Objective To compare the safety and effectiveness of two methods of perineal dissection in 60 consecutive patients of rectal carcinoma undergoing combined abdominoperineal resection.Methods In this retrospective study from 2007 to 2009, 30 cases underwent Miles' operation using modified method of perineal dissection( MM group) and 30 cases undergoing Miles' operation using classic method of perineal dissection ( CM group). Operative time, accidental tumor ( or rectal) perforation during the procedure, iatrogenic injury to the urethra ( or vagina) and postoperative perineal complications were compared between the two groups. Results The mean perineal operative time was (45±15) min in MM group and ( 70 ± 20) min in CM group respectively ( t = 5. 48, P ＜ 0. 05 ). There were no significant differences in the rate of tumor ( or rectal) perforation and that of urethral (vaginal) injury. There were significant difference in the rate of postoperative perineal complications (χ2=4.01, P＜0.05).Conclusions Modified method of perineal dissection is effective and safe, and this method offers a new approach for the perineal dissection during Miles' operation.

OBJECTIVETo compare the angiogenesis in unstable and stable plaques and to investigate the potential role of neovessels in creating vulnerable sites for atherosclerotic plaques.

METHODSSpecimens of coronary arteries were obtained from 52 autopsy cases with acute coronary syndromes. Plaque morphology was studied by use of stained slides. 922 tissue blocks of late-stage lesions were classified into two groups: (1) unstable plaque (n = 153), the plaque was characterized by a large extracellular lipid core (more than 40% of the plaque area); (2) stable plaque (n = 769), lipid core less than 40% of the plaque area. Forty blocks were selected randomly from each group and serial sections were stained immunohistochemically with a polyclonal antibody against F VIII RAg. Computer-aided planimeter was used for quantitative analysis.

RESULTSIn unstable plaques, the occurrence of neovessels was more frequent and the neovessel density (number/mm(2)) was significantly increased as compared to that of stable plaques (frequency: 80.4% vs 66.6%, P < 0.01; shoulder: 22.16 +/- 19.96 vs 10.04 +/- 11.52, base: 21.68 +/- 20.44 vs 9.68 +/- 11.52, fibrous cap: 3.80 +/- 5.32 vs 1.48 +/- 2.28, P < 0.05). Most neovessels were located in the shoulder region and at the base of plaques.

CONCLUSIONSThese findings suggest that neovessels in coronary atherosclerotic plaques are closely associated with the decreased stabilization of the plaques.

Aged ; Aged, 80 and over ; Coronary Artery Disease ; pathology ; Coronary Vessels ; pathology ; Female ; Humans ; Male ; Neovascularization, Pathologic ; pathology

OBJECTIVETo practice a more atraumatic, physiological and aesthetically valued approach of construction for neovagina.

METHODSLaparoscopically using peritoneum as neovagina lining.

RESULTSFrom March 2005 to September 2006, this technique was adopted to treat 10 patients whose diagnosis was congenital absence of vagina. The ages of the patients were from 19 to 32. The operation lasted average 2.34 hours. And hospitalization was about 20.5 days. Follow-up ranged from 3 - 12 months. No complication occurred. All of the patients was satisfied with their sexual life.

CONCLUSIONSLaparoscopically assisted neovaginaplasty, in which peritoneum was substituted for vaginal mucous membrane, was a kind of ideal approach of vaginal creation.

Adult ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Peritoneum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Vagina ; abnormalities ; surgery ; Young Adult

OBJECTIVETo evaluate the local risk factors of traumatic brain injury (TBI) patients developing gastrointestinal (GI) bleeding during the early hospitalization in neurosurgery intensive care unit (NICU).

METHODFrom September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m. to measure the concentrations of serum adrenocorticotropic hormone (ACTH), total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5.

RESULTSWithin 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group (P less than 0.05). The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group, (F equal to 1.413, P less than 0.253) for ACTH and (F equal to 9.371, P equal to 0.006) for gastrin. GI bleeding had a positive correlation with gastrin concentration (r equal to 0. 312, P less than 0.05) and a negative correlation with serum hemoglobin (Hb) (r equal to -0.420, P less than 0.01). The clinical incidence of GI bleeding was 24.39% (10/41) in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration (OR equal to 26.643, P less than 0.05) and hematocrit (Hct) (OR equal to 5.385, P less than 0.05). High ACTH concentration ( larger than 100 pg/ml) increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% (9/22) and the mortality rate was 20% (2/10).

CONCLUSIONSLow Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH (larger than 100 pg/ml) are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.

Adolescent ; Adrenocorticotropic Hormone ; blood ; Adult ; Aged ; Brain Injuries ; blood ; complications ; mortality ; Female ; Gastrins ; blood ; Gastrointestinal Hemorrhage ; blood ; etiology ; mortality ; Glasgow Coma Scale ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors

BACKGROUNDTrans-sacral axial L5/S1 interbody fusion (AxiaLIF), a novel surgical procedure, recently adopted in clinical practice, has excellent clinical outcomes. However, there is inadequate data on the feasibility of the approach in all adult patients and the optimal surgical approach is currently unclear; therefore, further studies are required. In order to enhance the surgical approach for AxiaLIF, prospective anatomical imaging optimization is necessary. The objective of this study was to investigate the ability of magnetic resonance imaging (MRI) to achieve an optimal procedural setting.

METHODSThe subjects (n=40) underwent lumbosacral MRI examination. The median sagittal MRI images were analyzed and four measurement markers were defined as follows: the center of the L5/S1 disc (A), the anterior margin of the S1/2 disc space (B), the sacrococcygeal junction (C), and the coccygeal tip (D). The measurement markers were connected to each other to produce five lines (AB, AC, AD, BC, and BD), as reference lines for surgical approaches. The distance between each reference line and the anterior and posterior margins of the L5 and S1 vertebral bodies was measured to determine the safety of the respective approaches.

RESULTSIn all patients, Lines AB and AC satisfied the imaging safety criteria. Line AB would result in a significant deviation from the median and was determined to be unsuitable for AxiaLIF. Line AD satisfied the imaging safety criteria in 39 patients. However, the anal proximity of the puncture point proved to be limiting. For lines BC and BD, the imaging safety criteria were satisfied in 70% and 45% of patients, respectively.

CONCLUSIONSThe AxiaLIF procedure is a safe technique for insertion of fusion implants in all subjects. Line AC is a favorable reference line for surgical approach and safe for all subjects, while line BC is not suitable for all subjects.

Adult ; Aged ; Aged, 80 and over ; Fractures, Bone ; surgery ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Sacrum ; surgery ; Spinal Fusion ; methods ; Treatment Outcome

BACKGROUNDPrevious clinical and basic research of axial lumbar interbody fusion (AxiaLIF) all focused on the L5/S1. However, there is no data on the feasibility of this approach for the fusion of both L4/5 and L5/S1. This study aimed to explore whether transsacral axial interbody fusion is a candidate for the fusion of both L4/5 and L5/S1.

METHODSThe subjects (n = 40) underwent lumbosacral magnetic resonance imaging (MRI). The median sagittal MRI images were analyzed and five measurement markers were defined as follows: the center of the L4/5 disc (A), the center of the L5/S1 disc (B), the anterior margin of the S1/2 space (C), the sacrococcygeal junction (D), and the coccygeal tip (E). The measurement markers were connected each other to produce nine lines (AB, AC, AD, AE, BC, BD, BE, CD and CE) as the reference lines for surgical approaches. The distance between each reference line and the anterior and posterior margins of the L4, L5 and S1 vertebral bodies were measured to determine the safety of the respective approaches.

RESULTSTwenty subjects were capable of finding one reference line to fuse both L4/5 and L5/S1 via transsacral axial interbody fusion approach. The surgical approach reference line was AE or CE line. In the other 20 subjects, it was failed to find a reference line which met the safety criteria for fusing both L4/5 and L5/S1.

CONCLUSIONSAbout half of subjects were capable of finding a suitable AxiaLIF reference line to fuse both L4/5 and L5/S1. In some subjects, it was difficult to find a suitable AxiaLIF reference line to fuse both L4/5 and L5/S1.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Spinal Fusion ; methods

The effects of human insulin 70/30 and insulin lispro 75/25 were compared in improving postprandial blood glucose excursions in 106 patients with type 1 or 2 diabetes in a one-month,open-labelled,self- controlled trial .The results showed that treatment of diabetic patients with insulin lispro 75/25 significantly improved 2 h postprandial blood glucose excursion compared to pre-study with human insulin 70/30 (baseline) without any significant adverse events or sustained hypoglycemic episodes.These physiological benefits were associated with a patient preference for insulin lispro 75/25.

Objective To study the relationship between resting heart rate and blood lipid level.
Methods A total of 9 415 subjects aged≥40 years were included in the present study. Their resting heart rate was monitored and their serum levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were measured to define dyslipidemia according to the 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults.
Results The subjects were divided into group A with their resting heart rate<70 beats/min, group B with their resting heart rate=70-79 beats/min, group C with their resting heart rate=80-89 beats/min, and group D with their resting heart rate≥90 beats/min. High TG, TC, and LDL-C were presented across the resting heart rate (Ptrend<0.01). Multiple logistic regression analysis revealed that the risk of high TG and TC was higher in subjects with their resting heart rate≥90 beats/min than in those with their resting heart rate<70 beats/min (OR=1.42;95%CI:1.16-1.74 and OR=1.33;95%CI:1.09-1.64, respectively).
Conclusion Elevated resting heart rate is associated with high TG and TC in middle-aged and elderly Chinese subjects.

Objective To evaluate the effect of cytochrome P450 2 D6*10 ( CYP2 D6*10 ) polymorphism on the pharmacokinetics of oral nebivolol after single and multiple doses. Methods Fifteen healthy volunteers which were selected according to their CYP2D6*10 genotype, consisted of 8 of CYP2D6*1 carriers and 7 of CYP2D6*10/*10 geno-types.All subjects received a single dose of 5 mg and multiple doses (5 mg? d-1 , qd, for 7 days) .Nebivolol in plasma were measured by LC-MS/MS.The main pharmacokinetic parameters were calculated by WinNonlin program.Results The main pharmacokinetic parameters of nebivolol in plasma between CYP2D6*1 carriers and CYP2D6*10/*10 genotypes after a single dose were as follows: t1/2 were (9.88 ±5.47), ( 12.29 ±6.19 ) h, AUCinf were ( 7.26 ±5.88 ), (8.56 ±5.20)μg? L-1? h, Cmax were (1.11 ±0.53), (1.42 ±0.75)μg? L-1 , respectively.The main pharmacokinetic parameters of nebivolol in plasma between CYP2D6*1 carriers and CYP2D6*10/*10 genotypes after multiple doses were as follows:t1/2 were (8.56 ±2.38), (7.67 ±4.75) h, AUCinf were (10.62 ±5.62), (12.74 ±7.40)μg? L-1? h, Cmax were (2.05 ±0.83), (2.02 ±0.75)μg? L-1, respectively.No significant differences in the pharmacokinetic parameters of nebivolol were found between CYP2D6*1 carriers and CYP2D6*10/*10 genotypes.The clearance of the multiple doses was significantly lower compared with that of single dose in the different genotyped groups.Conclusion CYP2D6*10 polymorphism has no significant effect on the pharmacokinetics of oral nebivolol after single and multiple doses.The elimination of nebivolol decreases after the multiple doses, which is not affected by CYP2D6*10 polymorphism.

Objective To study the characteristics and epidemic trend of Shigella in Shandong province through the analysis of serotype, virulence genes, molecular typing and drug sensitivity. Methods The serotype was classified using the method of slide agglutination. Polymerase chain reaction (PCR) was used to amplify the related virulence genes. The molecular typing was carried out by pulsed field gel electrophoresis (PFGE), and the antibiotic sensitivity of the strains was determined by micro-broth dilution method. Results The main serogroups of 44 Shigella strains were Shigella flexneri (54.55%) and Shigella sonnei (43.18%). The carrying rates of ipaH, Set1, Sen and ial were 100%, 43.18%, 56.82% and 50.00%, respectively. By PFGE typing, the strains of Shigella flexneri were divided into 18 patterns with a low similarity. The strains of Shigella sonnei were divided into 14 patterns, and the similarity of 89.47% of the strains was more than 90%. 44 strains of Shigella had different levels of resistance to 14 of the 15 antibiotics. 93.18% of the strains were multidrug resistant. Conclusion The Shigella in Shandong province is dominated by serogroups of Shigella flexneri and Shigella sonnei, with high virulence gene carrying rate, clustering distribution and severe antibiotic resistance. It is necessary to strengthen the monitoring on serotype, traceability and antibiotic resistance of Shigella in Shandong province.