1,721,063 research outputs found
Prognostic and diagnostic role of peri-operative inflammatory markers in colorectal cancer
Full text linkBackground and objectives: The relationship between chronic inflammation and tumorigenesis has been largely investigated, and tumor-promoting inflammation proposed as an ‘enabling characteristic’ for tumor development. Also, it is increasingly recognized that the outcome of oncological patients depends not only on the intrinsic characteristics of the tumour, but also on the host immune-response and its ability to recognize and destroy tumour cells before escape. The aim of this study was to evaluate if changes in circulating immune cells occurs before the diagnosis of colorectal cancer (CRC), and to assess their relationship with survival outcomes. Moreover, we investigated if peri-operative inflammation influences long-term outcomes.
Materials and methods: Consecutive patients undergoing surgery for CRC at a single center were assessed for inclusion. The longitudinal changes in immune cell profile were evaluated in patients undergoing surgery for all stages (2005-2020) with a minimum follow-up of 24 months. For each patient a complete blood count (Pre-CBC) dated at least 24 months before surgery was retrieved. All parameters of Pre-CBC were tested for potential associations with survival after surgery. To evaluate the role of peri-operative inflammation, the analysis was restricted to patients submitted to elective minimally invasive potentially curative (R0-1) surgery for stage I-III CRC (2005-2022). Patients were categorized in a high-CRP (H-CRP) and low-CRP (L-CRP) group according to the highest value of post-operative CRP. Peri-operative outcomes, long-term survival and recurrence rates were compared between the two groups.
Results: Pre-CBC was available for 334 patients. Pre-Leukocyte (Pre-Leu), Pre-Neutrophils (Pre-Neut), and Pre-neutrophils-to-lymphocyte ratio (Pre-NLR) showed an increasing trend approaching the date of diagnosis, while Pre-Lymphocyte (Pre-Lymph) tended to decrease. On multivariate Cox regression analysis, Pre-Leu, Pre-Neut, Pre-Lymph and Pre-NLR resulted independent prognostic factors for OS and CSS, with pathological stage and age. Higher Pre-Leu, Pre-Neut, and Pre-NLR and lower Pre-Lymph were associated with worse CSS, and the effect was more evident when blood samples were closer to surgery.
Considering peri-operative inflammation, 436 patients with stage I-III CRC were included in the analysis. According to ROC analysis for recurrence, the optimum cut-off for postoperative CRP was 151.5 mg/L (AUC = 0.599). Patients who developed a recurrence showed a higher CRPmax compared to patients without recurrence (170.8 versus 136.8 mg/L, p = 0.019). OS (p < 0.001), RFS (p = 0.005), and CSS (p = 0.001) were significantly worse in patients in the H-CRP group. When conducting subgroup analysis for stage, the results were confirmed only in stage III CRC. Considering pT, no differences in OS, RFS and CSS were found in patients with early pT, while the difference remained statistically significant for pT3 and pT4. On multivariate analysis, H-CRP proved to be an independent risk factor for recurrence (p = 0.007), together with rectal location of the tumor (p < 0.001), presence of lympho-vascular invasion (p = 0.027), and stage III (p = 0.007).
Conclusions: Changes in circulating immune cells could be detected as early as 24 months before the diagnosis of CRC, and this may represent an important window of opportunity for early diagnosis. Moreover, we demonstrated a significant association between early changes in circulating immune cells, OS, and CSS, reinforcing the body of evidence that suggests a bidirectional relationship between the tumor and the immune system. Our study also highlighted the potential role of surgical stress as tumor-promoting inflammation identifying post-operative CRP peak as a negative prognostic factor for OS, CSS, and RFS
ASO Author Reflections: Toward the Prediction of Peritoneal Recurrence After Curative Resection for Colon Cancer
No full textAbstract not availabl
123I-FP-CIT SPECT in the differential diagnosis between dementia with Lewy bodies and other dementias
No full textAIM: To systematically review the utility of dopamine system imaging using 123I-FP-CIT SPECT in the differential diagnosis between dementia with Lewy bodies (DLB) and other dementia syndromes.
