With the developments of endoscopic and interventional techniques, the role of surgical treatment in some diseases is gradually replaced by endoscopic or interventional treatment.The word surgery may not preserve only for surgeons, therefore it is redefined.According to different interventional pathways, digestive surgery can be divided into two categories, although both are with similar surgical essentials as resection and repair. Serosa surgery is traditional surgery,characterized for its pathway from skin to visceral serosa and cavity, either by open or laparoscopic platform. Mucosa surgery performs endoscopic operations from natural orifice then mucosa surface.The intercrossing or merging of different disciplines is an inevitable trend for modern medical science, traditional disciplines may be replaced by disease-centered medical model combined with multiple disciplines and techniques.Facing challenges, digestive surgeons should be confidential and inclusive;facing competitions, digestive surgeons should be brave enough for innovation and cooperation, and always regard patients' interest as his first priority.A universal norm for various disciplines should be set up on the practice of evidencebased medicine;surgeons in different specialties should learn from each other, and reinforcing comple-mentary advantages from each other;creating a novel disease-centered multidisciplinary heahhcare model on the basis of fusion of different disciplines is the development direction of digestive surgery.

Objective The aim of this study is to evaluate the effects of drug,electric cardiovertion,radiofrepuency ablation and implantable anti-atrial-fibrillation pacemaker on patients with persistent idiopathic atrial fibrillation.Methods 58 patients with persistent idiopathic atrial fibrillation were treated with drug or electric cardjovertion,radiofrequence ablation and anti-atrial-fibrillation pacemaker.Results There were 30 patients successfully converted to sinus rhythm by drug.The mean conversion time of drug was 8?5 days.22 patients were converted by electric cardioversion.10% of cases(6 of 58)failed to convert by both methods.In follow-up period,12 cases of patients were healed,19 cases got significant improvement,14 cases got moderate improvement,8 cases had no improvement.The total efficiency rate was 76%.18 cases in successful cardioversion patients were healed,5 cases got significant improvement,5 cases got moderate improvement,4 cases had no improvement.The total efficiency rate was 75%(14 of 18).2 cases got improvement by anti-atrial-fibrillation pacemaker.Conclusion Combined treatment of drug,electric cardioversion,radiofreqency ablation and anti-atrial-fibrillation pacemaker can imrove cure rate of persistent idiopathic atrial fibrillation.

Osteonecrosis is the most common disorder in femoral head and scaphoid. However, avascular necrosis (AVN) in metacarpal head is a rare disease. In the present study, a 14-year-old male patient complained of right-hand pain with a limited range of motion for one month. Physical examination showed that the active flexion was 70° and the extension was limited to 30° of the metacarpophalangeal (MCP) joints. The grip strength decreased to 60% of the contralateral hand. X-rays demonstrated flattening and sclerotic changes in the long finger and ring finger of metacarpal head. CT scanning indicated cystic, osteochondral defects and sclerotic changes in metacarpal head. Imaging examination further confirmed the diagnosis of AVN in the long metacarpal finger and ring finger. After conservative treatments including splint immobilization, non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy, the local pain symptoms of the MCP joint gradually disappeared. The range of motion of MCP joint returned to normal with the grip strength score as 105% of the contralateral hand. MRI confirmed excellent remodeling and regeneration in the metacarpal head at two years later. The clinical characteristics, diagnosis and treatments of AVN of metacarpal head were reviewed. Although radiograph examination is commonly used, early-stage osteonecrosis of the metacarpal head should be confirmed by MRI. Given the rarity of this disorder, there is no consensus on the treatments. Metacarpal necrosis is the more common disorder in adolescent patients with a history of trauma. Considering the potential of bone remodeling, juveniles with metacarpal head necrosis could recover by conservative treatments.

