BackgroundFunctional constipation (FCon), is a symptom-based functional gastrointestinal disorder without an organic etiology and altering brain structure and function. However, previous studies mainly focused on isolated brain regions involved in brain plasticity. Therefore, little is known about the altered large-scale interaction of brain networks in FCon.MethodsFor this study, we recruited 20 patients with FCon and 20 healthy controls. We used group independent component analysis to identify resting-state networks (RSNs) and documented intra- and inter-network alterations in the RSNs of the patients with FCon.ResultsWe found 14 independent RSNs. Differences in the intra-networks included decreased activities in the bilateral caudate of RSN 3 (strongly related to emotional and autonomic processes) and decreased activities in the left precuneus of RSN 10 (default mode network). Notably, the patients with FCon exhibited significantly decreased interactive connectivity between RSNs, mostly involving the connections to the visual perception network (RSN 7–9).ConclusionCompared with healthy controls, patients with FCon had extensive brain plastic changes within and across related RSNs. Furthermore, the macroscopic brain alterations in FCon were associated with interoceptive abilities, emotion processing, and sensorimotor control. These insights could therefore lead to the development of new treatment strategies for FCon.

Long non-coding RNA long intergenic non-protein coding RNA 01315 (LncRNA LINC01315) has been found to be implicated in various cancers, but its role and functions in colorectal cancer (CRC) remain to be addressed. Data on LINC01315 expression in CRC were gathered using bioinformatics analysis, and cancer stem cells (CSCs) were sorted by aldehyde dehydrogenase (ALDH) assay and flow cytometry. Migration, invasion, and stemness of CSCs isolated from CRC cells after transfection were determined by scratch, Transwell, and sphere-formation assays, respectively. Tumor xenograft model was constructed. Target genes and potential-binding sites were predicted using online databases and further confirmed via dual-luciferase reporter assay. Relative factors expressions were determined via quantitative real-time polymerase-chain reaction and Western blot as needed. LINC01315 was high-expressed in CRC and ALDH+ cells. LINC01315 silencing suppressed the migration, invasion, and sphere formation of CRC cells and tumor growth, and downregulated expressions of CSC molecules (ALDH, cluster of difference 44 (CD44), Prominin, and sex determining region Y-box 2 (SOX2)), Zinc Finger E-Box Binding Homeobox 1 (ZEB1) and Vimentin but upregulated E-Cadherin expression. MiR-484 could competitively bind with LINC01315, and LINC01315 silencing promoted miR-484 expression. The level of Delta Like Non-Canonical Notch Ligand 1 (DLK1), the target gene of miR-484, was enhanced by overexpressed LINC01315 yet was suppressed by LINC01315 silencing. Also, DLK1 silencing reversed the effects of downregulated miR-484 on migration, invasion, sphere formation, and CSC molecules expressions in CRC cells. LINC01315 silencing modulated CSC properties and epithelial-to-mesenchymal transition via miR-484/DLK1 axis.

随着人们生活方式和饮食习惯的改变,结直肠肿瘤的发生率逐年上升,并出现年轻化趋势.国家癌症统计报告提示,结直肠癌发病率和死亡率分别位居全部恶性肿瘤的第3和第5位.而低位直肠癌能否保肛治疗,一直是肠癌治疗中的难点和重点.

早期结直肠癌可通过内镜黏膜切除术(EMR)或内镜黏膜剥离术(ESD)治疗,但如果术后病理显示存在预后不良的危险因素,则需追加根治性手术.在结直肠癌根治手术中,提高转移淋巴结的检出率及清除率对判断肿瘤分期、改善预后等意义重大.纳米碳淋巴示踪技术能够对淋巴结进行染色定位,提高根治术中淋巴结的检出率.现报道1例内镜黏膜剥离术后追加纳米碳淋巴染色辅助下腹腔镜结肠癌切除术,治疗乙状结肠癌患者的诊疗经过,通过对此病例的分析,以期对临床工作有所帮助.

目的 探讨五水头孢唑林钠配合中药熏蒸治疗老年肛肠疾病术后切口感染患者的临床疗效与安全性.方法 将2014年1月至2015年12月接受手术治疗且发生术后切口感染的122例老年患者依据随机数字表分为对照组与观察组,每组61例.对照组单独应用五水头孢唑林钠进行治疗,观察组在对照组的基础上联合中药熏蒸予以治疗,对比2组研究对象治疗后的临床疗效与安全性.结果 观察组有效率为98.36%;对照组有效率为88.52%,2组差异有统计学意义(P<0.05);对照组水肿消失时间、渗出物消失时间、疼痛消失时间及切口愈合时间均明显长于观察组(P<0.05);观察组与对照组患者治疗后的疼痛评分均明显下降,但观察组患者的疼痛评分明显低于对照组患者(P<0.05);观察组不良反应发生率明显低于对照组(P<0.05).结论 五水头孢唑林钠配合中药熏蒸应用于老年肛肠疾病术后切口感染患者中,可取得良好临床疗效,缩短恢复时间,安全性较高,值得临床上推广应用.

