Predictive factors for technically difficult endoscopic submucosal dissection in large colorectal tumors.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) for colorectal tumors is dangerous, particularly those that are large. However, the technical difficulty in resecting large tumors in the colonrectum has seldom been investigated. MATERIALS AND METHODS: Between October 2012 and January 2015, 36 consecutive large colorectal tumors were resected by ESD at the endoscopic center of PLA Army General Hospital. Five factors were investigated in predicting the technical difficulty in resecting such tumors. RESULTS: En bloc resection, complete (R0) resection, and curative resection rates were 83.33% (30/36), 80.56% (29/36), and 77.78% (28/36), respectively. Tumor location in a flexure was risk a factor for difficult ESD in the colonrectum as measured by perforation (4.55, 0.09-6.25), non-en bloc resection (4.94, 0.10, 9.45), and dissection speed (ß±SE: 1.75±0.05). When tumor size increased, the perforation rate also increased (9.93, 0.96-10.32). CONCLUSION: ESD was more technically demanding in flexures for resecting large colorectal tumors, and for large tumor effective technique to close perforation is essential. Our study will guide endoscopists in using ESD to remove large colorectal tumors.

MicroRNA-135b regulates apoptosis and chemoresistance in colorectal cancer by targeting large tumor suppressor kinase 2.

Colorectal cancer remains the third most common cause of death from cancer worldwide. MicroRNA emerges as a good area of research for current cancer therapy. Here, we identified miR-135b to be a contributor to anti-apoptosis and chemoresistance in colorectal cancer. We observed high levels of miR-135b in colorectal cancer cell lines and clinical tissues, compared to colorectal epithelium cell line and noncancerous tissues. Furthermore, enforced expression of miR-135b attenuated doxorubicin-induced apoptosis in colorectal cells. (Doxorubicin alone can trigger significant apoptosis). In elucidating the molecular mechanism by which miR-135b participate in the regulation of apoptosis and chemoresistance in colorectal cancer, we discovered that large tumor suppressor kinase 2 (LATS2) is a direct target of miR-135b. The role of miR-135b was confirmed in colorectal tumor xenograft models. The growth of established tumors was suppressed by an inhibition of miR-135b expression and enhanced apoptosis was further assessed by TUNEL assay. Taken together, our results reveal that miR-135b and LATS2 axis may be a novel therapeutic target for colorectal cancer.

Documentation of advance care planning for community-dwelling elders.

BACKGROUND: Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful. METHODS: Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age > or = 65 years and screened for high risk of death/functional decline in 1998-1999) and ACOVE-2 (566 patients age > or = 75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002-2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record. RESULTS: In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%-93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%-22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record. CONCLUSIONS: Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data collection for end-of-life care could begin to ameliorate this problem.