Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant beha...Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of trans-thoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013) at the Ottawa Hospital for pathologically confirmed SFTP. Data were collected on biopsy-related, clinical, histopathological & immunohistochemistry (IHC) variables. Appropriate tests of statistical inference were conducted for all variables. Results: Pathologically confirmed SFTP was identified in 26 cases. Transthoracic needle biopsy was conducted in 22 (84.6%);with 16 (72.7%) biopsies diagnostic of SFTP with IHC;3 (13.6%) being malignant. Primary management was surveillance in 3 and complete surgical resection in 23. Surgical pathology reported 15 (65.2%) benign and 8 (34.8%) malignant cases. Local recurrence occurred in 3 and distant recurrence in 1. Initial pathology was benign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p 4 mitoses/ 10 high power field (p Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP;however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.展开更多
Background:Platinum chemotherapy(CT)remains the backbone of systemic therapy for patients with smallcell lung cancer(SCLC).The nucleotide excision repair(NER)pathway plays a central role in the repair of the DNA damag...Background:Platinum chemotherapy(CT)remains the backbone of systemic therapy for patients with smallcell lung cancer(SCLC).The nucleotide excision repair(NER)pathway plays a central role in the repair of the DNA damage exerted by platinum agents.Alteration in this repair mechanism may affect patients’survival.Materials and Methods:We conducted a retrospective analysis of data from 38 patients with extensive disease(ED)-SCLC who underwent platinum-CT at the Clinical Oncology Unit,Careggi University Hospital,Florence(Italy),from 2015 to 2020.mRNA expression analysis and single nucleotide polymorphism(SNP)characterization of three NER pathway genes—namely ERCC1,ERCC2,and ERCC5—were performed on patient tumor samples.Results:Overall,elevated expression of ERCC genes was observed in SCLC patients compared to healthy controls.Patients with low ERCC1 and ERCC5 expression levels exhibited a better median progression-free survival(mPFS=7.1 vs.4.9 months,p=0.39 for ERCC1 and mPFS=6.9 vs.4.8 months,p=0.093 for ERCC5)and overall survival(mOS=8.7 vs.6.0 months,p=0.4 for ERCC1 and mOS=7.2 vs.6.2 months,p=0.13 for ERCC5).Genotyping analysis of five SNPs of ERCC genes showed a longer survival in patients harboring the wild-type genotype or the heterozygous variant of the ERCC1 rs11615 SNP(p=0.24 for PFS and p=0.14 for OS)and of the rs13181 and rs1799793 ERCC2 SNPs(p=0.43 and p=0.26 for PFS and p=0.21 and p=0.16 for OS,respectively)compared to patients with homozygous mutant genotypes.Conclusions:The comprehensive analysis of ERCC gene expression and SNP variants appears to identify patients who derive greater survival benefits from platinum-CT.展开更多
BACKGROUND Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors.Synchronous cardiac myxoma and other malignancies are extremely rare,and only limited cases have been reported....BACKGROUND Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors.Synchronous cardiac myxoma and other malignancies are extremely rare,and only limited cases have been reported.CASE SUMMARY We describe a young patient with newly diagnosed locally advanced laryngeal cancer,with a synchronous cardiac tumor detected on staging scans.An echocar-diogram showed the typical appearance of myxoma in the left atrium.Early cardiac surgery was performed in view of its obstructive features and post cardiac surgery recovery was uneventful.The patient was scheduled for subsequent oncological treatment for the laryngeal cancer.However,due to rapid progression of the advanced laryngeal malignancy,he was placed on supportive care.CONCLUSION To our knowledge,this is the first reported case of synchronous cardiac myxoma with laryngeal malignancy.Individualized treatment strategy should be adopted to manage synchronous tumors in a multidisciplinary approach.The most life-threatening condition needs be treated first.Single resection,staged operations or simultaneous resection of both tumors have been reported with good outcomes.展开更多
Background:Liver cancer,particularly hepatocellular carcinoma(HCC),is a major global health concern,showing high recurrence and mortality rates.Chronic inflammation and oxidative stress are key factors in the developm...Background:Liver cancer,particularly hepatocellular carcinoma(HCC),is a major global health concern,showing high recurrence and mortality rates.Chronic inflammation and oxidative stress are key factors in the development of HCC.Previous studies have shown that paracetamol,a common anti-inflammatory drug,preventsHCCby inhibiting the cyclooxygenase pathway and reducing inflammation and oxidative stress.This study aimed to investigate the hepatoprotective effects of acetaminophen against diethylnitrosamine(DEN)–induced HCC in male rats.Methods:Male Sprague-Dawley rats(5–6 weeks old,240–290 g)were divided into control and treatment groups(6 rats each).HCC was intraperitoneally induced with DEN(50 mg/kg body weight)in both groups once aweek for 10weeks.The treatment group also received acetaminophen(200 mg/kg per day)from one week before DEN administration until the 24th week.Liver function biomarkers(aspartate aminotransferase,alanine transaminase[ALT],α-fetoprotein,bilirubin,and albumin)were measured,and liver tissues histopathologically evaluated.Data were analyzed using SPSS software,using Shapiro-Wilk tests for normality and unpaired t tests for comparisons.Results:The acetaminophen group showed significant differences in aspartate aminotransferase,ALT,and bilirubin levels over time,which were higher than those of the control group(p<0.05).Rats in the control group exhibited substantial liver damage and early death,whereas those in the treatment group showed improved survival and liver function.Histopathological analysis revealed fewer necrotic and precancerous changes in the treatment group.Albumin levels were significantly associated with cirrhosis manifestation(p=0.005),and ALT and bilirubin levels correlated with precancerous conditions(p<0.05).Conclusions:Acetaminophen at 200 mg/kg body weight protected rat hepatocytes against DEN-induced liver damage and potential carcinogenesis.Our findings could serve as a basis for developing future research approaches in patients with HCC undergoing liver resection that are aimed at preventing recurrence and reducing inflammation.展开更多
BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct p...BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.展开更多
BACKGROUND Hepatic manifestations in chronic lymphocytic leukemia(CLL)are common:Elevation of liver enzymes frequently occurs,and differential diagnosis is often challenging.Liver infiltration by leukemic cells,primar...BACKGROUND Hepatic manifestations in chronic lymphocytic leukemia(CLL)are common:Elevation of liver enzymes frequently occurs,and differential diagnosis is often challenging.Liver infiltration by leukemic cells,primary and secondary hepatic malignancies,drug-induced hepatotoxicity,immunological disorders,and infections have been reported.Nevertheless,syncytial giant cell hepatitis(GCH)as a manifestation of autoimmune hepatitis in patients with CLL is an extremely rare condition,currently reported only in anecdotal cases.CASE SUMMARY Here,we report the case of a 62-year-old Caucasian woman affected by CLL,who developed GCH with peculiar histopathological features.The patient was evaluated for abnormal liver test results.Liver histology revealed significant inflammatory lymphomononuclear infiltrates with a plasma cell component,widespread syncytial changes in the hepatocytes with gigantocellular features,hepatocyte rosettes,and the typical feature of emperipolesis,consistent with a diagnosis of GCH.The patient was treated with corticosteroids and mycophenolate mofetil,resulting in a complete biochemical response.CONCLUSION Early histological diagnosis of GCH is crucial in patients with CLL,with mycophenolate mofetil representing a promising treatment option.展开更多
BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influen...BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.展开更多
BACKGROUND Endocytoscopy is an advanced imaging modality that provides real-time,ultrahigh magnification views of the intestinal mucosa.In ulcerative colitis(UC),the combined assessment of endoscopic and histological ...BACKGROUND Endocytoscopy is an advanced imaging modality that provides real-time,ultrahigh magnification views of the intestinal mucosa.In ulcerative colitis(UC),the combined assessment of endoscopic and histological remission is now becoming a standard practice.However,histological evaluation typically falls outside the scope of the endoscopist.By offering in vivo microscopic imaging,endocytoscopy has the potential to streamline workflow and enhance efficiency in assessing UC activity.AIM To evaluate the utility of real-time endocytoscopy in assessing endoscopic and histological disease activity in UC,and to validate endocytoscopic scoring systems.METHODS This study was conducted at Concord Hospital.Patients with UC who consented to undergo colonoscopy with endocytoscopy were enrolled.Data collected included patient demographics,clinical disease activity,Mayo endoscopic score(MES),and endocytoscopic features such as crypt architecture,intercrypt distance and cellular infiltration.Correlation between endocytoscopic findings were evaluated against MES and the Nancy histological index.Agreement and validation were assessed using the ErLangen Endocytoscopy in ColiTis(ELECT)score and the endocytoscopy score(ECSS),applying Kappa(κ)statistics and Spearman’s correlation coefficient(r).RESULTS A total of 61 colonic segments from 15 patients were assessed,with 187 analyzable endocytoscopic images.Endocytoscopy showed significant correlation with the MES using both the ECSS(κ=0.60,P<0.001;r=0.78,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.81,P<0.001)scoring systems.Similarly,correlations with the Nancy histological index were significant for both ECSS(κ=0.47,P<0.001;r=0.69,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.74,P<0.001).The ELECT score demonstrated superior diagnostic accuracy in identifying histological remission,with a sensitivity of 100%,specificity of 85%,and an area under the receiver operating characteristic curve of 0.90(95%confidence interval:0.78-1.00),compared to 68.3%,85%,and an area under the receiver operating characteristic curve of 0.88(95%confidence interval:0.75-1.00)for the ECSS.No serious adverse events occurred,except for transient urinary discoloration due to methylene blue excretion.CONCLUSION Endocytoscopy allows for real-time,simultaneous assessment of endoscopic and histological activity in UC and has been proven to be accurate,safe,and well-tolerated.Compared with the ECSS,the ELECT score showed superior concordance with histological findings.展开更多
A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm ava...A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma.Tumor markers were unremarkable.A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord.Due to a suspicion of chronic torsion vs.malignancy,a left radical orchiectomy was performed.Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia,a rare entity.展开更多
BACKGROUND Citrullination is a post-translational modification mediated by calcium-dependent peptidylarginine deiminases that results in notable changes in protein structure and function.Glial fibrillary acidic protei...BACKGROUND Citrullination is a post-translational modification mediated by calcium-dependent peptidylarginine deiminases that results in notable changes in protein structure and function.Glial fibrillary acidic protein(GFAP),which is highly vulnerable to peptidylarginine deiminases-mediated modification,has been found to be elevated in activated hepatic stellate cells,with GFAP-positive hepatic stellate cells and myofibroblasts accumulating within and around areas of hepatic fibrosis.Although recent studies have shown that the expression of citrullinated GFAP(cit-GFAP)increases during hepatic fibrosis,its expression pattern and functional roles in hepatocellular carcinoma(HCC)remain unclear.AIM To determine whether cit-GFAP expression influences the recurrence and survival of patients undergoing hepatic resection for HCC.METHODS We retrospectively analyzed 169 patients with HCC who underwent hepatic resection.Based on the immunohistochemical staining of resected specimens,the enrolled patients were stratified into two groups according to cit-GFAP expression:Low(-/1+)or high(2+/3+)levels of expression.Kaplan-Meier survival curves were constructed to assess overall survival and recurrence-free survival,and comparisons between groups were performed using the log-rank test.RESULTS The median follow-up duration was 33 months(range,1-183).High cit-GFAP expression,identified in 81 patients(48.2%),was significantly associated with male sex,hepatitis B virus positivity,and higher Edmonson-Steiner grade.No associations were found between age,diabetes,hypertension,cirrhosis,Child-Pugh classification,major portal vein invasion,hematological or biochemical parameters,tumor size,or number.Patients exhibiting high cit-GFAP expression demonstrated significantly poorer overall survival.Multivariate Cox analysis identified large tumor size(hazard ratio:2.967;95%confidence interval:1.097-8.024;P=0.032)and high cit-GFAP expression(hazard ratio:2.753;95%confidence interval:1.015-7.464;P=0.047)as independent predictors of poor postoperative survival.Although recurrence rates were high in patients with high cit-GFAP expression,the difference was not statistically significant.CONCLUSION Following curative resection in patients with HCC,high cit-GFAP expression may serve as a potential prognostic biomarker,although further validation through independent cohort studies is warranted.展开更多
