Role of Oncogenes and Tumor-suppressor Genes in Carcinogenesis: A Review

Cancer is a medical condition which has a molecular basis. Proto-oncogenes are the first regulatory factors of this biological process. They act in transmitting signals, resulting as growth factors. Modifications of these genes, called oncogenes, lead to the appearance of cancer cells. The activation process leading to proto-oncogenes are chromosomal translocation, point mutation, and gene amplification. Concerning the clonal theory of oncogenesis, it is believed that a tumor starts from a cell. Furthermore, there is close association between tumor development and inhibition of apoptosis or programmed cell death, providing cell immortality. Angiogenesis and angiogenic factors found to be expressed in tumors and may play a key role in tumor formation and development. Tumor-suppressor genes block the growth of cancer and contribute to the normal development of cells. This article highlights the evidence that neoplasms develop as the after-effect of the increase of acquired and physical genetic variations in proto-oncogenes and tumor-suppressor genes; these form a target group in the cells of neoplasms. Tumor formation and development are characterized by individual processes, working synergistically, and an understanding of each individual process may provide a better basis for further anticancer research.

The Relevance of Notch Signaling in Cancer Progression

The Notch signaling pathway controls normal embryonic development and tissue homeostasis of many cell types. It regulates cell proliferation, fate, differentiation, and cell death by short-range signaling between nearby cells that come in contact. The Notch pathway has also been critically involved in the pathobiology of a variety of malignancies, regulating cancer initiation and development, as well as early stages of cancer progression, by adjusting conserved cellular programs. Fibroblasts, an essential for tumor growth component of stroma, have also been affected by Notch regulation. Sequencing Notch gene mutations have been identified in a number of human tumors, revealing information on the progression of specific cancer types, such as ovarian cancer and melanoma, immune-associated tumors such as myeloid neoplasms, but especially in lymphocytic leukemia. Activation of the Notch can be either oncogenic or it may contain growth-suppressive functions, acting as a tumor suppressor in other hematopoietic cells, hepatocytes, skin, and pancreatic epithelium.

Knowledge of Blood Transfusion in Medical And Biology Students

Introduction: Blood transfusion (hemotherapy) is a therapeutic intervention used in treatment strategies of multiple diseases, thus, proper education is of utmost importance. Since currently there are no specified educational programs, undergraduate students were evaluated for the knowledge gained during university courses.

Purpose: To evaluate and compare the level of knowledge of students of the faculty of Health Science, Department of Medicine (DM), and Department of Molecular Biology-Genetics (DMB&Gs) on issues related to the transfusion of blood products.

Methods: A cross-sectional observational study was carried out with 123 students from the aforementioned departments of the Democritus University of Thrace, from the third year to the last year of study. A questionnaire was used, weighted, and was based on the European Commission's Guide to the Preparation, Use and Quality Assurance for Blood Components. Statistical tests such as chi-square (χ2), t-test, analysis of variance (ANOVA), and linear regression were used to investigate the factors that affect the overall score.

Results: The mean score of the students was 42.55 while the standard deviation (SD) was 12.27. The difference in the scores between the students of the DM (M = 44.63, SD = 13.2) and those of the DMB&Gs (mean = 38.25, SD = 9.05) was statistically significant in the univariable analysis (t= 3.1, p = 0.0), but in the multivariable analysis, it was not statistically significant (β = -4.1, p = 0.1.). The results of the multiple regression model indicated that the year of study, the professional status of the father, and the grade in the hematology course were associated with the total score.

Conclusions: The level of knowledge regarding blood product transfusion among students of the faculty of Health Science is insufficient.

Association of Low Maternal Pregnancy-associated Plasma Protein A with Adverse Perinatal Outcome

The aim is to provide an overall view of the association of low pregnancy-associated plasma protein A (PAPP-A) levels with adverse perinatal outcomes. The available literature in PubMed/Medline regarding PAPP-A and adverse pregnancy outcomes was searched for related articles, including terms such as “PAPP-A,” “intrauterine growth restriction (IUGR),” “small for gestational age (SGA),” “stillbirth,” “adverse outcome,” and others. The fifth percentile is supported by many recent studies to be PAPP-A’s cutoff for adverse outcome detection and the increased risk seems to be extremely high below 0.2 PAPP-A MoM (multiple of the median). Apart from chromosomal abnormalities, preeclampsia, intrauterine fetal demise, and pregnancy loss have been associated with maternal serum PAPP-A. For results below the first centile, PAPP-A has a strong positive predictive value for SGA and IUGR. Except for its vital role on the cleavage of insulin-like growth factor binding proteins (IGFBP), PAPP-A has proven to be a reliable marker for prenatal screening. Even though PAPP-A as a single predictor proved to be valuable for the prediction of some adverse perinatal outcomes, in some cases, a combination of PAPP-A to other maternal serum markers led to an increase in detection rates. PAPP-A is a promising maternal serum marker for pregnancy outcome prediction with more studies needed in order for its potentials to be fully understood and exploited.

A Rare Case of Massive Hematometra with a Tubo-ovarian Abscess in a 16-year-old Female

Imperforate hymen is a congenital defect of the lower genital tract and specifically the vagina. The examination of a neonatal can be quite helpful to avoid a multitude of complications in puberty like hematocolpos and tubo-ovarian abscess.

We present the case of a 16-year-old who presented to the emergency department with fever (37.9° C), which was progressive the last two days, swollen abdomen, and pain in the lower abdomen. She also had a one-year history of cyclic abdominal pain. The patient had primary amenorrhea, the secondary sexual characteristics were normal for her age (Tanner III), and there was no family history of primary amenorrhea. The physical and ultrasound examination revealed an imperforate and bulging vaginal membrane and a multilocular adnexal mass, respectively.

Every doctor should suspect this medical condition when there is a triad of symptoms like cyclic lower abdominal pain, primary amenorrhea, and swollen abdomen. Early diagnosis of an imperforate hymen can prevent serious complications for young patients.

The Role of ARID1A in Endometrial Cancer and the Molecular Pathways Associated With Pathogenesis and Cancer Progression

AT-rich interaction domain 1A gene (ARID1A) encodes for a subunit of the switch/sucrose non-fermentable (SWI/SNF) complex, a chromatin remodeling complex, and it has been implicated in the pathogenesis of various cancer types. In this review, we discuss how ARID1A is linked to endometrial cancer and what molecular pathways are affected by mutation or inhibition of ARID1A. We also discuss the potential use of ARID1A not only as a prognostic biomarker, but also as a target for therapeutic interventions.

Association of Pregestational Maternal Sleeping Disorders and Preeclampsia: A Retrospective Cohort Study and Review of the Literature

In this retrospective cohort study, primigravidas with normal pregnancies and women who developed preeclampsia (PE) were assigned to complete sleeping disorder questionnaires. The Crown-Rump length (CRL) of the first prenatal screening was used to determine the gestational age and the participants were assigned to complete the following questionnaires according to their everyday life before pregnancy: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Epworth Sleepiness Scale (ESS), and (3) Athens Insomnia Scale (AIS). Women were also asked to evaluate their stress before pregnancy with the Beck Anxiety Inventory (BAI). The results of the women developing preeclampsia were analyzed to test the primary hypothesis that women with pre-existing to pregnancy sleep disorders are more likely to develop preeclampsia. Statistically significant differences were found between women who developed preeclampsia and women in the control group concerning sleeping disorder features before pregnancy of all three research tools, namely AIS (p<0.001), PSQI (p<0.001), and ESS (p=0.012<0.05). The results support that there is a possible statistical effect of pre-existing to pregnancy sleep disorders on the development of preeclampsia and women with pregestational sleep disorders request strict monitoring during pregnancy, however, further investigation with larger studies is needed to reach safe conclusions.

The Impact of microRNAs in Breast Cancer Angiogenesis and Progression

OBJECTIVE

The study aims to review the recent data considering the expression profile and the role of microRNAs in breast tumorigenesis, and their impact on -the vital for breast cancer progression- angiogenesis.

METHODS

PubMed was searched for studies focused on data that associate microRNA with breast cancer, using the terms ''breast", "mammary gland", "neoplasia'', "angiogenesis" and ''microRNA'' between 1997-2018.

RESULTS

Aberrant expression of several circulating and tissue miRNAs is observed in human breast neoplasms with the deregulation of several miRNAs having a major participation in breast cancer progression. Angiogenesis seems to be directly affected by either overexpression or down regulation of many miRNAs, defining the overall prognostic rates. Many miRNAs differentially expressed in breast cancer that reveal a key role in suppression - progression and metastasis of breast cancer along with the contribution of the EGF, TNF-a and EGF cytokines. Conclusion Angiogenesis has proven to be vital for tumor development and metastasis while microRNAs are proposed to have multiple biological roles, including participation in immunosuppressive, immunomodulatory and recent studies reveal their implication in angiogenesis and its possible use as prognostic factors in cancer Even though larger studies are needed in order to reach safe conclusions, important steps are made that reveal the connection of serum microRNA expression to the angiogenic course of breast cancer, while miRNAs could be potential prognostic factors for the different breast cancer types.

Interleukins Associated with Breast Cancer

A tumor consists of a group of cells with abnormal growth, capable of acquiring unique characteristics that provide them with the ability to display mercurial migration patterns, adapting to microenvironments and their chemical and physical factors. Interleukins are small proteins secreted mainly by CD3+ and CD4+ T lymphocytes that mediate the "essential for cancer progression" interactions between cells. Interleukins are implicated in both the development and differentiation of different cells (NK, B, and T leukocytes) and, in general, play a major role in many diseases, including breast cancer, due to their unique participation in systemic inflammation and immune system modulation. During the past decade, interleukins proved to be decisive for future immunotherapy, predisposing a more reliable treatment with fewer side effects on normal proliferating cells. The aim of this review is to provide an overview of the role of interleukins implicated in breast cancer progression.

Genetic variations in the SULF1 gene alter the risk of cervical cancer and precancerous lesions

Human papillomavirus (HPV) infection alone is not sufficient to explain the development of cervical cancer. Genetic variants have been linked to the development of precancerous lesions and cervical cancer. In this study, we aimed to evaluate the association of 10 single nucleotide polymorphisms (SNPs) of the Fas cell surface death receptor (FAS), trinucleotide repeat containing 6C (TNRC6C), transmembrane channel like 8 (TMC8), DNA meiotic recombinase 1 (DMC1), deoxyuridine triphosphatase (DUT), sulfatase 1 (SULF1), 2′-5-oligoadenylate synthetase 3 (OAS3), general transcription factor IIH subunit 4 (GTF2H4) and interferon gamma (IFNG) genes with susceptibility to precancerous lesions and cervical cancer. In total, 608 female participants, consisting of 199 patients with persistent low-grade precancerous lesions (CIN1), 100 with high-grade precancerous lesions (CIN2/3), 17 patients with cervical cancer and 292 healthy controls, were enrolled in this study. SNPs were tested for associations with each of the above-mentioned cervical group lesions or when considering an overall patient group. A significant difference for rs4737999 was observed between the controls and the overall patient group considering the recessive mode of inheritance [odds ratio (OR), 0.48; 95% confidence interval (CI), 0.24–0.96; P=0.033]. This effect was even stronger on the risk of CIN1 lesions. Carriers of the rs4737999 AA genotype were almost 3-fold less likely of having low grade lesions compared to the other genotypes. On the whole, this study provides evidence of an influence of the SULF1 gene rs4737999 SNP in the development of precancerous lesions/cervical cancer.

MicroRNAs as Potential Serum Biomarkers for Early Detection of Ectopic Pregnancy

Diagnosis of ectopic pregnancy relies on both ultrasound findings and human chorionic gonadotropin (hCG) measurements but due to the need for serial tests, tubal rupture and death represent major maternal and fetal risks. Early detection of ectopic pregnancy is essential and thus a noninvasive diagnostic tool seems crucial for the prevention of adverse effects since studies suggest there is a specific relationship between ectopic pregnancy and increasing microRNA factors. Human fluids in women with ectopic pregnancy reveal a particular change in comparison to healthy women. In addition to certain placental microRNAs circulating through plasma that present a specific concentration and serum profile, microRNAs seem to be possible biomarkers for the detection of pregnancy complications linked to placental pathologies. The aim of this study is to review current literature considering the expression levels of several circulating microRNAs that have shown to be novel potential biomarkers for the diagnosis of tubal ectopic pregnancy.

Hydrops Fetalis and THE Parvovirus B-19

DEFINITION

Hydrops Fetalis (HF) or fetal hydrops is identified as an abnormal interstitial collection of fluid in at least 2 or more compartments of the fetal torso (peritoneal cavity, pleura, and pericardium). An alternative definition discusses about liquor accumulation in two fetal anatomical areas or an effusion in one site and anasarca.

BACKGROUND

Parvovirus B-19 is a common childhood illness; the virus can cause fetal anemia, non-immune fetal hydrops, and spontaneous abortion and might lead to fetal demise. HF is the pathological distribution of body fluids between the interstitial and the intravascular areas of the fetus. Normally, in the fetal organism there is a continuous circular movement of the lymph from the interstitial space into the vascular system and vice versa. The detection of a solely effusion represents the initial stage of a systemic disorder that will lead to a fully developed hydrops or remain just a local disorder.

