Colorectal cancer poses a global burden, and colonoscopy is an effective screening tool, with unsedated colonoscopy offering distinct advantages but facing completion challenges. A retrospective analysis of 745 patients who underwent unsedated colonoscopy between July 2021 and August 2022 was conducted, with participants divided into completion (n = 670) and incompletion (n = 75) groups. Univariate analysis revealed significant differences in gender, age, constipation history, anxiety grade, postoperative Visual Analogue Scale scores and examiner experience between groups. Multivariate logistic regression identified constipation (odds ratio [OR] = 4.981, 95% confidence interval [CI]: 2.755-5.633), high anxiety (OR = 8.499, 95% CI: 4.987-10.212) and examination by a less-experienced physician (OR = 3.319, 95% CI: 2.673-4.732) as independent risk factors. The constructed nomogram model demonstrated good predictive accuracy (Hosmer-Lemeshow test: χ2 = 4.561, p = 0.683) and discriminative ability (area under the receiver operating characteristic curve = 0.886, 95% CI: 0.749-0.970). This model enables clinicians to identify high-risk patients preoperatively, optimise examination plan selection (e.g. recommending sedation) or implement intensive interventions, thereby improving the completion rate of unsedated colonoscopy and enhancing patient experience.

BACKGROUND Complex anal fistulas (AFs) frequently require extensive surgical excision, leading to large, slow-healing wounds that significantly affect the quality of life. Therefore, the optimization of the postoperative wound microenvironment to accelerate healing is an urgent clinical priority. AIM To evaluate the clinical efficacy and mechanism of modified Hu-Lian-Bi-Guan decoction (mHLBGD) in promoting postoperative wound healing for complex AF. METHODS In this randomized controlled trial, 56 adults with complex AF were randomly assigned (1:1) to receive standard surgical care (control group, n = 28) or standard care with oral mHLBGD (treatment group, n = 28) for 14 days. Clinical outcomes included wound healing rate, Visual Analog Scale, wound exudate, wound edema, and Wexner incontinence scores, and complete healing time. Mechanistically, paired tissue samples were analyzed to assess the expression of inflammatory cytokines, TGF-beta/Smad pathway components, and epithelial-mesenchymal transition (EMT) markers. RESULTS Baseline characteristics were comparable between the two groups. The mHLBGD group demonstrated a significantly shorter median time to complete wound healing than the control group (32 days vs 50 days; P < 0.001), and achieved higher wound healing rates at all postoperative follow-ups. Postoperative pain, wound exudate, and edema scores were significantly lower in the mHLBGD group (P < 0.001) with no adverse effects on continence. Per histological analysis, mHLBGD treatment significantly diminished inflammatory infiltration, edema, and hemorrhage while enhancing granulation tissue maturation and promoting reparative epithelial proliferation. At the molecular level, mHLBGD treatment significantly downregulated the expression of IL-1 beta, IL-6, TGF-beta, Smad2, N-cadherin, and vimentin, and upregulated E-cadherin by day 14 compared to controls. CONCLUSION Oral mHLBGD effectively accelerates postoperative wound healing in complex AF by reducing local inflammation and TGF-beta/Smad signaling pathway regulation to inhibit pathological EMT, suggesting its potential for improving recovery post-surgery.

BACKGROUND:The occurrence and development of intestinal diseases are closely related to intestinal metabolic disorders. PURPOSE:This study focuses on the metabolic analysis of intestinal diseases under nutritional intervention as the core perspective, aiming to construct a prediction model for the tolerance of patients undergoing non-sedating colonoscopy. RESULTS:The results showed that the completion rate of the examination for the study subjects was 89.93%. Those who did not complete the examination mainly suffered from pain intolerance and poor intestinal preparation. Univariate analysis indicated that age, grade III anxiety, history of constipation, and the operator had statistical effects on the completion rate. Age and history of constipation affected the examination completion time. Multivariate analysis confirmed that grade III anxiety, history of constipation. CONCLUSION:The study provides clinical evidence and intervention targets for using nutritional intervention to regulate intestinal metabolic status and enhance the tolerance of non-sedating colonoscopy.

BackgroundDepression is highly prevalent in patients with ulcerative colitis (UC), affecting prognosis and patients’ quality of life. While related studies grow rapidly, a systematic review of the development trends in this field is still lacking. Based on this, the present study used bibliometric and visualization analysis methods to systematically examine the research landscape, hot topics, and future directions in the global field of UC comorbid with depression.MethodsRelevant literature published between January 1, 2006 and December 31, 2025 in the Web of Science Core Collection (WOSCC) and Scopus databases was retrieved. CiteSpace and VOSviewer software were used to analyze countries, journals, authors, references, and keywords, and co-occurrence network maps were generated. For complementary analysis, clinical trial articles published in PubMed over the same time period were retrieved.ResultsA total of 2,069 papers were included in the visualization analysis, with an additional 28 records identified through supplementary searching. In 2021, the number of publications increased significantly and has since remained at a relatively high level. International academic exchanges in UC comorbid with depression research are active, with the United States, the United Kingdom, and Canada being the core research forces in this field. Inflammatory Bowel Diseases is the most published and most representative professional journal. Bernstein, Charles N. and Mikocka-Walus, Antonina have published the highest number of studies, while Ananthakrishnan, Ashwin N. and Ford, Alexander C. have the highest academic influence. The co-citation network of references suggests that research in this field is based on backgrounds such as pain management, perceived stress, and psychiatry. Keyword analysis shows that core research hotspots focus on epidemiological studies, drug safety, and side effect management. Multidisciplinary combined treatment involving gastroenterology, psychiatry, and endocrinology is a frontier research direction.ConclusionExternal environmental stressors and intrinsic metabolic dysregulation are jointly reshaping the frontier landscape of this field. Beyond traditional epidemiological investigations, patient quality of life and drug safety have emerged as current research priorities. Future research should focus on generating a greater volume of clinical evidence and promoting multidisciplinary collaborative care, with the goal of improving patients’ quality of life and long-term prognosis.

Objective:To evaluate the efficacy and safety of acupoint embedding for FC by meta-analysis, in order to provide evidence-based medical evidence for clinical practice. Methods:A comprehensive literature search was conducted in China National Knowledge Infrastructure, WanFang, VIP, PubMed, Web of Science and The Cochrane Library for randomised controlled trials (RCTs) on ACE for FC published from inception to November 2024. The included studies were assessed for quality using the modified Jadad scale, and statistical analysis was performed using RevMan 5.4.1 and Stata BE 17. Results:A total of 23 studies involving 1,794 patients were included. The meta-analysis showed that the total effective rate of ACE was significantly higher compared with oral Western medicine (odds ratio [OR] = 2.71, 95% confidence interval [CI]: 1.91-3.83, p < 0.00001), acupuncture (OR = 2.90, 95% CI: 1.68-5.01, p = 0.0001) and placebo groups (p < 0.05). There was no significant difference between ACE and oral Chinese medicine (OR = 2.34, 95% CI: 0.79-6.89, p = 0.12). The incidence of adverse reactions in the ACE group was low, presenting mainly as mild local discomfort such as soreness, bruising and pain, which were self-limiting. Conclusion:Acupoint catgut embedding demonstrates superior clinical efficacy compared with Western medicine, acupuncture and placebo in treating FC, with a low incidence of adverse effects. However, due to the limitations of the included studies, high-quality, large-sample RCTs are still needed to verify the long-term efficacy and safety of ACE. Systematic review registration:Identifier INPLASY202570017.

The theory of"Wind Dispelling Dampness"originates from the Huangdi Neijing,with its core being the application of wind-dispelling herbs.Through clinical practice,professor ZHANG Shuxin,has identified that the core pathogenesis of ulcerative colitis(UC)lies in the persistent presence of dampness,which lingers in the intestines and is difficult to eliminate.Due to the"sticky and lingering nature of dampness",the disease often follows a prolonged and recurrent course.Conventional dampness-removing treatments often yield limited results,whereas the"Wind-Dispelling and Dampness-Resolving Method",established based on the theory of"Wind Dispelling Dampness",has shown significant efficacy.Under this theoretical framework,the Qufeng Ningkui formula was developed to dispel wind,resolve dampness,clear heat,cool the blood,and stop diarrhea,demonstrating notable clinical effectiveness.This theory and treatment approach can also provide guidance for other diseases caused by dampness.

