Objective:To evaluate the short-term and long-term outcomes of patients with locally advanced low rectal cancer who achieved clinical complete response (cCR) or near-clinical complete response (near-cCR) after neoadjuvant chemoradiotherapy (nCRT) and then underwent local excision.Methods:This was a descriptive case series study. Clinical data of patients with low rectal cancer who received neoadjuvant therapy, achieved cCR or near-cCR, underwent local excision, and had complete postoperative follow-up data were retrospectively analyzed. The study period was from May, 2015 to October, 2024, and the patients were treated at Fujian Medical University Union Hospital. Indications for local excision in this study were as follows: pathologically confirmed rectal adenocarcinoma, with the lower edge of the tumor ≤ 6 cm from the anal verge; maximum diameter of the lesion ≤ 2 cm after nCRT; no regional lymph node metastasis detected by transrectal endoscopic ultrasound (ERUS), pelvic magnetic resonance imaging (MRI), or positron emission tomography-computed tomography (PET-CT) after nCRT; MRI showing fibrosis of the primary lesion with a small amount of high signal on diffusion-weighted imaging (DWI), consistent with ymrT0-1 stage; serum carcinoembryonic antigen level within the normal range (< 5 μg/L) after nCRT; complicated with severe underlying diseases such as cardiovascular and cerebrovascular diseases and assessed as unable to tolerate radical surgery through comprehensive evaluation; and signed informed consent for local excision. The contraindications were: colonoscopic pathology indicating poorly differentiated adenocarcinoma or signet ring cell carcinoma; suspected lateral lymph node metastasis before neoadjuvant therapy; patients with residual lesions exceeding 3 cm in range after treatment. A total of 153 patients were included in this study, including 84 males and 69 females. The median age was 62 years, and the median distance from the tumor to the anal verge after neoadjuvant therapy was 4.0 cm. The short-term efficacy indicators of this study included postoperative complications of local excision and postoperative pathological results, and the long-term efficacy indicators included oncological prognosis (3-year cumulative local recurrence rate, 3-year cumulative distant metastasis rate, 3-year progression-free survival, and 3-year overall survival) and anal function at 1 year after surgery evaluated using the Low Anterior Resection Syndrome (LARS) scale where the total score is 42 points such that 0-20 points indicate no LARS, 21-29 points indicate mild LARS, and 30-42 points indicate severe LARS.Results:Postoperative pathology showed 122 cases (79.7%) of ypT0 stage, 10 cases (6.5%) of ypT1 stage, 18 cases (11.8%) of ypT2 stage, and 3 cases (2.0%) of ypT3 stage. The incidence of surgery-related complications was 42.5% (65/153), and the main complications included perianal pain (39.9%, 61/153), intestinal wall incision dehiscence (21.6%, 33/153), and intestinal wall incision infection (18.3%, 28/153). The proportion of patients who received hypofractionated radiotherapy before surgery and developed intestinal wall incision dehiscence was 65.2% (15/23), which was higher than that in the conventional long-course (13.6%, 16/118) and short-course radiotherapy groups (16.7%,2/12) (χ 2=30.55, P<0.001); of the 20 patients who received additional immunotherapy before surgery, 13 developed intestinal wall incision dehiscence was 65.0%, which was higher than that in the group without additional immunotherapy [15.0%(20/133),χ 2=25.66, P<0.001]. The median follow-up time of the entire group was 35.4 months. During the follow-up period, there were 9 cases of postoperative local recurrence, with a 3-year cumulative local recurrence rate of 7.9% and 5 cases of distant metastasis, with a 3-year cumulative distant metastasis rate of 5.0%. The 3-year progression-free survival rate was 89.0%, and the 3-year overall survival rate was 95.9%. At 1 year after surgery, 10 cases (10.5%, 10/95) had severe anal dysfunction, and the median LARS score of the entire group was 5.0 (range: 0-41.0) points. Conclusions:For patients with locally advanced low rectal cancer who achieve cCR or near-cCR after neoadjuvant therapy, local excision results in favorable oncological prognosis and anal function preservation effects; however, the incidence of complications is relatively high.

Objective:To evaluate the short-term and long-term outcomes of patients with locally advanced low rectal cancer who achieved clinical complete response (cCR) or near-clinical complete response (near-cCR) after neoadjuvant chemoradiotherapy (nCRT) and then underwent local excision.Methods:This was a descriptive case series study. Clinical data of patients with low rectal cancer who received neoadjuvant therapy, achieved cCR or near-cCR, underwent local excision, and had complete postoperative follow-up data were retrospectively analyzed. The study period was from May, 2015 to October, 2024, and the patients were treated at Fujian Medical University Union Hospital. Indications for local excision in this study were as follows: pathologically confirmed rectal adenocarcinoma, with the lower edge of the tumor ≤ 6 cm from the anal verge; maximum diameter of the lesion ≤ 2 cm after nCRT; no regional lymph node metastasis detected by transrectal endoscopic ultrasound (ERUS), pelvic magnetic resonance imaging (MRI), or positron emission tomography-computed tomography (PET-CT) after nCRT; MRI showing fibrosis of the primary lesion with a small amount of high signal on diffusion-weighted imaging (DWI), consistent with ymrT0-1 stage; serum carcinoembryonic antigen level within the normal range (< 5 μg/L) after nCRT; complicated with severe underlying diseases such as cardiovascular and cerebrovascular diseases and assessed as unable to tolerate radical surgery through comprehensive evaluation; and signed informed consent for local excision. The contraindications were: colonoscopic pathology indicating poorly differentiated adenocarcinoma or signet ring cell carcinoma; suspected lateral lymph node metastasis before neoadjuvant therapy; patients with residual lesions exceeding 3 cm in range after treatment. A total of 153 patients were included in this study, including 84 males and 69 females. The median age was 62 years, and the median distance from the tumor to the anal verge after neoadjuvant therapy was 4.0 cm. The short-term efficacy indicators of this study included postoperative complications of local excision and postoperative pathological results, and the long-term efficacy indicators included oncological prognosis (3-year cumulative local recurrence rate, 3-year cumulative distant metastasis rate, 3-year progression-free survival, and 3-year overall survival) and anal function at 1 year after surgery evaluated using the Low Anterior Resection Syndrome (LARS) scale where the total score is 42 points such that 0-20 points indicate no LARS, 21-29 points indicate mild LARS, and 30-42 points indicate severe LARS.Results:Postoperative pathology showed 122 cases (79.7%) of ypT0 stage, 10 cases (6.5%) of ypT1 stage, 18 cases (11.8%) of ypT2 stage, and 3 cases (2.0%) of ypT3 stage. The incidence of surgery-related complications was 42.5% (65/153), and the main complications included perianal pain (39.9%, 61/153), intestinal wall incision dehiscence (21.6%, 33/153), and intestinal wall incision infection (18.3%, 28/153). The proportion of patients who received hypofractionated radiotherapy before surgery and developed intestinal wall incision dehiscence was 65.2% (15/23), which was higher than that in the conventional long-course (13.6%, 16/118) and short-course radiotherapy groups (16.7%,2/12) (χ 2=30.55, P<0.001); of the 20 patients who received additional immunotherapy before surgery, 13 developed intestinal wall incision dehiscence was 65.0%, which was higher than that in the group without additional immunotherapy [15.0%(20/133),χ 2=25.66, P<0.001]. The median follow-up time of the entire group was 35.4 months. During the follow-up period, there were 9 cases of postoperative local recurrence, with a 3-year cumulative local recurrence rate of 7.9% and 5 cases of distant metastasis, with a 3-year cumulative distant metastasis rate of 5.0%. The 3-year progression-free survival rate was 89.0%, and the 3-year overall survival rate was 95.9%. At 1 year after surgery, 10 cases (10.5%, 10/95) had severe anal dysfunction, and the median LARS score of the entire group was 5.0 (range: 0-41.0) points. Conclusions:For patients with locally advanced low rectal cancer who achieve cCR or near-cCR after neoadjuvant therapy, local excision results in favorable oncological prognosis and anal function preservation effects; however, the incidence of complications is relatively high.

