Objective To discuss the survivorship of rat mesenchymal stem cells (rMSCs) and the expression of human brain-derived neurotrophic factor (hBNDF) protein after transplantation of the hBDNF-modified rMSCs (hBDNF-rMSCs) to the adult rats with spinal cord injury (SCI) and discuss the effect of hBDNF-rMSCs on the apoptosis of rat neural cells. Methods A total of 240 adult male Sprague-Dawley rats were randomly divided into sham operation group,SCI group,hBDNF-rMSCs transplantation group and empty vector-rMSCs transplantation group,with60 rats in each group.The SCI model was established by using the modified Allen technique.At day 7 after modeling,an equal volume of hBDNFrMSCs suspension,empty vector-rMSCs suspension and phosphate buffered saline (PBS) were injected through the L4,5 subarachnoid space into the hBDNF-rMSCs group,empty vector-rMSCs group and SCI group,respectively.Then,the injured spinal cord tissues were obtained from each group at days 1,2,3,7 and 14 after transplantation to observe the viability and distribution of rMSCs with enhanced green fluorescent protein gene by fluorescent microscope,measure the expression of hBDNF protein by Western blot and detect the apoptosis of neural cells by TdT-mediated dUTP nick end labeling (TUNEL). Results Both hBDNF-rMSCs and empty vector-rMSCs groups showed green fluorescence expression of rMSCs.The hBDNF protein expression was observed in hBDNF-rMSCs group and changed with time,ie,the expression was detected at day 2 after transplantation,reached the highest level at day 7 and then decreased gradually.Among the hBDNF-rMSCs,empty vector-rMSCs and SCI groups,the number of TUNEL positive cells was the least in hBDNF-rMSCs group,followed by the empty vector-rMSCs group and the number was relatively more in SCI group at days 2,3,7 and 14 after transplantation,with significant differences among groups (P ＜ 0.05). Conclusions Transplantation of the hBDNF-modified rMSCs through subarachnoid approach are able to survive and assemble at the injured spinal cord area and express hBDNF protein.The hBDNF-modified rMSCs can inhibit the apoptosis of neural cells after SCI.

Objective To investigate the effect of FK506 on the expression of axon guidance cue slit-2 after spinal cord injury(SCI)in rats.Methods A total of 75 adult Sprague-Dawley rats were randomly divided into three groups,ie,sham operation group,SCI group and FK506 treatment group.The SCI model was made by using the modified Allen's technique.Then,the rats were sacrificed and the spinal cord was removed at different time points(at days 1,3,7,14 and 28)for detection of the expression of slit-2 by means of reverse transcription polymerase chain reaction(RT-PCR)and immunohistochemistry.Results The expression of slit-2 changed with time.The expression of slit-2 could be detected at day 1 after SCI,reached the highest at day 7 and then decreased gradually,with higher expression level in the injury group compared with treatment group(P ＜ 0.05).Conclusion Following spinal cord injury,administration of FK506 can up-regulate the expression of slit-2 and may exert important effect on the guidance of the axon regeneration.

Objective To observe the effect of FTY720 on the expressions of Bel-2 and Bax protein and explore the neuroproteetive effect of FTY720 on neuron after acute spinal cord injury in the rats.Methods A total of 75 SD rats were divided randomly into three groups,ie,the test group(treated with FTY720),the injury group(treated with normal saline)and the control group.The test and injury groups were impacted to create T10 spinal cord injury(SCI)by Allen's method.Both the mRNA and protein expressions of Bcl-2 and Bax in the injured spinal cord section were studied respectively with hematoxylin and eosin(HE)staining,immunohistochemical examination and reverse transcription polymerase chain reaction(RT-PCR)technique at different time points(at6 h,12 h,24 h,3 d and 7 d). Results The expressions of Bcl-2 and Bax in the test group and the injury group were higher than that in the control group at all time points.Meanwhile,at 12 h,24 h,3 d and 7 d,the mRNA and protein expressions of Bcl-2 in the test group were significantly higher than that in the injury group(P<0.05),while the mRNA and protein expressions of Bax in the test group were obviously lower than that in the injury group (P<0.05). Condusion Early administration of FTY720(0.5 mg/kg)after spinal cord injmy Canincrease the mRNA and protein expressions of Bcl-2,decrease the expression of Bax and inhibit neuron apoptosis in the injured spinal cord.

ObjectiveTo investigate the effect of sivelestat sodium on the prognosis in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).Methods Databases including PubMed, EBSCO, Springer, Ovid, Wanfang data, CNKI and China Biology Medicine (CBM) were searched to identify randomized controlled trials (RCTs) regarding sivelestat sodium treatment for ALI/ARDS published from 1985 to December 2014. The patients in treatment group received intravenous infusion of sivelestat sodium, and those in control group received normal saline. The items for analysis were 28-day mortality, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and oxygenation index on day 3. According to the evaluation method of Cochrane system, data extraction and quality assessment from the literature were carried out. Meta-analysis was performed using RevMan 5.3. The publication bias was analyzed with funnel plot.Results Five RCTs with a total of 780 participants were included, with 389 patients in sivelestat sodium group, and 391 in control group. Meta analysis showed: compared with control group, sivelestat sodium could not lower the 28-day mortality [odds ratio (OR) = 0.91, 95% confidence interval (95%CI) =0.66-1.26,P = 0.58], or shorten the duration of mechanical ventilation or length of ICU stay [duration of mechanical ventilation: mean difference (MD) = -0.02, 95%CI = -0.29 to 0.24,P = 0.87; length of ICU stay:MD = -9.63, 95%CI =-23.34 to 4.08,P = 0.17], but it could improve oxygenation index on day 3 (MD = 0.88, 95%CI = 0.39 to 1.36, P = 0.000 4). Heterogeneity was not significant for the main analysis and no publication bias was shown on funnel plot. Conclusion Sivelestat sodium gave rise to a better oxygenation on day 3, but did not change the length of mechanical ventilation and ICU stay, and it did not improve 28-day mortality in ALI and ARDS.

Objective To evaluate the effects of rosiglitazone on ventilator-associated lung injury (VALI) in mice.Methods Twenty-four healthy male C57 mice,weighing 20-25 g,aged 6-8 weeks,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (group S);group VALI;rosiglitazone group (group RGZ).The mice only underwent tracheotomy in group S.In group VALI,the mice were ventilated (respiratory rate 80 breaths/min,duration 4 h,tidal volume 40 ml/kg,fraction of inspired oxygen 21％,inspiratory/expiratory ratio 1:2,PEEP 0).In group RGZ,30 mg/kg rosiglitazone was given orally at 30 min before ventilation,and the other treatments were similar to those previously described in group VALI.At the end of ventilation,the mice were sacrificed,and the left lung was lavaged,and the broncho-alveolar lavage fluid (BALF) was collected for determination of neutrophil count.The pulmonary specimens were collected from the upper lobe of right lungs for microscopic examination of the pathological changes which were scored.The pulmonary specimens were obtained from the middle lobe of right lungs for measurement of the contents of interleukin-lbeta (IL-1β),tumor necrosis factor-alpha (TNF-α),high mobility group box-1 (HMGB-1) and receptor for advanced glycation end-products (RAGE) by enzyme-linked immunosorbent assay.Results Compared with group S,the neutrophil counts in BALF,contents of IL-1β,TNF-α,HMGB1 and RAGE,and lung injury score were significantly increased in VALI group (P＜0.01),and no significant change was found in the parameters mentioned above in group RGZ (P＞0.05).Compared with group VALI,the neutrophil counts in BALF,contents of IL-1β,TNF-α,HMGB1 and RAGE,and lung injury score were significantly decreased in group RGZ (P＜0.01).Conclusion Rosiglitazone can mitigate VALI in mice.

Objective To investigate the influence of“double low”technology(low concentration iodinated contrast agent and low-dose scan) combined with body mass index(BMI) on radiation dose and image quality of contrast-enhanced upper abdominal CT examination. Methods One hundred and twenty patients who received upper abdominal enhanced CT examination were randomly divided into 4 groups:group A1, the iodinated contrast agent iodixanol(270 mg/ml), BMI<18.5 kg/m2 and 80 kVp;group A2, the iodinated contrast agent iodixanol(270 mg/ml), 18.5 kg/m2≤BMI≤24.9 kg/m2 and 100 kVp; group B1, the iodinated contrast agent ioversol(320 mg/ml),<18.5 kg/m2 and 120 kVp; group B2, the iodinated contrast agent ioversol(320 mg/ml), 18.5 kg/m2≤BMI≤24.9 kg/m2 and 120 kVp. Image quality was subjectively scored, the objective parameters(noise, CT values of abdominal aorta and liver parenchyma, contrast noise ratio of abdominal aorta and liver parenchyma) were evaluated and radiation dose was recorded. The differences of the indexes between A1 and B1 groups, A2 and B2 groups were compared with Mann-Whitney U test and pared-samples t test. Results All CT images were good. No images with 4 scores were obtained. No significant difference was found between group A1 and B1, between group A2 and B2(P>0.05). There was no significant difference in contrast noise ratio of liver parenchyma(P>0.05), while significant differences existed in CT values of abdominal aorta and liver parenchyma, contrast noise ratio of abdominal aorta between group A1 and B1(P<0.05). Significant differences existed in the parameters above mentioned between group A2 and B2, respectively(P<0.05). Radiation dose was lower in group A1 than in group B1 and in group A2 than in group B2(P<0.05), respectively. Radiation dose was decreased by 40.1%(0.89/2.22) in group A1 than group B1 while radiation dose decreased by 56.9%(3.02/5.31) in group A2 than group B2. Conclusion According to BMI, the low concentration iodinated contrast agent and low-dose scan CT scanning technology could effectively reduce radiation dose and generate ideal images during the contrast-enhanced upper abdominal CT examination.

Objective To assess the capability of monochromatic energy images of Gemstone spectral imaging(GSI) in reducing artifacts caused by metallic implants. Methods Twelve subjects with metallic implants underwent GSI (Discovery CT750 HD, GE Healthcare, Milwaukee ). The metallic orthopedic implants included 3 patients of dentures, 2 patients of cervical spinal vertebraplasty, one clavicle fracture fixation, one lumbar spinal vertehraplasty, 3 patients of artificial femoral head, one iliac fracture fixation and one tibial fracture fixation. GSI was performed by using a single source ultra-fast dual energy X-ray switching (80 kVp and 140 kVp). Following GSI scanning, thin slice images were reconstructed into 1.25 mm slice thickness. The monochromatic energy images were set to the same window width and level (window width 1500 HU,window level 500 HU). The artifact indexes (AI) at different kiloelectronvolts (keV) images were measured and compared. 3D reconstruction was performed using images with minimal AI. Result The artifacts index on monochromatic energy images varied with the change of keV. Of the images from 12 subjects, the maximal AI ranged between 145-225 at 40 keV, and minimal AI ranged between 15-90 at the 95-140 keV. The artifacts are clearly visible on polychromatic energy images and the artifacts are reduced markedly on the monochromatic energy images with minimal AI. Conclusion The artifacts caused by metallic implants can be reduced significantly by GSI with high keV monochromatic energy images.

Objective To explore the clinical efficacy of laparoscope-assisted transanal total mesorectal excision (La-TaTME) for middle-low rectal cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 16 patients with middle-low rectal cancer who underwent La-TaTME in the Peking University Third Hospital from August 2015 to August 2016 were collected.Sequential surgery of La-TaTME was applied to patients in the same team,with laparoscopic surgery first and then transanal surgery.Observation indicators:(1) operation and postoperative recovery situations:conversion to open surgery,anastomosis method,operation time,volume of intraoperative blood loss,intraoperative complications,time for out-of-bed activity,time for liquid diet intake,postoperative complications and duration of postoperative hospital stay.(2) postoperative pathological situations:length of surgical specimen,tumor diameter,distance from tumor to resected distant intestinal canal,complete degree of mesorectum,circumferential resection margin,pathological T stage,pathological N stage,number of lymph node detected and tumor cell differentiation.(3) follow-up.Patients in stage Ⅲ-ⅣV of TNM stage of RC underwent postoperative adjuvant chemotherapy.Follow-up using outpatient examination was performed once every 3 months postoperatively to detect the patients' survival and tumor recurrence up to December 2016.Measurement data were represented as M (range).Results (1) Operation and postoperative recovery situations:all the 16 patients underwent successful La-TaTME without conversion to open surgery,including 10 with colorectal anastomosis,3 with colon-canalis analis anastomosis and 3 with permanent colostomy.Operation time and volume of intraoperative blood loss were 290 minutes (range,215-420 minutes) and 50 mL (range,30-100 mL),respectively.One patient had intraoperative complication,showing broken ends ischemia of sigmoid colon after dragging out resected rectum from the anus,following free splenic flexure of colon,about 5 cm ischemic sigmoid colon were resected,and descending colon-rectum anastomosis was performed.Time for out-of-bed activity and time for liquid diet intake were 1 days (range,1-3 days) and 2 days (range,1-9 days),respectively.Among 3 patients with postoperative complications (Ⅱ stage of ClavienDindo),2 with incomplete intestinal obstruction were improved by gastrointestinal decompression and total parenteral nutrition,and 1 with presacral infection was improved by drainage and antibiotic therapy.Duration of postoperative hospital stay was 7 days (range,5-21 days).(2) Postoperative pathological situations:length of surgecal specimen,tumor diameter and distance from tumor to resected distant intestinal canal were respectively 18.0 cm (range,12.0-24.0 cm),3.5 cm (range,0.5-6.8 cm) and 2.5 cm (range,1.0-5.0 cm).Evaluation of mesorectum of surgical specimen:14 patients had complete mesorectum of surgical specimen and 2 had nearly complete mesorectum.There was no residual tumor at circumferential resection margin,proximal and distal ends.Pathological T stage of 16 patients:T0 (pathological complete response after neoadjuvant therapy),T1,T2 and T3 stages were found in 1,1,4 and 10 patients,respectively.Pathological N stage:12,2 and 2 patients were detected in N0,N1 and N2 stages,respectively.Number of lymph node detected was 16 (range,6-32).Tumor cell differentiation:no tumor cell (pathological complete response after neoadjuvant therapy),high-,moderateand low-differentiated tumors were respectively detected in 1,2,7 and 6 patients.(3) Follow-up.All the patients were followed up for 12 months (range,4-16 months).There were no local tumor recurrence or distant metastasis and death.Conclusion La-TaTME may be a new,safe and effective resection for middle-low rectal cancer.

Objective To investigate the application value of transabdominal-tansanal total mesorectal excision combined with liver metastasis resection for synchronous low rectal liver metastasis.Methods The retrospective descriptive study was adopted.The clinical data of a male patient with synchronous low rectal liver metastasis who was admitted to the Peking University Third Hospital in November 2015 was collected.Transabdominal-transanal total mesorectal excision combined with liver metastasis resection was performed after multidisciplinary team conference.The liver metastasis resection,vascular disconnection,lymph node dissection and upper and middle mesorectal disconnection were done by transabdominal approach.Then complete mesorectal excision and specimen removal of rectum and liver were done by transanal approach.The intraoperative status (operation method,operation time,volume of intraoperative blood loss,blood transfusion),occurrence of postoperative complications,results of pathological examination and follow-up were observed.The patient was followed up by outpatient examination till January 2016.Results The operation was performed successfully without severe perioperative complications.The operation time and volume of intraoperative blood loss were 360 minutes and 170 mL,respectively.The patient did not receive intraoperative blood transfusion,without urinary retention and presacral abscesses.The patient was discharged at postoperative day 9.The postoperative pathological results showed high-differentiated rectal protruded adenoma and high-middle differentiated adenocarcinoma metastasis in the liver tissue with the negative resection margins.The tumor sizes of rectum and liver metastasis were 5.0 cm × 5.0 cm× 1.5 cm and 1.5 cm × 1.0 cm × 1.5 cm,respectively.The tumor node metastasis (TNM) stage was stage Ⅳ (pT3N0M1).The patient had a good life quality during the follow-up of 1 month.Conclusion Transabdominal-transanal approach might provide an alternative operative approach and resection method for synchronous low rectal liver metastasis,with a good short-term outcome.

Objective To analyze the clinicopathological characteristics of upper gastrointestinal submucosal tumors ( SMTs ) . Methods Clinicopathological data of 1 743 patients with 1 775 upper gastrointestinal SMTs in our department from January 2008 to December 2012 were retrospectively analyzed. Results The first finding was that in 702 esophagus cases,leiomyoma(92?59%,650/702) was the most common type of esophageal SMTs. Second, in 1 045 gastric cases, there were 405 lesions at gastric fundus, the most common type of SMTs were 249 ( 61?48%) GISTs and 144 ( 35?56%) leiomyoma. In 307 lesions located at body,the most common type of SMTs were 143( 46?58%) GISTs and 90( 29?32%) leiomyoma. In 191 lesions located at antrum, the most common type of SMTs were 83( 43?46%) heterotopia pancreas and 45(23?56%) hamartoma, followed by 28(14?66%) lipoma and 20(10?47%) GISTs. In 142 lesions located at cardia, the most common type of SMTs was 110 ( 77?46%) leiomyoma. Third, in 28 duodenum cases, there were 19 lesions at duodenal bulb, the most common type of SMTs was 10 heterotopia pancreas, 4 Brunner gland adenoma and 3 GISTs. In 9 lesions located at descending duodenum,the most common type of SMTs was 4 lipomyoma, followed by 2 ectopic pancreas,1 GISTs and 2 others. Conclusion Leiomyoma is the most common type of esophageal SMTs. In gastric fundus and body, the most common type of SMTs are GISTs and leiomyoma. In antrum, the most common type of SMTs are heterotopia pancreas and hamartoma, but in cardia, that is leiomyoma.In duodenal bulb, the most common type of SMTs are heterotopia pancreas, Brunner gland adenoma and GISTs,and in descending duodenum, is lipomyoma.