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High-quality clinical research is an important method to improve clinical diagnosis and treatment, promote discipline construction, and expand the frontier of medicine. In recent years, multi-center clinical studies in colorectal surgery in China have increased, and the level of clinical research has gradually improved, accumulating a wealth of clinical research experience. Innovative research topics and scientific design are the foundations of high-quality clinical research. Standardization of surgical techniques and quality control at all steps of the study are key to high-quality research. At the same time, researchers should establish a data management system, select appropriate data collection systems, and conduct regular data checks and feedback to ensure the quality of research data. Fully utilizing the advantages of case resources and further enhancing clinical research capabilities will provide assistance in promoting high-quality clinical research in the field of colorectal surgery in China. The authors summarize the experience of high-quality clinical research in colorectal surgery at home and abroad, in order to further promote the development of high-quality clinical research in China.
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Objective@#To explore the relationship between physical fitness and energy balance related behaviors (EBRBs), and their influencing factors among primary school students, so as to provide a scientific basis for the improvement of physical fitness in primary school students.@*Methods@#By using a random sampling method, a total of 1 451 pupils aged 10-12 were selected from 8 regions of Shannxi Province (Fengxiang, Weibin, Danfeng, Shangzhou, Huazhou, Linwei, Gaoling, Weiyang). According to the total score of physical fitness test, pupils were divided into the excellent good physical fitness group and the pass failed group. The students EBRBs and their influencing factors were investigated cross sectionally, and the Mann-Whitney U test and stepwise linear regression analysis were used to explore the relationship between physical fitness and EBRBs.@*Results@#Breakfasts behavior( r = 0.061 ) and physical activity behavior( r =0.105) among primary school students were positively correlated with total physical scores, with the excellent good physical fitness group (757.56, 768.57)were higher than that of the pass failed group(710.93, 705.67) ( Z= -2.41, -2.69, P <0.05). The screen behavior ( r =-0.065) was negatively correlated with the total physical fitness scores, with the excellent good physical fitness group (681.96) was significantly lower than the pass failed group(747.04) ( Z=2.78, P < 0.05 ). There was no statistically significant correlation between the frequency of beverage behavior and the total score of physical fitness ( P >0.05). The excellent good physical fitness group scored(762.22, 761.19, 758.82, 756.00, 761.20, 755.57, 761.52, 759.48, 781.78) higher than the pass failed group(708.70, 709.19, 710.32, 711.67, 709.19, 711.88, 709.04, 710.01, 699.36) including health beliefs, parental norms and parental role models for breakfast behaviors, and preferences, self efficacy, and self regulation for physical activities, as well as self efficacy, parental role models, family rules for screen behavior ( Z=-2.40, -2.78, -2.35, -2.48, -2.52, -2.27, -2.35, -2.22, -3.65, P <0.05).@*Conclusion@#The physical fitness of primary school students is affected by EBRBs. Parents should model positive behaviors in the family, promote the health behavior of primary school students, improve the physical health of primary school students health.
