Objective To assess the value of endorectal elastography in the diagnosis of malignant rectal adenoma. Methods Sixty patients referred to the department of basic surgery of Peking Union Medical College Hospital for the evaluation of rectal adenoma from January 2011 to May 2013 were included in this prospective cohort. All patients underwent elasticity score (ES) and strain ratio(SR) examine before operation. To evaluate the reproducibility of the strain-ratio measurements, the intraclass correlation coefficient (ICC) was calculated. Compared with final operational pathological results,the diagnostic values of elasticity score and strain ratio method were assessed. Results Histopathological result showed there were 20 adenomas and 40 adenocarcinomas. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ERUS was 68%(27/40), 40%(8/20), 58%(35/60), 69%(27/39), 38%(8/21), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of elasticity score was 85%(34/40), 70%(14/20), 80%(48/60), 85%(34/40), 70%(14/20), respectively. The SR of adenocarcinomas was significantly higher than that of adenomas(2.82±1.81 vs 1.23±0.57, t=3.333, P < 0.05). The differences among the SR of benign adenoma, benign adenoma with severe atypical hyperplasia and completely malignant lesions were statistically significant (1.26±0.84 vs 2.94±1.95, 1.42±0.55 vs 2.94±1.95, t=2.619, 2.415, P=0.013, 0.021). When 1.240 was chosen as the best cut-off value of SR, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of strain ratio was 82%(33/40), 75%(15/20), 80%(48/60), 87%(33/38), 68%(15/22), respectively. Conclusion Endorectal elasotgraphy can accurately diagnose the malignant rectal adenoma, which can provide reliable preoperative imaging evidence for clinical operation mode.

Objective To investigate the effects of ischemic postconditioning on apoptosis, structural and functional changes of mitochondria induced by myocardial isehemia/reperfusion (I/R) injury of rabbits and potential mechanism. Methods Eighty healthy rabbits were divided randomly into five groups: sham operation group ( Group Sham) , ischemic reperfusion group (Group IR) , ischemic preconditioning group (Group IP) , ischemic postconditioning group (Group PC) and 5-HD plus ischemic postconditioning group (Group PC +5-HD). All rabbits in the five groups were killed 4 h after reperfusion. The hearts were quickly collected for microscopy by TUNEL. We observed ultrastructural changes of myocardium under electron microscope and examined mitochondrial membrane potential and Ca~(2+) concentration, MDA content and SOD activity of myocardial mitochondria. Results Compared with group IR, the damage of mitoehondrial ultrastrueture was milder, the apoptosis rate decreased and Ca concentration and MDA content were much lower in group IP and group PC ( P < 0. 05 ). Mitochondrial membrane potential and SOD activity of myocardial mitochondria in group IP and group PC was significantly higher than that in group IR(P<0.05). The protective effect of PC against I/R injury was partially counteracted by 5-HD .Conclusion Ischemic posteonditioning can protect the heart from I/R injury, this is supported by improvement mitochondrial ultrastructure and by decreasing apoptosis, increasing mitochondrial membrane potential and SOD activity, alleviating Ca~(2+) overload and decreasing MDA content in myocardial mitochondria. The cardio protective effects may be explained by mitochondrial ATP sensitive potassium channel.

Objective Our objective was to design a new type of bedpan (inflatable, bed urinal) and compare its effect with common bedpan. Methods We divided 144 patients with bone fracture and lying in bed into the test group and the control group with 72 cases in each group from May 2006 to February 2007. Inflatable bed urinals were used in the test group and common bedpans were used in the control group. The pain alleviation, comfort degree, staining of bed sheet and skin injury were observed and evaluated in each group. Results Application of inflatable bed urinal was superior to common bedpan in the following aspects: alleviation of pain, comfort degree, staining of bed sheets and skin injury. Conclusions Adoption of inflatable bed urinal could alleviate pain, prevent the incidence of complication and reduce the workload of nurses.

Objective:The effect of antiviral therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radical hepatectomy was assessed. Methods:A total of 478 HBV-HCC patients treated by radical hepatectomy were retrospectively col-lected. Patients in the treatment group (n=141) received postoperative lamivudine therapy (100 mg/d), whereas patients in the control group (n=337) did not. Recurrence-free survival rates, overall survival rates, treatments for recurrent HCC and cause of death were com-pared between the two groups. Propensity score matching was also conducted to reduce confounding bias between the groups. Results:The one-, three-, and five-year recurrence-free survival rates didn't significantly differ between the two groups (P=0.778);however, the one-, three-, and five-year overall survival rates in the treatment group were significantly higher than those in the control group (P=0.002). Similar results were observed in the matched data. Subgroup analysis showed that antiviral treatment conferred a significant sur-vival benefit for Barcelona Clinical Liver Cancer stage A/B patients. Following HCC recurrence, more people in the treatment group were able to choose curative treatments than those in the control group (P=0.031). For cause of death, fewer people in the treatment group died of liver failure than those in the control group (P=0.041). Conclusion:Postoperative antiviral therapy increases chances of receiving curative treatments for recurrent HCC and prevents death because of liver failure, thereby significantly prolonging overall sur-vival, especially in early-or intermedian-stage tumors.

Objective To investigate the alterations of connexin 43 (Cx43) expression and its distribution at different stages of myocardial infarction (MI) in rats after transplantation of allogenic mesenchymal stem cells (MSCs).Methods Wistar rats were ligated on the left anterior descending coronary artery to make MI models.They were injected with allogenic MSCs,which were induced by 5-aza and labelled by DAPI,during the second operation after 7 days of MI.In subgroups,MSCs were detected by fluorescence microscope.Cx43 expression and GJ distribu-tion were examined by immunohistochemistry after 4,8 or 12 weeks respectively.Results MSCs differentiated into cardiac muscle cell-like cells which were capable of pulsing spontaneously,expressing cTnT and forming myofilament in vitro.Transplanted MSCs can survive in MI host and upregulate Cx43 expression and normalize Cx43 distribution at ischemic zones after 4,8 and 12w.No change of Cx43 was seen at infarcted zones.Conclusion MSCs have the plasticity of differentiating into cardiac muscle cell-like cells which can continuously upregulate Cx43 expression and normalize Cx43 distribution at ischemic zones after 4,8 and 12w.

Objective To explore the efficacy of postoperative adjuvant transarterial chemoembolization (TACE) on the survival of patients after radical resection for hepatocellular carcinoma (HCC).Methods Between March 2007 and March 2010,229 HCC patients who underwent radical resection were retrospectively studied.Patients who underwent resection alone were used as the control group (138 patients) while those who received post-operative adjuvant TACE was used as the interventional group.In order to balance the covariates between the groups,a matched comparison of the patients was done by selecting patients using the propensity score matching (PSM).Then,the efficacy of adjuvant TACE upon survival was evaluated.Results After PSM,we obtained 67 pairs of patients.The survival time for the interventional and the control groups were 32.1 months and 28.3 months respectively.The survival rates at year 1,2,3 post-resection were 94.0％,84.8％ and 75.3％ in the interventional group versus 83.6％,69.9％ and 61.5％ in the control group respectively.There were no significant differences between the two groups (P =0.062).Univariate analysis showed the serum level of AFP,tumor size,number of tumor,BCLC stage,and adjuvant TACE significantly affected the survival of HCC patients who received radical resection (P ＜0.05).Cox model suggested that AFP≥400 μg/L and tumor diameter ＞ 5 cm were independent risk factors of survival for HCC patients who received radical resection (P ＜ 0.05).Conclusion Postoperative adjuvant TACE had no positive effect on survival,and AFP level ≥ 400 μg/L and tumor size ＞5 cm were independent risk factors of survival of HCC patients who received radical resection.

Objective To retrospectively assess the prognostic impact of diabetes mellitus (DM) on patients with hepatocellular carcinoma (HCC) after curative resection.Methods A total of 417 HCC patients who had undergone curative hepatic resection were included into two groups.108 patients were classified into DM group and 309 patients into the non-DM group.Overall survival,disease-free survival,postoperative morbidity and mortality were compared between the two groups after reducing confounding bias by propensity score matching.Independent prognostic predictors were determined by Cox proportional hazards model.Results Propensity score matching resulted in 89 patients in each group,and variables were balanced between two groups.In the matched cohort,DM and non-DM groups showed similar morbidity and 30-and 90-day mortality after curative hepatectomy (respectively x2 =0.837,x2 =Fisher,x2 =Fisher,all P ＞ 0.05),the 1-,3-,and 5-year overall survival rates were 82.0％,59.9％,and 33.4％ in DM group and 90.7％,79.1％,and 69.3％ in non-DM group,respectively(P =0.001),however,there was no significant difference in disease-free survival between DM and non-DM groups.Cox multivariate analysis revealed that DM is an independent risk factor for overall survival in patients with HCC after curative resection,but not for disease-free survival.Conclusions DM does not increase the postoperative morbidity or mortality for patients with HCC after curative resection,however,DM may increase the risk of mortality of HCC patients in the long-term.

BACKGROUND:Cell transplantation can repair damaged myocardial tissue.However,whether transplaned cells and host cells formed an effective electricity and mechanical couple or whether reconstruction of connexin (Cx) and arrhythmia formed,are still unclear.OBJECTIVE:It is hypothesized that arrhythmia can be treated by changing Cx levels and intervening abnormal GJ channel.Moreover,to explore the effects of bone marrow mesenchyma stem cells (MSCs) on the expression of Cx43 and Cx45 in rata with myocardial infarction.DESIGN,TIME AND SETTING:The randomized controlled animal study was performed at the Experimental Center,Guangxi Medical University from January 2008 to May 2009.MATERIALS:A total of 180 Wistar rats were randomly divided into four groups:normal control,sham operation,myocardial infarction,and MSCs,with 45 animals in each group.Each group was then divided into 3 subgroups (n=15) according to 4 weeks,8 weeks and 12 weeks post-transplantation.Additional 20 healthy,Wistar rats,aged 1 month,were selected to harvest MSCs.METHODS:The third passage of MSCs was induced by 5-aza like cardiomyocytes for 4 weeks,labeled with DAPI at 2 hours before transplantation.Models of acute myocardial infarction were established in all groups except sham operation group.At day 7 after model preparation,2×10~(10) /L MSCs were infused into the edge and center of myocardial infarcted region by multipoint injection.Rats in the myocardial infarction group were subjected to an equal volume of saline as wall as those in the normal control and sham operation groups.MAIN OUTCOME MEASURES:The mRNA expressions of Cx43,Cx45 were assayed by fluorescence quantitative PCR.RESULTS:The mRNA expression of Cx43 among each groups had no difference at weeks 4,8 and 12 after intervention in the normal areas.Compared to the normal areas,Cx43 mRNA reduced significantly at ischamic zone in the myocardial infarction group and MSCs group (P＜0.01),with notably increased of Cx45 mRNA expression (P＜0.01).Compared to myocardial infarction group,Cx43 mRNA expression was statistically higher in the MSCs group at the same points (P ＜ 0.01),and the Cx45 mRNA dramatically declined (P ＜ 0.01).CONCLUSION:Acute myocardial infarction reduces the mRNA expression of Cx43 and increases the Cx45 mRNA expression.The exogenous cells transplantation can upturn the mRNA expression of Cx43 in the border-zone of the infarcted area,and down-regulate the Cx45 mRNA expression in the border-zone of the infarcted area.

BACKGROUND: Stem cell transplantation in repairing infarct myocardium and in improving cardiac function has been widely accepted. However, whether transplanted cells and host cells formed an effective electricity and mechanical couple, whether a relevant independent electrical system with contractile function formed or whether severe malignant ventricular arrhythmia formed, are still unclear.OBJECTIVE: To investigate electrophysiological abnormaltiy and left ventricular remodeling in rats with myocardial infarction following allogenic bone marrow mesenchymal stem cell (BMSC) transplantation.DESIGN, TIME AND SETTING: The randomized controlled animal study was performed at the Experimental Center, Guangxi Medical University from December 2005 to October 2008.MATERIALS: A total of 120 healthy Wistar rats were equally randomized into normal control, sham operation, saline control and cell transplantation groups. Healthy Wister rats aged 1 month were selected to harvest bone marrow.METHODS: At the third passage, rat BMSCs were collected and treated with 5-aza, and differentiated into cerdiomyocytes.BMSCs were labeled with DAPI at 2 hours before transplantation. In the saline control and cell transplantation groups, rat models of myocardial infarction were established by ligating the left anterior descending coronary artery. In the sham operation group, the coronary artery was not ligated, but only braid. At 7 days following ligation, BMSCs in the cell transplantation group at 2×10-1/L were infused into the edge and center of myocardial infarct region by multipoint injection. Rats in the other three groups were subjected to an equal volume of saline.MAIN OUTCOME MEASURES: Electrocardiogram and cardiac electrophysiology were performed. Ultrasonic cardiography was used to detect left ventricular function. Infarct size was determined. DAPl-labeled donor cell migration and distribution was observed with a fluorescence microscope.RESULTS: BMSCs could differentiate into cardiacmuscle cell-like cells which were capable of pulsing spontaneously, expressing cardiactoponin T and forming myofilament in vitro. Compared with the saline control group, PR interval, QRS duration and ventdcular effective refractory period shortened, ventricular fibrillation threshold increased at 4, 8 and 12 weeks (P < 0.05); left ventricular internal diameter at end-systole reduced, and left ventricular ejection fraction and shortening traction was significantly increased (P< 0.05). At 8 and 12 weeks, infarct size was significantly smaller (P < 0.05). At 4 weeks, DAPl-labeled BMSCs could be seen under the fluorescence microscope, and still could he detected at 12 weeks. However, the fluorescence became weak with prolonged time.CONCLUSION: BMSCs have the plasticity of differentiating into cardiac muscle cell-like cells, which can modulate theelectrophysiological abnormality and left ventricular remodeling following myocardial infarction.

Objective To evaluate the mid-term follow-up of the pereutaneous angioplasty of the occlusive acrtoiliac artery diseases.Methods The data of 30 patients who had distal abdominal aorta and bi-lateral iliac artery stenosis or occlusion and treated by percutaneous angioplasty were retrospectively reviewed.They are 24 males and 6 females,aged from 35 to 75 years (average 55 ± 10 years). The interventional procedures include wire-guided canalization,thrembolysis,balloon angioplasty and stents implantation.They were followed up by telephone,letter or visiting after discharged.Results Twenty-six patients with aarto-iliac are revascularized successfully.Three cases failed.Of them,one failed because only one side of iliac artery and aorta were successfully canalized while the eontralateral not,one failed to revascularize both the aorta and the iliac artery,the other one failed due to the ihac rupture and replaced by WallGraft implantation.Two cases had distal thrombosis during the procedure.One case was amputated due to the aggravated isebemia of the right lower extremity after the revascularization failed.Twenty-seven cases were followed uo after 1 to 112 months,averaged (41±9) months.One case showed that the iliac artery was uncanalized after 6 months.One case showed bilateral iliac artery occlusion during 25 months follow-up and re-occluded 3 months after balloon angioplasty and finally had stent implanation in bilateral iliac artery.The other patients had no aggravated symptom of recurrence.Conclusion The percutaneous angioplasty is a good choice for occlusive aorto-iliac artery disease,showing good recovery during mid-term follow-up.