In recent years, with continuous advancements in molecular biology and gene testing technologies, the diagnosis and treatment of colorectal cancer have been rapidly transitioning toward precision medicine. The application of molecular classification, target detection, and liquid biopsy technologies has driven ongoing updates to clinical guidelines. Multidisciplinary team colla-boration, innovations in precision surgical techniques, and the widespread adoption of neoadjuvant combination therapies have collectively promoted more individualized and scientific management of colorectal cancer. Looking ahead,the authors believe that as multi-omics biomarkers, organoid models, and artificial intelligence are increasingly integrated into clinical practice, precision diagnosis and treatment of colorectal cancer will deepen further, offering patients more efficient and personalized therapeutic options.

Objective:To analyze the clinical characteristics of locally advanced rectal cancer patients with pathological complete response (pCR) after neoadjuvant chemoradiotherapy combined with immunotherapy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 46 patients with locally advanced rectal cancer who were admitted to 6 medical centers, including Beijing Friendship Hospital of Capital Medical University et al, from June 2021 to November 2022 were collected. There were 29 males and 17 females, aged (61±4)years. Patients received neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitor therapy, and under-went radical total mesorectal excision during 6-12 weeks after radiotherapy. Observation indicators: (1) comparison of clinical characteristics between pCR and non-pCR patients;(2) postoperative complications and adverse reactions of pCR and non-pCR patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Comparison of clinical characteristics between pCR and non-pCR patients. Before neoadjuvant therapy, there were 14 cases aged ≥50 years and 6 cases aged <50 years in pCR patients, versus 25 cases and 1 case in non-pCR patients, showing a significant difference between the two groups ( P<0.05). After neoadjuvant therapy, cases in clinical stage T0, T1, T2, T3, T4 were 11, 1, 5, 3, 0 for pCR patients versus 7, 4, 2, 11, 2 for non-pCR patients, cases of tumor regression grade 1, 2, 3, 4 were 11, 8, 1, 0 for pCR patients versus 7, 14, 4, 1 for non-pCR patients, cases in low-risk, medium-risk, high-risk of neoadjuvant rectal scoring and grading were 20, 0, 0 for pCR patients versus 4, 18, 4 for non-pCR patients, respectively, showing significant differences in above indicators between the two groups ( Z=-2.256, -2.104, -5.458, P<0.05). (2) Postoperative complications and adverse reactions of pCR and non-pCR patients. Postoperative complications occurred in 2 cases of pCR patients and 5 cases of non-pCR patients, postoperative adverse reactions occurred in 11 cases of pCR patients and 10 cases of non-pCR patients, showing no significant difference between the two groups ( P>0.05). Conclusion:Compared with locally advanced rectal cancer patients aged ≥50 years, those aged <50 years have significant benefits from neoadjuvant chemoradiotherapy combined with immunotherapy. Clinical T staging and magnetic resonance imaging-detected tumor regression grade after neoadjuvant therapy have predictive value for patients with pCR .

In recent years, with continuous advancements in molecular biology and gene testing technologies, the diagnosis and treatment of colorectal cancer have been rapidly transitioning toward precision medicine. The application of molecular classification, target detection, and liquid biopsy technologies has driven ongoing updates to clinical guidelines. Multidisciplinary team colla-boration, innovations in precision surgical techniques, and the widespread adoption of neoadjuvant combination therapies have collectively promoted more individualized and scientific management of colorectal cancer. Looking ahead,the authors believe that as multi-omics biomarkers, organoid models, and artificial intelligence are increasingly integrated into clinical practice, precision diagnosis and treatment of colorectal cancer will deepen further, offering patients more efficient and personalized therapeutic options.

Objective:To analyze the clinical characteristics of locally advanced rectal cancer patients with pathological complete response (pCR) after neoadjuvant chemoradiotherapy combined with immunotherapy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 46 patients with locally advanced rectal cancer who were admitted to 6 medical centers, including Beijing Friendship Hospital of Capital Medical University et al, from June 2021 to November 2022 were collected. There were 29 males and 17 females, aged (61±4)years. Patients received neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitor therapy, and under-went radical total mesorectal excision during 6-12 weeks after radiotherapy. Observation indicators: (1) comparison of clinical characteristics between pCR and non-pCR patients;(2) postoperative complications and adverse reactions of pCR and non-pCR patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Comparison of clinical characteristics between pCR and non-pCR patients. Before neoadjuvant therapy, there were 14 cases aged ≥50 years and 6 cases aged <50 years in pCR patients, versus 25 cases and 1 case in non-pCR patients, showing a significant difference between the two groups ( P<0.05). After neoadjuvant therapy, cases in clinical stage T0, T1, T2, T3, T4 were 11, 1, 5, 3, 0 for pCR patients versus 7, 4, 2, 11, 2 for non-pCR patients, cases of tumor regression grade 1, 2, 3, 4 were 11, 8, 1, 0 for pCR patients versus 7, 14, 4, 1 for non-pCR patients, cases in low-risk, medium-risk, high-risk of neoadjuvant rectal scoring and grading were 20, 0, 0 for pCR patients versus 4, 18, 4 for non-pCR patients, respectively, showing significant differences in above indicators between the two groups ( Z=-2.256, -2.104, -5.458, P<0.05). (2) Postoperative complications and adverse reactions of pCR and non-pCR patients. Postoperative complications occurred in 2 cases of pCR patients and 5 cases of non-pCR patients, postoperative adverse reactions occurred in 11 cases of pCR patients and 10 cases of non-pCR patients, showing no significant difference between the two groups ( P>0.05). Conclusion:Compared with locally advanced rectal cancer patients aged ≥50 years, those aged <50 years have significant benefits from neoadjuvant chemoradiotherapy combined with immunotherapy. Clinical T staging and magnetic resonance imaging-detected tumor regression grade after neoadjuvant therapy have predictive value for patients with pCR .

Objectives:To explore the Clavien-Dindo (CD) classfication of short-term (within 30 days postoperative) complications of distal major gastrectomy (DG) and the associated risk factors affecting this classification.Methods:A retrospective analysis was conducted on the clinical data of 230 patients with gastric cancer who underwent DG completed by the same operator at Beijing Friendship Hospital, Capital Medical University from January 2016 to December 2021. There were 159 males (69.1%) and 71 females (30.9%), aged from 31 to 80 years, with an average age of (61.69±10.91) years, all patients average body mass index was (23.59±3.46) kg/m 2. Chi-square test or Fisher exact probability method was used to compare the count data between groups, and rank sum test was used to compare the rank data between groups. Multiple factors were analyzed by stepwise Logistic regression. Results:In this study, a total of 30 cases (13.0%) experienced CD grade Ⅱ or higher postoperative complications. Among them, 20 cases (66.7%) were grade Ⅱ, 8 cases (26.7%) were grade Ⅲ, and 2 cases (6.6%) were grade Ⅳ, Among the 30 patients with complications, there were 2 cases of simple anastomotic leakage, 2 cases of anastomotic bleeding, 3 cases of duodenal stump leakage, 2 cases of intra-abdominal infection, 6 cases of intestinal obstruction, 5 cases of pulmonary infection, 2 cases of incision infection, 2 cases of delayed gastric emptying, 3 cases of pulmonary infection combined with atelectasis, 2 cases of anastomotic leakage combined with intra-abdominal infection, and 1 case of pulmonary infection and intra-abdominal infection combined with intestinal obstruction. Pulmonary infection, intestinal obstruction, and anastomotic leakage were the main postoperative complications of DG. The surgical approach was an independent risk factor for postoperative complications ( P<0.05), and there was no statistically significant difference in the grade of postoperative complications of patients with different surgical methods( P>0.05). Conclusions:Pulmonary infection, intestinal obstruction, abdominal infection, and anastomotic leakage are the main postoperative complications of DG. The independent risk factor for complications is the surgical approach, but the surgical approach does not affect the CD grading of complications.

Objective To explore the sufentanil by adjusting the adenosine monosodium phosphate activa-ted protein kinase(AMPK)/thioredoxin interacting proteins(TXNIP)/nucleotide-binding oligomerization do-main-like receptor protein 3(NLRP3)signaling pathways of the alveolar epithelial cells induced by lipopo-lysaccharide to the dead.Methods Human alveolar epithelial type Ⅱ cell(AECⅡ)were cultured to logarith-mic phase.Then they were divided into control group(normal glucose culture),lipopolysaccharide group(li-popolysaccharide induced injury by 50 μg/mL),low concentration sufentanil group(20 μmol/L),high concen-tration sufentanil group(40 μmol/L),high concentration sufentanil(40 μmol/L)+AMPK-IN-3 group(50μmol/L AMPK inhibitors).MTT assay was used to detect cell proliferation.Pyroptosis was detected by Ho-echst 33342 and propidium iodide(PI)double staining.The levels of interleukin(IL)-1β,IL-18 and tumor nec-rosis factor-α(TNF-α)in cell supernatant were detected by enzyme-linked immunosorbent assay.Quantitative real-time PCR was used to detect the mRNA expression of focal death related factors cysteinyl proteinase-1(Caspase-1),apoptosis-associated speck-like protein(ASC),and gasdermin D(GSDMD).The protein expres-sion of AMPK,phosphorylated adenosine monosodium phosphate activated protein kinase(p-AMPK),TXNIP and NLRP3 were detected by Western blot.Results Compared with the control group,the survival rate of AEC Ⅱ cells in the lipopolysaccharide group decreased,the number of PI+positive cells increased,the release of inflammatory factors IL-1β,IL-18 and TNF-α increased,the expression of Caspase-1,ASC and GSDMD mR-NA increased,the expression of p-AMPK/AMPK decreased,and the expression of TXNIP and NLRP3 in-creased(P＜0.05).Compared with the lipopolysaccharide group,the survival rate of AEC Ⅱ cells in the low concentration sufentanil group and the high concentration sufentanil group increased,PI+positive cells de-creased,the release of inflammatory factors IL-1β,IL-18 and TNF-α decreased,the expression of Caspase-1,ASC and GSDMD mRNA decreased,the expression of p-AMPK/AMPK increased,and the expression of TX-NIP and NLRP3 decreased(P＜0.05).Compared with the high concentration sufentanil group,the survival rate of AEC Ⅱ cells in the high concentration sufentanil+AMPK-IN-3 group decreased,the number of PI+positive cells increased,the release of inflammatory factors IL-1β,IL-18 and TNF-α increased,the expression of Caspase-1,ASC and GSDMD mRNA increased,the expression of p-AMPK/AMPK decreased,and the ex-pression of TXNIP and NLRP3 increased(P＜0.05).Conclusion Sufentanil may improve lipopolysaccharide induced alveolar epithelial cell pyroptosis by regulating AMPK/TXNIP/NLRP3 signaling pathway.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Objective:To analyze the clinical characteristics of obese adolescents undergoing metabolic and bariatric surgery for the purpose to guide clinical decision-making and practice of metabolic and bariatric surgery in adolescents.Methods:The perioperative clinical profile of 123 adolescent patients under the age of 21 years who underwent metabolic and bariatric surgery in Beijing Friendship Hospital, Capital Medical University from 2018 to 2021 were extracted, and compared their clinical data with the overall data of 6807 patients in the 2021 GC-MBD Annual Report. Analyzed the clinical characteristics of adolescent weight loss metabolic surgery patients from multiple aspects such as preoperative complications, surgical methods, surgical outcomes, and follow-up. Statistical analysis was conducted using SPSS25.0 software.Results:Among adolescent bariatric surgery patients, the proportion of female patients (74.0%) was higher than that of male patients (26.0%). Except for the incidence of polycystic ovary syndrome (31.9%), which was higher than the overall rate, the proportion of other related diseases or symptoms was low and usually mild. The changes of systolic blood pressure ( Z=-5.73, P<0.001), body weight ( Z=-5.69, P<0.001), umbilical abdominal circumference ( Z=-2.40, P=0.017), glycosylated hemoglobin ( Z=-5.23, P<0.001), fasting insulin ( Z=-2.95, P<0.003), fasting C-peptide ( Z=-4.59, P<0.001), triglyceride ( Z=-2.75, P=0.006) at 3 months after operation were statistically significant compared with those before operation. The changes of systolic blood pressure ( Z=-3.42, P=0.001), body weight ( Z=-5.14, P<0.001), umbilical abdominal circumference ( Z=-2.86, P=0.004) and glycosylated hemoglobin ( Z=-2.67, P<0.008), fasting C-peptide ( Z=-2.09, P=0.037), high-density lipoprotein ( Z=-2.08, P=0.038) at 6 months after operation were statistically significant compared with those before operation. Conclusions:The outcomes of bariatric surgery in obese adolescents are similar to those in adults. The indications and timing of bariatric surgery need to be further explored. In view of the high proportion of females, poor self-management ability and low follow-up compliance of adolescent patients, it is urgent to construct a full-cycle care model suitable for adolescent patients with bariatric surgery to improve their self-management ability, follow-up compliance and long-term clinical outcomes.

Objective:To investigate the incidence and influencing factors of parastomal hernia in patients with permanent colostomy.Methods:The retrospective cohort study was conduc-ted. The clinicopathological data of 72 patients with permanent colostomy in the Beijing Friendship Hospital of Capital Medical University from January 2016 to June 2020 were collected. There were 50 males and 22 females, aged (66±12)years. Observations indicators: (1) follow-up; (2) analysis of factors affecting the incidence of parastomal hernia; (3) comparison of the incidence of parastomal hernia in patients with different age. Follow-up was conducted using outpatient examination. Patients were followed up once every 12 months after surgery to detect the incidence of parastomal hernia up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers and percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model. Kaplan-Meier method was used to draw the parastomal hernia occurrence curve and calculate the incidence rate of parastomal hernia and Log-rank test was used to analyze the incidence of parastomal hernia. Results:(1) Follow-up. All 72 patients were followed up for 23(range, 12?76)months. During the follow-up, there were 31 patients developed parastomal hernia, with the incidence as 20.8%(15/72), 36.1%(26/72) and 43.1%(31/72) at postoperative 1 year, postoperative 2 year and postoperative 5 year, respectively. Of the 31 patients with parastomal hernia, there were 21 cases of type Ⅰ, 3 cases of type Ⅱ and 7 cases of type Ⅲ. Patients with parastomal hernia recovered with conservative treatment. (2) Analysis of factors affecting the incidence of parastomal hernia. Results of univariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were related factors affecting the incidence of parastomal hernia ( χ2=7.98, t=?2.95, 2.02, P<0.05). Results of multivariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were independent factors affecting the incidence of parastomal hernia ( odds ratio=4.07, 3.19, 0.07, 95% confidence interval as 1.46?11.32, 1.43?7.09, 0.01?0.84, P<0.05). (3) Comparison of the incidence of parastomal hernia in patients with different age. Of the 72 patients, there were 37 cases with age <65 years and 35 cases with age >65 years. Of the 31 patients with parastomal hernia, there were 10 cases with age<65 years and all of them with type Ⅰ parastomal hernia, and the incidence of parastomal hernia in postoperative 1 year and postoperative 2 year was 13.5%(5/37) and 27.0%(10/37), respectively. There were 21 cases with age ≥65 years and cases with type Ⅰ, type Ⅱ and type Ⅲ parastomal hernia were 11, 3 and 7, respectively. The postoperative 1 year and postoperative 2 year incidence of parastomal hernia in the 21 cases was 28.6%(10/35) and 45.7%(16/35), respectively. There was a significant difference in the incidence of parastomal hernia between patients<65 years and ≥65 years ( χ2=9.28, P<0.05). Conclusion:Age, subcutaneous fat thickness and rectus abdominis thickness are independent factors affecting the incidence of parastomal hernia.

Objective Radiation safety of emergency repair personnel in the reactor cabin under the natural circulation condition of the reactor is studied, the radiation protection method of emergency repair personnel in the reactor cabin is described, which provides a theoretical reference for personnel radiation protection and emergency repair time control. Methods The radiation was simulated by the Monte Carlo method for emergency repair personnel in the reactor cabin under the natural circulation condition of the reactor, and the radiation was also analyzed with the radiation data measured by experiments in the reactor cabin under the natural circulation condition of the reactor. Results The neutron dose of external irradiation about reactor simulated computation was 140 μSv/h, and gamma radiation dose rate was 48 μSv/h. By experiment and calculation, the effective dose received by emergency repair personnel in the 30-minutein the reactor cabin was 2.2 mSv. Conclusions Under the natural circulation condition of the reactor, the gamma radiation is harmful to emergency repair personnel, but the focus of protection is different locations for maintenance. It's safe for emergency personnel to repair the reactor in 30 minutes in turn, wearing the respirators.