42 patients with chronic hepatitis B virus(HBV)infection were studiedby enumeration of T-cell subsets in peripheral blood with SACI-Ig rosetteforming technique.Among which,10 patients with reduction of OKT_4/OKT_8 ratio were evaluated by assay the effect of their sera on T-cell su-bsets. OKT_4/OKT_8 atwas significantly lower in patients with HBeAg(+),serum HBV-DNA(+and HBcAg(+)of liver tissue than in normal con-trast.OKT_4/OKT_8 ratio of patients with chronic active hepatitis(CaH) was similar to that of pants with chronic persistant hepatitis(CPH).Itseoisprpoad fhat there isa relationship in OKT_4/OKT_8 ratio and HBV rep-lication. when lymphocytes from a normal individual were incubated with seraof 10 patients with reduction of OKT_4/OKT_8 ratio for 24-48 hours,OKT~+_8cell proportion was significantly increased.As lymphocytes from the samenormal individual were proportion incubated witn sera of 10 helthy donorsfor 24-48 hours,OKT~+_8 cell proportion was only moderately increased.It issuggested that there is a factor in sera of patients with chronic hepatitisB,which probably makes OKT~+_4 cell bear both OKT~+_4 and OKT_8~+antigenicmarkers.

11 patients with chronic hepatitisB virus(HBV)infection were studiedby enumeration of T cell subsetsin peripheral blood withStaphylococco-SRBC DoubleRosette Forming Technique.It was found that T_3~+ cell subsetwas higher and T_4/T_8 ratio was sig-nificantly lower in patients withchronic HBV infection than in con-rol and higher numbers of doublelabeled cells (expressing both T_4 andT_8 antigens) were also found in pa-tients with chronic HBV infection.

BACKGROUND:Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee, but unicompartmental knee arthroplastystil has some problems, such as excessive bleeding-induced postoperative blood transfusion, increased blood transfusion rate, hospitalization expense and complication of blood transfusion. As tranexamic acid for total knee arthroplasty has achieved good effects. It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty.
OBJECTIVE:To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty.
METHODS:122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplastyinthe Department of Orthopedics, the Second Affiliated Hospital ofDalian Medical University from January 2014 to August 2015wereenroled in this study. Al patients were randomly divided into two groups. Patients in the tranexamic acid group were injected with 10 mL of tranexamic acid (containing 1000 mg) + 10 mL of sodium chloride injection in the articular cavity before loosening the tourniquet. Patients in the control group received 20 mL of sodium chloride injection in the articular cavity. In both groups, the drainage tube was clipped for 3 hours after injection.At 48 hours after replacement, the drainage tube was puled out. We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively, total blood loss and drainage volume at 2 days postoperatively, the number of patients receiving blood transfusion, Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively, and thrombosis at 1 week postoperatively, and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty.
RESULTS AND CONCLUSION:(1) Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). No significant difference in hemoglobin levels and hematocrit was detected at 1 month postoperatively in both groups (P> 0.05). (2) Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). (3) The number of patients receiving blood transfusion was significantly less in the tranexamic acid group (0 case) than in the control group (6 cases) (P< 0.05). (4) Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively (P< 0.05). No significant difference in above socres was identified between the two groups at 1 month postoperatively. (5) No venous thrombosis was found at 1 week postoperatively in both groups. (6) These results confirm that during knee medial unicompartmental arthroplasty, intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume, perioperative blood loss, blood transfusion, is beneficial to the early recovery of knee jointfunction after replacement, and does not increase the risk of lower extremity deep venous thrombosis.

Objective To investigate the clinical manifestations of early postoperative internal hernia. Methods Patients who were diagnosed with early postoperative small bowel obstruction(EPSBO)within 30 days after operation and underwent laparotomy between 1994 and 2006 were included for study.Clinical and radiological findings were analyzed. Results Totally 38 EPSBO patients were identined.among those,9 patients(23.7%)had an internal hera ag the cause of the howel obstruction.Other causes included intestinal adhesions in 27 patients(71.1%),gallstone ileus in 1 patient(2.6%)and stoma obstruction in 1 patient(2.6%).In the internal hernia group,6 cases were male and 3 cases were female witIl a mean age of 53.6 years.The mean time from the primary operation to symptom development was 7.8 d(range,2～17 d)and the mean time of conservative treatment Was 3.4 d(range,1～8 d).The main clinical features included:complete mechanical obstruction with symptoms rapidly progressing and early bowel strangulation.Specific radiologic abnormalities misht be identified,especially by contrast-enhanced CT.In this series,intestinal strangulation was found in 6 patients with bowel necrosis in 4 eases,necessitating howel resection in 5 patients.Wound infection developed in one cage and there was no perioperative death.Conclusion Internal hernia can occur early postoperatively and it bears a high risk of strangulation and bowel necrosis.Prompt operative intervention should be carried out in highly suspicious patients in order to avoid complications and achieve good outcome.

Objective To evaluate the number of lymph node harvested during radical resection of invasive rectal carcinoma(stage Ⅰ toⅢ).Methods From January 2000 to June 2008,the pathological data of colorectal carcinoma patients who were operated on were retrospectively reviewed.Exclusion criteria included recurrent colorectal tumor,Tis tumor,R1 or R2 resection,tumor resection transanally or endoscopically,synchronous diseases affecting the surgical procedure for the reetal cancer(familial adenomatous polyposis.synchronous coloreetal carcinoma)and rectal cancer receiving perioperative neoadiuvant chemoradiation.Statistical analysis was performed using Mann-Whitney Test and Chi-Square Test (SPSS 15.0).Results were expressed as mean±SEM.Results A total of 2282 patients were identified.including 1216 cases in the rectal carcinoma group and 1066 cases in the colon carcinoma group.There were no significant difference in gender(719/1216 vs.593/1066,P=0.092)and overall TNM stage (P=0.067)between the two groups.But patients of rectal cancer were younger(58.6±0.4 vs.62.0±0.4.P=0.000).The lymph node retrieval in the rectal carcinoma group was significantly less than that of colon carcinoma group(9.4±0.1 vs.10.5±0.1,P=0.000).There were significantly less rectal cancer patients with a 1ymph node harvest equal to or more than 12 nodes(P=0.000).Patients in the low rectal cancer group(≤7 cm from the anal verge.n=834)had less lymph nodes harvested than the mid-high rectal cancer group(＞7 am and≤15 cm from the anal verge.n=382)(9.2±0.1 vs.9.9±0.2,P=0.009).Conclusion The lymph node harvest in the rectal carcinoma group was significantly less than that in the colon carcinoma group.A new standard may be necessary to define the adequate number of lymph nodes for rectal cancer.

OBJECTIVETo compare the clinicopathological features and prognosis between left-sided colon cancer (LC) and right-sided colon cancer (RC).

METHODSClinicopathological and follow-up data of 2 174 colon carcinoma cases undergoing resection at Shanghai Changhai Hospital of The Second Military Medical University from January 2000 to December 2010 were retrospectively analyzed. Patients with transverse colon cancer, overlapping position, unknown location, recurrent cancer, multiple primary cancer, concomitant malignant tumors, preoperative chemotherapy, local resection, incomplete clinical data and missed follow up were excluded. Finally, a total of 1 036 patients, whose primary tumors were radically removed, were enrolled, with 563 patients in LC group (including carcinoma in cecum, ascending colon and hepatic flexure) and 473 in RC group (including carcinoma in splenic flexure, descending colon and sigmoid colon). The clinicopathological features and survival, including median overall survival, 5-year overall survival rate, tumor specific median overall survival, cancer specific 5-year overall survival rate, were compared between LC and RC groups. Tumor specific overall survival was defined as the period between operation date to the date of death caused by cancer progression. Multivariate Cox regression analysis was used to analyze the influencing factors of survival. Propensity score matching was carried out to balance the clinicopathological factors between the two groups with the SAS 9.3, taking the following parameters into consideration (age, gender, gross appearance, tumor diameter, invasion depth, lymph node metastasis, distant metastasis, TNM stages, differentiation, CEA and CA199-9). Patients in RC group and LC group were matched according to the propensity scores and the clinicopathological characteristics and prognosis of two groups were compared again.

