Criteria for selection and classification of studies in medical events

OBJECTIVE

The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events.

METHODS

A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach's alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi's all-pairs comparisons.

RESULTS

A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p<0.001) for all the criteria that were used [CR1-CR2 (p<0.001), CR1-CR3 (p<0.001), and CR2-CR3 (p=0.004)]. The Friedman test showed differences in the ranking of the studies (p<0.001) for all studies (p<0.01).

CONCLUSION

Methodologies that use multiple criteria show good correlation and should be taken into account when ranking the best studies.

Performance of three colposcopic images for the identification of squamous and glandular cervical precursor neoplasias

Purpose

To evaluate prevalence and diagnostic performance of three colposcopic images to diagnose squamous and glandular cervical precursor neoplasias.

Methods

Cross-sectional study, conducted through analysis of stored digital colposcopic images. To evaluate the diagnostic performance of three images, herein named grouped glands, aceto-white villi, and atypical vessels, for detection of adenocarcinoma in situ (AIS) and cervical squamous intraepithelial neoplasias (CIN) grades 2 and 3, calculations of sensitivity, specificity, accuracy, positive likelihood ratio, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were made, with their respective 95% confidence intervals.

Results

Grouped glands, aceto-white villi, and atypical vessels images had: prevalence of 21.3, 53.8, and 33.8% in patients with AIS, and 16.2, 19.5, and 9.3% in those with CIN 2 and 3; for the diagnosis of AIS, sensitivity of 21.3, 53.8, and 33.8%, specificity of 89.8, 95.2, and 94.9%, accuracy of 76.6, 87.2, and 83.1%, positive likelihood ratio of 2.1, 11.2, and 6.6, and AUC of 0.55, 0.74, and 0.64; for the diagnosis of CIN 2 and 3, sensitivity of 16.2, 19.5, and 9.3%, specificity of 89.8, 95.2, and 94.9%, accuracy of 39.4, 43.4, and 36.3%, positive likelihood ratio of 1.6, 4.1, and 1, 8, and AUC of 0.53, 0.57, and 0.52, respectively.

Conclusion

Prevalence and accuracy of the three images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias. Sensitivity, specificity, positive likelihood, and AUC of aceto-white villi and atypical vessels images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias.

Performance of Conventional Cytology and Colposcopy for the Diagnosis of Cervical Squamous and Glandular Neoplasias

OBJECTIVE

 To estimate the cytological and colposcopic performances for the diagnosis of cervical neoplasias.

METHODS

 Cross-sectional retrospective study with data from patients' charts. The participants underwent colposcopy, guided biopsies, and excision when needed. The cytological and colposcopic categorization followed the Bethesda System and the international colposcopic terminologies. The cytology and colposcopy performances were evaluated by sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) analyses with 95% confidence interval (95% CI).

RESULTS

 From 1,571 participants, a total of 1,154 (73.4%) were diagnosed with cervical squamous intraepithelial neoplasia grade 2 or worse (CIN 2⁺), 114 (7.2%) with adenocarcinoma in situ or worse (AIS⁺), 615 (39.2%) presented atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or worse (ASC-H⁺) cytology, and 934 (59.4%) presented major or suspicious for invasion colposcopic abnormalities. The SE, SP, PPV, and NPV of ASC-H⁺ for diagnoses of CIN 2⁺ and AIS⁺ were, respectively: 44% (95% CI: 41-47) and 72% (95% CI: 67-76), 79% (95% CI: 77-81) and 79% (95% CI: 75-83), 88% (95% CI: 87-90) and 55% (95% CI: 50-60), and 28% (95% CI: 26-31) and 88% (95% CI: 85-91). The SE, SP, PPV, and NPV of major or suspicious for invasion colposcopic abnormalities for diagnoses of CIN 2⁺ and AIS⁺ were, respectively: 62% (95% CI: 60-65) and 86% (95% CI: 83-89), 59% (95% CI: 57-62) and 59% (95% CI: 55-64), 85% (95% CI: 83-87) and 44% (95% CI: 40-49), and 29% (95% CI: 27-32) and 92% (95% CI: 89-94).

CONCLUSION

 The SE analyses results of ASC-H⁺ and major or suspicious for invasion colposcopic abnormalities were higher for diagnoses of glandular neoplasias. These results confirm the role of cytology in identifying women at risk who will have their final diagnoses settled by colposcopy and histology.

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients

Introduction:

Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis.

Objective:

The two dyes were compared regarding detection of the sentinel lymph node (SLN).

Method:

A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded.

Results:

Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies.

Conclusion:

Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE:

This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection.

METHODS:

The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552.

RESULTS:

The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups.

CONCLUSION:

Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

Is the combination of fat grafts and platelet rich plasma effective in rats?

PURPOSE:

To investigate if the association of fat grafts and platelet-rich plasma (PRP) improves graft viability in female rats.

METHODS:

This is an experimental, randomized and blinded study, which involved 47 rats. Fat was harvested from the inguinal region and grafted to the cranial region. The experimental group consisted of PRP-enriched fat grafts (n=22) whilst the control group consisted of fat graft only (n=25). After a 100-day period, the animals were euthanised and the fat grafts were analyzed using scores from 0 (absent) to 4 (abundant), in optical microscopy by two independent and blinded pathologists.

RESULTS:

Regarding fat graft cell viability, the PRP group scored moderate/abundant in 63% of cases and the fat graft only group scored absent/slight in 72% of cases (p=0.03). The PRP group also presented lower fat necrosis scores when compared to the fat graft only group (p=0.03). Tumors (dermoid cysts) within the fat grafts were observed in three animals in which the grafts were mixed with PRP.

CONCLUSION:

Platelet-rich plasma improves the viability and integration of fat grafts in rats, but more studies are needed to fully understand the exact mechanisms that lead to this improvement and assess the safety of the method for use in humans.

High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground-glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings.

Utility of Ki-67, CD10, CD34, p53, CD117, and Mast Cell Content in the Differential Diagnosis of Cellular Fibroadenomas and in the Classification of Phyllodes Tumors of the Breast

Adequate management of phyllodes tumors of the breast (PTB) remains a challenge because of the difficulty in correctly establishing preoperative diagnosis. The aim of this study was to evaluate the usefulness of Ki-67, CD10, CD34, p53, CD117, and of the number of mast cells in the differential diagnosis of benign PTB and cellular fibroadenomas (CFs) as well as in the grading of PTB. Fifty-one primary PTB and 14 CFs were examined by immunohistochemistry.When evaluating CD117 expression, higher epithelial expression was present in CF as well as an increased number of mast cells in benign PTB. Stromal expression of Ki-67, CD10, CD34, and p53 were relevant to PTB grading, of which the first 3 showed significance in the distinction of benign and borderline PTB, as well as between benign and malignant PTB. P53 was relevant only for the discrimination between benign and malign PTB. None of the markers showed significance in distinguishing between borderline and malign PTB.

Prevalence, genotype profile and risk factors for multiple human papillomavirus cervical infection in unimmunized female adolescents in Goiânia, Brazil: a community-based study

Background

The epidemiology of infection with multiple human papillomavirus (HPV) types in female adolescents is poorly understood. The purpose of this study was to explore the epidemiology of infection with multiple HPV types in adolescents and its association with demographic, behavioral and biological variables, as well as with cytological abnormalities.

Methods

This community-based study included 432 sexually active females between 15 and 19 years of age. Genotyping for 30 HPV types was performed using a reverse blot strip assay/restriction fragment length polymorphism. Unconditional multivariate logistic regression was performed to identify factors significantly associated with HPV infection. The association between HPV infection and cytological abnormalities was calculated using a prevalence ratio.

Results

The most common HPV types detected were 16, 51, 31, 52 and 18. Of the 121 HPV-positive women, 54 (44.6%) were infected with multiple HPV types. Having more than one lifetime sexual partner was associated with infection with any HPV infection, single HPV infection, and infection with multiple HPV types. The presence of cytological abnormalities was associated with infection with multiple HPV types.

Conclusions

Co-infecting HPV genotypes occur in a high proportion of sexually active adolescents. Socio-demographic or sexual behavior factors associated with single HPV infection were similar to those associated with multiple HPV types. The higher risk of cytological abnormalities conferred by infection with multiple HPV types suggests a potential role of co-infection in the natural history of HPV infection.

Monitoring the profile of cervical cancer in a developing city

Background

Medical records are frequently consulted to verify whether the treatment and guiding principles were correct. Determine incidence and mortality trends of in situ and invasive neoplasms of the uterine cervix, in the period 1988–2004 in Goiânia, Brazil.

Methods

The incident cases were identified through the Population-Based Cancer Registry of Goiânia. Population data were collected from census data of the Brazilian Institute of Geography and Statistics. For mortality analysis, data were extracted from the Mortality Information System. The Poisson Regression was utilized to determine the annual incidence and mortality rates.

Results

A total of 4446 cases of in situ and invasive neoplasms of the uterine cervix were identified. No significant reductions were verified in invasive cervical cancer rates (p = 0.386) during the study period, while in situ carcinomas presented an annual increasing trend of 13.08% (p < 0.001). A decreasing trend was observed for mortality (3.02%, p = 0.017).

Conclusion

No reduction was observed for the incidence of invasive cancer of the uterine cervix; however, increasing trends were verified for in situ lesions with a consequent reduction in mortality rates. These increasing trends may be the result of recently-implemented screening programs or due to improvements in the notification system.

There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia

BACKGROUND AND OBJECTIVES

Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia.

METHODS

Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly.

RESULTS

Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p=0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p=0.257).

CONCLUSIONS

High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.

There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia

BACKGROUND AND OBJECTIVES

Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the fi rst and third drops of CSF of patients undergoing spinal anesthesia.

METHODS

Samples of the fi rst and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the fi rst drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly.

RESULTS

Squamous epithelial cells were identified in 35 (89.7%) samples from the fi rst drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the fi rst drop (p = 0.046). Nucleated epithelial cells were found in a sample of the fi rst drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than fi rst drop with no statistical difference (p = 0.257).

CONCLUSIONS

High percentage of epithelial cells was found in the fi rst (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.

Estudo experimental comparando o uso do 2-octil cianoAcrilato ao nylon 4-0 na sutura da pele

OBJETIVO: Comparar o 2-octil cianoacrilato com o fio de "nylon" no fechamento da pele em ratos. MÉTODOS: Vinte e cinco ratos da linhagem Wistar, foram submetidos à incisão de 3 cm de cada lado do abdome. A síntese foi feita utilizando em um dos lados o "nylon" 4.0, pontos intradérmicos, e do outro o 2-octil cianoacrilato. Após sete dias, o fio foi removido e as incisões, analisadas quanto às complicações. Após 40 dias, o resultado da cicatriz foi avaliado. Os ratos foram sacrificados, as cicatrizes foram ressecadas, fixadas e enviadas ao patologista, sem informação sobre qual o método utilizado. RESULTADOS: Houve dois óbitos durante a anestesia e um tardio. O tempo de operação foi de 136 segundos com a cola e 176 segundos, com o "nylon" (P=0,003). Dentre as 50 operações realizadas, as complicações foram: um hematoma com cada método (P=0,80), quinze deiscências da cola contra 11 do "nylon" (P=0,20), sete cicatrizes de aspecto ruim ou razoável da cola contra quatro do "nylon" (P=0,30), três infecções na cola contra duas (P=0,40). Ao exame patológico, a mediana da largura da cicatriz foi de 1.119 micra com a cola e 1.800 com o "nylon" (P=0,40). A espessura foi de 1.795 contra 1.705 micra (P=0,40). CONCLUSÃO: O 2-octil cianoacrilato apresentou o mesmo aspecto cicatricial, a mesma resistência e as mesmas complicações que a sutura com o "nylon" 4.0, porém permitindo redução no tempo cirúrgico.

