Calidad asistencial y seguimiento de los pacientes operados por cáncer colorrectal en un Hospital de Paysandú, Uruguay / Quality of care and follow-up of patients operated on forcolorectal cancer at the Paysandú Hospital, Uruguay

Introducción: el cáncer colorrectal (CCR) es la segunda causa de muerte dentro de las enfermedades neoplásicas. El pronóstico individual está signado por el estadio de la enfermedad al momento del diagnóstico y la posibilidad de realizar un tratamiento curativo. Este también depende de la estratificación post quirúrgica y de la aparición de complicaciones ulteriores. El objetivo del seguimiento es diagnosticar la recidiva en un estadio potencialmente curable y detectar otros cánceres primarios. Objetivo: realizar una valoración de la calidad de la cirugía colorrectal y el seguimiento de los pacientes operados de CCR en nuestro hospital. Diseño: estudio descriptivo, observacional, retrospectivo. Material y métodos: se analizaron todos los pacientes con CCR operados en el servicio de cirugía del Hospital de Paysandú entre enero de 2017 y diciembre de 2020. Se describen diversas variables que influyen en la calidad quirúrgica y se analizan las relacionadas al seguimiento post operatorio dividiendo a los pacientes en 3 grupos, seguimiento completo, perdidos y sin datos de seguimiento. Resultados: se incluyeron 39 pacientes, con una edad media de 68 años. El 28% se diagnosticaron en estadio IV, con porcentajes bajos en estadios tempranos. Hubo 57% de cirugías de urgencia y 43% electivas. La causa más frecuente de urgencia fue la oclusión intestinal (36,6%). La tasa de dehiscencia anastomótica fue 16,6% y la de mortalidad 15,3%. Solo el 33% de los pacientes tuvieron seguimiento completo. Conclusión: existe un déficit en la atención y el seguimiento de los pacientes operados por CCR en nuestro hospital. Se impone la creación de un equipo específico en el área de coloproctología, así como un protocolo de seguimiento unificado para mejorar estos resultados. (AU)

Introduction: colorectal cancer (CRC) is the second cause of death among neoplastic diseases. The individual prognosis is determined by the stage of the disease at the time of diagnosis and the possibility of curative treatment. This also depends on the postsurgical stratification and the appearance of subsequent complications. The goal of follow-up is to diagnose recurrence at a potentially curable stage and detect other primary cancers. Objective: to carry out an evaluation of the quality of colorectal surgery and the follow-up of patients operated on for CRC in our hospital. Design: descriptive, retrospective observational study. Material and methods: all patients with CRC operated on in the surgery service of the Paysandú Hospital between January 2017 and December 2020 were analyzed. Variables that influence surgical quality are described and those related to postoperative follow-up are analyzed by dividing patients in 3 groups, complete follow-up, lost to follow-up and without follow-up data. Results: Thirty-nine patients were included, with a mean age of 68 years. Twenty-eight percent were diagnosed in stage IV, with low percentages in early stages. There were 57% emergency procedures and 43% elective proceduress. The most common cause of emergency was intestinal obstruction (36.6%). The anastomotic dehiscence rate was 16.6% and the mortality rate was 15.3%. Only 33% of patients had complete follow-up. Conclusion: there is a deficit in the care and follow-up of patients undergoing CRC surgery in our hospital. The creation of a specific team in the area of coloproctology is required, as well as a unified monitoring protocol to improve these results. (AU)

Protocolo de recuperación mejorada después de cirugía (ERAS) atenúa el estrés y acelera la recuperación en pacientes después de resección radical por cáncer colorrectal: Experiencia en la Clínica Universitaria Colombia / Enhanced Recovery After Surgery (ERAS) protocol attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: Experience at Clínica Universitaria Colombia

Introducción. El conjunto de estrategias de recuperación mejorada después de la cirugía (ERAS, por sus siglas en inglés) constituye un enfoque de atención multimodal y multidisciplinario, cuyo propósito es reducir el estrés perioperatorio de la cirugía, disminuir la morbilidad y acortar la estancia hospitalaria. Este estudio tuvo como objetivo describir los resultados clínicos de pacientes sometidos a cirugía por cáncer colorrectal, identificando las complicaciones principales y los factores perioperatorios relacionados con el alta temprana. Métodos. Se analizaron los pacientes consecutivos sometidos a cirugía colorrectal entre los años 2020 y 2023, todos los cuales siguieron el protocolo ERAS institucional. Se evaluaron las características clínicas, los factores perioperatorios, los desenlaces postoperatorios y la tasa global de adherencia al protocolo. Resultados. Un total de 456 pacientes fueron sometidos a cirugía colorrectal, 51% de sexo masculino, con edad media de 60 años. La mayoría de las intervenciones se realizaron por laparoscopia (78 %), con una tasa de conversión del 14,5 %. Las complicaciones postoperatorias incluyeron fuga anastomótica (4,6 %), sangrado, infección intraabdominal y obstrucción intestinal. La estancia hospitalaria promedio fue de 4 días y la mortalidad del 2,8 %. La tasa global de adherencia al protocolo ERAS fue del 84,7 %. Conclusiones. El enfoque combinado de cirugía laparoscópica y protocolo ERAS es factible, seguro y se asocia con una estancia hospitalaria más corta. La implementación y adherencia al protocolo ERAS no solo mejora los resultados postoperatorios, sino que también resalta la importancia de acceder a datos sólidos, permitiendo mejorar la atención perioperatoria local.

Introduction. The Enhanced Recovery After Surgery (ERAS) protocol is a multimodal, multidisciplinary approach to care, the purpose of which is to reduce the perioperative stress of surgery, decrease morbidity, and shorten hospital stay. This study aimed to describe the clinical outcomes of patients undergoing surgery for colorectal cancer, identifying the main complications and perioperative factors related to early discharge. Methods. Consecutive patients undergoing colorectal surgery between 2020 and 2023 were analyzed, who followed the institutional ERAS protocol. Clinical characteristics, perioperative factors, postoperative outcomes, and overall protocol adherence rate were evaluated. Results. A total of 456 patients underwent colorectal surgery, 51% male, with a mean age of 60 years. Most interventions were performed laparoscopically (78%), with a conversion rate of 14.5%. Postoperative complications included anastomotic leak (4.6%), followed by bleeding, intra-abdominal infection, and intestinal obstruction. The average hospital stay was 4 days and mortality was 2.8%. The overall adherence rate to the ERAS protocol was 84.7%. Conclusions. The combined approach of laparoscopic surgery and ERAS protocol is feasible, safe, and associated with a shorter hospital stay. Implementation and adherence to the ERAS protocol not only improves postoperative outcomes, but also highlights the importance of accessing solid data, allowing for improved local perioperative care.

Mortalidade por Câncer de Cólon e Reto no Brasil e suas Regiões entre 2006 e 2020 / Mortality due to Colon and Rectal Cancer in Brazil and its Regions between 2006 and 2020

No Brasil, estima-se a ocorrência de 704 mil casos novos de câncer para cada ano do triênio 2023-2025, sendo o câncer de cólon e reto (CCR) o tipo de neoplasia responsável pela terceira maior taxa de mortalidade para ambos os sexos. Objetivo: Analisar a tendência temporal de mortalidade prematura por CCR de 2006 a 2020, em ambos os sexos, no Brasil e em suas cinco Macrorregiões, e avaliar o alcance da meta proposta pelo Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas não Transmissíveis no Brasil 2011-2022 do Ministério da Saúde (MS) em relação ao CCR. Método: Estudo de séries temporais das taxas de mortalidade prematura e padronizada de CCR (CID-10: C18-21) tendo como população de estudo a do Brasil, com dados obtidos a partir do Sistema de Informação sobre Mortalidade do DATASUS de 2006 a 2020. Resultados: As taxas de mortalidade prematura por CCR apresentaram aumento linear ao longo do período observado, porém com importantes diferenças regionais. Em relação ao CCR, a meta proposta pelo plano do MS não foi alcançada. Conclusão: Houve um aumento das taxas de mortalidade prematura por CCR no Brasil, tendência esperada em países em desenvolvimento. Por ser um câncer que envolve fatores de risco modificáveis, são importantes ações contínuas voltadas para o manejo desses fatores, tais como políticas nacionais de promoção de saúde. Além disso, são necessários estudos que subsidiem políticas preventivas de programas de rastreamento e diagnóstico precoce.

In Brazil, 704 thousand new cases of cancer were estimated for each year of the triennium 2023-2025, and colon and rectal cancer (CRC) is the type of neoplasm responsible for the third highest mortality rate for both sexes in the country. Objective: To analyze the temporal trend of premature mortality by CRC from 2006 to 2020, for both sexes, in Brazil and its five macroregions, and to evaluate whether the goal proposed by the Strategic Action Plan for Tackling Chronic non Communicable Diseases in Brazil 2011-2022 of the Ministry of Health (MH) in relation to CCR has been met. Method: Time series study of standardized premature mortality rates by CRC (ICD-10: C18-21); the study population is Brazil's population obtained from DATASUS' Mortality Information System from 2006 to 2020. Results: Premature mortality rates by CRC in Brazil and in all five macroregions increased linearly over the period investigated, but with important regional differences. The target proposed by the MH's Plan for CRC was not met. Conclusion: There was an increase in premature mortality rates by CRC in Brazil, a trend expected for developing countries. As it is a type of cancer that involves modifiable risk factors, continuous actions to manage these factors are important, such as national health promotion policies. Furthermore, studies are needed to support preventive policies for screening and early diagnosis programs

En el Brasil, se estimó la aparición de 704 000 nuevos casos de cáncer para cada año del período 2023-2025, siendo el cáncer de colorrectal (CCR) el tipo de neoplasia responsable de la tercera mayor tasa de mortalidad para ambos sexos en el país. Objetivo: Analizar la tendencia en el tiempo de la mortalidad prematura por CCR en el período de 2006 a 2020, en ambos sexos, en el Brasil y sus 5 macrorregiones, y evaluar si fue alcanzada la meta propuesta por el Plan de Acción Estratégica para el Enfrentamiento de las Enfermedades Crónicas no Transmisibles en el Brasil 2011-2022 del Ministerio de Salud (MS) con relación a la CCR. Método: Estudio de series de tiempo de tasas de mortalidad prematura estandarizadas por CCR (CIE-10: C18-21) utilizando como población de estudio toda la población del Brasil, con datos obtenidos del Sistema de Información sobre Mortalidad del DATASUS de 2006 a 2020. Resultados: Las tasas de mortalidad prematura por CCR en el Brasil y en las cinco regiones mostraron un aumento lineal durante el período observado, pero con importantes diferencias regionales. Con relación al CCR, la meta propuesta por el Plan del MS no fue alcanzada. Conclusión: Hubo un aumento de las tasas de mortalidad prematura por CCR en el Brasil, tendencia esperada en países en desarrollo. Al tratarse de un tipo de cáncer que involucra factores de riesgo modificables, son importantes las acciones continuas encaminadas a gestionar estos factores, como las políticas nacionales de promoción de la salud del CCR. Además, se necesitan estudios que respalden las políticas preventivas para los programas de detección y diagnóstico temprano

Protective Autophagy in 5-Fluorouracil-Resistant Colorectal Cancer Cells and ERK-RSK-ABCG2 Linkage / Autofagia Protectora en Células de Cáncer Colorrectal Resistentes al 5-Fluorouracilo y Enlace ERK-RSK-ABCG2

