THE ROLE OF MARKERS OF SYSTEMIC INFLAMMATORY RESPONSE IN PATHOGENESIS OF THROMBOTIC COMPLICATIONS IN MALIGNANCY

Patients with malignancy have higher risk of developing venous thromboembolism. The incidence among different groups of cancer patients varies considerably depending on clinical factors, the most important being tumor entity and stage. The study was approved by the local ethics committee on human research, and written informed consent was obtained from all the study participants. After written informed consent was obtained, a precise medical history was taken, with particular attention to questions about the presence of thrombotic risk factors at the onset of VTE. We retrospectively enrolled 50 patients with Venous Thromboembolism (DVT and PTE) having malignancy and 50 healthy controls from January 2020 to December 2020. DVT were diagnosed using peripheral vascular duplex ultrasonography while PTE was confirmed in all cases by computed tomography. Patients having treatment with anticoagulant therapy, recent surgery less than 8 days previously, refusal or inability to give informed consent, and inability for ascending contrast venography or inadequate results of the venographic examination were excluded from the study. Biomarkers have been specifically investigated for their capacity of predicting venous thromboembolism (VTE) during the course of disease. The relationships between inflammation markers e.g., IL-6, IL-8 and CRP as indicators of the inflammatory process and clinical venous thromboembolism need to be investigated. We investigated IL-6, IL-8 and CRP in 50 patients with venous thromboembolism having malignancy and reported that patients having venous thromboembolism have increased levels of IL-6, IL-8 and CRP (p value < 0.05). Our study concluded that in cancer patients, inflammatory biomarkers play significant role in developing venous thromboembolism. This supports the hypothesis that, markers of systemic inflammatory response are involved in development of thromboembolism in patients with malignancy.

Treatment of Massive Bladder Hemorrhage of Cancerous Etiology Using Selective Embolization

Background: Massive and intractable bladder hemorrhage of cancerous etiology are very dangerous and directly life-threatening. Its treatment is very difficult and complicated because of the severity of bladder tumor and the general poor condition of the patient which does not enable a radical surgical treatment. Aim: To evaluate the efficiency of the treatment of massive bladder hemorrhage of cancerous etiology using internal iliac artery selective embolization of anterior division. Methods: From January 2006 through June 2015, 23 patients (17 male and 6 female) were admitted to Urology Department as a matter of urgency because of massive bladder hemorrhage of cancerous etiology secondary to muscle-invasive bladder cancer (MIBC) - 14 patients, rectal cancer (RC) with invading bladder - 2 patients, bowel cancer with invading bladder - 2 patients, prostate cancer (PC) with invading bladder - 3 patients and cervical cancer with invading bladder - 2 patients ( Fig 1 ). The mean age of patients was 63.5 (range 37-80). In all patients, internal iliac artery selective embolization of anterior division was performed. The baseline mean hematocrit level during admission of patients to hospital was 23%, after embolization - 27.5%. In 14 patients it was necessary a mean of 6 transfusion units of packed red blood cells (PRBCs), range 2-16 transfusion units of PRBCs. 6 patients also required a mean of 8 transfusion units of fresh frozen plasma (FFP), range 2-27 transfusion units of FFP. Results: In 20 (86.96%) patients, therapeutic success was achieved after the first procedure. In 3 (13.04%) patients who developed hematuria after 12-38 days from the first endovascular procedure, the next successful embolization was performed bilaterally. It was not developed any major complications after embolization. Conclusion: Embolization of internal iliac artery is considered as a highly effective and minimally invasive method in case of massive bladder hemorrhage of cancerous etiology.[Figure: see text]

Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition

Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.

Molecular detection and phylogenetic relationship of wild-type strains of canine distemper virus in symptomatic dogs from Uberlândia, Minas Gerais

This study investigated the occurrence of canine distemper virus (CDV) by evaluating the presence of viral RNA within urine samples of dogs from Uberlândia, MG, with clinical manifestations suggestive of infection by CDV by targeting the CDV N gene. Of the clinical samples collected ( n =33), CDV viruria was detected in 45.5%. Five dogs died spontaneously; all had characteristic CDV-associated histopathological alterations and demonstrated CDV viruria. Statistical analyses revealed that the age, gender, breed, or the organ system of the dog affected had no influence on the occurrence of canine distemper. Myoclonus and motor incoordination were the most significant neurological manifestations observed. A direct association was observed between keratoconjunctivitis and dogs with CDV viruria. These findings suggest that CDV viruria in symptomatic dogs might not be age related, and that symptomatic dogs can demonstrate clinical manifestations attributed to CDV without viruria identified by RT-PCR. Additionally, the results of the sequence identities analysed have suggested that all Brazilian wild-type strains of CDV currently identified are closely related and probably originated from the same lineage of CDV. Nevertheless, phylogenetic analyses suggest that there are different clusters of wild-type strains of CDV circulating within urban canine populations in Brazil.

