Dreierotto2055

Management of enterocutaneous fistulas in Crohn's disease is challenging. The majority of patients still need intestinal resection in the biologic era.

The aim of this study was to evaluate the efficacy of endoscopic treatment for enterocutaneous fistulas.

This is a retrospective study of medical records.

This study was conducted in a single institution.

All consecutive Crohn's disease patients with an enterocutaneous fistula who underwent endoscopic fistula closure using an over the scope clip or a hemostatic clip were included.

The main outcomes measure was the clinical success at 3 months after the procedure defined as the complete closure of all fistulae at physical examination and complete cessation of the drainage from the external opening, without surgery.

Eight patients (men, 25%, median age 45 years (interquartile range, 33-51)) were followed. Selleck HS-173 In 7 patients, fistulas were localized at the ileocolonic or colocolonic anastomosis, and on the stomach in one patient. Seven patients were treated with an over the scope clip and one with a hemostatic clip. Technical success was achieved in all cases. Clinical success at 3 months was achieved in 75% of cases (6/8 patients). After a median 16-month (interquartile range, 13-23) follow-up, 3/8 (37.5%) patients had enterocutaneous fistulas closure and 2/8 (25%) needed intestinal resection. No complications were observed.

The retrospective nature, the small sample size of the study and the heterogeneity of the population limits the interpretation of the results.

Endoscopic treatment of enterocutaneous fistulas is feasible with a short-term effectiveness. New studies are needed to confirm these results. See Video Abstract at http//links.lww.com/DCR/B614.

Endoscopic treatment of enterocutaneous fistulas is feasible with a short-term effectiveness. New studies are needed to confirm these results. See Video Abstract at http//links.lww.com/DCR/B614.

The local recurrence of rectal cancer has been improved by total mesorectal excision following neoadjuvant chemoradiotherapy. However, in patients with low locally advanced rectal cancer, lateral pelvic recurrence remains to be addressed.

To determine the efficiency of neoadjuvant radiotherapy in addressing lateral pelvic recurrence and which subgroup of patients might be optimal to receive lateral lymph nodes dissection.

The MRI/CT images were reassessed for the lateral lymph nodes status. The lateral lymph nodes with short-axis ≥ 5 mm and ≥ 4 mm were considered positive in pretreatment and restaging MRI/CT, respectively.

This was a post hoc analysis of a prospective randomized controlled trial (FOWARC, NCT01211210).

A total of 495 patients with stage II or III rectal adenocarcinoma was included in the original trial. According to the excluding criteria, the finally included population consists of 253 patients; of these, 195 patients received neoadjuvant chemoradiotherapy and 94 received chemothera. See Video Abstract at http//links.lww.com/DCR/B613.

The addition of radiotherapy in neoadjuvant regimens could not address lateral pelvic recurrence adequately. Some subgroups of patients might need additional dissection. See Video Abstract at http//links.lww.com/DCR/B613.

Transanal and robotic-assisted total mesorectal excision are techniques that can potentially overcome challenges encountered with a pure laparoscopic approach in patients with rectal cancer.

The aim of this study was to evaluate the proportion and predictive factors of restorative procedures and subsequent short-term outcomes of three minimally invasive techniques to treat low rectal cancer.

This is a nationwide observational comparative registry study.

Rectal cancer patients selected from the mandatory Dutch ColoRectal Audit.

Patients with low rectal cancer (≤5 centimeter) that underwent curative minimally invasive total mesorectal excision between 2015 and 2018.

Proportion of restorative procedure, positive circumferential resection margin, and postoperative complications.

A total of 3,466 patients were included for analysis, of which 33% underwent a restorative procedure. Resections were performed laparoscopic in 2,845 patients, transanal in 448 patients and robot-assisted in 173 patients, wire. Short term oncological outcomes are comparable between the three minimally invasive techniques. See Video Abstract at http//links.lww.com/DCR/B608 .

Patients with low rectal cancer in the Netherlands are more likely to get a restorative procedure with a transanal approach, compared to a laparoscopic or robotic procedure. Short term oncological outcomes are comparable between the three minimally invasive techniques. See Video Abstract at http//links.lww.com/DCR/B608 .

Colon cancer survival is dependent upon metastatic potential and treatment. Large RNA-sequencing datasets may assist in identifying colon cancer-specific biomarkers to improve patient outcomes.

To identify a highly specific biomarker for overall survival in colon adenocarcinoma using an RNA-sequencing data set.

Raw RNA-sequencing and clinical data for patients with colon adenocarcinoma (n=269) were downloaded from The Cancer Genome Atlas. A binomial regression model was used to calculate differential RNA expression between paired colon cancer and normal epithelium samples (n=40). Highly differentially expressed RNAs were examined.

This study was conducted at the University of Louisville using data acquired by The Cancer Genome Atlas.

Patients from United States accredited cancer centers between 1998-2013 were analyzed.

The primary outcome measures were recurrence-free and overall survival.

The median age was 66 years (147/269 men, 180/269 Caucasian). Thirty RNAs were differentially expressed in ve a role as a colon-specific prognostic biomarker and help in patient risk stratification for increased surveillance.

Aquaporin8 is a water channel selectively expressed in normal colon tissue. Low AQP8 expression is a risk factor for worse overall survival in colon cancer patients. Aquaporin8 measurement may have a role as a colon-specific prognostic biomarker and help in patient risk stratification for increased surveillance.Intraductal carcinoma of the prostate gland (IDCP) is characterized by an expansile, architecturally, and cytologically atypical proliferation of prostatic epithelial cells within preexisting prostatic ducts and acini. There has been a wider recognition of IDCP by practicing pathologists since its recognition as a separate category in the World Health Organization (WHO) 2016 classification of tumours of the prostate gland. However, there is also a lack of clarity regarding the diagnosis and reporting of IDCP, which has been compounded by divergent expert recommendations regarding the grading of invasive prostate cancers associated with an intraductal component. The International Society of Urological Pathologists (ISUP) recommends that the IDCP component should be incorporated into the Gleason score, while the Genitourinary Pathology Society (GUPS) recommends excluding it when grading prostate cancer. This review seeks to clarify some of these issues and outline a pragmatic approach to reporting IDCP, particularly in needle biopsies. Diagnostic issues and terminology for lesions falling short of IDCP but exceeding that of high-grade prostatic intraepithelial neoplasia are discussed. The management of patients whose prostate biopsies show only IDCP without an associated invasive component is controversial. Some experts recommend radical therapy, while others recommend prompt repeat biopsy. An alternative clinicopathologic approach that takes into consideration the extent, histomorphology, and location (with respect to a radiologic abnormality) of IDCP, as well as radiologic features, is outlined.

HIV reduces bone mineral density, mineralization, and turnover and may impair fracture healing.

This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing after trauma.

All adults with acute tibia and femur fractures who underwent intermedullary (IM) nailing for fracture fixation between September 2017 and December 2018, at 2 tertiary hospitals, were followed up for a minimum of 12 months postoperatively. The primary outcome was delayed bone union at 6 months (defined by the radiological union scoring system for the tibia score <9), and the secondary outcome was nonunion (defined as radiological union scoring system for the tibia score <9) at 9 months. Multivariable logistic regression models were constructed to investigate the associations between HIV status and impaired fracture healing.

In total, 358 participants, who underwent 395 IM nailings, were enrolled in the study and followed up for 12 months. Seventy-one of the 358 (19.8%) participants were HIV-positive [83/395 (21%) IM nailings]. HIV was not associated with delayed fracture healing after IM nailing of the tibia or femur (multivariable odds ratio 1.06; 95% confidence interval 0.50 to 2.22). HIV-positive participants had a statistically significant lower odds ratio of nonunion compared with HIV-negative participants (multivariable odds ratio 0.17; 95% confidence interval 0.01 to 0.92).

Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in HIV-negative individuals, with no increased risk of delayed union or nonunion.

Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in HIV-negative individuals, with no increased risk of delayed union or nonunion.

Cryptococcosis remains a leading cause of meningitis and mortality among people living with HIV (PLHIV) worldwide. We sought to evaluate laboratory-based cryptococcal antigen (CrAg) reflex testing and a clinic-based point-of-care (POC) CrAg screening intervention for preventing meningitis and mortality among PLHIV in South Africa.

We conducted a prospective pre-post intervention study of adults presenting for HIV testing in Umlazi township, South Africa, over a 6-year period (2013-2019). Participants were enrolled during 3 phases of CrAg testing CrAg testing ordered by a clinician (clinician-directed testing, 2013-2015); routine laboratory-based CrAg reflex testing for blood samples with CD4 ≤100 cells/mm3 (laboratory reflex testing, 2015-2017); and a clinic-based intervention with POC CD4 testing and POC CrAg testing for PLHIV with CD4 ≤200 cells/mm3 with continued standard-of-care routine laboratory reflex testing among those with CD4 ≤100 cells/mm3 (clinic-based testing, 2017-2019). The laboratory and ting, there was no significant difference in the cumulative incidence of cryptococcal meningitis (4.5% vs. 4.1%; P = 0.836) or mortality (8.1% vs. 9.9%; P = 0.557).

Laboratory reflex and clinic-based CrAg testing facilitated the diagnosis of HIV-associated cryptococcosis and fluconazole initiation but did not reduce cryptococcal meningitis or mortality. In this nonrandomized cohort, clinical outcomes were similar between laboratory reflex testing and clinic-based POC CrAg testing.

Laboratory reflex and clinic-based CrAg testing facilitated the diagnosis of HIV-associated cryptococcosis and fluconazole initiation but did not reduce cryptococcal meningitis or mortality. In this nonrandomized cohort, clinical outcomes were similar between laboratory reflex testing and clinic-based POC CrAg testing.