Rectal carcinoma is a common malignant tumor in China. Although it decreased greatly after the introduction of total mesorectal excision and preoperative radiotherapy, the local recurrence rate of rectal carcinoma after curative surgery is still up to 11.3%. Surgery is the most effective treatment for local recurrence of rectal carcinoma. If excised radically, the five-year survival of patients with rectal carcinoma could be more than 35%. Only a few patients will benefit from ex-tended radical surgery because of its extremely high postoperative morbidity and mortality. Strict selection of patients by mul-tiple preoperative examinations makes extended radical surgery more reasonable. For the unresectable advanced recurrent rectal carcinoma, multimodality palliative therapy could lead to symptom relief, elevated quality of life and prolonged surviv-al. We discuss the diagnosis and treatment of recurrent rectal carcinoma in this review.

The left triangular ligament of liver and its fibrous appendix(free border) was studied in 42 Chinese adult male cadavers. 37 fibrous appendices were further studied histologically.In order to prove the formation of the fibrous appendix 30 left triangular ligaments of new born cadavers were also studied. The average length of the left triangular ligament of adult cadavers was 13.91cm.,and that of their fibrous appendices was 6.86cm. Almost all of the left triangular ligaments were attached to the superior surface of the left lobe of liver,consequ- ently, the left suprahepatic space could be properly subdivided into anterior and posterior left suprahepatic spaces by the ligament. The forms of the fibrous appendices were classified into 5 types:triangular (23.8％), narrow band(14.3%), triangular-narrow band(50.0％),membranous (7.1%), and bifurcate type(4.8%).The left triangular ligaments of the 30 new born cadavers were devoid of fibrous appendix. Histological observations of the 37 fibrous appendices showed:aberrant bile ducts were found in 89% of the cases, rudimentory liver-cell cord 65％,nerves 78％, and blood vessels 100％.Their size and number diminished gradually from the pro- Kimal (hepatic) end of the fibrous appendix to the distalend. The authors agreed with Toldt and Zuckandl that the fibrous appendix might be the result of the retrogression of the left lobe and suggested that the occurrence of the fibrous appendix was after birth. The clinical importance of the fibrous appen- dix was discussed.

Objective To discuss the features,such as clinical symptoms,pathologic morphologies,immunohistochemical staining of minimal deviation adenocarcinoma and microglandular hyperplasia of the uterine cervix in order to improve the accuracy of pathological diagnosis.Methods s:Histopathologic characteristics of total hysterectomies in 2 cases of minimal deviation adenocarcinoma and 1 case of cervical microglandular hyperplasia based on the formalin-fixed,paralfin-embedded and hematoxylin-eosin stained tissue were analyzed retrospectively.Immunohistochemical staining was used to detect the expression of CEA,p53,PCNA,and Ki-67 in all 3 cases.Results The main clinical symptoms of minimal deviation adenocarcinoma were watery leucorrhea and enlargement of the cervix.The pathological findings of MDA included hyperplasia of the glands with cytological minimal atypia,invasion effects into the stroma could be observed in some glands and abortive glands with desmoplastic changes,or edema and inflammatory infiltration around the glands were also observed.The invasion presented in the deep part of the cervix as well.The patiant of MGH had a history of oval contraceptive use.Histological features of MGH included tightly packed glands in different sizes and shapes,presentation of inflammatory cells in stroma and glandular lumens,and focal epithelial cell pleomorphism and hyperchromatism but without mitosis.CEA was positive in all two MDA cases,but the tissue of MGH was negative for CEA.The expressions of the other four markers had no difference between MDA and MGH.Conclusions For patients with watery discharge and/or hypertrophy of cervix,the deep ( ＞ 5 mm ) biopsies should be performed.The immunohistochemical staining for CEA,p53,CA125 and ER has adjuvant diagnostic values.It is extremely important to recognize that MGH is an entirely benign lesion.

Objective To determine the relationship between expression of topoisomerase Ⅱ α and clinicopathological factors,overall survival in colorectal caner.Methods Expression of topoisomerase Ⅱ α was measured using EnVision immunohistochemistry in 490 colorectal cancer patients.The relationship between topoisomerase Ⅱ α expression and various clinicopathological parameters was analyzed.Kaplan-Meier analyses and multivariate analyses were used to evaluate the significance of topoisomerase Ⅱ α expression in prognosis prediction.Results Overexpression of topoisomerase Ⅱ α was found to be related with lower T stage ( P =0.042 ),lower N stage ( P =0.038 ),and possibly with lower recurrence rate ( P =0.053 ).Kaplan- Meier analyses showed that overexpression of topoisomerase Ⅱ α was related with prolonged overall survival (P =0.022 ) and prolonged disease-free survival ( P =0.036).Multivariate analyses showed that elevated serum CEA ( P ＜ 0.001 ),elevated serum CA199 ( P =0.002 ),poor differentiation ( P =0.001 ),advanced Dukes stage ( P ＜ 0.001 ) and lower expression of topoisomerase Ⅱ α( P =0.017 ) were independent predictive factors for poor prognosis.Conclusions Expression of topoisomerase Ⅱ α is a favorable predictive factor for colorectal cancer,and would be useful in prognosis prediction and treatment selection for early colorectal cancer and malignant colorectal polyps,especially when it is used in combinations with serum CEA,CA199 and differentiation.

Objective To evaluate the efficacy of integrated traditional Chinese medicine(TCM)and western medicine in treatment of acute exacerbations of chronic obstructive pulmonary disease(AECOPD)combined with respiratory failure,TCM syndromes of spleen-kidney-yang deficiency and phlegm-dampness by comparison between the integrated therapy and simple western therapy in treatment of the disease. Methods 160 patients with AECOPD combined with respiratory failure,spleen-kidney-yang deficiency and phlegm-dampness syndrome in the intensive care units(ICU)of Affiliated Hospital of Chengdu University of TCM and other four hospitals were randomly allocated into two groups in this double-blinded,multicenter,prospective,randomized,controlled trial. In the control group (78 cases),western medicine and placebo were given to the patients,and in the treatment group(82 cases), conventional western medicine plus fei-shuai mistura 25 mL were administered,four times per day,the therapeutic course lasting for 2 weeks in both groups. The all-cause mortality,respiratory failure-cause mortality,improvement of modified Medical Research Council(mMRC)Dyspnea Scale grades,6 minutes walk distance(6MWD),the forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were observed in the 28 days after the end of treatment. Results In the comparisons between the control and treatment groups,there were no statistical significant differences in the all-cause mortality〔54.87%(45/82)vs. 64.10%(50/78)〕and the cases of FEV1/FVC(both P>0.05)in the 28 days after the end of treatment;the 28 day respiratory failure-cause mortality was significantly decreased〔19.51%(16/82)vs. 33.33%(26/78),P<0.05〕,the number of patients with mMRC Dyspnea Scale grades (1-2)was obviously increased(22 cases vs. 7 cases,P<0.05),and the number of patients with 6 MWD grades (4-6)was markedly enhanced in the treatment group(21 cases vs. 8 cases,P<0.05). Conclusions The integrated TCM and western medicine has better therapeutic results in improvement of the patients' degree of dyspnea, 6 MWD and respiratory failure mortality than simple treatment with western therapy for treatment of patients with AECOPD combined with respiratory failure, spleen-kidney-yang deficiency and phlegm-dampness syndrome. However,in regard to the effect on pulmonary function and all cause mortality,the integrated therapy for treatment of such patients in short term has no significant effect.

Objective To test the reliability and validity of the rating scale of social function deficit due to mental disorders (SSFD-MD). Methods 1003 cases with mental disability evaluation were tested by SSFDMD. At sametime, 100 cases of 1003 cases were test-retested and back to back tested by two examiners. 300 cases of 1003 cases also were tested by social disability screening schedule( SDSS),scale of social function for psychosis inpatients(SSPI),global assessment function(GAF) ,the brief psychiatric rating scale(BPRS) ,WH0 disability assessment scale Ⅱ (WHO-DASⅡ ), adult rating scale of mentally disabled ( ARSMD) and rating scale for extrapyramidal side effects (RSESE). Results ①The Cronbach's α coefficients of the total score and all dimensions of SSFD-MD were more than 0.90. The test-retest reliability ranged from 0.67～0. 83 ,and the scorer reliability were 0. 87～0.97. ②The correlations between item scores ranged from 0.46 ～0.74(P＜0.01). The correlations between the factor scores and the total scores ranged from 0.73～0.87(P＜0.01). To extract five full-scale principal components after orthogonal rotation to maximize variance,the cumulative total variance explained was 82.25%.There were highly correlations between SSFD-MD and SDSS.SSPI and GAF,respectively ( r = 0. 71,0.72 and 0. 78). There were moderate correlations between SSFD-MD and BPRS WHO-DAS II ARSMD,respectively(0.62,0. 50 and 0.46). There was a low correlations between SSFD-MD and RSESE ( r = 0.22) ,but all correlations were significant(P＜0.01). Conclusion SSFD-MD has acceptable psychometrics properties on reliability and validity.

Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time, and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after total colectomy, ileal pouch anal anastomosis (IPAA) can reduce fecal frequency and improve patients' quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.
Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Humans ; Ileum ; surgery ; Rectum ; surgery

Objective Atherosclerosis is widely accepted as a chronic inflammatory disease. Serum biomarkers for vulnerable plaques not only serve as diagnostic tools for the identification of patients with acute coro-nary syndrome, but also assist the identification of high-risk patients. However, the existing data are limited and conflicting. In the present study, we determined whether the plasma levels of interleukin-1β (IL-1β) are correlated with adverse cardiac outcomes in patients with ST-evaluate acute myocardial infarction (STEAMI) undergoing pri-mary percutaneous coronary intervention (PCI). Effect of the plasma intedeukin-1β level on prognosis of patients with ST-segment elevation acute myocardial infarction. Method This prospective single-center study included 96 patients with SIEAMI with onset < 12 h who underwent primary PCI, 271 patients with stable angina pectoris (SAP) and 148 control subjects without coronary artery disease who were consecutively admitted to hospital be-tween Mar, 2006 and Mar, 2008. Plasma IL-1β levels were measured by enzyme-linked immunosorbent assay in all subjects. The patients with STEAMI were then followed prospectively for the occurrence of major adverse car-diac events (MACE) (including cardiovascular death, non-fatal myocardial infarction, heart failure, and cardio-genie shock) during hospitalization. We determined the association between IL-1β levels with the risk of MACE using multivariate logistic regression. Results Compared with the SAP patients and control subjects, patients with STEAMI had higher levels of IL-1β (P < 0.05). During hospitalization, 32 patients (33.3%) experienced MACE [23 males, 9 females; age: (75.44±13.45) years]. In the STEAMI patients, IL-1β was elevated in patients with MACE compared with patients without MACE (median [range]: 26.52 [12.010 to 155.244] pg/mL vs 2.157 [0.433 to 83.021] pg/mL; P < 0.01) by non-parameter analysis. Significant and positive correlations be-tween IL-1β and cardiac troponin-I (cTnI) (r = 0.353, P =0.004) were observed by Spearman's correlations analysis. Multivariate logistic regression analysis revealed that IL-1β levels ≥20 pg/mL were significantly and in-dependently associated with MACE during hospitalization (odds ratio: 32.05; 95% confidence interval: 4.28 to 240.151; P =0.001). Conclusions The present study revealed that patients with STEAMI had elevated IL-1β levels on admission. The plasma IL- 1β level is an independent inflammatory predictor for in-hospital MACE in pa-tients with STEAMI undergoing percutaneous coronary intervention.

Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection.Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital,were recruited between 2005 and 2010.Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients' survival.Cox regression model was used to assess independent factors associated with clinical prognosis.Results The 1,3,5-year overall survival rates were 94.3％,81.2％ and 76.5％,median survival time was 53 months.328 patients had recurrence and metastases,with a median recurrence time of 18 months.The independent prognostic factors for overall survival time were CEA,CA19-9,tumor distance to dentate line,surgical modality,radical operation,tumor invasion,tumor differentiation,lymph node metastasis and postoperative treatment.Surgical treatment,radical operation or not,tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases.Conclusions The important factors inffuencing the prognosis of rectal cancer patients were CEA,CA19-9,tumor distance to dentate line,surgical modality,radial operation,tumor in vasion,tumor differentiation,lymph node metastasis,and post operative treatment.

OBJECTIVETo investigate the microRNA101(miR101) expression and its clinical significance in colorectal cancer.

METHODSTissue microarrays containing 56 specimens of normal mucosa, 51 adenoma and 735 colorectal cancer were examined by locked nucleic acid in-situ hybridization(LNA-ISH) for miR101 expression. Relationship between miR101 expression and clinicopathologic parameters and prognosis of colorectal cancer patients were analyzed. Fresh frozen tissues containing 5 specimens of normal mucosa, 5 adenoma and 47 colorectal cancer were examined by RT-PCR to verify the accuracy of LNA-ISH.

RESULTSExpression of miR101 increased gradually from normal mucosa, adenoma to stage I colorectal cancer (all P<0.01), and decreased gradually from stage II(, stage III( to stage IIII( colorectal cancer (all P<0.01). Overexpression of miR101 was related with lower incidence of lymph node metastasis, lower metastasis rate, higher differentiation and lower recurrence rate (all P<0.01). Multivariate survival analysis demonstrated that miR101 expression was an independent prognostic factor of overall survival (HR=0.550, 95% CI: 0.351-0.863) and disease free survival(HR=0.562, 95% CI: 0.397-0.794) in colorectal cancer patients. Overexpression of miR101 predicted a better prognosis in colorectal cancer patients.

CONCLUSIONSExpression of miR101 is associated with the genesis and development of colorectal cancer, and may serve as an independent prognostic factor for colorectal cancer patients.

Adenoma ; Colorectal Neoplasms ; Disease-Free Survival ; Gene Expression Regulation, Neoplastic ; Humans ; Lymphatic Metastasis ; MicroRNAs ; Multivariate Analysis ; Neoplasm Staging ; Prognosis