Objective:To systematically investigate international trends and dynamics in research on Janus kinase (JAK) inhibitor applications for ulcerative colitis (UC) management over the past decade (2015-2024) and delineate current research frontiers. Methods:Publications was retrieved from the Web of Science core collection database and subjected to bibliometric analysis. VOSviewers, CiteSpace, Scimago Graphica, and Excel were used to conduct this bibliometric analysis and visualization. Results:A total of 696 articles were included. Publication output exhibited an overall upward trajectory. The United States ranked first in global publication volume and served as the central hub for multiple extensive collaborative networks. Inflammatory Bowel Diseases published the highest number of relevant studies. William J. Sandborn emerged as the most academically influential scholar. Both reference and keyword analyses revealed that early research (pre-2018) focused on clinical efficacy validation and drug development of JAK inhibitors, while post-2018 studies shifted toward systematic evaluations of efficacy and safety, integration of clinical practice guidelines, and development of novel subtype selective JAK inhibitors. Conclusion:This study delineates the evolution of JAK inhibitor research in UC over the past decade. Future efforts should prioritize strengthening global collaboration, advancing novel subtype selective JAK inhibitors, generating long-term safety data from clinical trials, and optimizing patient-stratified treatment strategies to address unmet therapeutic needs.

Objective To study Ermiaosan in the treatment of UC by using network pharmacology and molecular docking, and to provide references for experiments and clinical application for treating UC with dampness-heat syndrome. Methods The main active chemical components of Ermiaosan were screened out through TCMSP, the targets of components were obtained from TCMSP, the SwissTargetPrediction, TTD and the DrugBank database, and these targets genes were retrieved by UniProt database, the disease genes were obtained from TTD and Genecard database. String tool was used to constructed the PPI network, to built these components and their corresponding targets, Cytoscape software was applied to merge the networks and screen out the core network. And Bioinformatic analysis was performed using the OECloud tools to explore the enrichment analyses of GO and KEGG. Molecular docking was applied to check the affinity between the components and selected targets. Results Forty-six main active components were predicted from Ermiaosan, and 408 intersection genes were screened from drug-disease genes. The enrichment included PI3K–Akt, TNF and HIF-1 signaling pathway, and the networks analysis showed that Ermiaosan acted on seven key targets AKT1, TNF, IL6,TP53, VEGFA, IL1B and CTNNB1 to play roles in treating UC. Molecular docking showed that top 3 chemical components could bind stably with these targets. Conclusion Ermiaosan can relieve dampness-heat syndrome of UC, the possible potential mechanism might be related to the targets AKT1, TNF, IL6,TP53, VEGFA, IL1B and CTNNB1 linked with TNF, PI3K-Akt, and HIF-1 signaling pathway, it will provide meaningful references for further study in experiments and clinical investigations.

Colon adenocarcinoma (COAD) is a malignant tumor type. Fever is the most common postoperative complication of COAD. The present study described the treatment of a patient with early-stage COAD with precancerous colon polyps and the possible cause of postoperative fever. The patient was a 48-year-old woman with intermittent hematochezia, defecation urgency and liquid feces. The patient received surgical treatment, a whole segment from the intestine was removed, which contained a 4-cm-long mass and a 2-cm-long firm mass. Within 3 days after the operation, the patient's incision healed well, but the body temperature increased to a range of 37.8-38.6 degrees C. The suture was removed on the 10th postoperative day. After another three days, it was discovered that the upper end of the patient's surgical incision split to the anterior rectus abdominis sheath. The patient was provided with recombinant human acidic fibroblast growth factor to promote wound healing. The patient was finally diagnosed with rectosigmoid junction adenocarcinoma and precancerous colon polyps according to pathological examination results. The patient was given intravenous bevacizumab combined with irinotecan hydrochloride and oral capecitabine, and all drugs were repeatedly applied every 3 weeks, and a total of four treatment cycles were used. The cause of this postoperative fever was concluded to be anemia coming from chronic hematochezia and combined with deep wound dehiscence with secondary infection. The present study showcased that low-dose and short-course prophylactic adjuvant therapy is feasible for early-stage COAD with precancerous colon polyps.

