Objective To evaluate the clinical efficacy of neoadjuvant chemo radiotherapy combined with surgical treatment for advanced rectal cancer.Methods Fifty-one patients with advanced rectal cancer were randomly divided into treatment group and control group by random number table.In treatment group,26 cases received three-dimensional conformal radiotherapy synchronization XELOX chemotherapy for 2 cycles,then they received radical resection after 4-6 weeks.Twenty-five cases in control group received neoadjuvant chemotherapy with XELOX for 2 cycles,then received radical resection.Results The objective response rate in treatment group was 84.6％ (22/26),and in control group was 60.0％(15/25),there was significant difference between two groups (P =0.049).Radical resection in treatment group was 96.2％ (25/26),significantly higher than that in control group 76.0％ (19/25)(P =0.037).The sphincter preservation rate in treatment group was 61.5％ (16/26),and in control group was 20.0％ (5/25),there was significant difference between two groups (P =0.003).The pathologic complete response rate in treatment group was 26.9％ (7/26),significantly higher than that in control group 4.0％ (1/25)(P =0.024).The 1,2 and 3 year survival rate in treatment group were 88.0％(22/25),60.0％(15/25),32.0％(8/25),which were significantly higher than those in control group 62.5％ (15/24),29.2％ (7/24),8.3％ (2/24) (P =0.038,0.030,0.040).The 1,2,and 3 year recurrence rate in treatment group were 8.0％(2/25),20.0％(5/25),36.0％ (9/25),which were significantly lower than those in control group 33.3％ (8/24),44.8％(12/24),66.7％ (16/24) (P=0.028,0.027,0.032).Conclusion Neoadjuvant chemoradiotherapy can improve the rate of surgical resection,sphincter preservation and prolong survival of rectal cancer,it can be used as a kind of effective treatment for rectal cancer.

Objective To study the lateral branch of thoracodorsal nerve and the deltoid branch of axillary nerve under microscope for clinical application in the reconstruction of brachial nerve injury. Methods 31 lateral branches and deltoid branches of axillary nerve on 17 cadaver specimens were studied on topography under the light microscope(? 5) to observe the length, diameter, and the number of branches. The number of fibers was counted on the HE- stained section of the nerves. Three cases were performed: In operationⅠ , the lateral branch of thoracodorsal nerve was connected with the deltoid branch of axillary nerve. In operationⅡ , on the base of the first operation, the medial branches of the thoracodorsal nerve partially the latissimus dorsi was reconstructed for recovery of the flexion function of the elbow. In operationⅢ , the latissimus dorsi was section into two parts according to the innervation of the medial and lateral branches of the thoracodorsal, and the two branches of the thoracodorsal were transplanted in a dislplaced position for the restoration of flexion function of the elbow and the fingers. Results Thoracodorsal nerves have 2 branches near dorsal aspect of the latissimus dorsi. The lateral branch is thicker with the average length of 58.2 mm avaliable for the reconstruction purpose; the diameter is in average of 1.46 mm, the number of fibers is in average of 1 519; 90.4％ of the lateral branches redivided into 2 or 3 branches. The diameter of the deltoid branch of axillary nerve is 2.31 mm in average and 61.3％ give 3 branches; 32.3％ 2 branches; the number of fibers is in average of 2 341. Clinically the reconstruction operation is successful. In operationⅠ the strength of the deltoid muscle recovered to grade 4; in operationⅡ the strength of the deltoid muscle and elbow- flexing is reached grade 4 and in operationⅢ the strength of elbow- and finger- flexion recovered to grade 4. Conclusion Reconstruction of two muscular groups of the latissimus dorsi with loss of nerve innervation is effective by the application of double branch potential of the thoracodorsal nerve.

Objective To investigate the clinical application of robot-assisted laparosocopic ureterolithotomy.Methods The clinical data of 28 cases(15 males and 13 females),aged 42(18～72),of laparosocopic ureterolithotomy with AESOP system(computer Motion,USA) was analyzed.Of the 28 cases,18 patients had upper ureter stones and 10 had middle ureter stones.Results All procedures were completely performed by robot assisted laparosocopic ureterolithotomy.The operative time was ranged from 35 to 150 min(averaged 50 min) and the intraoperative blood loss was ranged from 20 to 50 ml(averaged 30ml).The postoperative hospital time was 3 to 5 days and no ureter stricture or recurrent calculus was found during the follow-up period(2～13 months).Conclusion The ZEUS AESOP system has the characteristics of high intelligence and humanization.The robot-assisted laparoscopic ureterolithotomy is effective,safe and precise.

Atrial fibrillation (AF) is a common kind of arrhythmia,it is one of the main reasons causing ischemic stroke in aged patients.Left atrial appendage is the primary site where the thrombus is formed in non-valvular atrial fibrillation (NVAF) patients.Recent researches have indicated that occlusion of left atrial appendage can effectively reduce the occurrence of ischemic stroke in NVAF patients,its curative effect is no less than the preventive treatment effect of warfarin.The use of an ideal left atrial appendage occluder is the key to ensure a successful occlusion of the left atrial appendage.After decades of research,several left atrial appendage occluders have been developed,among them Watchman occluder and Amplatzer cardiac plug (ACP) are commonly used nowadays in clinical practice,and some kinds of occluder are still at their experimental research stage.This article aims to make a brief introduction about the current status of the study and the clinical application of left atrial appendage occluder.(J Intervent Radiol,2017,26:281-284)

OBJECTIVE:To study clinical effect of argatroban for progressive stroke patients of different cerebral ischemic ranges. METHODS:A total of 116 progressive stroke patients selected from neurology department of our hospital during Feb. 2015-May 2016 were divided into anterior circulation (ischemia) group (n=60),posterior circulation (ischemia) group (n=50) and lacunar(cerebral infarction)group(n=6)according to cerebral ischemic ranges. They all received routine treatment combined with argatroban,and given continuous intravenous infusion of argatroban 60 mg/d on the day and 2nd day of disease aggravation, and then continuous intravenous infusion of argatroban 5th day after relieving,3 h/time,bid,7 d as a treatment course. NIHSS scores,modified RANKIN (mRS) scores,APTT and ADR were compared among 3 groups. RESULTS:Forteen days after treat-ment,NIHSS scores and mRS scores of 3 groups were decreased significantly compared to before treatment,with statistical signifi-cance (P<0.05). There was statistical significance between anterior circulation group and posterior circulation group (P<0.05). Two hours after treatment,APTT of 3 groups were prolonged significantly,especially in lacunar group,with statistical significance (P<0.05). Forty hours after treatment,APTT of 3 groups were recover to normal,without statistical significance (P>0.05). No obvious ADR was found in 3 groups. CONCLUSIONS:Argatroban shows significant therapeutic efficacy for progressive stroke of different ischemic ranges with good safety;especially for the patients with anterior circulation ischemics stroke,the effect is quick and anticoagulant effect is significant.

OBJECTIVE:To explore the preventive effect and safety of levetiracetam combined with sodium valproate of diaze-pam on recurrent febrile seizures(FS). METHODS:A total of 90 children with recurrent FS were randomly divided into observa-tion group and control group with 45 cases in each group. Control group was treated with sodium valproate or diazepam orally. On the basis of control group,observation group additionally received levetiracetam orally,with initial dose of 15 mg/kg,bid,for 7 d,and then decreasing gradually;decreasing to 10 mg/kg on 8th-12th day,bid;decreasing to 5 mg/kg on 13th-15th day,bid;drug withdrawal on 16th day. The children of 2 groups were followed up for 1 years,and received routine test every 2 months. The times of fever,the rate of recurrent convulsion,the conversion of epilepsia and the incidence of ADR were recorded in 2 groups during follow-up period. The serum levels of NSE and S-100β protein were determined in 2 groups before treatment and 6 months after treatment. The intelligence and behavior ability of 2 groups were scored by Chinese Modified Wechsler Intelligence Scale for Children and Children’s Adaptive Behavior Rating Scale. RESULTS:3 children of observation group and 2 of control group were failure in follow-up. During the follow-up period,fever times and the rate of recurrent convulsion in observation group were signifi-cantly lower than in control group,with statistical significance(P<0.05). There was no statistical significance in the rate of epilep-sia conversion and the incidence of ADR between 2 groups (P>0.05). After treatment,serum levels of NSE and S-100β in 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical signif-icance(P<0.05). To the end of follow-up,verbal IQ,performance IQ and total IQ score of observation group were significantly higher than those of control group,and the cognition factor,social factor and behavior ability scores of observation group were sig-nificantly higher than those of control group,with statistical significance (P<0.05). CONCLUSIONS:Levetiracetam combined with sodium valproate or diazepam can prevent the occurrence of recurrent FS,relieve cerebral injury and improve the intelligence and behavior ability of the children,so as to improve the life quality of Children.

Objective To evaluate the effect of electroconvulsive therapy (ECT) on the expression of phosphorylated glutamate receptor 1 (p-GluR1) and Ca2+/calmodulin-dependent protein kinase Ⅱ α (p-CaMK Ⅱ α) under small dose ketamine combined with propofol anesthesia in the depressed rats.Methods Forty healthy adult male Sprague-Dawley rats,weighing 200-250 g,aged 2-3 months,were used in this study.Mental depression was induced by exposing the animals to chronic unpredictable mild stress (CUMS).Forty mentally depressed rats were divided randomly into 5 groups (n =8 each) using a random number table:M0-4 groups.Propofol 80 mg/kg and ketamine 10 mg/kg were injected intraperitoneally in M0-4 groups.After disappearance of righting reflex,M1-4 groups received ECT of 60,120,180 and 240 mC once a day for 7 consecutive days,respectively,by means of a current (frequency 50 Hz,sine-wave,pulse width 0.7 ms,1-s duration) delivered via ear-clip electrodes,while group M0 received ECT of no quantity of electric charge via ear-clip electrodes.Before CUMS,at 1 day after CUMS and at 1 day after ECT,sucrose preference test was applied to evaluate the depressive behavior.The sucrose preference percentage (SPP) was calculated.At 4 days after CUMS and 4 days after ECT,the learning and memory function was assessed using Morris water maze test.The rats were then sacrificed,and hippocampi were isolated to detect the expression of GluR1,p-GluRl,CaMK Ⅱ α and p-CaMK Ⅱ α by Western blot.Results The SPP was significantly lower after CUMS than before CUMS in M0-4 groups (P＜0.05).Compared with that after CUMS,the SPP was significantly increased,the escape latency was shortened,and the space exploration time was prolonged after ECT in M1-4 groups (P＜0.05).There was no significant difference in SPP after ECT between M1-4 groups (P＞0.05).Compared with group M0,the SPP was significantly increased,and the expression of pGluR1 and p-CaMK Ⅱ α was up-regulated in M1-4groups (P＜0.05).Compared with group M2,the escape latency was significantly prolonged,the space exploration time was shortened,and the expression of pGluR1 and p-CaMK Ⅱ α was down-regulated after ECT in the other groups (P＜0.05).There was no significant difference in GluR1 and CaMK Ⅱ α expression after ECT between the five groups (P＞ 0.05).Conclusion ECT can induce cognitive decline when applied for anti-depression under small dose ketamine combined with propofol anesthesia,and the mechanism is related to increased phosphorylation of GluR1 and CaMK Ⅱ α expression in rats.

Objective:To study the collapse of the contralateral femoral head after the total hip arthroplasty (THA) in patients with bilateral steroid-induced femoral head necrosis leg-length discrepancy (LLD) influences.Methods:A total of 108 patients with bilateral steroid-induced femoral head necrosis who were treated in Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2014 to June 2016 underwent THA surgery on the hip joints that had symptoms and developed to Association Research Circulation Osseous (ARCO) Ⅲ. At the same time, the non-surgical hip-preserving treatment of the non-collapsed femoral head developed to the ARCO Ⅱ stage was performed. The follow-up period was 2 years, and 98 cases were finally included. According to the size of the leg-length discrepancy [LLD<3 mm group ( n=50), LLD≥3 mm group ( n=48)] and the type of leg-length discrepancy[non collapse side longer group ( n=58) and shorter group ( n=58)], the collapse of the femoral head and the THA were observed. Results:Finally, a total of 56 cases of femoral head collapse occurred in the non collapse side of the hip, of which 50 cases underwent THA within 24 months. There were significant statistical differences in THA and femoral head collapse between LLD<3 mm group and LLD≥3 mm group, non collapse side longer group and non collapse side shorter group ( P<0.05). The 2-year survival rate without collapse in the LLD<3 mm group and LLD≥3 mm group were 52.1% and 34.0%, respectively, and the 2-year survival rates in the longer and shorter non-collapsed limb groups were 56.9% and 22.5%, respectively. Compared with patients with moderate lesions, the survival rate of femoral heads in patients with larger lesions was lower ( OR: 4.25, 95% CI: 1.55-11.26; P=0.003). LLD<3 mm group ( OR: 0.24, 95% CI: 0.06-0.50; P<0.01) or non collapse side longer group ( OR: 0.13, 95% CI: 0.04-0.29; P<0.01) had lower risk of contralateral femoral head collapse after THA. Conclusions:For patients with bilateral steroid-induced femoral head necrosis who have collapsed lateral THA, postoperative leg-length discrepancy extremities is a potential risk factor for collapse of non-collapsed femoral head. LLD<3 mm and avoiding shortening of the uncollapsed limb may reduce the risk of collapse of the uncollapsed femoral head.

