Ulcerative colitis(UC)is a chronic inflammatory bowel disease characterized by persistent inflammation of the colon and disrupted intestinal function.Ramulus mori(Sangzhi)alkaloids(SZ-A),derived from twigs of mulberry...Ulcerative colitis(UC)is a chronic inflammatory bowel disease characterized by persistent inflammation of the colon and disrupted intestinal function.Ramulus mori(Sangzhi)alkaloids(SZ-A),derived from twigs of mulberry,were approved by the National Medical Products Administration in 2020 for treating type 2 diabetes mellitus.Accumulated evidence has confirmed that SZ-A also alleviates non-alcoholic fatty liver disease and ameliorates inflammation,indicating its potential to address inflammation in UC.However,the treatment of UC faces challenges due to low drug delivery efficiency and short retention time.To overcome these challenges,an injectable and adherent in-situ thermo-sensitive hydrogel containing SZ-A was developed for rectal drug delivery,utilizing the thermo-sensitive polymers Poloxamer 407and 188.The thermo-sensitive hydrogel system was designed with a moderate gelation temperature of 32±0.5℃,a short gelation time of 64 s,a p H range of 7-10,high moisturizing capability exceeding 90%,and moderate mechanical strength of 4-5 s.In a rat model with UC,the in situ thermo-sensitive hydrogel significantly extended the retention time at the colonic site and enabled sustained release after rectal administration.Symptoms of UC were markedly reduced following rectal administration of SZ-A thermosensitive hydrogel.Furthermore,the release of inflammatory factors,such as interleukin-1β(IL-1β),IL-6,IL-18,tumor necrosis factor-α(TNF-α),and transforming growth factor-β1(TGF-β1),significantly decreased in the SZ-A thermo-sensitive hydrogel group.The integrity of the colonic mucosal barrier was significantly enhanced following the application of SZ-A thermo-sensitive hydrogel.In conclusion,rectal administration of SZ-A in situ thermo-sensitive hydrogel effectively alleviated UC symptoms,inhibited the secretion of inflammatory factors,and promoted the repair of the colonic mucosal barrier.This approach holds promise as a potential treatment for UC.展开更多
Rectal mucinous adenocarcinoma(RMAC)is a relatively rare but highly aggressive type of tumour,and its early diagnosis and accurate staging are highly important for disease prognosis.With the continuous development of ...Rectal mucinous adenocarcinoma(RMAC)is a relatively rare but highly aggressive type of tumour,and its early diagnosis and accurate staging are highly important for disease prognosis.With the continuous development of medical imaging technology,MRI,a noninvasive imaging tool,is increasingly being used to diagnose rectal cancer.Although there have been several studies on the application of MRI in rectal cancer,there is still a lack of systematic summaries regarding the specific types,imaging characteristics,diagnostic challenges,and potential solutions for RMAC.In this review,we aim to summarize the MRI characteristics of RMAC,explore the current research status and application prospects of emerging technologies in this field,and provide references for clinical practice.展开更多
Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study a...Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.Methods:We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023.All patients underwent neoadjuvant concurrent chemoradiotherapy(CRT)followed by robotic-assisted surgery with total mesorectal excision(TME).Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen(CEA)levels.Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival(OS)and disease-free survival(DFS).Results:Patients with a pretreatment NLR of≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of<3.2(OS:94.4 vs.116.5 months,p=0.001;DFS:78.8 vs.101.7 months,p=0.003).Group A exhibited the poorest prognosis,whereas Group D had the most favorable outcomes.Multivariate analysis revealed NLR≥3.2 as an independent predictor of poor OS(hazard ratio[HR]=2.306,95%CI:1.149-3.747;p=0.001)and DFS(HR=2.055,95%CI:1.341-3.148;p=0.001).Conclusion:Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC.A higher pretreatment NLR(≥3.2)independently predicted worse OS and DFS.Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.展开更多
BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burde...BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.展开更多
In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment...In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.展开更多
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
It is essential in treating rectal cancer to have adequate preoperative imaging,as accurate staging can influence the management strategy,type of resection,and candidacy for neoadjuvant therapy.In the last twenty year...It is essential in treating rectal cancer to have adequate preoperative imaging,as accurate staging can influence the management strategy,type of resection,and candidacy for neoadjuvant therapy.In the last twenty years,endorectal ultrasound(ERUS) has become the primary method for locoregional staging of rectal cancer.ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers(T stage) .Lower accuracy for T2 tumors is commonly reported,which could lead to sonographic overstaging of T3 tumors following preoperative therapy.Unfortunately,ERUS is not as good for predicting nodal metastases as it is for tumor depth,which could be related to the unclear definition of nodal metastases.The use of multiple criteria might improve accuracy.Failure to evaluate nodal status could lead to inadequate surgical resection.ERUS can accurately distinguish early cancers from advanced ones,with a high detection rate of residual carcinoma in the rectal wall.ERUS is also useful for detection of local recurrence at the anastomosis site,which might require fine-needle aspiration of the tissue.Overstaging is more frequent than understaging,mostly due to inflammatory changes.Limitations of ERUS are operator and experiencedependency,limited tolerance of patients,and limited range of depth of the transducer.The ERUS technique requires a learning curve for orientation and identification of images and planes.With sufficient time and effort,quality and accuracy of the ERUS procedure could be improved.展开更多
Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this...Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one.For this reason a review of all the literature examining robotic surgery for rectal cancer was performed.Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE)using the key words"rectum","rectal","cancer","laparoscopy","robot".After the initial screen of 266 articles,43 papers were selected for review.A total of 3013 patients were included in the review.The most commonly performed intervention was low anterior resection(1450 patients,48.1%),followed by anterior resections(997 patients,33%),ultra-low anterior resections(393 patients,13%)and abdominoperineal resections(173 patients,5.7%).Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function.Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times.This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative,clinical outcomes and incidence of complications.In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide,until now,any significant clinical advantages to the patients.展开更多
In this article,we comment on the article by Long et al published in the recent issue of the World Journal of Gastrointestinal Oncology.Rectal cancer patients are at risk for developing metachronous liver metastasis(M...In this article,we comment on the article by Long et al published in the recent issue of the World Journal of Gastrointestinal Oncology.Rectal cancer patients are at risk for developing metachronous liver metastasis(MLM),yet early prediction remains challenging due to variations in tumor heterogeneity and the limitations of traditional diagnostic methods.Therefore,there is an urgent need for noninvasive techniques to improve patient outcomes.Long et al’s study introduces an innovative magnetic resonance imaging(MRI)-based radiomics model that integrates high-throughput imaging data with clinical variables to predict MLM.The study employed a 7:3 split to generate training and validation datasets.The MLM prediction model was constructed using the training set and subsequently validated on the validation set using area under the curve(AUC)and dollar-cost averaging metrics to assess performance,robustness,and generalizability.By employing advanced algorithms,the model provides a non-invasive solution to assess tumor heterogeneity for better metastasis prediction,enabling early intervention and personalized treatment planning.However,variations in MRI parameters,such as differences in scanning resolutions and protocols across facilities,patient heterogeneity(e.g.,age,comorbidities),and external factors like carcinoembryonic antigen levels introduce biases.Additionally,confounding factors such as diagnostic staging methods and patient comorbidities require further validation and adjustment to ensure accuracy and generalizability.With evolving Food and Drug Administration regulations on machine learning models in healthcare,compliance and careful consideration of these regulatory requirements are essential to ensuring safe and effective implementation of this approach in clinical practice.In the future,clinicians may be able to utilize datadriven,patient-centric artificial intelligence(AI)-enhanced imaging tools integrated with clinical data,which would help improve early detection of MLM and optimize personalized treatment strategies.Combining radiomics,genomics,histological data,and demographic information can significantly enhance the accuracy and precision of predictive models.展开更多
