Well-differentiated gastroenteropancreatic G3 NET: findings from a large single centre cohort.

Neuroendocrine neoplasms are known to have heterogeneous biological behavior. G3 neuroendocrine tumours (NET G3) are characterized by well-differentiated morphology and Ki67 > 20%. The prognosis of this disease is understood to be intermediate between NET G2 and neuroendocrine carcinoma (NEC). Clinical management of NET G3 is challenging due to limited data to inform treatment strategies. We describe clinical characteristics, treatment, and outcomes in a large single centre cohort of patients with gastroenteropancreatic NET G3. Data was reviewed from 26 cases managed at Queen Elizabeth Hospital, Birmingham, UK, from 2012 to 2019. Most commonly the site of the primary tumour was unknown and majority of cases with identifiable primaries originated in the GI tract. Majority of cases demonstrated somatostatin receptor avidity. Median Ki67 was 30%, and most cases had stage IV disease at diagnosis. Treatment options included surgery, somatostatin analogs (SSA), and chemotherapy with either platinum-based or temozolomide-based regimens. Estimated progression free survival was 4 months following initiation of SSA and 3 months following initiation of chemotherapy. Disease control was observed following treatment in 5/11 patients treated with chemotherapy. Estimated median survival was 19 months; estimated 1 year survival was 60% and estimated 2 year survival was 13%. NET G3 is a heterogeneous group of tumours and patients which commonly have advanced disease at presentation. Prognosis is typically poor, though select cases may respond to treatment with SSA and/or chemotherapy. Further study is needed to compare efficacy of different treatment strategies for this disease.

Growth, carcass characteristics, meat quality, and microbial aspects of growing quail fed diets enriched with two different types of probiotics (Bacillus toyonensis and Bifidobacterium bifidum).

The present investigation aimed to explore the impact of dietary graded levels of 2 types of probiotic bacteria (Bacillus toyonensis [BT] and Bifidobacterium bifidum [BB]) on growth, carcass traits, meat quality, and bacteriology of growing Japanese quail reared under the cage system. One thousand three hundred sixty Japanese quail day-old chicks were randomly divided into 10 groups (8 replicates each). Birds were fed a basal diet (control, T1) and the basal diet plus 0.05, 0.075, 0.10, and 0.125% BT (T2, T3, T4, and T5, respectively), 0.10% BB (T6), and the same previous doses of BT plus 0.05% BB (T7, T8, T9, and T10, respectively). Results showed a significant (P < 0.001) increase in final BW and weight gain because of probiotic supplementation (except T2 for weight gain). Both feed intake and feed conversion ratio did not differ during the overall experimental period (1-42 D of age) except feed intake that was reduced in T2 and increased in T5 and T9 groups. All carcass traits studied were significantly (P < 0.01) affected by probiotics, and the combination between BT and BB in group T8 increased all studied parameters as compared with the other treatment groups. The quail meat color of redness a∗ and L∗ values, thiobarbituric content, cooking loss, proteolysis, and total coliform were decreased (P < 0.001) by probiotic treatment. In general, supplementing BT, BB, or their combination to the basal diet delayed the proliferation of pathogenic bacteria in the diet and intestine. Using BT and BB as feed supplements enhanced growth performance and meat quality of quails as well as diminished pathogenic bacteria proliferation in their diet and intestine. As per our results, we can recommend the application of T5 and T8 to T10 levels for the best performance, carcass traits, and meat quality of growing quails.

Comparison of different scoring systems in predicting short-term mortality after liver transplantation.

BACKGROUND: Many scoring systems have been used in predicting the outcomes of liver transplantations. The aim of this study was to compare between 4 scoring systems-Sequential Organ Failure Assessment (SOFA), Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Child Turcotte-Pugh -among patients who underwent living-donor liver transplantation (LDLT) seeking to evaluate the best system to correlate with post-operative outcomes. METHODS: This study retrospectively reviewed the medical records of 53 patients who had received LDLT in a tertiary care hospital from January 2005 to December 2010. Demographic, clinical, and laboratory data were recorded. Each patient was assessed by use of 4 scoring systems before transplantation and on post-operative days 1 to 7 and at 3 months. RESULTS: The overall 3-month survival rate was 64%. The pre-transplant SOFA score had the best discriminatory power; moreover, the SOFA score on post-operative day 7 had the best Youden index (.875). The survival rate at 3-month follow-up after liver transplantation differed significantly (P = .00023, highest area under the receiver operator characteristic curve = .952) between patients who had SOFA scores <8 and those had SOFA score >8 on post-liver transplant day 7. This study also demonstrated that respiratory rate (P = .017) and serum bilirubin level (P = .048) and duration of intensive care unit stay (P = .04) are significant risk factors related to early mortality after LDLT. CONCLUSIONS: The pre-transplant SOFA score was a statistically significant predictor of 3-month mortality; SOFA score on post-liver transplant day 7 had the best discriminative power for predicting 3-month mortality.

Transdermal natural progesterone cream for postmenopausal women: inconsistent data and complex pharmacokinetics.

Transdermal progesterone cream (PC) is propagated as a possible alternative to hormone replacement therapy (HRT) in the management of menopausal symptoms and treatment of osteoporosis. Nonetheless, considerable concerns were raised regarding the inconsistent results and the credibility of some studies that were not peer-reviewed. Further, the complex nature and diversity of the pharmacokinetics of progesterone led to difficult interpretation of the findings. Given the current best available evidence, using PC for postmenopausal therapy regimens should be considered as an unsubstantiated treatment option, and its clinical applications must be restricted to well-designed interventional trials that assess its efficacy and safety.

Ipsilateral fracture of the femoral neck and shaft, treatment by reconstruction interlocking nail.

This study involved nine patients with ipsilateral fractures of the neck and shaft of the femur. They were all male with an average age of 28.5 years. All of the fractures resulted from high-energy trauma. The neck fracture was initially missed in one case. All fractures were fixed by a Russell-Taylor reconstruction femoral nail. Surgery was delayed for an average of 6.6 days (range 2-21 days). The patients were followed up for an average of 2.1 years. All fractures healed; the average time of union for the neck fracture was 4.2 months (range 3-6 months) and for the shaft fracture, 6.9 months (range 4-18 months). A delay in surgery did not affect the union rate. There were no cases of avascular necrosis or non-union of the femoral neck fracture. One hip healed into mild varus, one shaft fracture had a delayed union, and one developed a late infection of the femoral shaft. The use of the reconstruction nail offers superior stabilization over other currently used methods and is associated with fewer complications.

Congenital lung herniation.

Congenital lung herniation is a rare condition. It is usually associated with a costal cartilage defect. We report on a newborn boy with a partial lung herniation through the parietal pleura and skin associated with a sternal malformation. We propose the herniation occurred around the fifth month of fetal life and interfered with sternal ossification.