Introduction. Stage III colorectal cancer is treated with adjuvant chemotherapy based on 5-fluorouracil and leucovorin. Drug resistance to anticancer treatment might be due to adenosine triphosphate binding cassette transporter family members.Aim. The aim of study was to analyze the expression of two ABC transporters, known as ABCC5 and ABCC11, in tumor tissue obtained from stage III colorectal cancer patients and to correlate the results to clinical data including disease-free survival. Patients and Methods. The expression of ABCC5 and ABCC11 was analyzed in 488 patients out of which 225 were treated with 5-fluorouracil in combination with leucovorin whereas 263 did not receive any chemotherapy. Gene expression was determined using real time qPCR and related to clinical variables. Results. ABCC5 expression was associated with age (r =0.34, P =0.0001) and tumor location (P = 0.0001). ABCC5 expression was not associated with disease-free survival in both groups of treated (P=0.22) and untreated patients (P=0.83). ABCC11 was not associated with disease-free survival in the group of treated patients(P=0.35). Low expression of ABCC11 was significantly associated with a longer disease-free survival of untreated patients (P=0.01). Since the P-value was significant, a further analysis called cox regression multivariate analysis was performed in search of an interaction between the expression of ABCC11 and other covariates. Cox regression multivariate analysis showed that the expression of ABCC11 was an independent marker for disease-free survival in untreated patients [HR 0.67 (range 0.49-0.93), P=0.015]. Conclusions. None of the two analyzed genes predicted disease-free survival of patients treated with 5-fluorouracil.

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Introduktion: Attenueringskorrektion är en ny teknik inom nuklearmedicinska undersökningar som korrigerar attenueringen (foton förluster). Myokardscintigrafi som avspeglar hjärtats perfusionsförmåga används framför allt för att undersöka om det föreligger ischemisk hjärtsjukdom hos patienter. Syftet med denna studie är att undersöka om attenueringskorrektion kan förbättra känsligheten för myokardscintigrafi att detektera ischemiska hjärtsjukdomar.     Material och metod: 476 patienter under 2017 – 2018 som genomförde myokardscintigrafi i Skaraborgssjukhuset ingick i studien. Sökning i patientjournaler av dessa patienter gjordes för att hitta läkarsvaren av myokardscintigrafi med attenueringskorrektion samt eventuellt angiografi svar om angiografi utfördes efter myokardscintigrafi. Resultatet jämfördes med en parallell studie som undersökte om sensitiviteten för myokardscintigrafi utan attenueringskorrektion.    Resultat: Under 2017 – 2018 då myokardscintigrafi genomfördes med attenueringskorrektion var det 29,6% av totalt 476 patienter som bedömdes ha ischemi. 1,1% blev felbedömd vid myokardscintigrafi. 39,5% av 476 patienter hade patologiska resultat och 40% av dessa patologiska patienter gick vidare till angiografi, 61% av de som gick vidare till angiografi bedömdes faktiskt ha ischemi.    Konklusion: Attenueringskorrektionen har minskat onödiga angiografi-undersökningar i samband med utredning av ischemiska hjärtsjukdomar. Även en ökning av känsligheten för att detektera ischemiska hjärtsjukdomar med myokardscintigrafi har kunnat ses med attenueringskorrektionen. / Introduction: Attenuation correction is a new technique in nuclear medicine that corrects attenuation (photon losses). Myocardial scintigraphy, which reflects the perfusion capacity of the heart, is mainly used to investigate the presence of ischemic heart disease in patients. The aim of this study is to investigate whether attenuation correction can improve the sensitivity of myocardial scintigraphy to detect ischemic heart disease.     Material and method: 476 patients in 2017 - 2018 who underwent myocardial scintigraphy in Skaraborg Hospital were included in the study. Search of medical records of these patients was done to find the medical response of myocardial scintigraphy with attenuation correction and possibly angiography response if angiography was performed after myocardial scintigraphy. The results were compared with a parallel study investigating the sensitivity of myocardial scintigraphy without attenuation correction.    Results: In 2017 - 2018 when myocardial scintigraphy was performed with attenuation correction, 29.6% of a total of 476 patients were assessed as having ischemia. 1.1% were misdiagnosed on myocardial scintigraphy. 39.5% of 476 patients had pathological findings and 40% of these pathological patients went on to angiography, 61% of those who went on to angiography were diagnosed to have ischemia.    Conclusion: The Attenuation correction has reduced unnecessary angiography investigations in the investigation of ischemic heart disease. Also, an increase in the sensitivity of detecting ischemic heart disease with myocardial scintigraphy was seen with the attenuation correction.

Kvalite inom patologi är viktigt och det finns flera steg i preanalysen som kan påverka diagnostiken. Fixering, dehydrering och snittning är viktiga steg där fel kan uppstå som påverkar diagnostiken. Fixering förhindrar autolys och att mikroorganismer inte kan tränga in i vävnaden. Det finns olika fixeringsmedel och ett vanligt fixeringsmedel är formalin. Dehydrering innebär att vattnet i vävnaden byts ut mot paraffin, vävnaden bör ha fixerats minst i 24 timmar innan. I processen läggs vävnaderna i olika bad, första steget är en låghaltig alkohol och sedan ökar styrkan på alkoholen för att minska att vävnaden krymper. Nästa steg är clearing som förbereder vävnaden för paraffin då alkohol och paraffin inte är blandbara med varandra, tillsist sker en infiltrering av paraffin. Syftet var att optimera dehydreringen för 5 mm vävnader med Logos. Nio olika dehydreringar utfördes där vävnaderna gick igenom formalin, etanol, isoparaffin, isopropanol och vax infiltrering. Vävnader som hade dehydrerats i 12 timmar blev hårda, torra och svårsnittade. Vävnader som dehydrerats under 7 timmar blev underdehydrerade och det förekom hål i snitten. Hud, uterus och tyroidea var svårsnittade medans appendix, njure, mjälte, navelsträng, placenta, adnex, gallblåsa och testikel gick lättare att snitta. Försök 1 hade en starkare infärgning än resterande försök. Anledning till att hål förekommit vid försöken kan bero på en överdehydrering som gör vävnaden torr och hård eller en underdehydrering som gör att partier blir mjuka. Det behöver göras flera försök för att uppnå den mest optimala dehydreringen för 5 mm vävnader, eller att programmet baseras på vävnadstypen. / Quality in pathology is important and there are several steps in the pre-analysis that can affect the diagnosis. Fixation, dehydration and sectioning are important steps where errors can occur. Fixation prevents autolysis and the microorganisms from penetrating the tissue. There are differernt types of fixatives and a common fixative is formalin. Dehydration means that the water in the tissue is replaced by paraffin, the tissue should have been fixed for at least 24 hours. In the process the tissues are placed in different baths, the first step is alcohol with a low precent and then the strength of the alcohol increases to reduce tissue shrinkage. The next step is clearing which prepares the tissue for paraffin because alcohol and paraffin are not miscible with each other. The purpose was to optimize the dehydration for 5 mm tissues with Logos. Nine different dehydrations were performed where the tissues went through formalin, ethanol, isoparaffin, isopropanol and wax infiltration. Tissues that had been dehydrated for 12 hours became hard, dry and difficult to section. Tissues that were dehydrated for shorter than 7 hours became underdehydrated and holes occurred. Skin, uterus and thyroid were difficult to section while the appendix, kidney, spleen, umbilical cord, placenta, adnex and testicle were easier to section. The first attempt had a stronger staining than the other attempts. Reasons why holes occurred in the attempts may due to an overdehydration that makes the tissue dry and hard or an underdehydration that makes parts of the tissue soft. Several attempts need to be made to achieve the most optimal dehydration for 5 mm tissues, or that the program is based on the tissue type.

Neuroblastoma is a tumour derived from cells of the nervous system and is the most common solid tumour in childhood. MYCN amplified and 11q-deleted neuroblastoma, two high-risk neuroblastoma were investigated in this study. RAD51 gene family includes six central genes for the dsDNA breaks repair by homologous recombination, which has been reported as important in varying types of cancer. The study aims to investigate if the dysregulation of this gene family could be involved in the unstable genome of 11q-deleted neuroblastoma, and to better understand the link between both high-risk tumours. The RAD51 family genes’ expression level was measured by RT-qPCR in samples of 11q-deleted and MYCN-amplified neuroblastoma that were treated with a UVC treatment and were recovered during varying hours. R2 database and DAVID were used to study the RAD51 family’s expression levels, associated event-free survivability, and altered pathways. RAD51 family is highly dysregulated in these tumours, four genes of six were found to be altered in high-risk neuroblastoma. Four of six genes presented altered expression levels in 11q-loss, and three of six in the MYCN-amplified case after the UVC treatment. The event-free survival probability analysis shown that the levels of expressions associated with high-risk neuroblastoma coincide with those that represent a poor life expectancy. Altered pathways were different in each type of tumour. 11q-deletion neuroblastoma’s pathways were associated with the nervous system development, and MYCN-amplified was related to the immune system. This study suggests that 11q-loss neuroblastoma presents a greater RAD51 family dysregulation compared with MYCN-amplified one, which could explain why its genome is unstable.

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