Multiple Signatures of the JC Polyomavirus in Paired Normal and Altered Colorectal Mucosa Indicate a Link with Human Colorectal Cancer, but Not with Cancer Progression.

The JC polyomavirus (JCV) has been repeatedly but discordantly detected in healthy colonic mucosa, adenomatous polyps, and colorectal cancer (CRC), and proposed to contribute to oncogenesis. The controversies may derive from differences in JCV targets, patient's cohorts, and methods. Studies of simultaneous detection, quantification, and characterization of JCV presence/expression in paired samples of normal/altered tissues of the same patient are lacking. Therefore, we simultaneously quantified JCV presence (DNA) and expression (mRNA and protein) of T-antigen (T-Ag), Viral Protein 1 (Vp1), and miR-J1-5p in paired normal/altered tissues of CRC or polyps, and from controls. JCV signatures were found in most samples. They increased in patients, but were higher in normal mucosa than in corresponding polyp or CRC lesions. JCV non-coding control region (NCCR) DNA rearrangements increased in CRC patients, also in normal mucosa, thus before the onset of the lesion. A new ∆98bp NCCR DNA rearrangement was detected. T-Ag levels were higher in normal mucosa than in adenoma and adenocarcinoma lesions, but decreased to levels of controls in established CRC lesions. In CRC, miR-J1-5p expression decreased with CRC progression. Vp1 expression was not detected. The data indicate a JCV link with the disease, but possible JCV contributes to oncogenesis should occur at pre-polyp stages.

Surgical and Endovascular Management of Patients with Chronic Mesenteric Ischemia: A Single Center Experience.

Chronic mesenteric ischemia is a rare intestinal disorder, with a potential evolution toward intestinal infraction. The choice of the appropriate treatment is currently the most crucial issue in the management of patients with chronic mesenteric ischemia. We describe our experience with 16 cases, and we discuss the current diagnostic and therapeutic approaches. A retrospective review of the clinical records was performed, and demographic, clinical, therapeutic, and prognostic data were collected. Six patients were females (37%), and the mean age was 62 years. Postprandial pain was present in all the cases, whereas sitophobia and weight loss were detected in 87 per cent of them. Eight patients were treated with open surgery; no perioperative deaths or relevant complications occurred. One patient had a restenosis of the celiac trunk and superior mesenteric artery 10 months after surgery. No deaths or relevant complications occurred in the remaining patients, who underwent an endovascular procedure. One patient presented a restenosis distal to the vascular stent, whereas two patients died due to comorbidities. The low rates of postoperative morbidity, mortality, and restenosis obtained suggest that surgical or endovascular correction of chronic mesenteric ischemia is satisfactory when performed by experienced surgeons, with an adequate selection of the patients.

Surgical outcomes in patients with hepatic synchronous and metachronous colorectal metastases.

AIM: To evaluate the impact of several clinical and pathological factors on the outcomes of surgery for hepatic colorectal cancer metastasis. METHODS: Eighty-four liver metastasectomies in 77 consecutive patients with 90 colorectal cancer hepatic metastases were performed in our institution from 2009 to 2014. Surgery was carried out in 75 cases, as two patients were not eligible for surgery. Among them 43 (Group A) were affected by synchronous, and 32 (Group B) by metachronous lesions. Furthermore, 9 reoperations were performed in patients with initially synchronous lesions. The follow-up after surgery included total body CT scan every 3 months for the first year, and every 6 months for 4 years thereafter. Blood level of CEA was determined every 3 months. RESULTS: The univariate analysis evidenced significantly more recurrences in patients with synchronous lesions (p=0.011), and higher grade, pN stage and CEA blood levels. In multivariate logistic regression analysis the statistically significant parameters found were: the pT stage (OR: 3.92, p = 0.039), the use of adjuvant chemotherapy for the colonic tumor (OR: 0.19, p = 0.025), and the adjuvant chemotherapy (OR: 4.11, p = 0.048). The global survival was 32 patients (41.5%), 17 with synchronous and 15 with metachronous lesions, and a significant difference in long-term survival between these two groups was found (p = 0.008). CONCLUSIONS: The most relevant prognostic factor in patients with hepatic colorectal cancer dissemination is the timing of metastasis; the metachronous lesions present better survival when surgically treated. KEY WORDS: Colorectal cancer, Liver, Metastasis, Surgery.