Immunohistochemical expression of programmed death-ligand 1 and CD8 in glioblastomas.

BACKGROUND: Glioblastoma is the most aggressive primary malignant brain tumor in adults and is characterized by poor prognosis. Immune evasion occurs via programmed death-ligand 1 (PD-L1)/programmed death receptor 1 (PD-1) interaction. Some malignant tumors have responded to PD-L1/PD-1 blockade treatment strategies, and PD-L1 has been described as a potential predictive biomarker. This study discussed the expression of PD-L1 and CD8 in glioblastomas. METHODS: Thirty cases of glioblastoma were stained immunohistochemically for PD-L1 and CD8, where PD-L1 expression in glioblastoma tumor tissue above 1% is considered positive and CD-8 is expressed in tumor infiltrating lymphocytes. The expression of each marker was correlated with clinicopathologic parameters. Survival analysis was conducted to correlate progression-free survival (PFS) and overall survival (OS) with PD-L1 and CD8 expression. RESULTS: Diffuse/fibrillary PD-L1 was expressed in all cases (mean expression, 57.6%), whereas membranous PD-L1 was expressed in six of 30 cases. CD8-positive tumor-infiltrating lymphocytes (CD8+ TILs) had a median expression of 10%. PD-L1 and CD8 were positively correlated (p = .001). High PD-L1 expression was associated with worse PFS and OS (p = .026 and p = .001, respectively). Correlation of CD8+ TILs percentage with age, sex, tumor site, laterality, and outcomes were statistically insignificant. Multivariate analysis revealed that PD-L1 was the only independent factor that affected prognosis. CONCLUSIONS: PD-L1 expression in patients with glioblastoma is robust; higher PD-L1 expression is associated with lower CD8+ TIL expression and worse prognosis.

Air embolism during lumbar surgery in the prone position.

Only a few clinical cases of cerebral arterial gas embolism during spinal surgery are published. It seems important not to overlook this diagnosis in order to initiate rapid appropriate treatment. This was a suspected case of paradoxical gas embolism revealed postoperatively by neurological deficits and whose recovery was noted during hyperbaric oxygen treatment. Unfortunately, no complementary examination showed gas embolism and only the context, the clinical picture and the case evolution evoke this diagnosis. The diagnostic difficulty in the immediate postoperative period is highlighted.

Coronary Computed Tomographic Angiography Imaging as a Prognostic Indicator for Coronary Artery Disease: Data from a Lebanese Tertiary Center.

BACKGROUND: Coronary artery disease (CAD) is a major cause of death and disability worldwide. Coronary computed tomographic angiography (CCTA) is a noninvasive imaging technique with a high negative predictive value (NPV). Most studies were done in developed countries, where the prevalence of CAD does not reflect the actual disease burden in developing countries, such as Lebanon. METHODS: We retrospectively evaluated the prognostic value of CCTA in predicting acute myocardial events (AMEs) in 200 Lebanese patients. We determined if specific medical and radiological characteristics are linked with AME and looked for any association between the patient's medical risk factors and the type/location of detected atheromatous plaques. Patients' records were reviewed, and the follow-up period of 5-8 years ensued. Chi-square/Fisher test and Student's t-test were used, in addition to multinomial logistic regression to adjust for the confounding variables. P <0.05 was considered statistically significant. RESULTS: Our study showed that CCTA had a NPV that reaches 97.9% in asymptomatic patients, a positive predictive value (PPV) of 76.4% for symptomatic patients, a sensitivity of 88.9%, and a specificity of 52.5%. AMEs were significantly increased in patients with a mixed plaque type and/or a moderate-to-severe lumen reduction on CCTA. CONCLUSIONS: CCTA is a sensitive modality for plaque detection and is found to have a remarkably high NPV for asymptomatic patients. A CCTA, along with a low pretest clinical probability of CAD, can be sufficient to rule out an AME for up to 8 years.

Surgery for Pulmonary Parenchymatous Schistosomiasis (Bilharziomas): A 20-Year Single-Centre Experience.

BACKGROUND: Pulmonary schistosomiasis may complicate urinary or intestinal infestations. Pulmonary pathology is either in the acute or chronic form. The chronic form of the disease may result in granuloma formation. This study presents 20 years of experience in surgical management of pulmonary bilharziomas. METHODS: A retrospective review was undertaken of 17 consecutive patients who had surgery for lung bilharziomas from 1996-2016. Demographics, clinical presentation, underlying lung disease, investigations performed, operative procedure, and outcome were retrieved and reviewed. RESULTS: All patients were males, with ages ranging from 22-52 years (median 33 years). Haemoptysis was the main presentation (53%). Coexisting lung tuberculosis was present in five (29.4%) patients. Indications for surgery were solitary shadows in 12 (70.6%) patients and persistent tuberculous cavities in five (29.4%) patients. Segmentectomy was performed in one (5.9%) patient, lingulectomy in one (5.9%) patient, lobectomy in 14 (82.3%) patients, and bi-lobectomy in one (5.9%) patient. The histologic nature of the infestation was: bilharzial ova with extensive granulomatous reaction and suppuration in eight cases (47%); both tuberculosis and bilharzial ova within a granulomatous tissue reaction in five cases (29.4%); and bilharzial ova within malignant tissue in four cases (23.6%). There was no operative mortality. One (1) patient (5.9%) developed postoperative bronchopleural fistula after left upper lobectomy; surgical repair of the fistula and omental flap buttress was needed after failure of conservative management. CONCLUSION: Pulmonary schistosomiasis is not an uncommon infestation and occurs more frequently in patients with underlying tuberculosis. It may predispose to granulomatous parenchymatous lung masses or even malignancy, which necessitate surgical intervention with a good outcome. However, predisposition of pulmonary schistosomiasis for the development of bronchogenic carcinoma warrants further studies.

Effects of smoking on human telomerase reverse transcriptase expression in the skin.

BACKGROUND: Telomeres are DNA-protein complexes that cap chromosomal ends, promoting chromosome stability. Telomerase is a ribonucleoprotein complex with a direct telomere protective function. Telomere shortening represents lifetime exposure to oxidative stress and is negatively correlated with age, smoking, and mortality. Smoking increases oxidative DNA modification and thus may influence telomere dynamics and human telomerase reverse transcriptase (hTERT) activity. OBJECTIVES: This study investigated the effect of smoking on hTERT expression in the skin of smokers and non-smokers. METHODS: A cross-sectional study in 20 current smokers and 20 non-smokers was conducted. Three-mm punch skin biopsies were obtained. Biopsies were examined in routine hematoxylin and eosin staining and immunohistochemistry to investigate expression of hTERT. RESULTS: All skin biopsies from smokers and non-smokers showed cytoplasmic staining in epidermal cells. Sections positive for hTERT expression showed nuclear and some nucleolar staining in cells of the basal and suprabasal layers. In the dermis, hTERT expression was present in some skin appendages. The epidermis of smokers showed positive hTERT in 55% and negative hTERT in 45% of biopsies. The epidermis of non-smokers showed positive hTERT in 70% and negative hTERT in 30% of biopsies (P > 0.05). Among smokers, 20% showed positive and 80% showed negative hTERT expression in the dermis. Among non-smokers, 30% showed positive and 70% showed negative hTERT expression in the dermis. A higher mean pack year value was found in subjects with negative rather than positive hTERT expression (P < 0.01). In addition, pack year was inversely correlated with hTERT expression in the epidermis (P < 0.05): as pack year increased, hTERT expression decreased. Mean pack year values were higher in subjects with negative rather than positive hTERT expression in the dermis (P < 0.01). CONCLUSIONS: This research focused on smoking as a lifestyle factor that may alter telomere length and subsequently telomerase kinetics in the skin. Findings showed a higher percentage of negative hTERT in the epidermis and dermis among smokers compared with non-smokers and a higher percentage of positive hTERT expression among non-smokers (not significant). The results of this work showed a statistically significant higher mean pack year count among cases with negative rather than positive hTERT expression in the epidermis and dermis. Pack year count was inversely correlated to hTERT scoring in the epidermis (percentage of cells stained) and hTERT expression in the dermis. Thus, smoking may affect telomerase activity in the skin, thereby contributing to skin aging.