Apical Node Research Articles

Laparoscopic segmental colectomy with extensive D3 lymph node dissection for right transverse colon cancer.

We herein propose a novel approach, laparoscopic segmental colectomy with extensive D3 lymph node dissection (ED3LND), for right-sided transverse colon cancer (TCC). Forty-two patients with right-sided TCC were randomly assigned to two groups: Group 1 (segmental colectomy with D3LND) and Group 2 (segmental colectomy with ED3LND). Clinical characteristics, surgical and pathological outcomes, and oncological outcomes were retrospectively compared between the two groups. The number of lymph nodes retrieved, apical lymph nodes retrieved, and apical lymph node metastases were significantly lower in Group 1 than in Group 2. No significant differences were observed in the operation time, length of hospital stay, estimated blood loss, lymph node metastases, postoperative lymphoceles, or other Clavien-Dindo grade ≥III postoperative complications between the two groups. The 3-year disease-free survival rate was 82.6% in Group 1 and 84.2% in Group 2, with no significant difference. Laparoscopic segmental colectomy with ED3LND for right-sided TCC may offer better oncological outcomes than D3LND. A large-scale prospective randomized controlled study is needed to further validate the oncological benefits of this novel procedure.

Vascular-oriented D3 lymph node dissection with left colic artery preservation for distal sigmoid colon cancer: a variety of techniques.

One of the approaches to distal sigmoid colon cancer surgical treatment is segmental colonic resection with vascular preservation of left colic artery (LCA). D3 lymph node dissection may technically vary according to different vascular anatomy. This study aims to show the approaches to D3 lymph node dissection with LCA preservation for distal sigmoid colon cancer according to different patterns of inferior mesenteric artery (IMA) branching. CTangiography with 3D reconstruction was routinely performed to identify the IMA branching pattern. Laparoscopic distal sigmoid colon resection with D3 lymph node dissection and left colic artery preservation in standardized fashion was performed in all cases. Data, including clinical, intraoperative, and short-term surgical outcomes, is presented as median numbers (Me) and interquartile range (IQR). Twenty-six patients with distal sigmoid colon cancer were treated with laparoscopic distal sigmoid colon resection. The approach to D3 lymph node dissection varied according to different anatomical variations. There was one conversion (3.8%) and one anastomotic leakage (3.8%) in patients with high BMI. At the same time, there was a high apical lymph node count (Me 3 (IQR 2-5), min-max 0-10) due to the skeletonization of the IMA. The technical aspects of D3 lymph node dissection with left colic artery preservation may vary in different types of LCA and sigmoid artery branching patterns regardless of the standardized anatomical landmarks. The anatomical features should be considered when performing vascular-sparing lymph node dissection.

Surgical treatment of right colon cancer

The study aimed to perform a systematic review of the literature on surgical treatment for right colon cancer (RCC) with complete mesocolic excision (CME) and D2/D3 lymph node dissection (LND). Material and Methods. A literature review was performed for studies published between 2013 and 2023 by the online resources from the official Web sites of the societies/panels and PubMed database. Sources included guidelines, meta-analyses, randomized and nonrandomized clinical studies, guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network, Russian clinical guidelines. Results. CME significantly improved both immediate and long-term treatment results, which was confirmed by numerous meta-analyses. The extent of LND remains one of the most controversial issues in RCC. For many Asian surgeons, D3 LND is the standard procedure for the treatment of RCC, whereas the European approach is more conservative and apical lymph node dissection is not mandatory. There are also large differences in understanding the extent of D3 LND in RCC. Most surgeons understand this term as dissection of adipose tissue along the anterior and lateral surface of the superior mesenteric vein, however, there are authors who perform circular dissection along the superior mesenteric vessels, considering this extent of surgery to be the most radical. Conclusion. It is necessary to standardize methods and effective criteria for quality control of CME for RCC and LND. In this case, external independent assessment of the quality of surgical intervention is important. There is also currently a growing number of studies in which intraoperative fluorescence imaging makes it possible to better visualize the location of the apical lymph nodes and individualize LND.

Comparison of short-term outcomes of D2 and D3 lymph nodes dissection for colon cancer

Background. D3 lymph node dissection remains controversial in colon cancer surgery.Aim. To compare the short-term of D2 and D3 lymph nodes dissection for colon cancer.Materials and methods. Design of the study – prospective randomize controlled study. Inclusion criteria: age over 18 years, colon adenocarcinoma cT3–4n0–2m0, patient consent to participate in the study. Exclusion criteria: distant metastases diagnosed preoperatively, cTis–T2, cT4b (pancreas, stomach, small intestine, ureter, bladder, kidney), emergent cases (limited to tumor perforation, acute bowel obstruction), history of previous chemotherapy or radiation therapy, synchronous or metachronous cancer, pregnancy or breastfeeding, refusal to participate in the study. withdrawal criteria were exploratory laparotomy/laparoscopy or other reasons for refusing resection.Results. A total of 436 patients were included in the study no differences were found in the clinical characteristics of groups D2 and D3. In the D2 lymph node dissection group the incidence of unintentional vascular injuries was in 7 (3.2 %) patients, in the D3 lymph node dissection group – in 15 (6.9 %) patients (p = 0.12). The operating time increased by 30 minutes in D3 lymph node dissection group (p p = 0.42). Hartmann’s procedure was performed in 2 (0.9 %) patients in the D2 lymph node dissection group. Complications IIIb were recorded in 5 (2.3 %) and 9 (4.1 %) patients in lymph node dissection groups D2 and D3, respectively (p = 0.42). Anastomotic leakage was not observed in the D2 lymph node dissection group; in the D3 lymph node dissection group, it was diagnosed in 3 (1.4 %) patients (p = 0.25). postoperative multiple-organ failure (Iv) or mortality (v) were not observed. grade 3 quality of the specimen was observed in 160 (73.4 %) patients in the D2 lymph node dissection group, 163 (74.8 %) in the D3 lymph node dissection group (p = 0.79). The median number of lymph node harvested was 11 more in the D3 lymph node dissection group (p < 0.001). Apical lymph nodes were positive in 5 (2.3 %) patients in the D3 lymph node dissection group. There was no difference between the groups in R0 resection margin.Conclusion. D3 lymph node dissection is safe in terms of short-term outcomes in the treatment of colon cancer.

Comparative Analysis of the Outcomes of Laparoscopic Right Hemicolectomy with D2 and D3 Lymphadenectomy in the Treatment of Patients with Right Colon Cancer

Introduction. The standard volume of removed groups of lymph nodes for right colon cancer (RCC) has not been determined. According to Japanese clinical guidelines, it is necessary to perform D3 lymphadenectomy in all cases, except stage I, while according to European and Russian clinical guidelines, the standard scope of surgical intervention includes only D2 lymphadenectomy. There are no long-term results regarding differences between D2 and D3 lymph node dissection in RCC; therefore, it is relevant to conduct studies to improve the long-term results of treatment of patients with RCC.Aim: to comparatively evaluate the results of treatment of patients with RCC who underwent laparoscopic right hemicolectomy at A. Tsyb Medical Radiological Research Center.Materials and methods. Conducted from 2018 to 2023, the study included 174 patients with stage I–III RCC: in 106 patients, laparoscopic right hemicolectomy with D2 lymph node dissection was performed, in 68 patients — with D3 lymph node dissection. When assessing the homogeneity and comparability of the groups, according to input parameters, such as clinical stage, gender, age, body mass index and tumor location, their heterogeneity was noted, which did not allow a direct comparative assessment of both groups. To eliminate heterogeneity and adequately select groups, a pseudorandomization technique was used, after which the groups (n = 68) became statistically comparable in all main clinical parameters.Results. Statistically significant differences were obtained in the median duration of surgical intervention, which was longer in the group of patients with D3 lymph node dissection — 150 (60–393) and 213 (70–390) minutes (p < 0.001), and in the median time of flatus passage — 2 (1–4) and 3 (1–9) days, respectively (p = 0.042). Postoperative complications in accordance with the Clavien — Dindo classification occurred in 16 (23.5 %) patients in the group with D2 and in 15 patients (22.1 %) in the group with D3 lymph node dissection (p = 0.999); III–V grade complications were noted in 2 (2.9 %) cases in each group (p = 0.999). Postoperative hospital stay was 6 days for patients in both groups (p = 0.369). During pathomorphological assessment of the removed specimen, the median number of examined lymph nodes was significantly higher in the group with D3 lymph node dissection: 14 (1–52) and 19 (3–59) lymph nodes, respectively (p < 0.001). Involvement of apical lymph nodes (groups 203, 213, 223) was noted in 2 (3 %) patients. In the group with D2 lymph node dissection, distant metastases were recorded twice as often as in the group with D3 lymph node dissection — in 8 (11.8 %) and 4 (5.9 %) patients, respectively (p = 0.365). Local recurrence was not established in any case. The three-year overall and disease-free survival rates were 94.8 ± 3.0 and 100 % (p = 0.149) and 80.5 ± 5.8 and 88.7 ± 5.8 % (p = 0.177), respectively.Conclusions. The experience of using total mesocolonectomy with D3 lymph node dissection for RCC indicates the safety of this surgical intervention in comparison with traditional surgical techniques, while we did not obtain statistically significant differences in patient survival. To definitively determine the role of D3 lymph node dissection in the treatment of patients with RCC, large multicenter randomized studies are certainly needed.

Anaplastic thyroid carcinoma: Rare clinical case of extrathyroidal primary retroperitoneal tumour and review of literature

Anaplastic thyroid carcinoma is a very rare type of undifferentiated thyroid carcinoma. Mostly, the ATC is diagnosed in advanced stage when local and distant metastases are detected. Multimodal approach and personal treatment managed by a multidisciplinary team of specialist is recommended in all ATC cases. Despite new treatment methods this type of cancer has a very poor prognosis due to fast growth and invasiveness, airway problems and failures of distant metastases control. We present a very rare case of occurrence of anaplastic thyroid carcinoma in the extrathyroidal area. Primary fast growing retroperitoneal tumor with differentiation of anaplastic thyroid carcinoma was diagnosed to a 72-year-old female when no changes were detected in thyroid glands. Due to severe patient status, abdominal pain, and mass effect on surrounding organs caused by suspected retroperitoneal tumor urgent resection surgery was performed. Histopathology analysis confirmed diagnosis of primary retroperitoneal cancer with differentiation of anaplastic thyroid cancer. Later suspected metastases in the left subclavicular lymph node were found but the patient refused further investigation and treatment. Even though the patient is still alive more than 2 years after initial diagnosis and represents a better survival than is described in the literature.

Confirmed Pathological Response to Nivolumab Combined with Chemotherapy for Advanced Gastric Cancer with Left Subclavicular Lymph Node Metastasis: A Case Report.

Confirmed Pathological Response to Nivolumab Combined with Chemotherapy for Advanced Gastric Cancer with Left Subclavicular Lymph Node Metastasis: A Case Report.

D2 and D3 lymph node dissection for colon cancer

To evaluate surgical and oncological results of standard and extended lymph node dissection (D2 and D3) in patients with colon cancer. We analyzed treatment outcomes in 74 patients with colon cancer stage T1-4aN0-2M0 who underwent right- and left-sided hemicolectomy, resection of sigmoid colon with standard and extended lymph node dissection (D2 and D3). Surgical approach and level of D3 lymph node dissection did not increase intra- and postoperative morbidity. Laparoscopic interventions were followed by significantly lower intraoperative blood loss and earlier gas discharge. Metastatic lesion of apical lymph nodes was observed in 5 out of 36 patients who underwent D3 lymph node dissection (13.8%), and metastases in regional lymph nodes rN1-2 were found in all these patients. Overall 5-year survival was 86%. Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection. D3 lymph node dissection is safe for colon cancer. Metastatic lesions of apical lymph nodes during D3 lymph node dissection were detected only in patients with lesions of regional lymph nodes (rN1-2). Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection.

RGS1 Modulates Autophagic and Metabolic Programs and Is a Critical Mediator of Human Regulatory T Cell Function.

Regulatory T cells (Tregs) are critical mediators of immune tolerance and play a diametric role in cancer and autoimmunity. Tumor-infiltrating Tregs are often associated with poor prognosis in solid tumors because their enrichment in the tumor microenvironment contributes to immunosuppression. Conversely, dysregulation in the Treg compartment can disrupt self-tolerance, leading to autoimmunity. In the present study, we describe what is, to our knowledge, a novel regulator of Tregs, the GTPase activator regulator of G protein 1 (RGS1), demonstrating that RGS1-deficient human Tregs show downregulation of Treg-associated genes and are less immunosuppressive. These RGS1-deficient Tregs exhibit perturbations to the FOXP3-c-MYC transcriptional axis and downstream metabolic and autophagy programs by shifting their energy demands toward glycolysis and rendering them less autophagic. Taken together, RGS1 may serve as an apical node of Treg function by regulating the FOXP3-c-MYC transcriptional axis, thereby providing a therapeutic rationale for targeting RGS1 for treatment of cancer and autoimmune diseases.

The bulbils of Palaeonitella cranii (Charales, Charophyceae) revisited, with notes on other inflated cells of this alga that are not bulbils

Palaeonitella cranii is a charophyte alga (Charophyceae) from the Lower Devonian Rhynie chert of Scotland that consists of an axis of alternating internodes and nodes, with whorls of branchlets arising from the nodes. Conspicuous spherical to ovoid structures believed by most to be the bulbils of P. cranii are often found together with the axes and branchlets; however, they have so far only been insufficiently studied. Here, we revisit the bulbils, along with the rhizoids on which they were formed, based on new material from the Rhynie and Windyfield chert sites. The bulbils are up to 540 μm in diameter and occur singly or in groups on rhizoid nodes. A small node recognizable at the apical end in some specimens is evidence that the bulbils are modified branch rhizoids. There is also evidence of lower-order branch rhizoids extending from the apical node, as well as for sprouting. Palaeonitella cranii thrived in shallow pools and outflow channels of the Rhynie geothermal wetland. The bulbils might have enabled the plant to persist if photosynthesis was limited and to regenerate if the thallus was destroyed, but they might also have served as dispersal units. Other significantly inflated cells, which are not bulbils, may occur in both axes and branchlets of P. cranii, but are generally rare. Some of these cell alterations may be due to parasites. This study complements our understanding of P. cranii, the only fossil charophyte known from both above- and below-ground parts of the thallus, and from reproductive structures.

Level of Inferior Mesenteric Artery Ligation in Sigmoid Colon and Rectal Cancer Surgery: Analysis of Apical Lymph Node Metastasis and Recurrence

Introduction: Whether high or low ligation of the inferior mesenteric artery (IMA) is optimal for treating sigmoid colon and rectal cancers is controversial. The present study aimed to compare outcomes of high and low ligation of the IMA and determine the adequate extent of IMA lymph node dissection. Methods: Subjects were 455 consecutive stage I–III colorectal cancer patients who underwent curative surgery between 2011 and 2019. We assessed the association between the level of IMA ligation and overall survival and recurrence-free survival (RFS) by propensity score matching analysis. Clinicopathological features of IMA lymph node metastasis and recurrence patterns were analyzed. Results: After propensity score matching, the low ligation group had a significantly worse prognosis than that of the high ligation group for RFS (p = 0.039). Positive IMA lymph nodes were associated with pathological T3 or T4 stage and N2 stage. IMA lymph node recurrences in the high ligation group occurred at the superior left side of the IMA root. In contrast, all recurrences in the low ligation group occurred at the left colic artery bifurcation. Conclusion: High ligation of IMA is oncologically safe. However, even with high ligation, care must be taken to ensure adequate lymph node dissection.

Effect of sterilants and plant growth regulators in regenerating commonly used cassava cultivars at the Kenyan coast

Cassava is an important root crop whose seed system is undeveloped. Micropropagation of explants in vitro has the potential of addressing the challenge of the unavailability of healthy cassava planting materials. Therefore, the study determined the effect of sterilization and plant growth regulators on cassava explants to produce certified disease-free plants of commonly used cultivars at the coast of Kenya. The apical nodes drawn from the three cultivars of cassava, Tajirika and Kibandameno and Taita, were used as explants. The sterilant sodium hypochlorite (NaOCl) at 5, 10 and 15% and 70% ethanol for 1 and 5 min and sprayed for 20 s were tested for the effect on the explant. Similarly, the effect of BAP (6-Benzyl amino purine) and NAA (1-Naphthalene acetic acid) Plant Growth Regulators (PGRs) each at 0.5, 1 and 5 mg/L under optimal conditions of sterilization was determined. Surface sterilization using 10% NaOCl followed by spraying 70% ethanol for 20 s had 85% initiation on Tajirika whereas 5% NaOCl followed by spraying 70% ethanol for 20 s had 87% and 91% initiation in Kibandameno and Taita cultivars, respectively. In Tajirika, significantly (p < 0.05) high shooting of 68% was from 5 mg/L BAP in MS media whereas approximately 50% rooting was from either 0.5 mg/L BAP or 5 mg/L NAA in MS media. Kibandameno and Taita cultivars had approximately 50% shooting from MS media without PGRs. Kibandameno had >37% rooting from 0.5 to 5 mg/L BAP or NAA in MS media whereas Taita had approximately 50% rooting from 0 to 5 mg/L NAA in MS media. This protocol showed at least 50% success rate of initiation, shooting and rooting as a rapid multiplication regeneration of Tajirika and Kibandameno and Taita cultivar plantlets with little modification of humidity and temperatures in the growth chambers. This protocol requires validation for use in large-scale production of cassava plantlets to alleviate the inadequacy of cassava planting materials among farmers.

Évaluation prospective des dysthyroïdies radio-induites après irradiation mammaire et sus-claviculaire

PurposeThe thyroid is an endocrine gland playing a major role in metabolism and development by the secretion of T4 and T3 thyroid hormones. Due to its anatomical position, it is often included in the target volume for the irradiation of certain tumours and thus receives significant doses (10 to 80Gy). The treatment of breast cancer requires in most cases a breast irradiation associated or not with a lymph node irradiation. The aim of our study was to investigate prospectively the frequency of thyroid disorders in patients with breast cancer treated by radiation, with or without irradiation of the supra- and subclavicular lymph nodes. Material and methodsThis prospective multicentre study (institut Godinot, institut de cancérologie Strasbourg Europe and institut de cancérologie de Lorraine) concerned adult patients with non-metastatic breast carcinoma treated by adjuvant irradiation. They were included in a non-randomized way between February 2013 and June 2015 and divided into two groups according to treatment: (i) breast radiotherapy associated with irradiation of the supra- and subclavicular lymph nodes (group 1), or (ii) breast irradiation alone (group 2). The dose – volume histogram of the thyroid was systematically edited by the physics department. Each patient had a consultation with an endocrinologist at the beginning of the treatment and was monitored by blood analyses including TSH, T4L, antithyroglobulin and antiperoxidase antibodies every 6 months until the 60th month after the end of radiotherapy. Data were described by numbers and percentages for qualitative variables; by means, medians, standard deviation and ranges for quantitative variables. Statistical associations were tested by Chi2, Fisher's, Student's, or analysis of variance tests depending on the conditions of application. Survival analyses were performed by log rank tests and Cox models. ResultsThis study initially included 500 patients, 245 in group 1 and 252 in group 2 (three patients were later excluded for false inclusion). Thyroid abnormalities occurred in 76 patients, representing an incidence of 15.3%. The mean time of the first occurrence of thyroid disorders was 24.3 months. It was more frequent in group 1 with a prevalence of 19.2% against 11.5% in group 2 (P=0.01745). A maximal radiation dose delivered to the thyroid gland greater than 20Gy (odds ratio [OR]: 1.82; P=0.018) or 30Gy (OR: 1.89; P=0.013) was significantly associated with a higher incidence of thyroid disorders, as was a mean dose greater than 30Gy (OR: 5.69; P=0.049). A percentage of thyroid volume receiving 30Gy (V30) greater than 50% (P=0.006) or greater than 62.5% (P=0.021) was significantly associated with an increased incidence of thyroid disorder and more precisely, hypothyroidism (P=0.0007). In multivariate analysis, no factor associated with the occurrence of thyroid disorder was identified. However, in the subgroup analysis concerning group 1 (receiving supraclavicular irradiation), a maximal radiation dose greater than 30Gy appeared to be a risk factor for the occurrence of thyroid disorders (P=0.040). ConclusionThyroid disorder, and in particular hypothyroidism, may be a late side effect of locoregional breast radiotherapy. Patients receiving this treatment should have a biological monitoring of thyroid function.