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Objective@#To explore the relationship between physical fitness and energy balance related behaviors (EBRBs), and their influencing factors among primary school students, so as to provide a scientific basis for the improvement of physical fitness in primary school students.@*Methods@#By using a random sampling method, a total of 1 451 pupils aged 10-12 were selected from 8 regions of Shannxi Province (Fengxiang, Weibin, Danfeng, Shangzhou, Huazhou, Linwei, Gaoling, Weiyang). According to the total score of physical fitness test, pupils were divided into the excellent good physical fitness group and the pass failed group. The students EBRBs and their influencing factors were investigated cross sectionally, and the Mann-Whitney U test and stepwise linear regression analysis were used to explore the relationship between physical fitness and EBRBs.@*Results@#Breakfasts behavior( r = 0.061 ) and physical activity behavior( r =0.105) among primary school students were positively correlated with total physical scores, with the excellent good physical fitness group (757.56, 768.57)were higher than that of the pass failed group(710.93, 705.67) ( Z= -2.41, -2.69, P <0.05). The screen behavior ( r =-0.065) was negatively correlated with the total physical fitness scores, with the excellent good physical fitness group (681.96) was significantly lower than the pass failed group(747.04) ( Z=2.78, P < 0.05 ). There was no statistically significant correlation between the frequency of beverage behavior and the total score of physical fitness ( P >0.05). The excellent good physical fitness group scored(762.22, 761.19, 758.82, 756.00, 761.20, 755.57, 761.52, 759.48, 781.78) higher than the pass failed group(708.70, 709.19, 710.32, 711.67, 709.19, 711.88, 709.04, 710.01, 699.36) including health beliefs, parental norms and parental role models for breakfast behaviors, and preferences, self efficacy, and self regulation for physical activities, as well as self efficacy, parental role models, family rules for screen behavior ( Z=-2.40, -2.78, -2.35, -2.48, -2.52, -2.27, -2.35, -2.22, -3.65, P <0.05).@*Conclusion@#The physical fitness of primary school students is affected by EBRBs. Parents should model positive behaviors in the family, promote the health behavior of primary school students, improve the physical health of primary school students health.
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Objective@#To explore the relationship between physical fitness and energy balance related behaviors (EBRBs), and their influencing factors among primary school students, so as to provide a scientific basis for the improvement of physical fitness in primary school students.@*Methods@#By using a random sampling method, a total of 1 451 pupils aged 10-12 were selected from 8 regions of Shannxi Province (Fengxiang, Weibin, Danfeng, Shangzhou, Huazhou, Linwei, Gaoling, Weiyang). According to the total score of physical fitness test, pupils were divided into the excellent good physical fitness group and the pass failed group. The students EBRBs and their influencing factors were investigated cross sectionally, and the Mann-Whitney U test and stepwise linear regression analysis were used to explore the relationship between physical fitness and EBRBs.@*Results@#Breakfasts behavior( r = 0.061 ) and physical activity behavior( r =0.105) among primary school students were positively correlated with total physical scores, with the excellent good physical fitness group (757.56, 768.57)were higher than that of the pass failed group(710.93, 705.67) ( Z= -2.41, -2.69, P <0.05). The screen behavior ( r =-0.065) was negatively correlated with the total physical fitness scores, with the excellent good physical fitness group (681.96) was significantly lower than the pass failed group(747.04) ( Z=2.78, P < 0.05 ). There was no statistically significant correlation between the frequency of beverage behavior and the total score of physical fitness ( P >0.05). The excellent good physical fitness group scored(762.22, 761.19, 758.82, 756.00, 761.20, 755.57, 761.52, 759.48, 781.78) higher than the pass failed group(708.70, 709.19, 710.32, 711.67, 709.19, 711.88, 709.04, 710.01, 699.36) including health beliefs, parental norms and parental role models for breakfast behaviors, and preferences, self efficacy, and self regulation for physical activities, as well as self efficacy, parental role models, family rules for screen behavior ( Z=-2.40, -2.78, -2.35, -2.48, -2.52, -2.27, -2.35, -2.22, -3.65, P <0.05).@*Conclusion@#The physical fitness of primary school students is affected by EBRBs. Parents should model positive behaviors in the family, promote the health behavior of primary school students, improve the physical health of primary school students health.
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Objective:To investigate the incidence and influencing factors of parastomal hernia in patients with permanent colostomy.Methods:The retrospective cohort study was conduc-ted. The clinicopathological data of 72 patients with permanent colostomy in the Beijing Friendship Hospital of Capital Medical University from January 2016 to June 2020 were collected. There were 50 males and 22 females, aged (66±12)years. Observations indicators: (1) follow-up; (2) analysis of factors affecting the incidence of parastomal hernia; (3) comparison of the incidence of parastomal hernia in patients with different age. Follow-up was conducted using outpatient examination. Patients were followed up once every 12 months after surgery to detect the incidence of parastomal hernia up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers and percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model. Kaplan-Meier method was used to draw the parastomal hernia occurrence curve and calculate the incidence rate of parastomal hernia and Log-rank test was used to analyze the incidence of parastomal hernia. Results:(1) Follow-up. All 72 patients were followed up for 23(range, 12?76)months. During the follow-up, there were 31 patients developed parastomal hernia, with the incidence as 20.8%(15/72), 36.1%(26/72) and 43.1%(31/72) at postoperative 1 year, postoperative 2 year and postoperative 5 year, respectively. Of the 31 patients with parastomal hernia, there were 21 cases of type Ⅰ, 3 cases of type Ⅱ and 7 cases of type Ⅲ. Patients with parastomal hernia recovered with conservative treatment. (2) Analysis of factors affecting the incidence of parastomal hernia. Results of univariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were related factors affecting the incidence of parastomal hernia ( χ2=7.98, t=?2.95, 2.02, P<0.05). Results of multivariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were independent factors affecting the incidence of parastomal hernia ( odds ratio=4.07, 3.19, 0.07, 95% confidence interval as 1.46?11.32, 1.43?7.09, 0.01?0.84, P<0.05). (3) Comparison of the incidence of parastomal hernia in patients with different age. Of the 72 patients, there were 37 cases with age <65 years and 35 cases with age >65 years. Of the 31 patients with parastomal hernia, there were 10 cases with age<65 years and all of them with type Ⅰ parastomal hernia, and the incidence of parastomal hernia in postoperative 1 year and postoperative 2 year was 13.5%(5/37) and 27.0%(10/37), respectively. There were 21 cases with age ≥65 years and cases with type Ⅰ, type Ⅱ and type Ⅲ parastomal hernia were 11, 3 and 7, respectively. The postoperative 1 year and postoperative 2 year incidence of parastomal hernia in the 21 cases was 28.6%(10/35) and 45.7%(16/35), respectively. There was a significant difference in the incidence of parastomal hernia between patients<65 years and ≥65 years ( χ2=9.28, P<0.05). Conclusion:Age, subcutaneous fat thickness and rectus abdominis thickness are independent factors affecting the incidence of parastomal hernia.
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Objective:To investigate the clinical value of magnetic resonance imaging (MRI) in predicting pathological complete response (pCR) after immunotherapy combined with neo-adjuvant therapy for local advanced rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 48 patients with local advanced rectal cancer who were admitted to Beijing Friendship Hospital of Capital Medical University from January 2020 to March 2022 were collected. There were 35 males and 13 females, aged 62(32?77)years. Of 48 patients, 30 patients received neoadjuvant therapy, 18 patients received immunotherapy combined with neoadjuvant therapy. All patients underwent total mesorectal excision. Observation indicators: (1) T staging on MRI and postoperative pathological examination after neoadjuvant therapy and immunotherapy combined with neoadjuvant therapy; (2) changes of apparent diffusion coefficients (ADC) in pCR and non-pCR patients after neoadjuvant therapy and immunotherapy combined with neoadjuvant therapy; (3) evaluation of predictive performance of MRI for pCR after immunotherapy combined with neoadjuvant therapy. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Sensitivity, specificity and accuracy were used to evaluate the predictive performance. Results:(1) T staging on MRI and postoperative pathological examination after neoadjuvant therapy and immunotherapy combined with neoadjuvant therapy. Of the 30 patients receiving neoadjuvant therapy, 1 patient in stage T2 showed stage T2 on both MRI and postoperative pathological examination after neoadjuvant therapy, 16 patients in stage T3 showed stage T0, T1, T2, T3, T4 of 0, 1, 6, 9, 0 cases and 3, 0, 8, 4, 1 cases on MRI and postoperative pathological examination respectively after neoadjuvant therapy, 13 patients in stage T4 showed stage T0, T1, T2, T3, T4 of 0, 0, 1, 2, 10 cases and 1, 0, 4, 7, 1 cases on MRI and postoperative pathological examination respectively after neoadjuvant therapy. The pCR rate was 13.3%(4/30) and the accuracy rate of MRI was 43.33% for patients with neoadjuvant therapy. Of the 18 patients receiving immunotherapy combined with neoadjuvant therapy, 12 patients in stage T3 showed stage T0, T1, T2, T3, T4 in 4, 2, 2, 4,0 cases and 5, 1, 1, 5, 0 cases on MRI and postoperative pathological examination respectively after immunotherapy combined with neoadjuvant therapy, 6 patients in stage T4 showed stage T0, T1, T2, T3, T4 in 0, 0, 1, 3, 2 cases and 4, 0, 0, 2, 0 cases on MRI and postoperative pathological examination respectively after immunotherapy combined with neoadjuvant therapy. The pCR rate was 50.0%(9/18) and the accuracy rate of MRI was 38.89% for patients with neoadjuvant therapy. (2) Changes of ADC in pCR and non-pCR patients after neoadjuvant therapy and immunotherapy combined with neoadjuvant chemoradiotherapy. Of the 30 patients receiving neoadjuvant therapy, the ADC differences were 0.30±0.04 and 0.21±0.17 for 4 pCR and 26 non-pCR patients, respectively, showing a significant difference ( t=2.36, P<0.05). Of the 18 patients receiving immunotherapy combined with neoadjuvant therapy, the ADC change rates and ADC differences were 40%±14% and 0.39±0.14 for 9 pCR patients, versus 22%±13% and 0.21±0.12 of 9 non-pCR patients, showing significant differences in the above indicators ( t=2.86, 2.79, P<0.05). Receiver operation charac-teristic curve analysis of ADC change rate and ADC difference associated with pCR for 18 patients receiving immunotherapy combined with neoadjuvant therapy suggested that the areas under the curve were 0.81 (95% confidence interval as 0.60?1.00, P<0.05) and 0.86 (95% confidence interval as 0.70?1.00, P<0.05), with cutoff values as 0.23 and 0.36, respectively. (3) Evaluation of predictive performance of MRI for pCR after immunotherapy combined with neoadjuvant therapy. For the 18 patients receiving immunotherapy combined with neoadjuvant therapy, the sensitivity, specificity, accuracy were 33.33%, 88.89%, 61.11% of stage T0 on MRI for predicting pCR, 88.89%, 55.56%, 72.22% of down-staging of T staging on MRI for predicting pCR, and all 77.78% of ADC difference greater than the cutoff value for predicting pCR. Conclusions:Patients with local advanced rectal cancer who received immunotherapy combined with neoadjuvant therapy achieve a higher pCR rate. ADC difference and down-staging of T staging on MRI can predict pCR effectively.
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The number of colorectal cancer patients in China ranks the top in the world, but there are few international guidelines for the diagnosis and treatment of colorectal cancer formulated by Chinese, nor high-level evidence-based medicine research of colorectal cancer from China. Transanal total mesorectal excision (taTME) is a new technology in the field of colorectal surgery in recent years. At present, clinical practice related to taTME has been carried out simul-taneously with clinical researches in the world. Based on the experience of participating in the top clinical trials in the field of international colorectal surgery, like the COLOR series prospective research, the authors introduce the organization and implementation of COLOR Ⅲ research in China. It is hoped that the COLOR series trials will become an example in the field of high-quality surgical clinical research, so as to improve the clinical research level of colorectal surgery in China.
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The idea, development, exploration, assessment, and long-term follow-up (IDEAL) framework and recommendations provide a guiding path for high-quality research and practice for surgical technology innovation. Transanal total mesorectal excision, as a new technology in the field of colorectal surgery, has evolved step by step following the IDEAL framework. At the technical design and development stage, the technique feasibility is verified. At the exploratory stage, small-scale clinical practice is conducted, standardized diagnosis and treatment and surgical technique are developed, and structured training is carried out. During the assessment stage, large-scale rando-mized controlled studies are conducted to confirm the safety and efficacy. Subsequently, long-term monitoring and follow-up of the technique is carried out in clinical practice. All the processes become good example in the field of surgical clinical research. The authors summarize the pioneering works of the research team in quality control, in order to provide references for peers.
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Objective:To investigate the possible role of long non-coding RNA (LncRNA) 00602 in promoting browning in adipocytes induced by adenovirus type 36 (Ad36).Methods:According to Ad36 infection, adipose tissue samples of obese patients were divided into Ad36-negative group and Ad36-infected group. Realtime fluorescent quantitative PCR (qRT-PCR) was used to detect the changes in the expression of LncRNA00602 mRNA in omental adipose tissue of the two groups, and analyze the differences between the two groups. The correlation between waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triacylglyceride and other indicators of the patients in the group with LncRNA00602 mRNA expression were analyzed. HE staining was used to detect the size of adipocytes in the omental adipose tissue of the Ad36 negative group and the Ad36 infection group. qRT-PCR and Western blotting were used to detect the mRNA and protein expression levels of uncoupling protein 1 (UCP1) and PR domain containing 16 (PRDM16) in omental adipose tissue of two groups of patients. Human adipose-derived stem cells (hADSC) were isolated and cultured, using Ad36 to induce differentiation, and divided into control group and LncRNA00602 knockdown group. On 0, 2, and 4 days after LncRNA00602 knockdown, fluoroboron dipyrrole (BODIPY) and mitochondrial red fluorescence (Mito-Tracker Red) were used to stain intracellular lipid droplets and mitochondria. At the same time, qRT-PCR and Western blotting were used to detect changes in the expression of UCP1 and PRDM16.Results:The expression of LncRNA00602 gene in the Ad36 infection group was higher than that in the Ad36 negative group (all P<0.05). The expression of LncRNA00602 in the Ad36 negative group was not significantly different from the above clinical indicators, while the expression of LncRNA00602 was negatively correlated with serum fasting blood glucose and triacylglyceride ( r=-0.522, -0.486, P<0.05) in the Ad36 infection group; HE staining showed that the average adipocyte area of the Ad36 infection group was smaller than that of the Ad36 negative group. At the same time, UCP1 and PRDM16 gene expression were higher than the negative group (all P<0.05). At the cellular level, on the 2nd and 4th days after knockdown of LncRNA00602, the lipid droplet area of adipocytes in the LncRNA00602 knockdown group was larger than that of the control group, the number of mitochondria decreased compared with the control group, and difference was statistically significant ( P<0.05 or P<0.01); Compared with the control group, there was significantly lower expression of the browning marker genes UCP1, PRDM16, and protein in the adipocytes in the LncRNA00602 knockdown group (all P<0.05). Conclusion:In Ad36-induced adipocyte differentiation, LncRNA00602 may positively regulate the expression of UCP1, PRDM16 and lipid droplet metabolism, and promote the browning of adipocytes.
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Transanal total mesorectal excision (taTME) is a hot topic surgical approach in the field of colorectal surgery. However, the therapeutic effect of this surgical approach is controversial. Based on the accumulated experience and evidence, the domestic and international consensus and guidelines on taTME have been updated and improved. The importance of taTME registry study is emphasized again in the 'International expert consensus guidance on indications, implementation and quality measures for transanal total mesorectal excision' published in 2020. The implementation of prospective case registration is the fundamental premise to ensure the quality of data and the advancing data collection methods and online platform construction can further improve the quality of data. Based on the latest taTME international consensus, the authors discuss the importance of case registry study to improve the data quality of taTME registry study and provide reliable and timeliness evidence based medicine in the field of colorectal surgery.
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Intracorporeal anastomosis in laparoscopic right hemicolectomy of colon cancer is becoming a hot spot in colorectal surgery. A number of retrospective studies have suggested that intracorporeal anastomosis has potential advantages in promoting postoperative recovery and reducing postoperative complications compared with conventional extracorporeal anastomosis. Several randomized controlled trials published recently have also confirmed that intracorporeal anastomosis can promote postoperative gastrointestinal function recovery and reduce postoperative pain, but there is still insufficient evidence to draw a conclusion about the incidence of complications, especially the anastomotic leakage rate. Heterogeneity of surgical techniques and unclear definition of anastomotic leakage are the main difficulties in current studies. Several high-quality prospective randomized controlled trials are currently under way, and high level of evidence is needed to objectively evaluate the laparoscopic right hemicolectomy of colon cancer. The authors review the relevant literatures at home and abroad, systematically elaborate the research status and prospects of digestive tract reconstruction after laparoscopic right hemicolectomy of colon cancer, in order to explore a new direction for the clinical research of colorectal surgery in China.
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Objective@#To investigate the role of adenovirus type 36 (Ad36) in the browning of 3T3-L1 cells.@*Methods@#BODIPY staining was performed on the 0, 2nd, 4th, 6th and 8th days of the cocktail induction (control) group and the cocktail plus Ad36 induction (experimental) group to observe the adipogenesis of 3T3-L1 cells.The mRNA and protein expressions of uncoupling protein-1(Ucp1), ATP synthase, H+ transporting, mitochondrial F1 complex, O subunit (Atp5o), cytochrome c oxidase subunit 5B(Cox5b), and perilipin were detected by real-time PCR and Western-blot.@*Results@#The results of BODIPY staining showed that the lipid droplets in the control group gradually became larger with the differentiation of the cells, while the lipid droplets in the experimental group firstly became larger, and then appeared smaller after Ad36 was added on the fourth day. Compared with the control group, the mRNA and protein expression levels of Ucp1, Atp5o, and Cox5b in the experimental group were significantly increased while the expression level of perilipin was significantly decreased (all P<0.05).@*Conclusion@#During the differentiation of 3T3-L1 cells, Ad36 promotes its browning via increasing the expressions of Ucp1, Atp5o, and Cox5b.
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Objective To investigate the role of adenovirus type 36 ( Ad36) in the browning of 3T3-L1 cells. Methods BODIPY staining was performed on the 0, 2nd, 4th, 6th and 8th days of the cocktail induction (control) group and the cocktail plus Ad36 induction ( experimental) group to observe the adipogenesis of 3T3-L1 cells. The mRNA and protein expressions of uncoupling protein-1 ( Ucp1 ), ATP synthase, H+ transporting, mitochondrial F1 complex, O subunit ( Atp5o), cytochrome c oxidase subunit 5B ( Cox5b), and perilipin were detected by real-time PCR and Western-blot. Results The results of BODIPY staining showed that the lipid droplets in the control group gradually became larger with the differentiation of the cells, while the lipid droplets in the experimental group firstly became larger, and then appeared smaller after Ad36 was added on the fourth day. Compared with the control group, the mRNA and protein expression levels of Ucp1, Atp5o, and Cox5b in the experimental group were significantly increased while the expression level of perilipin was significantly decreased ( all P＜0. 05 ). Conclusion During the differentiation of 3T3-L1 cells, Ad36 promotes its browning via increasing the expressions of Ucp1, Atp5o, and Cox5b.
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Objective To understand the life quality status of freshmen in higher medical colleges,and discuss the factors influencing the quality of life,in order to improve their life quality,and put forward the countermeasures and suggestions.Methods We randomly selected a higher medical colleges and universities in Yunnan,the grade one students were investigated with SF-36 scale investigation,the data were analyzed by t test and multiple linear regression analysis.Results The quality of life scores (PCS,MCS) of freshmen in this medical college are lower than the national norm,the segmentation in the field of eight only GH is higher than the national norm,and the RP,BP,VT,RE are lower than the national norm.There are six factors into the regression equation of the quality of life:health,insomnia,life pressure,communicating with people,life rule.Conclusions The QOL of freshmen in higher medical colleges and universities is low,relevant departments should be caused to take seriously.To improve the QOL,the government,society,school,personal must make joint efforts in many ways,and take targeted measures.