Targeting histone deacetylases in endometrial cancer: a paradigm-shifting therapeutic strategy?

OBJECTIVE

Endometrial cancer is increasingly prevalent in western societies and affects mainly postmenopausal women; notably incidence rates have been rising by 1.9% per year on average since 2005. Although the early-stage endometrial cancer can be effectively managed with surgery, more advanced stages of the disease require multimodality treatment with varying results. In recent years, endometrial cancer has been extensively studied at the molecular level in an attempt to develop effective therapies. Recently, a family of compounds that alter epigenetic expression, namely histone deacetylase inhibitors, have shown promise as possible therapeutic agents in endometrial cancer. The present review aims to discuss the therapeutic potential of these agents.

MATERIALS AND METHODS

This literature review was performed using the MEDLINE database; the search terms histone, deacetylase, inhibitors, endometrial, targeted therapies for endometrial cancer were employed to identify relevant studies. We only reviewed English language publications and also considered studies that were not entirely focused on endometrial cancer. Ultimately, sixty-four articles published until January 2018 were incorporated into our review.

RESULTS

Studies in cell cultures have demonstrated that histone deacetylase inhibitors exert their antineoplastic activity by promoting expression of p21WAF1 and p27KIP1, cyclin-dependent kinase inhibitors, that have important roles in cell cycle regulation; importantly, the transcription of specific genes (e.g., E-cadherin, PTEN) that are commonly silenced in endometrial cancer is also enhanced. In addition to these abstracts effects, novel compounds with histone deacetylase inhibitor activity (e.g., scriptaid, trichostatin, entinostat) have also demonstrated significant antineoplastic activity both in vitro and in vivo, by liming tumor growth, inducing apoptosis, inhibiting angiogenesis and potentiating the effects of chemotherapy.

CONCLUSIONS

The applications of histone deacetylase inhibitors in endometrial cancer appear promising; nonetheless, additional trials are necessary to establish the therapeutic role, clinical utility, and safety of these promising compounds.

[Psychosomatic disorders in ancient Greek medicine]

The concept of psychosomatic disorders, as defined by modern medicine, was difficult to be perceived by the ancient Greek physicians. Two main reasons contributed to this. One was that physicians in Greek antiquity had formed the idea that the mental illnesses that were recognized at that time, namely mania, melancholy, frenzy, caros, lethargy, apoplexy, but even epilepsy, was the result of a disturbance of the essential elements of the body, the balance of them contributed to the preservation of health. Thus, depending on the school of medical thought of each physician in antiquity, mental and corporal illnesses were the result of various disorders such as the dyscrasia of humors for the physicians of the Dogmatic school that followed the Hippocratic principles or the disorder of the qualitative characteristics of the humor and the pneuma (air), as the physicians of the Pneumatic School considered, but also of the stenosis or the expansion of the pores as the physicians of the Methodic school thought. Although there was the perception that the diseases were the result of various combinations of the previous theories, as concluded by the physicians who constituted the Eclectic school. The second reason was that ancient physicians could not perceive the autonomy of man's psychic world as an element of human nature in which emotional distress and irrational mental processing of stimuli from the social, cultural and natural environment of the individual would be aggravating to the challenge of mental imbalance. Nevertheless, many physicians such as physicians who wrote various work of Corpus Hippocraticum, Soranus of Ephesus (1st - 2nd c. AD) Galen (1st - 2nd c. AD), Aretaeus of Cappadocia (1st - 2nd or 4th c. AD) and Caelius Aurelianus (5th c. AD) did not forget to describe in their works psychosomatic disorders as they are defined by modern medicine. In their works there are the observations about intense sweating, tremor, eating disorders, hysteria and even death as a result of an intense and long psychological unrest. These corporal symptoms, although were onset due to a psychological unequilibrium they could not been listed by the ancient Greek physicians in any of the mental diseases as they were defined in antiquity. The psychological disturbance which could provoke the above corporal disorders arose by various phobias, shame, sorrow, anger, envy, excessive drinks and food, excessive sexual desire, passion for gambling and anxiety of everyday life.

Cystic hygroma of the neck: single center experience and literature review

OBJECTIVE

Malformations of the lymphatic system are recognized as benign congenital tumors that affect infant and children in the perinatal era. In children, these abnormalities usually found in the neck and the axillary region, but they can present in other parts of the body such as mediastinum, pelvis, retroperitoneum as well as in solid organs (e.g., adrenal glands, pancreas, stomach). Our aim is to report our experience on cystic hygromas via two cases and review the literature.

MATERIALS AND METHODS

Herein we present two cases of cystic hygroma, the first of female children and the second of a female adult patient respectively. Both of these patients underwent surgical excision of the masses.

RESULTS

After the procedure, both patients have recovered well, and no recurrence of the lesion has been noted during the follow-up period.

CONCLUSIONS

Surgical treatment remains the gold-standard treatment for these tumors, while other modalities have been used with mixed results.

The anatomy of the ACL and its importance in ACL reconstruction

The anterior cruciate ligament (ACL) anatomy is very significant if a reconstruction is attempted after its rupture. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. In this review, an attempt is made to summarize the most recent and authoritative tendencies as far as the anatomy of the ACL, and its surgical application in its reconstruction are concerned. Also, it is significant to take into account the anatomy as far as the rehabilitation protocol is concerned. Separate placement in the femoral side is known to give better results from transtibial approach. The medial tibial eminence and the intermeniscal ligament may be used as landmarks to guide the correct tunnel placement in anatomic ACL reconstruction. The anatomic centrum of the ACL femoral footprint is 43 % of the proximal-to-distal length of lateral, femoral intercondylar notch wall and femoral socket radius plus 2.5 mm anterior to the posterior articular margin. Some important factors affecting the surgical outcome of ACL reconstruction include graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing. The rehabilitation protocol should come in phases in order to increase range of motion, muscle strength and leg balance, it should protect the graft and weightbearing should come in stages. The cornerstones of such a protocol remain bracing, controlling edema, pain and range of motion. This should be useful and valuable information in achieving full range of motion and stability of the knee postoperatively. In the end, all these advancements will contribute to better patient outcome. Recommendations point toward further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.