BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
The theory of“Wind Dispelling Dampness”originates from the Huangdi Neijing,with its core being the application of wind-dispelling herbs.Through clinical practice,professor ZHANG Shuxin,has identified that the core p...The theory of“Wind Dispelling Dampness”originates from the Huangdi Neijing,with its core being the application of wind-dispelling herbs.Through clinical practice,professor ZHANG Shuxin,has identified that the core pathogenesis of ulcerative colitis(UC)lies in the persistent presence of dampness,which lingers in the intestines and is difficult to eliminate.Due to the“sticky and lingering nature of dampness”,the disease often follows a prolonged and recurrent course.Conventional dampness-removing treatments often yield limited results,whereas the“Wind-Dispelling and Dampness-Resolving Method”,established based on the theory of“Wind Dispelling Dampness”,has shown significant efficacy.Under this theoretical framework,the Qufeng Ningkui formula was developed to dispel wind,resolve dampness,clear heat,cool the blood,and stop diarrhea,demonstrating notable clinical effectiveness.This theory and treatment approach can also provide guidance for other diseases caused by dampness.展开更多
BACKGROUND Activation of the epithelial-mesenchymal transition(EMT),a pivotal process in tumor metastasis and evasion,as well as the NLRP3 inflammasome,both promote colorectal cancer(CRC)progression.Recent studies hav...BACKGROUND Activation of the epithelial-mesenchymal transition(EMT),a pivotal process in tumor metastasis and evasion,as well as the NLRP3 inflammasome,both promote colorectal cancer(CRC)progression.Recent studies have shown that Transmembrane protein 176B(TMEM176B)regulates NLRP3 and promotes CRC malignant phenotypes.AIM To investigate the role of TMEM176B in modulating NLRP3 inflammasome and its implications on EMT and tumor progression in CRC.METHODS CRC in situ mouse and co-cultured cell models were established using CT26 cells,BALB/c mice,and primary cultured mouse natural killer(NK)cells.Short hairpin RNA knocked down TMEM176B and NLRP3 expression in CT26 cells.Fluorescence imaging,Terminal deoxynucleotidyl transferase dUTP nick end labeling assays,immunohistochemistry staining,flow cytometry,and molecular assays were used to investigate the effects of TMEM176B knockdown on the NLRP3 inflammasome in NK cells to assess tumor metastasis,apoptosis,and EMT indicators.RESULTS Silencing TMEM176B in CRC mice significantly reduced tumor metastasis,proliferation,and EMT,while activating apoptosis,NLRP3 inflammasome,and NK cell activity.Furthermore,silencing TMEM176B in co-cultured cell models inhibited cell migration and invasion,and promoted apoptosis.The interference of NLRP3 reversed these effects by modulating key proteins such as phosphorylated nuclear factor kappa B subunit 1 p65,matrix metallopeptidase 9,and transforming growth factor-β.CONCLUSION This study highlights the critical role of TMEM176B/NLRP3 in CRC progression and provides a basis for targeting this axis as a novel therapeutic approach to manage CRC progression and metastasis.展开更多
BACKGROUND Hemorrhoids,a prevalent chronic condition globally,significantly impact patients'quality of life.While various surgical interventions,such as external stripping and internal ligation,procedure for prola...BACKGROUND Hemorrhoids,a prevalent chronic condition globally,significantly impact patients'quality of life.While various surgical interventions,such as external stripping and internal ligation,procedure for prolapse and hemorrhoids,and tissue selecting technique,are employed for treatment,they are often associated with postoperative complications,including unsatisfactory defecation,bleeding,and anal stenosis.In contrast,Xiaozhiling injection,a traditional Chinese medicine-based therapy,has emerged as a minimally invasive and effective alternative for internal hemorrhoids.This treatment offers distinct advantages,such as reduced dietary restrictions,broad applicability,and minimal induction of systemic inflammatory responses.Additionally,Xiaozhiling injection effectively eliminates hemorrhoid nuclei,prevents local tissue necrosis,preserves anal cushion integrity,and mitigates postoperative complications,including bleeding and prolapse.Despite its clinical efficacy,the molecular mechanisms underlying its therapeutic effects remain poorly understood,warranting further investigation.AIM To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids.METHODS An internal hemorrhoid model was established in rats,and the rats were randomly divided into a modeling group[control group(CK group)]and a treatment group.One week after injection,Stereo-seq and electron microscopy were used to study the changes in gene expression and subcellular structures in fibroblasts.RESULTS Single-cell sequencing revealed differences in the expression and transcript levels of the genes collagen 3 alpha 1,decorin,and actin alpha 2 in fibroblasts between the CK group and the treatment group.Spatial transcriptome analysis revealed that genes of the sphingosine kinase 1(Sphk1)/sphingosine-1-phosphate(S1P)pathway spatially overlapped with key genes of the transforming growth factor beta 1 pathway,namely,Sphk1,S1P receptor,and transforming growth factor beta 1,in the treatment group.The proportion of fibroblasts was lower in the treatment group than in the CK group,and Xiaozhiling treatment had a significant effect on the proportion of fibroblasts in hemorrhoidal tissue.Immunohistochemistry revealed a significant increase in the expression of a fibroblast marker.Electron microscopy showed that the endoplasmic reticulum of fibroblasts contained a large amount of glycogen,indicating cell activation.Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site,suggesting that after Xiaozhiling intervention,the Sphk1-S1P pathway could be activated to promote fibrosis.CONCLUSION Xiaozhiling injection exerts its therapeutic effects on internal hemorrhoids by promoting collagen synthesis and secretion in fibroblasts.After Xiaozhiling intervention,the Sphk1-S1P pathway can be activated to promote fibrosis.展开更多
Objective:Ulcerative colitis is closely associated with intestinal stem cell(ISC)loss and impaired intestinal mucus barrier.Sinisan(SNS),a compound Chinese herbal medicine,has a long history in the treatment of intest...Objective:Ulcerative colitis is closely associated with intestinal stem cell(ISC)loss and impaired intestinal mucus barrier.Sinisan(SNS),a compound Chinese herbal medicine,has a long history in the treatment of intestinal dysfunction,yet whether SNS can relieve acute experimental colitis by modulating ISC proliferation and secretory cell differentiation has not been studied.Our study tested the effect of SNS against acute colitis and focused on the mechanisms involving intestinal barrier recovery.Methods:Network pharmacology analysis and blood entry component analysis of SNS were used to explore the underlying mechanism by which SNS affects the acute dextran sulfate sodium(DSS)-induced murine colitis model.RNA-sequencing was used to demonstrate the mechanism.Further,reverse transcription-quantitative polymerase chain reaction,immunofluorescence staining,and alcian blue and periodic acid-Schiff staining were performed in vivo and in the colonic organoids to investigate the cell lineage differentiation-related mechanism of SNS.Furthermore,potential active ingredients from SNS were predicted by network pharmacology analysis.Results:SNS dramatically suppressed DSS-induced acute colonic inflammation in mice.RNA-sequencing analysis revealed downregulation of inflammation and apoptosis-related genes,and upregulation of lipid metabolism and proliferation-related genes,such as Irf7,Ppara,Clspn and Hspa5.Additionally,ISC renewal and intestinal secretory cell lineage commitment were significantly promoted by SNS both in vivo and in vitro in colonic organoids,leading to enhanced mucin expression.Furthermore,potential active ingredients from SNS that mediated inflammation,lipid metabolism,proliferation,apoptosis,stem cells and secretory cells were predicted using a network pharmacology approach.Conclusion:Our study shed light on the underlying mechanism of SNS in attenuating acute colitis from the perspective of ISC renewal and secretory lineage cell differentiation,suggesting a of novel therapeutic strategy against colitis.展开更多
BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical...BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.AIM To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques,namely,high-frequency electroresection(HFE),cold snare polypectomy(CSP),and endoscopic mucosal resection(EMR),for the treatment of colonic polyps.METHODS This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023.Patients were grouped by technique:HFE(n=107),CSP(n=106),and EMR(n=108).Standardized preoperative,intraoperative,and postoperative protocols were applied.Outcome measures included resection status(en bloc,R0,R1,and Rx),adverse events(immediate/delayed bleeding,perforation,and post-polypectomy coagulation syndrome),postoperative pain(visual analog scale at 1,3,and 5 hours),and 12-month recurrence rate.RESULTS Baseline demographics and polyp characteristics,except for polyp diameter,were comparable among groups.CSP achieved the highest en bloc resection rate,whereas HFE had a higher R0 resection rate.Polyp diameter was largest in the EMR group.Procedure duration was shortest with HFE.Adverse reactions were more frequent with HFE,particularly post-polypectomy bleeding and delayed perforation,whereas CSP demonstrated a superior safety profile and the lowest incidence of complications.Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR.Recurrence rates were significantly higher in the EMR group vs CSP group,with HFE showing intermediate recurrence.CONCLUSION CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps,whereas HFE confers a high R0 resection rate but increased risk of adverse events.EMR remains essential for large polyps despite elevated recurrence.Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.展开更多
Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide,ranking among the highest in both incidence and mortality rates.Traditional Chinese medicine,with a history spanning thousands of years,has dem...Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide,ranking among the highest in both incidence and mortality rates.Traditional Chinese medicine,with a history spanning thousands of years,has demonstrated unique efficacy and advantages in the prevention and treatment of CRC,playing a pivotal role at all levels of China’s healthcare system.This article provides a comprehensive analysis and summary of traditional Chinese medicine’s contri-butions to CRC prevention,antitumor therapy,palliative care for advanced tumors,perioperative rehabilitation,and postoperative functional recovery.展开更多
BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tum...BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tumor areas,no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.AIM To develop and evaluate nomograms for predicting the risk of DM and person-alized prognosis in patients with duodenal cancer.METHODS Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer,and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM.Two novel nomograms were established,and the results were evaluated by receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS A total of 2603 patients with duodenal cancer were included,of whom 457 cases(17.56%)had DM at the time of diagnosis.Logistic analysis revealed independent risk factors for DM in duodenal cancer patients,including gender,grade,tumor size,T stage,and N stage(P<0.05).Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM,including age,histological type,T stage,tumor grade,tumor size,bone metastasis,chemotherapy,and surgery(P<0.05).The accuracy of the nomograms was validated in the training set,validation set,and expanded testing set using ROC curves,calibration curves,and DCA curves.The results of Kaplan-Meier survival curves(P<0.001)indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.CONCLUSION The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM,potentially enhancing clinical decision-making.展开更多
BACKGROUND There is still considerable heterogeneity regarding which features of cryptoglandular anal fistula on magnetic resonance imaging(MRI)and endoanal ultrasound(EAUS)are relevant to surgical decision-making.As ...BACKGROUND There is still considerable heterogeneity regarding which features of cryptoglandular anal fistula on magnetic resonance imaging(MRI)and endoanal ultrasound(EAUS)are relevant to surgical decision-making.As a con-sequence,the quality and completeness of the report are highly dependent on the training and experience of the examiners.AIM To develop a structured MRI and EAUS template(SMART)reporting the minimum dataset of information for the treatment of anal fistulas.METHODS This modified Delphi survey based on the RAND-UCLA appropriateness for consensus-building was conducted between May and August 2023.One hundred and fifty-one articles selected from a systematic review of the lite-rature formed the database to generate the evidence-based statements for the Delphi study.Fourteen questions were anonymously voted by an interdisciplinary multidisciplinary group for a maximum of three iterative rounds.The degree of agreement was scored on a numeric 0–10 scale.Group consensus was defined as a score≥8 for≥80%of the panelists.RESULTS Eleven scientific societies(3 radiological and 8 surgical)endorsed the study.After three rounds of voting,the experts(69 colorectal surgeons,23 radiologists,2 anatomists,and 1 gastroenterologist)achieved consensus for 12 of 14 statements(85.7%).Based on the results of the Delphi process,the six following features of anal fistulas were included in the SMART:Primary tract,secondary extension,internal opening,presence of collection,coexisting le-sions,and sphincters morphology.CONCLUSION A structured template,SMART,was developed to standardize imaging reporting of fistula-in-ano in a simple,systematic,time-efficient way,providing the minimum dataset of information and visual diagram useful to refer-ring physicians.展开更多
BACKGROUND Colon cancer(CC)occurrence and progression are considerably influenced by the tumor microenvironment.However,the exact underlying regulatory mechanisms remain unclear.AIM To investigate immune infiltration-...BACKGROUND Colon cancer(CC)occurrence and progression are considerably influenced by the tumor microenvironment.However,the exact underlying regulatory mechanisms remain unclear.AIM To investigate immune infiltration-related differentially expressed genes(DEGs)in CC and specifically explored the role and potential molecular mechanisms of complement factor I(CFI).METHODS Immune infiltration-associated DEGs were screened for CC using bioinformatics.Quantitative reverse transcription polymerase chain reaction was used to examine hub DEGs expression in the CC cell lines.Stable CFI-knockdown HT29 and HCT116 cell lines were constructed,and the diverse roles of CFI in vitro were assessed using CCK-8,5-ethynyl-2’-deoxyuridine,wound healing,and transwell assays.Hematoxylin and eosin staining and immunohistochemistry staining were employed to evaluate the influence of CFI on the tumorigenesis of CC xenograft models constructed using BALB/c male nude mice.Key proteins associated with glycolysis and the Wnt pathway were measured using western blotting.RESULTS Six key immune infiltration-related DEGs were screened,among which the expression of CFI,complement factor B,lymphoid enhancer binding factor 1,and SRY-related high-mobility-group box 4 was upregulated,whereas that of fatty acid-binding protein 1,and bone morphogenic protein-2 was downregulated.Furthermore,CFI could be used as a diagnostic biomarker for CC.Functionally,CFI silencing inhibited CC cell proliferation,migration,invasion,and tumor growth.Mechanistically,CFI knockdown downregulated the expression of key glycolysis-related proteins(glucose transporter type 1,hexokinase 2,lactate dehydrogenase A,and pyruvate kinase M2)and the Wnt pathway-related proteins(β-catenin and c-Myc).Further investigation indicated that CFI knockdown inhibited glycolysis in CC by blocking the Wnt/β-catenin/c-Myc pathway.CONCLUSION The findings of the present study demonstrate that CFI plays a crucial role in CC development by influencing glycolysis and the Wnt/β-catenin/c-Myc pathway,indicating that it could serve as a promising target for therapeutic intervention in CC.展开更多
BACKGROUND Primary lung cancer is the leading cause of cancer-related death worldwide.Common metastatic sites include the brain,liver,bones,and adrenal glands.However,gastric metastases from lung cancer are rare.This ...BACKGROUND Primary lung cancer is the leading cause of cancer-related death worldwide.Common metastatic sites include the brain,liver,bones,and adrenal glands.However,gastric metastases from lung cancer are rare.This case may be the first report of a combined gastroscopic and laparoscopic resection for gastric metasta-tic adenosquamous carcinoma(ASC).CASE SUMMARY We report a case of gastric metastasis from lung cancer.The patient was a 61-year-old Han Chinese female who first attended our hospital complaining of a per-sistent cough,leading to the diagnosis of advanced-stage lung adenocarcinoma.After more than four years of chemotherapy,the patient began to experience epi-gastric pain.Endoscopy was performed,and pathological examination of biopsy specimens confirmed that the gastric lesion was a metastasis from lung cancer.The lesion was successfully resected by combined gastroscopy and laparoscopy.Histopathological examination of the resected gastric specimen revealed ASC.CONCLUSION Gastric metastases from lung cancer are rare.Endoscopy,histological and immunohistochemical staining are useful for diagnosing metastatic lesions.Surgical management may provide extended survival in appropriately selected patients.展开更多
BACKGROUND Functional constipation(FC)is a common gastrointestinal disorder characterized by abdominal pain and bloating,which can greatly affect the quality of life of patients.Conventional treatments often yield sub...BACKGROUND Functional constipation(FC)is a common gastrointestinal disorder characterized by abdominal pain and bloating,which can greatly affect the quality of life of patients.Conventional treatments often yield suboptimal results,leading to the exploration of alternative therapeutic approaches.AIM To evaluate the efficacy of KiwiBiotic in the management of FC and related symptoms.METHODS This prospective,interventional,single-center,crossover study compared the safety and effectiveness of KiwiBiotic®vs psyllium husk in managing FC,abdominal pain,and bloating.Participants diagnosed with FC were randomly assigned to receive KiwiBiotic or psyllium husk during the two treatment periods,with a 14-day washout period between them.RESULTS Seventy participants were enrolled,32 of whom received KiwiBiotic followed by psyllium husk,and 33 received KiwiBiotic.KiwiBiotic showed superiority over psyllium husk in alleviating abdominal pain and bloating,as evidenced by significantly lower mean scores.Furthermore,KiwiBiotic resulted in more than 90.0%of patients experiencing relief from various constipation symptoms,while psyllium husk showed comparatively lower efficacy.CONCLUSION KiwiBiotic is an effective treatment option for FC,abdominal pain,and bloating,highlighting its potential as a promising alternative therapy for patients with FC and its associated symptoms.展开更多
BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem...BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem cell therapy for the treatment of complex perianal fistula can be an innovative option with potential long-term healing.AIM To evaluate the results of local administration of allogenic,adipose-derived mesenchymal stem cells(darvadstrocel)for complex anal Crohn’s fistula.METHODS All patients with complex anal fistulas associated with Crohn’s disease who were amenable for definite fistula closure within a defined observation period were potential candidates for stem cell injection(darvadstrocel)if at least one conventional or surgical attempt to close the fistula had failed.Darvadstrocel was only indicated in patients without active Crohn’s disease and without presence of anorectal abscess.Local injection of darvadstrocel was performed as a standardized procedure under general anesthesia including single-shot antibiotic prophylaxis,removal of seton drainage,fistula curettage,closure of the internal openings and local stem cell injection.Data collection focusing on healing rates,occurrence of abscess and follow-up was performed on a regular basis of quality control and patient care.Data were retrospectively analyzed.RESULTS Between July 2018 and January 2021,12 patients(6 females,6 males)with a mean age of 42.5(range:26-61)years underwent stem cell therapy.All patients had a minimum of one complex fistula,including patients with two complex fistulas in 58.3%(7/12).Two of the 12 patients had horse-shoe fistula and 3 had one complex fistula.According to Parks classification,the majority of fistulas were transsphincteric(76%)or suprasphincteric(14%).All patients underwent removal of seton,fistula curettage,transanal closure of internal opening by suture(11/12)or mucosal flap(1/12)and stem cell injection.At a mean follow-up of 14.3(range:3-30)mo,a healing rate was documented in 66.7%(8/12);mean duration to achieve healing was 12(range:6-30)wk.Within follow-up,4 patients required reoperation due to perianal abscess(33.3%).Focusing on patients with a minimum follow-up of 12 mo(6/12)or 24 mo(4/12),long-term healing rates were 66.7%(4/6)and 50.0%(2/4),respectively.CONCLUSION Data of this single-center experience are promising but limited due to the small number of patients and the retrospective analysis.展开更多
Objective: To study the effect of hypoxia on the expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia. Methods: Trophoblastic cell lines HRT8/SVneo w...Objective: To study the effect of hypoxia on the expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia. Methods: Trophoblastic cell lines HRT8/SVneo were cultured, SATB1 and β-catenin expression and cell biological behavior were determined after hypoxia reoxygenation treatment; cell biological behavior and the expression of related genes were determined after the transfection of SATB1 and β-catenin siR NA; preeclampsia placenta and normal placenta tissues were collected and the expression of SATB1 and β-catenin were determined. Results: OD value, cell migration rate, m RNA contents of SATB1 and β-catenin of H/R group were significantly lower than those of Nor group, cell apoptosis rate was higher than that of Nor group and the number of invasive cells was less than that of Nor group; OD value and bcl-2 mRNA content of SATB1-siRNA group were lower than those of NC group; cell apoptosis rate as well as Bax, Caspase-3, caspase-6 and caspase-9 mRNA contents were higher than those of NC group; cell migration rate as well as CTSB, CTSD, MMP2 and MMP9 mRNA contents of β-catenin-siRNA group were lower than those of NC group; the number of invasive cells was less than that of NC group; the expression levels of SATB1 and β-catenin in preeclampsia placenta tissue were significantly lower than those in normal placenta tissue. Conclusions: Hypoxia can inhibit the expression of SATB1 and β-catenin in the pathogenesis of preeclampsia, which can affect the proliferation, apoptosis, migration and invasion of cells.展开更多
Objective:To study whether miR-200a and miR-200b target PTEN gene expression to regulate the endometrial cancer cell growth in vitro. Methods:Endometrial cancer cells ECC-1 were cultured and transfected with the miR-2...Objective:To study whether miR-200a and miR-200b target PTEN gene expression to regulate the endometrial cancer cell growth in vitro. Methods:Endometrial cancer cells ECC-1 were cultured and transfected with the miR-200a and miR-200b mimics and inhibitors as well as the negative control mimics and inhibitors,and then the cell proliferation activity as well as the expression of PTEN and downstream genes in cells was determined; after transfection of miR-200a and miR-200b mimics as well as PTEN-3'UTR luciferase report gene plasmids,the fluorescence activity of luciferase reporter gene was determined. Results:12 h,24 h and 48 h after transfection,the cell proliferation activity of miR-200a mimics group and miR-200b mimics group were significantly higher than those of NC mimics group while the cell proliferation activity of mi R-200 a inhibitor group and miR-200b inhibitor group were significantly lower than those of NC inhibitor group; 48 h after transfection,PTEN expression in cells and PTEN-3'UTR luciferase reporter gene fluorescence activity of miR-200 a mimics group and miR-200b mimics group were significantly lower than those of NC mimics group while p-PI3K and p-Akt expression were significantly higher than those of NC mimics group; PTEN expression in cells and PTEN-3'UTR luciferase reporter gene fluorescence activity of miR-200 inhibitor group and miR-200b inhibitor group were significantly higher than those of NC inhibitor group while p-PI3K and p-Akt expression were significantly lower than those of NC inhibitor group. Conclusion:miR-200 a and miR-200b can promote the endometrial cancer cell growth in vitro by targeted inhibition of PTEN gene expression.展开更多
BACKGROUND Slow transit constipation(STC)is a common intestinal disease with increasing incidence.STC results from various factors,such as the enteric nervous system and metabolic changes.As a classical formula of tra...BACKGROUND Slow transit constipation(STC)is a common intestinal disease with increasing incidence.STC results from various factors,such as the enteric nervous system and metabolic changes.As a classical formula of traditional Chinese medicine,Ji-Chuan decoction(JCD)has been extensively and effectively used in STC treatment,yet its pharmacological mechanism remains unclear.AIM To explore the integrated regulatory pattern of JCD against STC through hyphenated techniques from metabolism,network pharmacology and molecular methods.METHODS STC model mice were generated by intragastric administration of compound diphenoxylate(10 mg/kg/d)for 14 d.The STC mice in the low dose of JCD(3.04 g/kg),middle dose of JCD(6.08 g/kg)and high dose of JCD(12.16 g/kg)groups were orally administered JCD solution once a day for 2 wk.The acetylcholine(ACH)level was examined by enzyme-linked immunosorbent assay.The pathological features of colon tissue were observed by hematoxylin and eosin staining.The differentially expressed metabolites and metabolic pathways were tested by nontargeted metabolomics.The main targets and core ingredients of JCD were identified by network pharmacology,and the expression of AKT was confirmed by immunohistochemistry.Finally,the pathways involved in JCD treatment were predicted using a combination of differentially expressed metabolites and targets,and intestinal glial cell apoptosis was demonstrated by immunofluorescence.RESULTS JCD significantly promoted intestinal motility,increased the levels of the excitatory neurotransmitter ACH and reduced intestinal inflammation in STC mice.Untargeted metabolomics results showed that JCD significantly restored metabolic dysfunction and significantly affected taurine and hypotaurine metabolism.Network pharmacology and molecular experiments showed that JCD regulates AKT protein expression,and the core component is quercetin.Combined analysis demonstrated that apoptosis may be an important mechanism by which JCD relieves constipation.Further experiments showed that JCD reduced enteric glial cell(EGC)apoptosis.CONCLUSION This work demonstrated that reducing EGC apoptosis may be the critical mechanism by which JCD treats STC.These findings call for further molecular research to facilitate the clinical application of JCD.展开更多
AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hosp...AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5(range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion(on the 10 th postoperative day), the persistence of inflammatory tissue around the fistula tract(at the 2-mo follow up), and the persistence of serum discharge(at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results.展开更多
AIM:To show that aluminum potassium sulfate and tannic acid(ALTA)sclerotherapy has a high success rate for GradeⅡandⅢhemorrhoids.METHODS:This study was based on the clinical data of 604 patients with hemorrhoids who...AIM:To show that aluminum potassium sulfate and tannic acid(ALTA)sclerotherapy has a high success rate for GradeⅡandⅢhemorrhoids.METHODS:This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015.The objective of this study was to assess the efficacy of this treatment for GradesⅡandⅢhemorrhoids.Preoperative and postoperative symptoms,complications and success rate were all assessed retrospectively.Follow-up consisted of a simple questionnaire,physical examination and an anoscopy.Patients were followed-up at one day,one week,two weeks,one month,one year,two years,three years,four years and five years after the ALTA sclerotherapy.RESULTS:One hundred and sixty-nine patients were diagnosed with GradeⅡhemorrhoids and 435 patients were diagnosed with GradeⅢhemorrhoids.The one year,three year and five year cumulative success rates of ALTA sclerotherapy for GradesⅡandⅢhemo-rrhoids were 95.9%and 93.1%;89.3%and 83.7%;and 89.3%and 78.2%,respectively.No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between GradesⅡandⅢhemorrhoids(P=0.09).There were forty-seven post-operative complications(low grade fever;anal pain;urinary retention;rectal ulcer;and others).No serious or life-threatening complications occurred and all cases improved through conservative treatment.At univariate analysis there were no predictive factors of failure.CONCLUSION:ALTA sclerotherapy has had a high success rate for GradeⅡandⅢhemorrhoids during five years of post-operative treatment.However,additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease.展开更多
BACKGROUND Studies have shown that a high-fat diet(HFD) can alter gut microbiota(GM)homeostasis and participate in lipid metabolism disorders associated with obesity.Therefore, regulating the construction of GM with t...BACKGROUND Studies have shown that a high-fat diet(HFD) can alter gut microbiota(GM)homeostasis and participate in lipid metabolism disorders associated with obesity.Therefore, regulating the construction of GM with the balance of lipid metabolism has become essential for treating obesity. Salvia miltiorrhiza extract(Sal), a common traditional Chinese medicine, has been proven effective against atherosclerosis, hyperlipidemia, obesity, and other dyslipidemia-related diseases.AIM To investigate the anti-obesity effects of Sal in rats with HFD-induced obesity, and explore the underlying mechanism by focusing on GM and lipid metabolism.METHODS Obesity was induced in rats with an HFD for 7 wk, and Sal(0.675 g/1.35 g/2.70g/kg/d) was administered to treat obese rats for 8 wk. The therapeutic effect was evaluated by body weight, body fat index, waistline, and serum lipid level. Lipid factors(cAMP, PKA, and HSL) in liver and fat homogenates were analyzed by ELISA. The effect of Sal on GM and lipid metabolism was assessed by 16S rRNAbased microbiota analysis and untargeted lipidomic analysis(LC-MS/MS),respectively.RESULTS Sal treatment markedly reduced weight, body fat index, serum triglycerides(TG), total cholesterol(TC), low-density lipoprotein, glucose, free fatty acid, hepatic lipid accumulation, and adipocyte vacuolation, and increased serum high-density lipoprotein(HDL-C) in rats with HFD-induced obesity. These effects were associated with increased concentrations of lipid factors such as c AMP, PKA, and HSL in the liver and adipose tissues, enhanced gut integrity, and improved lipid metabolism. GM analysis revealed that Sal could reverse HFD-induced dysbacteriosis by promoting the abundance of Actinobacteriota and Proteobacteria, and decreasing the growth of Firmicutes and Desulfobacterita. Furthermore, LC-MS/MS analysis indicated that Sal decreased TGs(TG18:2/18:2/20:4, TG16:0/18:2/22:6), DGs(DG14:0/22:6, DG22:6/22:6), CL(18:2/18:1/18:1/20:0), and increased ceramides(Cers;Cer d16:0/21:0, Cer d16:1/24:1),(O-acyl)-ω-hydroxy fatty acids(OAHFAs;OAHFA18:0/14:0) in the feces of rats. Spearman’s correlation analysis further indicated that TGs, DGs, and CL were negatively related to the abundance of Facklamia and Dubosiella, and positively correlated with Blautia and Quinella, while OAHFAs and Cers were the opposite.CONCLUSION Sal has an anti-obesity effect by regulating the GM and lipid metabolism.展开更多
BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,d...BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,due to which they are neither accurate nor comprehensive.AIM To develop a new scoring system for FI that is accurate,comprehensive,and easy to use.METHODS A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and urge.The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each FI.The average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI type.The scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency score.The score for each FI would be derived by multiplying the frequency score and the weight for that FI type.In the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’rankings.RESULTS Fifty patients and 50 laypersons participated in the study.The weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was formulated.The maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI differently.CONCLUSION A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomings.Patients’and surgeons’perceptions of FI severity of FI did not correlate well.展开更多
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
基金supported by the Beijing Natural Science Foundation(No.7202112)the Chinese Medicine Clinical Youth Talent Training Program of the Chinese Association of Chinese Medicine(No.CYJH2024024)+1 种基金the Chinese Association of Chinese Medicine Youth Talent Project(No.CACM-2022-QNRC2-A03)the Beijing Hospital Administration Innovation Dream Factory Funding(No.202122).
文摘The theory of“Wind Dispelling Dampness”originates from the Huangdi Neijing,with its core being the application of wind-dispelling herbs.Through clinical practice,professor ZHANG Shuxin,has identified that the core pathogenesis of ulcerative colitis(UC)lies in the persistent presence of dampness,which lingers in the intestines and is difficult to eliminate.Due to the“sticky and lingering nature of dampness”,the disease often follows a prolonged and recurrent course.Conventional dampness-removing treatments often yield limited results,whereas the“Wind-Dispelling and Dampness-Resolving Method”,established based on the theory of“Wind Dispelling Dampness”,has shown significant efficacy.Under this theoretical framework,the Qufeng Ningkui formula was developed to dispel wind,resolve dampness,clear heat,cool the blood,and stop diarrhea,demonstrating notable clinical effectiveness.This theory and treatment approach can also provide guidance for other diseases caused by dampness.
基金Ministry of Education Industry-University Co-operation Collaborative Education Project,No.202102242020.
文摘BACKGROUND Activation of the epithelial-mesenchymal transition(EMT),a pivotal process in tumor metastasis and evasion,as well as the NLRP3 inflammasome,both promote colorectal cancer(CRC)progression.Recent studies have shown that Transmembrane protein 176B(TMEM176B)regulates NLRP3 and promotes CRC malignant phenotypes.AIM To investigate the role of TMEM176B in modulating NLRP3 inflammasome and its implications on EMT and tumor progression in CRC.METHODS CRC in situ mouse and co-cultured cell models were established using CT26 cells,BALB/c mice,and primary cultured mouse natural killer(NK)cells.Short hairpin RNA knocked down TMEM176B and NLRP3 expression in CT26 cells.Fluorescence imaging,Terminal deoxynucleotidyl transferase dUTP nick end labeling assays,immunohistochemistry staining,flow cytometry,and molecular assays were used to investigate the effects of TMEM176B knockdown on the NLRP3 inflammasome in NK cells to assess tumor metastasis,apoptosis,and EMT indicators.RESULTS Silencing TMEM176B in CRC mice significantly reduced tumor metastasis,proliferation,and EMT,while activating apoptosis,NLRP3 inflammasome,and NK cell activity.Furthermore,silencing TMEM176B in co-cultured cell models inhibited cell migration and invasion,and promoted apoptosis.The interference of NLRP3 reversed these effects by modulating key proteins such as phosphorylated nuclear factor kappa B subunit 1 p65,matrix metallopeptidase 9,and transforming growth factor-β.CONCLUSION This study highlights the critical role of TMEM176B/NLRP3 in CRC progression and provides a basis for targeting this axis as a novel therapeutic approach to manage CRC progression and metastasis.
基金Supported by the National Natural Science Foundation of China,No.81774118the Foreign Cooperation Project of Science and Technology Department of Fujian Province,No.2023I0021the Medical Innovation Project of Fujian Province,No.2024CXB013.
文摘BACKGROUND Hemorrhoids,a prevalent chronic condition globally,significantly impact patients'quality of life.While various surgical interventions,such as external stripping and internal ligation,procedure for prolapse and hemorrhoids,and tissue selecting technique,are employed for treatment,they are often associated with postoperative complications,including unsatisfactory defecation,bleeding,and anal stenosis.In contrast,Xiaozhiling injection,a traditional Chinese medicine-based therapy,has emerged as a minimally invasive and effective alternative for internal hemorrhoids.This treatment offers distinct advantages,such as reduced dietary restrictions,broad applicability,and minimal induction of systemic inflammatory responses.Additionally,Xiaozhiling injection effectively eliminates hemorrhoid nuclei,prevents local tissue necrosis,preserves anal cushion integrity,and mitigates postoperative complications,including bleeding and prolapse.Despite its clinical efficacy,the molecular mechanisms underlying its therapeutic effects remain poorly understood,warranting further investigation.AIM To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids.METHODS An internal hemorrhoid model was established in rats,and the rats were randomly divided into a modeling group[control group(CK group)]and a treatment group.One week after injection,Stereo-seq and electron microscopy were used to study the changes in gene expression and subcellular structures in fibroblasts.RESULTS Single-cell sequencing revealed differences in the expression and transcript levels of the genes collagen 3 alpha 1,decorin,and actin alpha 2 in fibroblasts between the CK group and the treatment group.Spatial transcriptome analysis revealed that genes of the sphingosine kinase 1(Sphk1)/sphingosine-1-phosphate(S1P)pathway spatially overlapped with key genes of the transforming growth factor beta 1 pathway,namely,Sphk1,S1P receptor,and transforming growth factor beta 1,in the treatment group.The proportion of fibroblasts was lower in the treatment group than in the CK group,and Xiaozhiling treatment had a significant effect on the proportion of fibroblasts in hemorrhoidal tissue.Immunohistochemistry revealed a significant increase in the expression of a fibroblast marker.Electron microscopy showed that the endoplasmic reticulum of fibroblasts contained a large amount of glycogen,indicating cell activation.Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site,suggesting that after Xiaozhiling intervention,the Sphk1-S1P pathway could be activated to promote fibrosis.CONCLUSION Xiaozhiling injection exerts its therapeutic effects on internal hemorrhoids by promoting collagen synthesis and secretion in fibroblasts.After Xiaozhiling intervention,the Sphk1-S1P pathway can be activated to promote fibrosis.
基金supported by the National Natural Science Foundation of China(No.82322075)。
文摘Objective:Ulcerative colitis is closely associated with intestinal stem cell(ISC)loss and impaired intestinal mucus barrier.Sinisan(SNS),a compound Chinese herbal medicine,has a long history in the treatment of intestinal dysfunction,yet whether SNS can relieve acute experimental colitis by modulating ISC proliferation and secretory cell differentiation has not been studied.Our study tested the effect of SNS against acute colitis and focused on the mechanisms involving intestinal barrier recovery.Methods:Network pharmacology analysis and blood entry component analysis of SNS were used to explore the underlying mechanism by which SNS affects the acute dextran sulfate sodium(DSS)-induced murine colitis model.RNA-sequencing was used to demonstrate the mechanism.Further,reverse transcription-quantitative polymerase chain reaction,immunofluorescence staining,and alcian blue and periodic acid-Schiff staining were performed in vivo and in the colonic organoids to investigate the cell lineage differentiation-related mechanism of SNS.Furthermore,potential active ingredients from SNS were predicted by network pharmacology analysis.Results:SNS dramatically suppressed DSS-induced acute colonic inflammation in mice.RNA-sequencing analysis revealed downregulation of inflammation and apoptosis-related genes,and upregulation of lipid metabolism and proliferation-related genes,such as Irf7,Ppara,Clspn and Hspa5.Additionally,ISC renewal and intestinal secretory cell lineage commitment were significantly promoted by SNS both in vivo and in vitro in colonic organoids,leading to enhanced mucin expression.Furthermore,potential active ingredients from SNS that mediated inflammation,lipid metabolism,proliferation,apoptosis,stem cells and secretory cells were predicted using a network pharmacology approach.Conclusion:Our study shed light on the underlying mechanism of SNS in attenuating acute colitis from the perspective of ISC renewal and secretory lineage cell differentiation,suggesting a of novel therapeutic strategy against colitis.
文摘BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.AIM To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques,namely,high-frequency electroresection(HFE),cold snare polypectomy(CSP),and endoscopic mucosal resection(EMR),for the treatment of colonic polyps.METHODS This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023.Patients were grouped by technique:HFE(n=107),CSP(n=106),and EMR(n=108).Standardized preoperative,intraoperative,and postoperative protocols were applied.Outcome measures included resection status(en bloc,R0,R1,and Rx),adverse events(immediate/delayed bleeding,perforation,and post-polypectomy coagulation syndrome),postoperative pain(visual analog scale at 1,3,and 5 hours),and 12-month recurrence rate.RESULTS Baseline demographics and polyp characteristics,except for polyp diameter,were comparable among groups.CSP achieved the highest en bloc resection rate,whereas HFE had a higher R0 resection rate.Polyp diameter was largest in the EMR group.Procedure duration was shortest with HFE.Adverse reactions were more frequent with HFE,particularly post-polypectomy bleeding and delayed perforation,whereas CSP demonstrated a superior safety profile and the lowest incidence of complications.Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR.Recurrence rates were significantly higher in the EMR group vs CSP group,with HFE showing intermediate recurrence.CONCLUSION CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps,whereas HFE confers a high R0 resection rate but increased risk of adverse events.EMR remains essential for large polyps despite elevated recurrence.Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.
基金Supported by Hunan Provincial Natural Science Foundation,No.2025JJ90028Changsha Natural Science Foundation Project,No.kq2502190.
文摘Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide,ranking among the highest in both incidence and mortality rates.Traditional Chinese medicine,with a history spanning thousands of years,has demonstrated unique efficacy and advantages in the prevention and treatment of CRC,playing a pivotal role at all levels of China’s healthcare system.This article provides a comprehensive analysis and summary of traditional Chinese medicine’s contri-butions to CRC prevention,antitumor therapy,palliative care for advanced tumors,perioperative rehabilitation,and postoperative functional recovery.
基金Supported by State Administration of Traditional Chinese Medicine Base Construction Stomach Cancer Special Fund,No.Y2020CX57Jiangsu Provincial Graduate Research and Practical Innovation Program Project,No.SJCX23-0799.
文摘BACKGROUND Duodenal cancer is one of the most common subtypes of small intestinal cancer,and distant metastasis(DM)in this type of cancer still leads to poor prognosis.Although nomograms have recently been used in tumor areas,no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer.AIM To develop and evaluate nomograms for predicting the risk of DM and person-alized prognosis in patients with duodenal cancer.METHODS Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance,Epidemiology,and End Results database.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer,and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM.Two novel nomograms were established,and the results were evaluated by receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).RESULTS A total of 2603 patients with duodenal cancer were included,of whom 457 cases(17.56%)had DM at the time of diagnosis.Logistic analysis revealed independent risk factors for DM in duodenal cancer patients,including gender,grade,tumor size,T stage,and N stage(P<0.05).Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM,including age,histological type,T stage,tumor grade,tumor size,bone metastasis,chemotherapy,and surgery(P<0.05).The accuracy of the nomograms was validated in the training set,validation set,and expanded testing set using ROC curves,calibration curves,and DCA curves.The results of Kaplan-Meier survival curves(P<0.001)indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer.CONCLUSION The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM,potentially enhancing clinical decision-making.
文摘BACKGROUND There is still considerable heterogeneity regarding which features of cryptoglandular anal fistula on magnetic resonance imaging(MRI)and endoanal ultrasound(EAUS)are relevant to surgical decision-making.As a con-sequence,the quality and completeness of the report are highly dependent on the training and experience of the examiners.AIM To develop a structured MRI and EAUS template(SMART)reporting the minimum dataset of information for the treatment of anal fistulas.METHODS This modified Delphi survey based on the RAND-UCLA appropriateness for consensus-building was conducted between May and August 2023.One hundred and fifty-one articles selected from a systematic review of the lite-rature formed the database to generate the evidence-based statements for the Delphi study.Fourteen questions were anonymously voted by an interdisciplinary multidisciplinary group for a maximum of three iterative rounds.The degree of agreement was scored on a numeric 0–10 scale.Group consensus was defined as a score≥8 for≥80%of the panelists.RESULTS Eleven scientific societies(3 radiological and 8 surgical)endorsed the study.After three rounds of voting,the experts(69 colorectal surgeons,23 radiologists,2 anatomists,and 1 gastroenterologist)achieved consensus for 12 of 14 statements(85.7%).Based on the results of the Delphi process,the six following features of anal fistulas were included in the SMART:Primary tract,secondary extension,internal opening,presence of collection,coexisting le-sions,and sphincters morphology.CONCLUSION A structured template,SMART,was developed to standardize imaging reporting of fistula-in-ano in a simple,systematic,time-efficient way,providing the minimum dataset of information and visual diagram useful to refer-ring physicians.
文摘BACKGROUND Colon cancer(CC)occurrence and progression are considerably influenced by the tumor microenvironment.However,the exact underlying regulatory mechanisms remain unclear.AIM To investigate immune infiltration-related differentially expressed genes(DEGs)in CC and specifically explored the role and potential molecular mechanisms of complement factor I(CFI).METHODS Immune infiltration-associated DEGs were screened for CC using bioinformatics.Quantitative reverse transcription polymerase chain reaction was used to examine hub DEGs expression in the CC cell lines.Stable CFI-knockdown HT29 and HCT116 cell lines were constructed,and the diverse roles of CFI in vitro were assessed using CCK-8,5-ethynyl-2’-deoxyuridine,wound healing,and transwell assays.Hematoxylin and eosin staining and immunohistochemistry staining were employed to evaluate the influence of CFI on the tumorigenesis of CC xenograft models constructed using BALB/c male nude mice.Key proteins associated with glycolysis and the Wnt pathway were measured using western blotting.RESULTS Six key immune infiltration-related DEGs were screened,among which the expression of CFI,complement factor B,lymphoid enhancer binding factor 1,and SRY-related high-mobility-group box 4 was upregulated,whereas that of fatty acid-binding protein 1,and bone morphogenic protein-2 was downregulated.Furthermore,CFI could be used as a diagnostic biomarker for CC.Functionally,CFI silencing inhibited CC cell proliferation,migration,invasion,and tumor growth.Mechanistically,CFI knockdown downregulated the expression of key glycolysis-related proteins(glucose transporter type 1,hexokinase 2,lactate dehydrogenase A,and pyruvate kinase M2)and the Wnt pathway-related proteins(β-catenin and c-Myc).Further investigation indicated that CFI knockdown inhibited glycolysis in CC by blocking the Wnt/β-catenin/c-Myc pathway.CONCLUSION The findings of the present study demonstrate that CFI plays a crucial role in CC development by influencing glycolysis and the Wnt/β-catenin/c-Myc pathway,indicating that it could serve as a promising target for therapeutic intervention in CC.
文摘BACKGROUND Primary lung cancer is the leading cause of cancer-related death worldwide.Common metastatic sites include the brain,liver,bones,and adrenal glands.However,gastric metastases from lung cancer are rare.This case may be the first report of a combined gastroscopic and laparoscopic resection for gastric metasta-tic adenosquamous carcinoma(ASC).CASE SUMMARY We report a case of gastric metastasis from lung cancer.The patient was a 61-year-old Han Chinese female who first attended our hospital complaining of a per-sistent cough,leading to the diagnosis of advanced-stage lung adenocarcinoma.After more than four years of chemotherapy,the patient began to experience epi-gastric pain.Endoscopy was performed,and pathological examination of biopsy specimens confirmed that the gastric lesion was a metastasis from lung cancer.The lesion was successfully resected by combined gastroscopy and laparoscopy.Histopathological examination of the resected gastric specimen revealed ASC.CONCLUSION Gastric metastases from lung cancer are rare.Endoscopy,histological and immunohistochemical staining are useful for diagnosing metastatic lesions.Surgical management may provide extended survival in appropriately selected patients.
文摘BACKGROUND Functional constipation(FC)is a common gastrointestinal disorder characterized by abdominal pain and bloating,which can greatly affect the quality of life of patients.Conventional treatments often yield suboptimal results,leading to the exploration of alternative therapeutic approaches.AIM To evaluate the efficacy of KiwiBiotic in the management of FC and related symptoms.METHODS This prospective,interventional,single-center,crossover study compared the safety and effectiveness of KiwiBiotic®vs psyllium husk in managing FC,abdominal pain,and bloating.Participants diagnosed with FC were randomly assigned to receive KiwiBiotic or psyllium husk during the two treatment periods,with a 14-day washout period between them.RESULTS Seventy participants were enrolled,32 of whom received KiwiBiotic followed by psyllium husk,and 33 received KiwiBiotic.KiwiBiotic showed superiority over psyllium husk in alleviating abdominal pain and bloating,as evidenced by significantly lower mean scores.Furthermore,KiwiBiotic resulted in more than 90.0%of patients experiencing relief from various constipation symptoms,while psyllium husk showed comparatively lower efficacy.CONCLUSION KiwiBiotic is an effective treatment option for FC,abdominal pain,and bloating,highlighting its potential as a promising alternative therapy for patients with FC and its associated symptoms.
文摘BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem cell therapy for the treatment of complex perianal fistula can be an innovative option with potential long-term healing.AIM To evaluate the results of local administration of allogenic,adipose-derived mesenchymal stem cells(darvadstrocel)for complex anal Crohn’s fistula.METHODS All patients with complex anal fistulas associated with Crohn’s disease who were amenable for definite fistula closure within a defined observation period were potential candidates for stem cell injection(darvadstrocel)if at least one conventional or surgical attempt to close the fistula had failed.Darvadstrocel was only indicated in patients without active Crohn’s disease and without presence of anorectal abscess.Local injection of darvadstrocel was performed as a standardized procedure under general anesthesia including single-shot antibiotic prophylaxis,removal of seton drainage,fistula curettage,closure of the internal openings and local stem cell injection.Data collection focusing on healing rates,occurrence of abscess and follow-up was performed on a regular basis of quality control and patient care.Data were retrospectively analyzed.RESULTS Between July 2018 and January 2021,12 patients(6 females,6 males)with a mean age of 42.5(range:26-61)years underwent stem cell therapy.All patients had a minimum of one complex fistula,including patients with two complex fistulas in 58.3%(7/12).Two of the 12 patients had horse-shoe fistula and 3 had one complex fistula.According to Parks classification,the majority of fistulas were transsphincteric(76%)or suprasphincteric(14%).All patients underwent removal of seton,fistula curettage,transanal closure of internal opening by suture(11/12)or mucosal flap(1/12)and stem cell injection.At a mean follow-up of 14.3(range:3-30)mo,a healing rate was documented in 66.7%(8/12);mean duration to achieve healing was 12(range:6-30)wk.Within follow-up,4 patients required reoperation due to perianal abscess(33.3%).Focusing on patients with a minimum follow-up of 12 mo(6/12)or 24 mo(4/12),long-term healing rates were 66.7%(4/6)and 50.0%(2/4),respectively.CONCLUSION Data of this single-center experience are promising but limited due to the small number of patients and the retrospective analysis.
基金supported by National Natural Science Foundation of China(No.39770176)National Natural Science Funds for Distinguished Young Scholar(No.3 9925012)
文摘Objective: To study the effect of hypoxia on the expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia. Methods: Trophoblastic cell lines HRT8/SVneo were cultured, SATB1 and β-catenin expression and cell biological behavior were determined after hypoxia reoxygenation treatment; cell biological behavior and the expression of related genes were determined after the transfection of SATB1 and β-catenin siR NA; preeclampsia placenta and normal placenta tissues were collected and the expression of SATB1 and β-catenin were determined. Results: OD value, cell migration rate, m RNA contents of SATB1 and β-catenin of H/R group were significantly lower than those of Nor group, cell apoptosis rate was higher than that of Nor group and the number of invasive cells was less than that of Nor group; OD value and bcl-2 mRNA content of SATB1-siRNA group were lower than those of NC group; cell apoptosis rate as well as Bax, Caspase-3, caspase-6 and caspase-9 mRNA contents were higher than those of NC group; cell migration rate as well as CTSB, CTSD, MMP2 and MMP9 mRNA contents of β-catenin-siRNA group were lower than those of NC group; the number of invasive cells was less than that of NC group; the expression levels of SATB1 and β-catenin in preeclampsia placenta tissue were significantly lower than those in normal placenta tissue. Conclusions: Hypoxia can inhibit the expression of SATB1 and β-catenin in the pathogenesis of preeclampsia, which can affect the proliferation, apoptosis, migration and invasion of cells.
基金supported by Natural Science Foundation of China(No.39770176)National Science Fund for Distinguished Young Scholars(No.39925012)
文摘Objective:To study whether miR-200a and miR-200b target PTEN gene expression to regulate the endometrial cancer cell growth in vitro. Methods:Endometrial cancer cells ECC-1 were cultured and transfected with the miR-200a and miR-200b mimics and inhibitors as well as the negative control mimics and inhibitors,and then the cell proliferation activity as well as the expression of PTEN and downstream genes in cells was determined; after transfection of miR-200a and miR-200b mimics as well as PTEN-3'UTR luciferase report gene plasmids,the fluorescence activity of luciferase reporter gene was determined. Results:12 h,24 h and 48 h after transfection,the cell proliferation activity of miR-200a mimics group and miR-200b mimics group were significantly higher than those of NC mimics group while the cell proliferation activity of mi R-200 a inhibitor group and miR-200b inhibitor group were significantly lower than those of NC inhibitor group; 48 h after transfection,PTEN expression in cells and PTEN-3'UTR luciferase reporter gene fluorescence activity of miR-200 a mimics group and miR-200b mimics group were significantly lower than those of NC mimics group while p-PI3K and p-Akt expression were significantly higher than those of NC mimics group; PTEN expression in cells and PTEN-3'UTR luciferase reporter gene fluorescence activity of miR-200 inhibitor group and miR-200b inhibitor group were significantly higher than those of NC inhibitor group while p-PI3K and p-Akt expression were significantly lower than those of NC inhibitor group. Conclusion:miR-200 a and miR-200b can promote the endometrial cancer cell growth in vitro by targeted inhibition of PTEN gene expression.
基金Supported by the National Natural Science Foundation of China,No. 82074151the Experimental Formulary Sichuan Youth Science and Technology Innovation Research Team,No. 2020JDTD0022
文摘BACKGROUND Slow transit constipation(STC)is a common intestinal disease with increasing incidence.STC results from various factors,such as the enteric nervous system and metabolic changes.As a classical formula of traditional Chinese medicine,Ji-Chuan decoction(JCD)has been extensively and effectively used in STC treatment,yet its pharmacological mechanism remains unclear.AIM To explore the integrated regulatory pattern of JCD against STC through hyphenated techniques from metabolism,network pharmacology and molecular methods.METHODS STC model mice were generated by intragastric administration of compound diphenoxylate(10 mg/kg/d)for 14 d.The STC mice in the low dose of JCD(3.04 g/kg),middle dose of JCD(6.08 g/kg)and high dose of JCD(12.16 g/kg)groups were orally administered JCD solution once a day for 2 wk.The acetylcholine(ACH)level was examined by enzyme-linked immunosorbent assay.The pathological features of colon tissue were observed by hematoxylin and eosin staining.The differentially expressed metabolites and metabolic pathways were tested by nontargeted metabolomics.The main targets and core ingredients of JCD were identified by network pharmacology,and the expression of AKT was confirmed by immunohistochemistry.Finally,the pathways involved in JCD treatment were predicted using a combination of differentially expressed metabolites and targets,and intestinal glial cell apoptosis was demonstrated by immunofluorescence.RESULTS JCD significantly promoted intestinal motility,increased the levels of the excitatory neurotransmitter ACH and reduced intestinal inflammation in STC mice.Untargeted metabolomics results showed that JCD significantly restored metabolic dysfunction and significantly affected taurine and hypotaurine metabolism.Network pharmacology and molecular experiments showed that JCD regulates AKT protein expression,and the core component is quercetin.Combined analysis demonstrated that apoptosis may be an important mechanism by which JCD relieves constipation.Further experiments showed that JCD reduced enteric glial cell(EGC)apoptosis.CONCLUSION This work demonstrated that reducing EGC apoptosis may be the critical mechanism by which JCD treats STC.These findings call for further molecular research to facilitate the clinical application of JCD.
文摘AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5(range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion(on the 10 th postoperative day), the persistence of inflammatory tissue around the fistula tract(at the 2-mo follow up), and the persistence of serum discharge(at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results.
文摘AIM:To show that aluminum potassium sulfate and tannic acid(ALTA)sclerotherapy has a high success rate for GradeⅡandⅢhemorrhoids.METHODS:This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015.The objective of this study was to assess the efficacy of this treatment for GradesⅡandⅢhemorrhoids.Preoperative and postoperative symptoms,complications and success rate were all assessed retrospectively.Follow-up consisted of a simple questionnaire,physical examination and an anoscopy.Patients were followed-up at one day,one week,two weeks,one month,one year,two years,three years,four years and five years after the ALTA sclerotherapy.RESULTS:One hundred and sixty-nine patients were diagnosed with GradeⅡhemorrhoids and 435 patients were diagnosed with GradeⅢhemorrhoids.The one year,three year and five year cumulative success rates of ALTA sclerotherapy for GradesⅡandⅢhemo-rrhoids were 95.9%and 93.1%;89.3%and 83.7%;and 89.3%and 78.2%,respectively.No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between GradesⅡandⅢhemorrhoids(P=0.09).There were forty-seven post-operative complications(low grade fever;anal pain;urinary retention;rectal ulcer;and others).No serious or life-threatening complications occurred and all cases improved through conservative treatment.At univariate analysis there were no predictive factors of failure.CONCLUSION:ALTA sclerotherapy has had a high success rate for GradeⅡandⅢhemorrhoids during five years of post-operative treatment.However,additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease.
基金Supported by the National Natural Science Foundation of China,No. 82060836Jiangxi Province Graduate Student Innovation Special Fund Project,No. YC2021-B146Jiangxi University of Chinese Medicine Science and Technology Innovation Team Development Program,No. CXTD22008
文摘BACKGROUND Studies have shown that a high-fat diet(HFD) can alter gut microbiota(GM)homeostasis and participate in lipid metabolism disorders associated with obesity.Therefore, regulating the construction of GM with the balance of lipid metabolism has become essential for treating obesity. Salvia miltiorrhiza extract(Sal), a common traditional Chinese medicine, has been proven effective against atherosclerosis, hyperlipidemia, obesity, and other dyslipidemia-related diseases.AIM To investigate the anti-obesity effects of Sal in rats with HFD-induced obesity, and explore the underlying mechanism by focusing on GM and lipid metabolism.METHODS Obesity was induced in rats with an HFD for 7 wk, and Sal(0.675 g/1.35 g/2.70g/kg/d) was administered to treat obese rats for 8 wk. The therapeutic effect was evaluated by body weight, body fat index, waistline, and serum lipid level. Lipid factors(cAMP, PKA, and HSL) in liver and fat homogenates were analyzed by ELISA. The effect of Sal on GM and lipid metabolism was assessed by 16S rRNAbased microbiota analysis and untargeted lipidomic analysis(LC-MS/MS),respectively.RESULTS Sal treatment markedly reduced weight, body fat index, serum triglycerides(TG), total cholesterol(TC), low-density lipoprotein, glucose, free fatty acid, hepatic lipid accumulation, and adipocyte vacuolation, and increased serum high-density lipoprotein(HDL-C) in rats with HFD-induced obesity. These effects were associated with increased concentrations of lipid factors such as c AMP, PKA, and HSL in the liver and adipose tissues, enhanced gut integrity, and improved lipid metabolism. GM analysis revealed that Sal could reverse HFD-induced dysbacteriosis by promoting the abundance of Actinobacteriota and Proteobacteria, and decreasing the growth of Firmicutes and Desulfobacterita. Furthermore, LC-MS/MS analysis indicated that Sal decreased TGs(TG18:2/18:2/20:4, TG16:0/18:2/22:6), DGs(DG14:0/22:6, DG22:6/22:6), CL(18:2/18:1/18:1/20:0), and increased ceramides(Cers;Cer d16:0/21:0, Cer d16:1/24:1),(O-acyl)-ω-hydroxy fatty acids(OAHFAs;OAHFA18:0/14:0) in the feces of rats. Spearman’s correlation analysis further indicated that TGs, DGs, and CL were negatively related to the abundance of Facklamia and Dubosiella, and positively correlated with Blautia and Quinella, while OAHFAs and Cers were the opposite.CONCLUSION Sal has an anti-obesity effect by regulating the GM and lipid metabolism.
文摘BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,due to which they are neither accurate nor comprehensive.AIM To develop a new scoring system for FI that is accurate,comprehensive,and easy to use.METHODS A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and urge.The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each FI.The average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI type.The scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency score.The score for each FI would be derived by multiplying the frequency score and the weight for that FI type.In the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’rankings.RESULTS Fifty patients and 50 laypersons participated in the study.The weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was formulated.The maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI differently.CONCLUSION A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomings.Patients’and surgeons’perceptions of FI severity of FI did not correlate well.
