In silico study of polyphenols as potential inhibitors of MALT1 protein in non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is one of the most common cancer types. Deregulated signaling pathways can trigger certain NHL subtypes, including Diffuse Large B-cell lymphoma. NF-ĸB signaling pathway, which is responsible for the proliferation, growth, and survival of cells, has an essential role in lymphoma development. Although different signals control NF-ĸB activation in various lymphoid malignancies, the characteristic one is the CARD11-BCL10-MALT1 (CBM) complex. The CBM complex is responsible for the initiation of adaptive immune response. Our study is focused on the molecular docking of ten polyphenols as potential CARD11-BCL10-MALT1 complex inhibitors, essentially through MALT1 inhibition. Molecular docking was performed by Auto Dock Tools and AutoDock Vina tool, while SwissADME was used for drug-likeness and absorption, distribution, metabolism, excretion, and toxicity (ADMET) analysis of the ligands. Out of 66 ligands that were used in this study, we selected and visualized five. Selection criteria were based on the binding energy score and position of the ligands on the used protein. 2D and 3D visualizations showed interactions of ligands with the protein. Five ligands are considered potential inhibitors of MALT1, thus affecting NF-ĸB signaling pathway. However, additional in vivo and in vitro studies are required to confirm their mechanism of inhibition.

COVID-19 Vaccines and Myocarditis: An Overview of Current Evidence

COVID-19 vaccines have been widely used to reduce the incidence and disease severity of COVID-19. Questions have lately been raised about the possibility of an association between COVID-19 vaccines and myocarditis, an inflammatory condition affecting the myocardium, or the middle layer of the heart. Myocarditis can be caused by infections, immune reactions, or toxic exposure. The incidence rate of myocarditis and pericarditis was calculated to be 5.98 instances per million COVID-19 vaccine doses delivered, which is less than half of the incidences after SARS-CoV-2 infection. Myocarditis rates in people aged 12 to 39 years are around 12.6 cases per million doses following the second dose of mRNA vaccination. Adolescent men are more likely than women to develop myocarditis after receiving mRNA vaccines. The objectives of this systematic review and meta-analysis are to find out how often myocarditis occurs after receiving the COVID-19 vaccine, as well as the risk factors and clinical repercussions of this condition. Nevertheless, the causal relationship between vaccination and myocarditis has been difficult to establish, and further research is required. It is also essential to distinguish between suggested cases of myocarditis and those confirmed by endomyocardial biopsy.

A review on drug repurposing in COVID-19: from antiviral drugs to herbal alternatives

Background

COVID-19 is an illness caused by severe acute respiratory syndrome coronavirus 2. Due to its rapid spread, in March 2020 the World Health Organization (WHO) declared pandemic. Since the outbreak of pandemic many governments, scientists, and institutions started to work on new vaccines and finding of new and repurposing drugs.

Main body of the abstract

Drug repurposing is an excellent option for discovery of already used drugs, effective against COVID-19, lowering the cost of production, and shortening the period of delivery, especially when preclinical safety studies have already been performed. There are many approved drugs that showed significant results against COVID-19, like ivermectin and hydrochloroquine, including alternative treatment options against COVID-19, utilizing herbal medicine.

Short conclusion

This article summarized 11 repurposing drugs, their positive and negative health implications, along with traditional herbal alternatives, that harvest strong potential in efficient treatments options against COVID-19, with small or no significant side effects. Out of 11 repurposing drugs, four drugs are in status of emergency approval, most of them being in phase IV clinical trials. The first repurposing drug approved for clinical usage is remdesivir, whereas chloroquine and hydrochloroquine approval for emergency use was revoked by FDA for COVID-19 treatment in June 2020.

SURVIVIN POSITIVITY AND PROGNOSTIC FACTORS IN PAPILLARY THYROID CARCINOMAS

CONTEXT

Papillary thyroid carcinoma(PTC)s are the indolent progressive tumours. Survivin is a unique bifunctional protein with cell cycle regulation and apoptosis inhibition. The expression of this protein has been shown to be increased in thyroid tumours correlated with aggressive behavior from well differentiated to anaplastic.

OBJECTIVE

In this study, we aimed to investigate the relationship between immunohistochemically survivin expression and tumour-associated prognostic factors in papillary thyroid carcinomas.

DESIGN

In patients with thyroidectomy, we compared the clinicopathological findings and immunohistochemical positivity for survivin.

SUBJECTS AND METHODS

In 109 patients, sex, age, tumour size, histological tumour variant, tumour focality, tumour border pattern, tumour peripheral/intratumoural lymphocytic and stromal response, intraglandular spread, extrathyroideal spread, lymph node metastases, lymphocytic tiroiditis and relationships of these findings with survivin positivity were investigated.

RESULTS

When we indicated the tumour size and compared it with survivin expression, tumour size correlates with, survivin expression (p = 0.016). Survivin expression was correlated statistically significant with lymphovascular invasion, without stromal response and with intraglandular extension respectively (p<0.001, p = 0.043, p<0.001). No significant correlation was found between other clinicopathological parameters and survival.

CONCLUSION

Few studies have investigated the relationship of survivin expression with prognosis in thyroid papillary carcinomas and showed that survivin was a poor prognostic marker. If its expression is detected in preoperative cytology smears, it may affects the surgical treatment strategy. When it is detected in the tissue, postoperative radioactive iodine treatment plan may be modified and the need for more aggressive follow-up may be considered.

Abstract P6-16-01: The importance of loco-regional tumor burden and surgery on survival in patients with de novo stage IV breast cancer; post-hoc analyses of protocol MF07-01

Background: The MF07-01 trial is a multicenter phase III randomized controlled trial of treatment naive stage IV BC patients comparing loco-regional surgery (LRS) followed by appropriate systemic therapy (ST) versus ST alone.

Aims: To evaluate the importance of loco-regional tumor burden and surgery on overall survival rate in patients with de novo stage IV breast cancer.

Methods: At initial diagnosis patients were randomized 1:1 to LRS group or ST group. The surgery was a lumpectomy (L) or mastectomy (M) and sentinel lymph node biopsy (SLNB) ± axillary lymph node dissection (ALND). After surgery all patients received systemic treatment + endocrine treatment (ET) and Trastuzumab based on pathology results. The demographic, pathologic, and clinical characteristics of the patients were recorded.

Results:274 patients were accrued; 138 in the LRS group and 136 in the ST group. The groups were comparable regarding age, BMI, HER2 neu, tumor type and size, histologic grade, and bone and visceral metastasis (all p&gt;0.05). In the LRS group 36 patients (26%) had L+ALND, 92 patients (67%) had M+ALND and 10 patients (7%) had M+SLNB, respectively.

The patients and tumor characteristicsPatients and Tumors Characteristics and Surgical TreatmentSurgerySystemic TherapyP ValueAge (mean /year±SD)51.8 ±12.651.5±13.6NSMedian follow-up (25%,75%)41.0 (24,54)37 (18,49) Tumor Size (%)   T18.7 (12) NST252.2 (72) NST321.7 (30) NST417.4 (24) NSHistologic Grade (%)   I4.4 (6)9.6 (10)NSII39.9 (55)31.7 (33)NSIII55.8 (77)58.9 (61)NS    Surgical Treatment   Lumpectomy+ ALND26 (36)--M + SLNB7 (10)--M + ALND67 (92)---SLNB17 (23)--ALND92.8 (128)--pN+89.1 (123)--30-day mortality1.4 (2)1.5 (2)0.98SLNB-Sentinel Lymph Node Biopsy; ALND-Axillary Lymph Node Dissection; M-Mastectomy

The axillary positivity rate was 89.1%. There were 76 (55%) deaths in the LRS group and 101 (74%) in the ST group during the median 40 (20-51) month follow-up. Overall survival (OS) was 34% higher in the LRS group compared to the ST group (HR: 0.66, 95%CI 0.49-0.88: p = 0.005).

Overall survival rate was higher in LN (+) (p=0.01), tumor size&lt;5cm (p&lt;0.0001), and high histologic grade (HG III, p&lt;0.008) patients who underwent axillary surgery than ST group ; OS rate was with a marginal significant level in patients without axillary involvement (pN0) in the LRS group compared with ST group (p=0.05).

Conclusion: In this subgroup analysis, we observed that patients with high grade tumor, without skin or chest wall involvement and positive axilla who underwent surgery for primary breast tumor and axilla had better overall survival than ST in de novo stage IV breast. These results can be considered in clinical research design for stratification.

Citation Format: Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan NZ, Ozaslan C, Evrensel T, Uras C, Aksaz E, Soyder A, Ugurlu UM, Col C, Cabioglu N, Bozkurt B, Sezgin E, Dagoglu T, Uzunkoy A, Dulger M, Koksal N, Cengiz O, Gulluoglu B, Unal B, Atalay C, Yildirim E, Erdem E, Salimoglu S, Sezer A, Koyuncu A, Gurleyik G, Alagol H, Ulufi N, Berberoglu U, Soran A. The importance of loco-regional tumor burden and surgery on survival in patients with de novo stage IV breast cancer; post-hoc analyses of protocol MF07-01 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-01.

A RARE CLINICAL PRESENTATION: A PATIENT WITH CHRONIC RENAL FAILURE, SECONDARY HYPERPARATHYROIDISM AND CALCIPHYLAXIS

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is usually observed in women and it is a serious complication of hyperparathyroidism secondary to chronic renal failure. CUA is characterized by ischemic tissue loss secondary to progressive vascular degeneration. Although it is rare, it may end up with sepsis and organ failure and can be fatal. Its pathogenesis is not fully understood, but it is thought that it occurs secondary to increased calcification activators such as oxidized LDL, TNF- α, calcitriol, fibronectin, collagen-I, and TGF-1α. The most effective treatment is managing underlying pathology and decreasing serum calcium and phosphorus levels. In this report, we aimed to present an end stage renal failure case with coexisting hyperparathyroidism, hyperthyroidism and calciphylaxis in whom cutaneous manifestations were healed 6 months after parathyroidectomy.

CLINICALLY UNDETECTABLE OCCULT THYROID PAPILLARY CARCINOMA PRESENTING WITH CERVICAL LYMPH NODE METASTASIS

Background

Occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy without clinical and radiologic findings has been rarely reported.

Case report

A 47 years old female patient admitted to otorhinolaryngology clinic with 4X3 cm sized cervical mass. Physical examination of the patient was noted as a nontender, firm, mobile lymph node at right lateral cervical region. There was no inflammatory or infection disease in the history of patients anamnesis and no abnormal value on laboratory tests. Ultrasound screening of the neck detected a lymph node with suspicious features for malignancy. Head and neck examination was normal and there is no evidence of a tumoral mass or nodule in the thyroid gland. Whole body scan of MRI showed no pathologic sign both in the neck and body. Excisional biopsy was performed and revealed a carcinoma with papillary morphology. Immunohistochemical staining features of the tumor confirmed a papillary carcinoma derived from the thyroid gland. Second look USG of the neck and thyroid was performed but it revealed no tumoral mass. The patient underwent total thyroidectomy with right functional and central lymph node dissection. Histological examination of the thyroid gland showed multicentric 2 mm sized, three foci of papillary carcinoma located in bilateral thyroid lobes and metastatic lymph nodes in the right side of the neck.

Conclusion

A metastatic cervical lymph node can be evidence of a clinically undetected occult papillary thyroid carcinoma. Specific immunohistochemistry staining of specimen may lead to appropriate surgery and progression of carcinoma may be hindered by application of additional RAI therapy.

Effectiveness of preoperative plasmapheresis in a pregnancy complicated by hyperthyroidism and anti-thyroid drug-associated angioedema

Hyperthyroidism is not a rare entity in pregnancy and 85% of these cases attributed to Graves' disease (GD). There is no therapeutic modality for GD considered as totally safe in pregnancy. Fetal and neonatal risks of maternal hyperthyroid disease are related to the hyperthyroidism itself and/or to the medical treatment of the disease. There are no data supporting an association between congenital anomalies in the fetus and propylthiouracil (PTU). Hepatotoxicity, cytopenias--especially agranulocytosis and quite rarely, angioedema, may be seen as side effects of PTU. In this case report, we examine an instance of Graves' hyperthyroidism diagnosed during pregnancy. In this case, a serious side effect during anti-thyroid drug usage was encountered, eventually resulting in surgery in the second trimester. This intervention was assisted by the use of plasmapheresis to obtain rapid normalization of serum thyroid hormone levels.

The presence of donor-specific antibodies in renal transplantation

Determining the presence of anti-HLA antibodies before transplantation is an important factor to prevent loss of function among renal transplantations. In addition, recent studies have shown that not only the pretransplantation existence of anti-HLA antibody but also posttransplantation donor-specific antibodies (DSA) and non-donor-specific antibodies are significantly associated with allograft rejection or loss of graft function. This study presented DSA among patients after renal transplantation together with graft function and survival.

