Lymphatic mapping and sentinel node biopsy in a patient with upper limb Merkel Cell Carcinoma: a case report and brief review of literature

Sentinel node mapping is an integral part of regional lymph node staging in many solid tumors and plays an important role in surgical oncology. This technique has been used with excellent results for non-melanoma skin cancers including Merkel Cell Carcinoma (MCC). In the current study, we reported our first MCC patient who underwent successful sentinel node mapping. We also reviewed the available literature regarding the prognostic significance of sentinel node mapping in cN0 MCC patients.Sentinel node mapping is an integral part of regional lymph node staging in many solid tumors and plays an important role in surgical oncology. This technique has been used with excellent results for non-melanoma skin cancers including Merkel Cell Carcinoma (MCC). In the current study, we reported our first MCC patient who underwent successful sentinel node mapping. We also reviewed the available literature regarding the prognostic significance of sentinel node mapping in cN0 MCC patients

A randomized clinical trial on the anti-tumoral effects of low molecular weight heparin in the treatment of esophageal cancer

The current treatment approaches for esophageal cancer are associated with poor survival, and there are ongoing efforts to find new and more effective therapeutic strategies. There are several reports on the antitumoral effects of low‐molecular‐weight heparins (LMWHs). We have assessed the possible survival benefit of LMWHs in esophageal malignancies. This was a randomized, single‐blind, multicenter, Phase II clinical trial on nonmetastatic esophageal cancer candidate for neoadjuvant chemoradiotherapy. Patients were randomly assigned to the chemoradiotherapy‐only arm or chemoradiotherapy plus enoxaparin arm using 1:1 allocation. Radiotherapy was delivered in 1.8‐Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC 2) were administered weekly, concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) and chemoradiation daily. 4–6 weeks after treatment, all patients underwent esophagectomy. After a median follow up of 7 months, estimated 1 year disease‐free survival (DFS) in the intervention group was 78.9% and was 70% in the control groups ( p = 0.5). Toxicity from the experimental treatment was minimal, and there were no treatment‐related deaths. A pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively ( p = 0.9). There was a nonsignificant trend toward improved survival by the addition of enoxaparin to the concurrent chemoradiotherapy regimen. However, 1 y DFS of both groups were high as expected. A longer follow‐up and a larger sample size are required.delivered in 1.8-Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC 2) were administered weekly concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) daily as well as chemoradiation. Four to six weeks after treatment, all patients underwent esophagectomy. After a median follow up of 7 months,estimated one year disease free survival (1y DFS) in the intervention group was 78.9% and in the control groups was 70% (p=0.5). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. A Pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively (p=0.9). There was a non-significant trend toward improved survival by the addition of enoxaparin to the concurrent chemoradiotherapy regimen. However, 1y DFS of both groups were high as expected. A longer follow-up and larger sample size is required

Concentrations, spatial distribution, and human health risk assessment of asbestos fibers in ambient air of Tehran, Iran

The aim of current research was to determine airborne asbestos fiber concentrations in the ambient air of Tehran, and to investigate their spatial distribution, seasonal variation, and human health risk assessment. For this, the sampling of the study was carried out during August 2017 and June 2018, and totally, 64 samples were taken from 8 stations along the different areas of Tehran. The concentrations of airborne asbestos fibers were determined by phase contrast microscope (PCM) and scanning electron microscopy (SEM) analyses. Spatial mapping was conducted using the inverse distance weighting (IDW) technique. The health risk assessment was done based on the detected levels of airborne asbestosis fibers. The mean concentrations of the airborne asbestos fiber were 1.9 × 10−3 f/ml and 595 × 10−3 f/ml based on PCM and SEM analyses, respectively. One of the effective factors on ambient level of asbestos fibers is meteorological parameters, where the maximum and minimum concentrations of asbestos fibers are related to cold and warm seasons, respectively. These differences could be due to the presence of inversions phenomenon in cold seasons in Tehran. It was observed that the excess lifetime cancer risk (ELCR) calculated for all the sampling areas are between 5.26 × 10−5 and 5.37 × 10−4. Based on the EPA-suggested standards (10−4–10−6), these values are categorized rather to moderate levels. The obtained data indicated no threat of asbestos fibers to Tehran’s citizens’ health

