S1‐Guideline: Microscopically controlled surgery

Microscopically controlled surgery (MCS) comprises various methods allowing histologically proven complete resection of malignant tumors while at the same time sparing the tumor-free tissue in the immediate vicinity as much as possible. All procedures subsumed under MCS have in common the marking of the excised tissue for topographical orientation, which provides an assignment of remaining tumor remnants. Indications for MCS are malignant skin tumors in problem localizations as well as aggressive subtypes of skin tumors. Established indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen’s disease as well as Bowen’s carcinoma, dermatofibrosarcoma protuberans, melanoma in chronically light-damaged skin as well as acral lentiginous melanoma and Merkel cell carcinoma. For other tumors such as extramammary Paget’s disease and various cutaneous sarcomas, evidence exists that MCS has demonstrated benefits, such as local recurrence rates. In addition, MCS is indicated when it is foreseeable that a complex closure technique is required and complete resection of the tumor must be assured. Various methods of MCS have been described, including 3D histology, horizontal method and Mohs surgery. A close cooperation of qualified surgeons and (dermato)pathologists as well as laboratory staff is essential for the successful application of MCS

Targeted ultra-deep sequencing reveals recurrent and mutually exclusive mutations of cancer genes in blastic plasmacytoid dendritic cell neoplasm

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare haematopoietic malignancy characterized by dismal prognosis and overall poor therapeutic response. Since the biology of BPDCN is barely understood, our study aims to shed light on the genetic make-up of these highly malignant tumors. Using targeted high-coverage massive parallel sequencing, we investigated 50 common cancer genes in 33 BPDCN samples. We detected point mutations in NRAS (27.3% of cases), ATM (21.2%), MET, KRAS, IDH2, KIT (9.1% each), APC and RB1 (6.1% each), as well as in VHL, BRAF, MLH1, TP53 and RET (3% each). Moreover, NRAS, KRAS and ATM mutations were found to be mutually exclusive and we observed recurrent mutations in NRAS, IDH2, APC and ATM. CDKN2A deletions were detected in 27.3% of the cases followed by deletions of RB1 (9.1%), PTEN and TP53 (3% each). The mutual exclusive distribution of some mutations may point to different subgroups of BPDCN whose biological significance remains to be explored

Rationale and design of the German-speaking myeloma multicenter group (GMMG) trial HD6: a randomized phase III trial on the effect of elotuzumab in VRD induction/consolidation and lenalidomide maintenance in patients with newly diagnosed myeloma

Background: Despite major advances in therapy, multiple myeloma is still an incurable malignancy in the majority of patients. To increase survival, deeper remissions (i.e. CR) translating into longer PFS need to be achieved. Incorporation of new drugs (i.e. bortezomib and lenalidomide) as induction and maintenance treatment in an intensified treatment concept, including high dose melphalan (200 mg/m2), has resulted in increased CR rates, and is considered the standard of care for younger patients. Elotuzumab in combination with lenalidomide and dexamethasone has given better results as lenalidomide and dexamethasone alone in a phase III trial. The GMMG-HD6 trial will be the first phase III trial investigating the role of elotuzumab in combination with bortezomib, lenalidomide and dexamethasone (VRD) induction/consolidation and lenalidomide maintenance within a high dose concept. Methods: GMMG-HD6 is a randomized, open, multicenter phase III trial. The planned recruitment number is 564 NDMM patients. All patients will receive 4 VRD cycles as induction and undergo peripheral blood stem cell mobilization and harvesting. Thereafter they will be treated with high dose melphalan therapy plus autologous stem cell transplantation followed by 2 cycles of VRD consolidation and lenalidomide maintenance. Patients in arm B1 + B2 will additionally receive elotuzumab in the induction phase, whereas patients in A2 + B2 will be treated with elotuzumab added to consolidation and maintenance. The primary endpoint of the trial is PFS. Secondary objectives and endpoints are OS, CR rates after induction therapy comparing the two arms VRD (A1 + A2) vs VRD + elotuzumab (B1 + B2), CR rates after consolidation treatment, best response to treatment during the study, time to progression (TTP), duration of response (DOR), toxicity and quality of life. Results: Since this is the publication of a study protocol of an ongoing study, no results can be presented. Discussion: This phase III trial is designed to evaluate whether the addition of elotuzumab to an intensified treatment concept with high dose melphalan chemotherapy plus autologous stem cell transplantation and induction, consolidation and maintenance treatment with bortezomib and lenalidomide is able to improve PFS compared to the same concept without elotuzumab. Trial registration: NCT02495922 on June 24th, 2015

A complex secretory program orchestrated by the inflammasome controls paracrine senescence

Oncogene-induced senescence (OIS) is crucial for tumour suppression. Senescent cells implement a complex pro-inflammatory response termed the senescence-associated secretory phenotype (SASP). The SASP reinforces senescence, activates immune surveillance and paradoxically also has pro-tumorigenic properties. Here, we present evidence that the SASP can also induce paracrine senescence in normal cells both in culture and in human and mouse models of OIS in vivo. Coupling quantitative proteomics with small-molecule screens, we identified multiple SASP components mediating paracrine senescence, including TGF-β family ligands, VEGF, CCL2 and CCL20. Amongst them, TGF-β ligands play a major role by regulating p15INK4b and p21CIP1. Expression of the SASP is controlled by inflammasome-mediated IL-1 signalling. The inflammasome and IL-1 signalling are activated in senescent cells and IL-1α expression can reproduce SASP activation, resulting in senescence. Our results demonstrate that the SASP can cause paracrine senescence and impact on tumour suppression and senescence in vivo

The accessibility of community pharmacies for physically disabled people.

