Lymphoglandular Complex-Like Colorectal Carcinoma-A Series of 20 Colorectal Cases, Including Newly Reported Features of Malignant Behavior

Distinguishing colon carcinoma that is surrounded by well-circumscribed lymphoid tissue from adenomas involving lymphoglandular complexes can be difficult. We assessed a multi-institutional international cohort of 20 colorectal carcinomas with associated prominent lymphoid infiltrates, which we referred to as lymphoglandular complex-like carcinoma (LGCC). We collected clinical and endoscopic features, including lesion size, endoscopic appearance, location, procedure, follow-up, AJCC stage, and mismatch repair status. We recorded the presence of the following histologic features: haphazard gland distribution, gland angulation, gland fusion, solid nest formation, single-cell formation, stromal desmoplasia, presence of lymphovascular invasion and perineural invasion, presence of lamina propria, cytologic atypia as low- or high-grade, presence of goblet cells in the invasive component, and the presence of a surface lesion. Most cases (9 of 13) were described endoscopically as sessile polyps with an average size of 1.56 cm. Most cases (90%) were associated with a surface lesion, of which the majority were tubular adenomas, though a subset was associated with sessile serrated lesions with dysplasia (3 of 18). All cases of LGCC demonstrated haphazard gland distribution and either gland angulation, fusion, or solid nest formation. A portion of cases demonstrated single-cell infiltration (35%) and desmoplasia (50%), and rarely lymphovascular invasion was present (5%). A subset (10%) of cases invaded beyond the submucosa. Deficient mismatch repair was present in 22% (2 of 9) of cases for which it was performed. In cases of colectomy or completion colectomy, nodal metastasis was present in 38% (3 of 8). No cases demonstrated disease recurrence or disease-specific mortality. Overall, LGCC represents an enigmatic subset of carcinomas that is important to distinguish from adenomas involving lymphoglandular complexes due to its varying prognostic outcomes.

Randomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol

INTRODUCTION

There remains an unmet need for safe and cost-effective adjunctive treatment of advanced colorectal cancer (CRC). The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) is safe, well-tolerated and has anti-inflammatory as well as antineoplastic properties. A phase 2 randomised trial of preoperative EPA free fatty acid 2 g daily in patients undergoing surgery for CRC liver metastasis showed no difference in the primary endpoint (histological tumour proliferation index) compared with placebo. However, the trial demonstrated possible benefit for the prespecified exploratory endpoint of postoperative disease-free survival. Therefore, we tested the hypothesis that EPA treatment, started before liver resection surgery (and continued postoperatively), improves CRC outcomes in patients with CRC liver metastasis.

METHODS AND ANALYSIS

The EPA for Metastasis Trial 2 trial is a randomised, double-blind, placebo-controlled, phase 3 trial of 4 g EPA ethyl ester (icosapent ethyl (IPE; Vascepa)) daily in patients undergoing liver resection surgery for CRC liver metastasis with curative intent. Trial treatment continues for a minimum of 2 years and maximum of 4 years, with 6 monthly assessments, including quality of life outcomes, as well as annual clinical record review after the trial intervention. The primary endpoint is CRC progression-free survival. Key secondary endpoints are overall survival, as well as the safety and tolerability of IPE. A minimum 388 participants are estimated to provide 247 CRC progression events during minimum 2-year follow-up, allowing detection of an HR of 0.7 in favour of IPE, with a power of 80% at the 5% (two sided) level of significance, assuming drop-out of 15%.

ETHICS AND DISSEMINATION

Ethical and health research authority approval was obtained in January 2018. All data will be collected by 2025. Full trial results will be published in 2026. Secondary analyses of health economic data, biomarker studies and other translational work will be published subsequently.

TRIAL REGISTRATION NUMBER

NCT03428477.

Immune microenvironment and lymph node yield in colorectal cancer

BACKGROUND

Lymph node (LN) harvesting is associated with outcomes in colonic cancer. We sought to interrogate whether a distinctive immune milieu of the primary tumour is associated with LN yield.

METHODS

A total of 926 treatment-naive patients with colorectal adenocarcinoma with more than 12 LNs (LN-high) were compared with patients with 12 or fewer LNs (LN-low). We performed immunohistochemistry and quantification on tissue microarrays for HLA class I/II proteins, beta-2-microglobulin (B2MG), CD8, CD163, LAG3, PD-L1, FoxP3, and BRAF V600E.

RESULTS

The LN-high group was comprised of younger patients, longer resections, larger tumours, right-sided location, and tumours with deficient mismatch repair (dMMR). The tumour microenvironment showed higher CD8+ cells infiltration and B2MG expression on tumour cells in the LN-high group compared to the LN-low group. The estimated mean disease-specific survival was higher in the LN-high group than LN-low group. On multivariate analysis for prognosis, LN yield, CD8+ cells, extramural venous invasion, perineural invasion, and AJCC stage were independent prognostic factors.

CONCLUSION

Our findings corroborate that higher LN yield is associated with a survival benefit. LN yield is associated with an immune high microenvironment, suggesting that tumour immune milieu influences the LN yield.

Clinical, pathological, genetics and intratumoural immune milieu of micropapillary carcinoma of the colon

AIM

Micropapillary carcinoma (MPC) is a recognised WHO variant of colonic carcinoma (CC), although little is known about its prognosis, immune microenvironment and molecular alterations. We investigated its clinical, pathological and immunological characteristics.

METHODS

We assessed 903 consecutive CCs and used the WHO definition to identify MPC. We recorded serrated and mucinous differentiation and mismatch repair (MMR) status. We performed immunohistochemistry and quantification on tissue microarrays for HLA class I/II proteins, beta-2-microglobulin (B2MG), CD8, CD163, LAG3, PD-L1, FoxP3, PD-L1and BRAF V600E.

RESULTS

We classified 8.6% (N=78) of CC as MPC. Relative to non-MPC, MPC was more often high grade (p=0.03) and showed serrated morphology (p<0.01); however, we found no association with extramural venous invasion (p=0.41) and American Joint Committee on Cancer stage (p=0.95). MPCs showed lower numbers of CD8 positive lymphocytes (p<0.01), lower tumour cell B2MG expression (p=0.04) and lower tumour cell PD-L1 expression (p<0.01). There was no difference in HLA class I/II, LAG3, FOXP3, CD163 and PD-L1 positive histiocytes. There was no association with MMR status or BRAF V600E relative to non-MPC. MPC was not associated with decreased disease-specific survival (p=0.36).

CONCLUSION

MPCs are associated with high-grade differentiation and a less active immune microenvironment than non-MPC. MPC is not associated with inferior disease-specific survival.

Abstract 1352: SOX17 plays a critical role in immune evasion of colorectal cancer

Colorectal cancers (CRCs) are a leading cause of cancer-related death. Most CRCs are immune cold, and do not respond to checkpoint blockade therapy except for microsatellite-high CRCs harboring high mutational burdens. Deciphering the mechanism by which CRC cells evade immune surveillance has the potential to dramatically improve the prognosis of CRC patients. During tumor evolution of CRCs, epigenetic changes play critical roles in addition to accumulation of genetic mutations. However, distinct mutational patterns and patient backgrounds render it challenging to distinguish the driver epigenetic alterations from passenger epigenetic alterations induced by gene mutations or other environmental factors. Identification of the driver epigenetic alterations may provide novel mechanistic insights into colon cancer biology including how they evade immune surveillance. Here, we utilized the colon cancer organoid orthotopic transplantation approach to establish colon cancer organoids from different stages of the tumors, and performed comprehensive epigenomic and transcriptomic analyses to understand the epigenetic alterations during tumor evolution. We found that in vivo environment induces epigenetic alterations that converge on SOX17, a transcription factor that is required for endoderm development. SOX17 is re-expressed in colon cancers in vivo, but not in the in vitro organoid culture, and reprograms tumor cell fate with fetal intestinal gene expressions. Importantly, SOX17 knockout leads to tumor rejection in immunocompetent mice, but not in immunodeficient mice, by turning immune cold tumors into hot tumors with robust intratumoral infiltration of activated CD8+ T cells. Mechanistically, SOX17 directly downregulates Ifngr1 expression and mitigates MHC-I expression to evade CD8+ T cell-mediated tumor cell killing. Together, our result reveals that SOX17 is a master transcription factor that induces the in vivo epigenetic reprograming of tumors, which contributes to the immune evasion of colon cancers.

