Combined immunohistochemistry of β-catenin, cytokeratin 7, and cytokeratin 20 is useful in discriminating primary lung adenocarcinomas from metastatic colorectal cancer

BACKGROUND: It is important to discriminate between primary and secondary lung cancer. However, often, the discriminating diagnosis of primary lung acinar adenocarcinoma and lung metastasis of colorectal cancer based on morphological and pathological findings is difficult. The purpose of this study was to evaluate the clinical usefulness of immunohistochemistry of β-catenin, cytokeratin (CK) 7, and CK20 for the discriminating diagnosis of lung cancer. METHODS: We performed immunohistochemistry of β-catenin, CK7, and CK20 in 19 lung metastasis of colorectal cancer samples, 10 corresponding primary colorectal cancer samples and 11 primary lung acinar adenocarcinoma samples and compared the levels of accuracy of the discriminating diagnosis by using antibodies against these antigens. RESULTS: Positive staining of β-catenin was observed in all the lung metastasis of colorectal cancer samples as well as in the primary colorectal cancer samples but in none of the primary lung acinar adenocarcinoma samples. Positive staining of CK7 was observed in 90.9% of the primary lung acinar adenocarcinoma samples and in 5.3% of the lung metastasis of colorectal cancer samples, but in none of the primary colorectal cancer samples. Positive staining of CK20 was observed in all the primary colorectal cancer samples and in 84.2% of the lung metastasis of colorectal cancer samples, but in none of the primary lung acinar adenocarcinoma samples. CONCLUSION: Combined immunohistochemistry of β-catenin, CK7, and CK20 is useful for making a discriminating diagnosis between lung metastasis of colorectal cancer and primary lung acinar adenocarcinoma. This method will enable accurate diagnosis of a lung tumor and will be useful for selecting appropriate therapeutic strategies, including chemotherapeutic agents and operation methods

Significance of circadian rhythms in severely brain-injured patients. A clue to consciousness?

Objective: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviourally assessed consciousness levels in patients with disorders of consciousness (DOC, i.e. vegetative state/unresponsive wakefulness syndrome [VS/UWS] or minimally conscious state [MCS]). Methods: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across six to seven days using external skin temperature sensors in 18 patients suffering from DOC. Beyond this; we examined the relationship between behaviourally assessed consciousness levels and circadian rhythmicity. Results: Interestingly, analyses with Lomb-Scargle periodograms revealed significant circadian rhythmicity in all patients (range 23.5-26.3h). We found that especially scores on the arousal subscale of the Coma Recovery Scale-Revised (CRS-R) were closely linked to the integrity of circadian variations in body temperature. Finally, we piloted whether bright light stimulation could boost circadian rhythmicity and found positive evidence in two out of eight patients. Conclusion: In conclusion, the study provides first evidence for an association between circadian body temperature rhythms and arousal as a necessary precondition for consciousness. Thereby, our findings also make a case for circadian rhythms as a target for treatment as well as the application of diagnostic and therapeutic means at times when cognitive performance is expected to peak

Significance of circadian rhythms in severely brain-injured patients. A clue to consciousness?

Objective: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviourally assessed consciousness levels in patients with disorders of consciousness (DOC, i.e. vegetative state/unresponsive wakefulness syndrome [VS/UWS] or minimally conscious state [MCS]). Methods: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across six to seven days using external skin temperature sensors in 18 patients suffering from DOC. Beyond this; we examined the relationship between behaviourally assessed consciousness levels and circadian rhythmicity. Results: Interestingly, analyses with Lomb-Scargle periodograms revealed significant circadian rhythmicity in all patients (range 23.5-26.3h). We found that especially scores on the arousal subscale of the Coma Recovery Scale-Revised (CRS-R) were closely linked to the integrity of circadian variations in body temperature. Finally, we piloted whether bright light stimulation could boost circadian rhythmicity and found positive evidence in two out of eight patients. Conclusion: In conclusion, the study provides first evidence for an association between circadian body temperature rhythms and arousal as a necessary precondition for consciousness. Thereby, our findings also make a case for circadian rhythms as a target for treatment as well as the application of diagnostic and therapeutic means at times when cognitive performance is expected to peak

European Journal of Neurology / Healthier rhythm, healthier brain? : Integrity of circadian melatonin and temperature rhythms relates to the clinical state of braininjured patients

Background Healthy circadian rhythmicity has been suggested to relate to a better state of braininjured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (DOC). Methods Going beyond earlier studies, a systemslevel perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state [Coma Recovery Scale Revised (CRSR) score] of DOC patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients behavioural repertoire (CRSR score) varied (i) with time of day or (ii) offset from the body temperature maximum (BTmax), i.e. when cognitive performance is expected to peak. Results The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher CRSR scores are, by trend, related to assessments taking place at a later daytime or deviating less from the prespecified time of occurrence of BTmax. Conclusions In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in braininjured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (preassessed) BTmax (4 pm in healthy individuals) as this is when patients should be most responsive.W 1223G16Y00777(VLID)354656