Background and purpose:Due to the lack of cost-effective pre-treatment predictors for advanced cervical squamous cell carcinomas treated with concurrent chemoradiotherapy (CCRT), both baseline circulating CD4+CD25+CD127Low/- regulatory T cell (Treg) count and serum squamous cell carcinoma antigen (SCC-Ag) level were measured for this feasibility study. Methods: Peripheral blood samples were collected from 44 patients with stageⅡB-ⅣA cervical squamous carcinomas before CCRT. Flow cytometry immunophenotyping and enzyme-linked immunosorbent assay were used for circulating CD4+CD25+CD127Low/-Treg count and serum SCC-Ag level testing,respectively. Clinical and pathological characteristics were retrospectively reviewed to analyze the predictive value of the 2 indexes. Results:The baseline circulating CD4+CD25+CD127Low/-Treg count was lower in the patient group with positive treatment response than in the group with negative response [(8.78±2.80)%vs (10.95±2.56)%, P<0.05], and the serum SCC-Ag level showed no signiifcant difference between the 2 groups. No correlation was detected between these 2 markers (Spearman’rho=-0.093, P=0.540). Determined by plotting receiver operating characteristic curves, the best cut-off points were 9.76%for circulating CD4+CD25+CD127Low/-Treg count and 9.50 ng/mL for serum SCC-Ag level, respectively. Univariate analysis showed that pretherapeutic circulating CD4+CD25+CD127Low/-Treg count (OR=1.901, 95%CI:1.112-3.219, P=0.017), but not serum SCC-Ag level (OR=0.998, 95%CI:0.001-4.253, P=0.897), was predictive of clinical response to CCRT. Multivariate Logistic regression analysis revealed that pre-treatment CD4+CD25+CD127Low/-Treg count was an independent predictor for clinical response to CCRT (OR=3.115, 95%CI:1.253-7.742, P=0.014). Conclusion:Pretherapeutic circulating CD4+CD25+CD127Low/-Treg count is a feasible method to predict clinical response to CCRT in patients with advanced cervical squamous cell carcinomas.

Objective To investigate the effecof arthroscopiminimally invasion fothe local excision of benign bone tumo.MethodEighpatientwith benign bone tumofrom Augus2011 to Decembe2012 were treated by arthroscopimini-mally invasive operation ,including 3 caseof osteochondrom,2 caseof bone cys,1 case of non-ossifying fibromand 2 caseof osteoid osteom.The lesion location wadetermined by the preoperative imaging dat,the arthroscope and plane cuttewere placed into the lesion arethe tumowaperformed the local lesion resection undethearthroscopimonitoring ,then the plasmwaadopt-ed to treathe resected wound surface of tumo,the bone defectwere implanted by allogeneibone .ResultEighcasewere re-covered well afteoperation .No postoperative complicationwere found .The approach incision ＜3 and the wound length ＜1 .5 cm .Two casewere filled with allogeneibone .There were no recurrence ,fracture odyfunction during the average follow up peri-odof 8-12 month.The postoperative X-ray showed thathe lesion wacompletely resected and the bone defeclesion wacom-pletely filled with allogeneibone .Conclusion The resection of deep benign bone tumoundethe arthroscopimonitoring can maximize to retain the local anatomistructure .

Objective To investigate the effect of smoking status after vascular construction on the long term prognosis in the patients with coronary heart disease(CHD).Methods Totally 893 patients with CHD were divided into 3 groups according to the smoking status before and after vascular construction,non-smoking group(n=458),quiting smoking group(n=287) and smoking group(n=148).The occurrence situation of major adverse cardiovascular and cerebrovascular events(MACCE) during follow-up period were recorded in detail.The postoperative cumulative survival rate was described by using Kaplan-Meier survival analysis.The effect of smoking status on the all-cause death and MACCE was compared.The Cox stepwise regression analysis was used to analyze the all-cause death and the influence factors of MACCE.Results The average follow up time was about 27 months,the postoperative smoking rate was significantly lower than the preoperative multivariable smoking rate(16.57 ％ vs.48.71％),the patients in the smoking group were younger (P＜0.01);the patients in the non-smoking group were mainly female (P＜0.01),the body mass index (BMI) was smaller(P＜0.01).The all-cause death in the smoking group was higher (1.53％ vs.1.05％ vs.6.76％,P=0.002) and the occurrence rate of MACCE was higher (4.37％ vs.5.23％ vs.15.54％,P=0.001).The Cox multivariable stepwise regression analysis showed that postoperative persistent smoking was an important risk factor leading to the all-cause death[HR=2.753,95％CI(1.695-4.473),P＜0.01] and MACCE[HR=1.552,95％CI(1.049-1.754),P=0.001].Conclusion Persistent smoking is an independent risk factor leading to all-cause death and MACCE occurrence in CHD patients after vascular construction.

Objective　To investigate the feasibility of applying transvescal approach laparoendoscopic single-site radical prostatectomy (TVSSLRP) and assess the oncological and functional outcomes.Methods　Eight patients with clinically localized prostate cancer (PCa) of low risk underwent TVSSLRP.Demographic data were accrued including patient age,body mass index (BMI),preoperative PSA level,the International Index of Erectile Function 5,biopsy Gleason score,clinical TNM stage and D'Amico risk classification.One surgeon performed all TVSSLRP procedures.A homemade triple-port was introduced percutaneouly into the bladder to establish pneumovesicum through a 4 cm incision.The major steps of the surgery were described as follows:initial incision was made along posterior margin of the bladder neck to expose bilateral vas deference and spermatic vesicle.After opening Denonvilliers' fascia and extending the space to lateral prostatic pedicles,an intra-fascial nerve sparing procedure was performed.The puboprastatic ligaments were then separated close to the prostate surface and the dorsal vein complex was cautiously swept off.Subsequently,careful apical dissection and urethral transection was sequentially conducted. To reduce the tension of vesico-urethral anastomosis,3 additional incisions parallel to vesio-urethral margin were created and a novel tension - reduced V-LocTM barbed polydioxanone sutures was used.　Results　All the operations were successfully performed and there was no conversion to standard laparoscopic approach or open surgery.The total operative time range was 75 - 180 min with mean time of 125 min.The blood loss was 85 -450 ml with mean 140 ml and no blood transfusion was required.The catheter was removed after a mean (range) of 14 (9 -16) days.No intra-operative complications occurred. No patient had positive surgical margins.The mean (range) hospital stay was 17 (13 -25) days after surgery. All the cases were continent after removal of the catheter.No cases demonstrated vesico-urethral stricture and biochemical recurrence on 12 - 18 months follow up postoperatively.　Conclusions　TVSSLRP is technically feasible for cases with organ-confined prostate cancer with good oncological and functional results.

Objective To reveal the influence of environmental factors on the active components in Scutellaria baicalensis through analyzing the data sampled from the herbal plants along the altitudinal gradient in mountainous region of Western Beijing.Methods In total 85 individuals of S.baicalensis herbs were collected and the surface soils under each of the plant were also sampled from eight different habitats,with an interval of about 100—150 m vertically ranging from 800 to 1 800 m in August through September,2007.The contents of active components in the herbal samples,namely baicalin,wogonoside,baicalein,wogonin,and oroxylin A were determined by HPLC.The organic matter and the total nitrogen contents in the soil samples were analyzed through standard measurement process.The various habitat conditions represented by temperature were estimated through a vertical lapse rate of-0.56 ℃/100 m,and those by precipitation and solar radiation calculated according to the isoline maps.Results The signi-ficant positive correlations were observed only between the contents of baicalin,wogonoside and the elevation.Both those two contents showed the significant negative correlations with the annual mean temperature and precipitation,while showed positive with annual mean solar radiation.No coorelation with any statistical significance was observed between the contents of active components in S.baicalensis and the soil parameters in this study.Conclusion It seems that the plants of S.baicalensis growing in a habitat with annual mean temperature within a range of 2—6 ℃ could concentrate relatively rich contents of active components.Within the natural distribution areas of S.baicalensis,the habitats with an annual tem-perature averaged at 3—4 ℃ tend to be the most fitting sites for growing best quality S.baicalensis rich in active components,and those sites are almost coincident with the environment for trueborn production area of traditional S.baicalensis herbs.

Objective The purpose of the present study was to analyses video-assisted thoracic surgery (VATS) lobectomy for early lung cancer and to provide evidence in guiding clinical practice.Methods From May 1997 to October 2009,VATS lobectomy for early lung cancer was performed in 518 patients.All patient data was reviewed retrospectively.Results The data group consisted of 297 male patients and 221 female patients with a mean age of (58.9 ± 10.6) years ( 19 - 89 years).Morbidity was 10.8％ and mortality was 0.4％.Multivariate analysis identified patient’ s age ( P =0.0300,OR =2.0148,95％ CI 1.0700-3.7940) and operation duration (P=0.0007,OR =1.0086,95％ CI 1.0036-1.0136) as the statistically significant predictors of postoperative complications.Overall 1,3 and 5-year survival rates were 98％,81％ and 66％.And postoperative patbological staging ( P =0.0036,OR =1.6071,95 ％ CI 1.1677 -2.2118 ) is a prognostic determinant.Conclusion VATS lobectomy is a safe and effective therapeutic method for early lung cancer.However,patient selection plays key role in VATS.Operation duration should be shortened as possible,otherwise,it may result in increased postoperative morbidity.It is important to deal with the accident situation rationally and converse to thoracotomy decidedly if necessary.

OBJECTIVETo investigate the impact of NU7026 and Wortmannin, inhibitors of DNA-dependent protein kinase (DNA-PK), in HL60 cells apoptosis induced by 1, 4-benzoquinone (1, 4-BQ).

METHODSHL60 cells were divided into three groups according to the exposures: the poisoned groups which were treated with 0, 5, 10, 25 and 50 µmol/L 1, 4-BQ for 24 h, respectively, the NU7026 groups which were preincubated with 10 µmol/L NU7026 for 1h prior to the 24h treatment of 0, 5, 10, 25 and 50 µmol/L 1, 4-BQ and the Wortmannin groups which were preincubated with 25 µmol/L Wortmannin for 1h prior to the 24 h treatment of 0, 5, 10, 25 and 50 µmol/L 1, 4-BQ. Then we detected the apoptosis via flowcytometry Annexin V-FITC/PI and the DNA Ladder, respectively. We also tested the expressions of Bax mRNA with Real-Time PCR in HL60 cells which were exposed to 10 µmol/L NU7026 for 24 h, 25 µmol/L Wortmannin 24 h, 10 µmol/L 1, 4-BQ 24 h, 10 µmol/L NU7026 1h+10 µmol/L 1, 4-BQ 24 h and 25 µmol/L Wortmannin 1 h+10 µmol/L 1, 4-BQ 24 h, as well as null (control). We also examed the expressions of p53 in HL60 cells with Western blot.

RESULTSAnnexin V-FITC/PI apoptosis tests suggested that apoptosis rates of NU7026+10 µmol/L 1, 4-BQ group and Wortmannin +10 µmol/L 1, 4-BQ were 17.6±1.19% and 15.2±1.22%, respectively. Both of results were higher than that of 10 µmol/L 1, 4-BQ group (6.3±1.04%); Apoptosis of NU7026+25 µmol/L 1, 4-BQ group was 46.2±3.55%, and Wortmannin +25 µmol/L 1, 4-BQ group 26.9±2.62%. Both of results were also higher than that of 25 µmol/L 1, 4-BQ group (14.1±1.54%); Apoptosis of NU7026+50 µmol/L 1, 4-BQ group (61.8±1.78%) was higher than that of 50 µmol/L 1, 4-BQ group (35.9±4.51%). The above results were all statistically significant (P < 0.05).

RESULTSof DNA-Ladder were basically consistent with those of Annexin V-FITC/PI apoptosis tests. In addition, both NU7026 and Wortmannin pretreatment elicited the higher expression of Bax mRNA in HL60 treated by 1, 4-benzoquinone with statistically significance (P < 0.05). However, p53 protein was not detected in HL60 cells as the western blot indicated.

CONCLUSIONInhibitors of DNA-PK, NU7026 and Wortmannin, promote p53-independent apoptosis induced by 1, 4-benzoquinone in HL60 cells.

Androstadienes ; pharmacology ; Apoptosis ; drug effects ; Benzoquinones ; toxicity ; Chromones ; pharmacology ; DNA-Activated Protein Kinase ; antagonists & inhibitors ; Flow Cytometry ; HL-60 Cells ; Humans ; Morpholines ; pharmacology ; RNA, Messenger ; Tumor Suppressor Protein p53