Serum TRAIL levels in patients with epithelial ovarian cancer or primary peritoneal cancer treated with neoadjuvant chemotherapy. A pilot study

AIMS

The study attempted to evaluate the kinetics of changes in serum TRAIL levels as a potential predictive and prognostic factor in patients with epithelial ovarian cancer (EOC) or primary peritoneal carcinoma (PPC), eligible for an interval debulking surgery (IDS).

MATERIAL AND METHODS

17 patients with primary inoperable EOC or PPC in FIGO Stage IIIC or IV who underwent an exploratory operation were enrolled to the study. Serum TRAIL levels were determined by ELISA method (DIACLONE, Besancon Cedex, France) before and after two courses of neoadjuvant chemotherapy (NAC) based on paclitaxel and platinum analogue (cisplatin or carboplatin). The control group consisted of six healthy volunteers. The median difference in concentration of TRAIL (dTRAIL) between the initial marking and after two courses of NAC in each patient was 192 pg/ml and it was used for dichotomization of the test group.

RESULTS

Suboptimal interval debulking surgery (IDS) was performed in 23.5% (4/17) and optimal IDS in 76.5% (13/17) patients. TRAIL concentration before chemotherapy did not differ significantly between patients with EOC or PPC [1426.96 +/- 321.06 pg/ml (mean +/- SD) (U = 26, p = 0.08)] and the control group [1160.40 +/- 256.39 pg/ml (mean +/- SD. After two courses of NAC serum TRAIL concentration level was 1247.49 +/- 378.46 pg/ml (mean +/- SD). The difference was significant (Z = 2.44, p = 0.0147). Statistical analysis showed that dTRAIL did not significantly influence either extent of IDS (U = 35, p = 0.0962) or time to progression (log-rank test, p = 0.1185), overall survival (log-rank test, p = 0.1973) and response to treatment according to RECIST criteria (U = 35.5, p = 0.9616).

CONCLUSIONS

Serum TRAIL concentration levels changed significantly during NAC. However, it seems that the concentration of this protein has no critical value as a predictive or prognostic factor in patients with EOC or PPC.

Tau expression as a predictive marker in ovarian cancer patients (pts) treated with platinum/paclitaxel chemotherapy

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Background: Ovarian cancer is the most lethal gynecologic cancer and its standard treatment consists of cytoreductive surgery followed by paclitaxel/platinum-based chemotherapy. Additional prognostic biomarkers may allow for more tailored chemotherapy and an improved outcome. Recently, microtubule associated protein tau was identified as a marker of response to paclitaxel in breast cancer. Its predictive value in ovarian cancer has not been established. We evaluated the relevance of tau expression in ovarian cancer. Methods: Tissue specimens were obtained from 74 ovarian cancer patients (stage I-IV) who underwent cytoreductive surgery followed by standard paclitaxel/platinum (cisplatin or carboplatin) chemotherapy. Tau expression was determined by immunohistochemistry using semiquantitative DAKO test. Statistical analysis included long rank test and Mann Whitney test. Results: Median age of pts was 54 years (range 31–73). 25.7% and 74.3% of the pts were classified as tau-negative and tau-positive, respectively. In the univariate analysis 2-year progression free survival in tau-negative and tau-positive groups was 75.0% and 30.6%, respectively (p = 0.0153). This relationship was confirmed in the multivariate analysis including age, disease stage, histology type, and grade (HR 2.68; 95%CI [1.13–6.37]; p = 0.0255). Among the 46 pts with measurable disease, overall response rate in tau-negative and tau-positive groups was 90.9 and 54.5%, respectively (p = 0.0299, Z = 2.17). Conclusions: Tau protein expression seems to be a strong predictor of clinical outcome in ovarian cancer pts applied paclitaxel/platinum-based chemotherapy.

No significant financial relationships to disclose.

