Microenvironment, systemic inflammatory response and tumor markers considering consensus molecular subtypes of colorectal cancer

Introduction: Colorectal carcinomas (CRC) are one of the most frequent malignancies worldwide. Based on gene expression profile analysis, CRCs can be classified into four distinct subtypes also known as the consensus molecular subtypes (CMS), which predict biological behaviour. Besides CMS, several other aspects of tumor microenvironment (TME) and systemic inflammatory response (SIR) influence the outcome of CRC patients. TME and inflammation have important role in the immune (CMS1) and mesenchymal (CMS4) subtypes, however, the relationship between these and systemic inflammation has not been assessed yet. Our objective was to evaluate the connection between CMS, TME and SIR, and to analyze the correlation between these markers and routinely used tumor markers, such as CEA (Carcinoembryonic Antigen) and CA19-9 (Carbohydrate Antigen 19-9). Methods: FFPE (Formalin Fixed Paraffin Embedded) samples of 185 CRC patients were collected. TME was described using tumor-stroma ratio (TSR), Klintrup-Makinen (KM) grade, and Glasgow Microenvironment Score (GMS). CMS classification was performed on tissue microarray using MLH1, PMS2, MSH2 and MSH6, and pan-cytokeratin, CDX2, FRMD6, HTR2B and ZEB1 immunohistochemical stains. Pre-operative tumor marker levels and inflammatory markers [C-reactive protein - CRP, albumin, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute platelet count (APC)] and patient history were retrieved using MedSolution database. Results: Amongst TME-markers, TSR correlated most consistently with adverse clinicopathological features (p < 0.001) and overall survival (p < 0.001). Elevated CRP and modified Glasgow Prognostic Score (mGPS) were associated with worse outcome and aggressive phenotype, similarly to tumor markers CEA and CA19-9. Stroma-Tumor Marker score (STM score), a new combined score of CA19-9 and TSR delivered the second best prognostication after mGPS. Furthermore, CMS4 showed association with TSR and several laboratory markers (albumin and platelet derived factors), but not with other SIR descriptors. CMS did not show any association with CEA and CA19-9 tumor markers. Conclusion: More routinely available TME, SIR and tumor markers alone and in combination deliver reliable prognostic data for choosing the patients with higher risk for propagation. CMS4 is linked with high TSR and poor prognosis, but in overall, CMS-classification showed only limited effect on SIR- and tumor-markers.

Digital image analysis provides robust tissue microenvironment-based prognosticators in stage I-IV colorectal cancer patients

AIMS

In colorectal cancer (CRC) patients, a promising marker is tumor-stroma ratio (TSR). Quantification issues highlight the importance of precise assessment that might be solved by artificial intelligence (AI)-based digital image analysis systems. Some alternatives have been offered so far, although these platforms are either proprietary developments or require additional programming skills. Our aim was to validate a user-friendly, commercially available software running in everyday computational environment to improve TSR assessment and also to compare the prognostic value of assessing TSR in three distinct regions of interests (ROIs), like hotspot, invasive front and whole tumor. Furthermore, we compared the prognostic power of TSR with newly suggested carcinoma percentage (CP) and carcinoma-stroma percentage (CSP).

METHODS AND RESULTS

Slides of 185 stage I-IV CRC patients with clinical follow up data were scanned and evaluated by a senior pathologist. A machine learning-based digital pathology software was trained to recognize tumoral and stromal compartments. The aforementioned parameters were evaluated in the hotspot, invasive front and whole tumor area, both visually and by machine learning. Patients were classified based on TSR, CP and CSP values. On multivariate analysis, TSR-hotspot was found to be an independent prognostic factor of overall survival (hazard ratio for TSR-hotspot_software: 2.005 (95% confidence interval (CI): 1.146-3.507), p=0.011, for TSR-hostpot_visual: 1.781 (CI: 1.060-2.992) p=0.029). Also, TSR was an independent predictor for distant metastasis and local relapse in most settings. Generally, software performance was comparable to visual evaluation and delivered reliable prognostication in more settings also with CP and CSP values.

CONCLUSIONS

This study presents that software assisted evaluation is a robust prognosticator. Our approach used a less sophisticated and thus easily accessible software without the aid of convolutional neural network; however, it was still effective enough to deliver reliable prognostic information.

