[Conjecture on the next development direction of colorectal cancer and its minimally invasive surgery].

The surgical treatment of colorectal cancer will be more and more accurate and minimally invasive under the guidance of precision medicine. At the same time, it will derive and evolve non-surgical paths, such as immune checkpoint inhibitors and immune targeted therapy for microsatellite instability high/mismatch repair deficient colorectal cancer, and wait and watch path after neoadjuvant treatment for low advanced rectal cancer. Laparoscopic minimally invasive surgery for colorectal cancer will be gradually iterated by robots, which is the only way to intelligent surgery.

[Current application and prospect of accurate navigation technology in orthopaedic trauma].

In the past decades,a dramatic development of navigation technology in orthopaedic surgery has been witnessed. By assisting the localization of surgical region,verification of target bony structure,preoperative planning of fixation,intraoperative identification of planned entry point and direction of instruments or even automated insertion of implants,its ability and potential to reduce operation time,intraoperative radiation,surgical trauma,and improve accuracy has been proved. However,in contrast to the widespread use of navigation technology in arthroplasty,orthopaedic tumor,and spine surgery,its application in orthopaedic trauma is relatively less. In this manuscript,the main purpose is to introduce the technical principles of navigation devices,outline the current clinical application of navigation systems in orthopaedic trauma,analyze the current challenges confronting its further application in clinical practice and its prospect in the future.

[Promote the high-quality development of gastrointestinal surgery with technological concept innovation].

In the past 30 years, gastrointestinal surgery in China has made significant progress, which is reflected in the gradual standardization of clinical diagnosis and treatment, significant improvement in surgical quality, improvement in short-term and long-term postoperative outcomes, and continuous development of high-quality clinical research. At present, the spectrum of disease in gastrointestinal surgery has changed from traditional benign diseases to malignant diseases represented by gastric cancer and colorectal cancer, metabolic diseases represented by obesity and diabetes, and immune diseases represented by inflammatory bowel disease. It is necessary to carry out full-cycle management for patients. In the new era full of opportunities and challenges, surgeons must be driven by innovation in surgical technology, guided by high-quality clinical research and guaranteed by standardized diagnosis and treatment of diseases, to continue to promote the high-quality development of gastrointestinal surgery in China.

[Fortify clinical advantages and promote innovative development: comparison of the Chinese Colorectal Cancer Surgery Database with foreign databases].

With the continuous development of evidence-based medicine, increasing attention has been paid to the construction of a large medical database to ensure a source of high quality real-world data. The Chinese Medical Association Colorectal Surgery Group created the Chinese Colorectal Cancer Surgery Database (CCCD), whose objective is to promote the development of colorectal surgery and improve patient prognosis with evidence-based medicine theory. Compared to major databases around the world, CCCD contains more comprehensive information on colorectal cancer surgical cases, recording the main epidemiological characteristics and detailed surgical information, but perioperative treatment data still need to be strengthened. It is necessary to continuously expand the coverage, enrich perioperative data and strengthen data, quality control. In the future, CCCD is expected to play a role in promoting homogenization of medical services, promoting smooth and effective graded diagnosis and treatment, giving full role to the characteristics of each center to achieve integrated development, and connecting real-world data and artificial intelligence.

MIR-147B Regulated Proliferation and Apoptosis of Gastric Cancer Cells by Targeting CPEB2 Via the PTEN Pathway.

The present study has been performed to illustrate the role and mechanism of microRNA-147b (miR-147b) in the cellular viability and apoptosis of gastric cancer (GC) cells. The GC tissues of 50 patients with complete data and the adjacent tissues were selected from Shanxi Cancer Hospital, and 3 pairs of tissues were randomly selected for microarray detection of high-expressing microRNAs. The expressions of miR-147b were quantified in numerous GC cell lines, i.e., BGC-823, SGC-7901, AGS, MGC-803 and MKN-45, normal tissue cell lines and 50 pairs of gastric cancer tissues. Moreover, two cell lines of miR-147b high-expressing used PCR quantitative analysis were selected for transfection experiments. The differentially expressed miR-147b was screened from 3 pairs of samples by miRNA chip. The expression ofmiR-147b was found highly expressed in gastric cancer tissues of 50 pairs of gastric cancer and adjacent tissues. The miR-147b found in diverse range in each of GC cell line. Therefore, two cell lines, BGC-823 and MGC-803, with relatively high expression levels of miR-147b were selected for further analysis and research. Scratch analysis results showed that compared with miR-147b NC, the miR-147b inhibitor group inhibited GC cell growth and reduced cell migration. The early apoptosis of MGC-803, and BGC-823 cells was enhanced by miR-147b inhibitor. miR-147b inhibitor significantly repressed the proliferation of BGC-823 and MGC-803 cells. Our study showed that the high expression of miR-147b is positively correlated with the occurrence and development of gastric cancer.

[Prognosis factors for non-reversal of defunctioning ileostomy in patients with radical resection of rectal cancer].

Objective: To examine the prognosis factors for non-reversal of defunctioning ileostomy in rectal cancer surgery. Methods: The data of 234 patients with rectal cancer undergoing radical resection and defunctioning ileostomy in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2013 to June 2020 was analyzed retrospectively. There were 166 males and 68 females, aging (M(IQR)) 62(12) years (range: 33 to 89 years). Telephone following-up was conducted intensively in July 2021 to investigate whether stoma was reversed, causes of reversal failure, and tumor recurrence or metastasis after surgery. The non-reversal stoma was defined as stoma not being reversed during the follow-up period (more than 12 months). The χ2 test or Fisher's exact test was used to conduct a univariate analysis of clinical data related to reversal failure, and the factors with P<0.05 were selected into Logistic regression for multivariate analysis. Results: A total of 165 patients received stoma reversal postoperatively with an interval time of (6.5±2.4) months (range: 0.9 to 17.8 months), but 69 patients failed to closure of stoma. Univariate analysis showed that age, concomitant diseases, surgical methods, preoperative hemoglobin, preoperative carcinoembryonic antigen, tumor maximum diameter, depth of invasion, lymph node metastasis, TNM stage, anastomotic-related complications, postoperative tumor local recurrence or distant metastasis were associated with non-reversal of diverting ileostomy in rectal cancer surgery (all P<0.05). Multivariate analysis showed that age (OR=2.270, 95%CI: 1.150 to 4.479, P=0.018), open surgery (OR=7.249, 95%CI: 1.977 to 26.587, P=0.003), preoperative hemoglobin<120 g/L (OR=3.092, 95%CI: 1.566 to 6.105, P<0.01), anastomotic-related complications (OR=4.375, 95%CI: 1.686 to 11.349, P=0.002), postoperative local recurrence or distant metastasis (OR=7.065, 95%CI: 2.591 to 19.264, P<0.01) were independent prognosis factors for reversal failure of defunctioning stoma in rectal cancer surgery. Conclusions: There is a high risk of reversal failure of defunctioning ileostomy among rectal cancer patients with age>65 years, open surgery, preoperative hemoglobin<120 g/L, anastomotic-related complications, postoperative local recurrence or distant metastasis. Colorectal surgeons should fully evaluate the outcome and risk of reversal failure before making a decision of diverting ileostomy. Reducing anastomotic complications is helpful to the successful return of preventive ileostomy.

[The development process and new requirements of structured training on transanal total mesorectal resection].

Due to the technical difficulty and long learning curve, the benefits of Transanal total mesorectal excision may be obscured by surgical complications that arise from rapid, large-scale development, therefore the surgeons need to receive sufficient training before performing this surgery. At present, a mature structured training system has been formed, but the development of structured training has not met the needs of existing surgical development. In order to standardize the development of transanal total mesorectal excision, the European Society of Colorectal Diseases and 14 international surgical societies recently launched the "International Expert Consensus Guidelines for the Indication, Implementation and Quality Evaluation of Transanal Total Mesorectum Resection". The consensus involves the requirements for trainees, the content and process of training, as well as the evaluation and registration of training results. Training in cadaver is the core of structured training. Beginners should receive repeated training and conduct the surgery under the guidance of instructors.

[Analysis of the clinical confusion and controversy of esophagogastric junction tumor from basic anatomy].

There are still many controversies in the surgical treatment of esophagogastric junction tumors in terms of surgical approach, cleaning range, and resection scope. The reason is the confusion about the scope of the esophagogastric junction. The previous domestic and foreign anatomy descriptions of this part are not enough to solve the current problems. Based on a large number of basic anatomy and clinical operations, this article proposes that the esophagogastric junction may be wrapped by a complete and separate esophagogastric junction membrane with independent anatomy other than infracardiac bursa. The structure of the transitional tissue, mainly from the distribution of submucosal veins, explained the relationship and significance of tissue transitional changes and clinical operations, and made a reasonable analysis of the current controversy based on the anatomical characteristics, which is worthy of further investigation.

Cavity ring-down spectroscopy based on a comb-locked optical parametric oscillator source.

Spectroscopy of molecules in the mid-infrared (MIR) region has important applications in various fields, such as astronomical observation, environmental detection, and fundamental physics. However, compared to that in the near-infrared, precision spectroscopy in the MIR is often limited by the light source and has not shown full potential in sensitivity. Here we report a cavity ring-down spectroscopy system using a tunable narrow-linewidth optical parametric oscillator, which fulfills the requirement of high sensitivity and high precision in the MIR region. The Lamb-dip spectrum of the N2O molecule at 2.7 µm was measured as a demonstration of spectroscopy in the MIR with kilohertz accuracy.

Seeded optical parametric oscillator light source for precision spectroscopy.

Precision spectroscopy of fundamental bands of molecules in the mid-infrared (MIR) region is of great interest in applications of trace detection and testing fundamental physics, where high-power and narrow-linewidth MIR lasers are needed. By using a frequency-stabilized near-infrared laser as a seed of the signal light of a continuous-wave optical parametric oscillator, we established a broadly tunable MIR light source that has an output power of several hundred milliwatts and a linewidth of a few tens of kilohertz. The MIR laser frequency drift was reduced to below 1 kHz by using an optical frequency comb to stabilize the frequency of the 1064 nm pumping laser. The performance of the light source was investigated and tested by measuring the saturated absorption spectroscopy of a few molecular transitions at 3.3 µm.

Ferromagnetic frustration in ternary nitride ZnFe3N.

As a new antiperovskite nitride, ZnFe3N was synthesized and characterized by almost completely substituting iron atoms at corner positions of γ'-Fe4N. The magnetic interactions of the system with the space group Pm3[combining macron]m are fully investigated. The critical behavior was investigated based on the measured magnetic data around the ferromagnetic phase transition temperature. In this work, the values of critical exponents (ß, γ and δ) were obtained systematically using the Kouvel-Fisher method in the critical region. The Widom scaling law (δ = 1 + γß-1) and the scaling equation (m = f±(h)) were used to reveal the reliability of these values. The values of the critical exponents (ß = 0.325, γ = 1.228, and δ = 4.778) are different from those predicted by the three-dimensional (3D) Heisenberg model and mean-field model, and are very close to those of the 3D-Ising model. Combined with ESR analysis, the spin clusters induced by changes in chemical bonds are considered to be the cause for the existence of an anisotropic short-range ordered state in this ferromagnetic system.

[Promoting the colorectal surgery in virtue of new theories and techniques].

Since the 21st century, with the development of minimally invasive surgical technology, the update of comprehensive treatment strategies and the progress of clinical research, colorectal surgery has developed rapidly. However, in recent years, some disputable issues still exist in colorectal surgery, such as transanal total mesorectal excision, pelvic cavity lateral lymph node dissection, the "wait and observe" strategy for clinical complete remission of rectal cancer after neoadjuvant therapy, and robotic colorectal surgical operation. In addition, the application of three dimensions imaging, 4K resolution, 5th generation wireless systems, virtual reality, artificial intelligence and other new techniques may provide extensive space and new opportunity for the development of colorectal surgery. The therapic outcome could be optimized by more relevant clinical research and evidence, which contribute to the standardization of surgical treatment of colorectal cancer.

[The individualized strategy for lateral pelvic lymph node dissection in advanced rectal cancer].

Recently, with the development and widespread application of total mesorectal excision and neoadjuvant chemoradiotherapy, the long-term overall survival and disease-free survival of patients with middle & low rectal cancer have been greatly improved. Moreover, there are also researches in minimally invasive techniques, such as laparoscopy and robotic surgical system in the radical rectal surgery, as well as the combination of tumor molecular targeting markers and gene sequencing technology. Nowadays, the treatment of rectal cancer has entered a new era of individualized precise medicine. However, there are still some controversies in lateral lymph node dissection. The criteria of diagnosis and treatment, neoadjuvant therapy, indications of lateral lymph node dissection, the area of dissection and neuroprotection are still unsatisfactory. It is necessary to explore the personalized treatment strategies of lateral lymph node dissection in the precise medical era.

[Medical imaging clinical appropriateness:rational examination according to evidence-based medical imaging].

The rational clinical examination is important. The authors raised the concept of "medical imaging clinical appropriateness (MICA) " to meet the medical need in clinic (for diagnosis or assessment of a kind of disease or syndrome), which means radiologists and clinicians work together to carefully evaluate the necessity and rationality of an examination according to evidence of evidence-based medicine, expertise, experience, and patient's willing.The necessity is prerequisite, the rationality is the core, the evaluation of evidence is the basis, the application of evidence-based medicine is the important method. This work will provide us a series of criteria in the format of guidelines, providing evidence of rational examination for clinicians. Based on hard working and cooperation between radiologists and clinicians, we will establish the system of MICA in China, standardizing medical process, promoting rationalization, optimizing medical resources allocation and usage.

[Effect of death decoy receptor 3 on prognosis of breast cancer and function of breast cancer cells in vitro].

Objective: To study the effect of death decoy receptor 3 on the prognosis of breast cancer and the invasive function of breast cancer cells in vitro. Methods: Expression of DcR3 were assessed qualitatively by Q-PCR to analyze the correlation in 115 mammary tissue samples with a 10-year median follow-up. The expression of DcR3 was examined in MCF7 and MDA-MB-231 cell lines using immunocytochemical staining and RT-PCR. DcR3 knock-down cell sub-lines were constructed. The effects of reduced DcR3 expression were observed by establishing invasion and migration models. Results: Patients were divided into the good prognosis group (n=81) and the poor prognosis group (n=26). The expression of DcR3 in the poor prognosis group (133 350+49 646 copies/50 ng RNA)was significantly higher than that in the good prognosis group (5 393+1 428 copies/50 ng RNA, P=0.020). DcR3 transcripts were found to be increased significantly in grade 2 cancers compared to well differentiated grade 1(82 844±34 068 copies/50 ng RNA, n=39,) vs (5 371±3 500 copies/50 ng RNA, n=20, P=0.029).The DcR3 gene of MCF7 cell line and MDA-MB-231 cell line were successfully knocked out and verified that DcR3 knockout. And the invasion and migration of MCF7 cells were inhibited (P=0.009, P=0.001). However, no significant difference was found in these two aspects of the MDA-MB-231 cell line (P=0.475, P=0.102). Conclusion: DcR3 promotes the capacity of invasion of breast cancer cells and plays an important role in the metastasis of breast cancer. DcR3 detection is helpful to the judgment about prognosis of breast cancer.

Microbial sensor for drug susceptibility testing of Mycobacterium tuberculosis.

AIMS: Drug susceptibility testing (DST) of clinical isolates of Mycobacterium tuberculosis is critical in treating tuberculosis. We demonstrate the possibility of using a microbial sensor to perform DST of M. tuberculosis and shorten the time required for DST. METHODS AND RESULTS: The sensor is made of an oxygen electrode with M. tuberculosis cells attached to its surface. This sensor monitors the residual oxygen consumption of M. tuberculosis cells after treatment with anti-TB drugs with glycerine as a carbon source. In principle, after drug pretreatment for 4-5 days, the response differences between the sensors made of drug-sensitive isolates are distinguishable from the sensors made of drug-resistant isolates. The susceptibility of the M. tuberculosis H37Ra strain, its mutants and 35 clinical isolates to six common anti-TB drugs: rifampicin, isoniazid, streptomycin, ethambutol, levofloxacin and para-aminosalicylic acid were tested using the proposed method. The results agreed well with the gold standard method (LJ) and were determined in significantly less time. The whole procedure takes approximately 11 days and therefore has the potential to inform clinical decisions. CONCLUSIONS: To our knowledge, this is the first study that demonstrates the possible application of a dissolved oxygen electrode-based microbial sensor in M. tuberculosis drug resistance testing. This study used the microbial sensor to perform DST of M. tuberculosis and shorten the time required for DST. SIGNIFICANCE AND IMPACT OF THE STUDY: The overall detection result of the microbial sensor agreed well with that of the conventional LJ proportion method and takes less time than the existing phenotypic methods. In future studies, we will build an O2 electrode array microbial sensor reactor to enable a high-throughput drug resistance analysis.

Association of thymidylate synthase polymorphisms with the tumor response to preoperative chemoradiotherapy in rectal cancer: a systematic review and meta-analysis.

Preoperative chemoradiotherapy (pCRT) followed by surgery is currently the standard therapy for patients with locally advanced rectal cancer. It is very important to develop biomarkers to prior identify the patients who have a higher likelihood of responding to pCRT. Recently, a series of studies have been conducted to investigate the association of thymidylate synthase (TYMS) polymorphisms with the tumor response to pCRT in rectal cancer, but the results were not consistent and conclusive. In the present study, we performed a systematic literature search for relevant studies up to 30 March 2015 and conducted a meta-analysis to summarize and clarify the association between the TYMS polymorphisms and the tumor response to pCRT in rectal cancer. Finally, 7 studies containing 892 cases for TYMS 2R/3R polymorphism, 7 studies involving 715 cases for TYMS 1494del6 polymorphism and 6 studies containing 616 cases for TYMS 5' untranslated region (UTR) expression allele polymorphism were analyzed in the meta-analysis. The results suggested that TYMS 2R/3R was associated with the response and the patients with 2R/2R or 2R/3R genotype with rectal cancer might benefit more from pCRT than others. On the contrary, neither 1494del6 nor 5'UTR expression allele polymorphisms was associated with the response to pCRT.

[Detection and clinical significance of circulating tumor cells in patients with colorectal carcinoma].

Objective: To detect circulating tumor cells (CTC) in patients with colorectal carcinoma and to evaluate the relationship among CTC, clinic-pathological characteristics and prognosis of colorectal carcinoma. Methods: Peripheral blood samples were obtained from 109 patients with colorectal carcinoma in Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from April 2014 to October 2016. There were 60 male and 49 female patients, aging from 33 to 86 years with a mean age of (65±10) years.CTC were detected using density-gradient centrifugation and immunofluorescence staining. χ(2) test, Fisher exact test and rank-sum test were used to analyze the relation between positive rate of CTC and clinical characteristic, respectively. The correlation analysis of CTC and common tumor markers was detected by χ(2) test and Spearman test. The overall survival of patients was analyzed by Kaplan-Meier curve and Cox proportional hazard model. Results: CTC were found in 71 of the 109 patients with colorectal carcinoma. The presence of CTC was significantly correlated with N stage (Z=4.422, P=0.035) and M stage (χ(2)=4.424, P=0.049). However, CTC was not significantly correlated with age, sex, tumor location, tumor size, differentiation, T stage, Ki-67 and TNM stage (P>0.05). Meanwhile, there was significant correlation between CTC and carcino-embryonic antigen (CEA) (χ(2)=4.897, P=0.027; r=0.212, P=0.027) indicated by χ(2) test and Spearman correlations analysis. The positive rate of CTC was higher than that of CEA (χ(2)=15.45, P=0.000). Survival analysis suggested that positive CTC was poor for overall survival in colorectal cancer with adjusted HR as 3.023(95%CI: 1.330 to 6.872, P=0.008). Conclusions: CTC is helpful to early diagnosis tumor recurrence and metastasis. Hence, combined multiple tumor markers, including the CTC as common indicators of tumor diagnosis, relapse and metastasis could effectively improve the accuracy of diagnosis.

Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis.

BACKGROUND: The best approach for cholecystocholedocholithiasis remains a matter of debate. The aim of this study was to evaluate the technical aspects, learning curve and outcome of laparoscopic transcystic common bile duct exploration (LTCBDE). METHODS: Patients who underwent laparoscopic cholecystectomy with LTCBDE between January 2007 and December 2012 were identified from an institutional database. Data on preoperative investigations, intraoperative and postoperative findings were retrieved retrospectively from the patients' hospital notes. RESULTS: There were 399 women (56·4 per cent) and 309 men (43·6 per cent), with a median age of 58 (range 18-87) years. Microincision (incision of the cystic duct at the confluence with the common bile duct (CBD) with extension of only 3-5 mm at the lateral margin of the CBD) and lithotripsy were used in the transcystic exploration in 119 patients, and increased the success rate of LTCBDE from 74·2 to 91·0 per cent. The median duration of operation was 85 (i.q.r. 65-120) min and the median postoperative hospital stay was 2 (1-3) days. Retained common bile duct stones were observed in 13 patients, and postoperative complications developed in 27 patients. The cumulative sum duration of operation learning curve comprised two phases; phase 1 included the first 250 patients and phase 2 the remaining 458 patients. Duration of operation and postoperative hospital stay decreased with increasing volume per surgeon. Recurrence of common bile duct stones was diagnosed in 26 patients during a median follow-up of 4 years. CONCLUSION: LTCBDE with or without microincision and/or lithotripsy is a safe and effective approach.