Analysis of micrometastatic lymphogenic propagation of colorectal carcinoma metastases

Cilj: Ispitati učestalost i distribuciju mikrometastatskih limfnih nodusa hepatičnog sliva i prognostički značaj rutinske regionalne limfadenektomije s posebnim osvrtom na pojavu recidiva maligne bolesti. Metod: Ukupno 50 bolesnika sa metastatskom bolesti jetre podvrgnuto je resekciji jetre sa rutinskom limfadenektomijom. Rezultati: Pozitivni limfni nodusi hepatičnog sliva prisutni su kod 14 bolesnika (28%) bolesnika. Standardna H&E patohistološka analiza verifikuje 6 bolesnika (12%) sa pozitivnim limfnim nodusima hepatičnog sliva. Imunohistohemijska analiza dodatno verifikuje još 8 bolesnika (16%) pozitivnih limfnih nodusa hepatičnog sliva preostalih limfnih nodusa. Limfni nodusi duž zajedničke hepatične arterije (grupa 8a i 8p) najčešće sadrže mikrometastaze kolorektalnog karcinoma (53,84%, i 19,23%). MSCT trbuha je od koristi za preoperativnu dijagnostiku limfadenopatije (18,42%). Slobodni interval do pojeve metastaza je u proseku 15 meseci. Recidiv maligne bolesti javio se kod 38,0% bolesnika. Volumen metastatske bolesti jetre značajan faktor recidiva maligne bolesti (p<0,05) Zaključak: Rutinska limfadenektomija hepatičnog sliva je bezbedna i preporučljiva procedura u prevenciji širenja kolorektalne metastatske bolesti, koja neznatno povećava vreme trajanja operacije u celini (prosečno 32 minuta) i ne povećava učestalost postoperativnih komplikacija.Objective: To investigate the frequency and distribution of micrometastatic lymph nodus of the hepatic basin and the prognostic significance of routine regional lymphadenectomy with particular reference to the occurrence of relapse of malignant disease. Methods: A total of 50 patients with metastatic liver disease underwent resection of the liver with routine lymphadenectomy. Results: Positive lymph nodes of the hepatic basin are present in 14 patients (28%) of patients. The standard H & E pathohistological analysis verifies 6 patients (12%) with positive lymph nodes of the hepatic basin. Immunohistochemical analysis further verified another 8 patients (16%) of positive lymph nodes of the hepatic basin of the remaining lymph nodes. Lymph nodes along the common hepatic artery (group 8a and 8p) most commonly contain colorectal carcinoma micrometastases (53.84%, and 19.23%). MDCT abdomen is beneficial for preoperative diagnosis of lymphadenopathy (18.42%). The free interval to metastasis rates is on average 15 months. The recurrence of malignancy occurred in 38.0% of patients. The volume of metastatic liver disease is an important factor of relapse of malignant disease (p <0.05). Conclusion: Routine lymphadenectomy of the hepatic basin is a safe and recommended procedure in the prevention of the spread of colorectal metastatic disease, which slightly increases the duration of the operation as a whole (an average of 32 minutes) and does not increase the incidence of postoperative complications

Impact of genetics on neoadjuvant therapy with complete pathological response in metastatic colorectal cancer: case report and review of the literature

Treatment of colorectal metastatic cancer is still challenging, despite recent improvements in chemotherapy. A genetic cancer profile, such as the KRAS (Kirsten rat sarcoma) gene status, plays a key role in individualized tailored therapy. Molecular targeted therapy added to neoadjuvant chemotherapy can achieve a better pathological response and prolong survival. Pathological complete response of colorectal cancer stage N is rare. A 47-year-old female patient presented with rectal adenocarcinoma and three liver metastases (cT3d/4, N2, M1). After seven cycles of Bevacizumab and CAPOX in neoadjuvant setting, we noted more than 70.0% regression of metastases and complete regression of the primary tumor. We performed low anterior resection of rectum and synchronous subsegmental resection of S3, because the other two lesions were not detectable. Pathology revealed complete response of the primary and also secondary tumors. After 8 months, diagnostic tests did not show any sign of recurrence and the remaining liver lesions disappeared. Colorectal cancer is a heterogeneous disease and it is necessary to identify patients who are at-risk of recurrence and suitable for neoadjuvant therapy. Genetic biomarkers play an important role in metastatic colorectal cancer treatment. Because of the mutated KRAS gene, Bevacizumab was added to cytotoxic therapy achieving a complete pathological response of primary tumor and metastasis. This case is unique because all reported cases with similar results, described staged surgery and one of reverse staged surgery, but with similar results. This neoadjuvant therapy has extra ordinary results for colorectal cancer stage IV and can help disease-free and long-term survival

A density functional theory based analysis of photoinduced electron transfer in a triazacryptand based K+ sensor

The electronic structure and photoinduced electron transfer processes in a K+ fluorescent sensor that comprises a 4-amino-naphthalimide derived fluorophore with a triazacryptand lig- and is investigated using density functional theory (DFT) and time-dependent density functional theory (TDDFT) in order to rationalise the function of the sensor. The absorption and emission energies of the intense electronic excitation localised on the fluorophore are accurately described using a ∆SCF Kohn-Sham DFT approach, which gives excitation energies closer to experiment than TDDFT. Analysis of the molecular orbital diagram arising from DFT calculations for the isolated molecule or with implicit solvent cannot account for the function of the sensor and it is necessary to consider the relative energies of the electronic states formed from the local excitation on the fluorophore and the lowest fluorophore→chelator charge transfer state. The inclusion of solvent in these calculations is critical since the strong interaction of the charge transfer state with the solvent lowers it energy below the local fluorophore excited state making a reductive photoinduced electron transfer possible in the absence of K+, while no such process is possible when the sensor is bound to K+. The rate of electron transfer is quantified using Marcus theory, which gives a rate of electron transfer of k_ET=5.98 x 10^6 s−1

On the Incompressible Limit of a Strongly Stratified Heat Conducting Fluid

Funder: Institute of Mathematics of the Czech Academy of SciencesAbstractA compressible, viscous and heat conducting fluid is confined between two parallel plates maintained at a constant temperature and subject to a strong stratification due to the gravitational force. We consider the asymptotic limit, where the Mach number and the Froude number are of the same order proportional to a small parameter. We show the limit problem can be identified with Majda’s model of layered “stack-of-pancake” flow.</jats:p