Rectal cancer does great harm to human health which is one of the common gastrointestinal malignancies.The most effective treatment to rectal cancer is surgical resection at present.With the increasing demand on the quality of life,we minimize the surgical resection to preserve the anal function of patients while removing the tumor completely depends on the distal excision margin.But how long of the distance is safe? Lots of domestic and foreign scholars have a great controversy without a certain definition.This article reviews the progress on the distal excision margin,aiming to give help to clinical sphincter-preserving surgery.

Objective To study the possible pathogenesis of TNBS (2,4,6-trinitrobenzenesulfonic acid)-induced inflammatory bowel disease (IBD) in a mouse model by analyzing histological changes in colon and the expression of cytokines and transcription factor RORγt related to T cell subsets in mesenteric lymph nodes.Methods Female BALB/c mice aged 6-8 weeks were randomly grouped into two groups: IBD model and normal control groups.The mouse model of IBD was established by treating mice with 200 μl of 5％ TNBS/50％ ethanol solution (1∶1) through intestinal instillation, while the mice in the normal control group were instilled with PBS.Pathological changes in colon samples of mice were observed.Real-time PCR was performed to detect the dynamic expression of Th1 cytokines (IL-2, IFN-γ and IL-12p40), Th2 cytokine (IL-4), Treg-related cytokine (IL-10), Th17 cell-related cytokines (IL-17, IL-21 and IL-23) and transcription factor RORγt in mesenteric lymph nodes.Results The mice in the model group begun to show abnormal vital signs such as diarrhea, loss of weight and reduced activity, and mild hyperemia of intestinal mucosa and edema from the third day after modeling.Slight lesions were observed in histological slices of colon tissues stained with hematoxylin and eosin (HE).The expression of IL-21, IL-23 and IL-17 at mRNA level were significantly increased, while the expression of other cytokines showed no significant change.On the sixth day after modeling, many pathological symptoms and intestinal mucosal lesions were aggravated, and marked infiltration of inflammatory cells was observed in histological slices of colon tissues, which indicated that the IBD model was successfully induced by TNBS.Compared with the control group, the IBD model group showed significantly enhanced expression of IL-2, IL-12p40 and IL-10 in mesenteric lymph nodes at mRNA level on the sixth day after modeling.Although the expression of IL-21, IL-23, IL-17 and RORγt at mRNA level on the sixth day were down-regulated to different extent as compared with those on the third day, they were still significantly higher than those of the control group.Conclusion Th17 cell-related cytokines play an important role in the early stage of TNBS-induced IBD.With the progression of the disease, both Th1 and Th17 cells are involved in the immunopathological injury of colon tissues.

Objective To investigate the diffevential diagnostic value of preinvasive and invasive lung adenocarcinoma (including minimally invasive adenocarcinoma and invasive adenocarcinoma) presented as pure ground-glass nodules(pGGN) by CT.Methods One hundred and fifty-six cases of pGGN verified by operative pathology were retrospectively analyzed,including 58 ca ses of preinvasive adenocarcinoma and 98 cases of invasive adenocarcinoma(TNM staging were T1N0M0).The CT features and sex were statistically processed.The difference between the CT features and sex were performed by thex2 test.The ROC curve of lesion focus size was drawn.Results Statistically significant differences were found in the lesion shape,vacuole sign,air bronchogram,blood vessel through,tumor-lung interface and vascular cluster sign between the two groups(all P＜0.05).The ROC curve showed that the accuracy rate of invasive adenocarcinoma was 75.0％ when the size of the pGGN lesions was larger than 15.35 mm.Conclusion The lesion size,shape,vacuole sign,air bronchogram,blood vessels through and vascular cluster sign have some predictive value.

Objective To discuss the pathological classification and lesion's inner imaging features of lung adenocarcinoma presented as pure ground-glass opacity.Methods CT imaging features of 156 pGGO lesions which confirmed by surgery and pathology were analyzed in retrospectively.There were 58 lesions of pre-invasive (including atypical adenomatous hyperplasia and adenocarcinoma in situ),32 lesions of minimally invasive adenocarcinoma and 66 lesions of invasive adenocarcinoma.CT features were analyzed including lesion density,vacuole sign,air bronchogram and abnormal vascular changes (vascular dilatation,distortion or rigid).Results There were statistical difference in lesions density and abnormal vascular changes in 3 different pathological types (P ＜ 0.05),with increase of lesions invasive,the incidence of uneven density and abnormal vascular changes increase,its mean the more invasive of the lesion,the lesion tent to be more uneven and higher incidence of the dilation,twist or rigid of the vascular happened;while the incidence of the air bronchogram will be higher when the lesions invasive degree increased,but there was statistical difference only between the pre-invasive and invasive groups (including minimally invasive adenocarcinoma and invasive adenocarcinoma) (x2 =4.868,P =0.027).Conclusions The uneven density and abnormal vascular changes had certain value in differential diagnosis of lung adenocarcinoma presented as pGGO.