BACKGROUND Pancreatic neuroendocrine microtumors(PNEMTs)are small(<5 mm),nonfunctioning,well-differentiated neuroendocrine neoplasms.Although they are rare,they are not invariably benign.PNEMTs are typically discov...BACKGROUND Pancreatic neuroendocrine microtumors(PNEMTs)are small(<5 mm),nonfunctioning,well-differentiated neuroendocrine neoplasms.Although they are rare,they are not invariably benign.PNEMTs are typically discovered incidentally during autopsy.However,data regarding the occurrence of PNEMTs in the elderly population,particularly those identified incidentally in cadaveric studies,remain limited.AIM To investigate the prevalence and histopathological characteristics of PNEMTs in elderly individuals by analyzing cadaveric pancreatic tissues.METHODS We conducted a retrospective analysis of 85 pancreatic specimens(age range:58-109 years)obtained from cadavers for anatomical education and research at the Department of Life Dentistry,Nippon Dental University.Paraffin sections of the pancreatic head,body,and tail were prepared for histological and immunohistochemical analysis.RESULTS Five cases with PNEMTs(5/85,5.9%;male,n=33;female,n=52;mean age:85.8±12.1 years)were identified.The tumors were solitary,well circumscribed,and located within the pancreatic parenchyma(body:n=4;tail:n=1),and all were<5 mm(range:0.54-2.20 mm)in size.All tumors showed strong chromogranin A and synaptophysin positivity,and were predominantly glucagon(GLU)-positive.Ki-67 immunostaining indicated minimal proliferative activity;therefore,these tumors were considered non-functioning,GLU-producing,well-differentiated grade 1 PNEMTs.CONCLUSION Small,predominantly low-grade,GLU-secreting PNEMTs were present in 5.9%of elderly individuals,highlighting the prevalence of subclinical PNEMTs and the need for careful follow-up.展开更多
Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), mu...Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), multifactorial diseases due to obesogenic environment (availability of convenience food, media influence, etc.), psycho-social factors (social support systems, cultural/environmental influence, etc.) and genetic variants. Other causes are a subgroup of etiological factors (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Obesity is measured clinically by several common tools apart from body mass index (BMI), such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and neck circumference. WC and WHR are common tools for measuring central obesity while BMI measures generalized obesity. Aims: The goal of this study is to assess the prevalence of obesity amongst health workers of David Umahi Federal University Teaching Hospital, Uburu, Ebonyi state, Southeast Nigeria and to note the prevailing factors. A reliable estimate of the prevalence of obesity among health workers will contribute to the statistics needed to sway policymakers in the country to take urgent and substantial action on the increasing prevalence of obesity, especially in the healthcare industry. Methodology: The study was carried out between May 2024 and June 2024 at the David Umahi Federal University Teaching Hospital situated in Uburu, Ohaozara Local government area of Ebonyi state, Southeast Nigeria. The questionnaire was designed using the Finnish diabetic risk score (FINDRISC). It contained basic comprehending questions on age, gender, exposure to high blood pressure medication, and anthropometric measurement amongst others. Weight was taken with a portable weighing scale and height, with a stadiometer. Both were taken with shoes and headgear removed. The BMI was calculated using the weight (kg) divided by the square of the height (m2). Result: Generally, the prevalence of obesity (>30 kg/m2) in this study was low 17.6% (38), Overweight (BMI 25 - 30), 38.9%, (84) healthy Weight, (BMI 18.5 - 24.9), 43.5% (94). The study revealed that a family history of diabetes was significantly related to higher BMI, with participants more likely to be overweight or obese (p = 0.00030). Similarly, participants with a personal history of diabetes were predominantly in the obese category (p = 0.00038). Waist circumference also showed a strong association with BMI, as larger waist measurements were more common among obese individuals (p = 9.2 × 10−8). In contrast, the analysis found no significant relationships between BMI and age, gender, high blood pressure, or exercise habits. Conclusion: The socio-demographic determinants of obesity in this study were gender, age < 45 years and exposure to exercise. These determinants should form the areas of focus for interventions such as health education and the design of work environments as environments designed to promote physical activities while working will reduce the prevalence of obesity in tertiary institutions.展开更多
Background: Diarrheal diseases have globally decreased over the past few decades, yet they remain one of the top three causes of mortality in children under five years, especially in sub-Saharan Africa and Nigeria. Se...Background: Diarrheal diseases have globally decreased over the past few decades, yet they remain one of the top three causes of mortality in children under five years, especially in sub-Saharan Africa and Nigeria. Seasonal peaks of diarrheal episodes continue to contribute significantly to childhood mortality in these regions. One of the notable causes of diarrhea in children is parasitic infections, particularly Cryptosporidium, which poses a serious health risk. In Nigeria, the burden of Cryptosporidium diarrhea is under-researched, making it imperative to investigate its prevalence and associated risk factors. Study Objectives: The study aims to determine the prevalence and risk factors associated with Cryptosporidium diarrhea among children aged five years and below in selected health institutions in Abakaliki, South-East Nigeria. Methodology: This cross-sectional study was conducted from January to May 2017, recruiting 200 children under five years with diarrhea from health institutions in Abakaliki. Fecal specimens were analyzed for Cryptosporidium oocysts using light microscopy with modified Ziehl-Neelsen staining and immunofluorescent antibody test (IFAT). Deoxyribonucleic acid (DNA) was extracted from positive samples using QIAmp® DNA stool kit, followed by Polymerase Chain Reaction (PCR) and molecular genotyping. Results: Cryptosporidium was detected in 0.5% (1/200) of children via light microscopy and 6.5% (13/200) via IFAT. All positive samples were confirmed as Cryptosporidium hominis by PCR. The prevalence of infection was significantly higher in children from institutionalized homes (50.0%) compared to monogamous homes (6.2%) (p Conclusion: Cryptosporidium hominis is a notable cause of diarrhea among children in Abakaliki, primarily transmitted through human-to-human contact. The study underscores the need for targeted interventions in childcare institutions to prevent outbreaks. Health authorities should promote breastfeeding and enhance education on hygiene practices in vulnerable populations.展开更多
Objective:Focal therapy(FT)is a potential treatment option for limited-volume clinically-significant prostate cancer(csPCa).However,despite rigorous selection,approximately 20%of patients experience early failure.We i...Objective:Focal therapy(FT)is a potential treatment option for limited-volume clinically-significant prostate cancer(csPCa).However,despite rigorous selection,approximately 20%of patients experience early failure.We investigated the association of transcriptomic profiles and csPCa recurrence post-FT.Methods:52 men from a phase II trial(NCT04138914)and a prospective observational cohort underwent focal cryotherapy for csPCa.Patients underwent multiparametric magnetic resonance imaging,and targeted and systematic-saturation biopsy before-and 1-year post-FT.Recurrence was defined as grade-group(GG)≥2 cancer in the 1-year post-FT biopsy.Pre-treatment lesions were profiled using the Decipher genomic classifier(GC).GC scores,luminal-basal status,tumor microenvironment and cancer hallmark pathways were correlated with csPCa recurrence.Results:Median PSA was 7.0 ng/dl;37/52(71.1%)men had GG2,12/52(23.1%)GG3,and 3/52(5.8%)GG4 cancer.Recurrence was observed in 9/52(17.3%)men.Median GC score was higher in patients with recurrence(0.60 vs 0.38,P=0.014)and remained significantly associated with recurrence after adjustment for GG(adjusted OR:1.37[95%CI:1.01-1.93],P=0.04).Luminal-proliferative tumors based on the prostate cancer-specific subtyping classifier(PSC)had more csPCa recurrence compared with luminal-differentiated(LD)and basal subtypes(30.4%vs 0%[LD]vs 15.4%[basal-neuroendocrine]and 14.3%[basal-immune],P=0.027).Higher expression of DNA repair pathway was also associated with recurrence(OR:2.12[95%CI:1.09-4.57],P=0.025).Conclusions:Higher GC score is associated with risk of csPCa recurrence post-FT.Patients with GC low-risk and PSC-LD csPCa may represent the ideal subgroup for FT.Prospective validation in a large cohort is warranted.展开更多
AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecuti...AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS:We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori ) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI:67-92), a specificity of 96% (95%CI:93-99), a positive predictive value of 84% (95%CI:73-96), a negative predictive value of 95% (95%CI:92-98), and an accuracy of 93% (95%CI:90-97). The NBI-ME examination overlooked GIM in 8 cases, but the GIM was less than 5% in 7 of the cases. Moreover, in the 6 false positive cases, the histological examination showed the presence of reactive gastropathy (4 cases) or H. pylori active chronic gastritis (2 cases). The semiquantitative correlation between the rate of LBC appearance and the percentage of GIM was 79% (P < 0.01). CONCLUSION:NBI-ME achieved good sensitivity and specificity in recognising GIM in an unselected population. In routine clinical practice, this technique can reliably target gastric biopsies.展开更多
AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examin...AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examination data from 9311 healthy subjects with overnight physical examinations performed between January 2004 and December 2006. Examined data included gender, age, life style, anthropometric measurements, blood pressure, biochemical and hematological studies, H. pylori infection detected by esophagogastroduodenoscopy and biopsy urease tests, and colorectal adenomas detected with a complete total colonoscopy. RESULTS: The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% conf idence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas. CONCLUSION: Our study revealed H. pylori infection with concomitant metabolic syndrome might further increase the risk of colorectal adenomas.展开更多
AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node statu...AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status. METHODS: IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens froma consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ2 test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer. RESULTS: The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (k=0.50) and low for BVI (k=0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P=0.001, P=0.013, and IHC: P=0.001, P=0.019). The mor-phologic features associated with LVI were location of the tumor in the distal third of the stomach (P=0.039), Borrmann's macroscopic type (P=0.001), organ inva-sion (P=0.03) and the depth of tumor invasion (P=0.001). The presence of BVI was related only to the depth of tumor invasion (P=0.003). CONCLUSION: The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.展开更多
AIM To establish a threshold value for liver fat content between healthy children and those with nonalcoholic fatty liver disease(NAFLD) by using magnetic resonance imaging(MRI), with liver biopsy serving as a referen...AIM To establish a threshold value for liver fat content between healthy children and those with nonalcoholic fatty liver disease(NAFLD) by using magnetic resonance imaging(MRI), with liver biopsy serving as a reference standard. METHODS The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel pointresolved 1H MR-Spectroscopy(1H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cutoff value. Lin coefficient test was used to evaluate thecorrelation between histology, MRS and MRI-PDFF. A Mann-Whitney U-test and multivariate analysis were performed to analyze the continuous variables. RESULTS According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF.CONCLUSION MRS is an accurate and precise method for detecting NAFLD in children.展开更多
文摘Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of trans-thoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013) at the Ottawa Hospital for pathologically confirmed SFTP. Data were collected on biopsy-related, clinical, histopathological & immunohistochemistry (IHC) variables. Appropriate tests of statistical inference were conducted for all variables. Results: Pathologically confirmed SFTP was identified in 26 cases. Transthoracic needle biopsy was conducted in 22 (84.6%);with 16 (72.7%) biopsies diagnostic of SFTP with IHC;3 (13.6%) being malignant. Primary management was surveillance in 3 and complete surgical resection in 23. Surgical pathology reported 15 (65.2%) benign and 8 (34.8%) malignant cases. Local recurrence occurred in 3 and distant recurrence in 1. Initial pathology was benign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p 4 mitoses/ 10 high power field (p Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP;however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.
文摘Background:Platinum chemotherapy(CT)remains the backbone of systemic therapy for patients with smallcell lung cancer(SCLC).The nucleotide excision repair(NER)pathway plays a central role in the repair of the DNA damage exerted by platinum agents.Alteration in this repair mechanism may affect patients’survival.Materials and Methods:We conducted a retrospective analysis of data from 38 patients with extensive disease(ED)-SCLC who underwent platinum-CT at the Clinical Oncology Unit,Careggi University Hospital,Florence(Italy),from 2015 to 2020.mRNA expression analysis and single nucleotide polymorphism(SNP)characterization of three NER pathway genes—namely ERCC1,ERCC2,and ERCC5—were performed on patient tumor samples.Results:Overall,elevated expression of ERCC genes was observed in SCLC patients compared to healthy controls.Patients with low ERCC1 and ERCC5 expression levels exhibited a better median progression-free survival(mPFS=7.1 vs.4.9 months,p=0.39 for ERCC1 and mPFS=6.9 vs.4.8 months,p=0.093 for ERCC5)and overall survival(mOS=8.7 vs.6.0 months,p=0.4 for ERCC1 and mOS=7.2 vs.6.2 months,p=0.13 for ERCC5).Genotyping analysis of five SNPs of ERCC genes showed a longer survival in patients harboring the wild-type genotype or the heterozygous variant of the ERCC1 rs11615 SNP(p=0.24 for PFS and p=0.14 for OS)and of the rs13181 and rs1799793 ERCC2 SNPs(p=0.43 and p=0.26 for PFS and p=0.21 and p=0.16 for OS,respectively)compared to patients with homozygous mutant genotypes.Conclusions:The comprehensive analysis of ERCC gene expression and SNP variants appears to identify patients who derive greater survival benefits from platinum-CT.
文摘BACKGROUND Cardiac myxoma is a benign neoplasm and one of the most common types of primary cardiac tumors.Synchronous cardiac myxoma and other malignancies are extremely rare,and only limited cases have been reported.CASE SUMMARY We describe a young patient with newly diagnosed locally advanced laryngeal cancer,with a synchronous cardiac tumor detected on staging scans.An echocar-diogram showed the typical appearance of myxoma in the left atrium.Early cardiac surgery was performed in view of its obstructive features and post cardiac surgery recovery was uneventful.The patient was scheduled for subsequent oncological treatment for the laryngeal cancer.However,due to rapid progression of the advanced laryngeal malignancy,he was placed on supportive care.CONCLUSION To our knowledge,this is the first reported case of synchronous cardiac myxoma with laryngeal malignancy.Individualized treatment strategy should be adopted to manage synchronous tumors in a multidisciplinary approach.The most life-threatening condition needs be treated first.Single resection,staged operations or simultaneous resection of both tumors have been reported with good outcomes.
文摘Background:Liver cancer,particularly hepatocellular carcinoma(HCC),is a major global health concern,showing high recurrence and mortality rates.Chronic inflammation and oxidative stress are key factors in the development of HCC.Previous studies have shown that paracetamol,a common anti-inflammatory drug,preventsHCCby inhibiting the cyclooxygenase pathway and reducing inflammation and oxidative stress.This study aimed to investigate the hepatoprotective effects of acetaminophen against diethylnitrosamine(DEN)–induced HCC in male rats.Methods:Male Sprague-Dawley rats(5–6 weeks old,240–290 g)were divided into control and treatment groups(6 rats each).HCC was intraperitoneally induced with DEN(50 mg/kg body weight)in both groups once aweek for 10weeks.The treatment group also received acetaminophen(200 mg/kg per day)from one week before DEN administration until the 24th week.Liver function biomarkers(aspartate aminotransferase,alanine transaminase[ALT],α-fetoprotein,bilirubin,and albumin)were measured,and liver tissues histopathologically evaluated.Data were analyzed using SPSS software,using Shapiro-Wilk tests for normality and unpaired t tests for comparisons.Results:The acetaminophen group showed significant differences in aspartate aminotransferase,ALT,and bilirubin levels over time,which were higher than those of the control group(p<0.05).Rats in the control group exhibited substantial liver damage and early death,whereas those in the treatment group showed improved survival and liver function.Histopathological analysis revealed fewer necrotic and precancerous changes in the treatment group.Albumin levels were significantly associated with cirrhosis manifestation(p=0.005),and ALT and bilirubin levels correlated with precancerous conditions(p<0.05).Conclusions:Acetaminophen at 200 mg/kg body weight protected rat hepatocytes against DEN-induced liver damage and potential carcinogenesis.Our findings could serve as a basis for developing future research approaches in patients with HCC undergoing liver resection that are aimed at preventing recurrence and reducing inflammation.
文摘BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
文摘BACKGROUND Hepatic manifestations in chronic lymphocytic leukemia(CLL)are common:Elevation of liver enzymes frequently occurs,and differential diagnosis is often challenging.Liver infiltration by leukemic cells,primary and secondary hepatic malignancies,drug-induced hepatotoxicity,immunological disorders,and infections have been reported.Nevertheless,syncytial giant cell hepatitis(GCH)as a manifestation of autoimmune hepatitis in patients with CLL is an extremely rare condition,currently reported only in anecdotal cases.CASE SUMMARY Here,we report the case of a 62-year-old Caucasian woman affected by CLL,who developed GCH with peculiar histopathological features.The patient was evaluated for abnormal liver test results.Liver histology revealed significant inflammatory lymphomononuclear infiltrates with a plasma cell component,widespread syncytial changes in the hepatocytes with gigantocellular features,hepatocyte rosettes,and the typical feature of emperipolesis,consistent with a diagnosis of GCH.The patient was treated with corticosteroids and mycophenolate mofetil,resulting in a complete biochemical response.CONCLUSION Early histological diagnosis of GCH is crucial in patients with CLL,with mycophenolate mofetil representing a promising treatment option.
基金Supported by National Research Foundation of Korea Grant Funded by the Korea Government,No.RS-2023-00213951.
文摘BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.
基金the Sydney Local Health District Human Research Ethics Committee,No.2023/ETH01690.
文摘BACKGROUND Endocytoscopy is an advanced imaging modality that provides real-time,ultrahigh magnification views of the intestinal mucosa.In ulcerative colitis(UC),the combined assessment of endoscopic and histological remission is now becoming a standard practice.However,histological evaluation typically falls outside the scope of the endoscopist.By offering in vivo microscopic imaging,endocytoscopy has the potential to streamline workflow and enhance efficiency in assessing UC activity.AIM To evaluate the utility of real-time endocytoscopy in assessing endoscopic and histological disease activity in UC,and to validate endocytoscopic scoring systems.METHODS This study was conducted at Concord Hospital.Patients with UC who consented to undergo colonoscopy with endocytoscopy were enrolled.Data collected included patient demographics,clinical disease activity,Mayo endoscopic score(MES),and endocytoscopic features such as crypt architecture,intercrypt distance and cellular infiltration.Correlation between endocytoscopic findings were evaluated against MES and the Nancy histological index.Agreement and validation were assessed using the ErLangen Endocytoscopy in ColiTis(ELECT)score and the endocytoscopy score(ECSS),applying Kappa(κ)statistics and Spearman’s correlation coefficient(r).RESULTS A total of 61 colonic segments from 15 patients were assessed,with 187 analyzable endocytoscopic images.Endocytoscopy showed significant correlation with the MES using both the ECSS(κ=0.60,P<0.001;r=0.78,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.81,P<0.001)scoring systems.Similarly,correlations with the Nancy histological index were significant for both ECSS(κ=0.47,P<0.001;r=0.69,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.74,P<0.001).The ELECT score demonstrated superior diagnostic accuracy in identifying histological remission,with a sensitivity of 100%,specificity of 85%,and an area under the receiver operating characteristic curve of 0.90(95%confidence interval:0.78-1.00),compared to 68.3%,85%,and an area under the receiver operating characteristic curve of 0.88(95%confidence interval:0.75-1.00)for the ECSS.No serious adverse events occurred,except for transient urinary discoloration due to methylene blue excretion.CONCLUSION Endocytoscopy allows for real-time,simultaneous assessment of endoscopic and histological activity in UC and has been proven to be accurate,safe,and well-tolerated.Compared with the ECSS,the ELECT score showed superior concordance with histological findings.
基金VMR is funded by the AUA and Urology Care Foundation(Research Scholars Award)as well as an NIH NRSA training grant(5T32DK060442-20)HT is funded by the AUA and Urology Care Foundation(Research Scholars Award),SUFU(Chemodenervation Grant),and the Office of Faculty Development at Harvard Medical School.
文摘A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma.Tumor markers were unremarkable.A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord.Due to a suspicion of chronic torsion vs.malignancy,a left radical orchiectomy was performed.Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia,a rare entity.
基金Supported by Korean Society of Gastroenterology funded by Korea Research Foundation of Internal Medicine,No.KSG-2022-02.
文摘BACKGROUND Citrullination is a post-translational modification mediated by calcium-dependent peptidylarginine deiminases that results in notable changes in protein structure and function.Glial fibrillary acidic protein(GFAP),which is highly vulnerable to peptidylarginine deiminases-mediated modification,has been found to be elevated in activated hepatic stellate cells,with GFAP-positive hepatic stellate cells and myofibroblasts accumulating within and around areas of hepatic fibrosis.Although recent studies have shown that the expression of citrullinated GFAP(cit-GFAP)increases during hepatic fibrosis,its expression pattern and functional roles in hepatocellular carcinoma(HCC)remain unclear.AIM To determine whether cit-GFAP expression influences the recurrence and survival of patients undergoing hepatic resection for HCC.METHODS We retrospectively analyzed 169 patients with HCC who underwent hepatic resection.Based on the immunohistochemical staining of resected specimens,the enrolled patients were stratified into two groups according to cit-GFAP expression:Low(-/1+)or high(2+/3+)levels of expression.Kaplan-Meier survival curves were constructed to assess overall survival and recurrence-free survival,and comparisons between groups were performed using the log-rank test.RESULTS The median follow-up duration was 33 months(range,1-183).High cit-GFAP expression,identified in 81 patients(48.2%),was significantly associated with male sex,hepatitis B virus positivity,and higher Edmonson-Steiner grade.No associations were found between age,diabetes,hypertension,cirrhosis,Child-Pugh classification,major portal vein invasion,hematological or biochemical parameters,tumor size,or number.Patients exhibiting high cit-GFAP expression demonstrated significantly poorer overall survival.Multivariate Cox analysis identified large tumor size(hazard ratio:2.967;95%confidence interval:1.097-8.024;P=0.032)and high cit-GFAP expression(hazard ratio:2.753;95%confidence interval:1.015-7.464;P=0.047)as independent predictors of poor postoperative survival.Although recurrence rates were high in patients with high cit-GFAP expression,the difference was not statistically significant.CONCLUSION Following curative resection in patients with HCC,high cit-GFAP expression may serve as a potential prognostic biomarker,although further validation through independent cohort studies is warranted.
