Objective: To observe the incidence and treatment of radiation rectal injury complicated with anxiety, depression and somatic symptom disorder. Methods: A cross-sectional survey research method was carried out. Patients with radiation rectal injury managed by members of the editorial board of Chinese Journal of Gastrointestinal Surgery were the subjects of investigation. The inclusion criteria of the survey subjects: (1) patients suffered from pelvic tumors and received pelvic radiotherapy; (2) colonoscopy showed inflammatory reaction or ulcer in the rectum. Exclusion criteria: (1) patient had a history of psycho-somatic disease before radiotherapy; (2) patient was unable to use a smart phone, unable to read and understand the questions in the questionnaire displayed on the phone; (3) patient refused to sign an informed consent form. According to the SOMA self-rating scale, PHQ-15 self-rating scale, GAD-7 and PHQ-9 self-rating scale, the electronic questionnaire of "Psychological Survey of Radiation Proctitis" was designed. The questionnaire was sent to patients with radiation rectal injury managed by the committee through the WeChat group. Observational indicators: (1) radiation rectal injury symptom assessment: using SOMA self-rating scale, radiation rectal injury symptom classification: mild group (≤3 points), moderate group (4-6 points) and severe group (> 6 points); (2) incidence of anxiety, depression and physical disorder: using GAD-7, PHQ-9 and PHQ-15 self-rating scales respectively for assessment; (3) correlation of radiation rectal injury symptom grading with anxiety, depression, and somatic symptom disorder. Results: Seventy-one qualified questionnaires were collected, of which 41 (56.9%) were from Guangzhou. Among the 71 patients, 6 were males and 65 were females; the mean age was (55.7±9.3) years old and 48 patients (67.6%) were less than 60 years old; the median confirmed duration of radiation rectal injury was 2.0 (1.0, 5.0) years. (1) Evaluation of symptoms of radiation rectal injury: 18 cases of mild (25.4%), 27 cases of moderate (38.0%), and 26 cases of severe (36.6%). (2) Incidence of anxiety, depression and somatic disorder: 12 patients (16.9%) without comorbidities; 59 patients (83.1%) with anxiety, depression, or somatic disorder, of whom 2 patients only had anxiety, 1 patient only had depression, 9 only had somatic disorder, 2 had anxiety plus depression, 4 had anxiety plus somatic disorder, 2 had depression plus somatic disorder, and 40 had all three symptoms. (3) correlation of radiation rectal injury grading with anxiety, depression, and somatic symptom disorder: as compared to patients in mild group and moderate group, those in severe group had higher severity of anxiety and somatic symptom disorder (Z=-2.143, P=0.032; Z=-2.045, P=0.041), while there was no statistically significant difference of depression between mild group and moderate group (Z=-1.176, P=0.240). Pearson correlation analysis revealed that radiation rectal injury symptom score was positively correlated with anxiety (r=0.300, P=0.013), depression (r=0.287, P=0.015) and somatic symptom disorder (r=0.344, P=0.003). Conclusions: The incidence of anxiety, depression, and somatic symptom disorder in patients with radiation rectal injury is extremely high. It is necessary to strengthen the diagnosis and treatment of somatic symptom disorder, so as to alleviate the symptoms of patients with pelvic perineum pain and improve the quality of life.
Aged ; Anxiety ; Cross-Sectional Studies ; Depression ; Female ; Humans ; Male ; Middle Aged ; Quality of Life ; Rectum ; Surveys and Questionnaires

Cerasomes with different shapes were constructed to investigate the effect of the nanocarriers' shape on the cellular uptake and transmembrane capacity. Cerasome-forming lipid (CFL) was synthesized via halogenation, nucleophilic addition and acylation reaction and detected by mass spectrometry and nuclear magnetic resonance spectroscopy. CFL and short chain 1,2-dihexanoyl-sn-glycero-3-phosphocholine (DHPC) were employed to prepare organic-inorganic hybrid bicelles in discal shapes (nanodisc) by the thin-film hydration method, and CFL was also used to prepare spherical cerasomes (nanosphere). The particle size and zeta potential of nanocarriers were measured by dynamic light scattering analysis, and the morphology was observed by transmission electron microscopy. With human colon cancer cell line Caco-2 as the model, the effect of the shape of nanocarriers on cellular uptake and transmembrane capacity was investigated qualitatively by confocal laser scanning microscope (CLSM), and the transmembrane capacity was analyzed quantitatively by high performance liquid chromatography (HPLC). The results showed that nanosphere and nanodisc had similar particle diameters around 110 nm and similar zeta potential around -25 mV, with regular morphology under transmission electron microscope. The cellular uptake rate of nanodisc was significantly higher than that of nanosphere in 20 minutes. Further research on Caco-2 cell monolayer demonstrated that nanodisc with faster uptake had less accumulation in the monolayer, which means it had a higher transmembrane rate on Caco-2 cell monolayer and the transmembrane capacity of the nanodisc was better than that of nanosphere within 2 h. These results suggest that rational design of the shape of nanocarriers is expected to regulate nano-bio interactions, promote the transmembrane transport of nanocarriers, and improve the drug absorption.

CY-1-4 is a tryptanthrin derivative exhibiting antitumor activity. The solubility of CY-1-4 was poor and the corresponding mechanism needs further study. To solve this problem, we prepared nanoparticles encapsulated with CY-1-4 (CY-1-4 NPs) by nanoprecipitation method using poly(caprolactone) (PCL) and poly(ethylene glycol)-co-poly(ε-caprolactone) (PEG-PCL) as carriers to improve solubility. We then explored whether CY-1-4 NPs induced B16-F10 cytotoxicity via ferroptosis by determining the effect of CY-1-4 NPs on reactive oxygen (ROS) levels, repairing efficacy of lipid reactive oxygen inhibitor ferrostatin-1 and iron chelator deferoxamine (DFO), and potentiation of protoporphyrin (PPIX) induced B16-F10 cell death. The results showed that nanoparticlated strategy significantly improved solubility of CY-1-4. With the particle size about 116 nm, encapsulating efficacy was about 83% and the drug loading capacity was about 4.80%. Ferroptosis mechanistic studies indicated that CY-1-4 NPs could improve the ROS level in B16-F10 cells, whereas ferrostatin-1 and DFO could partly inhibited the cytotoxicity and PPIX could potentiated the cytotoxicity of CY-1-4 NPs in B16-F10 cells. These results showed that ferroptosis was one of the cell death mechanisms induced by tryptanthrin derivative CY-1-4 nanoparticle.

Objective How to improve the operational safety of foraminoplasty has become a hot spot in present clinical research. This study was to observe the clinical effect of minimally invasive treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy (PTED) combined with dynamically assisted visualized intervertebral foraminoplasty (VIVF).Methods Totally, 61 patients with lumbar disc herniation underwent PTED combined with dynamically assisted VIVF in Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January to November 2017. We evaluated the clinical effects using the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab Criteria.Results The VAS scores of the patients were significantly lower at 3 days, 3 months and 6 months after surgery than the baseline (1.10±0.60, 1.03±0.26 and 1.07±0.31 vs 7.64±1.11, P<0.05), and so were the ODIs (2.10±0.54, 1.30±0.49 and 1.23±0.46 vs 34.46±3.57, P<0.05). The excellence rate of treatment 96.72% (59/61). None of the patients experienced such postoperative complications as nerve root injury, spinal injury, and dural matter, and no recurrence was observed.Conclusion PTED combined with dynamically assisted VIVF is safe and effective for the treatment of lumbar disc herniation.

Objective To investigate the correlation between different postoperative serum cortisol cut-off values measured in different periods and the long-term outcomes in patients with Cushing's disease (CD). Methods The clinical data of 102 CD patients undergoing transsphenoidal surgery (TSS) in Peking Union Medical College Hospital from May 1985 to July 2008 were analyzed retrospectively. The differences of long-term outcomes were compared between patients with cortisol levels below 2 μg/dl (2 μg/dl group) and levels between 2 and 5 μg/dl (5 μg/dl group) in the 1postoperative day and 3 and 6 months after surgery. Results The mean follow-up duration was (10.7±1.7) years (range:5-29.1 years). Among these 102 patients,the disease was cured in 74 patients (72.5%) and recurred in 28 patients (27.5%). On the 1postoperative day,there were 63 patients in the 2 μg/dl group,in which 48 patients (76.2%) achieved long-term cure;there were 39 patients in the 5 μg/dl group,in which 26 (66.7%) achieved long-term cure. The difference was not statistically significant (χ=1.097,P=0.295). Three months after TSS,the long-term cure rate was 84.2% (48/57) in the 2 μg/dl group,which was significantly higher than that (65.0%,26/40) in the 5 μg/dl group (χ=4.795,P=0.029). Six months after TSS,the long-term cure rate was 88.7% (47/53) in the 2 μg/dl group,which was significantly higher than that(69.2%,27/39) in the 5 μg/dl group(χ=5.400,P=0.020). Conclusion The serum cortisol level of below 2 μg/dl is more useful than 2-5 μg/dl 3 months and 6 months after surgery in predicting the prognosis of CD patients.
Follow-Up Studies ; Humans ; Hydrocortisone ; blood ; Pituitary ACTH Hypersecretion ; blood ; surgery ; Postoperative Period ; Prognosis ; Recurrence ; Retrospective Studies