Objective To investigate the changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery. Methods Thirty ASA Ⅰ-Ⅱ patients scheduled for laparoscopic colorectal surgery were accepted general anesthesia and trachea cannula. Hemodynamic measurements, respiratory parameters and artery blood gas analysis were drawn at 5 min after intubating, 5 min, 30 min and 60 min after pneumoperitoneum, before the side-incisions were opened and the end of operations. Results The operation time was (216.1±39.1) min, pneumoperitoneum time was (117.3±11.5) min. Comparing to the data after pneumoperitoneum, there were differences among the parameters of circulating dynamics, but the values were acceptable, pH was decreasing with time, except 5 min after pneumoperitoneum, it was significantly decreased 30 min after pneumoperitoneum until the end of operations, compared with pre-intlation value (P<0.01), pH withdrawn a little at the end of the operations. The PETCO2 and PaCO2 at different times after pneumoperitaneum were significantly higher compared with pre-inflation value (P<0.05 or<0.01). They were increasing with the time of pneumoperitoneum, and withdrawn a little at the end of the operations. There was a good correlation between PETCO2 and PaCO2, although the correlation was worst after deflation. Conclusions The circulation dynamics are stable, the correlation of PETCO2 and PaCO2 is good during the laparoscopic colorectal surgery, PaCO2 may exceed the normal value after long-term of penumoperitoneum. It is necessary to monitor the blood gas analysis during such surgeries.

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Guardian for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients of both sexes,aged 26-64 yr,weighing 48-95 kg,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with Mallampati grade Ⅰ-Ⅲ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were divided into group Ⅰ and group Ⅱ (n =30 each) using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA Guardian.In group],the nasogastric tube was inserted through the nostril before operation,and after successful LMA Guardian placement,another nasogastric tube was inserted through the drain tube of LMA Guardian.The hemodynamic parameters,SpO2,end-tidal pressure of carbon dioxide and peak airway pressure (Ppeak) were monitored during operation.The fiberoptic laryngoscopy scores were assessed after successful LMA placement,and the nasogastric tube displacement was recorded.The LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,occurrence of air leakage of LMA and nasogastric tube drainage were recorded.The bloodstains and gastroesophageal reflux were observed after removal of the LMA.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after operation.Results The hemodynamics was stable,the SpO2 and Ppeak were within the normal range during operation,and Ppeak was lower than airway sealing pressure in the two groups (P＞0.05),and there was no significant difference between the two groups.There was no significant difference between the two groups in the LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,score for exposure of oropharynx,development of adverse reactions in the oropharynx,consumption of anesthetics,development of bloodstains within the body of LMA and gastroesophageal reflux,and pH values at the tip of LMA and on the dorsal and ventral sides of the body of LMA (P＞0.05).Nasogastric tube drainage:the rate of nasogastric tube drainage through the LMA Guardian was 67％ in group Ⅰ;the rate of nasogastric tube drainage through the nostril was 40％,and the rate of nasogastric tube drainage though the LMA Guardian was 50％ in group Ⅱ.No nasogastric tube displacement was found after operation in group Ⅱ.Conclusion For the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy,insertion of LMA Guardian is easy,and LMA Guardian can assure good airway sealing and adequate ventilation and can be safely and effectively used for airway management in this type of patients.

Objective To assess longitudinal segmental myocardial strain(?),displacement(D) and the changes of the inner dimension of left ventricle(?L),and to establish their spatial correlationship during cardiac pacing and conductive block.Methods The standard apical four chamber view of left ventricle were acquired during cardiac pacing(n=12),right bundle branch block(RBBB,n=13) and sinus rhythm(n=14) using GE Vivid 7 dimension and the M3S probe with(4.0) MHz for the analysis of the longitudinal myocardial segmental(apical and basal segments) ? and D of left ventricle with two dimensional strain analysis software.The maximal and change longitudinal dimension of left ventricle was measured and calculated at end-diastole and end-systole respectively.The differences of the above parameters were compared and the spatial correlationships among them were analyzed.Results The peak ? of the septal basal segment during cardiac pacing was significant higher than that of the apical segment.There were significant differences in the peak D and(?D)(D_(basal)-D_(apical)) at lateral wall among sinus rhythm,RBBB and pacing group(P

Objective To evaluate the CT appearances and diagnostic value of calcific metastases originated from the alimentary system mucous carcinoma.Methods CT appearances of calcific metastases originated from the alimentary system mucous carcinoma confirmed by surgery and pathology were retrospectively analysed.Results Calcification inside the metastatic tumors could be seen in all 9 patients.The calcification was multiple in 6,single in 3;4 lesions were in the brain and 5 in the liver.The calcific rate of tumors was 100%.Conclusion The metastases originated from malignant tumors of alimentary system are easy appearing calcification,CT scanning plays an important role in diagnosing the calcific metastases.

