Objective The changes of peripheral T cell subgroup in patients with rectal cancer preoperatively and postoperatively were studied dynamicly.Method Peripheral T cell subgroup of 46 patients with rectal cancer was measured dynamicly by the monoclonar antibody enzyme labelling techniques during the preoperative and postoperative period.Result (1)CD3 cell and CD4 cell decreased markedly,the CD4/CD8 rate increased apparently in patients with rectal cancer.(2)Depressed immunity was related to the term of cancer.(3)The immunity of patients treated by radical rectal resection may recover gradually,the immunity of patients treated by palliative rectal resection,colostomy and laparotomy was depressed constantly.Conclusion The depressed immunity of patient with rectal cancer was related to the tumour preponderance.T cell subgroup dynamic surveillance was important to juide the possibility of recurrence and prognosis in patient with rectal cancer.

Objective To investigate the feasibility of gene delivery to the ischemic myocardium of rabbits by ultrasound-mediated destruction of microbubbles. Methods A ligation model of left circumflex branch coronary artery was established in 48 rabbits. Three days after ligation, the mixture of gene and microbubbles was infused into the vein of rabbits with or without simultaneous ultrasound. Additional controls included ultrasound of microbubbles that did not contain gene, gene alone, gene plus ultrasound,and blank control. Rabbits were killed after two weeks and examined for the expression of vascular endothelial growth factor(VEGF). Results The hearts of five rabbits that underwent ultrasound-mediated destruction of microbubbles containing gene showed VEGF expression in ischemic myocardium.None of the control animals showed VEGF expression. Conclusions Ultrasound-mediated destruction of microbubbles is a promising method for the delivery of bioactive agents to the heart.

OBJECTIVE:To observe clinical efficacy and safety of paclitaxel or 5-fluorouracil combined with nadaplatin in the treatment of advanced nasopharyngeal carcinoma(NPC). METHODS:42 patients with advanced NPC were randomly divided into observation group and control group(n=21). 2 groups of patients were treated with radiotherapy. Observation group received che-motherapy of paclitaxel(135 mg/m2,d1)and nedaplatin(80 mg/m2,d 2-4);control group received chemotherapy of 5-fluoroura-cil(500 mg/m2,d1-5)and nedaplatin(80 mg/m2,d1-3);a treatment course lasted for 3 weeks,and both groups received 2 courses of treatment. Clinical efficacy, survival rate and ADR were observed in 2 groups. RESULTS:The overall response rate was 95.2%in observation group and 90.5% in control group,with no significant difference between 2 groups (P>0.05). The 3-year overall survival rate and progression-free survival rate were 81.0% and 71.4% in observation group and 76.2% and 66.6% in control group,with no significant difference(P>0.05). The incidence of nausea and vomiting in observation group were lower than in con-trol group,while the incidence of oral mucosa inflammation was higher than control group,with statistical significance(P<0.05). CONCLUSIONS:The chemoradiotherapy of paclitaxel or 5-fluorouracil combined with nadaplatin have similar therapeutic efficacy for advanced NPC. ADR by chemoradiotherapy should be monitored closely and treated timely.

Objective To evaluate the effect and complication of inductio n chemot herapy combined with three-dimensional conformal radiation therapy (3DCRT) for l ocally advanced non small cell lung cancer (NSCLC). Methods Ninety-two such pa t ients were randomized into radiation therapy alone group(RT-, 50 patients) and i nduction chemotherapy combined radiotherapy group (CMT-, 42 patients). The indu c tion chemotherapy consisted of 2-4 cycles of platinum-based regimen. Results Th e overall median survival time was 15 months with 12 months in the RT group and 18 months in the CMT group(P=0.014)respectively. The 1-year o verall survival rates were 48.6% and 71.2% in RT and CMT group,respectively (P=0.004). The 2-year survival rates w ere 20.8% and 37.6% in RT and CMT group, respectively (P=0.0 41). Treatment was w ell tolerated and the toxicities were similar in either group. C onclusion The ad dition of induction chemotherapy to 3DCRT takes a survival advantage over 3DCRT alone for Stage Ⅲ NSCLC without increasing toxicities.

