Cordyceps spp.: A Review on Its Immune-Stimulatory and Other Biological Potentials

In recent decades, interest in the Cordyceps genus has amplified due to its immunostimulatory potential. Cordyceps species, its extracts, and bioactive constituents have been related with cytokine production such as interleukin (IL)-1ß, IL-2, IL-6, IL-8, IL-10, IL-12, and tumor necrosis factor (TNF)-a, phagocytosis stimulation of immune cells, nitric oxide production by increasing inducible nitric oxide synthase activity, and stimulation of inflammatory response via mitogen-activated protein kinase pathway. Other pharmacological activities like antioxidant, anti-cancer, antihyperlipidemic, anti-diabetic, anti-fatigue, anti-aging, hypocholesterolemic, hypotensive, vasorelaxation, anti-depressant, aphrodisiac, and kidney protection, has been reported in pre-clinical studies. These biological activities are correlated with the bioactive compounds present in Cordyceps including nucleosides, sterols, flavonoids, cyclic peptides, phenolic, bioxanthracenes, polyketides, and alkaloids, being the cyclic peptides compounds the most studied. An organized review of the existing literature was executed by surveying several databanks like PubMed, Scopus, etc. using keywords like Cordyceps, cordycepin, immune system, immunostimulation, immunomodulatory, pharmacology, anti-cancer, anti-viral, clinical trials, ethnomedicine, pharmacology, phytochemical analysis, and different species names. This review collects and analyzes state-of-the-art about the properties of Cordyceps species along with ethnopharmacological properties, application in food, chemical compounds, extraction of bioactive compounds, and various pharmacological properties with a special focus on the stimulatory properties of immunity.This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2020R1G1A1004667), Republic of Korea

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Images in Pathology - Squamous Cell Carcinoma of breast

A 47-year-old postmenopausal woman presented with the history of a lump in the upper outer quadrant of left peast for which a lumpectomy had been done. She did not have pain, nipple discharge or skin changes prior to the lumpectomy. She did not have a family history of peast cancer. The histopathology of the lump was an invasive squamous carcinoma of the peast. Examination of her oral cavity and pelvic examination was normal. Her chest radiograph was normal. She did not have any other site of squamous carcinoma. She was subsequently subjected to a mastectomy with axillary clearance. Histopathological examination after exhaustive sampling revealed a moderately differentiated keratinising type of pure squamous carcinoma (Figure 1). There was no associated in-situ carcinoma and there were no features of glandular differentiation. The axillary lymph nodes did not harbour metastases. The surrounding peast tissue had areas of inflammatory mastitis and ductal hyperplasia. There was no squamous metaplasia at the interface between the tumour and the normal peast parenchyma. The skin and the nipple-areola complex were not involved

Spot the Diagnosis

A 73-year-old lady was admitted with abdominal pain, vomiting and significant weight loss. Her initial biochemical profiles were normal. Plain radiographs of the chest and abdomen were normal. An abdominal ultrasound scan revealed stones in the gallbladder as well as in the common bile duct. She underwent endoscopic retrograde cholangiopancreaticography (ERCP) with removal of duct stones. Three days later, she developed severe abdominal pain associated with abdominal distension and obstipation. The plain radiograph done at this stage is depicted as Figure 1. What is the Diagnosis

The Red Rectum (Carpet villous adenoma of the rectum)

Carpeted villous adenomas of rectum may be extensive and not suitable for transanal excision or Endoscopic mucosal resection. We present a case of such lesion extending from anorectal junction to rectosigmoid region. After biopsy and staging, this was managed by a sphincter saving procedure, i.e. a combination of transabdominal total mesorectal excision and transanal intersphincteric dissection, with acceptable functional outcome with 8 years of follow up

Laparoscopic Right Hemicolectomy for Ileocolic Intussusception Secondary to Caecal Neoplasm

Intussusception in adults is a rare cause of abdominal pain. Unlike its paediatric counterpart, intussusception in adults is associated with obvious pathology. We describe a case of ileocolic intussusception extending to the splenic flexure. We were able to reduce the intussusception partially and pedicle was stapled carefully. The specimen was delivered through a small incision and right hemicolectomy was performed adhering to oncological principles. We recommend laparoscopic-assisted surgery is considered for adult intussusceptions