OBJECTIVE

The connection between parvovirus B-19 and fetal hydrops.

CONCLUSION

The view is unbeatable, severely swollen babies; immune hydrops is surfaced because of the maternal antibodies targeted against red blood cells with Rh positive antibody of the fetus, while the non-immune is due to a variety of pathological conditions in pregnancy.

Diagnosis and Management of Congenital Dyserythropoietic Anaemia Type II in a Secundigravida

Congenital dyserythropoietic anaemias (CDAs) are very rare, heterogeneous hereditary red blood cell disorders characterized by ineffective erythropoiesis, erythroblast morphological abnormalities, haemolysis, and hypoglycosylation of red-blood-cell membrane proteins and lipids. There are four types (I-IV) of the disease identified, and all of them are associated with abnormal maturation and division of erythroid precursors. We report the management of a rare case of CDA type II diagnosed in a 26-year-old pregnant woman.

The social stigma of HIV-AIDS: society's role

AIDS is a devastating and deadly disease that affects people worldwide and, like all infections, it comes without warning. Specifically, childbearing women with AIDS face constant psychological difficulties during their gestation period, even though the pregnancy itself may be normal and healthy. These women have to deal with the uncertainties and the stress that usually accompany a pregnancy, and they have to live with the reality of having a life-threatening disease; in addition to that, they also have to deal with discriminating and stigmatizing behaviors from their environment. It is well known that a balanced mental state is a major determining factor to having a normal pregnancy and constitutes the starting point for having a good quality of life. Even though the progress in both technology and medicine is rapid, infected pregnant women seem to be missing this basic requirement. Communities seem unprepared and uneducated to smoothly integrate these people in their societies, letting the ignorance marginalize and isolate these patients. For all the aforementioned reasons, it is imperative that society and medical professionals respond and provide all the necessary support and advice to HIV-positive child bearers, in an attempt to allay their fears and relieve their distress. The purpose of this paper is to summarize the difficulties patients with HIV infection have to deal with, in order to survive and merge into society, identify the main reasons for the low public awareness, discuss the current situation, and provide potential solutions to reducing the stigma among HIV patients.

MicroRNA: The Potential Regulator of Endometrial Carcinogenesis

MicroRNAs (miRNAs) are small stable endogenous RNAs, found in all complex organisms and considered by nature as inhibitors of mRNA translation. This class of small posttranscriptional regulatory RNAs originates from the random formation of hairpin precursors in "non-coding" DNA regions; their main function is the control of gene expression status. The premature forms of the fullydeveloped microRNAs are the pre-microRNAs; molecules composed of thousands of nucleotides and constitute 1-2% of the human genome; the human genome encodes at least 1,500 miRNAs. miRNAs do not encode for any proteins; they guide gene modulation and affect crucial biological processes such as cell proliferation, tissue differentiation, apoptosis, cancer progression and female physiology. miRNAs are detected in specific tumor types and seem to be effectively involved in invasion, metastasis and acquire a role in clinical prognosis. miRNA expression is the vital key in cancer cell dysregulation. Cancer cells present with abnormal growth and lack of their apoptosis fate. Normal and neoplastic tissues have dissimilar expression patterns. Endometrial cancer subtypes are outlined by an irregular miRNA expression, along with other human malignancies. miRNAs retain manifold roles in angiogenesis; have a bidirectional impact on oncogenes and tumor suppressor genes in the steps of endometrial cancer growth, being positive or negative regulators of metastasis. The scientific significance of this new class of noncoding RNAs is gradually comprehended. The current review summarizes our knowledge on the role of miRNA in endometrial cancer development and clinical behavior; it outlines the biological pathways strictly modulated by them.

Chronic renal failure, diabetes mellitus type-II, and gestation: an overwhelming combination

This case report highlights on a child-bearer with chronic renal failure and diabetes mellitus type-II. Chronic renal failure (CRF) with diabetes mellitus (DM) type I in gestation is a rare case of a high-risk pregnancy. What is of significance though in this gestation, is that conception was achieved with the patient treated by a dialysis program. Furthermore, neither hypertension nor intrauterine growth restriction (IUGR) were detected and the patient was normotensive throughout gestation with no clinical signs of anemia. Strict and frequent application of the dialysis programs eradicates the uremic intrauterine environment, reduces the amniotic fluid volume, eliminates the chances of uterine rupture, leads to a longer gestation, increases the newborn's birth weight, and offers an optimal fetal survival rate; this is of note mainly in patients with cesarean sections reported in their medical history. To eliminate the complications of a premature delivery, the present authors had to find the right time point to give birth to this baby taking into account lung maturity, amniotic fluid volume, and preservation of the anatomical uterine integrity.

