The apoptosis pathway is a programmed cell death mechanism that is crucial for cellular and tissue homeostasis and organ development. There are three major caspase‐dependent pathways of apoptosis that ultimately lead to DNA fragmentation. Cancerous cells are known to highly regulate the apoptotic pathway and its role in cancer hallmark acquisition has been discussed over the past decades. Numerous mutations in cancer cell types have been reported to be implicated in chemoresistance and treatment outcome. In this review, we summarize the mutations of the caspase‐dependant apoptotic pathways that are the source of cancer development and the targeted therapies currently available or in trial.
e16169 Background: Surgical resection can provide an increase in survival for incurable patients with cholangiocarcinoma (CCA); Since outcomes improve significantly with more aggressive intervention liver resection (LR) should be pursued together with common bile duct resection (CBDR). We aimed to analyze the trends of surgical management of hilar CCA also known as Klatskin tumor (KT) across 15 years in the U.S. Methods: We extracted two cohorts of hospitalizations from Nationwide Inpatient Sample (NIS) 2005-2019yy using ICD-9 and ICD-10 diagnosis and procedure codes for KT, CBDR and LR. First group of patients with KT had CBDR performed alone and the second group of KT patients received CBDR and LR during the same hospitalization. We compared mortality, performed socio-demographic analysis stratified by patient and hospital information and used length of stay (LOS) and mean charges (MC) as additional outcomes. Results: We extracted a total of 3,095 hospitalizations with KT that underwent CBDR alone or CBDR with LR. There was a transition in proportion of CBDR alone versus CBDR with LR across years, which we attribute to the change in coding from ICD-9 to ICD- 10, with the combined coding year 2015 demonstrating equalization of proportion of performed procedures prior to the flip in 2016. Since ICD-10 procedure coding was more specific for CBDR and LR, we as a result of this conclude that ICD-10 coding years 2016 and onward are more accurate and the latest trends demonstrate the increasing performance of only CBDR in KT patients rather than CBDR with LR (75% vs. 25% in 2019). Analysis of socio-demographics is presented in the Table. More than 2/3 of the patients were above age 60. Proportionally CBDR alone was more likely to be covered by public insurance than CBDR with LR (Public: 63.7% vs. 57.1%; Private: 34% vs. 40%). Even though it is a more invasive intervention, CBDR with LR had slightly less mean overall charges (MC=$223,903 for CBDR vs. $212,072 for CBDR with LR (P=0.5574)) and similar hospital resource utilization (LOS= 14 days for CBDR vs.14.7 days for CBDR with LR) compared to CBDR alone. Most of the procedures (>94%) were performed in teaching hospitals. Inpatient mortality was 5.5% for CBDR alone vs. 8.7 % for CBDR with LR. Conclusions: Our analysis demonstrated that for KT proportionally, CBDR performance is more prevalent than CBDR with LR in the latest years 2016-2019. Considering the comparable cost and hospital resource utilization with intent to cure, more aggressive surgical management should be pursued. Inpatient mortality was higher for more aggressive surgical management 5.5% for CBDR alone vs. 8.7% for CBDR with LR. Insurance type may play a role in the procedure choice. [Table: see text]
Background: Vascular thrombotic events such as pulmonary embolisms have been frequently reported in the course of SARS-Cov-2 infection. However, sagittal sinus thrombus is extremely rare, and patients may lack other appealing Covid-19 infection symptoms. Case report: 46-year-old female with past medical history of Hyperlipidemia, Hypertension presented to Emergency room with headache, chest pain, vomiting. SARS-CoV-2 IgG Antibodies were reactive. Except for elevated PTT-Lupus Anticoagulant at 50 Sec, Hypercoagulable workup was negative. The MRI venogram findings were consistent with the Dural thrombus of superior sagittal sinus. Patient subsequently developed chest pain, and Computed tomography angiography found pulmonary emboli within segmental branches of the right lower lobe pulmonary artery. Patient was managed in the ICU with Heparin and switched to Coumadin for discharged. Conclusion: The incidence of Cerebral Venous Sinus thrombus (CVST) among Covid-19 patients is inferior to 0.02%. And most of the patients lack typical Covid-19 presentations such as pneumonia. The lack of symptoms may promote the insidious course of pre-thrombotic events that lead to CVST. However more Retrospective studies are necessary to established consistent odd ratios. Due to the higher mortality associated with CVST and the ongoing of Covid-19 pandemic, we recommend a higher level of clinical suspicion.
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