Laparoscopic D3 lymph node dissection with left colic artery and first sigmoid artery preservation in rectal cancer

BackgroundD3 lymph node dissection with left colic artery (LCA) preservation in rectal cancer surgery seems to have little effect on reducing postoperative anastomotic leakage. So we first propose D3 lymph node dissection with LCA and first sigmoid artery (SA) preservation. This novel procedure deserves further study.MethodsRectal cancer patients who underwent laparoscopic D3 lymph node dissection with LCA preservation or with LCA and first SA preservation between January 2017 and January 2020 were retrospectively assessed. The patients were categorized into two groups: the preservation of the LCA group and the preservation of the LCA and first SA group. A 1:1 propensity score-matched analysis was performed to decrease confounding.ResultsPropensity score matching yielded 56 patients in each group from the eligible patients. The rate of postoperative anastomotic leakage in the preservation of the LCA and first SA group was significantly lower than that in the LCA preservation group (7.1% vs. 0%, P=0.040). No significant differences were observed in operation time, length of hospital stay, estimated blood loss, length of distal margin, lymph node retrieval, apical lymph node retrieval, and complications. A survival analysis showed patients’ 3-year disease-free survival (DFS) rates of group 1 and group 2 were 81.8% and 83.5% (P=0.595), respectively.ConclusionD3 lymph node dissection with LCA and first SA preservation for rectal cancer may help reduce the incidence of anastomotic leakage without compromising oncological outcomes compare with D3 lymph node dissection with LCA preservation alone.

Selective approach to arterial ligation in radical sigmoid colon cancer surgery with D3 lymph node dissection: A multicenter comparative study.

Radical surgery for sigmoid colon cancer is commonly performed with complete mesocolic excision (CME) and apical lymph node dissection, reached by central vascular ligation (CVL) of the inferior mesenteric artery (IMA) and associated extended left colon resection. However, IMA branches can be ligated selectively according to tumor location with D3 lymph node dissection (LND), economic segmental colon resection and tumorspecific mesocolon excision (TSME) if IMA is skeletonized. This study aimed to compare left hemicolectomy with CME and CVL and segmental colon resection with selective vascular ligation (SVL) and D3 LND. Patients (n= 217) treated with D3 LND for adenocarcinoma of the sigmoid colon between January 2013 and January 2020 were included in the study. The approach to vessel ligation, colon resection and mesocolon excision was based on tumor location in the study group, while in the comparison group, left hemicolectomy with routine CVL was performed. Survival rates were estimated as the primary endpoints of the study. Long- and short-term surgery-related outcomes were evaluated as the secondary endpoints of the study. The studied approach to the IMA branch ligation was associated with a statistically significant decrease in intraoperative complication rates (2 vs 4, p= 0.024), operative procedure length (225.56 ± 80.356 vs 330.69 ± 175.488, p <0.001), and severe postoperative morbidity (6.2% vs 19.1%, p= 0.017). Meanwhile, the number of examined lymph nodes significantly increased (35.67 vs 26.69 per specimen, p <0.001). There were no statistically significant differences in survival rates. Selective IMA branch ligation and TSME resulted in better intraoperative and postoperative outcomes with no difference in survival rates.

Concentration and Timing of Dikegulac Sodium on Helianthus hybrida ‘Sunfinity’ Seedlings for Potted Plant Production

Sunflower ‘Sunfinity’ (Helianthus hybrida) can be produced as a potted plant if apical dominance is removed with a manual pinch to control plant height and promote branching and flower number. Chemical pinching agents such as dikegulac sodium could prove to be valuable tools to reduce the labor and costs associated with manual pinching. Our objective was to determine the time of seedling growth and concentration of dikegulac sodium foliar spray application that would result in morphology similar to manually pinched plants. Dikegulac sodium was applied to sunflower ‘Sunfinity’ seedlings at one of four concentrations increasing from 200 to 500 mg⋅L−1 at the time of growth when the first, second, or third node (N1, N2, or N3) was the apical node and axillary stems at those nodes were undeveloped. Applications of 400 mg⋅L−1 at N3 and 500 mg·L−1 at N2 removed apical dominance because of total senescence of the apical meristem and produced a well-branched plant similar to that subjected to manual pinching. Apical dominance was temporarily inhibited without senescence of the apical meristem when 400 mg⋅L−1 was applied at N2 and when 500 mg⋅L−1 was applied at N3, which, nevertheless, resulted in branching that formed a well-rounded canopy.

What are the problems with the current staging of discontinuous tumour nodules (DTNs) in colorectal carcinoma? Is there a better way?

Discontinuous extramural tumour nodules (DTNs) are deposits of metastatic carcinoma in soft tissue not associated with lymph nodes. Although they are established as an adverse prognostic factor in colorectal carcinoma (CRC), under the AJCC eighth edition staging system their presence does not upstage patients who also have lymph node metastases. Counterintuitively, in some situations the presence of lymph node metastases may in effect downstage a patient with DTNs from pN1c to pN1a/b. Therefore, we sought to critically assess the significance of DTNs in a large unselected single institution cohort of patients undergoing surgical resection for CRC. Of 3822 CRC patients undergoing surgical resection from 2005 to 2021, DTNs were present in 686 (18.0%). In univariate (HR=2.687, 95CI 2.355-3.065; p<0.001) and multivariate analysis (HR=1.805, 95CI 1.529-2.132; p<0.001) in a model including age, gender, stage, grade, location, lymph node ratio and apical lymph node status, DTNs were associated with worse overall survival (OS). N1c patients (DTN present but no nodal metastasis) demonstrated worse OS compared to the current pN1a group (p<0.001) and were least different to the current pN2a group (p=0.571). Within the current N1a (p=0.013), N1b (p=0.004) and N2a (p=0.002) groups, patients who also had DTNs had worse OS. DTNs were associated with worse OS for all stage III CRCs combined (p<0.001), and for stage IIIB (p<0.001) and stage IIIC (p=0.007) individually. We conclude that DTNs are an independent adverse prognostic factor that should be considered in the staging system in a way that is additional to (rather than integrated with) the number of involved lymph nodes. We then assess a simple suggestion for how this could be achieved by increasing the overall stage by one group in the presence of DTNs (requiring the creation of a new stage IIID).

B-mode and Doppler ultrasonography patterns of axillary and supraclavicular lymphadenopathy associated with mRNA COVID-19 vaccine

In this study, we present the ultrasound imaging features of lymph nodes arising in the regional lymph node chain after the first or second dose of the Pfizer-BioNTech COVID-19 vaccine. Ipsilateral lymphadenopathy adjacent to the vaccine injection site is an extremely rare but expected adverse reaction following COVID-19 vaccination. Although axillary lymphadenopathy is more common, cases of supraclavicular lymphadenopathy have also been reported after widespread vaccination against COVID-19. Ultrasonography examinations were performed on seven patients with no previous pathological conditions, who presented to our radiology department after receiving the Pfizer-BioNTech COVID-19 vaccine. Bilateral axillary, supraclavicular and subclavicular lymph node stations were explored. These patients typically present with enlarged hypoechoic lymph nodes with the loss of fatty hilum, asymmetric or diffuse cortical thickening, and increased hilar and cortical vascularization on the color doppler ultrasonography of the ipsilateral axillary and supraclavicular regions. Radiologists and clinicians should be aware of the ultrasonographic features of these lymph nodes and should inform the patient that these lymph nodes are often a self-limiting process. Thus, unnecessary axillary lymph node biopsies should be avoided, and patients should be treated conservatively.

Preservation versus nonpreservation of the left colic artery in anterior resection for rectal cancer: a propensity score-matched analysis

BackgroundPreserving the left colic artery (LCA) during anterior resection for rectal cancer is controversial, and robust evidence of the outcomes of LCA preservation plus apical lymph node dissection is lacking. The purpose of this study was to investigate the impact of LCA preservation plus apical lymph node dissection surgery on anastomotic leakage and number of harvested lymph nodes.MethodsPatients who underwent laparoscopic or robotic anterior resection for rectal cancer between September 2017 and May 2020 were retrospectively assessed. The patients were categorized into two groups: preservation of LCA and nonpreservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was anastomotic leakage within 30 days after surgery. The secondary outcomes were number of harvested lymph nodes, 3-year overall survival, and 3-year disease-free survival.ResultsA total of 216 patients were eligible for this study, and propensity score matching yielded 60 patients in each group. Anastomotic leakage in the LCA preservation group was significantly lower than that in the LCA nonpreservation group (3.3% vs. 13.3%, P = 0.048). No significant differences were observed in blood loss, operation time, intraoperative complications, splenic flexure mobilization, total number of harvested lymph nodes, number of positive lymph nodes, time to first flatus, or postoperative hospital stay. Kaplan–Meier survival analysis showed a 3-year disease-free survival of 85.7% vs. 80.5% (P = 0.738) and overall survival of 92.4% vs. 93.7% (P = 0.323) for the preservation and nonpreservation groups, respectively.ConclusionLCA preservation plus apical lymph node dissection surgery for rectal cancer may help reduce the incidence of anastomotic leakage without impairing the number of harvested lymph nodes. Preliminary results suggest that 3-year disease-free survival and overall survival rates may not differ between the two types of surgery, but studies with larger sample sizes are needed to confirm these conclusions.Trial registration ClinicalTrials.gov, NCT03776370. Registered 14 December 2018—Retrospectively registered, https://clinicaltrials.gov.

Procedure for in vitro seed sterilization, germination and aseptic seedling establishment of Zehneria capillacea (Schumach) C. jeffrey

The most important step in plant tissue culture technique is standardizing a protocol for explant sterilization using phytotoxic sterilants. In this study, two sterilants, sodium hypochlorite (household bleach) and mercuric chloride were evaluated to determine the most suitable concentration and exposure time for explant sterilization of Zehneria capillacea seeds, an undomesticated diploid herbaceous edible cucurbit that is rarely distributed in the Niger Delta region of Nigeria. O.1% mercuric chloride for 1minute and 20% sodium hypochlorite for 15 minutes achieved an efficient (95%) seedling establishment. The study also evaluated the effect of aseptic seed coat removal on in vitro seedling establishment. Seeds with intact coat had 0% germination six weeks after initiation into Murashige and Skoog (MS) medium while all the decorticated seeds showed 100% germination with cotyledonary growth and roots one week after initiation, indicating that the seed coat is a major barrier to the in vitro germination of this species. It was also observed that seed orientation during culture initiation influenced seedling vigor and growth. Three weeks after culture initiation, the aseptic seedlings generated from decorticated seeds were observed to have grown 4-5 cm in height with formation of tendrils, apical and axillary nodes, which could be used as explant source for various in vitro culture studies such as callus induction, shoot multiplication, in vitro polyploidization and production of secondary metabolites.