Questionnaire investigation of radiation rectal injury with anxiety, depression and somatic disorder / 中华胃肠外科杂志

Objective: To observe the incidence and treatment of radiation rectal injury complicated with anxiety, depression and somatic symptom disorder. Methods: A cross-sectional survey research method was carried out. Patients with radiation rectal injury managed by members of the editorial board of Chinese Journal of Gastrointestinal Surgery were the subjects of investigation. The inclusion criteria of the survey subjects: (1) patients suffered from pelvic tumors and received pelvic radiotherapy; (2) colonoscopy showed inflammatory reaction or ulcer in the rectum. Exclusion criteria: (1) patient had a history of psycho-somatic disease before radiotherapy; (2) patient was unable to use a smart phone, unable to read and understand the questions in the questionnaire displayed on the phone; (3) patient refused to sign an informed consent form. According to the SOMA self-rating scale, PHQ-15 self-rating scale, GAD-7 and PHQ-9 self-rating scale, the electronic questionnaire of "Psychological Survey of Radiation Proctitis" was designed. The questionnaire was sent to patients with radiation rectal injury managed by the committee through the WeChat group. Observational indicators: (1) radiation rectal injury symptom assessment: using SOMA self-rating scale, radiation rectal injury symptom classification: mild group (≤3 points), moderate group (4-6 points) and severe group (> 6 points); (2) incidence of anxiety, depression and physical disorder: using GAD-7, PHQ-9 and PHQ-15 self-rating scales respectively for assessment; (3) correlation of radiation rectal injury symptom grading with anxiety, depression, and somatic symptom disorder. Results: Seventy-one qualified questionnaires were collected, of which 41 (56.9%) were from Guangzhou. Among the 71 patients, 6 were males and 65 were females; the mean age was (55.7±9.3) years old and 48 patients (67.6%) were less than 60 years old; the median confirmed duration of radiation rectal injury was 2.0 (1.0, 5.0) years. (1) Evaluation of symptoms of radiation rectal injury: 18 cases of mild (25.4%), 27 cases of moderate (38.0%), and 26 cases of severe (36.6%). (2) Incidence of anxiety, depression and somatic disorder: 12 patients (16.9%) without comorbidities; 59 patients (83.1%) with anxiety, depression, or somatic disorder, of whom 2 patients only had anxiety, 1 patient only had depression, 9 only had somatic disorder, 2 had anxiety plus depression, 4 had anxiety plus somatic disorder, 2 had depression plus somatic disorder, and 40 had all three symptoms. (3) correlation of radiation rectal injury grading with anxiety, depression, and somatic symptom disorder: as compared to patients in mild group and moderate group, those in severe group had higher severity of anxiety and somatic symptom disorder (Z=-2.143, P=0.032; Z=-2.045, P=0.041), while there was no statistically significant difference of depression between mild group and moderate group (Z=-1.176, P=0.240). Pearson correlation analysis revealed that radiation rectal injury symptom score was positively correlated with anxiety (r=0.300, P=0.013), depression (r=0.287, P=0.015) and somatic symptom disorder (r=0.344, P=0.003). Conclusions: The incidence of anxiety, depression, and somatic symptom disorder in patients with radiation rectal injury is extremely high. It is necessary to strengthen the diagnosis and treatment of somatic symptom disorder, so as to alleviate the symptoms of patients with pelvic perineum pain and improve the quality of life.

Endemic situation of schistosomiasis in Jiangshan City from 2008 to 2018 / 中国血吸虫病防治杂志

