Colorectal cancer peritoneal metastasis (CRC-PM) is a prevalent and intractable late-stage complication of colorectal cancer with extremely poor prognosis. Inspired by distinctive pathology of PM tumors from CRC-PM patients, including upregulation of ferredoxin 1 (FDX1) and lipoyl synthase (LIAS), high glutathione (GSH) level and dense stroma, a cuproptosis-potentiating nanotherapeutics (designated PGd-MC) was rationally designed with efficient tumor-penetrating and GSH-depleting ability, aiming to amplify cuproptosis-mediated cell death for CRC-PM treatment. PGd-MC exhibited robust intratumoral penetration in murine and patient-derived xenograft (PDX)-PM models, and produced a 72.68% and 81.82% inhibition of PM progression, ultimately resulting in a 1.98-fold and 1.72-fold survival prolongation, outperforming the clinical standard FOLFIRI regimen. Collectively, the pathology-inspired PGd-MC provides a promising therapeutic strategy for CRC-PM treatment.

Background and Objective: Colorectal cancer (CRC), a leading global malignancy, continues to challenge the medical community. Despite advancements in surgical, chemotherapeutic, radiation, targeted, and immunotherapeutic strategies, issues like resistance and side effects persist. This review illuminates the potential of ferroptosis, an emerging non-apoptotic cell death form, and graphene oxide (GO), with its distinctive physicochemical properties, in CRC therapy. Methods: The databases search included PubMed, Medline and Web of Science. Search terms focused on CRC, graphene, GO, ferroptosis, and related aspects in therapy and drug delivery. The time frame for literature retrieval was up to April 2024. Studies in languages other than English were excluded. Key Content and Findings: Ferroptosis has been recognized for its role in addressing treatment resistance, a notable hurdle in effective CRC management. This form of cell death offers a promising avenue for enhancing the effectiveness of existing treatments. However, understanding its mechanisms and clinical implications in CRC remains an area of active research, with significant progress required for its practical application. Simultaneously, GO, a versatile two-dimensional material, has demonstrated substantial potential in biomedical applications, especially in cancer therapy. Its high specific surface area and unique it-electron domains facilitate the effective binding of chemotherapy drugs, target genes, and photosensitizers. This makes GO a promising candidate in cancer diagnosis and treatment, particularly through tumor photothermal and photodynamic therapy (PDT). Despite these advancements, GO's clinical application faces challenges, including in vitro cytotoxicity and decreased biodegradability, necessitating further research. Conclusions: This review focuses on the characteristics of GO and ferroptosis, as well as their applications in tumor diagnosis and treatment, with a particular emphasis on their potential in CRC.

The purpose of this study was to explore the effect of electroacupuncture (EA) at Baliao point on short-term complications, such as anal pain and swelling, after procedure for prolapse and hemorrhoids (PPH) in patients with mixed hemorrhoids. A total of 124 eligible patients undergoing PPH surgery were included in this study and randomly divided into a control group (n = 67) and an EA group (n = 57), with patients in the control group receiving only PPH surgery and patients in the EA group receiving PPH surgery and EA at Baliao point. The visual analogue scale (VAS) scores of EA group at 8, 24, 48, and 72 h after operation were significantly lower than those of control group. The anal distension scores at 8, 48, and 72 h after operation were also significantly lower than those of control group. The number of postoperative analgesic drug administration per patient was also significantly lower in the EA group. The incidence of urinary retention and tenesmus in EA group was significantly lower than that in control group within the first day after surgery. EA treatment at the Baliao point can alleviate short-term anal pain and anal swelling after the procedure for prolapse and hemorrhoids, reduce the incidence of urinary retention, and decrease the use of postoperative analgesic drugs. This study was approved and registered by the Chinese Clinical Trial Center, Registration number: ChiCTR2100043519, Registration time: February 21, 2021 ( https://www.chictr.org.cn/ ).

