Background and Objectives: Rectal cancer poses significant treatment challenges, especially in advanced stages. Radiologic assessment, particularly with MRI, is critical for surgeons and oncologists to understand tumor dynamics and tailor treatment strategies to improve patient outcomes. The purpose of this study was to correlate MRI-based tumor volumetric and tumor regression grade analysis in patients with advanced rectal cancer, assessing the impact of preoperative chemotherapy (CT) alone or chemoradiotherapy (CRT) on surgical technique choices. Materials and Methods: Between 2015 and 2022, a prospective study was enrolled, including a cohort of 89 patients diagnosed with rectal cancer at stage II or III. The participants were divided into two distinct therapy groups, ensuring an equal distribution with a ratio of 1:1. The initial group was treated with the contemporary preoperative chemotherapy protocol FOLFOX4. In contrast, the alternative group received conventional preoperative chemoradiotherapy. Before surgery, each patient underwent a rectal MRI scan at 1.5 T, including T2-weighted and diffusion-weighted imaging (DWI) sequences. Results: The CT group showed a 36.52% tumor volume reduction rate (TVRR), and the CRT group showed 54.87%, with varying magnetic resonance and pathological tumor regression grades (mrTRG and pTRG). Analysis revealed a significant interaction between mrTRG and tumor volumetrics (volume and VRR) in both groups, especially CRT, underscoring the complexity of tumor response. Both treatment groups had similar initial tumor volumes, with CRT displaying a higher TVRR, particularly in higher pathological TRG (3/4) cases. This interaction and the strong correlation between mrTRG and pTRG suggest mrTRG’s role as a non-invasive predictor for treatment response, highlighting the need for personalized treatment plans. Conclusions: Rectal tumor volume, volume reduction rate, and mrTRG are not just abstract measures; they are concrete indicators that have a direct and practical impact on surgical decision-making, planning, and prognosis, ultimately influencing the quality of care and life expectancy of patients with rectal cancer.

Kraujagyslinė demencija yra antra pagal dažnį demencijos rūšis po Alzheimerio ligos. Tai ne viena liga, o grupė demencijos sindromų, kurių priežastys yra smegenų pažeidimai, sukelti smegenų ir sisteminės kraujotakos sutrikimų – nuo smulkių lakūnarinių iki plačių ar daugybinių infarktų galvos smegenyse, hipertenzinės encefalopatijos sąlygotų smulkiųjų arterijų fibrohialinozės, stambesnių arterijų fibrinoidinės nekrozės. Ji taip pat gali būti paveldima ir išsivystyti dėl NOTCH3 geno mutacijos, dėl ko vystosi Binswangerio liga, CADASIL sindromas pasireiškia išeminiais smegenų infarktais subkortikalinėje baltojoje smegenų medžiagoje ir daugybiniais lakūnariniais insultais. Pastaruoju metu ypač intensyviai tobulėjant neuroradiologiniams diagnostikos tyrimo metodams, tobulėja ir pakitimų smegenyse diagnostika. Neurovizualiniai tyrimai yra svarbūs cerebrovaskulinei ligai nustatyti, kraujagyslinių pakitimų lokalizacijai ir jų sunkumui įvertinti. Pagal naujausias rekomendacijas, magnetinio rezonanso tomografijos ar kompiuterinės tomografijos tyrimas bent vieną kartą turi būti atliktas kiekvienam pacientui, kuriam įtariama demencija. Šiame straipsnyje aptariamos pagrindinės kraujagyslinę demenciją sukeliančios priežastys – kraujagyslinė demencija, išsivysčiusi po persirgto hemoraginio ar išeminio insulto, daugybinė smegenų kraujagyslinė demencija, Binswangerio liga ir CADASIL sindromas. Pateikiami klinikiniai atvejai, aptariama klinikinė jų eiga, atlikti radiologiniai ir kiti diagnostiniai tyrimai, diferencinė diagnostika, trumpai apžvelgiama literatūra.

Background: Locally advanced rectal cancer (LARC) treatment selection between neoadjuvant intensified chemotherapy (NIC) and standard chemoradiotherapy (CRT) lacks validated predictive biomarkers. Interleukin-1β (IL1B) polymorphisms modulate IL-1β expression and may influence treatment-specific outcomes through tumor microenvironment remodeling. Methods: In this prospective, single-center, randomized, open-label noninferiority trial (NCT05378919), 150 patients with stage II–III rectal cancer were randomized 1:1 to NIC (FOLFOX4, 8 cycles; n=68) or CRT (50 Gy/25 fractions with concurrent fluoropyrimidine; n=82). The primary endpoint was 5-year disease-free survival (DFS; noninferiority margin HR ≤1.29, NIC vs. CRT). IL1B rs1143634 and rs16944 were genotyped by TaqMan assay. Treatment–genotype interactions were assessed using Cox regression with multiplicative interaction terms. Results: Noninferiority was not demonstrated: 5-year DFS was 54.4% (NIC) versus 68.1% (CRT) in the ITT population (HR 1.52, 95% CI 0.90–2.56; p=0.114), with the upper CI bound exceeding the prespecified margin of 1.29. Per-protocol DFS was significantly inferior for NIC (62.5% vs. 82.1%; HR 2.27, 95% CI 1.06–4.76; p=0.029). Overall survival and cancer-specific survival (CSS) did not differ significantly between arms. A statistically significant treatment–genotype interaction was identified for rs1143634 in CSS (interaction p<0.001): T-allele carriage (CT+TT) was associated with inferior CSS exclusively in the NIC arm (HR 4.84, 95% CI 1.04–22.43; p=0.044), with no prognostic effect in the CRT arm (HR 0.69; p=0.494). A DFS interaction was also significant (p=0.047). rs16944 showed a borderline CSS interaction (p=0.082). Conclusions: NIC (FOLFOX4) did not achieve DFS noninferiority versus CRT in unselected LARC patients. IL1B rs1143634 demonstrates a treatment-arm-specific prognostic effect on cancer-specific survival, with a highly significant treatment–genotype interaction (p<0.001) identified within a prospective randomized design with prespecified translational hypotheses, satisfying the formal criterion for predictive biomarker classification. Prospective validation in an adequately powered, biomarker-stratified trial is warranted.