Deep Learning Based Prognostic Prediction in Oropharyngeal Cancer Patients Using Multiparametric MRI Inputs

PURPOSE/OBJECTIVE(S)

While prognostic outcomes for oropharyngeal cancer (OPC) patients have improved in recent years, patients still face a non-negligible risk of disease recurrence or death. Accurately predicting post-therapy prognosis would be highly valuable for risk stratification and treatment guidance for OPC patients. Recent studies using PET/CT data have demonstrated the effectiveness of large-scale, end-to-end image-based deep learning (DL) models for predicting progression-free survival (PFS) in OPC patients. Multiparametric MRI (mpMRI), which combines anatomical and functional MRI sequences, has the potential to offer similar results, and has the added advantage of high-frequency longitudinal imaging capabilities, such as through MR-Linac devices. Therefore, this study aimed to develop a DL model using mpMRI data to predict PFS, and to evaluate the impact of anatomical and functional input channels on model performance.

MATERIALS/METHODS

From a large-scale head and neck cancer database at MD Anderson Cancer Center, treatment-naïve OPC patients with available pre-radiotherapy mpMRI imaging were selected for this study. mpMRI images used for this study included T2-weighted images (T2) and apparent diffusion coefficient (ADC) maps. PFS event status was defined as having either a local, regional, or distant failure, and/or death; data were right censored if an event had not occurred. Images were resampled to the T2 resolution, normalized to a [-1,1] scale, and cropped to the field of view of the ADC image for use in DL models. A DL convolutional neural network model based on the DenseNet121 architecture from the Medical Open Network for AI (MONAI) Python package using a negative log-likelihood loss function was implemented. The model used mpMRI images as input channels and 20 output channels representing the different time intervals of the predicted PFS conditional probabilities of surviving that time interval; final PFS in days was obtained by summing the cumulative probability of surviving each interval times the interval duration. A 5-fold cross validation approach was used for model training and evaluation. Separate models using only T2, only ADC, and T2 + ADC channel inputs were compared. Model performance was measured using the C-index.

RESULTS

Out of 1154 patients, 404 met inclusion criteria. The overall PFS event rate was 16%. Median C-index values from the 5-fold cross validation were 0.62, 0.67, and 0.69 for the ADC, T2, and T2+ADC models, respectively.

CONCLUSION

Using large-scale datasets and open-source DL implementations, we find that OPC PFS prediction models using mpMRI data yield modest but comparable performance to existing models (i.e., state-of-the-art reference performance using PET/CT). Moreover, combining mpMRI channels may increase the performance of models for OPC prognostic prediction. Future work will involve integration of additional timepoints, additional mpMRI images, clinical variables, and saliency maps.

Multi-Specialty Physician Performance in Predicting Radiographic Extranodal Extension in Nodal Metastases of Oropharyngeal Squamous Carcinoma

PURPOSE/OBJECTIVE(S)

The presence of extranodal extension (ENE) in oropharyngeal (OPC) cancer patients is an important prognostic factor and can be used to determine the optimal course of treatment; however, currently, the gold standard method for ENE assessment is performed pathologically, which can only be done in a post-hoc fashion after surgical treatment has already been performed. Anatomic imaging features are being explored as a possible method for the pre-therapeutic determination of ENE, but there is currently no objective standard for the assessment of ENE from radiographic images. In this study we recruited expert clinicians, including surgeons, radiation oncologists, and radiologists, across multiple institutions to individually evaluate the presence of ENE from CT scans in order to assess the performance of radiographic ENE evaluation in human experts across different specialties.

MATERIALS/METHODS

Pre-therapy contrast-enhanced CT scans were collected from 25 OPC patients with lymph node metastasis that were pathologically evaluated for ENE after surgical resection. 5 scans were randomly chosen to be duplicated and left/right inverted, resulting in a total of 30 scans of which 21 had pathologically-confirmed ENE. To hide the inversion, all images were cropped to only show the oropharynx region. 34 expert head and neck cancer physicians, comprised of 12 surgeons, 11 radiation oncologists, and 11 radiologists, then separately evaluated the 30 CT scans using 3D Slicer for ENE presence or absence with their prediction confidence. For each physician, discriminative performance metrics were measured by calculating the accuracy, sensitivity, specificity, area under the receiver-operating characteristic curve (AUC), and Brier score, a measure of the probabilistic prediction accuracy calculated from their confidence where a lower Brier score is better. Statistical tests were performed using the Mann Whitney U test.

