[Application of short-course radiotherapy with total neoadjuvant therapy in the treatment of middle and low rectal cancer]

Objective: To compare the efficacy and safety of short-course radiotherapy with total neoadjuvant therapy (SCRT-TNT) and neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced middle and low rectal cancer. Methods: A retrospective cohort study was carried out. A of 126 patients with locally advanced middle and low rectal cancer who were treated in the Department of Gastrointestinal Cancer Surgery of Fujian Cancer Hospital from September 2016 to March 2020 were enrolled, including 73 males and 53 females, with a mean age of (56.5±9.8) (23-77) years. Based on neoadjuvant regimen (nCRT treatment was performed before December 2018 and SCRT-TNT treatment was carried out after January 2019), patients were divided into nCRT group (n=68) and SCRT-TNT group (n=58). There were no statistically significant differences in age, sex, distance from tumor to anal verge, Eastern Cooperative Oncology Group (ECOG) performance status and clinical TNM stage between the two groups (all P>0.05). Patients in both groups received pelvic intensity-modulated radiotherapy (IMRT). The radiotherapy dose of nCRT group was 50Gy/25 times/5 weeks. Patients in nCRT group received oral capecitabine chemotherapy during radiotherapy and underwent surgery 6-8 weeks after chemoradiation. However, patients in SCRT-TNT group received CapeOX regimen (oxaliplatin+capecitabine) for 2 cycles of induction chemotherapy, followed by short-course radiotherapy (25Gy/5 times/5 days), then underwent a radical surgery two weeks after completion of consolidation chemotherapy (4 cycles). The adverse reactions, perioperative safety and efficacy of neoadjuvant therapy were compared and analyzed between the two groups. Results: Both groups completed neoadjuvant therapy as planned. Patients in nCRT group and SCRT-TNT group had similar incidence of adverse reactions to radiotherapy and chemotherapy, however, there were no statistically significant differences in the incidence of surgical complications, operation time, intraoperative blood loss and postoperative length of hospital stay (all P>0.05). A total of 119 patients underwent total mesenterectomy (TME), including 64 patients in the nCRT group and 55 patients in the SCRT-TNT group, all with R0 resection. The pathological complete response (pCR) rate was 10.9% (7/64) in the nCRT group and 25.5% (14/55) in the SCRT-TNT group, respectively, with a statistically significant difference (P=0.038). Two years after surgery, there was no statistically significant difference in local recurrence rate and overall survival rate between the two groups (both P>0.05). However, the clinical metastasis rate of SCRT-TNT group was significantly lower than that of nCRT group (20.3% vs 9.1%), with a statistically significant difference (P<0. 05). Conclusion: SCRT-TNT do not increase the adverse reactions of radio chemotherapy and perioperative risks in the treatment of locally advanced middle and low rectal cancer, and the tumor regression effect is good, which is worthy of clinical promotion.

[Early clinical efficacy analysis of personalized three-dimensional printing talus prosthesis in the treatment of collapse talus necrosis]

Object To examine the preliminary clinical efficacy of custom-made three-dimensional(3D) printed talus prosthesis in the treatment of collapse talus necrosis. Methods: The clinical data of 8 patients who received 3D printed custom-made talus prostheses replacement for severe collapsed necrosis of the talus at the Orthopaedic Sports Medical Center, the First Affiliated Hospital to Army Medical University were analyzed retrospectively.All patients were male,with an average age of 38.0 years (range:22 to 65 years).There were 5 cases of left talus collapse and 3 cases of right talus collapse,with the course of disease of 29.7 weeks (range:6 to 96 weeks).The CT data of contralateral healthy talus were used for mirror image design references for the prosthesis,and the electron-beam 3D printing technology was used to prepare the prosthesis.Titanium alloy (Ti6Al4V) was taken as the material for the preparation of the talus body prosthesis,and Co-Cr-Mo material was used as the material for the preparation of the tibialis talus lateral joint surface prosthesis,and the subtalar joint surface of the prosthesis was made from a microporous casting technique.The prosthesis was analyzed preoperatively by digital three-dimensional finite element analysis and solid comparison techniques to measure anatomic match of the prosthesis.A longitudinal incision on medial ankle was made.The necrotic talus was completely removed and the prosthesis was then implanted.The patient was reexamined in the outpatient department 3, 6, and 12 months after surgery.Primary outcome measures were the American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hind foot score,visual analogue scale(VAS) and ankle range of motion.Changes in imaging data and plantar pressure were also assessed.Repeated measures analysis of variance and paired-t test were used to compare the data. Results: The talus prosthesis measure preoperatively was completely consistent with that contralateral healthy talus and there was no operation-related complication. All the wounds healed primarily. The patients were followed up effectively for 23.17 months (range:12 to 48 months).The preoperative dorsiflexion of patients was (7.6±5.7)°,it increased to(14.2±6.6)° at 12 month after surgery (t=-2.67,P=0.03).The plantar flexion increased from (22.0±9.9)°preoperatively to (29.2±8.7)° at 12 month after surgery (t=-8.95,P<0.01).Preoperative AOFAS ankle-hind foot score was 26.3±6.6,and it increased to 70.1±2.2,76.0±3.4 and 79.3±4.2 at 3 month,6 month and 12 month after surgery(F=56.81,P<0.01);Pre-operative VAS was[M(Q_R)]3.0(0.8),and it increased to 2.5(1.0),1.5(1.0),1.0(1.0)at 3 month,6 month and 12 month after surgery(F=20.00,P<0.01).At the last follow-up,imaging reexamination showed that the prosthesis of all patients were in stable position with no sign of subsidence.No secondary ankle fusion or revision was required.The talus height increased from (27.6±6.0)mm preoperatively to (34.6±3.5)mm (t=-2.94,P<0.01).The plantar pressure showed that the maximum pressure on the healthy ankle was(629.9±26.1)N,and that on the affected side was(521.4±14.4)N.The pressure on the healthy ankle was(350.6±29.6)N,and that on the necrotic side was (212.3±9.7)N.The load on the contralateral forefoot was(38.1±2.8)% and that on the necrotic side was(11.5±2.0)%.The load on the contralateral hindfoot was (24.6±2.5)% and that on the necrotic side was (21.1±1.8)%. Conclusions: The custom-made 3D printed talus prosthesis could restore the talus anatomy,recover the ankle joint function,relieve the pain of patients and improve the life quality of patients.The effect on plantar pressure is mainly achieved by adjusting the center of gravity of plantar pressure backwards and the increase of weight bearing of the healthy foot.

[Clinical value of myositis antibodies in patients with connective tissue disease-associated interstitial lung diseases]

Objective: To investigate the clinical significance of detection of myositis-specific antibodies (MSAs) and myositis-associated antibodies (MAAs) in patients with connective tissue disease-associated interstitial lung diseases (CTD-ILD). Methods: Serum samples of 120 patients with CTD-ILD admitted to the Department of Respiratory, Affiliated Drum Tower Hospital of Nanjing University Medical College from December 2016 to April 2018 were collected for analysis. The patients included 45 with polymyositis/dermatomyositis (PM/DM), 36 with Sjogren's syndrome (SS) and 39 with undifferentiated connective tissue disease (UCTD). There were 37 males and 83 females with an average age of (56±11) years. Thirty-two patients with non-CTD-ILD, 10 males and 22 females with an average age of (42±17) years, were enrolled as the control group. Euroline Autoimmune Inflammatory Myopathies 16 Ag kit was used for detecting MSAs and MAAs, and the positive rates of serum MSAs and MAAs were calculated. The antibody distribution and clinical characteristics of different groups were analyzed and compared. Results: Eighty-nine of the 120 patients with CTD-ILD were positive for MSA and/or MAA (74.2%), and the detection rates of MSAs and MAAs were 52.5% (63/120) and 61.7% (74/120) respectively. No myositis antibody was detected in the non-CTD-ILD group. The detection rates of MSAs in PM/DM-ILD group, SS-ILD group and UCTD-ILD group were 75.6% (34/45), 33.3%(12/36) and 43.6%(17/39) respectively. The total detection rate of MSAs in PM/DM group was significantly higher than that in SS group and UCTD group (χ(2)=14.53, 8.95, 0.01). The anti-ARS was the most frequent (50/120, 41.7%). The positive rates of MAAs in the three groups were 64.4%(29/45), 77.8%(28/36), 43.6%(17/39) respectively, and anti-Ro-52 accounted for 60%(72/120), and were highly correlated with MSAs such as anti-Jo-1 antibodies. Conclusion: Myositis antibody profiling should be performed in patients with ILD who were negative for conventional autoimmune antibody testing and had no CTD. In patients with SS-ILD and UCTD-ILD, the myositis antibody spectrum could detect the presence of myositis-specific antibodies and myositis-related antibodies in some patients, and its role in clinical diagnosis and treatment needed further observation.

Activities for leptin in bovine trophoblast cells

Leptin is involved in various reproductive processes in humans and rodents, including placental development and function. The specific ways that leptin influences placental development and function in cattle are poorly understood. This work was completed to explore how leptin regulates hormone, cytokine and metalloprotease transcript abundance, and cell proliferation in cultured bovine trophoblast cells. In the first set of studies, cells were cultured in the presence of graded recombinant bovine leptin concentrations (0, 10, 50, 250 ng/mL) for 6 or 24 h. Transcript profiles were examined from extracted RNA. Leptin supplementation did not affect abundance of the maternal recognition of pregnancy factor, interferon-tau (IFNT), but leptin increased (P < 0.05) abundance of chorionic somatomammotropin hormone 2 (CSH2; ie, placental lactogen) at both 6 and 24 h at each concentration tested. At 24 h, the greatest CSH2 abundance (P < 0.05) was detected in cells supplemented with 50 ng/mL leptin. Transcript abundance of the remodeling factor, metalloprotease 2 (MMP2), was greater (P < 0.05) in leptin-treated cells at 24 h but not at 6 h. The 24 h MMP2 response was greatest (P < 0.05) at 250 ng/mL. Transcript abundance for MMP9 was not altered by leptin treatment. In a separate set of studies, cell proliferation assays were completed. Leptin supplementation did not affect bovine trophoblast cell line proliferation at any dose tested. In conclusion, leptin supplementation did not affect bovine trophoblast cell proliferation or IFNT expression, but leptin increases CSH2 and MMP2 transcript abundance. Both of these factors are involved with peri-implantation and postimplantation placental development and function, and this implicates leptin as a potential mediator of early placental development and function in cattle.