Musings from the Tribbles Research and Innovation Network.

This commentary integrates historical and modern findings that underpin our understanding of the cell-specific functions of the Tribbles (TRIB) proteins that bear on tumorigenesis. We touch on the initial discovery of roles played by mammalian TRIB proteins in a diverse range of cell-types and pathologies, for example, TRIB1 in regulatory T-cells, TRIB2 in acute myeloid leukaemia and TRIB3 in gliomas; the origins and diversity of TRIB1 transcripts; microRNA-mediated (miRNA) regulation of TRIB1 transcript decay and translation; the substantial conformational changes that ensue on binding of TRIB1 to the transcription factor C/EBPα; and the unique pocket formed by TRIB1 to sequester its C-terminal motif bearing a binding site for the E3 ubiquitin ligase COP1. Unashamedly, the narrative is relayed through the perspective of the Tribbles Research and Innovation Network, and its establishment, progress and future ambitions: the growth of TRIB and COP1 research to hasten discovery of their cell-specific contributions to health and obesity-related cancers.

Tratamiento quirúrgico de la diverticulitis aguda. Estudio retrospectivo multicéntrico / Surgical treatment of acute diverticulitis. A retrospective multicentre study

INTRODUCCIÓN: Se pretende analizar los resultados a corto y medio plazo de diferentes técnicas quirúrgicas en el tratamiento de la diverticulitis aguda complicada (DAC). MÉTODOS: Estudio retrospectivo y multicéntrico de pacientes operados de urgencia o de urgencia diferida por DAC. RESULTADOS: Estudiamos a 385 pacientes: 218 hombres y 167 mujeres, de edad media 64,4 ± 15,6 años, intervenidos en 10 hospitales. La mediana (25-758 percentiles) de evolución desde el inicio de los síntomas hasta la cirugía fue de 48 h(24-72), y su indicación más frecuente, un cuadro peritonítico (66%). El abordaje fue generalmente abierto (95,1%) y los hallazgos más comunes, peritonitis purulenta (34,8%) o absceso pericólico (28,6%). La técnica más habitual fue el procedimiento de Hartmann (PHT) en 278 (72,2%), seguida de resección y anastomosis primaria (RAP) en 69 (17,9%). Se complicaron 205 pacientes (53,2%) y fallecieron 50 (13%). Edad avanzada, inmunodepresión, factores de riesgo quirúrgico y peritonitis fecal se asociaron a mayor mortalidad. El lavado peritoneal laparoscópico (LPL) tuvo elevada tasa de reintervenciones, implicando frecuentemente un estoma, y la RAP se complicó con dehiscencia de sutura en el 13,7% de pacientes, sin diferencias en la morbimortalidad al compararla con el PHT. La mediana de estancia postoperatoria fue de 12 días; su mayor duración se relacionó con la mayor edad, riesgo quirúrgico ASA, hospital y complicaciones postoperatorias. CONCLUSIONES: La cirugía por DAC tiene importante morbimortalidad y se asocia frecuentemente a un estoma terminal. Además, el LPL presenta alta tasa de reintervenciones. LA RAP, aun asociando un estoma de protección, parece de elección en muchos casos

INTRODUCTION: To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD). METHODS: Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD. RESULTS: A series of 385 patients: 218 men and 167 women, mean age 64.4 ± 15.6 years, operated on in 10 hospitals were included. The median (25th-75th percentile) time from symptoms to surgery was 48 (24-72) h, being peritonitis the main surgical indication in a 66% of cases. Surgical approach was usually open (95.1%), and the commonest findings, a purulent peritonitis (34.8%) or pericolonic abscess (28.6%). Hartmann procedure (HP) was the most used technique in 278 (72.2%) patients, followed by resection and primary anastomosis (RPA) in 69 (17.9%). The overall postoperative morbidity and mortality was 53.2% and 13% respectively. Age, immunosupression, presence of general risk factors and faecal peritonitis were associated with increased mortality. Laparoscopic peritoneal lavage (LPL) was associated with an increased reoperation rate frequently involving a stoma, and anastomotic leaks presented in 13.7 patients after RPA, without differences in morbimortality when compared with HP. Median postoperative length of stay was 12 days, and was correlated with age, surgical risk, ASA score, hospital and postoperative complications. CONCLUSIONS: Surgery for CAD has important morbidity and mortality and is frequently associated with an end-stoma. Moreover LPL presented high reoperation rates. It seems better to resect and anastomose in most cases, even with an associated protective stoma

Surgical treatment of acute diverticulitis. A retrospective multicentre study. / Tratamiento quirúrgico de la diverticulitis aguda. Estudio retrospectivo multicéntrico.

INTRODUCTION: To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD). METHODS: Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD. RESULTS: A series of 385 patients: 218 men and 167 women, mean age 64.4±15.6 years, operated on in 10 hospitals were included. The median (25th-75th percentile) time from symptoms to surgery was 48 (24-72) h, being peritonitis the main surgical indication in a 66% of cases. Surgical approach was usually open (95.1%), and the commonest findings, a purulent peritonitis (34.8%) or pericolonic abscess (28.6%). Hartmann procedure (HP) was the most used technique in 278 (72.2%) patients, followed by resection and primary anastomosis (RPA) in 69 (17.9%). The overall postoperative morbidity and mortality was 53.2% and 13% respectively. Age, immunosupression, presence of general risk factors and faecal peritonitis were associated with increased mortality. Laparoscopic peritoneal lavage (LPL) was associated with an increased reoperation rate frequently involving a stoma, and anastomotic leaks presented in 13.7 patients after RPA, without differences in morbimortality when compared with HP. Median postoperative length of stay was 12 days, and was correlated with age, surgical risk, ASA score, hospital and postoperative complications. CONCLUSIONS: Surgery for CAD has important morbidity and mortality and is frequently associated with an end-stoma. Moreover LPL presented high reoperation rates. It seems better to resect and anastomose in most cases, even with an associated protective stoma.

Tumores presacros. Análisis de nuestra experiencia en 20 casos tratados quirúrgicamente / Presacral tumors. Analysis of 20 surgically treated patients

Introducción Los tumores presacros son una enfermedad infrecuente y poco conocida. Presentamos nuestra experiencia en su tratamiento quirúrgico. Métodos Análisis de una serie (1995–2008).Resultados Estudiamos a 20 pacientes (14 mujeres y 6 varones), media de edad de 46 (29–71) años. Los pacientes con tumores benignos tenían una media ± desviación estándar de edad (43,5±10,2 años) menor que los que presentaban tumores malignos (62±10,7; p=0,002). La mediana de duración de los síntomas fue de 1 año (2 meses–50 años). El primer síntoma fue supuración, masa palpable o estreñimiento en 10 casos; dolor abdominal en 4, lumbalgia en 4 y hallazgo casual en 3. El abordaje quirúrgico fue perineal en 9 (45%) casos, abdominal en 8 (40%) y combinado en 3 (15%). Hubo 15 (75%) tumores benignos; los más frecuentes, los teratomas, con 5 casos. Otros 5 fueron malignos: 2 cordomas, 1 teratoma quístico maligno, 1 cistoadenocarcinoma mucinoso y 1 linfoma. La media de estancia hospitalaria fue 6,6±5 días. Hubo complicaciones posquirúrgicas en 5 (20%) casos. Tras una media de seguimiento de 3,5±4 años, fallecieron 2 pacientes (teratoma maligno y cistoadenocarcinoma) por comorbilidad y recidiva inextirpable, respectivamente, y ha recidivado uno benigno (schwannoma); los demás están libres de enfermedad. Conclusiones El tratamiento quirúrgico realizado por un grupo de cirujanos experimentado en cirugía pelviana-perineal, puede obtener buenos resultados con pocas complicaciones, a excepción de algunos tumores malignos, según la infiltración de estructuras vecinas y su tipo histológico (AU)

Introduction Presacral tumors are a rare and little known pathology. We present our experience in its surgical treatment. Methods Analysis of a series (1995–2008).Results20 patients (14 women and 6 men), average age 46 (29–71) years. Patients with benign tumors were younger (43.5±10.2) years that those who had malignant tumors (62±10.7; p=0.002). The median duration of symptoms was 1 year (2 month–50 years). The first symptom was suppuration, palpable mass or constipation in 10 cases or constipation, abdominal pain in 4, back pain in 4 and a casual finding in 3. The surgical approach was perineal in 9 (45%), abdominal in 8 (40%) and combined in 3 (15%) cases. Fifteen (75%) tumors were benign, with teratomas being the most frequent (5 cases). Another 5 were malignant: 2 chordomas, 1 malignant cystic teratoma, 1 malignant mucinous cystadenocarcinoma and 1 lymphoma. Mean postoperative stay was 6.6±5 days. There were post-surgical complications in 5 (20%) patients. After an average follow-up of 3.5±4 years, 2 patients died (malignant teratoma and cystadenocarcinoma, respectively) due to morbidity and to a non-resectable recurrence, and a benign schwannoma has recurred, the rest being free of disease. Conclusions Surgical treatment by a group of surgeons experienced in perineal and pelvic surgery can obtain good results with few complications, with the exception of some malignant tumors, depending on the infiltration of adjacent structures and their histological type (AU)

[Presacral tumors. Analysis of 20 surgically treated patients]. / Tumores presacros. Análisis de nuestra experiencia en 20 casos tratados quirúrgicamente.

INTRODUCTION: Presacral tumors are a rare and little known pathology. We present our experience in its surgical treatment. METHODS: Analysis of a series (1995-2008). RESULTS: 20 patients (14 women and 6 men), average age 46 (29-71) years. Patients with benign tumors were younger (43.5+/-10.2) years that those who had malignant tumors (62+/-10.7; p = 0.002). The median duration of symptoms was 1 year (2 month-50 years). The first symptom was suppuration, palpable mass or constipation in 10 cases or constipation, abdominal pain in 4, back pain in 4 and a casual finding in 3. The surgical approach was perineal in 9 (45%), abdominal in 8 (40%) and combined in 3 (15%) cases. Fifteen (75%) tumors were benign, with teratomas being the most frequent (5 cases). Another 5 were malignant: 2 chordomas, 1 malignant cystic teratoma, 1 malignant mucinous cystadenocarcinoma and 1 lymphoma. Mean postoperative stay was 6.6+/-5 days. There were post-surgical complications in 5 (20%) patients. After an average follow-up of 3.5+/-4 years, 2 patients died (malignant teratoma and cystadenocarcinoma, respectively) due to morbidity and to a non-resectable recurrence, and a benign schwannoma has recurred, the rest being free of disease. CONCLUSIONS: Surgical treatment by a group of surgeons experienced in perineal and pelvic surgery can obtain good results with few complications, with the exception of some malignant tumors, depending on the infiltration of adjacent structures and their histological type.