Variations in the expression of TIMP1, TIMP2 and TIMP3 in cutaneous melanoma with regression and their possible function as prognostic predictors

Regression in melanoma is a frequent biological event of uncertain prognostic value as the lesion exhibits heterogeneous phenotypical features, both at the morphological and immunohistochemical level. In the present study, we examined the expression of tissue inhibitors of metalloproteinases (TIMP1, TIMP2 and TIMP3) in melanoma with regression. We specifically examined the expression levels of these TIMPs in regressed components (RC) and non-regressed components (NRC) of the tumor and compared their expression levels with those in non-regressed melanomas. We found that TIMP1 was overexpressed in the NRC of melanomas with partial regression (PR) compared with the NRC in melanomas with segmental regression (SR) (P=0.011). TIMP2 was overexpressed in the NRC of melanomas with PR compared with the NRC in melanomas with SR (PR/SR, P=0.009); or compared with the NRC in melanomas with simultaneous SR-PR (P=0.002); or compared with melanomas without regression (absence of regression) (P=0.037). Moreover, TIMP3 was overexpressed in the NRC of all melanomas with SR as compared to the RC component (P=0.007). Our findings on the differential expression of TIMP1, TIMP2 and TIMP3 in melanomas with regression support the hypothesis that the morphological differences identified in the melanoma regression spectrum may have a correlation with prognosis. This may explain the controversial findings within the literature concerning the biological and prognostic role of regression in melanoma.

A Comparison Of The Improving In Major Depressive Symptoms As Reported By Romanian Physicians And Patients In a Prospective, Multicenter, Observational Study

Introduction

Depression leads to substantial suffering for the patients, their families and becomes an economic burden for system [1,2]. Patients and clinicians tend to rate the remission differently [3].

Objectives and methods

We investigate if clinicians and patients rate different the treatment response. This study assed the evolution of major depressive episode (MDE) in patients treated with Agomelatine, in Romania. It was designed as a multicentre, observational study that included 1213 adult patients evaluated in 75 sites in 2014. The design included 3 visits (baseline (V1); visit at 2/3 weeks (V2); visit 6/8 weeks (V3)). The scales used were: MADRS, SHAPS, CGI-I, CGI-S, PGI-I, PGI-S.

Results

The MDE improvement was significant (P < 0.001) for all aspects evaluated. At baseline, more clinicians vs. patients considered the moderately or markedly ill as best descriptors of the state. The difference between the two assessments was even higher for V2 and V3. During V2 clinicians reported “minimally improvement” while patients reported “much improvement” in higher percentage. During V3, both, clinicians and patients reported a “very much improved” clinical status. Of the patients 42.60% reported at V3 “normal”, not at all ill’ in comparison to 34.81% of clinicians who reported the same (P < 0.001).

Conclusions

This could mean that patients are not aware of the severity of their disease. This data could be interpreted in the way that patients are more prone to rate higher the improvements as response to treatment and the clinicians to rate as response a more than 50% decrease of symptomatology.

References not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Spectrum of morphologic alterations of regression in cutaneous melanoma--potential for improving disease prognosis

INTRODUCTION

Regression occurs as a complex interaction between tumor cells and host's immune response; neither biologic mechanisms, nor regression prognostic significance are deciphered to date but promising anti-cancer vaccine strategies were thus developed.

METHODS

We analyzed 127 superficial spreading melanomas identifying melanoma with regression (segmentary (SR), partial (PR) and segmentary & partial (SR-PR)) or without regression (AR). Several histopathologic parameters were registered; statistical analysis was performed (level of significance P < 0.05).

RESULTS

Regression was present in 52% cases, less frequently in pT4 melanomas. Ulceration and vascular invasion were similarly present in pT2-pT4 melanomas with regression and significantly less in pT1 ones; their incidence increased with stage in AR (P < 0.001). SR and SR-PR melanomas showed significantly more tumor infiltrating lymphocytes within the non-regressed tumor than AR melanomas (P < 0.05). SR melanomas presented significantly less frequent mitoses than PR (P = 0.04), SR-PR (P = 0.04) or AR ones (P = 0.03). Marked inflammation and more numerous melanophages were present regressed areas advanced stage melanomas. More numerous plasma cells were identified in advanced stages; in SR and SR-PR melanomas less numerous plasma cells were present in pT1 than in advanced stages. Vascular hyperplasia was significantly higher in SR than SR-PR cases.