Background: Graphene oxide (GO) has been widely used in the field of biomedicine and has shown great potential in drug delivery. Oral administration is an important mode of administration, but there are few studies on the effects of oral GO on gastrointestinal tract and gut microbiota. This study sought to explore the effects of oral GO on the gastrointestinal tract and gut microbiota. Methods: In total, 20 C57BL/6 male mice, aged 5 weeks old, were randomly divided into the following 4 groups (n=5): the control group, the GO30 group, the GO60 group, and the GO120 group. The GO sample solution was administered intragastrically at the doses of 30, 60, or 120 mg/kg every 3 days, and the control group was given an equal volume of distilled water. On the 16th day, mouse feces were taken for 16S ribosomal ribonucleic acid (rRNA) sequencing analysis, and the mice were dissected, and the heart, liver, kidney, and colon removed for histological analysis. Additionally, the ultrastructure of the colon was observed by transmission electron microscopy. Results: No obvious damage was observed in the hearts, livers, and kidneys of the mice. However, the intestinal ultrastructure of the mice in the GO group was damaged. The main manifestations were an uneven arrangement and local atrophy of the microvilli, swelling of the mitochondria and endoplasmic reticulum, and the widening of the intercellular spaces. The damage was positively correlated with increasing GO doses. The 16S rRNA sequencing results showed that the structure of the gut microbiota in the GO group was altered, and the contents of Alistipes, Enterobacteriaceae, Eubacterium, and Xanthobacteraceae were decreased. Conclusions: The oral administration of GO had no obvious toxicity effects on the hearts, livers, and kidneys of the mice. However, it did destroy the ultrastructure of the mouse colon and shift the structure of the gut microbiota, decreasing the contents of Alistipes, Enterobacteriaceae, Eubacterium, and Xanthobacteraceae.

Aim: To investigate the anticancer effects and action mechanism of graphene oxide (GO) in colorectal cancer (CRC). Materials & methods: Anticancer effects and mechanisms of GO in CRC were investigated both in vivo and in vitro. Results: GO significantly inhibited tumor growth both in vitro and in vivo. GO was able to enter HCT116 cells through endocytosis. GO treatment resulted in cytotoxicity, reactive oxygen species (ROS) production, apoptosis, autophagy and activation of the AMPK/mTOR/ULK1 signal pathway. However, ROS scavenger N-acetylcysteine (NAC) attenuated the above effects and restored the effects of GO on protein expressions related to apoptosis, autophagy and AMPK/mTOR/ULK1 signal pathways. Conclusion: GO exerts anticancer effects against CRC via ROS-dependent AMPK/mTOR/ULK-1 pathway-related autophagy and apoptosis.

Transanal minimally invasive surgery (TAMIS) is mainly used for benign tumors of the rectum, but there are few reports on treating malignant tumors of the rectum with a large volume. The aim of this study was to evaluate the feasibility and safety of TAMIS for resection of rectal malignant tumors. A 57-year-old patient was pathologically diagnosed as rectal malignancy before surgery. Computed tomography (CT), magnetic resonance imaging (MRI), fludeoxyglucose-18F (18F-FDG), and endoscopic mucosal biopsy were performed to assess the tumor location and preoperative size. There were no contraindications in all preoperative examinations. We applied TAMIS technology to perform the operation on this patient, And the operative time, the amount of blood loss, the length of hospital stay, the cost of hospital stay, surgical complications, postoperative complications and other relevant data were all collected. The operation was successful, the operation time was 45 min, 10 mL of intraoperative blood loss, and the length of stay was 3 days, a tumor of a maximum diameter of 4 cm being completely removed. There were no related complications or recurrence during postoperative follow-up. The pathological results were tubular villous adenoma with low-grade intraepithelial neoplasia, and a focal area of high-grade intraepithelial neoplasia. The pathological stage was T1N0M0. At 3-month follow-up there were no signs of recurrence. The patient was followed up for 5 years after the operation and there was no tumor recurrence or metastasis in other parts and no other discomfort. TAMIS is less commonly used in rectal malignancies, especially for tumors with larger diameters. We successfully performed complete resection of a 4-cm rectal malignant tumor with TAMIS. Given its low risk, low cost, simple operation, and few complications, TAMIS can be used for more indications of rectum diseases.