Pre-eclampsia and the vascular endothelial growth factor: a new aspect

Pre-eclampsia (PE) is a multi-system disorder of human gestation characterized by hypertension, proteinuria, and edema, which resolves with placental delivery. This disease affects 3-14% of all pregnancies worldwide and 5-8% in the USA. Furthermore PE remains one of the leading causes of maternal and neonatal mortality and morbidity worldwide. One of the most important goals in obstetrics is the early identification of the patient with an increased risk for PE. This paper unifies the essential and validated findings of past and current scientific investigation which encompass the relationship between PE and the vascular endothelial growth factor (VEGF). VEGF and its receptors have acquired great interest due to their vital role in neovascularization (vasculogenesis and angiogenesis) in a variety of physical and pathological processes such as the female reproductive cycle, PE, and tumorigenesis. VEGF is secreted in response to tissue hypoxia and endothelial cell damage. Alterations in the circulating levels of this factor may therefore identify those pregnancies with a high possibility of developing PE. This review will summarize the present authors' current understanding of the role of circulating VEGF in the pathogenesis, clinical diagnosis, and prediction of PE.

MiRNAs: regulators of human disease

MicroRNAs (miRNAs) represent the mediators of important leading biological functions of molecular pathways in humans. They are a class of very small, non-coding RNAs; their function is the balance of the protein levels at the post-transcriptional stage. They are implicated in molecular processes and diseases, including diabetes, metabolism, autoimmune diseases, angiogenesis and tumorigenesis, and female fertility, exhibiting an altered expression profile. Any process taking place in the human organism is intertwined by miRNAs. MiRNAs have an impact on the biochemistry of pathways of the invisible molecular world. They circulate in a stable chemical configuration in body fluids (tears, serum, plasma, amniotic fluid, ascetic fluid, urine) with their molecular sequence specificity remaining unchanged. Their indisputable molecular stability ranks them as extremely vigorous potential markers in human disease. MiRNAs demonstrate a specific expressive signature, representative of the tissue specificity and the clinical staging. The shift on the concentration and expression of a miRNA reflects the course of a disease. MiRNAs may operate as oncogenes (tumor growth) or tumor suppressor (tumor reduction) genes in cancer pathways. In malignant disease, proliferation, maintenance, and progression of cancer cells is induced by the stimulation of the oncogenes or complete deactivation of the tumor suppressor gene activity.

The riddle of Ballantyne's syndrome in the aspect of hydrops fetalis

Ballantyne's syndrome, the combination of maternal generalized edema and fetal ascites, is rare and alarming in gestation. Early diagnosis might be useful in providing proper management of the fetus and aiming at an improved clinical result. The syndrome is an indication that HF is there, it has already started expanding the fetal torso and endangering the child-bearer's life. Despite the detailed investigation, no apparent cause for the emergence of the hydrops was identified.

Ultrasound diagnosis of recurring Jeune's syndrome: a case report

Jeune's Syndrome or asphyxiating thoracic dystrophy (ATD) is a rare autosomal recessive skeletal dysplasia syndrome characterized by a small and narrow chest, short extremities, and often polydactyly associated with multiple organ manifestations. The severity of complications ranges from mild to lethal. This is a report of two cases of ATD diagnosed in successive pregnancies of a nonconsanguineous couple. The contribution of sonography in prenatal diagnosis of the syndrome is highlighted.

Immature malignant sacrococcygeal teratoma: case report and review of the literature

Immature malignant sacrococcygeal teratoma (SCT) is a rare tumor, deriving from the three germinal layers and is found in the sacrococcygeal region. It is the most frequent site of teratomas in the fetus. A nut-brown, solid tumor with cystic areas with a ten-cm diameter is reported in the sacrococcygeal region of a female fetus of 23 weeks and with a weight of 308 g. The ultrasound and pathology evaluations revealed characteristics of an immature malignant SCT. The incidence of this tumor type is one in 35,000 to 40,000 live births and females are four times more likely to be affected than males. Sacrococcygeal and cervical teratomas can be diagnosed by prenatal ultrasound and magnetic resonance imaging (MRI). Teratomas are considered an interesting field for research.