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Trials Jul 2024Colon cancer is a global health concern, ranking fifth in both new diagnoses and deaths among tumors worldwide. Surgical intervention remains the primary treatment for... (Comparative Study)
Comparative Study
BACKGROUND
Colon cancer is a global health concern, ranking fifth in both new diagnoses and deaths among tumors worldwide. Surgical intervention remains the primary treatment for localized cases, with a historical evolution marked by a focus on short-term outcomes. While Japan pioneered radical tumor removal with a systematic categorization of lymph nodes (D1, D2, D3), the dissemination of Japanese practices to the West was delayed until 90th of last century. Discrepancies between Japanese D3 dissection and the CME with CVL principle persist, with variations in longitudinal margins and recommended procedures. Non-randomized trials indicate the superiority of D3 over D2, but a consensus is lacking.
METHODS
This prospective, international, multicenter, randomized controlled trial employs a two-arm, parallel-group, open-label design to rigorously compare the 5-year overall survival outcomes between D2 and D3 lymph node dissection in stage II-III right colon cancer. Building on prior studies, the trial aims to address existing knowledge gaps and provide a comprehensive evaluation of the outcomes associated with D3 dissection. The study population comprises patients with right colon cancer, ensuring a focused investigation into the specific context of this disease. The trial design emphasizes its global scope and collaboration across multiple centers, enhancing the generalizability of the findings.
DISCUSSION
This study's primary objective is to elucidate the potential superiority in 5-year overall survival benefits of D3 lymph node dissection compared to the conventional D2 approach in patients with stage II-III right colon cancer. By examining this specific subset of patients, the research aims to contribute valuable insights into optimizing surgical strategies for improved long-term outcomes. The trial's international and multicenter nature enhances its applicability across diverse populations. The outcomes of this study may inform future guidelines and contribute to the ongoing discourse surrounding the standardization of colon cancer surgery, particularly in the context of right colon cancer.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03200834. Registered on June 27, 2017.
Topics: Humans; Lymph Node Excision; Colonic Neoplasms; Prospective Studies; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Treatment Outcome; Time Factors; Neoplasm Staging; Lymphatic Metastasis; Lymph Nodes; Colectomy
PubMed: 38956698
DOI: 10.1186/s13063-024-08269-5 -
Journal of Cardiothoracic Surgery Jul 2024This study evaluated the prevalence and quantity of lymph nodes at particular stations of the mediastinum in patients with lung cancer. These data are important to...
BACKGROUND
This study evaluated the prevalence and quantity of lymph nodes at particular stations of the mediastinum in patients with lung cancer. These data are important to radiologists, pathologists, and thoracic surgeons because they can serve as a benchmark when assessing the completeness of lymph node dissection. However, relevant data in the literature are scarce.
METHODS
Data regarding the number of lymph nodes derived from two randomised trials of bilateral mediastinal lymph node dissection, the BML-1 and BML-2 study, were included in this analysis. Detectable nodes at particular stations of the mediastinum and the number of nodes at these stations were analysed.
RESULTS
The mean number of removed nodes was 28.67 (range, 4-88). Detectable lymph nodes were present at stations 2R, 4R, and 7 in 93%, 98%, and 99% of patients, respectively. Nodes were rarely present at stations 9 L (33%), and 3 (35%). The largest number of nodes was observed at stations 7 and 4R (mean, 5 nodes).
CONCLUSION
The number of mediastinal lymph nodes in patients with lung cancer may be greater than that in healthy individuals. Lymph nodes were observed at stations 2R, 4R, and 7 in more than 90% of patients with lung cancer. The largest number of nodes was observed at stations 4R and 7. Detectable nodes were rarely observed at stations 3 and 9 L.
TRIAL REGISTRATION
ISRCTN 86,637,908.
Topics: Humans; Lung Neoplasms; Mediastinum; Lymph Node Excision; Lymph Nodes; Male; Female; Aged; Middle Aged; Lymphatic Metastasis; Prevalence
PubMed: 38956617
DOI: 10.1186/s13019-024-02928-z -
Journal of Orthopaedic Surgery and... Jul 2024Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse...
BACKGROUND
Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model.
METHODS
Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL.
RESULTS
SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R = 0.996).
CONCLUSION
The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction of tunnel pressure and diagnosis of carpal tunnel syndrome.
Topics: Humans; Carpal Tunnel Syndrome; Pressure; Elasticity Imaging Techniques; Cadaver; Ligaments, Articular; Male; Female; Middle Aged; Aged
PubMed: 38956611
DOI: 10.1186/s13018-024-04874-x -
International Journal of Emergency... Jul 2024The presentation of acute aortic dissection can pose a challenge for emergency physicians, as it may occur without pain. Atypical presentations can lead to significant...
BACKGROUND
The presentation of acute aortic dissection can pose a challenge for emergency physicians, as it may occur without pain. Atypical presentations can lead to significant delays in diagnosis and increased mortality rates.
CASE DESCRIPTION
Our case illustrates that isolated painless syncope can be a rare presenting symptom of acute aortic dissection type A. What is unique about our case is the limited extension of the dissection tear and the availability of Holter monitoring during the syncopal episode.
CONCLUSION
This constellation provides insight into the pathophysiological mechanism of the syncope in this patient. Mechanisms of syncope related to acute aortic dissection are diverse. We show that vasovagal activation not related to pain can be the underlying mechanism of syncope in acute aortic dissection type A. Although excessive vasovagal tone in the setting of aortic dissection has been hypothesized in the past, it has never been as clearly illustrated as in the present case. This also highlights the challenge in risk stratification of syncope in the emergency department.
PubMed: 38956477
DOI: 10.1186/s12245-024-00664-8 -
Nature Immunology Jul 2024Natural killer (NK) cells are innate lymphoid cells (ILCs) contributing to immune responses to microbes and tumors. Historically, their classification hinged on a...
Natural killer (NK) cells are innate lymphoid cells (ILCs) contributing to immune responses to microbes and tumors. Historically, their classification hinged on a limited array of surface protein markers. Here, we used single-cell RNA sequencing (scRNA-seq) and cellular indexing of transcriptomes and epitopes by sequencing (CITE-seq) to dissect the heterogeneity of NK cells. We identified three prominent NK cell subsets in healthy human blood: NK1, NK2 and NK3, further differentiated into six distinct subgroups. Our findings delineate the molecular characteristics, key transcription factors, biological functions, metabolic traits and cytokine responses of each subgroup. These data also suggest two separate ontogenetic origins for NK cells, leading to divergent transcriptional trajectories. Furthermore, we analyzed the distribution of NK cell subsets in the lung, tonsils and intraepithelial lymphocytes isolated from healthy individuals and in 22 tumor types. This standardized terminology aims at fostering clarity and consistency in future research, thereby improving cross-study comparisons.
PubMed: 38956378
DOI: 10.1038/s41590-024-01883-0 -
Annals of Surgical Oncology Jul 2024Immediate lymphatic reconstruction (ILR) has been proposed to decrease lymphedema rates. The primary aim of our study was to determine whether ILR decreased the...
BACKGROUND
Immediate lymphatic reconstruction (ILR) has been proposed to decrease lymphedema rates. The primary aim of our study was to determine whether ILR decreased the incidence of lymphedema in patients undergoing axillary lymph node dissection (ALND).
METHODS
We conducted a two-site pragmatic study of ALND with or without ILR, employing surgeon-level cohort assignment, based on breast surgeons' preferred standard practice. Lymphedema was assessed by limb volume measurements, patient self-reporting, provider documentation, and International Classification of Diseases, Tenth Revision (ICD-10) codes.
RESULTS
Overall, 230 patients with breast cancer were enrolled; on an intention-to-treat basis, 99 underwent ALND and 131 underwent ALND with ILR. Of the 131 patients preoperatively planned for ILR, 115 (87.8%) underwent ILR; 72 (62.6%) were performed by one breast surgical oncologist and 43 (37.4%) by fellowship-trained microvascular plastic surgeons. ILR was associated with an increased risk of lymphedema when defined as ≥10% limb volume change on univariable analysis, but not on multivariable analysis, after propensity score adjustment. We did not find a statistically significant difference in limb volume measurements between the two cohorts when including subclinical lymphedema (≥5% inter-limb volume change), nor did we see a difference in grade between the two cohorts on an intent-to-treat or treatment received basis. For all patients, considering ascertainment strategies of patient self-reporting, provider documentation, and ICD-10 codes, as a single binary outcome measure, there was no significant difference in lymphedema rates between those undergoing ILR or not.
CONCLUSION
We found no significant difference in lymphedema rates between patients undergoing ALND with or without ILR.
PubMed: 38955992
DOI: 10.1245/s10434-024-15715-w -
Doklady. Biochemistry and Biophysics Jul 2024Metacestode infestation of Semibalanus balanoides (L., 1767) and Balanus crenatus Bruguiеre, 1789, collected in the Barents and White Seas and in the northern part of...
Semibalanus balanoides (L.) and Balanus crenatus Bruguière (Balanidae) Are Intermediate Hosts of Fimbriarioides intermedia (Fuhrmann, 1913) and Two Species of the Genus Microsomacanthus (Cestoda: Hymenolepidae), Parasites of Sea Ducks from the Atlantic Sector of the Arctic and Northern Pacific.
Metacestode infestation of Semibalanus balanoides (L., 1767) and Balanus crenatus Bruguiеre, 1789, collected in the Barents and White Seas and in the northern part of the Sea of Okhotsk in 2020 and 2021, respectively, was studied. A total of 313 S. balanoides from Mogilnaya Bay of Kildin Island (Barents Sea) and isolated mature wrinkled barnacles B. crenatus, two and four specimens from the Pechora Sea and Kandalaksha Bay of the White Sea, respectively, were examined in 2020. Metacestodes Fimbriarioides intermedia (Fuhrmann, 1913) (Cyclophyllidea, Hymenolepididae) were found in 1.0 ± 0.6% of S. balanoides in the Barents Sea with an invasion intensity (I. I.) of 2-5 specimens, and in one of two B. crenatus from the Pechora Sea (I. I. 15 specimens). For the first time, in both B. crenatus from the Pechora Sea, taken from the valves of the mussel Mytilus edulis, metacestodes Microsomacanthus sp. I (I. I. 13 and 20 specimens) with proboscis hooks 38-41 (39.4 ± 0.1) µm long and blades of 9.5-11 (10.7 ± 0.1) µm were obtained. One of four B. crenatus from the Kandalaksha Bay was infected with another Microsomacanthus sp. II (I. I. 19 specimens) with proboscis hooks 44.0-49.5 (45.7 ± 0.5) µm long and blades 14.0-16.0 (14.8 ± 0.07) µm long. A total of 362 S. balanoides were collected and dissected in Gizhiginskaya Bay of the northern part of the Sea of Okhotsk in 2021, of which 8.0 ± 1.4% were infected with F. intermedia metacestodes (I. I. 1-19 specimens). Study results of the infestation of S. balanoides on the Koni-Pyagin coast of the Sea of Okhotsk (according to the collections of 2006-2007) were supplemented and clarified. Description of metacestodes and the taxonomic affiliation of cysticercoids Microsomacanthus spp. are given.
PubMed: 38955915
DOI: 10.1134/S1607672924701035 -
Surgical Endoscopy Jul 2024Thoracic esophageal cancer surgery using robotic approaches for the thoracic and abdominal parts has recently been reported as total robot-assisted minimally invasive...
BACKGROUND
Thoracic esophageal cancer surgery using robotic approaches for the thoracic and abdominal parts has recently been reported as total robot-assisted minimally invasive esophagectomy (RAMIE). We herein present the first report of a new technique for esophageal cancer: total RAMIE with three-field lymph node dissection (3FLND) by a simultaneous two-team approach using a new docking method.
METHODS
We reviewed 20 patients who underwent total RAMIE with 3FLND by a simultaneous two-team approach at the National Cancer Center East Hospital from March 2023 to September 2023. Short-term surgical outcomes and the safety and efficacy of this technique were analyzed.
