Search

Purpose: This study seeks to systematically analyze the research literature pertaining to breast cancer surgery from 2010 to 2024, as indexed in the PubMed database, employing bibliometric methodologies. Methods: Employing the "bibliometrix" package in the R programming language, alongside VOSviewer and CiteSpace software, this research conducted a comprehensive visual analysis of 1,195 publications. The analysis encompassed publication trends, collaborative networks, journal evaluation, author and institutional assessments, country-specific analyses, keyword exploration, and the identification of research hotspots. Results: The study observed a rising trend in the number of publications related to breast cancer surgery. However, there was a concomitant decline in citation rates, potentially indicating either a saturation of the research field or a diminution in research quality. The United States, China, and Japan are the leading contributors to research output, with the United States showing the most extensive international collaboration. The University of California, University of Toronto, and University of Texas MD Anderson Cancer Center were the top institutions for the number of published papers. Through a comprehensive analysis of keywords, we have identified "breast cancer" "pain" "anxiety" "lymphedema" "mastectomy" and "surgery" as central research themes within this domain, the corresponding clusters were subjected to analysis. Conclusion: This study provides a comprehensive review of breast cancer surgery research, emphasizing major research areas and proposing future research directions. This study provides a significant resource for researchers and clinicians in the field. [ABSTRACT FROM AUTHOR]

Background: Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient's risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries. Aim: This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings. Methods: Using the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval. Results: ICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection. Conclusions: Advanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon's visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures. [ABSTRACT FROM AUTHOR]

Purpose: This study seeks to systematically analyze the research literature pertaining to breast cancer surgery from 2010 to 2024, as indexed in the PubMed database, employing bibliometric methodologies. Methods: Employing the "bibliometrix" package in the R programming language, alongside VOSviewer and CiteSpace software, this research conducted a comprehensive visual analysis of 1,195 publications. The analysis encompassed publication trends, collaborative networks, journal evaluation, author and institutional assessments, country-specific analyses, keyword exploration, and the identification of research hotspots. Results: The study observed a rising trend in the number of publications related to breast cancer surgery. However, there was a concomitant decline in citation rates, potentially indicating either a saturation of the research field or a diminution in research quality. The United States, China, and Japan are the leading contributors to research output, with the United States showing the most extensive international collaboration. The University of California, University of Toronto, and University of Texas MD Anderson Cancer Center were the top institutions for the number of published papers. Through a comprehensive analysis of keywords, we have identified "breast cancer" "pain" "anxiety" "lymphedema" "mastectomy" and "surgery" as central research themes within this domain, the corresponding clusters were subjected to analysis. Conclusion: This study provides a comprehensive review of breast cancer surgery research, emphasizing major research areas and proposing future research directions. This study provides a significant resource for researchers and clinicians in the field. [ABSTRACT FROM AUTHOR]

Phoenix sylvestris, commonly known as the wild date palm, holds immense potential in traditional medicine due to its diverse phytochemical composition. Leaf identification plays a crucial role in botanical research, ecological studies, and biodiversity conservation. Phoenix sylvestris, commonly known as the wild date palm or silver date palm, is an economically and ecologically significant palm species. Traditional methods of identifying plant species based on morphological characteristics can be challenging, especially when dealing with closely related species or in cases of morphological variation. In this study, we present a DNAbased approach for the identification of Phoenix sylvestris leaves through DNA extraction, amplification of specific genetic markers, and sequencing. Leaf samples were collected from various geographical locations to encompass genetic diversity. DNA was extracted using a modified CTAB method, and the internal transcribed spacer (ITS) region of the nuclear ribosomal DNA was amplified using polymerase chain reaction (PCR). Sanger sequencing was performed to obtain DNA sequences, which were then compared to reference sequences in public databases for species identification. The results demonstrate the efficacy of this approach in accurately identifying Phoenix sylvestris leaves, even in cases where morphological characteristics may be ambiguous or variable. This DNA-based method provides a reliable tool for rapid and accurate identification of Phoenix sylvestris, contributing to its conservation and management efforts, as well as facilitating research on its ecology, distribution, and evolutionary history. This study presents a multifaceted analysis of P. sylvestris extract, encompassing phytochemical characterization, antioxidant, antimicrobial, and anticancer evaluations, along with molecular docking simulations. The phytochemical analysis revealed the presence of various bioactive compounds such as phenolics and flavonoids contributing to its medicinal properties. Assessment of antioxidant activity through DPPH assay demonstrated significant radical scavenging potential, indicating its potential therapeutic application in oxidative stress-related disorders. Moreover, the antimicrobial evaluation against a panel of pathogenic microorganisms highlighted the extract's efficacy in inhibiting microbial growth, suggesting its utility as a natural antimicrobial agent. Furthermore, the anticancer potential was evaluated against various cancer cell lines, revealing promising cytotoxic effects, particularly against specific cancer types. Molecular docking studies provided insights into the interaction between bioactive compounds of P. sylvestris extract and key molecular targets implicated in cancer progression, validating its potential as a source of novel anticancer agents. Overall, this comprehensive investigation underscores the pharmacological significance of P. sylvestris extract, emphasizing its therapeutic versatility and potential for drug discovery and development. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the optimal surgical timing in patients with preoperative coronavirus disease 2019 (COVID-19) infection to minimize postoperative morbidity and mortality during the COVID-19 vaccination era. Methods: The Korean nationwide data on patients who underwent standard surgery under general anesthesia in 2021 were analyzed. Patients were categorized based on the time from COVID-19 diagnosis to surgery: 0-4, 5-8, > 8 weeks, and those without preoperative COVID-19 infection. Multivariable logistic regression analysis, considering preoperative COVID-19 vaccination status (fully vaccinated vs. unvaccinated or partially vaccinated), was performed to associate the preoperative COVID-19 infection timing with 30- and 90- day postoperative mortality and 30-day respiratory complications. Results: Among the 750,175 included patients, 28.2% were preoperatively fully vaccinated. Compared with patients without prior COVID-19 infection, those who had surgery 0-4 weeks (adjusted odds ratio [OR]: 4.28, 95% CI [1.81, 10.13], P = 0.001) and 5-8 weeks (adjusted OR: 3.38, 95% CI [1.54, 7.44], P = 0.002) after COVID-19 infection had a significantly increased risk of 30-day mortality. Preoperative full vaccination was significantly associated with a decrease in 90-day mortality (adjusted OR: 0.93, 95% CI [0.89, 0.98], P = 0.007) and 30-day respiratory complications (adjusted OR: 0.85, 95% CI [0.82, 0.87], P < 0.001), but not with 30-day mortality (P = 0.916). Conclusions: COVID-19 infection eight weeks preoperatively was associated with an increased 30-day postoperative mortality. Preoperative full vaccination was not associated with 30-day mortality but was related to lower risk of 90-day mortality and 30-day respiratory complications. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to reveal the impact of coronavirus disease 2019 on the number of practices commonly used for cancer diagnosis in Japan. Methods: The sampling dataset of the National Database of Japan from January 2015 to January 2021 was used to generate 25-point time-series data for the number of practices (21 points before and 4 points during the pandemic outbreak). The decreased number was estimated by interrupted time-series analysis using a seasonal autoregressive integrated moving average model. Using the pre-pandemic data, expected counterfactual numbers during the pandemic were predicted, and decreased rate was calculated. Results: In most practices, the number dramatically decreased in the early stage of the pandemic and recovered rapidly thereafter. As of April 2020, gastric endoscopy decreased at the top of the practices (− 42.1%, with 95% confidence intervals of − 50.5% and − 33.7%), followed by gastric biopsy (− 38.6%, with 95% confidence intervals of − 46.7% and − 30.6%). The period of declined practices for lung cancer was relatively prolonged. The number of sentinel lymph node biopsies for breast cancer and colposcopies and biopsies for cervical cancer did not decrease in April 2020, but significantly decreased later in July 2020, which is assumed to be the time lapse after the primary testing before surgical treatment or intense scrutiny. Conclusion: In general, the number of practices for cancer diagnosis in Japan showed only a temporary decline, which was concordant with reports from several other countries. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. Our study sought to evaluate the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. Methods: The National Cancer Database was queried for patients diagnosed with clinical stages I–IV HCC (2017–2020). Patients were categorized based on their year of diagnosis as "Pre-COVID" (2017–2019) and "COVID" (2020). TTI based on stage and type of treatment first received was compared by the Mann-Whitney U test. A logistic regression model was used to evaluate factors of increased TTI and treatment delay (> 90 days). Results: In total, 18,673 patients were diagnosed during Pre-COVID, whereas 5249 were diagnosed during COVID. Median TTI for any first-line treatment modality was slightly shorter during the COVID year compared with Pre-COVID (49 vs. 51 days; p < 0.0001), notably in time to ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In a multivariate analysis, patients of Black race, Hispanic ethnicity, and uninsured/Medicaid/Other Government insurance status were associated with increased TTI by factors of 1.057 (95% CI: 1.022–1.093; p = 0.0013), 1.045 (95% CI: 1.010–1.081; p = 0.0104), and 1.088 (95% CI: 1.053–1.123; p < 0.0001), respectively. Similarly, these patient populations were associated with delayed treatment times. Conclusions: For patients diagnosed during COVID, TTI for HCC, while statistically significant, had no clinically significant differences. However, vulnerable patients were more likely to have increased TTI. [ABSTRACT FROM AUTHOR]

Various countries have reported a decrease in breast cancer surgeries during the coronavirus disease 2019 (COVID-19) pandemic; however, inconsistent results have been reported in Japan. This study revealed changes in the number of surgeries during the pandemic using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from January 2015 to January 2021, where insurance claims data from Japan as a whole are comprehensively accumulated. The number of breast-conserving surgeries (BCS) without axillary lymph node dissection (ALND) significantly decreased in July (− 846; 95% confidence interval (CI) − 1190 to − 502) and October 2020 (− 540; 95% CI − 861 to − 218). No decrease was observed for other types of surgery, BCS with ALND, and mastectomy with or without ALND. In the age-specific subgroup analysis, significant and transient reduction in BCS without ALND was observed in all age groups (0–49, 50–69, and ≥ 70 years). The number of BCS without ALND significantly decreased for a relatively short period in the early pandemic stages, suggesting reduced surgery for patients with a relatively low stage of cancer. Some patients with breast cancer might have been left untreated during the pandemic, and an unfavorable prognosis would be a concern. [ABSTRACT FROM AUTHOR]

Purpose: Anastomotic leakage (AL) is one of the severe complications after rectal surgery, and anastomotic ischemia is one of the main factors. This prospective in vivo pilot study aimed to evaluate the effectiveness of Sidestream Dark Field (SDF) imaging in quantitative assessment of anastomotic microcirculation and to analyze its correlation with AL. Methods: Thirty-three patients with rectal cancer who underwent laparoscopic low anterior resection from 2019 to 2020 were enrolled. Microcirculation was measured by SDF imaging at the descending colon, the mesocolon transection line (MTL), and 1 cm and 2 cm distal to the MTL. Anastomotic microcirculation was measured at the stapler anvil edge before anastomosis. Quantitative perfusion–related parameters were as follows: microcirculation flow index (MFI), perfused vessel density (PVD), proportion of perfused vessels (PPV), and total vessel density (TVD). Results: All patients obtained stable microcirculation images. Functional microcirculation parameters (MFI, PPV, PVD) decreased successively from the descending colon, the colon at MTL, and 1 cm and 2 cm distal to the MTL (all P < 0.01). Extremely poor microcirculation was found at the intestinal segment 2 cm distal to the MTL. Micro-perfusion was significantly lower at the colonic limb of the anastomosis compared with the descending colon (all P < 0.001). Anastomotic leakage occurred in 3 patients (9.1%) whose anastomotic microcirculation was significantly lower than those without AL (all P < 0.01). Blood perfusion at the colonic limb of the anastomosis was significantly higher in patients with left colic artery preservation than in controls. Conclusion: SDF imaging is a promising technique for evaluating anastomotic microcirculation and has potential clinical significance for risk stratification of AL. [ABSTRACT FROM AUTHOR]

Aim: Due to the overwhelming spread of SARS‐CoV‐2 and its disruption of the healthcare system, delays and reduced numbers were reported for colorectal cancer screening, colonoscopies, and surgery during the COVID‐19 pandemic. This multicenter retrospective study investigated the still poorly understood impact of the COVID‐19 pandemic on colorectal cancer treatment in Japan. Methods: This study was organized by the Clinical Study Group of Osaka University, which comprised 32 major institutions in Osaka. We retrospectively analyzed the number of surgeries and colonoscopies performed and the characteristics of patients who underwent surgery for colorectal cancer between March 2019 and February 2021. We compared data collected before and during the COVID‐19 pandemic. We also assessed the methods used for detecting colorectal cancer, including fecal occult blood test, abdominal symptoms, and anemia. Results: The COVID‐19 pandemic caused reductions in the annual numbers of surgeries (3569 vs 3198) and colonoscopies (67 622 vs 58 183) performed in the 2020 fiscal year, compared to the 2019 fiscal year. During the COVID‐19 pandemic, a significantly lower proportion of patients were treated for clinical stages ≤I (24.2% vs 26.9%; P =.011), compared to the proportion treated before the pandemic. Fecal occult blood tests for detecting colorectal cancer were used significantly less frequently during the COVID‐19 pandemic (26.2% vs 29.6%; P =.002). These trends were more significant in larger institutions. Conclusion: The COVID‐19 pandemic reduced the number of colonoscopies and surgeries performed for colorectal cancer and hindered the detection of asymptomatic early‐stage cancers, and its impact varied by hospital size. [ABSTRACT FROM AUTHOR]