CONCLUSIONS

Differences in perception of regression might be the result of labeling with similar name of various processes comprising inflammation and tumor cells destruction; at least in thin melanomas, PR and SR seem to belong to different spectrum of alteration, SR bearing a more favorable potential. Further studies will be performed in order to further elucidate the mechanisms involved in regression in melanoma.

Neurobiological and somatic particularities at women with depressive disorder

Background

Depressive disorder at women associated important neurobiological (cortical atrophy) and somatic vulnerabilities. (metabolic syndrome, hypertension, coronary heart disease and diabetes mellitus associated with weight gain).

Methods

Retrospective study on 100 women patient lot, 36–55 years, hospitalized in Psychiatry Clinic of Craiova from January 1st 2007 to December 31st 2009. The inclusion criteria are: depressive disorder (HDS score 20–24), without somatic disorders. The final assessment was realized for this items: remission level (full, partially remission, persistent depression), cognitive impairment (MMSE), weight gain (+7.5 kg from baseline), somatic disorders.

For patients with cognitive impairment, persistence depression and weight gain we effectuated the psychostress evaluation and brain computer tomography.

Results

Full remission - 40% of patients; partially remission - 37%; persistence depression: 23% (HAD >18).

Cognitive impairment - MMSE < 25 - all the patients with persistence depression and 5 patients with partially remission, 72 patients does not have cognitive impairment.

Weight gain: >7kg from baseline - 45 patients.

Somatic disorders: hypertension: 32 patients; coronary heart disease: 27 patients; diabetes mellitus: 21 patients.

At patients with persistence depression, cognitive impairment and weight gain (12 patients) the CT revealed cortical atrophy, calcification of choroid plexus and ventricular enlargement.

All the patients had high scores on the Lloyd Stress Scale.

Conclusions

Weight gain and high scores for psychosocial stress can be in the future markers for the prediction of evolution risk in depression at women and is required the association of psychopharmacological treatment with psychokinetotherapeutic and psychotherapeutic methods for the decrease of psychostress.

Information of genome sequences and molecular basis of cancer

This survey paper presents in a widely accessible form a thermodynamical approach to cancerogenesis and its relevance and utility for molecular biologists; it also suggests a possible definition of information contained in genome and of entropy leaps during cell transformation. A scenario concerning the amplification of an initial alteration in the genomic information during cancerogenesis is proposed, and its implication in our knowledge about spatial and temporal pattern of oncogenes and suppressor genes cooperation during cancerogenesis is discussed.

Unilateral exophthalmos through non-Hodgkinian malignant lymphoma

A 57-year old male patient with unilateral exophthalmos was transferred to our hospital from an Ophthalmologic Clinic for suspicion of Graves' disease. Lateral skull X-ray showed the optic holes and orbits within normal limits. Orbital echography and CT scan revealed an intraorbital tumor which on histopathologic examination proved to be malignant lymphoma.

Effects of zinc-aspartate and zinc-glycinate in healthy rats and on reserpine-induced gastric lesions

Experimental studies performed on 227 rats showed that Zn-aspartate and Zn-glycinate administered ip lowered the incidence, number, and severity of the reserpine-induced gastric lesions ensuring significant protection indices. Histochemical methods revealed increased amount of mucosal glycoproteins. The activity of dehydrogenases involved in energy metabolism that modulates acid secretion in the parietal cells was depressed. RNA content in the chief cells, as premises of pepsinogen synthesis, was decreased. ATPase reaction in the periglandular capillaries was uniform and stronger, showing an improvement of gastric mucosal microcirculation. Since these histochemical changes were also noted in healthy rats receiving Zn salts, it might be suggested that they are not the mere expression of an anti-ulcer protective effect of zinc, but rather reflect its mechanism of action, relating to the complex metabolic events induced by the trace element. Our results are in agreement with those previously reported concerning the noxious influence of Zn depletion, the accelerated healing of peptic ulcer patients after Zn treatment, and the protective effect of Zn against ulcerogenesis in several experimental models involving different pathomechanisms.

