National trends and survival outcomes of penile squamous cell carcinoma based on human papillomavirus status

Background

There are no series evaluating penile squamous cell carcinoma (pSCC) based on human papillomavirus (HPV) infection. Herein, we present national registry data on clinical and survival outcomes for pSCC based on HPV status.

Methods

We performed a retrospective review of 1224 pSCC patients with known HPV staining from the National Cancer Database. Patients with cM1 disease, those who did not receive treatment, or had missing follow‐up data were excluded. Logistic regression identified factors associated with locally aggressive disease. Univariable, multivariable, and inverse probability of treatment weighting (IPTW)‐Cox proportional hazard modeling were used to assess hazard ratios (HR) associated with overall survival (OS).

Results

After exclusion criteria, we identified 825 cases of which 321 (38.9%) were HPV positive. The HPV‐positivity rate did not significantly change by year. HPV‐positive patients were younger, had lower Charlson‐Deyo performance score, and resided in areas with both lower median household income and lower school education completion. HPV‐positive tumors presented with lower American Joint Committee on Cancer clinical T‐stage (cT), poorer differentiation, lower rates of lymphovascular invasion (LVI), but more node‐positive disease (cN+). For those who underwent lymph node surgery, there were no differences in final pathologic stage, upstaging, or presence of extranodal extension. Only tumor differentiation, LVI, and performance score were independent predictors for locally aggressive disease. HPV status was not a predictor of OS (IPTW‐HR:0.89, p = 0.13).

Conclusions

In the largest series evaluating pSCC based on HPV status, HPV‐positive tumors were associated with lower cT stages, less LVI, but more cN + disease. More studies on prognostic factors are needed, and time may still be immature to use HPV information for risk stratification.

Leiomyosarcoma of the scrotum: a case report and literature review

Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes. When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.

Postoperative and Survival Outcomes After Cytoreductive Surgery in the Treatment of Metastatic Upper Tract Urothelial Carcinoma

OBJECTIVE

To analyze utilization and outcomes of cytoreductive surgery (CRS) after systemic chemotherapy in select patients with metastatic upper tract urothelial carcinoma (UTUC).

MATERIAL AND METHODS

We identified 1,73 patients with cM1 UTUC from the National Cancer Database who were treated with first-line multiagent chemotherapy from 2004 to 2015. Patients considered surgical candidates based on Charlon-Deyo performance score were stratified into nonsurgical versus surgical arms based on receipt of CRS after systemic therapy. Those receiving radiation, immunotherapy, or other types of treatment were excluded. Cox proportional hazard models were used to analyze prognostic factors for overall survival (OS). Propensity-score matching and inverse probability of treatment weighting-adjusted regression models were used to compare OS.

RESULTS

A total of 1182 patients were included of which 349 (29.5%) were treated with definitive surgery. Median follow-up was 64 months (95% confidence interval:49.8-79.4) for chemotherapy+surgery versus 61.2 (52.2-78.7) for the chemotherapy-alone arms (P = .09). Patients treated with surgery were younger and more commonly treated at academic facilities. Patients who received CRS had improved median-OS versus those treated with chemotherapy alone (13.7 vs 10.8 months, log-rank P-value <.001). Predictors of OS were performance score, treatment at academic facility, and performance of CRS. Furthermore, in propensity-score and inverse probability of treatment weighting-adjusted Cox regression analyses, CRS was associated with significant OS benefit (hazard ratios = 0.61, 95% confidence interval:0.49-0.77, and 0.63;0.55-0.72; respectively).

CONCLUSION

We provide a contemporary report on the survival benefit of CRS after treatment with systemic therapy for M1 UTUC patients. Longitudinal studies are needed to evaluate the role of surgery, when feasible, within multidisciplinary approaches for this relatively, rare disease.

Clinical presentation, risk factors and treatment outcomes of first allograft rejection after penetrating keratoplasty in early and late postoperative period

PURPOSE

Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty.

METHODS

A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information.

RESULTS

A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors).

CONCLUSION

Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally.

The Occurrence of Arterio-venous Fistula during Lower Limb Subintimal Angioplasty: Treatment and Outcome

OBJECTIVES

To describe our experience with iatrogenic arterio-venous fistula (AVF) occurring during lower limb subintimal angioplasty, their management and the final clinical, radiological outcome.

DESIGN

Retrospective review of case series from two centres, from a computerised database over a period of five years.

MATERIAL

Twelve patients whose lower limb subintimal angioplasty was complicated by Iatrogenic AVF.

RESULTS

The Majority of AVF occurred at the popliteal trifurcation vessels. And the incidence of this complication in our case series was 0.8%. This was managed with a variety of techniques-Coil embolisation, balloon tamponade, alternative dissection and stent placement. In one patient, the fistula was left open intentionally. All twelve patients had a successful angioplasty. The overall technical success rate for AVF ablation was eighty percent.

CONCLUSIONS

AVF is a potential complication of angioplasty. The majority can be managed by endovascular means during the angioplasty procedure with good technical success.

Activation of NF-κB in the mouse spinal cord following sciatic nerve transection

NF-kappaB is a ubiquitous nuclear transcription factor that regulates a number of physiological processes. NF-kappaB activity has been implicated in enhancing neuronal survival following CNS injury. The present study was conducted to test the hypothesis that NF-kappaB activity is up-regulated in neurons of the spinal cord in response to peripheral nerve transection. In this series of experiments, we used NF-kappaB reporter mice in which activation of NF-kappaB drives the expression of the lac-z gene. The response to injury of cells in the spinal cord was assessed by evaluating the number and distribution of beta-galalactosidase (beta-gal)-positive cells following sciatic nerve transection. The animals were randomly assigned to four groups, which were allowed to survive for one, three, five and ten days. Four mice that did not undergo sciatic nerve transection were assigned to each group to serve as controls. The total number of beta-gal-positive cells in the right and left dorsal and ventral horns were compared. The numbers of beta-gal-positive cells between the right and left sides were significantly different three and five days post axotomy (p<0.05). Double immunofluorescent labeling was utilized to characterize which cells showed NF-kappaB activity, and it revealed that all beta-gal-positive cells were colocalized with MAP-2-positive neurons. The results of this study demonstrated that complete sciatic nerve transection leads to an up-regulation of NF-kappaB transactivation in spinal neurons ipsilateral to the side of transection. The increase in activity in the ipsilateral dorsal horn is consistent with this transcription factor acting as neuronal survival signal during this time frame in response to the peripheral nerve insult.

Hypoglycemia manifested by sinus bradycardia: a report of three cases

Three cases are reported of hypoglycemia manifested by profound sinus bradycardia and fatigue, which responded to i.v. dextrose with prompt normalization of the cardiac rhythm. The cases involved 3 different patients and disease processes: a young female who had anorexia nervosa and profound malnutrition; an elderly, nondiabetic male who subsequently experienced a transient ischemic attack: and a patient who had diabetes mellitus managed with chronic, subcutaneous insulin administration. It is vitally important that the emergency physician recognize unusual clinical manifestations of hypoglycemia and fully evaluate such scenarios when hypoglycemia may occur. Untreated, hypoglycemia may result in significant chronic morbidity, and rarely, in death. Bradyarrhythmias--particularly sinus bradycardia--should be added to the list of potential clinical manifestations of hypoglycemia.

The ambivalence of the maternal body: psychoanalytic readings of the legend of Van Gogh

This article aims to identify the collective social investment in 'Van Gogh' as a cultural icon, and to ask what function his life story, colourfully illustrated by his art work, has performed in the West since the 1890s. It argues that the life and work of a Dutch artist have become the raw materials for a series of secular 'mystery' plays and christological psychodramas that reflect the ills of twentieth-century experience. The key moments when Van Gogh was made into a figure in a popular imagination were psychologically significant: the Depression and the immediate aftermath of World War II. 'Van Gogh', a fantasy figure of modern man, has been over-'psychologised', his work becoming only the testament to the myth of modern man. Using social-art-historical techniques, the author tries to distance this kind of reading in the case of one drawing of a peasant woman, bending over. Situating the fantasy that the drawing services in precise social and historical terms of bourgeois men formed in childhood in relation to a split feminine/maternal figure of the lady/mother and the working-class nursemaid, the article examines how to use psychoanalysis to read the formal oddities of the work--distortion and monumentality, attention to a fragmented, eroticised but also punished body--for the oscillation between pre-oedipal fantasies of maternal plenitude and awe and oedipal anxieties which sadistically inflict humiliation on the maternal body. Finally, instead of producing Van Gogh as the extreme case of an 'other', the author recognises the drawing as a space where present fantasies of the reader encounter those of the producer. Psychoanalysis informing historically-precise interpretation becomes a demythologising hermeneutic.

Thyroid peroxidase glycosylation: the location and nature of the N-linked oligosaccharide units in porcine thyroid peroxidase

Highly purified, trypsin/detergent-solubilized thyroid peroxidase (TPO), prepared from pig thyroid tissue, was subjected to reduction and alkylation followed by trypsin digestion. The resulting peptides were fractionated using HPLC. Corresponding carbohydrate positive regions from three separate HPLC experiments were pooled and further chromatography was carried out to yield purified peptide suitable for sequence analysis and complete carbohydrate composition analysis. Four of the five putative sites for N-linked glycosylation were found to carry oligosaccharide units in which mannose and glucosamine were the sole or predominant sugars. Three of the four glycosylations occur at asparagine residues which are likely to be at beta turns or bends. The fifth putative glycosylation site could not be confirmed and may either be poorly glycosylated or escape glycosylation. All of the confirmed glycosylated sites occur in the N-terminal third of the TPO polypeptide chain, in the portion of the molecule believed to be extracellular. The isolation of at least two chromatographic forms of glycopeptide derived from each of the confirmed sites suggests microheterogeneity in the structure of the oligosaccharide units of thyroid peroxidase similar to that observed in many other glycoproteins.

The metabolism of carbohydrates by extremely halophilic bacteria: identification of galactonic acid as a product of galactose metabolism

Cell-free extracts prepared from the extremely halophilic bacterium Halobacterium saccharovorum oxidize galactose and accumulate a product which reacts as if it were a lactone. The product does not act as a reducing sugar and contains all six of the carbon atoms initially present in galactose. The product was jugged to be galactonic acid, based on the behavior of the acetylmethyl ester derivative of the product and the pentaacetyl derivative of the galactonic methyl ester during gas chromatography.

Search for organic compounds in the lunar dust from the sea of tranquiblity

A sample of lunar dust was examined for organic compounds. Carbon detected in concentrations of 157 micrograms per gram had a delta(13)C per mil (PDB) value of + 20. Treatment with hydrochloric acid yielded hydrocarbons of low molecular weight, suggesting the presence of carbides. The gas chromatogram of the acylated and esterified derivatives of the hydrolyzate was similar to that obtained for the Pueblito de Allende meteorite. There were no detectable amounts of extractable high-molecular-weight alkanes, aromatic hydrocarbons, isoprenoid hydrocarbons, normal alkanes, fatty acids, amino acids, sugars, or nucleic acid bases. Traces of porphyrins were found, perhaps arising from rocket exhaust materials.

Report of a Case of Molluscum Fibrosum or Fibroma; with observations

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