Selection of Therapeutic Strategies after Preoperative Neoadjuvant Chemoradiotherapy for Rectal Cancer

Rectal cancer is one of the most common malignant tumors in China, which is mainly middle and low rectal cancer. Due to the particularity of the physiological and anatomical location of the rectum and the neglect of the relevant clinical symptoms, patients with rectal cancer in real life often have the local progression stage. A large number of studies have shown that neoadjuvant chemoradiotherapy should be performed in such patients, to achieve tumor downstaging before rectal cancer surgery. In this study, different treatment measures for rectal cancer patients after neoadjuvant chemoradiotherapy are presented

Exploration of Treatment in Patients with T3 Rectal Cancer with EMVI

To explore the clinical efficacy of neoadjuvant chemoradiotherapy, combined with surgery and direct surgery in patients with stage T3 rectal cancer combined with EMVI. Method: The clinical data of patients with extragastrointestinal middle and low rectal cancer in the First Affiliated Hospital of Chongqing Medical University from January 2015 to May 2019 were retrospective reviewed, including 59 patients in the neoadjuvant treatment group (neoadjuvant chemoradiotherapy + surgical treatment) and 71 patients in the direct surgery group. Both groups underwent total rectal total membrane resection. Data and Methods:The concurrent chemotherapy regimens were all included in the XELOX regimen. The RT was performed by IMRT with D T 45 to 50.4 G y, from 1.8 to 2.0 G y each, for 25 to 28 sessions. Perioperative conditions, postoperative pathology and follow-up of the two groups were observed. Results: There was no significant difference in postoperative conditions (gastrointestinal function recovery time, postoperative drainage drainage, postoperative time of drainage removal) between the neoadjuvant treatment group and the direct surgery group (P> 0. 05); The length of postoperative hospital stay was significantly different (P <0.05); No significant operation time occurred between the neoadjuvant treatment group (264 min vs. 239 min) and the surgical group, (P> 0. 05)；The amount of intraoperative bleeding (85.7ml vs.110.0 ml), the number of lymph node dissection (11 vs. 13), the lymph node positive rate (27.12% vs.43.6%) betweenthe neoadjuvant treatment group and the direct surgery group had statistical significant (P＜0. 05); The 3-yearrecurrence-free survival (93.2 %) rate was higher in the neoadjuvant treatment group than in the direct surgery group (74.6 %), which was significant (P <0.05); The 3-year survival rate (98.30,% vs. 85.9 %) was significantly significant (P <0.05); There was no significant difference in the anal preservation rate (71.19% vs. 80.28%) (P> 0. 05). Conclusion: The neoadjuvant chemoradiotherapy improves the recurrence-free survival rate of locally advanced rectal cancer, and has no obvious effect on the postoperative complications rate, anal preservation rate and gastrointestinal function recovery

Involvement of Human Papillomaviruses in Cervical Cancer

Human papillomaviruses (HPV) are the first viruses to have been acknowledged to prompt carcinogenesis, and they are linked with cancers of the uterine cervix, anogenital tumors, and head and neck malignancies. This paper examines the structure and primary genomic attributes of HPV and highlights the clinical participation of the primary HPV serotypes, focusing on the roles that HPV-16 and 18 play in carcinogenesis. The mechanisms that take place in the progression of cervical neoplasia are described. The oncogenic proteins E6 and E7 disrupt control of the cell cycle by their communication with p53 and retinoblastoma protein. Epidemiological factors, diagnostic tools, and management of the disease are examined in this manuscript, as are the vaccines currently marketed to protect against viral infection. We offer insights into ongoing research on the roles that oxidative stress and microRNAs play in cervical carcinogenesis since such studies may lead to novel methods of diagnosis and treatment. Several of these topics are surfacing as being critical for future study. One particular area of importance is the study of the mechanisms involved in the modulation of infection and cancer development at cervical sites. HPV-induced cancers may be vulnerable to immune therapy, offering the chance to treat advanced cervical disease. We propose that oxidative stress, mRNA, and the mechanisms of HPV infection will be critical points for HPV cancer research over the next decade

Genomic amplification patterns of human telomerase RNA gene and C-MYC in liquid-based cytological specimens used for the detection of high-grade cervical intraepithelial neoplasia

