Objective To investigate the risk factors and treatment of local recurrence after Dixon operation of rectal cancer.Methods The clinical data of forty-seven patients who had local recurrence after Dixon operation of rectal cancer in our hospital from January 2011 to December 2013 was analyzed retrospectively.According to literature review,the high risk factors and treatment methods of local recurrence of rectal cancer in China and abroad were analyzed.Results The treatment methods of patients with local recurrence after anterior resection were radical resection,palliative resection and chemotherapy.The prognosis of patients with radical resection whose overall survival time was (38.202±2.411) months,better than that with palliative resection ((24.591±2.150) months),better than that with chemotherapy ((12.833±1.033) months).There was a significant difference in the survival time among the three groups (χ2=30.155,P<0.001).Conclusion Fully understanding of high risk factor can help reduce the probability of local recurrence.For patients with local recurrence of the rectal cancer,radical resection should be performed.In case that radical surgery is not possible,positive treatments should be adopted if the patients are in good physical condition.

BACKGROUND:Hyperbaric oxygen(HBO)treatment promotes the proliferation and differentiation of endogenous neural stem cells in neonatal rats following hypoxic/ischemic brain damage(HIBD).The Wnt signaling pathway is associated with neurogenesis.However,there are few data recording the role of HBO in the differentiation of neural stem cells in vitro.OBJECTIVE:To observe the effect of HBO on differentiation and Wnt3 expression of bone marrow mesenchymal stem cells(BMSCs).METHODS:BMSCs were isoiated and cultured.The rat BMSCs of passages 3-5 were cultured in DMEM/F12(1:1)medium with basic fibroblast growth factor,epidermal growth factor and B27 for 24 hours.The induced BMSCs were randomly divided into two groups:control group(no treatment)and HBO group(HBO,0.10 MPa,60 minutes stabilizing pressure with at least 90% oxygen).The neuron specific encloase(NSE),glial fibrillary acidic protein(GFAP)and 04 marked oligodendrocyte immunocytochemistry were detected by immunofluorescent staining,and Wnt3 protein expression was detected by Western-blot.RESULTS AND CONCLUSION:BMSCs cultured in classic medium of neural stem cells could significantly induce the expression of nestin.The expression of NSE and 04 of HBO group was greater than control group(P＜0.01),but GFAP expression displayed no significant difference between the groups(P＞0.05).Western blot showed HBO could enhance the Writ3 expression (P＜0.05).Results show that HBO can induce BMSCs to differentiate into neural cells and oligodendrocyte,which is correlated with the activation of the Wnt3 protein.

Objective To investigate the expression of corticotropin-releasing factor (CRF) and its receptors including CRFR1 and CRFR2 on mouse mesenteric lymph nodes dendritic cells (MLNDC), and to analyze their effects on the biological phenotypes of intestinal dendritic cells .Methods The MLNDCs were isolated from C57BL/6 mice by using magnetic bead sorting .The purity of CD11c+DCs was identified by flow cytometry .The double-labeling immunofluorescence and the reverse transcriptase-polymerase chain reaction (RT-PCR) were performed to detect the expression of CRF , CRFR1 and CRFR2 on MLNDCs.The MLNDCs were exposed to CRF with or without the interference of CRFR 1 and CRFR2 antagonists .Flow cy-tometry was used to measure the changes of surface molecules ( MHCⅠ and MHCⅡ) and co-stimulatory molecules (CD80 and CD86).Results The CD11c+DCs accounted for (80.12±6.34)% of the isolate cells with a high cell viability of more than 90%.The expression of CRF , CRFR1 and CRFR2 at mRNA lev-el were detected in MLNDCs by RT-PCR.Results of the immunofluorescent staining assay indicated that both CRFR1 and CRFR2 were expressed on the surface of MLNDCs .The expression of CD86 on MLNDCs was inhibited by the treatment of MLNDCs with CRFR 1 antagonist , but enhanced by the treatment with CRFR2 antagonist .Conclusion Both CRF and CRFRs were detected in the MLNDCs isolated from the C57BL/6 mice.The CRF could alter the biological phenotypes of MLNDCs through binding to different CRFRs (CRFR1 and CRFR2), which affected the phenotypes of MLNDCs in opposite ways .

Objective To study the relationships between the standing balance and walking ability of hemiplegic stroke survivors.Methods Eighty-eight post-stroke hemiplegic patients who could walk independently for more than 10 metres were selected into a patient group,while 88 healthy counterparts were recruited into a control group.Descriptors of the gait and balance function of both groups were collected using a gait and balance training and evahuation apparatus (Model:AL-600).The gait parameters were step width,walking speed,step length asymmetry (SLA),swing time asymmetry (SWTA) and stand time asymmetry (STA).The balance parameters studied were total trajectory length of the center of plantar pressure (COPD),the average left and right deviation of the center of plantar pressure (COPD-X) and the average anterio-posterior deviation of the center of plantar pressure (COPD-Y).Differences in indexes of gait and balance function between the two groups were analyzed using t-tests,and the relationships between the gait and balance indicators were analyzed using Pearson correlation coefficients.Results The walking speed,step width,COPD,COPD-X,COPD-Y,SLA,SWTA and STA of the patient group [(37.64± 18.29)cm/s,(14.45±4.17)cm,(66.75±29.04)cm,(2.04±1.41)cm,(2.48±1.28)cm,(1.30±0.46),(1.65±0.67) and (1.18±0.16),respectively] all increased significantly more compared to the control group [(90.76±14.72)cm/s,(8.70±2.62) cm,(27.84±6.54) cm,(1.30±0.53) cm,(1.68±0.40) cm,(1.07±0.06),(1.07±0.08) and (1.05±0.06),respectively],though the walking speed was significantly slower than that in the control group (P＜0.05).The patient group's average COPD-X showed slightly and moderately negative correlation with their walking speed,step width,SLA and SWTA (P＜0.05).COPD-Y was weakly related with step width (P＜0.05).Conclusion The standing balance of hemiplegic patients after stroke is related to their walking speed,step width and gait asymmetry.Especially significant correlation is observed between standing balance parameters such as COPD-X and gait parameters.

Objective To analyze the correlation between the dry eye symptom and signs in middle-aged and aged people by Lipiview(R) ocular surface interferometry.Methods A total of 170 eyes from 85 middle-aged and aged people (55-80 years old) were examined with Standard Patient Evaluaion of Eye Dryness(SPEED) questionnaire and Lipiview(R) ocular surface interferometry,meanwhile obtaining the consent of the subjects.Then the correlation between the symptom and Lipid Layer Thinckness (LLT) and partial blink rate were analyzed.Results SPEED questionnaire score was 6.13 ±4.60.LLT was(74.88 ± 21.16) nm.LLT variability was 4.47 ± 3.40.The partial blink rate was 0.62 ± 0.36.The Spearman correlation analysis indicated that the nega-tive correlation was shown between the SPEED questionnaire score and LLT (r =-0.823,P =0.000),SPEED questionnaire score and LLT variability(r =-0.268,P =0.018).The positive correlation were found between LLT and Std.Dev of LLT (r =0.339,P =0.030).However,the results of the SPEED score were uncorrelated with partial blink rate (P ＞ 0.05).Conclusion The results from this study demonstrate that correlation among symptom,LLT and LLT variability,but poor correlation between symptom and partial blink rate.

