Rare rectal gastrointestinal stromal tumor case: A case report and review of the literature.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract accounting for less than 1% of all gut tumors. GISTs occurring in the rectum are extremely rare, and these usually present at an advanced stage compared with other sites. CASE SUMMARY: A 60-year-old male who presented with features of sensations of rectal tenesmus was referred to our department with a mass in the lower rectum that was detected during a routine checkup. Colonoscopy, transrectal ultrasound, perianal magnetic resonance imaging and ultrasonic contrast were used to diagnose the rectum GIST, and then the patient underwent complete transanal resection using the ultrasonic scalpel. The patient was discharged ten days after the operation and was defined as low risk. Therefore, he had no need to receive subsequent adjuvant therapies, and he had not suffered any anal dysfunction or had any evidence of recurrence at follow up. CONCLUSION: Surgical resection with histologically negative margins is the standard curative treatment for rectal GISTs. Appropriate surgical techniques based on the location, size, and resectability of the tumor should attract great attention from clinicians.

Loganin alleviates LPS-activated intestinal epithelial inflammation by regulating TLR4/NF-κB and JAK/STAT3 signaling pathways.

Inflammatory bowel disease (IBD) is a chronic, recurrent gastrointestinal inflammation that affects millions of people around the world. Loganin, an iridoid glycoside, has shown the anti-inflammatory effects. However, the effect of loganin on IBD and its underlying molecular mechanism are not clear. The present study aimed to investigate whether loganin could alleviate IBD and its mechanisms. The intestinal epithelial Caco-2 cell line was treated with lipopolysaccharide (LPS) to establish an in vitro IBD model. MTT assay was used to detect cell viability. The expression and release level of inflammatory factors were determined by both real-time-PCR and ELISA. Western blotting was used to assess the NF-κB and JAK/STAT3 pathway-related protein levels. The results showed that loganin repressed the expression and release of IL-6, TNF-α, and IL-1ß, and inhibited TLR4/NF-κB and JAK/STAT3 signaling pathways in a concentration-dependent manner. Overexpression of TLR4 could reverse the effect of loganin, leading to activation of NF-κB signaling and production of inflammatory factors. Meanwhile, IGF-1, a JAK/STAT3 signaling activator, could also reverse the anti-inflammation effect of loganin. In conclusion, loganin inhibited LPS-activated intestinal epithelial inflammation by repressing TLR4/NF-κB and JAK/STAT3 signaling pathway.

Three-dimensional reconstruction of anomalous eutectic in laser remelted Ni-30 wt.% Sn alloy.

Laser remelting has been performed on Ni-30 wt.% Sn hypoeutectic alloy. An anomalous eutectic formed at the bottom of the molten pool when the sample was remelted thoroughly. 3D morphologies of the α-Ni and Ni3Sn phases in the anomalous eutectic region were obtained and investigated using serial sectioning reconstruction technology. It is found that the Ni3Sn phase has a continuous interconnected network structure and the α-Ni phase is distributed as separate particles in the anomalous eutectic, which is consistent with the electron backscatter diffraction pattern examinations. The α-Ni particles in the anomalous eutectic are supersaturated with Sn element as compared with the equilibrium phase diagram. Meanwhile, small wavy lamella eutectics coexist with anomalous eutectics. The Trivedi-Magnin-Kurz model was used to estimate undercooling with lamellar spacing. The results suggest that the critical undercooling found in undercooling solidification is not a sufficient condition for anomalous eutectic formation. Besides, α-Ni particles in the anomalous eutectic do not exhibit a completely random misorientation and some neighboring α-Ni particles have the same orientation. It is shown that both the coupled and decoupled growth of the eutectic two phases can generate the α-Ni + Ni3Sn anomalous eutectic structure.

[Physiological responses of tubificidae to heavy metal chromium stress].

Tubificidae is now used in the wastewater treatment systems to successfully minimize the sludge production, which has been proved an effective, economical and sustainable technology. But the excess sludge inevitably contains a variety of heavy metals, especially the sludge from industrial wastewater treatment plant. In order to apply tubificidae to these systems, Chromium was selected as pollutant object and the physiological responses of tubificidae to Chromium were studied in this paper. Acute toxicity was analyzed and Median lethal concentrations (LC50) were determined over 96 h periods for Cr. Results indicated that 24 h LC50 and 96 h LC50 were 7.94 mg x L(-1) and 0.49 mg x L(-1), respectively. The duration f tubificidae in Cr solution decreased with increasing Cr concentration. Under the Cr stress, a highest respiration rate was obtained when the concentration of Cr(VI), temperature, pH and DO was 2.50 mg x L(-1), 26 degrees C, 6.0 and 6.0 mg x L(-1), respectively. The order of these factors was the concerntration of Cr(VI), temperature, DO and pH. The respiration experiments demonstrated that low concentration (< 2.50 mg x L(-1)) of Cr could promote the respiration rate of tubificidaes. On the other hand, when the concentration of Cr was 8.00 mg x L(-1), it could remarkably inhibit the respiratory rates of tubificidae.

Biofeedback therapy combined with traditional chinese medicine prescription improves the symptoms, surface myoelectricity, and anal canal pressure of the patients with spleen deficiency constipation.

In order to observe the clinical therapeutic effects of Yiqi Kaimi Prescription and biofeedback therapy on treating constipation with deficiency of spleen qi, the 30 cases in the control group were given oral administration of Yiqi Kaimi Prescription, in combination with anus-lifting exercise; the 30 cases in the treatment group were given biofeedback therapy on the basis of the afore mentioned methods for the control group. The TCM symptom scores and anorectal pressures before and after treatment were observed and evaluated. There were significant differences in TCM symptom scores, anorectal pressure, and clinical recovery rate before and after treatment. In the treatment group, the total recovery rate was 86.66%, while in the control group it was 50%; there were significant differences between the two groups (P < 0.01). Yiqi Kaimi Prescription coupled with biofeedback therapy is clinically effective for treating constipation with deficiency of spleen qi, and thus this method is applicable for functional constipation with deficiency of spleen qi.

Traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.

AIM: To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess. METHODS: Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression (SDPC)] and control group [fistulotomy (FSLT)]. In the SDPC group, the internal opening was excised and incisions at external openings were made for drainage. Silk sutures were put through every two incisions and knotted in loose state. The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge. In the FSLT group, the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed. The time of healing, postoperative pain score (visual analogue scale), recurrence rate, patient satisfaction, incontinence evaluation and anorectal manometry before and after the treatment were examined. RESULTS: There were no significant differences between the two groups regarding age, gender and fistulae type. The time of healing was significantly shorter (24.33 d in SDPC vs 31.57 d in FSLT, P < 0.01) and the patient satisfaction score at 1 mo postoperative follow-up was significantly higher in the SDPC group (4.07 in SDPC vs 3.37 in FSLT, P < 0.05). The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT. None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively. The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and trans-sphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT. The maximal squeeze pressure and resting pressure declined after treatment in both groups. The maximal anal squeeze pressures after treatment were reduced (23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures (12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT), but there were neither significant differences between the two groups and nor significant differences before or after treatment. CONCLUSION: Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe, effective and less invasive.

Thread-dragging therapy in treatment of a rat model of infected subcutaneous fistula.

OBJECTIVE: This study was to develop an experimental rat model of subcutaneous fistula induced by bacteria infection and treat it with thread-dragging therapy. METHODS: A spring-gauze was surgically implanted into 24 male Sprague-Dawley rats' dorsal muscles, respectively, then mixed Staphylococcus aureus and Escherichia coli were injected into the spring-gauze. After 45 d, all the spring-gauzes were removed from the rats under anesthesia. X-ray and ultrasound were performed to assess the fistula tract. Each rat was examined by a fistula probe and four rats were randomly selected for histological assessment. The residual rats were randomly divided into two groups. Group A was treated with thread-dragging therapy, and group B was treated with fistulotomy. The healing time and body weight of the two groups were compared. RESULTS: On the 45th day of the spring-gauze implantation, imaging assessment proved a tract with two openings in all rats and histological results proved that lumen and surrounding granulation tissue with epithelium were similar to the features of fistula in human beings. The mean healing time of rats in group A was shorter than that of the rats in group B (P<0.01). The body weight of rats in group A was heavier than that of the rats in group B on the 7th and 14th day after surgery, respectively (P<0.05). CONCLUSION: A rat model of subcutaneous fistula induced by mixed Staphylococcus aureus and Escherichia coli infection was successfully established. Traditional Chinese medicine thread-dragging therapy is less invasive and safer than fistulotomy.

[Progress in surgical treatment of perianal abscess].

There were more and more patients suffered from perianal abscess. The patient's condition will become even worse if the patients cannot be treated properly. Selecting proper operation method according to special condition is the key point of increasing curative effect, decreasing suffering and relapse rate and promoting quality of life of patients. The authors summarized operation methods, including abscess incision drainage, radical incision and thread-drawing, and staging incision and thread-drawing, etc. in treating perianal abscess in clinic.

[Design characteristics of clinical surgery trial based on treatment program of tunnel thread-drawing method for anal fistula: a prospective randomized controlled multicenter trial].

BACKGROUND: Basic principles of clinical trials of nonpharmacologic treatment are similar to those of pharmacologic treatment, but its some special characteristics should be discussed. OBJECTIVE: To explore the design characteristics of clinical surgery trial through the example of tunnel thread-drawing therapy for simple anal fistula. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: The clinical trial was designed as a prospective, controlled, randomized multicenter trial. The patients came from Longhua Hospital, Yueyang Hospital of Integrated Traditional Chinese and Western medicine, and Affiliated Hospital of Jianxi University of Traditional Chinese Medicine. Stratified random was performed according to the subtype of anal fistula including low and high anal fistula. Full analysis set was applied to analyze the baseline data, and per protocol set was used in efficacy and safety analysis. The intervention was tunnel thread-drawing method. Classical therapy of thread-drawing method was employed as positive control. MAIN OUTCOME MEASURES: The primary outcomes were course of recovery and cure rate. Quality of life score was used as secondary outcome and anal maximum constriction pressure was considered as safety outcome. RESULTS: Optimal efficiency testing method was used to estimate sample size. A total of 244 subjects were recruited and 236 subjects completed the trial. There was no significant difference in the cure rate of the low and high anal fistula between the treatment group and control group. There was a significant difference in the course of recovery in the patients with low and high anal fistula between treatment group and control group (P<0.01). To the patients with low anal fistula, the course of recovery in the treatment group was (22.26 + or - 8.67) d, and the course of recovery in the control group was (31.41+ or - 11.39) d. To the patients with high anal fistula, the course of recovery in the treatment group was (24.73 + or - 8.15) d, and the course of recovery in the control group was (32.20 + or - 12.60) d. There was no significant difference in the scores of quality of life in the patients with low anal fistula between the treatment group and control group (P>0.05). The trial showed that the tunnel thread-drawing therapy was significantly more effective than classical method for improving the anal sphincter function and patient satisfaction with treatment in the patients with high anal fistula. However the other items of quality of life in the two groups did not show significant difference. There was no any adverse event report in each group. There was no significant difference in the anal maximum constriction pressure in the treatment group before and after the operation. CONCLUSION: The trial shows that the tunnel thread-drawing therapy for simple anal fistula can shorten the course of recovery and improve the patients' quality of life. The training about surgical intervention and clinical implementation program is important in clinical surgery trial. Blind is absolutely difficult to implement and placebo cannot be used in this kind of trial.

[Effects of mild moxibustion on angiogenesis and microcirculation in wound repair after operation of anal fistula in rats].

OBJECTIVE: To observe the effects of mild moxibustion on angiogenesis and microcirculation in wound repair after operation of anal fistula, and to explore the mechanism of action. METHODS: Seventy-two SD male rats were made to bear an "acute, open, bleeding, infected" wound surface and were divided randomly into mild moxibustion group, microwave group and control group (24 rats per group). The wound surfaces of the treatment groups were treated for 15 min with mild moxibustion or microwave medical instrument from the first day after operation, and the control group was not given any treatment. At the first, third, seventh and fourteenth days after operation (1, 3, 7 and 14 days of treatment), six rats in each group were sacrificed after examining the blood flow of the wound surface, and the samples of granulation tissues were collected. The numbers of CD34 and positive expression of vascular endothelial growth factor (VEGF) in granulation tissues were detected. RESULTS: In the early and middle stages of wound healing, mild moxibustion could obviously increase the expression of VEGF, the number of CD34, and the blood flow of the wound surface. And the expression of VEGF, the number of CD34, and the blood flow of the wound surface began to increase at the third day, and reached the peak level at the seventh day, and then began to decrease. In the late stage of wound healing (day 14), mild moxibustion could decrease the expression of VEGF, the number of CD34, and decrease the blood flow of the wound surface. There were significant differences between the mild moxibustion group and the control group in the blood flow of the wound surface, the expression of VEGF and the numbers of CD34 in granulation tissues (P<0.05) after treatment, and except the number of CD34 at 14-day treatment, there were also differences between the mild moxibustion group and the microwave group. CONCLUSION: Mild moxibustion has better regulative actions on blood flow of the wound surface and the number of CD34 and positive expression of VEGF in granulation tissues, and can regulate microcirculation in wound surface and promote the wound healing.

[Superiority of thread-dragging therapy in treatment of refractory sinus tracts or fistulae].

The thread-dragging therapy, as a new external treatment of traditional Chinese medicine, could eliminate pathogenic factors and restore the vital qi by promoting qi and activating blood circulation to advance tissue repair in treating refractory sinus tracts or fistulae. This article reviewed its origin and development, and introduced its use in treating refractory sinus tracts or fistulae.

[Effects of Yiqi Kaimi Recipe on gastrointestinal motility and neuropeptides in rats with colonic slow transit constipation].

OBJECTIVE: To observe the effects of Yiqi Kaimi Recipe (YQKMR), a traditional Chinese compound medicine, on gastrointestinal motility and neuropeptides in rats with colonic slow transit constipation. METHODS: Eighty specific pathogen free rats were included, and there were sixty rats with slow transit constipation (STC) and twenty normal rats. Sixty rats with STC were randomly divided into untreated group, cisapride-treated group and YQKMR-treated group, and twenty normal rats were allocated to normal control group. Percentage of carbon propelling, contraction frequency and amplitude of the muscle segments in vitro, and expressions of nitric oxide synthase-1 (NOS1) and substance P proteins were observed. RESULTS: Compared with the normal control group, the percentage of carbon propelling, and the contraction frequency and amplitude of the muscle segments in the untreated group decreased obviously (P<0.05) The percentage of carbon propelling, and the contraction frequency and amplitude of the muscle segments in the YQKMR-treated group and cisapride-treated group were higher than those in the untreated group (P<0.05). The expression of NOS1 protein in the untreated group was higher than that in the normal control group, YQKMR-treated group and cisapride-treated group. However, there were no significant differences between the YQKMR-treated group and the normal control group (P>0.05). The expression of substance P protein in the untreated group was lower than that in the normal control group, and there was no significant difference between the YQKMR-treated group and the normal control group too (P>0.05). CONCLUSION: Yiqi Kaimi Recipe could promote colon motility by increasing the contraction frequency and amplitude of the smooth muscle, and this may be due to its effect of regulating the expressions of NOS1 and substance P proteins in the enteric plexus.

[Effect of exogenous cytokine-stimulated decidual cells of early pregnancy on IgG secretion of B lymphocytes].

OBJECTIVE: To study the effect of exogenous cytokine-stimulated decidual cells on IgG secretion of B lymphocytes and investigate the features of local immunological microenvironment of the decidua. METHODS: Exogenous cytokines interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-6 and epidermal growth factor (EGF) were added separately in cultured decidual cells, and the supernatant of the culture medium was prepared for stimulating human peripheral blood lymphocytes. IgG secretion of the B cells was measured by radio-immunological method. RESULT: The decidual cells of normal early pregnancy stimulated B lymphocyte IgG secretion, and the supernatant of exogenous cytokine-stimulated decidual cells had the same effect, which, however, was depended not on the concentration and category of the cytokines, but only on the time of treatment. CONCLUSION: The exogenous cytokines can increase the humoral immunity in the decidual immunological microenvironment, but such effect might result from a self-regulatory mechanism of the local immunological microenvironment of the decidua, which can be fundamental for maintenance of normal pregnancy.

[Clinical research of thread-dragging through fistula method in treating patients with simple anorectal fistula].

OBJECTIVE: To evaluate the efficacy and safety of thread-dragging through fistula method in treating patients with simple anorectal fistula. METHODS: In this multi-centered, prospective, and randomized controlled clinical trial, 244 patients with simple low or high anorectal fistula were randomly divided into study group (with the method of thread-dragging through fistula) and control group (with the method of incision or thread-drawing). The healing time and curative rate of anorectal fistula, and the integral calculus of clinical symptom and life quality evaluations before and after treatment were all examined. The maximal anal canal squeeze pressure was measured to compare the therapeutic safety between these two groups. The health economical benefits were also assessed to determine which therapeutic method was more economical. RESULTS: The curative rate of simple low and high anorectal fistula were of no significant differences between the study group and the control group. The healing time of simple low anorectal fistula in the study group and the control group were (22.26+/-8.67) d and (31.41+/-11.39) d respectively, while the healing time of simple high anorectal fistula in the study group and the control group were (24.73+/-8.15) d and (32.20+/-12.60) d respectively, and there revealed significant differences between these two groups. Each integral calculus of clinical symptom evaluation in the study group was not obviously different from those in the control group besides the integral calculus of anal sphincter function. The integral calculus of life quality between the study group and the control group of simple low anorectal fistula had no significant differences. The integral calculus of anal sphincter function and confidence in treatment in the study group of high anorectal fistula were better than those in the control group. The hospitalization expense of the study group was remarkably lower than that of the control group. The maximal anal canal squeeze pressure in the study group after treatment was not reduced obviously as compared with that in the same group before treatment, while it was decreased significantly in the control group after treatment as compared with those in the same group before treatment and in the study group after treatment. CONCLUSION: The method of thread-dragging through fistula in treating simple low and high anorectal fistula can shorten the course of the disease, save the hospitalization expenses, improve the life quality of the patients, and protect the anal sphincter function.