This article discusses the relationship between ecological environment、ethical awareness and ecological moral.It tells us that only when we esteem the natural rights,establish the natural power,maintain ecological balance and erect the ethical awareness of ecological civilization that the human benefits can be adequately obtained and social enlightenment can be unceasingly developed.

This article analyzes the characteristics of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection (proximal or total gastrectomy) and the resection of spleen or splenic preservation. The metastasis of lymph node in proximal advanced gastric cancer has certain characteristics, which can provide a significant guidance for lymphadenectomy. Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer, because of the requirement of lymphadenectomy.

Objective To compare the safety and efficiency of endoscopic total extraperitoneal patchplasty(TEP)and modified Kugel hernioplasty for inguinal hernia.Methods The clinical data of 284 cases(312 surgeries)of preperitoneal inguinal hernia repair,including 134 cases(152 surgeries)of TEP and 150 cases (160 surgeries)of modified Kugel hernioplasty,were retrospectively evaluated from June 2009 to June 2011.Mean operative time,postoperative hospital stay,postoperative complications and recur-rence were compared between groups.Results There were no significant differences in mean operative time [(48.75 ±12.14)min vs(51.46 ±24.76)min,P=0.248],postoperative hospital stay [(5.23 ± 1.85)d vs(5.84 ±1.52),P=0.126],postoperative complications [5 cases(3.3%)vs 8 cases(5.0%), P=0.598]and recurrence [1 case(0.7%)vs 2 cases(1.3%),P=1.00]between TEP and modified Kugel hernioplasty,espectively.Conclusion TEP and modified Kugel hernioplasty are both methods for preperitoneal hernia repair and they can completely repair the defect of myopectineal orifice.They are safe and effective,which is worthy of being spread in clinical practice.

Objective To investigate the clinical results and prognosis between proximal and total gastrectomy in proximal advanced gastric cancer.Methods The clinicopathological data of 221 patients with proximal advanced gastric cancer who undcrwent radical gastrectomy were retrospectively analyzed.82 patients and 139 patients underwent proximal and total gastrectomy respectively.The number of dessected lymph nodes,postoperative complications and mortality were compared.Kaplan-Meier survival rate curves and Log-rank test were drawn and compared.Results A total of 1 411 (11-34) and 3 345 (14-35) lymph nodes were harvested from the surgical specimens of 82 and 139 patients with proximal and total gastrectomy respectively,the average number of harvested lymph nodes was 17 ± 11 and 24 ± 10 (t =2.586,P ＜0.05).The overall complications in proximal gastrectomy were higher than total gastrectomy (73.2％ vs.30.2％,x2 =38.291,P ＜0.01).The ratio of functional delayed gastric emptying,anastomotic leakage and stenosis,reflux esophagitis in proximal gastrectomy patients was higher than total gastrectomy.The survival rate in proximal gastrectomy were lower than total gastrectomy in proximal advanced gastric cancer (P ＜0.01).Conclusion Total gastrectomy is recommended for proximal advanced gastric cancer.

Objective To explore the role and possible mechanism of transforming growth factor (TGF)-β autocrine in CDH17 regulating invasion of gastric cancer cells.Methods Construction and transfection of siRNA-CDH17 into MKN-45 gastric cancer cell line to silence the expression of CDH17.Expression of TGF-β and concentrations of TGF-β in supernatants were detected before and after CDH17 silence by immunofluorescence,immunoblotting and ELISA.The autocrine situation of TGF-β was observed.Meanwhile,the activation of TGF-β/Smad3 signaling pathway was also detected by immunoblot.After giving signaling pathway inhibitor,the changes of invasion ability of MKN-45 cells were observed by Transwell invasion experiment.The role of TGF-β autocrine and related signaling pathway activation in CDH17-regulated invasion of gastric cancer cells was evaluated.Results After transfecting siRNA-CDH17 for silencing CDH17 expression in MKN-45 cells,the expression of TGF-β was significantly decreased compared with non-transfection group,its concentration in supernatants was also significantly reduced[(510 ±55)pg/mL vs.(115±20) pg/mL,P<0.01].The immunoblots revealed that phosphorylation level of Smad3 after CDH17 silence was also significantly diminished.However,giving the TGF-β/Smad3 signaling inhibitor SIS3 (10 μmol/L) could also suppress the phosphorylation level of Smad3 when CDH17 was highly expressed,meanwhile silencing CDH17 and inhibiting Smad3 phosphorylation could significantly decrease the invasion of MKN-45 gastric cancer cells (P<0.05).Conclusion CDH17 could participate in the invasion of gastric cancer cells by promoting TGF-β autocrine to activate TGF-β/Smad3 signaling pathway.

Objective To sum up the experience on the diagnosis and treatment of abdominal compartment syndrome(ACS). Methods In this report, ACS was diagnosed by special clinical features in all 5 patients. Following emergency decompressive celiotomy, the abdominal viscera were covered with a 3 L sterile plastic bag for nutrition support. Results The first case died despite abdominal decompression through uper midline incision. 4 cases underwent decompressive celiotomy through incision from xiphoid to symphysis, one died postoperatively. The overall mortality in this series was 40% (2 / 5). Conclusions Close attention paid to the abdominal and systemic signs facilitates the diagnosis of ACS.Emergent decompressive celiotomy through a incision from xiphoid to symphysis is effective in treating ACS. Temporary abdominal closure could be fulfiled with 3L sterile plastic bag for nutrition support.

BACKGROUND:Compared with the fixation of bone cement prosthesis,the fixation of cementless femoral prosthesis does not have the folowing worries,including cement-prosthesis separation,cement sheath rupture,and cement debris-induced osteolysis.Long-term outcomes are good,and the survival rate is high.OBJECTIVE: To observe the preliminary clinical results and complications of total hip arthroplasty with Accolade TMZF cementless femoral stem.METHODS:From February 2010 to July 2012,67 patients (70 hips) underwent primary total hip arthroplasty with cementless femoral stem.Al patients were treated with Accolade TMZF Biological hip prosthesis system.Femoral component was treated with the same Accolade TMZF cementless femoral stem.Acetabular component was treated with Secure-fit HA and Trident PSL HA.The first mortar joint friction surface was treated withceramic-ceramic composite in 49 hips,ceramic-polyethylene composite in 19 hips and metal-polyethylene composite in 2 hips.After replacement,hip imaging data were utilized to assess biological fixation of femoral stem prosthesis,osteolysis surrounding the prosthesis,and prosthesis subsidence,and to observe hip function,thigh pain and complications.RESULTS AND CONCLUSION:Al cases were folowed up for more than 2 years.The mean Harris hip score was (32.7±6.2) preoperatively,and improved to (89.2±5.1) during final folow-up.During final folow-up,four patients (6％) suffered from slight pain.No moderate and severe pain or extremely severe pain occurred.None of the patients needed second operation due to failure for various reasons.X-ray films showed that no prosthesis displacement or loosening.Bone fixation surrounding the prosthesis was visible at the femoral side.Only one hip had subsidence of less than 2 mm,and the remaining did not experience subsidence.No blood vessels or nerve injury appeared during the surgery.During prosthesis placement,femoral calcar cleavage fracture occurred in 4 hips,so wire cerclage was used.Deep vein thrombosis in the lower limb or fractures surrounding the prosthesis was not found after placement.These results indicated that the preliminary clinical results of primary total hip arthroplasty with Accolade TMZF cementless femoral stem are encouraging,can effectively improve the function of hip joint.But the folow-up time is shorter,mid-term long-term curative effect should be further observed.

Objective To investigate the effects of 7 5% hypertonic saline (HS) on fluid balance after elective major abdominal surgery Methods Twenty two patients undergoing elective major abdominal surgery were assigned to receive either Ringer lactate solution followed by 4 ml/kg of 7 5% HS (study group, n =11) or Ringer lactate solution (control group, n =11) during the early postoperative period in ICU We compared fluid infusion volumes and urine outputs, fluid balance, and body weight change between the 2 groups Results Urine outputs in the operative day and the first postoperative day in study group were significantly more than in control group [(2?650?531)ml vs (2?046?572)ml, t =2 551?7, P

BACKGROUND:Total knee arthroplasty has matured in clinical treatment. LPS-Flex Mobile Bearing System (Zimmer, USA) artificial knee prosthesis is the high-flexion rotating platform type knee prosthesis. The time of its clinical application in China is short, so its advantages have not been reported. OBJECTIVE:To investigate the preliminary clinical outcome of the total knee arthroplasty with LPS-Flex Mobile Bearing system artificial knee prosthesis (Zimmer, USA), and to assess the biocompatibility of artificial prosthesis and host using range of motion of knee and function after replacement. METHODS:We retrospectively analyzed 37 patients (42 knees) undergoing total knee arthroplasty using Zimmer LPS-Flex Mobile Bearing prostheses (high-flexion rotating platform type knee prosthesis) in The First Hospital Affiliated to Soochow University from February 2012 to March 2014, including 9 males (10 knees) and 28 females (32 knees), aged 47-78 years, averagely 63.7 years. Bone cement fixation was used, and the patel a was not treated with replacement. Postoperative complications were observed. Ranges of motion of knee joint preoperatively and postoperatively were compared. The recovery of knee joint function was evaluated using Hospital for Special Surgery Knee Score. RESULTS AND CONCLUSION:A total of 34 cases (38 knees) were fol owed up for 6-28 months. Range of motion of knee joint improved from 88.5° before operation to 124.2° after operation on average. Hospital for Special Surgery Knee Score improved from 52.5 before replacement to 91.1 after replacement, showing significant differences (P<0.01). Therapeutic effects were assessed according to Hospital for Special Surgery Knee Score:excel ent in 20 cases, good in 16 cases, average in 2 cases, with an excel ent and good rate of 95%. The incidence of various complications was low. These data suggested that short-period clinical outcomes of high-flexion rotating platform type knee prosthesis replacement are satisfactory. This prosthesis has advantages in its design, which is more close to the physical structure of knee joint, but its long-period outcomes deserve further investigations.

Objective To discuss the effect of the interval between neoadjuvant therapy and surgery on downstaging for local advanced rectal cancer.Method s From May 2003 to December 2008 as earlier period,32 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 4 -6 weeks.From January 2009 to December 2010 as later period,21 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 8 weeks.Dworak classification,TNM stage and clinical outcome after surgery were compared between two group paitents.Results All patients with local advanced rectal cancer received R0 resection.No surgical complications and mortality were observed in all cases.Pathological results showed that 0 and 2 cases were Dworak classification Ⅳ,5 cases were Dworak classification Ⅲ,3 and 6 cases were Dworak classification Ⅱ and 24 and 8 cases were Dworak classification Ⅰ in earlier period and later period,respectively (x2 = 9.109,P = 0.028).The postoperative staging showed that 6 and 13 cases were ypT1N0M0,22 and 6 cases were ypT2N0M0,1 case was ypT3 N0M0,3 and 1 cases were ypT3N1 M0,respectively (x2 = 10.909,P = 0.012).There were 65.6% or 81.0% cases reserved anus in earlier period and later period,respectively(x2 = 1.468,P = 0.226).Conclusions The neoadjuvant therapy followed by surgery after 8 weeks is associated with a more significant downstaging effect for local advanced rectal cancer.However,the effect of an extended interval between neoadjuvant therapy and surgery on clinical outcome still needs further investigation.