The application of enhanced recovery after surgery (ERAS) in hepatectomy is safe and feasible.The related researches of the clinical strategies of ERAS involved in colonic surgery instead of management of basic diseases of liver,and the influence of portal hypertension and hepatitis B virus infection on the ERAS has not been emphasized.According to the clinical strategies of ERAS in colon surgery,the basic diseases and the characteristics of liver were focused,and the clinical strategies of ERAS in the era of precision liver surgery were proposed.Through concerted efforts of the multidisciplinary team and a joint of surgeons,nurses and patients,the establishment of multicentre clinical studies under guidance of evidence-based medicine (EBM) will show clearly a development direction of the clinical strategies of ERAS in the era of precision liver surgery.

Objective To compare the clinical value of dynamic enhanced CT,MRI in differential diagnosis of adrenal tumors.Methods 62 patients with adrenal tumor by pathologically confirmed in our hospital were select-ed.All patients underwent unenhanced and dynamic enhanced CT,MRI examination.The qualitative and adrenal tumor localization diagnostic accuracy,the adrenal adenomas and non adenoma tumor clearance rate of the two meth-ods were compared.Results The accuracy of enhanced CT positioning,qualitative examination were 96.77%, 90.57%,respectively,which were slightly higher than those of the MRI enhancement(91.94%,86.79%),but the differences were not statistically significant (χ2 =0.479,0.376,all P >0.05).53 adrenal adenomas and 9 cases non-adenomas absolute and relative clearance rate clearance rate in enhanced CT 5 min delay time,the differences were statistically significant (t =2.962,2.018,all P <0.05).53 cases adrenal adenomas and 9 cases non adenoma clear-ance of correction in the enhanced MRI delay 5min,respectively (33.41 ±20.17)%,(14.74 ±12.16)%,the differ-ence was statistically significant (t =2.684,P <0.05).Conclusion Dynamic enhanced CT,MRI are good methods for differential diagnosis of adrenal tumors,two methods have location and qualitative diagnosis correct rate.So dynamic enhanced CT,MRI are reliable means of diagnosis of adrenal tumors.

Objective To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal Cancer.Methods 35 patients with colorectal cancer,treated by surgery were divided into two groups randomly.There were 20 patients in group A(pre-operative intra-arterial infusion chemotherapy) and 15 in group B(control).Arterial contrast technique Was used in group A then mitromye in 10mg,5-Fu 1000mg epirubic in 60mg were given through Weidner way-Results Microveasel density in the center,surface of the tumor and adjacent tissue around the tunlor were (40.46±7.06),(52.27±18.40),(49.92±8.15) in group A,and (46.09±12.21),(73.44±22.06),(51.94±12.64)in group B.Microvessel density on the surface in group A was significantly lower than that of group B(P＜0.05),with no significance between the center and the adjacent tissue.Conclusion Pre-operative intraarterial infusion chemotherapy is able to reduce micro-vessel density on the surface of eolorectal tumor.

Objective:To evaluate our self-made distraction reductor used in the percutaneous minimally invasive treatment of calcaneal fractures.Methods:A retrospective study was conducted of the 32 patients (37 feet) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Chongqing Medical University from January 2017 to December 2019 for calcaneal fractures. They were 26 males and 6 females, aged from 20 to 67 years (average, 46.5 years). The height and length of the calcaneus were restored by our self-made tri-plane distraction reductor in all patients; the displaced fracture blocks were reset in a minimally invasive manner in patients with intra-articular fracture; final fixation was performed with a minimally invasive plate and screws. Time for reductor installation, operation time and intraoperative blood loss were recorded; complications, fracture union and reduction were observed; height, length and width of the calcaneus, ankle-hindfoot scores of American Society of Foot and Ankle Surgery (AOFAS), Maryland scores, and visual analogue scale (VAS) were recorded at the last follow-up; B?hler and Gissane angles were compared between pre- and post-operation.Results:All patients were followed up for 12 to 36 months (average, 17.2 months). Time for reductor installation averaged 5.0 min (from 3 to 8 min), operation time 91.5 min(from 70 to 110 min), and intraoperative blood loss 25.2 mL (15 to 50 mL). Superficial infection of traction track occurred in one patient and sural nerve injury in one patient. All fractures united without any reduction loss by the last follow-up. On average, the last follow-up observed a calcaneal height of 39.3 mm, a calcaneal length of 70.6 mm, a calcaneal width of 32.7 mm, an AOFAS score of 87.8, a Maryland score of 86.7 and a VAS score of 2.2. The calcaneal B?hler angle was recovered significantly from 3.7°±13.7° preoperatively to 25.8°±6.4° at the last follow-up, and the calcaneal Gissane angle from 112.2°±21.3° preoperatively to 125.8°±5.7° at the last follow-up ( P< 0.05). Conclusion:In percutaneous minimally invasive treatment of calcaneal fractures, application of our self-made tri-plane distraction reductor can lead to fine clinical efficacy.

Objective To prepare a new type of micropore porcine acellular dermis matrix with the aid of laser (LPADM),and to validate the healing effect of the LPADM through the phrase Ⅰ composite transplanting on the back of the full- thickness skin defects in SD rats.Methods In vitro,the allogeneic fibroblasts were separately cultured with the LPADM (LPADM group) or the non-pore PADM (non-pore LPADM group),while fibroblasts cultured by pure medium were used as control.After culture of 1 day,3 days and 5 days,the contents of IL-10,IL-6,TGF-β1,LN,VEGF expressed by fibroblasts were determined by double-antibody sandwich ELISA method.In vivo,the phrase Ⅰ transplantations of LPADM graft with split-thickness autologous skin were carried on the backs of the full-thickness cutaneous defects of SD rats.The healing condition was observed and analyzed by histological tests.Results The differences of the absorbance value between the LPADMgroup,PADM group and control group in each day were not statistically significant (F=0.050-1.763,P＞0.05).The transplantation of LPADM graft with split-thickness autologous skin graft resulted in high rate of surviving without signs of rejection 3 weeks later.After 1-month of transplantation,the regenerated skin was well enough to be lifted without any serious scars.Conclusions The phrase Ⅰ transplantation of LPADM graft with split-thickness autologous skin graft can accelerate the healing process of full-thickness skin wounds with high biological safety.

Objective To evaluate the roles of signal transducer and activator of transcription 3(STAT3) played in delayed xenograft rejection.Method Mice-to-rats cardiac xenograft model was established and recipients were administrated by inhibitor of phosphorylation of STAT3,5,15-Diphenylporphyrin(DPP),and immunosuppressive agent,ciclosporin A (CsA) alone or both.The survival of graft was analyzed.Immunohistochemistry and immunoblotting were utilized to detect the phosphorylated STAT3 (p-STAT3),and real-time polymerase chain reaction was used to assess STAT3-targeted genes in grafts.Result The expression of p-STAT3 was increased significantly with the prolonged survival in grafts (P ＜ 0.05).Administration of DPP and CsA both significantly prolonged survival of the grafts (P＜0.05),and decreased the expressions of STAT3-targeted genes including Bcl-xl,Bcl-2,Cyclin D1,C-myc and VEGF (P＜0.05).DPP and CsA exerted the synergistic effects.Conclusion STAT3,which is persistently activated in cardiac xenografts,probably up-regulates downstream genes to promote proliferation and to inhibit apoptosis of endothelial cells,leading to the activation of endothelial cells and delayed xenograft rejection.

Objective To observe expression of human beta-defensin-3 (HBD-3) in tissues around the infected artificial prostheses and investigate its value in treatment and diagnosis of periprosthetic joint infection (PJI).Methods According to clinical diagnosis,periprosthetic tissues and normal synovial membrane excised in operation were collected and divided into the following four groups:PJI group (n =13),aseptic loosening group (loosening group,n =9),spacer treatment group (treatment group,n =12),and normal group (n =15).HE staining was used to observe infiltration of inflammatory cells.Immunofluorescence staining was used to detect positive cells number and fluorescence intensity.Image-pro plus (IPP) 7.0C software was used to measure the average value of absorbance.Preoperative peripheral white blood cell count,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) results were documented.Then,differences of those parameters were analyzed and compared among groups.Results HE staining revealed that all groups had different degree of inflammatory cell infiltration except for normal group.Immunofluorescence staining revealed that the most number of positive cells and highest fluorescence intensity existed in PJI group.Value of absorbance in PJI group was 0.430 ± 0.013,followed by 0.308 ±0.005 in loosening group,0.234 ± 0.009 in treatment group,and 0.089 ± 0.019 in normal group.Preoperative peripheral white blood cell count,ESR and CRP were the highest in PFI group,but were not significantly different among the remaining three groups.Conclusion HBD-3 is highly expressed in tissues around the prostheses which had infection or aseptic loosening,but its expression in response to infection and loosening has difference.

BACKGROUND:There is controversial in choosing the treatment method for the treatment of traumatic subaxial cervical fracture-dislocation and spinal cord injury.
OBJECTIVE:To evaluate the clinical effect of implant internal fixation and Halo-vest external fixation on the stability after treatment of subaxial cervical fracture-dislocation.
METHODS:A retrospective analysis was conducted on 17 patients with subaxial cervical fracture-dislocation in the Department of Orthopedics, the Second Affiliated Hospital of Shantou University Medical Col ege between January 2009 to December 2011, including 13 male patients and 4 female patients, the age was ranged from 21-65 years, average 41.6 years. There were six cases of high fal ing injury, three cases of crush injury and eight cases of traffic accident injury. The hospitalization time after injury was 2 hours to 5 days, average 2.5 days. Al the patients received Halo-vest external fixation under local anesthesia, then distraction gradual y, and received anterior decompression graft and titanium screw fixation under reduction. The treatment effect was evaluated
through Frankel classification and imaging examination.
RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months, average 15.4 months. Normal anteraposterior X-ray film showed fracture reduction, the cervical vertebra restored to the normal
sequence and physiological curvature;CT showed graft fusion without internal fixation fracture and loosing;
according to Frankel classification, marked effect (decreased for 2 grade) in five cases, effective (decreased for 1
grade) in 10 cases, and ineffective in two cases. Implant internal fixation combined with Halo-vest external fixation is safe and reliable in the instability fixation of subaxial cervical fracture-dislocation, and can better restore the spinal sagittal alignment.

In order to suit the trend of integration and development of modem medical disciplines and the reform trend of integration of curriculum system, the Third Military Medical University attempts to build a new curriculum system for medical postgraduates. The new system reveals the accuracy towards the teaching objects, the integration of curriculum structure, the update of the teaching contents and the diversity of the teaching methods. Besides, it combines the reform of teaching management, which will push forward the cultivation quality of the medical postgraduates.

Objective To study the effect of thermo-radiotherapy on multidrug resistance (MDR) and levels of intracellular adriamycin (ADM) in tongue squamous cell carcinoma cell line Tca 8113 and its MDR cell line Tca 8113/CBDEA. Methods Samples of the two cell lines were treated with thermo-radiotherapy (42℃ for 0.5 h and 2 Gy of radiation). Four and 24 hours later, the expression of the MDR relative proteins P-glycoprotein (P-gp),multidrug resistance associate protein 1 (MRP1) and glutathione s-tranferase-π (GST-π) were detected using immu-nohistochemistry. Intracellular ADM concentrations were measured using an HTS 7000 Plus bioassay reader. Re-sults No change in the expression of P-gp was observed in the Tca 8113/CBDEA and Tca 8113 cell lines after 4 or 24 hours. Expression of MRP1 was not significantly altered in the Tca 8113/CBDEA cell line, but there was a signifi-cant drop in the Tca 8113 cell line 24 hours post-thermo-radiotherapy. Expression of GST-π was not altered in either the Tca 8113/CBDEA or the Tca 8113 cell line at 4 hours post-thermo-radiotherapy, but there was a significant de-crease at 24 hours. At both 4 and 24 hours, drug tolerance had decreased and intracellular drug concentration had in-creased significantly in both cell lines. Conclusions Thermo-radiotherapy can enhance the effects of chemotherapy and suppress the expression of MDR factors induced by radiation. The combination of hyperthermia and radiotherapy does not induce MDR.