Relationship between metalloproteinase-9 (MMP-9) expression and clinicopathology in colorectal cancer: a cross-sectional study.

Introduction: According to the WHO's GLOBOCAN database, ~1,931,590 new colorectal cancer (CRC) cases and 915,607 CRC-related deaths occurred in 2020. The incidence of CRC in Indonesia is 8.6%, making it the fourth most common cancer. With CRC, matrix metalloproteinase-9 (MMP-9) has a role in tumour development and progression, such that patients with a higher MMP-9 expression had poorer survival. This study aimed to analyze the relationship between MMP-9 expression and clinicopathology in CRC patients. Methods: This was an analytic observational study with a cross-sectional research design. It was conducted from November 2021 to June 2022 with 52 patient tissue samples: these were subjected to MMP-9 immunohistochemistry stain, with the GeneTex (Irvine) MMP-9 monoclonal antibody. Patient data were collected with clinical variables based on medical records and histopathological examination by anatomy pathologists. Results: Primary tumour location, cancer staging, and histopathology grading were associated with MMP-9 (P=0.016, P=0.001, P=0.049). The more proximal to the primary tumour, the higher the stage of cancer, and the higher the histopathological grade, thus the greater the expression of MMP-9. Conclusion: A significant relationship existed of primary tumour location, cancer staging, and histopathology grading with MMP-9 expression in CRC patients. MMP-9 expression could be a useful indicator for the clinical assessment of tumour biologic behaviour and prognosis in CRC patients.

The Mutation Portraits of Oncogenes and Tumor Supressor Genes in Predicting the Overall Survival in Pancreatic Cancer: A Bayesian Network Meta-Analysis.

INTRODUCTION: In pancreatic cancer, the carcinogenesis can not be separated from genetics mutations. The portraits of genes alterations majorily including oncogenes (KRAS, HER2, PD-L1) and tumor supressor genes (P53, CDKN2A, SMAD4). Besides being notorious a screening marker, the genetic mutations were related to the prognosis of pancreatic cancer. The aim of this study is to determine the genetic mutations portrait in predicting the overall survival in pancreatic cancer. METHODS: The network meta analysis (NMA) was registered in PROSPERO (CRD42023397976) and conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) in addition of NMA extension guidance. Comprehensive searches were done including all studies which reported the overall survival of pancreatic cancer subjects with KRAS, HER2, PD-L1, P53, CDKN2A, SMAD4. Data were collected and analysis will be done based on Bayesian method, Markov Chain Monte Carlo algorithm, using BUGSnet package in R studio. Transivity was controlled by methods and consistency of the NMA will be fitted by deviance information criterion. Data analysis in NMA were presented in Sucra plot, league table, and forest plot. RESULTS: Twenty-four studies were included in this NMA with 4613 total subjects. The NMA was conducted in random-effects, consistent, and convergence model. Relative to control, the genetic mutation of SMAD4 (HR 1.84; 95%CI 1.39-2.46), HER2 (HR 1.76; 95%CI 1.14-2.71), and KRAS (HR 1.7; 95%CI 1.19-2.48) were significant to have worse survival. The mutations of PD-L1, P53, and CDKN2A also showed poor survival, but not statistically significant compared to control. CONCLUSION: In pancreatic cancer, the mutation of SMAD4 predicted the worst overall survival, compared to control, also mutation of HER2, KRAS, PD-L1, P53, and CDKN2A.

Recurrent cholangitis after choledochoduodenostomy: A case report.

INTRODUCTION: Recurrent cholangitis is a long-term consequence of choledochoduodenostomy (CDD) that requires urgent treatment. The frequency of recurrent cholangitis ranges between 2.5 and 15.7%. This case demonstrated the importance of rapid and precise diagnosis through screening and therapeutic modalities in recurrent cholangitis. PRESENTATION OF CASE: A male patient presented with a history of recurring right upper abdominal discomfort during the previous 3 years. The pain had been intermittent but had become more intense during the prior month. The patient was diagnosed with recurrent cholangitis following CDD. The therapeutic plan was closure of the CDD, which was identified as the cause of the recurrent cholangitis, and biliary drainage by modified Roux-en-Y choledochojejunostomy. DISCUSSION: Recurrent cholangitis was diagnosed based on clinical manifestations, including recurring right upper abdomen discomfort, jaundice, and fever accompanied with consistent laboratory and imaging findings. Drainage of bile into the distal common bile duct (CBD) is reduced in the side-to-side CDD arrangement. Consequently, the distal CBD becomes a reservoir with inadequate drainage, predisposing this so-called 'sump' to debris accumulation and cholangitis. The surgery was considered successful in preventing the recurrent cholangitis. CONCLUSION: The recurrent cholangitis was occurred due to inadequate biliary drainage. The choledochojejunostomy procedure with modified Roux-en-Y might prevent the recurrent cholangitis by improving biliary drainage to the enteric.

The relationship between glycine levels in collagen in the anterior rectus sheath tissue and the onset of indirect inguinal hernia: A cross-sectional study.

INTRODUCTION: An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Protection against an inguinal hernia depends on the integrity of fascial tissue, which is maintained by collagen. Collagen is a structural protein consisting of amino acids, the most common of which is glycine. This study aimed to determine the relationship between glycine and the appearance of lateral inguinal hernias. To this end, the researchers examined the profile of collagen and glycine levels in the tissue of the sheath of the rectus femoris in patients with lateral inguinal hernia (indirect inguinal hernia). METHODS: The study used a cross-sectional design to determine glycine levels in rectus anterior sheath tissue in patients with indirect inguinal hernia. Examination of collagen glycine levels was conducted using the ELISA (Enzyme-Linked immunosorbent assay) method. Data were analyzed using the Statistical Package for the Social Science (SPSS) program. An ANOVA test, Pearson's correlation test, and Spearman's correlation test were also performed. A p-value <0.05 was said to be significant. RESULTS: Across 72 samples, the mean body mass index (BMI) was 22.5 kg/m2 and, the mean clinical onset was 28.02 months. Correlation tests showed a correlation between glycine levels and clinical onset (p = 0.026). The ANOVA test showed a difference between glycine levels with age group (p = 0.025) and BMI (p = 0.015). The correlation between glycine levels and clinical-grade (p = 0.416) was not statistically significant. CONCLUSION: There is a significant relationship between glycine levels and age, BMI, and clinical onset of indirect inguinal hernia.

Relation between expression of hMLH1 and p53 mRNA genes, in the feces of patients with colorectal carcinoma. Cross-sectional study.

Colorectal carcinoma (CRC) is one of the main public health problems. The mortality of CRC is about 8%. Early detection of CRC is very important to prevent death because this cancer could be cured through surgery if the diagnosis can be made as early as possible. Therefore screening strategy for early detection of CRC is critical in reducing mortality. Many investigations supporting the detection of CRC have been developed, including the fecal DNA mutation test using advanced cytological techniques. It is capable of assessing colonocytes for the presence of DNA, RNA, and protein as molecular biomarkers of neoplasia in CRC, including p53 and hMLH1. This study implemented observational approach with a cross-sectional study of the feces of patients with CRC regardless of the stage and grade. The purpose of this study was to determine the expression of the hMLH1 and p53 mRNA genes in the feces of 48 patients with CRC from two hospitals in Indonesia, Siloam Hospitals in Cikarang and Dr. Wahidin Sudirohusodo Hospital in Makassar. The results showed that all adenocarcinoma feces samples with various tumor stages and grades had excess mRNA expression (more than twice the normal amount in Fold Change units) for both the hMLH1 and p53 genes. The average expression of the hMLH1 mRNA gene was the highest at stage two and grade one, while the lowest was at stage four and grade three. In contrast, the average p53 mRNA gene expression was the highest at stage four and grade three, while the lowest was at stage two and grade one. The study suggested that there was a relation between and the expression of hMLH1 and p53 mRNA gene. We concluded that while both hMLH1 and p53 genes in patients' feces with CRC were overexpressed, they did not significantly affect the grade of CRC.

Colorectal cancer survival rates in Makassar, Eastern Indonesia: A retrospective Cohort Study.

BACKGROUND: The 5-year overall survival (OS) rate for colorectal cancer (CRC) has been reported as 39%, and the 5-year recurrence-free survival (RFS) rate has been reported as 14%. Various prognostic factors have been associated with differences in survival rates among CRC patients. This study investigated the difference between several prognostic factors and the OS and RFS rates of CRC patients at the Dr. Wahidin Sudirohusodo General Hospital Makassar in Indonesia. MATERIALS AND METHODS: The study group comprised all CRC patients treated at the Division of Digestive Surgery from 2014 to 2016. Prognostic factor data were collected from medical records for 293 patients. The OS and RFS rates were analyzed using the bivariate Kaplan-Meier method and log-rank tests. RESULTS: Log-rank analysis of the association of age, histopathology, stage, definitive surgery, chemotherapy, and radiotherapy with the OS rate showed p-values of 0.031, 0.009, 0.014, 0.000, 0.343, and 0.381, respectively. Log-rank analysis of the association of these prognostic factors with the RFS rate showed p-values of 0.282, 0.006, 0.008, 0.020, 0.002, and 0.000, respectively. CONCLUSION: There were significant differences in the OS rate according to age, histopathology, stage, and history of definitive surgery. Histopathology, stage, history of definitive surgery, and chemotherapy and radiotherapy were significantly associated with differences in the RFS rate.

Association of clinicopathological features and gastric cancer incidence in a single institution.

BACKGROUND: Stomach cancer is the fifth most common malignancy. In 2012, 952,000 cancers were diagnosed worldwide, which led to 723,000 deaths. Elderly men are the most frequently observed category of gastric cancer patients, mostly affecting the antrum. The objective of this study was to analyze the association of age with sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies in cases of gastric cancer. METHODS: This cross-sectional descriptive study analyzed the associations between age, sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies among the total gastric cancer incidences during medical treatments from January 2016 to May 2019. The study samples were collected from the total gastric cancer respondents who met the inclusion criteria during medical treatments within the study period. RESULTS: Gastric cancer was most frequently observed among females (56%) and those aged 50-70 years old (47%). Most respondents had advanced stages of gastric cancer at first enrollment at our institution. The most frequently found tumor site was the corpus (43%). The most frequently performed type of surgical intervention was jejunostomy feeding (26%), and the most frequently diagnosed anatomical pathology was adenocarcinoma with poorly differentiation (39%). Overall, age had statistically significant correlations with sex (p < 0.001), tumor sites (p < 0.001), types of surgical intervention (p < 0.001), and diagnosed anatomical pathologies (p < 0.001). CONCLUSION: Gastric cancer was more common in males than females. In the older age group (>50 years old), gastric cancer was more prevalent in women than men, and the gastric tumor tended to be more distal. Non-cardia gastric cancers were more prevalent than cardia gastric cancers.

Profile of collagen prolines level of anterior rectus sheath tissue in indirect inguinal hernia: A cross-sectional study.

INTRODUCTION: A hernia is a protrusion of an organ or tissue through an abnormal anatomical channel or opening. Epidemiological data indicated an increased prevalence of inguinal hernias in patients with connective tissue diseases. The biomechanical strength of connective tissue is highly dependent on the constituent of the matrix, including collagen. Fibroblasts produce and secrete procollagen containing high concentrations of proline and lysine. Collagen integrity plays an essential role in preventing hernia formation in the abdominal wall. To investigate the relationship between collagen proline levels of the anterior rectus sheath tissue in patients with lateral inguinal hernias (indirect inguinal hernia). METHODS: The study participants consisted of 67 inguinal hernia patients. A sample of anterior rectus tissue was obtained at the time of surgery, then being washed in a PBS buffer (pH 7.4). The measurement of collagen proline levels was subsequently carried out with enzyme linked immunosorbent assay (ELISA). RESULTS: All study participants were male with mean age of 44 years, mean body mass index of 22.6 kg/m2 and mean onset of events of 27 months. Study subjects with reducible, irreducible, and incarcerated hernias were 45.7% (44/67 cases), 14.9% (10/67) and 19.4% (13/67), respectively. The mean proline level of the study subjects was 9.20. Correlation tests showed a correlation of proline levels and age (p = 0.001), body mass index (p = 0.006), and the onset of events (p = 0.023). Meanwhile, correlation of proline levels and occupation (p = 0.235) and clinical degree (p = 0.164) were not statistically significant. CONCLUSION: Presence if relationship between proline levels with age, and onset of incidence among indirect inguinal hernia patients.

