Correlation between Thyroid Radiation Dose and Thyroid Function after Adjuvant Hypofractionated Locoregional Radiotherapy in Breast Cancer Patients

PURPOSE/OBJECTIVE(S)

Radiotherapy (RT) is used quite often among breast cancer patients, and because these patients now live longer than they used to, long-term treatment-related adverse effects, such as hypothyroidism, are becoming increasingly relevant. Radiation-induced hypothyroidism is a late side effect of radiation to the thyroid gland, which could develop months to years after radiotherapy. However, there is no sufficient data on hypothyroidism in patients with breast cancer who receive locoregional RT, which usually affects a portion of the thyroid gland. In this prospective study, we tried to correlate between the radiation dose received by the thyroid gland and the incidence of thyroid dysfunction in breast cancer patients treated with hypofractionated locoregional radiotherapy, as well as establishing potential planning objectives that could help in sparing the thyroid gland.

MATERIALS/METHODS

Our study included 109 women who received 3-D conformal loco-regional breast radiotherapy, these patients had normal thyroid function prior to start of radiotherapy. Patients had follow-up thyroid function tests 6 months after finishing radiotherapy. Based on dose volume histograms (DVH), the percentages of the thyroid volume, and ipsilateral thyroid lobe, receiving 5, 10, 15, 20, 25, 30, 35, and 40 Gy (V5, V10, V15, V20, V25, V30, V35, and V40 respectively), in addition to the mean and maximum thyroid doses, were estimated.

RESULTS

Follow-up assessment of thyroid function and statistical analysis unveiled incidence of radiotherapy induced hypothyroidism to be 8.3%. Possible risk factors included high maximum radiation dose and V40 to the thyroid gland and the ipsilateral thyroid lobe, as well as high mean dose and smaller volume of the ipsilateral thyroid lobe.

CONCLUSION

The likelihood of hypothyroidism was significantly increased with V40 of >5% of the thyroid gland, and V40 of >11% of the ipsilateral thyroid lobe. Further study is recommended for larger populations and longer follow-up periods.

Medical Research Conduct and Publication during Higher Education in Syria: Attitudes, Barriers, Practices, and Possible Solutions

Background:  The huge workload on doctors especially residents, who are the main health care providers in public hospitals, in addition to the vanishing incomes and lack of personal safety during the decade-long Syrian crisis, led to further hurdles in the focus on research. Postgraduate students in the medical and paramedical fields must conduct original research projects as part of their graduation requirements. However, this does not reflect on research publications coming from Syria.

Methods:  This is a nation-wide cross-sectional study targeting medical, dental, and pharmacy postgraduate students who are at the phase of planning for their required projects. The questionnaire aimed to capture their attitudes toward research, perceived barriers, and previous research experiences in order to suggest evidence-based recommendations.

Results:  The sample consisted of 429 residents representing about 22% of the target population. Nearly all the participants had positive opinion toward the important role of medical research and the significance of their participation. Agreement was also clear regarding perceived barriers, including the lack of adequate training and research facility. Seventy-one percent of the participants were not involved in any research before the time of their master theses, less than 13% of them had submitted an article for publication, and less than 5% had submitted more than one paper. Despite that, high-quality internet connectivity and rich English writing skills were associated with further research experiences. Additionally, mentors' support and self-paced learning of research skills had significant positive impact on students' research contributions with odds ratios of 2.04 [[95% Confidence Interval]: 1.02–4.06] and 2.68 [1.48–4.84], respectively.

Conclusion:  Lack of training and mentorship, in addition to several common barriers to medical research, hampered residents' capacity of conducting and publishing research despite their positive attitudes toward it. Nevertheless, the variance within our sample exposed a promising window for implementing low-cost institutional and individual solutions such as peer-run self-paced training opportunities and long-distance mentoring.

Possible role of plasmacytoid dendritic cells in pityriasis lichenoides

BACKGROUND

Plasmacytoid dendritic cells (pDCs) and their product, type I interferons (IFNs), have been implicated in the pathogenesis of several skin disorders characterized by an interface dermatitis (ID) pattern, such as lichen planus (LP). A type I IFN signature has previously been documented in pityriasis lichenoides (PL). Although pDCs are known to be the main source and most potent producers of local type I IFNs, their role in PL has not been investigated.

