Laparoscopic lymph node biopsy for lymphoma with a novel use of indocyanine green fluorescence in a 66-year-old male patient

Introduction: Indocyanine green (ICG) near-infrared fluorescence is primarily employed in detecting Intraoperative sentinel lymph node (SLN) mapping or to evaluate the extent of radical lymphadenectomy mainly in colo-rectal and gastric cancer. To date there are no reports indicating the use of this dye to detect pathologic lymphatic tissue when a lymph node biopsy for suspected lymphoproliferative disease is performed. Presentation of case: A 66-year-old male patient was admitted to the hospital for severe pain of left renal colic type. A computed tomography (CT) scan and a positron emission tomography (PET) showed a left hydroureteronephrosis due to ureter compression by paraortic solid tissue of lymphomatous aspect with a standardized uptake value (SUV) of 15. Multiple lymphadenopathies on paracaval, para-aortic and common iliac sites were present as well. Discussion: A laparoscopic lymph node biopsy (LLB) was planned for diagnostic purposes. After induction of anesthesia a ICG solution was injected Intradermally at both inguinal regions. At laparoscopy a complete visualization of the pathologic lymphnodes was achieved, enabling incisional biopsies of the lymphomatous mass. Histopathological examination showed an extranodal localization of an aggressive B-cell non-Hodgkin lymphoma. Conclusion: ICG-fluorescence seems to offer a simple and safe method for pathologic lymph node detection. LLB in the suspicion of intra abdominal lymphoma can largely take advantage by this novel opportunity not yet tested to date. More studies with large case series are needed to confirm the efficacy of ICG-fluorescence for detecting pathologic lymph nodes

CD19-Targeted Immunotherapies for Diffuse Large B-Cell Lymphoma

Surgical resection, chemotherapy and radiotherapy were, for many years, the only available cancer treatments. Recently, the use of immune checkpoint inhibitors and adoptive cell therapies has emerged as promising alternative. These cancer immunotherapies are aimed to support or harness the patient\u2019s immune system to recognize and destroy cancer cells. Preclinical and clinical studies, based on the use of T cells and more recently NK cells genetically modified with chimeric antigen receptors retargeting the adoptive cell therapy towards tumor cells, have already shown remarkable results. In this review, we outline the latest highlights and progress in immunotherapies for the treatment of Diffuse Large B-cell Lymphoma (DLBCL) patients, focusing on CD19-targeted immunotherapies. We also discuss current clinical trials and opportunities of using immunotherapies to treat DLBCL patients

Effects of different diet alternatives to replace the use of pharmacological levels of zinc on growth performance and fecal dry matter of weanling pigs

A total of 300 weanling pigs (Line 400 × 200, DNA, Columbus, NE, initially 4.83 kg) were used in a 46-d trial to evaluate the effects of different nutritional strategies to replace pharmacological levels of Zn, provided by zinc oxide (ZnO), in nursery diets on growth performance and fecal dry matter (DM). Six treatments with 10 replicate pens per treatment and 5 pigs per pen were used. Diets consisted of: (1) positive control (ZnO providing 3,000 mg/kg added Zn from d 0 to 7 and 2,000 mg/kg added Zn from d 8 to 25 and 21% crude protein, CP); (2) negative control (NC; no added ZnO); (3) NC plus 1.2% Na diformate; (4) NC with 4% coarse ground wheat bran; (5) NC but formulated to 18% CP; and (6) the combination of NC with 18% CP, 1.2% Na diformate, and 4% coarse ground wheat bran. The diets formulated to 18% CP contained 1.2% standardized ileal digestible (SID) Lys from d 0 to 25, whereas the 21% CP diets contained 1.4% SID Lys from d 0 to 7 and 1.35% SID Lys from d 7 to 25. From d 25 to 46, all pigs were fed a common diet. From d 0 to 7, no differences in any variables were observed between treatments. From d 7 to 25, pigs fed the diet with added ZnO had greater (P < 0.01) average daily gain (ADG) and average daily feed intake (ADFI) than all other treatments. Pigs fed the diet formulated to 18% CP had decreased (P < 0.01) ADG when compared with pigs fed the other diets. From d 25 to 46, no previous treatment effects on ADG or gain to feed ratio (G:F) were observed. Overall (d 0 to 46), pigs fed the diet with added ZnO from d 0 to 25 had greater (P < 0.01) ADG, ADFI, and final body weight than pigs fed added Na Diformate, or 4% coarse ground wheat bran, or with the 18% CP diet, or with pigs fed the combination of the additives intermediate. There was no evidence for differences in overall G:F. Pigs fed the NC diet had the lowest fecal DM and highest fecal scores (P < 0.05), indicating the greatest incidence of loose stools. Pigs fed added ZnO had greater fecal DM than pigs fed the NC, 4% added wheat bran, or 18% CP diets, or with pigs fed the combination of additives intermediate (P < 0.01). These results suggest that adding pharmacological levels of Zn from ZnO improves nursery pig performance and increases DM content of feces when compared with pigs fed diets with either Na diformate, 4% course wheat bran, or 18% CP alone. However, a combination of all three alternatives appeared to be additive and partially restored growth performance similar to adding pharmacological levels of Zn

Impact of immunochemotherapy with R-bendamustine or R-CHOP for treatment naïve advanced-stage follicular lymphoma: A subset analysis of the FOLL12 trial by Fondazione Italiana Linfomi

