The tumor microenvironment of colorectal cancer: stromal TLR-4 expression as a potential prognostic marker

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer can be efficiently treated when found at early stages, thus the search for novel markers is of paramount importance. Since inflammation is associated with cancer progression and angiogenesis, we investigated expression of cytokines like IL-6 and other mediators that play a key role in the innate immune system, in particular toll like receptor 4 (TLR4), in the microenvironment of lesions from different stages of colon disease progression, from ulcerative colitis to adenoma and adenocarcinoma to find useful markers.</p> <p>Methods</p> <p>The presence of inflammatory cells and expression of key cytokines involved in the inflammation process were quantified by immunohistochemistry in specific tissue compartments (epithelial, stromal, endothelial) by immunohistochemistry. A murine azoxymethane/dextran sulfate model in which Tir8, a negative regulator of the inflammatory response, was ablated was used to confirm the clinical observations. 116 Archival tissue samples from patients with different stages of colorectal disease: 13 cases of ulcerative colitis (UC), 34 tubular or tubulo-villous adenomas (AD), and 53 infiltrating adenocarcinomas. 16 specimens of healthy mucosa surgically removed with the cancerous tissue were used as a control.</p> <p>Results</p> <p>The differences between healthy tissues and the diverse lesions was characterized by a marked inflammatory-angiogenic reaction, with significantly (P < 0.05) higher numbers of CD68, CD15, and CD31 expressing cells in all diseased tissues that correlated with increasing grade of malignancy. We noted down-regulation of a potential modulator molecule, Hepatocyte Growth Factor, in all diseased tissues (P < 0.05). TLR-4 and IL6 expression in the tumor microenvironment were associated with adenocarcinoma in human samples and in the murine model. We found that adenocarcinoma patients (pT1-4) with higher TLR-4 expression in stromal compartment had a significantly increased risk in disease progression. In those patients with a diagnosis of pT3 (33 cases) colon cancer, those with very high levels of TLR-4 in the tumor stroma relapsed significantly earlier than those with lower expression levels.</p> <p>Conclusions</p> <p>These data suggest that high TLR-4 expression in the tumor microenvironment represents a possible marker of disease progression in colon cancer.</p

Notulae to the Italian native vascular flora: 10

In this contribution, new data concerning the distribution of native vascular flora in Italy are presented. It includes new records, confirmations, exclusions, and status changes to the Italian administrative regions for taxa in the genera Artemisia, Chaetonychia, Cirsium, Cynanchum, Genista, Hieracium, Iberis, Melica, Misopates, Myosotis, Thalictrum, Trifolium, Utricularia, Veronica, and Vicia. Nomenclatural and distribution updates, published elsewhere, and corrigenda are provided as supplementary material

Notulae to the Italian flora of algae, bryophytes, fungi and lichens: 7

In this contribution, new data concerning algae, bryophytes, fungi, and lichens of the Italian flora are presented. It includes new records and confirmations for the algae genus Chara, the bryophyte genera Cephalozia, Conardia, Conocephalum, Didymodon, Sphagnum, Tetraplodon, and Tortula, the fungal genera Endophyllum, Gymnosporangium, Microbotryum, Phragmidium, and Pluteus, and the lichen genera Candelariella, Cladonia, Flavoplaca, Lichenothelia, Peltigera, Placolecis, Rinodina, Scytinium, and Solenopsora

At the intersection of cultural and natural heritage: Distribution and conservation of the type localities of Italian endemic vascular plants

We conducted a GIS spatial analysis with the aim of providing the first quantitative large-scale overview of the distribution patterns of 1536 type localities (loci classici) of 1216 Italian endemic vascular plants and their relationship with a set of descriptive variables. Whereas some variables were used to model the presence-absence distribution patterns of the type localities for the whole set of endemics as well as for the subset of narrow endemics, others (e.g., presence inside or outside protected areas and Italian Important Plant Areas) were considered with the purpose of assessing potential assets or risks for conservation. The largest number of type localities was found within the Mediterranean biogeographic region (1134), followed by the Alpine region (306) and Continental region (96). A total of 670 locations are located on islands, whereas 866 are located on the Italian mainland (139 and 124 in the case of narrow endemics, respectively). A large number of type localities are located in mountainous areas and along the coastline, which can be seen as a potential risk for conservation. On the contrary, we detected a positive correlation with the distance from roads, which might be considered to be an asset. Importantly, 1030 type localities fall inside protected areas, whereas 506 localities fall outside protected areas, with 259 of these unprotected localities on islands. We propose considering the results of the analysis of the distribution of type localities of Italian endemics to be a strategic tool for conservation planning and resource management. Application of plant micro-reserves and integration of diverse legislation tools are suggested to strengthen efforts and increase conservation success

Notulae to the Italian native vascular flora: 8

In this contribution, new data concerning the distribution of native vascular flora in Italy are presented. It includes new records, confirmations, exclusions, and status changes to the Italian administrative regions for taxa in the genera Ajuga, Chamaemelum, Clematis, Convolvulus, Cytisus, Deschampsia, Eleocharis, Epipactis, Euphorbia, Groenlandia, Hedera, Hieracium, Hydrocharis, Jacobaea, Juncus, Klasea, Lagurus, Leersia, Linum, Nerium, Onopordum, Persicaria, Phlomis, Polypogon, Potamogeton, Securigera, Sedum, Soleirolia, Stachys, Umbilicus, Valerianella, and Vinca. Nomenclatural and distribution updates, published elsewhere, and corrigenda are provided as Suppl. material 1

Notulae to the Italian native vascular flora: 1

In this contribution, new data concerning the Italian distribution of native vascular flora are presented. It includes new records, exclusions, and confirmations pertaining to the Italian administrative regions for taxa in the genera Arundo, Bromopsis, Cistus, Crocus, Festuca, Galeopsis, Genista, Lamium, Leucanthemum, Nerium, Orobanche, Peucedanum, Pilosella, Polycnemum, Stipa and Viola

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6&nbsp;years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P &lt; 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100&nbsp;years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries