1002-LB: ACE Polymorphism in asthmatic patients

Aim

The aim of the this study was to analyse if there is an association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism (287 base pairs, on chromosome 17q23, intron 16) with asthma severity . ACE plays a vital role in the renin-angiotensin-system (RAS) which regulates blood pressure by converting angiotensin I into a powerfull vasoconstrictor angiotensin II and could also have a role in bronchoconstriction and airway remodeling in asthmatic disease.

Methods

Asthmatic patients: n = 22;were compared with a control group of n = 206 healthy blood donors. The insertion/deletion (I/D) polymorphism was determined by PCR- Polymerase chain reaction. Control of asthma assessed by validated instrument (ACQ7 and PAQLQ). Statistical analysis was performed with PASW 18, establishing a significance level of p< 0.05. All patients signed an informed consent.

Results

The mean age of the 22 asthmatics was 42.86 ± 20.8 years; 9 females and 13 males; all caucasians; 20 atopic and 2 nonatopic. The mean age of the control-group (n = 206) was 41.05 ± 11.85 years; 70 females and 136 males. In asthmatics the frequencies of the D- Allele (ACE-D) is 0.591 and of the IAllele (ACE-I) is 0.409; in controls: 0.675 and 0.325 respectively. There is no statistical differences between these groups (p = 0.340). Genotypes in the asthmatics- DD: 45.4%; ID: 27.3%; II: 27,3%; in control group- DD:48.1%; ID:38.8%; II: 13.1%. There is no statistical differences between these groups (p = 0,175). In asthmatics, there is no statistical differences in genotype frequencies (p > 0.05) between : atopics and non atopics; controlled and uncontrolled asthma; males and females; and in the different age-groups.

Conclusions

The role of ACE insertion/deletion (I/D) polymorphism, in asthmatic patients is a controversy risk factor to the severity of asthma, but we think that we need a larger sample to infer about its role in remodeling, vascular tonus and bronchoconstriction.     

Added value of diffusion-weighted MRI in detection of cervical cancer recurrence: comparison with morphologic and dynamic contrast-enhanced MRI sequences

PURPOSE

We aimed to evaluate the added value of diffusion-weighted imaging (DWI) to standard magnetic resonance imaging (MRI) for detecting post-treatment cervical cancer recurrence. The detection accuracy of T2-weighted (T2W) images was compared with that of T2W MRI combined with either dynamic contrast-enhanced (DCE) MRI or DWI.

METHODS

Thirty-eight women with clinically suspected uterine cervical cancer recurrence more than six months after treatment completion were examined with 1.5 Tesla MRI including T2W, DCE, and DWI sequences. Disease was confirmed histologically and correlated with MRI findings. The diagnostic performance of T2W imaging and its combination with either DCE or DWI were analyzed. Sensitivity, positive predictive value, and accuracy were calculated.

RESULTS

Thirty-six women had histologically proven recurrence. The accuracy for recurrence detection was 80% with T2W/DCE MRI and 92.1% with T2W/DWI. The addition of DCE sequences did not significantly improve the diagnostic ability of T2W imaging, and this sequence combination misclassified two patients as falsely positive and seven as falsely negative. The T2W/DWI combination revealed a positive predictive value of 100% and only three false negatives.

CONCLUSION

The addition of DWI to T2W sequences considerably improved the diagnostic ability of MRI. Our results support the inclusion of DWI in the initial MRI protocol for the detection of cervical cancer recurrence, leaving DCE sequences as an option for uncertain cases.Cervical cancer is the fourth most frequent cancer in women worldwide (1). Early stage disease is treated with surgery or chemoradiotherapy and has a good prognosis. However, around 30% of all patients treated for cervical carcinoma develop progressive or recurrent tumors (2).Recurrent cervical cancer is defined as local tumor regrowth or the development of distant organ/lymph node metastases at least six months after regression of the initial lesion. Approximately two-thirds of recurrences appear within the first two years following initial treatment, with 90% recurring by five years post-treatment (3). Risk factors for recurrence include histopathologic features, depth of tumor invasion, and nodal status (4).Pelvic recurrence can be located centrally (cervix, uterus, vagina, parametria, ovaries, bladder, or rectum) or in the pelvic sidewalls. Extrapelvic recurrence most commonly involves the para-aortic lymph nodes, lungs, liver, or bone (4–6).Treatment of recurrent cancer depends on the primary treatment approach, location, and extension. Patients with locally recurrent disease can be offered salvage treatments with curative potential (chemoradiotherapy, if not given previously, or pelvic exenteration in patients who already received chemoradiotherapy). Distant metastases, however, are nearly always incurable (3).In patients who successfully completed primary treatment, surveillance has been advocated to detect the residual or recurrent disease at curable stages (7). The use of imaging studies such as magnetic resonance imaging (MRI) is indicated on the basis of clinical suspicion (8).T2-weighted (T2W) imaging is the reference sequence for cervical cancer staging (9). Recurrent tumors are known to show high signal intensity on T2W MRI, contrasting with the low signal intensity of the cervical stroma. However, some benign conditions such as necrosis, inflammation, and edema may also increase signal intensity on T2W images, representing a potential challenge to the radiologist, particularly after radiotherapy (10–13).Moreover, post-treatment changes can result in areas of fibrosis that are also difficult to differentiate from recurrence (14). MRI has proven to be superior to computed tomography (CT) in distinguishing fibrosis and scarring from active disease, but imaging findings are sometimes indeterminate, complicating the evaluation of recurrent disease (3).In recent years, the functional MRI techniques such as dynamic multiphase contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) have emerged as fundamental tools in female pelvic imaging evaluation (15). Although DCE was shown to be more accurate than T2W alone for tumor recurrence identification, the use of both sequences is recommended (10).Recently, DWI has been added to pelvic MRI protocols to increase diagnostic accuracy in tumor staging. This technique is a functional tool that relies on tissue water displacement to create a contrasted image. For correct evaluation and avoidance of pitfalls, the generated images must be interpreted alongside anatomical sequences. The apparent diffusion coefficient (ADC) map is also needed to reduce image misinterpretation, for example due to the T2 shine-through effect (15). In highly cellular tissues, water movement is restricted and such lesions appear bright at high b-values (1000 s/mm²) and have low ADC value, appearing dark gray on ADC maps in contrast to areas of freely moving water such as urine in the bladder (14). Some recent studies have suggested that DWI and ADC maps can be potentially useful in oncologic follow-up (14, 16).The purpose of this study was to compare the accuracy of T2W/DWI with that of conventional anatomical sequences alone and T2W/DCE imaging sequences in the evaluation of recurrent disease in patients treated for uterine cervical carcinoma.     

Assessment of Platelet REACtivity After Transcatheter Aortic Valve Replacement: The REAC-TAVI Trial

Objectives

The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI.

Comprehensive Treatment of Periorbital Region with Hyaluronic Acid

The periorbital subunit is one of the first facial regions to show signs of aging, primarily due to volume depletion of the soft tissue and bony resorption. Surgical and office-based nonsurgical procedures form an important basis for periorbital rejuvenation. It is important to make a detailed clinical evaluation of the patient to indicate the most appropriate procedure to be performed. With the objective of showing a nonsurgical procedure for the rejuvenation of the periorbital area, the authors describe a technique of applying fillers in the upper and lower periorbital regions, paying attention to the anatomy of this facial region and the type of product to be used besides the expected results of the procedure and its possible adverse effects and complications. The nonsurgical rejuvenation of the periorbicular region with hyaluronic acid is a new and innovative technique. In the opinion of the authors, it is a great aesthetic impact area and consequently brings high satisfaction to patients.Maintaining a youthful and pleasant appearance of the face in today’s culture impacts quality of life in many patients. The facial contour remodeling is being revolutionized by new nonsurgical techniques.Facial aging is a complex and dynamic process. All people age differently as a result of imbalance, disharmony, and disproportion of the aging process between the overlying soft tissue and the underlying bony frameworks.1 The upper periorbital subunit is one of the first facial regions to show signs of aging, and even minor changes in its structure and volume can distort the perceived emotions and health of patients.2 An aesthetic and youthful upper periorbital subunit is characterized by a well-defined brow of appropriate height and shape, fullness of the upper periorbit, a crisp and well-defined upper eyelid crease, minimal skin excess, and good skin quality.3,4In the aging process of this facial area, one group of patients displays signs of aging due predominantly to soft tissue ptosis of the upper eyelid, requiring surgical excision. Another group presents with volume depletion of the soft tissue and bony resorption of the orbit. The loss of septal support, leading to brow prolapse and an exacerbation of upper eyelid fullness and congestion, can also contribute to the aging process. This appearance is characterized by deflation of the upper eyelid as well as hollowing and visibility of the supraorbital bony rim, leading to a sunken, hollow, and skeletonized orbit, which can make the patient appear sickly, anorexic, and old. In recent years, modern facial rejuvenation surgery has evolved toward volume restoration in addition to tissue suspension.2Comprehensive analysis of both soft tissue and bony structural changes are essential for the periorbital rejuvenation. Surgical procedures and office-based nonsurgical procedures form an important basis for periorbital rejuvenation, including cosmeceuticals, chemical peels, laser and light treatments, neurotoxins, and fillers. Improved understanding of the pathophysiology of aging and technical advancements in nonsurgical techniques has enabled us to achieve better and more comprehensive improvement for patients.5     

Giant follicular lymphoblastoma of the rectum (brill-symmers disease)

Summary and Conclusions The authors have presented a case of giant follicular lymphoblastoma (Brill-Symmers disease) involving the rectum. It is a rare disease which pursues a fairly characteristic clinical course. The lesion can be discovered by proctoscopic examination but, to establish the differential diagnosis, microscopic examination is essential. Biopsy should not be relied upon: the entire lesion should be available for microscopic study. Eventually, the lesion may become malignant. Specific treatment consists of complete removal of the tumor by surgical operation; subsequently, irradiation should be administered to destroy residual cells. Read at the meeting of the American Proctologic Society, Cleveland, Ohio, June 20 to 22, 1966.     

Concomitant Benznidazole and Suramin Chemotherapy in Mice Infected with a Virulent Strain of Trypanosoma cruzi

Although suramin (Sur) is suggested as a potential drug candidate in the management of Chagas disease, this issue has not been objectively tested. In this study, we examined the applicability of concomitant treatment with benznidazole (Bz) and suramin in mice infected with a virulent strain of Trypanosoma cruzi. Eighty 12-week-old male C57BL/6 mice were equally randomized in eight groups: (i) noninfected mice (negative control) and mice infected with T. cruzi Y strain receiving (ii) no treatment (positive control), (iii) Bz, 100 mg/kg of body weight per day, (iv) Sur, 20 mg/kg/day, and (v to viii) Sur, 20 mg/kg/day, combined with Bz, 100, 50, 25, or 5 mg/kg/day. Bz was administered by gavage, and Sur was administered intraperitoneally. Sur dramatically increased the parasitemia, cardiac content of parasite DNA, inflammation, oxidative tissue damage, and mortality. In response to high parasitic load in cardiac tissue, Sur stimulated the immune system in a manner typical of the acute phase of Chagas disease, increasing tissue levels of gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) and inducing a preferential IgG2a anti-T. cruzi serum pattern. When Sur and Bz were combined, the infection severity was attenuated, showing a dose-dependent Bz response. Sur therapy had a more harmful effect on the host than on the parasite and reduced the efficacy of Bz against T. cruzi infection. Considering that Sur drastically reinforced the infection evolution, potentiating the inflammatory process and the severity of cardiac lesions, the in vivo findings contradicted the in vitro anti-T. cruzi potential described for this drug.