Clinical efficacy and pathological outcomes of transanal endoscopic intersphincteric resection for low rectal cancer.

BACKGROUND: Transanal endoscopic intersphincteric resection (ISR) surgery currently lacks sufficient clinical research and reporting. AIM: To investigate the clinical effectiveness of transanal endoscopic ISR, in order to promote the clinical application and development of this technique. METHODS: This study utilized a retrospective case series design. Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included. All patients underwent transanal endoscopic ISR as the surgical approach. We conducted this study to determine the perioperative recovery status, postoperative complications, and pathological specimen characteristics of this group of patients. RESULTS: This study included 45 eligible patients, with no perioperative mortalities. The overall incidence of early complications was 22.22%, with a rate of 4.44% for Clavien-Dindo grade ≥ III events. Two patients (4.4%) developed anastomotic leakage after surgery, including one case of grade A and one case of grade B. Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients. The mean distance between the tumor lower margin and distal resection margin was found to be 2.30 ± 0.62 cm. The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens. CONCLUSION: Transanal endoscopic ISR is safe, feasible, and provides a clear anatomical view. It is associated with a low incidence of postoperative complications and favorable pathological outcomes, making it worth further research and application.

Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer.

BACKGROUND: Laparoscopic radical gastrectomy is widely used, and perioperative complications have become a highly concerned issue. AIM: To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery, guide perioperative treatment strategies for gastric cancer patients, and prevent serious complications. METHODS: In total, 998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model, and 398 patients were included in the validation group. The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected. Three machine learning methods, lasso regression, random forest, and artificial neural networks, were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy, and their prediction efficacy and accuracy were evaluated. RESULTS: The constructed complication model, particularly the random forest model, could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy. It exhibited stable performance in external validation and is worthy of further promotion in more centers. CONCLUSION: Using the risk factors identified in multicenter datasets, highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established. We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

[Nicotine affects biological properties of the human osteosarcoma cell line MG63].

OBJECTIVE: To evaluate the effect of nicotine on cell proliferation. METHODS: The cells were cultured with DMEM medium containing 10% fetal bovine serum with 0, 1 x 10(-4) mol x L(-1), and 1 x 10(-3) mol x L(-1) nicotine for up to 3, 5, 7, 10, 14 days. The cell proliferation was evaluated by MTT. The alkaline phosphatase (ALP) activity was estimated by PNPP. The expression of collagen type I (COL1) and osteocalcin (OCN) were estimated by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Nicotine suppressed the cell proliferation. ALP activity increased to peak on 10 days in control and 1 x 10(-4) mol x L(-1) nicotine. COL1 expression increased to peak on 10 days in control and 1 x 10(-4) mol x L(-1) nicotine, but there was decreased to the minimum on 10 days and increased on 14 days in 1 x 10(-3) mol x L(-1) nicotine. OCN expression increased to peak on 10 days in control, and increased in 1 x 10(-4) mol x L(-1) nicontine from 3 days to 14 days, but there wasn't significant change in 1 x 10(-3) mol x L(-1) nicontine. CONCLUSION: Nicotine suppresses osteogenesis through a decrease in ALP and COL1 production by osteoblasts.