3541 Background: Approximately 75% of colorectal cancer liver metastasis patients relapse within two years after surgery due to circulating tumor cells and microscopic residual disease. Specific chimeric antigen receptor (CAR) T-cell therapy, effective for hematological tumors, may also treat recurrent colorectal cancer liver metastases. Carcinoembryonic antigen (CEA) is a glycoprotein which is highly expressed in colorectal tumor. Therefore, this study aimed to evaluate the safety and efficacy of this therapy in postoperative colorectal cancer liver metastasis patients. Methods: We conducted a single-arm, dose-escalating phase I clinical trial (NCT05240950). Key eligibility criteria were achieving no evidence of disease status after treatment and had CEA positivity of 30% or greater. Three dose levels of 1, 3, and 6 (10^6/kg) Anti-CEA CAR-T cells were administered in a dose-escalating manner. The primary endpoint is safety which measures are incidence and severity of adverse events within 28 days and relapse-free survival at 24 months. Results: From December 2021 to December 2024, 48 subjects were screened, and 12 received CAR-T cell infusion (2 in the 1 and 3×10^6/kg group, and 8 in the 6×10^6/kg group). Three subjects who had relapsed before the infusion still asked for the infusion, so we proceeded to infuse after fully informing about the benefits and risks of the infusion. 8 subjects experienced adverse events during treatment, including lymphopenia (5 subjects), arthralgia (1 subject), fever (1 subject), and rash (1 subject). No severe adverse events occurred. The median follow-up time for the 9 pre-infusion relapse-free subjects was 23 months, of which 5 relapsed after infusion. In the 6×10^6/kg dose group, 4 subjects remained relapse-free survival of 5, 7, 10 and 15 months after infusion, and their follow-up is ongoing. By infusing CAR-T cell, 57.14% of the subjects in the 6×10^6/kg dose group were free of recurrence within two years after radical resection. Conclusions: This is the first clinical trial of Anti-CEA CAR-T therapy for prolonging relapse-free survival of postoperative colorectal cancer liver metastases patients, showing no serious adverse events and significant reduced risk of recurrence with high doses. Clinical trial information: NCT05240950 . Clinical information of 9 pre-infusion relapse-free subjects. Subhects number TNM Stage Infusion dose (×10^6/Kg) 1 Current NED status Post-infusion relapse-free survival time (months) 2 Post-infusion survival time (months) 2 Overall survival time (months) 3 S01002 T3N0M1a 1 No 3 27 33 S01037 T2N1bM1a 3 No 12 12 26 S01008 T3N0M1a 6 Yes 10 10 25 S01010 T3N1M1a 6 No 10 10 26 S01015 T3N0M1a 6 Yes 15 15 21 S01023 T3N0M1a 6 No 12 14 23 S01042 T3N2aM1a 6 No 3 10 16 S01033 T3N1bM1a 6 Yes 7 7 18 S01043 T3N1bM1a 6 Yes 5 5 14 1 One subject in each of the 1, 3, and 6 dose groups relapsed before infusion. 2 From the day of infusion. 3 From the day of radical resection.

Objective: To explore the safety and efficacy of neoadjuvant chemoradiotherapy (nCRT) combined with a PD-1 antibody in improving complete clinical response (cCR) and organ preservation in patients with ultra-low rectal cancer. Methods: This was a prospective phase II, single-arm, open-label trial. Patients with confirmed pMMR status T1-3aN0-1M0 retcal adenocarcinoma were included. Long-course chemoradiotherapy was delivered to a dose of 50 Gy. A PD-1 antibody was added 2 weeks after the first radiotherapy session, and two courses were administered. After chemoradiotherapy, CapeOX plus PD-1 antibody was administered to patients for two cycles. After evaluation, patients with cCR were managed with a watch-and-wait (W&W) approach. Local excision or a W&W approach was performed for patients with near complete clinical response (ncCR) as per multidisciplinary team decision. Radical surgery was recommended for poorly regressed or progressed tumors. Results: Twenty-five patients were enrolled, but two patients withdrew from the study. A total of 23 patients completed the entire neoadjuvant therapy. Ten and five patients achieved cCR and ncCR, respectively, and the rest had a partial clinical response. Patients with cCR were managed with W&W. Four patients with ncCR underwent local excision and were managed using W&W. Eight patients with partial clinical response underwent anus-preserving surgery. At the last follow-up, the rectum and anus preservation rates were 63.4% (14/22) and 95.5% (21/22), respectively. Conclusion: nCRT combined with immunotherapy tended to achieve better cCR and rectum preservation rates with good tolerance in patients.

This paper presents a subwindow variance filtering algorithm for fusing infrared and visible light images, with the goal of addressing challenges related to blurred details, low contrast, and missing edge features. First, images to be fused are subjected to multilevel decomposition using a subwindow variance filter, resulting in corresponding base and multiple detail layers. PCANet extracts features from the base layer and obtains corresponding weight maps that guide the fusion process. A saliency measurement method is proposed for detail-level fusion to extract saliency maps from the source image. The saliency maps should be compared in order to obtain the initial weight map, which is then optimized using guided filtering technology to guide the fusion of detail layers. Finally, the information of the base layer and the detail layer after fusion is superimposed to obtain an ideal fusion result. The proposed algorithm is evaluated through subjective and objective measures, including information entropy, mutual information, multiscale structural similarity measurement, standard deviation, and visual information fidelity. The results demonstrate that the proposed algorithm achieves rich detail information, high contrast, and good edge information retention, making it a promising approach for infrared and visible image fusion.

BACKGROUND: Radiotherapy with or without chemotherapy has been widely used to improve patient outcomes due to locally advanced rectal cancer. The differential degree of pelvic fibrosis and anorectal function after preoperative or postoperative chemoradiotherapy has not been studied previously. METHODS: Data of patients who received chemoradiotherapy and radical resection of rectal cancer in our hospital from January 2000 to Aug 2021 were retrospectively analyzed. Anastomotic fibrosis scores and perirectal fibrosis scores based on magnetic resonance imaging findings were used to evaluate the extent of fibrosis one year postoperatively. The overall level of anorectal function and percentage of patients eligible for ileostomy reversal were assessed two years postoperatively. RESULTS: 1331 patients were finally included, with 522 and 809 patients in in the preoperative and postoperative chemoradiotherapy groups, respectively. The postoperative chemoradiotherapy group had a higher percentage of patients undergoing ileostomy reversal and had lower anastomotic fibrosis scores, perirectal fibrosis scores, Wexner scores, and percentage of patients with temporary ileostomy than the preoperative group; this difference persisted after propensity score matching. Univariate and multivariate analyses demonstrated that the timing of chemoradiotherapy was an independent predictor of the anastomotic fibrosis score, perirectal fibrosis score, percentage of patients with temporary ileostomy, and percentage of patients eligible for ileostomy reversal. CONCLUSIONS: Postoperative chemoradiotherapy is associated with less pelvic fibrosis and better anorectal function than preoperative chemoradiotherapy in the treatment of patients with locally advanced rectal cancer. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Shanghai Changhai Hospital gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Traditional multifucus image fusion often requires the inclusion of edge features, blurred details, and noise pollution when perturbed by noise. To address these problems, this study proposes a method for fusing noisy multifucus images using adaptive sparse and low-rank representations. The proposed method first decomposes the image into high- and low-frequency subband coefficients using a non-subsampled shearlet transform. Subsequently, the high-frequency energy components are fused and denoised using a low-rank representation. The corresponding fusion rules are then set using an adaptive sparse representation to fuse the low-frequency subband coefficients. The final fusion result is obtained by reconstructing the fused high- and low-frequency subband coefficients. Experimental results show that the proposed method outperforms traditional methods in terms of both subjective performance and objective indicators, making it a compelling fusion method for noisy multifucus images.

目的 探讨中低位直肠癌新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)后达到ypT0病人的临床病理特征和影响预后的因素.方法 回顾性分析2011年1月至2021年12月海军军医大学第一附属医院接受长程新辅助治疗、术后病理证实ypT0的中低位直肠癌病人的临床病理资料,采用Cox比例风险模型检验分析无病生存率(disease-free survival,DFS)和总生存率(overall survival,OS)的影响因素.结果 共入组132例病人,接受局部切除术病人26例(19.7％),术后病理提示ypN0和ypN+的病人分别为98例(74.2％)和8例(6.1％),接受辅助治疗的病人79例(59.8％).中位随访时间为43.5个月,全组5年DFS和OS分别为84.4％ 和90.4％.多因素Cox回归分析显示,新辅助治疗前癌胚抗原(CEA)水平升高(H R=3.540,P=0.029)和糖类抗原(CA)19-9水平升高(HR=4.982,P=0.020),以及ypN+/ypNx(HR=8.821/7.379,P=0.002/0.008)是DFS的独立危险因素;未发现OS的独立影响因素.结论 中低位直肠癌nCRT后达到ypT0的病人肿瘤学结局良好,nCRT前CEA、CA19-9水平升高及术后病理淋巴结状态为ypN+/ypNx的病人应加强术后治疗和随访.

IntroductionNeoadjuvant chemoradiotherapy (nCRT) could bring tumour shrinking and downstaging and increase the probability of organ preservation for patients with low rectal cancer. But for ultra-low rectal cancer, there is little possibility for organ preservation. Immunotherapy has been shown to have significant survival benefits in microsatellite instability-high patients but poor response in microsatellite stable (MSS) patients. Studies have demonstrated that radiotherapy and immunotherapy have synergistic effects in cancer treatment. There is no existing evidence about the clinical efficacy of immunotherapy combined with nCRT for patients with MSS ultra-low rectal cancer.Method and analysisThis trial is an open-labelled multicentre prospective randomised controlled trial (NCT05215379) with two parallel groups and allocation ratio 1:1 (nCRT+immunotherapy vs nCRT group). Eligible participants will be aged 18–75 years, with a desire for anus preservation, confirmed cT1–3aN0–1M0rectal adenocarcinoma, confirmed MSS type, inferior margin of ≤5 cm from the anal verge. The primary endpoint of this trial is complete clinical response (cCR) rate. Immunotherapy is added after 1 week of chemoradiotherapy for two cycles, and then the patients will be administered two cycles of immunotherapy and CAPOX. The evaluations will be carried out after the completion of the whole neoadjuvant therapy. We expect the programme to improve the cCR rate and the quality of life for patients with ultra-low rectal cancer.Ethics and disseminationThis trial was approved by the Ethics committee of Changhai Hospital and other medical centres (Grant number:CHEC2022-118). The results of this study will provide further insight into the clinical efficacy of immunotherapy in combination with nCRT in patients with MSS ultra-low rectal cancer.Trial registration numberNCT05215379.

Neoadjuvant therapy has been widely applied in the treatment of rectal cancer, which can shrink tumor size, lower tumor staging and improve the prognosis. It has been the standard preoperative treatment for patients with locally advanced rectal cancer. The efficacy of neoadjuvant therapy for rectal cancer patients varies between individuals, and the results of tumor regression are obviously different. Some patients with good tumor regression even achieve pathological complete response (pCR). Tumor regression is of great significance for the selection of surgical regimes and the determination of distal resection margin. However, few studies focus on tumor regression patterns. Controversies on the safe distance of distal resection margin after neoadjuvant treatment still exist. Therefore, based on the current research progress, this review summarized the main tumor regression patterns after neoadjuvant therapy for rectal cancer, and classified them into three types: tumor shrinkage, tumor fragmentation, and mucin pool formation. And macroscopic regression and microscopic regression of tumors were compared to describe the phenomenon of non-synchronous regression. Then, the safety of non-surgical treatment for patients with clinical complete response (cCR) was analyzed to elaborate the necessity of surgical treatment. Finally, the review studied the safe surgical resection range to explore the safe distance of distal resection margin.

To enhance the visibility of infrared and visible image fusion and overcome the problems of detail loss, insignificant target, and low contrast in infrared and visible image fusion results, a novel infrared and visible image fusion method based on two-scale decomposition and saliency extraction is proposed. Firstly, based on the theory of human visual perception, the source image is decomposed at different levels to avoid mixing high-frequency and low-frequency components to reduce the halo effect. In this paper, we use a two-scale decomposition method to decompose the source infrared and visible images and obtain the basic layer and detail layer, respectively, representing the image well and having good real-time performance. Then, a weighted average fusion rule based on a visual saliency map (VSM) is proposed to fuse basic layers, and the VSM method can extract the salient structures and targets in the source images. The VSM-based weighted average fusion rule is used to fuse the base layer, effectively avoiding the contrast loss caused by the direct use of the weighted average strategy and making the fused image perform better. The Kirsch operator is used to extract the source images separately to obtain the salient maps for the fusion of the detail layer. Then the VGG-19 network is applied to get the weight maps by extracting features from the salient maps and fusing them with the detail layer to obtain the fused detail layer. The Kirsch operator can quickly extract the image edges in eight directions, and the significant map will contain more edge information and less noise. The VGG-19 network can extract deeper feature information from the image, and the obtained weight map will have more helpful information. Finally, the fused basic and detail layer images are superimposed to get the final fusion result. Four sets of typical infrared and visible images are selected for testing and compared with six other current mainstream methods in the experimental part. The experimental results show that the method in this paper has the advantages of high contrast, prominent target, rich detail information and better retention of image edge features in terms of subjective quality. The objective metrics such as information entropy, mutual information, standard deviation, multiscale structural similarity measure and difference correlation sum also show relatively good results.

[Objectives] To analyze the clinical and pathological characteristics of colorectal cancer in organ transplant recipients and provide references for clinical diagnosis and treatment. [Methods] Retrospective analysis of 7 organ transplant recipients confirmed with colorectal adenocarcinoma who underwent radical surgery at the Department of Colorectal Surgery of the First Affiliated Hospital of Naval Medical University from September 2002 to September 2021 was performed. Clinical and pathological characteristics of colorectal cancer in organ transplant recipients were summarized and analyzed. [Results] The initial symptoms were hematochezia in 3 cases, abdominal pain in 1 case, diarrhea in 1 case, abdominal distension and vomiting in 1 case, and abnormal colonoscopy in 1 case. The preoperative serum levels of CEA were 1.61 to 123.20 ng/mL, the median serum CEA level was 5.12 (1.76, 10.28) ng/mL; the preoperative serum levels of CA199 were 4.79 to 184.96 U/mL, and the median serum CA199 level was 18.59 (9.37, 135.60) U/mL. Three patients had normal preoperative serum CEA, and five had normal preoperative serum CA199. The tumor was located in the ascending colon in 1 case, descending colon in 1 case, sigmoid colon in 1 case, rectosigmoid junction in 1 case, and rectum in 3 cases. Among them, 3 cases at stage Ⅲ, 3 cases at stage Ⅱ, and 1 case at stageⅠ;3 cases were poorly differentiated, 1 case was moderately to poorly differentiated, and 3 cases were moderately differentiated; The tumor occupied less than the entire intestinal circumference in 2 cases and the entire intestinal circumference in 5 cases. [Conclusion] Colorectal cancer in organ transplant recipients tends to occur within five years, and the tumor is usually located in the rectum, with most patients diagnosed with locally advanced stage. Therefore, for individuals who have undergone organ transplantation, it is recommended to strengthen early diagnosis and treatment of colorectal cancer to improve prognosis.

Background: To investigate the clinicopathological features and prognosis of synchronous and metachronous multiple primary colorectal cancer. Materials and methods: Patients who underwent operation for synchronous and metachronous colorectal cancer at the colorectal surgery department of Shanghai Changhai Hospital between January 2000 and December 2021 were included. Perioperative indicators were comprehensively compared and included in the survival analyses. Results: In total, 563 patients with synchronous (n=372) and metachronous (n=191) colorectal cancer were included. Patients with synchronous colorectal cancer were more likely to have a long onset time, positive carcinoembryonic antigen, advanced TNM stage, large tumor, perineural invasion, p53 high expression, and mismatch repair proficient. Compared with metachronous colorectal cancer, patients with synchronous colorectal cancer showed worse 5-year overall survival (68.6±3.0% vs 81.9±3.5%, P=0.018) and 5-year disease-free survival (61.2±3.1% vs 71.0±3.9%, P=0.022). In the subgroup analysis, segmental resection was an independent risk factor for the long-term outcomes of bilateral synchronous colorectal cancer. Conclusions: Clinicopathological and molecular features were different between synchronous and metachronous colorectal cancer. Patients with synchronous colorectal cancer showed a worse prognosis than those with metachronous colorectal cancer. Bilateral synchronous colorectal cancer requires extended resection to achieve improved long-term outcomes.

Abstract Background To investigate the learning curve of conformal sphincter preservation operation (CSPO) in the treatment of ultralow rectal cancer and to further explore the influencing factors of operation time. Methods From August 2011 to April 2020, 108 consecutive patients with ultralow rectal cancer underwent CSPO by the same surgeon in the Department of Colorectal Surgery of Changhai Hospital. The moving average and cumulative sum control chart (CUSUM) curve were used to analyze the learning curve. The preoperative clinical baseline data, postoperative pathological data, postoperative complications, and survival data were compared before and after the completion of learning curve. The influencing factors of CSPO operation time were analyzed by univariate and multivariate analysis. Results According to the results of moving average and CUSUM method, CSPO learning curve was divided into learning period (1–45 cases) and learning completion period (46–108 cases). There was no significant difference in preoperative clinical baseline data, postoperative pathological data, postoperative complications, and survival data between the two stages. Compared with the learning period, the operation time (P < 0.05), blood loss (P < 0.05), postoperative flatus and defecation time (P < 0.05), liquid diet time (P < 0.05), and postoperative hospital stay (P < 0.05) in the learning completion period were significantly reduced, and the difference was statistically significant. Univariate and multivariate analysis showed that distance of tumor from anal verge (≥ 4cm vs. < 4cm, P = 0.039) and T stage (T3 vs. T1-2, P = 0.022) was independent risk factors for prolonging the operation time of CSPO. Conclusions For surgeons with laparoscopic surgery experience, about 45 cases of CSPO are needed to cross the learning curve. At the initial stage of CSPO, beginners are recommended to select patients with ultralow rectal cancer whose distance of tumor from anal verge is less than 4 cm and tumor stage is less than T3 for practice, which can enable beginners to reduce the operation time, accumulate experience, build self-confidence, and shorten the learning curve on the premise of safety.

A 44-year-old woman was admitted to our emergency room with a diagnose of rectal burn due to an accidental hot normal saline enema before oophorocystectomy in a local hospital 8 days previously. She reported hypogastralgia and burning pain on the buttocks immediately when the enema was conducted. The enema was stopped instantly and she was treated with fasting, antibiotics, glucocorticoids, and parenteral nutrition for a week. However, the above symptoms did not resolve. Second-degree burn scars were seen on both buttocks (Figure 1A). Digital rectal examination revealed the anal function was normal, but the rectal wall was rough without mucosal folds. In addition, colonoscopy revealed severe edema, necrosis, and fibrin exudation around the rectal wall. However, the colonoscope could not be advanced beyond 10 cm above the anal verge due to luminal narrowing (Figure 1C). The patient was admitted and treated with a combination of fasting, proton-pump inhibitors, antibiotics, glucocorticoids, and parenteral nutrition. Sulfadiazine Zinc Silver cream was applied on the buttock wounds. Meanwhile, a retention enema was performed twice a day using 200 mL of Kangfuxin solution to accelerate rectal mucosa healing. After treatment for 1 week, hypogastralgia and hematochezia were gradually resolved, and she could have a liquid diet. After 2 weeks of treatment, she could have a semi-liquid diet. By Week 4 of treatment, the buttock wounds had almost healed (Figure 1B). Colonoscopy revealed a nodular granulation tissue with hyperemia and edema on the mucosa 3–10 cm above the dentate line. Although the lumina was still relatively narrow, the colonoscope could be advanced to the sigmoid colon (Figure 1D). Hypogastralgia and hematochezia had disappeared and she could pass loose stool. The patient was discharged on Day 30 after admission. She continued the Kangfuxin solution retention enema at home. About 1 month after discharge, she reported symptoms of frequent defecation, tenesmus, hematochezia, and occasional abdominal pain. She underwent colonoscopy that revealed an impassable stricture 5 cm above the anal verge (Figure 1E). Iodine angiography of the lower digestive tract showed that there was a stricture on the rectum (Figure 1F). Finally, we performed laparoscopic proctectomy (low anterior resection) with temporary terminal ileostomy and right oophorocystectomy 2 months after her injury (Figure 1G and H). The ileal diversion was buried 2 months later.

BackgroundMost prognostic signatures for colorectal cancer (CRC) are developed to predict overall survival (OS). Gene signatures predicting recurrence-free survival (RFS) are rarely reported, and postoperative recurrence results in a poor outcome. Thus, we aim to construct a robust, individualized gene signature that can predict both OS and RFS of CRC patients.MethodsPrognostic genes that were significantly associated with both OS and RFS in GSE39582 and TCGA cohorts were screened via univariate Cox regression analysis and Venn diagram. These genes were then submitted to least absolute shrinkage and selection operator (LASSO) regression analysis and followed by multivariate Cox regression analysis to obtain an optimal gene signature. Kaplan–Meier (K–M), calibration curves and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of this signature. A nomogram integrating prognostic factors was constructed to predict 1-, 3-, and 5-year survival probabilities. Function annotation and pathway enrichment analyses were used to elucidate the biological implications of this model.ResultsA total of 186 genes significantly associated with both OS and RFS were identified. Based on these genes, LASSO and multivariate Cox regression analyses determined an 8-gene signature that contained ATOH1, CACNB1, CEBPA, EPPHB2, HIST1H2BJ, INHBB, LYPD6, and ZBED3. Signature high-risk cases had worse OS in the GSE39582 training cohort (hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.42 to 1.67) and the TCGA validation cohort (HR = 1.39, 95% CI = 1.24 to 1.56) and worse RFS in both cohorts (GSE39582: HR = 1.49, 95% CI = 1.35 to 1.64; TCGA: HR = 1.39, 95% CI = 1.25 to 1.56). The area under the curves (AUCs) of this model in the training and validation cohorts were all around 0.7, which were higher or no less than several previous models, suggesting that this signature could improve OS and RFS prediction of CRC patients. The risk score was related to multiple oncological pathways. CACNB1, HIST1H2BJ, and INHBB were significantly upregulated in CRC tissues.ConclusionA credible OS and RFS prediction signature with multi-cohort and cross-platform compatibility was constructed in CRC. This signature might facilitate personalized treatment and improve the survival of CRC patients.

The pelvic cavity is a monolithic structure whose integrity plays an important role in the pelvic organ function. Currently, pelvic floor peritoneum reconstruction (PFPR) is rarely performed during laparoscopic surgery for middle and low rectal cancer patients. This study evaluated the effect of PFPR using barbed wire during laparoscopic surgery on the postoperative defecation function in middle and low rectal cancer patients. This was a retrospective study involving a total of 252 middle and low rectal cancer patients who had been subjected to laparoscopic-assisted anterior resection of rectal cancer at Shanghai Changhai Hospital from March 2018 to April 2020. The Wexner and low anterior resection syndrome (LARS) scores were used to evaluate the postoperative defecation function among patients. A Wexner score ≥ 8 and LARS score ≥ 30 were considered to indicate major defecation dysfunction. A total of 229 patients (52 patients subjected to PFPR) were followed up, and the Wexner and LARS scores were recorded. The follow-up rate was 90.87%, the mean follow-up time was 22.88 ± 6.93 months, the stoma rate was 64.29%, the ileostomy reduction surgical rate was 90.74%, and the stoma duration was 7.64 ± 2.94 months. Regarding the assessment of postoperative defecation dysfunction using the Wexner score, a multivariate analysis revealed that a long operation time (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.984–0.999, p = 0.026) and radiotherapy (OR, 0.352; 95% CI, 0.156–0.797, p = 0.012) were independent risk factors for major defecation dysfunction, while a high tumor location (OR, 1.318; 95% CI, 1.151–1.657, p = 0.001) and PFPR (OR, 4.770; 95% CI, 1.435–15.857, p = 0.011) were independent protective factors for major defecation dysfunction. Regarding the assessment of the postoperative defecation function using the LARS score, a multivariate analysis revealed that a high tumor location (OR, 1.293; 95% CI, 1.125–1.486, p < 0.001) and PFPR (OR, 3.010; 95% CI, 1.345–6.738, p = 0.007) were independent protective factors for major defecation dysfunction. A subgroup analysis showed that the postoperative Wexner score (3.13 ± 2.79 vs. 4.71 ± 3.45 p = 0.003) and LARS score (21.77 ± 8.62 vs. 25.14 ± 8.78 p = 0.015) were lower for patients with PFPR than for patients without PFPR. Regarding patients with low rectal cancer, those with PFPR had a lower LARS score than those without it (23.62 ± 8.94 vs. 28.40 ± 7.90, p = 0.022), but there was no significant difference in the Wexner score between the groups. A total of 9.76% of patients with PFPR and 48.89% of those without PFPR showed an intestinal accumulation in the sacral front (p < 0.001). PFPR and a high tumor location are protective factors for postoperative defecation dysfunction in middle and low rectal cancer patients. PFPR can be routinely performed during laparoscopic surgery.

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Purpose:To explore the treatments and short-term effects of different types of adult Hirschsprung's disease.Methods:89 patients treated in Shanghai Changhai Hospital were retrospectively analyzed. According to the patient's medical history, clinical manifestations, auxiliary examination and postoperative pathological results, the patients were divided into adult congenital megacolon, adult idiopathic megacolon, ganglion cell deficiency (types I and II), toxic megacolon and iatrogenic megacolon, The Treatment methods and short-term prognosis of patients in each group were summarized.Results:41 cases of Hirschsprung's disease in adults and low anterior resection or pull-out low anterior resection was performed, and 35 patients with idiopathic Megacolon were treated with one-stage subtotal colon resection under the condition of adequate preoperative preparation. Some patients admitted for emergency intestinal obstruction received conservative treatment first or underwent elective surgery after colonoscopic decompression was improved; two patients with ganglion cell deficiency subtotal colectomy were performed to remove the dilated proximal bowel segment and the narrow distal bowel segment; three patients with toxic Hirschsprung's disease underwent colostomy in mild cases, while subtotal colorectal resection was required in severe cases; Iatrogenic megacolon was diagnosed in eight cases and the optimum operation should be selected according to the specific conditions of patients.Conclusion:Adult Hirschsprung's diseases were divided into adult congenital hirschsprung's disease, idiopathic Hirschsprung's disease, ganglion cell deficiency, toxic hirschsprung's disease, and iatrogenic Hirschsprung's disease. Different types of surgical treatments for Hirschsprung's disease in adults should be selected according to the specific diagnosis. All patients with adult Hirschsprung's diseases have good short-term outcomes after surgical treatment.

Objective:To investigate the clinical efficacy and prognosis of simultaneous resection of synchronous colorectal liver metastasis in patients admitted in different phases.Methods:The retrospective cohort study was conducted. The clinicopathological data of 346 patients who underwent simultaneous resection of synchronous colorectal liver metastasis in the First Affiliated Hospital of Naval Medical University (Changhai Hospital of Shanghai) from January 2000 to April 2021 were collected. There were 217 males and 129 females, aged (58±12)years. Patients under-went simultaneous resection of synchronous colorectal liver metastasis. Observation indicators: (1) clinicopathological features of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021; (2) surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021; (3) analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000?2010 and 2011?2021. Follow-up was conducted using telephone interview or outpatient examination to detect survival of patients. The follow-up was performed once every 3 months, including blood routine test, liver and kidney function test, car-cinoembryonic antigen (CEA) test, CA19-9 test, abdominal B-ultrasound examination, and once every 6 months, including chest computed tomography (CT) plain scan, liver magnetic resonance imaging (MRI) and/or CT enhanced scan, abdominal or pelvic MRI and/or CT enhanced scan, within postoperative 2 year. The follow-up was performed once every 6?12 months within postoperative 2?5 years including above reexaminations. Electronic colonoscopy was performed once a year after operation. The follow-up was up to November 12, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distuibution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used to conduct survival analysis. Results:(1) Clinicopathological features of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021. Of the 346 patients, 59 cases underwent simultaneous resection within 2000?2010 and 287 cases underwent simultaneous resection within 2011?2021. The gender (males and females), cases with or without fundamental diseases, cases with the number of lymph nodes harvested in primary lesion as <12 or ≥12, the tumor diameter of primary lesion, the tumor diameter of liver metastasis lesion, the number of liver metastasis lesions, cases with or without preoperative treatment, cases with or without postoperative treatment, cases with adjuvant therapy as perioperative treatment, surgery or other treatment were 47, 12, 36, 23, 19, 40, (5.5±2.4)cm, (2.1±0.7)cm, 1.6±0.5, 59, 0, 16, 16, 0, 16, 43 in patients admitted in 2000?2010, respectively. The above indicators in patients admitted in 2011?2021 were 170, 117, 121, 166, 58, 229, (4.2±2.0)cm, (3.0±2.0)cm, 1.9±1.4, 208, 79, 34, 235, 74, 29, 184, respectively. There were significant differences in the above indicators between patients admitted in 2000?2010 and 2011?2021 ( χ2=8.73, 7.02, 4.07, t= 4.40, ?6.04, ?3.10, χ2=21.05, 28.82, 26.68, P<0.05). (2) Surgical and postoperative situations of patients with synchronous colorectal liver metastasis in 2000?2010 and 2011?2021. Cases with surgical methods as complete open surgery or laparoscopy combined with open surgery, the operation time, time to postoperative initial liquid food intake, cases with or without postoperative complications, cases with postoperative duration of hospital stay as ≤10 days or >10 days were 58, 1, (281±57)minutes, (5±1)days, 33, 26, 14, 45 in patients admitted in 2000?2010, respec-tively. The above indicators in patients admitted in 2011?2021 were 140, 147, (261±82)minutes, (3±1)days, 233, 54, 198, 89, respectively. There were significant differences in the above indicators between patients admitted in 2000?2010 and 2011?2021 ( χ2=49.04, t=2.24, 7.53, χ2=17.56, 26.02, P<0.05). There was no death in the 346 patients. (3) Analysis of prognosis of patients with synchro-nous colorectal liver metastasis in 2000?2010 and 2011?2021. Of the 346 patients, 295 cases were followed up for 47(range, 1?108)months. Of the 29 patients admitted in 2000?2010 who were followed up, there were 27 cases died. The median survival time, 1-, 3-, 5-year overall survival rates, 1-, 3-, 5-year disease free survival rates of patients admitted in 2000?2010 were 18.0 months (95% confidence interval as 12.7?23.3 months), 82.8%, 11.5%, 3.8%, 53.6%, 8.3%, 4.2%, respec-tively. Of the 266 patients admitted in 2011?2021 who were followed up, there were 109 cases died. The median survival time, 1-, 3-, 5-year overall survival rates, 1-, 3-, 5-year disease free survival rates of patients admitted in 2011?2021 were 54.0 months (95% confidence interval as 38.1?70.4 months), 93.3%, 61.8%, 47.0%, 68.2%, 33.7%, 28.3%, respectively. There were significant differences in overall survival rate and disease free survival rate between patients admitted in 2000?2010 and 2011?2021 ( χ2=47.57, 9.17, P<0.05). Conclusions:With the increase of the operation volume of simultaneous resection of synchronous colorectal liver metastasis, the operation time, time to postoperative initial liquid food intake, postoperative duration of hospital stay and postoperative complications have significantly decreased, while the overall survival rate and disease free survival rate have significantly increased.

A novel infrared and visible image fusion method in a multilevel low-rank decomposition framework based on guided filtering and feature extraction is proposed to address the lack of edge information and blurred details in fused images. Based on multilevel low-rank decomposition, the fusion strategy of base part and detail contents has been improved. Firstly, the source infrared and visible images are decomposed to the base part coefficients and n-level detail content coefficients by multilevel low-rank decomposition. Secondly, the base part coefficients are learned by the VGG-19 network to get the weight map, and then, the improved weight map is obtained by guided filtering, and the coefficients of the base part are fused to acquire the fused base part coefficients. The n-level detail content coefficients are fused using the rule of dynamic level measurement with maximum value and then reconstructed to obtain the final fused detail content coefficients. Finally, the fused base part and detailed content information are superimposed to get the final fusion result. The results show that the fusion algorithm can effectively preserve the edge and detail features of the source image. Compared with other state-of-the-art fusion methods, the proposed method performs better in objective assessment and visual quality. The average value of evaluation metrics EN and MI have been improved by 0.5337 and 1.0673 on the six pair images.