Corrigendum: The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases

[This corrects the article DOI: 10.3389/fimmu.2023.1191782.].

The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases

Interleukin-17 family (IL-17s) comprises six structurally related members (IL-17A to IL-17F); sequence homology is highest between IL-17A and IL-17F, displaying certain overlapping functions. In general, IL-17A and IL-17F play important roles in chronic inflammation and autoimmunity, controlling bacterial and fungal infections, and signaling mainly through activation of the nuclear factor-kappa B (NF-κB) pathway. The role of IL-17A and IL-17F has been established in chronic immune-mediated inflammatory diseases (IMIDs), such as psoriasis (PsO), psoriatic arthritis (PsA), axial spondylarthritis (axSpA), hidradenitis suppurativa (HS), inflammatory bowel disease (IBD), multiple sclerosis (MS), and asthma. CD4+ helper T cells (Th17) activated by IL-23 are well-studied sources of IL-17A and IL-17F. However, other cellular subtypes can also produce IL-17A and IL-17F, including gamma delta (γδ) T cells, alpha beta (αβ) T cells, type 3 innate lymphoid cells (ILC3), natural killer T cells (NKT), or mucosal associated invariant T cells (MAIT). Interestingly, the production of IL-17A and IL-17F by innate and innate-like lymphocytes can take place in an IL-23 independent manner in addition to IL-23 classical pathway. This would explain the limitations of the inhibition of IL-23 in the treatment of patients with certain rheumatic immune-mediated conditions such as axSpA. Despite their coincident functions, IL-17A and IL-17F contribute independently to chronic tissue inflammation having somehow non-redundant roles. Although IL-17A has been more widely studied, both IL-17A and IL-17F are overexpressed in PsO, PsA, axSpA and HS. Therefore, dual inhibition of IL-17A and IL-17F could provide better outcomes than IL-23 or IL-17A blockade.

Definition of Remission and Disease Activity Assessment in Psoriatic Arthritis: Evidence and Expert-Based Recommendations

OBJECTIVE

We aimed to reach a consensus on the best instruments to monitor disease activity in patients with psoriatic arthritis (PsA) and to develop a consensus definition of remission.

METHODS

A modified Delphi approach was used. A scientific committee provided statements addressing the definition of remission and the monitoring of PsA in clinical practice. The questionnaire was evaluated in 2 rounds by rheumatologists with experience in managing PsA patients.

RESULTS

A panel of 77 rheumatologists reached agreement on 62 out of the 86 proposed items (72.0%). The most recommended index for monitoring disease activity was DAPSA (cut-off values: ≤4 for remission and >4-14 for low disease activity ([LDA]), MDA (at least 5/7 criteria). In cases with axial involvement, ASDAS was the preferred index (cut-off values: <1.3 for remission and <2.1 for LDA). BASDAI (cut-off values: ≤2 for remission and ≤4 for LDA) may be used as an alternative. PsAID was the preferred tool to assess disease impact.

CONCLUSION

We propose a definition of remission in PsA as the absence of disease activity evaluated by DAPSA or MDA (ASDAS and/or BASDAI in patients with axial involvement), which would imply absence of signs or symptoms of inflammation, physical well-being, lack of disease impact, and absence of inflammation as measured by biological markers.

Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

Introduction  Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway.

Objective  To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty.

Methods  We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results.

Results  The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively ( p  = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p  = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p  = 0.007).

Conclusions  Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

Abstract P4-01-09: Combined analysis of tissue and blood biopsies by NGS in patients with advanced breast cancer identifies targetable molecular alterations

Background: Targeted-next generation sequencing (t-NGS) analysis in tissue and peripheral blood is increasingly performed in patients with advanced cancer. Liquid biopsy is a non-invasive method that allows to understand the molecular changes occurring in the tumor in real-time, derived from intratumor heterogeneity and/or therapeutic pressure. In the present work we sought to elucidate the ability of liquid biopsy to detect mutations related with acquired resistance.

Methods: 190 formalin-fixed paraffin-embedded (FFPE) samples from primary and metastatic tumors of patients with advanced breast cancer (ABC) were analyzed by OncoDEEP® (1000X depth of coverage of 75 gene alterations including point mutations, insertions/deletions, gene fusions and copy number variations), and comparison between targeted-NGS results from matched primary/metastatic tumors (FFPE) and cell-free DNA (cfDNA) recovery from plasma analyzed by OncoSTRAT&GO® in 34 patients with ABC (193 genes with 1000x and 40 genes with 10000x depth coverage for FFPE and plasma, respectively).

Results: Of the 190 FFPEs analyzed by OncoDEEP®, 41% were triple negative breast cancer (TNBC), 49% hormone receptor positive (HR+) and 11% were HER2+. Mutations in TP53 (44.2%), PIK3CA (41.1%) and ERBB2 (9.47%) were the most frequent. As expected, PIK3CA and TP53 mutations were significantly higher in HR+ and TNBC tumors, respectively (PIK3CA: 53.8% for HR+ vs 28.6% and 30% for TNBC and HER2+, respectively; TP53 68.8% for TNBC vs 26.9 and 30% in HR+ and HER2+, respectively; in both cases p&lt;0.001). Interestingly, the alteration c.1459-7C&gt;T in JAK1 (unknown significance) was detected in 8% of patients (9.7% and 6.5% in HR+ and TNBC, respectively). Also, in contrast to other reports, high frequencies of APC alterations were found exclusively in HR+ tumors (previously reported as germline mutations). From the OncoSTRAT&GO® analysis (tumor tissue and cfDNA), ESR1 and FGFR mutations in HR+ ABC were significantly more present in cfDNA (9/20 mutations found [45%]] compared to tumor tissue analysis (18/93 mutations found [19.3%]) (p=0.02), and in three patients, mutations in ESR1 and FGRF were only detected in cfDNA. Finally, 11/34 cases (32.3%) showed gene mutations only in cfDNA with predominant alterations in MAPK signaling pathway (54.5%), TP53 (36.4%) and ESR1 (18.2%), the latest as previously described.

Conclusions: JAK1 and APC mutations need further evaluation to establish their clinical significance in ABC. The combination of tumor tissue and cfDNA t-NGS analyses into clinical routine enables detailed and comprehensive evaluation of tumor heterogeneity under therapeutic pressure; in our cohort, known mutations for acquired resistance to endocrine therapy (ESR1 and FGFR2) were better detected by cfDNA compared to tumor tissue (45% vs 19.3%) in HR+ ABC patients, increasing the probability to identify early drug resistance to prioritize patients' selection into clinical trials with targeted agents.

Citation Format: Salvador JF, Pinto JA, Araujo JM, Tirado-Hurtado I, Flores CJ, Chirinos LA, Requena MC, Carpio S, Finzel Pérez A, Aguilar A, Demol F, Schwarz LJ. Combined analysis of tissue and blood biopsies by NGS in patients with advanced breast cancer identifies targetable molecular alterations [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-09.

Genetic variation at the glycosaminoglycan metabolism pathway contributes to the risk of psoriatic arthritis but not psoriasis

OBJECTIVE

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis affecting up to 30% of patients with psoriasis (Ps). To date, most of the known risk loci for PsA are shared with Ps, and identifying disease-specific variation has proven very challenging. The objective of the present study was to identify genetic variation specific for PsA.

METHODS

We performed a genome-wide association study in a cohort of 835 patients with PsA and 1558 controls from Spain. Genetic association was tested at the single marker level and at the pathway level. Meta-analysis was performed with a case-control cohort of 2847 individuals from North America. To confirm the specificity of the genetic associations with PsA, we tested the associated variation using a purely cutaneous psoriasis cohort (PsC, n=614) and a rheumatoid arthritis cohort (RA, n=1191). Using network and drug-repurposing analyses, we further investigated the potential of the PsA-specific associations to guide the development of new drugs in PsA.

RESULTS

We identified a new PsA risk single-nucleotide polymorphism at B3GNT2 locus (p=1.10e-08). At the pathway level, we found 14 genetic pathways significantly associated with PsA (p_FDR<0.05). From these, the glycosaminoglycan (GAG) metabolism pathway was confirmed to be disease-specific after comparing the PsA cohort with the cohorts of patients with PsC and RA. Finally, we identified candidate drug targets in the GAG metabolism pathway as well as new PsA indications for approved drugs.

CONCLUSION

These findings provide insights into the biological mechanisms that are specific for PsA and could contribute to develop more effective therapies.

Primary and metastatic brain cancer genomics and emerging biomarkers for immunomodulatory cancer treatment

Recent studies with immunomodulatory agents targeting both cytotoxic T-lymphocyte protein 4 (CTLA4) and programmed cell death 1 (PD1)/programmed cell death ligand 1 (PDL1) have shown to be very effective in several cancers revealing an unexpected great activity in patients with both primary and metastatic brain tumors. Combining anti-CTLA4 and anti-PD1 agents as upfront systemic therapy has revealed to further increase the clinical benefit observed with single agent, even at cost of higher toxicity. Since the brain is an immunological specialized area it's crucial to establish the specific composition of the brain tumors' microenvironment in order to predict the potential activity of immunomodulatory agents. This review briefly summarizes the basis of the brain immunogenicity, providing the most updated clinical evidences in terms of immune-checkpoint inhibitors efficacy and toxicity in both primary and metastatic brain tumors with the final aim of defining potential biomarkers for immunomodulatory cancer treatment.

Abstract P5-09-08: Molecular evaluation of Peruvian patients with hereditary breast cancer reveals a novel germline mutation in BRCA1

Background

Breast cancer is the leading cancer in women worldwide, while in Peru is the second most frequent cancer with a high incidence of triple negative breast cancers (21%). There is no previous information about BRCA1/BRCA2 mutations in Peruvian high-risk breast cancer patients. Prior studies from International diagnostic laboratories only presented results of our population as a pooled Hispanic data. Our aim was to characterize mutations in BRCA1/BRCA2 genes in Peruvian patients with breast cancer with hereditary patterns.

Methods

We evaluated mutations in BRCA1/BRCA2 genes by Sanger sequencing and large genomic rearrangements by multiplex ligation-dependent probe amplification (MLPA) in 18 families with hereditary breast cancer criteria identified at the Breast Unit of Oncosalud-AUNA (Lima-Peru). Molecular analysis was done in the facilities of Genetics and Molecular Biology Center at the San Martin de Porres University (Lima-Peru).

Results

Sequencing identified 4 pathogenic mutations in 4/18 families, three previously detected (BRCA1: c.302-1G&gt;C y c.815_824dup10; BRCA2: c.5946delT) and a novel germline mutation in exon 15 of BRCA1 (c.4647_4648dupAA, ClinVar SCV000256598.1) producing a frameshift variant. MLPA revealed 2 amplifications in exon 7 (duplication and triplication) in BRCA1 in unrelated patients with potential pathogenic effects, one of this co-existed with the BRCA2: c.5946delT mutation. In addition, three variants of uncertain significance were found (c.140G&gt;T, in exon 5 of BRCA1 and c.464G&gt;A and c.938C&gt;T in exon 5 and 10 of BRCA2, respectively).

Conclusions

After a comprehensive evaluation we found an alteration rate of 27.8% (5/18) in BRCA1/BRCA2 in families with criteria for hereditary breast cancer. We reported BRCA1 c.4647_4648dupAA as a novel mutation. Further studies including a larger sample size of Peruvian patients should evaluate the prevalence or founder effect of this mutation in our population.

Citation Format: Ponce J, Vigil C, Araujo JM, Castañeda C, Calderon G, Buleje JL, Acosta O, Danos P, Huaman F, Guevara-Fujita ML, Aguilar A, Pinto JA, Gomez HL, Fujita R. Molecular evaluation of Peruvian patients with hereditary breast cancer reveals a novel germline mutation in BRCA1 [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 P5-09-08.

Further description of early clinically silent lupus nephritis

Thirty silent lupus nephritis (SLN) patients were compared to 16 individuals bearing overt lupus nephritis (OLN). Results included: years of systemic lupus erythematosus (SLE) diagnosis were significantly earlier (4.6 ± 2.8 years) in SLN than in OLN (7.18 ± 3.61) ( P < 0.05). Neurological compromise, hypertension, normocitic anemia and lymphopenia were significantly prevalent in OLN than in SLN ( P < 0.05). Beside normal urinary sediment and renal function tests, the SLN group showed a moderate increase of both activity (AI) and chronicity (CI) renal pathology index when compared to highly increased AI and CI in OLN ( P < 0.05). Seventy percent of SLN patients were ISN/RPS Classes I (6.6%) and II (63.3%) while 81% of OLN cases were Classes III, IV (37.5%) and V. IgG, IgA, IgM, λchain, C3 and fibrinogen immune deposits were found in 90% or over in both SLN and OLN individuals while in 60% or over, both groups also showed K chain, C1q and C4 deposits. While prevalence of ANA, anti-dsDNA and anti-C1q antibodies were similar in both groups, anti-histone, anti-RNP, CIC and CH50 serum levels were significantly different in OLN versus SLN ( P < 0.05). We strongly suggest that indeed SLN is the earliest stage in the natural history of lupus nephritis.

Livedoid vasculopathy - a challenging disease

We present a rare association of idiopathic livedoid vasculopathy (LV) with peripheral sensory neuropathy successfully treated with intravenous immunoglobulin and warfarin and, after its failure, with rituximab. Although LV aetiology remains incompletely understood, the excellent clinical response observed in our patient suggests that B cells may be key players in its pathogenesis.

Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study

Introduction Obstructive sleep apnea (OSA) is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history.

Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA) and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA.

Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013.

Results We evaluated 100 patients with OSA (84 men and 16 women) with a mean age of 50.05 years (range 19–75 years). The prevalence of comorbidities were hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (GERD) (18%), diabetes mellitus (15%), hypercholesterolemia (10%), asthma (4%), and no comorbidities (33%). Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA.

Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI) values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations.

Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology

Introduction

 The Gastroesophageal Reflux Disease has a prevalence of ∼12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI).

Objective

 The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology.

Methods

 Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR. We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores.

Results

 The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64).

Conclusion

 The RSI and RFS can easily be included in ENT routines as objective parameters, with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests.

Accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea

Introduction

The use of handheld devices that assess peripheral arterial tonometry has emerged as an auxiliary method for assessment and diagnosis of obstructive sleep apnea syndrome.

Objective

To evaluate the accuracy of peripheral arterial tonometry in the diagnosis of obstructive sleep apnea.

Methods

Contemporary cohort cross-sectional study. Thirty patients with suspected obstructive sleep apnea underwent peripheral arterial tonometry and assisted nocturnal polysomnography concomitantly.

Results

The mean apnea/hypopnea index by peripheral arterial tonometry was significantly higher than that by polysomnography (p < 0.001), but the values of both sleep studies were significantly correlated (r = 0.762). There was a high correlation between variables: minimum oxygen saturation (r = 0.842, p < 0.001), oxygen saturation < 90% (r = 0.799, p < 0.001), and mean heart rate (r = 0.951, p < 0.001). Sensitivity and specificity were 60% and 96.2% (AUC: 0.727; p = 0.113), respectively, when at a threshold value of 5 events/h. In severe cases (≥30 events/h), the result was a sensitivity of 77.8% and a specificity of 86.4% (AUC: 0.846, p = 0.003).

Conclusion

Peripheral arterial tonometry is a useful portable device for the diagnosis of obstructive sleep apnea; its accuracy is higher in moderate and severe cases.

A deletion at ADAMTS9-MAGI1 locus is associated with psoriatic arthritis risk

OBJECTIVE

Copy number variants (CNVs) have been associated with the risk to develop multiple autoimmune diseases. Our objective was to identify CNVs associated with the risk to develop psoriatic arthritis (PsA) using a genome-wide analysis approach.

METHODS

A total of 835 patients with PsA and 1498 healthy controls were genotyped for CNVs using the Illumina HumanHap610 BeadChip genotyping platform. Genomic CNVs were characterised using CNstream analysis software and analysed for association using the χ(2) test. The most significant genomic CNV associations with PsA risk were independently tested in a validation sample of 1133 patients with PsA and 1831 healthy controls. In order to test for the specificity of the variants with PsA aetiology, we also analysed the association to a cohort of 822 patients with purely cutaneous psoriasis (PsC).

RESULTS

A total of 165 common CNVs were identified in the genome-wide analysis. We found a highly significant association of an intergenic deletion between ADAMTS9 and MAGI1 genes on chromosome 3p14.1 (p=0.00014). Using the independent patient and control cohort, we validated the association between ADAMTS9-MAGI1 deletion and PsA risk (p=0.032). Using next-generation sequencing, we characterised the 26 kb associated deletion. Finally, analysing the PsC cohort we found a lower frequency of the deletion compared with the PsA cohort (p=0.0088) and a similar frequency to that of healthy controls (p>0.3).

CONCLUSIONS

The present genome-wide scan for CNVs associated with PsA risk has identified a new deletion associated with disease risk and which is also differential from PsC risk.

Surgical treatment of severe laryngomalacia: a retrospective study of 11 case

Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia.

Objective

To describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia. Methodology: A retrospective study.

Method

The medical records of 11 consecutive cases of severe laryngomalacia who underwent surgical treatment between 2003 and 2012 were analyzed for age, gender, symptoms, associated diseases, surgical technique employed, extubation time, surgical complications, length of hospital stay and clinical outcome.

Results

Of the 11 cases of severe laryngomalacia, six patients (54.5%) were operated with the use of CO₂ laser and five patients (45.5%) were submitted to the cold technique. Only 1 patient (9.1%) required surgical reintervention. There were no cases of surgical complications. All patients had clinical improvement.

Conclusion

Supraglottoplasty proved to be effective and safe in the treatment of severe laryngomalacia.

Severe combined immunodeficiency in Brazil: management, prognosis, and BCG-associated complications

BACKGROUND

Severe combined immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency. The objectives of this study were to analyze the diagnosis, treatment, and prognosis of SCID in Brazil and to document the impact of BCG vaccine.

METHODS

We actively searched for cases by contacting all Brazilian referral centers.

RESULTS

We contacted 23 centers and 70 patients from 65 families. Patients were born between 1996 and 2011, and 49 (70%) were male. More than half (39) of the diagnoses were made after 2006. Mean age at diagnosis declined from 9.7 to 6.1 months (P = .058) before and after 2000, respectively, and mean delay in diagnosis decreased from 7.9 to 4.2 months (P = .009). Most patients (60/70) were vaccinated with BCG before the diagnosis, 39 of 60 (65%) had complications related to BCG vaccine, and the complication was disseminated in 29 of 39 (74.3%). Less than half of the patients (30, 42.9%) underwent hematopoietic stem cell transplantation (HSCT). Half of the patients died (35, 50%), and 23 of these patients had not undergone HSCT. Disseminated BCG was the cause of death, either alone or in association with other causes, in 9 of 31 cases (29%, no data for 4 cases).

CONCLUSIONS

In Brazil, diagnosis of SCID has improved over the last decade, both in terms of the number of cases and age at diagnosis, although a much higher number of cases had been expected. Mortality is higher than in developed countries. Complications of BCG vaccine are an important warning sign for the presence of SCID and account for significant morbidity during disease progression.

Abstract P6-06-41: Non-palpable tumor is a surrogate factor for longer disease free survival in early breast cancer: Evaluation of a 23 years-Venezuelan cohort

INTRODUCTION:

Tumor size has long been recognized as the strongest predictor of the outcome of patients with breast cancer. While screening programs are increasing the proportion of non-palpable breast cancer cases, it is important to know its relevance in the outcome. Our purpose was to evaluate various prognostic factors, including tumor palpability, in a multivariate fashion.

METHODS:

A Kaplan-Meier survival analysis was carried out for a retrospective cohort of 758 women with early stages of invasive breast carcinomas who were treated at the Breast Unit of the CECLINES (Caracas-Venezuela), Clinica el Viñedo y Centro Medico Dr. Rafael Guerra Mendez and University of Carabobo (Valencia-Venezuela), between 1987-2010. Endpoints were 10 years disease free survival (10 yrs-DFS) and 10 years overall survival (10 yrs-OS). Using a multivariate analysis, Hazard ratios (HR) were calculated in order to identify independent prognostic factors for 10 yrs-DFS and 10 yrs-OS.

