Long-Term Recurrence of Nonmelanoma Skin Cancer after Topical Methylaminolevulinate Photodynamic Therapy in a Dermato-Oncology Department

BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therapy from 2004 to 2008. Treatment protocol and clinical follow-up were standardized. The primary endpoint was clinically observed recurrence in a previous photodynamic therapy-treated area. Descriptive and survival analyses were performed. RESULTS: A total of 31 Bowen's disease lesions and 44 superficial basal cell carcinoma were treated, with a median follow-up of 43.5 months. Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in 11 superficial basal cell carcinoma (33.3%). Significantly higher estimates for recurrence rates were found in patients with Bowen's disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of recurrence was higher in patients with Bowen's disease than in those with superficial basal cell carcinoma and younger patients. CONCLUSIONS: Recurrence should be considered when choosing to treat non-melanoma skin cancer with photodynamic therapy. Younger age and Bowen's disease were independent predictors for long-term recurrence, suggesting the need to establish an extended period of follow-up for this subset of patients

Planting dates in relation to weather pattern at Manaus, Brazil.

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Three-body description of direct nuclear reactions: Comparison with the continuum discretized coupled channels method

The continuum discretized coupled channels (CDCC) method is compared to the exact solution of the three-body Faddeev equations in momentum space. We present results for: i) elastic and breakup observables of d-12C at E_d=56 MeV, ii) elastic scattering of d-58Ni at E_d=80 MeV, and iii) elastic, breakup and transfer observables for 11Be+p at E_{11Be}/A=38.4 MeV. Our comparative studies show that, in the first two cases, the CDCC method is a good approximation to the full three-body Faddeev solution, but for the 11Be exotic nucleus, depending on the observable or the kinematic regime, it may miss out some of the dynamic three-body effects that appear through the explicit coupling to the transfer channel.Comment: 12 pages, 10 figures, accepted for publication in Physical Review

Prenatal diagnosis of idic(9)

Tetrasomy of the short arm of chromosome 9 is a rare chromosome imbalance that may result from a supernumerary isochromosome 9 with the most recurrent breakpoints being 9p10, 9q12 and 9q13. On ultrasound, it usually presents with intrauterine growth restriction (IUGR), abnormal facial profile and ventriculomegaly. However, few reports establish a correlation between fetal features and the size of isochromosome or the presence of isodicentric 9. We report the clinical case of a 32-year-old pregnant woman, G2P1, underwent amniocentesis at 13 weeks of gestation with fetal increased nuchal translucency (7mm). The fetus also presented IUGR, cystic higroma, generalized subcutaneous edema, cardiac malformations, facial anomalies and fetal death. The karyotype was performed by standard in situ methods. Fluorescence in situ hybridization (FISH) was performed using centromeric probe CEP9. Conventional cytogenetic and FISH analyses revealed a supernumerary chromosome idic(9)(q12) in all cells examined. After counseling the couple opted for termination of pregnancy. The post-mortem analysis revealed a single umbilical arteria, IUGR, cystic higroma, facial dysmorphism with cleft lip and palate, hypertelorism and low set ears. These findings are in accordance with other reports. Nevertheless, the hypertelorism is not commonly described and such an early detection of a cardiac anomaly is uncommon. Additionaly the fetal death occurred early than in the most cases described in literature. Although breakpoint position effect on the severity on the phenotype is not consensual it has proposed that cases presenting with breakpoints on p10, on q12 or on q13 show a similar phenotype. However, cardiac defects seem more frequent on cases in which the abnormality includes 9q material. This work aims to contribute to a better karyotype-phenotype correlation in cases with tetrasomy 9p and isodicentric chromosomes idic(9)

Long-Term Evaluation of Recurrence after Photodynamic Therapy with Topical Methyl Aminolevulinate for Non-Melanoma Skin Cancer: a Hospital-Based Study

Introduction & Objectives: Several factors may influence the decision to pursue nonsurgical modalities for the treatment of non-melanoma skin cancer. Topical photodynamic therapy (PDT) is a non-invasive alternative treatment reported to have a high efficacy when using standardized protocols in Bowen’s disease (BD), superficial basal cell carcinoma (BCC) and in thin nodular BCC. However, long-term recurrence studies are lacking. The aim of this study was to evaluate the long-term efficacy of PDT with topical methylaminolevulinate (MAL) for the treatment of BD and BCC in a dermato-oncology department. Materials & Methods: All patients with the diagnosis of BD or BCC, treated with MAL-PDT from the years 2004 to 2008, were enrolled. Treatment protocol included two MAL-PDT sessions one week apart repeated at three months when incomplete response, using a red light dose of 37-40 J/cm2 and an exposure time of 8’20’’. Clinical records were retrospectively reviewed, and data regarding age, sex, tumour location, size, treatment outcomes and recurrence were registered. Descriptive analysis was performed using chi square tests, followed by survival analysis with the Kaplan-Meier and Cox regression models. Results: Sixty-eight patients (median age 71.0 years, P25;P75=30;92) with a total of 78 tumours (31 BD, 45 superficial BCC, 2 nodular BCC) and a median tumour size of 5 cm2 were treated. Overall, the median follow-up period was 43.5 months (P25;P75=0;100), and a total recurrence rate of 33.8% was observed (24.4 % for BCC vs. 45.2% for BD). Estimated recurrence rates for BCC and BD were 5.0% vs. 7.4% at 6 months, 23.4% vs. 27.9% at 12 months, and 30.0% vs. 72.4% at 60 months. Both age and diagnosis were independent prognostic factors for recurrence, with significantly higher estimated recurrence rates in patients with BD (p=0.0036) or younger than 58 years old (p=0.039). The risk of recurrence (hazard ratio) was 2.4 times higher in patients with BD compared to superficial BCC (95% CI:1.1-5.3; p=0.033), and 2.8 times higher in patients younger than 58 years old (95% CI:1.2-6.5; p=0.02). Conclusions: In the studied population, estimated recurrence rates are higher than those expected from available literature, possibly due to a longer follow-up period. To the authors’ knowledge there is only one other study with a similar follow-up period, regarding BCC solely. BD, as an in situ squamous cell carcinoma, has a higher tendency to recur than superficial BCC. Despite greater cosmesis, PDT might no be the best treatment option for young patients considering their higher risk of recurrence.Introduction & Objectives: Several factors may influence the decision to pursue nonsurgical modalities for the treatment of non-melanoma skin cancer. Topical photodynamic therapy (PDT) is a non-invasive alternative treatment reported to have a high efficacy when using standardized protocols in Bowen’s disease (BD), superficial basal cell carcinoma (BCC) and in thin nodular BCC. However, long-term recurrence studies are lacking. The aim of this study was to evaluate the long-term efficacy of PDT with topical methylaminolevulinate (MAL) for the treatment of BD and BCC in a dermato-oncology department. Materials & Methods: All patients with the diagnosis of BD or BCC, treated with MAL-PDT from the years 2004 to 2008, were enrolled. Treatment protocol included two MAL-PDT sessions one week apart repeated at three months when incomplete response, using a red light dose of 37-40 J/cm2 and an exposure time of 8’20’’. Clinical records were retrospectively reviewed, and data regarding age, sex, tumour location, size, treatment outcomes and recurrence were registered. Descriptive analysis was performed using chi square tests, followed by survival analysis with the Kaplan-Meier and Cox regression models. Results: Sixty-eight patients (median age 71.0 years, P25;P75=30;92) with a total of 78 tumours (31 BD, 45 superficial BCC, 2 nodular BCC) and a median tumour size of 5 cm2 were treated. Overall, the median follow-up period was 43.5 months (P25;P75=0;100), and a total recurrence rate of 33.8% was observed (24.4 % for BCC vs. 45.2% for BD). Estimated recurrence rates for BCC and BD were 5.0% vs. 7.4% at 6 months, 23.4% vs. 27.9% at 12 months, and 30.0% vs. 72.4% at 60 months. Both age and diagnosis were independent prognostic factors for recurrence, with significantly higher estimated recurrence rates in patients with BD (p=0.0036) or younger than 58 years old (p=0.039). The risk of recurrence (hazard ratio) was 2.4 times higher in patients with BD compared to superficial BCC (95% CI:1.1-5.3; p=0.033), and 2.8 times higher in patients younger than 58 years old (95% CI:1.2-6.5; p=0.02). Conclusions: In the studied population, estimated recurrence rates are higher than those expected from available literature, possibly due to a longer follow-up period. To the authors’ knowledge there is only one other study with a similar follow-up period, regarding BCC solely. BD, as an in situ squamous cell carcinoma, has a higher tendency to recur than superficial BCC. Despite greater cosmesis, PDT might no be the best treatment option for young patients considering their higher risk of recurrence

Recidiva de Cancro Cutâneo Não-Melanoma após Terapêutica Fotodinâmica num Serviço de Dermatologia

Introdução: São escassos os estudos de eficácia a longo prazo da terapêutica fotodinâmica(TFD) no tratamento da doença de Bowen (DB) e do carcinoma basocelular (CBC). Objectivos: Determinar a eficácia a longo prazo da TFD com metilaminolevulinato (MAL) no tratamento da DB e do CBC pela análise de recidiva. Material e método: Foram analisados retrospectivamente os processos clínicos de doentes com o diagnóstico de DB ou CBC tratados com TFD-MAL num serviço de Dermato- Oncologia entre 2004 e 2008. Foi efectuada a análise descritiva dos dados pelo teste do chiquadrado, seguida da análise de sobrevivência pelos métodos de Kaplan-Meier e regressão de Cox. Resultados: Foram tratados 68 doentes (mediana etária 71 anos, P25;P75=30;92) com um total de 78 tumores (31 DB, 45 CBC superficiais, 2 CBC nodulares finos). No período de seguimento efectuado (mediana 43,5 meses, P25;P75=0;100) observou-se uma taxa de recidiva de 25% no CBC e 45,2% na DB. As taxas de recidiva estimadas para os CBC e DB foram de 5,0% vs. 7,4% aos 6 meses, 23,4% vs. 27,9% aos 12 meses e de 30,0% vs. 72,4% aos 60 meses. Idade e diagnóstico constituíram factores independentes de prognóstico, com taxas de recidiva significativamente maiores nos doentes com DB (p=0,0036) ou com menos de 58 anos (p=0,039). De modo semelhante, o risco de recidiva foi 2,4 vezes superior nos doentes com DB face àqueles com CBC (p=0,033) e 2,8 vezes maior em doentes com menos de 58 anos (p=0,02). Conclusões: Na população estudada, a taxa de recidiva foi superior àquela encontrada na literatura. A TFD pode não ser a melhor opção para o tratamento do cancro cutâneo nãomelanoma em doentes mais jovens, em particular na doença de Bowen. Apesar do melhor resultado cosmético, o risco de recidiva deve ser equacionado e a escolha terapêutica deve ser ponderada caso a caso

Responsiveness to pulmonary rehabilitation is related with changes in oral microbiota of people with COPD

Introduction: Pulmonary Rehabilitation (PR) is one of the most cost-effective therapies for chronic obstructive pulmonary disease (COPD), with proven benefits in domains such as exercise capacity and quality of life. Despite its clear benefits, patients are not equal-ly responsive to PR. Reasons behind that as well as the role of the airway microbiota in PR effectiveness are currently unknown.Objectives: Here, we explored for the first time, the effects of PR on oral microbiota and inflammatory markers and the link with responsiveness to PR. Study design: 76 participants were enrolled in this prospective cohort study, half of whom integrated a 12-week PR program. During the 6-month follow-up, a total of 417 saliva samples, and data on dyspnoea during exercise (mBorg), exercise capacity (6MWT) and impact of the disease (CAT) were collected. PR responsiveness was defined as overcoming the published minimal clinically important difference for mBorg (-1 point), 6MWT (25m) and CAT (-2 points).Results: PR modulated patients’ microbiota composition and dy-namics. Specifically, an enrichment of Proteobacteria (Haemophi-lus) and a depletion in Bacteroidetes (Prevotella), previously as-sociated with increased severity (Melo-Dias et al, Respir Res 2022), were observed upon PR. We also observed changes in the levels of IL-1b, TNF-a and IL-10. When separating patients in responders (R) and non-responders (NR), distinct patterns of bacteria/bacteria and bacteria/inflammatory marker longitudinal correlation were ob-served among the groups. In R, the increase in Prevotella nega-tively correlated with Lautropia (enriched in most severe cases of COPD (Melo-Dias et al., Respir Res 2022)). The opposite trend was observed in NR, with Lautropia showing a positive correlation with several pro-inflammatory markers. Conversely, in all groups of R, Rothia and Gemellaceae presented negative correlations with sev-eral pro-inflammatory markers. Conclusions: Overall, despite responsiveness to PR being multidi-mensional and heterogeneous, giving rise to a moderate overlap across domains in individual response, PR-induced changes in mi-crobiota revealed surprisingly consistent patterns among R and NR. Future studies should address the implications and stability of these findings.publishe