Distribution and morphologic features of AChE-containing neurons were observed by the technique of AChE regeneration. There are three kinds: AChE-staining cells--heavily stained cells, medium stained cells and lightly stained cells. Most heavily stained cells are larger multipolar cells. They are located mainly in striatum, basal forebrain, hypothalamus, substantia nigra, locus coeruleus, red nucleus, ventral tegmental nucleus, parabrachial nucleus, pontine tegmental nucleus and the motor nuclei of cranial nerves. The results of AChE-staining were compared with the date of ChAT immunohistochemistry. The relationship between AChE and cholinergic neurons as well as the nature of AChE-containing neurons were discussed.

Objective To compare the clinical efficacy between continuous and intermittent androgen deprivation in high risk prostate cancer.Methods Sixty-four patients with high risk prostate cancer were treated from January 2008 to April 2009,36 cases who accepted goserelin and bicalutamide were taken as intermittent hormonal therapy (intermittent treatment group),while 28 cases who accepted bilateral orchiectomy in addition to flutamide were regarded as continuous hormonal therapy (continuous treatment group).The comparison of tumor specific mortality,time of prostate specific antigen (PSA) to nadir,tine to PSA recurrence,serum testerone and quality of life score were assessed between the two groups.Results In continuous treatment group and intermittent treatment group,follow-up period was (26.4 ± 10.3) and (28.1 ± 8.7) months,the time of PSA to nadir was (3.8 ± 2.1 ) and (4.0 ± 3.6) months,the time to PSA recurrence was (20.1 ± 12.3) and (24.5 ± 14.6) months,respectively.There was no significant difference between the two groups.At the time of 18,24 and 30 months after therapy,serum testerone was 0.85,0.88,0.89 μg/L in continuous treatment group,while 1.21,1.36,1.48 μg/L in intermittent treatment group,respectively (P ＜ 0.05 ).Similarly,quality of life score was 38.7,40.5,39.8 scores in continuous treatment group,while 49.2,51.4,52.3 scores in intermittent treatment group at the time of 12,18 and 30 months after therapy,respectively (P ＜ 0.05 ).Conclusions Clinical efficacy could not been found between continuous and intermittent endocrinic therapy of prostate cancer.During intermittent,quality of life seems to be better and increases in accordance with serum testerone recurrence at given time.

Objective To evaluate the safety and feasibility of laparoscopie colorectal surgery in elderly patients.Methods The clinical data of 117 patients with colorechal cancer who had been admitted to People's Hospital of Peking University from January 2005 to December 2008 were analyzed retrospectively.Ail patients were divided into laparoscopic group(n=49)and open group(n=68).The postoperative conditions,incidence of complications and results of follow-up of patients in the 2 groups were compared.All data were analyzed via t test,chi-square test and Mann-Whitney U test,and the survival was analyzed via Kaplan-Meier method and Log-rank test.Results The mean operation time in laparoscopic group was(246±64)minutes,which was significantly longer than(218±50)minutes in open group(t=-2.677,P<0.05).The volume of blood loss,anal exsufflation time,postoperative hospital stay,ratio of patients who used analgesics and incidence of complications were (207±135)ml,3 days,12 days,45%(22/49)and 20%(10/49)in laparoscopic group,and were(296±178)ml,4 days,14 days,74%(50/68)and 44%(30/68)in open group,with significant difference between the 2 groups(t=2.920,U=770.5,1181.0,X~2=9.864,7.115,P<0.05).The length of bowel resected and number of lymph node dissected were(19±7)cm and 13±6 in laparoscopic group,and were(20±8)cm and 16±6 in open group,with no significant difference between the 2 groups(X~2=0.790,t=2.007,P>0.05).The 1-and 3-year accumulative survival were 95.4%and 85.2%in laparoscopic group,and were 94.7%and 82.3%in open group,with no significant difference between the 2 groups(X~2=0.581,P>0.05).Conclusion Laparoscopic surgery is safe and feasible for elderly patients with colorectal cancer.

ObjectiveTo analyze therapeutic effects of conservative treatment and the causes of malunion of intertrochanteric fracture in elderly patients, and try to find the way to deal with the problems. MethodsFifteen cases aged 75 to 101 years with intertroehanterie fracture treated conservatively were included.Their average age was 88.8 years.All fractures were classified according to Evens-Jensen.Because of the medical complication or other reasons, they were conservatively treated by methods of traction, wearing shoes et al. X-ray examination was taken at regular time and their final functions were assessed. ResultsTwo cases were died 1-3 months after admission, and the fractures were only partially healed. The remaining thirteen cases got complete healing. Among the fifteen cases, the deformity did not happen in 4 cases of IA without fixation and 1 case of IIB with bone traction. All others got the deformity of varus, shorting and external rotation in different degree, which interfered the lower extremity motor function. ConclusionsThe fracture position not kept and fixed satisfactorily during treatment would lead to more joint deformity and deteriorated hip joint function for the displaced intertroehanterie fractures in elderly patients.

Objective To investigate the surgical curative effect of long-segment fixation and fusion on the degenerative scoliosis (DS) in the elderly.Methods The clinical data of 27 patients with DS undergoing surgical treatment from January 2011 to December 2013 in our department in Beijing Hospital were retrospectively analyzed.All patients suffered from degenerative scoliosis accompanied with lumbar canal stenosis, lumbar spondylolisthesis, lumbar vertebrae lateral slip in coronal surface, spinal vertebral rotation deformity and kyphosis.The decompression osteotomy and fixed segment, blood loss volume and operation time were recorded.The differences in scoliosis angle (Cobb angle), lumbar lordotic angle, top vertebral rotation degree (Nash-Moe vertebral rotation grade), apical vertebral offset distance, visual analogue scale (VAS) score and Oswestry disability index (ODI) score were compared between pretreatment versus the last follow-up.Results The selective 1-5 segment decompression and 5-10 segment fusion were selected in a total of 27 patients.Some patients were treated with Smith-Petersen osteotomy (SPO).All of 27 cases were treated with a lamina and inter-transverse fusion, among which 25 cases took inter-vertebral fusion additionally.The time of postoperative follow-up was more than 1 year.The Cobb angle, lumbar lordotic angle, apical vertebral offset distance, VAS and ODI scores were improved after treatment as compared with pretreatment [(11 6) vs.35 6 , (32±10) vs.(17±9) , (16.3±8.2) mm vs.(32.2±9.8) mm, (3.3±1.6) vs.(7.3±2.1), (18±14) vs.(33±14), t=2.469, 2.313, 2.331, 2.362, 2.395, P=0.021, 0.030, 0.029, 0.026, 0.023 respectively].The satisfaction survey result was excellent in 19cases, good in 5 cases, fair in 3 cases.Complications were found in 9 patients, among whom 2 cases had screw loosening in the internal fixation, 2 cases had adjacent segment degeneration, 1 case had pulmonary infection, 1 case had urinary tract infection, 2 eases had spinal fluid leakage, 1 case had epidural hematoma.No serious complications and deaths were observed.Conclusions Under strictly controlling the therapeutic indications, the limited decompression and long-segmental fixation and fusion have good therapeutic efficacy on degenerative scoliosis in elderly patients.

Objective To investigate the effect of pedicle screw augmentation with bone cement perfusion on the long segment fixation and fusion in the elderly patients with spinal deformity treated by osteotomy.Methods The cohort data of the older patients aged ≥70 years with spinal kyphosis were retrospectively analyzed in Beijing Hospital,Department of Orthopedic Surgery,Division of Spine Surgery from January 2012 to June 2014.32 cases with complete clinical date were included in this study.The kyphosis of all patients was secondary to thoracolumbar osteoporotic compression fracture.All patients were treated by posterior thoracolumbar spinal osteotomy with long segment fixation and fusion.The patients with fusions including sacral vertebral body fusion or the T score of BMD were less than-5 were excluded.Some patients with neurological compression symptoms also underwent selective decompression in spinal canal and nerve root foramen.All patients were divided into two groups:with (n=14)versus without(n=18)screw augmentation with bone cement perfusion(augmentation vs.non-augmentation/control group).The follow-up time was no less than 12 months.The data of age,gender,operative time,blood loss volume and preoperative bone mineral density were compared between two groups.Cobb angle of postoperative spinal surgery region,lordosis angle of postoperative lumbar,VAS and ODI improvement were analyzed.Data of surgical fixation and fusion segments were recorded.Pedicle screw loosening was compared between two groups.Results In the augmentation group,the pedicle screw loosening didn't occur.But control group showed screw loosening in 7 cases,a euphoric zone around screw in 4 cases,pedicle screw pullout in 2 cases,and vertebral cutting phenomenon with euphotic zone around screw in 1 case.There were no significant differences in ODI improvement rate and surgical satisfaction between the two groups.Conclusions When operative procedures of surgeon are in precision and skillful,bone cement augmentation technique for pedicle screw can reduce the occurrence of pedicle screw loosening in older patients during osteotomy and long segment fixation and fusion operation for spinal kyphosis.

ObjectiveTo investigate the effectiveness and feasibility of intraoperaive recurrent laryngeal nerve(RLN) monitoring via lateral cricoarytenoid muscle(LCA) compound muscle action potential (CMAP) monitoring by bipolar electrode implanting. MethodsSeventy-four cases were evenly divided into nerve monitoring group and non-monitoring group,NIM-Response 2.0 was applied into monitoring group for intraoperative nerve monitoring.A bipolar electrode was inserted into LCA to record CMAP,stimulating electrode intermittently stimulated exposed or unexposed recurrent laryngeal nerve to monitor the RLN function during cervical operation under the block anaesthesia of cervical plexus. ResultsThere were no statistically significant differences (P ＞ 0.05 ) in postoperative hospitalization days (5.14 ± 1.44 days,5.05 ± 1.31 days),operation time ( 125.54 ±42.23 min,107.30 ± 39.36 min) between monitoring group and the control group.Thirty-two RLNs were mapped their anatomical course with the NIM-Response 2.0 assistance before exposure,and 25 RLNs were anatomically exposed.The stimulating threshold between unexposed RLN (2.23 ± 0.57 mA) and exposed RLN ( 0.44 ± 0.20 mA) were statistically different ( P ＜ 0.01 ),but the evoked EMG amplitude(307.98 ± 253.47 μV,234.36 ± 142.18 μV) were not statistically different (P ＞ 0.05 ).With the NIM-Response 2.0 assistance the course of the unexposed RLNs detected were consistent to the course of the RLNs when exposed completely.ConclusionsIt is a effective and feasible method to monitor the RLN function by recording the CMAP of lateral cricoarytenoid muscle(LCA) via bipolar electrode implanted into LCA under block anaesthesia of the cervical plexus.

Objective To compare the therapeutic efficiency of laparoscopic and open radical colorectal surgery in the treatment of colorectal carcinoma. Methods Clinical data of 77 cases undergoing laparoscopic colorectal surgery from September 2004 to October 2007 were compared with 90 patients treated by open surgery. Results Mean operating time was longer in the laparoseopic group than that in the open group [248 minutes vs. 225 minutes (t = -2. 11 ,P =0. 036)], blood loss was less in laparoscopic group [210 ml vs. 315 ml (t = 2. 82, P = 0. 005)]. Laparoscopic surgery was associated with lower rate of analgesia use [48% vs. 80% (x2 = 18. 69 ,P < 0. 01)], earlier recovery of bowel function [2. 9 days vs. 4. 3 days(t =5.59,P <0. 01)]and shorter hospital stay [12. 5 days vs. 15.5 days (t =2. 32,P=0. 039)]compared with open surgery. The number of removed lymph nodes [14. 2 vs. 15.3 (t = 1.04, P = 0. 3)]and length of reseeted bowel [18. 9 cm vs. 20. 0 cm, (t = 0. 88,P = 0. 383)]were not different between the two groups. The mean follow-up time of the two groups were 28 months, local recurrence rate, metachronous metastases rate and 3-year cumulative survival rate were not statistically different between the two groups. Conclusion Laparoscopic surgery is as effective as conventional open surgery in the treatment of colorectal carcinoma.

OBJECTIVETo explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE).

METHODSThree cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum.

RESULTSThe mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications.

CONCLUSIONTPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.

Anal Canal ; Blood Loss, Surgical ; Digestive System Surgical Procedures ; methods ; Feasibility Studies ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Operative Time ; Pelvic Floor ; Perineum ; surgery ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Surgical Stomas

Transanal minimally invasive surgery (TAMIS) is a kind of minimally invasive surgery that local resection or total mesorectal excision for rectal neoplasm is performed through the use of multichannel port(single port) transanally. Compared to transanal endoscopic microsurgery(TEM) approach, TAMIS offers an alternative to TEM for rectal neoplasm, and shows the advantage of lower cost and shorter learning curve. TAMIS approach has been used not only in the local resection of rectal neoplasm but also in transanal total mesorectal excision (transanal TME), which is also called TAMIS-TME, in recent four years. The safety and efficacy of TAMIS approach has been shown in the currently published literatures. However, TAMIS approach has to wait for more evidence-based data with larger-scale and longer follow-up to get its validation.
Abdomen ; Anal Canal ; Digestive System Surgical Procedures ; Humans ; Learning Curve ; Minimally Invasive Surgical Procedures ; Rectal Neoplasms