AIM

To investigate the role of pDCs in PL.

METHODS

In total, 20 cases of PL and 20 comparable cases of LP were immunohistochemically tested for pDC occurrence and type I IFN production using anti-blood-derived dendritic cell antigen-2 (BDCA2; a specific pDC marker) and anti-myxovirus protein A (anti-MxA) antibodies (indirect marker of pDC activity), respectively. MxA is a well-established surrogate marker for local type 1 IFN production. A semiquantitative scoring system was used.

RESULTS

pDCs were present in all 40 cases with no statistically significant difference between the two groups. MxA expression was intense and diffuse in the majority of PL and LP cases.

CONCLUSIONS

pDCs constitute a central component of the inflammatory infiltrate in PL, suggesting that PL shares with the other entities that exhibit an ID a common pDC-driven process through type I IFN production, which ultimately leads to the cytotoxic attack.

Erythropoietic protoporphyria a clinical and molecular study from Lebanon: Ferrochelatase a potential tumor suppressor gene in colon cancer

Erythropoietic protoporphyria (EPP) is a rare cutaneous and systemic disease caused by mutations in the ferrochelatase gene (FECH). The molecular underpinnings of EPP in Middle Eastern populations and relative to other ethnic groups secondary to increased consanguinity are unknown. To understand the molecular pathogenesis of Middle Eastern EPP, we surveyed clinicopathological and molecular features in 6 large consanguineous families from Lebanon and Syria presenting with cutaneous and systemic features consistent with EPP. We observed 30% increased liver disease and 20% elevated end-stage liver complications in our EPP cohort compared to EPP patients previously reported elsewhere. In addition, Middle Eastern EPP patients in our cohort exhibited uniquely an increased incidence of colon cancer. Sequence analysis revealed 2 novel non-synonymous FECH mutations in the studied families designated p.M294T and p.I230M. In addition, FECH activity was significantly decreased (6%) in fibroblasts obtained from sun-exposed sites in a patient with p.M294T mutation, whereas in sharp contrast, protected sites from the same patient exhibited 54% activity for the gene. We also found that sun-exposed fibroblasts, relative to sun-protected and control fibroblasts, exhibited suppressed growth and atypical morphology in vitro, and that these effects were alleviated when the cells were co-cultured with sun-protected fibroblasts. Our findings on the increased incidence of colon cancer in EPP patients prompted us to survey FECH expression patterns in cancer. Using publicly available microarray datasets we found that FECH mRNA was largely significantly decreased in colon adenocarcinomas relative to normal colon tissues. Our findings suggest that families with autosomal recessive EPP should be screened more extensively for systemic involvement including liver diseases and colon cancer, and point to a previously unknown yet plausible tumor suppressor role for FECH in colon malignancy.

Plasmacytoid dendritic cells and type I interferon in the immunological response against warts

BACKGROUND

Plasmacytoid dendritic cells (pDCs) are the most potent producers of type I interferons (IFNs), and are involved in the pathogenesis of several cutaneous infectious (especially viral), inflammatory/autoimmune and neoplastic entities. Their role in the pathogenesis and regression of human papilloma virus (HPV)-induced skin lesions has not been well studied.

AIM

To investigate pDC occurrence and activity in HPV-induced skin lesions, including inflamed and uninflamed warts as well as epidermodysplasia verruciformis (EDV)-associated lesions.

METHODS

In total 20 inflamed and 20 uninflamed HPV-induced skin lesions (including 7 EDV lesions) were retrieved from our database, and the tissue was immunohistochemically tested for pDC occurrence and activity using anti-BDCA-2 and anti-MxA antibodies, respectively.

RESULTS

pDCs were present in all 20 inflamed warts and absent from all 20 uninflamed cases. MxA expression was also diffuse and strong in 75% (15/20) inflamed warts, but not in any of the uninflamed warts.

CONCLUSIONS

pDCs constitute a central component of the inflammatory host response in inflamed warts, possibly contributing to their regression through production of type I interferons.

A novel mutation in the RSPO4 gene in a patient with autosomal recessive anonychia

The Wnt signalling pathway is a major pathway involved in the embryogenic development of the various organs of the body. Appropriate signalling in this pathway relies on the proper functioning of several proteins including the R-spondin family of proteins. Deactivating mutations in R-spondin 4 are associated with anonychia. We present the case of a 26-year-old man presenting with anonychia of the 20 nails, which had been present since birth. Using genetic studies, we identified a novel nonsense mutation, c.164-165TC>AA, characterized by two consecutive mismatch bases. To our knowledge, this mutation is the first to be reported in R-spondin 4 in a Lebanese population. Evaluating new patients with anonychia provides fruitful clinical and molecular findings.

Genetics of syndromic and non-syndromic hereditary nail disorders

The nail is a unique epithelial skin appendage made up of a fully keratinized nail plate. The nail can be affected in several systemic illnesses, dermatological diseases, and inherited nail disorders. Nail dystrophies can present as isolated disorders or as a part of syndromes. Substantial progress has been achieved in the management and diagnosis of nail diseases; however, not much is known about the underlying molecular controls of nail growth. The homeostasis and development of the nail appendage depend on the intricate interactions between the epidermis and underlying mesenchyme, and comprise different signaling pathways such as the WNT signaling pathway. Digit-tip regeneration in mice and humans has been a known fact for the past six decades; however, only recently the underlying biological mechanisms by which the nail organ achieves digit regeneration have been elucidated. Moreover, significant progress has been made in identifying nail stem cells and localizing stem cell niches in the nail unit. More fascinating, however, is the role they play in orchestrating the processes that lead to the regeneration of the digit. Further elucidating the role of nail stem cells and the signaling pathways driving epithelial-mesenchymal interactions in the nail unit might contribute to the development of novel therapeutic tools for amputees.

Lyotropic behavior of Gelucire 50/13 by XRD, Raman and IR spectroscopies according to hydration

The present paper discuss the structural and vibrational properties of polyoxyethylene glycol glycerides (Gelucire 50/13) during the hydration with increasing water from 0% to 80%. The Gelucire 50/13 used as sustained release matrix forming agent in pharmaceutical applications and it was essentially studied by Small and Wide Angle X-ray Scattering (SWAXS), Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy according to the rate of hydration. The hydration behavior of this amphiphilic excipient has been investigated in the spectral range 4000-0cm^-1 in Raman spectroscopy, and 4000-600cm^-1 in FTIR. At increasing water contents Gelucire 50/13 forms successive bicontinuous to micellar supramolecular structures, and the vibrational changes were directly correlated with this conformational changes of the Gelucire structure. Overall, Raman and IR spectroscopy clearly demonstrated that the different functional groups studied could be characterized independently, allowing for the understanding of their role in Gelucire polymorphism.

Interstitial granulomatous dermatitis associated with systemic lupus erythematosus: case report and review of the literature

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease of unknown etiology that most frequently involves the skin and the musculoskeletal system. In addition to the more common cutaneous manifestations, interstitial granulomatous dermatitis (IGD) may rarely occur in association with SLE or even be the first sign of the disease. We describe a 40-year-old man with SLE-associated IGD, and review all cases of SLE-associated IGD in the literature.

Origin identification of dried distillers grains with solubles using attenuated total reflection Fourier transform mid-infrared spectroscopy after in situ oil extraction

The ban on using processed animal proteins in feedstuffs led the feed sector to look for other sources of protein. Dried distillers grains with solubles (DDGS) could be considered as an important source in this regard. They are imported into Europe mainly for livestock feed. Identifying their origin is essential when labelling is missing and for feed safety, particularly in a crisis situation resulting from contamination. This study investigated applying attenuated total reflection Fourier transform mid-infrared spectroscopy (ATR-FT-MIR) to the oil fraction extracted from samples in situ in order to identify the origin of DDGS. The use of spectroscopic and chemometric tools enabled the botanical and geographical origins of DDGS, as well as the industrial process used to produce them, to be identified. The models developed during the study provided a classification higher than 95% using an external validation set.

Metformin in dermatology: an overview

For several decades, metformin has been used as an oral hypoglycaemic agent, where it is the first line of treatment in overweight and obese type 2 diabetic patients. This is because it decreases the hepatic glucose output and acts as an insulin sensitizer by increasing the glucose utilization by muscles and adipocytes. As a result of the improvement in glycaemic control, serum insulin concentrations decline slightly, thus improving hyperinsulinaemia and its signs. In addition, it has been shown that metformin has platelet anti-aggregating and antioxidant effects. These pharmacological properties have allowed metformin to be effective in non-diabetic situations including cutaneous conditions. This is an evidence-based review on the use of metformin in the treatment of skin disorders such as hirsutism, acne, hidradenitis suppurativa, acanthosis nigricans, psoriasis, skin cancer, among others. In addition, cutaneous side-effects such as leukocytoclastic vasculitis, bullous pemphigoid, psoriasiform drug eruption, lichen planus and acute alopecia have been associated with metformin use and are discussed in the article.

Posterior reversible encephalopathy syndrome after bevacizumab therapy in a normotensive patient

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterised by distinct radiological features. Common precipitants of this disorder include acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy and chemotherapy. We present the case of a patient with advanced ovarian carcinoma who developed PRES shortly after receiving bevacizumab (Avastin), an inhibitor of vascular endothelial growth factor. The patient's medical history and clinical presentation both suggest bevacizumab as the precipitator for PRES. This agent has been often overlooked as a possible cause of this rare neurological syndrome.

Possible role of low level laser therapy on bone turnover in ovariectomized rats

OBJECTIVE

The aim of this study was to assess the effect of low level laser therapy (LLLT) on bone turnover markers in ovariectomized rats.

METHODS

Thirty adult female albino rats were divided into three groups; Group 1: 10 sham- operated control rats; Group 2: 10 bilaterally ovariectomized rats (OVX); Group 3: 10 OVX rats exposed to LLLT. LLLT was applied on the neck and shaft of femur, five times per week for 8 weeks. The dose applied on each point was 1000 Hertz, 5 Watts for 30 seconds with a total dose of 15 mJoule/cm². At the end of experiment, blood samples were collected and sera were separated for determination of serum calcium (Ca), inorganic phosphorus (Pi), osteocalcin and alkaline phosphatase (ALP). In addition, a 24 hour urine sample was also collected from each rat for the determination of urinary calcium, phosphorous and deoxypyridinoline (U-DPD)/creatinine.

RESULTS

Significant increase in serum Ca, Pi , ALP, osteocalcin and significant decrease in U-DPD/creatinine in LLLT exposed group was found as compared to the other two groups. Bone morphological findings revealed the increase in calcium deposition and alkaline phosphatase of femoral bones in LLLT exposed group as compared to sham-operated and OVX rats. The software image analysis showed increased osteoblast numbers, decreased osteoclast numbers and increased compact bone thickness in LLLT exposed group. Significant positive correlations was obtained between osteoblast numbers and serum Ca , Pi, ALP and osteocalcin in LLLT exposed group ,while a significant negative correlation was noticed with U-DPD.

CONCLUSION

The use of LLLT was found effective in enhancing bone formation and decreasing bone resorption in the osteoporotic OVX rats. Further studies are necessary to investigate the effect of different parameters of LLLT as wave length, duration and also numbers of sessions. The potential use of LLLT in postmenopausal women with osteoporosis is needed to be verified.

Expression of stem cell markers nestin and cytokeratin 15 and 19 in cutaneous malignancies

BACKGROUND

Emerging evidence is implicating stem cells in the pathogenesis of different cutaneous neoplasms. The immunohistochemical use of stem cell markers has facilitated stem cell identification. While few studies have examined the expression of cytokertatin (CK)15 and cytokeratin (CK)19 in basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), only rarely have nestin expression been examined in these two malignancies. Furthermore, stem cell marker expression, to the best of our knowledge, has not been examined in Merkel cell carcinoma (MCC).

