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1.
Christoph Schramm Moritz Kaiser Uta Drebber Inga Gruenewald Jeremy Franklin Fabian Kuetting Andrea Bowe Vera Hoffmann Sebastian Gatzke Ulrich Toex Hans-Michael Steffen 《International journal of colorectal disease》2016,31(2):319-325
Introduction
A substantial interobserver variation in the differential diagnosis of hyperplastic polyps (HPs) and sessile or traditional serrated adenomas (SSAs/TSAs) has been described.Methods
The aim of this study is to determine the magnitude of reclassification of HPs and associated factors after pathological reassessment of specimens from screening and surveillance colonoscopies, and to estimate its consequences for follow-up recommendations.Results
Among 1694 screening and surveillance colonoscopies, a total of 536 polyps were initially diagnosed as HPs and remained unchanged in 88.5 % (n?=?474), whereas 7.6 (n?=?41) and 1.1 % (n?=?6) were reclassified as SSA and TSA, respectively. Compared to definite HPs, SSAs were found more frequently in men than in women (82.9 vs. 61.2 %, p?<?0.05), and in individuals ≥65.0 years (51.2 vs. 31.6 %, p?=?0.05). Also, more SSAs were >5 mm in size (36.6 vs. 6.3 %, p?<?0.05) and were localized in the proximal colon (31.7 vs. 11.8 %, p?<?0.05). In a mixed model analysis, age ≥65.0 years (OR 4.13, 95 % CI 1.22–14.2), snare polypectomy (OR 23.6, 95 % CI 4.86–115), and coincident advanced adenomas (OR 7.56, 95 % CI 1.31–43.5) were significantly (p?<?0.05) associated with reclassification to SSAs. Only 0.53 % of patients had received false recommendations for follow-up visits based on the incorrect HP diagnosis. A c.1799T>A, p.V600E BRAF mutation was detected in 21.9 % (n?=?9) of reclassified SSAs.Conclusion
Considering these factors may be helpful in serrated lesions that are difficult to allocate. Incorrect recommendations regarding control colonoscopy intervals due to misdiagnosed HPs can explain only a small fraction of interval colorectal cancers.2.
Background
Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) are recognized precursors of colorectal cancer, but their risk factors are not well established. We investigated the association between Helicobacter pylori infection (HPI) and the development of SSA and TSA.Methods
Retrospective data were collected on patients aged ≥?18 years that underwent colonoscopy with biopsy between 2006 and 2016. Based on histology, patients were classified into three groups: those with SSA and/or TSA, (serrated neoplasia group, SN); conventional adenomas only (CA); and with no polyps (NP). Gastric HPI status, demographic, and clinical risk factors were compared between groups using bivariate and multivariable analysis.Results
HPI was significantly associated with increased risk of SN (SN vs. NP: OR 1.71 [95% CI 1.29–2.27]; SN vs. CA: 1.49 [1.14–1.96]). Additional factors associated with increased risk of SN included the following: age 50–75 years, compared to younger age (SN vs. NP: 2.83 [1.69–4.74]), female gender (SN vs. CA: 1.28 [0.99–1.64]), White race, compared to Blacks (SN vs. CA: 1.52 [1.07–2.15)], overweight and obese body mass index [SN vs. NP: p?<?0.001) and current smoking status (SN vs. CA: 2.09 [1.55–2.82)]. Among SN, higher HPI prevalence was associated with dysplasia (p?=?0.05) and proximal location (p?=?0.01).Conclusions
Our data suggest that gastric HPI is associated with increased risk of SN and CA, with a stronger association with SN as compared to CA. Age 50–75 years, female gender, White race, obesity, and smoking were also predictors of SN. A positive correlation of HPI with proximal and dysplastic SN suggests a possible role in serrated pathway carcinogenesis. Prospective studies with large patient population are needed to further investigate this association.3.
Purpose
The colonoscopy adenoma detection rate depends largely on physician experience and skill, and overlooked colorectal adenomas could develop into cancer. This study assessed a system that detects polyps and summarizes meaningful information from colonoscopy videos.Methods
One hundred thirteen consecutive patients had colonoscopy videos prospectively recorded at the Seoul National University Hospital. Informative video frames were extracted using a MATLAB support vector machine (SVM) model and classified as bleeding, polypectomy, tool, residue, thin wrinkle, folded wrinkle, or common. Thin wrinkle, folded wrinkle, and common frames were reanalyzed using SVM for polyp detection. The SVM model was applied hierarchically for effective classification and optimization of the SVM.Results
The mean classification accuracy according to type was over 93%; sensitivity was over 87%. The mean sensitivity for polyp detection was 82.1%, and the positive predicted value (PPV) was 39.3%. Polyps detected using the system were larger (6.3?±?6.4 vs. 4.9?±?2.5 mm; P?=?0.003) with a more pedunculated morphology (Yamada type III, 10.2 vs. 0%; P?<?0.001; Yamada type IV, 2.8 vs. 0%; P?<?0.001) than polyps missed by the system. There were no statistically significant differences in polyp distribution or histology between the groups. Informative frames and suspected polyps were presented on a timeline. This summary was evaluated using the system usability scale questionnaire; 89.3% of participants expressed positive opinions.Conclusions
We developed and verified a system to extract meaningful information from colonoscopy videos. Although further improvement and validation of the system is needed, the proposed system is useful for physicians and patients.4.
Introduction
Pneumothorax often develops in pulmonary Langerhans cell histiocytosis (PLCH), but some patients take a long time to be correctly diagnosed.Objectives
This study assessed the frequency of pneumothorax in PLCH and analysed the role of chest computed tomography (CT) in the prompt diagnosis.Patients and material
Of the 90 patients with PLCH seen from 2000 to 2015, 29 (32%) had pneumothorax as the initial finding. In this group, 18 (62%) patients were diagnosed within 1 month, whereas the diagnosis was delayed for 4–120 months in 11 (38%) patients.Results
Patients who had pneumothorax as the initial sign of PLCH tended to be younger (mean age 27.7?±?7.92 vs. 39.9?±?13.21 years; P?=?0.0001), male (69% vs. 43%; P?=?0.028), smoked less (mean pack/years 8.4?±?6.85 vs. 19?±?17.16; P?=?0.003), and had a significantly lower mean FVC (77.96?±?19.62 vs. 89.47?±?21.86% pred.; P?=?0.015) and FEV1 (68.6?±?19.93 vs. 79.4?±?21.48% pred.; P?=?0.03 than patients who had no pneumothorax. Recurrent pneumothorax was diagnosed more frequently in the group with a delayed diagnosis (82% vs. 39%; P?=?0.02). CT was performed in all of the patients who were diagnosed promptly, but in none of the patients with a delayed diagnosis.Conclusions
Patients who had pneumothorax as the initial sign of PLCH were younger, more frequently men, and had greater respiratory impairment than those who had no pneumothorax. CT in patients with pneumothorax led to a correct diagnosis of this disease.5.
