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Journal of Gastrointestinal Oncology Apr 2023Despite the rich proximity and vascularization to the pelvic organs, metastatic lesions to the penis are incredibly uncommon. Most primary tumors are genitourinary...
BACKGROUND
Despite the rich proximity and vascularization to the pelvic organs, metastatic lesions to the penis are incredibly uncommon. Most primary tumors are genitourinary cancers, and rectal origins are rare. Only 56 cases of metastatic penile tumors have been reported since 1870. Several palliative or curative methods, such as chemotherapy, total penectomy, and radiotherapy, have been applied to treat this condition in previous cases; however, the patient prognosis is poor. Immunotherapy is a beneficial treatment approach for multiple cancers, and recent investigations have shown that it may be beneficial for patients with advanced penile cancer.
CASE DESCRIPTION
Herein, we report the case of a 59-year-old Chinese man who had metastatic adenocarcinoma in the penile tissue 3 years after rectal cancer resection. The patient presented with penile pain and dysuria for 6 months when he was 54 years old, and Immunohistochemical staining showed that the origin was the rectum after total penectomy. The patient received surgery, chemotherapy, radiotherapy, targeted therapy and immunotherapy positively and still survived for a further 4 years and 6 months following penectomy despite the late metastasis of rectal cancer. There are two major changes and progress after penectomy, all of which have undergone surgical treatment during continuous treatment and follow-up, the patient completed right inguinal lymphadenectomy when his right regional nodes metastasis was found 23 months after penectomy. While the patient suffered from radiation injury after 47 months after penectomy, which led to radiation necrosis and hip soft tissue infection, and the patient tended to lay prone instead of lying on the back because of the hip pain. The patient ultimately died of multiple organ failure.
CONCLUSIONS
All of the previously reported cases of penile metastasis from rectal cancer since 1870 have been reviewed. Yet, the metastatic prognosis remains poor regardless of the treatment options, except for lesions where metastasis is only limited to the penis. We found that the patient may derive more benefit from strategic therapies including surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy.
PubMed: 37201076
DOI: 10.21037/jgo-23-84 -
Journal of Gastrointestinal Oncology Apr 2023The clinical outcomes and benefits of natural orifice specimen extraction surgery (NOSES) in colorectal cancer have not been fully evaluated comparing to conventional...
Short-term clinical effects and inflammatory response of natural orifice specimen extraction surgery versus conventional laparoscopic-assisted surgery for the treatment of sigmoid and rectal cancer.
BACKGROUND
The clinical outcomes and benefits of natural orifice specimen extraction surgery (NOSES) in colorectal cancer have not been fully evaluated comparing to conventional laparoscopic-assisted radical resection. This retrospective study was conducted to investigate the short-term clinical benefits of NOSES versus conventional laparoscopic-assisted surgery for the treatment of sigmoid and rectal cancer.
METHODS
A total of 112 patients with sigmoid or rectal cancer were included in this retrospective study. The observation group (n=60) was treated with NOSES, and the control group (n=52) was treated with conventional laparoscopic-assisted radical resection. Following these interventions, the postoperative recovery and inflammatory response indexes were compared between the two groups.
RESULTS
In contrast with the control group, the observation group significantly had longer operation time (t=2.83, P=0.006), but shorter durations for the resumption of a semi-liquid diet (t=2.17, P=0.032), and length of postoperative hospital stay (t=2.74, P=0.007), as well as fewer postoperative incision infections (χ=7.32, P=0.009). Moreover, the levels of immunoglobulin (Ig), including IgG (t=2.29, P=0.024), IgA (t=3.30, P=0.001), and IgM (t=3.38, P=0.001), in the observation group were markedly higher than those within the control group at 3 days postoperatively. Also, the levels of inflammatory indicators including interleukin (IL)-6 (t=4.22, P=5.02E-5), C-reactive protein (CRP) (t=3.73, P=3.5E-4), and tumor necrosis factor (TNF)-α (t=2.94, P=0.004) in the observation group were considerably lower than those in the control group at 3 days after the operation.
CONCLUSIONS
NOSES can improve the postoperative recovery and has benefits in reducing the inflammatory response than conventional laparoscopic-assisted surgery.
PubMed: 37201065
DOI: 10.21037/jgo-23-144 -
Journal of Dairy Science Jun 2023Twelve multiparous Holstein cows (42.2 ± 5.6 kg of milk/d; 83 ± 27 d in milk) were used in a split-plot design testing the effects of mineral and vitamin...
