Objective To further evaluate the long-term survival benefits and prognostic analysis of locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy.
Methods Clinical characteristics of locally advanced rectal cancer patients were retrospectively collected from January,2013 to January,2016 in the Department of General Surgery of Beijing Chaoyang Hospital.Kaplan-Meier for survival curve and log-rank test for univariate prognostic analysis,Cox proportional hazard model was used for multivariate analysis.
Results A total of 97 rectal cancer patients were included.All patients received nCRT and TME.The median follow-up time was 39(6~83) months.The cumulative 5-OS and DFS were 77.4% and 74.1% respectively.Univariate prognostic analysis revealed that advanced ypTNM stage(χ2=11.282，P=0.01),ypN+(χ2=8.134，P=0.004) and non-pCR(χ2=4.550,P=0.033) patients had a worse OS,while ypN+(χ2=5.007，P=0.025) and lymphvascular invasion(χ2=3.330,P=0.048) were significantly associated with decreased DFS.Multivariate analysis showed that ypN stage was independent risk factor for both OS(HR=3.006,95%CI:1.220~7.407,P=0.017)and DFS(HR=2.998,95%CI:1.138~7.894,P=0.026).
Conclusion ypN+ was independent risk factor for both OS and DSF for locally advanced rectal cancer who received neoadjuvant chemoradiotherapy,and consolidation therapy after nCRT might be benefical for patients with high risk factors.

Objective To investigate the risk factors of respiratory complications after right hemicolectomy,and to explore the prevention measures.
Methods A total of 336 patients who underwent right hemicolectomy from June 2012 to may 2020 were selected as the study subjects.According to the occurrence of postoperative respiratory complications,they were divided into respiratory complications group(25 cases) and no respiratory complications group(311 cases).The gender,age,body mass index,long-term smoking history,respiratory diseases,diabetes,American Society of Anesthesiologists scores,preoperative albumin,preoperative hemoglobin,disease nature,lesion location,operation type,operation method,compliance with the principle of complete mesocolic excision,operation time,and bleeding during the operation were analyzed by univariate analysis and multivariate logistic regression.
Results Univariate analysis showed that age ≥65 years,respiratory diseases,emergency surgery and operation time >3 hours related to respiratory complications after right hemicolectomy(P＜0.05).Multivariate analysis showed that age ≥65 years and respiratory diseases were independent risk factors of respiratory complications after right hemicolectomy(P＜0.05).
Conclusion The elderly and respiratory diseases will increase the risk of respiratory complications after right hemicolectomy.High risk population should be screened before right hemicolectomy.Reasonable preventive measures should be taken for the patients who were old and had respiratory diseases to reduce the incidence of postoperative respiratory complications.

Objective To investigate the risk factors of delayed perineal incision healing after abdominoperineal resection(APR) for low rectal cancer.
Methods A total of 172 patients with low rectal cancer who underwent APR from July 2008 to June 2020 were selected as the study subjects.According to the occurrence of delayed perineal incision healing,they were divided into delayed incision healing group(42 cases) and incision healed normally group(130 cases).The gender,age,body mass index,diabetes,score of American society of anesthesiologist,preoperative hemoglobin,preoperative albumin,neoadjuvant chemoradiotherapy,size of tumor,operation mode,pelvic floor restoration,operation time,bleeding during operation and depth of tumor invasion were analyzed by univariate analysis and multivariate logistic regression analysis.
Results Univariate analysis showed that body mass index≥28kg/m2,diabetes,preoperative albumin<35g/L,neoadjuvant chemoradiotherapy and no pelvic floor restoration related to delayed perineal incision healing after APR(P<0.05).Multivariate logistic regression analysis showed that neoadjuvant chemoradiotherapy was independent risk factor of delayed perineal incision healing after APR(P<0.05).
Conclusion Patients with low rectal cancer undergoing neoadjuvant chemoradiotherapy will increase the risk of delayed perineal incision healing after APR.we should screen relevant high-risk groups before operation and take active and reasonable treatment measures to reduce the impact of delayed perineal incision healing to help patients recover.

Objective To investigate the diagnostic value and clinical significance of gastrointestinal barium meal retention abdominal radiography in slow transit and outlet obstructive constipation.
Methods The X-ray data of gastrointestinal barium meal retention abdomen in 95 patients with moderate and severe constipation rated by Cleveland constipation scale were analyzed retrospectively.
Results By observing the morphology of the intestine and the retention time of barium,it was found that more than 91.6% of the patients reported that the activity of the right colon was hyperactive or normal,the transverse colon was long,and the transit time of the descending colon and its distant emptying disorder was significantly prolonged.Accompanied by loss or stiffness of colonic bands and mucosal folds.
Conclusion Abdominal radiography of gastrointestinal barium meal retention has important diagnostic value in slow transit and outlet obstructive constipation,and has important guiding significance for clinical treatment of etiology.

Objective To explore the titer ratio of local resection through anus and endoscopic submucosal dissection(ESD) for the treatment of large adenoma of lower rectum,so as to provide a reference for the rational choice of operation.
Methods From November 2012 to November 2019,96 patients with large low rectal adenoma were divided into two groups according to two surgical methods,48 cases in the observation group were treated with traditional transanal local resection,and 48 cases in the control group were treated with endoscopic submucosal dissection(ESD).The operation efficacy,anal pain,hospitalization expenses and consumables ratio of the two groups were compared.
Results There was no significant difference between the two groups in complete resection rate,whole block resection rate,postoperative complication rate and local recurrence rate(P>0.05).The VAS scores of postoperative anal pain at 2h, 8h and 12h in the local anal resection group were higher than those in the ESD group, and the difference was statistically significant(P<0.05);the cost of hospitalization and the ratio of consumables in the local anal resection group were significantly lower than that in the ESD group(P<0.05).
Conclusion In the treatment of low rectal adenoma,the best operation should be selected according to the patient's condition,the level of hospital medical technology and the patient's economic situation.
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Objective To investigate the effect of miR-711 on invasion,invasion,proliferation and epithelial-mesenchymal transition of colon cancer stem cells.
Methods Colon cancer stem cells were isolated from human colon cancer cell lines HT-29 by flow cytometry.miR-711-mimics and miR-NC were transfected into colon cancer stem cells.qRT-PCR was used to detect the expression of miR-711 mRNA.MTT was used to detect cell proliferation.Transwell test was used to detect cell migration and invasion.Western blot was used to detect the protein expression of E-cadherin,N-cadherin,Vimentin.
Results The percentage of CD44+/CD133+in colon cancer cell line HT-29 was the highest(29.90%).The expression of miR-711 in over-expression group was higher than that in empty group and blank group(P<0.05).The proliferation,invasion ans migration ability of over-expression group was lower than those of empty group and blank group(P<0.05).The expression level of E-cadherin protein in over-expression group was higher than that of empty group and blank group(P<0.05).The expression level of N-cadherin,Vimentin protein in over-expression group were lower than those of empty group and blank group(P all<0.05).
Conclusion Up-regulation of miR-711 can inhibit the invasion,invasion,proliferation and epithelial mesenchymal-transition of colon cancer stem cells.

Objective To explore the effect of enteral nutrition support on gastrointestinal function,nutritional status and stress inflammatory response with gastric cancer after radical operation.
Methods The 98 patients with gastric cancer who underwent radical gastrectomy in our hospital from January 2017 to January 2020 were randomly divided into observation group(49 cases) and control group(49 cases).The observation group was treated with enteral nutrition support,while the control group was treated with parenteral nutrition support.The exhaust time,bowel sound time,defecation time,preoperative, postoperative 1 day and 7 days after the changes of nutritional status and intestinal flora, and postoperative 1 day and 7 days after the changes of stress response were compared between the two groups.〖WT5”HZ〗Results The exhaust time,bowel sound time and defecation time of the observation group were faster than those of the control group(P<0.05).After postoperative 7 d,the observation group level of ALB and PA was higher control group(P<0.05).After postoperative 7 d,the observation group number of bifidobacteria was more control group,while that in the Enterococcus and Escherichia coli postoperative 7 d was less control group(P<0.05).After postoperative 7 d,the observation group levels of CRP,IL-6 and Cor in the observation group postoperative 7 d were lower control group(P<0.05).
Conclusion Enteral nutrition support has obvious effect with gastric cancer after operation,which can significantly improve the gastrointestinal function,improve the nutritional status of the patients,correct the intestinal flora disorder and reduce the stress response.

Objective Based on large sample data,to explore the 5-year mortality risk factors and 5-year mortality prediction model of young-onset rectal cancer patients.
Methods The clinical data of 6817 young-onset patients with rectal cancer were screened from the SEER clinical database of the National Cancer Institute,and then we evaluated the death-related risk factors in young patients with rectal cancer by univariate and multivariate regression analysis methods.Finally,the Nomogram prediction model was summarized and its accuracy was verified.
Results The results of Univariate and multivariate regression analysis showed that gender,marital status,Stage classification,T stage,N stage,radiotherapy,tumor size,and number of lymph nodes were the death-related risk in young-onset rectal cancer patients within 5 years.The Effective predictive performance of Nomogram prediction model was confirmed by the Area Under Curve of ROC(0.833，95%CI：0.823-0.843，P<0.001) and calibration curve for the risk of death of young-onset rectal cancer.
Conclusion The constructed nomogram chart can effectively predict the death-related risk of young-onset rectal cancer patients within 5 years,and has clinical guiding significance for the prognostic intervention of young-onset rectal cancer.

Objective Summarize the clinical characteristics of gastrointestinal tract schwannoma.
Methods Using schwannoma as the search term,the clinical case reports of gastrointestinal tract schwannomas published in the CNKI database,Wanfang database,and Pubmed database during 2018-2020 were searched,and statistics and summary were made.
Results The 81 patients with gastrointestinal tract schwannoma were mostly female,aged between 31-84 years old and most of them occur in the stomach.The diameter of the tumor was between 0.2-9 cm.The clinical manifestations were mostly abdominal pain and bloating as the first symptoms,but most patients had no obvious symptoms.The accuracy of preoperative diagnosis was only 8.6%.All patients showed positive s-100 immunohistochemical expression after surgery.Complete resection of the mass or partial gastric (colorectal) resection was the main surgical method,and there was no recurrence or metastasis after surgery.
Conclusion Gastrointestinal  tract schwannoma is a benign tumor that is rare in the gastrointestinal tract.It has a high preoperative misdiagnosis rate.S-100 positive is the gold standard for diagnosis;surgical treatment is the main method,and the prognosis is rarely recurrence and metastasis.

Objective To investigate the clinical manifestations, diagnosis and treatment of ischemic colitis (IC), and to analyze the misdiagnosis factors.
Method From January 2017 to September 2019,17 IC patients were reported and analyzed for their clinical features and diagnosis and treatment process.Except for 2 patients with peritonitis who did not undergo colonoscopy and underwent surgical operation,all the others whose condition was stable were diagnosed by early colonoscopy.15 patients were treated with anti-inflammatory,diet control,circulatory improvement,anticoagulation and fluid supplementation.The other 2 patients with peritonitis received surgical treatment,1 of whom underwent resection of the right half colon due to intestinal necrosis and recovered successfully after opration;Another patient was found with poor intestinal blood supply and scattered serous membrane necrosis during the operation.The family member refused to undergo intestinal resection and received abdominal drainage.The patient recovered with postoperative drug therapy.
Results All patients were middle-aged and elderly,more female than male,most of them were with diabetes,hypertension,coronary heart disease,hematological system diseases and other underlying diseases.All  patients had recovered and been released from hospital,with an average of two weeks in hospital.In the follow-up,except for 2 chronic patients,recurrence was not observed in the rest of the drug prevention.
Conclusion The middle-aged and the elderly,especially with the underlying diseases,should be vigilant the IC,if the abdominal pain,diarrhea,blood in the stool were appeared,and stable patients should be diagnosed early by colonoscopy.However,for patients with recurrent peritonitis,the rate of misdiagnosis is high,and early surgical treatment should be taken to patient with intestinal necrosis and perforation to reduce the mortality rate.

Objective To investigate the relationship between lymph node metastasis and r and clinical pathology in patients with left lung cancer resection combined with regional lymph node dissections.
Methods A retrospective analysis of 90 patients with left lung cancer resection combined with regional lymph node dissection in our hospital from February 2017 to February 2019 Patients was performed.Pathological analysis of the patient's clinical data and analysis of the correlation between lymph node metastasis and risk factors.
Results The number of metastases in upper lobe of left lung was higher than that in lower lobe of left lung(P<0.05).The number of small cell carcinoma metastases was significantly higher than that of adenocarcinoma and squamous cell carcinoma,and squamous cell carcinoma was significantly higher than adenocarcinoma(P<0.05).T3 was significantly higher than T1,T2,T4,while T2 was significantly higher than T1,T4,and T4 significantly higher than T1(P<0.05).The number of poorly differentiated metastases was significantly higher than that of the high differentiated and moderately differentiated,and moderately differentiated was significantly higher than high differentiated(P<0.05).The total left upper lung metastasis rate was 29.76%,of which groups 3 and 10 were the most;the total left inferior lung metastasis rate was 20.92%,of whichgroup 6 the most.
Conclusions The upper left lung is easily metastasized to lymph nodes in groups 3 and 10,the left middle lung is easily metastasized to lymph nodes in group 3,and the inferior left lung is easily metastasized to lymph nodes in 6 groups.At the same time,the risk factors for metastasis are related to tumor size,pathological classification,tumor location,and degree of pathological differentiation,and not to patient age,smoking,and gender.

Objective To investigate the clinical application of laparoscopic cholecystectomy(LC) combined with transabdominal anterograde  guided endoscopic retrograde cholangiopancreatography(CP) in the treatment of cholecystolithiasis with  small diameter choledocholithiasis.
Methods The 80 patients with cholecystolithiasis and small diameter choledocholithiasis admitted to our hospital from January 2017 to December 2018 were divided into the control group(40 cases) and the observation group(40 cases) according to random number table method.The observation group was treated with LC and transabdominal anterograde  guided Endoscopic Retrograde Cholangiopancretography,while the control group was treated with oral CP+ LC.The operation conditions,postoperative complications,residual stones,liver function at 3 days before and after operation,pain levels before and 7 days after operation,and quality of life before and 3 months after operation were compared between 2 groups.
Results Compared with the control group,the observation group's intraoperative blood loss,anal exhaust time,gastrointestinal function recovery time,drainage tube placement time,and hospital stay were significantly reduced(P＜0.05),there was no statistical difference in the residual rate of stones.After operation,there was no significant difference in the changes of serum ALT,AST and TB levels between 2 groups(P＞0.05).3 days after operation,the serum ALT,AST and TB levels,VAS Ⅰ,Ⅱ grade Ⅲ and grade Ⅳ were significantly reduced(P＜0.05),and life satisfaction,health index and emotional scores were significantly reduced(all P＜0.05).
Conclusion LC combined with transabdominal anterograde guided ERCP has good clinical effect in the treatment of cholecystolithiasis with small diameter choledocholithiasis,fewer complications,improve quality of life,which is worthy of clinical recommendation.

Objective To choose drug-coated balloon combined with Turbohawk plaque volume reduction therapy in patients with lower extremity arteriosclerosis occlusive disease,and compare it with DCB therapy alone to analyze the safety and effectiveness of its treatment.
Methods The subjects of the study were 84 ASO patients admitted to our hospital from August 2014 to August 2018.Patients in the simple group received DCB expansion therapy(40 cases),and patients in the combined group received DCB expansion combined with DA volume reduction therapy(44 cases).Observation indicators include the incidence of perioperative adverse reactions,follow-up indicators and prognostic indicators.
Results The incidence of adverse reactions in the combination group was significantly lower than that in the simple group [(2.3%) vs(12.5%)](P<0.05).At 24 months postoperatively,the Rutherford grade [(1.31±0.68) vs(2.86±0.82)],late lumen loss(LLL) [(0.41±0.76)mm) vs(0.98±0.87)mm] and restenosis rate (6.8% vs. 25.0%) in the combination group were significantly lower than those in the simple group,while the ankle-brachial index(ABI) [(0.87±0.14) vs(0.65±0.14)],the minimum diameter of the target vessel(MLD) [(4.18±0.84)mm vs(3.17±0.55)mm].The target lesion revascularization rate(TLR) (2.3% vs. 15.0%) was significantly better than that of the simple group(P<0.05).The improvement rate of walking disorder (72.7% vs. 42.5%) and 6-minute walking distance [(44.23±9.24)m vs(27.60±8.81)m] in the combined group were significantly better than those in the simple group(P<0.05).
Conclusion The use of DCB combined with DA in lower extremity arteriosclerosis occlusive disease has the advantages of safety,efficiency and stability.It can effectively maintain sufficient vascular lumen and control lumen loss in patients and restenosis rate.

