Objective To study the safety of laparoscopic total mesorectal excision for middle and lower rectal cancer.Methods A retrospective comparison was made between 52 cases of open total mesorectal excision from December 2002 to December 2005(Open Group) and 49 cases of laparoscopic mesorectal excision from January 2003 to June 2006(Laparoscopic Group).Results There was no difference in baseline parameters between the two groups.As compared with the Open Group,the Laparoscopic Group presented less blood loss [for anterior resection: 160?106 ml(n=37) vs 298?186 ml(n=36),t=-3.908,P=0.000;for abdominoperineal resection: 180?153 ml(n=10) vs 356?170 ml(n=14),t=-2.604,P=0.016].The recovery time of bowel functions was shorter in the Laparoscopic Group than in the Open Group(2.4?1.8 d vs 3.6?1.5 d;t=-3.648,P=0.000).The overall complication rate in the Laparoscopic Group(14.3%,7/49) was lower than that in the Open Group(44.2%,23/52)(?2=10.834,P=0.001).No significant difference was seen between the two groups in the number of lymph node resected(12.7?6.5 vs 13.6?7.0;t=-0.668,P=0.505),with negative margins in both groups.Follow-up observations were carried out in 45 cases in the Laparoscopic Group(91.8%) for 2～42 months and in 47 cases in the Open Group(90.4%) for 6～42 months,respectively.The local recurrence rate was respectively 4.4% in the Laparoscopic Group(2/45) and 4.3% in the Open Group(2/47). Conclusions Laparoscopic total mesorectal excision for middle and lower rectal cancer is safe and feasible.

0.05).Conclusions Laparoscopic resection of colorectal carcinoma is feasible and safe for elderly patients.The method can reduce the rate of postoperative complications.

Objective To study the feasibility of laparoscopic radical gastrectomy.Methods From August 2006 to May 2007,31 patients with gastric cancer received laparoscopic radical gastrectomy(radical distal gastrectomy in 26 cases and radical total gastrectomy in 5).Results Among the cases,1 was converted to an open surgery,2 were treated completely by laparoscopic radical gastrectomy;and in the other 28 cases,the radical gastrectomy was performed under the assistance of laparoscopy.Lymph node dissection of D1+? was performed on 2 patients and D2/D2+ was adopted in the other 29.One case was done in combination with partial liver dissection.The median operative time was 5 h(range 4.5-7 h).The median blood loss was 150 ml(range,100-600 ml).One patient received blood transfusion during the operation.Intraoperative spleen injury occurred in one case.The median number of harvested lymph nodes was 20(range,14-33).No patient died after the surgery.The median time for gastrointestinal function recovery was 4 d(range 3-6 d).One patient developed gastroparalysis after the operation and was cured by conservative therapy.One of the patients had bleeding of the jejunal pouch after total gastrectomy.And one showed subluxation of the articulatio cricothyroideus.No anastomotic leakage and lung infection occurred after the surgery.And no recurrence or metastasis was found during a 2-to 8-month follow-up(median,5).Conclusion Laparoscopic radical gastrectomy is feasible and safe.

Objective To compare effects of laparoscopic versus open anterior resection of rectal carcinoma on immune functions.Methods A total of 38 patients were given either laparoscopic(18 patients) or open(20 patients) anterior resection of rectal carcinoma from April 2004 to June 2005 in this department.The percentages of T-lymphocytes(CD_3,CD_4,and CD_8) and natural killer cells were calculated by using the flowcytometry.The levels of immunoglobins(IgG,IgA,and IgM) and complements(C_3 and C_4) were detected by using the immunonephelometry.Results In levels of T-lymphocytes,immunoglobins,and complements,there were no statistically significant differences between open and laparoscopic groups 24 and 96 hours after operation.In levels of natural killer cells,no differences were observed in laparoscopic group before and after operation(24 and 96 postoperative hours) while a significant decrease were found in open group after operation.Conclusions As compared with open surgery,laparoscopic anterior resection of rectal carcinoma has less influence on natural killer cells.

Objective To investigate the safety and feasibility of laparoscopic total/subtotal proctocolectomy. Methods Laparoscopic total/subtotal proctocolectomy was performed in 8 cases from March 2003 to November 2005, including 1 case of multiple colorectal tumors, 3 cases of ulcerative colitis, 2 cases of familial adenomatous polyposis, and 2 cases of slow transit constipation. The operation included ileal pouch-anal canal anastomosis in 3 cases, ileal pouch-rectum anastomosis in 3 cases, and cecum-rectum anastomsis in 2 cases. A prophylactic ileostomy was conducted in 5 cases. Results The operation was laparoscopically conducted in all the 8 cases, without conversions to open surgery. No fatal case was encountered. The operative time was 5.5~7.5 h (median, 6 h). The intraoperative blood loss was 150~400 ml (median, 200 ml). There was no intra- or post-operative blood transfusion. The patients began to take diet at 48 h postoperatively. Follow-up observations in 8 cases for 4~31 months (median, 25 months) showed 1 case of intraabdominal infection and 1 case of anastomsis stenosis. Conclusions Laparoscopic total/subtotal proctocolectomy is safe and feasible.

0.05).The median therapy fees in the open group was nine thousand yuan vs.eleven thousand yuan in the laparoscopic group,and the difference was significant(P

Objective To assess the impact of HLA-A,HLA-B,HLA-DRB1 matching on the prognosis of hematopoietic stem cell transplantation from unrelated donors.Methods A total of 81 patients with hematological malignancies including leukemia,myelodysplastic syndrome(MDS)and lymphoma who underwent hematopoietic stem cell transplantation from unrelated donors from 2007 to 2012 in our department were included in this retrospective analysis.Patients were classified into HLA match group(n=53)and HLA mismatch group(n=28)according to the HLA high-resolution matching.The overall survival (OS),treatmentrelated mortality(TRM),relapse rate(RR),graft-versus-host disease(GVHD)incidence were analyzed.Results The 81 patients were analyzed with a median follow-up of 11.9 months(0.3 to 57.4 months).The OS (66.0％vs 46.4％,P=0.031)and TRM(17.0％vs 42.9％,P=0.017)were significantly different between the HLA match group and HLA mismatch group,while the RR had no significant difference(14.3％vs 32.1％,P=0.111).Multivariate analysis showed HLA matching was an independent prognostic factor of TRM,but not OS.There's no significant difference of aGVHD(22.9％vs 40.9％,P=0.122)and cGVHD (40.0％vs 46.7％,P=0.655)incidence between the two groups,but the incidence of severe aGVHD in HLA match group were much lower(4.2％vs 25.0％,P=0.005)than HLA mismatch group.Conclusion the high-resolution matching of HLA-A,-B,DRB1 affect OS,TRM and the incidence of severe aGVHD in unrelated hematopoietic stem cell transplantation,but not affect RR,the incidence of aGVHD and cGVHD.

Objective A retrospective analysis of patients with T-cell lymphoma (TCL) received autologous peripheral blood stem cell transplantation (APBSCT) was performed to evaluate the outcome of APBSCT.Methods A total of 22 patients who underwent APBSCT from September 2006 to December 2011 in Ruijin hospital were enrolled in the study,including 6 cases of lymphoblastic lymphoma and 16 of peripheral T-cell lymphoma (8 anaplastic large cell lymphoma, 4 PTCL-u, 1 subcutaneous panniculitis-like T-cell lymphoma, 2 nasal type extranodal NK/T and 1 primary cutaneous T-cell lymphoma). All patients were diagnosed based on the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Conditioning regimens were high-dose chemotherapies alone which include 13 cases with BEAM, 4 with ICE and 5 with CBV. The outcomes of the treatment were evaluated according to the revised International Working Group criteria.Results With a median follow-up of 13.1(1-60) months,the predicted 2-year overall survival (OS) and progression-free survival (PFS) after transplantation were (67.6±11.0) ％ and (71.1±11.1) ％,respectively.A total of 6 patients experienced disease progression and 5 patients eventually died of disease. When all these patients based on the remission status before APBSCT (CR1 vs non-CR1) and chemosensitivity (sensitive vs refractory) were further classified, the PFS rates and OS rates were 100 ％ and 91.7 ％ respectively in CR1 or chemosensitive patients which were significantly higher than patients not in CR1 (42.6 ％ ) or with chemoresistant disease (19.0 ％ ). Conclusion Remission status and chemosensitivity at the time of transplantation significantly affect the outcome of APBSCT for TCL patients, thus it can be recommend to perform APBSCT for patients either in CR1 or early stage when the disease remain sensitive to chemotherapy.

Background and purpose: High-dose chemotherapy followed by autologous stem cell transplantation (auto-HSCT) is considered as the ifrst line treatment for patients with relapse/refractory lymphoma after conventional chemotherapy. However, most of these patients still relapse the second time. The purpose of this study was to analyze the efifcacy of the consolidation chemotherapy after autologous stem cell transplantation (HSCT) refractory/relapse lymphoma in high risk. Methods:A total of 38 patients with relapsed/refractory lymphoma including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were included, who were underwent auto-HSCT in our transplan-tation department from Jan. 2010 to Dec. 2013. In treatment group, 19 patients received 2 courses of consolidation che-motherapy after auto-HSCT every 2 to 3 months, with the regimen of mini-BEAM or modiifed mini-CBV. Another 19 patients had no chemotherapy after auto-HSCT as control group. Results:The median follow-up duration was 17.2 and 7.5 months in the treatment and control group respectively. The follow-up data demonstrated prolonged progression-free survival (PFS) in the treatment group than the control group [24.7 months vs 7.8 months, P=0.029 under intend-to-treat analysis ITT;24.7 months vs 5.2 months, P=0.01 under per protocol analysis(pp)]. There is also a trend of improved overall survival (OS) in the treatment group (P=0.055, ITT). Conclusion:Consolidation chemotherapy after auto-HSCT for refractory/relapsed lymphoma patients delay the relapse and tend to improve the overall relapse rate.

Objective To explore the effect of neural stem cells (NSCs) transplantation on neurogenesis in an alzheimer' disease mouse model and its related mechanism.Methods A total of 16 12-month old aPP/PS1 double transgenic aD mice were randomly divided into two groups:NSC group (receiving NSCs transplantation in the bilateral hippocampi,n=8) and PBS group as the negative control group (receiving an equal quantity of 0.01M/L phosphate buffer saline,n=8).another 8 wild type mice without any treatment were selected as the positive control group (Wt group).at five weeks after transplantation,the expressions of doublecortin (DCX) and nestin in the hippocampal dentate gyrus (DG) and subgranular zone (SGZ) were analyzed by immunofluorescence staining,the number of positive cells in these regions were counted by confocal microscopy,and Morris water maze (MWM) test was used to assess cognitive function in all mice.Results NSC group showed the enhanced spatial learning and memory ability in Morris water maze (MWM) as compared to PBS group,but it was still lower than that in Wt mice (both P＜0.05).Immunofluorescence staining showed NSCs induced the increased positive cells expressing DCX and nestin in the NSC group as compared with PBS group (F＝85.400 and 55.687,both P＜0.001).However,the number of DCX positive cells was still lower in NSC group than in Wt group (P＜0.05).There was no significant difference in the number of Nestin-positive cells between the NSC group and the Wt group (P＞ 0.05).Conclusions NSCs transplantation can promote endogenous neurogenesis via the increased expression of DCX-and Nestin positive cells in the hippocampal DG/SGZ in aD mice,which improves the cognitive abilities in aD mice in some extent.