BACKGROUND:The pelvic nerves innervate the pelvic viscera as wel as bring sensory information to the central nerve system, including splanchnic nerves and spinal nerves. Each of them comprises both motor fibers and sensitive fibers. Mostly, the key part of splanchnic plexus is pelvic plexus. Total mesorectal excision proposed by Heald in 1982 has been the “gold standard” for diagnosis and treatment of colorectal cancer. However, it carries a high risk of nerve damage during surgery, which results in urinary retention, sexual dysfunction and other complications. OBJECTIVE:To summarize the former researches so as to get a precise understanding of the pelvic fascia and nerve structure. METHODS:Using “splanchnic nerves, superior hypogastric plexus, pelvic plexus, pelvic splanchnic nerve, total mesorectal excision (TME), clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the pelvic nerves, including its pathway, consistent, ganglia, and reflection in pelvic viscera, published from 2000 to 2015. RESULTS AND CONCLUSION:The main splanchnic plexus in the pelvic cavity includes superior hypogastric plexus (it is located in the triangle formed by left and right common iliac artery and the sacral promontory), and pelvic plexus (hypogastric nerve, pelvic splanchnic nerve and sacral splanchnic nerve converge at the bottom of rectum, formed pelvic plexus, also known as the inferior hypogastric plexus). It is flattened against the lateral aspect of the rectum, the dorso-lateral bladder wal and the seminal vesicles. Nerves come from the plexus contain the sympathetic nerve, parasympathetic nerve and sensory nerve. They are in charge of the motions and sensations of the pelvic organs. The definite knowledge on the anatomy of pelvic fascia and nerve structures can avoid nerve damage during operation, which can help to improve the life quality of patients.

BACKGROUND:Currently, it is stil controversial about the border, surrounding fascia, space of pelvic cavity, distribution of nerves and lymph nodes of the mesorectum, and the development of new technologies makes a progress in related anatomic research.
OBJECTIVE:To summarize the previous studies so as to describe clearly the progress of mesorectal anatomy and to discuss its clinical value.
METHODS: Using “rectum; mesentery; fascia; space; nerve; lymph node; total mesorectal excision (TME); clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the mesorectum and surrounding fasciae, space of pelvic cavity, distribution of nerves and lymph nodes.
RESULTS AND CONCLUSION:Fresh or frozen specimens are often used for studying the mesenterium, fascia, nerves and lymph nodes by using traditional pelvic and perineum anatomical methods. Computer-assisted anatomical dissection can combine immunostaining with computer imaging. A three-dimensional model can wel reflect the relationship among the different anatomical structures, as wel as nerve traveling and spatial location. Mesorectum is located behind the denonviliers and in the front of the sacral fascia of the rectum. Pelvic splanchnic nerve of the mesorectum is derived from the anterior sacral nerve root, runs through the presacral fascia, and enters into the neuro-fascial layervia the pesacral space, which is divided into the upper and lower parts according to the peritoneum. There are more folds in the rear of lymph nodes within the mesorectum within and near the peritoneum. There are stil a lot of controversies about anatomical relationship between the mesorectum and surrounding structures, and to elaborate these issues can provide an objective basis for guiding clinical work.

Objective To investigate the effect of plasma homocysteine (Hcy) levels and cognitive dysfunction on patients with type 2 diabetes and explore the other factors that affect cognitive function.Methods 80 patients with type 2 diabetes were selected as our subjects and they were divided into cognitive impairment group (38 cases),cognitive normal group (42 cases) according to a simple mental state scale(MMSE) score.The plasma Hcy,glycosylated hemoglobin,blood lipid,uric acid,24 h urine trace albumin were measured.Results Plasma Hcy concentration in diabetic cognitive dysfunction,non cognitive impairment group and normal control group respectively were(19.56 ± 5.23),(16.21 ± 3.27),(14.67 ± 4.27) tmol/L,and there was statistically significant difference(F =3.76,P ＜0.05).The plasma Hcy levels in diabetic cognitive impairment group was higher than that non-cognitive impairment group(P ＜ 0.05) and normal control group (P ＜ 0.01),The factors impaired cognitive function in patients with other factors included age,glycosylated hemoglobin,body mass index,diabetes duration and plasma Hcy levels,and there were negative correlation with MMSE score (r =-0.336,-0.285,-0.226,-0.392,-0.312 ; all P values were less than 0.05).Conclusion Patient's age,duration of diabetes,glycosylated hemoglobin and BMI can affect cognitive function in patients.Higher Hcy levels in patients with type 2 diabetes is a risk factor for cognitive impairment.

BACKGROUND:Previous studies have found that endogenous gaseous signaling molecules such as NO, CO, H2S and SO2 play an important role in acute lung injury;there also have other gases participation, such as carbonyl sulfide.
OBJECTIVE:To investigate the effect of carbonyl sulfide for limb ischemia-reperfusion induced acute lung injury and its mechanism in rats.
METHODS:A total of 64 Sprague-Dawley rats were randomly divided into eight groups. Control group:without treatment;model group:limb ischemia for 4 hours and then reperfusion for 2 hours. Low-, moderate-and high-dose carbonyl sulfide groups were intraperitoneal y injected with 0.2, 0.5, 1.0 mL carbonyl sulfide respectively at 20 minutes before ischemia for 4 hours and reperfusion for 2 hours. Low-, moderate-and high-dose air groups were intraperitoneal y injected with 0.4, 1.0, 2.0 mL air respectively at 20 minutes before ischemia for 4 hours and reperfusion for 2 hours. 2 hours after reperfusion, the morphological changes of lung tissues and the change of lung coefficient were observed. The expressions of tumor necrosis factor-a, interleukin-1βand interleukin-6 both in lung tissue and serum were detected by enzyme linked immunosorbent assay. Cel apoptosis was measured by TUNEL assay.
RESULTS AND CONCLUSION:(1) Compared with the control group, significant damage of lung tissue was seen, and the lung coefficient increased significantly in the model group (P<0.05). The expressions of tumor necrosis factor-a, interleukin-l and interleukin-6 both in lung tissue and plasma increased (P<0.05), and apoptotic rate increased. (2) Compared with the model group, low-, moderate-and high-doses of carbonyl sulfide could mitigate the degree of lung injury, and reduce pulmonary coefficient and apoptotic rate. The low dose showed the most obvious effect. Low-and moderate-dose carbonyl sulfide could significantly decrease expressions of tumor necrosis factor-a, interleukin-1βand interleukin-6 both in lung tissue and plasma (P<0.05). (3) No significant difference in each index was visible in the low-, moderate-and high-dose air groups compared with the model group. (4) Results suggested that low dose of exogenous carbonyl sulfide through anti-inflammatory, anti-oxidant effects plays the protective role on limb ischemia/reperfusion-induced acute lung injury in rats.

According to the characteristics of minor students majored in clinical anesthesia, an objective structured clinical examination (OSCE) program was established. This OSCE was applied to clinical anesthesia minor students for departmental rotation examination. Meanwhile, a questionnaire was set to collect students' attitude towards the OSCE assessment program. Results showed that OSCE assessment program could objectively and comprehensively reflect the students' clinical skills. Students participated in OSCE were quite satisfied with its design, organization, quality and effectiveness.

OBJECTIVETo analyze early hematopoietic response and long-term survival of very severe aplastic anemia (VSAA) patients with different absolute neutrophil counts (ANC) after frontline immnunosuppressive therapy (IST).

METHODSClinical data and outcome of 145 VSAA patients treated with rabbit antithymocyte globulin combined with cyclosporine were retrospectively analyzed. Hematopoietic responses to IST and long-term survival were statistically analyzed for VSAA patients in different ANC subgroups.

RESULTSPre-IST ANC=0.05×10(9)/L acted as the best cutoff level to predict IST response at 3, 6 months. For 145 VSAA patients, early death rate was 13.4% (11/82) vs 1.6% (1/63), respectively, in the ANC≤0.05×10(9)/L group and ANC>0.05×10(9)/L group (P<0.05). Hematopoietic response rates to IST was 22.0% vs 54.0% (P=0.000) at 3 months, 34.1% vs 63.5% (P=0.000) at 6 months; the overall five-year survival rate was only (62.5±5.4) % vs (91.4±3.7) % (P=0.000) and five-year event-free survival rate was (42.3±5.5) % vs (63.1±6.5) % (P=0.003), respectively, in the ANC≤0.05×10(9)/L group and ANC>0.05×10(9)/L group.

CONCLUSIONVSAA patients with extremely low ANC (≤0.05×10(9)/L) had high early death rate and with very low response rate to frontline IST and poor survival, so it is urgent to seek for the alternative frontline therapy that will bring faster and better outcome for these patients.

Anemia, Aplastic ; blood ; drug therapy ; Animals ; Antilymphocyte Serum ; therapeutic use ; Cyclosporine ; therapeutic use ; Disease-Free Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Leukocyte Count ; Neutrophils ; cytology ; Rabbits ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo explore the effects of serum ferritin (SF) and iron overload (IO) pre-immunosupressive treatment (IST) on hematologic response of severe aplastic anemia (SAA/VSAA) patients treated with IST.

METHODS257 SAA/VSAA patients who underwent first-line IST from Feb, 2003 to Dec, 2011 in Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital were retrospectively analyzed, the status of SF before IST and the IO-affected factors were studied. The effects of IO on hematologic response of SAA/VSAA patients were evaluated as well.

RESULTSThe median level of SF of 257 patients was 387 (6-2 004) μg/L. 36 patients (14%) had IO, including 20 SAA and 16 VSAA patients. According to univariate logistical regression analyses, IO was influenced by age>14 years (P=0.010) and blood transfusion (P<0.001). The multivariate logistic regression analysis showed that blood transfusion [P=0.001, OR=0.218 (95% CI 0.092-0.520)] was the only independent prognostic factor. SAA (but not for VSAA) patients with IO had much lower hematologic response rate in 6 month after IST (P=0.037). Absolute reticulocyte count and IO correlated with response at 6 month by univariate logistical regression analysis (P=0.014, 0.037). The multivariate logistic regression analysis showed that IO [P=0.021, OR=4.092 (95% CI 1.235-13.563)], ARC ≥20×10(9)/L [P=0.040, OR=2.743 (95% CI 1.049-7.175)] were independent prognostic factors.

CONCLUSION84.8% patients had high serum ferritin before IST, and 14.0% reached IO. Adult and more blood transfusion caused IO more likely. IO correlated with response at 6 month, and was independent prognostic factor.

Adult ; Anemia, Aplastic ; drug therapy ; physiopathology ; Blood Transfusion ; Ferritins ; blood ; Humans ; Immunosuppressive Agents ; therapeutic use ; Iron Overload ; physiopathology ; Logistic Models ; Reticulocyte Count ; Retrospective Studies

Currently,electroencephalogram(EEG),functional near-infrared spectroscopy(fNIRS),and functional magnetic resonance imaging have been widely studied and applied to neuropsychiatric disorders.In recent years,the devices which can realize the simultaneous acquisition of EEG and fNIRS has been developed and gradually applied in the studies on neuropsychiatric disorders.The review provides an introduction of the techniques of synchronized detection and data analysis for EEG-fNIRS,summarizes the analysis methods and new findings of the recent studies of stroke,epilepsy,and other neuropsychiatric disorders using EEG-fNIRS,and also discusses the future research directions.

Clinical data of 19 patients with congenital pyruvate kinase deficiency were analyzed. Insufficient pyruvate kinase confirmed the diagnosis. Laboratory parameters of hemolysis were summarized. In cases of neonatal hyperbilirubinemia and unexplained hemolytic anemia, pyruvate kinase activity and next generation sequencing test may help the early diagnosis.

Objective: To evaluate the impact of the targeted next-generation sequencing (NGS) assay for difficult congenital anemias. Methods: Blood Disease Hospital Anemia Panel 2014 (BDHAP-2014) including 217 known genes of congenital anemias was developed. NGS and parental verification were performed for patients who were suspected diagnosed with congenital anaemia from August 2014 to July 2017. Results: A total of 46 patients were enrolled in this study, the clinical suspection were 11 cases Fanconi anemia (FA), 8 cases congenital dyserythropoietic anemia (CDA), 6 cases congenital sideroblast anemia (CSA), 12 cases congenital hemolytic anemia (CHA), 1 case dyskeratosis congenital (DC), 4 cases iron-refractory iron deficiency anemia and 4 cases unexplained cytopenia (Uc), respectively. 28 (60.9%) of 46 patients became confirmed cases after targeted NGS, corresponding to 44 mutations of which 33 were new. 26(56.5%) patients with results of the assay matching to clinical suspection, including FA (5/11, 45.5%), CSA (6/6, 100.0%), CDA (3/8, 37.5%) and CHA (12/12, 100.0%). 2 (4.3%) cases not matching to clinical suspection, including dyskeratosis congenital (DC) was made in 1(2.2%) patients with suspected FA and familial hemophagocytic lymphohistiocytosis (FHL) was made in 1(2.2%) patients with suspected unexplained cytopenia (Uc). In 12 CHA patients, the hemolytic type was further clarified by the NGS. The remaining 18 cases were not clearly diagnosed. Conclusion Targeted NGS assay is of major impact on congenital anemias. The assay should be used routinely in congenital anemias.