Clinical value of serum hepatocyte growth factor, B-cell lymphoma-2 and nitric oxide in primary breast cancer patients

OBJECTIVES

The present study was undertaken to determine the clinical significance of serum levels of HGF, Bcl-2 and NO in the diagnosis and prognosis of breast cancer patients.

PATIENTS AND METHODS

Forty four primary invasive breast cancer patients and fifteen health control subjects were enrolled in the present study. Serum HGF, Bcl-2 and No levels were assayed and correlated with clinico pathological parameters. ROS curve analysis was also done for each biochemical marker.

RESULTS

The mean level of HGF was 1198.79 +/- 76.32 pg/ml versus 884.67 +/- 66.88 pg/ml for the control (p = 0.026). The HGF levels were significantly elevated in the patients with increasing the tumor stage (p = 0.036). In addition, HGF levels were markedly increased in negative estrogen receptor patients (p = 0.039). The mean level of Bcl-2 in patients was 12.83 +/- 1.97 ng/ml versus 5.09 +/- 0.40 ng/ml in control (p = 0.027). Levels of Bcl-2 were elevated but not statistically significant in patients with grade I (GI) tumors, negative nodes, ER negative tumors and postmenopausal patients (p = 0.4, 0.8, 0.7 and 0.5, respectively). The patients mean serum levels of NO were 63.07 +/- 4.14 micromol/L versus 43.99 +/- 4.21 micromol/L in control (p = 0.014). The levels of NO were elevated but also not statistically significant in patients with tumor size I, GI tumors, ER negative tumors, positive nodes, stage II tumors and postmenopausal patients (p = 0.3, 0.6, 0.3, 0.7, 0.3 and 0.2 respectively). From the ROC curve analysis, it was observed that the area under curve for HGF, Bcl-2 and NO was 0.695, 0.842 and 0.711, respectively. This result indicates the good validity of the above biomarkers especially Bcl-2 to discriminate the ER positive from the negative tumors in primary breast cancer patients.

CONCLUSION

This study demonstrates that the serum levels of HGF, Bcl-2 or NO may help in the diagnosis of breast cancer patients and may aid in disease prognosis. However, larger study with more patients are required.

Oncocytic carcinoma of the breast: frequency, morphology and follow-up

Oncocytic breast carcinomas are tumors composed of no fewer than 70% of oncocytic cells (World Health Organization). The purpose of this study was to determine the frequency, morphologic, immunohistochemical, and clinical features of invasive oncocytic carcinoma in a large series. Twenty-eight cases of putative oncocytic breast carcinoma (selected cases group) and 76 consecutive cases of invasive breast carcinoma (consecutive cases group) were analyzed. Immunohistochemistry for mitochondria, gross cystic disease fluid protein 15, chromogranin, estrogen receptor, progesterone receptor, androgen receptor, HER2/Neu, cytokeratin 7, cytokeratin 14, epithelial membrane antigen, and differentiation cluster 68 was performed. Score for mitochondria was based on intensity and percentage of immunopositive cells. Classes were as follows: (1) oncocytic carcinoma: at least 70%, 3+; (2) mitochondrion-rich carcinoma: 50% to 70%, 3+, or more than 50%, 2+; and (3) all the other cases were referred to as invasive breast carcinoma. Ultrastructural examination was available for 6 cases of oncocytic carcinoma. Morphologic and immunohistochemical features of the 3 groups were compared using Fisher exact test (P < .05). For overall survival analysis, Kaplan-Maier curves were compared using log-rank and Wilcoxon tests (P < .05). Our results suggest that oncocytic breast carcinoma is a morphologic entity with distinctive histologic and ultrastructural features. Mitochondrion-rich carcinomas are histologically similar to oncocytic carcinomas and constitute 19.7% of all invasive carcinomas, indicating that cytoplasmic eosinophilia in breast cancer cells is often due to accumulation of mitochondria. Oncocytic carcinomas and mitochondrion-rich carcinomas are more often grade III tumors and show human epidermal growth factor receptor 2 overexpression. Clinical features and overall survival of oncocytic carcinomas are not distinctive because they are similar to those of the other cases when matched for grade and stage.

Melatonin ameliorates liver fibrosis induced by bile-duct ligation in rats

BACKGROUND

Hepatic stellate cells, the main mediators in the pathogenesis of fibrosis, are triggered by free radicals and produce collagen. Melatonin is a powerful physiologic scavenger of hydroxyl radicals. It is also involved in the inhibitory regulation of the collagen content in tissue. There is no effective treatment available for liver fibrosis. Our objective was to evaluate the effects of melatonin on liver fibrosis induced by bile-duct ligation (BDL) in rats.

