Objective:To introduce the method of cylindrical abdominoperineal resection(APR)for low rectal cancer.Methods:Cylindrical APR was performed for 6 patients with advanced ultralow rectal cancer according to standard protocol in Stockholm from February to May in 2009.The procedure involved careful mobilization of the mesorectum as low as the origins of the levator muscle.After stoma formation,the abdomen was closed,the patient was rotated into the prone position,and an extended perineal dissection was performed.This included the sphinctercomplex and followed the inferior surface of the levators to a point laterally where they originated on the pelvic sidewall.This point should be just inferior to the level where the abdominal procedure was terminated.Results:The cylindrical technique removed more tissue in the distal rectum.There was no bowel perforation,perineal wounds were uneventfully.One patient developed perineal seroma.One patient developed peritoneocele hernia of pelvic floor.Conclusion:Cylin-drical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in CRM involvement and intraoperative perforations,which should reduce local disease recurrence.

Objective To study the influence of Qingzao Runfei Huazhuo Xingxue decoction on pulmonary tissue and lung function in mouse model of lung injury induced by PM2.5, and to provide an idea of clinical prevention and treatment of respiratory diseases induced by PM2.5. Methods Totally 30 clean level male ICR mice were randomly divided into three groups: normal control group, model group and Qingzao Runfei Huazhuo Xingxue decoction intervention group, with 10 mice in each group. Model of PM2.5-induced respiratory disease in mice was reproduced by instilling nasal cavity drip PM2.5 suspension 40 mg/kg once a day for 6 weeks. In the treatment group, the mice were fed with the Qingzao Runfei Huazhuo Xingxue decoction twice a day from the 4th week of instilling PM2.5 suspension until the end of experiment. In the normal control group, the mice were fed as usual. At the end of the experiment, the total protein content in bronchoalveolar lavage fluid (BALF), and lung wet/dry weight (W/D) ratio was determined. Hematoxylin-eosin (HE) staining was used to observe the histopathological changes in lung tissue under light microscope. The inflammatory mediators levels in lung tissue were determined by antibody-sandwich enzyme linked immunosorbent assay (ELISA). Results Respiratory system damage model was successfully reproduced by dripping of PM2.5 suspension in nasal cavity. Compared with normal control group, inflammatory changes and inflammatory cell infiltration in model group were significant, and lung W/D ratio (4.71±0.33 vs. 3.13±0.12), total protein content in BALF (mg/L: 363.98±18.24 vs. 82.13±12.78), tumor necrosis factor-α [TNF-α (ng/L): 185.72±0.23 vs. 31.03±0.16], interleukin-8 [IL-8 (ng/L): 531.85±37.83 vs. 72.64±16.72], and leukotriene B4 [LTB4 (ng/L): 931.74±48.64 vs. 483.81±41.74] in lung tissue were significantly increased (all P < 0.05). Compared with the model group, the inflammatory changes of lung tissue in Qingzao Runfei Huazhuo Xingxue decoction intervention group were significantly reduced, lung W/D ratio (3.92±0.41 vs. 4.71±0.33), total protein content in BALF (mg/L: 213.21±19.62 vs. 363.98±18.24), TNF-α (ng/L: 124.15±0.27 vs. 185.72±0.23), IL-8 (ng/L: 238.42±35.82 vs. 531.85±37.83) and LTB4 (ng/L: 582.85±31.00 vs. 931.74±48.64) levels in lung tissue in Qingzao Runfei Huazhuo Xingxue decoction intervention group were significantly decreased (all P < 0.05). Conclusion Qingzao Runfei Huazhuo Xingxue decoction can improve PM2.5-induced damage and pathological inflammatory changes in lung tissue, which provided some new ideas for the treatment of PM2.5-induced respiratory diseases.

