ABSTRACT
The most important modifiable risk factors of renal cell carcinoma are smoking, obesity and hypertension. A biopsy of the renal tumour is not always necessary. It is important in situations where it can change the therapeutic attitude and should be discussed in particular for tumors < 4 cm in size and in metastatic stage. Treatment of localized and locoregional disease consists mainly of surgical removal of the tumor. Local ablative therapy (radiofrequency, thermoablation) or active surveillance are options for small tumors < 4 cm and frail patients with high surgical risk. Systemic treatment of metastatic disease consists of antiangiogenic tyrosine kinase inhibitors and immunotherapy with checkpoint inhibitors.
Les facteurs de risque modifiables du carcinome à cellules rénales les plus importants sont le tabagisme, l'obésité et l'hypertension. Une biopsie de la néoplasie rénale n'est pas toujours nécessaire. Elle est importante dans les situations où elle peut conduire à un changement d'attitude thérapeutique et devrait être discutée notamment pour les néoplasies dont la taille est < 4 cm et lors de situation métastatique. Le traitement de la maladie localisée consiste surtout en une exérèse chirurgicale. Un traitement ablatif local (radiofréquence, thermoablation) ou une surveillance active sont des options pour les petites néoplasies < 4 cm et pour les patients ayant un risque chirurgical élevé. Le traitement systémique de la maladie métastatique comprend les immunothérapies et les inhibiteurs de tyrosine kinases antiangiogéniques.
Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Humans , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , ImmunotherapyABSTRACT
Autoantibodies to nuclear components of cells (antinuclear antibodies, ANA), including DNA (a-DNA), are widely used in the diagnosis and subtyping of certain autoimmune diseases, including systemic lupus erythematosus (SLE). Despite clinical use over decades, precise, reproducible measurement of a-DNA titers remains difficult, likely due to the substantial sequence and length heterogeneity of DNA purified from natural sources. We designed and tested a panel of synthetic nucleic acid molecules composed of native deoxyribonucleotide units to measure a-DNA. ELISA assays using these antigens show specificity and reproducibility. Applying the ELISA tests to serological studies of pediatric and adult SLE, we identified novel clinical correlations. We also observed preferential recognition of a specific synthetic antigen by antibodies in SLE sera. We determined the probable basis for this finding using computational analyses, providing valuable structural information for future development of DNA antigens. Synthetic nucleic acid molecules offer the opportunity to standardize assays and to dissect antibody-antigen interactions.
Subject(s)
Autoantibodies/analysis , DNA/immunology , Lupus Erythematosus, Systemic/immunology , Autoantibodies/immunology , Base Sequence , Child , DNA/chemical synthesis , DNA/chemistry , DNA/genetics , Humans , Models, Molecular , Nucleic Acid ConformationABSTRACT
A general method for Cu-catalyzed C-H sulfenylation of purines, 7-deaza- and 9-deazapurines with aryl- or alkyldisulfides has been developed. In purines, the reaction occurs at position 8, in 7-deazapurines at position 7 and in 9-deazapurines at position 9, leading to new interesting arylsulfanyl derivatives of purine or deazapurine bases. The resulting 8-arylsulfanylpurines undergo Liebesking-Srogl coupling with arylstannanes or boronic acids, whereas the (arylsulfanyl)deazapurines are not reactive under these conditions.
Subject(s)
Purines/chemistry , Sulfur/chemistry , Copper/chemistry , Crystallography, X-RayABSTRACT
Novel direct C-H borylations of 7-deazapurines to position 8 by B2pin2 under Ir catalysis were followed by Suzuki cross-couplings with aryl halides and other functional group transformations to give diverse 8-substituted 7-deazaadenines.
