Advantage of HSP110 (T17) marker inclusion for microsatellite instability (MSI) detection in colorectal cancer patients

Colorectal cancer (CRC) is a leading cause of cancer death worldwide. Microsatellite instability (MSI) is a genetic pathway leading to CRC, associated with particular clinicopathological features, and recently a major biomarker of immunotherapy response. There is little information the frequency MSI among Brazilian CRC patients, and it is still debatable the ideal methodology for MSI screening in countries with limited resources. We proposed to evaluate MSI by molecular and immunohistochemistry (IHC) methods, to compare both methodologies and also to assess the inclusion of a novel microsatellite marker, HSP110 (T17). The molecular MSI evaluation was performed using a PCR-multiplex panel in a total of 1013 CRC patients. Mismatch repair (MMR) proteins (MLH1, MSH2, MSH6 and PMS2) expression were evaluated by IHC. HSP110 (T17) marker was analyzed by fragment analysis. Molecularly, 89.5% of cases were MSI-negative and 10.5% were MSI-positive. The IHC showed that 88.9% of cases exhibited MMR-proficient status, 10.2% were MMR-deficient and 0.9% was inconclusive. Genotyping of the HSP110 (T17) in 106 MSI-positive and 215 MSI-negative cases showed its alteration only among the MSI-positive cases. We observed agreement (0.956, Kappa Test) between both molecular and IHC methodologies, with only eight discordant results, and in this subset of cases the HSP110 (T17) corroborate the molecular findings. This study suggests the use of molecular assays over IHC for MSI analysis and proposes the inclusion HSP110 (T17) marker as a complementary analysis in discordant cases.

Absence of TERT promoter mutations in colorectal precursor lesions and cancer

Hotspot mutations (c.-124bp G > A and c.-146bp G > A) in the promoter region of the TERT gene have been recently described in several types of solid tumors, including glioma, bladder, thyroid, liver and skin neoplasms. However, knowledge with respect to colorectal precursor lesions and cancer is scarce. In the present study we aimed to determine the frequency of hotspot TERT promoter mutations in 145 Brazilian patients, including 103 subjects with precursor lesions and 42 with colorectal carcinomas, and we associated the presence of such mutations with the patients clinical-pathological features. The mutation analysis was conclusive in 123 cases, and none of the precursor and colorectal carcinoma cases showed TERT promoter mutations. We conclude that TERT mutations are not a driving factor in colorectal carcinogenesis.

Lisbon Burn Centre experience with intentional burn injuries

Burn injury as a form of hetero or auto-aggression accounts for a significant amount of admissions to a Burn Care Unit, with epidemiologic and clinical specificities. To investigate the differences in risk factors, psychiatric comorbidities, injury severity and mortality among adult patients with accidental or intentional burns, we analyzed routinely collected data from a Central Hospital Burn Unit over a period of 6 years (January 1st, 2010 to December 31st, 2015). We identified 22 intentional burn patients (5%) among all the admissions to our Burn Unit. When compared to the accidental burns, the intentional burn patients are significantly younger (45.7±14.7 vs. 54.9±19.9), have a bigger percentage of body surface area burned (35% vs. 14%), have a higher incidence of inhalation burn (50% vs. 22.8%) and higher mortality (18.2% vs. 6.1%). Fifty-five percent of cases of intentional burns were self-inflicted. Self-inflicted burns have a worse prognosis than hetero-aggressions (inhospital mortality 25% vs. 10%). Psychiatric comorbidities were largely more prevalent in the intentional burn patients (59% vs. 6.6%), namely mood disorders. Compared to patients with accidental burns, intentional burn patients have worse clinical condition and prognosis. A multidisciplinary preventive approach, looking at the specificities of the violent nature of the lesions and identifying risk groups may reduce the incidence and severity of this type of burns.

"Cirurgia Adjuvante" no Tratamento do Tumor Estromal Gastrointestinal Metastático: um Novo Conceito

Os recentes avanços no tratamento dos tumores estromais gastrointestinais (GIST) foram responsáveis pela mudança da história natural da doença. O melhor conhecimento dos mecanismos moleculares foi fundamental para o desenvolvimento de droga alvo-molecular dirigida capaz de obter resultados, até então, não alcançados em nenhum tratamento de tumor sólido. A introdução do imatinibe na prática clínica modificou não só a sobrevida dos portadores de GIST metastático, como também foi responsável por quebras de paradigmas bem estabelecidos; porém, apesar de o tratamento da doença metastática ser baseado na utilização do imatinibe, o papel do cirurgião, nesse contexto, tem sido revisado, havendo alguns indícios de que a cirurgia de resgate na doença metastática possa trazer benefícios a grupos selecionados de pacientes. Dessa forma, um novo conceito se estabelece, o da "cirurgia adjuvante"; ou seja, uma estratégia terapêutica que visa a otimizar os resultados do tratamento do GIST metastático.

Bilateral third-degree burn of the legs: lower limb salvage with dermal regenerative matrix

Third-degree burns of the lower extremities are among the most difficult burn injuries to treat as they frequently expose bone, tendons or articular surfaces. Coverage with a flap is the ideal treatment, but local tissue is often unavailable, and free flaps require sophisticated equipment and perfect microsurgical technique. We demonstrate a treatment option to obtain a stable cutaneous coverage for this kind of injury, consisting in an association of skin grafts, amniotic membrane and bilaminar dermal matrix templates. This combined treatment proved to be an excellent option to cover a wide area of tibial exposure with low donor site morbidity and good functional and aesthetic results. This shows that artificial dermis is a good alternative for treating bone exposure, especially in patients for whom a classic flap reconstruction is not suitable.

Analysis of brazilian paintings of the 20th century: Suspects and authentics through in situ and Non-Invasive techniques

This work studied suspicious and authentic artworks by Brazilian painters Ivan Serpa, Ismael Nery, and Iberê Camargo by XRF, FTIR, OM, and MA-XRF techniques. The studies made it possible to verify that all suspicious artworks are counterfeit artifacts. The analyses were conducted in situ, and different approaches were applied for data treatment. For example, principal component analysis and spectral deconvolution were performed on the XRF data. From these methods, it was possible to verify that the suspect artworks by Ivan Serpa and Iberê Camargo have different materiality than the authentic paintings. Additionally, MA-XRF images did not reveal the presence of a polychrome preparation layer in the suspicious paintings by Ivan Serpa. The suspect artworks from Ismael Nery exhibited a Ca-K/Ti-K ratio that indicates they were created on a low-quality paper support, which is not suitable for paintings. The differences in materials used in the suspicious and authentic artworks are further supported by the FTIR and OM results. In addition to the physicochemical analysis, the paintings were studies graphotechnical examinations, financial evaluations, and artistic analyses that demonstrated they were counterfeit artifacts. The results of the analysis demonstrate how physicochemical techniques can contribute to the forensic investigation of paintings. However, this work highlights the importance of applying distinct treatments to the XRF data in order to accentuate the differences between the suspect and authentic artworks.