Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Safety of trypan blue 1% and indocyanine green 0.5% in assisting visualization of anterior capsule during phacoemulsification in mature cataract

Purpose: To evaluate the safety of trypan blue 1% and indocyanine green (ICG) 0.5% in assisting visualization of anterior capsule during phacoemulsification in mature cataract. Setting: Department of Ophthalmology, United Christian Hospital, Hong Kong, China. Methods: This prospective randomized clinical trial comprised 46 eyes with mature cataract receiving phacoemulsification and posterior chamber intraocular lens implantation. They were randomized into 3 groups (trypan blue, ICG, and control without stain). Visual acuity, endothelial cell count, corneal clarity, anterior chamber reaction, and intraocular pressure (IOP) were documented before surgery and 1 week, 1 month, and 3 months postoperatively. The absolute phaco time was also recorded. Results: There was no significant difference in absolute phaco time (P =. 17), mean endothelial cell loss (P =. 72 at 1 week, P =. 43 at 1 month, and P =. 60 at 3 months) and no significant correlation between the absolute phaco time and the change in endothelial cell count (P =. 50 at 1 week, P =. 10 at 1 month, and P =. 60 at 3 months) in the 3 groups. None of the patients had postoperative IOP greater than 21 mm Hg. All eyes had clear corneas and a quiet anterior chamber 3 months after surgery. Conclusion: Both trypan blue 1% and ICG 0.5% are safe for assisting visualization of the anterior capsule during phacoemulsification of mature cataract. © 2005 ASCRS and ESCRS.link_to_subscribed_fulltex

Prognostic and diagnostic significance of beta-catenin nuclear immunostaining in colorectal cancer

In the present study, we investigated the prognostic and diagnostic significance of beta-catenin nuclear immunostaining in 60 specimens of normal colorectal tissue; 180 specimens of colorectal polyps, adenomas, and carcinomas; and 40 specimens from patients with the simultaneous occurrence of polyps, adenomas, and carcinomas. Additional specimens from 59 patients with colorectal carcinoma and 14 patients with adenoma who subsequently developed carcinoma were examined for possible survival study. Immunohistochemical staining showed that the occurrence of nuclear beta-catenin correlated with the sequential stages in colorectal carcinogenesis, in which positive staining was observed in 0\% of normal tissues, 8\% of polyps, 92\% of adenomas, and 100\% of carcinomas. High immunohistochemical scores in colorectal carcinoma were significantly associated with lymph node metastasis and poor survival. Adenomas associated with synchronous or metachronous carcinomas showed significantly higher levels of nuclear beta-catenin compared with adenomas without associated carcinomas. Nuclear translocation of beta-catenin was rare or absent in other types of cytokeratin 20 positive adenocarcinomas examined (99 cases). Thus, it was positive in only 7\% of colonic mucinous adenocarcinomas, 3\% of pancreatic adenocarcinomas, 8\% of ovarian mucinous cystadenocarcinomas, and 0\% of gastric adenocarcinomas. However, 100\% of primary and metastatic colorectal adenocarcinomas were positive for nuclear staining for beta-catenin. Thus, nuclear staining for beta-catenin may serve as an additional parameter to help distinguish colorectal adenocarcinomas from adenocarcinomas of other tissue sites. Collectively, the present large-scale study has clearly addressed the clinical significance of beta-catenin nuclear translocation with respect to tumor progression, survival, and differential diagnosis

Presence of filterable and nonfilterable mRNA in the plasma of cancer patients and healthy individuals

Background: As RNA is labile, we investigated whether circulating RNA in human plasma may be present in a particle-associated form. Methods: Blood was collected from 27 healthy individuals and 16 hepatocellular carcinoma (HCC) patients. The plasma from each individual was processed by two means: filtration through filters with different pore sizes (from 5 μm to 0.22 μm) and ultracentrifugation. We assessed plasma RNA content by a real-time quantitative reverse transcription-PCR assay for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) transcripts and plasma DNA by a real-time quantitative PCR assay for the β-globin gene. Results: The plasma GAPDH mRNA concentrations in the healthy individuals were significantly different in every pair of these filter sizes (P 0.05). In HCC patients, filtration with a 0.22 μm filter produced a median 9.3-fold (interquartile range, 6.9- to 311-fold) reduction in GAPDH mRNA concentration in plasma. Plasma GAPDH mRNA concentrations in HCC patients were significantly higher than those in healthy individuals, both with or without filtration (P <0.05 for filtered plasma samples; P <0.005 for unfiltered plasma sampies). Conclusions: A substantial proportion of plasma mRNA species is particle-associated. In HCC patients, both circulating particle- and non-particle-associated plasma RNA are increased. © 2002 American Association for Clinical Chemistry.link_to_subscribed_fulltex

