Early response evaluation during preoperative chemotherapy for colorectal liver metastases: Combined size and morphology-based criteria predict pathological response and survival after resection.

BACKGROUND: Short treatment-duration with early restaging is crucial to avoid liver injury after preoperative chemotherapy (preopCTX) for colorectal liver metastases (CRLM). Response evaluation according to response evaluation criteria in solid tumors (RECIST) criteria implies several limitations. Early tumor shrinkage (ETS; ≥20% size reduction <6-12 weeks) or morphological criteria (MC) may better predict oncological outcome. METHODS: In patients undergoing resection after preopCTX between 2003-2017 pathological and radiological response was reassessed according to Blazer classification, ETS, MC, and RECIST within 90 days and correlated with survival. RESULTS: Seventy-two patients were included, with a median of two (1-10) liver lesions, 53% bilobar involvement, and 7% extrahepatic disease. PreopCTX was applied for 3 months in median (1-6). During restaging after a median of 62 days, presence of ETS was associated with improved median overall survival (OS; 57.1 vs 33.7 months; P = .010) and disease-free survival (16 vs 7.2 months; P = .025). MC significantly correlated with major pathological response (P = .021). When combining ETS with optimal MC, presence of one or both factors was associated with pathological response (61.5% and 92.3%; P = .044) and OS in log-rank (P = .011), and multivariable analysis (hazard ratio [HR] 0.41; 95% confidence interval [CI], 0.19-0.90 and HR 0.32; 95%CI, 0.11-0.97). CONCLUSION: Response-grading by combined ETS/MC criteria less than 90 days after preopCTX initiation predicts pathological response and postoperative survival in CRLM.

Offline consolidation of memory varies with time in slow wave sleep and can be accelerated by cuing memory reactivations.

Memory representations are reactivated during slow-wave sleep (SWS) after learning, and these reactivations cause a beneficial effect of sleep for memory consolidation. Memory reactivations can also be externally triggered during sleep by associated cues which enhance the sleep-dependent memory consolidation process. Here, we compared in humans the influence of sleep periods (i) of 40min and (ii) of 90min without externally triggered reactivations and (iii) of externally triggered reactivations by an associated odor cue during a 40-min sleep period on the consolidation of previously learned hippocampus-dependent visuo-spatial memories. We show that external reactivation by an odor cue during the 40-min sleep period enhanced memory stability to the same extent as 90min of sleep without odor reactivation. In contrast, 40min of sleep without external reactivations were not sufficient to benefit memory. In the 90-min sleep condition, memory enhancements were associated with time spent in SWS and were independent of the presence or absence of REM sleep. These results suggest that the efficacy of hippocampus-dependent memory consolidation depends on the duration of sleep and particularly SWS. External reactivation cues can accelerate the consolidation process even during shorter sleep episodes.

Brunn's Cyst Inducing Persistent Lower Urinary Tract Symptoms in a Young Man: A Case Report.

Background: Lower urinary tract symptoms (LUTS) are mostly caused by hyperplasia of the prostate in the elderly generation or are the consequence of a urethral stricture in young men. Proliferated Brunn's cell nests forming cysts at the bladder neck can likewise result in similar symptoms and can, therefore, often be overlooked. Case Presentation: The case describes a 46-year-old man presenting with the typical LUTS of urgency and pathologic residual urine volume of 350 mL. Sonographic and cystoscopic diagnostics showed a cystic lesion located at the bladder neck, acting as a ball valve mechanism. Transurethral deroofing and resection of the cyst resulted in an immediate resolution of LUTS and a symptom-free patient with no residual urine at follow-up. Conclusion: The presence of a Brunn's cyst is rare but should be kept in mind as a differential diagnosis of LUTS in young men.