Objective; To evaluate the role of total mesorectal excision in radical resection of rectal carcinoma. Methods:The data of 538 consecutive patients with middle and lower rectal cancer were analyzed retrospectively. These patients were treated with total mesorectal excision between January 1997 and March 2004. Results;All 538 patients had middle or lower rectal cancer, 322 male, and 216 female. No patients died perioperatively and presented presacral hemorrhea. A total of 420 patients were treated by anterior rectal resection; 118 patients had to undergo abdomino - perineal resection. 403 patients were followed - up (12-60 months). The rate of local recurrence was 4.5%. 1 year and 5 - year survival rates after curative resection were 90. 3% and 65. 8% respectively. Conclusion; In our experience, with TME technique, the postoperative mortality and complication would not be increased. The anus - saving rate is increased and the patients'living quality is improved. These findings recommend TME as gold standard procedure for middle and lower rectal cancer.

Three kinds of enzymes,pepsin,trypsin and catalase,were selected to research the effects and mechanisms of ultrasound on protein,taking advantage of the change of their biological activity under sonication as the index.The results indicate that the three kinds of enzymes display different modes and degrees of activity change under sonication.In addition,the effects of ultrasound on the enzymes vary with their concentration,which means that the destruction of ultrasound to enzyme could be reduced by adjusting their concentration.Mannitol,a strong free radical scavenger,and Tween-80,a kind of non-ionic surfactant,could protect the activity of the enzymes during sonication.That implies that free radicals,which are produced through the thermal dissociation of water induced by ultrasound cavitation,and the cavitation bubbles,which could disturb the hydrophobic environment around the enzyme molecules,play important roles during the destruction of sonication to enzymes.However,for different enzyme,different factor play the main role.

Objective To investigate the efficacy of bundle care under the supervision of professionals in preven-ting ventilator-associated pneumonia(VAP). Methods Patients who received mechanical ventilation between July 2013 and June 2014 in the intensive care unit(ICU)of a hospital were selected,July-December 2013 was as control group (n= 150),patients received bundle care,but without special supervision;January-June 2014 was as special supervision group (n= 177),patients received bundle care under the supervision of professionals,incidence of VAP,duration of mechanical ventilation,and length of ICU stay were compared between two groups. Results In special supervision group,141 patients received invasive mechanical ventilation,mechanical ventilation day were 1937 days,9 patients developed VAP,incidence of VAP was 4.65‰ ;in control group,127 patients received inva-sive mechanical ventilation,mechanical ventilation day were 1965 days,21 patients developed VAP,incidence of VAP was 10.69‰ ,difference was statistically significant between two groups(χ2= 5.68,P= 0.042). In special su-pervision group,overall compliance rate of bundle management strategies,duration of average invasive mechanical ventilation,and length of ICU stay were 94.92% ,(11.11±2.57)days,and(15.11±2.88)days respectively,in con-trol group were 48.67% ,(14.67±4.35)days,and(19.33±5.81)days respectively,difference was statistically sig-nificant between two groups (all P<0.05). Conclusion Bundle care strategies supervised by professionals can ef-fectively prevent the occurrence of VAP,the implementation of bundle care strategies should be set up according to the clinical practice.

Objective To study the effect of edaravone on serum IL-6、TNF-α and neurologic functional in acute cerebral hemorrhage,discuss the protective mechanism of Edaravone on cerebral hemorrhage.Methods 80 casesof cerebral hemorrhage in 72h were randomly divided into treatment group(40 cases)and control group(40 cases),and the control group was given routine treatment,and the treatment group was administered with edaravone,30mg/d,for 14 days on the based treatment of the control group.The serum IL-6 and TNF-αwere detcted by ELISA before therapy and after treatment for 14 days.Neurological function deficit scores were utilized for assessment before given treatment.On the 21 th day after treatment,the patients were assessed again,and the efficacy was recorded.Results After 14 days treatment.the mean scale of NIHSS,the serum levels of IL-6 and TNF-α in treatment group were more obviously decreased than that in control group(all P＜0.05).Conclusion Edaravone could obviously alleviate inflammatory reaction on acute cerebral hemorrhage,which could effectively remove the generous free radicals and reduce the brain edema after intracerebral hemorrhage.So it could protect the tissue of brain.

Objective To investigate the clinical characteristics and related factors of metabolic disorder in acute cerebrevascular disease (ACVD) and to provide clinical basis for intervention of ACVD.Methods The clinical data of 202 healthy individuals (control group) and 621 cases of ACVD (341patients with cerebral infarction and 280 patients with cerebral hemorrhage) was analysed retrospectively.Based on the level of blood pressure,blood glucose and blood fat, 621 cases of ACVD were divided into me tabolism syndrome( MS ) group (hypertension + hyperglycemia + hyperlipidemia),two kinds of risk fatorsgroup (hypertension + hyperglycemia or hypertension + hyperlipidemia or hyperglycemia + hyperlipidemia),one kind of risk factor group (hypertension or hyperglycemia or hyperlipidemia) and no risk fastor group.Results Of the patients with cerebral infarction and cerebral hemorrhage 320 eases(93.8%) and 259 cases (92.5%) had hypertention,163 cases (47.8%) and 101 cases (36.1%) had hyperglycemia, 115 cases (33.7%) and 141 cases (50.4%) had hyperlipidemia, respectively. The blood pressure in one kind of risk factor group, two kinds of risk factors group and MS group was significantly higher than those in control group and no risk factor group,the body mass index (BMI), fasting plasma glucose (FPG),total cholesterol(TG)and low density lipoprotein cholesterol (LDL-C) in two kinds of risk factors group were higher than those in control group and no risk factor group (P <0.05). The age,BMI,blood pressure,FPG,TC,TG,high density lipoprotein cholesterol(HDL-C) and LDL-C had obvious correlation with ACVD. Conclusion ACVD is often combined with various kinds of metabolic disorders risk factors, suggesting that an effective control of metabolic disorders is benefit to intervention of ACVD.

Objective To explore the treatment method and clinical effect of LARS artificial ligament in treatment of combined anterior cruciate ligament(ACL) and posterior crueiate ligament (PCL) injuries of the knee under arthroscope. Methods Thirteen cases of ACL and PCL injuries were reconstructed with LARS ligament. The patients were followed up for 12-36 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scale were used for functional evaluation. In the meantime, KT-1000 was employed to check anterior and posterior laxation of the knee. Results No knee infection or limitation of knee extension occurred. Knee flexion was 105° -125° (average 117°). At termination of follow up, 10 cases (77%) was graded as A and 3 (23%) as B according to IKDC. KT-1000 examination at 25° flexion showed that the difference of anterior laxation was less than 2 mm in 12 cases and 3-5mm in 1. KT-1000 examination at 70°flexion showed that the difference of anterior laxation was less than 2mm in 12 cases and 2-4 mm in 1. The Lysholm score was (63.8±2.9) points (49459 points) before operation and (91.1 ±2.7) points (88-95 points) at follow up, with statistical difference (P ＜0.01). Conclusion Reconstruction of ACL and PCL by using LARS ligament under arthroscope is a kind of minimally invasive, safe and effective method to treat ACL and PCL injuries of the knee, with good short term outcome.

Objective To discuss the mechanism of growth hormone (GH) in infection and its safety. Methods Advances in the application of GH in infection of recent years were reviewed. Results In infectious patients, GH may promote protein synthesis, strengthen the immunity of body, and protect the integrity of intestinal barrier function. But some patients present GH resistance. The safety of GH for infectious patients needs further evaluation. Conclusion GH may play a supplementary role in infection therapy, but further research is needed.

Histone deacetylases inhibitors(HDACIs)are a group of compound regulating gene expression at transcriptional level.HDACIs can induce protein hyperacetylation and subsequently lead to chromatin remodeling,cell-cycle arrest,cell differentiation and apoptosis,and transcriptional activation and repression.HDACIs demonstrate promising antitumor activity and are presently tested in clinical studies for solid and hematologic malignancies.Cumulating evidence in animal models of immune disorders also suggests immunosuppressive properties of HDACIs,which provides us with new ideas for treating immune disorders and rejection after transplantation.This paper reviews the recent progress of immunosuppressive function induced by HDACIs from the following aspects:immune diseases,T lymphocytes,inflammatory cytokines and dendritic cells.

Objective To investigate therapeutic effect and molecular mechanism of RPS on Diabetic Nephropathy rats.Methods DN rats were induced by STZ injection and grouped into model group, low-dose RPS group, middle-dose RPS group, high-dose RPS group, Rosiglitazone group and normal group.24 h urine protein,kidney weight index,blood glucose level and TG, BUN and Scr level in normal and DN rats were detected.TGF-βlevel of serum of rats in all groups by ELISA were detected.mRNA and protein expression level of PPARγ,aP2 and GLUT4 by RT PCR and Western blot were also detected.Results DN rats were induced successfully because the 24 h urine protein, kidney weight index and the levels of blood sugar and TG, BUN,Scr l and TGF-βevels, and the mRNA level of PPARγ,aP2 and GLUT4 level in DN rats increased than normal group(P<0.05).The mRNA level of PPARγ,aP2 and GLUT4 level increased(P<0.05) and other indexes decreased(P<0.05) as the doses of RPS increasing.The therapeutic effects of Rosiglitazone group was better than high dose PRS group.The protein level of PPARγ, aP2 and GLUT4 in DN rat skeletal muscle were significantly lower than normal group(P<0.05), and RPS can increase their expression level obviously.Conclusion RPS has a dose-dependent therapeutic effect on DN rats by improving the expression level of related protein in PPAR gamma signaling pathways.

Background Statins has prominent roles in regulating lipids,anti-inflammation,autoxidation and protecting vascular endothelial cells.Sartans can promote cell growth and the expression of cytokines.Since the pleiotropic effects of statins and sartans on a variety of cell types,it is inferred that the two medicines can delay retinal aging.Objective This study was to explore the anti-aging effect of simvastatin and telmisartan on the physiological aging of retina.Methods Sixty-six three-month-old healthy SD rats were selected in this study,and 6 of them served as the youth group and the right eyeballs were immediately enucleated.The other rats were raised until 9-month-old in the same conditions and then randomly divided into the simvastatin group,telmisartan group and the control group with 20 rats for each group.The simvastatin of 5 mg/kg and telmisartan of 8 mg/kg were given by intragastric administration once a day in the simvastatin group and the telmisartan group until 17-month-old,and the equal amount of normal saline was used in the control group in the same way.The number of survival rats was 12 in the simvastatin group,10 in the telmisartan group and 8 in the control group.The right eyes were enucleated after heart perfusion of 4％ paraformaldehyde solution for the preparation of retinal paraffin sections.Retinal thickness was measured by pathological examination,and the expressions of the retinal neuron markers,including Thy-1,protein kinase C-α (PKC-ot),opsin and rhodopsin,were detected by immunofluorescence technique to evaluate the morphology of retinal ganglion cells (RGCs),bipolar cells as well as the thickness of the outer segment of photoreceptors.Results The retinal structure was clear in the rats of the youth group.However,the RGCs arrangement and inner segment (IS) and outer segment (OS) structure were abnormal in the simvastatin group,the telmisartan group and the control group.Compared with the rats of the youth group,the thickness of outer nuclear layer (ONL),outer plexiform layer (OPL),inner nuclear layer (INL),inner plexiform layer (IPL) and the total thickness of the aging rats were decreased,and the IS/OS thickness was increased in the simvastatin group and the telmisartan group (all at P＜ 0.01).Thy-1 stain showed that the number of RGCs was reduced in the simvastatin group,telmisartan group and the control group compared with the youth group,and that in the simvastatin group was increased in comparison with the control group (all at P＜0.01).PKC-αt stain exhibited that the density of bipolar cells was increased but the axon terminal bouton was declined in the simvastatin group,telmisartan group and the control group compared with the youth group,and the axon terminal bouton was declined in the simvastatin group compared with the youth group and the control group (all at P=0.000).Opsin and rhodopsin stains displayed that the OS thickness was increased in the simvastatin group,telmisartan group and the control group compared with the youth group,and that in the telmisartan group was reduced in comparison with the control group (all at P＜0.01).Conclusions As SD rat aging,retinal thickness is gradually attenuated and the number of RGCs is gradually declined.Although the density of bipolar cells seem to be unchanged,their synaptic connections are decreased and the OS is thicken.Simvastatin and telmisartan can delay retinal senescence by protecting retinal neurons against aging and thinning thickened OS.