Absence Of Nodes Research Articles

Primary lymphedema of the lower limb: the clinical utility of single photon emission computed tomography/CT.

ObjectiveThe aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb.Materials and MethodsFor a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65).ResultsIn comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%).ConclusionAs an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.

Expression analysis of heat shock protein 90 (HSP90) and Her2 in colon carcinoma.

The molecular chaperone heat shock protein 90 (HSP90) plays an important role in several types of tumors also participating in the modulation of the activity of receptor tyrosine kinases activity such as members of the Her family. We evaluated the significance of HSP90 and Her2 expression in colon cancer. HSP90 and Her2 expression was determined by immunohistochemistry and by fluorescence in situ hybridization (FISH) on 355 primary resected colon carcinomas. Results were correlated with pathologic features (Union for International Cancer Control (UICC) pTNM category, tumor localisation, tumor differentiation), additional molecular genetic characteristics (BRAF, KRAS mutational status, mismatch repair genes (MMR)), and survival. HSP90 immunoreactivity was observed in various degrees. Fifty-one cases (14 %) were positive for Her2 (score 2+ and 3+) with 16/43 cases with Her2 2+ staining pattern showing amplification of Her2 determined by FISH. There was a significant correlation between high HSP90 expression and Her2 overexpression (p = 0.011). High HSP90 expression was associated with earlier tumor stages (p = 0.019), absence of lymph node (p = 0.006), and absence of distant metastases (p = 0.001). Patients with high tumoral HSP90 levels had a better survival (p = 0.032), but this was not independent from other prognostic relevant pathologic parameters. Her2 expression was not associated with any of the investigated histopathological, molecular, or clinical parameters. High HSP90 levels are reflecting lower malignant potential in colon cancer. Her2 positivity can be observed in a small number of cases. Targeting HSP90 and/or Her2 may be an alternative therapeutic approach in colon cancer in a subset of patients.

Long-term results of salvage endoscopic treatment for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma.

207 Background: Local failure is a major problem after chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC), and salvage surgery presents high morbidity and mortality rates. We have introduced photodynamic therapy (PDT) and endoscopic resection (ER) for local failures to develop a less invasive salvage treatment.The aim of this retrospective study was to clarify the long-term outcome of salvage endoscopic treatments (SET). Methods: Between 1998 and 2008, 716 patients with ESCC were treated with definitive CRT in our institution. There were 314 patients with incomplete response and 103 with local recurrence after achieving complete response (CR) once. The indication criteria of SET were as follows: 1) absence of lymph node and distant metastasis and 2) local failures limited within T2. ER was performed for local failures limited to T1b (SM1), and PDT was performed for lesions invading T1b (SM2) or T2, in patients who could not tolerate or who refused surgery. We assessed overall survival (OS), relapse-free survival (RFS), and also prognostic factors. This study was approved by an institutional review board. Results: A total of 164 patients with local failure underwent SET (ER: 58, PDT: 106). The characteristics before CRT were as follows: T1/2/3/4, 44/25/75/20; N0/1, 85/79; stage I/II/III/IV, 35/59/57/13; and those of before SET were as follows: T1/2, 126/38; residue/recurrence, 76/88. ER achieved curative resection in 51 (87.9%), and PDT achieved CR in 61 (57.5%) patients. With a median follow up period of 73 months, the OS and RFS rates at 5 years from SET were 38.6% (95% CI 31.0–46.2) and 28.1% (95% CI 21.0–35.2). Multivariate analysis revealed 2 preferable prognostic factors in common for OS and RFS, N0 before CRT (OS HR: 0.47 [95% CI 0.32–0.69], RFS HR: 0.61 [95%CI 0.43–0.87]) and a period from initiation of CRT to SET longer than 6 months (OS HR: 0.57 [95%CI 0.39–0.84], RFS HR: 0.67 [0.47–0.95]). After 5 years of follow up, 58 patients (35.4%) were alive without any metastasis under esophagus preservation. Conclusions: SET demonstrated a favorable outcome in an analysis of a large number of patients with local failure after definitive CRT for ESCC.

