A novel perineal exposure method in laparoscopic abdominal perineal resection of rectal cancer: a case series study.

BACKGROUND: Abdominal perineal resection (APR) of rectal cancer, also known as Mile's procedure, is a classic procedure for the treatment of rectal cancer. Through the improvement of surgical skills and neoadjuvant therapy, the sphincter-preserving rate in rectal cancer patients has improved, even in patients with ultralow rectal cancer who underwent APR in the past. However, APR cannot be completely replaced by low anterior resection (LAR) in reality. APR still has its indications, when the tumor affects the external sphincter, etc. Good perineal exposure in APR is difficult and can seriously affect surgical safety and the long-term prognosis. METHODS: We reviewed the records of 16 consecutive patients with rectal cancer who underwent APR at Anqing Municipal Hospital from January 2022 to April 2023, including 11 males and 5 females, with an average age of 64.8 ± 10.3 years. The perineal operation was completed with the Lone-Star® retractor-assisted (LSRA) exposure method. After incising the skin and subcutaneous tissue, a Lone-Star® retractor was placed, and the incision was retracted in surrounding directions with 8 small retractors, which facilitated the freeing of deep tissues. We dynamically adjusted the retractor according to the plane to fully expose the surgical field. RESULTS: All 16 patients underwent laparoscopic-assisted APR successfully. Thirteen procedures were performed independently by a single person, and the others were completed by two persons due to intraoperative arterial hemostasis. All specimens were free of perforation and had a negative circumferential resection margin (CRM). Postoperative complications occurred in 4 patients, including urinary retention in 1 patient, pulmonary infection in 1 patient, intestinal adhesion in 1 patient and peristomal dermatitis in 1 patient, and were graded as ClavienDindo grade 3 or lower and cured. No distant metastasis or local recurrence was found for any of the patients in the postoperative follow-up. CONCLUSIONS: The application of the LSRA exposure method might be helpful for perineal exposure during APR for rectal cancer, which could improve intraoperative safety and surgical efficiency, achieve one-person operation, and increase the comfort of operators.

Uncovering the selectivity mechanism of phosphodiesterase 7A/8A inhibitors through computational studies.

The expression of phosphodiesterase 7A (PDE7A) and phosphodiesterase 8A (PDE8) genes is integral to human signaling pathways, and the inhibition of PDE7A has been associated with the onset of various diseases, including effects on the immune system and nervous system. The development of PDE7 selective inhibitors can promote research on immune and nervous system diseases, such as multiple sclerosis, chronic inflammation, and autoimmune responses. PDE8A is expressed alongside PDE8B, and its inhibitory mechanism is still unclear. Studying the mechanisms of selective inhibitors against different PDE subtypes is crucial to prevent potential side effects, such as nausea and cardiac toxicity, and the sequence similarity of the two protein subtypes was 55.9%. Therefore, it is necessary to investigate the differences of both subtypes' ligand binding sites. Selective inhibitors of two proteins were chosen to summarize the reason for their selectivity through molecular docking, molecular dynamics simulation, alanine scanning mutagenesis, and MM-GBSA calculation. We found that Phe384PDE7A, Leu401PDE7A, Gln413PDE7A, Tyr419PDE7A, and Phe416PDE7A in the active site positively contribute to the selectivity towards PDE7A. Additionally, Asn729PDE8A, Phe767PDE8A, Gln778PDE8A, and Phe781PDE8A positively contribute to the selectivity towards PDE8A.

Unraveling the causal role of immune cells in gastrointestinal tract cancers: insights from a Mendelian randomization study.

Background: Despite early attempts, the relationship between immune characteristics and gastrointestinal tract cancers remains incompletely elucidated. Hence, rigorous and further investigations in this domain hold significant clinical relevance for the development of novel potential immunotherapeutic targets. Methods: We conducted a two-sample Mendelian randomization (MR) analysis using the tools available in the "TwoSampleMR" R package. The GWAS data for these 731 immune traits were sourced from the GWAS Catalog database. Concurrently, data on gastrointestinal tract cancers, encompassing malignant tumors in the esophagus, stomach, small intestine, colon, and rectum, were extracted from the FinnGen database. The immune traits subjected to MR analysis predominantly fall into four categories: median fluorescence intensities (MFI), relative cell (RC), absolute cell (AC), and morphological parameters (MP). To ensure the reliability of our findings, sensitivity analyses were implemented to address robustness, account for heterogeneity, and alleviate the impact of horizontal pleiotropy. Results: A total of 78 immune traits causally linked to gastrointestinal tract cancers were identified, encompassing esophageal cancer (12 traits), gastric cancer (13 traits), small intestine cancer (22 traits), colon cancer (12 traits), and rectal cancer (19 traits). Additionally, 60 immune traits were recognized as protective factors associated with gastrointestinal tract cancers, distributed across esophageal cancer (14 traits), gastric cancer (16 traits), small intestine cancer (7 traits), colon cancer (14 traits), and rectal cancer (9 traits). Furthermore, it was observed that seven immune traits are causally related to gastrointestinal tract cancers in at least two locations. These traits include "CCR2 on CD14- CD16+ monocyte," "CD19 on IgD+ CD38-," "CD19 on IgD+ CD38- naive," "CD25hi CD45RA+ CD4 not Treg AC," "CD27 on unsw mem," "CD28 on CD39+ activated Treg," and "CD45 on CD4+." Conclusion: This study elucidates a causal link between immune cells and gastrointestinal tract cancers at various sites through genetic investigation. The findings of this research open up new perspectives and resources for exploring tumor prevention strategies and immunotherapeutic targets.

Saturable absorption properties and ultrafast photonics applications of HfS3.

In this Letter, we focus on investigating the ultrafast photonics applications of two-layer HfS3 nanosheets. We prepared two-layer HfS3 nanosheets and carried out experiments to study their nonlinear saturable absorption properties. The results showed that the two-layer HfS3-based saturable absorber exhibited a modulation depth of 16.8%. Additionally, we conducted theoretical calculations using first principles to estimate the structural and electronic band properties of the two-layer HfS3 material. Furthermore, we utilized the two-layer HfS3 materials as SAs in an erbium-doped fiber cavity to generate mode-locked laser pulses. We measured a repetition frequency of 8.74 MHz, a pulse duration of 540 fs, and a signal-to-noise ratio of 77 dB. Overall, our findings demonstrate that the two-layer HfS3 material can serve as a reliable saturable absorber, possessing properties comparable to currently used two-dimensional materials. This expands the application fields of HfS3 materials and highlights their potential for advanced optoelectronic devices.

[The correlation between preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and postoperative recurrence of chronic rhinosinusitis].

Objective:Neutrophil-to-lymphocyte ratio （NLR） and platelet-to-lymphocyte ratio （PLR） play important roles in the poor prognosis of different inflammatory and neoplastic diseases, but their effects on postoperative recurrence of chronic rhinosinusitis（CRS） are unknown. The aim of this study was to investigate the correlation between preoperative NLR and PLR and the risk of postoperative recurrence in CRS. Methods:Clinical data were collected from patients with CRS who underwent initial functional endoscopic sinus surgery from October 2018 to February 2022 at our institution. Follow-up was until February 2023, and the study endpoint was defined as patient postoperative recurrence or follow-up time up to date. The optimal preoperative NLR and PLR threshold values were obtained based on subject work curve analysis, and they were divided into high and low level subgroups, respectively, and the clinical characteristics and postoperative recurrence rates of patients were compared between groups; patients were divided into non-recurrent CRS and recurrent CRS according to their postoperative recurrence, and Kaplan-Meier survival curves and logistic regression analysis were performed to explore the correlation between NLR and PLR and CRS The correlation between NLR and PLR and postoperative recurrence was investigated by Kaplan-Meier survival curve and logistic regression analysis. Results:A total of 630 patients with CRS were included, including 382 and 140 patients with high NLR and high PLR, respectively. The postoperative recurrence rates of CRS patients in the high NLR and high PLR groups were significantly higher than those in the low NLR and low PLR groups（P<0.05）. The recurrent CRS had higher NLR and PLR levels and higher proportion of high NLR and high PLR than the non-recurrent CRS（P<0.05）, and similarly the duration of recurrent CRS and the rate of allergic rhinitis with recurrence were significantly higher than the non-recurrent CRS（P<0.05）. Kaplan-Meier survival curves showed that postoperative CRS was significantly higher in the high NLR and high PLR groups compared with the low NLR and low PLR groups. recurrence was significantly higher（P<0.05）. In addition, logistic regression analysis showed that high NLR, high PLR, disease duration, and combined allergic rhinitis were significantly associated with an increased risk of postoperative recurrence of CRS（P<0.05）. Conclusion:Both high preoperative NLR and high PLR are independent risk factors for postoperative recurrence of CRS, and they are expected to be new indicators for postoperative prognostic assessment and risk stratification of CRS patients. In addition, disease duration and comorbid allergic rhinitis were significantly associated with the risk of postoperative recurrence of CRS.