The objective of this study is to evaluate the efficacy of laparoscopic surgery combined with the rectal inversion and specimen extraction(RIES)technique for rectal cancer,focusing on both short-term and long-term out...The objective of this study is to evaluate the efficacy of laparoscopic surgery combined with the rectal inversion and specimen extraction(RIES)technique for rectal cancer,focusing on both short-term and long-term outcomes.A retrospective comparative analysis was performed on 120 patients who underwent laparoscopic radical excision for rectal cancer from June 2017 to June 2021.Patients were categorized into two groups:Group RIES(n=58),which received the novel RIES technique,and Group AIES(n=62),which underwent the conventional abdominal incision for specimen extraction.Short-term outcomes,such as postoperative pelvic sepsis,temporary ileus,anastomotic leakage,and anastomotic stricture,were meticulously recorded.Longterm efficacy was evaluated through the 3-year overall survival(OS),disease-free survival(DFS),and local recurrence rate(LRR).The RIES group demonstrated a 3-year OS,DFS,and LRR of 86.2%,77.6%,and 8.6%,respectively,with a low incidence of short-term complications.Comparatively,the AIES group showed a 3-year OS,DFS,and LRR of 83.9%,74.2%,and 19.4%,respectively,with slightly higher rates of postoperative complications.Statistical analysis using the Student's t-test,the chi-square(χ^(2))test revealed no significant differences in the primary outcomes between the two groups,and suggested the noninferiority of the RIES technique.The study suggests that the RIES technique is a safe,feasible,and potentially functional and oncological superior approach to rectal cancer treatment,without compromising clinical efficacy.Further research is warranted to validate thesefindings in a larger,multicenter,and randomized controlled trial.展开更多
Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for th...Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for these patients.This article discusses the development and implications of a novel prognostic tool,the GATIS score,which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods.Utilizing data from a large cohort and employing sophisticated statistical models,the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis.We evaluate the potential of this score to transform clinical decision-making processes,its integration into current medical practices,and future directions for its develo-pment.The integration of genetic markers and other biomarkers could further refine its predictive power,highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.展开更多
BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT e...BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.展开更多
Local excision(LE)is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy.Compared to traditional total mesorectal excision(TME),LE can achieve comp...Local excision(LE)is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy.Compared to traditional total mesorectal excision(TME),LE can achieve comparable on-cological outcomes while preserving function and improving quality of life(QoL).The indications for LE have been gradually expanded,but there are uncertainties regarding postoperative oncological results.Long-term follow-up prospective randomized controlled trials comparing TME and LE in terms of both oncological outcomes and QoL could help reduce uncertainties between these two approaches and contribute to the development of evidence-based guidelines for rectal cancer treatment.展开更多
Intrarectal infusion of butyrate improves colorectal disorders including ulcerative colitis （UC）. However, it is not established whether systemically administered butyrate benefits such patients. The current study a...Intrarectal infusion of butyrate improves colorectal disorders including ulcerative colitis （UC）. However, it is not established whether systemically administered butyrate benefits such patients. The current study aimed at ex- ploring and comparing the potential of intraperitoneally, intrarectally, and orally administered butyrate against acetic acid （AA）-induced UC in rats. Intrarectal administration of 2 ml of 50% AA was done after or without prior treatment of rats for 7 consecutive days with 100 mg/kg sodium butyrate （SB） intraperitoneally, intrarectally, or orally. Rats were sacrificed after 48 h of hA-treatment. Subsequently, colon sections were processed routinely for histopathological examination. We clinically observed diarrhea, loose stools, and hemoccult-positive stools, and histologically, epithelial loss and ulceration, crypt damage, goblet cell depletion, hemorrhage, and mucosal infiltration of inflammatory cells. The changes were significantly reduced by intraperitoneal, intrarectal, or oral butyrate, with intraperitoneal butyrate exhibiting the highest potency. It is concluded that intraperitoneal administration of butyrate abrogates the lesions of hA-induced UC and its potency surpasses that of intrarectal or oral butyrate.展开更多
In this work, some important parts of the system, and the relation between the parts, and its connections with other systems are defined, explained briefly. With this respect, the nature of the person is defined with ...In this work, some important parts of the system, and the relation between the parts, and its connections with other systems are defined, explained briefly. With this respect, the nature of the person is defined with related parts. A new science branch called ＂information science＂ is defined. Importance of the political organizing of a political party is shortly explained. The necessity of the academies for public sector, private sector, and for political administration system is expressed. How to choose a person and how a person can be choose for any part of the system is defined. For both cases ＂good and/or correct＂ system criterions, determination of the criterions, and evaluation criterions are defined. New evaluation levels are defined based on the 8-basic senses in philosophical point of view to deepen the sensitivity of the evaluations. The importance of the situation notice and how to make it for each of the association are explained. The 10 main service parameters are defined to show the interactive relations between the ideology, services, person nature and others. Present and possible future problems of a country are expressed. Aims/targets are characterized with real approach for all related sides. Other systems which proposed to be connected to continuable political administration system are shortly defined and expressed. Way of system administration and administration types are shortly explained. The importance and ways of the decision making are expressed. The general ways, types of inspection are shortly explained. Official units that could be assign for the new system are defined. The importance of these units and of the persons that could be assign for these units are expressed together with the definition of the characteristics of the persons or groups that could be. The necessity of an action planning, possible supply and demand cases are defined scientifically. The importance and necessity of sense of justice is explained to make system continuable. The methods of determination of the policies/strategies are expressed.展开更多
In this work all the political/non-political ideologies, 168 religions/beliefs/sects, nearly 1,600 ethnic origin groups are synthesized to define continuable political construction. It is found that all the past feder...In this work all the political/non-political ideologies, 168 religions/beliefs/sects, nearly 1,600 ethnic origin groups are synthesized to define continuable political construction. It is found that all the past federations, confederations, empires, ideologies, political administration systems, thoughts and senses, doctrines, etc. are in fact each reflects a special functional processes within a general system of where the kinds of services, subjects of services, way of services, service types and persons are considered and placed as a factor in it and where these factors are arranged through different priorities, weights, and also taken under record with some rules. It is evaluated that each groups, communities, societies, countries are separate models, but at the same time each of them are factors which owns different beginning points to reach a correct country structure with five new separate groups （New Era Group, Progression of The Country Group, Unity of The Country Group, Values of The Country Group, Social Progression Group）. The continuable political administration system is defined here by considering the all possible parts and by considering the other systems eormected for a country. Possible forceful factors which can effect political system administration are given. To realize political construction, some political construction methods are defined： Political construction by putting together the values, political construction based on different value, Political construction based on the new defined values, Political construction which considers stepped transition and Ideal political construction which will carry the political points of views and other standards of judgement, points of views of persons to a same line are expressed. New ideologies are put forwarded and ideal political construction for a world country is given with details. Integration of the political groups, political ideologies to the new system is explained. Some methods of politics are mentioned. Persons related with politics are classified simply.展开更多
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and ...The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.展开更多
Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and p...Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.展开更多
基金financially supported by the National Natural Science Foundation(No.82304393,China)Beijing Nova Program(Nos.Z211100002121127 and 20220484219,China)+1 种基金Beijing Natural Science Foundation(No.L212059,China)CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-028,China)。
