Cell-mediated immune hypersensitivity is stronger in the left side of the body than the right in healthy young subjects

Exploring the prognostic impact of tumor sidedness in ovarian cancer: A population-based survival analysis of over 10,000 patients

Very recently, emerging evidence demonstrated that laterality might be an independent prognostic factor in patients with advanced ovarian cancer (OC). Based on preliminary provocative observations, our study aimed to investigate the prognostic impact of sidedness in a large cohort of women with OC. Survival was estimated based on Kaplan-Meier method and survival curves were compared using Log-rank test. Cox proportional-hazards model was used to study the association between survival and covariates. A total of 10,177 women with OC were included. Mean age at diagnosis was 59.58 years (±13.5); 36.7% OC right-sided, 36.9% were left- sided, and 26.4% had bilateral OC. The median overall survival (OS) for the entire population was 77 months, with the lowest median OS observed in bilateral OC (median OS: 34 months). The prognostic value of OC sidedness was not confirmed at the univariable analysis (HR = 0.958; 95% CI: 0.888-1.033, p = 0.268). However, women with bilateral OC has a 45% higher risk of death as compared with unilateral diagnosis (HR = 1.453; 95% CI: 1.410-1.497; p< 0.001). The independent prognostic value was further confirmed on multivarible analysis after adjusting for covariates including age, marital status, histological type, CA-125 at diagnosis, grade, stage, chemotherapy and surgery (HR = 1.087; 95% CI: 1.043-1.136, p = 0.02). However, the ultimate prognostic significance appeared less prominent, with bilateral OC conferring a relative increase of 8.7% of mortality. Our real-world study demonstrated that impact of tumor sidedness has no prognostic implication (right vs left OC) but bilateral OCs might be marginally more prognostically unfavorable. Prospective validation might be warranted, to confirm the prognostic significance of OC sidedness, including for the presence of key genetic alterations and lymph nodes asymmetry, to better stratify patients with OC and predict outcomes according to tumor sidedness at diagnosis.

Lateralization bias for autoimmune optic neuritis

The asymmetrical structure of the human brain is reflected not only by innate interhemispheric differences but also by lateralization in neurological disease. We tested if unilateral autoimmune optic neuritis (aON) manifests more frequently on the left than the right eye in clinical and neuroimaging terms and whether Google searches for aON symptoms reflect this bias, too. We employed a retrospective analysis of a patient cohort from 2009 to 2019 with 552 unilateral aONs and 374 corresponding MRI imaging data sets. Searchmetrics Suite keywords tool was applied for the analysis of Google searches on aON-symptoms in Germany, the US and the UK for the last 12 months. Left eye aON manifestations were more frequent than right aON manifestations (55.3% vs. 44.7%, p = 0.015) and 1.9 times more likely to be associated with a pathological MRI finding in the affected optic nerve (p = 0.013). Keywords describing aON-typical but not other ocular symptoms were more frequently associated with Google searches for the left in comparison to the right eye (p < 0.001). Autoimmune optic neuritis more frequently affects the left than the right eye and people search on the Internet more often for left-sided aON symptoms. Although a reporting bias due to an increased perception of left eye symptoms is one possible explanation, MRI evidence of more frequent optic nerve affection for the left in comparison to the right side suggests a leftward lateralization bias similar to the one previously shown for cerebral neuroinflammatory lesions.

Right-Sided clinical findings are worse prognostic factor in Multiple Sclerosis patients?

OBJECTIVE

To investigate the importance of the side of clinical findings in predicting the prognosis in multiple sclerosis (MS) patients.

METHODS

In our study we enrolled 361 MS patients. This study as retrospective was performed. On neurological examinations, clinical findings were recorded as right, left and bilateral. We used the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS), Progression Index (PI) for neurological status.

RESULTS

At the first attack, there were differences in the EDSS, PI and MSSS of right-sided findings between remission and attack periods (p=0.057, p=0.008, p=0.017 respectively). In the right-sided clinical findings, the value of PI and MSSS were higher than the others between in remission and attack periods (p=0.002, p=0.045 respectively). At last attack, we found statically differences in EDSS, MSSS values between remission and attack periods in only right-sided clinical findings (p=0.042, p=0.027 respectively). In the first presentation the PI value in bilateral clinical signs was lower (p=0.016).

CONCLUSION

Right-sided clinical findings were poor prognostic factors in all stages of MS, whereas bilateral findings were not poor prognostic factor in the early-stage MS.