METHODS

In this study, we examined the expression of stem cell markers CK15, CK19 and nestin in 51 overall cases (11 cases of MCC and 20 cases each of BCC and SCC) retrieved from the pathology files of Skin Pathology Laboratory, Boston University School of Medicine.

RESULTS

Cytokeratin 15 immunoreactivity was observed in 30% of BCC cases and only a single (5%) SCC case, while all MCC cases were negative. While 60% of BCC cases and 30% of SCC cases stained positively with CK19, all MCC cases showed positive immunostaining in a dot-like pattern. While negative in BCC and MCC, nestin expression was interestingly seen in 45% of SCC cases.

CONCLUSIONS

Our study described the expression profiles of stem cell markers CK15, CK19 and nestin in BCC, SCC and MCC. In addition to confirming results of the previous reports, our study also showed positive nestin expression in around half of SCC cases, which adds this malignancy to the cutaneous tumours that have been so far reported to exhibit nestin expression.

Analysis of milk odd- and branched-chain fatty acids using Fourier transform (FT)-Raman spectroscopy

Fourier transform (FT)-Raman spectra of pure C13:0, C15:0, C17:0, iso C14:0, iso C15:0, and ante C15:0 fatty acid methyl ester standards (FAMESs) and 75 milk fat samples from 6 different dietary experiments were acquired at room temperature (RT) and immediately after freezing at -80 °C (FT). The latter generally included much more well-defined and sharper scattering bands than those obtained at RT. Further, the spectra at FT revealed additional acuate bands in the vicinity of peculiar wavenumber regions, as well as an increase of Raman scattering intensity, which was sometimes associated with a shift of the peak. Partial least-squares (PLS) regression models based on either selected regions or the full spectra and using two pretreatment methods [multiplicative scatter correction (MSC, using raw spectra of milk fat only) and modified MSC (MMSC, a combination of pure FAMESs and milk fat spectra)] with cross-validation were used to evaluate the different types of milk fat FT-Raman spectra for the predictions of individual odd- and branched-chain fatty acids (OBCFAs) and their sums. In general, most individual (C15:0, ante C15:0, iso C17:0, and ante C17:0) and grouped (ODD, ANTE, and total OBCFAs) fatty acids were favorably (coefficient of determination, R(2) > 0.65) predicted using models with FT spectra only or a combination of RT and FT spectra (RFT), when compared to models with spectra analyzed at RT only. The results indicate the interest to use FT-Raman spectra collected at different temperatures for the prediction of narrow concentrations of saturated OBCFAs in milk fat.

Solitary epidermolytic acanthoma: a clinical and histopathological study

BACKGROUND

Epidermolytic acanthoma (EA) is an uncommon cutaneous entity that typically presents as a solitary lesion, or, less commonly, as multiple or disseminated discrete lesions. It usually appears at or after middle-age, and has been reported in various locations including the face, trunk, extremities and genitalia. Histopathologically, EA shows epidermolytic hyperkeratosis (EHK) involving either the entire thickness of the epidermis or just the granular and upper spinous layers.

OBJECTIVE AND METHODS

To describe the clinical and microscopic features of EA, we retrospectively reviewed all cases diagnosed as EA at the Skin Pathology Laboratory at Boston University between 1999 and 2009.

RESULTS

Solitary EA is more common in men (65%) and usually presents as a hyperkeratotic papule on the trunk (45%) or extremities (25%). Histopathologically, all cases of solitary EA showed the classical features of hyperkeratosis, acanthosis and EHK. Three architectural patterns were observed on scanning magnification: papillomatous (55%), cup-shaped (40%) and acanthotic (15%). Additional common features encountered included focal parakeratosis (85%), and a sparse to mild superficial perivascular lymphocytic infiltrate (90%).

CONCLUSION

This large case series of solitary EA reviews the clinical features of this entity and describes several new histological variants.