Downsizing of rectal cancer following neoadjuvant radiotherapy (5 × 5 Gy) and long interval surgery evaluated using MRI semiautomated volumetric measurements, a retrospective study.

Introduction: Neoadjuvant conventional chemoradiation (CRT) is the standard treatment for primary locally non-curatively resectable rectal cancer, as tumor downsizing may allow R0 resectability. Short-term neoadjuvant radiotherapy (5x5 Gy) followed by an interval before surgery (SRT- delay) is an alternative for multimorbid patients who cannot tolerate CRT. This study examined the extent of tumor downsizing achieved with the SRT-delay approach in a limited cohort that underwent complete re-staging before surgery. Methods: Between March 2018 and July 2021, 26 patients with locally advanced primary adenocarcinoma (>uT3 or/and N+) of the rectum were treated with SRT-delay. 22 patients underwent initial staging and complete re-staging (CT, endoscopy, MRI). Tumor downsizing was assessed by staging and re-staging data and pathologic findings. Semiautomated measurement of tumor volume was performed using mint Lesion™ 1.8 software to evaluate tumor regression. Results: The mean tumor diameter determined on sagittal T2 MRI images decreased significantly from 54.1 (23-78) mm at initial staging to 37.9 (18-65) mm at re-staging before surgery (p <0.001) and to 25.5 (7-58) mm at pathologic examination (p <0.001). This corresponds to a mean reduction in tumor diameter of 28.9 (4.3-60.7) % at re-staging and 51.1 (8.7-86.5) % at pathology. Mean tumor volume determined from transverse T2 MR images mint LesionTM 1.8 software significantly decreased from 27.5 (9.8 - 89.6) cm3 at initial staging to 13.1 (3.7 - 32.8) cm3 at re-staging (p <0.001), corresponding to a mean reduction of 50.8 (21.6 - 77) %. The frequency of positive circumferential resection margin (CRM) (less than 1mm) decreased from 45,5 % (10 patients) at initial staging to 18,2 % (4 patients) at re-staging. On pathologic examination, the CRM was negative in all cases. However, multivisceral resection for T4 tumors was required in 2 patients (9%). Tumor downstaging was noted in 15 of 22 patients after SRT-delay. Conclusion: In conclusion, the observed extent of downsizing is broadly comparable to the results of CRT, making SRT-delay a serious alternative for patients who cannot tolerate chemotherapy.

Generation of colon cancer-derived tumor-infiltrating T cells (TILs) for adoptive cell therapy.

Adoptive cell therapy (ACT) using specific immune cells and stem cells has emerged as a promising treatment option that could complement traditional cancer therapies in the future. In particular, tumor-infiltrating lymphocytes (TILs) have been shown to be effective against solid tumors in various clinical trials. Despite the enormous disease burden and large number of premature deaths caused by colorectal cancer (CRC), studies on TILs isolated from tumor tissue of patients with CRC are still rare. To date, studies on ACT often lack controlled and comparable expansion processes as well as selected ACT-relevant T-cell populations. We describe a procedure for generating patient-specific TILs, which are prerequisites for clinical trials of ACT in CRC. The manufacturing and characteristics of these TILs differ in important modalities from TILs commonly used for this therapeutic approach. Tumor tissue samples were obtained from 12 patients undergoing surgery for primary CRC, predominantly with low microsatellite instability (pMMR-MSI-L). Tumors in the resected specimens were examined pathologically, and an approved volume of tumor tissue was transferred to a disposable perfusion bioreactor. Tissue samples were subjected to an automatically controlled and highly reproducible cultivation process in a GMP-conform, closed perfusion bioreactor system using starting medium containing interleukin-2 and interleukin-12. Outgrowth of TIL from tissue samples was initiated by short-term supplementation with a specific activation cocktail. During subsequent expansion, TILs were grown in interleukin-2-enriched medium. Expansion of TILs in a low-scaled, two-phase process in the Zellwerk ZRP bioreactor under hyperoxic conditions resulted in a number of approximately 2 × 109 cells. The expanded TILs consisted mainly (73%) of the ACT-relevant CD3+/CD8+ effector memory phenotype (CD45RO+/CCR7-). TILs harvested under these conditions exhibited high functional potential, which was confirmed upon nonspecific stimulation (interferon-γ, tumor necrosis factor-α cytokine assay).

Laparoscopic vs. Open Surgical Repair of Subxiphoidal Hernia Following Median Sternotomy for Coronary Bypass - Analysis of the Herniamed Registry.

Introduction: The repair of subxiphoidal incisional hernia following median sternotomy is technically demanding due to the specific anatomic situation and the lateral distracting forces in this region. Published data are available from retrospective reports with limited number of patients only. The aim of this study was to evaluate the outcome of subxiphoidal hernia repair comparing laparoscopic and open surgical approach. Materials and Methods: This analysis of Herniamed registry data of patients with subxiphoidal incisional hernia following sternotomy for coronary bypass assesses the perioperative and 1 year follow-up outcome of laparoscopic and open repair. Demographic data and perioperative outcomes were stratified by surgical approach (laparoscopic vs. open) and compared as unadjusted analyses using Chi square and Students t-tests. Results: Of 208 patients identified for the analysis 69 patients (33.2%) underwent laparoscopic and 139 (66.8%) patients had open repair. Concerning demographic data (gender, age, BMI, ASA score), risk factors and hernia size there were no significant differences between laparoscopic and open repair group. For intraoperative, postoperative and general complications as well as complication related re-operations no significant differences were seen between the groups. No significant advantage could be stated for laparoscopic repair regarding duration of operation and hospital stay. The recurrence rate at 1 year follow-up was higher in the laparoscopic group (7.2 vs. 2.2%; p = 0.072). No significant differences were reported in the 1 year follow-up evaluation of pain at rest, pain on exertion and pain requiring treatment. Conclusion: The repair of subxiphoidal incisional hernia is safe in both open and laparoscopic technique. With regard to the lower recurrence rate preference can be given to open repair.