Unusually large adrenal adenoma excreting unusually large amounts of androgen metabolites in urine

A 27-yr female patient was admitted to the hospital because of secondary amenorrhea and a severe and complex virilization syndrome. The urinary 17-Ks, 17 OHCS and testosterone glucuronide values were greatly increased. The plasma testosterone through very high, was within the normal limits in males (3.52 ng/ml). Urography, echography and CT scan revealed a large right adrenal tumor. Removal of the tumor brought about a considerable clinical improvement: reoccurrence of the menstrual cycle, a progressive decrease in the virilization syndrome and normalization of the urinary 17-Ks, 17-OHCS and of the plasma testosterone.

Circadian rhythm of beta-endorphin in the plasma of clinically healthy subjects and in patients with adrenocortical disorders

Immunoreactive beta-endorphin was determined in the plasma of 37 elderly subjects (73 +/- 7 years of age), in 3 young or young adult subjects without adrenal disease, in 4 women with clinical adrenogenital syndrome, in 1 man with Cushing's disease. Immunoreactive beta-endorphin in plasma was measured by radioimmunoassay in six samples of each subject collected at 4-hour intervals over a 24-hour span. The observation of a circadian rhythm in circulating immunoreactive beta-endorphin with highest values during the late night and early morning hours is extended to elderly subjects in the 8th decade. The beta-endorphin plasma concentrations in the few clinically healthy young adult subjects studied fell within the same range. The circadian variation of the group of elderly subjects was used as reference in the clinical evaluation of plasma beta-endorphin concentrations in patients with pituitary-adrenocortical disorders. The need for circadian rhythm qualified reference values is shown by the observation of the circadian variations of circulating immunoreactive beta-endorphins in the patients with adrenogenital syndrome and Cushing's disease in whom abnormalities in the concentration of circulating beta-endorphin were found at certain circadian stages but not at others.

Feminizing adrenal carcinoma

A 50-year old female patient was referred to our clinic. She had systolic-diastolic arterial hypertension, oedemas, physical asthenia, weight loss and a large tumor in the left hypochondrium. Hormone assay showed markedly high values of 17 OHCS, 17 KS and testosterone, and high values of estrogens. The tumor was diagnosed as functional adrenal carcinoma. Removal of the tumor and administration of OP'DDD led to the disappearance of all clinical symptoms and normalization of hormonal values.

Primary hyperparathyroidism associated with galactophorous ducts calcification

A 49-year-old woman at recent climacterium was admitted to our hospital for a dyspeptic-type symptomatology, weight loss, bone pain, moderate polyuric-polydipsic syndrome and in a marked astheno-depressive state. Paraclinical explorations revealed constant hypercalcemia with hypophosphoremia, calciuria, chronic renal failure in the polyuric phase with retention of nitric bases. X-ray films showed diffuse osteoporosis, right nephrocalcinosis and diffuse calcifications of the galactophorous ducts in both breasts. Computerized tomography revealed and surgery confirmed the presence of tumoral tissues on the anterior aspect of the trachea. Histopathologic examination revealed a parathyroid adenoma.

Plasma renin activity (PRA) and plasma aldosterone in the adrenal cortex hyperactivity. Studies on 50 hypertensive patients

The authors have studied on 50 patients hospitalized in the Adrenal Pathology unit of the Institute of Endocrinology, the etiopathogeny of arterial hypertension (AH) in hypercorticism and the therapeutic implications, arriving at the conclusion that in 20% of the cases AH was probably due to an increased activity of renin-angiotensin and in 47% to elevated levels of aldosterone. The authors hypothesize that AH in the remaining 30% of the hypercorticism cases in this study is due to other mineralocorticoids in excess and suggest that the treatment should be pathogenic and strictly individualized.

