Association of human papillomavirus (HPV), p16, p53 and p63 expression with non-bilharzia-associated squamous cell carcinoma of the bladder and algorithm construction for histopathological grading prediction

ABSTRACT Objective To investigate the expression of human papillomavirus (HPV), p16, p53, and p63 in non-schistosomiasis-related squamous cell carcinoma of the bladder and to develop an accurate and automated tool to predict histological classification based on clinicopathological features. Methods Twenty-eight patients with primary bladder pure squamous cell carcinoma who underwent cystectomy or transurethral resection of bladder tumor (TURBT) for bladder cancer between January 2011 and July 2017 were evaluated. Clinical data and follow-up information were obtained from medical records. Formalin-fixed, paraffin-embedded surgical specimens were used for immunohistochemical staining for p16, p53, and p63. Human papillomavirus detection was evaluated by PCR. Statistical analysis was performed, and statistical significance was set at p<0.05. Finally, decision trees were built to classify patients' prognostic features. Leave-one-out cross-validation was used to test the generalizability of the model. Results Neither direct HPV detection nor its indirect marker (p16 protein) was identified in most cases. The absence of p16 was correlated with less aggressive histological grading (p=0.040). The positive p16 staining detection found only in pT1 and pT2 cases in our sample suggests a possible role for this tumor suppressor protein in the initial stages of bladder squamous cell carcinoma. The decision trees constructed described the relationship between clinical features, such as hematuria/dysuria, the level of tumor invasion, HPV status, lymphovascular invasion, gender, age, compromised lymph nodes, and tumor degree differentiation, with high classification accuracy. Conclusion The algorithm classifier approach established decision pathways for semi-automatic tumor histological classification, laying the foundation for tailored semi-automated decision support systems for pathologists.

Occupational infection to Brucella abortus B19 vaccine despite antimicrobial prophylaxis / Infecção ocupacional pela cepa vacinal de Brucella abortus B19 apesar de profilaxia antimicrobiana

ABSTRACT: The authors report the case of a veterinarian who acquired brucellosis infection by accidental exposure to Brucella abortus vaccine (BRUCEL-VET B19) while performing animal vaccination. Antibiotic prophylaxis with doxycycline and rifampin for six weeks was indicated, but rifampin was discontinued after 10 days due to gastrointestinal in-tolerance. Despite prophylaxis, the patient seroconverted after 30 days, but was asymptomatic and did not require additional antibiotic therapy. Post-exposure prophylaxis of Brucella is not free from side effects and asymptomatic seroconversion can occur despite prophylaxis. (AU)

RESUMO: Os autores relatam o caso de um veterinário que adquiriu infecção por brucelose por exposição acidental à vacina Brucellaabortus (BRUCEL-VET B19) durante a vacinação animal. A profilaxia antibiótica com doxiciclina e rifampici-na por seis semanas foi indicada, mas a rifampicina foi descontinuada após 10 dias devido à intolerância gastroin-testinal. A profilaxia pós-exposição de Brucella não está isenta de efeitos colaterais e a soroconversãoassintomática pode ocorrer apesar da profilaxia. (AU)

Câncer de mama em mulheres jovens: análise de 12.689 casos / Breast Cancer in Young Women: Analysis of 12.689 Cases

Introdução: O câncer de mama em mulheres com idade inferior a 40 anos é incomum. Entretanto, nessa população,a doença cursa, em geral, com pior prognóstico. Objetivos: Descrever o perfil clínico e epidemiológico de mulheres jovens diagnosticadas com câncer de mama no Brasil e comparar as características clínicas entre mulheres com idade inferior a 34 anos e aquelas entre 35 e 39 anos. Método: Estudo transversal dos casos analíticos de câncer de mama em mulheres de 18 a 39 anos, inseridos no Módulo Integrador dos Registros Hospitalares de Câncer e no Registro Hospitalar de Câncer do Estado de São Paulo, entre 2000 a 2009. Foi realizada a análise descritiva das variáveis. Resultados: Foram incluídos 12.689 casos. A idade mediana foi de 36 anos, a maioria das mulheres possuía ensino médio (32,3%)e era proveniente do Sistema Único de Saúde (74,6%). O estadiamento avançado (≥IIB) foi registrado em 62,8% dos casos e, ao final do primeiro tratamento, 44,4% das pacientes encontravam-se sem evidência da doença. Mulheres muito jovens apresentaram mais frequentemente tamanho do tumor >2cm, status dos linfonodos positivo, presença demetástase, estadiamento clínico avançado (≥IIB) e ausência de resposta terapêutica ao primeiro tratamento. Conclusão: No Brasil, mulheres jovens com câncer de mama apresentam estadiamento avançado ao diagnóstico. Aquelas muitojovens (<35 anos) apresentam doença ainda mais avançada e pior resposta terapêutica que aquelas entre 35 e 39 anos

Introduction:Breast cancer in women under 40 years old is unusual. However, in this population the disease usually progresses with worse prognosis.Objectives:to describe the clinical and epidemiological profile of young women diagnosed with breast cancer in Brazil and to compare the clinical characteristics among women aged less than 34 years and those between 35 and 39 years...