Incorporation of immunotherapies and nanomedicine to better normalize angiogenesis-based cancer treatment

Neoadjuvant targeting of tumor angiogenesis has been developed and approved for the treatment of malignant tumors. However, vascular disruption leads to tumor hypoxia, which exacerbates the treatment process and causes drug resistance. In addition, successful delivery of therapeutic agents and efficacy of radiotherapy require normal vascular networks and sufficient oxygen, which complete tumor vasculopathy hinders their efficacy. In view of this controversy, an optimal dose of FDA-approved anti-angiogenic agents and combination with other therapies, such as immunotherapy and the use of nanocarrier-mediated targeted therapy, could improve therapeutic regimens, reduce the need for administration of high doses of chemotherapeutic agents and subsequently reduce side effects. Here, we review the mechanism of anti-angiogenic agents, highlight the challenges of existing therapies, and present how the combination of immunotherapies and nanomedicine could improve angiogenesis-based tumor treatment.

Dendritic cell-derived exosome (DEX) therapy for digestive system cancers: Recent advances and future prospect

Tumor-mediated immunosuppression is a fundamental obstacle to the development of dendritic cell (DC)-based cancer vaccines, which despite their ability to stimulate host anti-tumor CD8 T cell immunity, have not been able to generate meaningful therapeutic responses. Exosomes are inactive membrane vesicles that are nanoscale in size and are produced by the endocytic pathway. They are essential for intercellular communication. Additionally, DC-derived exosomes (DEXs) contained MHC class I/II (MHCI/II), which is frequently complexed with antigens and co-stimulatory molecules and is therefore able to prime CD4 and CD8 T cells that are specific to particular antigens. Indeed, vaccines with DEXs have been shown to exhibit better anti-tumor efficacy in eradicating tumors compared to DC vaccines in pre-clinical models of digestive system tumors. Also, there is room for improvement in the tumor antigenic peptide (TAA) selection process. DCs release highly targeted exosomes when the right antigenic peptide is chosen, which could aid in the creation of DEX-based antitumor vaccines that elicit more targeted immune responses. Coupled with their resistance to tumor immunosuppression, DEXs-based cancer vaccines have been heralded as the superior alternative cell-free therapeutic vaccines over DC vaccines to treat digestive system tumors. In this review, current studies of DEXs cancer vaccines as well as potential future directions will be deliberated.

A new vision of the efficacy of both CAR-NK and CAR-T cells in treating cancers and autoimmune diseases

Chimeric Antigen Receptor (CAR) based therapies are becoming increasingly important in treating patients. CAR-T cells have been shown to be highly effective in the treatment of hematological malignancies. However, harmful therapeutic barriers have been identified, such as the potential for graft-versus-host disease (GVHD), neurotoxicity, and cytokine release syndrome (CRS). As a result, CAR NK-cell therapy is expected to be a new therapeutic option. NK cells act as cytotoxic lymphocytes, supporting the innate immune response against autoimmune diseases and cancer cells by precisely detecting and eliminating malignant cells. Genetic modification of these cells provides a dual approach to the treatment of AD and cancer. It can be used through both CAR-independent and CAR-dependent mechanisms. The use of CAR-based cell therapies has been successful in treating cancer patients, leading to further investigation of this innovative treatment for alternative diseases, including AD. The complementary roles of CAR T and CAR NK cells have stimulated exploration in this area. Our study examines the latest research on the therapeutic effectiveness of these cells in treating both cancer and ADs.

Mysterious interactions between macrophage-derived exosomes and tumors; what do we know?

Through their ability to modify the tumor microenvironment and cancer cells, macrophages play a crucial role in the promotion of tumorigenesis, development of tumors and metastasis, and chemotherapy resistance. A growing body of research has indicated that exosomes may be essential for coordinating the communication between cancer cells and macrophages. One type of extracellular vehicle called an exosome is utilized for delivering a variety of molecules, such as proteins, lipids, and nucleic acids, to specific cells in order to produce pleiotropic effects. Exosomes derived from macrophages exhibit heterogeneity across various cancer types and function paradoxically, suppressing tumor growth while stimulating it, primarily through post-transcriptional control and protein phosphorylation regulation in the receiving cells. Exosomes released by various macrophage phenotypes offer a variety of therapeutic alternatives in the interim. We outlined the most recent developments in this article, including our understanding of the roles that mechanisms and macrophage-derived exosomal biogenesis play in mediating the progression of cancer and their possible therapeutic uses.