Iron and laterality effects on healing of cautery disbudding wounds in dairy calves

Hot-iron disbudding, the process of cauterizing the horn buds of calves or goat kids at an early age to prevent horn growth, is routinely practiced in dairy production. The wounds take weeks to heal and are painful to touch throughout this time. Possible strategies to hasten the healing of disbudding wounds are not well understood, but the type of iron used may be an important factor to consider. When evaluating strategies to hasten healing, a within-subjects design may be preferable, but laterality effects might act as a potential source of variation and confounding in this type of experiment. Our objectives were to compare healing after disbudding with 2 commercially available irons, and to determine whether wounds healed differently on the left versus the right side of the head. Ten Holstein calves 4 to 10 d of age were disbudded using the Rhinehart X50A electric disbudder (Rhinehart Development Corp., Spencerville, IN) on one horn bud and the Portasol gas disbudder (Portasol USA, Elmira, OR) on the other; side (left vs. right) was balanced between treatments. We scored wounds daily for the presence of 6 tissue types: attached necrotic tissue, detached necrotic tissue, exudate, granulation, crust, and epithelium. Surface temperature and size of the wound were measured twice-weekly using thermal and digital photographs, respectively. The type of iron used did not affect latency to re-epithelialize, which took on average (mean ± standard deviation) 53 ± 3 d and 55 ± 3 d for Portasol and Rhinehart wounds, respectively (range: 40-70 d). However, compared with Portasol wounds, those from the Rhinehart had fewer days of granulation tissue and tended to have more days of detached necrotic tissue. The Portasol tip had a smaller total surface area than the Rhinehart, which may have resulted in a less severe burn, causing the necrotic tissue to fall off sooner. The left side tended to re-epithelialize faster than the right side (mean ± standard error: left 51 ± 3 d; right 57 ± 3 d) and have fewer days of crust. Left-sided wounds were also cooler and tended to be smaller than those on the right. To assess the external validity of these laterality effects in our primary experiment (experiment A), we analyzed wound healing data from 2 other disbudding studies, one on calves (experiment B) and one on goat kids (experiment C). We observed laterality effects in the opposite direction in Experiment B, but negligible effects in experiment C, indicating that the differences in laterality had low external validity; the biological meaning of this asymmetry is unclear. Nonetheless, if using a within-subjects design, asymmetries in wound healing should be considered to avoid confounding effects. In conclusion, wounds from both irons took 7 to 8 wk to heal, on average; other strategies to accelerate healing should be explored.

Variation in risk and outcomes of Epstein-Barr virus-associated breast cancer by epidemiologic characteristics and virus detection strategies: an exploratory study

PURPOSE

A relationship of Epstein-Barr virus (EBV) and breast cancer etiology and outcome may have clinical utility and potential to enhance understanding of tumor biology. Research to date has yielded variable results, likely reflecting differing virus detection assays and unaddressed epidemiologic heterogeneity across studies.

METHODS

Applying our novel, five-target assay detection strategy in an exploratory study, we examined demographic, clinical, and tumor characteristics, and overall survival, associated with EBV positivity in breast adenocarcinomas from 59 non-Hispanic white and 68 Hispanic women sampled by age (<50, 50+) and stage (localized, regional/remote) and examined associations based on single assay targets.

RESULTS

EBV was localized only to lymphocytes. Nevertheless, viral prevalence, although low, varied across patient subgroups. Adjusted odds ratios (OR) for EBV positivity were lower for younger Hispanic than white women (p _interaction = 0.05), and marginally higher for larger [OR (95% confidence intervals) 1.03 (1.00-1.05) per mm increase] and right-sided [2.8 (0.97-7.8)] tumors. In whites, ORs were marginally higher for larger tumors [1.04 (1.00-1.07)] and marginally lower for age 50+ [0.24 (0.06-1.03)]; in Hispanics, ORs were higher for ER negative [5.6 (1.1-30.5)], and marginally higher for right-sided, tumors [5.8 (0.94-36.2)]. Survival was suggestively poorer for EBV-positive than EBV-negative tumors in older women with localized disease. EBV associations differed across single assay targets, indicating variation in prior findings likely due to assay performance.

CONCLUSIONS

The differing EBV associations by age and race/ethnicity suggest a non-random role of EBV in breast cancer and support further study using multi-target assays, relevant epidemiologic design, and a larger study sample.

Lateralization of Squamous Cell Carcinomas in the Head-Neck Region

Earlier studies have shown the lateralization of several immune disorders, including herpes zoster infection and breast cancer. We investigated whether there is lateralization of squamous cell carcinomas in the head-neck region and a relation of handedness with this cancer. Analysis showed right-sided lateralization of head-heck cancers in right-handed patients and vice versa in left-handed ones and a higher rate of left-handedness in patients with squamous cell cancer. Associations among left-handedness, squamous cell carcinoma, and its lateralization may result from a genetic togetherness.

Extragenital lichen sclerosus et atrophicus along the lines of Blaschko

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis of unknown etiology. Extragenital involvement is uncommon and commonly affects the neck, shoulders, and upper portion of the trunk. It is predominant in women with a male-to-female ratio of 1:6 and occurs at any age. Linear pattern along the lines of Blaschko are seen. There is no cure for LSA. Topical corticosteroids and calcineurin inhibitors, such as tacrolimus, pimecrolimus, PUVA antimalarial agents, and topical retinoids have been tried with varying results. A case of a 33-year-old man with LSA over right lower limb along the lines of Blasckho is reported here.

Left-right asymmetry in neck lymph nodes distribution in patients with bilateral laryngeal cancer

OBJECTIVE

We aimed to examine left-right asymmetry in involved and total neck lymph nodes distribution in patients with bilateral laryngeal cancer in the present study.

METHODS

Forty-six patients with bilateral laryngeal cancer was included the study. The oncologic database of our otorhinolaryngology department was used. The right and left lymph node with and without involvement by cancer cells counts were retrieved from pathological reports.

RESULTS

The numbers of both involved and total neck lymph nodes were significantly higher on right side than on left side for all neck levels in laryngeal malignancies.

CONCLUSIONS

The results of the present study suggest the existence of a left-right asymmetry in neck lymph node distribution and in the neck lymph node distribution involved by laryngeal cancer cells. The stronger cell-mediated immune activity in the left side of humans may be associated with the blocking of the metastatic invasion of cancer cells from laryngeal malignancies in the left body side.

Left–right asymmetry in pelvic lymph nodes distribution: Is there a right-side prevalence?

OBJECTIVE

To assess whether pelvic lymph nodes have a left-right asymmetric distribution.

STUDY DESIGN

The oncologic databases of two gynecologic academic departments were used to identify consecutive patients undergoing pelvic systematic lymphadenectomy as part of the treatment for a variety of gynecologic malignancies. All procedures were carried out in a standardized fashion. Lymph node counts were retrieved from pathological reports.

RESULTS

Four hundred and twenty-eight women underwent pelvic lymphadenectomy during the study period. The median lymph node count was higher on the right side than on the left side [10 (0-33) versus 8 (0-29); P<0.0001]. A prevalence of right-sided nodes was found in 265 (61.9%) patients, while in 44 (10.3%) cases pelvic nodes were equally distributed on the two sides. The right-sided prevalence was significantly higher than the expected 50% in each type of malignancy and surgical technique subgroup. The right-sided prevalence was statistically significant even when the analysis was performed for different nodal groups [external iliac nodes: 5 (0-23) versus 4 (0-13), P=0.005; hypogastric and obturator nodes: 6 (0-17) versus 5 (0-19), P=0.04]. Moreover, nodal count was higher on the right than on the left in obese [10 (1-33) versus 8 (1-26), P=0.0002] and nonobese women [10 (0-32) versus 9 (0-29), P<0.0001].

CONCLUSION

Our findings suggest the existence of a left-right asymmetry in pelvic lymph nodes distribution, with right-sided prevalence.

The embryonic origins of left-right asymmetry

The bilaterally symmetric body plan of vertebrates features several consistent asymmetries in the placement, structure, and function of organs such as the heart, intestine, and brain. Deviations from the normal pattern result in situs inversus, isomerisms, or heterotaxia (independent randomization), which have significant clinical implications. The invariance of the left-right (LR) asymmetry of normal morphology, neuronal function, and phenotype of several syndromes raises fascinating and fundamental questions in cell, developmental, evolutionary, and neurobiology. While a pathway of asymmetrically expressed signaling factors has been well-characterized in several model systems, very early steps in the establishment of LR asymmetry remain poorly understood. In particular, the origin of consistently oriented asymmetry is unknown. Recently, a candidate for the origins of asymmetry has been suggested: bulk transport of extracellular morphogens by rotating primary cilia during gastrulation. This model is appealing because it 'bootstraps' morphological asymmetry of the embryo from the intrinsic structural (molecular) chirality of motile cilia. However, conceptual and practical problems remain with this hypothesis. Indeed, the genetic data are also consistent with a different mechanism: cytoplasmic transport roles of motor proteins. This review outlines the progress and remaining questions in the field of left-right asymmetry, and focuses on an alternative model for 'Step 1' of asymmetry. More specifically, based on wide-ranging data on ion fluxes and motor protein function in several species, it is suggested that laterality is driven by pH/voltage gradients across the midline, which are established by chiral movement of motor proteins with respect to the cytoskeleton.

Linear extragenital lichen sclerosus with underlying bony atrophy

We describe a 21-year-old male patient with linear extragenital lichen sclerosus. The lesions are confined to the left side of his body and consist of 3 long bands running along the left leg and several patchy and linear lesions on the left side of his trunk. An associated finding is a smaller diameter of the distal part of his left lower leg caused by bony atrophy of the underlying portion the tibia. This is the fifth reported case of linear lichen sclerosus.