Advances in endoscopic diagnosis and management of colorectal cancer

Colorectal cancer(CRC)is a leading global health concern,and early identification and precise prognosis play a vital role in enhancing patient results.Endoscopy is a minimally invasive imaging technique that is crucial for the screening,diagnosis,and treatment of CRC.This editorial discusses the importance of advances in endoscopic techniques,the integration of artificial intelligence,and the potential of novel technologies in enhancing the diagnosis and management of CRC.

脊柱内镜辅助斜外侧椎间融合术与经椎间孔腰椎椎体间融合术治疗腰椎不稳伴腰椎间盘突出症的疗效观察

目的 探究脊柱内镜辅助斜外侧椎间融合术(OLIF)与经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎不稳伴腰椎间盘突出症的疗效。方法 选取2017年9月-2019年8月该院诊治的腰椎不稳伴腰椎间盘突出症的患者87例,根据不同手术方式分为OLIF组与TLIF组,OLIF组44例,TLIF组43例。OLIF组患者选用脊柱内镜辅助OLIF方式进行手术,TLIF组患者选用脊柱内镜辅助TLIF方式进行手术。比较两组患者术前、术后和末次随访的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、影像学参数(腰椎矢状位Cobb角、腰椎冠状位Cobb角以及顶椎中心偏移距离),比较两组患者初次下床行走时间、住院时间、融合率、塌陷率和并发症发生率,评估两组患者治疗效果。结果 时间上,术前、术后和末次随访时VAS和ODI比较,差异均有统计学意义(P <0.05)。组别上,术前、术后和末次随访时OLIF组与TLIF组VAS和ODI比较,差异均无统计学意义(P> 0.05);OLIF组和TLIF组腰椎矢状位Cobb角大于手术前,腰椎冠状位Cobb角以及顶椎中心偏移距离小于术前,差异均有统计学意义(P <0.05),且OLIF组3种影像学参数恢复情况均优于TLIF组,差异有统计学意义(P <0.05);OLIF组术后首次下床时间和住院时间明显短于TLIF组,差异有统计学意义(P <0.05);OLIF组与TLIF组椎间融合器融合率比较,差异无统计学意义(P> 0.05)。OLIF组椎间融合器塌陷率低于TLIF组,差异有统计学意义(P <0.05)。结论 脊柱内镜辅助下,OLIF比TLIF治疗腰椎不稳伴腰椎间盘突出症的疗效更好,患者恢复更快,值得临床推广应用。

Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

·AIM: To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure(APAC) using ultrasound biomicroscopy(UBM).·METHODS: Patients(n =23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy(n =24, 31 eyes). Best-corrected visual acuity(BCVA), intraocular pressure(IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively.· RESULTS: The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group(P 【0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up(P 【0.05),whereas there was no significant difference between the two groups at the latter follow-up(P 】0.05).Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery(P 【0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group.·CONCLUSION: Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However,phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.

Pseudotargeted metabolomics for exploring the changes of neurotransmitters profile in aging rat brain and the potential neuroprotective effect of alkaloids from Uncaria rhynchophylla

Background:Aging is an essential risk factor for most neurodegenerative diseases,including Alzheimer’s disease and Parkinson’s disease.However,changes in the levels of neurotransmitters that are associated with aging are not well understood.Methods:Methods such as liquid-liquid extraction,protein precipitation,and solid-phase extraction,using 20 different extraction solvents,were evaluated to optimize the extraction of neurotransmitters.A pseudotargeted metabolomics approach was developed to detect neurotransmitters in brain tissues using ultra-high-performance liquid chromatography coupled with tandem triple quadrupole mass spectrometry.Alkaloids that crossed into the brain were used to evaluate the effect of glutamic acid-induced excitatory neurotoxicity in SH-SY5Y cells.Results:The overall extraction efficiency using protein precipitation was high.The changes in neurotransmitters’levels in the brain exhibited changes during the different growth cycles.The levels of seven neurotransmitters(aspartic acid,tyrosine,isoleucine,leucine,tryptophan,valine,andγ-aminobutyric acid)were significantly different.Meanwhile,alkaloids could reduce the excitatory neurotoxicity of glutamic acid-induced SH-SY5Y cells via suppression of oxidative stress.Conclusion:Significant differences were observed in neurotransmitter profiling between 1-and 8-month-old rats,and the discrepant neurotransmitters were associated with aging.Seven indole alkaloids from Uncaria rhynchophylla,which could cross the blood-brain barrier,were screened and used to explore their protective effects against aging.Uncaria rhynchophylla alkaloids exhibited a neuroprotective effect by inhibiting oxidative stress,indicating that the alkaloid could be a potential therapeutic candidate for neurological disorders caused by glutamic acid toxicity.

Value of combining the serum D-lactate, diamine oxidase, and endotoxin levels to predict gut-derived infections in cancer patients

Objective:This is a retrospective observational cohort study.The objective of this retrospective observational cohort study was to evaluate the value of the combined serum D-lactic acid,diamine oxidase(DAO),and endotoxin levels to predict intestinal barrier impairment and gut-derived infection(GDI)in cancer patients.Methods:Cancer patients receiving chemotherapy or palliative care treatment at our hospital were enrolled in the study.The serum concentrations of DAO,D-lactic acid,and endotoxin were determined using the intestinal barrier function biochemical index analysis system.The patients'infection information came from the hospital's Medicom Prescription Automatic Screening System and themedical records.Three hundred fifty-three cancer patients were included in the study(53.8%female,73.7%cancer stage IV,27.8%had bowel obstruction).Results:The total incidence of GDI was 33.4%(118/353).The median length of hospital stay was 16 days for patients with GDI,compared with 7 days for patients without GDI(P<0.001).The media hospitalization costs were¥27,362.35 for patients with GDI compared with¥11,614.08 for patients without GDI(P<0.001).The serum concentrations of DAO,D-lactic acid,and endotoxin were significantly higher in patients with GDI.As malignant bowel obstruction(MBO)worsened,the concentrations of DAO,D-lactic acid,and endotoxin increased.Multivariate logistic regression models revealed that the DAO,endotoxin,IL-6,and C-reactive protein levels were significantly associated with an increased risk of GDI.In addition,we also found a fivefold increased risk of infection in patients withMBO compared with those without bowel obstruction(OR=6.210,P<0.001).All of the areas under the receiver operating characteristic curve(AUCs)for DAO,D-lactate,and endotoxin to predict GDI were<0.7(AUC=0.648,P<0.001;AUC=0.624,P<0.01;AUC=0.620,P<0.01,respectively).However,when the parameters were combined(DAO+D-lactate+endotoxin),the predictive power increased significantly(AUC=0.797,P<0.001).Moreover,combining these intestinal barrier indicators and the presence of MBO had better power to predict GDI than either alone(AUC=0.837,P<0.001).Conclusions:Combining the serum DAO,D-lactic acid,and endotoxin levels was a better predictor of GDI than any of the indicators alone,and combining these with the diagnosis of MBO could further improve the efficacy for predicting GDI.

A disputed evidence on obesity:comparison of the effects of Rcan2^(-/-) and Rps6kb1^(-/-) mutations on growth and body weight in C57BL/6J mice

It is widely accepted that body weight and adipose mass are tightly regulated by homeostatic mechanisms, in which leptin plays a critical role through hypothalamic pathways, and obesity is a result of homeostatic disorder. However, in C57BL/6J mice, we found that Rcan2 increases food intake and plays an important role in the develop- ment of age- and diet-induced obesity through a leptin-independent mechanism. RCAN2 was initially identified as a thyroid hormone （T3）-responsive gene in human fibroblasts. Expression of RCAN2 is regulated by T3 through the PI3K-Akt/PKB-mTOR-Rps6kbl signaling pathway. Intriguingly, both Rcan2-/- and Rps6kb1-/- mutations were re- ported to result in lean phenotypes in mice. In this study we compared the effects of these two mutations on growth and body weight in C57BL/6J mice. We observed reduced body weight and lower fat mass in both Rcan2-/- and Rps6kb1-/- mice compared to the wild-type mice, and we reported other differences unique to either the Rcan2-/- or Rps6kb1-/- mice. Firstly, loss of Rcan2 does not directly alter body length; however, Rcan2-/- mice exhibit reduced food intake. In contrast, Rps6kb1-/- mice exhibit abnormal embryonic development, which leads to smaller body size and reduced food intake in adulthood. Secondly, when fed a normal chow diet, Rcan2-/- mice weigh significantly more than Rps6kb1-/- mice, but both Rcan2-/- and Rps6kbl-/- mice develop similar amounts of epididymal fat. On a high-fat diet, Rcan2-/- mice gain body weight and fat mass at slower rates than Rps6kb1-/- mice. Finally, using the double-knockout mice （Rcan2-/- Rps6kb1-/-）, we demonstrate that concurrent loss of Rcan2and Rps6kbl has an additive effect on body weight reduction in C57BL/6J mice. Our data suggest that Rcan2 and Rps6kbl mutations both affect growth and body weight of mice, though likely through different mechanisms.