RESULTS

The median (interquartile) study results are shown in Table 1. There was no statistically significant difference among groups for accuracy or AUC, but significant differences among groups for Brier score, sensitivity, and specificity.

CONCLUSION

In this study we provide evidence that expert physicians, regardless of specialty, show poor performance in assessing the presence of ENE from CT scans in OPC patients. These results agree with conclusions from previous literature, and suggest the need for further research in the automated analysis of radiographic ENE.

Simvastatin in an experimental spinal cord injury model: a histopathological and biochemical evidence based study

AIM

In this study we tried to determine the possible neuroprotective effects of simvastatin in a rat model of Spinal Cord Injury (SCI) with the help of biochemical and histopathological tests.

METHODS

Rats were divided into 5 groups:1) SCI control, 2) Sham operated, 3) SCI with 10 mg/kg intraperitoneal simvastatin, 4) SCI with 10 mg/kg oral simvastatin, 5) SCI with 10 mg/kg subcutaneous simvastatin. After the treatment period, all rats were sacrificed; their blood and spinal cord samples were taken for biochemical and histopathological assessment.

RESULTS

When the groups were compared in terms of oedema and inflammation status, the scores of groups receiving simvastatin were better than the control and sham groups (p = 0.001 and p = 0.038 respectively). When the 3 treatment groups (oral, intraperitoneal and subcutaneous simvastatin groups) were compared with each other in terms of inflammation, haemorrhage and oedema, there were no significant differences between groups (p = 0.112, p = 0.797 and p = 0.188, respectively). NSE and S100B levels were significantly lower in the treatment groups compared to the sham group (p = 0.039 and p = 0.004 respectively).

CONCLUSION

According to our biochemical and histopathological findings, simvastatin 10 mg/kg has a positive impact in the spinal cord injury model in rats, regardless of route of application (Tab. 1, Fig. 5, Ref. 26).

A randomized study to evaluate post-dural puncture headache after cesarean section: Comparison with median and paramedian approaches

Background

Although the most popular anesthesia technique for cesarean is spinal anesthesia, its most common complication is post-dural puncture headache (PDPH).

Aim

We aimed to determine the effect of median and paramedian approaches during spinal anesthesia on PDPH in patients undergoing cesarean section.

Subjects and Methods

200 pregnant women between the ages of 19-45 years, ASA physical status II, scheduled to undergo elective cesarean section under spinal anesthesia, were studied. The patients were randomized into two groups: Group M; (n = 100) spinal anesthesia with the median approach, Group PM; (n = 100) spinal anesthesia with paramedian approach. The patients were questioned for the possible occurrence of PDPH on the first, third and seventh postoperative days. A telephone follow-up call was used if the hospital stay was shorter than seven days. Post-dural puncture headache was evaluated according to the International Classification of Headache Disorders (ICHD-III) diagnostic criteria. Normally distributed data were summarized using mean and standard deviation. Skewed data were summarized using median (range).

Results

A total of 200 patients completed the study. There were no statistically different between the groups by comparing the incidence and characteristics of PDPH (32% vs. 28%, P = 0.548). Most patients rated their pain intensity during PDPH as mild to moderate in both groups (p = 0.721). PDPH onset time was 2 (1-4) days in Group PM versus 3 (1-7) days in Group M (p = 0.173). No patient needed for epidural blood patch in both groups.

Conclusions

Spinal anesthesia with a median or paramedian approach at cesarean section has no effect on the incidence of PDPH, but we believe that there has been a need for further studies with larger or different patient populations.

Prognostic importance of 18F-fluorodeoxyglucose uptake by positron emission tomography for stage III non-small cell lung cancer treated with definitive chemoradiotherapy

OBJECTIVES

Survival heterogeneity exists among patients with non-small cell lung cancer (NSCLC), even within the same stage. We aimed to evaluate the prognostic role of pre-treatment maximum standardized uptake value (SUV_max) in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC.

MATERIALS AND METHODS

Between 2010 and 2017, 103 patients with stage III NSCLC who underwent ¹⁸F-FDG PET/CT at the time of diagnosis were included in the study.

