Background
Laterally spreading tumours represent a major challenge for endoscopic detection and resection.
Objective
To examine synchronous and metachronous neoplasms in patients with laterally ...spreading tumours.
Methods
We prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years' follow‐up. Post‐resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared.
Results
Between 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, p < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, p = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, p < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8–4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients.
Conclusion
Patients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.
Key Summary
Summarize the established knowledge on this subject
Laterally spreading tumours (LSTs) are a heterogeneous group of large, predominantly benign flat neoplasms that can be endoscopically treated, requiring additional time and expertise
LSTs consist of different endoscopic subtypes which are predictive of the risk of submucosal invasion (SMI)
Patients with LSTs harbour more synchronous neoplasms than patients with large polypoid colorectal neoplasms (LP‐CRNs)
What are the significant and/or new findings of this study?
Patients with LSTs more frequently have metachronous neoplasms than patients with LP‐CRNs, justifying strict surveillance
LSTs can be effectively managed by conventional endoscopic resections in most cases
Abstract BACKGROUND The microbiome has been associated with chemotherapy and immune checkpoint inhibitor (ICI) efficacy. How this pertains to resectable esophageal carcinoma (EC) is unknown. Our aim ...was to identify microbial signatures in resectable EC associated with response to neoadjuvant chemoradiotherapy (nCRT) with or without ICI. METHODS From two prospectively collected EC cohorts (n = 172 in total) treated with nCRT alone (n = 132) or a combination of nCRT and ICI (n = 40), fecal samples were available at baseline, during treatment, and pre-surgery. Additionally, in the ICI treated patients, tumor and duodenal snap frozen biopsies were collected over time. Fecal, tumor and duodenal DNA were extracted for 16S rRNA sequencing. Associations were investigated between microbiome composition pathological complete response (pCR) and progression-free survival (PFS). RESULTS There was a significant shift in the microbiota profile of the fecal, tumor and duodenal microbiota over time. In the total cohort, patients with a pCR had a stable fecal alpha diversity, while the diversity of poor responders decreased during treatment, p = 0.036. Pre-surgery, lower alpha diversity (<4.12) was related to worse PFS, log-rank p = 0.025. Baseline tumor biopsies of patients with short PFS had more Fusobacterium. A low baseline duodenal alpha diversity (<3.96) was associated with worse PFS, log-rank p = 0.012. CONCLUSIONS Lower intestinal alpha diversity was associated with worse response and survival of EC patients. In tumor biopsies Fusobacterium was more abundant in patients with poor PFS. After further mechanistic validation, these findings may aid in response prediction and the design of novel microbiome modulating treatments for EC patients.
We have remotely mapped optical scattering and absorption in glacial ice at the South Pole for wavelengths between 313 and 560 nm and depths between 1100 and 2350 m. We used pulsed and continuous ...light sources embedded with the AMANDA neutrino telescope, an array of more than six hundred photomultiplier tubes buried deep in the ice. At depths greater than 1300 m, both the scattering coefficient and absorptivity follow vertical variations in concentration of dust impurities, which are seen in ice cores from other Antarctic sites and which track climatological changes. The scattering coefficient varies by a factor of seven, and absorptivity (for wavelengths less than ∼450 nm) varies by a factor of three in the depth range between 1300 and 2300 m, where four dust peaks due to stadials in the late Pleistocene have been identified. In our absorption data, we also identify a broad peak due to the Last Glacial Maximum around 1300 m. In the scattering data, this peak is partially masked by scattering on residual air bubbles, whose contribution dominates the scattering coefficient in shallower ice but vanishes at ∼1350 m where all bubbles have converted to nonscattering air hydrates. The wavelength dependence of scattering by dust is described by a power law with exponent −0.90 ± 0.03, independent of depth. The wavelength dependence of absorptivity in the studied wavelength range is described by the sum of two components: a power law due to absorption by dust, with exponent −1.08 ± 0.01 and a normalization proportional to dust concentration that varies with depth; and a rising exponential due to intrinsic ice absorption which dominates at wavelengths greater than ∼500 nm.
Purpose:
A new method of reconstruction of the atrophic maxilla by combining a bilateral sinus floor elevation and cancellous bone graft with buccal and labial onlay graft using L-shaped ...corticocancellous blocks from the posterior iliac crest is presented.
Patients and Methods:
Seventeen patients were treated with this procedure. One hundred one IMZ implants were placed in 14 patients, and 22 Brånemark implants were placed in three patients. Patients were observed for 6 months after prosthetic rehabilitation.
Results:
All patients were fully rehabilitated with fixed bridges except one, who prefered an overdenture. Only two implants were lost at the time of the abutment connection. Some bone resorption was seen around six implants. The success rate with this procedure was 92.7% 6 months after prosthetic rehabilitation if implants with bone resorption were considered failures.
Conclusions:
These preliminary results indicate that this surgical procedure is suitable for reconstruction of most atrophic maxillas.
Upon addition of silica to aqueous solutions of poly(ethylene oxide)-b-poly(ε-caprolactone) copolymers (PEO-b-PCL) and sodium dodecyl sulfate (SDS), adsorption of the solutes occurs at the ...silica−water interface. The amount of the adsorbed constituents has been measured by the total concentration depletion method. Small-angle neutron scattering experiments (SANS) have been carried out to investigate the structure of the adsorbed layer. Although SDS is not spontaneously adsorbed onto hydrophilic silica, adsorption is observed in the presence of PEO-b-PCL diblocks, in relation to the relative concentration of the two compounds. Conversely, SDS has a depressive effect on the adsorption of the copolymer, whose structure at the interface is modified. Copolymer desorption is however never complete at high SDS content. These observations have been rationalized by the associative behavior of PEO-b-PCL and SDS in water.
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