Development of a prediction model for recurrence in patients with colorectal peritoneal metastases undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

INTRODUCTION

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival outcomes for selected patients with colorectal peritoneal metastases (PM), but recurrence rates are high. The aim of this study was to develop a tool to predict recurrence in patients with colorectal PM that undergo CRS-HIPEC.

MATERIALS AND METHODS

For this retrospective cohort study, data of patients that underwent CRS-HIPEC for colorectal PM from four Dutch HIPEC centers were used. Exclusion criteria were perioperative systemic therapy and peritoneal cancer index (PCI) ≥20. Nine previously identified factors were considered as predictors: gender, age, primary tumor characteristics (location, nodal stage, differentiation, and mutation status), synchronous liver metastases, preoperative Carcino-Embryonal Antigen (CEA), and peritoneal cancer index (PCI). The prediction model was developed using multivariable Cox regression and validated internally using bootstrapping. The performance of the model was evaluated by discrimination and calibration.

RESULTS

In total, 408 patients were included. During the follow-up, recurrence of disease occurred in 318 patients (78%). Significant predictors of recurrence were PCI (HR 1.075, 95% CI 1.044-1.108) and primary tumor location (left sided HR 0.719, 95% CI 0.550-0.939). The prediction model for recurrence showed fair discrimination with a C-index of 0.64 (95% CI 0.62, 0.66) after internal validation. The model was well-calibrated with good agreement between the predicted and observed probabilities.

CONCLUSION

We developed a prediction tool that could aid in the prediction of recurrence in patients with colorectal PM who undergo CRS-HIPEC.

Salinization of groundwater during 20 years of agricultural irrigation, Luxor, Egypt

Groundwater salinization is a global problem accounting for 11-30% of the world's irrigated areas. Luxor region in Upper Egypt is one of such areas affected by salinity. Multivariate statistics indicate that groundwater is affected by intermixed processes; mineralization (salinization), fertilization, domestic wastes, and meteoric recharge. Temporal change in salinity and hydrochemical facies during 1997-2017 revealed aquifer salinization, due to the dissolution of salts from overlain saline soil and marine deposits underneath as well as up-coning of deep saline water. Increasing salinity over time was statistically documented, exhibited temporally high significant differences (P < 0.05), where salinization consumed a quarter of the aquifer during 20 years. Evolution of water facies from less mineralized Ca-Cl, Mg-Cl to highly mineralized Na-Cl species explains the salinization process over time. Elevated content of Na and Cl is associated with the dissolution of marine sediments and saltwater intrusion. The shift from silicate weathering into evaporation dominance confirmed the saltwater intrusion. As a result, groundwater has a high degree of salinity, is not suitable for domestic and other uses. On other hand, fertilization and domestic sewage are probably responsible for the high NO₃^- and Cd content. Over 80% of Cd exists in mobile species facilitates Cd-plant uptake indicating an alarming environmental situation. Cd mobility is closely related to elevated salinity and chlorinity, allowing competition with major ions and forming of soluble complexes. The present approach will improve the uncertainties of environmental interpretation, as an initial step for aquifers management in reclaimed lands.

Multivariate statistics explaining groundwater chemistry, Asyut, Egypt

Groundwater is an important source for domestic and irrigation purposes in Asyut area. Water quality varied widely due to complex geochemical processes and pollution sources. Understanding the processes controlling groundwater chemistry is necessary to overcome related problems. Multivariate statistics revealed that groundwater is affected by anthropogenic recharge (agricultural/organic pollution), mineralization, and redox processes. Contributions from natural vs. anthropogenic sources explain the variance in hydrochemical data. Shallow wells are relatively higher in bicarbonate content due to oxidation of organic pollutants. Shallow wells anomaly high with iron and organically polluted are most probably owing to pipe corrosion in residential areas. N fertilization impact on natural weathering has been demonstrated. Groundwater is getting more mineralized toward desert fringes due to lithological and hydrogeological characteristics under unconfined conditions. Evaporation factor enhances groundwater salinity under aridity. Fe and Mn contents are relatively higher as the redox potential is getting more reducing. The current study will help in building suitable management plan to protect the aquifer.

Survival Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Synchronous Versus Metachronous Onset of Peritoneal Metastases of Colorectal Carcinoma

Background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal metastases (PM) from colorectal carcinoma (CRC). Because of considerable morbidity, optimal patient selection is essential. This study was designed to determine the impact of the onset of PM (synchronous vs. metachronous) on survival outcomes after CRS-HIPEC.

Methods

Patients undergoing CRS-HIPEC for colorectal PM in two academic centers in the Netherlands between 2010 and 2020 were eligible for inclusion. Patients were classified as synchronous (s-PM, i.e., diagnosis at time of presentation, staging, or primary surgery) or metachronous onset (m-PM, i.e., diagnosis during follow-up) of colorectal PM. Survival outcomes were compared between groups by Kaplan–Meier survival and Cox regression analyses.

Results

Of 390 included patients, 179 (45.9%) had synchronous onset of colorectal PM. These patients more often presented with higher TN-stage and poor differentiation/signet cell histology. Treatment with perioperative chemotherapy was more common in s-PM patients. m-PM patients experienced more serious postoperative complications (Clavien-Dindo ≥ III). There was no significant difference in disease-free survival (DFS) between s-PM (median 9 months, interquartile range [IQR] 5–15) and m-PM patients (median 8 months, IQR 5–17). Overall survival (OS) was significantly shorter for s-PM (median 28 months, IQR 11–48) versus m-PM patients (median 33 months, IQR 18–66, p = 0.049). Synchronous onset of PM was not independently associated with OS in a multivariable analysis.

Conclusions

Synchronous onset of colorectal PM was associated with poor tumor characteristics and more advanced disease, but was not an independent predictor of survival outcomes after CRS-HIPEC.

In Patients Undergoing CRS/HIPEC for Colorectal Adenocarcinoma with Peritoneal Metastases, Presence of Ascites on Computed Tomography Imaging is not a Prognostic Marker for Survival

Background

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative treatment for patients with colorectal peritoneal metastases (CRPM). Patient selection is key to optimizing outcomes after CRS/HIPEC. The aim of this study was to determine the prognostic value of ascites diagnosed on preoperative imaging.

Methods

A prospective database of patients eligible for CRS/HIPEC between 2010 and 2020 was retrospectively analyzed. The presence of ascites, postoperative complications, overall survival (OS), disease-free survival (DFS), and completeness of cytoreduction were assessed. Univariable and multivariable logistic regression was performed to identify independent predictors for outcome.

Results

Of the 235 included patients, 177 (75%) underwent CRS/HIPEC while 58 (25%) were not eligible for CRS/HIPEC. In 42 of the 177 patients (24%) who underwent CRS/HIPEC, ascites was present on preoperative computed tomography (CT) imaging. Peritoneal Cancer Index (PCI) score was significantly higher in patients with preoperative ascites compared with patients without (11 [range 2–30] vs. 9 [range 0–28], respectively; p = 0.011) and complete cytoreduction was more often achieved in patients without ascites (96.3% vs. 85.7%; p = 0.007). There was no significant difference in median DFS and OS after CRS/HIPEC between patients with and without ascites {10 months (95% confidence interval [CI] 7.1–12.9) vs. 9 months (95% CI 7.2–10.8), and 25 months (95% 9.4–40.6) vs. 27 months (95% CI 22.4–31.6), respectively}.

Conclusions

Ascites on preoperative imaging was not associated with worse survival in CRS/HIPEC patients with CRPM. Therefore, excluding patients from CRS/HIPEC based merely on the presence of ascites is not advisable.

Facile Fabrication of ZnMgAl/LDH/Algae Composites as a Potential Adsorbent for Cr(VI) Ions from Water: Fabrication and Equilibrium Studies

In order to improve the adsorption capacity of natural layered double hydroxyl (LDH) materials, the natural organic sources such as algae containing hydroxyl groups, amino groups, peptide connections, and alginate structures were used to improve LDH for the preparation of ZnMgAl LDH-algae composites (LDH-Ax). The structure of prepared composites was established and characterized via various techniques such as scanning electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy. The LDH-A2 sample displayed the highest efficiency for Cr(VI) removal, which reached to 99% at the optimum conditions. The prepared composite LDH-A2 showed high stability and reusability (91.7%) after five cycles. The kinetic studies revealed that the Cr uptake by LDH-A1 is described as pseudo-first order, while the case of LDH-A2 is described as pseudo-second order. This study reported that the easily synthesized LDH-Ax has an interesting environmental approval process to eliminate Cr ions from aqueous media quickly and effectively.

Environmental factors controlling potentially toxic element behaviour in urban soils, El Tebbin, Egypt

This study focuses on the assessment of surface soils from industrially polluted region (El Tebbin) of southern Cairo, Egypt. The impact of agricultural, residential and industrial land use on soils developed from Nile river sediments has significantly compromised their function. Previous evidence has shown that the food chain is contaminated and enhances risk of contaminant exposure of the residential communities. This study investigates factors controlling potentially toxic element (PTE) distribution (Co, Ni, Pb, Cd, Zn, Cr and Cu) in El Tebbin soils and provide estimates of their mobility and bioavailability. The PTE concentrations are characterised by high variability as result of the variety of natural and anthropogenic influences. Highest spatial variability is found for Zn, Cd, Pb and Cu (C.V = 260.0%, 280.4%, 140.8% and 159.6% respectively) and enrichment factors indicate strong anthropogenic inputs. For Co and Ni, relatively low spatial variability (C.V = 65.8% and 45.0% respectively) with depletion in Ni suggests a relatively minor contribution from anthropogenic sources. For Cr, a more uniform distribution pattern showing depletion to minimal enrichment across the study area (C.V = 19.2%) reflects almost exclusive lithogenic control. Using principle component analysis (PCA) to explore concentration data reveals that the major inputs affecting PTE distribution are modified by primary soil properties (texture and pH). Their relative bioavailability (identified through sequential chemical extraction) relates strongly to local input sources. Those elements dominated by lithogenic input (Ni and Co) were found predominantly in soil residual fractions (95.6% and 90.5% respectively), while elements with stronger anthropogenic contributions (Cd, Zn, Pb and Cu) showed much higher portion in the more mobile and bioavailable fractions obtained from sequential chemical extraction, with average proportions of the totals being 62.6%, 57%, 40.7% and 39.2% respectively. Those PTEs with strong anthropogenic influence are potentially much more mobile for bioaccumulation in food chain with increased health risk for exposed residents and are confirmed by elevated concentrations of Cd, Zn, Pb and Cu recorded in local plant species. The main pollution sources were further highlighted by cluster analysis and showed vehicle traffic and specific industrial activities but which varied significantly from site to site. The identification of sources through the approach developed here allows prioritisation of monitoring and regulatory decisions by the local government to reduce further environmental exposure of the local population.

Axial dispersion and mixing of coolant gas within a separate-effect prismatic modular reactor

Multiphase Reactors Engineering and Applications Laboratory performed gas phase dispersion experiments in a separate-effect cold-flow experimental setup for coolant flow within heated channels of the prismatic modular reactor under accident scenario using gaseous tracer technique. The separate-effect experimental setup was designed on light of local velocity measurements obtained by using hot wire anemometry. The measurements consist of pulse-response of gas tracer that is flowing through the mimicked riser channel using air as a carrier. The dispersion of the gas phase within the separate-effect riser channel was described using one-dimensional axial dispersion model. The axial dispersion coefficient and Peclet number of the coolant gas phase and their residence time distribution within were measured. Effect of heating intensities in terms of heat fluxes on the coolant gas dispersion along riser channels were mimicked in the current study by a certain range of volumetric air flow rate ranging from 0.0015 to 0.0034 m3/s which corresponding to heating intensity range from 200 to 1400 W/m2. Results confirm a reduction in the response curve spreads is achieved by increasing the volumetric air velocity (representing heating intensity). Also, the results reveal a reduction in values of axial dispersion coefficient with increasing the air volumetric flow rate.

Staphylococcus saprophyticus causing native valve endocarditis

Coagulase negative staphylococci are a rare cause of native valve endocarditis. Staphylococcus saprophyticus is a coagulase-negative Staphylococcus infrequently reported as a human pathogen, and most of the cases reported are urinary tract infections. We describe a case of native valve endocarditis attributed to this organism. The patient needed valve replacement due to heart failure.

Cell cycle changes associated with formation of Pt-DNA adducts in human ovarian carcinoma cells with different cisplatin sensitivity

The possible correlation between alterations in cytokinetic response to cisplatin (CP) treatment and drug resistance in human ovarian carcinoma cell lines was examined. Using dual parameter flow cytometry, we performed detailed time-course and dose-response analysis of cell cycle modifications in the parental A2780 and resistant A2780/CP cells exposed to CP. The data suggested that drug treatment resulted in similar types of cell cycle alterations in cells with different CP sensitivity. Rapid normalization of the cytokinetic pattern in both cell lines at low doses of CP was observed. At higher drug concentrations reversible S phase delay predominated, accompanied by blocks in both G1/S and G2/M and followed by complete normalization of cytokinetic patterns in the surviving cells. CP treatment by lethal doses resulted in almost complete S phase block. The surviving cells at 72 h accumulated in G2 phase. CP-induced cell cycle perturbations, among which the most pronounced were alterations in the S phase populations, correlated with the level of DNA damage, but not with cell survival in these cell lines. However, at identical levels of DNA damage, the resistant A2780/CP cell line demonstrated decreased p53 induction and decreased apoptosis compared to the parental cell line. Thus, at equivalent levels of DNA damage, resistance in this model system correlated with a diminished p53-dependent apoptotic pathway rather than with differences in cell cycle response.

Penicillin tolerance in Streptococcus faecium ATCC 9790

Tolerant strains of Streptococcus faecium had higher levels of muramidase 2 and lower levels of trypsinactivable muramidase 1 than did susceptible strains. Susceptible strains lysed faster than did tolerant strains in buffer and at some antibiotic concentrations. The addition of Triton X-100 produced equal lysis rates for susceptible and tolerant cultures.