Nonocclusive mesenteric ischemia associated with postoperative jejunal tube feeding: Indicators for clinical management.

Postoperative nutrition via a jejunal tube after major abdominal surgery is usually well tolerated. However, some patients develop nonocclusive mesenteric ischemia (NOMI). This morbid complication has a grave prognosis with a mortality rate of 41% to 100%. Early symptoms are nonspecific, and no treatment guideline is available. We reviewed cases of NOMI at our institution and cases described in the literature to identify factors that impact the clinical course. Among five patients, three had no necrosis and one had segmental necrosis and perforation. These patients recovered with limited resection and decompression of the bowel and abdominal compartment. In one patient with extended bowel necrosis at the time of re-laparotomy, NOMI progressed and the patient died of multiple organ failure. The extent of small bowel necrosis at the time of re-laparotomy is a relevant prognostic factor. Therefore, early diagnosis and treatment of NOMI can improve the prognosis. Clinical symptoms of abdominal distension, cramps and high reflux plus paraclinical signs of leukocytosis, hypotension and computed tomography findings of a distended small bowel with pneumatosis intestinalis and portal venous gas can help to establish the diagnosis. We herein introduce an algorithm for the diagnosis and management of NOMI associated with jejunal tube feeding.

Bilateral giant inguinoscrotal hernia. Presentation of a novel combined two-stage repair approach.

Giant inguinoscrotal hernia is typically defined as hernia extending below the midpoint of the inner thigh, in the standing position. These hernias can be a demanding surgical problem as replacing bowel contents into the abdomen that can cause a life-threatening increase in intra-abdominal pressures. Various techniques such as preoperative progressive pneumoperitoneum (PPP), debulking of abdominal contents with visceral resections with or without omentectomy and phrenectomy have been suggested. We report the case of a 65-year-old patient with giant bilateral inguinal hernia. We applied a novel two-stage combined approach consisting of PPP with simultaneous single shot injection of botulinum toxin Type A into the anterior abdominal wall, and a second stage laparotomy with hernia repair (Stoppa technique). This technique makes possible the successful treatment of giant inguinal hernias without the need for visceral resection. To our knowledge, this is the first presented case of this combined treatment modality.

Quantitative Estimation of Leaf Heat Transfer Coefficients by Active Thermography at Varying Boundary Layer Conditions.

Quantifying heat and mass exchanges processes of plant leaves is crucial for detailed understanding of dynamic plant-environment interactions. The two main components of these processes, convective heat transfer, and transpiration, are inevitably coupled as both processes are restricted by the leaf boundary layer. To measure leaf heat capacity and leaf heat transfer coefficient, we thoroughly tested and applied an active thermography method that uses a transient heat pulse to compute τ, the time constant of leaf cooling after release of the pulse. We validated our approach in the laboratory on intact leaves of spring barley (Hordeum vulgare) and common bean (Phaseolus vulgaris), and measured τ-changes at different boundary layer conditions.By modeling the leaf heat transfer coefficient with dimensionless numbers, we could demonstrate that τ improves our ability to close the energy budget of plant leaves and that modeling of transpiration requires considerations of convection. Applying our approach to thermal images we obtained spatio-temporal maps of τ, providing observations of local differences in thermal responsiveness of leaf surfaces. We propose that active thermography is an informative methodology to measure leaf heat transfer and derive spatial maps of thermal responsiveness of leaves contributing to improve models of leaf heat transfer processes.

Daily and seasonal dynamics of remotely sensed photosynthetic efficiency in tree canopies.

The photosynthesis of various species or even a single plant varies dramatically in time and space, creating great spatial heterogeneity within a plant canopy. Continuous and spatially explicit monitoring is, therefore, required to assess the dynamic response of plant photosynthesis to the changing environment. This is a very challenging task when using the existing portable field instrumentation. This paper reports on the application of a technique, laser-induced fluorescence transient (LIFT), developed for ground remote measurement of photosynthetic efficiency at a distance of up to 50 m. The LIFT technique was used to monitor the seasonal dynamics of selected leaf groups within inaccessible canopies of deciduous and evergreen tree species. Electron transport rates computed from LIFT measurements varied over the growth period between the different species studied. The LIFT canopy data and light-use efficiency measured under field conditions correlated reasonably well with the single-leaf pulse amplitude-modulated measurements of broadleaf species, but differed significantly in the case of conifer tree species. The LIFT method has proven to be applicable for a remote sensing assessment of photosynthetic parameters on a diurnal and seasonal scale; further investigation is, however, needed to evaluate the influence of complex heterogeneous canopy structures on LIFT-measured chlorophyll fluorescence parameters.