Objective:To introduce the method of using anal fistula endoscope to treat chronic sinus tract leakage at rectal anastomosis site.Methods:We used anal fistula endoscopy to treat a patient with chronic sinus tract leakage after radical resection of rectal cancer, mainly including the following 5 steps: (1) establishing a water injection circulation system through the anus; (2) scraping off purulent coating and mucosa on the surface of the sinus tract with the brush; (3) hemostasis and removal of necrotic tissue with electrocoagulation rods; (4) filling the sinus tract with bioprotein gel; (5) compressing the sinus tract with transanal drainage tube.Results:The patient is a 70 year old male with rectal cancer. After undergoing 3D laparoscopic assisted radical resection of rectal cancer via abdominal anterior resection (Dixon's procedure) and diverting ileostomy surgery for more than 3 months, leakage of the rectal anastomosis was found through colonoscopy and anal iodine water contrast imaging .The patient started eating and flowing juice 6 hours after surgery, got out of bed 24 hours after surgery, and was discharged 48 hours after the removal of the anal canal. Three months after surgery, colonoscopy and transanal iodine hydrography showed that the sinus repair was intact. The diverting ileostomy was reduced 4 months after surgery.Conclusion:Anal fistula endoscope is safe and feasible for the treatment of chronic sinus tract anastomotic leakage in selected patients.

Objective:To introduce the method of using anal fistula endoscope to treat chronic sinus tract leakage at rectal anastomosis site.Methods:We used anal fistula endoscopy to treat a patient with chronic sinus tract leakage after radical resection of rectal cancer, mainly including the following 5 steps: (1) establishing a water injection circulation system through the anus; (2) scraping off purulent coating and mucosa on the surface of the sinus tract with the brush; (3) hemostasis and removal of necrotic tissue with electrocoagulation rods; (4) filling the sinus tract with bioprotein gel; (5) compressing the sinus tract with transanal drainage tube.Results:The patient is a 70 year old male with rectal cancer. After undergoing 3D laparoscopic assisted radical resection of rectal cancer via abdominal anterior resection (Dixon's procedure) and diverting ileostomy surgery for more than 3 months, leakage of the rectal anastomosis was found through colonoscopy and anal iodine water contrast imaging .The patient started eating and flowing juice 6 hours after surgery, got out of bed 24 hours after surgery, and was discharged 48 hours after the removal of the anal canal. Three months after surgery, colonoscopy and transanal iodine hydrography showed that the sinus repair was intact. The diverting ileostomy was reduced 4 months after surgery.Conclusion:Anal fistula endoscope is safe and feasible for the treatment of chronic sinus tract anastomotic leakage in selected patients.

The treatment strategy for colon cancer with liver metastasis has always been a great challenge for clinical surgeons.Single treatment method such as surgical resection or systemic chemotherapy can no longer meet the treatment needs of such patients.With the extensive development of the multi-disciplinary team(MDT)for colorectal cancer based on surgery,more and more patients with advanced colorectal cancer have obtained better treatment effects and survival benefits.A case of descending colon cancer with huge hepatic metastasis diagnosed and treated by a multi-disciplinary team was reported,aiming to provide reference for clinical practice.

Stage T4 colon cancer is divided into two categories:tumor penetrating the visceral peritoneum(T4a)and tumor directly invading or attaching to adjacent organs or structures(T4b).Treatment of T4 colon cancer requires technically demanding surgical procedures,including total resection of adjacent infiltrating organs or structures,and is characterized by a high incidence of postoperative complications and a high rate of positive surgical margin microscopy.It has been found that taking laparoscopic surgery for T4 colon cancer may decrease long-term survival and increase the rate of peritoneal metastasis,but taking laparoscopic surgery for colon cancer also has the potential advantages in increasing perioperative benefits and improving the prognosis.With the upgrade of laparoscopic equipment and the improvement of surgeons'surgical skills,more and more surgeons have adopted laparoscopic surgery to treat T4 colon cancer.Currently,the oncologic safety of laparoscopic surgery for T4 colon cancer has not been effectively evaluated.Therefore,this article reviews the advantages,risks,and the choice of treatment strategies for laparoscopic surgery for T4 colon cancer,taking into account the current status and progress of domestic and international studies.

Sympathetic cues via the adrenergic signaling critically regulate bone homeostasis and contribute to neurostress-induced bone loss, but the mechanisms and therapeutics remain incompletely elucidated. Here, we reveal an osteoclastogenesis-centered functionally important osteopenic pathogenesis under sympatho-adrenergic activation with characterized microRNA response and efficient therapeutics. We discovered that osteoclastic miR-21 was tightly regulated by sympatho-adrenergic cues downstream the β2-adrenergic receptor (β₂AR) signaling, critically modulated osteoclastogenesis in vivo by inhibiting programmed cell death 4 (Pdcd4), and mediated detrimental effects of both isoproterenol (ISO) and chronic variable stress (CVS) on bone. Intriguingly, without affecting osteoblastic bone formation, bone protection against ISO and CVS was sufficiently achieved by a (D-Asp₈)-lipid nanoparticle-mediated targeted inhibition of osteoclastic miR-21 or by clinically relevant drugs to suppress osteoclastogenesis. Collectively, these results unravel a previously underdetermined molecular and functional paradigm that osteoclastogenesis crucially contributes to sympatho-adrenergic regulation of bone and establish multiple targeted therapeutic strategies to counteract osteopenias under stresses.
Adrenergic Agents/pharmacology* ; Apoptosis Regulatory Proteins/pharmacology* ; Bone Diseases, Metabolic/metabolism* ; Humans ; Liposomes ; MicroRNAs/genetics* ; Nanoparticles ; Osteoclasts ; Osteogenesis/physiology* ; RNA-Binding Proteins/pharmacology*

At present, radiotherapy as an auxiliary treatment for rectal cancer is widely used in clinic. Although radiotherapy has significant effect on reducing tumor stage, improving anus preservation rate and less tumor recurrence, radiotherapy will damage the anal function and seriously affect the quality of life of patients. Anal sphincter plays an important role in anal function. There are three main damage effects of radiotherapy on anal sphincter: first, the increased deposition of collagen in internal anal sphincter (IAS); second, the destroyed ultrastructure of external anal sphincter (EAS); third, degenerative lesions of the perianal nerve. This article reviews these three points, in order to provide a certain theoretical basis for how to reduce the incidence of anal dysfunction caused by radiotherapy.

At present, radiotherapy as an auxiliary treatment for rectal cancer is widely used in clinic. Although radiotherapy has significant effect on reducing tumor stage, improving anus preservation rate and less tumor recurrence, radiotherapy will damage the anal function and seriously affect the quality of life of patients. Anal sphincter plays an important role in anal function. There are three main damage effects of radiotherapy on anal sphincter: first, the increased deposition of collagen in internal anal sphincter (IAS); second, the destroyed ultrastructure of external anal sphincter (EAS); third, degenerative lesions of the perianal nerve. This article reviews these three points, in order to provide a certain theoretical basis for how to reduce the incidence of anal dysfunction caused by radiotherapy.

OBJECTIVE： To provide scientific evidence for establishing perfect rationality evaluation indicator system of antibiotics. METHODS： On the basis of literature research， Delphi method was used to conduct several rounds of consultations on 30 experts in related fields with E-mail and questionnaire field investigation. After several rounds of consultations， rationality evaluation index system for antibiotics was determined. The effective recovery rate of expert consultation questionnaire was used to express the positive coefficient of experts； the authoritative coefficient was used to express the authoritative degree of experts； the index importance assignment and the full score ratio were used to reflect the concentration degree of experts’ opinions； the coefficient of variation and the coefficient of coordination were used to express the coordination degree of experts’ opinions. RESULTS & CONCLUSIONS： After two rounds of consultations， response rates of the questionnaire in two rounds of surveys were 100％ and 96.67％， indicating experts were highly motivated. The authoritative coefficients were 0.91 and 0.88， indicating experts had a high degree of authority. Finally， an evaluation index system for rationality of antibiotics was established， which included four first-level indicators （indications， drug selection， medication process， management indicators） and 35 second-level indicators. Among them， the mean value of importance scoring of first-level indicators ranged from 4.28 to 5.00， the full score ratio from 0.93 to 1.00， the coefficient of variation from 0.00 to 0.15 and the coefficient of coordination was 0.446 （P＜0.001）. While， the mean value of importance scoring of second-level indicators ranged from 3.83 to 4.79； the full score ratio from 0.67 to 1.00； variation coefficient from 0.10 to 0.26 and the coefficient of coordination was 0.115 （P＜0.001）， which indicating the system was reliable.

OBJECTIVE: To investigate the relationship between Toll-like receptor 4 (TLR4) and collateral circulation in patients with acute cerebral infarction (AIS) after thrombolytic therapy. METHODS: This retrospective, observational cohort study was conducted among 65 patients with AIS receiving thrombolytic therapy, who were divided according to findings by computed tomographic angiography (CTA) into good collateral circulation (group A, = 34) and poor collateral circulation (group B, = 31). Serum samples were collected from all the patients and the levels of TLR4 were measured with ELISA. RESULTS: The patients in group A had significantly better outcomes than those in group B. The NIHSS scores at 24 h and 30 days after thrombolytic therapy, mRS scores at 90 days and serum TLR4 levels were significantly lower in group A than in group B ( < 0.05); the percentages of patients with symptomatic intracerebral hemorrhage were comparable between the two groups. The serum levels of TLR4 were negatively correlated with the rMLC score ( < 0.05). Multivariate logistic regression analysis showed that a high level of TLR4 was associated with a poor collateral circulation after thrombolysis. CONCLUSIONS Good collateral circulation can increase the benefit of intravenous thrombolysis in patients with ACI, and the level of TLR4 is a predictive factor for the compensation of collateral circulation following ACI.
Biomarkers ; Brain Ischemia ; Cerebral Infarction ; Cerebrovascular Circulation ; Cohort Studies ; Collateral Circulation ; Fibrinolytic Agents ; Humans ; Retrospective Studies ; Stroke ; metabolism ; therapy ; Thrombolytic Therapy ; Toll-Like Receptor 4 ; metabolism ; Treatment Outcome

Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctor-patient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit (P＜0.05). The influencing factors of medical staff's satisfaction included the type of payment, work unit, and working years among others(P＜0.05). The influencing factors of farmers'satisfaction included the type of payment and the average annual income, etc(P＜0.05). Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients'understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation.