Can we trust tumour markers in pregnancy after breast cancer? A case of elevated CA 15-3 in the third trimester of pregnancy normalising after delivery.

We realized a narrative review of the current literature starting from the case of a patient with raised CA15-3 during an uncomplicated pregnancy after breast cancer. The aim of our paper was to assess specificity, physiological changes and clinical utility of CA 15-3 monitoring during pregnancy after breast cancer, starting from clinical practice and retrieving the most relevant evidence in the literature.

Immune Checkpoint Inhibitor Nivolumab and Radiotherapy in Pretreated Lung Cancer Patients: Efficacy and Safety of Combination.

BACKGROUND: In the last decade, the discovery of immune checkpoint inhibitors such as the PD-1 inhibitor, nivolumab, has revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). Concurrent radiotherapy (RT) is of particular interest in showing the potential role of the combination. OBJECTIVE: The purpose of this study was to retrospectively evaluate the addition of RT to an immune checkpoint inhibitor, nivolumab, with regard to activity and feasibility in pretreated, advanced, or metastatic lung cancer patients at our center. PATIENTS AND METHODS: We retrospectively identified 35 consecutive patients (30 men and 5 women), who received nivolumab for pretreated NSCLC, between March 2015 to December 2016. Fifteen received hypofractionated RT as a palliative measure, and, in these patients, nivolumab was administered at an interval of at least 1 week from the end of RT. RESULTS: The median age was 69 years, and 23 patients (65.7%) had an Eastern Cooperative Oncology Group (ECOG) score of 0 to 1. All patients had previously received at least 1 systemic regimen, and, for only 3 (8.6%), nivolumab was a third-line treatment. The 2 treatment arms, RT-nivolumab and only-nivolumab, were well matched for baseline characteristics. At a median follow-up of 7.4 months, the 1-year overall survival rates were 57.8% for patients treated with RT-nivolumab and 27.4% for patients treated with only-nivolumab (P=0.043). The 1-year progression-free survival in the RT-nivolumab group was 57.8% and 20.6% in the only-nivolumab group (P=0.040). No difference in adverse events was detected. CONCLUSIONS: In conclusion, RT and nivolumab can be combined, obtaining a benefit in overall survival and progression-free survival, without an increase in acute toxicities in pretreated advanced NSCLC patients. Prospective studies are needed to confirm these results.

Multidisciplinary management improves survival at 1 year after surgical treatment for non-small-cell lung cancer: a propensity score-matched study.

OBJECTIVES: The management of patients affected by lung cancer requires the expertise of specialists from different disciplines. Although the advantages of multidisciplinary team discussions seem obvious, there are limited studies evaluating the influence of this approach on postoperative outcomes in non-small-cell lung cancer (NSCLC). The aim of this study is to examine the impact of a multidisciplinary approach on survival of patients undergoing surgery for NSCLC. METHODS: A retrospective analysis was performed on consecutive patients who underwent surgery for NSCLC between January 2008 and December 2015. Data were compared between patients treated before the implementation of a multidisciplinary tumour board (MTB), between 2008 and 2012, and those who received treatment after the implementation of the MTB, between 2012 and 2015. Patients were matched one to one according to the discussion of the MTB and on the basis of a propensity score built using several patient characteristics. A propensity score-matched analysis was performed to compare patient outcomes. RESULTS: A total of 246 patients were treated prior to the initiation of the MTB and 231 patients after the initiation of the MTB. Based on the propensity score, 2 well-matched groups of 170 patients were identified. Patients who were discussed at the MTB were noted to have better outcomes when compared with those who were not discussed at the MTB on different terms including complete staging evaluation, early tumour, node and metastasis (TNM) stages and 1-year survival rate. CONCLUSIONS: Implementation of a multidisciplinary thoracic malignancy conference increased the 1-year survival rate of patients who underwent a surgical resection for NSCLC.

Efeito da d-cicloserina no tratamento do transtorno de estresse pós-traumático: uma revisão / The effect of d-cycloserine in the treatment of post-traumatic stress disorder: a review

Objetivo: Realizar uma revisão da literatura sobre o efeito da D-cicloserina (DCS) no tratamento do Transtorno de estresse pós-traumático (TEPT). Métodos: Foram revisados 14 ensaios clínicos, revisões sistemáticas e meta-análises selecionados na base de dados PubMed que correspondessem aos descritores D-cicloserina e Transtorno de estresse pós-traumático. Resultados: Os resultados mostram-se heterogêneos, incluindo resultados com e sem benefícios clínicos para o uso da DCS, provavelmente devido à diferença de métodos utilizados nos estudos realizados. Entretanto, a DCS apresenta efeito benéfico quando administrada em pacientes com quadros mais graves de TEPT e quando associada à terapia de exposição com realidade virtual. Conclusão: A DCS tem se mostrado uma opção terapêutica promissora quando associada à terapia de exposição; entretanto, mais estudos devem ser realizados para comprovar sua efetividade no tratamento do TEPT.

Aim: To review the literature about the effect of D-cycloserine (DCS) on the treatment of Post-traumatic stress disorder (PTSD). Methods: Were reviewed fourteen clinical trials, systematic reviews and meta-analyzes selected in the PubMed database that corresponded to the descriptors D-cycloserine and Post-traumatic stress disorder. Results: The results are heterogeneous, including results with and without clinical benefit for the use of DCS, probably due to the different methods used in the studies. However, DCS has a beneficial effect when administered to patients with severe PTSD and when associated with virtual reality exposure therapy. Conclusion: It has been shown that DCS is a promising therapeutic choice when associated with exposure therapy, however further studies should be performed to prove its effectiveness in the treatment of PTSD.

A Novel Photocatalytic Purification System for Fish Culture.

The accumulation of nitrogen compounds represents a pivotal problem in the management of fish culture. Several methods were investigated in the last decades for treatment of waste waters, and the use of photocatalytic materials has received increasing attention. The photocatalytic degradation (PCD) process with titanium dioxide (TiO2) represents the most promising single-step method to promote the removal of nitrogen compounds from water. The present study compares for the first time the effects on fish culture of a classical mechanical, biological, and ultraviolet purification system to a TiO2-PCD one, with particular emphasis on water chemistry and on physiological responses in zebrafish. Fish were exposed for 14 days to the two different purification systems and samplings were performed 7 and 14 days after the experiment beginning. The photocatalytic system showed excellent efficiency in removing nitrogen compounds from water with no significant adverse effects on fish. Physiological analysis on fish samples included histological analysis of gills and gut, TUNEL assay of the gills, and real-time polymerase chain reaction (liver) of genes involved in stress response and growth. No significant biological alterations were detectable on the cultured fish.

Synthesis of lead nanowires in a single co-sputtering deposition step.

In the present work Pb NWs were grown in a single step by co-sputtering of an Al bulk target partially covered with Pb-metal pieces on its surface and without using extra catalyst. NWs have been characterized by X-ray diffraction technique and Secondary Electron Microscopy. Substrate materials, Pb concentration, and deposition time have been varied in order to establish their effects on NWs growth. In-situ single NW growth has been observed and analyzed by Secondary Electron Microscopy. The driving force that supports the growth of NWs is provided by compressive stress induced in these composite thin films during co-deposition. The present synthesis method was able to produce metal NWs over large area of the Al film with diameter ranging from 50 to 100 nm. The maximum achieved length of NWs is about 25 microm.

Immunohistochemical test for MLH1 and MSH2 expression predicts clinical outcome in stage II and III colorectal cancer patients.

PURPOSE: To evaluate the prognostic significance of DNA mismatch repair (MMR) status in a large series of stage II and III colorectal cancer patients. The relationship among MMR status, adjuvant chemotherapy, and clinical outcome was also investigated. PATIENTS AND METHODS: The study included 718 patients with colorectal adenocarcinoma (393 stage II and 325 stage III) who underwent curative surgical resection. MMR status was determined by immunohistochemical analysis of MLH1 and MSH2 expression. Microsatellite instability (MSI) was assessed in 363 patients using mononucleotide and dinucleotide markers. RESULTS: One hundred fourteen (15.9%) carcinomas showed abnormal MMR protein (MMRP) expression (96 MLH1 negative and 18 MSH2 negative) and were classified as MMRP negative, whereas 604 tumors demonstrated normal MLH1/MSH2 immunoreactivity (MMRP positive). MLH1/MSH2 expression was closely related to MSI status (P < .001) and several clinicopathologic features. Patients with MMRP-negative carcinomas demonstrated a marked reduction in the risk of cancer-related death with respect to patients with MMRP-positive tumors (hazard ratio, 0.2579; 95% CI, 0.1289 to 0.5159). A better clinical outcome for patients with MMRP-negative tumors was observed in both stage II (P = .0006) and stage III (P = .0052) disease. In stage III disease, the survival advantage conferred by MMRP-negative tumors was more evident among patients treated with surgery alone than among patients who received adjuvant chemotherapy. A nonsignificant trend for survival benefit from adjuvant chemotherapy was observed among patients with MMRP-positive carcinomas but not among those with MMRP-negative carcinomas. CONCLUSION: Immunohistochemical testing for MLH1/MSH2 expression provides useful prognostic information for the management of stage II and III colorectal cancer patients.

Microsatellite instability and colorectal cancer prognosis.

PURPOSE: Many studies have evaluated the role of high levels of microsatellite instability (MSI) as a prognostic marker and predictor of the response to chemotherapy in colorectal cancer (CRC); however, the results are not conclusive. The aim of this study was to analyze the prognostic significance of high levels of MSI (MSI-H) in CRC patients in relation to fluorouracil-based chemotherapy. EXPERIMENTAL DESIGN: In three different institutions, 1,263 patients with CRC were tested for the presence of MSI, and CRC-specific survival was then analyzed in relation to MSI status, chemotherapy, and other clinical and pathologic variables. RESULTS: Two hundred and fifty-six tumors were MSI-H (20.3%): these were more frequently at a less advanced stage, right-sided, poorly differentiated, with mucinous phenotype, and expansive growth pattern than microsatellite stable carcinomas. Univariate and multivariate analyses of 5-year-specific survival revealed stage, tumor location, grade of differentiation, MSI, gender, and age as significant prognostic factors. The prognostic advantage of MSI tumors was particularly evident in stages II and III in which chemotherapy did not significantly affect the survival of MSI-H patients. Finally, we analyzed survival in MSI-H patients in relation to the presence of mismatch repair gene mutations. MSI-H patients with hereditary non-polyposis colorectal cancer showed a better prognosis as compared with sporadic MSI-H; however, in multivariate analysis, this difference disappeared. CONCLUSIONS: The type of genomic instability could influence the prognosis of CRC, in particular in stages II and III. Fluorouracil-based chemotherapy does not seem to improve survival among MSI-H patients. The survival benefit for patients with hereditary non-polyposis colorectal cancer is mainly determined by younger age and less advanced stage as compared with sporadic MSI-H counterpart.

Estresse: vivência profissional de enfermeiras que atuam em UTI neonatal / Stress nurses's professional experience in neonatal ICUS (Intensive Care Units)

Esta pesquisa descritiva exploratória objetivou identificar as fontes geradoras de estresse que acometem as enfermeiras que trabalham em UTI Neonatal; reconhecer os fatores intrínsecos que interferem nas condições biológicas e emocionais destas enfermeiras; saber se as condições de trabalho interferem no processo de cuidar. Participaram da pesquisa oito enfermeiras que responderam um questionário; destas 62 por cento consideram-se estressadas, sendo o turno da tarde o mais estressante. As enfermeiras dedicam cinco horas semanais ao lazer e oito horas diárias ao sono, em média. Todas as participantes apresentaram sintomas de estresse, como perda de memória, anorexia, excesso de apetite, dificuldade de concentração, insõnia, sonolência, cansaço e irritabilidade. Para 87 por cento das enfermeiras esses sintomas interferem no processo de cuidar. Os recém-nascidos chorosos, informar familiares do agravamento do paciente ou óbito, atividades administrativas, carência de recursos materiais e humanos contribuem para desencadear o estresse. Conclui-se que o ambiente de UTI neonatal é estressante. Sugere-se que os profissionais verbalizem seus sentimentos de angústia propiciando-lhes alívio interior

Immunohistochemical pattern of MLH1/MSH2 expression is related to clinical and pathological features in colorectal adenocarcinomas with microsatellite instability.

Detection of colorectal carcinomas with high-frequency microsatellite instability (MSI-H) is clinically important for several reasons. Recent studies suggested that immunohistochemical analysis of MLH1 and MSH2 expression is a rapid and accurate method for identifying large bowel tumors of the MSI-H phenotype. In this study, we evaluated by immunohistochemistry MLH1 and MSH2 protein expression in 132 MSI-H, 23 MSI-L (low-frequency MSI), and 150 microsatellite stable (MSS) colorectal adenocarcinomas. Loss of MLH1 or MSH2 expression was detected in 120 (90.9%) MSI-H carcinomas, whereas all MSI-L and MSS tumors showed normal expression of both proteins. Lack of MLH1 nuclear staining was observed much more often than absence of MSH2 nuclear staining (106 and 14 cases, respectively). Among MSI-H carcinomas, MLH1/MSH2 pattern of expression was significantly related to several clinical and pathological variables. In particular, MSI-H MLH1/MSH2-positive carcinomas were more often located in the distal colon, were more frequently classified as ordinary adenocarcinomas, and were more likely to be well or moderately differentiated, p53 positive, and <7 cm in diameter than were MLH1-negative and MSH2-negative carcinomas. In addition, MLH1-negative carcinomas were less common among patients with hereditary nonpolyposis colorectal cancer (HNPCC) or suspected HNPCC and in the group of patients aged <50 years. Patients with MLH1-negative carcinomas more frequently died of disease than did patients with MLH1/MSH2-positive and MSH2-negative MSI-H tumors, but the difference was not statistically significant. The results of the present investigation strongly indicate that immunohistochemical analysis of MLH1 and MSH2 expression is a practical and reliable method for the routine detection of the vast majority of MSI-H large bowel adenocarcinomas. Our data also point out that MSI-H MLH1/MSH2-positive colorectal carcinomas are characterized by distinctive pathological features.