Objective To evaluate the preoperative T staging value of rectal carcinoma by using double contrast-enhanced ultrasonography (DCUS).Methods 71 patients with rectal carcinoma were examined by ultrasound after infusing contrast agent and bolus injection of SonoVue preoperatively.The border,shape and perfusion patterns of the tumor were observed.After surgery,the T staging made by DCUS and perfused contrast-enhanced ultrasonography (PCUS) was compared with final pathologic results respectively.Results The accuracy of PCUS and DCUS in determining the T stage of rectal carcinoma were 71.8％(T1 72.7％％,T250.0％,T374.4％,T476.9％) and 85.9％(T190.9％,T275.0％,T387.1％,T484.6％) respectively.The difference between these two methods was statistically significant (P ＜0.05).Conclusions DCUS is a new valuable method for T staging of rectal carcinoma with its high accuracy preoperatively.

Objective To study Twist,E-CD expression in colorectal cancer tissues and its relationship with colorectal cancer invasion,metastasis and prognosis.Methods Immunohistochemical staining (EnVision) was used to detect E-CD,Twist expression of normal colon mucosa in 30 cases,colorectal adenoma in 30 cases and colorectal cancer tissues in 142 cases.Chi-square、Fisher's and Spearman test were used to analyze E-CD and Twist protein expression,Kaplan-Meier survival analysis and multivariate COX regression were used to analyze prognosis of patients.Results E-CD in the normal mucosa were positively expressed in 90％ cases,which was significantly higher than that in colorectal adenomas (63％) (P =0.046) and colorectal cancer tissues (42％) (P =0.000).E-CD expression was related to tumor differentiation (P =0.048),invasion depth (P =0.000),vein (P =0.000) and lymph vessel invasions (P =0.030),lymph node metastasis (P =0.001) and Dukes' stage (P =0.016),but not related to patient's age(P =0.174),gender(P =0.159),tumor size (P =0.628) and tumor histological type (P =0.153).1,3,5 year survival rate in patients with positive E-CD expression was significantly higher than that in patients with negative expression (P =0.000).Positive expression rate of Twist in colorectal cancer tissues (68％) was significantly higher than that in normal mucosa (20％,P =0.000) and colorectal adenomas (30％,P =0.000).Twist expression was related to tumor histological type (P =0.000),differentiation(P =0.000),invasion depth(P =0.000),vein(P =0.000) and lymph vessel invasions(P =0.000),lymph node metastasis(P =0.010) and Dukes' stage(P =0.000).1,3,5 year's survival rate of Twist-negative expression patients was significantly higher than that in patients with positive expression (P =0.000).E-CD and Twist in colorectal cancer tissues were negatively correlated (r =-0.530,P =0.000).COX multivariate analysis shows that vein invasion (P =0.045),lymph node metastasis (P =0.040),Dukes' stage (P =0.000),E-CD (P =0.003) and Twist (P =0.031) were independent prognostic indicators.Conclusions E-CD and Twist expression in colorectal cancer are related to tumor invasion,metastasis and prognosis.Low E-CD expression and high Twist expression are related to poor prognosis of colorectal cancer patients.

Objective To introduce a novel technique of intracolonic shunt procedure used in the anus - preserving operation for acute intestinal obstruction resulted from cancer at low and middle portions of rectum and assess the clinical significance. Methods In total, 81 patients with acute obstruction of low and middle portion of rectum caused by cancer were randomly ( random number) divided into control group and study group. In control group, 42 patients were operated with preventive transverse colonostomy or terminal ileum stoma after low proximal resection of rectum involved in cancer, while 39 patients were operated with intracolonic shunt procedure by using a biodegradable anastomosis ring and a condom placed 5 cm above anastomosis for protection in study group. Results There were no significant differences in sex, age, tumor site, tumor size and the distance from anstomosis to anal-edge between two groups. In both groups, the bowel movement resumed in 2 ~ 5 days after operation (P > 0.05). In study group, the rate of anastomosis leakage was 7.7% (3/39), and leakages were treated with drainage for 7.1 days in average to be healed, and the biodegradable anastomosis ring detached and were discharged in 14 -23 days (17 days in average), and there were no complications of drainage happened. The anastomotic stenosis occurred in three patients (7. 7% ) within 6 months after operation. In control group, 11.9% patients (5/42) had anastomosis leakage and they treated with drainage for 18.2 days in average to get the leakage healed, and 35. 7% patients (15/42) had stoma complications, and anastomotic stenosis happened in 28.6% patients (12/42) within 6 months after operation, and 7. 1% patients need another operation because of severe anastomosis stenosis. There were no significant differences in rate of anastomosis leakage between tow groups ( P > 0. 05), but there were significant differences in drainage days after anstomosis leakage happened and 6 - months anastomosis stenosis between two groups (P<0.05). Conclusions In the anus -preserving operation for acute intestinal obstruction at low and middle portions of rectum caused by cancer , the intracolonic shunt procedure is convenient and safty, and reduces the hazard incurred by anastomosis leakage and anastomosis stenosis compared with classic stoma operation.

Objective To evaluate the preliminary clinical effect of anterior anatomical reduction plate fixation on the treatment of atlantoaxial dislocation. Methods A retrospective case series study was conducted to analyze the 13 patients with atlantoaxial dislocation admitted to the second affiliated hospital of Xi'an Jiaotong University from January 2016 to December 2017. There were eight males and five females, aged 20-57 years, with an average age of 42 years. All patients received transoropharyngeal reconstruction and atlantoaxial anterior anatomical reduction plate fixation, 12 of which underwent the surgery for the first time but one had the revision surgery. The operation time and intraoperative bleeding were recorded. The angle of the clivus axis was measured, and the reduction of the atlantoaxial spine and the fusion of bone graft were observed. The neurological function was evaluated by Japanese Orthopedic Association ( JOA ) score and the improvement rate of spinal cord function was calculated. The complications were also recorded. Results All patients were followed up for 10-30 months [(14. 2 ± 5. 0)months]. The operation time was 150-285 minutes [(216. 8 ± 36. 7)minutes]. The intraoperative blood loss was 50-130 ml [(80. 5 ± 19. 7)ml]. The slope axis angle was (113. 2 ± 9. 1)° before operation and (145. 8 ± 6. 7)° after operation, with an average increase of 32. 6° (P<0. 01). Anatomical reduction was obtained in nine patients, and partial reduction in four patients. At the last follow-up, the atlantoaxial fusion was obtained in all patients, and the healing time was ( 4. 6 ± 1. 1 ) months. Postoperative neurological symptoms were improved compared with those before operation. The JOA score was improved from preoperative (8. 7 ± 1. 7) points to postoperative (14. 3 ± 1. 2) points, with an average increase of 5. 6 points (P<0. 01). The average improvement rate of spinal cord function was 69％. Except for one patient with cerebrospinal fluid leakage, there were no complications such as spinal cord, nerve, blood vessel injury or wound infection after operation. Conclusions Anterior atlantoaxial anatomical reduction plate fixation can effectively restore the dislocated atlantoaxial joint, restore slope axis angle, improve bone fusion rate, and improve nerve function. It can be used as an alternative or supplement to posterior fixation.