Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Claudia Sousa, Claudia Botelho and Diana Rodrigues, respectively

Abstract LB-278: BRMS1 promoter methylation correlates with decreased expression of BRMS1 in non-small cell lung cancer

Abstract Background: Breast cancer metastasis suppressor gene-1 (BRMS1) mRNA and protein expression are significantly decreased in non-small cell lung cancer (NSCLC) cell lines and human NSCLC when compared to normal bronchial epithelial cells and adjacent noncancerous tumor tissue, respectively. We hypothesized that one mechanism through which BRMS1 expression was decreased in NSCLC was through BRMS1 promoter methylation. Materials and Methods: Human NSCLC BRMS1 promoter methylation was evaluated using methylation-specific PCR and bisulfite sequencing. The effect of methylation on BRMS1 mRNA and protein expression was assessed following treatment with 5-azacitidine, a demethylating agent in NSCLC cell lines. BRMS1 transcriptional activity was assessed using a human BRMS1-luc reporter gene construct cloned by our group. Student's T-Test and Chi-square tests were used to determine significance between variables of two patient populations separated based on tumor histology (squamous cell or adenocarcinoma) and to evaluate the methylation profile between the two tumor histologies. Immunohistochemical analysis for BRMS1 protein was performed on both tumor and adjacent noncancerous bronchial epithelium. A general linear model tested the association between BRMS1 promoter methylation in human NSCLC and specific clinical and histopathologic variables. Results: The BRMS1 promoter region contains a CpG island that was hypermethylated in all NSCLC cell lines and human tumors. This strongly correlated with reduced BRMS1 promoter activity. NSCLC cell lines treated with 5-azacitidine showed a robust recovery of BRMS1 mRNA and protein levels, suggesting that promoter methylation is involved in BRMS1 transcriptional regulation. Analysis of 40 patient NSCLC samples (20 adenocarcinoma and 20 squamous cell) identified a significant increase in the amount of BRMS1 promoter methylation when comparing tumor specimen to adjacent noncancerous tissue for both tumor histologies (p&amp;lt;0.0001). Additionally, the BRMS1 promoter region was significantly more methylated in squamous cell compared to adenocarcinoma histology (p=0.01). Subsequent immunohistochemical analysis confirmed a correlation between BRMS1 promoter methylation and decreased bronchial epithelium BRMS1 protein expression (p=0.06). Moreover, in the squamous cell histology, pathologic tumor stage was associated with elevated BRMS1 methylation (p=0.04). Conclusions: These studies identify BRMS1 promoter methylation as an important mechanism for silencing BRMS1 expression in NSCLC and highlight the potential clinical relevance of this epigenetic signature with respect to tumor histology and stage. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-278.</jats:p

Rural-Urban Differences in Esophagectomy for Cancer

Introduction. Patients who are socioeconomically disadvantaged or in rural areas may not pursue surgery at high-volume centers, where outcomes are better for some complex procedures. The objective of this study was to determine and compare rural and urban patient differences and outcomes after undergoing esophagectomy for cancer. Methods. An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database was performed, capturing adult patients with esophageal cancer who underwent esophagectomy. Patients were stratified into rural or urban groups by the National Center for Health Statistics Urban-Rural Classification Scheme. Demographics, hospital variables, and outcomes were compared. Results. A total of 2,877 patients undergoing esophagectomy for esophageal cancer were captured by the database, with 228 (7.92%) rural and 2,575 (89.50%) urban patients. The rural and urban groups had no difference in age, race, insurance status, and many common comorbidities. Major outcomes of mortality and length of stay were similar for both rural and urban patients (3.95% versus 4.27%, p=0.815) and (15.75±13.22 versus 15.55±14.91 days, p=0.828), respectively. There was a trend for rural patients to be more likely to discharge home (35.96% versus 29.79%, OR 0.667 [95%CI 0.479-0.929]; p=0.0167). Conclusions. This retrospective administrative database study indicates that rural and urban patients receive equivalent postoperative care after undergoing esophagectomy. The findings are reassuring as there does not appear to be a disparity in major outcomes depending on the location of residence, but further studies are necessary to assure equitable treatment for rural patients

Rural-Urban Differences in Esophagectomy for Cancer

Background: Patients who are socioeconomically disadvantaged or in rural areas may not pursue surgery at high-volume centers, where outcomes are better for some complex procedures. The objective of this study was to determine and compare rural and urban patient differences and outcomes after undergoing esophagectomy for cancer.&#x0D; Study Design: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database was performed, capturing adult patients with esophageal cancer who underwent esophagectomy. Patients were stratified into rural or urban groups by the National Center for Health Statistics Urban-Rural Classification Scheme. Demographics, hospital variables, and outcomes were compared.&#x0D; Results: A total of 2,877 patients undergoing esophagectomy for esophageal cancer were captured by the database, with 228 (7.92%) rural and 2,575 (89.50%) urban patients. The rural and urban groups had no difference in age, race, insurance status, and many common comorbidities. Major outcomes of mortality and length of stay were similar for both rural and urban patients (3.95% versus 4.27%, p=0.815) and (15.75±13.22 versus 15.55±14.91 days, p=0.828), respectively. There was a trend for rural patients to be more likely to discharge home (35.96% versus 29.79%, OR 0.667 [95%CI 0.479-0.929]; p=0.0167).&#x0D; Conclusions: This retrospective administrative database study indicates that rural and urban patients receive equivalent postoperative care after undergoing esophagectomy. The findings are reassuring as there does not appear to be a disparity in major outcomes depending on the location of residence, but further studies are necessary to assure equitable treatment for rural patients.</jats:p