Objective To study the effects of Qingzao Runfei Huazhuo Xingxue decoction (QRHXD) on inflammatory reaction and histopathology in mice with PM2.5-induced pulmonary injury, and to approach the possible mechanism of prevention and treatment of traditional Chinese medicine on lung injury induced by haze.Methods Fifty healthy male C57BL/6 mice were randomly divided into five groups (n = 10): namely control, PM2.5, PM2.5+ low-, moderate-, and high-dose groups. The PM2.5 suspensions at a dosage of 40 mg/kg was respectively given to mice by the nasal instillation for reproduction of mouse model of lung injury induced by PM2.5, and the mice in control group were given the same volume of normal saline. The mice in PM2.5+ low-, moderate-, and high-dose QRHXD groups were given 15, 25, 50 mL·kg-1·d-1 QRHXD by oral perfusion daily for consecutive 21 days at the next day of model reproduction (the QRHXD included: Pear 75 g,Bulbus Fritillariae Cirrhosae 10 g, Radix Stemonae 8 g,Rhizoma Pinelliae 8 g,Radix Platycodi 6 g, Aster 10 g, Almond 5 g, Lily 6 g, Rhodiola 4 g, Lotus 3 g,Fructrs Liquidambaris 6 g,Radix Paeoniae Rubra 5 g, Semen Cassiae 6 g). The mice in control and PM2.5 groups were given equivalent volume of normal saline respectively. After treatment for 21 days, the mice were sacrificed, and the left lung was harvested for bronchoalveolar lavage, and the bronchoalveolar lavage fluid (BALF) was collected for determination of levels of acid phosphatase (ACP), alkaline phosphatase (AKP), lactic dehydrogenase (LDH), and albumin (ALB). The right lung was harvested for histopathology observation under light microscope using hematoxylin and eosine (HE) staining.Results After intranasal instillation of PM2.5 suspension, the levels of ACP, AKP, LDH, and ALB in PM2.5 group were significantly higher than those in control group [ACP (U/L): 3.9±0.4 vs. 1.7±0.3, AKP (U/L): 9.0±1.5 vs. 4.8±0.3, LDH (U/L): 416.7±44.4 vs. 112.5±20.3, ALB (mg/L): 198.7±32.4 vs. 65.8±21.3, all P < 0.05]. Under light microscope, the PM2.5 particles were collected, the alveolar septa were thickened, and the inflammatory cells in the alveolar cavity and pulmonary interstitium were found. On the contrary, after administration of QRHXD, a significant reduction of biochemical indexes was found, which showed a dose-dependent manner. The parameters of PM2.5+ high-dose QRHXD group were significantly lower than those in PM2.5 group [ACP (U/L): 2.1±0.8 vs. 3.9±0.4, AKP (U/L): 5.3±1.4 vs. 9.0±1.5, LDH (U/L): 146.6±29.8 vs. 416.7±44.4, ALB (mg/L): 88.5±26.7 vs. 198.7±32.4, all P < 0.05]. At the same time, the pathological changes in lung tissue were better with the increase of the dose.Conclusions QRHXD can reduce the pulmonary inflammatory response and tissue damage caused by PM2.5, with the increase concentration of Chinese medicine, and the effect is more obvious. This may be related to the immune response of the human body to regulate inflammatory mediators, which provide basis for the treatment of pulmonary injury induced by PM2.5.

Objective To decrease tumor local recurrence after abdominoperineal resection (APR)for low rectal cancer using cylindrical abdominoperineal resection. Methods From February 2009 to February 2010 cylindrical APR was performed in 15 patients of advanced ultralow rectal cancer at the Department of General Surgery, Qilu Hospital of Shandong University, according to the standard protocol as described by Holm. The procedure involves careful mobilization of the mesorectum as far down as the origins of the levator muscle. Ater stoma formation, the abdomen is closed, the patient is rotated into the prone position, and an extended perineal dissection is performed. This includes the sphincter complex and the inferior surface of the levators to a point laterally where they originate on the pelvic sidewall. This point should be just inferior to the level where the abdominal procedure was terminated. The coccyx is often removed in continuity with the main specimen to improve direct visualization of the dissection.Results The cylindrical technique removed more tissue in the distal rectum. There was no bowel perforation, perineal wounds were primary healing. One patient developed perineal seroma. One patient developed peritoneocele hernia of pelvic floor. Conclusions Cylindrical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in intraoperative perforations, which should reduce local disease recurrence.

