OBJECTIVETo study the combination of trans-anal intersphincteric resection and transabdominal total mesorectal excision for anus-retained ultra-low rectal tumors.

METHODSClinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed.

RESULTSThe distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2.1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with neoplasia and 3 giant villous adenoma. For pathological stages, there were 18 cases at stage pTNM I, 5 at IIA, 1 at IIB, 4 at IIIA, 1 at III and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months.

CONCLUSIONThe combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.

Adult ; Aged ; Anal Canal ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Mesentery ; surgery ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVE To characterize the homogeneous polysaccharides from Dendrobium officinale Kimura et Migo and study the hypoglycemic activity of the isolated polysaccharides.METHODS DEAE-cellulose anion-exchange chromatography was used to isolate homogeneous polysaccharides from crude polysaccharides (DOP);Monosaccharide composition was ana-lysed after trimethylsilation;and the chemical structure of isolated polysaccharide was characterized with infrared spectroscopy;The effects of isolated polysaccharides on the levels of fasting blood glucose,plasma insulin,and glycosylated serum protein were estimated using diabetic mice models induced by alloxan.RESULTS Four isolated polysaccharides were isolated from DOP,in which DOP1 had the highest content.DOP1 was composed of arabinose,galactose,glucose and mannose in a molar ratio of 3.5∶1.2∶1.5∶1.0.The infrared spectroscopy of various isolated polysaccharides showed that they all had the obvi-ous characteristic absorption peaks of corresponding monosaccharides.The levels of fasting blood glucose and glycosylated ser-um protein decreased obviously after a 21 day ig administration in diabetic mice models(P <0.01),in addition,all the four iso-lated polysaccharides increased glycosylated serum protein levels in varying degrees after a 21 day dosage (P <0.05 ~0.01). DOP1 displayed the optimal effects on the improvements of above three biochemistry indexes compared with the other three i-solated polysaccharides.CONCLUSION Four isolated polysaccharides from DOP displayed hypoglycemic activity in diabetic mice models induced by alloxan.

OBJECTIVETo investigate the association of the clinical characteristics and the outcome of in vitro fertilization and embryo transfer (IVF-ET) in infertile women with polycystic ovarian syndrome (PCOS) of different subtypes.

METHODSA total of 189 infertile women with PCOS undergoing IVF-ET were enrolled in this study. According to Rotterdam PCOS diagnosis criteria, the patients were classified into 3 PCOS subtypes, namely type I with PCO ultrasonography and oligo-ovulation/anovulation and hyperandrogenism (54 women, for whom 58 fresh IVF-ET cycles were performed); type II with PCO ultrasonography and oligo-ovulation/anovulation (117 women with 126 cycles); type III with PCO ultrasonography and hyperandrogenism (18 women with 18 cycles). The number of retrieved oocytes, fertilization rate, implantation rate, clinical pregnancy rate, spontaneous abortion rates and incidence of ovarian hyperstimulation syndrome (OHSS) were compared between the 3 groups.

RESULTSExcept for the baseline serum T concentration in the early phase of menstrual cycle, which was significantly higher in groups I and III than in group II, no significant difference was found in the clinical characteristics between the 3 groups (P>0.05). Group I had the highest initial Gn dose, and the oocyte retrieval rates were significantly lower in groups I and III (P<0.05). The patients in group I had lower implantation rate and the clinical, on-going and cumulative pregnancy rates than groups II and III, but the differences were not statistically significant; the embryo early loss rate and spontaneous abortion rate appeared to be higher in groups I and III (P>0.05). Significantly elevated incidence of OHSS were noted in groups I and III (P<0.05).

CONCLUSIONThe women with different PCOS subtypes according to the Rotterdam criteria all have similar IVF-ET outcomes, and the increased embryo loss rate and spontaneous abortion rate in groups I and III might be associated with excessive androgen that disturbs oocyte and embryo development.

Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; etiology ; therapy ; Polycystic Ovary Syndrome ; classification ; complications ; Pregnancy ; Pregnancy Rate

The present study was aimed to analyze the immunogenicity of recombinant human zona pellucida-3 peptides (r-huZP3a(22 approximately 176) and r-huZP3b(177 approximately 348)) expressed in E. coli through immunizing rabbits, and to evaluate the efficacy of their polyclonal antisera against r-huZP3a(22 approximately 176) and r-huZP3b(177 approximately 348) to inhibit in vitro human sperm-egg binding respectively. Male New Zealand rabbits were immunized using r-huZP3a(22 approximately 176) or r-huZP3b(177 approximately 348) as antigen respectively, which was purified through an improved method of preparative gel polyacryulamide gel electrophoresis. The antibody response level of r-huZP3a(22 approximately 176) or r-huZP3b(177 approximately 348) immunogen in rabbits was determined by ELISA using mouse ZP3-5 (amino acid sequence(137 approximately 150) being completely conserved with huZP3(138 approximately 151) sequence) and specific huZP3-14 (amino acid sequence(327 approximately 340)) synthetic peptides as coating antigens respectively. The immunoreactivity and specificity of the anti-r-huZP3a(22 approximately 176) and anti-r-huZP3b(177 approximately 348) antisera with each r-huZP3 peptides, were tested by immunoblot and immunohistochemistry (using native huZP and human ovary section) respectively. A competitive hemizona assay (HZA) was used to evaluate the efficacy of the antisera against r-huZP3a(22 approximately 176) and r-huZP3b(177 approximately 348) to inhibit in vitro human sperm-egg binding. Both r-huZP3 peptides were able to induce higher antibody titers in rabbits. Each antiserum could specifically recognize or bind to each target r-huZP3 peptide expressed in E. coli and native human ZP in vitro. The antisera also inhibited sperm-egg binding in the HZA. These results show that r-huZP3a(22 approximately 176) and r-huZP3b(177 approximately 348) are of strong immunogenicity. They can be used to develop a kit for detecting whether there are autoantibodies to zona pellucida in unexplained infertile women, and their antisera might be useful tools for determining minimal B-cell epitope sequences of several known huZP3 epitope peptides.
Animals ; Egg Proteins ; biosynthesis ; genetics ; immunology ; Escherichia coli ; genetics ; metabolism ; Female ; Humans ; Immune Sera ; immunology ; Immunization ; Male ; Membrane Glycoproteins ; biosynthesis ; genetics ; immunology ; Rabbits ; Receptors, Cell Surface ; biosynthesis ; genetics ; immunology ; Recombinant Proteins ; biosynthesis ; genetics ; immunology ; Sperm-Ovum Interactions ; immunology ; Zona Pellucida Glycoproteins

AIMTo study the effect of ligustrazine (LGT) and L-arginine(L-Arg)on function of mitochondria in myocardium after myocardial ischemia/reperfusion injury (MI/RI).

METHODS50 rabbits were randomly divided into five groups (n=10): Control group(A), MI/R group(B), MI/R + LGT group (C), MI/R+ L-Arg group (D), MI/R+ LGT + L-Arg group (E). The mitochondrial respiratory function, Ca2+ concentration ([Ca2+]m), malondialdehyde (MDA) content and superoxide dismutase (SOD) activity were deter mined. Meanwhile, the contents of ATP and EC in the myocardial tissue were measured, respectively.

RESULTSIt was found that mitochondrial respiratory control rate (RCR), state 3 (ST3), SOD in C, D, E group were higher than those of B group, state 4 (ST4), [Ca2+]m, MDA were lower than those of B group, ATP and EC levels of myocardial tissue were higher than those in B group; and there were not significant differences between E and A group of above.

CONCLUSIONLGT and IL-Arg can improve function of mitochondria in myocardium after ischemia/reperfusion injury of myocardium in rabbits by decreasing oxygen free radical level and Ca" overload in the mitochondria.

Animals ; Arginine ; pharmacology ; Calcium ; metabolism ; Malondialdehyde ; analysis ; Mitochondria, Heart ; drug effects ; metabolism ; Myocardial Reperfusion Injury ; metabolism ; physiopathology ; Pyrazines ; pharmacology ; Rabbits ; Superoxide Dismutase ; metabolism

OBJECTIVETo study the clinical features and outcomes of in vitro fertilization and embryo transfer (IVF-ET) in infertile patients due to polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO).

METHODSThis study involved 189 infertile patients with polycystic ovary syndrome (PCOS), with 129 polycystic ovaries (PCO), and 142 without PCOS or PCO (control) undergoing IVF-ET. The dosage of gonadotrophin (Gn), sex hormone level on the day of HCG administration, clinical pregnancy rate, spontaneous abortion rate and ovarian hyperstimulation syndrome (OHSS) rate were analyzed and compared between the 3 groups.

RESULTSNo significant differences were found in the clinical pregnancy rate between the PCOS group (202 cycles), PCO group (134 cycles) and control group (150 cycles) (51.0%, 53.0% and 46.0%, respectively). The levels of LH and T and early spontaneous abortion rates were significantly higher in PCOS group than in PCO group and control group (P<0.05). The P level on HCG day was the highest in PCO group (P<0.05). The early spontaneous abortion rates and clinical pregnancy rate showed no significant differences between PCO group and control group (P>0.05). The dosage of Gn was significantly lower and OHSS rate higher in PCOS and PCO groups than in the control group (P<0.05).

CONCLUSIONSThe clinical pregnancy rate of infertile patients with PCOS is similar with that of PCO patients and control patients undergoing IVF-ET treatment. PCOS, however, is associated with increased spontaneous abortion rate, possibly due to abnormality of LH and T release. The clinical outcomes in PCO patients are similar with those in the control patients, and elevated P level in the late follicular phase does not obviously influence the outcomes of IVF. Both PCOS and PCO are associated with increased risk of OHSS.

Adult ; Case-Control Studies ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; etiology ; therapy ; Ovarian Cysts ; complications ; Polycystic Ovary Syndrome ; complications ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

OBJECTIVETo investigate the clinical application of intersphincter resection (ISR) combined with total mesorectal excision (TME) and colon-anal anastomosis in the treatment for ultra-low rectal carcinoma.

METHODSTo review and analyze retrospectively the data of 34 patients with ultra-low rectal carcinoma (without external anal sphincter involvement) who received treatment of ISR, TME and colon-anal anastomosis.

RESULTSPartial resection of internal sphincter was performed in the patients with a distal edge of the tumor greater than or equal to 2 cm from the dentate line. Subtotal removal of the rectum was performed between 1 cm and 2 cm. Total resection was performed in less than 1 cm or involvement of dentate line. Reconstruction of digestive tract was done by manual colon-anal anastomosis. The average distance from distal excised margin to the tumor was 2.3 (1.8 - 3.2) cm among 34 patients. The pathological types were as follows: 28 cases of adenocarcinoma (11 were well differentiated, 17 moderately differentiated), 1 case of papillary carcinoma and 5 cases of villous adenoma with malignant change. The postoperative pathological stages were: Dukes stage A in 28 cases, stage B in 1 and stage C in 5 cases. The pTNM staging was 28 cases in phase I, 1 in phase IIa, 4 in phase IIIa and 1 in phase IIIb. The T stages of the patients were as following: 16 Tl, 17 T2 and 1 T3. Postoperative anastomotic stenosis occurred in 3 cases, anastomotic dehiscence in 2 cases and rectovaginal fistula in 2 cases. The ability of controlling feces of patients decreased significantly in the early postoperative period, and restored gradually at 6 to 12 months after operation. Anastomotic recurrence occurred in 1 case at 5 months after operation and liver metastasis in 1 case at 40 months.

CONCLUSIONWith strictly grasping indications, radical resection can be attained and anal sphincter preserved by ISR combined with TME and colon-anal anastomosis. It is an effective sphincter-preserving operation.

Adenocarcinoma ; pathology ; surgery ; Adenoma, Villous ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Anal Canal ; surgery ; Anastomosis, Surgical ; Carcinoma, Papillary ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery ; Retrospective Studies ; Surgical Wound Dehiscence ; etiology

OBJECTIVETo investigate the effect of wortmannin on endothelial cells proliferation and migration induced by high glucose Müller cell conditioned medium (HGMCM).

METHODSImmunofluorescence, flow cytometry and Boyden chamber migration models were used to analyze the effect of wortmannin on endothelial cells.

