Objective To explore the value and criteria for primary tumor resection in patients with stage Ⅳ rectal cancer. Methods The clinical data were retrospectively analyzed for 53 patients with stage Ⅳ rectal cancer undergoing primary tumor resection. Results All patients were graded according to Eastern Cooperative Oncology Group (ECOG) performance as status 1. Seventeen of 53 patients (32%) received palliative resection. Thirty-six patients received adjuvant radiotherapy and/or chemotherapy. The median follow-up was 14 months. Forty-seven patients had complete resolution of their symptoms related to the primary rectal cancer for a year. The median survival was 16 months and 2-year overall survival of 24.5%. On multivariate analysis, chemotherapy was a determinant of prolonged survival (P=0.046). Conclusions Resection of primary tumor in patients with stage Ⅳ rectal cancer can improve the quality of life. Patients who have a good performance status, minimal metastatic disease and normal preoperative liver function tests should undergo resective surgery and aggresive systemic chemotherapy.

OBJECTIVE To analyze and compare the value of c-reactive protein(CRP) and body temperature in the infection diagnosis and severity of infection among the patients with malignant hematological disease.METHODS According to the microorganism detection and application of antibiotics,we divided the 119 patients into infection group and noninfection group from May 2004 to May 2005 in our ward.CRP and temperature of the patients were measured and.RESULTS There were 88 cases in the infection group and 31 cases in the noninfection group.The CRP plasma concentration had significant difference between too groups(P

A gap is found between the existing quality of care,and social expectations and the PDCA model.Peking University People's Hospital applied the quality control circle in building a supervision platform for medical quality and sustained improvement of civilized services.This study demonstrated the efforts in this regard made by the hospital,and the major outcomes of the platform in its 6-year practice in identifying service defects,optimizing service processes and sustained improvement of medical services.In addition,it also shared insights on enhanced real-time supervision,standardized management,and long-term mechanisms of the hospital.

Objective To construct eukaryotic expression vector encoding rat IMD gene and deliver it into rat renal tissue via ultrasound-mircobubbles. Methods IMD gene was inserted into pCDNA3.1 ( + )between Hind Ⅲ and EcoRI enzyme sites. The recombinant plasmid designated as IMD-pCDNA 3.1 wasconfirmed by restrictive enzyme digestion and sequencing. Eighteen male Wistar rats were randomized into 3groups, which were treated with no transfection, empty vector transfection and IMD transfection, respectively, in renal tissue via ultrasound-microbubbles. RT-PCR and Western blotting were applied to detect the expression level of IMD. Results Enzyme- digestion and sequencing data showed that IMD-pCDNA 3.1 was correctly constructed. The differences in ALT, AST, BUN and SCr were not significant; No obvious damage in the glomerular, tubular and interstitial was observed in all the treated groups;Compared with non-transfection group and empty vector-transfection group, IMD mRNA and protein expression in IMD transgenic renal tissue were significantly increased. Conclusion IMD-pCDNA 3.1 expression vector was successfully constructed and well expressed in rat kidney.

Objective To investigate the effect of intermedin (IMD) on renal ischemia/ reperfusion (I/R) injury after the up-regulation of IMD. Methods A total of 24 healthy Wistar male rats were randomly divided into four groups,sham-operated group,I/R group,IMD gene transfection +I/R group and empty plamid +I/R group.All the animals were killed at the end of 24 h of reperfusion.Histological changes and renal function were estimated.The expression and site of IMD were determined by Immunohistochemistry method,semi-quantitative RT-PCR and Western blotting.The protein expressions of endothelin 1 (ET-1),tumor necrosis factor αt (TNF-α) were detected by Western blotting. Results Compared with sham-operated group,tubulointerstitial pathological injury was significant aggravated in I/R group (7.6±2.3) and empty plamid +I/R group (7.0±1.8),and such injury was improved in IMD+I/R group (1.5±0.8) (P＜0.05).Compared with I/R group and empty plamid +I/R group,the renal dysfunction of IMD +I/R group was obviously lessened [BUN:(7.73±1.03) mmol/L vs (10.13±2.14) mmol/L,(9.77±1.92) mmol/L; Scr:(58.50±3.27) μmol/L vs (80.33±7.15) μmol/L, (75.67±7.58) μmol/L,all P＜0.05].IMD expression was weak in the plasma of tubulointerstitial cells in sham-operated group,and was up-regulated in I/R group. Compared with I/R group, immunohistochemical IMD expression increased obviously (262.03±67.89 vs 175.57±48.06,P＜0.01).The mRNA expression of IMD in IMD+I/R group was up-regulated significantly by 60.7％,66.1％ and the protein expression of IMD in IMD+I/R group increased significantly by 51.4％,55.9％ as compared to I/R and empty plasmid +I/R group.Meanwhile,the protein expressions of ET-1 and TNF-αt in IMD+I/R group were obviously lower compared with those in I/R group (ET-1:0.08±0.02 vs 0.17±0.02; TNF-α:0.21±0.04 vs 0.35± 0.02,all P＜0.05). Conclusion IMD gene transfected into kidneys of rats prior to I/R surgery can attenuate the over-expressions of both ET-1 and TNF-o in I/R injured rat kidneys as well as the damages to the structure and function of the kidneys.

Objective To know the establishment of the flap pedicle blood supply and the right moment of the cutting off of pedicle by means of laser Doppler blood perfusion imaging instrument on the random flap blood flow changes.Methods 20 adult healthy rabbits were divided in to four groups and each 5 have unilateral flaps.1,3,5,7,9,12,14,18 days after operation,the pedicle blood perfusion values (PU) measurement of the distal pedicle on the flap and midpoint of both ends of the pedicle were performed,and PU values were analyzed.Results Pedicle of the PU values at the different time points changed little (P＞0.05).The PU value in the distal flap reached the minimum 1 day after operation and then increased gradually [3 d (1.24±0.07),5 d (1.57±0.15),7 d (1.79±0.08),9 d(1.89±0.13),12 d(2.01±0.16),14 d(2.18±0.09) and 18 d(2.40±0.18),P＜0.05].When distal PU values/pedicle PU value≥1.2,the flap survival rate reached 99%.Conclusions The establishment of random skin flap blood circulation,as well as the ratio of PU values of distal to the pedicle flap pedicle can be used as the timing of an important indicators.

BACKGROUND:Classical deltopectoral approach leads to a great injury to soft tissues. It is difficult to lay the steel plate on the lateral side. The steel plate is frequently laid on the anterolateral side of humerus. Fixed position is not ideal.
OBJECTIVE:To evaluate the safety and feasibility of lateral deltoid-splitting approach in treatment of proximal humeral fractures.
METHODS:From August 2008 to August 2013, 114 patients with fracture of surgical neck of humerus, who were treated in the Department of Orthopedics, Yan’an Hospital Affiliated to Kunming Medical University in China, were enrol ed in this study. They were treated with locking compression plate, and assigned to deltoid splitting approach group and deltopectoral approach group (n=57). Surgical trauma, fracture healing, curative effects, functional recovery and Constant shoulder score were compared between the two groups.
RESULTS AND CONCLUSION:Al patients were fol owed up for at least 8 months. Compared with the deltopectoral approach group, the proximal humeral fractures were healed as scheduled in the deltoid splitting approach group, and the anteflexion, abduction, shoulder lifting of the shoulder joint, and sensation of lateral skin of the upper arm were not impacted. No significant difference in Constant shoulder score was detectable between the two groups (P>0.05), which suggested that deltoid splitting approach for treating the proximal humeral fractures was safe and feasible. In addition, in accordance with the Neer’s classification system, the excellent and good rate in the deltoid splitting approach group (91%) was significantly higher than that in the deltopectoral approach group (75%) (P<0.05). Therefore, the deltoid splitting approach can be used as the first choice for the treatment of proximal humeral fractures.