Objective To analyze the endemic situation of schistosomiasis in Jiangshan City from 2008 to 2018, so as to provide evidence for formulating the future control strategy. Methods The data regarding Oncomelania snail survey and control, schistosomiasis examinations and environmental improvements were collected in Jiangshan City from 2008 to 2018. The changes in snail status and morbidity due to Schistosoma japonicum infections were analyzed to assess the effectiveness of comprehensive schistosomiasis control. Results From 2008 to 2018, a total of 61 220 person-times were examined for S. japonicum infections in Jiangshan City, and the overall seroprevalence of S. japonicum infections was 0.56% (343/61 220); however, no egg-positives were detected. Among 4 231 cattle screened for S. japonicum infections using blood tests in Jiangshan City during the period from 2008 to 2018, 12 were sero-positive, with sero-prevalence of 0.28% (12/4 231), and no egg-positives were identified. There were 422 snail habitats identified in Jiangshan City during the study period, covering an area of 46.915 hm2, and among the 31 686 snails dissected, no S. japonicum infections were detected. An area of 3 625.492 hm2 snail habitats were subjected to repeated snail control and 11 settings were given environmental improvements, covering snail habitats of 17.880 hm2 and historical snail habitats of 204.380 hm2. Conclusions Following the implementation of environmental improvements-based comprehensive schistosomiasis control, the endemic situation of schistosomiasis is stable in Jiangshan City; however, there is still a risk of snail importation and re-emerging schistosomiasis. Therefore, the monitoring of snails and morbidity due to S. japonicum infections should be intensified in the city.

Study on clinical value of three localization methods in laparoscopic colorectal tumor surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effectiveness of three localization methods, including methylene blue, metal clips and intraoperative colonoscopy in laparoscopic colorectal surgery.</p><p><b>METHODS</b>A retrospective analysis was performed to review the clinical data of 64 patients who underwent the laparoscopic colorectal operations in Cancer Hospital of Fudan University from December 2009 to June 2012. Three methods of tumor localization were used perioperatively, including 23 cases of methylene blue, 20 of metal clips and 21 of colonoscopy.</p><p><b>RESULTS</b>Operations were successfully performed in this cohort and there were no deaths or complications. In methylene blue group, intraoperative colonoscopy was performed in two cases because of the inability to visualize blue dye on the serosal surface of the intestinal wall, another 2 cases were converted to open operation because of methylene blue diffusion and inability to identify resection margin. Intraoperative colonoscopic localization was required for 3 cases of sigmoid colon or upper rectal tumor because of inaccurate tumor localization by metal clips. Poor operative exposure due to obvious bowel distension prompted the conversion to open surgery in 2 cases of colonoscopy localization group, and the accurate position of the lesion was not found in another 2 cases due to long pedunculated adenoma.</p><p><b>CONCLUSIONS</b>Colorectal tumor can be localized effectively by endoscopic methylene blue tattooing at a maximum of 2 tumors before operation and the method of 4-point positioning can significantly improve the accuracy of colorectal tumor localization. Tumor localization preoperatively on the day of surgery by metal clip is accurate for the right or left colon cancer. Intraoperative colonoscopy can localize tumor accurately and rapidly for rectosigmoid or descending tumor, and the incidence of bowel distension can be significantly reduced. Localization method should be considered according to the tumor location and surgical procedure.</p>

Prospective study on the use of nickel-titanium temperature-dependent memory-shape device (CAR27) for anastomosis after colorectal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To prospectively evaluate the safety and efficacy of nickel- titanium temperature-dependent memory-shape device(CAR27) for colorectal anastomosis.</p><p><b>METHODS</b>Sixty colorectal cancer patients were randomly divided into two groups and received colorectal anastomosis with CAR27 or traditional stapling device. Complications, bowel function return, and the extrusion of anastomosis ring were prospectively monitored.</p><p><b>RESULTS</b>Both CAR27 and stapler group had one case of anastomotic leakage. Other complications such as stricture or obstruction were not found. Time for anastomosis of the two groups were (10.1±1.2) minutes and (11.2±2.1) minutes respectively. Time to first flatus was(3.2±1.2) days and (3.5±1.4) days respectively. Time to food intake resumption was (4.0±1.4) days and (4.3±1.3) days respectively. The differences above between the two groups were not statistically significant(P>0.05). The ring was expelled with stool within 7-16 days. The two groups were similar in operative time and the return of bowel function.</p><p><b>CONCLUSION</b>CAR27 is safe and simple for colorectal anastomosis.</p>

Compression anastomosis ring: a novel technique for colorectal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of a novel nickel-titanium memory alloy compression anastomosis ring(CAR27) for colorectal anastomosis.</p><p><b>METHODS</b>One sigmoid cancer patient undergone lower anterior resection(LAR) received colorectal anastomosis with CAR27 on November 12, 2009. The following parameters were recorded during 4 weeks postoperative follow-up:colorectal anastomotic complication,first post-operation flatus and bowel movement, extrusion of ring device.</p><p><b>RESULTS</b>The total operation time was 42 minutes, including 11 minutes for colorectal anastomosis. The patient had flatus at the first day and began feeding at the second day postoperatively. The ring was expelled with stool at the 10th day postoperatively. Patient didn't have anastomotic complications such as leakage or obstruction during 1 month postoperative follow-up.</p><p><b>CONCLUSION</b>This case study primarily indicates CAR27 is safe and feasible for colorectal anastomosis.</p>

Efficacy of laparoscopic sleeve gastrectomy on morbidly obese patients with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of laparoscopic sleeve gastrectomy(LSG) on improving glycemic control of morbidly obese patients with type 2 diabetes mellitus.</p><p><b>METHODS</b>Prospective study of 30 type 2 diabetes mellitus(T2DM) patients with BMI > or = 35 undergone LSG was carried out. Pre- and post-operative clinical parameters associated with diabetes mellitus 6 months after operation were evaluated. Data collected included demographics, weight loss(BMI, EWL%), diabetes control (FPG, HbA1C) and ghrelin.</p><p><b>RESULTS</b>Fasting plasma glucose and glycosylated hemoglobin concentration tests and clinical outcomes suggested LSG resulted in significant improvement or resolution of T2DM in all the 30 patients with CR 63%(19/30) and PR 37%(11/30).</p><p><b>CONCLUSIONS</b>LSG can lead to significant changes in controlling glycemia on morbidly obese patients with T2DM in 6 months. Long-term efficacy needs further follow-up.</p>

Efficacy of sleeve gastrectomy plus gastric remnant banding on weight reduction and remnant gastric dilatation: an animal experimental study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of sleeve gastrectomy plus gastric remnant banding on weight reduction and remnant gastric dilatation in SD rat model.</p><p><b>METHODS</b>Sleeve gastrectomy plus gastric remnant banding was performed in 20 male SD rats as the study group; sleeve gastrectomy was performed in 20 SD male rats as the control group, and laparotomy was performed in 10 SD male rats as the blank control group. Body weight was measured before the experiment, at day 1 and at 2-week intervals within 16 weeks after operation.</p><p><b>RESULTS</b>The number of survival rats was 15 in the study group (15/20), 13 in the control group (13/20), and 10 in the blank control group (10/10). Postoperative body weight increased markedly in the blank control group, returned to the pre-operative level two weeks after operation in the control group, and four weeks after operation in the study group. Weight increase of the study group was significantly slower than that of the other two groups (P<0.01). Postoperative gastric dilation of the control group was more obvious as compared to the study group.</p><p><b>CONCLUSION</b>Sleeve gastrectomy plus gastric remnant banding is safe and effective because of the restriction of postoperative gastric dilation.</p>

Application of laparoscopic compression anastomosis clip for laparoscopic gastrointestinal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of laparoscopic compression anastomosis clip (LapCAC) for laparoscopic gastrointestinal anastomosis.</p><p><b>METHODS</b>In March, 2007, three gastric cancer patients undergone total gastrectomy (1 case) and distal gastrectomy (2 cases) received laparoscopic gastrointestinal anastomosis with LapCAC. The gastrointestinal anastomotic complications, first post-operational flatus, bowel movement and extrusion of clip device were observed.</p><p><b>RESULTS</b>No anastomotic complications such as leakage or obstruction were found. The clip was expelled with stool within 12-18 days. All the patients had good results in recovery of bowel function.</p><p><b>CONCLUSION</b>LapCAC is safe and simple for laparoscopic gastrointestinal anastomosis.</p>