RESULTS:

The median age for the entire cohort was 55yo; 293 (38.7%) tumors were not palpable and 465 (61.3%) were palpable; 42.2% (318 cases) were in pathological stage (PS) I and 57.8% (436 cases) in PS II. Tumor size was &lt;1cm in 26% of cases; was between 1 - 3cm in 24.9% and &gt;3cm in 49.1%; 23.2% had nodal involvement. In regard to immunohistochemistry markers, 633 were evaluable for estrogen receptor (ER); 599 for progesterone receptor (PR) and 578 for HER2. In regard to the status for these markers, 76.9% were ER+; 68.4% PR+ and 28.4% HER2+. Patients more likely to have non palpable tumors were ≥45yo (p = 0.001); smaller tumors (p&lt;0.001); negative lymph nodes (p = 0.008); HER2 negative tumors (p = 0.001) and pathological stage I (p&lt;0.001). The median of follow up was 42.6 months. The 10yrs-DFS was 78.7% and the 10yrs-OS was 91%. There were significant differences in 10yrs-DFS according to tumor palpability (non-palpable 81.1% vs palpable 73.3%, p = 0.002); tumor size (&lt;1cm 81.7% vs 1-3cm 78.3% vs &gt;3cm 77.3%, p = 0.017); nodal involvement (negative 81.9% vs positive 67.2%, p = 0.054); PS (I-IIA: 89.4% vs IIB, 74.9%, p&lt;0.001); treatment with radiotherapy (yes 79% vs no 65.9%) and hormonotherapy (yes 78.9% vs no 70.1%). For 10yrs-OS, there were significant differences in palpability (palpable 78.2% vs non palpable 86.9%, p&lt;0.001); tumor size (&lt;1cm 96% vs 1-3cm 87.6% vs &gt;3cm 75.3%, p = 0.027); HER2 (positive 95.9% vs negative 87.4%, p = 0.052); PS (I-IIA: 95.4% vs IIB, 86.5%, p&lt;0.016) and radiotherapy (yes 92.7% vs no 79.1%, p = 0.001). In the multivariate analysis for 10 yrs-DFS, significant variables were: palpability (HR = 0.43 for non-palpable tumors, CI 95%: 0.242-0.781; p = 0.005) and radiotherapy (HR = 2.5 for patients that did not undergo radiotherapy, CI 95% 1.44 - 4.23). For 10 yrs-OS significant variables were HER2 (HR = 3.6 for HER2+, CI 95%: 1.18 - 10.86, p = 0.024). There was a statistical trend with palpability (HR = 0.23 for non-palpable tumors, CI 95%: 0.05-1.06; p = 0.06).

CONCLUSIONS

Women with early stage breast cancers with non-palpable tumors were less likely to present disease recurrence, independently of other factors. In the era of genomic profiling, a variable easily assessed in routine could be a surrogate factor for disease free survival.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-41.

Abstract P6-07-21: Signs and symptoms at central nervous system (CNS) relapse in breast cancer patients with Leptomeningeal carcinomatosis related with shorter survival after recurrence

Background: There are signs and symptoms detected at CNS relapse in breast cancer patients that could be identified as a poor prognosis feature of the disease.

Objectives: To describe the commonest signs and symptoms at CNS relapse and its relation with post SNC - recurrence survival in patients with leptomeningeal carcinomatosis (LMC).

Methods: We evaluated a retrospective cohort of 2597 women with breast cancer treated at the Instituto Nacional de Enfermedades Neoplásicas (Lima-Perú) in the period 2000–2005. Clinical data was retrieved from medical records. Breast cancer phenotypes were determined by IHC expression of hormonal receptors (HR) and HER2 and categorized in [HR+, HER2−], triple-negative (TN) [HR−, HER2−] and Her-2 [HR+/−, HER2 +]. The main endpoint was Post-CNS recurrence survival.

Results: A total of 157 cases had CNS relapse from which 124 had only brain metastases, 19 only leptomeningeal carcinomatosis (LMC), and 14 both. Forty three cases were [HR+, HER2−] (5 LMC), 68 were TN (13 LMC) and 51 were [HR+/−, HER2 +] (15 LMC). 152 cases were in clinical stages I-III at diagnosis (96.8% of all SNC relapses). There was no association between IHC phenotypes and age at CNS relapse, ECOG Performance Status (p = 0.837), extracraneal metastases (p = 0.304), control of primary tumor (p = 0.164), number or volume of brain metastases (p = 0.706). Significant association was found between phenotype and time from diagnosis to development of CNS metastases (≤8 months: 16.3% in TN, 7.3% in Her-2 and 0% for [HR+, HER2−]; p = 0.017) and histological grade (grade III: 74.4% in TN, 55.% in Her-2 and 30% for [HR+, HER2−]; p = 0.006). Symptoms/signs commonest in LMC patients were cephalea (7 cases, 72%), meningism (6, 24%), nausea (6, 24%), vomiting (5, 20%), ataxia (5, 20%), facial palsy (4, 16%), somnolence (4, 16%), paraparesia (3, 12%), hiporeflexia (3, 12%), apraxia (3, 12%), arreflexia (3, 12%), poor sphincter control (3, 12%), hemiparesia (2, 8%), seizures (2, 8%), bradypsichia (2, 8%), neuropathic pain (1, 4%). Meningism was most frequent in TN cases (50%). Post recurrence survival was shorter in LMC TN patients (3.61mo vs 4.89mo to [HR+, HER2−] vs 5.95mo to [HR+/−, HER2 +; p = 0.044] and in LMC patients with meningism (1.38mo vs 5.26mo; p = 0.02). Multivariate analysis identify meningism as the worse risk factor for survival in patients relapsed with LMC (HR: 4.33 compared with patients without LMC; p = 0.066).

Conclusions: In LMC patients, meningism was identified as a sign related to shorter survival after the SNC relapse.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-21.

Abstract P6-07-20: Variables measured at Central Nervous System (CNS) relapse, but not Immunophenotype, identify groups of breast cancer patients with shorter post CNS-relapse survival

Objective: We evaluated breast cancer immunophenotype and variables measured at CNS-relapse as prognostic factors in a cohort of Hispanic patients.

Methods: We reviewed data from 2602 breast cancer women in stages I-III diagnosed between 2000 and 2005 at the Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú. According to immunophenotype, tumors were categorized in luminal A (RE+ and/or RP+, HER2−), luminal B (RE+ and/or RP+, HER2+), HER2 (RE−, RP−, HER2+) and triple negative (RE−, RP−, HER2−). Clinicopathological data at diagnosis and at CNS relapse were evaluated and used to calculate prognostic scores according to Recursive Partitioning Analysis (RPA) score, Graded Prognostic Assessment (GPA) Score, and Basic Score for Brain Metastases. Endpoints were time to CNS metastasis and Post CNS-relapse survival.

Results: With a median follow-up of 7.5 years, 818 (31.4%) patients had locoregional or distant recurrence. In total, 159 (6.1%) patients developed CNS metastases, of whom 92 (3.5%) as the first site of recurrence and 22 meningeal metastases were detected. In triple negative, 51 (32.1%) developed SNC metastases, 46 (28.9%) in luminal A, 37 (23.3%) in HER2 and 25 (15.7%) in luminal B patients. Median time since breast cancer diagnosis to SNC metastases was 28.1 months (mo) and the variables influencing it were Clinical T (P &lt; 0.001), clinical stage (P &lt; 0.001), histologic grade (p = 0.005), estrogen and progesterone receptors ((p = 0.026 for both) and inmmunophenotype (P &lt; 0.005). None of these factors was associated with post SNC-recurrence survival. In regard to variables measured at SNC relapse, we couldn't find differences in age groups (&lt;65 vs ≥65 years old; p = 0.662), extracraneal metastases (present, 4.2mo vs absent, 5.3mo), number of brain metastases (&lt;1 vs ≥ 2; p = 0.550) or volume of CNS metastases (&lt;3cm; 7.7mo vs ≥3cm, 5.2mo; p = 0.298). Statistical differences were observed when patients were stratified by control of primary tumor (controlled, 6.3mo; vs uncontrolled, 3.6 mo; P &lt; 0.001), leptomeningeal involvement (present, 3.0mo vs absent, 5.2mo; p = 0.25) and karnofski performance status (≥ 7, 6.5mo vs &lt;7, 3.5mo; p = 0.002). In the multivariate analysis, significant variables related with a shorter post-SNC recurrence survival were a Karnofski performance status &lt;7 (HR 1.46; p = 0.048); uncontrolled primary tumor (HR 1.92; p = 0.001); and leptomeningeal involvement (HR 1.94; p = 0.025). When survival was evaluated stratifying patients according to prognostic scores, we found differences when cases were grouped according to RPA score (Class I, 6.8 mo vs Class II, 5.5 mo vs Class III, 3.5 mo; p = 0.014). GPA scores could not identify groups with significant difference (p = 0.070). The basic score for BM detected groups with significant differences (scores 0–1, 3.7 mo vs score 2, 6.9 mo vs score 3, 6.8 mo).

