Objective To evaluate transanal endoscopic microsurgery (TEM) for the resection of rectal neoplasms. Methods In order to analyze the therapeutic effect of TEM in the management of rectal tumors, clinical data of 110 patients with rectal neoplasms treated by TEM between April 2006 and August 2009 were summarized and analyzed retrospectively. Result The mean diameter of rectal lesions was 1.7±0.8 (range, 0.5 ～5.5)cm. The average distance of lesions from the anal verge was 7.4 ±2.6(range, 4 ～20) cm. 40 lesions were located at the anterior wall of the rectum, 29 on the posterior wall,22 on the left wall and 19 on the right. Surgical procedures included the transmural excision (98 cases) and the submucosal excision with partial muscular layer excision (12 cases). The average operating time was 73.5 ±31.1 (range, 25 ～180) min. The mean operative blood loss was 10.8 ±7.8 (range, 3 ～60) ml.The postoperative pathological examination identified 41 rectal adenomas、 35 rectal adenocarcinomas or carcinomatous changes of adenomas (21 Tis, 6 T1, and 8 T2 cases), 14 rectal carcinoids, 1 stromal tumor、1 leiomyoma and 18 cases of inflammatory polyps or others. Surgical margins of all specimens were negative.Postoperative complications included 2 cases of anal hemorrhage, one case of pulmonary infection and one urinary infection with a postoperative morbidity of 3.6%. The average postoperative stay was 3.4 ± 1.3( range, 2 ～ 8 ) d. With a mean follow-up period of 12. 5 (3 ～ 40) months, no tumor recurrence or metastasis was found. Conclusions TEM shows advantages of decreased blood loss, good therapeutic effect, and fast recovery of the patients, which can be adopted as the choice of therapy for small and well confined rectal neoplasms.

The incidence of rectal gastrointestinal stromal tumor is low,adequate diaganosis depends on the histopathological and immunohistochemical examination.Its treatment is a comprehensive therapy including surgery and molecular targeted therapy etal.The rectal gastrointestinal stromal is easily recurrent after operation,and so needs surveillance and following up.

Objective To investigate the causes and outcome of different treatment methods of iatrogenic rectovaginal fistula. Methods Clinical data of 52 patients with iatrogenic rectovaginal fistula were analyzed retrospectively. Results Twenty-two fistulae occurred after gynecological operation (42.3%), fourteen after obstetric injury (26.9%), thirteen after colorectal operation (25.0%) and three due to miscellaneous causes (5.8%). The fistulae were located in the lower rectum in 27 cases(51.9%), mid rectum in 10 cases(19.2%) and upper rectum in 15 cases(28.9%). They were treated by non-surgical treatment in 9 cases(17.3%), permanent diverting stoma(loop transverse colostomy) in 8 cases(15.4%), and surgical repair by various approaches in 35 cases(67.3%). The fistulae of all nine patients who received non-surgical treatment failed to heal. Eight patients who received permanent diverting stoma had symptomatic improvement without fistula healing. The overall cure rate of surgical repairs in 35 cases was 77.1%(27/35). The cure rates of trans-sphincteric (Mason′s operation), transanal, transabdominal, transperineal and transvaginal approaches were 100%(8/8), 100%(2/2), 83.3%(5/6), 0%(0/1) and 66.7%(12/18), respectively. The cure rate of Mason′s operation for the mid and lower rectovaginal fistulae was higher than that of transvaginal approach (100% vs 66.7%). Conclusions Iatrogenic rectovaginal fistula is caused by obstetric injury or injury of rectovaginal septum due to surgical mismanagement. Surgical repair is the only method that can cure rectovaginal fistulae. Mason′s operation is a favorable treatment method for the mid and lower (especially mid) rectovaginal fistulae.

AIM:To evaluate the repeatability of axial length (AL) and anterior chamber depth (ACD) obtained by A scan ultrasonography, and to compare AL and ACD obtained by A scan with those obtained by IOL Master.METHODS:Two hundred and fifty-seven cataract eyes of 170 patients were included.IOL Master and A scan were performed for each eye.Five measurements of IOL Master and 3 measurements of A scan were obtained.All the tested eyes were divided into 5 groups according to AL obtained by A scan:Group A (2129mm, 21 eyes).Cronbach's Alpha coefficient and intraclass correlation coefficient (ICC) were applied to evaluate the repeatability of AL and ACD obtained by A scan.Paired t test and Pearson correlation coefficient were used to analyze the differences and correlations of AL and ACD obtained by the 2 devices, respectively.Bland-Altman plots were presented to analyze the agreements of AL and ACD obtained by the 2 devices.RESULTS:All the Cronbach's Alpha and ICCs of AL and ACD values were more than 0.98.The differences of AL values between A scan and IOL Master were-0.11±0.08mm in Group A,-0.15±0.10mm in Group B,-0.19±0.15 mm in Group C,-0.29±0.16mm in Group D and-0.45±0.29mm in Group E, respectively (all P<0.01).The differences of ACD values between A scan and IOL Master were-0.10±0.16mm in Group A,-0.06±0.13mm in Group B,-0.06±0.13mm in Group C,-0.19±0.10mm in Group D,-0.18±0.21mm in Group E, respectively (all P<0.01).In all groups, the AL and ACD values obtained by A scan and IOL Master presented good correlations (all r>0.89, all P<0.01).CONCLUSION:The AL and ACD values in cataract eyes obtained by A scan were repeatable.The AL and ACD values obtained by A scan were smaller than those obtained by IOL Master.With the increase of AL values, the differences of AL values between A scan and IOL Master increased.