Objective To explore the correlation between plantar pressure and walking function in hemiplegic stroke patients.Methods Thirty hemiplegic patients with stroke (a hemiplegic group) and thirty age-matched healthy persons (a control group) were recruited.Gait and balance function training and assessment system (model:AL-600) were used to quantify the walking velocity,peak plantar pressure at heel-strike and push-off periods and displacement of center of pressure (DCOP) of all subjects during walking.The asymmetry of gait was calculated.Two independent sample t-test were used to compare the walking velocity,peak plantar pressure and DCOP for the two groups.Pearson correlation coefficients were applied to analyze the correlation between the walking velocity and peak plantar pressure and DCOP.Results The walking velocity,the peak plantar pressure at heel-strike and push-off periods and DCOP of the hemiplegic group were significantly lower than the control group.In the hemiplegic group,the asymmetry of peak plantar pressure and DCOPx significantly increased,while that of DCOPy became bigger without significant difference.Moreover,the walking capacity of the hemiplegic group was positively correlated with the peak plantar pressure and DCOP.Conclusion Among hemiplegic stroke patients,both the peak plantar pressure at heel-strike and push-off periods lower in a way.Their capacity of weight transfer decreases,which is closely related to their walking velocity.

Objective The clinical data of postoperative perirenal hematoma after renal biopsy in recent 10 years were retrospectively analyzed,and its relationship with pathological type was explored.Methods From April 2003 to April 2013,2062 patients of renal biopsy were enrolled and divided into 3 groups:youth group (18-39 years,1634 cases),middle age group (40-59 years,323 cases) and aged group (≥60 years,105 cases).Relationship between renal hematoma and pathology was analyzed.Results There were 1370,255,69 cases of primary glomerular disease respectively in 3 groups,and 264,68,36 cases of secondary glomerular diseases.Three hundred and seventy-nine in all patients were complicated with perirenal hematoma,and the incidence rates were 15.8％ (325/2062),1.8％ (37/2062),0.8％ (17/2062) respectively.Incidence rate of hematoma in primary glomerular disease was higher than that in secondary diseases [19.0％ (322/1694) vs.15.5％ (57/368)].Three most common primary glomerular disease in which perirenal hematoma occured was IgA nephropathy 7.4％ (126/1694),focal/segmental lesions 4.2％(71/1694) and membranous nephropathy 2.4％ (41/1694); while the incidence rate of lupus nephritis hematoma was as high as 9.0％ (33/368).Conclusion Single-center data shows that the most common pathology types of perirenal hematoma are lupus nephritis,IgA nephropathy,focal/segmental lesions and membranous nephropathy.

OBJECTIVETo observe the efficacy and safety of Qizhi Jiangtang Capsule (QJC) in treating stage 3b diabetic kidney disease (DKD) patients with macroalbuminuria.

METHODSPatients who conformed to the diagnostic criteria of stage 3b DKD were randomly assigned to two groups according to random digital table, the experiment group and the control group, 84 in each group. All patients received a two-week elution period, and then were treated with basic Western therapy. Patients in the experiment group took QJC, 5 pills per time, 3 times a day, while those in the control group took Valsartan Capsule 160 mg each time, once daily. The observation period of follow-ups was limited within 6 months, and the time points were set as the baseline, 1st month, 3rd month, and 6th month. Systolic blood pressure (SBP), diastolic blood pressure (DBS), 24 h urine protein quantitative (24 h UPQ), plasma albumin (ALB), and serum creatinine (SCr) were detected and recorded, and estimated glomerular filtration rate (eGFR) was calculated. The occurrence of hypoglycemic reaction, coagulation disorder, gastrointestinal tract reaction, allergy, hyperkalemia, doubling of creatinine, and overall adverse events were observed and recorded at same time.

RESULTSFinally 81 patients in the experiment group and 80 patients in the control group were effectively included. Compared with the baseline level, SBP and DBS obviously decreased in the control group at month 1 of treatment (P < 0.05), and more significantly decreased at month 6 of treatment (P < 0.01). SBP at month 1, 3, and 6 of follow-ups; DBS at month 6 of follow-ups was lower in the control group than in the experiment group (P < 0.05). At month 1, 3, and 6 of follow-ups, 24 h UPQ of the experiment group was significantly lower than the baseline level (P < 0.01). It was also significantly lower than the level of the control group at the same time point (P < 0.05). There was no significant difference in 24 h UPQ at month 1, 3, and 6 of follow-ups between the control group and the baseline level (P > 0.05). ALB of the experiment group showed an increasing trend. It was significantly higher than the baseline level at month 6 (P < 0.05), which was also higher than that of the control group at same period (P < 0.05). There was no significant difference in the ALB level in the control group (P > 0.05). SCr of two groups showed an increasing trend. SCr of the experiment group was significantly higher at month 1, 3, and 6 follow-ups than the baseline level (P < 0.05). But the increment of SCr was higher in the control group than in the experimental group, and obviously higher than the baseline levels (P < 0.05). eGFR of both groups showed a decreasing trend. The decrement was higher in the control group than in the experimental group (P < 0.05). The proportion of progression of renal functions at month 1, 3, and 6 of follow-ups in the experimental group was 0.0% (0 case), 9.55% (8 cases), and 21.4% (18 cases), while they were 8.3% (7 cases), 21.4% (18 cases), and 40.5% (34 cases) in the control group. There was no statistical difference in the proportion of progression of renal functions between the two groups at month 3 and 6 of follow-ups (P < 0.05). There was no statistical difference in the incidence of adverse reactions between two groups (P > 0.05).

CONCLUSIONQJC could effectively reduce urinary protein of patients with stage 3b DKD, and delay the progression of renal functions.

Adult ; Albumins ; analysis ; Albuminuria ; drug therapy ; Blood Pressure ; drug effects ; Creatinine ; blood ; Diabetic Nephropathies ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Tetrazoles ; therapeutic use ; Treatment Outcome ; Valine ; analogs & derivatives ; therapeutic use ; Valsartan

Medical education should combine clinical professional skills with humanities skills,integrate humanities knowledge into vocational education.Taking 2008 grade seven-year program clinical medicine students in the 2nd affiliated hospital of Harbin Medical University as fostering object,we made researches into students' understanding of doctor-patient relationship before practice and their mastering of skills.Through conducting questionnaire,we got to know the effect of humanities practice skill training for seven-year program clinical medicine students.Meanwhile,we compared students' self evaluation results before and after training,discussed on how to improve medical students' communication skills,cultural skills and the reform direction in an aim to guide students to transit from students to clinical doctor.

Objective To evaluate the treatment efficacy of leukocyte reduction in hyperleukocytic acute myeloid leukemia (HAML) patients with leukostasis grading score (LGS).Methods The data of 54 HAML patients were analyzed retrospectively.The relationship between LGS and leukocyte stasis symptoms or early mortality was observed, and the impact of leukapheresis on LGS was analyzed.Results Among 54 patients with HAML, there were 1 case of M1, 16 cases of M2, 10 cases of M4, 20 cases of M5 and 7 cases of unclassified AML.Based on clinical symptoms and LGS system, 3 cases were LGS 0, 15 cases LGS 1, 17 cases LGS 2, and 19 cases LGS 3.In patients with LGS ≤ 2, the rates of type Ⅰ respiratory failure, central nevers system (CNS) symptoms and early mortality caused by leukostasis were significantly lower than those in patients with LGS 3 (P ＜ 0.05).The LGS of HAML patients was reduced by leukocyte reduction therapy (P ＜ 0.000 1).The LGS of HAML patients treated by leukapheresis and low dose chemotherapy was improved significantly than that of patients treated without leukapheresis (P =0.008).Among 37 cases receiving induction chemotherapy, 20 cases reached complete remission (CR) after the first cycle of induction chemotherapy.CR rate of patients with LGS ≤ 2 was no significantly different compared with that of patients with LGS 3 (P =0.703).Conclusions LGS can be used to evaluate the degree and the improvement status of leukostasis after treatment in HAML patients.The early death often occurres in patients with high LGS.Leukapheresis combined with low-dose chemotherapy can effectively improve the LGS of HAML patients.