The purpose of this study was to evaluate the efficacy and long-term outcome of the ligation of the intersphincteric fistula tract (LIFT) procedure for transsphincteric fistula-in-ano.

目的 比较4种手术方法治疗藏毛窦的临床治疗效果.方法 回顾性分析2008年1月至2013年3月期间江苏省中医院肛肠科收治的43例骶尾部藏毛窦患者的临床资料,均接受手术治疗,其中藏毛窦切除+切口开放术4例(切口开放组)、藏毛窦切除+切口直接缝合术7例(直接缝合组)、藏毛窦切除+切口袋形缝合术19例(袋形缝合组)、藏毛窦菱形切除+ Limberg皮瓣转移术13例(皮瓣转移组).结果 ①4组患者的一般临床资料比较,差异无统计学意义(P＞0.05),具有可比性.②切口开放组、直接缝合组、袋形缝合组和皮瓣转移组的住院时间分别为(16.70±8.69)d、(16.43±10.68)d、(15.84± 11.29)d和(14.69±4.01)d,术后平均愈合时间分别为(64.75±6.50)d、(34.57±19.15)d、(35.16±15.49)d和(17.92±4.29)d.4组住院时间比较差异无统计学意义(P＞0.05).切口愈合时间皮瓣转移组明显短于其他3组(P＜0.05),直接缝合组和袋形缝合组均明显短于切口开放组(P＜0.05),直接缝合组与袋形缝合组间差异无统计学意义(P＞0.05).③4组的并发症:直接缝合组有2例患者切口部分裂开,2例患者因切口感染行部分拆开;皮瓣转移组l例患者术后切口渗血行部分拆开引流,l例患者出现张力性水泡;其余2组没有发生并发症.切口愈合后随访半年均无复发.结论 从本组有限的数据初步得出,藏毛窦术后的闭合方式根据切口张力大小而定,张力小者可行直接缝合,张力大者可行袋形缝合;病变范围广或术后复发的患者可行菱形切除+ Limberg皮瓣转移.

OBJECTIVE:To evaluate the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of complex fistula-in-ano.METHODS:Clinical data of 24 patients with complex fistula-in-ano who treated with LIFT in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2009 to February 2012 were analyzed retrospectively. The operative efficacy and postoperative continence were evaluated.RESULTS:The prime success rate of fistula healing was 66.7% (16/24) after the LIFT procedure. Two patients presented with intersphincteric incision infection which was successfully treated with topical of silver nitrate. Four patients had intersphincteric fistula with infection and managed with the complete laying open approach. The total clinical healing rate was 91.7% (22/24). Another 2 patients had persistent external opening with discharge. During follow-up of 6 to 44 (median 16) months, The Cleveland Clinic Florida Fecal Incontinence score revealed that no patient developed decreased continence.CONCLUSION:LIFT is a safe and effective sphincter-preserve procedure for complex fistula-in-ano.

目的:寻找治疗脱垂性环状混合痔更有效的临床方法.方法:对56例脱垂性环状混合痔采用外痔剥离,内痔核残端悬吊固定于痔上动脉区,外痔切口半缝合方法治疗,观察术后脱出、疼痛、肛缘水肿、肛门狭窄等情况.结果:术后所有病例的便血和脱出症状均得到消除,肛缘平整.结论:改良悬吊固定法治疗脱垂性环状混合痔具有疗效可靠、经济安全、恢复快等优点,术后无肛门狭窄、肛门失禁及黏膜外翻等并发症.

目的:在保证脓肿一期根治的前提下,保持肛门括约肌的完整性和连续性,减少手术对肛周组织的损伤,维持肛门的正常功能。方法:将50例随机分成两组,治疗组25例采用保留括约肌一期根治术,即内口切除、敞开括约肌间隙,挂线引流完整保留外括约肌皮下部和浅部;对照组25例采用一期切开根治术。术后对两组病人的总疗效、愈合时间、肛管静息压和最大收缩压变化、并发症等进行观察比较。结果:两组病人在总疗效、脓肿复发及后遗肛瘘方面没有显著性差异;而在愈合时间、肛管静息压和最大收缩压变化及并发症方面发生显著性差异。结论:保留外括约肌皮下部和浅部有重要的临床意义,采用挂线引流保留括约肌一期根治低位肛周脓肿是确实可行的。

笔者根据导师谷云飞教授多年临床经验,自拟中药方剂熏洗治疗肛窦炎72例,满意疗效,现报道如下.

采用一次性切开挂线法治疗肛周脓肿76例,一次手术成功,全部治愈,疗程16～30天,平均21天.无并发症及后遗症,随访均无后遗肛瘘及肛门失禁,肛门功能正常.