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The present study aimed to investigate in-depth a cytotoxic novel benzofuran-isatin conjugate (5a, 3-methyl-N'-(2-oxoindolin-3-ylidene)benzofuran-2-carbohydrazide) with promising potential anticancer activities in colorectal adenocarcinoma HT29 and metastatic colorectal cancer (CRC) SW620 cell lines. Thus, the primary cell events involved in tumorigenicity, tumor development, metastasis, and chemotherapy response were explored. Both CRC cell lines were exposed to different concentrations of Compound 5a and then subjected to real-time cell viability, migration, and invasion assays, colony formation and cytotoxicity assays, and flow cytometry for cell cycle analysis and apoptosis determination. Western blot and RT-qPCR were performed to assess the protein and transcript expression levels of epithelial-mesenchymal transition (EMT), cell cycle, and apoptosis markers. We showed that the Compound 5a treatment exhibited anticancer effects through inhibition of HT29 and SW620 cell viability, migration, and invasion, in a dose-dependent manner, which were associated with the upregulation of the tumor suppressor p53. Compound 5a also inhibited the colony formation ability of HT29 and SW620 cells and reversed EMT markers E-cadherin and N-cadherin expression. CRC cell exposure to Compound 5a resulted in a cell cycle arrest at the G1/G0 phase in HT29 cells and at the G2/M phase in SW620 cells, along with the downregulation of cyclin A1 expression, described to be involved in the S phase entry. Furthermore, Compound 5a-induced apoptosis was associated with the downregulation of the anti-apoptotic Bcl-xl marker, upregulation of pro-apoptotic Bax and cytochrome c markers, and increased mitochondrial outer membrane permeability, suggesting the involvement of mitochondria-dependent apoptosis pathway. In addition, the combination studies of Compound 5a with the main conventional chemotherapeutic drugs 5-fluorouracil, irinotecan, and oxaliplatin showed a more potent cytotoxic effect in both CRC cells than a single treatment. In conclusion, our findings described the interesting in vitro anticancer properties of Compound 5a, shown to have possible antitumor, antimetastatic, and pro-apoptotic activities, with the enhancement of the cytotoxic efficiency of conventional chemotherapeutic drugs. In vivo studies are requested to confirm the promising anticancer potential of Compound 5a for CRC therapy.

Background A considerable number of patients with colon cancer present with a colonic obstruction. The use of self-expanding metallic stents (SEMS) as a bridge to surgery (BTS) in potential curative patients with left-sided colonic cancer obstruction remains debatable. Therefore, this study aimed to investigate the 5-year oncological outcomes of using a SEMS as a BTS. Methods All patients with left-sided malignant colon obstruction who underwent curative surgery with no metastasis upon presentation between March 2009 and May 2013 were retrospectively reviewed and analyzed. Results A total of 45 patients were included, 28 patients underwent upfront surgery, and 17 patients had a stent as a bridge to surgery. T4 stage was statistically significantly higher in patients who had a SEMS as a BTS (35.3% vs. 10.7%) (p-value 0.043) . The mean duration in days of the SEMS to surgery was 13.76 (SD 10.08). TNM stage 3 was a prognostic factor toward distant metastasis (HR 5.05). When comparing patients who had upfront surgery to those who had a SEMS as a BTS, higher 5-year disease-free survival (75% vs. 72%) and 5-year overall survival (89% vs. 82%) were seen in patients who had upfront surgery. However, both were statistically insignificant. Conclusion Using self-expanding metallic stents as a bridge to surgery yields comparable 5-year survival and disease-free survival rates to upfront emergency surgery. The decision to use SEMS versus opting for emergency surgery should be made after careful patient selection and with the assistance of experienced endoscopists. Trial registration N/A.

Abstract Background: In this study, we aimed to identify the oncological outcomes in colon cancer patients who underwent elective versus emergency curative resection. Methods: All patients who underwent curative resection for colon cancer between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into two groups based on the presentation into elective and emergency groups. Results: A total of 215 patients with colon cancer were admitted and underwent curative surgical resection. Of those, 145 patients (67.4%) were elective cases, and 70 (32.5%) were emergency cases. Family history of malignancy was positive in 44 patients (20.5%) and significantly more common in the emergency group (P = 0.016). The emergency group had higher T and TNM stages (P = 0.001). The 3-year survival rate was 60.9% and significantly less in the emergency group (P = 0.026). The mean duration from surgery to recurrence, 3-year disease-free survival, and overall survival were 1.19, 2.81, and 3.11, respectively. Conclusion: Elective group was associated with better 3-year survival, longer overall, and 3-year disease-free survival compared to the emergency group. The disease recurrence rate was comparable in both groups, mainly in the first two years after curative resection.