Traditional Serrated Adenoma of the Gallbladder, a Case Report

While overwhelming majority of laparoscopic cholecystectomy specimens performed for gallstones or cholecystitis show rather typical findings, sometimes polypoid structures are also removed. These can be related to cholesterolosis or conventional adenomas, but occasionally extraordinary findings do emerge. In our case, a 67-year old lady with typical complaints of cholecystitis underwent routine laparoscopic cholecystectomy. Preoperative ultrasound revealed a polypoid mass with inflammation and without suspicion for malignancy. Microscopic examination showed partly conventional, low-grade dysplastic crypts forming a villous and rather complex structure. Ectopic crypt foci, slit-like serration pattern and serrated dysplasia with eosinophylic cytoplasm and centrally located nuclei were seen throughout the lesion, thus a traditional serrated adenoma (TSA) of the gallbladder was diagnosed. TSA represents the rarest subtype of serrated lesions in the colon and extracolonic manifestations are sporadically reported. Until now only a single case of a serrated adenoma was reported from the gallbladder. Here we describe the detailed clinical, pathological and molecular findings of our case and discuss these in the light of current literature data regarding this field.

Feasibility of non-gated dynamic fetal cardiac MRI for identification of fetal cardiovascular anatomy

Funding Acknowledgements

Type of funding sources: None.

Purpose

We sought to retrospectively evaluate the feasibility of identifying the fetal cardiac and thoracic vascular structures with non-gated dynamic balanced steady-state free precession MRI sequences.

Methods

We retrospectively assessed the visibility of cardiovascular anatomy in 66 fetuses without suspicion of congenital heart defect (mean gestational age 27+/- 4, range 21-38 weeks). Non-gated dynamic balanced steady-state free precession (SSFP) sequences were acquired in three planes (axial, coronal and sagittal) of the fetal thorax (slice thickness 4-5mm, FOV 400, FA 60°, matrix 256x256). The images were analysed following a segmental approach in consensus reading by an experienced paediatric cardiologist and radiologist. An imaging score was defined by giving one point to each visualized structure. Basic diagnostic structures included the atria, ventricles, systemic veins, right and left ventricular outflow tracts (RVOT/LVOT), aortic arch, descending aorta (DAO), ductus arteriosus and thymus (12 points); advanced diagnostic features included the atrioventricular (AV) valves, pulmonary arteries and veins, supraaortic arteries and trachea, yielding a maximum score of 21 points. Image quality was rated from 0 (poor) to 2 (good). The influence of gestational age (GA), field strength, placenta position, and maternal panniculus on image quality and imaging score were tested.

Results

34 scans were performed at 1.5 T, 32 at 3 T. Heart position, atria and ventricles could be seen in all 66 fetuses. Basic diagnosis (&gt;12 points) was achieved in 60 (90%) cases, with visualization of the IVC and SVC in 65 (98%) and 63 (95%), RVOT in 62 (94%), LVOT in 61 (92%), aortic arch in 60 (91%), DAO in 64 (97%), ductus arteriosus in 59 (89%) and thymus in 50 (76%) fetuses. The AV valves were recognised in 55 (83%), the pulmonary arteries in 35 (53%), at least one pulmonary vein in 46 (70%), the supraaortic arteries in 42 (64%), and the trachea in 59 (89%) fetuses. The mean imaging score was 16.8 +/- 3.7. Maternal panniculus (r -0.3; p 0.01) and gestational age (r 0.6; p &lt; 0.001) correlated with imaging score. Field strength influenced image quality, with 1.5 T being better than 3T images (p 0.04), but not the total imaging score. Imaging score or quality were independent from placenta position.

Conclusions

Fetal heart MRI with a non-gated SSFP sequence in multiple planes enables recognition of basic cardiovascular anatomy. Advanced diagnostics may be limited by thick maternal panniculus, lower GA and higher field strength.

The use of hysteroscopy in endometrial cancer: old questions and novel challenges

Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.

Effectiveness of different methods for polypectomy in the menopause: a retrospective study

Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.

Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding

OBJECTIVE

To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology.

METHODS

This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology.

RESULTS

The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m² (range, 16.0-72.1 kg/m² ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound.

