Comparison of Clinicopathological and Survival Features of Right and Left Colon Cancers: Experience of the Medical Oncology Department of Fez

Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) have different epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. The objective of our study is to compare right-sided colon cancers and left-sided colon cancers regarding clinicopathological and survival characteristics. This is a retrospective study of 664 patients with colon cancer treated at the medical oncology department of Fez over a period from December 2009 to September 2020. Rectosigmoid, descending colon, and splenic flexure tumors were considered left-sided colon cancers, whereas ascending colon tumors were considered right-sided colon cancers. The Kaplan Meier method was used to estimate median survival. The study included 664 patients (female, 47%) having colon cancer with a median age of 60 years (23 - 83). Of the patients, 78.5% (n = 519) had LCC and 19.36 % (n = 128) had RCC. The rate of patients aged ≥ 65 years and the rate of patients with a family history of colon cancer was higher in the LCC patients. The proportion of poorly differentiated adenocarcinomas represented 3%, of which 63% had cancer of the right colon. There was a significantly higher proportion of higher T stage (T3-4: 62% vs 38%) in right sided tumors as compared to left sided tumors. The rate of metastatic patients was 64.1% in the RCC group and 43% in the LCC group. The median follow-up period was 14 months in the RCC group and 19 months in the LCC group with higher median overall survival in the LCC group (32 vs 21 months). We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage associated with a median overall survival better in left colon cancer.

Expression of cyclin-dependent kinase 9 is positively correlated with the autophagy level in colon cancer

BACKGROUND Cyclin-dependent kinase 9(CDK9)expression and autophagy in colorectal cancer(CRC)tissues has not been widely studied.CDK9,a key regulator of transcription,may influence the occurrence and progression of CRC.The expression of auto-phagy-related genes BECN1 and drug resistance factor ABCG2 may also play a role in CRC.Under normal physiological conditions,autophagy can inhibit tumorigenesis,but once a tumor forms,autophagy may promote tumor growth.Therefore,understanding the relationship between autophagy and cancer,partic-ularly how autophagy promotes tumor growth after its formation,is a key motivation for this research.AIM To investigate the relationship between CDK9 expression and autophagy in CRC,assess differences in autophagy between left and right colon cancer,and analyze the associations of autophagy-related genes with clinical features and prognosis.METHODS We collected tumor tissues and paracarcinoma tissues from colon cancer patients with liver metastasis to observe the level of autophagy in tissues with high levels of CDK9 and low levels of CDK9.We also collected primary tissue from left and right colon cancer patients with liver metastasis to compare the autophagy levels and the expression of BECN1 and ABCG2 in the tumor and paracarcinoma tissues.RESULTS The incidence of autophagy and the expression of BECN1 and ABCG2 were different in left and right colon cancer,and autophagy might be involved in the occurrence of chemotherapy resistance.Further analysis of the rela-tionship between the expression of autophagy-related genes CDK9,ABCG2,and BECN1 and the clinical features and prognosis of colorectal cancer showed that the high expression of CDK9 indicated a poor prognosis in colorectal cancer.CONCLUSION This study laid the foundation for further research on the combination of CDK9 inhibitors and autophagy inhibitors in the treatment of patients with CRC.

Influence of High-Velocity Blood Flow on Right-to-Left Shunt in Patients with Patent Foramen Ovale during the Valsalva Maneuver

In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population consisted of 57 patients with symptoms highly suggestive of a PFO. These patients had been diagnosed with apsychia, migraine with aura, cerebral infarction, transient ischemic attack (TIA), and cerebral ischemia with unknown cause. Routine echocardiography was performed in all patients to rule out a cardiac malformation. Contrast-transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) were used to visualize and quantify the RLS. The standard apical four chamber view was used to observe the changes of E peak, A peak, and velocity-time integral (VTI) ratio of tricuspid blood flow during the strain phase and release phase of the Valsalva maneuver. Paired t-test was used to compare E peak, A peak, and VTI ratio of tricuspid blood flow during the different phases. The right-to-left shunt across the PFO (PFO-RLS) was graded in the two phases and compared by Kruskal-Wallis test. Compared with the strain phase of the Valsalva maneuver, the parameters of E, A, and VTI in diastolic period in patients with PFO-RLS at the release phase were significantly increased [54.30 ± 13.65 cm/s vs 100.35 ± 21.11 cm/s, 42.21 ± 12.32 cm/s vs 57.30 ± 18.88 cm/s, 10.34 ± 3.27 cm/s vs 19.58 ± 4.56 cm/s, respectively], and the difference was statistically significant. The positive consequence of PFO-RLS, as diagnosed by c-TTE with the Valsalva maneuver at the release phase of the Valsalva maneuver, was significantly higher than that at the strain phase of the Valsalva maneuver. At the beginning of release phase of the Valsalva maneuver, decreased intrathoracic pressure led to increased venous backflow into the right atrium. Thus, high-velocity blood flow rapidly pushed the PFO open, which resulted in a significant increase in the PFO-RLS. Therefore, the increase of the PFO-RLS during the Valsalva maneuver is caused by the impact of high-velocity blood flow the PFO.

