Objective To compare postoperative outcomes and complications between subtotal colectomy combined with modified Duhamel procedure and simple subtotal colectomy for severe functional constipation (SFC). Methods Between January 2006 and June 2010,40 SFC patients after strict but inefficient nonoperative treatments were randomized by number table method to control group (20 cases, receiving simple subtotal colectomy) and combined group (20 cases,receiving subtotal colectomy and modified Duhamel procedure). The selection criteria were normal colonoscopy,and abnormal dynamic proctography (DPG). The functional outcomes after surgery were assessed from 6 months to 2 years period. Results The preoperative clinical manifestations of the two groups were similar. No statistically significant difference was observed between the two groups for time for recovery of the bowel function,length of postoperative hospitalization.and the early postoperative complications (P > 0.05). Functional outcomes of combined group with CIQOL score [(110.5 ±5.0) scores],relieving of costive gastrointestinal symptoms [(79.0 ±6.5)%], recurrent constipation rate [10.0% (2/20)], satisfaction rate of defecation frequency [85.0%(17/20)], satisfaction rate of quality of life[90.0%(18/20)] were significantly better than those of control group[(90.5 ± 3.5) scores, (60.5 ± 2.8)% ,35.0%(7/20), 15.0%(3/20),20.0%(4/20)](P< 0.05). Conclusion Combined application of subtotal colectomy and modified Duhamel procedure for SFC has better outcomes.

The segmental and regional projections of the sciatic, tibial and common peroneal nerves to the substantia gelatinosa of spinal cord in rats were studied with the acid phosphatase method. Experiments were carried on 42 rats. Under chloral hydrate anesthesia, sciatic, tibial and common peroneal nerves were severed respecively. Then, after a survival time of 5～12 days, the lumbosacral segments of the spinal cord were removed and sectioned. The frozen sections were incubated with the modified Gomori's method.The projections of the sciatic and tibial nerves to the substantia gelatinosa (SG)were found in L_2～S_1, while these of the common peroneal nerve in L_(2～6).The projections of the sciatic nerve were found in the most medial, the intermediate and the most lateral parts of SG in the segments L_(2～3), and in entire SG in the segments L_4～S_1.The projections of the tibial nerve were shown in the most medial and the intermediate parts of SG in the segments L_(2～5), and in the medial parts of SG at L_6～S_1.The projections of the common peroneal nerve were found in the intermediate parts of SG in all segments L_(2～6).The above study has provided anatomical data for probing into the mechanism of somatosplanchnic interrelations and the principle governing acupuncture anesthesia.

Objective To evaluate the clinical efficacy of partial hepatectomy in treating intrahepatolithiasis. Methods The data of 63 cases with partial hepatectomy were retrospectively evaluated. Results All operations were successful. Mean hospital stay was 30.5d. Complications were found in 9 cases (14.3%), including 2 cases of sub-phrenic abacess,2 cases of biliary fistula,4 cases of wound infectiun,1 case of pleural effusion. Residual stones were found in 7 cases (11.1%) ,4 were in left hepatic lobe,3 were in right. 62 cases (98.4%) were followed for 6 months to 8 years. Stones recurred in 2 cases. Conclusion Partial hepatectomy is effective for the treatment of intrahepatoli-thiasis with low residual stone rate.

Objective To analyze the application value of side way lymph node cleaned up in the low order rectal cancer operation. Methods 45 cases were randomly divided into two groups:first group was 30 cases, they were used the side way lymph node cleaned up of the rectal cancer broadens the curing once and for all skill;second group was 15 cases,they were used traditional rectal cancer curing once and for all skill. Results 7 cases of 1 group happen the side way lymph nodes transfer,the rate of transform was 23. 33% ,that low disintegration gland cancer and mucus gland cancer happen the rate of the side way lymph nodes transfer was beyond one-fold much than hight and middle disintegration gland cancer( P＜0. 05 ) ,the divergence is obvious. The operation time and amount losing blood of two group is not obvious, but first group's 3 years living rate was more higher than second group. Conclusion To the low order rectal cancer case sufferer that the side way lymph node cleaned up, may cut down the pelvic cavity recurs,obviously improve the living quality,lift the living rate,it has clinical practice value.

OBJECTIVETo investigate the dynamic features of angiogenesis in residual tumors after high intensity focused ultrasound (HIFU),and to determine the temporal effect and mechanism of hypoxia inducible factor-2 alpha (HIF-2a) in the angiogenic process of residual tumors.

METHODSXenograft tumors of HepG2 cells were generated by subcutaneously inoculating athymic BALB/c nu/nu mice with the hepatoma cells.About 30 days after inoculation,all mice (except in the control group) were treated by HIFU and assigned randomly to the following 7 groups according to various time intervals post-treatment:1st,3rd,5th day and 1st,2nd,3rd,4th week when the residual tumor tissues were obtained from the experimental groups.Protein levels of HIF-2a and vascular growth factor A (VEGF-A) were quantified by immunohistochemistry and western blotting,and mRNA levels were measured by (real-time quantitative) qPCR. Microvascular density (MVD) was calculated by counting the CD31-positive vascular endothelial cells identified by means of an immunohistochemical staining method.

RESULTSCompared with results from the control group,the protein and mRNA levels of HIF-2a expression reached the highest level in the experimental mice at the 2nd week (P=0.000 and P < 0.01 respectively),and were decreased thereafter(3rd week and 4th week, P=0.000 and P < 0.05).VEGF-A expression in the residual tumor tissues group that received HIFU was significantly decreased,compared with the control group,at all time points uPto 1 week (all P=0.000 and P < 0.01),but the levels increased compared to controls in the 2nd through 4th week (all P=0.000, P < 0.05). Similar results were obtained for MVD.

CONCLUSIONHIFU treatment can inhibit angiogenesis in residual hepatoma tissues in the short-term (1 to 2 weeks post-treatment) in mice with hepatocellular carcinoma,but can promote angiogenesis overtime (2 to 4 weeks post-treatment); the angiogenic process may involve the HIF-2α/VEGFA pathway.

Animals ; Blotting, Western ; Carcinoma, Hepatocellular ; pathology ; Hep G2 Cells ; High-Intensity Focused Ultrasound Ablation ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Immunohistochemistry ; Liver Neoplasms ; pathology ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Neovascularization, Pathologic ; Vascular Endothelial Growth Factor A ; metabolism

Objective To investigate the efficiency, safety and application value of early utilization of nutrient of home-made formula in post-operation of gastric fundic cardia cancer patients. Methods One hundred and forty-five cases of gastric fundic cardia cancer patients were randomly divided into two groups,early enteral-intestinal nutrient formula of home-made (enteral-intestinal group,73 cases) and intra-venous nutrition (intra-venous group,72 cases). Patients in enteral-intestinal group were given home-mada nutrition-liquid plus nutrison fibre for 6-8 days from the first post-operation day, intravenous group were given venousnutrition injection for 6-8 days from the first post-operation day. The average residential day, spends,complications and recovery situation were recorded and compared between the two groups. Results The average residential day in enteral-intestinal group was less than that in intra-venous group, average spends /drugs cost were (9433.1±1024.6)/(3271.8±420.9) yuan vs (12 953.4±2919.7 )/(4832.9±872.6) yuan respectively (P < 0.01 ),the complication in enteml-intestinal group was less than that in intra-venous group (P < 0.01 ). Time of revive testinal function in enteral-intestinal group was earlier than that in intra-venous group,ALB in enteral-intestinal group was higher than that in intra-venous group (P < 0.01 ). Conclusion Early enteral-intestinal nutrient utilization of home-made formula in post-operation of gastric fundic cardia cancer patients is safe and applicable, it can improve patients' post-operation nutrition situation and intestinal function.

Objective To explore the advantages and disadvantages of ultrasound guided puncture microwave ablation and traditional surgical treatment of nodular goiter.Methods From January 2014 to June 2015,102 cases of nodular goiter who were treated in the Traditional Chinese Medicine Hospital of Gaozhou Affiliated to Guangzhou University of Traditional Chinese Medicine were randomly divided into two groups,51 cases in each group.Respectively by ultrasound guided puncture nodules of thyroid swollen microwave ablation (microwave ablation group) and traditional operation type removed most of the thyroid nodules (traditional surgery group) in the treatment of containing.The amount of bleeding,operation time,hospital stay,medical cost,clinical efficacy,postoperative complications and the degree of pain,and thyroid function were compared between the two groups.Results The amount of bleeding,operation time and length of hospital stay in the microwave ablation group were better than those in the traditional operation group((2.02±0.79) ml vs.(28.24±18.49) ml,(34.20 ±9.60) min vs.(75.59±25.41) min,(3.55± 1.05) d vs.(10.27±2.68) d),the medical cost of the microwave ablation group was higher than that of the traditional operation group((14 341±593) yuan vs.(5 812±970) yuan),the differences were statistically significant (t =-10.12,-10.88,-16.68,53.54;P ＜0.01).There were significant difference in terms of the postoperative pain and complications between the groups (x2=50.86,13.22;P＜0.01).The total absorption rate was 100％ in 18 months after the ablation of the nodule.There was no significant difference about postoperative residual small nodules between the two groups(P ＞0.05).Conclusion Compared with the traditional treatment,the microwave ablation treatment of nodular goiter with less complications,is a new technique of minimally invasive,beauty,safe and feasible,the exact clinical effect,and worthy of popularization and application.

Objective:To investigate the efficacy and safety of programmed death-1 (PD1) inhibitor combined with transcatheter arterial chemoembolization (TACE) in the treatment of huge primary liver cancer.Methods:From June 2016 to December 2019, the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed. The tumor size ranged from 10.1 to 18.8 cm, with an average of (14.2±2.3) cm. The patients were divided into TACE group (TACE treatment, 18 cases) and combined group (one week after TACE, patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days, 13 cases), according to whether patients receiving PD1 inhibitors. The patients were followed up. The disease control rate (DCR) were compared between the two groups using Mann-Whitney U test. The median overall survival (OS) and progression free survival (PFS) were calculated by Kaplan-Meier method. Results:The DCR in combined group (53.8%, 7/13) was higher than that in TACE group (22.2%, 4/18), and the difference was statistically significant ( Z=-2.13, P=0.04). The median PFS (5.0 months) in combined group was longer than that in TACE group (3.0 months), the difference was statistically significant (χ2=4.39, P=0.04). The median OS (15 months) in combined group was longer than that in control group (9 months), and the difference was statistically significant (χ2=5.51, P=0.02). Conclusion:The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.

OBJECTIVETo study the changes in hypoxia-inducible factor (HIF1α, HIF2α) in the residual tumor cells in nude mice bearing hepatocellular carcinoma (HCC) following treatment with high-intensity focused ultrasound (HIFU).

METHODSThirty nude mice bearing human HCC received treatment with HIFU. At 1, 3, and 5 days and 1 and 2 weeks after the treatment, the mice were examined for pathological changes of the residual tumor with HE staining; SP immunohistochemistry, Western blotting and real-time quantitative PCR were used to detect the protein and mRNA expressions of HIF1α and HIF2α in the tumor.

RESULTSHE staining revealed the presence of residual tumor cells and large necrotic areas after the treatment. Immunohistochemistry showed a gradual increment of HIF1α protein and mRNA expressions after the treatment, reaching the peak level at 3 days (P<0.05) followed by progressive reduction at 5 days and 1 and 2 weeks. HIF2α expressions at either the protein or mRNA levels exhibited no significant changes within 3 days after the treatment (P>0.05) but increased significantly at 5 days and 1 and 2 weeks (P<0.05).

CONCLUSIONThe changes of HIF1α and HIF2α in the residual tumor after HIFU treatment in nude mice bearing HCC can be associated with tumor cell apoptosis and angiogenesis after the treatment.

Animals ; Carcinoma, Hepatocellular ; metabolism ; pathology ; therapy ; Hep G2 Cells ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Liver Neoplasms ; metabolism ; pathology ; therapy ; Mice ; Neoplasm, Residual ; metabolism ; pathology ; Ultrasonic Therapy ; methods

Objective:To investigate the efficacy and safety of short-term transcatheter arterial chemoembolization （TACE）-radiofrequency ablation （RFA） sequential therapy for advanced hepatocellular carcinoma (HCC).Methods:The clinical data of 117 patients with advanced HCC enrolled in the Central Hospital of Lishui from March 2010 to January 2019 were retrospectively analyzed. All patients received TACE and RFA sequential therapy. The patients were divided into 2 groups including short interval group (interval≤7 d, 61 cases) and long interval group (interval>7 d, 56 cases) according to interval between TACE and RFA. The difference of response rate was analyzed by Wilcoxon test. Kaplan-Meier survival curve was used to calculate the overall survival (OS) time and progression free survival (PFS) time.The risk factors of TACE-RFA sequential therapy were tested using Cox multivariate analysis. The complications in the two groups were compared using χ 2 test. Results:The response rate in the short interval group (72.1%, 43/61) was significantly higher than that in the long interval group (41.1%，23/56) with significant difference ( Z=-2.50, P=0.01). The median PFS in the short interval group (14.9 months) was longer than that in the long interval group (9.1 months). The difference of PFS survival curve between the 2 groups was statistically significant (χ2 =5.90, P=0.01).The median OS in the short interval group (34.7 months) was longer than that in the long interval group (20.3 months). The difference of OS survival curve between the 2 groups was statistically significant (χ2 =6.60, P=0.01). Cox multivariate analysis showed that tumor size [hazard ratio (HR)=2.42, P<0.01], cirrhosis (HR=2.04, P<0.01), interval (HR=0.44, P<0.01), aspartate aminotransferase (HR=1.71, P=0.03) were the independent risk factors for advanced HCC.There were no significant differences in the complication incidence between the 2 groups ( P>0.05). Conclusion:Short-term interval TACE-RFA sequential therapy as a protective factor is efficient and safe for advanced HCC treatment.