Non-Melanoma Skin Cancers of the Fronto-Temporal Area Preferentially Localize in the Proximity of Arterial Blood Vessels.

BACKGROUND: Squamous cell carcinomas and basal cell carcinomas are both induced by chronic UV exposure. However, their predilection for specific areas of the face remains unexplained. Regional factors such as arterial blood flow may explain specific tumor localization. OBJECTIVE: To determine whether in the fronto-temporal area of the face there is a preferential localization of non-melanoma skin cancer (NMSC) at sites of arterial blood vessels. METHODS: Twenty-two patients with NMSC of the fronto-temporal area were selected for this study. The clinical tumor margins were demarked based on clinical examination. Arterial colocalization was determined using both sonography and histological analysis. RESULTS: Echo-Doppler analysis revealed the colocalization of NMSC with an arterial branch in 59% of the patients. Histologically, colocalization between NMSC and artery was found in 68% of the patients. When combining echo-Doppler and histological results, colocalization of NMSC and arteries were found in 82% of the patients. CONCLUSION: In this study, we found an unexpectedly high colocalization of NMSC with arterial branches in the fronto-temporal area of the face. These results suggest that in addition to UV exposure, pulsatile arterial blood flow may represent an additional factor determining the precise facial localization of NMSC.

[Risk of cutaneous squamous cell carcinomas: the role of clinical and pathological reports]. / Définir le risque du carcinome spinocellulaire: rôle de la clinique et du rapport anatomopathologique.

The history of most cutaneous squamous cell carcinomas (CSCC) is limited to the skin. However, about 4% of these malignancies are at risk of metastasis and can be life-threatening. This risk is determined by clinical and histological elements which are individually recognized, but so far staging systems allow us neither to assess a risk score, nor to adopt a standardized therapeutical approach. This article reviews prognostic factors for CSCC, and underlines the need for the clinician to have all clinical and histological elements available, in order to try to define the best therapeutical strategy for each case, following up-to-date recommendations.

How does the use of polytetrafluoroethylene neochordae for posterior mitral valve prolapse (loop technique) compare with leaflet resection? A prospective randomized trial.

OBJECTIVE: Mitral valve surgery for posterior mitral leaflet prolapse consists mostly of leaflet resection, but implantation of premeasured polytetrafluoroethylene neochordae (ie, loops) is another option. The aim of this prospectively randomized trial was to determine how preservation of leaflet structure in combination with premeasured neochordae compares with the widely adopted technique of leaflet resection. METHODS: A total of 129 patients with severe mitral regurgitation, with a mean mitral regurgitation grade of 3.6 +/- 0.6, underwent minimal invasive mitral valve surgery through a right lateral mini-thoracotomy. The mean age was 59.5 +/- 12 years, 90 patients were male, the mean preoperative ejection fraction was 65% +/- 8%, and the mean New York Heart Association functional class was 2.1 +/- 0.7. Posterior mitral leaflet prolapse was diagnosed in all patients. Randomization was performed preoperatively, and crossover was allowed if the surgeon deemed it medically necessary. Crossover from resection to loops occurred in 9 patients, and crossover from loops to resection occurred in 3 patients. RESULTS: Mitral valve repair was accomplished in all patients (n = 129, 100%), and all patients received an annuloplasty ring. The mean number of loops implanted on the posterior mitral leaflet was 3.2 +/- 0.9, with a mean length of 13.3 +/- 2.2 mm. The mean duration of cardiopulmonary bypass was 135 +/- 37 minutes and the mean aortic crossclamp time was 82 +/- 26 minutes in all patients, with no significant difference between groups. Intraoperative transesophageal echocardiography showed a significantly longer line of mitral valve leaflet coaptation after implantation of loops (7.6 +/- 3.6 mm) than after resection (5.9 +/- 2.6 mm; P = .03). Thirty-day mortality was 1.6% for the entire group (2/129), with both deaths occurring in the loop group. Cause of death was massive pulmonary embolism in 1 patient and acute right heart failure in 1 patient. Early and mid-term echocardiographic follow-up revealed excellent valve function in the majority of patients, with no significant difference in mitral orifice area (3.6 +/- 1.0 cm(2) vs 3.7 +/- 1.1 cm(2), P = .4). CONCLUSION: Both repair techniques for posterior mitral leaflet prolapse are associated with excellent results and appear comparable in the early postoperative course. The loop technique, however, results in a significantly longer line of leaflet coaptation and may therefore be more durable. Longer follow-up is required.

Distinct transcriptional programs activated by interleukin-10 with or without lipopolysaccharide in dendritic cells: induction of the B cell-activating chemokine, CXC chemokine ligand 13.

To understand the modulation of dendritic cell (DC) function by IL-10, gene expression profiling was performed by using Affymetrix technology (Santa Clara, CA) in human monocyte-derived DC treated with IL-10, alone or in combination with LPS. The modulation of selected genes was validated by real-time PCR, Northern blot, and protein production. IL-10 regulated in DC the expression of a limited number of genes, including IL-7, the receptors for transferrin and vitamin D(3), structural matrix proteins, and signal transduction elements. The combined treatment with LPS plus IL-10 modulated a number of genes comparable to LPS alone, but the expression profiles were distinct. As expected, IL-10 suppressed the expression of several LPS-inducible proinflammatory molecules. Among genes uniquely modulated by the concomitant treatment with LPS plus IL-10, phosphatidylinositol 3-kinase gamma was down-regulated while the suppressor of cytokine signaling 3, signaling lymphocytic activation molecule, regulator of G protein signaling 16, and the chemokine, CXC chemokine ligand (CXCL) 13, were up-regulated. Overall, four distinct transcriptional programs were identified, related to: 1) control of immunity and inflammation; 2) tuning of cytokine receptor and G protein-coupled receptor signaling; 3) remodeling of extracellular matrix; and 4) B cell function and lymphoid tissue neogenesis. Among the latter genes, we further demonstrate that IL-10 synergizes with TLR ligands for the production of functionally active B cell-attracting chemokine, CXCL13, in both myeloid and plasmacytoid DC. This novel finding reveals that IL-10 sustains humoral immunity by inducing the production in APCs of the chemokine, CXCL13, which amplifies B cell recruitment and promotes lymphoid tissue neogenesis.

Tuning of innate immunity and polarized responses by decoy receptors.

After the identification of the interleukin (IL)-1 type II receptor as the prototype, decoy receptors have been identified for a number of members of the IL-1/IL-18, TNF, IL-10 and IL-13 receptor families. Moreover, the silent receptor D6 is a promiscuous decoy and scavenger receptor of inflammatory chemokines. The IL-1 decoy receptor is regulated by pro- and anti-inflammatory signals and its levels may serve as a readout of the activation of anti-inflammatory pathways, for instance by glucocorticoid hormones. Decoy receptors represent a strategy to tune inflammatory and polarized adaptive responses.