Objective To evaluation the clinical implemented and primary experience of TME combined the double-stapling technique in low rectal carcinoma anus-preserving resection. Methods 22 cases of low rectal carcinoma (the distance between the inferior verge of rectal turnout and the anal verge were 4～7cm) were operated by TME combined the double-stapling technique. Results All of the 22 cases of TME combined double-stapling procedure were successful without operative mortality. Correlative complications including anastomotic leakage (3 cases), anastomotic stenosis (1 case). Temporary completely defunctioning loop colostomy 4 cases. Conclusions TME combined the double-stapling technique in low rectal carcinoma anus-preserving resection is feasibility and the tumour pathology and clinical stage should be considered. Mastering expert operation skill and adherence to sound surgical priciples is the key to prevent and to decrease postoperative complication.

Objective To explore the prevention and management of surgieal complications in Miles operation.Methods Retrospectively analyzed the main complications appeared in 176 patients of Miles operation.Results There was the eolostomy-related complications in 19 cases.Presacral venous plexus hemorrhage in 4 cases.Intestinal obstruction in 10 cases.Wound infection of perineum in 12 eases.Lesion of urinary tract in 1 case.The common complication rate of Miles operation was 26.1%.Conclusion Mastering operation skill and adherence to sound snrgical principles is the key to prevent and to decrease intra-postoperative complication.

Objective To investigate the effect of Rosuvastatin on micro-inflammatory and serum lipids in hemodialysis patients. Method A total of 100 hemodialysis patients enrolled in our hospital from April 2014 to April 2016 was divided into control and treatment group. The control group received regular hemodialysis. The treat-ment group received regular hemodialysis combined with rosuvastatin. The general information ,micro inflammatory index ,serum lipids and clinical symptoms were compared between the two groups. There was no significant dif-ference between the two groups in terms of age,sexual,time of hemodialysis,primary disease,ultrafiltration vol-ume,MQSGA score,BUN,Scr,TC and TG. There was no significant difference between these two groups in terms of CRP ,IL-6 ,TNF-α,TC ,LDL ,TG before the treatment. The treatment group was significantly lower than that of control group ,in terms of CRP ,IL-6 ,TNF-α,TG ,LDL ,TC and BUA ,after treatment. In the 3-month treatment,50 patients in control and treatment group appears weakness:4 vs. 0(8%vs. 0%,P=0.041);fatigue symptom:7 vs. 1(14%vs. 2%,P=0.027);muscle spasm:8 vs. 2(16%vs. 4%,P=0.045);hypotension:5 vs. 0(4% vs. 2%,P = 0.021). Treatment group was remarkably lower than control group(P < 0.05). Conclusion Rosuvastatin can effectively alleviate the micro-inflammatory state of remission ,reduce serum lipid and uric acid in hemodialysis patients ,and improve the complications in hemodialysis.

Objective To investigate the application value of CEUS combined with biopsy in qualitative diagnosis of pe ripheral pulmonary lesions.Methods A total of 158 patients with peripheral pulmonary lesions underwent percutaneous puncture biopsy.Among them,97 cases underwent CEUS before biopsy (experiment group),and 61 cases underwent conventional ultrasound (control group).Puncture times,positive rate of samples pathological diagnosis and occurrence rate of complications were compared between the two groups.The time intensity curve (TIC) was used to obtain the rise time (RT),time to peak (TTP),wash-in slope (WIS) and peak intensity (PI).The parameters of TIC between the two groups were compared.The enhanced morphology of lesions was also observed and recorded.Results The positive rate of samples pathological diagnosis was 94.85 ％ (92/97) in experiment group and 83.61％ (51/61) in control group.The difference of the positive rate was significant between the two groups (P=0.02).In experiment and control group,the average puncture times were 2.11±0.48 and 2.20±0.44;While the occurrence rate of complications were 2.06％ (2/97) and 4.91％ (3/61).No significant difference was found of the average puncture times and the occurrence rate of complications between the two groups (both P＞0.05).While the statistical differences of RT,PI and WIS were found between benign and malignant lesions (all P＜0.05) in experiment group.And no statistical difference of TTP was found (P =0.08).Totally 77.50％ (31/40) of the benign lesions showed inhomogeneous enhancement,while the proportion was 88.46％ (46/52) in malignant lesions.There was no statistical difference of enhanced morphology between benign and malignant lesions (P=0.16).Conclusion CEUS is helpful in distinguishing benign and malignant peripheral pulmonary lesions.And it has great value in guiding percutaneous biopsy in peripheral pulmonary lesions.

The paper introduced the background and concepts of municipal trusteeship of district-launched medical institutions, with the trusteeship of women and children′s hospital of Shunyi district as an example.In addition to the main approaches and contributions in improving hospital management, delivery of quality medical resources to primary care, and capacity building, the authors called for the support for standardized healthcare, respect for original hospital culture, and sustained government support to the hospital in question among other points, for reference of further public hospital reform.

Objective To analyze the mutation characteristics of GBA gene in one patient with Gaucher disease and platelet transfusion refractoriness.Methods A female patient with anemia and thrombocytopenia showed platelet transfusion refractoriness,and then the proband and her family were performed bone marrow smear,β-glucocerebrosidase activity in leukocytes (dried blood spot assay),Bultrasonography and gene sequencing examination and pedigree investigation.Results Pedigree investigation showed that the heterozygous mutation of GBA gene existed in the father,mother,son,daughter and sister of the proband.Bone marrow cytomorphologic examination showed that Gaucher cells accounted for 6.0％ in the female patient.The β-glucocerebrosidase activity in leukocytes was 3.78 nmol/(h · mg Pro).B-ultrasonography showed slightly splenomegaly.Gene sequencing found that the homozygous mutation of GBA gene,c.484A ＞ G,existed in the female patient.Conclusion The patients with Gaucher disease may appear platelet transfusion refractoriness due to hypersplenism.The mutation of GBA gene is the main pathogenic factor of the family with Gaucher disease.

Objective To evaluate the value of acoustic radiation force impulse imaging (ARFI) technique in differential diagnosis of renal tumors.Methods Totally 86 patients with 86 renal tumors underwent conventional ultrasound and ultrasound with ARFI technique.The shear wave velocity (SWV),virtual touch tissue imaging (VTI) score between tumors and the surrounding renal parenchyma,benign and malignant tumors were compared.Results In 86 patients with renal tumors,32 cases were renal benign tumors and all them were angiomyolipomas (AML),54 cases were renal malignant tumors,inculding 26 cases of renal clear cell carcinoma (ccRCC),8 cases of renal color cell carcinoma (cRCC),5 cases of renal papillary carcinoma (pRCC),15 cases of invasive urothelial carcinoma (IUC).The difference of SWV and VTI scores between lesions and the surrounding renal parenchyma were statistically significant (both P＜0.05).The SWV and VTI score renal benign tumors were lower than those of malignant tumors (both P＜0.05).The area under the ROC curve with SWV＞1.37 m/s or VTI score＞3.83 to distinguish benign and malignant renal tumors were 0.898,0.847,sensitivity were 88.9％,83.3％,specificity were 84.4％,78.1％,respectively (P＜0.05).Among renal malignant tumors,SWV and VTI score of ccRCC significantly higher than those of other malignant tumors,and the area under the ROC curve with SWV＞2.06 m/s or VTI score＞4.31 to distinguish ccRCC and other renal malignant renal tumors were 0.766,0.729,sensitivity were 65.4％,57.7％,specificity was 82.1％,78.6％,respectively (P＜0.05).Conclusion ARFI has important value in differential diagnosis of renal tumors,and can help to distinguish ccRCC with other renal malignant tumors.

Objective To explore the diagnostic value of CEUS for thyroid TI-RADS 3,4 nodules.Methods The CEUS performence of 95 patients with thyroid TI-RADS 3,4 nodules (all were confirmed by surgery pathology) diagosed by conventional ultrasound were reviewed retrospectively,and the value of CEUS in the revision and differential diagnosis of thyroid TI-RADS 3,4 nodules were analyzed.Results Compared with pathological pattern,conventional ultrasound TI-RADS classifications in assessing the property of thyroid nodule had no statistical differences (χ2 =3.56,P =0.06).For thyroid TI-RADS 3,4 nodules,compared with conventional ultrasound TI-RADS classifications,the diagnosis accuracy of CEUS score and revised CEUS TI-RADS classifications showed significant differeces respectively (P=0.03,＜0.01) for thyroid papillary carcinoma greater than 1 cm.But no statistical difference were found respectively (P=0.25,1.00) for thyroid papillary carcinoma smaller than 1 cm.According to the ROC curve analysis,the area under the curve of traditional ultrasound TI-RADS classifications,CEUS score and revised CEUS TI-RADS classifications were 0.64,0.75,0.81 respectively,cut-off value was TI-RADS 4a,1 score,TI-RADS 4a respectively,the sensitivity and specificity of evaluating benign and malignant nodules was 45.3％ and 80.0％,69.3％ and 65.0％,82.7％ and 60.0％,respectively.The area under the ROC curve were statistical difference between CEUS score,revised CEUS TI-RADS classifications and conventional ultrasound TI-RADS classifications (both P＜0.05),while CEUS score and revised CEUS TI-RADS classifications without statistical difference.Conclusion CEUS had the revised and improved identification value for thyroid TI-RADS 3,4 nodules.

The ancient discussion and modern clinical application regarding Yingxiang (LI 20) and Neiyingxiang (EX-HN 9) in acupuncture verses are explored. Acupuncture verses are the summary of clinical experiences of acupuncture scholars in the past dynasties, of which the records on application of Yingxiang (LI 20) and Neiyingxiang (EX-HN 9) mainly focused on nasal, facial and head-eye diseases, which is characterized with overall summarization, brilliant exposition, simple language, and distinctive characteristics. Nowadays, based on the ancient usage, the clinical application about these two acupoints is continuously developing. If the ancient acupuncture verses could be understood thoroughly, the clinical practice could be better guided and its effects could be improved.
Acupuncture Points ; Acupuncture Therapy ; history ; China ; History, Ancient ; Humans ; Medicine in Literature ; Rhinitis, Allergic ; therapy

Objective To study the change and significance of osteoprotegerin(OPG)/receptor activator of NF κB ligand(RANKL)during the process of rat arterial smooth muscle cells (SMC) to differentiate subgroups:7 d (early) subgroup and 14 d (late) subgroup.into osteoblast-like cells.Methods The rat arterial SMCs were divided randomly into the SMC group,atorvastatin group,and osteoblast-like group.Each group was also divided into 2.The osteoblast-like group was given β-glycerophosphate and vitamin C in culture medium,the atorvastatin group was given both β-glycerophosphate,vitamin C and atorvastatin.Von Kossa staining,Ca2+ content assay,ALP activity assay and osteocalcin assayed with Western blot were used to check the level of calcification.Real-time PCR was used to check the mRNA expressions of OPG and RANKL.Results There was high expression of OPG (early 2.71 ±0.08,late 2.69 ±0.02) but no RANKL in the SMC group all the time.The expressions of OPG were increased in the early subgroup and decreased in late subgroup in the atorvastatin group (early 3.52±0.05,late 2.50±0.03) and osteoblast-like group (early 4.18±0.10,late 2.30 ± 0.11).And the expressions of RANKL were both increased in the atorvastatin group and osteoblast-like group dnring the calcification process (from 1.01 ± 0.19 to 2.40 ± 0.10,and from 1.70±0.07 to 3.22±0.11,respectively).Among the three groups,the ratio of OPG/RANKL was decreased with the increasing calcification level (F =52.93,2.33,both P＜0.05).And compared with the early subgroups,the ratio of OPG/RANKL in the late subgroups was also decreased along with the increase of calcification level in each group(F=38.71,1.74,both P＜0.05).Conclusions The ratio of OPG/RANKL has a negative correlation with the level of the osteoblast-like cells differentiation,and atorvastatin could inhibit the calcification.