Objective To investigate the treatment of local recurrence after sphincter preserving surgery for low rectal cancer. Methods Fifty-six patients with local recurrence after sphincter preserving surgery for low rectal cancer were divided into three groups, 20 cases underwent radical resection (group A), 21 cases underwent palliative resection combined with 3 dimensional conformal radiation therapy (group B), and 15 cases only received 3 dimensional conformal radiation therapy (group C). Results All the patients were followed up from 6 months to 3 years. The 1-year,2-year and 3-year survival rates were 100.0%(20/20),80.0% (16/20),65.0% (13/20) in group A,90.5% (19/21),52.4% (11/21),33.3% (7/21) in group B and 80.0%(12/15),40.0%(6/15),20.0%(3/15) in group C respectively. Both 2-year and 3-year survival rates in group A were significantly higher than those in group B and group C (P <0.05). Conclusions The first choice of patients with local recurrence after sphincter preserving surgery for low rectal cancer is radical resection. Palliative resection combined with 3 dimensional conformal radiation therapy is the second choice.

Objective To evaluate the clinical application value of susceptibility weighted imaging (SWI) in neonatal hy-poxic ischemic encephalopathy (HIE). Methods Thirty-six neonates with HIE were collected and scanned by GE 3.0 T supercon-ducting MR scanner. Routine axial T1WI, T2WI, FLAIR scan and axial SWI scan were conducted. SWI sequence was compared with conventional head MRI sequences in detection rate of distribution and quantity of intracranial hemorrhage. Meanwhile, the display condition of the dilated cerebral deep veins and cortical veins was observed on SWI image and the performance of HIE in different clinical classification on SWI was compared. Results A total of 97 intracranial hemorrhages were detected by SWI in 27 cases. Only 41, 27 and 51 hemorrhages were found by TIWI, T2WI and FLAIR sequences, respectively. SWI were significantly superior to T1WI, T2WI and FLAIR in displaying the size, scope and boundary definition of hemorrhage. A total of 50 dilated ce-rebral deep veins and cortical veins were detected by SWI in 22 cases which were not found by conventional head sequences. The detection rates of intracranial hemorrhage and intracranial hemorrhage in addition of dilated cerebral veins on SWI sequence were the lowest in mild HIE group, and highest in severe group. There was significant difference among the mild, medium and severe groups (P<0.05). Conclusions SWI sequence has higher sensitivity than conventional MRI sequence in detecting intracranial hemorrhage and dilated vein in HIE, and is useful for early diagnosis of HIE.

AIM: To observe the effect of small dose ephedrine on hypote ns ion as the lithotomy position in laying down legs after the aged in the operatio ns with epidural anesthesia. METHODS: Twenty-seven ASA Ⅰ-Ⅱma le patients, aged 65-83 (71? 6.5 ) years undergoing transurethral resection of prostate (TURP) with the lithotomy position were randomly assigned to two gro ups by double blind method: ephedrine group (n=13) and contrasti ve group (n=14). The continual epidural anesthesia was administe red in T 12 -L 1 and L 3-4 for all patients used 1.5 % lidocaine. W hen the operation was finished off, before thirty seconds of horizontal position laying down legs, 15 mg ephedrine was iv at ephedrine group and 3 ml saline wat er at control group. After legs were laid down on the lithotomy position, variab les of SBP, MBP and P were recorded in ten minutes. RESULTS: Dur ing ten minutes after double legs were laid down, the variables were lightly ris en about 8.7 % to 76.9 % in ephedrine group and were fallen about 7.8 % to 85.7 % in control group. The difference on variables of two groups was significant (P

Objective To investigatc thc short-term clinical and radiographic outcomes of tantalum trabecular metal (TM) components associated with TM augments for Paprosky type Ⅱ and type Ⅲ acetabular defects in revision hip arthroplasty.Methods From June 2014 to April 2016,seventeen patients with aseptic loosening underwent revision total hip arthroplasty for Paprosky type Ⅱ or type Ⅲ acetabular defects with TM revision acetabular cups and TM augments.The subjects consisted of 5 males and 12 females with mean age of 56.6 years (range 30-75).Acetabular bony defects were Paprosky type Ⅱ A in 4 hips,Ⅱ B in 3 hips,Ⅲ A in 8 and Ⅲ B in 2 hips.The whole hip revision was performed in 13 hips and acetabular reconstruction in 4 hips.Preand post-operative functional outcomes were accessed by the Harris Hip Score.The vertical and horizontal position of the rotation center from the intertear drop line were measured and analyzed.Complications were recorded during the follow-up.Radiographic examination was performed after operation immediately by X-ray.The recent X-ray was conducted to assess bone ingrowths at the cup-bone or augments-bone interface,radiolucent lines and implant migration.Results All of the patients were followed-up for an average of 23 months (range 11-33 months).There was no infection,dislocation or periprosthetic fracture complications at the last followed-up.The Harris Hip Score was improved from 45.8±3.4 pre-operatively to 79.2±7.5 post-operatively (t=-16.8,P=0.00).The mean vertical distance of the center of rotation was 32.1±4.3 mm preoperatively and 14.5±2.3 mm postoperatively (t=14.8,P=0.00).The mean horizontal distance of the center of rotation was 33.6±6.1 mm preoperatively and 27.8±3.2 mm postoperatively (t=3.5,P=0.00).More than 3 radiographic signs of osseointegration were observed in 11 hips.No progressive radiolucent lines or component migration was observed.All the TM components were well-fixed at last follow-up.Conclusion Using tantalum TM cups with TM augments in revision hip arthroplasty could be regarded as an effective management for Paprosky type Ⅱ and type Ⅲ acetabular defects.This technology can avoid using over-large cup,provide reliable primary stability,restore the center of rotation with almost normal hip biomechanics and improve the functional outcome.

Objective To study the dynamic imaging changes of the uterine leiomyomas before and after uterine arterial embolization (UAE) treatment and to discuss its therapeutic mechanism. Methods Color Doppler senography and both plain and enhanced MR[scanning were performed in 45 patients with uterine leiomyomas before and after UAE. Plain CT scan was performed in all patients after UAE. All the patients were followed up for 3-16 months (average 10±3.5 months). Results In 41 of the total 45 cases, the color Doppler senography showed rich blood flow signals in leiomyomas and myometrium before UAE and no or less blood flow signals in both leiomyomas and myometrium on the first day after UAE. On the seventh day, the blood flow signal was still absent in leiomyomas while it was restored in myometrium, and the same phenomena remained in the first, the third and the twelfth month after UAE. In the other four eases, color Doppler sonography demonstrated blood flow signals inside leiomyomas on the seventh day after UAE and it remained till twelve months after embolization. The embolic agent (Lipiodol) was found in both leiomyomas and myometrium on CT scan for 45 cases on the first day of UAE. CT scan also showed the deposit of the Lipiodol in myometrium, but Lipiodol gradually vanished in leiomyomas at one, three and the twelve months after UAE. The enhancement was apparent in leiomyomas and myometrium on MRI scan in all 45 cases before UAE. The enhancement was found in the myometrium, but not in leiomyomas, on MRI scan in 39 cases 3 months after UAE. The other six cases demonstrated different degrees of enhancement in leinmyomas after embolization. In two cases the detachment of the leiomyomas were observed after embolization and the desquamating materials were pathologicallyproved to be necrotic tissue. The difference in the measuring data about leiomyoma volume between MPI and color Doppler sonography was of no statistical significance (P > 0.05). Conclusion The therapeutic mechanism of UAE for uterine leiomyomas is selectively embolizing the vascular bed of uterus, leading to subsequent necrosis of leiomyomas. The color Doppler sonography should be the fast choice for the dynamic imaging follow-up after UAE.