RESULTS50 nmol/L wortmannin could significantly inhibit the proliferation and migration of endothelial cells induced by HGMCM. The percentage of endothelial cells in S phase was obviously decreased [from (37.82 +/- 0.57)% to (21.91 +/- 0.23)%, P < 0.01], while there was an increase in the percentage of cells in G(0)/G(1) phase [from (54.57 +/- 1.19)% to (65.59 +/- 0.41)%, < 0.01] and G(2)/M phase (< 0.05).

CONCLUSIONWortmannin can inhibit proliferation and migration of endothelial cells induced by HGMCM, suggesting that wortmannin carries an anti-angiogenetic ability in diseased retina.

Androstadienes ; pharmacology ; Animals ; Cell Cycle ; drug effects ; Cell Movement ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Culture Media, Conditioned ; pharmacology ; Endothelial Cells ; cytology ; Female ; Glucose ; Humans ; Male ; Neovascularization, Pathologic ; Phosphatidylinositol 3-Kinases ; antagonists & inhibitors ; Rabbits ; Retina ; cytology

OBJECTIVETo evaluate the perineal rectosigmoidectomy(Altemeier procedure) in the emergent management of acute incarcerated rectal prolapse.

METHODSClinical and follow-up data of 9 patients with acute incarcerated rectal prolapse undergone Altemeier procedure were retrospectively analyzed.

RESULTSThe mean operation time was 1.7 (range 1.0-1.5) hours. The mean total blood loss during surgery was 109 (50-200) ml. The mean time to the first bowel movements was 2.8(1-6) days after surgery. The hospital stay was 5.3(3-10) days. There were no postoperative complications such as anastomotic leakage, intra-abdominal infection, or urogenital dysfunction. One patient developed thrombosis in the mesorectum and one patient had symptoms of anal discomfort. After a mean follow-up of 3.5(5 months-6.5 years) years, no patient had recurrent prolapse. Six months after operation, anal function was Kirwan grade I( in 8 cases and grade II( in 1 case. All the patients were satisfied with the result.

CONCLUSIONAltemeier procedure can result in good postoperative anal function when treating incarcerated rectal prolapse, which should be the first choice in emergency treatment.

Adult ; Aged ; Aged, 80 and over ; Colectomy ; methods ; Emergency Treatment ; Female ; Humans ; Male ; Middle Aged ; Rectal Prolapse ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the value of protective stoma in intersphincteric resection (ISR) for ultra-low rectal cancer.

METHODSClinical data of 56 ultra-low rectal cancer patients without involvement of external anal sphincter treated during January 1999 to July 2009 with trans-anal ISR plus trans-abdominal total mesorectum excision and coloanal anastomosis were retrospectively analyzed. The patients were divided into two groups based on whether they received protective ostomy: ostomy group (16 cases) and ostomy-free group (40 cases). The postoperative complications as well as anal functional restoration were compared between the two groups.

RESULTSSixteen cases (32.1%) of the 56 patients received protective stoma. The complication rate of anastomosis and anus complication rate in the ostomy-free group were significantly higher than those in ostomy group [35.0% (14/40) and 40.0% (16/40) vs. 1/16 and 1/16; P < 0.05]. In the ostomy-free group, one patient developed anastomotic dehiscence and tumor recurrence, the patients was given permanent colostomy, and the other three patients with lesions in the anastomosis and anus received ostomy and secondary surgical treatment, with a reoperation rate of 10.0% (4/40). The anal function of patients in the two groups were both decreased after the operation. The rate of patients got Kirwan grade I anal sphincter function in the 3rd, 6th and 12th month after protective stoma operation was 11/16, 13/15 and 11/13 in the ostomy group, respectively; and those were 30.0%, 37.5% and 45.0% in the ostomy-free group, respectively. Anal function was significantly better in the ostomy group than that in the ostomy-free group during the same postoperative period (P < 0.05).

CONCLUSIONProtective stoma can avoid anastomotic leakage following ISR for ultra-low rectal cancer, and alleviate the suffering of anal incontinence in the early postoperative period, and is conducive to the restoration of anal function.

Adult ; Aged ; Anal Canal ; surgery ; Anastomotic Leak ; etiology ; prevention & control ; Colostomy ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies