Total mesorectal excision (TME) has become the basic principle of surgical treat-ment for middle and low rectal cancer. Some of patients with ultra-low rectal cancer require under-going intersphincteric resection (ISR). Due to the limitation of the narrow pelvis, TME and ISR put forward higher requirements for the precise separation of the anatomical level and the protection of neurological function during the operation. At present, evaluation of the difficulty of surgery for middle and low rectal cancer is mainly based on the subjective judgment of chief surgeon, and there is no unified and objective scoring system or prediction model that can classify the difficulty of surgery for middle and low rectal cancer before surgery. The authors review relevant literatures and summarize the existing studies related to pelvic measurement for predicting the difficulty of surgery for middle and low rectal cancer, in order to provide significant guidance for the selection of surgical approach for patients with middle and low rectal cancer.

Objective To observe the clinical efficacy of Xiaozhi Yanggan tea on mixed hyperlipidemia with Phlegm-damp obstruction type. Methods According to the inclusion criteria,a total of 80 cases of mixed hy-perlipidemia were randomly divided into treatment group and control group,with 40 cases in each group. All pa-tients were treated with Atorvastatin Calcium capsule and those in the treatment group were additionally treated with Xiaozhi Yanggan tea,for a total of 12 weeks. Two groups of patients were observed for the integral of Tradition-al Chinese Medicine(TCM)syndrome,the change of blood lipids and safety. Results After treatment,the total effective rate for TCM syndrome was 95.00% in treatment group,which was better than 75.00% in control group (P < 0. 05). TC,LDL-C and non-HDL-C levels in the treatment group were lower than those in the control group (P < 0. 05). HDL-C was higher than that in the control group(P < 0.05). TG in the treatment group were lower than that before(P < 0. 05),while it was not obvious in the control group(P > 0.05). No obvious abnormality in hepatorenal function and creatine kinase in the two groups after treatment. Conclusion Xiaozhi Yanggan tea was an effective and safe therapy for mixed hyperlipidemia with Phlegm-damp obstruction type.

Objective To analyze the therapeutic effects of chemotherapy after chidamide pretreatment in 16 cases of high-risk and refractory lymphoid malignancy. Methods The efficacy and adverse reactions of 16 patients with high-risk and refractory lymphoid malignancy who received chidamide combined with chemotherapy after 3 days pretreatment of chidamide were analyzed. Results Sixteen patients included 6 males and 10 females, and the median age was 49.5 years old (23-88 years old). The median course of previous systemic chemotherapy was 4 (range 0-22). Among 14 patients who received induction chemotherapy, 7 patients achieved complete remission (CR), 7 patients achieved partial remission (PR). Fourteen patients had achieved clinical efficacy, and the overall response rate (ORR) was 100 %. After 2 cases had remission , the patients who entered this regimen for consolidation chemotherapy also had durable CR. The median follow-up time was 13 months (range 2-24 months) until December 2017. Nine cases had overall survival (OS), 7 cases died and 9 cases had progression-free survival. Common adverse effects of the chemotherapy included mild and controllable gastrointestinal reactions after chidamide. Conclusion Chemotherapy after chidamide pretreatment may improve the effect and prognosis of high-risk or refractory lymphoid malignancy.

Objective Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding. The purpose of this study was to recognize the clinical characteristics of gastric Dieulafoy and to identify possible predictive factors of rebleeding. Methods Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion from January 2009 to June 2016. We analyzed the clinical data and endoscopic findings and the correlated with rebleeding risk factors with Dieulafoy's lesion. Results 111 patients were included in the study, 97 (87.4%) patients were male; the most common location of the bleeding lesions were Proximal stomach of 53 cases (47.7%); According to the Forrest type, 46.8% of the cases were arterial (spurting), 52.3% of the cases were arterial (oozing), there were 101 (91.0%) patients treated by endoscopic combined drug therapy. The success rate of Endoscopic hemostatic treatment was 84.2%, endoscopic hemostatic treatment success rate was as follows: single endoscopic, 85.0%; two endoscopic, 84.8%; three endoscopic, 75.0%. The hemostatic treatment success rate of 101 patients with endoscopic combined drug was as follows: Proximal stomach, 83.7%; mid-stomach, 82.1%; and distal stomach, 88.9%. Age (P = 0.002) and blood transfusion (P = 0.004) were risk factors for rebleeding in the study. Blood transfusion was associated with a higher recurrence rate for bleeding (P = 0.018, OR=37.77, 95% CI = 1.86~766.47) for 101 patients with endoscopic in combination with drug. Conclusion Endoscopic therapy is effective for treating Dieulafoy's lesion. The blood transfusion was associated with a high rate of bleeding recurrence. There were no significant differences between the rebleeding and non-rebleeding groups with respect to bleeding location or hemostatic methods.

