Extralevator abdominoperineal excision (ELAPE) has been suggested to potentially improve oncological outcomes in advanced low rectal cancer patients. However, the urogenital function impairment as one of the main complications deteriorates the quality of life in these patients. The key point to prevent urogenital function impairment is to avoid autonomic nerve injury, including the superior and inferior hypogastric nerve plexus and neurovascular bundle. Three areas should be especially focused during surgery, including the posterolateral aspect of the prostate during the separation of the rectum from prostate, the lateral wall of ischioanal fossa and the area in front of anal canal. Previous presumption supposed that extended resection, though promoting oncologic outcomes, might lead to enlarged injury to surrounding vessels and nerves that deteriorated patients′ urogenital function. But recent studies show that postoperative urogenital function outcomes of rectal cancer patients who underwent ELAPE are not inferior to conventional APE after the induction of minimal invasive approaches including laparoscopic and robotic surgery. Their quality of life can be comparable with patients who underwent conventional APE, and are even better in some particular area. Moreover, as further improvement of ELAPE procedure has been made, the concept of individualized ELAPE addressed the importance of personalized surgical procedure based on tumor stage and location, dedicating to avoid injury to vessels and nerves through preserving more surrounding tissues. Urogenital function outcomes, as part of postoperative outcomes, get more and more attention in recent years. We review current studies on urogenital function after ELAPE from anatomy to clinical research, in order to raise surgeons′ attention of nerve preservation technique and to improve their understanding of ELAPE procedure.

Vertebral artery hypoplasia is a frequent variation type of vertebral arteries.At present,there is no unified theory about the relationship between vertebral artery hypoplasia and posterior circulation ischemic stroke.The available evidence suggests that vertebral artery hypoplasia may be a precipitating factor for posterior circulation ischemic stroke; particularly other vascular risk factors coexist.This article elaborates the epidemiology of vertebral artery hypoplasia,the clinical manifestation and imaging features of vertebral artery hypoplasia in patients with posterior circulation ischemic stroke,and the possible mechanism of vertebral artery hypoplasia caused posterior circulation ischemic stroke.

OBJECTIVE: To explore the characteristics of mutations of four common pathogenic genes (GJB2, SLC26A4, GJB3 and 12S rRNA) among patients with nonsyndromic hearing loss (NSHL) from eastern Shandong. METHODS: Peripheral blood samples of 420 NSHL patients were collected, and a hereditary-deafness-gene microarray was used to detect GJB2 c.235delC, c.299-300delAT, c.35delG and c.176del16 mutations, GJB3 c.538C>T mutation, SLC26A4 c.2168A>G and c.IVS7-2A>G mutations, and 12S rRNA c.1555A>C and c.1494C>T mutations. For patients carrying single heterozygous mutations, the coding regions of the above genes were analyzed with Sanger sequencing. RESULTS: The results of the microarray assay and Sanger sequencing showed that 84 patients (20.00%) carried GJB2 mutations, with c.235delC (16.43%) and c.299-300delAT (7.86%) being most common. Seventy-five patients (17.86%) carried SLC26A4 mutations, for which c.IVS7-2A>G accounted for 15.71%. In addition, 5.95% of patients carried 12S rRNA mutations. Only one patient was found to carried GJB3 mutation (c.538C>T). CONCLUSION Common pathogenic mutations for NSHL in eastern Shandong included GJB2 c.235delC and SLC26A4 c.IVS7-2A>G. Of note, 5.95% of patients were due to 12S rRNA m.1555A>G mutation, which gave a frequency greater than other regions of China.
China ; Connexin 26 ; Connexins ; DNA Mutational Analysis ; DNA, Mitochondrial ; Deafness ; Genes, rRNA ; Hearing Loss ; Humans ; Mutation ; RNA, Ribosomal ; Sulfate Transporters

Comprehensive experiments course is a bridge for higher vocational students to integrate theoretical knowledge with production practice. The article introduces that our biological pharmacy department is committed to the principles of "promotion of teaching, learning and construction through skills competition so as to integrate education and training". By taking penicillin fermentation process as an example, reform has been made in several aspects including teaching objectives, teaching content and teaching methods. We integrate the practical operation of fermentation equipment with virtual simulation software to develop a two-way interactive course. By reducing the subjective dependence, the quantitative management and evaluation of fermentation process parameter control were put into place, which efficiently integrated the skills competition with practical teaching. Improved teaching performance has been achieved over recent years, which may facilitate the reform and practice of similar courses based on skills competition.
Humans ; Clinical Competence ; Learning ; Students ; Technology ; Biological Products

Needle sticking method, which can be combined with multiple needling techniques, has been attached with great importance in recent years by doctors in clinic. Combining with the clinical experiences, the authors expounded the needle sticking method through its unified concept, differences between needle sticking method, which was an acupuncture technique, and stuck needle which was an accident during acupuncture, selection of needles, manipulations, mechanism of treatment, range of application, attentions and advantages of popularization. It is held that the technique can be widely applied for treatment of acute and chronic diseases of various departments with filiform needles. Easy to be manipulated, understood and mastered, the technique is without side effect and valuable to be popularized.
Acupuncture Therapy ; instrumentation ; methods ; Humans ; Medicine, Chinese Traditional

OBJECTIVETo observe the expression change of signal regulatory protein alpha1 (SIRPalpha1) in autoimmune hepatitis (AIH) and approach the relationship between SIRPalpha1 and the extent of inflammation.

METHODSImmunohistochemistry is used to detect the expression of SIRPalpha1 in the paraffin section preparations of 33 AIH and 10 normal hepatic tissue.

RESULTSSIRPalpha1 is positive or weakly positive expressed in AIH. The staining is localized in the cytoplasm of Kupffer cells in the hepatic sinusoid with focal distribution. It is negative in normal hepatic tissue. In light AIH, it is negative or weakly positive expressed with a 36.4 percent of the positive rate (4/11). The positive or strong positive expression is found in the moderate AIH with an 84.2 percent of the positive rate(16/19). There is statistical significance between both light AIH, moderate AIH and severe AIH (P less than 0.001) and moderate AIH and light AIH (P less than 0.001). There is no statistical significance between both light AIH and severe AIH (P = 0.145 ) and moderate AIH and severe AIH (P = 0.084).

CONCLUSIONSAs a negative regulatory factor, the expression of SIRPalpha1 in hepatic sinusoid Kupffer cells is some associated with the extent of AIH.

Adolescent ; Adult ; Aged ; Antigens, Differentiation ; metabolism ; Cell Communication ; Child ; Female ; Hepatitis, Autoimmune ; metabolism ; pathology ; Hepatocytes ; metabolism ; pathology ; Humans ; Kupffer Cells ; metabolism ; pathology ; Male ; Middle Aged ; Receptors, Immunologic ; metabolism ; Young Adult

Objective: To investigate the impact of obstructive sleep apnea hypopnea syndrome (OSAHS) on platelet function in patients with ischemic stroke. Methods: Patients with ischemic stroke treated in the Department of Neurology, Weihai Municipal Hospital from January 2017 to November 2017 were collected prospectively. The presence or absence of OSAHS was determined by polysomnography. After oral administration of aspirin enteric coated tablets for 7±1 d, the maximum aggregation ratio (MAR) induced by arachidonic acid (AA) was determined by PL-12 Platelet Function Analyzer. MAR-AA ≥50% was defined as platelet hyperresponsiveness. Multivariate logistic regression analysis was used to evaluate the risk factors for platelet hyperresponsiveness in patients with ischemic stroke, and multiple linear regression analysis was used to determine the correlation between sleep parameters reflecting the severity of sleep apnea and MAR-AA. Results: Among the 124 patients with ischemic stroke, 58 (46.77%) complicated with OSAHS, 66 (53.23%) without complicated with OSAHS; 84 (67.74%) had platelet hyperresponsiveness, and 40 (32.26%) had not platelet hyperresponsiveness. MAR-AA in the complicated OSAHS group was significantly higher than that in the non-complicated OSAHS group (48.98%±20.61% vs. 26.45%±15.15%; t=-6.858, P<0.001). Multivariate logistic regression analysis showed that OSAHS was an independent risk factor for platelet hyperresponsiveness in patients with ischemic stroke (odds ratio 9.551, 95% confidence interval 3.051-29.905; P<0.001). Multiple linear regression analysis showed that there was a significant linear relationship between apnea hypopnea index and MAR-AA (β=0.499, P<0.001). Conclusions OSAHS is an independent risk factor for platelet hyperresponsiveness in patients with ischemic stroke. Apnea hypopnea index is significantly correlated with MAR-AA.

