HPV and cervical cancer: A review of epidemiology and screening uptake in the UK

Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS

HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK

Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS

Evaluations of Laparoscopic Proctocolectomy Versus Traditional Technique in Patients With Rectal Cancer

These authors conclude that laparoscopic surgery for rectal cancer can be performed safely with a reduced rate of postoperative complications, need for blood transfusions, infection, and hospital stay

Urban thoracic trauma: diagnosis and initial treatment of non-cardiac injuries in adults.

This comprehensive review aims to delineate the prevailing non-cardiac thoracic injuries occurring in urban environments following initial on-site treatment and subsequent admission to hospital emergency departments. Our study involved a rigorous search within the PubMed database, employing key phrases and their combinations, including "thoracic injury," "thoracic trauma," "haemothorax," "lung contusion," "traumatic pneumothorax," "rib fractures," and "flail chest." We focused on original research articles and reviews. Non-cardiac thoracic injuries exhibit a high prevalence, often affecting poly-trauma patients, and contributing to up to 35% of polytrauma-related fatalities. Furthermore, severe thoracic injuries can result in a substantial 5% mortality rate. This review provides insights into clinical entities such as lung contusion, traumatic haemothorax, pneumothorax, rib fractures, and sternal fractures. Thoracic injuries represent a frequent and significant clinical concern for emergency department physicians and thoracic surgeons, warranting thorough understanding and timely intervention

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

The Implication of Gastric Microbiome in the Treatment of Gastric Cancer

Gastric cancer (GC) is one of the most common and deadly malignancies worldwide. Helicobacter pylori have been documented as a risk factor for GC. The development of sequencing technology has broadened the knowledge of the gastric microbiome, which is essential in maintaining homeostasis. Recent studies have demonstrated the involvement of the gastric microbiome in the development of GC. Therefore, the elucidation of the mechanism by which the gastric microbiome contributes to the development and progression of GC may improve GC’s prevention, diagnosis, and treatment. In this review, we discuss the current knowledge about changes in gastric microbial composition in GC patients, their role in carcinogenesis, the possible therapeutic role of the gastric microbiome, and its implications for current GC therapy

Study of oxidative stress in open and laparoscopic colectomy for colorectal cancer

Background: Colorectal cancer as well as colorectal surgery is associated with increased oxidative stress through different mechanisms. In this study the levels of different oxidative stress markers were comparatively assessed in patients who underwent laparoscopic or conventional resection for colorectal cancer.Methods: Sixty patients with colorectal cancer were randomly assigned to undergo laparoscopic (LS) or open surgery (OS). Lipid, protein, RNA, and nitrogen damage was investigated by measuring serum 8-isoprostanes (8-epiPGF2a), protein carbonyls (PC), 8-hydroxyguanosine (8-OHG), and 3-nitrotyrosine (3-NT), respectively. The primary end point of the study was to analyze and compare serum levels of the oxidative stress markers between the groups.Results: Postoperative serum levels of 8-epiPGF2a, 3-NT, and 8-OHG were significantly lower in the LS group at 24 h after surgery (p < 0.05). At 6 h postoperatively, the levels of 8-epiPGF2a and 3-NT were significantly lower in the LS group (p < 0.05). No difference in the levels of PC was found between the two groups at any time point. In the OS group, postoperative levels of 8-epiPGF2a were significantly lower than the preoperative values (p < 0.01). In the LS group, the postoperative values of 8-epiPGF2a, 3-NT, and 8-OHG were significantly lower than the pre- operative values (p < 0.05).Conclusion: Laparoscopic surgery for colorectal cancer is associated with lower oxidative stress compared to open surgery. 8-epiPGF2a was the most suitable marker for readily defining the oxidative status in patients who underwent surgery for colorectal cancer.Σκοπός: Ο ορθοκολικός καρκίνος, καθώς και η χειρουργικές επεμβάσεις που αφορούν στο παχύ έντερο και στο ορθό σχετίζονται με αυξημένο οξειδωτικό στρες μέσω διαφορετικών μηχανισμών. Στην παρούσα μελέτη, αξιολογήθηκαν και συγκρίθηκαν τα επίπεδα διαφορετικών δεικτών οξειδωτικού στρες σε ασθενείς με ορθοκολικό καρκίνο που υποβλήθηκαν σε χειρουργική επέμβαση με λαπαροσκοπική ή ανοιχτή προσπέλαση.Υλικό/Μέθοδοι: Εξήντα ασθενείς με καρκίνο του παχέος εντέρου τυχαιοποιήθηκαν σε δύο ομάδες, την ομάδα της λαπαροσκοπικής (ΑΠ) και την ομάδα της ανοικτής προσπέλασης (ΑΠ). Η λιπιδιακή υπεροξείδωση, η οξείδωση των πρωτεϊνών, η οξείδωση του RNA και οι βλάβες από δραστικές μορφές αζώτου διερευνήθηκαν μέσω προσδιορισμού των 8-ισοπροστανίων (8-epiPGF2a), των καρβονυλίων (PC), της 8-υδροξυγουανοσίνης (8-OHG) και της 3-νιτροτυροσίνης (3-ΝΤ) αντίστοιχα, στο πλάσμα των ασθενών. Σκοπός ήταν η ανάλυση και η σύγκριση των επιπέδων των δεικτών του οξειδωτικού στρες σε διαφορετικές χρονικές περιόδους και μεταξύ των ομάδων.Αποτελέσματα: Τα επίπεδα των 8-epiPGF2a, 3-ΝΤ, και 8-OHG ήταν σημαντικά χαμηλότερα στην ομάδα ΛΠ 24 ώρες μετά την επέμβαση (p < 0.05 ). Έξι ώρες μετεγχειρητικά, τα επίπεδα των 8-epiPGF2a και 3-ΝΤ ήταν σημαντικά χαμηλότερα στην ομάδα ΛΠ (p < 0,05 ). Δεν παρατηρήθηκαν διαφορές στα επίπεδα των PC μεταξύ των δύο ομάδων στα διάφορα χρονικά διαστήματα. Μετεγχειρητικά, στην ομάδα ΑΠ, τα επίπεδα των 8-epiPGF2a ήταν σημαντικά χαμηλότερα από τα προεγχειρητικά (p<0,01). Στην ομάδα ΛΠ, τα μετεγχειρητικά επίπεδα 8-epiPGF2a, 3-ΝΤ, και 8-OHG ήταν σημαντικά χαμηλότερα από τα προεγχειρητικά (p < 0,05).Συμπεράσματα: Η λαπαροσκοπική προσπέλαση στη χειρουργική για ορθοκολικό καρκίνο σχετίζεται με χαμηλότερο οξειδωτικό στρες σε σύγκριση με την ανοικτή. Τα 8-epiPGF2a φαίνεται να αποτελούν τον πλέον κατάλληλο δείκτη για τον άμεσο προσδιορισμό της οξειδωτικής κατάστασης των ασθενών που υποβλήθηκαν σε χειρουργική επέμβαση για ορθοκολικό καρκίνο

