Intra-abdominal desmoid tumors in familial adenomatous polyposis: How much do clinical and surgical variables interfere with their development?

Objective: Familial Adenomatous Polyposis is a complex hereditary disease that exposes the carrier to a great risk of Colorectal Cancer (CRC). After prophylactic surgery, intra-abdominal desmoid tumors are known to be one the most important cause of death. Therefore, recognition of increased-risk patients and modification of operative strategy may be crucial. Aim: The objective of this study was to estimate the desmoid tumor risk in relation to various surgical and clinical variables. Methods: Patients who had undergone polyposis since 1958 were included in the study. After exclusion criteria were met, those who had developed desmoid tumors were selected to undergo further evaluation. Results: The study revealed that the risk of developing desmoid tumors was associated with various factors such as sex ratio, colectomy, and reoperations. On the other hand, the type of surgery, family history, and surgical approach did not affect the risk of developing desmoid tumors. The data collected from 146 polyposis patients revealed that 16% had desmoid polyps. The sex ratio was 7:1, and the median age at colectomy was 28.6 years. Family history, multiple abdominal operations, and reoperations were some of the characteristics that were common in desmoid patients. Conclusion: Recognition of clinical (female sex) and surgical (timing of surgery and previous reoperations) data as unfavorable variables associated with greater risk may be useful during the decision-making process

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Evaluation of variables associated to the reduction in the number of lymph nodes in rectal cancer specimen after neoadjuvant chemoradiotherapy

Introdução: De acordo com a União Internacional Contra o Câncer um mínimo de 12 linfonodos (LN) deve ser obtido no espécime cirúrgico para o estadiamento do câncer colorretal (CCR). Estudos recentes reportaram que o uso da quimioirradioterapia neoadjuvante (QRN) pode resultar na não obtenção do número mínimo de LN na peça em 30-52% dos pacientes. Objetivo: Identificar os fatores relacionados à redução do número de LN ressecados em pacientes submetidos à neoadjuvancia e a excisão total do mesorreto. Pacientes e métodos: De janeiro de 2012 a março de 2013, 160 pacientes com câncer de reto foram submetidos à QRN (5-FU e 5040 Gys) seguida de excisão total de mesorreto com ligadura dos vasos mesentéricos inferiores nas suas raízes. Foram incluídos pacientes com estadiamento T3, T4 e/ou N+ que distavam até 10cm da borda anal e T2N0 que distavam até 7 cm da borda anal. Foram excluídos pacientes cujo tratamento com quimiorradioterapia neoadjuvante foi incompleto, ou que tiveram atrasos significativos para re-estadiamento e/ou realização da cirurgia. Todos foram estadiados através de toque retal, colonoscopia, TC de tórax e de abdome, e RM de pelve e igualmente re-estadiados 8 semanas após o término da neoadjuvância, operados e submetidos a excisão total do mesorreto. Os pacientes foram divididos em 2 grupos: A) menos de 12 LN, e B) 12 ou mais LN. Foram estudadas as possíveis variáveis relacionadas ao número de LN obtidos: sexo, idade, presença de LN acometidos, tamanho do tumor, localização da altura do tumor no reto, comprimento da peça, preservação esfincteriana, via de acesso, estadiamento inicial, grau de resposta tumoral e resposta patológica à quimiorrradioterapia neoadjuvante. Resultados: Noventa e cinco pacientes (60 masculinos) preencheram os critérios de inclusão e conseguiram ser tratados, re-estadiados e operados dentro das datas pré-estabelecidas. A média de LN ressecados foi 23,2 (3-67). Resposta patológica completa foi obtida em 18 pacientes (19%). Um mínimo de 12 LN foram obtidos em 81 pacientes (85%). Dentre os 14 doentes que obtiveram menos de 12 LN, 7 (50%) eram respostas patológicas completas. De todas as variáveis estudadas apenas resposta patológica completa na peça foi fator associado à não obtenção do número mínimo de 12 LN (p=0,002). Conclusões: Em pacientes submetidos à QRN e ETM, a resposta patológica completa foi o único fator associado a não obtenção de um mínimo de 12 de LN na peçaINTRODUCTION: According to the International Union against Cancer a minimum of 12 lymph nodes (LN) must be obtained from the surgical specimen for staging colorrectal cancer. However, recent studies reported that neoadjuvant chemoradiation may result in failure to obtain a minimum number of LN in 30-52 % of patients. OBJECTIVE: To identify factors associated with decreased number of LN resected in patients undergoing neoadjuvant therapy followed by total mesorectal excision (TEM). METHODS: From January/2012 to March/2013, 160 patients with rectal cancer underwent CRT (5 - FU and Gys 5040) followed by TEM and ligation of inferior mesenteric vessels in the roots. Patients with stage T3, T4 and/or N + within 10cm from anal verge were included. Patients with T2N0 located within 7cm from the anal verge were also included. Patients who were not able to complete the chemoradiation treatment or who presented significant delay on restaging and/or surgery were excluded from analyses. All patients were staged by digital rectal examination, colonoscopy, CT of the abdomen and chest, and MRI of the pelvis. Patients were re-staged 8 weeks after completion of neoadjuvant therapy, and submitted to total mesorectal excision right after that. Patients were stratified according to LN retrieval in two groups: A) less than 12 LN, B) 12 or more LN. Possible factors associated with the decreased number of LN were evaluated: gender, age, presence of metastatic LN, tumor size, tumor location, and length of the specimen, sphincter preservation, surgical access, initial staging, tumor regression grade and pathological response to chemoradiation. RESULTS: Ninety-five patients (60 male) met the inclusion criteria and were able to be treated, re-staged and operated within the pre-established intervals. The mean number of resected LN was 23.2 (3-67). Pathological complete response was achieved in 18 patients (19%). A minimum of 12 LN were obtained from 81 patients (85%). Half of the 14 patients with less than 12 LN presented pathologic complete response. Of all the variables studied only pathologic complete response was associated with less than 12 LN yield (p = 0.002). CONCLUSIONS: In patients submitted to chemoradiation followed by TME the complete pathological response was the only factor associated with failure to obtain a minimum of 12 LN in the specime

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

sem informaçãoIn addition to the presence of neoplasia in the colon and rectum, patients with familial adenomatous polyposis (FAP) may develop numerous polyps and carcinoma within the upper gastrointestinal tract. Methods: The aim of the present paper was to review the85877884sem informaçãosem informaçãosem informaçãoThe study was approved by the Gastroenterology Department Ethics Committee in Hospital das Clínicas (MemoCAPPesq 049/17) and written informed consent was obtained from all patient

Where Brain, Body and World Collide

The production cross section of electrons from semileptonic decays of beauty hadrons was measured at mid-rapidity (|y| < 0.8) in the transverse momentum range 1 < pt < 8 Gev/c with the ALICE experiment at the CERN LHC in pp collisions at a center of mass energy sqrt{s} = 7 TeV using an integrated luminosity of 2.2 nb^{-1}. Electrons from beauty hadron decays were selected based on the displacement of the decay vertex from the collision vertex. A perturbative QCD calculation agrees with the measurement within uncertainties. The data were extrapolated to the full phase space to determine the total cross section for the production of beauty quark-antiquark pairs

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk