Ulcerative colitis(UC)is characterized by chronic relapsing intestinal inflammation.Currently,there is no effective treatment for the disease.According to our preliminary data,1,8-cineole,which is the main active compound of Amomum compactum Sol.ex Maton volatile oil and an effective drug for the treat-ment of pneumonia,showed remarkable anti-inflammatory effects on colitis pathogenesis.However,its mechanism of action and direct targets remain unclear.This study investigated the direct targets and mechanism through which 1,8-cineole exerts its anti-inflammatory effects using a dextran sulfate so-dium salt-induced colitis mouse model.The effects of 1,8-cineole on macrophage polarization were investigated using activated bone marrow-derived macrophages and RAW264.7 cells.In addition,1,8-cineole targets were revealed by drug affinity responsive target stability,thermal shift assay,cellular thermal shift assay,and heat shock protein 90(HSP90)adenosine triphosphatases(ATPase)activity assays.The results showed that 1,8-cineole exhibited powerful anti-inflammatory properties in vitro and in vivo by inhibiting the macrophage M1 polarization and protecting intestinal barrier function.Mech-anistically,1,8-cineole directly interacted with HSP90 and decreased its ATPase activity,also inhibited nucleotide-binding and oligomerization domain-,leucine rich repeat-,and pyrin domain-containing 3(NLRP3)binding to HSP90 and suppressor of G-two allele of SKP1(SGT1)and suppressed NLRP3 inflammasome activation in macrophages.These results demonstrated that 1,8-cineole is a potential drug candidate for UC treatment.

Objective:To examine the correlation factors of acute appendicitis associated with appendiceal neoplasms.Methods:Consecutive 712 patients with acute appendicitis who treated at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2002 to December 2016 were analyzed retrospectively. There were 314 females and 398 males, aging (42.5±16.2) years (range: 14 to 94 years). Among the 712 cases, 36 patients were diagnosed with acute appendicitis associated with appendiceal neoplasms, the other 676 patients had no appendiceal neoplasm. The patients ′ clinical baseline characteristics and clinical parameters were compared between the two groups. The correlation factors of acute appendicitis associated with appendiceal neoplasms were evaluated by using the univariate (χ 2 test or t test) and multivariate Logistic regression analysis. The area under curve of receiver operating characteristic curves was utilized to evaluate the discriminatory power of the predictive models. Results:According to the univariate analysis, gender, age, body mass index, the duration of chronic right low abdominal pains≥3 months, the frequency of recurrently acute right lower abdominal pain≥2, the frequency of acute right lower abdominal pain, past history of diabetes, hypertension or coronary heart disease, the level of neutrophils and leukocytes preoperatively, stercolith and periappendiceal effusion, and modified Alvarado score were positively correlated with appendiceal neoplasms (all P<0.05). Then four variables were incorporated into the model eventually by multivariate Logistic regression analysis, which were as follows: age (increased per decade) ( OR=2.23, 95% CI: 1.68 to 2.95, P<0.01), gender (female) ( OR=4.21, 95% CI: 1.74 to 10.19, P=0.001), the duration of chronic right low abdominal pains (more than 3 months) ( OR=2.53, 95% CI: 1.01 to 3.37, P=0.048), and modified Alvarado score (decreased per 1 score) ( OR=2.54, 95% CI: 1.87 to 3.34, P<0.01). The area of curve was 0.93 (95% CI: 0.88 to 0.97), which indicated that the model exhibits an excellent ability to discriminate between appendiceal neoplasms and acute appendicitis. Conclusions:The older age, female, the duration of chronic right low abdominal pains, and lower modified Alvarado score are independent correlation factors for acute appendicitis associated with appendiceal neoplasms. Clinicians should be alert for the above clinical characteristics and choose optimal treatment for acute appendicitis associated with appendiceal neoplasms.

