Objective:This report presents the initial outcomes of endoscopic intermuscular dissection (EID), a novel technique introduced by our team for the diagnostic resection of early rectal cancer, focusing on the postoperative status of the vertical margins.Methods:On January 26, 2024, a patient with early rectal cancer (cT1-2N0M0) underwent Endoscopic Intermuscular Dissection. The EID procedure consists of six steps: (1) mucosal incision; (2) submucosal dissection; (3) superficial muscular layer incision; (4) intermuscular dissection; (5) complete tumor removal; (6) wound management.Results:The patient was a 70-year-old male with rectal cancer (cT1-2N0M0). The tumor was located on the left anterior wall of the rectum, approximately 9 cm from the anal margin, and measured 20mm in size. The dissection rate was 2.68 mm2/minute, and the total duration of the surgery was 109 minutes. The patient was successfully discharged on the fifth day after surgery. Pathological examination of the post-endoscopic surgery specimen revealed pT1b, with negative vertical margins. Follow-up after more than one month showed good recovery with no complications such as bleeding, perforation, infection, or stricture occurring. Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation.Conclusion:Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.

Objective:This report presents the initial outcomes of endoscopic intermuscular dissection (EID), a novel technique introduced by our team for the diagnostic resection of early rectal cancer, focusing on the postoperative status of the vertical margins.Methods:On January 26, 2024, a patient with early rectal cancer (cT1-2N0M0) underwent Endoscopic Intermuscular Dissection. The EID procedure consists of six steps: (1) mucosal incision; (2) submucosal dissection; (3) superficial muscular layer incision; (4) intermuscular dissection; (5) complete tumor removal; (6) wound management.Results:The patient was a 70-year-old male with rectal cancer (cT1-2N0M0). The tumor was located on the left anterior wall of the rectum, approximately 9 cm from the anal margin, and measured 20mm in size. The dissection rate was 2.68 mm2/minute, and the total duration of the surgery was 109 minutes. The patient was successfully discharged on the fifth day after surgery. Pathological examination of the post-endoscopic surgery specimen revealed pT1b, with negative vertical margins. Follow-up after more than one month showed good recovery with no complications such as bleeding, perforation, infection, or stricture occurring. Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation.Conclusion:Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.

Objective:To investigate the predictive value of the quantitative parameters of dual-layer detector spectral CT in arterial and venous phases for the differentiation degree and the E-cadherin protein expression of gastric cancer.Methods:This was a cross-sectional study. The preoperative data from the dual-layer detector spectral CT images among 183 patients with gastric adenocarcinoma confirmed by operation and pathology was retrospectively analyzed from October 2021 to October 2022 in the First Affiliated Hospital of Fujian Medical University. According to the differentiation degree and E-cadherin protein expression of gastric cancer, all patients were divided into the moderately well differentiated group ( n=82) and the poorly differentiated group ( n=101), as well as the E-cadherin-negative group ( n=80) and the E-cadherin-positive group ( n=103). The CT images in arterial and venous phases were used to reconstruct the virtual monoenergetic images (VMI) at 40, 50, 60, 70, 80, 90, and 100 keV, effective atomic number (Z eff) images and iodine concentration (IC) images. The CT values (CT keV) from VMI, Z eff and IC were measured, and the normalized Z eff (NZ eff) and the normalized IC (NIC) were calculated. Independent-sample t test or Mann-Whitney U test were used to compare the differences in quantitative parameters between groups. The logistic regression analysis was used to screen for the independent predictors, after which a combined prediction model was constructed. The receiver operating characteristic curves were used to evaluate the predictive efficiency of the parameters for the differentiation degree and the E-cadherin protein expression of gastric cancer. Results:There were statistically significant differences in CT 40 keV to CT 70 keV, NZ eff and NIC in dual-phase, as well as Z eff and IC in the venous phase between the moderately well differentiated group and the poorly differentiated group ( P<0.05). The combined prediction model was constructed by CT 40 keV ( OR=1.03, 95% CI 1.02-1.05, P<0.001) in arterial phase and CT 40 keV ( OR=1.05, 95% CI 1.03-1.07, P<0.001) and Z eff ( OR=1.32, 95% CI 1.06-1.65, P=0.015) in venous phase, of which the area under the curve (AUC) for the prediction of the moderately-well group and the poor group was 0.932 (95% CI 0.897-0.967), with a sensitivity of 90.1% and a specificity of 85.4%. Between the E-cadherin-negative group and the E-cadherin-positive group, CT 40 keV and NZ eff in arterial phase, as well as CT 40 keV to CT 70 keV, Z eff, NZ eff, IC and NIC in venous phase, had statistically significant differences ( P<0.05). The AUC for the combined prediction model established by CT 40 keV ( OR=1.02, 95% CI 1.01-1.04, P<0.001) and Z eff ( OR=1.33, 95% CI 1.09-1.63, P=0.006) in venous phase was 0.800 (95% CI 0.736-0.864), with a sensitivity of 95.0% and a specificity of 60.2%. Conclusion:The combined prediction model from the quantitative parameters of dual-layer spectral detector CT can be used to predict the differentiation degree and the E-cadherin protein expression of gastric cancer preoperatively.

Objective:To investigate the feasibility of individualized primary clinical target volume (CTV) delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).Methods:Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed. Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall. According to the tumor spread, the primary CTV was optimized as follows: CTV2 only covered the medial part of the contralateral pterygopalatine fossa, whereas the contralateral foramen oval was not included; on the level of parapharyngeal space, the contralateral side of CTV only covered the posterior lateral lymph nodes, whereas the contralateral internal jugular vein was not regularly covered. Failure patterns and 5-year survival [local control rate (LCR), progression-free survival (PFS) and overall survival (OS)] were evaluated by Kaplan-Meier method. Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions. Results:The median follow-up time was 59.5 months. The 5-year LCR, PFS, and OS were 98.9%, 86.5% and 92.1%, respectively. There was no local recurrence in the optimized area of CTV. Dosimetric comparison results showed that the doses of parotid gland, temporal lobe, cochlea and middle ear on the contralateral side were reduced by 13.45%, 9.14%, 38.83%, and 29.36%, respectively. Four cases (4.6%) developed grade 3 hearing loss, all on the ipsilateral side. The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side ( P<0.001). Other grade 3 late adverse reactions included cranial nerve injury, subcutaneous fibrosis in the neck and visual impairment, with 1 case each. Conclusion:Individualized primary CTV for lateralized NPC is feasible and safe, with obvious dosimetric advantages and reduced adverse reaction rate, which is worthy of clinical promotion.

The widespread of tigecycline resistance gene tet(X4) has a serious impact on the clinical efficacy of tigecycline. The development of effective antibiotic adjuvants to combat the looming tigecycline resistance is needed. The synergistic activity between the natural compound β-thujaplicin and tigecycline in vitro was determined by the checkerboard broth microdilution assay and time-dependent killing curve. The mechanism underlining the synergistic effect between β-thujaplicin and tigecycline against tet(X4)-positive Escherichia coli was investigated by determining cell membrane permeability, bacterial intracellular reactive oxygen species (ROS) content, iron content, and tigecycline content. β-thujaplicin exhibited potentiation effect on tigecycline against tet(X4)-positive E. coli in vitro, and presented no significant hemolysis and cytotoxicity within the range of antibacterial concentrations. Mechanistic studies demonstrated that β-thujaplicin significantly increased the permeability of bacterial cell membranes, chelated bacterial intracellular iron, disrupted the iron homeostasis and significantly increased intracellular ROS level. The synergistic effect of β-thujaplicin and tigecycline was identified to be related to interfere with bacterial iron metabolism and facilitate bacterial cell membrane permeability. Our studies provided theoretical and practical data for the application of combined β-thujaplicin with tigecycline in the treatment of tet(X4)-positive E. coli infection.
Humans ; Tigecycline/pharmacology* ; Escherichia coli/metabolism* ; Reactive Oxygen Species/therapeutic use* ; Plasmids ; Anti-Bacterial Agents/metabolism* ; Escherichia coli Infections/microbiology* ; Bacteria/genetics* ; Microbial Sensitivity Tests

Objective To explore the effect of ultrasound guided percutaneous dilatation tracheotomy in critical ill patients.Methods From January 2016 to January 2018,95 critical ill patients who were treated in the People's Hospital of Quzhou were selected.According to the random number table method,they were divided into control group (n =47) and observation group (n =48).The patients in the control group were treated with traditional tracheotomy,and the patients in the observation group were treated with percutaneous dilatation tracheotomy under ultrasonic guidance.The operation condition of the two groups was observed,including operative bleeding volume,operative time,incision length,extubation time,incision healing time,hospitalization time and so on.The postoperative complications and mortality were recorded in the two groups.Results The operative bleeding volume,operative time,incision length and incision healing time in the observation group were (12.91 ± 1.36) mL,(10.05 ± 1.14) min,(1.46 ± 0.32) cm,(5.48 ±0.39)d,respectively,which were lower than those in the control group[(38.54 ± 3.47)mL,(27.43 ±2.29) min,(3.25 ± 0.68) cm,(7.64 ± 0.72) d],there were statistically significant differences between the two groups(t =40.098,39.616,13.888,15.381,P =0.000,0.000,0.000,0.000).The extubation time,hospitalization time in the observation group were (14.19 ± 1.14)d,(20.17 ± 1.85)d,respectively,which in the control group were (14.23 ± 1.17) d,(20.26 ± 1.89) d,respectively,there were no statistically significant differences between the two groups (t =0.142,0.198,P =0.886,0.843).The incidence rate of postoperative complications in the observation group was 6.25％,which was lower than 21.28％ in the control group,there was statistically significant difference between the two groups (x2 =9.515,P =0.002).The ICU mortality and hospitalization mortality in the observation group were 2.08％ and 4.17％,respectively,which in the control group were 10.64％ and 12.77％,respectively,there were no statistically significant differences between the two groups (x2 =2.937,2.277,P =0.087,0.131).Conclusion Ultrasound guided percutaneous dilatation tracheostomy can improve operation condition,reduce hospitalization time,and has less complications,low mortality,which has good clinical value in critical ill care.

Objective? To investigate the effect of Team collaboration management program on the metabolic syndrome in schizophrenic patients. Methods? From March 2017 to March 2018, the schizophrenic patients with metabolic syndrome who were admitted in Shanghai Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine were selected as the participants of this study and divided into observation group (n=45) and control group (n=47) according to the time of admission. The two groups were both given routine treatment and nursing care in psychiatric department. Besides of that, the team collaboration management program was implemented in the observation group. Assessments were done before intervention and 16 weeks after intervention using related metabolic parameters, the Brief Scale of World Health Organization Quality of Life (WHOQOL-BREF) and the Positive and Negative Symptoms Scale (PANSS). Results? There was no significant difference in metabolic parameters, WHOQOL-BREF and PANSS scores between the two groups before intervention (P＞0.05). After 16 weeks of intervention, patients' fasting blood sugar level, body weight, waist circumference, triglyceride, high density lipoprotein and systolic pressure in the observation group were lower than those in the control group, and the difference was statistically significant (P＜0.05). The scores of"physical health" and "psychological function" in WHOQOL-BREF in the observation group were higher than those in the control group, meanwhile, the scores of "positive and general pathological symptoms" in PANSS in the observation group were lower than those in the control group, both with statistical significance (P＜0.05). Conclusions? Team collaboration management program can help controlling the related metabolic parameters of the schizophrenic patients with metabolic syndrome effectively, improve their quality of life and promote recovery from their mental symptoms.

Objective: To investigate the expression of grainyhead like 2 (GRHL 2) gene in human colorectal cancer (CRC) tissues and cells, and to explore the effects of GRHL 2 gene silence on the proliferation and cell cycle of CRC cells. Methods: The expression level of GRHL2 mRNA in CRC tissues and their para-cancerous normal tissues as well as CRC cells (HT29, SW480, SW1116, SW620, HCT116, Caco2 and LoVo cells) was detected by real-time fluorescent quantitative PCR. After the recombinant lentivirus carrying GRHL2-shRNA was infected into HT29 and HCT116 cells, the cell proliferation was determined by CCK-8 method and cloning formation assay, the cell cycle distribution was detected by FCM, and the expressions of cell cycle-related proteins (cyclin A, cyclin D1, p21 and p27) were determined by Western blotting. Furthermore, the subcutaneous transplantation models of CRC HT29 and HCT116 cells were established in nude mice, then the effect of GRHL 2 gene silencing on the growth of colorectal cancer xenografts was observed. Results: The expression level of GRHL2 mRNA in CRC tissues was higher than that in paracancerous normal tissues (2.8 times, P < 0.001). GRHL2 mRNA was highly expressed in most CRC cells (HT29, SW480, HCT116, Caco2 and LoVo cells). The expression levels of GRHL2 mRNA and protein in HT29 and HCT116 cells were down-regulated after transfection of GRHL2-shRNA (both P < 0.001). Silencing GRHL 2 gene significantly suppressed cell proliferation (both P < 0.05), produced the cell cycle arrest in G1 phase (both P < 0.01), down-regulated the expressions of cyclin A and cyclin D1 (P < 0.05, P < 0.01), and upregulated the expressions of p21 and p27 (P < 0.01, P < 0.05). Meanwhile, GRHL 2 gene silencing significantly promoted the growth of colorectal cancer xenografts in nude mice. Conclusion: GRHL2 maybe promote the proliferation of CRC cells by regulating the expression of cell cycle-related proteins.

OBJECTIVETo investigate the role of miR-26b in the invasion and metastasis of colorectal cancer.

METHODSData of public chip databases were extracted to analyze the relationship between miR-26b expression and lymph node metastasis. Two types of colorectal cancer cell lines, Caco2 and DLD1, were selected, and the miR-26b-high colorectal cancer cell line was constructed using the method of lentivirus infection. The effects of up-regulating miR-26b expression on the invasion and metastasis of colorectal cancer cells were analyzed by Transwell migration and invasion experiment and wound healing assay. The effect of up-regulating miR-26b expression on stem cell phenotype of colorectal cancer cells was analyzed by sphere-formation assay.

RESULTSThe microarray detection results showed that the expression of miR-26b in tumor tissues of patients with lymph node metastasis was significantly higher than those without lymph node metastasis[(12.04±0.20) vs. (11.31±0.19), t=2.646, P = 0.010]. In the in vitro experiment section, the Transwell experiment results showed that the number of invasive cells [(16.40±1.36) vs. (3.80±0.86), t=7.814, P=0.000] and migrating cells [(33.40±2.93) vs. (8.80±2.40), t=6.505, P=0.000] in miR-26b-high colorectal cancer cells was significantly higher as compared to miR-26b-low cells(all P<0.05). Would healing assay also confirmed that the migration speed of miR-26b-high colorectal cancer cells was significantly accelerated. Both the rate and the density of sphere formation were higher in miR-26b-high colorectal cancer cells than those in miR-26b-low colorectal cancer cells [Caco2:(168.3±11.7) vs. (54.2±10.8), t=7.185,P=0.002; DLD1:(4 076.0±409.8) vs.(1 613.0±210.1), t=5.349, P=0.006].

CONCLUSIONmiR-26b may promote the invasion and metastasis of colorectal cancer by accelerating the migration and invasion of colorectal cancer cells and enhancing the stem cell phenotype of tumor cells.

Caco-2 Cells ; Cell Line, Tumor ; Cell Movement ; physiology ; Cell Proliferation ; Colorectal Neoplasms ; genetics ; pathology ; Gene Expression Regulation, Neoplastic ; Humans ; MicroRNAs ; genetics ; metabolism ; Neoplasm Invasiveness ; Neoplasm Metastasis

Objective To evaluate the treatment outcome, prognostic factors, radiation dose, and toxicities in patients with early-stage primary diffuse large B-cell lymphoma of Waldeyer's ring (WR-DLBCL) treated with intensity-modulated radiotherapy (IMRT).Methods This study included 80 patients with a confirmed diagnosis of stage Ⅰ-Ⅱ primary WR-DLBCL who were admitted to our hospital from 2008 to 2015.Only 3 patients received radiotherapy alone, and the other patients received radiotherapy and chemotherapy.After chemotherapy, 24 patients achieved complete remission (CR), and 53 patients achieved partial remission (PR).IMRT was given to the primary lesion and cervical lymphatic drainage region.Survival analysis was performed using the Kaplan-Meier method and log-rank test.The Cox model was used for analysis of prognostic factors.The toxicities were scored using the RTOG criteria.Results The median follow-up was 64 months.The 5-year locoregional control (LRC), overall survival (OS), and progression-free survival (PFS) rates were 94%, 88%, and 84%, respectively.The dose-volume histogram showed that the maximum, mean, and minimum doses to primary gross tumor volume were 54.47 Gy, 52.27 Gy, and 38.83 Gy, respectively.Prognostic analysis showed that age>60 years and increased lactate dehydrogenase (LDH) were influencing factors for OS (P=0.009 and 0.002), and that aged>60 years, IPI ≥2, and increased LDH were influencing factors for PFS (P=0.001, 0.035, and 0.007).Among all patients, 12, 53, and 8 experienced grade 1-3 radiation-induced acute oral mucositis, respectively, and 16 and 13 experienced grade 1 and 2 xerostomia as the late toxicity, respectively.Conclusions For patients with early-stage primary WR-DLBCL, IMRT results in satisfactory OS, PFS, and LRC and has tolerable early or late radiation-induced toxicities.