Objective To evaluate the effects of individual extralevator abdominalperineal excision (ELAPE) for rectal neoplasms below levator hiatus on pelvic floor by finite element analysis. Methods MIMICS 10.01, GeoMagic Studio 12 and ANSYS Workbench 14.0 were used to deal with magnetic resonance data of 27 healthy nulliparous volunteers'pelvic, and then three types of finite element models were developed:intact models, ELAPE models and individual ELAPE models. The maximum stress in non levator ani tissue under the same load were measured in three types of models, and levator ani 's maximal stresses were measured in intact model and individual ELAPE and their stress distributions under the same pressure were analyzed and compared. Results The maximal stresses of non-levator ani tissue were (1.963±0.061) MPa, (5.127±0.070) MPa and (4.703±0.110) MPa for intact model, ELAPE model and individual ELAPE model respectively. The maximal stress was lower in individual ELAPE model than that in ELAPE model, but which was higher than that of intact model (P<0.01). The high-stress zone was found at the joints with surrounding structures on both sides of intact model and ELAPE model. The high-stress zone was found in front of the joints with surrounding structures on both sides in individual ELAPE model. The maximal stresses of three types of models were found in front of both sides. In intact model levator ani 's maximal stress was (0.812 ± 0.042) MPa, which was higher than that of individual ELAPE model (0.719 ± 0.027) MPa (P<0.01). The high-stress zone of intact model was found in front of the joints on both sides. The maximal stress was showed at ventral ends on both sides. For the individual ELAPE model the high-stress zone was found at the anterior part of the levator ani muscle and the surrounding structure. The maximum stress appeared at the top end of the left and right sides. Conclusion This individual ELAPE is able to decrease the stress of non-levator ani tissue, which suggests that the risk of postoperative pelvic floor hernia is relatively reduced.

Objective To review the results and complications of open reduction and internal fixation (ORIF) through the posteromedial approach for posterior pilon fractures.Methods From March 2009 through November 2013,18 consecutive posterior pilon fractures were surgically treated through the posteromedial approach,involving 12 males and 6 females.Their ages ranged from 15 to 65 years (average,42 years).All of them were complicated with fracture of external malleolus,and 6 of them with fracture of anterior colliculus of medial malleolus.The time from injury to surgery ranged from 2 to 15 days (average,7 days).Results The patients were followed up for an average of 15 months (range,from 10 to 19 months).All the fractures healed after 11 to 16 weeks (average,13 weeks).No complications like neurovascular injury,implants failure,nonunion,or malunion occurred,except one case of superficial wound infection which responded to nonoperative management.According to the AOFAS (American Orthopaedic Foot and Ankle Society) evaluation system,15 cases were excellent,2 cases good and one case fair.Conclusion It is safe,reliable and effective to treat posterior pilon fractures using anti-rotation plate ORIF through the posteromedial approach.

Objective Summarize the experience in the surgical treatment of multiple original colon cancer in aged patients. Methods The retrospective analysis was performed in the 46 cases of multiple original colon cancer in aged patients in our hospital from August 1955 to May 2000. Results The 46 cases of multiple original colon cancer in aged patients account for 7.6% (46/608) of the total cases of colon cancer in patients in the same period. There were 26 cases of the male and 20 cases of the female. 30 cases were colon cancer with tumors from other organs. "The different time cancer" could be found 31 years later. The follow-up rate was 100%. The survival rates for 3,5,10,15,20 years were 71.1%(27/38), 63.6%(21/33), 43.3%(13/30), 28.6%(8/28) and 16.0%(4/25) respectively. In this study, we found that the survival rate of the group was higher than that of the aged patients suffering colon cancer in the same period of time. Conclusions The number of multiple original colon cancer in aged patients has been increased in the decade. The incidence was 43.5% (20/46) in the study. With the development of society, both doctors and patients have improved their knowledge about multiple original carcinomas in aged patients. The positive rate of early diagnosis was promoted to a high level, especially in the monitor and treatment of per operation. Choosing the energetic operation, we will acquire the better therapeutic efficacy for treatment of multiple original cancer in aged patients.

Objecfive To investigate possibihty of monitoring myocardial isehemia by eontinuous EASI 12-lead ST-segment trend analysis during orthopaedic surgery and find its rules.Methods Three hundred and eleven consecutive patients who underwent orthopaedic surgery were monitored bv continuous EASI 12-lead ST-segment analysis during surgery.Results Among 311 patients 81 patients(26.0%) had myocardial ischemic events.The ischemie incidence of general anesthetics WaS signifieantly higher than local anesthetics(the spinal or epidural anesthetics and nerve-block anesthetics)(38.1%vs 23.0%.P＝ 0.01 5).During ischemie events the patients whose heart rate exceeded 90 beat per minute was 71.6% (58/81).Among the 177 isehemie events,the duration ofless than 5 minutes was 79.7%(141/177).ST-seg- ment deviation ofless than 0.15 mV was 71.2%(126/177).Conclusions During orthopaedic surgery EASt 12-lead electrocardiogram is the optimal approach for monitoring myocardial isehemia.The ischemic incidence of general anesthetics is significantly higher than local anesthetics.The myocardial ischemia events correlates with fast heart rate.The intraoperative myocardial ischemia events are more often transient.In most of these ischemic events ST-segment deviation is not very serious.

Mental workload research is important to people's health and work efficiency, Psychophysiological measures such as electroencephalography (EEG), ECG and respiration measures can be used to predict mental workload level. A Multi-channel phase-space reconstruction method is proposed in this paper which rearranges signal serials by the correlation coefficients and select time delay by signal determinism. The study of determinism and correlation dimension on simulative data exhibits a good performance. The result of EEG series shows a clearly consistency to workload level variety. The method is useful for multi-channel signals nonlinear analysis and mental workload detection.
Adult ; Algorithms ; Electroencephalography ; Humans ; Mental Processes ; physiology ; Nonlinear Dynamics ; Signal Processing, Computer-Assisted ; Task Performance and Analysis ; Workload

Correct sleep scoring is the base of sleep studying; nonlinear features of EEG can represent different sleep stages. In this paper, correlation dimension (D2) and approximate entropy (ApEn) of sleep EEG have been calculated. The statistical results reveal that: D2 does not come to be saturated when the embedding dimension increases, but the relative value of D2 can effectively distinguish different sleep stages. ApEn has the advantage of calculating simply, steady result and representing preferably different sleep stages. ApEn and the relative value of D2 reveal, from different point of view, the same rule about EEG (brain) complexity changing, that is, both complexity and its fluctuation are maximal in the subject's awake hour, are decreasing with the deepening of sleep, but the complexity in REM is about the level between S1 and S2.
Electroencephalography ; Entropy ; Humans ; Nonlinear Dynamics ; Sleep ; physiology ; Sleep Stages ; physiology

OBJECTIVETo seek the optimum treatment for patients with primary gastric non-Hodgkin's lymphoma and factors associated with prognosis.

METHODSA retrospective study was conducted on 157 primary gastric non-Hodgkin's lymphoma patients who had received operation for 45 years.

RESULTSThe X-ray diagnosis rate was 39.4% before operation. The diagnosis rate by gastroscopy was 52.7%. Among the 157 patients, 32 belonged to stage I(E), 40 stage II(E), 29 stage III(E), and 56 stage IV(E). All of the patients were received chemotherapy or radiation. The 3-, 5-, 10-, 15-year survival rates were 51.1% (69/135), 42.3% (55/130), 20.7% (23/111), and 13.5% (14/104).

CONCLUSIONSThe 3-, 5-year survival rates in stage I(E) and stage II(E) were 2 to 5 times higher than those in stage III(E) and IV(E) (P < 0.01). The 3-, 5-year survival rates of primary gastric non-Hodgkin's lymphoma were 60.2% (65/108) and 50.0% (52/104) respectively. The prognosis was better than the 5-year survival rate of gastric cancer patients with D(2) lymphodenectomy (33.3%). Early diagnosis and treatment are effective to prevent complications, enhance quality of patient's life, and prolong the survival.

Objective: To analyze clinical features and prognosis of hepatocellular carcinoma (cHCC) patients after liver resection, so as to clarify the prognostic risk factors. Methods: We retrospectively reviewed the data of patients who underwent mesohepatectomy for cHCC at Tianjin Medical University Cancer Hospital and Chinese Academy of Medical Sciences Cancer Hospital between October 2006 and December 2014. The patients were assigned into three subgroups according to disease-free survival (DFS): high risk (DFS≤1 year), middle risk (1 year3 years). Clinicopathological characteristics were compared and prognostic factors were evaluated using univariate and multivariate analyses. Results: In total, 173 patients were reviewed. The median overall survival (OS) in the high-risk group was 13.5 months compared with 24.0 months in the middle-risk group and 45.5 months in the low-risk group. Univariate analysis showed that liver capsule invasion (P=0.022), tumors adjacent to major vascular vessels (<1 cm) (P<0.01), HCC size>50 mm (P=0.012), presence of microvascular invasion (P<0.001), tumor invasive growth (P<0.001), and preoperative transarterial chemoembolization (TACE; P=0.028) were significant risk factors for recurrence. The main risk factors for OS were male gender (P=0.013), alpha-fetoprotein >200 ng/mL (P=0.005), tumor size >50 mm (P=0.013), adjacent to major vascular vessels (P<0.001), high Edmondson-Steiner differentiation grade (P=0.003), preoperative TACE (P=0.010), and tumor invasive growth (P=0.001). Cox multivariate analysis demonstrated that tumors adjacent (<1 cm) to major vascular trunks and tumor invasive growth were inde-pendent prognostic factors for both DFS and OS. In total, 40.5% patients in the high-risk group had both risk factors; this percentage was 13.4% in the middle-risk group and 3.1% in the low-risk group (P=0.001). A prognostic model including the above 9 factors were created based on Logistic regression to predict the percentage of patients belonging to the high-risk group. The results showed that the prediction accuracy continued to increase with the number of more factors added. When all the 9 factors were included, the pre-dictive percentage was 82.1%. Conclusions: cHCC patients in the high-risk group had more risk factors than those in the middle-and low-risk groups. A prognostic model containing these factors may provide accurate prediction of survival or risk stratification, and cHCC patients with these risk factors should be candidates for aggressive following-up and adjuvant therapy.

Introduction of the da Vinci robotic surgical system has revolutionized the field of minimally invasive surgery. Innovative ro-botic technologies have helped surgeons overcome the technical difficulties of conventional laparoscopic surgery. At present, da Vinci robotic colorectal surgery is a safe and feasible option and has shown comparable short-term outcomes with conventional laparoscop-ic surgery. However, it has no oncological advantage despite its significantly higher cost. Promising technologies have been developed to overcome the drawbacks and obstacles of the current robotic systems. Moreover, further randomized controlled clinical trials are re-quired to assess the long-term results and potential benefits of robotic surgery over laparoscopy. This review aimed to elucidate the current developments in robotic colorectal surgery and to explore emerging surgical robotic technologies currently available or in de-velopment.

Objective:To evaluate the effects of individual extralevator abdominoperineal excision (ELAPE) of rectal neoplasms in the low posterior wall on the pelvic floor by finite element analysis. Methods:MIMICS 10.01, Geo Magic Studio 12, and ANSYS Workbench 14.0 were used to analyze the magnetic resonance data obtained from the pelvic region of 27 healthy nulliparous volunteers. Three types of finite element models (intact model, ELAPE model, and individual ELAPE model) were developed. The maximal stress on non levator ani tissues were analyzed using the three models, while the maximal stress on levator ani tissues were analyzed using the in-tact model and the individual ELAPE model. Their stress distributions under the same pressure were analyzed and compared. Results:The maximal stress on non levator ani tissues obtained using the intact model, ELAPE model, and individual ELAPE model were (1.963± 0.061), (5.127 ± 0.070), and (3.667 ± 0.126) MPa, respectively, with P<0.01. High-stress zones were obtained at the joints with pelvic walls on both sides using the three models, while the maximal stresses were obtained at the joints with pubis on both sides. The maxi-mal stress on levator ani tissues obtained using the intact model and individual ELAPE model were (0.812 ± 0.042) MPa and (1.437 ± 0.043) MPa, respectively. Thus, the individual ELAPE model yielded higher values of maximal stress compared to the intact model. Both models generated high-stress zones at the joints with tendinous arch of levator ani tissues on both sides, and maximum stresses at the joints with pubis on both sides. Conclusion:Individual ELAPE decreases the stress on non levator ani tissues. This suggests that the risk of postoperative pelvic floor hernia is relatively reduced.