Objective To explore the values of manual anastomosis with two operations out of anus in laparoscopic anal sphincter preserving resection of ultra low rectal cancer. Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel in 12 patients based on the concept of total mesorectal excision (TME) and ultra low coloreclal/anal anastomosis was performed applying manual anastomosis with two operations out of anus. Results All the operations were finished successfully, without conversions to open for surgery. One case had anastomotic leakage, and there were no bleeding and infection of abdominal cavity, anastomotic stenosis and other complications. The operating time was 185-310 (218 ±10) min, the blood loss was 160-450 (232 ±8) ml,the length of hospital stay was 9-14 (11 ±3) d. All patients were followed up 6-36(18 ± 2) months, local recurrence was not found but 1 case had liver metastasis.Conclusions The manual anastomosis with two operations out of anus in laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive, and has the benefits of less bleeding during the operation and shorter hospital stay. It should be widely used.

AIM To study the influence of chronic stress on the level of CNTF and CNTF mRNA in hippocampal neurons of rats. METHODS The chronic stress model was established by chronic unpredictable mild stress, openfield test was performed to detect the behavior of rats. Immunohistochemistry and in situ hybridization were used to observe the level of CNTF and CNTF mRNA. RESULTS Compared to control group, the CNTF like immunoreactivity and signals of CNTF mRNA in situ hybridization in the hippocampal neurons of chronic stress group were significantly decreased. CONCLUSION These results show that chronic stress can significantly decrease the level of CNTF and CNTF mRNA in the hippocampal neurons of rats.

Objective To evaluate the efficacy and toxicity of postoperative chemoradiation for D2 dissection gastric cancer,and to compare the difference of toxicity between confromal and traditional radiotherapy.Methods Sixty four patients with T3-4,N + or R1 were enrolled.Radioation was given to a total dose of 46Gy delivered in 23fractions by use of 3D-CRT or 4 fields traditional radiotherapy.Chemothrepy was administered with paclitaxel 135 mg/m2 day 1 and 29,cisplantin 20 mg/m2 day 1 ～3 and day 29 ～31 during radiotherapy.Results The median follow-up time was 40 months.The 3-year overall and relapse-free survival rates were 78.2% and 70.9%,respectively.Eighteen patients had tumor relapse.Fifty-three patients completed chemoradiotheray.Toxicities on grade 3 or above included gastrointestinal toxicity (28.1% ),eutropenia (21.8 % ) and alopecia ( 18.7% ).One patient died of hemorrhage of upper digestion tract.Conclusion Adjuvant radiotherapy with paclitaxol and cisplatin yielded satisfactory overall survival and disease-free survival in gastric cancer patients.The toxicity was manageable.Conformal radiotherapy seems to decrease the gastrointestinal toxicities compared to that occurred in the traditional radiotherapy.

Objective To investigate the mechanism of COMMD7,a hepatocellular carcinoma gene,promoting human hepatocellular carcinoma cell line (HePG2 cells)proliferation and migration.Methods The specific siRNA (small interference RNA)was designed for COMMD7 gene,siRNA transfected HepG2 cells was set as Si-HePG2 group,and the PTEN inhibitor treating group (Si +BpV-HePG2),the control group (HePG2),the empty vector group (HePG2 was infected empty vector,N-HePG2 group)were also set up.qRT-PCR was per-formed to evaluate the mRNA expression changes of COMMD7 and PTEN,and Western blot was performed to test the expression changes of COMMD7,PTEN,p-AKT,and AKT.MSP method was performed to detect methylation level.CCK8 was performed to test cell proliferation a-bility.Transwell was performed to detect the invasion of cells.Results The results of qRT-PCR showed that the expression of COMMD7 gene in Si-HePG2 group was lower (0.101 times)than the control group and the N-HePG2 group,and the expression of PTEN gene was higher (2.841 times)than the control group and the N-HePG2 group,and all the results above were of statistically singificant difference (P <0.05). The results of Western blot showed that in Si-HePG2 group,the expression of COMMD7 reduced obviously,the expression of PTEN increased and the expression of p-AKT was significantly inhibited.In Si +Bpv-HePG2 group,the expression of PTEN was significantly inhibited and the expression of p-AKT was increased.The result of MSP showed that compared with the control group and the N-HePG2 group,Si-HePG2 group was more obviously demethylated,which indecated that the expression of COMMD7 gene could induce PTEN demethylation.The results of CCK8 showed that the proliferation in Si-HePG2 group was decreased compared with the control group,N-HePG2 group and Si +BpV-HePG2 group,and the difference was singificant (P <0.05).The results of Transwell showed that the numbers of cell permeating septum in Si-HePG2 group,N-HePG2 group,control group and PTEN group were (17.4 ±2.7),(36.2 ±3.2),(41.6 ±4.5)and (47.6 ±1.8)respec-tively,which were obviously decreased with a significant difference (P <0.05).Conclusion siRNA interference decreased the expression of COMMD7.It can induced the demethylation of PTEN gene in HePG2 and increase the expression of PTEN gene to inhibit PI3K/AKT signaling pathway,thus decreasing the proliferation,migration and invasion ability of HePG2 cells.

