Fulminant endogenous panophthalmitis caused by Clostridium septicum infection / Panoftalmite endógena fulminante por infecção por Clostridium septicum

ABSTRACT We report an unusual case of fulminant endogenous Clostridium septicum panophthalmitis. A 74-year-old male patient presented with sudden amaurosis in the right eye, which in a few hours, evolved into an orbital cellulitis, endophthalmitis, anterior segment ischemia, and secondary perforation of the eye. A complete diagnostic study, which included cranial and orbital contrast-enhanced computed tomography scan, contrast-enhanced magnetic resonance imaging, blood cultures, and complete blood work, were performed. No causal agent was identified. Clostridium septicum infection caused fulminant gaseous panophthalmitis. Despite broad-spectrum antibiotic treatment, evisceration of the eyeball was necessary. The extension study showed a colon adenocarcinoma as the origin of the infection. Clostridium septicum panophthalmitis is a rare but aggressive orbital infection. This infection warrants the identification of a neoplastic process in the gastrointestinal tract in many cases not previously described.

RESUMO Este é o relato de um caso incomum de panoftalmite endógena fulminante por Clostridium septicum. Um paciente do sexo masculino, 74 anos, apresentou amaurose súbita no olho direito, que em poucas horas evoluiu para celulite orbitária, endoftalmite, isquemia do segmento anterior e perfuração secundária do olho. Foi realizado um estudo diagnóstico completo, que incluiu uma tomografia computadorizada com contraste cranial e orbital, um exame de ressonância magnética, hemocultura e hemograma completo. Nenhum agente causal foi identificado. A infecção por Clostridium septicum causou uma panoftalmite gasosa fulminante. Apesar do tratamento com antibióticos de amplo espectro, foi necessário eviscerar o globo ocular. O estudo de seguimento mostrou um adenocarcinoma de cólon como a origem da infecção. A panoftalmite por Clostridium septicum é um tipo raro, mas muito agressivo de infecção orbitária. Essa infecção deve sugerir a busca por um processo neoplásico no trato gastrointestinal, em muitos casos não diagnosticado anteriormente.

Analysis of the application of nano-carbon lymphatic tracer technology in laparoscopic radical resection of colon cancer based on propensity matching / 中国医师进修杂志

Objective:To analyze the application effect of nano-carbon lymphatic tracer technology in laparoscopic colon cancer (CC) radical resection based on propensity matching.Methods:Retrospective case-control study was performed in this study. From January 2016 to April 2021, 714 cases of CC patients who underwent laparoscopic CC radical resection in Kunshan Second People′s Hospital were divided into groups according to whether or not the nano-carbon lymphatic tracing technique was applied. Seventy-eight cases in group A were applied with nano-carbon lymphatic tracing technique, while 636 cases in group B were not applied with nano-carbon lymphatic tracing technique. The initial data were matched 1∶3 by the propensity score matching method, and finally group A (73 cases) and group B (219 cases) were obtained. The detection of lymph nodes in the two groups after propensity score matching was compared.Results:By comparing the baseline data of the two groups after propensity score matching, it was found that there were no significant differences in gender, height, weight, body mass index, tumor T stage, tumor N stage, tumor TNM stage, preoperative chemotherapy, or tumor location ( P>0.05). The total number of lymph nodes in group A was higher than that in group B: (22.24 ± 7.08) pieces vs. (19.03 ± 6.29) pieces, and the difference was statistically significant ( t = 3.66, P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis in group A were not significantly different from those in group B ( P>0.05). Tumor T stage T 3, tumor N stage N 0, tumor TNM stage Ⅱ, and preoperative chemotherapy, the total number of lymph nodes in group A was higher than that in group B: 23 (6, 60) pieces vs. 19 (4, 54) pieces , 20 (3, 62) pieces vs. 18 (3, 75) pieces, 23 (6, 59) pieces vs. 20 (7, 54) pieces, 22 (5, 45) pieces vs. 14 (4, 46) pieces, and the difference was statistically significant ( Z = 2.43, 2.70, 2.64 and 3.32; P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis of tumor N stage N 2 in group A were lower than those in group B: 4 (4, 9) pieces vs. 6 (4, 25) pieces , 16 (10, 42) pieces vs. 32 (19, 100) pieces, and the difference between groups was statistically significant ( Z = -2.53 and -2.87, P<0.05). Followed up to April 2022, among the 292 patients, 5 were lost to follow-up, the 3-year disease-free survival rates of 72 patients in group A and 215 patients in group B were 83.33% (60/72) and 91.16% (196/215) respectively, there was no significant difference between two groups ( P>0.05). Conclusions:The number of lymph nodes detected in laparoscopic CC radical resection increases after the application of nano-carbon lymphatic tracing technology.

Application and challenge of microsatellite instability detection in colorectal cancer / 中华消化外科杂志

Colorectal cancer (CRC) is one of the most common gastrointestinal cancers. The incidence and mortality of CRC are still rising in China. It is of great importance to explore the molecular mechanisms of the development and progression of CRC. Microsatellites are short tandem repeats that are distributed throughout the genome. Detection of microsatellite instability (MSI) is of great value in the diagnosis and treatment of CRC. MSI detection is an important method for Lynch syndrome screening. For patients with stage Ⅱ CRC, MSI status is an influencing factor for post-operative recurrence and an important reference for adjuvant therapy. For patients with stage Ⅳ CRC, MSI status is an important indicator for screening potential patients suitable for treatment of immune checkpoint inhibitors. However, there are still problems concerning the application of MSI. The detection methods of MSI have not been fully unified. The requirement of MSI detection in CRC patients are universal but not precise. MSI is not a valid predictor for the prognosis of CRC patients, and it could not effectively predict the efficacy of chemotherapy and immunotherapy. Moreover, with the application of other molecular markers, such as programmed death-1, programmed death-ligand 1, tumor mutation burden and immunoscore, the value of MSI in CRC is being challenged and remains to be unveiled with more studies. The authors investigate the problems in MSI detection and application, in order to provide reference for clinical practice.

Pólipos adenomatosos en familiares de primer grado de pacientes con cáncer del colon

Introducción: El cáncer colorectal constituye en la actualidad la segunda neoplasia maligna más frecuente. La mayoría son esporádicos, otra pequeña proporción corresponde a formas hereditarias. Sin embargo, se estima que en un 15 % a 20 % de casos pueden existir un componente hereditario asociado. Los familiares de primer grado de pacientes con cáncer colorrectal, constituyen un universo de mayor riesgo que la población general de padecer esta enfermedad, por lo que se recomienda el cribado en estos individuos. Objetivo: Determinar la frecuencia de pólipos adenomatosos en individuos con familiares de primer grado diagnosticados con cáncer de colon. Métodos: Se realizó un estudio descriptivo, de corte transversal, que incluyó a 126 adultos con familiares de primer grado de consanguinidad con cáncer de colon, a los que se les realizó colonoscopia en el Instituto de Gastroenterología entre diciembre de 2019 y diciembre 2021. Se describen las características de los pólipos adenomatosos encontrados. Resultados: La media para la edad fue de 55,9 ± 10,6, predominaron las mujeres. Se encontraron pólipos adenomatosos; 27 eran sésiles y 12 pediculados; en 26 (66,7 %), el tamaño era menor de 10 mm. La mayoría de los pólipos, fueron del tipo tubular. Se observó diversidad en cuanto a la localización de las lesiones, sin que existiera un predominio en ningún segmento anatómico. Conclusiones: Lesiones precursoras del cáncer colorrectal, como los pólipos adenomatosos, son frecuentes en individuos asintomáticos con familiares de primer grado de consanguinidad que padecieron esta neoplasia maligna.

Introduction : Colorectal cancer is currently the second most frequent neoplasm. Most of them are sporadic, another small proportion corresponds to hereditary forms. However, it is estimated that in 15-20% of cases there may be an associated hereditary component. First-degree relatives of patients with colorectal cancer constitute a universe with a higher risk of developing this disease than that of the general population, so screening is recommended in these individuals. Objective : To determine the frequency of adenomatous polyps in individuals with first-degree relatives diagnosed with colon cancer. Methods : A descriptive, cross-sectional study was carried out, including 126 adult relatives with first-degree blood relatives with colon cancer, who underwent colonoscopy at the Institute of Gastroenterology between December 2019 and December 2021. The characteristics of the adenomatous polyps found are described. Results : The mean for age was 55.9 ± 10.6, women predominated: 94 (74.6 %). Thirty-nine (30.9 %) adenomatous polyps were found; 27 (69.2 %) were sessile and 12 (30.7 %) pedunculated; in 26 (66.7 %) the size was less than 10 mm. The majority, 37 (94.8 %), were of the tubular type. Diversity was observed as to the location of the lesions, with no predominance in any anatomical segment. Conclusions : Precursor lesions of colorectal cancer, such as adenomatous polyps, are common in asymptomatic individuals with first-degree relatives who have had this malignancy.

Caracterización del cáncer de colon en pacientes operados en el servicio de Coloproctología de Camagüey

Introducción: Dentro de las enfermedades neoplásicas el cáncer de colon ocupa sin dudas un lugar preponderante, por ser altamente frecuente. Por ello se hace necesario caracterizar los pacientes con cáncer de colon y contar con un registro real de la incidencia de este problema de salud. Objetivo: Caracterizar el cáncer de colon en pacientes operados en el servicio de Coloproctología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, en el período comprendido desde septiembre de 2018 hasta septiembre de 2022. Métodos: Se realizó un estudio descriptivo, longitudinal prospectivo con el objetivo de caracterizar el cáncer de colon en pacientes operados en el servicio de Coloproctología en el período comprendido desde septiembre de 2018 hasta septiembre de 2022. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período, la muestra a criterio de los autores la integraron 217 pacientes adultos, con diagnóstico de cáncer de colon operados. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: El cáncer de colon se presentó con mayor frecuencia en el grupo etáreo de 60-79 años en ambos sexos, predominó el sexo masculino. El síndrome general fue la sintomatología más frecuente. El diagnóstico se realizó mediante el examen clínico y endoscópico. El adenocarcinoma moderadamente diferenciado tuvo mayor recurrencia. La localización topográfica predominante fue en el colon derecho y la hemicolectomía derecha la técnica quirúrgica más utilizada. Las complicaciones quirúrgicas tuvieron una baja incidencia. Conclusiones: El cáncer de colon presentó una mayor frecuencia en el grupo de etáreo de 60-79 años en ambos sexos. El adenocarcinoma moderadamente diferenciado se presentó en mayor frecuencia. Las complicaciones quirúrgicas fueron infrecuentes con una proporción de uno de cada 10 pacientes.

Introduction: Within neoplastic diseases, colon cancer undoubtedly occupies a preponderant place, because it is highly frequent. For this reason, it is necessary to characterize patients with colon cancer and have a real record of the incidence of this health problem. Objective: To characterize colon cancer in patients operated in the Coloproctology service of the Manuel Ascunce Domenech University Hospital in Camagüey, in the period from September 2018 to September 2022. Methods: A prospective longitudinal descriptive study was carried out with the objective of characterizing colon cancer in patients operated in the Coloproctology service of the Manuel Ascunce Domenech University Hospital, in the period from September 2018 to September 2022. The universe was made up of all the patients who attended the consultation in that period, the sample was to the authors' criteria included 217 adult patients with a diagnosis of colon cancer who underwent surgery. The primary source of the investigation was given by the clinical history. Results: Colon cancer occurred more frequently in the age group of 60-79 years in both sexes, the male sex predominating. The general syndrome was the most frequent symptoms. The diagnosis was made by clinical and endoscopic examination. Moderately differentiated adenocarcinoma had a higher recurrence. The predominant topographic location was in the right colon, and right hemicolectomy was the most widely used surgical technique. Surgical complications had a low incidence. Conclusions: Colon cancer presented a higher frequency in the age group of 60-79 years in both sexes. Moderately differentiated adenocarcinoma occurred more frequently. Right hemicolectomy was the most used surgical technique. Surgical complications were in frequent with a proportion of one in 10 patients.

Modelo didáctico formativo del cirujano general para la atención del paciente con cáncer de colon / Didactic training model of the general surgeon for the care of patients with colon cancer

Fundamento: en la actualidad se observan restricciones epistemológicas y praxiológicas en la formación del residente de Cirugía General. La lógica hermenéutico-dialéctica de dicha formación se expresa en su relación con la práctica quirúrgica contextual; el desarrollo de las habilidades quirúrgicas discurre mediante la educación en el trabajo. Objetivo: diseñar un modelo didáctico de la formación quirúrgico-asistencial en la educación en el trabajo del residente de Cirugía General, para la atención integral de pacientes con cáncer de colon. Métodos: se realizó una investigación de desarrollo en el los hospitales "Saturnino Lora" y "Juan B. Zayas" de Santiago de Cuba durante 2021. Se emplearon métodos teóricos: análisis-síntesis, sistematización y generalización de experiencias, holístico-dialéctico, modelación y enfoque hermenéutico; empíricos: encuesta y entrevista a residentes, especialistas y expertos de ambos hospitales. Resultados: el modelo diseñado se sustenta en la sistematización y generalización de las experiencias de los autores concernientes a los períodos preoperatorio, operatorio y posoperatorio de la cirugía de esta neoplasia. Conclusiones: el modelo didáctico fue validado por expertos como pertinente, factible y aplicable; tiene como contradicción la relación entre la lógica secuencial algorítmica de la práctica quirúrgica y la lógica hermenéutico-dialéctica del proceso de formación del residente en Cirugía General, a fin de contribuir a disminuir las insuficiencias y limitaciones de este profesional durante el proceso formativo.

Background: currently epistemological and praxiological restrictions are observed in the training of the General Surgery resident. The hermeneutic-dialectical logic of such training is expressed in its relationship with contextual surgical practice; the development of surgical skills proceeds through the in-service training. Objective: to design a didactic model of surgical-care training in the in-service training of the General Surgery resident, for the comprehensive care of patients with colon cancer. Methods: a development investigation was carried out in the "Saturnino Lora" and "Juan B. Zayas" hospitals in Santiago de Cuba during 2021. Theoretical methods were used: analysis-synthesis, systematization and generalization of experiences, holistic-dialectical, modeling and hermeneutic approach; empirical ones: survey and interview with residents, specialists and experts from both hospitals. Results: the designed model is based on the systematization and generalization of the authors' experiences concerning the preoperative, operative, and postoperative periods of surgery for this neoplasm. Conclusions: the didactic model was validated by experts as pertinent, feasible and applicable; Its contradiction is the relationship between the algorithmic sequential logic of surgical practice and the hermeneutic-dialectical logic of the training process of the resident in General Surgery, in order to help reduce the insufficiencies and limitations of this professional during the training process.

Construction and validation of a prognostic model for colon cancer based on inflammatory response-related genes / 肿瘤研究与临床

Objective:To screen the differentially expressed genes (DEG) related to inflammatory response associated with the prognosis of colon cancer based on the bioinformatics approach, and to construct and validate a prognostic model for colon cancer.Methods:RNA sequencing and clinical data of 472 colon cancer patients and normal colon tissues of 41 healthy people were retrieved from the Cancer Genome Atlas (TCGA) database. Gene expression related to prognosis of colon cancer and clinical data were retrieved from the International Cancer Genome Consortium (ICGC) database. The retrieval time was all from the establishment of library to November 2022. A total of 200 genes associated with inflammatory response obtained from the Gene Set Enrichment Analysis (GSEA) database were compared with the RNA sequencing gene dataset of colon cancer and normal colon tissues obtained from the TCGA database, and then DEG associated with inflammatory response were obtained. The prognosis-related DEG in the TCGA database were analyzed by using Cox proportional risk model, and the inflammatory response-related DEG were intersected with the prognosis-related DEG to obtain the prognosis-related inflammatory response-related DEG. The prognostic model of colon cancer was constructed by using LASSO Cox regression. Risk scores were calculated, and colon cancer patients in the TCGA database were divided into two groups of low risk (< the median value) and high risk (≥the median value) according to the median value of risk scores. Principal component analysis (PCA) was performed on patients in both groups, and survival analysis was performed by using Kaplan-Meier method. The efficacy of risk score in predicting the overall survival (OS) of colon cancer patients in the TCGA database was analyzed based on the R software timeROC program package. Clinical data from the ICGC database were applied to externally validate the constructed prognostic model, and patients with colon cancer in the ICGC database were classified into high and low risk groups based on the median risk score of patients with colon cancer in the TCGA database. By using R software, single-sample gene set enrichment analysis (ssGESA), immunophenotyping difference analysis, immune microenvironment correlation analysis, and immune checkpoint gene difference analysis of immune cells and immune function were performed for prognosis-related inflammation response-related DEG in the TCGA database.Results:A total of 60 inflammatory response-related DEG and 12 prognosis-related DEG were obtained; and 6 prognosis-related inflammatory response-related DEG (CCL24, GP1BA, SLC4A4, SRI, SPHK1, TIMP1) were obtained by taking the intersection set. LASSO Cox regression analysis showed that a prognostic model for colon cancer was constructed based on 6 prognosis-related inflammatory response-related DEG, and the risk score was calculated as = -0.113×CCL24+0.568×GP1BA+ (-0.375)×SLC4A4+(-0.051)×SRI+0.287×SPHK1+0.345×TIMP1. PCA results showed that patients with colon cancer could be better classified into 2 clusters. The OS in the high-risk group was worse than that in the low-risk group in the TCGA database ( P < 0.001); the area of the curve (AUC) of the prognostic risk score for predicting the OS rates of 1-year, 3-year, 5-year was 0.701, 0.685, and 0.675, respectively. The OS of the low-risk group was better than that of the high-risk group in the ICGC database; AUC of the prognostic risk score for predicting the OS rates of 1-year, 2-year, 3-year was 0.760, 0.788, and 0.743, respectively. ssGSEA analysis showed that the level of immune cell infiltration in the high-risk group in the TCGA database was high, especially the scores of activated dendritic cells, macrophages, neutrophils, plasmacytoid dendritic cells, T helper cells, and follicular helper T cells in the high-risk group were higher than those in the low-risk group, while the score of helper T cells 2 (Th2) in the high-risk group was lower compared with that in the low-risk group (all P < 0.05); in terms of immune function, the high-risk group had higher scores of antigen-presenting cell (APC) co-inhibition, APC co-stimulation, immune checkpoint, human leukocyte antigen (HLA), promotion of inflammation, parainflammation, T-cell stimulation, type Ⅰ interferon (IFN) response, and type ⅡIFN response scores compared with those in the low-risk group (all P < 0.05). The results of immunophenotyping analysis showed that IFN-γ-dominant type (C2) had the highest inflammatory response score, and the differences were statistically significant when compared with trauma healing type (C1) and inflammatory response type (C3), respectively (all P < 0.05). Immune microenvironment stromal cells and immune cells were all positively correlated with prognostic risk scores ( r values were 0.35 and 0.21, respectively, both P < 0.01). The results of immune checkpoint difference analysis showed there was a statistically significant difference in programmed-death receptor ligand 1 (PD-L1) expression level between high-risk group and low-risk group ( P = 0.002), and PD-L1 expression level was positively correlated with prognostic risk score ( r = 0.23, P < 0.01). Conclusions:Inflammatory response-related genes may play an important role in tumor immunity of colon cancer and can be used in the prognostic analysis and immunotherapy of colon cancer patients.

Study on changes of proliferation, migration and invasion abilities of radiation-induced polyploid colon cancer SW1116 cells and their progeny and the related mechanisms / 肿瘤研究与临床

Objective:To investigate the characteristics related to proliferation, migration and invasion of radiation-induced polyploid colon cancer SW1116 cells and their progeny.Methods:Colon cancer SW1116 cells were conventionally cultured in Leibovitz's L-15 medium containing 10% fetal bovine serum. SW1116 cells at logarithmic growth stage were irradiated with 7 Gy X-ray, and the morphological changes of the cells were observed by inverted microscope on days 3, 5, 10 and 19 after radiation induction. According to the morphological changes of the cells, the cells at day 3 after radiation induction were labeled as polyploid giant cancer cell (PGCC) group, and the cells at day 19 were recorded as PGCC progeny group. SW1116 cells without radiation induction were used as control group. Flow cytometry was used to detect cell ploidy in the control, PGCC and PGCC progeny groups, CCK-8 assay was used to detect the proliferation ability of the three groups, cell migration and invasion abilities of the three groups were detected by cell scratch assay and Transwell assay, and Western blotting was used to detect the expressions of cell cycle and proliferation-related proteins and epithelial-mesenchymal transition (EMT) marker N-cadherin (N-cad) in the three groups.Results:The volume of SW1116 cells gradually became larger on days 3, 5 and 10 after radiation induction, and returned to normal on day 19. The proportions of polyploid (DNA content >4N) cell subsets in the control group, PGCC group and PGCC progeny group were (2.3±1.1)%, (23.1±8.1)% and (3.2±0.5)%, the difference was statistically significant ( F = 18.52, P < 0.05), and the proportion of polyploid cell subpopulations in the PGCC group was higher than that in the control group ( t = 5.38, P < 0.01), but the differences between the PGCC progeny group and the control group were not statistically significant ( t = 0.22, P > 0.05). After 72 h of culture, the cell proliferation rates of the control, PGCC and PGCC progeny groups were (100.0±4.1)%, (73.5±0.7)% and (123.9±3.5)%, and the difference was statistically significant ( F = 190.27, P < 0.001). After 48 h of cell scratching, the scratch healing rates in the control, PGCC and PGCC progeny groups were (38.0±2.7)%, (41.5±4.0)% and (63.7±4.2)%, and the difference was statistically significant ( F = 43.05, P < 0.001). After 24 h of culture, the number of invasive cells in the control, PGCC and PGCC progeny groups was 12.9±1.2, 3.4±0.6 and 23.7±1.5, and the difference was statistically significant ( F = 63.64, P < 0.001). The expression levels of cell cycle-related proteins P-cdc25c, cdc25c and cdc2 in the PGCC group were lower than those in the control group (all P < 0.05), and the expression levels of transcription factor-related proteins E2F-2, E2F-3 and EMT marker N-cad were downregulated compared with the control group (all P < 0.05); the expression levels of P-cdc25c, cdc25c, cdc2, E2F-2, E2F-3 and N-cad proteins in the PGCC progeny group were higher than those in the control group (all P < 0.05). Conclusions:Radiation can induce colon cancer SW1116 cells to produce polyploid, which may then generate daughter cells through asymmetric mitosis and gain new life, and then promote the recurrence and metastasis of colon cancer.

Association of microsatellite instability with clinicopathological features and prognosis of colon cancer patients / 中华普通外科杂志

Objective:To investigate the relationship between microsatellite instability (MSI) , and clinicopathological features ,prognosis in patients with stage Ⅱ and Ⅲ colon cancer.Methods:Patients undergoing surgical resection for stage Ⅱ and Ⅲ colonic tumor in the Affiliated Hospital of Qingdao University from Dec 2016 to Nov 2018 were enrolled. All the 292 patients were with stage Ⅱ and Ⅲ colon cancer and MSI status. Propensity score matching method was used to match the two groups of patients according to 1:1. χ 2 analysis, Logistic Regression and COX regression was used to analyse the relationship between MSI status, the clinicopathological features and prognosis. Results:The risk of MSI-H in young patients ( OR=0.340, 95% CI: 0.126~0.921, P=0.034), right-sided colon cancer ( OR=7.985, 95% CI: 3.040-20.973, P<0.001), mucinous adenocarcinoma ( OR=4.285, 95% CI: 1.495-12.284, P=0.007), poorer differentiation ( OR=4.848, 95% CI: 1.597-14.716, P=0.005), N0 staging ( OR=0.235 , 95% CI: 0.077-0.719, P=0.011) increased . The total OS of colon cancer patients in the MSS group (66.7%) and the MSI-H group (86.9%) were statistically different( P=0.003). The MSI status ( HR=0.367, 95% CI: 0.151-0.891, P=0.027) is an independent factor affecting the prognosis of patients. Conclusions:In stage Ⅱ and Ⅲ colon cancer, patients with MSI-H have a better prognosis. MSI status is prognosis relevant factor for colon cancer patients.

Indocyanine green and nanocarbon lymph node tracing in laparoscopic radical resection for right colon cancer / 中华普通外科杂志

Objective:To compare the lymph node tracing of indocyanine green (ICG) and nanocarbon in laparoscopic right hemicolectomy.Methods:Fifty-two patients with right colon cancer were randomly divided into two groups: ICG group and nanocarbon group at Peking University International Hospital between Oct 2020 and Jul 2022. Sentinel lymph node (SLN) mapping and standard oncologic resection was performed. The micrometastasis was to detect when the routine SLN pathological test was negative.Results:In ICG group, the detection rate of SLN was 100%, the sensitivity was 93%, the false negative rate was 7%, and the accuracy was 96%,which were better than nanocarbon group (92%,57%,43%,77%). The number of SLN and positive SLN detected in ICG group were significantly higher than nanocarbon group [(3.2±0.7) vs. (2.6±1.1), t=4.424, P=0.020; (1.2±1.2) vs.(0.5±0.8), t=15.176, P=0.013]. The SLN biopsy accuracy of patients with BMI ≥24 kg/m 2 and tumor diameter ≥3 cm in ICG group was significantly higher than nanocarbon group (90% vs. 44%, χ 2=7.935, P=0.005; 90% vs.57%, χ 2=4.309, P=0.038). The detection rate of micrometastasis in SLN of ICG group was significantly different from nanocarbon group (35% vs. 15%, χ 2=5.853, P=0.016). Conclusion:ICG fluorescence imaging is superior to nanocarbon in SLN biopsy during laparoscopic radical right hemicolectomy, especially when patients' BMI ≥24 kg/m 2 and tumor diameter ≥3 cm.

Effect of transcutaneous electrical acupoint stimulation on postoperative pulmonary function in patients undergoing robot-assisted radical resection of colon cancer / 中华麻醉学杂志

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pulmonary function in the patients undergoing robot-assisted radical resection of colon cancer.Method:Ninety-four patients of either sex, aged 50-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with ARISCAT grade of medium risk, undergoing elective robot-assisted radical resection of colon cancer, were enrolled in this study. The patients were divided into TEAS group (group T, n=47) and sham-TEAS group (group S, n=47) using a random number table method. In group T, patients received 30 min of TEAS at Hegu (LI4), Quchi (LI11), Zusanli (ST36) and Feishu (BL13) between 5: 00 and 7: 00 a. m. from 1st day before operation to 3rd day after operation, with disperse-dense wave 2/100 Hz, and the stimulation intensity was the maximum intensity that the patient could tolerate. Patients in group S were also connected to the device without electrical stimulation. Both groups adopted lung-protective ventilation strategy during operation. The oxygenation index was calculated at the time of entering the operating room (T 0), 5 min after anesthesia induction (T 1), 5 min of pneumoperitoneum (T 2), 5 min after changing to Trendelenburg position (T 3) and immediately after the end of pneumoperitoneum (T 4). Peak airway pressure, plateau airway pressure, driving pressure and dynamic lung compliance were recorded at T 0-T 4. The serum concentration of lung Clara cell 16 kDa protein was recorded using enzyme-linked immunosorbent assay at T 0, T 4 and 2 h after extubation (T 5). On 1 day before operation and 1, 3 and 7 days after operation, the forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured, and the FEV 1/FVC was calculated, and the concentrations of serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation were simultaneously determined using enzyme-linked immunosorbent assay. The occurrence of pulmonary complications within 7 days after operation was recorded. Results:There was no significant difference in pH values, PaCO 2, oxygenation index, peak airway pressure, plateau airway pressure, driving pressure, and dynamic lung compliance at each time point between the two groups ( P>0.05). Compared with S group, the serum Clara cell 16 kDa protein concentrations were significantly decreased at T 5, FEV 1 and FVC were increased at 3 and 7 days after operation, the serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation concentrations were decreased at 1, 3 and 7 days after operation, the incidence of unexpected oxygen supply and total incidence of postoperative pulmonary complications were decreased ( P<0.05), and no significant change was found in FEV 1/FVC at each time point in T group ( P>0.05). Conclusions:TEAS can improve lung function in the patients undergoing robot-assisted radical resection of colon cancer.

Relationship between abnormal imaging findings of adipose tissue around primary colon cancer and prognosis / 中华放射学杂志

Objective:To explore the relationship between the abnormal adipose tissue around the primary tumor of colon cancer and the prognosis.Methods:From January 2015 to December 2017, 448 patients with colon cancer in Peking University Cancer Hospital were retrospectively and consecutively collected. The scores were assigned to the severity, horizontal and vertical ranges of peritumoral adipose tissue (PAT) abnormalities, and the cumulative scores were calculated to establish the PAT grades from 1 to 3. We defined a score of 0 or 1 as PAT grade 1, a score of 2 as PAT grade 2, a score of 3 as PAT grade 3. The patients were followed up, and the overall survival (OS) and metastasis-free survival (MFS) were recorded. The Kaplan-Meier curve, log-rank test and Cox regression analysis were used to evaluate its impact on prognosis, and the hazard ratio (HR) and 95% confidence interval (CI) were calculated.Results:Among the 448 patients, patients with PAT grade 1, 2, and 3 accounted for 70.1% (314/448), 18.1% (81/448), and 11.8% (53/448), respectively. The Kaplan-Meier survival curve showed that patients with PAT grade 1 had the best OS, patients with grade 3 had the worst OS, and patients with grade 2 were in between, and the difference was statistically significant (χ 2=27.38, P<0.001). There were statistically significant differences between the grades in pairs ( P<0.05). There was no significant difference in MFS between different PAT grades (χ 2=2.85, P=0.240). The results of Cox regression analysis showed that PAT grade was an independent factor affecting the OS. Compared with PAT grade 1, the risk of death in patients with PAT grade 2 and 3 was significantly increased (HR 2.563, 95%CI 1.181-5.561; HR 2.269, 95%CI 1.005-5.121; P=0.034). PAT grade was not an independent factor of MFS ( P=0.253). Conclusion:The PAT grade established based on the degree and scope of abnormal PAT in colon cancer is an independent factor for poor prognosis of colon cancer.

The expression and clinical significance of microRNA-574-3p in colon cancer / 中国医师杂志

Objective:To study the expression and clinical significance of microRNA-574-3p (miR-574-3p) in colon cancer.Methods:A total of 106 colon cancer patients who were admitted to the First Hospital of Qinhuangdao and Shijiazhuang Hospital of Traditional Chinese Medicine from June 2012 to June 2015 were selected as the research objects. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression level of miR-574-3p in colon cancer tissues and normal adjacent tissues. The relationship between the expression of miR-574-3p and the clinicopathological characteristics and prognosis of patients with colon cancer was analyzed. Immunohistochemical staining was used to detect the relationship between the expression of miR-574-3p and the expression of CyclinA2 or E-cadherin.Results:Compared with normal tissues adjacent to cancer, the expression level of miR-574-3p in 106 cases of colon cancer was significantly lower ( P<0.01). The decreased expression of miR-574-3p was related to tumor diameter, Dukes stage, histological grade and lymph node metastasis (all P<0.05), but not to age and tumor location (all P>0.05). The patients with low expression of miR-574-3p, high Dukes stage and histological grade, and lymph node metastasis had poor survival (all P<0.05). The 5-year overall survival rate of patients with decreased miR-574-3p expression in cancer tissue was significantly lower than that of patients without decreased miR-574-3p expression ( P=0.007 6). Compared with patients with no decreased miR-574-3p expression, patients with decreased miR-574-3p expression had higher CyclinA2 protein integrated optical density (IOD) value and lower E-cadherin protein IOD value in colon cancer tissues (all P<0.05). Conclusions:The decreased expression of miR-574-3p is related to the poor prognosis of colon cancer patients, which may affect tumor recurrence and metastasis by regulating the expression of CyclinA2 and E-cadherin proteins.

Caracterización clínica y epidemiológica de los pacientes con cáncer de colon / Clinical and epidemiological characterization of patients with colon cancer

INTRODUCCIÓN. El cáncer de colon es una neoplasia del tubo digestivo considerada una de las más frecuentes en ambos sexos y que predomina en adultos mayores. OBJETIVO. Describir las características clínicas y epidemiológicas de los pacientes con cáncer de colon. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1 601 y muestra de 210 datos de Historias Clínicas Electrónicas de pacientes diagnosticados con cáncer de colon, atendidos por la Unidad de Oncología del Hospital de Especialidades Carlos Andrade Marín de la ciudad de Quito en el periodo enero de 2016 a diciembre de 2019. Criterios de inclusión: diagnóstico confirmado de Cáncer de Colon, edad igual o mayor a 18 años, y disponer de todos los datos clínicos requeridos en el estudio. Se utilizó el método de muestreo probabilístico con lo que se estimó una proporción para el estudio con un intervalo de confianza del 95%, un margen de error del 5% y una frecuencia esperada del 3%, de donde se obtuvo una muestra ajustada al 10% de pérdidas. El procesamiento de datos se realizó en los programas Microsoft Excel versión 16 y el Statistical Package for Social Sciences versión 24. RESULTADOS. La mayor presentación fue en adultos mayores de 50 años, con una relación 1:1 en cuanto a sexo, y en la procedencia, se ubicó mayoritariamente en la población de la región Sierra; las personas con una actividad económica de tipo profesional fueron las más afectadas; en lo que se refiere a los antecedentes se encontró mayor relación en los personales y dentro de estos los pólipos; no hubo relación con los antecedentes quirúrgicos ni familiares. El síntoma de debut más prevalente fue el dolor abdominal; la mayoría fueron sometidos a colonoscopia; predominó la lateralidad derecha y el tipo histológico principalmente identificado fue el adenocarcinoma. CONCLUSIÓN. No se observó relación estadísticamente significante entre estadíos, evolución y tratamientos instaurados, lo que pudo estar influenciado por el muestreo al azar; y que el 53,30% de los pacientes aún se encuentra en controles.

INTRODUCTION. Colon cancer is a neoplasm of the digestive tract considered one of the most frequent in both sexes and predominantly in older adults. OBJECTIVE. To describe the clinical and epidemiological characteristics of patients with colon cancer. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1 601 and sample of 210 data from Electronic Medical Records of patients diagnosed with colon cancer, attended by the Oncology Unit of the Hospital de Especialidades Carlos Andrade Marín of the city of Quito in the period January 2016 to December 2019. Inclusion criteria: confirmed diagnosis of Colon Cancer, age equal to or older than 18 years, and having all the clinical data required in the study. The probability sampling method was used with which a proportion was estimated for the study with a confidence interval of 95%, a margin of error of 5% and an expected frequency of 3%, from which a 10% loss adjusted sample was obtained. Data processing was performed in Microsoft Excel version 16 and Statistical Package for Social Sciences version 24. The greatest presentation was in adults over 50 years of age, with a 1:1 ratio in terms of sex, and in terms of origin, it was mainly located in the population of the Sierra region; people with a professional economic activity were the most affected; in terms of history, a greater relationship was found in personal history and within these, polyps; there was no relationship with surgical or family history. The most prevalent debut symptom was abdominal pain; the majority underwent colonoscopy; right laterality predominated and the histological type mainly identified was adestatistically significant relationship was observed between stages, evolution and treatment, which could be influenced by random sampling; and that 53,30% of the patients are still in controls.

Invaginación sigmoidea en un adulto. ¿Está indicada la reducción endoscópica preoperatoria? / Sigmoid invagination in an adult. Is preoperative endoscopic reduction indicated?

Introducción. La invaginación intestinal o intususcepción es el deslizamiento de una parte del intestino dentro de otra adyacente. Es la causa más común de obstrucción intestinal en niños entre 3 meses y 6 años de edad, con una baja incidencia en adultos, correspondiente al 1 % del total de los cuadros obstructivos en el adulto. Su localización en colon es poco frecuente, pero conviene prestar especial atención por su asociación a lesiones malignas. Caso clínico. Varón de 39 años que acude a Urgencias con cuadro de obstrucción intestinal secundario a una invaginación en sigmoide. Se intenta reducción endoscópica, sin éxito, por lo que se indicó cirugía urgente, realizando sigmoidectomía y anastomosis colorrectal. El resultado anatomopatológico informó un adenoma de gran tamaño como causante de la invaginación. Conclusión. Existen controversias respecto al manejo endoscópico en invaginación intestinal en los adultos, especialmente en el colon, debido al elevado porcentaje de etiología tumoral maligna, recomendándose actualmente la resección en bloque sin reducción, para minimizar el riesgo de potencial siembra tumoral.

Introduction. Intestinal invagination or intussusception is the sliding of one part of the intestine into the adjacent one. It is the most common cause of intestinal obstruction in children between 3 months and 6 years of age, with a low incidence in adults, corresponding to 1% of all obstructive conditions in adults. Its location in the colon is rare, but special attention should be paid due to its association with malignant lesions. Case report. A 39-year-old male admitted to the emergency department with symptoms of intestinal obstruction secondary to a sigmoid intussusception. Endoscopic reduction was attempted, without success, so urgent surgery was indicated, performing sigmoidectomy and colorectal anastomosis. The pathology result reported a large adenoma as the cause of invagination. Conclusion. There are controversies regarding the endoscopic management of intussusception in adults, especially in the colon, due to the high percentage of malignant tumor etiology, currently recommending en bloc resection without reduction, to minimize the risk of potential tumor seeding.

Determinantes de supervivencia en una cohorte de pacientes costarricenses con cáncer colorrectal / Determinants of survival in a cohort of Costa Rican patients with colorectal cancer

Objetivo: Identificar las variables pronósticas de supervivencia global en una cohorte de pacientes costarricenses con adenocarcinoma colorrectal que fueron atendidos en el Hospital San Juan de Dios entre enero de 2010 y diciembre de 2015 y determinar sus tasas de supervivencia a los 5 años. Métodos: Se realizó un estudio retrospectivo en el cual se incluyó a todos los pacientes diagnosticados con adenocarcinoma de colon o recto durante el período de estudio. Se obtuvieron las variables clínicas del expediente médico y se identificaron los factores determinantes de supervivencia global mediante un método de regresión de Cox univariado y multivariante, con el cual se calculó el hazard ratio (HR) y su respectivo intervalo de confianza del 95% (IC 95%). Resultados: Se incluyó a un total de 667 pacientes con una mediana de seguimiento de 25.4 meses. La supervivencia a 5 años según estadio clínico fue de 91.7%, 60%, 44.9% y 18.9% para los estadios I, II, III y IV, respectivamente. En el análisis univariado, la edad mayor de 65 años, el bajo grado de diferenciación tumoral, un estadio clínico elevado, un pobre desempeño funcional, el origen proximal del tumor primario, un alto índice de ganglios positivos entre ganglios negativos y la ausencia de inestabilidad microsatelital fueron las variables asociadas estadísticamente a mayor riesgo de muerte. No obstante, después del ajuste multivariado, solo el estado funcional al inicio del tratamiento (HR: 4.24; IC 95%: 2.20-8.19; p<0.001 para la comparación de estado funcional 0 vs. 1 y 2) y la edad mayor de 65 años (HR: 1.90; IC 95%: 1.03-3.53; p=0.014) se asociaron independientemente a mortalidad. Conclusión: La edad avanzada (mayor de 65 años) y el estadio funcional fueron las variables independientes asociadas a supervivencia en la cohorte estudiada. Descriptores: neoplasias del colon, Costa Rica, mortalidad, pronóstico, supervivenciaObjetivo: Identificar las variables pronósticas de supervivencia global en una cohorte de pacientes costarricenses con adenocarcinoma colorrectal que fueron atendidos en el Hospital San Juan de Dios entre enero de 2010 y diciembre de 2015 y determinar sus tasas de supervivencia a los 5 años. Métodos: Se realizó un estudio retrospectivo en el cual se incluyó a todos los pacientes diagnosticados con adenocarcinoma de colon o recto durante el período de estudio. Se obtuvieron las variables clínicas del expediente médico y se identificaron los factores determinantes de supervivencia global mediante un método de regresión de Cox univariado y multivariante, con el cual se calculó el hazard ratio (HR) y su respectivo intervalo de confianza del 95% (IC 95%). Resultados: Se incluyó a un total de 667 pacientes con una mediana de seguimiento de 25.4 meses. La supervivencia a 5 años según estadio clínico fue de 91.7%, 60%, 44.9% y 18.9% para los estadios I, II, III y IV, respectivamente. En el análisis univariado, la edad mayor de 65 años, el bajo grado de diferenciación tumoral, un estadio clínico elevado, un pobre desempeño funcional, el origen proximal del tumor primario, un alto índice de ganglios positivos entre ganglios negativos y la ausencia de inestabilidad microsatelital fueron las variables asociadas estadísticamente a mayor riesgo de muerte. No obstante, después del ajuste multivariado, solo el estado funcional al inicio del tratamiento (HR: 4.24; IC 95%: 2.20-8.19; p<0.001 para la comparación de estado funcional 0 vs. 1 y 2) y la edad mayor de 65 años (HR: 1.90; IC 95%: 1.03-3.53; p=0.014) se asociaron independientemente a mortalidad. Conclusión: La edad avanzada (mayor de 65 años) y el estadio funcional fueron las variables independientes asociadas a supervivencia en la cohorte estudiada.

Aim: To identify prognostic variables of overall survival in a cohort of Costa Rican patients with colorectal adenocarcinoma who were treated at the San Juan de Dios Hospital between January 2010 and December 2015. Methods: A retrospective cohort study was conducted with all patients diagnosed with colorectal adenocarcinoma during the study period. Clinical variables were obtained from medical records. Determinants of overall survival were identified by a Cox univariate and multivariate regression analysis, with its respective hazard ratio (HR) and 95% confidence interval (IC 95%). Results: A total of 667 patients were included in this study. Median follow-up was 25.4 months. Five-year survival according to clinical stage was 91.7%, 60%, 44.9% and 18.9% for stages I, II, III, and IV, respectively. In the univariate analysis, age greater than 65 years, tumor grade, dvanced clinical stage, poor performance status, proximal location of the primary tumor, a high index of positive nodes and negative retrieved nodes, and the absence of microsatelital instability were statistically associated to death. However, after adjustment for potential confounders, only the performance status at the beginning of treatment (HR: 3.06; IC 95%: 1.65-5.69; p<0.001 for the comparison of ECOG 0 vs 1 and 2.) and age older than 65 years (HR: 1.64, IC 95%: 1.10-2.43; p=0.014) were independently associated with overall survival. Conclusion: Functional status at the time of diagnosis and clinical stage were the independent variables associated to survival in the studied cohort.

Resultados de la cirugía de urgencia en pacientes con cáncer de colon perforado / Results of emergency surgery in patients with perforated colon cancer

RESUMEN: Gran parte de los pacientes con cáncer de colon (CC), son diagnosticados y tratados de forma electiva. Sin embargo, aproximadamente un 20 % de ellos debutará como una emergencia (obstrucción o perforación). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia global (SVG) en pacientes resecados por CC perforado (CCP). Serie de casos retrospectiva de pacientes con CCP, sometidos a colectomía y linfadenectomía, de forma consecutiva, en Clínica RedSalud Mayor y Hospital de Temuco, Chile, entre 2010 y 2019. Las variables resultados fueron SVG y MPO. Otras variables de interés fueron: tiempo quirúrgico, resecabilidad, número de linfonodos resecados, estancia hospitalaria, mortalidad operatoria, recurrencia y supervivencia libre de enfermedad (SLE). Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 15 pacientes (60 % mujeres), con una mediana de edad de 62 años. La localización más frecuente fue sigmoides (6 casos; 40,0 %). La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, número de linfonodos resecados y estancia hospitalaria; fueron 80 min, 20 y 5 días respectivamente. La MPO fue 26,7 % (4 casos). Con una mediana de seguimiento de 36 meses, se verificó una recurrencia de 40,0 %. Por otra parte, la SVG y SLE a 5 años fue 46,7 % y 33,3 % respectivamente. Los resultados obtenidos, en términos de MPO y SVG, fueron similares a series internacionales.

SUMMARY: Most patients with colon cancer (CC) are diagnosed and treated electively. However, a fifth of them will debut as an emergency (obstruction or perforation). The aim of this study was to determine postoperative morbidity (POM) and overall survival (OS) in patients resected by perforated CC (PCC). Retrospective case series of patients with PCC undergoing colectomy and lymphadenectomy, consecutively, at RedSalud Mayor Clinic and Temuco hospital, Chile, between 2010 and 2019. The outcome variable were POM and OS. Other variables of interest were surgical time, resectability, number of resected lymph nodes, hospital stay, mortality, recurrence, and disease-free survival (DFS). Patients were followed clinically. Descriptive statistics was used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves.15 patients (60 % women) were intervened, with a median age of 62 years. The most frequent location was the sigmoid colon (6 cases, 40.0 %). Resectability of the series was 100 %. Median surgical time, number of lymph nodes resected, and hospital stay; they were 80 min, 20 and 5 days respectively. POM was 26.7 % (4 cases). With a median follow-up of 36 months, recurrence was 40.0 %. On the other hand, OS and DFS at 5 years were 46.7 % and 33.3 %, respectively. The observed results, in terms of POM and OS, were like international series.

National and state-level colorectal cancer mortality trends in Mexico, 1998-2018 / Tendencias nacionales y estatales de mortalidad por cáncer colorrectal en México, 1998-2018

Abstract: Objective: To describe the burden of colorectal cancer (CRC) in Mexico and understand mortality patterns based on sex, geography, and insurance status. Materials and methods: Mortality data (1998-2018) from the Instituto Nacional de Estadística y Geografía was obtained. We included colon (C18.0, C18.2-18.9) and rectal cancer ICD-10 codes (C19, C20), and estimated age-standardized national, state-level and health insurance mortality rates. We estimated the average annual percent change using joinpoint regression. Results: Between 1998 and 2018, the observed women and men mortality rate increased annually by 1.3 and 2.7%, respectively. Higher CRC mortality was observed in northern and more urbanized states and in groups with greater access to health insurance, which currently facilitates but does not routinely cover screening. Conclusion: CRC mortality in Mexico is increasing rapidly, with marked differences based on sex, geography, and insurance status. Our findings underscore potential benefits of increased investment in comprehensive screening, diagnosis, and treatment strategies for the general population.

Resumen: Objetivo: Describir la carga del cáncer colorrectal (CCR) en México y patrones de mortalidad según sexo, geografía y servicios de salud. Material y métodos: Se obtuvieron datos de mortalidad (1998-2018) del Instituto Nacional de Estadística y Geografía. Se incluyeron códigos CIE-10 de cáncer de colon (C18.0,C18.2-18.9) y recto (C19,C20). Se estimaron tasas de mortalidad nacionales, estatales y por servicio de salud, estandarizadas por edad. Se estimó el cambio porcentual anual promedio usando regresión joinpoint. Resultados: Entre 1998-2018, la tasa de mortalidad aumentó anualmente 1.3% en mujeres y 2.7% en hombres. Se observó mayor mortalidad por CCR en estados del norte, más urbanizados y con afiliación a servicios de salud que actualmente facilitan pero no cubren rutinariamente la detección. Conclusión: La mortalidad por CCR en México está aumentando rápidamente, con diferencias por sexo, geografía y afiliación. Los presentes hallazgos destacan los beneficios potenciales de mayor inversión en estrategias integrales de detección, diagnóstico y tratamiento para la población.