Background:The incidence of perianal fistulizing Crohn's disease is increasing and can seriously affect patients'quality of life.The efficacy of perianal surgery combined with biological agents for perianal fistulizing Crohn's disease remains to be clarified.Aims:To evaluate the clinical efficacy of perianal surgery combined with anti-tumor necrosis factor(TNF)-α agents in the treatment of perianal fistulizing Crohn's disease systematically.Methods:Cohort studies on perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease were retrieved from PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Data,and SinoMed.The retrieval time span was from the establishment of each database to October 30,2024.Literatures were enrolled according to the inclusion and exclusion criteria,and the data were extracted.Newcastle-Ottawa scale was used to evaluate the quality of literature.Meta-analysis was conducted by RevMan 5.4 software.Results:A total of 9 literatures involving 736 patients with perianal fistulizing Crohn's disease were enrolled.Meta-analysis showed that perianal surgery combined with anti-TNF-α agents shortened the healing time of anal fistula(WMD=-0.76,95%CI:-1.06--0.46;Z=4.91,P<0.000 01),decreased the recurrence rate of perianal fistula(OR=0.47,95%CI:0.26-0.84;Z=2.55,P=0.01),and reduced the perianal disease activity index(PDAI)score(WMD=-1.51,95%CI:-1.84--1.18;Z=8.91,P<0.000 01)when compared with perianal surgery alone.However,no significant differences in complete healing rate,partial healing rate,and reoperation rate were found between the two groups(all P>0.05).Conclusions:Perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease demonstrates superior efficacy compared to perianal surgery alone in terms of shortening healing time,reducing recurrence rate and decreasing PDAI score.

Background:The incidence of perianal fistulizing Crohn's disease is increasing and can seriously affect patients'quality of life.The efficacy of perianal surgery combined with biological agents for perianal fistulizing Crohn's disease remains to be clarified.Aims:To evaluate the clinical efficacy of perianal surgery combined with anti-tumor necrosis factor(TNF)-α agents in the treatment of perianal fistulizing Crohn's disease systematically.Methods:Cohort studies on perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease were retrieved from PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Data,and SinoMed.The retrieval time span was from the establishment of each database to October 30,2024.Literatures were enrolled according to the inclusion and exclusion criteria,and the data were extracted.Newcastle-Ottawa scale was used to evaluate the quality of literature.Meta-analysis was conducted by RevMan 5.4 software.Results:A total of 9 literatures involving 736 patients with perianal fistulizing Crohn's disease were enrolled.Meta-analysis showed that perianal surgery combined with anti-TNF-α agents shortened the healing time of anal fistula(WMD=-0.76,95%CI:-1.06--0.46;Z=4.91,P<0.000 01),decreased the recurrence rate of perianal fistula(OR=0.47,95%CI:0.26-0.84;Z=2.55,P=0.01),and reduced the perianal disease activity index(PDAI)score(WMD=-1.51,95%CI:-1.84--1.18;Z=8.91,P<0.000 01)when compared with perianal surgery alone.However,no significant differences in complete healing rate,partial healing rate,and reoperation rate were found between the two groups(all P>0.05).Conclusions:Perianal surgery combined with anti-TNF-α agents in the treatment of perianal fistulizing Crohn's disease demonstrates superior efficacy compared to perianal surgery alone in terms of shortening healing time,reducing recurrence rate and decreasing PDAI score.

Objective:To explore the intimal injury of two kinds of hemostatic clips under different clamping forces, and to optimize and verify the calculation formula of minimum occlusion force (MOF), so as to provide theoretical basis for selecting appropriate hemostatic clips to reduce vascular injury.Methods:A total of 96 male SD rats with body weight ranging from 280 to 300 g (Animal Experimental Center of Shanxi Medical University) were randomly assigned to metal hemostatic clip group ( n=48) and disposable hemostatic clip group ( n=48) by random number table method. Each group was further divided into four subgroups with clamping forces of 0.3, 0.6, 0.9 and 1.2 N for abdominal aortic injury experiments. The damage to the vascular intima was observed under a scanning electron microscope. A vascular closure model was established for mathematical analysis to derive the theoretical calculation formula of the arterial blood management factor (MOF). According to blood pressure (BP), blood vessel diameter (D) and hemostatic clamp width (W), the average values of theoretical and actual MOF data were analyzed by paired t test to verify the accuracy of the formula. From January 2021 to December 2022, six patients (with 12 branch arteries) who presented with oral and maxillofacial malignancies at the Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, were included to validate the accuracy of the MOF formula. Results:Under electron microscopy, when the clamping force was 0.3 N, the one-time hemostatic clip caused very little damage to the vascular intima (grade 1 injury), with only a few folds being flattened. When the clamping force was 0.6 N, both types of hemostatic clips caused partial peeling of the intima surface (grade 2-3 injury). However, when the clamping force was adjusted to 0.9 and 1.2 N, the damage caused by both types of hemostatic clips was more severe (grade 3-4 injury), with large areas of intima peeling or even disappearance. In some specimens of the metal hemostatic clip group, the damage even reached the muscular layer. Vascular closure model analysis showed that MOF=2×(1/2×π×D×W×BP), the mean diameter of abdominal aorta of 24 SD rats was (1.41±0.07) mm, the blood pressure was (83.29±11.56) mmHg (1 mmHg=0.133 kPa). The theoretical MOF value was (0.096±0.015) N, the actual clamping force (ACF) was (0.095±0.012) N, there was no statistical significance between the two groups ( t=-0.35, P=0.725). In clinical application, the MOF calculation formula was used to select the appropriate hemostatic clip for 12 arteries, successfully blocking the blood flow, verifying the accuracy of the formula. Conclusions:Hemostatic clips can cause damage to the inner membrane of blood vessels, and the greater the clamping force, the more severe the damage. Disposable hemostatic clips have certain advantages in avoiding excessive damage to the inner membrane of blood vessels. The theoretical MOF calculation formula has a certain degree of reliability and can be used as a reference to select the appropriate hemostatic clip with low damage.

ObjectiveTo observe the clinical efficacy and safety of Bushen Ruyan Formulation （补肾乳岩方， BRF） in treating premenopausal breast cancer patients of disharmony of the chong （冲） and ren （任） meridian type under endocrine intensive therapy. MethodsA total of 88 premenopausal breast cancer patients who received endocrine intensive therapy and were diagnosed with disharmony of the chong and ren meridian by traditional Chinese medicine （TCM） were included and randomly divided into a control group and a treatment group， with 44 cases in each group. The control group received ovarian function suppression （OFS） combined with endocrine therapy， while the treatment group was given oral BRF additionally. Both groups were treated for three months. The clinical efficacy was evaluated by comparing the pre- and post-treatment results of the Functional Assessment of Cancer Therapy-Breast （FACT-B）， modified Kupperman score， T cell subsets （CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺）， sex hormone levels， including estradiol （E₂）， luteinizing hormone （LH）， follicle-stimulating hormone （FSH）， progesterone （P）， testosterone （T）， and prolactin （PRL）， tumor markers， such as carcinoembryonic antigen （CEA）， carbohydrate antigen 125 （CA125）， and carbohydrate antigen 153 （CA153）， TCM syndrome score， and TCM syndrome efficacy. Blood routine tests， liver function and kidney function were monitored to assess safety. ResultsThe FACT-B scores of each domains and the total scores of the treatment group increased， while the social/family status score of the control group decreased. The treatment group had significantly higher scores in all domains and total score compared to the control group （P＜0.05 or P＜0.01）. The modified Kupperman score and TCM syndrome score of the treatment group decreased， and were lower than those of the control group （P＜0.01）. The levels of CD3⁺ and CD4⁺ in the treatment group increased， and were higher than those of the control group （P＜0.05）. Serum testosterone levels in the treatment group were lower than those in the control group （P＜0.05）. The total effective rate of TCM syndrome efficacy in the treatment group was 67.44%， significantly higher than the 23.26% in the control group （P＜0.05）. No significant abnormalities were observed in the blood routine tests or liver/kidney function indicators in either group before or after treatment. ConclusionBRF can effectively improve quality of life， alleviate symptoms， increase serum CD3⁺ and CD4⁺ levels， and enhance clinical efficacy in premenopausal breast cancer patients undergoing endocrine intensive endocrine therapy. It is also safe with no significant adverse effects.

Objective:To explore the intimal injury of two kinds of hemostatic clips under different clamping forces, and to optimize and verify the calculation formula of minimum occlusion force (MOF), so as to provide theoretical basis for selecting appropriate hemostatic clips to reduce vascular injury.Methods:A total of 96 male SD rats with body weight ranging from 280 to 300 g (Animal Experimental Center of Shanxi Medical University) were randomly assigned to metal hemostatic clip group ( n=48) and disposable hemostatic clip group ( n=48) by random number table method. Each group was further divided into four subgroups with clamping forces of 0.3, 0.6, 0.9 and 1.2 N for abdominal aortic injury experiments. The damage to the vascular intima was observed under a scanning electron microscope. A vascular closure model was established for mathematical analysis to derive the theoretical calculation formula of the arterial blood management factor (MOF). According to blood pressure (BP), blood vessel diameter (D) and hemostatic clamp width (W), the average values of theoretical and actual MOF data were analyzed by paired t test to verify the accuracy of the formula. From January 2021 to December 2022, six patients (with 12 branch arteries) who presented with oral and maxillofacial malignancies at the Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, were included to validate the accuracy of the MOF formula. Results:Under electron microscopy, when the clamping force was 0.3 N, the one-time hemostatic clip caused very little damage to the vascular intima (grade 1 injury), with only a few folds being flattened. When the clamping force was 0.6 N, both types of hemostatic clips caused partial peeling of the intima surface (grade 2-3 injury). However, when the clamping force was adjusted to 0.9 and 1.2 N, the damage caused by both types of hemostatic clips was more severe (grade 3-4 injury), with large areas of intima peeling or even disappearance. In some specimens of the metal hemostatic clip group, the damage even reached the muscular layer. Vascular closure model analysis showed that MOF=2×(1/2×π×D×W×BP), the mean diameter of abdominal aorta of 24 SD rats was (1.41±0.07) mm, the blood pressure was (83.29±11.56) mmHg (1 mmHg=0.133 kPa). The theoretical MOF value was (0.096±0.015) N, the actual clamping force (ACF) was (0.095±0.012) N, there was no statistical significance between the two groups ( t=-0.35, P=0.725). In clinical application, the MOF calculation formula was used to select the appropriate hemostatic clip for 12 arteries, successfully blocking the blood flow, verifying the accuracy of the formula. Conclusions:Hemostatic clips can cause damage to the inner membrane of blood vessels, and the greater the clamping force, the more severe the damage. Disposable hemostatic clips have certain advantages in avoiding excessive damage to the inner membrane of blood vessels. The theoretical MOF calculation formula has a certain degree of reliability and can be used as a reference to select the appropriate hemostatic clip with low damage.

Objective To analyze the influencing factors of symptom clusters during chemoradio-therapy in patients with cervical cancer.Methods A retrospective analysis was conducted on the clini-cal data of 776 patients diagnosed with cervical cancer during chemoradiotherapy.The M.D.Anderson Symptom Inventory(MDASI-D)was used to assess common symptoms and their severity in cancer pa-tients.Exploratory factor analysis was employed to extract symptom clusters.Univariate and multiple linear regression analyses were performed to screen for influencing factors of the major symptom clus-ters.Results Among 776 cervical cancer patients undergoing chemoradiotherapy,the five most prevalentsymptoms were fatigue,nausea,dry mouth,disturbed sleep and vomiting.Through explora-tory factor analysis,a total of four symptom clusters,namely the digestive tract symptom cluster,the somatic symptom cluster,the side effect symptom cluster and the emotional symptom cluster were ex-tracted.Multiple linear regression analysis revealed that age and Eastern Cooperative Oncology Group(ECOG)score were influencing factors for gastrointestinal symptom cluster(P＜0.05);age,educa-tional level,disease stage and ECOG performance status were influencing factors for physical symptom cluster(P＜0.05);age,educational level,monthly household income per capita,ECOG performance status and disease stage were influencing factors for the emotional symptom cluster(P＜0.05);the ECOG performance status,disease stage and comorbid chronic diseases were influencing factors for the side effect symptom cluster(P＜0.05).Conclusion Patients with cervical cancer frequently experi-ence gastrointestinal,emotional,physical and side effect symptom clusters during chemoradiotherapy.

Objective:To understand the occupational injury situation of front-line workers in metallurgical and shipbuilding and repairing industry, and explore the risk factors of occupational injury.Methods:From September 2023 to March 2024, using cluster sampling method, front-line workers from 2 metallurgical enterprises in Shaoguan and Jinan City and 2 shipbuilding and repairing enterprises in Jiangmen and Shenzhen City were selected as the investigation objects. 6248 questionnaires were distributed and collected, and 6178 were effective questionnaires, with a effective recovery rate of 98.88%. The basic information, living habits, working system, protection and occupational injury of workers were investigated, and the data of occupational injury in factories was collected. The types, jobs and main causes of occupational injuries in different industries were analyzed, and the influencing factors of occupational injuries were analyzed by univariate and multi-factor logistic regression.Results:The incidence of occupational injury was 3.13% (128/4086) in metallurgical industry and 4.02% (84/2092) in shipbuilding and repairing industry. The top three occupational injuries in the metallurgical industry were furnace worker (17.19%, 22/128), steel rolling worker (14.84%, 19/128), maintenance worker (10.16%, 13/128), and the top three injury types were mechanical injury (24.22%, 31/128), height fall (20.31%, 26/128) and object strikes (17.97%, 23/128). The top three occupational injuries in shipbuilding and repairing industry were welder (20.24%, 17/84), riveter (9.52%, 8/84) and crane (8.33%, 7/84). The top three injury types were hit by objects (34.52%, 29/84), hit by falling objects (22.62%, 19/84), and lifting injury (20.24%, 17/84). The injuries of workers in metallurgical industry and shipbuilding and repairing industry were mainly fractures, accounting for 32.03% (41/128) and 60.71% (51/84), respectively. The incidence of occupational injury was higher in males, with sleep disorder, high temperature exposure and chemical toxicity exposure ( P<0.05). There were significant differences in age, smoking degree, working age and emotional state between workers with occupational injury and those without occupational injury ( P<0.05). Multivariate analysis showed that male, age above 50 years old, moderate smoking, working years of 5-9 years, mild anxiety, poor health status and high temperature exposure were risk factors for occupational injury ( OR=25.57, 3.72, 14.27, 2.09, 1.50, 4.36, 0.66, P<0.05) . Conclusion:The incidence of occupational injury is higher in shipbuilding and repairing industry, and fracture is the main type of occupational injury. The occurrence of occupational injury is affected by gender, age, smoking, working age, emotional state, health status and high temperature exposure.

Objective:To understand the occupational injury situation of front-line workers in metallurgical and shipbuilding and repairing industry, and explore the risk factors of occupational injury.Methods:From September 2023 to March 2024, using cluster sampling method, front-line workers from 2 metallurgical enterprises in Shaoguan and Jinan City and 2 shipbuilding and repairing enterprises in Jiangmen and Shenzhen City were selected as the investigation objects. 6248 questionnaires were distributed and collected, and 6178 were effective questionnaires, with a effective recovery rate of 98.88%. The basic information, living habits, working system, protection and occupational injury of workers were investigated, and the data of occupational injury in factories was collected. The types, jobs and main causes of occupational injuries in different industries were analyzed, and the influencing factors of occupational injuries were analyzed by univariate and multi-factor logistic regression.Results:The incidence of occupational injury was 3.13% (128/4086) in metallurgical industry and 4.02% (84/2092) in shipbuilding and repairing industry. The top three occupational injuries in the metallurgical industry were furnace worker (17.19%, 22/128), steel rolling worker (14.84%, 19/128), maintenance worker (10.16%, 13/128), and the top three injury types were mechanical injury (24.22%, 31/128), height fall (20.31%, 26/128) and object strikes (17.97%, 23/128). The top three occupational injuries in shipbuilding and repairing industry were welder (20.24%, 17/84), riveter (9.52%, 8/84) and crane (8.33%, 7/84). The top three injury types were hit by objects (34.52%, 29/84), hit by falling objects (22.62%, 19/84), and lifting injury (20.24%, 17/84). The injuries of workers in metallurgical industry and shipbuilding and repairing industry were mainly fractures, accounting for 32.03% (41/128) and 60.71% (51/84), respectively. The incidence of occupational injury was higher in males, with sleep disorder, high temperature exposure and chemical toxicity exposure ( P<0.05). There were significant differences in age, smoking degree, working age and emotional state between workers with occupational injury and those without occupational injury ( P<0.05). Multivariate analysis showed that male, age above 50 years old, moderate smoking, working years of 5-9 years, mild anxiety, poor health status and high temperature exposure were risk factors for occupational injury ( OR=25.57, 3.72, 14.27, 2.09, 1.50, 4.36, 0.66, P<0.05) . Conclusion:The incidence of occupational injury is higher in shipbuilding and repairing industry, and fracture is the main type of occupational injury. The occurrence of occupational injury is affected by gender, age, smoking, working age, emotional state, health status and high temperature exposure.

