BACKGROUND: Numerous epidemiologic studies have identified obesity as a vital risk factor for the development of colorectal cancer (CRC). More recently, obesity has been linked to the development of colorectal adenomatous polyps (adenomas), the precursor lesion of up to 80% of CRCs. The extent to which weight loss could reduce risk in obese patients is unclear. PROPOSED PROJECT: The proposed study is a randomized clinical trial that aims to evaluate the relationship between weight reduction and the prevalence of recurrent (metachronous) adenomas among obese patients in a safety-net health care setting. The intervention group will participate in a comprehensive, individually structured weight loss program in order to achieve successful long-term weight loss. The control group will receive no special recommendations about weight loss other than as part of “usual care”. Anthropometric measures (weight in kilograms [kg], height in meters squared [m2] and body mass index [BMI]) will be monitored annually until the time of surveillance colonoscopy which will occur in accordance with the U.S. Multi-Society Task Force recommendations. Statistical methods will be used to compare rates of recurrent adenomas among the two study groups after adjustments for duration of follow-up and potential confounders. CONCLUSION/SIGNIFICANCE: The results of this study will provide new evidence to support weight reduction as a preventive strategy for reducing CRC risk among obese patients.

BACKGROUND: An important characteristic of transitional cell carcinoma (TCC) is the formation of tumors in multiple sites throughout the whole urinary tracts. Two theories explain the pathophysiologic mechanisms of multifocal tumors: (1) intraluminal seeding, it indicates the multiple tumors come from a single transformed malignant cell with secondary seeding or migration at different sites, and (2) the field cancerization, carcinogens affect the urothelium at multiple sites, leading to numerous mutation and independent growth of multifocal polyclonal tumors. Multifocal urothelial carcinomas could come from intraluminal seeding or from field cancerization. However, the data of clinical behaviors between the two different tumor types are lacking. METHODS: Bilateral synchronous and metachronous primary TCC of the upper urinary tracts were derived from field cancerization. Recurrent bladder cancers following upper-tract tumors mostly come from intraluminal seeding. The recurrence, progression, and prognosis of the two different tumors were analyzed. RESULTS: Bilateral upper-tract urothelial carcinomas derived from field cancerization were frequently associated with renal insufficiency, which were more invasive and had poor prognosis than bladder tumors derived from intraluminal seeding. CONCLUSION: The clinical behaviors of the multiple urothelial tumors derived from field cancerization and from intraluminal seeding should be different.

Mucinous cystadenomas of the ovary are benign epithelial neoplasms that can grow rapidly during pregnancy. They may cause ovarian torsion, virilization, inferior vena cava syndrome, and even preterm labor and fetal growth restriction. Various theories exist regarding the pathogenesis of these tumors. One hypothesis suggests that they may arise from teratomas. Our case report describes synchronous mucinous cystadenomas and ovarian teratomas, as well as metachronous mucinous cystadenomas in patients with a history of ovarian teratoma. There has been no report of metachronous ipsilateral teratoma after previous mucinous cystadenoma. We present a 22-year-old female with a history of bilateral ovarian tumors in a prior pregnancy noted to have a recurrent ovarian mass on her left ovary at the time of cesarean section of a subsequent pregnancy. She had two prior cystectomies for metachronous mucinous cystadenomas of her left ovary, and a right salpingo-oophorectomy for the ovarian torsion in her previous pregnancy. On her current pregnancy, she developed a mature cystic teratoma of the remaining left ovary. The rapid growth and recurrence rate of these tumors highlights the importance of close surveillance of ovarian masses during pregnancy, even those that seem benign. In this case, a history of unilateral salpingo-oophorectomy with multiple contralateral cystectomies did not appear to affect her fertility. Her future ovarian reserve is unknown, pointing to the need for adequate pre-operative counseling in similar cases of ovarian masses in pregnancy.

