Operative and Pathological Factors in Right-Sided Colon Cancers: How Can We Improve the Outcomes?

INTRODUCTION: Though the tumour-node-metastasis staging classification is the standard approach to risk stratification in patients with colorectal cancer, several other important variables including the presence of extramural venous invasion (EMVI), the tumour mismatch repair status, as well as surgical technique and its influence on lymph node yield all have an impact on long-term survival. This study aims to review both the impact of the type of operation on lymph node yield: complete mesocolic excision (CME) versus right hemicolectomy, and the impact of EMVI and microsatellite instability in predicting overall survival in patients undergoing a right hemicolectomy for colon cancer. METHODS: Data of all patients who underwent an elective or emergency right hemicolectomy with curative intent for colon cancer between January 2013 and June 2022 (inclusive) was collected for this single-centre retrospective study. Kaplan-Meier survival curves were calculated using the Statistical Package for the Social Sciences (SPSS version 28, IBM Corp., Armonk, NY) software, and the log-rank (Mantel-Cox) test was used to compare survival distribution between different groups. RESULTS: A total of 421 patients underwent a right hemicolectomy for colon cancer with curative intent during the study period. EMVI was present in 173 (41%) tumours. Survival analysis showed significantly reduced cancer-related survival in patients with EMVI-positive tumours (p < 0.001), with five-year survival rates of 70% in EMVI-positive groups versus 96% in EMVI-negative groups. Subgroup analysis showed a significant difference in survival between node-positive and node-negative tumours in cancers found to have EMVI (p < 0.001). Mean lymph node yield was significantly higher in the CME group versus the standard right hemicolectomy group (p < 0.001). We found no significant difference in survival between patients with microsatellite instability-high (MSI-H) tumours and microsatellite stable (MSS) tumours (p = 0.432). CONCLUSION: Consideration of tumour biology and adopting the optimum surgical technique are factors that may influence long-term survival in patients with colorectal cancer. Extramural venous invasion is an important prognostic indicator of adverse outcomes in patients with right-sided colon cancer. Our study demonstrates a reduction in survival in patients with EMVI-positive tumours when undertaking subgroup analysis by the presence or absence of nodal disease. Further research needs to be undertaken to compare the relative efficacy of neoadjuvant versus adjuvant chemotherapy in right-sided cancers known to be EMVI-positive as some patients will fail to have adjuvant chemotherapy due to postoperative complications, thereby delaying recovery and missing the optimum window for treatment.

Prenatal lipopolysaccharide exposure affects maternal behavior and male offspring sexual behavior in adulthood.

OBJECTIVE: This study investigates the effects of prenatal lipopolysaccharide (LPS) exposure on the maternal behavior of pregnant rats and the physical development and sexual behavior of their male offspring in adulthood. METHODS: For two experiments, pregnant rats were injected with LPS (250 microg/kg, i.p.) on gestation day (GD) 21. In the first experiment, the maternal behavior (postnatal day, PND, 6) and the dam's open-field general activity (PND7) were evaluated. In the second experiment, the maternal pre- and postnatal parameters, the pup's development, the offspring's sexual behavior in adulthood, and the pup's organ weights were assessed. RESULTS: Compared to the control group, the LPS-treated dams presented reduced maternal behavior, decreased general activity, a smaller body weight difference between GD21 and PND1, a greater number of perinatal deaths, and smaller litters. For the male pups, LPS treatment resulted in a decreased body weight on PND2, whereas the anogenital distance and the day of testis descent were not modified. The male sexual behavior was impaired by prenatal LPS. Particularly the number of ejaculating animals was reduced. The testis weight was also lower in the prenatally LPS-treated rats than in the control rats. CONCLUSION: We propose that prenatal LPS exposure on GD21 acts as an imprinting factor that interferes with the programming of brain sexual determination in offspring.

Echocardiographic predictors of functional capacity in endomyocardial fibrosis patients.