Conclusions: Prognostic scores calculated from variables measured at CNS relapse are useful to identify groups with shorter post CNS recurrence survival while immunophenotype of breast cancer was unable to identify groups of different prognosis.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-20.

Abstract S3-6: Profiling of triple-negative breast cancers after neoadjuvant chemotherapy identifies targetable molecular alterations in the treatment-refractory residual disease

Background: Neoadjuvant chemotherapy (NAC) is increasingly used in patients with triple-negative breast cancer (TNBC). NAC can induce a pathologic complete response (pCR) in ∼30% of patients which portends a favorable prognosis. In contrast, patients with residual disease (RD) in the breast at surgical resection exhibit worse outcomes.

Objective: We hypothesized that profiling residual TNBCs after NAC would identify molecularly targetable lesions in the chemotherapy-resistant component of the tumor and that the persistent tumor cells would mirror micro-metastases which ultimately recur in such patients.

Methods: We utilized targeted next generation sequencing (NGS) for 182 oncogenes and tumor suppressors in a CLIA certified lab (Foundation Medicine, Cambridge, MA) and gene expression profiling (NanoString) of the RD after NAC in 102 patients with TNBC. The RD was stained for Ki67, which has been reported to predict outcome after NAC in unselected breast cancers.

Results: Thirteen tumors were not evaluable due to low tumor cellularity. Of 89 evaluable post-NAC tumors, 57 (64%) were basal-like; 19% HER2-enriched; 6% luminal A; 6% luminal B and 5% normal-like. Mean depth of coverage was 635 (range: 135–1207). Of 81 tumors evaluated by NGS, 72/81 (89%) demonstrated mutations in TP53, 22 were MCL1-amplified (27%), and 17 were MYC-amplified (21%). Alterations in the PI3K/mTOR pathway (AKT1-3, PIK3CA, PIK3R1, RAPTOR, PTEN, and TSC1) were identified in 27 tumors (33%). Cell cycle genes were altered in 25 tumors (31%), including amplifications of CDK2, CDK4, and CDK6, CCND1-3, and CCNE1 as well as RB loss. Alterations in the DNA repair pathway (BRCA1/2, ATM; 16 tumors; 20%) and the Ras/MAPK pathway (KRAS, RAF1, NF1; 10 tumors; 12%) were also common. Sporadic growth factor receptor amplifications occurred in EGFR, KIT, PDGFRA, PDGFRB, MET, FGFR1, FGFR2, and IGF1R. NGS identified 7 patients with ERBB2 gene amplification in the RD which was confirmed by FISH in both the pre- and post-treatment tissue, suggesting NGS could assist in the identification of ERBB2-overexpressing tumors misclassified at the time of diagnosis. In general, the gene amplifications identified by NGS corresponded to enhanced gene expression levels. Amplifications of MYC were independently associated with poor recurrence-free survival (RFS) and overall survival (OS). An interaction effect on survival was observed between MEK activation (assayed by a gene expression signature) and MYC amplification, suggesting cooperation between these pathways. Alterations in DNA repair also identified a subgroup with poor RFS and OS. In contrast, high post-NAC Ki67 score did not predict poor RFS or OS in this predominantly TNBC cohort.

Conclusions: The diversity of lesions in residual TNBCs after NAC underscores the need for powerful and broad molecular approaches to identify actionable molecular alterations and, in turn, better inform personalized therapy of this aggressive disease. Incorporation of this platform into clinical studies and eventually standards of care should aid in the prioritization of patients with RD after NAC into rational adjuvant studies.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S3-6.

Anthropometric data as predictors of Obstructive Sleep Apnea Severity

Abstract

The Obstructive Sleep Apnea Syndrome is a chronic disease characterized by episodes upper airway collapse, and has been associated with increased cardiovascular morbidity.

Aim

To correlate the neck, abdominal and pelvic circumference with the AHI and oxyhemoglobin saturation in OSA patients, and to correlate these values with disease severity.

Materials and methods

A prospective descriptive study of 82 patients evaluated complaints suggesting OSA, from July 2008 to March 2010. All patients underwent polysomnography, an ENT clinical exam, measures of the BMI, abdominal, pelvic, and cervical circumferences. The mean, standard deviations and Spearman's correlations were analyzed.

Results

The mean AHI in men was 39 events/hr; in women it was 21 events/hr in women. The mean neck circumference was 34.5 cm in women and 41.3 cm in men, the mean abdominal circumference was 94.3 cm in women and 101.5 cm in men, and the pelvic circumference was 105.7 cm in men and 108.7 cm in women. The neck circumference correlated more closely to the AHI in men (r=+0.389 p=0.001). The relationship between the abdominal circumference correlated more with AHI than with the BMI in men (AbC r=+0.358 p=0.003 BMI r=+0.321 p=0.009).

Conclusion

The neck circumference is the best anthropometric measurement of respiratory disorder severity compared to the AbC or the BMI.

Estudo da impressão plantar obtida durante o teste de Jack em crianças

OBJETIVO: Avaliar as impressões plantares durante o teste de Jack em crianças quantificando e observando os resultados numa faixa etária crítica para a formação do arco plantar. MÉTODO: Avaliamos 60 crianças brancas (120 pés) sendo 35 meninos e 25 meninas com idades entre 2 e 5 anos, sem queixas ortopédicas. Simulamos o teste de Jack com uma órtese em cunha de 45º apoiada sob o hálux. Obtivemos impressões em apoio monopodálico bilateralmente utilizando um pedígrafo. O exame dividiu-se em duas etapas: com e sem o uso da órtese. A metodologia de Valenti e Volpon foi utilizada para mensurar as impressões plantares e os dados obtidos foram analisados estatisticamente. RESULTADOS: Os valores dos índices de Valenti e Volpon diminuiram quando a órtese foi utilizada. A diferença entre os índices com ou sem órtese diminuiu gradualmente com a progressão etária. CONCLUSÕES: É possível quantificar o teste de Jack pelwas impressões plantares pelo método de Valenti e Volpon. A variação do seu formato apresentou tendência a ser menor a partir dos 4 anos. O teste de Jack perdeu gradativamente a capacidade de modificar a impressão plantar com a idade, diminuindo sua acuidade como parâmetro de bom prognóstico na formação do arco longitudinal medial. Nível de Evidência: Nível IV, estudo descritivo observacional.

