Development of a core descriptor set for Crohn's anal fistula

AIM: Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research. METHOD: Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting. RESULTS: One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life. CONCLUSION: The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies

Gastrointestinal stromal tumor mesenchymal neoplasms: the offspring that choose the wrong path

Nikolaos Machairiotis,1 Ioanna Kougioumtzi,1 Paul Zarogoulidis,2 Aikaterini Stylianaki,1 Konstantinos Tsimogiannis,3 Nikolaos Katsikogiannis11Surgery Department (National Health System), University General Hospital of Alexandroupolis, Alexandroupolis, 2Pulmonary Department – Oncology Unit, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, 3Department of Surgery, G Hatzikosta General Hospital of Ioannina, Ioannina, GreeceAbstract: Gastrointestinal stromal tumors (GISTs) are relatively rare neoplasms of the gastrointestinal tract originating from the pluripotential mesenchymal stem cells, which differentiate into interstitial Cajal cells. They are usually located in the upper gastrointestinal track. These tumors are typically defined by the expression of c-KIT (CD117) and CD34 proteins in the tumor cells. A small percentage of these tumors is negative for c-KIT. The neoplasms are positive for platelet-derived growth factor α (PDGFα) mutations. In addition to PDGFRα mutations, wild-type c-KIT mutations can also be present. The therapeutic approach to locally developed gastrointestinal stromal tumors is surgical resection, either with open or laparoscopic surgery. In case of systemic disease, molecular pharmacologic agents such as imatinib and sunitinib are used for treatment. These agents block the signaling pathways of neoplastic-cell tyrosine kinases, interfering in their proliferation and causing apoptosis.Keywords: GIST, mesenchymal stem cells, cancer pathways, interstitial cells of Cajal, PDGFR&alpha

Association of Syndecan-1 with Angiogenesis-related Markers, Extracellular Matrix Components, and Clinicopathological Features in Colorectal Carcinoma

Syndecan-1 is a transmembrane heparansulfate proteoglycan, which regulates cell proliferation, migration, angiogenesis, cell-to-cell and cell-to-extracellular matrix adhesion and may influence malignant cell behavior. We investigated the alterations of syndecan-1 expression in colorectal cancer and analyzed the relationship between clinicopathological parameters, proliferation indices, angiogenic markers, and extracellular matrix components. Syndecan-1 protein expression observed in the tumorous epithelium was high in 52197 (53.6%) of the studied cases, moderate in 20197 (20.6%), and weak in 5197 (5.22%) of the cases, and there was strong stromal expression in 34.02% of the tumors. Syndecan-1 expression was statistically correlated to VEGF expression in tumor (p=0.001) and vessels (p=0.007). In addition, there was a borderline correlation between syndecan-1 expression and tenascin (p=0.053). Patients with weak staining reaction had a more unfavorable prognosis (p=0.032) in univariate analysis. These results indicate the implication of syndecan-1 in the remodeling and angiogenesis of colorectal cancer tissue, through interaction with other extracellular matrix components and VEGF, probably influencing the tumor progression and aggressiveness

Current surgical status of thyroid diseases

Panagiotis Touzopoulos1, Michael Karanikas1, Paul Zarogoulidis2, Alexandros Mitrakas1, Konstantinos Porpodis2, Nikolaos Katsikogiannis3, Vasilis Zervas2, Ioannis Kouroumichakis4, Theodoros C Constantinidis5, Dimitrios Mikroulis6, Konstantinos E Tsimogiannis71First Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Alexandroupolis, Greece; 2Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece; 3Surgery Department (NHS), University General Hospital of Alexandroupolis, Greece; 4Second Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 5Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health, Eastern Macedonia-Thrace, Greece; 6Cardiothoracic Surgery Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 7Surgery Department, "G. Hatzikosta" General Hospital of Ioannina, GreeceAbstract: Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%–15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one.Keywords: thyroidectomy, surgical techniques, thyroid cance

Antioxidant activity and kinetics studies of quercetin, epicatechin and naringenin in bulk methyl linoleate

The objective of this work was to evaluate the antioxidant action of flavonoids with specific differences in chemical structure, namely, quercetin (Q), epicatechin (E) and naringenin (N), in bulk methyl linoleate (ML) under different oxidation conditions at 60 A degrees C, in an oven and in a Rancimat apparatus. The oxidation kinetics were studied by direct and concomitant analysis of primary and secondary oxidation compounds. Addition of 200 mg/kg of E or Q to ML increased about tenfold the oxidative stability of ML. The protective effect was significantly higher for E, independent of the oxidation conditions used. However, N showed no effect. Results obtained were attributed to differences in structural features and polarity. Thus, the presence of the ortho-dihydroxy structure in the B ring and the 3-hydroxyl group in the C ring of E and Q seemed to be determinant and the comparatively higher polarity of E may have enhanced its antioxidant efficiency.Fondecyt Project Grant (Conicyt, Chile) 1120308 ACT Project Grant (Conicyt, Chile) 1105 Spanish Ministry of Economy and Competitiveness AGL2013-45110-