[Unsuspected gallbladder carcinoma--the CAE-S/CAMIC registry]

INTRODUCTION

Results of earlier surveys raised the prospect that laparoscopic surgical procedures may specifically increase the risk of port wound metastasis and generally of tumour cell seeding if at the time of operation an unsuspected gallbladder cancer existed. Other observations lead to presume that laparoscopic technique could deteriorate the prognosis of gallbladder cancer. These assumptions are going to be verified by the CAES/ CAMIC-registry.

MATERIAL AND METHOD

The Workgroup Surgical Endoscopy (CAE) of the German Society of Surgery has started 1997 a registry of all cases of cholecystectomy--laparoscopic as well open--with a postoperative incidental finding of a gallbladder carcinoma. The aim of our registry is to compare the prospectively collected follow up data on the outcome of these patients and to answer the question whether laparoscopic cholecystectomy affects the course and the prognosis of patients with unsuspected gallbladder cancer.

RESULTS

Until now 142 cases of incidental gallbladder cancer following laparoscopic and 79 cases following open cholecystectomy as well as 24 cases after intraoperative conversion to the open procedure have been recorded. The median follow up runs up to 27 (1-69) months. Following laparoscopic primary procedure we registered 10 port site metastases (7 %), following open primary procedure 4 (5.1 %) wound recurrences. The total recurrence rate at the moment is about 27 % after laparoscopic treatment and 31 % for conventionally operated patients. 70 of the 245 patients underwent a second radical procedure after diagnosis of gallbladder carcinoma. A postoperative combined radio- and chemotherapy was undertaken in 4 cases, a chemotherapy alone in 14 cases. 64 patients already died due to the underlining disease.

DISCUSSION

At the present, after a median follow up of 27 months, the incidence of abdominal wall recurrences is very similar following laparoscopic and conventional procedure (7 % vs. 5.1 %). The total incidence of recurrences is at the moment slightly higher following open cholecystectomy (31 % vs. 27 %). The access technique, open or laparoscopic, doesn't seem to influence the prognosis of unsuspected gallbladder carcinoma. Until now we could not find disadvantages for the laparoscopically operated group.

Prevalence of resistance-associated substitutions and retreatment of patients failing a glecaprevir/pibrentasvir regimen

OBJECTIVES

To investigate resistance-associated substitutions (RASs) as well as retreatment efficacies in a large cohort of European patients with failure of glecaprevir/pibrentasvir.

METHODS

Patients were identified from three European Resistance Reference centres in Spain, Italy and Germany. Sequencing of NS3, NS5A and NS5B was conducted and substitutions associated with resistance to direct antiviral agents were analysed. Clinical and virological parameters were documented retrospectively and retreatment efficacies were evaluated.

RESULTS

We evaluated 90 glecaprevir/pibrentasvir failures [3a (n = 36), 1a (n = 23), 2a/2c (n = 20), 1b (n = 10) and 4d (n = 1)]. Ten patients were cirrhotic, two had previous exposure to PEG-interferon and seven were coinfected with HIV; 80 had been treated for 8 weeks. Overall, 31 patients (34.4%) failed glecaprevir/pibrentasvir without any NS3 or NS5A RASs, 62.4% (53/85) showed RASs in NS5A, 15.6% (13/83) in NS3 and 10% (9/90) in both NS5A and NS3. Infection with HCV genotypes 1a and 3a was associated with a higher prevalence of NS5A RASs. Patients harbouring two (n = 34) or more (n = 8) RASs in NS5A were frequent. Retreatment was initiated in 56 patients, almost all (n = 52) with sofosbuvir/velpatasvir/voxilaprevir. The overall sustained virological response rate was 97.8% in patients with end-of-follow-up data available.

CONCLUSIONS

One-third of patients failed glecaprevir/pibrentasvir without resistance. RASs in NS5A were more prevalent than in NS3 and were frequently observed as dual and triple combination patterns, with a high impact on NS5A inhibitor activity, particularly in genotypes 1a and 3a. Retreatment of glecaprevir/pibrentasvir failures with sofosbuvir/velpatasvir/voxilaprevir achieved viral suppression across all genotypes.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Intensity dependent deflection spectroscopy for absorption measurements

We report on a method for the characterization of optical absorption in semiconductors at photon energies below the bandgap energy. We use intensity dependent deflection spectroscopy to measure spatially resolved the optical absorption and to separate the occurring absorption mechanisms. To this end, we take advantage of the different intensity scaling of these mechanisms and extract the material parameters by fitting the intensity dependent absorption to a physical model. Our method enables a simple but sufficient determination of crucial optical loss properties (e.g. impurity related absorption and two-photon absorption) in various semiconductor systems, e.g. substrates for optical components or solar cells.

