Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer.

AIM: The aim was to evaluate the physiological variation in rectoanal inhibitory reflex (RAIR) after laparoscopic intersphincteric resection (Lap-ISR) for ultralow rectal cancer. METHOD: This was a retrospective study that included 56 patients who underwent Lap-ISR from a prospectively collected database. The RAIR was examined preoperatively and up to 12 months after ileostomy closure. The primary outcome included physiological variation in RAIR and its difference between partial, subtotal and total ISR. The secondary outcome was its correlation with functional outcome. RESULTS: The reflex was present in 95% (53/56) of patients preoperatively, in 36% (20/56) before ileostomy closure, in 48% (27/56) at 3-6 months and in 61% (34/56) at 12 months after ileostomy closure. The elicited volume of RAIR was significantly increased at 12 months after ileostomy closure than at baseline (P = 0.005), but its duration and amplitude did not differ significantly. There was no significant difference in the reflex recovery between the ISR groups (partial vs. subtotal vs. total: 65% vs. 63% vs. 44%, P = 0.61). At 12 months after ileostomy closure, the RAIR-present group had favourable functional results and patient satisfaction (P < 0.05). Major faecal incontinence was found in 82% of patients in the RAIR-absent group. CONCLUSION: The RAIR is abolished in the majority of patients after Lap-ISR, but a time-dependent recovery could be observed in more than half of the patients. The reflex recovery is not influenced by the resection grade of the internal sphincter. However, persistent loss of the RAIR correlates with worse continence.

State-resolved dynamics study of the H + HS reaction on the 3A' and 3A″ states with time-dependent quantum wave packet method.

The quantum dynamics calculations of the H + HS (v = 0, j = 0) reaction on the 3A' and 3A″ potential energy surfaces (PESs) are performed using the reactant coordinate based time-dependent wave packet method. State-averaged and state-resolved results for both channels of the title reaction are presented in the 0.02-1.0 eV collision energy range and compared with those carried out with quasi-classical trajectory (QCT) method. Total integral cross sections (ICSs) for both channels are in excellent agreement with previous quantum mechanical (QM)-Coriolis coupling results while poorly agree with the QCT ICSs of the exchange channel, particularly near the threshold energy region. The product rotational distributions show that for the abstraction channel, the agreement between our QM and the QCT results improves with increasing collision energy. For the exchange channel, our calculations predict colder rotational distributions as compared to those obtained by QCT calculations. Although the QM total differential cross sections (DCSs) are in qualitatively good agreement with the QCT results, the two sets of the state-to-state DCSs with several peaks exhibit great divergences. The origin of the divergences are traced by analyzing the QM DCS for the H + HS (v = 0, j = 0) → H2 (v' = 0, j' = 0) + S reaction on the 3A″ PES at Ec = 1.0 eV. It is discovered that several groups of J partial waves are involved in the reaction and the shape of the DCS is greatly altered by quantum interferences between them.

Bergapten promotes bone marrow stromal cell differentiation into osteoblasts in vitro and in vivo.

Many recent studies have suggested that bergapten (BP), a class of native compound with numerous biological activities such as anti-resorptive properties, may exert protective effects against postmenopausal bone loss. However, it remains unknown whether BP regulates or improves the osteogenic function of bone marrow stromal cells (BMSCs) in the treatment and prevention of osteoporosis. In our study, BMSCs were cultured in osteogenic induction medium with the addition of BP for 2 weeks and an ovariectomized mouse model of osteoporosis was used to investigate the anti-resorptive effect of BP by gavage administration for 3 months. The concentrations of BP used were 0.1, 1, and 10 µmol/L in vitro and the gavage dose was 20 mg/kg/d. The result of our study indicated that BP promotes the expression of alkaline phosphatase (ALP) by BMSCs in vitro in a dose-dependent manner, as revealed by ALP staining. Runt-related transcription factor 2 and osteocalcin were up-regulated both in vitro and vivo, while osterix and collagen Iα1, assessed by immunofluorescence and immunohistochemistry, were correspondingly raised in the presence of BP in BMSCs in vitro. In addition, a protective effect of BP against ovariectomy-induced bone loss was found by distal femur micro-CT scanning, with improvements of bone metabolism parameters such as bone mineral density, trabecular number, and trabecular separation. Furthermore, WNT/ß-catenin signaling was activated in the presence of BP in BMSCs in osteogenic culture. Finally, BP promoted differentiation of BMSCs into osteoblasts by up-regulation of the WNT/ß-catenin pathway.

