Age and sex have no impact on expression levels of markers of immune cell infiltration and immune checkpoint pathways in patients with muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy

OBJECTIVES

Advanced age and female sex have been associated with worse outcomes in patients undergoing radical cystectomy for muscle-invasive bladder cancer. A reduced immune response has been implicated as a mechanism. The objective of our study was to analyze the expression patterns of various cellular proteins active in bladder cancer immune pathways, and assess the correlation between age, sex, and the expression of these immune markers.

METHODS

We obtained surgical tissue samples from equally distributed male/female patients with/without lymph node metastasis who had undergone radical cystectomy for urothelial carcinoma (UC) of the bladder (n = 50). Immunohistochemistry (IHC) for CD3 (cluster of differentiation), CD4, CD8, CD56, LAG-3 (lymphocyte-activation gene), TIM-3 (T-cell immunoglobulin and mucin-domain), PD-1 (programmed death) and PD-L1 molecules was performed and scored by a single pathologist (high versus low). Spearman's correlation and Chi square tests investigated the association between age, sex, and IHC results.

RESULTS

Mean age at surgery was 67 years (range 50-78 years); all patients were Caucasians. The following percent of patients scored high for a stain: 18% CD3, 10% CD4, 0% CD8, 0% CD56, 20% LAG-3, 4% TIM-3, 0% PD-1 and 0% PD-L1. There was no association between patients' age, sex, and the expression of any of the immune markers (p > 0.05 for all).

CONCLUSIONS

The association between advanced age, female sex, and worse outcomes in bladder cancer may be independent of the immune pathways active in the disease that we examined in this study.

A1 Adenosine Receptor-Mediated Inhibition of Parasympathetic Neuromuscular Transmission in Human and Murine Urinary Bladder

The potential role of A1 adenosine receptors in modulating neuromuscular transmission in the detrusor muscle of the urinary bladder has been tested in human and murine preparations with the intent to determine the viability of using adenosine receptor agonists as adjuncts to treat overactive bladder. In human detrusor muscle preparations, contractile responses to electrical field stimulation were inhibited by the selective A1 adenosine receptor agonists 2-chloro-N(6)-cyclopentyladenosine, N(6)-cyclopentyladenosine (CPA), and adenosine (rank order of potency: 2-chloro-N(6)-cyclopentyladenosine > CPA > adenosine). Pretreatment with 8-cyclopentyl-3-[3-[[4(fluorosulphonyl)benzoyl]oxy]propyl]-1-propylxanthine, an irreversible A1 antagonist, blocked the effects of CPA, thus confirming the role of A1 receptors in human detrusor preparations. In murine detrusor muscle preparations, contractions evoked by electrical field stimulation were reduced by CPA or adenosine. Amplitudes of the P2X purinoceptor-mediated excitatory junctional potentials (EJPs) recorded with intracellular microelectrodes were reduced in amplitude by CPA and adenosine with no effect on the spontaneous EJP amplitudes, confirming the prejunctional action of these agents. 8-Cyclopentyltheophylline, a selective A1 receptor antagonist, reversed the effects of CPA on EJP amplitudes with no effect of spontaneous EJPs, confirming the role of A1 receptors in mediating these effects.

Low enhancing papillary renal cell carcinoma diagnosed by using dual energy computerized tomography: a case report and review of literature

BACKGROUND

Papillary renal cell carcinoma (pRCC) is a mixed group of tumors that constitutes about 15-20% of all renal cortical cancers. Strong enhancement on computerized tomography (CT) is a feature of clear cell, but not of pRCC making the differentiation of papillary tumors from benign cysts a diagnostic problem in some cases.

CASE PRESENTATION

We report here a case of a female patient with pRCC that was initially diagnosed as a benign renal cyst. The patient is a 66 year old Caucasian female who initially presented with an ultrasound showing a 2.6 cm hypo-echoic lesion within the inferior pole of her left kidney. This was followed by a contrast enhanced computerized tomography that suggested the hypo-echoic lesion to be a hyper-attenuating benign renal cyst. Follow-up CT scan 4 months later demonstrated an increase in the size of the lesion to 3.2 cm with equivocal enhancement. A dual energy computerized tomography (DECT) showed the lesion to be a solid mass suspicious for renal cell carcinoma. A robotic partial nephrectomy revealed a papillary renal cell carcinoma with negative margins.

CONCLUSION

In this case report, we reviewed the literature on variations in enhancement of renal tumors and the possible role of dual energy contract enhanced CT in differentiating papillary tumors with low enhancement from benign kidney cystic lesions.

Body composition analysis in bariatric surgery: use of air displacement plethysmograph

Body weight, body mass index (BMI), and percent excess weight loss are used to assess patient outcomes after bariatric surgery; however, they provide little insight into the true nature of the patient's weight loss. Body composition measurements monitor fat versus lean mass losses to permit interventions to reduce or avoid lean body mass loss after bariatric surgery. A retrospective review of patients who underwent bariatric surgery between 2002 and 2008 was performed. Patients underwent body composition testing via air displacement plethysmography before and after surgery (6 and 12 months). Body composition changes were assessed and compared with the BMI. Results include 330 patients (54 male, 276 female). Average preoperative weight was 139 kg, BMI was 50 kg/m(2), fat percentage was 55 per cent, and lean mass percent was 45 per cent. Twelve months after surgery average weight was 90 kg, mean BMI was 32 kg/m(2), fat percentage was 38 per cent, and lean mass percent was 62 per cent. Body composition measurements help monitor fat losses versus lean mass gains after bariatric surgery. This may give a better assessment of the patient's health and metabolic state than either BMI or excess weight loss and permits intervention if weight loss results in lean mass losses.

Project PROMIS: Peoria Regional Outpatient Medical Imaging Study

BACKGROUND

Abdominal aortic aneurysm (AAA) accounts for > 15,000 reported deaths annually. Early screening in high-risk populations is important to decrease morbidity and mortality from rupture.

METHODS

A prospective, population-based study of free ultrasound-based AAA screening was conducted from July 2004 to December 2006. Before examination, subjects completed surveys asking their medical history, including known AAA risk factors. Incidence rates and comparison analyses were performed.

RESULTS

The final analysis included 979 patients, of whom AAA was discovered in 27 (2.8%). AAA was found in only male patients > 60 years old (4% of the male population). AAA size ranged from 3 to 10 cm. Of patients diagnosed with AAA, 85% were current or past smokers, and 70% had hypercholesterolemia. There was a 6% incidence of AAA in male smokers > or = 60 years old who had hypercholesterolemia.

CONCLUSIONS

Four factors were predominant in our population of patients with AAA: patient age, male sex, smoking history, and hypercholesterolemia.

Stricture dilation after laparoscopic Roux-en-Y gastric bypass

BACKGROUND

In surgical treatment of morbid obesity, maintaining a restrictive anastomosis is key to long-range success. However, laparoscopic Roux-en-Y gastric bypass (LRYGB) may result in gastrojejunal (GJ) stricture, requiring treatment in up to 27% of patients.

METHODS

This is a retrospective review of the outcome of 223 consecutive LRYGB patients. Patients developing stricture received standard endoscopic balloon dilation by the same surgeon. Stricture and nonstricture groups were compared for excess body weight loss (EBWL) at 1, 3, 6, and 12 months.

RESULTS

GJ stricture requiring dilation occurred in 38 patients (17%). After dilation all patients were relieved of stricture symptoms and none required revision. By 12 months, patients with stricture had an EBWL of 86% compared with nonstrictured patients at 75%.

CONCLUSION

Endoscopic balloon dilation is a safe and effective treatment option for GJ stricture. Improved weight loss occurred for patients with stricture requiring dilation.