Systematic review of prognostic importance of extramuralvenous invasion in rectal cancer

AIM: To systematically review the survival outcomes relating to extramural venous invasion in rectal cancer.METHODS: A systematic review was conducted using PRISMA guidelines. An electronic search was carried out using MEDLINE, EMBASE, CINAHL, Cochrane library databases, Google scholar and Pub Med until October 2014. Search terms were used in combination to yield articles on extramural venous invasion in rectal cancer. Outcome measures included prevalence and 5-year survival rates. These were graphically displayed using Forest plots. Statistical analysis of the data was carried out.RESULTS: Fourteen studies reported the prevalence of extramural venous invasion(EMVI) positive patients. Prevalence ranged from 9%-61%. The pooled prevalence of EMVI positivity was 26% [Random effects: Event rate 0.26(0.18, 0.36)]. Most studies showed that EMVI related to worse oncological outcomes. The pooled overall survival was 39.5% [Random effects: Event rate 0.395(0.29, 0.51)].CONCLUSION: Historically, there has been huge variation in the prevalence of EMVI through inconsistent reporting. However the presence of EMVI clearly leads to worse survival outcomes. As detection rates become more consistent, EMVI may be considered as part of risk-stratification in rectal cancer. Standardised histopathological definitions and the use of magnetic resonance imaging to identify EMVI will improve detection rates in the future.

Update on global epidemiology of viral hepatitis and preventive strategies

Viral hepatitis is one of the major public health concerns around the world but until recently it has drawn little attention or funding from global health policymakers.Every year 1.4 million people die from viral hepatitisrelated cirrhosis and liver cancer.However,the majority of the infected population are unaware of their condition.This population have significant obstacles to overcome such as lack of awareness,vulnerability,increased migration,disease stigma,discrimination,as well as poor health resources,conflict in policy development and program implementation.Despite implementing infection control measures over the last few decades eradication or significant disease reduction remains elusive.This study aims to present the current global prevalence status and examines potential elimination strategies.The information for this research were obtained through a systematic review,published scientific literatures,the official websites of various government organisations,international public health organisations and internationally recognised regulatory bodies over a period of 40 years between 1978 and2018.

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease.The last decade has seen increasing numbers of surgeons trained to a high standard in minimallyinvasive surgery.However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery.There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes.The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery(LCS)in the emergency setting.The literature is broadly divided by the underlying pathology;that is,inflammatory bowel disease,diverticulitis and malignant obstruction.There were no randomized trials and the majority of the studies were case-matched series or comparative studies.The overall trend was that LCS is associated with shorter hospital stay,par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection,the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.

Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales

AIM To define good and poor regression using pathology and magnetic resonance imaging(MRI) regression scales after neo-adjuvant chemotherapy for rectal cancer.METHODS A systematic review was performed on all studies up to December 2015, without language restriction, t h a t w e r e i d e n t i f i e d f r o m M E D L I N E, C o c h r a n e Controlled Trials Register(1960-2015), and EMBASE(1991-2015). Searches were performed of article bibliographies and conference abstracts. MeS H and text words used included "tumour regression", "mr TRG", "poor response" and "colorectal cancers". Clinical studies using either MRI or histopathological tumour regression grade(TRG) scales to define good and poor responders were included in relation to outcomes [local recurrence(LR), distant recurrence(DR), disease-free survival(DFS), and overall survival(OS)]. There was no age restriction or stage of cancer restriction for patient inclusion. Data were extracted by two authors working independently and using pre-defined outcome measures.RESULTS Quantitative data(prevalence) were extracted and analysed according to meta-analytical techniques using comprehensive meta-analysis. Qualitative data(LR, DR, DFS and OS) were presented as ranges. The overall proportion of poor responders after neo-adjuvant chemoradiotherapy(CRT) was 37.7%(95%CI: 30.1-45.8). There were 19 different reported histopathological scales and one MRI regression scale(mrT RG). Clinical studies used nine and six histopathological scales for poor and good responders, respectively. All studies using MRI to define good and poor response used one scale. The most common histopathological definition for good response was the Mandard grades 1 and 2 or Dworak grades 3 and 4; Mandard 3, 4 and 5 and Dworak 0, 1 and 2 were used for poor response. For histopathological grades, the 5-year outcomes for poor responders were LR 3.4%-4.3%, DR 14.3%-20.3%, DFS 61.7%-68.1% and OS 60.7-69.1. Good pathological response 5-year outcomes were LR 0%-1.8%, DR 0%-11.6%, DFS 78.4%-86.7%, and OS 77.4%-88.2%. A poor response on MRI(mr TRG 4,5) resulted in 5-year LR 4%-29%, DR 9%, DFS 31%-59% and OS 27%-68%. The 5-year outcomes with a good response on MRI(mrT RG 1,2 and 3) were LR 1%-14%, DR 3%, DFS 64%-83% and OS 72%-90%.CONCLUSION For histopathology regression assessment, Mandard 1, 2/Dworak 3, 4 should be used for good response and Mandard 3, 4, 5/Dworak 0, 1, 2 for poor response. MRI indicates good and poor response by mr TRG1-3 and mrT RG4-5, respectively.

Notch signalling pathway in development of cholangiocarcinoma

Cholangiocarcinoma(CCA)comprises of extra-hepatic cholangiocarcinoma and intrahepatic cholangiocarcinoma cancers as a result of inflammation of epithelium cell lining of the bile duct.The incidence rate is increasing dramatically worldwide with highest rates in Eastern and South Asian regions.Major risk factors involve chronic damage and inflammation of bile duct epithelium from primary sclerosing cholangitis,chronic hepatitis virus infection,gallstones and liver fluke infection.Various genetic variants have also been identified and as CCA develops on the background of biliary inflammation,diverse range of molecular mechanisms are involved in its progression.Among these,the Notch signalling pathway acts as a major driver of cholangiocarcinogenesis and its components(receptors,ligands and downstream signalling molecules)represent a promising therapeutic targets.Gamma-Secretase Inhibitors have been recognized in inhibiting the Notch pathway efficiently.A comprehensive knowledge of the molecular pathways activated by the Notch signalling cascade as well as its functional crosstalk with other signalling pathways provide better approach in developing innovative therapies against CCA.

Does music reduce anxiety and discomfort during flexible sigmoidoscopy?A systematic review and meta-analysis

To investigate the role of music in reducing anxiety and discomfort during flexible sigmoidoscopy. METHODSA systematic review of all comparative studies up to November 2016, without language restriction that were identified from MEDLINE and the Cochrane Controlled Trials Register (1960-2016), and EMBASE (1991-2016). Further searches were performed using the bibliographies of articles and abstracts from major conferences such as the ESCP, NCRI, ASGBI and ASCRS. MeSH and text word terms used included “sigmoidoscopy”, “music” and “endoscopy” and “anxiety”. All comparative studies reporting on the effect of music on anxiety or pain during flexible sigmoidoscopy, in adults, were included. Outcome data was extracted by 2 authors independently using outcome measures defined a priori. Quality assessment was performed. RESULTSA total of 4 articles published between 1994 and 2010, fulfilled the selection criteria. Data were extracted and analysed using OpenMetaAnalyst. Patients who listened to music during their flexible sigmoidoscopy had less anxiety compared to control groups [Random effects; SMD: 0.851 (0.467, 1.235), S.E = 0.196, P < 0.001]. There was no statistically significant heterogeneity (Q = 0.085, df = 1, P = 0.77, I2 = 0). Patients who listened to music during their flexible sigmoidoscopy had less pain compared to those who did not, but this difference did not reach statistical significance [Random effects; SMD: 0.345 (-0.014, 0.705), S.E = 0.183, P = 0.06]. Patients who listened to music during their flexible sigmoidoscopy felt it was a useful intervention, compared to those who did not (P < 0.001). There was no statistically significant heterogeneity (P = 0.528, I2 = 0). CONCLUSIONMusic appeared to benefit patients undergoing flexible sigmoidoscopies in relation to anxiety and was deemed a helpful intervention. Pain may also be reduced however further investigation is required to ascertain this.

Anaemia in Critically Ill COVID-19 Patients: A Cohort Study

Anaemia is common in critically ill patients and has been shown to be a predictor of mortality in general Intensive Therapy Unit (ITU). Patients with Corona Virus Infectious Disease 2019 (CV-19) have also been reported to be anaemic, more profound in those admitted to ITU. We report our experience in the management of anaemic CV-19 patients admitted to ITU between 1st March and 1st June 2020. Demographic and clinical variables collected included age, sex, BMI, Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, haemoglobin concentration, blood transfusion, and mortality. 105 patients were admitted to the ITU with Severe Acute Respiratory Syndrome Coronavirus 2 disease requiring invasive mechanical ventilation and 73 patients with complete dataset were included in the study. Results: 36 patients (49%) were anaemic on admission, with 56 (77%) patients developing anaemia at some stage in the first 7 days of ITU stay. Anaemia at admission to ITU, a higher CCI and a higher APACHE II score were all independently associated with a blood transfusion (OR 12.5, 95% CI: 1.48 - 106, p = 0.02), (OR 1.95, 95% CI: 1.08 - 3.52, p = 0.03) and (OR 4.8, 95% CI: 1.48 - 15.6, p = 0.009) respectively. Univariable analysis showed that an increasing age (OR 2.15, 95% CI: 1.18 - 3.91, p = 0.01) and a higher APACHE II score (OR 1.60, 95% CI 1.01 - 2.54, p = 0.04) were significantly associated with mortality. There was also some evidence of an association with mortality for CCI, although the results for this variable were only of borderline statistical significance. Neither haemoglobin concentration (OR 1.09, 95% CI: 0.83 - 1.43, p = 0.55) or anaemia (OR 1.08, 95% CI: 0.41 - 2.85, p = 0.87) at admission to ITU was significantly associated with mortality. 13 patients received blood transfusions, with a mean (SD) pretransfusion Hb of 75.2 (12.02). These numbers were too small to identify any association between receiving blood transfusion and mortality.

盆底功能障碍的预防和非手术治疗:NICE指南总结

盆底功能障碍是一种复杂的疾病,与尿失禁、膀胱排空障碍、盆腔器官脱垂、性功能障碍、慢性盆腔疼痛、大便失禁和肠道排空障碍有关。在英国,大约500万女性曾患盆底功能障碍。年龄对盆底功能障碍有显著影响,20岁女性中出现相关症状者仅占6%,60岁女性中,这一比例增加到40%。这些症状可能会严重影响生活质量。2020年7月,《独立医学和医疗器械安全审查》声明强调了盆腔补片手术的主要并发症。预防性和非手术治疗可以减少重症和需要侵入性治疗的患者数量。

前足痛

一名有前足痛的46岁女性,自诉第3和第4脚趾间有烧灼感,穿高跟鞋时症状加重。临床上常见前足痛的主诉包括脚趾和跖趾关节疼痛幕前足痛可影响两个主要解剖区域:第1跖骨和趾骨(拇趾),或较小的跖骨和趾骨。在首诊中明确疼痛部位和其他临床特征,可以帮助医生明确前足痛原因,并指导最初的治疗。

饱和脂肪酸不是主要问题--让我们重新认识其在心脏疾病中的作用

科学家普遍认为，许多方便食物、烘焙食品和人造黄油中的反式脂肪酸通过炎症过程增加心血管疾病风险。但是，“饱和脂肪酸”则完全不一样。去除饱和脂肪酸以降低心血管疾病风险已经主导饮食建议和指南近40年。