Malignant mesothelioma of the male genital tract: report of two cases

Two patients with urogenital mesothelioma are presented. The first patient had a malignant epithelial mesothelioma involving the scrotum and the peritoneal cavity. This patient was treated by extensive surgery and intraperitoneal perioperative chemotherapy; he is well and alive 62 months after diagnosis. The second patient had an aggressive malignant epithelioid mesothelioma of the tunica vaginalis testis; he died 24 months after diagnosis, with locoregional and metastatic recurrent disease, in spite of surgical and systemic chemotherapy treatment. Calretinin immunostains were positive in the first case and negative in the second. Eighty-eight previously published cases of malignant mesothelioma of the tunica vaginalis testis were found in a review of the literature to date. Mesothelioma of the tunica vaginalis testis usually presents as a scrotal mass, thus requiring urologist skills for first line treatment. A multidisciplinary approach is advised when dealing with the malignant form, considering its aggressive natural history.     

Three-Dimensional Stereoscopic Volume Rendering of Malignant Pleural Mesothelioma

Our objective was to investigate the application of three-dimensional (3D) stereoscopic volume rendering with perceptual colorization on preoperative imaging for malignant pleural mesothelioma. At present, we have prospectively enrolled 6 patients being considered for resection of malignant pleural mesothelioma that have undergone a multidetector-row computed tomography (CT) scan of the chest. The CT data sets were volume rendered without preprocessing. The resultant 3D rendering was displayed stereoscopically and used to provide information regarding tumor extent, morphology, and anatomic involvement. To demonstrate this technique, this information was compared with the corresponding two-dimensional CT grayscale axial images from two of these patients. Three-dimensional stereoscopic reconstructions of the CT data sets provided detailed information regarding the local extent of tumor that could be used for preoperative surgical planning. Three-dimensional stereoscopic volume rendering for malignant pleural mesothelioma is a novel approach. Combined with our innovative perceptual colorization algorithm, stereoscopic volumetric analysis potentially allows for the accurate determination of the extent of pleural mesothelioma with results difficult to duplicate using grayscale, multiplanar CT images.     

Diagnosis of Mesothelioma

Mesothelioma is a rare neoplasm that arises from mesothelial cells lining body cavities including the pleura, pericardium, peritoneum, and tunica vaginalis. Most malignant mesotheliomas occur in the chest and are frequently associated with a history of asbestos exposure. The diagnosis of malignant mesothelioma is challenging and fraught with pitfalls, particularly in small biopsies. This article highlights what the pathologist needs to know regarding the clinical and radiographic presentation of mesothelioma, histologic features including subtypes and variants, and recent advances in immunohistochemical markers and molecular testing.     

尿液外泌体作为泌尿系统肿瘤分子标志物的研究进展

外泌体是由包括肿瘤细胞在内的多种细胞分泌的膜性小囊泡,性状稳定,可反映来源细胞的生理/病理状态,是肿瘤早期诊断和判断预后的分子标志物的良好来源。尿液外泌体直接来源于泌尿系统,对泌尿系统肿瘤的诊断和判断预后有更加直接的作用。本文对尿液外泌体作为泌尿系统肿瘤早期诊断分子标志物的研究进展进行综述。     

Biomarkers in diabetic nephropathy: Present and future

Diabetic nephropathy (DN) is the leading cause of end stage renal disease in the Western world. Microalbuminuria (MA) is the earliest and most commonly used clinical index of DN and is independently associated with cardiovascular risk in diabetic patients. Although MA remains an essential tool for risk stratification and monitoring disease progression in DN, a number of factors have called into question its predictive power. Originally thought to be predictive of future overt DN in 80% of patients, we now know that only around 30% of microalbuminuric patients progress to overt nephropathy after 10 years of follow up. In addition, advanced structural alterations in the glomerular basement membrane may already have occurred by the time MA is clinically detectable.Evidence in recent years suggests that a significant proportion of patients with MA can revert to normoalbuminuria and the concept of nonalbuminuric DN is well-documented, reflecting the fact that patients with diabetes can demonstrate a reduction in glomerular filtration rate without progressing from normo-to MA. There is an unmet clinical need to identify biomarkers with potential for earlier diagnosis and risk stratification in DN and recent developments in this field will be the focus of this review article.     

蛋白质组学应用在大肠癌中的进展

蛋白质组学是研究蛋白质的组成和动态变化的一门学科。随着大肠癌的发生蛋白表达展现出一个动态的变化过程。蛋白组学研究技术可以对蛋白进行定性和定量分析并与正常人蛋白代谢谱进行对比分析,找出与大肠癌进展程度相关的标志物。本综述对蛋白质组学在大肠癌中的研究进行小结,归纳与大肠癌诊断、预后及治疗方面相关的标志物。     

Biomarkers predicting sepsis in polytrauma patients: Current evidence

Introduction

Major trauma still represents one of the leading causes of death in the first four decades of life. Septic complications represent the predominant causes of late death (45% of overall mortality) in polytrauma patients. The ability of clinicians to early differentiate between systemic inflammatory response syndrome (SIRS) and sepsis is demonstrated to improve clinical outcome and mortality. The identification of an “ideal” biomarker able to early recognize incoming septic complications in trauma patients is still a challenge for researchers.

Aim

To evaluate the existing evidence regarding the role of biomarkers to predict or facilitate early diagnosis of sepsis in trauma patients, trying to compile some recommendations for the clinical setting.

Methods

An Internet-based search of the MEDLINE, EMBASE and Cochrane Library databases was performed using the search terms: “Biomarkers”, “Sepsis” and “Trauma” in various combinations. The methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies Checklist (QUADAS). After data extraction, the level of evidence available for each bio-marker was rated and presented using the “best-evidence synthesis” method, in line with the US Agency for Healthcare Research and Quality.

Results

Thirty studies were eligible for the final analysis: 13 case–control studies and 17 cohort studies. The “strong evidence” available demonstrated the potential use of procalcitonin as an early indicator of post-traumatic septic complications and reported the inability of c-reactive protein (CRP) to specifically identify infective complications. Moderate, conflicting and limited evidence are available for the other 31 biomarkers.

Conclusion

Several biomarkers have been evaluated for predicting or making early diagnosis of sepsis in trauma patients. Current evidence does not support the use of a single biomarker in diagnosing sepsis. However, procalcitonin trend was found to be useful in early identification of post-traumatic septic course and its use is suggested (Recommendation Grade: B) in clinical practice.     

Urinary Biomarkers as Indicators of Renal Disease

Using modern technology, minute quantities of LMWP, prostanoids, growth factors, intra-renal and extra-renal enzymes can be measured in urine. Excretory patterns that are characteristic for site and mechanism of renal injury often can be found. It is possible to recognise urinary biomarker patterns that suggest the putative environmental nephrotoxin. Our own studies performed in subjects with low level occupational and environmental exposures in New Jersey confirm the pattern specificity and threshold effects for Cr, Hg and Pb. In addition, we have been able to show that increased NAG and LAP excretion following Pb exposure correlates with current (blood Pb) but not with the cumulative Pb burden (bone Pb). The relatively specific characteristic patterns of biomarker excretion are lost as renal failure progresses. Moreover, renal injury that results in tubular proteinuria may not progress to renal failure. Nevertheless, urine biomarkers can help to establish acceptable levels and identify the need for long term surveillance to ascertain when clinical renal disease may result.     

Biomarkers in Occupational Volatile Organic Chemical Exposure

Evidence exists that in certain groups of workers exposed to volatile organic chemicals, there is subclinical renal damage and dysfunction. Also, there is activation of biological mechanisms that are suggested links between volatile organic chemical exposure and renal disease. Notably, the workers studied are employed in factories where exposures are considered controlled, with on-site professional health and safety management. Recent studies continue to indicate an increased risk of renal disease in those exposed to volatile organic chemicals.