基金Supported by Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science and Technology of Japan,No.25K10147.
文摘BACKGROUND Pancreatic neuroendocrine microtumors(PNEMTs)are small(<5 mm),nonfunctioning,well-differentiated neuroendocrine neoplasms.Although they are rare,they are not invariably benign.PNEMTs are typically discovered incidentally during autopsy.However,data regarding the occurrence of PNEMTs in the elderly population,particularly those identified incidentally in cadaveric studies,remain limited.AIM To investigate the prevalence and histopathological characteristics of PNEMTs in elderly individuals by analyzing cadaveric pancreatic tissues.METHODS We conducted a retrospective analysis of 85 pancreatic specimens(age range:58-109 years)obtained from cadavers for anatomical education and research at the Department of Life Dentistry,Nippon Dental University.Paraffin sections of the pancreatic head,body,and tail were prepared for histological and immunohistochemical analysis.RESULTS Five cases with PNEMTs(5/85,5.9%;male,n=33;female,n=52;mean age:85.8±12.1 years)were identified.The tumors were solitary,well circumscribed,and located within the pancreatic parenchyma(body:n=4;tail:n=1),and all were<5 mm(range:0.54-2.20 mm)in size.All tumors showed strong chromogranin A and synaptophysin positivity,and were predominantly glucagon(GLU)-positive.Ki-67 immunostaining indicated minimal proliferative activity;therefore,these tumors were considered non-functioning,GLU-producing,well-differentiated grade 1 PNEMTs.CONCLUSION Small,predominantly low-grade,GLU-secreting PNEMTs were present in 5.9%of elderly individuals,highlighting the prevalence of subclinical PNEMTs and the need for careful follow-up.
文摘Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), multifactorial diseases due to obesogenic environment (availability of convenience food, media influence, etc.), psycho-social factors (social support systems, cultural/environmental influence, etc.) and genetic variants. Other causes are a subgroup of etiological factors (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Obesity is measured clinically by several common tools apart from body mass index (BMI), such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and neck circumference. WC and WHR are common tools for measuring central obesity while BMI measures generalized obesity. Aims: The goal of this study is to assess the prevalence of obesity amongst health workers of David Umahi Federal University Teaching Hospital, Uburu, Ebonyi state, Southeast Nigeria and to note the prevailing factors. A reliable estimate of the prevalence of obesity among health workers will contribute to the statistics needed to sway policymakers in the country to take urgent and substantial action on the increasing prevalence of obesity, especially in the healthcare industry. Methodology: The study was carried out between May 2024 and June 2024 at the David Umahi Federal University Teaching Hospital situated in Uburu, Ohaozara Local government area of Ebonyi state, Southeast Nigeria. The questionnaire was designed using the Finnish diabetic risk score (FINDRISC). It contained basic comprehending questions on age, gender, exposure to high blood pressure medication, and anthropometric measurement amongst others. Weight was taken with a portable weighing scale and height, with a stadiometer. Both were taken with shoes and headgear removed. The BMI was calculated using the weight (kg) divided by the square of the height (m2). Result: Generally, the prevalence of obesity (>30 kg/m2) in this study was low 17.6% (38), Overweight (BMI 25 - 30), 38.9%, (84) healthy Weight, (BMI 18.5 - 24.9), 43.5% (94). The study revealed that a family history of diabetes was significantly related to higher BMI, with participants more likely to be overweight or obese (p = 0.00030). Similarly, participants with a personal history of diabetes were predominantly in the obese category (p = 0.00038). Waist circumference also showed a strong association with BMI, as larger waist measurements were more common among obese individuals (p = 9.2 × 10−8). In contrast, the analysis found no significant relationships between BMI and age, gender, high blood pressure, or exercise habits. Conclusion: The socio-demographic determinants of obesity in this study were gender, age < 45 years and exposure to exercise. These determinants should form the areas of focus for interventions such as health education and the design of work environments as environments designed to promote physical activities while working will reduce the prevalence of obesity in tertiary institutions.