BACKGROUND: Random flap as a primary means of wound healing, is widely used at present, its blood circulation to establish the situation is also researched a lot, but not yet the system of random skin flap perfusion were observed and measured. In addition, the timing of pedicle division of a pedicle flap random is also a hot topic, but not yet a mature clinical testing method has been discovered to determine the best timing.OBJECTIVE: By means of laser Doppler blood perfusion imaging, this study was designed to dynamically observe random flap microcirculation, to understand the changes on random flap blood flow, and to determine the best timing of pedicle division. METHODS: A total of 18 cases were divided into traditional pedicle division group and early pedicle division group. Pedicle flap blood perfusion values were statistically measured immediately after surgery, at 3, 7,11,15, and 19 days after surgery, before division, immediately after division, and at 24 hours after pedicle division, 8-9 phases in total.RESULTS AND CONCLUSION: Distal blood perfusion value was increased with the time prolongation in both groups; while, the blood perfusion in various time phases was significantly different from that after surgery (P < 0.05); but, the blood perfusion was decreased immediately after surgery, which was still significantly compared with traditional pedicle division group (P< 0.05). There was no significant different in blood perfusion between early pedicle division and immediate after surgery of pedicle division (P > 0.05), but there was significant difference between 24 hours after pedicle division and immediate after surgery of pedicle division (P< 0.05). Blood perfusion values were less changed in both groups (P> 0.05). The ratio of both groups peaked before pedicle division and then gradually decreased after pedicle division. The best timing of pedicle division was the ratio of 1.2.

Objective To investigate the correlation between CT perfusion parameters of pulmonary carcinoma and standardized uptake values(SUV)derived from ~(18)F-fluoro-deoxyglucose positron emission tomography(~8F-FDG PET)and tumor microvessel density(MVD),and to determine the validity of CT perfusion in assessing tumor angiagenic activity of pulmonary carcinoma.Methods Fifty patients(mean age 57.5,17 females)with pulmonary carcinoma underwent CT perfusion using 16-slice helical CT.Blood flow(BF,ml?100g~(-1)?min~(-1)),blood volume(BV,ml?100g~(-1)),mean transmit time(MTF,s)and permeability surface area product(PS,ml?100g~(-1)?min~(-1))were analyzed.SUV of PET was calculated in 14 patients.The CD34 immunohistochemical staining was used for tumor microvessel counting.CT perfusion parameters of pulmonary carcinoma were correlatively studied with SUV and tumor MVD.Pearson's correlation analysis was performed to evaluate the association between CT perfusion parameters and SUV and MVD.Results The average values of BF,BV,MTT and PS were 97.30 ml?100g~(-1)?min~(-1), 8.86 ml?100g~(-1),6.75 s and 34.52 ml?100g~(-1)?min~(-1),respectively.The average value of MVD was 61.82/FOV.The mean value of SUV was 5.96.There was positive correlation between BF and SUV(r= 0.727,P

AIM: To further investagate the mechanism of thrombus formation and develop a new remedy of anti-thrombus formation. METHODS: The amplified DNA fragment of vWF-A1 domain was inserted into expression vector with 6?his taq (pQE-31), the recombinant expression vect or was transformed into E coli (strain M15) and induced by IPTG. The recombinant fragment, comprising residues 449-728 of mature vWF subunit, designate rvWF-A1. It was purified by Ni-NTA agarose column and renatured by Tris buffer containin g GSH and GSSG. FACS and platelet aggregometer were employed to analyse the rvWF -A1 function of binding to platelet glycoprotein Ib and inhibiting ristocetin-in duced platelet aggregation. RESULTS: The rvWF-A1 was expressed successfully in E coli, comin g up to 30% of total bacterial protein. Its purify was over 95% through Ni-NTA a garose. It was identified to have ability to bind to GPIb, its biologic activity to inhibit ristocetin-induced platelet aggregation was observed, and the inhibi tive rate was 84 7%. CONCLUSION: The above results indicated that high-level expressi on of rvWF-A1 was successfully achieved in E coli and rvWF-A1 may be an effectiv e antithromotic agent in preventing thrombus formation.