The clinicopathological features of programmed death ligand-1 expression in colorectal carcinoma

Background

Few studies have addressed the clinicopathological features of colorectal cancer (CRC) that express programed death-ligand 1 (PD-L1). Various assays and scoring methodologies were used and thus inconsistent results were obtained. In this study, we aimed to investigate the relationship of PD-L1 expression in CRC with various clinicopathological variables using a standardized assay and scoring algorithm.

Design

Tissue microarrays were constructed from 91 random cases of CRC diagnosed at King Hussein Cancer Center (KHCC). Immunohistochemical (IHC) staining using the monoclonal antibody 22C3 was performed. Scoring using the standard “Combined Positive Score” (CPS) method was done. CPS of ≥1 was considered positive. Various clinicopathological features were collected from the medical records of the patients.

Results

Of the 91 cases, 49 (53.8%) were PD-L1 positive (CPS ≥1). PD-L1 expression was more frequent among moderately differentiated carcinomas (43 of 72 (59.7%) were positive compared to 6 of 19 (31.5%) poorly differentiated cases ( P = 0.029)); among node negative cases (21 of 24 (87.5%) N0 cases were PD-L1 positive in contrast to 28 of 67 (41.8%) N1/N2 cases ( P = <0.001)); among mucinous subtype (12 of 15 (80%) of cases ( P = 0.02)); and among mismatch repair deficient (dMMR) (16 of 16 (100%) versus 11 of 30 (36.6%) MMR proficient ( P = <0.001)). Age, gender, localization, and T or M stages were not significantly associated with PD-L1 expression.

Conclusion

PD-L1 expression in CRC is associated with favorable prognostic features; namely, lower grade, N0, mucinous variant, and dMMR tumors.

Colorectal cancer mortality after randomized implementation of FIT-based screening - a nationwide cohort study

Objective

Evidence of reduction in colorectal cancer (CRC) mortality following CRC screening based on the faecal immunochemical test (FIT) is insufficient. This study aimed to analyse if CRC mortality was reduced after implementing FIT-based screening.

Setting

The Danish national CRC screening programme.

Methods

This nationwide cohort study included residents aged 50–71 years invited to the prevalence round of the screening programme. Invitation order was decided by randomising on birth month; the first two birth months to be invited were classified as invited and the five last were classified as not-yet-invited and given a pseudo invitation data. Follow-up was from (pseudo)invitation date until 31 December 2017, emigration or death. Relative risk (RR) of CRC death was calculated with 95% confidence intervals (CIs).

Results

A total of 897,812 residents were included (29% invited and 71% not-yet-invited). The median follow-up was 3.3 years. The RR of CRC death at end of follow-up was 0.83 (95% CI 0.66; 1.03) among those invited to screening compared with those not yet invited. For men aged 60–71 years, this RR was 0.68 (95% CI 0.49; 0.94). For those participating in screening compared with a similar group of not-yet-invited residents, the RR was 0.71 (95% CI 0.46–1.08). For male participants aged 60–71 years, this RR was 0.49 (95% CI 0.27−0.89). For women and men aged 50–59 years, RRs were small and statistically non-significant.

Conclusion

This nationwide study showed that even within a median follow-up of only 3.3 years, implementing FIT-based CRC screening reduced CRC mortality among older men.

Microbiome Analysis in Patients with Colorectal Cancer by 16S Ribosomal RNA Sequencing in the Southeast of Iran

Background: Colorectal cancer (CRC) is the third most common malignant tumor worldwide. Emerging evidence suggests that dysbiosis of the colon microbiome may be involved in CRC development. Objectives: The present study aimed to compare the composition and diversity of the colon microbiome by high-throughput 16S ribosomal RNA (rRNA) sequencing between CRC patients and healthy controls. Microbiome composition and diversity were also examined based on gender. Methods: The colon microbiome richness and diversity of samples from 17 CRC patients and 13 healthy controls were analyzed by 16S rRNA sequencing. Alpha and beta diversity were calculated to determine the differences in colon microbiome diversity. Results: Alpha and beta diversity showed significant differences between the CRC and healthy control groups regarding the microbiome. Our results showed that CRC samples had the highest richness and diversity. The total number (P ≤ 0.01), phylogenetic diversity (P ≤ 0.01), Chao1 (P ≤ 0.01), Shannon (P ≤ 0.05), and Simpson (P ≤ 0.01) indices were significantly higher in the CRC group than in the healthy control group. In addition, the comparison between females and males showed that the microbiome diversity was higher in the CRC female (CRC-F) group than in other groups. Prevotella, Fusobacterium, Akkermansia, Leptotrichia, Streptococcus, and ParaBacteroides were more commonly observed in the CRC group, while Bacteroides, Enterobacteriaceae (unknown genus), Ruminococcus, and Campylobacter were more commonly observed in the healthy control group. Conclusions: This study showed differences between the CRC and healthy control groups regarding the diversity and composition of the colon microbiome, suggesting a contribution of the microbiome in the development and progression of CRC.

Immune cell responses in pancreatic cancer and their clinical application

Pancreatic cancer is one of the most lethal diseases around the world, for hardly detection and poor prognosis. Recent years, functions of the tumor microenvironment and immune cells attract people’s view and there is emerging evidence implicating some immune cells hold the key points in the metabolism, invasion, and metastasis in pancreatic cancer. In this review, we highlight some main immune cells, such as Tumor-associated neutrophils (TANs) and macrophages (TAMs), Pancreatic stellate cells (PSCs), Myeloid-derived suppressor cells (MDSCs), and Regulatory T cells (Tregs). Furthermore, we review current clinical applications and discuss potential values in future.

