Long-term results of the treatment of Stanford type B aortic dissection with medical and invasive therapy in Hungary / Akut Stanford B típusú aortadissectio konzervatív és invazív terápiájának hosszú távú eredményei Magyarországon

Introduction and objective: Acute Stanford type B aortic dissection (ATBAD) is a potentially life-threatening condi-tion, which may require immediate intervention. This study aims to compare the short-and long-term results of medical, open surgical and endovascular management of ATBAD. Method: This is a retrospective, multi-centre cohort study, where patients admitted with acute and subacute TBAD between Jan. 2011 and Dec. 2020 were included. Results were compared between patients treated with medical, open surgical and thoracic endovascular aortic repair (TEVAR). 30-day mortality and major complications were registered. Survival and freedom from reintervention were noted. Results: A total number of 188 patients were included (69.7% man, mean age: 57 +/- 12.2 years). Hypertension was present in 88.8% of the patients. The 30-day mortality was more higher among patients who underwent open sur-gery, than among patients after TEVAR (26% and 16.7%, p = 0.12). Postoperative lung complication (22.6% and 19.4%) and vascular complication (25.9% and 16.7%) were common in both open and TEVAR groups. In the con-servatively treated group, three patients required intervention in the first 30 days (renal stent implantation: n = 2, TEVAR: n = 1). Median follow-up was 41 (IQR, 73.5) months. There was no significant difference in reoperations during follow-up between the three groups (p = 0.428). 6-year survival was significantly lower among patients with open surgery compared to the other two patient populations (54.8% vs. 79.3% and 75%, p = 0.017). Conclusion: In the invasive treatment of ATBAD, TEVAR is associated with superior short-and long-term compli-cation rate, and survival. There is no significant difference between the long-term results of medical therapy and TEVAR.

Candida albicans Enhances the Progression of Oral Squamous Cell Carcinoma In Vitro and In Vivo.

Oral squamous cell carcinoma (OSCC) is associated with oral Candida albicans infection, although it is unclear whether the fungus promotes the genesis and progression of OSCC or whether cancer facilitates fungal growth. In this study, we investigated whether C. albicans can potentiate OSCC tumor development and progression. In vitro, the presence of live C. albicans, but not Candida parapsilosis, enhanced the progression of OSCC by stimulating the production of matrix metalloproteinases, oncometabolites, protumor signaling pathways, and overexpression of prognostic marker genes associated with metastatic events. C. albicans also upregulated oncogenes in nonmalignant cells. Using a newly established xenograft in vivo mouse model to investigate OSCC-C. albicans interactions, oral candidiasis enhanced the progression of OSCC through inflammation and induced the overexpression of metastatic genes and significant changes in markers of the epithelial-mesenchymal transition. Finally, using the 4-nitroquinoline 1-oxide (4NQO) murine model, we directly correlate these in vitro and short-term in vivo findings with the progression of oncogenesis over the long term. Taken together, these data indicate that C. albicans upregulates oncogenes, potentiates a premalignant phenotype, and is involved in early and late stages of malignant promotion and progression of oral cancer. IMPORTANCE Oral squamous cell carcinoma (OSCC) is a serious health issue worldwide that accounts for 2% to 4% of all cancer cases. Previous studies have revealed a higher yeast carriage and diversity in oral cancer patients than in healthy individuals. Furthermore, fungal colonization in the oral cavity bearing OSCC is higher on the neoplastic epithelial surface than on adjacent healthy surfaces, indicating a positive association between oral yeast carriage and epithelial carcinoma. In addition to this, there is strong evidence supporting the idea that Candida contributes to carcinogenesis events in the oral cavity. Here, we show that an increase in Candida albicans burden promotes an oncogenic phenotype in the oral cavity.

[Acute transverse myelitis in childhood]. / Akut myelitis transversa gyermekkorban.

We reviewed the medical history, clinical signs, imaging studies, laboratory data and treatment effectiveness of our 10 patients presented with acute idiopathic transverse myelitis. We used the criteria of the Transverse Myelitis Consortium Working Group (2002). So we excluded all those cases by whom the cause of the inflammation could be detected (e. g. direct viral inflammatory disease, systemic autoimmune disease). Age of the patients at disease onset ranged from 3 to 15 years. The first clinical signs were pain in different locations, and urinary retention. Paraparesis or plegia reached its maximum within five days. By all patients spinal MRI and lumbar puncture were performed at admission. These results were interpreted together with the clinical signs, and therapy was started immediately. We used methylprednisolon pulse therapy. Within 10-30 days the patients started to walk. We have followed the children for 1.5-13 years. Few residual clinical signs were observed: by one child left sided spastic monoparesis persisted, by the other right sided latent monoparesis was stated, and by one partial urinary incontinence persisted. By the control spinal MRI persisting signal changes or atrophy were detected just by those two children who had residual clinical signs. In the follow-up period no clinical relapse occured. Neither did the brain or spinal MRI show new lesions. The quick diagnosis and the immediately started therapy determine mostly the clinical outcome of these children. We hope that our long follow-up period can help in better understanding the disease even in adult patients. In the future we try to join multicenter clinical studies.