Immunohistochemical Typing of Adenocarcinomas of the Pancreatobiliary System Improves Diagnosis and Prognostic Stratification

MethodsThis was a retrospective observational cohort study on patients with adenocarcinoma of the pancreatobiliary system who underwent diagnostic core needle biopsy or surgical resection at a tertiary referral center. 409 tumor samples were analyzed with up to 27 conventional antibodies used in diagnostic pathology. Immunohistochemical scoring system was the percentage of stained tumor cells. Bioinformatic analysis, internal validation, and survival analysis were performed.ResultsHierarchical clustering and differential expression analysis identified three immunohistochemical tumor types (extrahepatic pancreatobiliary, intestinal, and intrahepatic cholangiocarcinoma) and the discriminant markers between them. Among patients who underwent surgical resection of their primary tumor with curative intent, the intestinal type showed an adjusted hazard ratio of 0.19 for overall survival (95% confidence interval 0.05–0.72; p value = 0.014) compared to the extrahepatic pancreatobiliary type.ConclusionsIntegrative immunohistochemical classification of adenocarcinomas of the pancreatobiliary system results in a characteristic immunohistochemical profile for intrahepatic cholangiocarcinoma and intestinal type adenocarcinoma, which helps in distinguishing them from metastatic and pancreatobiliary type adenocarcinoma, respectively. A diagnostic immunohistochemical panel and additional extended panels of discriminant markers are proposed as guidance for their pathological diagnosis.     

The Milk Protein Trial: Influence Analysis of the Dropout Process

Diggle and Kenward (1994) proposed a selection model for continuous longitudinal data subject to possible non‐random dropout. Their method in general, and the milk protein example in particular, has provoked a large debate about the role of such models. The original enthusiasm was followed by skepticism about the strong but untestable assumption upon which this type of models invariably rests. Concern was raised about the very nature of incompleteness which is arguably more due to design reasons (the experiment was stopped due to insufficient feed supply), than to genuine dropout. In the meantime, the view has emerged that these models should ideally be made part of a sensitivity analysis. This paper presents a formal and flexible approach to such a sensitivity assessment, based on both global influence (Chatterjee and Hadi , 1988) as well as local influence (Cook , 1986). It will be argued that local influence is more apt to zoom in on a particular source of influence, such as the assumed non‐response mechanism. The method is applied to a set of data on milk protein contents in dairy cattle. The same data were used in the original paper by Diggle and Kenward (1994), who concluded that the dropout process was non‐random.     

Exercise-induced, but not creatine-induced, decrease in intramyocellular lipid content improves insulin sensitivity in rats

The effect of creatine supplementation, alone or in combination with exercise training, on insulin sensitivity, intramyocellular lipid content (IMCL) and fatty acid translocase (FAT)/CD36 content was investigated in rats fed a sucrose-rich cafeteria diet during 12 weeks. Five experimental conditions were CON, receiving normal pellets; CAF, fed the cafeteria diet; CAF_TR, fed the cafeteria diet together with exercise training in weeks 8-12 and CAF_CR and CAF_CRT that were analogous to CAF and CAF_TR, respectively, but which received daily 2.5% of creatine monohydrate. During intravenous glucose tolerance test, compared with CON, whole-body glucose tolerance was reduced in CAF and CAF_CR but not in CAF_TR and CAF_CRT. Insulin-stimulated glucose transport in perfused red gastrocnemius muscles was impaired in CAF and CAF_CR but not in the trained groups. IMCL content in soleus and extensor digitorum longus muscles was higher in CAF than in CON, but not in CAF_TR, CAF_CR and CAF_CRT. Compared with CON and CAF, FAT/CD36 protein content in m. soleus, was ∼40% lower in CAF_CR, CAF_TR and CAF_CRT. The fraction of fecal fat, as determined in a 3-week post hoc study, was 25% higher in CAF_CR than in CON. Moreover, in CAF_CR, triglyceride concentration in blood and liver were significantly lower than in CAF. It is concluded that creatine supplementation in rats on a cafeteria diet inhibits IMCL accumulation via inhibition of gastrointestinal lipid absorption together with lower muscle FAT/CD36 content. Furthermore, exercise-induced but not creatine-induced reduction of IMCL is associated with improved insulin action on glucose transport in muscle cells.     

Soluble Tumor Necrosis Factor Receptor 1 and 2 Predict Outcomes in Advanced Chronic Kidney Disease: A Prospective Cohort Study

Background

Soluble tumor necrosis factor receptors 1 (sTNFR1) and 2 (sTNFR2) have been associated to progression of renal failure, end stage renal disease and mortality in early stages of chronic kidney disease (CKD), mostly in the context of diabetic nephropathy. The predictive value of these markers in advanced stages of CKD irrespective of the specific causes of kidney disease has not yet been defined. In this study, the relationship between sTNFR1 and sTNFR2 and the risk for adverse cardiovascular events (CVE) and all-cause mortality was investigated in a population with CKD stage 4-5, not yet on dialysis, to minimize the confounding by renal function.

Patients and methods

In 131 patients, CKD stage 4-5, sTNFR1, sTNFR2 were analysed for their association to a composite endpoint of all-cause mortality or first non-fatal CVE by univariate and multivariate Cox proportional hazards models. In the multivariate models, age, gender, CRP, eGFR and significant comorbidities were included as covariates.

Results

During a median follow-up of 33 months, 40 events (30.5%) occurred of which 29 deaths (22.1%) and 11 (8.4%) first non-fatal CVE. In univariate analysis, the hazard ratios (HR) of sTNFR1 and sTNFR2 for negative outcome were 1.49 (95% confidence interval (CI): 1.28-1.75) and 1.13 (95% CI: 1.06-1.20) respectively. After adjustment for clinical covariables (age, CRP, diabetes and a history of cardiovascular disease) both sTNFRs remained independently associated to outcomes (HR: sTNFR1: 1.51, 95% CI: 1.30-1.77; sTNFR2: 1.13, 95% CI: 1.06-1.20). A subanalysis of the non-diabetic patients in the study population confirmed these findings, especially for sTNFR1.

Conclusion

sTNFR1 and sTNFR2 are independently associated to all-cause mortality or an increased risk for cardiovascular events in advanced CKD irrespective of the cause of kidney disease.     

Successful Outcome of Disseminated Fusarium musae Fungemia with Skin Localization Treated with Liposomal Amphotericin B and Voriconazole in a Patient with Acute Myeloid Leukemia

Fusarium spp. may cause invasive disseminated infections in immunocompromised patients, associated with significant morbidity and mortality. We describe a case of disseminated fusariosis with fungemia and skin localization caused by Fusarium musae in a patient with acute myeloid leukemia successfully treated using liposomal amphotericin B and voriconazole.