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ObjectiveTo evaluate the effect of Astragali Radix （AR）-Angelicae Sinensis Radix （ASR） drug pair on supplementing Qi and activating blood circulation in rats with Qi deficiency and blood stasis and provide a theoretical basis for clinical rational medication and identification and quality control of compound pharmacodynamic substances from the three aspects of characteristic map， identification of pharmacodynamic substances， and comparison of blood components. MethodHigh-performance liquid chromatography （HPLC） was employed to establish the fingerprint of AR∶ASR （3∶1）， and ultra-high performance liquid chromatography-Q-Exactive Orbitrap-mass spectrometry （UPLC-Q-Exactive Orbitrap-MS） was employed to analyze the ingredients of the decoction. Adult male Wistar rats with SPF grades were selected and randomly divided into a blank group， a model group， a 3∶1 group， and a 5∶1 group. The rat model of Qi deficiency and blood stasis syndrome was prepared by controlling food intake and swimming in cold water every day. In parallel， each group was given medicine （or water） once a day. The dose of drug groups was 10.2 g∙kg-1， and the model group and blank group were given the same amount of distilled water for 15 d. Animal behavior， body weight， whole blood and plasma viscosity， thymus index， spleen index， the levels of adenosine triphosphate （ATP）， adenosine diphosphate（ADP）， von willebrand factor （vWF）， and ATP/ADP value in serum of rats were recorded. The morphology of vascular endothelium was observed by hematoxylin-eosin （HE） staining and scanning electron microscopy. UPLC-Q-Exactive Orbitrap-MS was used to analyze prototype and metabolic components in serum. ResultThe fingerprint of AR-ASR drug pair （AR-ASR 3∶1） was established. UPLC-Q-Exactive Orbitrap MS identified 49 chemical components in vitro and preliminarily identified 11 prototype components absorbed into blood in vivo. As compared with the blank group， the body mass decreased significantly （P<0.01）， the whole blood （high shear， middle shear， and low shear） viscosity and plasma viscosity were significantly increased （P<0.05， P<0.01）， the thymus index and spleen index decreased significantly （P<0.05， P<0.01）， serum ATP content decreased significantly （P<0.01）， ADP content increased significantly （P<0.01）， ATP/ADP value decreased significantly （P<0.01）， and vWF content increased significantly （P<0.01）. The results of HE staining and scanning electron microscopy showed that the vessels were partially damaged， showing the structural disorder of the intima， the bulge， defect， and roughness of the endothelium， and the obvious cell adhesion and migration in the model group. As compared with the model group， the body mass also increased significantly （P<0.01）. The results of whole blood and plasma viscosity showed that the whole blood low shear viscosity was significantly decreased in the 3∶1 group （P<0.05）. The results of thymus index and spleen index showed that 5∶1 group significantly increased the thymus index of rats （P<0.05）. The results of serum ATP and ADP levels showed that the 5∶1 group had more significant effects on ATP and ADP levels （P<0.05）， and both groups significantly reduced ATP/ADP values （P<0.01）. The results of serum vWF level showed that the vWF content in the 3∶1 group decreased significantly （P<0.05）. The results of HE staining and scanning electronic microscopy showed that the damage of vascular endothelium was improved in the treatment group and the structure of intima was neat. ConclusionAR-ASR drug pair can improve the macro and micro indexes of rats with qi deficiency and blood stasis in the 3∶1 and 5∶1 groups. Overall， the 5∶1 ratio has a better effect on supplementing Qi but 3∶1 ratio has a better effect on promoting blood circulation.
