Locally advanced mid/low rectal cancer with synchronous resectable liver metastases: systematic review of the available strategies and outcome.

The management of patients with locally advanced mid/low rectal cancer with resectable liver metastases is complex because of the need to combine the optimal treatment of both tumors. This study aims to review the available treatment strategies and compare their outcome, focusing on radiotherapy (RT) and liver-first approach (LFA). A systematic review was performed in PubMed, Embase, and web sources including articles published between 2000 and 02/2023 and reporting mid-/long-term outcomes. Overall, twenty studies were included (n = 1837 patients). Three- and 5-year overall survival (OS) rates were 51-88% and 36-59%. Although several strategies were reported, most patients received RT (1448/1837, 79%; > 85% neoadjuvant). RT reduced the pelvic recurrence risk (5.8 vs. 13.5%, P = 0.005) but did not impact OS. Six studies analyzed LFA (n = 307 patients). LFA had a completion rate similar to the rectum-first approach (RFA, 81% vs. 79%) but the interval strategy-an LFA variant with liver surgery in the interval between radiotherapy and rectal surgery-had a better completion rate than standard LFA (liver surgery/radiotherapy/rectal surgery, 92% vs. 75%, P = 0.011) and RFA (79%, P = 0.048). Across all series, LFA achieved the best survival rates, and in one paper it led to a survival advantage in patients with multiple metastases. In conclusion, different strategies can be adopted, but RT should be included to decrease the pelvic recurrence risk. LFA should be considered, especially in patients with high hepatic tumor burden, and RT before liver surgery (interval strategy) could maximize its completion rate.

Media interventions to increase cervical screening uptake in South Africa: an evaluation study of effectiveness.

Successful cervical cancer prevention depends on reaching, screening and treating women with pre-invasive disease. We aimed to evaluate the effectiveness of two media interventions-a photo-comic and a radio-drama-in increasing cervical screening uptake. A randomized controlled trial compared a photo-comic on cervical cancer screening with a placebo comic. One month after the comics were distributed a radio-drama paralleling the photo-comic was broadcast on the community radio station and a retrospective evaluation was carried out. The trial was set in Khayelitsha, a peri-urban squatter community near Cape Town, South Africa. A random sample consisted of 658 women between the ages of 35 and 65 years, from a stratified sample of census areas. The main outcome measure was self-reported cervical screening uptake 6 months after distribution of the comics. Seven percent (18 of 269) of women who received the intervention photo-comic reported cervical screening during the 6 months follow-up, compared with 6% (25 of 389) of controls (P = 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (nine of 53, 17%) than those who did not (19 of 429, 4%; P < 0.001). We conclude that the photo-comic was ineffective in increasing cervical screening uptake in this population. The radio-drama may have had more impact, but only a minority of women recalled being exposed to it. Future research must concentrate not only on achieving high level of exposure to health messages, but also on investigating the links between exposure and action.

Two-stage cervical cancer screening: an alternative for resource-poor settings.

OBJECTIVE: We sought to introduce 2-stage cervical cancer screening in which 2 screening tests are performed sequentially (the second test is performed only if the first result is positive), followed by treatment if both test results are abnormal. STUDY DESIGN: A total of 1423 women from Cape Town, South Africa, were screened by direct visual inspection, human papillomavirus deoxyribonucleic acid testing, cytologic testing, and cervicography. If an abnormality was identified with any test, women were referred for colposcopy. RESULTS: Direct visual inspection, cytologic testing, human papillomavirus deoxyribonucleic acid testing, and cervicography, when used alone, identified 24, 26, 23, and 23 cases of disease (high-grade squamous intraepithelial lesion or cancer) per 1000 women, respectively, and would classify 182, 71, 137, and 112 women without disease as having abnormal results. Two-stage screening with direct visual inspection first, followed by cytologic testing, human papillomavirus deoxyribonucleic acid testing, or cervicography, would detect 18, 16, and 18 cases per 1000 women, respectively, and would substantially reduce the number of women without disease who were classified as having abnormal results. CONCLUSION: Two-stage screening for cervical cancer provides an attractive alternative to conventional screening for low-resource settings.

A survey of the use of post-exposure prophylaxis for occupational exposure to human immunodeficiency virus.

The objective of this study was to review the appropriateness of the use of post-HIV exposure prophylaxis for incidents involving occupational exposure to body fluids. The design was a retrospective analysis of the 32 incidents for which at least one dose of post-exposure prophylaxis was given, reported to the occupational health department of a London teaching hospital between 20 August 1997 and 20 January 1999. The main outcome measures were the proportion of prescriptions for exposure to a known HIV positive source, and criteria for prescribing when the source patient's HIV status was unknown. Only 31% of prescriptions were for exposure to a known HIV positive source. The reasons for prescribing post-exposure prophylaxis in the other 69% of cases were unclear. Safety data for short courses of anti-retroviral drugs in this setting could help to assess the appropriateness of their use to allay anxiety in healthcare workers, pending clarification of the source patient's HIV status. Closer collaboration between departments and more detailed guidance would improve consistency of practice, and may save some unnecessary prescriptions for expensive and toxic drugs.

[Influence of serotonin on some serum enzyme activities in rats]. / Influenza della serotonina su alcune attivita' enzimatiche sietiche in ratti.

The serotonin injected intraperitoneally in rats (20 mg/Kg of body weight) modifies some seric enzymatic activities (LDH, alpha-HBDH and CPK) at different times from the injection (30, 60, 90 min.), acting probably on membrane permeability and on intracellular metabolism.

[Oxygen consumption in organs of rats treated with serotonin]. / Consumi di ossigeno in organi di ratti trattati con serotonina.

The serotonin injected intraperitoneally in rats (20 mg/Kg of body weight) increases the oxygen utilization of slices of heart, liver and muscle with a maximum value after 60 min from the injection. The serotonin, probably, acts on intracellular metabolism increasing some enzymatic activities or metabolic pathways.