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Sun M, Han X, Liu X, Xu Y. Cinobufacini suppresses malignant behaviors of endometrial cancer by regulating NF-κB pathway. Biotechnol Genet Eng Rev 2024; 40:2221-2233. [PMID: 37022215 DOI: 10.1080/02648725.2023.2199236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
Cinobufagin has inhibitory effects on various tumors, but there are few studies on gynecological tumors. This study explored the function and molecular mechanism of cinobufagin in endometrial cancer (EC). Different concentrations of cinobufagin treated EC cells (Ishikawa and HEC-1). Clone formation, methyl thiazolyl tetrazolium (MTT), flow cytometry, and transwell assays were used to detect malignant behaviors. A Western blot assay was performed to detect protein expression. Cinobufacini was sensitive to the inhibition of EC cell proliferation in a time- and concentration-dependent manner. Meanwhile, EC cell apoptosis was induced by cinobufacini. In addition, cinobufacini impaired the invasive and migratory abilities of EC cells. More importantly, cinobufacini blocked the nuclear factor kappa beta (NF-κB) pathway in EC by inhibiting p-IkBα and p-p65 expression. Cinobufacini suppresses malignant behaviors of EC by blocking the NF-κB pathway.
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Affiliation(s)
- Mengyi Sun
- Beijing Medical Health Technology Development Center, Beijing Pharma and Biotech Center, Beijing, China
| | - Xiaodao Han
- Day Chemotherapy Ward, Qingdao Central Hospital, Qingdao, Shandong, China
| | - Xiaoyun Liu
- Day Chemotherapy Ward, Qingdao Central Hospital, Qingdao, Shandong, China
| | - Yintao Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Du CM, Leu WJ, Jiang YH, Chan SH, Chen IS, Chang HS, Hsu LC, Hsu JL, Guh JH. Cardenolide glycosides sensitize gefitinib-induced apoptosis in non-small cell lung cancer: inhibition of Na +/K +-ATPase serving as a switch-on mechanism. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:6533-6550. [PMID: 38451282 DOI: 10.1007/s00210-024-03031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
The treatment of non-small cell lung cancer (NSCLC) is known as a significant level of unmet medical need in spite of the progress in targeted therapy and personalized therapy. Overexpression of the Na+/K+-ATPase contributes to NSCLC progression, suggesting its potentiality in antineoplastic approaches. Epi-reevesioside F, purified from Reevesia formosana, showed potent anti-NSCLC activity through inhibiting the Na+/K+-ATPase, leading to internalization of α1- and α3-subunits in Na+/K+-ATPase and suppression of Akt-independent mTOR-p70S6K-4EBP1 axis. Epi-reevesioside F caused a synergistic amplification of apoptosis induced by gefitinib but not cisplatin, docetaxel, etoposide, paclitaxel, or vinorelbine in both NCI-H460 and A549 cells. The synergism was validated by enhanced activation of the caspase cascade. Bax cleavage, tBid formation, and downregulation of Bcl-xL and Bcl-2 contributed to the synergistic apoptosis induced by the combination treatment of epi-reevesioside F and gefitinib. The increase of membrane DR4 and DR5 levels, intracellular Ca2+ concentrations, and active m-calpain expression were responsible for the caspase-8 activation and Bax cleavage. The increased α-tubulin acetylation and activation of MAPK (i.e., p38 MAPK, Erk, and JNK) depending on cell types contributed to the synergistic mechanism under combination treatment. These signaling pathways that converged on profound c-Myc downregulation led to synergistic apoptosis in NSCLC. In conclusion, the data suggest that epi-reevesioside F inhibits the Na+/K+-ATPase and displays potent anti-NSCLC activity. Epi-reevesioside F sensitizes gefitinib-induced apoptosis through multiple pathways that converge on c-Myc downregulation. The data support the inhibition of Na+/K+-ATPase as a switch-on mechanism to sensitize gefitinib-induced anti-NSCLC activity.
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Affiliation(s)
- Chi-Min Du
- School of Pharmacy, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan
| | - Wohn-Jenn Leu
- School of Pharmacy, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan
| | - Yi-Huei Jiang
- School of Pharmacy, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan
| | - She-Hung Chan
- Department of Cosmetic Science, Providence University, 200, Sec. 7, Taiwan Boulevard, Shalu Dist, Taichung, 43301, Taiwan
| | - Ih-Sheng Chen
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Taiwan, Kaohsiung, Taiwan
| | - Hsun-Shuo Chang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Taiwan, Kaohsiung, Taiwan
| | - Lih-Ching Hsu
- School of Pharmacy, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan
| | - Jui-Ling Hsu
- School of Pharmacy, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan.
- Department of Nursing, Division of Basic Medical Sciences, Chang-Gung University of Science and Technology, Taoyuan, 333, Taiwan.
- Department of Medical Oncology, New Taipei Municipal TuCheng Hospital, New Taipei City, 236, Taiwan.
| | - Jih-Hwa Guh
- School of Pharmacy, National Taiwan University, No. 33, Linsen S. Rd., Zhongzheng Dist, Taipei, 100, Taiwan.
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Liu N, Chen HP, Yang ZM, Xia MY, Wang D, Zang LH, Liu DC. Enhancement of Dissolving Capacity and Reducing Gastric Mucosa Irritation by Complex Formation of Resibufogenin with β-Cyclodextrin or 2-Hydroxypropyl-β-cyclodextrin. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27103213. [PMID: 35630687 PMCID: PMC9146005 DOI: 10.3390/molecules27103213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 05/14/2022] [Indexed: 11/21/2022]
Abstract
Resibufogenin (RBG) is a natural medicinal ingredient with promising cardiac protection and antitumor activity. However, poor solubility and severe gastric mucosa irritation restrict its application in the pharmaceutical field. In this study, the inclusion complex of RBG with β-cyclodextrin (β-CD) and 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) was prepared using the co-evaporation method, and the molar ratio of RBG to CD was determined to be approximately 1:2 by continuous variation plot for both CDs. The formation of inclusion complexes between RBG and each CD (RBG/β-CD and RBG/HP-β-CD) was evaluated by phase solubility study, Fourier transform infrared spectroscopy, and thin-layer chromatography. Powder X-ray diffraction and differential scanning calorimetry confirmed drug amorphization and encapsulation in the molecular cage for both CDs. Moreover, the inclusion complexes’ morphologies were observed using scanning electron microscopy. The dissolution rate of the inclusion complexes was markedly improved compared to that of RBG, and the complexes retained their antitumor activity, as shown in the in vitro cytotoxicity assay on a human lung adenocarcinoma cancer (A549) cell line. Moreover, less gastric mucosal irritation was observed for the inclusion complex. Thus, the inclusion complex should be considered a promising strategy for the delivery of poorly water-soluble anticancer agents, such as RBG.
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Affiliation(s)
- Nan Liu
- Graduate School of Traditional Chinese Medicines, Shenyang Pharmaceutical University, Shenyang 110016, China; (N.L.); (H.-P.C.); (D.W.)
- Graduate School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Huan-Ping Chen
- Graduate School of Traditional Chinese Medicines, Shenyang Pharmaceutical University, Shenyang 110016, China; (N.L.); (H.-P.C.); (D.W.)
| | - Zi-Meng Yang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang 110016, China;
| | - Ming-Yu Xia
- Graduate School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang 110016, China; (M.-Y.X.); (L.-H.Z.)
| | - Dong Wang
- Graduate School of Traditional Chinese Medicines, Shenyang Pharmaceutical University, Shenyang 110016, China; (N.L.); (H.-P.C.); (D.W.)
| | - Ling-He Zang
- Graduate School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang 110016, China; (M.-Y.X.); (L.-H.Z.)
| | - Dong-Chun Liu
- Graduate School of Traditional Chinese Medicines, Shenyang Pharmaceutical University, Shenyang 110016, China; (N.L.); (H.-P.C.); (D.W.)
- Correspondence:
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Wang S, Fu JL, Hao HF, Jiao YN, Li PP, Han SY. Metabolic reprogramming by traditional Chinese medicine and its role in effective cancer therapy. Pharmacol Res 2021; 170:105728. [PMID: 34119622 DOI: 10.1016/j.phrs.2021.105728] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
Metabolic reprogramming, characterized by alterations of cellular metabolic patterns, is fundamentally important in supporting the malignant behaviors of cancer cells. It is considered as a promising therapeutic target against cancer. Traditional Chinese medicine (TCM) and its bioactive components have been used in cancer therapy for an extended period, and they are well-known for their multi-target pharmacological functions and fewer side effects. However, the detailed and advanced mechanisms underlying the anticancer activities of TCM remain obscure. In this review, we summarized the critical processes of cancer cell metabolic reprogramming, including glycolysis, mitochondrial oxidative phosphorylation, glutaminolysis, and fatty acid biosynthesis. Moreover, we systemically reviewed the regulatory effects of TCM and its bioactive ingredients on metabolic enzymes and/or signal pathways that may impede cancer progress. A total of 46 kinds of TCMs was reported to exert antitumor effects and/or act as chemosensitizers via regulating metabolic processes of cancer cells, and multiple targets and signaling pathways were revealed to contribute to the metabolic-modulating functions of TCM. In conclusion, TCM has its advantages in ameliorating cancer cell metabolic reprogramming by its poly-pharmacological actions. This review may shed some new light on the explicit recognition of the mechanisms of anticancer actions of TCM, leading to the development of natural antitumor drugs based on reshaping cancer cell metabolism.
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Affiliation(s)
- Shan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, PR China
| | - Jia-Lei Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, PR China
| | - Hui-Feng Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, PR China
| | - Yan-Na Jiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, PR China
| | - Ping-Ping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, PR China.
| | - Shu-Yan Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, PR China.
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5
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Lin X, Song Y, Tian F, Chen X, Yin K. The role of pyroptosis in lung cancer and compounds regulated pyroptosis of lung cancer cells. J Cancer Res Ther 2021; 17:1596-1602. [DOI: 10.4103/jcrt.jcrt_614_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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6
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Retraction Note to: Resibufogenin suppresses tumor growth and inhibits glycolysis in ovarian cancer by modulating PIM1. Naunyn Schmiedebergs Arch Pharmacol 2020; 394:575. [PMID: 33242124 DOI: 10.1007/s00210-020-02016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Temperature-sensitive gel-loaded composite nanomedicines for the treatment of cervical cancer by vaginal delivery. Int J Pharm 2020; 586:119616. [PMID: 32650113 DOI: 10.1016/j.ijpharm.2020.119616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/07/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Abstract
In this study, toad venom (TV) and realgar were loaded into a poloxamer 188/407 (F127/F188)-based temperature-sensitive in situ gel (TISG) and encapsulated in solid lipid nanoparticles (TV-SLN) or ground nano-realgar (NR) to improve drug release and reduce local irritation after vaginal administration. The combination of TV-SLN and NR (TV-SLN/NR) greatly enhanced the inhibition of tumor cell proliferation and was most effective at a dose ratio of 2:3 (w/w). After TV-SLN/NR treatment, S and G0/G1 phase arrest were observed in HeLa and SKOV-3 cells and the inhibitory effects on proliferation were stronger than those in the conventional powder group. The gelation temperature of TV-SLN and NR-loaded TISG (TV-SLN/NR-TISG) using the selected formulation was 33 ± 0.91 °C. The cumulative release of the drug increased as the dissolution of gel progressed, showing a linear relationship (r > 0.99). TV-SLN/NR-TISG enabled the sustained release of cargo by adhesion to the vaginal mucosa and showed excellent biocompatibility during continuous administration for 7 days. We specifically demonstrated the effectiveness of the TISG for the vaginal delivery of TV-SLN and NR, supporting its important clinical implications for the treatment of cervical cancer.