BACKGROUND Transanal minimally invasive surgery (TAMIS) is a good choice for resection of rectal neoplasms. Endoscopic mucosal resection (EMR) is also widely used in the treatment of benign rectal tumors such as rectal polyps and rectal adenomas. However, no studies have compared the outcome of TAMIS and EMR. AIM To compare the short-term outcomes after TAMIS and EMR for rectal carcinoid and benign tumors (including rectal polyps and adenomas). METHODS From January 2014 to January 2019, 44 patients who received TAMIS and 53 patients who received EMR at The Fifth People’s Hospital of Shanghai were selected. Primary outcomes (surgical-related) were operating time, blood loss, length of postoperative hospital stay, rate of resection margin involvement and lesion fragmentation rate. The secondary outcomes were complications such as hemorrhage, urinary retention, postoperative infection and reoperation. RESULTS No significant differences were observed in terms of blood loss (12.48 ± 8.00 mL for TAMIS vs 11.45 ± 7.82 mL for EMR, P = 0.527) and length of postoperative hospital stay (3.50 ± 1.87 d for TAMIS vs 2.72 ± 1.98 d for EMR, P = 0.065) between the two groups. Operating time was significantly shorter for EMR compared with TAMIS (21.19 ± 9.49 min vs 49.95 ± 15.28 min, P = 0.001). The lesion fragmentation rate in the EMR group was 22.6% (12/53) and was significantly higher than that (0%, 0/44) in the TAMIS group (P = 0.001). TAMIS was associated with a higher urinary retention rate (13.6%, 6/44 vs 1.9%, 1/53 P = 0.026) and lower hemorrhage rate (0%, 0/44 vs 18.9%, 10/53 P = 0.002). A significantly higher reoperation rate was observed in the EMR group (9.4%, 5/53 vs 0%, 0/44 P = 0.036). CONCLUSION Compared with EMR, TAMIS can remove lesions more completely with effective hemostasis and lower postoperative hemorrhage and reoperation rates. TAMIS is a better choice for the treatment of rectal carcinoids.

目的 探讨AirSeal智能气腹系统在腹腔镜直肠癌根治手术中的应用价值.方法 将2017年7月～2019年6月80例腹腔镜直肠癌根治手术,随机分为AirSeal组和对照组各40例,AirSeal组应用AirSeal智能气腹系统,对照组应用常规气腹机,比较2组术中擦镜次数、盆腔自主神经显示情况、手术时间、术中出血量、淋巴结清扫个数、术中动脉血气变化、肛门排气时间、腹腔引流量和并发症.结果 均成功完成手术,无严重并发症和死亡.术中擦镜次数AirSeal组更少[(8.3±2.5)次vs.(12.8±3.7)次,t=-7.686,P=0.000],盆神经丛显示例数AirSeal组更多(25例vs.14例,χ2=6.054,P=0.014),低位直肠癌手术时间AirSeal组更短[Dixon:(105.4±17.4)min vs.(136.8±25.6)min,t=-4.536,P=0.000;Miles:(145.2±17.6)min vs.(186.3±31.5)min,t=-2.829,P=0.016],术中动脉血气指标pH值、PaCO2、PaO2、BE和HCO3-2组差异无显著性(P>0.05).2组术中出血量、淋巴结清扫个数、肛门排气时间、术后腹腔引流量和术后并发症均无显著差异(P>0.05).结论 AirSeal智能气腹系统在腹腔镜直肠癌根治手术中能及时排出术中烟雾,减少术中擦镜次数,保持镜头清晰,缩短低位直肠癌腹腔镜手术时间,有一定的临床应用价值.

目的 探讨针灸联合生物反馈治疗直肠癌保肛术后排便失禁的效果.方法 2016年1月1日至2018年6月30日,本院收治的直肠癌保肛根治术后患者226例,筛选出排便失禁者120例,随机分为对照组(n=40)、针灸组(n=40)和观察组(n=40).术后1个月,三组均接受提肛锻炼,另外,针灸组接受针灸治疗,观察组接受针灸联合生物反馈治疗,共3个月.治疗前,治疗1、2、3个月分别检测各组大便失禁克利夫兰评分(CCF-FIS)、肛门直肠压力、盆底表面肌电和生活质量评分.结果 治疗前,三组CCF-FIS、肛门直肠压力、盆底表面肌电和生活质量评分均无显著性差异(F<2.943,P>0.05).治疗后,三组CCF-FIS均下降,肛门直肠压力、盆底表面肌电和生活质量评分均明显改善(F>5.235,P<0.01);不同时间点,针灸组和观察组各指标均优于对照组(P<0.05),观察组优于针灸组(P<0.05).观察组治疗1个月疗效与肿瘤位置高低有关(χ2=5.230,P<0.05),治疗后各时间点疗效与术中是否行盆腔自主神经保存术(χ2>5.657,P<0.05)、术后是否增加放疗(χ2>4.329,P<0.05)有关.治疗结束后3个月随访时,观察组复发率(8.6％)低于针灸组(35.7％)和对照组(35.0％)(χ2>5.976,P<0.05),三组均未发生并发症.结论 针灸联合生物反馈治疗可改善直肠癌保肛患者术后排便失禁症状,促进肛门功能康复.

目的:比较左、右手打结训练对腹腔镜下打结操作的影响.方法:选择2017年11月—2018年10月不同医学院校实习生32人,分为左手打结组(左手组)16人和右手打结组(右手组)16人,经临床三个阶段的培训后,比较两组培训前后腹腔镜打结时间、打结质量及打结方法得分.结果:培训前,左手组打结时间为590.50 s,少于右手组的590.50 s(P<0.05),打结得分为2.25分,高于右手组的2.00分,但组间差异无统计学意义(P>0.05).培训后,两组打结时间、打结得分差异均无统计学意义(P>0.05),但均优于培训前.结论:左手打结训练对于掌握腹腔镜打结有一定的临床实践价值和指导意义.

Objective To explore the effect of curcumin on intestinal flora in mice, as well as anti-cancer mechanisms and targets by monitoring the changes of intestinal flora during the development of colorectal cancer in mice. Methods Twenty-five 6-week-old C57BL/6 mice were randomly divided into basic diet group (BD) with 5, AOM/DSS model group (MO) with 10, and curcumin intervention model group (CU) with 10. DNA extraction and high-throughput microbiota sequencing were carried out before the experiment and before the execution. Results There was no significant difference in the diversity index of mice in each group at point T1 (before intervention), and the diversity index of MO group at point T2 (after intervention) was higher than that of the other 2 groups, with a significant difference from BD group (t=2.73, P=0.02) and no significant difference from CU group. The diversity index of each group at T2 was significantly higher than that at T1, in which the diversity index of CU group and BD group were more similar at T2, and were all smaller than the MO group. Before and after the molds were made, the flora of the genus changed greatly, and the intestinal flora of the CU group changed less than that of the MO group, especially the Bacteroidetes and Verrucomicrobia. The average weight increment of MO mice was lower than that of CU group, and the number of tumor formation and tumor volume of colorectal tumors in CU group were significantly lower than that of MO group. Conclusion Curcumin can maintain the stability of intestinal flora and reduce the incidence of intestinal tumor in mice during the occurrence of colorectal cancer, which indicating that it is possible one of the mechanisms to inhibit the occurrence and development of colorectal cancer. Key words: Colorectal neoplasms; Curcumin; Gut microbiota; Sequencing

To investigate acupuncture and electro-acupuncture for the recovery of pelvic autonomic nerve in patients with rectal cancer after anus-preserving operation, 120 patients with rectal cancer had anus-preserving operation at the Department of General Surgery in the Fifth People's Hospital of Shanghai Affiliated to Fudan University. They were enrolled between 1 st October-2015 and 30 th June-2017, and were randomly divided into experimental and control groups (60 each). Patients in experimental group were treated with acupuncture and electro-acupuncture. Patients in control group were treated with levator ani exercise. After early stage therapy of acupuncture and electro-acupuncture, the recovery time of patients bowel sound in experimental group and control group were 52.6±4.9 hours versus 66.3±6.4 hours (t=13.17, P<0.05), the recovery time was reduced by about 20% in experimental group. The first exhaust time were 60.5±5.7 hours versus 70.3±7.1 hours (t=8.337, P<0.05), the recovery time was reduced by about 10%. The catheter removal-time 5.5±1.3 days versus 7.1±1.4 days (t=6.487, P<0.05), the recovery time was reduced by about 20%. After late stage therapy of acupuncture and electro-acupuncture, fecal incontinence Wexner score, anorectal pressure, pelvic-floor electromyography, urodynamic index, male sexual function and quality of Life Questionnaire-Colorectal Cancer 29 (QLQ-CR29) in experimental group were improved about 2 months ahead of time in comparison with those in control group. So, the therapy of acupuncture and electro-acupuncture can promote the functional recovery of pelvic autonomic nerve after anus-preserving operation.