Objective To assess the relationship of serum prealbumin level with the severity of acute ischemic stroke (AIS).Methods The clinical data of 2522 AIS patients who were admitted in Peking Union Medical College Hospital from 2000 to 2008 were retrospectively analyzed.The serum prealbumin and hypersensitive C-reactive protein (hs-CRP) levels were evaluated by immunoturbidimetric assay within 24 hours after admission.The AIS severity was evaluated at admission using modified Rankin Scale (mRS).Patients were divided into mild AIS group (mRS score ≤ 3 ) and severe AIS group (mRS score ＞ 3 ).The levels of serum prealbumin and hs-CRP were compared between these two groups,and the relationship between praalbumin and hs-CRP was also analyzed.Results There were 1697 patients in the mild group (average mRS score:1.67) and 825 patients in the severe group ( average mRS score:4.53 ).The severe group had significantly lower prealbumin level [ ( 191.20,82.00)versus (219.18,72.00) mg/L,P =0.000] and higher hs-CRP level [ (6.01,8.22) versus (4.15,6.93) mg/L,P =0.000 ] than the mild group,respectively.Partial regression analysis showed that the stroke severity was negatively correlated with serum prealbumin level (r =-0.115,P =0.000) and positively correlated with hs-CRP level (r =0.098,P =0.000).Serum prealbumin level was inversely correlated with hs-CRP level ( r =- 0.396,P =0.000).Conclusion The prealbumin level is relevant with the severity of AIS and inflammation.

Objective To investigate the diagnostic values of transcranial Doppler ultrasonography (TCD) for vertebral artery hypoplasia (VAH) and focal vertebral artery stenosis (fVAS) with CT angiography (CTA) finding as a standard.Methods Consecutive patient who underwent TCD and CTA were included.According to the findings of CTA,they were divided into 3 groups:a normal group,a VAH group,and a fVAS group.The TCD parameters included the mean flow velocity (MFV),peak systolic velocity (PSV),pulsatility index (PI),resistance index (RI) and asymmetry index (AI),and they were compared among the groups,respectively.The receiver operator characteristic (ROC) curves were used to evaluate the sensitivity and specificity of TCD parameters for diagnosis of VAH and fVAS.Results A total of 405 patients were enrolled,including 278 (68.6％) in the normal group,75 (18.5％) in the VAH group,and 52 (12.8％) in the fVAS group.There were significant differences in MFV,PSV,PI,and RI on the affected sides among different groups (the affected side in the normal group was defined as the right side).The blood flow velocity in the VAH group was the slowest,and that in the fVAS group was the fastest.Other parameters had the same trend.There were significant differences in MFV and PSV on the unaffected side among different groups.The blood flow velocity in the VAH group was significantly faster,the fVAS group was slightly faster,and the fVAS group was less than the VAH group.There were significant differences in AI among different groups,and it could be used as an indicator for diagnosis of VAH (the area under the curve 0.78,95％ confidence interval 0.72-0.84;P＜0.001).With the AI ＞33.7％ as a cut-off value,the sensitivity and specificity of VAH diagnosis were 74.7％ and 68.7％.Conclusions Attention should be paid to identifying VAH and fVAS when using TCD for evaluation of vertebral artery.AI ＞33.7％ can be used as a reference index for diagnosis of VAH.

Adolescent ; Adult ; Arthroscopy ; methods ; Humans ; Knee Injuries ; surgery ; Male ; Menisci, Tibial ; surgery ; Middle Aged ; Tibial Meniscus Injuries ; Young Adult