Clinical profile of 1208 newly diagnosed colorectal cancer patients in Tamil Nadu-A multi-centric survey

BACKGROUND

An increasing incidence of colorectal cancer (CRC) is being reported in developing countries, including India. Most Indian studies on CRC are retrospective and single-centered. The present study is an attempt to understand the current clinical profile and stage of newly diagnosed CRCs across multiple centers in Tamil Nadu, India.

METHODS

A multi-centric observational survey was conducted between September 1, 2021, and August 31, 2022, under the aegis of the Indian Society of Gastroenterology - Tamil Nadu chapter. Patients 18 years of age and older with a recent diagnosis of CRC fulfilling the inclusion criteria were prospectively recruited at the participating centers. Their demographic, clinical, biochemical, endoscopic, histopathologic, radiologic and risk factor details were systematically collected and analyzed.

RESULTS

Across 23 centers in Tamil Nadu, 1208 patients were recruited. The male:female ratio was 1.49:1, while mean (SD) age was 57.7 (13.5) years. A majority (81.9%) were Tamils and 78.5% belonged to lower socioeconomic classes. The predominant symptoms were hematochezia (30.2%) and a change in bowel habits (27.5%). The most common locations were the rectum (34.3%) and rectosigmoid (15.1%). Synchronous CRCs were seen in 3.3% and synchronous colorectal polyps in 12.8%. Predisposing factors for CRC were seen in 2%. A past history of any cancer among CRC patients was obtained in 3.1% and a family history of any cancer was found in 7.6%. Patients who were either overweight or obese constituted 46.4% of the study population. At presentation, the predominant stages were stage III (44.7%) and stage IV (20.8%).

CONCLUSIONS

A majority of patients with newly diagnosed CRC in Tamil Nadu belonged to the lower socioeconomic classes. About 60% had CRCs located within the reach of the flexible sigmoidoscope. Two-thirds of the patients exceeded stage II disease at presentation.

TRIAL REGISTRATION

Not applicable.

Radiopaque fibrin nanocomplex as a promising tool for X-ray imaging applications

The raising burden of cancer can be controlled by fabricating smart nanomaterials that can detect tumours easily. In this study, we report about the preparation of radiopaque fibrin nanocomplex (RFN) for imaging solid tumours. The nanocomplex exhibits high X-ray absorption and therefore utilizes X-ray radiography and computed tomography (CT) for imaging tumours. The CT images taken after intratumoral administration of RFN in tumor bearing mice displayed excellent visibility of tumour. Moreover, increased amount of RFN was seen at the site of tumour after 45 min of post-injection. These research findings prove the promising use of RFN as a valuable tool for imaging solid tumours.

Challenges faced in the management of complicated Boerhaave syndrome: a tertiary care center experience

Spontaneous esophageal perforation is rare and is associated with high morbidity and mortality. A spectrum of various surgical modalities ranging from primary surgical repair to esophagectomy is available for its management. The optimal management of patients presenting late in a hemodynamically stable condition is not clearly defined in the literature. A retrospective review of all patients with Boerhaave syndrome managed by a single surgical team in a tertiary care center between 2008 and 2019 was performed (n = 16). Eleven patients were initially managed in the medical intensive care unit (MICU) as non-esophageal cause and 5 patients were referred after failed management (conservative/endoscopic). Demographics, clinical presentation, characteristics of perforation, initial diagnosis, and treatment were analyzed. All patients were males with a mean age of 42.2 years. A history of ethanol use was present in 6 patients. The median delay in diagnosis and referral was 16 days (range: 11-40 days). The common presenting symptoms were chest pain (n=11), dyspnoea (n=10), vomiting (n=4) and cough (n=2). The perforation was directed into right, left, and bilateral pleural cavities in 6, 8, and 2 patients respectively. The location of perforation was distal esophagus except for one patient. One patient was successfully treated with conservative management. The remaining patients underwent esophagectomy as a definitive surgical procedure. There was no significant postoperative morbidity and mortality. Esophagectomy can be done as a one-stage definitive procedure for patients with Boerhaave syndrome who present late in a hemodynamically stable condition with acceptable morbidity and good long term outcome.