Multi-analyte fluorescence sensing based on a post-synthetically functionalized two-dimensional Zn-MOF nanosheets featuring excited-state proton transfer process.

Covalent post-synthetic modification of metal-organic frameworks (MOFs) represents an underexplored but promising avenue for allowing the addition of specific fluorescent recognition elements to produce the novel MOF-based sensory materials with multiple-analyte detection capability. Here, an excited-state proton transfer (ESPT) active sensor 2D-Zn-NS-P was designed and constructed by covalent post-synthetic incorporation of the excited-state tautomeric 2-hydroxypyridine moiety into the ultrasonically exfoliated amino-tagged 2D Zn-MOF nanosheets (2D-Zn-NS). The water-mediated ESPT process facilitates the highly accessible active sites incorporated on the surface of 2D-Zn-NS-P to specifically respond to the presence of water in common organic solvents via fluorescence turn-on behavior, and accurate quantification of trace amount of water in acetonitrile, acetone and ethanol was established using the as-synthesized nanosheet sensor with the detection sensitivity (<0.01% v/v) superior to the conventional Karl Fischer titration. Upon exposure to Fe3+ or Cr2O72-, the intense blue emission of the aqueous colloidal dispersion of 2D-Zn-NS-P was selectively quenched even in the coexistence of common inorganic interferents. The prohibition of the water-mediated ESPT process and local emission, induced by the coordination of ESPT fluorophore with Fe3+ or by Cr2O72- competitively absorbs the excitation energy, was proposed to responsible for the fluorescence turn-off sensing of the respective analytes. The present study offers the attractive prospect to develop the ESPT-based fluorescent MOF nanosheets by covalent post-synthetic modification strategy as multi-functional sensors for detection of target analytes.

Analysis of Pediatric Oncology Nursing Research in Mainland China, 2008-2018.

BACKGROUND: Up-to-date research from low- and middle-income countries is needed to inform local pediatric cancer nursing care and share best practices from these settings. Access to all current Chinese-language publications on pediatric oncology nursing research is limited because of a language barrier. OBJECTIVE: The aim of this study was to document the volume, type of research study, and yearly and geographical distribution of published pediatric oncology nursing research in Mainland China and evaluate their content and quality. METHODS: A systematic search was performed for published pediatric oncology research conducted by nurses in Mainland China (2008-2018), using 3 English databases and 3 Chinese databases. Included articles were evaluated using the Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal for strength and quality of evidence. RESULTS: A total of 133 articles were included: 106 in Chinese and 27 in English. Most studies showed level III evidence (88/133) and were rated as good quality (81/133). The most frequently researched topics were psychosocial care, clinical nursing practice, and psychometric testing, which accounted for 63.2% of all publications. CONCLUSIONS: Progress in pediatric oncology nursing research capacity among Mainland China is promising. To gain higher-quality evidence and make existing evidence transferable for nursing practice, optimization of specific research topics is still needed. IMPLICATIONS FOR PRACTICE: In Mainland China, developing interventions to address the symptoms of children with cancer and caregivers' psychosocial issues based on local nursing research should be prioritized. Some synthesized findings of this review may serve as guidance for the future of pediatric oncology nursing science in similar settings.

Functional and morphologic outcome after stapled transanal rectal resection for obstructed defecation syndrome.