Studies of the reproduction function in hyper- and hypoadrenocorticism

The investigation was carried out on 66 patients with hypo- or hyperfunctional syndromes of adrenocorticism, hospitalized and treated by our team. The patients were grouped into 5 lots according to their diseases. Lot one consisted of 34 female patients with Cushing's syndrome, lot two of 10 males with Cushing's syndrome, lot three of 10 males with Addison's disease and lot four, of 6 females with androgenic hypercorticism. The morphofunctional disorders of reproduction were followed up clinically and by complex hormone assays, before and after treatment. The incidence of these disorders is very high, and the results of clinical observations and of laboratory data demonstrate that both the excess of adrenocortical hormones and the decrease in their circulating level have a negative influence on the reproduction function or represent a risk factor in cases of pregnancy. By the curative treatment of the adrenal cortex a preventive treatment of abortion and/or sterility is achieved.

The role of the renin-angiotensin system in arterial hypertension in hypercorticism

The authors have studied on 25 cases of hypercorticism, one of the mechanisms of producing arterial hypertension, the renin-angiotensin system. The study showed that in only 20% of the cases plasma renin activity was high whereas in the remaining 80% other mechanisms were responsible for the hypertension. In the cases in which the plasma activity of renin was high, by studying the changes in the value of electrolytes we were able to derive some understanding of the mechanism of action of the RA2A system. Thus, the literature data show that sometimes the excess of glucocorticoids causes hypertension by activating directly the RA2A system and concomitently inhibiting the renin-kalikrein system (RKKS) and PgS; at other times, the excess of glucocorticoids is exerted on the same renin-angiotensin system, but via ACTH and ADH, the electrolytes values being those that demonstrate the borrowed mechanism.

Mixed TSH- and HGH-secreting pituitary adenoma

A man aged 36 was found to have an invasive pituitary adenoma with evolutive acromegaly and hyperthyroidism and a high serum level of HGH and TSH, suggesting a tumoral production of HGH and TSH. The serum concentration of HGH was above 180 ng/ml; there was also an inappropriately high serum level of TSH, which failed to decrease following the triiodothyronine suppression test and did not increase after TRH (0.4 mg i.v.). In the tumoral tissue removed during pituitary surgery, the concentration of TSH was 1,267.2 microU/g and that of HGH was 1,158.6 micrograms/g, showing that the pituitary adenoma secreted both TSH and HGH.

The dyslipemic syndrome in acromegaly

The clinico-hormonal course of acromegaly and the presence of the hyperlipemic syndrome were studied in relation to age, sex, associated hypothyroidism, diabetes, obesity and cardiovascular and atherosclerotic complications in 43 acromegalic patients (18 males and 25 females) of which 6 had received no treatment and 37 had been submitted 2 - 13 years to conventional roentgentherapy (31 cases), 90Y (5 cases) and hypophysectomy (1 case). Hyperlipemia (HLP), present in 24 acromegalic patients (55.8% of the cases) unrelated to age, was more frequent in women (64% as against 44% in males) and correlated with the clinico-hormonal evolution (GH greater than 20 mg) (60% of the cases), and associated hypothyroidism (79%), obesity (42%) and diabetes (25%). Of the hyperlipemic acromegalic patients, 62% had cardiovascular and atherosclerotic complications. The results of the study point to the need for a hypoglucidic, hypolipidic and associated treatment for hypothyroidism, diabetes and obesity in the prophylaxis of acromegalic atherosclerosis.

Hypercorticism--a risk factor in arterial hypertension and atherosclerosis

The present work has attempted an analysis of the role hypercorticism as a risk factor in arterial hypertension and atherosclerosis. Our series consisted of 149 male and female patients of various ages. The incidence of cardiovascular disorders in relation to age and the glucidic lipidic metabolic disorders were also investigated. The results showed that hypercorticism may trigger in very young patients as well arterial hypertension (AH) and glucidic-lipid metabolic disorders both incriminated as risk factors in including atherosclerosis. Hypercorticism was proved to be an aggravating factor of pre-existing cardiopathy. Efficient management of adrenocortical hormones excess brings complete resolution of arterial hypertension and glucidic lipid metabolic disorders in young patients and most adult patients who had no cardiovascular complaints prior to the endocrine syndrome.