Objective To study the safety of laparoscopic total mesorectal excision for middle and lower rectal cancer.Methods A retrospective comparison was made between 52 cases of open total mesorectal excision from December 2002 to December 2005(Open Group) and 49 cases of laparoscopic mesorectal excision from January 2003 to June 2006(Laparoscopic Group).Results There was no difference in baseline parameters between the two groups.As compared with the Open Group,the Laparoscopic Group presented less blood loss [for anterior resection: 160?106 ml(n=37) vs 298?186 ml(n=36),t=-3.908,P=0.000;for abdominoperineal resection: 180?153 ml(n=10) vs 356?170 ml(n=14),t=-2.604,P=0.016].The recovery time of bowel functions was shorter in the Laparoscopic Group than in the Open Group(2.4?1.8 d vs 3.6?1.5 d;t=-3.648,P=0.000).The overall complication rate in the Laparoscopic Group(14.3%,7/49) was lower than that in the Open Group(44.2%,23/52)(?2=10.834,P=0.001).No significant difference was seen between the two groups in the number of lymph node resected(12.7?6.5 vs 13.6?7.0;t=-0.668,P=0.505),with negative margins in both groups.Follow-up observations were carried out in 45 cases in the Laparoscopic Group(91.8%) for 2～42 months and in 47 cases in the Open Group(90.4%) for 6～42 months,respectively.The local recurrence rate was respectively 4.4% in the Laparoscopic Group(2/45) and 4.3% in the Open Group(2/47). Conclusions Laparoscopic total mesorectal excision for middle and lower rectal cancer is safe and feasible.

BACKGROUND: Secretion of various neurotrophic factors by Schwann cells plays important roles in neural regeneration. However, the secretion capability is affected by many factors. To seek a feasible method for promoting nerve growth factor secretion by Schwann cells is a key of regeneraion following neurologic defect.OBJECTIVE: To explore the effects of methylprednisolone(solu-medrol) on the secreted function of Schwann cells of cultured rats.METHODS: Schwann cells were isolated and cultured by enzyme digestion method. Cell growth was observed under an inverted phase contrast microscope. Following passage, purity of some Schwann cells was identified using S-100 protein immunity. Other Schwann cells were regulated using cell counting plate into 1×10~9/L, and incubated in a 6-well culture plate (15 wells) for further incubation. Following 4 days of culture, different concentrations of solu-medrol (10~(-3), 10~(-4), 10~(-6), 10~(-8) mol/L) were administrated to the cell, while blank control group (1 well) was given no drug. 24, 48 and 72 hours after administration, reverse trancription-polymerase chain reaction (RT-PCR) was used in the detection of the levels of nerve growth factor mRNA.RESULTS AND CONCLUSION: Number of primarily cultured cells was significantly increased at day 7, and 80% cells were confluent. Subcultured cells were spindle-shaped, with 2 thin long processes, showing positive fluorescence staining. Fibroblasts were round or flat, showing negative reaction of fluorescence staining. Reserve transcription-polymerase chain reaction demonstrated that nerve growth factor number at 72 hours affected by 10~(-8) mol/L radiosone was increased compared with the blank control group and other concentrations and other time points (P < 0.05). Number of nerve growth factor was reduced following treatment of 10~(-3) mol/L radiosone compared with the blank control group and other concentrations (P < 0.05). These results suggested that high concentration of solu-medrol prohibits secreted function of Schwann's cells, but long time and low dosage solu-medrol promotes secreted function of Schwann's cells.

