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Purpose Modified Hinchey classification with computed tomography (CT)providesa good predictive factorfor medical failure. By using CT, the location of diverticulitis is proved as an important factor for medical treatment and right-sided diverticulitis is successfully treated medicallymore. However, will more accurate location for diverticulitis affect treatment is not evaluated. Methods Patients who were diagnosed withacute colonic diverticulitis by abdominopelvic CT were retrospectively recorded and analyzed.Patient demographics and clinical features were obtained from patients’ records.Abdominopelvic CT findings were categorized using the location in the colon, distribution of free air in the bowel lumen, fluid accumulation, and type of extra-luminal free air. RESULTS Patients with right-sided diverticulitis were more likely to be younger and elevation of C-reactive protein (CRP) in patients with left-sided diverticulitiswithout significantly different.Only 6.3% of patients received surgical treatment and left-sided diverticulitis is more suitablefor operation (P = 0.02).Most patients with local free air underwent successful medical treatment. The distribution of diverticulitis is different between right- and left-sided diverticulitis and lateral distribution included more cases of surgery. CONCLUSIONS Although there wasno statistical difference between location and emergent operation, we observed that location in the lateral region was an indicatorfor emergent operation. Right-and left-sided diverticulitis manifest indifferent locations, which maybe one of the causes of medical treatmentfailure. Asfeweremergent operations have been performed in recent years, we suggest conducting additionalstudies with larger cohortsto confirm the relationship between location and surgery.

Background This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. Methods This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. Results All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. Conclusion The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

Splenic hemangioendothelioma (HE) is an extremely rare vascular tumor with an uncertain malignant potential. Experience of treatment with this tumor is limited due to their rare occurrence. We herein describe a case of a 53-year-old woman who was found a splenic tumor incidentally. Radiological findings revealed marked splenomegaly with multiple ill-defined hypodense masses as well as a low-density nodule at the left lobe of the liver. The patient underwent splenectomy and wedge resection of the liver. Final pathology confirmed the diagnosis of an admixture of retiform and epithelioid HE of the spleen with metastasis of the liver. However, distant metastases of bilateral lungs developed 6 months after the operation. She received oral thalidomide therapy without significant progression of the disease over a period of 26 months' follow-up. To the best of our knowledge, only 11 cases had been described in the literature. We report the first case of splenic HE metastatic to both liver and lungs. Our patient received thalidomide, a drug with antiangiogenic action, was shown to let the disease progression slow down. It may be recommended for those patients with relapsed disease or metastases.

Development of colorectal cancer (CRC) involves sequential transformation of normal mucosal tissues into benign adenomas and then adenomas into malignant tumors. The identification of genes crucial for malignant transformation in colorectal adenomas (CRAs) has been based primarily on cross-sectional observations. In this study, we identified relevant genes using autologous samples. By performing genome-wide SNP genotyping and RNA sequencing analysis of adenocarcinomas, adenomatous polyps, and non-neoplastic colon tissues (referred as tri-part samples) from individual patients, we identified 68 genes with differential copy number alterations and progressively dysregulated expression. Aurora A, SKA3, and DSN1 protein levels were sequentially up-regulated in the samples, and this overexpression was associated with chromosome instability (CIN). Knockdown of SKA3 in CRC cells dramatically reduced cell growth rates and increased apoptosis. Depletion of SKA3 or DSN1 induced G2/M arrest and decreased migration, invasion, and anchorage-independent growth. AURKA and DSN1 are thus critical for chromosome 20q amplification-associated malignant transformation in CRA. Moreover, SKA3 at chromosome 13q was identified as a novel gene involved in promoting malignant transformation. Evaluating the expression of these genes may help identify patients with progressive adenomas, helping to improve treatment.

Natural products, such as fermented soybeans, have been used to treat various physical conditions, including cancer. MB-6 is a botanical preparation composed of fermented soybean extract, green tea extract, Antrodia camphorata mycelia, spirulina, grape seed extract, and curcumin extract. Based on this, we hypothesized that MB-6 would increase the effectiveness of chemotherapy in patients with colon cancer. In a rodent study, MB-6, in combination with leucovorin/5-fluorouracil chemotherapy, increased the survival rate and life span of colon cancer tumor-bearing BALB/c mice as compared with treatment with chemotherapy alone. In a proof-of-concept clinical study, 72 patients with metastatic colorectal cancer were randomized to receive leucovorin, 5-fluorouracil, and oxaliplatin in combination with either MB-6 or placebo for 16 weeks. The primary outcome was the best overall response, and secondary outcomes included progression-free survival, overall survival, and adverse effects. Up to 77 weeks after treatment, there was follow-up with the patients. No significant difference in the best overall response rate and overall survival was observed between the 2 groups. Patients in the MB-6 group had a significantly lower disease progression rate than patients in the placebo group, during the study period (0.0% vs 15.8%, P = .026). The placebo group had a significantly higher incidence of adverse events at least grade 4 compared with the MB-6 group (28.9% vs 2.9%, respectively, P = .004) and a significantly higher occurrence of increased serum creatinine compared with the MB-6 group (29% vs 5.9%, P = .014). MB-6 is a promising botanical supplement that may increase the effectiveness of chemotherapy in patients with metastatic colorectal cancer.