1.Mechanisms of Dihuang Yinzi in Treating Advanced Parkinson's Disease Based on Gut Microbiota-SCFAs-inflammation Axis
Renzhi MA ; Yasi LIN ; Tingyue JIANG ; Hongmei ZHU ; Jiayuan LI ; Yu WANG ; Ge ZHANG ; Wenxin FAN ; Jinli SHI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):11-21
ObjectiveTo observe the effects of Dihuang Yinzi (DY) on motor dysfunction in rats with advanced Parkinson's disease (PD) and to investigate the mechanisms by which DY improves advanced PD symptoms through the "gut microbiota-short-chain fatty acids (SCFAs)-inflammation-neuroprotection pathway". MethodsAn advanced PD rat model was induced by rotenone. Rats were divided into a normal group, model group, positive drug group (levodopa, 50 mg·kg-1), and DY low-, medium-, and high-dose groups (5.2, 10.4, 20.8 g·kg-1). After 7 days of administration, motor function was evaluated using the open-field, pole-climbing, and inclined plate tests. Hematoxylin-eosin (HE) staining was used to observe pathological changes in the substantia nigra and colon, and immunohistochemistry was performed to detect α-Synuclein (α-Syn) and tyrosine hydroxylase (TH) expression in the substantia nigra. Enzyme-linked immunosorbent assay (ELISA) was used to measure levels of dopamine (DA), 5-hydroxytryptamine (5-HT), 3,4-dihydroxyphenylacetic acid (DOPAC), Levodopa, homovanillic acid (HVA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β). Western blot analysis was used to detect the expression of zonula occludens-1 (ZO-1) and occludin. Gut microbiota diversity was analyzed by 16S rRNA sequencing, and gas chromatography (GC) was used to determine the content of SCFAs in colonic contents. ResultsCompared with the normal group, the model group showed significantly decreased movement speed and distance in the open-field test, prolonged pole-climbing time, and reduced retention angle on the inclined plate (P<0.01), accompanied by increased α-Syn expression (P<0.01) and decreased TH expression (P<0.01) in the brain. Compared with the model group, all DY dose groups improved motor dysfunction in advanced PD rats to varying degrees (P<0.05, P<0.01) and alleviated pathological damage in the brain and colon. High-dose DY significantly reduced α-Syn aggregation in the substantia nigra (P<0.01) and increased TH expression (P<0.01). ELISA and Western blot results showed that, compared with the normal group, the model group exhibited decreased levels of DA, 5-HT, DOPAC, Levodopa, and HVA in the striatum (P<0.01), increased levels of TNF-α, IL-6, and IL-1β in the colon and striatum (P<0.01), and significantly reduced expression of ZO-1 (P<0.05) and occludin in the colon (P<0.01). Compared with the model group, all DY dose groups increased the levels of DA, 5-HT, DOPAC, Levodopa, and HVA in the striatum to varying degrees (P<0.05, P<0.01). In the high-dose DY group, the levels of TNF-α, IL-6, and IL-1β in the colon and striatum were reduced (P<0.01), while the expression of ZO-1 (P<0.05) and occludin in the intestine was increased. The 16S rRNA sequencing results indicated that the relative abundances of Actinobacteriota, Enterobacteriaceae, and Erysipelotrichaceae were increased in the model group, whereas the relative abundances of Bacteroidota, class Clostridia, Lachnospiraceae, and Akkermansia muciniphila were decreased. These changes were effectively reversed after high-dose DY intervention. GC analysis showed that the content of SCFAs in the colonic contents of rats in the model group was decreased (P<0.05, P<0.01), while after high-dose DY intervention, the levels of acetate, propionate, isobutyrate, and butyrate were significantly increased (P<0.05, P<0.01). ConclusionDY may exert therapeutic effects in advanced PD by regulating the gut microbiota-SCFAs-inflammation pathway.
2.Long noncoding RNA TP53TG1 promotes odontogenic and osteogenic differentiation of stem cells from the apical papilla
Tingyue LI ; Qian GUO ; Wenxi HE ; Jiayuan WU
Chinese Journal of Tissue Engineering Research 2025;29(36):7776-7782
BACKGROUND:Long noncoding RNA TP53TG1(lncRNA TP53TG1)is involved in regulating the proliferation,migration,invasion,and apoptosis of various cancer cells,but there are few reports on its role in other cells.OBJECTIVE:To investigate the effects and pathways of lncRNA TP53TG1 on the proliferation and differentiation of human stem cells from the apical papilla.METHODS:Human stem cells from the apical papilla were isolated and cultured,and then transfected with lncRNA TP53TG1 overexpression lentivirus.RT-qPCR was used to detect the overexpression efficiency of lncRNA TP53TG1.Western blot assay was used to detect the relative expression levels of PI3K,AKT,ERK,P38,Smad3,and their phosphorylated proteins.Human stem cells from the apical papilla were divided into the empty lentiviral vector transfection group and the lncRNA TP53TG1 overexpression group.CCK-8 assay was used to measure the cell proliferation.Alkaline phosphatase activity was detected by alkaline phosphatase staining on day 5 of osteogenic induction.Formation of mineralized nodules was detected by alizarin red staining on day 21 of osteogenic induction.RT-qPCR was used to detect the mRNA expression levels of dentin sialophosphoprotein,Runt-related transcription factor 2,dentin matrix protein 1,and bone sialoprotein on days 3,7,and 14 of osteogenic induction.Western blot assay was used to detect the protein expression levels of dentin sialophosphoprotein and Runt-related transcription factor 2 on days 3,7,and 14 of osteogenic induction.RESULTS AND CONCLUSION:(1)RT-qPCR results showed that the lentivirus was successfully integrated into the genome of stem cells from the apical papilla.Western blot assay results showed that overexpression of lncRNA TP53TG1 up-regulated the protein levels of p-PI3K and p-AKT without affecting the expression of phosphorylated proteins in other pathways.(2)Starting from day 3 of cell culture,overexpression of lncRNA TP53TG1 significantly promoted the proliferation of stem cells from the apical papilla.(3)In the process of inducing odontogenic differentiation of stem cells from the apical papilla,overexpression of lncRNA TP53TG1 promoted the expression of odontogenic and osteogenic differentiation-related genes and proteins,significantly increased alkaline phosphatase activity and mineralized nodule formation.(4)The results show that lncRNA TP53TG1 may promote the odontogenic and osteogenic differentiation of stem cells from the apical papilla by activating the PI3K/AKT signaling pathway.
3.Fufang Kangjiaolv Capsules Treat Anxiety in Rat Model of Chronic Restraint Stress via Microbiota-gut-brain Axis
Wenxin FAN ; Tingyue JIANG ; Yu WANG ; Ge ZHANG ; Yifan LU ; Mengmeng LIU ; Jiayuan LI ; Renzhi MA ; Jinli SHI
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(4):95-107
ObjectiveTo observe the intervention effect of Fufang Kangjiaolv capsules on anxiety-like behaviors in the rat model of chronic restraint stress (CRS) and explore the mechanism underlying the anti-anxiety effect via the microbiota-gut-brain axis. MethodsRats were assigned into blank, model, positive drug (diazepam, 1 mg·kg-1), and low-, medium-, and high-dose (0.75, 1.5, 3 g·kg-1, respectively) Fufang Kangjiaolv capsules groups. After 14 days of administration, the elevated plus maze test, open field test, light and dark box test, and marble burying test were performed. Hematoxylin-eosin staining was employed to observe the pathological changes in the hippocampus and colon of rats, and Nissl staining was conducted to observe the damage of hippocampal neurons. The gut microbiota was analyzed by 16S rRNA gene sequencing. Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was employed to determine the mRNA levels of zonula occludens-1 (ZO-1) and occludin in the colon of rats. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) in the colon, serum, and hippocampus were determined by enzyme-linked immunosorbent assay. Western blot was employed to determine the protein levels of ZO-1, occludin, nuclear factor-κB p65 (NF-κB p65) in the colon tissue and NF-κB p65 and brain-derived neurotrophic factor (BDNF) in the hippocampal tissue. ResultsCompared with the blank group, the model group showed reductions in the time and frequency ratio of rats entering the elevated plus maze, the time and frequency of rats entering the central area of the open field, the time of entering the open box, the times of passing through the light and dark box, and the number of unburied beads (P<0.05, P<0.01). Compared with the model group, Fufang Kangjiaolv capsules ameliorated the anxiety of the model rats to varying degrees, and the high-dose group had the best effect, with increases in the proportions of time and frequency of rats entering the open arm in the elevated plus maze (P<0.05), the number of rats entering the central area in the open field (P<0.05), the time of entering the open box, the times of passing through the light and dark boxes, and the number of unburied beads (P<0.01). Moreover, the high-dose group showed alleviated pathological damage of hippocampal neurons and colon. The results of 16S rRNA gene sequencing showed that the model group had increased relative abundance of Firmicutes, Deferribacterota, Romboutsia, and Phascolarctobacterium, while it had decreased relative abundance of Bavcteroidota and Lactobacillus. The drug administration groups showed increased relative abundance of Bavcteroidota, Bacteroides, norank f norank o Clostridia UCG-014, and Blautia and decreased relative abundance of Firmicutes and Deferribacterota. Compared with the blank group, the model group showed down-regulated protein and mRNA levels of ZO-1 and occludin in the colon (P<0.01), elevated levels of TNF-α, IL-6, and IL-β in the colon, serum, and hippocampus (P<0.01), up-regulated protein level of NF-κB p65 in the colon and hippocampus (P<0.01), and down-regulated protein level of BDNF in the hippocampus (P<0.05). Compared with the model group, high-dose Fufang Kangjiaolv capsules up-regulated the mRNA levels of ZO-1 and occludin in the colon (P<0.01), lowered the levels of TNF-α, IL-6, and IL-β in the colon, serum, and hippocampus (P<0.01), up-regulated the protein levels of ZO-1 (P<0.01) and occludin (P<0.05) in the colon, down-regulated the protein level of NF-κB p65 in the colon and hippocampus (P<0.05), and up-regulated the protein level of BDNF in the hippocampus. ConclusionFufang Kangjiaolv capsules can reduce the anxiety-like behaviors in the rat model of CRS by regulating the gut microbiota disturbance, up-regulating the expression of tight junction proteins in the colon, repairing intestinal mucosal mechanical barrier, and down-regulating NF-κB/BDNF signaling pathway, thereby reducing peripheral and central inflammation. This study proves the hypothesis that Fufang Kangjiaolv capsules play an anti-anxiety role via the microbiota-gut-brain axis, providing a new idea for further research.
4.Predictive factors of pathological complete response after neoadjuvant therapy for locally advanced rectal cancer
Hao LI ; Yang LUO ; Tingfeng WANG ; Haiping LIN ; Tingyue GONG ; Yongheng ZHAO ; Ming ZHONG
Journal of Surgery Concepts & Practice 2025;30(1):47-53
Objective To analyze the tumor characteristics associated with achieving pathological complete response(pCR) and tumor prognosis in the patients undergoing laparoscopic rectal cancer surgery after neoadjuvant chemoradiotherapy(nCRT). Methods A retrospective review was conducted on clinical and pathological data of locally advanced rectal cancer(LARC) patients who underwent nCRT at Renji Hospital from January 2017 to January 2024. Factors influencing the achievement of pCR were analyzed, and the patients prognosis of pCR group and non-pCR group was compared. Results Univariate analysis, multivariate Logistic regression analysis, and receiver operating characteristic (ROC) curve analysis showed that tumor length less than 5 cm(cutoff value 5.24 cm) and baseline carcinoembryonic antigen(CEA) less than 5 μg/L(cutoff value 5.33 μg/L) were independent predictors of achieving pCR after nCRT in LARC patients. Prognostic survival analysis showed that the 3-year overall survival(OS) rate for pCR group and non-pCR group were 92.86% and 82.46%, respectively (P=0.193), and the 3-year disease-free survival (DFS) rate were 85.71% and 70.18%, respectively (P=0.141), with no statistically significant differences between the two groups. Conclusions Tumor length and baseline CEA level are independent predictors for achieving pCR after nCRT in LARC patients. Additionally, there were no statistically significant differences in 3-year OS and DFS between pCR group and non-pCR group.
