Incidence and influencing factors of anastomotic leakage after laparoscopic anterior resection for rectal cancer / 中华消化外科杂志

Objective:To investigate the incidence and influencing factors of anastomotic leakage after laparoscopic anterior resection for rectal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 804 patients with rectal cancer who were admitted to Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from January 2017 to December 2019 were collected. There were 521 male and 283 female, aged 63(range, 27-94)years. All 804 patients underwent laparoscopic anterior resection for rectal cancer. Observation indicators: (1) surgical situations; (2) incidence of postoperative anastomotic leakage; (3) follow-up; (4) influencing factors of postoperative anastomotic leakage; (5) subgroup analysis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribu-tion were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the chi-square test or independent sample t test. Factors with P≤0.2 in univariate analysis were included in multivariate Logistic regression analysis. Results:(1) Surgical situations. All 804 patients underwent laparoscopic radical resection of upper and middle rectal cancer successfully, with the operation time and volume of intraoperative blood loss as 135(range, 118-256)minutes and 30(range, 5-350)mL. All 804 patients completed end-to-end colon rectal anastomosis, including 287 patients with reinforced sutures at the anastomotic site, and 517 patients with routine anastomosis. (2) Incidence of postoperative anastomotic leakage. Of the 804 patients, 40 patients had postoperative anastomotic leakage, with the incidence rate as 4.98%(40/804). (3) Follow-up. All 804 patients were followed up for 32(range, 6-49)months. None of patient died during the perioperative period. (4) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that unreinforced suture at the anastomotic site was an independent risk factor for postoperative anastomotic leakage ( odds ratio=2.78, 95% confidence interval as 1.21-6.37, P<0.05). (5) Subgroup analysis. Of the 804 patients, 202 patients received neoadjuvant therapy and 602 patients did not receive neoadjuvant therapy. Of the 602 patients who did not receive neo-adjuvant therapy, cases with postoperative anastomotic leakage was 6 in the 253 patients with reinforced sutures, versus 21 in the 349 patients with routine sutures, showing a significant difference between them ( χ2=4.56, P<0.05). Conclusion:Unreinforced anastomosis at the anasto-motic site is an independent risk factor for anastomotic leakage after laparoscopic anterior rectal resection, especially for rectal cancer patients without neoadjuvant radiochemotherapy.

Identification and analysis of two Mycobacterium abscess with different morphology / 中华检验医学杂志

Two types of Mycobacterium abscesses (Mab) were found in sputum from a patient with severe pneumonia in May 2020. One was Mycobacteriumabscessus with smooth morphology (Mab S), the other was Mycobacteriumabscessus with rough morphology (Mab R). Both of them were compared and drug susceptibility testing were performed to provide clinical scientific diagnosis and treatment. Morphology, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA were used to analyze Mab S and Mab R, phylogenetic evolution tree was constructed by gene sequence alignment for homology, proportion and broth drug test were used for in vitro drug sensitivity test. There were morphological differences between Mab S and Mab R. MALDI-TOF MS analysis showed that there were 223 protein peaks in Mab R and 147 protein peaks in Mab S. Mab S contained 1 397 bp and Mab R contained 1 402 bp as 16s rRNA gene sequencing revealed. Drug susceptibility testing showed that both of them were almost resistant to all antituberculosis drugs, but sensitive to most of antibiotics. Mab S and Mab R were not only different in manifestations, but also in protein and gene comparison. Both of them were generally resistant to antituberculosis drugs. Antibiotic combined therapy has been confirmed to be an effective treatment in clinic.

