The Lancet, issue 10,0000: Surgery themed issue

How appropriate that the journal named after a surgical instrument would dedicate their 10,000th issue to surgery as such. Indeed, since its fist release it is but true to state that surgery is far from the dominant subject in this worldwide circulated journal.
Well, this has been more than rectified in the current issue, with several small pieces on surgery and historical vignettes, but more important; three randomised controlled trials on surgical themes are included in the issue (more on each of these later), and 3 review papers are included (more on these as well!), covering a wide range of important themes in general surgery, with the main theme being emergency surgery.

To read more on the STICH, PONCHO and Ladies trial go to:
http://www.thelancet.com/journals/lancet/issue/vol386no10000/PIIS0140-6736(15)X0006-7

I'll add in discussions on appendicitis, pancreatitis, diverticulitis, and perforated ulcer later on.

2015 and launch of first editorial

Long time since last post here on the blog - my apologies for the vacancy!

As the first post this year I would like to put forward a link to a recently published editorial I wrote for the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, that reviewed the progress of the Journal over the past few years. This journal has now really grown and is becoming a major stakeholder in Scandinavian acute medicine, providing a vehicle for academic work from the Nordic countries but also globally.
Please go read the full text editorial here.

Development, year on year

Career choice in medicine

Finding your career track has become more easy with this algorithm:

What is the role of EMAST in cancer?

Prevalence and implications of elevated microsatellite alterations at selected tetranucleotides in cancer

From Watson et al. British Journal of Cancer advance online publication 1 April 2014; doi: 10.1038/bjc.2014.167

Elevated microsatellite alterations at selected tetranucleotides (EMAST), a variation of microsatellite instability (MSI), has been reported in a variety of malignancies (e.g., neoplasias of the lung, head and neck, colorectal region, skin, urinary tract and reproductive organs). EMAST is more prominent at organ sites with potential external exposure to carcinogens (e.g., head, neck, lung, urinary bladder and colon), although the specific molecular mechanisms leading to EMAST remain elusive. Because it is often associated with advanced stages of malignancy, EMAST may be a consequence of rapid cell proliferation and increased mutagenesis. Moreover, defects in DNA mismatch repair enzyme complexes, TP53 mutation status and peritumoural inflammation involving T cells have been described in EMAST tumours. At various tumour sites, EMAST and high-frequency MSI share no clinicopathological features or molecular mechanisms, suggesting their existence as separate entities. Thus EMAST should be explored, because its presence in human cells may reflect both increased risk and the potential for early detection. In particular, the potential use of EMAST in prognosis and prediction may yield novel types of therapeutic intervention, particularly those involving the immune system. 

In a just released review in the BJC we will summarise the current information concerning EMAST in cancer to highlight the knowledge gaps that require further research

Cellular metabolism in colorectal carcinogenesis: Influence of lifestyle, gut microbiome and metabolic pathways

The interconnectivity between diet, gut microbiota and cell molecular responses is well known; however, only recently has technology allowed the identification of strains of microorganisms harbored in the gastrointestinal tract that may increase susceptibility to cancer. The colonic environment appears to play a role in the development of colon cancer, which is influenced by the human metabolic lifestyle and changes in the gut microbiome. Studying metabolic changes at the cellular level in cancer be useful for developing novel improved preventative measures, such as screening through metabolic breath-tests or treatment options that directly affect the metabolic pathways responsible for the carcinogenicity.

see more @  Hagland HR, Søreide K. Cellular metabolism in colorectal carcinogenesis:

Influence of lifestyle, gut microbiome and metabolic pathways. Cancer Lett. 2014 
Mar 12. pii: S0304-3835(14)00133-5. doi: 10.1016/j.canlet.2014.02.026.

Defining CIMP in epigenetics - a walk in the park?

Defining CIMP for correct classification of epigenetically altered tumors can be a challenging task, yet correct classification is very important for understanding tumor biology, identifying molecular classes that can explain differences in outcome or response to therapy, and for comparison between results from different groups.

We have recently added to the debate by comparing a set of commonly agreed panels to assess CIMP. The discrepancy between some of the markers and panels - and, depending on the number of genes and the number of probes in each gene included - was considerable and (maybe) even disturbing!

read the full text paper published in Plos One, if you would like to read beyond the abstract:

PLoS One. 2014 Jan 21;9(1):e86657. doi: 10.1371/journal.pone.0086657. eCollection 2014.

Comparison of CpG Island Methylator Phenotype (CIMP) Frequency in Colon Cancer Using Different Probe- and Gene-Specific Scoring Alternatives on Recommended Multi-Gene Panels.

Berg M1, Hagland HR2, Søreide K3.


Abstract

BACKGROUND:

In colorectal cancer a distinct subgroup of tumours demonstrate the CpG island methylator phenotype (CIMP). However, a consensus of how to score CIMP is not reached, and variation in definition may influence the reported CIMP prevalence in tumours. Thus, we sought to compare currently suggested definitions and cut-offs for methylation markers and how they influence CIMP classification in colon cancer.

METHODS:

Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA), with subsequent fragment analysis, was used to investigate methylation of tumour samples. In total, 31 CpG sites, located in 8 different genes (RUNX3, MLH1, NEUROG1, CDKN2A, IGF2, CRABP1, SOCS1 and CACNA1G) were investigated in 64 distinct colon cancers and 2 colon cancer cell lines. The Ogino gene panel includes all 8 genes, in addition to the Weisenberger panel of which only 5 of the 8 genes included were investigated. In total, 18 alternative combinations of scoring of CIMP positivity on probe-, gene-, and panel-level were analysed and compared.

RESULTS:

For 47 samples (71%), the CIMP status was constant and independent of criteria used for scoring; 34 samples were constantly scored as CIMP negative, and 13 (20%) consistently scored as CIMP positive. Only four of 31 probes (13%) investigated showed no difference in the numbers of positive samples using the different cut-offs. Within the panels a trend was observed that increasing the gene-level stringency resulted in a larger difference in CIMP positive samples than increasing the probe-level stringency. A significant difference between positive samples using 'the most stringent' as compared to 'the least stringent' criteria (20% vs 46%, respectively; p<0.005) was demonstrated.

CONCLUSIONS:

A statistical significant variation in the frequency of CIMP depending on the cut-offs and genes included in a panel was found, with twice as many positives samples by least compared to most stringent definition used.

Freebies from the BJS: Emergency surgery issue launched hot from the press!!!

Now it is available for access and free download: The themed Emergency surgery issue is now published on the BJS website and can be searched up in Pubmed.

Go to this link to access the content!

Have a Merry Xmas everyone!!!

Volume 101 Issue 1 (January 2014)

Leading articles

Improving outcomes in emergency surgery 

• Author:A. Bergenfelz, K. Søreide
• Published: Nov 27, 2013
• Pages: e1-e2

Barriers, regulations and solutions in emergency surgery research 

• Author:T. J. Coats
• Published: Nov 25, 2013
• Pages: e3-e4

Checklists and crisis management in surgical emergencies 

• Author:K. Ram, M. A. Boermeester
• Published: Nov 13, 2013
• Pages: e5-e6

Organization of emergency surgery 

• Author:A. Leppäniemi
• Published: Nov 13, 2013
• Pages: e7-e8

Reviews

Global disease burden of conditions requiring emergency surgery 

• Author:B. Stewart, P. Khanduri, C. McCord, M. Ohene‐Yeboah, S. Uranues, F. Vega Rivera, C. Mock
• Published: Nov 25, 2013
• Pages: e9-e22

Commentary

Global disease burden of conditions requiring emergency surgery ( Br J Surg 2014; 101: e9–e22) 

• Author:R. T. Petroze
• Published: Dec 12, 2013
• Pages: e23-e23

Reviews

Contemporary management of abdominal surgical emergencies in infants and children 

• Author:L. W. E. van Heurn, M. P. Pakarinen, T. Wester
• Published: Nov 29, 2013
• Pages: e24-e33

Multidisciplinary management strategies for acute non‐variceal upper gastrointestinal bleeding 

• Author:Y. Lu, R. Loffroy, J. Y. W. Lau, A. Barkun
• Published: Nov 26, 2013
• Pages: e34-e50

Strategies to improve the outcome of emergency surgery for perforated peptic ulcer 

• Author:K. Søreide, K. Thorsen, J. A. Søreide
• Published: Nov 29, 2013
• Pages: e51-e64

Staged multidisciplinary step‐up management for necrotizing pancreatitis 

• Author:D. W. da Costa, D. Boerma, H. C. van Santvoort, K. D. Horvath, J. Werner, C. R. Carter, T. L. Bollen, H. G. Gooszen, M. G. Besselink, O. J. Bakker
• Published: Nov 22, 2013
• Pages: e65-e79
• 
  

  Natural orifice transluminal endoscopic surgery for intra‐abdominal emergency conditions 

  • Author:J. Bingener, I. Ibrahim‐zada
  • Published: Nov 25, 2013
  • Pages: e80-e89

  Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis 

  • Author:F. D. McDermott, D. Collins, A. Heeney, D. C. Winter
  • Published: Nov 21, 2013
  • Pages: e90-e99

  Modern treatment of acute mesenteric ischaemia 

  • Author:S. Acosta, M. Björck
  • Published: Nov 20, 2013
  • Pages: e100-e108

  Damage control surgery for abdominal emergencies 

  • Author:D. G. Weber, C. Bendinelli, Z. J. Balogh
  • Published: Nov 25, 2013
  • Pages: e109-e118

  Early diagnosis of necrotizing fasciitis 

  • Author:T. Goh, L. G. Goh, C. H. Ang, C. H. Wong
  • Published: Nov 29, 2013
  • Pages: e119-e125

  Systematic Review

  Systematic review of emergency laparoscopic colorectal resection 

  • Author:D. P. Harji, B. Griffiths, D. Burke, P. M. Sagar
  • Published: Nov 28, 2013
  • Pages: e126-e133

  Original Articles

  A traffic‐light coding system to organize emergency surgery across surgical disciplines 

  • Author:A. Leppäniemi, I. Jousela
  • Published: Nov 22, 2013
  • Pages: e134-e140

  Effect of the introduction of an emergency general surgery service on outcomes from appendicectomy 

  • Author:K. Suen, I. P. Hayes, B. N. J. Thomson, S. Shedda
  • Published: Nov 25, 2013
  • Pages: e141-e146

  Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis 

  • Author:M. M. N. Leeuwenburgh, M. J. Wiezer, B. M. Wiarda, W. H. Bouma, S. S. K. S. Phoa, H. B. A. C. Stockmann, S. Jensch, P. M. M. Bossuyt, M. A. Boermeester, J. Stoker, 
  • Published: Nov 22, 2013
  • Pages: e147-e155

  Spectrum of oesophageal perforations and their influence on management 

  • Author:S. Wahed, B. Dent, R. Jones, S. M. Griffin
  • Published: Nov 22, 2013
  • Pages: e156-e162

Abdominal emergencies in children - free paper

Please access this link to read the full text paper on "Contemporary management of acute abdominal emergencies in infants and children" just published in the BJS and free to access online.

The paper deals with update info on acute appendicitis, hernia, intestinal malrotation and/or strangulation, pyloric stenosis, intussusception and a handful of other conditions that may present to the general surgeon on call.

Illustration of malrotation, from the paper by van Heurn and colleagues in the BJS. Source: 
British Journal of Surgery 29 NOV 2013 DOI: 10.1002/bjs.9335http://onlinelibrary.wiley.com/doi/10.1002/bjs.9335/full#bjs9335-fig-0001

Coming up: Emergency surgery issue in the BJS

A collective sieries on emergency surgery conditions will be launched in the January issue of the BJS. All papers will be free to access, either via PubMed searches or direct through the BJS website (or, most conveniently probably by downloading the BJS app for iPad, makes it easier to read on your tablet).

A leader to introduce the series has recently been launched and can be accessed here.

I will try to introduce some of the papers as they are real eased early online - I believe there are plenty material that will be of great use and interest to a worldwide readership.

Excited to have your response as we go!

Cheers,

Kjetil

Centenary Talks given at ASGBI, Glasgow and ACS, Washington 2013

Related to the BJS centenary a symposium was held at the International Surgical Congress of the Associations of Surgeons of Great Britain & Ireland in Glasgow, May 2013. You can find all the lectures to the ASGBI 2013 BJS Symposium: 100 years of BJS by going to the BJS website.

Also, a co-anniversary was held in Washington DC, marking the 100 years of both the BJS and the American College of Surgeons. The symposium can be view in entirety here.