Nossa proposta de trabalho visava estudar as propriedades do movimento ciliar, aplicando técnicas de microscopia eletrônica de varredura.. Escolheu-se como material de estudo a espécie Macrostomum tuba (turbelário), bastante comum em ambientes naturais de água doce, e em aquários. Sua superfície é inteiramente revestida por cilios, que o animal usa como meio locomoção suave e rápida. Cílios são estruturas em forma de projeções delgadas de células, com uma notável organização interna, constante em todas as espécies animais, e são dotados de movimento oscilatório rítmico e autônomo. O batimento ciliar coordenado origina ondas na superfície das células, e por conseguinte, na superfície do organismo, conhecidas como ondas metacrônicas. No caso em estudo, estas ondas são sufícientes para promover o deslocamento do organismo no meIO. Estudou-se a estrutura [ma destes cílios por microscopia eletrônica de transmissão, e a sua forma durante o batimento, por microscopia eletrônica de varredura. A frequência do batimento ciliar foi determinada por microscopia de luz com fonte estroboscópica, e o movimento do organismo em meio de diferentes viscosidades, foi registrado com câmara de vídeo. Os métodos utilizados neste trabalho permitiram obter-se as seguintes informações sobre o movimento ciliar de M. tuba: 1. Os cílios têm cerca de 5f..lm de comprimento, e estruruta interna típica (\"9+2\"). 2. Os cílios em meio aquoso, batem com frequência de 15 Hz, sendo esta reduzida de modo exponencial para os meios de viscosidade maior. 3. Os cilios trabalham de modo coordenado, produzindo ondas \"metacrônicas\" que apresentam um estágio de batimento efetivo e outro de recôbro, bem distintos. O comprimento de onda é da ordem de 4 a 5 f..lm e pode ser medido diretamente nas imagens de varredura. 4. Os cílios se distribuem ao longo da face ventral em campos, onde as ondas se orientam de modo conspícuo. 5. A velocidade de propagação da onda é da ordem de 78-80 ,.!In/s. e a velocidade média de deslocamento do animal em meio aquoso é cerca de 4 mmls, caindo a menos da metade para meios de viscosidades altas. 6. Os cílios podem ser removidos por diferentes métodos experimentais, tornando acessivel a superfície da célula: isto facilitou a observação de perfis de onda com mutio boa resolução, bem assim, pennitiu contagens de densidade ciliar (cerca de 200/célula ). / The aim of this study was to investigate the properties of ciliary motion in the flatwonn, Macrostomum tuba, using electron microscopy. This is a quite common species inhabiting freshwater ponds and fish aquaria. Its suface is entirely covered with cilia, that povide a smooth and fast gliding motion for the anima!. The fme structure of the cilia has been studied by use of transmission electron microscopy. The profiles assumed by the organelle during its undulatory motion have been described by use of special scanning microscopy techniques. Frequency of the ciliary beating has been detennined with a stroboscope system, and the gliding motion ofthe animal was recorded with a vide o camera. The several approaches used in the present study provide the following conclusions: 1. The cilia are 5 11m long; ultrastructurally they confonn to the \"9+2\" mode!. 2. The beating frequency in water is 15 Hz. This value is exponentially reduced for higher viscosity media. 3. The coordinated beating of a field of cilia gives rise to \"metachronal waves\" of about 4 to 5 11m in wavelength. A distinctive effective and another recovery stroke were characterized in the scanning images. 4. Along the ventral surface of the animal, oriented metachronal waves point to the directions ofwater flow. 5. Calculated metachronal wave velocity is 78-80 l1m/s, and the animal speed in water reaches some 4 mm/s; it slows down rapidly for higher viscosity fluids. 6. Experiments with deciliation have allowed a clear cut view of the wavefronts, as well as, the counting of ciliary density (about 200/cell).

Nossa proposta de trabalho visava estudar as propriedades do movimento ciliar, aplicando técnicas de microscopia eletrônica de varredura.. Escolheu-se como material de estudo a espécie Macrostomum tuba (turbelário), bastante comum em ambientes naturais de água doce, e em aquários. Sua superfície é inteiramente revestida por cilios, que o animal usa como meio locomoção suave e rápida. Cílios são estruturas em forma de projeções delgadas de células, com uma notável organização interna, constante em todas as espécies animais, e são dotados de movimento oscilatório rítmico e autônomo. O batimento ciliar coordenado origina ondas na superfície das células, e por conseguinte, na superfície do organismo, conhecidas como ondas metacrônicas. No caso em estudo, estas ondas são sufícientes para promover o deslocamento do organismo no meIO. Estudou-se a estrutura [ma destes cílios por microscopia eletrônica de transmissão, e a sua forma durante o batimento, por microscopia eletrônica de varredura. A frequência do batimento ciliar foi determinada por microscopia de luz com fonte estroboscópica, e o movimento do organismo em meio de diferentes viscosidades, foi registrado com câmara de vídeo. Os métodos utilizados neste trabalho permitiram obter-se as seguintes informações sobre o movimento ciliar de M. tuba: 1. Os cílios têm cerca de 5f..lm de comprimento, e estruruta interna típica (\"9+2\"). 2. Os cílios em meio aquoso, batem com frequência de 15 Hz, sendo esta reduzida de modo exponencial para os meios de viscosidade maior. 3. Os cilios trabalham de modo coordenado, produzindo ondas \"metacrônicas\" que apresentam um estágio de batimento efetivo e outro de recôbro, bem distintos. O comprimento de onda é da ordem de 4 a 5 f..lm e pode ser medido diretamente nas imagens de varredura. 4. Os cílios se distribuem ao longo da face ventral em campos, onde as ondas se orientam de modo conspícuo. 5. A velocidade de propagação da onda é da ordem de 78-80 ,.!In/s. e a velocidade média de deslocamento do animal em meio aquoso é cerca de 4 mmls, caindo a menos da metade para meios de viscosidades altas. 6. Os cílios podem ser removidos por diferentes métodos experimentais, tornando acessivel a superfície da célula: isto facilitou a observação de perfis de onda com mutio boa resolução, bem assim, pennitiu contagens de densidade ciliar (cerca de 200/célula ). / The aim of this study was to investigate the properties of ciliary motion in the flatwonn, Macrostomum tuba, using electron microscopy. This is a quite common species inhabiting freshwater ponds and fish aquaria. Its suface is entirely covered with cilia, that povide a smooth and fast gliding motion for the anima!. The fme structure of the cilia has been studied by use of transmission electron microscopy. The profiles assumed by the organelle during its undulatory motion have been described by use of special scanning microscopy techniques. Frequency of the ciliary beating has been detennined with a stroboscope system, and the gliding motion ofthe animal was recorded with a vide o camera. The several approaches used in the present study provide the following conclusions: 1. The cilia are 5 11m long; ultrastructurally they confonn to the \"9+2\" mode!. 2. The beating frequency in water is 15 Hz. This value is exponentially reduced for higher viscosity media. 3. The coordinated beating of a field of cilia gives rise to \"metachronal waves\" of about 4 to 5 11m in wavelength. A distinctive effective and another recovery stroke were characterized in the scanning images. 4. Along the ventral surface of the animal, oriented metachronal waves point to the directions ofwater flow. 5. Calculated metachronal wave velocity is 78-80 l1m/s, and the animal speed in water reaches some 4 mm/s; it slows down rapidly for higher viscosity fluids. 6. Experiments with deciliation have allowed a clear cut view of the wavefronts, as well as, the counting of ciliary density (about 200/cell).

Le carcinome rénal à cellules claires (ccRCC) est la tumeur du rein la plus fréquente. Il se caractérise par une inactivation fréquente du gène suppresseur de tumeur VHL retrouvée dans 70% des tumeurs conduisant à une transcription des gènes cibles du facteur de transcription HIF dont le VEGF. Il s’agit d’une tumeur agressive métastatique chez 50% des patients. Le sunitinib, un inhibiteur des récepteurs tyrosine kinase anti-angiogénique, est actuellement le plus utilisé en 1ère ligne malgré 30% des patients qui progressent rapidement. L’avènement d’un nouvel anti-angiogénique ciblant MET (cabozantinib) et d’immunomodulateurs (anticorps anti-PD-1, nivolumab) rend cruciale la découverte de facteurs prédictifs de réponse au traitement. Dans une 1ére partie, nous avons étudié une série rétrospective de 98 ccRCC consécutifs pour lesquels nous souhaitions étudiés le statut VHL complet et le corréler à l’expression de PD-L1. De plus, alors que le pronostic est différent entre ccRCC métastatiques synchrones (d’emblée) et métachrones (à distance), leur phénotype n’avait jamais été comparé. Pour cela, nous avons effectué une analyse histologique des principaux facteurs pronostiques, immunohistochimique (CAIX, VEGF, PAR3, PD-1 et PD-L1) et moléculaire (statut complet VHL : délétion, mutation et méthylation du promoteur) corrélée à la survie spécifique. Nous avons démontré que le statut VHL non-inactivé (niVHL) était associé à la présence de métastases synchrones, une composante sarcomatoïde, un infiltrat lymphocytaire dense, une surexpression de VEGF, une expression de PD-L1 et à un mauvais pronostic. Nous avons aussi comparé les phénotypes des ccRCC métastatiques métachrones et synchrones. Ces derniers étaient associés à une  composante sarcomatoïde, une expression cytoplasmique de PAR-3, une surexpression de VEGFA, un statut niVHL et à un mauvais pronostic depuis le diagnostic des métastases. Dans une 2ème partie, nous avons étudié une série rétrospective de 90 ccRCC métastatiques consécutifs traités par sunitinib en première ligne afin d’identifier des facteurs prédictifs de réponse ou de résistance. Nous avons utilisé les mêmes techniques que précédemment avec en plus le statut MET (mutation en NGS et expression en IHC). Les patients ont été classés en résistants primaires, intermédiaires et longs répondeurs en fonction de la durée de leur réponse évaluée par des critères radiologiques (RECIST). Nous avons aussi caractérisé le profil génétique de 73 ccRCC de cette série par CGH array pour lesquels nous disposions de congélation. Les patients résistants primaires avaient plus souvent un mauvais pronostic (score de Heng), des métastases hépatiques, une infiltration de la graisse hilaire. Sur le plan cytogénétique, leurs tumeurs présentaient des altérations génétiques plus nombreuses tant au niveau des gains que des pertes. Parmi ces altérations récurrentes, étaient décrites les gains du 5p, 7p, 8q22.1-qter et la perte de la région 6q21-q25.3. Le modèle de Cox multivarié mettait en évidence 4 facteurs indépendants : le score de Heng, des métastases hépatiques, une infiltration de la graisse hilaire et le gain du 8q qui intégrés dans un nomogramme pronostique avaient un c-index de 0.74 et 0.77 pour la survie sans progression et la survie globale. En conclusion, notre étude a permis d’identifier un sous-type de ccRCC avec un statut niVHL de mauvais pronostic qu’il conviendrait d’étudier de manière plus approfondie sur le plan génomique. De plus, nous avons montré une différence de phénotype entre les ccRCC des patients métastatiques synchrones et métachrones alors que leur prise en charge est actuellement équivalente. Enfin nous avons mis en évidence un nomogramme pronostique dans les ccRCC métastatiques traités par sunitinib en 1ère line. Ce nomogramme s’il est confirmé par une étude prospective plus large pourrait avoir un impact clinique important dans la sélection des patients les plus à même de bénéficier des anti-angiogéniques. / Clear cell renal cell carcinoma (ccRCC) is the most common kidney cancer. It is characterized by frequent inactivation of the tumor suppressor gene VHL found in 70% of tumors leading to the transcription of HIF transcription factor target genes such as VEGF. This is an aggressive tumor with 50% of metastatic patients. Sunitinib, an inhibitor of receptor tyrosine kinase antiangiogenic, is currently the most used in 1st line despite 30% of patients who progress quickly. The advent of a new anti-angiogenic targeting MET (cabozantinib) and immunomodulators (anti-PD-1 antibody, nivolumab) makes crucial discovery of predictors of response to treatment. In the first part, we studied a retrospective study of 98 consecutive ccRCC. We assessed complete VHL status and correlated it with the expression of PD-L1. Moreover, while the prognosis is different between ccRCC synchronous metastatic and metachronous, their phenotype have never been compared. In this purpose, we performed an analysis of the main pathological prognostic factors, immunohistochemical markers (CAIX, VEGF, PAR3, PD-1 and PD-L1) and molecular (VHL status: deletion, mutation and promoter methylation) correlated with specific survival. We demonstrated that non-inactivated VHL tumors (niVHL) were associated with the presence of synchronous metastases, sarcomatoid component, a dense lymphocytic infiltrate, an overexpression of VEGF, an expression of PD-L1 and a poor prognosis. We also compared the phenotypes of metachronous and synchronous metastatic ccRCC. The first ones were associated with sarcomatoid component, cytoplasmic expression of PAR-3 overexpression VEGFA and niVHL status and a poor prognosis even from the diagnosis of metastases. In the second part, we studied a retrospective study of 90 consecutive metastatic ccRCC treated with first line sunitinib to identify predictors of response or resistance. We used the same techniques as above plus the MET status (mutation in Next-Generation sequencing and expression by IHC). Patients were classified as primary-refractory, intermediate and long-term responders depending on the duration of their response as assessed by radiological criteria (RECIST). We also characterized the genetic profile of 73 ccRCC of this series by CGH array for which we had frozen tumor. Primary refractory patients often had poor prognosis (Heng criteria), liver metastases, infiltration of the hilar fat. Cytogenetically, their tumors had many more genetic alterations, both gains as losses. These recurrent alterations were gains of 5p, 7p, 8q22.1-qter and loss of 6q21-q25.3 region. The multivariate Cox model highlighted four independent factors: the score of Heng, liver metastases, infiltration of the hilar fat and gain of 8q which integrated into a prognostic nomogram had a c-index of 0.74 for survival progression-free survival and 0.77 for overall survival. In conclusion, our study identified a subtype of ccRCC with a poor prognosis with niVHL status that should be explored at the genomic level. Furthermore, we showed a phenotype difference between ccRCC synchronous and metachronous metastatic patients whereas their care is currently the same. Finally we have identified a prognostic nomogram in metastatic ccRCC treated with sunitinib in the first line. This nomogram if confirmed by a larger prospective study could have a significant clinical impact in the selection of patients most likely to benefit from anti-angiogenic therapy.