Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature

Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.

Occult hepatitis B virus infection among Egyptian blood donors

AIM:To identify blood donors with occult hepatitis B virus(HBV) infection(OBI) to promote safe blood donation.METHODS:Descriptive cross sectional study was conducted on 3167 blood donors negative for hepatitis B surface antigen(HBsAg),hepatitis C antibody(HCV Ab) and human immunodeficiency virus Ab.They were subjected to the detection of alanine aminotransferase(ALT) and aspartate transaminase(AST) and screening for anti-HBV core antibodies(total) by two different techniques;[Monoliza antibodies to hepatitis B core(Anti-HBc) Plus-Bio-Rad] and(ARC-HBc total-ABBOT).Positive samples were subjected to quantitative detection of antibodies to hepatitis B surface(anti-HBs)(ETI-AB-AUK-3,Dia Sorin-Italy).Serum anti-HBs titers > 10 IU/L was considered positive.Quantitative HBV DNA by real time polymerase chain reaction(PCR)(QIAGEN-Germany) with 3.8 IU/mL detection limit was estimated for blood units with negative serum anti-HBs and also for 32 whose anti-HBs serum titers were > 1000 IU/L.Also,265 recipients were included,34 of whom were followed up for 3-6 mo.Recipients were investigated for ALT and AST,HBV serological markers:HBsAg(ETI-MAK-4,Dia Sorin-Italy),anti-HBc,quantitative detection of anti-HBs and HBV-DNA.RESULTS:525/3167(16.6%) of blood units were positive for total anti-HBc,64% of those were antiHBs positive.Confirmation by ARCHITECT anti-HBc assay were carried out for 498/525 anti-HBc positive samples,where 451(90.6%) confirmed positive.Reactivity for anti-HBc was considered confirmed only if two positive results were obtained for each sample,giving an overall prevalence of 451/3167(14.2%) for total anti-HBc.HBV DNA was quantified by real time PCR in 52/303(17.2%) of anti-HBc positive blood donors(viral load range:5 to 3.5 x 105 IU/mL) with a median of 200 IU/mL(mean:1.8 x 104 ± 5.1 x 104 IU/mL).AntiHBc was the only marker in 68.6% of donors.Univariate and multivariate logistic analysis for identifying risk factors associated with anti-HBc and HBV-DNA positivity among blood donors showed that age above thirty and marriage were the most significant risk factors for prediction of anti-HBc positivity with AOR 1.8(1.4-2.4) and 1.4(1.0-1.9) respectively.Other risk factors as gender,history of blood transfusion,diabetes mellitus,frequent injections,tattooing,previous surgery,hospitalization,Bilharziasis or positive family history of HBV or HCV infections were not found to be associated with positive anti-HBc antibodies.Among anti-HBc positive blood donors,age below thirty was the most significant risk factor for prediction of HBV-DNA positivity with AOR 3.8(1.8-7.9).According to HBV-DNA concentration,positive samples were divided in two groups;group one with HBV-DNA ≥ 200 IU/mL(n = 27) and group two with HBV-DNA < 200 IU/mL(n = 26).No significant difference was detected between both groups as regards mean age,gender,liver enzymes or HBV markers.Serological profiles of all followed up blood recipients showed that,all were negative for the studied HBV markers.Also,HBV DNA was not detected among studied recipients,none developed post-transfusion hepatitis(PTH) and the clinical outcome was good.CONCLUSION:OBI is prevalent among blood donors.Nucleic acid amplification/HBV anti core screening should be considered for high risk recipients to eliminate risk of unsafe blood donation.

Neuroblastoma in Saudi Children: A Single Center Experience (2006-2014)

Introduction: Neuroblastoma is the most common extracranial solid tumor in childhood and survival rate has improved during the last few decades. Only a few studies, related to Neuroblastoma in Saudi Arabian children, have been performed. We report epidemiologic data and our clinical experience from the department of Pediatric Hematology Oncology (PHO), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Method: A retrospective observational study of all patients, with diagnosis of Neuroblastoma, who attended PHO-KFMC from July 2006 to June 2014 was performed. The survival periods (overall survival and disease-free survival) and the final outcomes for patients treated and followed at KFMC were recorded. The survival data were statistically correlated with the clinical, pathological and biological features of patients and tumors and compared to national and international cohorts. Results: Eight-year data were available for the 42 patients of which 22 (52.4%) were male and 20 (47.6%) were females. Age at diagnosis ranged 0 - 91 months with a mean and median of 26.3 and 18.5 months respectively. 16 (38.1%) patients were under one year and 26 (61.9%) above 1 year of age. The event-free survival (EFS) and overall survival (OS) rates were 66.5% and 71.5% respectively. EFS and OS among those who were <1 year age at presentation was 75% and 82%, whereas ≥1 yr age group had 59% and 62% survival rates respectively. Patients with tumors in the adrenal had considerably lower EFS (59%) and OS (63%);in comparison to patients with tumors sites other than the adrenal who had EFS and OS of 85% and 89% respectively. Both EFS and OS survival rates at the end of follow-up interval were 100.0%, in the low and intermediate risk groups. In contrast, patients in the high risk group had EFS and OS rates of 44% and 48% respectively. This difference was statistically significant (p < 0.05). Conclusion: Our results are very encouraging and comparable with known published international cohorts, and reveal an excellent outcome for stage 1, 2, 3 & 4 s. The prognosis for advanced (stage 4) disease remains rather poor. A collaborative Saudi-wide effort, with an emphasis on research in detecting clinical and biologic characteristics of aggressive disease and tailoring therapy, is needed.

A Retrospective Evaluation of Chemotherapy Regimens in Unselected Patients with Metastatic Non-Small Cell Lung Cancer

Background: Randomized clinical trials have demonstrated the benefits of chemotherapy in carefully selected non-small cell lung cancer (NSCLC) patients. How generalizable these results are to other NSCLC patients is unresolved. Methods: The outcomes of patients treated with standard chemotherapy regimens (paclitaxel / carboplatin;gemcitabine / carboplatin;pemetrexed / carboplatin;paclitaxel / carboplatin / bevacizumab) off study as first line therapy between 2002 and 2012 at our institution were compared to the reported results of trials supporting the FDA approval of these drugs and/or regimens. Results: In our population, 38.1% of the patients had hypertension, 11.9% of the patients were diabetic, 23.7% had chronic obstructive pulmonary disease (COPD), 11.9% had coronary artery disease (CAD) and 2.1% had renal or liver disease. Notably, the presence of a single or multiple comorbidities was associated with low overall survival compared to matched patients with no comorbidities (p = 0.007). Conclusion: The presence of single or multiple comorbidities is associated with inferior overall survival compared to matched groups without such pre-existing conditions.

Dexamethasone versus Prednisone in Childhood Acute Lymphoblastic Leukemia Treatment: Results of the Indonesian Randomized Trial

Background: Randomized trials report that, compared to prednisone, dexamethasone has reduced CNS relapse and improved event-free survival (EFS), despite a trend toward a higher risk for induction death. Because toxic death is a specific problem in the Indonesian setting, this study compares the outcome of dexamethasone versus prednisone. Methods: In the period 2006 - 2011, 196 patients with childhood acute lymphoblastic leukemia (ALL) treated on the Indonesia-ALL-2006 protocol [first standard risk (SR) and later high risk (HR) patients] were randomized to receive dexamethasone or prednisone as steroid. Patients in the dexamethasone arm (n = 102: 68 SR, 34 HR) received dexamethasone 4 mg/m2/day (SR) or 6 mg/m2/day (HR), while the prednisone arm (n = 94: 66 SR, 28 HR) received prednisone 40 mg/m2/day (SR and HR). Results: Patients in the dexamethasone arm showed no significant difference compared to the prednisone arm in abandonment rate (24.5% vs. 25.5%, P = 0.91), death rate (17.7% vs. 14.9%, P = 0.54), or leukemic events (13.7 vs. 11.7%, P = 0.59). After stratification for risk group, a trend towards a higher death rate was found in the dexamethasone arm of SR patients (16.2 vs. 6.1%, P = 0.06). The 3-year survival for EFS in SR and HR patients for dexamethasone versus prednisone was 31.5% ± 6.6% vs. 41.5% ± 5.9% (P = 0.51), for leukemia-free survival (LFS) it was 63.7% ± 9.3% vs. 74.5% ± 7.6% (P = 0.47), and for overall survival (OS) it was 49.5% ± 7.7% vs. 69.3% ± 6.1% (P = 0.09). Conclusions: In our setting, a trend toward higher induction deaths was observed in the dexamethasone arm of SR patients and the 3-year EFS;LFS and OS rates were lower in the dexamethasone group;however, these differences were not significant.

Rare primary presentation of chronic lymphocytic leukemia as chronic orbital space occupying lesion

Dear Sir,I am Dr. Vaibhav Kumar Jain from the Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. I a case report about the rare primary lymphocytic leukemia （CLL） as occupying lesion. write to present presentation of chronic chronic orbital space

Force-dependent calcium signaling and its pathway of human neutrophils on P-selectin in flow

P-selectin engagement of P-selectin glycoprotein Iigand-1 （PSGL-1） causes circulating leukocytes to roll on and adhere to the vascular surface, and mediates intracellular calcium flux, a key but unclear event for subsequent arresting firmly at and migrating into the infection or injured tissue. Using a parallel plate flow chamber technique and intracellular calcium ion detector （Fluo-4 AM）, the intracellular calcium flux of firmly adhered neutrophils on immobilized P-selectin in the absence of chemokines at various wall shear stresses was investigated here in real time by fluorescence microscopy. The results demon- strated that P-selectin engagement of PSGL-1 induced the intracellular calcium flux of firmly adhered neutrophils in flow, increasing P-selectin concentration enhanced cellu- lar calcium signaling, and, force triggered, enhanced and quickened the cytoplasmic calcium bursting of neu- trophils on immobilized P-selectin. This P-selectin-induced calcium signaling should come from intracellular calcium release rather than extracellular calcium influx, and be along the mechano-chemical signal pathway involving the cytoskeleton, moesin and Spleen tyrosine kinase （Syk）. These results provide a novel insight into the mechano-chemical regulation mechanism for P-selectininduced calcium signaling of neutrophils in flow.

Regulation and functions of integrin a2 in cell adhesion and disease

Integrins are cell adhesion molecules that are composed of an alpha(a)subunit and a beta(b)subunit with affinity for different extracellular membrane components.The integrin family includes 24 known members that actively regulate cellular growth,differentiation,and apoptosis.Each integrin heterodimer has a particular function in defined contexts as well as some partially overlapping features with other members in the family.As many reviews have covered the general integrin family in molecular and cellular studies in life science,this review will focus on the specific regulation,function,and signaling of integrin a2 subunit(CD49b,VLA-2;encoded by the gene ITGA2)in partnership with b1(CD29)subunit in normal and cancer cells.Its roles in cell adhesion,cell motility,angiogenesis,stemness,and immune/blood cell regulations are discussed.The pivotal role of integrin a2 in many diseases such as cancer suggests its potential to be used as a novel therapeutic target.