Objective To explore the effect of oxytocin on uterine fibroids treated by ultrasound ablation. Methods Eighty-two single points in 29 uterine fibroids from 26 patients were sonicated with magnetic resonance imaging guided by high intensity focused ultrasound before and after using oxytocin. The required total energy, sonication time required to reach 60 ℃ and the acoustic energy for increasing 1 ℃ of temperature at the single point before and after using oxytocin were compared. Results Before intravenous infusion of oxytocin, the average total sonication energy required to reach 60 ℃ was (5320 ±910) J and it took (21 ±20) seconds for sonicating a single point, the energy required for increasing 1 ℃ was (255 ± 302) J. In contrast, after intravenous infusion of oxytocin, the average total sonication energy required to reach 60 ℃ was (2890 ±325) J, and it took (12 ±7) seconds for sonicating a single point, the energy required for increasing 1 ℃ was ( 126 ± 94 ) J. Those three index all reached statistical difference ( P = 0.002, P = 0.001, P= 0.002, respectively). Conclusion It seemed that Oxytocin could significantly decrease the energy required for ablating uterine fibroids, shorten treatment time and improve the treatment efficiency.

Objective:To evaluate the safety and efficacy of high-intensity focused ultrasound (HIFU) ablation for the VX2 liver tumor near the hepatic main blood vessels of rabbits by using dosimetry and magnetic resonance imaging (MRI) and by analyzing path-ological changes and survival. Methods:Rabbits with VX2 liver tumor adjacent to the abdominal aorta were divided into the HIFU (n=32) and control groups (n=20). MRI-guided HIFU was employed for the ablation of the liver tumor in the HIFU group. The ablation vol-ume and the energy efficiency factor (EEF) of the 32 ablated rabbits were further analyzed. MRI and pathology were used to compare the changes in the tumor before and after HIFU. The survival of the animals in the HIFU and control groups was also determined. Re-sults: Both pathology and imaging showed that the rabbit liver VX2 tumor adjacent to the abdominal aorta was completely ablated, with an EEF of (25.72±11.40) J/mm3. The survival rate was significantly higher in the HIFU group than in the control group (P<0.05). Conclusion: HIFU ablation is safe and effective in rabbit VX2 liver tumor near the abdominal aorta. This approach significantly in-creases survival.

Objective To explore the protein expression of PLAC1/CP1 ( cancer-placenta 1 ) and its correlation with clinicopathological characteristics in patients of colorectal carcinoma. Methods The expression of PLAC1/CP1 gene was studied by using tissue chip and immunochemistry in 125 cases CRC tissue specimens. Data were analyzed with the x2-test or Fisher's x2 test statistic by SPSS 16. 0 software.Results The protein expression of PLAC1/CP1 gene was 57.6% (72/125) in 125 cases of CRC and 56. 7% (55/97)in 97 primary adenocarcinoma cases. That was 78. 9% (15/19)in poor differentiated colorectal primary adenocarcinoma, those were significantly higher than that of 35.3% (6/17) in well and 55.7% (34/61) in moderately differentiated adenocarcinoma ( P ＜ 0.05 ); PLAC1/CP1 protein expression was significantly higher in stage TNM Ⅲ + Ⅳ 71.2% (37/52) than in stage TNM Ⅰ + Ⅱ 40% (18/45)(P ＜ 0.05 ); PLAC1/CP1 genes expression rate was 69.6% (32/46) in these with lymphoid node metastasis and 45.1% (23/51)in patients without lymphoid node metastasis (P ＜ 0.05 ). The positive expression rate of PLAC1/CP1 increased in colorectal carcinoma with the increasing of the numbers of lymphoid node involved with metastasis( x2 = 13. 353, P = 0.001 ). Conclusions The protein expression of PLAC1/CP1 is associated with tumor differentiation, TNM stage and lymphoid node metastasis.

Objective To explore the clinical outcomes of laparoscopic appendectomy in acute and chronic appendicitis,and sum up the surgical experiences of lapaproscopic appendectomy.Method In this study 129 cases of appendicitis at the Department of Gastroentrological Surgery,Peking University People's Hosptial were collected retrospectively from June 2008 to December 2009.The clinical results of laparoscopic and open procedures for acute appendicitis and the outcomes of laparoscopic operation for acute and chronic appendicitis were compared.Results For acute appendicitis,the length of hospitalization [(4.8 ± 2.6) d vs.(7.0 ± 1.3) d,t =0.679,P =0.006] was significantly shorter in laparoscopic group than that in open surgery group.In addition,the mean length of operation time [(77 ± 33) min vs.(55 ± 23) min,t =3.431,P ＜0.01] were longer,postoperative first passing flatus [(2.3 ± 1.2) d vs.(1.4 ±0.9) d,t =4.665,P ＜0.01] and oral intake [(2.3 ± 1.4) d vs.(1.2 ±0.6) d,t =4.517,P＜0.01] were later for acute appendicitis patients than for chronic appendicitis in laparoscopic group.Conclusions Laparoscopic appendectomy for acute appendicitis is a safe and effective procedure,though it might cause more postoperative complications such as intra-abdominal abscess and small intestinal obstruction in patients with acute appendicitis.

Objective To investigate pulmonary embolism (PE) clinical characteristics, the first clinical symptoms, and risk factors.Methods Incidence trends, clinical manifestations, etiology and inducing factors of 459 PE cases were analyzed retrospectively.Results For women the two peak period of PE incidence are 20-25 years of age and 60-70 years of age, for men are 20-30 years and 60-70 years;For both men and women PE incidence is peaked at 40-65 years of age.Circular distribution statistics showed the peak incidence of PE falls from November 30 through April 4, roughly in seasons of winter and spring.Dyspnea, chest distress, were among the most common symptoms (64.04％).Pulmonary infarction trilogy accounted for only 8.50％.Surgery, trauma, fracture were the primary causes for PE (44.88％), with tumor accounting for 13.0％.The veins affected by DVT are plexus venosus leg muscle, femora popliteal vein, iliac veins, tibial and peroneal veins.Conclusions The incidence of PE has obvious central tendency of age, season.Clinical symptoms are varied and non-specific.Surgery, trauma and fractures are the primary cause of PE, tumor is an independent risk factor for PE.

Objective To explore the early predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive disease and its significance for the decision of exploratory laparotomy.Methods This retrospective study enrolled 29 patients diagnosed with acute superior mesenteric artery embolism or thrombosis in Peking University People's Hospital between July 1995 and June 2015.Results 12 patients developed intestinal necrosis.Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (x2 =14.867,P =0.000).In univariate analysis,the early predictive factors for intestinal necrosis were D-Dimer ≥ 600 μg/L (x2 =11.455,P =0.002),INR≥1.2 (x2 =3.948,P =0.047),pH values ＜7.4 (x2 =8.191,P =0.004),BE ＜ -1.0 mmol/L (x2 =8.191,P =0.004),blood lactate ≥ 2.2 mmol/L(x2 =7.535,P =0.006),BUN ≥ 6 mmol/L (x2 =10.076,P =0.002),CK ≥ 80 U/L (x2 =8.191,P =0.004),LDH ≥ 210 U/L (x2 =13.079,P=0.000),AST ≥25 U/L (x2 =10.076,P =0.002),SIRS (x2 =10.076,P =0.002).Multivariate logistic regression analysis found no independent predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive diseases.Conclusion Intestinal necrosis in acute mesenteric arterial occlusive diseases indicates a poor prognosis.Coagulation abnormalities,liver or kidney dysfunction,metabolic acidosis and SIRS necessitates an immediate exploration.

Objective To investigate the monitoring of the recurrent laryngeal nerve (RLN)function during thyroid surgery by recording the compound muscle action potential (CMAP) of lateral cricoarytenoid muscle(LCA) under block anaesthesia of the cervical plexus. Methods Nicolet Endeavor CR(Viasys Healthcare, USA) was applied for the intraoperative monitoring. A pair of needle electrodes were inserted into LCA to record CMAP, and a concentric electrode was used to intermittently stimulate the RLN for monitoring the RLN function during operation under block anaesthesia of the cervical plexus.Results In these 28 cases 31 RLNs were exposed during operation, CMAPs appeared with consistent latency when stimulation was applied at the exposed segment. The stimulating intensity threshold ranged from 0.2 to 1.6 mA. The average value was 0.96 mA. 25 of 31 showed CMAPs with consistent latency when stimulation was provided along the possible pathway of the unexposed segment. The stimulating intensity threshold ranged from 1.3 to 3.5 mA. The average value was 2. 03 mA. 6 of 31 did not evoked CMAP even though the maximal stimulating intensity was 5 mA. When these six nerves were exposured, compound muscle action potential were evoked consistently. All of the 28 patients had normal phonation function after surgery.Conclusions It is a safe, effective and feasible method to monitor the RL N function by recording the CMAP of lateral cricoarytenoid muscle under block anaesthesia of the cervical plexus.

Objective To explore the relationship between therapeutic dosage of ultrasound ablation in treatment of uterine fibroids and imaging characteristics of bloody supply of uterine fibroids by color Doppler ultrasound imaging. Methods One hundred and forty-two patients with 168 fibroids were treated by ultrasound ablation. Before treatment, bloody supply of fibroids were classified into grade 0 -4 by ultrasonography. Three patients lost follow-up with contrast MRI exam within 1 month after treatment, so 165 fibroids were enrolled in this study. Bloody supplies were 9 fibroids in grade 0, 34 fibroids in grade 1, 35 fibroids in grade 2, 55 fibroids in grade 3 and 32 fibroids in grade 4. After 1 month treatment, the treated area without blood supply and ratio of ablation were measured by contrast MRI to evaluate the efficacy of thermal ablation and compare status of blood supple based different therapeutic dosage. According to International Reditherapy for Society ( SIR ) standard, adverse effect and score of pain were evaluated. Results ( 1) Ratio of ablation based; ratios of ablation were 79% in grade 0, 89% in grade 1, 92% in grade 2, 86% in grade 3, 71% in grade 4. It reached statistical difference when blood supply of grade 0 compared with those of grade 2 and 3 (P ＜ 0. 05 ) and blood supply of grade 4 compared with those of grade 1, 2, 3 ( P ＜ 0. 05). (2) Factor of energy efficiency:factor of energy efficiency were 13.19 J/mm3 in degree 0, 9. 54 J/mm3 in degree 1, 12. 91 J/mm3 in degree 2, 17. 83 J/mm3 in degree 3 and 28. 10 J/mm in degree 4. Factor of energy of ablation in degree 4 was significantly higher than those in degree 1, 2 and 3 blood supply (P ＜ 0. 05). It exhibit the positive relationship between blood supply and factor of energy of ablation ( r = 0. 354 ,P ＜ 0. 01). ( 3 ) Score of pain and adverse effect: nearly 85% ( 120/142 ) patients could tolerate this treatment very well. Those scores of pain were in range of 0 to 4. All patients did not extend their hospitalization and C to F of SIR standard was not recorded. Conclusion blood supply of myoma measured by ultrasound could predict dosage of ultrasound ablation, it could help select indicated well patients.

UNLABELLEDBased on the T-map of MRI, this research sought to address the relationship between the simulated threshold thermal dose of coagulation and actual the coagulation on histological slides. The MR imaging guided HIFU system was used, the parameters of therapeutic transducer were: frequency--1 MHz, diameter--150 mm, and focal length--150 mm. In fresh beef liver tissue in vitro, sonications were delivered at a fixed depth of 20 mm and at varying powers. The temperature-sensitive MR images obtained during the sonications were used to estimate the temperature, and the thermal dosage of each voxel in the target region was calculated. The thermal dosage of each voxel was compared with the reference threshold thermal dosage, so as to calculate the boundary and area of the coagulated tissue. After the exposure, the tissue was dissected along the maximal section of the coagulation necrosis, and the area of the biological focal region was measured.