Variations in breast cancer incidence per decade of life (Goiânia, GO, Brazil): 16-year analysis

OBJECTIVE

To analyze the variation in breast cancer incidence, with stratification into ten-year age groups, 17 years after the nuclear accident in Goiânia.

METHODS

Between 1988 and 2003, 3312 new cases were recorded. The crude and standardized incidence rates were calculated. ANOVA was used to obtain the coefficient of determination (R2) for the incidence over the course of the years, and p-values were obtained both by linear and by polynomial regression.

RESULTS

The increases in crude and standardized incidence were statistically significant in all age groups, except for women between 20 and 29 years old. For the age group from 30 to 49 years, the increase in incidence was around 100% (p = 0.001), and from 50 to 59 years, 277% (p < 0.001). More modest increases of around 50% were observed in the age groups from 60 to 79 years (p = 0.013). For the women aged 80 years and over, the increase was 272% (p = 0.015).

CONCLUSIONS

There were significant increases in the crude and standardized incidence rates for breast cancer in the city of Goiânia. The women in the age group from 50 to 59 years were the ones who presented the highest increase in incidence. More wide-ranging epidemiological studies therefore become necessary for defining the factors that are possibly related to this excessive increase in breast cancer incidence, in certain specific segments of the female population.

Investigation of human papillomavirus by hybrid capture II in cervical carcinomas including 113 adenocarcinomas and related lesions

Hybrid capture is an easy and highly sensitive technique for screening population due to its capacity to detect malignant and premalignant lesions of the cervix. To evaluate its sensitivity, we investigated the frequency of high-risk human papillomavirus (HPV) infection and its correlation with glandular malignant lesions, analyzing a total of 113 cases of adenocarcinomas and related lesions. High-risk HPV was investigated using a hybrid capture II (HC2) assay. Samples were collected in two different ways: either brushed directly from surgical specimens before fixation or collected from the patients. We also investigated the frequency of HPV in squamous malignant lesions, 65 squamous cell carcinomas (SCC) and 66 in situ squamous cell carcinomas (ISSCC), to compare the occurrence of HPV for these lesions. The 113 glandular lesions comprised 62 invasive adenocarcinomas (IAC), 8 in situ adenocarcinomas (ISAC), 26 IAC plus SCC, and 17 adenosquamous cells carcinomas (ASCC). The HPV-positive reactions were as follows: 51 (82.2%) in IAC, 8 (100%) in ISAC, 25 (96.1%) in IAC plus SCC, and 14 (82.3%) in ASCC. HC2-positive results in the squamous malignant lesions were as follows: 58 of 63 (89.0%) for SCC and 94 of 103 (91.2%) for ISSCC. High-risk HPV infection was quite similar for glandular and pure squamous invasive malignant lesions, 82.2% and 89.0%, respectively, indicating that high-risk HPV is also highly prevalent in glandular lesions. Although hybrid capture proved to be an excellent adjunctive technique, we do not believe its results merit replacing the Pap smear as a screening tool.

Fine-needle aspiration biopsy for breast lesions: a comparison between two devices for obtaining cytological samples

CONTEXT AND OBJECTIVE

Fine-needle aspiration biopsy has been accepted worldwide for breast lesions. However, some questions remain, including the appropriateness of the puncture method. The objective of this work was to compare aspirates obtained by the auto-vacuum device and by the syringe pistol holder.

DESIGN AND SETTING

Randomized trial for validation of diagnostic method, at Hospital das Clínicas da Universidade Federal de Goiás and Hospital Araújo Jorge, Goiânia.

METHODS

351 patients presenting breast lumps underwent fine-needle aspiration biopsy, either with the auto-vacuum device or the syringe pistol holder. A single cytopathologist analyzed all of the cytology slides. The rates of insufficient material, cellularity, cell distortion and background hemorrhage were evaluated.

