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HighlightsAmyand’s hernias are an uncommon variant of inguinal hernia.Early recognition of this hernia type may improve patient care and outcome.Treatment for Amyand's hernias is dictated by additional factors, which has led to a classification scheme.There is no consensus on the approach to repair of these hernias but various described approaches have shown success.

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During early development of colon cancer, cyclooxygenase 2 (COX‐2) is constitutively induced. Constitutive expression of COX‐2 promotes colon carcinogenesis, however the underlying mechanisms are not totally understood. Western blot analysis showed reduced protein levels of an adhesion molecule α‐catenin in HCA‐7 colon cancer cells that endogenously express COX‐2 and HCT‐15 colon cancer cells that stably express recombinant COX‐2 (HCT‐15‐COX‐2). High levels of phosphorylated active ERKs were also detected in HCA‐7 and HCT‐15‐COX‐2 cells. Inhibition of COX‐2 stimulated α‐catenin levels and prevented activation of ERKs. Scratch wound gap assays were used to monitor cell motility and proliferation. HCT‐15‐COX‐2 cells closed the gap faster than parental HCT‐15 cells. Inhibition of COX‐2 or ERKs in HCA‐7 and HCT‐15‐COX‐2 cells decreased the gap closing. The Human Cancer RT2‐miRNA PCR array screening showed that 39 microRNAs (miRNAs) are modulated by COX‐2 signaling. Quantitative RT‐PCR confirmed that expression levels of 6 miRNAs were significantly lower in HCA‐7 or HCT‐15‐COX‐2 than in HCA‐7 cells that were treated with the COX‐2‐selecetive inhibitor NS‐398 or HCT‐15 parental cells. Those 6 miRNAs were selected due to their relevance to cancer cell migration. In summary, we have identified that activation of ERKs and modulation of miRNAs mediate COX‐2 signaling to promote colon carcinogenesis.

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placement in venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients.Methods: Single-center retrospective review of all consecutive patients who underwent peripheral VA-ECMO from 2016 to 2019. Patients were excluded if ECMO duration was <24 hours or if they underwent prophylactic DPC placement during time of cannulation. Clinical factors including laboratory shock markers, abnormal postcannulation computed tomography angiogram (CTA), limb near infrared spectroscopy (NIRS) discrepancy, and limb examination discrepancy were compared between patients requiring DPC placement to those who did not. Laboratory shock markers were defined as initial lactate $4 mmol/L and pH #7.2. Abnormal postcannulation CTA was defined as diminished or absent arterial contrast opacification distal to the arterial cannula. Limb NIRS discrepancy was defined as $25% rSO 2 saturation discrepancy relative to contralateral limb. Limb examination discrepancy was defined as two or more abnormal physical examination findings (absent dorsalis pedis signal, absent posterior tibial signal, capillary refill of >2 seconds, edema, motor deficit, sensory deficit, or pallor) not present in contralateral limb.Results: Fifty-four patients were included for analysis (35 males, 19 females; mean age, 55.9 6 13 years), of whom 17 (32%) underwent DPC placement. Thirty-three patients (61%) survived VA-ECMO and 27 (50%) survived to discharge. Using selective DPC placement, there was a 0% incidence of limb amputation. One patient (1.8%) developed cannulaassociated limb ischemia with persistent ischemic changes despite DPC placement; however, the patient did not survive ECMO. Patients with positive laboratory shock markers (n ¼ 22) were significantly more likely to undergo DPC placement compared to those without (n ¼ 32) (11 [50%] vs 6 [19%]; P ¼ .0198). Patients with abnormal postcannulation CTA (n ¼ 4) were significantly more likely to undergo DPC placement compared to those without (n ¼ 25) (4 [100%] vs 2 [8%]; P ¼ .006). All patients with unilateral limb NIRS discrepancy (n ¼ 4) underwent DPC placement, whereas all patients without limb NIRS discrepancy (n ¼ 15) did not undergo DPC placement (4 [100%] vs 0 [0%]; P ¼ .0003). Patients with limb examination discrepancy (n ¼ 15) were significantly more likely to undergo DPC placement compared to those without (n ¼ 39) (15 [100%] vs 2 [5%]; P < .0001). Using the above clinical factors, we have derived the Cannula-associated limb ischemia severity score (CALIS score), to predict VA-ECMO patients that will benefit from selective DPC placement (Table ).Conclusions: Cannula-associated limb ischemia requiring DPC placement can be predicted with high-fidelity using the CALIS score and was associated with no limb loss in our study.

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