Preoperative Locoregional Therapy May Relate with Stemness and Distinct Transitions Between Epithelial and Mesenchymal States in Hepatocellular Carcinoma.

Background/Objectives: Locoregional therapy (LRT) might impel hepatocellular carcinoma (HCC) to exhibit different phenotypes by modulating tumoral cell adaptation. HCCs presurgically treated with LRT were studied, focusing on stemness and mesenchymal features. Methods: Clinicopathological and immunohistochemical data (Ki67, p53, EpCAM, CK19, CK7, ASMA and vimentin expression) were considered in 89 HCC nodules (30 treated with LRT; 59 non-treated), comprising 46 liver transplanted/surgically resected patients. Results: In LRT group, well and poorly differentiated tumors without fibrous encapsulation were predominant (P < 0.05) and peritumoral necroinflammation severity tended to be greater. Peritumoral Ki67 expression was higher (P < 0.05) and p53, EpCAM, CK19 and CK7 peritumoral expression was relevant after LRT, where ablated carcinomas displayed higher peritumoral CK19 expression (P < 0.05). Tumoral ASMA and vimentin expression was higher in non-LRT group (P < 0.05). In LRT group, an exclusive association between progenitor/cholangiocytic cell and mesenchymal markers expressed by tumoral cells was observed (P < 0.05): EpCAM tumoral expression associated with vimentin stromal expression; tumoral CK19 expression associated with stromal ASMA expression; tumoral CK7 expression associated with tumoral vimentin expression. Conclusion: Peritumoral cellular proliferation and expression of progenitor/cholangiocytic cell markers seem to be more frequent after LRT, with a distinctive epithelial-mesenchymal interplay and plasticity in peritumoral and tumoral compartments.

Hepatocellular carcinoma: tumor heterogeneity and recurrence after preoperative locoregional therapy.

How locoregional therapy (LRT) may change tumor compositional and functional heterogeneity, consequently contributing to treatment resistance and tumor recurrence remains largely unknown. A series of hepatocellular carcinomas (HCCs) treated with preoperative locoregional therapy (LRT) that relapsed after surgery was studied. Thirty HCCs comprising 15 patients treated with LRT prior to liver transplantation (n = 14)/surgical resection (n = 1) were studied. Five patients undergoing pre-transplant LRT, comprising 11 HCCs, presented tumor recurrence (median recurrence time = 10 months). Clinicopathological data and immunoexpression of proliferation markers (Ki67, p53), cholangiocytic/hepatic progenitor cell (HPC) markers (EpCAM)/BerEp4, CK19, CK7) and mesenchymal markers (ASMA, vimentin) were evaluated in tumoral epithelial/stromal cells and in peritumoral parenchyma. Higher grading of tumor differentiation, microvascular invasion and tumoral cell p53 expression significantly associated with recurrence (p < 0.05). Piecemeal necrosis features were more frequent in tumors that recurred (p < 0,05). Tumoral and peritumoral Ki67 expression and EpCAM, CK19 and CK7 expression in tumoral cells tended to be higher in treated tumors that recurred. Peritumoral expression of cholangiocytic/HPC markers and tumoral epithelial and stromal cellular expression of mesenchymal markers tended to be higher for tumors without recurrence. Recurrence after transplant with preoperative LRT might be associated with poor HCC differentiation, higher cellular proliferation rate, peritumoral piecemeal necrosis features and cholangiocytic/HPC phenotypes. Understanding HCC progression factors after LRT might be important for optimizing patient selection for treatment, improving surveillance after LRT and to explore synergies between LRT and systemic targeted therapies to prevent recurrence.

Intervenção do enfermeiro especialista em enfermagem de reabilitação na preparação para alta da pessoa submetida a artroplastia total da anca: promoção do autocuidado / Intervention by a nurse specializing in rehabilitation nursing in preparation for discharge of a person undergoing total hip arthroplasty: Other titles: promoting self-care

A osteoartrose é reconhecida como uma doença comum e debilitante, pertencendo ao conjunto de doenças crónicas das populações atuais e com grande impacto social e económico. Sendo a articulação coxofemoral, uma das mais atingidas pela osteoartrose, a Artroplastia Total da Anca (ATA) surge como o tratamento cirúrgico com maior sucesso e com objetivo de promover a qualidade de vida das pessoas com esta afeção, através do alívio da dor e melhoria da função. No entanto, as alterações físicas e psíquicas decorrentes de um ato cirúrgico, e neste caso da ATA, originam um défice de autocuidado e consequentemente necessidades especificas à reintegração na comunidade. Desta forma, a Enfermagem de Reabilitação apresenta-se como elemento chave para cuidar e capacitar estas pessoas e maximizar as suas funcionalidades, com intuito de proporcionar a máxima independência e o desempenho seguro das atividades de autocuidado. Tendo em conta este contexto, o problema geral encontrado foi: "Qual a intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação na Preparação para a Alta da pessoa submetida a Artroplastia Total da Anca e na Promoção do Autocuidado?". Para sustentar a intervenção de Enfermagem de Reabilitação foi escolhida a Teoria do Défice de Autocuidado na Enfermagem, de Dorothea Orem, visto ser a teoria que melhor integra a promoção de autocuidado, mais especificamente a Teoria dos Sistemas de Enfermagem, por determinar como é que os enfermeiros, as pessoas e ambos, dão resposta às necessidades de autocuidado identificadas. O objetivo deste relatório é demonstrar, de forma reflexiva, como as atividades e experiências vivenciadas durante o estágio contribuíram para o desenvolvimento e aquisição de competências comuns e específicas do Enfermeiro Especialista em Enfermagem de Reabilitação (EEER).

Osteoarthrosis is recognized as a common and debilitating disease, belonging to the set of chronic diseases of the current populations and with great social and economic impact. Since the hip joint is one of the most affected by osteoarthrosis, Total Hip Arthroplasty emerges as the surgical treatment with greater success and aims to promote the quality of life of people with this affection, through pain relief and improvement of functionality. However, the physical and mental changes resulting from a surgical act, and in this case Total Hip Arthroplasty, result in a deficit of self-care and consequently specific needs for reintegration into the community. In this way, rehabilitation nursing is a key element to care for and empower these people to maximize their functionalities, in order to provide maximum independence and the safe performance of self-care activities. Given this context, the general problem encountered was: "What is the intervention of the Specialist Nurse in Rehabilitation Nursing in the Preparation for Discharge of the person undergoing Total Hip Arthroplasty and in the Promotion of Self-Care?" To support the Rehabilitation Nursing intervention, Dorothea Orem's Theory of Self-Care in Nursing was chosen, since it is the theory that best integrates the promotion of self-care, more specifically the Nursing Systems Theory, for determining how the nurses, people, and both respond to identified self-care needs. The objective of this report is to demonstrate, in a reflexive way, how the activities and experiences during the training period contributed to the development and acquisition of common and specific competences of the Specialist Nurse in Rehabilitation Nursing.

Pachymeningitis and cerebral granuloma in granulomatosis with polyangiitis: is rituximab a promising treatment option?

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by granulomatous inflammation involving upper and lower respiratory tract, kidneys and peripheral nervous system. However, central nervous system involvement is uncommon and frequently refractory to classical therapy. Rituximab has emerged as promising alternative, but published reports are scarce. We report a case of pachymeningitis and cerebral granuloma in a patient with a history of severe generalized GPA, treated with rituximab. This case illustrates the complexity of the management of neurologic manifestations and provides insight into the potential utility of rituximab in this condition.

Superior vena cava syndrome and colon carcinoma: a report of a multifactorial association.

Introduction. Superior vena cava (SVC) syndrome results from the obstruction of blood flow through the SVC, having distinct pathophysiological underlying mechanisms. Cancer is associated with an increased risk of thromboembolism that varies according to patient-, tumor-, and treatment-related factors. An individualized clinical approach is important to pursue the accurate diagnosis of the underlying pathology causing thromboembolism in cancer patients. Case Presentation. The authors present a case of a 58-year-old male with an infrequent presentation of an unknown colon carcinoma, who has never had any symptom until he was hospitalized with the diagnosis of superior vena cava syndrome and pulmonary thromboembolism. The patient had an advanced disease by the time of diagnosis and molecular alterations contributing to abnormal hemostasis. He presented venous and arterial thromboembolism and developed disseminated intravascular coagulopathy after surgery, anticoagulant and transfusion therapy, dying 40 days after the hospitalization. Conclusion. The authors discuss thromboembolic disease and tumor metastasis roles in a cancer patient with SVC syndrome. Thromboembolism in a malignancy context is a challenging clinical entity. A multifactorial perspective of the thrombotic disease is warranted to approach thromboembolism risk and stratify patients suitable to receive adequate anticoagulant prophylaxis and targeted therapies, aiming to improve clinical prognosis.

EGFR/erB-1, HER2/erB-2, CK7, LP34, Ki67 and P53 expression in preneoplastic lesions of bronchial epithelium: an immunohistochemical and genetic study.

A prognostic interpretation of preneoplastic lesions would have impact in bronchial carcinoma early diagnosis and through the study of Erb-B family receptors as they have an important role in lung carcinogenesis. The existence of drugs as tyrosine kinase inhibitors stressed the importance of studying gene alterations for selected chemoprevention schemes and characterization of carcinogenesis. Bronchial preneoplastic lesions were characterized by immunohistochemistry using the antibodies LP34 (high weigh molecular cytokeratin), CK7, chromogranin A, Ki67, p53, C-erbB-2 and EGFR. HER2 and EGFR gene copy number was also evaluated by fluorescent in situ hybridization in those lesions. The expected results defined the origin cell for basal cell hyperplasia and squamous metaplasia as adaptative lesions and dysplasia. By known experiences and published data, beyond the stem cell, the spectral evolution of bronchial preneoplastic lesions was demonstrated by characterizing basal cells (LP34) and their neoplastic potentiality. Dysplasias showed a higher expression of EGFR, Ki67 and p53 with a stepwise increase with the gravity of the respective grading. C-erbB-2 immunohistochemical overexpression was a rare event in preneoplastic lesions. Polysomy was the main mechanism for EGFR and HER2/neu higher gene copy number and together with increased proliferation index (Ki67) will account to preview bronchial carcinogenesis.