Purpose
The aim of our study was to compare the characteristics and prognosis between right- and left-sided metastatic colorectal carcinomas.Methods
Data from 937 patients with stage IV colorectal carcinomas (synchronous distant metastasis) who had a resection of the primary tumour between 1985 and 2014 were analysed. Carcinomas in the caecum to transverse colon were defined as right-sided (n?=?250; 26.7%). They were compared to tumours located from the splenic flexure to the rectum categorised as left-sided (n?=?687; 73.3%).Results
In right-sided carcinomas, we observed significantly more female patients (50.8 vs 36.2%; p?<?0.001), more unfavourable histological types (24.0 vs 8.6%; p?<?0.001), more M1c carcinomas (metastases to the peritoneum?±?others; 32.0 vs 14.4%; p?<?0.001) and more emergencies (11.6 vs 7.1%; p?=?0.029), while multimodal treatment was utilised in fewer patients (51.6 vs 63.8%; p?=?0.001) and curative resections were less frequently (24.1 vs 35.4%; p?=?0.002). Prognosis was significantly worse in patients with right-sided carcinomas (2-year-survival 27.2 vs 44.6%, p?<?0.01). This difference was more pronounced after R2 resection (15.3 vs 29.7%; p?<?0.001), than after macroscopic curative resection (2-year-survival 63.9 vs 71.9%; p?=?0.106). In multivariate Cox regression analysis, tumour site was found to be an independent prognostic factor for overall survival (HR 1.2; 95% CI 1.0–1.5; p?=?0.012). During the three 10-year periods, the prognosis improved equally in patients with right- and left-sided carcinomas, while the differences in survival remained identical.Conclusions
In a surgical patient cohort undergoing primary tumour resection, significant differences in prognosis were observed between patients with metastatic right- and left-sided colorectal carcinomas.6.
Tamotsu Sugai Makoto Eizuka Yasuko Fujita Keisuke Kawasaki Eiichiro Yamamoto Kazuyuki Ishida Hiroo Yamano Hiromu Suzuki Takayuki Matsumoto 《Digestive diseases and sciences》2018,63(10):2626-2638
Aim
The aim of your study is to characterize serrated lesions according to their molecular patterns, specifically BRAF/KRAS mutation, methylation, and microsatellite statuses. We evaluated the molecular patterns of 163 serrated lesions, including 37 microvesicular hyperplastic polyps, 73 sessile serrated adenomas/polyps (SSA/Ps), 31 traditional serrated adenomas, and 22 SSA/Ps with cytological dysplasia/adenocarcinoma.Methods
Mutations in BRAF (V600E)/KRAS (exon 2) and microsatellite status [microsatellite stability (MSS) vs. MSI] were examined using a pyrosequencer and the PCR-based microsatellite method, respectively. DNA methylation status was classified as low (LME), intermediate (IME), or high methylation epigenotype (HME) according to a PCR-based two-step method. In addition, mucin and annexin A10 expression was examined. Finally, we performed a hierarchical clustering analysis of the BRAF/KRAS mutation, DNA methylation, and microsatellite statuses.Results
The molecular patterns observed in the serrated lesions could be divided into five subgroups: lesions characterized by (1) BRAF mutation, HME, and MSI; (2) BRAF mutation, HME, and MSS; (3) BRAF mutation, LME/IME, and MSS; (4) no BRAF/KRAS mutations, LME/IME, and MSS; and (5) KRAS mutation, LME/IME, and MSS. In addition, we demonstrated that these observed molecular patterns help identify the associations of the molecular patterns and markers (i.e., mucin and annexin A10) with the clinicopathological findings, including histological features and histological diagnosis.Conclusions
We suggest that the identified molecular patterns play an important role in the pathway of serrated lesion development.7.
Aim
Foreshortened mesentery or thick abdominal wall constitutes a rationale for laparoscopic intracorporeal ileocolic anastomoses (ICA). The aim of this study was to compare intracorporeal to extracorporeal ICA in terms of surgical site infections in patients with Crohn’s ileitis and overweight patients with right colon tumors.Method
This was a prospective propensity score-matched cohort study enrolling consecutive patients with Crohn’s terminal ileitis and overweight patients with right colon tumors undergoing elective laparoscopic right colon resection with intracorporeal or extracorporeal ICA. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, BMI, ASA, and previous abdominal surgery.Results
Overall, 453 patients were enrolled: 233 intracorporeal vs. 220 extracorporeal. Propensity score matching left 195 intracorporeal and 195 extracorporeal patients comparable for age (p?=?0.294), gender (p?=?0.683), ASA (p?=?0.545), BMI (p?=?0.079), previous abdominal surgery (p?=?0.348), and diagnosis (p?=?0.301). Conversion rates (5.1 vs. 3.6%; p?=?0.457) and intraoperative complications (1 vs. 2.1%; p?=?0.45) were similar. Overall morbidity (5.1 vs. 12.8%; p?=?0.008) and re-intervention rates (3.1 vs. 8.7%; p?=?0.029) were significantly higher in extracorporeal patients. Anastomotic leak rates (0.5 vs. 1.5%; p?=?0.623) did not differ. Incisional SSI rate was significantly higher in extracorporeal patients (p?=?0.01).Conclusion
Laparoscopic intracorporeal ICA reduced incisional SSI rates as compared to its extracorporeal counterpart.8.
