Objective To compare pharmacodynamics of rocuronium in neonates,infants,young children and children.Methods One hundred and sixty ASA Ⅰ or Ⅱ pediatric patients undergoing elective surgicalprocedures under total intravenous anesthesia(TIVA)were divided into 4 groups according to ages(n=40 each):neonate group(0-28d),infant group(28 d0.05).Onset time of muscle relaxation.clinical duration and total duration were significantly shorter and recovery index lower in the other 3 groups than in neonate group(P<0.01).but there was nosignificant difference in the duration of peak effect among the 4 groups(P>0.05).ED50,ED90 and ED95 of rocuronium were significantly higher in children group than in young children group(P<0.01).Conclusions There are significant differences in dose-effect and time-effect relationships among different age children and neonate is more sensitive to rocuronium than the other age children.

Objective To explore the clinical value of magnetic resonance imaging( MRI) in the diagnosis and classification of perianal abscess and anal fistula.Methods Eighty patients with suspected perianal abscess and anal fistula were selected in Yuyao People＇s Hospital from May 2016 to December 2017.They were divided into general examination group and MRI group by random number table,with 40 cases in each group. The general examination group underwent ultrasound examination,and the MRI group underwent MRI examination.The detection rate of MRI examination for various types of perianal abscess and anal fistula was analyzed based on the results of operation. Results In the general examination group, the diagnostic accuracy of anal fistula supervisor, anal fistula internal orifice,perianal abscess and anal fistula branch were 65.0% (26/40),70.0% (28/40),57.5% (23/40) and 52.5% (21/40),respectively,which in the MRI group were 92.5% (37/40),77.5% (31/40),87.5% (35/40) and 95.0% (38/40),respectively.There were statistically significant differences in diagnostic accuracy of anal fistula supervisor, perianal abscess and anal fistula branch between the two groups ( χ2 =9.054,7.116,8.865, all P <0.05). The effective rate of operation in the MRI group was 67.5% (27/40),which was significantly higher than that in the general examination group [67.5% (27/40)],the difference was statistically significant(χ2 =9.935,P<0.01). Conclusion Using MRI to diagnose perianal abscess and anal fistula can accurately judge the number,involvement range,specific location and surrounding structure of the abscess and anal fistula,and has important value for clinical treatment and prognosis.

Objective: To evaluate the clinical value of 16-slice spiral CT low dose chest scanning in the diagnosis of pulmonary tuberculosis. Methods: From June 13, 2014 to June 20, 2017, 80 patients with pulmonary tuberculosis in Yuyao People's Hospital were selected in the study.The conventional chest dose(control group) and low dose(observation group) of 16-slice spiral CT were used.The diagnostic accuracy, radiation dose of the two methods, lymph node or vascular space display and image features were observed. Results: The diagnostic accuracy of the two methods had no statistically significant difference (P>0.05). The dose product length, the CT dose index in the observation group were (32.98±2.57) mGycm, (44.29±3.47), respectively, which were significantly lower than those in the control group[(127.66±5.03)mGycm, (44.29±3.47)](t=106.01, 21.05, all P<0.05). The display clarity of lymph nodes or vascular space of the observation group was 90.00%, which of the control group was 92.50%, there was no statistically significant difference between the two groups (P>0.05). The rates of ground glass shadow, burr of the observation group were 29.32%, 31.58%, respectively, which were significantly lower than those of the control group(41.35%, 47.37%), the differences were statistically significant (χ²=4.21, 6.94, all P<0.05). Other signs detection probability are similar between the two groups and had no statistically significant differences (all P>0.05). Conclusion The low dose chest CT scan with 16 rows spiral CT has high clinical value, low radiation dose and high diagnostic accuracy in the diagnosis of pulmonary tuberculosis.

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

OBJECTIVE: To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer. METHODS: This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541). INCLUSION CRITERIA: (1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent. EXCLUSION CRITERIA: (1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon. RESULTS: The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P<0.001]. There was no stent migration in either group. Three patients had perforation in the elective surgery group; one patient had perforation and one had obstruction in the neoadjuvant chemotherapy group; and all these patients received emergent surgery. Adverse reactions of neodajuvant chemotherapy were mainly degree 1 and 2 except one patient with degree 3 diarrhea. Patients in neoadjuvant chemotherapy group had significantly lower rate of stoma [4.8%(1/21) vs. 34.1%(14/41), χ²=6.538, P=0.011], higher rate of laparoscopic surgery [71.4%(15/21) vs. 36.6%(15/41), χ²=6.751, P=0.009], shorter mean operative time (147 minutes vs. 178 minutes, t=-3.255, P=0.002), less mean intraoperative blood loss (47 ml vs. 127 ml, t=-4.129, P<0.001), lower degree of surgical difficulty(3.3 vs. 5.6, t=-5.091, P<0.001), shorter mean postoperative exhausting time (56.2 hours vs. 69.0 hours, t=-2.891, P=0.006), and shorter mean postoperative hospital stay (8.5 days vs. 13.5 days, t=-2.246, P=0.028) as compared with patients in the elective surgery group. Surgical site infection rate and anastomotic leakage rate did not differ significantly between two groups(all P>0.05). CONCLUSION Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.
Aged ; Colorectal Neoplasms ; surgery ; therapy ; Female ; Humans ; Intestinal Obstruction ; Male ; Middle Aged ; Neoadjuvant Therapy ; Prospective Studies ; Stents ; Treatment Outcome