Ethnic Variations of Blood Groups in a Medical College of Eastern Nepal.

Background Red blood cells contain antigens in its membrane which are inherited according to Mendelian law. ABO and Rhesus blood group systems are considered the most important blood group systems for clinical procedures, blood transfusion, organ transplantation, anthropological study and medico-legal purposes. Determination of ABO and Rhesus blood groups and its frequency distribution in a multiethnic country like Nepal is important for effective management of blood banks, safe blood transfusion services. The trend of blood groups and its ethnic distributions in the eastern part of Nepal is still unknown. Objective To find the distribution of blood groups among the subjects of different ethnic groups of eastern Nepal. Method A cross-sectional perspective study was carried out among the subjects visited in the laboratory of Nobel Medical College, Biratnagar, Nepal for a period of one year from August 1, 2015 to July 30, 2016. Result The 11,960 subjects were included in the present study, among which 5012 were males and 6948 were females. The study revealed that in ABO system, blood group distribution was 34.80% O, 28.66% A, 27.66% B and 6.89% AB. With regard to Rh blood group system, Rhesus +ve was 96.79% and Rhesus -ve was 3.21%. O blood group dominant ethnic groups were Brahmin, Bhujel, Biswakarma, Shah, Gurung, Marwari, Magar, Mahato, Mandal, Newar, Sanyasi, Tamang, Terai Brahmin and Yadav. Similarly, blood group A dominant ethnic groups were Chhetri, Dhimal, Limbu, Rai and Muslim. Howerver, blood group B was dominant in ethnic groups, namely Biswakarma, Rajput, Satar and Tharu. Conclusion The frequency distribution pattern of ABO blood group was observed as O > A> B > AB and in Rhesus system, Rhesus +ve > Rhesus -ve. Variation in blood groups distribution was observed in various ethnic groups.

Patient quality of life and short-term surgical outcomes between robotic and laparoscopic anterior resection for adenocarcinoma of the rectum.

PURPOSE: To compare patient quality of life (QoL) and short-term surgical outcomes between robotic anterior resection (r-AR) and laparoscopic (l-AR) approach. METHODS: Consecutive patients having undergone either robotic or laparoscopic AR for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by post-operative histology and short-term complications. QoL was prospectively assessed using the EORTC QLC-CR30 and QLC-CR29 questionnaires. RESULTS: In total, 36 patients (18 r-AR) with a median follow-up of 12 months following surgery (9-month robotic and 20-month laparoscopic) were studied. The two groups were similarly matched for age and gender. Laparoscopic patients had a lower ASA grade (p = 0.02). There was no significant difference in surgical outcomes between groups. r-AR patients reported lower pain scales (2 ± 6 vs. 11 ± 13) (p = 0.04), lower levels of insomnia 0 vs. 8 ± 15 (p = 0.04) and a lower abdominal pain scale (2 ± 9 vs. 17 ± 27) (p = 0.04). Male impotence scores were higher in l-AR 33 ± 35 compared to r-AR 7 ± 21 (p = 0.03). CONCLUSION: Despite its recent introduction to our centre, the quality of oncological resection using the robotic surgery is comparable to laparoscopy. Lower impotence and QoL scores in patients after robotic procedure may be explained on the basis of better visualisation and precise tissue handling.

Solution phase synthesis and intense pulsed light sintering and reduction of a copper oxide ink with an encapsulating nickel oxide barrier.

Copper oxide nanoparticle inks sintered and reduced by intense pulsed light (IPL) are an inexpensive means to produce conductive patterns on a number of substrates. However, the oxidation and diffusion characteristics of copper are issues that must be resolved before it can be considered as a viable solution. Nickel can provide a degree of oxidation protection and act as a barrier for the diffusion of copper. In the present study we have for the first time synthesized copper oxide with an encapsulating nickel oxide nanostructure using a solution phase synthesis process in the presence of a surfactant at room temperature. The room temperature process enables us to easily prevent the formation of alloys at the copper-nickel interface. The synthesis results in a simple technique (easily commercializable, tested at a 10 g scale) with highly controllable layer thicknesses on a 20 nm copper oxide nanoparticle. These Cu(2)O@NiO dispersions were then directly deposited onto substrates and sintered/reduced using an IPL source. The sintering technique produces a highly conductive film with very short processing times. Films have been deposited onto silicon, and the copper-nickel structure has shown a lower copper diffusion. The nanostructures and resulting films were characterized using electron and x-ray spectroscopy, and the films' resistivity was measured.

