Mesorectal reconstruction with pedicled greater omental transplantation to relieve low anterior resection syndrome following total intersphincteric resection in patients with ultra-low rectal cancer

Abstract Background Total intersphincteric resection (ISR) is the ultimate anus-preserving surgery for patients with ultra-low rectal cancer (ULRC), which can result in various degrees of anorectal dysfunction. Known as low anterior resection syndrome (LARS), it seriously affects the postoperative quality of life of patients. The aim of this study was to discuss the value of mesorectal reconstruction with pedicled greater omental transplantation (PGOT) to relieve LARS following total ISR in patients with ULRC, hoping to provide new ideas and strategies for the prevention and improvement of LARS. Methods We retrospectively analyzed hospitalization data and postoperative anorectal function of 26 ULRC patients, who were met inclusion and exclusion criteria in our center from January 2015 to February 2022. And combined with the results of anorectal manometry and rectal magnetic resonance imaging (MRI) defecography of some patients, we assessed comprehensively anorectal physiological and morphological changes of the patients after surgery, and their correlation with LARS. Results In this study, 26 patients with ULRC were enrolled and divided into observation group (n = 15) and control group (n = 11) according to whether PGOT was performed. There were no significant differences in surgical results such as operative time, intraoperative blood loss and postoperative complications between the two groups (P > 0.05). Postoperative follow-up showed that patients in both groups showed severe LARS within 3 months after surgery, but from the 3rd month after surgery, LARS in both groups gradually began to decrease, especially in the observation group, which showed faster recovery and better recovery, with statistically significant difference (P < 0.001). Through anorectal manometry, the mean rectal resting pressure in the observation group was significantly lower than that in the control group (P = 0.010). In addition, the postoperative thickness of the posterior rectal mesenterium in the observation group was significantly higher than that in the control group (P = 0.001), and also higher than the preoperative level (P = 0.018). Moreover, rectal MRI defecography showed that the neo-rectum had good compliance under the matting of greater omentum, and its intestinal peristalsis was coordinated. Conclusions ULRC patients, with the help of greater omentum, coordinated their neo-rectum peristalsis after total ISR and recovery of LARS was faster and better. PGOT is expected to be an effective strategy for LARS prevention and treatment of ULRC patients after surgery and is worthy of clinical promotion

Patients with Asian-type DEL can safely be transfused using RhD-positive blood

Red blood cells (RBCs) of the Asian-type DEL phenotype express few RhD proteins and are typed as serologic RhD-negative (D-) in routine testing. RhD-positive (D+) RBC transfusion for Asian-type DEL patients has been proposed but has not been generally adopted due to a lack of direct evidence regarding its safety and underlying mechanism. We performed a single-arm multicenter clinical trial to document the outcome of D+ RBC transfusion in Asian-type DEL patients; none of the recipients (0/42; 95% confidence interval, 0%-8.40%) developed alloanti-D after a median follow-up of 226 days. We conducted a large retrospective study to detect alloanti-D immunization in 4,045 serologic D- pregnant women throughout China; alloanti-D was found only in true D- individuals (2.63%, 79/3,009), but not in those with Asian-type DEL (0/1,032). We further retrospectively examined 127 serologic D- pregnant women who had developed alloanti-D and found none with Asian-type DEL (0/127). Finally, we analyzed RHD transcripts from Asian-type DEL erythroblasts and examined antigen epitopes expressed by various RHD transcripts in vitro, finding a low abundance of full-length RHD transcripts (0.18% of the total) expressing RhD antigens carrying the entire repertoire of epitopes, which could explain the immune tolerance against D+ RBCs. Our results provide multiple lines of evidence that individuals with Asian-type DEL cannot produce alloanti-D when exposed to D+ RBCs following transfusion or pregnancy. Therefore, we recommend considering D+ RBC transfusion and discontinuing anti-D prophylaxis in Asian-type DEL patients, including pregnant women. This clinical trial is registered at www.clinicaltrials.gov as NCT03727230

Processing of nanostructured polymers and advanced polymeric based nanocomposites

The control of the nanostructure and the addition of nanoparticles to polymers have led to structural and functional property enhancements in a number of polymeric systems as a material answer to continuous requirements from advanced industrial sectors. The availability of new nanoparticles with extraordinary properties (i.e. carbon nanotubes, graphenes, but also nanoclays, nanocellulose, metals and ceramics) have determined new and exciting possibilities for a continuous enlargement of polymer markets. However, the potentialities of these new materials are still strongly dependent on the development and scaling-up of reliable processing routes. Therefore, the purpose of this report is to review the main processing approaches for nanostructured polymers and nanocomposites starting with a brief review of available nanoparticles and on their functionalization to promote a better polymer-particle interaction. Regarding processing, the review firstly addresses the bottom-up approaches typically adopted for nanostructured polymers, blends and copolymers. Then, the different technologies required by the top-down processing of thermoplastic and thermosetting polymer matrix systems are reviewed. Finally, the report addresses the recent applications of nanostructured polymers and nanocomposites as matrices of advanced composite materials. In all cases, the main processing approaches and the main structural and functional properties characterizing these materials and their potential and current industrial applications are specifically addressed.We are indebted to the Spanish Ministry of Economy and Competitiveness (MINECO) for their economic support of this research (MAT2013-48059-C2-1-R). LP acknowledges the support of a JAEDoc grant from CSIC cofinanced by FSE. JMK acknowledges the support of the Russian Ministry of Education and Science within State Contract No. 14.Z50.31.0002.Peer Reviewe