Colon and rectal cancer risk after bariatric surgery in a multicountry Nordic cohort study

Obesity is a risk factor for colorectal cancer. Yet, some research indicates that weight-reducing bariatric surgery also increases colorectal cancer risk. Our study was undertaken because current evidence examining bariatric surgery and risk of colorectal cancer is limited and inconsistent. This population-based cohort study included adults with a documented obesity diagnosis in Denmark, Finland, Iceland, Norway or Sweden in 1980–2015. The incidence of colorectal cancer in participants with obesity who had and had not undergone bariatric surgery was compared to the incidence in the corresponding background population by calculating standardized incidence ratios (SIR) with 95% confidence intervals (CI). Additionally, operated and nonoperated participants with obesity were compared using multivariable Cox regression, providing hazard ratios (HR) with 95% CIs adjusted for confounders. Among 502,772 cohort participants with an obesity diagnosis, 49,931(9.9%) underwent bariatric surgery. The overall SIR of colon cancer was increased after bariatric surgery (SIR 1.56; 95% CI 1.28–1.88), with higher SIRs ≥10 years postsurgery. The overall HR of colon cancer in operated compared to nonoperated participants was 1.13 (95% CI 0.92–1.39) and 1.55 (95% CI 1.04–2.31) 10–14 years after bariatric surgery. Bariatric surgery did not significantly increase the risk of rectal cancer (SIR 1.14, 95% CI 0.83–1.52; HR 1.08, 95% CI 0.79–1.49), but the risk estimates increased with longer follow-up periods. Our study suggests that bariatric surgery is associated with an increased risk of colon cancer, while the support for an increased risk of rectal cancer was weaker.     

Thylakoids suppress appetite by increasing cholecystokinin resulting in lower food intake and body weight in high‐fat fed mice

Thylakoids are membranes isolated from plant chloroplasts which have previously been shown to inhibit pancreatic lipase/colipase catalysed hydrolysis of fat in vitro and induce short‐term satiety in vivo. The purpose of the present study was to examine if dietary supplementation of thylakoids could affect food intake and body weight during long‐term feeding in mice. Female apolipoprotein E‐deficient mice were fed a high‐fat diet containing 41% of fat by energy with and without thylakoids for 100 days. Mice fed the thylakoid‐enriched diet had suppressed food intake, body weight gain and body fat compared with the high‐fat fed control mice. Reduced serum glucose, serum triglyceride and serum free fatty acid levels were found in the thylakoid‐treated animals. The satiety hormone cholecystokinin was elevated, suggesting this hormone mediates satiety. Leptin levels were reduced, reflecting a decreased fat mass. There was no sign of desensitization in the animals treated with thylakoids. The results suggest that thylakoids are useful to suppress appetite and body weight gain when supplemented to a high‐fat food during long‐term feeding. Copyright © 2009 John Wiley & Sons, Ltd.     

Case report: granular cell tumour of the breast.

We describe a granular cell tumour in the breast of a 62-year-old woman. This tumour is unusual in the breast, and though usually benign, may be misinterpreted as cancer.     

Graft failure and recurrence of symptoms after coronary artery bypass grafting

Objectives. Saphenous vein grafts (SVGs) most often used in coronary artery bypass grafting (CABG) are subject to graft disease and have poor long-term patency, however the clinical implication of this is not completely known. We aim to assess the influence of graft failure on the postoperative recurrence of coronary artery disease (CAD) symptoms in relation to the contribution from progression of atherosclerosis in the native coronary vessels. Design. Within the SWEDEHEART registry we identified 46,663 CABG cases between 2001 and 2015 with patient age 40–80 years where single internal mammary artery (IMA) anastomosis (IMA), single IMA with one (1SVG) or multiple SVG anastomoses (2+ SVG) had been performed. Clinical characteristics as well as mortality and postoperative incidence of coronary angiography were recorded and multivariable adjusted hazard ratios were calculated. Indications for the angiographies and occurrence of graft failure were also registered. Results. The adjusted hazard ratio for death was similar for the three groups. The adjusted hazard ratio for being submitted to angiography as compared to 2+ SVG was (95% CI) 1.24 (1.06–1.46) for IMA and 1.21 (1.15–1.28) for 1SVG. Failed grafts were found at the first postoperative angiography with preceding CAD symptoms in 21.4% of patients in the IMA group, 41.6% in the 1SVG group and 61.1% in the 2+ SVG group. Conclusions. A substantial amount of angiographies occur in patients without any graft failure and a large part of postoperative recurrence of CAD symptoms and are likely attributed to IMA failure or progression of atherosclerosis in the native coronary arteries.     

高位腰椎间盘突出症

目的：通过147例高位腰椎间盘突出症的回顾性研究,旨在提高对本症的认识,减少漏诊,误诊,方法：回顾性分析报告147例高位腰椎间盘突出,结果：治疗腰1,210例,腰2。3 32例,腰3,4 105例,其中双间隙突出34例,跳跃性突出27例,伴椎管狭窄31例。瘫痪3例,非手术治疗34例,手术113例,优47例,良8例,差92例,重点讨论了高位腰椎及椎间盘和神经根的解剖特点和临床三大特征及诊断治疗,提出对不同程度的病人用不同治疗方式以及手术中需要注意的六个问题。     

What pathologic features influence survival in patients with local residual tumor after resection of colorectal cancer?

BACKGROUND: Local residual tumor predicts poor patient survival after resection for colorectal cancer. The aim of this study was to determine the prevalence of residual tumor in a line of resection in a large prospective series and to identify other pathology variables that may influence survival in the absence of distant metastases in such patients. STUDY DESIGN: This study was based on all patients who had a resection for colorectal cancer at Concord Hospital between 1971 and 2001. Patients were followed up annually until death or December 2002. Survival analysis used the Kaplan-Meier method and log rank test. Proportional hazards regression was used in multivariate modeling. RESULTS: The overall prevalence of residual tumor in a line of resection was 5.9%. Of 12 pathology variables examined, only high grade and apical node metastasis were independently associated with survival in the subset of 120 patients with residual tumor in a line of resection but without distant metastases. The 2-year survival rate for patients with neither of these adverse features was 46.4% (95% CI, 31.7% to 59.9%) as compared with only 7.7% (CI, 0.5% to 29.2%) in those who had both. CONCLUSIONS: These results show that presence of local residual tumor after colorectal cancer resection does not carry a universally poor prognosis. Two specific histopathologic features independently associated with diminished survival were identified.     

The effects of suggestibility on relaxation

Thirty-two college student subjects were selected on the basis of scores on the Creative Imagination Scale. Eight of the high suggestibility subjects were assigned randomly to each training mode, progressive relaxation (PR) and suggestions of relaxation (SR). The 16 low suggestibility subjects were similarly assigned, which resulted in a 2 × 2 factorial design with one repeated measure, a pre-post relaxation scale that yields a total score and three subscale scores. A significant pre-post relaxation effect emerged. Main effects were found both for suggestibility and mode of training. High suggestibility subjects performed significantly better regardless of the training mode. PR yielded significantly higher relaxation scores than did SR. An interaction between suggestibility and training mode occurred on the cognitive factor scale; subjects who scored low on suggestibility reported relaxing significantly better when the training mode was PR.     

蒙药如达溃疡散对大鼠乙酸性胃溃疡及其血清促胃液素的影响

目的:探讨如达溃疡散对大鼠乙酸性胃溃疡的作用及对其血清促胃液素(gastrin)含量的影响.方法:采用乙酸法复制胃溃疡模型,将大鼠随机分为对照组、如达溃疡散组、雷尼替丁组,观察如达溃疡散对大鼠胃溃疡的作用,并检测其对大鼠血清中促胃液素含量的影响.结果:与对照组相比,如达溃疡散能明显抑制溃疡的发生,抑制血清促胃液素含量.结论:如达溃疡散具有抗胃溃疡的作用,其作用机理可能是通过抑制促胃液素释放,进一步减少胃酸分泌来实现的.