Understanding Household Catastrophic Health Expenditures and Fairness of Financing for Cancer Treatment: A Cross-Sectional Case Study in West of Iran

Background: Direct out-of-pocket (OOP) and indirect healthcare payments can limit the household budget and cause several financial problems for the household. Objectives: This study aimed to measure the financial protection and determinants of catastrophic health expenditures (CHEs) for cancer treatment in Shahid Rahimi Hospital, Khorramabad, located in western Iran. Methods: This study was conducted on 220 households of cancer patients in Lorestan Province, Iran. The framework of data collection was based on the World Health Organization (WHO) Global Health Survey. Interviews were conducted with individuals who met the inclusion criteria of this study; they were selected using a simple random sampling method. Data were analyzed using Chi-square test in STATA. Results: The present results showed that the incidence of CHEs and the fair financial contribution index (FFCI) were 70% and 86%, respectively. There was a significant relationship between the household CHEs and variables, such as supplementary insurance coverage, household income status, educational level of the household head, household size, age of the household head, type of cancer, and type of cancer treatment. Conclusions: More financial protection should be provided for the families of cancer patients due to the high incidence of CHEs and unfair financing of cancer care services. Moreover, healthcare systems should consider supportive policies for cancer patients and their household members by increasing the insurance coverage and expanding service packages to reduce cancer treatment expenditures.

Propuesta de modelo integral de intervención terapéutica paliativa en salud

Los Cuidados Paliativos (CP) constituyen un valor y una responsabilidad de los sistemas sanitarios y sociales. En vista de la alta demanda de servicios para la atención integral y humanizada del paciente con enfermedad crónica, degenerativa e irreversible, es necesario crear un modelo de atención integral paliativa con el fin de ejecutarlo en una población requiriente del mismo. Los CP son un derecho de la persona, reconocido internacionalmente, que ha de prestarse en 3 niveles de atención: primario (básico), secundario (atención especializada - AE) y terciario (Unidades de Cuidados Paliativos - UCP). El primer nivel de atención es responsable de los cuidados paliativos domiciliarios y debe garantizarlos cuando la complejidad no es elevada. La presente revisión bibliográfica propone un modelo integral, integrado e integrador de cuidados paliativos CP que permita justificar las intervenciones terapéuticas con el objetivo de obtener bienestar o atenuación del sufrimiento en pacientes que acuden al primer nivel de atención. Palabras claves. Cuidados paliativos, evaluación integral, evaluación de necesidades multidimensionales, derivación, complejidad.

ADXBladder molecular urine testing to risk stratify and prioritise management of suspected and known bladder cancers during the COVID-19 pandemic

Objective:

COVID-19 has challenged diagnostic and surveillance pathways for suspected and known bladder transitional cell cancer (TCC). Exclusion of high-grade/invasive TCC by molecular urine testing could risk stratify patients for priority flexible cystoscopy and transurethral resection (TUR). We evaluated ADXBladder (ArquerDx), which has a high negative predictive value (NPV) for high-grade and ⩾ pT1 TCC.

Patients and methods:

Prospective cohort study of patients referred with haematuria for diagnostics or on TCC surveillance (Dec 2020–Feb 2021). Patients underwent ADXBladder testing, flexible cystoscopy and imaging (for haematuria), followed by TUR/biopsy as necessary. Clinico-radiological/pathology findings were compared with ADXBladder results.

Results:

Of 117 eligible patients, 39 and 78 had positive and negative ADXBladder tests, respectively. Of 15 suspected TCC on cystoscopy, eight were confirmed on TUR/biopsy. Overall ADXBladder NPV was 96.2% (CI: 91.0–98.4). NPV for high-grade and ⩾pT1 TCC was 97.4% (CI: 94.4–98.8) and 98.7% (CI: 95.0–99.7), respectively.

Conclusions:

Our ‘real world’ evaluation confirmed a high NPV for high grade and ⩾pT1 TCC using ADXBladder. Further larger studies are required to determine whether a negative ADXBladder test combined with negative imaging and patient risk factors may justify patient downgrading on timed diagnostic pathways.

Level of evidence:

IV

Ovarian Cancer: Treatment and Resistance to Pharmacotherapy

Despite advances in surgical techniques and chemotherapy, ovarian cancer is still a leading cause of death among gynecological cancers. In addition to the late detection of the disease, the main reason for poor prognosis is resistance to pharmacotherapy, mostly platinum compounds. About a third of patients do not respond to primary platinum-based chemotherapy treatment, and over time, eventually, 80% of other patients develop chemoresistance, which makes the recurrence of disease incurable. In this review, we describe a difficult clinical hurdle faced in ovarian cancer therapy as a result of platinum resistance, as well as resistance to newer targeted therapy with PARP inhibitors and bevacizumab. We, furthermore, give attention also to the role of the tumor microenvironment as it is less well understood than the tumor cell-intrinsic mechanism. Because a central goal in ovarian cancer research is the development of novel strategies to overcome chemoresistance, treatment for cancer is moving toward personalized therapy.

