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ObjectiveTo explore the effect and mechanism of Qizhu prescription on liver lipid anabolism and oxidative stress in mice with non-alcoholic steatohepatitis （NASH） based on adenylate activated protein kinase （AMPK） signaling pathway. MethodA total of 60 male C57BL/6J mice were randomly divided into a normal group （n = 10） and a modeling group （n = 50）. The modeling group was fed by high-fat and high-cholesterol diet for 16 weeks to establish the NASH mice model and was randomly divided into model group， low-， medium， and high-dose groups of Qizhu prescription， and Yishanfu group， with 10 mice in each group. Qizhu prescription was administered intragastrically once a day at a dose of 4.75， 9.50， and 19.00 g·kg-1 in each group and 228 mg·kg-1 in Yishanfu group. The normal group and model group were given equal volumes of pure water for eight weeks. Serum alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total cholesterol （TC）， triglyceride （TG）， and glucose （GLU） levels were detected. The pathological changes of liver tissue were observed by hematoxylin-eosin （HE） and oil red O staining. Serum levels of interleukin-6 （IL-6）， interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， free fatty acids （FFA）， reduced glutathione （GSH）， malondialdehyde （MDA）， catalase （CAT）， and superoxide dismutase （SOD） were detected by enzyme-linked immunosorbent assay （ELISA）. The mRNA expression levels of acetyl-CoA carboxylase （ACC）， carnitine palmitoyl transferase 1A（CPT1A）， and mitochondrial uncoupling protein 2 （UCP2） were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. Protein expression levels of AMPK， p-AMPK， ACC， CPT1A， and UCP2 in liver tissue were detected by Western blot. ResultCompared with the normal group， the liver steatosis of the model group was obvious， with multiple inflammatory clusters and large amounts of intracellular lipid deposition. The activity of serum AST， ALT， as well as levels of IL-6， IL-1β， TNF-α， FFA， and MDA were significantly increased， the activity of CAT and SOD was significantly decreased， and the mRNA and protein expressions of ACC were significantly increased. The mRNA and protein expressions of CPT1 and UCP2 were significantly decreased， and the protein expression of p-AMPK was significantly decreased （P<0.01）. Compared with the model group， the degree of liver steatosis in the Qizhu prescription and Yishanfu groups was reduced， the activity of AST and ALT， as well as the levels of IL-6， IL-1β， TNF-α， FFA， and MDA was significantly decreased， and the activity of CAT and SOD was significantly increased （P<0.01）. The mRNA and protein expressions of ACC in liver tissue of mice in medium- and high-dose groups of Qizhu prescription were significantly decreased， while the mRNA and protein expressions of CPT1A and UCP2， as well as p-AMPK protein were significantly increased （P<0.01）. ConclusionQizhu prescription can improve liver lipid metabolism， reduce oxidative stress， and promote liver cell repair in NASH mice by activating the AMPK signaling pathway.
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Objective:To investigate the application effects of flipped classroom combined with mini-clinical evaluation exercise (Mini-CEX) evaluation on the cultivation of clinical ability of professional postgraduates majoring in clinical medicine.Methods:A total of 32 trainees, the professional postgraduates majoring in clinical medicine integrated with standardized residency training who rotated in the Department of Neurology, The Southwest Hospital of Army Medical University from January 2019 to January 2020 were selected and divided into control group and the experimental group, with 16 ones in each group. The control group were taught with the traditional standardized residency training program, while the experimental group were assessed by Mini-CEX evaluation once every two weeks combined with flipped classroom in stages on the basis of the control group. At the end of the training, the application effects of these two teaching methods were evaluated by theoretical knowledge and clinical comprehensive ability (including 7 aspects of medical history collection, physical examination, clinical diagnosis, treatment plan, medical ethics, doctor-patient communication and overall evaluation). SPSS 22.0 was used for t test. Results:At the end of the training, the scores of theoretical knowledge in the experimental group were higher than those in the control group [(89.83±3.93) points vs. (85.75±5.34) points], with statistical differences ( P<0.05). For the clinical comprehensive ability, the scores of history collection, physical examination, clinical diagnosis, treatment plan, doctor-patient communication and overall evaluation were higher in the experimental group than in the control group ( P<0.05), except for the medical ethics. Conclusion:The application of flipped classroom combined with Mini-CEX evaluation improves the teaching quality and strengthens the clinical comprehensive ability of students, which is worth promoting in clinical practice.
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Objective:To explore the efficient construction of HSF1 gene knockout mouse model using CRISPR/Cas9 gene editing technology, and to establish the early basis for the mouse model of primary osteosarcoma.Methods:According to exon 9 of HSF1 gene structure, the corresponding GRNA (guideRNA) was selected and screened. Then the transcription template of sgRNA (small guide RNA) was amplified by PCR, and four up stream primers were obtained. Subsequently, sgRNA was transcribed in vitro and screened by Tube Screen platform to screen the sgRNA with effective cutting, and the sgRNA with the highest cutting efficiency was selected from the screening results for subsequent experiments. The transcription template of SPCas9mRNA was amplified by PCR, and then Cas9mRNA was transcribed in vitro. The sgRNA transcribed in vitro and Cas9mRNA were injected into the fertilized eggs of healthy C57BL/6 mice, and the tissue was extracted from the tail of the born mice and identified by PCR sequencing. Heterozygous female mice of F0 generation were selected to mate with wild-type male mice too btain F1 generation off spring. The mutation of gene bases of F1 generation mice was detected by AGAR gel electrophoresis and gene sequencing. The heterozygous male mice of the F1 generation and female mice of the F0 generation were back crossed to obtain the F2 generation daughter mice. The tail tissues were cut and sequenced to obtain the F2 generation homozygous knockout mice. PCR was used to observe the cutting efficiency of sgRNA and the sequencing of rat tail tissue, and SNAPGene software was used for gene sequence alignment to determine the deletion of base fragments.Results:The up stream primers sgRNA-1 Primer-f, sgRNA-2 Primer-f, sgRNA-3 Primer-f, sgRNA-4 Primer-f and down stream primers sgRNA-4 Primer -r were obtained by PCR amplification. After in vitro tran scription and screening of sgrRNA, sgrRNA-1, sgrRNA-2 and sgrRNA-4 had high cleavage efficiency and were selected for subsequent experiments. T7 promoter was added to the 5 'end of Cas9 mRNA, and Cas9 mRNA was obtained by PCR and in vitro transcription kit. Mixed Cas9-sgRNA solution was injected into the fertilized eggs of mice and cultured. The cultured two-cell fertilized eggs were injected into the ampulla of the pseudo pregnant female mice, and the F0 generation mice were obtained successfully. A total of 8 heterozygous mice of F0 generation were obtained by Agar gel electrophoresis. Three heterozygous knockout mice of F1 generation were obtained by breeding the female heterozygous mice of F0 generation with healthy wild-type male mice and PCR and sequencing. Three heterozygous male mice of F1 generation were back crossed with female mice of F0 generation 3 to obtain F2 generation mice. Through the observation of electrophoresis and sequencing results of F2 generation mice, it was confirmed that 7 mice were missing HSF1 base sequence, and the electrophoresis results showed mutant bands and no wild-type bands, which were identified as homozygous. The F2 generation homozygous mice were able to breed stably. As eries of results proved that the HSF1 gene knockout mouse model was successfully established in this experiment.Conclusion:CRISPR/Cas9 technology was successfully used to construct HSF1 gene knockout mouse model, with strong stability and high reproducibility, which laida foundation for further study of HSF1 gene expression products and establishment of mouse model of primary osteosarcoma.
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Nonalcoholic fatty liver disease has become the most important chronic liver disease in China and the leading cause of abnormal liver biochemical parameters in physical examination. Mitophagy can degrade the mitochondria with impaired function and misfolded protein in the liver to regulate cell death and help to maintain stable lipid metabolism in the liver. The binding of adiponectin secreted by adipose tissue to adiponectin receptor 2 can increase the secretion of autophagy agonists in Kupffer cells, induce hepatocyte mitophagy, promote lipid metabolism, and thus reduce liver inflammation, which provides new thoughts for the research and development of drugs with a marked clinical effect and a clear mechanism of action in the treatment of nonalcoholic fatty liver disease.
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The Wnt/β-catenin signaling pathway is crucial in bone development and homeostasis.Normally, it has been suggested to play a significant role in regulation of osteogenic differentiation of bone marrow mesenchymal stem cells, osteoclastogenesis and?偅ibone mineral density. Dysregulated Wnt/β-catenin signaling pathway is responsible for bone tumor, metabolic bone disease, degenerative bone disease and it related to development and invasion of osteosarcoma and Ewing′s sarcoma.Studies of the molecular mechanisms of Wnt/β-catenin signaling pathway provide theoretical basis of a potential target for bone diseases.
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Osteosarcoma is the most common primary malignant tumor of bone in children and adolescents and advanced osteosarcoma patients with evidence of metastasis share a poor prognosis.Osteosarcoma frequently gains resistance to standard therapies highlighting the need for improved treatment regimens and identification of novel therapeutic targets.The composition of cancer stem cells is one of the attractive theoretical studies in osteosarcoma biology.It has been proposed that osteosarcomas are composed of a group of functionally heterogeneous cells.Only a small number of osteosarcoma cells have stem cell characteristics,with self-renewal and differentiation capacities,which facilitates in the generation of different types of osteosarcoma cells.These osteosarcoma stem cells play a decisive role in maintaining the proliferation,invasion,recurrence,and metastasis of tumors.Previous research suggests that osteosarcoma formation may result from the development of cancer stem cells by the deregulation of normal self-renewal pathways of tissue stem cells.The discovery of cancer stem cells in osteosarcoma offers a new approach to understanding the biology of these conditions.Further study is needed to understand both normal and osteosarcoma stem cell development and various signaling pathways which appear to regulate self-renewal of stem cells and CSCs,with dysregulation of these signaling pathways leading to tumorigenesis.Ultimately,new prognostic and predictive markers,as well as targeted therapeutic strategies,may be developed to force osteosarcoma into better outcome or permanent remission.In this review we will discuss the research advance of cancer stem cells in osteosarcoma such as commonly used isolation techniques for osteosarcoma stem cells as well as the identified biochemical and molecular markers and we share our viewpoints on controversy in research of osteosarcoma stem cells.
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Objective To investigate the clinical efficacy of laparoscopic anatomical left hepatectomy by guided middle hepatic vein approach.Methods The clinical data of 21 patients undergone anatomical left hepatectomy from Oct.2015 to Jul.2018 were retrospectively analyzed.Results Among the 21 cases,the primary hepatocellular carcinoma were found in 4 patients (19.1％),the cholangiocarcinoma in 1 patients (4.8％),the giant hepatic hemangioma in 1 patients (4.8％),the hepatolithiasis in 15 patients (71.3％).All 21 patients were operated under laparoscopy and recovered.The operative time was 160-380 min,the average operative time was(248 ± 56)min,the intraoperative blood loss was 100-700 ml.The average blood loss was (250 ± 40)ml,the average length of hospital stay of the patients was 8-14 (10 ± 2)d.Conclusions Laparoscopic anatomical left hepatectomy guided by middle hepatic vein approach is a safe and effective operation.
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OBJECTIVE:To provide reference for ensuring the medication safety of rural residents well.METHODS:A questionnaire survey was conducted among 162 rural residents of 27 townships in 11 counties (districts) from Yongzhou city of Hunan province.The survey data was analyzed statistically.RESULTS:A total of 5 670 questionnaires were issued and 4 376 valid questionnaires were recovered,with an effective recovery rate of 77.2％.73.6％ residents did not considered the incompatibility among drugs when receiving two or more drugs;the proportion of increasing or decreasing drug dosage and changing drugs at will was in high level.Most of the residents who had common drugs in the family did not pay enough attention to the custody of the reserved drugs and lacked of basic knowledge;the proportion of residents who bought drugs mainly from pharmacies was the highest (50.7％);in addition,nearly 20％ bought drugs mainly through the Intemet and other ways.More than half of the residents surveyed did not understand the drug instructions;after ADR occurred,more than half of the residents surveyed would stop or change their drugs voluntarily;more than 70％ of the residents surveyed did not know or did not pay attention to characteristics and incompatibility of drugs.CONCLUSIONS:Because of the low level of education,the lack of common sense of safe drug use in local rural residents and unbalanced allocation of medical resources,the phenomenon of irrational drug use is widespread and the safety of medication is not ideal;there is a lot of room for improvement.
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OBJECTIVE:To provide reference for ensuring the medication safety of rural residents well.METHODS:A questionnaire survey was conducted among 162 rural residents of 27 townships in 11 counties (districts) from Yongzhou city of Hunan province.The survey data was analyzed statistically.RESULTS:A total of 5 670 questionnaires were issued and 4 376 valid questionnaires were recovered,with an effective recovery rate of 77.2％.73.6％ residents did not considered the incompatibility among drugs when receiving two or more drugs;the proportion of increasing or decreasing drug dosage and changing drugs at will was in high level.Most of the residents who had common drugs in the family did not pay enough attention to the custody of the reserved drugs and lacked of basic knowledge;the proportion of residents who bought drugs mainly from pharmacies was the highest (50.7％);in addition,nearly 20％ bought drugs mainly through the Intemet and other ways.More than half of the residents surveyed did not understand the drug instructions;after ADR occurred,more than half of the residents surveyed would stop or change their drugs voluntarily;more than 70％ of the residents surveyed did not know or did not pay attention to characteristics and incompatibility of drugs.CONCLUSIONS:Because of the low level of education,the lack of common sense of safe drug use in local rural residents and unbalanced allocation of medical resources,the phenomenon of irrational drug use is widespread and the safety of medication is not ideal;there is a lot of room for improvement.
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Objective To investigate the best injection position and curative effect of ultrasound-guided thrombin injection (UGTI)on femoral pseudoaneurysm (FPA).Methods Review the data of FPA cases in the neurology department of southwest hospital from January 2010 to June 2015.Detailed clinical information of the patients,including the curative effect of local compression therapy,the position,meth-od,dosage and curative effect of ultrasound-guided thrombin injection were collected and analyzed.Results From January 2010 to June 2015,43 cases (1.20%)of FPA were diagnosed in 3573 patients undergoing cerebrovascular interventional operation.Local compression therapy was effective in 11 of 43 FPA patients.The remaining 32 patients who had no response to local compression therapy were treated by UGTI,and the average dosage of thrombin was (30 ±12)IU.All FPA were blocked successfully within 1 minute and without any distal em-bolism events after the first UGTI attempt.No relapse and complications occurred during the follow-up of 5 to 70 months,averagely (38.69 ± 20.79)months.Conclusion UGTI is effective for treatment of FPA who had no response to local compression therapy.Thrombin injection at position far away from the blood flow direction of pseudoaneurysm neck crevasse with ultrasound-guided could bring about highe success rate, less amount of thrombin,and less complications.
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Objective To investigate the regional homogeneity (ReHo) changes of primary insomnia (PI) with cognitive impairment using resting?state fMRI. Methods Twenty-one patients with primary insomnia and cognitive impairment and 25 healthy volunteers matched with age, gender and education level were collected from Southwest Hospital of China from November 2014 to June 2015. Pittsburgh sleep quality index (PSQI), Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Activity of Daily Living Scale (ADL), Hamilton depression scale (HAMD), and Hamilton Anxiety Scale (HAMA) were conducted to evaluate the sleep and cognitive conditions of all subjects. Independent sample t?test was performed to evaluate the significant difference of neuropsychology scores of two groups. ReHo of rs?fMRI were evaluated and compared between two groups using independent sample T?test, meanwhile, the partial correlation analysis was conducted in ReHo values of different brain regions and neuropsychology scores (age, gender and education level were regarded as covariates). Results Compared with normal controls, patients with primary insomnia and cognitive impairment showed significant higher PSQI score and lower MoCA and MMSE scores(P<0.05). The patient group also showed significant increased ReHo in the left medial temporal gyrus(54 voxels, t=3.14), left inferior temporal gyrus(76 voxels, t=4.80), right inferior temporal gyrus(84 voxels, t=4.30) and left parahippocampal gyrus(301 voxels, t=4.44) (P<0.05) and decreased ReHo in the left superior temporal lobe(79 voxels, t=-3.38), right fusiform gyrus(50 voxels, t=-3.17), right superior temporal gyrus(283 voxels, t=-5.34), right inferior frontal gyrus(56 voxels, t=-3.98), right anterior cingulate(233 voxels, t=-3.91), left parietal lobe angular gyrus(67 voxels, t=-3.27) and superior parietal lobule(65 voxels, t=-3.45) (P<0.05). The partial correlation analysis showed positive correlations between the ReHo values and PSQI scores of the left parahippocampal gyrus (R=0.771,P<0.01), negative correlations between the ReHo values and PSQI scores of the right anterior cingulate gyrus (R=-0.649,P<0.01) and positive correlations between the ReHo values and MoCA scores of the right anterior cingulate gyrus(R=0.555,P<0.05). Conclusions Patients with primary insomnia and cognitive impairment have ReHo alterations in various brain regions. The decreasing ReHo in the right anterior cingulate gyrus can reflect the level of sleep disorder and cognitive impairment, and increasing ReHo in the left parahippocampal gyrus can reflect the compensation of sleep disorders of PI.
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Hepatitis B virus (HBV) infection has become the main cause of hepatocellular carcinoma. A series of cell models for HBV infection are established to lay a good foundation for the research on the pathogenesis and treatment of HBV. In this review, we summarize culture models for a single type of cells, co-culture models for multiple types of cells, and other animal models, which are mainly for HBV transfection and infection. We also discuss the methods of cell model construction for HBV infection and their virological characteristics. It provides reliable evidence of models for scientific interpretation of advantages of traditional Chinese medicine in the prevention and treatment of chronic hepatitis B.
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The pathogenesis and progression of nonalcoholic fatty liver disease (NAFLD) are closely associated with the activation of the innate immune system. This article reviews how various types of immune cells, Toll-like receptors, and their downstream signaling pathways are involved in insulin resistance and mediate oxidative stress, inflammation, and fibrosis in the liver. Reduction or elimination of dendritic cells delays inflammatory responses and fibrosis in the liver. A decrease in natural killer T cells induces lipid accumulation at the stage of simple steatosis, but alleviates fibrosis at the inflammation stage. The mTOR signaling pathways for insulin and amino acids suppresses autophagy through short-term or long-term regulation, which leads to endoplasmic reticulum stress and altered insulin resistance, thereby modulating the development and progression of NAFLD. The research on the mechanisms by which traditional Chinese medicine offers therapeutic benefits for NAFLD increasingly focuses on the potential role of immunity.
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<p><b>OBJECTIVE</b>To observe the clinical effect of acupuncture for depression and to discuss its impact on the content of 5-HT in patients with depression.</p><p><b>METHODS</b>Eighty patients with depression were randomly divided into an acupuncture group and a western medication group,40 cases in each one. Acupuncture was applied in the acupuncture group,Siman(KI 14),Shenshu(BL 23),Guanyuan(CV 4),Dazhui(GV 14),Yinlingquan(SP 9), Zusanli(ST 36),Taichong(LR 3),Yanglingquan(GB 34) and Jingming(BL 1) were selected, the intensive moxibustion was applied at G(uanyuan(CV 4). Fluoxetine was treated with oral administration in the western medication group. The treatments of six weeks were required in each group. The Hamilton depression rating scale (HAMD) was applied to evaluate efficacy and serum 5-HT was detected before and after treatment in the two groups.</p><p><b>RESULTS</b>After treatment,the scores of HAMD were decreased obviously in the two groups compared with those before treatment (scores in the acupuncture group: 24. 48 ± 0. 28 vs 8. 95 ± 2. 24; scores in the western medication group: 24. 14±0. 24 vs 10. 29±1. 30),and the differences were statistically significant (both P<0. 05). Between the two groups,the scores of HAMD in the acupuncture group at the end of the lst,2nd,4th,6th weeks were superior to those in the western medication group (all P<0. 05). The content of serum 5-HT after treatment was increased markedly compared with that before treatment [the content in the acupuncture group: (26. 21 2. 36)pg/mL vs (52. 07 ± 0. 56)pg/mL, the content in the western medication group:(26. 26±2. 31)pg/mL vs (51. 70±0. 52)pg/ mL, both P<0. 05]. But there was no statistic significance between the two groups(P >0.05).</p><p><b>CONCLUSION</b>The efficacy of acupuncture for depression is superior to that of western medication with fluoxetine.</p>
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Adolescente , Adulto , Anciano , Humanos , Persona de Mediana Edad , Adulto Joven , Puntos de Acupuntura , Terapia por Acupuntura , Depresión , Sangre , Terapéutica , Moxibustión , Serotonina , SangreRESUMEN
AIM:To investigate the regulatory effects of phosphatylinositol 3-kinase/protein kinase B (PI3K/PKB) signaling pathway on the expression of osteopontin ( OPN) in transforming growth factor-β1 ( TGF-β1 )-induced hu-man hepatic stellate cells .METHODS:Human hepatic stellate cell line LX-2 was cultured in DMEM and stimulated by TGF-β1 at the final concentration of 2.5, 5, 10 and 20 μg/L for 24 h or at final concentration of 10 μg/L for 12 h, 24 h and 48 h.LX-2 cells were pretreated with wortmannin , a specific inhibitor of PI3K/PKB signaling pathway , at final con-centration of 0.1 μmol/L for 1 h, followed by incubation with TGF-β1 at final concentration of 10μg/L for 24 h.The cells were collected.The expression of OPN was detected by real-time PCR and Western blotting .RESULTS: In LX-2 cells, the expression of OPN was apparently elevated when incubated with TGF-β1 .With the increase in TGF-β1 concentration or the extension of incubation hours , the expression of OPN was increased gradually in a dose-and time-dependent manner with certain limits.LX-2 cells pretreated with wortmannin and incubated with TGF-β1 had a significant decrease in the OPN expression as compared with control group (P<0.01).CONCLUSION:The expression of OPN in TGF-β1-induced LX-2 cells is regulated by the PI3K/PKB signaling pathway.
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<p><b>OBJECTIVE</b>To investigate the association between rs414171 single nucleotide polymorphisms (SNP) of cytokine- inducible src homology 2 domain protein (CISH) and the susceptibility to chronic hepatitis B.</p><p><b>METHODS</b>A total of 233 Chinese Han patients with chronic hepatitis B and 148 age- and sex-matched healthy controls were enrolled in this case-control study. The SNP rs414171 was genotyped by Sequenom MassArray-IPLEX to analyze the relationship between rs414171 and chronic hepatitis B.</p><p><b>RESULTS</b>The distribution of SNP rs414171 allele and genotype frequencies showed no significant difference between the patients and healthy controls (P>0.05).</p><p><b>CONCLUSION</b>CISH rs414171 is not significantly associated with the susceptibility to chronic hepatitis B in Chinese Han population.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alelos , Pueblo Asiatico , Genética , Estudios de Casos y Controles , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genotipo , Hepatitis B Crónica , Genética , Polimorfismo de Nucleótido Simple , Proteínas Supresoras de la Señalización de Citocinas , GenéticaRESUMEN
The clinical internship is an important transitional period for humanistic spirit cultivation of the medical students.But in this period there are some problems exposed.For example,there is the lack of transitional link in management; the clinical instruction doctors lack educational consciousness or guidance ability,the medical students pay little attention to enhancing the individual humanistic spirit level and there is a gap between theory and practice of humanistic spirit for them.Strengthening training for students,attaching importance to training,selection and incentive of clinical instruction doctors and revising handbook of clinical internship will help to solve the problems.
