The application of enhanced recovery after surgery (ERAS) in hepatectomy is safe and feasible.The related researches of the clinical strategies of ERAS involved in colonic surgery instead of management of basic diseases of liver,and the influence of portal hypertension and hepatitis B virus infection on the ERAS has not been emphasized.According to the clinical strategies of ERAS in colon surgery,the basic diseases and the characteristics of liver were focused,and the clinical strategies of ERAS in the era of precision liver surgery were proposed.Through concerted efforts of the multidisciplinary team and a joint of surgeons,nurses and patients,the establishment of multicentre clinical studies under guidance of evidence-based medicine (EBM) will show clearly a development direction of the clinical strategies of ERAS in the era of precision liver surgery.

Objective To compare the clinical value of dynamic enhanced CT,MRI in differential diagnosis of adrenal tumors.Methods 62 patients with adrenal tumor by pathologically confirmed in our hospital were select-ed.All patients underwent unenhanced and dynamic enhanced CT,MRI examination.The qualitative and adrenal tumor localization diagnostic accuracy,the adrenal adenomas and non adenoma tumor clearance rate of the two meth-ods were compared.Results The accuracy of enhanced CT positioning,qualitative examination were 96.77%, 90.57%,respectively,which were slightly higher than those of the MRI enhancement(91.94%,86.79%),but the differences were not statistically significant (χ2 =0.479,0.376,all P >0.05).53 adrenal adenomas and 9 cases non-adenomas absolute and relative clearance rate clearance rate in enhanced CT 5 min delay time,the differences were statistically significant (t =2.962,2.018,all P <0.05).53 cases adrenal adenomas and 9 cases non adenoma clear-ance of correction in the enhanced MRI delay 5min,respectively (33.41 ±20.17)%,(14.74 ±12.16)%,the differ-ence was statistically significant (t =2.684,P <0.05).Conclusion Dynamic enhanced CT,MRI are good methods for differential diagnosis of adrenal tumors,two methods have location and qualitative diagnosis correct rate.So dynamic enhanced CT,MRI are reliable means of diagnosis of adrenal tumors.

Objective To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal Cancer.Methods 35 patients with colorectal cancer,treated by surgery were divided into two groups randomly.There were 20 patients in group A(pre-operative intra-arterial infusion chemotherapy) and 15 in group B(control).Arterial contrast technique Was used in group A then mitromye in 10mg,5-Fu 1000mg epirubic in 60mg were given through Weidner way-Results Microveasel density in the center,surface of the tumor and adjacent tissue around the tunlor were (40.46±7.06),(52.27±18.40),(49.92±8.15) in group A,and (46.09±12.21),(73.44±22.06),(51.94±12.64)in group B.Microvessel density on the surface in group A was significantly lower than that of group B(P＜0.05),with no significance between the center and the adjacent tissue.Conclusion Pre-operative intraarterial infusion chemotherapy is able to reduce micro-vessel density on the surface of eolorectal tumor.

Objective:To evaluate our self-made distraction reductor used in the percutaneous minimally invasive treatment of calcaneal fractures.Methods:A retrospective study was conducted of the 32 patients (37 feet) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Chongqing Medical University from January 2017 to December 2019 for calcaneal fractures. They were 26 males and 6 females, aged from 20 to 67 years (average, 46.5 years). The height and length of the calcaneus were restored by our self-made tri-plane distraction reductor in all patients; the displaced fracture blocks were reset in a minimally invasive manner in patients with intra-articular fracture; final fixation was performed with a minimally invasive plate and screws. Time for reductor installation, operation time and intraoperative blood loss were recorded; complications, fracture union and reduction were observed; height, length and width of the calcaneus, ankle-hindfoot scores of American Society of Foot and Ankle Surgery (AOFAS), Maryland scores, and visual analogue scale (VAS) were recorded at the last follow-up; B?hler and Gissane angles were compared between pre- and post-operation.Results:All patients were followed up for 12 to 36 months (average, 17.2 months). Time for reductor installation averaged 5.0 min (from 3 to 8 min), operation time 91.5 min(from 70 to 110 min), and intraoperative blood loss 25.2 mL (15 to 50 mL). Superficial infection of traction track occurred in one patient and sural nerve injury in one patient. All fractures united without any reduction loss by the last follow-up. On average, the last follow-up observed a calcaneal height of 39.3 mm, a calcaneal length of 70.6 mm, a calcaneal width of 32.7 mm, an AOFAS score of 87.8, a Maryland score of 86.7 and a VAS score of 2.2. The calcaneal B?hler angle was recovered significantly from 3.7°±13.7° preoperatively to 25.8°±6.4° at the last follow-up, and the calcaneal Gissane angle from 112.2°±21.3° preoperatively to 125.8°±5.7° at the last follow-up ( P< 0.05). Conclusion:In percutaneous minimally invasive treatment of calcaneal fractures, application of our self-made tri-plane distraction reductor can lead to fine clinical efficacy.

Objective To observe the therapeutic efficacy of continuous arterial infusion chemotherapy combined with radiofrequency hyperthermia in the treatment of patients with advanced colorectal cancer.Methods A total of 20 advanced colorectal cancer patients with various distant metastasis were treated by the combined continuous intra-arterial infusion chemotherapy and radiofrequency hyperthermia.For the chemotherapy,a dose of 200mg/m2 surface body area of calcium folinate(CF) was given for 1 to 3 days.80mg/m2 of cisplation was infused intravenously for the first day and repalced by etoposide Vp16,60mg/m2 for 1 to 3 days in patients with renal dysfunction.For intra-arterial infusion,a dose of 500mg/m2 5-FU was given for 72 hours.For patients with liver metastases,chemoembolization(ADM 30mg/m2+MMC 6mg/m2 mixed with ultra-lique fied lipiodol) was carried out.Radiof requency hyperthermia with a frequency of 41MHz was performed on the second day after chemotherapy.Results Response rates were as sessed by CT scan and ultrasonography.The overall response rate(CR+PR) of the cases was 70.0%.No serious side effect or complication was found in the course of chemotherapy.Local pain and lipid nodule were occasionally observed in some patients after hyperthermia.Conclusion Continuous intra-arterial infusion chemotherapy in combination with radiofrequency hyperthermia is an useful and safe method for the treatment of patients with advanced colorectal cancer.