Abstract P4-09-11: Variables of Worse Outcome in Premenopausal ≥35 Years old Patients (pts)

Background: Breast cancer (BC) has a worse prognosis in young than in older women; there is a lack of a standard definition of ages included in definition of young women; however ≥35 years old (yo) is frequently used. We analyzed pts according to their age at diagnosis and menopausal status (premenopausal ≥35 yo, premenopausal &gt;35 yo and postmenopausal). Methods: We reviewed 1024 cases with operable stage I-III BC from INEN, Lima-Perú (2000 - 2002). We used Kaplan-Meier estimates for comparing disease free survival (DFS) and overall survival (OS) by age at diagnosis and menopausal status according to clinicopathologic characteristics and IHC phenotype: [ER+ and/or PR+, HER2-], [ER-, PR-, HER2-] and [HER2+ (regardless ER/PR status)].

Results: 84 pts were premenopausal ≥35yo (8.2%), 425 premenopausal &gt;35yo (41.5%) and 515 postmenopausal (50.3%). We found significant association between groups and RP (P&lt;0.001) and RE (P=0.042) status; tumor size (P=0.002); nodal involvement (P=0.014); extracapsular extension (P=0.04); pathological stage (P=0.028) and phenotype (P=0.007). With a median of follow-up of 7.6 years, the DFS and OS to 6 years show differences in the group of ≥35 yo pts compared to premenopausal &gt; 35 yo

and postmenopausal pts (DFS: 58.4, 79.4 and 78.7%, P&lt;0.001; OS: 64.7, 84.3 and 80.5% respectively, P&lt;0.001). We found significant differences in DFS and OS between groups stratified by phenotype. differences were greater in [ER+ and/or PR+, HER2-] pts.

OS y phenotype

In this subset, we found significant association between ER status with premenopausal ≥35yo, &gt;35yo and postmenopausal pts (ER-=20.6 v 3.5 v 1.9%; P&lt;0.001).

Conclusion: Premenopausal pts with ≥35 yo has a worse prognosis than older premenopausal and postmenopausal pts; phenotypes [ER+ and/or PR+, HER2-] and [HER2+] present higher recurrence risks in premenopausal ≥35yo pts. In [ER+ and/or PR+, HER2-] ≥35yo pts, negative RE is an indicator of worse prognosis.

Abstract P4-09-18: Triple Negative Breast (TNBC) Cancer in Hispanic Population: Clinicopathological and Recurrence Features

Background: TNBC is characterized by the lack of hormonal receptors and HER2 expression and occurs most frequently in Black and Hispanic than in Caucasian population. We compare clinicopathological and outcome variables between TNBC and non-TNBC Hispanic patients (pts). Methods: We reviewed 1044 cases of operable breast cancer treated at INEN, Lima-Perú (2000 — 2002). Phenotypes were categorized by IHC into TNBC and non-TNBC. Variables in both groups were compared with the X2 test. We used Kaplan-Meier method for comparing disease free survival (DFS), overall survival (OS), post recurrence survival by phenotype (TNBC v non-TNBC) and the hazard rate (HR) for different times. Results: 212 pts (20.3%) were TNBC and 832 non-TNBC (79.7%); median for age was 48 and 49 years (y), for tumor size 3.5 and 2.9cm; TNBC was more likely to have involved nodes (55.7 v 45.6%; P=0.009), tumors &gt; 5cm (14.2 v 8.1%; P=0.011) and histological grade 3 (62.7 v 29.0%; P&lt;0.001). Recurrence rates (RR) were 25.9 v 22.5% (TNBC v non-TNBC). TNBC and non-TNBC present different RR.

Recurrence sites and phenotype

Median of follow-up was 7.63 and 7.57y; there was not significant differences for DFS between TNBC and non-TNBC (72.8 v 76.6%;P=0.057), but in OS had differences (73.2 v 79.9%; P=0.014). The HR for recurrence was calculated to 1y (7.9 v 2.7%); 2y (8.8 v 5.8%); 3y (8.0 v 6.5%); 4y (2.7 v 3.3%) and to 5y (3.5 v 3.9%) and the HR for death to 1y (4.3 v 0.8%); 2y (6.7 v 2.6%); 3y (8.4 v 3.8%); 4y (5.5 v 2.8%) and to 5y (2.6 v 4.5%) for TNBC and non-TNBC, respectively. HR for recurrence and death was higher in TNBC until the first 3y and 4y, respectively, then HR were similar for both groups. Post recurrence survival show differences between TNBC and non-TNBC (HR=1.7; 95% IC 1.2 - 2.3; P=0.002). Conclusion: In early breast cancer, TNBC is more aggressive than non-TNBC; present a higher RR in brain, distant nodes and other soft tissues; strongly time-dependent HR for recurrence and death, and a worse Post recurrence survival.

Traqueobroncopatia osteocondroplástica: relato de 2 casos e revisão bibliográfica

Abstract

Osteochondroplastic tracheobronchopathy (OT) is a rare benign disorder of the lower part of the trachea and the upper part of the main bronchus characterized by numerous submucosal calcified nodules, sessile, cartilaginous and/or osseous with laryngotracheobronchial lumen projection. There are less than 400 cases reported in the word literature.

Aim

to report and discuss 02 cases of OT with a bibliography review.

Materials and Methods

we report on 02 cases with bibliography revision from MEDLINE, LILACS and PUBMED data.

Study design

observational, descriptive, case reports.

Conclusion

the symptoms result from airway obstruction, causing dry cough, dyspnea and recurrent respiratory tract infections. The diagnostic hypothesis is established by endoscopy of the upper airway (laryngo-tracheo-bronchoscopy), and the trachea/chest computed tomography is the best image exam to define tracheal nodule alterations. The differential diagnoses are papillomatosis, amyloidosis and sarcoidosis chondrosarcoma hamartoma and calcified paratracheal lymph nodes. There is no specific treatment and the prognosis is good. Surgery is restricted to moderate or severe airway obstructions. Otorhinolaryngologists must include OT in the differential diagnosis of cases of upper airway and tracheobronchial tree suggestive symptoms.

CORRELATION BETWEEN AVASCULAR NECROSIS AND EARLY STABILIZATION OF PROXIMAL FEMORAL FRACTURES IN CHILDHOOD

OBJECTIVE

We developed this study with the aim of evaluating the results from treating patients with proximal femoral fractures, in a series of cases. We sought to observe the influence of the most prevalent complications on the final results after a minimum follow-up of two years. We especially considered the relationship between establishment of avascular necrosis and the time between the accident and the therapeutic intervention.

METHOD

We retrospectively studied proximal extremity fractures of the femur in 29 patients under 14 years of age between 1988 and 2007. We analyzed the following variables: sex, age, mechanism of injury, fracture classification (Delbet), treatment administered, complications (pseudarthrosis, varus deformity, leg length discrepancy and avascular necrosis), duration of surgery and results (Ratliff). We carried out individual descriptive analysis on each variable. The tests were used in accordance with the premise that normality applied. For the evaluation, we used Fisher's exact test.