RESULTSNo significant differences were identified between the two groups in age, distant metastasis and serum CEA level. Compared with RC group, LC group had more male patients [60.9%(343/563) vs. 51.0%(241/473), P=0.001], more ulcerative tumors [71.9% (405/563) vs. 65.3%(309/473), P=0.006], better differentiation [well/moderately differentiated: 87.5%(493/563) vs. 73.8%(349/473), P=0.000], lower infiltration depth [T1-2: 17.1%(96/563) vs. 10.1%(48/473), P=0.001], higher lymph node metastasis rate [N0: 53.3%(300/563) vs. 62.4%(295/473), P=0.013], lower TNM stage [stage I(: 13.3%(75/563) vs. 7.8%(37/473), P=0.000], lower serum CA199 level [<37 kU/L: 68.4% (385/563) vs. 62.6% (296/473), P=0.022] and smaller tumor diameter [<5.0 cm: 55.1%(310/563) vs. 38.3%(181/473), P=0.000]. The median overall survival was 82 months and 76 months in LC and RC groups, respectively, and the 5-year overall survival rate was 58.3% and 50.9%(P=0.038). The median tumor specific survival was 84 months and 78 months in LC and RC groups, respectively, and the 5-year tumor specific overall survival rate was 60.6% and 52.9% (P=0.031). Multivariate Cox regression analysis showed that tumor location (LC vs. RC) was not associated with overall survival (P=0.106) and tumor specific survival (P=0.091). After propensity score matching, no significant difference was found in clinicopathological factors and propensity score (0.458±0.129 vs. 0.459±0.129, P=0.622) between LC and RC group. After matching, there was no significant difference in overall survival rate (54.0% vs. 51.7%, P=0.982) and tumor specific overall survival rate(56.4% vs. 53.1%, P=0.819) between two groups.

CONCLUSIONSignificant difference exists between RC and LC in clinicopathological factors, but not in survival.

Animals ; Disease Models, Animal ; Hepatitis, Viral, Animal ; virology ; Humans ; Mice ; Murine hepatitis virus ; genetics ; pathogenicity ; physiology

Objective To compare the characteristics of clinical pathology between patients with early recurrence and those with late recurrence of colorectal cancer.Methods Clinicopathological data of 391 recurrence patients after surgery from Changhai Hospital were recruited between Jan 2005 and Dec 2015.The clinical and pathological characteristics of primary cancer in early recurrence group (less than 2 years after surgery) and late recurrence group (2 year or more after surgery) were compared.Results 246 patients had early recurrence (62.9％) and 145 had late recurrence (37.1％).Liver,systemic metastases and peritoneum were the main sites of distant recurrence in the early recurrence group,whereas liver,lung and systemic metastases were the most frequent sites of metastases in the late recurrence group.Patients with the increased tumor perimeter,lymph node metastasis,increased CEA and CA19-9,without postoperative adjuvant treatment and microsatellite stability are more likely to have early recurrence.5-year overall survival rate for patients with early recurrence was significantly lower than those with late recurrence.Conclusions This study showed that clinical and pathological factors are significantly associated with recurrence of colorectal cancer.Two years after surgery is an important period for the recurrence of colorectal cancer.