文摘Ulcerative colitis(UC)is a chronic inflammatory bowel disease characterized by persistent inflammation of the colon and disrupted intestinal function.Ramulus mori(Sangzhi)alkaloids(SZ-A),derived from twigs of mulberry,were approved by the National Medical Products Administration in 2020 for treating type 2 diabetes mellitus.Accumulated evidence has confirmed that SZ-A also alleviates non-alcoholic fatty liver disease and ameliorates inflammation,indicating its potential to address inflammation in UC.However,the treatment of UC faces challenges due to low drug delivery efficiency and short retention time.To overcome these challenges,an injectable and adherent in-situ thermo-sensitive hydrogel containing SZ-A was developed for rectal drug delivery,utilizing the thermo-sensitive polymers Poloxamer 407and 188.The thermo-sensitive hydrogel system was designed with a moderate gelation temperature of 32±0.5℃,a short gelation time of 64 s,a p H range of 7-10,high moisturizing capability exceeding 90%,and moderate mechanical strength of 4-5 s.In a rat model with UC,the in situ thermo-sensitive hydrogel significantly extended the retention time at the colonic site and enabled sustained release after rectal administration.Symptoms of UC were markedly reduced following rectal administration of SZ-A thermosensitive hydrogel.Furthermore,the release of inflammatory factors,such as interleukin-1β(IL-1β),IL-6,IL-18,tumor necrosis factor-α(TNF-α),and transforming growth factor-β1(TGF-β1),significantly decreased in the SZ-A thermo-sensitive hydrogel group.The integrity of the colonic mucosal barrier was significantly enhanced following the application of SZ-A thermo-sensitive hydrogel.In conclusion,rectal administration of SZ-A in situ thermo-sensitive hydrogel effectively alleviated UC symptoms,inhibited the secretion of inflammatory factors,and promoted the repair of the colonic mucosal barrier.This approach holds promise as a potential treatment for UC.
文摘Rectal mucinous adenocarcinoma(RMAC)is a relatively rare but highly aggressive type of tumour,and its early diagnosis and accurate staging are highly important for disease prognosis.With the continuous development of medical imaging technology,MRI,a noninvasive imaging tool,is increasingly being used to diagnose rectal cancer.Although there have been several studies on the application of MRI in rectal cancer,there is still a lack of systematic summaries regarding the specific types,imaging characteristics,diagnostic challenges,and potential solutions for RMAC.In this review,we aim to summarize the MRI characteristics of RMAC,explore the current research status and application prospects of emerging technologies in this field,and provide references for clinical practice.
基金supported by grants through funding from the National Science and Technology Council(NSTC112-2314-B-037-050-MY3,NSTC114-2314-B-037-103-MY3,NSTC114-2321-B-037-003)the Ministry of Health and Welfare(MOHW113-TDU-B-222-134014)+3 种基金funded by the health and welfare surcharge of on tobacco products,and the Kaohsiung Medical University Hospital(KMUH113-3R31,KMUH113-3R32,KMUH113-3R33,KMUH113-3M58,KMUH113-3M59,KMUH-S11412,KMUH-SH11403)Kaohsiung Medical University Research Center Grant(KMU-TC113A04)National Tsing Hua University-Kaohsiung Medical University Joint Research Project(NTHU-KMU-KT114P008)supported by the Grant of Taiwan Precision Medicine Initiative and Taiwan Biobank,Academia Sinica,Taiwan.
文摘Background:The long-term outcomes of robotic-assisted surgery and the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio(NLR)in locally advanced rectal cancer(LARC)remain uncertain.This study aimed to assess the long-term outcomes of patients with LARC undergoing robotic-assisted surgery and to determine the prognostic value of pretreatment NLR.Methods:We retrospectively reviewed 252 patients with LARC who were treated at a single medical center in Taiwan between January 2012 and January 2023.All patients underwent neoadjuvant concurrent chemoradiotherapy(CRT)followed by robotic-assisted surgery with total mesorectal excision(TME).Patients were stratified into four groups on the basis of pretreatment NLRs and carcinoembryonic antigen(CEA)levels.Univariate and multivariate analyses were conducted to identify prognostic indicators for overall survival(OS)and disease-free survival(DFS).Results:Patients with a pretreatment NLR of≥3.2 exhibited significantly worse OS and DFS compared with those with an NLR of<3.2(OS:94.4 vs.116.5 months,p=0.001;DFS:78.8 vs.101.7 months,p=0.003).Group A exhibited the poorest prognosis,whereas Group D had the most favorable outcomes.Multivariate analysis revealed NLR≥3.2 as an independent predictor of poor OS(hazard ratio[HR]=2.306,95%CI:1.149-3.747;p=0.001)and DFS(HR=2.055,95%CI:1.341-3.148;p=0.001).Conclusion:Neoadjuvant concurrent CRT followed by robotic-assisted TME is an effective treatment strategy for LARC.A higher pretreatment NLR(≥3.2)independently predicted worse OS and DFS.Stratification using the NLR in combination with CEA levels may enhance prognostic accuracy for patients undergoing robotic-assisted surgery for LARC.