Clinical anatomy study of superior mesenteric vessels and its branches / 中华外科杂志

Objective@#To examine the anatomical relationships of tributaries to superior mesenteric artery and vein in surgical procedures.@*Methods@#A prospectively designed observational trial, registried to Chinese Clinical Trial Registry, ChiCTR 1800014610, was conducted in Department of General Surgery, Peking Union Medical College Hospital from July 2016 to Decmeber 2018 to record the relationships of ileocolic artery and vein, right colic artery and vein, middle colic artery and vein, and combinations to assemble Henle′s trunk, during the laparoscopic operation of radical right colectomy for right colon malignancies. The length of middle colic artery, length of Henle′s trunk, and distance from Henle′s trunk to the inferior margin of pancreatic head to duodenum were measured during operation. A total of 100 patients, 52 male and 48 female, with right colon cancer, who underwent radical right colectomy, were enrolled in present study from July 2016 to December 2018, with age of (61.0±12.3) years (range: 31 to 82 years), and body mass index of (23.3±3.5) kg/m2 (range: 16.0 to 34.2 kg/m2).@*Results@#The ileocolic artery and vein presented as rates of 97.0% (97/100, 95%CI: 91.5% to 99.4%, the same below) and 98.0% (98/100, 93.0% to 99.8%), respectively. The ileocolic vein ran ventrally in 51 of 97 patients (52.6%, 42.7% to 62.5%). The right colic artery, which raised from superior mesenteric artery directly, was found in 42 of 100 patients (42.0%, 32.3% to 51.7%); and the right colic vein drained directly into superior mesenteric vein in 19 of 100 patients (19.0%, 11.3% to 26.7%). The presence of middle colic artery and vein were 95.0% (95/100, 90.7% to 99.3%) and 90.0% (90/100, 84.1% to 95.9%) respectively. The average length of middle colic artery, from its origin to bifurcation into right and left branches, was (2.6±1.6) cm (range: 0.1 to 7.2 cm). All the dissected middle colic vein drained into superior mesenteric vein (87.8% (79/90), 81.0% to 94.6%) and Henle′s trunk (12.2% (11/90), 5.4% to 19.0%). Henle′s trunk was found in 93 of 100 patients (93.0%, 88.0% to 98.0%), with average length of (1.0±0.6) cm (range: 0.1 to 2.4 cm). The distance between Henle′s trunk to the inferior margin of pancreatic head was (2.7±0.7) cm (range: 1.3 to 4.5 cm). More than half of the Henle′s trunk were composed of 3 tributaries (54.8% (53/93), 40.8% to 61.2%). The most frequently discovered tributaries to form Henle′s trunk were right gastroepiploic vein (98.0% (98/100), 93.0% to 99.8%), superior right colic vein (82.0% (82/100), 74.5% to 89.5%), and superior anterior pancreaticoduodenal vein (78.0% (78/100), 69.9% to 86.1%). In present study, the right branch of middle colic vessels was often found to run closely with Henle′s trunk, veins drained from small intestine could be found to run over superior mesenteric artery to converge into superior mesenteric vein. There were 2 incidences, injuries to Henle′s trunk and middle colic vein, happened during the operation, which were overcomed by bipolar coagulation and dividing the vessels.@*Conclusions@#Ileocolic vessels and middle colic vessels could be used as landmarks for laparoscopic surgery based on their constant anatomical existence. In contrast, the chances are rare for the presence of right colic artery or right colic vein. Nearly half of the Henle′s trunk was consisted of right gastroepiploic vein, superior right colic vein and superior anterior pancreaticoduodenal vein. Exceptional cautions should be made for the variations of the Henle′s trunk during the operation.

Overlap gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer / 中华胃肠外科杂志

Objective@#The aim of the current study is to compare the short-term clinical outcomes between Billroth-I reconstruction using an overlap method and delta-shaped anastomosis in totally laparoscopic distal gastrectomy (TLDG).@*Method@#A retrospective cohort study was performed. The following inclusion criteria were applied: (1) Preoperative gastroscopy and CT confirmed that the tumor is located in the antrum of the stomach, and the biopsy suggested adenocarcinoma; (2) Chest, abdomen and pelvis enhanced CT showed no evidence of distant metastasis; (3) Preoperative gastric reconstruction CT or endoscopic ultrasonography suggested that the clinical stage of the tumor is stage I-III. (4) During the operation, the tumor position was confirmed to be located in the antrum of the stomach by nanocarbon injection or gastroscope; (5) Complete laparoscopic radical gastrectomy for distal gastrectomy, and the gastrointestinal reconstruction was performed by delta-shaped anastomosis or overlap anastomosis. And the following exclusion criteria were applied: (1) History of gastric surgery; (2) Patients who cannot tolerate laparoscopic surgery because of comorbidities. Finally, data on 43 consecutive patients who underwent TLDG with Billroth-I reconstruction between January 2016 and November 2018 in Peking Union Medical College Hospital were retrospectively reviewed. Patients were divided into those who underwent Billroth-I reconstruction using an overlap method (n=20) or using delta-shaped anastomosis (n=23). The demographic and clinical characteristics and perioperative data of the two groups were analyzed. Measurement data that conformed to the normal distribution were expressed as the mean ± s, and differences between groups were compared using Student′s t-test; comparisons between the counting data groups were performed using the χ2 test or the continuously corrected χ2 test.@*Results@#The demographic and clinical characteristics were similar between the delta-shaped group and the overlap group (P>0.05). There was no significant difference between groups regarding operation time [(185.9±22.8) minutes vs. (184.0±25.8) minutes, t=0.260, P=0.796], blood loss [(50.9±36.0) ml vs. (47.0±30.8) ml, t=0.375, P=0.709], number of stapler reloads used for anastomosis (5.1±0.3 vs. 5.2±0.6, t=-0.465, P=0.651), time to flatus [(3.3±0.9) days vs. (3.6±0.9) days, t=-1.067, P=0.292) and postoperative hospitalization [(8.8±3.1) days vs. (10.4±3.8) days,t=-1.494, P=0.143]. As for the delta-shaped group and the overlap group, the anastomotic leakage rate was 4.3% (1/23) and 0 (χ2=0.000, P=1.000), respectively. The incidence of anastomotic bleeding was 4.3% (1/23) and 5.0% (1/20) (χ2=0.000, P=1.000), while the incidence of intra-abdominal hemorrhage was 4.3% (1/23) and 0 (χ2=0.000, P=1.000). The incidence of gastric emptying disorders was 4.3% (1/23) and 30.0% (6/20), respectively (χ2=3.454, P=0.063). All complications were cured after conservative treatment or symptomatic treatment.@*Conclusion@#The overlap method for Billroth-I reconstruction is safe and feasible.

The analysis of peripheral blood T lymphocyte subsets in patients with colorectal cancer : a single center cross-section study / 中华内科杂志

The distribution of peripheral blood lymphocyte subsets were compared between patients with colorectal cancer and healthy controls.The number of natural killer(NK) cells and CD8+T cells and the percentage of naive CD4+T cells were all decreased significantly in patients.On the contrary,the percentages of memory CD4+T cells,HLA-DR+ CD8+ T cells and CD38+ CD8+ T cells were significantly increased.It suggests that the tumor killing effect of cytotoxic lymphocytes in peripheral blood is impaired in patients with colorectal cancer,whereas the immune response is over stimulated.

Oncological outcomes analysis of colorectal cancer with unfavorable histological features / 中华外科杂志

Objective@#To explore the effect of unfavorable histological features on the clinical outcomes of patients receiving radical resection of colorectal cancer.@*Methods@#A retrospective analysis of patients with colorectal cancer who received radical surgery between January 2013 and December 2015 at Department of General Surgery, Peking Union Medical College Hospital was performed. The impact of unfavorable histological features on the oncological outcomes of patients with lymph node-negative colorectal cancer were analyzed.A total of 167 patients were enrolled, including 98 males and 69 females with age of (63.6±11.6) years. Observation indicators included age, T stage, lymphovascular invasion, perineural invasion, tumor deposits, number of lymph node dissection, degree of differentiation, tissue type, and circumferential margin. Univariate analysis was performed with χ2 test and multivariate analysis was performed with Cox regression model.@*Results@#Univariate analysis showed that positive circumferential margins (CRM), tumor deposits and age were associated with disease free survival (DFS) rate; positive CRM, age, tumor deposits, and lymph nodes dissection less than 12 were significantly associated with overall survival (OS) rate (all P<0.05). Multivariate analysis showed that over 70 years of age (HR=1.053, 95% CI: 1.013 to 1.095, P=0.009), poorly differentiated adenocarcinoma (HR=7.572, 95%CI: 1.815 to 31.587, P=0.005), tumor deposits (HR=4.711, 95% CI: 1.809 to 12.264, P=0.002), mucinous adenocarcinoma (HR=3.063, 95% CI: 1.003 to 9.354, P=0.049), lymphovascular invasion (HR=2.885, 95% CI: 1.062 to 7.832, P=0.038), and nerve infiltration (HR=6.610, 95% CI: 1.037 to 42.122, P=0.046) were adverse prognostic factors of DFS rate; poorly differentiated adenocarcinoma (HR=12.200, 95% CI: 1.985 to 74.972, P=0.007), tumor nodules (HR=5.379, 95% CI: 1.636 to 17.685, P=0.006), over 70 years of age (HR=1.062, 95% CI: 1.013 to 1.114, P=0.013), and perineural invasion (HR=8.043, 95% CI: 1.026 to 63.055, P=0.047) were adverse prognostic factors of OS rate. There was no significant difference in the 3-year DFS rate and 3-year OS rate between T1-2 group and T3-4 group (P>0.05).@*Conclusion@#Over 70 years of age, poorly differentiated adenocarcinoma, mucinous adenocarcinoma, tumor nodules, lymphovascular invasion, and perineural invasion are independent adverse prognostic factors of lymph node-negative colorectal cancer.

Analysis of Clavien-Dindo classification and its prognosis factors of complications after laparoscopic right hemicolectomy / 中华外科杂志

Objective@#To analyze the Clavien-Dindo classification of complications after right hemicolectomy and to explore the prognosis factors for postoperative complications.@*Methods@#The retrospective case-control study was adopted. The clinical data of 176 patients who underwent right hemicolectomy at Department of General Surgery, Peking Union Medical College Hospital from October 2016 to February 2018 were collected. There were 95 male and 81 female patients with age of (62.4±12.7) years. The Clavien-Dindo classification was used for postoperative complications. Univariate and multivariate analysis were used to analyze the independent prognosis factors of complications after right colon resection.@*Results@#Of the 176 patients, 2 patients had intraoperative complications (1.1%) and 39 patients had postoperative complications (22.2%), of which 10 cases had more than two complications, with a total of 53 complications. The proportions of Clavien-Dindo grade Ⅰ, Ⅱ, Ⅲ and Ⅳ complications were 41.5% (22/53), 49.1% (26/53), 7.5% (4/53), and 1.9%(1/53). Postoperative complications were associated with age, smoking history of the last 1 year, combined organ resection, lymph node dissection, intracorporeal anastomosis, and preoperative blood AST and Ca levels (all P<0.05). The results of multivariate analysis showed that intracorporeal anastomosis (OR=5.62, 95% CI: 2.46 to 12.85, P=0.00), preoperative blood AST (OR=-0.009, 95% CI: -0.018 to 0.000, P=0.04) and Ca (OR=0.51, 95% CI: 0.08 to 0.95, P=0.02) levels were independent prognosis factors affecting complications after right hemicolectomy.@*Conclusions@#Complications of right hemicolectomy were mainly Clavien-Dindo grade Ⅰ and Ⅱ. Laparoscopic intracorporeal anastomosis should be carefully chosen, which may increase postoperative complications.

Experience of transanal total mesorectal excision with laparoscopic assisted for min-low rectal cancer / 国际外科学杂志

Objective To investigate the advantages and disadvantages of transanal total mesorectal excision with laparoscopic assisted for min-low rectal cancer.Methods Retrospectively analyzed the clinical data of 38 patients with min-low rectal cancer who undement laparoscopically assisted transanal total anorectal rectal cancer from November 2014 to May 2018 in the Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.The main outcome measures included gender,BMI,the operating time,intra-operative blood loss,the intraand post-operative complication rate,the distal resection margin length and the circumferential resection margin status of the pathological specimen,the number of lymph nodes acquisitions,as well as the postoperative average hospitalization time.Results The surgery was completed smoothly for all patients in this studying,with no conversion to open surgery.Among all the 38 patients,there were 26 (68.4％) male cases and 12(31.6％) female cases,and 25 cases were with a body mass index (BMI) over 24 kg/m2.The average operating time was (175.2 ± 37.6) minutes.The average intra-operative blood loss was (63.9 ± 42.7) ml.The complications included 1 case of intra-operative presacral venous hemorrhage,and 6 cases of post-operative anastomotic leak (15.8％).There were 18 cases happened perioperative complications,and the rate was 47.4％.The average distance from the distal resection margin to the lower end of the tumor was (2.1 ± 0.4) cm.There were 34 cases of complete mesorectal excision.The average number of lymph nodes retrieved was 14.2 ± 4.5.The average postoperative hospital stay was (9.8 ±5.9) days.Conclusion Transanal total mesorectal excisionwithlaparoscopic-assisted formid-lowrectal cancer can more accurately ensure adequate distal margin and mesorectal integrity.

Comparison of intra-abdominal infection between intracorporeal anastomosis and extracorporeal anastomosis in patients undergoing laparoscopic right hemicolectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the difference of intra-abdominal infection between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in patients undergoing laparoscopic right hemicolectomy within postoperative 30 days.</p><p><b>METHODS</b>Clinical date of right colon cancer patients undergoing laparoscopic right hemicolectomy at the Department of Colorectal Surgery, PUMCH from January 1st, 2013 to October 31st, 2016 were retrospectively analyzed. Patients with stage IV cancers which could not be radically resected, emergency operation and conversion to open surgery were excluded. The intracorporeal anastomosis and extracorporeal anastomosis were compared in the items of operation time, postoperative infection and postoperative hospital stay.</p><p><b>RESULTS</b>A total of 194 patients were enrolled in the study, including 73 patients with IA and 121 patients with EA. No significant differences were found in gender, age, previous operation history, tumor site and T stage of the tumor between two groups (all P>0.05). There were also no significant differences in mean operative time (162.4 minutes vs. 167.7 minutes, P=0.257), time to first flatus (3.3 days vs. 3.4 days, P=0.744), number of harvested lymph nodes (30.3 nodes vs. 33.8 nodes, P=0.071) and postoperative hospital stay (7 days vs. 7 days, P=0.067) between two groups. The incidence of intra-abdominal infection in patients with IA was significantly higher than that in those with EA [13.7%(10/73) vs. 1.7%(2/121), P=0.001], while the differences of the incidence of wound infection [1.4%(1/73) vs. 3.3%(4/121), P=0.652], respiratory infection [1.4%(1/73) vs. 3.3%(4/121), P=0.652] and urinary tract infection [2.7%(2/73) vs. 0.8%(1/121), P=0.558] were not significant.</p><p><b>CONCLUSION</b>Compared with EA, IA may increase the risk of intra-abdominal infection in patients undergoing laparoscopic right hemicolectomy.</p>

Effects of Ringer’s sodium pyruvate solution on serum tumor necrosis factor-a and interleukin-6 upon septic shock

Objective: To study the effects of Ringer's sodium pyruvate solution on tumor necrosis factor-a [TNF-a] and interleukin-6 [IL-6] upon septic shock. Methods: Ninety emergency patients with septic shock were divided into a treatment group and a control group by random draw. The control group was resuscitated with 50 ml of compound sodium chloride [Ringer's solution], and the treatment group was given 50 ml of Ringer's sodium pyruvate solution. Both groups were basically treated. Results: All patients were successfully resuscitated. After treatment, extravascular lung water index, intrathoracic blood volume index, systemic vascular resistance index and cardiac index of the two groups were significantly improved compared with those before treatment [P<0.05]. However, there were no significant inter-group differences at different time points [P>0.05]. Blood lactic acid level, central venous oxygen saturation index and urine output were also improved after treatment, with significant inter-group differences [P<0.05]. Serum TNF-a and IL-6 levels of both groups significantly decreased after treatment [P<0.05], and the levels of the treatment group were significantly lower than those of the control group [P<0.05]. During 28 days of follow-up, the mortality rate of the treatment group [4.4%] was significantly lower than that of the control group [20.0%] [P<0.05]. Conclusion: Patients with septic shock are complicated with disordered expressions of inflammatory factors. During resuscitation, Ringer's sodium pyruvate solution can effectively promote blood circulation, mitigate inflammation and maintain acid-base equilibrium, thus decreasing the prognostic mortality rate

Predictive value of preoperative imaging and postoperative pathology on clinical complete response after neoadjuvant chemoradiation for locally advanced rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy and clinical significance of clinical complete response (cCR) after neoadjuvant themoradiotherapy for locally advanced rectal cancer.</p><p><b>METHODS</b>Locally advanced rectal cancer patients who received neoadjuvant chemoradiotherapy following radical resection were retrospectively assessed for tumor response during 2005 to 2014 from the database of colorectal cancer. The concomitant preoperative chemoradiation consisted of 50 Gy radiation, fractionated within 5 weeks and 5-FU combined with oxaliplatin. Endorectal ultrasound and MRI were applied to preoperative staging, and postoperative gross pathologic inspection was retrospectively employed to evaluate the status of clinical complete response(cCR).</p><p><b>RESULTS</b>A total of 227 patients undergoing radical surgery were enrolled in the study. Complete pathological response (ypT0N0, pCR) was found in 40 patients(17.6%) by postoperative pathologic examination while the rate of node involved in ypT0 patients was 11.1%. The preoperative rectal MRI was more sensitive to correlate ypT0 than endorectal ultrasound and gross pathologic inspection(60.0% vs 19.4% and 17.8%), but the accuracy and specificity showed no significant differences among these three tests. Multivariate Logistic regression analysis revealed preoperative MRI evaluation of cT0 might predict ypT0 independently(OR=4.975, 95% CI: 1.073 to 23.067, P=0.040).</p><p><b>CONCLUSION</b>It is difficult to diagnose the primary tumor to be a cCR status based on preoperative MRI, EUS, or ulceration of rectal mucosa, and further to predict pCR. Preoperative MRI is more sensitive. The strategy of "wait and see" for cCR patients after neoadjuvant chemoradiation should be seriously considered in the decision-making before surgery.</p>

Relation of personality to life satisfaction and depression in visual artists / 中国心理卫生杂志

Objective:To explore the linear and nonlinear relation of personality to life satisfaction and de-pression in visual artists.Methods:Totally 132 visual artists were recruited,most of them focused on painting, sculpture and photography.The Mini International Personality Item Pool-Five-Factor Model Measure (Mini-IPIP), the Satisfaction with Life Scale (SWLS)and the Center for Epidemiological Studies Depression Scale (CES-D) were adopted to all subjects.Results:The Mini-IPIP neuroticismscores had positive predictability to CES-D scores (β=0.41),while the scores of agreeableness,conscientiousnessand extraversionhad negative pre-dictability to CES-D scores(β=-0.27,-0.23,-0.19).Only conscientiousnessscores had positive predictabil-ity (β = 0.25 ) to SWLS scores in terms of linear relationship between personality traits and life satisfaction.Meanwhile,both'neuroticism'and conscientiousnessscores had U curve relationship with SWLS scores (β=0.32,0.22)after linear effects were controlled.Conclusion:It suggests that personality traits in visual artists could explain depression symptoms and life satisfaction.However,pattern between personality and life satis-faction may be more complex.

Promoter methylation and protein expression of tumor suppressor candidate 1 gene in adolescent papillary thy-roid carcinoma / 中华实用儿科临床杂志

Objective To study the relationship between status of methylation of tumor suppressor candidate 1 gene(TUSC1) promoter and expression of its protein in adolescent papillary thyroid carcinoma(PTC). Methods Forty cases of adolescent PTC were chosen and the corresponding para carcinoma tissues were taken from July 2010 to Decem-ber 2013 in the First Affiliated Hospital of Zhengzhou University surgical specimens of the thyroid gland and were con-firmed by pathology. Male 12 cases,female 28 cases,median age 14 (10-18) years old. Tumor node metastasis (TNM) stageⅠ-Ⅱ13 cases,Ⅲ-Ⅳstage 27 cases;gradeⅠin 15 cases,gradeⅡin 25 cases;lymph node metastasis in 22 cases,18 cases were negative. Methylation-specific polymerase chain reaction (MSP) and Western blot were applied respectively to examine the methyaltion of TUSC1 gene promoter and its protein expression of 40 samples of adolescent PTC and their matched adjacent non-cancerous epithelium. Results The results of MSP revealed that there was no methylation of TUSC1 gene promoter in adjacent non-cancerous epithelium,while in the adolescent PTC,the hyper-methylation rate was 60%(24/60 cases,χ2=34. 28,P<0. 05). In additional,it was related to the TNM stage,pathological grade and lymph node metastasis (χ2=4. 862,7. 111,5. 625,all P<0. 05). The result of Western blot revealed that the positive expression rate of TUSC1 protein was 100% in adjacent non-cancerous epithelium and 30%(12/40 cases) in adolescent PTC (χ2=14. 118,P<0. 05),which was related to the TNM stage,pathological grade and lymph node metastasis (χ2=5. 215,6. 222, 5. 079,all P<0. 05). There was distinct correlation between methylation of TUSC1 gene promoter and the protein expres-sion (r=-0. 84,P<0. 05). Conclusions Methylation of promoter might be one of the important mechanisms of inactiva-tion of TUSC1 gene,and might play an important role in carcinogenesis and progression of adolescent PTC.

Feasibility and short-outcomes of laparoscopic extralevator abdominoperineal excision without changing position for distal rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the short-term outcomes of laparoscopic extralevator abdominoperineal excision (ELAPE) without changing position during operation.</p><p><b>METHODS</b>Totally 51 patients with distal advanced rectal cancer received surgical operation in Peking Union Midical College Hospital from September 2011 to April 2014. There were 29 male and 22 female patients with a mean age of (61 ± 10) years. Twenty-six percent of the patients received preoperative concomitant chemotherapy and radiation. Twenty-seven patients underwent laparoscopic abdominoperineal excision (APE) procedure, while 24 patients underwent ELAPE procedure. In both groups, patients were kept Lithotomy-Trendelenburg position during operation. The fat tissue in ischialrectal fossa was not routinely removed, except the tumor invasion. All the patients' pelvic peritoneum was closed by continuous suturing, and subcutaneous tissue and skin by interrupted suturing. Retrospectively compare the pathoclinical features, operation time, bleeding, node retrieval, lateral margin and complications by t-text and χ(2) test respectively between ELAPE and APE procedures both by laparoscopic approach.</p><p><b>RESULTS</b>No significant differences were found in term of age, gender, BMI, distance from anal verge, percentage of neoadjuvant chemoradiation, and TNM staging between these two groups (all P > 0.05). The operation time was significantly shorter in ELAPE group ((181 ± 41) minutes vs. (228 ± 58) minutes, t = -3.265, P = 0.002). The bleeding volume was less in ELAPEE group (50 (80) ml vs 80 (100) ml (M(QR)), Z = -2.259, P = 0.024). The lateral margin, urinal retention and perineal wound healing were comparable for these two groups. No pelvic hernia was found during the postoperative follow-up (2 to 34 months) in both groups (all P > 0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic extralevator abdominoperineal excision without changing position is feasible for distal rectal cancer. Some essential steps can be simultaneously accomplished during operation without changing position. Closing the pelvic peritoneum is important for preventing the intestine dropping from abdominal cavity to presacral cavity.</p>