CONCLUSIONS

The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

P121918F-FDG perfusion-metabolism mismatch 3 days after acute myocardial infarction predicts worse outcome: molecular glucose steel phenomenon visualized by hybrid PET-MRI images

Background

The disturbance of cardiac energy substrate metabolism has a decisive role in the pathogenesis of adverse cardiac remodeling and heart failure. Under normoxic conditions, the free fatty acid metabolism is the predominant pathway by providing the highest energy per substrate molecule. Severe myocardial hypoxia leads to a switch from beta-oxidation to glucose metabolism to increase the ATP production per oxygen molecule. This metabolic disorder appears as perfusion-metabolism mismatch in 18F-fluorodeoxyglucose (18F-FDG) PET images, as increased 18F-FDG uptake in the under-perfused hypoxic myocardial area.

Purpose

The aim of our study was to evaluate the simultaneous perfusion, metabolism and function of the ischemic heart by hybrid 18F-FDG-PET-cMRI with late enhancement images in a translation animal model of heart failure.

Methods

Under general anesthesia, closed chest reperfused acute myocardial infarction (AMI) was induced in 36 domestic pigs by 90 min occlusion of the mid left anterior descending artery with a percutaneous intracoronary balloon, followed by reperfusion. Three days and 1 month after AMI, after 12h fasting, 18F-FDG-PET-cMRI were performed by using standardized acquisition protocols (n=30). Cardiac functional parameter, such as ejection fraction (EF), end-diastolic volume (EDV), infarct size, and mean tracer uptake of the infarcted area were quantitatively assessed. Six animals were euthanized after the 3-day 18F-FDG-PET-cMRI images to elaborate the differences in gene expression patterns in animals with perfusion-metabolic mismatch by using next generation sequencing (NGS) and pathway network analyses.

Results

Eight (group Mismatch) of the 30 animals (group Match) with 1-month follow-up showed high 18F-FDG uptake in the infarcted area (perfusion-metabolism mismatch) at the 3-day 18F-FDG-PET-cMRI-LE images (Figure). The animals in the Mismatch group had significantly lower EF at 3 days (34±8.8 vs 42±3%) and at the 1-month follow-up (35.8±6 vs 43±6.6%) and larger infarct size at day 3 (26.6±6.6 vs 22.1±4.4%) and 1 month (28±5.4 vs 20.3±4.3%) with higher EDV at 1 month. Mean tracer uptake of the infarcted area was significantly reduced in the Mismatch group at 1 month (56±23.1 vs 64.7±13.2%). NGS revealed downregulation of the cholesterol metabolism pathway, and upregulation of carbohydrate derivative catabolism pathway with highly activated innate immune system and genes responsible for cytokine activation in the infarcted area 3 days post-AMI in the Mismatch group, which explains the paradox high 18F-FDG tracer uptake in the infarction zone. Accordingly, the high energy demand of the severe hypoxic area led to “glucose steel phenomenon” at the molecular level, subtracting the 18F-FDG from the normally perfused non-ischemic myocardial regions.

Conclusions

18F-FDG-glucose perfusion-metabolism mismatch early after AMI visualized by hybrid 18F-FDG-PET-MRI images predict development of LV adverse remodeling.

Acknowledgement/Funding

Fibrotarget EU Grant Nr 602904

Network based statistics reveals trophic and neuroprotective effect of early high dose erythropoetin on brain connectivity in very preterm infants

Periventricular white matter injury is common in very preterm infants and it is associated with long term neurodevelopmental impairments. While evidence supports the protective effects of erythropoetin (EPO) in preventing injury, we currently lack the complete understanding of how EPO affects the emergence and maturation of anatomical brain connectivity and function. In this case-control study, connectomic analysis based on diffusion MRI tractography was applied to evaluate the effect of early high-dose EPO in preterm infants. A whole brain, network-level analysis revealed a sub-network of anatomical brain connections in which connectivity strengths were significantly stronger in the EPO group. This distributed network comprised connections predominantly in the frontal and temporal lobe bilaterally, and the effect of EPO was focused on peripheral and feeder connections of the core structural connectivity network. EPO resulted in a globally increased clustering coefficient, higher global and average local efficiency, while higher strength and increased clustering was found for regions in the frontal lobe and cingulate gyrus. The connectivity network most affected by the EPO treatment showed a steeper increase graph theoretical measures with age compared to the placebo group. Our results demonstrate a weak but widespread effect of EPO on the structural connectivity network and a possible trophic effect of EPO reflected by increasing network segregation, predominantly in local connections.

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Erythropoietin (EPO) is a potential neuroprotective agent in very preterm infants.

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EPO leads to increased structural brain connectivity in fronto-temporal regions.

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Clustering coefficient, local and global efficiency increases after EPO treatment.

Numerical impairment of nestin(+) bone marrow niches in acute GvHD after allogeneic hematopoietic stem cell transplantation for AML

The nestin(+) perivascular bone marrow (BM) stem cell niche (N(+)SCN) may be involved in GvHD. To investigate whether acute GvHD (aGvHD) reduces the number of N(+)SCN, we examined patients with AML who had undergone allogeneic hematopoietic stem cell transplantation. In the test cohort (n=8), the number of N(+)SCN per mm(2) in BM biopsies was significantly reduced in aGvHD patients at the time of aGvHD compared with patients who did not have aGvHD (1.2±0.78 versus 2.6±0.93, P=0.04). In the validation cohort (n=40), the number of N(+)SCN was reduced (1.9±0.99 versus 2.6±0.90 N(+)SCN/mm(2), P=0.05) in aGvHD patients. Receiver operating curves suggested that the cutoff score that best discriminated between patients with and without aGvHD was 2.29 N(+)SCN/mm(2). Applying this cutoff score, 9/11 patients with clinically relevant aGvHD (⩾grade 2) and 13/20 with any type of GvHD had decreased N(+)SCN numbers compared with only 10/29 patients without clinically relevant aGvHD (P=0.007) and 6/20 patients without any type of GvHD (P=0.028). In patients tracked over time, N(+)SCN density returned to normal after aGvHD resolved or remained stable in patients who did not have aGvHD. Our results show a decrease in the number of N(+)SCN in aGvHD.

Fertility of testicular cancer patients after anticancer treatment--experience of 11 years

Testicular cancer affects men mostly in their reproductive age with a cure rate over 90%. Preserved fertility is one of the main concerns of the survivors. To further elucidate the question of fertility after anticancer treatment for testicular cancer, we performed a survey among patients who underwent sperm cryopreservation procedure in our department. A structured questionnaire was designed to collect data on demography, anticancer treatment, histological type of cancer, family planning intentions and fertility prior to and after treatment. During a period of 11 years 86 men underwent semen cryopreservation before starting chemo-or radiotherapy. Fifty-nine of them consented to participate in the study. The average length of follow up was 4.6 +/- 3.8 years. In case of 11.9% of the patients their banked sperm was used, which led to live birth in 57% of the couples. The partners of 6 patients became pregnant after in vitro fertilization (IVF) resulting in 4 live births and 2 miscarriages. The spontaneous pregnancy rate was 22%. Spontaneous pregnancy occurred in 13 partners resulting in 18 pregnancies followed by 12 live births, 2 artificial abortions and 4 miscarriages. We could not prove any association between preserved fertility and anticancer treatment or the histological type of the cancer. In conclusion, although spontaneous pregnancy rate is remarkably high after anticancer treatment for testicular cancer, the risk of infertility after receiving gonadotoxic treatment cannot be predicted. Cryopreservation is a safe and effective method to preserve fertility in these cases. As a result we strongly recommend discussing the advantages of semen cryopreservation with all patients awaiting treatment for testicular cancer.

Generation of individualized thalamus target maps by using statistical shape models and thalamocortical tractography

BACKGROUND AND PURPOSE

Neurosurgical interventions of the thalamus rely on transferring stereotactic coordinates from an atlas onto the patient's MR brain images. We propose a prototype application for performing thalamus target map individualization by fusing patient-specific thalamus geometric information and diffusion tensor tractography.

MATERIALS AND METHODS

Previously, our workgroup developed a thalamus atlas by fusing anatomic information from 7 histologically processed thalami. Thalamocortical connectivity maps were generated from DTI scans of 40 subjects by using a previously described procedure and were mapped to a standard neuroimaging space. These data were merged into a statistical shape model describing the morphologic variability of the thalamic outline, nuclei, and connectivity landmarks. This model was used to deform the atlas to individual images. Postmortem MR imaging scans were used to quantify the accuracy of nuclei predictions.

RESULTS

Reliable tractography-based markers were located in the ventral lateral thalamus, with the somatosensory connections coinciding with the VPLa and VPLp nuclei; and motor/premotor connections, with the VLpv and VLa nuclei. Prediction accuracy of thalamus outlines was higher with the SSM approach than the ACPC alignment of data (0.56 mm versus 1.24; Dice overlap: 0.87 versus 0.7); for individual nuclei: 0.65 mm, Dice: 0.63 (SSM); 1.24 mm, Dice: 0.4 (ACPC).

CONCLUSIONS

Previous studies have already applied DTI to the thalamus. As a further step in this direction, we demonstrate a hybrid approach by using statistical shape models, which have the potential to cope with intersubject variations in individual thalamus geometry.

Evaluation of the thyroid function of healthy pregnant women by five different hormone assays

A normal function of the thyroid gland during pregnancy is essential. Any change can affect both the pregnant woman and the fetus. Thyroid hormones play a crucial role in the brain development of the fetus, thus proper maternal free thyroid hormone levels are important especially during the first trimester. We compared the free thyroid hormone levels FT3 and FT4 in forty pregnant women with no thyroidal disease by five different assays available on the market. The blood samples were collected between the 8th and 22nd weeks of pregnancy. The correlation coefficient "r" between different assays was 0.908-0.975 for TSH, 0.676-0.892 for FT4 and 0.480-0.789 for FT3. These data show that the inter-assay results varied widely in the studied population. One reasonable explanation may be that during pregnancy the serum levels of the thyroid hormone binding proteins are altered and "free" hormone measurements by immunoassays are influenced by these alterations. Thus, the results may show higher or lower thyroid hormone values depending upon the assay used. Therefore, it is strongly suggested that every laboratory should establish its own pregnant reference ranges for the tests used for the evaluation of thyroid function, based on values of the population served.

Comparative measurement of thromboxane A2 metabolites in exhaled breath condensate by different immunoassays

OBJECTIVE

Differences between detection techniques may be partly responsible for variable mediator concentrations reported in exhaled breath condensate (EBC). We compared two types of immunoassays to estimate thromboxane A(2) (TxA(2)) concentration.

MATERIALS AND METHODS

Thromboxane B(2) (TxB(2)) levels were measured by enzyme immunoassay (EIA) and TxB(2)/2,3-dinor TxB(2) by radioimmunoassay (RIA) in 10 healthy subjects and 13 asthmatic patients. 2,3-Dinor TxB(2) was also determined by a separate EIA.

RESULTS

Thromboxane was detected in all samples by RIA, but only in about 75% of samples by EIA. 2,3-Dinor TxB(2) was detected in most samples. There was no agreement between the results of the different immunoassays. As compared to healthy subjects, exhaled breath condensates of asthmatic patients contained significantly more immunoreactivity by RIA and TxB(2) EIA (but not by 2,3-dinor TxB(2) EIA).

CONCLUSION

RIA and EIA resulted in vastly different absolute values. The difference found between healthy volunteers and asthmatic patients however, suggests an increased level of TxA(2) in the airways of asthmatics.

Quantification of the ratio of positional isomer dilinoleoyl-oleoyl glycerols in vegetable oils

The distribution of fatty acids in a triacylglycerol is of great importance from nutritional, biochemical, quality and technological points of view. The ratio of triacylglycerol positional isomers containing two linoleic acid (18:2) and one oleic acid (18:1) moieties--namely, 1(3),2-dilinoleoyl-3(1)-oleoyl glycerol (LLO) and 1,3-dilinoleoyl-2-oleoyl glycerol (LOL)--were quantified in grape seed, olive, pumpkin seed, soybean, sunflower and wheat germ oils by high-performance liquid chromatography/atmospheric pressure chemical ionization mass spectrometry (HPLC/APCI-MS) in selected ion monitoring (SIM) mode. Relative LOL contents (LOL/(LLO+LOL)) of the oils were calculated from the mass abundances of the [LL]+ and [LO]+ diacylglycerol fragment ions ([M+H-RCOOH]+) using a calibration curve. The calibration curve of the relative diacylglycerol mass abundances was measured in SIM mode. The relative LOL contents were found to be relatively consistent for each oil variety. The relative LOL content in grape seed, sunflower, pumpkin seed, soybean and wheat germ oils accounted for 44.2 +/- 2.6, 26.8 +/- 3.2, 16.7 +/- 4.6, 15.9 +/- 2.9 and 13.9 +/- 4.3%, respectively. Only olive oils contained practically 100% of the LLO isomer. These results indicate that the unsaturated fatty acids such as linoleic and oleic acids have 'non-random' distribution patterns in various oils.

Biochemical markers of sperm function: male fertility and sperm selection for ICSI

The expression of a 70 kDa chaperone protein, HspA2 (formerly called CK-M), has been identified in mature human spermatozoa. The central role of HspA2 has been established, as the expression level of this protein is related to sperm cellular maturity, DNA integrity, chromatin maturity, chromosomal aneuploidy frequency and sperm function, including fertilizing potential. The spermiogenetic events of cytoplasmic extrusion and remodelling of the plasma membrane, which facilitate the formation of zona pellucida binding site(s) in human spermatozoa, are related. Finally, the presence of the hyaluronic acid (HA) receptor on the plasma membrane of mature sperm coupled with the HA-coated slide sperm-binding assay, facilitates the testing of infertile men and the selection of single mature spermatozoa for ICSI. Because mature spermatozoa have no residual cytoplasm, the HA-bound sperm fraction is also enriched in spermatozoa that are normal by the Kruger strict morphology method.

Differentiation of vegetable oils by mass spectrometry combined with statistical analysis

The main triacylglycerol (TAG) composition of different plant oils (almond, avocado, corn germ, grape seed, linseed, mustard seed, olive, peanut, pumpkin seed, sesame seed, soybean, sunflower, walnut and wheat germ) were analyzed using two different mass spectrometric techniques: HPLC/APCI-MS (high-performance liquid chromatography/atmospheric pressure chemical ionization mass spectrometry) and MALDI-TOFMS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry).Linear discriminant analysis (LDA) as a multivariate mathematical statistical method was successfully used to distinguish different plant oils based on their relative TAG composition. With LDA analysis of either APCI-MS or MALDI-MS data, the classification among the almond, avocado, grape seed, linseed, mustard seed, olive, sesame seed and soybean oil samples was 100% correct. In both cases only 6 different oil samples from a total of 73 were not classified correctly.

Occurrence and transferability of beta-lactam resistance in Enterobacteriaceae isolated in Children's University Hospital in Bratislava

Occurrence and transferability of beta-lactam resistance in 30 multi-resistant Escherichia coli, Klebsiella spp., Enterobacter spp., Pantoea agglomerans, Citrobacter freundii and Serratia marcescens strains isolated from children between 0 and 3 years of age is presented. The strains were resistant to ampicillin (30), cefoxitin (22), cefotaxime (30), ceftriaxone (30), ceftazidime (30) and aztreonam (28), but susceptible to cefepime (30) and imipenem (26). Twenty-eight of 30 isolates possessed a transferable resistance confirmed by conjugation and isolation of 79-89-kb plasmids. The beta-lactam resistance was due to production of beta-lactamases and ceftazidime proved to be stronger beta-lactamase inductor than ceftriaxone. Twenty-five clinical isolates expressed transferable extended spectrum beta-lactamases, and chromosomally encoded AmpC beta-lactamase.

Prevalence of iodine deficiency and goitre during pregnancy in east Hungary

OBJECTIVE

To assess the iodine nutritional status and the prevalence of goitre during pregnancy in a region of Hungary that appeared to be iodine sufficient in previous studies.

DESIGN

A cross-sectional voluntary screening study was organized in which 313 pregnant women participated.

METHODS

Urine iodine concentration and the volume of the thyroid gland were measured in every woman. In the presence of low urinary iodine concentrations, goitre, or both, thyroid function tests were performed.

RESULTS

Iodine deficiency was found in 57.1% of the pregnant women, and was severe in 15.6%. The volume of the thyroid gland was enlarged in 19.2% of individuals. Nodular goitre was found in 17 women (5.4%). The frequency of goitre and the mean thyroid volume were increased in the group of iodine-deficient women. In the 89 cases of iodine deficiency or goitre, thyrotrophin concentrations were in the normal range; however, the free triiodothyronine:free throxine ratio was increased in 97% of them, indicating that the thyroid gland was in a stimulated state in these individuals.

CONCLUSIONS

Iodine deficiency with high prevalence of goitre was recognized among pregnant women in an area that previously appeared to be iodine sufficient. An unexpected mild iodine deficiency was also noted in the non-pregnant control group. Reassessment and continuous monitoring of iodine nutritional status is warranted even in populations that are apparently considered to be 'at no risk' of iodine deficiency, especially in pregnant women. Regular administration of iodine, starting at preconception or in early pregnancy and continuing during the period of nursing, is recommended in these regions.

[Follow up examination of the endometrium during tamoxifen therapy]

Tamoxifen is a non-steroidal estrogen antagonist used mainly in the adjuvant therapy of breast cancer. Tamoxifen acts primarily as an antiestrogen, but also carries estrogenic effect, mainly to the endometrium. Although diverse pathological uterine findings has been described in connection with the long term use of this drug, there is no widely accepted protocol for the monitoring of the endometrium in these patients. All patients referred for gynecologic examination at the Department of Obstetrics and Gynecology University Medical School Debrecen, Hungary with previous treatment for breast cancer were involved in a screening programme. The gradual screening programme consists of: transvaginal sonography, color doppler imaging, hysteroscopy, and endometrial curettage or sampling. If any of the first steps proved to be negative, further evaluation could be avoided. Altogether 31 patients were referred for examination and transvaginal sonography alone excluded endometrial abnormality in 9 cases, while the rest of the patients went through further evaluation. The ratio of false positive results using transvaginal sonography alone was high and could be lowered with additional color doppler imaging. Endometrial pathology could be excluded in about 50% of cases without tissue sampling. Positive histology was found in 25% of patients receiving Tamoxifen. The most frequent pathological finding was endometrial polyp. In conclusion endometrial changes found by transvaginal sonography, should be further evaluated. The gradual screening procedures enable us to the proper use of more invasive procedures.

Management of the menopause and HRT by ultrasound

Recent improvement of the transvaginal grey-scale and colour Doppler ultrasound scanning permits to investigate the morphology and the perfusion parameters of the female pelvic organs in the menopause. Data from detailed scanning of the ovaries and the uterus reflect the hormonal status, but the menopausal age from the last menstrual bleeding (LMB) and the sequence of the HRT given must be taken into consideration. Screening for endometrial pathology is advisable in the days after the withdrawal bleeding in women taking HRT. The positive vascular changes and increased peripheral perfusion in women with HRT detected by Doppler ultrasound are due to the oestrogen's vasodilator effect, which leads to cardiovascular and cerebrovascular protection. Changes of the uterine perfusion during the combined sequential HRT cycle doesn't seem to reflect the reverse effect of the progestin to oestrogen on the general vasculature, but correlates to the vascular changes of the normal menstrual cycle. The disappearing uterine notch in the menopause suggests decreasing vessel compliance. In women taking HRT the uterine notch persists or even may reappear years after the LMB, as a sign of the vessel compliance reserve probably activated by oestrogen and may act also as an indicator of the effect of HRT on arterial status.

[Clinical picture of slow-evolving insulin-dependent diabetes mellitus]("1 1/2")]

The authors investigated the difficulties of differential diagnosis in diabetes, beginning in young age. They analysed the case records of fifteen young diabetics. The authors pointed out, that clinical diagnosis, carried out early, has utmost importance both of theoretical and practical significance, for correct classification according to the type of diabetes determines the therapy. In building the diagnosis, the clinician needs correct anamnestical, clinical data, immunogenetic markers (ICA, HLA), and the capacity of endogenous insulin secretion as well. In three patients they have observed a long period without insulin treatment that could be classified as remission phase. In eleven cases the treatment has started with oral antidiabetic drugs, one patient has got at he very beginning insulin treatment. At present, there is only one patient, still taking oral drugs. This diabetics has an ICA positivity in high titer, but he is refusing the recommended exogenous insulin treatment. In all of their cases the amount of injected daily insulin is low (0.3-0.6 IU/body weight/24 hours). Authors state by their careful analysis, that in all of their 15 diabetics there is existing a slowly developing type I IDDM, I/b, or very recently 1 1/2 diabetes form. The so called autoimmune form--described originally by Bottazzo--could have been disclosed in all of their cases.

[The management of acute complications in gastric cancer]

Forty-five acute complications (perforations and upper digestive hemorrhages) occurring in 650 admitted and operated gastric cancer patients were investigated. Despite all problems raised by these complication (gastric cancer, most commonly in advanced stages and invading the neighboring areas, the poor general condition of the patients, age-related deficiencies), the authors regard the removal of the complicated tumor and sometimes wide gastrectomy (the concomitant resection of gallbladder, spleen, atypical liver resection transverse colon resection) as the only solution for the complications, the postoperative complications and early recurrences of the complications as well as mortality rate being at the same time reduced.

[Hypertension and multimetabolic syndrome]

The occurrence of multi-metabolic syndrome was studied by authors on 31 patients with obesity of android type and hypertension. Plasma glucose and plasma insulin levels were investigated during oral glucose tolerance test, plasma lipid levels were determined, furthermore body mass index and waist/hip ratio were calculated. It was considered that in 65 percent of the cases the presence of multi-metabolic syndrome could have been proved. Dyslipidemia in 22 cases, hyperinsulinemia in 20 cases, deterioration of the carbohydrate metabolism in 14 cases could be demonstrated. The negative correlation between glucose- and insulin-responses to glucose challenge may suggest the presence of insulin resistance. No significant difference was found in metabolic parameters between men and women. The multi-metabolic syndrome is regarded by authors as a process which may lead to both type 2 diabetes mellitus and atherosclerosis. According to their appearance about two third of these patients could be screened. Authors emphasize the great significance of this problem and the importance of early diagnosis and prevention.

[Splenic hydatid cyst]

The localization of hexacanth embryo at spleen level is quite rare, although, in frequency order, it is the third affected organ after liver and lung. The infestation of the spleen usually takes place by arterial route after the parasite has passed through the two other filters, hepatic and pulmonary. The retrograde venous route, which avoids the liver and lung, is also considered. The diagnosis of splenic echinococcosis is made with the clinical, epidemiological and laboratory findings. The treatment is surgical, consisting, most commonly, in splenectomy; the anastomoses of splenic hydatid cysts with the digestive tube are indicated only in those cases with peculiar evolutive forms; cystotomy, with removal of the content and drainage of the remnant cavity, surgery performed either on abdominal or lumbar route, is the method of choice in the suppurated cysts which fix, by adherences, the spleen to its lodge.

[Voluminous malignant nonsecreting tumors of the adrenal cortex ruptured in thoracic-lumbar injuries]

Based on two cases of nonsecreting malignant adrenal tumors the authors make some clinical and therapeutical considerations. These tumors are rare, have a longer evolution without significant clinical manifestations, may reach considerable size and may become complicated, most frequently by intratumoral hemorrhages and necroses, which usually favour an infection, and more rarely by their rupture. The diagnosis is based on the clinical and laboratory findings. The treatment is surgical, associated with chemotherapy and radiotherapy. The survival interval is long, sometimes exceeding 10 years.

[Cancer of the rectosigmoid junction]

The authors present a statistics on 32 cases of proctosigmoid junction cancer and discuss diagnostic and management aspects. This localization of the colorectal cancer has certain characteristic features, among which most important are its severe complications. The treatment of choice is the high anterior proctosigmoid resection with restoration of digestive passage, with or without colostomy. In the complicated cases the interventions will be performed in two or even three stages. Hartman's surgery is also indicated in the complicated cancers and in the compromised patients. The postoperative mortality remains high.

Combined effects of fasting and vinblastine treatment on serum insulin level, the size of autophagic-lysosomal compartment, protein content and lysosomal enzyme activities of liver and exocrine pancreatic cells of the mouse

1. The volume fraction of autophagic vacuoles in liver parenchymal and exocrine pancreatic cells was smallest and the serum insulin level highest in the 24 hr prestarved mouse immediately after 3 hr feeding period. 2. The size of the autophagic vacuole and lysosome (dense body) compartments increased in both types of cells during 2-72 hr fasting parallel with decreasing serum insulin levels. 3. The protein content of the cells decreased and the DNA-based activity of acid phosphatase showed little change throughout fasting. The activity of cathepsin D increased during days 2 and 3 of food deprivation. 4. Vinblastine (50 mg/kg body wt) applied for the last 2 hr of different periods (2, 12, 24, 48 and 72 hr) of fasting decreased serum insulin level and increased the fractional cytoplasmic volume of autophagic vacuoles and dense bodies. This increase was smaller when the drug was applied shortly after feeding and much larger after prolonged fasting. The increase was more pronounced in the pancreatic than in the liver cells. 5. Our data show that the effect of vinblastine on the size of the autophagic-lysosomal compartment depends on the feeding status of the animals.