The aim: To investigate the accessibility of community pharmacies for physically disabled people Methods: It was made by two stages. In first stage qualitative method was used in this research. Structured interview was taken from experts to collect the data. Experts told which problems they have when they are trying to access drug store. For the second stage there were secret patient experiment. Which helped to identify the barriers for disabled peoples Results: There were found the main barriers preventing access to the pharmacy. It is also secret patient study aids, has identified three types of pharmacies. Available, semi-accessible with the help of an assistant and the third is not available. There is only 13 percent, which is not available. Then there is 34 percent, which is semi-accessible and 53 percent, which is fully adapted to disabled person. Conclusions: 1. Expert interviews were disclosed experiences in order to get to the pharmacy. More than half of the surveyed pharmacies in Kaunas adapts to the disabled person moving carriage. The main problem, why cannot get into all the pharmacies is that it is not adapted ramp. 2. The experiment of a secret patient during the investigation, was isolated three types of pharmacies, affordable, accessible and partially inaccessible. The investigation showed that all available pharmacies are located in shopping centers. This has resulted in facilities, public transport and door eligibility. 3. The absence of the ramp or slope is the biggest problem that has been encountered in this study. It is also one of the most common problems would agree is the threshold of the doorway. It is too high a disabled person moving carriag

BLIMP1 Expression in Diffuse Large B-cell Lymphoma

BLIMP1 ist ein Transkriptionsfaktor und Schlüsselregulator in der Plasmazell-Differenzierung. Um die Rolle des BLIMP1 in der Lymphomentstehung zu untersuchen, wurde die BLIMP1 Expression im normalen humanen lymphatischen Gewebe und in 78 diffusen großzelligen B-Zell Lymphomen untersucht. BLIMP1 wurde in Plasmazellen und GC B-Zellen sowie in einer Population extrafollikulärer B-Zellen exprimiert. Die reifen Plasmazellen vom Marschalko-Typ waren CD138+CD20-MUM1+Ki67-BCL6-PAX5-BLIMP1+. Außerdem zeigten die Keimzentrums-B-Zellen keine Ki67-Expression. Im Gegensatz hierzu waren die BLIMP1+ EGBZ Ki67+p27-. BLIMP1 wurde in 19% (15/78) der DLBCL Fälle, darunter ABC- (7/15) und GCB- (8/15) Typ, exprimiert. BLIMP1+ DLBCL konnten entsprechend dem BLIMP1, BCL6 und PAX5 Expressionsprofil in drei pathogenetisch unterschiedliche Typen unterteilt werden. In den Typ A-Fällen waren die BLIMP1+ Tumor- zellen ständig BCL6-/PAX5- und waren alle vom ABC-Typ (CD10-/BCL6-/MUM1+). Im Typ B-DLBCL waren die meisten Tumorzellen ständig BLIMP1-/BCL6+/PAX5+ und BLIMP1 war nur in relativ kleinen Arealen herdförmig exprimiert. Die BLIMP1+ Zellen zeigten keine BCL6 und PAX5 Expression, und alle Typ B-Fälle zeigten ein GCB-Profil (CD10+ oder BCL6+ und MUM1-). Die Typ C-Fälle waren durch eine gleichzeitige BLIMP1 und BCL6 und/oder PAX5 Expression gekennzeichnet, was einem abärranten und nicht in normalen B-Zellen auftretenden Immunphänotyp entspricht. Weiterhin wurden in 7 Fällen mit Allelverluste auf der Genomregion 6q21, der das BLIMP1 Gen enthält, keine BLIMP1 Mutationen gefunden. Hinsichtlich einer BLIMP1 Expression im normalen lymphatischen Gewebe konnte festgestellt werden, dass das BLIMP1 nicht nur während der Plasmazellentwicklung aus den Keimzentrums-B-Zellen eine bedeutende Rolle spielt, sondern auch mit der Plasmazell-Differenzierung außerhalb des Keimzentrums assoziiert ist. Eine BLIMP1 Expression in DLBCL kennzeichnet die Fälle mit einer Plasmazell-Differenzierung. BLIMP1 ist in den Lymphomen größtenteils wie in normalen B-Zellen reguliert und besitzt die Kapazität, die Plasmazell-Entwicklung in die Tumorzellen zu induzieren. Jedoch reicht die BLIMP1 Expression weder aus, den Zellzyklus aufzuhalten, noch eine komplette terminale Plasmazell-Reifung in den DLBCL zu leiten. Allerdings scheint BLIMP1 nicht von den bekannten TSG Inaktivierungsmechanismen in den DLBCL betroffen zu sein, wobei es sehr unwahrscheinlich ist, dass das BLIMP1 ein TSG darstellt, dessen Verlust bei der Lymphomentwicklung eine wesentliche Rolle spielt.BLIMP1 is a transcriptional factor that is a key regulator of plasma cell differentiation. To investigate if BLIMP1 is involved in lymphoma genesis, we studied a BLIMP1 expression in normal human lymphoid tissue and in 78 cases of human diffuse large B-cell lymphoma. We found BLIMP1 in plasma cells, a subset of lymphoplasmacytoid GC B-cells (BLIMP1+/Ki67-) and in a population of human reactive large extrafollicular B-cells (BLIMP1+/Ki67+). Generally BLIMP1+ B-cells were CD20-CD138-/+BCL6-PAX5-MUM1+. BLIMP1 was also expressed in 19% (15/78) of DLBCL cases, with both ABC (7/15) and GCB (8/15) subtypes. Importantly, the BLIMP1 expressing lymphoma could be subclassified into molecularly different three categories according to BLIMP1 and BCL6/PAX5 expression profile. In the Type A category ABC-type DLBCL cases were positive for BLIMP1 and negative for BCL6/PAX5. Type B group contained 5 GCB-type tumors with focal BLIMP1 expression. BLIMP1 expressing cells were BCL6-/PAX5-, while remaining lymphoma cells displayed a strong BCL6 and PAX5 expression. In Type C category there were 3 cases with mutually all cells co-expressing BLIMP1 and BCL6, but not PAX5. Additionally, all Type C cases harbored chromosome 3 aberrations involving the region where BCL6 gene is mapped. Importantly, we did not observe any correlation between BLIMP1 expression and aberrations involving chromosome 6q21 – a region where BLIMP1 encoding gene PRDM is mapped.The sequence analysis of BLIMP1 gene in selected 7 cases with 6q21 LOH revealed no mutations. Summarizing, our data suggest that the BLIMP1 induced terminal differentiation program is different in GC and extrafollicular B-cell responses to antigen and not necessarily involves cell cycle arrest in the latter. Importantly, we demonstrated that BLIMP1 is expressed in both ABC and GCB-type DLBCL cases with secretory differentiation, indicating that BLIMP1 is functional in lymphoma cells, but BLIMP1 expression is not sufficient to stop proliferation in DLBCL. Our data imply that in some DLBCL cases the lymphoma cells are able to differentiate to more mature stage and this secretory differentiation is marked by BLIMP1 expression. BLIMP1 is not affected by common TSG inactivation mechanisms in DLBCL and does not seem to play a major role in lymphoma establishment

Infiltration patterns in monoclonal plasma cell disorders: correlation of magnetic resonance imaging with matched bone marrow histology

To investigate how plasma cell infiltration patterns detected by MRI match the plasma cell distribution in bone marrow biopsy. We assessed 50 patients with monoclonal plasma cell disorders of all clinical stages. MRI infiltration pattern was compared with matched BM histology from the same anatomic region. MRI revealed a minimal (n=11, 22%), focal (n=5, 10%), diffuse (n=14, 28%) and mixed (n=20, 40%) infiltration pattern. Diffuse MRI pattern was predominant in smoldering myeloma patients whereas the MRI patterns with "focal component" (i.e. focal and mixed) were most common in symptomatic myeloma (p<0.01). In histology an interstitial (n=13, 26%), nodular (n=23, 46%) and packed marrow (n=14, 28%) was found respectively. All three histological types of infiltration were observed in patients with diffuse and mixed MRI patterns. Minimal MRI pattern was found in all MGUS patients and was associated with an interstitial BM infiltration. In two patients with minimal MRI pattern an extensive micro-nodular BM infiltration was found in histology. Infiltration patterns in MRI represent different histological growth patterns of plasma cells, but the MRI resolution is not sufficient to visualize micro-nodular aggregates of plasma cells

Influence of regioselectively sulfated cellulose on in vitro vascularization of biomimetic bone matrices

Vascularization is essential for the regeneration of bone tissue within composite material. We measured the effect of regioselectively modified cellulose/hemicellulose as an additive for porous scaffolds of collagen/hydroxyapatite nanocomposite on the tubule formation of human vascular endothelial cells. Using a coculture of endothelial cells and fibroblasts, endothelial cells formed a network of tubules within an incubation time of 14 to 24 days. A cellulose sulfate with irregular sulfation pattern along the polysaccharide backbone (13-TACS-01) led to an additional increase in vascular endothelial growth factor (VEGF)-induced tubule formation, as observed in an in vitro angiogenesis assays. In contrast with structurally different heparin, these cellulose sulfates have no apparent affinity to VEGF. Their impact on endothelial function may possibly be due to interactions with cell surface receptors/soluble factors not yet defined