5.A prospective study on the impact of surgical treatment on postoperative quality of life and mediating factors in breast cancer patients
Qingxian XU ; Yuan LI ; Maoshan CHEN ; Shi WANG ; Wei RONG ; Lei YANG ; Tingyue HUANG ; Heng YIN ; Jun FAN ; Wei XU ; Qiuling SHI ; Hongwei YANG
Chinese Journal of General Surgery 2025;34(5):978-987
Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.
6.Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis versus laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation: a multicenter retrospective cohort study
Yang LUO ; Taotao HOU ; Yifei MU ; Chundi MIAO ; Tingyue GONG ; Jun QIN ; Dongyang WANG ; Dawei SONG ; Hao LI ; Shaolan QIN ; Rong CUI ; Tingfeng WANG ; Ming ZHONG ; Minhao YU
Chinese Journal of Gastrointestinal Surgery 2025;28(12):1426-1433
Objective:To compare postoperative anal function recovery between laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation.Methods:This multicenter retrospective cohort study enrolled patients meeting the following criteria: (1) severe constipation symptoms (<2 bowel movements/week), absent or insignificant defecation urge, abdominal distension, requiring laxatives to maintain bowel movements or laxatives being ineffective; (2) constipation symptoms for over 5 years, ineffective after >2 years of medical treatment, with strong desire for surgery; (3) significantly prolonged colon transit time (>72 hours) without significant gastric or small intestinal transit dysfunction; (4) no organic colonic lesions confirmed by colonoscopy and abdominal CT. Exclusion criteria: (1) patients undergoing open surgery; (2) exclusion of outlet obstruction constipation (e.g., rectocele, rectal prolapse, puborectalis spasm) by functional defecation MRI; (3) comorbid psychiatric disorders; (4) missing clinical data or loss to follow-up (postoperative follow-up <24 months). Based on these criteria, clinical and follow-up data were collected from 220 patients who underwent either laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSC group, n = 115) or laparoscopic total colectomy with ileorectal anastomosis (LTC group, n = 105) for slow transit constipation between January 2013 and December 2022. Subjective anal function (Constipation Severity Score and Wexner Fecal Incontinence Score) and objective anal function (positive rate of rectoanal inhibitory reflex [RAIR] and anorectal manometry) were observed preoperatively and at 6, 12, and 24 months postoperatively. Results:No significant differences were found in baseline characteristics between the two groups (all P >0.05). All surgeries were completed successfully without major significant complications. Subjective anal function assessment: At 24 months postoperatively, Constipation Severity Scores decreased significantly compared to preoperative scores in both groups [LSC group: (25.2±2.8) vs. (2.9±1.8), P <0.001; LTC group: (25.8±2.9) vs. (2.8±1.9), P<0.001]. No significant differences were found between the groups at 6, 12, and 24 months postoperatively (all P>0.05). Wexner Fecal Incontinence Scores at 24 months were significantly lower than those at 6 months in both groups [LSC group: (12.9±1.8) vs. (3.9±2.5), P<0.001; LTC group: (12.6±1.8) vs. (5.4±2.4), P<0.001]. Although no significant difference was found at 6 months ( P = 0.190), the LSC group had significantly lower Wexner scores than the LTC group at 12 and 24 months postoperatively (both P < 0.001). Objective anal function assessment: (1) Positive RAIR rate: Preoperative positive RAIR rates were 33.0% (38/115) in the LSC group and 25.7% (27/105) in the LTC group ( P > 0.05). At 24 months, positive rates increased significantly in both groups [LSC: 66.1% (76/115); LTC: 63.8% (67/105)] compared to preoperative rates (both P<0.001), but no significant differences were found between groups at 6, 12, and 24 months (all P>0.05). (2) Resting pressure (RP) and squeeze pressure (SP): No significant differences were found in preoperative RP and SP between groups (all P>0.05). The LSC group had significantly higher RP and SP than the LTC group at 6 and 12 months postoperatively (all P<0.05), but no significant differences were found at 24 months ( P>0.05). Conclusion:Both laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis are safe for patients with slow transit constipation. However, laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis offers superior postoperative anal function recovery.
7.A prospective study on the impact of surgical treatment on postoperative quality of life and mediating factors in breast cancer patients
Qingxian XU ; Yuan LI ; Maoshan CHEN ; Shi WANG ; Wei RONG ; Lei YANG ; Tingyue HUANG ; Heng YIN ; Jun FAN ; Wei XU ; Qiuling SHI ; Hongwei YANG
Chinese Journal of General Surgery 2025;34(5):978-987
Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.
8.Long noncoding RNA TP53TG1 promotes odontogenic and osteogenic differentiation of stem cells from the apical papilla
Tingyue LI ; Qian GUO ; Wenxi HE ; Jiayuan WU
Chinese Journal of Tissue Engineering Research 2025;29(36):7776-7782
BACKGROUND:Long noncoding RNA TP53TG1(lncRNA TP53TG1)is involved in regulating the proliferation,migration,invasion,and apoptosis of various cancer cells,but there are few reports on its role in other cells.OBJECTIVE:To investigate the effects and pathways of lncRNA TP53TG1 on the proliferation and differentiation of human stem cells from the apical papilla.METHODS:Human stem cells from the apical papilla were isolated and cultured,and then transfected with lncRNA TP53TG1 overexpression lentivirus.RT-qPCR was used to detect the overexpression efficiency of lncRNA TP53TG1.Western blot assay was used to detect the relative expression levels of PI3K,AKT,ERK,P38,Smad3,and their phosphorylated proteins.Human stem cells from the apical papilla were divided into the empty lentiviral vector transfection group and the lncRNA TP53TG1 overexpression group.CCK-8 assay was used to measure the cell proliferation.Alkaline phosphatase activity was detected by alkaline phosphatase staining on day 5 of osteogenic induction.Formation of mineralized nodules was detected by alizarin red staining on day 21 of osteogenic induction.RT-qPCR was used to detect the mRNA expression levels of dentin sialophosphoprotein,Runt-related transcription factor 2,dentin matrix protein 1,and bone sialoprotein on days 3,7,and 14 of osteogenic induction.Western blot assay was used to detect the protein expression levels of dentin sialophosphoprotein and Runt-related transcription factor 2 on days 3,7,and 14 of osteogenic induction.RESULTS AND CONCLUSION:(1)RT-qPCR results showed that the lentivirus was successfully integrated into the genome of stem cells from the apical papilla.Western blot assay results showed that overexpression of lncRNA TP53TG1 up-regulated the protein levels of p-PI3K and p-AKT without affecting the expression of phosphorylated proteins in other pathways.(2)Starting from day 3 of cell culture,overexpression of lncRNA TP53TG1 significantly promoted the proliferation of stem cells from the apical papilla.(3)In the process of inducing odontogenic differentiation of stem cells from the apical papilla,overexpression of lncRNA TP53TG1 promoted the expression of odontogenic and osteogenic differentiation-related genes and proteins,significantly increased alkaline phosphatase activity and mineralized nodule formation.(4)The results show that lncRNA TP53TG1 may promote the odontogenic and osteogenic differentiation of stem cells from the apical papilla by activating the PI3K/AKT signaling pathway.
