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Pancreatic neuroendocrine tumors:Are tumors smaller than 2 cm truly indolent?

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1756-1762页

作者： Sergio Hoyos Pablo Posada-Moreno Natalia Guzman-Arango Romario Chanci-Drago Jaime chavez Alvaro Andrés-Duarte Santiago Salazar-Ochoa Hepatobilary and Liver Transplant Unit Hospital Pablo Tobon Uribe and Gastrohepathology Group Universidad de AntioquiaMedellin 050034AntioquiaColombia Department of General Surgery Universidad Pontificia BolivarianaMedellín 050034AntioquiaColombia

BACKGROUND Pancreatic neuroendocrine tumors(PNETs)are relatively rare but rank as the second most common pancreatic neoplasm.They can be functional,causing early metabolic disturbances due to hormone secretion,or non-functional and diagnosed later based on tumor size-related symptoms.Recent diagnoses of PNETs under 2 cm in size have sparked debates about their management;some practitioners advocate for surgical removal and others suggest observation due to the tumors’lower potential for malignancy.However,it is unclear whether managing these small tumors expectantly is truly safe.AIM To evaluate poor prognostic factors in PNETs based on tumor size(>2 cm or<2 cm)in surgically treated patients.METHODS This cohort study included 64 patients with PNETs who underwent surgical resection between 2006 and 2019 at a high-complexity reference hospital in Medellín,Colombia.To assess patient survival,quarterly follow-ups were conducted during the first year after surgery,followed by semi-annual con-sultations at the hospital's hepatobiliary surgery department.Qualitative variables were described using absolute and relative frequencies,and quantitative variables were expressed using measures of central tendency and their corresponding measures of dispersion.RESULTS The presence of lymph node involvement,neural involvement,and lymphovascular invasion were all associated with an increased risk of mortality,with hazard ratios of 5.68(95%CI:1.26–25.61,P=0.024),6.44(95%CI:1.43–28.93,P=0.015),and 24.87(95%CI:2.98–207.19,P=0.003),respectively.Neural involvement and lymphovascular invasion were present in tumors smaller than 2 cm in diameter and those larger than 2 cm in diameter.The recurrence rates between the two tumor groups were furthermore similar:18.2%for tumors smaller than 2 cm and 21.4%for tumors larger than 2 cm.Patient survival was additionally comparable between the two tumor groups.CONCLUSION Tumor size does not dictate prognosis;lymph node and lymphovascular involvement affect mortality,which high-lights that histopath

关键词： Neuroendocrine tumor Pancreatic neoplasm Pancreas Pancreatic neuroendocrine neoplasm Pancreatic neuroendocrine tumors

Clinicopathological alterations in wild mammals from the reservoir system of Trypanosoma cruzi:a scoping review

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Animal Diseases 2024年第1期4卷 48-58页

作者： Ricardo Sanchez Pérez JoséManuel Aranda-Coello JoséAntonio De Fuentes Vicente Oscar Rico chavez Facultad de Estudios Superiores Cuautitlan Universidad Nacional Autonoma deMexicoCuautitlan lzcalliEstadodeMexicoMexico El Colegio de la Frontera Sur-Unidad Campeche CampecheCampecheMexico Instituto de Ciencias Biologicas-Universidad de Ciencias y Artes de Chiapas Tuxtla GutierrezChiapasMexico Facultad de Medicina Veterinaria y Zootecnia-Universidad Nacional Autonoma deMexico Ciudad deMexicoMexico

Trypanosoma cruzi is the etiologic agent of Chagas disease.This flagellated protozoan is transmitted to humans as well as different species of domestic and wild animals via vectors from the Reduviidae family(known as"kissing bugs").Despite the fact that hundreds of species of wild mammals are part of the reservoir system,the morphologi-cal changes and clinical manifestations resulting from the pathogenesis of the infection have been largely neglected.The aim of this review is to systematically compile the available information regarding clinicopathological altera-tions in wild mammals due to natural infection by T.cruzi.Information was obtained from six online bibliographic data search platforms,resulting in the identification of 29 publications that met the inclusion criteria.Mortality was the most common clinical manifestation,cardiac damage was the main finding at necropsy,and lymphoplas-macytic inflammation was the most frequent microscopic injury.Thus,regardless of its role as a reservoir,T.cruzi has the potential to affect the health status of wild mammals,a situation that highlights the need for further research to analyze,measure,and compare its effects at both the individual and population levels.