Aberrant activation of beta-catenin/TCF (T-cell factor) signaling is frequently observed in the pancreatic cancer. However, the regulation of nuclear beta-catenin/TCF transcription machinery remains largely unknown. In this study, TFCP2 (transcriptional factor CP2) expression in pancreatic cancer was detected by qPCR, immunohistochemistry and western blot. Western blot, colony formation assay, migration and invasion experiment were performed to investigate the effects of TFCP2 on the growth and migration of pancreatic cancer cells. In vivo, mouse metastasis models were utilized to determine metastasis ability. Western blots were used to evaluate the related protein expression. Luciferase reporter assay was used to explore the role of TFCP2 on beta-catenin/TCF signaling. We have shown that the transcription factor TFCP2 was up-regulated in the pancreatic cancer. Over-expression of TFCP2 promoted the growth, migration, invasion and colony formation of pancreatic cancer cells, while knocking down the expression of TFCP2 inhibited the growth, migration, invasion, colony formation and metastasis of pancreatic cancer cells. The mechanism study revealed that TFCP2 interacted beta-catenin, enhanced the interaction between beta-catenin and TCF4, and activated beta-catenin/TCF signaling. Taken together, our study demonstrated the oncogenic roles of TFCP2 in pancreatic cancer, and suggested that TFCP2 might be a target for the treatment of pancreatic cancer.

AIM To evaluate the impact of recombinant Bacteroides fragilis enterotoxin-2 (BFT-2, or Fragilysin) on colorectal tumorigenesis in mice induced by azoxymethane/dextran sulfate sodium (AOM/DSS). METHODS Recombinant proBFT-2 was expressed in Escherichia coli strain Rosetta (DE3) and BFT-2 was obtained and tested for its biological activity via colorectal adenocarcinoma cell strains SW-480. Seventy C57BL/6J mice were randomly divided into a blank (BC; n = 10), model (AD; n = 20), model + low-dose toxin (ADLT; n = 20, 10 μg), and a model + high-dose toxin (ADHT; n = 20, 20 μg) group. Mice weight, tumor formation and pathology were analyzed. Immunohistochemistry determined Ki-67 and Caspase-3 expression in normal and tumor tissues of colorectal mucosa. RESULTS Recombinant BFT-2 was successfully obtained, along with its biological activity. The most obvious weight loss occurred in the AD group compared with the ADLT group (21.82 ± 0.68 vs 23.23 ± 0.91, P < 0.05) and the ADHT group (21.82 ± 0.68 vs 23.57 ± 1.06, P < 0.05). More tumors were found in the AD group than in the ADLT and ADHT groups (19.75 ± 3.30 vs 6.50 ± 1.73, P < 0.05; 19.75 ± 3.30 vs 6.00 ± 2.16, P < 0.05). Pathology showed that 12 mice had adenocarcinoma and 6 cases had adenoma in the AD group. Five mice had adenocarcinoma and 15 had adenoma in the ADLT group. Four mice had adenocarcinoma and 16 had adenoma in the ADHT group. The incidence of colorectal adenocarcinoma in both the ADHT group and the ADHT group was reduced compared to that in the AD group (P < 0.05, P < 0.05). The positive rate of Ki-67 in the ADLT group and the ADHT group was 50% and 40%, respectively, both of which were lower than that found in the AD group (94.44%, P < 0.05, P < 0.05). Caspase-3 expression in the ADLT group and the ADHT group was 45% and 55%, both of which were higher than that found in the BC group (16.67%, P < 0.05, P < 0.05). CONCLUSION Oral administration with lower-dose biologically active recombinant BFT-2 inhibited colorectal tumorigenesis in mice.

AIM To investigate the effect of epigallocatechin gallate (EGCG) on structural changes of gut microbiota in colorectal carcinogenesis. METHODS An azoxymethane (AOM)/dextran sodium sulfate (DSS)-induced colitis mouse model was established. Forty-two female FVB/N mice were randomly divided into the following three groups: group 1 (10 mice, negative control) was treated with vehicle, group 2 (16 mice, positive control) was treated with AOM plus vehicle, and group 3 (16 mice, EG) was treated with AOM plus EGCG. For aberrant crypt foci (ACF) evaluation, the colons were rapidly took out after sacrifice, rinsed with saline, opened longitudinally, laid flat on a polystyrene board, and fixed with 10% buffered formaldehyde solution before being stained with 0.2% methylene blue in saline. For tumor evaluation, the colon was macroscopically inspected and photographed, then the total number of tumors was enumerated and tumor size measured. For histological examination, the fixed tissues were paraffin-embedded and sectioned at 5 mm thickness. Microbial genomic DNA was extracted from fecal and intestinal content samples using a commercial kit. The V4 hypervariable regions of 16S rRNA were PCR-amplified with the barcoded fusion primers. Using the best hit classification option, the sequences from each sample were aligned to the RDP 16S rRNA training set to classify the taxonomic abundance in QIIME. Statistical analyses were then performed. RESULTS Treatment of mice with 1% EGCG caused a significant decrease in the mean number of ACF per mouse, when compared with the model mice treated with AOM/DSS (5.38 ± 4.24 vs 13.13 ± 3.02, P < 0.01). Compared with the positive control group, 1% EGCG treatment dependently decreased tumor load per mouse by 85% (33.96 ± 6.10 vs 2.96 ± 2.86, respectively, P < 0.01). All revealed that EGCG could inhibit colon carcinogenesis by decreasing the number of precancerous lesions as well as solid tumors, with reduced tumor load and delayed histological progression of CRC. During the cancerization, the diversity of gut microbiota increased, potential carcinogenic bacteria such as Bacteroides were enriched, and the abundance of butyrate-producing bacteria (Clostridiaceae, Ruminococcus, etc.) decreased continuously. In contrast, the structure of gut microbiota was relatively stable during the intervention of EGCG on colon carcinogenesis. Enrichment of probiotics (Bifidobacterium, Lactobacillu, etc.) might be a potential mechanism for EGCG’s effects on tumor suppression. Via bioinformatics analysis, principal coordinate analysis and cluster analysis of the tumor formation process, we found that the diversity of gut microbiota increased in the tumor model group while that in the EGCG interfered group (EG) remained relatively stable. CONCLUSION Gut microbiota imbalance might be a potential mechanism for the prevention of malignant transformation by EGCG, which is significant for diagnosis, treatment, prognosis evaluation, and prevention of colorectal cancer.

神经内分泌肿瘤，最初被称为类癌，是起源于弥散神经内分泌系统中的神经内分泌细胞的肿瘤，在全部恶性肿瘤中的比例不足1%，多见于消化道。消化道神经内分泌肿瘤是一种低度恶性肿瘤，可发生在消化道任何部位，有文献报道小肠与直肠是消化道神经内分泌肿瘤中最常见的发病部位。由于胃肠道神经内分泌肿瘤在临床发展过程中几乎无症状，所以有三分之二的患者在确诊时已发生远处转移，但5年存活率可超过60%。随着对神经内分泌肿瘤的研究不断深入，检测方法多样，近年来其发病率有很大幅度增加。本文报道1例直肠神经内分泌肿瘤伴肝转移的诊治过程，并对诊断和治疗直肠神经内分泌肿瘤的文献进行复习。

