External Validation of a Nomogram Developed for Predicting Overall Survival in Gastric Cancer Patients with Insufficient Number of Examined Lymph Nodes.

Objectives: Nomograms and scoring systems in gastric cancers have been mainly developed based on adequate lymph node (lN) dissections. This study aimed to perform external validation of a nomogram developed for predicting overall survival (OS) in gastric cancer patients with insufficient number of examined LNs (eLNs) and to evaluate its usability as compared with the 8th American Joint Committee on Cancer (AJCC)'s Tumor-Node-Metastasis staging system. Methods: Medical records of 262 patients undergoing complete surgical resection for gastric cancers and having pathologically confirmed diagnosis were retrospectively reviewed. The study included 104 (39.7%) patients (82 males, median age, 60.3 years) with insufficient number of eLNs (<16). The 5-year OS rate was calculated using the nomogram and according to the AJCC system. Results: The median follow-up period was 37.4 months (range: 0.9-122.9). Of the patients, 69 (66.3%) died and 35 (33.7%) achieved 5-year survival within the follow-up period. The nomogram and the AJCC system predicted OS were significantly lower in patients who died than in those who achieved 5-year survival (p<0.001 for both). According to the receiver operative characteristics-curve, the area under the curve for the nomogram (0.801; 95% CI, 0.715-0.887; p<0.001) was larger than that for the AJCC system (0.754; 95% CI, 0.659-0.849; p<0.001). Conclusion: The nomogram developed for gastric cancer patients with insufficient number of eLNs (<16) was effective in predicting 5-year OS in our cohort and was superior to the AJCC system.

Genetic landscape of pancreatic cancer: a narrative review.

BACKGROUND AND OBJECTIVE: Pancreatic cancer is an aggressive disease with an impaired survival despite improvements in clinical management. Thus, understanding disease biology is of vital importance in order to overcome therapeutic challenges and achieve better prognosis. The purpose of this review is to outline the genetic landscape of pancreatic cancer along with its clinical implications. METHODS: We reviewed existing literature using electronic databases to outline the genetic landscape in pancreatic cancer. KEY CONTENT AND FINDINGS: This review mainly contains information on the genetic background of pancreatic cancer, mainly KRAS, CDKN2A, TP53 and SMAD4, with emphasis on the importance of understanding disease biology. CONCLUSIONS: The genetic aspects of pancreatic cancer have been well described especially with the introduction of next generation sequencing techniques. Future studies focusing on translation of these alterations in clinical application might pave the way for personalized surveillance and therapy.

Does Albumin Level Change the Strength of the Memorial Sloan Kettering Cancer Center Nomogram Used to Predict 5-year Survival in Patients with Colon Cancer?

OBJECTIVE: To test the efficacy of including albumin in the Memorial Sloan Kettering Cancer Center (MKSCC) nomogram (MSKCC+A) on predicting the overall survival. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Ankara Training and Research Hospital & Ataturk Training and Research Hospital, Turkey, in 2020, on patients who were operated between 2009 and 2014 to confirm the 5-year survival results. METHODOLOGY: Patients who underwent R0 resection for colon cancer were evaluated. For each patient in the cohort, the 5-year probability of survival was calculated and compared with actual, using the AJCC (American Joint Committee on Cancer), MSKCC and MSKCC+A estimation systems obtained using logistic regression. The performance of the estimation methods was evaluated by the ROC analysis. RESULTS: Two hundred and thirty-nine patients were studied. When the patients with more than 5-year overall survival were compared, the AJCC, MSKCC, and enhanced MSKCC survival scores were significantly higher. AUC = 0.699 for the AJCC staging system, AUC = 0.702 for the MKSCC nomogram, and AUC = 0.777 when the albumin level was added to the MKSCC system. CONCLUSIONS: The use of the MSKCC overall survival nomogram in patients with colon cancer appears useful for both clinicians and patients. The prognostic power of this calculator was found to be further enhanced by including the preoperative serum albumin level as an extra variable in the nomogram. KEY WORDS: Nomograms, Neoplasm grading, Survival, Colon cancer, Serum albumin.

Gossypiboma mistaken for a hydatid cyst: case report.

Although considered a rare complication, gossypiboma continues to be a clinically important and probably more frequently encountered than reported situation. This study aimed to report a case of gossypiboma that was mistaken for a hydatid cyst in the preoperative evaluation. A 34-year-old male patient with a history of Nissen Fundoplication presented with a large mass palpable in the epigastrium and both the left upper and lower quadrants of the abdomen. Computerized tomography was reported to show a 20x18 cm cystic mass with a collapsed germinative membrane inside it. Laparotomy, which was performed with a suggested diagnosis of type 3 hydatid cyst, revealed that the mass was caused by a 30x30 cm surgical abdominal compress. We believe gossypiboma should be kept in mind in the differential diagnosis of abdominal hydatid cysts in the presence of a former abdominal operation, especially when the result of indirect hemagglutination test is negative.

Synthetic mesh placement in the presence of abdominal infection: An experimental study of feasibility.

BACKGROUND: There are varying opinions on the feasibility of the placement of synthetic materials in contaminated surgical fields. The aim of this study was to investigate the outcomes of the use of a commercially available composite mesh in the presence of abdominal infection. METHODS: Twenty-four hours after the induction of experimental peritonitis, 20 rats were randomized into 2 groups of 10 subjects. After abdominal cleansing with a second laparotomy, the abdomen was closed with running sutures in the control group and the composite mesh was applied in the experimental group before closure. The rats were followed up for findings of sepsis, mortality, and wound infection. On the 28th day, the rats were sacrificed and evaluated for abdominal infection, abdominal adhesions, and bacterial growth in the mesh and tissue cultures. RESULTS: The mortality rate was 0% and 30% in the control and mesh groups, respectively (p=0.21), and the wound infection rate was 20% and 57.1% (p=0.162). In the mesh group, the adhesions were significantly more intense (p=0.018) and significantly more microorganisms proliferated in the tissue cultures (p=0.003). CONCLUSION: The significant increase in the intensity of adhesions and bacterial proliferation, as well as the higher rate of mortality and wound infection in the mesh group indicated that this composite mesh cannot be used safely in the repair of abdominal defects in the presence of abdominal infection.

Surgeons' approach toward clinical nutrition: A survey-based study.

OBJECTIVE: Although many surgical patients face postoperative problems due to a poor nutritional status, there is evidence that many cases of malnutrition still go unnoticed and untreated in surgical wards. This study aims to define the current attitudes of surgeons toward nutritional screening and support. MATERIAL AND METHODS: A questionnaire with 13 questions was e-mailed to 1500 surgeons. Cross-queries were made over the responses. RESULTS: The response rate was 20.9%. Most of the respondents (89.5%) implemented nutritional screening. However, only 24.6% of these surgeons screened every patient for malnutrition. The time to initiate nutritional support varied among respondents, and only 25.5% started nutritional support early enough prior to surgery. Only 9.9% of respondents implemented evidence based practices for preoperative fasting, and 21.2% preferred immunonutrition products for patients undergoing major abdominal surgery for cancer. The responses of surgeons, who participated in at least one scientific meeting on nutrition per year, were more coherent with the nutrition guidelines. CONCLUSIONS: The results of this study reveal that the awareness and knowledge of clinical nutrition need improving amongst surgeons. To increase this awareness and knowledge, continuous learning throughout their career seems essential.

Mixture of Arginine, Glutamine, and ß-hydroxy-ß-methyl Butyrate Enhances the Healing of Ischemic Wounds in Rats.

BACKGROUND: This study investigated the effects of an amino acid mixture containing arginine, glutamine, and ß-hydroxy-ß-methyl butyrate on secondary healing of ischemic wounds in a rat model (N = 18). METHODS: After the formation of a bipediculated flap on each rat, 2 full-thickness excisional skin wounds (2 × 2 cm) were created on every flap. The rats were then randomized into the control and treatment groups. Every rat received standardized rat food throughout the study. The rats in the treatment group were administered an extra 200 mg/kg of L-arginine, 200 mg/kg of L-glutamine, and 40 mg/kg of ß-hydroxy-ß-methyl butyrate per day. Wound sizes were measured on days 0, 4, 10, and 14. The rats were sacrificed, and the wounds were excised for biochemical and histologic examination on the 14th day. RESULTS: As compared with the control group, the treatment group's wound sizes were significantly smaller on days 10 and 14 ( P < .001), as was its inflammatory cell accumulation score ( P = .008). There was no significant difference between the 2 groups in collagen accumulation ( P = .340), granulation tissue maturation ( P = .161), angiogenesis ( P = .387), or reepithelialization ( P = .190) and no significant difference between hydroxyproline concentrations in wounds ( P = .287). DISCUSSION: This amino acid combination seems to have a positive impact on the secondary healing of experimental ischemic wounds when introduced as a supplement to the standard diet, and the reduction in the inflammatory process appears to play a role in this effect.

The effects of enoxaparin on the liver in experimental pneumoperitoneum model.

PURPOSE:: To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum. METHODS:: Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination. RESULTS:: Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant. CONCLUSION:: Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.

The effects of enoxaparin on the liver in experimental pneumoperitoneum model

ABSTRACT PURPOSE: To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum. METHODS: Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination. RESULTS: Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant. CONCLUSION: Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.

Pilot Experimental Study on the Effect of Arginine, Glutamine, and ß-Hydroxy ß-Methylbutyrate on Secondary Wound Healing.

BACKGROUND: Wound healing is a complex process, dependent on available nutrition substrates. When used together with ß-hydroxy ß-methylbutyrate, arginine and glutamine have been shown to increase collagen deposition in human subjects. However, there are no experimental investigations on the influence of this amino acid mixture with regard to secondary wound healing. The aim of this study is to investigate the effects of the supplementation of these 3 amino acids on the healing of open wounds in otherwise healthy animals. MATERIALS AND METHODS: Twelve rats were divided into control and treatment groups. Two 2-cm × 1-cm full-thickness skin defects were prepared on each subject. The rats in both groups received a diet containing 1.2 g of protein per 100 g of body weight per day. The treatment group, in addition, received 200 mg/kg L-arginine, 200 mg/kg L-glutamine, and 40 mg/kg ß-hydroxy ß-methylbutyrate every day. Wound sizes were measured every 2 days. On the 10th day, tissue samples were taken for histopathologic evaluation and also for the measurement of hydroxyproline concentrations. RESULTS: There was no statistically significant difference between mean wound sizes for the 2 groups (P > .05). There was also no statistically significant difference between the groups with regard to histological healing parameters (reepithelialization [P = 1.00], granulation tissue [P = 1.00], collagen accumulation [P = .455], inflammatory cell accumulation [P = .455], angiogenesis [P = .242]) or tissue hydroxyproline concentrations (P = .240). CONCLUSION: Diet supplemented with arginine, glutamine, and ß-hydroxy ß-methylbutyrate is not beneficial in enhancing secondary healing of open wounds in rats. Further research regarding this topic is warranted.

Effects of nasal cleansing and topical decongestants on patient tolerance during upper gastrointestinal endoscopy: a prospective randomized study.

UNLABELLED: Adequate patient tolerance is essential for successful completion of safe endoscopic examination. Although there are many reported methods to increase patient tolerance, none of these fully resolve this problem. The aim of this study was to investigate whether relaxing the nasal airways increase patient tolerance to upper gastrointestinal endoscopy (UGE). A total of 300 patients scheduled for diagnostic UGE were randomized into three separate groups. Prior to the UGE procedure the first group was administered intranasal cortisone spray following nasal cleansing (INC). Patients in the second group were administered intranasal saline after nasal cleansing (INSP). The patients in the third group were treated with the standard endoscopic procedure alone (SEP). After the UGE procedure, both endoscopists and patients were asked to evaluate the ease of performing the procedure. Furthermore, patients who had undergone endoscopy before were asked to compare their current experience to their most recent endoscopy. Results shown that INC and INSP groups had significantly better tolerance than the SEP group. When comparing their current experience with the previous one, INC and INSP groups reported that the current experience was better. CONCLUSIONS: Taking measures to relax the nasal airways makes breathing more comfortable and increase patient tolerance during UGE.