Huaiwei Yang Jingwei Liu Jingjing Jing Zeyang Wang Yi Li Kaihua Gou Xue Feng Yuan Yuan Chengzhong Xing 《Digestive diseases and sciences》2018,63(11):2959-2968
Background
Damage-specific DNA binding protein 2 (DDB2) is implicated in the recognition of DNA damage and the initiation of nucleotide excision repair process. The aim of this study was to explore the role of DDB2 in the initiation, progression, and prognosis of colorectal cancer (CRC).Methods
Totally tissues of 300 CRC and 300 adjacent, 267 colorectal adenoma (CRA) and 214 normal (NOR) were collected. The expression of DDB2 protein was detected by immunohistochemical staining.Results
DDB2 protein was highly expressed in CRC and CRA compared with NOR (P?<?0.001, respectively) in the dynamic sequence of NOR?→?CRA?→?CRC; CRC tissue demonstrated increased DDB2 expression compared with non-tumor adjacent tissues (P?<?0.001). DDB2 expression was higher in T1–T2 than that in T3–T4 in CRC (P?=?0.023); cloddy/nested CRC demonstrated increased DDB2 expression than infiltrative CRC (P?=?0.007). Survival analysis showed that high DDB2 expression was associated with favorable survival in colon cancer (adjusted HR 0.20, 95% CI 0.06–0.72, P?=?0.014) and female CRC patients (adjusted HR 0.27, 95% CI 0.08–0.92, P?=?0.036).Conclusion
DDB2 protein expression was associated with the initiation, progression, and prognosis of CRC, and might function as a tumor biomarker for the diagnosis and prognosis of CRC.9.
Daiki Hirano Shiro Oka Shinji Tanaka Kyoku Sumimoto Yuki Ninomiya Yuzuru Tamaru Kenjiro Shigita Nana Hayashi Yuji Urabe Yasuhiko Kitadai Fumio Shimamoto Koji Arihiro Kazuaki Chayama 《BMC gastroenterology》2017,17(1):158
Background
Serrated adenocarcinoma (SAC) is a distinct colorectal carcinoma variant that accounts for approximately 7.5% of all advanced colorectal carcinomas. While its prognosis is worse than conventional carcinoma, its early-stage clinicopathologic features are unclear. We therefore aimed to clarify the clinicopathologic and endoscopic characteristics of early-stage SACs.Methods
Forty consecutive early-stage SAC patients at Hiroshima University Hospital were enrolled; SACs were classified into epithelial serration (Group A, n?= 17) and non-epithelial serration (Group B, n?=?23) groups. Additionally, we classified serrated adenoma into 4 types: sessile serrated adenoma (SSA), traditional serrated adenoma (TSA), unclassified, and non-serrated adenoma type.Results
There were significant differences between Groups A and B in terms of tumor size (27.6 vs. 43.1 mm), incidences of T1 carcinoma (71% vs. 13%), and having the same color as normal mucosa (47% vs. 17%), respectively (p?<0.01). In SACs >20 mm, the incidence of T1 carcinoma in Group A (70%) was significantly greater than that in Group B (13%) (p?<0.05). There were significant differences in ‘Japan NBI Expert Team’ type 3 and type V pit pattern classifications between the 2 groups. The average TSA-type tumor size (42.6 mm) was significantly larger than that of the SSA (17.2 mm) and non-serrated component types (18.3 mm). The incidences of submucosal invasion in SSA- (80%), unclassified- (100%), and non-serrated-type (100%) tumors were significantly higher than that in the TSA type (11%).Conclusions
Epithelial serration in the cancerous area and a non-TSA background indicated aggressive behavior in early-stage SACs.10.