Objective This study is to explore the relationship between blood components and thrombosis CT imaging of the(Deep vein thrombosis)DVT by Force CT spectrum,clarify the influence factors of thrombosis CT value,early evaluation on the study of thrombus stability.
Methods Analysis of 21 patients with suspected lower extremity deep venous thrombosis was conducted from Dec,2015 to Jan,2017.Scanning all the patients by SOMATOM Force CT after the injection of contrast agent in the elbow vein,recording vessel and thrombus shape,thrombus distribution and collateral vessels on CT enhanced image.Reconstructed the image and uploaded the data to the workstation.The 40-190Kev of Energy spectrum image can be obtained by energy spectrum analysis software.All the subjects were tested for hemoglobin,red blood cells and platelets.SPSS regression analysis was used to determine the relationship between the CT value of each single energy and the blood components.
Results According to the 40-190Kev,among red blood cell,hemoglobin and platelet,only hemoglobin has statistical relationship with blood CT values,only hemoglobin has a significant influence on the CT value of blood.The relationship between thrombosis CT spectrum curve of thrombus and blood components:through multiple stepwise regression analysis showed that regression equation between 40-190 Kev single energy thrombus CT and red blood cells,hemoglobin,platelet were no significant difference in all the regression equations(F=1.12~3.14,P>0.05),there was no obvious correlation between spectrum CT value of thrombus and red blood cells,hemoglobin,platelet.
Conclusion In normal blood,hemoglobin is the main factors influencing the CT value of blood,while red blood cells and platelets of blood CT value had no significant influence;there are no significant correlation between thrombosis and energy spectrum and CT value of blood red blood cells,hemoglobin,platelet.

Objective To investigate the expression regulation mechanism of miR-5189-3p in deep venous thrombosis of lower limbs through animal model test.
Methods 48 SPF SD rats were selected.They were randomly divided into 4 groups:normal control group(group A),simple inferior vena cava thrombosis model group(group B),hsa-miR-5189-3p mimics group(group C) and hsa-miR-5189-3p NC group(group D),with 12 mice in each group.DVT modeling was carried out in SD rats.24 hours after the modeling was completed,four groups of SD rats were sacrificed for cervical dislocation,and the thromboembolization of SD rats with inferior vena cava thrombosis was observed and tissue samples were collected.Pathological changes of SD rats' inferior vena cava and its contents were observed by pathological HE staining sections.Real-time fluorescence quantitative PCR was used to detect the expression differences of JAG1,Notch1 and Hes1 in inferior vena cava tissues of SD rats.
Results In the miRNA mimics group and the miRNA mimics negative control group,there were more nucleated cells in the thrombotic tissue,the degree of organization increased,and some small fissures were generated and formed in the peripheral area of thromboembolism,thus forming the lumen like structure with signs of blood flow recanalization.Real-time fluorescence quantitative PCR results of JAG1,Notch1 and Hes1 showed that after upregulation of miR-5189-3p,the expression levels of JAG1,Notch1 and Hes1 increased significantly(P<0.05).
Conclusion hsa-miR-5189-3p may be a key miRNA for deep venous thrombosis of lower extremities.

In the surgical treatment of colorectal malignant and benign diseases,laparoscopic technology is more and more widely used.With the progress of equipment and instruments,and the support of evidence-based medicine,laparoscopic surgery has become the main minimally invasive technology of abdominal surgery.Laparoscopy has not only brought about the progress of minimally invasive technology,but also made great progress in the treatment scheme,operation mode,anatomical level and energy platform.In recent years,colorectal anatomical landmarks,operation level and operation approach have been established.The operation technology is becoming more and more mature.Lymph node dissection and digestive tract reconstruction have been standardized,experts and scholars continue to explore on the basis of standardization,and derive more new surgical methods,under the premise of ensuring the curative effect,they pay more attention to minimally invasive and functional preservation.This article focuses on the application of laparoscopy in colorectal surgery for benign and malignant diseases.

Lateral lymph node metastasis(LLNM) is one of the main risk factors for lateral pelvic recurrence and leading poor prognosis after total mesorectal excision for rectal cancer.Lateral lymph node dissection(LLND) has been proven as effective approach to control LLNM.For a long time,LLND was mainly performed in Eastern Asian including Japan,China,and South Korea.However,in recent years,LLND has been increasingly adopted in Western countries.LLND is technique demanding with longer learning curve.Besides,heavy bleeding and pelvic plexus injury is easy to occur during the procedure and would cause high incidence of urogenital dysfunction.Up to now,LLND still lacks standard surgical approach and scope.In this review,we would summarize the current evidence of LLND in terms of surgical indication,key steps,and postoperative complication.

Lymph node metastasis is the main way of breast cancer metastasis.Axillary lymph node status is one of the important prognostic factors of breast cancer patients.Preoperative evaluation of axillary lymph node status and location of abnormal axillary lymph nodes play an important role in the decision-making of comprehensive treatment for breast cancer.Axillary ultrasonography is particularly important for early detection,diagnosis and treatment of breast cancer.