Cystatin C, an additional marker of ovarian cancer extent: A pilot study

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Background: Cystatin C is a cysteine protease inhibitor which has been recommended as the marker of glomerular filtration rate (GFR). We investigated significance of cystatin C in relation to ovarian cancer extent and its feasibility in assessment of renal function in patient with ovarian cancer (OC) who underwent chemotherapy. Methods: We prospectively included consecutive patients with OC who underwent chemotherapy : cisplatin 75 mg/m2 plus 24-hour infusion of paclitaxel 135 mg/m2 every three week after surgery. Before chemotherapy serum renal markers were noted as: creatinine (Cr), cystatin C (Cys C), albumin, creatinine clearance (ClCr) calculated by using 24-hour urine collection per 1.73 m2, creatinine clearance estimated with formulas Cocroft- Gault (ClCG) and Modification of Renal Disease (MDRD1), respectively. Results: Between February 2003 and January 2006 37 patients were enrolled onto this study. Median age 54 year (range from 28 to 68). Cystatin C and CrCl weakly correlated (R Spearman= -0.36; p=0,03). There were no correlation between cystatin C and other markers of GFR (serum creatinine, ClCG, MDRD1). We showed correlation between cystatin C and tumor extent revealed by spiral CT- scan (> 1 cm diameter) after surgery (R Spearman= 0.4; p=0.01), and CA 125 (R Spearman= 0.4, p=0.03). Cut-off values were established as medians for both factors, and patients with high and low values had no statistical differences in overall survival (log- rank test, p=0.9). Conclusions: We believe that cystatin C could imply OC extent in patients.This factor weakly was correlated with CrCl, and no correlated with other GFR parameters.

No significant financial relationships to disclose.

Topotecan therapy as salvage in heavily pretreated ovarian cancer patients (hpocp)

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Background: Topotecan is utilized as to a second-line chemotherapy agent in ovarian cancer. The third or more line of chemotherapy is possibly to use against ovarian cancer which is chemosensitive even when this malignancy progressed. Methods: Prior chemotherapy with platinum compounds, paclitaxel, doxorubicin was used. Topotecan was given as 30-minute infusion at the dose of 1.5 mg/m2 through 5 consecutive days every 21 days. Toxicity profile was assessed according to NCI CTC and response was measured while met RECIST and CA-125 criteria described by Rustin et al. Results: Between 2001 and 2005, 22 hpocop were enrolled onto the study and received at least two cycles of topotecan salvage, median 6 (range 2–6). The patients were previously treated with chemotherapy and characterised 37% (8/22) as platinum-sensitive, 9% (2/22) as partial platinum- sensitive, 27% (6/22) as platinum-resistant and 27% (6/22) as platinum-refractory. Twenty hpocp of the total number of 22 were monitored after chemotherapy through fulfilling RECIST criteria: 7/20 (35%) -PR, 7/20 (35%)-NC, 8/20 (40%)-PD. The clinical response rate in 20 patients with assessable CA 125 levels was 30% (6/20) with 75% response, and 15% (3/20) with 50% response by Rustin et al. criteria. Time to progression of ovarian cancer was median 5,0 months, SD ± 2.0 (range from 2 to 7) and median survival 8 months, SD ± 21 (range from 2 to 39). Toxicity profile was recorded as following: neutropenia 3/4th grade in 8/22 (36%), anaemia 3/4th grade in 9/22 (41%), thrombocytopenia 4th grade in 6/22 (27%), and non-hematologic toxicity relied on alopecia 7/22 (32%). We have not observed fatal outcome after topo salvage therapy. Conclusions: Topotecan could be involved in therapy of patients with ovarian cancer previously heavily pretreated. It offers clinical benefits in ovarian cancer course as to be a stabilised disease despite prior chemotherapy but reliable management alleviates hematologic toxicity.

No significant financial relationships to disclose.

An on-board TLD system for dose monitoring on the International Space Station

This institute has developed and manufactured a series of thermoluminescence dosemeter (TLD) systems for spacecraft, consisting of a set of bulb dosemeters and a small, compact, TLD reader suitable for on-board evaluation of the dosemeters. By means of such a system highly accurate measurements were carried out on board the Salyut-6, -7 and Mir Space Stations as well as on the Space Shuttle. A new implementation of the system will be placed on several segments of the ISS as the contribution of Hungary to this intemational enterprise. The well proven CaSO4:Dy dosemeters will be used for routine dosimetry of the astronauts and in biological experiments. The mean LET value will be measured by LiF dosemeters while doses caused by neutrons are planned to be determined by 6LiF/7LiF dosemeter pairs and moderators. A detailed description of the system is given.