Indian Association of Gastrointestinal Endo Surgeons COVID-19 endoscopy recommendations

These are recommendations from the Indian Association of Gastro Intestinal Endo Surgeons for safe performance of diagnostic and therapeutic endoscopy during the COVID-19 pandemic.

Surgical practice recommendations for minimal access surgeons during COVID 19 pandemic - Indian inter-society directives

These are inter-society guidelines for performance of laparoscopic surgery during COVID-19 pandemic that has affected the way of surgical practice. The safety of healthcare workers and patients is being challenged. It is prudent that our surgical practice should adapt to this rapidly changing health environment. The guidance issued is based on global practices and national governmental directives. The Inter-Society Group urges you to be updated with the developing situation and evolving changes.

Gastric cancer in India: epidemiology and standard of treatment

India has a low incidence of gastric cancer. It ranks among the top five most common cancers. Regional diversity of incidence is of importance. It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44. Helicobacter pylori carcinogenesis is low in India. Advanced stage at presentation is a cause of concern. Basic and clinical research in India reveals a globally comparable standard of care and outcome. The large population, sociodemographic profile and challenges in health expenditure, however, remain a major challenge for health care policy managers. The newer formation of National Cancer Grid, integration of national databases and the creation of social identification database Aadhaar by The Unique Identification Authority of India are set to enhance the health care provision and optimal outcome.

Macrophages mediated diagnosis of rheumatoid arthritis using fibrin based magnetic nanoparticles as MRI contrast agents

BACKGROUND

A variety of bioimaging tools assists in the diagnosis and evaluation of rheumatoid arthritis (RA) and other osteoarthritis. However, detection of RA in the early stages by targeting its macrophages with suitable contrast agents will help in arresting the progression of the disease.

METHODS

In the present study, we investigated the effectiveness of using magnetic fibrin nanoparticles (MFNPs) conjugated with folic acid (FA-MFNPs) as a specific contrast agent to target the activated macrophages, which overexpress the folate receptors (FR) in the knee joints of rats with antigen-induced arthritis (AIA).

RESULTS

FA-MFNPs were spherical with an average size of 18.3±1.6nm. In vitro studies have shown effective internalization of FA-MFNPs into the Raw264.7 macrophage cells. In vivo studies were carried out by injecting FA-MFNPs intravenously into the arthritic rats. The results showed enhanced MR imaging in the synovium of arthritic joints. Prussian blue histological staining confirmed uptake of FA-MFNPs by macrophages in the synovial tissue.

CONCLUSION

The animal experiment results indicate that FA-MFNPs can be used as a specific MRI contrast agent in identifying phagocytic active macrophages in the synovial joints.

GENERAL SIGNIFICANCE

Blood is the precursor source for synthesising the fibrin-based iron oxide (magnetic) nanoparticles (MFNPs) with diameters between 12 and 15nm. It has excellent superparamagnetic behaviour, biocompatibility, osteogenic potency, hemocompatibility, and biodegradable properties. MFNPs-based nanocomposites might be a promising contrast agent for bioimaging.

Neuro-Fuzzy-Based Control for Parallel Cascade Control

This paper discusses the application of adaptive neuro-fuzzy inference system (ANFIS) control for a parallel cascade control system. Parallel cascade controllers have two controllers, primary and secondary controllers in cascade. In this paper the primary controller is designed based on neuro-fuzzy approach. The main idea of fuzzy controller is to imitate human reasoning process to control ill-defined and hard to model plants. But there is a lack of systematic methodology in designing fuzzy controllers. The neural network has powerful abilities for learning, optimization and adaptation. A combination of neural networks and fuzzy logic offers the possibility of solving tuning problems and design difficulties of fuzzy logic. Due to their complementary advantages, these two models are integrated together to form more robust learning systems, referred to as adaptive neuro-fuzzy inference system (ANFIS). The secondary controller is designed using the internal model control approach. The performance of the proposed ANFIS-based control is evaluated using different case studies and the simulated results reveal that the ANFIS control approach gives improved servo and regulatory control performances compared to the conventional proportional integral derivative controller.

p53 and its influence in adenocarcinoma stomach

e15685

Background: Gastric cancer is the second most common cause of the malignancy in the world after lung cancer. Various pathogenesis have been given for the adenocarcinoma, like mutation in the E-catherin gene, amplification of COX-2, HGF/ SF, VEGF; deletion of FHIT, APC, p53 but none have provided a definite target for treatment. Methods: This is a immunohistochemical prospective experiment study done on 76 cases of Gastric Adenocarcinoma.The location of the tumors were recorded as in the proximal stomach (fundus and body) and distal stomach (antrum, prepylorus, and pylorus). PAb1801 clonewas obtained from the ZYMED LABORATRIES, San Franscisco. A standardised immunohistochemical method was followed in this study. Results: p53 mutations were seen 41 out of 76 cases(53.95%). And 23 out of 41(56.09%) cases of p53 expression of the total mutated cases expressed p53 100%. 20 out of 36 cases (55.55%) of age below 60 yrs and 21 out of 40 cases (52.55%) of age above 60 yrs were p53 positive. 33 out of 60 (55%)of the males and 8 out of 16 (50%) females were reported of having gastric adenocarcinoma with p53expression. The histology of the tissue samples from the gastric adenocarcinoma patients had following relationship with the p53 immunoreactivity, 20 out of 37 cases(54.05%) of the well differentiated,7 out of 17 cases (41.18% )of the moderately differentiated, and and 13 out of 21 cases(61.90%) of the poorly differentiated gastric adenocarcinoma showed positive immunoreactivity. 15 out of 33 cases (45.45%)were localized to the proximal stomach and 30 out of 52 cases (57.69%)were localized to the distal stomach. 52.63 % of the non-mucinous type of gastric adenocarcinoma showed positive p53 immunoreactivity. Conclusions: The TP53 mutation is slightly more common in males than females, with greater occurrence in the late years of life. The mutation is more marked in the poorly differentiated gastric adenocarcinoma. The antral, pylorus,and the prepyloric parts of the stomach( the distal stomach) are more prone for mutated p53 induced adenocarcinoma.

No significant financial relationships to disclose.

Hedgehog signaling: Gli2 and its influence in squamous esophageal cancer

e15596

Background: Gli family zinc finger proteins are mediators of Sonic hedgehog (Shh) signaling and are implicated as potent oncogenes. Gli2 plays a dual role as activator of keratinocyte proliferation and repressor of epidermal differentiation. This study is to determine the expression pattern and the extent of Hh-signaling molecule(Gli2) in squamous cell carcinoma of oesophagus. Methods: A prospective immunohistochemical experimental study was done to identify the expression of Gli2 in 64 cases of squamous cell carcinoma of oesophagus. The study population consisted of patients of the age group 38–87 yrs. The cases consisted of 29 cases of keratinised squamous cell carcinoma.. Of the 64 cases, 20 were well differentiated, 9 moderately differentiated and 35 poorly differentiated tumours. Results: See Table . Gli2 expression was 25%. The cytoplasmic expression is positive in 9 cases and nuclear expression is positive in 5 cases. The average intensity of cytoplasmic expression was more than that of nuclear expression.Gli2 is less expressed in elderly cancers.Gli2 expression is comparatively more in upper third tumours. There were no obvious differences amongst the sex, differentiation and keratinization. The reason can be attributed to the fact that Hh signalling pathway works in a time, concentration and position dependent manner.Conclusions: Deregulation of Hh signalling will result in defective proliferation and differentiation of cells. These findings can be used for better prognosis of the patients by using stem cell therapy and HH pathway inhibitors in the treatment for squamous cell carcinomas of oesophagus. Protein kinase A (Pka) maintains the Gli transcription factors in an inactive state, so activation of Pka with agonists such as forskolin would prevent Gli-mediated activation of target-gene transcription. Gli can also be inhibited at the RNA level by targeting its transcripts with antisense oligonucleotides. To the best of our knowledge, this is the first study of expression of Gli2 in squamous cell carcinoma of oesophagus. [Table: see text]

No significant financial relationships to disclose.