The Serum C-reactive Protein and Prooxidant-antioxidant Balance in Patients with Esophageal Cancer Compared to Healthy Subjects

Introduction: The molecular mechanisms involved in pathogenesis of esophageal cancer have been the main concern of several studies. In this study, we aimed to investigate the changes of serum prooxidant-antioxidant balance (PAB) value as a redox index, as well as serum C-reactive protein (CRP) compared to healthy control group. Materials and Methods: In a cross-sectional study, blood samples were drawn from 25 patients with esophageal cancer and 25 healthy subjects. Serum CRP and PAB value were measured in all samples according to relevant protocols. Results: Serum CRP was significantly higher in our patients (14.3 ± 3.2 mg/L) compared to healthy control group (4.6 ± 1.4 mg/L), with a p-value of less than 0.001. The value of PAB in our patients (133.9 ± 21.7) was also higher than that of healthy subject (51.3 ± 11.2), indicating a redox perturbation in favor of oxidants. Conclusion: There was a significant increase in both serum PAB value and CRP in patients with esophageal cancer compared to the control group, which indicated both oxidative stress and inflammatory response in patients with esophageal cancer, respectively

Ambient air PM2.5-bound PAHs in low traffic, high traffic, and industrial areas along Tehran, Iran

Polycyclic aromatic hydrocarbons (PAHs) have aroused considerable concern over their ubiquitous presence and potentially hazardous effects on the environment. This research provides the data on PM2.5-bounded PAHs distribution in the ambient air of areas with different land uses of Tehran, Iran. A total of 64 air samples - 16 samples in the industrial area (IS), 24 samples in high traffic areas (HTS), and 24 samples in low traffic areas (LTS) - were taken and analyzed by gas chromatography-mass spectroscopy (GC-MS). The results of this study showed that the mean concentration of ΣPAHs in the air of IS, HTS, and LTS regions was 13.58 ± 18.58, 22.45 ± 33.32, and 33.90 ± 65.006 ng/m3, respectively. The mean concentration of ΣPAHs in samples taken from the IS region was significantly (p < 0.05) higher than that taken from HTS and LTS regions. The source apportionment of PAHs in the air of Tehran was performed using the Unmix.6 EPA receptor model. The results of this model indicated that 41%, 34%, and 26% of PAHs were due to industrial activities and diesel vehicles, traffic and transportation sources, and burning coal and heating appliances, respectively. The total incremental life time cancer risk (ILCR) caused by exposure to PAHs through airborne-PM2.5 of Tehran city was 1.03 × 10−6, 1.51 × 10−6 and 3.23 × 10−6 for LTS, HTS and IS areas, respectively. Estimated results of ILCR indicate that the carcinogenesis risk values in the study area are at an acceptable level (between 10−6–10−4

Ambient air PM2.5-bound PAHs in low traffic, high traffic, and industrial areas along Tehran, Iran

Polycyclic aromatic hydrocarbons (PAHs) have aroused considerable concern over their ubiquitous presence and potentially hazardous effects on the environment. This research provides the data on PM2.5-bounded PAHs distribution in the ambient air of areas with different land uses of Tehran, Iran. A total of 64 air samples - 16 samples in the industrial area (IS), 24 samples in high traffic areas (HTS), and 24 samples in low traffic areas (LTS) - were taken and analyzed by gas chromatography-mass spectroscopy (GC-MS). The results of this study showed that the mean concentration of ΣPAHs in the air of IS, HTS, and LTS regions was 13.58 ± 18.58, 22.45 ± 33.32, and 33.90 ± 65.006 ng/m3, respectively. The mean concentration of ΣPAHs in samples taken from the IS region was significantly (p < 0.05) higher than that taken from HTS and LTS regions. The source apportionment of PAHs in the air of Tehran was performed using the Unmix.6 EPA receptor model. The results of this model indicated that 41%, 34%, and 26% of PAHs were due to industrial activities and diesel vehicles, traffic and transportation sources, and burning coal and heating appliances, respectively. The total incremental life time cancer risk (ILCR) caused by exposure to PAHs through airborne-PM2.5 of Tehran city was 1.03 × 10−6, 1.51 × 10−6 and 3.23 × 10−6 for LTS, HTS and IS areas, respectively. Estimated results of ILCR indicate that the carcinogenesis risk values in the study area are at an acceptable level (between 10−6–10−4)