METHODS

We divided male Wistar rats (n = 32) into 4 groups. Two groups received BDL and 2 groups received sham operations. One of the BDL groups and one of the sham groups were administered melatonin (100 mg/kg/day via intraperitoneal injection), and the controls were given vehicle only. After 1 month, we biochemically evaluated the changes in hepatic fibrosis by measuring tissue collagen levels and histopathologic examination. We evaluated the levels of malondialdehyde (MDA), glutathione (GSH), luminal and lucigenin in tissue homogenates, and we studied proinflammatory cytokines in serum using commercially available kits.

RESULTS

Bile-duct ligation caused hepatic fibrotic changes, whereas melatonin suppressed these changes in 5 of 8 rats (p < 0.001). Bile-duct ligation resulted in increased collagen, MDA, luminal and lucigenin levels and decreased GSH levels, whereas melatonin reversed these effects.

CONCLUSION

We found that melatonin functions as an effective fibrosuppressant and antioxidant, and the results suggest that it can be used as a therapeutic option.

Does the severity of tissue eosinophilia of colonic neoplasms reflect their malignancy potential?

BACKGROUND/AIMS

It was speculated that there was a relationship between the intensity of tissue eosinophilic infiltration in colonic malignancies and their prognosis. This retrospective study aimed to investigate the frequency and intensity of tissue eosinophilia in various colonic neoplasms, including serrated adenomas.

METHODS

We evaluated 448 colonic neoplasms to determine eosinophilic infiltration: 96 hyperplastic polyps, 50 serrated adenomas, 19 flat adenomas, 154 tubular adenomas, 71 tubulovillous adenomas, 13 villous adenomas and 45 adenocarcinomas. The eosinophilic infiltration was categorized into three groups by evaluating the percentage of eosinophils relative to total stromal inflammatory cells: mild (0-5%), moderate (5-40%), and marked (>;40%). Chi-square and Fisher's exact tests were used for analyses. P value <0.05 was considered statistically significant.

RESULTS

Moderate (46.7%) and marked (52.9%) intensity were noted in all colonic adenomas. Most of the hyperplastic polyps (96%) and adenocarcinomas (75.6%) showed mild intensity. Mostly moderate eosinophilic infiltration was observed in serrated adenomas.

CONCLUSIONS

Our findings suggest that the intensity of tissue eosinophilia is most prominent in adenomas including serrated adenomas and is diminished from adenoma to carcinoma. This finding may be used as a diagnostic indicator.

The effect of dehydration and irrigation on the healing of Achilles tendon: an experimental study

BACKGROUND

Air exposure is a factor that inhibits in vitro cellular proliferation and matrix synthesis in tendons. Aim of this experimental study was to evaluate effect of dehydration and irrigation on healing of Achilles tendon.

METHODS

Achilles tenotomy was done in forty-five Sprague-Dawley rats. In control group, tendon was sutured immediately. In the remaining two groups, the Achilles tendons were allowed to direct exposure of air. Irrigation of Achilles tendon was performed in one of exposed groups, while irrigation was not done in other group. After 60 minutes, tendons of both groups were sutured same as control group. Rats were sacrificed at postoperative day 28. Achilles tendons were dissected and histological and biomechanical evaluations were performed.

RESULTS

Histological evaluation revealed intense fibrosis formation with adhesion of tendon to surrounding tissues in the air exposed groups. The quantity of angiogenesis and inflammatory reaction were also higher in experimental groups regardless of irrigation. Air exposed tendons had higher tensile strength however lower stiffness than control group in biomechanical evaluation.

CONCLUSION

Air exposure decreases quality of healing by increasing fibrosis and adherence formation. These negative effects of exposure to air were not counteracted by irrigation. However, air exposure didn't affect tensile strength of the healing.

Postoperative granuloma after stapedectomy: is it destiny or avoidable?

OBJECTIVE

The aims of this study were (1) to investigate the pathophysiological characteristics of the middle ear mucoperiosteum against the caustic nature of the gastric content (GC), which consists largely of acid and pepsin components, and (2) to investigate the possible role of gastroesophageal reflux and postoperative vomiting (POV) in the etiology of poststapedectomy granuloma.

METHODS

40 Spraque-Dawley rats of either sex and with a body weight of 200-300 g were used, and divided into different study groups: group 1: GC administration to the middle ear (n = 8); group 2: phosphate-buffered saline administration to the middle ear (n = 8); group 3: GC (pH: 2) administration in the presence of a Teflon piston (TP) (n = 6); group 4: phosphate-buffered saline administration in the presence of a TP (n = 6); group 5: GC administration in the presence of a wired piston (WP) (n = 6); group 6: phosphate- buffered saline administration in the presence of a WP (n = 6). GC was administrated to the middle ear cavities by way of the eustachian tube (ET). In order to overcome the pressure of the ET, a pump mechanism was used. The increased nasopharyngeal pressure caused a passive opening of the ET, and transferred a bolus to the middle ear. The animals were decapitated after 1 week, and the bullae were isolated. The tympanic bullae were serially cut and examined with light microscopy.