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Objective:To explore the expression of vasohibin-1 (VASH1) and vascular endothelial growth factor A (VEGF-A) and clinical significance of VASH1 in gastric carcinoma.Methods:The expression of VASH1 and VEGF-A were detected by immunohistochemistry in formalin-fixed and paraffin-embedded sections in 56 pairs of gastric cancer and corresponding paraneoplastic tissue specimens. The correlation between the expression of VASH1, VEGF-A, clinicopathological parameters and prognosis were analyzed.Results:VASH1 and VEGF-A expression was significantly higher in gastric cancer tissues than normal paraneoplastic tissues. VASH1 and VEGF-A protein were expressed in 79% and 82% of gastric cancer tissues, respectively. A positive correlation was found between Vasohibin-1 and VEGF-A expression in gastric cancer tissues. VASH1 expression has significant positive correlation with TNM stage, tumor stromal invasion, tumor gross types and distant metastasis. Patients with high VASH1 expression had significantly worse overall survival (OS) and progression-free survival (PFS) than those with low VASH1 expression.Conclusion:VASH1 might be a clinically relevant predictor of patients in gastric cancer.
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Objective:To investigate the expression of CD157 and its significance in colorectal cancer.Methods:The expression of CD157 was detected in 50 cases of colorectal cancer tissues and corresponding adjacent normal colorectal tissues by immunohistochemistry. The correlation between the expression of CD157 and clinicopathological parameters and prognosis was analyzed statistically.Results:Higher expression of CD157 protein was observed in colorectal cancer than that in normal colorectal tissues (72% vs. 20%, χ 2=25.09, P<0.01). Moreover, High expression of CD157 was correlated with the tumor size (χ 2=7.368, P=0.007), TNM stage (χ 2=9.223, P=0.002), the depth of tumor infiltration (χ 2=4.158, P=0.041), distant metastasis (χ 2=5.521, P=0.019), vascular invasion (χ 2=6.307, P=0.012) and microsatellite instability (χ 2=4.778, P=0.029), but not with gender, age, histology type, location, differentiation grade, lymph node metastasis, nerve infiltration or Kras mutation (all P>0.05 respectively). Patients with low expression of CD157 had longer survival (45±4 )months than those with high expression (30±3)months (χ 2=5.234, P=0.022). Conclusions:High expression of CD157 in colorectal cancer tissue is related to poor survival of postoperative patients.
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<p><b>OBJECTIVE</b>To systematically review the safety of application of enhanced recovery after surgery(ERAS) to laparoscopic bariatric surgery.</p><p><b>METHODS</b>The randomized controlled trials (RCTs) or case-controlled trials concerning application of ERAS principles in bariatric surgery were collected by searching several national and international online databases, including PubMed, Cochrane Library, CNKI, EMBASE and Wanfang databases. Data collection was completed in October 2016. The ERAS protocol covered three phases (preoperative, intraoperative, and postoperative), including preoperative counseling, reduced fasting, early ambulation, early oral feeding, etc. The endpoints included at least one of the following parameters: length of stay (LOS), operation time, readmission rate within 30 days, morbidity of postoperative complication (major/minor), and reoperation rate within 30 days. The quality of enrolled literatures was evaluated according to Cochrane Handbook and Newcastle-Ottawa Scale. RevMan 5.2 software was applied to perform meta analysis. The weighted mean difference (WMD) was used to combine the statistics for the measurement data, and the ratio and its 95% confidence interval were used to combine the statistics for the counting data. Subgroup analysis was conducted based on the quality of the enrolled literatures for the results of high heterogeneity.</p><p><b>RESULTS</b>A total of 7 studies, including 1 randomized controlled trail and 6 case-control studies, with 3264 patients were enrolled. Among the 3264 patients, 2051 received ERAS management (ERAS group) and 1213 received traditional perioperative management (control group). Meta analysis showed that compared with control group, ERAS group had shorter operative time (WMD=-17.56, 95%CI: -29.50 to -5.62, P=0.00), shorter length of hospital stay (WMD=-1.11, 95%CI: -1.31 to -0.92,P=0.00). There were no statistically significant differences between the two groups in the morbidity of postoperative major complication(OR=1.21, 95%CI:0.87 to 1.69, P=0.26) or minor complication (OR=1.25, 95%CI:0.99 to 1.58, P=0.06), re-admission rate within 30 days (OR=1.07, 95%CI: 0.81 to 1.43, P=0.63) and re-operation rate within 30 days(OR=1.33, 95%CI: 0.84 to 2.11, P=0.23).</p><p><b>CONCLUSION</b>Application of ERAS protocols to bariatric surgery is safe and feasible, which can also reduce length of hospital stay and operative time, and accelerate recovery.</p>
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Objective To evaluate the efficacy and safety of sodium aescinate for abdominal operation in general surgery.Methods A multicenter,prospective and open labeled trail was conducted.Data of 2001 patients in PPS group who had undergone either conventional treated (n =500) or sodium aescinate treated (n =1 501) for abdominal operation in general surgery were analyzed.In the sodium aescinate treated group,sodium aescinate was given by ivgtt 12 h before the surgery started,and 20 mg daily after the surgery for 6 days.Time to recovery of gastrointestinal sounds (TRGS),time to recovery of passage of gas (TRPG),and time to recovery of bowel movements (TRBM) were recorded to evaluate the bowl function recovery.The difference of incision edema was observed by the evaluate edema level.Results The TRGS of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The TRPG of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The TRBM of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The incision edema of sodium aescinate treated group was better than that of conventional treated group.The rate of adverse event was low in the sodium aescinate treated group,phlebitis was the most common one,accounting for 0.66％.No serious adverse event happened.Conclusion Sodium aescinate is effective and safe in accelerating patients recovery in general surgery.
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MEDLINE,Ovid,CNKI,and Vip Database were retrieved for articles of diuretics induced hyponatremia.6 retrospective studies,2 prospective studies,and 31 case reports were included.Pearson correlation coefficient of the cumulative dose and serum sodium level was-0.121 (P =0.757).It is suggested that serum sodium level should be closely monitored while administrating diuretics,especially in patients with high-risk of hyponatremia.
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Objective To investigate the efficiency of the modified posterolateral curved incision with double intermuscular approach in the treatment of posterolateral tibial plateau fractures.Methods From August 2009 to March 2013,15 men and 17 women aged 28 to 77 (mean,46.25) years with posterolateral spitting or collapse tibial plateau fractures were treated to undergo a modified posterolateral approach.All types of fractures were closed,without nerve or artery injury.The duration from injury to fixation was 3-18 (mean,7.13) days.The modified posterolateral approach was preformed to expose tibial anterolateral condyle and posterolateral condyle through intermuscular space of anterior tibial muscle,popliteus muscle and soleus muscle.After open reduction,anterolateral fractures and posterolateral fractures were fixed by the T-shaped plate and Golf shaped plate respectively.Results All of the 32 patients were followed up from 6 months to 36 months (in average of 15.3 months).Postoperative X-ray showed satisfied fractures without obvious collapse of the articular surface.At the last follow-up,the Rasmussen scores were range from 6 to 18 (in average of 14.06),namely 14 cases excellent,15 cases good,3 cases fair.The knee joint functions were evaluated according to HSS.The HSS results showed that there were 12 cases excellent,16 cases good,3 cases fair and 1 case bad.None of the cases suffered from injuries of crucial blood vessel or nerves.No incision necrosis,wound infection or fixation failure occurred during follow-up.Conclusion Open reduction and internal fixation via modified posterolateral approach can expose posterolateral and anterolateral tibial plateau fracture in one incision.Fibular head osteotomy can be avoided.The present approach could also reduce surgical injury,minimize the possibilities of incision necrosis or plate exposure.The modified posterolateral approach can be recommended in clinical practice.
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Objective To evaluate the safety and feasibility of single-port laparoscopic surgery (SPLS) for chronic appendicitis.Methods Data of patients who had undergone either conventional threeport surgery (n =58) or SPLS (n =63) for chronic appendicitis between January 2010 and November 2012 were analyzed retrospectively.The short-term outcomes of these 2 operative modalities were compared.Results The overall satisfaction score of SPLS group was significantly higher than that of the three-port group (4.5 ±0.7) vs.(3.0 ±0.6),t =13.50,P =0.00,there was less frequent use of parenteral narcotics in SPLS patients (1.2 ± 0.5) vs.(2.1 ± 0.7) times,t =-8.25,P =0.00,length of operation time was the same in SPLS group (40 ± 10) vs.(37 ±9) minutes,t =1.94,P =0.055.There was not different in postoperative recovery (1.4 ± 0.6) vs.(1.6 ± 0.7) d,t =-1.82,P =0.072,nor different in perioperative complications and intraoperative blood loss between groups (12 ± 6) vs.(13 ± 6) ml,t =-1.50,P =0.137.Conclusions SPLS is both safe and feasible in the treatment of chronic appendicitis.
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Clinical practice guidelines play an important role in practitioner and patient decisions regarding appropriate clinical health care and in health policy formation. In the guideline development process, inappropriate methodologies and development strategies significantly influence the quality of guidelines; therefore, research and evaluation of guidelines have great significance. The original Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was published in 2003 by a group of international guideline developers and researchers. AGREE has important significance for the quality guarantee and successful implementation of guidelines, and has extensively achieved endorsement since 2003. In 2009, The AGREE Collaboration has developed the AGREE II by refining the original AGREE instrument. At present, the AGREE II has already replaced the original AGREE instrument; however, related introduction regarding AGREE II has not been found in China. The authors of this article briefly introduce the AGREE II, and believe that it will add value to research and evaluation of the guidelines as a whole.
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Objective To study the effect of mental intervention on patients with postsurgical gastroparesis syndrome (PGS). Methods 70 patients with gastroptroparesis syndrome after abdominal operation were divided into the control group and the experimental group with 35 patients in each group according to chronological order.The patients in the control group accepted routine care,and the experimental group was given mental intervention based on routine care.Center for Epidemiological Survey Depression Scale (CESD) was used to evaluated the emotional state before and after intervention.Besides,the recovery of gastrointestinal function was appraised. Results The improvement level of anxiety in the experimental group was higher than the control group.The extinction time of symptoms,indwelling time of gastric tube,recovery time of food intake were shorter than the control group.Drainage time when gastric juice ＞ 800ml/d was shorter,recovery time of PGS and hospitalization time were shorter,the treatment cost was reduced,compared with the control group. Conclusions Mental intervention can alleviate the negative emotion and shorten the recovery time of patients with postsurgical gastroparesis syndrome.
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Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation (RFA) therapy for hepatocellular carcinoma.Methods Clinical data of 78 hepatocellular carcinoma patients undergoing laparoscopic radiofrequency in Beijing China-Japan Friendship Hospital from May.2008 to July.2010 were reviewed retrospectively.Age ranged from 31 to 87 years,41 were male and 37 were female.Intraoperative ultrasound-guided needle biopsy was performed and diagnosis of hepatocellular carcinoma was established in all cases before RFA was carried out.Data analysis was performed using software SPSS or OriginPro7.Necrosis,local recurrence of the tumor and the cumulative survival rate were analyzed by Kaplan-Meier test and x2 test.Results The median follow-up time was 16 months after RFA treatment.Tumor size,proximity to intrahepatic vessels and combination with TACE were factors that influence local recurrence.The complete ablation (CA) rate was remarkably higher in tumors ＜ 3 cm than in tumors ＞ 3 -5 cm (90.5％ vs 71.4％,x2 =4.291,P =0.038 ).Tumors adjacent to major vessels had a significantly lower CA rate as compared with those not adjacent to them (63.6％ vs 91.9％,x2 =6.351,P =0.012).The CA rate were 88.9％ in the TACE ± RFA group and 75.0％ in the RFA group ( x2 =1.567,P =0.211 ).The mean overall survival were 48.7 ± 2.4 months,the cumulative survival rate was 86.1％ at 1 year、76.9％ at 2 years、60.3％ at 3 years、51.8％ at4 years and 33.1％ at 5 years.Conclusions Laparoscopic RFA is safe,mini-invasive and effective for unresectable hepatic carcinoma with a favorable long term survival.
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Objective: To investigate the effects of ω-3 fish oil fat emulsion on nutritional status and humoral immunity in postoperative patients suffering from gastrointestinal malignancy. Methods: Thirty patients of gastrointestinal malignancy were randomly divided into study group (n = 15) and control group (n = 15). All the patients were assigned to receive total parenteral nutrition with the equal nitrogen and calory,and those in study group received fish oil fat emulsion additionally. Liver and renal function, blood lipid, haemoglobin, albumin, transferrin, total lymphocyte count (TLC) , B lymphocyte subsets (B1, B2), immunoglobin(IgG, IgM, IgA) and complement(C3, C4) were determined preoperatively and 1, 6d postoperatively. Results: There were no significant differences in liver and renal function and blood lipid on postoperative day 6 versus preoperation in all the two groups. TLC, IgG, IgM, C3 on postoperative day 6 were siginificantly higher in the study group(P < 0. 05). Haemoglobin, albumin, transferrin and B lymphocyte subsets were not significantly different between the two groups. Conclusion: Fish oil fat emulsion treatment was safe and tolerated, and could improve the humoral immunity in patients.
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Objective The purpose of this study was to assess the value of serial sectioning and immunohistoehemistry(IHC)for the diagnosis of senfinel lymph node(SLNs)metastases in patients with breast cancer,and to evaluate the significance of mierometastases and isolated tunlor cells(ITCs)in the SLNs. Methods Eighty pailents with clinically node-negative breast cancer underwent SLN biopsy with both99mTc-labeled sulfur colloid and iBosulfan blue dye for SLN identification.All SLNS and non-SLNs were evalnated with standard H&E stain and IHC analysis. Results SLNs were successfully identified in 78 of 80 patients(97.5%),the isotope/blue dye concordanee rate was 76.5%for all SLNs.Thirty two patients (41%)had histologically positive SLNs,and 13(40.6%)of these patients hod SLNS with micrometastatic disease.In 14(43.8%)of these patients,the SLNs were the only nodes involved.The sensitivity,specificity and accuracy of SLN biopsy in predicting axillary node stams were 96.9%,100%and 98.7%,reslaeetively.Patients with positive SLNs metastasis had a markedly higher proportion of non-SLNs metastases compared with those with only micrometastasis in the SLNS(78.9% vs 23.1%). Conclusions Serial sectioning and IHC ale sensitive methods for detecting breast cancer metastases in SLNS.The incidence of non-SLNs metastases is rather low in patients with SLNs that contain only micrometsstatic foci and ITCs.The prognostic significance and effect on surgical management of these occult disease have yet to be determined.
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Objective To investigate the clinicopathologic features of gastrointestinal neuroendocrine carcinomas. MethodsThe diagnosis and treatment results of 45 cases were studied, and clinicopathologic features and immunohistochemical expressions of NSE, Syn and CgA were detected.ResultsMicroscopically carcinomas were divided into three types: type Ⅰ(25 cases), type Ⅱ(10 cases) and type Ⅲ(10 cases). The histologic categories were correlated with lymph node metastasis significantly( P0.05). The 5-year survival rate for type Ⅰ, type Ⅱ and type Ⅲ was 70%, 65% and 52%, respectively.ConclusionsThe combination of NSE, Syn and CgA immunohistochemical stainnig is necessary for the diagnosis of gastrointestinal neuroendocrine carcinomas. The histologic classification is coincident with the requirement of clinical treatment and prognosis.