Objective To investigate the clinical application of early postoperative enteral nutrition in patients undergoing colon cancer operation.Methods 90 patients suffering from colon cancer were randomly divided into the enteral nutrition group,indwelling stomach tube group and the control group.The control group was given conventional treatment and the indwelling gastric tube group was received postoperative intermittent clamping of stomach tube and enteral nutrition.Moreover,patients in the enteral nutrition group were pulled out the tube on the first postoperative day while giving enteral nutrition.All patients were observed for exhaust defecation time,length of hospital stay postoperative and nutrition indicators.Results Exhaust defecation time,length of hospital stay postoperative had significant difference among three groups.Indwelling stomach tube group set minimum length of stay and first passage of flatus and defecation in the three groups [the enteral nutrition group:(50.07±11.59) h,(76.75±27.37) h,(10.1 1±1.57) d,the control group:(62.03±12.31) h,(90.67±25.64) h,(11.80±1.83) d,indwelling stomach tube group:(43.53±11.94) h,(61.17± 22.67) h,(8.70±1.53) d (P ＜ 0.05)].The levels of hemoglobin and plasma albumin one week after operation were statistically lower than pre-operation,while that the level of these nutrition indicators were higher in indwelling stomach tube group compare to control group (all P ＜ 0.05).The same result was observed between enteral nutrition group and control group.Whereas,the change of nutrition indicators between the enteral nutrition group and the control group was not statistical significant (P ＞ 0.05).Conclusion Indwelling stomach tube combined with enteral nutrition is a reasonable choice for patients after colonic cancer surgery.

Objective To investigate the operational timing and manner for the digestive tract reconstruction after Hartmann procedure and the prevention for the postoperative complications in the patients with left colorectal cancer.Methods The data of twenty-four cases with digestive tract reconstruction were analysed retrospectively containing the cause of Hartmann procedure for left colorectal cancer,preoperative evaluation of the digestive tract reconstruction,operation timing,operation manner,postoperative complications and length of hospital stay and so on.Results Three of 24 patients gave up the digestive tract reconstruction due to the results of their distant metastasis detection in the preoperative evaluation.As a commonly manner of digestive tract reconstruction,rectum-sigmoid colon or sigmoid-descending colon end-end anastomosis was used for 17 patients.Meanwhile,ascending colon-sigmoid colon end-side anastomosis was used for 4 patients.The incidence of postoperative complications was 14.29 ％ (3/21),and the mean time of postoperative hospital stay was 10.5 days.Conclusions In patients undergoing Hartmann procedure for left colorectal cancer,adequate assessment of the tumor recurrence and metastasis is necessary.In addition,the optimal timing of surgery should be selected after completion of chemotherapy,and operational manner should be determined by the situation of intraoperative exploration.

Objective To explore the value of ultra?high b?value DWI in diagnosis of prostate cancer in central gland. Methods Seventy?one consecutive patients, who were scheduled for prostate biopsy, were prospectively screened. T2WI, conventional DWI with b?value of 1 000 s/mm2 and ultra?high b?value DWI with b?value of 2 000 s/mm2 and 3 000 s/mm2 were performed in each examination. Twelve?core ultrasound guided prostate systematic biopsy was operated within 3 weeks after MRI examination. Images were interpreted based on prostate MR guidelines (PI?RADS) and were corresponding to histological results conducted by ultrasound guided prostate systematic biopsy. Using biopsy as the gold standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for different imaging methods. Sensitivity and specificity differences between ultra?high b?value DWI and conventional DWI were analyzed using the McNemar test. The areas under the curves (AUCs) between ultra?high b?value DWI and other modalities were compared by using the Z test. Results Forty lesions were identified in the prostate central glands from the 33 sample patients in 71 examinees. Twenty two lesions were identified as prostate cancer in 15 patients and 18 lesions were identified as benign prostatic hyperplasia in 18 patients. MRI analysis of lesions in central gland, 27 (67.5%), 20 (50.0%), 32 (80.0%) and 35 (87.5%) were diagnosed accurately with the T2WI, conventional DWI and ultra?high b?value DWI (b=2 000, 3 000 s/mm2) respectively. The sensitivity and specificity for ultra?high b?value DWI was 90.9%and 83.3% with a b?value of 3 000 s/mm2 and was 86.4% and 72.2% for 2 000 s/mm2. These values were significantly higher than conventional DWI with a b?value of 1 000 s/mm2 (59.1%and 38.9%, P<0.05). The detection of lesions was comparable with ultra?high b?value DWI at 2 000 s/mm2 and 3 000 s/mm2 (P>0.05). The AUCs were 0.674, 0.510, 0.793 and 0.871 in T2WI, conventional DWI and ultra?high b?value DWI at 2 000 s/mm2 and 3 000 s/mm2 respectively. ROC analysis showed greater AUCs for the ultra?high b value DWI, than for the T2WI and conventional DWI (P<0.05). Conclusion The ultra?high b?value DWI is a valuable MRI modality in the diagnosis of prostate cancer in central gland.

Objective To document the MRI features of renal angiomyolipoma (RAML) containing minimal fat and to explore whether the MR features vary depending on the tumor size. Methods The MR findings of 15 cases of pathologically-proved RAML containing minimal fat were reviewed retrospectively from January 2008 to March 2010. All patients underwent MR in a 1.5 T or 3.0 T scanners. The MR features of the lesions were analyzed, with emphasis on the signal intensity and homogeneity on T2WI, in regards to pseudocapsule, lipid component, hemorrhage, cystic degeneration or necrosis, blood vessels, interface with renal parenchyma and enhancement pattern. All lesions were categorized into 2 groups; those with diameter ＞4 cm and those with diameter ≤4 cm. The difference of imaging characteristics between these two groups was analyzed using Fisher exact test. Results All 15 lesions demonstrated hypointensity on T2WI compared to the renal parenchyma. Homogeneous signal intensity on T2WI was seen in 6 lesions (6/15); peritumoral pseudocapsule in 3 lesions (3/15); cystic degeneration or necrosis, hemorrhage in 5 lesions (5/15); flow void of blood vessels in 2 lesions (2/15); lipid component in 4 lesions (4/15); angular interface with renal parenchyma in 10 lesions (10/15); homogeneous enhancement in 8 lesions (8/15). Fifteen lesions were divided into two groups; 9 categorized into group 1 (the maximum diameter ≤ 4 cm) and 6 into group 2 ( the maximum diameter ＞ 4 cm). Cystic degeneration or necrosis was seen in 0 of 9 in group one and 5 of 6 in group two respectively, hemorrhage(0 of 9 and 5 of 6 respectively) and pseudocapsule(0 of 9 and 3 of 6 respectively. The difference between these findings in the two groups demonstrated statistical significance (P ＜ 0. 05). Conclusion The MR features of RAML containing miminal fat were hypointensity on T2 WI,angular interface with renal parenchyma and homogeneous contrast enhancement, however, these findings can vary depending on the tumor size.

Objective To compare two separation medium of isolation of adult rat cardiomyocytes , and to observe the characteristics of excitation-contraction coupling of cardiomyocytes .Methods The isolated adult rat heart was hanged on to the Langendorff apparatus for aortic counter-current perfusion and collagenase digestion using two different separation medium.The single cardiomyocytes were cultured and infected with adenovirus . The morphological features of cardiomyocytes were observed with microscope and fluorescent microscope . The shortening-re-lengthening features of sarcomere and the intake-discharge features of calcium were simultaneously recorded by IonOptix equipment .Results 70%rod-shaped with clear-striation adult rat cardiomyocytes could be obtained with the stated two separation medium and cultured in serum-free medium for more than 7 days.GFP could express more than 7 days when the cardiomyocytes were infected with adenovirus .Cardiomyocytes obtained by the first separation medium could not contract with the electrical stimulation, while cardiomyoctyes obtained by the second separation medium could be used for the detection of excitation -contraction coupling .The shortening fraction of sarcomere was 11.61%±2.15% and the relaxing time was ( 0.177 ± 0.031) s.The amplitude of calcium transient was 30.79% ±9.74 % and the decaying time of calcium transient was (0.300 ±0.074) s.Conclusion With the stated two separation medium , adult rat cardiomyocytes can be well isolated , cultured and infected with adenovirus .The second separation medium can be used for the detection of excitation-contraction coupling characteristics .

Objective To investigate MRI features of metanephric adenoma(MA). Methods The retrospective analysis was performed on 6 adult patients that were scanned by regular, DWI and dynamic-enhancement MRI two weeks before surgery and diagnosed with MA pathologically after surgery. MRI features of lesions were observed. The signal intensities of lesions and contralateral normal renal cortex and medulla were respectively measured in plain scan, cortex, parenchyma and delayed phase. The enhancement magnitudes were calculated and the ADC values of lesions were measured. The differences of the signal intensity and enhancement magnitude were assessed by paired-sample t test among renal cotex, medulla and lesions. Results All lesions in MA were single and solid masses. Four cases occurred in the right kidney and two cases in the left kidney. The maximum diameters of the lesions ranged from 21 to 79 mm and the mean value was(41 ± 20)mm. Five cases were round or oval, while one case was irregular. The signal intensity in five cases was slightly lower in T2WI than the renal parenchyma, while one case was slightly higher than the renal parenchyma. The hyperintentsity of DWI and hypointensity of ADC were seen in all cases. The mean ADC value was(0.759 ± 0.211) × 10-3mm2/s. Hemorrhage were seen in two cases. Necrosis was present in one case and the capsules were seen in two cases. No scar, fat and swollen lymph nodes was seen in all cases . There was no statistical significance of the signal intensity between lesions measure in the plain scan and normal renal parenchyma(P>0.05). After adminstrating contrast materials, all lesions shown persistently mild to moderate enhancement . The siganl intensities of lesions measured in three phases after enhancement were signifcantly lower than those of the renal cortex(P<0.05). No significant differences of the signal intensity measured in cortex and medulla phase between lesions and normal renal medulla was present(P>0.05). But the signal intensities of leisons in delayed phases were significantly lower than thoseof renal medulla(P<0.05). Except from the difference of enhanced magnitude in cortex phase between lesions and normal medulla, significant differences were present between leisons and normal renal parenchyma(P<0.05). Conclusion MRI manifestations of MA show certain distinction, including, dominantly solid lesions, relatively lower signal intensity of lesions than that of renal cortex, slowly persistent enhancement, high signal on DWI and low signal on ADC.

Objective Explore the spine fractures treated by percutaneous one-way pedicle screws surgery compared with curative effect of traditional open surgery.Methods From October 2012 to October 2015,to collect 61 patients with single segmental thoracolumbar fractures were retrospectively analyzed,respectively for percutaneous minimally invasive one-way long tail pedicle screw(Observation group,n =32) of internal fixation were compared with traditional open surgery (control group,n =29).Compare two groups of paticnts in the differences of operation time,amount of operative bleeding,operative wound,postoperative VAS scores,the ratio of postoperative injured vertebral front height,and hospitalization expenses.Results All patients were followed up for an average of 9.6 months (from 7 to 14months),neither of the groups showed internal fixation of related complications.Time of operation(min):observation group(87.4 ± 13.6) min,control group (92.3 ± 10.3) min,(t =-1.648,P ＞ 0.05);Mount of operative bleeding:observation group (73 ± 8.8) mL,control group (352 ± 63.7) mL,(t =-23,385,P ＜ 0.05);Wound of operative (cm2):observation group (12.3 ± 2.30) cm2,control group (81.5 ± 14.2) cm2,(t =-25.937,P ＜ 0.05);Expenses of hospitalization (RMB ten thousand):observation group (3.5 ± 0.3),control group(2.3± 0.5),(t =-11.223,P ＜ 0.05);VAS score 2 days and 6 months after surgery:observation group (3.0±0.4) and (1.3±0.6),controlgroup(4.2±0.5) and (2.7±0.7),(t=-10.396 and-8.409,P＜ 0.05),and comparcd with the preoperative also statistically significant (P ＜ 0.05);2 days and 6 months after surgery in the ratio of injured vertebral front height:observation group(89.6 ±7.2)％ and (84.2 ±5.7)％,control group (91.3 ± 5.8) ％ and (86.3 ± 4.6) ％,(t =-1.009 and-1.573,P ＞ 0.05),but in the same group recovery of injured vertebral leading edge height ratio compared with preoperative postoperative were significantly (P ＜ 0.05).Conclusion For a single section of thoracolumbar spine fracture,Compared with the control group,Percutaneous one-way long tail pedicle screw internal fixation technology have the advantage of little trauma,less sequel,rapid postoperative recovery,also in the recovery of vertebral body height and loss of late has achieved the same cur-ative effect,but patients with costly.

