Objective To study the dissection technique of total mesoreetal excision(TME).Method One hundred and twelve eases of rectal cancer underwent TME from January 2000 to August 2008 were retrospectively analyzed.Results All the procedures were conducted sueeessfully,average blood loss was(45±32)ml during the dissection of rectal mesentery,the hypogastrie nerves were preserved in 96 eases,urinary retention occurred in 6 eases and recovered 1 month later.Anastomotie leakage occurred in 1 ease and healed after transverse colostomy.Wound infection in 6 eases and healed by dress changing.There was no ureter injury.There were 14 eases of death,6 eases of recurrence and 15 eases of distal metastasis according to(3.7±1.1)years follow-up in 112 eases.The survival rate of 1,3,5 years was 92.0%(103/112),84.8%(95/112),66.1%(74/112)respectively.Conclusion Anatomical dissection adequate exposure and hemostasis are critical factors for TME.

Objegtive To study the feasibility and clinical effects of enteral nutrition by needle catheter jejunostomy(NCJ)tube in the postoperative adjuvant chemotherapy for patients of staged gastric cancer.Methods Eighty-two patients with staged gastric cancer underwent radical gastrectomy and going to receive chemotherapy were randomly divided into group A(41 cases)and group B(41 cases).All of the patients had been NCJ.Group A received enteral nutrition through the tube during chemotherapy,and group B had been given general diet.A series of parameters were measured post-chemotherapy.And the gastrointestinal complications were carefully observed.Results In post-chemotherapy,the level of hemoglobin,albumin,prealbumin,interleukin-2,natural killer cell activities and CD3+,CDd4+,CD4/CD8 in group A[(106.9±12.0)g/L,(26.2±1.4)g/L,(202.9±32.2)mg/L,(11.9±2.1)μg/L,(21.3±5.2)%,(62.9±3.3)%,(26.1±4.7)%,1.1±0.2]were significantly higher than those in group B(P＜0.05 or＜0.01).The incidences of vomiting in group A(4.9%,2/41)was significantly lower than that in group B (26.8%,11/41)(P＜0.05).The average intake in group A[(1312±114)ml]was significantly more than that in group B[(76.5±186)ml](P＜0.05).No severe enteral nutrition related complications occurred in group A.Conclusions It is safe and feasible to enteral nutrition supported by NCJ tube in chemotherapy for patients of staged gastric cancer.It can improve the nutrition status and immune function in the given patients.

[Objective]To detect the effect of constant magnetic field on metal ion Co2+,Cr3+ induced TNF-? secreted by human mononuclear cells,and to search a method for prevention and treatment of aseptic loosening. [Methods]CoCl2 powder and CrCl3 powder were dissolved in the asepsis injecting water. Mononuclear cells from human peripheral blood,were taken and cultured with Co2+,Cr3+ ions in different magnetic field of 10Gs,100 Gs,1000Gs for 12,24 and 48 hs. There were nine groups:control group,Co2+ group,Cr3+ group,Co2+andCr3+ with various intensities of constant magnetic field,respectively.ELISA method was applied to detect tumor necrosis factor (TNF-?) in serum via the absorbance (A).[Results]Co2+ and Cr3+ ions stimulated human mononuclear cell to secrete TNF-? (P

Objective To study cortactin function in cancer cell endocytosis.Methods We applied cortactin siRNA interference to MDA-Mb-231,a human breast adenocarcinoma cell line in which cortactin was over-expressed,and introduced anti-cortactin immunoreagents into the cells with BioPorter system to interfere with cortactin function in vivo.Capture-ELISA assay was used to measure transferrin uptake.We used immunoblot assay to assess the effect of cortactin knock-down and immunoflurescence microscopy to examine the effect of cortactin down-regulation on transferrin uptake.Results Interference of cortactin function in cells resulted in impairment of transferrin endocytosis.Transferrin fluorescent intensity in cytoplasm in cortactin siRNA treated-cells was significantly reduced in comparison to that of mock-treated cells.Less than 50% of cells subjected to cortactin siRNA treatment had normal transferrin uptake.Endocytosis in MDA-Mb-231 cells introduced with cortactin antibodies was impaired as well,showing a 30%～ 60% reduction in transferrin uptake.Conclusion Crtactin,an actin-binding protein,plays an essential role in cell endocytosis.

Objective To discuss the quality of life in the postoperative patients with aortic valve replacement (AVR) and related influencing factors .Methods The changes of preoperative and postoperative survival quality in 102 cases of AVR surgery were assessed by using the SF‐36 scale ,and the Logistic regression was used to analyze the impact of age ,effective valve orifice area and prosthetic valve on the quality of life .Results Five patients died during follow‐up .The relative baseline survey after postopera‐tive 1 year showed that the quality of life of patients was significantly improved ,the Logistic regression analysis revealed that a lar‐ger effective orifice area(EOA) and biological valve replacement could have higher health scale scores ,and showed a positive corre‐lation .Conclusion The quality of life in the postoperative patients with AVR is affected by the valve type and EOA of prosthetic valve .

Objective To explore the modification of bionic silk fibroin nerve conduits (SF-NCs) by silk sencin.Methods The innovative SS/SF blended-NCs was fabricated by a vertical sequential cooling thermal induced phase separation (TIPS) processing with SF solution added sericin in proportion,its morphology was observed by Scanning electron microscopy (SEM),X-ray diffraction (XRD) and infrared spectroscopy (FTIR) were used to detect its internal molecular structure.MTT assay was used to quantitatively analyzed the PC12 cells viability co-cultured with the innovative SS/SF-NCs,SEM was used to observe the adhesion and morphology of PC12 cells seeded into the innovative SS/SF,PC12 cells were used to assess the NGF bioactivity released from the SS/SF.Results The SEM results showed that the new fabricated SS/SF-NCs had linearly oriented lamellar-like multiple-channel which distributed evenly,got great changes on the channel microstructure and their mechanical properties had been greatly improved,compared to SF-NCs.The XRD and FTIR results showed that the SS/SF-NCs had the similar internal molecular structure with natural silk.The spaces between parallel lamellar-like channels,porosities and compressive strengths of the SS/SF-NCs decreased with decreasing Sequential freezing temperature.MTT assay results showed that the viability of PC12 cell was better than the control group (P ＜ 0.05).The SEM observation indicated that PC12 cells showed good adhesion and differentiation with neuritis outgrowth during the period of co-culture with the SS/SF-NCs.NGF release from the innovative SS/SF-NCs was prolonged over 4 weeks,and remained bioactive.Conclusion The new fabricated SS/SF-NCs modified though silk sericin,which was highly bionic the structure of peripheral nerve fasciculus,had excellent mechanical properties and could be used as another alternative of artificial nerve conduits.

OBJECTIVE:To provide reference for further improving negotiation mechanism of drug medical insurance in Chi-na. METHODS:Questionnaire investigation was conducted among the medical insurance agency and pharmaceutical company staff who participated in drug medical insurance negotiation in Jiangsu province,Jiangxi province,Qingdao,Chengdu. Their business fa-miliarity and recognition of the negotiating mechanism were also investigated. The descriptive analysis,independent sample t test and other methods were adopted to analyze the data statistically. RESULTS:A total of 70 questionnaires were distributed and 68 val-id questionnaires were collected with effective recovery rate of 97.14%. Respondents included 21 staff members of medical insur-ance agencies and 47 of pharmaceutical companies. In terms of business familiarity,the average score of respondents in all aspects was greater than 3(4 points system),the lowest score wasmanagement of the implementation of drug negotiation projects. There were statistical significances in scores of 3 items between 2 parties in the negotiation(P<0.05):basic principles of the drug negotiation process should be followednegotiation objectives in the substantive negotiation process total score of busi-ness familiarity. The scores of respondents in pharmaceutical companies were higher than those of health insurance agencies. In the recognition of the negotiating mechanism,average score of each survey item was ≥4(5 points system)in the recognition of the overall effect of the negotiation mechanism except forwhich is conducive to maintaining the price system of pharmaceutical com-panies. The average score of all aspects of preparation of the negotiations,substantive negotiation,implementation of the negotia-tion agreement and negotiation project's supervision and evaluation was >4 except forpatients taking drugs is quick and easy. There was no statistical significance between 2 types of respondents in all aspects of overall effect of the negotiation mechanism, preparation of the negotiations and negotiation project's supervision and evaluation(P>0.05). But in the recognition of the substan-tive negotiation,there was statistically significance between 2 types of respondents innegotiations between the two sides in an equal,cooperative,harmonious atmosphere(P<0.05). Healthcare agencies'respondents had higher scores than pharmaceutical companies'ones. And in the recognition of the implementation of the negotiation agreement,there was statistical significance be-tween 2 types of respondents in theafter the agreement entered into force,the medical insurance agency will be strictly in accor-dance with the agreementandfund pay to pharmaceutical companies timely and reasonable(P≤0.05). Healthcare agencies're-spondents have higher scores for than pharmaceutical companies'ones. CONCLUSIONS:The current drug medical insurance nego-tiation mechanism shows good overall effect and runs smoothly. But there are still some shortages,such as collected information the preparation stage is not sufficient;the procedures of patients taking the drug is complicated;negotiating parties do not have equal status;the fund is not paid to the pharmaceutical enterprise timely;evaluation is not perfect.

Objective To compare the feasibility and safety of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Methods A retrospective study was performed on 37 patients who underwent pancreaticoduodenectomy for duodenal carcinoma or pancreatic head tumors at the First Hospital of Sun Yat-sen University from April 2006 to December 2010.Pancreatic anastomosis was carried out either using pancreaticogastrostomy (n＝ 19) or pancreaticojejunostomy (n=18).The operative time,intraoperative bHood Hoss,postoperative pancreatic Heak,mortaHity and Hength of hospitaH stay were compared between the two groups. ResuHts The mean operative time,intraoperative bHood Hoss,incidence of pancreatic fistuHa,mortaHity rate and mean Hength of postoperative hospitaH stay were (372.1 ±79.5) min vs (351.0±69.2) min; (693.5± 412.8) mH vs (645.1±488)ml; 10.5％ (2/19) vs 11.1％ (2/18); 5.3％ (1/19) vs 5.6％ (1/18); and (17.5± 8.9)d vs (16.1± 7.6)d,respectively.The differences between the two groups were not statistically significant.Conclusion Pancreaticogastrostomy appears to be a feasible and safe alternative to pancreaticojejunostomy for the pancreatic remnant after pancreaticoduodenectomy.

10.3969/j.issn.1008-9691.2013.03.005

Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS (CH-EUS)for pancreatic cancer.Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue.Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer.Character-istics of CH-EUS in different pancreatic tumors were analysed.Results A total of 76 patients were en-rolled,with an average age of 53. 1 ±14. 2.Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis,10 pancreatic neuroendocrine tumor,6 cystadenoma,4 intraductal papillary mucinous neoplasm.Tumor diameter was 3. 4 ±1. 4 cm and there were 18 less than 2 cm.The sensitivity and specificity,positive and negative predictive value of CH-EUS for pancreatic cancer was 97. 1%, 92. 9%,91. 7% and 97. 5% respectively.The sensitivity was 100% combined with FNA.Conclusion CH-EUS is safe,convenient for pancreatic cancer with high accuracy and can be used as an additional diag-nostic method to EUS-FNA.