AIM:To investigate the effects of epal-restat(Epa)on the mitochondrial oxidative stress damage of radiation pneumonitis(RP)mice and to explore its possible mechanism.METHODS:C57BL/6 mice were randomly divided into control(CON),Irradiation(IR),IR combined with Epa(10 mg/kg)and IR combined with Epa(20 mg/kg)group,16 mice in each group.Mouse models of RP were es-tablished by whole thorax irradiation at a dose of 15Gy using a 6-MV linear accelerator.Continuous intragastric administration after IR for 6 or 8 weeks.Lung histopathology was analyzed by HE staining.The expression of aldose reductase(AR)was deter-mined by immunohistochemistry.Mitochondrial morphology of lung tissues was observed by trans-mission electron microscopy.The levels of inflam-matory cytokines(IL-6,TNF-α and TGF-β1)in plas-ma were detected by ELISA.The contents of Malo-ndialdehyde(MDA)and 4-hydroxynonenal(4-HNE)in lung tissues were determined by colorimetry.Sin-gle cell suspension of lung tissues was prepared and reactive oxygen species(ROS)levels in the cells was examined using a DCFH-DA fluorescent probe.Real-time quantitative PCR was used to determine the expression of AR,IL-6,TNF-α and TGF-β1.The protein levels of AR,IL-6,TNF-α,TGF-β1,BAX,Bcl2,Cleaved Caspase-3,8-oxoguanine DNA glycosylase 1(OGG1)and silent information regulator 3(SIRT3)were detected by Western blot analysis.RESULTS:Compared with the CON group,the alveolar hyper-plasia,alveolar septum thickening and inflammato-ry cell infiltration were observed in the IR group.Moreover,the content of inflammatory factors such as IL-6,TNF-α and TGF-β1 and the expression of BAX and Cleaved Caspase-3 were significantly in-creased,and the expression of Bcl2 was obviously decreased after irradiation.Compared with the IR group,Epa robustly alleviated RP.Meanwhile,Epa down-regulated inflammatory cells infiltration and the expression of inflammatory cytokines,such as IL-6,TNF-α and TGF-β1.In addition,Epa could down-regulate the expression of BAX and Cleaved Caspase-3,and up-regulate Bcl2 in lung tissues.Compared with the CON group,the expression of AR,the levels of ROS,MDA and 4-HNE were signifi-cantly increased,the expression of OGG1 and SIRT3 were significantly decreased,and mitochon-drial damage was aggravated in the IR group.Com-pared with IR group,the expression of AR was sig-nificantly down-regulated,the levels of ROS,MDA and 4-HNE were significantly decreased,the expres-sions of OGG1 and SIRT3 were significantly in-creased,and the mitochondrial damage was signifi-cantly alleviated in IR group after 6 to 8 weeks of Epa administration.CONCLUSION:Epa has a pro-tective effect on RP,which may be related to the in-hibition of AR expression,the reduction of mito-chondrial oxidative stress injury,and the inhibition of inflammatory response and cell apoptosis.