Glucose transporter expression and the potential role of fructose in renal cell carcinoma: a correlation with pathological parameters

[Abstract] All mammalian cells contain one or more members of the facilitative glucose transporter (GLUT) gene family. Glucose transporter membrane proteins (GLUT) regulate the movement of glucose between the extracellular and intracellular compartments, maintaining a constant supply of glucose available for metabolism. Tumor cells are highly energy-dependent, therefore GLUT overexpression is often observed. In fact, overexpression of GLUT1 has been correlated with hypoxia markers in several tumor types, including renal cell carcinoma (RCC). We retrospectively analyzed 80 paraffin-embedded RCC samples. The pattern of GLUT1-5 expression in RCC specimens was evaluated using tissue-array technology and correlated with histological tumor characteristics. Pathological parameters included tumor location, renal pelvis, vein and lymph vessel invasion, capsule breakage, histological subtype, Furhman grade, hilar invasion and tumor stage at diagnosis. The expression of five facilitative glucose transporters, GLUT1 (erythrocyte type), GLUT2 (liver type), GLUT3 (brain type), GLUT4 (muscle/fat type) and GLUT5 (small intestinal type), was semi-quantitatively analyzed. In non-parametric, Mann-Whitney U and Kruskal-Wallis tests, a significant positive correlation was consistently found between moderately differentiated RCC tissues and the expression of GLUT5 (p=0.024). Patients who had pelvic invasion and capsule breakage at diagnosis also showed increased GLUT5 expression levels (p=0.039 and p=0.019, respectively). Moreover, GLUT5 showed statistical significance in those samples identified as being of clear cell histological type (p=0.001). A high expression of GLUT5 in human RCC was observed. GLUT5 appears to be correlated with grade II differentiation, locoregional invasion and aggressiveness, and may play a role in RCC development

Exercicios literarios de rudimentos, syntaxis, propiedad latina, poetica, retorica, filosofia y matematicas que se han de tener en el Real Seminario de Nobles de esta corte los dias [23, 24, 29 y 30] de diciembre de 1778 por la mañana a las [10] por la tarde a las [3 1/2]

Contiene: Certamen público de rudimentos y syntaxis, que en este Real Seminario de Nobles tendrán algunos caballeros seminaristas ... el dia [23] de diciembre de 1778 baxo la direccion de su maestro D. Angel Vazquez Millan...; Certamen público de la buena version y propiedad latina que en este Real Seminario de Nobles ... baxo la direccion de su maestro D. Juan de Arribas y Soria; Certamen público de Poética y Retórica que en este Real Seminario de Nobles tendrán algunos caballeros seminaristas ... baxo la direccion de su maestro D. Manuel Blanco Valbuena ...; Theses philosophiae practicae propugnandae a D. Joanne Loftus et Bazan et D. Francisco Arriaza et superviela ... patrono D. Bernardo Joachin Danvila et Villarrasa ..., Certamen público de Matemáticas, Geometría y Aritmética que ... tendrán ... Pedro Tineo Ramirez ... y JOseph Solano y Ortiz asistidos de su maestro Joseph Antonio Igaregui...Las fechas del tít. relativas a los certámenes aparecen ms. en el espacio en blanco que, tipográficamente, se dejó a tal efectoMarca tip. en ports.Sign.: [ ]10, [ ]2, B-D2, [ ]2, a-o2, p1Cada parte con port. propi

Exercicios literarios de rudimentos, syntaxis, propiedad latina, poetica, retorica, filosofia, matematicas y historia que se han de tener en el Real Seminario de Nobles de esta corte los dias [15, 16, 17 y 18] de diciembre de 1776 por la mañana a las [10] por la tarde a las [3 1/2]

Contiene: Certamen público de rudimentos y syntaxis, que en este Real Seminario de Nobles tendrán algunos caballeros seminaristas el dia 15 de diciembre de 1776 baxo la direccion de su maestro D. Angel Vazquez Millan; Certamen público de la buena version y propiedad de la lengua latina que en este Real Seminario de Nobles el dia 15 de diciembre de 1776 baxo la direccion de su maestro D. Juan de Arribas y Soria; Certamen público de Poética y Retórica que en este Real Seminario de Nobles tendrán algunos caballeros seminaristas el dia 16 de diciembre de 1776 baxo la direccion de su maestro D. Manuel Blanco Valbuena; Exercitationes philosophiae practicae in quibus continentur dissertatio de finibus bonorum et malorum ... quas publico offert examini D. Josephus Solano et Ortiz ..., patrono D. Bernardo Joachin Danvila y Villarasa .., Certámenes públicos de Matemáticas que ... tendrán ... Juan Antonio Montes de la Puente ... y Juan Nepomuceno Bernuy y Heredia ...; Certamen público de Geografía é Historia ... baxo la dirección de su maestro D. Antonio CarbonelLas fechas del tít. relativas a los certámenes aparecen ms. en el espacio en blanco que, tipográficamente, se dejó a tal efectoMarca tip. en ports.Sign.: [ ]6, A4, A-L2, [ ]4, B-M2, [ ]2, b-n2, A4Cada parte con port. propi

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy