Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report

BACKGROUNDNeoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable disease. The aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line treatment.CASE SUMMARYComputerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas, measuring approximately 4.2 cm × 2.7 cm, with an infiltrative aspect. The tumor had contact with the superior mesenteric vein, splenomesenteric junction and the proximal segment of the splenic artery, causing focal reduction of its lumens. Due to vascular involvement, neoadjuvant chemotherapy treatment with eight cycles of “folinic acid, 5-fluorouracil, irinotecan and oxaliplatine” (FOLFIRINOX) were performed. At the end of the cycles, surgery was performed, but the procedure was interrupted due to finding of lesions suspected of metastasis. Gemcitabine plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical resection.CONCLUSIONGemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FOLFIRINOX fails as the first line of treatment, suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.     

Detection of antibodies to Trypanosoma cruzi among blood donors in the southwestern and western United States. II. Evaluation of a supplemental enzyme immunoassay and radioimmunoprecipitation assay for confirmation of seroreactivity

BACKGROUND: Chagas' disease, caused by the protozoan parasite Trypanosoma cruzi, is endemic to Latin America and may be transmitted in the United States via blood donated by infected immigrants. Blood- borne pathogens such as T. cruzi require supplemental testing for confirmation of seroreactivity. STUDY DESIGN AND METHODS: A study was undertaken to determine an optimal scheme for confirmation of seroreactivity in repeatedly reactive samples identified by the Chagas antibody enzyme immunoassay (EIA). The procedure for initial confirmation involves three purified antigens coated onto three separate polystyrene beads and uses an EIA format. If the sample is reactive with two of three or three of three antigens, it is confirmed as seroreactive. If none or one of three beads is reactive, the sample is indeterminate and subjected to a radioimmunoprecipitation assay (RIPA). The RIPA must demonstrate characteristic bands at 32, 34, and 90 kDa. RESULTS: When tested with sera from persons with potentially cross-reactive diseases (n = 39) or against a presumed negative population from southeast Wisconsin (n = 289), the confirmatory EIA had a specificity of 100 percent. Sensitivity was 100 percent (28/28) with xenodiagnosis-positive sera and 97.6 percent (80/82) with chagasic sera from Latin America. The RIPA showed a specificity of 100 percent in EIA- nonreactive samples (n = 100) and a sensitivity of 100 percent with both xenodiagnosis-positive (28/28) and chagasic (82/82) sera. CONCLUSION: The confirmatory EIA and the RIPA together provide a highly specific and sensitive means of confirming seroreactivity for antibodies to T. cruzi.     

Serum Serotonin Abnormality in Depression

Background

Serotonin plays an important role in treatment of depression. We evaluated the clinical correlates of plasma serotonin levels in depressed patients before and after treatment.

Methods

Study sample comprised of 40 patients diagnosed on ICD-10 diagnostic criteria, and an equal number of healthy matched controls. Subjects were evaluated on Beck''s Depression Inventory (BDI) and Suicide Ideation Scale (SIS), before and after the treatment. Blood samples were collected from all the cases and controls before starting the antidepressant medication with selective serotonin reuptake inhibitors (SSRI''s). Serum serotonin levels were measured before and after treatment.

Result

Significant differences in scores before and after the intervention on BDI, SIS and serotonin levels of cases and controls (p<.000) were noted. Correlation between the serum serotonin levels before and after the treatment, and between the rating scales did not reveal significant association (p > 0.05). Patients with suicidal intentions had lower levels of serotonin. The scores changed after intervention.

Conclusion

Treatment with SSRI''s had shown significant changes in clinical conditions. However these changes did not relate significantly with serum serotonin levels.Key Words: Serotonin, Depression, Selective serotonin reuptake inhibitors     

Chronic postinfarction pseudo-pseudoaneurysm diagnosed by cardiac MRI

Left ventricular pseudo-pseudoaneurysm is an extremely rare complication of myocardial infarction. In this condition the postinfarction rupture of the myocardium is not transmural, but remains circumscribed within the ventricular muscle itself as a cavity joining to the left ventricle through a narrow neck. The differentiation between postinfarction pseudoaneurysms and pseudo-pseudoaneurysms may be very difficult using conventional imaging techniques, such as transthoracic, or transesophageal echocardiography and left ventricular angiography. Cardiac MRI (CMR), however, is capable of distinguishing among anatomical structures such as pericardium, thrombus, and myocardium. In our report a chronic postinfarction pseudo-pseudoaneurysm is described by CMR in a patient with an old myocardial infarction.     

Validation of MCADD newborn screening

Medium‐chain acyl‐CoA dehydrogenase deficiency (MCADD) represents a potentially fatal fatty acid β‐oxidation disorder. Newborn screening (NBS) by tandem mass spectrometry (MS/MS) has been implemented worldwide, but is associated with unresolved questions regarding population heterogeneity, burden on healthy carriers, cut‐off policies, false‐positive and negative rates. In a retrospective case‐control study, 333 NBS samples showing borderline acylcarnitine patterns but not reaching recall criteria were genotyped for the two most common mutations (c.985A>G/c.199C>T) and compared with genotypes and acylcarnitines of 333 controls, 68 false‐positives, and 34 patients. c.985A>G was more frequently identified in the study group and false‐positives compared to controls (1:4.3/1:2.3 vs. 1:42), whereas c.199C>T was found more frequently only within the false‐positives (1:23). Biochemical criteria were devised to differentiate homozygous (c.985A>G), compound heterozygous (c.985A>G/c.199C>T), and heterozygous individuals. Four false‐negatives were identified because our initial algorithm required an elevation of octanoylcarnitine (C₈) and three secondary markers in the initial and follow‐up sample. The new approach allowed a reduction of false‐positives (by defining high cut‐offs: 1.4 μmol/l for C₈; 7 for C₈/C₁₂) and false‐negatives (by sequencing the ACADM gene of few suspicious samples). Our validation strategy is able to differentiate healthy carriers from patients doubling the positive predictive value (42→88%) and to target NBS to MCADD‐subsets with potentially higher risk of adverse outcome. It remains controversial, if NBS programs should aim at identifying all subsets of all diseases included. Because the natural course of milder variants cannot be assessed by observational studies, our strategy could serve as a general model for evaluation of MS/MS‐based NBS.     

Italian healthcare workers' views on mandatory vaccination

Background  

Mandatory vaccination has contributed to the success of immunisation programmes but voluntary vaccination allows people to be responsible for their own health. There are benefits from both policies and the arguments between them remain subject to debate within and without the scientific community, both nationally and internationally. The aim of this study is to assess the opinions of those who actually work in the Vaccination Service.     

Serotonin receptor subtype and p11 mRNA expression in stress-relevant brain regions of suicide and control subjects

OBJECTIVE: Studies comparing people suffering from depression who committed suicide with control subjects have yielded inconsistent results regarding serotonin (5-HT) involvement in pathology, possibly owing to procedural factors. Our objective was to investigate which 5-HT receptor subtypes might be associated with depression and suicide, whether receptor differences vary across brain regions and whether they are moderated by sex. METHODS: We assessed messenger ribonucleic acid (mRNA) expression of several 5-HT receptor subtypes and that of p11, a protein involved in the functional expression of 5-HT(1B), in several stress-relevant brain regions. Tissue was obtained soon after death, and RNA integrity and pH was confirmed to be appropriate. Brain tissue from suicide subjects suffering from depression and from control subjects who had died from other causes (10 men and 10 women in each condition) was obtained within 6.5 hours postmortem. Quantitative polymerase chain reaction analyses determined mRNA expression of 5-HT receptor subtypes and p11 within the frontopolar cortex, orbitofrontal cortex, hippocampus, amygdala and paraventricular nucleus. The 5-HT transporter (5-HTT) was also assessed in the raphe nucleus. RESULTS: Differences of 5-HT(1A), 5-HT(1B) and p11 mRNA expression between people who committed suicide and control subjects were relatively widespread, whereas 5-HT(2A) and 5-HT(2C) variations were restricted to the frontopolar cortex and amygdala. Within the dorsal raphe nucleus, neither 5-HT(1A) nor 5-HTT mRNA expression differed between those who committed suicide and control subjects. CONCLUSION: Several 5-HT receptor subtypes are associated with depression and suicide, but these receptor differences vary across brain regions and are moderated by sex.