METHODS: We searched MEDLINE, CENTRAL and ClinicalTrials.gov to identify studies reporting enough data to determine accuracy measure of 123I-FP-CIT SPECT in differentiating between DLB and other dementia syndromes. Studies including patients with Parkinson's disease or other parkinsonisms associated with abnormal DAT imaging were excluded. The methodological quality of studies was evaluated with QUADAS-2.
RESULTS: Eight studies were included. Studies adopting a clinical diagnosis as a reference standard showed sensitivity and specificity values of DaTSCAN in differentiating between DLB and non-DLB dementia syndromes (all subtypes, AD and FTD) consistently higher than 80%, both considering a visual and a semiquantitative analysis. The meta-analyses from the three studies using a neuropathological reference standard yielded sensitivity and specificity values higher than those adopting a clinical diagnostic reference.
CONCLUSIONS: 123I-FP-CIT SPECT can represent an accurate method to differentiate between DLB and other dementia syndromes. However, most data in the literature derive from studies adopting the clinical diagnosis as the reference diagnostic standard and which are therefore intrinsically unable to demonstrate an accuracy of DAT imaging above that of careful clinical diagnosis alone. The very few studies providing information on the neuropathologic correlation for the DaTSCAN findings show however high sensitivity and specificity values, suggesting that SPECT scan is more accurate than clinical diagnosis and may prove useful in supporting the clinical diagnosis of DLB.
Copyright © 2015 Elsevier B.V. All rights reserved
Author Response to LTE CLC 22970 of John Madias: Brain-heart pathway to injury in takotsubo syndrome
No full textWe would like to thank John Madias for his interest in our review about the mystery of the pathogenesis of Takotsubo cardiomyopathy (TC) .1 We agree with his semantic restraint of the eponym Wellens electrocardiographic (ECG) pattern, which needs a contextual disambiguation. Indeed, as stressed by Dr. Madias in a previous letter to the editor, this term is often used incorrectly in the literature2,3 . In this respect, through the words of Cato: "Nos vera vocabula rerum amisimus"4 (we have lost the real names of things), we would like to emphasize how the scientific world suffers from a sort of daily linguistic Babel, where words seem to have lost their capacity to communicate. This article is protected by copyright. All rights reserved
Comment on: Total neoadjuvant therapy versus standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials
No full text[no abstract available
Prolonged QTc interval and insula in patients with ischemic stroke: Inductive or abductive reasoning?
No full textno abstract availabl
Important distinction between acute coronary syndromes and Takotsubo syndrome
No full text[no abstract available
Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil
No full textThe Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis
Internal carotid artery thrombosis and its evolution documented by computed tomography angiography
No full textA case of a 79-year-old man, affected by persistent right eye blindness after multiple episodes of transient left hemiparesis and right eye amaurosis. Brain computed tomography (Angio CT) well documented right internal carotid artery (ICA) plaque with a 8-mm thrombus extending from ICA origin to the ophthalmic artery, in progressive lysis in the next days
Ischemic stroke due to sporadic and genetic pulmonary arteriovenous malformations: Case report
Full text linkPulmonary arteriovenous malformations (PAVMs) encompass congenital and genetic vascular anomalies characterized by complex interlacing of arteries and veins connected by fistulas, which allow rapid and continuous extracardiac right-to-left shunting (RLS). Presenting neurologic manifestations of PAVM include brain abscess and stroke, as the consequence of paradoxical embolism. Although rare, PAVM represents an overlooked cause of cryptogenic ischemic stroke in young adults, being misdiagnosed as patent foramen ovale and a preventable trigger of silent cerebral ischemic changes. In the emergency clinical setting, the recommended ischemic stroke workup in patients with RLS should include the influence of postural changes and the effect of Valsalva maneuver on the entity of the RLS on contrast-enhanced transcranial color Doppler ultrasound and the delay in the right inferior pulmonary vein and left heart opacification on contrast-enhanced transthoracic echocardiography. This is in addition to the evaluation of chest X-rays or thoracic computed tomography. We here describe two patients with ischemic stroke due to sporadic and genetic PAVM-associated paradoxical embolism
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