Factors Influencing the Practice of Breast Self-Examination among Female Tertiary Students in Ho, Ghana

Background. Despite the implementation of various interventions towards the reduction of breast cancer prevalence, many women still report late symptoms to health facilities, and this decreases their chances of survival. Breast self-examination (BSE) is the most convenient form of examination to detect the development of breast cancer. We examined the factors that influence the practice of breast self-examination among female tertiary students in Ho, Volta Region of Ghana. Methods. This was a descriptive cross-sectional study that recruited 506 female students from four tertiary institutions in the Ho Municipality in Ghana using questionnaires. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, and binary logistic regression were used in analyzing the data. Results. About 73% of the respondents had ever practised BSE. Out of the respondents who have ever practiced BSE, 79% were practising it at the time of the study. Students in their fourth year were above 4 times more likely (95% CI = 1.73–9.29, $p=0.014$ ) to practise BSE than those in their first year. Also, students with good knowledge of BSE were 4 times more likely to practice BSE [(95% CI = 1.1–13.46), $p=0.036$ ] and students with good perception about BSE were 12 times more likely to practice BSE [(95% CI = 1.21–122.73), $p=0.034$ ]. Conclusion. The study found that 27% of the female students had never practised BSE. Those who practice BSE did not practice regularly and appropriately. Also, good knowledge and perception are associated with the practice of BSE. The implication of this result is the late presentation of breast cancer cases to health facilities and increases in breast cancer-related deaths in the country. Therefore, it is recommended that the Ministry of Health, the Ghana Health Service, and other stakeholders in Ghana’s healthcare should develop and implement innovative approaches and policies such as peer and support groups’ learning, and mass media BSE awareness aimed at ensuring better understanding and access to BSE education. This should be intensified during the foundation years such as the secondary and tertiary education levels to ensure the adoption of breast self-examination practice. It is also recommended that another study must be done using a qualitative approach to get an in-depth understanding of the steps and ways, by which female students practice BSE.

C-X-C Chemokine Receptor Type 4 (CXCR4) and Programmed Death-Ligand 1 (PD-L1) Expression are Prognostic Biomarkers for Papillary Thyroid Carcinoma

Chemokines and immunomodulatory factors involve in tumor development. Papillary thyroid carcinoma (PTC) is considered to start from dendritic cell infiltration and then produce immunomodulatory factors. In this study, CXCR4 and PD-L1 biomarkers were used to explore their prognostic role in PTC survival. Confocal microscopy detected the transfection efficiency in tumor cells. 42 PTC patients and thyroiditis patients (control) were enrolled to measure the expressions of CXCR4 and PD-L1. Multi-factor analysis analyzed the effect of combined CXCR4 and PD-L1 expression on ROC. The two groups had no differences in the baseline characteristics. CTXCR4 and PD-L1 level in PTC patients was significantly higher than control. CXCR4 was lowly expressed in thyroid cancer tissue and PD-L1 was highly expressed in serological samples. Compared with single measurement, the combined detection of CXCR4 and PD-L1 showed more ROC area. In conclusion, reduced CXCR4 and increased PD-L1 level is found in thyroid cancer and their level might be used as predictive markers for PTC to improve the curative effect.

Immunohistochemical expression of CD 14 in transitional cell carcinoma of the urinary bladder

CD14 is a co-receptor for bacterial lipolysaccharide (LPS) detection. It is found on myelomonocytic cells such as monocytes, macrophages, and Langerhans cells, CD14 expression in bladder cells is necessary for cytokine secretion and increased tumor growth. The goal of this study was to use immunohistochemistry (IHC) to assess CD14 expression in patients with transitional cell carcinoma of the urinary bladder in order to see if there was a link between CD14 marker expression in bladder cancer and cystitis. The immunoexpression of CD14 in paraffin sections from 30 bladder biopsy samples was separated into three groups: cystitis, low grade bladder cancer (L.G), and high grade bladder cancer (H.G), and studied using immunohistochemical assays (IHC). For bladder cancer (L.G & H.G), the percentage of samples that gave positive results for IHC/CD14 expression was 70% and 80%, respectively, compared to 30% for cystitis. The incidence of study samples appear in both sexes.

Single-Cell Epigenomics Reveals Mechanisms of Cancer Progression

Cancer initiation is driven by the cooperation between genetic and epigenetic aberrations that disrupt gene regulatory programs critical to maintaining specialized cellular functions. After initiation, cells acquire additional genetic and epigenetic alterations influenced by tumor-intrinsic and -extrinsic mechanisms, which increase intratumoral heterogeneity, reshape the cell's underlying gene regulatory networks and promote cancer evolution. Furthermore, environmental or therapeutic insults drive the selection of heterogeneous cell states, with implications for cancer initiation, maintenance, and drug resistance. The advancement of single-cell genomics has begun to uncover the full repertoire of chromatin and gene expression states (cell states) that exist within individual tumors. These single-cell analyses suggest that cells diversify in their regulatory states upon transformation by co-opting damage-induced and nonlineage regulatory programs that can lead to epigenomic plasticity. Here, we review these recent studies related to regulatory state changes in cancer progression and highlight the growing single-cell epigenomics toolkit poised to address unresolved questions in the field.

Cancer Genomic Rearrangements and Copy Number Alterations from Errors in Cell Division

Analysis of cancer genomes has shown that a large fraction of chromosomal changes originate from catastrophic events including whole-genome duplication, chromothripsis, breakage-fusion-bridge cycles, and chromoplexy. Through sophisticated computational analysis of cancer genomes and experimental recapitulation of these catastrophic alterations, we have gained significant insights into the origin, mechanism, and evolutionary dynamics of cancer genome complexity. In this review, we summarize this progress and survey the major unresolved questions, with particular emphasis on the relative contributions of chromosome fragmentation and DNA replication errors to complex chromosomal alterations.

Predicting the Death Rate Around the World Due to COVID-19 Using Regression Analysis

Nowadays, COVID-19 is considered to be the biggest disaster that the world is facing. It has created a lot of destruction in the whole world. Due to this COVID-19, analysis has been done to predict the death rate and infected rate from the total population. To perform the analysis on COVID-19, regression analysis has been implemented by applying the differential equation and ordinary differential equation (ODE) on the parameters. The parameters taken for analysis are the number of susceptible individuals, the number of Infected Individuals, and the number of Recovered Individuals. This work will predict the total cases, death cases, and infected cases in the near future based on different reproductive rate values. This work has shown the comparison based on 4 different productive rates i.e. 2.45, 2.55, 2.65, and 2.75. The analysis is done on two different datasets; the first dataset is related to China, and the second dataset is associated with the world's data. The work has predicted that by 2020-08-12: 59,450,123 new cases and 432,499,003 total cases and 10,928,383 deaths.

The Anticancer Mechanisms of Scutellaria barbata against Lung Squamous Cell Carcinoma

Objective. Scutellaria barbata (S. barbata) is a Chinese traditional medicinal crop with anti-inflammatory as well as anticancer properties. To explore the anticancer mechanisms of functional monomers of S. barbata against lung squamous cell carcinoma (LUSC), a network pharmacology approach and molecular docking were utilized. Methods. The expression profile of genes encoding functional monomer components in S. barbata was obtained from the Traditional Chinese Medicine Systems Pharmacology platform (TCMSP) database. Expression data of LUSC-related genes were acquired from DisGeNET, GeneCards, OMIM, DrugBank, and TTD databases. The target genes of S. barbata that confer anticancer effects against LUSC were obtained by considering the intersecting genes between S. barbata target genes and LUSC-related genes. The potential regulatory pathways enriched in these intersected genes were identified using the KOBAS database, and Gene Ontology (GO) function enrichment analysis was performed using the online tool DAVID. The relationship network of S. barbata functional monomer components-action targets-disease-pathways was established using Cytoscape 3.8.2, and the protein-protein interaction network of those intersected genes was established using the STRING database. Finally, the hub genes were screened by using CytoNCA, a plug-in of Cytoscape, and hub gene expressions in LUSC were evaluated via the Gene Expression Profiling Interactive Analysis (GEPIA) database. AutoDockTools and PyMOL software were employed to verify the molecular docking on disease target proteins and drug functional molecules. Results. In S. barbata, 104 target genes and 20 hub genes encoding functional components against LUSC were screened out, six of which were significantly differentially expressed between LUSC samples and normal tissue samples in the GEPIA database. Here, GO analysis illustrated the involvement of these genes in the signal transduction and positive regulation of transcription from RNA polymerase II promoter and negative regulation of apoptosis, while KEGG pathway enrichment analysis demonstrated that these genes were mainly involved in several pathways, for instance, AGE-RAGE, PI3K-Akt, p53, and MAPK signaling pathway. There are four main functional components docking with six key target proteins, all of which have strong binding activity. Conclusions. We predicted the molecular mechanisms and signaling pathways of genes encoding functional components in S. barbata against LUSC. These discoveries offer novel understanding for further study, laying a scientific foundation for the production of synthetic monomer components of S. barbata.

Effects of Timing of Invasive Mechanical Ventilation in Patients with Shock. An Analysis of the Multicenter Prospective Observational VOLUME–CHASERS Cohort

Objectives: Describe the variation in practice and identify predictors of invasive mechanical ventilation (IMV) use in shock. Explore the association between the timing of IMV initiation (“Early” vs. “Delayed”) on shock duration. Design: Multicenter, prospective, observational cohort study between September 2017 and February 2018 Setting: 34 hospitals in the United States and Jordan. Patients: Consecutive, adult, critically ill patients with shock, defined as a systolic blood pressure less than or equal to 90mm Hg, mean arterial pressure less than or equal to 65mm Hg, or need for a vasopressor medication. Interventions: None. Measurements and Main Results: “Early” IMV was defined as starting IMV 0–6 hours of shock onset and “Delayed” IMV was defined as starting IMV between 6 and 48 hours of shock onset. The primary outcome was shock–free days, defined as the number of days without shock after the first 48 hours of shock onset. Variation and predictors of IMV use were examined within the whole cohort as well as the subgroup of those intubated within 0–48 hours of shock onset. Mixed effects modeling with hospital site as a random effect showed that there was 7% variation by site in the use and timing of IMV in this shock cohort. In a propensity–matched model for the timing of IMV, “Early” IMV after shock onset was associated with more shock–free days when compared to “Delayed” IMV in those intubated within 0–48 hours of shock onset (Beta coefficient 0.65 days, 95% CI 0.14-1.16 days). Conclusions: Timing of IMV initiation for patients in shock has potentially important implications for patient outcomes and merits further study.

Practical considerations in utilizing cluster randomized controlled trials conducted in biopharmaceutical industry

Cluster randomized controlled trials (cluster RCTs), also known as parallel-arm group-randomized trials, are trials in which the randomized units are groups of participants, as opposed to individual participants. These trials have largely been implemented to address broad public health issues, but with the growing interest in use of real-world data in the regulatory setting, this design may be increasingly considered for industry trials. The key difference between cluster RCTs and traditional RCTs is the intraclass correlation coefficient (ICC) that needs to be considered in cluster RCTs. In this article, we discuss some key practical considerations that are related to ICC in the design, conduct, analysis, and report stages of a cluster RCT. These key considerations related to ICC can lead to improvement in how we translate research findings from cluster RCTs into practices in the biopharmaceutical industry.

Effectiveness of Training Workshop on ICD-10 Cancer Coding Guidelines for Clinical Coders

Background: The accurate retrieval of cancer data in health information systems depends on the correct coding and classification of data. Thus, it is essential to provide continuous training for clinical coders and ensure the effectiveness of this training to achieve high-quality data. Objectives: The present study aimed at evaluating the effectiveness of the training workshop on ICD-10 cancer coding guidelines for clinical coders. Methods: The present study was performed to evaluate the effectiveness of coding guidelines training regarding the second chapter of ICD-10 (2016 ed.). Forty-five clinical coders have participated in the study. A researcher-made questionnaire was provided for guidelines data gathering, with the scoring system of Likert (0 to 5 points) at the reaction level, and by and pre-and post-test questionnaires at the learning level. The descriptive statistics were applied on the reaction level and the paired sample t-test was performed on the reaction level data. Results: The results of descriptive statistics revealed that the learners had 84.4% of the average satisfaction with the training courses The paired-samples test indicated that, at the learning level, a significant difference (P = 0.000) existed between the mean pre-and post-test scores. Conclusions: Based on Kirkpatrick’s model, the training program resulted in satisfaction and improved the clinical coders skills regarding cancer coding. It is recommended that health information managers hold effective training courses to enhance the coders’ knowledge and skills.

Coronavirus disease 2019 and the cancellation of face-to-face prostate cancer active surveillance clinic reviews: Does the omission of digital rectal examination alone put patients at risk of missed detection of disease progression?

Objectives:

The coronavirus disease 2019 (COVID-19) pandemic has resulted in the cancellation or postponement of face-to-face clinic appointments, meaning patients on active surveillance (AS) for low- or intermediate-risk prostate cancer have been unable to undergo the recommended clinical assessment and digital rectal examination (DRE) during these times. This study aimed to determine whether the omission of DRE during the COVID-19 pandemic has put AS patients at risk by missing early detection of disease progression.

Methods:

This was a retrospective, regional study looking at the data of 142 men who qualified for placement on the Grampian AS protocol over a six-year span. It paid particular attention to the reasons for progression in those men who moved to active treatment (AT) during this six-year period.

Results:

The results showed that DRE played no role in triggering the move of these 42 patients onto AT. Nineteen (45%) of these patients moved to AT due to progression on trans-rectal ultrasound biopsy, 10 (24%) due to progression on multi-parametric magnetic resonance imaging, eight (19%) due to a rising prostate-specific antigen and five (12%) due to patient choice.

Conclusion:

This audit reassures us that those patients who cannot receive a timely DRE during the COVID-19 pandemic are unlikely to be at an increased risk of missing disease progression in our region.

Level of evidence:

Retrospective cohort study – level 3.

Gold Nanoparticle Drug Delivery System: Principle and Application

In recent years, gold nanoparticles (GNPs) have gradually become a major choice of drug delivery cargoes due to unique properties. Compared to traditional bulk solid gold, GNPs have basic physical and chemical advantages, such as a larger surface area-to-volume ratio and easier surface modification. Furthermore, these have excellent biocompatibility, can induce the directional adsorption and enrichment of biological macromolecules, help retain biological macromolecule activity, and cause low harm to the human body. All these make GNPs good drug delivery cargoes. The present study introduces the properties of GNPs, including factors that affect the properties and synthesis. Then, focus was given on the application in drug delivery, not only on the molecular mechanism, but also on the clinical application. Furthermore, the properties and applications of peptide GNPs were also introduced. Finally, the challenges and prospects of GNPs for drug delivery were summarized.

Effects of Radiotherapy in Combination With Irinotecan and 17-AAG on Bcl-2 and Caspase 3 Gene Expression in Colorectal Cancer Cells

Introduction: In this study, the cytotoxic and anti-cancer effects of Irinotecan as a conventional chemotherapeutic agent compared to 17-(allyl amino)-17-demethoxygeldanamycin (17-AAG) as possible radiosensitizers in the HCT-116 cell line were investigated. Methods: HCT-116 cells were treated with various concentrations of irinotecan and 17-AAG and also irradiated with a 2-Gy of X-ray radiation. Then, the cell viability was examined by a water-soluble tetrazolium-1 assay after 24 hours. For single therapies and double and triple combination cases, IC50, 0.5×IC50 and 0.25×IC50 concentrations of each drug were selected respectively for a terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) assay and other tests. In treated and untreated cells, the caspase 3 and Bcl-2 gene expression ratios were evaluated by the real-time PCR method. Likewise, caspase 3 activity was detected with a colorimetric assay. Results: In all combined treatments, including 17-AAG- radiation, irinotecan - radiation, irinotecan -17-AAG, and irinotecan-17-AAG-radiation, decreased cellular viability and increased TUNEL positive cells were presented versus the control group (P<0.05). There were increased TUNEL positive cells in the triple combination, in concentrations of 0.25×IC50 of each drug, in comparison with single and double agent treatments. Moreover, in triple combination, the caspase 3 mRNA level and caspase 3 activity increased versus related single treatments. Likewise, in the irinotecan-17-AAG-radiation combined treatment and the 17-AAG-radiation double treatment, the Bcl-2 gene expression level decreased in comparison with single therapies. Conclusion: It can be indicated that the combination of chemo-radiotherapy versus single treatments has significant anti-cancer effects.

Sox9, Hopx, and survivin and tuft cell marker DCLK1 expression in normal canine intestine and in intestinal adenoma and adenocarcinoma

Self-renewal of the intestinal epithelium originates from stem cells located at the crypt base. Upregulation of various stem cell markers in intestinal epithelial neoplasms indicates a potential role of stem cells in tumorigenesis. In this study, the immunoreactivity of potential intestinal stem cell markers ( Sry box transcription factor 9 [Sox9], homeodomain-only protein [Hopx], survivin) and tuft cell marker doublecortin-like kinase 1 (DCLK1) in normal canine intestine and intestinal epithelial neoplasms was investigated. Formalin-fixed paraffin-embedded (FFPE) small and large intestine as well as intestinal neoplasms (55 colorectal adenomas [CRAs], 17 small intestinal adenocarcinomas [SICs], and 12 colorectal adenocarcinomas [CRCs]) were analyzed immunohistologically. Potential stem cell markers Sox9, Hopx, and survivin were detected in the crypts of normal canine small and large intestine. DCLK1+ tuft cells were present in decreasing numbers along the crypt-villus axis of the jejunum and rarely detectable in large intestine. In canine intestinal epithelial tumors, nuclear Sox9 immunoreactivity was detectable in 84.9% (CRA), 80% (CRC), and 77% of epithelial neoplastic cells (SIC). Hopx and survivin were expressed within cytoplasm and nuclei of neoplastic cells in benign and malignant tumors. DCLK1 showed a cytoplasmic reaction within neoplastic cells. The combined score of Hopx, DCLK1, and survivin varied among the examined cases. Overall, malignant tumors showed lower DCLK1 scores but higher Hopx scores in comparison with benign tumors. For survivin, no differences were detectable. In conclusion, stem cell markers Sox9, Hopx, and survivin were detectable at the crypt base and the immunoreactivity of Sox9, DCLK1, survivin, and Hopx was increased in canine intestinal adenomas and adenocarcinomas compared with normal mucosa.

Co-Infection of COVID-19 and Pneumocystosis Following Rituximab Infusion—A Case Report

Immunocompromised patients with respiratory viral infections are at increased risk of fungal superinfections, including Pneumocystosis. Within the scope of the COVID-19 pandemic, Pneumocystis jirovecii co-infections are being increasingly reported. Differential diagnosis often creates a dilemma, due to multiple overlapping clinical and radiographic features. Awareness of fungal co-infections in the context of the COVID-19 pandemic is crucial to initiate prophylactic measures, especially in high-risk individuals. We report the second case of Pneumocystis jirovecii pneumonia and COVID-19 co-infection in a renal transplant recipient in Poland.

Sequential treatment strategy using fluoropyrimidine plus bevacizumab followed by oxaliplatin for metastatic colorectal cancer: A phase II study (OGSG 1107)

Introduction: Previous prospective studies suggest that the sequential use of cytotoxic agents, such as oxaliplatin, in patients with metastatic colorectal cancer (mCRC) has the potential to improve prognosis and maintain quality of life than combination chemotherapy. The purpose of this study was to investigate the feasibility and effectiveness of a sequential treatment strategy consisting of an initial therapy (capecitabine, S-1, or 5-fluorouracil with leucovolin [LV/5-FU] plus bevacizumab) and subsequent therapy (i.e., initial therapy plus oxaliplatin) for mCRC. Methods: The primary endpoint was second progression-free survival (2nd PFS) between the start of initial therapy and tumor progression after sequential therapy; secondary endpoints were PFS after initial treatment (1st PFS), overall survival (OS), objective response rate (ORR), and safety. Results: Sixty-six patients were planned to be recruited. However, owing to a slow accrual rate, recruitment was terminated when only 19 patients were enrolled between 2011 and 2015; 4, 10, and 5 patients were administered capecitabine plus bevacizumab, S-1 plus bevacizumab, and LV/5-FU plus bevacizumab, respectively. The proportions of those with a KRAS status (wild-type/mutant/unknown) were 26%, 21%, and 53%, respectively. The median 2nd PFS and OS were 19.1 months and not reached, respectively. The ORR was 45.5% in the initial therapy and 16.7% in the subsequent therapy. Grade 3/4 toxicities included neutropenia (5%), proteinurea (5%), and hypertension (47%). Discussion/Conclusion: Although our data are limited and preliminary, the sequential treatment strategy may provide a survival benefit in patients with mCRC. Further investigation of this treatment approach is warranted.

A Dose-Response Meta-Analysis of Dietary Fiber Intake and Breast Cancer Risk

Whether dietary fiber intake could reduce the risk of breast cancer (BC) is still controversial. The articles related to breast cancer and dietary fiber were retrieved through PubMed and Web of Science database. Summary relative risk (RR) and attributable risk percentage (ARP) for dietary fiber intake on the development of breast cancer were calculated. Dose-response meta-analysis modeled the relationship between dietary fiber intake and breast cancer risk. A total of 10 studies were included in this study. Meta-analysis showed that dietary fiber intake was negatively associated with breast cancer (RR = 0.83, 95% confidence interval [CI] [0.74, 0.93]). In dose-response analysis, the risk of breast cancer showed a statistically significant linear trend with increasing dietary fiber dose: when adding 10 g per day, the risk decreased by 4.7% (RR = 0.95, 95% CI [0.93, 0.98]). The ARP results demonstrated that the breast cancer dietary fiber–attributed percentage was 33.33% in Asia, which was higher than 16.28% in North America and 9.89% in Europe. In conclusion, dietary fiber intake may have a positive effect on reducing breast cancer risk, especially in high doses.

Barriers to early detection and management of oral cancer in the Asia Pacific region

Objective

Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region.

Methods

A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey.

Results

The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested.

Conclusion

The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.

Recent development of imidazole derivatives as potential anticancer agents

Cancer, one of the key health problems globally, is a group of related diseases that share a number of characteristics primarily the uncontrolled growth and invasive to surrounding tissues. Chemotherapy is one of the ways for the treatment of cancer which uses one or more anticancer agents as per chemotherapy regimen. Limitations of most anticancer drugs due to a variety of reasons such as serious side effects, drug resistance, lack of sensitivity and efficacy etc. generate the necessity towards the designing of novel anticancer lead molecules. In this regard, the synthesis of biologically active heterocyclic molecules is an appealing research area. Among heterocyclic compounds, nitrogen containing heterocyclic molecules has fascinated tremendous consideration due to broad range of pharmaceutical activity. Imidazoles, extensively present in natural products as well as synthetic molecules, have two nitrogen atoms, and are five membered heterocyclic rings. Because of their countless physiological and pharmacological characteristics, medicinal chemists are enthused to design and synthesize new imidazole derivatives with improved pharmacodynamic and pharmacokinetic properties. The aim of this present chapter is to discuss the synthesis, chemistry, pharmacological activity, and scope of imidazole-based molecules in anticancer drug development. Finally, we have discussed the current challenges and future perspectives of imidazole-based derivatives in anticancer drug development.

The Efficacy of Time Perspective Therapy in Reducing Symptoms of Post-traumatic Stress, Anxiety, and Depression in Females with Breast Cancer

Background: Breast cancer is the biggest risk factor that endangers women's health. It is considered the highest stress-causing disease due to the unpleasant effects of disease on different aspects of patients’ life. Breast cancer is commonly associated with the symptoms of post-traumatic stress and its comorbidities such as anxiety and depression. It appears that time perspective therapy (TPT), as a new psychological treatment, can reduce the symptoms of post-traumatic stress, anxiety, and depression in females with breast cancer. Methods: This is a randomized controlled trial conducted from February to September 2019. A total of 30 patients with breast cancer were selected through a convenience sampling technique and were randomly divided into the control and treatment groups. The latter group attended 6-week sessions (each session lasted 90 minutes long) to receive TPT. To conduct pretest and posttest, all participants in the two groups were asked to fill out the following questionnaires: (1) Zimbardo Time Perspective Inventory (ZTPI); (2) The Post-traumatic Stress Disorder Checklist (PCL); (3) Beck Anxiety Inventory (BAI); and (4) the second version of Beck Depression Inventory (BDI-II). The analysis of covariance (ANCOVA) was used to evaluate the effects of treatment. A P-value smaller than 0.05 was considered significant. Results: Data analysis of 28 patients from the experimental and control groups showed that TPT significantly reduced the symptoms of post-traumatic stress, anxiety, and depression in the treatment group (P < 0.001 for symptoms of post-traumatic stress and anxiety, and P = 0.002 for depression). Such a difference was not seen in the control group. Conclusions: TPT may be an effective approach to reduce symptoms of post-traumatic stress, anxiety, and depression in Iranian women with breast cancer. Further investigations are required to confirm these findings, which may in turn help heath care professionals use TPT to promote the mental health of females with breast cancer.

Factores epidemiológicos y educativos asociados al nivel de conocimiento sobre prevención de cáncer gástrico en internos de medicina de Lima, Perú

Introducción. El cáncer gástrico es uno de los cánceres más letales; por lo tanto, un alto nivel de conocimiento sobre su prevención es esencial en la formación de los futuros médicos. Objetivo. Determinar los factores epidemiológicos y educativos asociados al nivel de conocimiento en prevención de cáncer gástrico en internos de medicina de una universidad en Lima, Perú. Materiales y métodos. Estudio transversal analítico realizado en 319 internos de medicina matriculados en 2020 y 2021 en la Facultad de Medicina Humana de la Universidad Ricardo Palma. La información se recolectó utilizando encuestas. Además, el nivel socioeconómico y el nivel de conocimiento se midieron mediante la clasificación de Graffar y el test de conocimiento sobre prevención en cáncer gástrico, previamente validado en un centro de salud en Lima (Alfa de Cronbach: 0.84), respectivamente. Se realizó un análisis bivariado y uno multivariado con un modelo de regresión de Poisson, calculándose razones de prevalencia, con un intervalo de confianza (IC) de 95% y un nivel de significancia de p<0.05. Resultados. El nivel de conocimientos fue alto en 53.92% de los internos. En el análisis multivariado, se observó una asociación significativa entre el nivel alto de conocimiento sobre prevención de cáncer gástrico y las siguientes variables: planear realizar una especialidad quirúrgica (RPa:1.43, IC95%:1.13-1.81; p=0.003) y tener nivel socioeconómico I-II (RPa:1.58, IC95%:1.26-1.99; p=0.000). Por otro lado, las variables sexo, edad, tener un familiar directo con cáncer, tener un familiar médico directo y asistencia a conferencias de cáncer no mostraron asociación significativa. Conclusión. Planear realizar una especialidad quirúrgica y tener nivel socioeconómico I-II fueron las únicas variables asociadas con tener un nivel alto e conocimientos sobre prevención del cáncer gástrico, por lo que se recomienda que la Facultad de Medicina Humana desarrolle estrategias dirigidas a mejorar el nivel de conocimiento de los internos de medicina.

The Tradeoff of Temporariness: Economic and Social Impacts of H-2A Status on Mexican Migrant Men

As the H-2A visa program expands to become a core component of contemporary Mexican migration to the United States, questions emerge about the tradeoffs migrants face between temporary and undocumented statuses. This article employs propensity score matching of participants in the Mexican Migration Project—an extensive binational survey of Mexican migrants and their families—to compare economic and social outcomes of H-2A visa recipients vis-à-vis undocumented migrants. Findings indicate that although H-2A visas offer benefits like a lower cost of living while abroad, they do not produce a discernible effect on wages relative to wages earned by undocumented migrants. While H-2A migrants are more likely to work in the formal economy, they are also less likely to build social capital or language proficiency in the United States than undocumented migrants, indicating a degree of social isolation that can be exploited by employers. This comparison contributes to a growing literature on the proliferation of temporary migratory statuses and the marginality experienced by migrants within these statuses.

