Immunoexpression of LGR4 and Β-Catenin in Gastric Cancer and Normal Gastric Mucosa

Background: We evaluated the immunoexpression of LGR4 and ß-catenin in primary gastric carcinomas, lymph node metastases and histologically normal gastric mucosa in the surgical margins of gastric primary tumours. Methods: We performed a cross-sectional, observational study, based on 75 gastric carcinoma specimens from gastrectomies conducted at the hospital of the Federal University of Ceará, Brazil. The samples were analysed by tissue microarray and immunohistochemistry. Chi-square, Fisher's exact test and Pearson's linear regression were used in this study. Results: LGR4 expression was greater in the histologically normal gastric mucosa (basal third of the epithelial thickness) of the tumour surgical resection margin than in the cases of primary carcinomas (P<0.001, mainly diffuse-histotype cancer margins), and also in the number of cells stained in the normal mucosa (P<0.0001). Primary intestinal-type carcinomas showed greater positivity for LGR4 than diffuse tumours (59% vs 13%, P<0.0001) and in these the positivity was higher in the metastases (P=0.0242). The membranous immunoexpression of ß-catenin was ubiquitous in the normal mucosa and present in 2/3 of the positive carcinomas. In only one case, nuclear ß-catenin expression was observed. Most LGR4-positive cases were stained for membranous ß-catenin but not the opposite (P<0.01). Conclusion: LGR4 is a likely biomarker of stem cells in the normal gastric mucosa and carcinomas of the stomach, not specific to cancer cells and positively associated with cell proliferation. LGR4 immunoexpression is more frequent and found in a larger number of cells in normal tissues than in tumour samples. Expression of ß-catenin in the junctional membrane-complex occurred predominantly, in positive cases of gastric carcinomas and very rarely in the nucleus. LGR4 apparently influenced the membranous expression of ß-catenin. These findings suggest a controversial role for LGR4, related to proliferative status and inversely related to tumour progression, in contrast to most previous reports.

Serum levels of interleukin-6 in contacts of active pulmonary tuberculosis / Níveis séricos de interleucina-6 em contatos de tuberculose pulmonar ativa

INTRODUCTION: It is estimated that over two billion individuals are infected by Mycobacterium tuberculosis worldwide. Interleukin-6 (IL-6) is an important cytokine whose serum levels are commonly high in active pulmonary tuberculosis (TB). IL-6 screening in contacts of patients with TB may be useful to monitor the progress of the infectious process and to infer the risk of progression to active disease. OBJECTIVE: To evaluate the serum levels of interleukin-6 in contacts of patients with active pulmonary tuberculosis and to compare them with two other groups: a) patients affected by active pulmonary tuberculosis; b) non-contacts of tuberculosis. METHODS: Cross-sectional study with 15 contacts of patients with active pulmonary tuberculosis, selected according to the protocol recommended by the Ministry of Health. The serum levels of interleukin-6 were measured by Enzyme-linked immunosorbent assay (ELISA). The same test was also applied in the two comparison groups: 38 patients with active pulmonary tuberculosis (confirmed by clinical examination, X-rays of the chest and baciloscopy) and 63 non-contacts (healthy blood donors). RESULTS: In the contact group, the median IL-6 concentration was 1.7 pg/ml (0.96-4.8 pg/ml). For those affected by active pulmonary tuberculosis and non-contact individuals, these values corresponded to 4.3 pg/ml (0.5-24 pg/ml) and 0.5 pg/ml (0-2.8 pg/ml), respectively (p < 0.0001). CONCLUSION: Contacts of patients with active pulmonary tuberculosis had significantly higher IL-6 serum levels (3.4 times higher) in relation to non-contact individuals, but on a lower level (2.5 times lower) when compared to those affected by active disease.

INTRODUÇÃO: Estima-se em mais de dois bilhões o número de infectados pelo Mycobacterium tuberculosis no mundo. A interleucina-6 (IL-6) é uma importante citocina, cujos níveis séricos estão comumente elevados na tuberculose pulmonar ativa. A dosagem dessa citocina em contatos de pacientes com tuberculose pode ser útil para se acompanhar a evolução do processo infeccioso, bem como para inferir o risco de progressão da doença ativa. OBJETIVO: Avaliar os níveis séricos de IL-6 em contatos de pacientes com tuberculose pulmonar ativa e compará-los com os de dois outros grupos: a) pacientes acometidos por tuberculose pulmonar ativa; b) não contatos de tuberculose. MÉTODOS: Estudo transversal com 15 contatos de pacientes com tuberculose pulmonar ativa, selecionados de acordo com protocolo preconizado pelo Ministério da Saúde. Os níveis séricos de IL-6 foram mensurados por meio de ensaio imunoenzimático (ELISA). O mesmo ensaio também foi empregado nos dois grupos de comparação: 38 pacientes com tuberculose pulmonar ativa (confirmada por exame clínico, raios X de tórax e baciloscopia) e 63 não contatos, doadores saudáveis de sangue. RESULTADOS: Para o grupo de contatos, a mediana de concentração de IL-6 foi de 1,7 pg/ml (0,96-4,8 pg/ml); para os acometidos por tuberculose pulmonar ativa e indivíduos não contatos, esses valores foram 4,3 pg/ml (0-12 pg/ml) e 0,5 pg/ml (0-2,8 pg/ml), respectivamente (p < 0,0001). CONCLUSÃO: Contatos de pacientes com tuberculose pulmonar ativa apresentaram níveis séricos de IL-6 significativamente aumentados (3,4 vezes mais), em relação aos indivíduos não contatos, mas em um patamar inferior (2,5 vezes menos), quando comparados com os acometidos pela doença ativa.

Freqüência e percentual de suscetibilidade de bactérias isoladas em pacientes atendidos na unidade de terapia intensiva do Hospital Geral de Fortaleza / Frequency and susceptibility percentile of bacteria isolated in patients assisted in the intensive care unit of the General Hospital of Fortaleza

INTRODUÇAO: As infecções hospitalares, hoje, são motivo de grande preocupação no âmbito hospitalar, principalmente nas unidades de terapia intensiva (UTIs), nas quais encontramos uma associação de fatores propícios ao surgimento de infecções. Objetivos: Verificar a freqüência e o perfil de suscetibilidade aos antimicrobianos das bactérias isoladas de pacientes da UTI do Hospital Geral de Fortaleza (HGF). MATERIAL E MÉTODOS: As bactérias foram isoladas em meio de cultura e a identificação e o teste de suscetibilidade aos antimicrobianos realizados por meio do sistema de automação MicroScan WalkWay. RESULTADOS: No período de janeiro a dezembro de 2002 houve 34 por cento de positividade de bactérias no aspirado traqueal de pacientes da UTI; 10 por cento de positividade no cateter; 26 por cento de positividade na urina; e 30 por cento de positividade no sangue. As bactérias mais freqüentes do aspirado traqueal foram Pseudomonas aeruginosa (16 por cento) e Klebsiella pneumoniae (15 por cento). Em cateteres, houve maior freqüência de Staphylococcus coagulase negativa (SCN) (25 por cento) e Staphylococcus aureus (25 por cento); na urina, predominaram Klebsiella pneumoniae (16 por cento) e Pseudomonas aeruginosa (14 por cento). Em hemoculturas, as bactérias mais isoladas foram SCN (41 por cento) e Staphylococcus aureus (17 por cento). Foi observado, em relação ao perfil de suscetibilidade, que as Pseudomonas aeruginosa isoladas de aspirado traqueal apresentaram total suscetibilidade à piperacilina e resistência total à ceftriaxona e à cefotaxima. A Klebsiella pneumoniae isolada de aspirados traqueais foi totalmente sensível ao imipenem, não apresentando resistência total a nenhum antimicrobiano testado, e apresentou suscetibilidade de 54 por cento à ceftazidima. Em cateter ela apresentou resistência a ampicilina/sulbactam, cefepima, cefotaxima, ceftazidima, ceftriaxona, cefuroxima, gentamicina, piperacilina/tazobactam, piperacilina, ticarcil...

INTRODUCTION: Nosocomial infections are prominent problem in hospital environment, mainly in intensive care units (ICU), where innumerous factors favoring the development of these infections are found. Objectives: To determine the frequency and the antibiotic resistance pattern of bacteria isolated from ICU patients in the General Hospital of Fortaleza (HGF). MATERIAL AND METHODS: Bacteria were isolated in culture medium and the identification and test of susceptibility to antimicrobials was performed using MicroScan WalkWay automation device. RESULTS: From January to December of 2002, 34 percent of specimens from tracheal secretion; 10 percent from catheter cultures; 26 percent from urine and 30 percent from the blood yielded isolates. Specimens more frequent in tracheal secretion were Pseudomonas aeruginosa (16 percent) e Klebsiella pneumoniae (15 percent). In catheter cultures, we found high prevalence of Staphylococcus negative coagulase (SNC) (25 percent) and Staphylococcus aureus (25 percent); in urine, Klebsiella pneumoniae (16 percent) and Pseudomonas aeruginosa (14 percent) were the most prevalent. From blood, we isolated mostly SNC (41 percent) and Staphylococcus aureus (17 percent). About antimicrobial susceptibility patterns of Pseudomonas aeruginosa isolated from tracheal secretion, we found a high sensitivity to piperacilin and high resistance to ceftriaxone and cefotaxime. Klebsiella pneumoniae isolated fom tracheal secretion showed high sensibility to imipenem, but no resistance to other antimicrobials althogeter. Susceptibility to ceftazidime was 54 percent. Isolates from catheters showed broad resistance pattern (ampicillin/sulbactam, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, gentamicin, piperacillin/tazobactam, piperacillin, ticarcillin/clavulani acid and tobramycin) but imipenem susceptibility. In urine, the susceptibility to ciprofloxacin was 55 percent. Staphylococcus aureus e SNC were isolated...