Background: Crohn's disease (CD) is associated with malnutrition, an independent risk factor for surgical morbidity and mortality in more than 65% of patients, with a significant impact on disease outcomes. In this single-center retrospective cohort study, we aimed to investigate the impact of total parenteral nutrition (TPN) on the surgical outcomes of patients with CD. Methods: This study included patients with CD who underwent abdominal surgery. We compared patients who received preoperative total parenteral nutrition (TPN group) to those who did not (non-TPN group). Prolonged oral intolerance, albumin level <30 g/L, and body mass index <18.5 were the main indications for TPN. We evaluated postoperative surgical complications in both groups. Results: Between January 2010 and October 2018, 169 eligible patients underwent abdominal surgery. The TPN and non-TPN groups included 40 and 129 patients, respectively. The mean albumin level was significantly lower in the TPN group (P = 0.013). Laparoscopic surgery was performed in 76.9% of the patients, with a conversion rate of 11.6%. Infectious and non-infectious complications developed in 8.9% and 16% of patients, respectively. Surgical complications were comparable between the groups (P >0.05). Conclusions: Despite oral intake intolerance and severe disease in the TPN group, the surgical complications were comparable between the groups.

Colorectal cancer is a significant health concern in Saudi Arabia, ranking among the most common cancers and often presenting at advanced stages due to low early detection rates. Despite available screening tools, many cases are diagnosed late, leading to poor outcomes. The importance of early detection through screening cannot be overstated as it significantly improves prognosis and reduces mortality. This study was conducted as a cross-sectional survey in Riyadh from January to July 2024. It aimed to assess awareness and barriers to colorectal cancer screening among the general public. A self-administered questionnaire was distributed, yielding 768 eligible responses after applying exclusion criteria. The results revealed that, while 88% of respondents were aware of colorectal cancer, only 16% had undergone screening tests primarily via colonoscopy. Significant barriers to screening included a lack of physician recommendation, absence of a comprehensive national screening program and fear of complications from colonoscopy. Females were more likely to experience embarrassment and fair of pain as barriers compared to males. Additionally, residents of rural areas faced challenges related to the avalanche of screening facilities. These findings underscore the need for targeted public health interventions, including enhanced awareness campaigns and the development of a national CRC screening program to increase early detection rates and reduce the burden of colorectal cancer in Saudi Arabia.

Introduction: Colorectal cancer is a significant health concern in Saudi Arabia, ranking among the most common cancers and often presenting at advanced stages due to low early detection rates. Despite available screening tools, many cases are diagnosed late, leading to poor outcomes. The importance of early detection through screening cannot be overstated as it significantly improves prognosis and reduces mortality. Methods: This study was conducted as a cross-sectional survey in Riyadh from January to July 2024. It aimed to assess awareness and barriers to colorectal cancer screening among the general public. A self- administered questionnaire was distributed, yielding 768 eligible responses after applying exclusion criteria. Results: The results revealed that, while 88% of respondents were aware of colorectal cancer, only 16% had undergone screening tests primarily via colonoscopy. Significant barriers to screening included a lack of physician recommendation, absence of a comprehensive national screening program and fear of complications from colonoscopy. Females were more likely to experience embarrassment and fair of pain as barriers compared to males. Additionally, residents of rural areas faced challenges related to the avalanche of screening facilities. Conclusion: These findings underscore the need for targeted public health interventions, including enhanced awareness campaigns and the development of a national CRC screening program to increase early detection rates and reduce the burden of colorectal cancer in Saudi Arabia. Keywords: colon cancer screening, barriers, awareness

Background and Objectives: All-ceramic prosthesis is widely used in modern dental practice because of its improved physico-mechanical and optical properties. These restorations are exposed to coloring agents from various nutrition and beverages in the oral cavity. Long-term color stability is critical for the success of these restorative materials. The purpose of this in vitro study was to assess the effect of common beverages and mouthwash on the color stability of lithium disilicate (LD), monolithic zirconia (MZ) and bilayer zirconia (BZ) surfaces. Materials and Method: Thirty disc-shaped specimens from each material were fabricated; each group was subdivided (n = 10) according to coffee, green tea and chlorhexidine immersion solutions. The baseline color of ceramic discs was recorded according to the CIE L*a*b* system with a portable spectrophotometer. The second measurement was recorded after 3000 thermocycling and immersion in coloring agents for 7 days. The mean color difference was calculated and data were compared with Kruskal-Wallis and Mann-Whitney post hoc tests (0.05). Results: ΔE values for LD with the immersion of coffee, tea, and Chlorhexidine gluconate (CHG) were 1.78, 2.241 and 1.58, respectively. Corresponding ΔE values for MZ were 5.60, 5.19, and 4.86; marginally higher than the clinically acceptable level of 3.5. Meanwhile, BZ showed better color stability compared to MZ with ΔE values of 4.22, 2.11 and 1.43. Conclusions: Among the ceramics evaluated, LD ceramic was found to be more color stable, while MZ ceramics displayed a higher susceptibility to discoloration. MZ and BZ ceramic colors were significantly altered with coffee immersion, while LD ceramics were more affected by green tea.

Osteomyelitis (OM) is a serious bacterial bone infection and can be life-threatening if not treated promptly. A promising approach to manage OM involves using drug-loaded fibrous implants or scaffolds containing antibiotics, analgesics, or anti-osteoporosis medications to combat infection, reduce pain and promote bone healing, respectively. In this study, a coaxial electrospinning technology was employed to fabricate drug-loaded fibers encapsulating vancomycin hydrochloride (VAN), an antibiotic, and diclofenac sodium (DIC), an analgesic to prevent infection and alleviate post-surgical pain. The fibers were characterized using scanning electron microscopy (SEM) which indicated that the drug-loaded (DL) coaxial fibers had smooth surfaces and lacked beads and pores. The drug loading of the DL coaxial fibers was estimated by high-performance liquid chromatography (HPLC), and the results were calculated as 75 ± 4 µg/mL for VAN and 82 ± 3 µg/mL for DIC. The drug release was also measured by HPLC, which showed a rapid initial release, i.e., 59% for VAN and 75% for DIC within the first day, followed by a sustained slow release reaching approximately 92% and 79%, respectively after 264 h. The antimicrobial assay zone of inhibition confirmed the antibacterial activity of the DL fibers against Staphylococcus aureus . The cell viability assessments on the drugs alone against human dermal fibroblasts (HFF-1) demonstrated that the VAN and DIC combination is safe at concentrations up to 250 µg/mL but required careful dosing due to time-dependent cytotoxicity. Overall, the study highlights the potential use of VAN and DIC-loaded coaxial electrospun fibers as a localized drug delivery system for OM treatment, offering controlled drug release, effective antibacterial action, and biocompatibility.

Background Malignant colonic obstruction (MCO) occurs in 10–18% of colorectal cancers. Traditionally, emergency surgery has been the standard treatment modality. However, it is associated with higher morbidity and mortality rates compared to patients undergoing elective surgery. With the advancement of endoscopic techniques, the self-expandable metal stent has been advocated as an alternative management that provides relief of obstructive symptoms, allowing the patient’s general condition to be restored and enabling elective surgery. Furthermore, the ability to complete staging allowed identification and avoidance of unnecessary surgery in patients with advanced disease who need palliative measures. However, various stent-related complications have been reported in the literature, including perforation, migration, and obstruction. In this study, we aimed to evaluate the success and complication rates of stent placement in MCO and compare short-term outcomes to those of upfront surgical management. Methods We conducted a retrospective cohort study that included all patients with MCO between March 2015 and September 2021. Patients who had colon perforation at the time of the diagnosis, benign colonic obstruction, tumors of the rectum, or peritoneal metastasis that underwent cytoreductive surgery were all excluded. Patients were divided into groups according to the initial treatment, stent versus surgery, and the intent of therapy, curative versus palliative. Data was collected from medical records. Results Among 112 patients, 24 had stenting as a bridge to surgery (SBTS), and 16 underwent palliative stenting. The technical success rate was 95%, with failure in two patients due to complete obstruction and perforation in one patient each. Two patients (5%) who underwent stenting had clinical failure with persistent symptomatic obstruction beyond 48 h. The early complication rate following stent insertion was 8%, primarily due to perforation, obstruction from fecal impaction, and stent kinking. SBTS did not affect the laparoscopic approach or stoma creation rate among curative patients. However, it was associated with a more extended hospital stay. Half the patients who received stenting in the palliative group required re-stenting due to re-obstruction, with a mean stent patency time of 7 months. Conclusions Management of MCO varies based on the patient’s clinical presentation, tumor site, and surgeon’s preference. Stent placement, whether as a bridge to surgery or as a palliative measure, is a safe, less invasive, and effective management option with success and low complication rates.

Biologics, particularly anti-TNF agents, have transformed the management of inflammatory bowel disease (IBD), but concerns about their perioperative safety persist. This study evaluates the knowledge, attitudes, and practices of surgeons in Saudi Arabia regarding the preoperative management of IBD patients undergoing surgery while on biological treatments. A cross-sectional survey was conducted among 115 surgeons. Participants included general and colorectal surgeons with extensive experience in IBD management. Data were analyzed to assess knowledge, attitudes, and practices related to the impact of biologics, corticosteroids, and immunomodulators on wound healing and postoperative complications. The response rate of 67.8% and Most surgeons (74.4%) believed biologics negatively affect wound healing, despite evidence suggesting their safety. Corticosteroids were unanimously recognized for their adverse effects, while immunomodulators were widely perceived as safe. A majority preferred tapering biologics and corticosteroids 4 weeks preoperatively but continued immunomodulators. Differences between specialties were observed, with colorectal surgeons demonstrating greater adherence to evidence-based guidelines compared to general surgeons, who expressed more concerns about biologics' risks. This study identifies a persistent gap between evidence and practice in the perioperative management of IBD patients on biologics among Saudi surgeons, with general surgeons often stopping biologics due to safety concerns despite evidence of their safety, while colorectal surgeons are more likely to follow current guidelines. Unnecessary cessation may increase disease flare risk, highlighting the need for targeted education and multidisciplinary collaboration to optimize surgical outcomes.