Predictive Value of Endoscopic Observations and Biopsy After Neoadjuvant Chemoradiotherapy in Assessing the Pathologic Complete Response of Patients With Esophageal Squamous Cell Carcinoma

INTRODUCTION: No standard method has been defined to evaluate the therapeutic response of esophageal cancer to neoadjuvant chemoradiotherapy (CRT). This study aimed to determine the predictive value of endoscopic evaluation and biopsy after CRT in predicting the complete pathological response to neoadjuvant CRT in patients with esophageal squamous cell carcinoma (SCC). MATERIALS AND METHOD: This prospective, descriptive study was conducted on patients with stage II and III esophageal SCC who could undergo esophagectomy. Patients underwent neoadjuvant CRT. Four to six weeks after the end of treatment, re-endoscopy was performed and a biopsy was taken in the presence of a tumor lesion. In the absence of a tumor lesion, the marked site of the esophagus was removed as a blind biopsy. Gastrologist observations during endoscopy and the result of the pathological examination of an endoscopic biopsy were recorded. The patient underwent esophagectomy. The pathology obtained from endoscopic biopsy was compared with the pathology response obtained from esophagectomy. RESULTS: Sixty-nine patients were included in the study, of which 32 underwent esophagectomy. In an endoscopic examination after CRT, 28 patients had macroscopic tumor remnants and 4 patients did not. Pathological examination of the samples obtained from endoscopy showed no tumor remnants in 10 patients (31.3%), and in 22 patients (68.7%), living tumor remnants were seen in the biopsy specimen. Pathologic evaluation of the samples obtained by surgical resection showed that in 13 patients, there were no viable carcinomas in the esophagus or lymph nodes removed, and the rate of pathologic complete response was 40.6. Sensitivity, specificity, positive predictive, and negative predictive values of endoscopic observations were 94.7, 23, 64.2, and 75%, respectively. Preoperative biopsy sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 68.4, 30.7, 59, and 40%, respectively. CONCLUSION: Considering the negative and positive predictive values of endoscopic observations and biopsy after neoadjuvant CRT, it seems that these two methods alone are not suitable for assessing the pathologic complete response after neoadjuvant treatment

Effects of a polyherbal formulation on the quality of life and survival of patients with common upper gastrointestinal cancers: A randomized placebo-controlled trial

Objective: Previous clinical trials have suggested that herbal medicines can improve the quality of life (QOL) and survival of cancer patients. This study was aimed to evaluate the effects of a polyherbal compound (PHC, formulated as syrup) consisting of Allium sativum, Curcuma longa,Panax ginseng, and Camellia sinensis on the quality of life (QOL) and survival in patients with upper gastrointestinal cancers.Materials and Methods: A randomized placebo-controlled trial was carried out on patients with esophageal or gastric cancer who had finished their oncological treatments. The patients were randomly assigned to PHC (n=20) or placebo (n=20) group. The PHC group was treated with the PHC for 12 weeks, while the placebo group received 70% sucrose syrup. The QOL was assessed at baseline and after 12 weeks. The patients were followed for up to 24 months to determine overall survival.Results: PHC significantly improved cancer-related symptoms, physical performance, and psychological and social functions of the patients (p<0.05 for all cases). Death occurred in 33 and 22% of cases in the placebo and PHC group, respectively. The mean survival time was 16.8 months (95% CI: 12.8-20.9) in the placebo group and 21.4 months (95% CI: 19.1-23.6) in the PHC group but the difference was not statistically significant.Conclusion: The PHC improved cancer-related symptoms, physical performance, and psychological and social functions in patients with gastrointestinal cancers. It seems that this herbal compound has the potential to be used as a supplement in the management of cancer