Although radiotherapy can improve the local control rate of tumors and prolong the survival period of patients, it can also lead to long-term adverse effects such as radiation-induced intestinal fibrosis. Radiation-induced intestinal fibrosis has a high incidence and poses significant challenges to treatment, severely impacting the quality of life of patients. Combining findings from domestic and international research, along with experiences of our center, this article mainly discusses the pathological changes of radiation-induced intestinal fibrosis, as well as the current status and challenges of pathological assessment and pharmacological prevention of this condition. At present, there is no definitive method to reverse the fibrotic pathological changes. Thus, the prevention of fibrosis is a crucial issue to be resolved. In the meantime, there is a lack of ideal assessment methods and effective preventive medications in clinical practice. It is necessary to enhance both basic and clinical research, thoroughly investigate the pathogenesis of the disease, and identify effective intervention targets to promote the diagnosis and treatment of radiation-induced intestinal fibrosis.

Although radiotherapy can improve the local control rate of tumors and prolong the survival period of patients, it can also lead to long-term adverse effects such as radiation-induced intestinal fibrosis. Radiation-induced intestinal fibrosis has a high incidence and poses significant challenges to treatment, severely impacting the quality of life of patients. Combining findings from domestic and international research, along with experiences of our center, this article mainly discusses the pathological changes of radiation-induced intestinal fibrosis, as well as the current status and challenges of pathological assessment and pharmacological prevention of this condition. At present, there is no definitive method to reverse the fibrotic pathological changes. Thus, the prevention of fibrosis is a crucial issue to be resolved. In the meantime, there is a lack of ideal assessment methods and effective preventive medications in clinical practice. It is necessary to enhance both basic and clinical research, thoroughly investigate the pathogenesis of the disease, and identify effective intervention targets to promote the diagnosis and treatment of radiation-induced intestinal fibrosis.

Objective:To explore effects of intervention based on story theory on self-management behavior and emotional state of patients with rectal cancer undergoing anus-preserving surgery.Methods:Using the convenient sampling method, a total of 80 patients with rectal cancer who underwent anus preserving surgery in Henan Provincial People's Hospital from January to September 2019 were selected as the research objects. The patients were randomly divided into 42 cases in the control group and 38 cases in the observation group. The patients in the control group adopted perioperative routine nursing methods for patients with rectal cancer, while patients in the observation group adopted an intervention program based on story theory at basis of the control group. Profile of Mood States-Short Form (POMS-SF) and Bowel Symptoms Self-Management Behaviors Questionnaire For Rectal Cancer Patients After Anus Preservation were used for evaluation.Results:In the end, the control group recovered 40 valid questionnaires and the observation group recovered 38 valid questionnaires. After intervention, scores of all dimensions of POMS-SF of the two groups were compared and the differences were statistically significant ( P<0.05) . In the observation group, scores of dimensions of stress-anxiety, depression-depression, anger-hostility, fatigue-dullness and bewilderment-disorder were lower than those of the control group, and the score of energy-vitality was higher than that of the control group. After intervention, there was no statistically significant difference in the score of treatment management dimension in Bowel Symptoms Self-Management Behaviors Questionnaire For Rectal Cancer Patients After Anus Preservation between the two groups ( P>0.05) . The scores of diet management, perianal skin management, seeking help from others and self-emotional adjustment in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Intervention based on story theory can effectively improve the emotional state of patients with rectal cancer undergoing anus-preserving surgery and improve dietary management, perianal skin management, seeking others' help and self-emotional regulation behaviors in patients' intestinal self-management behaviors, which has good clinical application values.

Objective: To explore the correlation between menopausal hormone therapy（MHT）and breast lesions in perimenopausal women,and to provide evidence for safe use of MHT. Methods: The 40-60 year-old women who visited Hangzhou Women's Hospital and met the diagnostic criteria for perimenopausal syndrome were recruited. The intervention group received MHT and was divided into three subgroups according to the MHT regimen：estrogen-progesterone cycle therapy（A）,estrogen-progesterone continuous therapy（B）,estrogen therapy（C）. The control group did not receive MHT. All the patients received regular mammography to quantify and evaluate breast lesions. The generalized estimating equation was used to analyze the changes of breast lesions between different groups. Results: There were 80 cases in the intervention group,with 49 in group A,26 in group B,5 in group C,and 80 cases in the control group. After two years of follow-up,there was no statistically significant differences of time,group and interaction in breast density,volume of breast fibrous tissue and the volume of breast between three intervention groups and the control group（P>0.05）; there was no statistically significant differences of group and interaction in positive rate of calcification and breast mass between the intervention group and the control group（P>0.05）. Conclusion Receiving MHT intervention for two years did not increase the risk of breast lesions.

Objective To investigate the effect of Zinc finger E-box binding homeobox protein 1 (ZEB1) on the radiosensitivity of gastric cancer cells AGS and its possible mechanism. Methods AGS cells were irradiated by X-rays at different doses (0, 2, 4, 6, and 8 Gy). Western blot was used to observe the expression of ZEB1 in cells. AGS cells, in logarithmic growth phase, were transfected with of ZEB1 gene or its interference plasmids, the corresponding control plasmids ( pcDNA3. 1 ) and negative control interference plasmids. They were classified as overexpression ZEB1 group, silencing ZEB1 group, control group and negative control group, respectively. The effect of overexpression and silencing ZEB1 on the survival of AGS cells after irradiation were analyzed by colony formation assay. The cell apoptosis rate was analyzed by flow cytometry. The expressions of histone H2A (H2AX), phosphorylated H2AX (γ-H2AX) and telangiectasia mutated gene (ATM) were detected by Western blot. Results The expression of ZEB1 in AGS cells was dependent on radiation dose (F=58. 57, P<0. 05). Overexpression of ZEB1 increased AGS cells viability, inhibitedγ-H2AX expression (t=12. 18, P<0. 05), blocked cell apoptosis (t=7. 27, P<0. 05) and up-regulated ATM expression in time-dependent manner after irradaition (F=165. 70, P <0. 05). Silencing ZEB1 reduced AGS cells viability, increased γ-H2AX expression ( t =12. 88, P<0. 05) and cell apoptosis (t =8. 36, P <0. 05), and down-regulated of ATM expression (F=44. 80, P<0. 05). Conclusions ZEB1 regulates the radiosensitivity of gastric cancer AGS cells by up-regulating ATM expression.

OBJECTIVE: To study the effects of telmisartan combined with finasteride on blood pressure rhythm (BPR) in non-dipper type hypertension patients with benign prostatic hyperplasia (BPH). METHODS: From Jul. 2015 to Dec. 2016, medical information of 190 patients with non-dipper type hypertension complicated with BPH were retrospectively collected from Halison International Peace Hospital, and then divided into control group (n=82) and observation group (n=108) according to therapy plan. Control group was given telmisartan 40 mg, qd; observation group was additionally given finasteride 5 mg, qd, on the basis of observation group. Both groups were treated for 12 months, and followed up once every 3 months. The changes of blood pressure (24 hSBP, 24 hDBP, 24 hPP, dSBP, dDBP, dPP, nSBP, nDBP, nPP), morning blood pressure surge, prostate volume, nocturia times, the changes of BPR (the rate of non-dipper type blood pressure change) were observed in 2 groups. The occurrence of ADR was observed. RESULTS: Before treatment, there was no statistical significance in blood pressure, morning blood pressure surge, prostate volume or nocturia times between 2 groups (P>0. 05). After treated for 3, 6, 12 months, blood pressure, morning blood pressure surge, prostate volume, nocturia times and the rate of non-dipper type blood pressure change in 2 groups were decreased significantly; the observation group was significantly lower than the control group, with statistical significance (P>0. 05). There was no statistical significance in the incidence of ADR between 2 groups (P>0. 05). CONCLUSIONS: Telmisartan combined with finasteride show significant effects on non-dipper hypertension complicated with BPH, effectively reduce the level of blood pressure, prostate volume, nocturia times and improve BPR with good safety. The effect of two-drug is better than that of telmisartan.

Objective To investigate the clinical application and efficacy of DNA immune absorption in patients with lupus interstitial pneumonia.Methods to collect randomized 18 patients with lupus patients with pneumonia were enrolled in the study and randomly divided into immunoadsorption group and traditional CTX treatment group,in order to observe the ESR,CRP,ANA quantitative monitoring at different time,pulmonary function test (diffusing capacity of the lung for carbon monoxide,DLCO),6 min walking distance,procalcitonin (PCT).The difference between groups was statistically analyzed and the effect of DNA immunization was discussed.Results There were significant differences between immunoadsorption group and control group in ESR at the different time points before and after the treatment (Fgroup =7.841,P＜0.05;Fcross =6.512,P ＜0.05;Finteraction =10.421,P＜0.05),CRP(Fgroup =6.995,P＜0.05;Fcross=5.847,P＜0.05;Finteraction =8.847,P＜ 0.05) and ANA quantitative monitoring (FgrouP =12.336,P ＜ 0.05;Fcross =11.214,P ＜ 0.05;Finteraction =15.847,P＜0.05).At 1 and 2 weeks after treatment,CRP and ESR of the immunoadsorption group began to decrease,and the difference was statistically significant compared with those before treatment (P ＜0.05),while the difference between the control group and the treatment group was statistically significant after 4 weeks (P＜0.05).After 2 weeks of treatment,there was a significant difference in ANA quantitative monitoring between the immunoadsorption group,compared with that before treatment.There was a significant difference between the control group before treatment and the 6 months after treatment (P＜0.05).There was a significant difference between the immunoadsorption group and the control group in pulmonary function test (FgrouP =6.222,P＜ 0.05:Fcross =7.154,P＜ 0.05:Finteraction =8.527,P ＜ 0.05),6 min walking distance (FgrouP =8.669,P＜ 0.05;Fcross =7.154,P ＜ 0.05;Finteraction =11.547,P＜ 0.05) and PCT (FgrouP =5.621,P ＜0.05;Fcross =4.125,P ＜ 0.05;Finteraction =7.554,P ＜ 0.05.The pulmonary function and 6 min walking distance of 2-week treatment in the immunoadsorption group.There showed a significant difference compared with that before treatment.The difference between the control group after 4 weeks of treatment and that before treatment was statistically significant (P=＜0.05).There was a significant difference between the 2 weeks PCT treatment in the immunoadsorption group and that before treatment (P＜0.05).There was a significant difference between the control group after 3 months of treatment and before treatment (P ＜ 0.05).Conclusion The treatment of lupus interstitial pneumonia in traditional regimens is ineffective,and the efficacy of DNA is better than that of conventional regimens,and reduces the risk of infection.

OBJECTIVE: To investigate the efficacy and safety of the bladder training in male patients before urinary catheter removal after mid-low rectal cancer surgery. METHODS: This was a prospective, open, randomized controlled study. INCLUSION CRITERIA: male patients; pathologically diagnosed as mid-low rectal adenocarcinoma; distance from tumor lower edge to anal margin ≤10 cm; standard radical surgery for rectal cancer, including intestinal resection and regional lymph node dissection. EXCLUSION CRITERIA: previous history of benign prostatic hyperplasia or history of prostate surgery; bladder dysfunction such as dysuria and urinary retention before surgery; local resection of rectal tumor or extended resection. According to the above criteria, 92 patients who underwent colorectal surgery at the Union Hospital of Fujian Medical University from June to December 2016 were prospectively included. The patients were randomly divided into bladder training group (n=43) and bladder non-training group (n=49) according to the random number table method. The study was approved by the Ethics Committee of the Union Hospital of Fujian Medical University (ethical approval number: 2016KY005) and registered with the China Clinical Trial Registration Center (ChiCTR) (registration No.ChiCTR-IOR-16007995). The implementation of patient's treatment measures, the data collection and analysis were based on the three-blind principle, using envelopes for distribution concealment. In the bladder training group, bladder training was routinely performed from the first day after operation to catheter removal, and in bladder non-training group the catheter was kept open till its removal. The catheter was removed in the early morning at the 5th day after surgery, and the spontaneous urine output was recorded and the residual urine volume of the bladder was measured after the first urination. The international prostate symptom score (IPSS) was applied to evaluate the patient's urinary function before and after surgery. RESULTS: The age of whole group was (58.6±10.9) years old, the body mass index was (22.4±2.7) kg/m , and the distance from tumor lower edge to anal margin was (6.5±1.9) cm. The baseline data, such as age, body mass index, distance from tumor lower edge to anal margin, preoperative IPSS score, preoperative bladder residual urine volume, neoadjuvant radiotherapy and chemotherapy, preventive ileostomy and surgical procedure were not significantly different between two groups (all P>0.05). There was no significant difference in IPSS scores evaluated at the second day (3.6±4.0 vs. 3.5±3.4, t=0.128, P=0.899) and one month (3.7±2.9 vs. 3.0±3.1, t=1.113, P=0.269) after catheter removal between the bladder training group and bladder non-training group. No significant difference in the postoperative residual urine volume of bladder (media 44 ml vs. 24 ml, Z=-1.466, P=0.143), the first spontaneous urination volume (median 200 ml vs. 150 ml, Z=-1.228, P=0.219) after catheter removal, and postoperative hospital stay [(8.2±4.5) days vs. (9.1±5.5) days, t=-0.805, P=0.423] was found. Urinary infection rate was 20.9%(9/43) in the training group, which was even higher than 8.2%(4/49) in the non-training group, but the difference was not significant(χ²=3.077, P=0.079). No patient needed re-catheterization in either group. CONCLUSIONS The routine bladder training after mid-low rectal cancer surgery does not improve the urinary function, and can not reduce the residual urine volume of bladder after catheter removal. This routine clinical practice is not helpful for the bladder function recovery after rectal cancer surgery.
Aged ; China ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Rectal Neoplasms ; surgery ; therapy ; Treatment Outcome ; Urinary Bladder ; surgery ; Urinary Retention ; therapy

Laparoscopic total mesorectal excision (TME) has been commonly applied in the operation of mid-low rectal cancer, but the conventional laparoscopic TME has the disadvantages of major operative difficulty and long learning-curve, due to its limitations of 2-dimension vision and common laparoscopic instruments. Robotic surgical system with high-qualified 3-dimenstion vision and flexible Endo Wrist instruments can overcome those limitations of conventional laparoscopy, and is useful for the TME that demands deep pelvic operation and flexible dissection in the space of distal rectum. Robotic TME has the advantages of shorter learning curve and lower conversion rate, and it can even be performed by the surgeon with little laparoscopic experience. But according to the current studies, the superiority of robotic TME over laparoscopic TME can not be confirmed. To confirm the efficacy of robotic surgery, more high-level evidences are needed. Currently, the biggest obstacle for the widespread use of robotic surgical system is its high expense. But there is an obvious advantage that is the more comfortable feeling of surgeon while performing robotic surgical system, compared with performing laparoscopic operation, and it is helpful for long-time complicated operation. It is confirmative that robotic operation is the results of science and technology development, and it is the direction of future development. With the expiration of patent right of Da Vinci robotic system, there will be more kinds of robotic surgical systems which will lead to the much lower operation expense and the widespread use. The young surgeons should master the laparoscopic TME, which will help them master robotic TME technique quickly.

Objective To analyze the values of anteroposterior diameter (APD) in fetal renal pelvis separation during different gestational weeks and in predicting the prognosis.Methods Totally 182 cases of fetal renal pelvis separation in the Second Affiliated Hospital of Soochow University were enrolled in this study between January 2013 and October 2015.All of them were followed up to 12 months after birth.The detecting gestational weeks of non-reversible renal hydronephrosis and values of fetal renal pelvis APD were analyzed.Results Among the 182 cases of fetal renal separation,46 cases were detected in the second trimester,136 cases were detected in the third trimester (bilateral renal pelvis separation occurred in 92 cases).During the follow-up,114 cases recovered in the fetal period and 52 cases recovered within 12 months after birth,finally,16 cases (8.8％,16/182) of them progressed to non-reversible renal hydronephrosis.Among the 16 fetus of non-reversible renal hydronephrosis,10 cases (62.5％,10/16) were detected in the second trimester,their values of APD were 7.4-11.5 mm and the average was (8.0± 1.5) mm;6 cases (37.5％,6/16) were detected in the third trimester,their values of APD were 13.6-14.8 mm and the average was (12.8±2.0) rmm.The values of APD in fetus who were detected in the second trimester were smaller than those in the fetus who detected in the third trimester and the prognosis in the fetus who were detected in the second trimester was worse than those in the fetus who were detected in the third trimester,the fetus (21.7％,10/46) who progressed to non-reversible renal hydronephrosis in the second trimester were more than the fetus (4.4％,6/136) who were detected in the third trimester.Conclusion Clinical following-up combined with the detecting gestational weeks of fetal renal pelvis separation and values of fetal renal plevis APD by prenatal ultrasound may be helpful in predicting their prognosis.