Objective To comparative analyze the anorectal function before and after anus-preserving laparoscopic rectal resection in ultra low rectal cancer.Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of TME and ultra low colorectal/ anal anastomosis was perfomed by applying the manual anastomosis with two operations out of anus.The time of guid being controlled in the rectus,rectual rest pressure (RRP),anal rest pressure (ARP) and anal maximal contraction pressure (AMCP) were tested before operation.The function of their rectus and anus was tested,including the number of bowel movement in one day of 1,3,6 months after operation,the time of guid being controlled in the rectus,RRP,ARP and AMCP after 3,6 months of operation et al.Results All the operations were finished successfully,four cases were converted to open surgery,but there was no serious damage.All cases were followed up for 6 to 36 months with average of 20 months.After 3 months of operation,the retention time of liquid in rectus,the defecate feel function,the anus control function,RRP and ARP was statistically significant (P ＜ 0.05) compared to them before operation,there was no statistical significance (including AMCP) (P ＞ 0.05) after 6 months of operation.The results of tests in annus and rectus were near normal level after 6 month of operation.Conclusion The manual anastomosis with two operations out of anus in the laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive and shorter hospital stay,it is worth to be widely used.

Objective To determine the effect of COMMD7 inhibition on invasion and migration in liver cancer stem cells (LCSCs),and investigate the possible mechanism.Methods After LCSCs were infected by shRNA lentiviral vectors of COMMD7,adhesion assay and Transwell assay were used to detect the invasion and migration,and phalloidin staining was employed to observe the morphological changes.Western blotting was adopted to measure the expression of E-cadherin,N-cadherin and Vimentin.Results COMMD7 knockdown significantly inhibited the invasion and migration of LCSCs.The relative cell quantity of adhesion was 1.00 ± 0.12 and 2.35 ± 0.20 respectively in control cells and infected cells,suggesting there were significantly more adhesive cells in the infected group (P ＜ 0.05).The relative cell quantity per visual field of migration was 1.00 ±0.04 and 0.24±0.03,and that of invasion was 1.00 ±0.05 and 0.24 ±0.04 respectively in the control cells and infected cells,and there were significantly less invasive and migrated cells in the infected group (P ＜0.05).What's more,COMMD7 knockdown also induced some morphological changes of cells corresponding to the weakened abilities of migration and invasion.All the changes above were associated with up-regulation of E-cadherin (P ＜ 0.05) and down-regulation of N-cadherin and Vimentin (P ＜0.05),the molecules related to mesenchymal-epithelial transition (MET).Conclusion COMMD7 knockdown inhibits the invasion and migration in LCSCs,which may be through its regulation on the MET course.

Objective To study the different therapeutic proportion of the patient populations undergone coronary angiography (CAG) in the era of development in multislice spiral computed tomography(MSCT).Methods Two hundred and fifty four consecutive patients(mean age 59.24±10.65),who underwent CAG at Daxing Hospital from February 2007 through October 2007,were enrolled,160 patients were male and 94 were female.By evaluating from the coronary angiogram,the patients were not diagnosed to have coronary heart disease(CHD) with less than 50% diameter stenosis of coronary artery;the patients to have CHD with more than or equal to 50% stenosis of coronary artery;the patients were performed the procedure of percutaneous coronary intervention(PCI) with more than or equal to 70% stenosis;the patients were proposed to have coronary aortic bypass graft(CABG) surgery with left main coronary artery lesions or diffuse triple coronary artery lesions.Results In the 254 consecutive patients,59 patients(23.2%) had not been diagnosed to have CHD;195(76.8%)to have CHD,of these patients with CHD,49 patients(19.3%)were not indicated for PCI (including the patients receiving follow-up coronary angiography after stenting),81(31.9%)had been performed the procedure of stent implantation,57(22.4%)proposed to have CABG,8(3.1%)the procedure of PCI had not been successful,or had not been performed because of patients opposing to this therapy.Conclusion Multislice spiral computed tomography can be applied as a non-invasive screening tool to exclude the presence of CHD,to increase the positive proportion of the populations with CHD in all patients receiving coronary angiograhpy,to avoid the use of CAG in a subset of patients.

Objective To evaluate management stratagy for patients with traumatic splenic rupture.Methods The clinical data of 124 patients with traumatic splenic rupture admitted to the 422 Hospital of PLA from April 2008 to June 2016 were retrospectively analyzed.38 patients were treated conservatively,while 86 patients underwent surgery.To investigate impact factors of management strategy in patients with traumatic splenic rupture,clinical characteristics and CT features between the two groups were compared.Results Univariate analysis results showed that injury causes,blood pressure,at admission,pulse,CT grade and abdominocentesis were closely related with therapeutic scheme.And multivariate Logistic regression analysis results showed that pulse (OR =4.264,95％ CI 1.206-15.073),CT grade (OR =2.086,95％ CI 1.019-4.271) and abdominocentesis (OR =3.428,95％ CI 1.024-11.479) were the significant determining factors of therapeutic scheme in patients with traumatic splenic rupture.Surgical intervention was carried out in 86 patients accounting for 69.4％ of all patients.The rate of surgical intervention was 58.1％ in the patients with CT grade of 1 and 2,that was 94.7％ in patients with CT grade of 3 and 4.Conclusions Operative management is needed for most traumatic splenic rupture,patients those with hemodynamic stability and CT grade of 1 or 2 may be qualified for watchful non-operative management.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.