Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections.

PURPOSE: The enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery. METHOD: Patients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator characteristic curves (AUC) for logistic estimation. RESULTS: This study included 205 patients, of whom 56% were men and 43.9% were women with a mean age of 56.4 ± 13.1 years. Twenty-two patients (10.7%) had AL; 77.3% underwent surgery, and 22.7% were treated with drainage and antibiotics. Procalcitonin was the best predictor for AL compared to CRP and WBC at three days postoperatively (AUC: 0.84, 0.76, 0.66, respectively). On day 5, a cutoff value of 4.93 ng/mL for PCT had the highest sensitivity, specificity, and negative predictive value. The predictive power of PCT was substantially improved when combined with either CRP or WBC, or both (AUC: 0.92, 0.92, 0.93, respectively). CONCLUSION: The 5-day trajectories of combined CRP, PCT, and WBC had a better predictive power for AL than the isolated daily measurements. Combining the three parameters may be a reliable predictor of early patient discharge, which would be highly beneficial to ERAS programs.

Histopathological and epidemiological findings of colonoscopy screening in a population with an average risk of colorectal cancer in Kuwait.

BACKGROUND: Colorectal cancer (CRC) is the second most common cancer in women and the third most common in men worldwide, with a significantly rising incidence in the Middle East region over the last few decades. This study investigates the histopathological and epidemiological characteristics of colonoscopic findings in a population with an average risk of CRC in Kuwait. METHODS: In this study, 1,005 asymptomatic average-risk Kuwaiti adults aged over 40 years had their first colonoscopy screening during the 2015-2018 period. Data on lifestyle behaviors (cigarette smoking, alcohol consumption, and physical activity), body mass index (BMI), and comorbidities were routinely collected from these individuals. All colorectal polyps or masses were assessed for their site, size, and number and then resected and sent for histopathological examination. RESULTS: The mean age of the participants was 54 years, and 52.2% were women. In screened individuals, the polyp detection rate, adenoma detection rate, and carcinoma detection rate were 43.8%, 27.7%, and 1.2%, respectively. Tubular, tubulovillous, and villous types of adenoma constituted 17.3%, 2.8%, and 1.3% of all screened participants. Neoplastic lesions, particularly in the proximal colon, were more common among men aged 40-49 years. Age of 70 years and older (OR: 9.6; 95% CI: 4.7-19.9; P < 0.001), male gender (OR: 1.6; 95% CI: 1.1-2.3; P = 0.011), increased BMI (OR: 1.05; 95% CI: 1.02-1.08; P = 0.001), and smoking (OR: 3.5; 95% CI: 2.3-5.4; P < 0.001) were the most significant independent risk factors for colorectal neoplasia. CONCLUSIONS: The high adenoma detection rate (ADR) in Kuwaiti population calls for the establishment of a national programe for CRC screening. The higher ADR in those younger than 50 years calls for assessment of the threshold age at which to start screening.

Assessment of The Role of Serum Neutrophil Gelatinase-Associated Lipocalin in Egyptian Childhood Bronchial Asthma: One Centre Study.

Neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a potential biomarker in many medical conditions including asthma. The aim of this study was to assess the role of serum NGAL in Egyptian childhood bronchial asthma. The study included 156 patients and 39 apparently healthy control children. Full clinical examination, pulmonary function tests; CBC, CRP, IgE, liver function tests, and renal function tests, and serum NGAL level were performed. The difference between the studied groups was statistically significant regarding IgE, eosinophils and NGAL (P= 0.001 for each). In addition, the difference between the subgroup with severe persistent asthma and the subgroup with mild intermittent asthma was significant (P=0.001). ROC curve analysis showed that at a cut-off value of 0.884 the sensitivity and specificity of differentiating severe bronchial asthma patients from controls was 82 % and 76 %, respectively. In conclusion, NGAL may represent a potential marker of bronchial asthma in children with severe disease.

A kinetic view of acid-mediated tumor invasion.

According to the acid-mediated tumor invasion hypothesis, tumor-induced alteration of microenvironmental pH may provide a simple, yet complete mechanism for tumor invasion. The acid-mediation hypothesis analyzes the tumor growth and invasion process from a reaction-diffusion system perspective, where it incorporates the H+ ion concentration as a reaction factor and adds density-dependent diffusion parameters to the reaction terms, yielding independent reaction-diffusion equations for the normal, tumor, and acid populations. In this article, we apply the dynamical stability theory to the acid-mediation hypothesis. For reasonable biological parameters, we study the fixed points central to the model and their stability by calculating the eigenvalues of the Jacobian matrix of the partial differential equations that represent how these three populations evolve with time. For the case where a malignant behavior has not already taken place yet (the time rates of change of the densities of the three populations are equal to zero), our numerical results convey two different, yet possible configurations in three-dimensional space: stable and unstable dynamical equilibriums, and we discuss possible prospective trajectories for the normal and tumor populations starting from each configuration. Moreover, we discuss potential applications of our approach.

Effects of dietary methionine on productivity, reproductive performance, antioxidant capacity, ovalbumin and antioxidant-related gene expression in laying duck breeders.

The study investigated whether dietary methionine (Met) affects egg weight and antioxidant status through regulating gene expression of ovalbumin (OVAL), nuclear factor erythroid 2 like 2 (Nrf2) and haem oxygenase 1 (HO-1) in laying duck breeders. Longyan duck breeders (n 540, 19 weeks) were randomly assigned to six treatments with six replicates of fifteen birds each. Breeders were fed diets with six Met levels (2·00, 2·75, 3·50, 4·25, 5·00 and 5·75 g/kg) for 24 weeks. The egg weight (g), egg mass (g/d), feed conversion ratio, hatchability, 1-d duckling weight, albumen weight, albumen proportion and OVAL mRNA level improved with dietary Met levels, whereas yolk proportion decreased (P<0·05). The weight of total large yellow follicles increased linearly (P<0·001) and quadratically (P<0·05) with dietary Met concentration, and their weight relative to ovarian weight showed a linear (P<0·05) effect. Dietary Met level had a linear (P<0·05) and quadratic (P<0·001) effect on the gene expression of glutathione peroxidase (GPX1), HO-1 and Nrf2, and quadratically (P<0·05) increased contents of GPX and total antioxidant capacity (T-AOC) in liver of duck breeders. In addition, maternal dietary Met enhanced gene expression of GPX1, HO-1 and Nrf2, increased contents of GPX and T-AOC and reduced carbonylated protein in the brains of hatchlings. Overall, dietary Met concentration affected egg weight and albumen weight in laying duck breeders, which was partly due to gene expression of OVAL in oviduct magnum. A diet containing 4·0 g Met/kg would achieve optimal hepatic GPX1 and Nrf2 expression, maximise the activity of GPX and minimise lipid peroxidation.