P4HA2 involved in SLUG-associated EMT predicts poor prognosis of patients with KRAS-positive colorectal cancer

This study aimed to examine the immunohistochemical expression of epithelial-mesenchymal transition biomarkers: P4HA2 and SLUG in colorectal carcinoma (CRC) specimens, then to assess their relation to clinicopathological features including KRAS mutations and patients' survival, and finally to study the correlation between them in CRC. The result of this study showed that SLUG and P4HA2 were significantly higher in association with adverse prognostic factors: presence of lympho-vascular invasion, perineural invasion, higher tumor budding, tumor stage, presence of lymph node metastasis, and presence of distant metastasis. CRC specimens with KRAS mutation were associated with significant higher SLUG and P4HA2 expression. High expression of both SLUG and P4HA2 was significantly unfavorable prognostic indicator as regards overall survival (OS) and disease-free survival (DFS). In KRAS mutated cases, high P4HA2 expression was the only significant poor prognostic indicator as regarding DFS. In conclusions, our data highlight that both SLUG and P4HA2 expression may serve as potentially important poor prognostic biomarkers in CRC and targeting these molecules may be providing a novel therapeutic strategy. In KRAS mutation group, high P4HA2 expression is the only independent prognostic factor for tumor recurrence, so it can be suggested to be a novel target for therapy.

Assessing Egyptian oncology patients’ perceptions of treatment goals: A multicenter study

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Background: Management of metastatic solid malignancies is generally focused on prolonging life along with improvement of quality of life. Hence palliative intent treatment. The understanding of the disease nature and its treatment intent is variable among patients and it’s unclear what are the main contributing factors. Our study across multiple cancer centers in Egypt evaluated patients’ understanding of whether their treatment was for curative or palliative purposes and sought to identify factors associated with understanding of treatment intent. Methods: This was a survey based study of 489 consecutive patients with stage IV solid tumor malignancies at four different cancer centers in Egypt. Patients were given a questionnaire, during a routine visit. Requested information included primary site of malignancy, stage, duration of treatment, whether they think the treatment is curative, and whether they think the treatment will help them live longer and/or relieve cancer-related symptoms. Patients also provided basic demographic information such as age, gender, marital status, area of residence and education level. Their answers regarding cancer type, stage and length of treatment were compared with their medical records. Results: Median age was 53 with 67% females. Of the 489 patients, 48% finished at least middle school education. The primary malignancies consisted of 35% breast, 19% gastrointestinal/liver, 9% genitourinary, 9% lung, 8% ovarian/uterine, 11% others. 57% of patients had been on treatment for at least 6months. 45% of patients didn’t know they had a malignancy. 69% could not identify their disease stage, and only 19% of patients knew their cancer is stage 4. Only 11% of patients knew their treatment was not curative while 35% thought it was, and 53% did not know. Only 29% of patients believed their treatment would help them live longer and 62% believed the treatment would alleviate their symptoms. Younger patients were more aware of the Disease Nature (DN), however were less aware of the treatment intent (TI), compared to patients older than 60yo (P value 0.02). Urban residents answered more accurate DN questions compared to rural residents (P value 0.01), but both had similar limited understanding to TI (P value 0.2). Education level was the most consistent factor showing difference with higher level of education correlated with better understanding of DN and TI (P value 0.01). Conclusions: In our study, only 11% of patients receiving treatment with palliative intent reported understanding the intent was not curative. Factors influencing perception of treatment goals are many and include those specific to patients (education level), their cancers, and providers (educational materials). Ongoing studies will focus on identifying factors most strongly associated with a patient’s perceived TI with development of a knowledge score.

Concurrent capecitabine with external beam radiotherapy versus radiotherapy alone in painful bone metastasis of breast cancer origin

BACKGROUND

In breast cancer, painful bone metastases are common. Local radiotherapy is the standard treatment of painful bone metastases. Pain control and overall response rateswere low in radiotherapy alone.The objectives of this study were to compare the safety and efficacy of external beam radiotherapy with concurrent capecitabine vs. external beam radiotherapy alone in pain control of painful bone metastases in breast cancer patients.

MATERIALS AND METHODS

Eighty-four patients with painful bone metastases from breast cancer participated in this prospective study. We randomized the patients into two groups: group A treated with radiotherapy 30 Gy in 10 fractions and group B treated with capecitabine 825 mg/m2 every 12 hrs. concurrently with the same radiotherapy dose.

RESULTS

There was no statistically significant difference between the two groups regarding early treatment toxicity. Most of the toxicity was gastrointestinal (diarrhea and nausea) and mild (grade I or II). The median pain score decreased from week one, and there was a marked response at week4. The difference in median pain score between both groups was statistically significant with p-value = 0.045. The median analgesic score in both groups was statistically significant with a p-value = 0.032 at week 12. A complete response to pain at week 4 was 19% and 42.9% in groups A and B, respectively.

CONCLUSION

Concurrent chemoradiation in painful bone metastases from breast cancer origin was tolerable and safe; it had a higher overall response rate and pain palliation than radiotherapy alone.

Effect of transcranial direct current brain stimulation of the motor cortex on chemotherapy induced nausea and vomiting in female patients with breast cancer

OBJECTIVE

Chemotherapy-induced nausea and vomiting (CINV) is a negative impact associated to chemotherapy and its management still challenging. This study aimed to research the additive impact of single-session tDCS (2 mA) over the motor cortex for 20 minutes before chemotherapy to antiemetic on CINV in female patients suffers from breast cancer who obtained highly emetogenic chemotherapy.

STUDY LAYOUT

Prospective randomized double-blind Sham-controlled study.

SETTING

Academic medical center.

METHOD

Sixty breast cancer patients prepared for chemotherapy treatment were selected and allocated randomly into two equal groups: a real and a sham group; tDCS became implemented over the primary motor area (M1) (2 mA) for 20 minutes. Patients' nausea was measured by cumulative index of nausea and visual analog scale for nausea (VAS-N), and vomiting by cumulative index of episodes of vomiting, and Edmonton symptoms Assessment Scale (ESAS) to assess symptoms like pain, malaise, and sense of well-being. Evaluation was done prestimulation and every 24 h for 72 h after end of infusion of chemotherapy.

RESULTS

Real tDCS group showed reduction of cumulative index of nausea (P < 0.001, F = 50), VAS-N (P < 0.001, F = 52) and for ESAS in malaise score (P < 0.001, F = 37.6) and sense of wellbeing score (P < 0.001, F = 25) than sham group. Six patients (20%) in the real group required rescue antiemtic therapy vs. 14 patients (46.7%) in the Sham group (P < 0.028).

CONCLUSION

Single session of real M1 tDCS could be suggested as an effective adjuvant maneuver in control of CINV in female patients suffers from breast cancer who obtained highly emetogenic chemotherapy.

TRIAL REGISTRATION

Clinical Trials.gov trial registry (identifier: NCT03405324).

Microbiological status of Egyptian prawn

A total of 110 prawn individuals were collected from different markets at Cairo and Giza Governorates. The average counts of Aerobes, Psychrophiles, Enterobacteriaceae, Coliforms and Staphylococci were 5 x 10(3), 3 x 10(2), less than 2 x 10(2), less than 3 and 2 x 10(2) organisms per gram newly caught prawn sample, respectively. Such counts were significantly increased in samples collected from markets including raw prawn in shell, raw peeled samples and frozen samples either peeled or in shell. Arizona group, Escherichia coli, Enterobacter group, Proteus group, Providencia group A & B, Shigella group and Staphylococcus aureus could be isolated from examined samples with variable percentages. The public health significance of isolated organisms is discussed.

Effect of temperature on initial bacteria of prawn

This study was carried out to evaluate the effect of heat and cold on the microorganisms existing in prawn. Roasting for 5 min, boiling for 10 min and storage at -18 degrees C for 10, 20 and 30 days were applied on raw prawn to study the effect of each treatment on the bacterial load. The average counts of APC (aerobic plate count) at 25 degrees C and 0 degree C, Enterobacteriaceae, Coliforms and Staphylococci were 1.3 x 10(7), 6 x 10(4), 2 x 10(2) and 3 x 10(3) organisms per gram raw prawn sample, respectively, then reduced to 10(4), 8 x 10(2), 3 x 10(3), less than 3 and 3 x 10(2) organisms per gram roasted prawn in shell, respectively. Such counts were more reduced in roasted peeled samples. Boiling reduced the average counts of APC at 25 degrees C and 0 degrees C, Enterobacteriaceae, Coliforms and Staphylococci from 8 x 10(8), 2 x 10(5) 2 x 10(7), 3 x 10 and 3 x 10(4) organisms per gram raw prawn sample to 2 x 10(5), 3 x 10(3), 2 x 10(2), less than 3 and 4 x 10(2) organisms, respectively. Concerning freezing storage, it could be observed that the average counts of APC at 25 degrees C and 0 degree C, Enterobacteriaceae, Coliforms and Staphylococci were reduced from 4 x 10(7), 5 x 10(5), 3 x 10(5), 10(3) and 3 x 10(2) organisms per gram raw sample to 5 x 10(4), 10(3), 3 x 10(2), 10 and less than 2 x 10(2) organisms per gram after freezing storage for 30 days.