A THOROUGH STUDY AND META-ANALYSIS OF THE PROGNOSTIC RELEVANCE OF THE C-REACTIVE-ALBUMIN RATIO IN ACUTE PANCREATITIS

Although most cases of acute pancreatitis (AP) are minor, severe cases are associated with a substantial risk of death. Acute pancreatitis (AP) is a common illness. Therefore, it is critical to assess AP severity as soon as possible. This review aimed to ascertain the predictive significance of the CRP to albumin ratio in individuals with AP. We searched PubMed, Science Direct, and Cochrane Library electronic databases Until January 2023. Studies that reported the CRP/alb ratio at admission and its relationship to the severity or death of patients with AP were included. Using a random-effects model, we computed the pooled mean difference (MD) and 95% confidence interval (CI). The quality of the included studies was evaluated using the Newcastle-Ottawa scale. This meta-analysis combined data from six trials with a total of 2244 patients. Upon admission, the CRP/alb ratio was higher in patients with severe AP than in those with mild to moderate AP (pooled MD:3.59; 95% CI:2.51-4.68; p<0.00001). Additionally, non-survivor AP patients had a substantially higher CRP/alb ratio than survivor AP patients (pooled MD:2.12; 95% CI:0.43-3.8; p<0.01). Individuals with AP may benefit from a high CRP/ALB ratio as a preliminary indicator of poor prognosis.

Bone marrow embolism: should it result from traumatic bone lesions? A histopathological human autopsy study

Bone marrow embolism (BME) is likely a consequence of fractures in which pulmonary vessels are the most affected. However, some cases of BME were reported in the absence of trauma. Thus, a traumatic injury might not be necessary for developing BME. This study discusses BME cases in patients without signs of fractures or blunt trauma. The discussion addresses various possible mechanisms for the appearance of BME. Options include cancer in which bone marrow metastasis is a suggestive cause. Another proposal is the chemical theory where bone marrow fats are released via lipoprotein lipase in a pro-inflammatory state, resulting in vascular/pulmonary obstruction. Other cases discussed in this study are hypovolemic shock and drug-abuse related BME. All autopsy cases with BME were included regardless of the cause of death for a period of 2 years. Autopsies involved complete dissection with the macroscopic evaluation of the affected organs, including the heart, lungs, and brain. Tissues were also prepared for microscopic examination. Of the 11 cases, eight showed non-traumatic BME (72%). These findings conflict with theories in the literature that BME most commonly occurs after fractures or trauma. One of the eight cases exhibited mucinous carcinoma; one is presented with hepatocellular carcinoma; and two cases showed severe congestion. Lastly, one case was found to be associated with each of the following conditions: liposuction, drug abuse, pulmonary hypertension, and heart failure. Each case suggests a different pathophysiology for developing BME, yet the exact mechanisms are not fully understood. Further study of non-traumatic associated BME is recommended.

Kekuasaan: Determinan Sosial dan Kebudayaan Penyakit Tuberkulosis Paru di Cinangka Serang Banten

The backgrounds of this research are the reality of pulmonary tuberculosis cases in Indonesia which has never been resolved since the colonial era until now, and the ignorance of biomedical experts to the results of medical anthropology research on pulmonary tuberculosis. Therefore, this study tries to get out of the usual themes of medical anthropological research and offer “power” as a new theme in medical anthropological research on pulmonary tuberculosis. The method used is a qualitative method with an ethnographic approach to describe the process of occurrence and transmission of pulmonary tuberculosis. The findings of this research are; (1) the knowledge of society in Cinangka Serang Banten regarding pulmonary tuberculosis is constructed by staff of public health center (puskesmas), as well as personalistic and naturalistic traditional healers, (2) social process, as a form of power implementation, can stimulate, encourage, or even facilitate the biological process of pulmonary tuberculosis, (3) the use of power issue in medical anthropology perspective for the understanding disease is significant as one of the themes in pulmonary tuberculosis research. The effect of these findings is; to stimulate the dynamization of theory and method in medical anthropology; reconstruct the way of thinking in the study of disease; provide a conceptual contribution to overcoming pulmonary tuberculosis.

