Neoadjuvant chemoradiation therapy combined with immunotherapy for microsatellite stable ultra-low rectal cancer (CHOICE II): study protocol of a multicentre prospective randomised clinical trial.

INTRODUCTION: Neoadjuvant chemoradiotherapy (nCRT) could bring tumour shrinking and downstaging and increase the probability of organ preservation for patients with low rectal cancer. But for ultra-low rectal cancer, there is little possibility for organ preservation. Immunotherapy has been shown to have significant survival benefits in microsatellite instability-high patients but poor response in microsatellite stable (MSS) patients. Studies have demonstrated that radiotherapy and immunotherapy have synergistic effects in cancer treatment. There is no existing evidence about the clinical efficacy of immunotherapy combined with nCRT for patients with MSS ultra-low rectal cancer. METHOD AND ANALYSIS: This trial is an open-labelled multicentre prospective randomised controlled trial (NCT05215379) with two parallel groups and allocation ratio 1:1 (nCRT+immunotherapy vs nCRT group). Eligible participants will be aged 18-75 years, with a desire for anus preservation, confirmed cT1-3aN0-1M0 rectal adenocarcinoma, confirmed MSS type, inferior margin of ≤5 cm from the anal verge. The primary endpoint of this trial is complete clinical response (cCR) rate. Immunotherapy is added after 1 week of chemoradiotherapy for two cycles, and then the patients will be administered two cycles of immunotherapy and CAPOX. The evaluations will be carried out after the completion of the whole neoadjuvant therapy. We expect the programme to improve the cCR rate and the quality of life for patients with ultra-low rectal cancer. ETHICS AND DISSEMINATION: This trial was approved by the Ethics committee of Changhai Hospital and other medical centres (Grant number:CHEC2022-118). The results of this study will provide further insight into the clinical efficacy of immunotherapy in combination with nCRT in patients with MSS ultra-low rectal cancer. TRIAL REGISTRATION NUMBER: NCT05215379.

Single-cell sequencing technology in colorectal cancer: a new technology to disclose the tumor heterogeneity and target precise treatment.

Colorectal Cancer (CRC) is one of the most common gastrointestinal tumors, and its high tumor heterogeneity makes traditional sequencing methods incapable of obtaining information about the heterogeneity of individual cancer cells in CRC. Therefore, single-cell sequencing technology can be applied to better analyze the differences in genetic and protein information between cells, to obtain genomic sequence information of single cells, and to more thoroughly analyze the cellular characteristics and interactions in the CRC microenvironment. This will provide a more comprehensive understanding of colorectal cancer development and metastasis and indicate the treatment plan and prognosis. In this study, we review the application of single-cell sequencing to analyze the tumor microenvironment of CRC, explore the mechanisms involved in CRC metastasis and progression, and provide a reference for potential treatment options.

[Estimating glomerular filtration rate based on serum cystatin C].

OBJECTIVE: To develop an estimating formula for glomerular filtration Rate (GFR) based on serum cystatin C in patients with chronic kidney disease (CKD). METHODS: Clinical characteristics of 242 CKD patients were collected. The patients were randomly divided into modeling group and model validation group. The rGFR obtained from 99mTc-DTPA clearance rate was used as a reference value of GFR. s-cystatin C was detected by latex enhanced immunoturbidimetric method. Preliminary linear regression analysis followed by multiple linear regression were performed to investigate the association between s-cystatin C and rGFR. The validity of the estimation formula was tested in the model validation group in comparison with Hoek formula and Orebro formula. RESULTS: With standardised countdown conversion, s-cystatin showed linear correlation with rGFR, with a correlation coefficient of 0.773. The multiple correlation coefficient, determination coefficient, adjusted R square and std. error of the estimation model were 0.863, 0.745, 0.742, and 0.207, respectively. The residuals P-P probability plot analysis showed that the model residuals fitted into normal distribution with homogeneity of variance. Theeformula was: eGFR = 67/s-cystatin C +3. No significant difference was found between the distribution of eGFR and rGFR. Our formula had an accuracy of 30% and 50%, which were no less than those obtained from Hoek formula and Orebro formula. The new formula also had acceptable bias and high precision. The Bland-Altman analysis and ROC curve analysis showed good applicability of the new formula. CONCLUSION: The GFR prediction formula we established has a good prediction performance as comparised with other formulae, which could be used in measuring GFR in CKD patients.

[Source of variations of serum urea levels and consideration of reference interval in urban Chengdu].

OBJECTIVE: To determine the serum Urea levels in healthy adults living in urban Chengdu and to identify factors that influence the serum urea levels for the purpose of establishing reference interval. METHODS: Serum urea levels were determined in 17 787 healthy adults in urban Chengdu who underwent physical examinations. The characteristics of distribution of serum urea levels in the population and its relationships with liver function, renal function, serum glucose, and serum lipid were analyzed. RESULTS: Increased Crea, Uric, Glu, and HDL-C levels and decreased Glb level were associated with increased serum urea levels, which was independent of the impact of sex and age. The association between serum urea and Crea, Glu, and HDL-C existed in normal healthy adults. Men had higher urea levels than women. Regardless of gender, serum urea increased with age (with a cut off point at 30, 50, 60 and 70 years). CONCLUSION: Serum urea levels in healthy adults living in urban Chengdu vary in different gender and age groups. Serum urea levels are associated with serum Crea, Glu, the HDL-C levels. It is necessary to establish gender and age-specific reference intervals for serum urea.

[Bacterial conversion of sulfur-and phosphorous-compounds and microbial diversity in sediments from a near-shore marine-cultural region].

The H2S-producing bacteria and the phosphorous-cycling bacteria in sediments from near-shore marine-cultural region were investigated. Results indicate that the bacterial H2S production in aerobic condition is the dominating process to produce H2S in the sediment of cultural pond. The total counts of H2S-producing bacteria utilizing cysteine and Na2S2O3 were 1.6 x 10(6) and 4.35 x 10(3) cells g(-1) respectively. The counts of sulfate-reducing bacteria in the sediments were very little, only 2.5 x 10(1) g(-1). Further results show that the bacterial counts of decomposing lecithin and secreting phosphatase were 2.17 x 10(5) and 1.21 x 10(6) g(-1) respectively, bacterial counts of dissolving Ca3PO4 were 6.96 x 10(3) g(-1). Traditional taxonomy and partial 16S rRNA gene sequencing on the H2S-producing and phosphate-cycling bacteria indicate that most isolates could be classified as members of the following Genera: Bacillus, Halobacillus, Microbacterium, etc.