systemic factors skew BC patient blood monocytes towards a pro-metastatic profile, resulting in the accumulation of further polarised CD163high TAMs resembling type-2 MΦ (M2-MΦ) in the local BC microenvironment. These data indicate that monitoring circulating monocytes in BC patients may provide an indication of early systemic alterations induced by cancer and, thus, be instrumental in the development of improved personalised immunotherapeutic interventions.

Secondary lymphedema of limbs and chikungunya fever.

Certain systemic viral infections can be related to development of vascular complications, such as deep venous thrombosis and lymphedema of lower and upper limbs. These links have been well-established in patients with human immunodeficiency virus (HIV), hepatitis C, or influenza. Recently introduced into the American continent (2013), chikungunya virus is an arbovirus transmitted by mosquitoes of the Aedes genus and is the etiologic agent of chikungunya fever (CF), but its relationship to these vascular complications has not yet been consolidated. However, the CF outbreak that occurred during 2015 and 2016 resulted in the first cases described in the medical literature of acute and chronic vascular complications secondary to infection by this arbovirus. In this report, we describe the case of a patient who developed lymphedema of upper and lower limbs after an episode of CF.

Protocol for a systematic review and meta-analysis of interventions for pathologic perforator veins in chronic venous disease.

INTRODUCTION: Perforator veins (PVs) play an important role in the development of chronic venous insufficiency and ulceration. Procedures to eliminate incompetence and reflux in PV may include open surgery, subfascial endoscopic surgery, intravenous ablation techniques and sclerotherapy. With the aim of filling the evidence gap, this is a protocol for a systematic review that will assess the effects of any form of intervention for the treatment of pathologic PVs of the lower limbs in patients with chronic venous disease. METHODS AND ANALYSIS: Systematic searches will be carried out in MEDLINE, EMBASE, Cochrane CENTRAL, IBECS and LILACS databases at a minimum without date or language restrictions for relevant randomised controlled trials (RCTs) and quasi-RCTs (trials in which the method of allocation is not truly random). In addition, a search will also be carried out in the WHO International Clinical Trials Registry Platform, in the clinical trial registries of ClinicalTrials.gov and in the grey literature source OpenGrey.eu. The RCT and quasi-RCT comparison techniques isolated or in combination for treating PVs will be considered. Three review authors will independently perform data extraction and quality assessments of data from included studies, and any disagreements will be resolved by discussion. The primary outcomes will be wound healing and pain. Secondary outcomes will include oedema, adverse events, recurrence or recanalisation, quality of life and economic aspects. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis in RevManV.5 software (eg, if the data have considerable heterogeneity and are drawn from different comparisons), a descriptive analysis will be performed. ETHICS AND DISSEMINATION: Ethics committee approval is not necessary. We intend to update the public registry used in this review, report any important protocol amendments and publish the results in a widely accessible journal. PROSPERO REGISTRATION NUMBER: CRD42018092974.

Importance of three-dimensional speckle tracking in the assessment of left atrial and ventricular dysfunction in patients with myotonic dystrophy type 1.

INTRODUCTION AND AIM: Myotonic dystrophy type 1 (DM1) is a multisystem disease in which cardiac involvement is common. The aim of this study was to identify early changes in left atrial (LA) mechanics and left ventricular (LV) systolic function in patients with myotonic dystrophy type 1 using three-dimensional (3D) speckle tracking echocardiography (3D-STE). METHODS: This observational study included 25 patients with DM1 and 25 healthy volunteers. We assessed LA and LV global strain parameters using 3D-STE. RESULTS: Patients with DM1 showed significantly lower longitudinal LA strain (22.85%±5.06 vs. 26.82%±5.15; p=0.008 in univariate analysis and p=0.026 in multivariate analysis) and global LV longitudinal strain (-13.55%±1.82 vs. -16.11%±1.33; p<0.001 in univariate analysis and p<0.001 in multivariate analysis), which was not observed with LA area tracking (p=0.412) or LV global circumferential strain (p=0.879), global radial strain (p=0.058), area tracking (p=0.092) or twist (p=0.992). CONCLUSION: LA and LV global longitudinal strain is significantly decreased in patients with DM1, which may be an early marker of subclinical dysfunction in these patients.

A complex case of pacemaker lead endocarditis. / Um caso complexo de endocardite de sondas de pacemaker.

Pacemaker lead endocarditis is an uncommon complication after pacemaker implantation, but is associated with high rates of morbidity and mortality. The authors describe the case of a 68-year-old woman with a double-chamber pacemaker since 2007, admitted to an internal medicine department for spondylodiscitis and Staphylococcus aureus bacteremia. During hospitalization, she had an episode of syncope; the 12-lead electrocardiogram showed pacemaker malfunction with ventricular undersensing and loss of capture. A transesophageal echocardiogram showed images compatible with vegetations on the pacemaker leads. After antimicrobial therapy, the patient developed acute renal failure with subsequent multiple organ failure and death. A high index of clinical suspicion is required for early diagnosis and appropriate treatment of cardiac device-related infective endocarditis.

Accounting for the unique, doubly dual nature of ionic liquids from a molecular thermodynamic and modeling standpoint.

The fascinating, complex behavior of ionic liquids is analyzed using a molecular perspective that emphasizes the doubly dual nature of ionic liquids underlying the existence of cations and anions forming high- and low-charge-density regions. Our work bridges the liquid, gas, and solid phases spanning 5 years of research on themes as diverse as the vaporization, liquid-liquid demixing, solidification, and thermophysical behavior of ionic liquids and their mixtures and solutions.

Evidence for lower critical solution behavior in ionic liquid solutions.

Lower critical solution temperatures (LCST)-type of phase diagrams, including the presence of closed loops, have been encountered for the first time in binary and quasi-binary liquid solutions of ionic liquids. Furthermore, the results constitute the first experimental support for the existence of a theoretically postulated, but never encountered, special kind of type VII phase diagram. Two distinct mechanisms are involved in the appearance of demixing upon temperature increase. These findings underlie the presence of specific, oriented interactions between the ionic liquid, 1-alkyl-3-methylimidazolium bis{(trifluoromethyl)sulfonyl}amide, [Cnmim][NTf2], and trichloromethane, as well as aggregation phenomena.

Deviations from ideality in mixtures of two ionic liquids containing a common ion.

Excess molar volumes of six binary mixtures composed of two ionic liquids of the 1-methyl-3-alkyl-imidazolium bis(trifluoromethylsulfonyl)amide family -- ([C(m)()mim] + [C(n)()mim])[NTf(2)] with n and m ranging from 2 to 10 -- were measured for several compositions at 298 and 333 K. Similarly, three other binary systems containing [C(4)mim](+) (1-methyl-3-butylimidazolium) as a common cation have been studied: [C(4)mim]([NTf(2)] + [PF(6)]), [C(4)mim]([NTf(2)] + [BF(4)]) and [C(4)mim]([BF(4)] + [PF(6)]). Thus, the mixing process of two distinct ions of equal sign embedded in a constant field network of a given counterion was analyzed. All systems exhibit small, positive V(E) values of the order of a few tenths of cm(3) mol(-1), which are essentially temperature and pressure independent. The results show additive trends, for instance, the V(E) values become larger as the difference between the alkyl chain lengths of the two cations increases. The Flory theory of mixtures provides a useful, semiquantitative correlation between the excess volumes and excess enthalpies in these systems, allowing for comparison with analogous results obtained within the linear primary alcohols.

O diagnóstico e tratamento do linfedema periférico / The diagnosis and treatment of peripheral lynphedema

Este documento tenta resumir o largo espectro de diferentes protocolos utilizados pra o diagnóstico e tratamento do linfedema em uma declaraçäo que represente um consenso da comunidade internacional. O documento näo pretende prevalecer sobre consideraçöes clínicas individuais para pacientes específicos nem, tampouco, objetiva ser uma fórmul a legal sobre a qual variaçöes possam ser consideradas erros médicos. Antes de tudo, representa o melhor julgamento dos membros do Comitê Executivo da Sociedade Internacioanl de Linfologia de como abordar pacientes com linfedema em 1995. Antecipamos que o documento será questionado, debatido nas páginas do Lymphology (por exemplo, nas Cartas ao Editor)e, idealmente, tornar-se um ponto de grande discussäo em conferências linfológicas locais, nacionais e internacionais. Prevemos de antemäo que, com o desenvolvimento da experiência e aparecimento de novas idéias, este documento "atual" sofreráa ajustes e revisöes periódicas.