RESULTS

The percentages of insufficient material were 16% and 22% (p = 0.18), for the auto-vacuum and pistol aspirates, respectively. Good cellularity was seen in 34% of auto-vacuum and 29% of pistol samples (p = 0.4). Cell distortion was seen in 31 and 26 cases, respectively (p = 0.7). Background hemorrhage occurred in 63 (35%) and 54 cases (31%) (p = 0.2), for auto-vacuum and pistol. The sensitivity was 88% and 86%; specificity 99% and 100%, positive predictive value 96% and 100%, negative predictive value 96% and 95% and total accuracy 76% and 75% for the auto-vacuum and pistol, respectively.

CONCLUSION

The results obtained from the two fine-needle aspiration biopsy methods were equivalent. Therefore, the auto-vacuum device is a good option for obtaining aspirates for cytology.

Risk of malignancy in solid breast nodules according to their sonographic features

OBJECTIVE

The purpose of this study was to assess the risk of malignancy for each type of sonographic feature in solid breast nodules.

METHODS

The study included 304 patients from the Department of Gynecology and Obstetrics of the Federal University of Goiás who had solid breast nodules. A medical trainee, working under the supervision of a preceptor, obtained the sonographic images of the breast, and the features were recorded in a questionnaire. Each sonographic feature was analyzed and compared with the anatomic and pathologic findings after the lesion was excised.

RESULTS

Of the 304 patients included in the study, 292 (96%) had a conclusive diagnosis. Among these women, 216 (74%) had benign tumors and 76 (26%) had malignant tumors. The odds ratio of malignancy in breast nodules, as calculated by multivariate analysis, was as follows: lesions without circumscribed margins, 17.02 (95% confidence interval, 5.28-54.90); lesions with heterogeneous echo texture, 7.70 (2.99-19.84); lesions with thickened Cooper ligaments, 15.61 (1.08-225.10); nodules whose anteroposterior dimension was larger than their width, 3.29 (1.09-9.96); those with an anterior echogenic rim, 2.59 (0.80-8.40); and those with posterior shadowing, 1.57 (0.62-4.01). Among the 133 cases that had all the sonographic features of a benign lesion, 3 nodules (2.3%) had a histologic diagnosis of malignant.

CONCLUSIONS

Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.

P-cadherin expression in glandular lesions of the uterine cervix detected by liquid-based cytology

OBJECTIVE

To study P-cadherin aberrant expression as a possible marker for cervical adenocarcinomas in cytological samples.

METHODS

We studied P-cadherin immunoexpression in liquid-based cervical cytology samples of biopsy-proven cervical lesions.

RESULTS

We found a statistically significant correlation between P-cadherin expression and a cytological diagnosis of malignancy, either glandular or squamous (P < 0.0001). Twenty-two of 33 malignant cases showed P-cadherin membrane staining. None of the 30 benign cases tested showed membrane staining, but three of them displayed an aberrant nuclear P-cadherin expression.

CONCLUSIONS

We concluded that P-cadherin can be used to discriminate between malignant and benign cervical cytological specimens, but not to discriminate glandular from squamous lesions.

Ischemic preconditioning of renal tissue: identification of early up-regulated genes

Given the important effects of ischemic preconditioning (IPC) in minimizing tissue damage induced by sustained ischemia in several tissues, this study evaluated the effect of IPC in preserving renal function and identified up-regulated genes after 30 min of preconditioning. IPC induced by 2, 3 and 4 min of ischemia, intercalated by 5 min of reperfusion, induced a measurable protection of renal function and morphology. The improved functional and histological parameters occurred in parallel with up-regulation of 39 genes, as evaluated by subtractive hybridization; for 13 of them we could show, by RNAse protection assay, a significant increase in mRNA levels. These genes code for chaperones/chaperonins and cytoskeleton proteins that could be involved in preservation of protein folding and cellular structures after sustained ischemia; proteins related to oxidative metabolism that might be relevant for cellular use of alternate sources of energy or for faster recovery of ATP levels in this condition, and proteins that are putative scavengers of oxidant products. Summarizing, ischemic preconditioning induced up-regulation of genes that code proteins whose functional roles suggest their involvement in the tolerance of the preconditioned tissue to sustained ischemia.