Factor XII signaling via uPAR-integrin β1 axis promotes tubular senescence in diabetic kidney disease

Coagulation factor XII (FXII) conveys various functions as an active protease that promotes thrombosis and inflammation, and as a zymogen via surface receptors like urokinase-type plasminogen activator receptor (uPAR). While plasma levels of FXII are increased in diabetes mellitus and diabetic kidney disease (DKD), a pathogenic role of FXII in DKD remains unknown. Here we show that FXII is locally expressed in kidney tubular cells and that urinary FXII correlates with kidney dysfunction in DKD patients. F12-deficient mice (F12-/-) are protected from hyperglycemia-induced kidney injury. Mechanistically, FXII interacts with uPAR on tubular cells promoting integrin β1-dependent signaling. This signaling axis induces oxidative stress, persistent DNA damage and senescence. Blocking uPAR or integrin β1 ameliorates FXII-induced tubular cell injury. Our findings demonstrate that FXII-uPAR-integrin β1 signaling on tubular cells drives senescence. These findings imply previously undescribed diagnostic and therapeutic approaches to detect or treat DKD and possibly other senescence-associated diseases.

Exploring Raloxifene-Based Metallodrugs: A Versatile Vector Combined with Platinum(II), Palladium(II) and Nickel(II) Dichlorides and Carborates against Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) poses challenges in therapy due to the absence of target expression such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Frequently, the treatment of TNBC involves the combination of several therapeutics. However, an enhanced therapeutic effect can be also achieved within a single molecule. The efficacy of raloxifene can be improved by designing a raloxifene-based hybrid drug bearing a 2,2'-bipyridine moiety (2). Integration of platinum(II), palladium(II), and nickel(II) complexes into this structure dramatically changed the cytotoxicity. The platinum(II) dichloride complex 3 did not demonstrate any activity, while palladium(II) and nickel(II) dichloride complexes 4 and 5 exhibited various cytotoxic behavior towards different types of hormone-receptor positive (HR+) cancer and TNBC cell lines. The replacement of the two chlorido ligands in 3-5 with a dicarbollide (carborate) ion [C2B9H11]2- resulted in reduced activity of compounds 6, 7, and 8. However, the palladacarborane complex 7 demonstrated higher selectivity towards TNBC. Furthermore, the mechanism of action was shifted from cytotoxic to explicitly cytostatic with detectable proliferation arrest and accelerated aging, characterized by senescence-associated phenotype of TNBC cells. This study provides valuable insights into the development of hybrid therapeutics against TNBC.

[Nutritional support in patients with acute pancreatitis]

A causal therapy for acute pancreatitis is not available, so treatment has to focus on best supportive care. As nutrition is a cornerstone in the treatment of the disease, recent clinical research has focused on this question. The concept of enteral nutrition is aiming at the maintenance of a normal mucosal barrriere function which has been discovered to be important in mild and severe acute pancreatitis. This review offers an overview about current concepts of nutritional support and gives recommendations for clinical care as well.

Bipyraloxifene - a modified raloxifene vector against triple-negative breast cancer

Raloxifene, a selective oestrogen receptor modulator (SERM), has demonstrated efficacy in the prevention and therapy of oestrogen receptor-positive (ER+) breast cancer, with some degree of effectiveness against triple-negative forms. This suggests the presence of oestrogen receptor-independent pathways in raloxifene-mediated anticancer activity. To enhance the potential of raloxifene against the most aggressive breast cancer cells, hybrid molecules combining the drug with a metal chelator moiety have been developed. In this study, we synthetically modified the structure of raloxifene by incorporating a 2,2'-bipyridine (2,2'-bipy) moiety, resulting in [6-methoxy-2-(4-hydroxyphenyl)benzo[b]thiophen-3-yl]-[4-(2,2'-bipyridin-4'-yl-methoxy)phenyl]methanone (bipyraloxifene). We investigated the cytotoxic activity of both raloxifene and bipyraloxifene against ER+ breast adenocarcinomas, glioblastomas, and a triple-negative breast cancer (TNBC) cell line, elucidating their mode of action against TNBC. Bipyraloxifene maintained a mechanism based on caspase-mediated apoptosis but exhibited significantly higher activity and selectivity compared to the original drug, particularly evident in triple-negative stem-like MDA-MB-231 cells.