BACKGROUND: Femoral head necrosis can be induced in adult rabbits when a large dose of steroid has been used for a long time. However, the pathogenesis of steroid-induced femoral head necrosis needs further study.OBJECTIVE: To probe into the mechanism of the disease by light microscope and transmission microscope from morphological perspective based on the model of femoral head necrosis in rabbits.DESIGN: A randomized controlled observation.SETTING: Laboratory of Morphology; Teaching and Research Division of Pathology; Laboratory of Surgery, Weifang Medical College.MATERIALS: The experiment was carried out at the Experimental Center of Morphology, Weifang Medical College, between March 2002 and March 2003. Totally 40 adult New Zealand white rabbits were randomly divided into control group (n=10), dexamethasone group (n=10) and horse serum group (n=20).METHODS: Control group was given intravenous injection of normal saline of 10 mL/(kg·d) for 7 consecutive days. Dexamethasone group was given intramuscular injection of dexamethasone of 10 mL/(kg ·d)for 7consecutive days. Horse serum group was given intravenous administration of horse serum of 10 mL/kg; 3 weeks later the same volume of horse serum was injected once again, followed intramuscular injection of dexamethasone of 10 mL/(kg·d)for 7 consecutive days. Inferior sections of cartilage of the femoral head necrosis in the experimental animals were obtained 5 and 10weeks later, and then histological and ultrastructural changes were observed under the light microscope and transmission microscope.MAIN OUTCOME MEASURES: ① Histo-morphological observation of the animals in each group. ② Ultrastructural changes.RESULTS: All the experimental animals survived and entered the result analysis. ① Histo-morphological observation: The cells of inferior sections of cartilage of the femoral head necrosis of the experimental animals in control group were arranged regularly and had a small volume of elliptical bone cells. The cell body was located at bone lacuna, blood vessel arranged well in the medullary cavity of bone. Lesion haracteristics of femoral head in dexamethasone group and horse serum group were similar:Hematopoietic adipose in the medullary cavity of bone was significantly decreased while fat adipose obviously increased; bone trabecula of metaphysis and the inferior sections of cartilage of femoral head were found with ered, and so was the bone nucleus. The number of lacuna of bone was increased. ② Ultrastructural changes: Normal bone cells in control group were elliptical, located at bone lacuna. Nucleus was at one end of the cell with complete karyotheca and many mitochondria in the cytoplasm. In dexamethasone group and horse serum group there were lipid droplets in the osteocytes, narrowed blood capillary in the medullary cavity of bone and injured vascular endothelial cells.CONCLUSION: Corticotropin can induce necrosis of femoral head; the hormone causes accumulated fat adipose in the medullary cavity of bone.The increased internal pressure in the medullary cavity leads to ischemia of femoral head, thus inducing the necrosis of osteocytes.

BACKGROUND:Uterine arterial embolization is a minimal y invasive technique and widely used for the treatment of several obstetrics and genecology diseases. However, reports about the influence of uterine arterial embolization on the pathophysiological microvessel density and angiogenesis changes in the endometrium have been very limited.
OBJECTIVE:To investigate the influence of uterine artery embolization on endometrial microvessel density and neovascularization.
METHODS:Sixty female guinea pigs were randomly divided into control group (n=15) and uterine artery embolization group (n=45). In the uterine artery embolization group, trisacryl gelatin microspheres (Embosphere) was used to perform uterine artery embolization and animals were further divided into three subgroups including E1, E2, and E3 (n=15 in each subgroup). Uterine specimens were col ected at 7-15 days, 16-30 days, and 31-45 days after uterine artery embolization respectively in the three subgroups.
RESULTS AND CONCLUSION:Microspheres were visible in the lumen of primary branch of uterine artery, subserosal arteriole and intramuscular arteriole. Statistical analysis demonstrated that CD34-positive microvessel density of the endometrial basal layer significantly decreased after uterine artery embolization, and reverted to the normal level (P<0.05). Increase of neovascularization with CD105-postive microvessel density presented after uterine artery embolization, and then returned to the normal (P<0.05). These findings indicate that uterine artery embolization may lead to a temporal decrease of microvessel density in the endometrium which wil recover over time as a result of the increase of CD105-postive neovascularization.

Objective To investigate the feasibility of diffusion-weighted(DWI) MRI on basis of the intravoxel incoherent motion (IVIM) in nasopharyngeal carcinoma (NPC),and the diagnostic value of pure molecular diffusion coefficient (D),perfusion-related diffusion coefficient (D *) and perfusion fraction (f) in first onset NPC.Methods From December 2011 to January 2013,40 consecutive patients (26 men,14 women; median age,52 years) with suspected NPC were examined on a 3.0 T MR scanner.DW imaging was performed by using a single-shot echo-planar sequence with 13 b-values (0,10,20,30,50,80,100,150,200,300,400,600,800 s/mm2).MR imaging was compared with endoscopy and biopsy for the detection of NPC.Mean interval time between MR imaging examination and subsequent nasopharyngeal biopsy was 3 days (range,0-11 days).The subjects were divided into 2 groups according to the pathological results,group A was subjects with NPC (17 men,9 women; median age,35) and group B was ones with nasopharyngeal chronic hyperplastic inflammation(NPH) (9 men,5 women; median age,35).The D,D * and f were measured and compared in patients with first onset NPC and nasopharyngeal hyperplasia (Mann-Whitney test).Results IVIM DWI was successful in 24/26 with NPC and 12/14 with NPH.D value was significantly lower in A group compared with B group [mean,(0.70 ± 0.13) ×10-3 mm2/s vs (0.78 ± 0.05) × 10-3 mm2/s ; U =2.05,P ＜ 0.05],as was f value [mean,(16.25 ±1.46) ％ vs (26.20 ± 3.90) ％ ; U =11.16,P ＜ 0.01].However,D* value was significantly higher in Agroupas compared with B group[mean,(161.8 ±23.56) × 10-3 mm2/s vs (55.28 ± 17.05) × 10-3 mm2/s; U =13.90,P ＜0.01].Conclusions IVIM DWI is a feasible technique for investigating first onset NPC and D value has a certain value in differentiating NPC and NPH.D* value has an important potential value in distinguishing benign and malignant NPC.

BACKGROUND:The magnetic resonance molecular imaging used in the research of lumbar disc degeneration includes T2 mapping and T1ρtechnologies at present.
OBJECTIVE:To evaluate the feasibility of 1.5 T MR equipment on T2 mapping of New Zealand white rabbits lumbar disc.
METHODS:T2 mapping images of New Zealand white rabbit lumbar discs were obtained on 1.5 T MR equipment. The regions of interest T2 values of lumbar discs were measured with post-processing workstation.
RESULTS AND CONCLUSION:Sagittal and coronal T2 maps of 3-month rabbit discs were obtained
satisfactorily on 1.5 T MR equipment. The regions of interest T2 values of nucleus pulposus in L 4/5 , L 5/6 and L 6/7 discs were (104.6±14.0) ms, (109.1±13.8) ms and (109.5±15.1) ms respectively at Pfirrmann
regions of interest T2 values of anterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (82.1±9.5) ms, (80.4± 11.2) ms and (79.9±10.6) ms respectively, and T2 values of posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (85.8±11.9) ms, (85.1±12.1) ms and (85.3±9.3) ms respectively. There were no significant differences in T2 values of nucleus pulposus, anterior annulus fibrosus and posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs at PfirrmannⅠP>g 0ra.0d5e).( However, the T2 values of nucleus pulposus were higher than those of annulus
fibrosus in the same discs (P<0.01), and there were no significant differences in T2 values between the anterior and posterior annulus fibrosus (P>0.05). The T2 values of rabbit lumbar discs obtained on 1.5 T MR equipment can be used for quantitative assessment of intervertebral disc signal.

Pulmonary vein isolation (PVI) is a new ,effective and radical method to cure atrial fibrillation .Within a period after radiofrequency ablation (RFA) ,coagulation system is activated in patients ,then thrombus incident such as cerebral embolism may happen .The present article made a review on its mechanism .