Objective:To explore the predictive factors of pathological complete response (pCR) after neoadjuvant chemoradiotherapy for middle-low rectal cancer.Methods:A case-control study was conducted. The inclusion criteria were as follows: (1) colonoscopy, digital examination or magnetic resonance imaging (MRI) showed a distance from the lower edge of the tumor to the dentate line of no more than 10 cm; (2) complete clinicopathological data were available; (3) preoperative biopsy revealed adenocarcinoma; (4) preoperative pelvic MRI or endorectal ultrasonography was performed; (5) no distant metastasis was found. Exclusion criteria: (1) preoperative radiotherapy and chemotherapy were not administrated according to the standard; (2) simultaneous multiple primary cancer and familial adenomatous polyposis were observed. According to the above criteria, clinicopathological data of 245 patients with middle-low rectal cancer undergoing preoperative neoadjuvant chemoradiotherapy in Changhai Hospital of Navy Medical University from January 2012 to December 2019 were retrospectively collected. Univariate analysis and multivariate logistic analysis were used to identify the clinical factors predicting pCR. pCR is defined as complete disappearance of cancer cells under the microscope in cancer specimens (including lymph nodes) after neoadjuvant chemoradiotherapy.Results:A total of 72 patients with pCR were enrolled in this study. Univariate analysis showed that preoperative T stage, tumor circumference, tumor morphology, carbohydrate antigen (CA) 19-9, interval between the end of neoadjuvant therapy and operation were associated with pCR (all P<0.05). The above 5 variables were included in multivariate logistic analysis and the results revealed that the T stage (OR=5.743, 95% CI: 2.416-13.648, P<0.001), tumor circumference (OR=7.754, 95% CI: 3.822-15.733, P<0.001), tumor morphology (OR=0.264, 95% CI: 0.089-0.786, P=0.017) and the interval between the end of neoadjuvant therapy and operation (OR=0.303, 95% CI: 0.147-0.625, P=0.001) were independent predictive factors of pCR, while CA 19-9 level was not an independent factor (OR=1.873, 95% CI:0.372-9.436, P=0.447). Conclusion:By knowing the clinical features of preoperative T stage, tumor circumference, tumor morphology and the interval between neoadjuvant chemoradiotherapy and operation, patients with higher likelyhood of pCR after neoadjuvant chemoradiotherapy may be identified.

Objective:To explore the predictive factors of pathological complete response (pCR) after neoadjuvant chemoradiotherapy for middle-low rectal cancer.Methods:A case-control study was conducted. The inclusion criteria were as follows: (1) colonoscopy, digital examination or magnetic resonance imaging (MRI) showed a distance from the lower edge of the tumor to the dentate line of no more than 10 cm; (2) complete clinicopathological data were available; (3) preoperative biopsy revealed adenocarcinoma; (4) preoperative pelvic MRI or endorectal ultrasonography was performed; (5) no distant metastasis was found. Exclusion criteria: (1) preoperative radiotherapy and chemotherapy were not administrated according to the standard; (2) simultaneous multiple primary cancer and familial adenomatous polyposis were observed. According to the above criteria, clinicopathological data of 245 patients with middle-low rectal cancer undergoing preoperative neoadjuvant chemoradiotherapy in Changhai Hospital of Navy Medical University from January 2012 to December 2019 were retrospectively collected. Univariate analysis and multivariate logistic analysis were used to identify the clinical factors predicting pCR. pCR is defined as complete disappearance of cancer cells under the microscope in cancer specimens (including lymph nodes) after neoadjuvant chemoradiotherapy.Results:A total of 72 patients with pCR were enrolled in this study. Univariate analysis showed that preoperative T stage, tumor circumference, tumor morphology, carbohydrate antigen (CA) 19-9, interval between the end of neoadjuvant therapy and operation were associated with pCR (all P<0.05). The above 5 variables were included in multivariate logistic analysis and the results revealed that the T stage (OR=5.743, 95% CI: 2.416-13.648, P<0.001), tumor circumference (OR=7.754, 95% CI: 3.822-15.733, P<0.001), tumor morphology (OR=0.264, 95% CI: 0.089-0.786, P=0.017) and the interval between the end of neoadjuvant therapy and operation (OR=0.303, 95% CI: 0.147-0.625, P=0.001) were independent predictive factors of pCR, while CA 19-9 level was not an independent factor (OR=1.873, 95% CI:0.372-9.436, P=0.447). Conclusion:By knowing the clinical features of preoperative T stage, tumor circumference, tumor morphology and the interval between neoadjuvant chemoradiotherapy and operation, patients with higher likelyhood of pCR after neoadjuvant chemoradiotherapy may be identified.