Objective To explore the risk factors and prevention measures for anastomotic leakage after rectal radical resection.Methods The clinical data of 404 patients with rectal radical resection were analyzed retrospectively and the risk factors for anastomotic leakage were analyzed.Results Thirty-one patients (7.67％,31/404) were subjected to anastomotic leakage.The mean leakage time was 6.5 (3-14) d postoperatively.The muhivariate Logistic regression analysis showed that preoperative hemoglobin (OR =3.023,95％ CI:1.101-8.303,P=0.031 8),tumor size (OR =2.543,95％ CI:1.075-6.018,P=0.033 7) and tumor distance from anal verge (OR =3.160,95％ CI:1.387-7.199,P=0.006 2) were the risk factors for anastomotic leakage.Conclusions Preoperative hemoglobin,tumor size and tumor distance from anal verge are significant factors for anastomotic leakage.Therefore correction of anemia,improvement of surgical technique and suitable use of preventive diversion stoma ane all benefit for prevention of anastomotic leakage after rectal radical resection.

Purpose:To study the expression of CD 44 V 5 and Nm23 H 1 gene products and their significance in esophageal cancer patients.Methods:The expression of CD 44 V 5 and Nm23 H 1 in 85 cases of formalin fixed, paraffin embedded specimens of esophageal cancer were measured by immunohistochemistry S P method. Fifty cases were followed up for 3 years after operation.Results:①The positive expression rate of CD 44 V 5 and Nm23 H 1 was 61.2% 、57 6%, respectively in esophageal cancer.②Overexpression of CD 44 V 5 gene products were closely related with the invasive extent , histopathologic classification , TNM stage ,lymph node metastasis(LNM) and prognosis of Ec( P

Objective To investigate the clinical value of continuously detecting serum and pelvic drainage fluid C-reactive protein (CRP) and drainage fluid matrix metalloproteinase-9 (MMP-9) in the early diagnosis of anastomotic leakage after anterior resection of low rectal cancer.Methods The levels of CRP and MMP-9 in serum and pelvic drainage fluid were measured on postoperative 1,3,5,7 d in 158 patients with low rectal cancer anterior resection.The patients were divided into the anastomotic group (n=9) and non-anastomotic leakage group (n=149).The differences in the detection values between the two groups were compared and analyzed statistically.Results Among 158 cases,anastomotic leakage occurred in 9 cases.The correlation analysis of serum and drainage fluid CRP detection value and postoperative days (POD) in the two groups showed the POD 3,POD 5 and POD 7 difference was statistically significant (P＜0.05).The ROC curve analysis showed that the accuracy of the serum and drainage fluid CRP continuous detection for diagnosing the anastomotic leakage on postoperative 3 d was middle,which on postoperative 5,7 d was higher.The patients with CRP detection value ＞ 128.23 mg/L and drainage fluid CRP ＞89.93 mg/L on postoperative 5 d and those with CRP detection value＞113.71 mg/L and drainage fluid CRP＞81.75 mg/L on postoperative 7 d developed the anastomotic leakage.The drainage fluid MMP-9 detection value had no statistical difference between the anastomotic leakage group and the non-anastomotic leakage group (P＞0.05).Conclusion Continuous detection of serum and drainage fluid CRP level can be used for early diagnosing postoperative anastomotic leakage in low rectal cancer anterior resection.The drainage fluid MMP-9 continuous detection has no relation with early diagnosis of anastomotic leakage after low rectal cancer anterior resection.

The relationship between acupuncture and stress is discussed from three aspects, including is it possible for acupuncture stimulation to be a stressor, whether acupuncture will start stress reaction, and whether acupuncture effects contain some stress factors. It is believed that correct acupuncture manipulation will not cause stress response, however, under some circumstances, such as inaccurate manipulation, improper treatment or patients who are very nervous but do not receive effective intervention, acupuncture is likely to cause stress response. Acupuncture-induced stress response is totally different from acupuncture anti-stress. The possible stress factors in acupuncture effect are explored, which can provide a new angle for the research on action mechanism of acupuncture. From the view of stress to review acupuncture treatment, there are three enlightenments: emphasizing on communication between doctors and patients, avoiding over-pursuit of deqi and focusing on analysis of the body constitution.
Acupuncture Points ; Acupuncture Therapy ; adverse effects ; psychology ; Humans ; Qi ; Sensation ; Stress, Physiological