We conducted a post hoc analysis of the FOLL12 trial to determine the impact of different initial immunochemotherapy (ICT) regimens on patient outcomes. Patients were selected from the FOLL12 trial, which included adults with stage II–IV follicular lymphoma (FL) grade 1–3a and high tumor burden. Patients were randomized 1:1 to receive either standard ICT followed by rituximab maintenance (RM) or the same ICT followed by a response-adapted approach. ICT consisted of rituximab-bendamustine (RB) or rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP), per physician's decision. A total of 786 patients were included in this analysis, 341 of whom received RB and 445 R-CHOP. RB was more frequently prescribed to older subjects, females, patients without bulky disease, and those with grade 1–2 FL. After a median of 56&nbsp;months of follow-up, R-CHOP and RB had similar progression-free survival (PFS) (Hazard Ratio for RB 1.11, 95% CI 0.87–1.42, p&nbsp;=&nbsp;0.392). Standard RM was associated with improved PFS compared to response-adapted management both after R-CHOP and RB. Grade 3–4 hematologic adverse events were more frequent with R-CHOP during induction treatment and more frequent with RB during RM. Grade 3–4 infections were more frequent with RB. RB was also associated with a higher incidence of transformed FL. R-CHOP and RB showed similar activity and efficacy, but with different safety profiles and long-term events, suggesting that the treating physician should carefully select the most appropriate chemotherapy regimen for each patient based on patient's individual characteristics, choices, and risk profile

EARLY METABOLIC RESPONSE IN FOLLICULAR LYMPHOMA: A SUBSET ANALYSIS OF THE FOLL12 TRIAL BY THE FONDAZIONE ITALIANA LINFOMI (FIL)

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Tracing the combustion of coal blends in a thermobalance by optical microscopy

Combustion at programmed temperature in a thermobalance is a common test for the rapid assessment of coal combustibility. In this study two series of blends (low rank/medium rank coal-AB and low rank /petroleum coke-AC) with the low rank coal in three different proportions (1/4, 2/4 and 3/4) have been tested.Ministry of Education (Ministerio de Educación), Project PSE2-2005. Consejo Superior de Investigaciones Científicas, CSICCNPq, Project 2005BR00054. CNPq, Project CNPq/CSIC 491127/2005-7.Peer reviewe

Tris(8-hydroxyquinolinato)gallium(III)-loaded copolymer micelles as cytotoxic nanoconstructs for cosolvent-free organometallic drug delivery

Therapeutically useful concentrations of the water-insoluble organometallic drug, tris(8-hydroxyquinolinato)gallium(III), are delivered to haematological cell lines without the need for toxic cosolvents. Delivery is by sequestration into aqueous micelles of a poly(ethylene glycol)/poly(propylene glycol)/poly(ethylene glycol) triblock copolymer using a facile method based on emulsion-mediated evaporation. The drug-loaded micelles function as a cell cycle inhibitor and cause cell death by a dose-dependent increase in apoptosis

Management of early stage chronic myeloid leukemia: State-of-the-art approach and future perspectives

Tyrosin Kinase inhibitors (TKI), have dramatically changed the natural history of chronic myeloid leukemia (CML) leading to an impressive increase in overall survival rates and allowing many CML patients to achieve a close-tonormal life expectancy. Unfortunately, there is growing evidence that these drugs are not curative, about 30-35% of the patients who receive imatinib become resistant or discontinue the drug because of side effects; moreover, 15% of all patients become resistant to all TKIs, a condition which represents the biggest challenge in CML treatment. Recent progresses in CML stem cell biology have identified new agents and therapeutic strategies that can be used to target the CML stem cell compartment. These studies have opened new perspectives and have highlighted key strategies for treating, and possibly curing, CML in the upcoming years. © 2013 Bentham Science Publishers

Single-Port vs. Conventional Multi-Port Laparoscopic Lymph Node Biopsy

Background and objectives: The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution. Methods: A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique. Results: SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis. Conclusion: SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption

Serial monitoring of isavuconazole blood levels during prolonged antifungal therapy

BACKGROUND: Isavuconazole is the newest triazole antifungal approved for the treatment of invasive aspergillosis (IA) and invasive mucormycosis in adult patients. OBJECTIVES: To characterize the assessment of the blood levels of isavuconazole and their association with efficacy and toxicity. METHODS: From January 2017 to May 2018, blood samples obtained from patients receiving isavuconazole were analysed for therapeutic drug monitoring. Factors influencing the blood concentrations of isavuconazole, such as weight, length of treatment, route of administration and results of selected liver function tests, were analysed in univariate and multivariate models. The receiver operating characteristic (ROC) curve was analysed to detect the best cut-off for isavuconazole toxicity. RESULTS: A total of 264 isavuconazole blood concentrations in 19 patients were analysed. The median value of isavuconazole concentration in all patients during the first 30\u2009days of therapy was 3.69\u2009mg/L (range 0.64-8.13\u2009mg/L). A linear increase of 0.032\u2009mg/L (range 0.023-0.041\u2009mg/L) for each day of treatment (P\u205f=\u205f0.002) was observed. In multivariate analysis the association between the length of treatment and higher levels of isavuconazole (P\u205f&lt;\u205f0.001) and higher serum GGT and lower isavuconazole levels (P\u205f=\u205f0.001) was confirmed. Adverse events, mainly gastrointestinal, were reported in six patients (31.6%). Based on time-dependent and fixed-time ROC curve analysis, 4.87\u2009mg/L and 5.13\u2009mg/L, respectively, were the identified thresholds for toxicity. CONCLUSIONS: Isavuconazole was efficacious and well tolerated. Side effects, mainly gastrointestinal, were associated with prolonged administration and high serum levels