RESULTS

Higher tumor stages were correlated with higher pre-treatment SUV_max of lymph nodes (LNs) (p=0.005) but were not correlated with higher SUV_max of primary tumor (p=0.2). The median SUV_max of LNs was 2.84, 8.06, and 11.11 in stage IIIa, IIIb and IIIc, respectively. Higher nodal stage was also correlated with higher SUV_max of LNs (p=0.01). According to ROC analysis, there was no significant cut-off value of SUV_max observed for primary tumor, therefore continuous variables were used for survival analyses. The best SUV_max cut-off was 3.5 for the LNs, therefore the SUV_max of LNs was evaluated as both a dichotomous and a continuous variable. Pre-treatment SUV_max of primary tumor did not predict survival outcomes but both the continuous and dichotomous variables of SUV_max of LNs predicted recurrence free survival and overall survival. Nodal stage (N0-2 vs. N3) and AJCC stage (IIIa vs IIIb vs. IIIc) were the other prognostic factors.

CONCLUSIONS

Pre-treatment SUV_max of LNs had prognostic value in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. In future trials, pre-treatment SUV_max of the LNs would serve as a guide for patients who might benefit from more aggressive treatments.

Selection of ideal pterygoid osteotome: A preliminary study

Background

Pterygomaxillary separation is the most critical step of Le Fort I osteotomy. Nonideal separation of pterygomaxillary junction could be associated with many complications. The purpose of this study was to evaluate the anatomic basis of proper pterygoid osteotome in Le Fort I surgery.

Materials and Methods

The cone beam computed tomography image of 177 patients were evaluated retrospectively. To design an ideal osteotomy, the angle and the length of the posterior curvature of the maxillary sinus wall were measured. For the classification of the posterior angle as low, medium, and high, the category was based on upper and lower groups consisting of 27%, where the measurement and representability are at the maximum level.

Results

The mean posterior length of three angle groups was as follows: low group: 7.81 mm, medium group: 7.54 mm, and high group: 7.41 mm. The differences were not statistically significant (P > 0.05). In addition, the posterior angle and length were evaluated according to the gender and the sides, and no statistically significant difference was found. (P > 0.05).

Conclusion

Ideal osteotomy technique for pterygomaxillary disjunction and the avoidance of related complications could be achieved by selecting patient-specific osteotome using radiographic assessment.

Removal of the residual root and implant therapy simultaneously via bone lid approach

Residual root fragments in posterior mandibula after extraction are often rarely seen. Implant treatment presumes that implants are placed in bone, without any contact with root. At ankylosed teeth, complete root removal is often invasive; subsequently, the sites require additional augmentation procedures to complete the treatment. Different techniques can be used for removal of these residual root fragments. To our knowledge, there are no study in the literature to provide the extraction of the root fragment using bone lid technique and achieve implant rehabilitation at the same time. The aim of the present study is to reduce bone loss during the residual root extraction for implant therapy. The bone lid approach is an easy and safety technique that could be performed to remove the residual root fragment and achieve implant rehabilitation at the same time. Future studies involving long-term follow-up are needed to evaluate the permanence of these results.

Factors Affecting Operative Time Intervals for Lower Limb Arthroplasties - Correlation with Total Operative Time

PURPOSE OF THE STUDY The aim of this study is to evaluate the operative time intervals for major orthopaedic surgeries and analyze the correlation of different operative factors on total operative time. MATERIAL AND METHODS Specific time intervals; anesthesia release time (ART), surgical preparation time (SPT), operative procedure time (OPT), and anesthesia end time (AET); were recorded by independent observers. Total operative procedure time (TOPT), was also calculated and statisctical correlation analysis was performed between TOPT and study parameters. RESULTS The difference for ART and SPT time intervals between age groups below 65 and 65 to 85 years were found statistically significant. As the patient's age increased, ART and SPT time intervals were also significantly increased. As the patients ASA status increased, the ART intervals were also increased. ART and AET time intervals were significantly longer for residents compared to specialists. DISCUSSION This is one of the first studies in the literature analyzing different time intervals and their correlation on total operative time for major orthopaedic surgeries. Current study also analyzed the effects of other factors including age and ASA score of the patients, type of anesthesia and experience of anesthegiogist on operative time intervals. This study was designed for the analysis of specific time intervals previously described in the literature for only some major orthopaedic surgeries. By this way, we aimed to achieve a homogenous study group and to obtain comparable results with the literature. CONCLUSIONS The strongest correlation was found between ART and TOPT. As the patient's age increased, ART and SPT time intervals were also significantly increased. Increased age and higher ASA scores with an unexperienced anesthegiologist significantly increased the ART intervals. Therefore, reducing ART is the most important factor in reducing TOPT. Key words:arthroplasty, anaesthesia, operation time.

Lateralization of Squamous Cell Carcinomas in the Head-Neck Region

Earlier studies have shown the lateralization of several immune disorders, including herpes zoster infection and breast cancer. We investigated whether there is lateralization of squamous cell carcinomas in the head-neck region and a relation of handedness with this cancer. Analysis showed right-sided lateralization of head-heck cancers in right-handed patients and vice versa in left-handed ones and a higher rate of left-handedness in patients with squamous cell cancer. Associations among left-handedness, squamous cell carcinoma, and its lateralization may result from a genetic togetherness.

Does hyperbaric oxygen therapy reduce the effects of ischemia on colonic anastomosis in laparoscopic colon resection?

BACKGROUND

An increase in intra-abdominal pressure causes a decrease in the splanchnic blood flow and the intramucosal pH of the bowel, as well as increasing the risk of ischemia in the colon. The aim of the present study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the ischemia caused by laparoscopy in colonic anastomosis in an experimental model of laparoscopic colonic surgery.

MATERIALS AND METHODS

We divided 30 male Wistar albino rats into three groups: Group A was the control (open colon anastomosis); Group B received LCA (laparoscopic colon anastomosis); while Group C received both LCA and HBOT. Each group contained ten animals. We placed Group C (LCA and HBOT) in an experimental hyperbaric chamber into which we administered pure oxygen at 2.1 atmospheres absolute 100% oxygen for 60 min for ten consecutive days.

RESULTS

The anastomotic bursting pressure value was found to be higher in the open surgery group (226 ± 8.8) (Group A). The result for Group C (213 ± 27), which received HBOT, was better than that for Group B (197 ± 27). However, there was no statistically significant difference between Group B and Group C. Group A showed better healing than the other groups, while significant differences in the fibroblast proliferation scores were found between Groups A and B. In terms of tissue hydroxyproline levels, a significant difference was found between Groups A and B and between Groups A and C, but not between Groups B and C.

CONCLUSIONS

HBOT increases the oxygen level in the injured tissue. Although HBOT might offer several advantages, it had only a limited effect on the healing of colonic anastomosis in rats with increased intra-abdominal pressure in our study.

KEY WORDS

Anastomosis, Colon, Hyperbaric Oxygen Treatment, Oxidative Stress.

Ultrasound-guided intrauterine insemination versus blind intrauterine insemination: a randomized controlled trial

PURPOSE

This study was performed to determine the effects of ultrasound (US) guidance during intrauterine insemination (IUI) on pregnancy rate.

MATERIALS AND METHODS

This study is a prospective randomized controlled trial which was performed in Women's Health Research and Education Hospital, Infertility Unit. The study enrolled 130 couples who were scheduled to undergo IUI. The couples were randomized according to a computer-generated list into two groups; 1) the ultrasound-guided IUI group included 64 couples (n = 64) treated for 99 cycles 2) blind IUI group included 66 couples (n = 66) treated for 104 cycles. All women underwent controlled ovarian stimulation before IUI. The study's main measurements were pregnancy rate per cycle; pregnancy rate per woman.

RESULTS

The pregnancy rates were similar in both the ultrasound-guided (USG) (16.2%, 16/99) and non-ultrasound-guided (NUSG)(12.5%, 13/104) groups (p = 0.386).

CONCLUSIONS

The present results suggest a routine ultrasound guidance during IUI is not essential as it does not increase pregnancy rates but it can be used in such cases to overwhelm some sort of difficulties.

Metatarsal transfer for the treatment of post-axial metatarsal-type foot synpolydactyly: a new technique that allows for comfortable shoe wearing

We analysed the clinical and radiological outcomes of a new surgical technique for the treatment of heterozygote post-axial metatarsal-type foot synpolydactyly with HOX-D13 genetic mutations with a mean follow-up of 30.9 months (24 to 42). A total of 57 feet in 36 patients (mean age 6.8 years (2 to 16)) were treated with this new technique, which transfers the distal part of the duplicated fourth metatarsal to the proximal part of the fifth metatarsal. Clinical and radiological assessments were undertaken pre- and post-operatively and any complications were recorded. Final outcomes were evaluated according to the methods described by Phelps and Grogan. Forefoot width was reduced and the lengths of the all reconstructed toes were maintained after surgery. Union was achieved for all the metatarsal osteotomies without any angular deformities. Outcomes at the final assessment were excellent in 51 feet (89%) and good in six (11%). This newly described surgical technique provides for painless, comfortable shoe-wearing after a single, easy-to-perform operation with good clinical, radiological and functional outcomes.

Circulating resistin is elevated in patients with non-alcoholic fatty liver disease and is associated with steatosis, portal inflammation, insulin resistance and nonalcoholic steatohepatitis scores

AIM

We aimed to investigate the association between serum levels of resistin and the biochemical and histological features of patients with nonalcoholic fatty liver disease (NAFLD) to determine the usefulness of this relationship in the clinical practice.

METHODS

A total of 97 patients with NAFLD and 66 age- and sex-matched healthy controls were recruited. Detailed epidemiological, anthropometric and laboratory data were recorded. Serum levels of resistin were measured with ELISA.

RESULTS

Serum levels of resistin were significantly higher in patients with NAFLD (32.10±10.0 ng/mL and 26.57±13.60 ng/mL, respectively) compared with healthy controls (P=0.003). Serum resistin levels were associated with AST, ALT, HOMA-IR, histological steatosis, portal inflammation and nonalcoholic steatohepatitis (NASH) scores. The serum levels of resistin were significantly higher in patients with definite NASH compared to patients with simple steatosis (29±13 and 20±10 ng/mL, respectively, P=0.03). There was no association between the serum resistin levels and the liver fibrosis stages.

CONCLUSION

Our data suggest that resistin levels are elevated in patients with NAFLD and could discriminate simple steatosis from definite NASH.

Single high dose atorvastatin does not ameliorate endothelial function and large arterial stiffness in dyslipidemic patients without atherosclerosis

BACKGROUND

Many studies show that statins have beneficial effects on atherosclerotic risk factors and markers such as flow mediated dilatation (FMD). However, studies on early effects of statins on endothelial function of non atherosclerotic humans are limited.

AIM

The purpose of this study was to determine whether a single high dose of atorvastatin could improve endothelial function and large arterial stiffness in statin naive dyslipidemic non-atherosclerotic patients.

MATERIALS AND METHODS

Thirty statin naïve dyslipidemic non-atherosclerotic patients from Cardiology Outpatient Clinic were enrolled. Arterial stiffness and endothelial function of patients were evaluated by assessing the finger photoplethysmography and the flow-mediated dilatation (FMD) of the brachial artery before and 24 hour after oral administration of 80 mg atorvastatin.

RESULTS

Stiffness indices and FMD 24 hours after administration of 80mg atorvastatin did not differ from baseline measurements (6.89 +/- 1.90 vs. 7.06 +/- 2.37 p : NS and 9.13 +/- 6.07 vs. 9.80 +/- 6.34 p : NS).

CONCLUSIONS

Although it is widely accepted that statins improve endothelial function, evidences of early effect might largely be associated with endothelial injury. Our study suggests that beneficial early effects of statins might not be applicable to patients without atherosclerosis.

Plasma fibrinogen-like protein 2 levels in patients with non-alcoholic fatty liver disease

BACKGROUND/AIMS

Fibrinogen-like protein 2 (fgl2), has recently been identified as a new member of the fibrinogen-like family of proteins. In this study we assayed plasma levels of fgl2 in patients with biopsy proven non-alcoholic fatty liver disease (NAFLD) and examined their association with clinical, biochemical and histological phenotypes.

METHODOLOGY

Levels of plasma fgl2 were measured by enzyme linked immunosorbent assay and compared between the study groups. Moreover, concentrations of fgl2 were assessed in relation to the general characteristics of the study participants and the results of the liver biopsy.

RESULTS

Levels of fgl2 were significantly higher in patients with definite non-alcoholic steatohepatitis (NASH) (788±190pg/mL, p<0.001) and borderline NASH (710 ± 140pg/mL, p<0.001) compared with controls (515±174pg/mL). No significant differences were found in patients with simple steatosis (649 ± 162pg/mL) as compared with controls. There were no associations between the plasma fgl2 levels with the fibrosis stage and steatosis grade.

CONCLUSIONS

Although subject to future confirmation, our data suggest that fgl2 levels are elevated in the more severe forms of NAFLD.

Investigation of a possible relationship between EPHX1 gene polymorphisms and colorectal cancer in Turkish society

Metabolism of chemical carcinogens, including their activation and detoxification, plays a key role in carcinogenesis. Microsomal epoxide hydrolase (EPHX1) has an important role in the metabolism of polycyclic aromatic hydrocarbons and detoxification of procarcinogens. The aim of this study was to investigate the association between colorectal cancer (CRC) development and EPHX1 gene polymorphisms. We investigated the polymorphisms in exon 3 (T>C, Tyr113His) and exon 4 (A>G, His139Arg) of the EPHX1 gene in 68 CRC patients and 116 controls by polymerase chain reaction-restriction fragment length polymorphism. The frequencies of the Try113Try, Try113His, and His113His for EPHX1 exon 3 were 37.9%, 55.2%, and 6.9% in controls and 39.7%, 42.6%, and 17.6% in CRC patients, respectively. Frequencies of EPHX1 exon 4 genotypes were 62.1% His139His, 37.9% His139Arg, and 0% Arg139Arg in the control group and 76.5% His139His, 22.1% His139Arg, and 1.5% Arg139Arg in the patient group. Individuals carrying the EPHX1 exon 3 His113His genotype had a 2.5-fold increased risk (p=0.024), and those carrying the EPHX1 exon 4 His139Arg genotype had decreased risk of CRC compared with controls (p=0.019). Even though exon 3 Tyr113His and exon 4 His139Arg polymorphisms for EPHX1 gene appear to be important factors for CRC risk, further investigations with larger study groups are needed to fully elucidate the role of these polymorphisms in the development of CRC.

Simple calcaneal bone cysts: a pilot study comparing open versus endoscopic curettage and grafting

This pilot study analysed the outcome of open versus endoscopic curettage and bone grafting for the treatment of simple calcaneal bone cysts. A total of 26 patients were evaluated into two equal groups: group 1 was treated with traditional open curettage and bone grafting and group 2 was treated with endoscopic curettage and percutaneous bone grafting. Cyst size, operating time, length of stay, time to healing, complications, further surgery and radiological healing were recorded and differences were statistically compared. The mean age of the patients was 22.9 years (18 to 28) and the mean follow-up was 28.7 months (24 to 36). There were no statistically significant differences in regard to age of patients, cyst size and the follow-up periods in the two groups. The operating time and mean length of stay of group 2 patients was significantly shorter than group 1 patients (p < 0.001). The time to healing was similar in the two groups. The overall success rates for groups 1 and 2 were 92.3% (12 of 13) and 100% (13 of 13), respectively, and there were no statistically significant differences regarding radiological healing. This pilot study suggests that endoscopic curettage and percutaneous grafting is a simple and safe form of treatment, with similar results to those following open treatment.

Diagnosis and management of cesarean scar pregnancy

OBJECTIVE

To evaluate the diagnosis and management modalities of cesarean scar pregnancy according to our experience.

DESIGN AND SETTING

Retrospective study at the Women's Health Research and Education Hospital.

PATIENTS

Six patients were diagnosed and treated for cesarean scar pregnancy (CSP) with dilatation and curettage, methotrexate (MTX), or laparatomy.

RESULTS

One patient chose the surgical option due to her desire to have a tubal ligation. In the second case methotrexate was applied initially, but two weeks later suction curretage was applied due to abdominal pain and vaginal bleeding. Suction curettage was used as an initial treatment for four patients. There were not any complications in three of four patients. One patient had heavy vaginal bleeding which started after curettage. On ultrasonographic examination, increasing hemorrhage was seen between the uterus and the bladder so subtotal hysterectomy was performed.

DISCUSSION

Ultrasound should be used effectivelly in evaluation of pregnant patients with previous cesarean deliveries. There is still no unique treatment modality for CSP, so treatment should be tailored for each patient. Before the 7th week, abortion should be considered. After the 7th week, MTX and/or surgical options should be preferred.

MicroRNA-520/373 family functions as a tumor suppressor in estrogen receptor negative breast cancer by targeting NF-κB and TGF-β signaling pathways