RESULTS

Five patients (17.2%) had avascular necrosis, and three of them (60.0%) were over 10 years of age. 73.3% of the patients treated within the first 24 hours showed good results. The most common cause of fractures was traffic accidents (44.8%). The best results were observed among patients who were treated surgically. 41.4% developed some type of complication.

CONCLUSIONS

Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results, according to the Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while 69.3% had good results from surgical intervention. Likewise, 73.3% of the results were good results when surgery was performed within the first 24 hours and only 42.8% of the results were good among patients who underwent surgery after this period. Patients operated within the first 24 hours developed necrosis of the femoral head in 13.3% of cases, while 21.4% of those operated after this period developed this complication.

Possible association between NOD2 variants and joint surgery in psoriatic arthritis

BACKGROUND

Psoriatic arthritis (PsA) has been inconsistently associated with common NOD2 gene variants, although some of these studies did not include patient stratification by clinical phenotype.

OBJECTIVES

To analyse the association between the three common NOD2 variants (R702W, G908R and L1007fs) and clinical phenotypes of PsA, particularly with surrogate markers of severe joint destruction.

PATIENTS AND METHODS

A total of 183 unrelated PsA patients and 187 controls were included. Demographic, clinical, biological and immunological characteristics were collected. Genotypes for the three common NOD2 gene variants were obtained by PCR and direct sequencing.

RESULTS

NOD2 variants in PsA patients (7.6%) are just as prevalent as in healthy controls (7.5%). 18.5% of PsA patients carrying at least one NOD2 variant underwent joint surgery compared with 4.5% of those without these variants (p=0.019). Multivariate analysis confirmed this finding (OR 8.82, CI 1.7-46.3). There was no requirement for early surgery in patients carrying the NOD2 variants but there was an increased possibility of requiring surgery at similar times of disease duration. No other association with clinical features and NOD2 status carrier was found.

CONCLUSIONS

Common NOD2 gene variants are not associated with PsA, but might increase the risk of undergoing joint replacement surgery, suggesting that this autoinflammatory-associated gene could act as a phenotypic modifier gene in PsA patients by increasing the risk of joint destruction. Given the small number of PsA patients with joint surgery included, we consider our findings a new hypothesis that will need further testing.

Influence of variants of Fc gamma receptors IIA and IIIA on the American College of Rheumatology and European League Against Rheumatism responses to anti-tumour necrosis factor alpha therapy in rheumatoid arthritis

OBJECTIVE

Fc gamma receptor (Fc gammaR) polymorphism influences the affinity of the receptor for Ig, which may, in turn, affect the efficacy of Ig-based therapies. The relationship between functional single nucleotide polymorphisms (SNP) of the FCGR2A and FCGR3A genes and the response to anti-tumour necrosis factor (TNF)alpha therapy (infliximab) in patients with rheumatoid arthritis (RA) was assessed.

METHODS

A total of 91 patients with RA (89% female; 76.7% rheumatoid factor (RF) positive) starting therapy with infliximab were evaluated at 0, 6 and 30 weeks using the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) response criteria and the 28-joint Disease Activity Score (DAS28) was evaluated using three parameters, including C-reactive protein (CRP) (DAS28 3v-CRP) changes during the follow-up. Genotyping of FCGR2A-R131H and FCGR3A-F158V polymorphisms was performed by allele-specific PCR and PCR sequence-based typing, respectively. The chi(2) and Fisher exact tests were used to show differences in the outcome variables, and analysis of variance (ANOVA) to analyse the evolution of DAS28 3v-CRP. A generalised linear models multivariable analysis was also performed.

RESULTS

At week 6 of follow-up, the proportion of patients achieving 50% improvement as per ACR criteria (ACR50) and EULAR good responses were significantly higher among homozygotes of the low affinity FCGR3A allele (FF: 24.1% and VV-VF:2.2%; p = 0.003 and FF: 44.8% and VV-VF: 22.9%; p = 0.040, respectively). At week 30, homozygotes of the low affinity FCGR2A allele had a better ACR20 response (RR: 60% and HH-RH: 33.3%; p = 0.035). Changes in DAS28 3v-CRP during follow-up were consistent with those observed in ACR and EULAR responses.

CONCLUSIONS

The response to anti-TNFalpha treatment with infliximab in patients with RA is influenced by the FCGR2A and FCGR3A genotypes. This effect is observed at different times in the follow-up (6 and 30 weeks, respectively) indicating the dynamic nature of the Fc gammaR versus Ig interaction.

Avaliação da anatomia arterial no pé torto congênito através da ultrassonografia com doppler colorido

OBJETIVO: Avaliação ultrassonográfica das artérias tibial anterior e posterior no pé torto congênito (PTC). MATERIAL E MÉTODO: Foram incluídos 20 pacientes portadores de PTC idiopático compreendendo 18 casos unilaterais e dois bilaterais, sendo que 17 pacientes foram submetidos a tratamento cirúrgico e três a tratamento conservador. Todos os pacientes apresentavam pés plantígrados e foram submetidos à avaliação clínica e radiográfica, seguido pelo exame de ultrassom Doppler colorido (UDC), visando a identificação das artérias tibiais anterior e posterior na altura do tornozelo. O nível funcional foi classificado pelos critérios de Lehman. RESULTADOS: Nesta série de 20 pacientes, somente em um não foi identificada a artéria tibial anterior. Nos 12 pacientes submetidos à mensuração de fluxo e calibre pelo UDC, foi encontrada uma correlação positiva entre o grau funcional do PTC e o calibre da artéria tibial anterior. Não houve redução estatisticamente significante entre o fluxo e calibre da artéria tibial anterior do lado normal em comparação com o lado alterado (nos casos de doença unilateral). CONCLUSÕES: Não houve alteração significativa da morfologia e fluxo arterial quando comparamos os lados afetado e normal. Além disso, quanto melhor o resultado clínico da correção do PTC, maior foi o calibre da artéria tibial anterior.

Exclusively endoscopic surgery for juvenile nasopharyngeal angiofibroma

OBJECTIVE

To present the indications of nasal endoscopic surgery for treating juvenile nasopharyngeal angiofibroma (JNA).

STUDY DESIGN

Chart review.

MATERIALS AND METHODS

Twelve patients underwent nasal endoscopic surgery exclusively to resect JNA from January 2001 to June 2004. According to the classification of Andrews et al, eight patients were stage I and four patients were stage II.

RESULTS

The follow-up was between five and 42 months, and no patient has shown a residual tumor or recurrence to date.

CONCLUSION

In JNA stages I and II, the endoscopic approach was effective without preoperative arterial embolization. There were no residual tumors or recurrence in this study.

SIGNIFICANCE

It seems to be appropriate to reevaluate the surgical limits of endoscopic surgery for resecting JNA.

Multiple parosteal lipoma associated to polyarthritis

Parosteal lipoma is a benign adipose tissue tumor situated directly in the bone cortex. All cases previously reported in the literature were described as solitary lesions. We describe a patient who presented with polyarthritis associated with multiple parosteal lipomatous involvement. A tissue sample from the distal portion of the forearm confirmed the presence of cumulative fat tissue with nodes of esteatonecrosis. To the best of our knowledge this is the first case of multiple parosteal lipoma associated to polyarthritis.