文摘Background: Diarrheal diseases have globally decreased over the past few decades, yet they remain one of the top three causes of mortality in children under five years, especially in sub-Saharan Africa and Nigeria. Seasonal peaks of diarrheal episodes continue to contribute significantly to childhood mortality in these regions. One of the notable causes of diarrhea in children is parasitic infections, particularly Cryptosporidium, which poses a serious health risk. In Nigeria, the burden of Cryptosporidium diarrhea is under-researched, making it imperative to investigate its prevalence and associated risk factors. Study Objectives: The study aims to determine the prevalence and risk factors associated with Cryptosporidium diarrhea among children aged five years and below in selected health institutions in Abakaliki, South-East Nigeria. Methodology: This cross-sectional study was conducted from January to May 2017, recruiting 200 children under five years with diarrhea from health institutions in Abakaliki. Fecal specimens were analyzed for Cryptosporidium oocysts using light microscopy with modified Ziehl-Neelsen staining and immunofluorescent antibody test (IFAT). Deoxyribonucleic acid (DNA) was extracted from positive samples using QIAmp® DNA stool kit, followed by Polymerase Chain Reaction (PCR) and molecular genotyping. Results: Cryptosporidium was detected in 0.5% (1/200) of children via light microscopy and 6.5% (13/200) via IFAT. All positive samples were confirmed as Cryptosporidium hominis by PCR. The prevalence of infection was significantly higher in children from institutionalized homes (50.0%) compared to monogamous homes (6.2%) (p Conclusion: Cryptosporidium hominis is a notable cause of diarrhea among children in Abakaliki, primarily transmitted through human-to-human contact. The study underscores the need for targeted interventions in childcare institutions to prevent outbreaks. Health authorities should promote breastfeeding and enhance education on hygiene practices in vulnerable populations.
基金supported by National Medical Research Council Sin‐gapore,National Medical Research Council Singapore(grant numbers:TA20nov-0011,NMRC/CSA‐INV/0027/2018,CSAINV20nov‐0021)Duke‐NUS Oncology Academic Program+2 种基金Goh Foundation Proton Research ProgramNCCS Cancer FundKua Hong Pak Head and Neck Cancer Research Program.
文摘Objective:Focal therapy(FT)is a potential treatment option for limited-volume clinically-significant prostate cancer(csPCa).However,despite rigorous selection,approximately 20%of patients experience early failure.We investigated the association of transcriptomic profiles and csPCa recurrence post-FT.Methods:52 men from a phase II trial(NCT04138914)and a prospective observational cohort underwent focal cryotherapy for csPCa.Patients underwent multiparametric magnetic resonance imaging,and targeted and systematic-saturation biopsy before-and 1-year post-FT.Recurrence was defined as grade-group(GG)≥2 cancer in the 1-year post-FT biopsy.Pre-treatment lesions were profiled using the Decipher genomic classifier(GC).GC scores,luminal-basal status,tumor microenvironment and cancer hallmark pathways were correlated with csPCa recurrence.Results:Median PSA was 7.0 ng/dl;37/52(71.1%)men had GG2,12/52(23.1%)GG3,and 3/52(5.8%)GG4 cancer.Recurrence was observed in 9/52(17.3%)men.Median GC score was higher in patients with recurrence(0.60 vs 0.38,P=0.014)and remained significantly associated with recurrence after adjustment for GG(adjusted OR:1.37[95%CI:1.01-1.93],P=0.04).Luminal-proliferative tumors based on the prostate cancer-specific subtyping classifier(PSC)had more csPCa recurrence compared with luminal-differentiated(LD)and basal subtypes(30.4%vs 0%[LD]vs 15.4%[basal-neuroendocrine]and 14.3%[basal-immune],P=0.027).Higher expression of DNA repair pathway was also associated with recurrence(OR:2.12[95%CI:1.09-4.57],P=0.025).Conclusions:Higher GC score is associated with risk of csPCa recurrence post-FT.Patients with GC low-risk and PSC-LD csPCa may represent the ideal subgroup for FT.Prospective validation in a large cohort is warranted.
文摘AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS:We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori ) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI:67-92), a specificity of 96% (95%CI:93-99), a positive predictive value of 84% (95%CI:73-96), a negative predictive value of 95% (95%CI:92-98), and an accuracy of 93% (95%CI:90-97). The NBI-ME examination overlooked GIM in 8 cases, but the GIM was less than 5% in 7 of the cases. Moreover, in the 6 false positive cases, the histological examination showed the presence of reactive gastropathy (4 cases) or H. pylori active chronic gastritis (2 cases). The semiquantitative correlation between the rate of LBC appearance and the percentage of GIM was 79% (P < 0.01). CONCLUSION:NBI-ME achieved good sensitivity and specificity in recognising GIM in an unselected population. In routine clinical practice, this technique can reliably target gastric biopsies.
基金Supported by Buddhist Dalin Tzu Chi General Hospital
文摘AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examination data from 9311 healthy subjects with overnight physical examinations performed between January 2004 and December 2006. Examined data included gender, age, life style, anthropometric measurements, blood pressure, biochemical and hematological studies, H. pylori infection detected by esophagogastroduodenoscopy and biopsy urease tests, and colorectal adenomas detected with a complete total colonoscopy. RESULTS: The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% conf idence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas. CONCLUSION: Our study revealed H. pylori infection with concomitant metabolic syndrome might further increase the risk of colorectal adenomas.
基金Supported by Grants from Coordenao de Aperfeioamentode Pessoal de Nível Superior
文摘AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status. METHODS: IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens froma consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ2 test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer. RESULTS: The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (k=0.50) and low for BVI (k=0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P=0.001, P=0.013, and IHC: P=0.001, P=0.019). The mor-phologic features associated with LVI were location of the tumor in the distal third of the stomach (P=0.039), Borrmann's macroscopic type (P=0.001), organ inva-sion (P=0.03) and the depth of tumor invasion (P=0.001). The presence of BVI was related only to the depth of tumor invasion (P=0.003). CONCLUSION: The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.
文摘AIM To establish a threshold value for liver fat content between healthy children and those with nonalcoholic fatty liver disease(NAFLD) by using magnetic resonance imaging(MRI), with liver biopsy serving as a reference standard. METHODS The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel pointresolved 1H MR-Spectroscopy(1H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cutoff value. Lin coefficient test was used to evaluate thecorrelation between histology, MRS and MRI-PDFF. A Mann-Whitney U-test and multivariate analysis were performed to analyze the continuous variables. RESULTS According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF.CONCLUSION MRS is an accurate and precise method for detecting NAFLD in children.
