Colorectal cancer.

Despite decreased incidence rates in average-age onset patients in high-income economies, colorectal cancer is the third most diagnosed cancer in the world, with increasing rates in emerging economies. Furthermore, early onset colorectal cancer (age ≤50 years) is of increasing concern globally. Over the past decade, research advances have increased biological knowledge, treatment options, and overall survival rates. The increase in life expectancy is attributed to an increase in effective systemic therapy, improved treatment selection, and expanded locoregional surgical options. Ongoing developments are focused on the role of sphincter preservation, precision oncology for molecular alterations, use of circulating tumour DNA, analysis of the gut microbiome, as well as the role of locoregional strategies for colorectal cancer liver metastases. This overview is to provide a general multidisciplinary perspective of clinical advances in colorectal cancer.

Anal Cancer: Emerging Standards in a Rare Disease.

The social stigma surrounding an anal cancer diagnosis has traditionally prevented open discussions about this disease. However, as recent treatment options and an increasing rate of diagnoses are made worldwide, awareness is growing. In the United States alone, 9,090 individuals were expected to be diagnosed with anal cancer in 2021. The US annual incidence of squamous cell carcinoma of the anus continues to increase by 2.7% yearly, whereas the mortality rate increases by 3.1%. The main risk factor for anal cancer is a human papillomavirus infection; those with chronic immunosuppression are also at risk. Patients with HIV are 19 times more likely to develop anal cancer compared with the general population. In this review, we have provided an overview of the carcinoma of the anal canal, the role of screening, advancements in radiation therapy, and current trials investigating acute and chronic treatment-related toxicities. This article is a comprehensive approach to presenting the existing data in an effort to encourage continuous international interest in anal cancer.

Improved transformation of Agrobacterium assisted by silver nanoparticles.

In transgenic plant development, the low transformation efficiency of Agrobacterium with exogenous DNA is the major constraint, and hence, methods to improve its transformation efficiency are needed. Recently, nanoparticlemediated gene transfer has evolved as a key transformational tool in genetic transformation. Since silver nanoparticles (AgNPs) can induce pores on the cell membrane, their efficacy in the improvement of conventional calcium chloride freeze-thaw technique of transformation of Agrobacterium was explored in this study. Agrobacterium cells in the exponential growth phase were exposed to different concentrations of AgNPs (0.01, 1, 5, 10, and 20 mg/l), and the half-maximal effective concentration (EC50) was determined via Probit analysis using the SPSS software. Transformation efficiency of AgNPs alone and in combination with calcium chloride was compared with that of the conventional calcium chloride freeze-thaw technique. AgNPs at a concentration of 0.01 mg/l in combination with calcium chloride (20 mM) showed a ten fold increase in the transformation efficiency (3.33 log CFU (colony-forming unit/microgram of DNA) of Agrobacterium tumefaciens strain EHA 105 with plasmid vector pART27 compared with the conventional technique (2.31 log CFU/µg of DNA). This study indicates that AgNPs of size 100 nm can eliminate the freeze-thaw stage in the conventional Agrobacterium transformation technique, with a 44% improvement in efficiency. The use of AgNPs (0.01 mg/l) along with 20 mM calcium chloride was found to be an economically viable method to improve the transformation of Agrobacterium with exogenous plasmid DNA.

Greater than 5-year follow-up of outpatient L4-L5 lumbar interspinous fixation for degenerative spinal stenosis using the INSPAN device.

BACKGROUND: Lumbar spinal stenosis is treated with decompression directly such as laminectomies and indirectly with an interspinous device through distraction and extension block. Interspinous devices (IPD) have also been used as an adjunct to spinal fusion. However, the design for IPD to treat spinal stenosis does not fixate the spine while the design for spinal fusion is designed to fixate the spine. There is a paucity of data on a single device that has been used for both fusion and stenosis. Authors aim to demonstrate the long-term outcomes of interspinous fixation at L4-5 for degenerative spinal stenosis. METHODS: We evaluated patients with spinal stenosis and degenerative disc disease who were treated with open decompression and distraction of the spinous processes at L4-L5 using an interspinous device. All patients complained of lower back pain and neurogenic claudication. This is a retrospective review of prospectively collected data (level 3) under an IRB approved study cohort. The charts of patient undergoing lumbar decompression with Interspinous Distraction, Fixation using InSpan device (INSPAN LLC) in an outpatient setting were reviewed with over a 5-year follow-up period. RESULTS: 122 surgical cases of lumbar decompression with interspinous fixation, spanning between the timeframe of September 2011 to October 2016. A total of 56 patients had instrumentation at L4-L5. Total female population was 46%. The median age of the patients included in the population was 50.9±10.7 years with a median BMI of 24.8±11.4 kg/m2. Two-year VAS and ODI showed significant improvement from 8.1±1.2 to 1.5±1.1 and 42.9±14.3 to 14.8±5.1. All surgeries were completed in less than one hour. There was a total of 1 revision case with removal of INSPAN and open hemilaminectomy decompression. CONCLUSIONS: Long term results demonstrated improved outcomes in patients who underwent Interspinous distraction decompression in an ambulatory surgery center using the INSPAN IPD at L4-L5 for Degenerative Spinal Stenosis. There was one revision converted to hemilaminectomy. There were no complications or blood transfusions.

Platysma sparing approach to anterior cervical spine surgery: A less exposure surgery technique.

INTRODUCTION: Authors aim to demonstrate the surgical technique and outcomes of using a platysma sparing approach to anterior cervical spine surgery. METHODS: Medical records of 496 prospective patients, group 1 (259 patients) with an outpatient platysma muscle-sparing approach. Group 2 (237 patients) with inpatient standard muscle-splitting approach. RESULTS: Intergroup comparison showed statistical significant improvement in VAS neck and NDI scores p = 0.009 and p = 0.012 and surgical operative time and estimated blood loss, p = 0.003 and p = 0.006 respectively. CONCLUSION: This anatomy sparing technique demonstrates a safe, effective and reproducible approach to cervical spine surgery which is a goal of less exposure surgery philosophy.

Placing ball and socket cervical total disc replacement using instant center of rotation.

BACKGROUND: Authors aim to evaluate the correct placement of TDR using the instant center of rotation (ICR) as a guide. METHODS: Placement of disc would be divided into three groups using a standard of 1 mm from the ICR: Posterior to ICR, In line with ICR and Anterior to ICR. RESULTS: 49 patients, mean age was 39.96 ±â€¯1.45 years. 42 intraop fluoroscopy images compared to 41 post op radiographic images demonstrated TDR in line with ICR. CONCLUSION: Total discs replacements can be placed intraoperatively using proper technique with verification confirmed using the ICR postoperatively. KEYWORDS: Total disc replacement; instant center of rotation; ideal placement; fluoroscopy; adjacent segment disease; less exposure surgery.

Sentinel sign in standalone anterior cervical fusion: Outcomes and fusion rate.

BACKGROUND: The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting. METHODS: 48 consecutive patients undergoing standalone ACDF (S-ACDF) (Group 1) were compared to control group of 49 patients who had ACDF with ACP (Group 2). RESULTS: Analysis of follow-up at the one year period postoperative outcomes between groups 1 and 2 demonstrated no intergroup statistical significant difference in VAS neck, arm and NDI scores p = 0.414, 0.06 and p = 0.328 respectively. CONCLUSION: We conclude that S-ACDF can be safely done in an ambulatory surgery center with satisfactory clinical and patient-reported outcomes.

Option for transverse midline incision and other factors that determine patient's decision to have cervical spine surgery.

BACKGROUND: Authors aim to determine patients' preference for surgical incision and factors affecting the decision for surgery to the anterior neck. METHODS: A questionnaire was presented prior to evaluation and if preceded to surgery followup given. RESULTS: 243 patients completed questionnaire, with 60% female population and younger than 50 years. 151 patients preferred a transverse midline incision with a statistically significant increase in outcomes and cosmesis importance and a decrease in the importance of board certification. CONCLUSION: Findings of questionnaire demonstrate that patients' prefer a transverse midline anterior neck incision, with surgical outcomes being the overall factor affecting decision making.

Utility of Mobile Apps for Video Conferencing to Follow Patients at Home After Outpatient Surgery.

INTRODUCTION: Outpatient surgery has a great opportunity to demonstrate the role of using mobile video conference (VC) postoperatively. Our patients use technology to help decision making in finding physicians. The authors aim to assess patient's perception on the use of mobile apps for VC with the surgeon and/or staff. METHODS: Consenting patients completed a questionnaire of 10 questions preoperatively and postoperatively to assess the difference in opinion. RESULTS: Overall, 120 patients completed the questionnaire preoperatively with 58% female population, 71% younger than 65 years, and 67% having a GED/higher education. Fifty-two patients had surgery with 54% female population, and 60% were younger than 65 years. All patients had mobile apps for VC with 55% using WhatsApp, 40% using Facetime, and 5% other. In person, being with a trained educator at the office was the preferred method for learning about surgical procedures. Overall, four patients contacted the surgeon directly preoperatively. After surgery, 8 of 52 patients (15%) used VC to the surgeon directly, and 37 patients used the VC with the team. CONCLUSION: With advances in new technology, the use of mobile video conferencing adds a new forum for communication with patients. In the outpatient surgical setting, this forum would improve patient-physician relations.