To observe different expression patterns of β-catenin and its clinical significance in colorectal cancer (CRC).Methods A total of 181 cases of CRC tissues and 30 cases of normal colorectal tissue were investigated by immunohistochemistry for the expression of β-catenin.Results The expression rate of β-catenin was 56.9％ (103/181) in CRC,and higher than that in normal colorectal tissue (P ＜ 0.05).The overexpression of nuclear β-catenin was significantly correlated with histological differentiation,lymph node metastasis and Dukes' stage in CRC (P ＜ 0.05),and no relationship with other pathological parameters,such as age,gender and the depth of infiltration.The incomplete membranous expression of β-catenin was significantly correlated with histological differentiation,the depth of infiltration,lymph node metastasis and Dukes' stage in CRC (P ＜ 0.05).The high expression of nuclear β-catenin related to histological differentiation and Dukes' stage in CRC (P ＜ 0.05).In the follow-up data of 82 cases of CRC,the expression of nuclear β-catenin was associated with poor prognosis,and the 5-year survival rate was significantly lower than that of self-control groups (P ＜ 0.05).Conclusion β-catenin plays important roles in colorectal carcinogenesis.Abnormal expression of β-catenin was related to the aggressive progression of CRC and may be helpful for evaluating the prognosis of patients with CRC.β-catenin is expected to become a new target for diagnosis and treatment of CRC in future.

Objective To establish nursing safety management system in the operating room and explore the effect of clinical application.Methods Toally 350 patients with surgical treatment from January to December 2013 were assigned as the control group,where routine nursing safety management was conducted.Another 350 patients from June 2014 to June 2015 were as the observation group,where nursing safety management system was used in the operating room.The two groups were compared in terms of adverse events,the passing rate of quality and safety.Result As compared with the contrast group,the incidence of adverse events was significantly lower and the passing rate of quality and safety was significantly higher in the observation group (P＜0.05).Conclusion Establishment of nursing safety management system can improve the nursing risk awareness,reduce the incidence of preoperative and postoperative adverse events and improve the level of nursing safety management and the quality of care.

Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101(5.18%)pancreatitis, 54(2.77%)hyperamylasemia(not including pancreatitis), 134(6.87%) biliary infection,8(0.41%)hemorrhage,1(0.05%)obstruction and 1(0.05%)perforation.Multivariate analyses showed cholangiocarcinoma(P=0.002,OR=2.39, 95% CI:1.38-4.14), long operation time(>60 min)(P=0.020,OR=3.77,95%CI:1.23-11.53)and endoscopic sphincterotomy(EST)(P=0.008, OR=2.56,95% CI:1.28-5.14)and entrance of guidewire to pancreatic duct(P=0.012,OR=1.43, 95%CI:1.08-1.87)were independent risk factors for PEP. Cholangiocarcinoma(P<0.01, OR=2.93, 95%CI:1.88-4.56),multiple times of ERCP during the period of hospitalization(P<0.01, OR=2.53, 95%CI:1.63-3.93)were independent risk factors for post-cholangitis. However, EST(P=0.03, OR=0.65,95%CI:0.44-0.97)and antibiotics prophylaxis after ERCP(P=0.03, OR=0.64, 95% CI:0.39-0.95)were protective factors for post-cholangitis. ConclusionCholangiocarcinoma, endoscopic sphincterotomy, long operation time(> 60 min)and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis.EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis.

Objective To analyze the diagnostic value of endoscopic ultrasonography(EUS)for staging of early gastric cancer(EGC)and its influential factors. Methods Clinical information of 120 EGC patients admitted from February 2009 to January 2016 was reviewed. Diagnostic accuracy and the influencing factors of EUS for the invasive depth were analyzed by comparing the results of preoperative EUS and the pathology. Results Thirty-six patients were over-staged by EUS,and 10 patients were under-staged among 120 EGC patients. The accuracy, sensitivity, specificity of EUS for the submucosal invasion were 61.67%(74/120),58.33%(14/24),62.50%(60/96)respectively. The accuracy, sensitivity and specificity for protruded EGCs(Type I)diagnosis were 74.36%(29/39), 50.00%(6/12), 85.19%(23/27) respectively;these three variables were 59.02%(36/61),83.33%(5/6),56.36%(31/55)respectively for flat EGCs(Type Ⅱ), and 45.00%(9/20), 50.00%(3/6), 42.86%(6/14)respectively for excavated EGCs(Type Ⅲ). The univariate factor results showed that differentiated degree, location and endoscopic morphology of the tumor were possible influential factors for over-stage. Multivariate factor results showed that flat type(OR=3.667,95%CI:1.086-12.386,P<0.05)and excavated type(OR=6.552,95%CI:1.421-30.218,P<0.05)were independent risk factors. Gender,age and tumor maximum diameter were not factors influencing the diagnostic accuracy of EUS. Conclusion The EUS shows higher clinical value for diagnosing the invasive depth in EGC. Tumor differentiated degree, location and endoscopic morphology may be the influencing factors for diagnostic accuracy of EUS. Flat type and excavated type may lead to over-staging.

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.

Purpose To investigate the expression and clinical significance of microRNA-21 (miR-21) in patients with prostate cancer (PCa).Methods The human tissue specimens were paraffin-embedded blocks which were collected from the Department of Pathology.miR-21 was detected by in situ hybridization (ISH) in 90 cases of PCa and 69 cases of benign prostatic hyperplasia (BPH).Results The ISH data showed that the positive rate of miR-21 in PCa (71.1％) was significantly higher than that in BPH (24.6％) (P ＜ 0.05),the expression of miR-21 correlated with the Gleason grade (P ＜ 0.05),and no relationship was observed with other clinicpathological features (P ＞ 0.05).Conclusion The miR-21 plays an important role in the pathogenesis of PCa,which can be a new diagnostic target for PCa.