Shinya Yamada Fa-Po Chung Yenn-Jiang Lin Shih-Lin Chang Li-Wei Lo Yu-Feng Hu Tze-Fan Chao Jo-Nan Liao Chung-Hsing Lin Chin-Yu Lin Yao-Ting Chang Abigail Louise D. Te Ying-Chieh Liao Po-Ching Chi Shih-Ann Chen 《Journal of interventional cardiac electrophysiology》2018,53(2):175-185
Purpose
In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown.Methods
A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) <?50%, n?=?25 and LVEF ≥?50%, n?=?105, respectively). The 12-lead PVC morphologies were assessed.Results
Patients with RVOT PVC-CMP had a lower LVEF (42?±?5% vs. 60?±?7%, P?<?0.01) and higher PVC burden (24?±?14% vs. 15?±?11%, P?=?0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143?±?14 ms vs. 132?±?17 ms, P?<?0.01) and higher peak deflection index (PDI; 0.60?±?0.07 vs. 0.55?±?0.08, P?<?0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020–1.253, P?=?0.02) and PDI (OR 1.240, 95% CI 1.004–1.532, P?=?0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration >?139 ms and PDI >?0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP.Conclusions
The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.11.
12.
J. Seidel E. Färber R. Baumbach W. Cordruwisch U. Böhmler B. Feyerabend S. Faiss 《International journal of colorectal disease》2016,31(3):603-611
Purpose
Endoscopic resection is a widely used technique for treatment of large colorectal adenomas, but few data are available including only lesions larger than ≥2 cm. The aim of this study is to evaluate the complication and recurrence rate after endoscopic resection of high-risk colorectal adenomas ≥3 cm in size.Methods
Retrospective analysis of a prospectively maintained database of patients undergoing polypectomy of large colorectal polyps of ≥3 cm.Results
In 341 patients, 360 colorectal adenomas with a mean size of 3.9 cm were resected endoscopically. In 25 patients, a complication including 22 delayed bleedings (6.5 %) and three perforations (0.9 %) occurred. Single-variate analysis showed an increasing risk of complications for larger adenomas (3.9 vs. 4.6 cm; p?≤?0.05). Two hundred twelve patients with 224 adenomas had undergone at least one documented follow-up endoscopy with a medium follow-up period of 16 months. In 95 resected lesions (42.4 %), a residual adenoma occurred in the first follow-up colonoscopy (n?=?88, 92.6 %) or a recurrent adenoma occurred after at least one negative follow-up colonoscopy (n?=?7, 7.4 %). In multivariate analysis, risk factors were lesion size, sessile growth pattern, and the performing endoscopist. The complication and recurrence rate correlated inversely between endoscopists.Conclusions
The present study is the largest study showing complication and recurrence rates after colorectal polypectomy of advanced colorectal adenomas of ≥3 cm in size. Polyp size was identified as the most important risk factor for complications. For the first time, this study shows that the complication rate after colorectal polypectomy of large adenomas is correlated inversely with the residual and/or recurrence rate.13.
Zhi-Xiong Li Xiao-Hua Wu Hai-yan Wu Wen-Ju Chang Xiu-juan Chang Tuo Yi Qiang Shi Jing-Wen Chen Qing-Yang Feng De-Xiang Zhu Ye Wei Yun-Shi Zhong Jian-Min Xu 《International journal of colorectal disease》2016,31(3):561-570
Backgroud
The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies.Methods
From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group.Results
The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51?±?28.65 vs. 160.39?±?58.94 min, P?<?0.001; 8.00?±?3.97 vs. 12.59?±?9.07 days, P?=?0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00?±?43.70 vs. 121.18?±?85.90 ml, P?<?0.001; 16.7 vs. 37.3 %, P?=?0.003). Kaplan–Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P?=?0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P?=?0.025), and similar long-term survival (P?=?0.81).Conclusions
Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.14.
Lluis Asmarats Mathieu Bernier Gilles O’Hara Jean-Michel Paradis Kim O’Connor Jonathan Beaudoin Sylvie Bilodeau Rafael Cavalcanti Jean Champagne Josep Rodés-Cabau 《Journal of interventional cardiac electrophysiology》2018,53(2):151-157
Purpose
Percutaneous left atrial appendage (LAA) closure has become a valid alternative to anticoagulation therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). However, scarce data exist on the impact of LAA closure on left atrial and ventricular function. We sought to assess the acute hemodynamic changes associated with percutaneous LAA closure in patients with paroxysmal AF.Methods
The study population consisted of 31 patients (mean age 73?±?10 years; 49% women) with paroxysmal AF who underwent successful percutaneous LAA closure. All patients were in sinus rhythm and underwent 2D transthoracic echocardiography at baseline and the day after the procedure. A subset of 14 patients underwent preprocedural cardiac computed tomography (CT) with 3D LA and LAA reconstruction.Results
Left ventricular systolic function parameters and LA volumetric indexes remained unchanged after the procedure. No significant changes in left ventricular stroke volume (72.4?±?16.0 vs. 73.3?±?15.7 mL, p?=?0.55) or LA stroke volume (total 15.6?±?4.2 vs. 14.6?±?4.2 mL, p?=?0.21; passive 9.0?±?2.8 vs. 8.3?±?2.6 mL, p?=?0.31; active 10.3?±?5.6 vs. 10.0?±?6.4 mL, p?=?0.72) occurred following LAA closure. Mean ratio of LAA to LA volume by 3D CT was 10.2?±?2.3%. No correlation was found between LAA/LA ratio and changes in LA stroke volume (r?=?0.35, p?=?0.22) or left ventricular stroke volume (r?=?0.28, p?=?0.33).Conclusions
The LAA accounts for about 10% of the total LA volume, but percutaneous LAA closure did not translate into any significant changes in LA and left ventricular function.15.
Purpose
Anastomotic leakage (AL) and surgical site infection (SSI) are prevalent complications of colorectal surgery. To lower this risk, we standardized our surgical procedures in 2012, with a preferential use of laparoscopic approach (LS) for both colon and rectal surgery, combined with triangulating anastomosis (TA) for colon surgery and defunctioning ileostomy (DI) for low anterior resection. Our aim was to evaluate the outcomes of our standardized procedures.Methods
The incidence rate of AL (primary outcome) and of reoperation and SSI (secondary outcome) was compared before (early period, n?=?648) and after (late period, n?=?541) standardization, through a retrospective analysis.Results
The incidence rate of AL (6.6 versus 1.8%; P?=?0.001), reoperation (3.5 versus 0.7%; P?=?0.0012), and SSI (7.7 versus 4.6%; P?=?0.029) was lower in late than in the early period. For colon cancer, TA and LS reduced the risk of AL (2.1 versus 0.3%, P?=?0.020, for TA, and 3.2 versus 0.4%, P?=?0.0027, for LS) and reoperation (2.9 versus 0.3%, P?=?0.003, for TA, and 2.5 versus 0.2%, P?=?0.0040, for LS). For rectal cancer, the incidence of all adverse outcomes (AL, reoperation, and SSI) was lower in cases treated by LS. However, the incidence of AL was lower in the late than in early period (P?=?0.002) and with LS (P?=?0.002). On multivariate analysis, late period and LS were independent factors of a lower risk of adverse outcomes.Conclusions
Our surgical standardization seems to be effective in lowering the risks of AL, reoperation, and SSI after colorectal cancer surgery.16.
Willem Staels Yannick Verdonck Yves Heremans Gunter Leuckx Sofie De Groef Carlo Heirman Eelco de Koning Conny Gysemans Kris Thielemans Luc Baeyens Harry Heimberg Nico De Leu 《Diabetologia》2018,61(8):1804-1810
Aims/hypothesis
The initial avascular period following islet transplantation seriously compromises graft function and survival. Enhancing graft revascularisation to improve engraftment has been attempted through virus-based delivery of angiogenic triggers, but risks associated with viral vectors have hampered clinical translation. In vitro transcribed mRNA transfection circumvents these risks and may be used for improving islet engraftment.Methods
Mouse and human pancreatic islet cells were transfected with mRNA encoding the angiogenic growth factor vascular endothelial growth factor A (VEGF-A) before transplantation under the kidney capsule in mice.Results
At day 7 post transplantation, revascularisation of grafts transfected with Vegf-A (also known as Vegfa) mRNA was significantly higher compared with non-transfected or Gfp mRNA-transfected controls in mouse islet grafts (2.11- and 1.87-fold, respectively) (vessel area/graft area, mean?±?SEM: 0.118?±?0.01 [n?=?3] in Vegf-A mRNA transfected group (VEGF) vs 0.056?±?0.01 [n?=?3] in no RNA [p?<?0.05] vs 0.063?±?0.02 [n?=?4] in Gfp mRNA transfected group (GFP) [p?<?0.05]); EndoC-bH3 grafts (2.85- and 2.48-fold. respectively) (0.085?±?0.02 [n?=?4] in VEGF vs 0.030?±?0.004 [n?=?4] in no RNA [p?<?0.05] vs 0.034?±?0.01 [n?=?5] in GFP [p?<?0.05]); and human islet grafts (3.17- and 3.80-fold, respectively) (0.048?±?0.013 [n?=?3] in VEGF vs 0.015?±?0.0051 [n?=?4] in no RNA [p?<?0.01] vs 0.013?±?0.0046 [n?=?4] in GFP [p?<?0.01]). At day 30 post transplantation, human islet grafts maintained a vascularisation benefit (1.70- and 1.82-fold, respectively) (0.049?±?0.0042 [n?=?8] in VEGF vs 0.029?±?0.0052 [n?=?5] in no RNA [p?<?0.05] vs 0.027?±?0.0056 [n?=?4] in GFP [p?<?0.05]) and a higher beta cell volume (1.64- and 2.26-fold, respectively) (0.0292?±?0.0032 μl [n?=?7] in VEGF vs 0.0178?±?0.0021 μl [n?=?5] in no RNA [p?<?0.01] vs 0.0129?±?0.0012 μl [n?=?4] in GFP [p?<?0.001]).Conclusions/interpretation
Vegf-A mRNA transfection before transplantation provides a promising and safe strategy to improve engraftment of islets and other cell-based implants.17.
Background
This study aimed to investigate the prognostic factors of patients with stage IIA (T3N0M0) colon cancer in terms of macroscopic serosal invasion and small tumor size.Methods
We enrolled 375 stage IIA colon cancer patients who underwent curative resection between January 2004 and December 2011. Macroscopic serosal invasion was defined as tumor nodules or colloid changes protruding the surface of the serosa. The clinicopathologic characteristics were analyzed to identify independent prognostic factors.Results
The median follow-up was 47 months (range, 1–90 months). On multivariate survival analysis, macroscopic serosal invasion (adjusted hazard ratio [HR]?=?4.750; p?=?0.013), tumor size <?5 cm (adjusted HR?=?3.112, p?=?0.009), perineural invasion (adjusted HR?=?3.528; p?=?0.002), <?12 retrieved lymph nodes (adjusted HR?=?4.257; p?=?0.002), and localized perforation (adjusted HR?=?7.666; p?=?0.008) were independent risk factors for recurrence.Conclusion
We found novel prognostic factors of stage IIA colon cancer, including macroscopic serosal invasion and small tumor size (<?5 cm). Further studies are needed to evaluate the benefit of adjuvant chemotherapy in patients with these prognostic factors.18.
Sachin Nayyar Lauren Wilson Anand Ganesan Thomas Sullivan Pawel Kuklik Glenn Young Prashanthan Sanders Kurt C. Roberts-Thomson 《Journal of interventional cardiac electrophysiology》2018,51(1):13-24
Purpose
Protected channels of surviving myocytes in late postinfarction ventricular scar predispose to ventricular tachycardia (VT). However, only a few patients develop VT spontaneously. We studied differences in electric remodeling and protected channels in late postinfarction patients with and without spontaneous VT.Methods
Patients with ischemic cardiomyopathy (ICM) with recurrent sustained monomorphic VT (n?=?22) were compared with stable ICM patients without spontaneous VT (control group; n?=?5). Left ventricular mapping was performed with a 20-pole catheter. Detailed pace mapping was used to identify channels of protected conduction, and confirmed, when feasible, by entrainment. Anatomical and electrophysiological properties of VT channels and non-VT channels in VT patients and channels in controls were evaluated.Results
Seventy-three (median 3) VTs were inducible in VT patients compared to two (median 0) in controls. The VT channels in VT patients (n?=?57, 3?±?1 per patient) were lengthier (mean?±?SEM 53?±?5 vs. 33?±?4 vs. 24?±?8 mm), had longer S-QRS (73?±?4 vs. 63?±?3 vs. 44?±?8 ms), longer conduction time (103?±?13 vs. 33?±?4 vs. 24?±?8 ms), and slower conduction velocity (CV) (0.85?±?0.21 vs. 1.39?±?0.20 vs. 1.31?±?0.41 m/s) than non-VT channels in VT patients (n?=?183, 8?±?6 per patient) (p?≤?0.01) and channels in controls (n?=?46, 9?±?8 per patient) (p?≤?0.01). Additionally, non-VT channels in VT patients had longer S-QRS (p?=?0.02); however, they were similar in length, conduction time, and CV compared to channels in controls.Conclusions
Channels supporting VT are lengthier, with longer conduction times and slower CV compared to channels in patients without spontaneous VT. These observations may explain why some ICM patients have spontaneous VT and others do not.19.
Purpose
Conflicting evidence exists regarding any association between diverticulosis and adenomatous polyps. We evaluated the prevalence of polyps and cancer in colonic regions containing diverticula.Methods
Six hundred consecutive colonoscopy reports from a single endoscopist were reviewed to determine prevalence and location of diverticulosis and polyps. Additionally, pathology reports of 88 colon cancer resection specimens were reviewed for the presence of diverticulosis, and compared with expected prevalence of diverticulosis in that colonic region based on the collected colonoscopy data.Results
Overall, rates of detected polyps were comparable between patients with and without diverticulosis. However, analyzing the data by colonic segment containing diverticulosis, the prevalence of adenomatous polyps was reduced in regions of diverticulosis compared to the same colonic segment unaffected by diverticulosis (7 vs. 17% for rectosigmoid (p = 0.005); 5 vs. 18% for descending (p < 0.0001); and 17 vs. 27% for ascending colon (p = 0.0495)). Among colon cancer resection specimens, the prevalence of diverticulosis was significantly reduced in the rectosigmoid and ascending colon, compared with expected rates of diverticulosis in those regions. (13 vs. 42% in rectosigmoid (p = 0.0006); 3 vs. 17% in ascending colon (p = 0.043)).Conclusion
Despite similar overall frequency of polyps in patients with and without diverticulosis, polyps were significantly less likely in the colonic segment affected by diverticulosis. Additionally, the frequency of diverticulosis in areas of cancer in the rectosigmoid and ascending colon was significantly lower than expected compared with the expected frequency of diverticulosis for those colonic regions. These observations suggest a true negative association between colonic neoplasia and diverticulosis.20.
Hideaki Kato Yukihiro Yoshimura Yoshihiro Suido Kazuo Ide Yoshifumi Sugiyama Kasumi Matsuno Hideaki Nakajima 《Infection》2018,46(5):635-640