Papillary carcinoma thyroid - A 11 year epidemiological study with histopathological correlation in a tertiary care centre in South Malabar Region in Kerala, India

Background: Thyroid cancer is the commonest endocrine malignancy. Based on recent data, thyroid cancer is the fifth most common cancer in women. To our knowledge the  present study  is the first of its kind, correlating epidemiological and histomorphological data so as to assess the  major cause hypothesis for thyroid cancers, focusing more on  papillary  carcinoma and its variants, comparing it with each other and with other  thyroid carcinomas and also correlating with gender, life style and religion.Materials and methods: This study was conducted in the Department of Pathology, MES Medical College, Perinthalmanna, Kerala, India, from January 2004 to June 2015.Two thousand and fifty thyroidectomy cases were studied.Results: Out of the total 2050  cases, thyroid cancers constituted  295 (14.39%);  of which 10.1% (208 cases) were Papillary carcinoma thyroid (PCT) and its variants; 165 cases were seen in females (79.33%) and  the incidence in males were only 20.68% (43 cases).The commonest variant encountered was classical papillary carcinoma (113 cases, 54.32%).Conclusion: Our study of papillary thyroid carcino

Low grade endometrial stromal sarcoma – A series of 4 cases and review of relevant literature

Endometrial stromal tumors are rare uterine malignancies composed of cells resembling those of proliferative endometrial stroma. Because of their indistinct clinical and radiological features, these malignancies are very rarely diagnosed preoperatively. They are mostly often diagnosed as fibroid uteruspreoperatively and as a result managed conservatively many a time. Usually distinguishing these tumors from benign smooth muscle tumors of the uterus are not problematic by light microscopy, however, difficulties arise in distinction between highly cellular leiomyomas and endometrial stromal sarcomas with smooth muscle differentiation. Here we present four consecutive cases of low grade endometrial stromal sarcomaswith emphasis on their clinical, histopathological and immunohistochemical features. By this study, we have attempted to document the histologic features of LGESS with discussion of the differential diagnoses to contribute to this rare spectrum of uterine neoplasms.Journal of Pathology of Nepal (2015) Vol. 5, 774-777

Brucellosis among animals and human contacts in eastern Sudan

OBJECTIVE

To study the relative frequency of brucellosis among domestic animals in Kassala State, Sudan, in the year 1999 and compare the results of previous studies since 1908. Also to study the frequency rates of the disease in animal contacts in the area.

METHODS

Sero-survey for Brucella melitensis and Brucella abortus was carried out on sera of animals brought for slaughter to Kassala abattoir and on sera of occupational contacts of animals. All sera were tested by the slide agglutination test. The positive reactors were confirmed by tube agglutination test.

RESULTS

A total of 1225 sera were tested - 1038 were animal sera and 187 were human sera. Four percent of goats sera, 1% of sheep sera and 5% of cattle sera were found to be positive. Of the 64 camel sera tested, none were positive reactors. Of the occupational contacts, which included butchers, slaughterhouse workers, milkers and cow attendants, (1%) reacted positively.

CONCLUSION

The study showed low frequency rates of brucellosis among animals in the Kassala area compared with other parts of Sudan. Occupational contacts showed very low frequency rates of the disease. This is often over-looked by medical practitioners due to the overwhelming problem of malaria in the area. We draw the attention of practitioners to think of brucellosis in the differential diagnosis of fever especially in rural communities.

Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers

OBJECTIVE

To estimate quantitatively consumers' satisfaction and correlates of satisfaction with physicians' services provided by Ministry of Health Primary Health Care Centers in attending consumers.

METHODS

Consumers (n = 540) attending the selected Primary Health Care Centers in Riyadh were asked about their satisfaction with physician's services. Eight Primary Health Care Centers were randomly selected according to the geographical location, two from each geographical zone. Seventy-five subjects were selected systematically where every tenth Saudi aged 15 years and above who visited the selected Primary Health Care Centers during the study period was chosen. Data was collected via a self administered pilot tested, internally consistent patient satisfaction questionnaire which included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of physicians' services in the selected Primary Health Care Centers rated in a scale of 1 5 points, the higher the score the higher the satisfaction.

RESULTS

The results revealed that males constituted 60%, and 58% of all patients were married, more than 60% were employees and more than 70% have a monthly income of less than 6000 Saudi Riyals. Almost 95% have an open file in the Primary Health Care Center and 39% think that the distance to the Primary Health Care Center is far or very far. The summary satisfaction score was 3.77 points and the mean satisfaction with the services provided by physicians was 2.56 points out of a maximum of 5 points The highest satisfaction was for discussing psychological aspects of patients' problems (2.96 points) and the lowest was for attentive listening to patients' complaints (2.22 points). Physicians' communication skills were more satisfactory to patients than their professional skills and satisfying patients' wishes scored the lowest satisfaction- Unskilled laborers, literate patients and patients with higher income showed significantly higher mean satisfaction while students, illiterates, those aged less than 50 years and patients with income less than 6000 Riyals per months scored the lowest satisfaction. The longer the distance travelled the lower the satisfaction scores but having a file or not was not related to satisfaction.

CONCLUSION

Some physicians' service items need corrective intervention and students and young patients appear to need more attention.

[Neutralization of lidocaine-adrenaline. A simple method for less painful application of local anesthesia]

The amount of sodium bicarbonate necessary to neutralise commercially available lignocaine-epinephrine (pH 4.7) to physiologically neutral pH (7.4) was established. The analysis showed that neutral pH could be accomplished by adding 1.0 ml sodium bicarbonate (8.4 g/l) to 10 ml lignocaine-epinephrine (1%, 5 microgram/ml). Chemical analysis also established that the neutralised lignocaine-epinephrine was stable for 24 hours after adding sodium bicarbonate. A double-blinded randomised clinical trial with crossover design done on volunteers from hospital staff proved that injection of neutralised lignocaine-epinephrine is less painful than commercially available lignocaine-epinephrine (p < 0.001).