Is flow cytometry crossmatch analysis using sera with different dilutions important for pretransplant analysis? A case report

The most effective form of treatment for chronic renal failure is kidney transplantation from a cadaver or a living donor. For a kidney transplant to be successful, tissue compatibility and a lack of donor-specific anti-human leukocyte antigen (HLA) antibodies in the circulation of the patient are vital, in addition to ABO blood group compatibility. The presence of anti-HLA antibodies is assayed before transplantation using various methods, but because organ rejections have been observed in previous studies, different techniques are required to detect anti-HLA antibodies. Today, flow cytometry crossmatching is one of the most important and effective techniques in testing for donor-specific anti-HLA antibodies (DSAs). If weakly positive serum is assayed after serial dilution, it can yield high positivity. Herein, we describe the differences between the results for diluted and undiluted weakly positive sera studied using the flow cytometry crossmatch (FCXM) technique. In a recent study, the sera of weakly FCXM-positive patients were diluted 1/50, and the FCXM test was repeated. The use of diluted serum eliminated the effect of the prozone so that the DSAs could be detected.

Kaposi's Sarcoma following Chronic Lymphocytic Leukemia: A Rare Entity

Cutaneous manifestations can occur in the wide range of internal malignancy. They can occur by metastases or local spread, direct infiltration, or a site of primary malignancy itself. Sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes. Chronic lymphocytic leukemia (CLL) is the most common leukemia all over the world. Cutaneous lesions occur in up to 25% of patients. Most commonly seen cutaneous lesions in CLL are those of infectious or hemorrhagic origin. Skin cancer risk was also increased eightfold in CLL when compared with normal population, so cutaneous lesions in CLL can be the first manifestation of secondary skin malignancy. Herein, we report an interesting case of Kaposi's sarcoma which was diagnosed during the course of CLL.

Effect of Epidural Levobupivacaine on Recovery from Vecuronium-Induced Neuromuscular Block in Patients Undergoing Lower Abdominal Surgery

The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surgery were randomised into two groups after an epidural test dose: the epidural group (n=45) received a bolus of 15 ml of 0.5% levobupivacaine whereas the control group (n=45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg/kg and monitored with acceleromyographic train-of-four at the adductor pollicis. Patients in each group received neostigmine at 25% recovery of the first twitch of train-of-four during recovery from anaesthesia. The effect of epidural levobupivacaine on the speed of recovery of neuromuscular function was evaluated. The lag time, onset time and time from vecuronium administration until 25% T1 recovery did not differ between the groups. The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P <0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.

Patients with advanced cholangiocarcinoma benefit from chemotherapy if they are fit to receive it: single center experience

PURPOSE

The purpose of this study was to report the clinical course and outcome of patients suffering from advanced cholangiocarcinoma (CCA).

METHODS

The medical records of 93 patients with unresectable or metastatic CCA were retrospectively analyzed.

RESULTS

Out of 93 patients, 53 (64.9%) were initially managed with palliative biliary drainage (PBD). Cisplatinbased regimens were administered to 18 (19.3%) patients, and non-cisplatin regimens (mainly 5-fluorouracil [5-FU]- based) were administered to 23 (24.8%) patients. Of all 93 patients 53 (55.9%) did not receive chemotherapy. The median overall survival (OS) for all patients was 6.1 months and was significantly higher in patients treated with chemotherapy as compared to those without chemotherapy (p=0.002). However, no difference in OS was seen in patients treated with cisplatin- or 5-FU-based chemotherapy. We noticed that a high number of patients were not referred to a medical oncologist even for advice.

CONCLUSION

The relief of bile duct obstruction is an important part of the initial patient management. One of the main observations of this study was that systemic chemotherapy significantly improved survival. Increased awareness of the medical oncologists' role in the management of CCA can increase the number of patients who can have access to chemotherapy.

Nontraumatic giant fat necrosis of the breast presenting as a rapidly growing tumor

Nontraumatic rapid growing giant fat necrosis of the breast mimicking breast tumors is a rare clinical manifestation. The imaging features of the fat necrosis which range from benign to malign findings may be better explained with associated aetiology. The present paper reports a 54-year old woman with a rapid growing, fibrous, and hard giant mass originating in the subareolar region of the left breast. Mammography and magnetic resonance imaging demonstrated a heterogeneous, well circumscribed mass in 12 × 12 cm size in the left breast. The lesion was suspected as a malignant tumor and underwent core biopsy. The histopathology examination of the biopsy revealed mononuclear cells, foamy, vacuolated, and bubbly cells containing fat. Excision biopsy of the mass was performed and the final pathological diagnosis was confirmed as fat necrosis. The wide clinical and radiologic manifestations of fat necrosis are still difficult to diagnose even with the new diagnostic modalities and a great proportion of these lesions need a biopsy to diagnose.

Colon adenocarcinoma and solitary tibia metastasis: rare entity

INTRODUCTION

Colorectal cancer is the third leading cause of cancer-related deaths in the world. Mostly, death occurs with complications of distant metastases.

DISCUSSION

Effective systemic chemotherapy regimen and resultant improved survival for patients are associated with an increased incidence of metastases at uncommon sites. Therefore, incidences of osseous metastases are rising at the last decade. Osseous metastases are mostly diffuse, along with visceral metastases.

CONCLUSION

Most common osseous metastatic sites are lumbal, sacral vertebrae, and pelvis region, probably because of colonic anatomical proximity to the paravertebral venous plexus. Herein, we report an uncommon case of isolated solitary tibia metastasis in the colorectal cancer patient and management of disease course.

Treatability of cefazolin antibiotic formulation effluent with O3 and O3/H2O2 processes

The effect of applying ozonation and perozonation to antibiotic cefazolin-Na formulation effluents were investigated in this study. Twenty minutes of ozonation at a rate of 1,500 mg/L-h was observed to remove COD by 38%, whereas a COD removal efficiency of 40% was achieved via H2O2 enhanced ozonation (same conditions + 31.25 mM H2O2). Both of the pretreatment alternatives were monitored to elevate the BOD5/COD ratio from 0.01 to 0.08. The initially inert COD was reduced by 38% using ozonation and by 60% employing H2O2 enhanced ozonation. In terms of the lowest achievable effluent COD levels after bio-treatment, ozonation was observed to yield a residual COD of 205 mgL(-1), while a residual COD of 135 mgL(-1) was involved for perozonation. According to the results of acute toxicity on Phaedactylum tricornutum, ozonated and perozonated samples exhibited more toxicity than the untreated effluent after 4 days. The activated sludge inhibition test demonstrated that both of the pretreatment alternatives efficiently eliminated the inhibition of investigated formulation effluent.

P53 mutations and other prognostic factors of renal cell carcinoma

OBJECTIVE

Tumor stage, histological pattern, cell type, diameter and cell ploidy are the factor that have been proposed for predicting the prognosis of renal cell carcinoma (RCC). There is a wide variation in the reported incidence of p53 mutation in RCC, and its prognostic significance for this tumor is unknown. We investigated the prognostic value of p53 mutations among other prognostic factors.

PATIENTS AND METHOD

We evaluated the stages, tumor diameters, histological grades, cellular patterns and the presence of mutant p53 protein in 50 cases of RCC. The survival function of each parameter was estimated by Kaplan-Meier and log-rank tests, and the significance of each parameter on survival was evaluated by logistic regression analysis.

RESULTS

The p53 mutation incidence was 20% in the RCC cases included in the study (n = 50). The survival rates of stages pT(2), pT(3) and pT(2-3)N+ were 87.8, 61.0 and 0%, respectively (p = 0.0462). The survival analysis of grade 1-2 and grade 3-4 tumors revealed 92.3 and 51.5% survival rates, respectively (p = 0.002). The survival rates of mutant p53+ and mutant p53- cases were 33.3 and 84.2%, respectively (p = 0.0027). The logistic regression test analysis demonstrated that tumor grade, tumor stage and mutant p53 positivity status were the most significant prognostic factors (p < 0.03). The survival rates of mutant p53+ and p53- cases at stages pT(2), pT(3) and pT(2-3)N+ were 66.67 versus 91.48%, 33.3 versus 71.43% and 0 versus 100%, respectively (p = 0.0392). A similar finding was present at each stage for cellular grades (p = 0.0093). The survival rates of mutant p53+ and p53- cases for grades 3 and 4 were 33.33 and 74.48%, respectively (p = 0.2731).

CONCLUSION

Our results suggested that many parameters can affect survival of RCC cases, but among these, tumor grade, tumor stage and p53 mutation status are the most important prognostic factors, but p53 mutation status and cellular grade can afford additional prognostic information at each stage.