Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform?

BACKGROUND

Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection.

MATERIALS AND METHODS

A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed.

RESULTS

A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not.

CONCLUSIONS

Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.

Latent Class Analysis of School Refusal Behavior and Its Relationship With Cyberbullying During Adolescence

Cyberbullying is a common relational problem having negative repercussions on the academic performance of adolescents. Numerous questions remain to be answered with regard to the relationship between cyberbullying and school refusal behavior. This study examines school refusal profiles (measured by School Refusal Assessment Scale-Revised) and assesses whether these profiles vary with respect to the level of victimization, aggression, aggression-victimization, and observation of cyberbullying (measured with the Screening of Harassment among Peers). The sample consisted of 1,102 Spanish high school students, aged 12–18 (M = 14.30, SD = 1.71). Latent class analysis revealed three school refusal behavior profiles: non-school refusal behavior, school refusal behavior by negative reinforcements (oriented to the avoidance of social evaluation and negative affectivity in school situations), and school refusal behavior by positive reinforcements (oriented to obtaining the attention of others with significant or tangible reinforcements). The ANOVA found statistically significant differences for all cyberbullying behaviors. Students with school refusal by negative reinforcements had significantly higher mean scores as compared to the other profiles in victimization, aggression, aggression-victimization, and observation behaviors, while the levels of cyberbullying were similar between students without school refusal and students with school refusal behavior by positive reinforcements. These findings underscore the need to consider priority interventions to prevent cyberbullying in children who refuse school for the purpose of avoiding situations of anxiety and negative emotions.

A study of torrefied cardboard characterization and applications: Composition, oxidation kinetics and methane adsorption

Torrefaction is proposed as a valorization process for non recycled cardboard. Torrefied cardboard was physically and chemically characterized and it was proposed for energy production and methane adsorption. The surface area and pore volume obtained were among 3.0-6.0m²/g and 5.7·10^-3-2.3·10^-2cm³/g, respectively. The carbon content increased with temperature and residence time of torrefaction. Oxidation kinetics of torrefied cardboard at different temperatures (250-300°C) and at different plateaus (60-120min) were tested. Torrefied cardboard was chemically treated with KOH in order to study the effect of K on thermal oxidation kinetics. It was observed that high torrefaction temperatures and residence times lead to a more stable char. Furthermore, kinetic parameters were obtained by iso-conversional methods and Coats and Redfern method. Attending to iso-conversional method, a decrease of E_a was observed with both, temperature and residence time of torrefaction. Whereas chemically treated presented highest E_a values than torrefied cardboard. In addition, regarding Coats and Redfern method, the oxidation model was not highly modified by torrefaction temperature and residence time. However, for chemically treated samples the oxidation model was modified by K presence. Finally, CH₄ adsorption capacity of torrefied cardboard was studied at 30°C and atmospheric pressure. CH₄ partial pressures tested were lower than 0.45kPa. It was observed that CH₄ adsorption capacity increased with torrefaction time and decreased with chemical treatment. Thus, for the tested samples, the highest adsorption capacity observed was 5.70mgCH₄/g of sample.

Adjuvant aromatase inhibitor therapy in patients with stage I breast cancer at a regional oncology center in Israel: implementation of a 'switching' policy in postmenopausal patients after initial tamoxifen

OBJECTIVE

To analyze the implementation of a switching policy of adjuvant aromatase inhibitor (AI) therapy sequentially after tamoxifen in consecutively treated stage I (T1N0M0) hormone receptor (HR)-positive breast cancer (BC) patients.

METHODS

The records of 279 consecutive HR-positive BC patients diagnosed between 2002 and 2006 and followed at the Soroka Medical Center were reviewed.

RESULTS

Two-hundred-seventeen patients who initially received tamoxifen were suitable for switching and 28 received an AI as initial adjuvant treatment. The switch was accomplished in 82.5% of the 217 patients. Those who switched to an AI had a higher proportion of T1c stage than patients eligible who were not switched, but did not differ in age, histologic grade, or having received chemotherapy. Of the 179 patients who switched, 155 (86.6%) completed at least 4.5-5 years of adjuvant tamoxifen/AI therapy. Eighteen patients discontinued AI therapy prematurely because of toxicity.

CONCLUSIONS

In this stage I BC population, despite the toxicities of AI therapy, >84% of eligible patients received an AI as adjuvant therapy. Measures to improve the management of AI toxicity, such as changing to a different AI, may reduce early stopping.

The impact of the 21-gene recurrence score assay on decision making about adjuvant chemotherapy in early-stage estrogen-receptor-positive breast cancer in an oncology practice with a unified treatment policy

BACKGROUND

The 21-gene recurrence score (RS) assay has been validated in retrospective studies as prognostic of distant disease recurrence and predictive of the benefit of adjuvant chemotherapy in estrogen-receptor-positive breast cancer (BC). There is limited published data on the impact of the assay on clinical practice, particularly in the context of a single practice with a unified treatment policy.

PATIENTS AND METHODS

Between 2006 and 2009, RS was obtained on 135 patients in a single practice with a uniform treatment policy. Treatment recommendations before and after RS result were analyzed retrospectively. Pre-RS treatment recommendations were based on clinicopathological features and Adjuvant! Online (AO) calculated survival advantage. RS and AO survival advantage for adding chemotherapy were compared for each patient.

RESULTS

The distribution by risk group of RS was low- 49.6%, intermediate-37.8%, and high-12.6%. In 34 patients (25.2%, 95% confidence interval 17.9% to 32.5%), recommendation for chemotherapy was changed after obtaining assay result. Most changes (70.6%) were from chemotherapy to no chemotherapy. The RS correlated poorly with AO predictions.

CONCLUSION

The 21-gene assay, when applied in a consistent manner in early-stage BC, changes treatment recommendations in one-quarter of patients tested.

Stage I breast cancer in a regional oncology practice in Israel 2002-2006: clinicopathologic features, risk estimation and planned therapy of 328 consecutive patients

We present the clinicopathologic features and treatment plans of 328 consecutive stage I (T1N0M0) breast cancer patients seen at a regional medical center in Israel. Predicted 10-year mortality risk was calculated using the Adjuvant! Online website. The 21-gene recurrence score (RS) (OncotypeDx) was obtained on a minority of patients. Eighty-nine per cent of patients had estrogen receptor (ER) and/or progesterone receptor (PgR) positive tumors. In 43.3% of patients history of an invasive malignancy was reported in a first degree relative and in 15.5% specifically breast and/or ovarian cancer was reported. Chemotherapy was added to endocrine therapy in 59 ER/PgR positive patients, decreasing predicted 10-year mortality risk by a median of 1.8%. Individualized risk estimation by genetic analysis may further decrease the use of chemotherapy in stage I patients. Breast cancer screening may provide an opportunity to identify cancer prone families.

Expression of D-type cyclins in colon cancer and in cell lines from colon carcinomas

Cyclins D1, D2 and D3 play important roles in cell proliferation and differentiation. Although their abnormal expression has been linked to cancer development and progression in a number of tissues, the expression of cyclin D2 and D3 proteins in colon cancer has not yet been characterised. In this study, we examined cyclin D1, D2 and D3 protein expression by Western blot analysis in tumour and adjacent normal colon tissues of 57 patients. In addition, we examined D-type cyclins protein expression in HT29 and LoVo39 cell lines from colon carcinomas, as a function of induced proliferation and differentiation. In both cell lines, the expression of the three D-type cyclins increased as a result of induced proliferation, whereas the expression of cyclin D3 increased as a result of induced differentiation. In colon tumours, cyclin D1 was overexpressed in 44%, cyclin D2 was overexpressed in 53% and cyclin D3 was overexpressed in 35% of the cases. We also found that in 16% of the cases, cyclin D3 protein expression was reduced in the tumour, as compared to the adjacent normal tissue. Examination of D-type cyclin protein overexpression in relation to the TNM stage of the tumours revealed that overexpression of cyclins D1 and/or D2, but not cyclin D3, is linked to colon carcinogenesis and that overexpression of cyclin D2 may be related to a higher TNM stage of the tumour.

[Treatment with Savary-Gilliard bougies in esophageal stenosis in children]

30 patients (less than 15 years old) were admitted for esophageal strictures, 16 of them secondary to corrosive injury. All the patients were treated with endoscopic dilatation with Savary-Gilliard bougie. The dilations were done with general anesthesia using an Olympus GIF-XP10 endoscope and with fluoroscopic control. In the esophageal stenosis secondary to caustic ingestion endoscopic injection with Betamethasone was also used. The most frequent site of the stenosis was the upper third of the esophagus, and the main type of stenosis was tubular in the secondary to caustic burns and annular in the other group. In the post-caustic group 385 dilations were performed in 115 sessions. In the other group 159 dilations were done in 51 sessions. Two perforations and one sepsis were reported in patients with corrosive stenosis. There was no mortality. 43.7% of the patients with corrosive stenosis and 85.7% with stenosis secondary to other causes obtained complete healing. Esophageal dilation with Savary-Gilliard bougies represents a safe and reliable method for the treatment of esophageal strictures.

The effect of pH on the covalent and metabolic control of C4 phosphoenolpyruvate carboxylase from Sorghum leaf

The influence of pH on the in vitro activity and regulatory properties of Sorghum leaf C4 phosphoenolpyruvate carboxylase (PEPC) was investigated with respect to the phosphorylation status of the enzyme. In vitro protein phosphorylation was achieved using the catalytic subunit of a cAMP-dependent protein kinase (PKA) and a recombinant, immunopurified PEPC (0.9 mol of covalent Pi/mol PEPC subunit). Between pH 6.8 and 8, velocity and IC50 for L-malate increased for both the nonphosphorylated and the phosphorylated forms. With respect to the nonphosphorylated PEPC, the phospho-PEPC always gave high values for these kinetic parameters at the pH range investigated, especially between pH 7 and 7.3. The phosphorylation-induced stimulation of PEPC activity was four- to fivefold at pH 7.1 and approximately twofold at pH 7.3. The IC50 for L-malate showed a two- to threefold increase at pH 7.3, but varied less at pH 7.1 upon PEPC phosphorylation. Thus, phosphorylation of PEPC caused a predominant V effect or a mixed (V/IC50) effect at pH 7.1 or 7.3, respectively. This was also observed with the enzyme from desalted crude protein extracts from dark or light-adapted Sorghum leaves and leaf-derived mesophyll protoplasts illuminated in the presence of methylamine, a compound known to increase cytosolic pH (pHc). At pH 7.3, desensitization to L-malate of phospho-PEPC was due to an enhanced ability of PEP to compete with the inhibitor. The positive effector glucose-6P acted similarly to phosphorylation; however, a combination of both factors (glucose-6P and phosphorylation) led to a much larger increase in the IC50 for L-malate than that observed by a single factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Nitrate-dependent o(2) evolution in intact leaves

Evolution of O(2) by illuminated intact detached leaves from barley (Hordeum vulgare L. cv Athos) and pea (Pisum sativum L. cv Lincoln) in a CO(2)-saturating atmosphere was enhanced when KNO(3) (1-2.5 millimolar) had been previously supplied through the transpiration stream. The extra O(2) evolution observed after feeding KNO(3) increased with the light intensity, being maximal at near saturating photon flux densities and resulting in no changes in the initial slope of the O(2)versus light-intensity curve. No stimulation of O(2) evolution was otherwise observed after feeding KCl or NH(4)Cl. The data indicate that nitrate assimilation uses photosynthetically generated reductant and stimulates the rate of non-cyclic electron flow by acting as a second electron-accepting assimilatory process in addition to CO(2) fixation.

Nodular fasciitis initially diagnosed by aspiration cytology

A case of nodular fasciitis diagnosed by fine needle aspiration cytology is described. The cytologic findings included fusiform cells, mitoses, macrophages, multinucleated giant cells and mesenchymal elements in a characteristic granular background substance. The cytopathologic diagnosis was subsequently confirmed by the histopathologic study of the tumor and by electron microscopy.