Investigating the WNT/TCF pathway and the value of DCE-MRI in predicting and evaluating the efficacy of neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer.

The purpose of this research was to Detach the DCE-MRI value in predicting and evaluating the efficacy of neoadjuvant radiotherapy and chemotherapy in middle and low locally advanced rectal cancer (READ). For this purpose, 40 patients with READ were examined by DCE-MRI and DWI before CRT treatment and 4 weeks after CRT treatment, and examined by Avanto1.5T magnetic resonance imaging scanner. According to the comparison of the postoperative pathological T stage and pre-nCRT T stage, the patients with decreased stage were defined as the T-descending group, and those with unchanged or elevated staging were defined as the T-undescending group. The ROC curve was used to evaluate the value of ADC value and Ktrans value to predict the early curative effect of neoadjuvant radiation therapy and chemotherapy for READ. Results showed that The ADC values of the two groups after nCRT were higher than those before nCRT (P<0.05). Compared with the pre-nCRT T-decline group and T-non-decline group, the Ktrans value of the pre-T-decline group was higher than that of the T-non-decline group (P<0.05), and the Ktrans value of both groups after the nCRT was higher than that before nCRT (P<0.05). The difference and the rate of ADC in the T-depression group were higher than in the T-undescending group (P<0.05). Taking the change rate of the ADC value 0.17 as the optimal threshold, the sensitivity and specificity of predicting the T-descending stage of patients with READ after neoadjuvant radiotherapy and chemotherapy were 72.69% and 75.84%, respectively (95%CI:0.608-0.954); taking the pre-nCRTKtrans value 1.18/min as the optimal threshold, the sensitivity and specificity to predict the T-descending stage of READ patients after neoadjuvant radiation therapy and chemotherapy was 78.65% and 80.47%, respectively (95%CI:0.637-0.971). There was no significant difference between the change rate of ADC value and the Ktrans value before nCRT in predicting the early efficacy of neoadjuvant radiotherapy and chemotherapy for READ. In conclusion, ADC value and Ktrans value can reflect the tissue structure changes of READ after neoadjuvant chemotherapy. It can be seen that the change rate of ADC value and pre-nCRTKtrans value can predict the early efficacy of neoadjuvant radiotherapy and chemotherapy for READ. The results showed that Axin2 and ß-catenin factors along with other factors such as APC and CKI proteins are effective at the molecular level along with other factors in the WNT/TCF signaling pathway. These agents start their activity in the cytoplasm and exert their final effect on the genes in the nucleus.

Video-Assisted Modified Ligation of the Intersphincteric Fistula Tract, an Integration of 2 Minimally Invasive Techniques for the Treatment of Parks Type II Anal Fistulas.

Introduction. Complex anal fistula (CAF) is a challenging anorectal condition. Although numerous treatments for its management have been proposed, none is ideal. Herein, we investigated the clinical efficacy of video-assisted modified ligation of the intersphincteric fistula tract (LIFT) in comparison with the incision-thread-drawing procedure for Parks type II anal fistulas. Methods. Male and female adult patients with Parks type II anal fistula who were randomized to receive one of two procedures in the Anorectal Surgery Unit of the Affiliated People's Hospital of Ningbo University: video-assisted modified LIFT (test group, 30 cases) or incision thread drawing (control group, 30 cases). Healing and recurrence, postoperative pain, and postoperative autonomous anal control ability were compared. Results. In the test group, the pain scores were significantly lower (P = .001) and wound healing was faster (P = .001). However, there were no marked differences between groups in operative efficacy or postoperative infection rate (all P > .05). We followed all the patients for more than 18 months, with the test group having lower Jorge-Wexner incontinence (P = .005) and fecal incontinence (FI) severity index (P = .000) scores. No significant difference in recurrence (χ2 = .351, P = .554) or healing (χ2 = 1.071, P = .301) rate was found between the 2 groups. Conclusions. We established that video-assisted modified LIFT is superior in repairing Parks type II anal fistulas, with less trauma, quicker recovery, and better anal function.