Low Anterior Resection Syndrome in Total Mesorectal Excision: Risk Factors and Its Relationship with Quality of Life

Background: Low anterior resection syndrome (LARS) is a bowel dysfunction following sphincter-sparing proctectomy. The occurrence of LARS may affect a patient's overall quality of life (QoL) after surgery. Current research was aimed to investigate related factors of LARS and major LARS in total mesorectal excision (TME) and its relationship with QoL. Methods: This study included patients who underwent TME at authors' institutes. LARS was evaluated with an LARS score. QoL was identified using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, version 3.0. Appropriate statistical methods were used to ascertain risk factors for LARS and major LARS and to analyze the relationships between QoL and LARS. The primary objective was to identify related factors of LARS and major LARS. The secondary objective was to examine the relationships between QoL and LARS. Results: Multivariable analysis identified neoadjuvant chemoradiotherapy (odds ratio [OR] 4.923, 95% confidence interval [CI] 2.335-10.379, P < .001), local anal distance from the lower edge of the tumor (OR 6.199, 95% CI 2.701-14.266, P < .001), and anastomotic leakage (OR 5.624, 95% CI 1.463-21.614, P = .012) as independent predictors for development of LARS. Meanwhile, neoadjuvant chemoradiotherapy (OR 4.693, 95% CI 1.368-16.107, P = .014) and local anal distance from the lower edge of the tumor (OR 4.935, 95% CI 1.332-18.285, P = .017) were dramatically correlated with development of major LARS in a multivariable analysis. In the major LARS group, statistically significant differences (P < .05) were ascertained, include physical functioning, role functioning, emotional functioning, social functioning, and global health. In addition, pain and diarrhea were evidently higher. Conclusions: Neoadjuvant chemoradiotherapy, local anal distance from the lower edge of the tumor, and anastomotic leakage correlated strongly with development of LARS, and neoadjuvant chemoradiotherapy and local anal distance from the lower edge of the tumor correlated strongly with development of major LARS. Meanwhile, the QoL of patients with major LARS was lower than that of patients with no/minor LARS.

Ecosystem services relationship characteristics of the degraded alpine shrub meadow on the Qinghai-Tibetan Plateau

Alpine shrub meadows hold significant importance as grassland ecosystems on the Qinghai-Tibetan Plateau (QTP). They provide a range of vital ecosystem services (ESs) and are commonly utilized as summer pastures by herders, resulting in short grazing periods and high grazing intensities. Unfortunately, these practices have led to varying degrees of degradation, thereby affecting the sustainable provision of ESs. However, the current knowledge regarding changes in ESs and their characteristics under the influence of degradation, particularly the differences between alpine shrub and alpine meadow ecosystems, is insufficient. To address this gap, this study aimed to investigate and analyse changes in four ESs within alpine shrub meadows across different levels of degradation, as well as explore their relationships. The research was conducted in a summer pasture located in the northeastern QTP. The findings revealed a substantial reduction of 85.9% in forage supply due to degradation in alpine shrub meadows. Moreover, regulating services experienced a decline followed by an increase in instances of heavy degradation. Trade-offs were observed between provisioning and regulating services, while synergistic relationships were identified among different regulating services. Degradation exacerbated imbalances between provisioning and regulating services, whereas light degradation allowed for a better equilibrium between the two. Comparatively, alpine meadows exhibited higher levels of forage supply and carbon storage services, whereas alpine shrub ecosystems displayed greater nutrient supply and water retention services. It was observed that changes in ESs and relationship patterns within alpine shrub meadows were significantly influenced by the presence of alpine meadows. Consequently, safeguarding the structural integrity of alpine meadows and addressing conflicts over ESs is essential to ensure coordination and sustainability of ESs within alpine shrub meadows. The outcomes of this study provide valuable insights for ecosystem management and ecological restoration initiatives in alpine shrub meadows on the QTP.

Restoration of Degraded Grassland Significantly Improves Water Storage in Alpine Grasslands in the Qinghai-Tibet Plateau

Alpine grassland has very important water conservation function. Grassland degradation seriously affects the water conservation function; moreover, there is little understanding of the change of water state during grassland restoration. Our study aims to bridge this gap and improve our understanding of changes in soil moisture during the restoration process. In this study, the water storage, vegetation, and meteorology of a non-degradation grassland (grazing intensity of 7.5 sheep/ha) and a severely degraded grassland (grazing intensity of 12-18 sheep/ha) were monitored in the Qinghai-Tibet Plateau for seven consecutive years. We used correlation, stepwise regression, and the boosted regression trees (BRT) model analyses, five environmental factors were considered to be the most important factors affecting water storage. The severely degraded grassland recovered by light grazing treatment for 7 years, with increases in biomass, litter, and vegetation cover, and a soil-water storage capacity 41.9% higher in 2018 compared to that in 2012. This increase in soil-water storage was primarily due to the increase in surface soil moisture content. The key factors that influenced water storage were listed in a decreasing order: air temperature, litter, soil heat flux, precipitation, and wind speed. Their percentage contributions to soil-water storage were 50.52, 24.02, 10.86, 7.82, and 6.77%, respectively. Current and future climate change threatens soil-water conservation in alpine grasslands; however, grassland restoration is an effective solution to improve the soil-water retention capacity in degraded grassland soils.

Cell therapy of a knee osteoarthritis rat model using precartilaginous stem cells

OBJECTIVE

To explore the effect and mechanism of precartilaginous stem cells (PSCs) engraftment-inducing tissue repair in a knee osteoarthritis (OA) rat model.

MATERIALS AND METHODS

Knee osteoarthritis (OA) model was constructed in Sprague Dawley (SD) rats by partial removal of the medial meniscus of the right knee. PSCs were engrafted by injecting precartilaginous stem cells (PSCs) into the right knee cavity. At 4 and 8 weeks after model construction, the serum levels of interleukine (IL)-1β, tumor necrosis factor (TNF)-α, and IL-6 were assessed using enzyme-linked immunosorbent assay (ELISA). Hematoxylin-eosin (HE) staining was performed to assess the histopathology of synovial membrane and cartilage. Western blot analysis was used to assess Notch1, Bcl-2 and Bax levels in the articular cartilage.

RESULTS

At 4 and 8 weeks, OA rats demonstrated significantly higher IL-1β, TNF-α, and IL-6 levels than normal rats (p < 0.05), whereas PSCs treatment prominently attenuated IL-1β upregulation (p < 0.05). In OA rats, the number of chondrocytes dramatically decreased over time in OA rats, with disruption of chondrocytes organization and cell layers. PSCs alleviated the deterioration of cartilage, as evidenced by the relatively smooth articular surface, distinct tidemark and clear cell layers. The model and treatment groups demonstrated substantially higher Notch1 expression. The Bcl-2/Bax value in the OA rats was lower than the control group, while PSCs treatment led to increase in Bcl-2/Bax value.

CONCLUSIONS

PSCs treatment downregulated the expression of inflammatory cytokines, alleviating osteoarthritis in the knee of rats. Notch1 signaling pathway plays an important role in this ameliorating effect of PSCs treatment.

Cell therapy of a knee osteoarthritis rat model using precartilaginous stem cells

OBJECTIVE

To explore the effect and mechanism of precartilaginous stem cells (PSCs) engraftment-inducing tissue repair in a knee osteoarthritis (OA) rat model.

MATERIALS AND METHODS

Knee osteoarthritis (OA) model was constructed in Sprague Dawley (SD) rats by partial removal of the medial meniscus of the right knee. PSCs were engrafted by injecting precartilaginous stem cells (PSCs) into the right knee cavity. At 4 and 8 weeks after model construction, the serum levels of interleukine (IL)-1β, tumor necrosis factor (TNF)-α, and IL-6 were assessed using enzyme-linked immunosorbent assay (ELISA). Hematoxylin-eosin (HE) staining was performed to assess the histopathology of synovial membrane and cartilage. Western blot analysis was used to assess Notch1, Bcl-2 and Bax levels in the articular cartilage.

RESULTS

At 4 and 8 weeks, OA rats demonstrated significantly higher IL-1β, TNF-α, and IL-6 levels than normal rats (p < 0.05), whereas PSCs treatment prominently attenuated IL-1β upregulation (p < 0.05). In OA rats, the number of chondrocytes dramatically decreased over time in OA rats, with disruption of chondrocytes organization and cell layers. PSCs alleviated the deterioration of cartilage, as evidenced by the relatively smooth articular surface, distinct tidemark and clear cell layers. The model and treatment groups demonstrated substantially higher Notch1 expression. The Bcl-2/Bax value in the OA rats was lower than the control group, while PSCs treatment led to increase in Bcl-2/Bax value.

CONCLUSIONS

PSCs treatment downregulated the expression of inflammatory cytokines, alleviating osteoarthritis in the knee of rats. Notch1 signaling pathway plays an important role in this ameliorating effect of PSCs treatment.

Effectiveness and safety of Mobi-C for treatment of single-level cervical disc spondylosis

Aims

In order to evaluate the effectiveness of the Mobi-C implant in cervical disc degeneration, a randomised study was conducted, comparing the Mobi-C prosthesis arthroplasty with anterior cervical disc fusion (ACDF) in patients with single level cervical spondylosis.

Patients and Methods

From January 2008 to July 2009, 99 patients were enrolled and randomly divided into two groups, those having a Mobi-C implant (n = 51; 30 men, 21 women) and those undergoing ACDF (n = 48; 28 men, 20 women).The patients were followed up for five years, with the primary outcomes being the Japanese Orthopaedic Association score, visual analogue scale for pain and the incidence of further surgery. The secondary outcomes were the Neck Disability Index and range of movement (ROM) of the treated segment.

Results

The incidence of further surgery was found to be statistically significant between the two groups (p = 0.49), with seven ACDF patients requiring further surgery and only one Mobi-C patient requiring re-operation. There were significant differences (p < 0.001) between the two groups in the ROM of the treated segment. However, both Mobi-C surgery and ACDF surgery were effective in improving the patient’s clinical symptoms. Take home message: Mobi-C implant surgery is a safe alternative to ACDF surgery in cervical disc degeneration. Cite this article: Bone Joint J 2016;98-B:829–3.

Plumbagin Protects Against Spinal Cord Injury-induced Oxidative Stress and Inflammation in Wistar Rats through Nrf-2 Upregulation

BACKGROUND

Spinal cord injury causes post-traumatic degeneration through series of biochemical events. This study aims to evaluate the possible protective mechanism of Plumbagin against Spinal cord injury induced oxidative stress and inflammation. Plumbagin is a potent antioxidant and shows anti-carcinogenic, anti-inflammatory and analgesic activities. However, its exact molecular mechanism of action has yet to be explored.

METHODS

We tested the effects of Plumbagin on spinal cord injury induced ROS generation and lipid peroxidation content in wistar rats. Additionally, the expression of 2 important transcription factors NF-κB and Nrf-2 was investigated.

RESULTS

Plumbagin treatment significantly ameliorated oxidative stress through inhibition of ROS and lipid peroxidation with a concomitant increase in antioxidant status. Western blot analysis revealed enhanced nuclear levels of Nrf-2, while NF-κB expression was suppressed during Plumbagin administration. Enzyme linked immunosorbent assay for pro-inflammatory cytokines (TNF-α, IL-1β) showed a significant downregulation followed by Plumbagin treatment in spinal cord injury rats.

CONCLUSION

Taken together, the data suggests potential and novel role of Plumbagin in cytoprotection by modulating NF-κB and Nrf-2 levels against spinal cord injury.

Modulation of K(v)7 potassium channels by a novel opener pyrazolo[1,5-a]pyrimidin-7(4H)-one compound QO-58

BACKGROUND AND PURPOSE

Modulation of K(v)7/M channel function represents a relatively new strategy to treat neuronal excitability disorders such as epilepsy and neuropathic pain. We designed and synthesized a novel series of pyrazolo[1,5-a] pyrimidin-7(4H)-one compounds, which activate K(v)7 channels. Here, we characterized the effects of the lead compound, QO-58, on K(v)7 channels and investigated its mechanism of action.

EXPERIMENTAL APPROACH

A perforated whole-cell patch technique was used to record K(v)7 currents expressed in mammalian cell lines and M-type currents from rat dorsal root ganglion neurons. The effects of QO-58 in a rat model of neuropathic pain, chronic constriction injury (CCI) of the sciatic nerve, were also examined.

KEY RESULTS

QO-58 increased the current amplitudes, shifted the voltage-dependent activation curve in a more negative direction and slowed the deactivation of K(v)7.2/K(v)7.3 currents. QO-58 activated K(v)7.1, K(v)7.2, K(v)7.4 and K(v)7.3/K(v)7.5 channels with a more selective effect on K(v)7.2 and K(v)7.4, but little effect on K(v)7.3. The mechanism of QO-58's activation of K(v)7 channels was clearly distinct from that used by retigabine. A chain of amino acids, Val(224)Val(225)Tyr(226), in K(v)7.2 was important for QO-58 activation of this channel. QO-58 enhanced native neuronal M currents, resulting in depression of evoked action potentials. QO-58 also elevated the pain threshold of neuropathic pain in the sciatic nerve CCI model.

CONCLUSIONS AND IMPLICATIONS

The results indicate that QO-58 is a potent modulator of K(v)7 channels with a mechanism of action different from those of known K(v)7 openers. Hence, QO-58 shows potential as a treatment for diseases associated with neuronal hyperexcitability.

Thermally induced phase transitions and morphological changes in organoclays

Thermal transitions and morphological changes in Cloisite organoclays were investigated by differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), Fourier transform infrared (FTIR) spectroscopy, and in situ simultaneous small-angle X-ray scattering (SAXS) and wide-angle X-ray diffraction (WAXD) over the temperature range of 30-260 degrees C. On the basis of DSC and FTIR results, the surfactant component in organoclays was found to undergo a melting-like order-disorder transition between 35 and 50 degrees C. The transition temperatures of the DSC peaks (Ttr) in the organoclays varied slightly with the surfactant content; however, they were significantly lower than the melting temperature of the free surfactant (dimethyldihydrotallowammonium chloride; Tm = 70 degrees C). FTIR results indicated that within the vicinity of Ttr, the gauche content increased significantly in the conformation of surfactant molecules, while WAXD results did not show any change in three-dimensional ordering. Multiple scattering peaks were observed in SAXS profiles. In the SAXS data acquired below Ttr, the second scattering peak was found to occur at an angle lower than twice that of the first peak position (i.e., nonequidistant scattering maxima). In the data acquired above Ttr, the second peak was found to shift toward the equidistant position (the most drastic shift was seen in the system with the highest surfactant content). Using a novel SAXS modeling technique, we suggest that the appearance of nonequidistant SAXS maxima could result from a bimodal layer thickness distribution of the organic layers in organoclays. The occurrence of the equidistant scattering profile above Ttr could be explained by the conversion of the bimodal distribution to the unimodal distribution, indicating a redistribution of the surfactant that is nonbounded to the clay surface. At temperatures above 190 degrees C, the scattering maxima gradually broadened and became nonequidistant again but having the second peak shifted toward a scattering angle higher than twice the first peak position. The changes in SAXS patterns above 190 degrees C could be attributed to the collapse of organic layers due to desorption and/or degradation of surfactant component, which was supported by the TGA data.

[A comparison of SERS of positive and negative nano-silver adsorbing cation and anion molecule]

A study on the negative charge colloid of nano-silver particles with anion and cation molecules has been done. The results of the experiment show that the negative charge colloid of nano-silver particle has no SERS effect when anion molecule adsorbed on its surface. While the cation molecule in adsorbed on its surface the SERS effect is enhanced. The SERS effects are just opposite when the two molecules separately adsorbed on the surface of the positive colloid of nano-silver particles. The paper hypothesizes that strong SERS effect can be got by using proper colloid of nano-silver particles. It is practical to develop the use of SERS.

[The enhanced mechanism of Cl- to SERS in silver colloid]

The SERS is enhanced when KCl is added to silver colloid and cation molecule. The hypothesis supposed that Cl- bridged between nano-silver and molecule, as a result the molecule adsorbing on nano-silver surface is promoted and the SERS is therefore enhanced. The CN- and NH3 can be better adsorbed when they are added separately to the nano-silver particles, Cl- and anion molecule. The SERS reduces when CN- and NH3 are added separately to Cl-, anion molecule and silver colloid. The result is that the CN- and NH3 are so strong that they have replaced Cl- and anion molecules. Therefore the SERS reduces. This has proved the bridge role of Cl-.

Regulation of endothelial heme oxygenase activity during hypoxia is dependent on chelatable iron

The regulation of heme oxygenase (HO) activity and its dependence on iron was studied in bovine aortic endothelial cells (BAEC) subjected to hypoxia-reoxygenation (H/R). HO activity was induced by hypoxia (10 h) and continued to increase during the reoxygenation phase. HO-1 protein levels were strongly induced by hypoxia from undetectable levels and remained elevated at least 8 h postreoxygenation. Addition of the Fe(3+) chelator desferrioxamine mesylate (DFO) or the Fe(2+) chelator o-phenanthroline during hypoxia alone or during the entire H/R period inhibited the induction of HO activity and HO-1 protein levels. However, DFO had no effect and o-phenanthroline had a partial inhibitory effect on HO activity and protein levels when added only during reoxygenation. Loading of BAEC with Fe(3+) enhanced the activation of the HO-1 gene by H/R, whereas loading with L-aminolevulinic acid, which stimulates heme synthesis, had little effect. These results suggest that chelatable iron participates in regulating HO expression during hypoxia.

Removal of bedrails on a short-term nursing home rehabilitation unit

Our goal was to determine whether bedrails could be removed safely on a geriatric rehabilitation unit. Staff attended in-services about bedrails, assessment, and possible alternatives. Residents in the study group were assessed by an interdisciplinary team, following which a determination was made about the use of bedrails or alternatives. Eighty percent of residents in the study group were free of bedrails, which suggests that bedrails can be safely removed from most short-stay nursing home rehabilitation residents.

