The abdominoperineal excision (APE) is still one of the standard operations for low rectal cancer. The exralevator APE can reduce the positive rate of circumferential margin and perforation rate of rectal cancer, but the incidence of postoperative complications is relatively high. With the continuous development of minimally invasive surgery, the transperineal minimally invasive Abdominoperineal excision (Tpm-APE) is proposed. Compared with traditional APE, the Tpm-APE has potential technical advantages, but there is a lack of large sample and multicenter clinical research evidence. The authors share the design and results of an international multicenter clinical study to investigate the clinical practice of Tpm-APE in the treatment of low rectal cancer.

Objective To investigate whetherthe extract of HUANGPI inhibitthe secretion of TNF-αvia TLR4/MyD88/TRAF6 signaling pathway. Methods ELISA assay was performed to determine TNF-α level in cell culture medium. MTT assay was used to detect the effects of the extract of HUANGPI and LPS on the viabilities of RAW 264.7 cells. Proteinexpressions of TLR4 and TRAF6 were detected by Western blotting assay. Results The extract of HUANGPI inhibited the secretion of TNF-αin a dose-dependent manner. Compared to LPS group , were TNF-αwas significantly suppressed in the cells in LPS+MyD88 inhibitor group , LPS+extract group and LPS+extract+MyD88 inhibitor group,with the corresponding reductions of TLR4 and TRAF6 protein expression at74% and21%,70% and27%,44% and8.5%, respectively. Conclusion MYD88-dependent signaling pathway might be involved in the mechanism underlying the effect of the extract of HUANGPI on suppressing LPS-induced inflammation.