With the standardized training and spreading,laparoscopic total mesorectal excision for rectal cancer has been spread nationwide.The oncological adequacy and long-term outcomes have also been confirmed by series of randomized controlled trials such as COLOR Ⅱ in Europe.There were still some technical issues,such as safe surgical plane,surgical approach,lymph node dissection,and function-preserving,which were still under debate.In the current article,authors will discuss the issues with clinical experiences about preserving of Denonvilliers facial,preserving of pelvic autonomic nerve,strategy of surgical approach,dissection of lateral lymph nodes,and necessity of protective diverting stoma.

Three-dimensional (3D) laparoscopic surgery has been developed rapidly in China since 2012.Based on mature two-dimensional (2D) laparoscopic surgery,3D laparoscopic surgery has the same technique as 2D,with similar indication as 2D as well.However,3D laparoscopic surgery can offer better depth description,more accurate spatial location,and less error in operation.It might offer better visional experience if hybrid with virtual reality or with 4K in the future.But in current status,laparoscopy with 3D technique is only a technique with innovation,but not a revolutionary technique.

The paper collects the network data from www.haodf.com to establish a model,conducts an empirical study on the factors influencing the selection of doctors in online medical websites,and puts forward the suggestions for the construction of online medical websits from 4 aspects of normalizing management,focusing on propaganda,highlighting online public praise,and expanding profit channels.

Most colorectal surgeries now are carried out as minimally invasive surgery along with the development and application of laparoscopy.However,the surgical imaging system does not meet the progressing requirement of laparoscopic surgeons.Thanks to the advent of three-dimensional (3D) laparoscopy,a more sophisticated surgical scene with realer images of anatomy is provided to surgeons.It makes identification and manipulation easier,so that to shorten the learning curve.Meanwhile,the 3D laparoscopy is not perfect.But authors believe it will finally be used broadly in colorectal surgery with the improvement of the technology.

Objective The objective of this study was to investigate the levels of serum miR-21 and miR-34a in patients with advanced gastric cancer before and after Folfox chemotherapy and its relationship with chemotherapy efficacy.Methods Forty-five patients with advanced gastric cancer who underwent Folfox chemotherapy were enrolled from May 2015 to October 2015.The levels of miR-21 and miR-34a were analyzed by Real-time PCR before and after chemotherapy.The relationship between miR-21 and miR-34a levels and chemotherapy efficacy was analyzed.The predictive values of miR-21 and miR-34a on the efficacy of chemotherapy were evaluated by the receiver operating curve(ROC).Results After chemotherapy,6 cases(13.33%)were relieved,10 cases(22.22%)were stable disease(SD),29 cases(64.44%)were disease progress(PD),the objective response rate(ORR)was 13.33%,the disease control rate(DCR)was 35.56%,the median survival time was 8.1 months.The level of miR-21 was down-regulated and up-regulation for miR-34a after chemotherapy.They were statistically significant(P<0.05).The level of miR-21 in the chemotherapy group was lower than that in the ineffective group,and the level of miR-34a was higher than that of the ineffective group(P<0.05).MiR-21 was negatively correlated with the efficacy of chemotherapy(rs=-0.431,P<0.05),while miR-34a was positively correlated with it(rs=0.504,P<0.05).The median survival time was 7.6 months for low-level patients with miR-21 and 6.0 months for high-level patients.The median survival time of miR-34a patients was 5.5 months,compared with 8.3 months for high-level patients,with a statistically significant difference(P<0.05).The Log-Rank test showed that the median survival of patients with low miR-21 was higher than that of patients with high miR-21(P<0.05).The median survival of patients with high miR-34a was higher than that of patients with low miR-34a(P<0.05).The miR-21 combined with miR-34a in predicting chemotherapy efficacy under the curve(AUC)was 0.865,the sensitivity was 80.9% and the specificity was 89.8%.Conclusion miR-21 and miR-34a are correlated with chemotherapy efficacy median survival time of patients with advanced gastric cancer.

ObjectiveTo compare the accelerating effect of topical recombinant human epidermal growth factor (rhEGF) and recombinant bovine basic fibroblast growth factor (rb-bFGF) on wound healing after fractional CO2 laser therapy.MethodsTwenty male guinea pigs were included in this study.After hair removal and irradiation with fractional CO2 laser,the back of each guinea pig was divided into 4 regions to be topically treated with rhEGF of 10 μg/cm2 (rhEGF group),rb-bFGF of 262.51 IU/cm2 (rb-bFGF group),the combination of rhEGF and rb-bFGF (combination group),or normal saline (control group),twice daily until the healing of wound.Skin physiology parameters including elasticity index and melanin index were detected before the irradiation,7,14 and 28 days after the irradiation,and compared between the 4 groups by analysis of variance.Tissue specimens were obtained from 4 mice at the above time points and subjected to pathological examination for the observation of collagen fibers and quantification of fibroblasts.ResultsAfter fractional CO2 laser therapy,the crusts fall off completely in growth factor-treated regions,while partly in the control regions,within 3 to 7 days; the wounds healed completely in 14 to 28 days in all the groups,with the regenerating tissue being more tender and redder compared with the surrounding unirradiated tissue.The wound surface was smaller in area and redder in color in the 3 growth factor-treated groups than in the control group.At 28 days after the irradiation,the elasticity index was 262.29 ± 62.40 in the combination group,202.00 ± 65.62 in the rhEGF group,188.86 ± 35.02 in the rb-bFGF group,167.14 ± 42.49 in the control group.Statistical difference was observed in elasticity index,but not in skin melanin index among the 4 groups.Pathological examination showed a dense and organized arrangement of collagen fibers in the combination group but a sparse and disorganized arrangement of collagen fibers in the control group.ConclusionThe combined application of rhEGF and rbbFGF can accelerate the healing of wound and increase the elasticity of regenerating tissue after fractional CO2 laser therapy.

Objective To explore the effect of organizational commitment and leader-member exchange on ethical decision-making in nurses. Methods 520 nurses were questionnaired by the Chinese Employees′ Organizational Commitment Scale,Leader-Member Exchange Scale and the Ethical Decision-making Scale. Results The total scores of organizational commitment and leader-member exchange and ethical decision-making in nurses were respectively (2.11 ± 0.39), (3.54 ± 0.51), (286.62 ± 20.14) points. Pearson correlation analysis showed that the scores of organizational commitment and leader-member exchange were positively correlated with ethical decision-making (r=0.352-0.464,P<0.05). Hierarchical regression analysis showed that leader-member exchange, opportunity commitment and affective commitment, economic commitment could explain 35.3%of the total variance of ethical decision-making in nurses. Conclusions The organizational commitment and leader-member exchange are the influencing factors of ethical decision-making in nurses.

Objective To evaluate urinary nucleosides determination for the diagnosis of colorectal carcinoma. Methods The concentrations of 14 different urinary nucleosides from 42 colorectal carcinoma patients, 10 patients with villous adenoma and 62 normal adults were determined by high-performance liquid chromatography (HPLC); Principal component analysis was applied to classify colorectal cancer patients and normal adults. Results The levels of Pseu、 C、 m1A、 mU、 m22G、 I、 m1G、 ac4C、 m6A in colorectal carcinoma group were (42.67?21.89)、(0.44?0.51)、(2.72?0.83)、(0.13?0.08)、(1.79?0.55)、(0.50?0.36)、(1.44?0.52)、(0.82?0.30)、(0.07?0.08)nmol/(?mol creatinine) respectively, which were much higher than those in normal adults (P

Aim Series of compounds,which were considered to be the antagonists of ET-1 receptor,were synthesized by Beijing Institute of Pharmacology and Toxicology.The biological activity of these compounds was screened and some active compounds were selected for further pharmacological characterization on pulmonary hypertension.Methods Radioligand binding assay was performed to study the binding affinity of compounds for ETA and ETB receptors.The biological activity of compounds was evaluated in isolated rat aortic ring and in systemic arterial pressure(SAP)of anesthetized rat experiments.In addition,hypotensive effect of compounds was investigated on monocrotaline induced pulmonary hypertension in rats.Results Compounds bind to ETA receptor had over 10 000 fold higher affinity than to ETB receptor.Contraction induced by ET-1 in isolated rat aortic ring was inhibited by compounds,and 1 ?mol?L-1 ETP-508 shifted the cumulative concentration-contraction response curve to ET-1 to right with no change in the maximal response.In vivo,the increase in SAP induced by ET-1 〔3.7 ?g?(0.5 ml)-1?kg-1〕 was inhibited by 2 mg?kg-1 compounds by intravenous infusion.Furthermore,BQ-485 and ETP-508 by intravenous infusion(0.4 mg?h-1)significantly inhibited 80 mg?kg-1(sc)monocrotaline induced pulmonary hypertension in rats.Conclusions These results indicate that ETP-508 and BQ-485 are highly selective ETA receptor antagonists and significantly inhibite monocrotaline induced pulmonary hypertension in rats.

Objective To explore the characterization of the long-term survival patients through monitoring the lymphoeytes subgroup and cytokines level.Method The lymphocytes subgroups (T,B,and NK) and cytokines (IL-9,-17,-22) of patients and healthy groups were tested by using flow cytometry and ELISA.Results The levels of CD3+,CD4+,CD8+,CD8+ CD28+/CD8+ and IL-9 were gradually increased in the short-term group and long-term group as compared those in healthy group.The percentage of CD3 + cells and level of IL-9 were significantly lower in short-term group and long-term group than in healthy group (P＜0.05).The percentage of CD8+ cell was significantly lower in short-term group than in healthy group (P＜0.05).The ratio of CD8+ CD28+/CD8+ was significantly lower in short-term group than in longterm group and healthy group (P＜0.05).The percentage of B cells and NK cells,and IL-22 were gradually increased in the healthy group,shortterm group and long-term group.The percentage of B cells and NK cells was significamly higher in long-term group than in healthy group (P＜0.05).The level of IL-22 was significantly higher in longterm group than in short-term group and healthy group (P＜0.05).However,NKT lymnphocytes and IL-17 showed no statistically significant difference between long-term group and short-term group.Conclusion The ratio of T lymphocyte subgroups and the level of IL-9 were good biomarkers for evaluating the immune characterization of OLT patients; NK and B lymphocytes,and IL-22 may be associated with the long-term survival in patients after OLT.