Objective To investigate the comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer.Methods Retrospectively analyzed 36 patients with low rectal cancer (TNM stage:Ⅱ-Ⅲ) undergoing laparoscopic abdominoperineal excision.Patients were divided into two groups.Lithotomy position group:laparoscopic Miles surgery with lithotomy position.Jackknife position group:single-port access laparoscopic Miles surgery with jackknife position.The operation time,blood loss,postoperative recovery,postoperative complication,postoperative recurrence and survival rate were observed.Results Blood loss of perineal position in jackknife position group was less than that in lithotomy position group [(31.5 ± 22.4) ml vs.(53.5 ± 25.6) ml] (P =0.01),and removal of drainage tube in jackknife position group was earlier than that in lithotomy position group [(6.7 ± 1.9) d vs.(9.8 ± 1.7) d] (P ＜ 0.01).However,the operation time,blood loss in abdomen,blood loss,postoperative out-of-bed activity time,recovery of gastrointestinal function time,dermal sutures out time,postoperative hospital stay,complication,postoperative recurrence in 2 years and survival rate between two groups had no significant difference (P ＞0.05).Conclusions Single-port access laparoscopic Miles surgery is safe and feasible with better surgical outcome and cosmetic benefits.Furthermore,the blood loss and postoperative exudation at perineal region is less than that in traditional lithotomy position.

Objective To quantify the concentration of peripheral blood plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with acute pancreatitis (AP) and to explore its value in assessment of the severity of AP.Methods From June 2011 to March 2012,83 patients with AP were selected,among those 43 cases were mild acute pancreatitis (MAP) and 40 were severe acute pancreatitis (SAP).The control group included 30 healthy individuals.The peripheral blood of patients with AP and healthy controls was collected,and plasma was isolated after centrifuged.The concentration of NGAL in plasma was detected by enzyme-linked immunosorbent assay (ELISA).The t-test was performed for comparison between groups.The correlation between the concentration of NGAL in plasma and clinical parameters of AP was analyzed by Spearman rank order correlation analysis.The diagnosis value of the concentration of NGAL in SAP was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).Results The concentration of plasma NGAL in AP group ((10.30± 5.97)nmol/L) was higher than that in healthy control group ((1.94±1.35) nmol/L) and the difference was statistically significant (t=11.924,P＜0.01).The concentration of plasma NGAL in SAP group ((14.61 ±5.28) nmol/L) was higher than that in MAP group ((6.27±-3.09) nmol/L) and healthy control group,the differences was statistically significant (t=8.677 and 14.539,both P＜0.01).The concentration of plasma NGAL of AP patients was positively correlated with acute physiology and chronic health evaluation-Ⅱ score,Ranson score,bedside index for severity in acute pancreatitis score,computed tomography (CT) severity index,C-reactive protein,white blood cells and the days of hospitalization (r=0.651,0.556,0.514,0.620,0.320,0.458 and 0.346,all P＜0.05).The area under the ROC curve of plasma NGAL concentration in diagnosis of SAP was 0.926 (95％CI:0,870-0.983).The cutoff value of plasma NGAL level in diagnosis of SAP was 8.44 nmol/L.The sensitivity and specificity was 87.5 ％ and 88.9％,respectively.Conclusions Plasma NGAL level is correlated with the severity of patients with AP.NGAL may be one of the markers for the early diagnosis of SAP.

Objective To explore the methods of internal fixation for femoral neck fractures and evaluate the biomechanical characteristics of the interlocking expanding compressive screw (IECS)of Type HZS. Methods Based on the special biomechanical characteristics of the femoral neck fracture, the device of internal fixation was designed to consist of main screw, bifurcate screw, boost screw cap, washer, compressive screw cap, oblique interlocking screw and main screw cap. Its biomechanical performances were evaluated through comparison with those of the dynamic compressive screw (DCS), twin compressive screw (2CS) and three cannulated screws (3CS) respectively. Results The mechanical performances of the femoral neck fracture fixed with the interlocking expanding compressive screw were superior to those of the others in displacement ,axial and level stiffness, torsional strength and stiffness and terminal loading. Conclusion Interlocking expanding compressive screw can efficiently withstand the splitting, torsional, shearing, tensional and compressive forces in the fracture, and is simple, safe and easy to use. [

Objective To observe the apoptosis of Th1 and Th2 cells in C57BL/6 mice chronically infected with Schistosoma japonicum.Methods The apoptotic Th1 and Th2 cells in spleen and lymph node from C57BL/6 mice infected with Schistosoma japonicum for 13 weeks were examined by three-color and indirect flow cytometery with staining surface molecule and intracellular cytokines.Results Compared with the normal mice,the proportion of apoptotic Th1 and Th2 cells of 13-week post-infection was significantly high,and the apoptotic Th1 cells increased more than apoptotic Th2 cells in the infected C57BL/6 mice,and the Th1 cells were more susceptible to apoptosis than Th2 cells.Conclusions Unequal susceptibility to apoptosis in Th1 and Th2 cells may be one of the reasons leading to Th2 polarization on mice chronically infected with Schistosoma japonicum,which provides the new proof of Th polarization.

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.

BACKGROUND: Previous researches suggested that correction of scoliosis of patients with Marfan syndrome (MFS) has a high incidence of complication and loss of corrective rate; however, there were seldom reports on using spinal three-dimensional orthopaedic internal fixation system to treat scoliosis of MFS patients.OBJECTIVE: To observe the corrective effect of CD and TSRH, the third generation of spinal three-dimensional orthopaedic internal fixation system, on scoliosis of MFS patients.DESIGN: Retrospective analysis.SETTING: Second Department of Orthopaedics, First People's of Hefei.PARTICIPANTS: From September 1997 to July 2003, 10 MFS patients with scoliosis were selected and corrected at posterior site with CD and TSRH system; meanwhile, confluence operation of auto-bone transplantation was undergone.Eight cases had bilateral scoliosis, 2 curvature of thoracic spine towards right side, 3 posterior curvature of thoracic spine, and 2 posterior curvature of thoracic waist.METHODS: X-ray film was imaged at standing position before operation, 1 week after operation and during follow-up;meanwhile, X-ray film was also imaged at left and right curved positions and sling position to evaluate ductility of scoliosis before operation. Angle of scoliosis was measured with Cobb technique and stable and neutral mallets were recorded. Among 10 cases, 2 were internally fixed with CD system and other 8 with TSRH system. Material of bone transplantation was derived from auto-posterior superior iliac spine and remained for 3 months after operation.MAIN OUTCOME MEASURES: Corrective rate and complication of scoliosis after operation.RESULTS: The follow up lasted for 12-60 months. Corrective rate of 8 cases with bilateral scoliosis was 48% and lost rate was 20%; corrective rate of 2 cases with lumbar curvature was 56% and lost rate was 16%; corrective rate of 2 cases with single thoracic curvature was 61% and lost rate was 8%. Body balance of all patients was improved. No one had nerve complication; 2 had junctional posterior curvature of lumbar vertebra; 1 had delayed union of incisions.CONCLUSION: It is satisfactory for spinal three-dimensional orthopaedic intemal fixation system to treat scoliosis of MFS patients. Statuses of heart and lung of patients are evaluated before operation; in addition, during operation, a great effect is obtained through prolonging confluence segments, avoiding over correction, decreasing soft tissue injury and paying much attention on confluence of transplanted bone.

Objective:To identify the risk factors for early neurological complications after revascularization in adult patients with moyamoya disease.Methods:The medical records of patients of both sexes with moyamoya disease, aged 18-65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, who underwent revascularization in our hospital from January 2017 to June 2019, were retrospectively collected.According to the occurrence of early postoperative neurological complications, patients were divided into early postoperative neurological complication group and non-early postoperative neurological complication group.The factors such as patient′s age, gender, preoperative clinical symptoms, previous history of hypertension, history of diabetes, history of coronary heart disease, American Society of Anesthesiologists physical status, methods of anesthesia, type of operation, anesthesia time, time for start of operation, operation time, intraoperative urine volume, times of intraoperative vasoactive drugs used, and time of the post-anaesthesia observation room (PACU) stay were collected.Logistic regression analysis was used to identify the risk factors for postoperative early neurological complications.Results:A total of 510 adult patients with moyamoya disease underwent revascularization were enrolled in this study, and the incidence of early postoperative neurological complications was 9.0%.The results of logistic regression analysis showed that preoperative ischemia, intraoperative use of vasoactive drugs more than 3 times and PACU stay time>90 min were risk factors for postoperative neurological complications ( P<0.05). Conclusion:Preoperative ischemia, intraoperative use of vasoactive drugs >3 times and PACU stay time>90 min are risk factors for early neurological complications after revascularization in the patients with moyamoya disease.