Prognostic role of annexin A2 and cancer-associated fibroblasts in advanced non-small cell lung cancer: Implication in epithelial-mesenchymal transition and gefitinib resistance.

BACKGROUND: Despite advances in treatment of non-small cell lung cancer (NSCLC), its prognosis remains dismal. Development of drug resistance is a major obstacle against success of targeted epidermal growth factor receptor (EGFR) -tyrosine kinase inhibitors (TKI) therapy. This study aimed to assess the prognostic role of annexin A2 (ANXA2) expression, within both tumor cells and stroma, as well as cancer associated fibroblasts (CAFs) in NSCLC and to investigate their potential role in induction of epithelial mesenchymal transition (EMT) and resistance to gefitinib. METHOD: Immunohistochemistry was performed to evaluate tumoral and stromal ANXA2 expression and α-SMA-stained CAFs in 110 advanced NSCLC patients. Furthermore, STAT3 and E-cadherin mRNA expression was studied by quantitative reverse transcription PCR (qRT-PCR). RESULTS: Both tumoral and stromal ANXA2 as well as CAFs were significantly related to clinical stage IV and malignant pleural effusion, while tumoral ANXA2 was significantly related to poor tumor differentiation. EGFR mutation and high tumoral ANXA2 were independent factors for poor overall survival, whereas high stromal and tumoral ANXA2 and high CAFs were independent predictors for poor progression-free survival. Moreover, high ANXA2 and CAFs were significantly associated with high STAT3 and low E-cadherin mRNA expression. Focusing on EGFR mutated cases, gefitinib resistance was significantly associated with high tumoral and stromal ANXA2, high CAFs, high STAT3 and low E-cadherin. CONCLUSION: CAFs and ANXA2 could be considered as poor prognostic parameters in advanced NSCLC and are potential factors for gefitinib therapy resistance through EMT induction.

Maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria: A 3-year observational study.

OBJECTIVE: To assess the maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria. METHODS: This was a prospective 3-year observational study carried out at Menoufia University Hospital and included 106 patients with gestational hypertension and 124 patients with gestational proteinuria after 20 weeks' gestation. Enrolled patients were followed to assess the maternal and fetal outcome. Data were collected and tabulated. RESULTS: There was a highly significant difference between the two groups regarding the development of preeclampsia (PE) and persistence of the condition after the end of the puerperium (p < 0.001) with more women progressed to PE and lower number suffered persistence of the disorder in the gestational hypertension group. There was no significant difference between the two groups regarding other maternal complications (p > 0.05). There was a significant difference between the two groups regarding preterm delivery, admission to NICU, and neonatal mortality (p < 0.05) which were higher in the gestational proteinuria group. There was no significant difference between the two groups regarding other fetal and neonatal complications (p > 0.05). CONCLUSIONS: Although gestational hypertension progressed more frequently to PE than gestational proteinuria, poorer fetal outcome was more encountered in women with gestational proteinuria. Larger studies are warranted to confirm these findings.

Impact of maternal fasting on fetal well-being parameters and fetal-neonatal outcome: a case-control study.

OBJECTIVE: To assess the impact of maternal fasting on fetal well-being parameters and neonatal outcome. METHODS: Two-hundred ten healthy women with singleton uncomplicated pregnancies at 36-40 weeks' gestation who had fasted for 12-16 h were defined as the study group with 240 healthy non-fasted pregnant women matched for age, parity and gestational age were defined as the control group. Both groups were subjected to tests of fetal well-being in the form of non-stress test (NST), modified biophysical profile and Doppler indices of the umbilical and middle cerebral arteries (MCA). Women were followed-up till delivery to record the obstetric outcome. RESULTS: There was no significant difference between the two groups regarding the reactivity of NST, modified biophysical scores, Doppler indices of the umbilical and MCA (resistive index, pulsatility index and systolic/diastolic ratio) and the cerebroplacental ratio (p > 0.05). There was no significant difference between the two groups regarding the gestational age at delivery, mode of delivery, neonatal weight, 5-min Apgar scores and admission to neonatal intensive care unit (p > 0.05). CONCLUSIONS: Short-term maternal fasting has no deleterious effect on fetal well-being parameters or neonatal outcome. Pregnant women who desire fasting, should be reassured regarding the health of their babies.

Lactoferrin versus ferrous sulphate for the treatment of iron deficiency anemia during pregnancy: a randomized clinical trial.

OBJECTIVE: This study was conducted to evaluate the efficacy and safety of lactoferrin in comparison to ferrous sulphate for the treatment of iron deficiency anemia (IDA) during pregnancy. MATERIALS AND METHODS: This prospective, randomized, parallel-group, single-center study was conducted in the Department of Obstetrics and Gynecology at Menoufia University Hospital, Egypt and included a total of 200 pregnant women in the second trimester with IDA who were enrolled and randomly assigned either to receive 150 mg of dried ferrous sulphate capsules or lactoferrin 250 mg capsules once daily for eight consecutive weeks. The primary efficacy parameter was the amount of increase in hemoglobin concentration by 4 and 8 weeks, the adverse effects related to iron therapy and the patient compliance to the treatment. RESULTS: Total increase in Hb after 2 months with lactoferrin was higher (2.26 ± 0.51 g/dL) compared to ferrous sulfate (1.11 ± 0.22 g/dL) (p < 0.001). Gastrointestinal adverse events occurred more frequently with ferrous sulphate than the lactoferrin group (p < 0.001). The number of women requesting change the drug was higher in the ferrous sulphate group (p < 0.001). CONCLUSION: Lactoferrin was more effective than ferrous sulfate over a two-month period in pregnant women with IDA, with fewer gastrointestinal adverse events and better treatment acceptability.