The Prognostic Role of Mismatch Repair Status and CDX-2 Expression with Inflammatory Markers and Pathological Risk Factors in Stage II and III Colon Cancer: Multicenter Real-Life Data

OBJECTIVE

Colorectal cancer is common worldwide, and adjuvant treatment's benefit is still controversial. We designed this study to determine the role of MSI and CDX-2 status determined by immunohistochemistry (IHC) combined with the inflammatory markers and pathological parameters in predicting disease recurrence in stage II and III colon cancer.

METHODS

A total of 226 stage II/III colon cancer patients with a median age of 59 years who underwent initial surgery were included in this retrospective study. The pathologic assessment of MSI and CDX-2 was performed twice by immunohistochemistry (IHC) and two different pathologists. No staining/weak staining below 10% of the tumor was accepted as CDX-2 negative, and any MSI clones with weak staining below 10% were accepted as MSI-H. The laboratory parameters were noted at the initial diagnosis.

RESULTS

One hundred twenty-one and 105 patients were diagnosed with stage III and II colon cancer. 58.0% of patients were male, 46 (20.4%) of tumor tissue were MSS, and 17 (7.5%) were CDX-2 negative. One hundred twenty-nine tumors were localized in the right colon. Disease recurrence was significantly correlated with tumor localization, CDX-2 status, stage at diagnosis, and preoperatively median CRP and CEA levels. DFS rates for MSS patients with CDX-2 negative and positive were 36.7% and 98.1%, respectively [p < 0.001]. There was no significant correlation between MSI status and CDX-2 status. MSI status, the presence of adjuvant treatment, and systemic inflammatory markers were not significant prognostic factors for DFS. CDX-2 status [HR:0.08, CI 95% 0.03-0.17, p < 0.001 HR: 1.7, CI 95% 1.1-3.0, p = 0.03], disease stage [HR:2.6, CI 95% 1.43-4.74], and preoperatively CEA levels [HR:4.1 CI 95% 2.18-785, p < 0.001 were independent significant prognostic factors for DFS.

CONCLUSION

CDX-2 loss was an independent prognostic factor for DFS and disease recurrence in early-stage colon cancer. MSS patients with CDX-2 loss had significantly worse survival outcomes, and this might be the reason for deciding on adjuvant chemotherapy.

The safety and efficacy of first-line atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma: A multicenter real-world study from Turkey

The aim of the study was to evaluate the real-world clinical outcomes of atezolizumab and bevacizumab (Atez/Bev) as the initial therapy for advanced hepatocellular carcinoma (HCC). We retrospectively analyzed 65 patients treated with Atez/Bev for advanced HCC from 22 institutions in Turkey between September 2020 and March 2023. Responses were evaluated by RECIST v1.1 criteria. The median progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Cox regression model was employed to conduct multivariate analyses. The median age was 65 (range, 22-89) years, and 83.1% of the patients were male. A total of 1.5% achieved a complete response, 35.4% had a partial response, 36.9% had stable disease, and 26.2% had progressive disease. The disease control rate was 73.8% and associated with alpha-fetoprotein levels at diagnosis and concomitant antibiotic use. The incidence rates of any grade and grade ≥ 3 adverse events were 29.2% and 10.7%, respectively. At a median follow-up of 11.3 (3.4-33.3) months, the median PFS and OS were 5.1 (95% CI: 3-7.3) and 18.1 (95% CI: 6.2-29.9) months, respectively. In univariate analyses, ECOG-PS ≥ 1 (relative to 0), Child-Pugh class B (relative to A), neutrophil-to-lymphocyte ratio (NLR) > 2.9 (relative to ≤ 2.9), and concomitant antibiotic use significantly increased the overall risk of mortality. Multivariate analysis revealed that ECOG-PS ≥ 1 (HR: 2.69, P = .02), NLR > 2.9 (HR: 2.94, P = .017), and concomitant antibiotic use (HR: 4.18, P = .003) were independent predictors of OS. Atez/Bev is an effective and safe first-line therapy for advanced-stage HCC in a real-world setting. The survival benefit was especially promising in patients with a ECOG-PS score of 0, Child-Pugh class A, lower NLR, and patients who were not exposed to antibiotics during the treatment.

Comparison of different cyclin-dependent kinase inhibitors and KI-67 levels on survival and toxicity in breast cancer treatment

OBJECTIVE

As cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors, which play a crucial role in the cell cycle, palbociclib and ribociclib are two novel drugs that are recently being used in the treatment of breast cancer. Despite targeting the same pathway, these agents have different molecular activities and processes. KI-67 is known to play a significant role in cell proliferation that has been related to prognosis. This study investigated the impact of palbociclib, ribociclib, and KI-67 on toxicity and survival in breast cancer treatment.

PATIENTS AND METHODS

The study included 140 breast cancer patients in total. Patients were divided into groups based on the use of different CDK inhibitors and KI-67 values. Mortality, progression, treatment response rates, frequency, and severity of adverse events were assessed retrospectively.

RESULTS

The patients in our study had an average age of 53.62±12.71 years, and 62.9% of them were diagnosed at an early stage. 34.3% (n=48) of the patients progressed after receiving treatment, while 19.3% (n=27) of the patients died. The median follow-up time was 576 days, the maximum follow-up time was 1,471 days, and the median time to progression was 301 days (min=28-max=713). Mortality, progression, and treatment response rate between two different CDK inhibitors or KI-67 groups revealed no statistically significant differences.

CONCLUSIONS

Our data show a comparison between the effectiveness of palbociclib and ribociclib, and no noticeable difference is found in breast cancer patients' survival, progression, or severity of adverse effects. Likewise, there is no meaningful difference in KI-67 expression subgroups between progression and survival following treatment.

The impact of adjuvant oxaliplatin and tumor sidedness on the overall survival of stage IIB colon cancer patients: a multicentre study

The aim of this multicentre retrospective study was to compare the efficacy of adjuvant chemotherapy regimens both with and without oxaliplatin and tumor sidedness in stage IIB (pT4aN0) colon cancer patients. This study included patients with stage IIB colon cancer who underwent curative surgery and received adjuvant chemotherapy. The patients were divided into two groups (one with and one without oxaliplatin) to compare the overall survival (OS) in right- and left-sided tumors. The study population included 298 patients with stage IIB colon cancer (median age: 57) of whom 69.1% were male. Forty-four per cent of these patients (n = 131) were diagnosed with right-sided colon cancer. The median follow-up duration was 35.9 months. In the entire population, a median OS was not reached, and the five-year OS was 83%. The median disease-free survival (DFS) was 12 months. There was no significant difference in terms of the five-year OS between right- (82%) and left-sided (84%) colon tumors (p = 0.67). In addition, the five-year OS of patients treated with and without oxaliplatin were 76% and 89%, respectively, and there was no statistically significant difference (p = 0.23). The five-year OS of the patients treated with and without oxaliplatin were 83% and 96.5%, respectively, (p = 0.8) in right-sided colon tumors, while it was 75% and 93% (p = 0.06), respectively, in left-sided colon tumors. Tumor sidedness and the addition of oxaliplatin to adjuvant chemotherapy were not found to be associated with the OS in stage IIB colon cancer patients in our study. Further large prospective studies that also include MSI, RAS and BRAF status data are warranted in colon cancer patients.

A new biomarker for lung metastasis in non-seminomatous testicular cancer: De Ritis Ratio

PURPOSE

We aimed to show that the De Ritis Ratio (DRR) may be a new biomarker for lung metastasis in non-seminomatous Testicular Cancers (TC).

MATERIAL AND METHODS

Patients who underwent radical orchiectomy due to TC between January 2010 and January 2021 were included in the study. Demographic characteristics, preoperative laboratory and radiological findings and pathological data of the patients were recorded. The DRR was calculated from preoperative peripheral blood analysis.

RESULTS

A total of 124 patients with non-seminomatous TC were included. Mean patient age was 30.67±7.45 years, and the mean tumour diameter was 4.69±2.55 cm. 61 patients had T1, 51 had T2, and 12 had T3 disease. 42 of them had lung metastasis; 82 of them had no lung metastasis. The optimal DRR threshold was 1.21 for lung metastasis. [Area Under the Curve (AUC): 0.724 with a sensitivity of 81% and specificity of 74%]. DRR was determined as an independent prognostic factor for lung metastasis in univariate and multivariate analyses (p=0.002).

CONCLUSIONS

A high preoperative DRR can be used to detect the presence of lung metastases in non-seminomatous TCs.

AB1470 DOES TESTING FOR SAA IS MORE BENEFICIAL THAN CRP FOR THE FOLLOW-UP OF PATIENTS WITH FMF?

Background

In order to follow subclinical inflammation and adjust the therapy for an optimal disease control, clinicians seek for readily accessible, affordable and reproducible markers. C reactive protein (CRP) is widely used for this purpose. Some suggest that the Serum Amyloid A (SAA) is preferable to CRP as a biomarker of inflammation in FMF patients1.

Objectives

To evaluate and to compare the sensitivity of the serum SAA and CRP levels in FMF patients.

Methods

Serum SAA and CRP levels were measured in 45 patients. 153 measurements from 28 patients with M694V homozygous mutation and 74 measurements from 17 patients with M694V heterozygous mutation were obtained during a mean follow-up of 1 year. For the analysis, the folds of normal CRP and SAA values were used for correlation. Serum levels of the given markers were measured with nephelometric kits (normal CRP levels < 5 mg/L and SAA levels < 6,8 mg/L). More than one and half fold increasement of CRP and SAA was defined as an active inflammation. The correlation coefficients and their significance were calculated using the Spearman test.

Results

Except a patient, all patients in whole cohort were on prophylactic colchicine. Among 28 patients with M694V homozygous mutation, a patient with adalimumab, 12 (42,8%) patients with anti-IL-1 regimens. Of the 17 patients with M694V heterozygous mutation, four (23,5%) were under anti-IL-1 treatment. There was a total of 227 measurements of CRP and SAA from 45 patients. Twenty-five (11%) measurements were obtained during the attack period in and the remaining 202 measurements were collected in attack free period. Figure 1 demonstrates the correlation between CRP and SAA levels (r=0.8, p< 0,001). Both acute phase reactants were increased in 72 (31,7%) measurements, while in 13 (5,7%) CRP level was high but SAA level was normal and in 31 (13,6%) SAA level was high however CRP level was within the normal limits. The vast majority (30:31) of high SAA with normal CRP levels were observed in patients with M694V homozgous mutation. The mean increase in CRP of the entire cohort was 2,06 ± 3,34-fold, whereas mean increase in SAA was 6,23 ± 15,04-fold of the normal levels.

Figure 1.

The folds of the serum CRP and SAA levels in the entire cohort.

Conclusion

According to our results, serial testing of SAA does not provide any additional advantages over CRP. Readily accessible and affordable bio-marker CRP seems to be sufficient for follow-up of patients with FMF.

References

[1]DOI: 10.1038/nrrheum.2010.181

Disclosure of Interests

None declared

Cisplatin plus paclitaxel and bevacizumab versus carboplatin plus paclitaxel and bevacizumab for the first-line treatment of metastatic or recurrent cervical cancer

OBJECTIVE

Cisplatin-paclitaxel and bevacizumab is a frequently used treatment regimen for metastatic or recurrent cervical cancer, and carboplatin-paclitaxel and bevacizumab are also among the recommended regimens. In this study we aimed to evaluate the efficacy of these two regimens for the treatment of metastatic or recurrent cervical cancer.

METHODS

Patients with metastatic or recurrent cervical cancer treated with cisplatin-paclitaxel and bevacizumab or carboplatin-paclitaxel and bevacizumab were retrospectively evaluated in this study. The clinical and demographic characteristics of patients in each group were evaluated. Median overall survival, progression-free survival, and response rates between the two groups were compared.

RESULTS

A total of 250 patients were included. Overall, the numbers of patients with recurrent disease and metastatic disease were 159 and 91, respectively. The most common histologic subtype was squamous cell carcinoma (83.2%). The median duration of follow-up was 13.6 (range 0.5-86) months. The median progression-free survival was 10.5 (95% CI 9.0 to 11.8) months in the cisplatin-paclitaxel and bevacizumab group (group 1), and 10.8 (95% CI 8.6 to 13.0) months in the carboplatin-paclitaxel and bevacizumab group (group 2) (HR 1.20; 95% CI 0.88 to 1.63; p=0.25). The median overall survival was 19.1 (95% CI 13.0 to 25.1) months in group 1 and 18.3 (95% CI 15.3 to 21.3) months in group 2 (HR 1.28; 95% CI 0.91 to 1.80; p=0.15).

CONCLUSIONS

There is no survival difference between cisplatin or carboplatin combined with paclitaxel and bevacizumab in metastatic or recurrent cervical cancer.

Effect of Adjuvant Chemotherapy in Stage III Cervical Cancer Patients Treated With Concurrent Chemoradiation: A Multicenter Study

INTRODUCTION

A significant proportion of cervical cancer (CC) patients are diagnosed at a locally advanced stage. Concurrent chemoradiotherapy (CCRT) is the cornerstone of treatment for patients with locally advanced CC. However, the role of adjuvant chemotherapy (AC) after CCRT is controversial. In this study, we analyzed the efficacy of AC after CCRT in stage III CC patients.

METHODS

We performed a multicenter, retrospective analysis of 139 FIGO stage III CC patients treated with CCRT of whom 45.3% received AC. Our goal was to determine the impact of AC on survival in these patients.

RESULTS

Five-year progression-free survival was 37.5% and 16% in patients receiving CCRT with and without AC, respectively (p=0.008). Median PFS was 30.9 months (CI 95 %14.8-46.9) and 16.6 months (CI 95% 9.3-23.9) in patients receiving CCRT with and without AC, respectively. Five-year overall survival was 78.2% and 28.4% in patients receiving CCRT with and without AC, respectively (p<0.001). Median OS was 132.2 months (CI 95, %66.5-197.8) and 34.9 months (CI 95% 23.1-46.7) in patients receiving CCRT with and in without AC, respectively.

CONCLUSION

Our study suggests that AC provides OS and PFS benefit in stage III CC patients. Larger studies are needed to identify subgroups of patients who would benefit from AC.

Survival and Prognostic Factors in Limited-stage Small-cell Lung Cancer

OBJECTIVE

To evaluate the factors affecting overall survival (OS) and progression-free survival (PFS) in patients with limited stage-small cell lung cancer (LS-SCLC).

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey from January 2002 to October 2019.

METHODOLOGY

Data of 89 patients was analysed, who were treated with chemoradiotherapy (CRT) for LS-SCLC, of whom some had also received prophylactic cranial irradiation (PCI). The clinical course and survival rates of LS-SCLS patients treated with different treatment modalities, were evaluated and the prognostic factors were analysed by Cox-regression analysis.

RESULTS

The median age of the patients was 59.6 (39 - 83) years-old; 82% were men. The median follow-up duration was 20 (1 - 189) months. The median PFS and OS were 16 (95% CI, 13-18) months and 33 (95% CI, 25-41) months. Patients, who underwent PCI had better OS compared to patients who did not [54 (95% CI, 27-87) months vs. 19 (95% Cl,, 13-25) months, log-rank, p = 0.004]. Grade 3-4 hematologic toxicities were observed in 12 (13.5%) patients and grade 3-4 esophagitis was observed in 25 (28.1%) patients. Younger age, ECOG 0-1, stage I-II disease, complete response to CRT were good prognostic factors on OS and PFS. A complete response to  CRT was also a good independent factor in terms of PFS and OS.

CONCLUSION

In this study, younger age, better ECOG status, stage I-II disease, and complete response to CRT had a favourable impact on OS and PFS in LS-SCLC. In addition, PCI has been shown to increase survival in these patients. Key Words: Limited-stage, Small-cell lung cancer, Thoracic radiotherapy, Chemoradiotherapy.

Anakinra treatment in patients with familial Mediterranean fever: a single-centre experience

OBJECTIVES

Anakinra is proven to be effective in controlled trials in terms of attack frequency and subclinical inflammation in colchicine-resistant patients. The objective of this study was to review the patients followed in our single centre with FMF who received anakinra because of insufficient colchicine response.

METHODS

The study was conducted at a tertiary rheumatology centre experienced in autoinflammatory diseases. The patients were treated for at least 1 month with anakinra. Patients with amyloidosis and pregnancy were not included. Attack frequency, patient global assessment scales of disease severity and acute phase reactants were recorded before and throughout anakinra treatment. Criteria of treatment termination were side effects, disease remission, inadequate response, pregnancy plan and non-compliance.

RESULTS

One hundred and six patients diagnosed with FMF were treated with anakinra; 45.92% of the patients had a homozygous M694V mutation; 83 of the 98 patients tested for MEFV carried at least one copy of M694V. Attack frequency decreased while on anakinra treatment; in fact, no attacks were observed in 75 patients. Visual analogue scale score decreased from 7.49 (2.03) to 3.08 (2.82) (P = 0.001). Currently, 71 patients are still on anakinra treatment. Treatment of 34 patients was discontinued (32%). Insufficient response and side effects were the most common reasons for treatment discontinuation. All of the side effects observed were reversible and the patients alleviated after treatment cessation. In four patients, leukopenia was observed.

CONCLUSION

In patients who were refractory to colchicine, anti-IL-1 agent anakinra was shown to be effective and safe. The effectiveness of anakinra stems from preventing attacks and increasing the quality of life.

Safety and efficacy of anti-interleukin-1 treatment in 40 patients, followed in a single centre, with AA amyloidosis secondary to familial Mediterranean fever

OBJECTIVE

The main devastating complication of FMF is AA amyloidosis. Approximately 10-15% of the patients are either intolerant or have an insufficient response to colchicine treatment. The most promising alternative treatment approach is anti-IL-1 agents. The aim of this study was to evaluate the efficacy and safety of anti-IL-1 therapy in FMF amyloidosis.

METHODS

Forty-four patients with amyloidosis who had been treated with anti-IL-1 agents, anakinra and/or canakinumab, were assessed retrospectively for efficacy and safety. Five patients were on haemodialysis and four had received a renal transplant.

RESULTS

The mean duration of anti-IL-1 treatment was 21.4  (18) months. Among 35 patients who were not on dialysis, renal function was maintained or improved in 79.4% but deteriorated in 20.6%. Patients with creatinine levels below 1.5 mg/dl at onset benefitted more from IL-1 inhibition with regard to their kidney functions and acute phase reactants. No additional side effects were observed in patients with renal replacement treatments. The major side effect of anakinra was injection-site reaction observed in four patients.

CONCLUSION

Anti-IL-1 agents are well tolerated and effective in the treatment of amyloidosis secondary to FMF, including patients on dialysis and renal transplant recipients. This approach may improve the lifespan of transplanted kidneys in FMF patients.

FRI0498 DOES TESTING FOR SAA IS MORE BENEFICIAL THAN CRP FOR THE FOLLOW-UP OF FMF PATIENTS WITH M694V HETEROZYGOUS OR M694V HOMOZYGOUS MUTATIONS?

Background:

In order to follow subclinical inflammation and adjust the therapy for an optimal Familial Mediterranean Fever (FMF) disease control, clinicians seek for readily accessible, affordable and reproducible markers. C-reactive protein (CRP) is widely used for this purpose. Some suggest that CRP measures are not conclusive in all cases, especially at initial stages of inflammation. It is suggested that Serum Amyloid A (SAA) may be more reliable and sensitive in predicting an ongoing inflammation.

Objectives:

In order to evaluate and to compare the sensitivity of SAA and CRP in FMF patients with M694V homozygous and M694V heterozygous mutations respectively.

Methods:

Blood samples from 28 patients with M694V homozygous mutation and from 15 patients with M694V heterozygous mutation were obtained during a mean follow-up of 1 year. Multiple samples were drawn in both attacks and attack-free periods of FMF (153 from M694V Homozygous and 31 from M694V Heterozygous). For the analysis of the correlation, the folds of normal CRP and SAA levels were used. Serum levels of the given markers were measured with nephelometric kits (normal CRP levels <5 mg/L and SAA levels <6,8 mg/L). More than one-and-a-half-fold increase of CRP and SAA was defined as an active inflammation.

Results:

Except in one patient, all patients in the whole cohort were on prophylactic colchicine. Among 28 patients with M694V homozygous mutation, one patient was treated with adalimumab, and 12 patients with anti-IL-1 regimens. Among 15 patients with M694V heterozygous mutation, 4 were under anti-IL-1 treatment. There were a total of 183 measurements of CRP and SAA from 43 patients. Twenty-three measurements were obtained during the attack period in M694V homozygous group and the remaining 160 measurements were obtaine in attack-free period. The figure demonstrates the correlation between CRP and SAA results (r=0.745, p<0.001). Both acute phase reactants were increased in 69 measurements, while in 13, CRP was high but SAA was normal and in 31, SAA was high however CRP was within normal limits. The mean increase in CRP of the whole cohort was 2,37 ± 3,22-fold of the normal, whereas mean increase in SAA was 6,77 ± 13,23-fold of the normal.

Conclusion:

According to these results, serial testing of SAA does not provide any additional advantages over CRP. As it is readily accessible and affordable, CRP seems to be sufficient for the follow-up of FMF patients.

Figure:

Figure.

The folds CRP and SAA in whole M694V homozygous and heterozygous mutant population

Disclosure of Interests:

None declared

SAT0518 CANAKINUMAB TREATMENT IN ADULT PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: A SINGLE-CENTER STUDY

Background:

Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease characterized by recurrent, self-remitting attacks of fever, serositis, arthritis, and erysipelas-like erythema. Canakinumab is an Interleukin-1β inhibitor that is shown to be effective and safe in treating colchicine resistant FMF patients.

Objectives:

The main objective of this study is to present the single tertiary center experience of adult FMF patients who received Canakinumab.

Methods:

The study is a retrospective analysis conducted at a tertiary rheumatology center experienced in FMF. The patients who had a clinical diagnosis of FMF and who were treated with at least a single subcutaneous injection of canakinumab were included. Patients with amyloidosis and pregnancy were excluded. In order to evaluate the disease status, acute phase reactants and patient-reported disease severity visual analog scale (VAS) scores were analyzed. Acute phase reactants were evaluated during attack-free periods. The VAS score was reported on a scale of 0-10, 10 meaning the disease at its most severe form, and 0 meaning the least.

Results:

Fifty-two patients (21 male, 31 female) with the mean age of 35.88±12.4 years, were included in this study. The presenting signs and symptoms of the patients are shown in Figure 1. The mean age of initial symptoms and diagnosis were 12.84±10.06 and 20.39±12.35 years in respective order. The treatment information of the patients before and during Canakinumab injections was shown in Table 1. The mean Erythrocyte Sedimentation Rate (ESR) decreased from 25.31±20.64 to 11.52±9.78 mm/hour. The mean C-reactive Protein (CRP) decreased from 28.18±47.04 to 2.02±2.31 mg/L (both p<0.0001). The mean VAS score decreased from 8.04±1.9 to 1.4±1.73 (p<0.0001). Canakinumab treatment was terminated in 33 patients, 22 of which was due to successful remission. The termination of the treatment was because of pregnancy or will of pregnancy in 4 patients, inadequate treatment response 3 patients, treatment noncompliance in 2 patients, chronic hepatitis C related cirrhosis in 1 patient, and change to a different biologic agent in 1 patient. The only side effect experienced was hallucinations in one patient who was already under remission.

Figure 1.

The Presenting Signs and Symptoms of the Patients

Table 1.

The Treatment Information of the Patients

Initial Mean Daily Colchicine Dose, mg (mean± standard deviation)1.68±0.46Mean Daily Colchicine Dose before Canakinumab Treatment, mg1.63±0.6The Mean Injection Number, n17.5±17.8Canakinumab Treatment Indication, n (%) Inadequate Response to Previous Treatment38 (73.08) Side Effect to Previous Treatment8 (15.38) Poly Arteritis Nodosa2 (3.85) Recurrent Pericarditis1 (1.92) CNS Vasculitis2 (3.85) Poor Anakinra Treatment Adherence1 (1.92) FMF Encephalopathy1 (1.92)

Conclusion:

Canakinumab seems effective in controlling the subclinical inflammation and raising the quality of life of the patient. It has a favorable side effect profile. According to our single-center, real-life data, Canakinumab can be used as an alternative treatment method in colchicine resistant patients.

Disclosure of Interests:

None declared

Ultrasound guided erector spinae plane block as a cause of unintended motor block

Erector spinae plane block (ESPB) as postoperative analgesia method has been successfully carried out in several surgical interventions. Postoperative pain treatment for cesarean section is considered one of the important challenges for anesthesiologists due to the risk of chronic pain development and even pospartum depression. Regional anesthesia techniques were effectively used to prevent the pain together with multimodal analgesia regimes in cesarean section. Formerly, successful erector spinae plane block was documented as postoperative analgesia treatment for cesarean section; however, no motor weakness was recorded as a side effect. In this case report, we present an unexpected motor weakness as a side effect of the erector spinae plane block after cesarean delivery operation in a 29 year old patient. To our knowledge, this is the first report of motor weakness related to the ESPB.

A novel mechanism of anti-T-lymphocyte globulin mediated by fractalkine in renal ischemia-reperfusion injury in rats

BACKGROUND

Ischemia-reperfusion injury (IRI) is among the main challenges in kidney transplantation. It causes delayed graft function and graft loss in long-term follow-up studies. Anti-T lymphocyte globulin (ATG), a common induction immunosuppressive, has been used in kidney transplantation to prevent rejection. Fractalkine (FKN) is among the main chemokines involved in IRI. This study was designed to identify the relationship between ATG and FKN after warm ischemia in rat kidneys.

METHODS

Rats were divided into three groups: Control, IRI+normal saline(NS) and IRI+ATG. After IRI was initiated, rats received a dose of ATG or NS during surgery as well as two more doses at 24 and 48 hours after surgery. All rats were humanely killed at 72 hours.

RESULTS

The concentration of FKN as well as dendritic cells (DC) and macrophages were lower in both peripheral blood and the injured kidney among ATG-treated versus control rats. Additionally cell necrosis, cytoplasmic vacuolization, cast formation, and tubular dilatation were improved among ATG-treated rats. Serum creatinine levels were lower in rats that received ATG.

CONCLUSION

ATG depleted the concentration of FKN, which inhibits migrations of DCs and macrophages into the kidney, and reduces IRI-related pathology.