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Ⅰ-gel for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients,aged 26-64 yr,weighing 54-90 kg,of ASA physical status Ⅰ-Ⅲ (Mallampati Ⅰ-Ⅲ),scheduled for elective laparoscopic surgery,were randomly divided into Ⅰ,Ⅱ and Ⅲ groups (n =20 each) using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA I-gel.In group Ⅱ,the nasogastric tube was inserted through the nostril before surgery.In group Ⅲ,the nasogastric tube was inserted through the nostril before surgery,and another nasogastric tube was inserted through the drain tube of LMA I-gel after induction of anesthesia.The hemodynamic parameters,SpO2,PET CO2 and peak airway pressure were monitored during surgery.The fiberoptic laryngoscopy scores were assessed and the development of nasogastric tube displacement was recorded after successful LMA placement.The LMA placement time,success rate of LMA placement at the first attempt,depth of placement,airway sealing pressure,and occurrence of air leakage of LMA and nasogastric tube drainage were recoded.The bloodstains and gastroesophageal reflux were observed after removal of LMA Ⅰ-gel.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA by using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after surgery.Results The hemodynamics was stable and SpO2,peak airway pressure and PETCO2 were all within the normal range during surgery,and Ppeak was lower than airway sealing pressure in the three groups.There were no significant differences between the three groups in LMA placement time,success rate of LMA placement at the first attempt,depth of placement,airway sealing pressure,incidence of air leakage of LMA,fiberoptic laryngoscopy scores,time for removal of LMA I-gel,incidences of adverse reactions in the oropharynx,bloodstains within the body of LMA and gastroesophageal reflux,and pH values at the tip of LMA and on the dorsal and ventral sides of the body of LMA.There was no nasogastric tube displacement in Ⅱ and Ⅲ groups.There were 7 patients developing gastric juice outflow from drainage tube of the LMA I-gel and 2 patients developing gastric juice outflow from the nostril gastrictubes in group Ⅱ.Conclusion For the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy,insertion of LMA I-gel is easy,and I-gel LMA can assure good airway sealing and adequate ventilation.

Objective To determine the relationship between neuronuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis (MG).Methods Sixty-five patients of both sexes with MG,aged 20-75 yr,weighing 53-92 kg,with body height of 155-185 cm,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective videoassisted thoracoscopic thymectomy,were enrolled in the study.Among the 65 patients,there were 8 patients with ocular MG (type Ⅰ),19 patients with mild generalized MG (type]Ⅱ a),33 patients with subacute generalized MG (type Ⅱ b),2 patients with acute MG (type Ⅲ) and 3 patients with late severe MG (type Ⅳ).Neuromuscular monitoring was initiated when the patients lost consciousness after induction of anesthesia.Cisatracurium was administrated with the initial dose of 0.05 mg/kg,and if T1 depression was less than 95％ within 6 min,cisatracurium 0.015 mg/kg was intravenously injected until T1 depression was more than 95％.The patients were then tracheally intubated.The amount of cisatracurium consumed for intubation,onset time (from the beginning of cisatracurium injection to T1 depression ＞95％) and recovery time (recovery of T4/T1 to 25％ of control height) of neuromuscular block were recorded.T1 depression ＞ 95％ within 6 min after administration of 1-fold ED95 cistracuriun was defined as sensitivity to muscle relaxants.The requirement for cistracurium ＞ 1-fold ED95 when T1 depression ＞ 95％ was defined as insensitivity to muscle relaxants.The proportion of sensitivity/insensitivity was calculated.Results There was no significant difference in the amount of cisatracurium consumed for intubation and onset time and recovery time of neuromuscular block between patients with type Ⅰ and those with type Ⅱ a (P＞0.05).Compared with patients with type Ⅰ and type]Ⅱ a,the amount of cisatracurium consumed for intubation was significantly decreased,the proportion of sensitivity/insensitivity was increased,the onset time was shortened,and the recovery time was prolonged in patients with type Ⅱ b (P＜0.05).Conclusion With the severity of MG,the consumption of cisatracurium is gradually decreased when used for tracheal intubation during anesthesia induction,and the sensitivity is gradually increased in the patients with MG.