António Gouveia

Analysis of a bone metastasis gene expression signature in patients with bone metastasis from solid tumors

Bone is a major target for metastases in the most frequent solid tumors, which result in severe complications and are a major cause of pain. A bone metastasis gene expression signature was identified using human breast cancer cells in a mouse model. The bone metastasis-related genes encode secretory and cell surface proteins implicated in bone-homing (CXCR4), angiogenesis (CTGF and FGF5), invasion (MMP-1 and ADAMTS1), and osteoclast recruitment (IL11). This signature superimposes on the 70-gene poor prognosis gene expression signature for breast cancer, and only ADAMTS1, CTGF and IL11 were found to be overexpressed in human primary breast cancers with bone relapse. We analyzed the expression of the six bone metastasis-related genes in bone metastases from patients with different types of solid tumors, to assess its relevance in human clinical samples. MMP-1, CXCR4, FGF5 and CTGF were found to be overexpressed in tumor cells of human bone metastases when compared to a human normal epithelial cell line. All the analyzed genes were overexpressed in the tumor cells of breast cancer bone metastases when compared to normal breast tissue. We did not detect any differences between the expression of these genes in bone metastases from breast cancer or from other types of solid tumors. Importantly, there was a significant correlation between the expressions of IL11/CTGF, IL11/ADAMTS1, CTGF/CXCR4, CTGF/ADAMTS1, and MMP-1/ADAMTS1, supporting the cooperative function of these proteins in the bone microenvironment, and the potential functional role of these genes in the establishment of bone metastases in vivo.

Enfisema subcutâneo maciço – Tratamento com drenos subcutâneos

Resumo O enfisema subcutâneo e uma complicacao relativamente comum na sequencia de tecnicas invasivas, procedimentos cirurgicos e algumas patologias medicas. Na maior parte dos casos apenas causa sintomatologia minor e o tratamento e habitualmente conservador. Mesmo quando grave, raramente tem consequencias patofisiologicas significativas, apesar de ser extremamente desconfortavel para o doente. Os autores descrevem um caso clinico de enfisema subcutâneo macico, de rapida instalacao, apos saida acidental de tubo de drenagem toracica, em doente com pneumotorax espontâneo secundario e fistula broncopleural. O enfisema foi tratado atraves da colocacao, sob anestesia local, de dois drenos subcutâneos na parede anterossuperior do torax, conectados a sacos de drenagem. Apos a colocacao dos drenos subcutâneos verificou-se uma franca melhoria clinica do doente, com descompressao eficaz do enfisema subcutâneo. No presente caso clinico, a tecnica de drenagem do enfisema macico mostrou-se simples, segura e eficaz, permitindo o alivio sintomatico imediato.

Prevalence of bronchial obstruction in a tobacco smoke exposed population - the PNEUMOBIL project.

The use of spirometry is not yet widespread enough in chronic respiratory or at -risk patients whose diagnosis is incomplete. There is scarce knowledge and inadequate management of the burden of these diseases, particularly chronic obstructive pulmonary disease (COPD). Pneumobil, an initiative aimed at raising awareness among smokers and ex -smokers, was reactivated 10 years after its launch in Portugal. It found a large prevalence of bronchial obstruction as measured by spirometry (30% and 25% in men and women respectively) in a sample of 5324 smoke -exposed individuals, 50% current smokers, screened at state or business (private company group) health institutions. This risk is neither mainly attributable to occupational exposure nor mainly related to respiratory symptoms, which were very common in our population. Only dyspnoea (OR=1.28; p=0.02) and frequent episodes of sputum production (OR=1.21; p=0.008) or acute bronchitis (OR=1.31; p=0.05) were somewhat related to bronchial obstruction. Prior knowledge of COPD is rare and bronchial obstruction is not correlated (p=0.204) to a possible diagnosis of COPD.