Comparison of staging systems in gastric carcinoma

AIM

Gastric carcinoma is one of the most frequent cancers and leading causes of cancer-related death worldwide. Treatment strategies are planned according to the Tumour-Node-Metastasis (TNM) stage of the disease. However, the prognosis varies substantially even within the same stage. Prognostic nomograms were designed to overcome this diversity. In this study, staging systems and prognostic tools are compared in the context of their ability to predict patients' prognosis.

METHODS

Records of 391 patients operated for gastric cancer from January 2006 to September 2013 were analysed retrospectively. TNM staging system, Metastatic lymph node ratio (LNR), Kattan Prognostic Tool and Prognostic Tool of Italian Research Group on Gastric Cancer (GIRCG) were compared with the patients' survival times by their concordance indices and correlation coefficients.

RESULTS

A total of 343 patients were included in the study. Concordance indices of the compared staging systems were 0.678 for TNM, 0.601 for GIRCG scale, 0.646 for LNR stage and 0.680 for Kattan scale. Pearson correlation coefficients were 0.404 for TNM staging, 0.314 for GIRCG scale, 0.304 for LNR stage and -0.406 for Kattan scale. Spearman correlation coefficients were 0.383, 0.311, 0.310 and -0.400 respectively.

CONCLUSION

Based on these results, Kattan prognostic scale was found to be the most accurate system for predicting mortality. This was followed by TNM staging system.

Long-term results from modified sphincteroplasty in patients with traumatic sphincter injury: a retrospective study

BACKGROUND

The results from sphincteroplasty may worsen over time. Reseparation of the rectum and vagina/scrotum in conjunction with sphincteroplasty achieves good results. Improving the surgical effect of sphincteroplasty through perineal body reconstruction is crucial.

OBJECTIVE

To evaluate the long-term results from anterior sphincteroplasty and perineal body reconstruction (modified sphincteroplasty) among patients with traumatic sphincter injury.

DESIGN AND SETTING

Retrospective study among patients who underwent modified sphincteroplasty in a university hospital between January 2006 and December 2018. Fifty patients were evaluated in detail.

METHODS

The following variables were evaluated: gender, age, additional disease status, time interval between trauma and surgery, surgical technique, duration of hospitalization, follow-up period after surgery, manometric values, electromyography results, magnetic resonance imaging scans, Wexner scores, satisfaction levels with surgery and surgical outcomes.

RESULTS

The patients' mean age was 44.6 ± 15.1 years. The median follow-up period was 62 months (range, 12-118). The mean Wexner scores preoperatively, postoperatively in first month (M1S) and at the time of this report (AAS) were 15.5 ± 3.2, 1.9 ± 3.15 and 3.9 ± 5.3, respectively. Although improvements in the patients' mean Wexner scores became impaired over time, the postoperative Wexner scores were still significantly better than the preoperative Wexner scores (P = 0.001).

CONCLUSION

Good or excellent results were obtained surgically among patients with traumatic sphincter injury. Performing perineal body reconstruction in addition to sphincteroplasty can provide better long-term continence. Surgical outcomes were found to be better, especially among patients younger than 50 years of age and among patients who underwent surgery within the first five years after trauma.

The Severity of Acute Pancreatitis According to Modified Balthazar Classification in Patients With Pancreatic Cancer

OBJECTIVE

Although acute pancreatitis (AP) is a self-limited disease under supportive and medical treatment, it can have life-threatening potential in some patients. Results of studies reporting outcomes of AP-associated pancreatic malignancy are controversial. The aim of this study was to evaluate the severity and prognosis of pancreatic cancer (PC)-related AP by modified Balthazar score.

METHODS

A total of 354 patients hospitalized and followed up in our clinic between 2013 and 2019 were included in the study. Demographic data of all patients were recorded. The etiology of all cases was determined. According to the etiology, the cases were divided into 2 groups: AP related to pancreatic malignancy and AP due to nonmalignant causes. The patients underwent computed tomography of the abdomen within the first 12 hours of admission and after 3 to 7 days. Patients were evaluated and classified by modified Balthazar classification.

RESULTS

Malignancy-related AP was detected in 18 (5.1%) patients. A total of 336 cases (94.9%) were related to nonmalignant causes. There was no statistically significant difference in the severity of AP in both groups at admission and after 3 days (p > 0.05). The changes (regression, progression, or no change) in the disease severity at the first and the subsequent imaging were examined. There was no significant relationship between the 2 groups (p > 0.05).

CONCLUSION

AP may be the clinical manifestation of PC or PC may induce AP in various ways. It was shown that the underlying malignancy did not adversely affect the severity and course of AP.

Recurrent bacterial translocation from gut and sepsis in Head and neck cancer patients and its prevention by probiotics

Head and neck cancers are the 6th most common cancer type in human malignant tumors and treated with chemoradiotherapy and surgery. Chemotherapy during these treatment modalities leads to damage of intestinal epithelial barriers and results in translocation of intestinal bacteria in bloodstream through invasion in these damaged regions. In this report, we report two cases of hypopharyngeal cancer patients, both of whom received chemotherapy before surgery. The patients demonstrated repeated sepsis before and after surgery, supporting translocation of intestinal bacteria. Proper continuous probiotic use prevented proliferation and intestinal bacterial translocation. Hypothesis of bacterial translocation and prevention by probiotics are discussed.

Novel approach for selective reduction of NNN in cigarette tobacco filler and mainstream smoke

Research conducted during past decades to reduce the level of the tobacco specific nitrosamine N-nitrosonornicotine (NNN) and its precursor nornicotine in tobacco yielded identification of three tobacco genes encoding for cytochrome P450 nicotine demethylases converting nicotine to nornicotine. We carried out trials to investigate the effect of using tobaccos containing three non-functional nicotine demethylase genes on the selective reduction of NNN in cigarette tobacco filler and mainstream smoke. Our results indicate that the presence of non-functional alleles of the three genes reduces the level of nornicotine and NNN in Burley tobacco by 70% compared to the level observed in currently available low converter (LC) Burley tobacco varieties. The new technology, named ZYVERT™, does not require a regular screening process, while a yearly selection process is needed to produce LC Burley tobacco seeds for NNN reduction. The reduction of NNN observed in smoke of blended prototype cigarettes is proportional to the inclusion level of tobacco having ZYVERT™ technology. Inclusion of Burley tobacco possessing the new trait into a typical American blend resulted in a selective reduction of NNN in cigarette smoke, while the levels of other Harmful and Potentially Harmful Constituents (HPHC) currently in the abbreviated list provided by the US Food and Drug Administration are statistically equivalent in comparison with the levels obtained in reference prototype cigarettes containing LC Burley.

Tobacco-specific N-nitrosamines NNN and NNK levels in cigarette brands between 2000 and 2014

The evolution of the levels of tobacco-specific N-nitrosamines (TSNA), N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in mainstream (MS) cigarette smoke is investigated based on smoke and tobacco chemistry data of cigarette brands sold by Philip Morris International (PMI) between 2000 and 2014. A total of 315 cigarette samples representing a wide range of product and design characteristics manufactured by PMI between 2008 and 2014 were analyzed and compared to a previously published dataset of PMI brands manufactured in 2000. The data indicate that there is a substantial reduction of NNN and NNK levels in tobacco fillers and MS cigarette smoke per mg of tar and per mg of nicotine using Health Canada Intense (HCI) machine-smoking regime. This observed reduction in NNN and NNK levels in MS cigarette smoke is also supported by the downward trend observed on NNN and NNK levels in USA flue-cured Virginia and Burley tobacco lots from 2000 to 2014 crops, reflecting effectiveness of measures taken on curing and agricultural practices designed to minimize TSNA formation in tobacco.

Characterization of SMV Resistance Genes in Tousan 140 and Hourei Soybean

'Tousan 140' and 'Hourei', two soybean [Glycine max (L) Merr.] accessions from Japan, each possess a single gene at different loci for resistance to Japanese Soybean mosaic virus (SMV) strain SMV C. However, more genetic information is needed to utilize these lines in a breeding program. The objectives of this study were to determine (i) the reaction of Tousan 140 and Hourei to SMV-G1 through G7 strains, (ii) the inheritance of SMV resistance in Tousan 140 and Hourei to strains SMV-G1 and G7, and (iii) the allelomorphic relationship of resistance genes in these accessions with previously known resistance genes. Tousan 140 and Hourei were crossed with SMV susceptible cultivar Lee 68 to study the inheritance of resistance. They were also crossed with lines possessing Rsv1, Rsv3, and putative Rsv4, and to each other, to elucidate the allelomorphic relationships among the genes in Tousan 140, Hourei, and previously reported genes. Inheritance and allelism studies indicated that Tousan 140 possesses two SMV resistance genes. These two genes were separated in two F(2:3) lines. One of the genes, an allele of Rsv1, expresses resistance to SMV-G1 through G3 and susceptibility to SMV-G5 through G7 while the other one, an allele of Rsv3, expresses resistance to SMV-G5 through G7 and susceptibility to SMV-G1 through G3. Their presence in Tousan 140 makes it resistant to strains SMV-G1 through G7. Hourei also is resistant to SMV-G1 through G7 and possesses two SMV resistance genes, which are also alleles of Rsv1 and Rsv3. One, probably the Rsv1 allele, expresses resistance to SMV-G1 and G7 and the other, probably the Rsv3 allele, expresses resistance to SMV-G7, but is susceptible to G1.

Characterization of SMV Resistance Genes in Tousan 140 and Hourei Soybean

'Tousan 140' and 'Hourei', two soybean [Glycine max (L) Merr.] accessions from Japan, each possess a single gene at different loci for resistance to Japanese Soybean mosaic virus (SMV) strain SMV C. However, more genetic information is needed to utilize these lines in a breeding program. The objectives of this study were to determine (i) the reaction of Tousan 140 and Hourei to SMV-G1 through G7 strains, (ii) the inheritance of SMV resistance in Tousan 140 and Hourei to strains SMV-G1 and G7, and (iii) the allelomorphic relationship of resistance genes in these accessions with previously known resistance genes. Tousan 140 and Hourei were crossed with SMV susceptible cultivar Lee 68 to study the inheritance of resistance. They were also crossed with lines possessing Rsv1, Rsv3, and putative Rsv4, and to each other, to elucidate the allelomorphic relationships among the genes in Tousan 140, Hourei, and previously reported genes. Inheritance and allelism studies indicated that Tousan 140 possesses two SMV resistance genes. These two genes were separated in two F(2:3) lines. One of the genes, an allele of Rsv1, expresses resistance to SMV-G1 through G3 and susceptibility to SMV-G5 through G7 while the other one, an allele of Rsv3, expresses resistance to SMV-G5 through G7 and susceptibility to SMV-G1 through G3. Their presence in Tousan 140 makes it resistant to strains SMV-G1 through G7. Hourei also is resistant to SMV-G1 through G7 and possesses two SMV resistance genes, which are also alleles of Rsv1 and Rsv3. One, probably the Rsv1 allele, expresses resistance to SMV-G1 and G7 and the other, probably the Rsv3 allele, expresses resistance to SMV-G7, but is susceptible to G1.

Genetic and Sequence Analysis of Markers Tightly Linked to the Soybean mosaic virus Resistance Gene, Rsv3

Soybean mosaic virus (SMV) is a major viral pathogen, affecting soybean [Glycine max (L.) Merr.] production worldwide. The Rsv3 gene of soybean confers resistance to three of the most virulent strains (G5-G7) of SMV. The objectives of this study were to map Rsv3 and develop polymerase chain reaction (PCR) based markers for marker-assisted selection (MAS) purposes. Disease-response data were collected from two F(2) mapping populations, L29 (Rsv3) x Lee68 (rsv3) and Tousan 140 (Rsv3) x Lee68 (rsv3). Bulk segregant analysis based on amplified fragment length polymorphism (AFLP) markers demonstrated that the Rsv3 locus maps to the soybean molecular linkage group (MLG) B2 between restriction fragment length polymorphism (RFLP) markers A519 and Mng247. These two tightly linked RFLP markers were converted to PCR-based markers to expedite MAS. Sequence analysis of the Mng247 genomic region revealed similarity to the consensus sequence of a leucine-rich repeat (LRR) characteristic of the extracellular LRR class of disease resistance genes. Results from this study will be useful in pyramiding viral resistance genes and in cloning the Rsv3 gene.

Genetic and Sequence Analysis of Markers Tightly Linked to the Soybean mosaic virus Resistance Gene, Rsv3

Soybean mosaic virus (SMV) is a major viral pathogen, affecting soybean [Glycine max (L.) Merr.] production worldwide. The Rsv3 gene of soybean confers resistance to three of the most virulent strains (G5-G7) of SMV. The objectives of this study were to map Rsv3 and develop polymerase chain reaction (PCR) based markers for marker-assisted selection (MAS) purposes. Disease-response data were collected from two F(2) mapping populations, L29 (Rsv3) x Lee68 (rsv3) and Tousan 140 (Rsv3) x Lee68 (rsv3). Bulk segregant analysis based on amplified fragment length polymorphism (AFLP) markers demonstrated that the Rsv3 locus maps to the soybean molecular linkage group (MLG) B2 between restriction fragment length polymorphism (RFLP) markers A519 and Mng247. These two tightly linked RFLP markers were converted to PCR-based markers to expedite MAS. Sequence analysis of the Mng247 genomic region revealed similarity to the consensus sequence of a leucine-rich repeat (LRR) characteristic of the extracellular LRR class of disease resistance genes. Results from this study will be useful in pyramiding viral resistance genes and in cloning the Rsv3 gene.

Inheritance and allelism tests of Raiden soybean for resistance to soybean mosaic virus

The gene symbol Rsv2 was previously assigned to the gene in the soybean [Glycine max (L.) Merr.] line OX670 for resistance to soybean mosaic virus (SMV). The Rsv2 gene was reported to be derived from the Raiden soybean (PI 360844) and to be independent of Rsv1. Accumulated data from our genetic experiments were in disagreement with this conclusion. In this study, Raiden and L88-8431, a Williams BC5 isoline with SMV resistance derived from Raiden, were crossed with two SMV-susceptible cultivars to investigate the mode of inheritance of SMV resistance in Raiden. They were also crossed with five resistant cultivars to examine the allelomorphic relationships of the Raiden gene with other reported genes at the Rsv1 locus. F1 plants, F2 populations, and F2-derived F3 (F2:3) lines were tested with SMV strains G1 or G7 in the greenhouse or in the field. The individual plant reactions were classified as resistant (R, symptomless), necrotic (N, systemic necrosis), or susceptible (S, mosaic). The F2 populations from R x S crosses segregated in a ratio of 3 (R + N):1 S and the F2:3 lines from Lee 68 (S) x Raiden (R) exhibited a segregation pattern of 1 (all R):2 segregating:1 (all S). The F2 populations and F2:3 progenies from all R x R crosses did not show any segregation for susceptibility. These results demonstrate that the resistance to SMV in Raiden and L88-8431 is controlled by a single dominant gene and the gene is allelic to Rsv1. The heterozygous plants from R x S and R x N crosses exhibited systemic necrosis when inoculated with SMV G7, indicating a partial dominance nature of the resistance gene. Raiden and L88-8431 are both resistant to SMV G1-G4 and G7, but necrotic to G5, G6, and G7A. Since the resistance gene in Raiden is clearly an allele at the Rsv1 locus and it exhibits a unique reaction to the SMV strain groups, assignment of a new gene symbol, Rsv1-r, to replace Rsv2 would seem appropriate. Further research is ongoing to investigate the possible existence of the Rsv2 locus in OX670 and its relatives.