Explore the effects of forest travel activities on university students' stress affection.

This study aims to explore the effects of forest travel activities on university students' stress affection. Forty volunteer university students participated in this study. All participants were asked to complete physiological (Heart Rate Variability) and psychological (Brief Profile of Mood State and State-Trait Anxiety Inventory) tests before and after the travel activities. The results reported that students' heart rates were significantly lower after the forest travel activities than before. All domains of negative mood and anxiety decreased from the pre-test to the post-test. This study found that university students could feel less stressed if they went on forest travel activities.

Analysis of Prevention and Treatment of Anastomotic Leakage after Sphincter-Preserving Surgery for Middle- and Low-Grade Rectal Cancer under Laparoscopy.

Background: Anastomotic leakage is one of the most serious complications that can occur after laparoscopic-assistedsphincter-preserving surgery for middle- and low-grade rectal cancer. Objectives: To explore the cause, prevention, and treatment of anastomotic leakage after sphincter-preserving surgery for middle- and low-grade rectal cancer under laparoscopy. Methods: The clinical data from patients with mid- and low-grade rectal cancer who underwent laparoscopic-assistedanus-preserving surgery in the anorectal surgery department of our hospital have been analyzed. Patients with a definite diagnosis, indications for laparoscopic surgery, and sphincter-preserving surgery were included in the analysis, and patients with a protective loop ileostomy and laparotomy were excluded. Results: Among the 126 patients with middle- and low-grade rectal cancer undergoing sphincter-preserving surgery under laparoscopy. There were 75 male patients and 51 female patients, ranging in age from 37 to 89 years old, with an average age of 60.2 ± 6.7. The distance from the lower edge of the rectal tumor to the anal edge was ≤10 cm. 6 developed anastomotic leakage after the operation (leakage rate of 4.7%). Moreover, turbid purulent fluid was drained from the abdominal drainage tube in three patients on the third and fourth days after the operation, and the abdominal drainage tube drained serous drainage in three more patients on the fifth and sixth days, with signs of peritonitis appearing locally. All patients received continuous flushing and negative pressure drainage with a self-made double cannula and symptomatic treatment, and all were cured and discharged. Conclusion: Many factors can cause anastomotic leakage after this operation, and adequate perioperative preparation, meticulous operation during surgery, and careful postoperative management are key factors in preventing it.

Short-term clinical and oncological outcomes after single-incision plus one-port laparoscopic surgery for rectosigmoid cancer: a retrospective clinical analysis of 30 cases.

OBJECTIVE: To evaluate the safety and feasibility of single-incision laparoscopic surgery+1 (SILS+1) radical resection of sigmoid and upper rectal cancer. METHODS: The clinical data of 30 consecutive patients with sigmoid and upper rectal cancer who underwent SILS+1 radical resection between October 2018 and January 2020 in our hospital were retrospectively analyzed. An initial 5-cm periumbilical transverse incision was made. Then, a multiport device was placed in the umbilical incision. Two 10-mm ports were used for laparoscope insertion, and the other two ports were used for laparoscope device insertion. A 12-mm trocar was placed in the right lower abdominal quadrant under laparoscopic view and served as the surgeon's dominant operating channel. RESULTS: All operations were performed successfully without conversion to conventional laparoscopic surgery or open operation. Three patients developed postoperative complications: one patient developed ileus, one developed postoperative bleeding, and one developed wound infection. There were no perioperative deaths. CONCLUSIONS: The safety and feasibility of SILS+1 radical resection of sigmoid and upper rectal cancer was established by experienced surgeons in our study. However, further studies are needed to demonstrate the advantages of this procedure compared with the benefits of conventional laparoscopic surgery.

Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids.

OBJECTIVE: To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. METHODS: Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. RESULTS: The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. CONCLUSION: Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.

Chemotherapy and resection for gastric cancer with synchronous liver metastases.

AIM: To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM). METHODS: A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter. RESULTS: Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the response evaluation criteria in solid tumors criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Three patients in surgery group were still alive at the end of the cut-off date. CONCLUSION: Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.

Vascular endothelial growth factor-A and -C: expression and correlations with lymphatic metastasis and prognosis in colorectal cancer.

Previous studies obtained contradicting results regarding the correlation between expression of VEGF-A, VEGF-C and colorectal cancer patients' clinicopathological features and prognosis. Moreover, the association between the growth factors' expression and lymphatic vessel invasion (LVI) with intratumoral and peritumoral difference has not been reported. In this study, 81 primary colorectal cancer samples were immunohistochemically stained for VEGF-A, VEGF-C and podoplanin. The expression of VEGF-A and VEGF-C in marginal portion was significantly higher than those in central portion (P = 0.000 for both). The expression of VEGF-A in marginal portion was correlated with lymph node metastasis (P = 0.031). The expression of VEGF-C in marginal portion was correlated with TNM stage (P = 0.045), peritumoral LVI (P = 0.048) and lymph node metastasis (P = 0.019). The group with high VEGF-A expression in marginal portion showed worse survival than the low expression group (P = 0.039). Patients with high expression of VEGF-C in the marginal portion were not significantly different from those with low VEGF-C expression (P = 0.121). Patients with high expression of both VEGF-A and VEGF-C in the marginal portion showed the worst survival (P = 0.015). In conclusion, increased expression of VEGF-A and VEGF-C in marginal portion of colorectal cancer was correlated with lymph node metastasis. VEGF-C facilitates colorectal cancer cells invade into peritumoral lymphatic vessels, and different mechanisms may exist in the invasion of tumor cells into peritumoral and intratumoral lymphatic vessels. Assessment the expression of both VEGF-A and VEGF-C in the marginal portion of tumor may help to identify patients with colorectal cancer with unfavourable overall survival.

Intratumoral as well as peritumoral lymphatic vessel invasion correlates with lymph node metastasis and unfavourable outcome in colorectal cancer.

The aim of this study was to assess the intratumoral and peritumoral distribution of lymphatic vessel density (LVD) and lymphatic vessel invasion (LVI) in colorectal cancer and their relationships with patients' clinicopathological characteristics and survival. Paraffin sections of 81 primary colorectal cancers were examined by immunohistochemical staining using monoclonal antibody D2-40. Peritumoral LVD was significantly higher than intratumoral LVD (P = 0.000). Both intratumoral LVD and peritumoral LVD were correlated with the presence of LVI (P = 0.006 and P = 0.003, respectively). LVI, intratumoral LVI and peritumoral LVI were identified, respectively in 38, 28 and 32% of the samples investigated. Both intratumoral LVI and peritumoral LVI were correlated with lymph node metastasis (P = 0.030 and P = 0.014, respectively). Lymph node metastasis, the presence of intratumoral LVI and peritumoral LVI were adversely associated with the 5-year overall survival in a univariate analysis (P = 0.001, P = 0.011 and P = 0.017, respectively). Multivariate analysis using Cox proportional hazard model showed that neither intratumoral LVI nor peritumoral LVI was an independent prognostic factor of overall survival. The results of this study demonstrated that intratumoral as well as peritumoral LVI was associated with lymph node metastasis and adverse outcome in colorectal cancer.

[Study on the early liver metastasis forecast of colorectal neoplasms].

OBJECTIVE: To obtain some effective objective markers used to predict the early liver metastasis of colorectal tumor, the relationship of liver metastasis of colorectal tumor with associate detection three markers such as CK20mRNA, CD44v6 and VEGF was studied. METHODS: The expression of CK20mRNA in patrol venous blood from 30 colorectal cancer patients was detected by fluorescent quantitative RT-PCR, and the results of CD44v6 and VEGF in colorectal cancer tissue were determined by means of immunohistochemistry, and then compared with those in control groups. RESULTS: The rate of positive expression of CK20mRNA in colorectal cancer patients' patrol venous blood was obviously superior to the level of benign pathological changes controls (P < 0.01), and significantly higher than that of normal controls (P < 0.01). The rate of positive expression of CD44v6 and VEGF in colorectal tumor tissue was distinctly superior to the level of benign pathological controls, and remarkable higher than that of normal controls (P < 0.01). The positive expression of liver metastasis was also clearly higher than that of no liver metastasis (P < 0.05). The rate of positive expression of CK20mRNA in patrol venous blood was evidently correlated to the expression of CD44v6 and VEGF in tumor tissue (r(1) = 0.933, r(2) = 0.906, P < 0.05). The results of associate detection of CK20mRNA, CD44v6 and VEGF were closely related to the incidence of liver metastasis. CONCLUSIONS: If combined detecting these markers of CK20mRNA, CD44v6 and VEGF to forecast liver metastasis of colorectal tumor, the sensitivity and specialty of prediction will be improved, there were highly clinical values in predicting in early diagnosis liver metastasis of colorectal tumor.

[The significance of pepsinogen with its subgroup and CA72-4 associate detect applied to early diagnostic and prognosis judgment on gastric cancer].

OBJECTIVE: To find out the connection of serum pepsinogen and it's subgroups (PGI, PGII) with CA72-4 to early diagnosis and postoperative recurrence on gastric cancer. METHODS: RIA was applied to detect the results of serum PGI, PGII and CA72-4 on gastric cancer and other stomach diseases, then the clinic value of associating detection on gastric cancer diagnosis and prognosis judgment were assessed. RESULTS: The serum PG levels of GC patients were significantly lower comparing to those of healthy controls (P < 0.01), apparent changes had taken place on earlier period GC (P < 0.05), and aggressive GC were even lower (P < 0.01). On the earlier period of GC diagnosis, CA72-4 levels were not apparently different to healthy controls (P > 0.05), and aggressive GC were significantly higher (P < 0.01). Compared preoperative with postoperative, the serum PGI and PGII and CA72-4 levels were significantly different (P < 0.01). In the patients underwent total gastrectomy, both of pepsinogen levels were lower than those of subtotal or large partial gastrectomy (P < 0.05). The serum PGI, PGII and CA72-4 levels of patients with recurrence of GC after total gastrectomy were significantly higher than those without. Compared before recurrence patients with after ones, the serum PGI and PGII levels of partial gastrectomy were no apparent difference (P > 0.05), however apparent changes had taken place on CA72-4 levels. The associate detection had even higher specificity (P < 0.01). CONCLUSIONS: Apply to detect the serum PG levels on crowds, especially pGI, PGI/II levels decrease, which may be expected to become the index to earlier period GC screening. The associating detection to PG and CA72-4 levels may significantly improve sensitivity and specificity, which have chances to be applied to monitoring to postoperative gastrectomy.