Evaluation of serum Nestin and HOTAIR rs12826786 C>T polymorphism as screening tools for breast cancer in Egyptian women.

BACKGROUND: Nestin is a neural stem cell protein that plays an important role in cancer stem cells (CSC) development and proliferation. It has been identified as a marker for newly formed endothelial cells and was shown to be preferentially expressed in basal and myoepithelial cells of the mammary gland. HOTAIR is long intergenic non-coding (linRNA) associated with tumorigenesis through promotion of epithelial-mesenchymal transition (EMT) and stemness as well. HOTAIR gene contains a functioning single nucleotide polymorphic site rs12826786 C>T that has been associated with several cancer types. METHODS: We evaluated serum Nestin and the HOTAIR rs12826786 C>T polymorphism in healthy Egyptian women and those with breast cancer as a possible screening tool to identify patients with breast cancer. Also, we tested the possible association of the two markers with each other and the aggressiveness of the disease. RESULTS: Patients with breast cancer had a median (Min-Max) of serum Nestin 31.3 (6.7-167.3 pg/mL), while control subjects had a median (Min-Max) of serum Nestin 42.3 (25.7-315.95) pg/mL. The best cut-off value for serum Nestin to differentiate normal subjects and patients with breast cancer was 39.9 pg/mL. This cut-off value had a diagnostic sensitivity of 84.8% and specificity of 65.1%. There was a significant difference in the distribution of different alleles in patients with breast cancer than normal subjects (P=0.039 Exact Fisher test). The breast cancer patients group had 23.9% CC, 52.1% CT, and 23.9% TT genotypes, respectively, while the control group had 46.9% CC, 42.8% CT, and 10.2% TT, respectively. CONCLUSIONS: A significantly low serum Nestin below 39.9 pg/mL and a higher percentage of the T/T homozygous variant allele of HOTAIR rs12826786 C>T were found in Egyptian patients with breast cancer. We suggest that the reported cut-off value of serum Nestin and the presence of C/T polymorphism can be used to assess the risk of females for developing breast cancer and might be of potential benefit in screening the disease. Larger studies in different ethnic groups are needed to confirm our findings.

Latissimus Dorsi flap enhancement by lipofilling as an immediate breast reconstruction technique for skin-preserving mastectomy.

AIM: To evaluate Latissimus Dorsi flap (LD) enhancement by lipofilling as an immediate breast reconstruction technique, for skin-preserving mastectomy regarding oncological safety, fat graft resorption after radiotherapy, and patients' satisfaction. PATIENTS AND METHODS: This is a prospective study that included female patients complaining of breast cancer. Patients were subjected to skin-preserving mastectomy associated with Latissimus Dorsi flap enhancement by lipofilling using the multisite, and multilayer fat grafting technique of injection. Patients were followed up for early and late postoperative complications including recurrence. Volumetric CT was performed before and after the radiotherapy to detect the percentage of fat resorption. Postoperative patients' satisfaction was assessed using the Kyungpook National University Hospital (KNUH) Breast Reconstruction Satisfaction Questionnaire. RESULTS: The study included 25 female patients with a mean age of 36.48 ± 5.87 years. The mean period of follow-up was 30.32 ± 5.82 months. Local recurrence was encountered in 1 patient (4%). The mean volume reduction of the injected fat graft was 27.36 ± 8.58%. Twenty-three patients (92%) declared their satisfaction after the operation, one of them was satisfied only after she underwent a second session of lipofilling. CONCLUSIONS: Skin-preserving mastectomy with the enhancement of the LD by lipofilling for immediate reconstruction of the breast seems to be a safe and simple technique for the achievement of autologous breast reconstruction. It has an acceptance rate of locoregional recurrence and minor postoperative complications. The procedure showed high postoperative patients' satisfaction and a reasonable percentage of fat resorption as confirmed by volumetric CT imaging techniques.

Serum procalcitonin in viral and bacterial meningitis.

BACKGROUND: In children with meningitis, there is a difficulty to verify the etiology as viral or bacterial. Therefore, intensive research has been carried out to find new and rapid diagnostic methods for differentiating bacterial from viral meningitis. OBJECTIVES: The aim of this work was to study the behavior of procalcitonin (PCT) and whether it can be used to differentiate children with bacterial from those with viral meningitis. We also compared PCT to C-reactive protein (CRP) and white blood cell count. PATIENTS AND METHODS: Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days. METHODS: Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days. RESULTS: PCT levels were significantly higher in patients with bacterial meningitis (mean, 24.8 ng/ml) compared to patients with viral meningitis (mean, 0.3 ng/ml) (P<0.001). PCT levels in bacterial meningitis group decreased after 3 days of starting treatment, but remained higher than viral meningitis group (mean, 10.5 ng/ml). All CSF parameters, blood leukocytes, and CRP showed overlapping values between the two groups. Serum PCT with cut off value >2 ng/ml showed sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 66%, 68%, and 100%, respectively, for the diagnosis of bacterial meningitis. CONCLUSION: Serum procalcitonin level has a better diagnostic and prognostic value than CRP or leukocyte count to distinguish between bacterial and viral meningitis. It is also a good indicator of the efficacy of treatment of bacterial meningitis.