Particular aspects of treating rectal cancer: The watch and wait approach.

Background: Rectal cancer is one of the most common malignant pathologies worldwide. Currently, the standard treatment of this pathology consists of radio-chemotherapy followed by low anterior resection with total mesorectal excision or abdominoperineal proctectomy for medium/low rectal cancer. Objectives: In recent years, another treatment strategy has been proposed, stemming from the finding that up to 40% of patients receiving neoadjuvant treatment had a complete pathological response. This method, also referred to as the watch and wait approach, implies delaying surgery and following a rigorous protocol for patients who have developed a complete response to neoadjuvant treatment with a good oncologic outcome. The objective of this study was to highlight the merits of this approach in selected patients. Case Reports: In this study, we present two patients with low-rectal tumors who developed complete response post neoadjuvant therapy and for whom the watch and wait protocol has been applied over the past 4 years. Conclusion: Although the watch and wait protocol appears to be a feasible option in the management of patients with a complete clinical and pathological response post neoadjuvant therapy, more prospective studies and randomized trials comparing this approach with standard surgical treatment are required before establishing it as the standard of care for distal rectal cancer. Therefore, establishing universal criteria for the selection and assessment of the patients with a complete clinical response following neoadjuvant treatment is required.

Effects of advanced maternal age and acute prenatal alcohol exposure on mouse offspring growth and craniofacial phenotype.

BACKGROUND: Prenatal alcohol exposure (PAE) can result in developmental defects that include growth restriction, craniofacial anomalies, and cognitive behavioral deficits, though the presence and severity of these adverse outcomes can vary dramatically among exposed individuals. Preclinical animal models have demonstrated that the dose and timing of PAE account for much, but not all, of this phenotypic variation, suggesting that additional factors mitigate the effects of PAE. Here, we used a mouse model to investigate whether maternal age modulates the effects of PAE on the severity and variation in offspring growth and craniofacial outcomes. METHODS: Nulliparous C57BL/6N dams received either an intraperitoneal injection of ethanol (EtOH) or vehicle solution on gestational day 7.5. Dams were divided into four groups: (1) EtOH-treated young dams (6 to 10 weeks); (2) control young dams; (3) EtOH-treated old dams (6 to 7 months); and (4) old control dams. Neonate offspring growth restriction was measured through body mass and organ-to-body mass ratios, while skeletal craniofacial features were imaged using micro-CT and analyzed for size, shape, and variation. RESULTS: PAE and advanced maternal age each increased the risk of low birthweight and growth restriction in offspring, but these factors in combination changed the nature of the growth restriction. Similarly, both PAE and advanced maternal age individually caused changes to craniofacial morphology such as smaller skull size, dysmorphic skull shape, and greater skull shape variation and asymmetry. Interestingly, while the combination of PAE and advanced maternal age did not affect mean skull shape or size, it significantly increased the variation and asymmetry of those measures. CONCLUSION: Our results indicate that maternal age modulates the effects of PAE, but that the effects of this combination on offspring outcomes are more complex than simply scaling the effects of either factor.

Posttraumatic Injury Polymorphism - The Experience of an Emergency Surgical Department During 5 Years.

Introduction: Traumatic injuries are a major public health problem, being one of the main causes of death, the subsequent decline in the quality of life of the patients involved, as well as the costs of hospitalization in the health system. Material and Method: We conducted a 5-year retrospective study on 798 hospitalized patients with traumatic injuries, by collecting a series of general, clinical, imaging and biological parameters. Results: The results showed a higher proportion of male patients, the main lesion mechanism being represented by road accidents, followed by falls from another level. The most common traumatic intraabdominal parenchymal lesions were splenic, followed by hepatic and renal lesions. In addition to intraabdominal trauma, the lesion balance also included thoracic, spinal cord, head and limb injuries. A total of 288 patients underwent emergency surgery, but there were also cases of delayed surgical procedures or reoperations. We had 67 deceased patients. Conclusions: Trauma is a major public health problem, both socially and economically, being responsible for a significant number of deaths, but also in terms of the significant number of hospitalizations and the subsequent impact on the quality of life of those involved.

Traumatic Diaphragmatic Lesions - Considerations Over a Series of 15 Consecutive Cases.

Introduction: Diaphragmatic injuries are produced by blunt or penetrating thoracoabdominal trauma. They are potentially life-threatening due to the herniation of abdominal organs into the pleural cavities and severe associated lesions. The aim of this retrospective study was to analyse the clinical presentation and management of patients admitted with diaphragmatic rupture in our institution. Material and Method: We performed a 5-year retrospective study of patients admitted with acute blunt or penetrating diaphragmatic rupture in the Department of General Surgery of "Bagdasar- Arseni" Emergency Hospital. We have studied sex, age, mechanism of trauma, side-location, timeto-diagnosis, concomitant injuries, surgical treatment and outcome. Results: Fifteen patients (8 males, 7 females, mean age: 42 years) with diaphragmatic rupture (left-side: 13, right-side: 2) following blunt (8 patients) or penetrating (7) trauma were included. Patients with blunt diaphragmatic injury had larger tears and abdominal viscera herniation was observed in 6of these cases. A direct suture was performed for all 15 patients. Laparotomy was the surgical approach preferred in most of the cases. Mortality rate was 20%, mainly caused by severe associated lesions. Conclusion: Although traumatic diaphragmatic lesions are frequently associated with severe cerebral and thoraco-abdominal trauma that is also the main cause of death, a prompt diagnosis and treatment can lead to good outcome.

A Feedforward Mechanism Mediated by Mechanosensitive Ion Channel PIEZO1 and Tissue Mechanics Promotes Glioma Aggression.

Alteration of tissue mechanical properties is a physical hallmark of solid tumors including gliomas. How tumor cells sense and regulate tissue mechanics is largely unknown. Here, we show that mechanosensitive ion channel Piezo regulates mitosis and tissue stiffness of Drosophila gliomas, but not non-transformed brains. PIEZO1 is overexpressed in aggressive human gliomas and its expression inversely correlates with patient survival. Deleting PIEZO1 suppresses the growth of glioblastoma stem cells, inhibits tumor development, and prolongs mouse survival. Focal mechanical force activates prominent PIEZO1-dependent currents from glioma cell processes, but not soma. PIEZO1 localizes at focal adhesions to activate integrin-FAK signaling, regulate extracellular matrix, and reinforce tissue stiffening. In turn, a stiffer mechanical microenvironment elevates PIEZO1 expression to promote glioma aggression. Therefore, glioma cells are mechanosensory in a PIEZO1-dependent manner, and targeting PIEZO1 represents a strategy to break the reciprocal, disease-aggravating feedforward circuit between tumor cell mechanotransduction and the aberrant tissue mechanics. VIDEO ABSTRACT.