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- The correlation between serum vascular endothelial growth factor (VEGF) and tumor VEGF receptor 3 in colorectal cancerPublication . Goulart, A; Ferreira, C; Rodrigues, A; Coimbra, B; Sousa, N; Leão, PPURPOSE: Despite plasma biomarkers offering a number of advantages over tissue-based markers, the relationship between serum vascular endothelial growth factor (VEGF) and VEGF receptor (VEGF-R) tumor expression in colorectal cancer (CRC) is still unclear. This study was designed to establish the relationship between the concentration of serum VEGF and tumor VEGF-R expression in patients with CRC. METHODS: A prospective study of consecutive patients undergoing elective colorectal surgery during 1 year. Preoperative VEGF was determined by enzyme-linked immunosorbent assay and VEGF-R3 by immunochemistry. RESULTS: The initial sample included 134 patients with CRC diagnosis. Results showed significant association of serum values of VEGF with VEGF-R3 expression (P < 0.001), even in the presence of confounders (sex, age, body mass index, tumor location, and surgical approach). The estimated effect size was high (η2 = 0.35). CONCLUSION: Serum VEGF has a significant correlation with tumoral VEGF-R3 expression in CRC.
- Rational Identification of a Colorectal Cancer Targeting Peptide through Phage DisplayPublication . Ferreira, D; Silva, AP; Nobrega, FL; Martins, IM; Barbosa-Matos, C; Granja, S; Martins, SF; Baltazar, F; Rodrigues, LRColorectal cancer is frequently diagnosed at an advanced stage due to the absence of early clinical indicators. Hence, the identification of new targeting molecules is crucial for an early detection and development of targeted therapies. This study aimed to identify and characterize novel peptides specific for the colorectal cancer cell line RKO using a phage-displayed peptide library. After four rounds of selection plus a negative step with normal colorectal cells, CCD-841-CoN, there was an obvious phage enrichment that specifically bound to RKO cells. Cell-based enzyme-linked immunosorbent assay (ELISA) was performed to assess the most specific peptides leading to the selection of the peptide sequence CPKSNNGVC. Through fluorescence microscopy and cytometry, the synthetic peptide RKOpep was shown to specifically bind to RKO cells, as well as to other human colorectal cancer cells including Caco-2, HCT 116 and HCT-15, but not to the normal non-cancer cells. Moreover, it was shown that RKOpep specifically targeted human colorectal cancer cell tissues. A bioinformatics analysis suggested that the RKOpep targets the monocarboxylate transporter 1, which has been implicated in colorectal cancer progression and prognosis, proven through gene knockdown approaches and shown by immunocytochemistry co-localization studies. The peptide herein identified can be a potential candidate for targeted therapies for colorectal cancer.
- International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancerPublication . Guan, X; Liu, Z; Longo, A; Cai, JC; Tzu-Liang Chen, W; Chen, L; Chun, HK; Costa Pereira, JM; Efetov, S; Escalante, R; He, QS; Hu, JH; Kayaalp, C; Kim, SH; Khan, JS; Kuo, LJ; Nishimura, A; Nogueira, F; Okuda, J; Saklani, A; Shafik, AA; Shen, MY; Son, JT; Song, JM; Sun, DH; Uehara, K; Wang, GY; Wei, Y; Xiong, ZG; Yao, HL; Yu, G; Yu, SJ; Zhou, HT; Lee, SH; Tsarkov, PV; Fu, Chuan-Gang; Wang, Xi-ShanIn recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.
- Laparoscopic colorectal resection for a giant colonic diverticulum - video vignettePublication . Louro, HC; Fonte-Boa, A; Lencastre, L; Leão, P; Vilaça, JA giant colonic diverticulum (GCD) is a rare disease with less than 200 cases reported in the literature. By definition, a GCD is larger than 4cm in diameter with close sigmoid colon relationship in more than 90% of the cases. En bloc resection of the diverticulum with anterior sigmoid-rectal segment with primary anastomosis is the best treatment approach. The authors present a case of laparoscopic colorectal resection with partial cystectomy for a giant colonic diverticulum. A 62-years-old man with sigmoid colon diverticulosis and several episodes of diverticulitis presented at the office with a painless hypogastric/left iliac abdominal mass. CT scan showed a round 11 cm smooth walled structure filled with gas, adjacent to the sigmoid anti-mesenteric border and the urinary bladder. Four trocars were used for the laparoscopic approach. Step-by-step as follows: i. complete mobilization of colon splenic flexure. ii. Giant diverticulum dissection with partial bladder resection. iii. Bladder closure. iv. Sigmoid colon and intra-peritoneal rectum resection with primary anastomosis. The post-operative course was uneventful and the patient was discharged home on post-operative day 4. Vesical catheter was removed on post-operative day 10. Pathological specimen analysis confirmed the pre-operative diagnosis of a GCD. There is a consensus that this extremely rare diverticular disease complication should be approached with prompt standard resection due to high risk of diverticulum rupture. Laparoscopic approach seems to be feasible and safe despite of dissection higher complexity owing to the mega diverticulum. This article is protected by copyright. All rights reserved.
- Trait determinants of impulsive behavior: a comprehensive analysis of 188 ratsPublication . Soares, AR; Esteves, M; Moreira, PS; Cunha, AM; Guimarães, MR; Carvalho, MM; Raposo-Lima, C; Morgado, P; Carvalho, AF; Coimbra, B; Melo, A; Rodrigues, AJ; Salgado, AJ; Pêgo, JM; Cerqueira, JJ; Costa, P; Sousa, N; Almeida, A; Leite-Almeida, HImpulsivity is a naturally occurring behavior that, when accentuated, can be found in a variety of neuropsychiatric disorders. The expression of trait impulsivity has been shown to change with a variety of factors, such as age and sex, but the existing literature does not reflect widespread consensus regarding the influence of modulating effects. We designed the present study to investigate, in a cohort of significant size (188 rats), the impact of four specific parameters, namely sex, age, strain and phase of estrous cycle, using the variable delay-to-signal (VDS) task. This cohort included (i) control animals from previous experiments; (ii) animals specifically raised for this study; and (iii) animals previously used for breeding purposes. Aging was associated with a general decrease in action impulsivity and an increase in delay tolerance. Females generally performed more impulsive actions than males but no differences were observed regarding delay intolerance. In terms of estrous cycle, no differences in impulsive behavior were observed and regarding strain, Wistar Han animals were, in general, more impulsive than Sprague-Dawley. In addition to further confirming, in a substantial study cohort, the decrease in impulsivity with age, we have demonstrated that both the strain and sex influences modulate different aspects of impulsive behavior manifestations.
- Prospective Observational Study on acute Appendicitis Worldwide (POSAW)Publication . Sartelli, M; Baiocchi, GL; Di Saverio, S; Ferrara, F; Labricciosa, FM; Ansaloni, L; Coccolini, F; Vijayan, D; Abbas, A; Abongwa, HK; Agboola, J; Ahmed, A; Akhmeteli, L; Akkapulu, N; Akkucuk, S; Altintoprak, F; Andreiev, AL; Anyfantakis, D; Atanasov, B; Bala, M; Balalis, D; Baraket, O; Bellanova, G; Beltran, M; Melo, RB; Bini, R; Bouliaris, K; Brunelli, D; Castillo, A; Catani, M; Che Jusoh, A; Chichom-Mefire, A; Cocorullo, G; Coimbra, R; Colak, E; Costa, S; Das, K; Delibegovic, S; Demetrashvili, Z; Di Carlo, I; Kiseleva, N; El Zalabany, T; Faro, M; Ferreira, M; Fraga, GP; Gachabayov, M; Ghnnam, WM; Giménez Maurel, T; Gkiokas, G; Gomes, CA; Griffiths, E; Guner, A; Gupta, S; Hecker, A; Hirano, ES; Hodonou, A; Hutan, M; Ioannidis, O; Isik, A; Ivakhov, G; Jain, S; Jokubauskas, M; Karamarkovic, A; Kauhanen, S; Kaushik, R; Kavalakat, A; Kenig, J; Khokha, V; Khor, D; Kim, D; Kim, JI; Kong, V; Lasithiotakis, K; Leão, P; Leon, M; Litvin, A; Lohsiriwat, V; López-Tomassetti Fernandez, E; Lostoridis, E; Maciel, J; Major, P; Dimova, A; Manatakis, D; Marinis, A; Martinez-Perez, A; Marwah, S; McFarlane, M; Mesina, C; Pędziwiatr, M; Michalopoulos, N; Misiakos, E; Mohamedahmed, A; Moldovanu, R; Montori, G; Mysore Narayana, R; Negoi, I; Nikolopoulos, I; Novelli, G; Novikovs, V; Olaoye, I; Omari, A; Ordoñez, CA; Ouadii, Mt; Ozkan, Z; Pal, A; Palini, GM; Partecke, LI; Pata, F; Pędziwiatr, M; Pereira Júnior, GA; Pintar, T; Pisarska, M; Ploneda-Valencia, CF; Pouggouras, K; Prabhu, V; Ramakrishnapillai, P; Regimbeau, JM; Reitz, M; Rios-Cruz, D; Saar, S; Sakakushev, B; Seretis, C; Sazhin, A; Shelat, V; Skrovina, M; Smirnov, D; Spyropoulos, C; Strzałka, M; Talving, P; Teixeira Gonsaga, RA; Theobald, G; Tomadze, G; Torba, M; Tranà, C; Ulrych, J; Uzunoğlu, MY; Vasilescu, A; Occhionorelli, S; Venara, A; Vereczkei, A; Vettoretto, N; Vlad, N; Walędziak, M; Yilmaz, TU; Yuan, KC; Yunfeng, C; Zilinskas, J; Grelpois, G; Catena, FBACKGROUND: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. METHODS: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. RESULTS: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. CONCLUSIONS: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.
- Mucinous Carcinomatosis: A Rare Association between an Ovarian Tumor and an E-GISTPublication . Palma Rios, H; Goulart, A; Leão, PPseudomyxoma peritonei (PMP) and extragastrointestinal stromal tumors (E-GISTs) are both rare entities. Most of the time, PMP is associated with an appendiceal tumor. An ovarian mucinous tumor can mimic appendiceal metastases. E-GIST is a mesenchymal tumor that can arise from the omentum, retroperitoneum, mesentery, or pleura. We present a case of an 87-year-old woman with mucinous carcinomatosis and acute intestinal occlusion submitted to an emergency laparotomy. She has found to have a borderline mucinous tumor of the ovary from the intestinal type with several lesions of pseudomyxoma peritonei and an E-GIST from the epiploons retrocavity (intermediated risk). In the literature, no relation was found between these two rare tumors. E-GIST was an incidental finding in the context of a mucinous carcinomatosis.
- Abdominal Catastrophe in Crohn's Disease SurgeryPublication . Palma Rios, H; Goulart, AM; Leão, PINTRODUCTION: Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients. CASE REPORT: The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis. Several perforations and dehiscences were observed and necessitated an end ileostomy and an open abdomen treated with negative pressure wound therapy. Multiple surgical interventions in the abdomen were performed and negative pressure was maintained until all fistulas were sealed and granulation tissue formed. Patient was discharged after 134 days of hospitalization with both the abdomen and the ileostomy closed. After several months, a hernia repair was performed with bilateral component separation and polypropylene mesh without complications. CONCLUSIONS: Anastomotic dehiscence after intestinal resection can lead to an abdominal catastrophe. Severe peritonitis with enteric fistulas and an open abdomen demands a multidisciplinary approach. Negative pressure wound therapy and nutritional support are key treatments. In these patients, stoma closure and abdominal wall reconstruction after recovery from the acute event represents another surgical challenge.
- Transanal total mesorectal excision with triangle rules: a road map to prevent injuriesPublication . Silva, PA; Goulart, A; Sousa, M; Rios, H; Atallah, S; Leão, P
- The influence of metabolic syndrome in the outcomes of colorectal cancer patientsPublication . Goulart, A; Varejão, A; Nogueira, F; Martins, S; Mesquita-Rodrigues, A; Sousa, N; Leão, PAIMS: Determine the influence of metabolic syndrome and its different components in the outcomes of colorectal cancer surgery at 30days. MATERIALS AND METHODS: Prospective study that included all patients submitted to elective colorectal cancer surgery between August 2015 and August 2016 at Hospital de Braga. Clinical and laboratory parameters evaluated pre-operatively were: central obesity, blood pressure, fasting glucose, triglycerides levels and HDL cholesterol levels. Any complications during the first 30-days after surgery were recorded (readmission, reintervention, anastomotic dehiscence, morbimortality). RESULTS: One hundred and thirty-four patients were included. Metabolic syndrome was diagnostic in 40.7% of patients with the ATPIII definition, 67.5% with the AHA definition and 67.0% with the IDF definition. At 30days after colorectal cancer surgery, 73.1% patients don't have any complication, 15.7% have minor complications (grade I/II of Clavien-Dindo classification), 11.1% have major complications (grade III/IV/V of Clavien-Dindo classification) and 1.5% have died from surgical complications (grade V of Clavien-Dindo classification). The statistic analysis didn't reveal any association between MS, or it's different components, and surgical outcomes. CONCLUSION: This study seems to indicate that metabolic syndrome don't have any influence in surgical outcomes of colorectal cancer surgery.