Objective To evaluate the cardioprotective effect of dexmedetomidine in patients undergoing off-pump coronary artery bypass grafting. Methods Forty-six ASA Ⅱ or Ⅲ patients aged 37-64 yr weighing 54-81 kg undergoing off-pump coronary artery bypass grafting were randomized into 2 groups ( n = 23 each): control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine was infused at 0.5 μg·kg-1·h-1 starting after induction of anesthesia until the end of operation in group D. Radial artery was cannulated and Swan-Ganz catheter placed via right internal jugular vein. HR, MAP, mean pulmonary arterial pressure, pulmonary capilary wedge pressure, central venous pressure, and cardiac output were recorded and stroke volume index, left and right ventricular stroke work index, systemic vascular resistance and pulmonary vascular resistance were calculated at the beginning of operation (T1 ), immediately (T2 ) and at 30 min after reestablishment of coronary blood flow (T3 ) and the end of operation (T4 ) . Venous blood samples were taken before induction of anesthesia (T0 , baseline) , at T4 and 4 h (T5 ) and 24 h (T6 ) after operation for determination of plasma concentration of cardiac troponin I by ELISA. Results Stroke volume index and left ventricular stroke work index were significantly higher at T4 while systemic vascular resistance was lower at T34 in group D than in group C. Plasma cardiac troponin Ⅰ concentration was significantly lower at T6 in group D than in group C. Conclusion Dexmedetomidine infusion at 0.5 μg ·kg-1·h-1 during operation can protect myocardium in patients undergoing off-pump coronary artery bypass grafting.

ObjectiveTo investigate the effects of dexmedetomidine on cerebral oxygen and glucose metabolism in patients undergoing mitral valve replacement under cardiopulmonary bypass (CPB).Methods Fiftyeight ASA Ⅱ or Ⅲ patients of both sexes aged 32-64 yr weighing 52-90 kg undergoing mitral valve replacement were randomly divided into 2 groups (n =29 each): control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was infused iv at 0.5 μg· kg- 1 · h- 1 starting after tracheal intubation until the end of operation in group D,while in group C equal volume of normal saline was infused instead of dexmedetomidine.Blood samples were collected from radial artery and jugular venous bulb for blood gas analysis and determination of glucose and lactate concentrations before CPB (T1,nasopharyngeal temperature =36 ℃ ),during CPB (T2,nasopharyngeal temperature =30 ℃ ),immediately and 30 min after restoration of spontaneous heart beat ( T3,T4 ).Arterial O2 content ( CaO2 ),arteriovenous O2 content difference ( Da-jvO2 ),cerebral extraction of O2 ( CEO2 ),arteriovenous glucose and lactate content differences (Da-jvGlu and Da-jvLac) were calculated.ResultsThe Da-jvO2 and CEO2 were significantly decreased at T2 in group D as compared with group C.There was no significant difference in CaO2,Da-jvGlu and Da-jvLac between the 2 groups.ConclusionDexmedetomidine can reduce cerebral O2 metabolism and help maintain the balance between cerebral O2 supply and demand but has no effect on cerebral glucose metabolism in patients undergoing mitral valve replacement under CPB.

Objective To investigate the efficacy of prostaglandin E1 administered via the pulmonary artery for treatment of pulmonary hypertension in patients.Methods Thirty ASA Ⅱ or Ⅲ patients undergoing offpump coronary artery bypass grafting complicated with pulmonary hypertension,with pulmonary arterial systolic pressure (PASP) ＞ 40 mm Hg,were randomly divided into 2 groups (n =15 each):administration via the central vein group (group C) and administration via the pulmonary artery group (group P).Anesthesia was induced with midazolam,etomidate,cisatracurium and sufentanil.The patients were tracheal intubated and mechanically ventilated.Swan-Ganz catheter was placed via the right internal jugular vein for monitoring of hemodynamic parameters after induction of anesthesia.The central vein and pulmonary artery were cannulated for infusion of prostaglandin E1.Prostaglandin E1 was infused at a rate of 20-50 ng· kg-1 · min-1 starting from the end of skin incision until PASP was decreased to 20-30 mm Hg.Heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),PASP,pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were recorded at 5 rain before administration (To) and 5 min after administration (T1).The pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) were calculated.The amount of prostaglandin E1 consumed was recorded.Results Compared with group C,the amount of prostaglandin E1 consumed was significantly reduced,PASP and PVR were decreased at T1,while MAP and SVR were increased at T1 in group P(P ＜ 0.05).Conclusion Administration via the pulmonary artery can increase the potency of prostaglandin E1 for treatment of pulmonary hypertension and exerts no influence on the systemic hemodynamics.