SUMMARY: To evaluate the anti-cancer effects of yeast extract on resistant cells, autophagy and necroptosis were investigated in 5-fluorouracil (5-FU)-resistant colorectal cancer cells. Further underlying characteristics on drug resistance were evaluated, focused on ERK-RSK-ABCG2 linkage. SNU-C5 and 5-FU resistant SNU-C5 (SNU-C5/5-FUR) colorectal cancer cells were adopted for cell viability assay and Western blotting to examine the anti-cancer effects of yeast extract. Yeast extract induced autophagy in SNU-C5 cells with increased Atg7, Atg12-5 complex, Atg16L1, and LC3 activation (LC3-II/LC3-I), but little effects in SNU-C5/5-FUR cells with increased Atg12-5 complex and Atg16L1. Both colorectal cancer cells did not show necroptosis after yeast extract treatment. Based on increased ABCG2 and RSK expression after yeast extract treatment, drug resistance mechanisms were further evaluated. As compared to wild type, SNU-C5/5-FUR cells showed more ABCG2 expression, less RSK expression, and less phosphorylation of ERK. ABCG2 inhibitor, Ko143, treatment induces following changes: 1) more sensitivity at 500 mM 5-FU, 2) augmented proliferation, and 3) less phosphorylation of ERK. These results suggest that protective autophagy in SNU-C5/5-FUR cells with increased ABCG2 expression might be candidate mechanisms for drug resistance. As the ERK responses were different from each stimulus, the feasible mechanisms among ERK-RSK-ABCG2 should be further investigated in 5-FU-resistant CRC cells.

Para evaluar los efectos anticancerígenos del extracto de levadura en células resistentes, se investigaron la autofagia y la necroptosis en células de cáncer colorrectal resistentes al 5-fluorouracilo (5-FU). Además se evaluaron otras características subyacentes de la resistencia a los medicamentos centrándose en el enlace ERK-RSK-ABCG2. Se usaron células de cáncer colorrectal SNU-C5 (SNU-C5/5-FUR) resistentes a SNU-C5 y 5- FU para el ensayo de viabilidad celular y la transferencia Western para examinar los efectos anticancerígenos del extracto de levadura. El extracto de levadura indujo autofagia en células SNU-C5 con mayor activación de Atg7, complejo Atg12-5, Atg16L1 y LC3 (LC3-II/LC3-I), pero pocos efectos en células SNU-C5/5-FUR con aumento de Atg12-5 complejo y Atg16L1. Ambas células de cáncer colorrectal no mostraron necroptosis después del tratamiento con extracto de levadura. Se evaluaron los mecanismos de resistencia a los medicamentos. en base al aumento de la expresión de ABCG2 y RSK después del tratamiento con extracto de levadura.En comparación con las de tipo salvaje, las células SNU-C5/5-FUR mostraron más expresión de ABCG2, menos expresión de RSK y menos fosforilación de ERK. El tratamiento con inhibidor de ABCG2, Ko143, induce los siguientes cambios: 1) más sensibilidad a 5-FU 500 mM, 2) proliferación aumentada y 3) menos fosforilación de ERK. Estos resultados sugieren que la autofagia protectora en células SNU-C5/5-FUR con mayor expresión de ABCG2 podría ser un mecanismo candidato para la resistencia a los medicamentos. Como las respuestas de ERK fueron diferentes de cada estímulo, los mecanismos factibles entre ERK-RSK- ABCG2 deberían investigarse más a fondo en células CCR resistentes a 5-FU.

Caracterización de los adultos mayores con cáncer colorrectal en la comunidad / Characterization of Community Older Adults with Colorectal Cancer

Introducción: El cáncer colorrectal es la neoplasia más frecuente del sistema digestivo en los adultos mayores. En Cuba es un problema de salud de primer orden por su elevada incidencia y mortalidad, que constituye la tercera causa de muerte. Objetivo: Caracterizar a los adultos mayores con cáncer colorrectal en el Policlínico Sur de Sancti Spíritus. Métodos: Investigación de tipo descriptiva en el Policlínico Sur del municipio y la provincia de Sancti Spíritus de enero a marzo del 2019. Muestra intencional de 127 adultos mayores, pertenecientes a consultorios urbanos. Las variables: edad, sexo, escolaridad, estadio del cáncer colorrectal al diagnóstico, estado de salud, comorbilidades, capacidad y percepción del autocuidado y supervivencia. Para determinar el estadio al diagnóstico se utilizó la clasificación anatomoclínica. La comorbilidad se midió mediante el índice de Chalson mientras que para medir la capacidad y percepción del autocuidado se empleó el Test de CYPAC-AM. Resultados: En la caracterización de la muestra predominaron las mujeres, el grupo de edad entre 70 y 79 años y la escolaridad de secundaria básica. El estadio II, con un mal estado de salud y la inadecuada percepción de autocuidado, fue mayoritario. La comorbilidad fue moderada con una supervivencia entre 40 a 60 meses. Conclusiones: La adecuada caracterización de los adultos mayores con cáncer colorrectal en la comunidad posibilita trazar estrategias dirigidas a la mejora del autocuidado y el estado de salud de los gerontes desde el primer nivel de atención(AU)

Introduction: Colorectal cancer is the most frequent neoplasm of the digestive system in older adults. In Cuba, it is a highly significant health problem due to its high incidence and mortality, also being the third cause of death. Objective: To characterize older adults with colorectal cancer at Policlínico Sur of Sancti Spíritus. Methods: A descriptive research was carried out in Policlínico Sur of Sancti Spíritus Municipality and Province from January to March 2019. The intentional sample was made up of 127 older adults, belonging to urban family medical offices. The variables were age, sex, school level, stage of colorectal cancer at diagnosis, health status, comorbidities, selfcare capacity and perception, and survival. The anatomoclinical classification was used to determine the stage at diagnosis. Comorbidity was measured using the Chalson index, while the CYPAC-AM (older adult selfcare capacity and perception) test was used to measure selfcare capacity and perception. Results: In the characterization of the sample, there was a predominance of women, the age group between 70 and 79 years, and the junior high school level. Stage II prevailed, together with poor health status and inadequate selfcare perception. Comorbidity was moderate, with survival between 40 to 60 months. Conclusions: The adequate characterization of older adults with colorectal cancer in the community makes it possible to outline strategies aimed at improving selfcare and their health status from the first level of care(AU)

Relationship between age and the histopathological features to chemotherapy response in colorectal cancer patients: a prospective observational study

Introduction: Chemotherapy response in early age-onset colorectal cancer patients is still controversial, and the results of chemotherapy response are unknown. Therefore, the purpose of this study is to determine the relationship between the age of colorectal cancer patients and histopathological features and chemotherapy response. Methods: This is a prospective observational study. The subjects in this study were colorectal cancer patients in the Digestive Surgery division at Tertiary Hospital in West Java from September 2021 to September 2022. Results: There were 86 subjects who underwent chemotherapy in accordance with the inclusion and exclusion criteria. Consisting of 39 patients of early age onset and 44 female patients. The most common histopathological feature in early age onset (EAO) and late age onset (LAO) was adenocarcinoma (25% and 46%, respectively). Stage III colorectal cancer affected 38 patients, while stage IV affected 48 patients. There was a significant relationship between early age onset and late age onset with histological features (p < 0.001). The patients with the highest chemotherapy response had stable diseases in EAO (17 patients) and LAO (20 patients). There was no statistically significant relationship between age, histological features, and stage of colorectal cancer and chemotherapy response (p > 0.05). The results of the ordinal logistic regression test showed no systematic relationship between chemotherapy response and age, histopathological features, gender, or cancer stage (p > 0.05). Conclusion: There was no association between age and histopathologic features with chemotherapy response and there is no difference in chemotherapy response between early and late age onset. (AU)

Resecabilidad de las metástasis hepáticas según la lateralidad del tumor colorrectal primario y la temporalidad de presentación. Serie de casos en dos instituciones de alta complejidad de la ciudad de Medellín / Resectability of liver metastasis according to the laterality of the primary colorectal tumor and the temporality of presentation. Case series in two high-complex institutions in the city of Medellín

Introducción. La neoplasia colorrectal es una patología oncológica muy frecuente a nivel mundial y una de las causas más comunes de mortalidad por cáncer. La epidemiologia, diagnóstico y tratamiento han sido ampliamente estudiadas, mientras que los datos sobre la enfermedad metastásica siguen siendo escasos. El hígado es el órgano más comúnmente afectado y algunos estudios sugieren diferencias en sobrevida y resecabilidad según la localización del tumor primario. El objetivo de este estudio fue establecer el comportamiento y resecabilidad de neoplasias avanzadas colorrectales en dos hospitales de la ciudad de Medellín, Colombia. Métodos. Estudio analítico retrospectivo para identificar los patrones de las metástasis hepáticas y sus características en función de las diferencias clínicas, histológicas y endoscópicas del tumor colorrectal primario entre 2015 y 2020. Resultados. Se recolectaron 54 pacientes con neoplasia colorrectal y metástasis hepáticas, 21 (39 %) derechas y 33 (61 %) izquierdas. El número de metástasis promedio fue de 3,1 en tumores del lado derecho y de 2,4 del izquierdo y el tamaño promedio de cada lesión fue de 4,9 y 4,2 cm, respectivamente. La tasa de resecabilidad fue del 42 % en los tumores derechos y del 82 % en los izquierdos. Las lesiones metacrónicas presentaron una tasa de resecabilidad del 90 % y las sincrónicas del 61 %. Conclusión. En este estudio, las lesiones originadas en neoplasias primarias del colon izquierdo y las lesiones metacrónicas fueron factores pronósticos favorables para la resecabilidad, un factor que impacta en la sobrevida y el tiempo libre de enfermedad de estos pacientes.

Introduction. Colorectal tumor is the most frequent pathology worldwide and one of the most common causes of mortality attributed to cancer. Epidemiology, diagnosis and treatment have been extensively studied, while information on metastatic disease remains scarce, despite being the main cause of death. Some studies suggest differences in terms of survival and resectability according to the anatomical location of the primary tumor. The aim is to establish the behavior and resectability of advanced cancers in two high-complex hospitals in the city of Medellín, Colombia. Methods. Cross-sectional observational study from secondary sources of information based on a retrospective cohort, using available data from adult patients with colorectal cancer and liver metastases between 2015 and 2020. Results. Fifty-four patients with colorectal neoplasms and liver metastases were collected, of which 21 (39%) were on the right side. The average number of liver metastases was 3.1 on the right side and 2.4 on the left, and the average size of each metastatic lesion was 4.9 cm and 4.2 cm, respectively. The resectability rate was 42% in the right tumors and 82% in the left ones. Metachronous lesions had a resectability rate of 90% and synchronous ones 61%. Conclusion. The complete resectability of liver metastatic lesions is the only therapeutic alternative with impact, in terms of survival and disease-free time in these patients. The favorable prognostic factors for the resectability of these lesions in our study were those originating from left primary tumors and metachronous lesions, where less liver tumor involvement was evidenced

Study of long non-coding RNA Tug 1 expression in Egyptian colorectal adenocarcinoma patients

Purpose: Colorectal cancer (CRC) is one of the most fatal tumors worldwide. In Egypt, most CRC cases occur in individuals > 40 years old. TUG1 has been proved to be disrupted in different malignancies and may have a critical role in tumor progression, invasion, and metastasis. However, its role in CRC has not been adequately studied. Materials / Methods: Quantitative real-time polymerase chain reaction (PCR) was used to evaluate the expression levels of long non-coding RNA (LncRNA) taurine upregulated gene 1 (TUG1), in nonmetastatic and metastatic CRC tissues and adjacent noncancerous tissues as control. Results: LncRNA TUG1 expression was significantly upregulated in both nonmetastatic and metastatic CRC tissues, in comparison with the adjacent noncancerous tissue. It was found that TUG1 could have a possible prognostic role in CRC, by comparing the sensitivity and specificity of TUG1 with those of CEA and CA19-9. Conclusion: The results of the current study suggest that the LncRNA TUG1 participates in the malignant behaviors of CRC cells. (AU)

Twenty-four hours stay after colorectal surgery: a systematic review

Introduction: The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods: Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results: Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions: Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed. (AU)

Temporary stomas after rectal cancer resection; predilection of being permanent and predictors of complications?

Stomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas. (AU)

Atenção à saúde do estomizado na rede de atenção à saúde na perspectiva de enfermeiros / Health care of the stomized in the health care network from the perspective of nurses / Atención sanitaria de estomizados en la red de salud desde la perspectiva de enfermeras

Objetivo: Identificar como é o cuidado oferecido às pessoas que vivem com estomias na rede de atenção à saúde na ótica dos enfermeiros. Métodos: Estudo qualitativo, descritivo, desenvolvido com 29 enfermeiros que atuavam na Rede de Atenção à Saúde que dispensam cuidados ao paciente com estomia. O referencial teórico metodológico utilizado foi a pesquisa social de Minayo, a qual apoia-se no materialismo histórico e dialético. Coleta de dados realizada nos meses de março e abril de 2018, por meio de uma entrevista semiestruturada. Realizada análise temática dos dados. Resultados: Foram identificadas fragilidades na comunicação na rede de atenção à saúde, bem como nas ações de cuidado efetivadas pelos enfermeiros às pessoas que vivem com estomas, demonstrou-se um cuidado centralizado e falha na atenção devido a falta de educação continuada. Conclusão: O cuidado aos estomizados possui pontos a serem melhorados como à definição de itinerário para este paciente, centralização do cuidado, garantia da continuidade do cuidado e integralidade, referência e contrarreferência, necessidade de uma comunicação efetiva entre as equipes de saúde que assistem estes pacientes bem como falta de educação continuada. (AU)

Objective: To identify how care is provided to people living with ostomy in the health care network from the perspective of nurses. Methods: Qualitative, descriptive study, developed with 29 nurses who worked in the Health Care Network who provide care to patients with ostomy. The methodological theoretical framework used was Minayo's social research, which is based on historical and dialectical materialism.Data collection carried out in March and April 2018, through a semi-structured interview. Thematic analysis of the data was carried out. Results: Weaknesses were identified in communication in the health care network, as well as in the care actions carried out by nurses to people living with stomas, demonstrating a centralized care and failure in care due to the lack of continuing education. Conclusion: The care of ostomy patients has points to be improved, such as defining an itinerary for this patient, centralization of care, ensuring continuity of care and completeness, referral and counter-referral, need for effective communication between the health teams that care for these patients as well as lack of continuing education. (AU)

Objetivo: Identificar cómo se atiende a las personas que viven con ostomía en la red asistencial desde la perspectiva del enfermero. Métodos: Estudio cualitativo, descriptivo, desarrollado con 29 enfermeras que laboraban en la Red de Atención de Salud que brinda atención a pacientes con ostomía. El marco teórico metodológico utilizado fue la investigación social de Minayo, que se basa en el materialismo histórico y dialéctico. Recolección de datos realizada en marzo y abril de 2018, mediante entrevista semiestructurada. Se realizó un análisis temático de los datos. Resultados: Se identificaron debilidades en la comunicación en la red de atención de salud, así como en las acciones de atención que realizan las enfermeras a las personas que viven con estoma, ubicando la atención centralizada y falla en la atención por falta de educación continua. Conclusión: La atención al paciente con ostomía tiene puntos a mejorar, como la definición de un itinerario para este paciente, la centralización de la atención, asegurar la continuidad y la integralidad de la atención, la derivación y contrarreferencia, la necesidad de una comunicación efectiva entre los equipos de salud que atienden. estos pacientes, así como la falta de educación continua. (AU)

Proteína C reactiva como biomarcador predictivo de fuga anastomótica en cirugía oncológica colorrectal: estudio de cohorte retrospectivo / C-reactive protein as a predictive biomarker of anastomotic leak in colorectal cancer surgery: A retrospective cohort study

Introducción. La fuga anastomótica es la complicación más grave del tratamiento quirúrgico del cáncer de colon por su alta morbimortalidad. El diagnóstico evidente, manifestado por la salida de contenido intestinal por drenajes o la herida quirúrgica, ocurre tardíamente (entre el 6º y 8º día). El objetivo de este trabajo fue estudiar la variación de los valores de la proteína C reactiva postoperatoria para hacer un diagnóstico precoz. Métodos. Estudio observacional, analítico, retrospectivo, de una cohorte de pacientes con neoplasia, en quienes se realizó cirugía oncológica con anastomosis intestinal, entre enero de 2019 y diciembre de 2021. Se midieron los valores en sangre de proteína C reactiva postoperatoria (1°, 3° y 5° días). Resultados. Se compararon 225 casos operados que no presentaron fuga con 45 casos con fuga. En los casos sin fuga, el valor de proteína C reactiva al 3º día fue de 148 mg/l y al 5º día de 71 mg/l, mientras en los casos con fuga, los valores fueron de 228,24 mg/l y 228,04 mg/l, respectivamente (p<0,05). Para un valor de 197 mg/l al 3º día la sensibilidad fue de 77 % y para un valor de 120 mg/l al 5º día la sensibilidad fue de 84 %. Conclusión. El mejor resultado de proteína C reactiva postoperatoria para detectar precozmente la fuga anastomótica se observó al 5º día. El valor de 127 mg/l tuvo la mejor sensibilidad, especificidad y valor predictivo negativo, lo cual permitiría el diagnóstico temprano y manejo oportuno de esta complicación

Introduction. Anastomotic leak is the most serious complication of surgical treatment of colon cancer due to its high morbidity and mortality. The obvious diagnosis manifested by the exit of intestinal content through drains or the operative wound, occurs late (between the 6th and 8th day). The objective of this work was to study the postoperative C-reactive protein values to make an early diagnosis. Methods. Observational, analytical, retrospective study of a cohort of patients undergoing colorectal surgery for neoplasia, between January 2019 and December 2021, who underwent oncological surgery with intestinal anastomosis and measured CRP blood values on 1st, 3rd and 5th post-operative days. Results. Two-hundred-twenty-five operated cases that did not present leaks were compared with 45 cases with leaks, with CRP values on the 3rd and 5th day of 148mg/l and 71mg/l in cases without leakage and CRP values of 228.24mg/l and 228.04 mg/l in cases with leakage on the 3rd and 5th day, respectively (p<0.05), CRP value of 197mg/l on the 3rd day has a sensitivity of 77%; CRP value of 120mg/l on the 5th day, has a sensitivity of 84%. Conclusions. The best result for CPR to early diagnosis of anastomotic leak was observed on the 5th day, having the value of 127 mg/l the best sensitivity, specificity and NPV, which would allow early diagnosis and timely management

Identification of antarctic soil bacteria exhibiting antiproliferative activity against a colon cancer cell line / Identificación de bacterias de suelo antártico que presentan actividad antiproliferativa sobre una línea celular de cáncer de colon

SUMMARY: Cancer is the second leading cause of death in the world and colorectal cancer is the only cancer that has shown a sustained increase in mortality in the last decade. In the search for new chemotherapeutic agents against cancer, extremophilic microorganisms have shown to be a potential source to obtain molecules of natural origin and with selective cytotoxic action towards cancer cells. In this work we analyzed the ability of a collection of Antarctic soil bacteria, isolated on Collins Glacier from the rhizosphere of Deschampsia antarctica Desv plant, to secrete molecules capable of inhibiting cell proliferation of a colorectal cancer tumor line. Our results demonstrated that culture supernatants from the Antarctic bacteria K2I17 and MI12 decreased the viability of LoVo cells, a colorectal adenocarcinoma cell line. Phenotypic and genotypic characterization of the Antarctic bacteria showed that they were taxonomically related and nucleotide identity analysis based on the 16S rRNA gene sequence identified the bacterium K2I17 as a species belonging to the genus Bacillus.

El cáncer es la segunda causa de muerte en el mundo y el cáncer colorrectal es el único que presenta un aumento sostenido de la mortalidad en la última década. En la búsqueda de nuevos agentes quimioterapeúticos contra el cáncer, se ha propuesto a los microorganismos extremófilos como una fuente potencial para obtener moléculas de origen natural y con acción citotóxica selectiva hacia las células cancerígenas. En este trabajo analizamos la capacidad de una colección de bacterias de suelo antártico, aisladas en el glaciar Collins desde rizosfera de la planta de Deschampsia antarctica Desv, de secretar moléculas capaces de inhibir la proliferación celular de una línea tumoral de cáncer colorrectal. Nuestros resultados demostraron que los sobrenadantes de cultivo de las bacterias antárticas K2I17 y MI12 disminuyeron la viabilidad de la línea celular de adenocarcinoma colorrectal LoVo, en un ensayo de reducción metabólica de MTT. La caracterización fenotípica y genotípica de las bacterias antárticas, demostró que estaban relacionadas taxonómicamente y el análisis de la identidad nucleotídica en base a la secuencia del gen ARNr 16S identificó a la bacteria K2I17 como una especie perteneciente al género Bacillus.

Proteínas oxidadas de origen animal y su impacto sobre la salud intestinal / Oxidized proteins of animal origin and their impact on intestinal health / Proteínas oxidadas de origem animal e seu impacto na saúde intestinal

Los alimentos de origen animal como la carne de pollo, res, pescado y cerdo poseen una amplia demanda en todo el mundo debido, entre otros aspectos, a su valor nutricional, asociado al alto contenido proteico. No obstante, este tipo de proteínas son susceptibles de sufrir reacciones de oxidación, las cuales pueden mediar procesos de fragmentación, agregación, pérdida de solubilidad, funcionalidad y digestibilidad proteica; eventos implicados en la pérdida de su valor nutricional. En este sentido, las proteínas agrega­das tienden a no ser digeridas en el tracto gastrointestinal y acumularse en el intestino (colon), donde la microbiota colónica las degrada a productos mutagénicos como fenol y p-cresol, lo que incrementa el riesgo de cáncer colorrectal. Por otra parte, los ami­noácidos o péptidos oxidados liberados en la digestión podrían incorporarse en las vías de señalización celular intestinal y favorecer o exacerbar procesos intestinales crónicos como colon irritable o enfermedad de Crohn. Debido al gran interés de esta temática en los últimos años, el objetivo de esta revisión es realizar una descripción general del impacto de proteínas oxidadas de origen animal sobre la salud intestinal.

Animal foods such as chicken, beef, fish and pork are in wide demand throughout the world due, among other things, to their nutritional value, associated with their high protein content. However, this type of protein is susceptible to oxidation reactions, which can mediate processes of fragmentation, aggregation, loss of solubility, functionality, and protein digestibility, which are events involved in the loss of their nutritional value. In this sense, aggregated proteins tend not to be digested in the gastrointestinal tract and accumulate in the intestine (colon), where the colonic microbiota degrades them into mutagenic products such as phenol and p-cresol, which increases the risk of colorectal cancer. On the other hand, the oxidized amino acids or peptides released in digestion could be incorporated into intestinal cell signaling pathways and favor or exacerbate chronic intestinal processes such as irritable bowel syndrome or Crohn's disease. Due to the great interest in this topic in recent years, the objective of this review is to provide a general overview of the impact of oxidized proteins of animal origin on intestinal health.

Alimentos de origem animal como frango, carne bovina, peixe e carne suína são muito procurados em todo o mundo devido, entre outros fatores, ao seu valor nutricional, associado ao seu alto teor de proteínas. No entanto, esse tipo de proteína é suscetível a reações de oxidação, que podem mediar processos de fragmentação, agregação, perda de solubilidade, funcionalidade e digestibilidade da proteína; eventos envolvidos na perda de seu valor nutritivo. Nesse sentido, as proteínas agregadas tendem a não ser digeridas no trato gastrointestinal e se acumulam no intestino (cólon), onde a microbiota colônica as degrada em produtos mutagênicos como fenol e p - cresol, aumentando o risco de câncer colorretal. Por outro lado, os aminoácidos ou peptídeos oxidados liberados na digestão poderiam ser incorporados às vias de sinalização das células intestinais e favorecer ou exacerbar processos intestinais crônicos, como a síndrome do intestino irritável ou a doença de Crohn. Devido ao grande interesse neste tema nos últimos anos, o objetivo desta revisão é fornecer uma descrição geral do impacto das proteínas oxidadas de origem animal na saúde intestinal.

Vigilancia del cáncer colorrectal en la provincia de Córdoba mediante prevención y detección temprana: resultados de una prueba piloto / Surveillance of colorectal cancer in the province of Córdoba through prevention and early detection: results of a pilot test

INTRODUCCIÓN: El cáncer colorrectal (CCR) es la segunda causa de mortalidad por cáncer en Argentina. Su diagnóstico tardío reduce sustancialmente las posibilidades de sobrevida. El objetivo fue describir el estudio de implementación de prevención del CCR realizado en el departamento cordobés de Pocho y analizar factores de riesgo y vulnerabilidad según condiciones de riesgo promedio (RP) o elevado (RE). MÉTODOS: Se incluyó a 265 adultos de 50-75 años residentes en Pocho. Se diseñó un dispositivo de intervención territorial; se construyeron y analizaron indicadores de cobertura, salud, referencia y contrarreferencia. RESULTADOS: Hubo 19,6% de participantes con RE y 80,4% con RP. La cobertura por invitación fue de 36,6% de la población objetivo, con una tasa de aceptación del 84,2%, una positividad del test de sangre oculta en materia fecal inmunoquímico (TSOMFi) del 19,3% y un índice de cumplimiento de videocolonoscopia del 81,8%. El consumo inadecuado de frutas, verduras y carnes asadas fue mayor en el grupo de RP (p≤0,05); 17,4% había consumido al menos un cigarrillo en los últimos 30 días; 77,6% había realizado al menos 30 minutos diarios de actividad física; 52% reportó al menos una vez presión elevada, 21,7% glucemia elevada y 21,8% colesterol elevado; 29,5% presentó obesidad. DISCUSIÓN: La adherencia al test y al circuito de atención fue alta. Se sentaron las bases para el escalamiento provincial de la estrategia preventiva del CCR mediante tamizaje con TSOMFi.

Enhancement of Annexin V in response to combination of epigallocatechin gallate and quercetin as a potent arrest the cell cycle of colorectal cancer / Aumento da anexina V em resposta à combinação de galato de epigalocatequina e quercetina como uma potente parada do ciclo celular do câncer colorretal

Abstract Colorectal cancer (CRC) is one of the most common cancers leading to comorbidities and mortalities globally. The rational of current study was to evaluate the combined epigallocatechin gallate and quercetin as a potent antitumor agent as commentary agent for therapeutic protocol. The present study investigated the effect of epigallocatechin Gallate (EGCG) (150mg) and quercetin (200mg) at different proportions on proliferation and induction of apoptosis in human colon cancer cells (HCT-116). Cell growth, colonogenic, Annexin V in addition cell cycle were detected in response to phytomolecules. Data obtained showed that, the colony formation was inhibited significantly in CRC starting from the lowest concentration tested of 10 µg/mL resulting in no colonies as visualized by a phase-contrast microscope. Data showed a significant elevation in the annexin V at 100 µg/mL EGCG(25.85%) and 150 µg/mL quercetin (48.35%). Moreover, cell cycle analysis showed that this combination caused cell cycle arrest at the G1 phase at concentration of 100 µg/mL (72.7%) and 150 µg/mL (75.25%). The combined effect of epigallocatechin Gallate and quercetin exert antiproliferative activity against CRC, it is promising in alternative conventional chemotherapeutic agent.

Resumo O câncer colorretal (CCR) é um dos cânceres mais comuns, levando a comorbidades e mortalidade em todo o mundo. O racional do presente estudo foi avaliar a combinação de galato de epigalocatequina e quercetina como um agente antitumoral potente como agente de comentário para protocolo terapêutico. O presente estudo investigou o efeito de galato de epigalocatequina (EGCG) (150 mg) e quercetina (200 mg) em diferentes proporções na proliferação e indução de apoptose em células de câncer de cólon humano (HCT-116). O crescimento celular, colonogênico, anexina V, além do ciclo celular foram detectados em resposta a fitomoléculas. Os dados obtidos mostraram que a formação de colônias foi inibida significativamente no CRC a partir da concentração mais baixa testada de 10 µg/mL, resultando em nenhuma colônia conforme visualizado por um microscópio de contraste de fase. Os dados mostraram uma elevação significativa na anexina V a 100 µg/mL de EGCG (25,85%) e 150 µg/mL de quercetina (48,35%). Além disso, a análise do ciclo celular mostrou que essa combinação causou parada do ciclo celular na fase G1 na concentração de 100 µg/mL (72,7%) e 150 µg/mL (75,25%). O efeito combinado da epigalocatequina galato e quercetina exerce atividade antiproliferativa contra o CCR, é promissor como agente quimioterápico alternativo convencional.

STIP1 correlates with tumor immune infiltration and prognosis as a potential immunotherapy target: a pan-cancer bioinformatics analysis / 南方医科大学学报

OBJECTIVE@#To investigate the correlation of stress-inducible phosphoprotein 1 (STIP1) expression level with prognosis of different cancers and its potential role in immunotherapy.@*METHODS@#TCGA, TARGET and GTEx databases were used for bioinformatic analysis of STIP1 expression level and its prognostic value in different cancers. We also detected STIP1 expression immunohistochemically in 10 pairs of colorectal cancer and adjacent tissues. We further analyzed the correlation of STIP1 expression level with tumor mutational burden, microsatellite instability, immune cell infiltration, immune regulators and outcomes of different cancers. STIP1- related proteins were identified using protein- protein interaction (PPI) network analysis, and functional enrichment analysis was performed to analyze the regulatory pathways involving STIP1.@*RESULTS@#Bioinformatics analysis showed that STIP1 was highly expressed in most tumors compared with the normal tissues (P < 0.05), which was confirmed by immunohistochemistry of the 10 pairs of colorectal cancer tissues. STIP1 expression level was correlated with clinical stages of multiple cancers (P < 0.05), and in some cancer types, an upregulated STIP1 expression was correlated with a poor prognosis of the patients in terms of overall survival, disease-specific survival, disease-free survival and progression-free survival (P < 0.05). STIP1 expression was significantly correlated with tumor mutational burden, microsatellite instability, immune cell infiltration and immunomodulatory factors in most tumors (P < 0.05). PPI network analysis indicated that STIP1-related proteins included HSPA4, HSPA8, and HSP90AA1. KEGG enrichment analysis suggested that the high expression of STIP1 in liver cancer was related mainly with valerate metabolism, tryptophan metabolism, and butyrate metabolism pathways; HALLMARK enrichment analysis suggested high STIP1 expression in liver cancer was involved in bile acid and fatty acid metabolism.@*CONCLUSION@#STIP1 is up-regulated in multiple cancer types and its expression level is correlated with clinical tumor stage, tumor mutational burden, microsatellite instability, immune cell infiltration and immunomodulatory factors.

MiR-30e-5p overexpression promotes proliferation and migration of colorectal cancer cells by activating the CXCL12 axis via downregulating PTEN / 南方医科大学学报

OBJECTIVE@#To investigate the regulatory effects of miR-30e-5p on biological behaviors of colorectal cancer cells and the role of PTEN/CXCL12 axis in mediating these effects.@*METHODS@#Bioinformatic analysis was performed to explore the differential expression of miR-30e-5p between colorectal cancer tissues and normal tissues. RT-qPCR was used to detect the differential expression of miR-30e-5p in intestinal epithelial cells and colorectal cancer cells. Bioinformatics and dual luciferase assay were used to predict and validate the targeting relationship between miR-30e-5p and PTEN. Human and murine colorectal cancer cell lines were transfected with miR-30e-5p mimics, miR-30e-5p inhibitor, miR-30e-5p mimics+LV-PTEN, or miR-30e-5p inhibitor + si-PTEN. The changes in biological behaviors of the cells were detected using plate clone formation assay, CCK-8 assay, flow cytometry, scratch healing and Transwell assays. PTEN and CXCL12 expressions in the cancer cells were detected by Western blotting. The effects of miR-30e-5p inhibitor on colorectal carcinogenesis and development were observed in nude mice.@*RESULTS@#Bioinformatic analysis showed that miR-30e-5p expression was significantly elevated in colorectal cancer tissues compared with the adjacent tissue (P < 0.01). Higher miR-30e-5p expression was detected in colorectal cancer cell lines than in intestinal epithelial cells (P < 0.01). Dual luciferase assay confirmed the targeting relationship between miR-30e-5p and PTEN (P < 0.05). Transfection with miR-30e-5p mimics significantly enhanced proliferation and metastasis and inhibited apoptosis of the colorectal cancer cells (P < 0.05), and co-transfection with LV-PTEN obviously reversed these changes (P < 0.05). MiR-30e-5p mimics significantly inhibited PTEN expression and enhanced CXCL12 expression in the cancer cells (P < 0.01), and miR-30e-5p inhibitor produced the opposite effect. Transfection with miR-30e-5p inhibitor caused cell cycle arrest in the cancer cells, which was reversed by co-transfection with si-PTEN (P < 0.05). In the in vivo experiments, the colorectal cancer cells transfected with miR-30e-5p inhibitor showed significantly lowered tumorigenesis.@*CONCLUSION@#Overexpression of miR-30e-5p promotes the malignant behaviors of colorectal cancer cells by downregulating PTEN to activate the CXCL12 axis.

Colorectal cancer cells induce the formation of cancer-associated fibroblasts by activating the ERK signaling pathway in fibroblasts / 南方医科大学学报

OBJECTIVE@#To investigate the mechanism by which conditioned medium of colorectal cancer cells promotes the formation of cancer-associated fibroblasts (CAFs).@*METHODS@#Normal human colorectal fibroblasts (CCD-18Co cells) in logarithmic growth phase were treated with the conditioned media of colorectal cancer HCT116 cells (HCT116-CM) or Caco-2 cells (Caco-2-CM) alone or in combination with 300 nmol/L ERK inhibitor SCH772984. The expression levels of CAFs-related molecular markers were detected in the treated cells with real-time quantitative PCR (RT- qPCR) and immunofluorescence assay, and the changes in cell proliferation, colony formation and migration were assessed with RTCA, colony formation and wound healing assays; Western blotting was performed to detect the activated signaling pathways in the fibroblasts and the changes in CAFs formation after blocking of the signaling pathway.@*RESULTS@#HCT116-CM and Caco-2-CM significantly upregulated mRNA expression levels of CAFs markers (including α-SMA, FAP, FN and TGF-β) in CCD-18Co cells, and strongly promoted fibroblast transformation into CAFs (P < 0.05). The two conditioned media also promoted the proliferation, colony formation and migration of CCD-18Co cells (P < 0.05) and significantly increased the levels of α-SMA protein and ERK phosphorylation in the cells (P < 0.05). The ERK inhibitor SCH772984 obviously inhibited the expression of α-SMA and the transformation of CCD-18Co cells into CAFs induced by the conditioned medium of colorectal cancer cells (P < 0.05).@*CONCLUSION@#Colorectal cancer cells may induce the formation of colorectal CAFs by activating the ERK pathway in the fibroblasts.