Increased dietary vitamin D and calcium partially alleviate heat stress symptoms and inflammation in lactating Holstein cows independent of dietary concentrations of vitamin E and selenium.
Twelve multiparous Holstein cows (42.2 ± 5.6 kg of milk/d; 83 ± 27 d in milk) were used in a split-plot design testing the effects of mineral and vitamin supplementation on the time course of animal performance, metabolism, and inflammation markers during heat stress. The main plot was the average concentrations of dietary vitamin E and Se (adequate: 11.1 IU/kg of vitamin E and 0.55 mg/kg of Se, and high: 223 IU/kg of vitamin E and 1.8 mg/kg of Se, respectively). Within each plot, cows were randomly assigned to (1) heat stress (HS) with adequate concentrations of vitamin D and Ca (1,012 IU/kg and 0.73%, respectively), (2) HS with high concentrations of vitamin D and Ca (HS+D/Ca; 3,764 IU/kg and 0.97%, respectively), or (3) pair-feeding (PF) in thermoneutrality with adequate concentrations of vitamin D and Ca (1,012 IU/kg and 0.73% Ca) in a Latin square design with 14-d periods and 7-d washouts. The highest rectal temperature was recorded at 1700 h for HS (39.4°C; mean of d 1 to 14), being 1.2 and 0.8°C greater than for PF and HS+D/Ca, respectively. Respiratory rate and water intake were higher in HS (73 breaths/min and 115 L/d, respectively) relative to PF (28 breaths/min and 76 L/d). Heat stress decreased dry matter intake progressively, reaching a nadir on d 5 to 7 (33% reduction) and was not different between treatments. Milk yield decreased progressively in all treatments, but remained greater in PF relative to HS from d 3 to 14 (10%), whereas HS and HS+D/Ca were not different. Milk fat, protein, and lactose concentrations and yields were lower in HS relative to PF from d 3 to 14, but not different between HS and HS+D/Ca. Relative to PF, preprandial insulin concentrations were increased in HS, whereas plasma nonesterified fatty acids were decreased on d 7 and 14. Plasma lipopolysaccharide-binding protein concentrations increased in HS cows on d 7 and 14, respectively, relative to PF, whereas they were reduced in HS + D/Ca on d 14. Plasma C-reactive protein, tumor necrosis factor-α, and fecal calprotectin were increased in HS relative to both PF and HS+D/Ca on d 7 and 14. Rectal temperature was positively associated with plasma lipopolysaccharide-binding protein (r = 0.72), tumor necrosis factor-α (r = 0.74), C-reactive protein (r = 0.87), and with milk somatic cells (r = 0.75). Plasma 8-hydroxy-2-deoxyguanosine concentrations presented a 3-way interaction, where 8-hydroxy-2-deoxyguanosine was lower in HS than in PF on d 7 and 14, and lower in HS+D/Ca relative to HS on d 14 in the adequate vitamin E and Se treatment, but no effects were observed in the high vitamin E and Se group. Plasma superoxide dismutase concentrations increased over time, and were higher in HS relative to PF on d 14, whereas HS+D/Ca was similar to HS. Heat stress markedly reduced milk production and milk components while increasing markers of leaky gut and inflammation. In contrast, vitamin D and Ca supplementation reduced hyperthermia (d 7-14), markers of leaky gut, and inflammation independent of dietary concentrations of vitamin E and Se.
Topics: Female; Cattle; Animals; Lactation; Calcium; Selenium; Vitamin E; Cholecalciferol; C-Reactive Protein; Tumor Necrosis Factor-alpha; Diet; Milk; Heat-Shock Response; Calcium, Dietary; Inflammation; Deoxyguanosine; Dietary Supplements; Cattle Diseases
PubMed: 37164847
DOI: 10.3168/jds.2022-22345 -
Frontiers in Pharmacology 2023As our previous study revealed that -benzyl--methyldecan-1-amine (BMDA), a new molecule originated from , exhibits anti-neoplastic activities, we herein explored other...
As our previous study revealed that -benzyl--methyldecan-1-amine (BMDA), a new molecule originated from , exhibits anti-neoplastic activities, we herein explored other functions of the compound and its derivative [decyl-(4-methoxy-benzyl)-methyl-amine; DMMA] including anti-inflammatory and anti-oxidative activities. Pretreatment of THP-1 cells with BMDA or DMMA inhibited tumor necrosis factor (TNF)-α and interleukin (IL)-1β production, and blocked c-jun terminal kinase (JNK), p38 mitogen-activated protein kinase (MAPK), MAPKAP kinase (MK)2 and NF-κΒ inflammatory signaling during LPS stimulation. Rectal treatment with BMDA or DMMA reduced the severity of colitis in 2,4-dinitrobenzenesulfonic acid (DNBS)-treated rat. Consistently, administration of the compounds decreased myeloperoxidase MPO) activity (representing neutrophil infiltration in colonic mucosa), production of inflammatory mediators such as cytokine-induced neutrophil chemoattractant (CINC)-3 and TNF-α, and activation of JNK and p38 MAPK in the colon tissues. In addition, oral administration of these compounds ameliorated collagen-induced rheumatoid arthritis (RA) in mice. The treatment diminished the levels of inflammatory cytokine transcripts, and protected connective tissues through the expression of anti-oxidation proteins such as nuclear factor erythroid-related factor (Nrf)2 and heme oxygenase (HO)1. Additionally, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels did not differ between the BMDA- or DMMA-treated and control animals, indicating that the compounds do not possess liver toxicity. Taken together, these findings propose that BMDA and DMMA could be used as new drugs for curing inflammatory bowel disease (IBD) and RA.
PubMed: 37153778
DOI: 10.3389/fphar.2023.1095955 -
Journal of Surgical Case Reports Apr 2023Doppler-guided haemorrhoidal artery ligation and recto anal repair (HAL-RAR) procedure is a relatively new, minimally invasive procedure for the treatment of Grades III...
Doppler-guided haemorrhoidal artery ligation and recto anal repair (HAL-RAR) procedure is a relatively new, minimally invasive procedure for the treatment of Grades III and IV haemorrhoids. A 71-year-old female presented with sepsis, abdominal distension and extensive subcutaneous emphysema and was found to have intra- and extraperitoneal rectal perforation requiring repair, laparoscopy and sigmoid colostomy. Suture ligation of the haemorrhoidal artery can inadvertently be above the peritoneal reflection and result in full thickness rectal perforation secondary to ischaemic necrosis. Previous vaginal prolapse mesh repair should be considered as a relative contraindication to HAL-RAR as it can significantly distort the anatomy.
PubMed: 37064065
DOI: 10.1093/jscr/rjad177 -
Ecotoxicology and Environmental Safety May 2023Intestinal inflammation induced by heat stress is an important factor restricting the healthy growth of broilers. The aim of this study was to evaluate the effect of...
Intestinal inflammation induced by heat stress is an important factor restricting the healthy growth of broilers. The aim of this study was to evaluate the effect of chicken embryo thermal manipulation (39.5 ℃ and 65 % RH for 3 h daily during 16-18 th embryonic age) on intestinal inflammation in broilers under postnatal heat stress and to investigate whether transient receptor potential V4 (TRPV4) plays a role in this process. Our results suggest that broilers with embryo thermal manipulation experience could delay the rising of rectal temperature during postnatal heat stress (P < 0.05), and had better production performance (P < 0.05), intestinal morphological parameters (P < 0.05) and higher expression of tight junction related genes (P < 0.05). The increased serum lipopolysaccharide (LPS) content, activation of nuclear factor-kappa B (NF-κB) signaling pathway and the increased expression of pro-inflammatory cytokines interleukin (IL)-1β, IL-6 and tumor necrosis factor alpha (TNF-α) in jejunum during postnatal heat stress were alleviated by embryo thermal manipulation (P < 0.05). Postnatal heat stress induced an increase in mRNA and protein expression of TRPV4 in jejunum (P < 0.05), but had no effect on broilers which experienced embryo thermal manipulation (P > 0.05). Inhibition of TRPV4 reduced LPS-induced Ca influx and restrained the activation of NF-κB signaling pathway and the expression of downstream pro-inflammatory cytokines (P < 0.05). The expression of DNA methyltransferase (DNMT) in the jejunum of broilers exposed to postnatal heat stress was increased by embryo thermal manipulation (P < 0.05). The DNA methylation level of TRPV4 promoter region was detected, and the results showed that embryo thermal manipulation increased the DNA methylation level of TRPV4 promoter region (P < 0.05). In conclusion, Chicken embryo thermal manipulation can alleviate jejunal inflammation in broilers under postnatal heat stress. This may be due to the decreased circulating LPS or the increased DNA methylation level in the promoter region of TRPV4, which inhibits TRPV4 expression, thereby reducing Ca influx, and finally alleviating inflammation by affecting NF-κB signaling pathway. The work is an attempt to understand the mechanism involved in alleviation of adverse effects of heat stress during postnatal life through prenatal thermal manipulation and to reveal the important role of epigenetics.
