Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays.
Background: Rotator cuff tendinopathy is most often described as a continuum between the normal cuff and rotator cuff tears with calcific tendinitis having its place along this continuum. Although many studies have focused on the role of magnetic resonance imagining (MRI) in diagnosing the extent of rotator cuff tears and their associated findings with good interobserver reliability, the same cannot be stated about MRI tendinopathy findings. Because of this discrepancy in diagnostic reliability, tendinopathy tends to be overtreated with injections when associated with symptoms, thus potentially increasing the risk of calcific tendinitis and progression toward rotator cuff tears. This study aims to assess whether diagnosing shoulder MRI tendinopathy patterns through dichotomization can accelerate clinical progress toward consensus. Methods: This study is a large retrospective cohort of 184 patients that underwent a 1.5T shoulder MRI for shoulder pain. Inclusion criteria were acromioclavicular arthrosis diagnosed in patients of any age. Exclusion criteria were partial or complete rotator cuff tears. Tendinopathy was considered the dependent variable and registered as a dichotomous variable while acromioclavicular joint arthrosis together with gender was categorical and age was the continuous variable. An attempt was made to generate a clinically significant binary logistic regression to assess the odds ratio of diagnosing tendinopathy based on age, gender, and acromioclavicular joint arthrosis status. Results: An overwhelming proportion of patients was positive for tendinopathy findings (95.11%). 64.12% of patients were within the active age group with patients within the 50-59 group being diagnosed the most with rotator cuff tendinopathy. Conclusions: Due to the high variability of MRI findings that can be considered positive for rotator cuff tendinopathy, an overwhelming skew toward a positive diagnosis was observed, thus dichotomizing tendinopathy diagnosis is not appropriate for clinically relevant conclusion-making.
In the context in which life expectancy increases and the population becomes more active, the number of people who are affected by gonarthrosis symptoms increases proportionally. By the year 2030, in the United States of America, one in three adults is expected to suffer from gonarthrosis, this prediction will be the beginning of an epidemic. Total knee arthroplasty has been shown to relieve pain and improve joint function; however, studies have shown that active young patients still have limitations in performing high-level activities such as dancing, golfing, skiing, and gardening. Currently, modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological “medial pivot” pattern with greater compliance on the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side.
The squamous cell carcinoma antigen is a tumor marker that is receiving more interest due to its biological properties and importance in both pathological and normal physiological processes. Numerous clinical studies have been conducted to determine the potential function of squamous cell carcinoma antigen and its isoform complexes in clinical practice. These studies have been prompted by the fact that not only squamous cell carcinoma antigen but also circulating immune complexes of it and immunoglobulin M are involved in normal physiological and pathological processes. The therapeutic use of squamous cell carcinoma antigen as a tumor marker for either squamous carcinoma diagnosis or for monitoring the response to radiation or chemotherapy, tumor recurrence, and treatment failure are supported by prior investigations. The diagnostic or prognostic utility of squamous cell carcinoma antigen is debatable, nevertheless, as these investigations provide conflicting findings. A uniform detection method, scoring system, and cutoff level must be devised to limit clinical variability between studies and to provide a more accurate and trustworthy comparison of data. Additionally, even if the effectiveness of several approaches is equivalent, only one method should be used for the dynamic monitoring of tumor marker kinetics.
More than 75 years after its accidental discovery, methotrexate remains an important treatment option for many diseases. Whether it is various hematological and non-hematological neoplasms, rheumatological, dermatological, or other conditions, methotrexate remains in scope. For rheumatoid arthritis, current clinical guidelines (EULAR, ACR) recommend methotrexate as the first therapeutic option. This article aims to highlight important moments in the history of this remarkable drug, to review the literature on its mechanisms of action and the arguments for which after more than half a century, methotrexate remains the gold standard in the treatment of rheumatoid arthritis but also an important option for treatment of psoriasis vulgaris (PV) and psoriatic arthritis (PsA).
