Low anterior resection syndrome following rectal cancer surgery: are incidence and severity lower with long-term follow-up?

BACKGROUND: Low anterior resection syndrome (LARS) is a functional disorder that may follow restorative proctectomy. The aim of this study was to evaluate the long-term incidence and risk factors for LARS following surgery for rectal cancer. METHODS: A retrospective study was performed on patients from a prospectively maintained database, who underwent a restorative proctectomy between January 2014 and December 2019 at Hadassah Hebrew University Medical Center. The study cohort was divided into two groups: patients following partial proctectomy with a partial mesorectal excision and a colorectal anastomosis (PME group) and patients following total proctectomy with total mesorectal excision and a coloanal anastomosis (TME group). The incidence and severity of LARS were evaluated using the LARS questionnaire. Risk factors for LARS were also evaluated. RESULTS: A total of 240 patients (male: female ratio 134:106, median age 64 years [interquartile range 55-71 years]) were included in the analysis. There were 160 patients in the PME group and 80 patients in the TME group. The overall incidence of LARS was 37.4% (26.5% major LARS and 10.9% minor LARS). Major LARS was observed in 53.8% of patients who underwent TME and in 12.7% of patients who underwent PME (p < 0.001). On multivariate analysis, distance of the anastomosis from the anal verge, TME, and neoadjuvant radiotherapy were independent prognostic factors for LARS. The incidence and severity of LARS were significantly lower in patients with longer follow-up (p = 0.05). CONCLUSIONS: Significant improvement in LARS can be expected with longer follow-up. Distance of the anastomosis from the anal verge, TME and neoadjuvant radiotherapy are independent risk factors for LARS.

Corpus callosum area and brain volume in autism spectrum disorder: quantitative analysis of structural MRI from the ABIDE database.

Reduced corpus callosum area and increased brain volume are two commonly reported findings in autism spectrum disorder (ASD). We investigated these two correlates in ASD and healthy controls using T1-weighted MRI scans from the Autism Brain Imaging Data Exchange (ABIDE). Automated methods were used to segment the corpus callosum and intracranial region. No difference in the corpus callosum area was found between ASD participants and healthy controls (ASD 598.53 ± 109 mm(2); control 596.82 ± 102 mm(2); p = 0.76). The ASD participants had increased intracranial volume (ASD 1,508,596 ± 170,505 mm(3); control 1,482,732 ± 150,873.5 mm(3); p = 0.042). No evidence was found for overall ASD differences in the corpus callosum subregions.

Organ donation and transplantation in Brazil: university students' awareness and opinions.

This study was aimed at assessing university students' awareness and opinions about aspects of the law no. 10.221/01. This exploratory study was performed among students at the São Paulo Federal University-UNIFESP, from 2001 to July 2002, including 1284 undergraduates in the following courses: nursing, medicine, speech and language therapy, biomedicine, and ophthalmic technology. That data show that 47.7% (333) of undergraduates are aware of the kind of donation established by the new law. Among the adolescents of first and second grades, and courses, there was a difference on the awareness about the kind of donation (P =.000). Most undergraduates (57.6%, 402) agree with consented donation. However, the high percentage--35.1% (245)--that chose the alternative "I don't know" is remarkable. Results show that many undergraduates are unaware of the specifications of the technical files for transplants; only 48.3% (337) of them chose the correct answer, and 79.4% (554) do not believe that the order in the waiting list for transplants is respected. The conclusion is that it is worth emphasizing is that there are different opinions and levels of awareness among students, considering age, religion and religious practice, and course and level at school. In spite of unawareness and lack of belief in the principles of distribution of organs and tissue, most students are willing to be donors (68.2%).

Phase Ib trial of granulocyte-macrophage colony-stimulating factor combined with murine monoclonal antibody R24 in patients with metastatic melanoma.

R24, a murine monoclonal antibody, has been shown to mediate complement- and antibody-dependent cellular cytotoxicity (ADCC) of melanoma tumor targets. We conducted a Phase Ib clinical trial using granulocyte-macrophage colony-stimulating factor (GM-CSF) and R24 in 20 patients with metastatic melanoma. The purpose of this study was to test the hypothesis that treatment with GM-CSF could up-regulate monocyte and granulocyte ADCC and that the combination of GM-CSF plus R24, which mediates ADCC, would lead to enhanced anti-tumor activity in patients with melanoma. GM-CSF was administered by subcutaneous injection daily for 21 days at a dose of 150 micrograms/m2/day. R24 was administered by continuous intravenous infusion on days 8-15 at three dose levels: 0, 10, and 50 mg/m2/day. All 20 patients received one cycle of treatment only. Immune parameters measured were monocyte and granulocyte direct cytotoxicity and ADCC. All patients were evaluable for toxicity. Fifteen patients were evaluable for immune response. Treatment with GM-CSF alone was well tolerated. Toxicity from the combination of GM-CSF plus R24 included diffuse urticaria, nausea and vomiting, hypertension, and hypotension. Hypotension was the dose-limiting toxicity. Two patients on the 50-mg/m2/day dose level of R24 achieved a partial response lasting 2+ and 5+ months. Treatment with GM-CSF led to a statistically significant enhancement of monocyte and granulocyte direct cytotoxicity and ADCC. The maximally tolerated dose of R24 given at this schedule combined with GM-CSF is < 50 mg/m2/day. We conclude that GM-CSF given by subcutaneous injection at 150 micrograms/m2 x 21 days can enhance effector cell ADCC and direct cytotoxicity and that the combination of GM-CSF and R24 can be therapeutic.

Pure red cell aplasia associated with B cell lymphoma: demonstration of bone marrow colony inhibition by serum immunoglobulin.

A 58-year old male with follicular small cleaved B cell lymphoma developed pure red cell aplasia (PRCA) during chemotherapy. To understand the etiology of the PRCA, we studied the effects of patient sera on the progenitor cell colony formation of normal human bone marrow cells in vitro. We demonstrated a marked inhibition of normal bone marrow progenitor cell colony formation by patient sera, but not pooled normal human sera. Immunoglobulin was then precipitated from patient sera for similar studies. The majority of the precipitated immunoglobulin was of the IgG type. The immunoglobulin fraction markedly inhibited normal bone marrow progenitor cell colony formation, whereas the non-immunoglobulin fraction was not inhibitory. The presence of inhibitory serum immunoglobulin correlated with the hematologic status of the patient. We conclude that the development of PRCA in patients with B cell lymphoma may be due to a serum IgG inhibitor of bone marrow progenitor cell growth.

Abortion outcome as a function of sex-role identification.

The present study investigated the relationship between sex-role identification and abortion outcome in 120 women receiving 1st trimester abortions. The sex-role concept dimension was measured both ty self-attributions of sex-role traits (as measured by the Bem Sex-Role Inventory) and by lifestyle (career vs. homemaker) trait attbibutions. Psychological and physiological aspects of abortion outcome were included: slighlty more than 7% of scores were in the symptomatic range, similar to percentages found in previous studies. Both Androgyny (r = -.42, p.001) and Masculinity (r = -.23, p.05) were found to be related to positive abortion outcome. Androgyny was more strongly related, which suggests that a balance of masculine and feminine traits, at least for women in the post-abortion situation, is prefereable to high Masculinity scores alone. Congruence between one's self-image and one's image of a career woman was also found to be related to abortion outcome (r = .31, P.01). In attempting to differentiate between the upper and lower 10% of the distribution of abortion outcome, only 2 variables, Androgyny and self-career congruence, survived parameter criterion, and accounted for 32% of the variance.