Toll-like receptors and CD40 modulate each other's expression affecting Leishmania major infection.

Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns and results in innate immune system activation that results in elicitation of the adaptive immune response. One crucial modulator of the adaptive immune response is CD40. However, whether these molecules influence each other's expression and functions is not known. Therefore, we examined the effects of TLRs on CD40 expression on macrophages, the host cell for the protozoan parasite Leishmania major. While polyinosinic-polycytidylic acid [poly (I:C)], a TLR-3 ligand, lipopolysaccharide (LPS), a TLR-4 ligand, imiquimod, a TLR-7/8 ligand and cytosine-phosphate-guanosine (CpG), a TLR-9 ligand, were shown to enhance CD40 expression, CD40 stimulation enhanced only TLR-9 expression. Therefore, we tested the synergism between CD40 and CpG in anti-leishmanial immune response. In Leishmania-infected macrophages, CpG was found to reduce CD40-induced extracellular stress-regulated kinase (ERK)1/2 activation; with the exception of interleukin (IL)-10, these ligands had differential effects on CD40-induced IL-1α, IL-6 and IL-12 production. CpG significantly enhanced the anti-leishmanial function of CD40 with differential effects on IL-4, IL-10 and interferon (IFN)-γ production in susceptible BALB/c mice. Thus, we report the first systematic study on CD40-TLR cross-talk that regulated the experimental L. major infection.

Leishmania expressed lipophosphoglycan interacts with Toll-like receptor (TLR)-2 to decrease TLR-9 expression and reduce anti-leishmanial responses.

Two different Toll-like receptors (TLRs) have been shown to play a role in host responses to Leishmania infection. TLR-2 is involved in parasite survival in macrophages upon activation by lipophosphoglycan (LPG), a virulence factor expressed by Leishmania. In contrast, activation of TLR-9 has been shown to promote a host-protective response. However, whether there is a relationship between the interaction of LPG and TLR-2, on one hand, with the effect of TLR-9, on the other hand, remains unknown. In this study, we report that in-vitro infection of macrophages with a L. major parasite with high expression levels of LPG results in decreased TLR-9 expression compared to infection with a L. major parasite with lower expression levels of LPG. Addition of anti-LPG as well as anti-TLR-2 antibodies prevents this reduction of TLR-9 expression. Also, the addition of purified LPG to macrophages results in a decrease of TLR-9 expression, which is shown to be mediated by transforming growth factor (TGF)-ß and interleukin (IL)-10. Finally, in-vitro treatment of macrophages with anti-LPG and/or anti-TLR-2 antibodies before infection reduces the number of amastigotes in macrophages and co-treatment of mice with anti-TLR-2 antibodies and cytosine-phosphate-guanosine (CpG) reduces footpad swelling and parasite load in the draining lymph nodes, accompanied by an interferon (IFN)-γ-predominant T cell response. Thus, for the first time, we show how interactions between LPG and TLR-2 reduce anti-leishmanial responses via cytokine-mediated decrease of TLR-9 expression.

Mesenteric fat necrosis after recent surgery causing bowel obstruction: a case report and review of the literature.

Mesenteric fat necrosis causing bowel obstruction is a rare occurrence with only one case reported in humans. It is due to accidental or surgical trauma to the adipose tissue with extracellular liberation of fat or enzymatic lysis of fat due to the release of lipases resulting in fibrosis. Preoperative imaging may often be misleading and fail to identify fat necrosis as the cause of bowel obstruction. As surgical intervention is the only suitable treatment option in cases of failed conservative treatment, the diagnosis is made postoperatively. There is no published advice on the management of mesenteric fat necrosis. We recommend safe operating techniques to minimize the risk of developing fat necrosis and its potential harmful consequences.

Sulfide oxidation in fluidized bed bioreactor using nylon support material.

A continuous fluidized bed bioreactor (FBBR) with nylon support particles was used to treat synthetic sulfide wastewater at different hydraulic retention time of 25, 50 and 75 min and upflow velocity of 14, 17 and 20 m/hr. The effects of upflow velocity, hydraulic retention time and reactor operation time on sulfide oxidation rate were studied using statistical model. Mixed culture obtained from the activated sludge, taken from tannery effluent treatment plant, was used as a source for microorganisms. The diameter and density of the nylon particles were 2-3 mm and 1140 kg/m3, respectively. Experiments were carried out in the reactor at a temperature of (30 +/- 2) degrees C, at a fixed bed height of 16 cm after the formation of biofilm on the surface of support particles. Biofilm thickness reached (42 +/- 3) microm after 15 days from reactor start-up. The sulfide oxidation, sulfate and sulfur formation is examined at all hydraulic retention times and upflow velocities. The results indicated that almost 90%-92% sulfide oxidation was achieved at all hydraulic retention times. Statistical model could explain 94% of the variability and analysis of variance showed that upflow velocity and hydraulic retention time slightly affected the sulfide oxidation rate. The highest sulfide oxidation of 92% with 70% sulfur was obtained at hydraulic retention time of 75 min and upflow velocity of 14 m/hr.

NATURALLY OCCURRING RADIONUCLIDE 40K BODY CONTENT OF KAKRAPAR GUJARAT SITE POPULATION.

An attempt was made to investigate the naturally occurring radionuclide 40K body content of the Kakrapar Gujarat Site (India) population by using whole-body counting method. The population comprises occupational workers (regular and contract personnel working at Kakrapar Atomic Power station) and students from various educational institutions. A total of 1056 subjects of different age groups and gender were monitored for 40K body content by using a Standfast-II Whole Body Counting System. The reactor released radionuclides such as 137Cs, 60Co and 131I are not detected in occupational workers of Kakrapar Atomic Power station which indicates that occupational workers are free from radioactive contamination. Based on the activity measurement, an effective dose due to 40K was estimated for different groups of the site population based on the dietary habits, sex and age. Statistical significant correlation was not observed in any of the groups. The annual effective dose due to 40K was found to be in the range of 52-243 µSv y-1 with an average of 133 ± 35 µSv y-1 for the vegetarian group (588 subjects), 60-223 µSv y-1 with an average of 136 ± 35 µSv y-1 for the non-vegetarian group (468 subjects), 52-243 µSv y-1 with an average of 134 ± 35 µSv y-1 for the male group (1007 subjects) and 67-203 µSv y-1 with an average of 128 ± 35 µSv y-1 for the female group (49 subjects), respectively. Among the four age groups of the population studied, an effective dose due to 40K is slightly higher in the age group of 20-29 (161 subjects). The annual effective dose due to 40K reported by UNSCEAR, 1982(3) is 180 µSv y-1.

Development of electronic record-keeping software for remote participation in Large Volume Plasma Device upgrade using Angular 2 and NodeJS web technologies.

In an era of digital transformation and collaborations, the Web Information System (WIS) becomes an essential requirement for the information and data sharing of large experimental facilities among users. With the enhancement in the capabilities and performance of web technologies, sharing of experimental data using a flexible, modular, secure, and robust mechanism is feasible. In this direction, the Large Volume Plasma Device (LVPD), an experimental device dedicated for carrying out investigations for unfolding physical phenomena of relevance to Earth's magnetosphere and fusion plasmas, also adopts web-based electronic record keeping for its operation. The nature of investigations is concerned with plasma turbulence of electron scale, induced anomalous plasma transport and mitigation of energetic electrons by excited whistler turbulence that requires large scale, and simultaneous multiple point measurements from different electrostatic and electro-magnetic diagnostics. This paper discusses the WIS implementation in LVPD for the experimental configuration, information logging, and preliminary data analysis. The architecture of the system is spread over three tiers covering application, data, and presentation layers. The presentation layer is developed using the Angular 2 framework on the progressive web application architecture. The application and data layers are developed using NodeJS and PostgreSQL, respectively. The novelty of this paper lies in the integrated application development approach and applicability of the latest web technologies in the scientific and experimental domains. This paper discusses the literature survey of similar developments at other places, requirements, scopes, development artifacts, adapted tools and technologies, obtained results from actual plasma discharges of LVPD, and future enhancements.

Anal cancer survival: a socioeconomic analysis.

INTRODUCTION: Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre. MATERIALS AND METHODS: All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival. RESULTS: A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0-93.7%), 75.5% (95% CI 67.5-84.5%) and 68.9% (95% CI 59.7-79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61-1.63), (p = 0.99, HR=1.00; 95% CI 0.61-1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02-5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12-2.41). CONCLUSION: In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.

A massive rock and ice avalanche caused the 2021 disaster at Chamoli, Indian Himalaya.

On 7 February 2021, a catastrophic mass flow descended the Ronti Gad, Rishiganga, and Dhauliganga valleys in Chamoli, Uttarakhand, India, causing widespread devastation and severely damaging two hydropower projects. More than 200 people were killed or are missing. Our analysis of satellite imagery, seismic records, numerical model results, and eyewitness videos reveals that ~27 × 106 cubic meters of rock and glacier ice collapsed from the steep north face of Ronti Peak. The rock and ice avalanche rapidly transformed into an extraordinarily large and mobile debris flow that transported boulders greater than 20 meters in diameter and scoured the valley walls up to 220 meters above the valley floor. The intersection of the hazard cascade with downvalley infrastructure resulted in a disaster, which highlights key questions about adequate monitoring and sustainable development in the Himalaya as well as other remote, high-mountain environments.

Toxicity and survival of anal cancer patients treated with intensity-modulated radiation therapy.

INTRODUCTION: The definitive treatment of anal cancer with chemoradiotherapy spares abdominoperineal resection for salvage treatment but carries a high burden of toxicity. Intensity-modulated radiation therapy has been implemented to reduce toxicity, reduce treatment breaks and improve survival. However, large and long-term studies are lacking. We aimed to investigate the toxicities and long-term survival of anal cancer patients treated with intensity-modulated radiation therapy at James Cook University Hospital, Middlesbrough. MATERIALS AND METHODS: We conducted a retrospective analysis of all patients with squamous cell anal cancer treated at James Cook University Hospital between July 2010 and April 2017. All patients were uniformly treated with intensity-modulated radiation therapy-based chemoradiation with curative intent. A subset of these patients was followed-up prospectively by an oncologist for acute and late toxicity. We calculated Kaplan-Meier estimates of survival statistics and compared our results with those of previous trials which used conventional radiotherapy. RESULTS: We studied 132 patients, including a toxicity subset of 64, for a median follow-up time of 43 months (range 3-84 months). Eleven patients (8.3%) underwent salvage abdominoperineal resection. Grade 3+ acute non-haematological, gastrointestinal, genitourinary and dermatological toxicity were found in 56.2%, 12.3%, 0% and 50.7% of the toxicity subset (n = 64). Median treatment duration was 37 days. Overall and colostomy-free survival at five years were 68.3% and 85.3%, respectively. Tumour size (P = 0.006) and age (P = 0.002) predicted shorter overall survival. CONCLUSIONS: Intensity-modulated radiation therapy probably reduces acute gastrointestinal and genitourinary toxicity compared with conventional radiotherapy, while resulting in similar overall and colostomy-free survival. We suggest that further dose escalation may improve survival in patients with T3/T4 tumours.

Sperm motility in Mytilus edulis in relation to mitochondrial DNA polymorphisms: implications for the evolution of doubly uniparental inheritance in bivalves.

Bivalves of the families Mytilidae, Unionidae, and Veneridae have an unusual mode of mitochondrial DNA (mtDNA) transmission called doubly uniparental inheritance (DUI). A characteristic feature of DUI is the presence of two gender-associated mtDNA genomes that are transmitted through males (M-type mtDNA) and females (F-type mtDNA), respectively. Female mussels are predominantly homoplasmic with only the F-type expressed in both somatic and gonadal tissue; males are heteroplasmic with the M-type expressed in the gonad and F-type in somatic tissue for the most part. An unusual evolutionary feature of this system is that an mt genome with F-coding sequences occasionally invades the male route of inheritance (i.e., a "role reversal" event), and is thereafter transmitted as a new M-type. Phylogenetic studies have demonstrated that the new or "recently masculinized" M-types may eventually replace the older or "standard" M-types over time. To investigate whether this replacement process could be due to an advantage in sperm swimming behavior, we measured differences in motility parameters and found that sperm with the recently masculinized M-type had significantly faster curvilinear velocity and average path velocity when compared to sperm with standard M-type. This increase in sperm swimming speed could explain the multiple evolutionary replacements of standard M-types by masculinized M-types that have been hypothesized for the mytilid lineage. However, our observations do not support the hypothesis that DUI originated because it permits the evolution of mitochondrial adaptations specific to sperm performance, otherwise, the evolutionarily older, standard M genome should perform better.

Processing of rayon waste effluent for the recovery of zinc and separation of calcium using thiophosphinic extractant.

Zinc is used in various metallurgical, chemical and textile industries. In textile industries, waste effluent containing zinc is generated during the manufacture of rayon yarn. Due to the strict environmental regulations and the presence of toxic metallic and other constituents, the discharge of effluents in sewage is restricted. In view of above a process has been developed for the recovery of zinc from rayon waste effluent following solvent extraction technique using thiophosphinic extractants Cyanex 272 and 302. Before recycling of zinc sulphate solution in spinning bath, solution must be free from calcium, which is deleterious to the process as gypsum precipitates and forms scale. The extractant Cyanex 302 has been found selective for the recovery of 99.99% of zinc in the form of [R(2)Zn](org) from the effluent above equilibrium pH 3.4 maintaining the O/A ratio of 1/30 leaving all the calcium in the raffinate. The zinc from the loaded Cyanex 302 can be stripped with 10% sulphuric acid at even O/A ratio of 10. The stripped solution thus obtained could be recycled in the spinning bath of the rayon plant and raffinate could be disposed safely without affecting environment.

Nephron sparing surgery: A single institution experience.

OBJECTIVE: To report our experience in managing various benign and malignant renal tumors with nephron-sparing surgery. MATERIALS AND METHODS: Records of patients who underwent nephron-sparing surgery (NSS) either through open or laparoscopic approach between May 1997 and June 2006 at our institution were reviewed. Patient and tumor-related characteristics, treatment modality and complications were noted. RESULTS: There were 26 patients (29 renal units), including three with bilateral lesions who underwent nephron-sparing surgery. Mean age at surgery was 47.0 years (range 16-67 years). Mean tumor size was 4.7 cm (range 2-7.5 cm). Mean warm ischemia time was 41 min and 32.5 min, operative time 158 min and 186 min and blood loss 200ml and 85 ml in open (n=24) and laparoscopic approach (n=2) respectively. Complications were seen in five (19.2%) patients of whom two had postoperative bleeding requiring nephrectomy in one and angioembolization in another. One patient with persistent urinary leak required intervention. Local wound infection in one patient and incisional hernia in another were surgically managed. Histopathological profile revealed 13 (44.8%) benign lesions which included angiomyolipoma (eight), simple cyst (two), cortical adenoma (one), metanephric adenoma (one) and myelolipoma (one). The remaining 16 (55.2%) malignant lesions included renal cell carcinoma (15) and metastatic adenocarcinoma (one). At a mean follow-up of 38.6 months (range 1-91) no patient had local recurrence or distant metastasis. Cancer-specific survival was 100% and overall survival was 92.3%. CONCLUSIONS: Nephron-sparing surgery is a safe and effective alternative to nephrectomy in both benign and malignant lesions of the kidney.

Short-term surgical outcomes and patient quality of life between robotic and laparoscopic extralevator abdominoperineal excision for adenocarcinoma of the rectum.

Introduction Some studies advocate a laparoscopic extralevator abdominoperineal excision (l-ELAPE) approach for low rectal cancer. The da Vinci™ robot (r-ELAPE) technique has potential to overcome some limitations of l-ELAPE, such as reduction of the learning curve and more precise tissue handling. It is unknown whether this approach results in improved surgical or quality of life outcomes compared with l-ELAPE. This study aimed to address this issue. Methods Consecutive patients having undergone either robotic or laparoscopic ELAPE for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by postoperative histology and short-term complications. Quality of life was prospectively assessed using the European Organisation for Research and Treatment of Cancer QLC-CR30 and QLC-CR29 questionnaires. Results A total of 22 patients (11 r-ELAPE) with a median follow-up of 13 months (8 months robotic; 22 months laparoscopic) were studied. The groups were similarly matched for age, gender, American Society of Anesthesiologists status, preoperative chemoradiotherapy and tumour height. All had R0 resection. There was no significant difference in short-term surgical outcomes between groups. There was no significant difference in mean global health scores between the two groups (74 ± 14 r-ELAPE vs. 73 ± 10 l-ELAPE). The r-ELAPE group had a lower mean impotence score compared with the I-ELAPE group (55.5 ± 40 vs. 72.2 ± 44), although this was not statistically significant. Conclusions The newly introduced r-ELAPE was non-inferior to l-ELAPE in either patient quality of life or surgical outcomes. Robotic surgery could be particularly beneficial in the technically challenging area of low rectal cancer surgery with a shorter learning curve than laparoscopy.

Simulation of normal, carrier and affected controls for large-scale genotyping of cattle for factor XI deficiency.

