Hypercoagulable State in Patients with Advanced Gastrointestinal Cancer: Evidence for an Acquired Resistance to Activated Protein C

Aims and background

Thromboembolic complications are common in patients with cancer and represent the second cause of death in patients with overt malignant disease. The aim of this study was to investigate the activated protein C pathway in cancer.

Methods

We studied the coagulation cascade, natural clotting inhibitors, fibrinolytic proteins and resistance to activated protein C in 20 patients with advanced gastrointestinal cancer and 84 volunteers by measuring PT, APTT, fibrinogen, AT III, PC, PS, APC resistance, fibrinolytic system (PLG, ANPL, PAI-1 and t-PA) and activation peptides (D-Dimers, prothrombin 0 fragment 1+2/F1+2).

Results

Laboratory tests confirmed coagulation abnormalities in cancer patients. Fibrinogen, D-Dimers and F1+2 were increased, while t-PA activity was significantly lower than that of controls. APC resistance was higher in cancer patients compared to the control group (55% vs 2%; P < 0.0001). Excess thrombin generation was manifested by increased F1+2 plasma levels in APC-resistant cancer patients. Genetic analyses showed that only one patient with a poor response to APC carried a factor V R506Q mutation in exon 10.

Conclusions

Our findings show a high prevalence of APC resistance in cancer, compatible with an acquired defect in the APC pathway.

Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

OBJECTIVE

Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT.

METHODS

Patients were treated according to their stage: surgery and surveillance for stage I; a modified bleomycin-etoposide-cisplatin (BEP) regimen for stages II (three cycles), III, and IV (three cycles) with surgery on residual disease.

RESULTS

Seventy-seven patients were enrolled (median age 11.8 years), 26 with dysgerminoma (Dysg), 13 with immature teratoma and elevated serum alpha-fetoprotein levels (IT + AFP), and 38 with nondysgeminoma (Non-Dysg) staged as follows: 27 stage I, 13 stage II, 32 stage III, 5 stage IV. Among evaluable patients in stage I (5-year event-free survival [EFS] 72.1% [95% CI: 56.4-92.1%]; 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescued with chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II-IV, 48 (98%) achieved complete remission after chemotherapy ± surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6-100%) and 84.5% (95% CI: 76.5-93.5%).

CONCLUSIONS

We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists, we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers.

Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma

The aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.

A storage ring experiment to detect a proton electric dipole moment

A new experiment is described to detect a permanent electric dipole moment of the proton with a sensitivity of 10^-29 e ⋅ cm by using polarized "magic" momentum 0.7 GeV/c protons in an all-electric storage ring. Systematic errors relevant to the experiment are discussed and techniques to address them are presented. The measurement is sensitive to new physics beyond the standard model at the scale of 3000 TeV.

Self-Lubricity of WSex Nanocomposite Coatings

Transition metal chalcogenides with lamellar structure are known for their use in tribological applications although limited to vacuum due to their easy degradation in the presence of oxygen and/or moisture. Here we present a tailored WSex coating with low friction (0.07) and low wear rates (3×10(-7) mm3 Nm(-1)) even in ambient air. To understand the low friction behavior and lower chemical reactivity a tribological study is carried out in a high-vacuum tribometer under variable pressure (atmospheric pressure to 1×10(-8) mbar). A detailed investigation of the film nanostructure and composition by advanced transmission electron microscopy techniques with nanoscale resolution determined that the topmost layer is formed by nanocrystals of WSe2 embedded in an amorphous matrix richer in W, a-W(Se). After the friction test, an increased crystalline order and orientation of WSe2 lamellas along the sliding direction were observed in the interfacial region. On the basis of high angle annular dark field, scanning transmission electron microscopy, and energy dispersive X-ray analysis, the release of W atoms from the interstitial basal planes of the a-W(Se) phase is proposed. These W atoms reaching the surface, play a sacrificial role preventing the lubricant WSe2 phase from oxidation. The increase of the WSe2 crystalline order and the buffer effect of W capturing oxygen atoms would explain the enhanced chemical and tribological response of this designed nanocomposite material.

Routine Use of a Protease Zymogen-Based Colorimetric Assay for the Detection of Beta-Glucan and its Role in Clinical Practice

The detection of Aspergillus antigen (galactomannan) is considered a reliable marker for the diagnosis of invasive aspergillosis (IA), yet the sensibility and specificity of the assays commonly employed in routine are not optimal. The aim of the present study was to investigate whether the detection of another panfungal antigen, the (1,3)-b-D-glucan could have an auxiliary role in the identification of patients with IA. The study was carried out on 63 sera belonging to patients who had been screened for galactomannan, according to the clinical suspect of IA. Our data show that the positive galactomannan results were not confirmed by positive (1,3)-b-D-glucan results in patients receiving therapy with beta-lactam antibiotics associated with tazobactam, whereas in all the other cases, with the exception of four, the results of the (1,3)-b-D-glucan test were confirmatory of the galactomannan results.

Factors related to outcome of early and delayed prosthetic joint infections

In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome.

PATIENTS AND METHODS

Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained.

RESULTS

Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome.

CONCLUSION

Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.

Unraveling the variability and genetic structure of barker frog Physalaemus cuvieri (Leiuperinae) populations from different regions of Brazil

The barker frog Physalaemus cuvieri is widely distributed in South America and is found in all regions of Brazil. Significant intraspecific morphological variation in this species has been reported. To determine the genetic structure of the natural Brazilian populations of P. cuvieri, 10 different populations geographically separated by 99.41 to 2936.75 km were evaluated using 10 polymorphic microsatellite loci. In addition, mitochondrial DNA data were analyzed to determine genetic distance between the populations. The genetic variation was found to be significant in most of the populations (HE ranged from 0.40 to 0.59, and allelic richness ranged from 2.07 to 3.54). An FST value of 0.27 indicated that high genetic structure was present among the P. cuvieri populations. STRUCTURE analyses grouped the 10 populations into nine clusters and indicated that only two of the populations were not genetically differentiated. The genetic distance calculated from the mitochondrial DNA data showed values <0.03 for seven of the populations.

Source apportionment of size-segregated atmospheric particles based on the major water-soluble components in Lecce (Italy)

Atmospheric aerosols have potential effects on human health, on the radiation balance, on climate, and on visibility. The understanding of these effects requires detailed knowledge of aerosol composition and size distributions and of how the different sources contribute to particles of different sizes. In this work, aerosol samples were collected using a 10-stage Micro-Orifice Uniform Deposit Impactor (MOUDI). Measurements were taken between February and October 2011 in an urban background site near Lecce (Apulia region, southeast of Italy). Samples were analysed to evaluate the concentrations of water-soluble ions (SO4(2-), NO3(-), NH4(+), Cl(-), Na(+), K(+), Mg(2+) and Ca(2+)) and of water-soluble organic and inorganic carbon. The aerosols were characterised by two modes, an accumulation mode having a mass median diameter (MMD) of 0.35 ± 0.02 μm, representing 51 ± 4% of the aerosols and a coarse mode (MMD=4.5 ± 0.4 μm), representing 49 ± 4% of the aerosols. The data were used to estimate the losses in the impactor by comparison with a low-volume sampler. The average loss in the MOUDI-collected aerosol was 19 ± 2%, and the largest loss was observed for NO3(-) (35 ± 10%). Significant losses were observed for Ca(2+) (16 ± 5%), SO4(2-) (19 ± 5%) and K(+) (10 ± 4%), whereas the losses for Na(+) and Mg(2+) were negligible. Size-segregated source apportionment was performed using Positive Matrix Factorization (PMF), which was applied separately to the coarse (size interval 1-18 μm) and accumulation (size interval 0.056-1 μm) modes. The PMF model was able to reasonably reconstruct the concentration in each size-range. The uncertainties in the source apportionment due to impactor losses were evaluated. In the accumulation mode, it was not possible to distinguish the traffic contribution from other combustion sources. In the coarse mode, it was not possible to efficiently separate nitrate from the contribution of crustal/resuspension origin.

Myocardial damage following cardiac surgery: comparison between single-dose Celsior cardioplegic solution and cold blood multi-dose cardioplegia

Myocardial protection during cardiac surgery can be accomplished by different cardioplegic solutions. The aim of this study was to assess myocardial damage after heart valve surgery performed with myocardial protection of a single dose of Celsior cardioplegia or with repeated cold blood cardioplegia. After the stratification of 139 valvular patients by means of matching according to cross-clamp and cardiopulmonary bypass time, 32 patients were retained for comparison (16 patients received Celsior and 16 patients received cold blood cardioplegia). Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) release were evaluated until six days after the operation. Pre-operative characteristics were similar in both groups. In the Celsior group, CK-MB and cTnI values were significantly higher from the first up to the sixth post-operative day. Peak cTnI values were 19.4 ± 13.4 and 9.7 ± 7 ng/mL (p=0.01) in the Celsior and the Cold Blood group, respectively. Peak CK-MB values were 79.6 ± 58.8 and 45.9 ± 20.6 U/L (p=0.07) in the Celsior and the Cold Blood group, respectively. Cold blood cardioplegia reduces perioperative myocardial damage compared to the Celsior solution in elective cardiac valve operations.

LABAs in asthmatic children: highlights and new inside

International asthma guidelines recommend increasing the dose of ICS or adding leukotriene modifiers or the use of long-acting inhaled beta2-agonists (LABAs) in combination with inhaled corticosteroids (ICS) when uncontrolled asthma occurs in adult and children in treatment with low-dose inhaled corticosteroids. However, in children, the effects of this last treatment option are unclear because there are few studies on the efficacy and safety of these drugs in pediatric age. Furthermore, salmeterol is licensed for use in children over 4 years and formoterol in children of more than 6 years. Finally, recent data provides evidence that repeated bronchoconstriction induces epithelial cell stress that may lead to remodeling and these findings may have potential implications for asthma management, particularly for LABAs treatment in the future.