Outcomes of patients with esophageal and gastric cancer in Sri Lanka: A retrospective survival analysis

Introduction

Esophageal carcinoma is the fourth most common cancer among males and sixth most common cancer among females in Sri Lanka. Gastric cancer is less common, but its incidence is gradually rising. We conducted a retrospective analysis of survival of esophageal and gastric cancer patients treated at National Cancer Institute, Maharagama, Sri Lanka.

Methodology

Patients with esophageal and gastric cancer treated in three selected oncology units of the National Cancer Institute, Maharagama during 2015 and 2016 were included in the study. Data on clinical and pathological factors were extracted from clinical records. Overall survival (OS), defined as time to death or loss to follow-up, was the primary endpoint. Univariate and multivariate analyses of survival were performed using the log-rank test and Cox proportional-hazard model, respectively.

Results

The study population comprised 374 patients with a median age of 62 years (interquartile range 55-70). Majority (64%) were male and had squamous cell carcinoma (58%). In the sample, 20% were gastric cancers, while 71% were esophageal cancers, and 9% had gastro-esophageal junction tumors. The 2-year OS was 19% in patients treated with curative intent (95% confidence interval [CI] 14-26 months) with those receiving neoadjuvant chemotherapy, followed by radical surgery having the highest survival (P < 0.001, hazard ratio 0.25 [95% CI 0.11-0.56]). Median OS was 2 months (95% CI 1-2 months) in patients treated with palliative intent.

Conclusion

Our results suggest that the outcome of patients with esophageal and gastric cancer is poor in Sri Lanka. Early detection and greater utilization of multimodality treatment could improve outcomes of these patients.

Coronary inflammation by computed tomography pericoronary fat attenuation in young male anabolic androgenic steroid users

Background

The illicit use of anabolic androgenic steroids (AAS) has been associated with diminished cholesterol efflux mediated by HDL, remarkable decrease in high-density lipoprotein (HDL) plasma concentration and subclinical coronary artery disease (CAD). Inflammation is the key to the atherogenic process associated with atherosclerotic plaque vulnerability. The pericoronary mean fat attenuation (pFAM) has emerged as a marker of coronary inflammation and can predict future cardiovascular events, which is measurable from standard coronary computed tomography angiography (CCTA). However, whether AAS abuse has a role in pFAM in young male AAS users is unknown.

Purpose

The aim of this study was to evaluate whether AAS abuse could leads to higher pFAM and premature coronary inflammation in young male AAS users.

Methods

Twenty strength-trained AAS users (AASU) age 29±5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled in this study. Coronary inflammation was assessed by pFAM-CCTA in the right coronary artery (RCA), left anterior descending artery (LDA) and left circumflex coronary artery (Cx).

Results

pFAM in the RCA was significantly higher in AASU compared with AASNU and SC (−64.59±9.45 vs. −79.21±6.67 vs. −80.97±7,91 Hounsfield Units (HU), respectively, p&lt;0.001]. Also, the pFAM in the LAD was higher in AASU compared with AASNU and SC (−72.83±7.21 vs. −79.41±6.72 vs. −80.97±7.72 HU, p=0.006). However, no difference to pFAM in the Cx between AASU, AASNU and SC (−74.30±5.85 vs. −79.77±7.13 vs. −78.19±5.82 HU, respectively, p=0.069) was found.

Conclusion

This study indicates that AAS abuse may be associated with higher pFAM and premature coronary inflammation in the RCA and LAD. The higher pFAM may be linked to early development of CAD in young AAS users.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Fundação Zerbini

Curative-Intent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck in Sri Lanka: The Impact of Radiotherapy Technique on Survival

AIMS

We conducted a retrospective analysis of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with curative-intent radiotherapy at the National Cancer Institute of Sri Lanka to determine the impact of the treatment technique on disease-free survival (DFS).

MATERIALS AND METHODS

SCCHN patients treated with radical radiotherapy or adjuvant postoperative radiotherapy from 2016 to 2017 were included in the study. Data on the following variables were collected by reviewing clinical and radiotherapy treatment records: age, gender, tumour site, stage, time to delivery of radiotherapy, use of neoadjuvant chemotherapy, use of concurrent radiosensitising chemotherapy and treatment technique. DFS, defined as the time to death, tumour recurrence or loss to follow-up, was the primary end point and outcomes were compared between patients treated with intensity-modulated radiotherapy (IMRT) in linear accelerators and those treated with conventional radiotherapy in cobalt teletherapy units. Univariate and multivariate analyses were carried out on known prognostic variables.

RESULTS

In total, 408 patients were included in the study, with 138 (34%) being treated with IMRT in the linear accelerator. More than 75% of patients were of stage III or IV at diagnosis. The 2-year DFS of the whole cohort was 25% (95% confidence interval 21-30%). Patients treated with IMRT in the linear accelerator had a superior DFS in comparison with those treated with conventional radiotherapy in the cobalt teletherapy units (P < 0.001, hazard ratio 0.64, 95% confidence interval 0.5-0.82). Higher stage, cobalt treatment and use of neoadjuvant chemotherapy were adversely associated with DFS on multivariate analysis.