<p>Abstract</p> <p>Background</p> <p>The amplification of oncogenes initiated by high-risk human papillomavirus (HPV) infection is an early event in cervical carcinogenesis and can be used for cervical lesion diagnosis. We measured the genomic amplification rates and the patterns of human telomerase RNA gene (TERC) and C-MYC in the liquid-based cytological specimens to evaluate the diagnostic characteristics for the detection of high-grade cervical lesions.</p> <p>Methods</p> <p>Two hundred and forty-three residual cytological specimens were obtained from outpatients aged 25 to 64 years at Qilu Hospital, Shandong University. The specimens were evaluated by fluorescence in situ hybridization (FISH) using chromosome probes to TERC (3q26) and C-MYC (8q24). All of the patients underwent colposcopic examination and histological evaluation. A Chi-square test was used for categorical data analysis.</p> <p>Results</p> <p>In the normal, cervical intraepithelial neoplasia grade 1 (CIN1), grade 2 (CIN2), grade 3 (CIN3) and squamous cervical cancer (SCC) cases, the TERC positive rates were 9.2%, 17.2%, 76.2%, 100.0% and 100.0%, respectively; the C-MYC positive rates were 20.7%, 31.0%, 71.4%, 81.8% and 100.0%, respectively. The TERC and C-MYC positive rates were higher in the CIN2+ (CIN2, CIN3 and SCC) cases than in the normal and CIN1 cases (<it>p </it>< 0.01). Compared with cytological analysis, the TERC test showed higher sensitivity (90.0% vs. 84.0%) and higher specificity (89.6% vs. 64.3%). The C-MYC test showed lower sensitivity (80.0% vs. 84.0%) and higher specificity (77.7% vs. 64.3%). Using a cut-off value of 5% or more aberrant cells, the TERC test showed the highest combination of sensitivity and specificity. The CIN2+ group showed more high-level TERC gene copy number (GCN) cells than did the normal/CIN1 group (<it>p </it>< 0.05). For C-MYC, no significant difference between the two histological categories was detected (<it>p </it>> 0.05).</p> <p>Conclusions</p> <p>The TERC test is highly sensitive and is therefore suitable for cervical cancer screening. The C-MYC test is not suitable for cancer screening because of its lower sensitivity. The amplification patterns of TERC become more diverse and complex as the severity of cervical diseases increases, whereas for C-MYC, the amplification patterns are similar between the normal/CIN1 and CIN2+ groups.</p> <p>Virtual slides</p> <p>The virtual slide(s) for this article can be found here: <url>http://www.diagnosticpathology.diagnomx.eu/vs/1308004512669913</url>.</p

Function analysis of GhWRKY53 regulating cotton resistance to verticillium wilt by JA and SA signaling pathways

WRKY transcription factors (TFs) play an important role in regulating the mechanism of plant self-defense. However, the function of most WRKY TFs in upland cotton (Gossypium hirsutum) is still unknown. Hence, studying the molecular mechanism of WRKY TFs in the resistance of cotton to Verticillium dahliae is of great significance to enhancing cotton disease resistance and improving its fiber quality. In this study, Bioinformatics has been used to characterize the cotton WRKY53 gene family. we analyzed the GhWRKY53 expression patterns in different resistant upland cotton cultivars treated with salicylic acid (SA) and methyl jasmonate (MeJA). Additionally, GhWRKY53 was silenced using a virus-induced gene silencing (VIGS) to determine the contribution of GhWRKY53 to V. dahliae resistance in cotton. The result showed that GhWRKY53 mediated SA and MeJA signal transduction pathways. After VIGS of the GhWRKY53, the ability of cotton to resist V. dahliae decreased, indicating that the GhWRKY53 could be involved in the disease resistance mechanism of cotton. Studies on the levels of SA and jasmonic acid (JA) and their related pathway genes demonstrated that the silencing of GhWRKY53 inhibited the SA pathway and activated the JA pathway, thereby reducing the resistance of plants to V. dahliae. In conclusion, GhWRKY53 could change the tolerance of upland cotton to V. dahliae by regulating the expression of SA and JA pathway-related genes. However, the interaction mechanism between JA and SA signaling pathways in cotton in response to V. dahliae requires further study

Multicentre, prospective, randomised controlled trial to evaluate hexaminolevulinate photodynamic therapy (Cevira) as a novel treatment in patients with high-grade squamous intraepithelial lesion: APRICITY phase 3 study protocol