AIMS: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy manifested mainly by diastolic heart failure. It is recognized that diastole is an important determinant of exercise capacity. The purpose of this study was to determine whether resting echocardiographic parameters might predict oxygen consumption (VO(2p)) by ergoespirometry and the prognostic role of functional capacity in EMF patients. METHODS AND RESULTS: A total of 32 patients with biventricular EMF (29 women, 55.3 +/- 11.4 years) were studied by echocardiography and ergoespirometry. The relationship between the echocardiographic indexes and the percentage of predicted VO(2p) (%VO(2p)) was investigated by the 'stepwise' linear regression analysis. The median VO(2p) was 11 +/- 3 mL/kg/min and the %VO(2p) was 53 +/- 9%. There was a correlation of %VO(2p) with an average of A' at four sites of the mitral annulus (A' peak, r = 0.471, P = 0.023), E'/A' of the inferior mitral annulus (r = -0.433, P = 0.044), and myocardial performance index (r = -0.352, P = 0.048). On multiple regression analysis, only A' peak was an independent predictor of %VO(2p) (%VO(2p)= 26.34 + 332.44 x A' peak). EMF patients with %VO(2p)< 53% had an increased mortality rate with a relative risk of 8.47. CONCLUSION: In EMF patients, diastolic function plays an important role in determining the limitations to exercise and %VO(2p) has a prognostic value.

[Tuberculous pneumothorax: Diagnosis and treatment]. / Pneumothorax tuberculeux : prise en charge diagnostique et thérapeutique.

BACKGROUND: Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. METHODS: A retrospective multicentric and descriptive study including 65 patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. RESULTS: The mean age was 37.8 years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15 months for susceptible TB and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6 cases. Mean time to surgery was 171 days. Six patients had pleural decortication associated with pulmonary resection in 4 cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. CONCLUSION: The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately.

The effect of hetero- and homosexual experience and long-term treatment with fluoxetine on homosexual behavior in male rats.

INTRODUCTION: The selective serotonin reuptake inhibitors have become the most frequently prescribed drugs for the treatment of depression. Sexual side effects have been noted to occur with this treatment on heterosexual behavior in rats. Heterosexual experience facilitates sexual orientation of male rats and decreases the latencies to first mount and first intromission. On the other hand, homosexual behavior in male rats induced by female hormones has not been evaluated. AIM: The objective of this work is to evaluate the effects of heterosexual and homosexual experience in male rats long-term treated with fluoxetine (FLX) on homosexual hormone-induced behavior. MATERIALS AND METHODS: Male rats were treated with FLX or saline solution (10 mg/kg for 65 days). At days 36, 50, and 65 of the treatment, the rats were evaluated for homosexual behavior. Other rats treated with FLX or saline solution for 60 consecutive days were submitted to heterosexual behavior at 14, 21, and 28 days of the treatment. After this, they were orquiectomized and homosexual hormone-induced behavior was observed at 45 and 60 days of the treatment. RESULTS: (1) Only treatment with FLX did not affect the homosexual behavior. (2) The homosexual experience facilitated the homosexual behavior mainly on the animals from the control group. (3) The heterosexual experience facilitated the homosexual behavior on both groups. CONCLUSIONS: Only long-term administration of FLX does not interfere with the homosexual behavior in male rats. The homosexual and the heterosexual experience facilitated the homosexual behavior on the control and experimental groups. We suggested that learning aspects related to sexual behavior are responsible by these results.

The effects of exercise training on sympathetic neural activation in advanced heart failure: a randomized controlled trial.

OBJECTIVES: The goal of this study was to test the hypothesis that exercise training reduces resting sympathetic neural activation in patients with chronic advanced heart failure. BACKGROUND: Exercise training in heart failure has been shown to be beneficial, but its mechanisms of benefit remain unknown. METHODS: Sixteen New York Heart Association class II to III heart failure patients, age 35 to 60 years, ejection fraction < or =40% were divided into two groups: 1) exercise-trained (n = 7), and 2) sedentary control (n = 9). A normal control exercise-trained group was also studied (n = 8). The four-month supervised exercise training program consisted of three 60 min exercise sessions per week, at heart rate levels that corresponded up to 10% below the respiratory compensation point. Muscle sympathetic nerve activity (MSNA) was recorded directly from peroneal nerve using the technique of microneurography. Forearm blood flow was measured by venous plethysmography. RESULTS: Baseline MSNA was greater in heart failure patients compared with normal controls; MSNA was uniformly decreased after exercise training in heart failure patients (60 +/- 3 vs. 38 +/- 3 bursts/100 heart beats), and the mean difference in the change was significantly (p < 0.05) greater than the mean difference in the change in sedentary heart failure or trained normal controls. In fact, resting MSNA in trained heart failure patients was no longer significantly greater than in trained normal controls. In heart failure patients, peak VO(2) and forearm blood flow, but not left ventricular ejection fraction, increased after training. CONCLUSIONS: These findings demonstrate that exercise training in heart failure patients results in dramatic reductions in directly recorded resting sympathetic nerve activity. In fact, MSNA was no longer greater than in trained, healthy controls.

Repeated forced swim stress has additive effects in anxiety behavior and in cathecolamine levels of adult rats exposed to deltamethrin.

