Objective:To evaluate the effects of neoadjuvant chemoradiotherapy on anal function after intersphincteric resection (ISR) with low rectal cancer. Methods:A total of 103 patients were classified into the chemoradiotherapy (CRT) group and control group according to whether they received neoadjuvant chemoradiotherapy. Anal function was assessed using vectorial manometry, Saito function questionnaires, and Wexner incontinence scores. Results:The resting vector volume and squeezing vector volume of the CRT group were significantly lower than those of the control group prior to the operation. Both groups showed decreasing manometric re-sults after ISR. However, all indices of the CRT group were significantly lower than those of the control group (P<0.05). At 6 and 12 months after operation, the Saito questionnaire results reveal poor function for the CRT group compared with the control group, except for dyschesia. After 24 months, the stool frequency, ability to distinguish between feces and flatus, fragmentation, and alimentary re-striction remained poor for the CRT group (P<0.05). Although both groups showed decreasing Wexner scores with time, the score of the CRT group remained significantly higher than that of the control up to 24 months after operation. Conclusion:Neoadjuvant chemo-radiotherapy significantly affects the anal sphincter function for intersphincteric resection with low rectal cancer. This effect continues for at least 2 years after operation.

Objective_To investigate the effects of hypoxia-inducible factor-1 alpha ( HIF-1α) inhibitor YC-1 on hy-poxia induced human pulmonary artery smooth muscle cells ( HPASMCs) proliferation, apoptosis and the expression of P53, and to explore the molecular mechanism in the processes.Methods_HPASMCs were cultured in DMEM me-dium supplemented with 10%FBS in vitro.Then divided them into four groups:normoxia, hypoxia and hypoxia+YC-1(0.01 and 0.05 mmol/L).Cell proliferation was measured by CCK-8 and apoptosis was detected by flow cytom-etry.The expressions of HIF-1αand P53 were tested by Western blot, and the mRNA expression of P53 was tested by RT-PCR.Results_Hypoxia can promote the proliferation of HPASMCs.Treatment of HPASMCs with different concentrations of YC-1 intervention for 24h obviously dropped proliferation rate (P<0.05), and the apoptosis rate increased significantly (P<0.05).YC-1 can also down-regulate the expression of HIF-1αand up-regulate the ex-pression of P53 significantly ( P<0.05 ) .Conclusions_YC-1 can inhibit hypoxia-induced HPASMCs proliferation and promote apoptosis, the mechanism is potentially related to the up-regulation of P53 expression.

Background and purpose: Sorafenib hepatocellular carcinoma assessment randomized protocol (SHARP) and sorafenib in patients in Asia-Pacific region with hepatocellular carcinoma (ORIENTAL) had indicated that multi-kinase inhibitor sorafenib could prolong overall survival (OS) and time to progression (TTP) as well as improve progress free survival (PFS) in patients with advanced stage hepatocellular carcinoma. Drug-related adverse events in the course of treatment restricted its clinical application to a certain degree. This study was aimed to summerize the adverse events as well as the management of sorafenib in our clinic. Methods: Twenty-five cases clinically diagnosed as advanced hepatocellular carcinoma were enrolled from January 2008 to October 2009. All the patients who received sorafenib treatment met inclusion criteria as followed: (1) Progression of disease after trans-hepatic arterial chemoembolization therapy; (2) Extensive portal vein cancerous thrombus formation; (3) Portal zone or retroperitoneal lymph node metastasis or multiple remote metastasis, such as lung or bone; (4) Diffused poor blood supply to tumor; (5) Inform consent was obtained. All adverse events with different grade were observed during the beginning 12 weeks, and clinical treatment were carried out relatively. Results: Total of 25 cases were enrolled. Nine patients died of the disease, 3 of them died during the first 12 weeks, 3 patients abandoned sorafenib treatment, among them 2 died before the finish of 12 weeks treatment and 1 patient discontinued 5 months after the sorafenib treatment. Twenty cases finally assigned. Number of patients encountered drug-related adverse events were: HFSR (hand-foot-skin-reaction) 4(4/20), diarrhea 4(4/20), alopecia 5(5/20), rasb 4(4/20), fatigue 8(8/20), leukopenia and Thrombocytopenia 4(4/20), elevated blood pressure 1(1/20) and abdominal pain 1(1/20). After clinical management, 20 patients' sorafenib treatment were eventually not affected by adverse events. Conclusion: Sorafenib was well-tolerated and is a safe option of treatment for patients with advanced hepatocellular carcinoma.

Objective To evaluate the early change of left ventricular (LV) systolic function in patients with type 2 diabetes mellitus(T2DM) by ultrasound speckle tracking imaging. Methods Ninety-five subjects were included:40 T2DM with normal LV ejection fraction (LVEF≥50% ,group A),20 T2DM with abnormal LVEF (LVEF<550 %) (group B), and 35 normal controls. Two-dimensional strain images were acquired from LV short-axis view. LV peak systolic global and segmental radial strain and circumferential strain at the levels of mitral annulus, papillary muscle and apex, and LV systolic global and segmental rotation at the levels of mitral annulus and apex and LV peak systolic global twist were assessed. Results In group A, compared with control group, LV peak systolic radial strain parameters were not significant difference (P >0.05), peak systolic circumferential strain of part segments, average peak strain of each plane and global strain were reduced (P <50.05～0.001) ,and LV peak systolic rotation of all apical segments, peak systolic global rotation at the levels of mitral annulus and apex,and peak systolic global twist were significantly increased (P <0.05～0.001). Compared with control group and group A,all LV systolic radial strain and circumferential strain parameters, LV systolic global and segmental rotation and peak systolic global twist in group B were significantly reduced (P <0.05 ～ 0.001). Conclusions Speckle tracking imaging could be used to evaluate the early change of LV torsional deformation and LV systolic function in T2DM.

Objective This study was to evaluate the protective effect of pulmonary perfusion with cold modified low- potassium dextran (LPD) solution on lung function after cardiopulmonary bypass in combined aortic and mitral valve replacement. Method Twenty-four consecutive adult patients with combined aortic and mitral valve disease were divided into a control group ( n =14) and a perfused group ( n = 10). Cold modified LPD solution was infused to the main pulmonary artery in the protective group. PaO_2/FiO_2 were monitored at six different time points; preoperation, 0 hour, 1 hours, 2 hours, 6 hours and 12 hours after the termination of CPB. Concentrations of interleukin-6 and interleukin-10 in plasma were measured at four different time points; preoperation, 0 hour, 6 hours, and 12 hours after the termination of CPB. Result PaO_2/FiO_2 in the perfused group were increased more than that in the control group. The IL-6 and IL-10 increased in both groups after operations( P <0. 05). Patients of the perfused group showed significantly reduced IL-6 expression, compared with the control group ( P <0. 001), but the rising extents of IL-10 in the perfused group were higher than that in the control group ( P <0.001). Conclusion Pulmonary artery perfusion with cold modified LPD solution during cardiopulmonary bypass relieved lung injury in combined aortic and mitral valve replacement.

Objective:To screen and characterize aptamers against BCR-ABL fusion protein.Methods:A 90bp single stranded DNA( ssDNA) random library was subjected to 13 rounds of selection against BCR-ABL fusion protein by systematic evolution of ligands by expotential enrichment ( SELEX ) method, the selected aptamers were cloned and sequenced.The primary sequences and structure of aptamers were analyzed by Clustal W and DNA Folding Sever and the percentage of the ssDNA pool bound to BCR-ABL core protein were determinated.Results: after 13 rounds selection, the percentage of ssDNA pool bound to BCR-ABL fusion protein increased from 0.3%to 47.1%,the results showed that affinities of the Aptamers were different,the second structure analysis revealed possible stem-loops for binding to BCR-ABL fusion protein,the affinity of aptamer A2 to BCR-ABL fusion protein was highest with Kd values as low as 72 nmol/L.Conclusion:Aptamers against BCR-ABL fusion protein has been identified by SELEX methods from a 90 bp single stranded DNA library.And provide certain reference for the clinical treatment of chronic myelogenous.

5 patients with chronic prolonged mandibular dislocations(CPMD)were examined by CT scan.The patients were treated by manual reduction under general anaesthesia and muscle relaxants.Traction was performed with ligaturing steel wires on fixation titanium screws intermaxillaryly and wrapping up the skull-jaw bone with elastic bandages for 3 weeks.After 1 month,a maximal mouth opening of o-ver 30 mm was noted and no episode of redislocation occurred in 3 -34 month follow-up.

Objective:To discuss the clinical efficacy of laparoscopic radical cystectomy in the treatment of bladder cancer after partial cystectomy.Methods:The clinical data of 30 patients who underwent laparoscopic radical cystectomy after PC in Sichuan Provincial People's Hospital from March 2016 to August 2020 were retrospectively analyzed. Including 24 males and 6 females with an average age was 62.5 (45.5-82.5)years.6 out of 30 cases underwent pelvic lymph node dissection during PC. All patients had definite pathological diagnosis for the high-grade urothelial carcinoma after PC, and the tumor staging was pT 2-3bN 0M 0.5 patients received postoperative adjuvant chemotherapy with gemcitabine and cisplatin, 6 received postoperative adjuvant radiotherapy, 13 received postoperative adjuvant radiotherapy and chemotherapy, and all patients were received maintenance intravesical instillation. Median time for local tumor recurrence after PC was 9(5-29) months, all patients had pathological diagnosis for the high-grade papillary urothelial carcinoma, cT 2-4N 0M 0 stage.The average tumor diameter was 3.5(2.5-4.5)cm, an average number of tumors was 2(1-3). Laparoscopic salvage cystectomy was performed after recurrence.General anesthesia, supine position, 5 ports were inserted through the abdominal approach. Standard pelvic lymph node dissection (PLND) was used to clean the pelvic lymph nodes. Those who had underwent PLND no longer clean the obturator and peripheral iliac vessels, but including the common iliac vessel and the bifurcation of the abdominal aorta and lymphatic tissues around the inferior vena cava, as well as the presacral lymph nodes. Results:All 30surgeries were successfully performed. The average operative time was 270(240-310)min, average estimated intraoperative blood loss was 180(50-300)ml, and there was no blood transfusion during the perioperative period.The average number of lymph nodes dissected was 18 (10-27). There were 4 cases with positive lymph nodes, of which 3 cases were positive for 2 obturator lymph nodes, and 1 case was positive for 3 obturator and external iliac lymph nodes. No serious intraoperative complications occurred.No lymphatic leakage occurred. The average drainage duration was 4(3-7) d, and postoperative hospital stays was 9(7-20)d. The postoperative pathology was invasive high-grade papillary urothelial carcinoma, and pathological TNM stage was pT 2-4aN 0-2M 0.13 patients received postoperative adjuvant chemotherapy. The average postoperative follow-up time was 23(3-31) months. There were 2 cases of pelvic recurrence and 1 case of retroperitoneal lymph node metastasis. These 3 cases received adjuvant chemotherapy and radiotherapy. Conclusions:Radical cystectomy should be the primary treatment for recurrence of bladder cancer after partial cystectomy.

Quantification of right ventricular (RV) volume and function remains a challenge because of RV complex geometry by conventional echocardiography. The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot (TOF) by 2-dimensional ultrasound speckle tracking imaging (STI). Thirty-eight patients with TOF were enrolled in this study and divided into child group (n=25) and adult group (n=13) according to age. Thirty-eight age- and sex-matched normal subjects were selected as control groups including child control group (n=25) and adult control group (n=13). RV global longitudinal peak systolic strain (GLS), strain rate (GLSR(s)), early diastolic strain rate (GLSR(e)) and late diastolic strain rate (GLSR(a)) were measured in all subjects by STI from the apical 4-chamber view and compared between groups. Furthermore, the main factors affecting the RV global longitudinal functional parameters were assessed. Compared with those in controls, RV GLS, GLSR(s) and GLSR(e) were significantly reduced in patients with TOF (P<0.05 for all). RV GLSR(s) was significantly decreased in adult patients with TOF as compared with that in child patients (P<0.05). There was no significant difference in RV GLS, GLSR(e) and GLSR(a) between child and adult TOF groups (P>0.05). The diameter of right ventricle, main pulmonary artery and ventricular septum defect had correlations with RV GLSR(s) (r ( 1 )=-0.490, r ( 2 )=0.580, r ( 3 )=-0.528, respectively, P<0.05 for all). Tricuspid annular plane peak systolic velocity (Sm) was the independent predictor of RV global strain and strain rate (beta(1)=0.355, P (1)=0.031, beta(2)=0.307, P (2)=0.021). RV global longitudinal function is decreased in patients with TOF, especially in adult patients. STI is a sensitive and accurate technique in RV global functional assessment.

Objective To assess the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus and without coronary artery disease using two-dimensional strain echocardiography.Methods Eighty-nine subjects with normal ejection fraction were included:37 with diabetes mellitus(DM group),22 with both diabetes and left ventricular hypertrophy(DH group), and 30 normal controls.Two-dimensional strain images were acquired from the LV short-axis view at the levels of mitral annulus, papillary muscle and apex, and the apical four-chamber view, two-chamber view and long-axis views of the LV respectively.The longitudinal strain was measured in the apical views.The radial strain and the rotation were measured in the LV short-axis views.The LV twist was defined as the apical rotation relative to the base.Results The average peak systolic longitudinal strain of different segments and the peak longitudinal global strain in DM group and DH group were significantly reduced when compared with those in control groups ( P＜0.001 ),and these parameters in DH group were significantly lower than those in DM group (P＜0.001 or P＜0.05).There was no significant difference in the average peak systolic radial strain of different segments and peak radial global strain among all groups ( P＞0.05).The LV rotations and the LV twist were significantly higher both in DM group and in DH group than in control group ( P＜0.001 or P＜0.01),and the basal LV rotation and the LV twist were larger in DH group than in DM group ( P＜0.01, P＜0.05).Conclusions Two-dimensional strain echocardiography may be used to identify the LV systolic function in patients with type 2 diabetes mellitus.