Objective To investigate the value of the three-dimensional endorectal ultrasonography (3D-ERUS) in the tumor staging before transanal endoscopic microsurgery (TEM).Methods The clinical data of 30 patients with rectal cancer who underwent 3D-ERUS before TEM at the Nanjing Hospital of Traditional Chinese Medicine from April 2012 to December 2013 were retrospectively analyzed.The accuracy,sensitivity and specificity of the 3D-ERUS were evaluated according to the results of the postoperative pathological examination.The consistency of the results of the 3D-ERUS and postoperative pathological examination were compared by Kappa consistency test.Results Of 30 patients,25 patients in stage T0,3 in stage T1 and 2 in stage T2 were diagnosed by preoperative 3D-ERUS.There were 2 patients (stage pT0) with inflammatory polyp by postoperative pathological diagnosis,6 patients (stage pT0) with tubular adenoma,16 patients (stage pT0) with villioustublar adenoma,2 patients (stage pTis) with carcinoma in situ,2 patients (stage pT1) with tectal adenoma and 2 patients (stage pT2) with rectal adenoma.There were 2 patients with excessive tumor staging by 3D-ERUS,1 patient in stage pT0 was misdiagnosed in stage T1,1 in stage pT1 was misdiagnosed in stage T2 and 1 in stage pT2 was misdiagnosed in stage T1 with insufficient tumor staging.The accuracy of 3D-ERUS in the preoperative tumors staging of TEM was 90.0％ compared with the resuls of postoperative pathological examination.The accuracy,sensitivity and specificity of 3D-ERUS in stage pT0,pTl,and pT2 of TEM were 96.7％,90.0％,93.3％ and 96.2％,50.0％,50.0％ and 100.0％,92.8％,96.4％,respectively.There was a significant difference in the consistency between preoperative 3D-ERUS and postoperative pathological examination (κ =0.685,P ＜ 0.05).Conclusion 3D-ERUS is an accurate clinical method in the preoperative tumors staging of TEM,and can be used as the preoperative assessment for TEM.

Background Refractive lens exchange is one of corrective surgeries for high myopic eyes and is concerned in clinic recently. Its clinical value is worthy of consideration. Objective This study was to investigate the efficacy and safety of refractive lens exchange for high myopic eyes. Methods Phacoemulsification and intraocular lens implantation was performed on 124 eyes of 65 patients with high myopia. The mean age of these patients was 51. 4±8. 57 years old,and the preoperative corrected visual acuity was 4. 11±0. 51. The mean spherical equivalent was ( -20. 17±5. 34) D. The mean axial length was (31. 33±2. 08) mm and intraocular lens power 2. 88 D. The follow-up time was 31 months. The uncorrective visual acuity, best corrective visual acuity, the spherical equivalent lens and complications were observed after operation. Written informed consent was obtained prior to the surgery. Results The uncorrective visual acuity improved after the operation in all the eyes. The uncorrective visual acuity was ≥0.5 in 15 eyes(12% ). The best corrected visual acuity improved in 114 eyes (92% ) following the surgery and that of 64 eyes (51. 6% ) was 2s 0. 5. The mean postoperative spherical equivalent was ( -2. 57 ± 1. 76 ) D in the entire follow-up duration. Posterior capsular opacification was found in 58 eyes (46. 7% ) and received laser capsulotomy. Retinal detachment occurred in 4 eyes throughout the follow-up period. Conclusion Refractive lens exchange is an effective and safe method for high myopic eyes. But preoperative fundus examination and long-term postoperative follow-up should be carried out to prevent the complications.

Objective To explore the effects of gap junctional(GJ)proteins in pathogenesis of cerebral schistosomiasis, through observing the expression of gap junctional proteins Cx37 mRNA in cultured cerebral arterial endothelium incubated with soluble eggs antigen(SEA). MethodsCerebral artery endothelial cells of rabbits were incubated with SEA, and the experiments were divided into control group and SEA 1 - 5 groups (SEA concentrations were 10.0％ ,5.0％ ,3.3％ ,2.5％,2.0％, respectively), reverse transcription polymerase chain reaction (RT-PCR) and Western blotting were used to examine the expression of Cx37 mRNA and protein in cerebral artery endothelial cells of rabbits, respectively. Results Cx37 mRNA levels of control and SEA 1 - 5 groups were 0.239 ± 0.037, 0.260 ± 0.043, 0.218 ± 0.310, 0.647 ± 0.040, 0.419 ± 0.036, and 0.513 ± 0.038, respectively;SEA 3 - 5 groups were higher than control group of mRNA levels(all P＜ 0.05). Cx37 protein levels of control and SEA 1 - 5 group were 0.401 ± 0.045, 0.485 ± 0.048, 0.749 ± 0.052, 1.119 ± 0.063, 1.015 ± 0.057 and 0.605 ±0.047, respectively, of which SEA 2 - 5 groups were higher than control group(all P ＜ 0.05). ConclusionsExpression levels of Cx37 mRNA and protein in cultured cerebral artery endothelial cells incubated with SEA are higher than those of control cerebral artery endothelial cells, which suggests that the gap junction proteins may play an important role in pathogenesis of cerebral schistosomiasis through SEA and its secretion in infiltration of brain tissue and deposition in the cerebral arteries.

Objective To evaluate the efficacy of DSA-guided percutaneous transhepatic gallbladder catheter drainage (PTGCD) in treating aged patients with acute cholecystitis complicated by severe diseases. Methods The clinical data of 15 aged patients with acute cholecystitis or complicated by severe diseases, who were encountered at authors’ hospital in the past three years and were treated with PTGCD, were retrospectively analyzed. The clinical results were discussed. Results PTGCD was successfully accomplished with single procedure in all 15 patients. Abdominal pain was relieved within one to three days, and the abdominal symptoms and signs subsided or disappeared. Reexamination of routine blood test showed that the white blood cell count decreased to normal range in 1 - 2 weeks, and complete cure was achieved in some patients. Secondary surgery was carried out in some patients after the clinical condition was improved. During the follow-up period no complications occurred in all patients except one who developed biliary leakage after the catheter was retrieved two weeks after the treatment. Conclusion For the treatment of complicated acute cholecystitis in aged patients who are not suitable to receive surgery, DSA-guided percutaneous transhepatic gallbladder catheter drainage is an ideal therapeutic means as it can significantly relieve clinical symptoms.

By using enrichment media NPC and CVP, 792 strains of Pseudomonas and 515 strains of Erwinia were isolated from the rhizosphere of Digitaria adscendens (H. B. K.) Hem and Setaria vindis (L.) Beanv. Following which, experiments of antimetabolic test with E. coli, seed emergence controlling of S. viridis, herbicidal activity and security with green grass were carried out to select the desired bacteria. As the result, the selected strain, S7, could wholly control the seed emergence of S. viridis without any harm to the two tested green grass. And more, S7 promoted the seed emergence of Festuca arundinacea slightly. In spite of the comparatively low corrected mortality (56. 7%) of S7 after emergence of S. viridis, Selecting of microbial herbicides from weed DRB is thought to be more prospective.

Objective Tostudyrecentclinicalefficacyandadversereactionsofpemetrexedincombi-nationwithcisplatininthetreatmentofadvancedbreastcancer.Methods Usingenvelopesandrandomlythe patients were dividing into treatment group and control group.The treatment group with 1 8 cases of advanced breast cancer were treated with pemetrexed and cisplatin while in the control group ,23 cases advanced breast cancer patients were treated with gemcitabine and cisplatin with 21 days as a cycle.The efficacy and adverse re-actions were determined according to the WHO on Response Evaluation Criteria in Solid Tumors therapy and chemotherapytoxicityevaluationcriteria.Results Tumorcontrolrateinthetreatmentgroupwas83.3%(1 5/1 8),while in the control group was 78.3%(1 8/23 ),and the difference was not statistically significant (χ2 =0.000 94,P>0.05);while the adverse reactions differenced between the treatment group and the con-trol group were statistically significant(bone marrow suppression χ2 =9.23;fatigue χ2 =4.96;nausea and vomi-tingχ2=4.98;diarrheaχ2=4.45;skinrashχ2=5.03,P<0.05).Conclusion Pemetrexedcombinedwith cisplatin in patients with advanced breast cancer has a good effect,and the adverse reaction is low.

Background and purpose:It was reported that chemokine receptor CXCR4 and its ligand stromal cell-derived factor 1(SDF-1)were involved in the proliferation,differentiation,and metastasis of tumor.This study was designed to observe the expression of chemokine receptor CXCR4 in hypopharyngeal squamous cell carcinoma tissue and study the relationship between the expression of chemokine receptor CXCR4 and different clinicopathlogical characteristics,and further to explore the clinical significance.Methods:For the detection of the expression of chemokine receptor CXCR4,43 primary hypopharyngeal squamous cell carcinoma tissues,27 normal hypopharyngeal tissues,34 lymph node metastastatic lesions and 9 normal lymph node lesions were detected by immunohistochemical method using rabbit anti-human CXCR4 polyclonal antibody.Results:The positive expression rates of CXCR4 in 43 hypopharyngeal carcinoma tissues and normal tissues were 95.3% and 22.2%,respectively(P

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.

Adult ; Delivery of Health Care ; Female ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Occupational Health

Objective To summarize the experience of the prevention and treatment of iatrogenic hypo-parathyroidism in total thyroidectomy .Methods 377 patients received total thyroidectomy performed by the Thy-roid Professional Group of Hepatobiliary Surgery Department of the Third Affiliated Hospital of Soochow University from Jan.2010 to Dec.2012.Their clinical date were retrospectively analyzed .Results There was no perma-nent postoperative hypoparathyroidism .The incidence of temporary hypoparathyroidism was 13.79%( 52/377 ) . The occurrence of transient hypocalcemia was 10.61%( 40/377 ) .Conclusions Iatrogenic hypoparathyroidism can be prevented by intraoperative in situ protection of parathyroid glands and their blood supply using fine cap -sule anatomy method .Postoperative improvement of microcirculation and calcium supplement also help prevent postoperative hypoparathyroidism .