Objective:To examine the correlation factors of acute appendicitis associated with appendiceal neoplasms.Methods:Consecutive 712 patients with acute appendicitis who treated at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2002 to December 2016 were analyzed retrospectively. There were 314 females and 398 males, aging (42.5±16.2) years (range: 14 to 94 years). Among the 712 cases, 36 patients were diagnosed with acute appendicitis associated with appendiceal neoplasms, the other 676 patients had no appendiceal neoplasm. The patients ′ clinical baseline characteristics and clinical parameters were compared between the two groups. The correlation factors of acute appendicitis associated with appendiceal neoplasms were evaluated by using the univariate (χ 2 test or t test) and multivariate Logistic regression analysis. The area under curve of receiver operating characteristic curves was utilized to evaluate the discriminatory power of the predictive models. Results:According to the univariate analysis, gender, age, body mass index, the duration of chronic right low abdominal pains≥3 months, the frequency of recurrently acute right lower abdominal pain≥2, the frequency of acute right lower abdominal pain, past history of diabetes, hypertension or coronary heart disease, the level of neutrophils and leukocytes preoperatively, stercolith and periappendiceal effusion, and modified Alvarado score were positively correlated with appendiceal neoplasms (all P<0.05). Then four variables were incorporated into the model eventually by multivariate Logistic regression analysis, which were as follows: age (increased per decade) ( OR=2.23, 95% CI: 1.68 to 2.95, P<0.01), gender (female) ( OR=4.21, 95% CI: 1.74 to 10.19, P=0.001), the duration of chronic right low abdominal pains (more than 3 months) ( OR=2.53, 95% CI: 1.01 to 3.37, P=0.048), and modified Alvarado score (decreased per 1 score) ( OR=2.54, 95% CI: 1.87 to 3.34, P<0.01). The area of curve was 0.93 (95% CI: 0.88 to 0.97), which indicated that the model exhibits an excellent ability to discriminate between appendiceal neoplasms and acute appendicitis. Conclusions:The older age, female, the duration of chronic right low abdominal pains, and lower modified Alvarado score are independent correlation factors for acute appendicitis associated with appendiceal neoplasms. Clinicians should be alert for the above clinical characteristics and choose optimal treatment for acute appendicitis associated with appendiceal neoplasms.

Objective:To compare the short-term efficacy and perioperative safety of neoadjuvant chemoradiotherapy (nCRT) with total neoadjuvant treatment (TNT) in patients with locally advanced rectal cancer (LARC).Methods:A retrospective cohort analysis was carried out. Inclusion criteria: (1) rectal adenocarcinoma confirmed by pathology with a distance from tumor inferior border to anal verge within 12 cm; (2) clinical stage cT3-4N0 or cT1-4N1-2 diagnosed by magnetic resonance imaging (MRI) or endorectal ultrasonography; (3) a single rectal tumor confirmed by colonoscopy; (4) patients suitable for chemoradiotherapy; (5) no previous history of other tumors. Exclusion criteria: (1)patients with previous rectal cancer surgery and local recurrence; (2) those who did not complete nCRT course; (3) those with distant metastases; (4) those with defective clinicopathological data. According to the above criteria, a total of 134 LARC patients at the Department of General Surgery of Beijing Chaoyang Hospital from January 2016 to January 2019 were enrolled, including 82 males and 52 females, with a male-female ratio of 1.58∶1.00 and mean age of (59.6±11.2) (26-81) years. Based on neoadjuvant regimen, patients were divided into nCRT group ( n=55) and TNT group ( n=79). There were no statistically significant differences in baseline data, such as age, sex, distance from tumor to anal verge, Eastern Cooperative Oncology Group (ECOG) performance status and clinical TNM stage, between the two groups (all P>0.05). All the patients received pelvic intensity-modulated radiotherapy (IMRT) with a total dose of 50.4 Gy in 28 fractions. Patients in nCRT group received oral capecitabine chemotherapy during radiotherapy and underwent surgery 6-8 weeks after chemoradiation. Patients in TNT group received one cycle of induction CapeOX (oxaliplatin and capecitabine) and concurrent chemoradiotherapy, then underwent a radical surgery two weeks after completion of consolidation chemotherapy. The efficacy of neoadjuvant therapy, adverse events of chemoradiotherapy and perioperative safety were compared between the two groups. Results:Patients of two groups completed the course of neoadjuvant therapy. There were no statistically significant differences between nCRT group and TNT group in the incidence of adverse events in neutropenia [7.3% (4/55) vs. 10.1% (8/79)], anemia [3.6% (2/55) vs. 3.8% (3/79)], thrombocytopenia [5.5% (3/55) vs. 7.6% (6/79)], gastrointestinal dysfunction [3.6% (2/55) vs. 6.3% (5/79)] and radiation enteritis [9.1% (5/55) vs. 8.9% (7/79)] (all P>0.05). One hundred and thirty patients completed TME surgery, including 54 patients in nCRT group and 76 patients in the TNT group. Compared with the nCRT group, the proportion of abdominoperineal resection (APR) was higher in the TNT group [31.6% (25/76) vs. 13.0% (7/54), χ 2=9.382, P=0.009]. No statistically significant differences in morbidity of postoperative complication, operation time, intraoperative blood loss and postoperative hospital stay between the two groups were found (all P>0.05). The distal and circumferential margins were negative in all the patients. Seventeen patients in the TNT group 22.4% (17/76) got pathologic complete response (pCR), which was significantly higher than 7.4% (4/54) in nCRT group (χ 2=5.217, P=0.022). There were no statistically significant differences in ypTNM classification, perineural invasion and venous invasion between the two groups (all P>0.05). Conclusion:The pCR of TNT is higher than that of nCRT without increasing the incidence of toxicity and complications of radiotherapy and chemotherapy for patients with locally advanced rectal cancer.