Household disinfection practices by women living in Egypt during the 2020 COVID-19 lockdown and the association of information sources and suspected bleach toxicity

INTRODUCTION

The spread of contradictory health information was a hallmark of the early COVID-19 pandemic. Because of a limited understanding of the disease, its mode of transmission, and its pathogenicity, the public turned to easily accessible and familiar sources of information. Some of these sources included wrong or incomplete information that could increase health risks and incidents of toxicity due to improper information about the usage of disinfectants. The objective of this study was to assess the relationship between sources of information about the COVID-19 pandemic, the related household cleaning and disinfection practices among adult women living in Egypt, and the associated adverse effects of bleach toxicity during a national lockdown.

METHODS

Through a self-administered online survey, 452 adult women (18 years and older) living in Egypt were recruited from 13 cities between 4 June 2022 and 4 July 2022 to answer the questionnaire. The questionnaire included (41) questions in Arabic and collected data about respondents' household cleaning and disinfection practices to prevent the spread of the SARS-CoV-2 virus and protect their families during the lockdown that started in Egypt in March 2020.

RESULTS

The study found that 88.1% (n = 398) of participants reported increased use of disinfectants during the lockdown. Women who chose social media as their primary source of information to learn about disinfection practices reported an increased frequency of respiratory symptoms associated with bleach toxicity (correlation coefficient = 0.10, p-value = 0.03), followed by women who depended on relatives and friends as the primary source of information (correlation coefficient = 0.10, p-value = 0.02).

CONCLUSION

This study showed that social media is an easily accessible, efficient and fast communication tool that can act as a primary source for individuals seeking medical information compared to other media platforms (e.g., websites, T.V., satellite channels). However, better regulations and monitoring of its content may help limit the harms caused by the misinformation and disinformation spread by these popular platforms, particularly in times of uncertainty and upheaval.

Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study

BACKGROUND

Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race.

PATIENTS AND METHODS

Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted.

RESULTS

In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01).

CONCLUSIONS

MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.

Performance evaluation of the commercial aquafeeds available in the market of Pakistan on Channa marulius (Sole)

The present study aimed to determine the effect of different levels of protein on the growth, body composition, amino acid profile and serology of Channa marulius fingerlings. The experiment was conducted in ten happas installed in earthen ponds, each stocked with 10 fishes for 90 days. Four commercial fish feeds having 25%, 30%, 32% and 40% crude protein (CP) levels were fed to fish at 3% of their wet body weight three times a day. The results of the study revealed that highest weight gain, feed conversion ratio and survival rate were observed in 30% protein feed. Meanwhile, moisture content was higher in fish fed with 30% CP feed while highest crude protein was recorded in 40% CP fed fish. Lowest fat content was observed in 32% CP feed. Amino acid profile of fish revealed better results in 30% CP feed. Total protein, glucose and globulin were also highest in fish feeding 30% CP feed, while albumin was highest in 40% CP feed. It is concluded that 30% CP feed showed better results in terms of growth, amino acid profile and serological parameters without effecting fish body composition.

Selective use of Peptide Receptor Radionuclide Therapy following comparative imaging of Ga-68 DOTATATE PET/CT against I-131 MIBG scintigraphy in a small Asian cohort of Adult Neuroblastoma

Adult neuroblastoma (AN) is rare with an extremely poor prognosis. No standard therapy exists for this entity and treatment options are limited in recurrent or refractory disease. ¹³¹I-MIBG has been used in combination with myeloablative therapy before autologous bone marrow transplantation or in a salvage therapy setting. However, myelotoxicity is a dose-limiting factor in heavily pre-treated patients and response is not always sustained. Somatostatin receptor scintigraphy and theranostics with radiolabelled somatostatin receptor analogues are becoming more commonplace with the recognition of these receptors in over 90% of neuroblastoma cells. We describe three AN patients assessed for somatostatin receptor status and the novel use of ¹⁷⁷Lu-based peptide recep-tor radionuclide therapy (PRRT) in two of them and a literature review.

Relentless pulsatile tinnitus secondary to dural sinovenous stenosis: is endovascular sinus stenting the answer?

AIM

To assess the efficacy of endovascular venous sinus stenting (EVSS) in treating pulsatile tinnitus (PT) caused by dural venous sinus stenosis (DVSS), and to determine whether it is an adequate remedy in cases with concurrent venous anomalies.

MATERIALS AND METHODS

Seventeen patients (13 female and four male) with PT due to DVSS were treated using EVSS. The trans-stenotic pressure gradient (PG) was measured before and after stenting. The effect of stenting on the tinnitus was evaluated by questioning the patients at day 0, and at 3, 6, and 9 months after stenting.

RESULTS

Except for one patient who continued to complain of PT, all of the patients, including two with concomitant sinus diverticula, described complete resolution of the tinnitus immediately following stenting. The post-stenting PG was significantly lower than the pre-stenting PG (p<0.0001). No procedure related complications occurred and no recurrence was recorded during the follow-up period.

CONCLUSION

EVSS is a safe and successful treatment for PT due to DVSS even in cases with coexistent sinus diverticula.

Utility of the Mansoura Numeroalphabetic Constipation Score in detection of obstructed defaecation syndrome and prediction of the outcome of treatment

AIM

Thorough assessment of obstructed defaecation syndrome (ODS) is imperative for the selection of treatment options. The present study aimed to examine the utility of the Mansoura Numeroalphabetic Constipation Score (MNCS) in distinguishing patients with ODS from healthy control subjects and in predicting the outcome of treatment of ODS.

METHODS

Patients with ODS associated with anterior rectocele and/or rectoanal intussusception were assessed with the MNCS at the first visit to the clinic. All patients were offered conservative treatment for 3 months and patients who improved were continued on conservative treatment for six more months while patients who failed were treated surgically. The MNCS was reassessed at the end of follow-up in both groups. A cohort of healthy controls was compared to ODS patients with regard to age, sex and baseline MNCS.

RESULTS

In all, 124 ODS patients and 53 healthy controls were included. The ODS patients had a significantly higher baseline MNCS than controls (9.5 ± 1.5 vs 0.76 ± 0.71, P < 0.0001). Forty of 124 patients improved after conservative management and showed a significant decrease in MNCS (6.9 ± 1.08 to 3.1 ± 1.2, P < 0.0001). Eighty-four (67.8%) patients failed to respond to conservative measures and were surgically treated, 77 (91.6%) of whom showed significant improvement in symptoms postoperatively while seven (8.4%) failed to improve; the difference in postoperative MNCS between the two groups was significant.

CONCLUSION

The MNCS successfully distinguished ODS patients from controls and was able to predict the outcome of ODS treatment.

Applicability of the Sarculator and MSKCC nomograms to retroperitoneal sarcoma prognostication in an Asian tertiary center

AIM

To study the applicability of 2 common nomograms in retroperitoneal sarcoma patients treated in an Asian tertiary hospital, and to study relapse patterns.

METHODS

Patients from 1st January 2000 to 31st December 2017 were retrospectively analysed. R2 resection from an external institution were ineligible. Harrel's C concordance index and calibration plots were used to assess nomograms' accuracy.

RESULTS

109 patients were eligible, with a median age of 56, median tumour size of 16 cm and median follow up of 44.1 months. Most common subtypes were DDLPS (46.8%), LMS (19.3%) and WDLPS (13.8%). Overall, 81.1% had passed away from sarcoma. Recurrence patterns differed with subtypes; 6.7% of WDLPS and 66.7% of LMS had distant relapses. WDLPS patients had a median sarcoma specific survival of 139 months (122-NA), while the rest had a median SSS of 72.3 months (59.7-NA). The 5-years and 7-year OS were 63.0% (95% CI: 53.6%-74.0%) and 51.6% (41.1%-64.8%) respectively. The 5-years and 7-year DFS were 22.4% (15.5%-32.3%) and 17.5% (11%-27.8%) respectively. The 4-years, 8-years and 12-year SSS were 71.3% (62.7%-81.0%), 51.8% (40.8%-65.8%) and 32.2% (19.7%-52.6%) respectively. The concordance indices for 7-year DFS and OS (Sarculator) were 0.63 and 0.73. The concordance indices for 4-, 8- and 12-year SSS (MSKCC) were 0.64, 0.72 and 0.72.

CONCLUSION

Both nomograms were effective in our cohort. Both nomograms can be further improved by specifying the type of relapse and including a longer-term endpoint for the Sarculator.

Fistulotomy with or without marsupialisation of wound edges in treatment of simple anal fistula: a randomised controlled trial

BACKGROUND

Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula.

METHODS

This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications.

RESULTS

Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001).

CONCLUSION

Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.

Use of Chest X-Ray Examination as a Diagnostic Aid for Detection of Dengue Haemorrhagic Fever

The advantage of a chest X-ray in the RLD position in 15 children with DHF hospitalized at the paediatric ward of the Ternate General Hospital within the period of May-June-July 1990 and June-July 1991 were evaluated. Besides clinical and laboratory assessment to establish the diagnosis of DHF according to the WHO guidelines (1975), child and a haemaglutination-inhibition test was also done to confirm the diagnosis. Chest X-rays in the RLD position found a pleural effusion in 11 out of 15 patients with DHF especially in those with dengue shock syndrome. A positive serological test was always associated with the presence of PE (100%), while this could be shown in only 2 patients with negative test results. It may be concluded that the WHO criteria for the clinical diagnosis of DHF may be confirmed not only by the serological test but also by the presence of PE on chest film in the RLD position and therefore this examination may play an important role in establishing a diagnosis of DHF in a regency hospital.

An Analysis of the Psychosocial, Financial and Emotional Needs of Adolescent and Young Adult Cancer Survivors in Singapore Through Focus Group Discussions

Background: The adolescent and young adult (AYA) population, aged between 15-39 years, is an understudied and medically underserved community of cancer survivors in Singapore. Aim: This study was designed to elicit perspectives on various psychosocial, emotional and financial concerns that the AYA cancer survivors (CS) encountered, in their transition to survivorship. Methods: The AYA CS in the age range of 18-39 years, with at least 6 months to 2 years since diagnosis and/or completion of curative treatment were recruited for this study. Four focus group discussions, which consisted of 2-4 respondents, were conducted within the premises of National Cancer Centre Singapore. Participants were prompted by the facilitator with a series of open-ended questions on themes specific to survivorship, including treatment side-effects, sexual and reproductive health concerns, changes in work or education and survivorship support services. Participants' responses were then transcribed verbatim, and analyzed through qualitative content analysis. Results: Twelve AYA, with a mean (±SD) age of 27.1 (±5.9) years, participated in four focus group discussions. The mean (±SD) number of years since cancer diagnosis was 2.3 (±0.6) years, with majority diagnosed with non-Hodgkin's lymphoma (41.6%) and germ cell tumor (25.0%). AYA CS were greatly affected by physical side-effects such as alopecia, changes in body image, and cognitive changes. There were also emotional concerns including the fear of recurrence, infertility anxieties, poor insurance coverage and lack of career advancement opportunities. Majority expressed that they preferred consulting a specialist rather than a general practitioner for their follow-up care. Conclusion: The AYA CS suffer from a multitude of problems as they transit toward survivorship. Innovative and effective survivorship care models are required to timely address their bio-psychosocial, financial and emotional concerns.

Reduced microRNA-503 expression augments lung fibroblast VEGF production in chronic obstructive pulmonary disease

Alterations in microRNA (miRNA) expression may contribute to COPD pathogenesis. In COPD, lung fibroblast repair functions are altered in multiple ways, including extracellular mediator release. Our prior study revealed miR-503 expression is decreased in COPD lung fibroblasts, although the exact role played by miR-503 is undetermined. The current study examined a role of miR-503 in cytokine, growth factor and fibronectin production by lung fibroblasts from patients with and without COPD. Primary adult lung fibroblasts were isolated from patients with or without COPD. MiR-503 expression and interleukin (IL)-6, -8, PGE2, HGF, KGF, VEGF and fibronectin release were examined with or without inflammatory cytokines, IL-1β and tumor necrosis factor (TNF)-α. MiR-503 expression was decreased in COPD lung fibroblasts. The expression of miR-503 was positively correlated with %FVC, %FEV1, and %DLco as well as IL-6, -8, PGE2, HGF, KGF, and VEGF in the absence or presence of IL-1ß/TNF-α. In addition, IL-8 and VEGF release from COPD lung fibroblasts were increased compared to those from control. Exogenous miR-503 inhibited VEGF release from primary adult and fetal lung fibroblasts but not IL-8 release. As expected, COPD fibroblasts proliferated more slowly than control fibroblasts. MiR-503 did not affect proliferation of either control or COPD lung fibroblasts. MiR-503 inhibition of VEGF protein production and mRNA was mediated by direct binding to the 3' untranslated region of VEGF mRNA. Endogenous miR-503 was differently regulated by exogenous stimulants associated with COPD pathogenesis, including IL-1ß/TNF-α, TGF-ß1 and PGE2. Endogenous miR-503 inhibition augmented VEGF release by IL-1ß/TNF-α and TGF-ß1 but not by PGE2, demonstrating selectivity of miR-503 regulation of VEGF. In conclusions, reduced miR-503 augments VEGF release from lung fibroblasts from patients with COPD. Since VEGF contributes to disturbed vasculature in COPD, altered miR-503 production might play a role in modulating fibroblast-mediated vascular homeostasis in COPD.

Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis

AIM

Internal rectal prolapse (IRP) is a unique functional disorder that presents with a wide spectrum of clinical symptoms, including constipation and/or faecal incontinence (FI). The present review aims to analyse the results of trials evaluating the role of abdominal rectopexy in the treatment of IRP with regard to regarding functional and technical outcomes.

METHOD

A systematic review of the literature for the role of abdominal rectopexy in patients with IRP was conducted. PubMed/Medline, Embase and the Cochrane Central Register of Controlled Trials were searched for published and unpublished studies from January 2000 to December 2015.

RESULTS

We reviewed 14 studies including 1301 patients (1180 women) of a median age of 59 years. The weighted mean rates of improvement of obstructed defaecation (OD) and FI across the studies were 73.9% and 60.2%, respectively. Twelve studies reported clinical recurrence in 84 (6.9%) patients. The weighted mean recurrence rate of IRP among the studies was 5.8% (95% CI: 4.2-7.5). Two hundred and thirty complications were reported with a weighted mean complication rate of 15%. Resection rectopexy had lower recurrence rates than did ventral rectopexy, whereas ventral rectopexy achieved better symptomatic improvement, a shorter operative time and a lower complication rate.

CONCLUSION

Abdominal rectopexy for IRP attained satisfactory results with improvement of OD and, to a lesser extent, FI, a low incidence of recurrence and an acceptable morbidity rate. Although ventral rectopexy was associated with higher recurrence rates, lower complication rates and better improvement of bowel symptoms than resection rectopexy, these findings cannot be confirmed owing to the limitations of this review.

Laparoscopic ventral mesh rectopexy vs Delorme's operation in management of complete rectal prolapse: a prospective randomized study

AIM

Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delorme's operation for complete rectal prolapse.

METHOD

Fifty patients with complete rectal prolapse were enrolled in this study. Patients were randomly selected to undergo either LVMR or Delorme's procedure after clinical, manometric and radiological evaluation. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse and continence state were evaluated. Patients were followed for a mean duration of 18 months.

RESULTS

Thirty-one (62%) patients were women and 19 (38%) patients were men with a mean age of 39.7 ± 6.9 years. Patients were allocated into two equal groups: LVMR group and Delorme's group. Thirty-three (66%) complained of faecal incontinence preoperatively. Patients were followed for 18 months. There was no major postoperative complication or treatment death. Improvement in continence was reported in 80.9% of patients (83.3% in group 1 vs 71.4% in group 2). Recurrent prolapse was observed in 16% of patients in group 2 and 8% in group 1 (P = 0.66). The operation time was significantly greater in group 1 and the length of stay greater in group 2. There was no difference in the fall of constipation score between the groups.

CONCLUSION

There was no statistically significant difference in the incidence of recurrence of complete rectal prolapse or postoperative improvement of symptoms between the two groups. Hospital stay was longer after Delorme's procedure but the operation time was shorter. Neither procedure proved definite superiority regarding the clinical and functional outcome at 18 months of follow-up.

Motivasi Kerja, Internal Locus Of Control dan Kepuasan Kerja Pada Karyawan Bagian Marketing Dan Supporting di PT X Cabang Surabaya

Research that takes the subject 100 employees at PT. X in Surabaya branch fromand marketing supporting division to find the motivation to work and internal locus ofcontrol and job satisfaction in a correlational study. Data collected through questionnairesand analyzed by multiple regression test. The results show the value of F = 3.449; p =0.0036 (p <0.05), which means that work motivation and internal locus of controlcombination has a significant correlation with employees job satisfaction. It can besaid that the hypothesis that states motivation and internal locus of control on employeesat the marketing and supporting division have a relationship with employee satisfaction,that means it can be accepted. The value of R2 = 0.066 describe motivation and internallocus of control simultaneously have contributed effectively to job satisfaction up to 6.6%and that is a quite low in value. Partial test results of work motivation are t = 2.353; p= 0.021 (p <0.05), which means there is a significant positive correlation between workmotivation and job satisfaction, while the result of internal locus of control are = -0.572;p = 0.568 (p> 0.05), that means there is no correlation between the internal locus ofcontrol and job satisfaction.Keywords : Job satisfaction, work motivation, internal locus of control

JAK-STAT and G-protein-coupled receptor signaling pathways are frequently altered in epitheliotropic intestinal T-cell lymphoma

Epitheliotropic intestinal T-cell lymphoma (EITL, also known as type II enteropathy-associated T-cell lymphoma) is an aggressive intestinal disease with poor prognosis and its molecular alterations have not been comprehensively characterized. We aimed to identify actionable easy-to-screen alterations that would allow better diagnostics and/or treatment of this deadly disease. By performing whole-exome sequencing of four EITL tumor-normal pairs, followed by amplicon deep sequencing of 42 tumor samples, frequent alterations of the JAK-STAT and G-protein-coupled receptor (GPCR) signaling pathways were discovered in a large portion of samples. Specifically, STAT5B was mutated in a remarkable 63% of cases, JAK3 in 35% and GNAI2 in 24%, with the majority occurring at known activating hotspots in key functional domains. Moreover, STAT5B locus carried copy-neutral loss of heterozygosity resulting in the duplication of the mutant copy, suggesting the importance of mutant STAT5B dosage for the development of EITL. Dysregulation of the JAK-STAT and GPCR pathways was also supported by gene expression profiling and further verified in patient tumor samples. In vitro overexpression of GNAI2 mutants led to the upregulation of pERK1/2, a member of MEK-ERK pathway. Notably, inhibitors of both JAK-STAT and MEK-ERK pathways effectively reduced viability of patient-derived primary EITL cells, indicating potential therapeutic strategies for this neoplasm with no effective treatment currently available.

Hubungan Antara Religiusitas dan Dukungan Sosial dengan Kebahagiaan Pelaku Konversi Agama

The purpose of this study was to investigate the relationship between religiosity and social support with happiness among perpetrators of religious conversion. The data was collected from 60 participants who had experienced with religious conversion (muallaf) in Chinese Community. The participants were between 40 and 55 years of age. Data of this study was analysed by using a multiple regression analysisThe results of multiple regression analysis showed F = 20,060 with p = 0, 00 (p < 0, 01), it was revealed that religiosity and social support were found to be highly significant with happiness. Therefore, the result of this study indicated that hypothesis that there is any relationship between religiosity and social support with happiness was accepted. The results of partial correlation analysis were; (1) there was positive correlation between religiosity and happiness (r partial = 0,473, t = 4,056, with p = 0,000 (p<0,01)). It means,by increasing the religiosity, the happiness among perpetrators of religious conversion also will increase and (2) there was no any correlation between social support and happiness among perpetrators of religious conversion(r partial = 0,221 t = 1,715,with p = . 0,092 (p>0, 05)).

Pengaruh Experiential Learning Terhadap Kepercayaan Diri Dan Kerjasama Tim Remaja

Intisari. Penelitian ini akan mengkaji pengaruh Experiential learning terhadap kepercayaan diri dan kerjasama tim remaja. Penelitian ini merupakan penelitian eksperimen yang dilakukan pada siswa VII MTs. Babussalam Kalibening Mojoagung Jombang dengan jumlah subyek 60 orang siswa. Pengumpulan data untuk mengungkap kepercayaan diri menggunakan skala kepercayaan diri dan kerjasama tim ukur dengan skala kerjasama tim, sedangkan Experiential learning diberikan sebagai treatmen pada kelompok eksperimen. Analisis data untuk variabel kepercayaan diri dilakukan dengan analisis Mann-Whitney karena data variabel ini tidak homogen dan analisis untuk variabel kerjasama tim dilakukan dengan uji-t student. Hasil penelitian menunjukkan ada perbedaan kepercayaan diri antara kelompok eksperimen yang mendapat treatment Experiential learning dengan kelompok kontrol yang tidak mendapat treatment pretest-post test  (z = -2,537 ; p =0,011). Pada kerjasama tim ada perbedaan kerjasama tim antara kelompok eksperimen yang mendapat treatment Experiential learning dengan kelompok kontrol yang tidak mendapat treatment pretest-post test (t = 3,009 ; p. = 0,002). Hasil tersebut menunjukkan bahwa Experiential learning berpengaruh terhadap kepercayaan diri dan kerjasama tim  remaja.Kata kunci: Experiential learning, Kerpercayaan diri, dan Kerjsama Tim

Enteropathogenic Escherichia coli (EPEC): Does it have a role in colorectal tumourigenesis? A Prospective Cohort Study

BACKGROUND

Despite the characterization of many aetiologic genetic changes. The specific causative factors in the development of sporadic colorectal cancer remain unclear. This study was performed to detect the possible role of Enteropathogenic Escherichia coli (EPEC) in developing colorectal carcinoma.

