The Predictive Role of Serum Lipid Levels, p53 and ki-67, According to Molecular Subtypes in Breast Cancer: A Randomized Clinical Study.

Dyslipidemia is a component of metabolic syndrome, having an important role in the carcinogenesis of different tumor types, such as prostate, ovarian, or renal cancer. The number of studies on the predictive potential of the different components of the lipid profile with a predictive potential in breast cancer is quite low. The evaluation of the lipid profile was carried out for the 142 patients who benefited from neoadjuvant therapy (NAC) in order to identify a potential predictive biomarker. The serological sample collection was performed sequentially according to a standardized protocol, pre-NAC, post-NAC and 6 months post-NAC after a 6-h pre-collection fast. We also investigated in the general group the presence or absence of the p53 mutation (TP53) and of the mitotic index ki-67, respectively, in relation to the molecular subtypes. The menopausal status, tumor size, family history, grading, Ki-67, p53 and LN metastases have a predictive nature regarding overall survival (OS) (p < 0.05), while for disease free survival (DFS), only tumor size, tumor grading, Ki-67 > 14, and p53+ are of predictive nature. The genetic and molecular analysis carried out in our group indicates that 71.67% have a Ki-67 score higher than 14%, and 39% of the patients have the positive P53 mutation. The multivariate analysis in the case of patients included in the TNBC subtype showed that the increased tumor volume (p = 0.002) and increased level of HDL (p = 0.004) represent predictive factors for the tumor response rate to NAC. High HDL-C levels before NAC and increased LDL-C levels after NAC were associated with the better treatment response in ER-positive and HER2+ breast cancer patients. Increased HDL-C values and tumor volume represent predictive factors as to the response rate to NAC in the case of patients included in the TNBC subtype. Regarding the ER+ and HER2+ subtypes, increased levels of HDL-C pre-NAC and increased levels of LDL-C post-NAC were associated with a better therapeutic response rate. Tumor grading, Ki-67, p53, and LN metastases have a predictive nature for OS, while tumor size, tumor grading, and Ki-67 > 14, and p53+ are predictive for DFS.

Lipid Profile Paradox: Investigating Improved Lipid Levels in Diabetic Mellitus Patients with Foot Ulcer Infections-A Prospective Descriptive Study.

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder posing multifaceted challenges to global public health. Among its numerous complications, infected diabetic foot ulcers (IDFUs) represent a particularly debilitating consequence. Beyond cardiovascular implications, there is an emerging understanding of the interconnectedness among IDFUs, neuropathy, atherosclerosis, and dyslipidemia. IDFUs, peripheral neuropathy, and atherosclerosis share common risk factors and mechanistic pathways. The primary objective of this study was to characterize the lipid profiles in DM patients with IDFUs, comparing them with DM patients without foot ulcers, and with a control group of healthy subjects. The secondary objectives included evaluating apolipoprotein E (ApoE) levels across these study groups and comparing lipid profiles within IDFU subgroups. A total of 160 patients were assessed for this study. After applying exclusion criteria, 140 participants were included, divided into three groups: Group IDFU (80 patients with IDFUs), Group DM (32 patients with DM but no foot ulcers), and Group Controls (28 healthy controls). Compared to Group DM, Group IDFU demonstrated lower levels of high-density lipoprotein cholesterol (HDL-C) (30.9 ± 12.6 mg/dL vs. 40.8 ± 16.6 mg/dL, p = 0.002), but improved levels of ApoE (160.9 ± 68.4 mg/dL vs. 197.2 ± 69.6 mg/dL, p = 0.01), triglycerides (TG) (126.9 ± 56.2 mg/dL vs. 165.8 ± 79.0 mg/dL, p = 0.004), low-density lipoprotein cholesterol (LDL-C) (84.2 ± 32.3 mg/dL vs. 92.3 ± 39.3 mg/dL, p = 0.1), and total cholesterol (133.6 ± 43 mg/dL vs. 164.6 ± 44.4 mg/dL, p = 0.002). The IDFU patients exhibit improved lipid profiles, excepting HDL-C, which is unusual because IDFU follows complications related to dyslipidemia for DM patients. Anemia, impaired renal function, and elevated TG levels were identified as biomarkers for mortality among patients with IDFUs. The data suggest that a lower level of HDL-C and an improved lipid profile may indicate a systemic end-stage disease manifestation in DM patients with IDFUs.

CMV and HIV Coinfection in Women from a Region in Eastern Europe.

(1) Background: Human cytomegalovirus (CMV) infection is one of the most frequent opportunistic infections in immunosuppressed patients. Romania has one of the highest incidences of patients living with human immunodeficiency virus (HIV) which determines an immunosuppressive state. The aim of this study was to establish the prevalence of CMV infection among women living with HIV in Southeastern Romania and also to evaluate and correlate antiretroviral therapy (ART) with CD4 level and CMV disease evolution. (2) Methods: Seventy women living with HIV from Southeastern Romania were screened for CMV infection using antigen quantification. Of these, 50 were included in the study. First, the patients filled out a questionnaire regarding social conditions and other associated diseases. Then, we explored the statistical correlations between the data and HIV status, CD4+ cell counts, viral load, and antiretroviral therapy (ART). (3) Results: Median age of the patients was 33 years. Twenty-nine cases were diagnosed with HIV after sexual life beginning and 21 before. Most of the patients had a CD4 level over 200 cells/µL. ART duration in the CD4 under 200 cells/µL group was a bit longer than that in the CD4 over 200 cells/µL group. Forty-one patients had undetectable viremia. CD4 average value in the lot of patients with undetectable viremia was 704.71 cells/µL and in the lot with detectable viremia was 452.44 cells/µL. Viremia values correlated negatively with CD4 level. A positive correlation between IgG CMV values and ART therapy length was identified. A negative significant correlation between values of IgG CMV and values of CD4 was identified. CD4 value correlated negatively with IgG CMV values and with CMV avidity. (4) Conclusions: IgG CMV values had a weak positive correlation with ART therapy length, and a negative statistically significant correlation with values of CD4. CMV avidity has a negative correlation with CD4 value.

Pentraxin-3 and Other Inflammatory Markers for an Infected Diabetic Foot Ulcer Diagnosis: A Prospective Study.

Strategies have been researched and implemented to reduce the number of people with diabetic foot ulcers (DFUs). One problem is the accurate assessment of DFU severity, which is the main factor in resource allocation and treatment choice. The primary objective of this study was to assess pentraxin-3 as a biomarker of an infected DFU (IDFU), the limb amputation level prognosis, and patient survival. The secondary objectives were to evaluate and compare other markers, including white blood cells (WBCs), C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), and procalcitonin (PCT), for identifying IDFUs. Over a period of two years, 145 patients were followed; 131 of these were analyzed for this study. Pentraxin-3 was found to be a good predictor of death (p = 0.047). A comparison between IDFUs and DFUs revealed the following differences: PCT had the highest AUROC of 0.91, sensitivity of 93.7, and specificity of 83.3%. CRP had a cutoff value of 226 mg/L, an AUROC of 0.89, a sensitivity of 95.5%, and a specificity of 83.3%. Fibrinogen had an AUROC of 0.87 at a cutoff value of 5.29 g/L, with a good sensitivity and specificity of 85% and 87%, respectively. ESR had a cutoff value of 46 mm/h, an AUROC of 85%, a sensitivity of 83.7%, and a specificity of 83.3%. Pentraxin-3 showed promising results in predicting IDFUs and DFUs, and it served as a marker for the risk of death in IDFU patients during the 6 month follow-up. Other markers, including CRP, PCT, ESR, and fibrinogen, were more effective in differentiating between IDFUs and DFUs.

Low-Cost and Reproductible Method to Obtain Mapping of Lymphatic Drainage in Patient with Early Endometrial Cancer.

Introduction: Endometrial cancer is the most common form of gynecological cancer in developed countries. Current recommended therapeutic management takes into account a number of factors such as: TNM stage, justification for primary surgery, desire to preserve fertility. For primary operable cases, surgical staging has become an extremely important pillar, in which the status of the pelvic lymph nodes needs to be known (1-3). Material and Method: Between August 2015 and June 2021, a multicenter prospective observational study was performed in the "Prof. Dr. I. Chiricuta" Oncological Institute Cluj Napoca, 2nd Department of Surgery of "Pius Brinzeu" County Hospital Timisoara, 1st Department of General Surgery of Arad County Hospital, 2nd Department of Obstetrics and Gynecology "Dominic Stanca" Cluj Napoca and "Dr. Carol Davila" Central Military Emergency University Hospital Bucharest, Romania with the main aim of examining the sentinel lymph node detection rate using methylene blue as a tracer. Surgeries were performed by the team of surgeons of the mentioned clinics, and patients were informed about this study and signed an informed consent form for enrollment. Results: A total of 116 cases met the inclusion criteria for this prospective study. The mean age of the included patients was 62.3 years (minimum - 38, maximum - 83). The mean body mass index was 31.8 (minimum - 19.9, maximum - 48.2). In terms of histological type of the endometrial cancer, the majority of cases were endometrioid cancer, amounting to 72.5% of the total (n=84). A considerable number of cases were of mixed type, either with clear cell carcinoma (8.6%, n=10) or mixed carcinosarcoma (17.2%, n=20). The preferred approach for surgery was laparoscopic surgery rather than traditional surgery (72% vs 28%). Another element investigated from a histological point of view is the tumour grading, the degree of differentiation of cells with anarchic development, we note that 50% (n=58) were G2. Of the 116 cases of endometrial carcinoma included in the study, in 83% of cases (n=96) methylene blue tracer injection was successful and sentinel node was identified. The SLN technique continues to be of great interest and use in surgical centers around the world. The method of detecting sentinel lymph nodes varies depending on the individual. According to literature studies, indocyanine (ICG- Indocyanine green) is the gold standard for lymph node mapping, with superior detection rates when compared to other existing versions. Another key factor to consider when selecting a sentinel node identification method is cost-effectiveness. The use of methyl blue as a marker tracer is the most cost-effective option with equivalent detection rate outcomes. Conclusions: Based on the results of our study and other studies in the literature, lymphatic mapping using methylene blue as a tracer in endometrial cancer is a cost-effective method with a favourable detection rate. With this low-cost procedure we can achieve a correct tumor staging, avoiding overtreatment. There are multiple ways to identify the sentinel node using different tracers with higher accuracy, but the objective of the study was not to make a comparison between different tracers, but to present the feasibility of lymph node mapping using methylene blue as a low cost tracer with good reproducibility, short learning curve and optimal detection rate.

Sarcomatoid renal cell carcinoma with clear cells and eosinophilia: a case report and short review of the literature.

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive form of de-differentiated renal cell carcinoma. We report a case of a 79-year-old male who presented himself to the Department of Emergency complaining of macroscopic hematuria for the last two days and a back pain located in the lumbar region persisting for around a month; there were no major changes in the initial laboratory tests. Abdominal ultrasonography identified a renal mass located in the lower pole of the left kidney. The computed tomography (CT) scan with iodine-based contrast revealed the left kidney had a complete deletion of corticomedullary differentiation and a large renal mass located in the lower pole with inhomogeneous iodophilia, which measured around about 15 cm in transversal diameter and 13.6 cm in craniocaudal diameter. Nephrectomy of the left kidney was performed. Histopathological and immunochemistry tests diagnosed a SRCC with clear cells and eosinophilia. We present these findings along with a short review of the literature.