Soluble intercellular adhesion molecule-1,D-lactate and diamine oxidase in patients with inflammatory bowel disease

AIM： To study the levels of serum soluble intercellular adhesion molecule-1 （sICAM-1）, plasma D-lactate and diamine oxidase （DAO） in patients with inflammatory bowel disease （IBD）, and the potential clinical significance. METHODS： Sixty-nine patients with IBD and 30 healthy controls were included in this study. The concentration of sICAM-1 was detected with enzyme-linked immunosorbent assay, the level of D-lactate and DAO was measured by spectroscopic analysis, and the number of white blood cells （WBC） was determined by routine procedure. RESULTS： The levels of sICAM-I, DAO, and WBC in IBD patients were significantly higher than those in the control group （P 〈 0,01）, sICAM-I in IBD patients was found to be closely related to the levels of DAO and D-lactate （212.94 ± 69.89 vs 6.35 ± 2.35, P = 0.000）, DAO 212.94 ± 69.89 vs 8.65 ± 3.54, P = 0.000） and WBC （212.94 ± 69.89 vs 7.40 ± 2.61, P = 0.000）, but no significant difference was observed between patients with ulcerative colitis and patients with Crohn＇s disease. The post-treatment levels of sICAM-I, D-lactate and WBC were significantly lower than before treatment （sICAM-I 206.57 ± 79.21 vs 146.21 ± 64.43, P = 0.000）, （D-lactate 1.46 ± 0.94 vs 0.52± 0.32, P = 0.000） and （WBC 7.24 ± 0.2.33 vs 5.21 ± 3.21, P = 0.000）. CONCLUSION： sICAM-1, D-lactate and DAO are closely related to the specific conditions of IBD, and thus could be used as a major diagnostic index.

Real-time in vivo distal margin selection using confocal laser endomicroscopy in transanal total mesorectal excision for rectal cancer

BACKGROUND Transanal total mesorectal excision(TaTME)allows patients with ultralow rectal cancer to be treated with sphincter-saving surgery.However,accurate delineation of the distal resection margin(DRM),which is essential to achieve R0 resection for low rectal cancer in TaTME,is technically demanding.AIM To assess the feasibility of optical biopsy using probe-based confocal laser endomicroscopy(pCLE)to select the DRM during TaTME for low rectal cancer.METHODS A total of 43 consecutive patients who were diagnosed with low rectal cancer and scheduled for TaTME were prospectively enrolled from January 2019 to January 2021.pCLE was used to determine the distal edge of the tumor as well as the DRM during surgery.The final pathological report was used as the gold standard.The diagnostic accuracy of pCLE examination was calculated.RESULTS A total of 86 pCLE videos of 43 patients were included in the analyses.The sensitivity,specificity and accuracy of real-time pCLE examination were 90.00%[95%confidence interval(CI):76.34%-97.21%],86.96%(95%CI:73.74%-95.06%)and 88.37%(95%CI:79.65%-94.28%),respectively.The accuracy of blinded pCLE reinterpretation was 86.05%(95%CI:76.89%-92.58%).Furthermore,our results show satisfactory interobserver agreement(κ=0.767,standard error=0.069)for the detection of cancer tissue by pCLE.There were no positive DRMs(≤1 mm)in this study.The median DRM was 7 mm[interquartile range(IQR)=5-10 mm].The median Wexner score was 5(IQR=3-6)at 6 mo after stoma closure.CONCLUSION Real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer(clinical trial registration number:NCT04016948).

The complexity of climate reconstructions using the coexistence approach on Qinghai-Tibetan Plateau

Quantifying the palaeoclimates of Qinghai–Tibetan Plateau is vital for understanding the uplift history of plateau and the evolution of Asian monsoon since Cenozoic. Recently, the Coexistence Approach(CA) has been employed to reconstruct the palaeoelevation and palaeoclimate of the plateau by several studies. However, the application of CA in mountainous areas and the realism of climate reconstructions via this method are seldom discussed,although the complexity of reconstructions is speculated. Here we reevaluated the realism of climate reconstruction using the CA with modern pollen samples from the Qinghai–Tibetan Plateau, and try to explore the possible factors influencing the precipitation and temperature reconstructions by CA. We suggest that the long-distance transport pollen as a result of the Asian summer monsoon potentially significantly affects the reconstructions both for precipitation and temperature. The precipitation complexly interacting with snowmelt and permafrost thaw leads to the discrepancy between the reconstructed precipitation and the real value. The response temperature for blossoming of dwarfed plants on the plateau is mostly likely higher than the air temperature(usually measured at1.5 m above ground) due to energy flux or morphological adaptation of inflorescences during the growing season,causing the distortion of temperature reconstructions. Precipitation reconstruction is notoriously difficult as the establishers of CA have already suggested, but reconstructing the low temperatures may be even more challenging on Qinghai–Tibetan Plateau. Though all of the explorations in current paper are in a qualitative way, it offers an inspiration of how appropriately interpret the disagreements between CA results and the observations, and of how to obtain a reasonable reconstruction of palaeoclimate of the plateau.