Estudo comparativo entre duas técnicas de tonsilectomia: bisturi harmônico (Ultracision) e dissecção tradicional com bisturi de lâmina fria

Tonsilectomia é a cirurgia realizada com maior frequência na clínica otorrinolaringológica. As modificações e as evoluções da técnica ocorrem no sentido de simplificar o procedimento e minimizar as complicações. O bisturi harmônico (Ultracision) começou a ser utilizado na Otorrinolaringologia em 1999 para tonsilectomia com bons resultados. OBJETIVO: O objetivo deste estudo foi comparar o tempo cirúrgico, sangramento e hemostasia trans-operatórios, dor pós-operatória, aspecto cicatricial da loja tonsilar e intercorrências no trans e pós-operatório em pacientes submetidos a tonsilectomia pela técnica tradicional com lâmina fria e pela técnica utilizando lâmina cirúrgica em ganchos de coagulação Ultracision. FORMA DE ESTUDO: Coorte transversal. CASUÍSTICA E MÉTODO: Vinte e seis pacientes foram submetidos a tonsilectomia: 13 pela técnica tradicional com bisturi de lâmina fria e 13 pela técnica com Ultracision, avaliando os parâmetros previamente estabelecidos através de um protocolo padrão. Os pacientes foram submetidos a uma análise da intensidade da dor através da escala analógica visual horizontal. RESULTADOS: O tempo cirúrgico foi estatisticamente menor na cirurgia realizada pela técnica com o bisturi harmônico comparada com a técnica tradicional. O percentual de pontos dados na loja tonsilar também mostrou-se mais baixo do que pela técnica tradicional. Não houve diferença significativa em relação ao padrão de dor e a evolução pós-operatória do aspecto cicatricial da loja. CONCLUSÃO: O bisturi harmônico mostrou ser um excelente recurso para a realização de cirurgias onde o tempo cirúrgico e o sangramento trans-operatório são de grande importância.

Dysprosody nonassociated with neurological diseases--a case report

Dysprosody also known as pseudo-foreign dialect, is the rarest neurological speech disorder. It is characterized by alterations in intensity, in the timing of utterance segments, and in rhythm, cadency, and intonation of words. The terms refers to changes as to duration, fundamental frequency, and intensity of tonic and atonic syllables of the sentences spoken, which deprive an individual's particular speech of its characteristics. The cause of this disease is usually associated with neurological pathologies such as brain vascular accidents, cranioencephalic traumatisms, and brain tumors. The authors report a case of dysprosody attended to at the Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo (NOSP). It is about a female patient with bilateral III degree Reinke's edema and normal neurological examinations that started presenting characteristics of the German dialect following a larynx microsurgery.

Laryngeal herpes: a case report

Herpetic laryngitis is a rare inflammatory disease caused by herpes simplex or herpes zoster virus. The propensity for spreading along peripheral nerves and within the central nervous system, with frank herpetic meningoencephalitis, is a rare complication. We present one case of herpetic laryngitis by reactivation of varicella zoster, with central nervous system spreading, and discuss the relevant literature on the pathophysiology, diagnosis, evaluation, and management of this disease.

Ductal cell carcinoma of the kidney with extensive signet ring cell mucosecreting areas. A case report with immunohistochemical analysis

We present the case of a 45-year-old patient with a renal ductal cell carcinoma arising in the Bellini ducts that was composed of histologically well-differentiated tubulopapillary and cystic areas with desmoplastic stroma, extensive mucosecreting areas, and regions depicting a transition between these two constituents. The mucosecreting component was mostly formed by signet ring tumor cells containing cytoplasmic Alcian blue-PAS-stainable mucins. The tubulopapillary and cystic areas of the tumor showed the immunohistochemical staining for low and high molecular weight cytokeratin, EMA, vimentin and Ulex europaeus, characteristic of ductal cell carcinoma. The mucosecreting cells also presented intense positive staining for cytokeratin and vimentin, and this is quite similar to observations reported in some forms of gastrointestinal cancer with rhabdoid features that are indicative of poor prognosis. Our findings suggest that mucosecreting areas with signet ring cells represent an extreme metaplastic change that can seldom occur in certain forms of renal tumors.

A randomized double-blind placebo-controlled trial to evaluate the immunogenicity of a candidate vaccine against American tegumentary leishmaniasis

This study was aimed at evaluating the immunogenicity of a vaccine composed of killed Leishmania amazonensis promastigotes using several different protocols in a randomized, double-blind and controlled trial design in order to select one of them for further efficacy trials. One hundred and fourteen leishmanin skin test (LST)-negative healthy volunteers were allocated into eight groups that received either two or three deep intramuscular injections of vaccine at doses of 180, 360 and 540 microg or similar injections of placebo. Cell-mediated immune responses were evaluated before and after vaccination by means of LST as well as proliferative responses and cytokine production in Leishmania antigen-stimulated peripheral blood mononuclear cell cultures. The majority of the subjects who actually received vaccine converted to positive LST (89.5%). On the other hand, none of the subjects who received placebo converted to positive LST. Proliferative responses and production of interferon-gamma and interleukin-2 were significantly higher after vaccination than before vaccination in all groups, including those that received placebo. The dose of 360 microg provided the highest LST conversion rate (100%), as well as the greatest increase in interferon-gamma and interleukin-2 production after vaccination.

Immunochemotherapy in American cutaneous leishmaniasis: immunological aspects before and after treatment

In this study, we evaluated the immune response of patients suffering from cutaneous leishmaniasis treated with two distinct protocols. One group was treated with conventional chemotherapy using pentavalent antimonium salts and the other with immunochemotherapy where a vaccine against cutaneous leishmaniasis was combined with the antimonium salt. Our results show that, although no differences were observed in the necessary time for complete healing of the lesions between the two treatments, peripheral blood mononuclear cells from patients treated by chemotherapy showed smaller lymphoproliferative responses at the end of the treatment than those from patients in the immunochemotherapy group. Furthermore, IFN-gamma production was also different between the two groups. While cells from patients in the chemotherapy group produced more IFN-gamma at the end of treatment, a significant decrease in this cytokine production was associated with healing in the immunochemotherapy group. In addition, IL-10 production was also less intense in this latter group. Finally, an increase in CD8+ -IFN-gamma producing cells was detected in the chemotherapy group. Together these results point to an alternative treatment protocol where healing can be induced with a decreased production of a potentially toxic cytokine.

[Economic impact of animal diseases on production systems in South America: case studies]

The authors discuss the relative importance of the livestock sector in South America, in developing countries and in countries world-wide. The development of animal health services is highlighted and the new challenges which these services must meet, with respect to the restructuring of international trade, are described. The economic impact of animal diseases and of disease control is evaluated by taking a regional approach and by analysing production systems. A classification of production systems is accompanied by case studies on the economics of animal health. Emphasis is placed on national control programmes, diseases which affect reproduction, parasitic diseases and mastitis, with particular reference to the livestock sector of Colombia. The authors suggest that integrated livestock development programmes include the management of animal health and production information. A change of attitude is also recommended with greater participation of those involved. The need to co-ordinate sustained research initiatives is stressed.