INTRODUCTION: High-risk human papilloma virus (HPV)-associated cervical cancer is the fourth most common cancer in women worldwide. Current treatments of high-grade squamous intraepithelial lesion (HSIL) of the cervix are based on invasive surgical interventions, compromising cervical competence and functionality. APRICITY is a multicentre, prospective, double-blind, randomised controlled phase 3 study further evaluating the efficacy and safety of Cevira, an integrated drug-delivery and light-delivery device for hexaminolevulinate photodynamic therapy, which shows promise as a novel, non-invasive outpatient therapy for women with HSIL. METHODS AND ANALYSIS: Patients with biopsy-confirmed HSIL histology are invited to participate in the study planned to be conducted at 47 sites in China and 25 sites in Ukraine, Russia and the European Union. The aim is to include at least 384 patients, which will be randomised to either Cevira or placebo group (2:1). All patients will be assessed 3 months after first treatment and a second treatment will be administered in patients who are HPV positive or have at least low-grade squamous intraepithelial lesion. Primary endpoint is the proportion of the responders 6 months after first treatment. Secondary efficacy and safety endpoints will be assessed at 6 months, and data for secondary performance endpoints of the Cevira device will be collected at 3 months and 6 months, in case second treatment was administered. All patients in the Cevira group will be enrolled in an open, long-term extension study for 6 months to collect additional efficacy and safety data (study extension endpoints). ETHICS AND DISSEMINATION: The study was approved by the ethics committee of the Peking Union Medical College Hospital and Hannover Medical University, Germany. Findings will be disseminated through peer review publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT04484415; clinicaltrials.gov

Developing a questionnaire to evaluate the health information literacy in China

IntroductionHealth information literacy is critical for individuals to obtain, understand, screen, and apply health information. However, there is currently no specific tool available to evaluate all four dimensions of health information literacy in China. Public health emergencies can present an opportunity to evaluate and monitor the health information literacy level of residents. Therefore, this study aimed to develop a questionnaire to evaluate the level of health information literacy and to measure the reliability and validity.MethodsThe development process of the questionnaire consisted of the determination of questionnaire items, expert consultation, and validation. Based on the National Residents Health Literacy Monitoring Questionnaire (2020) and the 2019 Informed Health Choices key concepts, the researchers drafted the questionnaire, including all four dimensions of health information literacy. Experts in relevant fields were invited to evaluate the draft questionnaire, and revisions were made accordingly. Finally, the reliability and validity of the finalized version were examined in Gansu Province, China.ResultsThe research team preliminarily formulated 14 items encompassing the four dimensions of health information literacy. After consulting with 28 experts, modifications were made. A convenience sample of 185 Chinese residents was invited to participate. Cronbach's alpha coefficient was 0.715 and McDonald's omega was 0.739 for internal consistency, and the test-retest intra-class correlation coefficient after 4 weeks was 0.906, indicating that the questionnaire content and measurement structure was relatively stable.ConclusionThis questionnaire is the first evidence-based assessment tool developed for monitoring health information literacy in China, and it has shown good reliability and validity. It can help to monitor the health information literacy levels of Chinese residents, promote evidence-based decision-making, and guide interventions to improve health information literacy

Knowledge and attitudes of healthcare workers in Chinese intensive care units regarding 2009 H1N1 influenza pandemic

<p>Abstract</p> <p>Background</p> <p>To describe the knowledge and attitudes of critical care clinicians during the 2009 H1N1 influenza pandemic.</p> <p>Methods</p> <p>A survey conducted in 21 intensive care units in 17 provinces in China.</p> <p>Results</p> <p>Out of 733 questionnaires distributed, 695 were completed. Three hundred and fifty-six respondents (51.2%) reported their experience of caring for H1N1 patients. Despite the fact that 88.5% of all respondents ultimately finished an H1N1 training program, only 41.9% admitted that they had the knowledge of 2009 H1N1 influenza. A total of 572 respondents (82.3%) expressed willingness to care for H1N1 patients. Independent variables associated with increasing likelihood to care for patients in the logistic regression analysis were physicians or nurses rather than other professionals (odds ratio 4.056 and 3.235, p = 0.002 and 0.007, respectively), knowledge training prior to patient care (odds ratio 1.531, p = 0.044), and the confidence to know how to protect themselves and their patients (odds ratio 2.109, p = 0.001).</p> <p>Conclusion</p> <p>Critical care clinicians reported poor knowledge of H1N1 influenza, even though most finished a relevant knowledge training program. Implementation of appropriate education program might improve compliance to infection control measures, and willingness to work in a pandemic.</p

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe