Neutrophil–lymphocyte ratio dynamics during concurrent chemo-radiotherapy for glioblastoma is an independent predictor for overall survival

Elevated neutrophil–lymphocyte ratio (NLR) may predict worse outcomes in cancer, including glioblastoma (GBM). This study assessed whether change in NLR during focal radiotherapy and concomitant temozolomide (RT-TMZ) provides further prognostic information. This was a retrospective review of patients treated with RT-TMZ for histologically confirmed GBM from January 2004 to September 2010. Variables assessed included age, ECOG performance status (PS), dexamethasone use and extent of surgery. Hematological results were collected at baseline, during and 4 weeks post RT-TMZ. Kaplan–Meier method was used to calculate overall survival (OS). Multivariable analysis (MVA) assessed for joint effect of covariates on OS and Pearson Correlation Coefficients assessed for association between dexamethasone dose and NLR change. With a median age of 55 (range 18–70), 369 patients were included. Median follow up was 15.1 month (range 1.6–134.6). The OS was 66.1% (95% CI 61.2–70.6) and 31.4 (95% CI 26.8–36.1) at 1 and 2 years, respectively. On univariate analysis, both decrease in NLR post RT-TMZ (HR 0.641, p?<?0.0001) and baseline NLR?<?7.5 (HR 0.628, p?<?0.0001) were associated with longer OS. On MVA decrease in NLR (HR 0.727, 95% CI 0.578–0.915), age (HR 1.025, 95% CI 1.012–1.038), baseline neutrophil (<8) (HR 0.689, 95% CI 0.532–0.891), total TMZ cycles (HR 0.89, 95% CI 0.867–0.913) and PS (HR 0.476, 95% CI 0.332–0.683) were independent predictors of OS. These findings suggest that a decrease in NLR during RT-TMZ, accounting for known prognostic factors, is an independent prognostic factor for survival in GBM.     

Differential immunohistochemical reactions of carcinoid tumors

Neuron-specific enolase, S-100 protein, and Leu 7 are present in cells showing neuroendocrine differentiation. Leu 7 recognizes myelin-associated glycoprotein, and recent evidence suggests that it further recognizes a subset of neurosecretory granules. Forty-six primary and metastatic carcinoid tumors from various sites were evaluated immunohistochemically with antisera to neuron-specific enolase, S-100, and Leu 7. Only one tumor, a rectal carcinoid, failed to stain with neuron-specific enolase. The remaining cases showed four patterns of staining: nuclear, diffuse cytoplasmic, globular cytoplasmic, or mixed. The pattern of reaction did not correlate with either the embryonic origin or histologic pattern of the tumor. Two patterns of staining were obtained with anti-Leu 7: diffuse cytoplasmic, or dot or ring-like deposition of reaction product. The latter pattern was entirely confined to appendiceal carcinoids. Reactivity with S-100 was in the form of dense positivity in individual cells having a stellate outline. Less intense cytoplasmic positivity and, uncommonly, a mixture of both types of staining were also seen. These histochemical results may lend support to recent evidence suggesting the existence of identifiable subsets of neurosecretory granules in neuroendocrine tumors, including carcinoids.     

Fibrous hamartoma of infancy

Fibrous hamartoma of infancy is an uncommon fibroproliferative lesion that occurs only in infancy and childhood. The present case is unusual for the presence of two separate lesions, infiltration into the superficial muscle, infiltration and entrapment of nerves, and rapid recurrence after initial surgery. Despite these unusual and suspicious features, follow-up evaluations over the 15 months subsequent to the last resection showed no evidence of recurrence.     

Allotype-linked immune response genes: roles in network control of the immune system.

Studies on allotype-linked immune response genes and related genes are overviewed with particular attention to our current results in unique models. Significance of actions of various immune response genes in relation to allelic polymorphism of molecules in the immune system is discussed. The molecules involve immunoglobulins, T cell receptors, major histocompatibility complex and a number of cell interaction molecules, many of which belong to the immunoglobulin superfamily. Differential roles of V-linked and C-linked immune response genes for network control of the immune system, preparing the V structure repertoire, controlling antigen presentation and modulating the effector mechanism, are suggested.     

Effect of acute exacerbations on skeletal muscle strength and physical activity in cystic fibrosis

BackgroundSkeletal muscle weakness is an important complication of chronic respiratory disease. The effect of acute exacerbations on strength in patients with cystic fibrosis is not known.MethodsQuadriceps (QMVC) and respiratory muscle strength were measured in patients at the time of acute admission, at discharge and one month later. Patients wore an activity monitor during admission and at one month. Convalescent values were compared to the stable clinic population.ResultsData were available for 13 acute admissions and 25 stable CF outpatients. Strength and other parameters including daily step count did not differ significantly between the stable and one month post-admission groups. At admission, QMVC was 16.7 (8.3)% lower than at convalescence, whereas inspiratory muscle strength did not change significantly. Reduction in QMVC did not correlate with activity levels or with markers of systemic inflammation.ConclusionFurther research is needed to identify the mechanisms responsible for the reduction in QMVC.     

Feasibility of a dual microcatheter-dual interlocking detachable coil technique in preoperative embolization in preparation for distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer

Purpose

To describe the feasibility of a dual microcatheter-dual interlocking detachable coil (DMDI) technique for preoperative embolization of the common hepatic artery (CHA) in preparation for distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for locally advanced pancreatic body cancer.

Methods

From January 2007 to December 2009, 26 patients underwent embolization of the CHA by the DMDI technique. We compared the results with those of 37 patients in whom the CHA was embolized by conventional techniques from August 1998 to February 2007.

Results

With the DMDI technique, no coil migration or other embolization-related complications occurred. The success rate was 100%. The rate of embolization-related complications was significantly lower in the DMDI embolization group (0%) than in the conventional embolization group (24.3%) (P?=?0.008). The frequency of improper positioning of the embolic material necessitating its removal during DP-CAR was significantly lower in the DMDI embolization group (10%) than in the conventional embolization group (37.5%) (P?=?0.044).

Conclusion

The DMDI technique allows the development of collateral pathways, reduces the surgeon's burden in ligating the distal CHA, and prevents coil migration. For these reasons, we believe that this technique is feasible for embolization of the CHA in preparation for DP-CAR for locally advanced pancreatic body cancer.