BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with c...BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.展开更多
BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effe...BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effect and seriously affects the quality of life of patients.If the incidence of RE in patients can be predicted in advance,and targeted clinical preventive treatment can be carried out,the side effects of radiotherapy in cervical cancer patients can be significantly reduced.Furthermore,accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.AIM To analyze the relationships between severe acute RE(SARE)of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.METHODS We included 50 cervical cancer patients who received volumetric modulated arc therapy(VMAT)from September 2017 to June 2018 in the Department of Radiotherapy at The First Affiliated Hospital Soochow University.Clinical and dose-volume histogram factors of patients were collected.Logistic regression analysis was used to evaluate the predictive value of each factor for SARE.A nomogram to predict SARE was developed(SARE scoring system≥3 points)based on the multiple regression coefficients;validity was verified by an internal verification method.RESULTS Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy.The main adverse reactions were diarrhea,abdominal pain,colitis,anal swelling,and blood in the stool.There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups(P>0.05).There were significant differences in the small intestine V_(20),V_(30),V_(40),and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery(P<0.05).Univariate and multivariate analyses revealed anal bulge rating(OR:14.779,95%CI:1.281-170.547,P=0.031)and disease activity index(DAI)score(OR:53.928,95%CI:3.822-760.948,P=0.003)as independent predictors of SARE.CONCLUSION Anal bulge rating(>0.500 grade)and DAI score(>2.165 points)can predict SARE.The nomogram shows potential value in clinical practice.展开更多
AIM: To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability. METHODS: Five...AIM: To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability. METHODS: Five patients underwent enterectomy and partially anastomosed end-loop ileostomy at the University Hospital of Larissa between 2000 and 2006. Enterectomy was performed because of conditions such as mesenteric vascular occlusive disease, radiation entritis and small bowel injury. RESULTS: Postoperatively, none of the patients developed any stoma-related or anastomotic complications. There were no major complications. All patients were discharged between the 8th and 15th day after the procedure, and the stoma was closed 3 wk to 4 wk later. CONCLUSION: We believe that our proposed modification of end-loop ileostomy is a simple, quick and safe technique with minimal stoma-related morbidity, and with simple and safe reversion. This technique can be considered as a useful option in the treatment of ischemic or radiation-induced enteritis, and in the management of severe intestinal trauma.展开更多
Objective: To explore the mechanism of Qingre Buyi Decoction (清热补益汤,QBD) in prevention and treatment of radiation enteritis in rats. Methods: Forty-eight Wistar rats were randomly divided into four groups, the TC...Objective: To explore the mechanism of Qingre Buyi Decoction (清热补益汤,QBD) in prevention and treatment of radiation enteritis in rats. Methods: Forty-eight Wistar rats were randomly divided into four groups, the TCM group, the WM group, the model group and the control group, 12 in each group. Rats in the former three groups were given orally with QBD, norfloxacin and normal saline once a day for 7 successive days, after being irradiated with X-ray at single dose of 10 Gy for modeling of radiation enteritis, while rats in the control group were untreated. Animals were sacrificed at the end of the medication. NO concentration, mean height and number of villi per centimeter in their small intestinal mu-cosa were measured. Results: The intestinal NO concentration was significantly lower in the TCM and WM groups than that in the model group(P<0.05), while the number of villi was significantly more and the height higher in the former two groups than those in the model group (P<0.01 for both), but no significant difference was shown between the TCM group and the WM group. Conclusion: QBD could inhibit the production of NO, increase the number and height of intestinal villi in rats with radiation enteritis, suggesting that it could reduce the inflammatory reaction of intestinal mucosa to irradiation, protect muco-sa from radiation damage, and promote the regeneration of mucosa.展开更多
Radiotherapy is a common treatment for abdominal and pelvic malignancies with bone metastases.However,some patients develop radiation enteritis(RE)during the treatment or 2 months or more after the treatment,which ser...Radiotherapy is a common treatment for abdominal and pelvic malignancies with bone metastases.However,some patients develop radiation enteritis(RE)during the treatment or 2 months or more after the treatment,which seriously affects their quality of life.At present,the curative effect of western medicine is poor.Professor Renting Li believes that radiation kills tumor cells but at the same time,it damages the healthy Qi of the human body.Radiation causes heat and poison to accumulate in the intestinal tract,consumes and hurts Yin fluid,bums the vein,leads to deficiency of healthy Qi and poor detoxification,as well as cause blood stasis after a period of time.All these result in the combination of heat,blood stasis,and poison,manifesting as abdominal pain,diarrhea,mucus in stools,purulent and bloody stools,etc.Therefore,Professor Renting Li proposed the use of traditional Chinese medicine retention enema combined with oral traditional Chinese medicine to reduce symptoms,remove toxins,and improve the quality of life of patients.展开更多
Objective To observe the effect of Modified Xijiao Dihuang Decoction(加味犀角地黄汤,MXDD)on rats with radiation enteritis,and explore its action mechanism.Methods Thirty female Sprague Dawley rats were divided into th...Objective To observe the effect of Modified Xijiao Dihuang Decoction(加味犀角地黄汤,MXDD)on rats with radiation enteritis,and explore its action mechanism.Methods Thirty female Sprague Dawley rats were divided into the control,model,dexamethasone(DXM),golden bifid(GB)and MXDD groups using random number table,6 rats in each group.Except the control group,the other rats were developed into radiation enteritis model by exposing to a single 60Co-γray at a dose of 11 Gy.The rats in the DXM,GB and MXDD groups were treated with DXM(1.425 mg/kg),GB(0.8 g/kg)and MXDD(36.0 g/kg)for 3 days,respectively.Body weight and diarrhea condition of rats were evaluated daily.On day 3,the feces of rats were collected for intestinal flora detection and the small intestinal tissues were also collected.Bacterial species annotation,alpha and beta diversities as well as composition of intestinal flora were detected and compared.The protein and mRNA expressions of interleukin 17(IL-17),retinoid-related orphan nuclear receptor gamma t(ROR-γt)and forkhead/winged helix transcription factor p3(FoxP3)were determined by Western blot and polymerase chain reaction,respectively.The abundance and diversity of intestinal flora as well as the proportion at the phylum and genus levels were assayed by 16S rRNA metagenome sequencing.Correlation between intestinal flora and Th17/Treg was analyzed by heatmap method.Results On day 1 to 3 after radiation,compared with the control group,the body weight in model group was decreased(P<0.05 or P<0.01).Compared with the model group,MXDD could alleviate weight loss and diarrhea caused by irradiation.At the phylum level,MXDD cause a significant increase in Firmicutes,and a decrease in Proteobacteria(P<0.05 or P<0.01).At the genus level,MXDD reduced the proportion of Escherichia Shigella(P<0.01).In addition,IL-17 and FoxP3 mRNA and protein expression levels were down-regulated and ROR-γt was up-regulated by MXDD treatment(P<0.05).Besides,Firmicutes and Lactobacillus were positively correlated with FoxP3(r=0.73,0.79,respectively;P<0.01),negatively correlated with IL-17(r=0.66,0.64,respectively;P<0.01 or P<0.05)and ROR-γt(r0.73,0.81,respectively;P<0.01).Proteobacteria and Escherichia Shigella both had positive correlation with IL-17(r 0.77,0.57,respectively;P<0.01 or P<0.05)and ROR-γt(r=0.94,0.79,respectively;P<0.01)and negative correlation with FoxP3(r0.74,0.65;P<0.01).Conclusion MXDD could improve the survival status of irradiated rats by regulating the richness,diversity and composition of intestinal flora,and restoring the balance of Th17/Treg.展开更多
At present,there is no unified clinical approach for the treatment of radiation enteritis(RE).Clinically,its treatment is mainly based on nutritional support,mucosal protective agents,somatostatin,and microecological ...At present,there is no unified clinical approach for the treatment of radiation enteritis(RE).Clinically,its treatment is mainly based on nutritional support,mucosal protective agents,somatostatin,and microecological preparations.On the basis of syndrome differentiation and treatment,traditional Chinese medicine(TCM)is mainly used for internal administration,enteroclysis,acupuncture,and Tuina.It shows significant advantages in relieving the adverse reactions of radiotherapy and exhibits significant preventive and therapeutic effects against RE.This article reviews two aspects of TCM on RE,including internal and external administration,to explore and develop an effective and reliable standardized Chinese medicine program.展开更多
Common gastrointestinal diseases such as radiation enteritis(RE),acute pancreatitis,inflammatory bowel diseases(IBD)and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level,mostly inv...Common gastrointestinal diseases such as radiation enteritis(RE),acute pancreatitis,inflammatory bowel diseases(IBD)and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level,mostly involving the activation of many pathways of the immune response,ultimately leading to tissue injury.Increased oxidative stress,inflammatory cytokine release,inflammatory cell infiltration and activation and the up-regulation of inflammatory transcription factors participate in the pathophysiology of these complex entities.Treatment varies in each specific disease,but at least in the cases of RE and IBD immunosuppressors are effective.However,full therapeutic responses are not always achieved.The pathophysiology of ischemiareperfusion(IR)injury shares many of these mechanisms.Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs,a phenomenon called remote ischemic preconditioning(RIP).This procedure has been shown to protect the gut,pancreas and liver by modulating many of the same inflammatory mechanisms.Since RIP is safe and tolerable,and has shown to be effective in some recent clinical trials,I suggest that RIP could be used as a physiologicallyrelevant adjunct treatment for non-ischemic gastrointestinal inflammatory conditions.展开更多
文摘BACKGROUND The gut microbiota is strongly associated with radiation-induced gut damage.This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.CASE SUMMARY A 64-year-old female with cervical cancer developed abdominal pain,diarrhea,and blood in the stool 1 year after radiotherapy.An electronic colonoscopy was performed to diagnose chronic radiation enteritis.Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed.The patient experienced short-and long-term relief from symptoms without adverse effects.Whole 16S rRNA sequencing revealed significant differences in the intestinal flora’s composition between patient and healthy donors.Pathogenic bacteria,such as Escherichia fergusonii and Romboutsia timonensis,were more in the patient.Beneficial bacteria such as Faecalibacterium prausnitzii,Fusicatenibacter saccharivorans,Ruminococcus bromii,and Bifidobacterium longum were more in the healthy donors.Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition.The composition converged with the donor's flora,with an increase in core beneficial intestinal bacteria,such as Eubacterium rectale,and a decrease in pathogenic bacteria.Changes in the intestinal flora corresponded with the patients'alleviating clinical symptoms.CONCLUSION Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora.This study provides a new approach for treating patients with chronic radiation enteritis.
基金the National Natural Science Foundation of China,No.81602792 and No.81602802Project of State Key Laboratory of Radiation Medicine and Protection,Soochow University,No.GZK1202101+1 种基金Suzhou Science and Technology Development Plan Project,No.KJXW2020008BOXI Natural Science Cultivation Foundation of China of the First Affiliated Hospital of Soochow University,No.BXQN202107.
文摘BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effect and seriously affects the quality of life of patients.If the incidence of RE in patients can be predicted in advance,and targeted clinical preventive treatment can be carried out,the side effects of radiotherapy in cervical cancer patients can be significantly reduced.Furthermore,accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.AIM To analyze the relationships between severe acute RE(SARE)of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.METHODS We included 50 cervical cancer patients who received volumetric modulated arc therapy(VMAT)from September 2017 to June 2018 in the Department of Radiotherapy at The First Affiliated Hospital Soochow University.Clinical and dose-volume histogram factors of patients were collected.Logistic regression analysis was used to evaluate the predictive value of each factor for SARE.A nomogram to predict SARE was developed(SARE scoring system≥3 points)based on the multiple regression coefficients;validity was verified by an internal verification method.RESULTS Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy.The main adverse reactions were diarrhea,abdominal pain,colitis,anal swelling,and blood in the stool.There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups(P>0.05).There were significant differences in the small intestine V_(20),V_(30),V_(40),and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery(P<0.05).Univariate and multivariate analyses revealed anal bulge rating(OR:14.779,95%CI:1.281-170.547,P=0.031)and disease activity index(DAI)score(OR:53.928,95%CI:3.822-760.948,P=0.003)as independent predictors of SARE.CONCLUSION Anal bulge rating(>0.500 grade)and DAI score(>2.165 points)can predict SARE.The nomogram shows potential value in clinical practice.
文摘AIM: To evaluate a new technique of temporary ileal anastomotic stoma, following small bowel resection, in patients where the anastomosis is anticipated to have borderline margins with dubious viability. METHODS: Five patients underwent enterectomy and partially anastomosed end-loop ileostomy at the University Hospital of Larissa between 2000 and 2006. Enterectomy was performed because of conditions such as mesenteric vascular occlusive disease, radiation entritis and small bowel injury. RESULTS: Postoperatively, none of the patients developed any stoma-related or anastomotic complications. There were no major complications. All patients were discharged between the 8th and 15th day after the procedure, and the stoma was closed 3 wk to 4 wk later. CONCLUSION: We believe that our proposed modification of end-loop ileostomy is a simple, quick and safe technique with minimal stoma-related morbidity, and with simple and safe reversion. This technique can be considered as a useful option in the treatment of ischemic or radiation-induced enteritis, and in the management of severe intestinal trauma.
文摘Objective: To explore the mechanism of Qingre Buyi Decoction (清热补益汤,QBD) in prevention and treatment of radiation enteritis in rats. Methods: Forty-eight Wistar rats were randomly divided into four groups, the TCM group, the WM group, the model group and the control group, 12 in each group. Rats in the former three groups were given orally with QBD, norfloxacin and normal saline once a day for 7 successive days, after being irradiated with X-ray at single dose of 10 Gy for modeling of radiation enteritis, while rats in the control group were untreated. Animals were sacrificed at the end of the medication. NO concentration, mean height and number of villi per centimeter in their small intestinal mu-cosa were measured. Results: The intestinal NO concentration was significantly lower in the TCM and WM groups than that in the model group(P<0.05), while the number of villi was significantly more and the height higher in the former two groups than those in the model group (P<0.01 for both), but no significant difference was shown between the TCM group and the WM group. Conclusion: QBD could inhibit the production of NO, increase the number and height of intestinal villi in rats with radiation enteritis, suggesting that it could reduce the inflammatory reaction of intestinal mucosa to irradiation, protect muco-sa from radiation damage, and promote the regeneration of mucosa.
文摘Radiotherapy is a common treatment for abdominal and pelvic malignancies with bone metastases.However,some patients develop radiation enteritis(RE)during the treatment or 2 months or more after the treatment,which seriously affects their quality of life.At present,the curative effect of western medicine is poor.Professor Renting Li believes that radiation kills tumor cells but at the same time,it damages the healthy Qi of the human body.Radiation causes heat and poison to accumulate in the intestinal tract,consumes and hurts Yin fluid,bums the vein,leads to deficiency of healthy Qi and poor detoxification,as well as cause blood stasis after a period of time.All these result in the combination of heat,blood stasis,and poison,manifesting as abdominal pain,diarrhea,mucus in stools,purulent and bloody stools,etc.Therefore,Professor Renting Li proposed the use of traditional Chinese medicine retention enema combined with oral traditional Chinese medicine to reduce symptoms,remove toxins,and improve the quality of life of patients.