Design, synthesis, anticancer activity and mechanism studies of novel 2-amino-4-aryl-pyrimidine derivatives of ursolic acid

A series of novel 2-amino-4-aryl-pyrimidine derivatives of ursolic acid were designed, synthesized, and evaluated for their anticancer activities against four cancer cell lines (MCF-7, HeLa, HepG2, and A549) and a human hepatocyte cell line (LO2) via MTT assay.

The association of SOD2 and GST gene polymorphisms with the risk of development and prognosis of papillary renal cell carcinoma

Introduction: Redox imbalance is an important factor in both carcinogenesis and progression of renal cell carcinoma. Numerous studies are focused on finding potential biomarkers that can aid in early detection, as well as in monitoring disease progression. Among the candidates there are genes coding for antioxidant enzymes - superoxide dismutase 2 (SOD2) and glutathione S -transferase (GST). Aim: This study aims to assess the role of SOD2 and GST genes polymorphisms as risk biomarkers for papillary renal cell carcinoma (pRCC), along with their impact on the survival of these patients. Material and methods: This study included 39 patients and 336 controls. The following polymorphisms were determined by appropriate PCR methods: SOD2 (rs4880), GSTA1 C69T, GSTM1, GSTT1, and GSTP1 (rs1695) . ELISA method was used to measure 8-hydroxy-2'-deoxyguanosine (8-OHdG) and benzo(a)pyrene diol epoxide (BPDE)-DNA adducts plasma level. The effect of the polymorphisms on postoperative prognosis was examined using the available survival data. Results: There was no significant difference in the distribution of SOD2, GSTA1, GSTM1, and GSTT1 gene variants between patients and controls (p > 0.05). However GSTP1 variant (GSTP1 * IleVal + ValVal) genotype was statistically significantly more frequent in patients compared to controls (p < 0.05). Similarly, carriers of GSTP1 variant genotype were at significantly higher risk of developing carcinoma compared to carriers of GSTP1 reference genotype (OR = 16.103, 95% IP = 2.036 - 127.398). There was no association between the level of both 8-OHdG and BPDE-DNA adducts, and different genotypes (p > 0.05). The investigated polymorphisms did not show any prognostic significance (p > 0.05). Conclusion: These results indicate that the GSTP1 variant genotype was related to an increased risk of papillary renal cell carcinoma development. In order to fully understand the effect of investigated polymorphisms as a potential risk and prognostic biomarkers of this cancer, further research with a bigger sample size and longer follow-up are required.

Could nucleolin and nucleophosmin levels be prognostic indicators in non-small cell lung cancer?

Aim: Lung cancer is the leading cause of mortality from cancer across the world. In this study, the use of serum nucleolin (NCL) and nucleophosmin (NPM1) levels as a marker in the diagnosis, prognosis and treatment response evaluation in lung cancer was investigated. Materials and Method: NCL and NPM1 levels of serum samples taken before chemotherapy and after 3-4 courses of chemotherapy from the control group and the patients diagnosed with lung cancer were studied using ELISA method. Results: Serum NCL and NPM1 levels of the patients were higher than of the controls (p = 0.085 for NCL, p = 0.000 for NPM1). NCL and NPM1 levels by histopathologic type were significantly higher in adenocarcinoma than in squamous cell carcinoma (p < 0.05 for each). In view of the treatment responses to chemotherapeutic agents, there was a statistically insignificant difference between the values before and after chemotherapy (p > 0.05 for each). Conclusion: High serum NCL and NPM1 levels were found to correlate with poor prognosis, poor treatment response and low survival rate. It can be concluded that serum NCL and NPM1 levels in lung cancer can be used as diagnostic and prognostic markers for the disease.

Facteurs associés à la symptomatologie anxiodépressive chez des femmes tunisiennes atteintes d’un cancer du sein

Objectifs : L’étude avait pour objectif d’estimer la prévalence de la dépression et de l’anxiété dans une population de femmes tunisiennes suivies pour un cancer du sein et de relever les données sociodémographiques, cliniques et de vie de couple qui leur sont associées.

Matériels et méthodes : Une étude transversale auprès de 100 patientes suivies pour un cancer du sein a été réalisée. Un questionnaire portant sur les caractéristiques sociodémographiques, cliniques, thérapeutiques, sur la vie conjugale et sur la sexualité du couple a été administré. L’échelle HADS (Hospital Anxiety and Depression Scale) a été utilisée pour le dépistage des symptômes anxieux et dépressifs.

Résultats : Un score clinique a été retrouvé dans 48 % des cas pour l’anxiété et 37 % des cas pour la dépression. Les patientes qui ont vécu une réaction négative de leur conjoint face à leur maladie et dont la relation de couple et la relation sexuelle ont été altérées présentaient des scores significativement plus élevés de symptomatologie anxieuse et dépressive. Une relation sexuelle non altérée était retrouvée comme facteur protecteur de l’anxiété et de la dépression.

Conclusion : Les résultats de cette étude mettent en évidence l’importance de développer des mesures spécifiques pour améliorer la communication et promouvoir la santé sexuelle au sein du couple en Tunisie.

A DNA–Au nanomachine activated by dual types of biomarkers for multi-site imaging and gene silencing

A programmed DNA–Au nanomachine was constructed to achieve in situ imaging of the transmembrane glycoprotein MUC1 and cytoplasmic miRNA-21 and trigger precise gene silencing therapy for breast cancer.