An insertion mutation within exon 12 of the factor XI gene has been described in Holstein cattle. This has opened the prospect for large-scale screening of cattle using the polymerase chain reaction (PCR) technique for the rapid identification of heterozygous animals. To facilitate such a screening process, the mutant and normal alleles of factor XI gene, represented by 244- and 320-bp PCR amplified fragments, were individually cloned in Escherichia coli using a multicopy plasmid cloning vehicle to generate pFXI-N and pFXI-M, respectively. The authenticity of the inserts was confirmed by nucleotide sequencing. A nested PCR method was developed, by which PCR amplicons generated from primers with annealing sites on the recombinant plasmids and by flanking the insert were used as templates for amplification of the diagnostic products using factor XI gene-specific primers. An equimolar mixture of both PCR amplicons, originating from pFXI-N and pFXI-M, constituted the carrier control while the individual amplicons were the affected and normal controls. The controls were used as references for in-gel comparison to screen a population of 307 cattle and 259 water buffaloes; the frequency of the mutant allele was found to be 0. No DNA size standards were required in this study. The simulated control DNA samples representing normal, carrier and affected cattle have the potential to help in large-scale screening of a cattle population for individuals that are carriers or affected by factor XI deficiency.

Variance of surgeons versus pathologists in staging of colorectal cancer.

AIM: Accurate staging of colorectal cancer depends on adequate retrieval and reporting of lymph nodes in the specimen. The presence of positive lymph nodes is an indication for adjuvant therapy. Both surgeons and pathologists influence the number of lymph nodes that are retrieved and reported in specimens. Although several recommendations exist in the literature regarding the minimum number of lymph nodes required for reliable staging, the relationship of examined to infiltrated lymph nodes has not been clarified. The aims of this study were to examine variance among surgeons and pathologists in the retrieval and reporting of lymph nodes in colorectal cancer specimens; to examine the relationship between retrieved/examined lymph nodes and infiltrated lymph nodes; to identify in our own series the minimum number of retrieved lymph nodes required to secure accurate staging. METHODS: Cross-sectional study of 284 patients with colorectal cancer followed in our hospital and retrospective analysis of histopathology reports. Correlation analysis, ANOVA, and survival analysis were performed on the data. RESULTS: There were 127 patients with cancer of the rectum and 157 patients with cancer of the colon under follow-up. The median number of lymph nodes per specimen was 8 (range 0-29). There was no difference in the number of retrieved lymph nodes among 9 surgeons. There were 2 outliers among pathologists, with one reporting a mean of 11.4 (9.8-12.9) 95% CI nodes per specimen and another reporting a mean 4.9 (3.6-6.2) 95% CI nodes per specimen. Dukes and T stage did not affect the number of nodes. Correlation analysis revealed a linear correlation between the total number of reported lymph nodes and the existence of positive lymph nodes. From the correlation equation we calculated that, in order to have one positive node, a minimum of 8.4 nodes was required in the specimen. Therefore, in our group of patients, a minimum of 8.4 nodes was required for accurate Dukes staging. However, survival analysis did not show any difference between patients with more and patients with less than 9 reported lymph nodes. CONCLUSIONS: Variance among pathologists exists and may be at least as important as variance among surgeons. Specialisation of pathologists similar to that of surgeons as well as employment of new techniques may be required . There is a linear correlation between the number of examined lymph nodes and the presence of positive nodes in a colorectal cancer specimen. This linear correlation makes the calculation of the minimum number of lymph nodes possible. In our series a minimum of nine nodes must be examined. However, we have not demonstrated an effect of inadequate nodes numbers on survival, possibly because survival in colorectal cancer is multifactorial.

Cell cycle arrest by Colcemid differs in human normal and tumor cells.

In the continuous presence of Colcemid, the mitotic index in cultures of nine human tumor cell lines began to increase immediately upon addition of the drug. For 12 human normal (nontumorigenic) cell lines, the mitotic index did not begin to increase for some 2 to 3 h after the addition of Colcemid. The effect was independent of whether the cells were of fibroblast or epithelial origin and occurred over a 1000-fold range of Colcemid concentrations. No such differential effect was seen with single concentrations of either Taxol or nocodazole, but a similar delayed effect was seen for two concentrations of vinblastine. These observations suggest a fundamental difference between human normal and human tumor cells involving a cell cycle checkpoint in G2, about 1 to 2 h before mitosis.