Objective To explore the protection and molecular mechanism of histone deacetylase inhibitors (HDACIs) on the spleen of rats with hemorrhagic shock. Methods A total of 60 SPF male SD rats were selected for the modeling of severe hemorrhagic shock using the method of arterial and venous cannulation with the time-divided bleeding. The measurement of mean arterial blood pressure and blood lactic acid was used to verify the modeling. The modeled rats were randomly divided into shock group, shock + suberoylanilide hydroxamic acid (SAHA) group, shock + autogenous transfusion group and shock + SAHA + autogenous transfusion group. Three hours after the treatment, the spleen of rats was collected and TUNEL method was employed to detect the apoptosis of spleen cells in each group. The statistical analysis was performed. Afterwards, real-time PCR and western blot were employed to detect the expression of BCL-2, BAX and caspass3 in the spleen of rats in each group. Results A total of 53 rats had successful modeling of severe hemorrhagic shock, with success rate of 88%. Cell apoptosis in the severe hemorrhagic model group was the most serious. After the intervention of HDACIs and the autogenous transfusion, the tissue injury was a bit recovered. Cell apoptosis was least in the shock + SAHA + autogenous transfusion group (P < 0.05). After the intervention of HDACIs and the autogenous transfusion, the relative expression of BCL-2 was significantly increased (P < 0.05), with highest relative expression of BCL-2 in shock + SAHA + autogenous transfusion group (P < 0.05). After the intervention of HDACIs and the autogenous transfusion, the relative expression of BAX was significantly decreased (P < 0.05), with lowest relative expression of BAX in the intervention group of single HDACIs. The change in the expression of caspass3 was similar to BAX, namely the relative expression of caspass3 was significantly decreased after the intervention of HDACIs and the autogenous transfusion (P < 0.05). Conclusions HDACIs and autogenous transfusion can all protect the spleen injury because of the severe hemorrhagic shock. Its molecular mechanism may be related to the regulation on the expression of BCL-2/BAX and caspass3, which may affect the apoptosis process of cells.

AIM: To observe the surgical effects of the taumatic lens subluxation and cataract after manual fragmentation and emulsification of nucleus and foldable intraocular lens implantation.
METHODS: A 3. 0mm tunnel limbus incision was operated through the predicted bulbar conjunctiva and sclera on 26 cases ( 26 eyes ) with taumatic lens subluxation ( suspensory ligament rupture range less than 120 ) and cataract (Ⅰ ~ Ⅲ) . And after the manual fragmentation and emulsification of nucleus, foldable intraocular lens was implantated. Intraocular lens loop was imbedded in the middle of the lens zonular ligament breakup to reset the pouch. The surgical complications and postoperative vision changes were observed.
RESULTS:Three month after operation, 22 eyes had a intraocular lens centric position taking up 85% of the whole. Four eyes had a slightly eccentric position ( 1 ~2mm), taking up 15% of the whole. 21 eyes had their visual acuity 0. 5~0. 8, taking up 81% of the whole. Five eyes of visual acuity was 0. 2~0. 8. Within 24h intraocular pressure of 12 eyes (46%) after operation were elevated, and returned to normal after 2~7d. There was no severe complication during operation and postoperation.
CONCLUSION: The manual fragmentation and emulsification of nucleus and foldable intraocular lens implantation of the traumatic lens subluxation and the cataract through the 3. 0mm corneal sclera limbus tunnel incision is a simple and effective surgery.

OBJECTIVETo summarize the clinical experience of hyperbaric oxygen therapy in the patients with groupment acute carbon monoxide poisoning.

METHOD172 patients with acute carbon monoxide poisoning were received hyperbaric oxygen therapy besides some other regular therapies from january 2007 to december 2011. The clinical effect were analyzed retrospectively.

RESULTS160 patients were cured (93%), 12 cases improved (7%), the total effective rate was 100%. The cure rate of the patients with hyperbaric oxygen therapy within 6 hours after the poisoning for 100% (115/115), It was significantly higher than that of patients treated for more than 6 hours [The cure rate was 78.9% (45/57)], The difference was statistically significant (P < 0.05).

CONCLUSIONTreated by hyperbaric oxygen therapy early enough in the patients with acute carbon monoxide poisoning, can prevent or reduce the occurrence of delayed encephalopathy, decreasing disability and mortality.

Acute Disease ; Adolescent ; Adult ; Carbon Monoxide Poisoning ; therapy ; Humans ; Hyperbaric Oxygenation ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

The study examined the effect of DS147, the bioactive component of the traditional herbal recipe Bangdeyun, on pregnancy in mice with embryo implantation dysfunction induced by controlled ovarian stimulation (COS), and the underlying mechanisms. Female mice were superovulated by intraperitoneal injection of 7.5 IU of pregnant mare serum gonadotropin (PMSG) followed by an additional injection of 7.5 IU hCG 48 h later to establish embryo implantation dysfunction (EID) model. Pregnant mice were randomly divided into normal control group, COS group and DS147-treated groups. The pregnancy rate and the average implantation site were obtained on pregnancy day 8 (PD8). The side effect of 200 mg/kg of DS147 on naturally pregnant mice was also observed. Further, the uterine and ovarian tissue samples were collected on PD5 for measuring their weights, observing the development of the endometrium and ovary, and detecting the endometrial expression of MMP-2, TIMP-2, CD34 and angiogenin (ANG). The female mice treated with DS147 at doses of 100 to 800 mg/kg showed a higher pregnancy rate than those in COS group, and the highest pregnancy rate of 83.3% occurred in the 200 mg/kg DS147-treated group. Moreover, no obvious side effect was found in mice treated with 200 mg/kg DS147 on PD8 and PD16. The ovarian and uterine weights, and the expression levels of MMP-2, ANG and CD34 were significantly increased in DS147-treated groups when compared with COS group. The TIMP-2 expression level was much lower in DS147-treated mice than in COS mice and the ratio of MMP-2/TIMP-2 was much higher in DS147-treated group than in COS group, and even higher than normal control group. In all, these findings suggest that DS147 may improve pregnancy in mice with COS-induced EID by promoting matrix degradation and angiogenesis, and improving the development of corpus luteum and endometrial decidualization around the implantation window.
Animals ; Biological Factors ; pharmacology ; Embryo Implantation ; drug effects ; Female ; Mice ; Ovulation Induction ; methods ; Plants, Medicinal ; Pregnancy

OBJECTIVETo assess the value of application of percutaneous radiofrequency ablation (RFA) with artificial hydrothorax for liver cancer in the hepatic dome.

METHODSThirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) with artificial hydrothorax. Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter, which was ultrasound-guided percutaneously inserted before RFA, separating the right lung from the hepatic dome. The adverse reaction and therapeutic efficacy were also analyzed.

RESULTSIn the 32 patients with 43 lesions in the hepatic dome (4 tumors in segment IV 21 tumors in segment VII and 18 tumors in segment VIII), 18 lesions of 14 patients were not observed by ultrasound before the operation. Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter, and (1606.3 ± 485.9) ml (1000 - 2500 ml) saline solution was infused successfully. After obtaining an image of the whole tumor, 31 patients received percutaneous RFA therapy on schedule, and 22 patients received percutaneous transdiaphragmatic RFA therapy. One patient with 2 lesions gave up the treatment, because one of his tumors was not detectable by ultrasound. Diaphragmatic muscle hemorrhage was seen in two patients, subcutaneous edema in two patients, and pneumothorax in one patient. All the complications were cured, and no serious complications or related death occurred. 1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation, and the effective rate of this technique was 93.5% (29/31).

CONCLUSIONSArtificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome, but also offers a transdiaphragmatic route for therapy. Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible, safe, and effective technique for treating liver cancer in the hepatic dome and worthy of being promoted.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Catheter Ablation ; methods ; Female ; Follow-Up Studies ; Humans ; Hydrothorax ; Liver Neoplasms ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Sodium Chloride ; Ultrasonography, Interventional