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ObjectiveTo investigate the influence of internal sphincter deletions on postoperative fecal incontinence in rectal cancer patients after intersphincteric resection (ISR). MethodsSeventy one cases of rectal tumour were respectively treated by low anterior resection (group A, intact internal sphincter),partial ISR (group B,1/3 internal sphincter deletion),subtotal ISR (group C,2/3 internal sphincter deletion) and total ISR (group D,total internal sphincter deletion).Anorectal manometry and Vaizey scoring system were used to trace dynamic changes of fecal incontinence in the four groups in one year follow up. Data were analyzed with repeated-measures analysis of variance and multivariate analysis of variance. ResultsIn all cases the length of postoperative anal high-pressure zone shortened by groups.With time the length of high-pressure zone increased slightly.By the end of postoperative 12 months,there were still significant differences between groups( F =41.873,P =0.000).The maximum resting pressure of anal canal significantly reduced in all groups.By the end of postoperative 12 months,it almost restored to preoperative level in group A,while in group B and C it was about 2/3 of the preoperative level; and 1/3 of the preoperative level in group D.Vaizey score at postoperative 10 days,increased in all groups.In group B and C the score was on continuous decrease until the end of postoperative 12 months(P =0.158) it was close to that in group A.While in group D it was only 13.7 ±3.2 by the end of postoperative 12 months.Multiple regression analysis showed that by the end of postoperative 12 month,the maximum resting pressure of anal canal and postoperative anal high-pressure zone length were significantly and negatively related with the subjective Vaizey score of fecal incontinence ( t =- 4.802,P =0.000 ; t =- 2.011,P =0.048 ).ConclusionsIn patients of ultra-low rectal cancer undergoing intersphincteric resection,fecal incontinence severity indicator vaizey score as evaluated by the end of postoperative 12 months was associated with the maximum resting pressure of anal canal and anal high-pressure zone length.In addition,postoperative fecal incontinence severity carries reversible dynamic changes, and with time, most patients could restore satisfactory stool control function.
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Objective To evaluate the analgesic efficacy and effect of high intensity focused ultrasound (HIFU) in the treatment of advanced pancreatic cancer.Methods128 patients with pancreatic cancer ( Ⅲ stage 41 case,Ⅳ stage 87 case) were treated by HIFU.According to some parameters,such as the clinical symptoms,imaging examinations and survival analysis to assess the efficacy of HIFU treatment.Results22.9％ patients’ serum Ca19-9 decreased.The cancer pain was relieved in 72.5％ patients.Coagulated-necrosis by CT/MRI examination was observed.PR,SD and PD of all were 11.7％,70.3％ and 18.0％ respectively.1-year survival rate was 16.7％ for all patients,and median survival time was 7.0 months.1-year survival rate and median survival time for Ⅲ stage group were 28.5％ and 9.0 months,that of 10.8％ and 6.0 months for Ⅳ stage group respectively.ConclusionHIFU may benefit to advanced pancreatic cancer patient by stabilizing tumors,relieving pain and prolonging life expectancy with less side effects.
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Objective To investigate procedure and therapeutic effect of resection and reconstruction for axis tumors through the sub mandible approach. Methods Between December 2004 to June 2010,17 patients with axis neoplasm underwent tumor resection and antero-posterior reconstruction through the combined the sub mandible-inner sternocleidomastoid muscle (SMIS) approach and posterior approach. Tumor lesions involved C2 in 11 cases, C2-3 in 4, C2-4 in 2. Eight cases involved vertebral body, and 9 involved both vertebral body and element. Fourteen primary lesions including 4 giant cell tumors, 4 plasmocytomas, 2 chordomas, 2 eosinophilic granulomas, 1 hemangiopericytomas and 1 lymphoma, and 3 metastatic lesions were involved in this study. Three types of reconstruction in upper cervical spine including titanium mesh plus vertically placed titanium plate, titanium mesh plus obliquely placed titanium plate and trimmed titanium mesh alone, were adopted after anterior tumor resection, and then posterior tumor resection and reconstruction were performed. Results All patients experienced pain relief and neurological improvement after surgery. Except for one incidence of screw pull-out which was corrected by a revision surgery, solid fusion was achieved in all patients. A follow-up period of 6 months to 6 years was available for this study. One patient died of cerebral infarction 9 months postoperative. Two patients with chordoma relapsed 13 months and18 months postoperative, respectively, of whom one died of high plegia and respiratory failure, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases 12 months and 18 months postoperative, respectively. Conclusion Through the SMIS apporach, a satisfactory exposure can be obtained for axis tumor resection and reconstruction. Anterior reconstruction of upper cervical spine after tumor resection can be achieved with internal fixation system of cervical spine, which can improve intraopera-tive safety. The combined anterior reconstruction and posterior occipito-cervcial fixation can provide immediate stability, and benefit maintaining stability of upper cervical spine.