[Prognosis Analysis of Additional Surgical Treatment for High-Risk T1 Colorectal Cancer Patients After Endoscopic Resection]

Objective

To analyze the effect of additional surgery on the survival and prognosis of high-risk T1 colorectal cancer patients who have undergone endoscopic resection.

Methods

The clinical data of patients with high-risk T1 colorectal cancer were retrospectively collected. The patients were divided into the endoscopic resection (ER) plus additional surgical resection (SR) group, or the ER+SR group, and the ER group according to whether additional SR were performed after ER. Baseline data of the patients and information on the location, size, and postoperative pathology of the lesions were collected. Patient survival-related information was obtained through the medical record system and patient follow-up. The primary outcome indicators were the overall survival and the colorectal cancer-specific survival. Univariate Cox regression analysis was used to screen survival-related risk factors and hazard ratio (HR) was calculated. Multivariate Cox regression analysis was used to analyze the independent influencing factors.

Results

The data of 109 patients with T1 high-risk colorectal cancer were collected, with 52 patients in the ER group and 57 patients in the ER+SR group. The mean age of patients in the ER group was higher than that in the ER+SR group (65.21 years old vs. 60.54 years old, P=0.035), and the median endoscopic measurement of the size of lesions in the ER group was slightly lower than that in the ER+SR group (2.00 cm vs. 2.50 cm, P=0.026). The median follow-up time was 30.00 months, with the maximum follow-up time being 119 months, in the ER+SR group and there were 4 patients deaths, including one colorectal cancer-related death. Whereas the median follow-up time in the ER group was 28.50 months, with the maximum follow-up time being 78.00 months, and there were 4 patient deaths, including one caused by colorectal cancer. The overall 5-year cumulative survival rates in the ER+SR group and the ER group were 94.44% and 81.65%, respectively, and the cancer-specific 5-year cumulative survival rates in the ER+SR group and the ER group were 97.18% and 98.06%, respectively. The Kaplan-Meier analysis showed no significant difference in the overall cumulative survival or cancer-specific cumulative survival between the ER+SR and the ER groups. Univariate Cox regression analysis showed that age and the number of reviews were the risk factors of overall survival (HR=1.16 and HR=0.27, respectively), with age identified as an independent risk factor of overall survival in the multivariate Cox regression analysis (HR=1.10, P=0.045).

Conclusion

For T1 colorectal cancer patients with high risk factors after ER, factors such as patient age and their personal treatment decisions should not be overlooked. In clinical practice, additional caution should be exercised in decision-making concerning additional surgery.

[LncRNA SOX2OT enhances 5-fluorouracil resistance of cholangiocarcinoma cells by promoting autophagy via up-regulating SIRT1 expression]

OBJECTIVE

To investigate the role of SIRT1/autophagy pathway in mediating the regulatory effect of lncRNA SOX2OT on 5-fluorouracil (5-FU) resistance in cholangiocarcinoma cells.

METHODS

HCCC-9810 cells were used to construct a 5-FU-resistant cell model (HCCC-9810/5-FU cells), and the expression levels of lncRNA SOX2OT and SIRT1 mRNA and the protein expressions of SIRT1, Beclin1, LC3 and P62 were detected with qRT-PCR and Western blotting. The effects of transfection with a SOX2OT mimic on drug resistance and cell migration of HCCC-9810/5-FU cells were detected using CCK-8 assay and wound healing assay, and the changes in expressions of SOX2OT, SIRT1, Beclin1, LC3 and P62 were detected. Rescue experiment was performed by co-transfection of HCCC-9810/5-FU cells with both a SOX2OT-overexpressing plasmid and si-SIRT1 to confirm the role of SIRT1 in SOX2OT-mediated regulation of 5-FU resistance. A RNA pulldown assay was used to verify the targeted binding between SOX2OT and SIRT1.

RESULTS

The proliferation of HCCC-9810 cells was significantly inhibited after treatment with different concentrations of 5-FU (P < 0.05). The 5-FU-resistant cells showed significantly increased protein expressions of SIRT1, Beclin1 and p62, an increased LC3 Ⅱ/LC3 Ⅰ ratio, and enhanced expressions of SIRT1 mRNA and SOX2OT (P < 0.05). Transfection of the resistant cells with SOX2OT mimic significantly enhanced cell migration and increased the protein expressions of SIRT1, Beclin1 and p62, the LC3Ⅱ/LC3Ⅰ ratio, and expression levels of SIRT1 mRNA and SOX2OT (P < 0.05), and these changes were obviously attenuated by SIRT1 knockdown, which also resulted in lowered 5-FU resistance of the cells without significantly affecting the expression level of SOX2OT (P > 0.05). RNA pulldown assay suggested that SOX2OT could directly bind to SIRT1.

