[Perioperative management and operative treatment of malignant tumor of anal canal merging severe abdominal protuberance].

Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.

[Progress of laparoscopy and endoscopy cooperative surgery for early colorectal tumors].

Cooperative laparoscopic or robotic-endoscopic surgery has emerged as a promising approach for the treatment of early-stage colorectal cancers that are difficult to treat with endoscopic techniques alone. Cooperative surgery allows organ and function preservation by complementing the advantages of each modality, providing minimally invasive, precise and personalized treatment options. Laparoscopic-endoscopic cooperative surgery includes laparoscopic-assisted endoscopic resection, combined laparoscopic-endoscopic full-thickness resection, endoscopic-assisted laparoscopic wedge resection, endoscopic-assisted laparoscopic segmental resection, and laparoscopic-endoscopic cooperative surgery with sentinel lymph node dissection. Nearly three decades of clinical research and practice have demonstrated the safety and efficacy of laparoscopic and endoscopic cooperative surgery in the treatment of colorectal tumors. With the progress of the minimally invasive concept, the development of minimally invasive technology and the innovation of minimally invasive equipment, laparoscopy and endoscopy cooperative surgery is expected to have a proper place in the treatment of colorectal tumors.

[Application of robotic (or laparoscopic) surgery combined with colonoscopy in T1 stage colorectal cancer surgery: 13 cases].

Objective: To investigate the feasibility and safety of a robotic surgical system (or laparoscopy) in combination with colonoscopy (combined) for the treatment of stage T1N0M0 colorectal cancer. Methods: This was a descriptive case series. Indications for combined dual-scope surgery in this study were as follows: (1) preoperative colonoscopic examination of lesions in the middle and upper rectum and colon with pathologically confirmed high-grade intraepithelial neoplasia, intramucosal adenocarcinoma, or adenocarcinoma; (2) no distant or local lymph node metastases; and (3) endoscopic ultrasound and magnetic resonance imaging evidence of tumor invasion of the mucosal or submucosal, but not the muscular, layer (i.e., T1). The clinical data of 13 patients with stage T1 colorectal cancer who had undergone dual-scope combined resection using a robotic surgery system or laparoscope-assisted combined colonoscopy surgery at the First Affiliated Hospital of Zhengzhou University from April to October 2022 were retrospectively collected, including 6 males and 7 females, with a median age of 59 (48~88) years old. The tumors were located in the upper and middle rectum in six patients, in the sigmoid colon in three, and in the ascending colon in four. The median maximum diameter of the tumors was 3.0 (1.8-5.0) cm. The surgery was performed by a robotic surgery system (or laparoscopy) with peritumoral D1 lymph node dissection at the first station in the tumor area. The tumors were resected under direct vision and the defects in the intestinal wall were using a robotic surgery system (or laparoscopy). A robotic surgery system was combined with colonoscopy in eight cases and laparoscopy combined with colonoscopy in the remaining five. Studied variables includes surgical and pathological features, postoperative factors, and outcomes. Results: Surgery was successful in all 13 patients with no need for conversion to open surgery or intraoperative blood transfusion. The median operating time was 85 (60-120) minutes, median intraoperative bleeding 3 (2-5) mL, median number of lymph nodes harvested 3 (1-5), and the median circumferential resection margin 0.8 (0.5-1.0) cm. Postoperative pathological examination showed lymph node metastasis in one patient, who therefore underwent additional radical surgery. The median postoperative time to ambulation was 1 (1-2) days. The urinary catheters of all patients were removed 1 day after surgery and the median length of stay was 4 (3-5) days. No abdominal infection, anastomotic leakage or bleeding occurred in any of the study patients. The median follow-up time was 10 (6-12) months, during which no tumor recurrence or metastasis was found, and the quality of life was satisfactory. Conclusions: The combination of two minimally invasive platforms, a robotic surgery system (or laparoscopy) and colonoscopy, is safe and feasible for resection of stage T1 colorectal cancer and has a good short-term prognosis.

[Progress in intestinal adaptation after enterectomy].

Intestinal adaptation is a spontaneous compensation of the remanent bowel after extensive enterectomy, which improves the absorption capacity of the remanent bowel to energy, fluid and other nutrients. Intestinal adaptation mainly occurs within 2 years after enterectomy, including morphological changes, hyperfunction and hyperphagia. Intestinal adaptation is the key factor for patients with short bowel syndrome to weaning off parenteral nutrition dependence and mainly influenced by length of remanent bowel, type of surgery and colon continuity. In addition, multiple factors including enteral feeding, glucagon-like peptide 2 (GLP-2), growth hormone, gut microbiota and its metabolites regulate intestinal adaptation via multi-biological pathways, such as proliferation and differentiation of stem cell, apoptosis, angiogenesis, nutrients transport related protein expression, gut endocrine etc. Phase III clinical trials have verified the safety and efficacy of teduglutide (long-acting GLP-2) and somatropin (recombinant human growth hormone) in improving intestinal adaptation, and both have been approved for clinical use. We aim to review the current knowledge about characteristics, mechanism, evaluation methods, key factors, clinical strategies of intestinal adaptation.

Decreased circulating neopterin is associated with increased arterial elasticity: a beneficial role of periodontal treatment.

BACKGROUND: The aim of this study was to evaluate the effect of periodontal treatment on arterial elasticity and circulating neopterin in patients with moderate to severe periodontitis in a Chinese population. METHODS: One hundred and eight patients with moderate to severe periodontitis were eligible to take part in the study and were randomized into two groups. The treatment group received intensive periodontal treatment, while the control group received control periodontal treatment. All parameters, including brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI), serum neopterin (NP), high-sensitivity C-reactive protein (hs-CRP), Interleukin-6 (IL-6), were evaluated before treatment and 1 month after treatment. RESULTS: The parameters including NP, hs-CRP, IL-6 and baPWV decreased significantly after 1 month in the treatment group (p < 0.05 for all comparisons) but not in the control group (p > 0.05). There was no significant difference in the change of ABI between the two groups (p = 0.231). A positive correlation was found between the decreased circulating NP and increased arterial elasticity in the treatment group (r = 0.947, p < 0.001). CONCLUSIONS: This study demonstrates for the first time that the fall in circulating NP induced by periodontal treatment contributes to increased arterial elasticity in patients with moderate and severe periodontitis.

Influence of colorectal cancer tumor suppressor gene CHD5 methylation on its clinical and pathological characteristics.

Recently, abnormal tumor suppressor gene (TSG) methylation has become a hotspot in the research on colorectal cancer (CRC). This study aimed to explore the influence of CHD5 methylation of CRC TSG on its clinical and pathological characteristics. A total of 40 operation samples as well as corresponding tissue specimens were collected from CRC patients treated in the First Affiliated Hospital of Zhengzhou University from January to December in 2014. CHD5 gene methylation in tissue specimens was detected with methylation specific polymerase chain reaction (MSP); moreover, messenger ribose nucleic acid (mRNA) expression of CHD5 in each tissue was tested using reverse transcription-polymerase chain reaction (RT-PCR), and Western blot was applied to detect the expression of CHD5 protein in those tissues and to analyze the correlation between mRNA and protein of cancer tissue CHD5 as well as the relationship between CHD5 methylation and protein expression. Results revealed that the expression rate of CHD5 methylation in 40 normal mucosal tissues, para-carcinoma tissues, adenoma tissues and CRC tissues was 12.5% (5/40), 22.5% (9/40), 47.5% (19/40) and 72.5% (33/40), respectively. The mRNA expression of CHD5 in the above tissues was 0.225±0.276, 0.169±0.231, 0.147±0.159 and 0.013±0.011 and the protein expression of CHD5 was 0.438±0.205, 0.398±0.180, 0.156±0.1 and 0.024±0.311, respectively. Methylation rate of CHD5 was 87% (20/23) in 23 cases of CHD5 protein loss expression and 52.9% (9/17) in 17 cases of CHD5 protein expression. Results of chi-squared test indicated that there was a significant difference in methylation rate (P less than 0.05), that is, the methylation rate of negatively expressed CHD5 protein was obviously higher than positively expressed protein. Thus, it can be concluded that the CHD5 methylation rate rises gradually in the evolution of CRC, which is related to the occurrence and development of CRC. Furthermore, CHD5 mRNA is positively correlated with protein expression and CHD5 gene methylation is associated with protein loss expression. Therefore, TSG CHD5 methylation of rectal cancer has a great effect in influencing its clinical and pathological features.

Estimation of water vapor content in near-infrared bands around 1 mum from MODIS data by using RM-NN.

An algorithm based on the radiance transfer model (RM) and a dynamic learning neural network (NN) for estimating water vapor content from moderate resolution imaging spectrometer (MODIS) 1B data is developed in this paper. The MODTRAN4 is used to simulate the sun-surface-sensor process with different conditions. The dynamic learning neural network is used to estimate water vapor content. Analysis of the simulation data indicates that the mean and standard deviation of estimation error are under 0.06 gcm(-2 )and 0.08 gcm(-2). The comparison analysis indicates that the estimation result by RM-NN is comparable to that of a MODIS water vapor content product (MYD05_L2). Finally, validation with ground measurement data shows that RM-NN can be used to accurately estimate the water vapor content from MODIS 1B data, and the mean and standard deviation of the estimation error are about 0.12 gcm(-2 )and 0.18 gcm(-2).

Wavefront correcting properties of corner-cube arrays.

The performance of corner-cube arrays as pseudophase-conjugation wavefront correctors is investigated theoretically and experimentally. Hollow electroformed arrays and solid plastic arrays of corner-cube retroreflectors have been optically characterized and studied in a pseudophase-conjugate imaging system. The use of a collimating lens is found to improve dramatically the image quality.