The immunotherapeutic role of indoleamine 2,3‐dioxygenase in head and neck squamous cell carcinoma: A systematic review

xlomafota13 shared this article with you from Inoreader The immunotherapeutic role of indoleamine 2,3‐dioxygenase in head and neck squamous cell carcinoma: A systematic review Via Clinical Otolaryngology Abstract Background Novel cancer immunotherapy seeks to harness the body's own immune system and tip the balance in favour of antitumour activity. The intracellular enzyme indoleamine 2,3-dioxygenase (IDO) is a critical regulator of the tumour microenvironment (TME) via tryptophan metabolism. The potential immunotherapeutic role of IDO in head and neck squamous cell carcinoma (HNSCC) requires further exploration. We aim to assess the evidence on IDO in HNSCC. Methods A systematic review of literature and clinical trials databases. Results We included 40 studies: seven involved cell lines: eight assessed tumour immunohistochemistry: ten measured IDO gene transcription: 15 reported on clinical trials. Increased cell line IDO expression was postulated to adversely affect tumour metabolism and apoptosis. Immunohistochemical IDO expression correlated with worse survival. Gene transcription studies associated IDO with positive PD-L1 and human papillomavirus (HPV) status. Phase I/II clinical trials showed (a) overall response (34%-55%) and disease control rates (62%-70%) for IDO1 inhibitor in combination with a PD-1 inhibitor, (b) similar safety profiles when both are used in combination therapy compared to each as monotherapies and (c) IDO gene expression as a predictive biomarker for response to PD-L1 therapy. Conclusions IDO expression is increased in the TME of HNSCC, which correlates with poor prognosis. However, the exact mechanism of IDO-driven immune modulation in the TME is an enigma. Future translational studies should map IDO activity during HNSCC treatment and elucidate its precise role in the TME, such research will underpin the development of clinical trials establishing the efficacy of IDO inhibitors in HNSCC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pure large cell neuroendocrine carcinoma originating from the endometrium: A case report

paythelady.612 shared this article with you from Inoreader Pure large cell neuroendocrine carcinoma originating from the endometrium: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3449-3457. doi: 10.12998/wjcc.v9.i14.3449. ABSTRACT BACKGROUND: Large cell neuroendocrine carcinoma (LCNEC) of the endometrium is an uncommon and highly aggressive tumor that has not been comprehensively characterized. We report a case of pure endometrial LCNEC and review the current literature of similar cases to raise awareness of the histological features, treatment, and prognosis of this tumor. CASE SUMMARY: We report the case of a 73-year-old woman who presented with irregular postmenopausal vaginal bleeding. Ultrasonography showed an enlarged uterus and a 5.1 cm × 3.3 cm area of medium and low echogenicity in the uterine cavity. Biopsy by dilatation and curettage suggested poorly differentiated carcinoma. Magnetic resonance imaging revealed a heterogeneously enhanced uterine tumor with diffuse infiltration of the posterior wall of the uterine myometrium and enlarged pelvic lymph nodes. The patient underwent a hysterectomy and bilateral adnexal resection. Gross observation revealed an ill-defined white solid mass of the posterior wall of the uterus infiltrating into the serosa with multiple solid nodules on the serous surface. Microscopically, the tumor cells showed neuroendocrine morphology (organoid nesting). Immunohistochemistry revealed the tumor cells were diffusely positive for the neuroendocrine markers CD56, chromogranin A, and synaptophysin. Thus, the tumor was diagnosed as stage IIIC endometrial LCNEC. CONCLUSION: Pathologic findings and immunohistochemistry are essential in making a diagnosis of endometrial LCNEC. PMID:34002157 | PMC:PMC8107915 | DOI:10.12998/wjcc.v9.i14.3449 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Burden of atrial fibrillation in patients with rheumatic diseases

paythelady.612 shared this article with you from Inoreader Burden of atrial fibrillation in patients with rheumatic diseases Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3252-3264. doi: 10.12998/wjcc.v9.i14.3252. ABSTRACT BACKGROUND: Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation. AIM: To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD. METHODS: The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD. RESULTS: The prevalence of AF was 23.9% among all patients with RD (n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with g out (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen's syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%). CONCLUSION: A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF. PMID:34002134 | PMC:PMC8107898 | DOI:10.12998/wjcc.v9.i14.3252 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3458-3465. doi: 10.12998/wjcc.v9.i14.3458. ABSTRACT BACKGROUND: Diabetic mastopathy is a rare benign disease in clinical practice that mainly occurs in young and middle-aged women with type 1 diabetes. It has also been reported that this disease can be found in patients with type 2 diabetes and other autoimmune diseases, such as Hashimoto's thyroiditis, as well as in men. The pathogenesis of diabetic mastopathy is not yet clear, and it is easily confused with breast cancer due to their similar clinical manifestations and imaging features. CASE SUMMARY: A 69-year-old female patient was admitted because of painless breast masses, with a history of type 2 diabetes. The imaging and physical examination suggested a high risk of breast cancer. Further histopathological analysis showed dense lymphocytes infiltrating around the lobules of the breast, and extensive fibrosis of the surrounding stroma. Finally, diabetic mastopathy was diagnosed. CONCLUSION: The diagnosis of diabetic mastopathy in elderly patients with painless breast masses is difficult to distinguish from breast cancer, and its imaging manifestations are not specific. PMID:34002158 | PMC:PMC8107902 | DOI:10.12998/wjcc.v9.i14.3458 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skeletal muscle metastases of hepatocellular carcinoma: A case report and literature review

paythelady.612 shared this article with you from Inoreader Skeletal muscle metastases of hepatocellular carcinoma: A case report and literature review Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3334-3341. doi: 10.12998/wjcc.v9.i14.3334. ABSTRACT BACKGROUND: The metastasis of liver cancer to skeletal muscle is extremely rare compared to other sites. We herein report a case of rapidly developing skeletal metastases following liver transplantation due to primary liver cancer. CASE SUMMARY: A 70-year-old male with underlying chronic hepatitis B virus infection was diagnosed with hepatocellular carcinoma (HCC), for which he underwent liver transplantation in 2014. Six years after receiving the transplant, pathological examination confirmed the presence of HCC without vascular invasion. He was admitted to the hospital with a rapidly growing mass on his right thigh. Ultrasound examination revealed a mixed echo mass in the lateral soft tissue of the middle part of the right femur. Magnetic resonance imaging showed heterogeneous iso-signal intensity on T1-weighted images and heterogeneous hy per-intensity on T2-weighted images compared to the surrounding muscles. Pathological examination of the ultrasound-guided needle biopsy specimen revealed that it was similar to the previously detected liver cancer; the diagnosis was metastasis of HCC. Surgical excision was performed. There were no other sites of metastasis, and the patient recovered well after surgery. CONCLUSION: This report presents a rare case of skeletal metastasis following liver transplantation for HCC. The study suggests a possible role for skeletal muscle metastasis mechanisms, which should be the focus of future research. PMID:34002142 | PMC:PMC8107905 | DOI:10.12998/wjcc.v9.i14.3334 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cronkhite-Canada syndrome with steroid dependency: A case report

paythelady.612 shared this article with you from Inoreader Cronkhite-Canada syndrome with steroid dependency: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3466-3471. doi: 10.12998/wjcc.v9.i14.3466. ABSTRACT BACKGROUND: Cronkhite-Canada syndrome (CCS) is a rare nonhereditary disease characterized by chronic diarrhoea, diffuse gastrointestinal polyposis and ectodermal manifestations. The lethality of CCS can be up to 50% if it is untreated or if treatment is delayed or inadequate. More than 35% of the patients do not achieve long-term clinical remission after corticosteroid administration, with relapse occurring during or after the cessation of glucocorticoid use. The optimal strategy of maintenance therapy of this disease is controversial. CASE SUMMARY: A 47-year-old man presented to the hospital with a 3-mo history of frequent watery diarrhoea, accompanied by macular skin pigmentation that included the palms and soles, and onychodystrophy of the fingernails and toenails. Gastroscopy and colonoscopy revealed numerous polyps in the stomach and co lon. After other possibilities were ruled out by a series of examinations, CCS was diagnosed and treated with prednisone. The patient took prednisone for more than 1 year before achieving complete resolution of his symptoms and endoscopic findings. The patient was then given prednisone 5 mg/d for 6 mo of maintenance therapy. With clinical improvement and polyp regression, prednisone was discontinued. Eight mo after the discontinuation of prednisone, the diarrhoea and gastrointestinal polyps relapsed. Therefore, the patient was given the same dose of prednisone, and complete remission was achieved again. CONCLUSION: It is necessary to extend the duration of prednisone maintenance therapy for CCS. Prednisone is still effective when readministered after relapse. Surveillance endoscopy at intervals of 1 year or less is recommended to assess mucosal disease activity. PMID:34002159 | PMC:PMC8107897 | DOI:10.12998/wjcc.v9.i14.3466 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cluster headache due to structural lesions: A systematic review of published cases

paythelady.612 shared this article with you from Inoreader Cluster headache due to structural lesions: A systematic review of published cases Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3294-3307. doi: 10.12998/wjcc.v9.i14.3294. ABSTRACT BACKGROUND: Cluster headache (CH) is a severe incapacitating headache disorder. By definition, its diagnosis must exclude possible underlying structural conditions. AIM: To review available information on CLH caused by structural lesions and to provide better guides in the distinguishing process and to ensure that there is not a potentially treatable structural lesion. METHODS: We conducted a systematic review of 77 published cases of symptomatic CH and cluster-like headache (CLH) in PubMed and Google Scholar databases. RESULTS: Structural pathologies associated with CH were vascular (37.7%), tumoral (32.5%) and inflammatory (27.2%). Brain mass-like lesions (tumoural and inflammatory) were the most common diseases (28.6%), among which 77.3% lesions were at the suprasellar (pituitary) region. Cases of secondary CH related to sinus itis rose dramatically, occupying 19.5%. The third most common disease was internal carotid artery dissection, accounting for 14.3%. Atypical clinical features raise an early suspicion of a secondary cause: Late age at onset and eye and retroorbital pains were common conditions requiring careful evaluation and were present in at least one-third of cases. Abnormal neurological examination was the most significant red flag for impaired cranial nerves. CLH patients may be responsive to typical CH treatments; therefore, the treatment response is not specific. CLH can be triggered by contralateral structural pathologies. CLH associated with sinusitis and cerebral venous thrombosis required more attention. CONCLUSION: Since secondary headache could perfectly mimick primary CH, neuroimaging should be conducted in patients in whom primary and secondary headaches are suspected. Cerebral magnetic resonance imaging scans is the diagnostic management of choice, and further examinations in clude vessel imaging with contrast agents and dedicated scans focusing on specific cerebral areas (sinuses, ocular and sellar regions). Neuroimaging is as necessary at follow-up visits as at the first observation. PMID:34002138 | PMC:PMC8107893 | DOI:10.12998/wjcc.v9.i14.3294 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extremely rare case of necrotizing gastritis in a patient with autoimmune hepatitis: A case report

paythelady.612 shared this article with you from Inoreader Extremely rare case of necrotizing gastritis in a patient with autoimmune hepatitis: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3472-3477. doi: 10.12998/wjcc.v9.i14.3472. ABSTRACT BACKGROUND: Autoimmune hepatitis can cause liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. Its treatment option include the use of steroids and/or immune-suppressive agents such as azathioprine. However, these drugs have some side effects. Thus, close follow-up is needed during treatment. Here, we present an extremely rare case of a patient with an autoimmune hepatitis who died from necrotizing gastritis during immunosuppressive treatment. CASE SUMMARY: A 52-year-old female patient was diagnosed with autoimmune hepatitis. We treated this patient with immunosuppressive agents. High-dose steroid treatment was initially started. Then azathioprine treatment was added while steroid was tapering. Five weeks after the start of treatment, she visited the emergency room due to generalized abdominal pain and vomiting. After computed tom ography scan, the patient was diagnosed with necrotizing gastritis and the patient progressed to septic shock. Treatment for sepsis was continued in the intensive care unit. However, the patient died at 6 h after admission to the emergency room. CONCLUSION: In patients with autoimmune infections undergoing immunosuppressant therapy, rare complications such as necrotizing gastritis may occur, thus requiring clinical attention. PMID:34002160 | PMC:PMC8107894 | DOI:10.12998/wjcc.v9.i14.3472 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Incremental value of three-dimensional and contrast echocardiography in the evaluation of endocardial fibroelastosis and multiple cardiovascular thrombi: A case report

paythelady.612 shared this article with you from Inoreader Incremental value of three-dimensional and contrast echocardiography in the evaluation of endocardial fibroelastosis and multiple cardiovascular thrombi: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 16;9(14):3365-3371. doi: 10.12998/wjcc.v9.i14.3365. ABSTRACT BACKGROUND: Endocardial fibroelastosis (EFE) is a rare heart disease characterized by thickening of the endocardium caused by massive proliferation of collagenous and elastic tissue, usually leading to impaired cardiac function. Multimodality cardiovascular imaging for the evaluation of EFE with thrombi is even rarer. CASE SUMMARY: We report a rare case of EFE associated with multiple cardiovascular thrombi. Three-dimensional (3D) and contrast echocardiography (CE) were used to assess ventricular thrombi. Anticoagulant therapy was administered to eliminate the thrombi. The peripheral contrast-enhanced thrombi with the highest risk were dissolved with anticoagulant therapy at the time of reexamination, which was consistent with the presumption of fresh loose thrombi. CONCLUSION: This new echocardiography technique has a great advantage in the diagnosis and treatment of EFE. On the basis of conventional echocardiography, 3D echocardiography is used to display the position, shape, and narrow base of the thrombus. CE does not only help to confirm the diagnosis of thrombus, but also determines its risk. PMID:34002146 | PMC:PMC8107911 | DOI:10.12998/wjcc.v9.i 14.3365 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adaptation and Validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES

xlomafota13 shared this article with you from Inoreader Adaptation and Validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES Via swallowing exercises J Speech Lang Hear Res. 2021 May 25:1-9. doi: 10.1044/2021_JSLHR-21-00014. Online ahead of print. ABSTRACT Purpose While flexible endoscopic evaluation of swallowing (FEES) is a common clinical procedure used in the head and neck cancer (HNC) population, extant outcome measures for FEES such as bolus-level penetration-aspiration and residue scores are not well suited as global patient-level endpoint measures of dysphagia severity in cooperative group trials or clinical outcomes res earch. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) was initially developed and validated for use during videofluoroscopic evaluations as a way to grade safety, efficiency, and overall pharyngeal swallowing impairment. The purpose of this study was to adapt and validate DIGEST for use with FEES. Method A modified Delphi exercise was conducted for content validation, expert consensus, adaptation, and operationalization of DIGEST-FEES. Three blinded, expert raters then evaluated 100 de-identified post-HNC treatment FEES examinations. Intra- and interrater reliability were tested with quadratic weighted kappa. Criterion validity against the MD Anderson Dysphagia Inventory, Functional Oral Intake Scale, Secretion Severity Scale, and Yale Residue Rating Scale was assessed with Spearman correlation coefficients. Results Interrater reliability was almost perfect for overall DIGEST-FEES grade (κw = 0.83) and safety grade (κw = 0.86) and substantial for e fficiency grade (κw = 0.74). Intrarater reliability was excellent for all raters (0.9-0.91). Overall DIGEST-FEES grade correlated with MD Anderson Dysphagia Inventory (r = -.43, p < .0001), Functional Oral Intake Scale (r = -.43, p < .0001), Secretion Severity Scale (r = .47, p < .0001), Yale Vallecular Residue (r = .73, p < .0001), and Yale Pyriform Sinus Residue (r = .65, p < .0001). Conclusion DIGEST-FEES is a valid and reliable scale to describe the severity of pharyngeal dysphagia in patients with HNC. Supplemental Material https://doi.org/10.23641/asha.14642787. PMID:34033498 | DOI:10.1044/2021_JSLHR-21-00014 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.