BACKGROUND: Stapled transanal rectal resection is a novel surgery for obstructed defecation syndrome. Few data on the functional and morphologic outcome after the surgery have been reported. OBJECTIVE: This study aimed to evaluate the functional and morphologic outcome after stapled transanal rectal resection. DESIGN: This is a prospective study of consecutive patients undergoing transanal rectal resection. SETTING: The study was conducted at a tertiary referral hospital, Beijing, China, from May 2007 to May 2009. PARTICIPANTS: Eighty-six consecutive female patients with obstructed defecation syndrome were carefully selected. INTERVENTIONS: All patients underwent stapled transanal rectal resection. MAIN OUTCOME MEASURES: The main outcome measures were patients' symptoms, obstructed defecation syndrome score, Wexner incontinence score, anorectal manometry and defecography before and 1 year after surgery. RESULTS: The occurrence of all symptoms were significantly reduced after the procedure (P < .0001). Obstructed defecation syndrome score was decreased from 18.17 ± 4.68 preoperatively to 7.36 ± 3.52 postoperatively (P < .0001) with the Wexner incontinence score unchanged. Maximum tolerable rectal volume was significantly decreased (236.08 ± 50.00 vs 205.25 ± 29.60, P < .0001) after surgery with anal sphincter pressures unchanged. Postoperative defecography was performed in 64 patients. Rectocele disappeared in 40 of 62 patients. The depth of rectocele was reduced from 35.40 ± 4.58 mm preoperatively to 19.77 ± 9.19 mm postoperatively (P < .0001). Incomplete evacuation disappeared in 41 of 51 patients. Intussusception was completely corrected in 39 of 56 patients. The reduction of obstructed defection syndrome score was greater in patients with both rectocele and intussusception corrected than others (12.75 ± 2.24 vs 9.17 ± 3.47; P < .0001). LIMITATIONS: This study was limited owing to the lack of a control group and the medium-term results. CONCLUSIONS: Stapled transanal rectal resection is an effective procedure for obstructed defecation syndrome. The functional outcome is good with the preservation of sphincter function and continence postoperatively. The morphologic outcome confirmed its efficacy in correcting rectocele and intussusception, and correlated well with clinical improvement.

Time-dependent density functional theory study on the hydrogen bonding-induced twisted intramolecular charge-transfer excited states of 2-(4'-N,N-dimethylaminophenyl)imidazo[4,5-b]pyridine.

In this work, the time-dependent density functional theory (TDDFT) method was carried out to investigate the hydrogen-bonded intramolecular charge-transfer excited state of 2-(4'-N,N-dimethylaminophenyl)imidazo[4,5-b]pyridine (DMAPIP) in methanol (MeOH) solvent. All the geometric conformations of the ground state and locally excited (LE) state and the twisted intramolecular charge-transfer (TICT) state for isolated DMAPIP and its hydrogen-bonded complexes have been optimized. At the same time, the absorption and fluorescence spectra of DMAPIP and the hydrogen-bonded complexes in different electronic states are also calculated. We theoretically demonstrated for the first time that the intermolecular hydrogen bond formed between DMAPIP and MeOH can induce the formation of the TICT state for DMAPIP in MeOH solvent. Therefore, the two components at 414 and 506 nm observed in the fluorescence spectra of DMAPIP in MeOH solvent were reassigned in this work. The fluorescence peak at 414 nm is confirmed to be the LE state. Furthermore, the red-shifted shoulder at 506 nm should be originated from the hydrogen-bonded TICT excited state.

[Application of stapled transanal rectum resection in the treatment of obstructed defecation syndrome].

OBJECTIVE: To evaluate the effectiveness and safety of stapled transanal rectum resection (STARR) in the treatment of obstructed defecation syndrome (ODS). METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Effective shielding of triplet energy transfer to conjugated polymer by its dense side chains from phosphor dopant for highly efficient electrophosphorescence.

To examine the quenching of a triplet exciton by low triplet energy (E(T)) polymer hosts with different chain configurations for high E(T) phosphor guests, the quenching rate constant measurements were carried out and analyzed by the standard Stern-Volmer equation. We found that an effective shielding of triplet energy transfer from a high E(T) phosphor guest to a low E(T) polymer host is possible upon introducing dense side chains to the polymer to block direct contact from the guest such that the possibility of Dexter energy transfer between them is reduced to a minimum. Together with energy level matching to allow charge trapping on the guest, high device efficiency can be achieved. The extent of shielding for the systems of phenylene-based conjugated structures from iridium complexes follows the sequence di-substituted (octoxyl chain) in the para position (dC8OPPP) is greater than monosubstituted (mC8OPPP) and the PPPs with longer side chains are much higher than a phenylene tetramer (P4) with two short methyl groups. Further, capping the dialkoxyl-susbstituents with a carbazole (Cz) moiety (CzPPP) provides enhanced extent of shielding. Excellent device efficiency of 30 cd/A (8.25%) for a green electrophosphorescent device can be achieved with CzPPP as a host, which is higher than that of dC8OPPP as host (15 cd/A). The efficiency is higher than those of high E(T) conjugated polymers, poly(3,6-carbazole) derivatives, as hosts (23 cd/A). This observation suggests a new route for molecular design of electroluminescent polymers as a host for a phosphorescent dopant.