Subcapsular sinus macrophages limit dissemination of West Nile virus particles after inoculation but are not essential for the development of West Nile virus-specific T cell responses

Macrophages encounter flaviviruses early after injection by arthropod vectors. Using in vivo imaging of mice inoculated with firefly luciferase-expressing single-cycle flavivirus particles (FLUC-SCFV), we examined the initial dissemination of virus particles in the presence or absence of lymph node (LN)-resident macrophages. Higher luciferase activity, indicating higher SCFV gene expression, was detected in the footpad of macrophage-depleted mice after 24h post infection (hpi). Moreover, FLUC-SCFV particles disseminated to the spleen within 14hpi in macrophage-depleted, but not control mice. Although macrophages presented SCFV to naïve T cells in vitro, depletion of subcapsular sinus (SCS) macrophages did not alter the magnitude or effector function of the WNV-specific CD8+ T cell response. Together, these results indicate that SCS macrophages play a role in limiting the dissemination of SCFV early in infection but are not required for the generation of a polyfunctional WNV-specific CD8+ T cell response in the draining LN.

Platelet-activating factor (PAF) receptor expression is associated with histopathological stage and grade and patients' survival in gastric adenocarcinoma.

Platelet activating factor (PAF) has been considered as potent inflammatory lipid mediator that exerts its actions by binding to PAF receptor (PAFR). PAF/PAFR system has been implicated in several pathophysiological states, including tumor progression, angiogenesis and metastasis. The present study aimed to evaluate the clinical significance of PAFR expression in gastric adenocarcinoma. PAFR protein expression was assessed immunohistochemically on 54 gastric adenocarcinoma tissue samples and was analyzed in relation with clinicopathological parameters, tumor proliferative capacity and patients' survival. PAFR was abundantly expressed in all gastric adenocarcinoma cases examined. Increased PAFR expression was significantly more frequently observed in well/moderately compared to poorly differentiated gastric adenocarcinoma cases (p=0.011). PAFR expression was significantly increased in intestinal- compared to diffuse-type cases (p=0.020). Elevated PAFR expression was significantly associated with smaller tumor size, absence of lymph node and organ metastasis and low tumor histopathological stage (p=0.025, p<0.001, p=0.009 and p<0.001, respectively). Additionally, patients presenting elevated PAFR expression had significantly longer survival times compared to those with low PAFR expression (log-rank test, p<0.001). These results support an important potential role of PAFR signalling in gastric malignant disease progression and render further research in this field a necessity.

Factors Predicting Long-Term Survival Following Pancreatic Resection for Ductal Adenocarcinoma of the Pancreas: 40 Years of Experience

BackgroundLong-term survival after resection for pancreas carcinoma has rarely been reported. Factors influencing long-term survival are still under debate. The aim of this study was to define predictors for long-term survival. MethodsBetween 1972 and 2004, a total of 415 patients underwent resection. Data were collected in a prospective data base. Data of 360 patients were available for further analysis in 2011. All specimens of long-term survivors were histologically reviewed. ResultsLong-term survivors (n = 69) had a median survival of 91 months. Pathological re-evaluation of all specimens re-confirmed the diagnosis. Predictive factors for long-term survival in univariate analysis were no preoperative biliary stent, low CA 19-9 level, lack of blood transfusion, R0 resection, tumour diameter, and -grading, absence of lymph node or distant metastases, lymphangiosis, and perineural infiltration. Adjuvant chemotherapy showed a significant influence on overall survival but not on long-term survival. In multivariate analysis, lymph node ratio and volume of blood transfusion were predictors of long-term survival. ConclusionNearly 20 % of patients with pancreas carcinoma who undergo surgical resection have a chance of long-term survival. Survival beyond 5 years is predicted by clinical and tumour-specific factors. Adjuvant chemotherapy might prolong overall survival but is, according to these results, unable to contribute to long-term survival. There is still a risk of recurrence after a 5- or even a 12-year mark. Survival beyond 5 or even 12 years, therefore, does not assure cure.

Differentiation of large (≥5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists’ performance using CT

PurposeTo identify significant CT findings for the differentiation of large (≥5cm) gastric gastrointestinal stromal tumors (GIST) from benign subepithelial tumors and to assess whether radiologists’ performance in differentiation is improved with knowledge of significant CT criteria. Materials and methodsOne-hundred twenty patients with pathologically proven large (≥5cm) GISTs (n=99), schwannomas (n=16), and leiomyomas (n=5) who underwent CT were enrolled. Two radiologists (A and B) retrospectively reviewed their CT images in consensus for the location, size, degree and pattern of enhancement, contour, growth pattern and the presence of calcification, necrosis, surface ulceration, or enlarged lymph nodes. CT findings considered significant for differentiation were determined using uni- and multivariate statistical analyses. Thereafter, two successive review sessions for the differentiation of GIST from non-GIST were independently performed by two other reviewers (C and D) with different expertise of 2 and 9 years using a 5-point confidence scale. At the first session, reviewers interpreted CT images without knowledge of significant CT findings. At the second session, the results of statistical analyses were provided to the reviewers. To assess improvement in radiologists’ performance, a pairwise comparison of receiver operating curves (ROC) was performed. ResultsHeterogeneous enhancement, presence of necrosis, absence of lymph nodes, and mean size of ≥6cm were found to be significant for differentiating GIST from schwannoma (P<0.05). Non-cardial location, heterogeneous enhancement, and presence of necrosis were differential CT features of GIST from leiomyoma (P<0.05). Multivariate analyses indicated that absence of enlarged LNs was the only statistically significant variable for GIST differentiating from schwannoma. The area under the curve of both reviewers obtained using ROC significantly increased from 0.682 and 0.613 to 0.903 and 0.904, respectively, with information of the significant CT findings differentiating GISTs from non-GISTs (P<0.001). ConclusionNon-cardial location, heterogeneous enhancement, presence of necrosis, larger lesion size, and absence of lymphadenopathy are highly suggestive CT findings for large GISTs in differentiation from schwannomas or leiomyomas. Regardless of radiologists’ expertise, diagnostic performance in differentiation can be significantly improved with knowledge of these CT findings.

Performance Analysis of Two-hop Routing in Node-markovian Graph

In order to describe the strong dependence between the existence and absence of nodes in different times, we propose the Node-markovian graph. At every time step, nodes change their state (existence or not) according to a two-state Markov process. If nodes do not discard the messages stored in them when they quit from the graph, we think that they have memory, or they do not have memory, and we study the performance of two-hop routing in both situations. We give the upper and lower bound of the performance in this paper. Surprisingly, simulation and numerical results show that difference of the performance between both cases is small when nodes in the graph exist with bigger probability, but they have bigger difference when the probability is smaller, so we think that it is not necessary for nodes to have memory in some cases.

Early Gallbladder Cancer: Clinical, Morphological, Therapeutic and Evolutionary Aspects

Introduction: The early cancer of gallbladder is an entity which is not well recognized currently. It is a cancer which does not extend beyond the muscularis layer of the gallbladder and it is characterized in almost of cases by the absence of lymph node and visceral invasion. Patients and Method: We have conducted this retrospective study of all our cases of early gallbladder cancer treated in our surgical unit. We have studied these through clinical, morphological, therapeutical and evolutionary aspects. Results: Of 202 gallbladder carcinoma, 33 cancers were classified as early cancer. 25 were females and 8 were males. The mean age was 56.4 years (41 - 70 years). All patients were free of gallbladder cancer symptoms and all except one had normal CEA and CA19.9. 2 patients had synchronous tumors (one colonic cancer and one rectal cancer). For 16 patients, the diagnosis was done by ultrasonography and 17 by histological examination of the specimen removed for biliary lithiasis. 8 patients had PT1a tumor (confined only to mucosa) and 25 had PT1b tumor (tumor infiltration of the muscular layer). For 19 patients who benefited from extensive lymphadenectomy, only one (5.3%) had lymph node infiltration. 16 patients had a simple cholecystectomy and in two cases, the cholecystectomy was associated with bile duct resection. 17 patients had hepatectomy with extensive lymphadenectomy. 2 patients had a simultaneous right colectomy and abdominoperineal resection and another one benefited from choledocal cyst resection. 3 patients benefited from stone removal from bile duct and two had tumor removal from bile duct (ruptured tumor in the bile duct). 1 patient (3.7%) died in postoperative course (hospital mortality). In the follow-up period, 4 patients died from intercurrent causes. Two patients presented a recurrence at 14 and 36 months and died respectively at 19 and 42 months. One patient presented a bile duct cancer at 66 months. She died at 78 months after palliative treatment. Currently, 22 patients (66.7%) are still alive without recurrence with mean and median survival of 53 and 31 months. Conclusion: Early gallbladder cancer is an entity which must be known by the radiologist and the surgeon. Recognized on time and well treated, early gallbladder cancer can be cured and its prognosis is excellent.

Guidelines for Extended Lymphadenectomy in Gastric Cancer: A Prospective Comparative Study

To assess the efficacy of extended lymph node dissection in gastric cancer and to identify factors affecting lymph node detection. A prospective study of 126 gastric cancer patients was conducted. Patients eligible for curative resection received total gastrectomy and extended lymphadenectomy (D2) and paraaortic lymph node sampling as the standard of care (study group). Supramesocolic total lymphadenectomy of the upper gastrointestinal tract was performed on 23 autopsy cases as a control group. Fifty-five gastric carcinoma patients were included in the study group. Median age was 58 years (range 31-80 years); 14 patients were female (25%), and 41 were male (75%). The median number of lymph nodes harvested from the specimen was 47 (24-95), and the median number of metastatic lymph nodes was 15 (1-71). In contrast, in the autopsy comparative group, the median number of harvested lymph nodes was 72 (50-91). The median number of stational lymph nodes excised (lymph nodes excised from stations 4, 5, 10, 11, 12, and 16) was significantly higher in the control group than in the study group (P<0.05). Lymph node detection was adversely affected by body mass index (BMI) (P<0.03). In the study group, stations 5, 12, 11, and 10 had the highest lymph node absence (LNA) (noncompliance) ratio with percentages of 53, 36, 33, and 22%, respectively. In the autopsy group, LNA (noncompliance) was not detected. Lymph nodes should be dissected by surgeons with sufficient technical and anatomical experience, and then examined and counted by experienced pathologists to reduce the occurrence of LNA. The results of this anatomical study can serve as a guideline to assess the success of lymph node dissection during gastric cancer surgery. Similar studies should be conducted in every country to establish national guidelines.

Peritoneal dissemination of prostate cancer with the absence of lymph node, skeletal, or visceral metastases in a patient scheduled to undergo robot-assisted radical prostatectomy.

Peritoneal dissemination of prostate cancer (PCa) with the absence of other metastases is extremely rare. Atypical sites of metastatic disease, for example the peritoneum, are only a recognized finding at autopsy. Herein, we report a case of peritoneal dissemination of a PCa, with the absence of lymph node, skeletal, or visceral metastases in a patient scheduled to undergo robot-assisted laparoscopic prostatectomy.

Afectación ganglionar en el cáncer de laringe y actitud terapéutica

AimsTry to establish a relationship between the presence or absence of lymphadenopathy in tumors of the larynx and the location of the tumor and discuss the treatment required in each case. MethodsData collection sheets were designed for the 224 laryngeal cancer cases diagnosed in the province of Guadalajara between 1975 and 1998, among those data we included the presence or absence of lymph nodes at the time of diagnosis, as well as its location and treatment applied in each patient. ResultsAbout in a half the cases studied had lymphadenopathy, being about in a half of the cases unilateral and about in a half of the cases bilaterals. The lymph nodes appeared more frequently in the supraglottic and hypopharyngeal tumors and less frequently in the glottic tumors. More extensive surgical interventions corresponded to supraglottic tumors and those affecting multiple levels of the larynx. Lymph node dissection was required in the 87% of supraglottic tumors and in 38.6% of the glottic tumors. ConclusionsThe bigger size of the tumor correlated with more cases with lymphadenopathies and a more extensive treatment had to be applied.

Classifying endocervical adenocarcinoma (EADC) by pattern correlates better with the presence or absence of lymph node (LN) metastasis than using tumor depth of invasion

Classifying endocervical adenocarcinoma (EADC) by pattern correlates better with the presence or absence of lymph node (LN) metastasis than using tumor depth of invasion

Relaxation to quantum equilibrium for Dirac fermions in the de Broglie–Bohm pilot-wave theory

Numerical simulations indicate that the Born rule does not need to be postulated in the de Broglie–Bohm pilot-wave theory, but tends to arise dynamically (relaxation to quantum equilibrium). These simulations were done for a particle in a two-dimensional box whose wave function obeys the non-relativistic Schrödinger equation and is therefore scalar. The chaotic nature of the de Broglie–Bohm trajectories, thanks to the nodes of the wave function which yield to vortices, is crucial for a fast relaxation to quantum equilibrium. For spinors, we typically do not expect any node. However, in the case of the Dirac equation, the de Broglie–Bohm velocity field has vorticity even in the absence of nodes. This observation raises the question of the origin of relaxation to quantum equilibrium for fermions. In this article, we provide numerical evidence to show that Dirac particles also undergo relaxation, by simulating the evolution of various non-equilibrium distributions for two-dimensional systems (the two-dimensional Dirac oscillator and the Dirac particle in a two-dimensional spherical step potential).

Multislice CT imaging of gastrointestinal stromal tumors (GISTs)

ObjectiveThe purpose of this study is to investigate the anatomical and pathological features of the gastrointestinal stromal tumors. Patients and methodsin the period between 2008 and 2010 multislice CT images of 32 patients affected by GIST were analyzed, the scanning was obtained before and after contrast medium injection also the bowel distension was obtained by the diluted gastrografin. Images were evaluated for presence, site and origin of the tumor as well as growth pattern relative to the bowel wall density, relationship with adjacent structures and presence or absence of lymph nodes and metastases. ResultsThirty two patients with gists were identified (17 men and 15 women; mean age, 55.6years). The primary tumor was located in the stomach in 14 cases, in the small intestine in 10 cases, in the ceacum and rectum in 5 and 3 cases, respectively. Mean primary tumor size was 14.3cm (range from 2 to 18cm). Tumors were typically with regular margins (12/32 cases, 37.5%), lobular (4/32 cases, 12.5%) while (16/32 cases, 50%) were irregular. Central fluid attenuation was seen in (15/32 cases, 49%). An extramucosal origin was definitely established in (28/32 cases, 87%). In (10/32 cases, 31.25%), the lesions exhibited extraluminal growth. Infiltration of the adjacent structures was observed in (20/32 cases, 62.5%). Metastases were detected in (9 /32 cases, 28%) at presentation. Hepatic metastases were detected in four cases, in the omentum in three cases and lymphadenomegaly in two cases. Intestinal obstruction were detected in three cases and ascites in only one patient. ConclusionMultislice CT images can be considered an essential tool for the diagnosis and staging of gists.

Lymph node assessment by diffusion weighted imaging in cervical cancer

The use of node size alone to determine the presence ofmetastatic lymphadenopathy has been shown to be a poordiscriminator in pelvic oncological imaging. Functionalimaging is becoming increasingly important in the evalua-tion of cancer patients because of the limitations ofmorphologic imaging. In patients with uterine cervicalcancer, it is quite important to evaluate the involvement oflymph nodes as lymph nodes metastases are an importantprognostic factor, correlating with survival and modifyingtreatment option [1, 2]. In some institutions, routinelaparoscopic lymphadenectomy is performed to accuratelystage lymphatic extension. Non-invasive preoperativelymph nodes staging seems quite important in patient’smanagement as treatment is heavily influenced according tothe presence or absence of lymph node involvement.Recent imaging strategies, such as diffusion-weightedMR (DW-MR) imaging and positron emission tomographyand computed tomography (PET/CT) have lead to somecontroversies regarding the capability of preoperativeimaging to accurately stage malignant lymphadenopathy.DW-MR imaging is a functional imaging technique whosecontrast derives from the random motion of water mole-cules within tissues. PET/CT imaging contrast derives fromthe metabolic consumption of glucose within tissues.DW-MR sequences are quite relevant and recent imagingtechniques that are used to define disease involvement. Inoncological imaging, DW-MR imaging has been linked tolesion aggressiveness and tumour response, although thebiophysical basis for this is not completely understood. Inour clinical experience with female pelvic cancers, bothbenign and metastatic lymph nodes may appear with highsignal intensity on high b-value images, with correspondinglow apparent diffusion coefficient (ADC) values. The proofof concept behind the paper by Choi at el [1] is that tumourinvolvement changes the diffusion properties of malignantlymph nodes as measured by ADC. The reasons for diffusionrestriction and, therefore, lower ADC values in malignantnodesisprobablyrelatedtoacombinationofhighercellularity,tissue disorganization and increased extracellular space tortu-osity. If correct, lymph node involvement, both early indiagnosis and in the follow-up, could be evaluated withdiffusion-weighted images and the corresponding ADC calcu-lations. If these changes can be used to predict staging andmonitor early cancer treatment response, DW-MR techniqueswill become a considerable benefit for these patients.Choi et al. evaluated, in a node-by-node comparison,the diffusion-weighted ADC calculation and size-basedcriteria on T2-weighted images with PET/CT findings ina large series of patients [1]. The series included 163patients with 339 pelvic lymph nodes with short-axisdiameter >5 mm. The minimum and mean ADC, short-and long-axis diameters, and ratio of long- to short-axisdiameters (L/S ratio) were compared in PET/CT-positiveand -negative lymph nodes. There were 118 (35%)positive nodes in 58 patients. There were statisticallydifferent values in PET/CT-positive and PET/CT-negativegroups in minimum and mean ADCs, short- and long-axisdiameters, and L/S ratio (P<0.05). The best discriminatorwas the minimum ADC, with a larger area-under-the-curve (Az=0.864) than mean ADC (0.836), short-axisdiameter (0.764), long-axis diameter (0.640) and L/S ratio(0.652). The sensitivity and accuracy of the minimumADC (86%, 82%) were also greater than when the meanADC value was used.

Host response to tuberculosis as basis for rational design of vaccines and biomarkers

The current diagnostic techniques are not effective in key areas of tuberculosis (TB) research, such as predicting susceptibility, treatment outcome, and monitoring the effectiveness of drug or vaccine trials. Hence, more emphasis is to be placed on biomarker research. A biomarker is a characteristic feature that is objectively measured and evaluated as an indicator of a biological or pathological process or a response to therapy or prevention. Peripheral blood cells may not provide an accurate picture of what is happening in a TB patient at the site of disease manifestation, i.e., the granuloma. The fact that granulomas reach a point where they become largely autonomous and the immune response controls itself in the granuloma, has presented challenges. To address this point, our team infected splenectomized lymphotoxin β-receptor-deficient mice, which have no secondary lymphoid organs, with a small dose of Mycobacterium tuberculosis (M.tb). Without lymph nodes and spleen, the mice mounted an immune response and survived. Upon further analysis, CD8 and CD4 T-cells were generated in the granulomas as well as central memory and multifunctional T cells. Mice were then infected with M.tb, cured with antibiotics and then reinfected. When reinfected mice were compared to mice with a primary infection, we found that protective memory had developed. We conclude that granulomas can develop an immune response in the absence of lymph nodes and spleen. Moreover, in a study of TB lesions in humans, we found that the same appears to occur. Using metabolomics, and working with the company Metabalon, we examined a combination of metabolites in latently infected individuals and patients with active TB disease to define a profile to differentiate healthy infected from diseased individuals. Diagnoses made by metabolomics profiles were equally accurate as clinical diagnoses. Metabolomics was also used to identify markers for cell exhaustion, which can lead to reinfection. In particular, we studied the metabolite tryptophan, the degradation of which is involved in suppressive mechanisms. These studies were complemented using transcriptomics. Dendritic cells were stimulated with ManLam, a bacterial cell wall lipid component that binds to DC-SIGN, a host cell receptor known to be involved in immunosupression. This binding also caused the cells to over-express the enzymes involved in the degradation of tryptophan. We consider this pathway to be involved in reactivation of TB and sustenance of active disease.

Gender-Specific Prognostic Markers of Patients with Gallbladder Cancer after Surgical Resection

The aim of this study was to elucidate gender-specific markers for postresectional long-term survival of gallbladder cancer (GBC) based on a cohort of Chinese patients. Clinicopathological records of 81 patients (27 males and 54 females) after surgical resection for GBC were reviewed retrospectively. The influence of each variable on survival was determined using the Kaplan-Meier method and log-rank test. For females, Cox regression analysis was also adopted. Univariate analysis showed that the absence of lymph node and distant metastases, differentiation grade, and curative resection were associated with prolonged survival for all males, whereas tumor size, differentiation grade, and the presence of lymph node metastases influenced the overall or disease-free survival of patients after curative resection (all P < 0.05). On the other hand, Nevin stage was an independent marker for both overall survival for all females and overall and disease-free survival for female patients who underwent curative resection. Additionally, resection type and differentiation grade were of independent prognostic significance for different subgroups of females (all P < 0.05). Our data suggested that tumor-related factors affect prognosis of both male and female patients with GBC after resection. Of these factors, tumor differentiation status might be more significant for males, but Nevin stage had a stronger predictive potential for females.

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid. Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9. The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Dendritic cells interact with CD4 T cells in intestinal mucosa

Absence of lymph nodes in nonmammalian species, expression of MHCII by APCs in the periphery, and the recent findings that T cells can change their polarization status after presentation in the lymph nodes imply a role for MHCII-mediated presentation outside the organized lymphoid tissue. This study shows that MHCII(+) ECs and DCs from the intestinal mucosa of the pig can present antigen to T cells in vitro. In vivo, APCs colocalize with T cells in pig and mouse intestinal mucosa. In the pig, endothelium is involved in these interactions in neonates but not in adults, indicating different roles for stromal and professional APCs in the neonate compared with the adult. The ratio of expression of DQ and DR MHCII locus products was lower on ECs than on other mucosal APCs, indicating that the two types of cells present different peptide sets. Adult nonendothelial APCs expressed a higher ratio of DQ/DR than in neonates. These results suggest that mucosal DCs can present antigen locally to primed T cells and that stromal APCs are recruited to these interactions in some cases. This raises the possibility that local presentation may influence T cell responses at the effector stage after initial presentation in the lymph node.