关键词： Trypanosoma cruzi Chagas disease American trypanosomiasis Clinicopathological alterations Natural infection Wild mammals

Bendamustine and rituximab as frontline therapy in extranodal marginal zone lymphoma:a single-institution experience

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Oncology Research 2024年第6期32卷 1031-1036页

作者： CONSTANTINE N.LOGOTHETIS NATHAN P.HORVAT TONY KURIAN CELESTE BELLO JULIO chavez LEIDY ISENALUMHE BIJAL SHAH LUBOMIR SOKOL HAYDER SAEED JAVIER PINILLA SAMEH GABALLA Department of Internal Medicine University of South FloridaTampaFL33602USA College of Medicine University of South Florida MorsaniTampaFL33602USA H.Lee Moffitt Cancer Center and Research Institute TampaFL33612USA

Extranodal marginal zone lymphoma(EMZL)encompasses 70%of cases of marginal zone lymphoma.Frontline bendamustine and rituximab(BR)were derived from trials involving other indolent non-Hodgkin’s lymphomas.Only one trial has evaluated frontline BR prospectively in EMZL.This retrospective study reports outcomes among EMZL patients receiving frontline BR.Twenty-five patients were included with a median age of 69 years(40–81).Five(20.0%)patients had stage Ⅰ/Ⅱ disease,and 20(80.0%)had stage Ⅲ/Ⅳ disease.The median number of cycles was 6.0(3.0–6.0).Maintenance rituximab was administered to 10(41.7%)individuals.Overall response rate(ORR)was 100.0%(60.0%complete response,40.0%partial response).Medians of overall survival and progression-free survival were not reached.The estimated 2-year progression-free survival was 85.2%and overall survival was 100.0%.Four(16.6%)patients had infections related to treatment;3(12.0%)transformed to diffuse large B-cell lymphoma;5(20.8%)had a relapse or progression of EMZL;and 3(12.0%)died unrelated to BR.BR is an efficacious and well-tolerated front-line regimen for EMZL with response data consistent with existing literature.

关键词： Extranodal marginal zone lymphoma Bendamustine Rituximab Front-line therapy

Association between Helicobacter pylori infection,mismatch repair,HER2 and tumor-infiltrating lymphocytes in gastric cancer

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2487-2503页

作者： Carlos A Castaneda Miluska Castillo Luis A Bernabe Joselyn Sanchez Matteo Fassan Katherine Tello Ignacio Ivan Wistuba Ivan chavez Passiuri Eloy Ruiz Juvenal Sanchez Fernando Barreda Daniel Valdivia Yaqueline Bazan Milagros Abad-Licham Claudio Mengoa Hugo Fuentes Paola Montenegro Ebert Poquioma Raul Alatrista Claudio J Flores Luis Taxa Faculty of Health Sciences Universidad Cientifica del SurLima 15038Peru GECO PERU Grupo de Estudios Clinicos Oncologicos del PeruLima 15038Peru Department of Research Instituto Nacional de Enfermedades NeoplasicasLima 15038Peru Faculty of Human Medicine Universidad Ricardo PalmaLima 15039Peru Department of Medicine Surgical Pathology&Cytopathology UnitUniversity of PaduaPadua 35121Italy Department of Translational Molecular Pathology The University of Texas MD Anderson Cancer CenterHoustonTX 77030United States Department of Abdominal Surgery Instituto Nacional de Enfermedades NeoplasicasLima 15038Peru Department of Pathology Instituto Nacional de Enfermedades NeoplasicasLima 15038Peru Department of Medical Specialties Instituto Nacional de Enfermedades NeoplasicasLima 15038Peru Department of Pathology Instituto Regional de Enfermedades Neoplasicas del NorteTrujillo 13001Peru Faculty of Human Medicine Universidad Privada Antenor OrregoTrujillo 13008Peru Department of Surgery Instituto Regional de Enfermedades Neoplasicas del SurArequipa 04002Peru Department of Medical Oncology Instituto Nacional de Enfermedades NeoplasicasLima 15038Peru Department of Epidemiology Instituto Nacional de Enfermedades NeoplasicasLima 15038Peru Unidad de Investigación Básica y Traslacional Oncosalud-AUNALima 15038Peru Faculty of Medicine Universidad San Martin de PorresLima 15008Peru

BACKGROUND The influence of Helicobacter-pylori(H.pylori)infection and the characteristics of gastric cancer(GC)on tumor-infiltrating lymphocyte(TIL)levels has not been extensively studied.Analysis of infiltrating-immune-cell subtypes as well as survival is necessary to obtain comprehensive information.AIM To determine the rates of deficient mismatch-repair(dMMR),HER2-status and H.pylori infection and their association with TIL levels in GC.METHODS Samples from 503 resected GC tumors were included and TIL levels were evaluated following the international-TILs-working-group recommendations with assessment of the intratumoral(IT),stromal(ST)and invasive-border(IB)compartments.The density of CD3,CD8 and CD163 immune cells,and dMMR and HER2-status were determined by immunohistochemistry(IHC).H.pylori infection was evaluated by routine histology and quantitative PCR(qPCR)in a subset of samples.RESULTS dMMR was found in 34.4%,HER2+in 5%and H.pylori-positive in 55.7%of samples.High IT-TIL was associated with grade-3(P=0.038),while ST-TIL with grade-1(P<0.001),intestinal-histology(P<0.001)and no-recurrence(P=0.003).dMMR was associated with high TIL levels in the ST(P=0.019)and IB(P=0.01)compartments,and STCD3(P=0.049)and ST-CD8(P=0.05)densities.HER2-was associated with high IT-CD8(P=0.009).H.pylorinegative was associated with high IT-TIL levels(P=0.009)when assessed by routine-histology,and with high TIL levels in the 3 compartments(P=0.002-0.047)and CD8 density in the IT and ST compartments(P=0.001)when assessed by qPCR.A longer overall survival was associated with low IT-CD163(P=0.003)and CD8/CD3(P=0.001 in IT and P=0.002 in ST)and high IT-CD3(P=0.021),ST-CD3(P=0.003)and CD3/CD163(P=0.002).CONCLUSION TIL levels were related to dMMR and H.pylori-negativity.Low CD8/CD3 and high CD163/CD3 were associated with lower recurrence and longer survival.

关键词： Lymphocytes Macrophages Gastric cancer Helicobacter pylori HER2 Mismatch repair

Structural performance assessment of GFRP elastic gridshells by machine learning interpretability methods

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Frontiers of Structural and Civil Engineering 2022年第10期16卷 1249-1266页

作者： Soheila KOOKALANI Bin CHENG Jose Luis chavez TORRES Department of Civil Engineering Shanghai Jiao Tong UniversityShanghai 200240China Department of Civil Engineering Technical University of LojaLoja 110102Ecuador

The prediction of structural performance plays a significant role in damage assessment of glass fiber reinforcement polymer(GFRP)elastic gridshell structures.Machine learning(ML)approaches are implemented in this study,to predict maximum stress and displacement of GFRP elastic gridshell structures.Several ML algorithms,including linear regression(LR),ridge regression(RR),support vector regression(SVR),K-nearest neighbors(KNN),decision tree(DT),random forest(RF),adaptive boosting(AdaBoost),extreme gradient boosting(XGBoost),category boosting(CatBoost),and light gradient boosting machine(LightGBM),are implemented in this study.Output features of structural performance considered in this study are the maximum stress as f1(x)and the maximum displacement to self-weight ratio as f2(x).A comparative study is conducted and the Catboost model presents the highest prediction accuracy.Finally,interpretable ML approaches,including shapely additive explanations(SHAP),partial dependence plot(PDP),and accumulated local effects(ALE),are applied to explain the predictions.SHAP is employed to describe the importance of each variable to structural performance both locally and globally.The results of sensitivity analysis(SA),feature importance of the CatBoost model and SHAP approach indicate the same parameters as the most significant variables for f1(x)and f2(x).

关键词： machine learning gridshell structure regression sensitivity analysis interpretability methods

Vascular complications of pancreatitis

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World Journal of Clinical Cases 2022年第22期10卷 7665-7673页

作者： M Ammar Kalas Monica Leon Luis Omar chavez Eduardo Canalizo Salim Surani Department of Medicine Texas Tech University Health CenterEl PasoTX 79905United States Department of General Surgery Centro Medico ABCCiudad de Mexico 01120Mexico Department of Medicine Texas A&M UniversityBryanTX 77807United States

More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America.Necrotizing pancreatitis accounts for 20%-30%of the cases.One-quarter of the patients with pancreatitis develop vascular complications,which carries a high mortality.This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.

关键词： Acute pancreatitis Vascular complications Gastrointestinal bleeding Pseudoaneurysm Hemosuccus pancreaticus Pancreas

Predation of cassowary dispersed seeds:is the cassowary an effective disperser?

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Integrative Zoology 2011年第3期6卷 168-177页

作者： Matt G.BRADFORD David A.westcott CSIRO-Sustainable Ecosystems Tropical Forest Research CentreAthertonQueenslandAustralia

Post-dispersal predation is a potentially significant modifier of the distribution of recruiting plants and an often unmeasured determinant of the effectiveness of a frugivore’s dispersal service.In the wet tropical forests of Austra-lia and New Guinea,the cassowary provides a large volume,long distance dispersal service incorporating benefi-cial gut processing;however,the resultant clumped deposition might expose seeds to elevated mortality.We exam-ined the contribution of post-dispersal seed predation to cassowary dispersal effectiveness by monitoring the fate of 11 species in southern cassowary(Casuarius casuarius johnsonii Linnaeus)droppings over a period of 1 year.Across all species,the rate of predation and removal was relatively slow.After 1 month,70%of seeds remained intact and outwardly viable,while the number fell to 38%after 1 year.The proportion of seeds remaining intact in droppings varied considerably between species:soft-seeded and large-seeded species were more likely to escape removal and predation.Importantly,across all species,seeds in droppings were no more likely to be predated than those left undispersed under the parent tree.We speculate that seed predating and scatter-hoarding rodents are responsible for the vast majority of predation and removal from droppings and that the few seeds which undergo secondary dispersal survive to germination.Our findings reinforce the conclusion that the cassowary is an impor-tant seed disperser;however,dispersal effectiveness for particular plant species can be reduced by massive post-dispersal seed mortality.

关键词： Australia Casuarius casuarius disperser effectiveness secondary dispersal seed shadow

The genetics and biology of KRAS in lung cancer

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Chinese Journal of Cancer 2013年第2期32卷 63-70页

作者： Peter M.K.westcott Minh D.To Pharmaceutical Sciences and Pharmacogenomics Program University of California SanFrancisco Helen Diller Comprehensive Cancer Center University of California SanFrancisco Thoracic Oncology Program Department of SurgeryUniversity of California SanFrancisco

Mutational activation of KRAS is a common oncogenic event in lung cancer and other epithelial cancer types.Efforts to develop therapies that counteract the oncogenic effects of mutant KRAS have been largely unsuccessful,and cancers driven by mutant KRAS remain among the most refractory to available treatments.Studies undertaken over the past decades have produced a wealth of information regarding the clinical relevance of KRAS mutations in lung cancer.Mutant Kras-driven mouse models of cancer,together with cellular and molecular studies,have provided a deeper appreciation for the complex functions of KRAS in tumorigenesis.However,a much more thorough understanding of these complexities is needed before clinically effective therapies targeting mutant KRAS-driven cancers can be achieved.

关键词： RAS基因肺癌生物学遗传学基因突变致癌作用临床意义小鼠模型

Surgical treatment of acute cholecystitis in patients with confirmed COVID-19:Ten case reports and review of literature

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World Journal of Clinical Cases 2022年第4期10卷 1296-1310页

作者： Katya Bozada-Gutierrez Mario Trejo-Avila Fatima chavez-Hernandez Sara Parraguirre-Martinez Carlos Valenzuela-Salazar Jesus Herrera-Esquivel Mucio Moreno-Portillo Department of General and Endoscopic Surgery Hospital General Dr.Manuel Gea GonzalezMexico City 14090Mexico Department of Pathology Hospital General Dr.Manuel Gea GonzalezMexico City 14090Mexico

BACKGROUND Research concerning postoperative outcomes of confirmed coronavirus disease 2019(COVID-19)patients revealed unfavorable postoperative results with increased morbidity,pulmonary complications and mortality.Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis.The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection with concomitant acute cholecystitis who underwent cholecystectomy.CASE SUMMARY We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy.Six patients were males,the mean age was 47.1 years.Nine patients had moderate acute cholecystitis,and one patient had severe acute cholecystitis.All patients were treated with urgent/early laparoscopic cholecystectomy.Regarding the Parkland grading scale,two patients received a Parkland grade of 3,two patients received a Parkland grade of 4,and six patients received a Parkland grade of 5.Eight patients required a bail-out procedure.Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy.After surgery,five patients developed acute respiratory distress syndrome(ARDS)and required intensive care unit(ICU)admission.One patient died after cholecystectomy due to ARDS complications.The mean total length of stay(LOS)was 18.2 d.The histopathology demonstrated transmural necrosis(n=5),vessel obliteration with ischemia(n=3),perforation(n=3),and acute peritonitis(n=10).CONCLUSION COVID-19 patients with acute cholecystitis had difficult cholecystectomies,high rates of ICU admission,and a prolonged LOS.

关键词： COVID-19 SARS-CoV-2 Cholecystectomy in COVID-19 Acute cholecystitis in COVID-19 Case report