Rectal Ischemia Mimicked Tumor Mass

Ischemic proctitis is a rare disease which is usually encountered in elderly with comorbidities. We present a case of an 80-year old man with severe coronary disease who presented with severe hematochezia and hypotension. Endoscopy revealed a rectal mass 3-4 cm above the dental line and rectosigmoid mucosal inflammation compatible with ischemic colitis. The rectal insult was so intense that it resembled a neoplasmatic lesion. We discuss the causes, the prognostic factors, and the clinical and therapeutic challenges of this rare, albeit life-threatening entity, and we review the relative literature. A percentage of 10%–20% of patients with ischemic colitis usually have a distal potentially obstructing lesion or disorder such as cancer, diverticulitis or fecal impaction. Ischemic colitis, when mucosal and submucosal edema is severe and hemorrhagic nodules are large enough, can mimic a neoplasmatic lesion. The best treatment approach is a conservative management initially with a close clinical followup and after stabilization a repetition of rectal endoscopy with new biopsies. Early recognition of this clinical entity is of paramount importance to implement appropriate therapy (conservative or surgical) and avoid potentially fatal treatment of presumed inflammatory or infectious bowel diseases

Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot

Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically

Genetic Aberrations of DNA Repair Pathways in Prostate Cancer: Translation to the Clinic

Prostate cancer (PC) is the second most common cancer in men worldwide. Due to the large-scale sequencing efforts, there is currently a better understanding of the genomic landscape of PC. The identification of defects in DNA repair genes has led to clinical studies that provide a strong rationale for developing poly (ADP-ribose) polymerase (PARP) inhibitors and DNA-damaging agents in this molecularly defined subset of patients. The identification of molecularly defined subgroups of patients has also other clinical implications; for example, we now know that carriers of breast cancer 2 (BRCA2) pathogenic sequence variants (PSVs) have increased levels of serum prostate specific antigen (PSA) at diagnosis, increased proportion of high Gleason tumors, elevated rates of nodal and distant metastases, and high recurrence rate; BRCA2 PSVs confer lower overall survival (OS). Distinct tumor PSV, methylation, and expression patterns have been identified in BRCA2 compared with non-BRCA2 mutant prostate tumors. Several DNA damage response and repair (DDR)-targeting agents are currently being evaluated either as single agents or in combination in patients with PC. In this review article, we highlight the biology and clinical implications of deleterious inherited or acquired DNA repair pathway aberrations in PC and offer an overview of new agents being developed for the treatment of PC