Comparison of anal function and quality of life after conformal sphincter preservation operation and intersphincteric resection of very low rectal cancer: a multicenter, retrospective, case-control analysis.

PURPOSE: Conformal sphincter preservation operation (CSPO) is a sphincter preservation operation for very low rectal cancers. Compared to intersphincteric resection (ISR), CSPO retains more dentate line and distal rectal wall, and also avoids damaging the nerves in the intersphincteric space. This study aimed to compare the postoperative anal function and quality of life between the CSPO and ISR. METHOD: Patients with low rectal cancer undergoing CSPO (n = 117) and ISR (n = 66) were included from Changhai and Huashan Hospital, respectively, between 2011 and 2020. A visual analog scale (range 0-10) was utilized to evaluate satisfaction with anal function and quality of life. The anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score. Quality of life was evaluated with the EORTC QLQ-C30 and QLQ-CR38. RESULTS: The CSPO group had more male patients (65.8% vs. 50%, p = 0.042), more preoperative chemoradiotherapy (33.3% vs. 10.6%, p < 0.001), lower tumor position (3.45 ± 1.13 vs. 4.24 ± 0.86 cm, p < 0.001), and more postoperative chemotherapy (65% vs. 13.6%, p < 0.001) compared to the ISR group. In addition, CSPO patients had shorter postoperative stay (6.63 ± 2.53 vs. 7.85 ± 4.73 days, p = 0.003) and comparable stoma reversal rates within 1 year after surgery (92.16% vs. 96.97%, p = 0.318). Multivariable analysis showed that CSPO significantly contributed to higher satisfaction with anal function (beta = 1.752, 95% CI 0.776-2.728) and with quality of life (beta = 1.219, 95% CI 0.374-2.064), but not to Wexner, LARS score, or EORTC QLQ-C30 and QLQ-CR38. CONCLUSION: CSPO improved the satisfaction with anal function and quality of life but utilized more preoperative chemoradiotherapy. CSPO may be an alternative choice for patients with very low rectal cancers in better physical health and with higher requirements for anal function and quality of life.

[The impact of extended waiting time on tumor regression after neoadjuvant chemoradiotherapy for locally advanced rectal cancer].

Objective: To investigate the influence of extending the waiting time on tumor regression after neoadjuvant chemoradiology (nCRT) in patients with locally advanced rectal cancer (LARC). Methods: Clinicopathological data from 728 LARC patients who completed nCRT treatment at the First Affiliated Hospital, Naval Medical University from January 2012 to December 2021 were collected for retrospective analysis. The primary research endpoint was the sustained complete response (SCR). There were 498 males and 230 females, with an age (M(IQR)) of 58 (15) years (range: 22 to 89 years). Logistic regression models were used to explore whether waiting time was an independent factor affecting SCR. Curve fitting was used to represent the relationship between the cumulative occurrence rate of SCR and the waiting time. The patients were divided into a conventional waiting time group (4 to <12 weeks, n=581) and an extended waiting time group (12 to<20 weeks, n=147). Comparisons regarding tumor regression, organ preservation, and surgical conditions between the two groups were made using the t test, Wilcoxon rank sum test, or χ2 test as appropriate. The Log-rank test was used to elucidate the survival discrepancies between the two groups. Results: The SCR rate of all patients was 21.6% (157/728). The waiting time was an independent influencing factor for SCR, with each additional day corresponding to an OR value of 1.010 (95%CI: 1.001 to 1.020, P=0.031). The cumulative rate of SCR occurrence gradually increased with the extension of waiting time, with the fastest increase between the 10th week. The SCR rate in the extended waiting time group was higher (27.9%(41/147) vs. 20.0%(116/581), χ2=3.901, P=0.048), and the organ preservation rate during the follow-up period was higher (21.1%(31/147) vs. 10.7%(62/581), χ2=10.510, P=0.001). The 3-year local recurrence/regrowth-free survival rates were 94.0% and 91.1%, the 3-year disease-free survival rates were 76.6% and 75.4%, and the 3-year overall survival rates were 95.6% and 92.2% for the conventional and extended waiting time groups, respectively, with no statistical differences in local recurrence/regrowth-free survival, disease-free survival and overall survival between the two groups (χ2=1.878, P=0.171; χ2=0.078, P=0.780; χ2=1.265, P=0.261). Conclusions: An extended waiting time is conducive to tumor regression, and extending the waiting time to 12 to <20 weeks after nCRT can improve the SCR rate and organ preservation rate, without increasing the difficulty of surgery or altering the oncological outcomes of patients.

Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer.

BACKGROUND: Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4-5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. METHODS: Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. RESULTS: A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3-4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3-0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12-45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. CONCLUSIONS: For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

Planning for Community Scale-Up of Project HEAL: Insights From the SPRINT Initiative.

Project HEAL (Health through Early Awareness and Learning) is an evidence-based intervention rooted in health behavior change theory and aims to increase cancer awareness and early detection through African American faith-based organizations. This study explored the potential for broader scale-up and dissemination of Project HEAL with the team's participation in a training program called Speeding Research-Tested INTerventions (SPRINT). The SPRINT training was framed using tools from the Business Model Canvas and the Value Proposition Canvas to guide trainees in designing (1) compelling value propositions, (2) a minimal viable product, and (3) questions to gain critical insight from various stakeholders during a process called Customer Discovery. We report on our experiences and insights on intervention scale-up that we gained from the training, including key findings from 41 discovery interviews conducted with various stakeholders of the church. We learned several valuable lessons from the discovery interviews such as scale-up will likely be more incremental than immediate. Additional refinement is needed to scale up the intervention for "real-world" application, such as making our technology more user-friendly and including additional health topics beyond cancer. We discuss how insights from the training refined our plans for future scale-up and dissemination in a constituent-informed way.

Assessing Capacity of Faith-Based Organizations for Health Promotion Activities.

BACKGROUND: Faith-based organizations (FBOs) are important venues for health promotion, particularly in medically underserved communities. These organizations vary considerably in their structural capacities, which may be linked to variability in implementation success for health promotion initiatives. Lacking an existing validated assessment of organizational capacity specific to FBOs, an initial prototype assessment was developed. METHOD: The Faith-Based Organization Capacity Inventory (FBO-CI) assesses three structural areas of capacity: Staffing and Space, Health Promotion Experience, and External Collaboration. The multidisciplinary team, including FBO leaders, codeveloped the initial instrument. The initial reliability from a convenience sample of 34 African American churches including descriptions of FBOs representing three capacity levels is reported. RESULTS: The FBO-CI demonstrated feasibility of administration using an in-person interview format, and the three subscales had acceptable internal reliability (α ~ .70). Most churches had an established health ministry (n = 23) and had conducted activities across an average of seven health areas in the previous 2 years. CONCLUSIONS: This initial FBO-CI prototype is promising, and future work should consider validation with a larger sample of churches and domain expansion based on the conceptual model. The FBO-CI has a number of potential uses for researchers, FBO leaders, and practitioners working with FBOs in health promotion initiatives.

[Feasibility of screw placement on posterior occipital condyle assisted by occipital tangent angulation].

Objective: To investigate the practicability of occipital tangent angle in assisting posterior occipital condylar screw placement and to verify the safety and accuracy of self-made screw placement device for auxiliary screw. Methods: Occipito-cervical region specimens of 12 adult corpses were selected and scanned by thin-cut CT examination.The three-dimensional reconstruction of occipital and atlas was simulated for each specimen, and 3-matic software was used to measure the setting parameters, including occipital tangent angle, head obliquity, internal inclination angle, length of the screw and the distance from the inferior margin of hypoglossal canal to the screw axis.Using the self-designed occipital condylar screw placement device, combined with occipital tangent angle, internal inclination angle and insertion point, the posterior occipital condylar screw specimen was inserted with nails with assisting tool.The occipito-cervical region was reconstructed and scanned by thin-cut CT examination again after the operation to measuring the parameters of screw placement after actual screwing.The paired t test was used to compare the parameters of screw placement before and after operation. Results: Pre-operative three dimensional reconstruction of occipital condyle screw showed that the head obliquity was 5.3°±0.9°, the tangent angle was 14.9°±3.7°, the internal inclination angle was 28.1°±5.9°, and the length of screw insertion was (21.4±1.7) mm respectively; the distance from the inferior margin of hypoglossal canal to the screw axis was (4.74±0.36) mm.There was no significant difference in the parameters of analogue nailing between the left and right occipital condyles before the operation (t=-1.32, -0.48, 0.10, 0.23, 0.09, all P>0.05). The occipital condylar screw was safely implanted with screw placement device.The screw was located in the ideal nail insertion channel after operation by CT scan evaluation, without any injury to the hypoglossal canal, the atlanto-occipital articular surface and other structure.After the operation, the actual nailing parameters were measured: the head inclination angle was 5.2°±0.7°, the tangent angle was 15.1°±3.2°, the internal inclination angle was 28.2°±4.2°, the length of screw insertion was (21.5±1.7) mm, the distance from the inferior margin of hypoglossal canal to the screw axis was (4.54±0.29) mm.There was no significant difference between the left and right side in the actual screw placement parameters (t=-0.77, 0.82, 0.56, 0.22, 0.21, all P>0.05). It was found that there was no significant differences in the head obliquity, the occipital tangent angle, the internal inclination angle, length of screw entry, and the distance from the inferior margin of hypoglossal canal to the screw axis before and after the operation (t=0.56, -0.47, -0.18, -0.70, 1.89, all P>0.05). Conclusion: The occipital tangent angle can be measured directly in the process of posterior occipital condyle screw insertion to guide occipital condylar screw insertion, and the self-made occipital condylar screw placement device can effectively combine the three parameters: occipital tangent angle, head inclination angle and insertion point, which can improve the safety of posterior occipital condylar screw insertion.

The effect of burdock leaf fraction on adhesion, biofilm formation, quorum sensing and virulence factors of Pseudomonas aeruginosa.

AIMS: This study aimed to evaluate the effect of a fraction of burdock (Arctium lappa L.) leaf on the initial adhesion, biofilm formation, quorum sensing and virulence factors of Pseudomonas aeruginosa. METHODS AND RESULTS: Antibiofilm activity of the burdock leaf fraction was studied by the method of crystal violet staining. When the concentration of the burdock leaf fraction was 2·0 mg ml-1 , the inhibition rates on biofilm formation of P. aeruginosa were 100%. The burdock leaf fraction was found to inhibit the formation of biofilm by reducing bacterial surface hydrophobicity, decreasing bacterial aggregation ability and inhibiting swarming motility. Interestingly, the burdock leaf fraction inhibited the secretion of quorum-sensing (QS) signalling molecule 3-oxo-C12-HSL and interfered quorum sensing. Moreover, the QS-regulated pyocyanin and elastase were also inhibited. Chemical composition analysis by UPLC-MS showed 11 active compounds in the burdock leaf fraction. CONCLUSIONS: The burdock leaf fraction significantly inhibited the formation of biofilm and quorum sensing, as well as significantly decreased the content of virulence factors. SIGNIFICANCE AND IMPACT OF THE STUDY: This study introduces a natural and effective bacterial biofilm inhibitor, which could also significantly decrease the content of virulence factors and the drug resistance of P. aeruginosa.

Dysregulation of Hypothalamo-Pituitary-Adrenocortical Axis in Overweight Female Diabetic Subjects is Associated with Downregulation of Corticosteroid Receptors and 11ß-HSD1 in the Brain.

The objective of this work was to assess hypothalamo-pituitary-adrenocortical (HPA) axis dysregulation in overweight diabetic women and investigate the possible mechanism using overweight diabetic rats. Twenty-two overweight diabetic women were recruited alongside 34 lean and 23 overweight healthy women serving as controls. Dexamethasone suppression test (0.25 mg DST) and low dose adrenocorticotropic hormone (ACTH) stimulation assay were used to evaluate the HPA axis activity. Then, high fat diet (HF) and STZ-induced diabetic rats were utilized to investigate the possible mechanism. After measurement of corticosterone circadian patterns and dexamethasone suppression levels, mRNA amounts of mineralocorticoid receptors (MR), glucocorticoid receptors (GR), and 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) were determined by real time PCR at hippocampus, hypothalamus, and pituitary levels. Overweight diabetic women showed impaired HPA axis with negative feedback efficacy (suppression ratio F-DEX%: 0.52±0.06% vs. 0.49±0.06% vs. 0.14±0.08%), as well as increased adrenal cortisol secretion response to low dose ACTH stimulation. Interestingly, F-DEX% was negatively correlated with BMI (r=- 0.323, p=0.003), waist circumference (r=- 0.319, p=0.004), and HbA1c (r=- 0.334, p=0.002). Stepwise linear regression analysis showed F-DEX% was significantly related to HbA1c level (ß=- 0.328, p=0.007) after adjusting for other covariates (age, BMI, waist circumference, SBP, TC, TG, and HOMA-IR). Furthermore, 11ß-HSD1, MR, and GR mRNA expression levels were reduced at pituitary level while GR expression was downregulated at hippocampus level in HF and HF+STZ rats. In conclusion, hyperactive HPA axis in overweight diabetic subjects may be associated with downregulation of 11ß-HSD1, MR, and GR in the brain.

The effect of ofloxacin otic drops on the regeneration of human traumatic tympanic membrane perforations.

OBJECTIVE: To investigate the effects of direct application of ofloxacin otic drops on human traumatic tympanic membrane perforations (TMPs). STUDY DESIGN: Prospective, sequential allocation, controlled clinical study. SETTING: Tertiary university hospital. PARTICIPANTS: In total, 149 patients with traumatic TMPs were recruited. They were allocated sequentially to two groups: a conservative observation group (n = 75) and a ofloxacin drops-treated group (n = 74). MAIN OUTCOME MEASURES: The closure rate, closure time and rate of otorrhoea were compared between the groups at 6 months. RESULTS: In total, 145 patients were analysed. The closure rates of medium perforations between the groups were not significantly different (P = 0.35); however, the ofloxacin drops-treated group had a significantly shorter closure time for medium perforations than the observation group (P < 0.01). Additionally, the ofloxacin drops-treated group showed improvement in the closure rate of large perforations (P = 0.02) and a significantly shorter mean closure time (P < 0.01) than the observation group. However, purulent otorrhoea was not significantly different between the groups (P = 0.37). CONCLUSIONS: The present findings indicate that the moist eardrum environment resulting from topical application of ofloxacin drops shortened the closure time and improved the closure rate, but did not affect hearing improvement or increase the rate of middle ear infection of large traumatic TMPs. Thus, although traumatic TMPs tend to heal spontaneously, moist therapy can be considered for traumatic, large TMPs in the clinic.

Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations.

OBJECTIVE: We evaluated the effects of conservative treatment and topical application of epidermal growth factor (EGF) with no scaffold material on the healing of human traumatic tympanic membrane perforations (TMPs). STUDY DESIGN: Prospective, randomised clinical trial. METHODS: A prospective analysis was performed between January 2015 and March 2015 for the treatment of human traumatic TMPs. The closure rate, closure time, hearing gain and rate of purulent otorrhoea were compared between the topical application of EGF and conservative treatment. RESULT: In total, 97 patients were analysed. The total closure rates did not significantly differ between the observation and EGF groups (83.0% versus 92.0%, P = 0.182). The total average closure time in the observation group was significantly longer than in the EGF group (25.1 ± 10.5 versus 11.7 ± 5.2 days, P = 0.001). When the closure rate was evaluated according to perforation size, no significant difference was seen for medium or large perforations (P = 0.18 and 0.21, respectively). When closure time was evaluated according to perforation size, a significant difference was seen for medium and large perforations (P = 0.001). CONCLUSIONS: This study suggests that topical application of EGF with no scaffold material may significantly shorten the closure time of human traumatic TMPs. Such a shorter recovery time may lead to reduced healthcare costs. This alternative technique to a classic myringoplasty is particularly beneficial and suitable for the closure of large human traumatic TMPs.

[Preventive and therapeutic effects of compound ginkgo extract in rats with nonalcoholic steatohepatitis induced by high-fat, high-fructose diet].

Objective: To establish a rat model of nonalcoholic steatohepatitis (NASH), and to investigate the preventative and therapeutic effects of compound ginkgo extract against NASH. Methods: A total of 60 male Sprague-Dawley rats were fed with high-fat feed and 10% fructose water for 24 weeks to establish the rat model of NASH. The general behaviors of the rats were observed, and the body weight was recorded. Blood samples from the inferior vena cava and the liver were collected after the last administration to measure serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), as well as liver function parameters. The liver index was calculated, HE staining was performed to observe liver histopathological changes, and the total lipase activity and the levels of TC, TG, and free fatty acid (FFA) in liver tissue were measured. Results: After 24 weeks, compared with the normal group, the model group had a significantly faster increase in body weight, significant increases in serum levels of TC (2.20±0.52 mmol/L), TG (0.87±0.22 mmol/L), LDL-C (1.22±0.50 mmol/L), alanine aminotransferase (ALT) (129.4±44.7 U/L), and aspartate aminotransferase (AST) (209.3±42.8 U/L), liver index (3.62%±0.28%), and the levels of TC (4.42±1.39 mmol/mg.prot), TG (0.85±0.11 mmol/mg.prot), and FFA (644.78±36.65µmol/L) in liver tissue, and significant reductions in serum HDL-C level (0.58±0.11 mmol/L) and the activity of lipoprotein lipase (LPL) (9.95±1.64 U/mg.prot) and hepatic lipase (HL) (9.91±1.03 U/mg.prot) (allP< 0.01). In addition, the pathological results showed severe hepatocyte steatosis, varying degrees of inflammatory cell infiltration, exudation in the portal area, and necrosis of liver cells in the model group. After the intervention with compound ginkgo extract, there were significant reductions in serum levels of TC (1.78±0.21 mmol/L), TG (0.58±0.07 mmol/L), LDL-C (0.84±0.19 mmol/L), and ALT (84.1±17.1 U/L), AST (155.4±20.9 U/L), liver index (2.71%±0.15%), and the levels of TC (2.24±1.02 mmol/mg.prot), TG (0.46±0.11 mmol/mg.prot), and FFA (580.56±50.63µmol/L) in liver tissue, as well as significant increases in serum HDL-C level (0.68±0.10 mmol/L) and the activities of LPL (15.54±2.21 U/mg.prot) and HL (11.92±1.87 U/mg.prot) (P< 0.05 orP< 0.01). At the same time, it significantly reduced hepatomegaly in rats and improved fatty degeneration and degree of inflammation in liver cells. Conclusion: Compound ginkgo extract can prevent and treat NASH by correcting dyslipidemia, improving liver function and fatty degeneration in hepatocytes, and reducing the degree of inflammation, and its mechanism of action may be associated with increasing total lipase activity, reducing FFA in the liver, increasing the decomposition of TG, and reducing the synthesis of TG.

Surface conformations of an anti-ricin aptamer and its affinity for ricin determined by atomic force microscopy and surface plasmon resonance.

We used atomic force microscopy (AFM) and surface plasmon resonance (SPR) to study the surface conformations of an anti-ricin aptamer and its specific binding affinity for ricin molecules. The effect of surface modification of the Au(111) substrate on the aptamer affinity was also estimated. The AFM topography images had a resolution high enough to distinguish different aptamer conformations. The specific binding site on the aptamer molecule was clearly located by the AFM recognition images. The aptamer on a Au(111) surface modified with carboxymethylated-dextran (CD) showed both similarities to and differences from the one without CD modification. The influence of CD modification was evaluated using AFM images of various aptamer conformations on the Au(111) surface. The affinity between ricin and the anti-ricin aptamer was estimated using the off-rate values measured using AFM and SPR. The SPR measurements of the ricin sample were conducted in the range from 83.3 pM to 8.33 nM, and the limit of detection was estimated as 25 pM (1.5 ng mL(-1)). The off-rate values of the ricin-aptamer interactions were estimated using both single-molecule dynamic force spectroscopy (DFS) and SPR as (7.3 ± 0.4) × 10(-4) s(-1) and (1.82 ± 0.067) × 10(-2) s(-1), respectively. The results show that single-molecule measurements can obtain different reaction parameters from bulk solution measurements. In AFM single-molecule measurements, the various conformations of the aptamer immobilized on the gold surface determined the availability of each specific binding site to the ricin molecules. The SPR bulk solution measurements averaged the signals from specific and non-specific interactions. AFM images and DFS measurements provide more specific information on the interactions of individual aptamer and ricin molecules.

Sequence variation in the Toxoplasma gondii ROP20 gene among strains from different hosts and geographical locations.

Toxoplasma gondii, an opportunistic protozoan parasite, infects almost all warm-blooded animals. In this study, we examined the sequence variation in rhoptry protein 20 (ROP20) genes among 18 T. gondii isolates collected from different hosts and geographical regions. Full length ROP20 genes were amplified and sequenced. The results showed that the genes were 1659 bp in length and contained only a single exon, and that the A+T content varied from 46.68 to 47.20% among the 18 strains. The results of sequence alignment indicated that there were 30 variable nucleotide positions (0-1.40%) in the 18 T. gondii strains containing 18 transitions and 11 transversions, representing 1.81% overall sequence variation. Phylogenetic analysis of the ROP20 sequences showed that ROP20 variation could differentiate between the clonal lineage genotypes I and ToxoDB #9, indicating that ROP20 exhibits a relatively marked degree of sequence diversity and might represent a novel genetic marker for intraspecies phylogenetic analyses of T. gondii.

Feasibility of a web-based training system for peer community health advisors in cancer early detection among african americans.

We describe the feasibility of a Web-based portal for training peer community health advisors (CHAs). We conducted a community-based implementation trial in African American churches between 2012 and 2014. The Web-based portal allows CHAs to log in and view 13 training videos, preparing them to deliver 3 cancer early detection workshops in their churches. Of 8 churches, 6 completed the training, each certifying 2 CHAs. These CHAs took an average of 26 days to complete the training, requiring little technical assistance. Additional technical assistance was required to implement the workshops. The Web-based system appears to be a feasible method for training lay individuals for the CHA role and has implications for increasing the reach of evidence-based interventions.

[Quality control of colorectal tumor surgery].

Surgery is the main means of achieving cure for colorectal cancer. Minimally invasive surgery, represented by laparoscopy and robotic surgery, has gradually become the mainstream approach for colorectal cancer at present. At the same time, the concept of surgery has appeared from simply emphasizing oncological radical treatment to emphasizing both radical treatment and function preservation. The quality control of colorectal cancer surgery includes the qualification admission system and assessment system, surgical approaches and indications, key surgical techniques (correct plain extension, lymph node dissection and resection range, nerve protection and function preservation, digestive tract reconstruction, and intraoperative prevention and treatment of complications). Unified and standardized quality control of surgery is not only a key factor in determining patient prognosis and quality of life, but also an important prerequisite for ensuring the accuracy of clinical trial.

[Quality control of the surgical pathway for colorectal cancer].

The quality control of the surgical pathway for colorectal cancer is closely related to reducing the incidence of postoperative complications, recurrence and metastasis, prolonging survival, and preserving functions. This pathway involves multiple disciplines, stages, and contents: standardizing the diagnosis and treatment process for colorectal cancer is crucial to ensuring medical quality and safety. Strengthening perioperative management is an important essential step for accelerating postoperative recovery and improving patient prognosis. Establishing a standard training program and effective inspection system is guarantee for the quality of colorectal cancer surgery.

The clinical implication of SS18-SSX fusion gene in synovial sarcoma.

BACKGROUND: The aim of this study is to evaluate distribution and clinical impact of the SS18-SSX fusion gene in patients with synovial sarcoma in China. METHODS: We collected and analysed the clinical data of 88 patients using univariate and multivariate survival analysis. HEK 293T and NIH 3T3 cell lines were transfected with the SS18-SSX1 or SS18-SSX2 gene to determine the respective involvement of these fusion genes in cell proliferation and invasion. RESULTS: Overall survival was significantly better among SS18-SSX2 cases (P=0.001), FNCLCC grade 2 cases (P<0.001), and UICC stage 1 or 2 (P<0.001) by univariate and multivariate survival analysis. SS18-SSX1-positive cells were more proliferative and invasive than SS18-SSX2-positive cells. CONCLUSION: SS18-SSX fusion type is a significant prognostic factor for patients with synovial sarcoma.

Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three-armed trial.

OBJECTIVE: The goal of this study was to evaluate the effects of perforation edge approximation and direct application of basic fibroblast growth factor (bFGF) each alone on the healing of large traumatic tympanic membrane perforations with inverted edges in humans. STUDY DESIGN: Prospective, sequential allocation, three-armed, controlled clinical study. SETTING: University-affiliated teaching hospital. PARTICIPANTS: Fifty-eight patients with large traumatic tympanic membrane perforations (i.e. affecting >50% of the surface area) with inverted edges were recruited. They were sequentially allocated to three groups: no intervention (n = 18), edge approximation alone (n = 20) and direct application of bFGF (n = 20). Otoscopy were performed before the treatment and at follow-up visits. MAIN OUTCOME MEASURES: The closure rate, closure time and rate of otorrhoea. RESULTS: Application of bFGF yielded a significantly higher average rate of perforation closure (100%) than edge approximation (60%) and no intervention (56%) (P < 0.05). It also significantly shortened the average closure time (12.4 ± 3.6 days) as compared to edge approximation (46.3 ± 8.7 days) and no intervention control (48.2 ± 5.3 days) (P < 0.05). Purulent otorrhoea was observed in none of the three groups. CONCLUSION: Edge approximation of inverted edges has little benefit in improving the healing outcome of large traumatic tympanic membrane perforations and thus is not an ideal treatment option for large traumatic tympanic membrane perforations. Application of bFGF materially improves the closure rate of large traumatic tympanic membrane perforations and significantly shortens the closure time.

Can vocal process granuloma location forecast the efficacy of anti-reflux treatment?

OBJECTIVE: The objective of this study was to evaluate the efficacy of anti-reflux therapy on the idiopathic vocal process granulomas. METHOD: This was a prospective case series study. The patients with vocal process granulomas who met the inclusion criteria were analysed. Proton pump inhibitors and vocal hygiene education were conducted for 8-20 weeks. RESULTS: Of the 16 patients with vocal process granulomas, 5 (31.25 per cent) patients achieved complete remission. The complete remission rate of granulomas was not significantly related to age (p = 1.000), sex (p = 0.296), side (p = 0.299), position (p = 0.100), endoscopic morphology (p = 0.263) or proton pump inhibitor treatment course (p = 0.543) but was significantly associated with granuloma location (p = 0.001) and granuloma size (p = 0.012). CONCLUSION: Granulomas in the vocal cord and the margin of the vocal process had an excellent response to proton pump inhibitors, but granulomas on the surface of vocal process and arytenoid cartilage body had little response to proton pump inhibitors. The prolonged period of proton pump inhibitor treatment did not increase the complete remission rate of vocal process granulomas.

A comparison of radiofrequency Coblation and cold steel excision in the treatment of idiopathic vocal process granulomas.

OBJECTIVE: To compare the effectiveness of radiofrequency Coblation assisted excision and cold steel excision in the treatment of idiopathic vocal process granulomas. METHODS: A retrospective study was performed of patients with idiopathic vocal process granulomas who underwent radiofrequency Coblation excision or cold steel excision between January 2013 and January 2020. The recurrence rate was compared among the two groups at six months post-operatively. RESULTS: Of the 47 patients with vocal process granulomas, 28 were in the cold steel excision (control) group and 19 were in the Coblation-assisted group. The recurrence rate in the control group was significantly higher than that in the Coblation-assisted group (60.7 per cent vs 5.3 per cent; p < 0.001). In addition, the voice recovery of the Coblation-assisted group was significantly better than that of the control group; vocal quality recovered one month after surgery in the Coblation-assisted group. CONCLUSION: Radiofrequency Coblation should be considered the optimal method when approaching idiopathic vocal process granulomas surgically.