RESULTSThe occurrence of tissue damage correlated well with the equivalent thermal dose calculation based on the T-mapping of MRI, and they share the same variation tendency.

CONCLUSIONThe equivalent thermal dose calculation based on the T-Map of MRI correlates well with the actual tissue damage, and so an index to predict the threshold for tissue damage in vivo is provided. This index offers improved online control over minimally invasive thermal treatments and increases the security of the therapy.

Animals ; Cattle ; Dose-Response Relationship, Radiation ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; methods ; Hot Temperature ; therapeutic use ; In Vitro Techniques ; Liver ; radiation effects ; Magnetic Resonance Imaging ; methods ; Radiation Dosage ; Temperature ; Therapy, Computer-Assisted ; methods ; Thermography ; methods ; Ultrasonic Therapy ; methods

OBJECTIVETo investigate the risk factors of low anterior resection syndrome (LARS) after anal sphincter preserving surgery (SPS) for rectal cancer patients.

METHODSClinicopathological and follow-up data of rectal cancer patients who underwent SPS from January 2010 to June 2014 in Department of Gastroenterological Surgery, Peking University People's Hospital, were retrospectively analyzed. Patients receiving permanent colostomy and local resection were excluded. Meanwhile, during October 2014 and March 2015, the enrolled patients were asked to fill out a specially designed questionnaire for LARS through face-to-face interview or telephone inquiry, according to the chronological order of operation. Based on the score of questionnaire, patients were divided into three groups: 0-20 points: non LARS; 21-29: minor LARS; 30-42: major LARS. The demographic and clinicopathologic features were compared among groups and the risk factors of major LARS were tested by logistic regression analysis.

RESULTSA total of 100 patients (61 males, 39 females) completed the bowel function survey, with an average age of 66.2(41-86) years, 33 patients <60 years versus 67 patients ≥60 years. No significant difference was observed in age distribution (P=0.204). Interval from operation to first follow-up was more than 1 year in 70 patients, and the median follow-up was 23 months. Thirty-seven patients were non LARS, 18 were minor LARS and 45 were major LARS. No significant differences in clinicopathological data (all P>0.05) were observed among three groups except radiotherapy history (P=0.025), tumor location(P=0.000) and distance from anastomotic site to anal verge(P=0.008). After comparison of non LARS group combined with minor LARS group versus major LARS, re-analysis of risk factors showed that radiotherapy history (RR=5.608, 95%CI:1.457 to 21.584, P=0.006), distance from tumor lower margin to anal verge (RR=0.125, 95%CI:0.042 to 0.372, P=0.000), distance from anastomotic site to anal verge (RR=0.255, 95%CI:0.098 to 0.665, P=0.004) and preventive ileostomy history(RR=3.643, 95%CI:1.058 to 12.548, P=0.032) were associated with major LARS. One potential risk factor detected in combined analysis was female (RR=2.138, 95%CI: 0.944 to 4.844, P=0.078). Multivariate analysis revealed that female (RR=2.654, 95%CI: 1.005 to 7.014, P=0.049), radiotherapy history (RR=10.422, 95%CI:2.394 to 45.368, P=0.002) and distance from tumor lower margin to anal verge ≤7 cm (RR=8.935, 95%CI:2.827 to 28.243, P=0.000) were independent risk factors of major LARS.

CONCLUSIONSLARS is a significant problem in most rectal cancer patients after SPS. The risk of major LARS increases on condition of radiotherapy, low tumor position and female. When dealing with these patients, preventive measures should be taken into consideration during SPS.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; pathology ; surgery ; Anastomosis, Surgical ; adverse effects ; Colon ; surgery ; Defecation ; physiology ; Factor Analysis, Statistical ; Female ; Follow-Up Studies ; Humans ; Long Term Adverse Effects ; epidemiology ; Male ; Middle Aged ; Radiotherapy ; adverse effects ; Rectal Neoplasms ; complications ; pathology ; surgery ; Rectum ; physiopathology ; surgery ; Retrospective Studies ; Risk Assessment ; methods ; Risk Factors ; Sex Factors ; Surveys and Questionnaires ; Syndrome