Defining Early-Onset Colon and Rectal Cancers

Background: Colorectal cancer (CRC) incidence is rising in the young, yet the age of those affected is not clearly defined. In this study, we identify such cohorts and define clinicopathological features of early-onset colon and rectal cancers.Methods: The Surveillance, Epidemiology and End Results Program (SEER) database was queried to compare clinicopathological characteristics of colon and rectal cancers diagnosed during 1973–1995 with those diagnosed during 1995–2014.Results: We identified 430,886 patients with colon and rectal cancers. From 1973–1995 to 1995–2014, colon cancer incidence increased in patients aged 20–44 years, while rectal cancer incidence increased in patients aged ≤54 years. The percent change of cancer incidence was greatest for rectal cancer with a 41.5% (95% confidence interval (CI): 37.4–45.8%) increase compared to a 9.8% (CI: 6.2–13.6%) increase in colon cancer. Colon cancer has increased in tumors located in ascending, sigmoid, and rectosigmoid locations. Adenocarcinoma histology has increased in both colon and rectal cancers (P < 0.01), but mucinous and signet ring cell subtypes have not increased (P = 0.13 and 0.08, respectively). Incidence increases were race-specific, with rectal cancer seeing similar rises in white (38.4%, CI: 33.8–43.1%) and black populations (38.0%, CI: 26.2–51.2%), while colon cancer as a whole saw a rise in white (11.5%, CI: 7.2–15.9%) but not black populations (−6.8%, CI: −14.6–1.9%).Conclusions: Our study underscores the existence of key differences between early-onset colon (20–44 years) and rectal cancers (≤54 years) and provides evidence-based inclusion criteria for future investigations. We recommend that future research of CRC in the young should avoid investigating these cases as a single entity

Decreased Lymphangiogenesis Alters Angiogenesis and Dermal Remodeling in Wound Healing

Introduction: Delayed wound healing is a tremendous financial burden on healthcare, and a devastating personal burden for patients facing infections, decreased quality of life, and amputations. Dysfunctional lymphatics have been observed in delayed wound healing: in diabetes, metabolic syndrome, and lymphedema. Vascular endothelial growth factor receptor 3 (VEGFR3) is important for adult lymphangiogenesis. The effect of dysfunctional lymphangiogenesis on angiogenesis in wound healing is unknown. Methods: We used an excisional wound model of punch biopsies to create full thickness wounds on the dorsal skin of mice. We evaluated wound healing in a mouse model with no peripheral lymph nodes and decreased lymphatics due to knockout of lymphotoxin-a (LTa KO). Additionally, inducible conditional knock-out mouse models allowed us to evaluate healing when there is decreased expression of VEGFR3 in lymphatic endothelial cells, under the control of a Cdh5CreERT2 recombinase and a Prox1CreERT2 recombinase (VEGFR3 cKO). Immunohistochemistry revealed changes in tissue architecture with identification of variations in cell populations, the latter confirmed by flow cytometry. We also isolated endothelial cells from wound beds and characterized changes in gene expression. Results: LTa KO and VEGFR3 cKO mice displayed a decrease in lymphatic networks in uninjured and injured skin. Wound beds of VEGFR3 cKO mice exhibited increased hyperemia and angiogenesis. There was decreased apoptosis of blood endothelial cells in VEGFR3 cKO mice. Re-epithelialization of the wounds in VEGFR3 cKO mice, and migration of fibroblasts and immune cells were similar to littermate controls. However, wound beds of VEGFR3 cKO mice also have longterm changes, including defects in dermal remodeling. Conclusions: Increased angiogenesis in mice lacking proper lymphangiogenesis during skin repair highlights the intertwined nature of these vascular systems. One contributing mechanism was decreased apoptosis of blood endothelial cells in the wound bed. There may also be a role for increased chemotaxis as part of this hyperangiogenesis phenotype. Future work will explore how these types of endothelial cells interact during dermal wound healing and how lymphatics influence dermal remodeling mechanisms

Effectiveness and long-term durability of autologous fat transplant for HIV-related face lipoatrophy.

Autologous Fat Transplat (AFT) according to Coleman tachnique is an effective option for surgical treatment of HIV-related facial lipoatrophy; nevertheless, both patients and surgeons are often concerned about durability of this procedure in the fear of early fat reabsorption in the recipient area. The purpose of this study was to evaluate effectiveness and log-term durability of AFT with a 104 - week follow up in patients who were treated with single surgical procedure and in those who needed lipofilling reintervention or aesthetic correction with subcutaneous filler

The Green Print: Advancement of Environmental Sustainability in Healthcare

Healthcare is a major emitter of environmental pollutants that adversely affect health. Within the healthcare community, awareness of these effects is low, and recognition of the duty to address them is only beginning to gain traction. Healthcare sustainability science explores dimensions of resource consumption and environmental emissions associated with healthcare activities. This emerging field provides tools and metrics to quantify the unintended consequences of healthcare delivery and evaluate effective approaches that improve patient safety while protecting public health. This narrative review describes the scope of healthcare sustainability research, identifies knowledge gaps, introduces a framework for applications of existing research methods and tools to the healthcare context, and establishes research priorities to improve the environmental performance of healthcare services. The framework was developed through review of the current state of healthcare sustainability science and expert consensus by the Working Group for Environmental Sustainability in Clinical Care. Key recommendations include: development of a comprehensive life cycle inventory database for medical devices and drugs; application of standardized sustainability performance metrics at the clinician, hospital/health system, and national levels; revision of infection control standards driving non-evidence-based uptake of single-use disposable devices; call for increased federal research funding; and formation of a Global Commission on the Advancement of Environmental Sustainability in Healthcare. There is an urgent need for research that informs policy and practice to address the public health crisis arising from healthcare pollution. A transformational vision is required to align research priorities to achieve a sustainable healthcare system that advances quality, safety and value