Objective To study the effect of thermo-radiotherapy on multidrug resistance (MDR) and levels of intracellular adriamycin (ADM) in tongue squamous cell carcinoma cell line Tca 8113 and its MDR cell line Tca 8113/CBDEA. Methods Samples of the two cell lines were treated with thermo-radiotherapy (42℃ for 0.5 h and 2 Gy of radiation). Four and 24 hours later, the expression of the MDR relative proteins P-glycoprotein (P-gp),multidrug resistance associate protein 1 (MRP1) and glutathione s-tranferase-π (GST-π) were detected using immu-nohistochemistry. Intracellular ADM concentrations were measured using an HTS 7000 Plus bioassay reader. Re-sults No change in the expression of P-gp was observed in the Tca 8113/CBDEA and Tca 8113 cell lines after 4 or 24 hours. Expression of MRP1 was not significantly altered in the Tca 8113/CBDEA cell line, but there was a signifi-cant drop in the Tca 8113 cell line 24 hours post-thermo-radiotherapy. Expression of GST-π was not altered in either the Tca 8113/CBDEA or the Tca 8113 cell line at 4 hours post-thermo-radiotherapy, but there was a significant de-crease at 24 hours. At both 4 and 24 hours, drug tolerance had decreased and intracellular drug concentration had in-creased significantly in both cell lines. Conclusions Thermo-radiotherapy can enhance the effects of chemotherapy and suppress the expression of MDR factors induced by radiation. The combination of hyperthermia and radiotherapy does not induce MDR.

Objective: To establish a cell culture model of cervical-loop epithelial cells from Wistar rat lower incisors on culture bottle coated with rat tail collagen. Methods: The effect of self-made rat tail collagen on the culture of cervical-loop epithelial cells was observed. The cells were identified by immunohistochemistry staining. Results: Cervical-loop epithelial cells in Wistar rat lower incisors grew well in self-made rat tail collagen. The cervical-loop epithelial cells exhibited positive expression for integrin-β1 and monoclonal antibody CK in immunohistochemistry staining. Conclusion: The cell culture model of cervical-loop epithelial cells in Wistar rat lower incisors with self-made rat tail collagen can be helpful to research tooth development mechanism.

In order to suit the trend of integration and development of modem medical disciplines and the reform trend of integration of curriculum system, the Third Military Medical University attempts to build a new curriculum system for medical postgraduates. The new system reveals the accuracy towards the teaching objects, the integration of curriculum structure, the update of the teaching contents and the diversity of the teaching methods. Besides, it combines the reform of teaching management, which will push forward the cultivation quality of the medical postgraduates.

Objective To evaluate the roles of signal transducer and activator of transcription 3(STAT3) played in delayed xenograft rejection.Method Mice-to-rats cardiac xenograft model was established and recipients were administrated by inhibitor of phosphorylation of STAT3,5,15-Diphenylporphyrin(DPP),and immunosuppressive agent,ciclosporin A (CsA) alone or both.The survival of graft was analyzed.Immunohistochemistry and immunoblotting were utilized to detect the phosphorylated STAT3 (p-STAT3),and real-time polymerase chain reaction was used to assess STAT3-targeted genes in grafts.Result The expression of p-STAT3 was increased significantly with the prolonged survival in grafts (P ＜ 0.05).Administration of DPP and CsA both significantly prolonged survival of the grafts (P＜0.05),and decreased the expressions of STAT3-targeted genes including Bcl-xl,Bcl-2,Cyclin D1,C-myc and VEGF (P＜0.05).DPP and CsA exerted the synergistic effects.Conclusion STAT3,which is persistently activated in cardiac xenografts,probably up-regulates downstream genes to promote proliferation and to inhibit apoptosis of endothelial cells,leading to the activation of endothelial cells and delayed xenograft rejection.

Objective To observe expression of human beta-defensin-3 (HBD-3) in tissues around the infected artificial prostheses and investigate its value in treatment and diagnosis of periprosthetic joint infection (PJI).Methods According to clinical diagnosis,periprosthetic tissues and normal synovial membrane excised in operation were collected and divided into the following four groups:PJI group (n =13),aseptic loosening group (loosening group,n =9),spacer treatment group (treatment group,n =12),and normal group (n =15).HE staining was used to observe infiltration of inflammatory cells.Immunofluorescence staining was used to detect positive cells number and fluorescence intensity.Image-pro plus (IPP) 7.0C software was used to measure the average value of absorbance.Preoperative peripheral white blood cell count,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) results were documented.Then,differences of those parameters were analyzed and compared among groups.Results HE staining revealed that all groups had different degree of inflammatory cell infiltration except for normal group.Immunofluorescence staining revealed that the most number of positive cells and highest fluorescence intensity existed in PJI group.Value of absorbance in PJI group was 0.430 ± 0.013,followed by 0.308 ±0.005 in loosening group,0.234 ± 0.009 in treatment group,and 0.089 ± 0.019 in normal group.Preoperative peripheral white blood cell count,ESR and CRP were the highest in PFI group,but were not significantly different among the remaining three groups.Conclusion HBD-3 is highly expressed in tissues around the prostheses which had infection or aseptic loosening,but its expression in response to infection and loosening has difference.