Objective To investigate the feasibility of mono-segment pedicle instrumentation (MSPI)in management of thoracolumbar fracture (AO classification,A1 and A3) by being compared with short-segment(two-segment) pedicle instrumentation(SSPI).Methods Overall 141 patients with tape A1 or A3 thoracolumbar fractures,aged from 20 to 60 years (average,40.5 years),were enrolled in this prospective study.According to a simple randomized method,35 patients with type A1 fracture and 41 patients with type A3fracture were treated with MSPI,while 26 with type A1 fracture and 39 with type A3 fracture were treated with SSPI.Low back outcome score (LBOS) and ASIA2000 were used to evaluate clinical outcome.Eighteenth month postoperatively was assigned as the last follow up period.Wedge index (WI) and sagittal index (SI) of the affected vertebrae on radiography were measured and compared preoperatively,one week postoperatively and at the final follow-up.Results All patients were followed up successfully.The blood loss and duration of operation of MSPI group were significantly less than that of SSPI group,respectively.However,there were no significant differences of clinical outcome between two groups.For type A1 fracture,correction rate and correction loss of WI in MSPI group were better than those in SSPI group.For type A3 fracture,there were no significant differences of correction rate and correction loss of WI and SI between MSPI group and SSPI group; however,the failure rate of MSPI group was significantly higher than that of SSPI group.Conclusion For type A1 and partial type A3 thoracolumbar fractures,MSPI can provide the same or better fixation with less blood loss and operative duration than SSPI.Since MSPI for type A3.2 thoracolumbar fracture has a higher failure rate,the surgical indication should be strictly controlled.

The implementation of living donor liver transplantation not only extends the number of donors and effectively alleviates the shortage of organ donation, but also reduces the fatality of patients on the waiting list for liver transplantation. In recent years, with persistent development of laparoscopic techniques and instruments, laparoscopic donor liver hepatectomy has been widely applied in the field of living donor liver transplantation, which is also one of the research hotspots. It has multiple advantages of mild trauma, slight pain, accelerated postoperative recovery for the donors and slight psychological burden, etc. However, due to strict screening criteria for donors, complicated procedures and long learning curve, it has been carried out in a few transplantation centers nationwide. In this article, the development history and current status, specific surgical patterns, the problems and challenges of laparoscopic living donor liver procurement for liver transplantation were introduced, and the development direction of laparoscopic living donor liver procurement was predicted, aiming to provide reference for accelerating the development and enhancing clinical prognosis of living donor liver transplantation.

Objective To explore variety of suture methods in the prevention or reduction of calcaneal fracture incision complications.Methods The data on 120 patients receiving open reduction and internal fixation of the calcaneus fractures in our hospital from January 2014 to December 2015 were collected.A lateral L-like incisionwas used.Allgower-Donati suture,interrupted vertical mattress suture,intradermal suture,and interrupted suture were applied to manage the incision.The incidence of tension blisters in the incision and its surrounding areas,skin flap necrosis,stitch-cutting edge in the skin,and plate exposure was statistically analyzed.The SPSS 18.0 was used for statistical analysis,and P ＜ 0.05 was statistically significant.Results Postoperative complication rate was 6.7％ for Allgower-Donati suture,13.3％ for interrupted vertical mattress suture,26.7％ for intradermal suture and 33.3％ for interrupted suture (P ＜ 0.05).Conclusions Allgower-Donati suture can prevent or reduce wound complications of calcaneal fractures effectively,and it is worthy of extensive clinical use.

Objective This study aimed to investigate the effect of stage Ⅰ comprehensive cardiac rehabili-tation in patients with acute ST elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods A total of 72 patients with acute ST-segment elevation myocardial infarction combined with PCI admitted to the Department of Cardiovascular Medicine of Beijing Electric Power Hospital of State Grid Corporation from June 2021 to June 2022,which were selected as the research objectsand divided into control group and observation group randomly(36 cases in each group).The control group was treated with routine nursing and health education,and the observation group with stage Ⅰ comprehensive cardiac rehabilitation,including initial assessment(cardiovascular comprehensive assessment),exercise training(exercise training and breathing train-ing),daily activity suggestions and health education,discharge assessment(six-minute walking test and Barthel index assessment).The score of Barthel index(BI)at discharge,the 6-minute walking test distance(6MWD)at discharge,the incidence of major adverse cardiovascular event(MACE)during hospitalization and within one month of discharge,and the length of stay were compared between the two groups.Results After intervention,the six-minute walking test distance(6MWD)and Barthel index(BI)score in the observation group were better than those in the control group,the difference was statistically significant(P<0.05).The incidence of major adverse cardiovascular events(MACE)during hospitalization and one month after discharge was lower in the observation group than in the control group,and the difference was statistically significant(P<0.05).The length of hospital-ization in observation group was lower than that in control groupbut there was no statistical difference(P>0.05).Conclusion The application of phase Ⅰ comprehensive cardiac rehabilitation training in patients with acute ST-segment elevation myocardial infarction combined with emergency PCI could improve the patients'exercise ability,improve their ability of daily activity,reduce the incidence of major adverse cardiovascular events(MACE)in the early stage of the disease,facilitate the patients to return to their families and society as soon as possible,and improve their quality of life.It has high clinical application value.

The treatment of mediastinal tumor has always been a clinical difficulty due to its complex anatomical location and many important organs.Compared with traditional local treatment,endobronchial ultrasound guided laser multi-point ablation of mediastinal tumors has many advantages,including real-time monitoring of ablation range and effect,avoidance of damage to normal tissue and organs,few side effects and good tolerance.This article describes the standard operating procedure for endobronchial ultrasound guided laser multi-point ablation of mediastinal tumors.

Objective:To explore the causes and summarize the treatment experience for clinically relevant delayed gastric emptying(DGE) after laparoscopic pancreaticoduodenectomy(LPD).Methods:The clinical data of 1 000 patients who underwent LPD in the Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University between March 2017 and September 2022 was retrospectively collected. There were 640 males and 360 females,with an age of (60.1±11.4)years(range: 13 to 93 years),and 590 patients were older than 60 years. Depending on the severity of DGE,patients were divided into a clinically relevant DGE group and a 0/A grade DGE group. The comparison between the two groups was performed by the χ2 test,Fisher′s exact probability method, t test or the rank sum test,and the effects of various treatment strategies for clinically relevant DGE were evaluated. Results:LPD was conducted successfully in all 1 000 patients,with a surgical time of (344.8±103.6)minutes(range:160 to 450 minutes) and intraoperative blood loss ( M(IQR)) of 100 (150) ml(range:50 to 1 000 ml). A total of 74 patients(7.4%) developed clinically relevant DGE. Compared to those in the 0/A grade DGE group,patients in the clinically relevant DGE group had a higher preoperative body mass index of ((24.9±3.5)kg/m 2vs. (23.9±3.3)kg/m 2, t=-2.419, P=0.016),more postoperative bile leakage(51.4%(38/74) vs. 10.8%(100/926)),pancreatic fistula(59.5%(44/74) vs. 22.9%(212/926)),abdominal infection(74.3%(55/74) vs.14.6%(135/926)),and abdominal bleeding(43.2%(32/74) vs. 11.3%(105/926))(all P<0.05). Among these patients,10 cases(13.5%) received enteral nutrition treatment,22 cases(29.7%) received parenteral nutrition treatment,and 42 cases(56.8%) received a combination of enteral and parenteral nutrition treatment. The time for patients to return to a normal diet was 21(14)days (range: 8 to 85 days). Compared to those who received only enteral(23.5(27.0)days) or parenteral nutrition treatment(15.5(11.0)days),patients who received a combination of enteral and parenteral nutrition treatment(25.5(31.0)days) had a longer time to return to a normal diet ( Z=20.019, P<0.01). Among the 60 patients who developed secondary DGE,48 cases(80.0%) received ultrasound-guided puncture and drainage treatment,while 12 cases(20.0%) only received anti-infection treatment. The patients in the non-puncture drainage group had a longer time to return to a normal diet than those in the puncture drainage group (26.5(12.5)days vs. 20.0(11.0)days, Z=-2.369, P=0.018). Conclusions:Patients with clinically relevant DGE after LPD had a higher proportion of postoperative complications such as pancreatic fistula,biliary fistula and abdominal infection. A combination of enteral and parenteral nutrition treatment is needed for patients with a long-term course of DGE."Smooth" drainage and ani-infectious therapy could contribute to the recovery of DGE.