文摘Objective To observe the effect of Modified Xijiao Dihuang Decoction(加味犀角地黄汤,MXDD)on rats with radiation enteritis,and explore its action mechanism.Methods Thirty female Sprague Dawley rats were divided into the control,model,dexamethasone(DXM),golden bifid(GB)and MXDD groups using random number table,6 rats in each group.Except the control group,the other rats were developed into radiation enteritis model by exposing to a single 60Co-γray at a dose of 11 Gy.The rats in the DXM,GB and MXDD groups were treated with DXM(1.425 mg/kg),GB(0.8 g/kg)and MXDD(36.0 g/kg)for 3 days,respectively.Body weight and diarrhea condition of rats were evaluated daily.On day 3,the feces of rats were collected for intestinal flora detection and the small intestinal tissues were also collected.Bacterial species annotation,alpha and beta diversities as well as composition of intestinal flora were detected and compared.The protein and mRNA expressions of interleukin 17(IL-17),retinoid-related orphan nuclear receptor gamma t(ROR-γt)and forkhead/winged helix transcription factor p3(FoxP3)were determined by Western blot and polymerase chain reaction,respectively.The abundance and diversity of intestinal flora as well as the proportion at the phylum and genus levels were assayed by 16S rRNA metagenome sequencing.Correlation between intestinal flora and Th17/Treg was analyzed by heatmap method.Results On day 1 to 3 after radiation,compared with the control group,the body weight in model group was decreased(P<0.05 or P<0.01).Compared with the model group,MXDD could alleviate weight loss and diarrhea caused by irradiation.At the phylum level,MXDD cause a significant increase in Firmicutes,and a decrease in Proteobacteria(P<0.05 or P<0.01).At the genus level,MXDD reduced the proportion of Escherichia Shigella(P<0.01).In addition,IL-17 and FoxP3 mRNA and protein expression levels were down-regulated and ROR-γt was up-regulated by MXDD treatment(P<0.05).Besides,Firmicutes and Lactobacillus were positively correlated with FoxP3(r=0.73,0.79,respectively;P<0.01),negatively correlated with IL-17(r=0.66,0.64,respectively;P<0.01 or P<0.05)and ROR-γt(r0.73,0.81,respectively;P<0.01).Proteobacteria and Escherichia Shigella both had positive correlation with IL-17(r 0.77,0.57,respectively;P<0.01 or P<0.05)and ROR-γt(r=0.94,0.79,respectively;P<0.01)and negative correlation with FoxP3(r0.74,0.65;P<0.01).Conclusion MXDD could improve the survival status of irradiated rats by regulating the richness,diversity and composition of intestinal flora,and restoring the balance of Th17/Treg.
文摘At present,there is no unified clinical approach for the treatment of radiation enteritis(RE).Clinically,its treatment is mainly based on nutritional support,mucosal protective agents,somatostatin,and microecological preparations.On the basis of syndrome differentiation and treatment,traditional Chinese medicine(TCM)is mainly used for internal administration,enteroclysis,acupuncture,and Tuina.It shows significant advantages in relieving the adverse reactions of radiotherapy and exhibits significant preventive and therapeutic effects against RE.This article reviews two aspects of TCM on RE,including internal and external administration,to explore and develop an effective and reliable standardized Chinese medicine program.
文摘Common gastrointestinal diseases such as radiation enteritis(RE),acute pancreatitis,inflammatory bowel diseases(IBD)and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level,mostly involving the activation of many pathways of the immune response,ultimately leading to tissue injury.Increased oxidative stress,inflammatory cytokine release,inflammatory cell infiltration and activation and the up-regulation of inflammatory transcription factors participate in the pathophysiology of these complex entities.Treatment varies in each specific disease,but at least in the cases of RE and IBD immunosuppressors are effective.However,full therapeutic responses are not always achieved.The pathophysiology of ischemiareperfusion(IR)injury shares many of these mechanisms.Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs,a phenomenon called remote ischemic preconditioning(RIP).This procedure has been shown to protect the gut,pancreas and liver by modulating many of the same inflammatory mechanisms.Since RIP is safe and tolerable,and has shown to be effective in some recent clinical trials,I suggest that RIP could be used as a physiologicallyrelevant adjunct treatment for non-ischemic gastrointestinal inflammatory conditions.
