After receiving radical resection of primary rectal cancer,about 4％ to 30％ patients would occur local recurrence.Diagnosis of local recurrence relies on postoperative follow-up,physical examination,tumor markers and imageological examination.For the local recurrent patients,conservative therapeutic regimen had been popular in the past days with poor prognosis and quality of life.Nowadays multimodality treatment with radical resurgery combined with chemoradiotherapy and IORT has been taking the main part in the management of local recurrence.The choice of surgery depends on the site of recurrence and invasion situation inside the pelvic cavity.The aim of the radical reoperation is R0 resection because it leads to an optimistic prognosis.Previously irradiated patients are relatively safe after receiving median-dose reirradiation.For the cases whose recurrence are unavailable for radical resection,palliative operation and chemoradiotherapy may be the wise choice to relieve their symptoms and improve the quality of life.

Objective To observe the ingrowth characteristics of the interface between hydroxyapatite coated intervertebral implants and vertebral cortex loaded with physiological compressive stress. Methods Twelve titanium alloy intervertebral implants special for macaque were prepared, 4 of which were coated with corundum (control group) and 8 of which were coated with hydroxyapatite (HA, observed group). One control and two observed implants were randomly inserted into the intervertebral spaces of L2,3, L3,4 and L4,5 in each of 4 healthy homogenous adult macaques (2 males and 2 females). Roentgenology was performed at 3, 6, 12, 24 and 40 weeks postoperatively. Histomorphometry as well as histology were also evaluated at 40 weeks postoperatively. Results All the animals recovered well from the operation. Three days after operation all the animals began to stand and walk with normal gait. Gross anatomy showed excellent healing in the annulus fibrous involved, and no implant loosening or migration was found. On 40 weeks postoperatively, the interface of the observed group were filled with calcified mature bone and partly-mineralized osteoid tissue, the content of calcified bone as well as the amount of osteoblasts and osteocytes were significantly higher in observed group, and the differences were of statistical significance (t=5.001, P=0.000 and t=16.983, P=0.000). A tight connection was observed between the vertebral bones and HA coating. The thickness of coating decreased form 130-150 ?m to 100-130 ?m. And no evident breakage or debris was found on the implant coating. Conclusion HA coating was stable in vivo and had favorable biocompatibility with vertebral bone. It was more effective than corundum coating in inducing intervertebral cortical bone ingrowth under physical compressive loading.

BACKGROUND: In order to conserve blood and keep the operating field clean, cell saver is often used with electrocautery in hip arthroplasty. When applying the principle of thermal coagulation, electrocautery produces tissue self-burning with noxious gas byproducts, including carbon monoxide(CO). However the existing blood salvage systems do not have any reoxygenation or filtration function for CO.OBJECTIVE: To evaluate the effects of simultaneous use of electrocautery and a cell saver system on the blood levels of CO in patients undergoing hip arthroplasty.DESIGN: A comparative observation.SETTING: Department of Orthopedics, Duisburg-Essen University.PARTICIPANTS: From August 2002 to August 2003, patients undergoing hip arthroplasty including the use of electrocautery as well as intended use of a cell saver system were selected from the Department of Orthopedics, Duisburg-Essen University. Exclusive criteria: ① smoking history; ② history of anemia, hemoglobinopathy or coagulopathy; ③history of organ dysfunction, including lung, liver and kidney; ④ preoperative abnormal electrocardiogram (ECG), including cardiac ischemia and/or arrhythmia.Among all the enrolled patients, those who ultimately received the retransfusion of processed salvaged blood were counted as the observed group,whereas the others who did not receive any retransfusion for inadequate salvaged volume or possible contamination within salvaging were added as the control group, and no allogenic blood was transfused. All the patients agreed to participate in the study.METHODS: ① All the operations were performed under combined intravenous and inhalation general anesthesia. ② Electrocautery was used for coaluation during the incision of subcutaneous tissues, fascias, muscles as well as capsules. ③ A cell saver system (Haemonetics Cell Saver #5 System, manufactured by Haemonetics Corporation, U.S.A.) was applied during the operation. Salvaged blood were retransfused into the patients after the procedure of filtration and wash. ④ Blood CO-Oximetry: Blood CO levels were measured by carboxyhemoglobin (CO-Hb) concentration with a spectrophotometric blood gas analyzer (ABL 700 series, manufactured by Radiometer, Copenhagen, Denmark). In both groups, systemic blood samples were collected from a radial arterial catheter at 3 time points, including preoperatively, postoperatively and merely before the retransfusion of salvaged blood and at 6 hours postoperatively. In the observed group, additionally samples were collected instantly after skin incision from the aspirator connected to the cell saver reservoir, directly after femoral stem implantation also from the aspirator and immediately before retransfusion from the collecting sac, to reveal the trend of CO-Hb levels in salvaged blood.MAIN OUTCOMEMEASURES: CO-Hb levels in the systemic blood and salvaged blood at different time points were mainly observed.RESULTS: Totally 49 patients were involved in the analysis of results. ① General data: Forty-nine ASA Ⅰ -Ⅱ patients were enrolled in this study.There were 35 and 14 patients in the observed and control group, respectively, with 7 and 3 had a history of coronary heart diseases (heart function of class Ⅰ - Ⅱ ) correspondingly. There were no obvious differences in the sex, age, mean operative time and mean estimated blood loss between the two groups (P ＞ 0.05). The vital signs were stable in all the patients. ② CO-Hb concentration: In the observed group, the CO-Hb concentration in systemic blood at 6 hours postoperatively was significantly increased as compared with the preoperative and postoperative ones [(2.2±0.54)%,(1.6±0.34)%, (1.7±0.19)%, P ＜ 0.05]; the CO-Hb concentration in salvaged blood was (2.6±0.62)%, which was significantly higher than that in systemic blood preoperatively and postoperatively (P ＜ 0.01). In the control group, the CO-Hb concentration in systemic blood at 6 hours postoperatively had no obvious differences as compared with the preoperative and postoperative ones (P ＞ 0.05). ③ Postoperative conditions: In the observed group, sinus tachycardia and inferior myocardial ischemia were detected by ECG monitoring in 2 patients with pre-existing coronary heart disease,which complained of precardial discomfort at 4-6 hours postoperatively.Higher levels of CO-Hb were detected in salvaged blood before retransfusion (39% and 4.5%) and in systemic blood at 6 hours postoperatively(3.5% and 4.2%). No patient in the control group demonstrated symptoms of CO intoxication or cardiovascular compromise, also no abnormal changes were revealed by ECG monitoring.CONCLUSION: Retransfusion of salvaged blood in hip arthroplasty with simultaneous use of electrocautery and a cell saver system leads to a significant increase of systemic CO-Hb concentration, which can provoke the cardiovascular compromise. Therefore, it is suggested to measure CO-Hb level in salvaged blood, the retransfusion of which should be cautious, especially to patients with pre-existing heart diseases.

Purpose To explore the ultrasonic characteristics of idiopathic retroperitoneal fibrosis (IRPF) and assess the diagnostic value of ultrasound. Materials and Methods Ultrasonic images of 11 cases of IRPF were retrospectively analyzed.Results The hypoechogenic masses encasing the abdominal aorta were detected in all cases, among which the encasement of inferior vena cava was found in 4 cases, the involvement of iliac artery in 3 cases and hydronephrosis in 9 cases.Conclusion IRPF demonstrated ultrasonic characteristics that would facilitate its detection and diagnosis.

OBJECTIVE:To explore and extend a reasonable scheduling mode suitable for outpatient pharmacy.METHODS:The traditional scheduling mode was studied,and the fluctuation of the job intensity of dispensing personnel was revealed by drawing charts.In view of the disadvantage of the traditional scheduling mode,a new scheduling mode using mathematical conversion was adopted.RESULTS:Due to the new scheduling mode,the fluctuation of job intensity and the total man-hours were significantly decreased.CONCLUSIONS:Computing work intensity can help reasonably distribute and utilize the present human resources.

The PIK3CA gene codes p100α,the catalytic subunit of phosphatidylinositol 3-kinase (PI3K) and is involved in the initiating the PI3K/AKT pathway.PIK3CA plays its biological roles through.downstream PI3K pathway. PIK3CA gene mutants can be detected in many kinds of tumors. The mutant PIK3CA gene can abnormally activate PI3K pathway,leading to the abnormal cell cycle,decreased cell adhesion,down regulated apoptosis and neovascularization,and then promotes tumor genesis and development.Recent researches have found that mutant PIK3CA gene is closely correlated with the genesis,development,differentiation,metastasis and drug resistance of colorectal cancer.Research of PIK3CA in colorectal cancer may provide significant evidence for the early diagnosis,gene screen,therapeutic regimen making,recurrence and follow up.

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy(SAE).Methods From Jan 2013 to Oct 2014,we used the criteria of systemic inflammatory response syndrome (SIRS)positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit (ICU).Results Among 6 comatose patients with evidence of infection,3 cases were secondary infection after hemorrhagic stroke,1 case was secondary infection after trauma,and the other 2 cases were primary infection.All patients met the diagnosis of SIRS -positive sepsis with encephalopathy.Among them,the presence of SIRS 3 criteria was in 2 cases,four criteria in 4 cases. All patients with severe brain failure (100%),in addition to 5 cases with acute respiratory failure caused by lung injury,one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases (33.3%),the cerebral ischemic lesions in four cases(66.7%).The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions,and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case,eventually with a poor prognosis.Conclusion SAE is a common critically illness,the use of the new classifi-cation criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy.

Objective To investigate the condition and the related influence factors of small airway function in controlled bronchial asthmatic children.Methods Children diagnosed with bronchial asthma controlled,aged 5-14 years old without gender limitation were consecutively enrolled.Survey questionnaire including asthma symptoms in the past one month and medication usage were conducted.Physical condition and lung function were examined.Results A total of 255 patients were included in this study,and 224 patients had normal small airway function in which the level of forced expiratory flow at 50％ of forced vital capacity(FVC) exhaled (FEF50),forced expiratory flow at 75％ of FVC exhaled(FEF75),maximal mid-expiratory flow(MMEF) was 87.9％ (77.0％,97.2％),73.8％ (65.6％,93.5％),and 84.9％ (76.4％,97.5％) of the predicted value,respectively.Thirty-one patients had small airway dysfunction,accounting for 12.2％ (31/255 cases),and the level of FEF50,FEF75,MMEF were 62.8％ (59.9％,65.5％),51.9％ (46.6％,55.5％),and 62.7％ (57.2％,64.4％) of the predicted value,in which FEF75 had shown more decrease than others.In small airway dysfunction group,10 patients had conducted bronchodilation testing,and improvement rate of FEF50,FEF75 and MMEF were 41.1％,47.5％ and 41.3％,and all 10 cases (100.0％) returned to normal level.No significant difference was found in gender,body mass index,atopy,disease duration,drug usage between 2 groups (all P ＞ 0.05).Conclusion In 5-14 controlled asthmatic children,12.2％ have small airway dysfunction with a certain degree of reversibility.Gender,body mass index,atopy,disease duration,drug usage are not influencing factors.

Objective:To evaluate salvage surgery in patients with early gastric cancer after noncurative endoscopic resection .Method:A total of 56 cases with early gastric cancer receiving salvage surgery after noncurative endoscopic resection were enrolled and the clinicopathological and follow-up information were analyzed to evaluate the necessity and safety of salvage surgery.Results:Among the 44(79%)patients with submucosal invasion, 38 (68%) were with SM2 (invasion submucosal invasion≥500 μm) according to the pathological results after endoscopic resection. 33 (59%)cases had positive margin. The rate of lymph node metastasis and positive residual tumor as found by salvage gastrectomy were 11% (6/56) and 25% (14/56) . In the multivariate analysis, deeper submucosal invasion resulted as independent risk factor for residual tumor( OR=1.001, 95% CI=1.000-1.002, P=0.036). Among the 12(21%)cases with postoperative complications, 3 (5%)underwent unplanned reoperations because of anastomotic or intra-abdominal bleeding. There was no difference in the number of retrieved lymph nodes and rate of postoperative complications between laparoscopic and open surgery(all P>0.05). Conclusion:For patients with the risk factors of lymph node metastasis after noncurative endoscopic resection, salvage surgery was necessary and laparoscopic approach was safe and feasible.

BACKGROUND: In the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty, the efficacy and safety of bone cement injection by unipedicular and bipedicular approaches are still controversial. Some studies suggest that bone cement injection via unipedicular approach can shorten operation time and reduce postoperative complications, while the other studies suggest that bone cement injection via bipedicular approach can make bone cement distribute more evenly in the vertebral body and relieve pain better. OBJECTIVE: To systematically assess the efficacy and safety of percutaneous vertebroplasty via unipedicular versus bipedicular approach in the treatment of osteoporotic vertebral compression fractures. METHODS: Randomized controlled trials about unipedicular versus bipedicular percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before September 18 t h, 2018 were retrieved in the PubMed, Cochrane library, Embase, CNKI, VIP, WanFang data and CBM. Two researchers independently screened all the literatures, carried out data extraction and used improved Jadad to evaluate the methodological quality of the included studies. Meta-analysis using Revam 5.3 was conducted. Egger's test was utilized to evaluate the publication bias. RESULTS AND CONCLUSION: Totally 14 randomized controlled trials including 900 cases were eventually included, 452 cases in unipedicular approach group and 448 cases in bipedicular approach group. The Meta-analysis results showed that compared with the bipedicular approach, the unipedicular approach required shorter operation time [weighted mean difference (WMD) =-16.59, 95％ confidence interval (CI) (-19.25, -13.94), P < 0.001], smaller amount of bone cement injected [WMD=-1.27, 95％ CI (-1.64, -0.89), P < 0.001], and had lower incidence of cement leakage [relative risk=0.70, 95％ CI (0.53, 0.92), P =0.01]. There were no significant differences in short-and long-term Visual Analogue Scale scores, short-and long-term Oswestry Disability Index scores, and the postoperative incidence of adjacent vertebral fractures between the two groups (P> 0.05). Overall, bone cement injection both via bipedicular and unipedicular approaches can lead to a significant improvement in pain relief and living quality of osteoporotic vertebral compression fracture patients, but bone cement injection via unipedicular approach can shorten operation time, reduce cement volume and lower the incidence of cement leakage compared with the bipedicular approach.