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Recent studies on hypothermia typically focused on a single anesthesia method or a particular surgical procedure. Although there are multiple risk factors leading to hypothermia, such as the use of cold solutions or nonhumidified and nonheated anesthetic gases, few studies have reported the incidence of postoperative hypothermia among patients in the postanesthesia care unit (PACU).This is a retrospective analysis of patients who underwent surgery and were admitted to the PACU immediately after surgery at the Fourth Affiliated Hospital, College of Medicine, Zhejiang University, from September 2018 to March 2019.Patient data were collected and analyzed in two groups to understand the factors affecting the occurrence of hypothermia. Hypothermia was defined as a core temperature of less than 36°C. On the basis of body temperature, patients in the PACU were divided into hypothermic and nonhypothermic groups. Factors influencing hypothermia were studied by the univariate method, followed by logistic regression analysis to identify the risk factors for hypothermia onset.Of a total of 1,788 patients were enrolled in the study, 113 (6.32%) exhibited hypothermia (36°C) in the PACU. The hypothermic and nonhypothermic groups displayed significant differences (P.05) in the anesthesia method used as well as the American Society of Anesthesiologists physical classification status. The body temperature at the time the patients were admitted to the operating room influenced the occurrence of postoperative hypothermia (P.01). These parameters were recognized as independent risk factors for postoperative hypothermia in the PACU.Significant risk factors for the onset of hypothermia were general anesthesia and higher American Society of Anesthesiologists grade. However, epidural anesthesia was found to have a protective effect.

Background. Most of colorectal cancer (CRC) cases are sporadic and develop along the adenoma-carcinoma sequence. Intestinal microbial dysbiosis is involved in the development of colorectal cancer. However, there are still no absolute markers predicting the progression from adenoma to carcinoma. Aims. To investigate the characteristics of intestinal microbiota in colorectal adenoma and carcinoma patients and the correlations with clinical characteristics. Methods. Fecal samples were collected from 154 colorectal carcinoma patients (CRC group), 20 colorectal adenoma patients (AD group), and 199 healthy controls (control group). The intestinal microbiota was investigated by 16S rRNA gene sequencing. Results. Compared to the healthy controls, microbial diversity was dramatically decreased in AD/CRC. At the genus level, Acidaminococcus significantly decreased with the order of control-AD-CRC ( P < 0.05 ). Parvimonas, Peptostreptococcus, Prevotella, Butyricimonas, Alistipes, and Odoribacter were the key genera in the network of colorectal adenoma/carcinoma-associated bacteria. Combination of the top 10 most important species, including Butyricimonas synergistica, Agrobacterium larrymoorei, Bacteroides plebeius, Lachnospiraceae bacterium feline oral taxon 001, Clostridium scindens, Prevotella heparinolytica, bacterium LD2013, Streptococcus mutans, Lachnospiraceae bacterium 19gly4, and Eubacterium hallii, showed the best performance in distinguishing AD patients from CRC ( AUC = 85.54 % , 95% CI: 78.83%-92.25%). The clinicopathologic features, including age, sex, tumor location, differentiation degree, and TNM stage, were identified to be closely linked to the intestinal microbiome in CRC. Conclusion. Several intestinal bacteria changed along the adenoma-carcinoma sequence and might be the potential markers for the diagnosis and treatment of colorectal adenoma/carcinoma. Intestinal microbiota characteristics in CRC should account for the host factors.

Colorectal cancer (CRC) is a lethal malignant tumor and 25-30% of CRC patients develop liver metastasis (LM) with a worse prognosis, but the metastasis mechanism is yet elucidated. To identify the potential immune regulatory mechanism of CRC liver metastasis, single-cell sequencing and multiplex immunohistochemistry were applied to identify key cell populations of the tumor microenvironment (TME) in the CRC and LM sites. We found memory CD8

Background: Colorectal cancer (CRC) is recognized as one of the most common cancer globally. The association between CRC and apurinic endonuclease 1 (APE1) Asp148Glu polymorphism remains unclear; thus, this meta-analysis aimed to explore whether APE1 Asp148Glu polymorphism is related to CRC risk. Methods: Embase, PubMed, Cochrane library, CNKI and Wanfang databases were subject to a systematic search until April, 17, 2020 to evaluate the effect of APE1 Asp148Glu polymorphism on CRC risk. The associated strength was used to evaluate with odds ratios (ORs) with 95% confidence intervals (CIs) between Asp148Glu polymorphism and CRC risk. Subgroup analyses were also performed. Results: In total, 11 articles including 8,136 subjects (3,836 cases and 4,300 controls) were included. Five genetic models were analyzed, including the additive model (G vs. T), the heterozygote comparison (TG vs. TT), the homozygote comparison (GG vs. TT), the dominant model (TG+GG vs. TT), and the recessive model (GG vs. TG+TT). In these models, T refers to thymine and G refers to guanine. The APE1 Asp148Glu polymorphism in heterozygote comparison [OR (95%CI) = 1.36 (1.05, 1.75), P=0.019] and dominant model [OR (95%CI) =1.31 (1.07, 1.61), P=0.010] significantly increased CRC risk. No significant association was seen for the additive model [OR (95%CI) = 1.14 (1.00, 1.31), P=0.057], recessive model [OR (95%CI) = 0.97 (0.71, 1.31), P=0.826] or in homozygote comparison [OR (95%CI) = 1.15 (0.88, 1.52), P=0.309]. Moreover, CRC risk indicated a remarkable association with APE1 Asp148Glu polymorphism in the PCR-RFLP additive model, homozygote comparison and recessive model (PG) may be a potential risk factor for CRC.

This study aimed to investigate the effects of triggering receptor expressed on myeloid cell‐2 (TREM2) on the production of pro‐inflammatory mediators and cytokines induced by lipopolysaccharide (LPS) in BV2 microglia. TREM2 expression or TREM2‐specific siRNA were used to induce TREM2 overexpression or silencing. The BV2 cells were pre‐treated with the PI3 K inhibitor of LY294002 for 1 h and stimulated with LPS for 24 h. Then, the cell viability, apoptosis, phagocytosis, nitric oxide (NO), lactate dehydrogenase (LDH), and cytokine production, as well as the activation of AKT and NF‐kB were determined, respectively. We found LPS stimulation significantly reduced BV2 cell viability, enhanced BV2 cell phagocytosis and apoptosis compared to the control groups. In addition, LPS stimulation significantly increased the production of NO, LDH, TNF‐α, IL‐1β, and the activation of AKT and NF‐kB, while decreased the levels of IL‐10 and TGF‐β1. However, these pro‐inflammatory effects were significantly attenuated by TREM2 overexpression or pre‐treatment with LY294002, while enhanced by TREM2 silencing. Thus, we concluded that TREM2 inhibited neuroinflammation by down‐regulating PI3 K/AKT and NF‐kB signaling in BV2 microglia. Above all, therapeutic enhanced TREM2 expression may be a new strategy for intervention of neuroinflammatory diseases.

Summary Background The incidence of colorectal cancer (CRC) has significantly increased in adults Objectives The primary objective was to evaluate the age-standardized incidence (ASI) of young-onset CRC from 1988 to 2013. The secondary objective was to assess factors associated with cancer-specific death (CSD). Methods We accessed data of 64,854 CRC patients (20–49 years old) from the United States Surveillance, Epidemiology, and End Results Program (SEER) database. Results A gradual increase in the ASI of CRC in the study population was found: from 3.59/100,000 males in 1988 to 5.21/100,000 males in 2013, and from 3.15/100,000 females in 1988 to 4.45/100,000 females in 2013. ASI adjusted by race revealed a relatively pronounced increase in the white population compared to African American and other races, with an increase from 3.07/100,000 persons in 1988 to 4.79/100,000 persons in 2013. Males had a 19% higher likelihood of CRC-related death compared to females [hazard ratio (HR) = 1.19, 95% confidence interval (CI): 1.16–1.23], and African American had a 1.34-fold higher likelihood of CRC-related death compared to whites (95% CI: 1.28–1.39). CRC-related death was significantly higher in patients with signet ring-cell histology (HR = 1.56, 95% CI: 1.45–1.68), compared to patients with adenocarcinoma. Male gender, and advanced stage predicted a higher likelihood of CRC-related death in African Americans compared to the whole population. Signet ring-cell histology, advanced stage, and advanced grade were significantly associated with CRC-related death in African-American patients. Conclusion This study corroborates emerging data that the (ASI) of young-onset CRC is increasing. It also identified factors associated with cancer-specific death in this population that may aid in targeting screening strategies for adults

Aim The study was designed to evaluate a new completely diverted tube ileostomy (CDTI) with a reversible single-row stapled occlusion of the distal limb to defunction a low colorectal anastomosis, and to compare it with a loop ileostomy (LI). Method From September 2010 to August 2012, 95 patients with rectal cancer who underwent elective low anterior resections were recruited into the study. They received either a CDTI or a LI. Demographics, clinical features and operative data were recorded. Results Fifty-four patients (56%) had a CDTI and 41 (44%) a LI. There were no significant differences in patient demographics and clinical characteristics. Anastomotic dehiscence occurred in three (5.6%) patients in the CDTI group and two (4.9%) in the LI group (not significant) and no patient developed faecal peritonitis. In the CDTI group, the distal ileum spontaneously recanalized from the stapler occlusion with an average anastomosis exclusion time of 27.9 (14–70) days. The CDTI tube was removed on day 33 (20–75) and the subsequent stoma closure time was 12.3 (6–30) days. Conclusion The CDTI procedure is a safe and effective technique for defunctioning an elective low colorectal anastomosis and avoids a formal stoma.

To describe the initial experience of simultaneous resection of colorectal cancer and liver metastases through hand-assisted laparoscopy (HALS).After endotracheal general anesthesia, patients were placed in the Trendelenburg with lithotomy position. A 5-cm longitudinal subumbilical port was created, and the Lap Disc device was placed and pneumoperitoneum was established. A laparoscope was inserted to explore the liver and the whole pelvic cavity. The surgeon stood on the right side or between the patient's legs, and a 10-mm trocar was placed in the abdominal wall based upon the location of the tumor. The liver and the colorectal lesion were reselected with the assisted-hand through the Lap Disc to establish the possibility of resection, the tumor margin, and metastasis.Simultaneous resection of colorectal cancer and liver metastases through HALS were successful in all eight patients with operating time of 2-4 h. Average intraoperative blood loss was 100-300 ml, and no severe postoperative complications were observed. The average length of postoperative hospital stay was 7.5 days.HALS for simultaneous resection of colorectal and metastatic liver cancer has the advantages of safety, feasibility, minimal invasion, shorter operation time, reduced operative difficulty less pain and rapid recovery.

Background This study was designed to compare the long-term surgical outcomes of patients with mid and low rectal cancer after open or hand-assisted laparoscopic surgery (HALS). Methods A case-matched controlled prospective analysis of 116 patients who underwent hand-assisted laparoscopic surgery (HALS) for stage I to III mid and low rectal cancer from 2005 to 2010 was performed. Contemporary patients who underwent open rectal surgery were matched to the HALS group at the ratio of 1:1. The perioperative clinical outcomes, postoperative pathology, and survival outcomes were compared between the groups. Results The patient characteristics between the two groups were comparable. Ninety patients in the open group and 85 in the HALS group received sphincter-preserving surgery. HALS resulted in less blood loss and wound infection, faster return to oral diet, shorter postoperative hospital stay, and longer operating time. The two groups had similar complication rates. Lymph node retrieval and involvement of circumferential and distal margins were similar for both procedures. Cumulative incidences of locoregional recurrence, disease-free, or overall survival rates were statistically similar. Conclusions This study suggests that HALS for mid and low rectal cancer is acceptable in terms of short-term clinical outcomes and long-term survival results.

Background Colorectal cancer (CRC) is the most common cause of cancer death worldwide. Numerous studies have identified the roles of survivin −31 G/C and angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphisms in CRC risk; however, the results remain inconclusive. This study was to investigate associations between these two polymorphisms and CRC susceptibility. Methods A comprehensive literature search was conducted to collect relevant case–control studies published between 2000 and 2014. The extracted data were statistically analyzed, and the odds ratios (ORs) with 95% confidence intervals (CIs) were employed to estimate the strength of association. Results A total of 11 studies were included in the meta-analysis. For survivin G/C polymorphism, six articles reported 1,840 cases and 1,804 controls. Overall, we found the frequency of C allele is higher in CRC cases than that in the healthy controls (57.2% vs. 48.0%), and C allele significantly increased the risk of CRC compared to G allele in allele model (OR = 1.46, 95% CI = 1.33–1.60, P

Multiple primary tumors (MPT) are a well-known phenomenon. Rapid advancements in diagnostics and therapeutics have contributed to a significant improvement in the survival rates of cancer patients, and also in an increase in the incidence of cases with multiple primary neoplasms, such as synchronous primary carcinomas of the rectum and prostate. We present a case history of a small number of male patients with synchronous primary carcinomas of the rectum and prostate. Two of the three cases were treated with lower anterior resection (LAR) and radical retropublic prostatectomy (RRP) during the same operation, and 1 case was treated with abdominoperineal resection (APR) and RRP during the same operation. No significant complications occurred during these operations. Our experience with these 3 cases of synchronous primary carcinomas of the rectum and prostate indicated that LAR or APR and RRP can safely be performed in a single operation.

Caizhao Lin1, Ketao Jin2,3, Huanrong Lan4, Lisong Teng2, Jianjiang Lin1, Wenbin Chen11Department of Coloproctological Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 2Department of Surgical Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 3Department of Surgery, Affiliated Zhuji Hospital, Wenzhou Medical College, Zhuji, 4Department of Gynecology and Obstetrics, Affiliated Taizhou Hospital, Wenzhou Medical College, Linhai, Zhejiang, People’s Republic of ChinaBackground: The relative rarity and anatomical position of retrorectal tumors may lead to difficulty in diagnosis and surgical management.Methods: This was a retrospective review of 62 patients who had resection of retrorectal tumors between 2002 and 2010.Results: All patients in this study were treated by excision of the retrorectal tumors. Surgical approach included transsacral approach (52 cases), transabdominal approach (eight cases), and combined approach (two cases). A total of 48 benign lesions (77.4%) and 14 malignant lesions (22.6%) were confirmed by histological examination. The 48 benign cases included dermoid cysts (17 cases), simple cysts (eight cases), teratomas (eight cases), neurofibromas (eight cases), fibrolipomas (four cases), neurilemmomas (two cases), and synovioma (one case). The 14 malignant cases included lymphomas (four cases), malignant teratomas (three cases), fibrosarcomas (two cases), interstitialomas (four cases) and malignant mesothelioma (one case). Complications occurred in 14.5% of patients and included intraoperative bleeding (three cases), rectal injury (three cases), and presacral infection (three cases).Conclusion: Primary retrorectal tumors are very rare. Successful treatment of these tumors requires extensive knowledge of pelvic anatomy and expertise in pelvic surgery.Keywords: retrorectal space, retrorectal tumor, surgical treatment