RESULTS
The mean operative time for abdominal surgery with this new docking technique was 135 ± 19.6 min. The total operative time was 488 ± 42.9 min, and the time from the end of abdominal manipulation to the end of surgery was 80.1 ± 15.6 min. The intraoperative blood loss was 116.7 ± 64.4 mL. The incidence of anastomotic leakage, postoperative vocal cord paralysis, and postoperative pneumonia was 10%, 5%, and 10%, respectively. The median postoperative hospital stay was 14 days (range 11-63 days). No in-hospital deaths occurred, and R0 resection was possible in all cases. The average number of lymph nodes dissected was 87.7.
CONCLUSION
These results demonstrate that total RAMIE with a simultaneous two-team approach using the new docking method can be safely introduced. The simultaneous cervical and abdominal manipulation with the new docking method allowed total RAMIE without prolonging the operating time, suggesting that it may be a valuable approach for esophageal cancer surgery.
PubMed: 38955836
DOI: 10.1007/s00464-024-11001-8 -
Heart, Lung & Circulation Jul 2024This study aimed to analyse the baseline characteristics of patients admitted with acute type A aortic syndrome (ATAAS) and to identify the potential predictors of...
BACKGROUND
This study aimed to analyse the baseline characteristics of patients admitted with acute type A aortic syndrome (ATAAS) and to identify the potential predictors of in-hospital mortality in surgically managed patients.
METHODS
Data regarding demographics, clinical presentation, laboratory work-up, and management of 501 patients with ATAAS enrolled in the National Registry of Aortic Dissections-Romania registry from January 2011 to December 2022 were evaluated. The primary endpoint was in-hospital all-cause mortality. Multivariate logistic regression was conducted to identify independent predictors of mortality in patients with acute Type A aortic dissection (ATAAD) who underwent surgery.
RESULTS
The mean age was 60±11 years and 65% were male. Computed tomography was the first-line diagnostic tool (79%), followed by transoesophageal echocardiography (21%). Cardiac surgery was performed in 88% of the patients. The overall mortality in the entire cohort was 37.9%, while surgically managed ATAAD patients had an in-hospital mortality rate of 29%. In multivariate logistic regression, creatinine value (OR 6.76), ST depression on ECG (OR 6.3), preoperative malperfusion (OR 5.77), cardiogenic shock (OR 5.77), abdominal pain (OR 4.27), age ≥70 years (OR 3.76), and syncope (OR 3.43) were independently associated with in-hospital mortality in surgically managed ATAAD patients.
CONCLUSIONS
Risk stratification based on the variables collected at admission may help to identify ATAAS patients with high risk of death following cardiac surgery.
PubMed: 38955595
DOI: 10.1016/j.hlc.2024.02.016 -
Current Opinion in Plant Biology Jul 2024Inflorescence architecture is highly variable across plant lineages yet is critical for facilitating reproductive success. The capitulum-type inflorescence of the... (Review)
Review
Inflorescence architecture is highly variable across plant lineages yet is critical for facilitating reproductive success. The capitulum-type inflorescence of the Asteraceae is marked as a key morphological innovation that preceded the family's diversification and expansion. Despite its evolutionary significance, our understanding of capitulum development and evolution is limited. This review highlights our current perspective on capitulum evolution through the lens of both its molecular and developmental underpinnings. We attempt to summarize our understanding of the capitulum by focusing on two key characteristics: patterning (arrangement of florets on a capitulum) and floret identity specification. Note that these two features are interconnected such that the identity of florets depends on their position along the inflorescence axis. Phytohormones such as auxin seemingly determine both pattern progression and floret identity specification through unknown mechanisms. Floret morphology in a head is controlled by differential expression of floral symmetry genes regulating floret identity specification. We briefly summarize the applicability of the ABCE quartet model of flower development in regulating the floret organ identity of a capitulum in Asteraceae. Overall, there have been promising advancements in our understanding of capitula; however, comprehensive functional genetic analyses are necessary to fully dissect the molecular pathways and mechanisms involved in capitulum development.
PubMed: 38955094
DOI: 10.1016/j.pbi.2024.102589