文摘BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.
文摘In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘It is essential in treating rectal cancer to have adequate preoperative imaging,as accurate staging can influence the management strategy,type of resection,and candidacy for neoadjuvant therapy.In the last twenty years,endorectal ultrasound(ERUS) has become the primary method for locoregional staging of rectal cancer.ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers(T stage) .Lower accuracy for T2 tumors is commonly reported,which could lead to sonographic overstaging of T3 tumors following preoperative therapy.Unfortunately,ERUS is not as good for predicting nodal metastases as it is for tumor depth,which could be related to the unclear definition of nodal metastases.The use of multiple criteria might improve accuracy.Failure to evaluate nodal status could lead to inadequate surgical resection.ERUS can accurately distinguish early cancers from advanced ones,with a high detection rate of residual carcinoma in the rectal wall.ERUS is also useful for detection of local recurrence at the anastomosis site,which might require fine-needle aspiration of the tissue.Overstaging is more frequent than understaging,mostly due to inflammatory changes.Limitations of ERUS are operator and experiencedependency,limited tolerance of patients,and limited range of depth of the transducer.The ERUS technique requires a learning curve for orientation and identification of images and planes.With sufficient time and effort,quality and accuracy of the ERUS procedure could be improved.
文摘Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one.For this reason a review of all the literature examining robotic surgery for rectal cancer was performed.Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE)using the key words"rectum","rectal","cancer","laparoscopy","robot".After the initial screen of 266 articles,43 papers were selected for review.A total of 3013 patients were included in the review.The most commonly performed intervention was low anterior resection(1450 patients,48.1%),followed by anterior resections(997 patients,33%),ultra-low anterior resections(393 patients,13%)and abdominoperineal resections(173 patients,5.7%).Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function.Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times.This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative,clinical outcomes and incidence of complications.In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide,until now,any significant clinical advantages to the patients.
文摘In this article,we comment on the article by Long et al published in the recent issue of the World Journal of Gastrointestinal Oncology.Rectal cancer patients are at risk for developing metachronous liver metastasis(MLM),yet early prediction remains challenging due to variations in tumor heterogeneity and the limitations of traditional diagnostic methods.Therefore,there is an urgent need for noninvasive techniques to improve patient outcomes.Long et al’s study introduces an innovative magnetic resonance imaging(MRI)-based radiomics model that integrates high-throughput imaging data with clinical variables to predict MLM.The study employed a 7:3 split to generate training and validation datasets.The MLM prediction model was constructed using the training set and subsequently validated on the validation set using area under the curve(AUC)and dollar-cost averaging metrics to assess performance,robustness,and generalizability.By employing advanced algorithms,the model provides a non-invasive solution to assess tumor heterogeneity for better metastasis prediction,enabling early intervention and personalized treatment planning.However,variations in MRI parameters,such as differences in scanning resolutions and protocols across facilities,patient heterogeneity(e.g.,age,comorbidities),and external factors like carcinoembryonic antigen levels introduce biases.Additionally,confounding factors such as diagnostic staging methods and patient comorbidities require further validation and adjustment to ensure accuracy and generalizability.With evolving Food and Drug Administration regulations on machine learning models in healthcare,compliance and careful consideration of these regulatory requirements are essential to ensuring safe and effective implementation of this approach in clinical practice.In the future,clinicians may be able to utilize datadriven,patient-centric artificial intelligence(AI)-enhanced imaging tools integrated with clinical data,which would help improve early detection of MLM and optimize personalized treatment strategies.Combining radiomics,genomics,histological data,and demographic information can significantly enhance the accuracy and precision of predictive models.
文摘The objective of this study is to evaluate the efficacy of laparoscopic surgery combined with the rectal inversion and specimen extraction(RIES)technique for rectal cancer,focusing on both short-term and long-term outcomes.A retrospective comparative analysis was performed on 120 patients who underwent laparoscopic radical excision for rectal cancer from June 2017 to June 2021.Patients were categorized into two groups:Group RIES(n=58),which received the novel RIES technique,and Group AIES(n=62),which underwent the conventional abdominal incision for specimen extraction.Short-term outcomes,such as postoperative pelvic sepsis,temporary ileus,anastomotic leakage,and anastomotic stricture,were meticulously recorded.Longterm efficacy was evaluated through the 3-year overall survival(OS),disease-free survival(DFS),and local recurrence rate(LRR).The RIES group demonstrated a 3-year OS,DFS,and LRR of 86.2%,77.6%,and 8.6%,respectively,with a low incidence of short-term complications.Comparatively,the AIES group showed a 3-year OS,DFS,and LRR of 83.9%,74.2%,and 19.4%,respectively,with slightly higher rates of postoperative complications.Statistical analysis using the Student's t-test,the chi-square(χ^(2))test revealed no significant differences in the primary outcomes between the two groups,and suggested the noninferiority of the RIES technique.The study suggests that the RIES technique is a safe,feasible,and potentially functional and oncological superior approach to rectal cancer treatment,without compromising clinical efficacy.Further research is warranted to validate thesefindings in a larger,multicenter,and randomized controlled trial.
文摘Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for these patients.This article discusses the development and implications of a novel prognostic tool,the GATIS score,which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods.Utilizing data from a large cohort and employing sophisticated statistical models,the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis.We evaluate the potential of this score to transform clinical decision-making processes,its integration into current medical practices,and future directions for its develo-pment.The integration of genetic markers and other biomarkers could further refine its predictive power,highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.
文摘BACKGROUND Total neoadjuvant therapy(TNT)has been proposed as an advancement over standard long-course chemoradiotherapy(LCCRT)for the treatment of locally advanced rectal cancer(LARC).It has been suggested that TNT enhances resect-ability,improves treatment compliance,increases the rate of pathological comp-lete response,and reduces the risk of systemic recurrence.However,concerns have been raised that the prolonged interval to surgery associated with TNT,particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol,may exacerbate fibrosis,leading to more technically challenging resections and poorer surgical outcomes.RAPIDO vs LCCRT.METHODS A single-center,retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024.A total of 99 patients with LARC were analyzed,inclu-ding 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT.Demo-graphics,clinicopathological characteristics and early post-operative outcomes were compared between both groups.RESULTS Both groups were comparable in terms of demographics and clinicopathological characteristics.The median interval from initiation of neoadjuvant therapy to Core Tip:Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes.The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes,compared with long-course chemoradiotherapy,remains an area of ongoing debate.This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation(RAPIDO)protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy.It may also confer a shorter total stoma duration and a lower permanent stoma rate.randomized controlled trials in the future are warranted to more accurately assess the differences between TNT-RAPIDO and LCCRT in relation to oncological outcomes.
文摘Local excision(LE)is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy.Compared to traditional total mesorectal excision(TME),LE can achieve comparable on-cological outcomes while preserving function and improving quality of life(QoL).The indications for LE have been gradually expanded,but there are uncertainties regarding postoperative oncological results.Long-term follow-up prospective randomized controlled trials comparing TME and LE in terms of both oncological outcomes and QoL could help reduce uncertainties between these two approaches and contribute to the development of evidence-based guidelines for rectal cancer treatment.
文摘Intrarectal infusion of butyrate improves colorectal disorders including ulcerative colitis （UC）. However, it is not established whether systemically administered butyrate benefits such patients. The current study aimed at ex- ploring and comparing the potential of intraperitoneally, intrarectally, and orally administered butyrate against acetic acid （AA）-induced UC in rats. Intrarectal administration of 2 ml of 50% AA was done after or without prior treatment of rats for 7 consecutive days with 100 mg/kg sodium butyrate （SB） intraperitoneally, intrarectally, or orally. Rats were sacrificed after 48 h of hA-treatment. Subsequently, colon sections were processed routinely for histopathological examination. We clinically observed diarrhea, loose stools, and hemoccult-positive stools, and histologically, epithelial loss and ulceration, crypt damage, goblet cell depletion, hemorrhage, and mucosal infiltration of inflammatory cells. The changes were significantly reduced by intraperitoneal, intrarectal, or oral butyrate, with intraperitoneal butyrate exhibiting the highest potency. It is concluded that intraperitoneal administration of butyrate abrogates the lesions of hA-induced UC and its potency surpasses that of intrarectal or oral butyrate.
文摘In this work, some important parts of the system, and the relation between the parts, and its connections with other systems are defined, explained briefly. With this respect, the nature of the person is defined with related parts. A new science branch called ＂information science＂ is defined. Importance of the political organizing of a political party is shortly explained. The necessity of the academies for public sector, private sector, and for political administration system is expressed. How to choose a person and how a person can be choose for any part of the system is defined. For both cases ＂good and/or correct＂ system criterions, determination of the criterions, and evaluation criterions are defined. New evaluation levels are defined based on the 8-basic senses in philosophical point of view to deepen the sensitivity of the evaluations. The importance of the situation notice and how to make it for each of the association are explained. The 10 main service parameters are defined to show the interactive relations between the ideology, services, person nature and others. Present and possible future problems of a country are expressed. Aims/targets are characterized with real approach for all related sides. Other systems which proposed to be connected to continuable political administration system are shortly defined and expressed. Way of system administration and administration types are shortly explained. The importance and ways of the decision making are expressed. The general ways, types of inspection are shortly explained. Official units that could be assign for the new system are defined. The importance of these units and of the persons that could be assign for these units are expressed together with the definition of the characteristics of the persons or groups that could be. The necessity of an action planning, possible supply and demand cases are defined scientifically. The importance and necessity of sense of justice is explained to make system continuable. The methods of determination of the policies/strategies are expressed.
文摘In this work all the political/non-political ideologies, 168 religions/beliefs/sects, nearly 1,600 ethnic origin groups are synthesized to define continuable political construction. It is found that all the past federations, confederations, empires, ideologies, political administration systems, thoughts and senses, doctrines, etc. are in fact each reflects a special functional processes within a general system of where the kinds of services, subjects of services, way of services, service types and persons are considered and placed as a factor in it and where these factors are arranged through different priorities, weights, and also taken under record with some rules. It is evaluated that each groups, communities, societies, countries are separate models, but at the same time each of them are factors which owns different beginning points to reach a correct country structure with five new separate groups （New Era Group, Progression of The Country Group, Unity of The Country Group, Values of The Country Group, Social Progression Group）. The continuable political administration system is defined here by considering the all possible parts and by considering the other systems eormected for a country. Possible forceful factors which can effect political system administration are given. To realize political construction, some political construction methods are defined： Political construction by putting together the values, political construction based on different value, Political construction based on the new defined values, Political construction which considers stepped transition and Ideal political construction which will carry the political points of views and other standards of judgement, points of views of persons to a same line are expressed. New ideologies are put forwarded and ideal political construction for a world country is given with details. Integration of the political groups, political ideologies to the new system is explained. Some methods of politics are mentioned. Persons related with politics are classified simply.
文摘The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.
基金Supported by the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.
