Abstract Aim This study aimed to evaluate the expression levels of miR-99b and miR-135b in peritoneal carcinoma and liver metastases associated with Colorectal Cancer (CRC), assess their association with the intracellular signaling pathway proteins Kirsten Rat Sarcoma Virus (KRAS) and Akt, and investigate their effects on survival. Materials and methods Changes in the KRAS gene and Akt proteins, expression levels of miR-99b and miR-135b, and factors affecting survival were compared between colorectal cancer-associated peritoneal carcinomatosis and liver metastasis. Results The expression levels of miR-99b and miR-135b and the immunohistochemical grade classification score of Akt were higher in colorectal cancer, peritoneal carcinomatosis, and liver metastasis than in normal tissues (p< 0.05). MiR-99b expression was highest in CRC, whereas miR-135b expression was highest in peritoneal carcinomatosis (p< 0.05). The expression level of miR-99b decreased and that of miR-135b increased in peritoneal and liver metastases compared with that in the tumor tissue. MiR-99b, Akt, and recurrence were risk factors that affected the overall survival rate in the model of clinical predictions (p= 0.045, p= 0.006, and p= 0.012, respectively). Conclusion While the expression of miR-99b was highest in the primary tumor, its decrease in liver metastasis and peritoneal carcinomatosis suggests that miR-99b has a protective effect against liver metastasis and peritoneal carcinomatosis. However, the detection of miR-135b expression was highest in peritoneal carcinomatosis and liver metastasis compared with that in the colorectal cancer tissues suggesting that it facilitates peritoneal carcinomatosis and liver metastasis. Furthermore, miR-99b, KRAS mutations, and Akt are risk factors for the overall survival of colorectal cancer.

ABSTRACT BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients’ data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.

Background: The ideal sedative agent for endoscopic procedures should allow a rapid modification ofthe sedation level and should not have any adverse effects. Aim: To evaluate and compare the efficacy, safety, cost and patient satisfaction of some propofol-based sedation regimens administered during colonoscopy. Material and Methods: One hundred twenty one patients scheduled for elective outpatient colonoscopy with conscious sedation were randomized to four groups to evaluate the administration of dexmedetomidine, sufentanil, meperidine and midazolam in combination with propofol to maintain sedation during the procedure. Evaluated outcomes were efficacy, safety, cost and patient satisfaction of sedation procedures. Results: Patients receiving dexmedetomidine achieved a higher degree of sedation when compared with the other groups (p < 0.05). The lapse to recoverprotective reflexes and motor function, was significantly shorter in groups receiving dexmedetomidine or sufentanil than in groups receiving meperidine or midazolam (p < 0.05). Therewere no differences between groups in pre-sedation and post-sedation neurophysiologic performance, measured by the Trail MakingA and B tests. Conclusions: Sedation for endoscopy can be safely and effectively accomplished with low doses of propofol combined with dexmedetomidine, intranasal sufentanil, IV meperidine and IV meperidine with midazolam.

Antecedentes: El protocolo de sedación ideal para procedimientos endoscópi-cos es aquel que permita efectuar modificaciones rápidas del nivel de sedación y no tenga efectos secundarios. Objetivo: Comparar la eficacia, seguridad, costos y satisfacción del paciente con protocolos de sedación basados en propofol, durante colonoscopias. Material y Métodos: Ciento veinte pacientes programados para una colonoscopia fueron aleatorizados en cuatro grupos en que se evaluó la administración de dexmedetomidina, sufentanil, meperidina y midazolam en combinación con propofol, para mantener la sedación durante el procedimiento. Se evaluó la eficacia, seguridad, costo y satisfacción del paciente con los diferentes protocolos de sedación. Resultados: Los pacientes que recibieron dexmedetomidina, alcanzaron un mayor nivel de sedación que el resto de los grupos. El lapso necesario para recuperar reflejos y funciones motoras protectoras, fue significativamente menor en los grupos que recibieron dexmedetomidina o sufentanil comparado con los grupos que recibieron meperidina o midazolam (p < 0,05). No hubo diferencias entre los grupos en la capacidad neuro-cognitiva, medida con los Tests de Reitan A y B, antes o después de la sedación. Conclusiones: Se puede obtener una buena sedación para endoscopia combinando dosis bajas de propofol con dexmedetomidina, sufentanil intranasal, meperidina endovenosa con o sin midazolam.