Citation Format: Norihiro Goto, Saori Goto, Peter Westcott, Shinya Imada, Judith Agudo, Omer Yilmaz. SOX17 plays a critical role in immune evasion of colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1352.

The ureteral diameter ratio as a predictive factor in renal scarring associated with primary vesicoureteral reflux

INTRODUCTION

The ureteral diameter ratio (UDR) is reported to be effective in predicting the outcomes of vesicoureteral reflux (VUR) in several studies.

OBJECTIVE

The objective of the current study was to compare the risk of scarring in patients with VUR relative to UDR and the VUR grade. We also aimed to demonstrate other associated risk factors in scarring and investigate the long-term complications of VUR and their relationship with UDR.

STUDY DESIGN

Patients diagnosed with primary VUR were retrospectively enrolled in the study. UDR was calculated by dividing the largest ureteral diameter (UD) by the distance between L1-L3 vertebral bodies. Demographic and clinical data, laterality, VUR grade, UDR, delayed upper tract drainage on voiding cystourethrogram, recurrent urinary tract infections (UTI), and long-term complications of VUR were compared between the patients with and without renal scars.

RESULTS

A total of 127 patients and 177 renal units were included in the study. There was a significant difference between the patients with and without renal scars according to age at diagnosis, bilaterality, reflux grade, UDR, recurrent UTI, bladder bowel dysfunction, hypertension, decreased estimated glomerular filtration rate, and proteinuria. The logistic regression analysis revealed that UDR had the highest odds ratio among the factors affecting scarring in VUR.

DISCUSSION

VUR grading based on the evaluation of the upper urinary tract is one of the most important predictors for treatment options and prognosis. However, it is more likely to reflect ureterovesical junctional anatomy and function, which play a crucial role in the pathogenesis of VUR.

CONCLUSION

UDR measurement seems to be an objective method that can help clinicians predict renal scarring in patients with primary VUR.

Defining an abnormal p53 immunohistochemical stain in Barrett's oesophagus-related dysplasia: a single-positive crypt is a sensitive and specific marker of dysplasia

AIMS

p53 is an independent risk stratification marker in Barrett's oesophagus (BE), but no universally accepted definition exists for abnormal p53 staining. Herein, we assess p53 stains in two cohorts to: (1) define abnormal p53 staining in BE-related dysplasia (BERD) and (2) assess the specificity and sensitivity of this cut-point for the diagnosis of dysplasia.

METHODS

Cohort 1 (n = 313) included (1) dysplastic BE biopsies, (2) prior non-dysplastic BE (NDBE) biopsies from the same patients and (3) NDBE biopsies from patients who never progressed to dysplasia. Cohort 2 (n = 191) consisted of BE biopsies in which p53 staining aided in diagnosing dysplasia. Automated p53 staining quantification was performed on cohort 1. A semiquantitative p53 analysis, performed on both cohorts, included: (1) number of strongly positive glands, (2) strong glandular surface staining, (3) percentage of strongly positive glands and (4) null phenotype.

RESULTS

NDBE biopsies from cohort 1 patients who progressed to dysplasia were more likely to show p53 positivity than non-progressors (16.9 versus 0.6%) (P = 0.0001). The optimal quantitative cut-point for distinguishing dysplastic from never-dysplasia biopsies was 10 strongly positive cells. By semiquantitative analysis, a single strongly p53-positive gland distinguished dysplastic from never-dysplasia BE (sensitivity 98.6%, specificity 99.4%). The semiquantitative and quantitative analyses correlated (P = 0.0001). In cohort 2, the sensitivity and specificity for BERD of ≥ 1 strongly positive p53 gland were 86.0 and 88.6%.

CONCLUSIONS

A single strongly positive p53 gland is sensitive and specific for BERD. Automated p53 analysis may reduce subjectivity associated with the diagnosis of BERD.

Combined PD-1, BRAF and MEK inhibition in BRAFV600E colorectal cancer: a phase 2 trial

While BRAF inhibitor combinations with EGFR and/or MEK inhibitors have improved clinical efficacy in BRAFV600E colorectal cancer (CRC), response rates remain low and lack durability. Preclinical data suggest that BRAF/MAPK pathway inhibition may augment the tumor immune response. We performed a proof-of-concept single-arm phase 2 clinical trial of combined PD-1, BRAF and MEK inhibition with sparatlizumab (PDR001), dabrafenib and trametinib in 37 patients with BRAFV600E CRC. The primary end point was overall response rate, and the secondary end points were progression-free survival, disease control rate, duration of response and overall survival. The study met its primary end point with a confirmed response rate (24.3% in all patients; 25% in microsatellite stable patients) and durability that were favorable relative to historical controls of BRAF-targeted combinations alone. Single-cell RNA sequencing of 23 paired pretreatment and day 15 on-treatment tumor biopsies revealed greater induction of tumor cell-intrinsic immune programs and more complete MAPK inhibition in patients with better clinical outcome. Immune program induction in matched patient-derived organoids correlated with the degree of MAPK inhibition. These data suggest a potential tumor cell-intrinsic mechanism of cooperativity between MAPK inhibition and immune response, warranting further clinical evaluation of optimized targeted and immune combinations in CRC. ClinicalTrials.gov registration: NCT03668431.

Prospective Investigation on the Paternity Intention and Affecting Factors in 84 Post-treatment Testicular Cancer Patients

PURPOSE

to investigate the factors affecting post-treatment paternity intention in patients followed up after the diagnosis of testicular cancer and to make recommendations for the early postoperative period based on the identified factors.

MATERIALS AND METHODS

This prospective descriptive study included total 185 patients who presented to our outpatient clinic between February 2000 and July 2020 who had radical orchiectomy due to suspected testicular cancer based on physical examination and other assessments. Contact information was found for 88 of 185 patients, and accordingly, the patients were reached by one-to-one phone calls. Upon literature review, a questionnaire consisting of 10 previously validated items was developed by the researchers. The patients were compared by separating them into two groups composed of patients with (Group 1) and without (Group 2) paternity intention.

RESULTS

A total of 84 patients participated in the study, and the participation rate was 95.5%. It was found that 19 of 32 (38%) patients with paternity intention already had children. Only 21 (40%) of 52 patients without paternity intention were married. The mean age was 26.65 (18-39) years in Group 1, while it was 28.73 (19-45) years in Group 2. Tumor volume and serum tumor markers were higher in Group 2 than in Group 1. Parameters such as testicular side in which the tumor was located, smoking status, undescended testis history, and postsurgical chemotherapy history were not statistically significant difference between the two groups.

CONCLUSION

The major findings included that the young aged, unmarried, and serious testicular cancer (Tumor volume and serum tumor markers were higher) can be affecting factors for testicular cancer patients' paternity intention. Early psychological counseling about paternity may be useful for testicular cancer patients.

Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney

OBJECTIVE

Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephro ureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer.

MATERIAL AND METHODS

Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ure terorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were asso ciated with intravesical recurrence-free survival.

RESULTS

Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free sur vival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterore noscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location.

CONCLUSION

Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.

Impact of postnatal nutrition on neurodevelopmental outcome in rat model of intrauterine growth restriction

OBJECTIVE

There are limited data on nutritional management of infants with intrauterine growth restriction (IUGR). Postnatal protein supplementation for promoting growth is a common clinical practice in neonatology. The present study aims to investigate the consequences of protein supplementation on long-term growth, brain and body weight, brain histology and behavioral outcome in a rat model of IUGR.

MATERIALS AND METHODS

Twenty-four IUGR-formed rat puppies and 12 healthy puppies were included in the study. IUGR model was established by low (10%) protein diet throughout pregnancy together with intraperitoneal injection of lipopolysaccharide (LPS). Pups were started to be fed with either standard protein (SP), or high protein (HP) diet until postnatal day (PN) 35. Puppies in the control group were given SP diet for 35 days. Six pups from each group were sacrificed at PN7, remaining six were evaluated by Morris water maze test between PN 30 to 35 days and then sacrificed at PN35. Histologic evaluation of brain tissue was performed at PN7 and PN35.

RESULTS

IUGR group displayed lower body and brain weights at PN7 when compared with control. At PN35, SP group achieved similar brain/body weight ratios with control, whereas HP group displayed lowest brain/body weight ratio. The number of TUNEL positive cells was significantly higher and myelin basic protein and oligodendrocyte marker O4 immunoreactivity were significantly lower in HP group when compared with SP at PN35. Neuronal density in prefrontal cortex and hippocampus at PN7 were similar among SP and HP groups, but significantly lower in HP group when compared with SP at PN35. SP group displayed better results in the Morris water maze test when compared with HP group.

CONCLUSIONS

Although postnatal HP support is associated with increase in body weight at PN35, it did not result in better brain/body weight ratios in the rat model of IUGR. In IUGR rats, HP diet was associated with increased apoptosis in brain tissue with lower neuronal density and decreased myelination when compared to SP. Furthermore, better neurodevelopmental scores were achieved by SP diet rather than HP support in IUGR.

Hounsfield units: A promising non-invasive tool for diagnosing benign prostatic hyperplasia

OBJECTIVE

The clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools.

MATERIAL AND METHOD

International Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52).

RESULTS

A statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test.

CONCLUSION

This is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients.

Association between Serum Carcino-embryonic Antigen Levels and Micropapillary Bladder Cancer Metastasis in an Elderly Male

We, herein, present a case of a micropapillary variant of bladder cancer metastasizing to lymph nodes in an 87-year male with elevated serum carcinoembryonic antigen (CEA) levels (2637.8 ng/mL). The patient was evaluated for dyspeptic symptoms and elevated CEA levels. Colonoscopy and upper gastrointestinal endoscopy were normal. Contrast-enhanced computed tomography revealed a bladder tumour. Transurethral resection of bladder tumour (TUR-BT) was performed, and histologically, the tumour was reported as urothelial carcinoma (UC), high grade, and pT1. Intravesical Bacillus Calmette-Guérin (BCG) was started three weeks after TUR-BT and continued for two years. F-18 FDG PET/CT scans were performed every six months during the follow-up due to persistently elevated CEA levels. During follow-up, there was no recurrence of UC in the bladder. Two years later, he was admitted again with lymph node swelling in the left inguinal area. A tru-cut biopsy was performed, which showed UC with a micropapillary component. Gemcitabine monotherapy was given, which resulted in partial response, and a significant decline in serum CEA levels (490.17 ng/mL). Key Words: Carcinoembryonic antigen, Urothelial carcinoma, Bladder cancer, Micropapillary variant, Gemcitabine monotherapy.

Hematological, serum biochemical results, and treatment approach of an Arabian mare with squamous cell carcinoma of the vulva - case report

ABSTRACT A 20-year-old Arabian mare, was brought to the obstetrics and gynecology clinic with the complaint of an unknown wound in the genital area. Although the mare's general condition was good, examination of the genital area revealed a wide-open wound in the vulva and posterior vagina, characterized by fibrotic growth. The biopsy sample was sent to the pathology laboratory. A diagnosis of squamous cell carcinoma (SCC) was made after histopathological examination. Blood samples for serum biochemistry and hematological tests were collected from the jugular vein. Hematological and serum biochemical findings are generally used to diagnose diseases in animals and humans. Hematological and serum biochemical findings are important with genital SCC. Therefore, the findings of these values are given in this case report.

Prognosis of primary or metachronous prostate cancer in multiple primary genitourinary cancers; a single center experience with long-term results

OBJECTIVE

This study aims to analyze the challenges, approaches and long-term results of primary or metachronous prostate cancer (PCa) in cases with multiple primary genitourinary cancers.

METHODOLOGY

A total of 17 patients were included in the study. Patients with multiple primary genitourinary cancers were divided into two groups according to the diagnosis of primary or metachronous PCa as group 1 and group 2.

RESULTS

The median age of patients was similar in both groups. The median smoking status (pack-years) was higher in group 2 than group 1. The median prostate-specific antigen (PSA) level was higher in group 1 than group 2. The median follow-up time from primary to the metachronous tumour was higher in group 1 than group 2. The rate of recurrence in PCa was higher in group 1 than group 2. No statistically significant difference was observed in terms of patients' age, smoking status, PSA levels at diagnosis of PCa and biochemical recurrence or metastasis between the two groups (p > 0.05).

CONCLUSION

Primary PCa cases may progress more aggressively than metachronous PCa cases. Biochemical recurrence and metastasis may be less threatening in metachronous PCa cases than primary cases. Therefore, aggressive treatment can be avoided for metachronous PCa cases.

Fecal SARS-CoV-2 RNA is associated with decreased COVID-19 survival

The clinical significance of SARS CoV-2 RNA in stool remains uncertain. We found that extrapulmonary dissemination of infection to the gastrointestinal (GI) tract, assessed by the presence of SARS-CoV-2 RNA in stool, is associated with decreased COVID-19 survival. Measurement of SARS-CoV-2 RNA in stool may have utility for clinical risk assessment.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients

BACKGROUND

Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce.

AIM

To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP.

METHODS

We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey.

RESULTS

In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001).

CONCLUSION

Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

Association of Gleason score with PSA Values and Serum Testosterone Levels Measured Prior To Prostate Biopsy

OBJECTIVE

To analyse the association of prostate cancer (PCa) Gleason score evaluated upon prostate biopsy with clinical PSA values, total and free testosterone (TT and FT, respectively) levels measured prior to biopsy.

STUDY DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, from July to December 2019.

METHODOLOGY

A total of 85 patients were included and classified into non-PCa (group 1) and PCa (group 2) groups according the results of prostate biopsy pathology. Age, digital rectal examination (DRE) findings; prostate volume (PV); free/total prostate specific antigen (PSA) ratio (f/tPSA); PSA density (PSA-D) and total PSA (tPSA), free PSA (fPSA), TT and FT levels of the two groups were evaluated. Associations of the ISUP grade of patients in group 2 with age, DRE findings for PCa; PV; PSA-D; f/tPSA and tPSA, fPSA, TT and FT levels were analysed.

RESULTS

Mean patient age was 63.00 (57.50-70.00) years. Mean age, significant DRE findings for PCa, tPSA levels and PSA-D were significantly higher in group 2 (p <0.05), whereas PV was significantly higher in group 1 (p <0.05). The ISUP grade of patients in group 2 was significantly and positively correlated with age and tPSA levels (p <0.05). ISUP grade was significantly and positively correlated with significant DRE findings for PCa (p <0.05). However, ISUP grade was negatively correlated with PV and f/tPSA (p <0.05). No significant difference was observed between the two groups in terms of TT and FT levels (p >0.05).

CONCLUSION

TT and FT levels evaluated before prostate biopsy did not provide any additional benefit in predicting Gleason score grade before biopsy. Key Words: Prostate biopsy, prostate cancer, ISUP grade, Gleason score, total testosterone, free testosterone.

Perioperative Indices Predicting Fever Following Percutaneus Nephrolithotomy

OBJECTIVE

To investigate 18 independent peroperative parameters that may have an effect on fever after percutaneous nephrolithotomy (PCNL).

STUDY DESIGN

A descriptive study.

PLACE AND DURATION OF STUDY

Departments of Urology, Nevşehir State Hospital, and Sultan Abdulhamid Han Education and Research Hospital, Turkey, from January 2016 to June 2019.

METHODOLOGY

Two hundred and seventy-six patients, who underwent PCNL between 2016 and 2019 in two institutions, were evaluated retrospectively. Patients were divided as Group I and II, according to the absence or presence of fever after PCNL, then peroperative parameters were compared.