9.Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis versus laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation: a multicenter retrospective cohort study
Yang LUO ; Taotao HOU ; Yifei MU ; Chundi MIAO ; Tingyue GONG ; Jun QIN ; Dongyang WANG ; Dawei SONG ; Hao LI ; Shaolan QIN ; Rong CUI ; Tingfeng WANG ; Ming ZHONG ; Minhao YU
Chinese Journal of Gastrointestinal Surgery 2025;28(12):1426-1433
Objective:To compare postoperative anal function recovery between laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation.Methods:This multicenter retrospective cohort study enrolled patients meeting the following criteria: (1) severe constipation symptoms (<2 bowel movements/week), absent or insignificant defecation urge, abdominal distension, requiring laxatives to maintain bowel movements or laxatives being ineffective; (2) constipation symptoms for over 5 years, ineffective after >2 years of medical treatment, with strong desire for surgery; (3) significantly prolonged colon transit time (>72 hours) without significant gastric or small intestinal transit dysfunction; (4) no organic colonic lesions confirmed by colonoscopy and abdominal CT. Exclusion criteria: (1) patients undergoing open surgery; (2) exclusion of outlet obstruction constipation (e.g., rectocele, rectal prolapse, puborectalis spasm) by functional defecation MRI; (3) comorbid psychiatric disorders; (4) missing clinical data or loss to follow-up (postoperative follow-up <24 months). Based on these criteria, clinical and follow-up data were collected from 220 patients who underwent either laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSC group, n = 115) or laparoscopic total colectomy with ileorectal anastomosis (LTC group, n = 105) for slow transit constipation between January 2013 and December 2022. Subjective anal function (Constipation Severity Score and Wexner Fecal Incontinence Score) and objective anal function (positive rate of rectoanal inhibitory reflex [RAIR] and anorectal manometry) were observed preoperatively and at 6, 12, and 24 months postoperatively. Results:No significant differences were found in baseline characteristics between the two groups (all P >0.05). All surgeries were completed successfully without major significant complications. Subjective anal function assessment: At 24 months postoperatively, Constipation Severity Scores decreased significantly compared to preoperative scores in both groups [LSC group: (25.2±2.8) vs. (2.9±1.8), P <0.001; LTC group: (25.8±2.9) vs. (2.8±1.9), P<0.001]. No significant differences were found between the groups at 6, 12, and 24 months postoperatively (all P>0.05). Wexner Fecal Incontinence Scores at 24 months were significantly lower than those at 6 months in both groups [LSC group: (12.9±1.8) vs. (3.9±2.5), P<0.001; LTC group: (12.6±1.8) vs. (5.4±2.4), P<0.001]. Although no significant difference was found at 6 months ( P = 0.190), the LSC group had significantly lower Wexner scores than the LTC group at 12 and 24 months postoperatively (both P < 0.001). Objective anal function assessment: (1) Positive RAIR rate: Preoperative positive RAIR rates were 33.0% (38/115) in the LSC group and 25.7% (27/105) in the LTC group ( P > 0.05). At 24 months, positive rates increased significantly in both groups [LSC: 66.1% (76/115); LTC: 63.8% (67/105)] compared to preoperative rates (both P<0.001), but no significant differences were found between groups at 6, 12, and 24 months (all P>0.05). (2) Resting pressure (RP) and squeeze pressure (SP): No significant differences were found in preoperative RP and SP between groups (all P>0.05). The LSC group had significantly higher RP and SP than the LTC group at 6 and 12 months postoperatively (all P<0.05), but no significant differences were found at 24 months ( P>0.05). Conclusion:Both laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis are safe for patients with slow transit constipation. However, laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis offers superior postoperative anal function recovery.
10.Three-station OSCE skill assessment for standardized training of radiation oncology residents
Jishi LI ; Lingyu MA ; Qiongya LAN ; Tingyue LUO ; Ying HAN ; Zhiyuan XU ; Lee Wing Mui Anne
Chinese Journal of Radiation Oncology 2024;33(11):1064-1069
Objective:To conduct simulated graduation skill assessment and annual skill assessment by self-designed objective structured clinical examination (OSCE) for standardized training of radiation oncology residents.Methods:The structured examination, standardized questions and standardized tasks of each disease were designed by teaching team of radiation oncology in the University of Hong Kong-Shenzhen Hospital. The implementation effect of the annual assessment and simulated completion assessment of standardized training for residents in radiation oncology from Class 2019 to 2021 was prospectively observed. The difference between scores by two independent examiners was analyzed by the paired t-test. The overall feedback of residents and examiners for the implementation were collected after the completion of OSCE. Results:A total of 18 residents participated in 67 sessions of 3-station skill assessments of different diseases, including 2 make-up tests. There was no difference in the score pairing and grade pairing tests between two examiners at 3 stations ( t=0.85, -0.68, -1.16; P=0.401, 0.499, 0.255). A total of 91.3% of the residents reported that the assessment well reflected their actual clinical competency. Conclusions:The current program of OSCE assessment for radiation oncology meets objectification, standardization and high efficiency, and achieves the goal of making trainers familiar with the graduation skill assessment and assessing comprehensive clinical competence. It is a reproducible and flexible structured assessment model.

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