18 research outputs found
Cutaneous Implantation Metastasis of Cholangiocarcinoma after Percutaneous Transhepatic Biliary Drainage
Percutaneous transhepatic biliary decompression is a preoperative surgical adjunct in patients with obstructive jaundice that has been in use since 1973. It is recommended that this procedure be adopted for both palliative treatment in unresectable patients and as a preoperative means of lowering serum bilirubin in patients with potentially resectable malignancies of the pancreas or biliary tract. Metastatic tumor seeding along the transhepatic biliary catheter is an unusual complication resulting from this procedure but there have been a few cases reported in the literature. Below is a report on a 59-year-old woman in whom the percutaneous transhepatic catheter drainage of the biliary tree, performed before surgical resection of a cholangiocarcinoma, caused cutaneous tumor implantation at the catheter site 3 months later. The clinical aspect was morphea-like and histopathologic examination revealed typical features of a dermal metastasis of adenocarcinoma. Immunohistochemistry revealed cytoplasmic positivity for cytokeratin 7-19, specific for the biliary tract epithelium. A review of the literature available led us to conclude that port-site metastasis in patients with obstructive jaundice treated with percutaneous transhepatic biliary decompression was an unusual but possible complication. In fact, many catheter-tract metastatic deposits in the liver parenchyma, detected at autopsy or on operation, are mistakenly identified as hematogenous or lymphatic metastasis and are not attributed to a catheter-related process. We also report on this case because of the atypical morphea-like aspect of the skin metastasis
IgE antibody repertoire in nasal secretions of children and adults with seasonal allergic rhinitis: A molecular analysis
Background:
There is growing interest both in testing IgE in nasal secretions (NS) and in molecular diagnosis of seasonal allergic rhinitis (SAR). Yet, the reliability of nasal IgE detection with the newest molecular assays has never been assessed in a large cohort of pollen allergic patients.
Objective:
To investigate with microarray technology and compare the repertoires of specific IgE (sIgE) antibodies in NS and sera of a large population of children and adults with SAR.
Methods:
Nasal secretions were collected with an absorbent device (Merocel 2000Âź, Medtronic) and a minimal dilution procedure from 90 children and 71 adults with SAR. Total IgE (tIgE) (ImmunoCAP, Thermo Fisher Scientific (TFS)) and sIgE antibodies against 112 allergen molecules (ISAC-112, TFS) were measured in NS and serum.
Results:
Nasal sIgE was detectable in 68.3% of the patients. The detected nasal sIgE antibodies recognized airborne (88%), vegetable (10%), and animal food or other (<1%) allergen molecules. The prevalence and average levels of sIgE in NS and serum were highly interrelated at population level. A positive nasal sIgE antibody to a given molecule predicted the detection of the same antibody in the patient's serum with a specificity of 99.7% and a sensitivity of 40%.
Conclusions:
The concentration of sIgE is much lower in nasal secretions than in the serum. sIgE assays with very high analytical sensitivity and sampling methods with minimal dilution will be therefore needed to validate nasal secretions as alternative to serum in testing the sIgE repertoire
Use of Measurable Residual Disease to Evolve Transplant Policy in Acute Myeloid Leukemia: A 20-Year Monocentric Observation
Measurable residual disease (MRD) is increasingly employed as a biomarker of quality of
complete remission (CR) in intensively treated acute myeloid leukemia (AML) patients. We evaluated
if a MRD-driven transplant policy improved outcome as compared to a policy solely relying on a
familiar donor availability. High-risk patients (adverse karyotype, FLT3-ITD) received allogeneic
hematopoietic cell transplant (alloHCT) whereas for intermediate and low risk ones (CBF-AML and
NPM1-mutated), alloHCT or autologous SCT was delivered depending on the post-consolidation
measurable residual disease (MRD) status, as assessed by flow cytometry. For comparison, we
analyzed a matched historical cohort of patients in whom alloHCT was delivered based on the sole
availability of a matched sibling donor. Ten-years overall and disease-free survival were longer
in the MRD-driven cohort as compared to the historical cohort (47.7% vs. 28.7%, p = 0.012 and
42.0% vs. 19.5%, p = 0.0003). The favorable impact of this MRD-driven strategy was evident for
the intermediate-risk category, particularly for MRD positive patients. In the low-risk category, the
significantly lower CIR of the MRD-driven cohort did not translate into a survival advantage. In
conclusion, a MRD-driven transplant allocation may play a better role than the one based on the
simple donor availability. This approach determines a superior outcome of intermediate-risk patients
whereat in low-risk ones a careful evaluation is needed for transplant allocation
Nuovi orizzonti terapeutici per lâacrodermatite di Hallopeau = Future prospects for Hallopeau acrodermatitis diseaseâs therapy
Atypical Rearrangements in APL-Like Acute Myeloid Leukemias: Molecular Characterization and Prognosis
Acute promyelocytic leukemia (APL) accounts for 10-15% of newly diagnosed acute myeloid leukemias (AML) and is typically caused by the fusion of promyelocytic leukemia with retinoic acid receptor alpha (RARA) gene. The prognosis is excellent, thanks to the all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) combination therapy. A small percentage of APLs (around 2%) is caused by atypical transcripts, most of which involve RARA or other members of retinoic acid receptors (RARB or RARG). The diagnosis of these forms is difficult, and clinical management is still a challenge for the physician due to variable response rates to ATRA and ATO. Herein we review variant APL cases reported in literature, including genetic landscape, incidence of coagulopathy and differentiation syndrome, frequent causes of morbidity and mortality in these patients, sensitivity to ATRA, ATO, and chemotherapy, and outcome. We also focus on non-RAR rearrangements, complex rearrangements (involving more than two chromosomes), and NPM1-mutated AML, an entity that can, in some cases, morphologically mimic APL
Stereotactic Ablative Radiation Therapy in 3 Fractions Induces a Favorable Systemic Immune Cell Profiling in Prostate Cancer Patients
ABSTRACTThe impact of radiotherapy (RT) on immune cell status in prostate cancer (PCa) is only partially determined. The aim of this study was to assess the effect of different RT strategies on peripheral B, T, and Natural killer (NK) lymphocytes at precise longitudinal time-points in PCa. 18 patients treated with stereotactic body radiation therapy (SBRT) (40Â Gy/3FRX), definitive moderate-hypofractionation (62Â Gy/20FRX), or post-operative conventional-fractionation RT (66â69Â Gy/30FRX) were prospectively evaluated for the immune cell profile in terms of immune cell composition, differentiation stage, cytokine production and inhibitory receptor (IR) expression. The immune-monitoring of the 18 patients revealed that RT affects the balance of systemic immune cells, with the main differences observed between SBRT and conventionally fractionated RT. SBRT favorably impacts immune response in term of increased B cells, central-memory and effector-memory CD8+ T cells, along with decreased Treg cells after treatment. On the contrary, conventional fractionated RT had a long-term negative effect on the systemic immune profile, including a decrease of total lymphocyte counts accompanied by an increase of neutrophils-to-lymphocytes ratio. Total B and T cells decreased and Treg-to-CD8+ ratio increased. Functionality of T lymphocytes were not affected by any of the 3-fractionation schedules. Interestingly, SBRT significantly up-regulates the expression of V-domain immunoglobulin suppressor of T-cell activation (VISTA) in CD8+ T cells in the absence of other IRs. Our results indicate the relevance of systematic immunomonitoring during RT to identify novel immune-related target to design trials of combined radio-immunotherapy as a promising strategy in the clinical management of PCa
3D fiber deposited polymeric scaffolds for external auditory canal wall
The external auditory canal (EAC) is an osseocartilaginous structure extending from the auricle to the eardrum, which can be affected by congenital, inflammatory, and neoplastic diseases, thus reconstructive materials are needed. Current biomaterial-based approaches for the surgical reconstruction of EAC posterior wall still suffer from resorption (biological) and extrusion (synthetic). In this study, 3D fiber deposited scaffolds based on poly(ethylene oxide terephthalate)/poly(butylene terephthalate) were designed and fabricated to replace the EAC wall. Fiber diameter and scaffold porosity were optimized, leading to 200 ± 33 ”m and 55% ± 5%, respectively. The mechanical properties were evaluated, resulting in a Youngâs modulus of 25.1 ± 7.0 MPa. Finally, the EAC scaffolds were tested in vitro with osteo-differentiated human mesenchymal stromal cells (hMSCs) with different seeding methods to produce homogeneously colonized replacements of interest for otologic surgery. This study demonstrated the fabrication feasibility of EAC wall scaffolds aimed to match several important requirements for biomaterial application to the ear under the Tissue Engineering paradigm, including shape, porosity, surface area, mechanical properties and favorable in vitro interaction with osteoinduced hMSCs. [Figure not available: see fulltext.]
Una strategia partecipata e adattiva per riattivare Tor Bella Monaca
The redevelopment project for Tor Bella Monacaâs M4 and R5 sectors consists of a set of actions aimed to overcome the current physical, social and perceptive inaccessibility of the area. Each design action is related to the ribbon, an adaptive, architectural and technological system able to generate new spaces for domestic and social living. The ribbon is a spatial device that identifies: the demolitions at the ground floor and basement, increasing the accessibility of the courtyards from Via dellâArcheologia; the new hierarchy of public, semi-public and collective spaces; the volumetric additions on the facades. The quality and the accessibility of the outdoor spaces are pursued through their redefinition, increasing and diversifying, in order to host different activities like sports, recreation, leisure, culture, education. To improve pedestrian and cycling mobility, the sidewalk of Via dellâArcheologia has been increased in its depth, while the cycle path on the edge of the countryside has been reactivated and extended. To increase the energetic performance of the buildings, the project has focused on the facade envelope: the previous panels have been replaced with new prefabricated and strati ed ones with higher performance as well as the external windows and doors. The project also considering different upcycling and recycling scenarios to use the demolition materials. Eventually, the ribbon defines a âdynamic facadeâ with the double purpose to increase the domestic space for the residents and reduce the energy needs of the house units. All these interventions, associated with the centralization of the energy systems and the prevision of energy production from renewable sources, orient the project within an environmental sustainability and circular perspective
Der p 23âspecific IgE response throughout childhood and its association with allergic disease: A birth cohort study
Background
The Dermatophagoides pteronyssinus molecule Der p 23 is a major allergen whose clinical relevance has been shown in crossâsectional studies. We longitudinally analysed the trajectory of Der p 23âspecific IgE antibody (sIgE) levels throughout childhood and youth, their earlyâlife determinants and their clinical relevance for allergic rhinitis and asthma.
Methods
We obtained sera and clinical data of 191 participants of the German Multicentre Allergy Study, a prospective birth cohort. Serum samples from birth to 20âyears of age with sIgE reactivity to Der p 23 in a customised semiquantitative microarray were newly analysed with a singleplex quantitative assay. Early mite exposure was assessed by measuring the average content of Der p 1 in house dust at 6 and 18âmonths.
Results
Der p 23âsIgE levels were detected at least once in 97/191 participants (51%). Prevalence of Der p 23 sensitisation and mean sIgE levels increased until age 10âyears, plateaued until age 13âyears and were lowest at age 20âyears. Asthma, allergic rhinitis (AR) and atopic dermatitis (AD) were more prevalent in Der p 23âsensitised children, including those with monomolecular but persistent sensitisation (11/97, 11%). A higher exposure to mites in infancy and occurrence of AD before 5âyears of age preceded the onset of Der p 23 sensitisation, which in turn preceded a higher incidence of asthma.
Conclusions
Der p 23 sensitisation peaks in late childhood and then decreases. It is preceded by early mite exposure and AD. Asthma and AR can occur in patients persistently sensitised to Der p 23 as the only mite allergen, suggesting the inclusion of molecular testing of Der p 23âsIgE for subjects with clinical suspicion of HDM allergy but without sIgE to other major D.pt. allergens