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This study tests a new intracellular ATP delivery technique for tissue regeneration and compares its efficacy with that of Regranex. Twenty-seven adult New Zealand white rabbits each underwent minimally invasive surgery to render one ear ischemic. Eight wounds were then created: four on the ischemic and four on the normal ear. Two wounds on one side of each ear were treated with Mg-ATP encapsulated lipid vesicles (ATP-vesicles) while the two wounds on the other side were treated with Regranex. Wound healing time was shorter when ATP-vesicles were used. The most striking finding was that new tissue growth started to appear in less than 1 day when ATP-vesicles were used. The growth continued and covered the wound area within a few days, without the formation of a provisional matrix. Regranex-treated wounds did not have this growth pattern. In wounds treated by ATP-vesicles, histologic studies revealed extremely rich macrophage accumulation, along with active proliferating cell nuclear antigen (PCNA) and positive BrdU staining, indicating in situ macrophage proliferation. Human macrophage culture suggested direct collagen production. These results support an entirely new healing process, which seems to have combined the conventional hemostasis, inflammation, and proliferation phases into a single one, thereby eliminating the lag time usually seen during healing process.

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Introduction This study aims to understand patient factors associated with refusal of surgery for nonmetastatic colorectal cancer and the associated cancer-specific mortality. Methods Patients diagnosed with nonmetastatic colorectal cancer between 2004 and 2015 from the Surveillance, Epidemiology, and End Results Program were included. Results A total of 152,731 (99.4%) patients underwent surgery, and 983 (0.6%) refused surgery. Independent predictors of refusal included male sex, older age, minority race, single relationship status, being uninsured, more recent date of diagnosis, having an earlier stage of diagnosis, and rectal versus colon cancer. Refusing surgery for nonmetastatic colorectal cancer increased cancer-specific mortality (adjusted hazard ratio 5.10, 95% confidence interval 4.62–5.62). Conclusion Most patients diagnosed with nonmetastatic colorectal cancer undergo surgery in the United States. However, refusal of surgery is increasing and associated with higher cancer-specific mortality. A better understanding of surgical decision making in colorectal cancer is urgently needed.