1.Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia
Cian KEOGH ; Julie MOORE ; Danica COSSIO ; Nick SMITH ; David A. CLARK
Annals of Coloproctology 2024;40(3):268-275
Purpose:
Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes.
Methods:
Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates.
Results:
In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4–27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma.
Conclusion
Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.
2.Astrocyte lesions in cerebral cortex and cerebellum of dogs with congenital ortosystemic shunting
Alun WILLIAMS ; Adam GOW ; Scott KILPATRICK ; Mickey TIVERS ; Vicky LIPSCOMB ; Ken SMITH ; Michael Oliver DAY ; Nick JEFFERY ; Richard John MELLANBY
Journal of Veterinary Science 2020;21(3):e44-
Background:
Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS.
Objectives:
The objective of this study was to characterise the histological changes in the cerebral cortex and cerebellum of dogs with cPSS with particular emphasis on astrocyte morphology.
Methods:
Eight dogs with a confirmed cPSS were included in the study.
Results:
Six dogs had substantial numbers of Alzheimer type II astrocytes and all cases had increased immunoreactivity for glial fibrillary acidic protein in the cerebral cortex, even if there were minimal other morphological changes.
Conclusions
This study demonstrates that dogs with a cPSS have marked cellular changes in the cerebral cortex and cerebellum. The cellular changes that occur in the cerebral cortex and cerebellum of dogs with spontaneously arising HE are similar to changes which occur in humans with HE, further validating dogs with a cPSS as a good model for human HE.
3.Call for emergency action to limit global temperature increases, restore biodiversity, and protect health
Lukoye Atwoli ; Abdullah H. Baqui ; Thomas Benfield ; Raffaella Bosurgi ; Fiona Godlee ; Stephen Hancocks ; Richard Horton ; Laurie Laybourn-Langton ; Carlos Augusto Monteiro ; Ian Norman ; Kirsten Patrick ; Nigel Praities ; Marcel GM Olde Rikkert ; Eric J. Rubin ; Peush Sahni ; Richard Smith ; Nick Talley ; Sue Turale ; Damian Vazquez
Pediatric Infectious Disease Society of the Philippines Journal 2021;22(2):2-5