Objective To evaluate the safety and efficacy of laparoscopitotal mesorectal excision (TME) with sphincter-preservation in the treatmenof low rectal cancerby using metanalysi.MethodThe electronidatabase(PubMed ,Medline ,Ov-id ,Cochrane Library ,Controlled TrialRegistry ,SinoMedCBM ,Wanfang Dat,CNKI ,VIP ,eal) were retrieved .The related litera-tureon the randomized controlled trail(RCTs) and the non-randomized controlled trails(non-RCTs) comparing laparoscopiver-sulaparotomy TME with sphincter-preservation fotreating low rectal cancepublished from January 2001 to Octobe2012 were collected .The RevMan5 .2 software waused to conducthe metanalysi.ResultTwelve studieincluding 1 508 patientwere included ,in which the laparoscopigroup had 781 caseand the laparotomy group had 727 case.The metanalysiresultshowed thacompared with the laparotomy group ,the laparoscopiTME(LTME) group with sphincter-preservation had significantly lesestimated blood loss[mean difference(MD)= -67 .13 ,95% confidence interval(CI) (-78 .74 ,-55 .51) ,P＜0 .01] ,longedistal resection margins[MD=0 .15 ,95% CI(0 .01 ,0 .29) ,P= 0 .04] ,earlieintestinal functional recovery [MD= -1 .16 ,95% CI (-1 .32 ,-1 .01) ,P＜0 .01] ,shortehospital stay [MD= -3 .99 ,95% CI (-5 .36 ,-2 .63) ,P＜0 .01) ,lestotal morbidity [oddratio(OR)=0 .40 ,95% CI (0 .25 ,0 .63) ,P＜0 .01] ,anastomotileakage[OR=0 .60 ,95% CI (0 .37 ,0 .96) ,P=0 .03] ,urinary re-tention[OR=0 .40 ,95% CI(0 .18 ,0 .87) ,P=0 .02] and incision infection[OR=0 .26 ,95% CI(0 .11 ,0 .61) ,P=0 .002] .The statis-tically significandifferencewere nofound between the two groupin the numbeof lymph node dissection,length of resected specimen ,postoperative obstruction and the 2-yeaoverall survival rate(P＞0 .05) .Conclusion LTME with sphincter-preservation fotreating low rectal cancehathe advantageof lessurgical traum,rapid postoperative recovery and few complication.Never-theles,iineeded to conducfurtheresearch fovalidating whetheLTME with sphincter-preservation having the superiority in the aspectof postoperative anal function recovery and long-term outcome .

Objectives Understanding the characteristic changes of Keshan disease (KD) in different epidemic period to provide reference basis for prevention and teatment. Methods On the basis of medical record as fundamental element, the relative conditions of Keshan disease's prevailing and spreading period were compared. Results In high incidence years, familial aggregation [accounted for 12%(6/50)] and seasonal aggregation were found, and KD cases occurred mainly from May to September, which was 78% (39/50)of the total cases in the whole year. Circulatory dysfunction(gallop rhythm, pulmonary role, jugular venous engorgement, cyanosis of lips) was more severe in high incidence years than that in low incidence years(X2=8.53,P<0.01). The average age of incidence was (4.07±1.46) years old in high incidence years and (6.11±2.71) years old in low incidence years. The type constitution in high incidence years was significantly different from that in low incidence years (X2=40.68, P<0.01), and chronic type of KD accounted for 22.85%(707/3094),46.09%(53/115), respectively, in high and low incidence years. Conclusions Making a further research of seizure of disease, and improving diagnosis and cure management level are also the important content for prevention and cure research work of Keshan disease at right time.

OBJECTIVE:To provide reference for teaching reform of Pharmaceutical English in our university. METHODS:According to the theory of needs analysis,by the means of classroom observation,questionnaire survey combined with personal in-terview,the participation of students majoring in Pharmaceutical Engineering,Pharmaceuticals and TCM Source of Grade 2013 in Pharmaceutical English classrooms of our university were investigated to investigate target needs and learning needs of students and analyze main influential factors of students'enthusiasm. RESULTS:It was found that the students participated passively in the Pharmaceutical English classrooms,mainly targeted at credit hour(88 students,58.28%)and aimed at the improvement of read-ing ability(73 students,48.34%). From aspect of learning needs,the students presented evenly enthusiasm for between traditional teaching method and modern teaching method;expected teachers asked more difficult questions;the study focused on actual and ef-fective feedback from the students. Their participation was mainly influenced by course property,teaching content and teaching method. The students'learning objectives were greatly affected by course propevty;to the students,the teaching content was more important than teaching method. CONCLUSIONS:It is to be improved in course property and location,teaching content and teach-ing method of Pharmaceutical English in our university. Pharmaceutical English should be included in required course;teaching content is combined with pharmaceutical practice;various teaching mode is formulated according to teaching content so as to meet students'need and improve teaching effect.

Objective:To observe the clinical effect of mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in convalescence stage.Methods:A total of 136 patients conforming to the inclusion criteria were randomized into three groups by the random number table,including group A of 46 cases,group B of 44 cases and group C of 46 cases.Patients in group A received swallowing disorder therapeutic apparatus treatment,patients in group B received mind-refreshing and orifice-opening needling method treatment,and patients in group C received mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus treatment.The treatment was given once a day for 10 d as a course,the whole treatment lasted for 4 courses.Therapeutic evaluation items including water-swallowing test (WST),standardized swallowing assessment (SSA) and modified Barthel index (MBI) were measured before treatment,after treatment and at follow-up visit (2 months after treatment).Results:After treatment,scores of WST and MBI in all three groups increased significantly (all P＜0.05),while the SSA score dropped significantly (all P＜0.05).After treatment and during follow-up visit period,score of WST in group C was significantly higher than that in group A and group B (both P＜0.05),while the difference between group A and group B showed no statistical significance (P＞0.05);the SSA score in group C was substantially lower than that in group A and group B (all P＜0.05),the difference between group A and group B showed no statistical significance (P＞0.05);the MBI scores in group B and group C were substantially higher than that in group A (all P＜0.05),the difference between group B and group C showed no statistical significance (P＞0.05).After treatment and during follow-up visit period,the differences in overall therapeutic effect between group A and group B showed no statistical significance (P＞0.05),while the overall therapeutic effect in group C was substantially better than that in group A and group B (all P＜0.05).Conclusion:Both mind-refreshing and orifice-opening needling method and swallowing disorder therapeutic apparatus can alleviate symptoms of deglutition disorder of stroke patients respectively,and the combination of two methods can improve the therapeutic effect.

Humans ; Metals ; Microwaves ; adverse effects ; Occupational Exposure ; adverse effects ; analysis ; Workplace

Objective To screen the variation in NeuroD1 gene and to study its function in vitro and its clinical phenotypes and genetic characteristics in Chinese early-onset type 2 diabetic probands. Methods PCR-direct sequencing of NeuroD1 gene was performed in 85 early-onset type 2 diabetic probands, 95 late-onset type 2 diabetics with strong diabetic history and 87 non-diabetic control subjects. Distributions of the identified variation were calculated and compared among the three groups. Expression vectors with mouse NeuroD1 (mND1)cDNA wild type or mutant type and reporter vectors with human insulin promotor-linked luciferase were constructed. Then the above vectors were co-transfected into rat INS-1 cells. Relative luciferase activities were measured to compare transcriptional activities of insulin gene between WT and MT. Results S159P (T→C), a new mutation was identified in a proband, which was co-segregated with diabetes in 4 carriers from the paternal side. The functional study showed that the S159P mutant exhibited a 25% reduction in transcriptional activity of insulin gene as compared with the wild type. A45T (G→A), a common variation was identified. The AA + GA genotypic frequencies were markedly increased in early-onset type 2 diabetic probands as compared with late-onset type 2 diabetic probands and non-diabetic control subjects (P=0.006 and P=0.014, respectively). Conclusion The novel S159P mutation in the NeuroDl gene seems to contribute to the development of diabetes in the Chinese early-onset type 2 diabetic family. The A45T variation may increase susceptibility to or be in disequilibrium with early-onset type 2 diabetes mellitus in Chinese population. In addition, the A45T variation may affect the onset pattern of type 2 diabetes mellitns, such as early-onset but not late-onset type 2 diabetes mellitus.

Objective To investigate the association between TGFβ1-509 C/T gene polymorphism with primary ANCA associated vasculitis (AAV) in Chinese Han population . Methods The blood DNA and clinical data of 88 patients were collected, TGFβ1-509 C/T genotypes were determined by PCR-RFLP, 107 healthy individuals were tested as controL Clinical and pathological data of the patients with different genotype were compared. Results No significant difference was found in neither genotype distributions nor allele frequencies between the patients and the control (P > 0. 05). Significant difference was found in uria protien level of the three groups of patients with different genotypes(P <0.05) ,but not in blood pressure, serum urea nitrogen or creatinine, vasculitic damage index, birminghan vasculitis activity score (P > 0. 05 ). Significant difference was found in med-heavier glomerular mesangial proliferation of the three groups ( P < 0.05 ) , but not in lighter glomerular mesangial proliferation, glomerular sclerosis, crescent formation and tubule-interstitial fibrosis and atrophy. Conclusions In Chinese Han population, TGFβ1-509 C/T polymorphism might have no relationship to susceptibility of primary AAV, but might relate to uria protein and med-heavier degree of mesenterium proliferation.

Objective To investigate the relationship of TCRCα-575A/G polymorphism with anti-neutrophil antibody(ANCA) associated vasculitis in Chinese Han population. Methods 86 cases of ANCA associated vasculi-tis in Chinese Han population and 196 healthy subjects were enrolled. TCRCα-575A/G was genotyped by PCR-re-striction fragment length polymorphism (PCR-RFLP) assay. Case-control study was performed. Results No signifi-cant difference was found in either genotype distribution(AA,AG,GG) or allele frequencies between 86 patients and healthy subjects(P>0.05);But significant differences between AA group, AG group, and GG group in systolic pres-sure[(127.47±24.18)、(124.11±25.21)、(148.92±19.23) mm Hg],diastolic pressure [(75.35±14.12)、 (74.50±13.01)、(85.46±9.40) mm Hg],red blood cell count[(3.41±1.01)×109/L、(3.46±1.04)× 109/L、(2.68±0.67)×109/L] and hemoglobin [(90.45±20.69)、(100.66±29.80)、(77.61±15.81) g/L (P<0.05 for each) were found. The patients in GG group had higher blood pressure and more severe anaemia;By following the patients about (16.0±36.8) months,no statistics significance was found between groups with and without chronic renal failure in distributions and genetypes of TCRCα-575A/G (P>0.05 ). Conclusions In Chi-nese Han population,TCRCα-575A/G polymorphism might not be related to genetic susceptibility and chronic renal failure of ANCA associated vaseulitis;but G allele might be associated with more serious anaemia and hypertension.

Objective:To explore the effect of probiotics on reducing ventilator-associated pneumonia (VAP) in sepsis patients.Methods:A total of 94 cases were randomly (random number) divided into the probiotic group ( n = 46) and the control group ( n = 48). All of the patients were given enteral nutrition therapy by nasogastric tube within 24-72 h after admission. And patients in the probiotic group were given live combined bifidobacterium, lactobacillus and enterococcus powder besides the regular therapy. The incidence of VAP, bacteremia, mortality, mechanical ventilation time and length of ICU stay were compared between the two groups. Results:Compared with the control group, the incidences of VAP and bacteremia in the probiotics group were significantly lower (χ 2=4.763, P=0.029; χ 2=4.438, P=0.035). There were no significant differences in 28-day mortality and the length of hospital stay between the two groups (χ 2=2.02, P=0.167; t=1.29, P=0.208). Mechanical ventilation time in the probiotics group was significantly shorter than that in the control group ( t=2.16, P=0.038). The Log-Rank test showed that the time of VAP-free in the probiotics group was significantly longer than that in the control group ( P < 0.05). After adjusting for APACHEⅡ score and age, COX proportional risk model analysis showed that the RR values of the probiotics group and the control group for 28-day VAP were 0.18 (95% CI: 0.12-0.74, P=0.025) and 0.21 (95% CI: 0.19-0.95, P=0.042), respectively. Conclusions:Probiotics treatment can reduce the incidence of VAP in sepsis patients.

Objective:To investigate the efficacy and safety of Rituximab (RTX) in treating children with refractory steroid-resistant nephrotic syndrome (SRNS).Methods:The clinical data of 10 children with refractory SRNS receiving RTX in the Department of Pediatrics, Jinling Hospital from September 2013 to March 2018 were analyzed retrospectively.Results:The age of onset of 10 children (including 5 males and 5 females) was (4.47±2.75) years old.The renal biopsy showed focal segmental glomerular sclerosis in 5 cases (50%), minimal change nephropathy in 3 cases (30%), IgM nephropathy in 1 case (10%), and mesangial proliferative glomerulonephritis in 1 case (10%). Ten children received RTX treatment (1 or 4 doses; 375 mg/m 2 once; maximum: 500 mg) at the age of (6.74±2.62) years old.There were 8 patients (80%) receiving a single dose of RTX, 1 patient (10%) receiving 3 doses, and 1 patient (10%) receiving 8 doses.The follow-up time was 11.93 (5.17, 25.66) months.The remission rates at the 3-month follow-up, 6-month follow-up and last follow-up were 30% (3 patients), 40% (4 patients), and 40% (4 patients), respectively.The 24-hour urinary proteinuria and serum albumin levels were improved in 10 children after RTX treatment, but there were no significant statistical difference(all P>0.05). No significant difference was found in humoral immunity and renal function before and after RTX treatment (all P>0.05). During the treatment and follow-up, 3 patients (30%) developed infusion reaction, 2 patients (20%) showed severe pulmonary infection, and 1 patient (10%) died of severe pulmonary infection. Conclusions:RTX is effective in treating some children with refractory SRNS, and a long-term follow-up should be conducted to prevent infection.