Amino Acid-Starved Cancer Cells Utilize Macropinocytosis and Ubiquitin-Proteasome System for Nutrient Acquisition.

To grow in nutrient-deprived tumor microenvironment, cancer cells often internalize and degrade extracellular proteins to refuel intracellular amino acids. However, the nutrient acquisition routes reported by previous studies are mainly restricted in autophagy-lysosomal pathway. It remains largely unknown if other protein degradation systems also contribute to the utilization of extracellular nutrients. Herein, it is demonstrated that under amino acid starvation, extracellular protein internalization through macropinocytosis and protein degradation through ubiquitin-proteasome system are activated as a nutrient supply route, sensitizing cancer cells to proteasome inhibition. By inhibiting both macropinocytosis and ubiquitin-proteasome system, an innovative approach to intensify amino acid starvation for cancer therapy is presented. To maximize therapeutic efficacy and minimize systemic side effects, a pH-responsive polymersome nanocarrier is developed to deliver therapeutic agents specifically to tumor tissues. This nanoparticle system provides an approach to exacerbate amino acid starvation for cancer therapy, which represents a promising strategy for cancer treatment.

Near-infrared light-triggered prodrug photolysis by one-step energy transfer.

Prodrug photolysis enables spatiotemporal control of drug release at the desired lesions. For photoactivated therapy, near-infrared (NIR) light is preferable due to its deep tissue penetration and low phototoxicity. However, most of the photocleavable groups cannot be directly activated by NIR light. Here, we report a upconversion-like process via only one step of energy transfer for NIR light-triggered prodrug photolysis. We utilize a photosensitizer (PS) that can be activated via singlet-triplet (S-T) absorption and achieve photolysis of boron-dipyrromethene (BODIPY)-based prodrugs via triplet-triplet energy transfer. Using the strategy, NIR light can achieve green light-responsive photolysis with a single-photon process. A wide range of drugs and bioactive molecules are designed and demonstrated to be released under low-irradiance NIR light (100 mW/cm2, 5 min) with high yields (up to 87%). Moreover, a micellar nanosystem encapsulating both PS and prodrug is developed to demonstrate the practicality of our strategy in normoxia aqueous environment for cancer therapy. This study may advance the development of photocleavable prodrugs and photoresponsive drug delivery systems for photo-activated therapy.

Reactive Oxygen Species-Responsive Polymeric Prodrug Nanoparticles for Selective and Effective Treatment of Inflammatory Diseases.

It is challenging to manage inflammatory diseases using traditional anti-inflammatory drugs due to their limited efficacy and systemic side effects, which are a result of their lack of selectivity, poor stability, and low solubility. Herein, it reports the development of a novel nanoparticle system, called ROS-CA-NPs, which is formed using polymer-cinnamaldehyde (CA) conjugates and is responsive to reactive oxygen species (ROS). ROS-CA-NPs exhibit excellent drug stability, tissue selectivity, and controlled drug release upon oxidative stress activation. Using mouse models of chronic rheumatoid arthritis and acute ulcerative colitis, this study demonstrates that the systemic administration of ROS-CA-NPs results in their accumulation at inflamed lesions and leads to greater therapeutic efficacy compared to traditional drugs. Furthermore, ROS-CA-NPs present excellent biocompatibility. The findings suggest that ROS-CA-NPs have the potential to be developed as safe and effective nanotherapeutic agents for a broad range of inflammatory diseases.

Photo-Enhanced Synergistic Induction of Ferroptosis for Anti-Cancer Immunotherapy.

Ferroptosis as programmed cell death received considerable attention in cancer research. Recently, studies have associated ferroptosis with photodynamic therapy (PDT) because PDT promotes glutathione (GSH) deletion, glutathione peroxidase 4 (GPX4) degradation, and lipid peroxide accumulation. However, PDT-induced ferroptosis may be potentially prevented by ferroptosis suppressor protein 1 (FSP1). To address this limitation, herein, a novel strategy is developed to trigger ferroptosis by PDT and FSP1 inhibition. For enhancement of this strategy, a photoresponsive nanocomplex, self-assembled by BODIPY-modified poly(amidoamine) (BMP), is utilized to stably encapsulate the inhibitor of FSP1 (iFSP1) and chlorin e6 (Ce6). The nanosystem promotes intracellular delivery, penetration, and accumulation of ferroptosis inducers in tumors with light irradiation. The nanosystem presents high-performance triggering of ferroptosis and immunogenic cell death (ICD) in vitro and in vivo. Importantly, the nanoparticles increase tumor infiltration of CD8+ T cells and further enhance the efficacy of anti-PD-L1 immunotherapy. The study suggests the potential of photo-enhanced synergistic induction of ferroptosis by the photoresponsive nanocomplexes in cancer immunotherapy.

Chromium oxide film for Q-switched and mode-locked pulse generation.

Chromium oxide (Cr2O3) is a promising material used in the applications such as photoelectrochemical devices, photocatalysis, magnetic random access memory, and gas sensors. But, its nonlinear optical characteristics and applications in ultrafast optics have not been studied yet. This study prepares a microfiber decorated with a Cr2O3 film via magnetron sputtering deposition and examines its nonlinear optical characteristics. The modulation depth and saturation intensity of this device are determined as 12.52% and 0.0176 MW/cm2. Meanwhile, the Cr2O3-microfiber is applied as a saturable absorber in an Er-doped fiber laser, and stable Q-switching and mode-locking laser pulses are successfully generated. In the Q-switched working state, the highest output power and shortest pulse width are measured as 12.8 mW and 1.385 µs, respectively. The pulse duration of this mode-locked fiber laser is as short as 334 fs, and its signal-to-noise ratio is 65 dB. As far as we know, this is the first illustration of using Cr2O3 in ultrafast photonics. The results confirm that Cr2O3 is a promising saturable absorber material and significantly extend the scope of saturable absorber materials for innovative fiber laser technologies.

An ileal gastrointestinal stromal tumor misdiagnosed as pelvic metastases from rectal cancer: a case report.

With the advancement of imaging and pathological diagnostic methods, it is not uncommon to see synchronous gastrointestinal stromal tumors (GIST) and other primary cancers, the most common of which are synchronous gastric cancer and gastric GIST. However, synchronous advanced rectal cancer and high-risk GIST in the terminal ileum are extremely rare, and they are easily misdiagnosed as rectal cancer with pelvic metastases due to their special location near iliac vessels. Herein, we report a 55-year-old Chinese woman with rectal cancer. Preoperative imaging revealed a middle and lower rectal lesion with a right pelvic mass (considered possible metastasis from rectal cancer). Through multidisciplinary discussions, we suspected the possibility of rectal cancer synchronous with a GIST in the terminal ileum. Intraoperative exploration by laparoscopy revealed a terminal ileal mass with pelvic adhesion, a rectal mass with plasma membrane depression, and no abdominal or liver metastases. Laparoscopic radical proctectomy (DIXON) plus partial small bowel resection plus prophylactic loop ileostomy was performed, and the pathological report confirmed the coexistence of advanced rectal cancer and a high-risk ileal GIST. The patient was treated with the chemotherapy (CAPEOX regimen) plus targeted therapy(imatinib) after surgery, and no abnormalities were observed on the follow-up examination. Synchronous rectal cancer and ileal GIST are rare and easily misdiagnosed as a rectal cancer with pelvic metastases, and careful preoperative imaging analysis and prompt laparoscopic exploration are required to determine the diagnosis and prolong patient survival.

