Prognostic factors and survival after resection of colorectal liver metastasis in the era of preoperative chemotherapy: an 11-year single-centre study

INTRODUCTION

A variety of factors have been identified in the literature which influence survival following resection of colorectal liver metastases (CRLM). Much of this literature is historical, and its relevance to contemporary practice is not known. The aim of this study was to identify those factors which influence survival during the era of preoperative chemotherapy in patients undergoing resection of CRLM in a UK centre.

METHODS

All patients having liver resection for CRLM during an 11-year period up to 2011 were identified from a prospectively maintained database. Prognostic factors analysed included tumour size (≥5 or <5 cm), lymph node status of the primary tumour, margin positivity (R1; <1 mm), neo-adjuvant chemotherapy (for liver), tumour differentiation, number of liver metastases (≥4), preoperative carcinoembryonic antigen (CEA; ≥200 ng/ml) and whether metastases were synchronous (i.e. diagnosed within 12 months of colorectal resection) or metachronous to the primary tumour. Overall survival (OS) was compared using Kaplan-Meier plots and a log rank test for significance. Multivariate analysis was performed using a Cox regression model. Statistical analysis was performed in SPSS v19, and p < 0.05 was considered to be significant.

RESULTS

432 patients underwent resection of CRLM during this period (67% male; mean age 64.5 years), and of these, 54 (13.5%) had re-resections. The overall 5-year survival in this series was 43% with an actuarial 10-year survival of 40%. A preoperative CEA ≥200 ng/ml was present in 10% of patients and was associated with a poorer 5-year OS (24 vs. 45%; p < 0.001). A positive resection margin <1 mm was present in 16% of patients, and this had a negative impact on 5-year OS (15 vs. 47%; p < 0.001). Tumour differentiation, number, biliary or vascular invasion, size, relationship to primary disease, nodal status of the primary disease or the use of neo-adjuvant chemotherapy had no impact on OS. Multivariate analysis identified only the presence of a positive resection margin (OR 1.75; p < 0.05) and a preoperative CEA ≥200 ng/ml (OR 1.88; p < 0.01) as independent predictors of poor OS.

CONCLUSION

Despite the wide variety of prognostic factors reported in the literature, this study was only able to identify a preoperative CEA ≥200 ng/ml and the presence of tumour within 1 mm of the resection margin as being of value in predicting survival. These variables are likely to identify patients who may benefit from intensive follow-up to enable early aggressive treatment of recurrent disease.

Catalyst driven optical properties of the self-assembled ZnS nanostructures

In this paper, we present the effect of different catalysts (Mn, Au and Sn) on the room temperature photoluminescence and Raman spectra of VLS grown ZnS nanostructures. The catalysts found to self-dope the ZnS nanostructures during its growth were confirmed by XRD and XPS results. The extent of self-doping, which depended on the type and size of catalysts, was observed strongly to have affected the optical properties of ZnS nanostructures, particularly intrinsic defects like S and Zn vacancies. Intense broad bands in the visible due to intrinsic defects, namely Zn and S vacancies were observed, which were quite different for each catalyst as well as for the size of the catalyst. Au and Mn catalyzed ZnS nanostructures also showed creation of catalyst related defects, which were absent in the case of Sn. From the PL spectra, an estimation of the Zn and S vacancies was made for each type of catalyzed ZnS nanostructures. Surface optic (SO) phonon modes of the ZnS nanostructures were also observed to behave differently for the three catalysts. The dielectric continuum model was applied to determine the correlation length and variation in the surface potential modulations in these nanostructures. It was deduced from optical studies that the location of dopant in self-doped ZnS nanostructures strongly affected the luminescence properties. Finally it was concluded that self-doping using a suitable catalyst can be a simple and controllable way to dope ZnS nanostructures with tailored optical characteristics.

Nutritional evaluation of distillery sludge and its effect as a substitute of canola meal on performance of broiler chickens

The study was conducted to investigate the chemical composition of distillery yeast sludge and its inclusion in broiler diets to replace canola meal. Raw distillery yeast sludge was washed with water using water and sludge in the ratio 6:1, respectively. Proximate analysis of raw distillery yeast sludge and washed distillery sludge was carried out for crude protein (CP), true protein (TP), ether extract (EE), ash, acid insoluble ash and nitrogen free extract (NFE) determination. Mineral contents and amino acid profile of raw distillery yeast sludge and washed distillery sludge were also determined. After chemical evaluation, four iso-caloric and iso-nitrogenous broiler starter and finisher diets were prepared in mash form using 0 (control), 4, 8 and 12% levels of washed distillery sludge replacing canola meal. One hundred and twenty day-old broiler chicks were randomly distributed into 12 experimental units in such a way that each diet was offered to three experimental units, each comprising of 10 chicks. It was observed that washing affected the nutrients either by decreasing or increasing their concentration. It decreased the total mineral contents whereas CP, TP, EE and NFE contents increased. Washing also increased amino acid profile. Average feed intake and weight gain were higher in birds fed diet containing 8% washed distillery sludge and lower in birds fed diet containing 0% washed distillery sludge. Feed cost per kg live weight gain decreased significantly as the level of washed distillery sludge was increased in the diet. Average heart, liver and pancreas weights decreased with increased level of washed distillery sludge in the diet. The study revealed that after washing, distillery yeast sludge can be used successfully in broiler diets up to the level of 8% without any adverse effect on broiler’s performance.

Assisted closure of fasciotomy wounds: A descriptive series and caution in patients with vascular injury

Introduction

Negative pressure wound therapy (NPWT) and vessel loop assisted closure are two common methods used to assist with the closure of fasciotomy wounds. This retrospective review compares these two methods using a primary outcome measurement of skin graft requirement.

Methods

A retrospective search was performed to identify patients who underwent fasciotomy at our institution. Patient demographics, location of the fasciotomy, type of assisted closure, injury characteristics, need for skin graft, length of stay and evidence of infection within 90 days were recorded.

Results

A total of 56 patients met the inclusion criteria. Of these, 49 underwent vessel loop closure and seven underwent NPWT assisted closure. Patients who underwent NPWT assisted closure were at higher risk for requiring skin grafting than patients who underwent vessel loop closure, with an odds ratio of 5.9 (95% confidence interval 1.11 to 31.24). There was no difference in the rate of infection or length of stay between the two groups. Demographic factors such as age, gender, fracture mechanism, location of fasciotomy and presence of open fracture were not predictive of the need for skin grafting.

Conclusion

This retrospective descriptive case series demonstrates an increased risk of skin grafting in patients who underwent fasciotomy and were treated with NPWT assisted wound closure. In our series, vessel loop closure was protective against the need for skin grafting. Due to the small sample size in the NPWT group, caution should be taken when generalising these results. Further research is needed to determine if NPWT assisted closure of fasciotomy wounds truly leads to an increased requirement for skin grafting, or if the vascular injury is the main risk factor.

First Report of Citrus tristeza virus in National Germplasm of Citrus in Afghanistan

Rejuvenation of the horticulture industry is a government priority in Afghanistan. With that purpose, European Commission-supported programs specifically focus on greater access to improved and appropriate planting materials to increase the quantity and quality of more competitive horticultural products. Establishment of a biotechnology laboratory was considered essential support to horticulture sector development. This laboratory has begun screening the health status of the Afghan Germplasm National Collection to ensure multiplication of not only the best selected varieties or ecotypes but also to avoid reproduction and distribution of virus-infected fruit trees. Symptom inspection and sample collection for viral diseases was carried out in the citrus orchard during survey activity at the National Collection Experimental Farm in Jalalabad (Nangarhar Province). Ninety-nine variety plots (one row of five plants) were inspected visually and samples from two plants for each plot were collected and analyzed by double-antibody sandwich (DAS)-ELISA. Plants showing vein flecking, yellowing, and plant decline symptoms were observed in several plots. Four accessions were found to be infected by Citrus tristeza virus (CTV): kumquat cv. Margarita (isolates J4 and J8), orange cv. Mahali (J61), mandarin group cv. Fruter (J76), and rough lemon cv. Mahali (J101). Identified isolates have been characterized molecularly. A 655-nt fragment, corresponding to the major coat protein gene, has been amplified from all ELISA-positive samples by reverse transcription (RT)-PCR using CTVF (5'-TAATGGACGACGAACAAAGA-3') and CTVR (5'-CCAAGCTGCCTGACATTAGT-3') primers. Sequence analysis revealed high similarity, ranging from 91.1 to 99.8%, within CTV isolates detected in Jalalabad. In accordance with the phylogenetic groups previously defined (page 8 in: Proceedings of the 15th Conference of the International Organization of Citrus Virologists, 2002), nucleotide sequences of Afghan CTV isolates investigated in the current work cluster in Group 1 (J4 and J8), Group 4 (J61 and J76), and Group 5 (J101). In particular, J4 and J8 isolates show, respectively, identity of 99.4 and 99.2% with reference isolate T36 (GenBank Accession No. M76485) from the United States (Florida). Moreover, in Group 4, isolate J61 and J76 were more similar to ANO-1 isolate (GenBank Accession No. DQ211658) from Egypt (identity of 98.5 and 98.0%, respectively) than to isolate 443-4 (GenBank Accession No. AY791844) from Croatia (97.4 and 97.5%, respectively). Finally, isolate J101 in Group 5, shows identity of 95.6% with isolates C268-2 (GenBank Accession No. AY750770) and C269-6 (GenBank Accession No. AY750775) from Argentina. To our knowledge, our results identified for the first time CTV-infected plants in Afghanistan. The presence of CTV in four accessions of the national citrus collection is of concern for Afghan horticulture. Implementation of the certification schemes is therefore necessary to guarantee the production and the employment of virus-free propagating material.

Surface Modified Gold Nanorods in Two Photon Luminescence Imaging

Gold nanorods (AuNRs) possess unique optical properties which make them good contrast agents for optical microscopy. Their longitudinal plasmon resonance peak can be easily tuned from red to near infrared wavelength by increasing their aspect ratio to match the wavelengths of different imaging modalities. AuNRs are also stronger scatterers of light as compared with gold nanospheres. Nevertheless what sets them apart from other gold nanoparticles is their strong multiphoton luminescence. AuNRs are therefore being increasingly used as contrast agents for multiphoton microscopy of biological samples. In this study, control of the longitudinal resonance peak of gold nanorods is investigated with comparison of two chemical synthesis approaches. Both based on a seed-mediated method, one approach is to tune the aspect ratio through manipulation of the ratio of gold seeds to gold salt and the other is through variation of the volume of hydrochloric acid. The synthesized gold nanorods were made biocompatible by replacing the cytotoxic cetyltrimethylammonium bromide (CTAB) molecules with either silica (SiO2) or polyethylene glycol (PEG). Multiphoton imaging of gold nanorods taken up by cells was demonstrated and the effect of PEG chain length on passive uptake of gold nanorods by cells is discussed.

Neutron activation analysis and atomic absorption spectrophotometry for the analysis of fresh, pasteurised and powder milk

This study shows the application of semi-absolute k 0 instrumental neutron activation analysis (k 0-INAA), epithermal neutron activation analysis (ENAA) and atomic absorption spectrophotometry (AAS) for the determination of 21 elements (Br, Ca, Cl, Co, Cr, Cs, Cu, Fe, Hf, I, K, Mg, Mn, Na, Ni, P, Pb, Rb, Sc Sr, and Zn) in different types of milk samples. The ENAA was required for the determination of iodine, AAS for Cu, Ni and Pb and the rest of the elements were measured by k 0-INAA. Thirteen elements (Br, Ca, Cl, Cs, Cu, Fe, K, Mg, Na, P, Rb, Sr and Zn) were identified in all milk samples. Ni was detected in eleven and Pb in two samples. Concentrations of most of the elements were within the ranges of the world reported data. The data was further explored by principal component analysis to find relationships between samples and elements.

Pharmacotherapy-Based Problems in the Management of Diabetes Mellitus: Needs Much More to be Done!

A total of 856 diabetic patients were evaluated for pharmacotherapy-based problems like for possible drug interactions, adverse drug reactions, and other mismatches, if any. Poor correlation between the advised insulin therapy and patients’ fasting blood glucose levels (12%, n=103) was observed. To most of the patients (41.66%, n= 357), insulin therapy was advised in combination with glucocorticoides, thiazides diuretics, and propranolol. Prescribing beta blocker (propranolol) with insulin is contraindicated. The higher incidence of diabetic foot patients was in the mean age of 57±3.4 years that was controlled with combination therapy of insulin and oral antidiabetics (63.0%, n=516). 11.1% of the treated patients could not take the prescribed therapy due to poor acceptance of insulin therapy due to its syringe needle prick. 41.66% risks of potential drug interactions, 7.93% adverse drug reactions, and 6.6% mismatches were recorded, as per the international approved algorithm, for managing a diabetes mellitus that reflects poor health care system. All these events necessitate for coordinating with other health professionals to make the therapy safer in the better interest of the patients. It is concluded that in practice prescribing pattern carries more risks for patients. It is imperative to improve the practice of pharmacotherapeutics rather than to practice in routine.

Giant colonic mucocele following palliative surgery for metastatic adenocarcinoma

We report an unusual case of a giant colonic mucocele following ileo-sigmoid bypass surgery in a patient with advanced adenocarcinoma of the splenic flexure. The formation of a giant colonic mucocele resulted from distal splenic flexure obstruction due to tumour relapse and proximal caecal obstruction due to peritoneal disease with subsequent accumulation of mucus in the closed loop.

Src is a major signaling component for CTGF induction by TGF-beta1 in osteoblasts

Connective tissue growth factor (CTGF/CCN2) is induced by transforming growth factor beta1 (TGF-beta1) where it acts as a downstream mediator of TGF-beta1 induced matrix production in osteoblasts. We have shown the requirement of Src, Erk, and Smad signaling for CTGF induction by TGF-beta1 in osteoblasts; however, the potential interaction among these signaling pathways remains undetermined. In this study we demonstrate that TGF-beta1 activates Src kinase in ROS17/2.8 cells and that treatment with the Src family kinase inhibitor PP2 prevents Src activation and CTGF induction by TGF-beta1. Additionally, inhibiting Src activation prevented Erk activation, Smads 2 and 3 activation and nuclear translocation by TGF-beta1, demonstrating that Src is an essential upstream signaling partner of both Erk and Smads in osteoblasts. MAPKs such as Erk can modulate the Smad pathway directly by mediating the phosphorylation of Smads or indirectly through activation/inactivation of required nuclear co-activators that mediate Smad DNA binding. When we treated cells with the Erk inhibitor, PD98059, it inhibited TGF-beta1-induced CTGF protein expression but had no effect on Src activation, Smad activation or Smad nuclear translocation. However PD98059 impaired transcriptional complex formation on the Smad binding element (SBE) of the CTGF promoter, demonstrating that Erk activation was required for SBE transactivation. These data demonstrate that Src is an essential upstream signaling transducer of Erk and Smad signaling with respect to TGF-beta1 in osteoblasts and that Smads and Erk function independently but are both essential for forming a transcriptionally active complex on the CTGF promoter in osteoblasts.