Midterm outcome of stapled transanal rectal resection for obstructed defecation syndrome: a single-institution experience in China.

AIM: To assess midterm results of stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS) and predictive factors for outcome. METHODS: From May 2007 to May 2009, 75 female patients underwent STARR and were included in the present study. Preoperative and postoperative workup consisted of standardized interview and physical examination including proctoscopy, colonoscopy, anorectal manometry, and defecography. Clinical and functional results were assessed by standardized questionnaires for the assessment of constipation constipation scoring system (CSS), Longo's ODS score, and symptom severity score (SSS), incontinence Wexner incontinence score (WS), quality of life Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QOL), and patient satisfaction visual analog scale (VAS). Data were collected prospectively at baseline, 12 and 30 mo. RESULTS: The median follow-up was 30 mo (range, 30-46 mo). Late postoperative complications occurred in 11 (14.7%) patients. Three of these patients required procedure-related reintervention (one diverticulectomy and two excision of staple granuloma). Although the recurrence rate was 10.7%, constipation scores (CSS, ODS score and SSS) significantly improved after STARR (P < 0.0001). Significant reduction in ODS symptoms was matched by an improvement in the PAC-QOL and VAS (P < 0.0001), and the satisfaction index was excellent in 25 (33.3%) patients, good in 23 (30.7%), fairly good in 14 (18.7%), and poor in 13 (17.3%). Nevertheless, the WS increased after STARR (P = 0.0169). Incontinence was present or deteriorated in 8 (10.7%) patients; 6 (8%) of whom were new onsets. Univariate analysis revealed that the occurrence of fecal incontinence (preoperative, postoperative or new-onset incontinence; P = 0.028, 0.000, and 0.007, respectively) was associated with the success of the operation. CONCLUSION: STARR is an acceptable procedure for the surgical correction of ODS. However, its impact on symptomatic recurrence and postoperative incontinence may be problematic.

[Complications after stapled transanal rectal resection for obstructed defecation].

OBJECTIVE: To evaluate the safety of stapled transanal rectal resection (STARR) for the treatment of obstructed defecation syndrome(ODS). METHODS: 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. RESULTS: 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. CONCLUSION: STARR appears to be a safe technique for patients with obstructed defecation.

Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception.

AIM: To evaluate the safety and efficacy of stapled transanal rectal resection (STARR), and to analyze the outcome of the patients 12-mo after the operation. METHODS: From May 2007 to October 2008, 50 female patients with rectocele and/or rectal intussusception underwent STARR. The preoperative status, perioperative and postoperative complications at baseline, 3, 6 and 12-mo were assessed. Data were collected prospectively from standardized questionnaires for the assessment of constipation [constipation scoring system, Longo's obstructed defecation syndrome (ODS) score system, symptom severity score], patient satisfaction (visual analogue scale), and quality of life (Patient Assessment of Constipation-Quality of Life Questionnaire). RESULTS: At a 12-mo follow-up, significant improvement in the constipation scoring system, ODS score system, symptom severity score, visual analog scale and quality of life (P < 0.0001) was observed. The symptoms of constipation improved in 90% of patients at 12 mo after surgery. The self-reported definitive outcome was excellent in 15 (30%) patients, fairly good in 8 (16%), good in 22 (44%), and poor in 5 (10%). CONCLUSION: STARR can be performed safely without major morbidity. Moreover, the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

[Comparison of long-term efficacy on severe hemorrhoids between procedure for prolapse and hemorrhoids and Milligan-Morgan hemorrhoidectomy].

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: The long-term outcomes of PPH in the treatment of third and fourth-degree hemorrhoids are similar to Milligan-Morgan hemorrhoidectomy.