Single-Incision versus Conventional Multiport Laparoscopic Colorectal Surgery—Systematic Review and Pooled Analysis

Background

The aim of this pooled analysis is to determine the effect of single-incision laparoscopic colorectal surgery (SILC) on short-term clinical and oncological outcomes compared with conventional multiport laparoscopic colorectal surgery (CLC).

Methods

An electronic search of Embase, Medline, Web of Science, and Cochrane databases was performed. Weighted mean differences (WMD) were calculated for the effect size of SILC on continuous variables and pooled odds ratios (POR) were calculated for discrete variables.

Results

No significant differences between the groups were noted for mortality or morbidity including anastomotic leak, reoperation, pneumonia, wound infection, port-site hernia, and operative time. The benefits of a SILC approach included reduction in time to return of bowel function (WMD?=??1.11 days; 95 % C.I. ?2.11 to ?0.13; P?=?0.03), and length of hospital stay (WMD?=??1.9 days; 95 % C.I. ?2.73 to ?1.07; P?Conclusions SILC can be performed safely by experienced laparoscopic surgeons with similar short-term clinical and oncological outcomes to CLC. SILC may further enhance some of the benefits of minimally invasive surgery with a reduction in blood loss and length of hospital stay.     

Low dose total skin electron beam therapy for the management of T cell cutaneous lymphomas

Mycosis fungoides (MF) represent the most common type of primary cutaneous lymphomas. Total skin electron beam (TSEB) therapy to a total skin administered dose of 36 Gy represents a very effective treatment regimen and its role in the management of MF is well established. Unfortunately, the issue in MF is that despite the proved effectiveness of radiation therapy, disease regress, and the main goal of TSEB treatment seems to be the prolongation of the overall response duration time. Taking into consideration the high radio‐sensitivity of the disease, lower radiation doses have been tested with acceptable and comparable results. We prospectively analyzed low dose TSEB in 14 patients treated at ATTIKON University Hospital from 2011 to 2017. After a median duration of follow up time of 39 months we found that low dose TSEB is an effective treatment option, since therapeutic results are more than acceptable, with minimal toxicity. The fact that it can be repeated safely in the natural course of a “regressive” disease makes it more attractive than the standard full dose scheme of 36 Gy.     

Cell-cell contact and specific cytokines inhibit apoptosis of colonic epithelial cells: growth factors protect against c-myc-independent apoptosis.

In this study we sought factors that determine the survival of human colonic epithelial cells. Normal colonic epithelial cells are dependent on cell-cell contacts and survival factors for the inhibition of apoptosis whereas, during colorectal tumorigenesis, cells develop mechanisms to evade these controls. The ability to survive loss of cell-cell contacts and/or growth factor deprivation is a marker of tumour progression. Many adenoma (premaligant) cultures survive only if cell-cell contacts are maintained in vitro and die by apoptosis if trypsinized to single cells. This also occurs in adenomas derived from familial adenomatous polyposis (FAP) patients, therefore APC mutations do not confer resistance to cell death in response to loss of cell-cell contacts. We show here that if cell-cell contacts are maintained such cells are capable of survival in suspension. Adenoma cells also undergo apoptosis in response to removal of serum and growth factors from the medium. After removal of serum and growth factors c-myc is down-regulated within 2 h. Therefore, the induction of apoptosis is not an inappropriate response of the cells due to a deregulated c-myc gene. The apoptotic response is also p53 independent. Such cultures have been used to determine specific survival factors for colonic epithelial cells. Insulin, the insulin-like growth factors I and II, hydrocortisone and epidermal growth factor (EGF) protect cells from the induction of apoptosis in the absence of serum over a short-term period of 24 h. This approach may give insight into the factors governing growth and survival of colonic epithelial cells in vivo. This is the first report of specific growth factors protecting against apoptosis in human colonic epithelial cells.     

Possible involvement of chromosome 1 in in vitro immortalization: evidence from progression of a human adenoma-derived cell line in vitro

We have previously reported that continuous in vitro passage in the presence of 3T3 feeders of a non-tumorigenic adenoma-derived epithelial cell line, designated PC/AA, resulted in its becoming immortal. At early passage PC/AA was normal diploid, whereas every cell of PC/AA late passage had an isochromosome 1(q) which led us to suggest that abnormalities of chromosome 1 may be involved in tumour progression. We now report the isolation of a 3T3-feeder-independent variant of early-passage PC/AA, designated PC/AA/FI, which was immortal in vitro and remained non-tumorigenic. Each cell of PC/AA/FI again has an isochromosome 1(q), like the late-passage PC/AA. However, with PC/AA/FI it is the other chromosome 1 of the homologous pair which is involved in the formation of the isochromosome 1(q). This is possible to determine because of the polymorphic centromeric heterochromatin on chromosome 1 of the early-passage PC/AA. With the late-passage PC/AA (grown with 3T3 feeders) the homologue with the large C-band has given rise to an isochromosome 1(q) whereas with PC/AA/FI it is the other homologue with the smaller C-band which has given rise to this isochromosome. Both the immortal PC/AA/FI and the immortal PC/AA late passage, therefore, have independent abnormalities involving chromosome 1. These results indicate that chromosome 1 may be involved in in vitro immortalization.     

Specific cytogenetic abnormalities and k-ras mutation in two new human colorectal-adenoma-derived cell lines.

Two new human epithelial cell lines from sporadic colorectal adenomas designated S/RR and S/BR are reported. Both cell lines have extended growth capacities in vitro, reaching passages 38 and 40 respectively and show no sign of senescence. S/RR and S/BR cell lines have retained the ability to differentiate in vitro, as shown by mucin production from goblet-like cells. S/BR was derived from a large colonic tubular villous adenoma (3 to 4 cm), whereas S/RR was derived from a small rectal adenoma (< 1 cm), and may represent a relatively early-stage adenoma. The parent S/RR cell line has given rise to a clonogenic variant, designated S/RR/Cl, which also has shown no sign of senescence and has currently reached passage 43. Both the S/BR and the S/RR cell lines had mutations in codon 12 of the K-ras gene, while retaining one normal allele. The presence of this mutation, particularly in the cell line S/RR derived from a small adenoma, is consistent with ras mutation being a relatively early event in colorectal carcinogenesis and is perhaps involved in the ability of the adenoma cells to progress and to give rise to an immortal cell line in vitro. The clonal derivatives of the S/RR cells have an isochromosome 1q and abnormalities of chromosome 13 which include an isochromosome 13q. The S/BR cells have a deletion on the short arm of chromosome 1 and trisomy 7. The common abnormality for S/RR and S/BR cells involves chromosome 1. The involvement of different chromosomes in the 2 cell lines also suggests different pathways for malignant progression of the premalignant adenoma cells.     

Assessing the secular trends in the transmission of HIV in Greece

OBJECTIVE: To evaluate the current trends in HIV transmission in Greece. METHODS: A retrospective study of HIV infected individuals reported to the Hellenic Center for Infectious Diseases Control (HCIDC) was conducted. RESULTS: Since the beginning of the epidemic in Greece and until early 1990s most cases concerned men who have sex with men (MSM). After the mid-1990s the proportion of homosexual males among HIV positive individuals decreased slightly, then was stabilised but they still remain the dominant population among HIV positive people. On the other hand, heterosexual transmission increased steadily and has become a frequent route for the spread of HIV/AIDS in recent years. Individuals originating from or travelling to countries where this mode of transmission prevails were the most frequent cases in this category. A significant proportion of cases classified as "undetermined" were also recorded and were partially attributed to the increased heterosexual transmission among people (especially women) without obvious high risk behaviours. CONCLUSIONS: The HIV/AIDS surveillance system must evolve in order to find the new unreported risk information and identify the population groups at higher risk. This will help to implement preventive policies and information campaigns addressed to target populations with special attention paid to immigrants, women, and marginalized communities.