Soft corals and associated microorganisms are known to produce leads for anticancer drugs. Keeping this in mind, Nephthea sp.; a Red Sea soft coral was investigated for the first time using the OSMAC approach. Two isolates, Streptomyces sp. UR63 and Micrococcus sp. UR67 were identified. Their extracts revealed the presence of alkaloids, macrolides, quinones, fatty acids and terpenoids. Further comparison through a set of multivariate data analyses revealed their unique chemical profiles. The extracts displayed inhibitory potencies against HepG-2, Caco-2 and MCF-7 tumor cell lines with IC50 values ranging from 11.4 to 38.7 μg/mL when compared with the positive control, doxorubicin. The study not only highlights the cytotoxic potential of soft coral-associated actinomycetes but also shows the advantage of using the OSMAC approach in this regard. [ABSTRACT FROM AUTHOR]

Background: Longer time intervals to diagnosis and treatment are associated with worse survival for various types of cancer. The patient, diagnostic, and treatment intervals are considered core indicators for early diagnosis and treatment. This review estimated the median duration of these intervals for various types of cancer and compared it across high- and lower-income countries.Methods and Findings: We conducted a systematic review with meta-analysis (prospectively registered protocol CRD42020200752). Three databases (MEDLINE, Embase, and Web of Science) and information sources including grey literature (Google Scholar, OpenGrey, EThOS, ProQuest Dissertations & Theses) were searched. Eligible articles were published during 2009 to 2022 and reported the duration of the following intervals in adult patients diagnosed with primary symptomatic cancer: patient interval (from the onset of symptoms to first presentation to a healthcare professional), diagnostic interval (from first presentation to diagnosis), and treatment interval (from diagnosis to treatment start). Interval duration was recorded in days and study medians were combined in a pooled estimate with 95% confidence intervals (CIs). The methodological quality of studies was assessed using the Aarhus checklist. A total of 410 articles representing 68 countries and reporting on 5,537,594 patients were included. The majority of articles reported data from high-income countries (n = 294, 72%), with 116 (28%) reporting data from lower-income countries. Pooled meta-analytic estimates were possible for 38 types of cancer. The majority of studies were conducted on patients with breast, lung, colorectal, and head and neck cancer. In studies from high-income countries, pooled median patient intervals generally did not exceed a month for most cancers. However, in studies from lower-income countries, patient intervals were consistently 1.5 to 4 times longer for almost all cancer sites. The majority of data on the diagnostic and treatment intervals came from high-income countries. Across both high- and lower-income countries, the longest diagnostic intervals were observed for hematological (71 days [95% CI 52 to 85], e.g., myelomas (83 days [47 to 145])), genitourinary (58 days [50 to 77], e.g., prostate (85 days [57 to 112])), and digestive/gastrointestinal (57 days [45 to 67], e.g., colorectal (63 days [48 to 78])) cancers. Similarly, the longest treatment intervals were observed for genitourinary (57 days [45 to 66], e.g., prostate (75 days [61 to 87])) and gynecological (46 days [38 to 54], e.g., cervical (69 days [45 to 108]) cancers. In studies from high-income countries, the implementation of cancer-directed policies was associated with shorter patient and diagnostic intervals for several cancers. This review included a large number of studies conducted worldwide but is limited by survivor bias and the inherent complexity and many possible biases in the measurement of time points and intervals in the cancer treatment pathway. In addition, the subintervals that compose the diagnostic interval (e.g., primary care interval, referral to diagnosis interval) were not considered.Conclusions: These results identify the cancers where diagnosis and treatment initiation may take the longest and reveal the extent of global disparities in early diagnosis and treatment. Efforts should be made to reduce help-seeking times for cancer symptoms in lower-income countries. Estimates for the diagnostic and treatment intervals came mostly from high-income countries that have powerful health information systems in place to record such information. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The coronavirus disease-2019 pandemic has affected the entire health system and patients other than coronavirus-infected patients. Hospital admissions of cancer patients decreased during the closure periods due to the pandemic. This study was conducted to determine whether there was an effect on the hospital admissions of newly diagnosed lung cancer patients in Turkey during the coronavirus disease-2019 pandemic. MATERIAL AND METHODS: In this retrospective study, newly diagnosed lung cancer patients were recorded from the Hospital Information Management System between January 1, 2017, and December 31, 2020, at our tertiary hospital. The number of newly diagnosed lung cancer patients diagnosed in 2020 was compared with each year from 2017 to 2019. RESULTS: Between 2017 and 2020, 15 150 newly diagnosed lung cancer cases were analyzed. According to Global Cancer Observatory data, in 2018, 34 703 newly diagnosed lung cancer cases, and in 2020, 41 264 newly diagnosed lung cancer cases were observed in Turkey. Although a decrease was not observed in the number of patients according to Global Cancer Observatory data, both the total number of patients admitted to our hospital and the number of newly diagnosed lung cancer patients decreased in 2020. The number of newly diagnosed lung cancer patients by year was 4030 patients in 2017, 4004 patients in 2018, 4391 patients in 2019, and 2725 in 2020, respectively. In 2020, newly diagnosed lung cancer patients decreased by 38%, 32%, and 32% compared to 2019, 2018, and 2017, respectively. Also, a significant decrease was seen in the number of newly diagnosed lung cancer patients in the months with closure due to the pandemic compared to the months without closure. CONCLUSION: There was a significant decrease in hospital admissions of newly diagnosed lung cancer cases in the coronavirus disease- 2019 pandemic in our referral hospital. Precautions should be considered to diagnose and treat lung cancer patients in specialized centers during a pandemic due to epidemic diseases such as coronavirus disease-2019. [ABSTRACT FROM AUTHOR]

Cancer is a serious disease that affects the lives of millions around the globe. During COVID-19 pandemic, cancer patients were neglected and due to their miss management in hospitals, they presented in advanced stages of their primary disease specifically due to the suspension of elective services. The current study aimed to determine the impact of the COVID-19 pandemic on cancer patients. The current study was designed at the department of surgery in Khyber Teaching Hospital (KTH) Peshawar from 1st April 2020 to 30th March 2021 in Khyber Teaching Hospital, Peshawar. A total of 160-cancer patients were divided equally into 2 groups i.e. Group-A (pre-COVID-19 era patients) and Group-B (COVID-19 era patients). These two groups were selected on basis of non-probability consecutive sampling technique. Different statistic tools like SPSS and Origin 2018 soft ware were used for means, standard deviation and percentages. Results: During April and December a total of 160 cancer patients were studied in both years i.e. 2019 (pre-COVID-19 period) and 2020 (COVID-19 period). The mean age of presentation for patients in 2019 was 46.11 and in 2020 it was 50.38. Patients who were hospitalized to surgical wards during the COVID-19 tenure had comparatively longer mean duration of hospital stay with around 8 days (CI 2.49-13.39) hence showing significance with a p-value of 0.011. Breast cancer (n=32 [40% in 2019], n=17 [21.2% in 2020]) and rectal cancer (n=11 [13.8% in 2019], n=18 [22.5% in 2020]) were the two most common entities observed. Most importantly, study sample was analyzed and results showed that 57.5% (n=46) of the patients presented to surgical wards with less aggressive tumors in 2019 as opposed to 2020 where 67.5% (n=54) of patients came to the hospital with advanced stage malignancies; this indicates a significant p-value of 0.001. Conclusion: We are of the opinion that the pandemic is not over yet. Problems such as the global spread of cancer due to COVID-19 and its long term effects on the quality of life of patients worldwide is still being investigated. It is stipulated that the long-term consequences of decreased cancer screening, delayed hospital visits as well as the rise in elective surgery waiting times on cancer stage progression and outcomes, are anticipated to be significant. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has a worldwide negative impact on healthcare systems. This study aims to determine how the diagnosis, clinicopathological features, and treatment approaches of patients with breast cancer (BC) diagnosed at ≥65 years old were affected during the pandemic. This survey has shown that patients, especially the elderly, had to postpone their BC health problems or delay their routine controls due to the risk of COVID-19 transmission, high mortality rates due to comorbidity, and restrictions. Materials and Methods: The medical records of 153 patients with BC diagnosed at ≥65 years old before (January–December 2019; group A, n = 61) and during (March 2020–May 2021; group B, n = 92) the COVID-19 pandemic were retrospectively analyzed. In addition, clinicopathological features of patients, including age, admission form, clinical stage, tumor (T) size-grade-histology-subtype, lymph node involvement, surgery type, and treatment protocols, were evaluated. Results: Patients mostly applied for screening purposes were included in group A and patients who frequently applied for diagnostic purposes due to their existing BC or other complaints were included in group B (p = 0.009). Group B patients had a higher clinical stage (p = 0.026) and had commonly larger (p = 0.020) and high-grade (p = 0.001) Ts. Thus, mastectomy and neoadjuvant systemic therapy were more commonly performed in group B (p = 0.041 and p = 0.005). Conclusion: The survey showed significant changes in BC diagnosis and treatment protocols for patients diagnosed at ≥65 years old during the COVID-19 pandemic. Postponing screening and delaying treatment leads to more advanced BC stages in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases.Methods: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis.Results: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths.Conclusions: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients. [ABSTRACT FROM AUTHOR]

Since late December 2019, the 2019 coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its rapid international spread have posed a global health threat. The World Health Organization has declared the outbreak of COVID-19 as "public health emergency of international concern". COVID-19 not only brings tremendous pressure to the medical system but also brings new challenges to the global economy. The occurrence and development of cancer has always been an area of active research, and COVID-19 also has a long-lasting impact on the diagnosis, treatment, and research of cancer. In the context, we review the adverse effects of COVID-19 on the screening, diagnosis, treatment and prognosis of cancer patients and the countermeasures in this situation, and provide solutions for improving the quality of life of cancer patients in the normalized prevention and control of COVID-19. [ABSTRACT FROM AUTHOR]

Objective: In early 2020, the spread of coronavirus disease-2019 (COVID-19) led the World Health Organization to declare this disease a pandemic. Initial epidemiological data showed that patients with cancer were at high risk of developing severe forms of COVID-19. National scientific societies published recommendations modifying the patients' breast cancer (BC) management to preserve, in theory, quality oncologic care, avoiding the increased risk of contamination. The Senology International Society (SIS) decided to take an inventory of the actions taken worldwide. This study investigates COVID-19-related changes concerning BC management and analyzes the will to maintain them after the pandemic, evaluating their oncological safety consequences. Materials and Methods: SIS network members participated in an online survey using a questionnaire (Microsoft® Forms) from June 15th to July 31st, 2020. Results: Forty-five responses from 24 countries showed that screening programs had been suspended (68%); magnetic resonance imagines were postponed (73%); telemedicine was preferred when possible (71%). Surgeries were postponed: reconstructive (77%), for benign diseases (84%), and in patients with significant comorbidities (66%). Chemotherapy and radiotherapy protocols had been adapted in 28% of patients in both. Exception for telemedicine (34%), these changes in practice should not be continued. Conclusion: The SIS survey showed significant changes in BC's diagnosis and treatment during the first wave of the COVID-19 pandemic, but most of these changes should not be maintained. Indeed, women have fewer severe forms of COVID-19 and are less likely to die than men. The risk of dying from COVID-19 is more related to the presence of comorbidities and age than to BC. Stopping screening and delaying treatment leads to more advanced stages of BC. Only women aged over 65 with BC under treatment and comorbidities require adaptation of their cancer management. [ABSTRACT FROM AUTHOR]

Aim: Anastomotic leak (AL) after colorectal resection is associated with increased rates of morbidity and mortality: potential permanent stoma formation, increased local recurrence, reduced cancer‐related survival, poor functional outcomes and associated quality of life. Techniques to reduce leak rates are therefore highly sought. Method: A literature search was performed for published full text articles using PubMed, Cochrane and Scopus databases with a focus on colorectal surgery 1990–2020. Additional papers were detected by scanning references of relevant papers. Results: A total of 53 papers were included after a thorough literature search. Techniques assessed included leak tests, endoscopy, perfusion assessment and fluorescence studies. Air‐leak testing remains the most commonly used method across Europe, due to ease of reproducibility and low cost. There is no evidence that this reduces the leak rate; however, identification of a leak intra‐operatively provides the opportunity for either suture reinforcement or formal takedown with or without re‐do of the anastomosis and consideration of diversion. Suture repair alone of a positive air‐leak test is associated with an increased AL rate. The use of fluorescence studies to guide the site of anastomosis has demonstrated reduced leak rates in distal anastomoses, is safe, feasible and has a promising future. Conclusion: Although over reliance on any assessment tool should be avoided, intra‐operative techniques with the aim of reducing AL rates are increasingly being employed. Standardization of these methods is imperative for routine use. However, in the interim it is recommended that all anastomoses should be assessed intra‐operatively for mechanical failure, particularly distal anastomoses. [ABSTRACT FROM AUTHOR]

Structural plasticity of dendritic spines is a key component of the refinement of synaptic connections during learning. Recent studies highlight a novel role for the NMDA receptor (NMDAR), independent of ion flow, in driving spine shrinkage and LTD. Yet little is known about the molecular mechanisms that link conformational changes in the NMDAR to changes in spine size and synaptic strength. Here, using two-photon glutamate uncaging to induce plasticity at individual dendritic spines on hippocampal CA1 neurons from mice and rats of both sexes, we demonstrate that p38 MAPK is generally required downstream of non-ionotropic NMDAR signaling to drive both spine shrinkage and LTD. In a series of pharmacological and molecular genetic experiments, we identify key components of the non-ionotropic NMDAR signaling pathway driving dendritic spine shrinkage, including the interaction between NOS1AP (nitric oxide synthase 1 adaptor protein) and neuronal nitric oxide synthase (nNOS), nNOS enzymatic activity, activation of MK2 (MAPK-activated protein kinase 2) and cofilin, and signaling through CaMKII. Our results represent a large step forward in delineating the molecular mechanisms of non-ionotropic NMDAR signaling that can drive shrinkage and elimination of dendritic spines during synaptic plasticity. [ABSTRACT FROM AUTHOR]

Purpose: Anastomotic leak and other infectious complications are septic complications of rectal cancer surgery caused by bacteria. Data from registry analysis show a beneficial effect of local antimicrobial administration on anastomotic leaks, but data are inconsistent in recent clinical trials. Therefore, our aim was to study the efficacy of topical antibiotic treatment on the incidence of anastomotic leaks in rectal cancer surgery. Methods: A prospective, randomized, double-blind and placebo-controlled, single center trial was conducted. Patients received either placebo and amphotericin B or decontamination with polymyxin B, tobramycin, vancomycin, and amphotericin B four times per day starting the day before surgery until postoperative day 7. If a protective ileostomy was created, a catheter was placed transanally and the medication was administered locally to the anastomotic site. All patients received an intravenous perioperative antibiotic prophylaxis. Results: The trial had to be stopped for ethical reasons after first interim analysis with 80 patients instead of the initially planned 280 patients. Of the 40 patients randomized to receive placebo, eight (20%) developed anastomotic leak compared to only 2 (5%) in the treatment group of 40 patients (decontamination) with significant difference in the χ2 test (p = 0.0425). Twenty percent of the placebo group and 12.5% in the treatment group developed infectious complications not associated with anastomotic leak (p = 0.5312). One patient (2.5%) in the placebo group died (p = 0.3141). Conclusion: Local decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B is safe and effective in the prevention of anastomotic leak in rectal cancer surgery. [ABSTRACT FROM AUTHOR]

Organized screening for breast cancer (BC) was suspended in most countries of the world during the coronavirus disease-2019 (COVID-19) pandemic. Computed tomography (CT) scans of the chest, frequently performed in patients with severe forms of COVID-19, may detect asymptomatic breast abnormalities. A 72-year-old patient, with a severe form of COVID-19 underwent a diagnostic CT scan. This led to the unexpected discovery, at an early stage, of a 12 mm, high grade, Human epidermal growth factor receptor 2 positive BC, with a high proliferation index. After responding to chemotherapy, she was managed with conservative breast surgery with sentinel lymph node biopsy. Delayed management of BC can be responsible for poor outcomes. Patients with severe forms of COVID-19 are also at risk for developing BC due to common risk factors. Thirty percent of incidental breast lesions discovered on CT scans are undiagnosed BC. Careful study of the mammary glands on CT scan of patients with COVID-19 may allow early diagnosis of a malignant tumor in a high-risk population for BC and deprived of routine screening mammography. [ABSTRACT FROM AUTHOR]

Objective: The role of liver fatty acid-binding protein (FABP1) in obesity is presently unclear. We investigated the association of FABP1 with obesity and the changes noted after laparoscopic sleeve gastrectomy (LSG) in a Chinese population. Methods: The cross-sectional analysis included 187 individuals: 65 had normal weight (18.5 ≤ body mass index (BMI) < 24 kg/m2), 59 were overweight (24 ≤ BMI < 28 kg/m2), and 63 were obese (BMI ≥ 28 kg/m2). We also assessed 25 severely obese patients (BMI, 38.58 ± 4.59 kg/m2) at baseline and at 3, 6, and 12 months after LSG to observe FABP1 levels. Results: FABP1 levels in the obese (30.33 ± 23.59 ng/ml, **P < 0.01, ***P < 0.001) and overweight (18.96 ± 18.75 ng/ml, P = 0.471) individuals were significantly higher than those in normal weight individuals (14.30 ± 9.37 ng/ml). Linear regression analysis revealed that the FABP1 levels were positively correlated with BMI (R2 = 0.201, ***P < 0.001), ALT (R2 = 0.324, ***P < 0.001), AST (R2 = 0.387, ***P < 0.001), m-AST (R2 = 0.160, ***P < 0.001), γ-GT (R2 = 0.106, ***P < 0.001), DBil (R2 = 0.078, ***P < 0.001), UA (R2 = 0.111, ***P < 0.001), FBG (R2 = 0.066, ***P < 0.001), LDL (R2 = 0.042, **P = 0.005), and were negatively correlated with HDL (R2 = 0.051, **P = 0.002). After adjusting for age, sex, ALT, AST, TC, TG, HDL, LDL, FBG, and UA, FABP1 was independently correlated with BMI (*P < 0.05). With decreasing BMI after LSG, the FABP1 levels (29.46 ± 21.19 ng/ml, P = 0.463, P = 0.06, *P < 0.05) also decreased at 3 (23.00 ± 22.77 ng/ml), 6 (14.41 ± 15.48 ng/ml), and 12 months (11.55 ± 3.27 ng/ml). Conclusion: Serum FABP1 levels are closely correlated with obesity and many metabolic factors, and we found that with the decrease in BMI after LSG, the FABP1 levels also progressively decreased postoperatively. Trial Registration: ClinicalTrials.gov Identifier: ChiCTR-OCS-12002381 [ABSTRACT FROM AUTHOR]

An analysis of the results and conclusions from the most recent RCTs of the role of mechanical bowel preparation before colonic surgery is presented. A multicentre (4 hospitals), parallel, single-blinded trial was undertaken in patients undergoing colonic resection who were assigned randomly (1: 1) to either mechanical oral antibiotic bowel preparation or no bowel preparation[5]. Patients with colorectal cancer scheduled for elective curative surgery, considered high-risk patients, were included. Although the Dutch study emphasized the emerging role of the microbiome in pathogenesis of AL and the important role that collagenolytic pathogens may play in this complication, is it not time to document this patient by patient and make appropriate changes to the antibiotic regimen?. [Extracted from the article]

Background: According to the American Joint Committee on Cancer staging for cancer of the colon, a minimum of 12 lymph nodes (LN) has to be sampled for accurate staging. This has bearing on the long-term prognosis and the need for adjuvant chemotherapy. The aim of this study was to revisit the association of lymph node yield and the long-term survival in patients with stages I and II, i.e. node-negative, colon cancer. Method: Consecutive patients who underwent elective or emergency curative resections for cancer of colon between the years 2003 and 2012 were retrospectively reviewed. Only patients with stage I or II diseases (AJCC 8th edition) were included. They were analysed in three groups, LN<12, LN12-19 and LN≥20. Their clinic-pathological characteristics were compared. The disease-free (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Results: There was a total of 659 patients included in the analysis. Twelve or more LN were found in 65.6% of the specimens. The mean follow-up was 83.9 months. LN≥20 had significantly better DFS (p = 0.015) and OS (p = 0.036), whereas LN<12 had similar DFS and OS when compared to LN12-19. The advantage in DFS and OS were mainly seen in those with stage II diseases. A lymph node yield of greater than 20 was one of the predictors of favourable DFS, hazard ratio 0.358; 95% CI 0.170–.756, p = 0.007. Conclusion: The lymph node yield had a significant association with survival outcomes. A lymph node yield of 20 or more was associated with better survival outcomes. On the other hand, lymph node yield less than 12 was not shown to have inferior survival outcomes when compared to those between 12 and 19. [ABSTRACT FROM AUTHOR]

Background: Rectal prolapse is a disease presentation with a prevalence of about 1%, mainly affecting older women. It usually presents with symptoms of rectal mass, rectal bleeding, fecal incontinence or constipation, with patients frequently feeling socially isolated as a result. Perineal rectosigmoidectomy is associated with lesser morbidity and mortality than the abdominal procedure, but with a much higher recurrence rate. Therefore, this technique is mainly suitable for the frail elderly patient. Specific outcomes in an elderly population have been described in only a few studies. We evaluated the morbidity, mortality, recurrence rate and functional results after this procedure related to age. Methods: All patients who underwent a perineal rectosigmoidectomy over a 10-year period in two tertiary referral centers were included in the study. American Society of Anesthesiology (ASA) grade, pre- and postoperative symptoms, pathology-reported post-fixation specimen length, length of in-patient stay, 30-day morbidity/mortality, and recurrence were measured. Results: A total of 45 patients underwent a perineal rectosigmoidectomy. Forty-three (95%) were female, with a median age of 82.0 years (IQR 70.5–86.5), ASA grade III and median follow-up of 20 months (range 8.5–45.5 months). Half of the cohort was over 80 years old. Significant symptomatic relief was achieved, predominantly the resolution of rectal mass (8.9% vs. 60.0% preoperatively), fecal incontinence (15.6% vs. 46.7%) and constipation (4.4% vs. 26.7%). The median length of stay was 6 days, while morbidity occurred in 14 patients (31.1%) and recurrence occurred in 6 patients (13%). There were no deaths within 30 days of the procedure and outcomes were comparable in the < 80 and ≥ 80 age group. Conclusions: Perineal rectosigmoidectomy is safe for older patients with greater comorbidities resulting in good functional results and is associated with low morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Various surgical options for rectal prolapse are available but none have been shown to be clearly superior. The aims of this study were to investigate the long‐term recurrence rate of a variety of surgical approaches, their associated morbidities and the types of reoperation used to treat recurrence. Methods: A retrospective analysis was performed of all cases of rectal prolapse surgery within one colorectal surgical unit between January 2000 and June 2017. Abdominal approaches consisted of rectopexy (RP) and resection rectopexy (RRP); perineal approaches included perineal rectosigmoidectomy (PR) and Delorme's repair (DR). Complications were graded according to the Clavien–Dindo classification. The median follow‐up was 4.5 years (interquartile range 1.5–10.1, maximum 16.5). Statistical analysis was performed using Kaplan–Meier to determine recurrence rates. Results: A total of 157 patients were included in the study. The numbers for each procedure were: DR (n = 55), RRP (n = 44), RP (n = 38) and PR (n = 20). The majority were females (94%). The perineal group were significantly older than the abdominal group (80 versus 67 years, P = 0.0001). At 5 years, the recurrence rates were 52%, 30%, 5% and 3% for DR, PR, RP and RRP, respectively. Morbidity was highest in PR (20%) followed by RRP (18%), RP (16%) and DR (7%) (n.s.). The overall morbidity rates for perineal group and abdominal group were 10.7% and 17.1%, respectively (n.s.). Conclusion: Abdominal approaches have a significantly lower recurrence rate at 5 years but tend to be associated with higher morbidity. [ABSTRACT FROM AUTHOR]

Dynamic modification of synaptic connectivity in response to sensory experience is a vital step in the refinement of brain circuits as they are established during development and modified during learning. In addition to the well-established role for new spine growth and stabilization in the experience-dependent plasticity of neural circuits, dendritic spine elimination has been linked to improvements in learning, and dysregulation of spine elimination has been associated with intellectual disability and behavioral impairment. Proper brain function requires a tightly regulated balance between spine formation and spine elimination. Although most studies have focused on the mechanisms of spine formation, considerable progress has been made recently in delineating the neural activity patterns and downstream molecular mechanisms that drive dendritic spine elimination. Here, we review the current state of knowledge concerning the signaling pathways that drive dendritic spine shrinkage and elimination in the cerebral cortex and we discuss their implication in neuropsychiatric and neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Background: Anal residual tumors are consensually identified within six months of chemoradiotherapy and represent a persistent lesion that may have prognostic value for overall survival. The aim of this study was to evaluate the association of HPV and HIV status, p16 expression level and TP53 mutations with the absence of residual tumors (local response) in Squamous Cell Carcinoma (SCC) of the anal canal after chemoradiotherapy.Methods: We performed a study on 78 patients with SCC of the anal canal who submitted to chemoradiotherapy and were followed for a six-month period to identify the absence or presence of residual tumors. HPV DNA was identified by polymerase chain reaction and direct sequencing, HIV RNA was detected by TaqMan amplification, p16 expression was detected by western blotting, and the mutational analysis of TP53 was performed by direct sequencing; additionally, samples carrying mutations underwent fluorescent in sit hybridization. The evaluation of the tumor response to treatment was conducted six months after the conclusion of chemoradiotherapy. The following classifications were used to evaluate the outcomes: a) no response (presence of residual tumor) and b) complete response (absence of residual tumor).Results: The significant variables associated with the absence of residual tumors were HPV positive, p16 overexpressed, wild-type TP53, female gender, and stages I and II. Only the presence of HPV was independently correlated with the clinical response; this variable increased the chances of a response within six months by 31-fold.Conclusions: The presence of HPV in tumor cells was correlated with the absence of a residual tumor. This correlation is valuable and can direct future therapeutic approaches in the anal canal. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Netrin-1, a multifunctional axon guidance cue, elicits axon outgrowth via one of its receptors deleted in colorectal cancer (DCC) in several types of neurons, including cerebral cortical neurons of embryonic mice. However, we and others have observed de novo formation of axon branches without axon outgrowth induced by netrin-1 in cortical culture of neonatal hamsters. These previous reports suggested the possibility that netrin-1 function might alter during development, which we here investigated using dissociated culture prepared from cerebral cortices of embryonic mice.Results: Imaging analysis revealed netrin-1-induced outgrowth in embryonic day (E) 14 axons and netrin-1-induced branching in E16 axons. Netrin-1-evoked filopodial protrusions, which sprouted on the shafts of E16 axons preceding branch formation, were visualized by a novel method called atmospheric scanning electron microscopy. Treatment with an anti-DCC function-blocking antibody affected both axon outgrowth and branching.Conclusions: Morphological analyses suggested a possibility of a shift in the function of netrin-1 in cortical axons during development, from promotion of outgrowth to promotion of branch formation starting with filopodial protrusion. Function-blocking experiments suggested that DCC may contribute not only to axon outgrowth but branching. [ABSTRACT FROM AUTHOR]

Expediting pediatric access to new antiseizure drugs is particularly compelling, because epileptic seizures are the most common serious neurological symptom in children. Analysis of antiepileptic drug ( AED) efficacy outcomes of randomized controlled trials, conducted during the past 20 years in different populations and a broad range of study sites and countries, has shown considerable consistency for each drug between adult and pediatric populations. Historically, the majority of regulatory approvals for AEDs have been for seizure types and not for specific epilepsy syndromes. Available data, both anatomical and neurophysiological, support a similar pathophysiology of focal seizures in adults and young children, and suggest that by age 2 years the structural and physiological milieu upon which seizures develop is similar. Although the distribution of specific etiologies and epilepsy syndromes is different in children from in adults, this should not impact approvals of efficacy based on seizure type, because the pathophysiology of focal seizures and the drug responsiveness of these seizure types are quite similar. Safety and pharmacokinetics cannot be extrapolated from adults to children. The scientific rationale, clinical consensus, and published data support a future approach accepting efficacy data from adult trials and focusing exclusively on prospective pharmacokinetic, tolerability, and safety studies and long-term follow-up in children. Whereas tolerability studies can be compared easily in children and adults, safety studies require large numbers of patients followed for many years. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim There is a recognized need to include the views of patients and the public in prioritizing health research. This study aimed: (i) to explore patients' views on colorectal research; and (ii) to prioritize research topics with patients and the public. Method In phase 1, 12 charitable organizations and patient groups with an interest in bowel disease were invited to attend a consultation exercise. Participants were briefed on 25 colorectal research topics prioritized by members of the Association of Coloproctology of Great Britain and Ireland. Focus groups were conducted and discussions were recorded with field notes. Analysis was conducted using principles of thematic analysis. In phase 2, a free public consultation was undertaken. Participants were recruited from newspaper advertisements, were briefed on the same research topics and were asked to rate the importance of each on a five-point Likert scale. Descriptive statistics were used to rank the topics. Univariable linear regression compared recorded demographic details with mean topic scores. Results Focus groups were attended by 12 patients who highlighted the importance of patient-centred information for trial recruitment and when selecting outcome measures. Some 360 people attended the public consultation, of whom 277 (77%) were recruited. Participants rated 'What is the best way to treat early cancer in the back passage?' highest, with 227 (85%) scoring it 4 or 5. There was no correlation between participant demographics and mean topic scores. Conclusion The present study prioritized a colorectal research agenda with the input of patients and the public. Further research is required to translate this agenda into real improvements in patient care. [ABSTRACT FROM AUTHOR]

Aim The modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to reach a consensus on prioritizing clinical research questions in colorectal disease. Method Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds 2 and 3 they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority. Results Five hundred and two questions were submitted in Round 1. Following two rounds of voting and analysis, a list of 25 priority questions was produced, including 15 cancer-related and 10 noncancer-related questions. Conclusion It is anticipated that these results will: (i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, (ii) promote development and (iii) define funding of new research and prioritize areas of unmet clinical need where the potential clinical impact is greatest. [ABSTRACT FROM AUTHOR]

Aim Reported recurrence rates after perineal rectosigmoidectomy ( Altemeier's procedure) in patients with full-thickness rectal prolapse vary from 0% to 60%. The object of this study was to analyse risk factors for recurrence after this procedure. Method From May 2004 to December 2012, 63 consecutive patients suffering from full-thickness rectal prolapse undergoing perineal rectosigmoidectomy were included. Of these 46 were female and the median age of the whole group was 79 (30-90) years. The median follow-up was 53 (3-99) months. Patient characteristics and operative parameters were compared between patients with and without recurrence. Results One patient died and another patient needed re-operation. Eight full-thickness recurrences occurred in eight patients after a median of 18 (6-48) months. Stapled compared with handsewn anastomosis (hazard ratio 7.96, 95% confidence interval 1.90-33.47; P = 0.001) and shorter specimen length (hazard ratio 4.06, 95% confidence interval 0.97-16.99; P = 0.03) increased the risk of recurrence in Cox regression analysis. Conclusion The operative technique including stapled anastomosis and length of the resected specimen seems to be associated with a high recurrence rate after perineal rectosigmoidectomy. [ABSTRACT FROM AUTHOR]

This study investigated the impact of laparoscopic rectal cancer resection for patients with high operative risk, which was defined as American Society of Anesthesiology (ASA) grades III and IV. This study was conducted at a single center on patients undergoing rectal resection from 2006 to 2010. After screening by ASA grade III or IV, 248 patients who met the inclusion criteria were identified, involving 104 open and 144 laparoscopic rectal resections. The distribution of the Charlson Comorbidity Index was similar between the two groups. Compared with open rectal resection, laparoscopic resection had a significantly lower total complication rate ( P<.0001), lower pain rate ( P=.0002), and lower blood loss ( P<.0001). It is notable that the two groups of patients had no significant difference in cardiac and pulmonary complication rates. Thus, these data showed that the laparoscopic group for rectal cancer could provide short-term outcomes similar to those of their open resection counterparts with high operative risk. The 5-year actuarial survival rates were 0.8361 and 0.8119 in the laparoscopic and open groups for stage I/II (difference not significant), as was the 5-year overall survival rate in stage III/IV ( P=.0548). In patients with preoperative cardiovascular or pulmonary disease, the 5-year survival curves were significantly different ( P=.0165 and P=.0210), respectively. The cost per patient did not differ between the two procedures. The results of this analysis demonstrate the potential advantages of laparoscopic rectal cancer resection for high-risk patients, although a randomized controlled trial should be conducted to confirm the findings of the present study. [ABSTRACT FROM AUTHOR]

Although Renshaw cells (RCs) were discovered over half a century ago, their precise role in recurrent inhibition and ability to modulate motoneuron excitability have yet to be established. Indirect measurements of recurrent inhibition have suggested only a weak modulatory effect but are limited by the lack of observed motoneuron responses to inputs from single RCs. Here we present dual recordings between connected RC-motoneuron pairs, performed on mouse spinal cord. Motoneuron responses demonstrated that Renshaw synapses elicit large inhibitory conductances and show short-term potentiation. Anatomical reconstruction, combined with a novel method of quantal analysis, showed that the strong inhibitory input from RCs results from the large number of synaptic contacts that they make onto individual motoneurons. We used the NEURON simulation environment to construct realistic electrotonic models, which showed that inhibitory conductances from Renshaw inputs exert considerable shunting effects in motoneurons and reduce the frequency of spikes generated by excitatory inputs. This was confirmed experimentally by showing that excitation of a single RC or selective activation of the recurrent inhibitory pathway to generate equivalent inhibitory conductances both suppress motoneuron firing. We conclude that recurrent inhibition is remarkably effective, in that a single action potential from one RC is sufficient to silence a motoneuron. Although our results may differ from previous indirect observations, they underline a need for a reevaluation of the role that RCs perform in one of the first neuronal circuits to be discovered. [ABSTRACT FROM AUTHOR]

It is widely recognized that propagation of electrophysiological signals between the soma and dendrites of neurons differs depending on direction, i.e. it is asymmetric. How this asymmetry influences the activation of voltage-gated dendritic channels, and consequent neuronal behavior, remains unclear. Based on the analysis of asymmetry in several types of motoneurons, we extended our previous methodology for reducing a fully reconstructed motoneuron model to a two-compartment representation that preserved asymmetric signal propagation. The reduced models accurately replicated the dendritic excitability and the dynamics of the anatomical model involving a persistent inward current (PIC) dispersed over the dendrites. The relationship between asymmetric signal propagation and dendritic excitability was investigated using the reduced models while varying the asymmetry in signal propagation between the soma and the dendrite with PIC density constant. We found that increases in signal attenuation from soma to dendrites increased the activation threshold of a PIC (hypo-excitability), whereas increases in signal attenuation from dendrites to soma decreased the activation threshold of a PIC (hyper-excitability). These effects were so strong that reversing the asymmetry in the soma-to-dendrite vs. dendrite-to-soma attenuation, reversed the correlation between PIC threshold and distance of this current source from the soma. We propose the tight relation of the asymmetric signal propagation to the input resistance in the dendrites as a mechanism underlying the influence of the asymmetric signal propagation on the dendritic excitability. All these results emphasize the importance of maintaining the physiological asymmetry in dendritic signaling not only for normal function of the cells but also for biophysically realistic simulations of dendritic excitability. [ABSTRACT FROM AUTHOR]

Background: Postoperative ileus remains a significant clinical and economic burden to the health care system. Over the last decade, several advances in both medical and surgical therapies have been made to reduce the incidence and severity of postoperative ileus. Despite these advances, though, the incidence of ileus remains high. This narrative review focuses on interventions aimed to prevent and treat postoperative ileus while presenting a step-by-step process for implementation of an evidenced-based strategy. Methods: A literature search was performed using Medline/PubMed, and articles related to postoperative ileus were identified. The bibliographies of all retrieved articles were reviewed to obtain additional articles of relevance. Results: There are many factors that can influence gastrointestinal recovery that can be categorized as management-, drug-, or surgery-related. While several strategies exist to improve gastrointestinal recovery, few have been shown to reduce length of hospital stay. These strategies are described here, along with a structured approach organized by preoperative, intraoperative, and postoperative considerations. Conclusions: Postoperative ileus is associated with a significant clinical and economic burden to the health care system. Strategies such as the development of a multidisciplinary team and the creation of a multimodal protocol are encouraged with continuous quality assurance to assess outcomes at the local level. [ABSTRACT FROM AUTHOR]

The hypoxic response is mediated by two transcription factors, hypoxia-inducible factor (HIF)-1α and HIF-2α. These highly homologous transcription factors are induced in hypoxic foci and regulate cell metabolism, angiogenesis, cell proliferation, and cell survival. HIF-1α and HIF-2α are activated early in cancer progression and are important in several aspects of tumor biology. HIF-1α and HIF-2α have overlapping and distinct functions. In the intestine, activation of HIF-2α increases inflammation and colon carcinogenesis in mouse models. Interestingly, in ischemic and inflammatory diseases of the intestine, activation of HIF-1α is beneficial and can reduce intestinal inflammation. HIF-1α is a critical transcription factor regulating epithelial barrier function following inflammation. The beneficial value of pharmacological agents that chronically activate HIF-1α is decreased due to the tumorigenic potential of HIFs. The present study tested the hypothesis that chronic activation of HIF-1α may enhance colon tumorigenesis. Two models of colon cancer were assessed, a sporadic and a colitis-associated colon cancer model. Activation of HIF-1α in intestinal epithelial cells does not increase carcinogenesis or progression of colon cancer. Together, the data provide proof of principle that pharmacological activation of HIF-1α could be a safe therapeutic strategy for inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Background Colorectal cancer is among the leading causes of cancer and cancer-related mortality in the United States. The incidence and mortality associated with CRC can be reduced with preventive screening. Inadequate bowel preparation has been associated with missed adenomas and the need for repeat colonoscopies. Methods Separate claims source databases were analyzed to determine the costs associated with colonoscopy in the commercial and Medicare populations. Observed repeat rates for colonoscopy within 4 years of initial screening were also examined. Results Among the 6 most commonly used billing codes, the average allowed cost for an episode of colonoscopy in 2010 was $2,146 in the commercial population and $1,071 in the Medicare population, with average cost sharing of $334 and $275, respectively. The portion of colonoscopies associated with a biopsy or polyp removal exceeded 50% in the commercial and Medicare populations. Approximately 57% % of colonoscopies in the commercial population were associated with claims for a prescription bowel preparation product within 30 days prior to the procedure. Three branded and three generic bowel cleansing products accounted for approximately 75% of the total number of prescription claims for colonoscopy. Given literature reports that up to 25% of patients receive inadequate bowel preparation, the rate of repeat colonoscopy within 4 years of initial screening was lower than expected among patients who were not coded with common clinical reasons for early repeat: benign neoplasm, lesion, or polyp removed at initial screening colonoscopy. Conclusions The reported rates of inadequate bowel preparation are 15% to 25%, but the rates of repeat colonoscopy found in our analysis are much lower; this is a risk concern considering the reported, significant miss rate of adenomas secondary to inadequate bowel preparation. [ABSTRACT FROM AUTHOR]

Accurate quality measurement that allows for and results in improvement is essential to colon and rectal surgery. Currently, no consensus exists as to which variables are most important in measuring outcomes. Debate continues concerning the "best" variables to measure from a structural, process, and outcomes standpoint. Although American College of Surgeons National Surgical Quality Improvement Program provides an opportunity for outcomes measurement in general and vascular surgery, there is no specific quality improvement tool available for colon and rectal surgery. However, there is growing literature testing the validity of candidate variables to be used in such a data collection system. This article evaluates the current objective assessment measurements used for quality improvement in colon and rectal surgery. [ABSTRACT FROM AUTHOR]

Summary: Background: Complete rectal prolapse is more common in the elderly, with considerable effects on patient’s quality of life. Whenever co-existing morbidities render abdominal procedures impossible, perineal rectosigmoidectomy combined with levatorplasty as described by Altemeier is a viable option. However, performing a coloanal anastomosis without fecal diversion bears the risk of life-threatening (anastomotic) complications. We present our experience performing Altemeier’s procedure (AP) in a series of old and frail patients, and a review of literature. Methods: Demographic, perioperative and postoperative data of patients undergoing AP for complete rectal prolapse between January 2008 and April 2013 were analysed retrospectively. In addition, we reviewed the literature in regard to anastomotic complications, morbidity and mortality after AP. Results: In total, 16 (15 female) patients with a median age of 84.6 (range: 75–94) years underwent AP within the study period. American Society of Anaesthesiologists (ASA) score was I, II and III in four, six and six cases, respectively. General ( n = 12), spinal ( n = 3) or local ( n = 1) anaesthesia was applied according to anaesthetist’s decision. No anastomotic leak was seen, and no patient died perioperatively. Minor complications were observed in three patients (18.8 %). According to the reviewed literature, overall anastomotic leak rate, morbidity and mortality after AP have been 2.7, 12.1 and 0.5 %, respectively (median values). Conclusions: AP proved to be a safe repair for complete rectal prolapse in the elderly. [ABSTRACT FROM AUTHOR]