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Yin H, Liu YG, Li F, Wang LQ, Zha JH, Xia YC, Yu BT, Wen DH. Resibufogenin suppresses growth and metastasis through inducing caspase-1-dependent pyroptosis via ROS-mediated NF-κB suppression in non-small cell lung cancer. Anat Rec (Hoboken) 2020; 304:302-312. [PMID: 32396707 DOI: 10.1002/ar.24415] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
The purpose of this study is to explore the antitumor properties of resibufogenin (RB) in non-small cell lung cancer (NSCLC) and elucidate its underlying mechanism. A549 and H520 cells were treated with various concentrations of RB with or without NLRP3 inhibitor (MCC950), caspase-1 inhibitor (VX765), or N-acetyl-l-cysteine (an ROS scavenger). Cell counting kit-8 and colony formation assays were conducted to determine cell viability. Cell invasion was detected by using the transwell assay. The release of lactate dehydrogenase (LDH) was determined by the LDH detection assay. The protein expression levels of related genes were measured by western blotting and immunohistochemistry. The reactive oxygen species (ROS) level was detected by using a 2,7-dichlorodihydrofluorescein diacetate ROS Assay Kit. The in vivo effects of RB were evaluated in a xenograft mouse model. RB treatment reduced cell viability and invasion in a dose-dependent manner. Furthermore, RB also enhanced pyroptosis levels in A549 and H520 cells, as indicated by the increased release of LDH and pyroptosis-related proteins. Interestingly, we also found that the antiproliferative and antimetastatic effects of RB were alleviated by the blockade of pyroptosis using NLRP3 inhibitor MCC950. Further study demonstrated that RB induced pyroptosis in a caspase-1-dependent manner, as evidenced by the finding that VX765 effectively reversed the effects of RB on A549 and H520 cells. We also found that RB could trigger caspase-1-dependent pyroptosis through ROS-mediated NF-κB suppression. In summary, our findings provide a potential antitumor agent and a novel insight into the mechanism of RB treatment of NSCLC.
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Affiliation(s)
- Hui Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan-Ge Liu
- School of Basic Medical Sciences, Nanchang University, Nanchang, China
| | - Fei Li
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Lun-Qing Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Jian-Hua Zha
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ying-Chen Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Di-Hao Wen
- Department of Thoracic Surgery, Dongkou People's Hospital, Shaoyang, China
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Guo Y, Liang F, Zhao F, Zhao J. Resibufogenin suppresses tumor growth and Warburg effect through regulating miR-143-3p/HK2 axis in breast cancer. Mol Cell Biochem 2020; 466:103-115. [PMID: 32006291 DOI: 10.1007/s11010-020-03692-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
Increasing evidence confirmed that the Warburg effect plays an important role involved in the progression of malignant tumors. Resibufogenin (RES) has been proved to have a therapeutic effect in multiple malignant tumors. However, the mechanism of whether RES exerted an antitumor effect on breast cancer through regulating the Warburg effect is largely unknown. The effect of RES on glycolysis was determined by glucose consumption, lactate production, ATP generation, extracellular acidification rate and oxygen consumption rate in breast cancer cells. The total RNA and protein levels were respectively measured by RT-qPCR and western blot. Cell proliferation and apoptosis were examined using the CCK-8 assay, colony formation assay, and flow cytometry, respectively. The interaction between miR-143-3p and HK2 was verified by dual-luciferase reporter gene assay. We also evaluated the influence of RES on the tumor growth and Warburg effect in vivo. RES treatment significantly decreased glycolysis, cell proliferation and induced apoptosis of both MDA-MB-453 and MCF-7 cells. Simultaneously, the expression of HK2 was decreased in breast cancer cells treated with RES, which was positively associated with tumor size and glycolysis. Moreover, HK2 was a direct target gene of miR-143-3p. Mechanistically, upregulation of miR-143-3p by RES treatment inhibited tumor growth by downregulating HK2-mediated Warburg effect in breast cancer. Our findings suggested that RES exerted anti-tumorigenesis and anti-glycolysis activities in breast cancer through upregulating the inhibitory effect of miR-143-3p on HK2 expression, which provided a new potential strategy for breast cancer clinical treatment.
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Affiliation(s)
- Ying Guo
- Department of Breast and Thyroid Surgery, Provincial Hospital Affiliated To Shandong University, Jingwu Road 324, Huaiyin District, Jinan, 250021, Shandong, China
| | - Fei Liang
- Department of Breast and Thyroid Surgery, Provincial Hospital Affiliated To Shandong University, Jingwu Road 324, Huaiyin District, Jinan, 250021, Shandong, China
| | - Fuli Zhao
- Department of Breast and Thyroid Surgery, Provincial Hospital Affiliated To Shandong University, Jingwu Road 324, Huaiyin District, Jinan, 250021, Shandong, China
| | - Jian Zhao
- Department of Breast and Thyroid Surgery, Provincial Hospital Affiliated To Shandong University, Jingwu Road 324, Huaiyin District, Jinan, 250021, Shandong, China.
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Shen LD, Qi WH, Bai JJ, Zuo CY, Bai DL, Gao WD, Zong XL, Hao TT, Ma Y, Cao GC. Resibufogenin inhibited colorectal cancer cell growth and tumorigenesis through triggering ferroptosis and ROS production mediated by GPX4 inactivation. Anat Rec (Hoboken) 2020; 304:313-322. [PMID: 31961485 DOI: 10.1002/ar.24378] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/04/2019] [Accepted: 12/13/2019] [Indexed: 12/20/2022]
Abstract
Resibufogenin (RB) has been used for cancer treatment, but the underlying mechanisms are still unclear. This study aimed to investigate the effects of RB treatment on colorectal cancer (CRC) cells, and to determine the underlying mechanisms. The cell counting kit-8 assay was used to determine cell viability. Cell morphology was observed under light microscopy, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay was employed to detect cell apoptosis. Intracellular ferrous iron (Fe2+ ), malondialdehyde (MDA), glutathione (GSH), and reactive oxygen species levels were detected by using commercial iron assay kit, MDA assay kit, GSH assay kit, and 2,7-dichlorodihydrofluorescein diacetate probes, respectively. The protein expressions were determined by Western blot and immunohistochemistry. RB inhibited cell viability in the CRC cell lines (HT29 and SW480) in a dose- and time-dependent manner, and caused cytotoxicity to the normal colonic epithelial cell line (NCM460) at high dose. Similarly, RB induced morphological changes in CRC cells from normal to round shape, and promoted cell death. Of note, RB triggered oxidative stress and ferroptotic cell death in CRC cells, and only ferroptosis inhibitors (deferoxamine and ferrostatin-1), instead of inhibitors for other types of cell death (apoptosis, autophagy, and necroptosis), reversed the inhibitory effects of RB on CRC cell proliferation. Furthermore, glutathione peroxidase 4 (GPX4) was inactivated by RB treatment, and overexpression of GPX4 alleviated RB-induced oxidative cell death in CRC cells. Consistently, the in vivo experiments validated that RB also triggered oxidative stress, and inhibited CRC cells growth and tumorigenicity in mice models. RB can inhibit CRC cells growth and tumorigenesis by triggering ferroptotic cell death in a GPX4 inactivation-dependent manner.
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Affiliation(s)
- Lian-Dong Shen
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Wen-Hai Qi
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Jiang-Jiang Bai
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Chun-Yi Zuo
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Dong-Lin Bai
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Wei-Dong Gao
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Xin-Ling Zong
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Ting-Ting Hao
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Yan Ma
- Department of Medicine-Cardiovascular, Yan'an People's Hospital, Yan'an, Shaanxi, China
| | - Guang-Cai Cao
- Department of Anorectal Surgery, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
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