RESULTS

There was no statistically significant difference between Group I and II in terms of age, gender, side of stone, ipsilateral open stone surgery or PCNL history, presence of renal anatomic anomaly, preoperative hydronephrosis grade, stone size in computed tomography (CT), stone Houndsfield Unit (HU) value, skin stone distance, duration of operation, postoperative D-J insertion rate and postoperative blood transfusion requirement (p >0.05). Guy' s Stone Score (GSS), number of calyceal access and duration of achieving limpid urine coming out of the nephrostomy tube were significantly higher in Group II (p <0.05). The rate of postoperative fever was statistically significantly higher in patients with middle calyceal (mid-calyceal) access, than patients with inferior calyceal access (p=0.05).

CONCLUSION

High GSS, mid-calyceal access, the increase in the amount of mid-calyceal access, the longer duration of achieving limpid urine coming out of the nephrostomy tube were found to be related with fever after PCNL. Key Words: PCNL, Post-PCNL fever, Nephrolithiasis, Guy's stone score.

Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens

ABTRACTWe aimed to assess the correlation between ISUP 2014 grades of needle biopsy (NB) and radical prostatectomy (RP) specimens and the parameters effecting this correlation. A total of 353 patients, who underwent a radical prostatectomy with diagnose of prostate cancer, were included in the study. Especially, the maximum percentage of core involved by cancer (MPCI) of upgraded group was significantly higher than those of correlated group and downgraded group. MPCI might be used as a preoperative value to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.

Dickkopf-2 regulates the stem cell marker LGR5 in colorectal cancer via HNF4α1

Enhanced stemness in colorectal cancer has been reported and it contributes to aggressive progression, but the underlying mechanisms remain unclear. Here we report a Wnt ligand, Dickkopf-2 (DKK2) is essential for developing colorectal cancer stemness. Genetic depletion of DKK2 in intestinal epithelial or stem cells reduced tumorigenesis and expression of the stem cell marker genes including LGR5 in a model of colitis-associated cancer. Sequential mutations in APC, KRAS, TP53, and SMAD4 genes in colonic organoids revealed a significant increase of DKK2 expression by APC knockout and further increased by additional KRAS and TP53 mutations. Moreover, DKK2 activates proto-oncogene tyrosine-protein kinse Src followed by increased LGR5 expressing cells in colorectal cancer through degradation of HNF4α1 protein. These findings suggest that DKK2 is required for colonic epithelial cells to enhance LGR5 expression during the progression of colorectal cancer.

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APC, KRAS, and TP53 mutations induce DKK2 expression in murine colon cancer

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DKK2 increases Src phosphorylation in colon cancer cells

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Activated Src leads to degradation of HNF4α1 protein

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This DKK2 downstream signaling enhances LGR5 expression in colon cancer

Can the systemic immune inflammation index be a predictor of BCG response in patients with high-risk non-muscle invasive bladder cancer?

AIM

We aimed to investigate the predictor role of the systemic immune-inflammation index (SII) on Bacille Calmette-Guerin (BCG) response in patients with high-risk non-muscle invasive bladder cancer (NMIBC).

METHODS

A total of 96 patients with high-risk NMIBC, who received intravesical BCG, were enrolled in the study. BCG responsive group (group 1) and BCG failure group (group 2) were compared in terms of demographic and pathological data, peripheral lymphocyte, neutrophil and platelet counts, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), SII, recurrence-free survival (RFS) and progression-free survival (PFS). The SII was calculated as in the formula: SII = neutrophil × platelet/lymphocyte. The prognostic ability of the SII for progression was analysed with multivariate backward stepwise regression models.

RESULTS

The mean follow-up time 34.635 ± 14.7 months. Group 2 had significantly higher SII, peripheral lymphocyte, neutrophil and platelet counts than group 1. An ROC curve was plotted for the SII to predict the BCG failure and the cut-off point was calculated as 672.75. Effect of the SII to the model was statistically significant (P = .003) and a higher SII increased the progression onefold. A tumour greater than 30 mm in size and a high SII together increased the progression 3.6 folds.

CONCLUSIONS

The SII might be a successful, non-invasive and low-cost parameter for prediction of BCG failure in patients with high-risk NMIBC. The cut-off value for SII is 672.75 and above this level BCG failure and progression to MIBC might be anticipated. However, these results should be validated in prospective randomised controlled studies with large patient groups.

Is there any association of COVID-19 with testicular pain and epididymo-orchitis?

AIMS

This study aims to analyse the novel Coronavirus disease- (COVID-19) related testicular pain in hospitalised patients because of COVID-19 and to review as an aetiological factor for epididymitis, orchitis or both.

METHODS

A total of 91 patients were included in the study. A questionnaire was formed for the questioning of testicular pain or epididymo-orchitis in patients with COVID-19. Demographics and past medical history was also recorded. Patients' neutrophil and lymphocyte counts, neutrophil-lymphocyte ratios (NLR), C-reactive protein (CRP) levels and D-dimer values were recorded. Patients with COVID-19 were divided into two groups according to absence or presence of testicular pain or epididymo-orchitis as group 1 and group 2. All results were compared for both groups.

RESULTS

The median age of patients was similar in both groups. Testicular pain was occurred in 10.98% of the patients. Clinical presentation of epididymo-orchitis was diagnosed in only one patient. No statistically significant difference was reported in terms of patients' age, levels of CRP and D-Dimer or NLR and results of questionnaire form queries between the two groups (P > .05).

CONCLUSION

Testicular pain was observed more frequently in hospitalised COVID-19 cases. While no inflammation marker which is related to predict of testicular pain or epididymo-orchitis was found in patients with COVID-19.

COVID-19 infection threat in patients with high-risk non-muscle invasive bladder cancer receiving intravesical BCG therapy

AIM

We evaluated the COVID-19 infection threat in patients receiving intravesical BCG therapy which has immunotherapeutic effects and is of vital importance in most of the individuals with high-risk non-muscle-invasive bladder cancer (NMIBC) and investigated the need for postponement of this therapy.

METHODS

A total of 71 patients, who were diagnosed with high-risk NMIBC and on intravesical BCG treatment regularly (induction or maintenance), were enrolled in the study. The patients were classified into two groups depending on whether they were diagnosed with COVID-19 during the pandemic period or not.

RESULTS

Of 71 patients, 26 underwent a COVID-19 polymerase chain reaction test with clinical suspicion during the pandemic period. Of these 26 patients, 4 were diagnosed with COVID-19. Age of the patients, working status (working/retired), compliance with containment measures against the pandemic, number of BCG courses, adverse effects after BCG therapy and systemic immune-inflammation index, which is an inflammation-related parameter, were not different between groups (P > .05). Neutrophil/lymphocyte ratio was significantly higher in the COVID-19 positive group (P < .05). COVID-19 positivity was higher in age groups 50-64 (6.6%) and 65-80 (5.8%) years than that in similar age groups of the normal population.

CONCLUSION

Every effort should be made to administer intravesical BCG treatment in high-risk NMIBC patients even during the pandemic period. However, increased risk of COVID-19 transmission should be kept in mind and protective measures against COVID-19 for healthcare providers and patients before the procedure should be taken optimally. The procedure should be postponed in patients with lymphopenia in recent complete blood count.

Does arterial stiffness increase in patients with early surgical menopause?

Introduction

Surgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients.

Method

We included 40 patient early surgical menopause and 40 control group patients with clinically and demographically similar characteristics. Oscillometric measurement method with Mobil-O-Graph 24h-ABPM NG® arteriography was used to measure the arterial stiffness and cardiovascular hemodynamic parameters.

Results

Of the 40 patients who underwent surgical early menopause, 27 (67.5%) had malignancy, 11 (27.5%) with myoma and 2 (5%) with bleeding. There were no differences in baseline demographic, laboratory, echocardiographic parameters and coronary artery disease risk factors.In terms of arterial stiffness parameters, PWV were significantly higher in the early surgical menopause group than in the control group (6.5±0.8; 5.6±1.2 p&lt;0.001), but there was no statistically significant difference in Alx (28.3±10.9; 27.4±9.0 p=0.69).Also, there was no statistically significant difference in terms of cardiac hemodynamic parameters and central aortic pressures.

Conclusion

When arterial stiffness is noninvasively evaluated by oscillometric method, it is significantly increased in surgical early menopause patients independent of other risk factors.

Funding Acknowledgement

Type of funding source: None

Morphometric analysis and three-dimensional computed tomography reconstruction of the long bones of femoral and crural regions in Van cats

BACKGROUND

This study was conducted to determine the morphometric features and to make the three-dimensional (3D) reconstruction of the images obtained by computed tomography (CT) of the main long bones (femur, tibia, fibula) in Van cats, and to reveal the biometric differences between these measurement values of both sexual dimorphism and homotypic variations.

MATERIALS AND METHODS

A total of 16 adult Van cats, 8 male and 8 female, were used in the study. The pelvic limb long bones of the cats, which were anesthetized with the ketamine-xylazine combination, were scanned with a CT device and their images were obtained. These images were converted to a 3D structure by means of MIMICS 20.1 (The Materialise Group, Leuven, Belgium) software programme. Then, morphometric, volumetric, surface arae measurements of these bones were calculated and statistical analyses were performed.

RESULTS

In the analysis, it was observed that right greatest length (GL), left GL, right greatest length from caput ossis femoris (GLc), left greatest breadth of the distal end (Bd), right volume (V), and left V measurement values of the femur; left GL1, right greatest breadth of the proximal end (Bp), right Bd, left Bd, right smallest breadth of the diaphysis (SD), right V, left V, and right surface area (SA) measurement values of the tibia; right V, left V, right SA, and left SA measurement values of the fibula were statistically significantly higher in male cats than in female cats (p < 0.05). The volume and surface area measurement values of the femur, tibia and fibula of male and female cats were determined as 8.57 ± 1.33 cm3 and 7.00 ± 0.49 cm3, 64.28 ± 6.72 cm2 and 59.42 ± 4.72 cm2; 7.56 ± 1.28 cm3 and 6.15 ± 0.52 cm3, 56.89 ± 6.47 cm2 and 52.72 ± 3.15 cm2; 1.10 ± 0.17 cm3 and 0.83 ± 0.05 cm3, 14.18 ± 1.61 cm2 and 11.95 ± 0.48 cm2, respectively.

CONCLUSIONS

The statistical differences between the sexes in terms of the measurement parameters of the femur, tibia and fibula in adult Van cats were determined. We believe that these differences can be used in determining morphological variations of Van cats. In addition, it is thought that the data obtained from the present study would be beneficial to veterinary physicians in the clinical application areas in order to evaluate the pathological conditions related to these bones and to the studies in the field of zooarchaeology.

Rehabilitation of the completely edentulous young patient with the "Malo Bridge": A case report

It is possible to rehabilitate fully edentulous patients with implantsupported fixed or removable prostheses; however, implantsupported fixed prostheses are the gold standard for patients who not prefer to use removable dentures. This case report, prosthetic rehabilitation of a completely edentulous young patient with an implantsupported fixed hybrid prosthesis using the "Malo Bridge" technique is described. A 18 years old male patient was referred to the clinic with complaints of tooth loss, aesthetics, function, and phonetic. A total of 5 implants were placed in both the jaws. Considering that screw holes may cause aesthetic problems due to the Class III occlusion, these problems have been solved with the implant-supported hybrid prosthesis called Malo bridge. With the Malo Bridge design, the patient's aesthetic, functional and phonetic loss was eliminated, patient comfort and quality of life were improved, and patient expectations were met. It is a viable treatment option to rehabilitate completely edentulous jaws with a cross relationship and increase interarch distance using Malo Bridge to support a fixed prosthesis.

Abstract 3447: T cell antigen expression levels govern progression and therapy response in a novel model of colon cancer

Genetically-engineered mouse models have greatly advanced our understanding of cancer, yet do not recapitulate the mutational complexity of human cancer, and likely lack neo-antigens capable of eliciting potent anti-tumor T cell responses. We developed a novel orthotopic organoid transplant model of colorectal cancer (CRC) harboring the strong T cell antigen SIINFEKL, and demonstrate the importance of antigen expression level in the anti-tumor T cell response. Although SIINFEKL low-expressing organoids (SIINLow) elicit an endogenous antigen-specific T cell response, the magnitude is substantially lower and kinetics delayed relative to SIINFEKL high-expressing organoids (SIINHi). Consistently, transplant of SIINHi results in rejection and T cell memory, while SIINLow results in tumor progression, terminally-exhausted T cells, and metastasis to the liver. We have shown that suboptimal T cell priming is the major factor underlying SIINLow tumor escape. Importantly, co-transplant of SIINHi and SIINLow organoids at distinct sites in the colon of the same animal results in complete rejection of both lines. In addition, co-transplant rescues the SIINLow tumor-infiltrating antigen-specific T cell response to a magnitude and quality comparable to that of SIINHi tumors. Single-cell RNA-sequencing of antigen-specific T cells from SIINHi and SIINLow tumors 8 days post-transplant revealed distinct clusters dominated by SIINLow-primed T cells, including a cluster enriched for immediate early response genes, Tox, and a number of immune checkpoints, indicative of early dysfunction. Collectively, our results establish the existence of a neo-antigen expression threshold at which T cell priming is limiting, resulting in attenuated magnitude and functionality of the T cell response, and tumor escape. To assess the therapeutic relevance of a poorly-expressed neo-antigen in CRC, we performed preclinical trials with immune checkpoint blockade and agonistic-CD40 (aCD40), which has been shown to potentiate T cell priming and response in poorly-immunogenic mouse and human pancreatic adenocarcinoma. While monotherapies showed only modest effects, the combination of checkpoint blockade and aCD40 resulted in an 80% response rate with a number of complete responses. In conclusion, antigen expression level is a critical determinant of T cell dysfunction, resulting from poor priming. Our results argue that targeting T cell priming may be a promising therapeutic strategy to invigorate anti-tumor immunity in human CRC, the majority of which remains refractory to immunotherapy.

Citation Format: Peter Maxwell Kienitz Westcott, Nathan J. Sacks, Olivia Smith, Jason Schenkel, Zackery Ely, Daniel Zhang, Mary Clare Beytagh, William Hwang, George Eng, Jatin Roper, Omer Yilmaz, Tyler Jacks. T cell antigen expression levels govern progression and therapy response in a novel model of colon cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3447.

Primary human colonic mucosal barrier crosstalk with super oxygen-sensitive Faecalibacterium prausnitzii in continuous culture

Background

The gut microbiome plays an important role in human health and disease. Gnotobiotic animal and in vitro cell-based models provide some informative insights into mechanistic crosstalk. However, there is no existing system for a long-term co-culture of a human colonic mucosal barrier with super oxygen-sensitive commensal microbes, hindering the study of human-microbe interactions in a controlled manner.

Methods

Here, we investigated the effects of an abundant super oxygen-sensitive commensal anaerobe, Faecalibacterium prausnitzii, on a primary human mucosal barrier using a Gut-MIcrobiome (GuMI) physiome platform that we designed and fabricated.

Findings

Long-term continuous co-culture of F. prausnitzii for two days with colon epithelia, enabled by continuous flow of completely anoxic apical media and aerobic basal media, resulted in a strictly anaerobic apical environment fostering growth of and butyrate production by F. prausnitzii, while maintaining a stable colon epithelial barrier. We identified elevated differentiation and hypoxia-responsive genes and pathways in the platform compared with conventional aerobic static culture of the colon epithelia, attributable to a combination of anaerobic environment and continuous medium replenishment. Furthermore, we demonstrated anti-inflammatory effects of F. prausnitzii through HDAC and the TLR-NFKB axis. Finally, we identified that butyrate largely contributes to the anti-inflammatory effects by downregulating TLR3 and TLR4.

Conclusions

Our results are consistent with some clinical observations regarding F. prausnitzii, thus motivating further studies employing this platform with more complex engineered colon tissues for understanding the interaction between the human colonic mucosal barrier and microbiota, pathogens, or engineered bacteria.

Relevance between clinical status and exhaled molecules related to neutrophilic inflammation in pediatric cystic fibrosis

INTRODUCTION

Cystic fibrosis (CF) is characterized with chronic inflammation with neutrophil and related cytokines in airway secretions. We aimed to measure the levels of neutrophil related inflammatory markers as nitric oxide, IL-8, IL-17, leukotriene B4 and neutrophil elastase as well as e-cadherin in exhaled breath condensate (EBC), and to determine their relation with clinical findings.

METHODS

We consecutively enrolled cystic fibrosis patients into our clinics between the age of six and eighteen years who could cooperate for exhaled breath condensate to this case-control study (n = 30). The age and sex matched control group (n = 26) was enrolled. Spirometry was performed during the stable period and EBC samples were obtained for measurement of the markers.

RESULTS

The mean age of the subjects enrolled was 12.1(4.2) years and 40% were positive for P.Aeruginosa in sputum. Subjects who had P.Aeruginosa in sputum cultures had significantly lower FEV1, FVC and FEF 25/75 values compared to the ones without P.Aeruginosa (p = 0.002, p = 0.002 and p = 0.005 respectively). EBC neutrophil elastase levels were significantly higher in the CF patients compared to non-CF controls (3.11 ± 4.71 versus 0.90 ± 2.68, p = 0.04). Nitric oxide, IL-17, IL-8, e-cadherin, neutrophil elastase or leukotriene B4 levels in EBC of CF patients were not related to P.Aeruginosa s infection, FEV1 levels or hospital admission in the last year.

CONCLUSION

In our study, neutrophil elastase levels in EBC are higher in CF patients compared to non-CF controls. This is independent of acute infection and is evidence to the persistence of neutrophilic lung injury. However, EBC NO, IL-8, IL-17, e-cadherin, neutrophil elastase and leukotriene B4 levels as inflammatory markers, are not correlated with disease progression or clinical findings.

Dissecting cell-type-specific metabolism in pancreatic ductal adenocarcinoma

Tumors are composed of many different cell types including cancer cells, fibroblasts, and immune cells. Dissecting functional metabolic differences between cell types within a mixed population can be challenging due to the rapid turnover of metabolites relative to the time needed to isolate cells. To overcome this challenge, we traced isotope-labeled nutrients into macromolecules that turn over more slowly than metabolites. This approach was used to assess differences between cancer cell and fibroblast metabolism in murine pancreatic cancer organoid-fibroblast co-cultures and tumors. Pancreatic cancer cells exhibited increased pyruvate carboxylation relative to fibroblasts, and this flux depended on both pyruvate carboxylase and malic enzyme 1 activity. Consequently, expression of both enzymes in cancer cells was necessary for organoid and tumor growth, demonstrating that dissecting the metabolism of specific cell populations within heterogeneous systems can identify dependencies that may not be evident from studying isolated cells in culture or bulk tissue.

Tumors contain a mixture of many different types of cells, including cancer cells and non-cancer cells. The interactions between these two groups of cells affect how the cancer cells use nutrients, which, in turn, affects how fast these cells grow and divide. Furthermore, different cell types may use nutrients in diverse ways to make other molecules – known as metabolites – that the cell needs to survive.

Fibroblasts are a subset of non-cancer cells that are typically found in tumors and can help them form. Separating fibroblasts from cancer cells in a tumor takes a lot longer than the chemical reactions in each cell of the tumor that produce and use up nutrients, also known as the cell’s metabolism. Therefore, measuring the levels of glucose (the sugar that is the main energy source for cells) and other metabolites in each tumor cell after separating them does not necessarily provide accurate information about the tumor cell’s metabolism. This makes it difficult to study how cancer cells and fibroblasts use nutrients differently.

Lau et al. have developed a strategy to study the metabolism of cancer cells and fibroblasts in tumors. Mice with tumors in their pancreas were provided glucose that had been labelled using biochemical techniques. As expected, when the cell processed the glucose, the label was transferred into metabolites that got used up very quickly. But the label also became incorporated into larger, more stable molecules, such as proteins. Unlike the small metabolites, these larger molecules do not change in the time it takes to separate the cancer cells from the fibroblasts.

Lau et al. sorted cells from whole pancreatic tumors and analyzed large, stable molecules that can incorporate the label from glucose in cancer cells and fibroblasts. The experiments showed that, in cancer cells, these molecules were more likely to have labeling patterns that are characteristic of two specific enzymes called pyruvate carboxylase and malic enzyme 1. This suggests that these enzymes are more active in cancer cells. Lau et al. also found that pancreatic cancer cells needed these two enzymes to metabolize glucose and to grow into large tumors.

Pancreatic cancer is one of the most lethal cancers and current therapies offer limited benefit to many patients. Therefore, it is important to develop new drugs to treat this disease. Understanding how cancer cells and non-cancer cells in pancreatic tumors use nutrients differently is important for developing drugs that only target cancer cells.

The importance of PSA-Density in active surveillance for prostate cancer

OBJECTIVE

In this study, we aimed to determine the predictive factor for additional treatment requirement in active surveillance (AS) for patients with low or very low-risk prostate cancer (PCa) and we investigated the effect of tumor burden by total core involvement rate in biopsy to predict of need for additional treatment.

MATERIAL AND METHODS

107 patients with PCa in AS between 2005 and 2018 have been evaluated retrospectively. Groups were divided into two groups according to the need for additional treatment. Group 1 received additional treatment, group 2 did not receive additional treatments and active surveillance was continued. Patient's total prostate-specific antigen (tPSA), prostate-specific antigen density (PSA-D), total core involvement count, quantity and rate at biopsy pathology results and follow-up period were recorded and compared in the two groups.

RESULTS

The current cohort includes 107 patients. Mean age at diagnosis was 63.01years. Mean tPSA values at diagnosis were 6.09 ng/mL and 5.2 ng/mL in the group 1 and group 2, respectively. Mean follow-up period was 38.1 months (range, 12 to 134 months). Only PSA-D measurement significantly predicted need for additional treatment (p = 0.017). ROC analysis showed that the optimal threshold was 0.13 ng/mL/cc (sensitivity: 70.8%; specificity: 57.1%). Additional treatment requirement was not detected in patients with PSA-D cut-off level less than 0.07 ng/mL/cc.

CONCLUSIONS

Total tumor burden of less than 5% is safe for patients with low or very low-risk PCa in AS. A 0.13 ng/mL/cc cut-off level of PSA-D can predict to need for additional treatment in patients managed by AS.

Morphometric characterization and estimating body weight of two Algerian camel breeds using morphometric measurements

This study was carried out in order to identify the body measurements of two different Dromedary camel breeds raised in Algeria. The animal material of the study consisted of a total of 115 animals belong to Steppe (n = 55) and Sahraoui (n = 60) camel breeds. Eye and coat colors along with body measurements such as head length, neck length, neck girth, tail length, distance between eyes, distance between ears, body length, withers height, chest girth, and live weight were determined. Least squares means for head length, neck length, neck girth, tail length, distance between eyes, distance between ears, body length, withers height, chest girth, and live weight are found 48.2, 116.9, 65.7, 55.6, 24.1, 22.5, 152.2, 184.5, 141.2 cm, and 217.2 kg for Steppe and 48.1, 101.2, 56.2, 51.2, 23.4, 18.3, 135.6, 167.3, 176.8 cm, and 298.9 kg for Sahraoui camel breeds, respectively. The distribution of brown and black eye colors for the Steppe camel breed is as 58.2% and 41.8%, respectively, while all of the Sahraoui camels studied had a brown eye color. The proportional distribution in terms of body color included are coffee, dark coffee, and red colors for 1.8%, 83.6%, and 14.6% in the Steppe camel and 98.3%, 1.7%, and 0.0% for the Sahraoui camel, respectively. As a result, this study concluded that the withers height and chest girth could estimate the body weight in the two breeds of camels with different ages.

Genetic characterization of four Algerian cattle breeds using microsatellite markers

Cattle plays a very important role in agriculture and food security in Algeria. In the present study, the genetic diversity and structure of Algerian indigenous cattle populations were evaluated by microsatellite markers. A total of 138 individuals belonging to four cattle breed populations were characterized using 22 microsatellite markers. A total of 360 alleles was detected across studied all loci. Results obtained for the mean number of alleles (16.36), expected heterozygosity (0.84) and polymorphic information content (0.82) indicated that the total analyzed populations are characterized by noticeable genetic variability. It can be said that there is a low genetic differentiation in the cattle populations studied considering obtained mean F_ST value (0.039). It was revealed 97.10% of the total genetic variation can be explained by genetic differences among individuals while 2.90% among populations. The structure, factorial correspondence analysis results and dendrogram showed that cattle populations studied are clustered in three groups. The present study has revealed an important knowledge about the genetic diversity and the relationship between some native cattle breeds raised in Algeria. The results showed that the breeds studied have a high genetic diversity. Moreover, it can be said that microsatellite markers used can be successfully used to determine genetic diversity and population structure in Algerian cattle breeds.

The Clinical Significance of Seminoma Component in Testicular Mixed Germ Cell Tumour

BACKGROUND

The aim of this study was to examine clinical/pathological characteristics, prognosis and tendency to metastasis of mixed germ cell tumours (MGCTs) that contain a seminoma component.

METHODS

A total of 111 MGCT cases between 2008 and 2018 were retrospectively enrolled. The patients were divided into 2 groups according to the absence (group 1) or presence (group 2) of seminoma component in MGCTs. Patients' age, complaints at admission to our clinic, primary tumour localization, primary tumour size, preoperative testicular tumour markers, MGCT histopathological components and percentages, lymphovascular invasion, pathological tumour stage, postoperative testicular tumour markers, presence of lymph node involvement in abdominal tomography, lung metastasis based on thorax tomography, clinical tumour stage, adjunctive therapies performed, state of recurrence and survival were compared in 2 groups.

RESULTS

The mean age of the patients was 24.51 ± 4.79 years. The mean age, initial complaint rates, primary tumour size, postoperative testicular tumour markers, presence of lymphovascular invasion, presence of lymph node involvement and lung metastasis were found to be higher in group 2 than in group 1, although these differences were not statistically significant. Especially, it was found that a seminoma component rate of 30% and higher had a higher tendency for a poor prognosis.

CONCLUSION

Although the word "seminoma" may be initially interpreted as an indication of good prognosis, a seminoma component in MGCTs is actually not a good prognostic factor. MGCTs that contain a seminoma component (especially 30% and higher) can have a higher tendency for occult metastatic disease.

Gut-Liver Physiomimetics Reveal Paradoxical Modulation of IBD-Related Inflammation by Short-Chain Fatty Acids

Although the association between the microbiome and IBD and liver diseases is known, the cause and effect remain elusive. By connecting human microphysiological systems of the gut, liver, and circulating Treg and Th17 cells, we created a multi-organ model of ulcerative colitis (UC) ex vivo. The approach shows microbiome-derived short-chain fatty acids (SCFAs) to either improve or worsen UC severity, depending on the involvement of effector CD4 T cells. Using multiomics, we found SCFAs increased production of ketone bodies, glycolysis, and lipogenesis, while markedly reducing innate immune activation of the UC gut. However, during acute T cell-mediated inflammation, SCFAs exacerbated CD4⁺ T cell-effector function, partially through metabolic reprograming, leading to gut barrier disruption and hepatic injury. These paradoxical findings underscore the emerging utility of human physiomimetic technology in combination with systems immunology to study causality and the fundamental entanglement of immunity, metabolism, and tissue homeostasis.

Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children

INTRODUCTION

Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures.

MATERIAL AND METHOD

We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-Loc^TM, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion.

RESULTS

The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110 min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p = 0.001 and p = 0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p = 0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months.

CONCLUSION

In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.

Sarcoidosis is a rare cause of infertility: A case report

In this paper, we presented a patient, who applied to our clinic because of infertility. After an intensive investigation, we diagnosed systemic sarcoidosis with testicular involvement. Urogenital sarcoidosis is a rare and insidious condition, however, it can lead to infertility. Therefore, following the diagnosis, we applied systemic steroid therapy to the patient. Within one year, the patient had a child without assisted reproductive techniques. According to our experience, in this case, we concluded that infertility without an etiology should be investigated elaborately. Furthermore, urogenital sarcoidosis should keep in mind as a rare etiology.

ON THE ISSUE OF NECESSITY TO PERFORM THE DR-70 IMMUNOASSAY PRIOR TO PROSTATE BIOPSY IN PATIENTS WITH HIGH PROSTATE SPECIFIC ANTIGEN LEVEL AND ITS EFFICACY IN PREDICTING THE BIOPSY RESULTS

The aim is to discuss the contribution of the DR-70 for the patients with high PSA level and which cutofflevel of DR-70 must be consideredthe biopsy decision. 93 patients with high prostate specific antigen level were enrolled into the study. Before the prostate biopsy, total PSA (tPSA), free PSA (fPSA), free/total PSA rate (f/tPSA), PSA density (PSAD) and DR-70 levels were recorded. The patients were divided into two groups according to the pathological outcome of benign (G1) or malignant (G2). G1 and G2 were compared with Mann-Whitney U test, Spearman's rho and ROC curve for analysis. The significance level is taken as .05 for all tests. The median age of patients in G1 and G2 was 62.52 and 68.22 years, respectively. The mean PV in G1 and G2 were 52.16 and 39.6 mL, respectively. The mean tPSA, PSAD and DR-70 levels in G1 and G2 were found as 7.19 and 18.74 ng/mL, 0.14 and 0.48 ng/mL/cc and 0.44 and 0.5 µg/mL, respectively. The mean age of the patients in G2 was statistically significantly higher than G1 (p=.001).The mean PV of the patients in G2 was statistically significantly lower than G1 (p=.001).The mean PSAD of the patients in G2 was statistically significantly higher than G1 (p=.001). There was no statistically significant difference on DR-70 levelsbetween G1 and G2 (p=.38). In Spearman's rhocorrelationanalysis, there was nostatistically significant relationships between DR-70 levels and pathology results in G2 (p=.24). ROC curve of tPSA, fPSA, f/tPSA, PSAD and DR-70 levelswere evaluated. ROC curve of PSAD shows a fair discriminant power with AUC = 0.71 (95% CI: 0.607-0.828) for differentiation between PCa and benign tissue in prostate biopsy with moderate specificity and high sensitivity (62.5% and 75.7%, resp., cut-off level: 0.1377 ng/mL). Contrary to literature and guidelines, cutoff level of PSAD as 0.13ng/mL/cc should be kept in mind and accordingly, a biopsy decision should be made. We think that DR-70 is no needed for additional evaluation before prostate biopsy.

Study of Environmental Enteropathy and Malnutrition (SEEM) in Pakistan: protocols for biopsy based biomarker discovery and validation

Background

Environmental Enteropathy (EE), characterized by alterations in intestinal structure, function, and immune activation, is believed to be an important contributor to childhood undernutrition and its associated morbidities, including stunting. Half of all global deaths in children < 5 years are attributable to under-nutrition, making the study of EE an area of critical priority.

Methods

Community based intervention study, divided into two sub-studies, 1) Longitudinal analyses and 2) Biopsy studies for identification of EE features via omics analyses. Birth cohorts in Matiari, Pakistan established: moderately or severely malnourished (weight for height Z score (WHZ) < − 2) children, and well-nourished (WHZ > 0) children. Blood, urine, and fecal samples, for evaluation of potential biomarkers, will be collected at various time points from all participants (longitudinal analyses). Participants will receive appropriate educational and nutritional interventions; non-responders will undergo further evaluation to determine eligibility for further workup, including upper gastrointestinal endoscopy. Histopathological changes in duodenal biopsies will be compared with duodenal biopsies obtained from USA controls who have celiac disease, Crohn’s disease, or who were found to have normal histopathology. RNA-Seq will be employed to characterize mucosal gene expression across groups. Duodenal biopsies, luminal aspirates from the duodenum, and fecal samples will be analyzed to define microbial community composition (omic analyses). The relationship between histopathology, mucosal gene expression, and community configuration will be assessed using a variety of bioinformatic tools to gain better understanding of disease pathogenesis and to identify mechanism-based biomarkers. Ethical review committees at all collaborating institutions have approved this study. All results will be made available to the scientific community.

Discussion

Operational and ethical constraints for safely obtaining intestinal biopsies from children in resource-poor settings have led to a paucity of human tissue-based investigations to understand and reverse EE in vulnerable populations. Furthermore, EE biomarkers have rarely been correlated with gold standard histopathological confirmation. The Study of Environmental Enteropathy and Malnutrition (SEEM) is designed to better understand the pathophysiology, predictors, biomarkers, and potential management strategies of EE to inform strategies to eradicate this debilitating pathology and accelerate progress towards the 2030 Sustainable Development Goals.

Trial registration

Retrospectively registered; clinicaltrials.gov ID NCT03588013.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1564-x) contains supplementary material, which is available to authorized users.

What should be the PSA threshold value? 2.5 or 4 ng/mL?

Background: In this study, author aimed to detect of threshold value of prostate-specific antigen (PSA) to distinguish malignant or benign prostatic lesions in PSA evaluation.Methods: A total of 61 patients underwent TRUSBP due to high PSA values (2.5-4 ng/mL) at the clinic between 2012-2017. Digital rectal examinations of all patients were normal. Cases with PSA elevation were divided into groups according to the pathology by benign (group 1) or malign (group 2). Author evaluated the predictive factors with the exception of digital rectal examination findings in two groups.Results: Benign prostate hyperplasia was detected in 35 patients (57.4%) and prostate adenocarcinoma was detected in 26 patients (42.6%). The patient’s age, tPSA, fPSA and PSA density were 62.07 years, 3.55 ng/mL, 0.65 ng/mL and 0.09 ng/ml2 in group 1 and 58.54 years, 3.55 ng/mL, 0.74 ng/mL and 0.10 ng/ml2 in group 2, respectively. Patient’s age was statistically significant between in two groups (p<0.05). Number of received cores and rate of f/tPSA were 12.24-12 and 20.51-18.45% in group 1 and 2, respectively. tPSA, fPSA and PSA density, number of received cores and rate of f/tPSA were similar in both groups. In group 2, prostate adenocarcinoma was most common detected with Gleason score 3+3 in 19 of 26 patients (73.1%).Conclusions: There is a need different assessment to distinguish of malignant lesions from benign lesions. Nowadays, it was impossible to make this difference in patients without digital rectal examination findings, so accepted threshold of PSA should be 2.5 ng/mL.

Protection with thymoquinone against formaldehyde-induced neurotoxicity in the rats

INTRODUCTION

This study aimed to investigate the neurotoxic damage of formaldehyde (FA), which is commonly used in medicine and industrial fields, for the hippocampus of rats and the protective role of thymoquinone (TQ) against this neurotoxicity.

METHODS

There were five groups with eight rats in each. Two control groups were formed, in one of them physiological saline was applied and in the other one corn oil was applied. FA was injected in Group 3. Group 4 was exposed to FA and TQ simultaneously. Group 5 received TQ only. At the end of the experiment animals were sacrificed and brain tissues were removed for biochemical and histopathological investigation.

RESULTS

catalase (CAT), glutathione peroxidase (GSH-px) and superoxide dismutase (SOD), all known as enzymes with antioxidant activities, were increased in FA and TQ simultaneously administered group. FA caused prominent subarachnoidal hemorrhage and vacuolization. Vacuolization was not observed but occasional subarachnoidal hemorrhage was detected in the FA+TQ group.

CONCLUSION

Neurotoxic damage in hippocampus induced by FA was reverted by administration of TQ (Tab. 1, Fig. 1, Ref. 26).

Low-Carbohydrate Diet Score and Macronutrient Intake in Relation to Survival After Colorectal Cancer Diagnosis

Background

A low-carbohydrate diet may improve cancer survival, but relevant clinical evidence remains limited.

Methods

We followed 1542 stages I to III colorectal cancer (CRC) patients who completed a validated food frequency questionnaire between 6 months and 4 years after diagnosis. We calculated overall, animal-, and plant-rich, low-carbohydrate diet scores and examined their associations with CRC-specific and overall mortality using Cox proportional hazards regression after adjusting for potential predictors for cancer survival. We also assessed the intake and changes of macronutrients after diagnosis. Statistical tests were two-sided.

Results

Although no association was found for overall and animal-rich low-carbohydrate diet score, plant-rich, low-carbohydrate diet, which emphasizes plant sources of fat and protein with moderate consumption of animal products, was associated with lower CRC-specific mortality (hazard ratio [HR] comparing extreme quartiles = 0.37, 95% confidence interval [CI] = 0.25 to 0.57, P_trend < .001). Carbohydrate intake was associated with higher CRC-specific mortality, and this association was restricted to carbohydrate consumed from refined starches and sugars (HR per one-SD increment = 1.36, 95% CI = 1.14 to 1.62, P_trend < .001). In contrast, replacing carbohydrate with plant fat and protein was associated with lower CRC-specific mortality, with the HR per one-SD increment of 0.81 (95% CI = 0.69 to 0.95, P_trend = .01) for plant fat and 0.77 (95% CI = 0.62 to 0.95, P_trend = .02) for plant protein. Similar results were obtained for overall mortality and when changes in macronutrient intake after diagnosis were assessed.

Conclusion

Plant-rich, low-carbohydrate diet score was associated with lower mortality in patients with nonmetastatic CRC. Substituting plant fat and protein for carbohydrate, particularly that from refined starches and sugars, may improve patients’ survival.

Association between Dysphagia and Frailty in Community Dwelling Older Adults

OBJECTIVES

Dysphagia is described as a geriatric syndrome that occurs more frequently with aging. It is associated with the deterioration in functionality however, it is usually ignored. Frailty is a geriatric syndrome that is recognized more with its well-known adverse consequences. Very recently, dysphagia has been suggested to accompany frailty in older adults. We aimed to investigate the association between dysphagia and frailty in the community dwelling older adults.

DESIGN

Prospective, cross-sectional study.

SETTING

Geriatric outpatient clinic.

PARTICIPANTS

Older adults aged ≥60 years.

MEASUREMENTS

Dysphagia was evaluated by EAT-10 questionnaire and frailty by FRAIL scale. Handgrip strength (HGS) was evaluated by hand-dynamometer. Gait speed was evaluated by 4-meter usual gait speed (UGS). Nutritional status was assessed by mini-nutritional assessment-short form (MNA-SF).

RESULTS

1138 patients were enrolled. Mean age was 74.1±7.3 years. EAT-10 questionnaire was answered by all and FRAIL-scale by 851 subjects. EAT-10 score >15 points was regarded as significant dysphagia risk. The participants with EAT-10>15 points were older when compared to the participants with EAT-10<=15 points (p=0.002). Among participants with EAT-10>15 points, women gender and neurodegenerative diseases were more prevalent (p=0.04, p=0.002; respectively); number of chronic diseases, number of drugs and FRAIL score were higher (p=0.001 for each), and HGS, UGS, MNA-SF scores were lower (p=0.002, p=0.01, p<0.001; respectively). In multivariate analyses, the factors independently associated with presence of EAT-10 score>15 were FRAIL score and the number of drugs.

CONCLUSION

Dysphagia is associated with frailty irrespective to age, presence of neurodegenerative diseases, number of chronic diseases and drugs. To our knowledge, this is the largest serie in the literature providing data on independent association of dysphagia with frailty.