AIM:To explore the effect of sinomenine hydrochloride(SH)on microcirculation and renal func-tion in type 2 diabetic db/db mice with a focus on the diacylglycerol(DAG)/protein kinase C(PKC)signaling pathway.METHODS:Eighteen 6-week-old male db/db mice were randomly divided into three groups:model group(saline),LY group(administered with 1 mg·kg-1·d-1 LY333531),and SH group(administered with 124.8 mg·kg-1·d-1 SH).Addi-tionally,6 age-matched db/m mice comprised the control group(saline).Daily intragastric administration lasted 6 weeks.Body mass,fasting blood glucose(FBG),urinary microalbumin(mALB),urinary creatinine(UCr)and urinary β2-micro-globulin(β2-MG)were measured in each group.The serum levels of endothelin-1(ET-1),endothelial nitric oxide syn-thase(eNOS),collagen type Ⅳ(Col Ⅳ)and laminin(LN),and the levels of DAG and PKC in renal tissues were ana-lyzed by enzyme-linked immunosorbent assay(ELISA).The morphological changes of renal tissues were assessed using HE and PAS staining,and kidney ultrastructure was examined via transmission electron microscopy.Immunohistochemis-try and Western blot were used to detect PKC and p-PKC levels in renal tissues.RESULTS:Compared with model group,the mice in both LY and SH groups showed decreased body mass(P＜0.05),with significantly reduced FBG level in LY group(P＜0.01).In addition,the urinary mALB and β2-MG levels were markedly decreased(P＜0.01),while UCr level was significantly increased(P＜0.01).Serum ET-1,Col Ⅳ and LN levels were significantly lower(P＜0.01),whereas eNOS level was notably higher(P＜0.01).Renal tissue DAG and PKC levels,as well as p-PKC expression were significantly reduced(P＜0.01).Improvements in renal tissue pathology and ultrastructure were observed.CONCLU-SION:Sinomenine hydrochloride improves microcirculation in diabetic db/db mice by modulating DAG/PKC signaling pathway,thus exerting protective effect on the kidney.

AIM:To explore the effect of sinomenine hydrochloride(SH)on microcirculation and renal func-tion in type 2 diabetic db/db mice with a focus on the diacylglycerol(DAG)/protein kinase C(PKC)signaling pathway.METHODS:Eighteen 6-week-old male db/db mice were randomly divided into three groups:model group(saline),LY group(administered with 1 mg·kg-1·d-1 LY333531),and SH group(administered with 124.8 mg·kg-1·d-1 SH).Addi-tionally,6 age-matched db/m mice comprised the control group(saline).Daily intragastric administration lasted 6 weeks.Body mass,fasting blood glucose(FBG),urinary microalbumin(mALB),urinary creatinine(UCr)and urinary β2-micro-globulin(β2-MG)were measured in each group.The serum levels of endothelin-1(ET-1),endothelial nitric oxide syn-thase(eNOS),collagen type Ⅳ(Col Ⅳ)and laminin(LN),and the levels of DAG and PKC in renal tissues were ana-lyzed by enzyme-linked immunosorbent assay(ELISA).The morphological changes of renal tissues were assessed using HE and PAS staining,and kidney ultrastructure was examined via transmission electron microscopy.Immunohistochemis-try and Western blot were used to detect PKC and p-PKC levels in renal tissues.RESULTS:Compared with model group,the mice in both LY and SH groups showed decreased body mass(P＜0.05),with significantly reduced FBG level in LY group(P＜0.01).In addition,the urinary mALB and β2-MG levels were markedly decreased(P＜0.01),while UCr level was significantly increased(P＜0.01).Serum ET-1,Col Ⅳ and LN levels were significantly lower(P＜0.01),whereas eNOS level was notably higher(P＜0.01).Renal tissue DAG and PKC levels,as well as p-PKC expression were significantly reduced(P＜0.01).Improvements in renal tissue pathology and ultrastructure were observed.CONCLU-SION:Sinomenine hydrochloride improves microcirculation in diabetic db/db mice by modulating DAG/PKC signaling pathway,thus exerting protective effect on the kidney.

Objective:To investigate the influencing factors of refractory anastomotic stenosis after laparoscopic intersphincteric resection (Ls-ISR) for rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopatho-logical data of 495 patients who underwent Ls-ISR for rectal cancer in two medical centers, including 448 patients in Peking University First Hospital and 47 patients in Cancer Hospital Chinese Academy of Medical Sciences, from June 2012 to December 2021 were collected. There were 311 males and 184 females, aged 61 (range, 20-84)years. Observation indicators: (1) incidence of anastomotic stenosis; (2) influencing factors of refractory anastomotic stenosis after Ls-ISR; (3) construction and evaluation of nomogram prediction model for refractory anastomotic stenosis after Ls-ISR. Follow-up was conducted using outpatient examination and telephone interview to detect the incidence of postoperative anastomotic leakage and anastomotic stenosis up to August 2022. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. Factors with P<0.10 in univariate analysis were included in multivariate analysis. The R software (3.6.3 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of nomogram prediction model. Results:(1) Incidence of anastomotic stenosis. All 495 patients underwent Ls-ISR successfully, without conversion to laparotomy, and all patients were followed up for 47(range, 8-116)months. During the follow-up period, there were 458 patients without anas-tomotic stenosis, and 37 patients with anastomotic stenosis. Of the 37 patients, there were 15 cases with grade A anastomotic stenosis, 3 cases with grade B anastomotic stenosis and 19 cases with grade C anastomotic stenosis, including 22 cases being identified as the refractory anastomotic stenosis. Fifteen patients with grade A anastomotic stenosis were relieved after anal dilation treat-ment. Three patients with grade B anastomotic stenosis were improved after balloon dilation and endoscopic treatment. Nineteen patients with grade C anastomotic stenosis underwent permanent stoma. During the follow-up period, there were 42 cases with anastomotic leakage including 17 cases combined with refractory anastomotic stenosis, and 453 cases without anastomotic leakage including 5 cases with refractory anastomotic stenosis. There was a significant difference in the refractory anastomotic stenosis between patients with and without anastomotic leakage ( χ2=131.181, P<0.05). (2) Influencing factors of refractory anastomotic stenosis after Ls-ISR. Results of multivariate analysis showed that neoadjuvant therapy, distance from tumor to anal margin ≤4 cm, clinic N+ stage were independent risk factors of refractory anastomotic stenosis after Ls-ISR ( hazard ratio=7.297, 3.898, 2.672, 95% confidence interval as 2.870-18.550, 1.050-14.465, 1.064-6.712, P<0.05). (3) Construction and evaluation of nomogram prediction model for refractory anastomotic stenosis after Ls-ISR. Based on the results of multivariate analysis, neoadjuvant therapy, distance from tumor to anal margin and clinic N staging were included to constructed the nomogram prediction model for refractory anastomotic stenosis after Ls-ISR. Results of ROC curve showed the AUC of nomogram prediction model for refractory anastomotic stenosis after Ls-ISR was 0.739 (95% confidence interval as 0.646-0.833). Conclusions:Neoadjuvant therapy, distance from tumor to anal margin ≤4 cm, clinic N+ stage are independent risk factors of refractory anastomotic stenosis after Ls-ISR. Nomogram prediction model based on these factors can predict the incidence of refractory anastomotic stenosis after Ls-ISR.

Objectives:To examine the risk factors of anastomotic leakage for low rectal cancers undergoing laparoscopic intersphincteric resection (ISR), and to construct a nomogram prediction model for it.Methods:The perioperative data of 302 low rectal cancer patients undergoing laparoscopic ISR by the same surgical team of Department of General Surgery, Peking University First Hospital between January 2012 and January 2019 were retrospectively reviewed. There were 190 males and 112 females, aging 60(14) years (range: 20 to 84 years). χ 2 test, independent sample t test, U test and Logistic regression analysis were used to analyze the risk factors for anastomotic leakage. R software was used to complete the drawing of the nomogram prediction model, and the receiver operating characteristic curve was used to evaluate the predictive ability of the nomogram prediction model. Results:There were 24 patients (7.9%) had anastomotic leakage among the 302 patients enrolled, including 10 cases of grade A leakage, 9 cases of grade B leakage, and 5 cases of grade C leakage. Out of the 24 patients, 2 patients (8.3%) died, 3 patients (12.5%) received leakage-related reoperation. Median healing time of the anastomotic leakage was 74 (58) days (range: 14 to 180 days). Univariate analysis showed male gender ( P=0.009), preoperative serum albumin concentration ( P=0.004), neoadjuvant radiochemotherapy ( P=0.017), preserving left colonic artery ( P=0.002) and performing a diverting ileostomy ( P=0.015) were significantly correlated with anastomotic leakage. Logistic multivariate analysis showed male gender ( OR=6.052, 95% CI: 1.535 to 23.860, P=0.010), neoadjuvant radiochemotherapy ( OR=4.098, 95% CI: 1.318 to 12.821, P=0.015), no preserving left colonic artery ( OR=16.699, 95% CI: 3.051 to 91.406, P=0.001) and not performing a diverting ileostomy ( OR=21.218, 95% CI: 4.341 to 103.710, P<0.01) were independent risk factors for anastomotic leakage. According to the results of multi-factor regression analysis, the nomogram prediction model was constructed. The area under the curve of the nomogram prediction model was 0.840 (95% CI: 0.766 to 0.914). After internal verification, the concordance index value of the model was 0.840. Conclusion:Male gender, neoadjuvant radiochemotherapy, no preserving left colonic artery and not performing a diverting ileostomy are independent risk factors for anastomotic leakage for low rectal cancers undergoing laparoscopic ISR.