Pravastatin increases survival and inhibits natural killer cell enhancement factor in liver transplanted rats

Pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, has been shown to decrease the number of acute rejection episodes in cardiac and renal transplant patients. This study evaluates the effects of pravastatin on survival of rats following liver transplant and attempts to elucidate the mechanisms of these effects. Both survival and natural killer cell enhancing factor (NKEF) studies utilized Dark Agouti rats for donor livers transplanted into Brown Norway rats as recipients. All rats received daily low-dose cyclosporine (CsA) 2 mg/kg/day by gavage. The treated groups also received gavage doses of pravastatin, 20 mg/kg/day. Survival data were analyzed by the method of Kaplan-Meier and log-rank chi 2 tests for statistical significance. For NKEF evaluation, rats were sacrificed at varying time points; total RNA was extracted from the liver and hybridized with 32P-radiolabeled NKEF DNA probes in the Northern blot technique. Radiographs were quantitated using densitometry. Data were analyzed by two-way ANOVA. Actuarial survival was improved (P < < 0.05) in rats treated with pravastatin in addition to low-dose CsA (n = 41, CsA alone n = 74). Less fibrosis and chronic rejection was seen on histological section in the treated animal livers, P < 0.05, NKEF was seen maximally at Days 5-15 tapering off at Day 21. NKEF-a and NKEF-b levels were significantly decreased in the animals treated with CsA and pravastatin compared to CsA alone in the group of animals < 16 days postop (P < < 0.05). Pravastatin improves survival in rats following OLT and while the mechanism is still unknown, inhibition of natural killer cell enhancement factor may represent an alteration in the overall immune response.

Orthostatic change in blood pressure in non-demented, ambulatory nursing home patients

While postural hypotension was present in almost 20% of ambulatory patients of this long-term institution, associated symptoms were infrequent. A comparison of the groups with and without a history of falls in the prior year revealed no relationship to the presence of postural hypotension and no relationship to a number of medications which have been reported to be associated with orthostatic hypotension. Blood pressure readings should be obtained at 1,3 and 5 min after assuming the erect position as significant falls in blood pressure were found at each interval.

[The analysis of foreign bodies in the anterior chamber in 165 cases]

One hundred and sixty-six eyes of 165 patients with foreign bodies in the anterior chamber who were treated at our center from 1966 to 1988 were retrospectively reviewed. Among them there were 109 eyes with nonmetal foreign bodies, 55 eyes with metal foreign bodies and three eyes with foreign bodies of unknown nature. Most of these foreign bodies were stone or iron. 83.6% of the patients were in the age range from 7 to 40 years, and the left eyes were affected more than the right eyes. Mostly, the foreign bodies were located on the surface of iris (97 cases) and at the anterior chamber angle (40 cases). The rates of blindness were 27.8% and 16.3% before and after operation. The postoperative visual acuity were: 0.05-0.2 in 27 eyes, 0.3-0.9 in 66 eyes, greater than 1.0 in 43 eyes and the rest of the eyes lower than 0.05. The presurgery treatment such as miosis and reduction of intraocular pressure, the selection of operative methods according to the nature, size, location of the foreign bodies and tissue wrapped up were discussed. If combined procedures should be done, it is better to remove the foreign bodies first and then perform the operation for complications.

[The analysis of foreign bodies in the anterior chamber in 165 cases]

One hundred and sixty-six eyes of 165 patients with foreign bodies in the anterior chamber who were treated at our center from 1966 to 1988 were retrospectively reviewed. Among them there were 109 eyes with nonmetal foreign bodies, 55 eyes with metal foreign bodies and three eyes with foreign bodies of unknown nature. Most of these foreign bodies were stone or iron. 83.6% of the patients were in the age range from 7 to 40 years, and the left eyes were affected more than the right eyes. Mostly, the foreign bodies were located on the surface of iris (97 cases) and at the anterior chamber angle (40 cases). The rates of blindness were 27.8% and 16.3% before and after operation. The postoperative visual acuity were: 0.05-0.2 in 27 eyes, 0.3-0.9 in 66 eyes, greater than 1.0 in 43 eyes and the rest of the eyes lower than 0.05. The presurgery treatment such as miosis and reduction of intraocular pressure, the selection of operative methods according to the nature, size, location of the foreign bodies and tissue wrapped up were discussed. If combined procedures should be done, it is better to remove the foreign bodies first and then perform the operation for complications.