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 observe the effect of silencing P2X7 receptor (P2X7R) by RNA interference on microglial releasing interleukin 1β (IL-1β),tumor necrosis factor-α (TNF-α) and nitric oxide (NO).Methods The small interfering RNA (siRNA) targeting P2X7R gene was observed.The primary microglial cells activated by amyloid-β (Aβ-42) were infected with the lipofectaminesiRNA.The groups were designated as Aβ-1-42,Aβ1-42/siNC,Aβ1-42/siP2X7R and blank control groups according to the different stimulus.After RNA interference for 48 hours,the microglial cells were collected.The survival rate of microglia was detected by CCK-8.The levels of P2X7R mRNA and protein were detected by Real-time PCR and Western blotting respectively.The microglial morphology and the P2X7R immune response were observed by immunocytochemistry staining.Then levels of IL-1β,TNF-α and NO in the supernatantwere measured.Results The Aβ1-42 and siRNA had no effects on the survival rate of microglia.After RNA interference silencing P2X7R,the expression levels of P2X7R mRNA and protein in Aβ1-42/siP2X7R group were decreased significantly,and in this group,the microglial activity and P2X7R immune response were all reduced.In Aβ1-42,Aβ1-42/siNC,Aβ1-42 /siP2X7R and blank control groups,the supernatant levels of IL-1β were (52.54±3.21) μg L,(54.94±2.54) μg/L,(28.70±3.58) μg/L,(24.55±4.34) μg/L,respectively and the supernatant levels of TNF-α were (64.40±4.80) μg/L,(60.94±1.63) μg/L,(25.69±3.13) μg/l,(19.21±1.97)μg/L,respectively.As compared with Aβ1-42 and Aβ-42/siNC groups,the levels of IL 1β and TNF-α in Aβ1-42 /siP2X7R group was decreased significantly (P＜ 0.05),and IL-1β level had no significant difference between Aβ1-42/siP2X7R and blank control groups.The same result was observed in the level of NOin the supernatant.The levels of NO were (1.33±0.19) μmol/L,(4.49±0.28) μmol/L,(4.78±0.33) μmol/L and (1.07±0.36) μmol/L in Aβ1-42/siP2X7R,Aβ1-42,Aβ1-42 /siNC and blank control groups respectively.Conclusions The silencing expression of P2X7 R by RNA interference effectively decreases the levels of IL-1β,TNF-α and NO released by microglia.P2X7 R can be used as an effective therapeutic target for RNA interference treatment of Alzheimer's disease.

Objective　To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods　The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results　Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux-en-Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux-en-Y jejunal p-type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases.　86 patients (76%)have been followed up, the postoperative 1-,3-,5-year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9％,45.7％,37.2％;88.8％,55.5％,33.3％; and 80％,0％,0％ respectively. Conclusions　The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.

Objective To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux en Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux en Y jejunal p type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases. 86 patients (76%)have been followed up, the postoperative 1 ,3 ,5 year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9%,45.7%,37.2%;88.8%,55.5%,33.3%; and 80%,0%,0% respectively. Conclusions The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.

Background During the past two decades, a number of rating scales were developed to facilitate diagnosis and assessment of subjects with social anxiety disorder. One of the most commonly used scales for the assessment of social anxiety disorder is the Liebowitz social anxiety scale (LSAS). The LSAS is widely used in epidemiologic investigations and clinical researches,and its assessment in the pharmacotherapy efficacy for social anxiety disorder is superior to any other scale. So we designed this study to explore the validity and reliability of the LSAS in Chinese patients with social anxiety disorder and normal control, and to find the difference of the scores between the patients self -report version and clinician-administered version. Methods Fifty five patients meeting the DSM-Ⅳ diagnostic criteria for social anxiety disorder and 168 normal controls who were screened from 222 college students were rated by LSAS, social phobia scale and self-made General Information Forms. Results The Cronbath α of LSAS for the patients and the normal controls was 0.83 and 0.77, respectively. The 4-week test-retest reliability for total scores and its factors scores of LSAS in 31 normal controls were ranging from 0.68 to 0.79. The ROC area under curve value in discriminating the patients from normal controls was 0.87±0.03; the total score of 35 was considered to be the best cut-off score for LSAS, then its sensitivity was 0.77 and its specificity was 0.81; and no significant difference between the self-report version and clinician-administered version. Conclusions The LSAS is good in internal consistency and test-retest reliability, and has high sensitivity and specificity in discriminating the patients and the controls. There is no significant difference in the total score and each factor scores of LSAS between self-report version and clinician-administered version.

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Objective:To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods:The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed. The average age was 27.7(12-65) years. The mean duration of urethral stricture was 33.4(1-240) months. The number of prior surgeries was 2.5(1-9). There were 32 cases of ectopic urethral orifice, including 22 on penile, 8 on scrotum and 2 on perineum. There were 17 cases of urethral stricture with penile curvature, 11 with urethra-cutaneous fistula, 9 with urethral diverticulum, 11 with urethral calculus and 25 with urethral infection. Ten patients kept suprapubic tubes; 61 patients were able to urinate on their own, but suffered from dysuria and weak steam. The average maximum uroflow rate of 71 cases was 4.7(0-11.2) ml/s. The primary urethral reconstruction procedures were performed on 33 cases, included 11 penile or scrotal septum flap urethroplasty, 2 urethral diverticulum wall flap urethroplasty, 12 oral mucosal urethroplasty and 8 urethrotomy. Thirty-three cases underwent two-staged surgery. For patients with penile curvature greater than 30 degrees, the penis was straightened with a urethrotomy in first stage. Besides, the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate. In second-stage, Denis Brown urethroplasty was performed on 23 patients, tubularized incised plate (Snodgrass) urethroplasty on 6, and oral mucosa inlay urethral plate (Snodgraft) urethroplasty on 4. In 5 cases, preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty. Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results:The mean follow-up time was 30.5(4-59) months. Sixty-one patients got satisfying postoperative urination, with an average maximum uroflow rate of 22.7 ml/s (15.8-37.2 ml/s). Restenosis occurred in 10 cases, and urethral fistula in 7 cases. Re-stricture patients underwent urethrotomy in 5 cases, augmented urethroplasty with flap in 4 cases, and urethroplasty with oral mucosal graft in 1 case. Among the 7 patients with urethral fistula, 5 were cured by one fistula repair, and 1 cured by second repair; the rest one was left untreated. 2 patients still had penile curvature after operation.Conclusions:It is difficult to manage post-adolescent postoperative urethral stricture of hypospadias, especially for patients with residual penile curvature greater than 30 degrees and lack of penile skin. Performing correction of the curvature and reconstruction of the urethral plate in first stage and Denis Brown urethroplasty or Snodgrass urethroplasty in second or third stage could achieve good results.

Objective To evaluate a score system(Association of Coloproctology of Great Britain and Ireland ACPGBI)in prediction of postoperative mortality from colorectal cancer patients in a Chinese hospital. Methods We analyzed retrospectively 904 patients with histologically confirmed colorectal cancer who had colorectal surgery from 1992 to 2005.There were 525 colonic cancer patients and 379 rectal cancer patients.We divided patients into several groups according to operative urgency(elective or emergency);surgeons(colorectal specialists or other surgeons);cancer location(colon or rectal).According to ACPGBI score we got the prediction.This prediction was compared with the actual mortality;Chi-square test,receiver operator characteristic curve(ROC),Hosmer-Lemeshow goodness-of-fit test were used.Results Observed overall mortality within 30 days after surgery was 1.0%(9/904),and the predicted mortality was 8.3%(75/904).In all the subgroups the predicted momdity wag higher than observed mortality.We found that the actual mortality was higher in an individual subgroup in which the predicted mortality was higher. Conclusions For colorectal cancer patients undergoing a surgery the predicted mortality of ACPGBI score system was higher than the actual mortality in a Chinese hospital.

objective To compare three risk prediction system,the physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM),the Portsmouth POSSUM (P-POSSUM)and the colorectal POSSUM(Cr-POSSUM)for the accuracy in predicting operative mortality of patients of colorectal cancer in a single Chinese referral hospital setting. Methods Data of 903 patients,who undergone surgery for colon and rectal cancers from 1992 to 2005 at Peking University Third Hospital,were enrolled in the study.POSSUM,P-POSSUM and Cr-POSSUM was used respectively to predict the mortality rate.ROC curve was applied to judge the differentiation ability of each score.Model goodness-or-fit was tested by the Hosmer-Lemeshow statistic and subgroup analysis was performed by the ratio of observed to expected deaths(O∶E ratio). Results The actual inhospital mortality in our series was 1.0%(9/903).The oredicted mortality rate by POSSUM,P-POSSUM and Cr-POSSUM were 5.6%,2.8% and 4.8%respectively.These predicted mortality rate were significantly higher than actual mortality of our patients.The O∶E ratio was 0.18,0.35 and 0.2 respectively. Conclusion The predicted mortality rate of POSSUM,P-POSSUM and Cr-POSSUM were significantly higher than actual observed mortality rate in a single Chinese referral hospital for patients of colorectal cancer.

OBJECTIVETo explore CT and MRI manifestations of the axial area peripheral primitive neuroectodermal tumors (pPNETs) in order to improve the knowledge of this disease.

METHODSThe clinical data of 10 patients with pPNETs underwent pathologically confirmed were retrospectively analyzed from October 2008 to May 2014. There were 7 males and 3 females, aged from 8 to 49 years old with median of 23.6 years. The preoperative multi-slice spiral CT scan was completed in 3 cases, plain CT scan and enhancement in 4 cases; MRI and enhancement scanning in 5 cases; and among them, 2 cases underwent both MRI and CT scan.

RESULTSIn-bone type was found 6 cases and out-bone type was found 4 cases. Three cases occurred in sacral vertebrae, 2 cases in lumbar vertebrae, 1 case in cervical vertebrae, 1 case in cervical spinal canal, 1 case in coccyx, 1 case in the right iliac bone, 1 case in presacral space. Cross sectional the smallest tumor maximum level was 1.1 cmx 1.2 cm in size, the biggest tumor was 8.0 cm x 9.2 cm, the median size was 4.4 cm x 5.7 cm, of them, the tumor of maximal diameter larger than 5 cm had 6 cases. Except 2 cases-without destruction of bone, the other 5 cases with osteolytic destruction, 2 cases with calcification, 1 case with mixed. Equidensite was main in CT scan, 1 case with uniform density, other 6 cases with uneven density,in which 3 cases with "floating ice" change; 1 case with moderate strengthening, other 3 cases with obviously strengthening, 2 cases with multiple small blood vessels in enhancement scanning. MRI of 5 cases showed the signal of isointensity on T1WI, the slightly high signal on T2WI and the signal was not uniform; after enhancement scan, the signal of 5 cases obviously enhanced. Two patients complicated with vertebral compression fractures, no periosteal reaction was found in all patients, and no the destruction of intervertebral disk was found in 5 patients of MRI scan.

CONCLUSIONThe axial area pPNETs is common among children and the youth, and the mass often is huge. The mass of in-bone type often envelopes the vertebral body, and main located on prevertebral space, all associated with bone destruction, osteolytic destruction is common, and primary vertebral bodies also is common, attachment primary or involvement is few found, it can involve the spinal canal and anterior wall of spinal canal is common, some cases complicate with multiple newly born small vessels. The mass of out-hone type in deep soft tissue is common, minority primary spinal canal, many complicated with vertebral bone destruction, osteolytic destruction was main. The intervertebral disk was not invaded and intervertebral space has not stenosis. CT scan offer complicate with "floating ice" sign, and in-bone type is common. Isointensity is main on MRI TlWI and slightly longer signal is main on MRI T2WI, strengthening signal is obvious.

Adolescent ; Adult ; Child ; Cross-Sectional Studies ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuroectodermal Tumors, Primitive, Peripheral ; diagnosis ; diagnostic imaging ; Radionuclide Imaging ; Tomography, X-Ray Computed ; Young Adult