Objective To study Ermiaosan in the treatment of UC by using network pharmacology and molecular docking, and to provide references for experiments and clinical application for treating UC with dampness-heat syndrome.Methods The main active chemical components of Ermiaosan were screened out through TCMSP, the targets of components were obtained from TCMSP, the SwissTargetPrediction, TTD and the DrugBank database, and these targets genes were retrieved by UniProt database, the disease genes were obtained from TTD and Genecard database. String tool was used to constructed the PPI network, to built these components and their corresponding targets, Cytoscape software was applied to merge the networks and screen out the core network. And Bioinformatic analysis was performed using the OECloud tools to explore the enrichment analyses of GO and KEGG. Molecular docking was applied to check the affinity between the components and selected targets.Results Forty-six main active components were predicted from Ermiaosan, and 408 intersection genes were screened from drug-disease genes. The enrichment included PI3K-Akt, TNF and HIF-1 signaling pathway, and the networks analysis showed that Ermiaosan acted on seven key targets AKT1, TNF, IL6,TP53, VEGFA, IL1B and CTNNB1 to play roles in treating UC. Molecular docking showed that top 3 chemical components could bind stably with these targets.Conclusion Ermiaosan can relieve dampness-heat syndrome of UC, the possible potential mechanism might be related to the targets AKT1, TNF, IL6,TP53, VEGFA, IL1B and CTNNB1 linked with TNF, PI3K-Akt, and HIF-1 signaling pathway, it will provide meaningful references for further study in experiments and clinical investigations.

有些人一开始并不在意便秘,觉得无非就是排便不太痛快,自己吃点水果蔬菜,喝点"润肠茶",挤点开塞露,用上这"三板斧",便秘可能就缓解了,并不会选择去医院就诊.但随着时间的推移,这些人慢慢会发现,便秘症状越来越严重,再用原来的"通便三板斧"也不管用了,直到影响到生活,甚至引起其他更严重的后果,才悔之晚矣. 何人易患便秘? 便秘是常见的临床疾病,表现为排便困难、排便次数减少(每周少于3次)、大便干结等.这些症状出现一个或多个都可能属于便秘. 按照病程的长短,便秘又分为急性便秘和慢性便秘.急性便秘是指在近期内突然发生的便秘;慢性便秘是便秘患者主要的类型,其病程至少为6个月.慢性便秘病因复杂、表现多样、危害较大、治疗困难,会给患者带来极大的困扰.那么哪些人群易患便秘呢?

目的 观察止痛如神汤治疗吻合器痔上黏膜切除术(PPH)后肛门感觉功能障碍综合征的临床疗效.方法 选择2020年8月—2021年2月北京中医药大学东直门医院收治的60例PPH术后肛门感觉功能障碍综合征患者,采用随机数字分组法分为2组.治疗组30例予止痛如神汤颗粒配合术后常规治疗,对照组30例予致康胶囊配合术后常规治疗,总疗程14 d,观察并统计2组患者服药后1 d、2 d、3 d、7 d、14 d的肛门疼痛、肛门坠胀、里急后重、控便障碍评分及症状总积分,比较2组治疗14 d后总体疗效.结果 治疗组服药后1d、2d、3d、7d肛门疼痛评分,服药后2d、3 d、7 d、14 d肛门坠胀评分,服药后7 d、14 d里急后重评分,服药后14 d控便障碍评分和服药后2 d、3 d、7 d、14 d症状总积分均明显低于对照组(P均＜0.05);治疗组总有效率为96.7％(29/30),对照组总有效率为86.7％(26/30),2组比较差异有统计学意义(P＜0.05).结论 止痛如神汤治疗PPH术后肛门感觉功能障碍综合征疗效显著.