CONCLUSION

LncRNA SOX2OT enhances 5-FU resistance in HCCC-9810 cells by promoting autophagy through up-regulating SIRT1 expression.

[Risk factors for neonatal asphyxia and establishment of a nomogram model for predicting neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture: a multicenter study]

OBJECTIVES

To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia.

METHODS

A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively.

RESULTS

Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia.

CONCLUSIONS

The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

[Comparative Analysis of Clinical Efficacy of Negative Pressure Wound Therapy Plus Lavage System in the Treatment of Wagner Grade 3-5 Diabetic Foot Ulcers Combined with Infection]

Objective

To compare and analyze the clinical efficacy of negative pressure wound therapy (NPWT) combined with lavage system in the treatment of Wagner grade 3-5 diabetic foot ulcers combined with infections.

Methods

The clinical data of 100 patients with Wagner grade 3-5 diabetic foot ulcers combined with infections admitted to our department between January 2016 and January 2020 were retrospectively analyzed. According to the methods of surgical wound management, they were divided into two groups, a combination treatment group treated by NPWT plus a lavage system and a single treatment group receiving NPWT only. Patients were studied for the types of bacterial infection found in the wounds, the amount of time it took for the wound bacterial culture to turn negative, and the status of blood inflammatory indicators, including white blood cell count and C-reactive protein (CRP). Data concerning hospitalization were collected, including the waiting time before the first operation, the number of operations, length of hospital stay, NPWT usage time, and wound closure time. In addition, data concerning patient condition after discharge were also collected, including the duration of out-of-hospital antibiotic use, the final wound healing rate, the final wound healing time, and long-term wound complications, which include wound dehiscence, new ulcer, infection recurrence, readmission, reoperation, and amputation.

Results

There were no statistically significant differences in age, sex, course of disease, lesion side, lesion size and combined diseases between the two groups. Likewise, there was no significant difference in the species and genus, or the composition of bacteria found in the wounds ( P>0.05). However, the combination treatment group showed better results than the single treatment group did in the amount of time it took for wound bacterial culture to turn negative ( P<0.05). As for the blood inflammatory indicators, there was no significant difference between the two groups except that the CRP of the combination group decreased more significantly than that of the single treatment group did at one week postop. The number of surgeries, length of hospital stay, NPWT use time, and wound closure time were lower in the combination treatment group than those in the single treatment group ( P<0.05). However, there was no significant difference in long-term wound complications between the two groups.

Conclusion

When applying NPWT plus lavage system in the treatment of Wagner grade 3-5 diabetic foot ulcers combined with infection, wound infection can be controlled effectively at an early stage and the amount of time needed for wound bacterial culture to turn negative can also be reduced. In addition, the combination treatment stimulates granulation growth of the wounds to effectively cover the wound at an early stage.

[An unsupervised unimodal registration method based on Wasserstein Gan]

We propose an unsupervised unimodal registration method based on Wasserstein Gan. Different from the existing registration methods based on deep learning, the proposed method can finish training without ground truth or preset similarity metrics. The network is composed of a generation network and a discrimination network. The generation network extracts the potential deformation fields between fixed images (positive images) and moving images, and predicts the registered images (negative images) by interpolation; the discrimination network then judges the similarity between the positive images and negative images that are input alternately, and feeds back the judgment result as a loss function to drive the network parameter update. Finally, through adversarial training, the registration image generated by the generation network deceives the discrimination network and the network converges. In the experiment, we randomly selected 30 cases of LPBA40 brain dataset, 25 cases of EMPIRE10 lung dataset and 15 cases of ACDC heart dataset as the training datasets, with 10 cases of LPBA40 brain dataset, 5 cases of EMPIRE10 lung dataset and 5 cases of ACDC heart dataset as the test datasets. The results of registration were compared with those obtained using Affine algorithm, Demons algorithm, SyN algorithm and VoxelMorph algorithm. The DICE coefficient (DSC) and the normalized correlation coefficient (NCC) evaluation index of the proposed algorithm were the highest, indicating a better registration accuracy of our method than Affine algorithm, Demons algorithm, SyN algorithm and the current unsupervised SOTA algorithm VoxelMorph.