Objective:To compare the short-term efficacy and perioperative safety of neoadjuvant chemoradiotherapy (nCRT) with total neoadjuvant treatment (TNT) in patients with locally advanced rectal cancer (LARC).Methods:A retrospective cohort analysis was carried out. Inclusion criteria: (1) rectal adenocarcinoma confirmed by pathology with a distance from tumor inferior border to anal verge within 12 cm; (2) clinical stage cT3-4N0 or cT1-4N1-2 diagnosed by magnetic resonance imaging (MRI) or endorectal ultrasonography; (3) a single rectal tumor confirmed by colonoscopy; (4) patients suitable for chemoradiotherapy; (5) no previous history of other tumors. Exclusion criteria: (1)patients with previous rectal cancer surgery and local recurrence; (2) those who did not complete nCRT course; (3) those with distant metastases; (4) those with defective clinicopathological data. According to the above criteria, a total of 134 LARC patients at the Department of General Surgery of Beijing Chaoyang Hospital from January 2016 to January 2019 were enrolled, including 82 males and 52 females, with a male-female ratio of 1.58∶1.00 and mean age of (59.6±11.2) (26-81) years. Based on neoadjuvant regimen, patients were divided into nCRT group ( n=55) and TNT group ( n=79). There were no statistically significant differences in baseline data, such as age, sex, distance from tumor to anal verge, Eastern Cooperative Oncology Group (ECOG) performance status and clinical TNM stage, between the two groups (all P>0.05). All the patients received pelvic intensity-modulated radiotherapy (IMRT) with a total dose of 50.4 Gy in 28 fractions. Patients in nCRT group received oral capecitabine chemotherapy during radiotherapy and underwent surgery 6-8 weeks after chemoradiation. Patients in TNT group received one cycle of induction CapeOX (oxaliplatin and capecitabine) and concurrent chemoradiotherapy, then underwent a radical surgery two weeks after completion of consolidation chemotherapy. The efficacy of neoadjuvant therapy, adverse events of chemoradiotherapy and perioperative safety were compared between the two groups. Results:Patients of two groups completed the course of neoadjuvant therapy. There were no statistically significant differences between nCRT group and TNT group in the incidence of adverse events in neutropenia [7.3% (4/55) vs. 10.1% (8/79)], anemia [3.6% (2/55) vs. 3.8% (3/79)], thrombocytopenia [5.5% (3/55) vs. 7.6% (6/79)], gastrointestinal dysfunction [3.6% (2/55) vs. 6.3% (5/79)] and radiation enteritis [9.1% (5/55) vs. 8.9% (7/79)] (all P>0.05). One hundred and thirty patients completed TME surgery, including 54 patients in nCRT group and 76 patients in the TNT group. Compared with the nCRT group, the proportion of abdominoperineal resection (APR) was higher in the TNT group [31.6% (25/76) vs. 13.0% (7/54), χ 2=9.382, P=0.009]. No statistically significant differences in morbidity of postoperative complication, operation time, intraoperative blood loss and postoperative hospital stay between the two groups were found (all P>0.05). The distal and circumferential margins were negative in all the patients. Seventeen patients in the TNT group 22.4% (17/76) got pathologic complete response (pCR), which was significantly higher than 7.4% (4/54) in nCRT group (χ 2=5.217, P=0.022). There were no statistically significant differences in ypTNM classification, perineural invasion and venous invasion between the two groups (all P>0.05). Conclusion:The pCR of TNT is higher than that of nCRT without increasing the incidence of toxicity and complications of radiotherapy and chemotherapy for patients with locally advanced rectal cancer.

Objective To analyze the differentially expressed long non-cording RNA (lncRNA) in human colon carcinoma tissue and paracancerous normal colon tissue. Methods Total RNA from the colon carcinoma tissues and paracancerous normal colon tissues of 6 patients from July to August 2015 in Beijing Chao-Yang Hospital, Capital Medical University were prepared respectively. The mRNA of total RNA was amplified, labeled and purified. Hybridization was performed with the profile chip, and the data were normalized and analyzed. Results Compared with normal tissues, 1 339 lncRNAs expressed differentially (P < 0.05), 53 lncRNAs were significantly differential (fold change > 2) in colon carcinoma tissues, in which 41 lncRNAs were up-regulation and 12 lncRNAs were down-regulation.Three lncRNAs had more than 3 times changes. Conclusion Obvious changes of lncRNA expression profile are observed in the pathogenesis of colon carcinoma,suggesting that lncRNA may be related to the progress of colon carcinoma.

Objective To explore the clinical characteristics and treatment of abdominal cocoon.Methods Clinical data of 5 cases with abdominal cocoon in our hospital from October 2015 to February 2017 were analyzed.Results 5 patients with abdominal cocoon were recruited,including 3 males and 2 females.Of the 5 patients,one with gastric cancer,1 with colon cancer,2 with rectal cancer and 1 with cryptorchidism.All the patients have no symptoms of intestinal obstruction.Laparotomy revealed that all or part of small intestine had been wrapped in a layer of tough fibrous membrane.Excision of primary lesion without lysis of adhesions were done.No symptoms of intestinal obstruction and intestinal fistula occurred after operation.Conclusions The preoperative diagnosis of abdominal cocoon is difficult.It is often inadvertently found in the operation,asymptomatic patients,do not need treatment.

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

OBJECTIVETo evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.

METHODSClinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.

RESULTSAll the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.

CONCLUSIONLaparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.

Abdomen ; Aged ; Anal Canal ; Blood Loss, Surgical ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Operative Time ; Perineum ; Postoperative Complications ; Postoperative Period ; Rectal Neoplasms ; surgery ; Rectum ; Retrospective Studies

OBJECTIVETo investigate the incidence of surgical site infection (SSI) and risk factors in colorectal cancer surgery patients.

METHODSBetween October 2003 and October 2013, 1 381 consecutive patients with colorectal cancer managed surgically with primary anastomosis were included in the study. There were 762 male and 619 female patients with mean body mass index (BMI) was (27.7 ± 3.7) kg/m², aged from 20 to 90 years with a median of 67 years. Patients undergoing emergency surgery and requiring stoma creation were excluded. The patients' characteristics, surgical conditions and prognosis were recorded. Univariate and multiple logistic regression analysis were used to identify any variable predictive factors of SSI.

RESULTSOne hundred twenty-six (9.12%) cases developed incisional SSI. The occurrence time for SSI was from 2 to 20 days, mean (6.7 ± 2.9) days. According to multivariable logistic regression analysis, BMI (OR = 1.058, P = 0.030), intraoperative contamination (OR = 10.549, P = 0.000) and open operation as compared with a laparoscopic procedure (OR = 2.111, P = 0.001) were significant independent predictors of incisional SSI. There was a significant decrease in incisional SSI in wound protectors group (OR = 1.646, P = 0.012).

CONCLUSIONBMI and intraoperative contamination are independent predictors of incisional SSI, and wound protectors and laparoscopic surgery are associated with a lower incidence of incisional SSI following colorectal cancer surgery.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Body Mass Index ; Colorectal Neoplasms ; surgery ; Colorectal Surgery ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; etiology ; Young Adult