The theme of this article lies in how to preserve the anus or restore the anal function in the treatment of middle or lower rectal cancer in order to avoid abdominal artificial anus,on the basis of not violating the principles of radical resection.From August 1995 to October 2004,86 cases of rectal cancer were operated with radical resection,48 of which preserved anus.Based on close observation of the patients,postoperative anal function seems the best in those with Dixon's anterior approach.if transplantation of the gracilis muscle is successful,satisfactory function restoration is always possible.Many scholars ever reformed Dixon's resection with lots of operative procedures,such as Bacon's resection.Because stapler can join rectal and anal together at any location,Bacon's resection is seldom adopted in clinical practice.The indications for anus preserving operation are as follows:①early or middle stage disease with localized lesion not invading beyond the muscle layer of the bowel;②no metastatic regional lymph adenopathy and;③adenocarcinoma at high or moderate degree of differentiation.It is suggested that different types of operative procedures are adopted according to the location of the lesion.

Objective To investigate the effect of combined general anesthesia with localanesthetic infiltration on heart rate variability and hemodynamics in laparoscopic cholecystectomy.Methods By simple randomization 70 patients undergoing laparoscopic cholecystectomy were assignedto two groups,68 patients completed the study(34 in each group).Group GA was given generalanesthesia.Group GL was given general anesthesia combined with local anesthetic.Iow-frectuency(LF),high-frequency(HF),LF/HF,Lfnu(LF/TP×100%),Hfnu(HF/TP×100%)and totalpower(TP),were recorded at the time points of baseline(T_0),skin incision(T_1),skin closure(T_2)and 1 h(T_3),3 h(T_4)after surgery.MAP and HR were recorded at the points of baseline,skinincision,skin closure and 1,3 h after surgery.Results Compared with the baseline,there was anincrease in MAP and HR at T_1,T_3,T_4(P<0.05)in group GA. Heart rate variability changesshowed that in group GA Lfnu,LF/HF increased significantly at T_1-T_4(P<0.05)and in group GLLF/HF increased significantly at T_1,T_2(P<0.05),and TP in group GA and group GL decreasedsignificantly at T_1,T_2(P<0.05).Conclusion Our results support that combined general anesthesiawith local anesthetic infiltration has lass influence on hemodynamics and automomic nerve,and can bean useful analgesic adjuvanct for patients undergoing laparoscopic cholecystectomy.

Objective To study the effects of propofol on the expressions of tumor necrosis factor(TNF)-α, interleukin-10 (IL-10) and nuclear factor-κB(NF-κB) in rat cerebrum undergoing ischemia and reperfusion. Methods Thirty rats were randomly divided into five groups with 6 rats each. The rats in group S accepted sharm operation as the controls, in group IR focal cerebral ischemia Concentrations of TNF-α and IL-10 in the cerebrum were measured by enzyme-linked immunosorbance assay(ELISA). An isotope([32P]-ATP) technique was applied for detecting nuclear factor-κB(NF-κB) in rat cerebral cortex. Electrophoretic mobility shift assay (EMSA) was performed in nuclear extracts from cerebral tissues. Results Compared with group S,TNF-α of group IR increased [(2.57±0.19) pg/g vs. (1.60±0.15) pg/g](P<0.05),so did the IL-10 [(11.59±1.32) pg/g vs. (7.97±1.96) pg/g](P<0.05). Compaered with group IR,TNF-α of group PP decreased [(1.88±0.26) pg/g vs. (2. 57±0. 9) pg/g](P<0.05) ,so did the IL-10 [(8.35±1.00) pg/g vs. (11.59±1.32) pg/g](P< 0.05),with decreased activity of NF-κB. There was no significant difference in the levels of TNF-α, IL-10 and NF-κB between group IR and group PA. The changes of IL-10 and NF-κB activity were parallel to that of TNF-α. Conclusion Pre-treatment with propofol can prevent the elevation of inflammatory factors in the cerebrum undergoing ischemia and reperfusion, which was not when used after cerebral ischemia. The effect of propofol on reduction of TNF-α production in ischemic cerebrum may be through inhibiting transduction pathway of NF-κB.

ObjectiveTo compare and evaluate the effectiveness of Airtraq laryngoscope combined with a Bougie and Airtraq laryngoscope alone for tracheal intubation in simulated difficult airway.Methods Four anesthetists and 4 clinical physicians of standardized training were enrolled in the study.The participants intubated the trachea of the ALS simulator manikin in 5 tongue edema scenarios simulating modified Cormack-Lehane grade 1,2a,2b,3,and 4 views and 1 cervical immobilization scenario.Results No significant difference in the rate of successful intubation was detected between two techniques(P＞ 0.05 ).In Cormack-Lehane grade 1,2a views,the duration of successful intubation in Airtraq laryngoscope alone [ ( 14.3 ± 1.3),( 17.1 ± 2.9) s] was shorter than that in Airtraq laryngoscope combined with a Bougie [ (26.6 ± 3.8),(36.4 ± 3.6) s ] with significant difference (P ＜ 0.01 ).Cormack-Lehane grade 2b,3,4 views,the duration of successful intubation in Airtraq laryngoscope alone[ (74.5 ± 6.5 ),(116.3 ± 9.8),(53.0 ± 6.1 )s] was longer than that in Airtraq laryngoscope combined with a Bougie [ (35.4 ± 4.3 ),(52.3 ± 5.0),(40.4 ± 3.8 ) s ] with significant difference (P ＜ 0.05).ConclusionAirtraq laryngoscope combined with a Bougie can be quickly intubated in simulated difficult airway compared with Airtraq laryngoscope alone.

Objective To evaluate the influence of dexmedetomidine（Dex） on sedation and requirement of propofol during anesthesia induction. Methods Thirty patients（ASA Ⅰ or Ⅱ） undergoing selective operation were randomly divided into 2 groups：Dexmedetomidine group （group D,n=15） or control group （group C,n=15）. Patients in the group D received 1 μg/kg dex diluted to 10ml over 10 min by pumped infusion and patients in the group C was simply recieved normol saline at the same way.Twenty minutes after administrating the drug,patients in both groups were pumped propofol at the speed of 0.4 mg·kg-1·min-1. When holding up jaw without movement,patients received 1 μg/kg fentanyl and 0.6 mg/kg rocuronium,and endotracheal intubated 1.5 minutes later. RE,SE,Ramsay sedation scale of the patients were recorded before（T0） and after 5,10,20 minutes（T1-T3） of drug adminstration.The minimum dose and total dose of propofol during induction were recorded.Results Compared with group C and T0,RE and SE in group D decreased obviously at T1-T3 （P0.01）,while Ramsay sedation scale rised significantly （P0.01）. Compared with group C,the minimum dose and the total dose of propofol decreased obviously in group D during induction （P0.01）.Conclusion Dexmedetomidine causes sadetive without respiratory depression,and has the propofol sparing effect during anesthesia induction.

Objective To study curative efficacy of radix notoginseng saponin dispersible tablets combined with rivaroxaban in treatment of tibial fracture after operation and its effects on joint function and the leves of inflammatory factors .Methods 90 patients of tibial fracture who received therapy from March 2014 to March 2016 in our hospital were selected.According to random number table,all elective surgery,those patients were divided into the observation group (n=45) and the control group (n=45),the control group was treated with radix notoginseng saponin dispersible tablets,while the observation group was treated combined with rivaroxaban.After two weeks of treatment, the hemorheology, inflammatory factors, joint function were compared between two groups.Results The patient swelling time and bed time in the observation group were shorter than the control group (P<0.05);after treatment,the levels of red cell volume, whole blood viscosity,fibrinogen in the observation group were lower than the control group (P<0.05);the levels of tumor necrosis factor TNF-α, IL-1,IL-6 in the observation group were lower than the control group (P<0.05);after treatment three months and six months,the Baird-Jackson scores in the observation group were higher than the control group (P <0.05).Conclusion Radix notoginseng saponin dispersible tablets combined with rivaroxaban is well for tibial fracture after operation,which can improve hemorheology,reduce the level of inflammatory factors,promote joint functional recovery.

Myeloid-derived suppressor cells (MDSCs),a heterogeneous population of immature myeloid cells,play an important role in immune tolerance and immune suppression.In recent years,more and more research results show that the prostaglandin E2 (PGE2) has an inseparable relationship with MDSCs,and PGE2 through its relevant receptors,regulating signal transducer and activator of transcription 3 (STAT3) and protein kinase A cell signaling pathways and secretion cytokines in tumor microenvironment,affects the development,differentiation and function of MDSCs.

Objective To evaluate the role of interlukin-6 and signal transducer and activator of transcription 3 (IL-6/STAT3) signaling pathway in the up-regulation of high mobility group box 1 (HMGB1) expression in lung tissues in septic rats.Methods Ninety healthy male Wistar rats,aged 10-14 weeks,weighing 250-300 g,were randomly divided into 3 groups (n =30 each):sham operation group (group S),cecal ligation and puncture (CLP) group and anti-IL-6 monoclonal antibody group (group IL-6).Sepsis was induced by CLP.Anti-IL-6 monoclonal antibody 0.5 mg/kg was injected intraperitoneally 1 h before CLP,while the equal volume of normal saline was given in groups S and CLP.Six rats in each group were sacrificed at 6,12,24,48 and 72 h after CLP and lungs were removed for determination of HMGB1 content (by RT-PCR),HMGB1 mRNA expression (by ELISA) and STAT3-DNA binding activity (by electrophoretic mobility shift assay) in lung tissues.Results Compared with S group,HMGB1 content,HMGB1 mRNA expression and STAT3-DNA binding activity were significantly increased in groups CLP and IL-6 (P ＜ 0.05).HMGB1 content,HMGB1 mRNA expression and STAT3-DNA binding activity were significantly lower in group IL-6 than in group CLP (P ＜ 0.05).Conclusion IL-6/STAT3 signaling pathway is involved in the up-regulation of HMGB1 expression in lung tissues in septic rats.

Objective To observe the protective effects of lovastatin against lung injury and the expression changes of adiponectin in the septic rats.Methods Fifty four male Wistar rats weighting 250-300g were randomly divided into the three groups:sham operation group ( group Sham) ,sepsis group ( group CLP) and lovastatin interven tion group (group LOV).Rats were injected with lovastatin (4mg/kg) or 0.5%CMC (vehicle) for five days and then subjected to CLP.At 4h,12h and 24h after operation.BALF was collected to determine the levels of TNF-αand IL-6,lung tissue was obtained to observe histopathological changes,and to detect the content of MPO and MDA,the blood sample was obtained to detect the level of adiponectin.Results In the group Sham,at 4h,12h and 24h time points,the levels of TNF-αwere (1.80 ±0.13)pg/mL,(2.04 ±0.15)pg/mL and (1.930.19)pg/mL;the levels of IL-6 were (20.56 ±0.23)pg/mL,(18.35 ±0.15) pg/mL and (21.23 ±0.20) pg/mL;the contents of MPO were (2.82 ±0.14) U/g tissue,(2.88 ±0.07) U/g tissue and (2.76 ±0.18) U/g tissue;and the levels of MDA were (3.32 ±0.12)nmol/mg,(3.09 ±0.11)nmol/mg and (3.21 ±0.08)nmol/mg;the concentrations of adiponectin were (2.68 ±0.14)μg/mL,(2.80 ±0.07)μg/mL and (2.86 ±0.18)μg/mL.Compared with group Sham,both LOV group and CLP group had increased pulmonary damage:(1)the levels of TNF-α[4h,12h and 24h were (4.23 ± 0.18)pg/mL,(5.62 ±0.24)pg/mL and (5.14 ±0.10)pg/mL,t=28.41,30.98 and 36.62]and IL-6[4h,12h and 24h were (39.12 ±0.17) pg/mL,(47.25 ±0.21) pg/mL and (44.690.27) pg/mL,t =158.90,273.40 and 127.28] of the CLP group in BALF were both increased,and MPO[4h,12h and 24h were (4.85 ±0.13) U/g tissue, (6.17 ±0.08)U/g tissue and (7.84 ±0.10)U/g tissue,t=26.39,79.40 and 60.43]and MDA[4h,12h and 24h were (6.24 ±0.06)nmol/mg,(7.56 ±0.15)nmol/mg and (8.43 ±0.10)nmol/mg,t=53.31,58.86 and 90.06] concentrations in lung homogenate were raised with the decreased expression of serum adiponectin[4h,12h and 24h were (1.35 ±0.10)μg/mL,(1.17 ±0.07)μg/mL and (1.24 ±0.11)μg/mL,t=19.86,12.75 and 18.81](all P<0.05);(2) meanwhile the levels of TNF-α[4h,12h and 24h were (2.85 ±0.17) pg/mL,(3.720.13) pg/mL and (3.240.09)pg/mL,t=12.02、20.73 and 16.68]and IL-6[4h,12h and 24h were (30.75 ±0.22)pg/mL, (37.52 ±0.29)pg/mL and (32.43 ±0.26)pg/mL,t=78.42,68.29 and 83.67]in BALF of the LOV group were all increased,the contents of MPO[4h,12h and 24h were(3.59 ±0.05)U/g tissue,(4.67 ±0.11)U/g tissue and (5.33 ± 0.05)U/g tissue,t=12.03,33.63 and 33.70]and MDA[4h,12h and 24h were (4.45 ±0.10)nmol/mg,(5.01 ± 0.11)nmol/mg and (5.83 ±0.04) nmol/mg,t =17.72,30.23 and 71.75] were also increased with the serum adiponectin concentrations[4h,12h and 24h were (2.09 ±0.08)μg/mL,(2.07 ±0.05)μg/mL and (2.03 ± 0.10)μg/mL,t=8.96,20.79 and 6.30]dicreased(all P<0.05).There were less histopathological changes in the LOV group,and the levels of TNF-α(t=13.46,17.05 and 15.43),IL-6(t=73.70,64.10 and 80.12),MPO(t=22.16,27.01and 32.86) and MDA(t=37.59,42.72 and 59.13) were lower than those in CLP group,also the level of adiponectin(t=14.15,8.10 and 3.19) increased siginificantly(all P<0.05).Conclusion Administration of lovastatin could attenuate lung injury of the sepsis by down-regulate the level of TNF-αand IL-6,with reduced inflam-matory response and oxidative stress,and could upregulate the level of adiponectin in serums of rats with sepsis.

Objective To evaluate the effect of lovastatin on shedding of heparan sulfate proteoglycan (HSPG) and syndecan-1 (SDC-1) in the lung tissues of rats with sepsis-induced acute lung injury.Methods One-hundred and twenty male Wistar rats aged 8-12 weeks,weighing 325-425 g,were randomly divided into 3 groups (n =40 each) using a random number table:sham operation group (group S),cecal ligation and puncture (CLP) group and lovastatin group (group L).Lovastatin 4 mg/kg was injected once a day for 5 consecutive days in S and L groups,while the equal volume of 0.5％ CMC (the solvent) was given in CLP group.Sepsis was produced by CLP on 5th day of administration in CLP and L groups.The left lung was lavaged at 24 h after operation.The broncho-alveolar lavage fluid (BALF) was collected for determination of protein concentrations,white blood cell (WBC) count and percentage of neutrophils.Blood samples were collected for determination of the concentrations of HSPG and SDC-1 in serum (by ELISA).Evans blue was injected at 24 h after operation in the remaining 20 rats of each group.The lungs were removed for examination of the pathological changes and for measurement of HSPG and SDC-1 mRNA and protein expression (using Western blot and PCR),and Evans blue content (reflecting pulmonary capillary permeability) in the lung tissue.Results Compared with group S,the protein concentrations,WBC count and percentage of neutrophils in BALF,Evans blue content in lung tissues and the concentrations of HSPG and SDC-1 in serum were significantly increased,and HSPG and SDC-1 mRNA and protein expression was down-regulated in CLP and L groups.Compared with group CLP,the protein concentrations,WBC count and percentage of neutrophils in BALF,Evans blue content in lung tissues and the concentrations of HSPG and SDC-1 in serum were significantly decreased,and HSPG and SDC-1 mRNA and protein expression was up-regulated in group L.The pathological changes of lungs were significantly attenuated in group L as compared with group CLP.Conclusion The mechanism by which lovastatin attenuates acute lung injury induced by sepsis may be related to reduced shedding of HSPG and SDC-1 in lung tissues and improved function of pulmonary vascular endothelium in rats.