RESULTS

In the saline controls, there was only a mild amount of polymorphonuclear cell (PMN) infiltration in the mildly thickened subepithelial space, indicating a less pronounced inflammation as compared to the gastric acid group. In the GC group, in addition to focal hemorrhage and severe subepithelial infiltration of PMNs, the middle ear mucosa was dramatically thickened with subepithelial edema and dilated capillaries. In the subepithelial tissue, retention cysts and granulation tissue were present. In the piston groups (TP and WP), there was extensive subepithelial inflammation and edema after GC and saline administrations. Granulation tissue filling the entire bulla around the piston segments was detected.

CONCLUSION

The relationship between the administration of GC and middle ear inflammation, and the possible role of POV in the etiology of poststapedectomy granuloma are emphasized with our experimental study. The length of the TP may be considerably important to prevent POV which may lead to gastric reflux to the middle ear.

Accessory lateral discoid meniscus

The lateral meniscus tends to have more developmental variation than the medial counterpart. This is a report of an accessory discoid layer of lateral meniscus. All arthroscopic, magnetic resonance imaging and histopathological views are presented.

The effect of proteolytic enzyme serratiopeptidase in the treatment of experimental implant-related infection

BACKGROUND

Infection around an implanted orthopaedic device is a devastating complication, and the treatment of infections involving slime-forming bacteria is especially difficult. The purpose of the present study was to evaluate the effectiveness of a proteolytic enzyme, serratiopeptidase, in the eradication of a periprosthetic infection in an in vivo animal model.

METHODS

In sixty Sprague-Dawley rats, the medullary canal of the right femur was drilled through the intercondylar notch and was inoculated with a Staphylococcus epidermidis strain (ATCC 35984) with a high slime-producing capacity. The cavity was filled with polymethylmethacrylate cement, and a Kirschner wire that had contact with the knee joint was inserted. None of the animals received any treatment for two weeks. Twenty rats were killed at two weeks after the inoculation in order to determine if the infection had become established. The remaining forty rats were randomized into two groups. One group received serratiopeptidase enzyme injections into the knee joint in addition to antibiotic therapy for four weeks, and the other group received intra-articular saline solution injections together with the same antibiotic therapy. The animals from both groups were killed two weeks after the end of therapy (on Day 56). The knee specimens were evaluated bacteriologically and histologically to determine the prevalence of persistent infection and the effects of the enzyme on local tissue.

RESULTS

At two weeks, inoculated bacteria grew on culture of specimens from twelve (63.2%) of nineteen animals in the no-treatment group. Microbiological testing suggested that infection persisted in only one (5.6%) of eighteen animals in the serratiopeptidase-and-antibiotic group, whereas it was present in six (37.5%) of sixteen animals in the antibiotic-only group (p = 0.001). Histological evaluation showed similar results (kappa = 0.92).

CONCLUSIONS

Serratiopeptidase was effective for eradicating infection caused by biofilm-forming bacteria in this experimental animal model. The antibiofilm property of the enzyme may enhance antibiotic efficacy in the treatment of staphylococcal infections.

Effect of sagittal plane deformity of the lumbar spine on epidural fibrosis formation after laminectomy: an experimental study in the rat

STUDY DESIGN

An animal model of postlaminectomy lumbar column sagittal plane deformity was designed in rats.

OBJECTIVES

To analyze the effect of lumbar column deformity (lordosis and kyphosis) on postlaminectomy epidural fibrosis formation.

SUMMARY OF BACKGROUND DATA

Incidence of peridural fibrosis formation after lumbar spinal surgery is considerably high. Instability and sagittal plane deformity of the lumbar spine has been implicated (not proven) as the factors for the development of epidural fibrosis. The effect of traction (kyphosis) or relaxation (lordosis) of the lumbar spine on epidural fibrosis formation is not known.

METHODS

L4 laminectomies were performed in 30 rats. Three equal groups were formed. In the control group (group I), only laminectomy was performed. In other groups after laminectomy, lumbar lordosis (group II) and kyphosis (group III) was maintained with steel implants. The scar formation was evaluated both histologically and histomorphometrically on the 12th postoperative week.

RESULTS

Kyphosis developed in group I. The mean amount of peridural scar tissue was significantly more evident in groups I and III than the lordosis group. The extent of adherence to the dura mater and the nerve roots was most apparent in group III.

CONCLUSIONS

Kyphosis and consequent traction of the lumbar spine is one of the causes for increased epidural fibrosis formation after laminectomy. On the contrary, establishment of lordosis and relaxation of the lumbar spine decreased the scar tissue formation in rats.