Sleep patterns in patients treated for non-secreting intra- and parasellar tumors

PURPOSE: In this study we evaluate sleep patterns of patients treated for non-secreting intra- and parasellar tumors and age- and sex-matched healthy controls. METHODS: We conducted a self-report cross-sectional case-control study with 104 patients treated for non-secreting intra- and parasellar tumors and 1800 healthy controls in an 1:8 matching. All subjects answered the Munich ChronoType Questionnaire, whereas patients were provided the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Short-Form 36 Health survey, the Beck Depression Inventory and the State-Trait Anxiety Inventory additionally. RESULTS: Patients treated for non-secreting intra- and parasellar tumors go to bed earlier, fall asleep earlier, need less time to prepare to sleep but also to get up. Additionally, they lie and sleep longer. The subgroup analysis showed that patients with secondary adrenal insufficiency compared to controls experienced shorter daily light exposure and longer sleep latency. Higher hydrocortisone dose (>20mg) was associated with worse score in global, physical and mental health, shorter time to prepare to sleep, earlier sleep onset and longer sleep duration. CONCLUSION: Our study shows that patients treated for non-secreting intra- and parasellar tumors, even if successfully treated, experience altered sleep patterns compared to controls. We suggest that managing clinicians should enlighten these possible sleep alterations to their patients and use specific questionnaires to document sleep disturbances. Additionally, when treating patients surgically, especially by transcranial approach, damaging the suprachiasmatic nucleus should be avoided. Furthermore, circadian hydrocortisone replacement therapy ideally with dual-release hydrocortisone - if possible, in a dose not more than 20mg daily - that resembles physiological cortisol levels more closely may be beneficial and could improve sleep patterns and sleep-related quality of life

The role of chemokines in cervical cancers

Both clinical-pathological and experimental studies have shown that chemokines play a key role in activating the immune checkpoint modulator in cervical cancer progression and are associated with prognosis in tumor cell proliferation, invasion, angiogenesis, chemoresistance, and immunosuppression. Therefore, a clear understanding of chemokines and immune checkpoint modulators is essential for the treatment of this disease. This review discusses the origins and categories of chemokines and the mechanisms that are responsible for activating immune checkpoints in cervical dysplasia and cancer, chemokines as biomarkers, and therapy development that targets immune checkpoints in cervical cancer research

Elderly and patients with large breast volume have an increased risk of seroma formation after mastectomy — results of the SerMa pilot study

The collective of the SerMa pilot study included 100 cases of primary breast cancer or Carcinoma in situ who had undergone a mastectomy procedure with or without reconstruction of the breast using an implant or expander at Augsburg University Hospital between 12/2019 and 12/2022. The study aimed to investigate possible causes of seroma formation; reported here are the clinicopathological correlations between seroma formation and tumor biology and surgical procedures. Seroma occurred significantly more often in patients with older age (median patient age in cases with seroma was 73 years vs. 52 years without seroma; p < 0.001). In addition, patients with larger mastectomy specimen were significantly more likely to develop seroma (median ablation weight in cases with seroma 580 g vs. 330 g without seroma; p < 0.001). Other significant parameters for seroma formation were BMI (p = 0.005), grading (p = 0.015) and tumor size (p = 0.036). In addition, with insertion of implant or expander, a seroma occurred significantly less frequently (p < 0.001). In a binary logistic regression, age in particular was confirmed as a significant risk factor. In contrast, tumor biological characteristics, number of lymph nodes removed or affected showed no significant effect on seroma formation. The present study shows the need for patient education about the development of seroma in particular in older patients and patients with large breast volumes within the preoperative surgical clarification. These clinicopathological data support the previously published results hypothesizing that seroma formation is related to autoimmune/inflammatory processes and will be tested on a larger collective in the planned international multicenter SerMa study

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

The programmed cell death protein 1 (PD1) and the programmed cell death ligand 1 (PD-L1) are significantly downregulated on macrophages and Hofbauer cells in the placenta of preeclampsia patients

Preeclampsia is a pregnancy-specific disease characterized by abnormal placentation, endothelial dysfunction, systemic inflammation and a disruption of the immune system. The goal of this study was to characterize the PD-1/PD-L1 system, an important immune checkpoint system, on macrophages and Hofbauer cells (HBC) in the placenta of preeclamptic patients. The expression of the macrophage markers CD68 and CD163 and the proteins PD1 and PD-L1 in the placenta of preeclamptic patients and healthy controls was examined by immunohistochemistry and immunofluorescence. The numbers of CD68-positive and CD163-positive macrophages were significantly downregulated in the decidua (p = 0.021 and p = 0.043) and the chorionic villi (p < 0.001 and p < 0.001) of preeclamptic patients. The majority of macrophages in the decidua and the chorionic villi were identified to be CD163-positive, indicating a predominantly M2-polarisation. The expression of PD1 on maternal macrophages of the decidua (p < 0.001) and on Hofbauer cells (p < 0.001) was shown to be significantly lower in preeclampsia. The expression of PD-L1 was proven to be downregulated on maternal macrophages in the decidua of preeclamptic patients (p = 0.043). This difference was only caused by a downregulation of PD-L1 expression in male offspring (p = 0.004) while there was no difference in female offspring (p = 0.841). The variation of the immune checkpoint molecules PD1 and PD-L1 in preeclampsia might play an important role in the development of inflammation seen in preeclamptic patients. It might thereby be an important target in the therapy of preeclampsia

323P Macrophage population analysis of the breast cancer microenvironment within the context of seroma formation after mastectomy (SerMa pilot study) [Abstract]

Background The primary goal of the SerMa pilot study was to identify possible immunological/inflammatory factors related to seroma formation after mastectomy and first diagnosis of breast cancer. CD68 is a common marker for tumor-associated monocytes and macrophages in general. CD163 is used to detect M2-polarized macrophages. Both are known to have an influence on defense reactions and wound healing due to their immunomodulatory effect. Thus, the aim of this evaluation was to evaluate whether a correlation can be shown within the context of postoperative seroma formation. Methods From 100 patients meeting the criteria of the study, tumor tissue of 80 patients was available for evaluation. Immunohistochemical antibody staining against CD68 and CD163 was performed, and two groups were compared: Patients with and without seroma formation. The number of macrophages in the tumor microenvironment was manually quantified at three sites representative of each specimen in the entire field of view at a magnification of 40x lens. The mean value of the three areas was used for further analysis. Results For CD68, the range of the mean value was from 0 to 354 macrophages. The number of CD68-positive macrophages was significantly increased (p=0.036) in patients with seroma development (mean=45.31) compared to those without (mean=34.31). For CD163, the range extends from 0 to 309 macrophages. Again, the number of CD163-positive macrophages was significantly increased (p=0.027) in patients with postoperative seroma formation (mean=45.57) compared to patients without (mean=33.99). Conclusions These data demonstrate a significant correlation of CD68 and CD163 positive macrophages in the tumor microenvironment and seroma formation in the breast after mastectomy. This study was the first to investigate these possible relationships. As highly associated with immunological processes, the significant higher detection of CD68 and CD163 within the population of “Seroma developers” supports our study group’s previously published results on the identification of immunological markers in seroma fluid and thus the hypothesized relationship of seroma formation based on immunological/inflammatory processes