Research progress in predicting the difficulty of surgery for middle and low rectal cancer based on pelvic measurement / 中华消化外科杂志

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

The role of adipose-derived exosomes in the pathological progression of atherosclerosis / 生理学报

Atherosclerosis is a chronic inflammatory disease of vascular walls with a complex etiology. In recent years, the incidence of atherosclerosis continues to increase with obesity and diabetes as major risk factors. As an important metabolic organ in the body, adipose tissue also has a powerful endocrine function. In the case of obesity and diabetes, various cytokines and exosomes derived from adipose tissue mediate organ-organ/cell-cell crosstalk, and are involved in the occurrence and development of various diseases. As an important intercellular communicator, exosomes regulate the pathological process of various cardiovascular diseases and are closely related to atherosclerosis. In this paper, we reviewed the mechanism of adipose-derived exosomes in atherosclerosis with focus on endothelial dysfunction, inflammatory response, lipid metabolism disorder and insulin resistance, hoping to provide reference for the research, diagnosis and treatment of atherosclerosis.

The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study / 中华外科杂志

Objective: To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. Methods: Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (M(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the χ2 analysis, and a paired χ2 test was used to compare diagnostic validity. Results: Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received in vivo puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% vs. 60%, χ2=17.500, P<0.01) and accuracy (88.5% vs. 74.4%, χ2=5.125, P=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (χ2=4.026, P=0.045). The accuracy of the in vivo puncture was 94.4%, which was 83.3% of the in vitro puncture (χ2=1.382, P=0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (χ2=7.112, P=0.029). Conclusion: TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.

A new γ-valerolactone derivative from the roots of Ardisia crispa / 药学学报

Four compounds were isolated from the 70% EtOH extract of Ardisia crispa by using various chromatographic techniques, including silica gel, ODS and semi-preparative HPLC. The structures of 1-4 were elucidated based on physicochemical properties and spectroscopic data. These compounds were defined as crispalactone A (1), (+)-pinoresinol (2), 3,5-dimethoxy-4- hydroxyphenol-1-O-β-D-glucopyranoside (3) and (+)-schizandriside (4). Compound 1 is a new γ-valerolactone derivative, and compounds 2-4 are firstly isolated from Ardisia crispa.

Quantitative determination of nine furanocoumarins for quality evaluation of Angelica dahurica from different habitats / 中国中药杂志

A UPLC method has been developed for simultaneous determination of nine furanocoumarins of Angelica dahurics,and was used for quality evaluation of A. dahurica from different habitats. ACQUITY UPLC BEH C18 chromatographic column was employed,the separation was performed with the mobile phase consisting of acetonitrile and water,and the detection wavelength was set at254 nm. This method was used to simultaneously determine the content of xanthotoxol,oxypeucedaninhydrate,byak-angelicin,psoralen,xanthotoxin,bergapten,oxypeucedanin,imperatorin and isoimperatorin in A. dahurica from different habitats. Then,the further quality assessment of the drug was carried out by similarity evaluation,cluster analysis( CA),principal component analysis( PCA),and orthogonal partial least squares discriminant analysis( OPLS-DA). The content order of measured furanocoumarins from high to low was: oxypeucedanin>imperatorin>isoimperatorin>oxypeucedaninhydrate>bergapten>byak-angelicin>xanthotoxin>xanthotoxol>psoralen,with the mean content 2. 844,1. 277,0. 649 2,0. 216 2,0. 129 8,0. 062 68,0. 052 68,0. 019 30,0. 018 19 mg·g-1,respectively. There were difference between the batches of the drug,and the quality was influenced by smouldering sulphur based on the results of chemical pattern recognition and content determination. Finally,six active ingredients were recognized as the quality makers using OPLS-DA method. The validated UPLC fingerprint combined with chemical pattern recognition method can be used in the quality control and evaluation of A. dahurica.

Epidemiological investigation of burn patients with Klebsiella pneumoniae infection and the analysis of risk factors for sepsis in them / 中华烧伤杂志

Objective@#To analyze the prevalence trend of Klebsiella pneumoniae (KP) infection in the Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine (hereinafter referred to as the author′s department) from 2015 to 2017, and to screen out the independent risk factors for sepsis in burn patients with KP infection.@*Methods@#The clinical and bacteriological data of burn patients with KP infection from January 1, 2015 to December 31, 2017 were collected from the author′s department. The variation trend in infection rates of KP and carbapenems-resistant KP (CRKP) during the three years were statistically analyzed, and the data were processed with chi-square test. Clinical data were processed with binary logistic regression analysis to screen out the independent risk factors for sepsis in burn patients with KP infection.@*Results@#(1) From 2015 to 2017, 91 patients (50 males and 41 females, aged 15-90 years) with KP infection were diagnosed in the author′s department, of which 65 cases were CRKP positive, and 26 cases were carbapenems-sensitive KP positive. The KP infection rates of patients in 2015, 2016, and 2017 were 5.79% (35/605), 4.08% (23/564), and 5.54% (33/596), respectively. The CRKP infection rates of patients in 2015, 2016, and 2017 were 3.31% (20/605), 3.37% (19/564), and 4.36% (26/596), respectively. There were no statistically significant differences in KP infection rate and CRKP infection rate of patients among the three years (χ2=2.007, 1.175, P>0.05). (2) Total burn area and CRKP infection were independent risk factors for sepsis in burn patients with KP infection (odds ratios=1.03, 5.88, 95% confidence intervals=1.01-1.05, 1.08-31.94, P<0.05).@*Conclusions@#From 2015 to 2017, the infection rates of KP and CRKP in the author′s department did not increase obviously, but the proportion of CRKP infection was high. CRKP infection is one of the independent risk factors for sepsis in burn patients with KP infection. Strengthening the prevention and treatment of CRKP infection may have certain value in decreasing the incidence of burn sepsis.

Effect of atopy on serum glucocorticoid receptor levels in children with bronchiolitis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of atopy on the expression of glucocorticoid receptors in children with bronchiolitis.</p><p><b>METHODS</b>ELISA was used to measure the changes in the serum levels of glucocorticoid receptor α (GRα) and glucocorticoid receptor β (GRβ) in the bronchiolitis group (77 children, including 34 children with atopy) and pneumonia group (68 children). Thirty-eight children who were prepared to undergo surgeries for non-infectious diseases and had no atopy or family history of allergic diseases were enrolled as the control group.</p><p><b>RESULTS</b>The bronchiolitis group and the pneumonia group had significant increases in the serum levels of GRα and GRβ compared with the control group (P<0.01), and the bronchiolitis group had significant increases in these levels compared with the pneumonia group (P<0.01). Compared with the control group and the pneumonia group, the bronchiolitis group had a significant increase in the GRα/GRβ ratio (P<0.01). Compared with the control group, the children with or without atopy in the bronchiolitis group had significant increases in the serum levels of GRα and GRβ (P<0.01). The non-atopic children in the bronchiolitis group had a significant increase in the serum level of GRβ compared with the atopic children (P<0.01). The atopic children in the bronchiolitis group had a significant increase in the GRα/GRβ ratio compared with the control group and non-atopic children in the bronchiolitis group (P<0.01).</p><p><b>CONCLUSIONS</b>Children with bronchiolitis have increased serum levels of GRα and GRβ. The children with atopy have an increased GRα/GRβ ratio, suggesting that the atopic children with bronchiolitis are highly sensitive to glucocorticoids.</p>

Application of homemade wrist constraints for postoperative patients during anesthesia recovery period / 局解手术学杂志

Objective The purpose of this study is to evaluate the safety and effect of the homemade wrist restraint belt in postoperative patients during anesthesia recovery period.Methods Three hundred postoperative patients were randomly assigned into two groups,patients in the control group(n =150)were constrained with traditional restraint belt while patients(n =150)in the observation group were constrain-ed with homemade wrist restraint belt before recovered from general anesthesia in the post anesthesia care unit (PACU).The effectiveness of constraint,patients comfort,constraint related complications,PACU faculty responses on the satisfaction were recorded during anesthesia re-covery period.Results The complications in the observation group were lower than those in the control group (P <0.05).Compared with con-trol group,the patient satisfaction,patient comfort,PACU faculty satisfaction were significant higher in the observation group (P <0.05).Con-clusion The homemade wrist constraints could increase the patient’s safety and comfort,reduce restraint belt related complications during anesthesia recovery period.It revealed more effectiveness than the traditional restraint belt.

Inverse dynamics simulation on lower limb responses of badminton athlete under impact loads / 医用生物力学

Objective To analyze the badminton athletes’dynamic responses in their lower limbs under impact loads. Methods A human musculoskeletal model was established based on AnyBody Modeling System software and verified by measuring surface electromyography (EMG). The muscle force, joint force, joint torque of lower limbs during right Front-Court Lunge Step in badminton were studied by inverse dynamic simulation and analysis through Vicon motion capture system and force platform. Results The musculoskeletal model was validated to be effective by EMG. During right Front-Court Lunge Step in badminton，the force peak of the hip and ankle joint in Z direction was larger than that in X and Y direction, and the force peak of the knee joint in X direction was larger than that in Y and Z direction. During buffer period, the hip joint in X, Y, Z direction showed adduction, extension and internal rotation torque, respectively, the knee joint in X, Y, Z direction showed abduction, flexion and external rotation torque, respectively, and the ankle joint in X, Y direction showed varus and plantar flexion torque, respectively. The peak torque of the hip, knee and ankle joint in X direction was significantly larger than that in Y and Z direction. Vastus lateralis, biceps femoris, anterior tibial and medial gastrocnemius played a larger role against the ground reaction, while rectus femoris, semitendinosus, soleus played a relatively smaller role against the ground reaction. Conclusions The established musculoskeletal model in the study can provide a technical platform to analyze athletes’biomechanical properties of lower limbs under impact loads. To avoid sport injuries, more attention should be paid to the effect from ground reaction force load at touchdown instant on hip, knee and ankle joints in anteroposterior and mediolateral direction during footwork similar to Front-Court Lunge Step in badminton, and at the same time, the strength training of vastus lateralis, biceps femoris, anterior tibial and medial gastrocnemius of badminton players should not be ignored during specialized training.

Analysis of factors influencing short-term effect of presurgical pharmacological therapy and transsphenoidal microsurgery for somatotropinomas / 实用医学杂志

Objective To analyze factors influencing short-term effect of presurgical pharmacological thera-py and transsphenoidal microsurgery for somatotropinomas. Methods The clinical data of 53 patients underwent presurgical pharmacological therapy and transsphenoidal surgery for somatotropinomas were retrospectively analyzed in order to search for factors influencing effect of presurgical pharmacological therapy and transsphenoidal surgery for somatotropinomas. Results Serum GH inhibition rates decreased<50.00%from baseline in 62.26%of patients receiving presurgical pharmacological therapy. Statistical analysis concerning the influence of sex , neuropathological evaluation, tumor size and presence of invasion on presurgical pharmacological therapy effect were performed using a chi-squared test, no significant correlation was found among these factors and presurgical pharmacological therapy effect. Total remission rates were 43.40%, Statistical analysis concerning the influence of sex , neuropathological e valuation, tumor size, presence of invasion and presurgical pharmacological therapy effect on remission rate were performed using a chi-squared test, a significant correlation was found among tumor size, presence of invasion, presurgical pharmacological therapy effect and remission rate , while no significant correlation was found among the rest of the factors. Further Logistic regression analysis demonstrated a significant correlation among tumor size , presence of invasion and remission rate , while no significant correlation was found between presurgical pharmacolog-ical therapy effect and remission rate. Conclusions Presurgical pharmacological therapy effect revealed no signifi-cant correlation with sex, neuropathological evaluation, tumor size or presence of invasion. Total remission rate cor-related with tumor size and presence of invasion. A better presurgical pharmacological therapy effect may indicated a better outcome, while postoperative remission rate revealed no significant correlation with presurgical pharmacologi-cal therapy in our series.

Clinical study of functional hemispherectomy for pediatric intractable epilepsy with hemisphere lesions / 实用医学杂志

Objective To study the results of functional hemispherectomy for pediatric intractable epilepsy with hemisphere lesions , and to explore the indications of functional hemispherectomy , as well as the prognosis. Methods Twenty-four children with intractable epilepsy caused by hemisphere lesions were included , who underwent functional hemispherectomy. All patients were followed up for 3 ~ 48 months. Results All 24 cases obtained improvement of abnormal behavior , and no significant exacerbation of neurological deficits was observed. During the follow-up, 18 cases were in EngelⅠ(75%), 5 in Engel Ⅱ(21%), and 1 in Engel Ⅰ(4%) respectively. No long-term complication was observed. Conclusion Comprehensive presurgical evaluation is a prerequisite for the surgical treatment of pediatric intractable epilepsy caused by hemisphere lesions. Functional hemispherectomy can effectively control seizures and obviously improve the prognosis.

Transgenerational effects of prenatal ethanol ingestion-induced susceptibility to metabolic syndrome and the underlying mechanism in F2 rats / 中国药理学与毒理学杂志

OBJECTIVE To investigate the transgenerational effects of a hypothala mic-pituitary-ad-renal (HPA)axis -associated neuroendocrine metabolic progra mming alteration fro m F1 to adult second generation (F2)with prenatal ethanol ingestion.METHODS Pregnant Wistar rats were ad ministered with ethanol (4 mg·kg -1·d -1 )fro m gestational day 1 1 until delivery.F1 rats were fed a high-fat diet fro m postnatal week 4 (PW4)and were cross-mated in PW 16 -20.F2 rats were fed a standard diet fro m PW4 and rectal te mperature was measured in PW20,oral glucose tolerance test (OGTT)was con-ducted in PW21 ,blood sa mples and hypothala mus were collected in PW24 to investigate seru m lipids and HPA axis activity.RESULTS Co mparing to the F2 control group ,rectal te mperature in F2 ethanol group were higher (P<0.01 ),sugar tolerance in F2 male group was i mpaired (P<0.05),seru m corti-costerone and hypothala mus arginine vasopressin (AVP) mRNA were increased (P <0.05);seru m insulin were decreased (P<0.05)and male rats showed i mpaired glucose tolerance (P<0.05);seru m high-density lipoproteincholesterol (HDL-C)decrease (P <0.05)and total cholesterol (TCH)/HDL-C and low density lipoproteincholesterol (LDL-C)/HDL-C ratios were markedly increased (P <0.05,P <0.01 ).CONCLUSION Prenatal ethanol exposure induced metabolic syndro me has transgenerational effects,which may originate fro m the intrauterine progra mming of altered HPA axis-associated neuroen-docrine metabolis m.

Treating chronic persistent bronchial asthma children with abnormal myocardial enzyme spectrum by Yupingfeng powder: an efficacy observation / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the clinical efficacy of treating chronic persistent bronchial asthma (CPBA) children with abnormal myocardial enzyme spectrum (AMES) by Yupingfeng Powder (YP) combined routine therapy.</p><p><b>METHODS</b>From January 2010 to December 2012, 156 CPBA children patients with AMES were randomly assigned to the treatment group (80 cases) and the control group (76 cases). All patients received routine treatment (inhaled corticosteroids and/or leukotriene regulator). Besides, those in the treatment group took YP. The treatment duration was 3 months. The scores of children asthma control test (C-ACT), pulmonary function (FEV,% and PEF%), myocardial enzyme spectrum were observed before and after treatment, and 3 months before and after treatment. The myocardial enzyme spectrum of 40 healthy children at the baby clinics during the same period were recruited as the control.</p><p><b>RESULTS</b>Compared with the control group, creatine kinase isoenzyme (CK-MB), creatine kinase(CK), and lactate dehydrogenase (LDH) increased in the two treatment groups (P <0.01), but there was no statistical difference in AST (P >0.05). Compared with before treatment in the same group, CK-MB, CK, LDH, and AST decreased in the treatment group after treatment and 3 months after treatment (P <0.01). CK-MB, CK, LDH, and AST decreased in the control group 3 months after treatment (P <0.01, P <0.05).Compared with after treatment, CK decreased in the control group 3 months after treatment (P <0.01). C-ACT score, FEV(1),%, and PEF% all increased in the two groups after treatment and 3 months after treatment (P <0.01, P <0.05). Compared with after treatment in the same group, CK decreased in the control group 3 months after treatment (P <0. 01). Compared with the control group in the same period, post-treatment CK-MB and CK decreased (P <0. 01, P <0. 05), while post-treatment C-ACT score, FEV, %, and PEF% increased (P <0.05) in the treatment group (P <0.05).</p><p><b>CONCLUSION</b>YP could strengthen specific and non-specific immunity of the organism, and improve clinical symptoms and the level of myocardial enzyme spectrum.</p>

Clinical characteristics and medical cost of amputations in a single center in 2007-2011 / 中华创伤杂志

Objective To study demographic features,clinical characteristics and in-hospital cost of patients due to different causes in one center in 2007-2011 and discuss their correlation.Methods A retrospective analysis was conducted on all patients who were treated with amputation from 2007 to the first half of 2011 in the Second Affiliated Hospital of Zhejiang University to carefully record their data,such as demographic characteristics,entity,medical history,clinical information,amputation location,amputation level,hospital day and medical cost.Results A total of 805 patients at age of (42.1 ± 18.1)years underwent amputation from 2007 to the first half of2011.Among them,the male patients accounted for 72.3％.The patients engaged in farm,industry and transportation accounted for 69.7％.Traumatic amputation occupied 66.1％,followed by 15.3％ of tumor amputation and diabetic amputation proportioned 4.5％,occupying 13.2％ of non-traumatic amputation.Ratios of lower limb amputations and amputations above levels of joints of palmar digitals and toes were 64.9％ and 61.7％.Mean hospital day was 20 days (range,14-34 days) and mean medical cost was 15 000 RMB (range,8 881-31 975 RMB).Conclusions Amputation largely occurs in the male adults and mainly results from trauma.High amputation,long hospital stay and high medical cost are the main characteristics.

Probe into construction mode of wound care center / 中华烧伤杂志

Relevant data including diagnosis and treatment model, operation situation, etc. are analyzed in our wound care center and compared with abroad based-on literature retrieval, to find out a suitable way for setting up wound care centers in our country. Wound care center with mode of multidisciplinary cooperation that is "specialist-oriented" was established in our hospital, mirroring the experience of foreign wound care centers. The investigation showed the demands of patients could be met, their psychological and economic pressures as well as social burden might be greatly relieved in our center. For an example, we achieved our purpose readily by setting up a clinical pathway of diabetic foot according to the features of our hospital. The model of multidisciplinary cooperation, with minor adjustments, may be applicable for wound care centers at home and abroad. Our wound care center will establish better system of diagnosis and treatment to conform to the situation in our country.