Correlation of interleukin-6 and C-reactive protein levels in plasma with the stage and differentiation of colorectal cancer: A cross-sectional study in East Indonesia.

INTRODUCTION: Tumors most often develop due to inflammatory factors, including inflammatory cells that produce cytokines and cytotoxic mediators that can stimulate malignant transformation. Knowing that interleukin-6 (IL-6) and C-reactive protein (CRP) factor into the development of colorectal cancer (CRC), we aimed to assess IL-6 and CRP's relationship with the stage and differentiation of CRC. METHODS: In a sample of 46 patients with CRC, as confirmed by histopathological examination, plasma levels of IL-6 and CRP were measured from peripheral venous blood samples before surgery and examined using enzyme-linked immunosorbent assay. RESULTS: Most patients were male (63.0%) and at least 50 years old (73.9%). A positive correlation emerged between stage of CRC and both plasma IL-6 (r = 0.396, p = .003) and CRP (r = 0.376, p = .005) levels, which the Kruskal-Wallis test indicated were highest in stage IV (IL-6: median = 25.80, p = .019; CRP: median = 34.10, p = .040). Plasma IL-6 levels (median = 25.80, p = .019) were higher in well-differentiated CRC, whereas plasma CRP levels (median = 34.10, p = .040] were higher in poorly differentiated tissue. Linear plotting revealed a linear relationship between plasma IL-6 and plasma CRP levels in patients with CRC. CONCLUSION: Because the stage of CRC significantly correlates with plasma IL-6 and CRP levels, IL-6 and CRP can serve as diagnostic factors in assessing the progress and prognosis of CRC.

Association of superoxide dismutase enzyme with staging and grade of differentiation colorectal cancer: A cross-sectional study.

INTRODUCTION: The increase of superoxide dismutase (SOD) level in colorectal cancer (CRC) patients based on the examination of staging and grade of differentiation still evidently represents a clinical problem. SOD level raises at a certain staging and reduce at a certain grade of differentiation. For that reason, this study aimed to assess the association between SOD and the variables analyzed in this study. MATERIALS AND METHODS: This study was observational study using a cross-sectional research design aimed to measure the association between SOD and staging as well as grade of differentiation in CRC incidence. The study was conducted in our institution from January until March 2018. RESULTS: Statistical analyses of the data derived from the laboratory indicated that age and histopathological examination (TNM staging) had statistically significant correlation with SOD1 level. This significant correlation was proven from results of the statistical analyses of each variable at p = 0.039 (age) and p = 0.001 (TNM staging) respectively. Subsequent tests concerning the correlation between age and TNM staging on SOD1 level revealed that the study samples in the category of 30-49 age years old showed statistically significant correlation with SOD1 level with p = 0.009. CONCLUSION: The increase of grade of differentiation was proportional to the increase of SOD1 level as antioxidant against cancer in CRC patients.

Bilioenteric bypass stricture type II with hepatolithiasis: A case report.