ObjectiveTo evaluate the efficacy of mini-incisional double-tsuge suture method with 0-0 absorbable polydioxanone-cord (PDS-Ⅱ)in repair of acute achilles tendon rupture.MethodsA total of 34 patients were subjected to acute closed achilles tendon ruptures,including 25 males and 9 females at a mean age of 32 years ( range,20-45 years).Injury causes included sports injuries in 27 patients,falling injuries in six and heavy object impingement injury in one.The time from injury to operation was average 3 days (range,1-6 days).All patients underwent minimally invasive repair with double-tsuge suture method by using PDS-Ⅱ.The ankle joint was fixed with short leg plaster cast at 30° plantar flexion position and the cast was removed six weeks later to take functional exercise.The patients could walk with full weight-bearing 8-10 weeks later and could gradually return to activity 3-4 months later.Results There was one patient with poor incision healing and one patient with reflex sympathetic dystrophy postoperatively.The rest patients had stage Ⅰ incision healing without skin adhesions.No complications such as infection,lower extremity deep venous thrombosis or sural nerve injury occurred postoperatively.All the patients received follow-up of 12-24 months (average 15 months),which showed no complications like tendon rerupture occurred.According to clinical evaluation criterion of Termann,the average score was 92 points (range,76-96 points).The result was excellent in 28 patients,good in five and fair in one,with excellence rate of 97％.ConclusionsSmall incisional double-tsuge suture method achieves low rate of complications and good outcomes for repairing acute achilles tendon rupture and is an ideal tendon surgery approach.

Objective To compare the effects of different doses of FTY720 on inhibiting expression of Caspase-3 and neural apoptosisin rats with acute spinal cord injury (SCI), and find out the suitable dose. Methods 200 female SD rats were randomly divided into 5 groupswith 40 in each group. Group A (laminectomy but not contusion) were administered 0.3 ml normal saline by gavage. SCI model was establishedby Allen's WD method at the T9 level of spinal cord in other groups. Group B were administered 0.3 ml normal saline after modeling.Groups C, D and E were administered 0.3 ml FTY720- saline solution of 1, 3 and 5 mg/kg respectively. All the groups were sacrificed at 6 h,12 h, 24 h, 48 h, 72 h (n=8, per each time-point). Caspase-3 expression was detected with streptavidin-peroxidase immunohistochemistry,and neural apoptosis was detected with the TUNEL method. Results Positive Caspase-3 expression and neural apoptosis were not observedin Group A at 6 h. In Groups B、C、D and E, the number of apoptotic cells increased with increased time of acute SCI, peaked at 24 h afterinjury, and then gradually reduced. Caspase-3 expression was at equal pace with neural apoptosis. The difference of the number of apoptoticand Caspase-3 expression cells among all groups were significant, with the order Group B>Group C>Group D>Group A (P<0.05). However,there was no significant difference between Group D and Group E (P>0.05). The number of apoptotic and Caspase-3 expression cells negativelycorrelated with the dose of FTY720 when the dose was less than 3 mg/kg (P<0.05), and there was no relationship when the dose wasmore than 3 mg/kg (P>0.05). Conclusion FTY720 significantly reduces Caspase-3 expression and neural apoptosis in rats with acute SCI.There is a dose-effect relationship between the dose of FTY720 and the Caspase-3 expression and neural apoptosis. It's indicated that 3 mg/kg is the most appropriate dosage.

Objective To investigate the influence of respiratory motion on target dose distribution in radiotherapy for patients with lung tumors. Methods The Big Bore Brilliance CT with bellows system was used to gain the 4DCT sets and respiratory frequency information of the patients. The moving ranges of the tumors in left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were measured from the center coordinate values of gross tumor volume of ten time-phase CT sets in the treatment planning sys-tem. Then a breathing model was used to simulate the tumor motions due to respiration. A 4-dimensional motion table was used to mimic the motion of lung tumor in beams-eye-view (BEV). A 2-dimensional semi-conductor beams measurement system was fixed to the table to measure the 2-dimensional dose distribution of static and dynamic targets using the treatment beams at gantry angle of 0°. Finally, the differences of the dose distribution between the static and moving phantom were compared and analyzed with the statistical soft-ware R. Results When the amplitude (half of the moving rang) in the CC direction was 1 cm, the passing ratio of relative dose difference ≤4% in one beam field was minimal (1.1%), and there was 58% maximal relative dose absence. The 4% passing ratios media in the CC direction were 94.7%, 79.4%, 58.6% and 37.1% in <0.25, 0.25-<0.50, 0.50- <0.75 and ≥0.75 mm amplitude (X<'2>=29.20,P=0.000), but were all similar in the AP and LR directions. The mean value of the relative dose change in the high dose area was smaller than the low dose area in the 89% beam fields. When only the CC direction was consid-ered, the 4% passing ratio of 3.6 s and 8.2 s period was 72% and 60%, respectively. Conclusions The amplitude in the CC direction is a factor impacting the dose distribution of the moving target. The influence of respiratory motion on high dose area is more than that on low dose area. When the other respiratory param-eters are fixed, the motion of long period has more influence on the dose than that of short period. Special at-tention should be paid to the patients with tumor of more than 0.5 cm amplitude in the CC direction when planning the intensity modulated radiotherapy.

The conception and the history ofpoint, tender point and myofascial trigger point are described in the paper. All of three kinds of point are the reaction of musculoskeletal pain and visceral diseases. Theoretically,point originates from the theory of muscle region of meridian, tender point from the theory of soft tissue and muscles and myofascial trigger point from the theory of muscular fasciae. Anatomically,point is localized in the muscle region of meridian, on the boundary between muscles, tender point is on the muscular attachment to skeleton (the starting and ending points) and myofascial trigger point is on the motor point of neuromuscles. Pathologically,point reflects the disorders of soft tissue and internal organ, tender point reflects the disorders of soft tissue and myofascial trigger point reflects the disorders of soft tissue and few disorders of internal organ. To identify the relationship among them is very significant in the target treatment with acupuncture.

Objective To calculate the electric field intensity and transmembrane voltage of spherical cells and ellipsoi -dal red blood cells ( RBC) in an extremely low frequency electromagnetic field .Through this calculation , we can provide reference to the search for interaction targets and mechanics between the extremely low frequency electromagnetic field and organisms.Methods The Finite Element Method was used in the numerical computation for the spherical cell model and the ellipsoidal RBC model .Results The electric field intensity of the two types of cells on the cellular membrane was both significantly higher than the applied electric field strength , and the values of the induced field strength and transmembrane voltage varied with the direction of the electric field periodically .Conclusion The cell shape and direction of the applied electric field are not the main determinants of the cellular membrane electric field intensity and the transmembrane voltage compared with electromagnetic parameters .The distribution of the electric field intensity and transmembrane voltage are re-lated to the direction of the applied electric field.

OBJECTIVETo investigate the effects of arsenic trioxide (As(2)O(3)) on the apoptosis and p-glycoprotein (P-gp) expression of multidrug-resistant human leukemia cells.

METHODSHuman multidrug-resistant leukemia cell line K562/ADM overexpressing the MDR1 gene, was used as the target cells. The cell proliferating activity was assessed using the MTT colorimetric assay. Cytomorphology was investigated under light, confocal and electron microscopes. DNA fragmentation was examined using agarose gel electrophoresis, while p-gp expression, cell cycle status and sub-G1 cells were determined using flow cytometry.

RESULTSZero point five to 20 micromol/L As(2)O(3) inhibited the proliferation of K562/ADM cells, and K562/ADM cells were more sensitive to As(2)O(3) than the parental K562 cells. As(2)O(3)-induced apoptosis of K562/ADM cells was determined by the observance of typical morphological changes and the appearance of DNA ladder and sub-G1 cell populations. As(2)O(3) significantly inhibited the P-gp expression of K562/ADM cells, and synergistically enhanced the sensitivity of the drug-resistant cells to adriamycin.

CONCLUSIONSAs(2)O(3) induces growth-inhibition and apoptosis, down-regulates P-gp expression and exerts a synergistic effect in combination with adriamycin in multidrug-resistant leukemia cells.

ATP-Binding Cassette, Sub-Family B, Member 1 ; analysis ; Apoptosis ; drug effects ; Arsenicals ; pharmacology ; Drug Resistance, Multiple ; Gene Expression ; Genes, MDR ; Humans ; Leukemia ; genetics ; metabolism ; Oxides ; pharmacology

Objective:To investigate the associations of articular depression depth (ADD) and tibial plateau widening (TPW) by pre-operative CT measurement with incidence of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.Methods:Included in this retrospective study were 131 patients who had been admitted to Emergency Center of Trauma, The Third Hospital Affiliated to Hebei Medical University from January 2016 to January 2020 for Schatzker type Ⅱtibial plateau fractures. They were 88 males and 51 females, aged from 18 to 60 years (average, 41.5 years), with 74 right and 57 left sides injured. All patients were treated with closed reduction and internal fixation assisted by bidirectional traction. Arthroscopy was used to detect the status of lateral meniscus immediately after closed reduction and internal fixation of the fracture fragments. Furthermore, patients were divided into 2 groups according to the integrity of lateral meniscus: meniscal tear group ( n=70) and tear-free group ( n=61). The 2 groups were compared in terms of age, gender, body mass index(BMI), injury side, time interval from injury to surgery, TPW and ADD. The receiver operating curve (ROC) was drafted to calculate the cut-off values of TPW and ADD in complication of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture. Results:The overall incidence of lateral meniscal tear in this cohort was 53.4% (70/131). There was no statistically significant difference in terms of age, gender, injury side, BMI or time interval from injury to surgery between the 2 groups ( P>0.05); TPW and ADD were significantly higher in the meniscal tear group than in the tear-free group ( P<0.05). To predict lateral meniscal tear in patients with Schatzker type Ⅱtibial plateau fracture, the area under ROC was 0.656 (95% CI: 0.562 to 0.750, P=0.002) for TPW and 0.709 (95% CI: 0.619 to 0.800, P<0.001) for ADD, respectively; the cut-off values of TPW and ADD were 4.3 mm and 6.1 mm. Conclusion:TPW and ADD may be effective predictors for prediction of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.

Objective:To study the safety and feasibility of laparoscopic surgery for treatment of hepaticojejunostomy strictures after cholangiectasis surgery in children.Methods:The clinical data of 12 children was retrospectively analysed. There were 5 males and 7 females, aged 4 (range 0.45 to 9.00) years old, who developed hepaticojejunostomy strictures after cholangiectasis surgery and underwent reoperative treatment at Anhui Provincial Children's Hospital from January 2013 to January 2021. These patients were divided into the laparoscopic surgery group ( n=5) and the open surgery group ( n=7) based on the mode of reoperation. The children were followed-up by outpatient review and the relevant clinical data of the children in the 2 groups was analyzed. Results:The reoperations were completed successfully in the 2 groups. The maximum preoperative dilated common hepatic duct diameter was significantly larger in the laparoscopic group (1.26±0.23) cm than the open group (0.64±0.19) cm ( P<0.05). The alkaline phosphatase and glutamyltransferase levels in the laparoscopic surgery group were significantly lower before the operation (all P<0.05), and the total bilirubin, direct bilirubin, alkaline phosphatase, and glutamyltransferase levels were significantly lower in the laparotomy group than before the operations (all P<0.05). In the laparoscopic group, the time of the reoperations, postoperative hospital stay, and blood loss were 268(117, 340) min, (9.0±2.9) d and (14.0±5.5) ml, respectively, while those in the open group were 180(150, 205) min, (9.7±3.4) d and (13.3±2.6) ml, respectively. There were no significant differences between the two groups (all P>0.05). On follow-up, all children were well except for one child who showed mild elevation levels of alanine aminotransferase and aspartate aminotransferase. Conclusion:Laparoscopic surgery for hepaticojejunostomy strictures after cholangiectasis surgery in children was safe and feasible. Its curative effect was no less than that of open surgery.