CONCLUSION

A large proportion of patients with SCCHN treated with curative-intent radiotherapy in Sri Lanka had locally advanced disease and DFS was superior in patients treated with IMRT in the linear accelerator.

Differences in methane production, yield and intensity and its effects on metabolism of dairy heifers

The effects of divergent phenotypic classification in crossbreed Holstein × Gyr dairy heifers for methane emissions in relation to performance, digestibility, energy and nitrogen partition, blood metabolites and temperature of body surface were evaluated. Thirty-five heifers were classified as high and low emission for CH₄ production (g/day), yield (g/kg dry matter intake) and intensity (g/kg average daily gain). Digestibility was evaluated by total collection of feces and urine. Gas exchanges were obtained in open-circuit respiratory chambers. A completely randomized design was used and divergent groups were compared by Fisher's test. No differences were found in intake traits between groups of CH₄ production and intensity. The low yield group had higher intake. For digestibility and temperature at different body sites were no differences between variables. High production group had higher energy losses as methane and heat production. Low intensity group had higher digestible energy, energy balance and ratio between metabolizable and digestible energy. Urinary nitrogen was 14.3% lower for low production group. There was a difference between methane yield divergent groups for nitrogen intake, digestible and retained. Energy and nitrogen partitioning traits are correlated to the animals divergent for methane production and yield. The low production group presented lower blood insulin concentration. It was not possible to identify divergent animals for CH₄ emission using the infrared thermography technique.

Association between bovine digital dermatitis and annual periods of lower pluviometric precipitation in Central Brazil

We aimed to follow the epidemiologic evolution of bovine digital dermatitis (BDD) and other podal diseases grouped in a dairy farm in Central Brazil between the years 2010 and 2016. This study was carried out in a farm in Jataí, Goiás, Central Brazil, where the prevalence data of bovine digital dermatitis (BDD) and other podal diseases, as well as the composition, history, and management of the herd, was collected. We analyzed the collected data into the two annual pluviometric precipitation values in Central Brazil: rainy season and dry season. The cumulative frequency for comparison of prevalence between seasons throughout the years was calculated from 2011 to 2016. The comparison was carried out by post hoc chi-square test with the Bonferroni correction adopting a level of significance of 5% (p < 0.05). BDD was not diagnosed at the property in 2010; however, the disease became endemic from 2011, which coincides with the arrival of new animals to the herd. The comparison of the accumulated frequencies for prevalence of the diseases in the herd between 2011 and 2016 revealed BDD, as well as the grouped nutritional and metabolic foot diseases, has the highest prevalence in the period of lower annual precipitation in Central Brazil, which occurs between May and October. For a better control of BDD, we recommend greater attention in cattle management in the dry season of the year in Brazil, as well as in any other place in the world in which rainfall is seasonal.

Molecular features related to the binding mode of PPARδ agonists from QSAR and docking analyses

Diabetes affects approximately 4% of world's population and metabolic syndrome has been directly related to obesity. There is a class of nuclear receptors, peroxisome proliferator-activated receptors (PPARs), which controls the metabolism of carbohydrates and lipids. It has been considered an attractive target to treat diabetes and metabolic syndrome. Accordingly, the primary objective of this study was to employ molecular modelling techniques to understand the factors involved in PPARδ activation. The QSAR models obtained showed good internal and external consistency and presented good validation coefficients (QSAR: q(2) = 0.83, r(2) = 0.87; HQSAR: q(2) = 0.73, r(2) = 0.90; CoMFA: q(2) = 0.88, r(2) = 0.94). The selected properties and the contour maps described the possible interactions between the PPARδ receptor and its agonists. From these findings, it is possible to propose molecular modifications to design new compounds with improved biological properties.

Blindness after Blunt Facial Trauma: Are There Any Clinical Clues to Early Recognition?

BACKGROUND

Vision-threatening injury is a relatively rare but devastating complication of maxillofacial trauma. Identification is not always straightforward. The purpose of this study was to look at our experience of blindness after blunt facial injuries to see whether any useful patterns or risk factors were identified to assist in early recognition.

METHODS

This was a retrospective, qualitative study undertaken at the University Hospital of North Staffordshire. All case notes, plain radiographs, and computed tomographic scans were reviewed and the relevant data collated.

RESULTS

Over a 10-year period, 17 patients were identified in which loss of vision occurred secondary to blunt injury to the face.

CONCLUSION

It is important to maintain a high index of suspicion when dealing with maxillofacial trauma, particularly if the patient is not cooperative. We provide a list of salient features to look for in the examination and history to aid the clinician.

The alga Bryothamnion seaforthii contains carbohydrates with antinociceptive activity

Bryothamnion seaforthii, a red alga common to the Northeastern coast of Brazil, was used to prepare the protein fraction F0/60 by ammonium sulfate precipitation. The chromatography of F0/60 on DEAE-Sephadel column resulted in two lectin fractions, PI and PII, which have antinociceptive properties in rodents. We determined the antinociceptive activity of the PII fraction and of a carbohydrate-containing fraction (CF) in mice. The CF was prepared from the dried algae, after digestion with 100 mM sodium acetate, pH 6.0, containing 5 mM cysteine, EDTA and 0.4% papain, at 60 masculine C. A 10% cetylpyridinium chloride was added to the filtrate, and the precipitate was dissolved with 2 M NaCl:ethanol (100:15, v/v) followed by the carbohydrate precipitation with ethanol. The final precipitate, in acetone, was dried at 25 masculine C. The PII fraction markedly inhibited acetic acid-induced abdominal writhing after ip administration (control: 27.1 +/- 2.20; PII 0.1 mg/kg: 5.5 +/- 1.85; 1 mg/kg: 1.6 +/- 0.72 writhes/20 min) and after oral administration (control: 32.0 +/- 3.32; PII 0.1 mg/kg: 13.1 +/- 2.50; 1 mg/kg: 9.4 +/- 3.96 writhes/20 min). PII was also effective against both phases of pain induced by 1% formalin (control, ip: 48.2 +/- 2.40 and 27.7 +/- 2.56 s; PII: 1 mg/kg, ip: 34.3 +/- 5.13 and 5.6 +/- 2.14 s; control, po: 44.5 +/- 3.52 and 25.6 +/- 2.39 s; PII 5 mg/kg, po: 26.5 +/- 4.67 and 15.3 +/- 3.54 s for the 1st and 2nd phases, respectively) and in the hot-plate test. The CF (ip) also displayed significant antinociceptive properties in all tests but at higher doses (1 and 5 mg/kg, ip and po). Thus, CF at the dose of 5 mg/kg significantly inhibited writhes (ip: 7.1 +/- 2.47 and po: 14.5 +/- 2.40 writhes/20 min) as well as the 1st (po: 19.6 +/- 1.74 s) and 2nd (po: 7.1 +/- 2.24 s) phases of the formalin test compared to controls ip and po. The antinociceptive effects of both the PII and CF in the formalin and hot-plate tests were prevented at least partially by pretreatment with the opioid receptor antagonist naloxone (2 mg/kg, sc). Moreover, both fractions retained antinociceptive activity in the acetic acid-induced writhing test following heating, a procedure which abolished the hemagglutinating activity of the fraction, presumably due to lectins also present. Finally, both fractions also prolonged the barbiturate-induced sleeping time. These results indicate that carbohydrate molecules present in the PII (26.8% carbohydrate) and CF (21% of the alga dried weight) obtained from B. seaforthii display pronounced antinociceptive activity which is resistant to heat denaturation and is mediated by an opioid mechanism, as indicated by naloxone inhibition.

[Comparison of conductivity with sodium determination in the same sweat sample]

OBJECTIVE: To correlate sweat conductivity by Wescor with quantitative sodium determination in the same sample. METHODS: We analyzed 206 sweat samples, being 31 obtained from patients with cystic fibrosis (CF). Sweat was collected by quantitative pilocarpine iontophoresis in the Macroduct system for 30 minutes. Samples were immediately determined by Sweat-Chek analyzer (Wescor) and sodium quantification with a flame photometer. RESULTS: In non-CF subjects sweat (n=175), mean conductivity and quantitative sodium were 41mmol/L (16-75mmol/l) and 36mEq/ l (12-75mEq/l) respectively. In CF subjects (n=31), mean values of conductivity and sodium were 119mmol/L (84-155mmol/l) and 113mEq/l (80 - 146mEq/l) respectively. None of CF patients showed values lower than 80mmol/L. There was a correlation between sweat conductivity and sodium determination (r= + 0.99; p<0.0001). CONCLUSION: Sweat conductivity by Wescor simplifies the analysis with lower volumes and is well correlated to sodium concentration.

[Multicentric myxoid, metachronous and synchronous and multifocal liposarcoma: report of a case]

A case of a male patient, 66 years old, who exhibited in a period of six years many multicentric and multifocal synchronic and metachronic myxoid liposarcomas is reported. The authors made a revision of cytogenetics and DNA alterations recently identified in this type of tumor. The chromosomic alterations are represented by the translocation t(12;16) (q13;p11) and trisomy of the chromosome 8. The genic analysis revealed the presence of altered restriction fragments due to highly specific and reproducible methylation differences. In conclusion the authors suggest that the presence of the multiple tumors of this type in the same patient could be due to a common etiologic factor, not yet known, as being the initiator of this systemic illness of the fat tissue.

[Gastric epithelioid leiomyosarcoma simulating pancreatic pseudocyst. Report of a case and review of the literature]

The authors report a case of malignant gastric leiomyoblastoma (epithelioid leiomyosarcoma) which was mistaken for a pseudocyst of the pancreas. The patient was operated several times in another hospital. At one of the operations a cystogastrostomy was performed. In november, 1989, when operated again by us, a large tumoral mass arising from the posterior gastric wall was found. The histopathological diagnosis was leiomyoblastoma of the stomach. It is concluded that the wall of a pancreatic cystic lesion should always be submitted to histologic examination in order to be excluded the possibility of a malignant neoplasm.