Urinary Steroid Profiling for the Preoperative Identification of Adrenocortical Adenomas with Regression and Myelolipomatous Changes

Background: Adrenocortical neoplasms are classically divided into adenomas (ACA) and carcinomas (ACC). Heterogeneous appearance and greater size are criteria to suggest malignancy, along with the urinary steroid profile (USP). The presence of regression and myelolipomatous changes in adenomas (ACA-RML) can contribute to confusion with ACC and its USP remains unknown. Objective: To evaluate the features of ACA-RML in comparison with other adrenocortical neoplasms. Design: We selected consecutive ACA (11), ACA-RML (7) and ACC (13) cases for which USP analysis was performed before surgery and tissue was available for histological evaluation (King's College Hospital, 2005-2012). Cases were classified according to WHO and Armed Forces Institute of Pathology criteria. USPs were obtained by gas chromatography/mass spectrometry. Total excretion of individual steroids and indices (sums and ratios chosen to reflect steroid metabolic activity) were compared between ACA-RML, ACA, and ACC. Steroids that have proved to be useful markers of ACC were also compared empirically between groups, including tetrahydro-11-deoxycortisol, pregnene3,16,20-triols, 16a- and 21-hydroxypregnenolone and tetrahydro-11-deoxycorticosterone. Results: In comparison with ACA, tumors in ACA-RML were significantly larger (8.5±2.4 vs. 3.5±1.0, P=0.002), presented in older patients and showed relatively higher incidence in males. Mitotic figure counts were significantly lower (0.39±0.04 vs. 0.93±0.11 in ACA, p=0.001) and revealed higher frequency of apoptotic cells (100% vs. 9% in ACA, p= 0.001). The USP of ACA-RML showed no diagnostic features of ACC, along with lower levels of DHA and DHA metabolites. Conclusions: ACA-RML reveals distinctive histological features, and lack of USP markers of malignancy. It is important to recognize ACA-RML because its size and heterogeneous appearance raise the possibility of ACC; in this context, USP is an important tool for a correct preoperative diagnosis. Category: Endocrine PathologyUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Recent Progress on Anomalous X-ray Pulsars

I review recent observational progress on Anomalous X-ray Pulsars, with an emphasis on timing, variability, and spectra. Highlighted results include the recent timing and flux stabilization of the notoriously unstable AXP 1E 1048.1-5937, the remarkable glitches seen in two AXPs, the newly recognized variety of AXP variability types, including outbursts, bursts, flares, and pulse profile changes, as well as recent discoveries regarding AXP spectra, including their surprising hard X-ray and far-infrared emission, as well as the pulsed radio emission seen in one source. Much has been learned about these enigmatic objects over the past few years, with the pace of discoveries remaining steady. However additional work on both observational and theoretical fronts is needed before we have a comprehensive understanding of AXPs and their place in the zoo of manifestations of young neutron stars.Comment: 10 pages, 6 figures; to appear in proceedings of the conference "Isolated Neutron Stars: From the Interior to the Surface" eds. S. Zane, R. Turolla, D. Page; Astrophysics & Space Science in pres

Chandra observations of SGR 1627-41 near quiescence

We report on an observation of SGR 1627-41 made with the Chandra X-ray Observatory on 2011 June 16. Approximately three years after its outburst activity in 2008, the source's flux has been declining, as it approaches its quiescent state. For an assumed power-law spectrum, we find that the absorbed 2--10 keV flux for the source is $1.0^{+0.3}_{-0.2} \times 10^{-13} erg cm^{-2} s^{-1}$ with a photon index of $2.9 \pm 0.8$ ($N_H=1.0\times10^{23}$ cm^{-2}). This flux is approximately consistent with that measured at the same time after the source's outburst in 1998. With measurements spanning 3 years after the 2008 outburst, we analyze the long-term flux and spectral evolution of the source. The flux evolution is well described by a double exponential with decay times of 0.5 $\pm$ 0.1 and 59 $\pm$ 6 days, and a thermal cooling model fit suggests that SGR 1627-41 may have a hot core ($T_c ~ 2\times 10^8$ K). We find no clear correlation between flux and spectral hardness as found in other magnetars. We consider the quiescent X-ray luminosities of magnetars and the subset of rotation-powered pulsars with high magnetic fields ($B >~ 10^{13}$ G) in relation to their spin-inferred surface magnetic-field strength, and find a possible trend between the two quantities.Comment: 25 pages, 5 figures, 3 tables. Accepted for publication in Ap