Proteomic comparison of nasopharyngeal cancer cell lines C666-1 and NP69 identifies down-regulation of annexin II and β 2-tubulin for nasopharyngeal carcinoma

Context. - Nasopharyngeal carcinoma (NPC), common in southern China and North Africa, has a complex etiology involving interplay between viral, environmental, and hereditary factors and is almost constantly associated with the Epstein-Barr virus. Since the prognosis of locally advanced and metastatic diseases is poor, increased understanding of the pathogenesis of NPC would be important for discovering novel markers for patients' management. Objectives. - To compare the proteomic expression profile between an Epstein-Barr virus-associated NPC cell line (C666-1) and a normal NP cell line (NP69). The proteins with differential expression were analyzed in 40 undifferentiated NPC paraffin-embedded specimens. Design. - Differentially expressed proteins discovered between the two cell lines were identified by mass spectrometry. After confirmation by immunocytochemical staining, their expression in patient samples was measured using 40 pairs of undifferentiated NPCs together with their adjacent normal epithelia. Results. - Proteomic findings indicated that adenosine triphosphate synthase α chain was up-regulated, whereas annexin II, annexin V, β 2-tubulin, and profilin 1 were down-regulated. After confirming the results in agar-processed cell lines, annexin II and β 2-tubulin expression were found to be lower in tumor cells than in adjacent normal epithelial cells in 100% and 90% of the patients' specimens, respectively. Finally, annexin II down-regulation was positively associated with lymph node metastasis, suggesting that it may be a prognostic factor in NPC. Conclusions. - The results suggest that annexin II and β 2- tubulin down-regulation is important in NPC formation and may represent potential targets for further investigations.link_to_subscribed_fulltex

Fatores associados com a retenção e o ganho de peso pós-parto: uma revisão sistemática Risk factors associated with postpartum weight gain and retention: a systematic review

INTRODUÇÃO: A retenção de peso após o parto é um dos determinantes da obesidade em mulheres. Seu desenvolvimento está relacionado com o ganho de peso gestacional, paridade, idade, situação marital, consumo energético, atividade física e lactação, mas as associações encontradas têm se mostrado inconclusivas e contraditórias. Objetivos: Avaliar estudos que identificaram fatores preditores da retenção e ganho de peso após o parto. MATERIAL E MÉTODOS: Foi realizada uma revisão de literatura na Base de Dados LILACS e MEDLINE, referente aos anos de 1993 a 2003. RESULTADOS: Vinte e oito artigos foram identificados, sendo 23 estudos de coorte, quatro estudos transversais e um estudo caso-controle. A maioria dos estudos foi realizada nos EUA e o tempo de acompanhamento após o parto ocorreu principalmente entre seis semanas e 24 meses. Cerca de 25% dos estudos apresentaram perdas superiores a 30%, 61% incluíram adolescentes na amostra e 75% não aferiram o peso pré-gestacional. Sete estudos foram considerados de melhor qualidade, pois utilizaram o peso pré-gestacional medido, incluíram grupo de comparação, excluíram adolescentes, apresentaram perdas de seguimento inferiores a 30% e controlaram para variáveis de confundimento. CONCLUSÃO: Ganho de peso gestacional, raça negra e paridade estão associados positivamente com a retenção de peso pós-parto. As evidências são contraditórias para a variável lactação e insuficientes para as variáveis consumo alimentar e atividade física. São necessários estudos cuidadosamente desenhados para esclarecer estas questões.<br>BACKGROUND: Postpartum weight retention is a trigger for developing obesity in women. It is often associated with weight gain during pregnancy, parity, age, marital status, food intake, physical activity and lactation. However, the associations found have proven to be inconclusive or contradictory. OBJECTIVES: The purpose of this review was to study risk factors associated with postpartum weight gain and retention. METHODS: A systematic review of the literature between January 1993 and June 2003 was performed through Medline and LILACS databases. RESULTS: Twenty-eight studies were found: 23 cohort studies, four cross-sectional studies and one case-control study. Most studies were performed in the US and the postpartum follow-up time was mainly between six weeks and 24 months. Twenty five percent of the studies had loss to follow-up above 30%, 61% included adolescents and 75% used self-reported pregravid body weights. The most reliable results came from seven studies, whose strengths were: use of measured pregravid body weight and comparison groups, exclusion of adolescents, loss to follow-up rates below 30% and adequate control for confounders. CONCLUSION: Gestational weight gain, black women and parity are positively associated with postpartum weight retention. The effect of lactation on weight retention is still controversial and there is lack of evidence on physical activity and food intake. Improved longitudinal studies are needed to clarify theses issues