Chronic relapsing ulcerative colitis (CRUC) is classified as an inflammatory bowel disease, and traditional Chinese medicine (TCM) has been recognized for its therapeutic benefits in treating CRUC. According to TCM principles, the prevailing syndromes in CRUC are yang deficiency and dampness stagnation (YDDS). The objective of this study is to establish a novel animal model of CRUC exhibiting the YDDS syndrome. Initially, the rats were administered hydrocortisone succinate sodium through subcutaneous injection, followed by the administration of senna folium granule solution. Subsequently, the rats underwent three cycles of dextran sulfate sodium solution ingestion. Upon completion of the modeling process, it was observed that the disease activity index, colonic mucosal damage index score, colon weight/length ratio, colonic histopathology score, and tissue damage index scores of the model rats were elevated, while the colon length and spleen index exhibited a decrease compared to the control group. The pathological alterations in the model rats included the presence of shallow or deep ulcers and acute or chronic inflammation throughout the process of CRUC modeling. Additionally, our findings indicate a correlation between the proximity of the ulcer to the anal verge, the severity of the lesion, and the presence of precancerous glands, glandular disappearance, crypt abscesses, and tissue destruction. Furthermore, the expression levels of IL6, IL10, IFNG, and TNFA in the colon tissues were significantly elevated in the model rats compared to the control group. Notably, the end-stage lesions observed in CRUC exhibited greater severity when compared to those observed in cases of acute ulcerative colitis. In conclusion, we have successfully developed a rat model of CRUC with YDDS syndrome, which can be utilized to investigate the effectiveness and underlying mechanisms of TCM in treating CRUC.

Objective:To screen the differentially expressed genes (DEG) related to inflammatory response associated with the prognosis of colon cancer based on the bioinformatics approach, and to construct and validate a prognostic model for colon cancer.Methods:RNA sequencing and clinical data of 472 colon cancer patients and normal colon tissues of 41 healthy people were retrieved from the Cancer Genome Atlas (TCGA) database. Gene expression related to prognosis of colon cancer and clinical data were retrieved from the International Cancer Genome Consortium (ICGC) database. The retrieval time was all from the establishment of library to November 2022. A total of 200 genes associated with inflammatory response obtained from the Gene Set Enrichment Analysis (GSEA) database were compared with the RNA sequencing gene dataset of colon cancer and normal colon tissues obtained from the TCGA database, and then DEG associated with inflammatory response were obtained. The prognosis-related DEG in the TCGA database were analyzed by using Cox proportional risk model, and the inflammatory response-related DEG were intersected with the prognosis-related DEG to obtain the prognosis-related inflammatory response-related DEG. The prognostic model of colon cancer was constructed by using LASSO Cox regression. Risk scores were calculated, and colon cancer patients in the TCGA database were divided into two groups of low risk (< the median value) and high risk (≥the median value) according to the median value of risk scores. Principal component analysis (PCA) was performed on patients in both groups, and survival analysis was performed by using Kaplan-Meier method. The efficacy of risk score in predicting the overall survival (OS) of colon cancer patients in the TCGA database was analyzed based on the R software timeROC program package. Clinical data from the ICGC database were applied to externally validate the constructed prognostic model, and patients with colon cancer in the ICGC database were classified into high and low risk groups based on the median risk score of patients with colon cancer in the TCGA database. By using R software, single-sample gene set enrichment analysis (ssGESA), immunophenotyping difference analysis, immune microenvironment correlation analysis, and immune checkpoint gene difference analysis of immune cells and immune function were performed for prognosis-related inflammation response-related DEG in the TCGA database.Results:A total of 60 inflammatory response-related DEG and 12 prognosis-related DEG were obtained; and 6 prognosis-related inflammatory response-related DEG (CCL24, GP1BA, SLC4A4, SRI, SPHK1, TIMP1) were obtained by taking the intersection set. LASSO Cox regression analysis showed that a prognostic model for colon cancer was constructed based on 6 prognosis-related inflammatory response-related DEG, and the risk score was calculated as = -0.113×CCL24+0.568×GP1BA+ (-0.375)×SLC4A4+(-0.051)×SRI+0.287×SPHK1+0.345×TIMP1. PCA results showed that patients with colon cancer could be better classified into 2 clusters. The OS in the high-risk group was worse than that in the low-risk group in the TCGA database ( P < 0.001); the area of the curve (AUC) of the prognostic risk score for predicting the OS rates of 1-year, 3-year, 5-year was 0.701, 0.685, and 0.675, respectively. The OS of the low-risk group was better than that of the high-risk group in the ICGC database; AUC of the prognostic risk score for predicting the OS rates of 1-year, 2-year, 3-year was 0.760, 0.788, and 0.743, respectively. ssGSEA analysis showed that the level of immune cell infiltration in the high-risk group in the TCGA database was high, especially the scores of activated dendritic cells, macrophages, neutrophils, plasmacytoid dendritic cells, T helper cells, and follicular helper T cells in the high-risk group were higher than those in the low-risk group, while the score of helper T cells 2 (Th2) in the high-risk group was lower compared with that in the low-risk group (all P < 0.05); in terms of immune function, the high-risk group had higher scores of antigen-presenting cell (APC) co-inhibition, APC co-stimulation, immune checkpoint, human leukocyte antigen (HLA), promotion of inflammation, parainflammation, T-cell stimulation, type Ⅰ interferon (IFN) response, and type ⅡIFN response scores compared with those in the low-risk group (all P < 0.05). The results of immunophenotyping analysis showed that IFN-γ-dominant type (C2) had the highest inflammatory response score, and the differences were statistically significant when compared with trauma healing type (C1) and inflammatory response type (C3), respectively (all P < 0.05). Immune microenvironment stromal cells and immune cells were all positively correlated with prognostic risk scores ( r values were 0.35 and 0.21, respectively, both P < 0.01). The results of immune checkpoint difference analysis showed there was a statistically significant difference in programmed-death receptor ligand 1 (PD-L1) expression level between high-risk group and low-risk group ( P = 0.002), and PD-L1 expression level was positively correlated with prognostic risk score ( r = 0.23, P < 0.01). Conclusions:Inflammatory response-related genes may play an important role in tumor immunity of colon cancer and can be used in the prognostic analysis and immunotherapy of colon cancer patients.

结肠息肉病累积肠段广,息肉数目多,镜下切除并发症多,常需外科治疗,是现代难治病.张书信教授认为结肠息肉病常因饮食不节、情志不畅、禀赋不足等诱发,病机为脾虚阳衰、寒湿内生、水瘀结毒凝于肠腑,临证不拘泥于局部切除,而以"健脾解凝"法治疗,体现了张仲景津液阳气论的学术观点.张书信教授结合中医辨治、镜下望诊和西医药理构建"消蕈汤",首推大补脾胃以充阳气,再借肺脾之力消水散结,另逐瘀通络,解毒消瘤,疗效尚佳.现附医案 1 例,总结张书信教授治疗结肠息肉病的多年经验,与诸家共同学习.

本文结合近年来肠道黏膜免疫与溃疡性结肠炎的相关性研究,阐述肠道黏膜免疫与溃疡性结肠炎发病密切相关,提出"肠道伏风"引起溃疡性结肠炎发病,外风引动内风伏于肠道,伏风招引外风,引动内风,与湿热相合袭扰肠络,论述肠道伏风是溃疡性结肠炎发病的重要因素.基于肠道伏风理论,提出逆流挽舟法、清营凉血法两种治疗思路,以期为中医药治疗溃疡性结肠炎提供新的治疗思路与方法.

