No increased risk of flare in ulcerative colitis patients in corticosteroid-free remission after stopping 5-aminosalicylic acid: A territory-wide population-based study.

BACKGROUND AND AIM: Whether 5-aminosalicylic acid (ASA) can be stopped in patients with stable ulcerative colitis (UC) remains unclear. We aimed to examine whether 5-ASA can be safely withdrawn in UC patients who have been in corticosteroid-free clinical remission for ≥ 1 year. METHODS: This is a retrospective cohort study using territory-wide healthcare database in Hong Kong. Primary outcome was development of UC flare, defined as new corticosteroid use or UC-related hospitalizations within 5 years. UC patients on oral 5-ASA ≥ 2 g daily for ≥ 1 year with C-reactive protein (CRP) < 10 mg/dL and no 5-ASA dosage escalation, UC-related hospitalization or corticosteroid use in the past year were included. Patients on biological agents were excluded. Patients were classified as "stopping" if 5-ASA was withdrawn for ≥ 90 days within follow-up period. We performed multivariable Cox regression models adjusting for demographics, blood parameters and immunosuppressants used. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was reported comparing stopping and continuous-use groups. RESULTS: A total of 1408 patients were included with a median follow-up duration of 41.8 months (interquartile range [IQR]: 17.2-60.0 months). Stopping 5-ASA was not associated with an increased risk of UC flare (aHR 0.91; 95% CI 0.64-1.31; P = 0.620). A higher CRP levels at the time of stopping 5-ASA (aHR 1.15; 95% CI: 1.01-1.30; P = 0.037) were associated with increased risk of flare. CONCLUSION: Stopping 5-ASA in UC patients in corticosteroid-free remission for ≥ 1 year was not associated with increased risk of flare. Future prospective trials should evaluate the role of stopping 5-ASA in stable UC patients.

Prognosis after neoadjuvant chemoradiation or chemotherapy for locally advanced gastro-oesophageal junctional adenocarcinoma.

BACKGROUND: Trials typically group cancers of the gastro-oesophageal junction (GOJ) with oesophageal or gastric cancer when studying neoadjuvant chemoradiation and perioperative chemotherapy, so the results may not be fully applicable to GOJ cancer. Because optimal neoadjuvant treatment for GOJ cancer remains controversial, outcomes with neoadjuvant chemoradiation versus chemotherapy for locally advanced GOJ adenocarcinoma were compared retrospectively. METHODS: Data were collected from all patients who underwent neoadjuvant treatment followed by surgery for adenocarcinoma located at the GOJ at a single high-volume institution between 2002 and 2017. Postoperative major complications and mortality were compared between groups using Fisher's exact test. Overall survival (OS) and disease-free survival (DFS) were assessed by log rank test and multivariable Cox regression analyses. Cumulative incidence functions were used to estimate recurrence, and groups were compared using Gray's test. RESULTS: Of 775 patients, 650 had neoadjuvant chemoradiation and 125 had chemotherapy. These groups were comparable in terms of clinical tumour and lymph node categories, although the chemoradiation group had greater proportions of white men, complete pathological response to chemotherapy, and smaller proportions of diffuse cancer, poor differentiation, and neurovascular invasion. Postoperative major complications (20.0 versus 17.6 per cent) and 30-day mortality (1.7 versus 1.6 per cent) were not significantly different between the chemoradiation and chemotherapy groups. After adjustment, type of therapy (chemoradiation versus chemotherapy) was not significantly associated with OS (hazard ratio (HR) 1.26, 95 per cent c.i. 0.96 to 1.67) or DFS (HR 1.27, 0.98 to 1.64). Type of recurrence (local, regional, or distant) did not differ after neoadjuvant chemoradiation versus chemotherapy. CONCLUSION: In patients undergoing surgical resection for locally advanced adenocarcinoma of the GOJ, OS and DFS did not differ significantly between patients who had neoadjuvant chemoradiation compared with chemotherapy.

Treating advanced cancer of the gastro-oesophageal junction (GOJ) poses a challenge given its location in the distal oesophagus and proximal stomach, and whether it should be treated as oesophageal or gastric cancer. Given the indistinct location, it is unclear whether GOJ cancer should be treated with neoadjuvant chemoradiation, which is the treatment of choice for advanced oesophageal cancers, or perioperative chemotherapy, which is the treatment of choice for advanced gastric cancers. Few studies have addressed treatment options specifically for GOJ cancers. This study investigated whether there was a difference in survival between patients with GOJ cancer who were treated with chemoradiation versus chemotherapy.

National guidelines may reduce socioeconomic disparities in treatment selection for esophageal cancer.

The 2011 National Comprehensive Cancer Network guidelines first incorporated the results of the landmark CROSS trial, establishing induction therapy (chemotherapy ± radiation) and surgery as the treatment standard for locoregional esophageal cancer in the United States. The effect of guideline publication on socioeconomic status (SES) inequalities in cancer treatment selection remains unknown. Patients diagnosed with Stage II/III esophageal cancer between 2004 and 2013 who underwent curative treatment with definitive chemoradiation or multimodality treatment (induction and surgery) were identified from the Surveillance, Epidemiology and End Results (SEER)-Medicare registry. Clinicopathologic characteristics were compared between the two therapies. Multivariable regression analysis was used to adjust for known factors associated with treatment selection. An interaction term with respect to guideline publication and SES was included Of the 2,148 patients included, 1,478 (68.8%) received definitive chemoradiation and 670 (31.2%) induction and surgery. Guideline publication was associated with a 16.1% increase in patients receiving induction and surgery in the low SES group (21.4% preguideline publication vs. 37.5% after). In comparison, a 4.5% increase occurred during the same period in the high SES status group (31.8% vs. 36.3%). After adjusting for factors associated with treatment selection, guideline publication was associated with a 78% increase in likelihood of receiving induction and surgery among lower SES patients (odds ratio 1.78; 95% confidence interval (CI): 1.05,3.03). Following the new guideline publication, patients living in low SES areas were more likely to receive optimal treatment. Increased dissemination of guidelines may lead to increased adherence to evidence-based treatment standards.

A novel approach in drug discovery: synthesis of estrone--talaromycin natural product hybrids.

Hetero-Diels-Alder reaction of the steroidal exocyclic enol ethers 14 and 15, obtained from the secoestrones 8 and 9 by reduction, iodoetherification, and elimination, with ethyl O-benzoyldiformylacetate (16) leads to the spiroacetals 17 and 18 as a mixture of four diastereomers. Reduction of the major diastereomers 17a and 18a with DIBAH and subsequent hydrogenation yields the novel natural product hybrids 21, 23, 24, and 25, which possess the structural features of the steroid estrone (7) and the mycotoxin talaromycin 6.

Epidermoid cysts in the central nervous system of mice.

Two epidermoid cysts are described in mice, one intracranial, in the fourth ventricle and the other in the thoracic spinal canal. They were lined by compressed squamous epithelium and contained keratinaceous squamae. These incidental findings suggest that such cysts might be detected more often if more extensive examinations of the CNS were carried out in group studies.

Enzootic nasal tumour of sheep.

This is the first report of Enzootic Nasal Tumours (ENT) of sheep in Israel. The report includes a detailed clinical, pathological and histopathological description of the syndrome. All 7 affected sheep suffered clinically from serous to muco-purulent nasal discharge and respiratory distress due to obstruction of the upper airway by a neoplastic process. Three of the tumours were histopathologically identified as tubular adenomas, 3 were mucoid adenomas and one was a papillary adenoma. The tumours caused destruction of the turbinate bones and nasal septum.

The chronic course of a probable monensin toxicosis in cattle.

Feedlot calves given monensin in their feed developed an excessive mortality which peaked 3-4 mo after monensin was withdrawn. Typically the calves died suddenly and necropsy revealed areas of paleness in the skeletal muscles (early cases) and in the myocardium (more chronic cases). Histology (in 19 calves) showed swollen myocytes with loss of striation and sarcoplasmic vacuolization, followed by the appearance of necrotic fibres and infiltration with macrophages and neutrophils, and finally local and generalized fibrosis. Calcification was not evident. A differential diagnosis ruled out an etiology of nutritional and toxicological origin, thus leaving the probability of atypical (chronic) monensin toxicosis.

Lymphosarcoma in a spotted hyena, Crocuta crocuta.

Lymphosarcoma of the mesenteric and mediastinal lymph nodes with peritoneal and mediastinal implantations, as well as widespread intravascular metastases and thrombosis with haemorrhages was diagnosed in a spotted hyena.

Hepatic cirrhosis suggesting aflatoxicosis in a flock of geese.

An outbreak of hepatic cirrhosis in a flock of young geese was investigated. The affected geese were cyanotic with purple beaks, shanks and footwebs. On post mortem examination severe atrophy of the liver was seen and, histologically, extensive areas of necrosis, cirrhosis and bile duct proliferation were prominent. Liver function tests and serum enzyme levels confirmed that the liver damage was extensive. The findings are compared with those found in aflatoxicosis of other avian species.

Kidney lesions from mycotoxins as observed by electron microscope.

A number of histopathological changes, such as cloudy swelling, fatty and parenchymatic degeneration and vacuolisation caused in kidney by mycotoxins from mouldy hay, were examined and studied with the aid of the electron microscope. Changes were observed in mitochondria, membranes, plasma granulation, glycogen secretion, vesiculation and vacuolisation.

Enzootic calcinosis in sheep and C-cells hyperplasia of the thyroid.

In nine sheep belonging to the same flock, C-cells hyperplasia of the thyroid, associated with calcinosis of the soft tissues is reported. The C-cells hyperplasia was probably due to excessive feeding with poultry waste, rich in calcium. The soft tissue mineralisation was a result of hypersecretion of calcitonin, a blood calcium-lowering hormone of the C-cells.

Transitional cell carcinoma of the urethra in a cat.

A case of transitional cell carcinoma of the prostatic and anterior pelvic urethra of a cat is presented. Primary urinarty tract neoplasms in the cat are rare, and transitional cell carcinoma with major involvement of the urethra has not been previously reported. The appearance and location of this tumor made differentiation from a prostatic carcinoma difficult. The clinical presentation consisted of emaciation, constipation, anorexia, and hematuria.