Objective:To explore the effect of online appointment system of standardized patients (SP) in cardiology practice teaching.Methods:The undergraduate students who entered the cardiology department of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine for clinical practice in 2018 and 2019 were selected as teaching objects, and they were divided into traditional teaching group ( n=30) and appointed SP teaching group ( n=30). After the teaching, SPSS 19.0 software was used for data analysis to compare the teaching effect of the two groups. Results:The scores of SP teaching group were higher than those of traditional teaching control group, with statistical significance ( P<0.05). Conclusion:Through constructing SP database and typical case database, online appointment system of SP for medical history inquiry and doctor-patient communication skills training can effectively solve the problems such as lack of clinical practice cases and doctor-patient contradiction, and greatly improve the teaching efficiency.

With the advancement of surgical techniques, the 5-year survival rate of colorectal cancer has significantly improved. However, incomplete lymph node dissection during operation leads to local recurrence and distant metastasis of the tumor, which has seriously affected the prognosis of patients. In the era of laparoscopy, surgeons' sense of touch is limited, making it difficult to feel and distinguish lymph node metastasis and the location of early colorectal cancer with their hands. The emergence of carbon nanoparticle suspension can help surgeons accurately locate tumors and clean lymph nodes under laparoscopy. This article reviews the clinical application of carbon nanoparticles in lymph node tracing and tumor location in colorectal cancer.

Objective This study is designed to observe the effect of ischemic postconditioning in rats underwent acute myocardial ischemia/reperfusion injury and to investigate the related mechanism.Methods A total of 30 SD rats were randomly divided into sham operation group (control group,n =10),ischemia/reperfusion group (IR group,n =10) and ischemic postconditioning group (PC group,n =10) based on random number table.Rats in IR group underwent 30 minutes myocardial ischemia by occlusion of the proximal portion of left anterior descending (LAD) coronary artery followed by 2 hours reperfusion.In control group,there was no IR intervention.In PC group,at the start of reperfusion,three cycles of 30 seconds reperfusion and 30 seconds LAD reocclusion preceded the 2 hours of reperfusion.The hemodynamic values were measured via a cannula inserted into the right common carotid artery.The area at risk was assessed by Evans blue staining and the infarct size as measured by TTC staining.Western blot and Real time PCR were respectively used to assess the expression of predicted target gene Bim and microRNA-214(miR-214) in the area at risk at the end of 2 hours reperfusion.Results (1) The hemodynamic monitoring in different groups:the left ventricular systolic pressure (LVSP),± dp/dt and heart rate of IR group and PC group were lower than those of control group,but left ventricular end-diastolic pressure (LVEDP) was higher than that of control group (all P ＜ 0.05).The LVSP and ± dp/dtmax of PC group were higher than those of IR group,and LVEDP was lower than that of IR group (all P ＜ 0.05).(2) Myocardial ischemia area and infarction range in different groups:there was no statistically difference in the proportion of area at risk (AAR) in left ventricle (LV) (AAR/LV) between PC group and IP group ((27.00 ± 7.55) ％ vs.(26.67 + 11.68) ％,P ＞ 0.05).The proportion of infarct size in the area at risk (IS/AAR) of PC group was lower than that of IR group((30.67 ±3.51)％ vs.(48.67 ±4.62)％,P＜0.05).(3) The expression of Bim protein in rats ischemic myocardial tissue in different groups:the expression of Bim protein in ischemic myocardial tissue of IR group was higher than that of control group (2.34 ± 0.15 vs.0.75 ± 0.05,P＜0.05),and that of PC group was lower than IR group (1.25 ±0.14 vs.2.34 ±0.15,P＜0.05).(4) The expression of of miR-214 in rats ischemic myocardial tissue in different groups:the expression of miR-214 of IR group was lower than that of control group(0.20 ±0.04 vs.1.00,P ＜0.01),and that of PC group was higer than that of IR group (0.85 ±0.20 vs.0.20 ±0.04,P ＜0.01).There was no statistically difference between PC group and control group (P ＞ 0.05).Conclusions Postconditioning could significantly decrease the ischemia/reperfusion injury by reducing the infarct size and improve cardiac function in this in vivo rat model.The expression of Bim in postconditioning group is significantly depressed,which may play an important role in the protection process of postconditioning,and the downregulation of Bim might be mediated with the increase of miR-214 expression.