Topics: Animals; Chick Embryo; Chickens; Jejunum; NF-kappa B; Lipopolysaccharides; TRPV Cation Channels; Heat-Shock Response; Cytokines; Inflammation
PubMed: 37004430
DOI: 10.1016/j.ecoenv.2023.114851 -
Ethiopian Journal of Health Sciences Jan 2023Colorectal cancer (CRC) is one of the most prevalent and incident cancers worldwide with an Increasing prevalence in a younger age in developing countries. The aim of...
BACKGROUND
Colorectal cancer (CRC) is one of the most prevalent and incident cancers worldwide with an Increasing prevalence in a younger age in developing countries. The aim of the study was to determine the staging and imaging pattern of CRC at diagnosis.
METHODS
This is a descriptive cross-sectional study including all consecutive cases of CRC found in the departments of radiology and oncology during the study period from March 2016 - February 2017.
RESULTS
A total of 132 CRC cases were studied with M: F = 2.4:1, mean age of 46yrs and 67.4% = 50yrs. Left-sided tumors were associated with rectal bleeding (p = 0.001) and bowel habit change (p =0.045) whereas right-side tumors were associated with weight loss (p = 0.02) and abdominal pain (p = 0.004). 84.5% of CRC presented at an advanced stage, and 32% had distant metastasis. Young age was associated with the advanced stage (P=0.006) whereas family history was associated with the lower stage (P=0.008). Distance metastasis was associated with Colonic lesions (P=0.003) and emergent presentation (P=0.008). Asymmetric wall thickening with luminal narrowing was significantly associated with left side tumor (95% vs 21.4%) whereas large mass with necrosis was significantly associated with right side tumor (50% vs 5%) (P= 0.004).
CONCLUSIONS
CRC is presented at a younger age and at an advanced stage. The majority of CRCs were left-sided and rectal. Increasing the index of suspicion for CRC in patients with rectal bleeding and, bowel habit change is recommended.
Topics: Humans; Middle Aged; Cross-Sectional Studies; Colorectal Neoplasms; Gastrointestinal Hemorrhage
PubMed: 36890929
DOI: 10.4314/ejhs.v33i1.11 -
Frontiers in Oncology 2023There is controversy about the outcomes of prophylactic ileostomy the specimen extraction site (SES) after laparoscopic rectal cancer surgery (LRCS). We, therefore,...
Which site is better for prophylactic ileostomy after laparoscopic rectal cancer surgery? By the specimen extraction site or new site: A systematic review and meta-analysis.
BACKGROUND
There is controversy about the outcomes of prophylactic ileostomy the specimen extraction site (SES) after laparoscopic rectal cancer surgery (LRCS). We, therefore, performed a meta-analysis to determine the efficacy and safety of stoma through the SES versus new site (NS).
METHODS
All relevant studies from 1997 to 2022 were searched in the PubMed, EMBASE, Cochrane Library, CNKI, VIP databases. This meta-analysis was performed using RevMan software 5.3 for statistical analysis.
RESULTS
7 studies with 1736 patients were included. The present meta-analysis noted that prophylactic ileostomy SES was associated with a higher risk of overall stoma-related complications, especially parastomal hernia (OR, 2.39, 95% CI 1.43-4.00; p=0.0008). No statistical difference was found in terms of wound infection, ileus, stoma edema, stoma prolapse, stoma necrosis, stoma infection, stoma bleeding, stoma stenosis, skin inflammation around the stoma, stoma retraction and postoperative pain score on postoperative day 1 and 3 between SES group and NS group. However, prophylactic ileostomy SES was associated with lesser blood loss (MD = -0.38, 95% CI: -0.62 - -0.13; p=0.003), shorter operation time(MD = -0.43, 95% CI: -0.54 - -0.32 min; p<0.00001), shorter post-operative hospital stay (MD = -0.26, 95% CI: -0.43 - -0.08; p=0.004), shorter time to first flatus(MD = -0.23, 95% CI: -0.39 - -0.08; p=0.003) and lower postoperative pain score on postoperative day 2.
CONCLUSION
Prophylactic ileostomy SES after LRCS reduces new incision, decreases operative time, promotes postoperative recovery, and improves cosmetic outcomes, but may increase the incidence of parastomal hernias. The vast majority of parastomal hernias can be repaired by closing the ileostomy, therefore SES remain an option for temporary ileostomy after LRCS.
PubMed: 36874091
DOI: 10.3389/fonc.2023.1116502 -
EClinicalMedicine Mar 2023Onset of effect of advanced therapies is an important parameter due to symptom load and risk of disease complications in moderate-to-severe ulcerative colitis (UC), but...
BACKGROUND
Onset of effect of advanced therapies is an important parameter due to symptom load and risk of disease complications in moderate-to-severe ulcerative colitis (UC), but comparative data are lacking. Therefore, we aimed to assess the comparative onset of efficacy of biological therapies and small molecules for this patient population.
METHODS
In this systematic review and network meta-analysis, we searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to 24 August 2022, for randomised controlled trials or open-label studies assessing the efficacy of biologics or small molecule drugs within the first six weeks of treatment in adults with UC. The co-primary outcomes were the induction of clinical response and clinical remission at week 2. Network meta-analyses was conducted under the Bayesian framework. This study is registered with PROSPERO: CRD42021250236.
FINDINGS
The systematic literature search identified 20,406 citations, of which 25 studies comprising 11,074 patients fulfilled the eligibility criteria. Upadacitinib ranked highest for induction of clinical response and clinical remission at week 2 and was significantly superior to all agents but tofacitinib, which ranked second highest. Although the rankings remained consistent, no differences between upadacitinib and biological therapies were demonstrated in the sensitivity analyses of partial Mayo clinic score response or resolution of rectal bleeding at week 2. Tumor necrosis factor-α (TNF) inhibitors were significantly superior to vedolizumab and ustekinumab for patient-reported outcome-2 (PRO-2) remission at week 2 in bio-naïve patients. Filgotinib 100 mg, ustekinumab, and ozanimod ranked lowest across all endpoints.
INTERPRETATION
In this network meta-analysis, we found upadacitinib to be significantly superior to all agents but tofacitinib for the induction of clinical response and clinical remission two weeks after treatment initiation. In contrast, ustekinumab and ozanimod ranked lowest. Our findings help to establish the evidence regarding the onset of efficacy of advanced therapies.
FUNDING
None.
PubMed: 36864986
DOI: 10.1016/j.eclinm.2023.101866 -
Journal of Medical Case Reports Mar 2023Musculoskeletal manifestations are common extraintestinal manifestations of inflammatory bowel disease. Tofacitinib is a Janus kinase inhibitor approved for treating...
BACKGROUND
Musculoskeletal manifestations are common extraintestinal manifestations of inflammatory bowel disease. Tofacitinib is a Janus kinase inhibitor approved for treating rheumatoid arthritis and ulcerative colitis. There are limited data on the efficacy of tofacitinib in managing inflammatory bowel disease-associated arthritis. Here we report two patients with ulcerative colitis- and Crohn's disease-associated arthritis successfully responding to tofacitinib.
CASES
A 34-year-old Bangladeshi woman presented with lower limb polyarthritis for 7 years. Six months after the onset of polyarthritis, she developed abdominal pain with rectal bleeding. Colonoscopy and rectal biopsy findings confirmed ulcerative colitis. Ulcerative colitis associated arthritis was diagnosed. Treatment with sulfasalazine, etanercept, adalimumab, infliximab, and methotrexate gave no long-lasting remission. Methotrexate with mesalazine gave a partial response, and tofacitinib 5 mg twice per day was added. Her articular and abdominal symptoms improved within a month, and remission persisted till 24 months of follow-up, except a short-lasting mild flare at the seventh month. A 52-year-old Bangladeshi man had Crohn's disease for 5 years. He presented with a swollen left knee and pain in other joints. Laboratory showed positive HLA-B27. He was intolerant to sulfasalazine and experienced poor response to methotrexate. Due to his inability to afford anti-tumor necrosis factor, tofacitinib was initiated. His arthritis improved within a month, and he remained in remission up to the sixth month.
CONCLUSIONS
In a woman with ulcerative colitis associated arthritis, refractory to biologic therapy, both arthritis and colitis improved with tofacitinib. A patient with Crohn's disease-associated arthritis went into remission with tofacitinib. Tofacitinib may be effective in inflammatory bowel disease-associated arthritis.
Topics: Adult; Female; Humans; Male; Arthritis, Rheumatoid; Colitis, Ulcerative; Crohn Disease; Inflammatory Bowel Diseases; Methotrexate; Sulfasalazine; Middle Aged
PubMed: 36855206
DOI: 10.1186/s13256-023-03796-2