PATIENTS AND METHOD

Fresh biopsy specimens have been obtained from the colonic mucosa overlying the colorectal cancer as well as from the colon of the healthy controls. Culture, genotyping and virulence of EPEC were done using (nutrient broth culture, and PCR). Strains biochemically identified as Escherichia coli were selected from the surface of a MacConkey's plate and were serogrouped by slide agglutination tests.

RESULTS

From January 2011 to June 2014, 213 colorectal cancer patients (Group 1) and 248 healthy controls (Group 2) were prospectively enrolled in this study. EPEC was positive in 108 (50.7%) in group 1 and 51 (20.6%) in group 2 (P = 0.0001). A significant difference between both groups was observed regarding serotyping, genotyping (eae gene) and virulence category (P = 0.0001). A significant difference between the 2 subgroups of colorectal cancer cases was observed regarding genotyping (eae, bfb genes) and virulence category.

CONCLUSION

The incidence EPEC was higher significantly in patients with colorectal cancer. E. coli in patients with colorectal cancer significantly differed serotypically and genotypically from the E. coli in normal population. E. coli colonization of the colonic mucosa may be a cause colorectal cancer.

Fibroblasts that resist cigarette smoke-induced senescence acquire profibrotic phenotypes

This study assessed the effect of extended exposure to cigarette smoke extract (CSE) on tissue repair functions in lung fibroblasts. Human fetal (HFL-1) and adult lung fibroblasts were exposed to CSE for 14 days. Senescence-associated β-galactosidase (SA β-gal) expression, cell proliferation, and tissue repair functions including chemotaxis and gel contraction were assessed. HFL-1 proliferation was inhibited by CSE and nearly half of the CSE-exposed cells were SA β-gal positive after 14 days exposure, whereas 33% of adult lung fibroblasts were SA β-gal positive in response to 10% CSE exposure. The SA β-gal-positive cells did not proliferate as indicated by bromodeoxyuridine incorporation. In contrast, cells negative for SA β-gal after CSE exposure proliferated faster than cells never exposed to CSE. These nonsenescent cells migrated more and contracted collagen gels more than control cells. CSE exposure stimulated TGF-β1 production, and both inhibition of TGF-β receptor kinase and TGF-β1 siRNA blocked CSE modulation of fibroblast function. Extended exposure to CSE might induce two different fibroblast phenotypes, a senescent and a profibrotic phenotype. The fibroblasts that resist CSE-induced cellular senescence may contribute to the pathogenesis of idiopathic pulmonary fibrosis and could contribute to fibrotic lesions in chronic obstructive pulmonary disease acting through a TGF-β1-mediated pathway. In contrast, the senescent cells may contribute to the pathogenesis of emphysema.

Vitamin D modulates prostaglandin E2 synthesis and degradation in human lung fibroblasts

Vitamin D insufficiency has been increasingly recognized in the general population worldwide and has been associated with several lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), and respiratory tract infections. Fibroblasts play a critical role in tissue repair and remodeling, which is a key feature of COPD and asthma. Fibroblasts modulate tissue repair by producing and modifying extracellular matrix components and by releasing mediators that act as autocrine or paracrine modulators of tissue remodeling. The current study was designed to investigate if vitamin D alters fibroblast release of key autocrine/paracrine repair factors. First, we demonstrated that human fetal lung (HFL)-1 cells express the vitamin D receptor (VDR) and that vitamin D, 25-hydroxyvitamin D [25(OH)D], or 1,25-dihydroxyvitamin D [1,25(OH)2D] induce VDR nuclear translocation and increase VDR-DNA binding activity. We next demonstrated that vitamin D, 25(OH)D, and 1,25(OH)2D significantly reduced prostaglandin (PG)E2 production by human lung fibroblasts (HFL-1) but had no effect on transforming growth factor β1, vascular endothelial growth factor, or fibronectin production. Vitamin D, 25(OH)D, and 1,25(OH)2D significantly inhibited IL-1β-induced microsomal PGE synthase (mPGES)-1 expression; in contrast, all three forms of vitamin D stimulated 15-hydroxy PG dehydrogenase, an enzyme that degrades PGE2. Cyclooxygenase-1 and -2 and the other two PGE2 synthases (mPGES-2 and cytosolic PGE synthase) were not altered by vitamin D, 25(OH)D, or 1,25(OH)2D. Finally, the effect of PGE2 inhibition by 25(OH)D was observed in adult lung fibroblasts. These findings suggest that vitamin D can regulate PGE2 synthesis and degradation and by this mechanism can modulate fibroblast-mediated tissue repair function.

Phosphodiesterase-4 inhibition augments human lung fibroblast vascular endothelial growth factor production induced by prostaglandin E2

Lung fibroblasts are believed to be a major source of vascular endothelial growth factor (VEGF), which supports the survival of lung endothelial cells and modulates the maintenance of the pulmonary microvasculature. VEGF has been related to the pathogenesis of lung diseases, including chronic obstructive pulmonary disease (COPD). Prostaglandin E2 (PGE2) stimulates VEGF production from lung fibroblasts via the E-prostanoid (EP)-2 receptor. The EP2 signaling pathway uses cyclic adenosine monophosphate (cAMP) as a second messenger, and cAMP is degraded by phosphodiesterases (PDEs). This study investigates whether phosphodiesterase inhibition modulates the human lung fibroblast VEGF production induced by PGE2. Human fetal lung fibroblasts were cultured with PGE2 and PDE inhibitors. The PDE4 inhibitors roflumilast, roflumilast N-oxide, and rolipram with PGE2 increased VEGF release, as quantified in supernatant media by ELISA. In contrast, PDE3, PDE5, and PDE7 inhibitors did not affect VEGF release. Roflumilast increased VEGF release with either an EP2 or an EP4 agonist. Roflumilast augmented the cytosolic cAMP levels induced by PGE2 and VEGF release with other agents that use the cAMP signaling pathway. Roflumilast-augmented VEGF release was completely inhibited by a protein kinase A (PKA) inhibitor. Roflumilast with PGE2 increased VEGF mRNA levels, and the blockade of mRNA synthesis inhibited the augmented VEGF release. The stimulatory effect of roflumilast on VEGF release was replicated using primary healthy and COPD lung fibroblasts. These findings demonstrate that PDE4 inhibition can modulate human lung fibroblast VEGF release by PGE2 acting through the EP2 and EP4 receptor-cAMP/PKA signaling pathway. Through this action, PDE4 inhibitors such as roflumilast could contribute to the survival of lung endothelial cells.

Reprogramming of COPD lung fibroblasts through formation of induced pluripotent stem cells

Reprogramming somatic cells to induced pluripotent stem cells (iPSCs) eliminates many epigenetic modifications that characterize differentiated cells. In this study, we tested whether functional differences between chronic obstructive pulmonary disease (COPD) and non-COPD fibroblasts could be reduced utilizing this approach. Primary fibroblasts from non-COPD and COPD patients were reprogrammed to iPSCs. Reprogrammed iPSCs were positive for oct3/4, nanog, and sox2, formed embryoid bodies in vitro, and induced teratomas in nonobese diabetic/severe combined immunodeficient mice. Reprogrammed iPSCs were then differentiated into fibroblasts (non-COPD-i and COPD-i) and were assessed either functionally by chemotaxis and gel contraction or for gene expression by microarrays and compared with their corresponding primary fibroblasts. Primary COPD fibroblasts contracted three-dimensional collagen gels and migrated toward fibronectin less robustly than non-COPD fibroblasts. In contrast, redifferentiated fibroblasts from iPSCs derived from the non-COPD and COPD fibroblasts were similar in response in both functional assays. Microarray analysis identified 1,881 genes that were differentially expressed between primary COPD and non-COPD fibroblasts, with 605 genes differing by more than twofold. After redifferentiation, 112 genes were differentially expressed between COPD-i and non-COPD-i with only three genes by more than twofold. Similar findings were observed with microRNA (miRNA) expression: 56 miRNAs were differentially expressed between non-COPD and COPD primary cells; after redifferentiation, only 3 miRNAs were differentially expressed between non-COPD-i and COPD-i fibroblasts. Interestingly, of the 605 genes that were differentially expressed between COPD and non-COPD fibroblasts, 293 genes were changed toward control after redifferentiation. In conclusion, functional and epigenetic alterations of COPD fibroblasts can be reprogrammed through formation of iPSCs.