Objective:To investigate the efficacy of enhanced recovery after surgery(ERAS)combined with laparoscopy for the treatment of colorectal cancer in the elderly and its effects on proinflammatory factors and immune responses.Methods:A total of 158 elderly patients with colorectal cancer treated with surgery were retrospectively analyzed.According to different treatment methods, they were divided into the control group(76 cases)and the study group(82 cases). The control group received traditional open surgery and routine perioperative care.The study group received laparoscopic radical resection of colorectal cancer plus perioperative ERAS.Surgery parameters, complications, postoperative immune function and proinflammatory factor levels were compared between the two groups.Results:The operation duration of the study group was significantly longer than that of the control group[(128.5±33.7)min vs.(117.4±28.7)min, t=2.220, P=0.028], whereas the intraoperative blood loss[(100.8±20.5)ml vs.(250.7±62.3)ml, t=20.621, P<0.01]and the incision length[(4.5±1.2)cm vs.(17.5±3.0)cm, t=36.243, P<0.01]were significantly less than those in the control group.The time to first flatus[(2.0±0.9)d vs.(3.8±1.8)d, t=8.037, P<0.01], time to first defecation[(2.8±0.8)d vs.(4.5±1.1)d, t=11.167, P<0.01], time to first ambulation[(1.2±0.2)d vs.(3.8±1.3)d, t=17.888, P<0.01]and hospitalization length[(7.1±0.2)d vs.(11.4±2.2)d, t=17.625, P<0.01]were also significantly shorter than those in the control group.The incidences of surgical site infections(2.4% vs.10.5%, χ2=4.351, P=0.037), abdominal distension(7.3% vs.19.7%, χ2=5.279, P=0.023)and intestinal obstruction(9.8% vs.22.4%, χ2=4.711, P=0.030)in the study group were significantly lower than those in the control group.The levels of C-reactive protein, interleukin-6 and tumor necrosis factor-α in the study group were significantly lower than those in the control group at 1 d, 3 d and 7 d after surgery( t= 9.612, 7.300, 5.446, 8.762, 12.138, 15.370, 10.186, 10.432, 13.512, respectively, all P<0.05). The levels of CD3 + , CD4 + and CD4 + /CD8 + in the study group were significantly higher than those in the control group at 1 d, 3 d and 7 d after surgery( t= 2.128, 2.957, 2.313, 2.914, 2.937, 2.809, 5.089, 5.623, 5.409, respectively, P<0.05 for all), and the levels of CD8 + were significantly lower than those of the control group( t= 2.008, 2.580, 4.902, all P<0.05). Conclusions:Laparoscopy combined with ERAS for the treatment of colorectal cancer in the elderly can reduce surgical injury and complications and mitigate inflammatory responses with little impact on immune responses.

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191

Tetrandrine(TET),a natural bisbenzyl isoquinoline alkaloid extracted from Stephania tetrandra S.Moore,has diverse pharmacological effects.However,its effects on melanoma remain unclear.Cellular prolif-eration assays,multi-omics analyses,and xenograft models were used to determine the effect of TET on melanoma.The direct target of TET was identified using biotin-TET pull-down liquid chromatograph-mass spectrometry(LC-MS),cellular thermal shift assays,and isothermal titration calorimetry(ITC)analysis.Our findings revealed that TET treatment induced robust cellular autophagy depending on activating transcription factor 6(ATF6)-mediated endoplasmic reticulum(ER)stress.Simultaneously,it hindered autophagic flux by inducing cytoskeletal protein depolymerization in melanoma cells.TET treatment resulted in excessive accumulation of reactive oxygen species(ROS)and simultaneously triggered mitophagy.Sirtuin 5(SIRT5)was ultimately found to be a direct target of TET.Mechanistically,TET led to the degradation of SIRT5 via the ubiquitin(Ub)-26S proteasome system.SIRT5 knockdown induced ROS accumulation,whereas SIRT5 overexpression attenuated the TET-induced ROS accumula-tion and autophagy.Importantly,TET exhibited anti-cancer effects in xenograft models depending on SIRT5 expression.This study highlights the potential of TET as an antimelanoma agent that targets SIRT5.These findings provide a promising avenue for the use of TET in melanoma treatment and underscore its potential as a therapeutic candidate.

BACKGROUNDHemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction. Information on Chinese patients with HFS has not been well-characterized. This study aimed to evaluate the clinical feature and the treatment status of HFS across China.

METHODSA cross-sectional study including 1003 primary HFS patients had been carried out in 15 movement disorder clinics in China in 2012. The investigated information was acquired from questionnaires and medical records including demographic data, site of onset, aggravating and relieving factors, treatments prior to the investigation, etc.

RESULTSIn this study, the ratio of male to female was 1.0:1.8, the mean age at onset was (46.6 ± 11.5) years. About 1.0% patients were bilaterally affected. The most often site of initial onset was the orbicularis oculi muscle. The most often affected sites were orbicularis oculi, zygomatic, and orbicularis oris muscles. Stress/anxiety and relaxation were most often aggravating and relieving factors, respectively; 2.3% patients had family history, 28.4% cases were combined with hypertension, and 1.4% patients were with trigeminal neuralgia. Botulinum toxin type A (BTX-A) injection was the most commonly used treatment, followed by acupuncture and oral medication. BTX-A maintained the highest repeat treatment ratio (68.7%), while 98.4% patients gave up acupuncture. The mean latency of BTX-A effect was (5.0 ± 4.7) days, the mean total duration of the effect was (19.5 ± 11.7) weeks, and 95.9% patients developed improvements no worse than moderate in both severity and function. The most common side effect was droopy mouth.

CONCLUSIONSThe onset age of HFS in China is earlier than that in western countries. The most often used two treatments are BTX-A injection and acupuncture, while the latter kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect.

Adult ; Botulinum Toxins, Type A ; therapeutic use ; China ; Cross-Sectional Studies ; Female ; Hemifacial Spasm ; diagnosis ; drug therapy ; Humans ; Male ; Middle Aged ; Neuromuscular Agents ; therapeutic use