Third-line culture-guided treatment often fails to eradicate H. pylori infection. We need to find factors other than in-vitro antibiotic resistance to explain these suboptimal results.
BackgroundQuantification of B and T-cells infiltrate in minor salivary glands (MSG) of primary Sjögren's syndrome (pSS) patients is an on-going challenge. It might be a powerful tool to predict pSS prognosis (1). Manual counting on serial images is the most widely used method, but is very time consuming (2).ObjectivesOur objectives were to develop and evaluate an automated digital method to quantitatively assess B and T-cell infiltrate in a whole gland section.Methods62 complete sections of MSG from well characterized pSS patients were studied. MSG histology was analysed according to the classical Chisholm's classification, the Tarpley's score, the presence of germinal centres and the focus score. B and T-cells were respectively immunostained with CD-20 and CD-3 antibodies using red and brown chromogenes. Slides were digitized and spliced into a mosaic of smaller JPEG-format images. The digital procedure was based on colour isolation of red and brown signal for each pixel. Results were obtained as a number of pixels per JPEG-format image. The digital procedure was compared to a manual cell counting method by two pathologists, on a panel of 31 JPEG-format images. For each MSG of the cohort, digital B and T-cell counts were performed for one whole gland section. Levels of agreement between manual and digital methods were evaluated using Bland-Altman plots and ICC.ResultsWe found a good correlation between the number of pixels and the manual cell count. Intraclass coefficients between digital and manual quantification on the 31 JPEG-format images was excellent with ICC =0.92 (95% 0.85 -0.96) for B and T-cells. We observed a significant positive correlation between B-cell proportion (B cells/ total lymphocytic infiltrate) and the focus score (Spearman coefficient 0.463, P<0.0001). Median B-cell proportion was 2.5% (0.2-13.9) vs 30.0% (15.5-45.2) in MSG with Chisholm score 1-2 (n=24) vs 3-4 (n=38), respectively; 2.2% (0.2-6.6), 27.2% (13.0-38.9) and 48.5% (29.4-56.4) in MSG with Tarpley score of 1 (n=23), 2 (n=23), and 3-4 (n=16), respectively; and 12.3% (1.9-30.6) vs 51.4% (36.6-58.9) in MSG without germinal centres (n=50) versus MSG with germinal centres (n=12), respectively (P<0.001 for all comparisons). The time needed to analyse a whole MSG section was less than 3 minutes on average using this digital count.ConclusionsThis digital procedure exhibited good levels of accuracy compared to the gold standard. Software detection produced reliable, reproductive and fast results.ReferencesCarubbi F, Alunno A, Cipriani P, Benedetto P Di, Ruscitti P, Berardicurti O, et al. Is minor salivary gland biopsy more than a diagnostic tool in primary Sjögren's syndrome? Association between clinical, histopathological, and molecular features: a retrospective study. Semin Arthritis Rheum 2014;44:314–324.Christodoulou MI, Kapsogeorgou EK, Moutsopoulos HM. Characteristics of the minor salivary gland infiltrates in Sjögren's syndrome. J Autoimmun 2010;34:400–407.Disclosure of InterestNone declared
The association between cell phone use and the development of parotid tumors is controversial. Because there is unequivocal evidence that the microenvironment is important for tumor formation, we investigated in the parotid glands whether cell phone use alters the expression of cytokines. We used the saliva produced by the parotid glands to assess cytokines levels, comparing the saliva from the gland exposed to cell phone radiation (ipsilateral) to the saliva from the opposite, unexposed parotid (contralateral) of each individual. We compared salivary flow, total protein, IL-1 β, IL-6, IFN-γ and TNF-α between the ipsilateral and contralateral parotids of forty-three individuals. No difference was found for any of these parameters. Our study provides evidence that the exposure of parotid glands to cell phone use does not alter cytokines levels in the parotid. Supported by CAPES, FAPEMIG and CNPq, Brazil. Citation Format: Fabrício TA de Souza, Carolina C. Gomes, Luiz Armando De Marco, Elisa C. Siqueira, Samuel M. Costa, Jeane F. Correia-Silva, Ricardo S. Gomez. Cell phone use and cytokines expression in saliva of the parotid glands. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3297. doi:10.1158/1538-7445.AM2015-3297
A 55-year-old man was admitted to the emergency department because of decreased strength in his right limbs for 2 days. The only relevant information regarding his personal history was his daily alcohol intake of 80 g. On neurologic examination, he had nystagmus in all directions of gaze, right hemiparesis (grade 4), and hemihypoasthesia. A brain CT scan showed a space-occupying lesion in the left frontal lobe with vasogenic edema, conditioning a right midline shift. A brain MRI favored the hypothesis of secondary brain tumor (A), although the thoracoabdominal-pelvic CT scan showed normal results. The patient underwent resection of the left frontal lobe lesion, with recovery of neurologic deficits. Histologic examination of the specimen revealed metastasis of squamous cell carcinoma, with immunocytochemistry showing expression of p63 in cancer cells (B). In the meantime, the patient developed dysphagia, and esophagogastroduodenoscopy revealed an irregular and ulcerated esophageal lesion between 30 and 35 cm from the incisors (C). Histologic examination of biopsy specimens revealed a squamous cell carcinoma. This is a rare case of brain metastasis/neurologic symptoms as the initial presentation of esophageal cancer. CommentaryAlthough esophageal cancer is one of the 10 most common types of cancer worldwide, it represents only 1.0% of all new cancer cases in the United States. Humphrey Bogart, the American screen actor of the iconic film Casablanca, was a victim of this neoplasia, which is highly lethal; in fact, the number of deaths almost matches the number of new cases. Diagnosis is challenging, given that dysphagia, the typical presenting symptom, occurs when two thirds of the lumen is occluded. This leads to a delayed diagnosis, which is usually made in stages III and IV, resulting in poor survival. Distant metastasis is the main cause of morbidity and mortality in cancer patients. Although esophageal cancer metastases occur mainly to regional lymph nodes, solid viscera such as liver, lungs, and bones can also be involved. Brain involvement is extremely rare. According to published reports in Japan, the incidence of central nervous system (CNS) metastasis from esophageal cancer is 1.5%. Its development has been found to be related to increased tumor size. Documented mechanisms include invasion through the lymphatics or the bloodstream, through the vertebral venous system. The clinical presentation depends on the location and size of the tumor within the CNS, as shown in this patient. This case reveals that esophageal cancer can be an asymptomatic condition from the GI standpoint. Clinicians should be aware of this unusual metastatic pattern of squamous cell esophageal carcinoma.
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