Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial

BACKGROUND

This study investigated adhesive intestinal obstruction (AIO) and incisional hernia (IH) in patients undergoing laparoscopically assisted and open surgery for colorectal cancer.

METHODS

In a case-note review of patients randomized to the Medical Research Council's Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, primary and key secondary endpoints were AIO and IH admission rates respectively.

RESULTS

Of 411 patients, 11 were admitted for AIO: four (3.1 per cent) of 131 patients in the open arm of the trial versus seven (2.5 per cent) of 280 in the laparoscopic arm (difference 0.6 (95 per cent confidence interval (c.i.) - 2.9 to 4.0) per cent). Thirty-six patients developed IH: 12 (9.2 per cent) after open versus 24 (8.6 per cent) after laparoscopic surgery (difference 0.6 (95 per cent c.i. - 5.3 to 6.5) per cent). Results by actual procedure showed higher AIO and IH rates in the 24.5 per cent of patients who converted from laparoscopic to open surgery (AIO: 2.3, 2.0 and 6 per cent; IH: 8.6, 7.4 and 11 per cent-for open, laparoscopic and converted operations respectively).

CONCLUSION

Although this study has not confirmed that laparoscopic surgery reduces rates of AIO and IH after colorectal cancer surgery, trends suggest that a reduction in conversion to open surgery and elimination of port-site hernias may produce such an effect. Registration number for CLASICC trial: ISRCTN74883561 (http://www.controlled-trials.com).

Limits on new long range nuclear spin-dependent forces set with a K-3He comagnetometer

A magnetometer using spin-polarized K and 3He atoms occupying the same volume is used to search for anomalous nuclear spin-dependent forces generated by a separate 3He spin source. We measure changes in the 3He spin precession frequency with a resolution of 18 pHz and constrain anomalous spin forces between neutrons to be less than 2x10(-8) of their magnetic or less than 2x10(-3) of their gravitational interactions on a length scale of 50 cm. We present new limits on neutron coupling to light pseudoscalar and vector particles, including torsion, and constraints on recently proposed models involving unparticles and spontaneous breaking of Lorentz symmetry.

Palladium-catalyzed substitution of allylic fluorides

As unusual substrates for the Tsuji-Trost allylation reaction, allylic fluorides are responsive to palladium-catalyzed substitution. Their activity towards this reaction fits in the series OCO(2)Me>OBz>>F>>OAc. The classic stereoretention mechanism that involves sequential inversions does not operate in this case. Several distinct cases are considered.

Selective homogenous and heterogeneous catalysis

Catalysis of organic reactions by micellar aggregates in aqueous solution lacks synthetic utility in its present state, largely for two reasons: first, the selectivity attainable in a loose unstructured micelle is low, with little possibility of attaining the degree of substrate differentiation possible in enzymes, and, second, the scale of reaction is limited, since surfactant must be in large excess over reactant to avoid swamping of the catalytic effect. The discussion will cover initial attempts to overcome these drawbacks. Increased selectivity is apparent in the promotion of ester hydrolysis by micelles of asymmetric chain-functionalized surfactants. In the most favourable circumstances 3:1 discrimination in the rate of reaction of ester enantiomers may be observed. Increased scale of reaction is obtainable when polymer-linked cationic surfactants are used as insoluble catalysts, and these hold promise for various anionactivation reas are used as insoluble catalysts, and these hold promise for varous anion-activation reactions. Specific attention is given to mechanistic aspects of homogenous and heterogeneous catalysis.

Antigliadin antibodies in Cuban patients with spinocerebellar ataxia type 2

OBJECTIVE

To evaluate the significance of antigliadin antibodies (AGA) levels for spinocerebellar ataxia type 2.

METHODS

We determined AGA levels in 64 patients with spinocerebellar ataxia type 2 and in 65 healthy matched controls. The clinical assessment was carried out using the International Cooperative Ataxia Rating Scale and CAG repeat number was assessed by PCR.

RESULTS

Antibodies were positive in 23.4% of the ataxia patients and 9.09% of the controls. Statistical comparison using chi2 test with Yates's correction reveals significant differences between these two groups (chi2 = 3.94; p = 0.047). The same was obtained for strongly positive AGA (chi2 = 4.62; p = 0.032). There were no significant differences between AGA positive and AGA negative patients in age at onset, disease duration, ataxia score or CAG repeat number, neither in the prevalence of gastrointestinal symptoms, prevalence of wheat intolerance or body weight.

CONCLUSIONS

These results demonstrate an association between antigliadin antibodies serum levels and SCA2. However, more work has to be done to clarify the clinical consequences of such an association.

Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer

BACKGROUND

Intraoperative conversion from laparoscopically assisted to open surgery for colorectal cancer is thought to be influenced by several patient factors. Analysis of the Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) Trial data aimed to identify these risk factors.

METHODS

Of 488 laparoscopically assisted procedures attempted, 143 (29.3 per cent) were converted to open operation. Patient factors considered in multivariable analyses were age, sex, previous abdominal incisions, body mass index (BMI), tumour site, tumour diameter, pathological tumour (pT) and pathological node (pN) stage, extent of tumour spread from the muscularis propria, liver and peritoneal metastases, and American Society of Anesthesiologists (ASA) grade. As BMI was missing for 30.7 per cent of patients, two approaches were employed: one considered BMI as a possible risk factor and one did not.

RESULTS

When BMI was taken into consideration, male sex (odds ratio (OR) 2.07; P = 0.020), BMI (OR 1.10; P = 0.006) and extent of tumour spread from the muscularis propria (OR 1.08; P < 0.001) were independent predictors of conversion. When BMI was not considered, extent of tumour spread (OR 1.07; P < 0.001) and male sex (OR 2.05; P = 0.004) were again identified, as were tumour site (OR 2.11; P = 0.005) and ASA grade (II versus I, OR 0.92; III versus I, OR 2.74; P = 0.012).

CONCLUSION

Intraoperative conversion is more likely with larger BMI, in men, patients with rectal cancer, those graded ASA III or when there is greater local tumour spread.

Escherichia coli in household drinking water and diarrheal disease risk: evidence from Cambodia

Escherichia coli counts in household drinking water may or may not reliably indicate the presence of diarrheogenic pathogens originating in feces. The extent to which a bacterial indicator like E. coli predicts risks from all classes of pathogens (viruses and parasites as well as bacteria), especially in tropical waters, is uncertain. To investigate the association between E. coli in household drinking water and diarrheal diseases in Cambodia, we conducted a 22 week cohort study in a rural village in Kandal Province. Episodes of diarrhea (all) and bloody diarrhea (dysentery), water quality, water sources, and other covariates were monitored biweekly in 180 households. Households used a variety of water treatment, storage, and handling practices.Results suggest a weak but positive association between E. coli counts in household drinking water and diarrhea and for diarrhea with blood (dysentery), after adjusting for clustering within households and within individuals over time. Compared to households with <1 E. coli/100 ml in drinking water, there was no observed increased risk for having 1-10 E. coli/100 ml (LPR = 0.98, 95% CI 0.81-1.2 for diarrheal disease; LPR = 0.75, 95% CI 0.36-1.6 for dysentery). Households with measured E. coli of 11-100/100 ml did report increased diarrhea (LPR = 1.2, 95% CI 1.1-1.3 for diarrheal disease; LPR = 1.4, 95% CI 1.0-1.8 for dysentery), as did those with 101-1,000 E. coli/100 ml (LPR = 1.2, 95% CI 1.2-1.3 for diarrheal disease; LPR = 1.2, 95% CI 1.0-1.4 for dysentery) and those with >1,000 E. coli per 100 ml sample (LPR = 1.2, 95% CI 1.1-1.2 for diarrheal disease; LPR = 1.2, 95% CI 1.0-1.3 for dysentery). Unlike the results of some previous studies, diarrheal disease risks did not increase progressively in magnitude with increasing concentration of E. coli in drinking water.

Timing of breast cancer surgery in relation to menstrual cycle phase: no effect on 3-year prognosis: the ITS Study

The effect of breast cancer surgery timing during the menstrual cycle on prognosis remains controversial. We conducted a multicentre prospective study to establish whether timing of interventions influences prognosis. We report 3-year overall and disease-free survival (OS/DFS) results for ‘primary analysis’ patients (regular cycles, no oral contraceptives within previous 6 months). Data were collected regarding timing of interventions in relation to patients’ last menstrual period (LMP) and first menstrual period after surgery (FMP). Hormone profiles were also measured. Cox's proportional hazards model incorporated LMP in continuous form. Exploratory analyses used menstrual cycle categorisations of Senie, Badwe and Hrushesky. Hormone profiles with LMP and FMP data were also used to define menstrual cycle phase. Four hundred and twelve ‘primary analysis’ patients were recruited. Three-year OS from first surgery was 90.7, 95% confidence interval (CI) [87.9, 93.6%]. Menstrual cycle according to LMP was not statistically significant (OS: hazard ratio (HR)=1.02, 95%CI [0.995,1.042], P=0.14; DFS: HR=1.00, 95%CI [0.980,1.022], P=0.92). Timing of surgery in relation to menstrual cycle phase had no significant impact on 3-year survival. This may be due to 97% of patients receiving some form of adjuvant therapy. Survival curves to 10 years indicate results may remain true for longer-term survival.

The mast cell and allergic diseases: role in pathogenesis and implications for therapy

Mast cells have long been recognized for their role in the genesis of allergic inflammation; and more recently for their participation in innate and acquired immune responses. Mast cells reside within tissues including the skin and mucosal membranes, which interface with the external environment; as well as being found within vascularized tissues next to nerves, blood vessels and glandular structures. Mast cells have the capability of reacting both within minutes and over hours to specific stimuli, with local and systemic effects. Mast cells express the high affinity IgE receptor (FcepsilonRI) and upon aggregation of FcepsilonRI by allergen-specific IgE, mast cells release and generate biologically active preformed and newly synthesized mediators which are involved in many aspects of allergic inflammation. While mast cells have been well documented to be essential for acute allergic reactions, more recently the importance of mast cells in reacting through pattern recognition receptors in innate immune responses has become recognized. Moreover, as our molecular understanding of the mast cell has evolved, novel targets for modulation have been identified with promising therapeutic potential.