PPT CJR BIOMOLLECULAR CESP_GROUP 3_CESP 2020 (1).pptx

BIOMOLLECULAR

1. C ritical Journal Review (Case Method) Lecturer: Dr. Techn. Marini Damanik, M.Si.

2. Introduce Group 3 Feby Nabila Safira (4202131001) Miranda A. Sihite (4203131031) Rahma Safitri (4203332024)

3. Table of Contents 1. Identity of Journals 1. Summary of Journal 1 2. Summary of Journal 2

4. The Identity of Journals Journal 1 Title : Increased carbohydrate antigen 19-9 expression in a thymic neuroendocrine tumor. Name of Journal : Thoracic Cancer. Authors : Yuki Shimizu, Shintaro Kanda, Toshirou Fukushima, Takashi Kobayashi, Ryoichi Kondo, and Tomonobu Koizumi. Publisher : WILEY. Year Published : 2021. Volume and Issue : Volume 12, Issue 21. Page : 2949-2952. ISSN/ doi : 10.1111/1759-7714.14153

5. The Identity of Journals Journal 2 Title : Adherence to low carbohydrate diet in relation to glioma: A Q5 case-control study. Name of Journal : Clinical Nutrition. Authors : Soraiya Ebrahimpour-Koujan , Mehdi Shayanfar , Sanaz Benisi - Kohansal , Minoo Mohammad-Shirazi, Giuve Sharifi, and Ahmad Esmaillzadeh . Publisher : ELSEVIER. Year Published : 2018. Volume and Issue : Volume 38, Issue 6. Page : 2690-2695. ISSN/ doi : 10.1016/j.clnu.2018.11.023

6. Summary of Jornal 1 Definiton of Carbohydrate Antigen 19-9 Carbohydrate Antigen 19-9 (CA 19-9) is a substance produced by cancer cells of the exocrine pancreas and can be detected on blood tests. Carbohydrate antigen 19-9 (CA19-9), also known as sialyl-LewisA , is a tetrasaccharide which is usually attached to O-glycans on the surface of cells. It is known to play a vital role in cell-to-cell recognition processes. It is also a tumor marker used primarily in the management of pancreatic cancer.

7. Clinical Significance 1 2 3 Tumor marker Uses of CA 19-9 . examination Limitations Guidelines from the American Society of Clinical Oncology discourage the use of CA19-9 as a screening test for cancer, particularly pancreatic cancer. The main use of CA19-9 is therefore to see whether a pancreatic tumor is secreting it; if that is the case, then the levels should fall when the tumor is treated, and they may rise again if the disease recurs. The use of the CA 19-9 examination is to diagnose pancreatic cancer, help differentiate pancreatic cancer from bile duct cancer or other noncancerous conditions (such as pancreatitis), monitor response to therapy, and monitor the prognosis of pancreatic cancer. A normal serum CA 19-9 level is less than 37 U/ml. Evaluation of serum CA19-9 levels is used to support radiological results to determine whether the tumor can be resected. The CA 19-9 examination has the advantages of being cheaper in terms of cost, easy to do, and quick examination results obtained. CA19-9 can be elevated in many types of gastrointestinal cancer, such as colorectal cancer, esophageal cancer and hepatocellular carcinoma. Apart from cancer, elevated levels may occur in pancreatitis, cirrhosis, and diseases of the bile ducts. Elevated levels of CA 19-9 can also be found in patients with pancreatitis and ovarian cancer.

8. Specificity and Sensitivity of CA 19-9 Tumor Markers in Gastrointestinal Cancer Screening The American Society Of Clinical Oncology (ASCO) states that CA 19-9 should not be used as a screening tool for gastrointestinal cancer. The literature also suggests that CA 19-9 is not useful for screening asymptomatic populations. A large study in Korea, involving 70,940 asymptomatic subjects. Of these subjects, elevated CA 19-9 levels were found in 1063 people (1.5%), but only 4 were ultimately diagnosed with pancreatic cancer. The results of this study showed that although the sensitivity and specificity of CA 19-9 were quite high (100% and 98.5%), the positive predictive value was only 0.9% in the asymptomatic population. Existing studies indicate that the tumor marker CA 19-9 is not suitable as a screening tool in cases of gastrointestinal cancer. Levels of these tumor markers can be elevated in a variety of other conditions such as pancreatitis, lung cancer, breast cancer, or chronic bronchitis. However, this examination can be used to determine the patient's prognosis and as a monitoring tool in the management of gastrointestinal cancer.

9. Definition of Thymic Neuroendocrine Tumor Neuroendocrine tumors or NETs (Neuroendocrine Tumors ) usually known as carcinoid are abnormal growths that start from neuroendocrine cells that are widely distributed throughout the body, including the stomach, intestines and lungs. Causes of Neuroendocrine Tumors Neuroendocrine tumors are very rare and their cause is unknown. This tumor is associated with the factors below: 1. Age: neuroendocrine tumors are most common in patients over the age of 60. 2. Patients suffering from endocrine neoplasia are at high risk of developing neuroendocrine tumors.

10. Neuroendocrine Tumor Symptoms and Signs Different types of neuroendocrine tumors will cause different symptoms. Symptoms of a neuroendocrine tumor largely depend on the location of the tumor which can cause: Reddened face and neck without sweat Diarrhea Shortness of breath, fast heart rate High blood pressure Weak and easily tired Abdominal pain, cramps, bloating Unexplained weight gain Breath sounds and cough Swelling of the feet and ankles Skin lesions, colorless areas of skin, thin skin Frequent urination, increased thirst, hunger (high blood glucose) Shaking, dizziness, sweating, fainting (low blood glucose)

11. Neuroendocrine Tumor Diagnosis Each type of neuroendocrine tumor requires a specific diagnosis. This is very dependent on the location of the tumor, the level of hormone production, and the spread of the tumor to other organs. The usual diagnoses for neuroendocrine tumors are: Lab Test, Cytopathology Biopsy, endoscopic ultrasound ERCP CT scan, CT angiography MRI Laparoscopy Nuclear medicine imaging (NMI) Genetic test

12. Neuroendocrine Tumor Treatment Treatment of neuroendocrine tumors depends on the location and type of tumor. Treatment options are available, such as: Surgery — Doctors remove the entire tumor. Somatostatin analogues — drugs used to relieve symptoms of carcinoid syndrome, block the body from overproducing hormones, and control the growth of neuroendocrine tumors. Chemotherapy — can be used to shrink the tumor, which will then reduce symptoms. Targeted Therapy — a drug used to slow the growth of cancer cells. Interferon alpha — A protein that occurs naturally in the body. When cancer patients take this drug, it helps the immune system and destroys cancer cells. Radiotherapy — High-energy X-rays destroy cancer cells without causing too much damage to healthy cells. Targeted radionuclide therapy — Radioactive substances are given orally or injected into the bloodstream. The tumor will absorb radiation and will be less likely to hit healthy cells.

13. Case Report: Increased Carbohydrate Antigen 19-9 Expression in A Thymic Neuroendocrine Tumor A 54-year-old woman with no significant medical history or symptoms was referred to our hospital because of persistently elevated CA19-9 level for 3 months detected on health screening. Physical examinations were unremarkable. Laboratory findings indicated elevated CA19-9 (98.3 U/ml; normal: <37 U/ml). Figure 1. The pathological findings of the resected mass indicated irregularly shaped sheets and nests of tumor cells, and a diagnosis of neuroendocrine tumor was made (a, HE x 10; b, x 40). (c) The Ki-67 labeling index was 5.6%. (d) Immunohistochemical staining indicated that tumor cells were positive for synaptophysin, (e) insulinoma-associated protein 1, and (f) carbohydrate antigen 19-9

14. CA19-9 is a diagnostic tumor marker to differentiate between pancreatic adenocarcinoma and NETs. 6,7 Several studies of CA19-9 in pancreatic NET patients have been reported. Luo et al. reported that CA19-9 > 16 U/ml was significantly associated with a higher proportion of patients at advanced stages and was an adverse prognostic factor for overall survival. Thymic NET is a rare clinical entity with poorer prognosis than foregut counterparts and with the potential for local and distant metastases. In this our case, mediastinal lymph node metastasis and multiple bone metastasis were detected 1 and 4 years after initial surgery, respectively. Similar thymic NETs with multiple bone metastases have been reported with frequency ranging between 7% and 15% in NETs. The increase in CA19-9 produced by tumor cells was the initial clinical index for diagnosis, and serial changes in CA19-9 were associated with clinically relevant parameters. This case suggests that thymic NET has the potential to produce CA19-9. Case Report: Increased Carbohydrate Antigen 19-9 Expression in A Thymic Neuroendocrine Tumor

15. Summary of Jornal 2 Definition of Glioma Glioma is a tumor that originates in brain tissue. Glioma is an inflammatory tumor that can attack several parts of the brain. Malignant gliomas usually occur in the neoplasm of the brain which accounts for approximately 45% of all brain tumors.

16. Types of Glioma 1 2 3 Astrocytes Oligodendrocyte cells Ependymal cells which regulate electrical impulses in the brain, can form astrocytomas . which isolate nerve cells to help send nerve signals, produce oligodendrogliomas which line the cavities of the brain, called the ventricles, form ependymoma Three types of glial cells can cause glioma tumors .

17. There are four different "grades" of gliomas, which are classified as low-grade or high-grade. Recently, doctors have discovered that each grade of glioma is characterized by a specific DNA mutation in the tumor . Gliomas are primary brain malignancies, the most frequent and aggressive type of brain tumors with poor prognosis. The overall incidence of glioma is 2.74 per 100,000 person-years. Given the high mortality rates of brain tumors , findings appropriate preventive strategies is of great importance. Several environmental factors, including dietary factors, have been related to the incidence of glioma.

18. One of the most interesting dietary factors that has received great attention in several cancers, including glioma, is carbohydrate restriction (CR). Glioma cells critically depend on glucose as main source of energy to survive and invade due to dys -regulation of mitochondrial metabolism. Therefore, dietary carbohydrate intake can result in the proliferation of glioblastoma multiform (GBM) cells and might play a role in the initiation of neoplasia in these cell. Low carbohydrate dietary patterns have been linked with reduced risk of metabolic syndrome, diabetes, coronary heart disease and some cancers. Observational studies are required to examine the possible association of usual carbohydrate intake in routine lifestyle with the risk of glioma. This is particularly relevant in developing countries where dietary carbohydrate intake compose the greatest percentage of energy.

19. The cause of primary brain tumors is unknown. Some tumors tend to run in families, people who inherit this specific gene may be more likely to develop brain tumors. In other cases, a person's genes may change with age. Environmental factors such as diet, radiation, or chemicals can cause gene changes. Secondary brain tumors are caused by tumors in other areas of the body that spread to the brain. Causes of Glioma Diagnosys Doctors use a number of techniques or procedures to determine if a person has a brain tumor . First, the doctor performs a physical examination and reviews the person's medical history. If a brain tumor is suspected, the person will likely be referred to a neurologist. Other tests may include: Blood test. Chest X-ray CT scan (if there is a tumor , its location will be indicated). Magnetic resonance imaging (not always performed). Electroencephalogram. Tumor tissue samples.

20. DRUGS They are useful in treating gliomas. Just as antiepileptic drugs help reduce the risk of seizures, chemotherapy, which uses a combination of powerful drugs, helps kill cancer cells. OPERATION It is recommended in most cases to remove the tumor. The surgeon may decide to remove part or all of the tumor based on its location. If the tumor is at or near the base of the brain, surgery becomes more difficult. RADIOTHERAPY It uses X-rays to destroy cancer cells in tumors. Radiation therapy can damage healthy tissue around the tumor, but doctors try to limit this damage as much as possible. Glioma Treatment

21. Observational studies that investigated the association between adherence to low carbohydrate diet and odds of glioma are sparse. This is particularly relevant in developing countries where dietary carbohydrate intake is very high. Objective: This study was, therefore, conducted to investigate the association between adherence to low carbohydrate dietary pattern and odds of glioma among Iranian adults. Methods: In this hospital-based case-control study, 128 newly diagnosed glioma cases were recruited and 256 age- and sex-matched subjects were enrolled as controls. Dietary intakes were examined by the use of a 126-item validated FFQ. Low carbohydrate diet (LCD) score was computed for each participant based on deciles of percentages of energy from carbohydrates, proteins, and fats. Individuals in the lowest decile of carbohydrate consumption received 10 points. Participants in second decile received 9 points and so on down to participants in the highest decile received 1 points. Case Report

22. For fat and protein intakes, the points assigned to deciles were reversed; such that those in the highest decile received 10 points and those in the lowest decile received 1 point. We then summed all points of the three macronutrients to achieve the overall diet score, which ranged from 3 (highest carbohydrate intake and lowest fat and protein intakes) to 30 (lowest carbohydrate intake and highest fat and protein intakes). The higher the score, the greater adherence to the LCD dietary pattern. Results: After adjustment for age and sex, we found that individuals in top tertile of LCD score were 60% less likely to have glioma compared with those in the bottom tertile (OR: 0.40; 95% CI: 0.23, 0.67). Additional controlling for other potential confounders made the association slightly attenuated (OR: 0.49; 95%CI: 0.26, 0.93). Further adjustment for dietary nutrient intakes strengthened the association (OR: 0.32; 95%CI: 0.12, 0.81). After additional controlling for BMI, we found that adherence to LCD was protectively associated with reduced odds of glioma (OR: 0.32; 95%CI: 0.12, 0.81). We found an inverse association between adherence to LCD and odds of glioma among Iranian population. Prospective cohort studies are needed to confirm these findings. Case Report

23. Thanks! DIFFERENT ORNAMENTS TOP LINE Do you have any questions?