BACKGROUND: This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock. METHODS: Patients with early septic shock (<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled (research time: 12 months), and they didn't meet the criteria of EGDT. Patients who had one of the following were excluded: stroke, brain injury, other types of shock, severe heart failure, acute myocardial infarction, age below 18 years, pregnancy, end-stage disease, cardiac arrest, extensive burns, oral bleeding, difficulty in opening the mouth, and the onset of septic shock beyond 24 hours. Patients treated with the standard protocol of EGDT were included. Transcutaneous pressure of oxygen and carbon dioxide (PtcO2, PtcCO2) were monitored and hemodynamic measurements were obtained. Side-stream dark field (SDF) imaging device was applied to obtain sublingual microcirculation. Hemodynamics, tissue oxygen, and sublingual microcirculation were compared before and after EGDT. If the variable meets the normal distribution, Student's t test was applied. Otherwise, Wilcoxon's rank-sum test was used. Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method. RESULTS: Twenty patients were involved, but one patient wasn't analyzed because he didn't meet the EGDT criteria. PtcO2 and PtcCO2 were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO2 increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P<0.05) and tissue oxygenation index (PtcO2/FiO2) was 110.7±60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT (P<0.05). The difference between PtcCO2 and PCO2 decreased significantly after EGDT (P<0.05). The density of perfused small vessels (PPV) and microcirculatory flow index of small vessels (MFI) tended to increase, but there were no significant differences between them (P>0.05). PtcO2, PtcO2/FiO2, and PtcCO2 were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05). CONCLUSION: Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.

Objective To study the effect of family intervention on treatment compliance and social function for patients with schizophrenia.Methods 76 patients with schizophrenia were randomly divided into the intervention group and the control group with 38 cases in each group.The patients in both groups were treated with antipsychotics,the control group was only given general hygiene education,while the intervention group was given targeted systematic family intervention for 1 year.The Nurse-Brief Psychiatric Rating Scale (N-BPRS),Social Disability Screening scale (SDSS),Insight and Treatment Attitudes Questionnaire (ITAQ),medication adherence questionnaire were used before and after the intervention and then the recurrence rate within 1 year was calculated.Results At the end of 1 year the total scores of NBPRS,SDSS,medication adherence questionnaire significantly decreased in the intervention group and were signif-icantly lower than those of the control group at the same period,while the total score of ITAQ significantly increased in the intervention group and was significantly higher than those of the control group at the same period.The recurrence rate of the intervention group was significantly lower than the control group.Conclusions The family interventions contribute to promote insight recovery of the patients with schizophrenia ef-fectively and improve their treatment compliance,reduce recurrence and to promote the recovery of its so-cial function.

Objective To explore the best time point for the ipsilateral hepatocellular apoptosis and the contralateraI hepatic hypertrophy after selective portal vein embolization(SPVE)in rabbit.Methods In a randomized study design,forty rabbits were divided into 5 groups with 8 rabbits per-group,including one as the control and the other 4 were treated with SPVE during open surgery.The rabbits were killed postoperatively,in 3,7,14,21 days respectively after the embolization.The hepatic lobes volume,the ipsilateral hepatocellular necrosis rates and apoptosis index,and liver functions were determined as well. Results In the treatment groups,the average amount of the right liver volumes decreased from 46.4 cm~3 preoperatively to 46.0,44.4,42.0,39.7 cm~3 in groups of 3,7,14,21 days postoperatively;meanwhile,the left liver volumes increased from 54.0 cm~3 preoperatively to 54.5,56.3,61.7,63.9 cm~3 respectively during 3, 7,14,21 days after the procedures.The rates of future remaining live volumes(FRLV)increased from 53.8% preoperatively to 54.2%,55.9%,59.0%,61.0% at 3,7,14,21 days postoperatively.The apoptosis indexes of hepatocells from group A to E were 8.1%,12.2%,19.4%,20.1%,14.2% respectively.Conclusions SPVE leads to atrophy of the ipsilateral hepatic lobe and hypertrophy of contralateral lobe,indicating that hepatocytes undergone apoptosis,rather than necrosis.The time point is 7 to 14 days.

Objective To describe our experience in laparoscopic radical prostatectomy (LRP)for incidental prostate cancer after TURP. Methods From April 2007 to July 2010, 5 patients with incidental prostate cancer after TURP were treated with a mean age of 73 years. The patients underwent LRP (2.8± 1.1) months after TURP. Results The five cases of LRP were performed successfully, with 1 case of transperitoneal approach and 4 cases of extraperitoneal approach. Mean operation time was (227.6±38.4) min, mean blood loss was (130±152.5) ml, and the mean follow-up was (16.1 ± 15.9) months. All five patients survived, and their urinary function was good without any incontinence. Conclusions Previous TURP represents a technical challenge when performing LRP, but highly skilled surgeons trained to perform LRPs can handle it.

In this study, we focused on the study of pharmacodynamic effects for 6 major bioactive lignans of Schisandra chinensis, namely deoxyschizandrin, schisandrin B, schisandrin C, schisandrin, schizandrol B and schisantherin A. A compound-gene-pathway network, which contained 124 related genes and 88 pathways, was constructed by collecting drug genes through mining relevant literatures and network pharmacology analysis. Based on the network analysis, 32 pathways and 80 related genes were associated with inflammation, which implied that anti-inflammatory might be the major pharmacodynamic effects of these compounds. All lignans except schizandrol B reduced LPS-induced NO production in RAW264.7 cells, which validated the anti-inflammatory hypothesis generated from network analysis. Furthermore, we investigated the effects of deoxyschizandrin, schisandrin C, schisandrin and schisantherin A on the secretion of inflammatory cytokines TNF-α, IL-1β, IL-6, PGE2 and protein expressions of iNOS, COX-2. As a result, deoxyschizandrin showed the strongest anti-inflammatory activity with inhibitory effect on all 4 inflammatory cytokines secretions and protein expressions of iNOS, COX-2. This study provided evidences for systematic exploration on the pharmacolgical actions and mechanisms of schisandra.
Animals ; Cells, Cultured ; Cytokines ; secretion ; Internet ; Lignans ; pharmacology ; Mice ; Schisandra ; chemistry

OBJECTIVEParkinson's disease (PD), a neurodegenerative disorder, has been reported to be associated with brain neuroinflammation in its pathogenesis. Herein, changes in peripheral immune system were determined to better understand PD pathogenesis and provide possible target for treatment of PD through improvement of immune disorder.

METHODS1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was intraperitoneally injected into mice to prepare PD model. Expression levels of pro-inflammatory and anti-inflammatory cytokines and transcription factors of CD4+ T lymphocyte subsets in spleen and mesenteric lymph nodes and concentrations of the cytokines in serum were examined on day 7 after MPTP injection. Percentages of CD4+ T lymphocyte subsets were measured by flow cytometry.

RESULTSMPTP induced PD-like changes such as motor and behavioral deficits and nigrostriatal impairment. Expression levels of the pro-inflammatory cytokines including interferon (IFN)-γ, interleukin (IL)-2, IL-17 and IL-22, in spleen and mesenteric lymph nodes were upregulated and their concentrations in serum were elevated in PD progression. But, the concentrations of the anti-inflammatory cytokines including IL-4, IL-10 and transforming growth factor (TGF)-β were not altered in the two lymphoid tissues or serum of PD mice. In addition, expression of T-box in T cells (T-bet), the specific transcription factor of helper T (Th) 1 cells, was downregulated, but expression of transcription factor forkhead box p3 (Foxp3), the transcription factor of regulatory T (Treg) cells, was upregulated. In support of the results, the numbers of IFN-γ-producing CD4+ cells (Th1 cells) were reduced but CD4+CD25+ cells (Treg cells) were elevated in both the lymphoid tissues of PD mice.

CONCLUSIONPD has a dysfunction of peripheral immune system. It manifests enhancement of proinflammatory response and CD4+ T cell differentiation bias towards Treg cells away from Th1 cells.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine ; Animals ; CD4-Positive T-Lymphocytes ; pathology ; Cell Differentiation ; Cytokines ; blood ; Disease Models, Animal ; Flow Cytometry ; Forkhead Transcription Factors ; metabolism ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-17 ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Interleukins ; blood ; Lymph Nodes ; cytology ; Lymphocyte Activation ; Mice ; Parkinson Disease ; immunology ; physiopathology ; Spleen ; cytology ; T-Box Domain Proteins ; metabolism ; T-Lymphocytes, Regulatory ; Th1 Cells ; Transforming Growth Factor beta ; blood