Left Radial Approach versus Right Radial Approach of Coronary Angiography in the Diagnosis of Coronary Heart Disease

Background: Transradial coronary angiography has established itself as safe alternative to transfemoral approach. Today, the artery of approach lies completely on the operator’s choice. The Right Radial Approach (RRA) has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side. The Left Radial Approach (LRA) has always been a neglected route. LRA does have many advantages over the right, the vascular anatomy being one of them. The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Method: A total of 70 cases of Coronary Angiography (CAG) with normal Allen test and satisfying the inclusion criteria were prospectively observed and studied after randomly assigning them into two equal groups, LRA (Left Radial Approach) n = 35 and RRA (Right Radial Approach) n = 35. Multipurpose TIG (Tiger) catheter was used in both the approaches to catheterize the right as well as left coronary artery. Results: The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time. Conclusions: The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.

Consideration of the Necessity of Prophylactic Bypass Grafting for Anomalous Origin of the Right Coronary Artery—Based on a Case with Concomitant Left Main Trunk Disease Resuscitated from Cardiopulmonary Arrest

Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.

A Case of Premature Ventricular Complexes from the Proximal Left Bundle Branch Successfully Ablated from the Right Coronary Cusp

Background:Premature ventricular complexes(PVCs)from the proximal left bundle branch(LBB)can be ablated in the left ventricular outflow tract but can easily damage normal conduction bundles.Here,we report a case of successful ablation of PVCs from the proximal LBB within the right coronary cusp(RCC).Case presentation:Our patient was a 70-year-old woman with PVCs from the proximal LBB that were successfully ablated via the RCC through radiofrequency catheter ablation with a 3D mapping system;she had a complication of incomplete right bundle branch block(RBBB)and remained asymptomatic during follow-up.Conclusion:The RCC provides an alternative approach for ablating PVCs originating from the proximal LBB,ow-ing to the close relationship between the RCC and proximal LBB.

The Hidden Value of Assessing Right Ventricular Performance with Exercise in Hypertensive Patients with Left Ventricular Diastolic Dysfunction

Background: Right ventricular (RV) dysfunction could develop during exercise in patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S, while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P = 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P = 0.05), A’ (P = 0.04). The global RV function showed also a significant increase (P = 0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P = 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (P = 0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (P = 0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.

Chest Pain on Exertion: Origin of the Right Coronary Artery from the Left Coronary Sinus, through the Aortic Pulmonary Sulcus with Squeezed, or Anterior Descending Branch Borderline Coronary Lesion?

The prognosis of patients in whom the right coronary artery (RCA) arises from the left coronary sinus (LCS) is unequal. An initial intramural course of the coronary artery within the aortic media is considered to cause myocardial ischemia in cases of coronary anomalies. In this case report, we present one patient admitted due to chest pain on exertion that suggested angina. Her only risk factor for coronary artery disease was hypertension. Clinical examination findings that the origin of the right coronary artery from the LCS, through the aortic pulmonary sulcus with atherosclerotic narrowing and squeezed of the RCA critical ostial, stenosis at the ostium of the RCA and the middle of left anterior descending (LAD) coronary, intravascular ultrasonography (IVUS) showed LAD and RCA minimal lumen area were 3.9 mm2, 5.9 mm2;plaque burden 66%, 65% respectively. We inserted EXCEL 3.0 × 18 mm stent in LAD stenosis. No complaints and adverse events were noticed during a 1-year follow-up.

Prognostic value of the echocardiographic right/left ventricular end-diastolic diameter ratio in patients with idiopathic pulmonary arterial hypertension

Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.

Rise of the Right and Regression of the Left in Latin America

Though the turn to the right in Latin America will continue over the short term, the left has not diminished and its resurgence remains possible. The political situation in Latin America has undergone dramatic changes since 2015, when an ebbing of the"pink tide"and rise of the right in several countries occurred, coupled with US support to the right.Flexible political strategies and rightists' political pragmatism are occurring as the continent's middle class expands, coupled with US support to the right. Some conditions that promote the right's revival remain operative, but for the new right regimes, addressing economic vitality, the wellbeing of the poor, corruption, and divisions from within are imminent challenges against which a left resurgence has competitive ground.

STABILITY OF THE S-LEFT AND S-RIGHT ESSENTIAL SPECTRA OF A LINEAR OPERATOR

In the present paper, we define the S-left and the S-right essential spectra of a linear operator and we study the stability of the S-essential spectra on a Banach space.

A HYPOTHESIS ON THE EFFECT OF CORIOLIS FORCE ON THE DEVELOPMENT OF RIGHT-LEFT ASYMMETRY OF MAMMALS

ＡＨＹＰＯＴＨＥＳＩＳＯＮＴＨＥＥＦＦＥＣＴＯＦＣＯＲＩＯＬＩＳＦＯＲＣＥＯＮＴＨＥＤＥＶＥＬＯＰＭＥＮＴＯＦＲＩＧＨＴ－ＬＥＦＴＡＳＹＭＭＥＴＲＹＯＦＭＡＭＭＡＬＳＡＨＹＰＯＴＨＥＳＩＳＯＮＴＨＥＥＦＦＥＣＴＯＦＣＯＲＩＯＬＩＳＦＯＲＣＥＯＮＴＨＥ...

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

Inadvertent Lead Malposition in the Left Ventricle during Permanent Ventricular Pacing about One Case

Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-old man who was implanted with a ventricular single-chamber pacemaker for a slow atrial fibrillation with syncope and whose routine transthoracic echocardiography 23 months after implantation displayed a malposition of the pacemaker lead into the Left Ventricle through a patent foramen oval. The patient was asymptomatic. The electrocardiogram showed right bundle branch block QRS-paced morphology with a positive QRS pattern in V1, a median paced QRS axis on the frontal plane at -120°, a Precordial transition on V5. At the lateral Chest X-ray the lead curved backwards to the spine. Given the age of this old patient who already received oral anticoagulant for Atrial Fibrillation and the Lead malposition discovered 23 months after pacemaker’s implantation, we decided to maintain the lead in LV and continue anticoagulation.

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy(HAIC).Methods:From January 2013 to January 2017,159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system.In 86 of these patients(56 men;aged 28-88 years;mean:60.6±12.0 years),in whom the RGA was obvious on arteriography,embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC.In the first phase(first three years),antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients.In the second phase(next two years),embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery(LGA) in 31 patients.The success rates and the incidence of acute gastroduodenal mucosal toxicity(AGMT) in these two groups were compared.Results:The total success rate of the RGA embolization was 70.9%.The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization,which was significantly higher than that of antegrade embolization alone(63.6%) performed in 55 patients(p=0.047).No complications related to embolization of RGA were documented.The incidence of AGMT was 29.1%(16/55) in patients in the first phase,which was significantly higher than that in the patients in the second phase(9.7%,3/31)(p=0.037).Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.

Major hepatectomy using the glissonean approach in cases of right umbilical portion

Right umbilical portion(RUP) is a rare congenital anomaly associated with anomalous ramifications of the hepatic vessels and biliary system. As such, major hepatectomy requires a careful approach. We describe the usefulness of the Glissonean approach in two patients with vessel anomalies, such as RUP. The first patient underwent a right anterior sectionectomy for intrahepatic cholangiocarcinoma. We encircled several Glissonean pedicles that entered the right anterior section along the right side of the RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally cut them. The operation was performed safely and was successful. The second patient underwent a left trisectionectomy for perihilar cholangiocarcinoma. We secured the right posterior Glissonean pedicle. The vessels in the pedicle were preserved, and the other vessels and contents were resected. Identifying the vessels for preservation facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed the operation.

