[Clinicopathological analysis of lymph node metastasis in colorectal adenocarcinoma]

OBJECTIVE

To analyze the correlation of lymph node metastasis with clinicopathological parameters and outcomes of colorectal adenocarcinoma, and to explore its clinicopathological significance.

METHODS

The lymph node metastasis and clinicopathological features of 133 colorectal adenocarcinoma patients whose specimens were interpreted in Department of Pathology of Beijing Tongren Hospital between February 2011 and August 2015 were retrospectively analyzed. The relationship between the lymph node metastasis and clinicopathological features as well as outcomes was also analyzed according to the follow-up data of these patients.

RESULTS

Among the 133 cases, 69 had lymph node metastasis, and the other 64 had no lymph node metastasis. Compared with the non-lymph node metastasis group, the lymph node metastasis group had higher prevalence of neural invasion (20.29% vs 3.13%) and vascular invasion (36.23% vs 3.13%), deeper tumor invasion (beyond the serosa: 1.45% vs 0), lower tumor differentiation (poorly differentiated: 26.09% vs 14.06%), higher mortality (11.59% vs 1.56%) and distant metastasis (17.39% vs 4.69%) (all P<0.05). In the lymph node metastasis group, intra-group comparison among patients of different lymph node N staging (N0, N1a, N1b, N2a, N2b) also showed statistically significant differences in neural invasion, vascular invasion, circumferential resection margin, maximum diameter of the tumor, depth of tumor invasion, tumor differentiation, survival, and distant metastasis (all P<0.05). There were no statistically significant differences between the patients with lymph node metastases <12 and those with lymph node metastases ≥12 in these clinicopathological parameters(all P>0.05).

CONCLUSIONS

Presence/absence of lymph node metastasis and lymph node stage may be correlated with neural invasion, vascular invasion, depth of tumor invasion, tumor differentiation, survival, and distant metastasis. However, no marked relationship was detected of the number of lymph node metastases (<12 or ≥12) with clinicopathological parameters and outcomes.

Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review

BACKGROUND AND AIMS

EUS-guided biliary drainage (EUS-BD) has emerged as an alternative procedure after failed ERCP. However, limited data on the efficacy and safety of EUS-BD are available. Therefore, a systematic review was conducted to evaluate the efficacy and safety of EUS-BD and to evaluate transduodenal (TD) and transgastric (TG) approaches.

METHODS

PubMed and EMBASE were searched to identify relevant studies published in the English language for inclusion in this systematic review and meta-analysis. Data from eligible studies were combined to calculate the cumulative technical success rate (TSR), functional success rate (FSR), and adverse-event rate of EUS-BD and the pooled odds ratio of TSR, FSR, and adverse-event rate of the TD approach when compared with the TG approach.

RESULTS

Forty-two studies with 1192 patients were included in this study, and the cumulative TSR, FSR, and adverse-event rate were 94.71%, 91.66%, and 23.32%, respectively. The common adverse events associated with EUS-BD were bleeding (4.03%), bile leakage (4.03%), pneumoperitoneum (3.02%), stent migration (2.68%), cholangitis (2.43%), abdominal pain (1.51%), and peritonitis (1.26%). Ten studies were included in the meta-analysis for comparative evaluation of TD and TG approaches for EUS-BD. Compared with the TG approach, the pooled odds ratio of the TSR, FSR, and adverse-event rate of the TD approach were 1.36 (95% CI, .66-2.81; P > .05), .84 (95% CI, .50-1.42; P > .05), and .61 (95% CI, .36-1.03; P > .05), respectively, which indicated no significant difference in the TSR, FSR, and adverse-event rate between the 2 groups.

CONCLUSIONS

Although it is associated with significant morbidity, EUS-BD is an effective alternative procedure for relieving biliary obstruction. There was no significant difference between the TD and TG approaches for EUS-BD.

[Necrotizing cervico-facial cellulitis of dental origin in a developing country]

INTRODUCTION

Necrotizing cellulitis of dental origin is a serious disease and requires prompt and effective management to avoid adverse outcomes. The purpose of this work is to describe the diagnostic and therapeutic difficulties encountered in this condition.

METHODS

This was a prospective study in the thoracic surgery department of Mali Hospital from January 2011 to February 2015. We collected consecutively 19 cases of complicating cervico-facial cellulitis of dental origin. The anatomical and clinical aspects, therapeutic modalities and difficulties are described.

RESULTS

Dental pain and fever were the predominant symptoms followed by cervical edema. Chest CT-scan was the basis for the diagnosis in all cases. Cervicotomy with debridement was the most performed surgical procedure. Pleural drainage was performed in 6 cases. Three patients (15.8%) died.

CONCLUSION

Necrotizing cellulitis of dental origin is a serious disease with high morbidity and mortality. The key radiological examination is the thoracic CT-scan. Early medico-surgical management by emergency care, tailored antibiotic therapy, removal of necrotizing tissues and drainage of collections are required to deliver a good outcome.

Stimulatory effect of the secretogranin-ll derived peptide secretoneurin on food intake and locomotion in female goldfish (Carassius auratus)

Secretoneurin (SN) is a conserved peptide derived by proteolytic processing from the middle domain of the ∼600 amino acid precursor secretogranin-II (SgII). Secretoneurin is widely distributed in secretory granules of endocrine cells and neurons and has important roles in reproduction as it stimulates luteinizing hormone release from the pituitary. A potential new role of SN in goldfish feeding is the subject of this study. Firstly, we established that acute (26 h; p<0.0001) and short-term (72 h; p=0.016) fasting increased SgIIa precursor mRNA levels 1.25-fold in the telencephalon, implicating SN in the control of feeding. Secondly, we determined that intracerebroventricular injections of the type A SN (SNa; 0.2 and 1 ng/g BW) increased food intake and locomotor behavior by 60 min. Fish injected with the lower and higher doses of SNa (0.2 and 1 ng/g) respectively exhibited significant 1.77- and 2.58-fold higher food intake (p<0.0001) than the saline-injected control fish. Locomotor behavior was increased by 1.35- and 2.26-fold for 0.2 ng/g SNa (p=0.0001) and 1 ng/g SNa (p<0.0001), respectively. Injection of 1 ng/g SNa increased mRNA levels of hypothalamic neuropeptide Y 1.36-fold (p=0.038) and decreased hypothalamic cocaine-and amphetamine-regulated transcript by 33% (p=0.01) at 2h and 5h post-injection, respectively. These data suggest interactions of SNa with stimulatory and inhibitory pathways of food intake control in fish.

A new descriptor for computer-aided diagnosis of EUS imaging to distinguish autoimmune pancreatitis from chronic pancreatitis

BACKGROUND AND AIMS

Computer-aided diagnosis of EUS images was quite useful in differentiating pancreatic cancer from normal tissue and chronic pancreatitis. This study investigated the feasibility of using computer-aided diagnostic techniques to extract EUS image parameters to distinguish autoimmune pancreatitis from chronic pancreatitis.

METHODS

A new descriptor, local ternary pattern variance, was introduced to improve the performance of the classification model. Patients with autoimmune pancreatitis (n = 81) or chronic pancreatitis (n = 100) were recruited for this study. Representative EUS images were selected, and 115 parameters from 10 categories were extracted from the region of interest. Distance-between-class and sequential forward selection algorithms were used for their ideal combination of features that allowed a support vector machine predictive model to be built, trained, and validated. The accuracy, sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were used to evaluate the performance of experimental results.

RESULTS

Fourteen parameters from 3 categories were selected as an ideal combination of features. The sample set was randomly divided into a training set and a testing set by using two different algorithms-the leave-one-out algorithm and the half-and-half method. The half-and-half method yielded an average (± standard deviation) accuracy of 89.3 ± 2.7%, sensitivity of 84.1 ± 6.4%, specificity of 92.5 ± 3.3%, PPV of 91.6 ± 3.7%, and NPV of autoimmune pancreatitis of 88.0 ± 4.1%.

CONCLUSIONS

This study shows that, with the local ternary pattern variance textural feature, computer-aided diagnosis of EUS imaging may be valuable to differentiate autoimmune pancreatitis from chronic pancreatitis. Further refinement of such models could generate tools for the clinical diagnosis of autoimmune pancreatitis.