Objective To explore the clinical efficacy of endorectal advancement flap(ERAF)combined with ligation of the intersphincteric fistula tract(LIFT)in the treatment of high simple anal fistula.Methods A total of 84 patients with high simple anal fistula in Beijing Anorectal Hospital(Beijing Erlong Road Hospital)from March to September 2022 were selected,and were randomly divided into the observation group and the control group,with 42 patients in each group.The observation group was treated with ERAF combined with LIFT,while the control group was treated with traditional incision and thread-drawing surgery.The visual analogue scale(VAS),clinical efficacy and complications were compared between the two groups.Results Among the 84 patients,there were 58 males and 26 females,aged from 27 to 59 years,with an average of(32.6±6.8)years.The VAS of the observation group on the 1st,3rd and 7th day after operation was lower than those of the control group[(5.24±1.08)score vs.(7.19±1.35)score,(4.76±1.11)score vs.(6.21±1.09)score,(2.34± 0.54)score vs.(2.98±0.61)score],the blood loss,hospitalization time and wound healing time were lower than those in the control group[(7.83±1.62)ml vs.(12.66±2.46)ml,(3.75±1.66)d vs.(4.55±1.71)d,(28.15±8.65)d vs.(39.12± 10.23)d],Wexner score and anal systolic blood pressure two month after operation were lower than those in the control group[(3.28±0.63)score vs.(4.46±0.75)score,(178.49±8.82)mmHg vs.(186.22±10.29)mmHg,1 mmHg=0.133 kPa],the anal resting pressure was higher than that in the control group[(45.88±2.87)mmHg vs.(43.85±1.74)mmHg],and incidence of complications were lower than that of the control group(11.90％vs.33.33％),the differences were statistically significant(all P＜0.05).There was no significant difference in operation time between the two groups(P＞0.05).Conclusions Compared with the traditional incision and thread-drawing surgery for high simple anal fistula,ERAF combined with LIFT has an advantage of less bleeding,less pain,shorter course of disease,faster recovery,which is worthy of clinical promotion.

目的 Giligher分级是目前应用最广泛的痔病严重度评分系统,但其缺乏对脱垂以外临床症状和生命质量的评估,本研究拟从生命质量评价和临床症状的角度探讨Goligher分级评价痔病严重程度的性能.方法 对2017年5月至2018年9月在北京中医药大学东直门医院肛肠科住院的痔病病人进行人口学和疾病情况调查,予以Goligher分级,同时应用SF-36量表评估病人生命质量,统计分析痔病Goligher各分级之间生命质量和脱垂以外其他症状的差异.结果 共209例痔病病人完成本次调查,GoligherⅠ级74例、Ⅱ级27例、Ⅲ级42例、Ⅳ级66例.Goligher各分级比较,在SF-36总分、PCS和MCS两个领域以及PF、RP、GH、VT、SF、RE、MH7个维度方面差异无统计学意义(P>0.05),BP维度方面差异有统计学意义(P<0.05);该研究有痔核脱出者135例,便血127,肛门疼痛116例,瘙痒21例,潮湿感6例,Goligher各分级比较,在疼痛、便血、肛门潮湿感方面差异无统计学意义(P>0.05),在瘙痒症状方面差异有统计学意义(Z=7.99,P=0.046);有疼痛症状组和无疼痛症状组比较,在SF-36总分(Z=-3.73,P<0.001)、PCS(Z=-3.62,P<0.001)和MCS(Z=-3.03,P=0.002)两个领域和以及PF、RP、BP、VT、SF、RE 6个维度方面差异有统计学意义,在GH和MH维度方面差异无统计学意义(P>0.05);有便血症状组和无便血症状组比较,仅GH(Z=-2.29,P=0.022)和VT(Z=-2.84,P=0.004)两个维度方面差异有统计学意义;有瘙痒症状组和无瘙痒症状组比较,仅PF维度(Z=-2.05,P=0.040)方面差异有统计学意义.结论 Goligher分级不能反映痔病病人的生命质量和严重程度,缺少对疼痛和生命质量的评估是影响其评价能力的主要因素.

目的 回顾性分析吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)与外剥内扎术联合消痔灵注射术治疗混合痔的10年随访结果.方法 选择2010年1月至2012年1月在北京中医药大学东直门医院肛肠科住院的201例混合痔患者,按照既往手术方式分为PPH术组123例和外剥内扎术组78例,回顾性分析比较患者临床病历资料,观察并分析患者主要并发症、术后取钉情况、术后总复发率、再手术率以及术后满意度.结果 两组患者肛门狭窄、肛门坠胀、肛门疼痛、肛门出血的发生率比较,差异无显著性(P>0.05),PPH术组痔核脱出的发生率高于外剥内扎术组,差异有显著性(P<0.05);PPH术组总复发率、再手术率均明显高于外剥内扎术组,差异有显著性(P<0.05);两组术后满意程度比较,差异无显著性(P>0.05).PPH术组患者术后有26例于门诊取钉,其中门诊行1次、2次、3次及以上取钉者分别有17、6、3例,占该组随访人数的13.82％、4.88％、2.44％.结论 PPH术的复发率、再手术率较外剥内扎术更高,同时部分患者存在吻合钉残留现象,术后的附加支出更多,其长期获益与外剥内扎术相比无明显优势.

Objective:To explore the value of prognostic model based on ferroptosis-related long non-coding RNA (lncRNA) in predicting the prognosis of patients with colon cancer.Methods:Ferroptosis-related genes were downloaded from FerrDb database, and the RNA sequencing gene data and clinical data of colon cancer patients from the establishment of the database to November 2021 were downloaded from the Cancer Genome Atlas (TCGA) database. Through R3.6.3 software, the colon cancer gene expression data obtained from TCGA database and ferroptosis-related genes obtained from FerreDb database were analyzed to obtain differentially expressed ferroptosis-related genes in colon cancer and normal tissues. The expression correlation between ferroptosis-related genes and lncRNA in colon cancer was calculated by using R3.6.3 software to determine ferroptosis-related lncRNA in colon cancer. The survival-related differentially expressed ferroptosis-related lncRNA was screened and included in the multivariate Cox proportional hazards model to construct a colon cancer prognosis model; and the risk score of colon cancer patients was calculated by the prognostic model according to the lncRNA expression. According to the median risk score, the clinical cases collected from TCGA database were divided into high-risk group and low-risk group with 223 cases in each group. Kaplan-Meier survival analysis was performed for the two groups. The receiver operating characteristic (ROC) curve was used to analyze the effect of prognostic model risk score and clinical characteristics on predicting the survival of all patients. GSEA 4.1.0 software was used for gene set enrichment analysis (GSEA) of lncRNA in high-risk and low-risk groups, and ggpubr package of R3.6.3 software was used for single sample GSEA (ssGSEA) of immune cells and immune function of differentially expressed lncRNA between high-risk and low-risk groups.Results:According to the intersection of ferroptosis-related genes and differentially expressed genes obtained from databases, 65 differentially expressed ferroptosis-related genes were obtained, and 24 lncRNA related to the prognosis of colon cancer were analyzed, and then prognostic model was constructed based on lncRNA. Kaplan-Meier survival analysis showed that the survival of low-risk group was better than that of high-risk group ( P < 0.001); ROC curve analysis showed that the area under the curve (AUC) of 1-, 2-, 3-year survival predicted by the prognostic model risk score was more than 0.75, and the AUC of 1-year survival predicted by the risk score for all patients was greater than age, gender, the National Comprehensive Cancer Network (NCCN), T staging, N staging and M staging. GSEA showed that differentially expressed lncRNA in high-risk and low-risk groups concentrated in tumor and immune-related pathways; ssGSEA showed that there were differences in T cells, macrophages, mast cells, neutrophils, immune stimulation, human leukocyte antigen, type Ⅰ and type Ⅱ interferon response between high-risk group and low-risk group (all P < 0.05), and the expression levels of CD200 and TNFRSF14 at the immune checkpoint were significantly different (both P < 0.01). Conclusions:Ferroptosis-related lncRNA may play an important role in tumor immunity of colon cancer, and it can be used for the prognosis analysis of patients with colon cancer.