“Taking the Left for the Upper” or “Taking the Right for the Upper”

Currently, there are two rituals coexist in the world:"taking the left for the upper"and"taking the right for the up?per". The former is usually taken in domestic affairs such as meetings, dinners, etc. while the latter enjoys an overwhelmingly fa?vor in the west and so that it becomes the international practice in every conceivable social activities. The paper intends to offer a deep explanation of the differences of two rituals with adequate evidence and examples in some specific situations, say different kinds of seat arrangement in various large and small meetings, respectively in China and the west. Then it follows to provide the underlying reasons for the differences from the perspective of cultural difference. It finds that different denotation of"left"and"right"in English and Chinese may shed some light on the understanding of the two different rituals.

Cortical infarction of the right parietal lobe and neurogenic heart disease A report of three cases

Three male patients were diagnosed with new cortical infarctions of the right parietal lobe on the basis of head magnetic resonance imaging; high-intensity signals indicating lesions in the right parietal lobe were noted on diffusion-weighted images at admission. Two of them presented with left hand weakness, and one exhibited left upper limb weakness. Treatment for improving blood supply to the brain was administered. One patient died suddenly because of ventricular fibrillation 3 days after admission. The other two patients had increased troponin levels and abnormal electrocardiograms, and were diagnosed with acute myocardial infarction half a month after admission. When lesions exist in field 7 of the parietal cortex （resulting in paralysis of the contralateral hand）, the sympathetic center of the posterior lateral nucleus of the hypothalamus demonstrates compensatory excitement, which easily causes tachyarrhythmia and sudden death. Our experimental findings indicate that close electrocardiograph monitoring and cerebral infarction treatment should be standard procedures to predict and help prevent heart disease in patients with cerebral infarction in the right parietal lobe and left upper limb weakness as the main complaint.

Left Ventricular Pseudoaneurysm Caused by a Left Ventricular Venting Catheter via the Right Superior Pulmonary Vein during Thoracic Aortic Surgery: A Case Report

A left ventricular (LV) pseudoaneurysm is one of the complications of acute myocardial infarction. It is also reported after chest trauma, cardiac surgery, and endocarditis. We report a rare case of an LV pseudoaneurysm induced by an LV venting catheter through the right superior pulmonary vein during thoracic aortic surgery. A 77-year-old man was referred for surgical repair of a distal aortic arch aneurysm. He underwent total aortic arch reconstruction with the frozen elephant trunk technique. The early postoperative period was uneventful. Postoperative contrast computed tomography and transthoracic echocardiography (TTE) revealed a pseudoaneurysm with a narrow neck at the apex of the LV that had sub-clinically progressed. Because of the risk of spontaneous rupture, an urgent aneurysmectomy was performed via a repeat sternotomy. Under cardioplegic arrest, the pseudoaneurysm was opened and the small orifice, which communicated with the LV, was confirmed. No myocardial ischemic changes were observed around the orifice. The pseudoaneurysm was thought to be induced by endocardial laceration by the tip of the venting catheter. The pseudoaneurysm was closed by linear repair reinforced with felt strips. The patient recovered well and was discharged 18 days after the second surgery. TTE showed no recurrence of LV aneurysm at the last follow-up.

CRT-D Upgrading in a Patient with Persistent Left Superior Vena Cava and Right Superior Vena Cava Atresia Using the Novel Active-Fixation Quadripolar Left Ventricular Lead

The persistence of left superior vena cava (PLSVC) is the most common congenital anomaly of the venous return system to the heart. Because of the increasing number of patients referred for cardiac resynchronization therapy (CRT) devices implantations, it is expected to encounter this venous anatomic variation. Left ventricular lead placement at an appropriate site is an integral and technically challenging part of successful CRT. In case of cardiac abnormalities could be difficult to achieve an optimal cardiac rhythm management devices implantation. Previous reports in patients with PLSVC highlighted the challenges to achieve an optimal cardiac rhythm device implantation. Recently, a new quadripolar active fixation left ventricular lead is available for CRT device implantation. Hereby we report a case of a device upgrading from dual-chamber pacemaker to CRT with defibrillator backup using the active fixation left ventricular quadripolar lead in a patient with PLSVC and right superior vena cava atresia.