Objective: To compare the clinical effects among three techiques [ruiyun procedure for hemorrhoids(RPH) combined with Milligan-Morgan(M-M) , procedure for prolapse and hemorrhoids(PPH) and M-M] in the treatment of severe hemorrhoids.Methods: Three hundred patients with severe hemorrhoids were enrolled from Jan. 2011 to June 2012 and randomly divided into R-M group, PPH group and M-M group with 100 each. The curative effect, hospital stay, wound recovery time, postoperative pain, postoperative complication, surgery impact on the kinetics of the anal canal, cost of treatment, relapse rate and the satisfaction were compared among the three groups.Results: All three groups had achieved successful operation. There were no signiifcant differences in the effective rate of surgery among the three groups (P>0.05). The postoperative hospital stay of (4.2±2.3) d was found in the R-M group and (3.8±2.4)d in the PPH group, both were lower than (7.5±2.6)d in the M-M group(P<0.05). The wound healing time of (10.5±4.6)d was found in the PPH group which was shorter than that in the R-M group[(20.6±7.5)d] and the M-M group[(27.6±8.3)d](P<0.05). The visual analogue pain score in a period of 3 hrs after operation in the PPH group was lower than that in the R-M group and the M-M group(P<0.05). Postoperative complication was 16.0% in the R-M group which was lower than that in the PPH group(28.0%)and M-M group(30.0%,P<0.05). The increased values of anal resting pressure and systolic pressure after operation in the M-M group were higher than those in the R-M group and the PPH group(P<0.05). The rectal sensory threshold and the decreased value of defecation in PPH group were superior to those in the R-M group and the M-M group(P<0.05). The treatment cost of the M-M group was less than the R-M group and the PPH group(P<0.05). The relapse rate of the R-M group was lower than that of the PPH group and the M-M group(P<0.05). The satisfaction of the R-M group was higher than that of the PPH group and the M-M group(P<0.05).Conclusion: RPH combined with M-M or PPH is an effective way to treat severe hemorrhoid. RPH combined with M-M has been proved as simple, less invasive and less complications, while RPH combined with PPH has some advantages such as less pain, faster recovery and less impact on function of the anus.

骶尾部畸胎瘤是来源于尾骨的由3个胚层构成的先天性肿瘤，多见于婴幼儿患者，男女比例约1∶10，在成人中较为罕见，文献报道甚少。发生于成人中的多为腹腔内畸胎瘤，凸出于体外的巨大畸胎瘤甚为罕见。本文报道1例巨大外生型骶尾部畸胎瘤，并进行相关文献复习。

TRAIL is a tumor-selective apoptosis-inducing cytokine playing a vital role in the surveillance and elimination of some tumor cells. However, some tumors are resistant to TRAIL treatment. Proteasome inhibitor MG132 exhibits anti proliferative and pro-apoptotic properties in many tumors. In this study, we demonstrated that proteasome inhibitor MG132 in vitro and in vivo potentiates TRAIL-induced apoptosis in gallbladder carcinoma GBC-SD cells. MG132 was able to inhibit the proliferation of GBC-SD cells and induce apoptosis in a dose-dependent manner. The induction of apoptosis by proteasome inhibitor MG132 was mainly through the extrinsic apoptotic pathways of caspase activation such as caspase-8, caspase-3 and PARP cleavage. In addition, this process was also dependent on the upregulation of death receptor 5 (DR5), which promoted TRAIL-induced apoptosis in GBC-SD cells. Taken together, these findings indicate that MG132 possesses anti-gallbladder cancer potential that correlate with regulation of DR5-dependent pathway, and suggest that MG132 may be a promising agent for sensitizing GBC-SD cells to TRAIL-induced apoptosis.

The effect of hyperthermic carbon dioxide (CO2) pneumoperitoneum in combination with 5-fluorouracil (5-FU) on the proliferation and invasion of colon cancer was explored. Colon cancer cell line SW-480 was sealed into the urine collection bag to simulate pneumoperitoneum with 100% CO2 under a pressure of 12 mmHg. The cells were divided into group A, CO2 at 37 degrees C; group B, CO2 at 43 degrees C; group C, 5-FU; group D, CO2 at 37 C+5-FU; group E, CO2 at 43 degrees C+5-FU; and control groups under normal culture conditions. The cell proliferation was assessed by CCK-8 test; the cell apoptosis was tested by FACS analysis; the cell invasion was examined by Transwell assay; the expression of HSP-70, caspase-3, HIF-la and MMP-9 proteins and genes were detected by western blot analysis and RT-PCR. The SW-480 cells were injected into nude mouse cecum subserosal to establish a colon cancer model. We applied 43 degrees C CO2 pneumoperitoneum or 5-FU intraperitoneal chemotherapy to intervene, detected the transplantation tumor growth and metastasis. The cell proliferation was inhibited in groups B, C, D and E, apoptosis was induced in groups B, C, D and E, the Transwell cell number decreased in groups B, C, D and E, the transplantation tumor weight and metastasis rate were inhibited in groups B, C, D and E, but all not in group A. The most significant change was observed in group E. Hyperthermic CO2 pneumoperitoneum was able to reinforce the inhibition of 5-FU on proliferation and invasion of colon cancer.