Insulin is known to have direct and indirect effects on cell cycle progression, proliferation and metastatic activities. We performed a dose-response meta-analysis to investigate the association between hyperinsulinemia and all-cause cancer related mortality.A systematic literature search was conducted on MEDLINE and SCOPUS databases to include all published articles up to January 2019. Combined hazard ratios (HRs) with 95% Confidence Intervals (CIs) were estimated using DerSimonian and Laird random-effects models. A dose-response analysis was also conducted to further explore insulin's relationship with cancer-related mortality.We identified seven studies, with a total of 23,990 participants, who reported the association between hyperinsulinemia and cancer-related mortality. Results from the eligible studies indicated that higher fasting insulin levels were not associated with an increased risk of cancer mortality (pooled HR: 1.14, 95% CI: 0.99-1.32), however, significant heterogeneity was present (I2 = 60.3%, P heterogeneity = 0.001). A subgroup analysis based on gender demonstrated a significant association between fasting insulin level and cancer mortality in men (pooled HR: 1.92, 95% CI: 1.23-3.01, P heterogeneity = 0.281).This dose-response meta-analysis showed a direct significant association between fasting insulin level and cancer mortality in men.
Oral mucositis (OM) is a very frequent and potentially severe complication experienced by patients receiving chemotherapy and/or radiotherapy, which often leads to significant morbidity and mortality, and decreased quality of life, and is very costly. Despite its severity and prevalence, there is no standard recognised management today. The aim of this open clinical trial is to evaluate the efficacy and compliance of a new spray compound containing sodium hyaluronate (SH) and a pool of collagen precursor amino acids (AAs) combined with sodium hyaluronate (SH) to manage radio/chemotherapy-induced OM. Twenty-seven consecutive patients with OM were treated according to the manufacturer's instructions. At time TO (baseline — before intervention), we evaluated the following parameters: (i) pain score (by linear visual analogue scale; 0–100) and (ii) severity of OM scored according to WHO Mucositis scale. The treatment efficacy was evaluated on i) pain score, ii) clinical resolution index (CRI) and iii) patient compliance at times T01 (after 2 hours), T1 (after 24 hours), T2 (after 72 hours), T3 (after 7 days) and T4 (after 14 days). Results showed that painful symptoms were significantly reduced after only 2 hours of spray administration compared with baseline measurements ( p<0.0001; z=−4.541). A progressive reduction of pain through the 2 weeks was also noted ( p<0.0001). Patient lesions treated with SH-AAs-based spray also significantly improved after 72 hours of treatment ( p=0.0051; z=−2.803). During the two-week observation, all patients significantly improved from the baseline ( p<0.0001) and progressively ameliorated their ability to swallow foods and liquids. The compliance of all patients to the product was very good, and at the end of the study there were no adverse effects. The results suggest that the SH-AAs-based spray accelerates lesion healing and above all helps to manage mucositis pain, especially in terms of immediate pain relief (after 2 hours from application). Although further randomized controlled studies are recommended, our findings suggest that frequent applications of this spray may offer rapid and effective pain management, aiding faster mucosal wound healing.
A 43-year-old man presented with a 28-year history of multiple slow growing asymptomatic lesions affecting the scrotal skin. He had no other past medical history. On examination he had multiple pedunculated warty lesions of varying size (Fig 1). A biochemistry screen revealed a normal lipid profile and no immunodeficiency disorder. A skin punch biopsy was performed, and histopathological analysis revealed skin with verrucous acanthosis, hyperkeratosis, and focal parakeratosis. There was prominent accumulation of large xanthoma cells in the papillary dermis. Background moderate lymphoplasmacytic infiltrate was also noted (Fig 2). There was no evidence of dysplasia. Question 1: What is the most likely diagnosis?A.Condyloma acuminatumB.Bowenoid papulosisC.Warty squamous cell carcinomaD.Verruciform xanthoma (VX)E.Seborrheic keratosis Answers:A.Condyloma acuminatum – Incorrect. These are anogenital warts caused by the human papilloma virus (HPV). On histology these will show hyperkeratosis, papillomatous hyperplasia, koilocytosis, and acanthosis with positive polymerase chain reaction for the HPV.B.Bowenoid papulosis – Incorrect. This is a sexually transmitted infection cause by high-risk HPV which results in pigmented or reddish papules which histologically demonstrate focal epidermal hyperplasia and dysplasia.C.Warty squamous cell carcinoma – Incorrect. Warty squamous cell carcinoma is a rare subtype of squamous cell carcinoma which is due to the HPV virus. On histology, squamous cell carcinoma demonstrates conspicuous koilocytosis and, in later stages, stromal invasion.D.Verruciform xanthoma (VX) – Correct. VXs are rare benign neoplasms characterized by verrucous acanthosis, hyperkeratosis, and a dense accumulation of foam cell macrophages (xanthoma cells) in the papillary dermis. In most cases, VX appears as solitary slow growing asymptomatic lesions.E.Seborrheic keratosis – Incorrect. Seborrheic keratosis are benign warty epidermal tumors which are most often diagnosed on clinical examination. Histopathological presentation is varied and is only recommended in patients with high risk factors or atypical clinical features to exclude a malignancy. Question 2: What location is most common for this lesion to appear?A.Oral cavityB.Genital areaC.Soles of the feetD.Aerodigestive tractE.Trunk Answers:A.Oral cavity – Correct. In most cases, verrucous xanthomas appear as a solitary slow growing lesion affecting the oral cavity.1Belknap A.N. Islam M.N. Bhattacharyya I. Cohen D.M. Fitzpatrick S.G. Oral verruciform xanthoma: a series of 212 cases and review of the literature.Head Neck Pathol. 2020; 14: 742-748Crossref PubMed Scopus (15) Google Scholar,2Yu C.-H. Tsai T.-C. Wang J.-T. et al.Oral verruciform xanthoma: a clinicopathologic study of 15 cases.J Formos Med Assoc. 2007; 106: 141-147Crossref PubMed Scopus (37) Google Scholar A large case series, including 212 cases, reported that more than 50% of lesions were located on the gingiva.B.Genital area – Incorrect. Our case, which presented on the scrotum, is a rarer presentation of verrucous xanthomas. Genital presentations of VX are much more common in men and have a predisposition for presenting in older adults.3Wang Y.-H. Wang H.S. Shih I.-H. Verruciform xanthoma: an elderly male genital predominance trend.Australas J Dermatol. 2021; 62: e290-e292Crossref PubMed Scopus (1) Google ScholarC.Soles of the feet – Incorrect. Less than 40 cases of VX that are neither oral nor genital have been published. Presentation on the soles of the feet is extremely rare and to our knowledge there are less than 10 cases reported in the literature.4Seo H.-M. Jang J.W. Park S.K. et al.A case of verruciform xanthoma of the sole.Ann Dermatol. 2021; 33: 86-88Crossref PubMed Google ScholarD.Aerodigestive tract – Incorrect. There has only been 1 case of multiple VX presenting on the aerodigestive tract of a child. The child was subsequently diagnosed with a systemic lipid storage disease.5Travis W.D. Davis G.E. Tsokos M. et al.Multifocal verruciform xanthoma of the upper aerodigestive tract in a child with a systemic lipid storage disease.Am J Surg Pathol. 1989; 13: 309-316Crossref PubMed Scopus (42) Google ScholarE.Trunk – Incorrect. Again, presentation of extra-oral or extra-genital areas is very rare. Question 3: Which statement is true of this cutaneous lesion?A.It is frequently caused by HPV genotypes 6 and 11B.Approximately 2% to 5% will either harbor or progress to a squamous cell carcinomaC.It is usually associated with underlying immunosuppressionD.It is a nonneoplastic lesion that typically does not recur after excisionE.Surveillance in 6 months’ time is recommended as the lesions often recur Answers:A.It is frequently caused by HPV genotypes 6 and 11 – Incorrect. VX is often HPV negative, and this is not implicated in the aetiology of this diagnosis.B.Approximately 2% to 5% will either harbor or progress to a squamous cell carcinoma – Incorrect. VX is a benign lesion that does not harbor or progress to a squamous cell carcinoma.C.It is usually associated with underlying immunosuppression – Incorrect. It is usually not associated with underlying immunosuppression.D.It is a nonneoplastic lesion that typically does not recur after excision – Correct. Excision of the lesion is sufficient treatment of the lesion, with recurrence being rare.E.Surveillance in 6 months’ time is recommended as the lesions often recur – Incorrect. Recurrence is rare and patient self-surveillance is sufficient. None disclosed.
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