Colorectal cancer is one of the most common malignancies in the world, and rectal cancer accounts for a large percentage of this disease in Chinese patients. Surgical extirpation is the mainstay of therapy, Intraluminal ultrasound is highly accurate in detecting depth of invasion and lymph node metastasis, and is also helpful in preoperative staging of rectal cancer. Preoperative adjuvant therapy could down-stage tumors, improve the radical resection rates of advanced lower rectal cancer, increase the rate of sphincter-saving surgery, and decrease the local recurrence rate. Total mesorectal excision could signifi-candy decrease the local metastasis of rectal cancer, and rectal cancer resection with preservation of pelvic autonomic nerve is effective in preventing urinary or reproductive dysfunction. Recently, minimally invasive surgery has been introduced for the management of rectal cancer, and transanal endoscopic microsurgery is a new method with advantages in rectal cancer treatment.

Objective:To examine whether the thyroxine treatment can affect the serum lipid levels in patients with subclinical hypothyroidism by Meta analysis.Methods:Pubmed and China National Knowledge Infrastructure(CNKI)were searched for randomized controlled trials reporting the effectiveness of thyroxine treatment on serum lipid levels in subclinical hypothyroidism patients from January 1980 to September 2006;hand-search was also performed.The included trails were analyzed by RevMan4.2 software.Results:Six studies were finally included and five of them found thyroxine to be significantly more effective than placebo in improving the serum lipid disorders;one of them found thyroxine had no obvious effect.The pooled effect sizes(95%CI)of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),apoprotein A(ApoA),apoprotein B(ApoB)and lipoprotein a(Lp(a))were -0.39(-0.71, -0.07),-0.02(-0.07,0.04),-0.02(-0.06,0.03),-0.22(-0.31,-0.12),-0.08(-0.11,-0.06),-0.05(-0.08, -0.02),and -0.38(-2.41,1.64),respectively.The analysis results showed that thyroxine treatment was significantly effective on serum levels of TC,LDL-C,ApoA,and ApoB,but not on TG,HDL-C,or Lp(a).Conclusion:This Meta-analysis demonstrates that thyroxine treatment can improve thyroid function and lipid metabolism in patients with subclinical hypothyroidism,reducing the prevalence of artherosclerosis and coronary heart disease.

Objeetive To analyze the risk factors on anastomotic leakage after low anterior resection with the technique of total mesorectal excision(TME)for rectal carcinoma. Methods Our retrospective study included 498 patients of rectal cancer who underwent anterior resection with TME technique. Results 7.2%patients(36/498)developed clinical anastomotic leakage.Sex,distance of tumor from anal verge,preoperative radiotherapy were found related to the anastomotic leakage ( P＜0.05 or0.01),while age,diabetes,hypertensive disease,vesse]emboli,diversion stoma construction,anastomotic technique were not.Among the 37 patients with diversion stoma construction simultaneously,3 patients developed leakage who recovered conservatively.Among the other 33 leakages 10 were cured conservatively.The other 23 leakages necessitated a laparotomy and proximal colostomy. Conclusion Sex,distance of tumor from anal verge,preoperative radiotherapy were risk factors for anastomotic leakage after TME.

Adolescent idiopathic scoliosis has a high incidence in orthopedics,researches about its etiology begins early.However,it is still unclear until now.Idiopathic scoliosis trends to a familial aggregation,and its inheritance is diverse,which suggests idiopathic scoliosis can be the result of the interaction of many factors and major genes.It is reported that the inheritance mode of idiopathic scoliosis includes autosomal dominant inheritance,X-linkage dominant inheritance and polygenic inheritance.With the consummate of genome genetic map and the development of genetic technology at recent years,scholars have gained much advancement through the researches in gene screening,candidate gene,gene mutation and animal model.Further study should focus on the accurate site of related genes.

[Objective]To establish 3D finite element model of adolescent idiopathic scoliosis.Stress analysis on established 3D finite element model was done to compare the specific quantity of stress among every vertebra.[Method]Under the help of related softwares,3D finite element model was established from CT scan of a adolescent idiopathic scoliosi.A number of points were chosen on the model.Stress analysis was done in normal loading.[Result]Vertebral wedging and stress distribution showed significant regularity.The result was the largest in the apical region,and showed a gradual decrease to the end vertebral.[Conclusion]Relative biomechanical and clinical analysis can be easily conducted on 3D finite element model of scoliosis.It is possible to analyze diversity of stress on different conditions.

Collagen fibrils and hydroxyapatite might recognize each other at the mesoscale by multiple cooperative interactions due to their intrinsically repetitive structured surfaces, and thus effectively directing the biomineralization, a biological process involving regulating the growth of bones, teeth and other organs. In this work, we developed a simple technique to prepare nanowire arrays of biological macromolecules by reversely using the biomineralization mechanism, with results similar to the hot wall epitaxy, a molecular beam deposition technique under vacuum. With this technique, we successfully cultured 5-10 μg/mL rat tail type I collagen monomer solutions into collagen nanowire arrays on the mica (001) lattice plane along one unique direction across the whole cleavage surface. The atomic force microscope experiments indicated that the nanowires in the arrays became more crowded with higher monomer concentration, but their width and height remained unchanged, about 60.0 nm and 1.5 nm, respectively. The collagen nanowire coating enhanced the hydrophilicity of the mica surface, reducing the contact angle from 25.8° to 9.5°. Based on the characterization results of electron back scattering diffraction and transmission electron microscope, the collagen nanowires were most likely to be oriented along the mica [110] direction, which validated the quasiepitaxial growth mechanism in more details.

Objective:To establish an ion chromatography method for the determination of methane sulfonic acid in betahistine me-sylate and evaluate the uncertainty in the measurement. Methods: An ion chromatographic column IonPac AS11-HC ( 25 mm × 4. 0 mm,5 μm) was used with 12 mmol·L-1 NaOH as the eluent and an electrical conductivity detector with the suppressor of 30 mV. Results:The results showed that methane sulfonic acid could be detected without any interference. The calibration curve was linear within the range of 10-30 μg·ml-1(r=0.999 9)and the LOQ was 0.116 μg·ml-1. The average recovery was 100.8% (RSD=1. 2%, n=9). Based on the results of experiments, the influencing factors of uncertainty in the measurement were quantitatively eval-uated. The expanded uncertainty was obtained. Conclusion:The method is simple, accurate and selective. It can be used for the de-termination of methane sulfonic acid in betahistine mesylate. Based on the evaluation of uncertainty, the analysis can help reduce the uncertainty in the measurement and improve the accuracy and reliability of the determination.

OBJECTIVETo discuss the application and clinical effect of damage control concept in the treatment of severe limbs fractures combining with multiple trauma.

METHODSFrom July 2009 to July 2012, 30 patients with severe limbs fractures combining with multiple trauma were treated with the damage control concept, included 20 males and 10 females with an average age of (34.03 ± 12.81) years old ranging from 20 to 60 years old; the ISS averaged (35.00 ± 12.81) points (ranged from 26 to 54 points). And the control group also contained 30 patients with severe limbs fractures combining with multiple trauma treated by the traditional operation from June 2006 to June 2009, there were 23 males and 7 females with an average age of (34.23 ± 11.04) years old ranging from 18 to 65 years old. The ISS averaged (35.56 ± 11.04) points (ranged from 26 to 51 points). The age, gender, ISS, Gustilo classification, operation time, intraoperative blood loss, blood transfusion,postoperative complications and mortality rate were observed and compared.

RESULTSIn the damage control concept group,there were 28 cases surviving and 2 cases (6.7%) death; 6 cases of postoperative complication included 2 cases of adult respiratory distress syndrome, 1 case of multiple organ failure, 1 case of disseminated intravascular coagulation and 2 cases of wound infection. In the control group, there were 22 cases surviving and 8 cases death(26.7%); 13 cases of postoperative complication included 4 cases of adult respiratory distress syndrome,2 cases of multiple organ failure, 2 cases of disseminated intravascular coagulation and 3 cases of wound infection. There were no statistically significant differences between two groups in age, gender, ISS, Gustilo classfication and complication (P > 0.05), however there were statistically significant differences in mortality rate, operation time, blodd loss, blodd transfusion between two groups (P < 0.05).

CONCLUSIONDamage control concept is used to treat severe limbs fractures combining with multiple trauma which has the rapid and effective therapy, can improve survival rate and reduce complication.

Adolescent ; Adult ; Aged ; Embolism, Fat ; prevention & control ; Extremities ; injuries ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Postoperative Complications ; prevention & control

Objective To investigate the expression and clinical significance of p27 protein in stage Ⅱ colon cancer.Methods The expression of p27 protein in 57 samples of stage Ⅱ colon cancer tissue from BeijingCancer Hospital was detected by immunohistochemistry and tissue microarray technique.Survival was analyzed by the Kaplan-Meier method,and the correlation between the expression of p27 protein and the prognosis of patients was analyzed by Pearson chi-square test.Multivariate analysis was done by using Cox proportional hazard regression model.Results The rate of high expression of p27 protein in stage Ⅱ colon cancer was 60%(34/57).The differentiation.location and distal metastasis of the tumor were correlated with the expression of p27 protein(X2=5.97,5.93,5.05,P＜0.05);while age,tumor size,growth patterns of tumor were not correlated with the expression of p27 protein(X2=0.64,0.49,0.33,P＞0.05).The 5-year survival rate of the patients with high expression of p27 protein was 94%(32/34),which was significantly higher than the 78%(18/23)of the patients with low expression of p27 protein(X2=3.86,P＜0.05).Multivariate analysis showed that low expression of p27 protein and tumor penetrating serous membrane are the independent adverse prognostic factors for stage Ⅱ coloR cancer.Conclusions Low expression of p27 protein is one of the independent adverse prognostic factors for stage Ⅱ colon cancer,and the expression of p27 protein should be consulted when screening out the patients who are in the high risk group of stage Ⅱ colon cancer.

Objective To study the accuracy of SentinelTM system for patient setup using rigid-body phantom.Methods A 002LFC IMRT phantom was placed on Elekta HexaPODTM 6-degree couch using tattoo and the laser in the treatment room.When a well-know shift (3 directions) and rotation (3 positions) was moved,CBCT and SentinelTM system were scanned respectively,and the measuring errors of six dimensions were recorded.The absolute differences between applied and measured errors were compared and paired t-test.Results Total 15 well-know shifts were investigated.The SentinelTM system was very good stability and the largest absolute difference only 0.9 mm (z direction) and 0.2° (arbitrary direction).At the same time,a good conformance between SentinelTM system and CBCT was displayed because the largest absolute difference between applied and measuring error was less than 0.9 mm (z direction) and 0.2° (arbitrary direction).Conclusions SentinelTM system is fast,simple,non-invasive and seems to be reliable in detecting patient setup errors.It maybe hold potential to ensure precise patient positioning with reduced CBCT frequency in tumor locations with fixed relation to surface structures.