How successful is liver resection for colorectal cancer liver metastases in patients over 75 years old?

BACKGROUNDS/AIMS: As populations age, an increased incidence of colorectal cancer will generate an increase in colorectal cancer liver metastases (CRLM). In order to guide treatment decisions, this study aimed to identify the contemporary complication rates of elderly patients undergoing liver resection for CRLM in a, centralised, UK centre. METHODS: All patients undergoing operative procedures for CRLM between January 2013 and January 2019 were included. Patient, tumour and operative data were analysed, including the prognostic marker; tumour burden score. RESULTS: 339 operations were performed on 289 consecutive patients with CRLM (272 patients ＜75 years old, 67 patients ≥75 years old). Median age was 66 years (range 20-93). There was no difference in major complication rates between the two age cohorts (6.65 vs. 6.0%, p=0.847) or operative mortality (1.1% vs. 1.4%, p=0.794). Younger patients had higher R1 resection rates (20.4% vs. 4.5%, p=0.002) and post-operative chemotherapy rates (60.3% vs. 35.8%, p< 0.001). The 1, 3 and 5-year OS was 90.2%, 70.5% and 52.3% respectively, median 70 months, with no difference between age cohorts (p=0.772). Tumour Burden score and operation type were independent predictors of overall survival. CONCLUSIONS: Liver resection for CRLM in patients 75 years and older is feasible, safe and confers a similar 5-year survival rate to younger patients. The current outcomes from surgery are better than historical datasets.

Salmonella identified in pigs in Kenya and Malawi reveals the potential for zoonotic transmission in emerging pork markets.

Salmonella is a major cause of foodborne disease globally. Pigs can carry and shed non-typhoidal Salmonella (NTS) asymptomatically, representing a significant reservoir for these pathogens. To investigate Salmonella carriage by African domestic pigs, faecal and mesenteric lymph node samples were taken at slaughter in Nairobi, Busia (Kenya) and Chikwawa (Malawi) between October 2016 and May 2017. Selective culture, antisera testing and whole genome sequencing were performed on samples from 647 pigs; the prevalence of NTS carriage was 12.7% in Busia, 9.1% in Nairobi and 24.6% in Chikwawa. Two isolates of S. Typhimurium ST313 were isolated, but were more closely related to ST313 isolates associated with gastroenteritis in the UK than bloodstream infection in Africa. The discovery of porcine NTS carriage in Kenya and Malawi reveals potential for zoonotic transmission of diarrhoeal strains to humans in these countries, but not for transmission of clades specifically associated with invasive NTS disease in Africa.

Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project.

LAY ABSTRACT: Autistic adults commonly experience mental health conditions. However, research rarely involves autistic adults in deciding priorities for research on mental healthcare approaches that might work for them. The purpose of this article is to describe a stakeholder-driven project that involved autistic adults in co-leading and designing research about priorities to address mental health needs. Through a large online survey, two large meetings, and three face-to-face focus group discussions involving over 350 stakeholders, we identified five priorities for mental health research desired by autistic adults. These priorities and preferred outcomes should be used to guide research and practice for autistic adults.

Two out of three required: a case of incomplete Carney triad.

A 48-year-old woman presented with chest symptoms. Multiple lesions seen on chest imaging were found to be pulmonary chondromas following surgical resection. Whole body magnetic resonance scan performed to investigate the possibility of Carney triad demonstrated a gastric lesion. This was resected and found to be a gastrointestinal stromal tumor. No evidence of paragangliomata was found on imaging. A diagnosis of incomplete Carney triad was made. Carney triad is a rare multiple neoplastic association of pulmonary chondroma, gastrointestinal stromal tumor, and paraganglioma. At least 2 tumors are required for diagnosis. Most patients are young women. No genetic cause has been identified. Management involves surgical resection of tumors and follow-up for recurrence and investigation for other elements of the triad.

Enhanced bacterial disease resistance of transgenic channel catfish Ictalurus punctatus possessing cecropin genes.

The cecropin B gene from the moth Hyalophora cecropia, driven by the cytomegalovirus promoter, was transferred to the channel catfish Ictalurus punctatus. Transgenic individuals (P1) were mated to produce individuals (F1) that exhibited enhanced disease resistance and survival when challenged with pathogenic bacteria. During the epizootic of Flavobacterium columnare in an earthen pond, the percentage of transgenic individuals containing preprocecropin B construct that survived (100%) was significantly greater (P <0.005) than that of nontransgenic controls (27.3%). Also, when challenged in tanks with Edwardsiella ictaluri, the causative agent of enteric septicemia of catfish, the percentage of transgenic individuals containing catfish IG leader cecropin B construct that survived (40.7%) was significantly greater (P <0.01) than that of nontransgenic controls (14.8%). There were no pleiotropic effects of the transgenes, and growth rates of the transgenic and nontransgenic siblings were not different (P > 0.05). Inheritance of the transgene by the F1 generation, 20.2% to 30.7% was typical of that in studies with transgenic channel catfish.