ObjectiveTo observe the prevention and control effect of processed Polygonatum cyrtonema on depression induced by chronic unpredictable mild stress （CUMS） in female rats. MethodsForty rats were assigned into control， model， and low-， medium-， and high-dose processed P. cyrtonema groups according to the random number table method， with 8 rats in each group. The rat model of depression was established with the CUMS method. The body mass， open field test， forced swimming test， Morris water maze test， levels of neurotransmitters ［dopamine （DA）， 5-hydroxytryptamine （5-TH）， and acetylcholine （ACh）］， serum levels of sex hormones ［gonadotropin-releasing hormone（GnRH）， testosterone （T）， and estradiol （E₂）］ and inflammatory factors ［tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-10］， and mRNA and protein levels of factors in the brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TRKB）/cAMP-response element binding protein （CREB） pathway were employed to evaluate the effect of processed P. cyrtonema on the CUMS-induced depression in female rats. ResultsThe body mass， open field test results， and forced swimming test results showed that the rat model of depression was successfully established. The comparison of behaviors， neurotransmitters， sex hormones， inflammatory factors， and neural pathways among groups showed that processed P. cyrtonema had different effects of preventing the development of depression in female rats. SPSS 25 was used for statistical analysis of error and significance. T test was conducted between groups. Each treatment group showed significant therapeutic effect compared with the model group （P<0.05）. Processed P. cyrtonema elevated the level of 5-TH （P<0.01） and lowered the levels of DA and ACh （P<0.01） in the brain tissue of female rats. In addition， it reduced the serum levels of GnRH， T， E₂， TNF-α， and IL-6 （P<0.05） and up-regulated the mRNA levels of BDNF and TRKB in the rat brain. ConclusionProcessed P. cyrtonema has a non-hyperactive preventive effect on CUMS-induced depression in rats， which provides a theoretical basis for the development of processed P. cyrtonema as a functional food product.

ObjectiveTo observe the prevention and control effect of processed Polygonatum cyrtonema on depression induced by chronic unpredictable mild stress （CUMS） in female rats. MethodsForty rats were assigned into control， model， and low-， medium-， and high-dose processed P. cyrtonema groups according to the random number table method， with 8 rats in each group. The rat model of depression was established with the CUMS method. The body mass， open field test， forced swimming test， Morris water maze test， levels of neurotransmitters ［dopamine （DA）， 5-hydroxytryptamine （5-TH）， and acetylcholine （ACh）］， serum levels of sex hormones ［gonadotropin-releasing hormone（GnRH）， testosterone （T）， and estradiol （E₂）］ and inflammatory factors ［tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-10］， and mRNA and protein levels of factors in the brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TRKB）/cAMP-response element binding protein （CREB） pathway were employed to evaluate the effect of processed P. cyrtonema on the CUMS-induced depression in female rats. ResultsThe body mass， open field test results， and forced swimming test results showed that the rat model of depression was successfully established. The comparison of behaviors， neurotransmitters， sex hormones， inflammatory factors， and neural pathways among groups showed that processed P. cyrtonema had different effects of preventing the development of depression in female rats. SPSS 25 was used for statistical analysis of error and significance. T test was conducted between groups. Each treatment group showed significant therapeutic effect compared with the model group （P<0.05）. Processed P. cyrtonema elevated the level of 5-TH （P<0.01） and lowered the levels of DA and ACh （P<0.01） in the brain tissue of female rats. In addition， it reduced the serum levels of GnRH， T， E₂， TNF-α， and IL-6 （P<0.05） and up-regulated the mRNA levels of BDNF and TRKB in the rat brain. ConclusionProcessed P. cyrtonema has a non-hyperactive preventive effect on CUMS-induced depression in rats， which provides a theoretical basis for the development of processed P. cyrtonema as a functional food product.

[Objective]To clarify the therapeutic effect of five groups of ascending and descending drugs on ulcerative colitis(UC),and to explore its different characteristics and potential regulatory pathways.[Methods]Sixty-four C57BL/6J male mice were randomly divided into normal control group,model control group,positive control group and five groups of ascending and descending drug groups,with 8 mice in each group.The UC model of mice was induced by dextran sulfate sodium(DSS).Except for the normal control group,the other groups of mice freely drank 2.5%DSS solution every day,and the mice in each drug group were given corresponding doses of drugs by gavage.During the modeling period,the state of the mice was observed every day,and the body weight,food intake,water intake and fecal morphology of the mice were recorded.At the end of the experiment,the disease activity index(DAI)score and colonic histopathological changes of mice in each group were compared.Transcriptome sequencing was used to analyze the differentially expressed genes in the colon of mice in each intervention group.Real-time quantitative polymerase chain reaction(RT-qPCR)was used to detect the expression level of node genes in key signaling pathway.[Results]Compared with normal control group,the DAI score of the mice in model control group was significantly increased(P<0.0001),the body weight was significantly decreased(P<0.05),the colon was significantly shortened(P<0.05),and a large number of inflammatory cell infiltration was observed.Compared with model control group,the diet of UC mice in Citri Reticulatae Pericarpium-Aurantii Fructus Immaturus group increased gradually;Platycodonis Radix-Armeniacae Semen Amarum group still had formed feces after modeling;the expression of estrogen signaling pathway-related genes closely related to pro-inflammatory response was down-regulated in Scutellariae Radix-Pinelliae Rhizoma Praeparatum Cum Zingibere Et Alumine group;the DAI index of UC mice in Atractylodis macrocephalae Rhizoma-Poria cocos group was significantly lower than that in other groups,and the liver index of UC mice in Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group was significantly lower than that in model control group(P<0.01).The G protein-coupled receptors(GPCRs)signaling pathway was up-regulated in the Atractylodis macrocephalae Rhizoma-Poria cocos group and Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group.[Conclusion]The five groups of ascending and descending drug pairs had different therapeutic characteristics in the treatment of UC induced by DSS.Among them,Citri Reticulatae Pericarpium-Aurantii Fructus Immaturus group,Atractylodis macrocephalae Rhizoma-Poria cocos group and Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group had obvious improvement effects on colon tissue pathological damage and submucosal collagen deposition.The protective effect on colonic goblet cells was relatively obvious in Atractylodis macrocephalae Rhizoma-Poria cocos group and Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group.The reduction of apolipoprotein A1(ApoA1)was most significant in Atractylodis macrocephalae Rhizoma-Poria cocos group,and the down-regulation of CXC chemokine ligand 10(CXCL10)gene expression was most obvious in Platycodonis Radix-Armeniacae Semen Amarum group.In general,the protective effect of Atractylodis macrocephalae Rhizoma-Poria cocos drug pair on UC was more comprehensive and worthy of further study.

[Objective]To clarify the therapeutic effect of five groups of ascending and descending drugs on ulcerative colitis(UC),and to explore its different characteristics and potential regulatory pathways.[Methods]Sixty-four C57BL/6J male mice were randomly divided into normal control group,model control group,positive control group and five groups of ascending and descending drug groups,with 8 mice in each group.The UC model of mice was induced by dextran sulfate sodium(DSS).Except for the normal control group,the other groups of mice freely drank 2.5%DSS solution every day,and the mice in each drug group were given corresponding doses of drugs by gavage.During the modeling period,the state of the mice was observed every day,and the body weight,food intake,water intake and fecal morphology of the mice were recorded.At the end of the experiment,the disease activity index(DAI)score and colonic histopathological changes of mice in each group were compared.Transcriptome sequencing was used to analyze the differentially expressed genes in the colon of mice in each intervention group.Real-time quantitative polymerase chain reaction(RT-qPCR)was used to detect the expression level of node genes in key signaling pathway.[Results]Compared with normal control group,the DAI score of the mice in model control group was significantly increased(P<0.0001),the body weight was significantly decreased(P<0.05),the colon was significantly shortened(P<0.05),and a large number of inflammatory cell infiltration was observed.Compared with model control group,the diet of UC mice in Citri Reticulatae Pericarpium-Aurantii Fructus Immaturus group increased gradually;Platycodonis Radix-Armeniacae Semen Amarum group still had formed feces after modeling;the expression of estrogen signaling pathway-related genes closely related to pro-inflammatory response was down-regulated in Scutellariae Radix-Pinelliae Rhizoma Praeparatum Cum Zingibere Et Alumine group;the DAI index of UC mice in Atractylodis macrocephalae Rhizoma-Poria cocos group was significantly lower than that in other groups,and the liver index of UC mice in Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group was significantly lower than that in model control group(P<0.01).The G protein-coupled receptors(GPCRs)signaling pathway was up-regulated in the Atractylodis macrocephalae Rhizoma-Poria cocos group and Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group.[Conclusion]The five groups of ascending and descending drug pairs had different therapeutic characteristics in the treatment of UC induced by DSS.Among them,Citri Reticulatae Pericarpium-Aurantii Fructus Immaturus group,Atractylodis macrocephalae Rhizoma-Poria cocos group and Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group had obvious improvement effects on colon tissue pathological damage and submucosal collagen deposition.The protective effect on colonic goblet cells was relatively obvious in Atractylodis macrocephalae Rhizoma-Poria cocos group and Atractylodis macrocephalae Rhizoma-Paeoniae Radix Alba group.The reduction of apolipoprotein A1(ApoA1)was most significant in Atractylodis macrocephalae Rhizoma-Poria cocos group,and the down-regulation of CXC chemokine ligand 10(CXCL10)gene expression was most obvious in Platycodonis Radix-Armeniacae Semen Amarum group.In general,the protective effect of Atractylodis macrocephalae Rhizoma-Poria cocos drug pair on UC was more comprehensive and worthy of further study.

Objective:To evaluate the efficacy and safety of modified mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas.Methods:From March 1, 2022 to June 30, 2023, 12 patients with refractory thoracogastric-airway fistulas underwent the placement of modified mushroom-shaped occluder at the Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University were enrolled. The baseline clinical data of patients such as gender, age, course of disease, and fistula diameter were recorded. The data of operation and follow-up, such as operation time and method, intraoperative and postoperative complications were also collected. The occlusion efficacy at 1 month and 6 months after surgery, as well as the improvement of body mass index (BMI) and scores of the short form 36 (SF-36) were analyzed. Paired t test and non-parametric test were used for statistical analysis. Results:There were 10 males and 2 females among the 12 patients. The median age was 66.5 years old (ranged from 53.0 to 69.0 years old), the median course of disease was 7.5 months (ranged from 3.0 to 39.0 months), and the diameter of fistula was (9.3±3.4) mm. The occluder placements were successful in all the 12 patients, with 6 cases intracavitary release and 6 extracavitary release. The operation time was (30.9±9.9) min and the time of occluder placement was (3.5±1.3) min. One patient had minor (<2 mL) bleeding during the operation and 2 patients reported mild foreign body sensation but tolerable after operation. All patients resumed oral feeding and nasojejunal tubes were removed before discharge. The follow-up time of 12 patients was (11.3±1.7) months. The initial effective occlusion rate was 11/12, and the complete occlusion rate was 9/12. Two patients died but neither were related to the procedure or instruments. The BMI of 12 patients at 1 month after surgery was (18.5±1.9) kg/m 2, which was higher than that before operation ((17.6±2.3) kg/m 2), the BMI at 6 months after operation was (20.3±2.5) kg/m 2, which was higher than that at 1 month after operation, and the differences were statistically significant ( t=-4.15 and -4.45, P=0.002 and 0.001). The scores of 8 domains of SF-36 including physical functioning, general health, vitality, mental health, role-physical, bodily pain, social functioning and role-emotional of 12 patients before operation, at 1 month after operation and 6 months after operation were 49.6±13.6, 63.3±13.5 and 75.4±8.6, 17.1±11.2, 33.2±14.5 and 56.0±12.2, 30.0±12.6, 45.0±13.5 and 67.5±8.7, 41.3±18.7, 52.0±15.4 and 68.0±8.2, 0.0 (0.0 to 75.0), 25.0 (0.0 to 100.0) and 50.0 (25.0 to 100.0), 87.8 (44.0 to 100.0), 90.8 (57.0 to 100.0) and 100.0 (94.0 to 100.0), 12.5 (0.0 to 50.0), 50.0 (37.5 to 75.0) and 81.3 (50.0 to 87.5), 0.0 (0.0 to 100.0), 66.7 (33.3 to 100.0) and 100.0 (33.3 to 100.0), respectively. The scores of 8 domains at 1 month after operation were all higher than those before operation, and the differences were statistically significant ( t=-5.25, -5.32, -4.87 and -2.51, Z=-2.97, -2.20, -3.11 and -3.00; all P<0.05). The scores of 8 domains at 6 months after operation were all higher than those at 1 month after operation, and the differences were statistically significant ( t=-4.34, -7.48, -7.10 and -4.64, Z=-2.49, -2.20, -2.97 and -2.07; all P<0.05). Conclusion:The clinical application of the improved mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas is effective and relatively safe.

Objective:To evaluate the safety and efficacy of endoscopic injection of autologous platelet rich plasma(PRP)in the treatment of refractory upper gastrointestinal fistula(RUGF).Methods:From June 1, 2022 to March 1, 2023, at the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University, 8 RUGF patients who received PRP treatment were enrolled. The baseline data such as gender, age, course of disease, and body mass index, etc. as well as the PRP treatment-related data such as the time of first treatment, length of hospital stay after the first treatment, and adverse events were recorded. The postoperative follow-up lasted till 6 months after the first treatment to assess fistula healing, and to record body mass index and health survey short form. Paired t-test and non-parametric test were used for statistical analysis. Results:Among the 8 RUGF patients, there were 7 males and 1 female. The median age was 58.5 years old (ranged from 27.0 to 75.0 years old), and the median duration of the disease was 14 months (ranged from 4 to 120 months). The maximum diameter of the fistula was(4.50±2.62) mm, the concentration multiple of PRP was (4.02±0.48) times. The operation time of the first endoscopic PRP treatment was (21.88±4.52) min; the median length of the first postoperative hospital stay was 2 days (ranged from 1 to 2 days), and the median total number of treatment was 4 (ranged from 1 to 5). The healing time was (2.57±1.72) months, 7 RUGF patients healed within 6 months after the first treatment, and the fistula was narrowed in 1 patient. There were no adverse events during or after the operation. After 6 months of treatment, the body mass index and the scores of 8 dimensions of the health survey short form which included physical functioning, physical role functioning, body pain, general health, vitality, social functioning, emotional role functioning and mental health were all higher than those before treatment ((20.91±2.15) kg/m 2 vs. (18.67±3.21) kg/m 2, 86.88±13.35 vs. 58.13±20.34, 100 (0 to 100) vs. 0(0 to 100), 83.06±11.74 vs. 56.94±28.86, 67.88±26.77 vs. 31.88±13.08, 81.88±13.87 vs. 46.25±24.02, 76.56±22.60 vs. 37.50±26.73, 100 (0 to 100) vs. 0 (0 to 100), 78.00±17.37 vs. 51.50±22.77), and the differences were statistically significant ( t=-3.40 and -3.87, Z=2.06, t=-3.03, -4.26, -4.73 and -6.06, Z=-2.06, t=-4.32; P=0.012, 0.006, 0.039, 0.019, 0.004, 0.002, 0.001, 0.039 and 0.003). Conclusion:Endoscopic injection of autologous PRP for the treatment of RUGF is safe and effective, and has a significant promotion effect on the healing of small (maximum diameter ≤ 6 mm) fistula.

Objective:To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder (hereinafter referred to as occluder) in treatment of refractory tracheoesophageal fistula (TEF).Methods:From July 1, 2020 to January 31, 2021, 10 patients with refractory TEF treated with occluder at Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University were collected. The patients′ clinical data such as gender, age, body mass index and fistula diameter were recorded. The success rate of operation, intraoperative and postoperative complications, operation time, postoperative hospital stay, efficacy of fistula closure and postoperative recovery were analyzed. The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation. Paired t test was used for statistical analysis. Results:Among the 10 TEF patients, there were 7 males and 3 females, the median age was 64.5 years old (ranged from 49.0 to 78.0 years old), the body mass index was (18.0±2.5) kg/m 2 and the diameter of the fistula was (1.2±0.6) cm. Occluder placement was successful in all patients. The operation time was (17.6±7.8) min (ranged from 7.0 to 30.0 min). Two cases had little bleeding during the operation, and there was no bleeding after the operation. The postoperative hospital stay was (5.9±4.0) d (ranged from 1.0 to 12.0 d). Among the 10 TEF patients, fistula of 5 patients were completely blocked, 4 cases were partially blocked and 1 case was ineffectively blocked, the effective rate of blocking was 9/10. One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients, and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm. The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients, the occluder was displaced in 1 patient and the occluder was removed and treated with enteral nutrition. One patient died due to the recurrence of esophageal cancer. The Karnofsky score of TEF patients 3 months after operation and the body mass index of TEF patients 1 month and 3 months after operation were higher than those before operation (70.0±34.0 vs. 46.0±10.7, (19.32±2.59) and (19.73±2.92) kg/m 2 vs. (18.03±2.50) kg/m 2), and the differences were statistically significant ( t=-3.09, -2.37 and -2.82, all P<0.05). Conclusions:Gastrointestinal occluder is safe and effective in the treatment of refractory TEF.

To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.

Objective To study the influence of patient perceived medical service quality on the satisfaction and behavioral intention.Methods The AMOS21.0 software was adopted to construct a structural equation model with satisfaction as a medium for conducting the path analysis among the perceived medical service quality,satisfaction and behavioral intention.Results The perceived medical service quality produced the direct impact on behavioral intention(y=0.50) and satisfaction(γ=0.87),the satisfaction produced the direct impact on behavioral intention(γ=0.38);with the satisfaction as a medium,the perceived medical service quality had the indirect impact(0.33) on behavioral intention and the intermediary rate was 39.76％.Conclusion The perceived medical service quality has active influence on the patient satisfaction and behavior intention,and indirectly acts on the behavioral intention with the satisfaction as intermediary agent.

OBJECTIVE: To investigate the expression of Testin gene, and analyze its possible relationship with the clinicopathological features of human nasopharyngeal carcinoma. METHOD: The expression of Testin in nasopharyngeal carcinoma tissues were detected by immunohistochemistry methods, semi-quantitative reverse transcription polymerase chain reaction and Western blot. The correlations of Testin to clinicopathologic features of nasopharyngeal carcinoma were analyzed. RESULT: The positive expression rate of Testin in NPC biopsy tissue was 37.8% (17/ 45), while it was 88.9% (40/45) in the normal tissue; The expression of Testin mRNA was significantly lower than that in the normal tissue (P < 0.01); The expression levels of Testin protein in the NPC biopsy tissue by Western blot were lower than that in the normal tissue (P < 0.01); The expression of Testin in the tumor tissue had no significant correlation with sex, age (P > 0.05); but it had significant correlation with lympho node metastasis, distant metastasis and differentiation degree. CONCLUSION The decreased expression of Testin gene may play an importmant role in the development of nasopharyngeal carcinoma. And thus Testin gene might be a novel candidate of tumor-suppressor. It may be an objective marker for prognostic factor and malignant level for nasopharyngeal carcinoma.
Carcinoma ; Cytoskeletal Proteins ; metabolism ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; LIM Domain Proteins ; metabolism ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; RNA, Messenger ; metabolism