Case report: Efficacy of immunotherapy as conversion therapy in dMMR/MSI-H colorectal cancer: a case series and review of the literature

Immunotherapy has demonstrated a role in the therapeutic landscape of a small subset of patients with colorectal carcinoma (CRC) that harbor a microsatellite instability (MSI-H) status due to a deficient DNA mismatch repair (dMMR) system. The remarkable responses to immune checkpoint inhibitors (ICIs) are now being tested in the neoadjuvant setting in localized CRC, where the dMMR/MSI-H status can be found in up to 15% of patients, with remarkable results obtained in NICHE2 and 3 trials, among others. This case series aims to report our experience at a tertiary center and provide a comprehensive analysis of the possible questions and challenges to overcome if ICIs were established as standard of care in a neoadjuvant setting, as well as the potential role they may have as conversion therapy not only in locoregional advanced CRC but also in oligometastatic disease

Signatures of the post-hydration heating of highly aqueously altered CM carbonaceous chondrites and implications for interpreting asteroid sample returns

The CM carbonaceous chondrites have all been aqueously altered, and some of them were subsequently heated in a parent body environment. Here we have sought to understand the impact of short duration heating on a highly aqueously altered CM through laboratory experiments on Allan Hills (ALH) 83100. Unheated ALH 83100 contains 83 volume per cent serpentine within the fine-grained matrix and altered chondrules. The matrix also hosts grains of calcite and dolomite, which are often intergrown with tochilinite, Fe(Ni) sulphides (pyrrhotite, pentlandite), magnetite and organic matter. Some of the magnetite formed by replacement of Fe(Ni) sulphides that were accreted from the nebula. Laboratory heating to 400 °C has caused partial dehydroxylation of serpentine and loss of isotopically light oxygen leading to an increase in bulk δ18O and fall in Δ17O. Tochilinite has decomposed to magnetite, whereas carbonates have remained unaltered. With regards to infrared spectroscopy (4000–400 cm-1; 2.5–25 µm), heating to 400 °C has resulted in decreased emissivity (increased reflectance), a sharper and more symmetric OH band at 3684 cm-1 (2.71 µm), a broadening of the Si—O stretching band together with movement of its minimum to longer wavenumbers, and a decreasing depth of the Mg—OH band (625 cm-1; 16 µm). The Si—O bending band is unmodified by mild heating. With heating to 800 °C the serpentine has fully dehydroxylated and recrystallized to ∼Fo60/70 olivine. Bulk δ18O has further increased and Δ17O decreased. Troilite and pyrrhotite have formed, and recrystallization of pentlandite has produced Fe,Ni metal. Calcite and dolomite were calcined at ∼700 °C and in their place is an un-named Ca-Fe oxysulphide. Heating changes the structural order of organic matter so that Raman spectroscopy of carbon in the 800 °C sample shows an increased (D1 + D4) proportional area parameter. The infrared spectrum of the 800 °C sample confirms the abundance of Fe-bearing olivine and is very similar to the spectrum of naturally heated stage IV CM Pecora Escarpment 02010. The temperature-related mineralogical, chemical, isotopic and spectroscopic signatures defined in ALH 83100 will help to track the post-hydration thermal histories of carbonaceous chondrite meteorites, and samples returned from the primitive asteroids Ryugu and Bennu

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival