Overview and update on molecular testing in non-small cell lung carcinoma utilizing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples

Lung carcinoma remains one of the most frequent and aggressive human neoplasms. Fortunately, in the last decades, the increasing knowledge of the molecular mechanisms leading to cancer development has allowed the use of targeted therapies with improvement of prognosis in many patients. Clinical management has also changed after the introduction of endobronchialultrasonographic bronchoscopy that allows a conservative staging of lung tumors, avoiding the need of mediastinoscopy for lymph node staging. Lung pathologists and cytopathologists are facing the challenge of giving the more comprehensive prognostic and predictive information with ever smaller tissue or cytological samples. The aim of this review is to summarize the molecular testing for non-small cell lung carcinoma and how pathologists can contribute to the patient's outcome with a conscious management of biological samples.     

Distribution of Peripheral Blood Lymphoid Subsets in Alcoholic Liver Cirrhosis: Influence of Ethanol Intake

The aim of the present study was to investigate the effect of chronic ethanol (EtOH) consumption on the immune system in patients with alcoholic liver cirrhosis (ALC), as analyzed by the distribution of peripheral blood (PB-) T, B, and NK lymphoid subsets using multiple stainings with monoclonal antibodies and flow cytometry. For that purpose, we have analyzed a group of patients with ALC and active EtOH intake (ALCET group) which were re-evaluated 3 months after alcohol withdrawal. As controls, both ALC patients with at least 1 year of alcohol withdrawal (ALCAW group) and healthy subjects were used. Regarding the alcohol intake period, the most relevant findings were a significant activation of the PB T-cell compartment, and specifically of the TCR alpha beta+ subset, as reflected by an increased expression of both the HLA DR and CD11c antigens as well as a significant increase of both the PB NK cells (CD3-/CD56+) and the cytotoxic T cells coexpressing the CD3 and CD56 molecules. In addition, a decrease of both the numbers of total B cells and their CD5+/CD19+ subset were observed. After a relatively short withdrawal period (3 months), the abnormalities of T, P, and NK cells disappeared. These findings suggest the existence of a close relationship between EtOH consumption and the abnormalities of the immune system observed during active alcoholism. Nevertheless, ALCAW individuals displayed marked alterations on the immunophenotypic profile, as reflected by a significantly decreased number of total T cells, due to reduced levels of the CD3+/TCR alpha beta+, CD4+, CD8+, and CD4+/CD45RA+ T-cell subsets. In addition, a significantly decreased number of total PB B cells was observed in this group of patients. Our results show that in patients suffering from ALC, the abnormalities of the immune system due to a direct effect of EtOH intake (or its metabolites) should be distinguished from the immunological alterations related to the liver disease itself.     

Abnormalities of Peripheral Blood T Lymphocytes and Natural Killer Cells in Alcoholic Hepatitis Persist after a 3-Month Withdrawal Period

Present information about the behavior of the different lymphoid subsets in alcoholic hepatitis (AH), including cells displaying cyto-toxic activity, is scanty and contradictory. The aim of this study was to gain further insight into knowledge of the immunological abnormalities involved in AH and the possible role of ethanol (EtOH) consumption in these changes. We analyzed the distribution of a wide range of peripheral blood (PB) lymphoid subsets, both during active EtOH intake and after a 3-month withdrawal period, using multiple stainings with monoclonal antibodies and flow cytometry, as well as natural killer (NK) cytotoxic activity. AH patients entering the study were selected strictly; only those undergoing their first episode of AH with no other lesions at liver biopsy were enrolled. Regarding the alcohol intake period, the most striking finding was a significant increase of the absolute number of PB T cells affecting both CD4⁺ and CD8⁺ lymphocytes. These changes were associated with a higher expression of T-cell activation antigens, such as HLA DR and CD11c. Simultaneously, a significant increase in both NK cells (CD3⁻-^/ CD56⁺) and the cytotoxic T cells coexpressing the CD3 and the CD56 molecules together with an increased NK cytotoxic activity were observed. By contrast, the CD19⁺/CD5⁺ B-cell subset was significantly decreased. No significant changes were observed with EtOH withdrawal except in CD5⁺ B lymphocytes, which returned to normal values. Our results show that, in AH patients, a significant expansion of both activated T cells and NK lymphocytes occurs in the PB, which is associated with an increased NK cytotoxic activity. Interestingly these abnormalities persist during the withdrawal period.     

Comparative study of peridural anesthesia with bupivacaine alone and combined with fentanyl during vaginal delivery

Two groups of primiparous women with single fetus in cephalic presentation were prospectively randomized at the end of pregnancy to receive epidural analgesia with 0.25% bupivacaine, either single (n = 102) or associated with 0.05 mg of phentanyl (n = 102). Phentanyl significantly reduces the period of development of analgesia and increases the interdose period. The quality of analgesia is significantly better when fentanyl is associated with bupivacaine. The evolution of delivery (dilatation and expulsion) and the perinatal results (cord pH and vitality of the newborn as assessed by the Apgar test) were similar in both groups. We conclude that the association of phentanyl with bupivacaine has advantages for epidural analgesia during delivery, as the quality of analgesia is improved, its duration is prolonged and there are no adverse effects on the evolution of delivery or on the newborn.     

Aceleração da recuperação após protocolo cirúrgico versus cuidados perioperatórios convencionais em cirurgia colorretal. Um estudo de coorte em centro único

Background

Enhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery.

Bi-national evaluation of herbal product use on the United States/México border

The study objective was to compare the prevalence of herbal product use between El Paso, Texas, and Ciudad Juárez, Chihuahua, the largest U.S./México border population. 500 households on each side of the border were randomly selected following a strict procedure for household and participant selection. 1001 adult residents of selected households participated. Trained bi-lingual interviewers conducted semistructured interviews using a bi-lingual questionnaire. A chi-square test was used to compare populations when considering discrete variables and a t test was used for continuous variables. There was no significant difference in the overall prevalence of herbal product (HP) use between the El Paso (68%) and Ciudad Juárez samples (65%). El Paso residents used a greater number of HPs compared to Ciudad Juárez residents (P = 0.001). The most common HPs used in El Paso were chamomile, aloe vera, garlic, peppermint and lime. In Ciudad Juárez, they were chamomile, eucalyptus, garlic, linden tree flower and peppermint. In addition, intra-city variation in the use of HPs was observed. On both sides of the border, relatives were the most common source of advice regarding HP use, and most HPs were reportedly used in raw form. While participants in both groups believed that the HPs were effective and safe, a large number of HPs that could potentially be responsible for drug interactions, and side effects were identified. Very low disclosure rates to physicians were reported (33% in El Paso and 14% in Ciudad Juárez). A high prevalence of HP use was documented on both sides of the U.S./México border. Some significant variations in HP use were also identified. The possibilities of HP-related problems combined with low disclosure rates are of significant concern.