Thrombus formation in the suprahepatic inferior vena cava after microwave ablation in patients with hepatic metastasis: a case report.

BACKGROUND: Microwave ablation (MWA) via ultrasound guidance is an important tool in the treatment of liver metastases. The most common postoperative complications are abdominal hemorrhage and bile leakage, whereas thrombosis in the suprahepatic inferior vena cava (IVC) is very rare, and clinical management is very difficult when the head end of the thrombus reaches the right atrium. CASE PRESENTATION: This is a case report of a 52-year-old man with hepatic metastasis 21 months after radical resection of rectal cancer. After chemotherapy combined with targeted therapy, metastasis in segment IV (S4) of the liver was treated with microwave ablation. Two months after treatment, the hepatic metastasis in S4 showed a microwave ablation zone on MRI.Enhanced MRI showed venous thrombosis located in the left hepatic vein and IVC, and the head of the thrombus reached the right atrium. After two weeks of anticoagulation and thrombolytic treatment, the follow-up MRI showed that the venous thrombus had nearly disappeared. CONCLUSION: When liver metastases are close to the hepatic vein, clinicians should pay attention to the occurrence of hepatic vein and IVC thrombosis following MWA; through early diagnosis and anticoagulation, pulmonary thromboembolism (PTE) can be minimized.

Construction of Nanostructured Glass-Zirconia to Improve the Interface Stability of Dental Bilayer Zirconia.

Bilayer zirconia restoration is one of the most commonly used restorations in dental practice, but the high frequency of the cohesive/adhesive fracture of veneered porcelain is still a problem. This paper focuses on the development of nanostructured glass-zirconia to improve the interface stability of dental zirconia substrate and veneered porcelain. A novel SiO2-Li2O-Al2O3 (SLA) glass was prepared and infiltrated into the surface of fully sintered dental zirconia to obtain nanostructured glass-zirconia structure. The prepared glass-zirconia was analyzed with scanning electron microscopes (SEM), energy dispersive spectroscopy (EDS) and X-ray diffraction spectroscopy (XRD). The wettability, roughness and 3D morphology of zirconia were altered, and shear bonding strength (SBS) test demonstrated almost double increase in SBS values of the nanostructured glass-zirconia structure. The failure modes and microstructure characteristics also verified the improved interfacial stability. This investigation provides a promising method for enhancing the structural stability of bilayer zirconia restorations.

Social Bots' Role in the COVID-19 Pandemic Discussion on Twitter.

Social bots have already infiltrated social media platforms, such as Twitter, Facebook, and so on. Exploring the role of social bots in discussions of the COVID-19 pandemic, as well as comparing the behavioral differences between social bots and humans, is an important foundation for studying public health opinion dissemination. We collected data on Twitter and used Botometer to classify users into social bots and humans. Machine learning methods were used to analyze the characteristics of topic semantics, sentiment attributes, dissemination intentions, and interaction patterns of humans and social bots. The results show that 22% of these accounts were social bots, while 78% were humans, and there are significant differences in the behavioral characteristics between them. Social bots are more concerned with the topics of public health news than humans are with individual health and daily lives. More than 85% of bots' tweets are liked, and they have a large number of followers and friends, which means they have influence on internet users' perceptions about disease transmission and public health. In addition, social bots, located mainly in Europe and America countries, create an "authoritative" image by posting a lot of news, which in turn gains more attention and has a significant effect on humans. The findings contribute to understanding the behavioral patterns of new technologies such as social bots and their role in the dissemination of public health information.

Profiling of Antimicrobial Metabolites Synthesized by the Endophytic and Genetically Amenable Biocontrol Strain Bacillus velezensis DMW1.

The genus Bacillus is one of the most important genera for the biological control of plant diseases that are caused by various phytopathogens. The endophytic Bacillus strain DMW1 was isolated from the inner tissues of potato tubers and exhibited strong biocontrol activity. Based on its whole-genome sequence, DMW1 belongs to the Bacillus velezensis species, and it is similar to the model strain B. velezensis FZB42. 12 secondary metabolite biosynthetic gene clusters (BGCs), including two unknown function BGCs, were detected in the DMW1 genome. The strain was shown to be genetically amenable, and seven secondary metabolites acting antagonistically against plant pathogens were identified by a combined genetic and chemical approach. Strain DMW1 did significantly improve the growth of tomato and soybean seedlings, and it was able to control the Phytophthora sojae and Ralstonia solanacearum that were present in the plant seedlings. Due to these properties, the endophytic strain DMW1 appears to be a promising candidate for comparative investigations performed together with the Gram-positive model rhizobacterium FZB42, which is only able to colonize the rhizoplane. IMPORTANCE Phytopathogens are responsible for the wide spread of plant diseases as well as for great losses of crop yields. At present, the strategies used to control plant disease, including the development of resistant cultivars and chemical control, may become ineffective due to the adaptive evolution of pathogens. Therefore, the use of beneficial microorganisms to deal with plant diseases attracts great attention. In the present study, a new strain DMW1, belonging to the species B. velezensis, was discovered with outstanding biocontrol properties. It showed plant growth promotion and disease control abilities that are comparable with those of B. velezensis FZB42 under greenhouse conditions. According to a genomic analysis and a bioactive metabolites analysis, genes that are responsible for promoting plant growth were detected, and metabolites with different antagonistic activities were identified. Our data provide a basis for DMW1 to be further developed and applied as a biopesticide, which is similar to the closely related model strain FZB42.

Multiple Concurrent Causal Relationships and Multiple Governance Pathways for Non-Pharmaceutical Intervention Policies in Pandemics: A Fuzzy Set Qualitative Comparative Analysis Based on 102 Countries and Regions.

The global outbreak of COVID-19 has been wreaking havoc on all aspects of human societies. In addition to pharmaceutical interventions, non-pharmaceutical intervention policies have been proven to be crucial in slowing down the spread of the virus and reducing the impact of the outbreak on economic development, daily life, and social stability. However, no studies have focused on which non-pharmaceutical intervention policies are more effective; this is the focus of our study. We used data samples from 102 countries and regions around the world and selected seven categories of related policies, including work and school suspensions, assembly restrictions, movement restrictions, home isolation, international population movement restrictions, income subsidies, and testing and screening as the condition variables. A susceptible-exposed-infected-quarantined-recovered (SEIQR) model considering non-pharmaceutical intervention policies and latency with infectiousness was constructed to calculate the epidemic transmission rate as the outcome variable, and a fuzzy set qualitative comparative analysis (fsQCA) method was applied to explore the multiple concurrent causal relationships and multiple governance paths of non-pharmaceutical intervention policies for epidemics from the configuration perspective. We found a total of four non-pharmaceutical intervention policy pathways. Among them, L1 was highly suppressive, L2 was moderately suppressive, and L3 was externally suppressive. The results also showed that individual non-pharmaceutical intervention policy could not effectively suppress the spread of the pandemic. Moreover, three specific non-pharmaceutical intervention policies, including work stoppage and school closure, testing and screening, and economic subsidies, had a universal effect in the policies grouping for effective control of the pandemic transmission.

Intracellular angiopoietin-1 promotes TKI-resistance via activation of JAK/STAT5 pathway in chronic myeloid leukemia.

Drug resistance from BCR-ABL tyrosine kinase inhibitors (TKIs) and other chemotherapeutics results in treatment failure and disease progression in chronic myeloid leukemia (CML). However, the mechanism is still uncertain. In this study, we investigated the role of angiopoietin-1 (ANG-1) as a potential prognostic factor for drug resistance in CML. Both intracellular and secretory ANG-1 (iANG-1 and sANG-1) were overexpressed in multidrug-resistant CML samples. The IC50 value was higher in primary CD34+ CD38- cells with more ANG-1. Silencing ANG-1significantly sensitized three TKI-resistant CML cell lines to imatinib (IM) while recombinant human ANG-1 failed to retain cell survival in vitro. This indicated the important role of iANG-1 as opposed to sANG-1 in CML drug resistance. Moreover, a similar effect was observed in xenograft mice models bearing ANG-1-silenced CML cells. Subsequently, pathway analysis and protein validation experiments showed activation of the JAK/STAT pathway and augmentation of STAT5a phosphorylation in ANG-1 restored CML cells. Upstream Src phosphorylation, which plays a crucial role in CML drug resistance, was also upregulated as a key event in iANG-1-related JAK/STAT pathway activation. In conclusion, our study elucidated a new BCR-ABL independent molecular mechanism induced by intracytoplasmic ANG-1 overexpression as a potential strategy for overcoming CML resistance.

Case report: Rupture of an ileus tube in a patient with recurrent rectal cancer.

The insertion of an ileus tube is an important treatment for intestinal obstruction. According to previous reports, jejunal intussusception has been reported as a complication associated with ileus tube placement. However, rupture of the weighted tip of an ileus tube has not been reported before. Herein, we report a 55-year-old Chinese woman who underwent radical proctectomy (DIXON) for rectal cancer and developed pelvic recurrence and lung metastasis 65 months after surgery, accompanied by symptoms of acute intestinal obstruction. An ileus tube was inserted before the operation (extensive total hysterectomy, bilateral adnexal resection, rectal Hartman operation, partial enterectomy, and intestinal adhesion lysis). Rupture of the ileus tube occurred after the operation and was treated with paraffin oil and enteral nutrition, and the metal beads and spring were eliminated through the colostomy. During the follow-up, the patient received targeted therapy plus immunotherapy, which was successful: the quality of life of the patient was excellent, and no obvious abnormal symptoms were found. Endoscopy-assisted ileus tube insertion should be performed under intravenous anesthesia, and a knot should be tied at the tip of the ileus tube before insertion so that the ileus tube can be inserted easily by grasping the thread with biopsy forceps(the "thread-knotting" method). With the above methods, the procedure of ileus tube insertion could be improved to reduce the incidence of tube-related rupture.

Adipose-targeted triiodothyronine therapy counteracts obesity-related metabolic complications and atherosclerosis with negligible side effects.

Thyroid hormone (TH) is a thermogenic activator with anti-obesity potential. However, systemic TH administration has no obvious clinical benefits on weight reduction. Herein we selectively delivered triiodothyronine (T3) to adipose tissues by encapsulating T3 in liposomes modified with an adipose homing peptide (PLT3). Systemic T3 administration failed to promote thermogenesis in brown and white adipose tissues (WAT) due to a feedback suppression of sympathetic innervation. PLT3 therapy effectively obviated this feedback suppression on adrenergic inputs, and potently induced browning and thermogenesis of WAT, leading to alleviation of obesity, glucose intolerance, insulin resistance, and fatty liver in obese mice. Furthermore, PLT3 was much more effective than systemic T3 therapy in reducing hypercholesterolemia and atherosclerosis in apoE-deficient mice. These findings uncover WAT as a viable target mediating the therapeutic benefits of TH and provide a safe and efficient therapeutic strategy for obesity and its complications by delivering TH to adipose tissue.

Tumor thrombus formation in the right common iliac vein after radical proctectomy in a patient with rectal cancer: a case report.

BACKGROUND: Intravascular tumor thrombi are mainly found in patients with liver cancer or renal carcinoma but rarely occur in those with rectal cancer. CASE PRESENTATION: This is a case report of a 58-year-old woman with a swollen right lower extremity 14 months after radical resection for rectal cancer. Although ultrasonography indicated the presence of deep venous thrombosis (DVT) located in the right common iliac vein, interventional angiography showed that a circular mass, considered a tumor thrombus, was located in the right common iliac vein. The tumor thrombus was cured by interventional therapy, and the pathological report confirmed that the metastatic tumor thrombus originated from the rectal cancer. The patient underwent concurrent chemoradiotherapy and systemic therapy. However, right lung, retroperitoneum, and 2nd sacral vertebral metastases were discovered during follow-up. CONCLUSION: The correct diagnosis of a tumor thrombus and its differentiation from DVT can prevent incorrect treatment and prolong the survival of patients with rectal cancer.