AKT1E17K mutations cluster with meningothelial and transitional meningiomas and can be detected by SFRP1 immunohistochemistry

The activating E17K mutation in the AKT1 gene has been detected in several tumor entities. Currently several clinical studies with specific AKT1 inhibitors are under way. To determine whether AKT1 mutations are involved in human tumors of the nervous system, we examined a series of 1,437 tumors including 391 primary intracranial brain tumors and 1,046 tumors of the coverings of the central and peripheral nervous system. AKT1E17K mutations were exclusively seen in meningiomas and occurred in 65 of 958 of these tumors. A strong preponderance was seen in the variant of meningothelial meningioma WHO grade I of basal and spinal localization. In contrast, AKT1E17K mutations were rare in WHO grade II and absent in WHO grade III meningiomas. In order to more effectively detect this mutation, we tested for immunohistochemical markers associated with this alteration. We observed strong up-regulation of SFRP1 expression in all meningiomas with AKT1E17K mutation and in HEK293 cells after transfection with mutant AKT1E17K, but not in meningiomas and HEK293 cells lacking this mutation.     

Replacement of the trigonum vesicae by silicone rubber in mini pigs (author's transl)

Prostheses of the trigonum vesicae made of silicone rubber and covered with a textile layer were implanted in 18 mini pigs. Investigations were done in two series: in the first the prostheses were covered on the outside with a narrow woven textile layer, in the second with Dacron-velour. While the narrow woven textile-lined prostheses were rejected into the urinary bladder after a short period, the Dacron-velour-lined prostheses remained well attached to the bladder wall.     

Percentage of positive biopsies predicts lymph node involvement in men with low‐risk prostate cancer undergoing radical prostatectomy and extended pelvic lymphadenectomy

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? The current retrospective study evaluates predictive clinical parameters associated with lymph node metastasis in a homogeneous cohort of 499 men with low‐risk prostate cancer who underwent radical prostatectomy. Low‐risk profile and <50% of biopsies involved with cancer are strong predictors of metastasis‐free lymph nodes so that patients do not have to undergo extended pelvic lymphadenectomy.

OBJECTIVE

To evaluate preoperative predictive risk factors associated with lymph node metastases (LNM) in a cohort of low‐risk prostate cancer (PCA) patients.

PATIENTS AND METHODS

The charts of 499 patients were retrospectively reviewed to identify prognostic risk factors for the presence of LNM. Pathohistological data and Gleason score of the radical prostatectomy (RP) specimen, number of removed nodes, number of positive lymph nodes, and anatomical distribution of LNM were tabulated and evaluated. A correlation between clinical stage, preoperative serum prostate‐specific antigen (PSA), biopsy Gleason score, number of biopsies taken, percentage of positive biopsies and the presence of LNM were calculated. All 499 men underwent retropubic RP and extended pelvic lymphadenectomy (EPLND).

RESULTS

LNM were identified in 29 (5.8%) patients. A prediction model based on clinical stage, PSA, and biopsy Gleason score had a predictive accuracy of 79.2%. The addition of number of positive biopsies and % positive cores improved its predictive accuracy to 81.5% and 87.8%, respectively. The predicted frequency of LNM by the original nomogram was 7.4% and differed by less than 3% with the actual observation of LNM. The predictive accuracy of the nomogram was 81.5% as compared with 87.8% of the prediction model of this study.

CONCLUSIONS

The percentage of positive cores involved with PCA is the most reliable predictor of LNM and indicates the need for EPLND. The Briganti nomogram has been validated and a general applicability for predicting the presence of LNM was proven.     

Enteroglial cells act as antigen-presenting cells in chagasic megacolon

Chagas disease is one of the most serious parasitic diseases of Latin America, with a social and economic impact far outweighing the combined effects of other parasitic diseases such as malaria, leishmaniasis, and schistosomiasis. In the chronic phase of this disease, the destruction of enteric nervous system components leads to megacolon development. Besides neurons, the enteric nervous system is constituted by enteric glial cells, representing an extensive but relatively poorly described population within the gastrointestinal tract. Several lines of evidence suggest that enteric glial cells represent an equivalent of central nervous system astrocytes. Previous data suggest that enteric glia and neurons are active in the enteric nervous system during intestinal inflammatory and immune responses. To evaluate whether these cells act as antigen-presenting cells, we investigated the expression of molecules responsible for activation of T cells, such as HLA-DR complex class II and costimulatory molecules (CD80 and CD86), by neurons and enteric glial cells. Our results indicate that only enteric glial cells of chagasic patients with megacolon express HLA-DR complex class II and costimulatory molecules, and hence they present the attributes necessary to act as antigen-presenting cells.     

The relationship between pre-fitting expectations and willingness to use hearing aids

Hearing-aid use in the elderly population is problematic since not all people who would benefit from hearing aids actually obtain one. In this study, the relationship between pre-fitting expectations and willingness to use hearing aids is addressed.

One hundred adult hearing aid candidates (mean age 68.6 years) were randomly recruited from eight different private ENT practices. The subjects completed a questionnaire comprising a number of different aspects of expectation and some additional variables potentially influencing willingness to use hearing aids. Based on the outcome of the questionnaire a linear regression model predicting motivation to use hearing aids was calculated and evaluated.

Among the 11 parameters evaluated three contributed significantly to the model of willingness. The three predictor variables were expectations towards improvement of quality of life, stigmatization, and self-rated hearing ability. They accounted for about 55% of the variability in the data for willingness. Examination of a sub-sample three months after the survey had taken place revealed a distinct relationship between willingness and the decision to obtain or decline hearing aids.

In conclusion, the results strongly encourage supporting positive expectations in order to motivate individuals with hearing impairment to use hearing systems.