Objective To analyze the impact of climate change on the potential distribution patterns of the Tibetan medicinal resources Aconitum pendulum Busch.and Aconitum flavum Hand.-Mazz.;To provide a scientific basis for the sustainable utilization of related medicinal plants on the Qinghai-Tibet Plateau.Methods Based on the Biomod2 ensemble model,integrating distribution data and multi-dimensional environmental factors for the Aconitum pendulum Busch.and Aconitum flavum Hand.-Mazz.,the spatiotemporal dynamics and centroid migration trends of their potential suitable areas under current and four future shared socioeconomic pathways(SSP126,SSP245,SSP370,SSP585)were simulated.Results The ensemble model exhibited good prediction accuracy.The coefficient of variation of temperature seasonality(bio4)was identified as the dominant environmental factor influencing the distribution of both species.Aconitum pendulum Busch.demonstrated stronger dependence on the mean temperature of the coldest quarter(bio11),while Aconitum flavum Hand.-Mazz.was more influenced by the mean diurnal range(bio2)and precipitation of the driest month(bio14).Currently,the high suitable area for Aconitum pendulum Busch.is primarily located on the eastern edge of the Qinghai-Tibet Plateau,covering approximately 35.88×104 km2.The high suitable area for Aconitum flavum Hand.-Mazz.is centered in the eastern part of the plateau,spanning approximately 56.49×104 km2.Under future climate scenarios,significant changes in suitable area extent and centroid location were observed for both species.The high suitable area for Aconitum pendulum Busch.generally shrank,with its centroid migrating southeastward,whereas the high suitable area for Aconitum flavum Hand.-Mazz.showed an expanding trend,and its centroid shifted northwestward.Conclusion The findings reveal the key impact of climate change on the distribution evolution,migration and influencing factors of Aconitum pendulum Busch.and Aconitum flavum Hand.-Mazz.,providing theoretical reference for the conservation planning,adaptive management,and sustainable utilization of medicinal plant resources in the Qinghai-Tibet Plateau region.

Deep infiltrating endometriosis(DIE)is defined as endometriotic lesions infiltrating≥5 mm beneath the peritoneum,commonly affecting the uterosacral ligaments,rectovaginal septum,vaginal vault,and rectal wall.Due to nonspecific clinical manifestations and atypical imaging features,DIE is often misdiagnosed.This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)and summarizes the multidisciplinary treatment experience in conjunction with a literature review.A 35-year-old woman was admitted for defecation difficulty.MRI and EUS-FNA confirmed rectal DIE.After multidisciplinary team(MDT)evaluation involving colorectal,gynecologic,and urologic specialists,laparoscopic resection of the rectal lesion,sigmoid-rectal anastomosis,and protective ileostomy were performed.Pathology confirmed rectal DIE with negative margins.The stoma was successfully reversed 4 months later,and no recurrence was observed during 21 months of follow-up.These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness,providing valuable guidance for the individualized management of complex pelvic endometriosis.

Deep infiltrating endometriosis(DIE)is defined as endometriotic lesions infiltrating≥5 mm beneath the peritoneum,commonly affecting the uterosacral ligaments,rectovaginal septum,vaginal vault,and rectal wall.Due to nonspecific clinical manifestations and atypical imaging features,DIE is often misdiagnosed.This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)and summarizes the multidisciplinary treatment experience in conjunction with a literature review.A 35-year-old woman was admitted for defecation difficulty.MRI and EUS-FNA confirmed rectal DIE.After multidisciplinary team(MDT)evaluation involving colorectal,gynecologic,and urologic specialists,laparoscopic resection of the rectal lesion,sigmoid-rectal anastomosis,and protective ileostomy were performed.Pathology confirmed rectal DIE with negative margins.The stoma was successfully reversed 4 months later,and no recurrence was observed during 21 months of follow-up.These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness,providing valuable guidance for the individualized management of complex pelvic endometriosis.

Objective To analyze the impact of climate change on the potential distribution patterns of the Tibetan medicinal resources Aconitum pendulum Busch.and Aconitum flavum Hand.-Mazz.;To provide a scientific basis for the sustainable utilization of related medicinal plants on the Qinghai-Tibet Plateau.Methods Based on the Biomod2 ensemble model,integrating distribution data and multi-dimensional environmental factors for the Aconitum pendulum Busch.and Aconitum flavum Hand.-Mazz.,the spatiotemporal dynamics and centroid migration trends of their potential suitable areas under current and four future shared socioeconomic pathways(SSP126,SSP245,SSP370,SSP585)were simulated.Results The ensemble model exhibited good prediction accuracy.The coefficient of variation of temperature seasonality(bio4)was identified as the dominant environmental factor influencing the distribution of both species.Aconitum pendulum Busch.demonstrated stronger dependence on the mean temperature of the coldest quarter(bio11),while Aconitum flavum Hand.-Mazz.was more influenced by the mean diurnal range(bio2)and precipitation of the driest month(bio14).Currently,the high suitable area for Aconitum pendulum Busch.is primarily located on the eastern edge of the Qinghai-Tibet Plateau,covering approximately 35.88×104 km2.The high suitable area for Aconitum flavum Hand.-Mazz.is centered in the eastern part of the plateau,spanning approximately 56.49×104 km2.Under future climate scenarios,significant changes in suitable area extent and centroid location were observed for both species.The high suitable area for Aconitum pendulum Busch.generally shrank,with its centroid migrating southeastward,whereas the high suitable area for Aconitum flavum Hand.-Mazz.showed an expanding trend,and its centroid shifted northwestward.Conclusion The findings reveal the key impact of climate change on the distribution evolution,migration and influencing factors of Aconitum pendulum Busch.and Aconitum flavum Hand.-Mazz.,providing theoretical reference for the conservation planning,adaptive management,and sustainable utilization of medicinal plant resources in the Qinghai-Tibet Plateau region.

Benign symmetric lipomatosis (BSL) is a rare syndrome. This article presents a 65-year-old female patient with symmetric fat accumulation in both upper arms, along with hypertension and diabetes. Whole-body dual-energy X-ray absorptiometry revealed significantly higher fat content in the upper arms compared to other areas. Localized fat imaging indicated that the proliferative fatty tissue was non-encapsulated. Considering the patient′s lack of history of alcohol consumption, type 2 BSL, also known as Launois-Bensaude syndrome, was diagnosed. This article aims to help clinicians differentiate between obesity and various types of BSL, providing the most appropriate treatment for patients.

Objective:To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments).Methods:A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed.Results:Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment ( P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments ( P＜0.001). Conclusions:Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.

Objective:To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments).Methods:A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed.Results:Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment ( P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments ( P＜0.001). Conclusions:Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.

Objective To observe and evaluate the clinical curative efficacy of perineal stapled prolapse resection in the treatment of complete rectal prolapse.Methods 15 patients of complete rectal prolapse were all treated by perineal stapled prolapse resection,The anal function of the patients were evaluated according to the Wexner incontinence score standard.Results All patients were successfully completed the operation.Postoperative complications:postoperative bleeding in 2 cases,anastomotic stenosis in 2 cases.These symptoms were relieved after symptomatic treatment.The anal sphincter function was improved in all patients after operation.There were no obvious incontinence.The preoperative Wexner incontinence score was 13.5±1.8,andpostoperative Wexner incontinence score was 4.2±1.5,there were significant statistical difference between them(P<0.05).The mean follow-up were 18 months(2-30 months).There was no recurrence during the follow-up period.Conclusion Perineal stapled prolapse resection as a new type of operation had small trauma,simple operation,less complications and short-term curative effect of good characteristics.They can effectively improve the symptoms of anal incontinence in patients with complete rectal prolapse.

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

Objective To analyze the factors for willingness to pay(WTP)in different quantiles and to provide evidence for formulating premium of minors covered by Urban Residents'Basic Medical Insurance.Methods In a field survey,the study adopted the contingent valuation method and quantile regression to measure and analyze the WTP.Results The influencing factors and degree of influence varied in different quantiles.Annual household income was significant in 10 of 11 quantiles with the maximum marginal effect of 350 yuan.Whether the insured comes from a village in a city affects 8 of the 11 quantiles whereas gender,age and health conditions of minors have minor effect on willingness to pay.Conclusion The premium standard should be raised from 40 yuan per person per year to 100 yuan.Minors can be categorized into subgroups and be set with distinct premiums in terms of the significant influencing factors and its influence degree.