Microbiota Phenotype Promotes Anastomotic Leakage in a Model of Rats with Ischemic Colon Resection.

Anastomotic leakage (AL) is a major cause of morbidity and mortality after colorectal surgery, but the mechanism behind this complication is still not fully understood. Despite the advances in surgical techniques and perioperative care, the complication rates have remained steady. Recently, it has been suggested that colon microbiota may be involved in the development of complications after colorectal surgery. The aim of this study was to evaluate the association of gut microbiota in the development of colorectal AL and their possible virulence strategies to better understand the phenomenon. Using 16S rRNA sequencing of samples collected on the day of surgery and the sixth day following surgery, we analyzed the changes in tissue-associated microbiota at anastomotic sites created in a model of rats with ischemic colon resection. We discovered a trend for lower microbial diversity in the AL group compared to non-leak anastomosis (NLA). There were no differences in relative abundance in the different types of microbial respiration between these groups and the high abundance of the facultative anaerobic Gemella palaticanis is a marker species that stands out as a distinctive feature.

Effect of Neuromuscular Electrical Stimulation on the Duration of Mechanical Ventilation.

BACKGROUND: It has been proposed that neuromuscular or functional electrical stimulation may have effects on respiratory muscles through its systemic effects, similar to those produced by exercise training. However, its impact on the duration of invasive mechanical ventilation has not been adequately defined. We sought to evaluate the effect of neuromuscular or functional electrical stimulation on the duration of invasive mechanical ventilation in critically ill subjects. METHODS: We systematically searched 3 databases up to August 2019 (ie, CENTRAL, MEDLINE, and EMBASE) as well as other resources to identify randomized controlled trials (RCTs) that evaluated the effects of neuromuscular or functional electrical stimulation compared to usual care/rehabilitation or placebo of neuromuscular or functional electrical stimulation on the duration of invasive mechanical ventilation. RESULTS: After reviewing 1,200 single records, 12 RCTs (N = 530 subjects) fulfilled our eligibility criteria. Three studies included only subjects with COPD (n = 106 subjects), whereas the rest considered subjects with different diseases. The most frequently stimulated muscle group was the quadriceps. Neuromuscular or functional electrical stimulation may decrease the duration of invasive mechanical ventilation (mean difference = -2.68 d, 95% CI -4.35 to -1.02, I2 = 50%, P = .002; 10 RCTs; low quality of evidence), and we are uncertain whether this effect may be more pronounced in subjects with COPD (mean difference = -2.90 d, 95% CI -4.58 to -1.23, I2 = 9%, P < .001; 3 RCTs; very low quality of evidence). CONCLUSIONS: Neuromuscular or functional electrical stimulation may slightly reduce the duration of invasive mechanical ventilation; we are uncertain whether these results are found in subjects with COPD compared to subjects receiving usual care or placebo, and the quality of the body of evidence is low to very low. More RCTs are needed with a larger number of subjects, with more homogeneous diseases and basal conditions, and especially with a more adequate methodological design.

[Characterization of patients with sporadic colorectal cancer following the new Consensus Molecular Subtypes (CMS)]. / Caracterización de pacientes con cáncer colorrectal esporádico basado en la nueva subclasificación molecular de consenso.

BACKGROUND: Colorectal cancer (CRC) is an heterogeneous disease. Three carcinogenic pathways determine its molecular profile: microsatellite instability (MSI), chromosomal instability (CIN) and CpG island methylator phenotype (CIMP). Based on the new molecular classification, four consensus CRC molecular subtypes (CMS) are established, which are related to clinical, pathological and biological characteristics of the tumor. AIM: To classify Chilean patients with sporadic CRC according to the new consensus molecular subtypes of carcinogenic pathways. MATERIAL AND METHODS: Prospective analytical study of 53 patients with a mean age of 70 years (55% males) with CRC, operated at a private clinic, without neoadjuvant treatment. From normal and tumor tissue DNA of each patient, CIN, MSI and CIMP were analyzed. Combining these variables, tumors were classified as CMS1/MSI-immune, CMS2/canonical, CMS3/metabolic and CMS4/mesenchymal. RESULTS: CMS1 tumors (19%) were located in the right colon, were in early stages, had MMR complex deficiencies and 67% had an activating mutation of the BRAF oncogene. CMS2 tumors (31%) were located in the left colon, had moderate differentiation, absence of vascular invasion, lymphatic and mucin. CMS3 tumors (29%) were also left-sided, with absence of vascular and lymphatic invasion, and 29% had an activating mutation of the KRAS oncogene. CMS4 tumors (21%) showed advanced stages and presence of metastases. CONCLUSIONS: This new molecular classification contributes to understanding the heterogeneity of tumors. It is possible to differentiate molecular subgroups of a single pathological diagnosis of adenocarcinoma, opening the door to personalized medicine.

Caracterización de pacientes con cáncer colorrectal esporádico basado en la nueva subclasificación molecular de consenso / Characterization of patients with sporadic colorectal cancer following the new Consensus Molecular Subtypes (CMS)

Background: Colorectal cancer (CRC) is an heterogeneous disease. Three carcinogenic pathways determine its molecular profile: microsatellite instability (MSI), chromosomal instability (CIN) and CpG island methylator phenotype (CIMP). Based on the new molecular classification, four consensus CRC molecular subtypes (CMS) are established, which are related to clinical, pathological and biological characteristics of the tumor. Aim: To classify Chilean patients with sporadic CRC according to the new consensus molecular subtypes of carcinogenic pathways. Material and Methods: Prospective analytical study of 53 patients with a mean age of 70 years (55% males) with CRC, operated at a private clinic, without neoadjuvant treatment. From normal and tumor tissue DNA of each patient, CIN, MSI and CIMP were analyzed. Combining these variables, tumors were classified as CMS1/MSI-immune, CMS2/canonical, CMS3/metabolic and CMS4/mesenchymal. Results: CMS1 tumors (19%) were located in the right colon, were in early stages, had MMR complex deficiencies and 67% had an activating mutation of the BRAF oncogene. CMS2 tumors (31%) were located in the left colon, had moderate differentiation, absence of vascular invasion, lymphatic and mucin. CMS3 tumors (29%) were also left-sided, with absence of vascular and lymphatic invasion, and 29% had an activating mutation of the KRAS oncogene. CMS4 tumors (21%) showed advanced stages and presence of metastases. Conclusions: This new molecular classification contributes to understanding the heterogeneity of tumors. It is possible to differentiate molecular subgroups of a single pathological diagnosis of adenocarcinoma, opening the door to personalized medicine.