Matrix metalloproteinase-9 is a prognostic marker to predict survival of patients who underwent surgery due to rectal carcinoma

Common prognostic factors do not fully predict clinical outcomes in colorectal cancer, one of the most common malignancies in developed countries. Therefore, biological prognostic markers are under investigation. We investigated the prognostic value of expression of matrix metalloproteinases (MMP-2 and MMP-9) and their inhibitors (TIMP-2 and TIMP-3) in rectal carcinoma to predict survival of the patients. Retrospective analysis of clinicopathological findings of 64 patients who underwent rectal resection due to carcinoma and were followed-up from 2 to 96 months (median 48) was performed. Semi-quantitative scoring was used to assess the expression levels of MMP-2, MMP-9, TIMP-2 and TIMP-3 in rectal carcinoma. During the follow-up, 28 patients died. The deceased patients demonstrated significantly higher expression of MMP-9 and lower expression of TIMP-3 in parenchyma of carcinoma and lower expression of TIMP-2 in stroma of carcinoma, compared to survivors. Moreover, the deceased patients were associated with advanced tumor, metastases in lymph nodes and distant metastases. According to univariate analysis longer survival was predicted by lower expression of MMP-9 in parenchymal cells (p = 0.03), tumor size (early tumor) (p = 0.026), absence of metastases in lymph nodes (p = 0.02) or distant metastases (p = 0.04). Multivariate analysis revealed that metastases in lymph nodes, higher expression of MMP-9 in parenchyma, and lower expression of MMP-9 in stromal cells significantly increased mortality. Expression of MMP-9 in rectal carcinoma is a prognostic marker for overall survival. It is important to identify the origin of MMP-9 to predict better overall survival of the patients.     

Laparoscopic myotomy or pneumatic dilatation for achalasia treatment?

Background  

The aim of this study was to compare the long-term results between laparoscopic myotomy and pneumatic dilatation in achalasia treatment.     

Severe and acute maternal morbidity: Lithuanian experience and review

OBJECTIVE: To measure the incidence of severe acute maternal morbidity (SAMM) and to find the risk factors that could be useful in trying to predict the development of SAMM. METHODS: The data were collected prospectively in 7 maternity units from different Lithuanian regions over a 1-year period. Every woman with a clinical diagnosis of severe preeclampsia, eclampsia, Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome, severe hemorrhage, uterine rupture, or severe sepsis during pregnancy or delivery or until the 42nd day post partum was included after verification of diagnosis by using clinical criteria. RESULT: One hundred and six cases of SAMM and one maternal death were identified during the study among 13,399 deliveries (7.91/1000 deliveries 95% CI 6.48-9.56). There were 57 cases of severe preeclampsia, 3 cases of eclampsia, 38 cases of severe hemorrhage, 3 cases of uterine rupture, and 4 cases of severe sepsis. One maternal death occurred due to HELLP syndrome, so the case-fatality ratio for severe morbidity was 0.99%. CONCLUSIONS: The incidence of SAMM and case-fatality rate in Lithuania are similar to those in other European countries. The main risk factors for SAMM were previous peripartum hemorrhage, previous hypertension, previous renal diseases, lack of antenatal care, and dystocia.     

Early course of microcirculatory perfusion in eye and digestive tract during hypodynamic sepsis

ABSTRACT: INTRODUCTION: The aim of the study was to evaluate and compare the microcirculatory perfusion during experimental sepsis in different potentially available parts of the body, such as sublingual mucosa, conjunctiva of the eye, and mucosa of jejunum and rectum. METHODS: Pigs were randomly assigned to sepsis (n = 9) and sham (n = 4) groups. The sepsis group received a fixed dose of live Escherichia coli infusion over a 1-hour period (1.8 × 109/kg colony-forming units). Animals were observed 5 hours after the start of E. coli infusion. In addition to systemic hemodynamic assessment, we performed conjunctival, sublingual, jejunal, and rectal evaluation of microcirculation by using Sidestream Dark Field (SDF) videomicroscopy at the same time points: at baseline, and at 3 and 5 hours after the start of live E. coli infusion. Assessment of microcirculatory parameters of convective oxygen transport (microvascular flow index (MFI) and proportion of perfused vessels (PPV)), and diffusion distance (perfused vessel density (PVD) and total vessel density (TVD)) was done by using a semiquantitative method. RESULTS: Infusion of E. coli resulted in a hypodynamic state of sepsis associated with low cardiac output and increased systemic vascular resistance despite fluid administration. Significant decreases in MFI and PPV of small vessels were observed in sublingual, conjunctival, jejunal, and rectal locations 3 and 5 hours after the start of E. coli infusion in comparison with baseline variables. Correlation between sublingual and conjunctival (r = 0.80; P = 0.036), sublingual and jejunal (r = 0.80; P = 0.044), and sublingual and rectal (r = 0.79; P = 0.03) MFI was observed 3 hours after onset of sepsis. However, this strong correlation between the sublingual and other regions disappeared 5 hours after the start of E. coli infusion. Overall, the sublingual mucosa exhibited the most-pronounced alterations of microcirculatory flow in comparison with conjunctival, jejunal, and rectal microvasculature (P < 0.05). CONCLUSIONS: In this pig model, a time-dependent correlation exists between sublingual and microvascular beds during the course of a hypodynamic state of sepsis.