MicroRNAs (miRNAs) as modulators of gene expression have been described to display both tumor-promoting and tumor-suppressive functions. Although their role has been studied in different tumor types, little is known about how they regulate nuclear factor κB (NF-κB) signaling in breast cancer. Here, we performed an unbiased whole genome miRNA (miRome) screen to identify novel modulators of NF-κB pathway in breast cancer. The screen identified 13 miRNA families whose members induced consistent effects on NF-κB activity. Among those, the miR-520/373 family inhibited NF-κB signaling through direct targeting of RELA and thus strongly reduced expression and secretion of the pro-inflammatory cytokines interleukin (IL)-6 and IL-8. With a combination of in vitro and in vivo approaches, we propose a metastasis-suppressive role of miR-520/373 family. miR-520c and miR-373 abrogated both in vitro cell invasion and in vivo intravasation of highly invasive MDA-MB-231 cells. However, knockdown of RELA did not affect their metastatic ability. mRNA profiling of MDA-MB-231 cells on overexpression of miR-520/373 members revealed a strong downregulation of transforming growth factor-β (TGF-β) signaling. Mechanistically, the metastasis-suppressive role of miR-520/373 can be attributed to direct suppression of TGFBR2, as the silencing of TGFBR2 phenocopied the effects of miR-520/373 overexpression on suppression of Smad-dependent expression of the metastasis-promoting genes parathyroid hormone-related protein, plasminogen activator inhibitor-1 and angiopoietin-like 4 as well as tumor cell invasion, in vitro and in vivo. A negative correlation between miR-520c and TGFBR2 expression was observed in estrogen receptor negative (ER(-)) breast cancer patients but not in the ER positive (ER(+)) subtype. Remarkably, decreased expression of miR-520c correlated with lymph node metastasis specifically in ER(-) tumors. Taken together, our findings reveal that miR-520/373 family has a tumor-suppressive role in ER(-) breast cancer by acting as a link between the NF-κB and TGF-β pathways and may thus contribute to the interplay of tumor progression, metastasis and inflammation.

The protective effect of avocado soybean unsaponifilables on brain ischemia/reperfusion injury in rat prefrontal cortex

OBJECT

We investigated the protective effects of avocado/soybean unsaponifiables (ASU) on the prefrontal cortex (PFC) after global brain ischemia/reperfusion (I/R) injury in rats.

METHODS

Rats were randomly divided into three experimental groups as follows: Group I was control rats, Group II was ischemia rats, Group III was Isch + ASU rats. Brain ischemia was produced via four-vessel occlusion model. These processes followed by reperfusion for 30 min for both II and III groups. Rats were sacrificed and their brains were removed immediately. Malondialdehyde (MDA) and superoxide dismutase (SOD) were measured in left PFC, levels of TNF-α concentration were measured in the plasma. The number of apoptotic neurons was assayed in histological samples of the right PFC.

RESULTS

MDA and TNF-α levels as well as the number of apoptotic neurons were observed to have decreased significantly in Group III compared to Group II, while SOD activities have been found to have increased significantly in Group III in comparison to Group II, significantly.

CONCLUSIONS

We think that ASU might have an antioxidant and neuroprotective effects in brain I/R injured rats.

Association of serum lipoprotein-associated phospholipase A2 level with nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is one of the most common causes of chronic liver disease, worldwide. Lipoprotein-associated phospholipase A2 (Lp-PLA2) was recently characterized as a novel inflammatory biomarker that is correlated with several components constituting the metabolic syndrome.

METHODS

In this study, we determined the serum levels of Lp-PLA2 in patients with definite nonalcoholic steatohepatitis (NASH, n=25), borderline NASH (n=22), simple fatty liver (n=10), and healthy controls without evidence of liver disease (n=38). The levels of Lp-PLA2 were measured by enzyme-linked immunosorbent assay and compared in the four study groups. Moreover, concentrations of Lp-PLA2 were assessed in relation to the general characteristics of the study participants and the results of liver biopsy.

RESULTS

Concentrations of Lp-PLA2 were significantly higher in patients with definite NASH (161.8±0.9 μg/L, P<0.001), borderline NASH (135.4±47.7 μg/L, P=0.001), and simple fatty liver (132.4±46.2 μg/L, P=0.042) compared with healthy controls (86.2±40.7 μg/L). Furthermore, the serum Lp-PLA2 level was strongly associated to histological steatosis scores in patients with NAFLD (β=0.32, t=2.50, P=0.016).

CONCLUSION

Although subject to future confirmation, our data suggest that Lp-PLA2 levels are elevated in NAFLD.

Spatial Distribution of Putative Growth Factors in the Guinea Pig Placenta and the Effects of These Factors, Plasma, and Bile on the Growth and Chemotaxis of Campylobacter jejuni

The pregnant guinea pig is an effective model for studying abortifacient Campylobacter spp, and previous experiments have demonstrated that C. jejuni IA3902 has a marked predilection for the subplacenta while sparing the placental disc in this species. In the study described here, the growth and chemotaxis of IA3902 and a reference strain (NCTC 11168) are compared in the presence of subplacental and placental factors, as well as bile and plasma, from pregnant and nonpregnant guinea pigs. Both strains grew better in subplacental versus placental disc tissue extracts at 24 hours; however, only IA3902 maintained this enhancement at 48 hours. Histochemistry and lectin histochemistry were used to localize mucin, iron, and l-fucose within the placental unit. Mucin was most abundant in subplacental lacunae, the junctional zone, and visceral yolk sac placenta, while iron was most abundant in the placental disc, and l-fucose-containing surface glycans were limited to the visceral yolk sac placenta. These 3 individual factors, along with progesterone and estradiol, were evaluated for effects on growth and chemotaxis of C. jejuni. Mucin, iron, and l-fucose were growth promoting, while l-fucose was also chemoattractive for both strains. Progesterone, estradiol, and pregnant guinea pig plasma did not affect growth or chemotaxis, and no difference was observed when bile from pregnant and nonpregnant animals was compared. These findings demonstrate the presence of specific factors within the guinea pig placental unit that drive chemotaxis and enhance growth of C. jejuni, shedding light on potential mechanisms underlying the fetoplacental tropism observed with this strain.

Presence of interferon regulatory factor-1 in aggressive and nonaggressive histological variants of Basal cell carcinoma specimens

Background:

Expression of Interferon regulatory factor-1 (IRF-1) has been demonstrated in a variety of cancers previously. To the best of our knowledge, there is only one report about the IRF-1 expression in basal cell carcinoma (BCC) specimens, which has demonstrated increased expression of the IRF-1 gene in BCC versus normal skin. Furthermore, IRF-1 expression has not been compared between aggressive and nonaggressive subtypes of BCC before.

Aims:

Our aim is to examine the relation between IRF-1 staining patterns of aggressive and nonaggressive histological subtypes of BCC.

Materials and Methods:

Thirty-seven archival tissue specimens from 33 BCC patients were stained for cytoplasmic and nuclear IRF-1. Twenty-five tumors were grouped as nonaggressive and 12 were grouped as aggressive histological variants, according to the established criteria.

Results:

IRF-1 was not only expressed in tumor cells, but also in some surrounding inflammatory cells. There was no significant difference between the groups for cytoplasmic or nuclear IRF-1 staining. Aggressive or nonaggressive histological subtypes did not show any statistical difference for gender, relapse, treatment method, or localization. When staining was compared with gender, relapse, treatment method, localization, and tumor grades, no significant difference was found.

Conclusions:

Interferon seems to be expressed in BCCs with both aggressive and non aggressive histology. Further studies are needed to elaborate the precise diagnostic and prognostic roles and utility of interferon in the treatment of BCC.

Histological assessment of skin grafts stored in amniotic fluid and saline

We investigated the efficacy of amniotic fluid as a substance in which to store grafts; it is rich in nutrients, proteins, and growth factors, and has well-known antimicrobial features. We compared it with the widely-used and practical saline. Split-thickness grafts 4 × 4 cm were prepared from the back of 20 rats and divided into four groups (n = 5 each). The rolled grafts were wrapped in gauze dampened with saline or amniotic fluid and placed into refrigerators in sterile containers for storage. On days 7, 14, 21, and 28, histological examinations were made. A semiquantitative evaluation of the histological damage to the skin was made by scoring its degree of severity. Compared with saline, histological scores in the grafts stored in amniotic fluid were found to be significantly lower on the 14th, 21st, and 28th days (p values on days 14, 21, and 28; cell swelling: 0.014, 0.006, and 0.005, respectively; nuclear swelling: 0.003, 0.006, and 0.007, respectively; nuclear pleomorphism: 0.004, 0.005, and 0.003, respectively; nuclear haloes: 0.015, 0.005, and 0.005, respectively; nuclear pyknosis: 0.003, 0.005, and 0.003, respectively; dermo-epidermal clefting: 0.005, 0.003, and 0.003, respectively; eosinophilia and mitosis: 0.003, 0.006, and 0.004, respectively; dermal collagen: 0.003, 0.003, and 0.003, respectively). Amniotic fluid maintained preservation better for skin grafts than saline. Comparison with other modern storage media would be beneficial.

[Multilayer analysis of signal transduction and cell cycle control in GIST. Identifying new interaction partners with differential regulation]

To identify new interactions as well as diagnostically, prognostically and therapeutically relevant differences in the regulation of gene expression in gastrointestinal stromal tumors (GISTs), we analyzed the methylation status, mRNA expression, microRNA expression, protein expression and protein phosphorylation in parallel in identical tumor tissue samples. The data were analyzed in a multilayer approach and were correlated to each other and to clinico-pathological parameters. Differentially regulated genes were mapped to signal transduction pathways which are already known to play a major role in GISTs. A functionally orientated overview of the different data layers was constructed, which enabled new insights into gene regulation in GISTs.