Advances in functional assessment and bowel rehabilitation following intersphincteric resection for low rectal cancer / 中华胃肠外科杂志

Intersphincteric resection (ISR) has been performed as an ultimate sphincter-sparing strategy in selected patients with low rectal cancer. Accumulating evidence suggests that ISR may be an interesting alternative to abdominoperineal resection to avoid a permanent stoma without compromising oncological outcomes. However, bowel dysfunction is a most common consequence of ISR not to be neglected. To date, limited clinical research has reported functional and quality of life outcomes according to patient-reported outcome measures. Also, data concerning management of low anterior resection syndrome are scarce due to lack of quality evidence. Therefore, this review provides an up-to-date summary of systematic assessment (including function, quality of life, manometry and morphology) and bowel rehabilitation for ISR patients. Postoperative anal function is often assessed by a combination of scales, including the Incontinence Assessment Scale, the Gastrointestinal Function Questionnaire, the Specific LARS Assessment Scale and the Faecal Diary. The condition-specific Quality of Life Scale is more appropriate for Quality-of-life measures in fecal incontinence after ISR. Patients' physiological function after ISR can be assessed using water- or high-resolution solid-state anorectal manometry. Anatomical and morphological changes can be assessed using defecography and 3D endorectal ultrasound. Electrical stimulation and biofeedback, pelvic floor exercises, rectal balloon training, transanal irrigation and sacral neuromodulation are all options for post-operative rehabilitation.

Complications after procedure for prolapse and hemorrhoids for circular hemorrhoids / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the perioperative and postoperative long-term complications of procedure for prolapse and hemorrhoids(PPH) for the treatment of circular internal hemorrhoids and circular mixed hemorrhoids.</p><p><b>METHODS</b>A retrospective study was performed in 2152 patients with circular internal hemorrhoids and circular mixed hemorrhoids eligible for PPH from January 2002 to December 2011. The perioperative and postoperative long-term complications were recorded and assessed.</p><p><b>RESULTS</b>The median length of follow-up was 73 months. Perioperative complications and adverse events were reported including acute urinary retention(n=360, 16.7%) which was managed by temporary cathether indwelling, anastomotic bleeding(n=45, 2.1%) managed by surgical or endoscopic procedures, chronic anoperineal sustained pain(n=30, 1.4%) managed by local treatment or stapler removal, and thrombosed external hemorrhoid(n=28, 1.2%) managed by conservative treatment or resection. Long-term postoperative complications were reported including mild fecal incontinence(n=112, 6.3%), postoperative recurrence(n=82, 4.6%), anal distention and defecatory urgency(n=50, 2.8%), anastomotic stenosis(n=4, 0.2%). Postoperative recurrence developed in 82 patients(4.6%), 28 of whom were managed by repeat PPH and 54 by conservative treatment.</p><p><b>CONCLUSION</b>PPH appears to be a safe technique for patients with circular internal hemorrhoids and circular mixed hemorrhoids.</p>

Complications after stapled transanal rectal resection for obstructed defecation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety of stapled transanal rectal resection (STARR) for the treatment of obstructed defecation syndrome(ODS).</p><p><b>METHODS</b>A retrospective study was performed in 112 female patients with ODS eligible for STARR. The short-lerm and long-term postoperative complications were recorded and assessed.</p><p><b>RESULTS</b>Short-term postoperative complications and adverse events were reported in 18 patients (16.1%) including fecal incontinence (4.5%), anastomotic bleeding (2.7%), staple line partial dehiscence (0.9%), anal fissure (2.7%), acute urinary retention (1.8%), thrombosed external hemorrhoid (1.8%), hematoma of the rectovaginal septum (0.9%) and fecal impaction (0.9%). Reoperation was required in 2 patients (1.8%) due to the short-term postoperative complications. The median length of follow-up was 24 months. There were 6 patients with long-term postoperative complications (5.4%) including fecal incontinence (1.8%), defecatory urgency (0.9%), chronic pain due to anastomotic inflammation (1.8%), and chronic pain due to anal rectal diverticulum (0.9%). Three patients (2.7%) were reoperated.</p><p><b>CONCLUSION</b>STARR appears to be a safe technique for patients with obstructed defecation.</p>

Association of IVS10+12G>A polymorphism in hMSH2 gene with colorectal cancer in Chinese / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the association of the single-nucleotide polymorphism (SNP) IVS10+12 G>A in hMSH2 gene with colorectal cancer in a Chinese population of Jiangsu province.</p><p><b>METHODS</b>A case-control study to investigate whether this SNP affects the risk of developing colorectal cancer was conducted. Subjects included 108 colorectal cancer patients and 180 healthy individuals. Peripheral white blood cell DNA was obtained from all subjects. The hMSH2 gene IVS10+12 G>A was genotyped using a PCR-based DHPLC, the existence of IVS10+12 G>A was verified by DNA sequencing.</p><p><b>RESULTS</b>The allele frequency of the IVS10+12 G>A in the hMSH2 gene in the healthy individuals was 51.7%. There was significant difference in the frequency of the IVS10+12 G>A between patients and healthy controls (P<0.05), and between familial patients and healthy controls (P<0.05). There was also significant difference of the frequency of the IVS10+12 G>A between patients younger than 50 years, and patients with high consumption of fried food and pickled vegetable and healthy controls respectively (P<0.05).</p><p><b>CONCLUSION</b>This SNP may be associated with colorectal cancers in Chinese. Further investigation with larger sample size is needed.</p>

MTHFR polymorphisms, dietary folate intake and risks to breast cancer / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between dietary folate intake and genetic polymorphisms of 5, 10-methylenetetrahydrofolate reductase (MTHFR) with reference to breast cancer risk.</p><p><b>METHODS</b>A case-control study was conducted with 669 cases and 682 population-based controls in Jiangsu province of China. MTHFR C677T and A1298C genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. Dietary folate intake was assessed by using an 83-item food frequency questionnaire. Odds ratios (OR) were estimated with an unconditional logistic model.</p><p><b>RESULTS</b>The frequencies of MTHFR C677T C/C, C/T and T/T genotypes were 32.37% (202/624), 48.88% (305/624) and 18.75% (117/624) in cases and 37.66% (235/624), 48.24% (301/624) and 14. 10% (88/624) in controls, respectively. The difference in distribution was significant (chi2 = 6.616, P = 0.037), the T/T genotype being associated with an elevated OR for breast cancer (1.62, 95% CI: 1.14 -2.30). The frequencies of MTHFR A1298C A/A, A/C and C/C were 71.47% (446/624), 27.08% (169/624) and 1.44% (9/624) in cases and 68.11%(425/624), 30.13% (188/624) and 1.76% (11/624)in controls,with no significant differences found (chi2 = 1.716, P= 0.424). Folate intake of cases [(263.00 +/- 137.38) microg/d] was significantly lower than that of controls [(285.12 +/- 149.61) microg/d] (t = -2. 830, P =0.005). Compared with the lowest tertile (< or = 199.08 microg/d) of folate intake, the adjusted OR for breast cancer in the top tertile (> or = 315.11 microg/d) was 0.70 (95% CI: 0.53 -0.92). Among individuals with the MTHFR A1298C A/A genotype,adjusted OR for breast cancer were 0.89 (95% CI: 0.62 - 1.27) and 1.69 (95% CI: 1.20 - 2.36) for the second to the third tertile of folate intake compared with the highest folate intake group (X2trend = 11.372, P = 0.001).</p><p><b>CONCLUSION</b>The findings of the present study suggest that MTHFR genetic polymorphisms,and dietary intake of folate may modify susceptibility to breast cancer.</p>

Genetic polymorphisms of alcohol dehydrogenase-2 and aldehyde dehydrogenase-2 associated with the susceptibility on esophageal cancer / 中华流行病学杂志

Objective To evaluate the impact of alcohol dehydrogenase-2 (ADH2) and aldehyde dehydrogenase-2 (ALDH2) polymorphisms on the susceptibility of esophageal cancer. Methods A case-control study including 221 cases of esophageal cancer and 191 controls was carried out in Taixing city of Jiangsu province. ADH2 and ALDH2 genotypes were tested by PCR and denaturing high -- performance liquid chromatography (DHPLC). Results (1) Compared with ALDH2 G/G carriers, ALDH2 A/A (OR=5.69, 95%CI: 2.51-12.18) and ALDH2 G/A (OR=1.70, 95%CI: 1.08-2.68) carriers showed a significantly elevated risk of developing esophageal cancer, especially among alcohol drinkers with ALDH2 A/A (OR=8.63,95% CI: 2.07-35.95). (2) Statistical relation was not found between ADH2 genotypes and the risk of esophageal cancer, with regard to the status of alcohol consumption. (3) Whether subjects with whatever ADH2 genotype, ALDH2 G/A or A/A carriers was found to have significantly increased the risk of developing esophageal cancer, with ALDH2 A/A carriers appeared having higher esophageal cancer risk than those ALDH2 G/A carriers. (4)Compared those non-drinkers with both ALDH2 G/G and ADH2 A/A , drinkers with ALDH2 G/A or A/A and ADH2 C,/A or G/G genotypes showed a significantly elevated risk of developing esophageal cancer (OR=8.36, 95% CI: 2.98-23.46). Conclusion These results revealed that it was not ADH2 but ALDH2 polymorphisms and drinking alcohol had a significant interaction with the development of esophageal cancer, suggesting that in order to help lowering the risk of esophageal cancer, individuals who are carrying ALDH2 A/A or G/A genotypes should be encouraged to reduce their consumption of alcohols.

Comparison of long-term efficacy on severe hemorrhoids between procedure for prolapse and hemorrhoids and Milligan-Morgan hemorrhoidectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the long-term results of procedure for prolapse and hemorrhoids(PPH) and Milligan-Morgan(MM) hemorrhoidectomy in the treatment of third- and fourth-degree hemorrhoids.</p><p><b>METHODS</b>Ninety-one patients in PPH group and 120 patients in MM group, treated in our hospital from May 2001 to May 2005, were followed up. All the patients suffered with third- or fourth-degree hemorrhoids. The data including symptoms relief, complication and recurrence were compared between two groups.</p><p><b>RESULTS</b>PPH and MM both significantly relieved bleeding (95.6% vs 92.7%), pain (93.1% vs 94.3%) and prolapse (93.4% vs 93.1%). There were no significant differences between two groups(P >0.05). PPH significantly relieved constipation compared with MM(60.0% vs 32.1%, P <0.05). No significant differences of complete relief rates between PPH group and MM group according to different degrees, types and prolapses of hemorrhoids were found(P >0.05). There were no significant differences in the overall complication rate(14.3% vs 12.7%), recurrence rates(12.1% vs 8.8%) and satisfactory degree (85.1 vs 88.2) between two groups as well.</p><p><b>CONCLUSION</b>The long-term outcomes of PPH in the treatment of third and fourth-degree hemorrhoids are similar to Milligan-Morgan hemorrhoidectomy.</p>

Application of stapled transanal rectum resection in the treatment of obstructed defecation syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of stapled transanal rectum resection (STARR) in the treatment of obstructed defecation syndrome (ODS).</p><p><b>METHODS</b>Fifty-six patients with ODS who had rectocele and/or intussusception were treated with STARR from January 2007 to August 2008. The incidence of preoperative and postoperative symptoms of ODS was compared. Symptomatic relief was also observed by using scoring system.</p><p><b>RESULTS</b>The average operation time was 28 min, and in the first 3 days after operation the average VAS pain score was 3.2 points. Two patients experienced mild anal incontinence when followed-up to 6 months; 2 patients suffered mild anal pain during defecation due to slight anastomotic inflammation 2 and 4 months after the operation, respectively. No other complications was found. The mean follow-up period was 8 months after surgery, and the rate of symptoms of ODS reduced significantly compared with that before surgery, in particular the incidence of the difficult and obstructive defecation feelings decreased for more than 50 percent (P<0.05). Compared with that before the operation, the sense of no emptying stool decreased for 65 percent and all the other symptoms reduced for more than 72 percent (all P<0.05).</p><p><b>CONCLUSION</b>The stapled transanal rectum resection is simple, less invasive, less painful and with fewer complications and more satisfactory recent effect in treating obstructed defecation syndrome.</p>

Serotonin transporter gene polymorphism in slow transit constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association between the polymorphism of serotonin transporter gene-linked polymorphic region(5-HTTLPR) and slow transit constipation(STC).</p><p><b>METHODS</b>Polymerase chain reaction was used to assess 5-HTTLPR polymorphism of SERT gene in 54 patients with STC and 100 healthy controls.</p><p><b>RESULTS</b>The frequencies of serotonin transporter short/short(S/S) and allele S genotypes were significantly higher in STC patients than those in controls(72.2% vs 50.0%; 83.3% vs 72.5%; both P< 0.05). There were no significant differences in 5-HTTLPR polymorphism respectively between the two groups according to gender and age(less than 45 and more than 45 years old). The frequency of S/S genotype was higher in the patients with less than 40% of the ingested markers evacuated within 72 h than those with more than 40% evacuated(71.7% vs 42.6%, P< 0.05).</p><p><b>CONCLUSION</b>The presence of 5-HTTLPR allele S may contribute to the pathogenesis of STC.</p>

A case-control study on the polymorphisms of methylenetetrahydrofolate reductase 1298A-->C and susceptibility of esophageal cancer / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between polymorphisms of methylenetetra-hydrofolate reductase gene 1298A-->C (MTHFR 1298A-->C) and its susceptibility of esophageal cancer (EC).</p><p><b>METHODS</b>We conducted a case-control study with 141 cases of EC and 228 population-based controls in Huaian city of Jiangsu province, China. Epidemiological data were collected, and DNA of peripheral blood leukocytes was obtained from all of the subjects. MTHFR genotypes were identified by polymerase chain reaction.</p><p><b>RESULTS</b>(1) The frequency of MTHFR 1298AA, AC and CC genotype were 63.8%, 34.0% and 2.1% in EC and 71.9%, 28.1% and 0.0% in controls, respectively (chi(2)(MH) = 6.69, P = 0.035). The frequency of the MTHFR 1298C allele was 0.19 for EC and 0.14 for controls. (2) Individuals having MTHFR 1298C allele and smoking habit were at a significantly higher risk of developing EC (adjusted OR = 3.48, 95% CI: 1.57 - 7.71) compared with those who having AA genotype but no smoking habit. Individuals having MTHFR 1298C allele and habit of frequent alcohol drinking were at an increased risk of developing EC (adjusted OR = 2.91, 95% CI: 1.20 - 7.08) compared with those with AA genotype and low consumption of alcohol. Individuals having MTHFR 1298C allele but no habit of tea drinking had a 3.52-fold (95% CI: 1.64 - 7.54) increased risk of developing EC compared with tea drinkers with AA genotype. As compared with subjects having AA genotype, low consumption of alcohol, no smoking habit but having habit of drinking tea, the individuals having 1298C allele, habits of frequent alcohol drinking, smoking but no habit of tea drinking had a 12.64-folds (95% CI: 1.39 - 114.65) increased risk of developing EC.</p><p><b>CONCLUSION</b>Results in the present study suggested that there was a coordinated effect between MTHFR 1298 genotypes and habits of smoking, alcohol drinking and tea consumption in the development of EC.</p>

Interactions between lifestyle, methylanetetrahydrofolate reductase gene and polymorphisms in thymidylate synthase gene with risk of stomach cancer / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate interactions between lifestyle, methylanetetrahydrofolate reductase gene (MTHFR) and polymorphisms in the 3'-untranslated region (3'-UTR) of the thymidylate synthase gene (TS) with reference to development of stomach cancer (SC).</p><p><b>METHODS</b>We conducted a case-control study with 107 cases of SC and 200 population-based controls in Huaian city of Jiangsu province, China. TS genotypes were identified by polymerase chain reaction.</p><p><b>RESULTS</b>(1) The frequencies of TS genotypes (+6 bp/+6 bp, +6 bp/-6 bp and -6 bp/-6 bp) among the cases were 5.6%, 47.7% and 46.7% and among the controls were 9.0%, 54.0% and 37.0%, respectively. Individuals identified as -6 bp/-6 bp genotype had a slightly higher risk for SC than those individuals with +6 bp alleles (the crude OR = 1.49, 95% CI: 0.90 - 2.47; adjusted OR = 1.36, 95% CI: 1.00 - 1.78, P = 0.047). (2) Individuals having TS -6 bp/-6 bp genotype and having smoking habit were at a significantly higher risk of developing SC (adjusted OR = 2.79, 95% CI: 1.51 - 5.18) compared with those who had +6 bp alleles with no smoking habit. Individuals having TS -6 bp/-6 bp genotype and habit of frequent alcohol drinking were at an increased risk of developing SC (adjusted OR = 1.76, 95% CI: 1.07 - 2.90) compared with those with +6 bp alleles and low consumption of alcohol. As compared with individuals with +6 bp alleles and who had habit of tea drinking, individuals who had TS -6 bp/-6 bp genotype and but without habit of tea drinking had an increased risk of developing SC (adjusted OR = 2.34, 95% CI: 1.43 - 3.82). (3) Individuals with TS -6 bp/-6 bp genotype and with MTHFR T alleles had an increased risk of developing SC (adjusted OR = 2.67, 95% CI: 1.07 - 6.70) compared with those with +6 bp alleles and with MTHRF C/C genotype.</p><p><b>CONCLUSION</b>Results in the present study suggested that there was a combined effect between lifestyle, MTHFR C/T or T/T genotype and TS -6 bp/-6 bp genotype in the development of SC.</p>

Relationship between neurotoxicity of 6-hydroxydopamine and glutamate transport / 药学学报

<p><b>AIM</b>To study the relationship of neurotoxicity of 6-hydroxydopamine (6-OHDA) and the function of glutamate transporter.</p><p><b>METHODS</b>Using in vivo microdialysis together with high performance liquid chromatography (HPLC) to detect the alteration of glutamate in the striatum and extracellular fluid of the PC12 cell. The rate of apoptosis and the activity of PC12 cells are read in a flow cytometer and a photometer for enzyme-labeled assays. The function of glutamate transporter is decided by detecting the ability of L-[3H]-glutamate uptake.</p><p><b>RESULTS</b>6-OHDA was shown to induce apoptosis and decrease the activity of PC12 cells. Increased release of glutamate was also found in PC12 cells and the injured striatum of the PD rats. But glutamate uptake in PC12 cells and rat striatum synaptosomes are inhibited obviously.</p><p><b>CONCLUSION</b>The neurotoxicity of 6-hydroxydopamine is associated with declined function of glutamate transporters, which may be one important pathogenesis mechanisms of Parkinson's disease.</p>