Objectives:To examine the risk factors of anastomotic leakage for low rectal cancers undergoing laparoscopic intersphincteric resection (ISR), and to construct a nomogram prediction model for it.Methods:The perioperative data of 302 low rectal cancer patients undergoing laparoscopic ISR by the same surgical team of Department of General Surgery, Peking University First Hospital between January 2012 and January 2019 were retrospectively reviewed. There were 190 males and 112 females, aging 60(14) years (range: 20 to 84 years). χ 2 test, independent sample t test, U test and Logistic regression analysis were used to analyze the risk factors for anastomotic leakage. R software was used to complete the drawing of the nomogram prediction model, and the receiver operating characteristic curve was used to evaluate the predictive ability of the nomogram prediction model. Results:There were 24 patients (7.9%) had anastomotic leakage among the 302 patients enrolled, including 10 cases of grade A leakage, 9 cases of grade B leakage, and 5 cases of grade C leakage. Out of the 24 patients, 2 patients (8.3%) died, 3 patients (12.5%) received leakage-related reoperation. Median healing time of the anastomotic leakage was 74 (58) days (range: 14 to 180 days). Univariate analysis showed male gender ( P=0.009), preoperative serum albumin concentration ( P=0.004), neoadjuvant radiochemotherapy ( P=0.017), preserving left colonic artery ( P=0.002) and performing a diverting ileostomy ( P=0.015) were significantly correlated with anastomotic leakage. Logistic multivariate analysis showed male gender ( OR=6.052, 95% CI: 1.535 to 23.860, P=0.010), neoadjuvant radiochemotherapy ( OR=4.098, 95% CI: 1.318 to 12.821, P=0.015), no preserving left colonic artery ( OR=16.699, 95% CI: 3.051 to 91.406, P=0.001) and not performing a diverting ileostomy ( OR=21.218, 95% CI: 4.341 to 103.710, P<0.01) were independent risk factors for anastomotic leakage. According to the results of multi-factor regression analysis, the nomogram prediction model was constructed. The area under the curve of the nomogram prediction model was 0.840 (95% CI: 0.766 to 0.914). After internal verification, the concordance index value of the model was 0.840. Conclusion:Male gender, neoadjuvant radiochemotherapy, no preserving left colonic artery and not performing a diverting ileostomy are independent risk factors for anastomotic leakage for low rectal cancers undergoing laparoscopic ISR.

Objective To compare the curative effect and complication of traditional open thyroid operation and minimally invasive laryngeal endoscopic thyroid operation.Methods 80 cases with thyroid disease were randomly divided into group I and groupⅡof 40 cases in each group,the group Ⅰ received the minimally invasive laryngeal endoscopic thyroid operation, while the Ⅱ group was treated with traditional open thyroid operation.The operation time,intraoperative amount of bleeding,postoperative drainage,hospitalization time and complications of two groups were compared.Results The operation time,hospitalization time of groupⅠwere (63.1 ±0.2)min,(5.7 ±0.6)d, which were significantly shorter than those of the control group[(90.4 ±1.1) min,(8.4 ±0.2) d].Amount of bleeding,postoperative drainage volume after operation in groupⅠwere (19.2 ±0.9) mL,(30.4 ±2.6) mL,which were significantly less than those of the control group[(42.1 ±1.8)mL,(46.2 ±1.2)mL] (t=9.819,12.168, 11.182,9.928,all P <0.05);The incidence of postoperative complications of group Ⅰ was 2.5%,lower than 15.0%of groupⅡ,the difference was statistically significant between the two groups(χ2 =13.197,P <0.05). Conclusion Minimally invasive laryngeal endoscopic thyroid operation has advantages in little trauma,short opera-tion time,rapid postoperative recovery.