Identification of the most specific markers to differentiate primary pulmonary carcinoma from metastatic gastrointestinal carcinoma to the lung

Background A number of biomarkers have the potential of differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract, however, a standardised panel for that purpose does not exist yet. We aimed to identify the smallest panel that is most sensitive and specific at differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract. Methods A total of 170 samples were collected, including 140 primary and 30 non-primary lung tumours and staining for CK7, Napsin-A, TTF1, CK20, CDX2, and SATB2 was performed via tissue microarray. The data was then analysed using univariate regression models and a combination of multivariate regression models and Receiver Operating Characteristic (ROC) curves. Results Univariate regression models confirmed the 6 biomarkers’ ability to independently predict the primary outcome (p < 0.001). Multivariate models of 2-biomarker combinations identified 11 combinations with statistically significant odds ratios (ORs) (p < 0.05), of which TTF1/CDX2 had the highest area under the curve (AUC) (0.983, 0.960–1.000 95% CI). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75.7, 100, 100, and 37.5% respectively. Multivariate models of 3-biomarker combinations identified 4 combinations with statistically significant ORs (p < 0.05), of which CK7/CK20/SATB2 had the highest AUC (0.965, 0.930–1.000 95% CI). The sensitivity, specificity, PPV, and NPV were 85.1, 100, 100, and 41.7% respectively. Multivariate models of 4-biomarker combinations did not identify any combinations with statistically significant ORs (p < 0.05). Conclusions The analysis identified the combination of CK7/CK20/SATB2 to be the smallest panel with the highest sensitivity (85.1%) and specificity (100%) for predicting tumour origin with an ROC AUC of 0.965 (p < 0.001; SE: 0.018, 0.930–1.000 95% CI).

A Model for SynbioticActivity Evaluation: Static and Continuous Co-Culture Fermentation of BifidobacteriumAdolescentis ATCC 15703 and Bacillus Cereus ATCC 9634

In this study, the ability of a probioticstrain (BifidobacteriumadolescentisATCC 15703) to inhibit the growth of the common food contaminantBacilluscereusATCC 9634was studied, both individually and as part of a synbiotic with FOS during batch or continuous fermentation (flow fermentation). The conditions of the flow fermentation corresponded to the parameters of the human large intestine: maintaining a pH of 6.8; anaerobiosis; and a medium flow rate of 0.04 h−1. Bifidobacteria and bacilli were co-cultivated on a prebiotic carbohydrate substrate (10 g/L) and the prebiotic was replaced with glucose (10 g/L).The results of the batch and flow fermentation were compared.The synbiotic efficacy of the probioticBif. adolescentisand the prebiotic FOSagainst the common food contaminantBac. cereuswas shown for all conditions. Fermentation of a pure culture of bifidobacteria with varying prebiotic concentrations (2, 5, 10, 15 and 20 g/L) was carried out to study the state of dynamic balance. It was demonstrated that 48 hours is enough to achieve stable dynamic balance.Prebiotics were co-cultivated with varying carbohydrate concentrations of 5, 10, and 15 g/L.The results showed that increasing the prebiotic concentration increased the duration of the lag-phase and reduced the final number of bacilli. Keywords: probiotics, prebiotics, synbiotics, gastrointestinal tract modeling, antagonism, co-culture fermentation

Successful use of Tofacitinib in Reactive Arthritis Refractory to Conventional Therapies – A Case Series

Reactive arthritis is an immune mediated aseptic arthritis resulting from either genitourinary or gastrointestinal tract in a genetically susceptible host. It commonly presents as oligoarthritis of the lower limbs with or without extra articular features such as urethritis and non-purulent conjunctivitis. Therapies include NSAIDs, conventional DMARDs and rarely biologics in severe cases. We report successful use of tofacitinib in four cases of reactive arthritis who failed to respond to conventional therapies.