Churchillkumar2171

To diagnose small cell lung carcinoma (SCLC), neuroendocrine (NE) phenotype markers such as chromogranin A, synaptophysin, and CD56 are helpful. However, because they are dispensable, SCLCs occur without apparent NE phenotypes. Insulinoma-associated protein 1 (INSM1) is a transcription factor for NE differentiation and has emerged as a single practical marker for SCLC. Using the surgical samples of 141 pulmonary NE tumors (78 SCLCs, 44 large cell NE carcinomas, and 19 carcinoids), and 246 non-NE carcinomas, we examined the immunohistochemical expression and prognostic relevance of INSM1 in association with NE phenotype markers. We evaluated its sensitivity and specificity for SCLC diagnosis, as well as its usefulness to diagnose SCLC without NE marker expression and to estimate the prognosis. selleck chemicals llc INSM1 was expressed in SCLCs (92%, 72/78), large cell NE carcinomas (68%, 30/44), and carcinoids (95%, 18/19). In addition, among SCLCs with no expression of NE phenotype markers (n=12), 9 (75%) were positive for INSM1. These data suggest the superiority of INSM1 to the phenotype markers. Only 7% of adenocarcinomas (9/134) and 4% of squamous cell carcinomas (4/112) were positive for INSM1. SCLC with low-INSM1 expression (n=28) had a significantly better prognosis (P=0.040) than the high-INSM1 group (n=50). Our study revealed that INSM1 is highly sensitive and specific to detect SCLC and can estimate prognosis. INSM1 will be a promising marker for SCLC.BACKGROUND Physical activity might be directly or indirectly linked to the risk of colorectal cancer and the prognosis of patients with colorectal cancer. OBJECTIVE This study aimed to elucidate whether preoperative physical activity plays a role in reducing short-term postoperative complications and improving long-term survival of patients with colorectal cancer. DESIGN This was a retrospective analysis of prospectively collected data. SETTINGS This study was conducted at a department of colorectal surgery in a tertiary teaching hospital between January 1995 and December 2016. PATIENTS Patients who underwent curative resection for stage I-III primary colorectal cancer were enrolled. According to the preoperative leisure-time weekly metabolic equivalent of task values, patients were divided into two groups the metabolic equivalent of task less then 12 group and the metabolic equivalent of task ≥ 12 group. A 11 propensity score matching was used to reduce imbalance and selection biases based on six covariateterm postoperative morbidity and mortality, as well as long-term survival. See Video Abstract at http//links.lww.com/DCR/B189.BACKGROUND The optimal strategy for colonic polyps not amenable to traditional endoscopic polypectomy is unknown. Endoscopic Step Up is a promising strategy for definitive treatment. OBJECTIVE To determine whether Endoscopic Step Up leads to improved outcomes and decreased costs compared to planned-colectomy for endoscopically unresectable colon polyps. DESIGN Retrospective review of a prospective database. SETTING Tertiary referral center. PATIENTS Consecutive patients referred for endoscopically unresectable colon polyps size 15-50 mm. INTERVENTIONS Patients underwent planned-colectomy or Endoscopic Step Up at the surgeon's discretion. Endoscopic Step Up began with diagnostic colonoscopy in the operating room. If the polyp was amenable to endoscopic removal, Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection was performed with progression to Combined Endoscopic-Laparoscopic Surgery or laparoscopic colectomy as indicated. MAIN OUTCOME MEASURES The primary outcome was 30-day adverse events. We aon polyps is associated with less morbidity, decreased healthcare costs, and colon preservation in 95% of patients. Further studies are needed to evaluate long term quality of life and polyp recurrence in this group.See Video Abstract at http//links.lww.com/DCR/B188.OBJECTIVES To compare the stability of NT2B clavicle fractures fixed with either a Hook Plating (HP), Superior Plating with Suture Augmentation (SPSA), or Dual Orthogonal Mini-fragment Plating (DP) with the hypothesis that DP would provide increased multi-planar stability across NT2B fractures. METHODS NT2B distal clavicle fractures were created in cadaveric specimens and fixed using (1) HP, (2) SPSA or (3) DP. Specimens were cyclically loaded in three different planes of motion (1) anteroposterior (AP), (2) superior-inferior (SI), and (3) axial rotation (AR) while displacement was continually recorded. Afterward, a superiorly-directed load was applied to the clavicle. Load to failure, stiffness, and mode of failure were recorded. RESULTS During AP loading, clavicles fixed with a DP had significantly lower mean posterior displacement compared to those fixed with SPSA at every 100-cycle interval of testing, p less then 0.01. During inferior-superior loading, specimens fixed with a DP had less superior displacement than specimens fixed with an HP and SPSA, reaching significance at the 500-700 cycles of testing. There was no significant difference in AR stability or load to failure between the three fixation techniques. CONCLUSIONS Orthogonally placed mini-fragment plates provide improved stability against anterior displacement with no significant difference in superior stability, axial rotational stability, stiffness, or load to failure. Further clinical studies are needed to confirm the long-term stability of dual plating and determine the risks and benefits of this novel method of distal clavicle fixation.OBJECTIVE To determine the reliability of using 'fingerbreadths' and anatomic landmarks as reference points for predictable identification of the radial and ulnar nerves when utilizing the posterior approach to the humerus. METHODS A systematic approach using 'fingerbreadths' to mark and measure the skin prior to incision. Two markings were made the first four fingerbreadths proximal to the lateral epicondyle (radial nerve location) and the second two fingerbreadths proximal to the medial epicondyle (ulnar nerve location). Once the posterior approach was made, the same fingerbreadths were used on the radial and ulnar sides to identify the radial and ulnar nerves within the deep interval. Measurements were taken at each stage in cadaveric specimens. Clinical correlations followed. Statistical analysis was performed comparing measurements (outer vs. inner) in both cadaveric and clinical specimens. RESULTS Thirty-two elbows evaluated in this study, 20 patients and 12 cadaveric specimens. In the cadaveric specimens the mean distance of the radial nerve was 7.