Deltamethrin (DTM) is a type II pyrethroid insecticide that elicits autonomic and neuroendocrine responses that indicate high levels of stress, presumably caused by the neurotoxic effect of the insecticide. This study investigated the effect of DTM exposure (10 mg/kg, p.o.) and an additional stress induced in the forced swim test (FST) in behavioral tasks related to anxiety, serum corticosterone levels, and striatal neurotransmitter levels. Open field behavior and social interaction were evaluated after DTM administration (10 mg kg(-1), p.o). DTM per se reduced rearing frequency in the open field, but no alterations in locomotion frequency or immobility duration were detected. Stress increased immobility duration compared with non-stressed animals. DTM reduced social interaction and increased corticosterone levels, and these effects were enhanced in stressed animals. Mainly stress affected dopaminergic and serotoninergic activity. In anxiety behavior and in both neurotransmitters and metabolites levels it was observed an additive effect of stress in DTM treated rat data. These results indicate that DTM enhanced the anxiogenic responses and stress had an additive effect over the DTM stress. The neurochemical data did not indicate an interaction between stress and DTM exposure. The present results maybe important for implementing pyrethroid insecticide safety standards.

Consensos em saúde bucal aprimorando a atenção básica, Ribeirão Preto, SP / Guidelines in oral health improvement the primary health attention, Ribeirão Preto, SP

Atualmente, o desenvolvimento e utilização dos Protocolos clínicos e de regulação na área da saúde, como ferramenta para gestão, têm contribuído para a organização e padronização da prática clínica em diversas áreas assistenciais, bem como conferido clareza quanto aos fluxos a serem percorridos pelos pacientes, em busca do cuidado à saúde. Por meio de estudo de abordagem qualitativa e valendo-se daTécnica Delphi na busca da convergência de opiniões, objetivou-se obter um consenso entre os participantes da pesquisa para a adoção dos conceitos que pudessem subsidiar a criação e implantaçãode um Protocolo em Saúde Bucal a ser aplicado na Rede Pública de Saúde no município de Ribeirão Preto. A amostra inicial de caráter aleatório, a partir de sorteio entre as Unidades de Saúde do Distrito Oeste de Ribeirão Preto foi composta por 13 dentistas e profissionais da equipe de saúde sendo que a metodologia foi desenvolvida em 3 etapas. A primeira iniciou-se com o grupo de dentistas das unidades sorteadas, que responderam a uma série de questões sendo os resultados dessa primeira fase compilados e a síntese das tarefas reenviada aos membros para que respondessem novamente, reconsiderando as suas respostas...

Currently the development and use of protocols in the area of health as a tool has contributed to the Organization and standardization of clinical practice. Model of the study: this study is to estimate qualitatively. Goal of the study: this research if proposed using the Delphi Technique to achieve a consensus among the participants of the survey in the consolidation of the axles, concepts and categories that will contribute to the creation and implementation of the Protocol in dental health Public health network of the city of Ribeirão Preto. Methodology: Delphi Technique was used in the search for convergence of views. The initial sample of random character from sweepstakes between units of Health district west of Ribeirão Preto, was composed by 13 dentists and the method was described in 3 steps. Started with the Group dental units selected, which responded to a series of questions and the results of this first phase compiled and the summary of the results communicated again to members to reply again upon reconsideration of...

Sexual experience did not affect the long-term sexual behavior inhibition of male rats treated with fluoxetine

Antidepressants, including tricyclics, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors cause sexual dysfunctions such as decreased sexual desire, erectile difficulties, and delayed ejaculation. Studies have shown that treatment with fluoxetine inhibits several components of sexual behavior in male rats. It is known that sexual experience improves the sexual behavior of male rats. Thus, the effects of sexual experience were examined in male rats during long-term treatment with fluoxetine or vehicle. Rats treated with 10mg/kg fluoxetine or vehicle daily (28 days) were observed for sexual behavior at the 14th, 21st, and 28th day of treatment. Long-term administration of fluoxetine increased the mount latency in control rats in the first session; no differences were observed in other parameters on the same day. Still in the control group, the mount and intromission latencies gradually decreased, whereas the number of intromissions and ejaculations increased over the sessions. The group in long-term treatment with fluoxetine also showed reduced mount and intromission latencies, although latencies remained significantly higher as compared to the control group. Fluoxetine-treated rats showed increased mount and intromission rates on the 28th day of treatment in relation to the first day. These data suggest that the impairment caused by long-term treatment with fluoxetine persists throughout the sessions despite the rats’ sexual experience.