Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China:a 9-year data analysis

Background:The histologically complete resection(CR)rate of small rectal neuroendocrine tumors(RNETs)is unsatisfactory at the first endoscopy.Risk factors and clinical outcomes associated with incomplete resection(IR)have not been explicitly elucidated.This study aims to explore the relevant factors of IR.Methods:This retrospective study reviewed patients with small RNETs(10mm)in eight centers from January 2013 to December 2021.Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups,and the polypectomy and advanced treatment groups.Results:Of the 326 patients included,83(25.5%)were diagnosed with IR.Polypectomy(odds ratio[OR]=16.86),a central depression(OR=7.50),and treatment in the early period(OR=2.60)were closely associated with IR.Further analysis revealed that an atypical hyperemic appearance(OR=7.49)and treatment in the early period(OR=2.54)were significantly associated with the inappropriate use of polypectomy(both P<0.05).In addition,a total of 265(81.3%)were followed up with a median follow-up period of 30.9 months.No death,metastasis,or recurrence was found during the follow-up period.Conclusions:Polypectomy,a central depression,and treatment in the early period were risk factors for IR.Further,an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy.For histologically incompletely resected small RNETs,follow-up may be a safe and feasible alternative to rigorous salvage therapy.

Inflammation responsive tofacitinib loaded albumin nanomedicine for targeted synergistic therapy in ulcerative colitis

Patients with ulcerative colitis(UC)often loss responses over long term usage of conventional therapies.Tofacitinib,a pan-Janus kinases(JAK)inhibitor is approved for moderate to severe UC treatment,while dose-limiting systemic side effects including infections,cancers and lymphoma limit its popularity of clinical application.This study sought to construct an anti-mucosal vascular addressin cell-adhesion molecule-1(anti-MAdCAM-1)antibody modified reactive oxygen species(ROS)responsive human serum albumin-based nanomedicine denoted as THM,to improve the therapeutic efficacy of tofacitinib for UC treatment.THM has the drug releasing properties in response to ROS stimulation.In vitro studies show that THM selectively adhered to the endothelial cells and had obvious anti-inflammatory effect on macrophages.Meanwhile,the nanomedicine can inhibit the phenotypic switching of M1 macrophages and promote M2 polarization to produce anti-inflammatory medicators during wound healing.In addition,in vivo fluorescence imaging verified that THM exhibited enhanced preferential accumulation and extended retention in inflamed colon.Moreover,THM significantly reduced the production of proinflammatory cytokines in the colon and suppressed the homing of T cells to the gut in dextran sodium sulfate induced experimental colitis.This work elucidates that the inflamed colon-targeted delivery of tofacitinib by nanomedicine is promising for UC treatment and sheds light on addressing the unmet medical need.