Reliability and validity of public mood scale in college students / 中华行为医学与脑科学杂志

Objective To develop the public mood scale and test its reliability and validity,and explore the components construct of the public mood.Methods 423 college students responded to the inventory.Correlation analysis,exploratory factor analysis and confirmatory factor analysis were applied to the data analysis.Results Public mood scale was consisted of two dimensions,positive emotions and negative emotions.Factor analysis indicated that the two factors explain 61.3％ of the variance with factor loading ranging from 0.68 to 0.86;The Cronbach' s coefficients of positive and negative public mood were 0.81 and 0.76 respectively; Conffirmatory factor analysis indicated that the public mood scale had ideal structure validity.Joint factor analysis showed that public mood and personal mood were separated.Positive public mood had positive correlations with Big Five personalities,which were extraversion,agreeableness,responsibility and openness (r =0.22-0.33,P＜ 0.01),negative correlation was found between neuroticism and positive public mood(r=-0.25,P＜0.01).Positive public mood had significant positive correlation with government satisfaction,economic development confidence and social stability(r=0.34-0.45,P＜0.01),while they had significant negative correlations with negative public mood (r =-0.32--0.24,P＜ 0.01).Conclusion The public mood scale obtained in the present study has ideal validities and reliabilities and it is suitable to assess the public mood.

A Label-free and Separation-free Detection for Melamine Based on Surface Enhanced Raman Scattering / 分析化学

A rapid, sensitive, label-free and separation-free analytical method for determination of melamine ( MA) was developed based on surface enhanced Raman scattering ( SERS ) effect of gold nanoparticles. Through tri-sodium citrate reduction method, gold nanoparticles with average diameter of 30 nm were obtained. The melamine detection platform was constructed after self-assembling 4-mercapto phenylboronic acid (4-MPBA) on the surface of gold nanoparticles through Au S covalent bond. When MA existed in solution, 4-MPBA functionalized gold nanoparticles would aggregate because of strong hydrogen bond interaction between MA and 4-MPBA. Moreover, following increase of the concentration of MA, gold nanoparticles would aggregate more intensively and form more hot spots. As a result, Raman signal of 4-MPBA and MA was enhanced greatly. The characteristic Raman peaks of 4-MPBA and MA respectively located at 1076 cm-1 and 715 cm-1 . Hence, the qualitative and quantitative detection for MA were realized based on the ratio value of I715 cm-1 to I1076 cm-1 . The linear range of MA detection was 0 . 1 μmol/L-1. 5 μmol/L. The limit of detection (LOD) reached 0. 02 μmol/L in terms of three times signal to noise.

Clinicopathologic characteristics,diagnosis and treatment of rectal gastrointestinal stromal tumor / 基础医学与临床

The incidence of rectal gastrointestinal stromal tumor is low,adequate diaganosis depends on the histopathological and immunohistochemical examination.Its treatment is a comprehensive therapy including surgery and molecular targeted therapy etal.The rectal gastrointestinal stromal is easily recurrent after operation,and so needs surveillance and following up.

Early X-ray Diagnosis of Congenital Dislocation and Developmental Dysplasia of the Hip in Newborn and Infant / 实用放射学杂志

Objective To study the diagnostic method with computed radiography for congenital dislocation of the hip(CDH) and developmental dysplasia of the hip(DDH) in early stage in newborn and infant.Methods Followed-up with computed radiography made a comparison between 47 abnormal hips (CDH and DDH ) in 26 infants ,and 60 normal hips in 30 infants.Results (1)The normal pattern of acetabulum in neonate and infant appeared as definite“—”,indefinite“—” was considered as abnormal,its sensitivity,specificity and accuracy was 100%,91.59 and 85% respectively,and statistical comparison P