Adjuvant chemotherapy offered to treat colon cancer is based on the TNM staging system, which often fails due to molecular heterogeneity and undefined molecular mechanisms independent of TNM. ...Therefore, identification of markers to better predict therapeutic option and outcome is needed. In this study we have characterised the clinical association of CCR6 with colon cancer and defined CCR6-mediated molecular pathway.
Immunohistochemistry, RT-qPCR, western blot and FACS were used to determine expression of CCR6 and/or EMT markers in colon tissues/cells. BrdU assay and trans-well system were used to determine cell proliferation, migration and invasion in response to CCL20.
CCR6 was higher in cancer cases compared to normal adjacent tissue and expression was associated with nodal status and distant metastasis. Similarly, CCR6 expression was higher in cells derived from node-positive cases and highest expression was in cells derived from metastatic cases. Significant changes in EMT markers, that is, E-cadherin, vimentin, β-catenin, N-cadherin, α-SMA, SNAILl and ZEB1 were observed in response to CCL20 along with decreased proliferation, increased migratory and invasive potential.
Results suggest CCR6 as a potential therapeutic target as well as biomarker in addition to nodal status for predicting therapeutic option.
The growing popularity of virtual reality devices and increasingly widespread distribution of VR products into the home exposes users to risk of bodily harm. Safety features are integrated into the ...devices themselves, but the burden of cautious use rests upon the end user. The purpose of this study is to quantify and describe the array of injuries and demographics effected by the burgeoning VR industry to inform and encourage mitigation strategies.
The National Electronic Injury Surveillance System (NEISS) data was used to examine a nationwide sample of emergency department records from 2013 – 2021. Inverse probability sample weights for cases were applied to arrive at national estimates. NEISS data included consumer product injuries, patient age, sex, race and ethnicity, drug and alcohol involvement, diagnoses, injury descriptions, and emergency department disposition.
The first VR-related injury was reported in the NEISS data in 2017, and injuries were estimated to number 125. Incidents of VR-related injuries amplified as increased VR units sold, and by 2021, there was a 352% increase in VR injuries totaling a weighted estimate of 1,336 ED visits. The most common VR-related injury diagnosis is fracture (30.3%), followed by laceration (18.6%), contusion (13.9%), other (11.8%), and strain / sprain (10.0%). VR-related injuries involve the hand (12.1%), face (11.5%), finger (10.6%), and knee (9.0%), head (7.0%) and upper trunk (7.0%). Patients age 0–5 most commonly experienced injuries to the face (62.3%). Injuries in patients 6–18 were mostly to the hand (22.3%) and face (12.8%). Patients 19–54 experienced primarily injuries to the knee (15.3%), finger (13.5%), and wrist (13.3%). Patients aged 55 and older disproportionately experienced injuries in the upper trunk (49.1%) and upper arm (25.2%).
This is the first study to describe the incidence, demographics and characteristics of injuries from VR device use. Sales of home VR units continue to increase annually and the rapid increase in VR consumer injuries is being managed by emergency departments across the country. An understanding of these injuries will inform VR manufacturers, application developers, and users to promote safe product development and operation.
Because of lack of insurance, he was not a candidate for biofeedback. ...the decision was made to implant a SNS to treat the refractory nocturnal fecal incontinence. ...he was taken back to the ...operating room to undergo definitive placement of the SNS. The treatment for fecal incontinence is evolving. ...the treatment for nocturnal fecal incontinence refractory to medical management is not well defined.
First defined in 1860 by Gascoyen, blue rubber bleb nevus syndrome (BRBNS) is a rare congenital anomaly characterized by blood loss.1 This disorder became more well known in 1958 when William Bennett ...Bean named the disease bean syndrome.1 BRBNS is defined as a vascular disorder in which dilated venous tissue develops within a thin layer of endothelial cells.1 This rare condition consists of blue nevi that range in size from a few millimeters to several centimeters in diameter. During colonoscopy, she was found to have cecal and right colon raised nodules that were bluish in hue and blanched on compression using forceps. Because of the vascular nature of the nodule, biopsy or snare was not performed. Endoscopic sclerotherapy and band ligation are also used for cases of significant bleeding.1 Resection serves as the best treatment method when numerous lesions accompany a local disease.1 A noninvasive treatment approach should be the first-line option for addressing BRBNS.1 if there is no bleeding from the lesions, BRBNS can be closely observed. Because our patient was asymptomatic with few lesions, we opted to closely observe with routine endoscopy.
Historically, they were thought to arise from the stomach (51%), small intestine (36%), rectum (7%), colon (5%), or the esophagus (1%), with little recognition of these tumors outside of the ...alimentary tract.1 EGISTs were likely to be misclassified as liposarcomas or myosarcomas because of the rarity of these tumors outside of the GI tract and lack of awareness of practitioners.3 With the usage of specific tumor markers to increase the accuracy of classification, the incidence of EGISTs is increasing, with newer reports identifying as high as 5 per cent of GISTs being extra alimentary.4 Rectovaginal stromal tumors can pose a surgical dilemma. ...an accurate diagnosis is important. Chemother-apeutic agents have shown little to no use in the management course of GIST and EGIST. ...the definitive therapy for GIST and EGIST is surgical resection.4 Tyrosine kinase inhibitors imatinib or sunitinib used in an adjuvant or neoadjuvant fashion has been shown to increase survival rates in patients with metastatic and recurrent disease.4 Tyrosine kinase inhibitors can also reduce the size of the tumor to improve resectability and to render the patient a candidate for a less invasive surgical approach.
Stercoral Colitis: A Surgical Dilemma Ayeni, A. Juliana; Turner, Jacquelyn; Clark, Clarence E. ...
The American surgeon,
09/2019, Volume:
85, Issue:
9
Journal Article
Peer reviewed
The second case is of an 84-year-old woman residing in a nursing home with a past medical history of bilateral below-knee amputations, Alzheimer's disease, type 2 diabetes mellitus, hypertension, ...stage III chronic kidney disease, and chronic constipation who presented with stool per vagina. Because she was a very poor historian, the duration of her abdominal pain was unclear. ...she underwent an intraoperative colonoscopy which confirmed the stercoral ulcer and rectovaginal fistula. Because of her multiple comorbidities, this patient underwent a diverting colostomy as a treatment for her rectovaginal fistula and pelvic sepsis. When diagnosed early, stercoral colitis can have minimal complications and be treated nonoperatively. ...we advocate for health-care providers to have a high index of suspicion of stercoral colitis in patients with chronic constipation and new onset of abdominal pain for early diagnosis and management to reduce the morbidity and mortality of this disease.
Background Full thickness rectal prolapse (FTRP) is managed with an abdominal or perineal operation. Traditionally, the approach has been determined by patient age and comorbidities. Our aim was to ...determine operative trends and outcomes for repair of FTRP in elderly patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Study Design We queried the ACS NSQIP database from 2006 to 2009 for patients with FTRP who were 70 years of age or older. Patients were grouped according to type of surgical repair: laparoscopic (LR), open (OR), or perineal (PR) technique. We reviewed demographics, operative trends of surgical technique, and short-term outcomes for each group. Results A total of 816 patients were analyzed; 596 (73%) PR, 130 (16%) OR, and 90 (11%) LR patients. Patients who received OR and LR had lower mean American Society of Anesthesiologists (ASA) scores than PR patients (2.6, 2.5, and 2.7, respectively, p < 0.001). The percentage of LR and OR procedures decreased as age increased by decade; the inverse was seen for PR (p < 0.001). The distribution of operative techniques has not changed from year to year. Length of stay was significantly shorter for LR (3.77 days) and PR (3.44 days) patients vs OR patients (6.23 days) (p = 0.01). Complication rates were 2.22%, 8.72%, and 12.31% for LR, PR, and OR, respectively (p = 0.021). Open surgery was the only factor associated with an increased complication rate, with an odds ratio of 6.29 (95% CI 1.38 to 28.6, p < 0.02). Conclusions Despite the appeal of perineal proctectomy in the elderly and debilitated patient, the approach to FTRP is slowly evolving in the era of laparoscopic surgery. Laparoscopic repair of FTRP in the elderly is associated with improved short-term outcomes when compared with OR and PR.
Abstract Background Single-incision laparoscopic (SIL) colectomy has gained significant momentum with anticipated benefit of improved cosmesis. Feasibility and safety of SIL colectomy have been ...shown; however, benefits are not well defined. The purpose of this study is to directly compare outcomes of SIL sigmoid colectomy for diverticular disease with standard multiport laparoscopic (LAP) technique. Methods SIL sigmoid colectomy cases performed for diverticular disease between August 2009 and July 2011 were case matched for age, gender, body mass index, American Society of Anesthesiologists score, previous abdominal operation, and need to mobilize the splenic flexure and compared with an equal number of LAP cases. Data analyzed included operative time, estimated blood loss, procedure conversion, incision length, length of hospital stay (LOS), 30-d hospital readmission, and postoperative pain scores. Results Twenty patients were analyzed in each group with no significant differences found in the six case-matching criteria. Operative time, conversions, estimated blood loss, surgical site infection, and hospital readmissions were similar. The mean incision length for both groups was 5 cm ( P = 0.72). LOS was 3.7 d for the SIL group, which was >1 d shorter than that for the LAP group (5.0 d; P < 0.05). Pain score at post-anesthesia care unit discharge and total amount of narcotic pain medication delivered in the post-anesthesia care unit was significantly less in the SIL group ( P < 0.05), as was maximum visual analog scale pain score on postoperative day 1 and postoperative day 2 ( P ≤ 0.01). Conclusions SIL sigmoid colectomy is associated with noncosmetic benefits, including a reduction in early postoperative pain and decreased LOS. These findings may be related to reduced abdominal wall trauma.
...due to the significant amount of prolapsed tissue, the use of Doppler to confirm the loss of the arterial signal was difficult. ...fluorescence angiography was used to assess hemorrhoid cushion ...perfusion and confirm dearterialization at the points of hemorrhoid artery ligation. In a meta-analysis study comparing the effectiveness of these varied modalities, Doppler-guided hemorrhoid ligation is shown to result in significantly fewer reoperations than other excisional techniques, quicker recovery, and significantly less postoperative complications, specifically pain and bleeding.2 Also on review of the literature, hemorrhoid artery ligation and mucopexy is shown to provide lasting results in patients after long-term follow-up, even among patients with grade IV hemorrhoids.3 However, Simillis et al. report a higher probability of recurrence when using Doppler-guided transanal hemorrhoid dearterialization compared with stapled hemorrhoidectomy and traditional hemorrhoidectomy.2 Confirmation after hemorrhoid artery ligation may be necessary in large, prolapsed hemorrhoids in an effort to reduce disease recurrence. ...fluorescence angiography is a considerable alternative form of confirmation of dearterialized hemorrhoidal tissue after ligation.
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