INTRODUCTION: Secondary hepatolithiasis can occur as a result of bilioenteric stenosis or biliary anastomosis stenosis. The incidence of secondary hepatolithiasis appears to increase with increasing rates of hepatobiliary surgery. Here we report the first reported case of secondary hepatolithiasis. CASE PRESENTATION: A 57-year-old female patient complaining of jaundice all over the body since two years ago. The jaundice was intermittent and progressive. There was a history of previous bilioenteric bypass hepaticojejunostomy Roux-en-Y due to common bile duct cyst. On investigation, we found obstructive jaundice due to stricture of bilioenteric anastomosis type II after bilioenteric bypass hepaticojejunostomy Roux-en-Y with hepatolithiasis type II LR, according to the Takada classification. We did laparotomy found bilateral hepatic duct dilatation, we make incision and remove multiple stones. And then, we performed choledochoscope and confirm total occlusion of tract to distal common hepatic duct. We performed reconstruction Roux-en-Y hepaticojejunostomy with stenting. During the follow-up period, our patients were disease-free. CONCLUSION: Stricture of bilioenteric anastomosis were successfully treated by surgical reconstruction Roux-en-Y hepaticojejunostomy and stenting. This management has a good outcome and could be an effective alternative to surgery.

Interleukin-6 and interleukin-10 plasma levels and mRNA expression in polytrauma patients.

PURPOSE: Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient's outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 (IL-6) and interleukin-10 (IL-10). Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients. METHODS: This prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score (ISS) ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome (MODS) and death. MODS evaluation was performed using sequential organ failure assessment (SOFA). Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patient's outcome were examined with correlation test and statistical analysis. RESULTS: The elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-10 ratio with heavy trauma load (ISS > 30) showed that compensatory anti-inflammation response syndrome (CARS) state was more dominant than systemic inflammatory response syndrome (SIRS), indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality. CONCLUSION: The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient's outcome.

Pattern of cytokine (IL-6 and IL-10) level as inflammation and anti-inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma.

Massive injury remains the most common cause of death for productive age group globally. The current immune, inflammatory paradigm, based on an incomplete understanding of the functional integration of the complex host response, remains a major impediment to the development of effective innovative diagnostic and therapeutic effort. This study attempt to investigate the pattern of inflammatory and anti-inflammatory cytokines such as interleukin-6 and 10 (IL-6 and IL-10) and their interaction in severe injury condition with its major complication as multiple organ dysfunction syndrome (MODS) and failure (MOF) after polytrauma. This is multicenter study held at 4 academic Level-1 Trauma center included 54 polytrauma participants. Inclusion criteria were age between 16-60 years old, had new acute episode of polytrauma which defined as injury in ≥2 body region with Injury Severity Score (ISS) ≥16, and the presence of Systemic Inflammation Response Syndrome (SIRS). Serum level of IL-6 and IL-10 were taken on day 2, 3, and 5 after trauma. During hospitalization, samples were observed for the occurrence of MODS or MOF using Sequential Organ Failure Assessment (SOFA) and mortality rate were also noted. Participant were mostly male with mean of age of 35, 9 years old, endured polytrauma caused by traffic accident. Elevation of cytokines (IL-6, IL-10, and IL-6/IL-10 ratio) had directly proportional with MODS and mortality. Threshold level of compensation for severe trauma is IL-6 of 50 pg/mL and trauma load of ISS ≥30. Inflammation reaction greater than this threshold level would result in downhill level of IL-6, IL-10, or IL-6/IL-10 ratio which associated with poor outcome (MODS and death). The elevation of these cytokines level were represent as compensation/adaptive immune system and its fall represent decompensating/failure of immune system after severe trauma. The pattern of IL-6 and IL-10 after polytrauma represent immune system effort to restore homeostasis. Besides cytokines interaction, there must be other factors that contribute to mortality and poor outcome after major trauma. Further study is needed to investigate genomic variant or polymorphism related to trauma.

Multi-locus variable-number tandem repeat profiling of Salmonella enterica serovar Typhi isolates from blood cultures and gallbladder specimens from Makassar, South-Sulawesi, Indonesia.

Multi-locus variable-number tandem repeat analysis differentiated 297 Salmonella enterica serovar Typhi blood culture isolates from Makassar in 76 genotypes and a single unique S. Typhi genotype was isolated from the cholecystectomy specimens of four patients with cholelithiasis. The high diversity in S. Typhi genotypes circulating in Makassar indicates that the number of carriers could be very large, which may complicate disease prevention and control.