Objective To evaluate the long-term therapeutic results of intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection (ISR),and the clinical data were analyzed retrospectively.There were 39 males,21 females and their average age was 55 years old (range from 30 to 77 years old).The inferior border of the tumor were from 28 to 50 mm to the edge of anus,averaging 42 mm.Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively.After a median follow-up period of 49 months (range from 18 to 90 months),local and distant recurrence were observed in 6 and 4 patients respectively.Five-year overall survival rate and disease-free survival rate were 88.3％ and 83.3％ respectively.The mean stool frequency were (3.8 ± 1.3) times in each day based on data from 53 patients,and the stool control function of 73.6％ of all patients was preserved satisfactorily according to Kirwan classification.Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.

Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique.Methods From January 2002 to March 2011,forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique.The clinical data of these patients were reviewed.The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score.Results During the median follow-up of 65 months,2 patients with malignant adenomatous polyps died,2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing,1 patient developed persistent anastomotic stricture needing surgical intervention,16 patients developed at least 1 episode of pouchitis.There was no incontinence in these patients,and the median functional Oresland score was 6,3 and 2 after 1 year,2.5 years and 5 years respectively.Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising,with no incontinence in our patients.

Objective To compare the application,safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery(TEM) and the conventional transanal excision(TAE).Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed.Results Age,sex,tumour size,blood loss,postoperative hospital stay were similar in the two groups(P＞0.05).The median distance from the anal verge was significantly higher in the TEM group ( TEM/TAE =7.0/5.0 cm,P ＜ 0.01 ).The operation time was significantly longer in the TEM group (TEM/TAE =70.00/30.00 min,P ＜ 0.01 ).There was no operation-related mortality in both groups (P ＞ 0.05 ).Two patients in the TEM group developed postoperative haemorrhage,and one patient developed pulmonary infection and retention of urine respectively.There were two secondary haemorrhage cases in the TAE group.On median follow-up of 30 months,there was 7.8％ recurrence rate in the TEM group,compared with 23.2％ the in TAE group.Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm.It has broader indication,and better theraputic effect than the conventional transanal excision.

Objective To investigate the effect of CTLA4-Ig chimera protein on mice mortality, histopathological changes, viral fiters, expression of CTLA4 protein on infiltrated T lymphocyte and the balance of Thl/Th2 in mice myocarditis caused by coxsackie virus B3 (CVB3). Methods A total of 106 four to six week-old male BALB/c mice were used in the experiments, which were divided into CTLA4-Ig group (n = 16), CVB3 group (n=40), IgG group (n =40) and normal control group(n = 10) randomly. The mice in CVB3 group, IgG group and CTLA4-Ig group were inoculated intraperitoneally with 0. 15 ml CVB3 and the mice in norreal control group with 0. 15 ml Eagle. The mice in IgG group and CTLA4-1g group were inoculated with IgG (0. I mg/kg) and CTLA4-Ig(0. 1 mg/kg) at 6 h and 72 h post inoculation(p, i. ), respectively, The surplus mice in each group were sacrificed at day 7 p.i. Light microscope was used to quantify the inflammation. The expression of CVB3 mRNA in mycardium were semi-quantified by real-time quantitative polymerase chain reaction (RQ-PCR). The expression of CTLA4 protein were analyzed by immunohistochemistry. The levels of IL-2, IL-4 and 1FN-γ in serum were measured by ELISA. Results The mice mortality, histopathological score and CVB3 mRNA in CTLA4-Ig group were lower than that in CVB3 group ( P < 0.05, P < 0.01, P < 0. 05, respectively). The expression of CTLA4 was significantly increased in CTLA4-Ig therapy group (P < 0.05 ). The serum level of IFN-γ of mice in CVB3 group were significantly higher than that in normal control group( P < 0.01 ). The serum level of IL-4 of mice in CVB3 group were much lower than that in normal control group( P < 0.01 ). The serum level of IL-2 in CVB3 group had no statistical significance with that in normal control group ( P > 0.05 ). The serum level of IFN-γ in mice of CTLA4-Ig group were much lower than that in CVB3 group ( P <0.01 ) and lgG group (P < 0. 01 ). The serum level of IL-4 of mice in CTLA4-Ig group were significantly higher than that in CVB3 group (P<0.01) and IgG group (P<0.01). The serum level of IL-2 in CTLA4-Ig group had no statistical significance with that in CVB 3 control group and lgG group ( P > 0. 0 5 ) . Conclusion CTLA4-Ig may relieve inflammation and reduce mice mortality by blocking the costimulation signals for T lymphocyte activation and reinforcing Th2 response.

Objective To elucidate the evaluation of therapeutic effects and surgical treatments of 45 cases of inflammatory bowel disease. Methods Clinical data of 45 cases with inflammatory bowel disease by surgical treatment in recent 6 years were retrospectively analyzed. Results Patients received emergency operation in 16 cases, Crohn' s disease in 9 cases, Ulcerative Colitis( UC) in 7 cases. Among 13 cases of Crohn' s disease, partial enterectomy occured in 6 cases, partial enterectomy and colectomy and anastomosis in 1 patient because of internal fistula, repair of ileal perforation in 1 case, laparoscopic ileocolic resection in 5 cases. Among 32 cases of UC, 25 cases underwent ileal pouch-anal anastomosis operation, 3 cases underwent ileostomy with total colectomy, and 4 cases only underwent ileostomy. Twenty- seven cases were cured by operation, 14 cases were improved and 4 cases died. Conclusion It is the key point to achieve successful operation that the corresponding operative modes for varied manifestations of inflammatory bowel disease should be adopted.

To improve 3-ketosteroid-△1-dehydrogenase(KSDH) activity and the transformation level for androst-4-ene-3,17-dione, 3-ketosteroid-△1-dehydrogenase gene(ksdD) from Arthrobacter simplex was cloned into plasmid pWB980 and expressed in B. subtilis WB600 under the control of promoter P43. The molecular weight of expressed enzyme was about 55kDa by SDS-PAGE analysis. The activitities assayed by spectrophotometrical method of intracellular and extracellular soluble enzyme were 110?0.5mU and 15?0.6mU per milligram of protein respectively. The transformation rate of androst-4-ene-3,17-dione by the B. subtilis recombinant cells was 45.3%. Compared with Arthrobacter simplex, the enzyme activity of KSDH expressed in B. subtilis was improved about 30 fold, and the transformation level of androst-4-ene-3,17-dione by the B. subtilis recombinant cells was improved about 10 fold. The recombinant B. subtilis cells used in biotransformation of steroids provided a new way for steroid medicines production.

Objective To explore the diagnostic value of multislice spiral CT (MSCT) for breast carcinoma.Methods One hundred and twenty consecutive suspicious cases of breast carcinoma diagnosed clinically and/or by imaging modalities were studied with MSCT prospectively. The dynamic contrast-enhanced serial scanning was done as follows:Scanning was triggered 35 s (early arterial phase) after beginning of contrast agent infusion at a speed of 3 mL/s by high pressure automatic injector, and would be repeated at the time point of 60 s and 150 s. Eventually, the CT diagnostic results were compared with the pathological consequences to calculate the diagnostic accuracy of MSCT for breast carcinoma. Results Eighty-nine patients with 100 foci of breast cancer from 120 suspicious cases were confirmed pathologically and their imaging data were analyzed. Among the 89 cases, 61 cases were invasive ductal carcinomas,12 ductal carcinomas in situ, 8 invasive lobular carcinomas, 6 medullary carcinomas and 2 inflammatory carcinomas. According to lesion morphologic appearance, lesion enhancement mode, time-density curve of lesion, and combination of all the above three parameters, the diagnostic accuracies were 78%, 82%, 84% and 92%, respectively. Conclusion MSCT has a great clinical value in diagnosing breast carcinoma.

Objective To investigate the causes of recurrent hemoptysis one week after interventional treatment.Methods 56 patients with massive hemoptysis were included in this study.All patients underwent emergent interventional therapy, including angiography and embolization therapy of bronchial artery, intercostal artery, internal thoracic artery, external thoracic artery and phrenic artery via femoral artery puncture.Results 6 cases had rebleeding within one week after interventional therapy,including 2 cases with primary lung cancer,1 case with bronchiectasis,1 case with pulmonary tuberculosis,1 case with esophageal cancer after surgery,1 case with esophageal cancer after radiotherapy.Then, these patients once again underwent angiography and embolization therapy of bronchial artery,intercostal artery,internal thoracic artery,external thoracic artery and phrenic artery.Conclusion The use of vasoconstrictive drugs before intervention, diversification of pulmonary feeding artery, wide range of lesions, inappropriate embolic material and poor image quality can lead to recurrent hemoptysis after interventional treatment.

Objective:To optimize the forming process of Luomai granules. Methods: With the qualified granule yield and the moisture absorption as the indicators, the excipients were screened, and through the study of granulation effect, the proportion of excip-ients was optimized. With the normalized value of qualified granule yield, solubility, hygroscopicity and sensory evaluation as the eval-uation indices, and excipients times, ethanol concentration and amount of citric acid as the main influencing factors with five levels for each, the forming process of Luomai granules was optimized by central combination design-response surface methodology. Results:The option formula for Luomai granules was the follows:the excipients amount was 5-fold of the extract, 85% ethanol was used as the wet-ting agent, and citric acid content was 0. 3%. Conclusion:Optimized by the central combination design-response surface method, Lu-omai granules has such advantages as high qualified yield, low hygroscopicity, good solubility, soft taste and appropriate dosage, sug-gesting the optimized preparation process of Luomai granules is reasonable and feasible.