Objective To explore the effect of low-dose ketamine combined with propofol anesthesia on expres?sion of glutamine receptor subunit 1 (GluR1) and 2 (GluR2) in the hippocampus of depressed rats after electroconvulsive therapy. Methods Healthy adult male Sprague-Dawley rats, weighing 200~250 g, were used in this study. Mental depres?sion was induced by chronic unpredictable mild stress. Thirty-two depressed rats were randomly divided into 4 groups (n=8): metal depression group (group A), ECT group (group B), ECT+propofol group (group C) and ECT+propofol+ket?amine group (group D). Eight normal rats served as control group. Control group received no treatment. Group A received intraperitoneal injection of normal saline 8 mL/kg plus sham ECT. Group B, C and D received ECT once a day for 7 con?secutive days following intraperitoneal injection of normal saline 8 mL/kg, propofol 80 mg/kg and propofol 80 mg/kg +ketamine 10mg/kg, respectively. Sucrose preference test and Morris water maze were performed to assess depressed be?havior and learning and memory function, respectively. RT-PCR and Western-blot assay were used to detect the expres?sion of GluR1 , GluR2 and their mRNA expression. Results After ECT, compared with control group and group A, changes of SPP in group B, C and D were obvious. The change of SPP in group D was much higher than all other groups (P<0.05). Rats in group B showed prolonged escape latency and shortened space exploration time, which were significantly different from all other groups (P<0.05). Rats in group D showed the most shortened escape latency and prolonged space exploration time (P<0.05). The expression of GluR1 was significantly increased in group B, C and D compared with group A (P<0.05). The expression of GluR2 and mRNA was significantly decreased in group B and C (P<0.05). The difference in GluR2 and mRNA expression was not significant among group A, D and control group (P>0.05). Conclusion Low-dose ketamine combined with propofol anesthesia exert effective antidepressive action and improve learning and memory function of depressed rats after electroconvulsive therapy. The beneficial effects of the ketamine combined with propofol anesthesia may be related to up-regulation expression of GluR1 and GluR2 in hippocampus.

Objective: To investigate the incidence of adverse events following immunization (AEFI) of human papillomavirus (HPV) vaccines in Hangzhou City from 2017 to 2021, so as to provide insights into safety monitoring and evaluation for HPV vaccines. Methods: The AEFI caused by immunization of bivalent (HPV2), quadrivalent (HPV4) and nonavalent HPV vaccines (HPV9) reported in Hangzhou City from 2017 to 2021 were captured from the AEFI Surveillance Module of Chinese Disease Control and Prevention Information System, and HPV vaccination data were captured from the Zhejiang Municipal Immunization Information Management System. The incidence, temporal distributions and clinical symptoms of AEFI were analyzed. Results: Totally 922 310 doses of HPV vaccines were immunized in Hangzhou City from 2017 to 2021, and 232 cases with AEFI were reported, with an overall incidence rate of 25.15/105 doses. The reported incidence rates of AEFI caused by HPV2, HPV4 and HPV9 vaccination were 31.13/105 doses, 25.93/105 doses and 22.01/105 doses, respectively. General reactions and abnormal reactions were predominant AEFI, and the reported incidence rates of general reactions and abnormal reactions were 21.58/105 doses and 2.60/105 dose, respectively. AEFI predominantly occurred 0 to 1 day post-immunization (165 cases, 71.12%), and the main clinical symptoms included local swelling of injection sites, hard tubercle and fever, with reported incidence rates of 10.30/105 doses, 5.96/105 doses and 6.18/105 doses, respectively. Conclusions Low incidence of AEFI was reported following HPV vaccination in Hangzhou City from 2017 to 2021, and all AEFI were mild. The safety of HPV2, HPV4 and HPV9 remains high.