Objective To evaluate the validity and reliability of multi-slice spiral CT (MSCT) in preoperative TNM staging judgment of rectal carcinoma. Methods Three hundred and one patients with rectal carcinoma were diagnosed and treated consecutively in Colorectal and Anal Surgery Department of Shanxi Province Tumor Hospital from January 2009 to December 2009. The clinical data of these patients were analyzed retrospectively. The diagnosis results were compared between the preoperative MSCT staging and the postoperative pathological staging,the ROC curve and the diagnostic concordance test were analyzed by software Medcalc 11.2. Results The sensitivity, specificity, Kappa value, area under the curve of TNM staging were 64.7% ,96. 8% ,0. 667,0. 808 for T2 staging tumors; 93.8% ,75.0% ,0.709,0.844 for T3 staging tumors;87. 8% ,98. 1% ,0. 859,0. 929 for T4 staging tumors; 72. 0% ,91.2% ,0. 619,0. 816 for N staging tumors;92. 7%, 99. 7%, 0. 925,0. 963 for M staging tumors respectively. Conclusion The diagnostic value of independent use of MSCT in estimating the infiltration degree and lymph node metastasis of rectal cancer is very poor and cannot be used in preoperative staging judgment.

Objective To explore the clinical effect of the elderly far lateral lumbar disc herniation via Quadrant channel system under the Wiltse approach. Methods Thirty-three elderly patients suffering from far lateral lumbar disc herniation were treated by surgery, among whom 18 patients were treated by Quadrant minimally invasive channel system (Quadrant group), and 13 patients were treated by percutaneous transforaminal endoscopic discectomy (PTED group). The patients were followed up for 12 months, and the operation time, blood loss and length of incision were investigated. The JOA scores were compared preoperatively and postoperatively. Results The patients in two groups were followed up for 24 months, except 1 patient withdrew in Quadrant group. The incision length and blood loss in PTED group were superior to those in the Quadrant group:2.0-2.5 cm vs. 0.7 cm, (46.50± 15.20) ml vs.(23.87±6.58) ml, P<0.01, but the operation time in PTED group was longer than that in Quadrant group: (77.17 ± 8.71) min vs. (63.20 ±10.87) min, P<0.01.The two groups had achieved good curative effect, while JOA score in PTED group was superior to the Quadrant group 1 week after operation ( P<0.05), but in 3 month and 12 month two groups had no significant difference ( P>0.05). Conclusion Surgical treatment on elderly far lateral lumbar disc herniation via quadrant channel under wiltse approach is an effective method, and can achieve similar effect with PTED.

Objective To explore the impact of ischemic stroke on intestinal barrier changes in dogs.Methods Totally 20 mongrel dogs were divided into 2 groups by random number table with 10 in each.Double silicone cylinders measuring 1.1 mm in diameter and 8 mm in length were placed into their internal carotid arteries in all dogs of group A.Group B served as a control group and received sham operation.Light microscopy was performed for morphological measurement of intestinal epithelial cell.Immunohistochemistry was used to analysis the changes of protein zonula occludens-1(ZO-1)localizing at tight junction of intestinal epithelial cells.Results Ischemic stroke was confirmed by cranial CT scanning in all dogs of group A.Compared with the test results in group B,the occludin and Zo-1 protein levels in group A were significantly lower than those in group B(occludin:0.20 ±0.01 vs 0.22 ±0.01,P =0.007; ZO-1:0.20 ±0.01 vs 0.22 ±0.02,P =0.008).The apoptotic index in group A was significantly higher than in group B(29.04 ± 3.79 vs 6.44 ± 1.24,P =0.002).There was a positive correlation between occludin and ZO-1(R =0.71,P =0.02),and the apoptotic index was negatively correlated with levels of occludin,ZO-1(R =-0.91,P =0.00; R =-0.77,P =0.01).Light microscopy showed that the dogs in group A had intestinal mucousal injuries while no obvious change was detected in group B.Conclusions Dogs with ischemic stroke tend to develop intestinal barrier dysfunction,during which the destruction of tight junction plays a key role.The up-regulated apoptosis of intestinal epithelial cell constitutes one of the cellular bases of intestine injury.

Objective To investigate the effects of small volume resuscitation on hemodynamics and visceral perfusion in dog model of hemorrhagic shock. Methods Twenty-four dogs were hemorrhaged to hold mean arterial blood pressure at 45-55 nun Hg for 45 minutes, and then eight dogs were resuscitated with 6 ml/kg of hypertonic saline (HS group) solution and the other eight resuscitated with 6 ml/kg of hypertonic saline-hydroxyethyl starch (HSS group) solution. The rest eight dogs were set as control and resuscitated with normal saline (NS). Hemodynamics and gastrointestinal intramucosal pH (pHi) were detected after fluid resuscitation. Results (1) All three kinds of solutions could improve early hemodynamics and visceral perfusion. But 30 minutes after fluid resuscitation, the hemodynamics of dogs in HS group, HSS group and NS group began to decrease, with more obvious decrease HS group and NS group compared with HSS group. (2) pHi of three groups began to decrease 120 minutes after fluid resuscitation, but the level of arterial lactate remained unchanged. Conclusions (1) HS has the similar effect as NS in aspect of resuscitation, and HSS is better than HS and NS.(2) pHi is an ideal marker in monitoring the visceral perfusion and has higher sensitivity than arterial lactate.

Objective To study about the cardiac function of the mice suffering from sepsis induced by lipopolysaccharide (LPS) so as to probe the physiopathologic mechanism of the cardiac dysfunction of the mice.Method Sixty male C57BL/6 mice of eight weeks old were randomly (random number) divided into four groups:one control group (n =15) and three experimental groups (n =15 in each group).The mice of control group received intra-peritoneal injection of normal saline (10 mg/kg) while the mice of experimental groups got intra-peritoneal injection of LPS (10 mg/kg).The cardiac function of mice (n =12) was determined by echocardiography 6 h,12 h and 24 h later,respectively.The heart,kidney and lung tissues of mice (n =6) were stained with Haematoxylin-Eosin (HE) staining after embedding with paraffin for observing the histopathological changes under optic microscopy.The expressions of PECAM-1 and α-SMA of the heart tissue of mice (n =3) in three groups determined by immunohistochemical method.The RT-PCR method was used to test the expressions of VEGF (vascular endothelial growth factor) and HIF-α (hypoxia-inducible factor) of the myocardium of mice.In addition,the Western blot method was employed to test the levels of p53 and HIF-1α proteins in myocardium of mice,while ELISA was utilized to detect the level of tumor necrosis factor-α (TNF-α) and the interleukin-6 (IL-6).The data were analyzed by independent samples of t-test and one-way ANOVA respectively.Results The experiment result proved that the thickness of anterior wall of left ventricle of mice during systolic and diastolic periods increased and the inner diameter of the left ventricle also increased during the diastolic period in mice of the experimental group,while the stroke volume decreased compared with the control group (P ＜ 0.05).The immunohistochemical method showed that the new vessels of the mice' s heart in experimental groups increased compared with the control group (P ＜ 0.05).RT-PCR showed the expressions of VEGF and HIF-1α of the mice heart of experimental group increased (P ＜ 0.05) and Western blot showed the levels of HIF-1 α and p53 proteins in experimental groups increased significantly compared with the control group.The experimental group had higher levds of VEGF,HIF-1α,and IL-6 were evidenced by using ELISA than those of the control group (P ＜ 0.05).Conclusions The lipopolysaccharide can lead to cardiac dysfunction.In this process,myocardium angiogenesis and apoptosis phenomenon coexists,as VEGF and HIF-1α participating in angiogenesis,whereas BAX and p53 playing a role in the process of apoptosis.

Objective To study the clinical efficacy and safety of double incision double plate internal fixation in the treatment of complex fractures of tibial plateau .Methods According to the different treatment methods , 83 patients with tibial plateau complex fractures were divided into double plate group ( 51 cases ) and locking plate group ( 32 cases ) .The surgical indicators , treatment efficacy and complications were compared between the two groups .Results The time of implantation ,hospital stay and fracture healing time in the observation group were signif-icantly shorter than those in the control group [(9.36 ±2.14) d vs.(13.24 ±2.99) d;(11.71 ±1.32) d vs. (13.41 ±2.23)d;(13.27 ±1.83)weeks vs.(15.82 ±2.18)weeks],the differences were statistically significant (t=6.813,4.368,5.736,all P<0.05).The excellent rates of HSS score in the observation group and the control group were 94.12％and 93.75％,respectively,and there was no statistically significant difference (χ2 =0.746,P>0.05).The incidence rate of complications in the observation group was significantly lower than that in the control group(5.88％vs.21.88％) (χ2 =4.746,P<0.05).Conclusion Double-incision plate internal fixation surgery for tibial plateau complex fractures is effective ,has fast postoperative recovery ,high safety,and it is worthy of clinical application in a wide range of popularization .

Objective To evaluate the efficacy and the safety of Ulinastatin in treatment of severe acute pancreatitis.Methods A systematic review of randomized controlled trials (RCT) of Ulinastatin treatmen for severe acute pancreatitis was performed.The databases included Cochrane library controlled clinical trials database,PUBMED,EMBASE,China Biology Medicine disc,Wanfang Data were searched to date.Retrieval words were acute pancreatitis and Ulinastatin.Statistical processing using Review Manager 5.3 software provided by the Cochrane collaboration network.Results A total of 33 trials involving 1 786 patients were included,and all patients of the trials were not followed up at the end of the treatment.In the trials of Ulinastatin plus routine treatment vs routine treatment or placebo plus routine treatment,and 5 trials reported the fatality rate.Meta-analysis showed that the mortality rate in Ulinastatin group was lower than that in control group(RR =0.29,95％CI:0.17-0.52,P ＜ 0.01),and 16 trials used the total efficiency of treatment as outcome criteria.Meta-analysis results showed the total effective rate in the Ulinastatin group was significantly higher than that in control grouIn the trials of Ulinastatin plus routine treatment vs octreotide plus routine treatment,9 trials used the total efficiency of treatment as outcome criteria.Meta-analysis results showed there was no statistically significant difference in total effective rate between Ulinastatin group and octreotide group.Conclusions Ulinastatin treatment was superior to conventional therapy in improving the short-term clinical efficacy of severe acute pancreatitis,and the mortality rate was lower than that in conventional treatment.But no obvious advantage was found in ulinastatin treatment compared with octreotide treatment.

Objective To explore the expression of YKL-40,TLR4 and NF-κB in chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP and CRSsNP),and to investigate their expressional correlation and the potential role in pathogenesis of CRS.Methods The specimens were obtained from sinus mucosa and inferior turbinate mucosa of the patients with informed consent.The different expression of YKL-40,TLR4 and NF-κB among each group was detected by real time RT-PCR and immunohistochemistry(S-P method).SPSS 17.0 software was used to analyze the data.Results mRNA level:The relative expression of YKL-40 in CRSwNP group (0.91 ± 0.17) was higher than those in the control group (0.49 ± 0.09),the difference was significant (t =2.12,P ＜ 0.05).The relative expression of TLR4 in CRSsNP group(0.88 ±0.19) and CRSwNP group(0.67 ± 0.13) were lower than those in control group(1.48 ± 0.14),the differences were significant (t value was-4.11,-2.48,all P ＜ 0.05).The relative expression of NF-κB in CRSsNP group (0.69 ± 0.13) and CRSwNP group (0.72 ± 0.14) were lower than those in control group(1.20 ±0.15),the differences were significant(t value was 2.33,2.27,all P ＜0.05).Protein level:The expression of YKL-40 in CRSwNP group was stronger than that in CRSsNP group and control group (U value was 72.5 and 73,all P ＜0.01).The expression of TLR4 in CRSwNP group and CRSsNP group was weaker than that in control group(U value was 62 and 38,all P ＜ 0.01).There was a negative correlation between YKL-40 and TLR4 (rmRNA =-0.741,P ＜ 0.01 ; rprotein =-0.46,P ＜ 0.05)in CRSwNP group.Conclusions The expression of YKL-40 in pantients with CRSwNP is higher than those in healthy control and CRSsNP patients.There was a negative correlation between YKL-40 and TLR4.Both of them may be involved in the pathogenesis of CRSwNP.

Objective To analyze the clinical features of neuropsychiatric systemic lupus erythematosus (NPSLE) with convulsion or coma as the main manifestation to facilitate the improvement of such patients' diagnosis. Methods Ninety-two patients with NPSLE confirmed in Peking Union Medical Hospital from January 2013 to December 2016 were collected, 27 NPSLE patients with convulsion or coma were in the study group, and the remaining 65 cases were in the control group. The following items in the two groups were compared in order to discover the differences in characteristics between the two groups: including sex, age, the first NPSLE episode or not, history of systemic lupus erythematosus (SLE), kidney, blood, heart, lung, skin mucous membrane, gastrointestinal involvement and co-infection, cerebrospinal fluid (CSF) pressure, cerebrospinal fluid cell count, cerebrospinal fluid/serum protein ratio, cerebrospinal fluid/serum glucose ratio, cerebrospinal fluid/serum chlorine ratio, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement 3 (C3), complement 4 (C4), magnetic resonance imaging (MRI) results, double strand deoxyribonucleic acid (ds-DNA) antibody, treatment status and hospitalization days. Results The number of CSF cells in the study group was significantly lower than that in the control group (×106/L: 91.84±25.37 vs. 279.52±101.12, P < 0.01). The skin mucosa involvement rate in the study group was significantly higher than that in the control group [14.81% (4/27) vs. 1.54% (1/65), P < 0.05]. Cerebrospinal fluid/serum protein ratio was higher in the study group than that in the control group (0.12±0.02 vs. 0.04±0.01, P < 0.05); the cerebrospinal fluid/serum glucose ratio was significantly lower than that in the control group (0.55±0.17 vs. 0.70±0.20, P < 0.01). The positive rate of MRI in the study group was higher than that in the control group [81.48% (22/27) vs. 55.38% (36/65), P < 0.05]; there were no significant differences between the two groups in other indexes (all P > 0.05). Conclusion Few cerebrospinal fluid cells increased involvement of skin mucosa, increased cerebrospinal fluid/serum protein ratio, decreased cerebrospinal fluid glucose/serum glucose ratio and increased MRI positive results were the clinical features of NPSLE patients with convulsion or coma as the clinical manifestation, early detection of this type of patients and early intervention can be beneficial to improve the prognosis.

Purpose: The aim of this study was to assess carotid stiffening in a pre-hypertensive (PHT) population using ultrafast pulse wave velocity (ufPWV). Methods: This study retrospectively enrolled 626 individuals who underwent clinical interviews, serum tests, and assessments of the systolic blood pressure (SBP), diastolic blood pressure (DBP), carotid intima-media thickness (cIMT), pulse wave velocity-beginning of systole (PWV-BS), and pulse wave velocity-end of systole (PWV-ES) between January 2017 and December 2021. The patients were divided into three groups according to their blood pressure (BP)—normal BP (NBP): SBP <130 mmHg and DBP <80 mmHg (n=215); PHT: 130 mmHg≤SBP<140 mmHg and/or 80 mmHg≤DBP<90 mmHg (n=119); hypertensive (HT): SBP ≥140 mmHg and/or DBP ≥90 mmHg (n=292). Correlation analyses and comparisons were performed among the groups and in the cIMT subgroups (cIMT ≥0.050 cm and <0.050 cm). Results: cIMT and PWV-ES significantly differed among the BP groups (P<0.05). The BP groups had similar PWV-BS when cIMT <0.050 cm or cIMT ≥0.050 cm (all P>0.05). However, the NBP group had a notably lower PWV-ES than the PHT (P<0.001 and P=0.024) and HT (all P<0.001) groups in both cIMT categories, while the PWV-ES in the PHT group were not significantly lower than in the HT group (all P>0.05). Conclusion Carotid morphological and biomechanical properties in the PHT group differed from those in the NBP group. ufPWV could be used for an early evaluation of carotid stiffening linked to pre-hypertension.