The World Health Organization (WHO) classification serves as the internationally recognized standard for diagnosing and classifying hematopoietic and lymphoid tissue tumors(WHO-HEAM). Since 2001, it has undergone multiple upgrades and revisions, updating, clarifying, and refining previous tumor diagnostic and classification standards while incorporating numerous new genetic and molecular biological subtypes. In 2022, two classification proposals emerged due to a wealth of clinical and scientific research results: the fifth edition of the WHO hematopoietic and lymphoid tissue classification (WHO-HAEM5), published in Leukemia journal; and the International Consensus Classification (ICC), published in Blood journal. These two schemes differ in their approach to classifying hematopoietic and lymphoid tissue tumors, posing challenges for clinical laboratory diagnosis and treatment.

Objective:To investigate the flow cytometric characteristics of bone marrow in patients with aplastic anemia (AA) and hypoplastic myelodysplastic syndrome (hypoMDS) and its value in differential diagnosis between AA and hypoMDS.Methods:A total of 618 patients were recruited from Shandong Provincial Hospital affiliated to Shandong First Medical University from January 2017 to December 2021, including 441 patients as controls with abnormal peripheral blood counts but confirmed to have no AA, hypoproliferative MDS, or other hematological tumors, 57 patients with AA, 52 patients with hypoMDS and 68 patients with diluted bone marrow. The proportions of bone marrow myeloid progenitor cell, lymphocyte, neutrophil and erythroid cell in bone marrow were analyzed by flow cytometry immunophenotyping. The differences between the four groups were compared by Kruskal-Wallis one-way ANOVA. The diagnostic efficacy was evaluated by the receiver operating characteristic (ROC) curve.Results:The proportion of myeloid progenitor cells in control group was [0.30%(0.20%, 0.46%)]; the proportion of myeloid progenitor cells in AA group was [0.00 (0.00, 0.04)]%, while the proportion of myeloid progenitor cells in hypoMDS group was [3.10%(1.25%, 6.71%)]. The proportion of myeloid progenitor cells in AA group was lower than that in control group( χ2=302.90, P<0.001), while the proportion of myeloid progenitor cells in the bone marrow of patients with hypoMDS was higher than that in the control group ( χ2=203.88, P<0.001). The area under the ROC curve for identifying AA and hypoMDS by the ratio of myeloid progenitor cells in bone marrow is 0.996, with the sensitivity of 96.2% and the specificity of 100% when the cutoff value is 0.21%. The proportion of bone marrow lymphocytes in control group was [10.39%(7.33%, 14.80%)]; the proportion of bone marrow lymphocytes in AA group was [52.67%(42.20%, 67.68%)], and the proportion of bone marrow lymphocytes in hypoMDS group was [24.68%(15.51%, 35.19%)]. The proportion of bone marrow lymphocytes in AA group or hypoMDS group was higher than that in control group( χ2=298.74, P<0.001; χ2=194.33; P<0.001), and the proportion of bone marrow lymphocytes in AA group is higher than that in hypoMDS group, with a statistically significant difference( χ2=104.41, P=0.002). The area under the ROC curve for identifying AA and hypoMDS by the ratio of bone marrow lymphocyte is 0.882, with the sensitivity of 78.9% and the specificity of 92.3% when the cutoff value is 41.6%. Conculsion:Patients with AA and hypoMDS could be differentiated effectively by the proportions of myeloid progenitor cell and lymphocyte in bone marrow by flow cytometry immunophenotyping.

OBJECTIVE: Although the pathogenesis of depression remains unclear, C-reactive protein (CRP) levels are commonly elevated in depressed patients. Thus, CRP single-nucleotide polymorphisms (SNPs) that influence CRP levels may be associated with depression. In the present study, we explored whether CRP SNPs are related to depressive symptoms and antidepressants efficacy in Han Chinese patients.METHODS: We analyzed data from 440 patients with first-episode depression. We obtained genome CRP SNPs, scores of the 17-item Hamilton Rating Scale for Depression 17 (HAMD17) and its four-factor at baseline and after 6 weeks. Quantitative trait analysis was performed using UNPHASED software and curative effects were analyzed using SPSS software.RESULTS: Male patients with SNP rs1800947G exhibited lower insomnia scores and rs2794521CC exhibited lower scores of anxiety/ physical symptoms, total HAMD17 score. Female patients with rs2794521TT exhibited higher scores of insomnia and lower antidepressants efficacy.CONCLUSION: CRP SNPs rs1800947 and rs2794521 may be associated with depressive symptoms in patients with depression in a sex-specific fashion. Furthermore, rs2794521 may be a predictor of the efficacy of antidepressants in female patients.
Antidepressive Agents ; Asian Continental Ancestry Group ; C-Reactive Protein ; Depression ; Female ; Genome ; Humans ; Male ; Polymorphism, Single Nucleotide ; Sleep Initiation and Maintenance Disorders

Early intervention contributes to improving patient experience and doctor-patient relationship in the case of non-psychiatric outpatients with psychological problems.The authors studied the psychological assessment and hierarchical management for non-psychiatric inpatients at a general hospital. Measures taken include establishing multi-disciplinary and inter-department teams, building an intra-hospital joint-action system, and implementing the psychological assessment and hierarchical management for non-psychiatric inpatients.These efforts explored ways for a general hospital in psychological counseling, offering humanistic service, and transformation of medical pattern.

Objective To evaluate the role of PICK1 in remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) mediated by AMPA receptors in spinal dorsal horn neurons and in the expression of AMPA receptors in juvenile rats.Methods Thirty-six male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Eighteen rats were randomly selected,their lumbar segments of the spinal cord were immediately removed,and 108 spinal cord slices (400 μm thick,for wholecell patch-clamp recording) aud 108 spinal cord slices (5 μm thick,for immunofluorescence detection) were prepared.The 108 slices with two kinds of thickness were divided into 3 groups (n=36 each) using a random number table:blank control group (group C),remifentanil group (group R) and remifentanil plus PICK inhibitor group (group R+PlCKi).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF containing remifentanil at the fiual concentration of 4 mnol/L in group R.Spinal cord slices were incubated for 90 min in ACSF containing remifentanil at the final concentration of 4 nmol/L and 50 μmol PICK inhibitor in group R+PICKi.The whole-cell patch-clamp technique was used to record the amplitude and time interval of AMPA receptors-mediated mEPSCs.The method of immunofluorescence was used to detect the expression of AMPA receptors.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened,the expression of GluR1 and GluR3 was up-regulated,and the expression of GluR2 was down-regulated in R and R+PICKi groups (P＜0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval was prolonged,the expression of GluR3 was down-regulated,the expression of GluR2 was up-regulated (P＜0.05),and no significant change was found in GluR1 expression in group R+PICKi (P＞0.05).Conclusion PICK1 is involved in the process of remifentanil-induced mEPSCs mediated by AMPA receptors in spinal dorsal horn neurons and of expression of AMPA receptors in juvenile rats,which may be the mechanism underlying remifentanil-induced hyperalgesia.

Objective To evaluate the effect of dexmedetomidine on remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) of N-methyl-D-aspartate (NMDA) receptors in spinal dorsal horn neurons of rats.Methods Thirty male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Their lumbar segments of the spinal cord were immediately removed and sliced.The 180 slices were divided into 5 groups (n =36 each) using a random number table:blank control group (group C),remifentanil group (group R),low-dose dexmedetomidine group (group L),moderate-dose dexmedetomidine group (group M) and high-dose dexmedetomidine group (group H).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L in group R.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L and dexmedetomidine at the final concentrations of 2,4 and 6 nmol/L in L,M and H groups,respectively.The whole-cell patch-clamp technique was used to record the amplitude and time interval of mEPSCs of NMDA receptors.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened in the other 4 groups (P＜0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in L,M and H groups (P＜0.05).Compared with group L,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in M and H groups (P＜0.05).Compared with group M,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in group H (P＜0.05).Conclusion Dexmedetomidine weakens remifentanil-induced enhancement in the function of NMDA receptors in spinal dorsal horn neurons probably via the presynaptic and postsynaptic mechanisms in rats.

Objective To evaluate the effect of dexmedetomidine on remifentanil-induced miniature excitatory postsynaptic currents (mEPSCs) mediated by N-methyl-D-aspartate (NMDA) receptors in spinal dorsal horn neurons of rats.Methods Thirty male Sprague-Dawley rats,aged 14-18 days,weighing 50-60 g,were used in the study.Their lumbar segments of the spinal cord were immediately removed and sliced.A total of 180 slices were selected and divided into 5 groups (n=36 each) using a random number table:blank control group (group C),remifentanil group (group R),low-dose dexmedetomidine group (group L),moderate-dose dexmedetomidine group (group M) and high-dose dexmedetomidine group (group H).Spinal cord slices were incubated in artificial cerebrospinal fluid (ACSF) for 90 min in group C.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L in group R.Spinal cord slices were incubated for 90 min in ACSF with remifentanil at the final concentration of 4 nmol/L and dexmedetomidine at the final concentrations of 2,4 and 6 nmol/L in L,M and H groups,respectively.The whole-cell patch-clamp technique was used to record the amplitude and time interval of NMDA receptors-mediated mEPSCs.Results Compared with group C,the amplitude of mEPSCs was significantly increased,and the time interval of mEPSCs was shortened in the other 4 groups (P＜ 0.05).Compared with group R,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in L,M and H groups (P＜0.05).Compared with group L,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in M and H groups (P＜0.05).Compared with group M,the amplitude of mEPSCs was significantly decreased,and the time interval of mEPSCs was prolonged in group H (P ＜ 0.05).Conclusion Dexmedetomidine weakens remifentanil-induced enhancement in the function of NMDA receptors in spinal dorsal horn neurons probably via the presynaptic and postsynaptie mechanisms in rats.

Objective To investigate the status of depression with anxiety symptoms, and analyze the influencing factors of anxiety symptoms from demographic data and social psychological factors. Methods Hamilton depression rat?ing scale (HAMD), Hamilton anxiety rating scale (HAMA), Eysenck personality questionnaire (EPQ), life event scale (LES), trait coping style questionnaire (TCSQ) and social support scale (SSS) were used to evaluate 729 patients with de?pression. According to HAMA scores, patients were divided into non anxiety symptoms group (HAMA<7) and anxiety symptoms group (HAMA>14). Social psychological factors were compared between two groups, and the influencing fac?tors of anxiety symptoms were analyzed. Results The incidence of anxiety symptoms in depression was 58.85% (429/729), and 119 cases (16.32%) were certainly without anxiety symptoms. Compared with the group without anxiety symp?toms, the anxiety symptoms group had higher scores on neuroticism, psychoticism, negative life events and negative cop?ing style (P<0.001), but lower scores on introversion and extroversion (P=0.010). Degree of depression (OR=9.255, 95%CI:4.726~18.127), neuroticism (OR=1.595, 95%CI:1.197~2.125), negative life events (OR=1.009, 95%CI:1.001~1.017) and negative coping style (OR=1.046, 95%CI:1.013~1.080) were the risk factors of anxiety symptoms (P<0.05). Conclu?sion The incidence of anxiety symptoms in patients with depression is high. Patients with higher degree of depression and typical neurotic personality experiencing more negative life events and those with tendency to adopt negative coping style are more susceptible to anxiety symptoms.