To detect furaltadone metabolite 3-amino-5-morpholinomethyl-2-oxazolidinone ( AMOZ ) in fish sample, an Eu3+ labeling time-resolved fluoroimmunoassay ( TRFIA ) was developed. The effects of experimental conditions including AMOZA-OVA concentration, dilution of antibody, and reaction time on the sensitivity of TRFIA were explored. The results showed that the optimized assay conditions were as follows:the AMOZA-OVA concentration was 0. 25 μg/mL; the antibody was diluted 5í104 folds, and the competitive reaction time was 50 min. Under optimal conditions, the method showed a detection limit of 0. 01 ng/mL, an IC50 of 0. 26 ng/mL and a linear range (IC20-IC80) of 0. 025-2. 83 ng/mL. The recoveries of AMOZ in fish at three spiked levels ranged from 78 . 0% to 86 . 0%, and the relative standard deviations were less than 15%. Good correlation between the ic-TRFIA and high performance liquid chromatography-tandem mass spectrometry was obtained for spiked food samples. The proposed ic-TRFIA method was suited for the determination of AMOZ residue in food samples.

Objective:To evaluate and summarize the best evidence for exercise intervention in patients with hypertension, and to provide the basis for clinical medical workers to manage hypertension.Methods:We searched UpToDate, BMJ Best Practice, the Cochrane Library, the International Guideline Collaborative Network to collect guidelines, systematic evaluation, and evidence summary. The retrieval time was from database establishment to June 1st 2022. Two researchers independently conducted literature quality evaluation and extracted evidence from the included literature.Results:A total of 13 articles were included, including 10 guidelines, 1 expert consensus and 2 Meta analysis. A total of 23 pieces of best evidence were collected, mainly involving 8 aspects, including exercise principles, exercise assessment, exercise environment, pre-exercise preparation, exercise program, post-exercise collation, tracking and review, exercise compliance.Conclusions:Exercise has a positive effect on improving blood pressure in patients with hypertension. The suggestions summarized in this study can be tried to guide clinical practice.

OBJECTIVETo demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.

METHODSA prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.

RESULTSAll patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).

CONCLUSIONSELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Perineum ; surgery ; Postoperative Complications ; Prognosis ; Prospective Studies ; Rectal Neoplasms ; surgery ; Treatment Outcome

ObjectiveBy observing the effect of Qianyang Yuyin granules on the phenotype of renal tubule epithelial cells， the intervention of Qianyang Yuyin granule on renal interstitial fibrosis was investigated. MethodThe renal tubular epithelial cells （HK-2） were treated with different concentrations of transforming growth factor （TGF）-β₁ （5， 10， 15， 20， 25 μg·L^-1） for 24 hours， and cell morphology and growth state were observed with an inverted phase contrast microscope. The 20 μg·L^-1 was selected as the most appropriate concentration of TGF-β₁ according to Western blot results for subsequent experiments. HK-2 cells were divided into six groups： blank group， TGF-β₁ group （concentration of 20 μg·L^-1）， low， medium， and high dose Qianyang Yuyin granule groups （concentration of 0.5， 1， 2 g·L^-1）， and valsartan group （1 × 10^-5 mol·L^-1）. The cell activity was measured by cell proliferation and cell counting kit-8 （CCK-8）. The cell migration ability was detected by scratch test. The Transwell method was used to detect the invasiveness of cells. Western blot was used to detect levels of fibronectin （FN）， E-cadherin， α-smooth muscle activator （α-SMA）， Vimentin， collagen type Ⅰ（Col Ⅰ）， collagen type Ⅳ（Col Ⅳ）， and other related proteins. ResultTGF-β₁ stimulating epithelial-mesenchymal transition （EMT） in renal tubular epithelial cells was time- and concentration-dependent. Compared with the blank group， higher concentration in the TGF-β₁ group indicates longer intervention time and more obvious long spindle change of cells， and the migration and invasion ability of the cells was significantly enhanced. The protein expression level of FN， α-SMA， Vimentin， Col Ⅰ， and Col Ⅳ increased significantly （P<0.05， P<0.01）， while the expression level of E-cadherin protein decreased （P<0.05）. Compared with the TGF-β₁ group， Qianyang Yuyin granule groups could maintain normal cell morphology， and the migration and invasion ability of the cells was inhibited. The protein expression level of FN， α-SMA， Vimentin， Col Ⅰ， and Col Ⅳ decreased （P<0.05， P<0.01）， and the expression of E-cadherin protein was significantly restored （P<0.05）. ConclusionQianyang Yuyin granule can reverse TGF-β₁-induced interstitial transformation of renal tubular epithelial cells by reducing the phenotypic expression of mesenchymal cells and increasing the phenotypic expression of epithelial cells.