BACKGROUND:Neural stem cells transplanted into the infarct region can promote the recovery of damaged nerve cells after cerebral infarction.
OBJECTIVE:To analyze the relevant influential factors of neural stem celltransplantation in the treatment of cerebral infarction.
METHODS:In this paper, we analyzed the experimental studies concerning neural stem celltransplantation for cerebral infarction published in recent years based on database search. There were main two aspects for discussing the progress in neural stem cells and cerebral infarction, the Chinese clinical trial registration and basic experimental studies.
RESULTS AND CONCLUSION:After cerebral infarction, neural stem cellproliferation and differentiation is closely related to the brain microenvironment. Large amount of nerve cellloss can be found in the infarct region. Cytokines can play a role in the neural stem celltransplantation to repair neurological injury after cerebral infarction, and also can induce neural stem cellproliferation, differentiation and migration, including epidermal growth factor, brain-derived neurotrophic factor, insulin-like growth factor 1, nerve growth factor, and basic fibroblast growth factor. Acupuncture and traditional Chinese medicine can promote the proliferation, migration and differentiation neural stem cells in the subependymal zone after cerebral infarction. Neural stem celltransplantation in the treatment of cerebral infarction has yielded progress, but there are stil many issues that need to be resolved in the future.

Objective To analyze features of the lateral leg peroneal artery perforator free flap,and study the clinical application of free peroneal artery perforator flap transplantation for repairing forefoot defects.Methods Retrospectively analyzed 9 patients with forefoot defects which had been repaired with free lateral leg peroneal artery perforator flap transplantation.In this group,the skin and soft tissue defects size were 4.5 cm ×4.0 cm-13.5 cm × 6.5 cm,Focused on analyzing the features of forefoot skin and soft tissue defects,the design and harvesting of lateral leg peroneal artery perforator flap,and vascular anastomosis and vessel matching,meanwhile,follow-up the survival condition and appearance of the flap,the function of foot and ankle after operation.Results In the 9 cases,the larger myocutaneous perforator arising from peroneal artery,accompanying 2 vena comitans,were found slightly above the midpoint of the line between fibula head and lateral malleolus in lateral leg.The flaps transfered to repair forefoot defects,artery end-end anastomosis:in 5 cases cutaneous branch of peroneal artery to dorsal artery of foot,in 4 cases by cutaneous branch of peroneal artery to dorsal metatarsal artery;vein end-end anastomosis:in 1 case 2 accompanying veins of peroneal artery cutaneous branch to 2 accompanying veins of dorsal artery of foot,in 5 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,in 3 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,simultaneously,the another accompanying vein of peroneal artery cutaneous branch to 1 dorsal superficial vein of the foot.All the 9 flaps survived,and no vessel articulo happened.The venous return of flaps had no significant difference between repairing 1 vein and 2 veins in gross appearance.All wounds healed in one-period.Followed-up 2-6 months postoperative,1 patient was performed flap reshaping due to flap fat and clumsy at 5 months postoperative,others,the skin texture and appearance of the flaps were good and satisfactive.Conclusion Free transplantation of the lateral leg peroneal artery perforator flap broke away from the bondage of pedicled flap,had more freedom in flap design,and effectively controlled the trauma of donor and recipient site.The flap have the merits,blood vessel anatomy is relatively stable,blood supply is reliable,harvesting is simple,skin texture is similar to the forefoot and the effect is better,operation of the donor and recipient sites can accomplish under a identical anaesthesia and tourniquet.Thus,the lateral leg peroneal artery perforator free flap is an effective metheod in reparation of the forefoot defects.

Objective: To investigate hard tissue changes produced by maxillary protraction in patients with skeletal Class III malocclusion at different bone age,and to determine the relationship between the effect of maxillary protraction and bone age.Methods:75 subjects of skeletal Class III malocclusion with retruded maxilla were treated by maxillary protraction and rapid maxillary expansion for 6 months.Cephalometric radiographs were taken before and after treatment.The bone age of individual patients was assessed using cephalometric radiographs at the initiation of treatment on the basis of cervical vertebrace maturation indicators(CVMI).Patients were divided into three groups:Prepubertal growth peak group (CVMI Ⅰ-Ⅱ,8.2-11.3 years old), pubertal growth peak group (CVMI Ⅲ,10.2-12.3 yeasr old), and postpubertal growth peak group (CVMI Ⅳ-Ⅵ,11.5-14.5 years old).Results:(1)There was no difference in the maxillary advancement after maxillary protraction between the prepubertal growth peak and the pubertal growth peak groups;(2) in the postpubertal growth peak group, there was a decrease in maxillary skeletal advancement, whereas the dentoalveolar advancement was increased; (3) the posteroinferior rotation of mandible, the increase of lower facial height, and the eruption of maxillary molars showed no correlation with bone age.Conclusion:The importance of performing a biologic evaluation of bone age in the diagnosis and treatment planning of skeletal Class III malocclusions in individual patients must be emphasized.