Blood transfusion of haemodynamically stable patients with Hgb level ≥ 7 g/dl is associated with increased organ/space SSIs in rectal cancer surgery.
In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.
Salvage surgery after failure of endoscopic balloon dilatation is associated with increased adverse outcomes in comparison with surgery first. This should be discussed with patients being considered for endoscopic balloon dilatation for ileocolonic anastomotic stricture due to recurrent Crohn's disease.
OBJECTIVE: The chemokine CXCL12 attracts bone marrow derived cells, which express the CXCL12 receptor, CXCR4. Here we determined the expression and role of CXCl12-CXCR4 in endometriosis.DESIGN: case-control study. MATERIALS AND METHODS: Biopsies of endometriosis were obtained from 11 patients undergoing laparoscopy. Control endometrium was obtained from 11 patients without endometriosis. Endometriosis was confirmed histologically. The cellular localization of CXCR4 and CXCl12 protein were determined by immunohistochemistry (IHC). The H score was used to compare expression levels. Stromal cell cultures were prepared from 5 biopsies of endometriosis as well as 5 biopsies of eutopic endometrium. Total RNA was isolated from these primary cells and the expression of CXCR4 and CXCL12 genes was analyzed by qRT-PCR. CXCL12 was assayed in the stromal cell conditioned using ELISA. The chemo attractant activity of CXCL12 was determined by the trans well chamber migration assay. ELISA and qRT-PCR results were compared using the students T test. The Mann-Whitney rank test was used to compare H scores.RESULTS: qRT-PCR analysis showed increased expression of CXCR4 (3.9 fold, p<0.01) and CXCl12 (2.7 fold, p<0.04) in women with endometriosis compared with eutopic endometrium. IHC revealed that CXCR4 was expressed in stroma, glands, and epithelium in both endometriosis as well as in control tissues; however, the intensity was significantly higher in all cellular compartments of the endometriotic lesions when compared to control endometrium (H score: 243 versus 142, p<0.01). CXCL12 expression was also higher in endometriotic lesions and was greatest in the epithelial compartment (H-score, 260 versus 160, P<0.02). Secreted CXCL12 protein concentration was higher in the endometriosis conditioned media than in controls (1146 AE 60 versus 439AE 172 pg/ml, p < 0.01). The migration assay demonstrated increased chemo attraction of mouse bone marrow cells (mBMC) towards endometriotic conditioned medium than conditioned medium of controls.CONCLUSIONS: The CXCR4-CXCl12 signaling pathway attracts BMderived stem cells into endometriotic lesions. Higher level of CXCL12 production by endometriosis compared to normal endometrium results in preferential recruitment of stem cells to endometriosis. These data explain prior research showing that endometriosis outcompetes eutopic endometrium, preferentially recruiting the limited supply of circulating stem cells. This pathway presents a potential therapeutic target for the treatment of endometriosis and associated endometrial disorders.
Adenocarcinoma is a histologic diagnosis based on subjective findings. Transcriptional profiles have been used to differentiate normal tissue from disease and could provide a means of identifying malignancy. The goal of this study was to generate and test transcriptomic profiles that differentiate normal from adenocarcinomatous rectum. Comparisons were made between cDNA microarrays derived from normal epithelium and rectal adenocarcinoma. Results were filtered according to standard deviation to retain only highly dysregulated genes. Genes differentially expressed between cancer and normal tissue on two-groups t test (P , 0.05, Bonferroni P value adjustment) were further analyzed. Genes were rank ordered in terms of descending fold change. For each comparison (tumor versus normal epithelium), those 5 genes with the greatest positive fold change were grouped in a classifier. Five separate tests were applied to evaluate the discriminatory capacity of each classifier. Genetic classifiers derived comparing normal epithelium with malignant rectal epithelium from pooled stages had a mean sensitivity and specificity of 99.6% and 98.2%, respectively. The classifiers derived from comparing normal and stage I cancer had comparable mean sensitivities and specificities (97% and 98%, respectively). Areas under the summary receiver-operator characteristic curves for each classifier were 0.981 and 0.972, respectively. One gene was common to both classifiers. Classifiers were tested in an independent Gene Expression Omnibus-derived dataset. Both classifiers retained their predictive properties. Transcriptomic profiles comprising as few as 5 genes are highly accurate in differentiating normal from adenocarcinomatous rectal epithelium, including early-stage disease.
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